Monthly Archives: November 2015

Post #46 – What is Arthritis and what can you do about it?

16 Monday Nov 2015

Posted by in Aging, Bikram Yoga, Optimal Exercise, Optimal Health, Reversing Chronic Diseases, Vitality

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I often hear my contemporaries talk about pain in the knees, hands, shoulder, back. When I ask them what is going on, a common response is: “It is just arthritis.”  When I probe further about what kind of arthritis or what are they doing about it, I may get answers like:

  • No idea, have not talked to a doctor yet
  • Just have to live with it, I guess
  • Managing with pain meds
  • I could have surgery, but it is not that bad yet.

So, I thought I will go ahead and share what I have experienced and learned over the years on this topic

My ambition to run a marathon thwarted

Almost twenty years ago, I met Stu Mittleman, an ultra-distance running champion. He won the 1,000 Mile World Championship and set a new world record by running the distance (1 609.344 kilometers) in 11 days, 2 hours, 6 min. 6 sec. (Yes, that is right one thousand mile!). After winning that race, he got himself admitted to a graduate school to figure out how he did what he did.

With that knowledge and experience, he started teaching mere mortals how to run marathons.  When I met, I was so inspired, I signed up.

So, with his coaching program, I started building up my endurance. I ran my first 5K. And, then, my knees started hurting. He had no ideas on how to fix my knees.  So, I quit running.

Knees got worse over the next few years. I went to a Sports Medicine guy. He took a quick look at the X-ray of my knees and said, “Looks like arthritis. Do some physical therapy. When they are not good enough to do what you want to do, we can always go in and clean them up.”

So, what the heck is this Arthritis?

There are two excellent, very accessible resources for arthritis:  Arthritis Foundation and NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases.  Per the Arthritis Foundation website:

Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of arthritis. It is most common among women and occurs more frequently as people get older.

Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints.

There can be many underlying causes for swelling, inflammation, stiffness and pain in the joints. For example, Rheumatoid Arthritis, Lupus, Infectious Arthritis and Osteoarthritis can all cause these symptoms, but they are all very different diseases. It is very important to figure out with the help of a doctor what you are dealing with.

Osteo-arthritis is the most common type of arthritis. Per NIH website on Osteoarthritis:

Osteoarthritis (AH-stee-oh-ar-THREYE-tis) is the most common type of arthritis and is seen especially among older people. Sometimes it is called degenerative joint disease. Osteoarthritis mostly affects cartilage (KAR-til-uj), the hard but slippery tissue that covers the ends of bones where they meet to form a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, small deposits of bone—called osteophytes or bone spurs—may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.

Figure Showing a Healthy Knee

Knee without damage

Figure Showing Knee with Severe Osteoarthritis

Knee with damage

A doctor friend of mine told me that when doctors don’t know what the disease is, they call it osteoarthritis.  And, that is not far from the truth. If you eliminate, other diseases that might be causing inflammation, e.g., auto-immune diseases, it is osteo-arthritis.  Underlying disease causing damage to cartilage is not known at this point – if it is not one of the other specific diseases.

So, what can you do?

Well treatment can be quite different based on the type of arthritis or the condition that might be causing the joint issues.

However, in case of osteoarthritis, which is often the most common and age related, here are the treatment options, according to NIH:

  • Exercise
  • Weight control
  • Rest and relief from stress on joints
  • Nondrug pain relief techniques and alternative therapies
  • Medications to control pain
  • Surgery

Notice that exercise is on the top of the list. As soon as most people start to feel pain in the joints, guess what do they give up? Yep, exercise.  And, what do they need most to keep ostearthritis in check? Yep, exercise.

And, that is an interesting paradox I have seen played out again and again – including with my own mother.

Back to My Knee

Having learned the theory, I took on three things aggressively:

  1. Strength training to strengthen everything involved in functioning of my knee: quads, calves, hamstrings, and stabilizers muscles and ligaments.
  2. e-cises by Pete Egoscue to realign my knee since my knees were a little pronated and that was probably the reason why running aggravated my knees.
  3. Doing Bikram Yoga to help flush out any bone spurs or lose particles
  4. Started on supplement of Glucosamine Sulfate with Chondroitin and MSM that help rebuild the cartilage. See http://www.lifeextension.com/vitamins-supplements/item03157/glucosamine–chondroitin–msm#panelSupplements.

