List of Topics
Food For Thought
Repeating Epidural Steroid Injections
Supplements Yes or No (how to choose the best supplements)
Pain Control Alternatives
I often anecdotally share with patients about my initial exposure to the chiropractic and nutrition. My indoctrination took some getting use to, especially concerning food. “Health food “was not in my
vocabulary. I was a Hamburger Helper person. What ever tasted good was good food to me. Looking back it was mostly refined food with a
lot of salt, sugar and fat. The typical American diet actually. My first experience in a cooperative health food store entailed some guy telling me what great organic carrots they had that day. I thought…….
they’re all organic aren’t they?! I’d never been to a health food store before that. But when in Rome do as the Romans do.
So, the transition began and our diet changed as well as our taste, until we actually ate and liked a “healthy diet”. Of course, a healthy diet is subject to debate but it was high in fiber, low in salt, sugar
and fat; a diet that would have been dietary purgatory for me before chiropractic school.
The kicker is we actually enjoyed this diet. It’s important to note we weren’t dieting. We were just exploring different foods and ways of eating that were “healthier”. I can remember eating carrots or corn or squash and actually enjoying the taste of the vegetable.
The side effects were weight loss, increased energy and better health. My usual allergies went away and we seemed to get sick less often as
After graduation, I distinctly remember reintegrating back into the “American” diet. Fast food was initially almost unbearable because of the salt. A soda was like pancake syrup. But when in Rome………
Currently we eat a relatively healthy diet. It’s probably higher in fiber than the average diet, with more beans, whole grains and vegetables.
The point I’m trying to make is you can eat a moderately healthy diet and enjoy it too. Moderation is the key and choosing food you like is very important. Many people believe a high fiber diet is eating more salads. You can’t stick to that, unless you’re a rabbit. If you look at any food pyramid you’ll note the base of the pyramid is bean and grain foods. Your grains must be whole grain products, not Uncle Ben’s minute Rice. This base must be the staple of your diet. There are hundreds of different rice’s and beans and you can cook them in a multitude of combinations with veggies and different meat sources (seafood, poultry, lean red meat) to suit your taste.
If you are a big breakfast eater, then grains are the perfect cereals, hot or cold. A little salt, butter or sugar for taste is ok! Grits are refined so substitute another whole grain with your eggs. Skip the bacon though, or eat it much less often, when you want to indulge.
Want a high fiber taco? Try ground white turkey meat with oatmeal. Stir fry that and add your taco fixings and you have a relatively low fat high fiber taco. Sound crazy? You really can’t tell the oatmeal is there. I know because it passed the kid test at home. I like to make things at home and flavor it with a little butter, salt, garlic or what ever with different combinations of beans, grains and or poultry and have the family eat it without knowing what it is first. Many times they won’t eat it if they know what it is ahead of time because it’s “health food”. So I have them taste it first or have them eat it
first then tell them what was in it.
The Basis for Recommending Repeating Epidural Steroid Injections for Radicular Low Back Pain: A Literature Review
Suzanne Novak MD, PhDa, , and William C. Nemeth MDb
aCollege of Pharmacy, University of Texas, Austin, TX
bSOMI Healthlink, Austin, TX.
Available online 21 February 2008.
Novak S, Nemeth WC. The basis for recommending repeating epidural
steroid injections for radicular low back pain: a literature review.
To determine the current evidence to support guidelines for frequency and timing of epidural steroid injections (ESIs), to help determine
what sort of response should occur to repeat an injection, and to outline specific research needs in these areas.
A PubMed, Medline (EBSCO), and Cochrane library search (January 1971– December 2005), as well as additional references found from the initial search.
There were no studies that specifically addressed the objectives outlined. Eleven randomized controlled trials, 1 prospective controlled trial, and 2 prospective cohort studies were identified that included a protocol involving repeat epidural injections for radicular pain secondary to herniated nucleus pulposus or spinal stenosis. One ualitative survey was also identified. Five review articles were also included that discussed this topic.
Data were extracted from clinical trials if they included the following: (1) protocols in clinical trials on ESIs that included repeat injections and the response required to trigger these injections, (2) any evidence given for establishing these protocols, and (3) similar studies that included only 1 injection. Specific mention of repeat ESIs and partial response that was mentioned in
review articles was also included.
There does not appear to be any evidence to support the current common practice of a series of injections. Recommendations for further research are made, including a possible study design.
