Laser therapy

The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial
Béla Hegedűs, László Viharos, Mihály Gervain, Márta Gálfi. Photomedicine and Laser Surgery. August 2009, 27(4): 577-584. doi:10.1089/pho.2008.2297.
Published in Volume: 27 Issue 4: August 20, 2009 Online Ahead of Print: June 16, 2009

Introduction: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).
Materials and Methods: Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4wk with a diode laser (wavelength 830nm, continuous wave, power 50mW) in skin contact at a dose of 6J/point. The placebo control group was treated with an ineffective probe (power 0.5mW) of the same appearance. Before examinations and immediately, 2wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded.
Results: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5°C increase in temperature—and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur.
Conclusion: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

Laser therapy

FDA Cleared for Osteoarthritis of the Hand. The Effects of Low Level Laser Therapy on Osteoarthritis (OA) of the Hand. A Clinical Study
Dr Larry Lytle, DDS, Ph.D. and Dr. Serafettin Ozdogan, MD

Conclusions: Laser can provide temporary relief of pain and stiffness arising from osteoarthritis of the hand.

“What should I do for a sprained ankle?”

Treatment of a sprained ankle can be separated into immediate first aid and longer term rehabilitation and strengthening.
• Immediate First Aid for a sprained ankle:
• Aim to reduce the swelling by RICE (Rest, Ice, Compression, Elevation) as soon as possible. Come into the office for an evaluation as soon as possible. The sooner I can start to treat the injury with the Laser the better it will feel.
• R is for rest. It is important to rest the injury to reduce pain and prevent further damage. Use crutches if necessary. I advocate partial weight bearing as soon as pain will allow. Getting you back to your activities of daily living will accelerate the rehabilitation process.
• I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (when used later). Apply an ice pack immediately following the injury for 15 minutes. Repeat this every hour.
• C is for compression – This reduces bleeding and helps reduce swelling. A wrap or bandaging technique is excellent for providing support and compression to a recently injured ankle.
• E is for Elevation – Uses gravity to reduce bleeding and swelling by allowing fluids to flow away from the site of injury. So put your feet up and get someone else to wait on you!

• Following the initial painful stage, there are other treatments that can help the ankle return to normal as soon as possible. Range of motion exercises such as ankle circles can help to get the ankle moving again, as well as reducing swelling if performed with the leg elevated. The calf muscles often tighten up to protect the joint following a sprained ankle, and so gently stretching the calf muscles can also help to maintain movement at the joint.

BREAKFAST and SNACK SUGGESTIONS

The following are some additional breakfast/snack options you may use to design your own dietary program.
Breakfast Suggestions
(275-325 calories)
Omelet made with 3 egg whites, 1 whole egg, and unlimited Category 1 vegetables, chopped and cooked with 1 tsp. olive oil
1 slice whole-grain toast
(servings: 1 protein, 1 grain, 1 oil)

¾ cup nonfat or lowfat cottage cheese
2 small fresh peaches
8 walnut or pecan halves, chopped, sprinkled with cinnamon
(servings: 1 protein, 1 fruit, 1 nut)

4 oz. plain lowfat yogurt or 6 oz. nonfat yogurt
1 ½ cups mixed strawberries, blueberries, and raspberries
2 Tbsp. sliced almonds
(servings: 1 fruit, 1 dairy, 1 nut)

½ whole-wheat pita
¼ cup nonfat or lowfat ricotta
1 ½ oz. smoked salmon/lox
Red onion slices
(servings: 1 protein, 1 grain)

1 poached egg
1 slice whole rye bread, toasted
1 half grapefruit
(servings: 1 protein, 1 grain, ½ fruit)

Scramble together 2 oz. tofu, 1/3 cup egg substitute
Category 1 vegetables, chopped; cook with 1 tsp. olive oil
1 Tbsp. Parmesan cheese
3 approved crackers
(servings: 1 protein, 1 grain, 1 oil)

Morning/Afternoon Snack Suggestions
(150-175 calories)
1 egg, hard-boiled
1 medium apple
(servings: ½ protein, 1 fruit)

