Say No To Arthritis (Optimum Nutrition Handbook
?CHAPTER 3: HOW YOUR BODY MaKes Pain
The first indication that you may be developing arthritis is joint pain. Pain and inflammation are the body’s way of saying, ‘Help!’ Although it is important to understand and deal with the underlying causes, taking painkillers and anti-inflammatory substances can help to calm down excessive and harmful inflammation, taking the body out of ‘emergency’ mode. Drugs can reduce pain by blocking chemicals that trigger inflammation, but they don’t come without side effects, which is why so many people are turning to natural alternatives.Inflammation – characterised by swelling, redness, pain and heat – underlies many diseases, probably a lot more than most of us realise. These include all the ‘itis’ conditions: arthritis, dermatitis, colitis, nephritis and hepatitis. Also included are asthma and others not usually associated with inflammation, such as Alzheimer’s and Parkinson’s (in which parts of the brain become inflamed), and atherosclerosis (in which the arteries become inflamed).
Pain and inflammation can be caused by an imbalance in a number of body processes, such as impaired liver detoxification, disturbed blood sugar control, allergies, excess oxidants, insufficient antioxidants and a lack of essential fats. Each of these can tip the body into a state of alarm. We’ll be looking into each of these key factors, because simple diet and lifestyle changes can strengthen your body’s resilience so that it won’t be tipped into a state of inflammation.
YOUR PAIN LEVEL
Before we look at what happens in your body when pain occurs, and the mechanism behind painkilling drugs and natural painkilling nutrients and herbs, let’s gauge your pain level.
Unlike a disease such as diabetes, which can be measured in the blood, there is no easy indicator in the blood for arthritis. The main indicator of pain and inflammation is simply how you feel. For this reason, health professionals use questionnaires to discover how effective a treatment is. There are several standard questionnaires, including the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) check for hip and knee pain, and the Oswestry test for back and leg pain. Check yourself out on the
questionnaire below
?Questionnaire: how’s your pain
? Do you suffer from arthritis
? Do you have painful or aching muscles
? Do you suffer from muscle stiffness that limits your movement
? Do you wake up with physical pain
? Do you suffer from headaches ?If so, how often
On average once a week (score 1)
, twice a week (score 2) or more (score 3)
? Does your level of pain make you feel tired
? Does pain make you feel weak
? Does it limit your ability to move around?Do you have aching or painful joints
? Does it limit your ability to sit for more than 30 minutes
? How intense is your pain, without medication
Mild (score 1); discomforting (score 2); distressing
(score 3); horrible (score 4); excruciating (score 5)
Score 1 for each ‘yes’ answer, then add up your score
:Total score
Score
Score
:If your total score is
Below 5
Your level of pain might be reduced by following the advice in this chapter. If not, I recommend you seek
advice from a nutritional therapist or nutritionally oriented doctor
Between 5 and 10 You have a moderate level of pain and should definitely explore each of the options in this chapter as well as seeking advice from a nutritional therapist or nutritionally oriented doctor
More than 10 You have a high level of pain and I advise you to consult a nutritional therapist or nutritionally oriented doctor. Although exploring the options in this chapter will give you a good background, you may well need additional help to put it all into practice.
WHAT CAUSES PAIN AND INFLAMMATION AND HOW ARE
?THEY TREATED
The substances that cause inflammation and pain are called ‘inflammatory mediators’, which your body produces in response to some sort of ‘insult’. There are many of these body chemicals, such as prostaglandins, interleukins, cytokines, leukotrienes, oxidants, nitric oxide, insulin, and immunoglobulins. These in turn promote the accumulation of the substances that cause swelling, redness and pain.Pain-causing prostaglandins and leukotrienes are made from one of the omega-6 fats, arachidonic acid, which is very high in meat and dairy products. Too much of these foods in your diet can lead to over-production of these pain-causing body chemicals. So it’s a good reason to go easy on these foods if you’re in pain. Although some degree of inflammation can be an important protective mechanism, too many inflammatory mediators create pain. This is because inflammation is an ‘alarm signal’ to alert the body that something is wrong.
All over the body there are chemical accelerators and brakes. In the case of inflammation, there are three critical enzymes that turn harmless arachidonic acid into harmful inflammatory mediators. These enzymes are called COX-1, COX-2 and 5-LOX, as shown in Figure 4 overleaf. You could think of COX-1 as the ‘good’ COX, because it helps to protect the gut and the kidneys and promotes normal blood clotting; however, COX-2 is the ‘bad’ one because it increases pain and swelling, but also thins the blood. Blocking COX-1 alone reduces pain but damages the gut and thins the blood. Blocking COX-2 alone reduces pain but increases blood clotting (this is examined in detail on pages 32–34). Non-steroidal anti-inflammatory drugs (NSAIDs for short), such as aspirin or ibuprofen, target both of these enzymes, so they are good for stopping pain and inflammation. On the minus side, though, they are also likely to put you at risk of gastrointestinal bleeding when used regularly over the long term, and they also tax the liver.
