2: Adrenal Disorders
3: Causes and Treatments for Pain
4: Mindfulness studies reports
Dysglycemia refers to any disorders in serum (blood) glucose stability. We will be covering hypoglycemia, insulin resistance, diabetes and some of the technical information related to glucose management. A study by J. Grimm in Public Health and Nutrition conservatively estimated that 30% of the population suffers from insulin resistance, an advanced state of dysglycemia. I have read that if current trends continue, projections hold that 60% of the population will be in this state or worse and that it will probably bankrupt our current medical system in the next ten years, caring for more than a hundred million people suffering from severe diseases related to blood sugar physiology.
Blood sugar disorders affect every aspect of our physiology. One of our body’s primary sources of energy is dependent on the ability to convert glucose into ATP, adenosine triphosphate. Glucose is also called dextrose and is comprised of 6 carbon atoms, 12 hydrogen atoms, and 6 oxygen atoms, and is split into ATP by the enzyme ribase. ATP is made of adenine and ribose with three phosphoric acid groups. Adenine and ribose are both forms of pentose, sugars with 5 carbon atoms. ATP is used by all cells of the body and particularly muscle cells for energy. The splitting of these groups of atoms is known as the citric acid cycle. A steady supply, storage of, and re-conversion of glucose back into the blood supply and the proper conversion of glucose into ATP are important for many reasons, as we will see.
First I will review basic components of glucose regulation.
Insulin is a protein hormone secreted by beta cells of the pancreas. Insulin allows glucose to enter the cells and begins the process of transforming glucose into energy that is used by all the cells in the body. Insulin is secreted when glucose levels are high. Insulin is also an anabolic hormone. This hormone promotes the production and growth of tissues. It signals the liver to produce and store glycogen, a stored form of glucose. Glucose is thus lowered in the blood stream by the utilization of the cells (forming ATP), and by the formation of glycogen in the liver called glycolysis.
Cortisol is secreted when glucose levels in the blood are low. It is a catabolic hormone secreted by the adrenal glands that breaks down glycogen into glucose, putting it back in the blood stream. This is called glycogenesis. This steroid hormone is also known as an adreno-cortico-tropic hormone, or ACTH. Cortisol should be highest in the morning after the body has been fasting. It should be low in the evening when glucose has been made available by feeding. When blood sugar levels are low, signals are sent to the hypothalamus to secrete cortisol releasing hormones. The hypothalamus thus becomes another critical link in stabilizing blood sugar.
Leptin is a hormone secreted by fat cells that signal the hypothalamus to stop feeding, by shutting down the production of hunger signals, altering the production of neuropeptides and neurotransmitters that stimulate feeding. The process of fat metabolism is closely related to sugar metabolism, as both are sources of energy. Fat metabolism is also called lipid metabolism. Lipolysis and Lipogenesis refer to the storage and synthesis of lipids. Lipids play many important roles in physiology such as regulating temperature, called thermogenesis. -Temperature is very important for enzyme processes and pH. The average number of enzyme reactions per cell is 35,000 per second. Lipids are also important for hormone production, prostaglandin production, regulating intercellular communication, transformation and transportation of micronutrients between cells. Lipids are closely related to phosphatides, cerebrocides, and sterols.
The liver is the main tissue that responds to signals indicating high or low blood sugar. High and low blood sugar trigger hormonal responses that induce pathways of restoring blood sugar. Signals like growth hormone released from the pituitary increase blood glucose by inhibiting uptake in the liver. Gluco-corticoids also leave more glucose in the blood stream to be used where it is most needed. Thus the pituitary/liver relationship is also important in blood sugar physiology. The liver performs glycolysis, glucogenesis, lipolysis, lipogenesis.
Now we will begin to explore various forms and effects of dysglycemia. Hypoglycemia refers to a lowered fasting glucose state. There are two types, hypoglycemia and reactive hypoglycemia. Reactive hypoglycemia has all the symptoms of hypoglycemia but may not be outside the laboratory range for glucose and may or may not have a lactic acid dehydrogenase, LDH below 140 U/L. The symptoms will include dizziness or light headedness if meals are missed or between meals, shaky, jittery, tremors, craving sweets during the day, craving coffee in the morning, eating relieves fatigue, easily agitated, poor memory, and blurred vision, and when severe can cause fainting blackouts and will eventually result in seizures. All proteins, fats and carbohydrates can and should be converted to glucose eventually. If a person only ate lean meats, they should still have a glucose level between 85-100 mg/dl.