1 medium pear
10 whole almonds
(servings: 1 fruit, 1 nut)

1 slice whole rye bread, toasted
1 Tbsp. almond butter
(servings: 1 grain, 1 nut)

1 medium carrot
Celery and cucumber sticks, unlimited
¼ cup hummus
(servings: ½ category 2 vegetable, 1 legume)

2 pieces turkey bacon
1 egg, hard-boiled
(servings: 1 protein)

1 small nectarine or peach, sliced
½ cup blueberries
4 oz. plain lowfat yogurt or 6 oz. nonfat yogurt
(servings: 1 fruit, 1 dairy)

Unlimited Category 1 vegetables, raw
1 Tbsp. tahini
3 approved crackers
(servings: 1 nut, 1 grain)

Benign Prostate Hyperplasia (BPH)

By the time you are 60 years old — if you’re a man — there’s a fifty-fifty chance that you’ll be suffering from an enlarged prostate. If you live long enough, your chances climb to 90%.

An enlarged prostate — a condition called benign prostate hyperplasia (BPH), is a non-cancerous swelling of the prostate. As your prostate begins to swell, you’ll typically feel the urge to make more frequent trips to the bathroom, your urine stream could be weak, and you’ll have a hard time finishing, you’ll probable dribble more than usual.

An enlarged prostate can also interfere with your sex life and your overall quality of life. Often an enlarged prostate is a symptom of a hormone imbalance in part due to testosterone and estrogen imbalances. A process called aromatization causes testosterone to be converted to estrogen, triggering both male breast development and/or prostate problems. Most doctors take a ‘watch-and-wait’ approach to an enlarged prostate. They figure if it doesn’t grow too fast and the symptoms don’t become too severe, then it’s something you can live with. If the symptoms get worse and become unmanageable, then the next option they recommend is surgery.

This is not the approach I recommend for my clients. There are many intelligent options and steps to try prior to recommending surgery. In fact, you can begin treating your enlarged prostate right away. Many of the same steps you take now for an enlarged prostate can also protect you from prostate cancer in the future — an unrelated condition. Natural approaches can be successful in relieving a lot of the symptoms that come with an enlarged prostate.
Caring for an Enlarged Prostate…

How to Slow Its Growth and Keep it From Becoming a BIG Problem

Most doctors chalk up an enlarged prostate to a natural part of the aging process. And that’s why they feel comfortable taking a hands-off approach until things get real bad!
This pro-active strategy is part of a therapeutic lifestyle change that improves the quality of your life and has the added bonus of cutting your risks of cancer. So, just how do you keep your prostate from growing out-of-control?

I emphasize a proper diet as a major to help prostate health. This involves a low carbohydrate diet. It’s also important that you be physically active. Daily physical activity helps. Research shows that men who get the most exercise reduce their risks of an enlarged prostate by 40%. Increasing your metabolism and preventing muscle wasting (especially of type II muscle fiber) by strength training is very helpful. Doing only cardio aerobics won’t help muscle from wasting, in fact it may add to it. Resistance exercise is the key.

The way to stop/reverse, or outright prevent poor quality testosterone build up, is by doing resistance training with bodyweight exercise, free weights, kettlebells, bands, or cables – I do not recommend weight machines because these do not resemble real life movements. Weight machines limit motion and enhance loss of flexibility. Where in real life are you sitting down and pushing weights other than in a gym? You might call the combination of diet and resistance training Prostate Fitness.

Most people don’t want to do or stay committed to the fitness portion. We’ve been brainwashed into using food as medicine, as a substitute for pills and potions, and that alone will do it for us. Don’t be lazy! Put a demand on your endocrine system so that testosterone is being used. Thirty minutes of high intensity weight training four-six times a week will restore your manliness.

Once you start eating right and taking care of your embodiment, many ailments/problems start to disappear – and instead of a swollen prostate, a new healthy guy comes to life.

