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High Cholesterol

What is High Cholesterol?

Cholesterol is a fat-like substance, naturally found in humans and animals. It has many important functions that are essential to the body. Cholesterol forms part of the basic structure of many hormones, all cell membranes and the insulation layer around nerves.

Although some cholesterol is found on its own in the bloodstream, most cholesterol molecules are bonded to specialised proteins called lipoproteins. The better-known ones are low-density lipoprotein (LDL), and high-density lipoprotein (HDL).

What is the difference between HDL and LDL cholesterol?

Because of certain chemical properties, fat cannot be dissolved in a watery medium unless it undergoes a chemical dispersion process. Called ‘emulsification’, this process allows fatty substances to disperse into a range of micro-droplets varying in size that allows them to remain in suspension.

Besides the portion of cholesterol found on its own in the bloodstream, the majority of cholesterol is contained within micro lipoprotein droplets. These are distinguished by their size, density and the proteins they are composed of. Within its core, ‘Low Density Lipoprotein’ or LDL contains the highest number of cholesterol molecules (estimated at 1500). Its main function is to transport cholesterol from the liver to the peripheral tissues via the bloodstream. Cholesterol bonded to LDL tends to accumulate inside arteries and is therefore ‘bad’ for our bodies. Cholesterol bonded to high-density lipoprotein or HDL, on the other hand, gets transported to the liver, where it is naturally expelled from the system as a component of bile. It is therefore beneficial to the body to have high levels of HDL.

How are blood cholesterol levels controlled?

Blood cholesterol levels are influenced by several metabolic pathways which involve cholesterol production, absorption, transport and reabsorption.

In our diet, cholesterol is mainly derived from food sources that contain animal products. This is because cholesterol is predominantly manufactured by cells of animal origin. Although plants produce miniscule amounts of cholesterol, they produce large amounts of substances that are structurally very similar to cholesterol, called plant- or ‘phytosterols’. The relevance of phytosterols is that they compete with cholesterol for absorption within the intestinal tract, thereby offering a natural protective mechanism that helps to reduce cholesterol absorption.

Although diet plays a crucial role in the development of cardiovascular disease, the actual cholesterol content within the average diet only influences blood cholesterol levels to a small degree. This is because the human body is highly efficient at manufacturing cholesterol itself, using a molecule called ‘Acetyl coenzyme A’ (acetyl-CoA) as a building block. It is estimated that on average, a man weighing about 70 kg will typically produce around 1000 mg of cholesterol per day, a large amount in relative terms.

Although all kinds of cells can produce cholesterol, liver cells are responsible for the majority of production. This is the site of action where the statins, a group of cholesterol-lowering drugs, plays a dominant role. Other sites with higher cholesterol production rates are the intestines, adrenal glands and reproductive organs.

Cholesterol recycling – nowhere to go

Besides cholesterol production, an important factor that influences blood cholesterol levels is the ability of the body to recycle its own cholesterol continually. As a consequence of normal physiology, large amounts of cholesterol are excreted by the liver via bile as a natural waste product. Once this cholesterol arrives in the intestines, up to 50% of it is automatically re-absorbed and therefore recycled back into the system. Since this mechanism contributes to elevated cholesterol blood levels, blocking this pathway has become a new therapeutic target to help control blood cholesterol levels.

What is hardening of the arteries?

Hardening of arteries called ‘atherosclerosis’ in medical terms is a complex process whereby a layer or crust of cholesterol accumulates within an artery. As this layer increases in thickness, the inner passage of the artery, called the lumen, becomes progressively obstructed. This causes a decrease in the amount of blood flowing through the artery. A clot may also easily form inside this diseased and narrowed blood vessel, sealing it off entirely. This event causes heart attacks and strokes.

What role does cholesterol play in predicting cardiovascular disease (CVD)?

Cardiovascular disease, or CVD, is a broad term that refers to many different conditions that affect the heart and blood vessels. The causes of CVD are numerous, but hardening of the arteries (atherosclerosis) and high blood pressure are the most common. Since various risk factors other than cholesterol are involved in the development of CVD, cholesterol cannot really be used to accurately determine CVD risk single-handedly.

However, when it comes to the development of hardening of the arteries, numerous studies have indicated that cholesterol plays a dominant role. Various health authorities have based their predictions on either determining CVD risk, or providing treatment guidelines, on cholesterol, HDL, LDL or HDL/LDL ratios, or other lesser known lipoproteins. Over the years, these have regularly been adjusted in accordance with the publication of new studies. A recent new meta-analysis published in the Journal of the American College of Cardiology (July 2014), suggests that lowering LDL-cholesterol levels to very minor levels does equate to a significant reduction in cardiovascular events. ^[1,2]

What are South African guidelines?

Health authorities in South Africa recommend that in the absence of other risk factors, cholesterol levels should ideally be no higher than 4.9 mmol per litre for total cholesterol and 2.9 mmol/l for LDL cholesterol. If there are other known cardiovascular risk factors present, for example a previous heart attack or diabetes, then the target for LDL should be reduced to 1.8mmol/L, as per the LASSA treatment guidelines.

As cholesterol-related deaths continue to rise, South Africans need to start managing their cholesterol levels far more proactively if they wish to extend their lifespan. The first step is to check your cholesterol levels. Women are particularly bad at doing this, in part because they tend to be under the erroneous impression that heart disease is predominantly a ‘male’ condition. Although cardiovascular disease in children is rare, the pathologic processes underlying hardening of the arteries actually begins in childhood. In a surprise discovery, a recent study conducted at primary-care paediatric clinics in Texas found that one out of three children between the ages of 9 and 11 either had borderline or high cholesterol. It has also been found that the blood cholesterol levels in childhood are the most significant predictor of high cholesterol levels in adults.

How do ‘Saturated’ and ‘Unsaturated’ fats differ from each other?

Several different compounds naturally found in food and in the body are chemically classified as ‘fats’ or ‘lipids’. All fats are made up from smaller components such as ‘triglycerides’. Within a typical Western diet, triglycerides form the dominant source of fat (90%).

Within its structure, each triglyceride contains three fatty acids. Individually, fatty acids are made up of a central chain of carbon atoms, with hydrogen and oxygen atoms attached to this chain. The term ‘saturated’ is used when a fatty acid has no more space for hydrogen atoms and is therefore ‘saturated’ with hydrogen. ‘Monounsaturated’ fatty acids (MUFAs) have one space left, whilst ‘polyunsaturated’ fatty acids (PUFAs) have more than one space available.Due to the fact that these ‘empty spaces’ allow a fatty acid to behave differently in a biochemical manner, they are considered either ‘beneficial’ or ‘detrimental’ to health.

The chemical differences between fatty acids also contribute to taste. ‘Butyric acid’, for example, is one of the saturated fatty acids responsible for the characteristic flavour of butter.

What role does ‘saturated fat’ play in cardiovascular disease (CVD)?

Currently, all leading medical, heart-health and governmental authorities advise that saturated fat is a risk factor for cardiovascular disease (CVD). This includes the World Health Organization, the American as well as British Dietetic Associations, the World Heart Federation, the Food and Drug Administration and the European Food Safety Authority.

However, some recent questions have been raised in medical literature querying this accepted norm. A meta-analysis published in the American Journal of Clinical Nutrition (2010), for example, did not find significant evidence for concluding that dietary saturated fat is necessarily associated with an increased risk of CVD.^[3] In another review published in the Annals of Internal Medicine (2014), the authors concluded that their findings did not necessarily support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fat.^[4]

Other experts have warned that these conclusions could potentially be misleading due to certain omissions based on available data. A central question is what replaces saturated fat if someone reduces the amount of saturated fat in their diet. If it is replaced with refined starch or sugar, which are the largest sources of calories in the typical Western diet, then the risk of heart disease remains the same. However, if saturated fat is replaced with polyunsaturated fat or monounsaturated fat in the form of olive oil, nuts and probably other plant oils, there is still significant scientific evidence that CVD risk will be reduced.

Why have opinions become slightly contentious?

Because the numerous factors that contribute towards health and the burden of disease are multifactorial. Besides consuming fat, various other factors help to determine cardiovascular health. This includes the process of fat digestion and the intake of other nutritional agents that offer proven health benefits.

Large fatty chains in food cannot be absorbed into the system until they are reduced in size. This happens naturally through the action of enzymes during digestion, a process that leads to the separation of chemical bonds that join individual fatty acids. In the human body, this process is controlled by several digestive enzymes called lipases. Fat digestion, called ‘lipolysis’, starts in the stomach and continues in the small intestine by means of the combined action of various fat digestive enzymes. The rate at which fat digestion takes place and how many free fatty acids it supplies can be influenced by many factors. These include the levels of fat digestive enzymes, as well as the presence of agents that reduce the biological efficacy of fat-digestive enzymes, referred to as ‘lipase inhibitors’ in medical terms.

Besides blocking fat digestion, other agents naturally present in food form insoluble bonds with fat in the intestines, thereby allowing fat to leave the system as waste matter. This is where fibre plays a significant role. The plant-fats or phytosterols, on the other hand, directly compete with cholesterol for absorption in the intestines. Besides blocking the uptake of new dietary cholesterol by the system, a more important task is blocking the body’s tendency to reabsorb its own cholesterol excreted through the liver, thereby breaking the cholesterol recycling pathway.

A recent study on participants with known high cholesterol, for example, examined the effects of a reduced saturated fat diet, against a diet containing foods rich in phytosterols and fibre. After six months, this diet resulted in a significantly greater LDL-cholesterol reduction when compared to the low-saturated fat diet, and produced results that almost equalled the reduction in cholesterol levels that were observed in the earlier trials on statins.

‘An apple a day keeps the doctor away’ has been a health message delivered since the 19^th century. Apples, a rich source of phytochemicals such as polyphenols, are widely consumed and many epidemiological studies have linked the consumption of apples to a reduced risk of some cancers, cardiovascular disease, asthma and diabetes. In the laboratory, apples have been found to inhibit cancer cell proliferation, decrease the oxidation of fats and lower the production of cholesterol in intestinal cell cultures.

To determine whether a daily apple could potentially have a similar protective effect against CVD mortality as statins, adults over 50 years old in the UK were prescribed either a statin or an apple a day. In a recent study (December 2013) released by the British Medical Journal (BMJ), researchers from the University of Oxford concluded that apples managed to rival statins in preventative medicine when it comes to lowering the burden of CVD.

From these findings, it becomes clear that the numerous factors that contribute towards health and the burden of disease are complex. Ideally, they should not be reduced into a one-size-fits-all problem or solution.

Which lifestyle changes will help you reduce your CVD risk?

The following lifestyle modifications will help you to reduce your risks significantly:

Avoid any secondary exposure to smoke, and get help to QUIT SMOKING if you are a smoker.
Increase your level of physical activity by any means, even if just moderately.
Try to maintain your body weight as close to your ideal level. Even slight reductions can make a statistically-measurable difference.
Reduce your intake of saturated fats, trans-fats and cholesterol. An easy way to achieve this goal is to avoid processed food and take-aways. (See below)
Increase your intake of heart-healthy foods. This will automatically result in an increase of fibre, unsaturated fats and phytosterols.
Significantly reduce or avoid the intake of refined carbohydrates and sugar.
Consume alcohol in moderation.
Avoid adding salt to your food.
Monitor your cholesterol levels on a regular basis and start doing this from early adulthood.

Which foods are high in ‘saturated fat?’

Various foods contain different proportions of saturated and unsaturated fat. Examples of foods containing a high proportion of saturated fat include animal fat products such as cream, cheese, butter, ghee, lard, and fatty meats. Certain vegetable-based products also have a high saturated fat content. Examples are coconut oil.

Foods to Avoid:

Fatty meats
Processed meats like salami and sausages
Snack foods like chips, crisps and samoosas
Most takeaway foods, especially deep-fried foods
Cakes, biscuits, doughnuts and pastries
Chocolate

Which foods are ‘heart healthy’?

These are foods rich in phytosterols and sticky fibres. Since both these come from plants, a diet rich in plant-based products will ensure that this objective is easily achieved. The richest naturally-occurring sources of phytosterols are vegetable oils and nuts. Cereal-based products, vegetables, fruit and berries, which are not as rich in phytosterols as nuts and vegetable oil, may also be significant sources of phytosterols if consumed in higher quantities. Sources of fibre are all fruits, all vegetables, legumes (peas and beans) and grains (oats, rye and barley).

