Going Gluten Free

This blog entry was written by my best friend and wife, Colleen Thomas, who has a different perspective of our gluten free diet.

by Colleen Thomas, M.S.

Pierre and I made the decision to begin our gluten-free diet on December 1^st.  I wasn’t too excited about the idea at first.  Considering my love of bread, crackers, and cookies, the decision to go gluten free was not an easy one.  After learning that some of my husband’s symptoms (fibromyalgia) as well as my own (Hashimoto’s thyroiditis, chronic neck pain, and joint stiffness) might improve with a gluten-free diet, I was willing to give it a try.

The first step to starting our gluten-free diet was to go through the refrigerator and pantry and remove all of the products that contain gluten (wheat, barley, or rye).  This included bread, wheat flour, cereal, crackers, pasta, barbeque sauce, and some of our soups.

The next thing we did was to go to the grocery store and look for products to replace the gluten-containing products that we love.  Here are some of the substitutions we made:

We did have to make some modifications to our breakfast menu.  Instead of our typical wheat-based cereal, we replaced it with a gluten-free rice cereal.  We continued to eat our oatmeal despite the fact that it may contain traces of gluten.  On days when we had eggs, we used to have a slice of toast.  On the gluten-free diet we replaced the toast with fresh fruit.

Lunch was the most difficult meal to modify.  Prior to starting on this diet we would typically have sandwiches for lunch.  They do make gluten-free bread, but it is expensive ($4-$8 for a small loaf) and it is hard to find. As a replacement for the bread, I purchased some inexpensive corn tortillas.  They were a little dry when prepared as a wrap, but they made delicious quesadillas.  Unfortunately, making quesadillas for lunch is not always practical as it requires a stove top.  Other gluten free lunch options included yogurt with fruit, gluten-free soup, smoothies, and meat and cheese roll-ups.

Dinner was easy since we usually eat basmati or brown rice with vegetables and some type of meat.  These meals didn’t require any change.  However, I did pick up some brown rice pasta as a replacement for some of our pasta-based dishes that we have on occasion.  The brown rice pasta had a nice taste and texture, but it did require a longer cooking time than wheat-based pasta. Another alternative to pasta is spaghetti squash.

The natural foods section of the grocery store had quite a few options for gluten-free snacks.  One of our favorite snacks is crackers with cheese.  We did find some rice and nut crackers.  They were flavorful, although I did notice that we didn’t eat them as often as our multigrain crackers.  Other gluten-free snacks include corn tortilla chips with salsa or guacamole, popcorn, nuts, fresh fruit, celery with peanut butter, and yogurt.

Overall, switching to a gluten-free diet was not as difficult as I expected it to be as long as we prepared our meals at home.  Trying to eat out or attend holiday parties while on a gluten-free diet is a little more challenging.  The first time I went shopping for gluten-free food it took nearly twice as long as usual since I had to read all of the labels.  Subsequent shopping trips did not require as much time as I already knew what I was looking for.

For more information on how to go gluten free, read the following article by Mayo Clinic: http://www.mayoclinic.com/health/gluten-free-diet/DG00063.

The First Month on a Gluten-Free Diet

by Colleen Thomas, M.S.

I noticed an improvement within the first week on the gluten-free diet.  The stiffness and pain that had been in my neck for the past several years had almost disappeared and I had a full range of motion in my neck, which I hadn’t had since I fell off my bike a few years ago.  Now being the skeptic that I am, I was not completely convinced that this was due to the diet.  However, during the holidays I indulged in several gluten-based products (cookies, pasta, pie crust, and graham cracker crust).  The day after indulging in these goodies, I developed neck stiffness.  A couple days afterwards I decided to have a sandwich with multigrain bread for dinner and the next morning I felt it.  Not only was my neck stiff and sore, but the joints in my hands, feet, and shoulders were stiff as well.  Now I can’t say for sure that this is due to gluten, but I have a strong suspicion that gluten was the culprit.

Pierre did not see the same benefits on the gluten-free diet as I did.  This could be due to him working several long shifts (12-14 hours) during this time period.  Working long shifts often causes fibromyalgia flare ups for him.  The other downside of the gluten-free diet is that he often felt hungry during the day which caused him to sometimes overeat in the evening.

For now we both plan to continue on the gluten-free diet since there is some evidence that some people need to be gluten free for several months before they see the full benefits.  I am encouraged by how much better I felt while on the gluten-free diet and I am hoping it will improve my Hashimoto’s thyroiditis and prevent other autoimmune disorders.

Gluten Sensitivity and Autoimmune Disease

“More than 40 autoimmune conditions have been identified, including such common conditions as type 1 (insulin dependent) diabetes, rheumatoid arthritis and celiac disease. Together they constitute the third leading cause of sickness and death after heart disease and cancer.” - Scientific American—March 2007

Your immune system is fascinatingly complex, and normally works extremely well to ward off disease, but sometimes it becomes part of the problem.  With autoimmune disorders the immune system attacks the body’s own tissues—and the results can be devastating.

