Posts

No “Bones” About It…

Essential Fatty Acids and BonesEssential Fatty Acids may be a key ingredient in supporting bone health.

Essential fatty acids (EFAs) do not come to mind as the first thought in searching for nutritional answers regarding bone health.  “Recent evidence-based research, however, supports intervention with adequate amounts of specific nutrients including vitamin D, strontium, vitamin K, and essential fatty acids in the prevention and primary management of osteoporosis” (Genius, Clin Nutr. 2007).  Osteoporosis has become an epidemic in the Western World in recent years.  How do EFAs fit into this problem that plagues us especially as we get older?

When we think about osteoperosis, we think calcium.  Calcium and bone go together like salt and pepper.  Add in some vitamin D and that’s about it.  However, looking into it deeper we came up with a number of studies that say that EFAs should be right up front and strongly considered in our first line of bone defense.

Essential fatty acids are necessary to human survival, and are called essential because they must come from the diet; they cannot be made by the body.  The omega-6 and omega-3 fatty acids are the best known.  Learning that they are also important for bone health is something we need to know.

In vivo studies (that means in a living animal) have shown that supplementation with long chain n-6 poly-unsaturated fatty acids (PUFAs) in rats causes increases in intestinal Calcium absorption (Haag 2001).  Haag and his colleagues reported a higher total calcium balance and bone calcium content just by adding in either sunflower or safflower oil in their diet.

In another study pregnant female rats were made diabetic. They use a chemical called streptozotocin to duplicate the disorder in the animals.  They were then fed evening primrose oil (GLA) at 500 mg/kg/d throughout their pregnancy and found an almost complete restoration of bone ossification (process of laying down new bone) occurred just by adding in the primrose oils (Braddock, Pediatr Res. 2002).

Claassen et al, Prostaglandins 1995, found that the supplementation of essential fatty acids (EFAs) leads to increased intestinal calcium absorption and calcium balance. The main dietary EFAs they used were linoleic acid (LA) from sunflower oil and alpha-linolenic acid (ALA) from flax seed oil.  They were administered in a ratio of 3:1 which is very close to our 4:1 BodyBio Balanced oil.  The calcium balance (mg/24 h) and bone calcium (mg/g bone ash) increased significantly in the group that were on the EFAs as compared to the animals that were not given the oils.

Schlemmer et al, Prostaglandins 1999, found that if you make animal’s essential fatty acid deficient they flat out develop osteoporosis.  He then added in evening primrose oil (GLA) and completely reversed the loss of bone and reported positive effects on bone metabolism in both the growing male and female rat.

It certainly goes against what you might think.  Oils are thin, some of them even squishy, while bone is completely hard as a rock.  But leaning on our visual senses doesn’t work with body chemistry, obviously.

Bone remodeling is a life-long process where mature bone tissue is removed from the skeleton and is called resorption, while new bone tissue is formed.  It’s a process called ossification or new bone formation. These processes go on all the time and are managed by special cells that crawl along our bones and chew up excess bone growth, osteoclast.  There is another cell osteoblast, that busily does the opposite, laying down new growth where it’s needed.

In the first year of life, almost 100% of the skeleton is replaced.  In adults, remodeling proceeds at about 10% per year (Wheeless).  That means that in a span of 10 years our skeleton is brand new,  If the process is continuous those cells that do the work must be directly influenced by essential fatty acids, and if EFAs are needed to get the job done, well…

References

Genuis SJ, Schwalfenberg GK. Picking a bone with contemporary osteoporosis management: Nutrient strategies to enhance skeletal integrity. Clin Nutr. 2007 Apr;26(2):193-207

Haag M, Kearns SD, Magada ON, Mphata PR, Claassen N, Kruger MC. Effect of arachidonic acid on duodenal enterocyte ATPases. Prostaglandins Other Lipid Mediat. 2001 Aug;66(1):53-63

Braddock R, Siman CM, Hamilton K, Garland HO, Sibley CPGamma-linoleic acid and ascorbate improves skeletal ossification in offspring of diabetic rats. Pediatr Res. 2002 May;51(5):647-52.

Claassen N, Coetzer H, Steinmann CM, Kruger MC. The effect of different n-6/n-3 essential fatty acid ratios on calcium balance and bone in rats. Prostaglandins Leukot Essent Fatty Acids. 1995 Jul;53(1):13-9.