Hyperglycemia refers to a state of excess glucose in the blood. This is a definite indication that glucose is not being managed properly. Hyperglycemia usually includes hyperinsulinemia. Hyperglycemia usually begins with hypoglycemia and progresses to insulin resistance or syndrome X, and then to diabetes. Insulin resistance is a state where the insulin receptors in the cells become desensitized to insulin. The cells are thus deconditioned to insulin stimuli and do not take up glucose as well. When people have insulin resistance they will display symptoms such as fatigue, especially after eating; difficulty with sleep patterns; usually difficulty falling asleep; digestive disturbances, such as gastric reflux, which may be proxysmal; other G.I. disturbances; cravings for sugar; inability to lose weight; constant hunger; eating sweets does not reduce cravings; increased thirst and appetite; migrating aches and pains. Lesser recognized but related dysfunctions may occur, such as leptin resistance and cortisol resistance. These display similar symptoms and will usually be accompanied by heightened stress and anxiety levels. Hypoglycemics can also have dysfunctions in cortisol that will manifest as stress. Hyperinsulinism is an independent risk factor for cardiovascular disease. It adversely affects the physiology of lipoproteins, coagulation protein synthesis, and blood pressure. Insulin upregulates the synthesis of cholesterol by stimulating the Hmb-coA reductase enzyme. This is why cholesterol goes up when glucose is not being managed properly. This is the same enzyme that statin drugs down regulate. We will see more examples of how some drugs only mask disease processes and do not address the underlying bio-chemical dysfunction. Insulin also negatively impacts the cholesterol ester transfer protein, CETP, the protein that is responsible for shifting cholesterols into HDL. The result is lower HDL. HDL is responsible for moving cholesterol out of the arteries. LDL transports cholesterol into arteries. HDL protects against arthrosclerosis by moving cholesterol to the liver where it can be removed from the body. Cholesterol is important for the formation of hormones. High cholesterol and the body’s inability to manage it properly negatively impacts hormone balance, as we will see.
When the insulin is not managed properly, males and females both have difficulty binding or synthesizing proper hormones and eliminating excess hormones. This leads to a variety of metabolic malfunctions. Hyperinsulinemia and its resultant hormone imbalance have different effects in males and females.
Females respond to a hyper insulin state with up-regulated hormone synthesis in the adrenal glands and ovaries of testosterone and cortisol. This is called an androgen shift. These hormones become abnormally increased and further promote insulin resistance, creating a vicious cycle. The increased androgen hormones increase free fatty acids in the liver, which decrease the liver’s ability to respond appropriately to the hormones. The androgen shift also affects the hypothalamus-pituitary feedback loop, resulting in changes in the leutinizing hormone, LH. This is an important signal that regulates menstruation and induces changes in the reproductive system. There are several other causes for disruption of LH. They are surges in estrogen at the end of the follicular phase and elevations of b-endorphin. Other causes of androgenism should be ruled out. These include ovary and adrenal hormone dysfunction in the absence of insulin disorders. The most common effect of the androgen shift in hormones is poly-cystic ovarian syndrome. Eighty percent of all women with this disorder have it as a result of the androgen shift due to hyperinsulinemia. The current model suggests using birth control to treat the androgen shift. This further dysregulates the hypothalamus-pituitary feedback loop creating post birth control syndrome, or an inability to regain a normal cycle after oral contraceptives. The current health care model suggests another way to treat the hormone imbalance is to prescribe drugs that directly suppress adrenal function such as prednisone, dexmethasone, or gluco-corticoids. These drugs have a long list of side effects and do not treat the underlying problems of hyperinsulinemia.
Hyperinsulinemia affects male hormone pathways differently. First progesterone may not be converted to testosterone and may be converted to cortisol instead. Excess cortisol again down-regulates insulin receptors creating a vicious cycle. Insulin resistance again disturbs proper fat metabolism. Progesterone is one of the hormones that protects and regulates the prostate function. Other factors that relate to prostate function are estrogen levels, and conversion of testosterone to dihydrotestosterone. Changes in insulin and adrenal hormones can impact the conversion of these hormones. When any or all of these processes occur, the prostate will undergo changes similar to the ovaries in women when LH is disturbed, swelling and abnormal growth. Progesterone also influences neurochemistry and osteoblastic activity.
