Monday, September 28th, 2009
Over the past several months I have received comments that I think need to be addressed in a much longer format than a comment response. The comments are related to treatment options for rheumatoid arthritis and which treatment is best.
We are fortunate enough to have many options available to us today to manage our rheumatoid arthritis (RA). Traditional medicine offers everything from NSAIDs (Non Steroidal Anti-Inflammatory Drug) like Advil and DMARD s(Disease Modifying Antirheumatic Drugs) such as Plaquenil, Arava, Methotrexate, Gold, and Cyclosporine to biologics like Remicade, Enbrel and Humira. There is a growing trend toward alternative medicine as a solution to deal with this disease. Each option has its benefits, risks and side effects.
NSAIDs are a class of drug that are used primarily to treat inflammation and mild to moderate pain. These medications vary in potency and include the brand names Advil, Motrin, Naproxen, Anaprox and Celebrex. Between 10% to 50% of patients are unable to tolerate NSAIDs because of their side effects. These side effects include upset stomach, stomach pain, and diarrhea. About 15% of people on long term NSAID treatment develop ulcers of the stomach and/or the duodenum.
DMARDs cover a variety of different of drugs. Anti-malarial drugs such as Plaquenil (Hydroxycloroquine) are considered a DMARD and were initially used to treat malaria. It was discovered to help arthritis when patients noticed an improvement in their arthritis symptoms while taking plaquenil for malaria. Plaquenil effects the immune system but doctors do not know how it works for rheumatoid arthritis. Arava (leflunomide) interferes with genes in developing immune cells. When taking Arava, liver monitoring for toxicity is required. You should not take this drug if you are planning to get pregnant or are currently pregnant because of birth defects. The most common side effects for patients taking Arava are rash, nausea, hair loss, liver enzyme elevation and anemia. Methotrexate is a chemotherapy drug that initially was used to treat acute leukemia. Methotrexate (MTX) has become the gold standard for treatment of rheumatoid arthritis (RA). Methotrexate interferes with the growth of cells in the bone marrow. The most common side effects from methotrexate include stomach upset, hair loss, diarrhea, and mouth sores. Folic acid is given while taking this medication to reduce the side effects. Liver function monitoring is necessary to watch for toxicity. Methotrexate should also not be taken if you are pregnant or planning to get pregnant. Injectable Gold has been shown to improve symptoms of rheumatoid arthritis however toxicity is common and constant monitoring in necessary. Side effects include rash, diarrhea, conjunctivitis and marrow suppression. Cyclosporine is a medication that is used primarily for the prevention of rejection of transplanted organs. It is effective for the treatment of rheumatoid arthritis because it stops an overactive immune system from attacking the joints. Side effects can be severe and include hypertension, kidney problems, headache, nausea and diarrhea.
Biologic response modifiers (biologics) are the latest treatment option for rheumatoid arthritis pain and inflammation. They work by blocking the tumor necrosis factors(TNF) components of the immune system. People with RA have too much TNF in their bodies and it overwhelms the immune systems response to inflammation. Biologics such as Enbrel, Remicade and Humira are genetically engineered proteins that binds to and deactivates the TNF molecules before they can do damage. The risks in taking this class of drug include serious infection including sepsis and tuberculosis, nervous system diseases such as multiple scholosis, allergic reactions, lymphoma and congestive heart failure. Because these drugs are fairly new their long term side effects are not known.
There has been much debate on the effectiveness of complimentary and alternative treatments options for rheumatoid arthritis. These treatments include GLA (Gamma Linolenic Acid), DHA (Docosahexaenoic Acid, Tai Chi, herbal supplements and acupuncture. There are many more complimentary and alternative treatment options that will be discussed in future posts.
GLA (Gamma-linolenic Acid) is an essential fatty acid found primarily in plant oils. It is found in borage oil and black currant seed. In preliminary testing it has shown to reduce morning stiffness and swelling however studies have been small to date and additional research would provide more information. DHA (Docosahexaenoic Acid) is an omega 3 fatty acid found in cold water fish. Several studies have shown that DHA reduces inflammation but not the progression of the disease. The movements of Tai Chi improve strength, flexibility and balance. There is no indication that Tai Chi effects the progression of rheumatoid arthritis. Acupuncture in thought to stimulate the release of chemicals called endorphins that block pain. Acupuncture is very effective in treating chronic pain like that in rheumatoid arthritis. The list of supplements as an alternative solution to conventional medicine for the treatment of rheumatoid arthritis include vitamin E, MSM, copper, manganese, vitamin C, selenium, zinc, bromelain, ginger, turmeric and boswellia. These alternatives have proven to help in inflammation and in some cases joint damage.