Schlemmer CK, Coetzer H, Claassen N, Kruger MC. Oestrogen and essential fatty acid supplementation corrects bone loss due to ovariectomy in the female Sprague Dawley rat. Prostaglandins Leukot Essent Fatty Acids. 1999 Dec;61(6):381-90

Wheeless Textbook of Orthopedics, Clifford R. Wheeless, III, MD.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Vitamin C For Bone Health?

skeleton-vitamin-cHow many bones are in the human skeleton? How come it’s on the inside? What does it do? Does anybody really care? Sometimes.

The human skeleton offers shape and protection to the body. It supplies a place for organs to attach or to be supported. It comprises 206 bones, the largest of which is the thigh (femur). It makes up about 15% of your body weight, part of which is water. This fifteen percent refers to ideal body weight, not to a 400-pound behemoth who is less than six feet tall. Infants have more than 206. The skull starts out with more than twenty bones, some of which fuse together during development. Besides helping you to move, bones make red and white blood cells in their marrow, and act as a storage house for minerals. It takes about twenty years to develop completely.

Bone is actually a type of connective tissue, obviously denser than cartilage, which is the flexible stuff at the flap of your ear (tragus) and the tip of your nose. Cartilage also makes the discs that separate your vertebrae from each other and the femur from the tibia at the knee. Bone tissue is heavily mineralized by a form of calcium called hydroxyapatite. Calcium is the mineral found in the greatest amount in the body, about ninety-nine percent of which is in bone. Phosphorus works with calcium to maintain bone health by combining to make hydroxyapatite. This aggregation helps bone to remodel—to break down and then to redeposit. Trace amounts of other minerals, including magnesium, boron, copper and zinc, stimulate bone growth. But there’s one element of bone health that is overlooked because it’s thought of as nothing more than an anti-oxidant—vitamin C, aka ascorbic acid.

In a study of prepubescent females done in Philadelphia, it was learned that specific bone parameters were positively affected by vitamin C, especially in combination with zinc. For every milligram a day of vitamin C intake, there was an increase in trabecular bone area (Laudermilk, 2012). That’s the porous part of a bone found in the center and at the end of a long bone, like the femur. It’s important to the manufacture of blood cells inside the red marrow. Because it’s porous, trabecular bone is not as strong as the harder cortical outer layer. As hormones change with development, bone requirements also change. This is why it’s necessary to lay down as much bone as possible in one’s early years. By the time a girl reaches thirty, she will have laid down all the bone she ever will, which is probably why a DXA scan compares/contrasts a patient’s bone density to that of a thirty-year-old. You can read about this at the NIH Osteoporosis and Related Bone Diseases National Resource Center website,
http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/bone_mass_measure.asp

If vitamin C intake promotes bone, then deficiency must degrade it. Too little vitamin C causes scurvy, the condition that once affected seamen who were deprived of fresh fruits and vegetables for prolonged periods. That doesn’t happen anymore; at least it shouldn’t. The sailors’ joints and muscles would hurt, they bruised easily, their gums would bleed, and their teeth would sometimes fall out. Since vitamin C is responsible for the formation of connective tissue, these occurrences seem relevant.  Spontaneous fractures caused by low bone mineral density, and considered to be induced by a failure of collagen synthesis, also characterize scurvy (Park, 2012). Deficiency of vitamin C is implicated in scurvy by the inhibition of osteoblast activity. You remember osteoblasts.  They’re the cells responsible for making new bone material.

Most animals do not require external sources of vitamin C because they can get it from glucose through their enzyme systems. Humans and other primates, guinea pigs, and fruit bats lack this ability, so they have to get it from their diets. Since fast foods have replaced fruits and vegetables, many of us may be vitamin C deficient in the absence of supplementation.  Lettuces, onions, apples and bananas don’t help. Citrus fruits, cruciferous vegetables and strawberries do. Besides diet, other lifestyle factors influence vitamin C status, especially smoking, a habit that seriously affects the neck of the femur (Sahni, 2008) unless ascorbic acid intake is considerably greater than the RDA. The dietary recommendation for vitamin C is that amount needed to prevent a condition caused by its lack, in this case, scurvy and its aftermath. Sixty milligrams a day is hardly enough to meet a human’s physiological and metabolic needs. The 400-pound gorilla at the zoo gets 4000 milligrams a day. Shouldn’t a 200-pound human get 2000, then?

