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Posted: 19 Jan 2013 04:44 PM PST

Lower limb alignment is not the only thing that can cause back pain, but it is certainly the most commonly overlooked diagnosis.

WHAT is the first thing that comes to mind when someone says the word podiatrist?

If you're familiar with the term, most will answer "foot specialist", or "foot doctor".

If you're not familiar with the term, the responses you get can range from "the doctor who deals with children" to "it's some kind of diet".

Yes, I've heard it all, but after 12 years of practice, I can assure you that nobody has ever said: "The doctor who treats back pain."

However, that is exactly what we've done over the past 20 years, since more and more research has shown that if the lower limbs (your legs and feet) malfunction, it will most likely lead to chronic back pain.

If you're unfortunate enough to fall into the large percentage of the population experiencing lower back pain (LBP), then you will know that it can oftentimes make your thigh, calf or foot feel numb or tingle.

Many patients experience a tugging, or pulling sensation in the leg while back pain is more subdued.

Others may just experience discomfort in the back of the thigh, or a distinct pain in the lower back on certain movements.

Your doctor may take a MRI or an x-ray, and diagnose you as having a problem with your disc, which lies between the vertebrae, or perhaps a nerve compression.

There are a few diagnoses that can be made, and just as many treatments can be offered.

Often, this leads to what we call revolving-door practice. The patient comes in for treatment and leaves feeling better, only to show up again to repeat the whole process. This happens both with surgical and non-surgical treatments.

Why?

The answer to this lies in the research that has been conducted over recent years on the link between the lower limbs and your spine.

For treatments to be effective, we need to find the root cause of the problem. Just knowing what's wrong is not enough. We have to answer why the problem occurred. We say this because the diagnosis you are given is oftentimes the manifestation of the root cause.

What's the root cause?

Let's consider Angela's (name has been changed) case study. She goes to work Monday to Friday where she spends an average of three hours standing and walking. The rest of the time, she is seated.

For two years now, she has had this dull lower back pain, and she goes for a massage to relieve the pain and the tight leg muscles on her left side once a week. She noticed that the pain was always worse after a day of shopping or having walked long hours.

One day, she decided to finally mention this to her general practitioner, who gave her an anti-inflammatory drug. It felt good, but as soon as she stopped the drugs, the irritating pain returned.

She then turned to a chiropractic, which helped. An orthopaedic surgeon referred her to their physiotherapy department, and that helped too, but the discomfort returned as soon as she stopped treatment.

One day, her aunt jokingly said to her: "Why do you walk with your feet turned like that?" Her aunt later insisted that she should see her podiatrist.

It was on this visit that we discovered not just the diagnosis, but more importantly, the root of the problem.

Angela had a limb length discrepancy, which is to say, one leg was shorter than the other by eight millimetres.

This made Angela's pelvis tilt, causing the spine to curve. Biomechanical data shows that any difference greater than three millimetres can wreak havoc with your alignment and cause persistent lower back pain.

After addressing the difference, the lower back pain and its associated leg discomfort resolved within three weeks.

There are many other biomechanical anomalies, such as flat feet, incorrect leg bone rotational alignment, knee position, pelvis rotation, and weakened buttock muscles that can be the underlying cause. It can be discovered by having a biomechanical evaluation of your lower limbs by a podiatrist.

A typcial biomechanical examination can last 10-20 minutes, and may include x-rays and video gait analysis, depending on the problem.

Expect to have your walking and alignment scrutinised.

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The power of three

Posted: 19 Jan 2013 04:38 PM PST

Three evidence-based nutritional therapies for diabetes.

IN my previous article, I shared some herbal and nutritional therapies for diabetes, most of which do not have proper scientific studies done, but are used based on traditional and current experience of consumers and health professionals (including medical doctors).

Today, I will share three nutritional therapies that are backed by scientific studies.

Bitter gourd and polypeptide-k

Bitter gourd (bitter melon) has long been used as traditional herbal medicine for improving blood sugar levels in many countries, across many continents. The traditional use is to consume the juice of four to five gourds as a drink, or to consume the raw fruit.