The benefits of using conventional medicine for the treatment of rheumatoid arthritis are that knowledgeable doctors using this method are readily available and the medications work for many people. These medications have significantly improved the lives of many with rheumatoid arthritis. The downside to this treatment option is the side effects can vary from mild to severe and some long term effects are not even known.
The benefits to choosing an alternative medical solution for the treatment of rheumatoid arthritis is that the side effects to these treatment are few and are less damaging to the body. The disadvantage to complimentary and alternative treatments are that finding a qualified medical professional that can help guide you through all the options available can be a challenge and there is debate on whether or not they can help with joint damage.
Ultimately the choice for a treatment option is a personal one. What matters is what works for you. Everyone has their own body chemistry. What works for one person may not work for another. The advantage that we have today is that we have options, many options, and if something is not working for us we can try in another direction until we find our own solution. It is not up to me or anyone else to decide what is best for you and your body. Trust yourself to figure out what is best for you.
Tags: acupuncture, advil, ananprox, anemia, Arava, arthritis, black currant oil, bone marrow, borage oil, boswellia, bromelain, celebrex, chemotherapy, congestive heart failure, copper, damage, DHA, diarrhea, DMARD, Enbrel, folic acid, ginger, GLA, gold, hair loss, headache, Humira, hypertention, immune system, joint, kidney, leflunomide, leukemia, liver enzyme, lymphoma, m, manganses, methotrexate, MSM, multiple sclerosis, naproxen, nausea, NSAID, plaquenil, pregnant, RA, rash, Remicade, rheumatoid, rheumatoid arthritis, selemium, Tai Chi, toxicity, tuberculosis, turmeric, vitamin C, vitamin E
Posted in Autoimmue Disease, Coping, Decisions, Diet/Nutrition, Good News!, Health/Fitness, Lesson Learned, Rheumatoid Arthritis RA, Solutions, Wellness | 10 Comments »
Wednesday, September 16th, 2009
One of my favorite healthy snacks this time of year is the pomegranate. The kids and I just love to pick at the little gems and eat the sweet, crunchy seeds just as nature made them.
Pomegranates are native to the mediterranean region and are a good source of vitamins A, C, E , folic acid and potassium. The name “pomegranate” in Latin is translated as seeded apple. The polyphenols in pomegranate juice are antioxidants that can prevent and repair oxidative damage caused by free radicals.
In a recent study funded in part by the National Center for Complimentary and Alternative Medicine researchers from Case Western Reserve University studied the effect that the dietary supplement made from pomegranate extract called POMx had on an animal model of rheumatoid arthritis (RA) in mice. The mice were treated before and after the arthritis was induced. The mice that were treated with the POMx before the induced arthritis had significantly reduced incidence and severity of disease than the untreated mice. In mice that were treated to exhibit arthritis symptoms before receiving the POMx, the effected joints showed less inflammation and less destruction of cartilage and bone that those that did not receive the POMx.Future studies will test the disease modifying effects of POMx on mice that have been treated to mimic the symptoms of RA.
Pomegranates are available in the market in the northern hemisphere from September to February. In the southern hemisphere you can find them from March to May but the juice is available year round.
Tags: antioxidant, arthritis, Case Western Reserve University, folic acid, health, inflammation, liver health, National Center for Complimentary and Alternative Medicine, pain, polyphenol, pomegranate, POMx, RA, rheumatoid, rheumatoid arthritis, Rheumatoid Arthritis RA, vitamin A, vitamin C, vitamin E, vitamins
Posted in Autoimmue Disease, Diet/Nutrition, Health/Fitness, Rheumatoid Arthritis RA, Solutions, Wellness | 3 Comments »
Tuesday, August 11th, 2009
Strawberries are at their peak of sweetness in this part of the planet right now. Strawberries are sweet and delicious and great for fighting inflammation as well. They are loaded with vitamin C and Manganese. Strawberries also have Iodine, Potassium, Folate and Vitamins B2, B5 & B6 as well as Vitamin K, Omega 3 fatty acids, magnesium and copper.
Strawberries lower blood levels of C-reactive protein in the blood. C-reactive protein signals inflammation and is high in RA and lupus patients when they are experiencing a flare. At the Harvard School of Public Health, researchers found that women who ate 16 or more strawberries per week were 14 percent more likely to have lower levels of this protein than non strawberry eaters.
It is important to note that strawberries are known to be heavily treated with pesticides. When in comes to strawberries it is organic or nothing for me.