My goal was to be pain-free when I doing lunges with free weight, squats and single leg jump ropes. And, I am happy to say that I have been able to get there.

In my last X-ray, I still noticed some bone spur and what radiologist called “mild arthritis”.   I would really like to reverse that without any surgery. So, the chase is still on.

Bottomline

  1. If you have any stiffness, swelling, inflammation, or pain in the joints, it is important to get it checked out with the primary physician and if necessary with a Rheumatologist to first figure out what are you dealing with.
  2. If it is osteoarthritis, the following is a good list in order of priority:
    1. Exercise
    2. Weight control
    3. Rest and relief from stress on joints
    4. Nondrug pain relief techniques and alternative therapies
    5. Medications to control pain
    6. Surgery
  3. If it is other than osteoarthritis, use Arthritis Foundation and NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases  to study up and pursue your options.

I would love to hear your perspective on this topic.

What is your experience and knowledge from which I and others could learn?

#45 – Does Testosterone Replacement Therapy Increase Your Chances of Heart Attack?

01 Sunday Nov 2015

Posted by in Aging, Optimal Health, Supplements

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Ever since I learned about testosterone and Testosterone replacement therapy (TRT) and had personal experience I have looked for opportunities to publicize this.

On September 7, 2015, I published on this blog post #43: What is the role of Testosterone Replacement Therapy for Optimal Health? There I discussed the downside and upside of undergoing TRT  for men.

Well, at least two men that I know of, inspired by these conversations and the blog post went to their doctors, got their testosterone (T) levels checked and found that their clinical conditions were correlated with the very low T levels.  However, on both cases their doctors told them they would not recommend TRT since it would increase their chances of heart attack.

When I learned of this, I decided to research this notion of increased chances of heart attack with TRT and hence this blog post.

An article was published in Journal of American Medical Association September 2013 issue: Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310(17):1829-36.  The conclusion of the research was:

“Among a cohort of men in the VA health care system who underwent coronary angiography and had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of adverse outcomes. These findings may inform the discussion about the potential risks of testosterone therapy.”

Basically, they looked at the historical patient data on the computers (not patient charts) for those who had heart health issues (they had undergone angiography) and had low-T.  Researchers then compared the mortality results of those who had undergone TRT against those who had not.  Based on their statistical analysis of this data, they presented the above conclusion.

Media picked up this story and ran with it. Of course, adding all kinds of media color on these results. If you Google the title of this article, you will see many media stories.

And, of course, medical malpractice lawyers picked up the story and started to put together class action law suits against doctors and practices.

Prospect of the Malpractice law suits will scare the dickens out of any doctor, who is not expert in TRT.  No wonder, the two men that I referred to above got the response they got from their doctors.

Of course, you know that there are at least three sides to every story. So, here are the three sides of this story.

RESPONSE FROM FDA

Here is the most recent word from the FDA on this topic as a result of the study and the various Advisory Committee Meetings (See http://www.fda.gov/drugs/drugsafety/ucm436259.htm for full text):

“Testosterone is FDA-approved as replacement therapy only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause a condition called hypogonadism. Examples of these disorders include failure of the testicles to produce testosterone because of genetic problems, or damage from chemotherapy or infection. However, FDA has become aware that testosterone is being used extensively in attempts to relieve symptoms in men who have low testosterone for no apparent reason other than aging. The benefits and safety of this use have not been established… Based on our findings, we are requiring labeling changes for all prescription testosterone products to reflect the possible increased risk of heart attacks and strokes associated with testosterone use. Health care professionals should make patients aware of this possible risk when deciding whether to start or continue a patient on testosterone therapy…

RESPONSE FROM Urology Care Foundation

The official foundation of the American Urological Association (specialists who you would normally consult for TRT had the following response (See http://www.urologyhealth.org/patient-magazine/magazine-archives/2014/summer-2014/testosterone-replacement-therapy-is-it-right-for-you for full response)

“On January 31, 2014, the Food and Drug Administration (FDA) stated they would study the risk of heart attack, stroke and death in men taking testosterone replacement therapy (TRT). This was after two recent studies suggested that TRT raises the risk of heart attack in men.