As the name suggests, the bitter taste can be a problem for many to judiciously consume it in the long term. Regular consumption may cause stomach discomfort, abdominal pain or diarrhoea. Taking too much may also cause liver toxicity.

Pregnant and nursing women, and those with G6PD deficiency, should not take bitter gourd at all.

With technology, bitter gourd extracts have been made available in capsule form. These are presumably extracts from the juice or fruit as it was long believed that it is the flesh that contains the active ingredients.

Bitter gourd reduced blood glucose levels in several research studies conducted in both animal and human studies. Some of these studies reported that bitter gourd improves glucose metabolism and tolerance (Memorial Sloan-Kettering Cancer Center).

A 1996 clinical trial found that bitter gourd is effective in helping to treat diabetes (reported in Phytomedicine).

Studies published in Phytotherapy Research in 1993 and the Journal of Ethnopharmacology in 1986 also reported that bitter gourd has anti-diabetic effects on glucose tolerance, and may treat type 2 diabetes.

A 1982 study in Germany found that bitter gourd affected insulin release.

Besides lowering glucose levels, animal studies also show that bitter gourd improves blood lipid levels (study published in Journal of Medicinal Food, June 2010). Bitter gourd decreased triglycerides and LDL, or "bad", cholesterol, and increased HDL, or "good". cholesterol levels.

Another positive finding was that bitter gourd has antioxidant activity, which protects cells from free radicals that are abundant in diabetes.

With further advances in science, several key active ingredients have been identified. Some of these active ingredients reduce blood glucose in a similar way to insulin, albeit in a much weaker way. They also improve cellular sensitivity to native insulin.

After three decades of research, a local company has succeeded in identifying what is probably the most active glucose-controlling ingredient in bitter gourd. It is a polypeptide extracted from the seeds, instead of the fruit. Note that most traditional recipes exclude the seeds from the concoction because the seeds are covered by a toxin that causes diarrhoea.

This active ingredient, called polypeptide-K, has 33% similarity in amino acid sequence to human insulin, and therefore, is appropriately called "plant insulin".

Fortunately, the company has made polypeptide-K available in tablet form. The dose for diabetics is four times a day, 10 minutes before food. It is to be taken sublingually (put under the tongue) because oral ingestion will lead the stomach acids to destroy the peptide. The bonus is that it is not bitter at all.

It has been used locally for over 10 years with good results. Patients (not all) have reported being able to reduce their drug dosages, including insulin.

A local doctor claims to have gathered a series of 100 patients treated with polypeptide-K (including consuming a polypeptide-K-enriched diet), who were able to be taken completely off their insulin injections.

I hope the results on this series of patients will be published, so that we have a more objective evaluation of its effectiveness.

Polypeptide-K can be used for diabetic patients on oral drugs or insulin injections, who wish to try to prevent increases in their dosages, or want to reduce their dosages.

Unlike raw bitter gourd, polypeptide-K is free from any side effects. It can be used by pre-diabetics to prevent progression to overt diabetes. In fact, it can even be used by healthy people who are at risk of becoming diabetic.

Polypeptide-K has now been included as an ingredient in gourmet bread, pasta, noodles and as food additive for diabetics to help prevent prolonged glucose surges after their meals. These enriched foods are called functional foods, as they have ingredients that are proven to improve health.

A local study on healthy individuals showed that those who consumed bread infused with polypeptide-K had their blood glucose levels returning to normal in 110 minutes (average), compared to 190 minutes in controls (consumed ordinary bread). I hope the researchers repeat the study on diabetic patients as well.

GTF (Glucose Tolerance Factor)

GTF was discovered by Dr Schwartz and his colleagues way back in 1957. However, we did not hear much about it until research on it was rekindled by scientists in the United Kingdom and Taiwan recently.

GTF was first discovered in Brewer's yeast, and was shown to reduce glucose levels in early animal studies.

It is made of biologically-active trivalent chromium, together with vitamins and amino acids. It stimulates insulin secretion and insulin-receptor sensitivity to the hormone. It thus, encourages glucose transport into the cells, and lowers plasma glucose levels.

Our GTF level is highest during the infancy and childhood growth stages, then steadily declines with age. Other factors that cause GTF level to decline are stress, obesity, pregnancy, alcohol, pollution, high fat and high sugar foods, lack of exercise, surgery, and various diseases.