Speaking of the femur…This is where the hip joint is, at the top of the thigh bone.  In a seventeen-year follow-up study conducted by Tufts University, those elderly (70-80 yrs.) in the highest third of vitamin C intake had significantly fewer hip and non-vertebral fractures than those in the bottom third, suggesting a protective effect of vitamin C on bone health (Sahni, 2009). It’s important to note that oral contraceptives may adversely affect vitamin C accumulation. Women who fail to supplement while taking hormones as oral contraceptives have lower plasma levels of vitamin C than those who do supplement (Kuo, 2002). This, however, would seem to be the case regardless of contraceptive use.  Concerning sex steroids, both estrogen and testosterone are important for developing peak bone mass (Riggs, 2002). In the case of hypogonadism, where sex glands produce little or no hormones, vitamin C stimulates bone formation (Zhu, 2012), allowing bone recovery in light of hormone deficit. This finding is particularly important to those at risk for osteoporosis, as may be such in developing countries, among the food insecure, and in men who have had certain treatments for prostate disease, including one called gonadotropin-releasing hormone, abbreviated GnRH  (Mittan, 2002).

Despite having lost the ability to synthesize vitamin C, humans can take supplements or increase dietary intake to avert the onset of osteoporosis, realizing that ascorbic acid can block osteoclast proliferation and bone loss while promoting osteoblast activity and bone remodeling.

References

Fain O.
Musculoskeletal manifestations of scurvy.
Joint Bone Spine. 2005 Mar;72(2):124-8.

Gabbay KH, Bohren KM, Morello R, Bertin T, Liu J, Vogel P.
Ascorbate synthesis pathway: dual role of ascorbate in bone homeostasis.
J Biol Chem. 2010 Jun 18;285(25):19510-20.

Kuo SM, Stout A, Wactawski-Wende J, Leppert PC.
Ascorbic acid status in postmenopausal women with hormone replacement therapy.
Maturitas. 2002 Jan 30;41(1):45-50.

Laudermilk MJ, Manore MM, Thomson CA, Houtkooper LB, Farr JN, Going SB.
Vitamin C and Zinc Intakes are Related to Bone Macroarchitectural Structure and Strength in Prepubescent Girls.
Calcif Tissue Int. 2012 Oct 18.

Lean JM, Davies JT, Fuller K, Jagger CJ, Kirstein B, Partington GA, Urry ZL, Chambers TJ.
A crucial role for thiol antioxidants in estrogen-deficiency bone loss.
J Clin Invest. 2003 Sep;112(6):915-23.

Mittan D, Lee S, Miller E, Perez RC, Basler JW, Bruder JM.
Bone loss following hypogonadism in men with prostate cancer treated with GnRH analogs.
J Clin Endocrinol Metab. 2002 Aug;87(8):3656-61.

NIH Osteoporosis and Related Bone Diseases National Resource Center
Bone Mass Measurement: What the Numbers Mean
January, 2012
http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/bone_mass_measure.asp

Park JK, Lee EM, Kim AY, Lee EJ, Min CW, Kang KK, Lee MM, Jeong KS.
Vitamin C deficiency accelerates bone loss inducing an increase in PPAR-γ expression in SMP30 knockout mice.
Int J Exp Pathol. 2012 Oct;93(5):332-40.

B. Lawrence Riggs, Sundeep Khosla and L. Joseph Melton II
Sex Steroids and the Construction and Conservation of the Adult Skeleton
Endocrine Reviews June 1, 2002 vol. 23 no. 3 279-302

Sahni S, Hannan MT, Gagnon D, Blumberg J, Cupples LA, Kiel DP, Tucker KL.
High vitamin C intake is associated with lower 4-year bone loss in elderly men.
J Nutr. 2008 Oct;138(10):1931-8.

Sahni S, Hannan MT, Gagnon D, Blumberg J, Cupples LA, Kiel DP, Tucker KL.
Protective effect of total and supplemental vitamin C intake on the risk of hip fracture–a 17-year follow-up from the Framingham Osteoporosis Study.
Osteoporos Int. 2009 Nov;20(11):1853-61.

Markus J. Seibel, Colin R. Dunstan, Hong Zhou, Charles M. Allan and David J. Handelsman
Sex Steroids, Not FSH, Influence Bone Mass
Cell. 2006 Dec 15;127(6):1079

Simon JA, Hudes ES.
Relation of ascorbic acid to bone mineral density and self-reported fractures among US adults.
Am J Epidemiol. 2001 Sep 1;154(5):427-33.

Zhu L-L, Cao J, Sun M, Yuen T, Zhou R, Mne Zaidi, et al.
Vitamin C Prevents Hypogonadal Bone Loss.
PLoS ONE (2012); 7(10): e47058.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

What’s A Nice Bone Like You Doin’ In A Joint Like This? (Part 1)

joint-pain-manIt hurts. It hurts when I get out of bed. It hurts when I bend down to pick up the laundry basket. Ooh, my knees! Yow, my shoulder! What’s goin’ on?

