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Tuesday 3 February 2015

(First edited)) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Polymalagia Arthritis(Rheumatica, PMR)

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By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Polymalagia Arthritis(Rheumatica, PMR)

Polymalagia Arthritis is a condition a common inflammatory rheumatic disease causeing pain, stiffness and tenderness in large muscles, including muscles shoulders and pelvic girdle as a result of the presence of a synovitis in proximal joints and periarticular structures.

A. Signs and Symptoms
1. According to University of North Carolina School of Nursing in Greensbor, polymyalgia rheumatica (PMR) is a periarticular rheumatic condition, found in approximately 10% to 30% of people who have PMR characterized by
a. Pain and stiffness, primarily in the neck, shoulders, hips, and pelvic girdle.
b.Temporal arteritis (TA) or giant cell arteritis, the most common primary vasculitis in older adults, (3).

2. Other symptoms include
a. Fever and lumbar pain
Polymalagia Arthritis may causes symptoms of persistence of fever and lumbar pain. Administration of prednisolone (PSL) at 10 mg/day was found effectively for treatment of muscular pain involving the bilateral shoulders and forearms suddenly developed(4).
b. PMR is a rheumatic disease which mainly affects the elderly, and is seldom diagnosed in patients <50 years of age with symptoms of
b1. Spiking fever,
b.2. Malaise,
b.3. Fatigue,
b.4. Weight loss
b.5. Other features suggesting inflammation(5).
b.6. Pain and stiffness in the proximal muscles,
b.7. Anorexia,
b.8. Depression,
b.9. Temporal headaches(6).
c. Etc.

B. Causes and Rick factors
B1. Causes
The cause of PMR is not well understood, but researchers believe it is a result of the abnormal inflammatory activity of inflammatory cells and proteins of the immune system caused bt the presence of a synovitis in proximal joints and periarticular structures.
1. Genetic factors
Althernation of gene HLA-DRB1 is found to be associated to the susceptibility of development of polymyalgia rheumatica (PMR) in the Spanish populationin patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in the Spanish population.(7).

2. Environmental contagious factors
Environmental contagious factors could have trigger synchronous disease onset in up to one-fourth of the cases of polymyal-gia rheumatica (PMR(8).

3. Giant cell arteritis
Giant cell arteritis (GCA) is an inflammatory vasculopathy involved large- and medium-sized arteries causing vision loss, stroke and aneurysms. GCA occurs in people aged >50 years and shares the same pattern of age and sex distribution as PMR(9)
4. Etc.

B.2. Risk factors
1. Aging
If you are over 50 years of age, you are at increased risk of Polymalagia Arthritis (PMR). Polymyalgia rheumatica is a rheumatic disease which mainly affects the elderly, with approximately 16.8 to 53.7 per 100,000 of the population >50 years of age(10).

2. Diet
According to University of Manchester, high level of red meat consumption is a novel risk factor for inflammatory arthritis. It is also may be considered as a marker for a group of persons with an increased risk from other lifestyle causes(11).

3. Smoking
According to a study of 3 years among patients newly presenting with inflammatory polyarthritis (IP), smokers being more likely to develop nodules and to be RF positive, current smokers did not have higher levels of radiologic damage, and had fewer swollen joints(12).

4. Gender
If you are women, you are at increased risk to develop Polymalagia Arthritis(9).

5. Geography
The prevalence of Polymalagia Arthritis increased presently, but it remains lower than that in developed countries(13).
6. Etc.

C. Complications
1. Visual complications
Polymyalgia rheumatica (polymyalgia arteritic) may induce the developed evidence of cranial arteritis, following withdrawal of steroid therapy after apparent cure(14).

2. Stroke
Elder patients with PMR are susceptible to vascular events such as stroke, according to study of researchers at the Taipei Medical University(15).

3. Low back pain and MRI-abnormalities
Abnormalities in shoulder and hip joints are most common, but signs of cervical and lumbar interspinous bursitis might be found in patients with PMR(16).

4. Cervical interspinous bursitis
Cervical interspinous bursitis is a likely basis for discomfort in the neck found in all patients with PMR. (17).

5. Renal failure
Renal involvement in PMR is extremely rare. According to Dr. Javaid MM, patient with history PMR may develope nephrotic range proteinuria and rapidly deteriorating renal function secondary to AA amyloidosis within 18 months of the onset of symptoms of PMR(18).

6. Perforated colonic diverticular disease
Patients with polymyalgia may have perforated colonic diverticular disease which mimics their rheumatic pathology. Steroid therapy, which is the mainstay of polymyalgia therapy, can be harmful(19).

7. Cancer
Patients hospitalized for PMR and GCA had a marginally increased risk of cancer, with the highest risk noted for the first year after hospitalization, including skin cancer and leukaemia(21)
8. Etc.

D. Diagnosis
There is no specific test to diagnose Polymalagia Arthritis (PMR). If you are suspected to develop Polymalagia Arthritis, after a general physical exam, including the examination of shoulder motion, or swelling of the joints in the wrists, hands, etc., certain tests may be necessary.
1. Blood test(24)
a. Erythrocyte sedimentation rate (ESR) is the blood test to exam the red blood cells in a test tube. he higher the ESR value is an indication of inflammation.
b. C-reactive protein (CRP)
Blood test measures the levels of C-reactive protein (CRP) produced by the liver in response to an injury or infection and people with polymyalgia rheumatic.
c. Blod test for thrombocytes
Patient with polymyalgia rheumatica have an unusually high number of thrombocytosis. On the other hand, People with anemic polymyalgia rheumatica have a lower number of red blood cells than normal.
d. Rheumatoid factor (RF)
RF is an antibody, a protein made by the immune system presented in the blood of people with rheumatoid arthritis, but not in the blood of people with polymyalgia rheumatica.