Chromium supplementation has been used by naturopaths and nutritional therapists as a way to combat diabetes for many decades, but all the studies so far have produced equivocal results.

Understanding that it is trivalent chromium, which is biologically active, and is the main component of GTF, allows us to zoom into using the right form of chromium for improving glucose control.

Trivalent chromium exists naturally in food (eg egg yolk, broccoli, meat, Brewer's yeast, etc), but the amount is small, and absorption is also poor.

Researchers in Taiwan discovered that mother's milk contains abundant trivalent chromium in a stable form (lactoferrin chromium), which is also easily absorbed. That is why breastfeeding infants get plenty of it.

Using modern technology, the researchers have succeeded in producing lactoferrin chromium from cow's milk, which is almost identical to that from mother's milk. Taking lactoferrin chromium is expected to boost our GTF to healthy levels.

The product is now available as GTF milk powder or in capsules. Clinical (human) studies done in Taiwan have shown that the product significantly reduces fasting, as well as two-hour postprandial (after meal) blood glucose.

In addition, animal studies also show that GTF improves liver function and protects against fatty liver disease. GTF has anti-inflammatory properties; improves antioxidant enzyme activity; and improves Sirt1 longevity gene expression. All these could help delay ageing and a host of chronic diseases.

GTF was shown to protect against heart and brain infarction (tissue death). It also helps in weight management through modulation of leptin (one of the hormones that modify hunger sensation). Let us hope human studies will confirm this amazing array of benefits that GTF provides.

It is safe, and has no known side effects.

If you are diabetic and would like to try polypeptide-K or GTF, you should discuss it with your doctor first. You should not modify your drug dosages by yourself; your doctor should do that, should it become necessary.

Sometimes, it may take two to three weeks before any improvement is seen. You should plan to try for at least one month before deciding if it works for you.

Cinnamon

The addition of cinnamon into your diet is unlikely to be classified as a "therapy" that requires prior consultation with your doctor. I have included it here because, like many other spices, its benefits have been grossly underestimated.

Previously, I wrote about the goodness of curcumin (the active ingredient in turmeric).

Cinnamon, alone or with honey, has been used for ages as a traditional remedy for diabetes. Fortunately, modern research has justified this practice.

The polyphenols in cinnamon have been shown to activate insulin receptors on cells, allowing glucose to enter the cells and produce energy.

The improved insulin sensitivity has been shown to improve glucose control and reduce central obesity (study done by Penn State University College of Agricultural Sciences).

In an eight-week placebo-controlled study (published in Fertility and Sterility), cinnamon extract reduced insulin resistance in women with polycystic ovary syndrome. Another study (published in Journal of the American College of Nutrition, 2009) showed that cinnamon reduced oxidative stress and improved fasting blood glucose levels.

There were other studies that produced conflicting results. However, it has become clear that no standardised dose was used in these studies, and that researchers have also discovered that different cinnamon species give different results.

As spices have always surprised us with their special qualities (for example, cloves have the highest antioxidant powers, being many times stronger than that of the best fruits), I have full faith that further studies on cinnamon will prove it to be a good way to prevent or fight diabetes.

In the meantime, I continue to put lots of cinnamon in my food. And I just love cinnamon tea!

■ Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Rebuilding brittle bones

Posted: 19 Jan 2013 04:34 PM PST

Emerging studies are indicating that tocotrienols can help strengthen brittle bones, thus assisting those suffering from osteoporosis.

MANY overlook the importance of bone health, but as we age, our bones become thinner and start to lose their density. If left untreated, the decrease in bone density could lead to osteoporosis, a condition that is characterised by brittle bones and skeletal weakness.

Because the disease often progresses without any symptoms or pain, it is often not discovered until weakened bones cause painful fractures, usually in the spine, hip or wrist.

Fractures are the most dangerous aspect of osteoporosis as they can be debilitating and can lead to chronic pain and disability, especially in the elderly. Unfortunately, once you have had an osteoporotic fracture, you are likely to develop another.

The increased likelihood of falling due to old age further exacerbates the risk of incurring a fracture.

