Joint and Tissue Repair
Content
Joint and Tissue Repair – Enough to Make You “GAG”
October 19, 2011 by Sock Doc
Joint and tissue health is an important topic among many
people, especially athletes. Supplements such as glucosamine, chondroitin, MSM, and
other products are often taken when there is joint pain or degeneration, in hopes that a
cure can be found in a bottle. Sometimes these substances work and sometimes they
don‘t. Some research says they may help, other studies say otherwise. But whether you
should take these supplements or not for your joint pain or injury is not the point of this
article, but rather what brought you to even consider taking such a supplement is. You
see, you‘re supposed to make these compounds naturally in your body every day, and
even consume some of them in the foods you should be eating. But first, a little bit of
biochemistry to get you up to speed…
GAGS: Glycosaminoglycans
Making new connective tissue is all about something called GAGs. That stands for
glycosaminoglycans which are primarily a bunch of sugar molecules linked together.
They come from what is known as the glycolytic pathway – that‘s the same pathway you
use to make energy from sugar in your body.
Connective tissue is fibrous tissue found throughout your body in the form of tendons,
and the framework of fibers in muscles, ligaments, bone, cartilage, and even blood and
lymph tissue. Connective tissue not only connects body tissue together, but it protects
organs and even stores energy. All tissues in the body, with the exception of teeth, can
be repaired. Some tissue, such as liver tissue and bone, can even be regenerated.
Glucosamine’s Role in Tissue Repair
In order to make GAGs you need the main precursor, which is glucosamine.
Glucosamine is high in the shells of shellfish as well as animal bones, which is why our
grandparents who used to make soup with the animal bones in the pot received many of
the necessary bone-building nutrients we lack today because most of us just buy the
broth. But you also make glucosamine naturally through the glycolytic pathway
(mentioned previously) with nutrients such as vitamins B1, B2, B3, and B5, as well as
magnesium, lipoic acid, and potassium. Glutamine, which is an amino acid our bodies
can synthesize, is also necessary and added into this step. Let‘s learn more!
Glutamine
Glutamine is the most abundant naturally occurring, non-essential amino acid. It‘s been
shown to be useful in the treatment of serious illnesses, injury, trauma, and burns.
Glutamine is also used by many athletes as a supplement because evidence indicates
that glutamine may increase plasma human growth hormone levels by stimulating the
pituitary gland, which in turn increases muscle growth. A healthy individual has plenty of
glutamine.
Chondroitin’s Role in Tissue Repair
Now when this glucosamine is linked to a protein it can form substances called
proteoglycans, such as chondroitin and eventually into chondroitin sulfate, which is an
important component of cartilage. Much of chondroitin is made up of more sugar
molecules and glucuronic acid, another amino acid. This amino acid is primarily used in
a process called glucuronidation which is how your body (primarily the liver) detoxifies
certain drugs, pollutants, hormones (especially cortisol and estrogen), and other
substances. Magnesium, manganese, vitamin B2, and vitamin C are all needed here in
order to make this work. Artichokes are naturally high in glucuronic acid. Yum.
So we‘re getting there. We have the amino acid glutamine and the glycolytic pathway
working well so we‘ve made glucosamine. Then we‘ll will bring it down to make
chondroitin as long as our liver hasn‘t used up all our glucuronic acid dealing with a lot of
detoxification. Next, we need some sulfur.
Sulfation and Tissue Health
Sulfation is very important as sulfur is needed to make glucosamine sulfate and
chondroitin sulfate which helps facilitate cartilage repair. The amino acid L-cysteine is
very high in sulfur and can sometimes be of great benefit as a supplement, and it‘s also
high in protein-rich foods like eggs and whey protein. Sulfates are high in foods such as
broccoli, cauliflower, garlic, cabbage, onions, radishes, and mustard. Proper levels of
magnesium, vitamin B12, vitamin B6, (in its active form of pyrodixal-5-phosphate), and
folic acid, (also typically in its active form of 5-MTHF), are also needed for proper
sulfation. Sulfation, like glucuronidation, is another major liver pathway and very
necessary for the detoxification of hormones and drugs, especially NSAIDs. *Note, sulfa,
which is a classification of drugs that many people are allergic to, is not the same thing
as sulfur, the element.