2. Biopsy
Polymyalgia rheumatica is often associated with giant cell arteritis in biopsy. A small sample from the scalp artery in the emporal artery to examine under a microscope in a laboratory. These patients may initially present with symptoms referable to the head and neck(25).

3. Etc.

E. Preventions
E.1. The do’s and do not’s list
1. Reduce intake of saturated and trans fat and increase intake of omega 3 fatty acids
Although Limited studies have shown that certain dietary fatty acids (ie, oleic acid and alpha-linolenic acid) reduce biomarkers of inflammation. Null effects, or conflicting results have been reported with saturated and trans fatty acids(26). But according to the results of over 13 double-blind, placebo-controlled studies involving a total of more than 500 people suggest that omega-3 fatty acids may improve symptoms of rheumatoid arthritis. One of the ways it appears to work is by decreasing the production of inflammatory chemicals(27).

2. Increase intake of increasing the ratio of (n-3) : (n-6) PUFA
Intake mega 3 fatty acids may lead to reductions of the incidence of chronic inflammatory diseases as it increases the ratio of (n-3) : (n-6) PUFA(28).

2. Increase intake of fruit and vegetable
According to Tufts University, showed that FV variety, but not quantity, appears to be important in reducing inflammation(29).

3. Avoid high glycemic index diets
Other studies suggested that the consumption of high glycemic index diets, which have low fiber content and are rich in trans fat cause the activation of the immune system, leading to excessive production of pro-inflammatory mediators and the reduction of the anti-inflammatory ones(30).

4. Reduced intake of pro inflammatory foods, such as sugar, dairy products, red meat and processed, meat, alcohol, artificial ingredients, refined products, etc.

5. Increase in take of anti inflammatory foods, such as fresh vegetables and fruits, seeds and sprouts whole grain, fish, turkey, chicken, legumes, etc.

6. Stop smoking
Smoking is associated with increased of Polymalagia Arthritis.

7. Moderate exercise
Moderate exercise enhances immune function in fighting against inflammation and increase the blood circulation to provide nutrients to the body’s organs need.
8. Etc.

E.2. The diet
1. Organic Soy
Isoflavones, such as genistein, in organic soy is found to ne a useful tool to dissect regulatory pathways and may have potential use as novel antiinflammatory therapeutic agents(31).

2. Green tea
Green tea contains more amount of antioxidants than any drinks or food with the same volume, and is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from China.
a. Immune system
a. 1. Decaffeinated green tea in lower doses of administration is found to be optimum to enhance the immunity of rainbow trout(32).
a.2. EGCG, a phytochemical found abundantly in green tea, provide scientific evidence of the anti-rheumatic activity in many studies(33).

3. Olive oil
Olive is belongs to the the family Oleaceae, native to the coastal areas of the eastern Mediterranean Basin and south end of the Caspian Sea.
a. Olive oil phenolics
Olive oil phenolics of the Mediterranean diet showed a positive effects on certain physiological parameters, including plasma lipoproteins, oxidative damage, inflammatory markers, platelet and cellular function, and antimicrobial activity(34).
b. Antioxidants and weight lossMediterranean dietary pattern on plasma total antioxidant capacity (TAC) found that Mediterranean diet, especially rich in virgin olive oil, is associated with higher levels of plasma antioxidant capacity in reduction of body weight(35).

4. Salmon
a. Antioxidants
Vitamin E found in salmon showed not only having pro-oxidative activity, but actually increased the anti-oxidative capacity of the liver(36)
b. Selenium
Salmon containing trace minerals selenium is essential for the healthy function of the thyroid and immune system as it increases the antioxidant defense system by fighting against the forming of free radicals and reduce the risk of irregular cells growth causes of tumor and cancer, according to the study(37)
c. Omega 3 fatty acids
Omega 3 fatty acids is necessary to maintain the ratio of good and bad cholesterol, for reduction of the risk of cholesterol inflammation and plaque forming in the arterial wall, thus also decreasing the risk of stoke, according to the study(38).

5. Circuit fruits
Circuit fruit containing high amount of Quercetin showed to reduce the risk of Rheumatoid Arthritis through anti inflammatory and antioxidant effects
a. Anti-Inflammatory
According to Université du Québec à Chicoutimi , Chicoutimi, Québec, Canada.), flavonoids have been reported to possess beneficial effects in cardiovascular and chronic inflammatory diseases associated with overproduction of nitric oxide.
b. Free radical scavenger
According to the University Coimbra, Portugal), three-fisetin, luteolin and quercetin-are showed effectively in inhibition of free radicals.

6. Turmeric
Turmeric, is principal curcuminoid of the popular Indian spice, a rhizomatous herbaceous perennial plant of the ginger family, Zingiberaceae, native to tropical South Asia.
a. Anti inflammatory effects
In six human trials, curcumin showed to be safe and to be safe and demonstrated anti-inflammatory activity, through inhibition of a number of different molecules that play a role in inflammation(39).
b. Antioxidants
Curcumin, a component of turmeric, has been shown to be non-toxic, to have antioxidant activity, and to inhibit such mediators of inflammation in experimental animal models of a number of diseases, including arteriosclerosis, cancer, diabetes, respiratory, hepatic, pancreatic, intestinal and gastric diseases, neurodegenerative and eye diseases(40).
7. Etc.