The diet must include cruciferous vegetables like broccoli, cauliflower, or cabbage five to six times a week. Snacks that are high in zinc and magnesium are also beneficial to your prostate.

Higher levels of estradiol promote prostate enlargement and getting that under control reduces the problem. For some men, the problem is that testosterone gets converted to estradiol, especially if testosterone replacement uses patches or creams – less so with injections. The life extension foundation, while not mentioning prostate issues specifically, notes after a review of almost all the literature on estradiol that estradiol is best in men when it is within the 20-30 ng/ml range. Lower levels and higher levels than 20-30 ng/ml leads to a greater incidence of stroke, heart problems, bone thinning and other issues. The lab reference range goes from 0 to 50 or so.

Additionally, having high or low estradiol leads to Erectile Dysfunction (ED), depression, anxiety, lethargy, low motivation and a whole host of other problems that one’s doctor is prone to prescribe a wide range of drugs instead of testosterone replacement. Most often men require supplements to prevent Testosterone from converting to estradiol.

Some Physicians hold that DHT (5-alpha diHydroxyTestosterone) is the culprit of prostate health. Areas of the body rich in hair follicles are also rich in 5-alpha reductase, the enzyme producing DHT. That conversion can be thwarted by means of half doses of OTC progesterone (found in the menopause section of natural food stores).
Supplements
Supplements I recommend can be ordered on my website by clicking onto the Metagenics website.

Testralin is designed and intended for daily, ongoing support of the prostate gland and to balance hormones in aging males (40 years and older). In terms of mechanism of action:

- The vitamins and minerals in the formula (for example Vitamin B6, B12, and folic acid) support liver enzymes involved in hormone detoxification.
- The isoflavones and lignans support sex hormone binding globulin (SHBG) production and sensitivity.
- Isoflavones also have an inhibitory effect on 5-alpha reductase, the enzyme in the prostate that converts testosterone to 5-alpha dihydrotestosterone, the main prostatic androgen. Furthermore, isoflavones are also known to inhibit aromatase activity, the enzyme in adipose tissue that converts androgens to estrogens. Lastly, according to the article attached, since prostate cancers and BPH specimens can express estrogen receptors, their growth may also be inhibited by the antiestrogenic effects of isoflavones.
- Turmeric serves as an anti-inflammatory and the green tea catechins are powerful antioxidants that protect tissues from oxidative stress.

Tribulus Synergy (aka puncture vine) has traditionally been used (literally for more than 1000 years) as an aphrodisiac for males. It has recently been used as a performance enhancer by some former Eastern block countries. While the mechanism is not really known, it is felt that Tribulus Synergy decreases testosterone clearance as opposed to directly stimulating its production.

Ashwagandha, also referred to as “Indian Ginseng,” has also been traditionally used as a “tonic” for men. Finally, cowage/mucuna contains natural L-dopa, a side-effect of which is spontaneous erection.

Thus, the rationale for using Tribulus Synergy is more philosophical and in line with the traditional use of these herbs contained in the formula. While Tribulus has very controversial documentation in western literature, it is one of the oldest herbs in Traditional Chinese Medicine and is well respected in that circle.

1. Tribulus.
“… In castrated rats, increases in [testosterone] levels by 51% and 25% were observed with [testosterone] and [tribulus] extract respectively that were statistically significant. [Tribulus] increases some of the sex hormones, possibly due to the presence of protodioscin in the extract. [Tribulus] may be useful in mild to moderate cases of ED…” Phytomedicine. 2008 Jan;15(1-2):44-54. The hormonal effects of Tribulus terrestris and its role in the management of male erectile dysfunction–an evaluation using primates, rabbit and rat. Gauthaman et al.
2. Ashwagandha.
“…Withania somnifera, popularly known as Ashwagandha is widely considered as the Indian ginseng. In Ayurveda, it is classified as a rasayana (rejuvenation) and expected to promote physical and mental health, rejuvenate the body in debilitated conditions and increase longevity…” Prog Neuropsychopharmacol Biol Psychiatry. 2007 Sep 21 Withania somnifera: An Indian ginseng. Kulkarni et al.
3. Mucuna.
“…Mucuna pruriens possesses significantly higher antiparkinson activity compared with levodopa in the 6-hydroxydopamine (6-OHDA) lesioned rat model of Parkinson’s disease…” Phytother Res. 2004 Sep;18(9):706-12. Neuroprotective effects of the antiparkinson drug Mucuna pruriens. Manyam et al.