Tags: anti-inflammatory, arthritis, C-reactive protein, flare, folate, Harvard School of Public Health, immune system, inflammation, lupus, manganese, omega 3, potassium, RA, rheumatoid, Rheumatoid Arthritis RA, vitamin C, vitamins
Posted in Autoimmue Disease, Decisions, Diet/Nutrition, Good News!, Health/Fitness, Rheumatoid Arthritis RA, Solutions, Wellness | 4 Comments »
Sunday, July 19th, 2009
This is a really quick easy recipe that can be served warm or chilled for a nice summer side dish. The beans and lemon are rich in vitamin C, the almonds are loaded with omega 3 fatty acids, and the garlic is anti-inflammatory.
2 lbs. Fresh Washed Green Beans
2 tsp. Extra Virgin Olive Oil
3 Clove Garlic minced
2/3 cup sliced almonds
1/2 lemon juice
Steam green beans approximately 4 minutes until they become bright green in color. On high heat, in a nonstick skillet place the almond slices stir constantly until the almonds release their oils and begin to become crisp (about 2 minutes) Remove the almonds from the pan. In the same pan heat the olive oil and garlic until the garlic begins to become soft. Add the green beans, almonds and squeeze the juice from 1/2 lemon. Toss and remove from pan and serve. Enjoy.
Tags: almondine, anti-inflammatory, fatty acid, green bean, omega 3, Recipe, vitamin C
Posted in Autoimmue Disease, Diet/Nutrition, Recipe, Rheumatoid Arthritis RA, Solutions, Wellness | 4 Comments »
Friday, June 26th, 2009
I haven’t added a recipe in a quite a while so today I thought I would share one of my favorite salads. This is a nice light summertime dish that won’t weigh you down on the hottest of days. We enjoy it for either lunch or dinner and the kids really love it. On the rheumatoid arthritis front this salad has garlic, ginger, vitamin C, folic acid, omega 3′s and beta carotene. All of which are good for fighting inflammation.
Marinade:
1 Tablespoon Minced Ginger
1 Tablespoon Minced Garlic ( about 2-3 cloves depending on the size of the cloves)
1 Tablespoon Soy Sauce ( a good quality soy sauce like Tamari is best )
1 Cup Orange Juice
1 Tablespoon Orange Zest
Put all the above ingredients in a zip close bag ( gallon size is probably best)
Chicken:
Prepare 2 full skinless boneless chicken breast by trimming away any excess fat. Place chicken between 2 pieces of plastic wrap and take out any anger and aggression you have about having rheumatoid arthritis out on your chicken. I use a metal mallet so that I don’t have to use a lot of muscle to pound the chicken out. Pound the chicken to about 1/2 inch thickness. Add chicken to the marinade and zip up plastic bag making sure to squeeze out any excess air and place in refrigerator while preparing the salad.
Salad:
You can use whatever salad greens that make you happy. When I made this recipe today for lunch. I used the lettuce and spinach from the garden. If you don’t feel like cutting up salad greens getting the prepackaged stuff will work just as well.
2 Large Carrot peeled and julienned ( My son gave me an oxo julienne peeler that makes the process easy with very little effort ) or you can buy prepackaged stuff
2 Cup shredded Red Cabbage
2 Oranges Supremed (How to supreme and orange) or if it is easier for you or your hands are bothering you use a jar of mandarin oranges
1/2 Cup Toasted Slivered Almonds ( just place slivered almonds in a non stick fry pan and heat for about 5 minutes stirring occasionally to make sure that the almonds release some of their oils and get crunchy)
Wash and dry all the vegetables. ( My kids like to use the salad spinner so they do that for me ) Tear lettuce into bite sized pieces unless of course you have purchased the ready made stuff.
Take the marinading chicken out of the refrigerator and grill until fully cooked. Cooking times will vary based on the grill size and the amount of btu’s that it puts out. It usually only takes me about 15 minutes flipping the chicken halfway though the cooking process. When the chicken is fully cooked place on a cutting board to rest while you prepare the dressing.
Dressing:
1 Tablespoon Dijon Mustard
1 Tablespoon Soy Sauce ( a good quality soy sauce like Tamari is preferable )
1 Tablespoon Sesame Oil
1 Tablespoon Rice Wine Vinegar
1/4 Cup Orange Juice
2 Tablespoon Honey
2 Teaspoon Grated Ginger
Whisk all ingredient together in a mixing bowl. ( You can also just throw everything together in the blender and mix )
Place the lettuce, cabbage and carrot in a large salad bowl or serving platter and toss until well mixed. Place oranges randomly about the bowl or plate. Slice grilled chicken and place warm chicken on top of lettuce mixure. Top with slivered almonds and drizzle with dressing. Serves 4 – 6
Enjoy!