E.3. Phytochemicals
1. Green tea Polyphenols
(-)-epigallocatechin-3-gallate (EGCG), the predominant green tea polyphenol showed to inhibit enzyme activities and signal transduction pathways that play important roles in inflammation and joint destruction in arthritis(41).
2. Curcumin
BDMC33, a curcumin Derivative found in curcumin, showed to exhibit its inflammatory action through activation of macrophage(white blood cell)-like cellular systems, related to chronic inflammatory diseases(42).

3. Resveratrol
Resveratrol (RES), a well-known antioxidant and anti-inflammatory compound, found abundantly in red wine has shown to exert numerous pharmacological effects, including hepatoprotection and cadioprotection(43).

4. Boswellic acid
Gum-resin extracts of Boswellia serrata used traditionally used in folk medicine for centuries to treat various chronic inflammatory diseases. Its antioxidant components are found to be responsible for inhibition of pro-inflammatory enzymes(44).

5. Cucurbitacins
High performance liquid chromatography-characterized (HPLC) dichloromethane fraction isolated from Wilbrandia ebracteata (WEDC) showed to inhibit the pro inflammatory parameters in experimental models of inflammation in vivo and in vitro(45).
6. Etc.

F. Treatments
Treatments
F.1. In conventional medicine perspective
1. Non Medication
The aim of non medical treatment is to control painful myalgia, improve muscle stiffness, and relieve the symptoms of constitutional features of the disease.
a. Fasting as part of a naturopathic treatment
Fasting may be formed part of polymyalgia rheumatica (PMR) treatment. According to the report of a 67-year-old woman with proven diagnosis of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR)(56).
b. Diet therapy
Leucine-rich milk and whey proteins may be a potential treatment of age related loss of muscle mass and strength, according to Helsinki University Central Hospital(57). Exercise and amino acid supplementation (AAS) together may be effective in enhancing not only muscle strength, but also combined variables of muscle mass and walking speed and of muscle mass and strength in sarcopenic women(58).
c. Etc.

2. Medical treatment
2.1. Tocilizumab (TCZ)
Tocilizumab (TCZ) is the first humanized interleukin-6 receptor-inhibiting monoclonal antibody developed to treat rheumatoid arthritis.
a. TCZ is highly effective and generally well tolerated(60)for improvement of refractory/relapsing GCA, TAK, or PMR(59).
b. Side Effects are not limit to
b.1. Dizziness
b.2. Headache
b.3. Allergic effects, such as rash; hives; itching; difficulty breathing, etc.
b.4. Skin changes
b.5. Tiredness or weakness
b.6. Etc.

2.2. Corticosteroids [CS] and nonsteroidal antiinflammatory drugs [NSAIDs])
2.2.1.. Corticosteroids, a drug, a common presentation in primary care, and non-selective non-steroidal anti-inflammatory drugs (sometimes also referred to as traditional NSAIDs or tNSAIDs) and selective cyclo-oxygenase 2 inhibitors (COX-2 inhibitors)(PMR) also be the first choice of treating of Polymalagia Arthritis(61).

2.2.2. Side effects
a. Corticosteroids [CS]
a.1. Corticosteroid withdrawal syndrome
b.2. Hyperglycemia
b.3. Insulin resistance
b.4. Diabetes mellitus
b.5. Osteoporosis
b.6. Depression
b.7. Colitis
b.8. Etc.

b. Nonsteroidal antiinflammatory drugs [NSAIDs]
NSAIDs may cause large intestinal ulcers, bleeding, and perforation, relapse of classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation). NSAIDs may occasionally cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs, however, frequently cause small intestinal inflammation, and the associated complications of blood loss and protein loss may lead to difficult management problems, according to King’s College School of Medicine and Dentistry(61).
2.3. Etc.

F.2. In Herbal medicine perspective
1. Comfrey
Comfrey used in herbal and traditional medicine to ease excessive bleeding or on open wounds, relief pain and swollen, treat circulation issues, reduce cholesterol, etc., is a perennial Plant in the genus of Symphytum, belonging to the family Boraginaceae, native to Europe.
Comfrey root extract ointment is well suited for the treatment of osteoarthritis of the knee, through Pain reduction, improvement of mobility of the knee improved and increased quality of life increased(46).

2. Devil’s claw
Devil’s claw, used as herb in traditional and herbal medicine to treat fever, rheumatoid arthritis, skin, gallbladder, pancreas, stomach and kidneys conditions, etc., also known as wood spider, is a plant of genus Harpagophytum in the family of Pedaliaceae, native to South Africa.
2.1. Antiinflammatory effects
Standardized ethanol Hp extract from Harpagophytum procumbens inhibits induction of pro-inflammatory gene expression, possibly by blocking pro inflammatory pathway(47).
2.2. Osteoarthritis
Devil’s Claw showed effectively in the reduction of the main clinical symptom of pain(48)(49).
2.3. Degenerative diseases of the musculoskeletal system
Extracts of the secondary tubers of Devil’s Claw (Harpagophytum procumbens) inhibits degenerative painful rheumatism effects through its analgesic, antiphlogistic and antiinflammatory actions(50)
2.4. Arthrosis of hip or knee
In observation of Preparations made from the secondary tubers of Devil’s claw (Harpagophytum procumbens) inhibits rheumatic diseases (arthrosis and low back pain) with a continuous improvement in typical clinical findings such as 45.5% for pain on palpation, 35% for limitation of mobility and 25.4% for joint crepitus, after administration(51)
2.5. Low back pain
Harpagophytum extract at a daily dose equivalent of 50 mg harpagoside may be used for treatment of acute exacerbations of chronic NSLBP(52).

