Insulin Resistance

What is Insulin Resistance?

Insulin is a hormone that plays a dominant role in regulating various metabolic processes including blood sugar and body fat percentage. Under normal circumstances, this process is highly dynamic and constantly fine-tuned by the body. However, under certain conditions, the body becomes blunted to the regulatory effects of insulin. When this happens, the normal mechanism starts to fail and ‘insulin resistance’ sets in. As a result, blood sugar levels start to climb.

To compensate the body increases its production of insulin, thereby causing insulin levels to rise. When it comes to regulating blood sugar, rising insulin levels are beneficial since it helps keep rising blood sugar under control. However, when it comes to regulating body fat percentage, rising insulin levels spell somewhat of a disaster. This is because the hormone insulin not only makes the body more effective at storing fat but also makes it more difficult to burn fat.

The net effect is that your metabolism effectively slows down.

How is metabolism regulated?

All biochemical processes that take place in the body are initiated and controlled by a complex communication system that relies on messenger molecules that are able to convey biochemical instructions. Examples of messenger molecules are hormones, neurotransmitters and cytokines. Chemicals contained within pharmaceutical drugs or medicinal plant extracts also achieve their results through the same mechanism.

Depending on their design, messenger molecules deliver their biochemical communication either broadly at a high level to a large audience, or more selectively at a local level in a more specific manner. They can also override or overrule each other, as well as strengthen or amplify another’s message.

Metabolism is a complex process which involves the regulatory activity of various different messenger molecules. It is commonly believed that the thyroid gland is in charge of this process. This misguided view is based on oversimplification, since the numerous regulatory tasks that insulin performs relating to carbohydrate, protein and fat metabolism, as well as how insulin overrules virtually all other messenger molecules involved in the process, makes insulin the single most dominant controller of metabolism.

What causes insulin resistance?

Whilst genetic makeup, increasing age and certain disease states make you more prone to developing insulin resistance, lifestyle factors that lead to weight gain and the ultimate triggers. These include diet and a sedentary lifestyle. At the heart of the problem is excess body fat, not because of the space that it consumes within the body, but because excess body fat starts to release a range of messenger molecules that not only initiates a pathological communication process within fatty tissue itself but as a secondary consequence, spreads a message that usually results in disease to the rest of the body.

Why excess body fat causes insulin resistance

Two major mechanisms contribute towards weight gain. Not only do existing fat cells increase their fat content, but new fat cells are continuously being formed through a proliferation process. Individually, newly formed fat cells also start accumulating fat which collectively leads to accelerated weight-gain and the progressive enlargement of the total fat mass. In a more advanced state, this process leads to the distortion of fatty tissue, commonly referred to as cellulite.

In the past, fat cells were accredited with only two main functions, namely that of storing calories for later use and preserving body temperature via improved insulation. However, in the presence of excess body fat, fat cells also assume a new biochemical communication function by starting to manufacture various messenger molecules including ‘adipokines’ and ‘inflammatory cytokines’. These have an effect on many different tissue types and tend to interfere with the normal chemical function of the body. For reasons not completely understood, some inflammatory cytokines disrupt insulin’s role on a cellular level when it comes to regulating blood sugar, leading to type 2 diabetes.

Adipokines, on the other hand, initiate the process of new fat cell formation called ‘adipogenesis’. In reality, by releasing adipokines and inflammatory cytokines, fat cells, in essence, become an endocrine organ which starts to function independently from the body. A vicious cycle ensues during which you become physiologically and biochemically altered, and you are virtually held hostage by your own abnormal fatty tissue.

Blocking the communication process between fat cells at a cellular level, especially when it comes to the formation of new fat cells and the development of insulin resistance, has, therefore, become a modern therapeutic focus.

Why elevated insulin levels cause weight gain

Insulin performs several different functions that may lead to the accumulation of excess body fat. Firstly, insulin regulates fat production. After a meal, when the quantity of glucose that enters the system is more than what can be used for immediate energy requirements, insulin promotes the conversion of excess sugar into fatty acids. These are subsequently grouped as larger molecules called triglycerides and transported to the fatty tissue where they are stored.

In the body, fat cells represent the ultimate energy store room. Starting life as a miniature pantry, these unique storage containers can rapidly expand in size to fulfil the role of a massive warehouse. Within the environment of fat cells, insulin fulfils the role of storeroom manager. By design, insulin’s tasks are to firstly fill each warehouse to maximum capacity and then secondly, to keep stock levels as high as possible by actively preventing fat from leaving.

Inside a fat cell, however, another messenger molecule called ‘hormone-sensitive lipase’ (HSL) plays an opposing role to insulin. Acting as the dispatch manager of the warehouse, HSL has the sole task of releasing as much fat from the fat cell as possible so that it can be shipped off to fuel the metabolic furnace. In the presence of insulin, however, this biochemical function is overruled and fat effectively stays trapped inside fat cells. Only once insulin levels drop can HSL perform its duty by mobilising and releasing fat from the warehouse.

The bottom line is that insulin not only helps you to gain weight but when levels are chronically elevated as in the presence of insulin resistance, it also makes it more difficult for you to lose weight.

The medical consequences of insulin resistance

Doctors deal with the complications of insulin’s obesity-promoting tendency on a daily basis. Whilst insulin is the critical regulator of blood sugar control, increased insulin levels may also lead to weight gain. In fact, these effects can be rather counterproductive when treating an overweight diabetic patient.

