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Dr. Gregory Pais, ND
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Home arrow Naturopathic News arrow Issue #131 August 2013
Issue #131 August 2013
Welcome to this Special Arthritis issue of Naturopathic News, issue #131. It's my mission to help you find optimal solutions to health problems. This newsletter is one way to do that. The more educated you are about your health options the better able you will be to take control of your health. If you would like to stop receiving my newsletter please send me an email and let me know. If you have a friend or family member who you think would appreciate the information provided, send me their email address. 

Living Arthritis Free
Monday, Aug. 19, 2013; 6-7:30pm
Lowry Theater, James V. Brown Library, Williamsport

Steps to Arthritis Free Living
Live Arthritis Free
Is it possible to live free of arthritis? Are there lifestyle changes you can make to live arthritis free? How do you do prevent arthritis from getting worse? Can arthritis be cured without drugs or surgery? What steps can you take to keep your joints healthy? Find out how to do this in the simplest way possible.

It’s estimated that 1 out of every 2 people will develop knee arthritis by age 85. That 1 out of 4 people will develop painful hip arthritis in their lifetime. An estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition; this represents approximately 1 in every 250 children in the U.S. By 2030, an estimated 67 million Americans ages 18 years or older are projected to have doctor-diagnosed arthritis. 

Come to this free lecture to learn how to avoid unnecessary surgery and drugs. Learn how to get well through a holistic approach—lifestyle, diet, nutrition, and homeopathy. Dr. Gregory Pais shares his 39 years of experience to help you stay healthy. Make a difference in yours and your family’s health. 

For those of you not currently working with me I want to give you a chance to learn a bit more in depth. For any topic I write about in this newsletter, or something of your own, you can ask for a free 30 minute consultation, by Skype or by phone. I have 2 openings available before the end of the month. If you’d like to learn more about the articles below or have a question to ask, email me to schedule a consultation. Just another way to say thanks for your support.
In preparing for my lecture, and the healing arthritis course I will be teaching, I ran across a 2006 textbook on arthritis, Arthritis, by DK publishing. A comment in the Foreword is the epitome of the essential difference between how I help my patients heal and the approach of conventional medicine.

Dr. Dore writes in the Foreword, “As a rheumatologist treating patients with arthritis, I see people affected in many different ways. No two cases of rheumatoid arthritis are exactly alike. No two people with osteoarthritis have the same experience. Regardless, physicians like me treat all patients the same (my emphasis).”

I agree wholeheartedly with the first part of this statement. People are affected in different ways. Gender, age, genetics, lifestyle, diet, other health issues—all are part of how one manifests their disease. No two cases are the same. This is why I don’t treat all patients the same. Homeopathy and lifestyle treatment depend on learning what each persons needs to heal. That’s why they are such powerful tools to help you heal.

Osteoarthritis (OA), the most common form, has been described as joint damage, resulting from various insults to the joint. The bones forming the vast majority of joints in the body are covered by a lining of cartilage where they come into contact with each other. The cartilage has no blood vessels, lymph ducts, or nerves and only very few cells, called chondrocytes. People therefore do not feel their cartilage, and it gets its nutrients from the fluid secreted by the joint lining cells (synovium). To the naked eye cartilage looks like hard, glistening whitish plastic.

Cartilage is made up of strands of type II collagen that hold long, complex sugars and proteins tightly in place. These molecules attract water very powerfully. When
weight is applied to the cartilage some of the water is squeezed out, and then as the weight eases off, the water is sucked back into the cartilage. This gives joints their sponginess and protects the bones from the constant jarring to which they would otherwise be subjected. Normal joints contain a small amount of synovial fluid, which provides nutrients to the cartilage and reduces friction between the cartilage on each side of the joint. 

This fluid is thicker at relatively low speeds, allowing smooth sliding while walking and running. At rapid speeds, however, it becomes elastic, providing give and bounce as, for example, when landing from a jump. In early OA, the character of the synovial fluid
changes so that there is more friction and less sponginess. The surface of the cartilage becomes worn and ragged. As the disease progresses, cracks develop in the cartilage and it becomes thinner.

Often there is low-grade inflammation, which contributes to the changes in cartilage and bone. The loss of shock absorption by cartilage puts increased stress on the underlying bone. This bone develops a thickened surface, growing protrusions around the edges of the joint (called osteophytes), and sometimes forming cysts in the bone.