In addition to the diseases described above, autoimmune diseases include psoriasis, lupus and multiple sclerosis.  Autoimmunity can also play a role in thyroid disease, asthma, chronic fatigue, anemia, and many other conditions. The good news is we are finally seeing a common link that may help to treat, and even prevent, these health problems.

The most helpful research has been in the study of celiac disease, a severe form of gluten sensitivity that causes abdominal pain, diarrhea and severe malnutrition because of damage to the intestinal wall. Until recently celiac disease was thought to be very rare, but researchers at the University of Maryland have determined one out of 130 people have the disease.  Other experts have estimated that as much as one third of the population has gluten sensitivity (not necessarily manifested as celiac disease) and this is important because it appears that many of the autoimmune disorders may be triggered by gluten—a protein found in wheat, rye and barley.

So why are only some people affected by gluten?  Like most disease processes, you need a genetic predisposition and, in the case of gluten sensitivity, an increase in intestinal permeability—also known as a “leaky gut”.  This condition allows whole protein molecules, such as gluten, to pass directly from the gut into the blood stream setting up a cascade of events that causes the body’s immune system to overreact.

While there are laboratory tests that can help make a diagnosis, the best way to find out if you are gluten sensitive is to completely eliminate it from your diet. A gluten-free diet contains no wheat, rye or barley. This means no bread, pasta or beer! Most cereals are forbidden and gluten is used in many processed foods, so you have to read the label. I recommend that you visit the Mayo Clinic website to learn more (http://www.mayoclinic.com/health/gluten-free-diet/).  I also recommend an excellent book by Shari Lieberman called The Gluten Connection.

Even if you don’t have symptoms of celiac disease or another serious autoimmune disorder, you may have anemia, arthritis, bone loss, depression, fatigue, or musculoskeletal pain that could be related to gluten sensitivity. Isn’t it worth going without bread and pasta for a month or two to see if you improve?

On a personal note, my brother has ulcerative colitis and had a fairly dramatic improvement after eliminating gluten from his diet. I have fibromyalgia and chronic fatigue, and my wife has Hashimoto’s thyroiditis (an autoimmune condition that destroys the thyroid gland).  Consequently we also are going “gluten free” for the month of December, and perhaps longer, to see if we feel better. We will keep you posted on how we do and the challenges we encounter in removing all gluten-containing products from our diet.

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Find gluten-free products at the Living Gluten Free Amazon Store (http://astore.amazon.com/glutenfree0a-20)

News Flash: Exercise can be Fun!

A lot of us don’t like to exercise. In fact, many of the people I see at the gym look like they’d rather be anywhere else, but I maintain that exercise can be fun. You may be skeptical, but if you think back to your childhood you can probably come up with at least a few physical activities that you enjoyed. It might have been jumping rope, playing ball or just running around in the woods. So if you could have fun then, why not now?

I encourage you to find exercise that you find pleasurable—for the simple reason that you’ll be more likely to do it regularly.

Here’s a list of ideas to get you thinking:

• Get a friend or family member to join you while you exercise. It’s a great way to build a relationship.
• Join a club—hiking, cycling, tennis—it doesn’t matter as long as it gets you moving.
• Get a dog (woof, woof).
• Purchase some exercise DVDs that interest you. Often you can buy these inexpensively at garage sales or rent them from the local library to try.
• Sign up for a “fun” run or walk. You may be more motivated if you have to prepare for an event.
• Attend an exercise class. It could be yoga or spinning or anything else that interests you.
• Listen to music or audio books on your iPod. I usually like to just meditate and clear my head while I exercise, but sometimes it’s nice to have a distraction.

Also, I encourage you to mix things up a bit. You don’t have to do the same thing every day. It might be that you go to the health club three times a week, and on the other days you ride your bike or take your kids for a walk. Whatever you do, make sure your exercise is appropriate for your lifestyle and level of conditioning. If in doubt, talk to your doctor about what is safe for you.

To increase your chances of success, start with small goals and build up from there. If you haven’t exercised since gym class in seventh grade, don’t try to run a 5K the first time out. If you have trouble staying motivated, consider hiring a fitness trainer or coach—that’s what we’re for!

We, as humans, were designed to exercise. It is only a recent phenomenon that we became sedentary. According to the Mayo Clinic, lifestyle issues account for 70% of chronic conditions and the majority of our health care costs. The bottom line is that you really can’t be healthy unless you exercise, so you might as well have fun doing it!

Some Other Hints

You should have a back-up plan for the days that are really busy or when the weather is bad. I think having something that you can do in your home is important.

To use some personal examples, during my residency I had a free gym membership, but no time to use it. I ended up buying a Schwinn Air Dyne and I would ride it while watching the Late Show. My wife, Colleen, likes exercise DVDs, and even used them when we were traveling in our RV. My 86-year-old father has a gym in his basement that he uses regularly, and my Mom, also in her eighties, is on the treadmill for 30 minutes a day. The point is you want to create options so that it’s easy for you to exercise regularly.