Could it be arthritis, the affliction of the musculoskeletal system that attacks the joints and is the main cause of disability among people over fifty-five years of age? Maybe so. The word comes from the Greek arthron, meaning “joint,” and the Latin itis, meaning “inflammation.”  Aha! Inflammation. Drat! Where did that come from?

Arthritis is not a single disease, but one that covers almost a hundred conditions, the most common being osteoarthritis, which generally affects older folks. Some forms, though, can strike at any age—even very young.

Of course, you know what a joint is. It’s held together by ligaments, the elastic bands that keep bones in place when you move. The surface of each bone is covered with cartilage to keep the bones from rubbing directly against each other, allowing smooth, painless movement. At least that’s how it’s supposed to work. The joint is surrounded by a kind of capsule that contains synovial fluid, which is secreted by membranes inside joint cavities, tendon sheaths and bursae (always found at friction points) to provide lubrication. If you have arthritis something goes wrong with the machinery, and what goes wrong depends on the kind of arthritis you have. It could be that the cartilage is wearing thin, or that fluid is in short supply, or that there is an infection, or that the body is attacking itself in an autoimmune response. It might even be a combination of these factors.

Of the many types of arthritis, osteo- is probably the best known and most often treated. This is where we will focus—after a brief rundown of the other types. (Otherwise, this would take lots of room. Look for separate mention in future musings.) Osteoarthritis is characterized by cartilage that loses elasticity and shock absorption. As cartilage wears down, tendons and ligaments stretch, causing discomfort. Eventually, bone rubs against bone, causing considerable pain. Symptoms start slowly and develop over time, getting worse. Stiffness, especially in the A.M., might go away with use of the joint. Sometimes spurs appear around the joint; sometimes swelling, too. Hands, knees, hips and the spine are worst hit.

Rheumatoid arthritis is downright inflammatory. Here, the synovial membrane is attacked, resulting in swelling and agony. Untreated, it can cause deformity. More common in women than men, RA usually strikes between ages 40 and 60, but young children may also be afflicted. Here, the same joints in each side of the body are painfully swollen, inflamed and stiff. Fingers, arms, legs and wrists are the most common targets. Hands may be red and puffy, and tender when touched. The smaller joints are noticeably affected first.

The signs of infectious arthritis, another type, include fever, joint swelling and of course, inflammation. Tenderness or sharp pain is common. Often these symptoms are linked to an injury or another illness. Most often, only a single joint is affected. Bacterial or viral invasion of the synovial tissue might be at the root.

Juvenile rheumatoid arthritis (JRA) attacks children under sixteen and presents as one of three types: pauciarticular, which is mildest; polyarticular, which is more severe; and systemic, which is the least common, but the worst because it can affect organs. With this form, there will be intermittent fevers that spike at night and suddenly disappear. Appetite and weight will fall. Blotchy rashes may appear on the extremities, and joints will swell and remain larger than normal.

The medications used to treat arthritis vary according to the type of arthritis. Analgesics help to fight pain, but do not necessarily address inflammation. Tylenol is one, but prescription narcotics may be recommended in some cases. Nonsteroidal anti-inflammatory drugs (NSAIDS) reduce both pain and inflammation. Ibuprofen and naproxen are available over the counter, and some require a prescription. These can cause stomach upset. Rub-on creams and ointments containing capsaicin, the component that makes hot peppers hot, are called counterirritants. Sometimes they work; sometimes not. Biological medicines are genetically engineered to target specific proteins involved in an immune response. You see ads for these on TV. Each of these different kinds of medications can have unpleasant side effects, ranging from simple gastric distress to susceptibility to serious infections to cardiac involvement. To add insult to injury, you have to stay out of the sun. So much for trips to the beach. We can’t forget steroids, such as cortisone. They can reduce pain, but they also reduce vitamin and mineral levels in the body, especially calcium.