References

Boekholdt SM, Hovingh GK, Mora S, et al. Very low levels of atherogenic lipoprotein and the risk for cardiovascular events. J Am Coll Cardiol 2014; DOI:10.1016.j.jacc.2014.02.615.
Ben-Yehuda O, DeMaria AN. LDL-cholesterol after the ACC/AHA 2013 guidelines. J Am Coll Cardiol 2014; DOI:10.1016.j.jacc.2014.05.020.
Siri-Tarino PW, Sun Q, Hu FB, Krauss RM (2010). “Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease”. American Journal of Clinical Nutrition 91 (3): 535–546.
Chowdhury R, Warnakula S, Kunutsor S, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk. Ann Intern Med 2014; 160(6):398-406.
Oh K, Hu FB, Manson JE, Stampfer MJ, Willett WC. Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the Nurses’ Health Study. Am J Epidemiol 2005;161:672-9.
American Heart Association, Cholesterol Guidelines
South African Dyslipidaemia Guideline Consensus Statement Vol 102, No 3, (2012)
Health Society of South Africa, Cholesterol Guide, 2014
World Health Organisation, Cardiovascular Disease Program, Avoiding Heart Attacks and Strokes, 2005

Hypertension

What is High Blood Pressure (Hypertension)?

Your blood pressure (BP) is the force exerted by your heart and arteries to keep blood flowing through your body. Your blood pressure is high when that force is excessive.

Most people will experience short bursts of elevated blood pressure at times. This is normal and may be caused by stress, anxiety, excitement, exertion, etc. In fact, an increase in blood pressure can be helpful, enabling you to act quickly, like jumping away from a speeding car, for example.

It’s normal for your blood pressure to rise and fall during the day. But, when it stays elevated over time, this is called hypertension, which is the medical term for high blood pressure.

Blood pressure is recorded using two numbers. The top figure, called the systolic pressure, represents the pressure during the phase of systole, meaning the maximum pressure exerted by the heart when it contracts. The bottom figure, or diastolic pressure, is the pressure exerted during the phase of diastole, when the heart is totally relaxed and being filled with blood. Blood pressure is therefore an indication of the inward force exerted by the arteries, continuously ‘squeezing’ the column of blood due to their elastic nature.

How common is high blood pressure?

High blood pressure is very common. Globally, the overall prevalence of elevated blood pressure in adults aged 25 and over was around 40% in 2008. Due to population growth and ageing, the number of people with uncontrolled hypertension rose from 600 million in 1980 to nearly one billion in 2008.

What causes high blood pressure?

Despite billions of dollars spent on research by the pharmaceutical industry investigating the mechanisms of high blood pressure in order to invent new drugs, the exact cause of hypertension is still not clearly understood. No specific single cause is found in 90-95% of all cases of high blood pressure.

Hypertension is therefore classified as either ‘primary’ or ‘essential’ hypertension (which means high blood pressure with no obvious underlying medical cause) or ‘secondary hypertension’; the remaining 5–10% of cases that are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.

Hypertension can affect anyone, regardless of age, gender or race. The disease processes leading to the development of high blood pressure include narrowing of the arteries, a greater than normal volume of blood, or the heart beating faster or more forcefully than it should. Any of these conditions will cause increased pressure against the artery walls.

There is overwhelming evidence to suggest that lifestyle and body weight plays a major contributing role in hypertension. Blood pressure rises in direct relation to an increase in body weight. Those who are obese are 2-6 times more likely to develop high blood pressure than those of normal weight.

The excessive intake of salt (sodium chloride), especially aggravated by the diminished intake of potassium, causes an impairment of the body’s blood pressure regulating mechanisms. Nutritional factors such as excess alcohol and coffee intake also contribute. Smoking, a lack of exercise and being overweight are all common causes of high blood pressure, with stress being an aggravating factor.

How is hypertension diagnosed?

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) uses the following classifications to diagnose hypertension:

	Diastolic BP	Systolic BP
Normal	<120	<80
Pre-hypertension	120 – 139	80 – 89
Hypertension, Stage 1	140 – 159	90 – 99
Hypertension, Stage 2	≥160	≥100

What are the complications of high blood pressure?

Persistent levels of elevated blood pressure are detrimental to your health. It makes your heart work harder, straining it abnormally. The heart eventually becomes enlarged and overworked, losing its ability to pump blood properly, which can lead to heart failure. High blood pressure also damages the lining of your arteries, leading to heart attacks, kidney disease and strokes.

Hypertension is also a major risk factor for stroke, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and chronic kidney disease. A moderately high arterial blood pressure, left untreated, is associated with a shortened life expectancy.

What are the symptoms of high blood pressure?

One of the more sinister aspects of high blood pressure is that you may not know that you have it. In fact, nearly a third of people with hypertension are totally unaware of the condition. This is why it is often referred to as a ‘silent killer’.

The only reliable way to know if your blood pressure is high is through regular check-ups. This is especially important if you have been told that you are at increased risk of developing high blood pressure in the past. For example, you could be at risk if you have a weight problem, are diabetic, have cholesterol abnormalities or have a family history of high blood pressure and/or heart disease.

What lifestyle changes can improve high blood pressure?

You can take the following steps to both prevent and manage high blood pressure by adopting a healthy lifestyle:

Maintain a normal body weight (losing even 5kg can lower your blood pressure)
Reduce dietary salt intake
Engage in regular aerobic physical activity, such as brisk walking (≥30 min per day, most days of the week)
Limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women
Consume a diet rich in fruit and vegetables (e.g. at least five portions per day)

Effective lifestyle modification may lower blood pressure as much an individual antihypertensive drug. Combinations of two or more lifestyle modifications can achieve even better results.

What is the link between high blood pressure and the metabolic syndrome?

The metabolic syndrome is a cluster of disease processes that include obesity, hypertension, impaired glucose tolerance/diabetes and abnormal blood cholesterol profiles. Combined, these conditions lead to an increased risk of heart attack, stroke and diabetes.

References

National Institute of Health, National Heart, Lung, and Blood Institute. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
JNC 2014 Evidence Based Guidelines for the Management of High Blood Pressure in Adults. JAMA 2014; 311(5):507-520
Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. Journal of Human Hypertension 18 (3): 139–85.

Immune System

What Is The Immune System?

The immune system is a complex biological system, consisting of many different types of cells, tissues and organs, each with their own specific function. The immune system’s major functions are to recognise and neutralize harmful substances and infective organisms (like bacteria, viruses and parasites), heal damaged tissue and remove cells of our own body that are not functioning correctly, such as cancer cells. The immune system gets stronger as we approach adulthood, but again gets weaker in old age. This is why children and the elderly are more susceptible to illness.

The most important ability of the immune system is to be able to distinguish between self and non-self, or in other words, normal and abnormal. If it is not able to do this properly, it will either allow infectious organisms to invade, or begin attacking your own body. The latter is known as autoimmune disease. Early on, the body learns to recognise specific proteins that are on the surface of the body’s cells as ‘self’. As we are exposed to infectious organisms, the body learns to recognise proteins on the surface of the invaders cells, known as antigens, which signal that it should attack them.

What Are The Different Types Of Immunity?

There are three types of immunity in humans called innate, adaptive, and passive immunity.

What Is Innate Immunity?

Innate immunity consists of the parts of the immune system that you are born with and that do not change significantly throughout life. It includes defensive structures such as the skin and mucous membranes, as well as a number of white blood cell types such as Natural Killer Cells. These are general defences, which means that they don’t recognise specific invaders, but rather that you have been infected and attempt to attack all invaders in a similar way. The innate immune system is your body’s first line of defence against new threats. While it can often deal with infections before they become an issue, invaders are sometimes able to overcome it. This is where adaptive immunity comes in.

What Is Adaptive Immunity?

Adaptive, or acquired, immunity is the part of the immune system that changes over time, learning to recognise new invaders and mount a response to them. This is known as immunological memory.

This memory is why vaccines can confer immunity, as well as why we do not get certain diseases (like chickenpox) twice. This is also the part of the immune system which takes the most time to develop. In children, the adaptive immune system is largely untrained, which is why they get sick so much more often. By adulthood, we have come into contact with many more pathogens and therefore are able to stay healthier longer.

The adaptive immune system relies on two special types of white blood cell, called lymphocytes. These are B-cells and T-cells. B-cells do not directly attack invaders, but are more involved in remembering what they look like and ensuring T-cells (which do attack invaders) and other immune cells can recognise them. One way they do this is through production of antibodies. Antibodies are protein molecules which circulate through the body and bind to the surfaces of invading organisms. Through binding they coat the invader (making it harder for it to move around or get inside cells) and signal to T-cells to attack.

What Is Passive Immunity?

Passive immunity is the passing of resistance to a disease from one person to another. An important role of passive immunity is to protect new-born infants from infection. Various antibodies are transferred from mother to child in the womb and through breast milk. The infant therefore temporarily receives the mother’s highly developed immunity while its own immune system begins to develop.

Passive immunity is short-lived (from days to several months), and the immunity to a wide range of organisms that an infant has while breast feeding is gradually lost as it is weaned. Toddlers and older children will therefore not be resistant to the complete range of organisms their parents are. As such, focus on supporting their growing immune system is paramount to prevent illness and develop their adaptive immune system.

What Happens To The Immune System As I Age?

As with many other biological functions, the immune system becomes less effective as you age. This includes its ability to recognise and ward off pathogens, prevent the proliferation of cells of our own body that cause disease, as well as its ability to recognise self from non-self. As we age, we therefore become more likely to develop a number of diseases, including autoimmune disorders, and become more susceptible to invading organisms.

It is therefore important to focus on immune health as you age. Some micronutrient deficiencies are also more prevalent in the elderly, and these have been linked to a decline in the immune system.

How Can You Strengthen Your Immune System?

The immune system is complex, relying on the correct function of a wide variety of cells, tissues and organs. Optimal immune function therefore relies on maintaining a healthy lifestyle.

This includes following a healthy, well-balanced diet, getting an adequate amount of sleep, regular exercise, reducing stress, and avoiding toxic substances.

Deficiencies in zinc, selenium, iron, copper, folic acid and vitamins A, B6, C, D and E have been associated with poor immunity and higher rates of disease. Ensuring you are receiving optimal amounts of these nutrients is therefore essential. These nutrients can be obtained from a healthy diet, centred on plant-based foods, as well as supplements designed to optimise your immunity. Contact the MNI dietician at expert@mnilifestyle.co.za for healthy diet tips for you and your children.

ImmunoVance has been specifically formulated to contain all of the micronutrients essential to immune function. These, together will scientifically prove herbal extracts, work to strengthen your immune system and optimise its function. Read more about ImmunoVance here.

What Negatively Affects Immunity?

The health of your immune system is inseparable from general health. Factors which negatively affect general health, therefore, impair the functioning of the immune system. These include poor diet, stress, lack of exercise and bad habits such as smoking and excessive alcohol consumption.

Stress may seem to be the least obvious, and yet it is a major contributor to general negative health, and specifically affects the immune system. In the short term, stress can have a positive effect on immunity, priming the body for attack. Short term stress is therefore beneficial, or at least not harmful. Stress becomes an issue, both for health and immunity, when it is chronic.

Biologically, stress causes a number of changes in the body. Many of these are linked to the secretion of cortisol, a hormone which regulates a variety of processes in the body. Cortisol prepares you for ‘fight or flight’, steering energy away from processes that normally use energy but would not necessarily be useful to helping you survive an attack by a bear, for example. One of the biological functions which these hormones impair is the immune response. In the short term, this is not problematic, but in the long term, if cortisol is secreted in excess, the body can enter a state of chronic immune deficiency. Managing stress is therefore extremely important to ensuring optimal immune function.

Why Does Exercise Supress The Immune System?

Regular exercise is important to maintaining health and the immune system. Despite this, excessive amounts of exercise can negatively affect immunity. This is because exercise is a form of stress. During a normal exercise regime, the body has time to recover and return to normal. When exercise is prolonged (over 90 minutes) and extreme, however, the body does not get this opportunity, and it begins to affect the immune system in a similar way to chronic psychological stress. Athletes may also develop deficiencies of certain micronutrients important to the immune system, such as zinc, which is lost through sweat.

The phenomenon is especially observed in endurance and professional athletes, who are more likely to develop upper respiratory tract infections than the general population. Prolonged, intense exercise leads to suppression of the immune system, affecting white blood cell function, lasting up to 24 hours. During this period, athletes are more susceptible to infection. If adequate rest is not taken between sessions, the body is not able to normalise, and a chronic state of immune suppression can develop.

Adequate recovery periods and rest is therefore important, as is focus on good nutrition, high in vitamins and minerals. It has also been found that maintaining energy levels through consumption of carbohydrates while training can reduce the negative effect on the immune system.

Infectious organisms

What is an infection?

An infection occurs when a foreign organism (such as a bacteria or virus) colonises, gets nourishment from and reproduces inside the body. Infection does not necessarily lead to disease, but when the organism damages cells and tissue, it does.

Among the millions of types of organisms, only a few are able to infect our bodies and even fewer are able to cause disease. Those which do are called pathogens. Pathogens usually enter the body through openings to the environment such as the nose, mouth, eyes and wounds. They then migrate to tissues which they can more easily live in.