If you want to see how many calories you burn with a particular exercise, you might visit www.nutristrategy.com/activitylist4.htm. They have calorie counts for everything from skate boarding to tai chi. I’m not familiar with their software, but they have a great website with lots of free information. 

NEWS FLASH
My 21-year-old daughter, Kayla, recently participated in the MightyMan Sprint triathlon in Montauk, NY—and WON!  In a sprint triathlon you swim 750 meters, bike 17K and run 5K. It’s quite a workout!  She was first place in the woman’s collegiate conference. GO KAYLA!

 

Natural Ways to Prevent and Treat Swine Flu

The swine flu, caused by the H1N1 virus, has already resulted in the deaths of 76 children this year. My heart goes out to those families that have suffered such a great loss. The fact is the worse is probably yet to come as we have barely started into the flu season.  What are you doing to prepare?

Of course you should do the obvious — wash your hands a lot, avoid crowds if possible, and consider getting the vaccine. It’s just become available and there are no guarantees that it works, but it might just save your life.

You also want your body’s own defenses optimized. Here are some easy ways to kick you immune system into high gear:

1.  Get plenty of rest, drink plenty of water and eat healthy foods, including plenty of garlic. Garlic is a well-known immune booster. If you don’t like to eat it, or you’re concerned about bad breath, you can always take Kyolic which is available in pharmacies and health food stores.  Make sure you eat plenty of protein and don’t starve yourself if you’re dieting. Either of these can affect your ability to make antibodies which you need to fight infection

2.  Minimize, or learn to better manage your stress. Stress has been shown to greatly increase your chances of getting sick. In fact, I usually ask patients why they think they got sick, and more often than not they tell me thy think it’s from stress.

3.  Take a good multi-vitamin. Even the AMA recommends this now, but for years those of us who study nutrition were aware of the benefits of a good supplement. One of my favorite studies is out of Canada, where they gave older patients a multi-vitamin or placebo. The group that took vitamins got colds and flu only half as often as the placebo group. And, when they did get sick, they got better in half the time. This is a no-brainer. Take a good multi-vitamin like Vita-Lea made by Shaklee. It will cost you about 30 cents a day to take the best supplement in the industry.

4.  I take other food supplements that have also been shown to improve immune function. These include:

• Sustained release Vitamin C 500 mg twice a day
• Vitamin E Complex 400 IU per day
• Omega 3 Fatty acids 1000 mg per day (Flax seed oil works too)

5.  THIS IS REALLY IMPORTANT! One of the most significant advances in medicine was the discovery of interferon in the 1950’s. This compound is made naturally by the body to fight infection, but it has also been successfully used intraveneously to treat patients with severe viral infections such as hepatitis, cancer patients and those with MS.

In Europe and Russia they have been using interferon intranasally to treat the flu, and just this past week in Germany scientists reported two separate studies indicating that intranasal or oral administration of interferon helps combat influenza and the H1N1 virus.

So far interferon has been used to treat the flu, not prevent it. But this is really important because we don’t have enough vaccine or Tamiflu to go around. Other options like interferon could save many lives, but it’s not yet available in the US for treating the flu.

Here’s something you can use now! Dr. Yasuhiko Kojima, who discovered interferon over 40 years ago, isolated four natural compounds that increase the body’s natural production of interferon. These can only be found in Nutriferon, a product made by Shaklee. It’s expensive, but I take at least one caplet a day (half a dose) and I take two if I’m around sick people, under a lot of stress or feel any illness coming on. I’ve used it for years with great results. In fact, I won’t even get on a plane unless I dope up on Vitamin C and Nutriferon.

6.  One last compound that can be used for treating influenza, and possibly H1N1, is elderberry root. This has been used for centuries to treat colds and flu, and there are many good studies that show it works. While Shaklee sells this as a tablet (Defend and Resist Complex), I recommend that you get elderberry extract (brand name = Sambucol) as this is what most of the studies have used.

If you get sick with a high fever, cough and marked fatigue, you need to stay away from people so you don’t spread this around. Drink lots of fluids to avoid dehydration and if you have trouble breathing or have other serious symptoms, get yourself to the doctor. If you can get Tamiflu in the first 72 hours it may help to minimize your symptoms and get you better sooner. Yeah, it’s a drug, but I’d sure take it and you will too if you get hit by one of these bad bugs. It could keep you out of the hospital or even save your life!

You can order Shaklee products at www.Shaklee.net/getwellvt . We appreciate your business! Also, I am happy to give a FREE nutritional consult to anyone who signs up as a Shaklee member at the above website.  Just visit www.PhysicianHealthCoach.com to make an appointment.

I haven’t forgotten to write about ways to make exercise fun. It’s just that I thought getting this info out was more important. Stay tuned at www.PierreAngier.wordpress.com.

Sincerely,

Pierre Angier, D.O.