Figure 4 – How your body’s chemistry makes pain
Because of the gastrointestinal problems mentioned above, the thinking was that the ideal NSAID would be one that blocked only COX-2 and left COX-1 alone. And the launch of drugs such as Vioxx in 1999 caused huge excitement because that’s exactly what they did. But problems with these drugs began emerging a few years after they appeared on the scene. Blocking an element – such as an enzyme – that is part of a network as complex as the body almost never has just one effect, which is why drugs nearly always have damaging side effects.
In 2004, Merck voluntarily withdrew Vioxx from the market because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use. The precise details of the case have been chewed over in the courts for years, but whatever the legal niceties it’s clear that behind the scenes and in the medical literature, alarm bells had been ringing for years about the link with heart attacks. It’s just that they had been deliberately ignored.
NEW DISCOVERY
Scientists have focused on the COX-1 and COX-2 enzymes, but another pain-causing enzyme called 5-lipoxygenase (5-LOX) has been largely ignored. Scientists at the University of British Columbia found that combinations of COX and 5-LOX inhibitors were more effective than single inhibitors. Some nutrients – boswellic acid and curcumin, for example – have been found to inhibit this enzyme. Although 5-LOX is only just beginning to receive the attention it deserves among researchers, some pioneering work on the nature of this powerful enzyme suggests that levels tend to increase as we age.7 What is even more exciting is that the effect of various nutrients working together is only just starting to become known. When you combine some nutrients in a certain way the pain-relieving effect is multiplied.Using anti-inflammatory drugs in the short term can improve healing – as long as the problem that triggered the inflammation in the first place has gone. Eventually, if pain and inflammation persist over the long term, body tissues will begin to break down. In the case of arthritis, for example, the joint becomes increasingly hard and stiffened – calcified – until you can’t use it at all.
If you have joint problems, you may have had your erythrocyte sedimentation rate (ESR) measured. A high ESR means that your body is in a state of inflammation, as does a high level of c-reactive protein (CRP)?How is inflammation usually treated
The most common medical treatment for inflammation is anti-inflammatory drugs. These drugs are effective symptom suppressors, providing pain relief but doing nothing to address the causes of the inflammation. According to Dr Jeffrey Bland, a pioneer in new approaches to dealing with inflammation, instead of thinking pain means drug, inflammation is the body’s way of saying something is wrong. Inflammation is a systemic problem, not just a localised phenomenon, in which the body’s physiology is shifted into an ‘alarm state’. It’s as if there is a series of underlying imbalances in the body’s chemistry that build up and then burst forth, once the body can no longer cope. The actual symptoms, or pain, are the wave breaking, but the wave is a long time coming.
?CHAPTER 3: HOW YOUR BODY MaKes Pain
The first indication that you may be developing arthritis is joint pain. Pain and inflammation are the body’s way of saying, ‘Help!’ Although it is important to understand and deal with the underlying causes, taking painkillers and anti-inflammatory substances can help to calm down excessive and harmful inflammation, taking the body out of ‘emergency’ mode. Drugs can reduce pain by blocking chemicals that trigger inflammation, but they don’t come without side effects, which is why so many people are turning to natural alternatives.Inflammation – characterised by swelling, redness, pain and heat – underlies many diseases, probably a lot more than most of us realise. These include all the ‘itis’ conditions: arthritis, dermatitis, colitis, nephritis and hepatitis. Also included are asthma and others not usually associated with inflammation, such as Alzheimer’s and Parkinson’s (in which parts of the brain become inflamed), and atherosclerosis (in which the arteries become inflamed).
Pain and inflammation can be caused by an imbalance in a number of body processes, such as impaired liver detoxification, disturbed blood sugar control, allergies, excess oxidants, insufficient antioxidants and a lack of essential fats. Each of these can tip the body into a state of alarm. We’ll be looking into each of these key factors, because simple diet and lifestyle changes can strengthen your body’s resilience so that it won’t be tipped into a state of inflammation.
YOUR PAIN LEVEL
Before we look at what happens in your body when pain occurs, and the mechanism behind painkilling drugs and natural painkilling nutrients and herbs, let’s gauge your pain level.
Unlike a disease such as diabetes, which can be measured in the blood, there is no easy indicator in the blood for arthritis. The main indicator of pain and inflammation is simply how you feel. For this reason, health professionals use questionnaires to discover how effective a treatment is. There are several standard questionnaires, including the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) check for hip and knee pain, and the Oswestry test for back and leg pain. Check yourself out on the
questionnaire below
?Questionnaire: how’s your pain
? Do you suffer from arthritis
? Do you have painful or aching muscles
? Do you suffer from muscle stiffness that limits your movement
? Do you wake up with physical pain
? Do you suffer from headaches ?If so, how often
On average once a week (score 1)
, twice a week (score 2) or more (score 3)
? Does your level of pain make you feel tired
? Does pain make you feel weak
? Does it limit your ability to move around?Do you have aching or painful joints
? Does it limit your ability to sit for more than 30 minutes
? How intense is your pain, without medication
Mild (score 1); discomforting (score 2); distressing
(score 3); horrible (score 4); excruciating (score 5)
Score 1 for each ‘yes’ answer, then add up your score
:Total score
Score
Score
:If your total score is
Below 5
Your level of pain might be reduced by following the advice in this chapter. If not, I recommend you seek
advice from a nutritional therapist or nutritionally oriented doctor
Between 5 and 10 You have a moderate level of pain and should definitely explore each of the options in this chapter as well as seeking advice from a nutritional therapist or nutritionally oriented doctor
More than 10 You have a high level of pain and I advise you to consult a nutritional therapist or nutritionally oriented doctor. Although exploring the options in this chapter will give you a good background, you may well need additional help to put it all into practice.
