Friday, June 25, 2010

More lifestyle changes to reduce chronic inflammation

What's the big deal about inflammation? Well, researchers have been finding that it's a big deal when inflammation becomes chronic.  We're all familiar with the acute inflammation that occurs with a broken bone, scrape or infection. This is a short term, healing response to injury. The immune system responds with a cascade of events.  Once the threat or injury to the body has been addressed, the acute inflammatory response turns off.

Chronic inflammation arises when the immune system doesn't shut off.  It continues its healing response and the inflammatory cascade of events can occur for weeks, months or even years. You might think that having the immune system working all the time is a good thing. However, it's a case of too much of a good thing, because over time this abnormal response can damage body tissues. Research has identified that chronic inflammation can be the springboard for many diseases, like Alzheimer's, asthma, emphysema, bronchitis, chronic pain, various cancers, Type 2 diabetes, heart disease, inflammatory bowel disease, stroke and diseases where the immune system attacks the body's own tissues.

Clearly with chronic inflammation linked to so many diseases it's important to prevent it.  There are several lifestyle changes that make a big difference in limiting chronic inflammation: 

  1. Nutrition - According to the Linus Pauling Institute at University of Oregon, "Overall, studies suggest that diets rich in saturated fats, trans fats (hydrogenated or partially hydrogenated oils), and high glycemic index foods stimulate inflammation." The take away here is - avoid animal products, refined sugar, refined vegetable oils, and refined carbohydrates. 




      • Eat at least 5 and shoot for 7 servings of anti-oxidant rich, low glycemic index (GI) fruits and vegetables a day. You can find the University of Sydney's GI listing of foods here and the National Cancer Institute's list of anti-oxidant rich foods here. The table below shows a few of the anti-oxidant powerhouse foods. Note the serving sizes.
    Estimates of antioxidant capacities of selected foods. Micromole TE per household measure and grams. (Credit: USDA)
      • Eat wild salmon, walnuts, ground flaxseed, purified fish oil and leafy greens rich in the good Omega 3 fat. Exclude all commercially produced fats like those found in margarine, crackers, chips, cookies and deep fried foods like french fries.  Read food labels and be on the look out for partially hydrogenated oils.
      • Eat fresh herbs and spices that reduce inflammation like ginger, turmeric, green tea and nettles. The American Cancer Society lists oregano as the herb containing the highest levels of anti-oxidants. "It has 42 more times antioxidant activity than apples, 30 times more than potatoes, and 12 times more than oranges." Evidently good things do come in small packages because "gram for gram, oregano and other fresh herbs ranked even higher than fruits and vegetables that are known to be high in antioxidants." Check out the  Phytochemicals website here, for their list of the herbs and spices highest in anti-oxidants.
      • Eat whole grains and skip the refined, white flour. Whole grains have a lower glycemic index than refined grains and more fiber. The Whole Grains Council has details on types of whole grains and daily serving requirements here.
      • Speaking of whole grains, it's best to eat whole foods in general. They contain fiber and vital nutrients that are lost when foods are processed.
      • Another great resource for information on an anti-inflammatory eating plan can be found at Dr. Weil's website.  
     
  2. Physical Activity - Excess body weight and chronic inflammation are linked.  Studies have shown that "various forms of exercise decrease both acute and chronic inflammation" (Linus Pauling Inst.). This is because increasing physical activity usually has the effect of reducing body weight.  The more healthy the body weight, the less chronic inflammation results.
  3. Persistent Stress - Researchers are linking the ways physical and psychological stressors such as poor sleep, PTSD, and depression, trigger the inflammatory response and increase the risk of disease. Try to limit stress and get some sleep.
  4. Tobacco Use - Tobacco products contain toxins that cause inflammation to the mouth, throat and respiratory tract, among other things. Don't smoke and if you do, quit.
  5. Environmental Toxins - Take a look at your cleaning products. Learn what's in your water. Become familiar with which foods contain the most chemical residues here and which fish have the most mercury content here. Limiting your exposure to chemicals, airborne irritants and heavy metals, like mercury, is important in reducing chronic inflammation.
For more detailed information about the steps outlined above there are two books that I've found helpful: The Anti-Inflammation Diet and Recipe Book by Jessica K. Black, N.D. and The Whole Life Nutrition Cookbook by Alissa Segersten and Tom Malterre, MS, CN. 

Making lifestyle changes isn't easy. Attempting to tackle all of these suggestions at once may feel overwhelming. Try implementing one change at a time.  Since chronic inflammation is something we can't see or feel, it may not seem like that big of a deal.  However, as more research continues to reveal the increasing numbers of diseases being linked to chronic inflammation, it seems prudent to take steps to reduce this silent condition.