Infections can be divided into primary and secondary infections. Primary infections are caused by the first organism to invade the body. Secondary infections are caused by organisms that colonise the body due to a weakened immune response or other complications caused by a primary infection. For example, flu, a primary infection, can cause infection of the lungs or airways by bacteria, leading to bronchitis or pneumonia.

What is a virus?

A virus is the smallest and most primitive type of infectious organism. There are thought to be millions of types of viruses, found almost everywhere on earth. These can infect anything from the smallest bacteria to mammals, reptiles and plants.

Viruses cannot reproduce and survive on their own in the way a bacteria, plant or animal can. Instead, they consist of only a few genes packaged tightly into an outer coating made of protein. The coat serves to protect the viral DNA and help the virus to break into and enter a host cell. Once inside, their genes take over the replication machinery of the cell, causing it to produce more viruses. In the process, the cell dies, either because it cannot sustain both itself and the virus, or because the virus causes it to swell until it bursts. New viruses are then released, which spread into the environment and infect other cells.

What is a bacterium?

Bacteria are microscopic, single-celled organisms which are able to replicate and survive on their own. After viruses, they can be considered the next simplest infective agent. Bacteria can be found in almost every environment on earth, from the soil to the bottom of the ocean, on and in plants and animals, and even in radioactive waste and the atmosphere.

Most bacteria are essential to life on earth. They are extremely important to cycling nutrients, from causing the decomposition of dead animals and plants, to creating new nutrients by turning nitrogen in the air into fertilizer that plants can use. It is thought that bacteria where the first organisms to begin producing oxygen millions of years ago, thereby creating a world that was hospitable to other, more advanced life.

Surprisingly, the majority of bacteria living in your gut and other parts of your body are actually good for you. They keep other dangerous bacteria at bay by outcompeting them, or even producing their own antibiotics to kill their competition. These bacteria also help regulate your immune system, improve your overall health and produce nutrients which you may not usually be able to acquire from your diet. This is one reason why bacteria are used to create foods such as yogurt and other fermented foods.

Less than 1% of bacteria can actually be considered dangerous. The few types of bacteria that can make you sick cause diseases such as pneumonia, cholera, tuberculosis and food poisoning, amongst others. They cause disease by invading tissue and releasing toxins which damage cells and organs.

Are There Other Infectious Organisms?

Yes, there are a few. Fungi, protozoa and parasitic worms are more complex than viruses and bacteria. Infection by these organisms is not as common, however, and is often linked to unhygienic environments, contaminated foods and insects.

Fungal infections most often affect the skin and nails and sometimes the airways. They do not usually cause severe disease, but in some cases can, especially when infecting the lungs. Fungi are responsible for common conditions such as athlete’s foot and ringworm.

Protozoa are usually contracted from contaminated water or bites from insects like mosquitos. These organisms cause diseases like malaria and amoebic dysentery.

Parasitic worms are internal parasites and can be contracted from soil, water, raw meat and infected surfaces. Proper sanitation, cooking food thoroughly and avoiding swimming in stagnant water can efficiently prevent them.

What Do Antibiotics Treat?

Antibiotics specifically treat bacterial infections and have no effect on viruses. Taking an antibiotic for the flu is therefore unnecessary and will have no effect, unless your doctor has reason to believe that a secondary bacterial infection is developing. This can be difficult for a doctor to determine, and so they may prefer to be cautious and prescribe antibiotics just in case.

Over prescription and incorrect use of antibiotics can give rise to bacteria that are resistant to these drugs. It is therefore extremely important to take antibiotics exactly as they are prescribed.

Unlike antibiotics, which can kill a broad spectrum of bacteria, antivirals, prescribed for certain viral infections, are often very specific to the virus they target. This is why antiretroviral medication can not be used for the flu, for example. Because of this specificity, many viral infections cannot be directly treated.

What Makes Us Sick?

Why Do We Get Sick?

We get sick due to an infection by a foreign, disease causing organism. The most common symptoms of sickness, such as a runny nose, cough, fever and fatigue are, however, not caused directly by the infecting organism, but are rather part of your body’s immune response. For example, a runny nose results from your body trying to flush an infection out with increased mucous production.

Microorganisms can cause disease in many ways, including by releasing toxic substances, invading cells and tissues as well as releasing signalling molecules that can affect the whole body. These are the effects that damage the body, and are why it is essential to ensure the infection lasts for as short a time as possible, and specific treatment for the infection, rather than its symptoms, receives focus.

Why Are We More Likely To Get Sick In Winter?

Scientists are still unsure why we tend to catch colds and flu mainly in the winter. There are, however, a number of hypotheses, and as with most things in biology, the answer is more likely to be a complex interaction of all of them, rather than any specific one in particular.

It is thought that cold, dry air protects viruses and bacteria, allowing them to survive in the environment longer. The same conditions may also dry out the organisms, making them lighter and able to travel further. Cold, dry air also prevents mucous secreted in the nose, etc., from being as effective at clearing out inhaled material, giving the organisms more time to gain a foothold. Another reason is that people spend more time indoors in winter, creating a perfect environment for pathogens to spread from one person to the next.

When Should I Go To The Doctor For A Cold Or The Flu?

Colds and flu will usually clear up on their own but, in some cases, they may become more severe or result in secondary infections. If you are unsure whether to go to the doctor or not, it is always better to be cautious – rather pay a visit to your doctor than wait until an illness becomes really problematic. This is especially important for individuals who are at greater risk of developing serious complications, including young children, the elderly, immunocompromised individuals, pregnant women and persons suffering from respiratory conditions, such as asthma.

If you are an otherwise healthy individual, and experience any of the following symptoms, you should contact your healthcare practitioner:

You are not recovering, your symptoms are not subsiding, or are getting worse
Unrelenting fever: If the fever does not subside after a few days or respond to over the counter medication
Persistent vomiting or diarrhoea
Shortness of breath
Worsening or persistent cough

See your doctor immediately or visit the emergency room of you experience any of the following:

Chest pain
Severe weakness
Difficulty breathing or breathlessness
Severe headache
Severe rash

Vaccines

What Is A Vaccine?

A vaccine is a medicine aimed at preventing a disease rather than curing it. In medical terms, this is known as a prophylactic treatment. Vaccines train your immune system to recognise certain infectious organisms without actually having to come into contact with them. In order to do this, they contain only the parts of the organism that your immune system can recognise, killed organisms, or a similar organism that doesn’t cause disease. Therefore, a vaccine doesn’t make you sick, but your immune system can recognise the important antigens and train itself to recognise them in future.

Over time, vaccines have reduced the number of infections (and deaths) linked to many infections. For example, vaccines have eliminated smallpox. Getting vaccinated therefore not only protects you, but those around you, especially children and the elderly, as you are less likely to carry and spread an infectious organism if it is eliminated or supressed as soon as it tries to invade your body.

If My Body Can Recognise Previous Infections, Why Do I Get The Flu & Need A Flu Vaccine Every Year?

The flu virus has developed to change itself rapidly in order to avoid detection by our immune system. The strain that infected you last year is therefore very unlikely to be the same one that infects you this year. Before each flu season, scientists and regulators meet to decide which types of the virus will be more prevalent that season. Pharmaceutical companies then begin production of a vaccine containing antigens for these particular strains. By the next season, however, the virus has again changed, and so a new vaccine needs to be developed.

There is also not just one type of flu circulating at any one time, but thousands of slightly or very different versions. Some of these may be similar to what has been vaccinated against or what has been experienced before, and so the body can recognise and fight them off quicker, leading to less severe and shorter duration of symptoms.

Therefore a vaccine can never provide complete protection. In general, however, your chance of catching the flu is reduced by half, and the likelihood you get very sick is much less.

ImmunoVance contains micronutrients essential to optimal immune function. It has been specifically formulated to deliver those vitamins and minerals that are difficult to obtain through our modern lifestyles, and which are often more seriously depleted in the elderly. ImmunoVance® may therefore aid in preventing the decline of your immune system as you age.

Immune support

The immune system is a complex biological system, consisting of many different types of cells, tissues, and organs, each with their own specific function. The immune system’s major functions are to recognise and neutralize harmful substances and infective organisms (like bacteria, viruses, and parasites), heal damaged tissue and remove cells of our own body that are not functioning correctly, such as cancer cells.

The immune system gets stronger as we approach adulthood, but again, gets weaker in old age. This is why children and the elderly are more susceptible to illness. Here are some ways you can strengthen your immune system with exercise.

Immune support for adults

Regular exercise is important to maintaining health and the immune system. Despite this, excessive amounts of exercise can negatively affect immunity.

Immune support for kids

Children will naturally get sick and it is impossible to completely protect them from invading organisms. It is possible, however, to prevent them from getting sick as often, and to speed up recovery.

Neck pain and tension headache

What causes neck pain?

Both acute and chronic neck ache is caused by inflammation, a biological process that is initiated and controlled by several different biochemical signalling pathways within the body. Whilst a painful or stiff neck is a common condition that affects up to two-thirds of the general population at some stage of their lives, repetitive or recurrent bouts of neck pain may also indicate that inflammation could slowly be causing permanent, structural damage to the neck. If this is allowed to happen, acute neck pain will become a chronic, permanent feature. In the latest Global Burden of Disease study (GDB 2013), chronic neck pain is ranked the fourth biggest cause of chronic disability in the world, suggesting that early treatment and prevention are too often neglected

Where does neck pain originate from?

The neck consists of several different tissue types which can each be a source of pain. These are:

Vertebrae – segments of bone stacked upon each other that provide strength and structure.
Intervertebral discs – circular pads of pliable soft tissue situated between the vertebrae. These allow for flexibility in all directions.
Ligaments – fibrous bands which keep the vertebra in place.
Nerves (spinal chord) – runs along the spinal column and branches off between each vertebra. These pass information from the brain to the rest of the body.
Muscles – situated on the sides and behind the vertebrae.
Facet joints – small joints covered by cartilage that allow the vertebra to rotate upon each other.

Importantly, all of these tissues can activate the sensation or perception of pain, both individually and in combination. Effective treatment is therefore highly dependent on identifying the exact source of pain, and extremely important as some tissues may be irreversibly damaged by inflammation. For example, whilst muscles are able to recover from inflammation with ease, inflammatory damage done to the intervertebral discs can become a real and permanent problem.

What is the most common cause of acute neck pain?

Muscle inflammation
Whilst most muscles in the body completely relax when they’re not being used, others, called ‘anti-gravity muscles’, work continuously to maintain your posture. A large proportion of muscles in your neck are of this kind, and so are always tense to prevent your head from flopping over. This gives your neck muscles very little time to relax and often contributes to chronic pain, as there is insufficient opportunity to recover. Painful muscle inflammation can be caused by several mechanisms, including sprains, strain, poor posture, falling asleep in an awkward position, or whiplash injury. Another common cause is the use of a computer for prolonged periods of time, which can contribute to chronic muscle spasm and pain. Additionally, anxiety and stress commonly cause increased muscle tension and pain in your neck muscles.

How does muscle inflammation trigger headaches?

A tension headache, also known as a tension-type headache, originates from the neck and radiates around the head in a band like a manner where it creates a frontal, nagging, and pressing headache. Tension-type headaches are the most common form of a headache and account for nearly 90% of all headaches. In the majority of cases, neck muscle inflammation and spasm are the most frequent triggers that both causes and aggravates tension type headaches.

What are the most common causes of chronic neck pain?

Spondylosis or disc prolapse
Spondylosis is a collective term used to describe the combined effects of several degenerative processes that progressively start to affect the spine. It usually begins in one or more of the intervertebral discs situated between the vertebrae and then spreads to surrounding tissues such as ligaments, joints, and bones. Besides causing local pain, an inflamed intervertebral disc may progressively become weakened through continual enzymatic activity caused by inflammation. This corrosive activity makes the disk increasingly more prone to future damage and even collapse. A collapsed disk may cause direct pressure on the nerve roots as they exit the spinal cord between each vertebra, causing a referred pain syndrome during which pain radiates down the shoulder or arm. Tingling or pins and needles are also common symptoms, whilst in a more advanced state, weakness and loss of sensation may occur within the hands or arms.
Osteoarthritis
This is a common condition that mainly affects the integrity of the cartilage, especially as one becomes older. Osteoarthritis mostly affects the small facet joints between the vertebrae, as they are the only cartilage containing structures in the neck. Importantly, the presence of osteoarthritis in the neck is commonly associated with the presence of several other inflammatory conditions, such as spondylosis, where protein containing structures in the spine are simultaneously degraded. Since the neck is predominantly protein-based, these cumulative effects can cause severe impairment and chronic disability over time.

How is neck pain treated?