Although osteoporosis can affect anyone at any age, women are at the greatest risk of developing the disease after they hit menopause. This is largely due to the decreased oestrogen levels in a woman's body after menopause. Oestrogen plays an integral role in helping to prevent bone loss.

Genetics plays a huge role in determining one's risk in developing the disease. Women of Asian descent are particularly susceptible to developing osteoporosis after menopause. This is because Asian women above the age of 50 who are post-menopausal, have significantly lower bone density than any other group.

As such, Asian women have the highest incidence of osteoporosis. Recently, the United States National Osteoporosis Foundation (NOF) reported that up to 20% of Asian women over the age of 50 display symptoms of osteoporosis, compared to only 10% of non-Asian white females.

Meanwhile, only 5% of African American women who were examined showed any symptoms of osteoporosis.

In any case, in the first five to seven years following menopause, a woman can lose up to 20% of bone mass.

Despite its reputation, osteoporosis is not just an "old woman's disease". Other causes of osteoporosis include hyperthyroidism, and calcium and vitamin D deficiency. Prolonged immobility could also lead to the onset of the disease.

In men, androgen deficiency can also increase their risk of osteoporosis.

Prevention of osteoporosis begins with adequate calcium intake in youth, when bone mass is built. Building strong bones and reaching peak bone density with regular weight-bearing exercises and a healthy diet before the age of 30 is probably your best defense against developing osteoporosis.

Current treatment of the disease typically involves medications, an increased calcium and vitamin D intake, as well as increased participation in regular physical activity.

While there is no magic bullet cure for this disease (or to prevent all fractures), emerging studies suggest that there could be new hope for osteoporosis patients.

According to a study done by researchers from Universiti Kebangsaan Malaysia (UKM), tocotrienols, which are a part of vitamin E, can help strengthen brittle bones, thereby reducing the complications of osteoporosis.

The term vitamin E encompasses eight natural compounds: four tocopherols and four tocotrienols – each named alpha, beta, gamma and delta.

While most available vitamin E supplements in the market contain only mixed tocopherols, or alpha, beta, gamma and delta tocopherols, they only make up half of the vitamin E family.

Since the 1980s, awareness of alpha, beta, gamma and delta tocotrienols have been rising steadily in the scientific world.

Emerging evidence has shown that vitamin E tocotrienols are more potent in their antioxidant and anti-cancer effects than tocopherols.

These health-enhancing properties make tocotrienols an ideal addition to existing anti-ageing supplements.

Food sources rich in vitamin E include vegetable oils, nuts and seeds. However, tocotrienols are most abundantly found in palm oil fruit. About 75% of vitamin E from palm oil comprises tocotrienols.

Professor Dr Ima Nirwana Soelaiman, UKM's deputy dean for research and innovation in the Faculty of Medicine, who led the 15-year study on the effects of tocotrienol on osteoporosis, says their research has shown that tocotrienols are superior to tocopherols in helping to prevent, as well as treat, osteoporosis.

Prof Ima, who is also the head of the university's Bone Metabolism Research Group, explains that her research team had experimentally induced osteoporosis in laboratory rats and treated them with tocotrienols derived from palm oil.

"So far, our research has shown that vitamin E tocotrienols are effective in helping to prevent the onset of osteoporosis, as well as to help treat the symptoms of osteoporosis in these rats," she says.

"In fact, we have found that vitamin E tocotrienols can help restore osteoporotic bones it to their original condition."

In her studies, Prof Ima also discovered that tocotrienols can help improve bone integrity and structure in normal, healthy rats.

These findings suggest that regular doses of these palm oil-derived tocotrienols can be administered to healthy young adults to help increase their peak bone mass. This could help prevent osteoporosis later in life, she says.

"Tocotrienols may also be beneficial to patients with fractures resulting from osteoporosis, as they have been shown to accelerate fracture healing," she added.

Besides menopausal women, other individuals who may benefit from regular tocotrienol intake include elderly men and bed-ridden patients.

However, Prof Ima notes that these findings are still preliminary. She adds that her team in UKM hopes to conduct clinical trials in humans in the near future to confirm the effects of tocotrienols on bones.

Kredit: www.thestar.com.my

Ahad, 20 Januari 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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