How to Reduce Disease-Related Pain

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The first two memos on pain were relatively easy: joints and nerves. From that point forward, it can get very challenging: Lyme disease, irritable bowel syndrome, shingles—the list of diseases that lead to pain could go on and on. To complicate matters, with the concern over opioid addiction, many people in pain don’t want to even try those medications. What do you do?

The key is to work with your physician and specialists to develop a strategy for pain relief. That will vary by disease. A medication that benefits the nerves for shingles pain may be helped by NSAIDS or other pain relievers, but NSAIDS may not be beneficial for someone with IBS; the absorption of the pain reliever may cause more bowel pain.


Two Strategies to Help

There are two things you can try that may directly or indirectly help with pain. The first is to reduce inflammation and as I mentioned on Tuesday, the supplements that may help are omega-3s, turmeric, and glucosamine. They can help reduce inflammation in more than joints.

The second would be to strengthen the immune system. Lyme disease is bacterial, shingles is a virus, and IBS is an attack on the lining of the intestines. While strengthening the immune system is not directly involved, it may assist the body in dealing with the cause and reduce the pain. To me, that means using probiotics, antioxidants such as vitamin C and E, and using herbs such as echinacea and garlic. As I said, it may not directly affect pain but may indirectly help the body cope with the condition.


The Bottom Line

The two strategies won’t work for every disease. Every form of cancer can result in different pain. Some diseases such as type 2 diabetes can impact the extremities and eyes in ways that require professional guidance. But in general, strengthening the immune system may help over the long term. That also means increasing the intake of vegetables and fruit and getting some exercise within the limitations of the condition. That’s a topic for another time.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Nerve Pain

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Do you ever have pain that shoots down your leg? How about your hands getting numb or painful? Ever get a headache because you’ve clenched your neck muscles so tight due to stress? More than likely, you’re experiencing some form of pain caused by a firing nerve, and these three examples are the ones I’m asked about most often.

It’s always important to get an examination and diagnosis of the potential cause of the pain. If it’s mechanical, that’s one thing. If it’s neural, your approach will be slightly different. The cause of the pain may be a completely different location than where you feel the pain. In the first example, the probable cause is an impingement of the sciatic nerve somewhere; it could be in the spine where the nerve exits the spinal cord or it could be in the pelvic girdle. The second is the classic symptom of carpal tunnel syndrome; the nerves in the neck and shoulder are the primary cause even though the resulting pain is in the wrist and hands.

The critical part of dealing with nerve pain is to try to relieve the pressure on the nerve. Physical therapy and possibly massage that stretches and strengthens the appropriate joints are critical, but they must be done consistently. For some, pain relievers other than non-steroidal anti-inflammatories may be beneficial. Supplements that may help would be high-DHA omega-3s, gingko biloba, and magnesium. If you pushed me to say what’s the best approach, I would say take whatever you can to relieve the pain so you can do the physical therapy. Use the supplements for a longer term solution.

One more type of pain to look at Saturday.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Mechanical Pain

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Every morning, the process of getting my body moving is challenging. My back is stiff and my knee is tender, on the border of painful. The longer I’m up, the better I move. After about 30 minutes, I can get my workout. It takes my knee 10 minutes to warm-up once I start running.

I’m going to talk about pain this week—specifically, three types of pain and what may help. Today it’s mechanical pain. Remember the time you slipped and twisted your knee? Wrenched your shoulder when you picked up something you thought was a lot lighter? Broke your ankle skiing? Those are the types of injuries that can lead to mechanical changes that can result in pain; the injury heals but the tendons, ligaments, and cartilage are not quite the same. It can lead to pain, even many years later. That’s what happened to my right knee.

What can you do about it? Strengthen the supporting tissues to the extent you can. I went to a physical therapist, got an evaluation, was assigned some exercises and I do them regularly. It has strengthened the muscles that directly and indirectly impact the knee. While it’s still tender when I wake up, the swelling is gone and I can run if I choose. To me, that’s the most important thing. But I also take a timed release non-steroidal anti-inflammatory in the morning and use omega-3s, turmeric, and glucosamine twice a day. That works for me. You may need more pain relievers or you may need none.