WHAT CAUSES PAIN AND INFLAMMATION AND HOW ARE
?THEY TREATED
The substances that cause inflammation and pain are called ‘inflammatory mediators’, which your body produces in response to some sort of ‘insult’. There are many of these body chemicals, such as prostaglandins, interleukins, cytokines, leukotrienes, oxidants, nitric oxide, insulin, and immunoglobulins. These in turn promote the accumulation of the substances that cause swelling, redness and pain.Pain-causing prostaglandins and leukotrienes are made from one of the omega-6 fats, arachidonic acid, which is very high in meat and dairy products. Too much of these foods in your diet can lead to over-production of these pain-causing body chemicals. So it’s a good reason to go easy on these foods if you’re in pain. Although some degree of inflammation can be an important protective mechanism, too many inflammatory mediators create pain. This is because inflammation is an ‘alarm signal’ to alert the body that something is wrong.
All over the body there are chemical accelerators and brakes. In the case of inflammation, there are three critical enzymes that turn harmless arachidonic acid into harmful inflammatory mediators. These enzymes are called COX-1, COX-2 and 5-LOX, as shown in Figure 4 overleaf. You could think of COX-1 as the ‘good’ COX, because it helps to protect the gut and the kidneys and promotes normal blood clotting; however, COX-2 is the ‘bad’ one because it increases pain and swelling, but also thins the blood. Blocking COX-1 alone reduces pain but damages the gut and thins the blood. Blocking COX-2 alone reduces pain but increases blood clotting (this is examined in detail on pages 32–34). Non-steroidal anti-inflammatory drugs (NSAIDs for short), such as aspirin or ibuprofen, target both of these enzymes, so they are good for stopping pain and inflammation. On the minus side, though, they are also likely to put you at risk of gastrointestinal bleeding when used regularly over the long term, and they also tax the liver.
Figure 4 – How your body’s chemistry makes pain
Because of the gastrointestinal problems mentioned above, the thinking was that the ideal NSAID would be one that blocked only COX-2 and left COX-1 alone. And the launch of drugs such as Vioxx in 1999 caused huge excitement because that’s exactly what they did. But problems with these drugs began emerging a few years after they appeared on the scene. Blocking an element – such as an enzyme – that is part of a network as complex as the body almost never has just one effect, which is why drugs nearly always have damaging side effects.
In 2004, Merck voluntarily withdrew Vioxx from the market because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use. The precise details of the case have been chewed over in the courts for years, but whatever the legal niceties it’s clear that behind the scenes and in the medical literature, alarm bells had been ringing for years about the link with heart attacks. It’s just that they had been deliberately ignored.
NEW DISCOVERY
Scientists have focused on the COX-1 and COX-2 enzymes, but another pain-causing enzyme called 5-lipoxygenase (5-LOX) has been largely ignored. Scientists at the University of British Columbia found that combinations of COX and 5-LOX inhibitors were more effective than single inhibitors. Some nutrients – boswellic acid and curcumin, for example – have been found to inhibit this enzyme. Although 5-LOX is only just beginning to receive the attention it deserves among researchers, some pioneering work on the nature of this powerful enzyme suggests that levels tend to increase as we age.7 What is even more exciting is that the effect of various nutrients working together is only just starting to become known. When you combine some nutrients in a certain way the pain-relieving effect is multiplied.Using anti-inflammatory drugs in the short term can improve healing – as long as the problem that triggered the inflammation in the first place has gone. Eventually, if pain and inflammation persist over the long term, body tissues will begin to break down. In the case of arthritis, for example, the joint becomes increasingly hard and stiffened – calcified – until you can’t use it at all.
If you have joint problems, you may have had your erythrocyte sedimentation rate (ESR) measured. A high ESR means that your body is in a state of inflammation, as does a high level of c-reactive protein (CRP)?How is inflammation usually treated
The most common medical treatment for inflammation is anti-inflammatory drugs. These drugs are effective symptom suppressors, providing pain relief but doing nothing to address the causes of the inflammation. According to Dr Jeffrey Bland, a pioneer in new approaches to dealing with inflammation, instead of thinking pain means drug, inflammation is the body’s way of saying something is wrong. Inflammation is a systemic problem, not just a localised phenomenon, in which the body’s physiology is shifted into an ‘alarm state’. It’s as if there is a series of underlying imbalances in the body’s chemistry that build up and then burst forth, once the body can no longer cope. The actual symptoms, or pain, are the wave breaking, but the wave is a long time coming.
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