Dextrose Prolotherapy and Knee Osteoarthritis

A colleague and someone that I learned directly from, Jeff Patterson DO, co-authored a recent blinded trial of dextrose prolotherapy vs. placebo injection or exercise therapy. The results suggested that prolotherapy is an effective solution for knee osteoarthritis with reductions in pain and stiffness and an increase in range of motion and function. Prolotherapy can be extremely beneficial for numerous types of joint pain and musculoskeletal complaints. Dr Glen Jarosz is a skilled practitioner of prolotherapy as well as numerous other regenerative injection therapies. Please contact him for a free consultation to see if you may benefit from these types of therapies.

June 04, 2013

Dextrose Prolotherapy Can Improve Knee Osteoarthritis

(HealthDay News) – For adults with knee osteoarthritis, dextrose prolotherapy is associated with greater improvements in pain, function, and stiffness compared with saline injections or at-home exercise, according to a study published in the May/June issue of the Annals of Family Medicine.

David Rabago, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues conducted a three-arm blinded, randomized controlled trial involving 90 adults with ≥3 months of painful knee osteoarthritis. Participants were randomized to receive blinded injection (dextrose prolotherapy or saline) or at-home exercise. Injections were provided at weeks one, five, and nine, with additional treatments at weeks 13 and 17, as needed. An exercise manual and in-person instruction were provided to exercise participants.

The researchers found that all groups reported an improvement in composite Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores from baseline to 52 weeks. The improvement in WOMAC scores at 52 weeks was significantly more for the dextrose prolotherapy group compared with the saline or exercise groups, after adjustment for age, sex, and body mass index. In the prolotherapy group, the individual knee pain scores also improved more. High satisfaction was noted with prolotherapy and there were no adverse events reported.

“Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises,” the authors write.

 

The Abstract From the Recent Study:

Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial

  1. David Rabago, MD1, Jeffrey J. Patterson, DO1, Marlon Mundt, PhD1,Richard Kijowski, MD2, Jessica Grettie, BS1, Neil A. Segal, MD, MS3 andAleksandra Zgierska, MD, PhD1

Author Affiliations

  1. 1Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
  2. 2Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
  3. 3Departments of Orthopaedics & Rehabilitation, Epidemiology, and Radiology, The University of Iowa, Iowa City, Iowa
  1. CORRESPONDING AUTHOR: David Rabago, MD, Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715,david.rabago@fammed.wisc.edu

Abstract

PURPOSE Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.

METHODS Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.

RESULTS No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.

CONCLUSIONS Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.

For full text of this research study: http://www.annfammed.org/content/11/3/229.full

Paleo Pumpkin Bites

Paleo Pumpkin Bites

~Grain free~Sugar free~Dairy free

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Ingredients:
1/2 can of organic pumpkin puree (7.5 oz)
1/4 cup full fat coconut milk
1 medium mashed banana
1/4 cup almond meal
1/4 cup coconut flour
2 egg whites
1 tsp baking soda
2 tbsp cinnamon
1/4 tsp sea salt
1/4 tsp vanilla extract
Stevia to taste

Preheat oven to 350 °F

Preparation:
In a small bowl, combine almond meal, coconut flour, baking soda, cinnamon, salt and stevia. Set aside. Us a larger bowl or mixer to combine pumpkin, coconut milk, banana, egg whites and vanilla. Mix until smooth.

Slowly add in dry ingredients until batter thickens–it should be slightly thicker in consistency than pancake batter. If mixture is too thick, add more coconut milk 1 tsp at a time.

Spoon batter into a lined cupcake pan. Recipe makes 8 small cakes.

Bake at 350 °F for 40 minutes

 

Cool. Nibble. Smile.

 

 

Dr. Kaley Bourgeois

Eating to Erase Eczema

Eating to Erase Eczema

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A friend recently asked me what she could do to treat her eczema. After finding minimal help with prescription corticosteroid creams and antihistamines, she was hoping for an affordable, lasting treatment approach that she could manage at home.

Is there a home treatment worth trying? “Yes,” I told her. “You can find relief by eating to erase eczema.”

Eczema, also known as Atopic Dermatitis, is by no means a simple condition with one simple solution. The rash is an outward sign of inward dysfunction in the immune system, involving over-reactive inflammatory cells, often accompanied by a history of hay fever and asthma. Causes of inflammation and specific triggers vary from person to person, but most of us can get considerable relief by avoiding the most common dietary allergens and inflammatory foods. This gives the immune system a chance to calm down, and allows the rash an opportunity to heal.

By following a few strict, but straightforward dietary recommendations, my friend saw her eczema begin to resolve after 2 days. Another friend, this one suffering from Phompholyx (a form of eczema on the hands and feet) watched the itchy, painful bumps disappear after 1 week.

Below are the recommendations that worked for them.