That’s how you can deal with mechanically-induced pain. On to nerve-induced pain on Thursday and disease-related pain on Saturday.

What are you prepared to do today?

Dr. Chet

 

The Bottom Line on Weight Loss Supplements

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In the weight loss supplement debate, who is correct: proponents or opponents? Are any weight loss supplements beneficial? The answer is complicated.

The opponents of weight loss supplements have the bulk of research on their side for two primary reasons. Weight loss studies using dietary supplements have a lack of consistency in the form of the supplement used, the combination of nutrients in the supplements, and the methodology. That can include everything from the amount of the key ingredient being examined to the number of subjects in the study. The second reason is that some studies examining weight loss supplements on humans don’t control for confounding variables such as age, menopausal status, gender, and type of diet and exercise used to lose weight.

That doesn’t mean that opponents of weight loss supplements have evidence on their side—just the lack of consistent evidence. The problem is a lack of research that demonstrates a significant and permanent impact on body weight. In addition, some weight loss supplements may have potentially negative side effects, so the opponents have the advantage.

Another reason for the opponents’ advantage is the overselling of weight loss benefits based on marginal research. Remember what I began these memos with: “The fat will melt away!” I wish that were true, but there’s no supplement that directly does that. Even if we go back to a banned weight loss supplement, ephedra, it didn’t burn fat. It helped control appetite and may have increased metabolism slightly. There are no safe dietary supplements that do that to any significant degree. Small studies in rodents or even test-tube studies show the potential benefit of many types of herbs, but there are few human trials.

The problem for those selling weight loss supplements is that the type of research that would satisfy the opponents will never be done—it simply costs too much money. While the weight loss supplement industry is a multi-billion dollar industry in total, no single product comes close to generating that kind of revenue. With the type of clinical trials necessary to satisfy critics, there would be no profitability, especially when any other company could put out a competing product with the same ingredient in a different dose and say it’s just as good.

Bleak picture? It depends on how you look at it. Let me give you my perspective.

 

My Take on Weight Loss Supplements

I’ve spent a considerable amount of time checking out weight loss supplements. Is the research perfect? No. But if a nutrient or herb has at least some positive outcome helping people lose weight, I’m fine with that. If it’s mostly theory and animal research with poor human trials, I let it go until they prove something. With that in mind, I think there are some supplements that have consistently shown a benefit in helping people lose weight. The reason they work is not always what is purported to be the reason. The results will be different for different users based on their genetics, their microbiome, and their environment.

So here goes. In my opinion, the weight loss supplements that have shown the most benefit helping people lose weight when they eat less and move more are:

  • Chromium picolinate
  • Garcinia cambogia
  • Conjugated linoleic acid (CLA)
  • Green tea extract

Why do I think these will help? For one reason: they give people an edge in their effort. They positively affect carbohydrate and lipid metabolism, may help increase overall metabolism, and help control hunger. They will never help people lose weight without diet and exercise, but they will give those who are trying an edge in their efforts. To me, that’s worth the cost. That’s why I use most of them myself.

The opponents of weight loss supplements offer nothing other than an opinion. To me, that may be intellectually correct but it’s morally corrupt. With 70% of the population overweight, we don’t need naysayers and obstructionists. We need alternatives that work.

What are you prepared to do today?

Dr. Chet

 

Weight Loss Supplements: Pro vs. Con

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The proponents and opponents of weight loss supplements both cite research to support their opinions. For the opponents, the claim is that there’s a lack of adequate research that supports the benefits of weight loss supplements, and the research that has been done is marginal. The proponents often overstate the benefits of studies that have been done on some weight loss supplements. What gives?

