Author: Mokhtar

  • How osteoporosis drugs cause disruptions in vital communication between bone cells

    How osteoporosis drugs cause disruptions in vital communication between bone cells

    Our bones are maintained by a continuous cycle of remodeling. Specialized cells called osteoblasts and osteoclasts are responsible for creating new bone and resorbing old bone, respectively.

    A scientific study has shed new light on how these cells work, revealing robust and complex layers of communication between these types of cells. Today we’ll listen to the conversations our cells have about our bones, and we’ll consider how osteoporosis drugs disrupt that natural communication to the detriment of our bone health.

    What did the osteoblast say to the osteoclast?

    A study published in the journal Cells offers us a rare insight into the mechanisms by which our bone cells communicate. Researchers in New York and Massachusetts have compiled and reviewed current knowledge about how osteoblasts and osteoclasts communicate with each other.

    Osteoblasts are cells that build new bone mass. Osteoclasts are cells responsible for dissolving and resorbing old bone mass. Together they complete the cycle of bone remodeling, replacing old bone with new bone.

    Researchers have revealed that the impulse for the body to activate or deactivate one cell type originates in another. Osteoblasts and osteoclasts communicate with each other about their activity level and about the amount of each cell type.1

    This communication takes place in different ways. The study identifies eight compounds derived from osteoblasts that promote or suppress osteoclasts and seven derived from osteoblasts that affect osteoclasts. These compounds move between cells either by direct cell-to-cell contact or by secretion into the fluid surrounding the cells.

    Some compounds inhibit the production of new osteoclasts or osteoblasts or conversely promote their new production. Some of them affect the survival of precursors necessary for the formation of new cells, or they influence which type of cell becomes a developing cell.1

    The communication between osteoblasts and osteoclasts allows them to balance the processes of bone remodeling and achieve homeostasis in which healthy bone mass is maintained.

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    A study published in the journal Cells gathered information about the compounds released by osteoclasts and osteoblasts to communicate with each other. These compounds, released by one cell type, cause the promotion or suppression of the other type. This helps maintain a balanced bone remodeling cycle.

    Disruptions in mobile communications

    Many of the physical changes that naturally accompany aging affect the balance of osteoblasts and osteoclasts in favor of osteoclasts. This results in bone loss, as old bone is resorbed more quickly than replaced.

    Furthermore, many behaviors can reinforce the changes that throw our bone remodeling process out of balance. For example, increases in the stress hormone cortisol and chronic inflammation have been shown to suppress osteoblasts and activate osteoclasts.2 These stressors disrupt communication between our bone cells, which could otherwise keep them in balance.

    Fortunately, it is possible to counteract the forces that disrupt bone remodeling at the source. The Osteoporosis Reversal Program recommends making beneficial changes in diet, physical activity and lifestyle to create the right conditions for bone remodeling.

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    The aging process can cause an imbalance between osteoblasts and osteoclasts, as well as certain behaviors. For example, increased stress and inflammation hinder osteoblasts and increase the number of osteoclasts. You can counteract these disruptions through changes in your diet, exercise and lifestyle, as described in the Osteoporosis Reversal Program.

    Artificial manipulation causes communication breakdowns

    Over the past thirty years we have witnessed the rise of osteoporosis medications, which take a limited approach. Most of these drugs attempt to force a change in the number or activity of osteoclasts by introducing synthetic replicas of factors that inhibit them.

    However, research into cellular communication has shown that osteoclasts are responsible for providing instructions to osteoblasts. As a result, any change in any part of the system has a ripple effect. In their report, the researchers describe this chain of disruptions caused by anti-osteoporosis drugs.

    “…interactions between osteoblasts and osteoclasts have played a powerful role in shaping the actions of all currently approved drugs that act on the skeleton, often imposing limitations on the activities of these agents. Most antiresorptive agents that inhibit osteoclast formation and activity simultaneously suppress bone formation, while the activity of anabolic agents that induce bone formation is similarly dampened by simultaneously increasing bone resorption.”1

    This demonstrates one of the fundamental dysfunctions of osteoporosis drugs. You cannot artificially change part of the process without it leading to a change in the rest of the system. The result is medications that have no effect and are accompanied by unwanted – and often distressing – side effects.

    Short content

    Because osteoclasts and osteoblasts require instructions from each other to maintain healthy bone remodeling, osteoporosis medications that force a decrease in the number of osteoclasts also impact osteoblasts. This limits the ability of osteoporosis drugs to be useful, effective and safe.

    What this means for you

    Communication is the cornerstone of any relationship – and that includes our bone cells! Avoiding fractures is a goal you can pursue in many ways. One of those ways is to support healthy communication between your osteoblasts and osteoclasts.

    The recommendations in the Osteoporosis Reversal Program are designed to achieve just that – through diet, exercise and lifestyle changes. One of the simplest ways to support bone cell communication is by choosing a drug-free approach to prevent fractures.