The most important indicator of blood sugar management is how you feel after you eat a meal. If anything in your diet creates an insulin surge, you will feel tired after you eat. This indicates that glucose is not being converted to ATP. Food allergies and infections will also disturb the citric acid cycle and must be ruled out. Food allergies will induce inflammatory states, which stress the liver’s ability to respond to hormones, as well as adrenal stress affecting cortisol, disrupt intercellular communication between lypolysis and lipogenesis, decrease the activity and synthesis of thyroid hormones, upregulate the immune system and many other stressful and destructive effects. Infections will uncouple the citric acid cycle by disturbing phosphorylation. Gastro intestinal dysfunction may induce anemia, thus compromising the blood’s ability to carry oxygen, which is necessary in the production of ATP. Anemia must be treated before the blood sugar can return to normal. The lungs may also play a role in the failure to provide enough oxygen to the blood. When glucose is incompletely metabolized, the leftover glucose in the system will oxidize, lose electrons, and thus become tree radicals called g1ycolated end products. These compounds will cause inflammation and damage to sensitive tissues such as the retina, small nerves and blood vessels, and the kidneys.
When the glucose pathways are disturbed significantly enough, the body will begin to seek other sources of energy. When the glucose cannot be utilized directly for energy, it will be shifted into adipose or fat. The fat will then be converted to energy. This process is not very efficient for ATP production for several reasons. First, the breakdown of fats into ATP leaves a residue of ketones or ketone bodies. Ketone bodies deplete the cellular and extracellular acid buffers and the system becomes very acidic. When the system becomes acidic and loses its buffers, mineral and electrolyte reserves are damaged. Abnormal urination, kidney and adrenal dysfunction will ensue. This will further compromise the kidney/adrenal function already disturbed by glycolated end products. The body may try to reestablish ph by producing ammonia. Ammonia is very alkaline, but also very toxic. The body may try to restore mineral reserves in the blood by taking calcium from the bones. The second reason why utilizing fats for ATP is inefficient is that it requires more energy to break down the fats than is gained, resulting in low energy and weight gain. When the patient eats, they will put out more energy for the process of lipogenesis and lipolysis and have less potential for ATP from these cycles than they will be gaining.
Hyperinsulinemia has several other serious consequences for the human organism. Hyperinsulinism will down regulate the glucose-6-phosphate dehydrogenase (G6DP), which will then suppress the hexose monophosphate shunt (HMS). Reduced HMS activity will decrease NADP, which is the cofactor required to produce glutathione. Glutathione is the major nutrient for the oxidation/reduction axis. The net result is compromised phase I and phase II liver detoxification. Poor elimination of toxins will further compromise the liver’s ability to respond to managing blood sugar and other metabolic functions. The patient will also report heightened stress levels. In women menses may get heavier and more painful. Over exposure of insulin also has deleterious effects on fatty acid metabolism. It upregulates enzymes that convert DGLA into arachidonic acid. This is a precursor to prostaglandins and will shift the balance of prostaglandins, creating an inflammatory state and all of its detriments, as well as affecting prostaglandin function, which regulate lypolysis, platelet aggregation, gastro-intestinal activities, neuro-transmission; and many other functions. Prostaglandins are short-lived intracellular modulators of the biochemical activity of the tissues in which they were formed. They are called autocoids and are similar to hormones. Alterations of fatty acids affect many prostaglandin functions.
Diet is the MOST critical factor in treating dysglycemia. All forms of dysglycemics must eat a healthy breakfast, with lean meats, vegetables and legumes. A protein dominant diet will ensure a slow steady supply of glucose that avoids surges in hormones and glucose. A slow steady supply of glucose will reduce insulin surges. This is determined by how quickly a flood breaks down into glucose. The faster the food breaks down into glucose, the higher the insulin surge. The spike in insulin is what dis-regulates the entire hormonal system. A spike in insulin will cause all of the aforementioned alterations in physiology. All of the body systems will become stressed and challenged and concomitant shifts in chemistry take place. The more repeatedly this happens the more the system is likely to become compromised. The liver, the adrenal glands, the pituitary, the hypothalamus, the pancreas, the tyroid, the digestive system, and all of their mechanisms of regulation will begin to exhibit maladaptive responses that will create a viscous cycle of dysfunction and poor health, weight gain, insomnia, heartburn, menstrual irregularity, fatigue, pain, inflammation that will damage many other systems eventually, as mentioned in detail above. If a person exhibits fatigue after eating, they may have exceeded their carbohydrate limits or may be exhibiting food intolerance symptoms. This will be best managed by including high quality animal protein with every meal. The more blood sugar dysfunction there is, the more crucial this will be. Each person will have different tolerances and limits in both these areas.