Are there alternatives to drugs? Yes. The one most often used is glucosamine, often accompanied by chondroitin. Glucosamine works by stimulating the metabolism of chondrocytes—the cartilage cells—and the cells that make synovial fluid. Chondroitin is found in cartilage tissue, where it serves as the substrate for the joint matrix and works to pull water into the joint. When money is available for research, integrative therapies may be tested against allopathic treatments and placebos. Some results are real eye-openers, while others are ho-hum. Not only is glucosamine alone, as well as combined with chondroitin, well-tolerated, but also as effective as commonly used pharmaceutical interventions, and faster acting than any placebo (Lopes, 1982). A characteristic of natural treatments for an ailment is that, since they come from plants or animals as opposed to chemicals, they take longer to evoke a positive response. In a head-to-head comparison with ibuprofen, glucosamine did a better job of ameliorating pain after eight weeks of treatment than did the drug (Lopes, 1982), and did so for a larger group of people (Pujalte, 1980). As the quality of most merchandise varies from maker to maker along the continuum, so does the quality of supplements, realizing that cost is not the best indicator of grade (McAlindon, 2000). But, in the long run, glucosamine seems to be an ally in modifying the course of osteoarthritis (Reginster, 2001) and in maintaining (and even improving) structural integrity of knee joints (Bruyere, 2004). Drugs come with caveats, but so, too, do alternatives. It is not a good idea to take a supplement without at least a little guidance from someone who knows the territory, such as an integrative dietitian, a holistic-oriented physician, or some other credentialed practitioner. People don’t generally know that glucosamine could increase eye pressure in those with glaucoma. That’s the last thing they need (Murphy, 2013). And if you take a blood thinner or an aspirin a day, be careful about taking chondroitin because its chemistry is close to that of heparin and that could increase bleeding risk (Rozenfeld, 2004).

SAM-e, S-Adenosyl Methionine, is a naturally-occurring molecule distributed throughout the body that diminishes as we get older. It plays a role in more than a hundred biochemical reactions involving methylation, where it contributes to hormones, neurotransmitters, nucleic acids, proteins and phospholipids. In an early study of SAM-e effectiveness in treating osteoarthritis of the knee, hip and spine, patients found relief from morning stiffness, pain at rest and pain at movement in the first few weeks of the trial, which lasted for twenty-four months. No adverse effects were reported and none of the subjects dropped out (Konig, 1987). Mild nausea may occur with SAM-e, but that inconvenience is more bearable than the effects of drugs like Indomethacin (Vetter, 1987). What’s more, SAM-e has virtues beyond arthritis treatment. Remember that we mentioned the slowness of natural substance results. In a test at the University of California, it was learned that SAM-e is equal to celecoxib (Celebrex®) in the management of knee osteoarthritis, but slower in onset of action (Najm, 2004). If there is a problem with SAM-e, it’s the cost. However, the result is worth the outlay.

Prostaglandins are chemicals in the body that regulate several functions, including inflammation and vascular permeability. Some can start the inflammation ball rolling, while others can interrupt it. The activity of these proteins can be modulated by essential fatty acids in the omega-3 family, notably EPA, a component of fish oil and the downstream product of the alpha linolenic acid common to flaxseed oil. We know that essential fatty acids are just that—essential, meaning they must come from food or supplements because the body cannot make them. Decades-long studies have pronounced the efficacy of omega-3 fats in the management of arthritis—and other inflammatory conditions—by virtue of their capacity to tone down the pro-inflammatory and to lift up the anti-inflammatory substances that alleviate pain (Hurst, 2010) (Zainal, 2009).  A Welsh study performed at the beginning of the century noticed that n-3 fats, in a dose-dependent manner, were able to abolish the expression of pro-inflammatory mediators via a mechanism different from that of other polyunsaturated fatty acids (Curtis, 2002). Later study, also in the British Isles, found that n-3 fats reduced arthritic disease in laboratory animals inclined to suffer it (Knott, 2011). When glucosamine and n-3 fats were combined, the positive results were declared superior (Gruenwald, 2009).

Avoiding sugary foods and refined grains, and limiting red meats can do much to ease arthritic discomfort. Losing weight also helps by reducing stress on knees and hips, where the extra pounds squeeze cartilage into oblivion. Although moderate alcohol consumption is associated with decreased risk of arthritis, especially rheumatoid, it’s not recommended as a treatment. Nor is it a reason to start drinking (DiGiuseppe, 2012).

References

Bruyere O, Pavelka K, Rovati LC, Deroisy R, Olejarova M, Gatterova J, Giacovelli G, Reginster JY.
Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies.
Menopause. 2004 Mar-Apr;11(2):138-43.

Curtis CL, Rees SG, Little CB, Flannery CR, Hughes CE, Wilson C, Dent CM, Otterness IG, Harwood JL, Caterson B.
Pathologic indicators of degradation and inflammation in human osteoarthritic cartilage are abrogated by exposure to n-3 fatty acids.
Arthritis Rheum. 2002 Jun;46(6):1544-53.