As this protective layer of cartilage vanishes, the bone beneath becomes pitted and uneven, and the structural integrity of the joint is destroyed. Movement can become extremely painful and, in the worst cases, people who have severe osteoarthritis can no longer take care of themselves on a day-to-day basis.

Effective treatment of osteoarthritis includes the protection of the cartilage and synovial fluid in the joint against further destruction. In addition, it is important to stimulate restoration of joint cartilage and synovial fluid. Chondroprotective agents are compounds the body produces to regenerate cartilage and maintain healthy joint function. Chondroprotective agents protect and restore joint cartilage by a variety of mechanisms. They enhance development of chondrocytes, enhance the synthesis of synovial fluid, and inhibit free-radical damage to proteins and joint cartilage degradation by autoimmune processes.

Glucosamine is a naturally occurring substance. It is synthesized by chondrocytes for the purpose of producing joint cartilage. In osteoarthritis, glucosamine synthesis is defective, and supplementation with glucosamine has proven to be beneficial. The body uses the supplemental glucosamine to synthesize the proteoglycans and the water-binding glycosaminoglycans in the cartilage matrix. In addition to providing raw material, the presence of glucosamine seems to stimulate the chondrocytes to produce more proteoglycans and glycosaminoglycans. Glucosamine also inhibits certain enzymes such as collagenase and phospholipase, which destroy cartilage. By blocking pathogenic mechanisms that lead to joint degeneration, glucosamine prevents the progression of the disease, relieves symptoms, and can help the joint heal. 
DR. PAIS'S COMMENTS: Among all the nutritional supplements for osteoarthritis, glucosamine sulfate (GS) is what works best for my patients. It has to be of high quality and sufficient amount (1 gram glucosamine sulfate per 50# body weight). Commercial sources of glucosamine are from the exoskeleton of certain shellfish and are available as glucosamine sulfate. I do not see glucosamine HCl or chondroitin being as effective at all.

A France study has shown that patients with chronic musculoskeletal disorders had a 50% reduced usage of conventional pain medication by being under the care of a physician who specializes in prescribing homeopathic.

This study of 1,153 patients with musculoskeletal disorders compared treatments from conventional physicians (CM), physicians who specialized in homeopathic medicine (Ho), and physicians who engaged in a mixed practice of conventional and natural treatments (Mx). Some of the musculoskeletal disorders of patients who were included in this study were: Osteoarthritis, rheumatism, fibromyalgia, muscle spasms, tendinitis, rotary cuff syndrome, ankylosing spondylitis, intervertebral disc disorders, neck pain, torticollis, and spinal stenosis.

This study was approved by the French National Data-Protection Commission and the French National Council of Physicians. Prior to the start of the study, a higher percentage of patients who received care from a MD homeopath were found to have a "chronic" musculoskeletal disorder (61 percent), as compared with those going to conventional MDs (50 percent) or to MDs who practiced a mixed treatment (52 percent).

Despite the fact that the homeopathic patients were considered ill for a longer period of time, this study showed that the patients with chronic musculoskeletal pain had a 50 percent reduced use of conventional pain medication, while patients with acute musculoskeletal pain had a 38 percent reduced use. In addition to this significant reduction in the use of painkillers, the patients who received homeopathic treatment showed a similar clinical progression of their musculoskeletal disease as assessed by standardized functional scales.

The researchers acknowledged that musculoskeletal disorders are a leading reason for medical consultation in primary care. Because homeopathic medicine in France is only practiced by MDs, the researchers asserted that maintaining the present reimbursement schedule for homeopathic treatment keeps health care costs down.

At present, homeopathic medicine is the leading natural treatment offered by physicians in Europe, where approximately 40 percent of French physicians and 20 percent of German physician prescribe homeopathic medicines regularly. Further, approximately 30 percent of the European population has used homeopathic medicines at some time.
Rossignol M, Begaud B, Engel P, et al. Impact of physician preferences for homeopathic or conventional medicines on patients with musculoskeletal disorders: results from the EPI3-MSD cohort. Pharmacoepidemiol Drug Saf. 2012 Jul 11. doi: 10.1002/pds.3316. 
DR. PAIS’S COMMENTS: Dealing with ongoing pain is one of the most debilitating health issues. Any of you that have experienced this know what I mean. As a practitioner, pain is one of the most difficult issues to address. Anyone in pain wants it to be gone right now, immediately. The search for that magic pill that will make it all go away consumes us, even when we know that it doesn’t work that way.