Various studies have confirmed the role that insulin plays in weight gain. This includes data obtained from two landmark studies; the UKPDS (United Kingdom Prospective Diabetes Study) and DCCT (Diabetes Control and Complication Trial). The most obvious example, however, can be seen in someone who develops an insulinoma, a rare tumour of the pancreas that secretes insulin. Besides developing low blood sugar, individuals with insulinomas also gain weight at an alarming rate and can become massively obese in a very short period of time.

In the presence of insulin resistance, limiting insulin-associated weight gain through an insulin sparing mechanism has, therefore, become a novel therapeutic target.

How is insulin resistance diagnosed?

In clinical practice, a combination of fasting insulin and glucose levels are used. These are calculated according to the HOMA (Homeostatic Model Assessment) or QUICKI (quantitative insulin sensitivity check index) method. In specialised medical research, however, a more accurate technique called the ‘hyperinsulinemic euglycemic clamp’ is used. Research has shown that results from the HOMA and QUICKI correlate reasonably well with clamping studies regarding accuracy.

Although less precise, a more simple way to predict insulin resistance is to measure your waist circumference. According to American guidelines, males with a waistline measurement of more than 90cm and females measuring more than 80cm will be significantly more inclined towards insulin resistance. European guidelines differ slightly from American guidelines, with 93cm for males and 79cm for females being the upper range of normal.

Research suggests that these waist circumference guidelines may be set too high for black South African men, and an even lower cutoff measurement may be more accurate for diagnosing insulin resistance. However, more research is required to confirm this.

How is insulin resistance linked to type 2 diabetes?

Since some of the inflammatory cytokines that fat cells start releasing disrupt insulin’s role on a cellular level when it comes to regulating blood sugar, insulin resistance is one of the leading causes of type 2 diabetes. This escalating process, however, may also fuel a vicious cycle of increased levels of insulin resistance and as a consequence, a greater requirement for insulin, thereby posing the threat of gaining even more weight. Whilst optimal glycemic control is essential to good health, weight gain is also known to accelerate some of the other disease processes associated with the metabolic syndrome, thereby potentially undermining the metabolic and cardiovascular benefits of optimal blood glucose control.

What is the link between insulin resistance and inflammation?

Excess body fat leads to the release of various inflammatory cytokines. In type 2 diabetics, insulin resistance is associated with low-grade chronic inflammation. Since this process is a known risk to develop blood clots in the presence of hardening of the arteries, it is often used to explain some of the microvascular complications that occur in type 2 diabetes. However, there is also significant evidence to suggest that even before the clinical diagnosis of type 2 diabetes is made, those with excess body fat have an increased risk of cardiovascular disease and vascular thrombosis because of low-grade inflammation.

What is the link between insulin resistance and PCOS?

Besides playing the dominant role in metabolism, insulin has a number of other hormonal effects including the regulation of normal ovarian function and influencing a number of male hormones present in females. Increased levels of insulin, as caused by insulin resistance, causes a reduction in a hormone called sex hormone-binding globulin (SHBG) in the liver. This results in abnormally high levels of male hormones in women.

What is the link between insulin resistance and stress?

Various hormones are influenced by stress, especially cortisol, which has been implicated in the development of insulin resistance. It is also known that insulin resistance and the various inflammatory cytokines that are released by the fat cells during the process can result in far reaching biochemical consequences. These are known to have a negative impact on brain function, leading to concentration and mental processing problems, irritability and mood disorders, including depression, sleep disorders and dementia.

Weight Loss

Get started today, by understanding why it is so hard

Are you finding it more difficult than ever to lose weight? If so, you may have become insulin resistant. An easy way to find out is to check your waist circumference. Males with a waistline measurement of more than 94 cm and females more than 80cm have a high chance of having insulin resistance.

Do you want to lose weight and improve your health?

If so, we suggest that you follow a strategy that will:

Put your body into a fat burning mode by combatting insulin resistance
Help maintain your energy levels and prevent hunger and cravings
Be medically safe and help improve your overall health
Be practical and sustainable over the short and long term
Suppress the storage of fat and slow the formation of new fat cells

Despite what you may have been told, losing weight is difficult, everyone is different and there is no quick-fix solution. The reasons why people gain or fail to lose weight are numerous and scientifically rather complex. From our ever-increasing understanding of the biochemistry and genetics of obesity, one thing is clear; being overweight has a strong underlying biological foundation which can prove very difficult to overcome. What this means is that while you can make the physiological decision to lose weight and stick with it, your own body might not make it so easy.

Why do I gain weight so easily?

One gains weight because of the progressive accumulation of body fat and in some cases, additional tissue fluid. This process is based on two different mechanisms. The first involves growth of your existing fat cells, in other words, the ones that you were born with. Depending on your genetics, environment in the womb and other factors you may be at a disadvantage from day one, starting with more fat cells that are better and more efficient at storing fat.

The second, somewhat lessor known but equally important mechanism relates to how adults constantly make new fat cells, called adipocytes in medical terms, through the biological process of adipogenesis. This not only takes place in one’s existing fatty tissue, where new fat cells are squashed in-between those that already exist, but also begins to happen in other parts of one’s body which, under normal conditions, would not contain many fat cells. Once manufactured, these new fat cells start to accumulate more fat and progressively grow in size. Besides causing general weight-gain, these two mechanisms also lead to the progressive enlargement and distortion of fatty tissue, often referred to as ‘cellulite’ in cosmetic terms. The ability of fat cells to both grow and multiply therefore leads to an exponential increase in fatty tissue.