Sources:
http://lpi.oregonstate.edu/ss07/inflammation.html
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Common_Cooking_Herbs_Packed_with_Antioxidants.asp
http://www.fammed.wisc.edu/files/webfm-uploads/documents/outreach/im/handout_ai_diet_patient.pdf 
http://www.drweil.com/drw/u/ART02995/Dr-Weil-Anti-Inflammatory-Food-Pyramid.html
http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/ORAC/ORAC_R2.pdf 
http://www.ewg.org/ourfood
http://www.gotmercury.org/article.php?list=type&type=75

http://www.phytochemicals.info/research/antioxidants-herbs.php

Thursday, June 17, 2010

First step to reduce chronic inflammation

Eat your vegetables. I can't count how many times I heard my Mom say this and how often I repeated it to my children.  There really is wisdom in this statement, especially when it comes to reducing chronic inflammation, among other things.  It turns out vegetables, as well as other plant foods, contain something really good for us called phytochemicals.

Phytochemicals are chemical compounds that occur naturally in plants. Plant foods also contain essential nutrients. Phytochemicals and essential nutrients work synergistically, like a team, in the body.  Scientists aren't exactly sure yet how each specific phytochemical and nutrient in plant foods benefits the body. However, research clearly shows that phytochemicals have a positive impact on the process of chronic inflammation and the progression of cancer. As a matter of fact, some experts believe as much as 30-35% of all cancers are linked to poor nutrition! If you would like more information, check out "Cancer is a Preventable Disease that Requires Major Lifestyle Changes" written by a group of researchers from the M.D. Anderson Cancer Center.

It's also good to become familiar with what's called the glycemic index (GI) and the glycemic load (GL) of foods. The GI is a measurement of how fast a food causes your blood sugar to rise after you've eaten it. This is important because high GI foods cause insulin levels to rise rapidly and when this occurs repeatedly it can lead to a variety of health problems. The University of Australia has a great website, The Glycemic Index. It lists the GI and GL of thousands of foods.

I've also learned that specific vegetables are particularly important in reducing breast cancer.  These are cruciferous vegetables like broccoli, brussells sprouts, cabbage, cauliflower and kale.  These are nutritionally valuable because they contain something called indole-3-carbonyl (I-3-C), which helps in regulating certain enzymes that deal with estrogen metabolism.  This is especially beneficial for cancer that is an estrogen receptor positive type of breast cancer. 

So, the first step in reducing chronic inflammation is to eat more plant foods, and I'm not talking french fries here. That leads me to the next step: watching what oils you're eating, but that's for next post.  For now, I'm wondering...does beginning to take steps to reduce inflammation seem as overwhelming and daunting to you as it first did to me? I have learned that it's all doable, if I take it in steps. When I get discouraged it also helps to remind myself of the proverb, "Eat to live and not live to eat." This message makes sense to me, and although they're not my Mom's words of wisdom, they're just as motivating.


Sources
http://www.drmercola.info/2009/09/8-ways-to-avoid-chronic-inflammation.html
http://www.psychiatrictimes.com/display/article/10165/100433
http://www.cfp.ca/cgi/content/abstract/53/11/1905
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/
http://www.glycemicindex.com/
 http://lpi.oregonstate.edu/infocenter/phytochemicals/i3c/

Tuesday, June 15, 2010

Chronic inflammation and breast cancer

When it came time for me to consider treatments for early stage breast cancer, I learned that each treatment option had the potential to reduce the risk of the cancer recurring.  Even with the best of odds, I began to realize that there was no sure thing. Kind of like placing a bet, only instead of chips I was playing with my health! Scary stuff. If only, I wished, there was some way that doctors could better predict the chances of cancer returning. Well, my wishful thinking may be one step closer to becoming a reality!

Last month, an article published in the National Institutes of Health News discussed results of the National Cancer Institute's HEAL (Health, Eating, Activity, & Lifestyle) study. In this well conducted study, researchers were able to identify biological markers that may indicate poor breast cancer outcomes. The research report states that:
 "breast cancer patients with elevated levels of C-reactive protein (CRP) and serum amyloid A (SAA) were approximately two to three times more likely to die sooner or have their cancer return than those patients who had lower levels of these proteins, regardless of the patient’s age, tumor stage, race, body mass index, or history of previous cardiovascular issues."