It has also been found that the combinations of foods eaten will affect how carbohydrates and fats are absorbed. These factors make the glycemic index a poor predictor of how foods will affect someone. Therefore, when determining food intolerances, the most important initial indicator is the body's reaction to what is eaten. These reactions may include mental clarity or dullness, an increase or decrease in energy levels, a general feeling of well being or discomfort. It is up to each individual to begin to notice how they feel after eating specific foods, and note how their energy level reacts. Restricting diet to identify problem foods is of paramount importance. The most likely initial reason for tiredness after eating in hyperglycemics is an insulin surge, resultant from poor glucose metabolism. The important thing to do is not to exceed the carbohydrate limits for that individual. This will minimize the insulin surge, and all its concomitant hormone, lipid, inflammatory, toxicity reactions.
There are three critical guidelines for hypoglycemics. 1) They must eat a healthy breakfast, 2) they must not go long periods without eating, 3) they must not snack on sweets. This will stress the adrenals, which will result in cortisol excess and often manifest as insomnia. These patients may also complain that they experience nausea in the morning or at other times when they eat. This is due to the stressed adrenals putting the body into an excess sympathetic nervous system state. If they eat small meals and stabilize their blood sugar, this will take the body out of sympathetic stress, and they will have an easier time eating breakfast. They must not snack on fruit alone. However, if they want to eat a piece of fruit after a protein rich meal, they can.
Fat metabolism has not been studied as extensively as sugar metabolism, and there are many competing theories on what kinds of fats are better. Dr. Watson was probably the most groundbreaking theorist and researcher in this area. He found that hypoglycemics do better with meats high in adenine and saturated tats. Hyperglycemics have been found to do better with meats low in adenine and low in saturated fats. He also coined the terms glucogenic and ketogenic to describe different metabolic tendencies. He further developed specific amino acid and other micro nutrient supplementation for the different types. There have been extensive trials of this theory, and its practice has been found to be extremely beneficial for hypoglycemia and its severe consequence of seizure disorders, as well as benefiting hyperglycemics and their disease processes. The general guidelines for hypoglycemics, according to Dr. Watson, is to eat chicken organ meats, lamb, venison or beef protein at every meal, nut butters, sardines, salmon and tuna, vegetables, especially cauliflower. Hyperglycemics should eat fish or poultry protein at every meal and vegetables. Whole grains are neutral for both groups and both groups must avoid sweeteners of all kinds and fruit juices.
The adrenal glands are triangular shaped glands that attach to the caudal aspect of the kidneys. “Ad” refers to above, and “renal” refers to the kidneys. The gland is made up of an outer adrenal cortex which produces the steroid hormones; cortisol, aldosterone, progesterone, and DHEA. The inner adrenal medulla produces catecholamines such as epinephrine and norepinephrine, described below. Steroid hormones (sterones) are fat soluble compounds which means they can pass through cell membranes easily. They travel through the blood attached to globulin, (a protein) and once inside a cell will interact with the corresponding receptors to initiate a variety of effects depend on the sterone. These effects are described below.
Mineral corticoids primarily affect sodium potassium balance.
Glucocorticoids influence carbohydrate, fat and protein metabolism. Cortisol is the main glucocorticoid produced by the adrenal cortex. It regulates blood glucose in two ways.
Increase hepatic glucogenesis. Cortisol also allows other glycolytic hormones, such as epinephrine and glucagon to mobilise glucose between meals.
The catecholamines, epinephrine and norepinephrine are release when a threat is perceived and increase heart rate, breathing rate, constricts blood vessels, relaxes bronchioles. They stimulate the release of free fatty acids from stored fat, and the release of glucose from stored sources, (glycogen.)
The adrenal cortex response is modulated by the hypothalamus-pituitary-adrenal axis. The hypothalamus responds to stress by releasing corticotropin releasing factor, the hormone signals the pituitary to replace adrenocorticotropic hormone which stimulates the adrenals to secrete cortisol.
The circadian rhythm of cortisol. Cortisol levels should follow a natural rhythm based on dietary intake, the body’s energy demands, and sleep cycle. Alterations in this rhythm indicate adrenal dysfunction. Cortisol should be high in the morning after the body has been fasting all night. This level should slowly decrease during the day as food supplies more glucose and cortisol is not needed to release stored glucose. The level should be lowest before bed. When cortisol cycles are disturbed due to stress and other factors, described below, sleep will often be one of the first disturbances to manifest.
The stages of Adrenal Stress.
The first stage is called the alarm stage. Demands of stress and increased activity will cause the adrenals to accelerate their secretion of hormones.