    References

    1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564526/

    2 https://www.ncbi.nlm.nih.gov/pubmed/10487665



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  • We need more evidence to guide postoperative care for children after anterior cruciate ligament reconstruction

    We need more evidence to guide postoperative care for children after anterior cruciate ligament reconstruction

    Use of cryotherapy in the postoperative treatment of anterior cruciate ligament reconstruction in children: a prospective randomized controlled trial

    Wong JYS, Ashik MBZ, Mishra N, Lee NKL, Mahadev A, Lam KY. J Pediatr Orthop B. August 25, 2023. doi: 10.1097/BPB.0000000000001120. E-publishing prior to printing. PMID: 37669155.
    https://pubmed.ncbi.nlm.nih.gov/37669155/

    Take home message

    Young patients experienced minimal benefits in pain and range of motion with the use of an ice pack for the first six weeks after anterior cruciate ligament (ACL) reconstruction.

    Background

    ACL injuries and subsequent ACL complaints are becoming increasingly common among the young active population. However, we lack a consensus on the best treatment protocols after ACLRs within this population. For example, some physicians disagree on whether cryotherapy should be used acutely after ACLR.

    Study aim

    The authors sought to investigate the efficacy of cryotherapy in relieving postoperative pain and restoring knee range of motion after ACLR in pediatric patients for six weeks.

    Methods

    The authors randomized 42 pediatric patients (~15 years old; 55% female) who underwent ACLR from January 2019 to December 2020 to a postoperative ice group (n=21) or no ice group (n=21) and assessed pain at rest and movement via a visual analogue scale and range of motion of the knee at baseline (day 1 postoperatively) and then at 1, 4, and 6 weeks postoperatively. Patients in the ice group received an ice pack and applied the pack for 20 minutes three times a day with a minimum of 4 hours between ice treatments for six weeks. Patients were excluded from the data analysis if they missed more than two of six physical therapy visits.

    Results

    The ice treatments had minimal impact on knee extension range of motion and pain at rest or with movement. Immediately after surgery, the no-ice group had better knee flexion range of motion than those given ice (53 versus 31 degrees). The ice group subsequently showed greater improvements in range of motion during the first 6 weeks postoperatively compared to the no-ice group (99 vs. 65 degree improvement; final range of motion: 130 vs. 119 degrees). No one reported a cold injury or skin change.

    Viewpoints

    The authors suggest that adding cryotherapy during the acute phase after ACLR is a low-risk intervention that could improve range of motion. However, we must be careful as each group only had 21 participants and the groups started with different amounts of knee flexion range of motion. It would be useful to conduct larger studies examining these outcomes, medication use, adherence, and patient preferences/expectations. It would be interesting to know whether other strategies, such as cold water immersion or active recovery, would improve outcomes more than an ice pack. Additionally, it would be interesting to use newer assessment strategies to determine whether an ice pack provided pain relief immediately after treatment compared to before. The ice packs may provide minimal benefit for biweekly visits, but provide significant relief at that time. We need more evidence to determine the best way to treat young patients after an ACLR, but an ice pack is an inexpensive, low-risk treatment that can be used if a patient wishes.

    Clinical implications

    Medical professionals can continue to provide athletes with cryotherapy education and treatment options. However, they should note that the improvements in pain and range of motion are small. This information is important to communicate with patients so that they can make informed treatment decisions about whether to continue with ice.

    Questions for discussion

    Do you encourage your patients to use ice after surgery? What results have you seen from using ice? Within six weeks of surgery, will you use other alternative methods to reduce pain and increase range of motion?

    related posts

    1. Take a dunk if you want, but don’t expect more
    2. Cold water immersion for the prevention and treatment of muscle pain after exercise
    3. Colder may not be cool for recovery
    4. Delayed onset muscle soreness: freezing or warming?
    5. Whole body cryotherapy for proprioception and muscle damage

    Written by Jane McDevitt
    Reviewed by Jeffrey Driban

    9 EBP CEU courses

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  • Plowing on with gratitude on all fronts – Bone Talk

    Plowing on with gratitude on all fronts – Bone Talk

    Diane+Barry+Preston 2.2

    It’s fair to say that I’ve been a rule follower for most of my life. After all, I am an eldest child.

    I have always valued and protected my health, making sure I eat healthy foods and do many of my favorite exercises such as walking, yoga, swimming and cycling. I have been grateful for good health.

    So I was stunned when, at age 61, I learned that I had quite severe osteoporosis. I heard this after begging my doctor for one DXA scan. She said I didn’t have any risk to warrant the screening. I argued that I have a small frame, which puts me at risk. She finally gave in three years after my original request.

    After the shock of the diagnosis and the anger at the lack of prevention wore off, I had to do something – quickly, I thought. My grades were that bad. Two endocrinologists told me to take anti-resorptive medication immediately, and my doctor gave me a 25-year-old book on building bone.

    Of course I needed more than this. There was probably someone who could help me tackle this on all fronts. I never believed in taking a pill. But this search proved futile for quite some time.

    I took the medication and was fortunate that I had no side effects. But I was plagued by doubts about whether and how to lead an active life. How was I supposed to do yoga now? What about gardening; lifting my luggage, and most importantly – my grandchildren? How was I supposed to live my life? I hated thinking of myself as vulnerable.