Daniela Di Giuseppe, Lars Alfredsson, Matteo Bottai, Johan Askling, Alicja Wolk
Long term alcohol intake and risk of rheumatoid arthritis in women: a population based cohort study
BMJ 2012;345:e4230

Delle Chiaie R, Pancheri P, Scapicchio P.
Efficacy and tolerability of oral and intramuscular S-adenosyl-L-methionine 1,4-butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies.
Am J Clin Nutr. 2002 Nov;76(5):1172S-6S.

Gruenwald J, Petzold E, Busch R, Petzold HP, Graubaum HJ.
Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis.
Adv Ther. 2009 Sep;26(9):858-71.

Hedbom E, Häuselmann HJ.
Molecular aspects of pathogenesis in osteoarthritis: the role of inflammation.
Cell Mol Life Sci. 2002 Jan;59(1):45-53.

Hurst S, Zainal Z, Caterson B, Hughes CE, Harwood JL.
Dietary fatty acids and arthritis.
Prostaglandins Leukot Essent Fatty Acids. 2010 Apr-Jun;82(4-6):315-8.

Knott L, Avery NC, Hollander AP, Tarlton JF.
Regulation of osteoarthritis by omega-3 (n-3) polyunsaturated fatty acids in a naturally occurring model of disease
Osteoarthritis Cartilage. 2011 Sep;19(9):1150-7.

König B.
A long-term (two years) clinical trial with S-adenosylmethionine for the treatment of osteoarthritis.
Am J Med. 1987 Nov 20;83(5A):89-94.

Laudanno OM.
Cytoprotective effect of S-adenosylmethionine compared with that of misoprostol against ethanol-, aspirin-, and stress-induced gastric damage.
Am J Med. 1987 Nov 20;83(5A):43-7.

Lopes Vaz A.
Double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthrosis of the knee in out-patients.
Curr Med Res Opin. 1982;8(3):145-9.

Maccagno A, Di Giorgio EE, Caston OL, Sagasta CL.
Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis.
Am J Med. 1987 Nov 20;83(5A):72-7.

McAlindon TE, LaValley MP, Gulin JP, Felson DT.
Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis.
JAMA. 2000 Mar 15;283(11):1469-75.

Müller-Fassbender H.
Double-blind clinical trial of S-adenosylmethionine versus ibuprofen in the treatment of osteoarthritis.
Am J Med. 1987 Nov 20;83(5A):81-3.

Ryan K. Murphy, DO, MA; Lecea Ketzler, DO; Robert D. E. Rice, MD; Sandra M. Johnson, MD; Mona S. Doss, MA; Edward H. Jaccoma, MD
Oral Glucosamine Supplements as a Possible Ocular Hypertensive Agent
JAMA Ophthalmol. 2013; May 23:1-3.

Najm WI, Reinsch S, Hoehler F, Tobis JS, Harvey PW.
S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. [ISRCTN36233495].
BMC Musculoskelet Disord. 2004 Feb 26;5:6.

Pujalte JM, Llavore EP, Ylescupidez FR.
Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis.
Curr Med Res Opin. 1980;7(2):110-14.

Reginster JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O, Giacovelli G, Henrotin Y, Dacre JE, Gossett C.
Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial.
Lancet. 2001 Jan 27;357(9252):251-6.

Roush JK, Cross AR, Renberg WC, Dodd CE, Sixby KA, Fritsch DA, Allen TA, Jewell DE, Richardson DC, Leventhal PS, Hahn KA.
Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis
J Am Vet Med Assoc. 2010 Jan 1;236(1):67-73.

Soeken KL, Lee WL, Bausell RB, Agelli M, Berman BM.
Safety and efficacy of S-adenosylmethionine (SAMe) for osteoarthritis.
J Fam Pract. 2002 May;51(5):425-30.

Towheed TE, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC.
Glucosamine therapy for treating osteoarthritis.
Cochrane Database Syst Rev. 2001;(1):CD002946.

Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V, Hochberg MC, Wells G.
Glucosamine therapy for treating osteoarthritis.
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002946.

Vetter G.
Double-blind comparative clinical trial with S-adenosylmethionine and indomethacin in the treatment of osteoarthritis.
Am J Med. 1987 Nov 20;83(5A):78-80.

