March 29, 2004 Research Update

James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com

Selenoprotein synthesis and side-effects of statins

I must admit that this biochemical pathway much have been covered while I was sleeping in biochemisty... I have always felt that the side effects from statin drugs was related to their inhibition of CoQ10 synthesis via the inhibition of the the enzyme HMG-CoA reductase. This enzyme produces mevalonate, which is a precursor to both cholesterol and CoQ10. Maybe the answer to patients who suffered fatal rhabdomyalisis (basically their muscles melted) lies somewhere with both mechanisms. I could envision a SNP (single nucleotide polymorphism) along both pathways that severely reduced these patient's antioxidant reserves. Either way, there are so many other ways to lower cholesterol that most patients would not have to use them if they were willing to make the right lifestyle choices.

The Journal : Back Issues

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Musculoskeletal pain in Europe

As a chiropractic physician, I am not surprised that the authors were basically beating up on the medical profession in their handling of musculoskeletal complaints. I see many patients in my office who's cases were not handled properly. I do not fault allopathic medicine for their lack of training and knowledge in musculoskeletal medicine--there is so much to learn it really is its own cirriculum. There just is not enough time in medical school to learn all of it. What I do have a problem with is physicians handling musculoskeletal complaints when they are not familiar or trained in them.

Ann Rheum Dis -- Abstracts: Woolf et al. 63 (4): 342

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Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease

If I have a dime for every time I heard someone say (in my office or otherwise) that they have arthritis I would be writing this from a small island in the Bahamas. I know that in my office it is rare that someone with arthritis does not get complete relief under my care. Did I get rid of the arthritis? Of course not. It's just that the arthritis was not causing their pain. Remember that arthritis is just something we find on xray--just because it's there does not mean it's the pain generator. This article confirms this--using ultrasound these authors found "subclinical" arthritits in high numbers. Of course--if these patients had no arthritis they should be in a lab somewhere trying to find out why.

Ann Rheum Dis -- Abstracts: Wakefield et al. 63 (4): 382

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Clinical comorbidity in patients with osteoarthritis

While we're on the subject, might I mention that much research points to osteoarthritis as a systemic disorder. Poor nutrition to the joint surface does not give the synovium the nutrients it needs to keep up with normal wear-and-tear. This article would support prior research along these lines--it's not just the joint surface getting poor nutrition, it's all other organs systems as well.

Ann Rheum Dis -- Abstracts: Kadam et al. 63 (4): 408

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Link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing

This is an interesting one. Although the diagnosis of fibormyalgia no longer seems to be the "flavor of the month," patients with symptoms that would match those in FM are still walking around. Here is my concern: I firmly believe that a relatively small amount of true FM patients really exist. I feel that FM is more of a systemic manifestation of IBS. Dysfunction of the GI tract can explain all the symtoms of FM if you follow the physiology. In this study, the authors found evidence of small bowel bacterial overgrowth in both IBS and FM patients, and the patients with more overgrowth the more likely they had somatic (muscle) pain. Research has shown that small bowel bacterial overgrowth can occur with anti-secretory therapy for GI complaints and from destruction of normal, protective bacterial flora. Some research has also shown the small bowel bacterial overgrowth will increase small bowel permeability--basically stuff is getting into the body that shouldn't be and the body has no choice but to react and attach the invaders. Then, following that further, small bowel bacterial overgrowth has been linked to non-alcoholic steatohepatitis. So, not only could we have an upregulated immune system from the leaky gut, but the liver is now likewise burdened. Put these together and you've got a recipe for FM.

Ann Rheum Dis -- Abstracts: Pimentel et al. 63 (4): 450

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Increased antigen and bacterial uptake in follicle associated epithelium induced by chronic psychological stress in rats

Okay, so we're not all rats. But this does suggest, and common sense will tell you, that chronic stress can have some serious, negative, long term side effects. In this study, the altered GI permeability will result in stuff getting past the GI tract into the body that should never get in. Now the immune system and liver have to deal with these invaders, and many times the liver is already overloaded from our chemical-laden lifestyles.

Gut -- Abstracts: Velin et al. 53 (4): 494

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Fatigue and primary biliary cirrhosis

And, just in case you were thinking, "so what if my liver is overburdened?" This study looked at patients with primary biliary cirrhosis--their livers were losing the ability to move things out of the body into the GI tract for elimination--and found that these patient's fatigue may be related to brain damage from increased manganese levels. Manganese elimination is via the bile, so these patients have a reduced ability to get rid of manganese and it accumulates in the brain. Really makes you appreciate just how interactive the human body systems truly are. As a side note, manganese has been implicated in violent behavior in institutionalized criminals.

Gut -- Abstracts: Forton et al. 53 (4): 587

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Requiring doctors to take part in continuing medical education doesn't improve heart attack care

The bottom line that is probably at the heart of why research takes decades to reach clinical practice is that many physicians' continuing education is sponsored by the drug companies. Every year there is a functional medicine symposium with some 20-odd experts in functional medicine. The cost is usually around $1000. I recently got an invite to a family practice symposium in CA with some 30+ speakers. The cost of this pharmaceutical sponsored symposium? $35 if you register early.

bmj.com Tanne 328 (7441): 664

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Severe Hypovitaminosis D in Patients w/ Persistant, Non-Specific Musculoskeletal Pain

I must admit that an article like this really does open up my eyes. I know that osteomalacia (softening of the bones) can present as generalized pain, but this is not something that I routinely check for in my office. The results of this article are definately eye-opening. Receptors for Vit D are found on every cell of the body, which means that Vit D has functions in all cells, most of which have not yet been identified. Serum levels of 25-hydroxyvitamin D are easily checked and are a good marker of Vitamin D status.

Selenoprotein synthesis and side-effects of statins

I must admit that this biochemical pathway much have been covered while I was sleeping in biochemisty... I have always felt that the side effects from statin drugs was related to their inhibition of CoQ10 synthesis via the inhibition of the the enzyme HMG-CoA reductase. This enzyme produces mevalonate, which is a precursor to both cholesterol and CoQ10. Maybe the answer to patients who suffered fatal rhabdomyalisis (basically their muscles melted) lies somewhere with both mechanisms. I could envision a SNP (single nucleotide polymorphism) along both pathways that severely reduced these patient's antioxidant reserves. Either way, there are so many other ways to lower cholesterol that most patients would not have to use them if they were willing to make the right lifestyle choices.

The Journal : Back Issues

Click here for more information