Wow! These protein markers have the potential to identify breast cancer risk of recurrence in women who have had treatment and show no visible signs of cancer. This could contribute to a better understanding of why cancer returns in some women and not in others. Also, these biological markers could be indicative of why an initial breast cancer develops in 1 out of 8 women.  With this insight  women could have the ability to address risk factors with lifestyle changes. We all know that when it comes to disease, prevention is the first and best treatment of all!

So why are CRP and SAA important? They are both markers for inflammation.You might remember from a previous post that there are two kinds of inflammation: acute and chronic.  Acute inflammation is the beneficial response that occurs immediately after an injury to the body. Chronic inflammation is the same response in the body, but it occurs on a long term basis and can cause tissue damage.
 (Image from:DeNardo and Coussens Breast Cancer Research 2007 9:212   doi:10.1186/bcr1746)
 
Experts now believe that tumors are triggered by cancer stem cell growth in response to chronic inflammation. So in my mind the really big question is, how do I avoid chronic inflammation? Well, I'll get to that in my next post. My take away now is knowing I may be able to do things that potentially help prevent a recurrence of breast cancer. Obviously there's no sure bet, but it looks like the odds may be improving!

Sources:
http://www.nih.gov/news/health/may2009/nci-26.htm
http://appliedresearch.cancer.gov/cgi-bin-pubsearch/pubsearch/index.pl?initiative=HEAL
http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1417
http://breast-cancer-research.com/content/9/4/212/figure/F4?highres=y
http://www.cancer.org/docroot/cri/content/cri_2_2_1x_how_many_people_get_breast_cancer_5.asp

Wednesday, June 9, 2010

More on Breast Thermography

When my doctor suggested a breast thermogram he also mentioned that I should check with my insurance company to see if they covered it.  My insurance informed me that this screening test is considered experimental and unproven. I was surprised by this because from what I understand breast thermography has been approved by the FDA since 1983. So what's up?

Well, unfortunately it seems that thermography has become a victim of ethics and politics. According to Dr. William Cockburn, some less than ethical providers aren't adhering to testing protocol, or aren't qualified to interpret the thermograms.  These should always be read by doctors trained in thermography, just as doctors trained in radiology read mammograms. Politically, thermography is seen as competition with mammography. The American College of Clinical Thermography states that thermography  is a supplement to mammography, not a competitor. "In fact, thermography has the ability to identify patients at the highest risk and actually increase the effective usage of mammography."

I found several studies that underscore the effectiveness of thermography in detecting breast cancer. Research reported in the International Cancer Journal suggests that it shows considerable predictive value.  It's important to note that thermography and mammography do not diagnosis breast cancer.  This can only be done by pathology, but both screening tools do aid in detection.  Where thermography shines is in its ability to find abnormalities before they can be seen with mammography. This is especially important for young women who typically have denser breast tissue, which makes detection of irregularities more challenging with mammography. 

Another benefit of thermograms is their cost. Screening mammograms aren't routinely offered to women under the age of 40. Electing to monitor breast health with an annual screening thermogram is a more cost effective option than paying for a mammogram. With the recent advances in digital technology, current research in breast cancer screening is showing that "for breast cancer care, it has become possible to use thermography as a powerful adjunct and biomarker tool, together with mammography for diagnosis purposes." I think a thermogram is worth it.  What do you think?

By the way, if you're interested in finding a qualified thermography clinic in the US, this link lists them by state: http://www.thermologyonline.org/Breast/breast_thermography_clinics.htm
 



Sources:
http://www.breastthermography.org/paradigmshift.html
http://www.thermologyonline.org/Breast/breast_thermography_what.htm
http://www.biomedcentral.com/content/pdf/1471-2407-4-17.pdf
http://informahealthcare.com/doi/abs/10.1080/03091900600562040

Sunday, June 6, 2010

Breast thermography?

Isn't technology incredible? Especially when it works. My most recent remarkable medical technology moment occurred the other day when I had a digital infrared thermal imaging (DITI) test. DITI, or thermography, is a no contact, non-invasive screening tool. When I took the test all I had to do was stand in front of the scanner. There is no risk of radiation, no needles and no nuclear dyes.  Ladies, imagine no cold, glass plates clamping down on your sensitive body parts! A screening test with NO side effects.  Like I said, remarkable.


No side effects sounded great, but I wondered how does thermography work? From what I understand, we all radiate infra-red heat (think night vision goggles). Each of us has our own unique heat signature and usually these are fairly symmetrical. Symmetry is important in heat signatures, but more on that later.

Anyway, the thermography technician explained to me that as I stand in front of the scanner it converts the infrared heat radiating from my body into electrical impulses. As the image from Meditherm shows, these impulses are then computer mapped using different colors. A photo is taken of these colored heat patterns. This is called a thermogram. Each color on the thermogram indicates more or less heat coming off the body.