Your Physician Health Coach

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Author Biography: Dr. Pierre Angier is an osteopathic physician with over 20 years of clinical experience. Presently Dr. Angier works as a wellness coach—helping people reach optimum levels of health through nutrition, exercise and stress management. Read more.

Disclaimer:  This article is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information in Dr. Angier’s Health and Wellness Newsletter (www.PierreAngier.WordPress.com) for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment.

The Nuts and Bolts of Losing Weight

In my previous article, I made the case for using both diet and exercise for losing weight. I even implied that this could be fun! I admit it might be a bit of stretch to claim that dieting is fun, but I have some ideas that should make it less painful.

For starters, it helps to know where you’re at.  Your weight, when calculated with your height, will give you your body mass index or BMI (for a BMI calculator go to http://www.nhlbisupport.com/bmi/bminojs.htm) You might not like what this shows, but it may help you get motivated to start your weight loss program.

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For a more accurate picture you can get a body fat analysis done with skin calipers or a BIA (bioelectric impedance analysis) device. This is usually performed by dietitians or fitness trainers, who can also help you come up with a reasonable weight loss goal. I always ask patients what was the weight where they felt best, and this is usually amazingly close to their calculated ideal body weight. In other words, most people have a pretty good idea what they should weigh.

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I would urge you to lose weight gradually. Let’s face it, you didn’t put it all on in a few months, and you shouldn’t try to take it off quickly. If you do, you’ll likely just get frustrated.  Even if you are able to starve yourself enough to lose weight fast, studies show that you’ll likely put it on again. Losing weight, and keeping it off, occurs because you’ve changed your habits. So instead of making yourself miserable, let’s look at some strategies that work, starting with easy ways to cut your calories.

A useful tool is a program called CalorieKing®. This software calculates your calories and nutrient intake from the foods you input. It also takes into account your activity level to help you develop a calorie deficit that will result in you losing weight. Of course, you can just get a calorie counter book, but it’s not near as much fun and it’s more work. Remember, we want to make this as easy as possible.

Using the CalorieKing® program, you’ll easily identify those problematic, high-calorie foods. Most people start to limit these automatically, but you may need to spend some time thinking about where you can make some small changes that can have big results. For example, it may be that you’re loading up your coffee with cream and sugar. You might consider drinking your coffee black, switching to tea, or cutting it out altogether (do this gradually or you’ll get a headache). It might also be that the “healthy” salad you’re having for lunch is loaded with 600 calories of dressing. You might switch to a low calorie dressing and shave 300 calories off your lunch. You’ll find Ten Easy Ways to Cut Calories at my website www.PhyscianHealthCoach.com.

So let’s say you find some relatively easy ways to reduce your intake by 500 calories a day. This is 3500 calories a week which equates to a pound of fat, or 52 pounds a year. Wow, could it really be that easy! Of course not, because you need to eat 500 calories a day less than what you need to maintain your weight. Again, CalorieKing® will help you with these calculations, or you can go to http://health.discovery.com/tools/calculators/basal/basal.html where you can easily calculate your basal metabolic rate (this just takes a minute).

For example, my basal metabolic rate is 1900 calories, which means if I’m sedentary, and eat only 1400 calories a day I’ll lose about a pound a week. However, I’d get really hungry. Instead, it makes a lot more sense to eat a little less and exercise enough to create a 500 calorie deficit. I know this works because I’ve done it.

I don’t want to overwhelm you, so I’ll talk about exercise in more detail in my next newsletter. Make sure you don’t miss Secrets for Making Exercise Fun. I’m not kidding! Sign up now to get your free newsletter.

Just a word of warning, you should never go below 1200 calories a day when you are dieting. Starving yourself like this can sometimes lead to heart and kidney damage, and you can lose muscle mass as well, making it even harder to lose weight.  As a general rule, if you’re losing more than a pound or two a week you’re probably pushing yourself too hard.

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On a personal note, I used to occasionally indulge in a few beers (Hey, I’m a sailor after all). However, I began to have problems with my blood sugar and decided to make some changes. I cut out the beer, and with the help of a coach I made some relatively painless modifications to my diet. Consequently, I was able to lose 25 pounds—most of which I’ve kept off. I must admit, it would have been a lot tougher without the support and encouragement from my coach. Again, I encourage you to make a small investment in CalorieKing®.  It’s fun and easy to use, but if you need some help contact me, or my wife Colleen, and we’ll walk you through it. You can contact us via my website www.PhysicianHealthCoach.com or call us toll free at 877-800-0509.  You can also sign up for a FREE coaching session during which I’ll help you identify your health goals, and what is more important, I’ll tell you how to reach them!

*****

Pierre Angier, D.O.

Your Health and Wellness Coach

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Author Biography: Dr. Pierre Angier is an osteopathic physician with over 20 years of clinical experience. Presently Dr. Angier works as a wellness coach—helping people reach optimum levels of health through nutrition, exercise and stress management. Read more.

Disclaimer:  This article is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information in Dr. Angier’s Health and Wellness Newsletter (www.PierreAngier.WordPress.com) for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment.