Added to the above, as your body puts on fat, it also accelerates this increase in fat. New research has shown that compared to lean adults, obese adults produce about twice as many new fat cells every year. Having built up a large supply of fat cells, and with each new cell making it easier to add to the pool, it is not surprising that so many overweight and obese people find it very hard to lose, and so easy to gain, weight.

More than a numbers game…

It is a generally accepted medical fact that excess body fat causes ill health. It is also known that the body has various self-regulating healing mechanisms that control or counteract disease. Ideally, one would expect the same to happen with excess body fat.

On the contrary, however, once fat cells progressively fill with fat, an odd and somewhat counterproductive phenomenon occurs. Instead of releasing its fat, which for obvious reasons would be beneficial to the ailing body, engorged fat cells start to safeguard their fatty content by progressively decreasing the release of fat. They also begin to tell other fat cells to do the same and to multiply in areas where fat would not usually be prevalent, such as the liver. Modern researchers searching for clues as to why this happens have discovered that the secret largely lies with the fact that engorged fat cells initiate a cellular communication process through the release of certain chemical messenger molecules, called ‘adipokines’. These messenger molecules start to communicate not only with cells in the immediate area, but also with other cells in distant parts of the body. Some adipokines trigger the formation of new fat cells whilst others disrupt the normal functioning of insulin, the hormone that controls metabolism.

The importance of insulin resistance

Although insulin is the dominant regulator of blood sugar control and therefore plays a crucial role in health, various studies have demonstrated that chronically elevated insulin levels also causes you to gain weight. This is due to the fact that insulin plays an intricate role in the body’s ability to store fat. Insulin as a hormone essentially puts your body into an energy storing mode, increasing the storage and creation of new fat, and making it harder to use this fat for energy. Insulin resistance is a condition during which the body fails to respond to the normal regulatory effects of insulin. Trying to overcome this, the body compensates by producing more insulin, causing blood insulin levels to rise.

Once insulin resistance sets in, your metabolism effectively slows down and it becomes increasingly more difficult to lose weight. This is because, with insulin resistance, fat cells stop releasing fat, leaving you virtually incapable of shedding those unwanted kilos.

Insulin resistance can be managed

In summary, you may be experiencing a real uphill struggle with your weight because:

You have more body fat, but that’s only part of the problem.
You most likely also have more fat cells.
In addition, you are adding to that pool by making new fat cells at twice the rate of a lean person.
To crown it all, your fat cells, because of the likely presence of insulin resistance, will biochemically be significantly less inclined to release their stored fat.

In order to lose weight, the modern therapeutic approach to improve your metabolism follows a strategy which optimises your body’s biochemical processes in such a manner that it simultaneously alleviates insulin resistance, suppresses the storage capabilities of fat by existing fat cells and prevents the continual formation of new fat cells. Therapies able to regulate both the size and number of fat cells over the long term have therefore become a new therapeutic goal to help treat overweight and obese individuals. In addition, this strategy should also help you to regulate your appetite.

But how can this be achieved?

Losing weight is not easy, but by rationally developing and actively implementing a weight loss plan based on all the different contributors to insulin resistance and fat accumulation, it can be achieved. Depending on the extent of weight you wish to lose, and underlying health conditions, this process may need to involve active participation from your healthcare provider, including various medications. In most cases, however, actively adjusting your lifestyle to focus on healthy habits together with complementary supplements can be enough to see a satisfactory change.

In order to get started on your journey towards a healthy lifestyle and slimmer body, follow these two simple steps:

Get yourself a free insulin-friendly meal plan (C.A.P.E Diet). Click to download.

Optimise your metabolism with AntaGolin. Read more.

Sleep Patterns

The link between sleep, concentration, and mood.

Disrupted sleep may involve difficulty falling asleep, staying asleep or an alteration in the quality of sleep. This leaves the individual feeling unrefreshed, emotionally depleted, and vulnerable to the development of various mental and physical disorders.

What is the purpose of sleep?

Metabolism is a complex biological chain reaction that fluctuates all day. Anabolism is the set of metabolic pathways that construct new molecules from smaller units mostly derived from food. While anabolism takes care of the building-up and creational aspects of metabolism, catabolism is responsible for the breaking-down and ultimate degradation of cellular components.

At night, during the sleep-cycle, many of the body’s systems go into ‘anabolic state’, a renewal process that is essential for the restoration of the immune, skeletal, muscular, and nervous systems. These are also required to optimally maintain the function of neurons which ultimately regulate mood, memory, and cognitive function.

Of the most pronounced physiological changes that happens in the body during sleep occurs in the brain. This is because sleep allows the brain to use significantly less energy for ‘thinking’, thereby allowing it to replenish its energy supply in the form of the molecule ATP (adenosine triphosphate) required for nerve transmission, neurotransmitter production and nerve growth.

What are the consequences of poor sleep?

Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate sleep duration and/or quality of sleep to support your normal level of alertness and mental performance to get your hardworking brain through the next day. Sleep insufficiency can be either chronic or acute and may vary widely in severity.

Research has demonstrated that individuals with sleep deprivation problems are more likely to display decreased levels of concentration, battle to keep their mood upbeat and have an increased risk of developing a mood disorder or chronic pain syndrome.

Why should sleep deprivation not be ignored?

Over the last thirty years the concept that sleep serves a restorative function has gained strong scientific support from several research studies. More of these are emphasizing the key role of deep and proper sleep.