Step 1 – the alleviation of acute pain to improve the quality of your life and help you to remain functional and productive.
Step 2 – the implementation of preventative self-help strategies to protect you from the permanent structural damage that chronic inflammation may cause to your neck.

Acute pain management for acute neck ache and tension-type headaches

Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long-term, since as a class, these drugs pose a significant side-effect risk relating to cardiovascular, gastrointestinal and kidney disease. (Ask your doctor or pharmacist for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
Hot or cold packs – applying a heat pack to your neck can help to ease the pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
Rehabilitation therapies – physiotherapy, biokinetics or chiropractic therapy may prove helpful. A good massage may also assist.

Preventative self-help strategies:

By preserving the integrity and mobility of your neck you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from chronic neck pain, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

Stretch your neck
Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain. This is achieved by gently stretching your neck muscles as you tilt your head up and down, and rotating your head by looking far right and far leftover your shoulders.
Strengthen your neck muscles with exercise
Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue plays as an endocrine (hormone-producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects assist locally with inflammation in your neck, as well as systemically in the rest of your body. As with any physical activity, you’ll need to use some common sense when doing these.
Use supplements that naturally reduce inflammation
Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high-level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.
Manage stress better
Since any form of stress will increase the tension in the muscles of your neck and could precipitate tension headaches, you will benefit tremendously from learning how to manage stress.
Correct your posture
A bad posture especially, when sitting or reading is a common cause for neck pain. Ideally you should be sitting with your hips and knees at right angles and you should have good support for your lower back. Hardback, upright chairs or straight-backed rocking chairs are better for your posture than low, soft, upholstered chairs or sofas. Using back supports can help your posture when sitting at home, at work or in the car. If your desk is too low, so that your head is bent forward for long periods, then your neck may be stretched and you may develop muscle pain. Check the height of your desk and the design of your chair at work and at home. Many employers have occupational health specialists who can check that workstations are set up according to your needs. If you do a lot of reading, having the book or papers on a reading frame will often help to correct your posture.
Avoid periods of immobility
Keeping your head in the same position for too long may cause muscle inflammation. Take regular breaks from your desk, driving or any activity where your neck may be held in the same position for an extended period of time, or perform regular stretches during the day.
Choose the correct pillow
Your head and neck should be supported so your head is level with your body in a neutral position. Ideally the pillow should fill in the natural hollow between the neck and shoulders, – a soft or moulded pillow may be useful. A supportive roll inside your pillow case can also be introduced to support the hollow of your neck. Only use enough pillows (usually only one) to keep your head level with your body.
Check your mattress
If your mattress doesn’t give your back proper support, it can also make neck pain worse. Make sure your mattress is relatively firm – a soft mattress could mean that your neck is bent while you sleep.
Massage your neck
A regular and gentle massage of your neck will help alleviate pain and muscle inflammation.

Lower back pain

What causes back pain?

Acute and chronic backache are both caused by inflammation, a biological process that the body activates in order to heal injured tissues. Acute backache usually settles within a few weeks when the inflammatory process naturally abates. Chronic inflammation, however, results in continuous and unabating discomfort in the spine. Besides causing pain, chronic inflammation also progressively damages the spine if left to continue. In the latest Global Burden of Disease study (GDB 2013), lower back pain is ranked the single biggest cause for chronic disability in the world.

Where does the pain originate from?

The body experiences the perception of pain through specialised nerve cells called nociceptors. These are situated throughout the entire body and respond to potentially damaging stimuli by sending signals to the spinal cord and brain, usually causing the perception of pain. This process, called nociception, is biochemically triggered by certain molecules which are released or become activated during inflammation. The spine consists of several different tissue types which all contain nociceptors, as listed below:

Vertebrae – segments of bone stacked upon each other, providing strength and structure.
Intervertebral discs – circular pads of pliable soft issue situated between the vertebrae. These allow flexibility and shock absorption in the spine.
Ligaments – fibrous bands which keep the vertebra in place.
Nerves – fibres that run along the spinal column throughout the body and branches off in a segmental manner between each vertebra, passing information from the body to the brain.
Muscles – vertical columns running down, and anchored to, the spine.
Facet joints – small joints covered by cartilage that allow the vertebra to rotate upon each other.

Of importance is that each tissue type can be a source of pain, either individually or collectively. In a more chronic situation, pain often originates from several different disease processes, activating pain signals in several different tissue types at the same time.

What are the most common mechanisms that causes back pain?

Muscle inflammation
Painful muscle inflammation can be caused by several mechanisms including sprain, strain, poor posture, lifting heavy objects, or whiplash injury. Several different groups of muscles associated with the spine can be involved.

Intervertebral disc prolapse or spondylosis
Spondylosis is the medical term used to describe the combined effects of several degenerative processes that progressively start to affect the spine. It usually begins in one or more of the intervertebral discs situated between the vertebrae and then spreads to surrounding tissues such as ligaments, joints, and bones. Besides causing local pain, an inflamed intervertebral disc may progressively become weakened through continual enzymatic activity caused by inflammation. This corrosive activity makes the disc increasingly more prone to future damage and even collapse. A collapsed disc may cause direct pressure on the nerve roots as they exit the spinal cord between each vertebra, causing a referred pain syndrome during which pain radiates down the shoulder or arm. Tingling or pins and needles are also common symptoms, whilst in a more advanced state, weakness and loss of sensation may occur within the hands or arms.

Osteoarthritis
This is a common condition that mainly affects the integrity of the cartilage, especially as one becomes older. Osteoarthritis mostly affects the small facet joints between the vertebrae, as they are the only cartilage containing structures in the neck. Importantly, the presence of osteoarthritis in the neck is commonly associated with the presence of several other inflammatory conditions, such as spondylosis, where protein containing structures contained in the spine are simultaneously degraded. Since the neck is predominantly protein based, these cumulative effects can cause severe impairment and chronic disability over time.

Other diseases
Less common conditions may cause or contribute to back pain in certain circumstances. These include osteoporosis (reasonably common) as well as rheumatoid arthritis and certain forms of cancers (quite rare).

What are the risk factors for chronic back pain?

The following factors increase your risk:

Age – lower back pain typically occurs as a first symptom between the ages of 30 and 40 and increases with age.
Fitness level – back ache is more common among people who are physically unfit. Weak back and abdominal muscles offer poor support to the spine.
Diet/weight – excess body fat increases mechanical stress on the back.
Genetics – conditions such as ankylosing spondylitis, a rare form of arthritis that affects the spine, are genetically inheritable. Genetics may also contribute to poor bone structure, muscle development, and numerous other factors. These conditions are therefore often passed down among families.
Occupational risk factors – having a physical job that requires heavy lifting, pushing, or pulling, particularly when this involves twisting or vibrating the spine, can lead to injury and back pain. An inactive job or a desk job, on the other hand, may also lead to or contribute to pain, especially if you have poor posture or sit all day in an uncomfortable chair.

How is back ache treated?

Step 1 – alleviation of acute pain in order to improve your quality of life and help you remain as functional as possible.
Step 2 –implementation of self-help strategies to help prevent recurrent or chronic bouts of back ache and help to protect your spine from the permanent structural damage that chronic inflammation often causes.

Acute pain management for back ache:

Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the blood takes to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
Rehabilitation therapies – physiotherapy, biokinetics, or chiropractic therapy may prove helpful. A good massage may also assist. Therapy may reduce inflammation, correct posture, muscle tension, or other contributors to neck pain.

Preventative self-help strategies:

By preserving the integrity and mobility of your back you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from a chronic backache, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

Stretch your back
Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain.
Strengthen your back muscles with exercise
Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue play as an endocrine (hormone producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects will assist you locally with inflammation in your spine, as well as systemically in the rest of your body. Regular exercise can help reduce your risk of developing a herniated disc by slowing down their age-related deterioration as a result of chronic inflammation. It can also help keep your supporting back muscles strong and supple. Always stretch properly in order to warm up and cool down properly before and after any workout or sports activity.
Use supplements that naturally reduce inflammation
Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.
Manage stress better
Any form and stress can increase the tension in the muscles of your spine and should therefore be managed.
Sleeping posture
Your mattress should be firm enough to support your body and the weight of your shoulders and buttocks, keeping your spine straight. If your mattress is too soft, place a firm board under the mattress. Support your head with a pillow, but make sure that your neck is not forced up at a steep angle. Ideally the pillow should fill in the natural hollow between the neck and shoulders, and a soft or moulded pillow may be useful.
Weight-control
Excess weight contributes to back pain as it increases the mechanical stress on the spine, hips and knees, Controlling weight may therefore prove helpful/beneficial. Although weight-loss can be very difficult to achieve, there are certain strategies that you can follow that will significantly increase your chance of success.

Osteoarthritis

What is osteoarthritis?

Osteoarthritis is the most common form of arthritis. Unlike other forms of arthritic diseases that may affect other parts of the body, osteoarthritis is primarily a disease of the joints.

What is joint cartilage?

Joint cartilage is the layer of robust slippery tissue that covers the ends of bones where they connect within a joint. Its purpose is to reduce the friction between apposing bone surfaces in order to allow bones to glide over each other during movement. During osteoarthritis the outer layer of cartilage becomes progressively weakened, starts to crumble and slowly breaks away. This eventually exposes the underlying bone and causes bone-to-bone friction during joint movement. Not surprisingly, bone rubbing on bone causes severe pain and reduces joint flexibility.

What causes osteoarthritis?

In the past, osteoarthritis was thought to be a natural consequence of the “wear and tear” process that results from ageing and frequent usage. Although partially true, new research by various investigators has since demonstrated that this is a somewhat simplistic outlook, and that the corrosive biochemical effects that inflammation has on cartilage plays a far bigger role than friction alone. This explains the reason why many marathon runners often have surprisingly low levels of osteoarthritis of their knees and hips at a later stage of their lives, especially when compared to some of their more sedentary peers. In addition, radiological evidence demonstrating the slow but steady destruction of the entire joint proves that osteoarthritis involves far more than just cartilage degradation.

Why does inflammation damage cartilage?

As part of the natural immune response, inflammation triggers the activation and release of several different enzyme systems that splice or cleave the bonds that join protein molecules together. Since cartilage is predominantly made from protein, these enzymes progressively corrode, and in the process, soften the cartilage. As a result, it becomes less resistant to impact and more prone to fragmentation. Of importance is that these enzymatic processes do not selectively degrade joint cartilage alone, but damage all other regional protein-based tissues, including ligaments, capsules, synovial membranes and adjacent bone.

What are the risk factors for developing osteoarthritis?

Various factors including genetic, biochemical, and mechanical factors play a role in the development of osteoarthritis. These determine to a degree how resistant cartilage will be against inflammatory damages, and why inflammation often lingers within a joint. The following play a role:

Getting older
Being overweight (increases friction)
Previous joint injury, fracture, or sprain (activates inflammation)
Previous joint infection (activates inflammation)
Joints that were not properly formed (increases risk of damage)
A genetic defect in joint cartilage (may cause structural weakness)
Extreme stresses on the joints – certain jobs and high-impact sports (increases friction)

What are the symptoms of osteoarthritis?

Osteoarthritis predominantly causes joint pain and stiffness. The following symptoms are common:

Pain aggravated by movement
Joint tenderness
Stiffness, especially after having rested
Joints appearing slightly larger or more ‘knobbly’ than usual, especially the fingers
Grating sensation or crackling sound with movement
Decreased range of movement
Weakness and muscle wasting

Which joints does osteoarthritis affect?

Almost any joint can be affected by osteoarthritis, but the knees, hips, and small joints of the hands are the most common.

Hands
Osteoarthritis of the hands has a strong genetic basis. Women are more likely to develop osteoarthritis in the hands, especially if both your mother and grandmother were affected. Bony growths or nodules may develop on the finger joints. Nodules on the joints closest to the nails are called Heberden’s nodes whilst Bouchard’s nodes appear in the middle. This may cause the fingers to become gnarled and distorted. Additionally, the base of the thumb joint is commonly affected by osteoarthritis.
Knees
Symptoms include stiffness, swelling, and pain, which makes it hard to walk, climb stairs, and get out of chairs.
Hips
Symptoms include pain and stiffness of the hip joint itself, but pain can often be felt in the groin, inner thigh, or buttocks. Osteoarthritis of the hip may limit moving and bending, making daily activities such as dressing and putting on shoes a challenge.
Spine
Symptoms include stiffness and pain in the neck, mid-back, or lower back. In most cases, osteoarthritis is associated with other degenerative conditions such as intervertebral disc degeneration or spondylosis.

How does one diagnose osteoarthritis?

If clinically suspected, X-rays may confirm the diagnosis and exclude other forms of arthritis. The radiological findings on X-ray include cartilage loss, bone damage, and joint distortion. The development of bony outcrops or protrusions called spurs or osteophytes are common.