The Truth about Exercise and Weight Loss

It was brought to my attention that Time Magazine recently had an article titled, “How Exercise Won’t Make You Thin”. As a physician who promotes exercise as being essential to good health, just the title alone was enough to make my blood pressure go up. Certainly, it deserves a response.

First of all, the author of the article, John Cloud, is a staff writer for Time and has absolutely no expertise on the subjects of health and wellness. He’s a professional writer—but that’s it. He also has a long history of writing controversial stories that have been criticized as being misleading and irresponsible. Now I know that Time needs to sell magazines, but publishing articles such as this can lead to serious repercussions because it gives people just one more excuse to avoid exercise.

Mr. Cloud begins his article by lamenting his failure to lose weight despite years of vigorous work-outs at the gym. However, he also admits that he’s not overweight!  Additionally, he admits that he eats more on the days he works out. It may seem obvious, but if he’s eating enough extra calories, it would offset the amount of calories he burned and he would not experience weight loss. He is also at a healthy weight that he has maintained almost all of his adult life. So what’s his problem anyway?

He does make the point that many people eat right after working out because exercise stimulates hunger and some folks feel “entitled” to eat more because of their activities at their health club. If this is what you’re doing, you are sabotaging yourself and need to develop different eating habits. Try eating a healthy snack before you work out, don’t drink high calorie sports drinks (water is better anyways) and whatever you do—don’t stop at McDonalds or Starbucks after you leave the gym. That’s just plain silly.

The author goes on to state, “Many recent studies have found that exercise isn’t as important in helping people lose weight as you hear…” In fact, he reports just one adult study, in the journal PLoS-ONE, which has inconclusive results. Somehow, Mr. Cloud forgot to mention the dozens of studies that show exercise does help with losing weight and maintaining weight loss. I would refer you to a review an article in the journal Nature Clinical Practice Endocrinology and Metabolism http://www.nature.com/nrendo/journal/v3/n7/full/ncpendmet0554.html
which looks at sixteen recent studies on exercise and weight loss, all of which were randomized controlled trials.  The article concluded that, compared to caloric restriction alone, exercise not only helps people lose weight, it helps them keep it off.

In short, Mr. Cloud’s article is journalism at its worse. It uses pseudoscience, false statements and illogical conclusions that will give many the idea that exercise is a waste of time. We have an epidemic of obesity that leads to premature death, disease and enormous costs to society. The best way to deal with these problems is simply to exercise more and eat less (I said it was simple—not easy).

I have a lot of experience in this area. I’ve been studying nutrition for 25 years, I’ve struggled with weight issues myself, and I’ve worked with thousands of patients who have shared their successes and failures with me. It is clear that it’s difficult to lose weight with exercise or diet alone. Success almost always results from combining exercise and diet in a reasonable manner to lose weight.

By the way, in case you were wondering about some of the benefits of exercise in addition to weight loss, here is a partial list:

•    Lower blood pressure
•    Lower cholesterol
•    Decreased blood sugar (and prevention of Type 2 diabetes)
•    Stronger bones
•    Improved sleep
•    Better mood
•    Higher energy levels
•    Improved libido (Oh yeah!)

In my next blog entry I’ll tell you how you can lose weight and live longer without making yourself miserable in the process. In fact, it might even be fun!

Pierre Angier, D.O.
Your Health and Wellness Coach

Don’t miss an issue. Sign up today for this FREE newsletter at:
www.PhyscianHealthCoach.com

My Secret for Relieving Neck Pain

If you suffer from chronic neck pain, you’ve probably already recognized the importance of good posture during the day, but what about your sleeping posture? After all, most of us spend about a third of our time in bed. If you don’t sleep well, or wake up with neck pain or stiffness, it may be due to your pillow.

I’ve had neck pain for many years (probably a result of wrestling in high school). I get massage and occasional manipulation from chiropractors and osteopathic physicians. Medications are sometimes necessary if the pain is severe or if I get an associated headache. Over the years I’ve tried all kinds of pillows to get comfortable at night. I’ve used thin and thick pillows, feather pillows, cervical rolls, buck wheat pillows (kind of noisy) and even pillows with magnets!  Without question the pillow that worked the best was the Mediflow water pillow.

The Mediflow water pillow (also known as the Chiroflow water pillow) is simply a pillow with a water-filled base that you can adjust by putting in more or less water. The base is insulated and there is a layer of polyester between you and the water bladder. Once you get it adjusted right (and that may take a few nights), you should be able to get your head lined up with the rest of your spine.

In most cases this results in a better night’s sleep and less neck pain. A clinical study done at the Johns Hopkins School of Medicine in 1997 showed that this pillow was significantly better than the cervical roll pillows that many people use. I have provided hundreds of my patients with these pillows and found that they are almost always helpful. In fact, in a way they were bad for business because after buying the Mediflow pillow, these patients often didn’t need to see me anymore! Reviews at Amazon are overwhelmingly positive as well.