The American Urological Association (AUA) has followed these reports closely. The AUA notes there are also conflicting studies suggesting TRT may lower heart attack risk. More studies need to be done to be certain whether and how TRT changes men’s risk of heart attack.

The AUA is also concerned about misuse of TRT. You should not take testosterone for non-medical reasons, such as bodybuilding, preventing aging changes or performance enhancement. Men should not take TRT if they have normal testosterone levels or if their testosterone levels have not been tested. If you have normal testosterone levels, using TRT will not help your health problems.”

RESPONESE FROM Life Extension Foundation

Life Extension Foundation is generally at the cutting edge of evidence-based recommendations for supplements and therapies for optimal health that might not yet be in the mainstream. Here is summary of their take on the controversy: (See the full article at http://www.lifeextension.com/magazine/2014/3/response-to-media-reports-associating-testosterone-treatment-with-greater-heart-attack-risk/page-01)

The age-related decline of men’s testosterone levels is inevitable.

Unless aging men replace their diminishing testosterone, they could succumb to any of the numerous health problems linked to low testosterone levels: frailty, muscle loss, weight gain, impaired cognition, fatigue, loss of self-confidence, depression, declining bone health, increased risk of type II diabetes, stroke, and cardiovascular disease.

A number of studies show that testosterone replacement therapy improves multiple measures of men’s vitality, especially related to cardio-metabolic health.

Therefore, on November 5, 2013, we were startled to see media headlines like “Testosterone Treatments Linked to Heart Risks.”

This headline and others like it were prompted by a retrospective, observational study in the September 5, 2013, issue of the Journal of the American Medical Association (JAMA). The study suggests testosterone therapy may increase risk of death and certain cardiovascular events.5

There are several significant shortcomings in the study’s design and methodology, and the results conflict with an existing body of research showing that low testosterone increases a man’s risk of heart problems:

  • Woefully inadequate Testosterone Replacement (T should be over 550 ng/dL to accrue benefits)
  • Failure To Account For Impact Of Estrogen (To much Estrogen can increase heart attack/stroke risk)
  • Significant Difference In Baseline Testosterone Levels Between Groups (hard to reach the right conclusion)
  • Achieving Higher Testosterone Levels Has Clear Cardiovascular Benefits (Again total T should be over 550 ng/dL to accrue benefits0
  • Additional Studies Demonstrate The Benefits Of Maintaining Higher Testosterone Levels (See the articles for cited research that has shown higher T actually lowers the risk of heart attack/stroke)
  • Study Conflicts with Previous Research
  • Retrospective Observational Study – Unmeasured Confounding Or Hidden Bias Might Exist
  • Unnatural Forms Of Testosterone Used By 1/3 Of Subjects (Proper form is bio-identical testosterone gel to maintain even levels as opposed to injection which promote peaks and valleys)

So, there you have it at least three sides of this story.

BOTTOMLINE

Are you sufficiently confused, yet?  Here is what I would recommend as a bottom line:

  • Talk to a specialist who knows what he/she is doing. Not just your primary physician.
  • Read the life extension article in full. For optimal health through “non-mainstream methods”, I constantly find that I have to show up at the doctor’s office armed with information.
  • Doctors often rather prescribe meds for individual symptoms than get to the root cause.  To avoid prospect of litigation, they also have to engage in defensive medicine.
  • Know your numbers and their implications: Total Testosterone, Free Testosterone, DHEA, Estradiol, LH, FSH.
  • Your numbers should correlate with your health issue for TRT to be effective or advised.
  • Ask for testosterone in the form of gel from a compounding pharmacy. That is the right therapy and is much cheaper.

Your thoughts?

I would love to hear from you, learn and share with others what I learn.