Zainal Z, Longman AJ, Hurst S, Duggan K, Caterson B, Hughes CE, Harwood JL.
Relative efficacies of omega-3 polyunsaturated fatty acids in reducing expression of key proteins in a model system for studying osteoarthritis.
Osteoarthritis Cartilage. 2009 Jul;17(7):896-905.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Sports Injuries: Young and Foolish

youth-footballBefore you think of us as overly refined pinky lifters, let it be known that we played rough and tumble when baseballs needed to be covered with friction tape, and the only head protection in the fall was attached to your scalp. B-ball entailed a fruit basket nailed to a telephone pole, dribbling in spite of the traffic, and using a ball borrowed when the high school coach wasn’t looking. Much can be learned from the sage counsel of a city-grown sandlot kid who survived the 1960‘s. Today, these activities are organized and supervised, right down to the altercations (which, in those good old days, were occasional blood-letting rituals). Youth sports build character. We learned that playing in high school and college.

The reasons for playing sports haven’t changed since the 1960’s, or the 40’s or the aught-5’s, as mentioned in a Canadian-American study done a few years ago (Gould, 2009). Here they are: to have fun (a term crying for definition beyond the inference that comes from observation), to improve old skills and to learn new ones, to be with your buddies, to get excited about things you might not be able to control, to succeed (read win), and to become physically fit (you can argue this as a primary or secondary goal), plus whatever else you can add.

In organized kids’ sports programs, the differences between youth and professional models of the sport occasionally—maybe even too often—get hazy. Professional sports have goals linked to entertainment and money. In pro sports, players are chattel to be bought, sold and traded. Even Willie Mays (to be admired for his character as much as for his basket catch) commented on being traded by the Giants late in his career,”All they seem to care about is what you did for them yesterday and what you can do for them tomorrow.” (Smith, 2002)

The pro’s job is to win. Professional managers don’t get extra credit for developing character. Those who lose file papers with the State at the end of the season…or sooner. The developmental model of sports has a different vision that is apparent in its name—development.  Despite the historical attribution, Vince Lombardi didn’t say that winning is the only thing. He said that striving to win is. This is where some coaches err in the management of youth teams, regardless of the sport. Popularity of a coach extends beyond the feelings of his or her players and their loyalty. The athletic director and board of education look for wins. Mom and dad look for playing time. The community expects to be proud. Even Sparky Anderson prefers that we ask our kids to compete for fun instead of building adult egos (Smith, 2002). Our kids need not be tokens in a board game of organized sports, where dad coaches may lack the training needed to teach the proper technique peculiar to that sport, and are even less versed in the area of physical and emotional development.

Our focus here is on football, the game where collisions are required by etiquette, where you run full speed into a wall, where injury at a young age can threaten the future of life and limb and mind so much so that Dr. Pietro Tonino of Loyola University’s Department of Orthopedic Surgery wants parents to ban football for their kids (Tonino, 2004). In the battle of Mack truck against VW Beetle, the winner is predetermined and the loser is headed for the body shop. Knee injuries, ankle sprains, shoulder and various overuse injuries are among the most commonly treated. Let’s not forget the heat stroke from summer practices. Lamentable is that a small percentage of football programs have a physician at the sidelines and even fewer have athletic trainers. In almost all community programs and in most high school programs the coach is the only staffer available to handle medical problems. At game time, at least in school programs, paramedics are often on the scene.

Ligaments are the tough, fibrous rubber bands that connect bones to other bones. Yank on one of these and you get a sprain, as opposed to a strain that is more common to a tendon or a muscle that gets overstretched. Either can put a player out of commission for some time. Contact sports and those that require gripping, like tennis or golf, put people at risk for strains. Running can sprain an ankle, the commonest joint so bothered, followed by the knee and wrist.

In football, helmets have not been found to reduce concussions (McGuine, 2013), the scariest of all injuries. Improper tackling techniques, lowering the head and leading with the head, cause serious head and neck injuries, regardless of helmet quality. In concussion, consciousness may be lost for a brief time, but changes in mental status, confusion and even amnesia are characteristic. Disorientation is common. About one in five high school football players will experience a concussion—or worse— in their short career (Langburt, 2001). Although lasting neurological problems may be unusual, the symptoms of post-concussion syndrome can last for months, and the danger of a second concussion is increased. There are no seatbelts in football…or soccer, or boxing, or hockey… After the first one, the second concussion should be prevented at all costs for someone who doesn’t get paid for playing.

During his rookie year with the Kansas City Chiefs, Hall of Fame linebacker Willie Lanier dove to make a tackle and was kneed in the head, suffering a concussion and a brain bleed. After that he never dropped his head to make a tackle. Helmet ramming as a tackling maneuver needs to halt.