In cases where people didn’t respond well, I found they had usually put too much water in the pillow. The manufacturer recommends that you start with 3 liters which is way too much for most people. It’s always better to start with less (1.5-2 liters) and increase it gradually. I also recommend that you first try out the pillow during a short nap so that you’re not trying to adjust the amount of water at eleven o’clock at night. Keep your old pillow beside the bed in case you need to switch back to it in the middle of the night. In time, you should be able to find the perfect thickness for you and then leave it alone!  It may be that you’ll want to change the water every few months, but measure what you took out to save going through the adjustment process again.

As with most types of chronic pain, there is rarely one intervention that will fix you, but if you improve your nighttime posture with the right pillow it should significantly reduce your neck pain. These pillows are available at many chiropractic offices and are also available at Amazon for around $50, and that’s a lot cheaper than repeat visits to the doctor or chiropractor.

For more information on chronic neck pain order my book, Comfortable Sex—A Guide for Couples with Back or Neck Pain. It is available at Amazon or through my website: www.ComfortableSex.com .

Pierre Angier, D.O.

Your Physician Health Coach

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Author Biography: Pierre Angier is a board-certified osteopathic physician and the author of Comfortable Sex—A Guide for Couples with Back and Neck Pain. For more information, visit www.comfortableSex.com

Disclaimer:  This article is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information in Dr. Angier’s Health and Wellness Newsletter (www.PierreAngier.WordPress.com) for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment.

Expert Advice on Fibromyalgia

If you hurt all over, experience chronic fatigue, and feel so stiff you’re afraid to move, you may have fibromyalgia, also referred to as fibromyalgia syndrome (FMS). Fibromyalgia is one of the most common pain syndromes and a frequent cause of back and neck pain. Exactly how many people are affected by this condition is difficult to determine because it often goes undiagnosed. It is found more commonly in women, but this may be because men don’t go to the doctor as often and are less likely to report pain.

The American College of Rheumatology defines fibromyalgia as generalized pain (pain all over) that lasts for three months or longer. Additionally, there are specific tender points that are easily identified on physical examination. Patients may experience a variety of other symptoms including chronic fatigue, headaches, and intestinal problems such as cramping and diarrhea. However, muscle pain and joint stiffness are the most common complaints.

While the cause of FMS is unknown, it is likely that the condition results from abnormal pain processing by the central nervous system. In other words, the pain pathways in the nervous system get “wound up.” Because of this, fibromyalgia patients have roughly twice the pain sensitivity of normal subjects. To put this in perspective, think about the soreness you might experience after an especially strenuous activity, such as shoveling snow or a vigorous hike—then imagine doubling that pain. This is the sort of pain FMS patients experience much of the time. For this reason many FMS patients stop exercising and become deconditioned (they get out of shape).  It’s hard to get motivated to exercise when you know you’re going to hurt a lot afterward.

The onset of fibromyalgia is often related to a significant trauma, illness, or infection, but in many cases there is no precipitating event. One common denominator is that almost everyone with FMS has trouble sleeping. Specifically they have non-restorative sleep, meaning that they may fall asleep but still feel tired when they wake up. Fibromyalgia patients almost never feel well rested. We’re not sure if this is a cause or effect, but we do know that helping patients get a good night’s sleep is an important step in helping them get better.

Treatment

Before starting treatment, I provide patients with a copy of The Fibromyalgia Handbook by Harris McIlwain, M.D., and Debra Bruce, Ph.D., who have done an extraordinary job of describing this condition and outlining practical treatments.

After patients read the book, together we develop an individualized treatment program. If patients have a nonchalant attitude or are in denial about their diagnosis, I inform them that they need to deal with their fibromyalgia, or it will deal with them. If they allow the condition to go untreated, they will become progressively more deconditioned to the point where they won’t be able to do much of anything. In fact, it’s not unusual for people with FMS to become completely disabled. With a good physician to coach them and armed with knowledge from reading The Fibromyalgia Handbook, patients generally do very well and can return to leading productive lives.

Because most patients I see have had fibromyalgia for years, I tend to use a somewhat aggressive approach to get them on the path to wellness. If they’re not sleeping well, I may prescribe a sleeping pill or at least a sedating muscle relaxant at bedtime. Additionally, if they are not allergic to sulfa, I start them on Celebrex, which is the only anti-inflammatory that seems to significantly affect fibromyalgia pain. Generally, I avoid prescribing narcotics for fibromyalgia, but other pain medications—in particular, tramadol—can be just as effective with fewer complications.

FMS patients are almost always referred for physical therapy. If they are unable to tolerate land-based exercises, they are sent for aquatic therapy in a heated pool. If they are able to walk, they are put on a walking program. If they are really weak, I ask them to buy a treadmill, and they walk for just five minutes three or four times a day, gradually building up their strength and endurance. In short, FMS patients need to exercise, but they need to start very slowly. Medications often are required to help them overcome the pain they feel with even minimal activity. If they go to the gym and work out as they did in high school, they will almost certainly pay the price of increased pain for as long as two weeks afterward. A very gentle and consistent exercise program that includes lots of stretching will help fibromyalgia patients feel better and allow them to resume their normal activities.