Of course, being the wondering type of person I am,  I questioned why I needed a thermogram when I've already had digital mammograms, a contrast MRI and a sonogram of my breasts. My doctor explained that a thermogram is about looking at physiology, which is the study of the function of the body's systems.  Whereas, a mammogram, MRI and sonogram are all about anatomy, which is the study of the body's physical structures. He went on to say that because of this they can be complementary tests. 

So what is significant about temperature imbalances in the body showing up on a thermogram?  Well, remember I mentioned that symmetry or balance of heat signatures in the body is important. My doctor explained that he compares the heat signatures from one breast with the other.  If an imbalance between them is noted he considers it a "thermal signal." A thermal signal may be the result of "increased vascularity". What's that? Well, it may indicate disease and in some cases cancer. According to the American Cancer Society (ACS), when cancer cells begin to grow they start out by using nearby blood vessels. But the tumor soon outgrows this blood supply and it begins angiogenesis - the growth of new blood vessels.  As a result, increased vascularity, or blood flow, occurs in the area of the tumor. This additional blood supply increases metabolic heat which shows up as a thermal signal on the thermogram.
 
Interestingly, "without new blood vessels, a tumor can't grow larger than about the size of a pin head (about 1 to 2 cubic millimeters)(ACS)." Cancerquest states that "a mammogram can detect tumors at very early stages, when they are around the size of a pencil eraser." So what about the period of growth between pin head and pencil eraser stage? This is where breast thermography is particularly useful. It has the potential to detect problems earlier than mammography and this allows for earlier intervention and treatment.

So you may be wondering, like I was, why thermography isn't offered as a standard screening tool for breast cancer? Why isn't it used in conjunction with mammography? Why doesn't my insurance company cover this test? I'll get into this in my next post.  



Sources:
http://degreedirectory.org/articles/What_is_Anatomy_and_Physiology.htmlhttp://www.meditherm.com/thermography.htm
http://www.acsevents.org/docroot/ETO/content/ETO_1_4X_Why_Do_Tumors_Need_Their_Own_Blood_Supply.asp
http://www.cancerquest.org/index.cfm?page=3223#Q19
http://www.radiologyinfo.org/en/info.cfm?pg=bodymr

Thursday, June 3, 2010

Part 2 - Self Myofascial Release Foam Rolling Techniques

The last post discussed the physiology of the self myofascial release technique (SMRT).  In this post you'll find animations of techniques that focus on specific areas of concern. The foam roller is being used in these descriptions.  However, depending on the area you're focusing on, there are other tools that may be more appropriate or beneficial. For example, a tennis ball, medicine ball, or a device called The Stick can be utilized with success. I haven't used The Stick myself, but I have found foam rollers and balls to be beneficial. I've included the Self Myofascial Release: Purpose, Methods and Techniques for reference. Just click on the title of this post for this excellent resource by Mike Robertson, MS, CSCS.

Form
Before we get into the actual SMRT exercises we need to discuss form. Form is always of critical importance when performing any exercise.  Be aware of your body positioning and alignment.  For example, when lying on your side make sure your elbow is directly under your shoulder.  Poor alignment and improper placement on the foam roller can lead to injury. Also, remember to breathe deeply while performing SMRT.

Pressure
There are several ways to increase or decrease the amount of pressure we place on a trigger point.  To increase pressure, for example, in the hamstring technique you would remove one leg off the roller. You can also use a denser (harder) foam roller.

Duration
I try to spend at least a minute rolling while I'm noting any trigger spots I feel. Then I locate the trigger point and hold pressure on the spot for 30 seconds to 1 minute.  This can seem like an eternity when you're feeling pain, however, the pain should decrease as you hold the position. The pain should be what I can only describe as a "working pain" and definitely not anything near excruciating.  Rule of thumb: Listen to your body. You should feel better after SMRT, not worse. 

Contraindications
Last, but not least, it's important to note that some experts suggest SMRT is appropriate when pain or inflexibility is present, but should be reduced or stopped once the issue has resolved. In addition, SMRT is contraindicated in certain situations including, but not limited to, a recent injury, circulatory problems, pregnancy, osteoporosis and hypertension.  Always check with your medical professional before beginning any exercise program.

Types of Foam Rollers

I prefer the longer roller because I can also use it for balance and stability exercises that require me to lay on it.  You may prefer the shorter roller for ease of transport.  Be aware of the various foam densities and textures. Click here for foam roller options.