“…From animal research, there is ample evidence for a facilitating effect of dopamine on sexual behavior…These results support the view that dopamine is involved in the energetic aspects of appetitive sexual behavior in men…” Neuropsychopharmacology. 2005 Jan;30(1):173-83. Effect of a single dose of levodopa on sexual response in men and women. Both et al.

Other supplements often recommended are Nettle root (not leaf). This is a very good supplement to take if you’re suffering from benign prostate enlargement. Nettle inhibits the Aromatase and 5-Alpha Reductase enzymes that cause enlargement of the prostate, and it inhibits the binding of DHT to the prostate cells. Just don’t overdo it…take too much, or take it too often, and you’ll experience a reduction in your testosterone levels.

Vitamin D3 is particularly important for prostate health and the higher ones blood serum levels, the lower the chance of prostate problems including cancer.

I hope this helps!

Dr. Jeffrey Tucker

Damaged skin question

Hi Dr. Tucker. I spent a lot of time in the sun and have abused my skin over the years. What vitamins or supplements should I take to help my skin look better?

The skin is the largest organ of your body. Most of the time, the body does a pretty good job of healing your skin from scorched sun, cuts, scuffs, and scratches.

Poor, abused skin can get healthier, but it needs to start on the inside. Make sure you drink plenty of water everyday.

A German research team recruited 45 healthy women between the ages of 18 and 65 and divided them into three groups. For 12 weeks, one group received a daily flaxseed oil supplement, one group received a daily borage oil supplement, and one group received a placebo. Before the intervention began, nicotinate was applied to each subject’s skin to prompt reddening and inflammation.

Results: Compared to baseline, flaxseed oil was most successful in reducing skin reddening and blood flow, while significantly increasing hydration. Borage oil prompted similar results, but not as significant as flaxseed oil. Except for a slight improvement in hydration, there was no change in skin condition in the placebo group.

I recommend a product from Metagenics called Omega-EFA. It contains alpha-linolenic acid – an omega-3 fatty acid which should help your skin.

OMEGA-EFA™
Natural Lemon Flavor
• Supplies a balance of omega-3s (EPA & DHA) from cold-water fish and omega-6 (GLA) from borage seed oil
• Supports cardiovascular health and healthy neurological function
• Features a natural lemon flavor to promote patient compliance
Each Softgel Supplies:
Natural Marine Concentrate …………………………….500 mg
EPA (Eicosapentaenoic Acid) …………………………….155 mg
DHA (Docosahexaenoic Acid) …………………………..120 mg
Other Omega-3 Fatty Acids ……………………………… 40 mg
Borage Oil …………………………500 mg
GLA (Gamma-Linoleic Acid) ………………………………90 mg
Other Omega-6 Fatty Acids …………………………….150 mg
Other Ingredients: Natural lemon flavor, rosemary extract, ascorbyl palmitate, and natural mixed tocopherols.

References
1. Curtis CL, Rees SG, Cramp J, et al. Effects of n-3 fatty acids on cartilage metabolism. Proc Nutr Soc 2002;61(3):381-89.
2. Harris WS, Park Y, Isley WL. Cardio-vascular disease and long-chain omega-3 fatty acids. Curr Opin Lipidol 2003;14(1):9-14.
3. Belluzzi A, Brignola C, Campieri M, et al. Effect of an enteric-coated fish-oil preparation on relapses in Crohn’s disease. N Engl J Med 1996;3334(24):1557-60.
4. Helland IB, Smith L, Saarem K, et al. Maternal supplementation with very long-chain n-3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age. Pediatrics 2003;111(1):e39-e44.
5. Lombard CB.What is the role of food in preventing depression and improving mood, performance and cognitive function? Med J Aust 2000;173(Suppl):S104-S05.