Methylsulfonylmethane (MSM) is a biologically available source of sulfur, like the amino
acid cysteine. MSM is a metabolite of dimethylsulfoxide (DMSO). DMSO is a solvent and
is readily absorbed into the skin so it is often used as a drug delivery system. DMSO, a
byproduct of paper manufacturing, was banned for some time by the FDA and allowed
only in veterinary medicine, primarily equine vet care. It‘s high in sulfur, which is why it
can help with tissue repair and is known for its distinctive smell – some say it smells like
garlic, others say rotten milk, and I‘ve even heard old socks. You will stink! I can attest to
the smell first-hand as I used DMSO a lot throughout my high school and college years
as I was always injured. Skin burns are also very common using DMSO especially if it‘s
mixed with a NSAID and then applied directly to the injured area, as many athletes do.
So if you are having joint pain or a connective tissue problem, especially the common
cartilage degeneration, what do you do? Do you take glucosamine sulfate? Chondroitin
sulfate? MSM? DMSO? Cysteine or glutamine? Taking all the nutrients I just mentioned
won‘t be practical, and multi-supplements won‘t work. It‘s more important to realize how
you got to the point of even seeking out these supplements in the first place, and what
you can do to possibly reverse and prevent further tissue and joint degeneration. Let‘s
look at the anatomy of an injury to understand this more.
Stress and Joint Problems
Chronic stress is the cause of most injuries. You do not just wake up one day with a sore
knee or neck; and you do not ―catch‖ ITB syndrome or pull a hamstring one day while
running because you just overdid it on that particular day. You sure don‘t all of a sudden
develop ―bone-on-bone‖ joint problems or joint degeneration. Chronic stress, whether
from overtraining, lack of sleep, ingestion of too much caffeine or refined sugar, or an
emotionally unstable job or relationship, leads to hormonal imbalances. The hormone
cortisol increases as a result. This decreases tissue insulin sensitivity – a phenomenon
termed ―insulin resistance.‖ It is very important because it leads to the decreased
absorption of glucose into the body‘s cells. When glucose doesn‘t enter the cells, not
only is energy production impaired, but joints ultimately cannot be repaired due to the
inability to make GAGs, as discussed previously.
In insulin resistance, the cells are starving for sugar that is sitting right outside the
doorway in the bloodstream waiting to be let in, and often you will crave sweets. You
may crave something sugary throughout most of day, and usually right after a workout or
a low carbohydrate meal. You may be irritable and moody from the roller coaster blood
sugar levels hitting more highs and lows than most Internet stocks of early 2000. Over
time, your muscles may start to spasm or cramp up. You may also experience what
some physicians describe as ―restless leg syndrome‖ and other sleep problems related
to blood sugar dis-regulation. Insomnia and waking up frequently are very common too.
So in order to properly make the glycolytic pathway work so you have glucose available
to make glucosamine you obviously have to monitor and deal with your stress levels.
High stress = high cortisol = decreased glucose absorption = inability to make
glucosamine = an injured athlete. This may mean training more aerobically rather than
anaerobically, cutting down caffeine, getting more sleep, adjusting your life or work
schedule; you get the idea. Diet plays a huge role here too. More protein, healthy fats
(fish, grass fed beef, flax, eggs, avocado, nuts, seeds, coconut, butter, olive oil), and a
low grain and sugar diet will help you use fat primarily as a fuel allowing the body to
focus on making glucosamine and GAGs. That means the less stress you‘re under and
the healthier you eat, the healthier your joints will be! I think a Paleo-Type Diet is great to
implement here. This GAGs process is not just inhibited by cortisol, but also estrogen as
well as certain drugs such as anticoagulants, immune-suppressive agents, and
antibiotics. Ladies, that means you‘re more susceptible to joint issues than us guys, due
to your estrogen levels, and you‘ll be even more at risk if you take birth control pills or
other hormonal replacement drugs.