In my opinion, there are several problems. The first problem is attempting to apply the randomized, placebo-controlled trial used in pharmaceutical studies. Trials haven’t included enough subject groups or anywhere near enough subjects per group. The obvious answer is to use people who want to lose weight as subjects: put them on a diet and exercise program while you give half the supplement and the other half the placebo. Reasonable but not good enough. There should be at least four more control groups: normal-weight people with the supplement or placebo, and overweight people who take the supplement or the placebo without a diet and exercise program. Without doing that, no one really knows how much the supplement helps.

The second is not including enough variables. Weight loss and fat loss are obvious and are always included. Some include blood indicators: hormones such as ghrelin, leptin, and cortisol. Too often they don’t do measures of hunger and satiety with simple 0-10 scales. For the guy who criticizes the Food Frequency Questionnaire as much as I do, do I really think a simple hunger scale could be important? I do. For one thing, I think it would be a good predictor of whether people will stick with the study, and by extension, with the program in real life.

The final problem is the expectation of the researchers. I believe that researchers on both sides go in with an expectation of success or failure. They’re supposed to begin a study anticipating both outcomes equally, but I think there’s an inherent investigator bias; they’re just people, after all.

Given the problems, and believe me, this list could include at least a dozen more problems, are all weight loss supplements suspect? No, and I’ll give you my list of real contenders on Saturday.

What are you prepared to do today?

Dr. Chet

 

Are Weight Loss Supplements Fact or Fiction?

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Last week I talked about fat—body fat—why it’s bad and what you can do about it, which raises a question about weight loss supplements. Will they give you a short-cut to getting rid of that fat, inside or outside? Can they help you or are they a waste of money? Worse yet, can they harm you? It depends on who’s doing the talking.

Traditional healthcare professionals such as physicians, nurses, and dieticians often say to save your money: there’s no good research that weight loss supplements will do anything but empty your wallet. They often cite the lack of adequate research on the supplements as the reason for their recommendations.

On the other hand, there are television and Internet physicians and health gurus who always seem to be promoting some type of supplement that will not only “melt away the fat” but do it “without diet or exercise!” They talk about research that proves how well these weight loss supplements work.

Who are we supposed to believe? We need some perspective here and that’s what I’m going to give you this week: what’s real, what’s imagined, and what you should expect.

What are you prepared to do today?

Dr. Chet

 

The Bottom Line on Belly Fat

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Our pretend daughter Jamie slow-cooked a roast for Memorial Day, and it was delicious, the best she’s ever done. She does them very well to begin with, so what made this one so good? Fat. It was a chuck roast. What made it so good was not the fat that you could see, it was the intramuscular fat you really can’t see when it’s cooked. The marbling you see before cooking? That’s more like what I mean, but some fat is so woven into the muscle you can’t see it even then. Why on earth am I talking about chuck roast? It’s because we humans are well marbled as we age, but in our case, it’s not a good thing.

I’ve told you about subcutaneous and visceral fat, but there’s one more type: intramuscular fat. Because we are so sedentary, we have plenty of it, and the more sedentary we are, the more intramuscular fat we have. While it could be a readily available supply of fuel, it’s a sign of muscle loss and sedentary living.

How can we tell whether our fat is located under our skin or around our organs? The only definitive way is with a CAT or PET scan. Dual energy x-ray absorptiometry (DEXA) can be used to determine body fat, but it’s not as precise on the location.

Let’s make it simple. Stand up. Contract your abdominal muscles as tight as you can. Now grab your belly fat, opening your hand as far as you have to get a good hold. If you seem to have more fat in your hands but there doesn’t seem to be much under the muscle, you most likely have more under the skin than under the muscle. If you can’t grab much fat in your hands but you still have a large waist, it’s mostly visceral fat.

While not exactly a scientific method, it can give you an idea of where you stand. And this doesn’t count the marbling effect. For me, it’s almost all subcutaneous fat I can grab.


The Bottom Line

How do you get rid of belly fat? Eat less. Eat better. Move more.