How is osteoarthritis treated?

Step 1 – the alleviation of acute pain to improve your quality of life and help you to remain functional and productive.
Step 2 – the implementation of preventative self-help strategies to control your level of pain, maintain mobility, and reduce chronic inflammation.

Acute pain management

Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or hot-water bottle. Heat alters the sensation of pain. Cold (for example a bag of frozen peas) may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area, and may reduce the sensation of pain through reducing nerve activity.
Rehabilitation therapies – Physiotherapy, biokinetics, or chiropractic therapy may prove helpful.

Preventative self-help strategies:

Exercise
Research has shown that regular exercise provides numerous benefits for those suffering from osteoarthritis. Exercise can decrease pain, increase flexibility, strengthen the heart and improve blood flow, help maintain weight, promote general physical fitness and improve mood. Contracting muscles also release multiple substances, known as myokines, which promote the growth of new tissue and facilitate tissue repair. Myokines have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases.
Use supplements that combat inflammation
Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin® is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high-level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.

Weight-control
Being overweight causes increased friction on your hips and knees. Although weight-loss can be very difficult to achieve, there are certain strategies that you can follow that will significantly increase your chance of success. Read more about weight-loss strategies.

Surgery
In some cases of advanced osteoarthritic disease, surgery may be required.

Slipped Disk

What is a slipped disc?

The spine consists of 24 individual bones called vertebrae that are stacked on top of each other. These give the spine strength and rigidity. To enable bending and flexibility, circular pads of pliable connective tissue are situated between each vertebra. These are therefore called intervertebral discs. Under certain circumstances, especially when a sudden downwards force is applied to the intervertebral disc (such as in the case of a whiplash injury or from lifting a heavy object), the internal structure gives way and the disc collapses. This occurrence is referred to as a “slipped disc”, although strictly speaking, no actual “slipping” has really taken place. The medical terms that are used to describe the same problem are “herniated disc” or “prolapsed disc”. Once collapsed, some section of the disc may bulge outwards, an occurrence that may cause certain neurological complications including pressure on spinal nerves and a referred pain syndrome.

What causes a slipped disc?

A slipped disc is largely caused by a medical condition called spondylosis. Key to this process is the corrosive effects of several highly caustic enzyme systems that are released and activated by inflammation.

What is spondylosis?

Spondylosis is a collective term used to describe the combined effects of several degenerative processes that progressively start to affect the spine. It usually begins in one or more of the circular pads of soft tissue between the vertebrae called intervertebral discs, and then spreads to surrounding tissues such as ligaments and bones.

What are the symptoms of spondylosis?

Although spondylosis may occur without causing many symptoms, it is mostly associated with some degree of pain and stiffness of the spine. Certain neurological complications may also occur. Cervical spondylosis involves the intervertebral discs of the neck, whilst occurrence in the lower back is referred to as lumbar spondylosis. Symptoms are dependent on the severity of the condition. Pain can either be local, causing regional pain, or referred, causing pain to travel down the arm or leg. Referred pain is caused by nerves that are either trapped or irritated in the spine. It is quite common for both local and referred pain to occur simultaneously.

What are the symptoms of cervical spondylosis?

Localised symptoms

neck and shoulder pain
headaches radiating up the neck to the back of the head (tension type headaches)
stiffness and decreased mobility of the neck

Referred symptoms

pins and needles in the arm, hands or fingers
pain radiating down the arms towards the hands
loss of feeling in parts of your hands

What are the symptoms of lumbar spondylosis?

Localised symptoms

lower backache
stiffness and decreased mobility of the back

Referred symptoms

pins and needles in the legs, buttocks, feet, or toes
pain radiating down the legs and buttocks towards the feet
difficulty in maintaining your balance
problems with bladder control (advanced cases)

How is spondylosis diagnosed?

Once suspected in a clinical context, the diagnosis of spondylosis is confirmed via an imaging procedure such as an X-ray, MRI, or CT scan. The most obvious feature visible on the radiological image is the collapse or disintegration of one or more intervertebral discs, as judged by loss of height when compared to normal discs. Later features are the distortion of the bony skeleton in the immediate vicinity of the collapsed disc, caused by inflammatory damage and the growth of bony projections or spurs along the collapsed disc’s margins. These are called osteophytes and resemble the tip of a parrot’s beak in appearance.

How does spondylosis develop?

Spondylosis is often triggered by a traumatic event such as an injury, especially when a sudden downwards force is applied to a normal or healthy intervertebral disc. Examples are whiplash injuries and strains caused by the lifting of heavy objects. However, the slow but progressive deterioration of intervertebral discs over time, caused by chronic inflammation, is also a major contributing factor. This is because chronic inflammation slowly degrades the basic structure of a disc and “softens” it, making the disc more vulnerable to injury. An inflamed disc also becomes increasingly less resilient to the daily micro-trauma that is caused by the usual stresses and strains of normal activity.

Which factors contribute to spondylosis?

Within a healthy spine, intervertebral discs are largely avascular and aneural, meaning that in their normal state they contain neither blood vessels nor nerves. New research has demonstrated that an early sign predicting the onset of the future disease is the microscopic appearance of blood vessels and nerve fibres that progressively start to tunnel through a healthy disc. New blood vessels provide access to several inflammatory factors present in blood plasma, which result in progressive damage to the disc.

Why does inflammation damage the intervertebral discs?

Starting at the outer, more durable layer (annulus fibrosus), the progressive infiltration of blood vessels into the pliable inner core of the intervertebral disc (nucleus pulposus) provide access to inflammatory components present in the bloodstream. This activates an escalatory biochemical cascade that progressively degrades a healthy disc through powerful enzymatic action. Degradation is also accelerated by the activity of white blood cells which, under normal conditions, contain large quantities of severely caustic enzymes. These serve as the main offensive weapon used to eradicate and digest harmful microorganisms. Once these enzymes are released within the intervertebral disc, they rapidly degrade the protein-structures that the disc is made of.

Why does pain often gets worse?

The progressive infiltration of a network of new nerve fibres creates a rich network of additional neural pathways both around and within the core of the intervertebral disc. These new neural pathways then result in the signalling of pain from previously unconnected regions. Additional neural pathways also increase the volume of signals thereby enhancing the total sensation of pain. The increased nerve signals from the spinal cord to the neighbouring back and neck muscles also triggers muscle tension and spasm, which significantly aggravates pain. A vicious cycle ensues. During this process, several other pain related syndromes are also likely to develop. Examples are hyperalgesia, or abnormally increased sensitivity to pain, and allodynia, during which minor stimuli such as touch and temperature, now trigger a significantly exaggerated pain response.

How is spondylosis treated?

Acute pain management

Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long-term, since as a class, these drugs pose a significant side-effect risk relating to cardiovascular, gastrointestinal and kidney disease. (Ask your doctor or pharmacist for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
Hot or cold packs – applying a heat pack to your neck can help to ease the pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
Rehabilitation therapies – physiotherapy, biokinetics, or chiropractic therapy may prove helpful. A good massage may also assist. Therapy may reduce inflammation, correct posture, muscle tension, or other contributors to neck pain.

Preventative self-help strategies:

Stretch your back
Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain.
Strengthen your back muscles with exercise
Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue play as an endocrine (hormone-producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects will assist you locally with inflammation in your spine, as well as systemically in the rest of your body. Regular exercise can help reduce your risk of developing a herniated disc by slowing down their age-related deterioration as a result of chronic inflammation. It can also help keep your supporting back muscles strong and supple. Always stretch properly in order to warm-up and cool down properly before and after any workout or sports activity.
Use supplements that naturally reduce inflammation
Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin® is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high-level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.

Surgery
In a small number of cases, surgery may be required to remove a section of a damaged prolapsed disc that is pressing on a nerve.

Spondylosis

What is spondylosis?

What are the symptoms of spondylosis?

What are the symptoms of cervical spondylosis?

Localised symptoms

neck and shoulder pain
headaches radiating up the neck to the back of the head (tension type headaches)
stiffness and decreased mobility of the neck

Referred symptoms

pins and needles in the arm, hands or fingers
pain radiating down the arms towards the hands
loss of feeling in parts of your hands

What are the symptoms of lumbar spondylosis?

Localised symptoms

lower backache
stiffness and decreased mobility of the back

Referred symptoms

pins and needles in the legs, buttocks, feet, or toes
pain radiating down the legs and buttocks towards the feet
difficulty in maintaining your balance
problems with bladder control (advanced cases)

How is spondylosis diagnosed?

How does spondylosis develop?

Spondylosis is often triggered by a traumatic event such as an injury, especially when a sudden downwards force is applied to a normal or healthy intervertebral disc. Examples are whiplash injuries and strains caused by the lifting of heavy objects. However, the slow but progressive deterioration of intervertebral discs over time, caused by chronic inflammation, is also major contributing factor. This is because chronic inflammation slowly degrades the basic structure of a disc and “softens” it, making the disc not only more vulnerable to injury. An inflamed disc also becomes increasingly less resilient to the daily micro-trauma that is caused by the usual stresses and strains of normal activity.

Which factors contribute to spondylosis?

Within a healthy spine, intervertebral discs are largely avascular and aneural, meaning that in their normal state they contain neither blood vessels nor nerves. New research has demonstrated that an early sign predicting the onset of future disease is the microscopic appearance of blood vessels and nerve fibres that progressively start to tunnel through a healthy disc. New blood vessels provide access to several inflammatory factors present in blood plasma, which result in progressive damage to the disc.

Why does inflammation damage the intervertebral discs?

Intervertebral discs are predominantly made out of protein in the form of collagen fibres. These provide a robust, mesh-like structure that accommodates other protein-based molecules making up the rest of the disc (proteoglycans & aggrecans). This unique structural arrangement enables the spine to resist the extreme tensile forces required when lifting, bending and rotating the body. Starting at the outer, more durable layer (annulus fibrosus), the progressive infiltration of blood vessels into the pliable inner core of the intervertebral disk (nucleus pulposus) provide access to inflammatory components present in the blood stream. This activates an escalatory biochemical cascade that progressively degrades a healthy disk through powerful enzymatic action. Degradation is also accelerated by the activity of white blood cells which, under normal conditions, contain large quantities of severely caustic enzymes. These serve as the main offensive weapon used to eradicate and digest harmful microorganisms. Once these enzymes are released within the intervertebral disk, they rapidly degrade the protein-structures that the disc is made of.

Why does pain often gets worse?

The progressive infiltration of a network of new nerve fibres creates a rich network of additional neural pathways both around and within the core of the intervertebral disc. These new neural pathways then result in the signalling of pain from previously unconnected regions. Additional neural pathways also increase the volume of signals thereby enhancing the total sensation of pain. The increased nerve signals from the spinal cord to the neighbouring back and neck muscles also triggers muscle tension and spasm, which significantly aggravates pain. A vicious cycle ensues. During this process several other pain related syndromes are also likely to develop. Examples are hyperalgesia, or abnormally increased sensitivity to pain, and allodynia, during which minor stimuli such as touch and temperature, now trigger a significantly exaggerated pain response.

How is spondylosis treated?

Acute pain management

Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
Rehabilitation therapies – physiotherapy, biokinetics, or chiropractic therapy will prove helpful. A good massage may also assist. Therapy may reduce inflammation, correct posture, muscle tension, or other contributors to neck pain.

Preventative self-help strategies:

By preserving the integrity and mobility of your back you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from chronic back ache, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

Stretch your back Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain.
Strengthen your back muscles with exercise Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue play as an endocrine (hormone producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects will assist you locally with inflammation in your spine, as well as systemically in the rest of your body. Regular exercise can help reduce your risk of developing a herniated disc by slowing down their age-related deterioration as a result of chronic inflammation. It can also help keep your supporting back muscles strong and supple. Always stretch properly in order to warm up and cool down properly before and after any workout or sports activity.
Use supplements that naturally reduce inflammation Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.

Surgery
In a small number of cases, surgery may be required to remove a section of a damaged prolapsed disc that is pressing on a nerve.

Sciatica

What is sciatica?

Sciatica is the medical term for any sort of pain that is caused by the irritation or compression of the sciatic nerve, a large nerve that runs from your lower back (lumber spine) past your pelvis down your leg towards your foot. The sciatic nerve is made up from five separate nerve roots, which leave the spinal column between each of the five vertebrae which form the lumber spine.

What are the symptoms of sciatica?

Sciatic pain may present as a dull, nagging pain which runs from your lumbar spine down the back, outside, or front of your leg. It is often compared to toothache. Sharp, stabbing pains may also be experienced, often triggered by movement. Symptoms usually only occur on one side of the body, but in certain cases pain occur on both sides of the body. Sciatica may not necessarily be associated with the presence of pain in the lower back. It may also present as weakness, pins and needles or numbness that may occur in various parts of the leg and foot.