Tags: arthritis, beta carotene, Chicken, folic acid, garlic, ginger, inflammation, omega 3, orange, oriental, rheumatoid, salad, vitamin C
Posted in Diet/Nutrition, Recipe | 7 Comments »
Monday, June 8th, 2009
The most commonly deficient vitamins for people dealing with rheumatoid arthritis are vitamin C, vitamin B6, folate (vitamin B9), vitamin D, vitamin B12 and vitamin E. It is preferable to get these vitamins in your diet however if that is not possible then supplements can be used. There are many reasons that people with rheumatoid arthritis (RA) are deficient in these nutrients many of which are the treatments for the disease.
- Folate (Folic Acid/ Vitamin B9) is not stored in the body so it is important to get a daily dose. Folate deficiency can cause anemia, weight loss, loss of appetite, and diarrhea. Folic acid is used to manufacture red blood cells. It can be found in leafy green vegetables such as spinach and turnips greens. It is also found in broccoli, asparagus, dry beans and peas as well as mushrooms and fortified grains and cereal. It is important to keep fortified milk and grains away from strong light because vitamins are easily destroyed by light. Supplements should be stored at room temperature. How much folate you need daily may depend on the medication you are taking. People taking methotrexate require higher doses. Make sure to check with you physician.
- Vitamin C is also known as ascorbic acid Vitamin C and is necessary for growth and repair of tissues in all parts of your body. It is important for the formation of collagen, an important protein used to make skin, tendons, ligaments, and blood vessels. Vitamin C is essential for healing wounds, and for healthy cartilage, bones, and teeth. Vitamin C is a water-soluble vitamin which means that the body does not store it. Excess vitamin C that the body does not use leave the body through the urine. Daily dosage for adult men is 90mg/day and for adult women is 75mg/day. Low levels of vitamin C can lead to anemia, decreased ability for fight infection, joint inflammation, gingivitis, easy bruising, and possible weight gain due to slowed metabolism.
- Vitamin B6 is important for our nervous system health. It regulates the productions of serotonin, melatonin and epinephrine. It is also important in the processing of carbohydrates. Vitamin B6 is able to remove sulfur from other molecules so it helps maintain hormone balance and the elimination of toxic substances. Vitamin B6 plays a key role in the formation of new cells. It is also important for the formation of red blood cells. Deficiencies can lead to anemia, fatigue and malaise. Daily dosage of 100 milligrams for adults should not be exceeded because vitamin B6 toxicity can lead to imbalances in the nervous system. It can be naturally in tuna, bananas, chicken and turkey breast, cod and salmon.
- Vitamin D is found in many dietary sources such as fish, eggs, fortified milk, and cod liver oil. The sun also contributes significantly to the daily production of vitamin D, and as little as 15 minutes of exposure is thought to be enough to prevent deficiencies. The most important function of vitamin D is to maintain normal blood levels of calcium and phosphorus. Vitamin D aids in the absorption of calcium, helping to form and maintain strong bones. Recently, research also suggests vitamin D may provide protection from osteoporosis, hypertension (high blood pressure), cancer, and several autoimmune diseases. In adults, vitamin D deficiency can lead to a condition called osteomalacia, which results in muscular weakness in addition to weak bones. People who may be at risk for vitamin D deficiencies include the elderly, the obese and those who have limited sun exposure.
- Vitamin E is a fat soluble vitamin. It is found naturally in some foods and is an antioxidant. Antioxidants protect cells from free radicals which damage cells. Vitamin E is important for healthy immune function. Vitamin E is found in avocados, egg yolk, nuts, wheat germ, whole grains, and peanut butter. Because vitamin E is stored in the body large doses can lead to toxicity. For adult men 10 milligrams/day and for adult women 8 milligrams/day is enough to gain the benefits and not lead to overdose.
- Vitimin B12 is an essential water-soluble vitamin. It can be found in shellfish, fish, meat, and dairy products.Vitamin B12 helps to maintain healthy nerve cells and red blood cells. It is also needed to make DNA. Vitamin B12 is bound to the protein in food. Hydrochloric acid in the stomach releases B12 from protein during digestion. Vitamin B12 deficiency can result from being unable to absorb vitamin B12 in the intestinal tract and can cause pernicious anemia. Vegetarians or vegans who are not taking in proper amounts of B12 are also prone to a deficiency in vitamin b12.
Tags: arthritis, folate, health, RA, rheumatoid, suppliment, treatment, vitamin B12, vitamin B6, vitamin B9, vitamin C, vitamin E, vitamins
Posted in Diet/Nutrition, Health/Fitness, Wellness | 7 Comments »
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