A number of studies have expressed concerns that steroids injected into the tendons and muscles can significantly weaken the collagen fibres and precipitate rotator cuff ruptures when injected for
subacromial impingement[2-5,16]. Corticosteroids damage the ultrastructure of collagen molecules, reduce collagen density , as well as inhibiting the reparative properties of tendon by inhibiting tendon cell migration  and synovial fibroblast roliferation .
My relatively educated opinion is yes.
Good web site for learning about supplements…
Consider a few of these issues:
The soil we grow crops in today is likely a real issue with respect to the vitality of the food we eat. By vitality I mean nutrient value. There is ample evidence that our farm soils are depleted of much of the nutrients (primarily minerals) that our food sources used to give us. Plants can generated much of the vitamins we need but they cannot make minerals. Even plants need minerals to make healthy vitamin rich fruits and veggies. (Scroll down to “soil depletion”)
I’ve read some studies of the loss of nutrient value in selected veggies and fruits and it would amaze you as to how much loss there is today as compared to yesteryear.
Many if not most of the crops are harvested prematurely. Vine ripening
is where much of the nutrient production takes place.
So even if, and that’s a big if, you are getting the recommended daily servings of veggie, fruits, beans and grains; it’s likely the essential nutrient value isn’t what it should be.
Many health professionals feel that many signs and symptoms that we experiences are due to subtle marginal deficiencies in essential nutrients and these issues contribute to slow progressive degenerative illness.
Bear In Mind
Supplements work synergistically; meaning that most of the time a single essential nutrient will not help you if the synergists aren’t available. For Example: Iron needs folic acid, pyridoxine, ascorbate, tocopherol, cobalamin and zinc to work efficiently in the body. (p 228 OSN Colgan) So popping a single this or that vitamin likely will not benefit you.The whole business of supplements is quite complex and much too involved for a simple newsletter such as this to give individual advise. We all have different needs. However, reasonable supplementation will likely benefit your health, physically and mentally. If you take medication or have special needs you must consult your health care advisor to rule out contraindications to
My basic premise is that if you do not have the foundation materials available, it doesn’t matter what you are doing i.e. glucosamine sulphate for joints, St John’s Wort for depression, etc… Without the
essential nutrients you will never achieve your optimum health potential.
The Recommended Dietary Allowances (RDAs) were originally set up by the National Academy of Sciences during World War II as general guidelines for feeding the country's soldiers. These recommendations have grown to be guidelines for the general public and were last revised in 1997 and given a new name. RDAs are now known as Daily Values (DVs). Another term you may see is DRVs (Daily Reference Value), which are dietary guidelines for protein, carbohydrates, fat,
saturated fat, cholesterol, fiber, sodium, and potassium. Another new term is RDIs (Reference Daily Intake), which are guidelines for essential vitamins and minerals. Daily Values (DVs) are made up of both DRVs and RDIs.
Some nutritionists believe that the DV has not kept pace with the latest nutritional research and believe that some of the recommendations may be thirty years out of date. The DV's have particularly come under fire regarding the recommended level of
antioxidant nutrients, such as vitamin C, E, and beta carotene. Some nutritionists believe the DV's for these health-promoting nutrients should be at least two to five times the current values. On the other hand, the DV's may be too high for some individuals. They were initially figured for young, active, military males, which means they may be less appropriate for the very young, very old, or for women. A valid, but unavoidable criticism of the concept behind the DV is that it does not respect the biochemical individuality of each person.
The DV's are based upon measures of physical health, not mental or
psychological. Thus, the RDAs do not reflect the suspicion that some
emotional and behavioral difficulties of school children could be the result of nutritional deficiencies.
UL: Tolerable Upper Intake Level UL is the highest level of daily nutrient from dietary and supplement
sources that is likely to pose no risk of adverse health effects for almost all individuals in a population. As intake increases above the UL, the potential for risk of adverse effects increases. Exceeding dosages over the UL for a long period of time is not recommended, but may be beneficial and tolerated by some individuals in some
circumstances. Generally, there is no need to take supplements at the level of UL. Always be aware of a product's UL and how much of that product you are taking.
While dietary supplements can indeed fill in a lot of gaps in your nutritional needs, they will never replace the role of a good, balanced, and varied diet. Time has attested the benefits of eating
lots of fruits, vegetables, fiber and lean protein sources. And this should always be your top priority before any efforts at vitamin supplementation.
What’s A Good Product?
When shopping for vitamin supplements, look for "USP" on the label. This means the stands of the U.S. Pharmacopeia have been meet under
exacting laboratory conditions. Not all quality vitamins will carry this mark, but it can help you determine if a brand you are not familiar with is reputable, especially if the price is remarkably low.