What causes sciatica or sciatic pain?

Common causes (around 90%):

Spondylosis / Intervertebral disc degeneration – In the majority of cases sciatic pain is due to the collapse of one or more of the rubbery pads of tough, elastic tissue situated between the vertebrae, called intervertebral discs. Under certain circumstances, especially when a sudden downwards force is suddenly applied to the intervertebral disc such as in the case of an injury or as a result of lifting a heavy object, the internal structure of the disc gives way and it ruptures or collapses. The medical terms used to describe this phenomenon are “herniated disc” or “prolapsed disc” and the general condition that leads to disc degeneration is called spondylosis. Once collapsed, some portion of the disk may bulge outwards and press on one of the five nerve roots that collectively form the sciatic nerve (See below).

Rare causes (around 10%):

Spondylolisthesis – the forward displacement of a vertebra, especially the fifth lumbar vertebra, most commonly occurring after a fracture. (Backward displacement is referred to as retrolisthesis).
Spinal stenosis – the abnormal narrowing (stenosis) of the spinal canal that may occur in any part of the spine.
Piriformis syndrome – caused by the piriformis muscle, either as a result of inflammation or direct pressure on the sciatic nerve.
Pelvic tumors – a rare cause.
Pregnancy – direct compression by a baby’s head.

How is spondylosis diagnosed?

How does spondylosis develop?

Spondylosis is often triggered by a traumatic event such as an injury, especially when a sudden downwards force is applied to a normal or healthy intervertebral disc. Examples are whiplash injuries and strains caused by the lifting of heavy objects. However, the slow but progressive deterioration of intervertebral discs over time, caused by chronic inflammation, is also major contributing factor. This is because chronic inflammation slowly degrades the basic structure of a disc and “softens” it, making the disc more vulnerable to injury. An inflamed disc also becomes increasingly less resilient to the daily micro-trauma that is caused by the usual stresses and strains of normal activity.

Which factors contribute to spondylosis?

Within a healthy spine, intervertebral discs are largely avascular and aneural, meaning that in their normal state they contain neither blood vessels nor nerves. New research has demonstrated that an early sign predicting the onset of future disease is the microscopic appearance of blood vessels and nerve fibres that progressively start to tunnel through a healthy disc. New blood vessels provide access to several inflammatory factors present in blood plasma, which result in progressive damage to the disc.

Why does inflammation damage the intervertebral discs?

Starting at the outer, more durable layer (annulus fibrosus), the progressive infiltration of blood vessels into the pliable inner core of the intervertebral disk (nucleus pulposus) provide access to inflammatory components present in the blood stream. This activates an escalatory biochemical cascade that progressively degrades a healthy disk through powerful enzymatic action. Degradation is also accelerated by the activity of white blood cells which, under normal conditions, contain large quantities of severely caustic enzymes. These serve as the main offensive weapon used to eradicate and digest harmful microorganisms. Once these enzymes are released within the intervertebral disk, they rapidly degrade the protein-structures that the disc is made of.

Why does pain often gets worse?

The progressive infiltration of a network of new nerve fibres creates a rich network of additional neural pathways both around and within the core of the intervertebral disc. These new neural pathways then result in the signalling of pain from previously unconnected regions. Additional neural pathways also increase the volume of signals thereby enhancing the total sensation of pain. The increased nerve signals from the spinal cord to the neighbouring back and neck muscles also triggers muscle tension and spasm, which significantly aggravates pain. A vicious cycle ensues. During this process several other pain related syndromes are also likely to develop. Examples are hyperalgesia, or abnormally increased sensitivity to pain, and allodynia, during which minor stimuli such as touch and temperature, now trigger a significantly exaggerated pain response.

How is spondylosis treated?

Acute pain management

Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
Rehabilitation therapies – physiotherapy, biokinetics, or chiropractic therapy may prove helpful. A good massage may also assist. Therapy may reduce inflammation, correct posture, muscle tension, or other contributors to neck pain.

Preventative self-help strategies:

By preserving the integrity and mobility of your back you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from chronic back ache, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

Stretch your back
Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain.
Strengthen your back muscles with exercise
Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue play as an endocrine (hormone producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects will assist you locally with inflammation in your spine, as well as systemically in the rest of your body. Regular exercise can help reduce your risk of developing a herniated disc by slowing down their age-related deterioration as a result of chronic inflammation. It can also help keep your supporting back muscles strong and supple. Always stretch properly in order to warm up and cool down properly before and after any workout or sports activity.
Use supplements that naturally reduce inflammation
Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.

Surgery
In a small number of cases, surgery may be required to remove a section of a damaged prolapsed disc that is pressing on a nerve.

Gout

What Is Gout?

Gout is a form of arthritis caused by the slow but progressive accumulation of uric acid crystals within joints spaces as well as the surrounding soft tissues. For several reasons, the presence of these crystals has the ability to provoke the immune system and activate severe bouts of inflammation, often at a rapid rate.

What are the symptoms of gout?

As compared to other causes of joint inflammation, acute attacks of gout are characterised by agonising pain. The most common symptom of gout is pain and swelling in the first joint of the big toe. This symptom is called ‘podagra’ in medical terms and occurs in about 50% of cases of gout. Other regions that gout may affect are the insteps, ankles, heels, knees, wrists, fingers, and elbows. Episodes of pain are intermittent, and may take weeks or months to reoccur. In a more advanced stage, gout may become chronic and cause permanent symptoms.

What is uric acid?

Uric acid is a natural by-product of the metabolic breakdown of purines, protein-based substance found in DNA and RNA. Uric acid on its own may not pose a problem, but the crystallisation of uric acid within a joint or the adjacent soft tissue leads to gout. This process is directly dependant on blood uric acid levels.

What influences blood uric acid levels?

After production, uric acid is dissolved in the blood and passed through the kidneys where it is eliminated from the body as a natural waste product. If there is an increase in the rate of production of uric acid, or if the kidneys do not eliminate enough uric acid from the body, uric acid blood levels increase, resulting in a condition called hyperuricemia. Uric acid blood levels are therefore dependent on both the production as well as excretion of uric acid.

What causes high blood levels?

Under-excretion of uric acid by the kidney is by far the primary cause of high blood uric acid levels (hyperuricemia) and accounts for about 90% of cases. Various factors contribute to under-excretion, including genetics, diet and certain medication. Overproduction only causes about 10% of cases of hyperuricemia. In this case hyperuricemia may result when a person eats too much high-purine containing food, or eats too much food in general.

How does gout develop?

Based on the blood uric acid levels and the presence of symptoms, gout can be divided into stages:

Stage 1 – Asymptomatic hyperuricemia. (meaning without symptoms)
This is the early stage where a person has elevated uric acid blood levels (hyperuricemia), but displays no other symptoms suggestive of gout. Depending on blood uric acid levels, treatment is usually not required at this stage. This is because hyperuricemia is not considered a disease in itself and may not pose a health risk until symptoms develop.
Stage 2 – Acute gout / acute gouty arthritis.
By now chronically elevated uric acid blood levels has led to the deposition and crystallisation of uric acid within the joint spaces and surrounding soft tissues. This triggers bouts of severe inflammation resulting in intense pain of sudden onset. Acute attacks commonly occur at night and can be triggered by a variety of factors including stressful events, a minor injury, excess alcohol intake, certain medication, or the presence of another illness. Attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not occur for months or even years. As increasing quantities of uric acid crystals start to accumulate within joints and soft tissues over time, attacks occur more frequently and last longer, and may eventually become persisting and chronic. If left untreated, recurrent bouts of inflammation triggered by gout will cause progressive and permanent damage to a joint.
Stage 3 – Chronic tophaceous gout.
If preventative treatment of stage 1 and 2 gout is neglected, the accumulation of uric acid crystals may progress to such a degree that visible lumps of uric acid deposits start forming under the skin. This may also lead to the distortion of a joint. Subcutaneous uric acid deposits are called tophi, hence the term tophaceous gout. When surgically drained, tophi exude a chalky white substance similar to toothpaste in consistency. Chronic tophaceous gout is the most disabling stage of gout. At this stage the disease would most likely have caused permanent damage to the affected joints. High uric acid levels may also affect the kidneys where uric acid kidney stones are formed.

What is “Pseudo-gout”?

Gout is sometimes confused with other forms of arthritis because the symptoms are very similar. One of these conditions is “pseudo-gout” where the pain, swelling, and inflammation also presents in a sudden and severe manner, and thus mimics the symptoms of gout. However, pseudo-gout is caused by the accumulation of calcium phosphate crystals within a joint, not uric acid.

What are the risk factors for gout?

A number of risk factors are associated with hyperuricemia and gout. They include:

Genetics – There is a strong family history of the disease. In most of these cases these individuals excrete less uric acid via their kidneys.
Gender – Men are more commonly affected than women.
Weight – Being overweight increases the risk of developing hyperuricemia and gout through providing more tissue for turnover or breakdown, leading to excess uric acid production.
Alcohol consumption – Too much alcohol can lead to hyperuricemia, since alcohol blocks uric acid excretion by the kidneys.
Diet – Eating too many foods that are rich in purines or eating too much food in general can increase blood uric acid content. (See below).
Medical conditions – Some diseases may cause an excessively rapid turnover of cells, increasing uric acid waste. Some examples are psoriasis, haemolytic anaemia and some forms of cancer.
Medications – Diuretics, aspirin, cyclosporine and levodopa may affect uric acid excretion by the kidneys.

Which foods are high in purine content?

Purines are found in high concentration in meat and meat products, especially internal organs. In general, plant-based diets are low in purines. Specific examples of high-purine foods include anchovies, sardines, herring, mackerel, scallops, liver, kidneys, brains, meat extracts (e.g., Oxo, Bovril), game meats, beer (from the yeast), and gravy.

A moderate amount of purine is also contained in beef, pork, poultry, other fish and seafood, asparagus, cauliflower, spinach, mushrooms, green peas, lentils, dried peas, beans, oatmeal, wheat bran and wheat germ.

How is gout treated?

With proper treatment, most people who experience gout are able to control their symptoms and prevent further deterioration. Treatment aims to ease the pain associated with acute attacks as well as to prevent future episodes. Since gout may also lead to the formation of tophi and kidney stones, focus should also be placed on avoiding the development of these conditions.

Step I – dealing with acute attacks

Prescription medication
The severe pain caused by acute attack of gout can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. In severe cases these can be used in combination. Although effective with reducing inflammation and controlling pain caused by the deposition of uric acid crystals, these drugs have no effect on the amount of uric acid present with the blood stream, soft tissue or joints.

Step 2 – preventing future attacks and protecting your joints from permanent damage

Prescription medication
Since hyperuricemia and gout are chronic conditions, the ideal approach is to lower uric acid levels through either increasing the rate of excretion of uric acid by the kidney, or by lowering the production of uric acid in the body. The drugs probenecid and allopurinol are commonly used for this purpose.
Supplements that help prevent inflammation
In addition to lowering blood uric acid levels with prescription drugs, several natural molecules derived from plants are highly effective in suppressing certain pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. Read more about RheumaLin.

Complex regional pain syndrome

What is complex regional pain syndrome?

Complex regional pain syndrome (CRPS) is the experience of persistent and severe, long-lasting, and debilitating pain, often after an injury to bone or soft tissue. In many cases of the disease, pain slowly fades over time, and may disappear completely. However, in some cases the symptoms of CRPS may persist for years. Middle aged woman seem to be more susceptible to the condition.

What are the symptoms of CRPS?

CRPS primarily presents as continuous and severe burning, stabbing, or stinging pain in the arms, legs, hands, or feet. Although the condition begins at the site of injury, the symptoms often spread to the rest of the limb, usually on one side of the body. Pain may, however, begin to affect other regions of the body as the disease progresses. Additional common symptoms include tingling and numbness of the affected areas, as well as increased sensitivity to pain in the surrounding skin (hyperalgesia). Sensitivity may increase to such an extent that normally painless stimuli (such as soft touch or slight change in temperature) trigger extreme discomfort (allodynia). Episodes of increased pain may be experienced intermittently, known as “flare-ups”, and may last days or weeks.

A number of other symptoms besides chronic pain may also occur, including:

Swelling and stiffness of affected areas and joints
Muscle spasms and tremors
Osteoporosis in the affected limb
The feeling that the affected area is not part of one’s body, is out of proportion, or other extraordinary sensations
Skin may be at times hot, red, and dry, and at others, cold, blue, and sweaty
Unusual rapid or slow growth and fragility of hair and nails, and nails may become grooved

What further complications are associated with CRPS?

Severe chronic pain in this form can result in a significant reduction in quality of life. One’s ability to move, travel, think clearly, and sleep is retarded, leading to both physiological and psychological problems such as anxiety and depression, and even suicide.