Two common symptoms of not getting enough sleep or poor sleep are fatigue and excessive daytime sleepiness. But having poor or insufficient sleep also increases one’s risk of developing a mood disorder such as depression and/or anxiety. This becomes a vicious cycle as sleep becomes more disturbed in a mood disorder, the mood disorder is more resistant to treatment unless the sleep disorder is concurrently treated, and lastly, any residual untreated sleep disorder increases the risk of relapse even after successful management of the mood disorder.

What does SleepVance contain?

SleepVance contains a unique blend of plant-derived (phytochemical) ingredients, vitamins and minerals known to promote healthy sleep patterns, increase sleep quality, and alleviate the daytime consequences of sleep deprivation. These are Valerian root (Valeriana officianalis), American skullcap (Scutellaria lateriflora) Passionflower (Passiflora incarnata), 5-hydroxytryptophan (5-HTP), Inositol, Glycine, Folate (as L-5-methyltetrahydrofolate), Magnesium, Vitamin B6, Vitamin D3, Vitamin C and Zinc.

What can SleepVance do for you?

SleepVance:
- Aids with the promotion of healthy sleep patterns
- Increases sleep quality
- Alleviates the daytime consequences of sleep deprivation
- It can be combined with any insomnia medication to improve sleep patterns

What are the side-effects and contra-indications of SleepVance?

SleepVance elicits natural sedative properties and should therefore not be taken before driving or operating heavy machinery.
Safety and efficacy in pregnancy and lactation has not been established and the administration of SleepVance during pregnancy and breastfeeding is therefore contraindicated.
Mild gastric irritation may occur if taken on an empty stomach, but generally, the natural ingredients in SleepVance have a low side effect profile.
Anyone with a known hypersensitivity or allergy to Valerian root, American skullcap, Passionflower, 5-HTP, Inositol or any other active or inactive ingredient in SleepVance should avoid taking SleepVance.

How should SleepVance be used?

ADULTS:

Take two tablets on a daily basis 1-2 hours before bedtime with supper or a later pre-bedtime snack/drink (preferably not on an empty stomach).

Tablets may be crushed or chewed to facilitate swallowing.

CHILDREN:

SleepVance is not recommended for children under the age of 18 years.

OLDER CHILDREN:

SleepVance contains the amino acid 5-HTP pharmaceutically registered in some countries for adult use only. SleepVance kids, a specialised teenage formulation, is better suited for children between 8 and 18 years.

YOUNGER CHILDREN:

SleepVance is not recommended for children under the age of eight.

Excess Central Weight

What is Excess Body Fat?

In humans and animals, adipose or fatty tissue is the body’s way of storing metabolic energy over extended periods. Depending on current physiological conditions, fat cells or adipocytes either store fat that is derived from the diet or liver metabolism, or release stored fat as fatty acids in times of additional energy requirement. These metabolic activities are regulated by several hormones, of which insulin, glucagon and cortisol play the dominant role.

The location of the fatty tissue determines its metabolic profile. ‘Visceral fat’ is located within the abdominal cavity, beneath the wall of the abdominal muscle, whereas ‘subcutaneous fat’ is located beneath the skin (and includes fat that is located in the abdominal area beneath the skin but above the abdominal muscle wall). Visceral fat was recently identified as being a significant producer of various hormonal-like messenger chemicals, among which several have directly been linked to inflammation and the inflammatory response.

Two major mechanisms contribute towards weight gain. Not only do existing fat cells slowly increase the amount of fat that they store, but new fat cells are continuously being formed by the body. Besides causing weight-gain, this mechanism also leads to the progressive enlargement and eventual distortion of fatty tissue, commonly referred to as cellulite. Once this has happened, a counterproductive phenomenon occurs. Instead of releasing more stored fat, the body biochemically starts to reduce the ability of fat cells to release their contents of stored fat, making it more difficult to lose weight.

Modern research seeking clues as to why this happens has discovered that the secret largely lies with certain biochemical messenger molecules released by the actual fat cell themselves. Called adipokines, these chemicals not only play a dominant role in triggering the formation of new fat cells, but also start causing another condition, referred to as insulin resistance.

How do you measure body fat?

The standard way to classify an individual’s body weight is to calculate their body mass index (BMI). This is done by using a formula that divides their weight (kg) by their height squared (m²).

Underweight:          BMI > 18.5 kg/m²
Normal weight:       BMI 18.5 to 24.9 kg/m²
Overweight: BMI 25.0 to 29.9 kg/m²
Obese class I:         BMI 30.0 to 34.9 kg/m²
Obese class II:        BMI 35.0 to 39.9 kg/m²
Obese class III:       BMI ≥ 40 kg/m²

Since many other factors that may falsely influence an individual’s weight according to the BMI classification (e.g. increased muscle mass, for example) lead to an erroneous overweight or obese classification, other measurements are often used in conjunction with BMI to assess an individual’s weight classification more accurately. These measures include waist circumference and body fat percentage calculations.

It is interesting to note that a normal weight BMI classification does not exclude excess body fat. This may sound counter-intuitive, but recent medical research has shown that many individuals with BMIs below 25 actually have excess body fat that would only be detected by assessing body fat percentage, or by more sophisticated methods such as computer-aided tomography (CAT scans). These individuals are now classified as ‘metabolically obese, normal weight’ (MONW).

Why is the distribution of excess body fat significant?