Whether it’s pain from acute injury, surgery, drug reaction, trauma, or from a continuing disease process, the more we address underlying issues, the better the opportunity for healing. This can be the person who continues to run on asphalt even though they know it’s making their knee arthritis worse. It may be possible to make a difference with homeopathy, diet changes, supplements, etc., but until you stop running on asphalt (maybe stop running all together for a while) the knee isn’t going to get better past a certain point. 

If you’re habitually using your arms and shoulders in such a way that inflames the tendons in the elbow, your tennis game is going to make you hurt until you learn how to change your biomechanics. Probably need to have a good chiropractic adjustment as well. 

The toughest cases are those where either the pain is too strong, too long lasting, or too changeable, that the person has no idea where to begin to address it. Maybe they’ve changed their diet a bit. Took an over the counter homeopathic combination that said ‘arthritis’. Tried the latest multi level marketing arthritis miracle supplement. So they feel that nothing helps. They’ve resigned themselves to the knee replacement or the hip replacement because ‘there’s nothing else that can be done’.

That’s where homeopathy can really shine. If we can get a ‘good case’ and choose the best fitting homeopathic medicine, improvement will happen. Pain does change. It can go away.

BOSWELLIA SERRATA (Indian frankincense)
Chronic inflammatory conditions, including osteoarthritis, rheumatoid arthritis, and repetitive strain injuries debilitate thousands of people each year. Standard medical treatment is aimed at controlling the inflammation and pain associated with these conditions, and usually involves long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and/or steroids. These medications can cause serious side effects, ranging from bruising with aspirin to immune suppression with steroids. For decades, researchers have been searching for a drug that could control inflammation and pain without side effects. 

Over the last 30 years, the ancient herb frankincense (Boswellia spp.) has been shown to have anti-inflammatory properties. Since 1982, the gum resin of Boswellia serrata has been marketed in India for use in the treatment of rheumatoid arthritis, with no reported side effects. Several products made from B. serrata, are now commercially available in Europe and America.

The gum resin from B. serrata has been used extensively in conventional and Ayurvedic medicine to treat a variety of conditions. Among these conditions are: chronic ulcers, pain, inflammation, and rheumatic diseases. The traditional use of B. serrata gum resin in the treatment of inflammatory conditions is dependent on the activity of certain constituents. Citric acid should not be in your Boswellia supplement as it will adversely affect its activity and potency.

Inflammation is the physiological response to infection or injury aimed at destroying the infectious agent or repairing the damaged area. This process involves an increase of blood supply to the affected region, which allows immune agents to move to the area, resulting in the familiar symptoms of redness, heat, swelling, and pain. 

The anti-inflammatory activity of boswellic acids does not inhibit the same physiological mechanisms as NSAIDS. Hence there is no problem with bleeding (aspirin), or liver toxicity (acetaminophen, ibuprofen, etc,). Boswellia works in part by preventing the degradation of connective tissue that occurs in the inflammatory process. In addition, its anti-inflammatory activity do not cause generalized immune suppression associated with long-term use of steroid drugs.

In studies, treatment with Boswellia resulted in a significant reduction in pain, time duration of morning stiffness, joint score, and the disability score among patients with rheumatoid arthritis. Patients with osteoarthritis experienced a significant drop in severity of pain and disability score in response to treatment.
Kulkarni FR, et al. Efficacy of an Ayurvedic formulation in rheumatoid arthritis: a double-bind, placebo-controlled, cross over study Indian Journal Pharmacology, 1992; 24:98-101.
Kullcami FR, et al. Treatment of Osteoarthritis with a Boswellia formulation: a double-bind, placebo-controlled, cross over study Journal of Ethnopharmacology, 1991; 33:91-95.
DR. PAIS’S COMMENTS: Boswellia is one of the very few supplements outside of glucosamine sulfate that I’ve seen be useful for arthritis. Its usefulness seems to be limited in my patient population but for those few who respond to it, there is no doubt that it’s effective.

As is true for any herbal extract, the quality of what you’re using is paramount. If you’re Boswellia is from Walmart or some online distributor more than likely it’s worthless. Or, even worse, you use it and it helps a little. So you keep on using the crap product when you’d have faster, more effective care with the higher quality extract.

Findings from the University of Florida study suggest a protective effect for increased vitamin D levels against knee osteoarthritis pain.