    So many questions, so few answers. It was clear that the specialists I consulted did not have a holistic approach.

    A search for the Bone Health and Osteoporosis Foundation website led me to answers that made sense to me through a newly formed monthly virtual support group over three years ago. It’s called OsteoBoston and is led by an experienced facilitator who hosts expert presentations in all aspects of wellness to improve bone health. Over time, I have learned so much about the latest research and how diet, bone-building exercises, nutritional supplements, and medications can work together to improve this condition. Just as valuable is the second hour of our Zoom calls, in which the 30+ people (mainly women) learn from and support each other. And while I never got a one-stop-shop, one-place approach, OsteoBoston has been a lifesaver.

    As I reflected on my journey over the past six years, I realized that it wasn’t my doctor’s fault for not giving me a basic DXA screening. She was just following protocol. Why isn’t this done for bone health, just as baseline mammograms at age 40 detect and treat breast cancer? If it is common for women to lose significant bone in the years after menopause, should they not have a basic DXA scan before menopause to detect bone loss, treat it early, and prevent unnecessary suffering and mobility loss caused by fractures ?

    So today, I am still a rule follower, but I listen to a variety of sources and the wisdom of experience to determine which rules I follow. I know where to find the latest research. I have an endocrinologist I trust. I do bone-building exercises most days and eat a variety of calcium-rich foods. I am confident that I am doing everything I can to deal with this condition. The medications I have been taking have improved my bone strength. And I am also satisfied that this learning process has given me the tools to prevent further bone loss. I am forever grateful to this OsteoBoston support group, which includes people from all over the country. Thanks to the leadership’s dedication, we now have a YouTube channel sharing recordings of more than 25 recorded presentations and a website where we can share our resources at osteoboston.org.

    Finally, I now accept that this is a lifelong condition that must be managed. And as I do that, I want to focus on advocating for early screening and education to help others become aware of how important bone health is to our well-being.

    I hope to be around for a long time and I want a body that supports my dreams.

    This story is part of a support initiative called Voices of Osteoporosis: Stories of Hope and Inspiration. If you have experienced osteoporosis as a patient or caregiver, we invite you to share your story. Your story can inspire others to learn how to protect their ability to live their best life and stay strong. click here learn more.

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  • International sales gain for PUR Biologics

    International sales gain for PUR Biologics

    PUR Biologics’ robust distribution channels appear to be expanding sales worldwide

    October 24, 2023, Irvine, CA., / OrthoSpineNews / – Following a successful participation at the North American Spine Society (NASS) conference, healthcare technology company HippoFi, Inc. (OTC: ORHB) announced that its wholly owned subsidiary, PUR Biologics, has expanded its sales to include several notable global healthcare institutions.

    Ryan Fernan, Head of PUR Biologics, said: “Our recent collaborations with ZIMMER BIOMET and Italian company BPB Medica have attracted wider international attention. It is encouraging to see our spinal biologics expertise and innovation gaining global recognition.”

    CJ Wiggins, Executive Chairman and CEO of HippoFi, added: “The strength of our distribution channels is a core component of our company design and provides us with deep coverage and a source of revenue opportunities for our spinal biologics.”

    With PUR Biologics’ clear leadership trajectory in the biotech sector, there is incredible momentum building.

    For more information about PUR Biologics’ full line of biological products, visit www.PURbiologics.com.

    __________

    About PUR Biologics
    PUR Biologics, a wholly owned subsidiary of HippoFi, Inc. (OTC PINK: ORHB), is a leading biologics company committed to supporting surgeons and hospitals in providing the best care to their patients. PUR Biologics’ full line of biological products currently includes: advanced allografts and demineralized extracellular matrices (d-ECM), innovative synthetic solutions, cellular-derived tissues, and a future of next-generation regenerative stem cell and growth factor-driven therapies for the treatment of osteoarthritis and cartilage. regeneration.

    About HippoFi, Inc.
    HippoFi, Inc. delivers its breakthrough healthcare innovations through an extensive sales channel network while deploying first-to-market solutions in the multi-billion dollar biotech, fintech and artificial intelligence (AI) markets. HippoFi consists of three segments: Regenerative Therapeutics, Digital Payments and AI, which use the same customer channels to commercialize solutions, increase revenue and improve patient outcomes.

    HippoFi, Inc. is publicly traded under the symbol: ORHB and is headquartered in Irvine, California. For more information, please visit: www.HippoFi.com and www.PURbiologics.com.

    Contact
    HippoFi, Inc.
    949-323-2330
    info@hippofi.com

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  • Tapering and discontinuation of glucocorticoids in patients with rheumatoid arthritis treated with tofacitinib

    This study aimed to evaluate the steroid-sparing effect of tofacitinib in patients with RA. To the best of our knowledge, this is the first prospective study that evaluated the feasibility of a predetermined schedule for GCs discontinuation in patients initiating tofacitinib treatment. This showed that already 12 weeks after starting treatment, 30% of patients were able to stop their daily dose of GCs. The most recent recommendations for the treatment of RA suggest that the dosage of GCs should be reduced to discontinuation as soon as possible1. In fact, the dose and duration of steroid treatment influence the safety profile and there is no agreement on the definition of the ‘safe’ dose.17. The optimal dose and duration of GC therapy and the best strategy to taper off and withdraw GCs are still scarce. A recent systematic literature review reported 14 different regimens proposed to reduce and/or stop oral GCs18. Randomized clinical trials with RA drugs do not provide sufficient information on GC therapy during treatment with biologics and do not allow to displace definitive conclusions on GC discontinuation, also considering that the steroid-sparing effect never appears as a secondary endpoint19.