SMRT exercises:



SMRT for Hamstrings
  • Position the back of the upper thigh on the roller. 
  • Make sure that your hands are placed directly under the shoulders.
  • If your wrists are uncomfortable you can raise up on your knuckles and straighten the wrists.
  • Roll until you find a trigger point(s). Hold until you feel a reduction in pain. Breathe. Release.
  • To increase pressure place one leg on top of the other.
  • To decrease pressure put one foot on the floor.





SMRT for Quadriceps
  • Lay face down with the front of the upper thigh on the roller.
  • Position elbows directly under the shoulders. Make sure your neck is aligned with your spine.
  • Maintain core strength. Think of drawing your navel in toward the spine.
  • Roll forward and back extending down the length of your thigh to the top of your knee until you locate a trigger point(s). Hold. Breathe. Release.



SMRT for Illiotibial Band
  • This particular SMRT can be particularly painful for some.  If this is the case remember to adjust the pressure as needed.
  • Lay on your side with your upper thigh on the roller.
  • Make sure your elbow is directly under your shoulder.
  • Keep the neck aligned with your spine.
  • Roll from the top of the thigh down to just above the knee until you locate a trigger point(s). Hold for 1-2 minutes. Breathe. Release and roll.


Sources:
http://www.optp.com/Foam-Roller-Therapy.aspx
animations from:
http://www.sport-fitness-advisor.com/self-myofascial-release.html

Tuesday, June 1, 2010

What's self myofascial release?

A few posts ago I discussed the merits of trigger point massage therapy.  If a trip to the massage therapist isn't possible, here's another option: self myofascial release technique (SMRT).  It sounds technical, but it isn't all that difficult to practice.  We've been using foam rollers for SMRT in our group exercise class.  Unfortunately, we haven't really had a chance to discuss the mechanics and benefits of this technique. So, why is SMRT helpful? The key is our body's fascia.

Just what is fascia? It's a thin sheath of tough connective tissue. It spreads throughout the body without interruption, from head to toe, in what I think of as a web. Fascia covers and separates different layers of tissue. It also encloses muscles. When an imbalance occurs in the fascia, pain usually results.

Remember the discussion of trigger point massage a few posts ago? It mentions how often times the pain we feel in one location isn't always at the actual site of injury. This is called referred pain. It's important to trace our pain to its source, or trigger point, in order to treat the cause of the pain and not just the symptom.
   
Dr. Michael Leahy's diagram  is a great illustration of what happens when we develop a trigger point. He calls the process the Cumulative Injury Cycle. I like that he begins the cycle with the term overwork. This word can describe injuries, repetitive motion or prolonged inactivity. It might seem contrary to use the word "overwork" to describe  prolonged inactivity.  However, if you think about sitting at a computer in one position for hours at a time it's easy to see how this could be a type of overwork for our muscles.

Let's take a closer look at overwork in the form of a soft tissue injury like a sprain or strain. Treatment at the acute phase of injury is usually with the RICE (rest, ice, compression, elevation) prescription. Then we'll typically follow this up with strengthening and stretching rehabilitation exercises. In a perfect situation the injury will heal and not cause us any chronic issues. Unfortunately, this is not the norm. 

Sometimes muscle imbalances can result from the injury. These imbalances are compounded by unequal tension in the body's fascia. Internal swelling occurs, blood flow is restricted to the area and scar tissue, or adhesions, form. Adhesions are also referred to as trigger points.  These result when localized areas of muscle and fascia bind together. Adhesions can change a muscle's ability to contract or lengthen. Pain can result.

What about Dr. Leahy's Cumulative Injury Cycle as it relates to other overwork, like repetitive motions or inactivity? These also can cause chronic muscle strain, imbalance and adhesions. Regardless of the cause, in order to break up these adhesions some form of deep tissue or trigger point massage is helpful. This is where you and the foam roller come in.

Basically here's what you do:
  • use your body weight to provide direct pressure to an area of concern, while rolling back and forth on the muscle/fascia. 
  • Once you find the trigger point, which is typically the area of greatest discomfort, you hold the pressure on that spot for 30-90 seconds or until you feel the discomfort subside. 
  • You need to work within your pain tolerance by applying less or more of your body weight on the roller and holding for more or less time. Focusing the pressure on this trigger point will help to break up adhesions. This will allow the muscle to return to its normal ability to contract or lengthen. The end result is less or no pain. It's not a magic bullet, but it helps.

In my next post I'll talk about the mechanics of SMRT and will post some illustrations of a few of the positions. I'll also include suggestions for rollers and other tools to use for your SMRT.

Happy rolling.

Sources:
Complimentary Therapies in Rehabilitation, Carol M. Davies
The Myofascial Release Manual, Carol Manheim