Treatments Performed By Dr. Tucker

Below you will find techniques utilized in my treatments.
• Joint Mobilization and Manipulation
o Promotes improved joint mobility and range of motion using a variety of treatment philosophies including: PNF, McKenzie, Mulligan, Muscle Energy, Janda, Comerford, Sahrmann.
• Soft Tissue Mobilization
o Mobilization of the skin, muscle, nerve, and fascial layers to break down scar tissue and adhesions. This is also known as transverse friction technique. I frequently use the Deep Muscle Stimulator (DMS) to achieve soft tissue mobilization.
• Myofascial Release
o Deep tissue palpation and fascial release to promote fascial stretch/gliding and muscle relaxation based on the work of Tom Myers.
o If a muscle is in spasm it can lead to imbalances such as leg length discrepancies or rotation/obliquities in the pelvis, hips or shoulders. I use the Deep Muscle Stimulator (DMS) as part of my practice for myofascial release.
• Trigger Point Release
o Deep palpation to promote muscle relaxation in an area of hyper-irritability and contracture. This is also known as “ischemic compression” or trigger point therapy.
• Dynamic muscular release
o Deep palpation to the origin (attachment site) of a muscle as the patient contracts to engage in the muscles intended action.
o Promotes improved muscle function.
o Can eliminate musculoskeletal imbalance.
• Neuromobilization (as taught by Dr. Kim Christensen)
o AKA “Flossing” or “Gliding.”
o Helps decrease inflammation in nerves.
o Breaks up adhesions around nerves that result from inflammation.
o Can eliminate the sensation of “pins and needles”, “weakness” or “numbness and tingling”.
• Therapeutic exercise and activities
o Corrective exercises with the intent to decrease pain, improve injury prevention, muscle recruitment, strength, flexibility, and endurance.
o Promotes proper technique in performing functional activities (example: lifting weights, gait, posture).
• Gait training and mechanics
o Analysis of walking to optimize form and make sure that your gait is not a repetitive trauma.
• Neuromuscular training
o Enhances the function of the body by balancing the muscle activation patterns about a joint.
• Free weight training for weight loss and osteoporosis prevention
o Specific exercise prescription based on your individual body type.
• Balance training
o Decreases fall risk.
o Improves coordination for increased performance.
• Core trunk stabilization training
o Improves the recruitment of specific muscle groups that stabilize the hip, pelvis and lumbar spine.

Some specialty treatments include:
• Temporomandibular treatments.
• Scar/tissue, capsular adhesion mobilization.
• Diet, nutrition, vitamin recommendations.

Vitamin D

When summer is here, it is the right time for brief (less than 20 minutes) whole body exposure to sunshine. Your skin turns the sunshine into vitamin D. Other sources of vitamin D include cod liver oil and vitamin D3 supplements. Everyone knows that too much sun exposure can burn the skin but it seems that some doctors discourage any sun and still believe that vitamin D relates just to the health of bones. The truth is that vitamin D is responsible for so much more.
Research shows how adequate vitamin D levels can help prevent cancer and that there may be heart benefits as well. A Harvard research team led by Edward Giovannucci, M.D., Sc.D. showed a clear link between vitamin D deficiency and heart attack risk. In fact, the data revealed that heart attack risk might be cut in half when low vitamin D levels are doubled.