    A subanalysis of the ACTION (AbataCepT In rOutiNe Clinical Practice) study showed that over a 24-month period from the start of abatacept, approximately 40% of the 734 patients taking GCs at the start of the study were able to control their prednisone levels to lower. dose, usually within the first 3 months of treatment, and that the median GC dose decreased from 7.5 mg/day to 5 mg/day after 24 months of treatment20. The need to evaluate the steroid-sparing effect of RA medications is real and relevant, as evidenced by real-world studies. Most real-world evidence comes from retrospective studies evaluating the effect of bDMARDs on GC therapy in patients with long-standing RA, such as those enrolled in our study. Many years ago, Naumann et al. described dose reduction of GCs that was associated with reduced disease activity as early as 3 months after starting a TNF inhibitor in 87 patients with RA; during 5 years of follow-up, 81% of patients reduced the dose of GCs and 32% of patients discontinued treatment21.

    In a French retrospective study published in 2009, the authors noted an overall 30% reduction in the dose of oral GCs in the first year of treatment with TNF inhibitors, starting as early as 3 months; on the other hand, 61% of patients were still using low-dose prednisone after 1 year7. More recently, analysis of the TReasure database found that after a median of 59 months, 28.4% of 1936 patients receiving GCs at registry entry discontinued concomitant steroid treatment.22. The retrospective nature of the study explains the lack of prespecified criteria for GC tapering. The SPARE-1 ​​study included RA patients treated with tocilizumab (TCZ) and an oral prednisone dose > 5 mg/day and aimed to evaluate the percentage of patients who reduced their GC dose to less than 5 mg/day after 12 months of TCZ22. At the end of follow-up, 40% of patients reached the target dose; RA duration not more than 5 years, daily prednisone dose <7.5 mg, and low baseline ESR were predictive of PDN reduction to less than 5 mg/day23.

    Fernandez-Nebro et al. prospectively followed for 24 months 161 patients starting infliximab, etanercept, or adalimumab, showing that almost 60% of patients taking GCs at baseline were able to discontinue and the remaining patients significantly reduced the daily dose24. In a previous paper published by our group, we demonstrated a 56% reduction in the percentage of RA patients treated with baricitinib who were taking glucocorticoids after 24 weeks; In addition, we registered a significant reduction in the daily dose of prednisone from an average of 5 mg/day to 0 mg/day, simultaneously with a significant reduction in pain after just 4 weeks.25. Similarly, in the current study, the rapid effect of tofacitinib on pain and disease activity certainly contributed to the rapid reduction of the dose of GCs, to complete discontinuation; Indeed, approximately one-third of included patients discontinued daily GCs within 12 weeks of starting tofacitinib.

    The initial adjunctive GCs therapy on a DMARD background would allow rapid control of disease activity, also guaranteeing long-term structural benefits, which persist even after GCs withdrawal; doses ranging from 5 to 10 prednisone per day appear to be associated with significantly slower radiographic progression2. A post hoc analysis of 6 randomized, controlled phase III trials of tofacitinib suggested that concomitant use of GCs did not affect either the clinical or radiographic efficacy of the drug.26. In a prospective evaluation of the efficacy of tofacitinib according to discontinuation of GCs, we observed no difference in the reduction of disease activity as assessed by DAS28_CRP, CDAI and SDAI; furthermore, low disease activity or remission was achieved regardless of the concomitant use of GCs. In contrast, data from a Turkish registry showed a significantly higher DAS28_CRP score and a significantly lower proportion of patients achieving low disease activity or remission in patients who continued GCs concurrently with bDMARDs or tsDMARDs.20. Data on the effect of GCs on clinical response to TNF inhibitors are also conflicting and have shown that a higher or lower percentage of patients achieve the treatment goal.27,28. In the SEMIRA (The Steroid EliMination In Rheumatoid Arthritis) trial, patients were randomly assigned to the regimen of continued prednisone or tapered prednisone; two-thirds of patients who achieved low disease activity with tocilizumab tapered the steroid dose in the 24-week study, but contrary to what we observed in our patients, patients who continued with prednisone had better control of disease activity29.

    In our study, age at enrollment and disease duration were negatively associated with GC discontinuation. This is not surprising, as results from a recent double-blind, placebo-controlled study showed that elderly patients (over 70 years at baseline) with established and severe RA had long-term beneficial effects in both disease and disease activity. and joint damage resulting from taking a low dose of prednisolone as an addition to basic treatment30. However, this study did not include patients taking tsDMARDs. Recently, data from the Veterans Affairs Rheumatoid Arthritis Registry showed that 54% of patients tapered and 33% discontinued oral GCs; younger age, positive rheumatoid factor, higher ESR at enrollment, a greater number of prior csDMARDs, and a higher mean glucocorticoid dose during the 30 days before the index date were all significantly associated with GC tapering and discontinuation31.