3. Valerian
Valerian, used as a sedative and relaxing agent and to treat the liver, the urinary tract, the digestive tract problem, nerve conditions, etc.  is a perennial flowering plant, in the genus Valeriana, belonging to the family Valerianaceae, native to Europe and parts of Asia.
V. officinalis extracts showed to exert its antioxidant properties against iron in hippocampal neurons in vitro(53). The herb valerian may also be useful as a mild sleep aid in clinical populations, such as persons with rheumatoid arthritis, according to the research team at the University of Virginia, School of Nursing(54).

F.3. In traditional Chinese medicine perspective
Du huo Ji Sheng Tang (DHJST), the Chinese herbal medicine formula is to enhance the immune system and promote kidney’s Qi.
a. According to the Shanghai Municipal Hospital of Traditional Chinese Medicine, Du huo Ji Sheng Tang (DHJST) showed that at the end of the sixth week after surgery, significantly effects on osteoarthritis rabbits, through inhibition of stimulation of vasculogenesis and angiogenesis (VEGF) and HIF-1α expression(a modulator of degradation)(62).
b. Ingredients
1. Du Huo (Radix Angelicae Pubescentis)
2. Chuan Xiong (Rhizoma Chuanxiong)
3. Sang Ji Sheng (Herba Taxilli)
4. Ren Shen (Radix et Rhizoma Ginseng)
5. Du Zhong (Cortex Eucommiae)
6. Gan Cao (Rx et Rz Glycyrrhizae)
7. Niu Xi (Radix Cyathulae)
8. Dang Gui (Radix Angelicae Sinensis)
9. Xi Xin (Radix et Rhizoma Asari)
10. Bai Shao (Radix Paeoniae Alba)
11. Qin Jiao (Radix Gentianae Macrophyllae)
12. Sheng Di Huang (Radix Rehmanniae)
13. Fu Ling (Poriae)
14. Gui Xin (Cortex Rasus Cinnamomi)
15. Fang Feng (Radix Saposhnikoviae)(63)

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References
(1) http://www.ncbi.nlm.nih.gov/pubmed/14528524
(2) http://health.yahoo.net/channel/musculoskeletal-disorders.html
(3) http://www.ncbi.nlm.nih.gov/pubmed/11410767
(4) http://www.ncbi.nlm.nih.gov/pubmed/12462022
(5) http://www.ncbi.nlm.nih.gov/pubmed/19562970
(6) http://www.ncbi.nlm.nih.gov/pubmed/3388001
(7) http://www.ncbi.nlm.nih.gov/pubmed/15305244
(8) http://www.ncbi.nlm.nih.gov/pubmed/19646354
(9) http://www.ncbi.nlm.nih.gov/pubmed/21812500
(10) http://www.ncbi.nlm.nih.gov/pubmed/19562970
(11) http://www.ncbi.nlm.nih.gov/pubmed/15593211
(12) http://www.ncbi.nlm.nih.gov/pubmed/11229462
(13) http://www.ncbi.nlm.nih.gov/pubmed/18237382
(14) http://www.ncbi.nlm.nih.gov/pubmed/1223854
(15) http://www.ncbi.nlm.nih.gov/pubmed/22057203
(16) http://www.ncbi.nlm.nih.gov/pubmed/21262024
(17) http://www.ncbi.nlm.nih.gov/pubmed/18208867
(18) http://www.ncbi.nlm.nih.gov/pubmed/20969738
(19) http://www.ncbi.nlm.nih.gov/pubmed/20819228
(21) http://www.ncbi.nlm.nih.gov/pubmed/20299378
(23) http://www.ncbi.nlm.nih.gov/pubmed/11858317
(24) http://web.archive.org/web/20080623203621/http://www.mayoclinic.com/health/polymyalgia-rheumatica/DS00441/DSECTION=tests-and-diagnosis
(25) http://www.ncbi.nlm.nih.gov/pubmed/3619280
(28) http://www.ncbi.nlm.nih.gov/pubmed/22570770
(29) http://www.ncbi.nlm.nih.gov/pubmed/22696854
(30) http://www.ncbi.nlm.nih.gov/pubmed/18820806
(31) http://www.ncbi.nlm.nih.gov/pubmed/19281374
(32) http://www.ncbi.nlm.nih.gov/pubmed/21985858
(33) http://www.ncbi.nlm.nih.gov/pubmed/20447316
(34) http://www.ncbi.nlm.nih.gov/pubmed/19093267
(35) http://www.ncbi.nlm.nih.gov/pubmed/19707219
(36) http://www.ncbi.nlm.nih.gov/pubmed/18577222
(37) http://www.ncbi.nlm.nih.gov/pubmed/12730442
(38) http://www.ncbi.nlm.nih.gov/pubmed/20207121
(39) http://www.ncbi.nlm.nih.gov/pubmed/12676044
(40) http://www.ncbi.nlm.nih.gov/pubmed/16387899
(41) http://www.ncbi.nlm.nih.gov/pubmed/20462508
(42) http://www.ncbi.nlm.nih.gov/pubmed/22489138
(43) http://www.ncbi.nlm.nih.gov/pubmed/22480310
(44) http://www.ncbi.nlm.nih.gov/pubmed/22457547
(45) http://www.ncbi.nlm.nih.gov/pubmed/12927589
(46) http://www.ncbi.nlm.nih.gov/pubmed/17169543
(47) http://www.ncbi.nlm.nih.gov/pubmed/22072539
(48) http://www.ncbi.nlm.nih.gov/pubmed/17212570
(49) http://www.ncbi.nlm.nih.gov/pubmed/17212570
(50) http://www.ncbi.nlm.nih.gov/pubmed/10483693
(51) http://www.ncbi.nlm.nih.gov/pubmed/14669250
(52) http://www.ncbi.nlm.nih.gov/pubmed/15369596
(53) http://www.ncbi.nlm.nih.gov/pubmed/19191025
(54) http://www.ncbi.nlm.nih.gov/pubmed/15222600
(56) http://btcm.ehrenwerks.com/index.php?main_page=product_info&cPath=28_29&products_id=1938
(57) http://www.ncbi.nlm.nih.gov/pubmed/17848800
(58) http://www.ncbi.nlm.nih.gov/pubmed/21623468
(59) http://www.ncbi.nlm.nih.gov/pubmed/22674883
(60) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194518/
(61) http://www.ncbi.nlm.nih.gov/pubmed/9336424
(62) http://btcm.ehrenwerks.com/index.php?main_page=product_info&cPath=28_29&products_id=1938
(63) http://www.ncbi.nlm.nih.gov/pubmed/17848800