If this state goes on for a prolonged time the adrenals and the pituitary will go into what is called the resistance stage. This stage is also called the pregnenolone steal phase, as the body will convert pregnenolone into cortisol instead of DHEA. Thus cortisol may be high and DHEA may be low.
The final stage is referred to as the exhaustion stage. This reflects the adrenal glands inability to maintain the levels required to meet the demands of the stress or activity and associated metabolic functions. This will be reflected by low DHEA and cortisol levels. If this pattern continues the body may convert pregnenolone to DHEA. The cortisol levels will thus be low and DHEA will be normal.
Dysglycemia and Adrenal Disorders
Elevated cortisol will down regulate insulin receptors and create insulin receptor desensitivity. AS the receptors do not respond to insulin the pancreas will respond by secreting more insulin. This will result in elevated insulin and all the associated adverse impacts associated with it. (See my article on Dysglycemia.)
Decreased cortisol associated with adrenal exhaustion will impact the signals to the liver to induce glycogenesis and glycolysis. This will result in Hypoglycemia.
Thyroid dysfunction and Adrenal Disorders.
Adrenal stress adversely impacts many of thyroid hormone functions. Elevated cortisol suppresses the enzymes 5’diodinase which converts T4 to T3. There has been a lot of research into the mechanisms of maladaptive Thyroid hormone conversion and elevated cortisol. Lopresti and Nicoloff have demonstrated how much of the T4 can get converted into the inactive rT3 which does not have the metabolic stimulating properties of T3.
Anterior Pituitary Hypofunction
Elevated Steroid hormones can suppress TSH by a similar action described above, the receptors of the pituitary will become blunted and thus effect associated endocrine function especially the thyroid.
One of the livers functions is detoxification. It does this by making fat soluble substances into water soluble substances. The body can only eliminate water soluble compounds. Hormones are fat soluble and can accumulate into unhealthy levels causing pathology if not conjugated by the liver. Elevated hormone levels, cortisol and others, will place an added load on the liver and compromise its detoxification functions.
Intestinal Dysbiosis, Leaky gut and Adrenal disorders.
Elevated cortisol hormones will suppress secretory IgA. IgA is the main immunocyte cell in the digestive tract. Suppressing this function will lead to a diminished intestinal barrier, as well as other mucosal linings that can lead to recurring ulcers and dysbiosis.
Suppressed Immune function and Adrenal disorders.
Chronic hypercortisolemia will also suppress white blood cells, inhibiting the patients’ ability to fight infections. This will cause a diminished function and atrophy of the thymus gland and interleukin-2 production.
Bone density and Adrenal disorders.
Elevated cortisol will have negative impacts on bone metabolism. It appears that either endogenous or exogenous cortisol will disrupt normal calcium absorption. One of the most common side effects of patients on cortisol replacement therapy is increased risk of fractures.
Depression and Adrenal Disorders.
The changes in metabolism that occur as a result from chronic stress are causative factors in depression. Over active HPA activity has been linked to depression, Alterations in catecholiamine activity have also been reolated to depression. The neurotransmitter norepinephrine plays a signifuicant contributing role in neurochemistry associated with depression. Over stimulated norepinephrine will cause a sililar down regulated neural receptors as noted above. Adrenal exhaustion will lead to depleted supply of norepinephrine which will result in the same symptoms.
Insomnia and Adrenal Disorders.
This disorder is very common today and involves several components addressed above. The circadian rhythm of cortisol, and the stimulation of epinephrine and norepinephrine.
The hypo functioning patient will present with hypoglycemia symptoms. This person depends on sweets and stimulants to keep them going. They have low energy and miss meals. (also see my article on dysglycemia for more information.) This diet contributes to the body’s natural ability to store and replenish (glycolysis and glycogenesis) appropriate levels of glucose. As a result they will not be able to maintain healthy levels at night and sleep. Their glucose levels will drop and the body will respond by releasing cortisol, epinephrine and norepinephrine to break down stored glucose. This will have an excitatory effect on the body and nervous system causing the person to wake up.
The other pattern is people who can not fall asleep. These patients will present as over stimulated during the day. The nature of their chronic stress will not allow their cortisol levels to drop during the day as they accumulate glucose from food. The cortisol will remain high at night when it should be declining. The reason for this (also above) is that he alarm pattern of their nervous system places an added demand on the HPA axis. These stresses may also come from endogenous sources such as food sensitivities, which will activate gut associated lymphoid tissue and place the body in an alarm pattern. Other gastro intestinal disturbances will have a similar effect.