    The 2013 EULAR recommendations on the treatment of moderate to high doses of glucocorticoids in rheumatic diseases state that “When deciding to initiate glucocorticoid treatment, comorbidities and risk factors for adverse effects should be evaluated and treated where indicated […]”32. Particularly at medium to high doses, GCs are often associated with the occurrence of adverse events, including osteoporosis, diabetes, hypertension, cardiovascular events, and recurrent infections. Sparing GCs – as suggested by our results – may be beneficial in terms of short-term safety (risk of infection, especially reactivation of herpes Zoster) and long-term safety (metabolic and cardiovascular events, as well as osteoporotic fractures ). A large study of RA patients from the CorEvitas registry showed that GCs increased the risk of cardiovascular events after just six months of treatment, at a daily dose of more than 5 mg33.

    Some of these side effects – mainly infections and cardio-metabolic effects – raise concerns in patients treated with both bDMARDs and tsDMARDs; in particular, the results of the ORAL Surveillance study raised a warning about cardiovascular safety in patients treated with tofacitinib34.

    The current study has some limitations. The small sample size did not allow stratification of patients based on concurrently administered MTX. However, the MTX dose remained stable and the logistic regression did not identify the co-medication as a factor influencing the ability to discontinue GCs. The long disease duration and failure of previous treatments probably caused the steroid-sparing effect of tofacitinib to be underestimated. Still, 30% of patients stopping GCs after just three months is an impressive result.

    The strength of the study lies in its prospective nature and interventional design, which allowed the GC dose reduction schedule to be predefined to homogenize the outcome.

    In conclusion, in our cohort of patients with long-standing RA treated with tofacitinib, discontinuation of glucocorticoids was feasible in up to 30% of patients. The results of the study should encourage rheumatologists to consider GC tapering and withdrawal as a possible goal in the daily management of RA patients on long-term treatment with oral GC.

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  • 4 free tools for a healthy holiday – better bones

    4 free tools for a healthy holiday – better bones

    In my house, Thanksgiving consists of family and friends gathering for a mega cooking event and the pie baking competition that happens once a year. This Thanksgiving, more than ever, we will pause and appreciate our good health and many blessings.

    Starting this holiday season, I also want to take a moment to appreciate you, my readers. I am very grateful that my work gives me the opportunity to connect with you and all women (and men too) on their journey to better health. You challenge me every day with your experiences and thoughtful questions, which I really appreciate.

    I am also grateful for your openness to new ways to bring health and joy into your life. With that in mind, I invite you to try some more ideas to help you maintain the well-being of body, mind, and spirit this holiday season. These simple tools below can help you prepare holiday meals, cope with the hustle and bustle of the season, or think about New Year’s resolutions.

    Find Thanksgiving Wellness

    1. Choose healthy products. Each year, the Environmental Working Group (EWG) produces its Shopper’s Guide to Pesticides for products known as the Dirty Dozen (fruits and vegetables with the most pesticide residues) and the Clean Fifteen (fruits and vegetables with the least residues). of pesticides). After looking at this list, you may want to add extra sweet potatoes to your Thanksgiving dinner.

    2. Reduce worries. Many of the women I talk to feel a little out of control. Meditation is a way to relax and also to alkalize. In this 8-minute meditation I guide you through the Alkaline Breath Detox exercise.

    3. Test your vitamin C levels with this new free tool I developed! This winter, more than ever, we need to actively support our immune systems and two of the most effective ways to do this are to give yourself therapeutic doses of the immune-boosting, antiviral vitamin C ascorbate and get enough vitamin D. news is that you can assess your vitamin C status with the simple, free tool I developed. However, detecting your vitamin D levels is a little trickier. Your doctor may order a blood test or you can purchase our at-home vitamin D test kit.

    4. Take 10 action steps to build bones naturally. With this free booklet you can learn the same 10 steps that I use with my clients at the Center for Better Bones. I wrote this booklet to empower women who are concerned about bone loss, osteoporosis or osteopenia. There is too much information out there designed to create fear and self-doubt. Instead, I believe women should be encouraged to take positive action to expand their self-care programs. You have more power than you realize!

    Sending you my warmest wishes for a happy and healthy Thanksgiving.

    -Dr. Susan Brown, PhD

    Dr.  Susan Brown PhD

    Dr.  Susan BrownI am Dr. Susan E. Brown. I am a clinical nutritionist, medical anthropologist, writer and motivational coach speaker. Learn my proven 6-step natural approach to bone health in my online courses.



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  • Injury awareness: does stretching prevent injuries?

    Injury awareness: does stretching prevent injuries?