While overweight and obesity, in general, are associated with an increased risk of several diseases and premature death, research is showing that excess adipose tissue in the abdominal cavity (central or abdominal obesity) has a much greater influence on chronic inflammation. This is due to the fact that central adipose tissue has a significant hormonal effect on inflammatory cytokines, chemical substances released by cells, especially fat cells.

The resulting inflammation has been identified as a key role-player in a multitude of diseases including atherosclerosis, insulin resistance, diabetes, hypertension and many more. In fact, it is now thought that chronic inflammation is the leading cause of all the components of the metabolic syndrome and could be the factor that forms the link between all its components.

The latest National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) defines central obesity as a waist circumference of ≥102cm in men and ≥88cm in women. In individuals with insulin resistance, the NCEP ATP III recognises that an increased risk of cardiovascular disease and diabetes exists at waist circumferences of ≥94cm in men and ≥80cm in women, which are the cut-off points used by the International Diabetes Federation (IDF).

How common is excess body fat?

The current global pandemic of obesity and excess weight is clearly illustrated by the 1.6 billion overweight adults worldwide, of which at least 400 million are obese. These numbers are expected to escalate in both developed and developing countries.

In the Western world, and specifically the USA, the prevalence of obesity has increased by 50% in each of the past two decades, with two-thirds of the US population being overweight, half of whom are obese. The majority of the increase is occurring in children, adolescents and men.

In 2008 the World Health Organisation estimated that 65% of South Africans were overweight (58.5% of men and 71.8% of women) and the figure is anticipated to rise, both locally and globally.

How are excess body weight and insulin resistance linked?

Adipose tissue (fat cells) has historically been accredited with only two main functions, namely that of storing energy for later use and preserving body temperature via improved insulation.

In the presence of excess body fat, however, adipose tissue also assumes a hormonal function and manufactures various chemical substances called ‘inflammatory cytokines’. For various reasons, some of these inflammatory cytokines disrupt insulin’s role on a cellular level and render it less effective. The medical term for this condition is ‘insulin resistance’. To get the same task done as before, the body compensates by producing, even more, insulin, causing levels to rise above the norm.

Because of insulin’s obesity-promoting effects, the subsequent elevation of insulin levels makes the individual more prone to gaining weight. In addition, higher insulin levels also make it more difficult to lose weight. Once this condition sets in, a vicious cycle begins, explaining why many overweight individuals find that their metabolism has effectively slowed down.

How are excess body fat and the metabolic syndrome linked?

The prevalence of the metabolic syndrome increases dramatically as BMI increases. Compared to normal and under-weight individuals, research has shown that overweight individuals are six times more likely to meet the criteria for the syndrome. This risk rises even further in obesity, where females are 17 times more likely and males are 32 times more likely to meet the criteria of the metabolic syndrome.

As described, excess body fat induces a generalised, chronic, low-grade inflammatory state. This is now considered to be the leading cause of all the components of the metabolic syndrome and the syndrome in its entirety.

How are excess body weight and stress linked?

Cortisol, a glucocorticoid (steroid hormone), is produced from cholesterol in the two adrenal glands located above each kidney. It is normally released in response to events and circumstances such as waking up in the morning, exercising and acute stress. Cortisol’s far-reaching, systemic effects play many roles in the body’s effort to carry out its processes and maintain homeostasis.

Cortisol also plays an important role in human nutrition. It regulates energy by selecting the right type and amount of substrate (carbohydrate, fat, or protein) the body needs to meet the physiological demands placed on it. When chronically elevated, cortisol can have negative effects on weight, immune function, and chronic disease risk.

One of the ways that elevated cortisol can lead to weight gain is via visceral fat storage. Cortisol can mobilise triglycerides from storage and relocate them to visceral fat cells (those under the muscle, deep in the abdomen). Cortisol also aids adipocytes’ development into mature fat cells. The biochemical process at the cellular level has to do with enzyme control (11-hydroxysteroid dehydrogenase), which converts cortisone to cortisol in adipose tissue. More of these enzymes in the visceral fat cells may mean greater amounts of cortisol produced at the tissue level, adding insult to injury (since the adrenals are already pumping out cortisol). Also, visceral fat cells have more cortisol receptors than subcutaneous fat.

A second way in which cortisol may be involved in weight gain goes back to the blood sugar-insulin problem. Consistently high blood glucose levels, along with insulin suppression, lead to cells that are starved of glucose. But those cells are crying out for energy and one way to regulate energy is to send hunger signals to the brain, which can lead to overeating. And, of course, unused glucose is eventually stored as body fat.

Another connection is cortisol’s effect on appetite and cravings for high-calorie foods. Studies have demonstrated a direct association between cortisol levels and calorie intake in populations of women. Cortisol may directly influence appetite and cravings by binding to hypothalamus receptors in the brain. Cortisol also indirectly influences appetite by modulating other hormones and stress responsive factors known to stimulate appetite.

What are the complications of excess body fat?

Excess body fat is directly linked to a wide variety of diseases, including insulin resistance, diabetes, chronic inflammation, cardiovascular disease, the metabolic syndrome and certain types of cancers. It is estimated that every 0.45kg gained between the ages of 30 and 42 years increases the risk of disease by 1%. This doubles to 2% between the ages of 50 and 60.

Excess body fat also contributes significantly to premature death, with studies suggesting that the risk increases by 20- 40% in non-smoking overweight individuals and by at least 2- 3 times among obese individuals.

How can lifestyle interventions affect excess body fat?