There’s a movement to teach heads-up tackling, which looks more like a dance than the knee-pumping, arm-swinging, tripping and shoving match that tackling is. Keeping the head up and avoiding contact with the top of the helmet might not be the most effective way to drop an opponent, but it helps to address the “spearing” that has caused death among high school players. Youth sports need to be devoid of a professional modeling regimen, especially where kids are affected by a system that rewards only the most talented and capable and ignores those most in need of teaching and coaching.  While there’s no nice way to tackle someone, kids don’t have to start at the age of four. Few adults know that the NFL is being sued by more than 4,000 former players who claim that the league lied about, and covered up, evidence that football can cause long-term cognitive damage (Takeaway, 2013) (Hayes/CNN, 2011). After all, football is a demolition derby.

References

Balyi I.
Sport system building and long-term athlete development in Canada. The situation and solutions.
Coaches Report. The Official Publication of the Canadian Professional Coaches Association. 2001;8(1): 25-28.

Tina L. Cheng, MD, MPH, Cheryl B. Fields, MPH, Ruth A. Brenner, MD, MPH, Joseph L. Wright, MD, MPH, Tracie Lomax, Peter C. Scheidt, MD, MPH,
Sports Injuries: An Important Cause of Morbidity in Urban Youth
Pediatrics. Vol. 105 No. 3;  March 1: 2000pp. e32

Covassin T, Elbin RJ, Nakayama Y.
Tracking neurocognitive performance following concussion in high school athletes.
Phys Sportsmed. 2010 Dec;38(4):87-93.

Faude O, Rößler R, Junge A.
Football Injuries in Children and Adolescent Players: Are There Clues for Prevention?
Sports Med. 2013 May 31.

Ferry T. Game on: the All-American race to make champions of our children. New York, NY: Hyperion; 2008.

Barry Goldberg, Philip P. Rosenthal, Leon S. Robertson, James A. Nicholas
Injuries in Youth Football
Pediatrics. Vol. 81 No. 2; February 1, 1988: pp. 255 -261

Gould D, Carson S.
Myths surrounding the role of youth sports in developing Olympic champions.
Youth Studies Australia. 2004;23: 19-26.

Gould D.
The professionalization of youth sports: it’s time to act!
Clin J Sport Med. 2009 Mar; 19(2):81-2.

Matthew M. Grinsell, MD, PhD, Kirsten Butz, MD, Matthew J. Gurka, PhD, Kelly K. Gurka, MPH, PhD, and Victoria Norwood, MD
Sport-Related Kidney Injury Among High School Athletes
Pediatrics. Vol. 130 No. 1; July 1, 2012: pp. e40 -e45

Ashley Hayes and Michael Martinez, CNN
Former NFL players: League concealed concussion risks
July 20, 2011 7:16 p.m. EDT
http://www.cnn.com/2011/HEALTH/07/20/nfl.lawsuit.concussions/index.html

Langburt W, Cohen B, Akhthar N, O’Neill K, Lee JC.
Incidence of concussion in high school football players of Ohio and Pennsylvania.
J Child Neurol. 2001 Feb;16(2):83-5.

Harold Mandel
Sports Medicine physician urges parents to say no to football (Video)
Health News. July 23, 2013
http://www.examiner.com/article/sports-medicine-physician-urges-parent-to-say-no-to-football

McGuine, Timothy
Presentation, American Orthopaedic Society for Sports Medicine annual meeting, Chicago
July 13, 2013

Radelet MA, Lephart SM, Rubinstein EN, Myers JB.
Survey of the injury rate for children in community sports
Pediatrics. 2002 Sep;110(3):e28.

Rizzone K, Diamond A, Gregory A.
Sideline coverage of youth football.
Curr Sports Med Rep. 2013 May-Jun;12(3):143-9.

Smith. RE and SmollFL, 2002; Way to Go, Coach, Portola Valley, CA: Warde Publishers, Inc.
http://fscs.rampinteractive.com/collingwood/files/association/youth_sports.pdf

The Takeaway
NFL faces class action lawsuit from thousands of former players
Published 01 February, 2013 08:00:00
http://www.pri.org/stories/arts-entertainment/nfl-faces-class-action-lawsuit-from-thousands-of-former-players-12846.html

Tonino PM, Bollier MJ.
Medical supervision of high school football in chicago: does inadequate staffing compromise healthcare?
Phys Sportsmed. 2004 Feb;32(2):37-40.

West TA, Marion DW.
Current Recommendations for the Diagnosis and Treatment of Concussion in Sport: A Comparison of Three New Guidelines.
J Neurotrauma. 2013 Jul 23.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.