The best recipe for Diabetes: Olive and Lemon Juice Vinaigrette

Monday 2 February 2015

(Preview) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Gout

III. Causes and risk factors

A. Causes

The causes of gout is as the result of high levels of uric acid in the body, leading to forming of crystals causes of inflammation due to inability of your body in getting rid of uric acid.

B. Risk factors

1. If you body can not get rid uric acid quickly, intake foods with high levels of purine is associated to increased risk of gout.

2. According to the review of data base of Birmingham VA Medical Centre, 751 titles and abstracts, 53 studies met the criteria. Risk factors include
a. Alcohol consumption.
b. Meat intake, seafood intake, sugar sweetened soft drinks, and consumption of foods high in fructose.
c. Thiazide and loop diuretics.
d. Hypertension, renal insufficiency, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, diabetes, obesity, and early menopause.(2).

3. Genetics

Mutation of gene GLUT9 and ABCG2 is associated to increased risk of uric acid levels and gout(3).

4. Medication

Thiazide and loop diuretics users are at increased risk of gout(4).

5. Obesity, weight change, hypertension
a. Higher adiposity and weight gain are strong risk factors for gout in men,
b. Hypertension and diuretic use are also important independent risk factors for gout(5).
c. Obesity, hypertension, insulin resistance and metabolic syndrome(6).
d. Chronic renal failure.

6. Chronic kidney disease

Patient with Chronic kidney disease are at higher risk of gout. Serum uric acid control in gout was poor among patients without CKD and even worse among those with CKD(7).

7. Menopause

Menopause increases the risk of gout, whereas postmenopausal hormone therapy modestly reduces gout risk(8).

9. Etc.

III. Prevention
A. The Do’s and Do not’s list

1. Coffee

Long-term moderate coffee consumption is associated with a lower risk of incident gout in women(9).

2. Maintaining adequate fluid intake
Dehydrate is associated with the increased risk of gout. Drinking water or skim milk can improve gout control(10).

3. Weight reduction
Obesity is not only a risk factor for incident gout but is associated with an earlier age at gout onset(11).

4. Dietary changes
a. Reduce alcohol
Alcohol intake is strongly associated with an increased risk of gout. This risk varies substantially according to type of alcoholic beverage: beer confers a larger risk than spirits, whereas moderate wine drinking does not increase the risk(12).

b. Reduce intake of foods with high levels of purine, such as sardines, herring, kidney and sweetbreads, shrimp, etc. (14).

5. Reduce intake of medications which can cause gout by reviewing them with your doctor, such as Thiazide and loop diuretics.

6. Exercise
“Exercises to relieve gout should be done steady and cautiously as to avoid further irritation to the joints. The best exercises for gout are range of motion types: strength training, stretching and building endurance such as yoga 14a)
7. Etc.

B. Phytochemicals to prevent Gout
1. Quercetin and Rutin
According to Nanjing University, quercetin and rutin inhibited gout and hyperuricemia through theirs promotion of liver absorption and metabolism(15).

2. Morin
Morin (3,5,7,2′,4′-pentahydroxyflavone), a phytochemical found in the twigs of Morus alba L. documented in traditional Chinese medicinal literature to treat conditions akin to gout exert potent inhibitory action on urate uptake in rat renal brush-border membrane vesicles(16).

3. Other phytichemicals
Other phytochemicals, such as puerarin, myricetin, and kaempferol significantly reduced liver uric acid level in hyperuricemic animals(17).
4. Etc.

IV. Treatments
A. In conventional medicine perspective
A.1. Acetaminophen
a. Acetaminophen such as Tylenol can help to relive the pain of Gout.
b. Side effects if overdose are not limit to
b.1. Nausea and vomiting
b.2. Appetite loss
b.3. Sweating
b.4. Diarrhea
b.5. Irritability
b.6. Abdominal pain
b.7. Etc.