Generally speaking, the start of weight gain is an excess of calories: too many calories consumed and too few calories utilised. However, once excess body fat induces inflammation and insulin resistance, the weight gain process becomes more complicated due to the obesity-inducing effect of insulin.

Lifestyle interventions, including weight loss, increased physical activity and stress management have repeatedly been shown to improve chronic inflammation and insulin sensitivity, which in turn improve all the components of the metabolic syndrome.

While the thought of losing a tremendous amount of weight can be demoralising, it is important to realise that even small losses have a significant impact. The loss of every 0.45kg reduces an individual’s disease risk by 1%. This can be a very good motivator for overweight and obese individuals and the starting point to a healthier lifestyle.

References

Karelis AD, David H, et al. “Metabolic and Body Composition Factors in Subgroups of Obesity: What Do We Know?” The Journal of Clinical Endocrinology and Metabolism Volume 89 Issue 6 June 1, 2004.
Kassi E, Pervanidou P, Kaltsas G, et al. Metabolic syndrome: definitions and controversies. BMC Medicine 2011,9:48
The National Health and Nutrition Examination Survey (NHANES) 2003-2004

Type 2 diabetes

What is Diabetes?

Diabetes is a group of metabolic disorders that all manifest in one common symptom, namely high blood glucose levels. The underlying defect that leads to its development always relates to the hormone insulin, either as a result of a deficiency, or due to a fault in the way insulin conducts its biological function. In many cases, a combination of both these two defects is present in the same individual.

What are the different types of diabetes?

There are 3 different subtypes:
Type 1 diabetes
Type 1 diabetes is caused by the loss or destruction of the insulin-producing units in the pancreas, called ‘beta cells’. This leads to an acute or chronic shortage of insulin, causing blood insulin levels to drop. The majority of cases occur as a result of an auto-immune attack, where the body accidently destroys its own beta cells. Most people affected by type 1 diabetes are otherwise healthy and of normal weight. The onset of the condition is mostly sudden and symptoms develop rapidly. Type 1 diabetes accounts for about 5-10% of all diabetes cases.

Type 2 diabetes
Type 2 diabetes is caused by a sequence of events during which the body becomes less responsive to its own insulin. The underlying mechanism that leads to the development of type 2 diabetes is therefore referred to as ‘insulin resistance’. Unlike type 1, insulin levels actually rise as a result of insulin resistance, although a decrease in levels may also ensue at a later stage as the condition progresses and the beta cells fail to meet the increasing demand. The onset of the condition is usually slow and symptoms are often so subtle that they may go unnoticed for many months or even years. Type 2 diabetes accounts for about for 90-95% of all diabetes cases.

Gestational diabetes
Due to various physiological and metabolic changes that a pregnant woman naturally undergoes during the normal course of pregnancy, elevated blood glucose levels may occur. This is called ‘gestational diabetes’ and occurs in about 2-10% of all pregnancies. Resembling type 2 diabetes, gestational diabetes usually disappears after childbirth. However, having had gestational diabetes at some stage increases your risk of developing type 2 diabetes later in life.

What does the term’ pre-diabetes’ mean?

Pre-diabetes is the term used when fasting blood glucose levels are higher than normal, but not sufficiently elevated to qualify for the more formal diagnosis of diabetes. Pre-diabetes is also referred to as ‘impaired glucose tolerance’.

How common is diabetes?

The World Health Organisation (WHO) currently estimates that 10% of South Africans have elevated blood glucose levels. Globally, 285 million people are diagnosed as diabetic and this number is expected to increase to 439 million by 2030. Africa is set to experience a 100% increase in the number of diabetes cases in the next 15 years.

This increase is attributed to the growing obesity epidemic, urbanisation and increased life expectancy. However, many individuals with diabetes are unaware that they have the condition. A recent report released by the Centers for Disease Control and Prevention (CDC) indicated that 25% of Americans who have diabetes are currently undiagnosed. This figure is most likely to be much higher in South Arica.

What are the symptoms of type 2 diabetes?

Common symptoms include thirst, increased urination, fatigue, irritability, nausea, increased appetite, loss of weight, blurred vision and headaches. However, unlike type 1, type 2 diabetes may present in a slow and subtle manner with symptoms hardly even being obvious.

What are the complications associated with type 2 diabetes?

In uncontrolled diabetes, various pathological processes can develop that may lead to a number of serious life-threatening complications. This includes a significant risk of developing cardiovascular disease (CVD), which may result in heart attacks and stroke. If left unchecked, chronic elevated blood sugar levels cause tissue damage to a variety of organs, including the kidneys, eyes, peripheral nerves and all blood vessels. In most countries, uncontrolled diabetes is ranked amongst the leading causes of blindness, renal failure and lower-limb amputation.
The mechanisms that lead to these complications are complex and involve the direct toxic effects of high glucose levels on bodily tissue, together with the structural defects that occur in blood vessels such as arteries and capillaries.

Common complications of type 2 diabetes are:

Cardiovascular disease (angina, hypertension, heart attacks and heart failure).
Eye disorders (damage to the retina, cataracts, glaucoma and blindness).
Nerve disorders (neuropathy, numbness, tingling, burning, pain and poor bladder control).
Kidney failure.
Sexual dysfunction.
Dementia and cognitive dysfunction.
Poor wound healing and increased risk of infection.

What are the causes and risk factors associated with type 2 diabetes?