A number of other complications may also result, but are rare. These include open sores and skin infections, shortening and reduced movability of muscles (muscle contractures), and the wasting away of muscles (muscle atrophy).

How is CRPS treated?

Step 1 – the alleviation of acute pain to improve your quality of life and help you to remain functional and productive.
Step 2 – the implementation of preventative self-help strategies to control your level of pain, maintain mobility, and reduce chronic inflammation.

Acute pain management

Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or hot-water bottle. Heat alters the sensation of pain. Cold (for example a bag of frozen peas) may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area, and may reduce the sensation of pain through reducing nerve activity.
Rehabilitation therapies – Physiotherapy, biokinetics, or chiropractic therapy will prove helpful.

Preventative self-help strategies:

Exercise
Research has shown that regular exercise provides numerous benefits for those suffering from CRPS. Exercise can decrease pain, increase flexibility, strengthen the heart and improve blood flow, help maintain weight, promote general physical fitness and improve mood. Contracting muscles also release multiple substances, known as myokines, which promote the growth of new tissue and facilitate tissue repair. Myokines have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases.
Use supplements that combat inflammation
Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high-level research projects have produced strong evidence that these agents alleviate inflammation. Read more about RheumaLin.

Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a form of inflammatory arthritis caused by an autoimmune disorder. This means that your immune system mistakenly recognises some tissue or organ as foreign or potentially threatening, and inadvertently attacks it. During RA, this tissue is the synovium, a fibrous membrane that coats the inside of your joint cavities. As a consequence, severe inflammation is initiated. This results in significant corrosive damage to the interior of a joint through the release of several highly caustic protein-dissolving enzymes. Besides damaging the synovium, these enzymes also progressively degrade all other adjacent joint components, such as cartilage, tendons, ligaments and bone. In a more advanced stage, progressive tissue destruction can cause a joint to lose its shape and alignment, and become visibly distorted.

What causes rheumatoid arthritis?

Although the underlying mechanism involves the body’s immune system attacking the joints, the exact trigger is still not clearly understood and is generally believed to involve a combination of genetic and environmental factors:

Family history – if a direct member of your family has had rheumatoid arthritis, you are at an increased risk. While your genes don’t directly cause rheumatoid arthritis, they can make you more prone to environmental factors such as infection, which may activate your immune system.
Smoking – cigarette smoke is the most significant non-genetic risk factor. Rheumatoid arthritis is three times more common in smokers than non-smokers, particularly among men.
Infections – certain viruses and bacteria are suspected to increase the risk. Epidemiological studies have confirmed a potential association between rheumatoid arthritis and two viral infections, namely Epstein-Barr virus (EBV) and Human Herpes Virus 6 (HHV-6).
Gender – women are more likely to develop rheumatoid arthritis. The disease may improve during pregnancy and flare up afterwards, while breastfeeding may aggravate the disease. Additionally, a person’s likelihood of developing RA may be increased slightly by hormonal contraceptive use. These observations suggest that certain female hormones, or possibly deficiencies or changes in the response to hormones, promote the development of rheumatoid arthritis in a genetically susceptible woman who has been exposed to an environmental trigger.
Age – although rheumatoid arthritis can occur at any age, it is more common after the age of 40.

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis typically manifests with signs of inflammation in the joint. Specifically, the affected joint becomes swollen, warm, painful and stiff. A prominent feature which distinguishes RA from osteoarthritis is increased morning stiffness upon waking, which typically lasts for up to an hour. The small joints of the hands, feet and cervical spine, are most commonly affected, but larger joints like the shoulders, elbows, hips, knees, and ankles can also be involved. Gentle movements may relieve symptoms in early stages of the disease. The following symptoms are common:

Swollen, tender, warm, and stiff joints.
More than one joint involved at the same time (polyarthritis).
Both large- and small-joints (fingers) involved at the same time.
Symmetrical pattern, namely similar joints on both sides of the body are simultaneously involved.
Inflammation in the fingers mostly affects the finger-joints closest to the hand (Osteoarthritis affects the opposite joints).
Morning stiffness which lasts more than 30 minutes.
General symptoms such as fatigue, low grade fever, malaise, loss of appetite and loss of weight.
Deformity of joints and fingers in more advanced cases.

What are the common complications of rheumatoid arthritis?

Although rheumatoid arthritis predominantly affects the synovium and therefore causes joint disease, the inflammatory process activated by the immune system may have a detrimental effect on other organs. Examples are:

Skin – the appearance of subcutaneous lumps called rheumatoid nodules. These range from a few millimetres to a few centimetres in size and are usually found over bony prominences, such as the elbow, the heel, the knuckles, or other areas of skin exposed to repeated mechanical stress.
Lungs – fibrosis or scaring of the lungs may occur, either as a direct result of the disease or as consequence of treatment (methotrexate and leflunomide).
Kidneys – chronic damage from inflammation. Treatment with penicillamine and gold salts may also lead to renal disease.
Heart and blood vessels – individuals with rheumatoid arthritis are more prone to hardening of the arteries (atherosclerosis). Risk of heart attack (myocardial infarction) and stroke is therefore markedly increased.
Eyes – inflammation of the sclera (episcleritis) and dry eye syndrome.
Blood – anaemia caused by a variety of mechanisms.
Neurological – peripheral neuropathy and carpal tunnel syndrome.
Bones – osteoporosis, both local (around inflamed joints) and systemic. This is caused by immobility, inflammation (as a result of certain inflammatory signalling molecules called cytokines), as well as corticosteroid therapy.

How is rheumatoid arthritis treated?

The goals of treatment are:

To relieve pain
To reduce inflammation
To slow or stop joint damage
To improve a person’s sense of well-being and ability to function

Current treatment approaches are:

Medication
Lifestyle strategies
Surgery
Routine monitoring and ongoing care

Medication:

Disease-modifying anti-rheumatic drugs (DMARDs) – these are the primary treatment for RA and have been found to improve symptoms, decrease joint damage, and improve overall DMARDs should ideally be started early in the disease since they result in disease remission in approximately half of patients. They comprise a diverse collection of different drugs grouped according to their pharmaceutical function. Common DMARDs include methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine. Other DMARDs, called biologic response modifiers, may be used in people with more serious disease. These are genetically engineered medications that reduce inflammation and structural damage to the joints by interrupting the cascade of events that cause inflammation. Examples are abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, and tofacitinib. (Ask your rheumatologist for advice).
Anti-inflammatory drugs (NSAID’s) – these include the COX-2 inhibitors and reduce both pain and stiffness in those with RA. Generally, no effect on people’s long term disease course is observed and are therefore no longer first line agents. NSAIDs should be used with caution in those with increased risk of gastrointestinal, cardiovascular, or kidney disease. (Ask your doctor or pharmacist for advice).
Steroids – glucocorticoids can be used over the short term for acute flare-ups, especially when waiting for slow-onset drugs to take effect. Injections of glucocorticoids into individual joints are also effective. While long-term use reduces joint damage, it also results in osteoporosis and an increased susceptibility to infections. (Ask your doctor for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).

Lifestyle strategies:

Exercise – regular exercise is recommended as both safe and useful to maintain muscle strength and overall physical function. However, individuals with rheumatoid arthritis need to balance rest and exercise, with more rest during stages when the disease is active and more exercise when it is not. Rest reduces active joint inflammation, pain, and fatigue. Resting time varies from person to person, but shorter rest breaks are generally more helpful than long times spent in bed. Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, maintaining flexibility, improving sleep better, reducing pain, maintaining a positive attitude, and managing weight. Exercise programs should take into account the person’s physical abilities, limitations, and changing needs. Contracting muscles also release substances called myokines, which promote the growth of new tissue and facilitate tissue repair. Myokines have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various other inflammatory diseases such as cardiovascular disease.
Use supplements that combat inflammation – various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making the approach attractive when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised, and combat inflammation via different biochemical mechanisms compared to existing anti-inflammatory drugs. Read more about RheumaLin.
Hot or cold packs – applying a heat pack to inflamed joints can help to ease pain. You can use a microwavable heat pad or hot-water bottle. Heat alters the sensation of pain. Cold (for example a bag of frozen peas) may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area, and may reduce the sensation of pain through reducing nerve activity.
Rehabilitation therapies – physiotherapy, biokinetics, or occupational therapy will prove helpful.
Joint care – supporting an inflamed joint and allowing it to rest often reduces pain and swelling. Splints are useful for wrists, hands, ankles, and feet. Other ways to reduce stress on joints include self-help devices such as zipper pullers and long-handled shoe horns. Devices to assist with getting on and off chairs, toilet seats, and beds may also be required.
Stress reduction – besides physical hardship, individuals with rheumatoid arthritis face several emotional challenges as well. Distress, anger, and frustration stem from the disease itself, aggravated by chronic pain and physical limitations. These increase levels of stress which also increase the amount of pain that one experiences. There are a number of successful techniques for coping with stress.

Fasting Blood Glucose

What is fasting blood glucose?

A fasting blood glucose test determines the concentration of glucose circulating in your blood stream after a fast, or in other words, after not eating or drinking anything other than water for 8 – 12 hours. The test itself is used to diagnose diabetes, and is easy to perform, convenient and less expensive than other tests. It is therefore the preferred test for initial screening for blood sugar disorders.

Why measure fasting blood glucose?

When fasting, such as in the period between dinner and breakfast, your body still needs glucose for energy, even though you have not eaten. As a result, it produces a number of hormones which activate the release of glucose from the muscles, liver and other tissues. This increases blood glucose levels. To prevent blood glucose from going too high, this is followed by release of insulin, slowing glucose release and promoting its uptake and use. In people with diabetes and prediabetes, however, this normal process becomes dysregulated. Either the body doesn’t produce enough insulin to rebalance blood sugar levels or it does not respond to the insulin produced. Blood sugar levels therefore continue to rise during fasting. When compared to non-diabetics, persons with diabetes or prediabetes will have a significantly higher blood glucose content when fasting. In a normal day, this translates to abnormally elevated blood glucose in the morning.

The assessment of fasting blood glucose offers an easy and quick view into how the body manages blood sugar levels. It may also be less variable than other tests, as these are taken sooner after meals and depend more heavily on what was eaten, activity levels and other factors. Despite this, the levels of fasting blood glucose do vary, and will be dependent on a number of factors, including the contents, size and time of the last meal, how the body responds to blood sugar variations and the person’s individual metabolic rate, amongst others. For formal diagnosis, therefore, abnormal blood sugar levels need to be observed on at least two separate occasions.

How is fasting blood glucose tested?

Fasting blood glucose can be tested by obtaining a small blood sample through a simple finger prick in a pharmacy or even at home. This basic assessment will give you an indication of your blood sugar levels. Accurate diagnosis, however, requires a proper blood test. After obtaining a blood sample, it will be sent away for analysis. Ideally, it is best to measure fasting blood glucose in the morning, as you will be in a natural fasting state after not eating since dinner the night before. Testing later in the day is not standard due to day time fasting not being normal, and the discomfort this may cause due to not eating during the day.

What do the numbers mean?

It is important to keep in mind that conclusions can only be made from the average result of at least two tests on different occasions. Blood sugar levels can fluctuate naturally, and a high reading once may not necessarily point to any underlying condition. Furthermore, blood sugar targets are depicted as ranges as there is no one blood sugar level that is ideal in every individual or at every time. As such, your own blood sugar level should be compared to these ranges and then, together with your doctor, interpreted in the context of your own body type, metabolic demands and lifestyle before a definite conclusion can be reached.

In areas outside the USA, including South Africa, blood glucose concentration is measured in millimole glucose per litre of blood (mmol/L). Typically, fasting blood sugar ranges are classified as follows:

3.8 mmol/L or less: Generally too low. Ingest sugar and seek medical attention if symptoms persist.
From 3.9 to 5.5 mmol/L: Normal fasting glucose levels, ruling out diabetes.
From 5.6 to 6.9 mmol/L: Impaired fasting glucose, indicating prediabetes and future risk of diabetes. Adopt a healthy lifestyle and seek medical advice.
7.0 mmol/L and above: Diabetes. Seek medical advice and adopt a healthy lifestyle.

How can I reduce my fasting blood sugar?

Apart from medication recommended by your doctor, it is vital to follow a healthy lifestyle if you are to prevent short-term spikes in blood sugar, and, more importantly, stabilize or reverse long-term negative effects of high-blood sugar and diabetes. Adopting a healthy lifestyle and following the tips below can also prevent blood sugar metabolism problems from developing in the first place. Take action today, even if your blood sugar levels are normal.