When it comes to repairing an injury, or making sure an injury doesn‘t surprise you
tomorrow, you‘ve also got to have sulfation and glucuronidation working well for you as
I‘ve talked about. So remember that glucuronidation has to do with liver detoxification of
hormones, drugs, and other pollutants. So the less environmental stress you‘re under
(think air pollution, for example), the less medications you take, and the less cortisol you
make (because you‘ve dealt with stress levels), the more you have glucuronidation
working for you. Now for the sulfation part…
Sulfates as a reminder, are present in foods such as broccoli, cauliflower, garlic,
cabbage, onions, radishes, and mustard. But more importantly, sulfates are also
depleted during high stress levels too because they are needed to detoxify cortisol in the
liver. Do you see a pattern here? I sure hope so. If you are under a lot of stress then
cortisol really makes a mess of every part of this GAGs pathway! The key is to not
deplete more sulfur than you take in. Interesting is the fact that NSAIDs restrict sulfate
availability, so cartilage cannot be repaired. This is a shocking fact for many people who
are trying to help their injury with these drugs, (aspirin and ibuprofen) yet are actually
doing more harm than good by depleting their sulfate levels. Research shows that
NSAIDs are only beneficial 2-3 days after injury. Taking them longer, or for the many
that take them every day, is inviting greater problems later in life. Deficiency of the trace
mineral molybdenum also inhibits sulfate availability.
Once glucose is available, because it was allowed inside the cells since you‘ve
managed your stress, (normal cortisol levels), your body can make glucosamine and
then ultimately make chondroitin, which will happen because you‘ve got good
glucuronidation going on. This all looks for the sulfur, (which is present when there are
also low stress levels and no signs of NSAID abuse), to make chondroitin sulfate – the
ultimate prize in injury repair. And of course we needed some glutamine along the way
but we have plenty of that because a healthy individual naturally makes more than
enough and is getting some in their diet – beef, chicken, fish, eggs, dairy products,
cabbage, beets, beans, spinach, and parsley.
The big idea here is actually very simple in such a complex way. You have to embrace a
healthy lifestyle because it all is going to affect the health of your tissues and joints.
Make sure your diet contains some of the foods mentioned so you have the resources
available to make GAGs happen. Consider looking at individual nutrients you may be
deficient in to help you repair your tissue. Deal with your excess stress whether that‘s
adjusting your training, diet, or lifestyle. If you take one of the joint/cartilage supplements
and it benefits you that‘s fine as it may be very necessary to get you going in the right
direction; it‘s better than taking some drug to deal with your problem, but you should still
investigate why you aren‘t making the substance on your own to truly fix your health
problem. The GAGs lesson is over.
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Filed Under: Diet & Nutrition, Injury Prevention & Treatment Tagged With: aerobic, anaerobic, carbohydrate
intolerance, chondroitin sulfate, cysteine, DMSO, GAGs, glucosamine, Glutamine, glycolytic pathway,
glycosaminoglycans, insulin resistance, MSM, natural running, NSAIDS, sulfation
Comments
1.
Michael says:
October 19, 2011 at 10:31 am
Yet another extremely valuable post by Dr. Gangemi. The internet makes it possible to disseminate so much
mistruth and hype (usually with an ulterior motive) and it is refreshing to know there are still people like Dr.
Gangemi out there who care about our long term well being, health and do not seek to profit from it. While Dr.
Gangemi does make a very nice living through his practice, this is but one example of how he gives back with
no expectation of anything in return. Thank you Dr. Gangemi.
o
Sock Doc says:
October 19, 2011 at 10:59 am
Thank you very much Michael!
2.