A.2. The options available for the treatment of acute gout (18)may include

1. NSAIDs

a. NSAIDs are commonly prescribed to control gout attacks in patients with hyperuricaemia.

b. Side effects are not limit to
Ingested NSAIDs may cause
b.1. Nonspecific colitis (in particular, fenemates)
b.2. Large intestinal ulcers, bleeding, and perforation
b.3. Classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation)
b.4. Small intestinal perforation, ulcers, and strictures requiring surgery.
b.5. Small intestinal inflammation
b.6. Complications of blood loss and protein loss (19).

2. Colchicine

a. Colchicine, used for a long period in gout, was approved for the first time in 2009 by the FDA for the prophylaxis and the treatment of acute attack, on the basis of a pivotal trial that showed the efficacy reduce pain in patients with acute gout – when given early in the very short term(20).

b. Side effects are not limit to

1. Diarrhea

2. Dizziness

3. Flushing

4. Hair loss

5. Headache

6. Loss of appetite

7. Nausea; sore gums

8. Stomach pain

9. Vomiting

10. Etc.

3. Corticosteroids

a. Corticosteroids are used to reduce and maintaine duric acid serum level below 60mg/L (360μmol/L).

b. Side effects are not limit to

b.1. Stomach irritation

b.2. Rapid heartbeat

b.3. Nausea

b.4. Insomnia

b.5. A metallic taste in the mouth

b.6. Etc.

4. Adrenocorticotropic hormone (ACTH)

a. Adrenocorticotropic hormone (ACTH) may be a useful agent in the therapy of acute gout but not suitable for prophylactic use in the prevention of acute gouty attacks(20).

b. Side effects are not limit to

According to the Children’s Hospital, Helsinki, and at the Aurora Hospital, Helsinki, during 1960–76.
Adrenocorticotropic hormone (ACTH) caused
Pronounced side effects, and the mortality was 4.9% with common complications of infections, septic infections, pneumonias, and urinary and gastrointestinal infections as well as arterial hypertension, osteoporosis, hypokalaemic alkalosis, and other marked electrolyte disturbances (21).

5. Intra-articular corticosteroids

a. Intraarticular steroid injections are injected directly into an affected joint to improve joint function.

b. Side effects are not limit to

b.1. Infection

b.2. Facial flushing

b.3. Local skin atrophy and depigmentation

b.4. Crystalline synovitis

b.5. Allergic reaction

b.6. Uterine haemorrhage

b.7. Etc.

The most important determinant of therapeutic success is not which anti-inflammatory agent is chosen, but rather how soon therapy is initiated and what the dose be appropriate.

B. In herbal medicine perspective
1. Artichoke
Artichoke (Cynara scolymus L.) leaves inhibited XO with only minimal inhibitory action at 100 microg/mL but the intraperitoneal injection of luteolin, an aqueous ALE, caffeic acid derivatives showed a decrease in uric acid levels(22).

2. Green teas
Epigallo catechin-O-gallate (EGCG), found abundantly in green tea, inhibited various diseases such as dermatosis, gout, atherosclerosis and cancer, through its anti-oxidant properties via antagonistic action in some inflammatory processes(23).

3. Alfalfa
In the article by By jeffwend, alfalfa reduced the amount of uric acid available to crystallize through increase uric acid levels in the urine(24).

4. Devil’s claw
Harpagoside, a Glycoside, the chemical, principle extracted from the Devil’s Claw root, contributes the natural anti-inflammatory properties and may be a potential agent for treatment of gout and other painful disorders of the Musculoskeletal system(25).

5. Purple Sweet Potato
In the study to investigate the hypouricemic effects of a
Anthocyanin extracts from purple sweet potato (APSP), and allopurinol, in a single oral dose of 100 mg/kg on hyperuricemic mice, reduced the serum uric acid concentration to 4.10 ± 0.04 mg/dL(26).

C. In Traditional Chinese medicine perspectiveAccording to TCM assistant, gout is a condition of a joint painful wind syndrome caused by
1. Damp-Heat

1.1. Painful obstruction due to the containment of Damp-Heat in the channels can lead to acute articular rheumatism, acute attack of gout, arthritis, hot joints, joint pain, tremors, dark urine, etc.

1.2. Chinese Herbal Formula Xuan Bi Tang used to clear and damp-Heat, unblock the Channels, eliminate painful obstruction, etc., may be used for treatment of gout
Ingredients include

a. Guang Fang Ji (Radix Aristolochiae Fangchi, Aristolochia Root, Stephania) – 15g. -expels damp heat in upper jiao, expels superficial swellings, induces urination

b. Xing Ren (Semen Pruni Armeniacae, Apricot Seed) – 15g. -regulates lung Qi and water metabolism

c. Yi Yi Ren (Semen Coicis Lachryma Jobi) – 15g. -tonify spleen, clear dampness, relieve painful obstructions

d. Can Sha (Excrementum Bombycis Mori, Silkworm Feces) – 9g. -tonify spleen, clear dampness, relieve painful obstructions

e. Ban Xia (Rhizoma Pinelliae Tematae, Pinellia Rhizome) – 9g. -dries dampness, transforms tubidity

f. Lian Qiao (Fructus Forsythiae Suspensae, Forsythia Fruit) – 9g. -clears superficial heat

g. Zhi Zi (Fructus Gardeniae Jasminoidis, Cape Jasmine Fruit, Gardenia) – 9g. -clear heat, drains dampness, induces urination

h. Hua Shi (Talcum, Talcum) – 15g. -clear heat, drains dampness, induces urination

i. Chi Xiao Dou (Semen Phaseoli Calcarati) – 9g. -clears heat, drains dampness, induces urination(28).