Yes, you’ve heard that before, but here’s why it’s the solution to this problem:

  • Eating less will help you lose fat from under the skin and under the muscle.
  • Eating better means you will be eating fewer refined carbohydrates, and that can benefit your visceral fat.
  • Exercise will help the intramuscular fat because you’ll use it as fuel. It will help the subcutaneous fat because you’ll be burning calories—and yes, do your crunches and leg lifts to strengthen your core. But the visceral fat will benefit the most from exercise because exercise can help use the hormones it produces and move your metabolic function more toward normal.

Find a way to eat less, eat better, and move more that suits your lifestyle. It may be completely different from what works for your best friend or your Aunt Mary, but it will work for you. For many people, my Optimal Performance Program is helping them achieve results they haven’t gotten any other way. But whatever approach you use, you must do something; when I say the guy in the photo has a killer belly, I mean it literally. The answer isn’t a pill or a special food; it’s the effort you put into it.

What are you prepared to do today?

Dr. Chet

 

The Dangers of Undercover Fat

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What’s lurking under your abdominal muscles, in and around your liver and other internal organs? Undercover fat, actually called intra-abdominal or visceral fat. It’s dangerous because visceral fat is more metabolically active and increases the risk of heart disease and type 2 diabetes among other diseases.

What does “metabolically active” mean? Primarily, this fat makes more chemicals that can impact other organs in a negative way: protein, fat, and cholesterol-based hormones such as cortisol, insulin, and estrogen. These chemicals are critical to our health but in excess amounts can result in insulin resistance, fatty liver, and excess estrogen in women and men.

How do you know what type of fat predominates in your body? Better yet, is there anything you can do about it? We’ll finish this up on Saturday.

What are you prepared to do today?

Dr. Chet

 

“Sit-Ups Make You Fatter”

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When I spot a headline like that, I have to click on it to see what they’re talking about. And I usually end up disappointed because it’s about some product to help you lose belly fat. What about the sit-up claim? They say doing crunches or sit-ups or leg lifts will make the muscle under the fat bigger, thereby pushing the fat out farther, and giving you the appearance of being fatter.

Baloney. Sit-ups won’t make you fatter and those products they’re pitching won’t help you lose belly fat. But it does merit a look at the types of fat, where it’s stored, and what you can do about it.

The most obvious fat is the type you can see and pinch: subcutaneous fat. Literally, that means it’s right under the skin. We can see the rolls and bulges. It doesn’t make us happy and, in fact, can make us feel bad about ourselves. I can’t tell you to stop feeling that way because I feel the same way at times.

But there are two things that are important about it. First, it’s a form of protection against famine; not that famine is likely on this continent, but it’s a reserve energy supply. Second, it’s not as metabolically active as intra-abdominal fat, which is found underneath the abdominal muscle. I’ll talk more about that on Thursday.

What are you prepared to do today?

Dr. Chet

 

The Microbiome of Your Lungs

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When we think of the microbiome, it’s logical to think only of the digestive system and our skin. In reality, the microbiome includes every microbe in and on our entire body, including our lungs. At one time, the lungs were thought to be microbe free; that certainly seemed to be the case for newborns. As babies are exposed to various bacteria and other microbes, a microbiome develops in the lungs much as it does throughout the body. It seems to have the same balance of good and bad microbes, although not as extensive as the gut.

Research has shown that in serious lung conditions such as cystic fibrosis as well as chronic lung conditions such as asthma and allergies there’s a dysbiosis of the lung microbiome. In other words, the lung microbiome is out of balance.

What can be done to restore the balance? Nothing other than traditional treatments for now, but this is an area of great research interest. I believe that focusing on eating foods with probiotics as well as prebiotics can help our entire microbiome, not just our gut.

Vegetables, beans, yogurt, fermented foods, and fruit should still be the foundation of our diet. Whether it helps the lung microbiome is not known, but it will help the gut microbiome. As we know, what helps the gut microbiome can influence other parts of the body; it’s reasonable to believe that it just may help the lung microbiome as well.

What are you prepared to do today?

Dr. Chet
References:
1. JAMA. 2017;317(17):1713-1714. doi:10.1001/jama.2017.3023
2. http://www.news-medical.net/life-sciences/Lung-microbiome.aspx