Neurodegenerative Disease and Adrenal Disorders
There have been many recent studies that demonstrate how the HPA axis contributes to and causes a number of neurological disorders. Neurology published a study in 1999 that linked HPA hyperactivity with MS. Alzheimer’s disease has been linked to lowered DHEA levels associated with the pregnenolone steal phase. Elevated cortisol and its’ proinflammatory reactions (elevated cytokines,) have been shown to destruct hippocampal cells, and trigger glial cells in the brain to produce a variety of neurotoxic agents that cause neuronal apoptosis. Gliosis has been identified in Alzheimer’s, Huntington’s. MS, ischemia, oedema, and seizures.
The Effects and Cycle of Chronic Stress
The H-P-A axis-Hippocampus cycle.
The hypothalamus releases corticotrophin releasing factor, CRF, when cortisol levels are low. This is carried to the anterior pituitary gland where it induces ACTH. ACTH then stimulates the production of hormones in the adrenal glands. When cortisol levels are high the hypothalamus sends out signals to reduce hormone production. When hormone levels are increased for a prolonged period of time, the HPA becomes desensitized and can no longer respond to the levels of cortisol. This occurs due to the sensitivity of the hippocampus to cortisol, prolonged exposure directly causing desensitivity, and destruction of its’ cells by inflammatory cytokines, nitric oxide, and other oxides, and gluco-corticoid down regulation.
Elevated Cortisol and Insulin resistance and Leptin resistance.
Elevated cortisol has been shown to lead to insulin resistance. Insulin resistance is a similar mechanism as above, only that insulin receptors become desensitized to insulin and thus can not dysregulate the feedback mechanism involved with blood sugar levels.
( See my article on Dyglycemia.) Insulin resistance is also associated with hyper cortisolemia. Both of these co occurring states will induce Leptin resistance. Leptin is a hormone that regulates fat storage. Leptin is also associated with hunger signals. Leptin also acts as an intercellular messenger in the brain to regulate hunger signals. Leptin receptors in the brain become down regulated and do not respond to the feedback mechanism of cortisol, insulin and leptin. Leptin also promotes the inflammatory cycle by its transcription on cytokine receptors. Thus higher levels of leptin will promote cytokine activity. The loss of feedback in the insulin, cortisol cycle will starve cells of glucose since the insulin receptors have become desensitized. The message is that the body is lacking glucose and so will increase even more cortisol productivity.
Vitamin D and Steroid Hormones
The term Vitamin D refers to several different kinds of molecules. They are also known as secosteroids as they have several different chemical characteristics than steroid hormones. Vitamin D receptors are found in most if not all cells in the body. These receptors function as gene expression modulators. This means Vit. D affects the growth, differentiation and expression of many different kinds of cells. The far reaching impacts of Vitamin D are only just beginning to be understood.
The holistic treatment of pain: western and eastern views of pain, etiology, and treatment.
Through out the ages, there have been many different ways people have identified and treated the sufferings of humankind. This is true of existential, and well as physiological suffering. These discoveries have many commonalities. I will give a brief presentation of some of the ways western science and eastern science have developed their approaches to understanding and treating pain in the physical body.
In terms of western physiology, physical pain has been described in the following ways. A German physician, in 1843, named Robert Friedrich Froriep, coined the term " muskelschiele " translated as muscle callus. We commonly think of a callus as developing on a bone, or the skin. Dr. Frorieps' description entailed a hardening of nodules of bands in muscles that offered relief of pain patterns, when treated by pressing, or massaging. These nodules were named "trigger points" by Janet Travel in 1942, in her books Myofascial Pain and dysfunction, the trigger point manual, Volumes 1 and 2. Dr Travel and Dr. Simmons, who co authored the books, also describe these nodules as existing in ligaments, tendons, musculo-tendonous junctions, periosteum tissue, ( bone associated tissue ) and cutaneous tissue, ( skin related tissue. ) The description of, and development of, or etiology of this phenomena, that the authors suggest is known as the trigger point hypothesis, and has been reviewed, further studied and developed, and their findings published in journals and books by many scientists in all disciplines of physical medicine. The authors description can be found in volume 1 of the trigger point manual on pages 45-74. The Journal of the American Osteopathic Association presents another similar description of this phenomena in their June 2004, Vol. 104, pgs 244-249, which includes some findings from modern genetic studies that contribute to this pathology.