2. Recurrent Wind-Cold-Damp

2.1. Recurrent Wind-Cold-Damp painful obstruction in which localized constraint generates Heat can lead to acute attack of gout, arthritis, difficulty in movement, joint pain, edema of lower extremities, painful lower limbs, rheumatism;, swelling of joints, etc

2.2. Chinese herbal formula Gui Zhi Shao Yao Zhi Mu Tang used to disperses Damp and Wind, unblocks the Channels. moves Yang, etc., may be used for treatment of gout.

a. Gui Zhi (Ramulus Cinnamomi Cassiae, Cinnamon, Cassia Twig) – 12g. -warms and unblocks channels

b. Ma Huang (Herba Ephedrae, Ephedra Stem, ma-huang) – 6g. -unblocks channels, relieves superficial swellings

c. Fu Zi (Radix lateralis Aconiti Carmichaeli, Szechuan Aconite Root, Aconite) – 6g. -warms channels, relieves pain

d. Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis, Anemarrhena Rhizome) – 12g. -clear heat from the joints, nourish yin

e. Shaoyao (Radix Paeoniae , Peony Root) – 9g. -clear heat, nourish yin

f. Bai Zhu (Rhizoma Atractyloids Macrocephaelae, Atractylodes White Rhizome) – 15g. -harmonizes ying and wei Qi levels (Bai Shao)

g. Fang Feng (Radix ledebouriellae, Ledebouriella Root, Siler) – 12g. -expels wind and dampness

h. Sheng Jiang (Rhizoma Zingiberis officinalis Recens, Fresh Ginger Rhizome) – 15g. -promotes Qi circulation

i. Gan Cao (Radix Glycyrrhizae uralensis, Licorice Root) – 6g. -harmonizes other herbs within formula, regulates middle jiao(29).

3. Wind-Damp, Phlegm and Blood stasis

3.1. Wind-Damp, Phlegm and Blood stasis lead to acute attack of gout. arthritis, difficulty in movement, joint pain, edema of lower extremities, swelling of joints;, chills, etc.

3.2. Chinese herbal formula Shu Feng Huo Xue Tang used to disperses Damp and Wind, eliminates Blood stasi, ., may be used for treatment of gout.

a. Gui Zhi (Cinnamon twig, cassia twig) 2.5g

b. Qiang Huo (Notopterygium root, chiang-huo) 2.5g

c. Bai Zhi (Angelica root) 2.5g

d. Huang Bai (amur cork tree bark, phellodendron bark) 2.5g

e. Wei Ling Xian (Chinese clematis root, clematis) 2.5g

f. Cang Zhu (Atractylodes rhizome) 2.5g

g. Chuan Xiong (Sichuan lovage root, cnidium, Chuanxiong root) 2.5g

h. Hong Hua (Safflower flower, Carthamus) 1g

i. Gan Jiang (Dried ginger rhizome) 1g

j. Dang Gui (Chinese angelica root) 2.5g

k. Dan Nan Xing (P Arisaematis cum Fel Bovis) 2.5g

l. Han Fang Ji (Stephania root) 2.5g(30)

The best recipe for Diabetes: Kara's Vinaigrette

Sunday 1 February 2015

(Preview)Most common diseases of 50 plus - Diseases of Central Nervous system(CNS): TCM Dan shen treatments of Dementia Caused by Heart Qi Deficiency

Diseases of Central Nervous system

Dementia

About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability, severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people.

V. Treatments
C. In traditional Chinese Medicine Perspective(*)
Based on Chinese ancient medical records. causes of dementia are the results of (810)
C.2. Deficiency of Qi, mainly due to
C.2.2. Heart (Yang) Qi deficiency
Heart Qi deficiency is a condition of the inability of the heart in transportation of nutrients to body organs, including the brain through blood circulation. Prolong period of malnutrition of brain cells may induce abnormal function of brain's cells in information transmitting or death of neurons, causing cognitive impairment(844), including learning and memory deficits(842) and changes in brain tissue and behavior patterns(843)(842).
Herbal medicine for Heart Qi deficiency

1. Dan shen
Dan Shen is also known as Red Sage Root with taste of the bitter and slightly cold in nature, used in TCM as antithrombotic(845), antihypertonic (lowering blood pressure)(846), antimicrobial(847), anti-inflammatory(848)(849), agent and to treat coronary and cerebrovascular disease, dysmenorrhea, amenorrhea, hepatitis, hepatocirrhosis, restlessness, insomnia, irritability,(850) etc., by enhancing the functions of heart and liver channels.

Phytochemicals
1. Cryptotanshinone
2. Hydroxytanshinone,
3. Methyltanshinonate
4. Methylene tanshiquinone
5. Przewatanshinquinone A
6. Przewatanshinquinone B
7. Miltirone
8. Dihydrotanshinone I
9. Tanshinol A
10. Tanshinol B
11. Tanshinol C,
12. Nortanshinone
13. 1, 2, 15, 16-tetrahydrotanshiquinone
14. Danshensuan A, B, C
15. Protocatechuic acid,
16. Protocatechuic aldehyde
17. Etc.