Heat, especially moist heat, can play a major role in controlling the pain of fibromyalgia. I routinely recommend that patients buy a hot tub spa or at least take a couple of long, hot showers every day. Electric heating pads or the rice-filled wraps you warm up in the microwave work well, as do the heating pads that get warm when exposed to air. (ThermaCare is a popular brand.)  With any hot pack it’s possible to get burned, so be careful.

Many FMS patients and chronic pain patients in general have low levels of a neurotransmitter called serotonin—which can lead to depression. Even if you’re not depressed, a small dose of antidepressant can dramatically reduce fibromyalgia pain. I usually recommend a low dose of citaprolam (Celexa), since it is less likely to interact with other drugs and is generally well tolerated, but be careful of taking this with tramadol (Ultram or Ultracet) as it can slightly increase your risk of having a seizure.

Most fibromyalgia patients benefit from massage therapy and spinal manipulation—especially if these can be done at the same visit. I would encourage very gentle massage at first, because deep-tissue massage can increase the pain. For this reason I generally recommend against Rolfing, which involves applying very deep pressure to realign the fascia that surrounds the muscle. This almost always results in increased pain that may not start until a day or two after the treatment. You might look into the Alexander Technique and Feldenkrais. Both of these bodywork techniques are very gentle and focus on improving posture and allowing more efficient movement.

There is no cure for fibromyalgia, but the pain can almost always be reduced and managed. I have seen many people with this condition who experience almost complete resolution of their symptoms. If you think you have fibromyalgia, go to your doctor, develop a treatment plan, and get started on getting better.

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Author Biography: Pierre Angier is a board-certified osteopathic physician, a fibromyalgia patient and the author of Comfortable Sex—A Guide for Couples with Back and Neck Pain. For more information, visit www.comfortableSex.com

Disclaimer:  This article is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information in Dr. Angier’s Health and Wellness Newsletter (www.PierreAngier.WordPress.com) for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment.

A Physician Speaks out on Health Care Reform

It’s coming. Like it or not there will be a new health care bill sitting on President Obama’s desk in the near future. Written by legislators who have no experience with health care administration and who are in a rush to begin their summer recess, this bill will likely become the nation’s biggest entitlement program ever.

As a physician, I have no fondness for insurance companies. I also recognize the human and financial cost of having some 50 million Americans uninsured. However, judging from the way the government runs the Medicare system and the Veteran’s Administration, I can only look at this process with cynicism.

My outlook was not helped by watching C-Span while congressmen and women debated parts of the bill. It was clear that most of these lawmakers had very little idea what they were talking about. Several of them were confused about the difference between Medicaid and Medicare (two completely different programs), there was no discussion about other countries’ experiences with government sponsored health care, and not one of these elected officials had a clue as to how to pay for the program (which undoubtedly will be much more than the one trillion dollars currently estimated). Frankly, I was aghast at the ignorance displayed in the short time I wasted watching this debacle.

I recognize that President Obama had promised health care reform in his campaign, and it is something that most of us (including myself) feel is necessary. However, he has insisted that this very important bill be on his desk before the end of the summer. With congress gnawing at the bit to begin the summer recess, there is an apparent “GET-R-DONE” attitude with a lack of interest in getting it done right.

President Obama has also not made this task easier by refusing to consider any limits on malpractice awards. Now, I know that Mr. Obama is an attorney, and I know that most politicians are attorneys, and I know that the trial lawyers are one of the most powerful lobbying groups on the hill, but if the President and the democratically controlled congress are serious about containing health care costs they will include some reasonable reforms of the tort system in this bill. To omit this would be truly irresponsible.

It’s time for a deep breath, and to give thoughtful consideration to meaningful health care reform. It will not be helpful to trade one flawed system for another one that is equally flawed. The goal should be to improve access to quality care with a minimum burden on the taxpayers.

For meaningful healthcare reform there needs to be incentives for healthy lifestyles and an emphasis on preventative medicine. Except for those that truly cannot help themselves (this includes children), patients should always shoulder some of the financial burden. Without this there is a tendency for patients to become passive partners in the decision-making process. “If insurance pays for it, why not?” is the phrase we physicians hear so often, when what we should be hearing are questions about the costs and benefits of the different options available.

We need to encourage physicians to practice in a manner that is best for their patients, and part of that means removing the burden of practicing “defensive medicine” – the ordering of tests and specialty referrals out of fear of litigation. To do this there needs to be a restructuring of the way we deal with medical errors that result in poor patient outcomes. There are many ways of doing this including the NICA program (http://www.nica.com/). The malpractice attorneys won’t like this, but too bad.