NSF Dietary Supplement Certification NSF's Dietary Supplement Certification Program is designed to help consumers and health care practitioners identify supplement products that have been tested by a third-party organization. Product formulations and labels are tested to ensure: Products contain the identity and quantity of ingredients listed on the label. Products are free of any undeclared contaminants. Testing for NSF Dietary Supplement Certification is voluntary and available to all manufacturers. Standards for certification were developed by NSF and the American National Standards Institute (ANSI); known as NSF/ANSI 173.
NSF Contact Information
Address NSF International
P.O. Box 130140
789 N. Dixboro Road
Ann Arbor, MI 48113-0140, USA
Telephone Number 800-NSF-MARK
Fax Number (734) 827-6108
A good vitamin supplement should contain 100% of the Daily Value of Vitamins D, B1, B2, B3, B5, B12 and folic acid. There should be a minimum of 20 micrograms of vitamin K as well. There should be 5,000 IU or less of vitamin A and 40-50% of that vitamin A should be beta carotene.
Choose a mineral supplement that contains 100% of the Daily Value for copper, zinc, iodine, selenium and chromium. It can also contain some
magnesium. Additionally, minerals should come in a “chelated” form for better absorption!
The American Medical Association
"Healthy adult men and healthy adult nonpregnant, nonlactating women consuming a usual, varied diet do not need vitamin supplements. Infants may need dietary supplements at given times, as may pregnant and lactating women. Occasionally, vitamin supplements may be useful for people with unusual lifestyles or modified diets, including certain weight reduction regimens and strict vegetarian diets. "Vitamins in therapeutic amounts may be indicated for the treatment of deficiency states, for pathological conditions in which absorption and utilization of vitamins are reduced or requirements increased, and for certain on-nutritional disease processes. "The decision to employ vitamin preparations in therapeutic mounts clearly rests with the physician. The importance of medical supervision when such amounts are administered is emphasized. Therapeutic vitamin mixtures should be so labeled and should not be used as dietary supplements." The American Medical Association reviewed the statement which follows. They stated that this statement was consistent with their statement.
The author of this NebFact recommends that if a typical adult wants to take a supplement, that supplement should be a multivitamin- multimineral, one that contains vitamins and minerals at U.S. RDA
levels. Many multivitamin-multimineral supplements containing 100 percent U.S. RDA levels are on the market. The consumption of this level of supplement will not be harmful to health and may or may not be helpful. The best advice is to obtain vitamins and minerals by eating a wide variety of foods. If an individual chooses to take a multivitamin- multimineral supplement, a balanced diet also should be consumed. This is because knowledge is inadequate as to all of the essential nutrients needed by adults -- all required nutrients may not be present in the supplement.
Perhaps the best summary is by Dr. William A. Albrecht, Chairman of the Department of Soils at the University of Missouri, who said: "A declining soil fertility, due to a lack of organic material, major
elements, and trace minerals, is responsible for poor crops and in turn for pathological conditions in animals fed deficient foods from such soils, and that mankind is no exception." Dr Albrecht goes further to unequivocally lay the blame: "NPK formulas, as legislated and enforced by State Departments of Agriculture, mean malnutrition, attack by insects, bacteria and fungi, weed takeover, crop loss in dry weather, and general loss of mental acuity in the population, leading to degenerative metabolic disease and early death."
1992 Earth Summit Statistics 1992 Earth Summit Report* indicate that the mineral content of the
world's farm and range land soil has decreased dramatically.
Percentage of Mineral Depletion From Soil During The Past 100 Years,
North America 85% **
South America 76%
* You may remember the 1992 Earth Summit by the fact that President Bush wouldn't sign any of the treaties. ** Some US farms are 100% depleted and some are 60% depleted, the average is 85% depletion as compared to 100 years ago. This is worse than in any other country in the world because of the extended use of fertilizers and "maximum yield" mass farming methods.