For at least 2 weeks, remove the following top allergens:
1. Zero dairy (this includes foods with added whey or casein).
2. Zero grains (this includes corn, gluten free products such as rice, and items thickened with flour).
For at least 2 weeks, remove foods that promote inflammation:
3. Zero cane sugar (use stevia, or honey or palm sugar in moderation).
4. Limit red meat & eat only grass-fed, free-range animal products (animals fed grains and corn produce higher levels of inflammatory proteins that you then ingest).
Additional Recommendations:
5  Eat healthy fats in abundance (olive oil, coconut oil, fish oil, avocado, nuts & seeds).
6. Avoid already-known food allergens (such as eggs, soy, so on).

In my experience, most people report symptom relief, better energy and an increased sense of well-being after following steps 1-6. These patients often choose to stay on a grain-free, dairy-free diet. For those that hope to regularly enjoy a tasty rice pilaf or a thick wedge of gouda cheese, I recommend trying the following steps:

After at least 2 weeks, once the rash has significantly improved:
1. Add back 1 food per week (for example, cheese week 1, rice week 2, so on)
2. If the eczema begins to return, the most recently re-introduced food is likely a trigger for you. Avoid it.
3. Continue to minimize sugar–it will exaggerate any inflammatory response, regardless of the trigger.

Why does this work?
Picture your over-reactive immune system as a well built fire. The kindling is made up of various allergens (foods, dust, mold, pollen, etc.), and the lighter fluid is sugar and other inflammatory foods. With enough allergens, the fire will keep burning. Add some sugar, and you’ve got a bonfire.

If you can remove enough of the kindling, the fire will start to die down. A little lighter fluid may string it along, but the size and heat of the fire will begin to fade. This is exactly what you do by removing dairy and grains, and limiting sugar.

An estimated 80% of your immune system lives in your gut, meaning that your inflammatory cells and overall state of inflammation are especially sensitive to the foods you eat. For most people with food sensitivities, milk and gluten proteins are at the top of the list; I’ve found that many of these individuals are reactive to the proteins in other grains, too. Removing dairy and grains may not eliminate all of your allergen exposure, but it may be enough to put out the fire.

 

For additional information on eczema, allergies, and naturopathic treatment options,  please contact us at (503) 747-2021. Diagnostic testing and effective therapies are available, including allergy panels, immune system support, and gastrointestinal medicine.

Yours in health,
Dr. Kaley Bourgeois

References:
Allam, JP, Novak, N. “The pathophysiology of atopic eczema. .” Clin Exp Dermatol. 31.1 (2006): 89-93. Web. 13 Feb. 2013.
Furness, J, Kunze, W. “Nutrient Tasting and Signaling Mechanisms in the Gut, II. The intestine as a sensory organ: neural, endocrine & immune responses.” Am J Physiol. 277.5 (1999): G922-G928. Web. 13 Feb. 2013. <http://ajpgi.physiology.org/content/277/5/G922.full>.
Basic Almond Bread – Spice It Up

Basic Almond Bread – Spice It Up

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~No grains~No dairy~No problem~

 

Ingredients:
1 1/2 cups almond meal
1/2 cup flax meal
5 large eggs
2 tsp baking powder
1 1/2 tsp sea salt
2 tbsp melted coconut oil (76 °F)

Want to spice it up?
1 1/2 tsp ground ginger
1 tsp ground cinnamon
1/4 tsp ground clove
1 tbsp honey
1/4 cup crystalized ginger candy, chopped (optional)

Pre-heat oven to 350 °F

Preparation:
Combine almond meal, flax meal, baking powder, salt and additional spices (optional) in a large mixing bowl. Once mixed, blend in coconut oil, eggs, and honey (optional). Scoop dough into a medium sized bread loaf pan, pre-greased with coconut oil.

Bake for 25 minutes at 350 °F

Cool. Slice. Devour. 

Dr. Kaley Bourgeois

Motherhood & Lupus: Taking Steps Toward a Healthy Pregnancy

Motherhood & Lupus: Taking Steps Toward a Healthy Pregnancy

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For young women living with Lupus, becoming a mother can be a challenge both emotionally and physically. As the disease progresses, there is an increased risk of miscarriage and pregnancy complications such as preeclampsia. Furthermore, pregnancy has been known to increase the risk of worsening symptoms and disease flares for the mother.

A recent study, spotlighted by the National Institute of Health earlier this month, suggests a healthy pregnancy and birth may not be far from reach for hopeful young women. If general health is supported prior to conception, and antibodies are reduced such that there is low lupus activity, there is a significant decrease in risk of pregnancy complications. Disease flares, especially, were less likely to occur.

While decreased disease activity during pregnancy lessens risk to mother and child, how the Lupus is stabilized is equally important. The conventional treatment of Lupus involves immunosuppressive medications that my be harmful to a developing fetus. Methotrexate, commonly used to treat Lupus, is known to cause birth defects and cannot be used during and after conception. Corticosteroids, conventionally given to pregnant mothers to reduce a disease flare, have an unknown effect on the fetus and should also be avoided. Both medications increase the risk of infection for the mother, and therefore the child.