    FH Blog Stretch3 1

    It used to be believed that stretching before a workout was as important as eating breakfast before the start of a big day. If you want to minimize the risk of possible muscle tears, joint injuries or pain-free running, then stretching to prevent injuries is an essential part of your exercise regimen before you start training. But why do we need to think about stretching in terms of injury awareness? Does stretching before exercise reduce the risk of injuries? What was once considered the ideal precursor to our regular workouts has produced conflicting results.

    Current research has shown that stretching for injury prevention is a misconception and, at best, inconclusive about preventing injuries. It’s not that stretching is considered ineffective within the physical therapy community. Instead, what is essential to physical therapy is how stretching is applied and translates to the activity that is soon to follow. Essentially, one must do a warm-up in addition to stretching to perform a functional exercise. For example, if you want to increase the strength of your quadriceps and gluteus maximus by performing squats, it’s best to use light sets before adding heavier weights.

    Warm-up routine in addition to stretching

    Two women relax in a sauna.

    1. External heat: Heat pack, gel pack, sauna, etc.
    2. Massage
    3. Self-traction: Arm hangs, streamers etc.
    4. General or specific warm-ups
      1. Jumping jacks, cycling, short walk (general)
      2. Light activities before adding heavier weights (specific)
    5. Relaxation training

    This is a simple method to reduce and relieve pain, reduce muscle tension and minimize anxiety and stress. The definition of relaxation training is “a reduction in muscle tension throughout the body or region that is painful or limited by conscious effort and thought.”

    Related content >> Stretches for marathon runners

    Three types of relaxation training

    1. Autogenic training: Conscious relaxation through self-suggestion and promotion of exercises and meditation.
    2. Progressive relaxation: Using methodical, distal to proximal progression of voluntary contraction/relaxation of muscles. The sequence for the technique can be as follows:
    • Place yourself in a quiet area, in a comfortable position
    • Breathe deeply and relaxed
    • Contract the distal muscles in the hands/feet for at least 5-10 seconds, followed by consciously relaxing those muscles for 20-30 seconds
    • Get a feeling of reduced heaviness in the hands/feet, with a feeling of warmth in the muscles that have just relaxed.
    • Realize a feeling of relaxation and warmth in your limbs and then throughout your body
    1. Awareness through movement: Combination of sensory awareness, limb and trunk movements, deep breathing, conscious relaxation procedures and self-massage to alter postural abnormalities and muscle imbalances to reduce muscle tension and pain.

    Older woman meditating.

    If someone is truly relaxed, the following indicators may be present:

    • Decreased muscle tension
    • Decreased heart and breathing rate, decreased blood pressure
    • Increased skin temperature
    • Constriction of the pupil
    • Minimal to no exercise
    • Flat facial expression and closed eyes
    • Palms open with jaw and hands relaxed
    • Reduced distractibility

    When it comes to preventing injuries, there are numerous factors to consider:

    1. Warm up well
    2. Good technique and postural mechanics
    3. Duration, frequency and intensity of the stretch.

    The better prepared your body is, the less likely you are to get injured. Stretching is not a panacea and may not make as much of a difference as you might think in preventing injuries. But if it is to provide any benefit in terms of risk prevention, it must be carried out with other methods of rewarming.

    If you have any questions or would like a professional to evaluate your stretching and exercise routine, visit us at the Foothills location nearest you.

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  • Have I torn my ACL again?  How do I know if I have re-damaged my ACL graft?

    Have I torn my ACL again? How do I know if I have re-damaged my ACL graft?

    After ACL surgery, many people worry that they have re-damaged their ACL or torn their ACL graft. If you are concerned about this, know that this is a common concern. You have undergone a stressful operation and have probably experienced significant pain and limitations in your movement. In your eyes, the worst thing would be if you damaged the ACL graft and now had to go through it all again! Many people worry that simple activities such as bending and straightening their knee after surgery can damage the ACL. Others worry that simply by putting weight on their leg they may damage their ACL graft. These activities do not result in an ACL graft tear. In this video, Lauren Youssef, a physiotherapy student at the University of Toronto, explains why your ACL graft is unlikely to re-rupture after surgery with normal movements and recovery exercises. If you’d also like to learn more about the ACL recovery timeline, we have a great blog on that topic here.

    To read the entire blog and learn more about ACL re-injury, read Lauren’s blog “Did I re-torn my ACL graft after surgery?”

    Make sure you do everything you need to recover after your ACL injury or surgery by downloading Curovate from the links below. Curovate is a physiotherapy app that provides daily video-guided exercises for each day of your recovery. Curovate also tracks your progress and gives you the ability to measure your knee’s range of motion using just your phone.

    If you need more tailored help after your ACL surgery or ACL injury, check out our Virtual Physiotherapy page to book your 1-on-1 video session with a physiotherapist.

    app-store-badge-128x128-2 google-play-badge-128x128

    Other blogs related to ACL injuries:

    1. ACL injury. (2021, March 10). Retrieved from https://www.mayoclinic.org/diseases-conditions/acl-injury/symptoms-causes/syc-20350738

    2. Beischer, S., Gustavsson, L., Senorski, E. H., Karlsson, J., Thomeé, C., Samuelsson, K., & Thomeé, R. (2020). Young athletes who return to sports within nine months of anterior cruciate ligament reconstruction are seven times more likely to sustain new injuries than those who delay their return. The Journal of Orthopedic and Sports Physiotherapy, 50(2), 83–90.