A total of 155 patients with chronic knee pain, regardless of radiographic evidence of OA were recruited. Upon radiographic exam of the knees, 67% of participants had OA scores from 2–4 (mild to severe). Total serum vitamin D was. Of the patients, 73% had vitamin D levels < 30ng/mL and 9% had severe deficiency at < 10ng/mL.

Compared with vitamin D levels ? 25ng/mL, patients with vitamin D levels < 25ng/mL had greater self-reported OA symptoms including pain, stiffness, physical dysfunction and increased pain sensitivity to mechanical stimulation, respectively.

"Chronic pain is a disease," lead author Toni L. Glover, MSN, ARNP and her associates write. "The triage theory, proposed by Ames, hypothesizes long-term micronutrient deficiencies trigger chronic inflammation. In turn, chronic inflammation leads to chronic health conditions, many of which are characterized by pain as a disabling symptom.”
Journal Arthritis & Rheumatism, November 7, 2012
DR. PAIS’S COMMENTS: Though a small study, this demonstrates that a segment of the population with less than optimal Vit. D levels may be more likely to experience greater arthritis symptoms. A simple Vitamin D test and inexpensive supplementation can address this need.

This double-blind, placebo-controlled study involved 156 patients with osteoarthritis. Daily oral supplementation with Pycnogenol, an antioxidant plant extract from the bark of the French maritime pine tree, was carried out at a dose of 100 mg/day, for a period of 3 months.

This regime was found to reduce symptoms of osteoarthritis. It increased walking distance on a treadmill test (from 68 meters at baseline to 198 meters after treatment in the treatment group versus from 65 meters at baseline to 88 meters after treatment in the placebo group). It also decreased gastrointestinal complications as NSAIDS use were discontinued or decreased. Use of anti-inflammatory drugs was also reduced--58% reduction in treatment group versus 1% reduction in placebo group.
"Treatment of osteoarthritis with Pycnogenol. The SVOS (San Valentino osteo-arthrosis study). Evaluation of signs, symptoms, physical performance and vascular aspects," Belcaro G, Cesarone MR, et al, Phytother Res, 2008; 22(4): 518-23
DR. PAIS’S COMMENTS: Though Pycnogenol supplementation at this level is more expensive than GS it’s good to have another effective therapeutic for those rare occasions when glucosamine sulfate is ineffective or insufficient to the task.

There are a host of dietary approaches that can be effective in reducing arthritis symptoms. Eliminating gluten, restricting nightshade vegetables, taking GMOs out of your diet, discovering and eliminating food sensitivities—these are just a few. Any one of these and other dietary therapeutics may be the one that sets you on the road to healing and recovery. There’s so much to look at and it’s so particular to the individual that listing a couple of arthritis diets in this newsletter would more than likely miss the one that just might work for you. 

Diet and nutrition will be a significant part of the 6 week course on Healing Arthritis in planning for this Fall. Watch this space.

Here are some pages that are of particular interest:

Store: There are 401 products from Emerson listed on this page. If yours isn’t one of them please let me know and I will add it so you can order online. This is particularly convenient after hours or on the weekend. Of course, you can always order by phone from Emerson at 800-654-4432.

Newsletter: Here you will find all 131 issues of my health newsletter, "Naturopathic News”.

Optimal Health Points: This is my blog that I update periodically. Check out my latest post, “No Deaths From Vitamins, Minerals, Amino Acids Or Herbs”.

Come join my fan page at 
Help me bring information, news, and stories about natural medicine to the Facebook community. 

For those of you who don’t know, Facebook is a social networking website. Users can add friends and send them messages, and update their personal profiles to notify friends about themselves. Additionally, users can join networks organized by city, workplace, and school or college. 

Facebook pages help you discover new artists, businesses, and communities as well as those you already love. On my fan page I post discussions that you can join in with and relay breaking health news related to disease prevention, clinical nutrition, and ways to make you healthier. 

I’m looking forward to exploring this community with you. See you there!

As is often the case, a recent new patient asked if I would review their choice and use of supplements and herbs. Why does this happen so often? For many, taking a vitamin or herb is their introduction to natural medicine. Their desire to be healthier drives them to take supplements and herbs. The death, pain, discomfort, and side effects experienced with over the counter and prescription drugs compel people to look elsewhere. It’s very different with supplements and herbs which, when used correctly, have an incredibly low risk of harm.