Complementary and alternative medicine are often used in treatment of Lupus and other autoimmune conditions, and offer fewer side effects for mother and child. Below is an example of some research-based treatment options that may be used to treat Lupus before conception:

High Dose Vitamin D
Another study shared by NIH revealed high-dose vitamin D therapy to boost general immune function, while reducing activity of autoimmune cells, thereby reducing Lupus activity levels. As vitamin D is known to play a significant role in the brain development of a fetus, assessing for adequate levels in any future mother is important.
Omega-3 Essential Fatty Acids
Dietary supplementation of omega-3 fatty acids has a therapeutic effect on Lupus activity, as well as offering cardiovascular protection and benefitting fetal development.
DHEA
DHEA is a mild corticosteroid made naturally in the body, and found to be low in Lupus patients. Supplementation to balance hormone deficiencies prior to conception may help to reduce symptoms and disease activity by controlling excessive inflammation.

Work with your healthcare provider to create the appropriate treatment plan for yourself and your future child. There are many options available for addressing autoimmune disease and supporting your overall health.

 

Questions? Feel free to contact us at Restorative Health Clinic, (503) 747-2021.

 

Dr. Kaley Bourgeois

 

 

Resources:

Pregnancy Safe for Most Women with Lupus: Study. Nov 7, 2011. MedlinePlus, US National Library of Medicine-NIH, http://www.nlm.nih.gov/medlineplus/news/fullstory_118393.html

Vitamin D, Interferon Alpha Vaccine Show Promise Against Lupus, Nov 7, 2011. MedlinePlus, US National Library of Medicine-NIH, http://www.nlm.nih.gov/medlineplus/news/fullstory_118395.html

A randomised interventional trial of omega-3-polyunsaturated fatty acids on endothelial function and disease activity in systemic lupus erythematosus. Ann Rheum Dis. 2008 Jun;67(6):841-8. Epub 2007 Sep 17.

Dehydroepiandrosterone suppresses interleukin 10 synthesis in women with systemic lupus erythematosus. Ann Rheum Dis. 2004 Dec;63(12):1623-6.

Early Metabolic Syndrome Increases Breast Cancer Risk

Early Metabolic Syndrome Increases Breast Cancer Risk

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A recently published study in this year’s edition of Proceedings in the National Academy of Sciences suggests that biochemical changes resulting from metabolic syndrome likely increase breast cancer risk, independent from the role estrogen plays.

The research findings, based on a mouse model using a modified diet to induce metabolic syndrome in combination with estrogen-blocking medication, demonstrated that increased breast growth and tumors can occur independent of the commonly assumed cause: excess estrogens or xenoestrogens (such as plastics).

The male and female mice were fed a diet with high levels of Linoleic acid (in the form of 10,12,CLA) believed to induce a state of metabolic dysfunction mimicking metabolic syndrome as it is seen in humans. Estrogen blocking medication was given to the females so that only the estrogen-independent effects of obesity and diabetes type II were evaluated (elevated cholesterol, blood sugar and insulin resistance.)

It is well established that estrogen is responsible for stimulating breast growth, and it has long been suspected that outside sources (hormones in meat, xenoestrogens, etc.) are partially responsible for early breast development and an increased risk for breast cancer in adulthood. We now know that early onset diabetes and obesity-related changes can also increase breast cancer risk, even in the absence of estrogen.

These findings are significant, because they establish additional independent risk factors for breast cancer, one of the leading cancers among women. Metabolic syndrome (characterized by central obesity, hypertension, high blood sugar and fats) is already suspected of playing a role in certain pathologies related to estrogen imbalance; we know that adipocytes (fat cells) which accumulate in obesity synthesize their own estrogen and other hormones. Based on this understanding, it has been theorized that metabolic syndrome’s relationship to breast cancer may result primarily from changes in estrogen levels.

We must now acknowledge metabolic syndrome, and even obesity or diabetes type II on their own, as independent risk factors in the development of breast cancer (primarily in early development, but likely in all age groups). An increase in estrogen levels, secondary to obesity, is no less concerning based on this research and should not be overlooked. Rather, these individual findings in a patient (obesity, insulin resistance, high estrogen exposure) should be viewed as multiple, individual factors which combine to produce a greater overall risk.

 

Dr. Kaley Bourgeois

 

Studies:
1. Grace E. Berryhill, et al. Diet-induced metabolic change induces estrogen-independent allometric mammary growth. PNAS. September, 2012.

2. Starche, S., Vollmer, G. Is there an estrogenic component in the metabolic syndrome? Genes & Nutrition, Vol. 1, pp. 177-188. 2006