    3. Kaeding, C. C., Pedroza, A. D., Reinke, E. K., Huston, L. J., MOON Consortium, & Spindler, K. P. (2015). Risk factors and predictors of subsequent ACL injury in both knees after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. The American Journal of Sports Medicine, 43(7), 1583–1590.

    4. Lai, C., Ardern, CL, Feller, JA, & Webster, KE (2018). Eighty-three percent of elite athletes return to sport before injury after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport, graft rupture rates and performance outcomes. British Journal of Sports Medicine, 52(2), 128–138.

    5. Nagelli, CV, & Hewett, TE (2017). Should the return to sport be postponed until two years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Medicine (Auckland, NZ), 47(2), 221–232.

    6. Noyes, F. R., Huser, L. E., Ashman, B., & Palmer, M. (2019). Anterior cruciate ligament graft conditioning required to prevent abnormal Lachman and twist shift after ACL reconstruction: a robotic study of 3 ACL graft constructs. The American Journal of Sports Medicine, 47(6), 1376–1384.

    7. Paterno, MV, Rauh, MJ, Schmitt, LC, Ford, KR, & Hewett, TE (2014). Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. The American Journal of Sports Medicine, 42(7), 1567–1573.

    8. Samuelsen, BT, Webster, KE, Johnson, NR, Hewett, TE, & Krych, AJ (2017). Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47,613 patients. Clinical Orthopedics and Related Research, 475(10), 2459–2468.

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  • Genetic markers can help women with rheumatoid arthritis make informed decisions about pregnancy

    Genetic markers can help women with rheumatoid arthritis make informed decisions about pregnancy

    shutterstock 390538711 6b3c40fdd32742caa54307db3553cab1

    When women with rheumatoid arthritis (RA) plan to become pregnant, many worry about whether they should stop their medications, risking a flare-up of their disease, or continue taking medications and risk possible damage to the baby.

    About 50% to 75% will see their disease improve naturally during pregnancy for reasons yet unknown, while others may see a worsening of their RA. But they couldn’t have known what would happen to them.

    Now, for the first time, Northwestern Medicine scientists have identified pre-pregnancy genetic markers that can predict who will get better and who will get worse.

    The research was published this week in Research and therapy for arthritis.

    RA is an incurable disease that affects 1% of the world’s adult population and is three times more common in women. It leads to significant disability due to inflammation of the joints and destruction of cartilage and bones.

    “When women with RA become pregnant, there is often a natural improvement,” said lead researcher Damini Jawaheer, associate professor of medicine in rheumatology at Northwestern University Feinberg School of Medicine. “They describe it as ‘a miracle.’ They say, “I’ve never felt better with the medicine I’ve been taking.” But the cause of this improvement is a complete mystery.

    “If women with RA can know in advance whether their disease is likely to resolve during pregnancy, they know they can stop taking their medications. Some RA medications are toxic and affect the fetus, while others are considered safe. But some women with RA don’t want to take RA medications during pregnancy, even those that are considered safe.”

    Being able to predict who will get better and who will get worse will help women in their pregnancy planning and will also help ensure that treatment during pregnancy is targeted only to those women who are predicted to get worse, Jawaheer said . In addition, women who are predicted to improve, and their fetuses, will not be unnecessarily exposed to medications.

    Jawaheer and her team found that before pregnancy, a group of white blood cells called neutrophils were highly expressed among the women who improved during pregnancy, and that some genes related to B cells were highly expressed among women who deteriorated.

    This field hasn’t been well studied, in part because it’s difficult to find women for pregnancy screenings before they become pregnant, Jawaheer said.

    She and colleagues were able to conduct the study because they had previously established a unique pregnancy cohort in Denmark, which enrolled women with RA and healthy women before pregnancy and followed them over time to determine who improved and who deteriorated. Using blood samples taken from these women before pregnancy, they examined the levels of several genes expressed in the blood. Blood samples were collected before pregnancy from 19 women with RA and 13 healthy women participating in the prospective pregnancy cohort.

    Next, Jawaheer plans to conduct a study on a larger cohort of women to validate these findings. Additionally, her lab is trying to figure out why RA improves during pregnancy.

    How does nature ensure that an incurable disease disappears? If we can understand how pregnancy produces natural improvement, we can use that as a model to develop a new drug that would be safer and could improve the lives of women and men living with this terrible disease.”


    Damini Jawaheer, associate professor of medicine in rheumatology at Northwestern University Feinberg School of Medicine

    The name of the paper is: “Pre-pregnancy gene expression traits are associated with subsequent improvement/worsening of rheumatoid arthritis during pregnancy.”

    The other Northwestern author is Matthew Wright.

    The study was funded by grants R21AR057931 and R01AR073111 from the National Institute of Arthritis, Musculoskeletal and Skin Diseases of the National Institutes of Health and by Gigtforeningen and Juliane Marie Center in Denmark.