The fact is, everyone is going to take a hit on this. Patients won’t be happy about waiting for their care, as is the case in most countries that have socialized medicine.  Doctors will make less money (maybe a lot less), and if the government plan is anything like Medicare, we’ll spend more time and money trying to get paid for our services. Taxpayers will see a larger percentage of their income taken for yet another government program. And, we will likely see health insurance companies relegated to selling “gap insurance” to cover what the government won’t pay for. It’s possible that some of these corporate giants could go out of business, as more and more companies will drop health care benefits and push their employees into the government sponsored plan. It will be a few short years before company-sponsored health plans will be a thing of the past, or at least a rarity.

This I know. If the reform bill is badly flawed, it could be catastrophic in that many doctors will either refuse to participate, or if mandated to participate, they will do so begrudgingly. This will further restrict access to health care, or at least quality health care. If the government sponsored plan pays what Medicare does (or less, as some of the democrats are proposing), many doctors will simply not be able to stay in business. It would make sense to have practicing physicians participate in this debate.  Without the health care providers’ involvement in this process, there is very little chance of success.

I’ve also done the math. The tax on the rich (those families earning over $250,000) will not even begin to pay for the costs of this plan, so who is going to pay for it?  As is almost always the case, it will be the middle class, who provide the vast majority of tax revenue. The extra burden on the middle class may not be in the form of a tax increase, but may instead be in the form of premiums for your government-sponsored health care plan that YOU will be picking up instead of your employer.

If you are concerned about these issues contact your senators and representatives now! Plead with them to slow this process down so it can be done rationally and with the due diligence such an important piece of legislation deserves.

I would also ask you to send this statement on to your friends and family that might give a damn about the future of this country. “We the People” is very quickly becoming “We the Subjects”. It doesn’t have to be this way, but we need to speak up and hold our elected officials responsible for the success or failure of this bill.

Sincerely,

Pierre Angier, D.O.

Resveratrol: Will the Health Benefits of this Super Antioxidant Help you Feel Younger or Live Longer?

What is resveratrol?

Resveratrol is a compound found in grapes and red wine that has anti-aging properties. It is a powerful antioxidant that scavenges free radicals. Free radicals, or unstable oxygen atoms, are what cause damage to cells and result in the diseases of aging. For many years scientists have been studying this process in hopes of decreasing the incidence of heart disease, cancer, diabetes and another conditions associated with aging.

In 1992 resveratrol was found in red wine and caused speculation that this might be the explanation of the “French paradox”—the observation that mortality from coronary artery disease is lower in France, despite diets high in fat and a high incidence of smoking.

A major breakthrough came when Dr. David Sinclair at Harvard discovered that resveratrol activated Sir2, an enzyme linked to increased lifespan for yeast. When tested, resveratrol increased the lifespan of yeast, worms, fruit flies and fish. What was more amazing was that mice fed a high calorie diet also lived longer when on resveratrol, when normally they would die prematurely from diseases associated with obesity. The mice also had increased endurance and were less likely to develop diabetes. In short, resveratrol not only helped the mice live longer, they acted younger.

To date there have been over 2000 published research studies done on resveratrol including studies conducted by Harvard University, the National Cancer Institute and the National Institute on Aging. There have been no toxic or adverse affects reported with its use. In vitro studies (done in a test tube) have shown that resveratrol can decrease the growth of cancer cells. Human studies on cancer prevention are pending.

Should I take resveratrol?

I think that everyone should be taking anti-oxidants* because even if we try to eat a good diet, much of our food has been raised on depleted soils, sprayed and treated with chemical fertilizers, and picked before it’s had a chance to ripen naturally. It helps to buy organic, but in many areas of the country it’s hard to find fresh, organic foods that have enough naturally occurring anti-oxidants. Do your best to eat five servings of fresh fruit and vegetables, eat less red meat (the fat in meat is often rancid and causes oxidation) and eat plenty of whole grains, but you should also take anti-oxidant supplements that will help combat the stresses your body endures.

Where can I purchase resveratrol?

I recommend the Shaklee product, Vivix. This product was developed with the input of Dr. Sinclair and has polyphenols that make this product 10X more powerful than resveratrol alone. In fact, one daily serving of Vivix has the same amount of resveratrol as drinking 100 glasses of wine. Like most of Shaklee products, it is completely natural and has no artificial coloring. To order this product, go to http://www.shaklee.net/getwellvt/product/21000.

Vivix is expensive ($100 per month retail) so I recommend you become a member for $19.95 and you’ll save 15% on this and all your Shaklee products. In my opinion, $3 a day is a small investment for a product that can help you feel younger and live longer.

*Precautions: Pregnant or lactating women and young children should not take high doses of the anti-oxidant Vitamin C. Also Vivix has not been tested in this group. It is also possible that resveratrol could increase the risk of bleeding when high doses are combined with anti-coagulant drugs such as warfarin (Coumadin), anti-platelet drugs such as clopidogrel (Plavix) and dipyridamole (Persantine). Non-steroidal drugs such as aspirin, ibruprofen and others present a theoretical risk as well.