The hypothesis of this dysfunction is called "motor endplate depolarization. " This is where nerve endings innervate or connect to the muscle fibers by the synapse junction. This region becomes depolarized by inflammation, or other chemical dysfunction, including those caused by genetic SNP's, and/or muscle strain. Some of the chemicals involved in this dysfunction include bradykinins, cytokines, serotonin, histamine, potassium, calcium, prostaglandins, leukotrienes, somatostatin, adenosine triphosphate, acetylcholine, oxygen, and substance P. These factors disrupt the release of neurotransmitters and ions within the endplate region. The basic mechanism is seen as caused by the excess release of Acetylcholine from the nerve end plate. Acetylcholine is a substantial neurotransmitter to regulate many functions through out the brain and nervous system. The release of Ach stimulates the release of calcium from the sarcoplasmic reticulum, which causes the actin and myosin heads to move closer together resulting in a tiny shortening within a muscle fibril. Millions of these processes result in a muscle contraction. An excess of which then depletes the synapse of ATP, adenosine triphosphate. ATP regulates the release of Ach, which is now dysregulated and a perpetual upregulation occurs. The ATP also, along with oxygen, returns Ca ions back to the sarcoplasm. The muscle is now in a chronic state of contracture. With a depletion of the chemistry that would cause it to release. Oxygen is deprived by the contracted muscle having less blood supply. This creates a chronic, self perpetuating condition where the muscle can not perform it's normal functions of tightening and releasing. Please see the above references for a more detailed descriptions and diagrams of how this process works.
The proper chemical balance of this region must be restored in order for the muscle to regain normal function. This can be accomplished by improving circulation, which disperses the accumulation of the above chemistry. The restoration of proper circulation detoxifies the region, removing the excess ions, inflammatory chemistry, and replenishing the depleted supply of other chemistry. This can be accomplished in many ways such as stretching, exercise, massage, acupuncture, and trigger point injections. The result is dependent on how well the perpetuating factors have been identified, and the understanding of the muscles and associated systems condition will lead to the correct employment of the correct technique. None of these techniques will restore the system completely with out a correct evaluation, diagnosis, and correct application of the appropriate technique, for that particular stage of dysfunction.
Dr. Travel and Dr. Simmons pioneered the injection of substances to inject into the trigger points to rebalance the muscle chemistry. This can employ the direct restoration of some important chemistry, and the flushing out of some pathological chemistry.
Acupuncture can directly reduce nerve inflammation, reducing the release of Ach. Acupuncture can also reduce inflammatory factors from different immune dysfunctions, if they are correctly identified. Acupuncture can also detoxify other chemistry, if performed accurately. Acupuncture can reduce inflammation from other sources, such as cortisol, insulin reactions, and other pathologies, if performed correctly.
Some of the other perpetuating factors include pathological inflammation due to food irritants and sensitivities, infectious pathogens, hormonal imbalances including cortisol, glucagon, insulin, and sex hormones, medications, stress, injury and strain related inflammation. These may also need to be identified and treated, especially in cases of chronic pain, but also perhaps in other conditions too.
Muscular imbalances can cause parts of the muscle to contract and lose range of motion, which can profoundly alter the health of joints and proper joint function, including the spine, pelvis, knees and any and all other associated joints. Compromised joints will be painfully affected and, after prolonged dysfunction, can undergo degeneration, arthritis, bursitis, and other common ailments. The compromised muscle may also become weakened and/or trap nerves, which will also create pain and compromise musculoskeletal actions and integrity.
Effective treatment depends upon proper identification of precipitating and perpetuating factors, meaning accidents, injuries, illnesses, daily activities, diet, and other information. Dr. Ruther conducts an intake to gather subjective information and patient history, as well as objective information about range of motion, orthopedic testing, postural analysis, and strength testing. Often blood chemistry testing is requested to identify excesses and deficiencies of many components mentioned above. A complete picture of the patient’s health is then determined, Dr. Ruther can employ the correct treatment that addresses each patient’s individual needs.
I have always thought that acupuncture was pretty safe for everyone. That is because most peoples bodies do a pretty good job of regulating themselves, and they would probably get better anyway. Acupuncture generally works for most people, almost regardless of the skill of those performing it, because it works with the bodies own self regulating system. Some people do require very specialized techniques, as their body does not regulate itself very well. I have seen some incidences of people getting worse from seeing some acupuncturists, and even hospitalized. People often site the release of endorphins to be an effect of acupuncture to relieve pain and create other states of well being. I think the release of endorphins is a minor player in the treatment of pain and effect of acupuncture. There was actually a whole book written by a western medical doctor asserting that this was the entire mechanism of acupuncture's healing. The book went on to state that it does not even matter where you put in the needles. First of all, you might expect of trained western medical doctor to have some fairly detailed knowledge of basic physiology of the body, and perhaps the nervous system. In my experience of talking with medical doctors and nurses, they do not possess such understanding. They often are not aware of many serum tests that should be run for the medications they are prescribing. I have, of course, come across some more knowledgeable people than others. The other assertion of the book is also completely erroneous and unfounded. Myself, and all my patients can tell you that the placement of the needles does indeed make a very significant difference. A small change in the location can alter the entire therapeutic principal, or treatment stratagy of the treatment. It can make the difference between treating someone for blood stasis problems in the head, or gall bladder problems in the abdomen. Just by changing the location of the needle less than 1/2 inch. The result will follow accordingly. I can prove this to you over and over again, and you will feel the different effects of proper needle placement. My patients have often seen many other acupuncturists, with relatively small improvements.