    Source:

    Magazine reference:

    Wright, M., et al. (2023). Pre-pregnancy gene expression signatures are associated with subsequent improvement/worsening of rheumatoid arthritis during pregnancy. Research and therapy for arthritis. doi.org/10.1186/s13075-023-03169-6.

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  • Mineral water and bone health.  Not all water is the same

    Mineral water and bone health. Not all water is the same

    Skelly and I like to quench our thirst. Instead of reaching for filtered water, we drink one bottle of Gerolsteiner Mineral Water of 750 mg. Not only because of the bioavailability of calcium and magnesium, but because mineral water compensates for a very acidic Western diet characterized by high grains and animal products. Drinking 1,500-2,000 ml of mineral water rich in bicarbonate (>1.8 g/l) can help reduce the net acid load in the diet. [1]

    Personally, I am a mostly grain-free animal protein eater. Animal proteins keep me grounded. Otherwise I float away and my brain doesn’t function properly. Not everyone eats this way, as we are all individuals with different nutritional needs. Vegetarians generally eat more grains, which are more acidic.

    gerolsteiner mineral water

    “Eating a diet high in acid can cause low-grade metabolic acidosis (LGMA) which is associated with long-term negative health effects including urolithiasis, bone lossand even cardiometabolic diseases. [1]

    Gerolsteiner sparkling mineral water contains 1800 mg bicarbonate (1.8 g/l). Please note: Each bottle of Gerolsteiner is 750 ml, which means you need to drink 2 bottles to equal this amount of bicarbonate.

    What is bicarbonate?

    “Bicarbonate (hydrogen carbonate) is not a mineral, but a component of the salts of carbonic acid. HCO3- is the chemical formula. Your body produces bicarbonate.

    Daily requirement: Unlike many essential nutrients, for example calcium and magnesium, your body can produce bicarbonate, but generally in insufficient amounts for optimal health and well-being. There is no recommended daily allowance.”[2]

    Balance – Our bones need balance

    According to Gerolsteiner’s website, “The unique balance of minerals in Gerolsteiner ensures their bioavailability. The minerals are already dissolved so your body can absorb them quickly.

    The ratio of minerals, especially calcium and magnesium, also allows maximum use. In mineral water, the bioavailability of calcium is 84% ​​and that of magnesium is 92%. By comparison, in a banana the bioavailability of calcium is only 38% and that of magnesium only 29%.”

    How is the mineral water Made

    “Over time, the water seeps through the mineral-rich layers of the dolomite rock and absorbs minerals and carbon dioxide, before collecting in deep aquifers as Gerolsteiner Mineral Water. From the depths of the Volcanic Eifel to every cell of your body: one liter of Gerolsteiner Sparkling Mineral water contains more than 2,500 mg of minerals and trace elements.

    Comparison of other mineral waters

    mineral water comparison

    Dressing your water

    When I add a slice of lemon, fresh berries, mint or even a drop of therapeutic orange essential oil, my refreshing drink suddenly changes. Pour your water into a beautiful glass, relax, drink and find yourself participating in conscious pleasure for your bones and your health.

    Type of calcium

    During the Natural Approaches to Osteoporosis Summit, the question arose as to what type of calcium is in Gerolsteiner water. The below is from the company.

    “All mineral waters are different from each other. The degree and type of mineralization of each mineral water depends on its composition and the rock layers through which the water has seeped. Germany’s most popular mineral water comes from a source in West Germany: the Volcanic Eifel region, which has a unique geological profile.

    Deep underground, as precipitation seeps down from the Earth’s surface, it absorbs the carbon dioxide present as a result of ancient volcanic activity. This water then flows through layers of dolomite, a limestone rock containing calcium and magnesium – this geology is specific to the Gerolstein region. The carbon dioxide dissolves valuable calcium and magnesium from the otherwise virtually insoluble dolomite – creating mineral water of exceptional quality.”


    Gerolsteiner USA

    For more information, please take a look at their website: Gerolsteiner USA –
    About Gerolsteiner (gerolsteiner-usa.com).

    What’s new?

    Easy Cooking Guide for Bone Health – 7 Day Meal Plan

    This 81-page interactive ebook (completely clickable to navigate to all the different sections) will deliver what you, my readers, have been asking for:

    • 7-day meal plan (animal protein and vegetable eaters)
    • 27 Bone-friendly recipes with bone-specific nutritional values
    • Printable recipes
    • Printable shopping list
    • Clickable “Table of Contents” so you can easily navigate to breakfast, lunch, dinner and snacks.
    • Shopping, storing and soaking tips to save you money
    • 5 Cooking Videos with Skelly
    • Why conscious eating is important
    • Cook One – Eat Twice… saves time, energy and money
    • Guidelines for antinutrients (oxalates and phytates) made simple
    • Why soaking nuts, seeds and beans matters
    • Everything available as a download to your computer, tablet or mobile, so you can refer to it again and again.

    From my bones to yours,

    Sharing this blog using the share buttons below helps significantly. Thank you.

    Irma Jennings, INHC

    Your holistic bot coach

    [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901030/

    [2] https://www.webmd.com/a-to-z-guides/qa/wat-is-bicarbonate


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