A healthier blood sugar level can be achieved by:

Eating a diet high in plant-based foods
Avoiding processed foods
Avoiding sweets and foods high in sugar. This may include limiting natural sources of sugar such as fruit.
Where carbohydrates are included, ensuring they are whole-grain and high in fibre
Focussing on high protein foods
Eating regular meals
Limiting alcohol
Getting regular exercise
Managing stress
Getting regular and adequate amounts of sleep

MNI places emphasis on assisting you with living a better lifestyle and therefore we developed lifestyle support tools:

For more information on how to follow a healthy diet, download our free C.A.P.E Meal Plan (your insulin-friendly meal plan) here.
You can also begin exercising by adopting one of our exercise plans. Download your free copy here.
For further assistance, try our range of products include unique blends of ingredients that work synergistically to help improve your health outcome. Read more here.

Cancer

What is Cancer?

Cancer is a term used for a group of potentially life-threatening diseases during which normal cells become abnormal, divide without control and invade other tissues.

‘Tumour’ is the collective term used for the growths or lumps caused by the abnormal multiplying of cells. Depending on their ability to spread or invade other body tissue, tumours can be ‘benign’ or ‘malignant’. Malignant tumours tend to spread, whilst benign tumours mainly remain localised.

Why does cancer start?

Normal cell division is required for the generation of new cells during growth and to replace old or injured cells as they die. The normal cell cycle is a critical process that a cell undergoes in order to copy itself exactly.

Most cancers are caused by mutations that impair the controls and signals that the body uses to regulate a cell’s cycle of growth and division. Cells that progress through the cell cycle unchecked may eventually form tumours. Where masses of cells rapidly grow and divide uncontrollably, they may develop the ability to spread and migrate throughout the body.

How common is cancer?

Globally, approximately 12 million new cases of cancer are diagnosed annually. According to Dr Carl Albrecht, the head of research at the Cancer Association of South Africa (CANSA), the current prevalence in South Africa is not really known, but it is estimated that 1 in 4 males and 1 in 6 females in South Africa will develop cancer. In South Africa, more than 100 000 new diagnoses are made every year, and the South African cancer survival rate is 6/10. Cancer kills more people than TB, malaria and HIV/AIDS combined.

What causes cancer?

Only 5-10% of all cancer cases can be attributed to genetic defects, whereas the remaining 90-95%have their roots in the environment and lifestyle. According to CANSA, the following factors contribute to the development of cancer:

Age: Longevity and urbanisation are the two factors that play a leading role in the global upsurge of cancer. As cancer cells take time to develop, the longer you live, the higher your chances of developing cancer.
Smoking: World-wide, the most common cause of cancer is smoking. About 1 out of every 3 cancer cases is due to smoking.
Viruses: Viruses, such as hepatitis B, which causes liver cancer and human papillomavirus, which leads to cervical cancer, cause about 20% of cancers, although vaccines for both are available. South Africa initiated vaccination of children against Hep B in 1996 and this should help to eliminate liver cancer in South Africa within the next 20 years.
Chemicals: Chemicals are responsible for approximately 15% of cancer cases. For example, man-made chemicals such as Bisphenol A (BPA), which is used to make certain types of plastics, are strongly linked to breast cancer.
Water: Toxic water can cause cancer. For example, water in the Tlokwe municipality (Potchefstroom) has been found to contain radioactive elements such as uranium. Excessive exposure to uranium is associated with certain types of cancer, including leukaemia.
Alcohol: About 3% of European cancer cases in women are associated with alcohol consumption, compared with 10% in men. Drinking moderately (1 to 2 units a day) appears to have no impact on cancer development. A higher intake can, however, be problematic and binge drinking is more detrimental due to the sudden spikes of alcohol which cause more damage than constant exposure.
Sunlight or ultraviolet exposure: Sun cancers, such as malignant melanomas, account for about 5% of cancer cases.
Genes: About 10% of cancer cases are linked to DNA.
Obesity and diet: Being excessively overweight is strongly associated with the development of 15-20% of cancers.

How is cancer linked to the metabolic syndrome?

The metabolic syndrome is associated with many physiological changes, including insulin resistance, resulting in high levels of insulin in the blood stream, central obesity, increased oestrogen levels and increases in many inflammatory substances. These factors are known to lead to the development of cancer.

A number of studies published in the Metabolic Syndrome and Cancer Project (Me-Can) explain the association between the metabolic syndrome as a whole and its individual components with the risk of cancer.

Higher glucose levels are associated with increased risk of liver, gallbladder, respiratory and thyroid cancer and multiple myeloma in men, as well as pancreatic, bladder, endometrial, cervical and stomach cancer in women.
A higher composite metabolic syndrome score (i.e. the more components present in an individual) has been linked to an increased incidence of bladder cancer in men and post-menopausal breast cancer in women.
High triglycerides have been shown to increase the risk of colon, respiratory tract, kidney and thyroid cancers and melanomas in men, as well as respiratory, cervical and non-melanoma skin cancers in women.
Hypertension (high blood pressure) is associated with an increased risk of multiple cancers in men and women.
Cholesterol may have direct effects on tumour cells and may interact with androgen and oestrogen signalling tumours.
Hyperinsulinaemia: high levels of insulin could be a major player in cancer, not just as an indicator of insulin resistance, but actually as a hormone driving cancer growth.

How are excess weight and cancer linked?

Many scientific studies have demonstrated that obesity is associated with an increase in both the development of many common types of cancer, as well as an increase in cancer-related deaths.

Cancers associated with obesity include oesophageal, pancreatic, colo-rectal, breast, endometrial, renal, thyroid and gallbladder. The biggest risk appears to occur in breast, colorectal, endometrial and oesophageal cancers.

Fat tissue (adipose tissue) is an active hormonal organ. Excess adipose tissue influences the risk of developing cancer via a variety of mechanisms, including its effect on hormones, increased insulin levels (hyperinsulinaemia), increased cell proteins (cytokines), systemic inflammation and the body’s altered immune response.

Obese adipose tissue also results in an imbalance of a variety of substances that would normally control cell division. Adipokines (substances secreted by fat cells) that limit cell growth and regulate natural cell death are supressed (e.g. adiponectin), while those that play a role in tumour growth and metastases are increased (like tumour necrosis factor TNF).

How are cancer and diet connected?

In South Africa, the urban diet has led to an increase in diet-induced obesity and hence an increased incidence of cancer. Our urban diet primarily consists of high glycaemic load carbohydrates, such as white bread, rice and pap, accompanied by high saturated animal fat proteins such as chicken and high-fat meat cuts. Furthermore, these foods are frequently cooked in oils which are high in omega-6 fatty acids (e.g. sunflower oil), which contributes to the high omega 6: omega 3 ratio. This has been implicated in the disease process of cancer, cardiovascular, inflammatory and auto-immune diseases.

A healthy omega 6: omega 3 ratio, associated with greatly reduced risk of disease, is regarded to be equal to or less than 4:1, whereas the ratio in the South African Western Diet is in excess of 30:1. ^[9]

How does inflammation cause cancer?

Research indicates that the factors causing obesity (e.g. diet, physical inactivity, etc.) might contribute directly to the inflammatory state.

Systemic inflammation is a pre-requisite for the development of cancer and insulin resistance may, therefore, play a pivotal role in the increased incidence of cancer in obesity, through its many interconnections with other factors which lead to obesity-related inflammation, a breeding ground for cancer development.

Systemic inflammation is not exclusive to obesity. Normal-weight individuals may experience chronic inflammation as a result of other factors, including diet and physical inactivity. As such, they are also at higher risk of developing cancer.

How are cancer and diabetes linked?

Multiple studies have shown an increased incidence and mortality of cancer in those with Type 2 diabetes, as well as an increased risk of metastases and recurrence.

Early studies found an association between diabetes and cancers of the pancreas and liver, and more recently to endometrial, breast, colorectal, bladder and kidney cancers, as well as non-Hodgkin lymphoma.

An interesting aspect to note is that the association of diabetes and cancer in these studies is independent of BMI.

Glucose is known to be a critical nutrient for proliferating cells and hyperglycaemia may play a role in combination with hyperinsulinaemia, inflammation, adipokines and altered oestrogen levels.

What are the symptoms of cancer?

CANSA has released a list of symptoms which may indicate non-specific cancer. These include:
C: Change in a wart or mole
A: A sore/ wound that doesn’t heal
U: Unusual discharge or abnormal bleeding
T: Thickening or lump
I: Indigestion or difficulty swallowing
O: On-going cough or hoarseness
N: Notable change in bowel or bladder movement

As colorectal and breast cancer are amongst the most common types of cancer and are linked directly to obesity, we will list the common symptoms.

Breast cancer

Early breast cancer usually does not show symptoms and it is only as the tumour grows that the appearance or feeling of the breast may change.

Common changes include:

A lump or thickening in or near the breast or axilla
Change in the size or shape of the breast
Dimpling or puckering in the skin of the breast
The nipple becoming inverted
Abnormal discharge from the nipple
Scaly, red or swollen skin on the breast, nipple or areola
The skin of the breast taking on an orange-peel look or feel

Colorectal cancer

Common signs and symptoms include:

A change in bowel habits, including diarrhoea or constipation or change in the consistency of the stools
Rectal bleeding or blood in stools
A feeling that the bowel doesn’t empty completely
Weakness or fatigue
Unexplained weight loss

Many people with colorectal cancer experience no symptoms in the early stages of the disease. When appearing, symptoms will likely vary, depending on the size and location of the cancer within the large bowel.

How can I decrease my risk of developing cancer?

It is estimated that approximately 1 third of all cancer cases can be prevented.
The South African Cancer Association (CANSA) advises the following lifestyle changes to reduce the risk of cancer:

DO:

Eat fresh fruit and vegetables every day, especially apples and broccoli
Exercise regularly
Drink plenty of fresh, clean water daily
Conduct regular self-examinations
Cover up in the sun or stay in the shade

DON’T:

Don’t smoke or use any tobacco products, including hubbly-bubbly
Don’t drink more than one serving of alcohol per day
Don’t eat processed food, junk food or food high in animal fat
Don’t eat lots of red meat (follow a mainly plant-based and whole grain diet)

References

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Linkov F, PhD. Cancer Epidemiology: The Need for Global Information Sharing in obesity and cancer? World Congress of Epidemiology, Aug 2011
Pazaitou-Panayiotou, K., Polyzos, S. A. and Mantzoros, C. S. (2013), Obesity and thyroid cancer: epidemiologic associations and underlying mechanisms. Obesity Reviews. doi: 10.1111/obr.12070
Yehuda-Shnaidman E, Schwarts B. Mechanisms linking obesity, inflammation and altered metabolism to colon carcinogenesis. Obes Rev. 2012 Dec: 13(12): 1083-95. Epub 2012 Sep 3.
Birk S, Peeters A, Mackholder K, O’Brien P, Brown W. A systemic review of the impact of weight loss on cancer incidence and mortality. Obesity Review, Vol 13, Issue 10, pgs. 868-891, Oct 2012
Gallagher EJ, MB BCH BAO MRCPI, LeRoith D, MD, PhD. Epidemiology and molecular mechanisms tying obesity, diabetes and the metabolic syndrome with cancer. Diabetic Care, Vol36, Sup 2, Aug 2013
Messiah SE, Lipschultz SE, Natale RA, Miller TL. The imperative to prevent and treat childhood obesity: why the world cannot afford to wait. Clinical Obesity
The Cancer Association of South Africa. http://www.CANSA.org. Accessed 16 October 2013
Krygsman, A. Can restriction of carbohydrate and/or omega fatty acids prevent breast cancer development? Dept. of Physiological Sciences, University of Stellenbosch.
Albrecht, C MD. Cancer stakes its Territory- Causes and Link to Stress. Head of research, CANSA, Aug 2012
Herbst MC, Prof. Fact sheet on Colorectal Cancer. Cancer Association of South Africa. June 2013
Donna Kerrigan, M.S. Jeanne Kelly. Brian Hollen. Understanding Cancer and Related Topics, Understanding Cancer Genomics. National Cancer Institute.
Shmoop Editorial Team. “The Cell Cycle, Cellular Growth, and Cancer” Shmoop.com. Shmoop University, Inc., 11 Nov. 2008. Web. 17 Oct. 2013.
Chow AY, PhD. (2010) Cell Cycle Control by Oncogenes and Tumour Suppressors: Driving the Transformation of Normal Cells into Cancerous Cells. Nature Education 3(9):7
National Cancer Institute at the National Institutes of Health. Fact Sheet: Obesity and Cancer Risk. www.cancer.gov/cancertopics/factsheet/risk/obesity Accessed 18 October 2013
Nissen MJ, Shapiro A, Swenson KK. Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clin Breast Cancer, 2011 Mar;11(1):52-60
The Cancer Association of South Africa. Breast Cancer – Big & Small Let’s save them all. www.cansa.org.za Accessed 16 October 2013
National Academy of Sciences. The Role of Obesity in Cancer Survival and Recurrence: Workshop Summary 2012