Chinese medicine and the etiology, evaluation and treatment of pain.
Chinese medicine identifies twelve causes that perpetuate pain symptoms, which are summed up by descriptions of excess and deficiency. Excess describes accumulations of some kind of pathological substance which should not be present, such as inflammatory toxic chemistry. The excess may also be energetic accumulations of protons or ions that disturb proper musculoskeletal function. Deficiency describes not enough supportive nutritive chemistry, or energy.
These treatment are classically described as Warming exterior resolving methods, Cooling exterior resolving methods, Heat clearing and depression resolving methods, Coursing the liver and rectify the qi methods, Heat clearing and dampness disinhibiting methods, Heat clearing and draining repletion methods, Warming the center and dissipate cold methods, Free the network vessels and quicken the blood methods, Abduct, disperse and harmonize the stomach methods, Supplement the kidneys methods, Dispel wind, dissipate cold, and dry dampness methods, and expel worms and abduct stagnation methods. ( From Blue Poppy Press research reports. )
These methods also require a detailed knowledge of the subjective signs and symptoms of Chinese Medicine, as well as objective signs and symptoms, a detailed patient history, and an ability to synthesize all the different parts of the patterns, which are often a combination of two, or three or more patterns, and put this together into an effective strategy. Furthermore, the correct strategy must be tailored to the correct region of the body. There are never any textbook cases to be found in either eastern or western medicine, and that is where the years and years of experience begin to form understanding. It should never be assumed that any treatments are safe and without possible side effects. It should be clear that if the improper method is used, the condition will get worse.
Dr. Ruther has been studying and practicing in all these perspectives and treatments of eastern and western medicine for more than 28 years.
Studies of mindfulness showed it prevented depression relapse, reduced self injury, alleviated obsessive compulsive disorder, and managed the stress of chronic illness of self, and loved ones. Studies also show mindfulness makes people more open minded, and this allows them to experience more positive states as well as try new things and experiences. Mindfulness studies show the technique enhances peoples ability to respond to what’s happening now, not what if’s. They don’t overgeneralize or over react. Studies found that mindfulness allows people to attend more deeply to their environment and self in deeper and more enriching ways. They become more accepting of themselves and others and forge deeper and more trusting relationships and feel more support from others. They find more purpose in life. They are healthier, with less stress hormones, more growth hormones, dopamine and opioids. This resulted in lower blood pressure, less stomach problems, less back pain, better immune function, less sore throats, less colds, better sleep and much more. Studies also showed faster recovery from stress in orbito frontal lobes and insula. This means people are less likely to get triggered by cravings and stresses. One study of mindfulness reported that 30 minutes of mindfulness practice could reduce cortisol by 20%
Common Conditions Treatable With Acupuncture
Some common symptoms that can often be successfully treated with acupuncture and or herbs, nutation, massage: Joint swelling, Joint stiffness, Joint pain, Muscle spasms, Muscle pain, Muscle stiffness, Muscle Swelling, Radiating pain, Diabetic neuropathy, Radiculopathy, Chills, Fever, Fatigue, Runny nose, Nosebleed, Sudden loss of hearing, Ear pain, Throat pain, Difficulty swallowing, Eye pain, Chest pain, Palpitations, Irregular heart beat, Shortness of breath, Cough, Wheezing, Nausea, Vomiting, Acid reflux, Bowel dysfunction, Bowel pain, Constipation, Diarrhea, Abdominal pain, Loss of urine control, Blood in urine, Painful urination, Sinus pain, Recurrent infections, Rash, Loss of hair, Itching, Ulcers, Wound infection, Headache, Tingling/numbness, Dizziness, Anxiety, Depression, Anger, Thirst and sweating, Cold intolerance, Bruising problems, Bleeding problems, Swollen glands.