The optimal blood range for vitamin D is now considered by world experts to be at least 45-50 ng/ml (nanograms per millilitre). Some nutritionist like to see it even higher, in the range of 50 – 60 or more, depending on your overall health. Below 40 ng/ml is considered sub-optimal; below 30 ng/ml is deficient; below 20 ng/ml is now considered seriously deficient, and below 10 ng/ml places the patient at real risk, requiring prompt intervention.
Deficiency results in chronic illnesses, and is associated with muscle pain and weakness, and is a risk factor for cardiovascular disease. If you have high blood pressure or a family history of stroke or heart attack you should get your Vitamin D levels checked. Low levels of Vitamin D are implicated in autoimmune disorders, and in at least 16 different types of cancer, especially pancreatic, lung, breast, ovarian, prostate and colon cancers.
It would seem to be imperative that patients suffering from fatigue or any of the above mentioned conditions take charge of their own management and check their vitamin D status. Please feel free to talk to me before adding any new supplements to your daily regimen.
Dr Jeffrey Tucker works full time as a Nutrition Consultant and Chiropractor in the WLA area. (telephone: 310-473-2911). His website is www.DrJeffreyTucker.com
References:
“Vitamin D Deficiency”. Michael F Holick MD PhD; NEJM 2007:357:266-281; see also “Ultraviolet B and blood pressure”. Rolfdieter Krause, Michael Holick et al. Lancet 1998:352:709-710)
“Prevalence of Cardiovascular Risk Factors and the Serum Levels of 25-Hydroxyvitamin D in the United States”. David Martins et al. Arch Intern Med: 2007:167:1159-1165).

Pre-Workout Foods: Protein Bar vs. Eggs?

• Eating 60 to 90 minutes before exercising helps to prevent light-headedness and loss of concentration during moderate to high-intensity activity. You’ll need a simple fat, sugar and protein combination—this balance can be found in both a healthy breakfast food or an UltraMeal Bar or UltraMeal shake (Metagenics link).
• Which will power you through your workout without a crash? Try two eggs one day and a bar the next. A bar is easy, but the eggs are real. Both are filling food, and pack good protein. Egg whites are the purest form of muscle-building fuel available.

Whatever you choose just get going on your exercise and be consistent!

• Are Eggs good for me?
• Eggs contain tons of important vitamins and minerals, and egg whites contain the purest form of protein available in whole foods—exactly what you’ll need to feed your muscles during a workout.

Eating Right For Working Out

Question for Dr. Tucker: “I am a 40 year old female weighting 150 pounds and I’m 5’ 7”. My eating habits are getting better. I want to know what you recommend I might eat before and after a boot camp class or kettlebell workout? I want to lose fat and keep my muscle.”
Dr. Tucker’s response: Decide on a protein shake or bars vs turning to your fridge: One cup of lowfat chocolate milk or lowfat fruit yogurt will likely provide an athlete/active individual with the amount of Essential Amino Acids (EAA) and carbohydrate they need to enhance muscle growth.
• For those who need more specific calculations for estimating quantity of protein and carbohydrate to consume, research recommends 0.045 grams of EAA per pound of body weight in combination with 0.23 grams of carbohydrate per pound of body weight.
• For example: For a 150-pound woman, a simple cup of lowfat, fruit-flavored yogurt will work. I prefer the UltraMeal shake (www.DrJeffreyTucker.meta-ehealth.com) with approximately 15 grams of high quality protein. This provides the appropriate amount of protein and carbohydrate with a comprehensive spectrum of essential vitamins and minerals in every serving. It also gives me the insurance to know that you will lose fat and not muscle.

During Workout Nutrition:
The research here has actually been similar in that we want to feed the body a product with a 2:1 ratio of carbs:protein . Here I recommend the UltraMeal Shake (2 scoops) with one scoop of UltraPure Protein (www.DrJeffreyTucker.meta-ehealth.com)

Other Pre- and Post Exercise Snack Ideas for Combining Carbs and Protein
• 2 slices whole grain toast and 2 tablespoons peanut butter
• Apple and 1 cup lowfat cottage cheese*
• 1 cup fruit yogurt and 1/4 cup granola*
• 2-egg omelet with 1 cup fresh vegetables, 1 whole-wheat English muffin*
• String cheese and 1 ounce pretzels*
• 1/4 cup nuts and an orange
• Hard-boiled egg and 1/2 whole-wheat bagel*
• Whole-wheat pita and 1/2 cup canned tuna*
• UltraMeal Bar (order at www.DrJeffreyTucker.meta-ehealth.com)
*These food combinations provide higher quality protein (that is, protein with all the nine EAA).