Non-modifiable risk factors for type 2 diabetes which cannot be changed are age, family history and race (genetic predisposition). Modifiable risk factors are associated with lifestyle and can all be changed to reduce the risk. These are excess body fat, smoking, a sedentary lifestyle and a poor diet.

How are diabetes and the metabolic syndrome linked?

Both pre-diabetes and type 2 diabetes are directly linked to metabolic syndrome.

How are diabetes and excess body fat linked?

Excess body fat plays a major role in the development of type 2 diabetics. This is because increased fatty deposits, especially those that accumulate around the abdominal area, cause various biochemical abnormalities that lead to insulin resistance. Read more about insulin resistance

What lifestyle measures can I take to prevent or manage diabetes?

Research has shown that by combining lifestyle changes with diabetic medication, the incidence of diabetic complications are reduced by 58%. This illustrates the significance and importance of lifestyle changes, not only in the prevention, but also in the management of diabetes. These include establishing healthy eating patterns, exercising regularly and losing weight where necessary.

Weight loss is mandatary in all overweight individuals with pre-diabetes or type 2 diabetes. The therapeutic advantages of weight loss not only help blood glucose levels, but also lower cholesterol and blood pressure levels too.

Which diet should I follow to help manage diabetes?

In the past, diabetics were advised to follow a “diabetic diet” rich in “complex carbohydrates” such as crackers and breads. The basic idea behind this concept was that complex carbohydrates in theory will take longer to digest in the intestines and therefore release glucose at a slower rate. “Simple carbohydrates”, in contrast, like sugars and fruit, would be absorbed too rapidly and were therefore limited or virtually forbidden.

However, according to the Glycaemic Index (GI), a more modern classification representing the total rise in a person’s blood glucose level following carbohydrate consumption, this advice was based more on assumption than fact. Most crackers and bread, for example, raise blood glucose levels much faster than pure white sugar. Fruit, especially grapes, were often excluded in the past, but vegetables such as potatoes were considered beneficial. Again, the GI has proved that this concept has little scientific foundation, since a baked potato, for example, has a much higher GI value than grapes, and therefore raises your blood glucose levels much faster.

The concept of the “diabetic diet” has therefore become obsolete, and the principles of diabetic dietary management are basically the same health-orientated guidelines that everyone should follow to control their body weight and reduce their risk for cardiovascular disease (CVD). Since diabetics have a higher risk of developing elevated blood cholesterol, hardening of the arteries and cardiovascular disease, it is therefore also important that diabetics adhere to a diet low in saturated fat, in spite of new controversial opinions regarding the intake of saturated fat.

Sources

Prof. P Rheeder. Type 2 diabetes: an emerging epidemic. SA Fam Pract 2006;48(10): 20
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2014.
American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetic Care Vol 37, Supplement 1, January 2014
Alan J Garber et al. American Association of Clinical Endocrinologists’ Comprehensive Diabetes Management Algorithm 2013 Consensus Statement. Endocrine Practice Vol. 19 (Suppl 2) May/June 2013

Blood Glucose Levels

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, therefore, 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 together to help improve your health outcome. Read more here.

Blood Pressure

What is blood pressure?

Blood pressure is the force which moves blood around your body. Every time your heart beats, it is actually contracting like a pump and pushing blood out of its valves and into your arteries. In order for your blood to flow, your arteries squeeze back, ensuring it moves forward. The strength of this pressure is your blood pressure. How hard your heart pumps, how elastic your arteries are and a number of other factors determine how high or low your blood pressure is.

How is abnormal blood pressure diagnosed?

High blood pressure, or hypertension, is often called the silent killer, as there are usually no symptoms associated with it. Generally, the first sign will be a heart attack, stroke or kidney failure. The only way to know what your blood pressure is, is to have it measured. Low blood pressure, or hypotension, is associated with light headedness or dizziness. If you are in a high risk group or have a family history of high or abnormal blood pressure, it is essential you have your blood pressure tested.

How is blood pressure measured?

Blood pressure is measured using an instrument called a sphygmomanometer. The doctor or nurse will place a rubber armband around your upper arm and inflate it. From here the doctor will measure your blood pressure. The procedure is quick, easy and painless.

The measurement is taken using two numbers, called systolic and diastolic blood pressure. Systolic pressure is the maximum amount of pressure exerted when your heart pumps, and diastolic pressure is the amount of pressure your arteries exert to force blood forward. A blood pressure of 120 over 80, written as 120/80 mmHg, for example, means you have a systolic blood pressure of 120, and a diastolic blood pressure of 80. The units of measurement are mmHg, or millimetres of mercury, a reference to a time when medical pressure gauges used mercury.

Why is abnormal blood pressure problematic?

Blood pressure is tightly controlled in order to keep you healthy. If blood pressure is too low, blood doesn’t move fast enough around your body, and your tissues do not receive enough oxygen and nutrients. If blood pressure is too high, unnecessary stress is placed on your cardiovascular system. High blood pressure makes your heart work harder to pump blood. It also puts extra strain on your arteries and organs, especially your brain and kidneys. High blood pressure may therefore lead to heart attacks and strokes, the risk of which double with every increase of 20 mmHg systolic or 10mmHg diastolic blood pressure, as well as kidney failure and other disorders.

When is a blood pressure measurement abnormal?

It is important to note that high or low blood pressure can only be diagnosed from a number of readings over a period of time. One abnormal reading does not mean you have high blood pressure, but could be a result of some acute stress, illness or a number of other factors.