Some people take this to an extreme and take every supplement or herb that someone tells them is ‘good for them’. It might be a clerk, an internet ‘expert’ source, or a friend who is marketing the latest or greatest fad. Most of these individuals or companies have no professional training or experience in the medical use of the supplements or herbs that they’re selling. The people they’re selling to come into my office with 5, 10, 15, or more supplements that they’re taking. Sometimes it’s been so long since they started taking them that they don’t remember why they’re doing it. When I ask, they can’t tell me what, if anything, a particular product is doing for them. Yet, they can be quite fearful of stopping any of these items, as if their health would careen off a precipice without them.

Why do I think my approach is any different? Partly, it’s because of my background. I’ve literally been working with nutritional supplements since 1974. That’s 36 years assessing the quality and effectiveness of supplements. Beginning in 1980 I started working with Western and Chinese herbs. The quality of herbs used and how they’re combined together has the greatest effect on the efficacy of the final product. Because I’ve grown, identified, harvested, and produced medicinal herbal products I recognize a good formula when I see one.

Licensed naturopaths like me receive the most extensive academic and clinical training in the use of nutritional supplements and herbal medicines of any professional in the United States. Nothing can substitute for such hands on experience, especially when you see, and are responsible for, the results of your treatments. Very different from the clerk in the store, or coworker who’s part of a MLM scheme. 

What I’m offering to is easy access to this experience and training. Both for you and your family. If you have questions about the supplements or herbs you are taking, or are thinking about taking, now is the time to ask. Send me an email with the brand and name of the product you’re taking. Let me know that you want to bring the bottles in at your next visit, so I can see what you’re taking. Start a discussion on my Facebook fan page. Either way I’ll give you honest feedback about what I think is good, or what isn’t. We’ll fine tune what you’re taking to maximize effect and eliminate waste. 

Let me hear from you and we’ll get started.

It just happened again the other day. A patient sent me a copy of the Vitamin D test she just had done. With frustrating results. The wrong test was done. After all these years, and all the information available, MDs and laboratories still order the wrong test. What a waste of money and time. 

For a long time I looked for a home Vitamin D test. One that would be simple, easy, and accurate to do on your own. I finally found one. ZRT Laboratory in Beaverton OR. ZRT emphasizes research and technological innovation. 

Until now, venipuncture blood serum has been the standard medium for testing Vitamin D. ZRT has developed and refined Vitamin D testing in blood spots. A few drops of blood from a quick and nearly painless nick of the finger, placed on a filter paper to dry are all that is needed. The total 25 (OH) Vitamin D is then determined by liquid chromatography/tandem mass spectrometry (LC-MS/MS). This method has been shown to be as accurate as the assay standard.

Ordering A Vitamin D Test 
ZRT allows anyone to order a Vitamin D test kit for $95 plus shipping and have it sent to their home. ZRT will let me prepay for kits and send them to my office for $55 each, plus $8 shipping. I am charging $65 per kit for patients to cover the total. 

If you are interested in getting a Vitamin D test done through my office please prepay so I can order you a kit. Then you can either pick it up at my office or have it shipped to your home. Once you’ve taken the sample and sent it back to ZRT it’s only a matter of time before your results are sent back to me. I can even look at them online before the mail arrives.

If your doctor has refused to order a Vitamin D test or worse, ordered the wrong one, this is the fastest, least expensive, most accurate way to do it ourselves. Once we know what your Vitamin D levels are, the next step is making sure that you achieve optimum levels for prevention of disease and maintenance of health.

I am often asked what supplements I recommend. Many of you have been surprised to discover that I favor food over pills; lifestyle changes over fads. I have been working with nutrition for over 30 years, herbs for over 20 years. Where and when appropriate I recommend them to my patients. I strive to act from knowledge, experience, and research.

Emerson Ecologics (800-654-4432) carries almost all of the nutritional supplements and botanical extracts that I think are useful. Their customer service is excellent and their delivery is reliable (often only 2-3 days to this region). It’s a great way to get physician quality products at reasonable prices. 

To offset the cost of shipping, reference my name when you establish your account and receive a 10% discount on every order. If you have any questions about these items feel free to email me.

That’s it for this issue of Naturopathic News. If you’ve thought a bit extra or learned something new, then I achieved my goal. As usual, if you have questions or concerns brought up by these subjects, let me know. 

Gregory Pais, ND, DHANP
580 E. 3rd. St.
Williamsport PA 17701
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