"In the future, we will not be able to rely anymore on our premise that the consumption of a varied balanced diet will provide all the essential trace elements, because such a diet will be very difficult to obtain for millions of people." Dr. Walter Mertz, U.S. Department of Agriculture, told to congress in 1977. Dr. Linus Pauling the two-time Nobel Prize winner states that: "You can trace every sickness, every disease, and every ailment to a mineral deficiency. "Mineral insufficiency and trace elements insufficiency are more likely to occur than are vitamin insufficiency states. Because of differing geologic conditions, minerals and trace elements may be scarce in the soils of certain regions and rich in those of other regions. Thus, you can live in some areas, eat a perfectly 'balanced' diet and still develop mineral deficiencies or trace element deficiencies that can only be averted through dietary change or supplementation." The Doctor's Vitamin and Mineral Encyclopedia In Dr. Jensen's book, Empty Harvest, he talks about how many of our illnesses are correlated with our improper stewardship of the land. Our immunity very much parallels the immunity of the land. Of special mention is that trace minerals are very depleted in our soils. Veterinarians have long since known this, which is why there are some 45 trace minerals added to dog and livestock food. They would much rather spend a few cents everyday than hundreds of dollars on vet bills! Dr. Charles Northen, MD researcher reports that, "In the absence of minerals, vitamins have no function. Lacking vitamins, the system can make use of the minerals, but lacking minerals vitamins areuseless." Gaylord Hauser, from his book, "Diet Does It", concurs by stating, "Minerals are certainly as important to us as vitamins, yet minerals are overlooked, neglected and their value underestimated."
So, there you have it!
All the body systems & organs & tissue; nervous, skeletal, muscle, hormonal, immune, respiratory, circulatory, cardiovascular etc…, require essential nutrients to function at optimum levels.
To Your Health
Inflammation is a primary source of pain
The following products been shown to help reduce inflammation & pain
Disclaimer: This column is for information only and no part of its contents should be construed as medical advice, diagnosis, recommendation or endorsement by Dr. Greathouse.
Always first discuss with your medical doctor before use!
Curcumin (Turmeric) An herb, a major ingredient in curry powder and also used in mustard. Curcumin dosage as anti-inflammatory, 200 to 400 mg, three times per day. To achieve similar amounts of curcumin using turmeric would require 4,000 to 40,000 mg. In combination with Bromelain (also an anti-inflammatory) increases absorption. Best taken on empty stomach 20 minutes before meal.
Quercetin 250 mg 3 times per day, between meals.
Bromelain 500 mg 3 times per day (pineapple enzyme)
Ginger, 2 grams per day in powdered form or 500 to 1000 mg per day in extract form.
Omega-3, Essential fatty acids (EPA/DHA), 360 mg per day.
Comfrey Root Extract Ointment Relieves Back (topical)
Vitamin C, 3 to 4 grams per day.
Zinc, 50 mg per day, also promotes white blood cell production which clean-up the injured cellular debris.
Vitamin E, (D-Alpha-tocopheral), 600 IU.
Creatine & L-tryptophan suppress acute and chronic inflammation.
MSM (methylsulfonylmethane) If allergic to sulfur, do not use! Dosage recommendations, 400 mg to 8,000 mg per day in divided doses for severe pain.
Green drinks, barley, wheat grass juice provide powerful anti-inflammatory and pain-relieving effects.
Magnesium 400-1000 mg / day
Increase water intake, and eat fruits and vegetables.
Avoid products (omega-6 fatty acid), such as safflower oil, corn oil & sunflower oil.
DMSO (dimethyl sulfoxide) For extremely debilitating pain. Julian Whitaker M.D., recommends DMSO. I am unfamiliar with its use and its safety. For referral to an M.D. who may utilize this product try calling call 800 532-3688. It may be available in health food stores.
Boswellia extract, from India medicine. Effective for arthritis; 100 mg daily in divided doses, with food.
Sea Cucumber: 200 mg daily. You can take as much as 1,000 mg per day and cut back as you feel better.
Penetran+Plus: a topical product sold in health food stores, works by re-establishing electrical balance in cell membranes. Studies show good effectiveness.
Magnets; some studies do support pain relief effectiveness.
Prolotherapy: Before you have surgery and when all else fails you may want to consider this approach. Basically it’s utilized for lax or loose joints (unstable). Injections are used to stimulate production of new collagen. Contact American Association of Orthopedic Medicine 800 992-2063, a $10 charge for info.
Acupuncture: plenty of evidence this helps. Like anything else though, works for some but not for others. Well worth a try.
Vitamin B6 (pyridoxine) utilized in almost all biochemical functions. Used for neurotransmitter (nerve) disorders, 250-mg/day safe dose. Scientific study indicates a possible causal relationship between carpal tunnel syndrome and B6 deficiency. A recommendation for additional supplementation of 50 to 100 mg/day, not to exceed 250mg/day, is suggested for carpal tunnel syndrome.
Glucosamine sulfate beneficial for joint repair (500mg 3x per day) & Chondroitin sulfate 200 mg per day. These two are normally found in combination and have good supporting evidence in the literature.
Knox Gelatin, 2 ounces per 100 lb. body weight.