Blood pressure ranges are categorized as follows (sourced from The Heart and Stroke Foundation of South Africa):

Low blood pressure

In general, low blood pressure is actually desirable. It only becomes problematic when the brain and other organs are not getting enough oxygen. The point at which this happens varies from person to person, and so what constitutes low blood pressure is dependent on your own body.

Symptoms indicating your blood pressure has fallen too low include dizziness, light-headedness and fainting. If you regularly experience these symptoms, see your doctor.

In some cases, blood pressure can fall dangerously low and be life-threatening. If the below symptoms are experienced, seek medical attention:

Confusion, especially in older people
Cold, clammy and pale skin
Rapid, shallow breathing
Fast, weak pulse

Optimal blood pressure (less than 130 / 85 mmHg):

If your blood pressure falls within this range it is normal. Adopt heart-healthy habits or keep them up to ensure your blood pressure does not start to rise.

Elevated blood pressure (130-139 / 86-89 mmHg):

Elevated blood pressure is a sign that a problem could be developing. Although no medications are required at this stage, you should begin to practice a heart-healthy lifestyle. If you’re older than 65, your doctor might recommend treatment to further ensure your blood pressure does not rise.

Mild hypertension (140-159 / 90-99 mmHg):

If you are experiencing mild hypertension, lifestyle changes are essential and doctors may consider including blood pressure medication based on your risk of cardiovascular disease.

Moderate hypertension (160-179 / 100-109 mmHg):

If you have moderate hypertension, doctors will prescribe a combination of blood pressure medications and lifestyle changes. Both are extremely important to ensuring long-term positive health outcomes are reached.

Hypertensive emergency (from 180 / 110 mmHg):

If your blood pressure is higher than 180/110 mmHg and/or you are experiencing the following symptoms, you should seek emergency treatment:

Chest pain
Shortness of breath
Visual changes
Symptoms of stroke, such as paralysis or a loss of muscle control in the face or an extremity
Blood in your urine
Dizziness
Headache

How can I lower my blood pressure and what can I do to prevent it from rising?

Even if your blood pressure is normal, it is still important to ensure you practice heart-healthy habits. As you age, arteries naturally increase in stiffness, plaque builds up inside them and blood pressure increases. This is coupled with the general decline in cardiovascular health with age. Certain other conditions such as diabetes and kidney problems may also contribute.

The following habits will help to lower or prevent a rise in blood pressure, as well as keep you healthy in general:

Reduce salt intake

Sodium (or salt) is part of the natural signalling system keeping blood pressure in check. A diet high in salt can disrupt this balance, leading to an increase in blood pressure. Generally, persons at risk of blood pressure issues shouldn’t consume more than 2300 mg per day. People who already have high blood pressure may need to reduce this even further.

The easiest way to cut down your salt intake is to refrain from adding extra to your food. Instead, make use of herbs and spices to flavour your food. These also have their own positive health benefits. It is also wise to avoid processed foods which are generally high in sodium, as well as foods such as french fries, biltong and others which use salt as flavouring or a preservative. If in doubt, check the nutritional information on the package.

Download our C.A.P.E meal plan for meals and recipes naturally low in sodium.

Reducing caffeine intake

Caffeine and other stimulants can increase blood pressure, partly through increasing heart rate. Reduce intake of caffeine and other stimulants in order to help keep your blood pressure low.

Exercise

Exercising has many benefits, including reducing blood pressure and resting heart rate. It will also improve the health of your heart, arteries and organs, significantly reducing your chances of heart attack, stroke and other cardiovascular disorders. In order to maximise the effectiveness of exercising, it is better to exercise for shorter periods more frequently (at least 30 minutes a day) as opposed to longer periods only once or twice a week. If this is difficult for you, keep in mind that any exercise is better than none – park your car further away from the shop entrance or office, climb the stairs or do some gardening.

Download one of our free exercise plans for simple daily exercise routines.

Note, that it is important to obtain permission from your doctor to exercise if diagnosed with serious hypertension.

Maintaining a healthy weight

Excess weight is one of the chief contributors to cardiovascular disease and high blood pressure. Losing even a few kilograms can make a huge difference to your blood pressure. Adopt a healthy diet and exercise to begin losing weight today.

Try AntaGolin, the C.A.P.E meal plan and our exercise programs to start losing weight today.

Managing stress

Stress naturally increases your heart rate, blood pressure and other contributors to cardiovascular disease. When you are threatened, these serve to improve energy and alertness so you can better deal with the danger. In the modern world, however, this stress is too often chronic, leading to constantly elevated blood pressure and other health issues.

Stress doesn’t have to rule your life and take its toll on your health. Try NeuroVance or NeuroVance Focus today.

Find out how serious your stress levels are with our FREE stress test.

Reducing alcohol intake and quitting smoking

Both alcohol and smoking contribute significantly to cardiovascular disease. Avoiding smoking and excessive alcohol consumption could very well be the difference between having a healthy heart and early cardiovascular disease. Quit smoking as soon as possible and limit your alcohol consumption to only a few drinks per week.

Diet

Diet can both cause and prevent disease, it’s all about what, and how much, you eat. A healthy diet is essential to good health. This is not only in terms of keeping your blood pressure down, but also in avoiding diverse lifestyle diseases, including cardiovascular disorders, diabetes and cancer. Eat a diet high in fruits and vegetables and avoid processed foods. Where possible, foods should be as close to their natural form as possible.

Download our C.A.P.E meal plan for more tips and recipes for a heart-healthy diet.

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.

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.

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.