1.1. Dementia
According to Mashhad University of Medical Sciences, dan shen in the pharmacological effects on the central nervous system, showed to exert its neuroprotective activity through antiparkinsonian, relaxant, analgesic and memory enhancing(850). In PC12 cells, combination application of salvianolic acid B (Sal B) and Ginkgo biloba extract EGb 761, effectively inhibited the formation of amyloid fibrils and protected PC12 cells(855) from beta-AP25-35-induced cytotoxicity and ROS accumulation(854).

1.2. Alzheimer's disease (AD)
Simple poly hydroxycinnamic acids and diterpenoid quinone, showed to improve cognitive deficits in mice model, through protection of neuronal cells, prevention of amyloid fibril formation and preformed amyloid fibril disaggregation related to Alzheimer's disease(851). Salvianolic acid B (Sal B)isolated from dan shen, in animal model, not only prevented Abeta-induced cytotoxicity(857) but also improved cognitive deficits and protection of neuronal cells(852), through its effects on suppressing the production of ROS, calcium flux, and apoptosis(853) and promoted amyloid precursor protein (APP) metabolism toward the non-amyloidogenic products pathway in cortical neuronal cell(856) and multifunctional machenisms(857). Compound Danshen Tablets (CDST), in rat model, exhibited spatial cognitive protection through decreased beta-APP expression in the cortex and hippocampus, detected via immunohistochemistry(859).

1.3. In learning and memory impairment
In diabetic rats model, dan shen injection improved the learning and memory decline, through upregulation of expression of MKP-1 in reduced inflammation(861) under hyperglycemia(860). HX106N, a Chimese herbal formula, containing dan shen, in Aβ25-35 peptide mice, enhanced on memory impairment and oxidative stress through increased levels of heme oxygenase-1 (HO-1)(862). In a joint study of renowned institutions, in mouse model, myelophil, a combination of extracts taken from Astragali Radix and Salviae Miltiorrhizae Radix, significantly exhibited its anti-amnesic properties in memory impairment, through the modulation of cholinergic activity(863). Tanshinones, a group of diterpenoids found in dan shen, improved learning and memory impairments, through its inhibitory effect on acetylcholinesterase(864)

1.4. In neuroprotective effects
Tanshinone IIA (Tan IIA), one of the major active constituents of dan shen exerted its neuroprotective effects, by inhibiting transcription and translation of genes involved AD development(858). In neurotoxicity of β-amyloid protein (Aβ) contributed Alzheimer's disease (AD), dan shen extract suppressed the increased intracellular reactive oxygen species levels, through deduction of decreased the protein expression involved in the development of neurodegenerative disease, including ADs(865). According to Eur J Pharmacol and University of Sydney, salvianolic acid B (SalB), in mouse model, exhibited neuroprotective effects in an amyloid β (Aβ) peptide-induced Alzheimer's disease, through its anti-inflammatory and anti-oxidative effects(866) and ameliorated cholinergic dysfunction- or Aβ(25-35)-induced memory impairment(867), respectively.
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Reprinted from Norton Journal, Volume I, Most Common Diseases of Ages of 50 Plus - Chapter of Diseases of Central Nervous system(CNS): Dementia - Treatments in Traditional Chinese Medicine by Kyle J. Norton

References
(842) http://www.ncbi.nlm.nih.gov/pubmed/25313575
(843) http://www.ncbi.nlm.nih.gov/pubmed/24224039
(844) http://www.ncbi.nlm.nih.gov/pubmed/23391905
(845) http://www.ncbi.nlm.nih.gov/pubmed/20451955
(846) http://www.ncbi.nlm.nih.gov/pubmed/21855622
(847) http://www.ncbi.nlm.nih.gov/pubmed/25272827
(848) http://www.ncbi.nlm.nih.gov/pubmed/23469598
(849) http://www.ncbi.nlm.nih.gov/pubmed/25525444
(850) http://www.ncbi.nlm.nih.gov/pubmed/16619340
(851) http://www.ncbi.nlm.nih.gov/pubmed/24393583
(852) http://www.ncbi.nlm.nih.gov/pubmed/17964692
(853) http://www.ncbi.nlm.nih.gov/pubmed/16890202
(854) http://www.ncbi.nlm.nih.gov/pubmed/17039773
(855) http://www.ncbi.nlm.nih.gov/pubmed/22314911
(856) http://www.ncbi.nlm.nih.gov/pubmed/19154776
(857) http://www.ncbi.nlm.nih.gov/pubmed/23703159
(858) http://www.ncbi.nlm.nih.gov/pubmed/24859152
(859) http://www.ncbi.nlm.nih.gov/pubmed/22594104
(860) http://www.ncbi.nlm.nih.gov/pubmed/25187809
(861) http://www.ncbi.nlm.nih.gov/pubmed/22320295
(862) http://www.ncbi.nlm.nih.gov/pubmed/24694662
(863) http://www.ncbi.nlm.nih.gov/pubmed/24690775
(864) http://www.ncbi.nlm.nih.gov/pubmed/17714702
(865) http://www.ncbi.nlm.nih.gov/pubmed/24932696
(866) http://www.ncbi.nlm.nih.gov/pubmed/23461850
(867) http://www.ncbi.nlm.nih.gov/pubmed/21903108