Tracy says:
October 19, 2011 at 11:17 am
So, would you think that if I am eating Paleo (8 mo now) and running barefoot and aerobically (using Maffetone‘s
MAF heartrate), I don‘t need to be taking the Glucosamine/Chondroitin I‘ve taken for years? (49 yo female with
history of arthritis and osteoporosis in the family — starting to feel pain in my feet upon waking about 10 yrs ago,
that‘s when I started taking Gluco/Chond).
Obviously not medical advice in this forum, but your general sense?
o
Sock Doc says:
October 19, 2011 at 11:37 am
Correct, in a general sense there should be no reason to take it anymore, unless you have a specific nutrient
deficiency. For example, did you notice how I mentioned the active form of folic acid? 5-Methyltetrahydrofolate
(5MTHF) is what your body is supposed to convert folic acid into when you take it and it‘s the form found
naturally in fruits and veges. But most people don‘t eat enough fruits and veges to get their necessary amounts
AND it is known that at least 10-15% of the population have a genetic mutation that does not allow them to fully
make 5MTHF, and 20-30% of the population is said to have a single gene mutation which makes it more
difficult for them to make 5MTHF. So, in this case a person may not be making enough cartilage repairing
tissue because they aren‘t methylating their folic acid (B12 too) correctly. So if they don‘t get enough naturally
from their diet or from taking 5MTHF (not the typical folic found in most supplements), then there could be
issues. Other genetic issues can occur to making it necessary for individuals to need certain nutrients more
than others.
One more point – an important one I did not address in the post. Taking this stuff month after month, especially
year after year is not healthy. I have seen numerous patients react to these supplements, most often with
problems in their pancreas (blood sugar metabolism – makes sense as you learned from reading the post). So
don‘t think that more is better. It isn‘t. And definitely don‘t think that if it doesn‘t work then it won‘t cause a
problem, because it very well could be, especially after all those years.
Tracy says:
October 20, 2011 at 4:29 am
That is interesting. I must say, I‘ve definitely taken the ―it can‘t hurt‖ approach. My problem now is that I am
working as a volunteer and where I live, it is very expensive. This month, I‘m skating on the edge of running
out of food. So buying an expensive supplement that might not be necessary doesn‘t seem wise. I think I‘ll
finish what I have and then stop it for awhile and see what happens.
Now, any opinions about Vitamin C?
Sock Doc says:
October 20, 2011 at 8:17 am
Vitamin C for another day, but I don‘t use or recommend the highly synthetic and isolated form of vitamin C
we are all familiar with and are told is ―vitamin C‖ – ascorbic acid. It‘s best in its whole, natural form with all its
cofactors as found in whole foods, and some whole food supplements too.
sqt says:
October 30, 2011 at 8:25 pm
I think I have one of those genetic mutations you speak of (Ehlers Danlos syndrome). I‘ve been going Paleo for
a few months and have seen a significant reduction in pain. But I wonder if my body is capable of rebuilding
itself thanks to my faulty genetics. Supplementation doesn‘t really work for me because my system is very
sensitive and I react badly to most of them. Do you have any experience with collagen disorders and/or have
any suggestions?
Sock Doc says:
October 31, 2011 at 9:33 pm
Other than the suggestions I note in the post, it would be hard to advise where to look in a more specific case
for you. Yes, I‘ve seen some people with collagen disorders and like you, they tend to do much better with a
Paleo-Type diet. Lots of antioxidants from fruits, veges, and herbs are a must too. I‘m not sure how much you
can rebuild, if any, but I‘m sure you can limit (perhaps significantly) the disorder by living as much of a healthy
life as you possibly can.
3.
Nick says:
October 19, 2011 at 11:47 pm
You should add that oral glucoseamine –> glucose as well. To big a bolus its a pretty good OGTT
4.
Andrew Klein says:
October 20, 2011 at 12:01 am
Doc! What a great post! Every day I hear ―Well, I‘m getting old, I guess I‘ll just have pain‖, but that is the furthest
anyone will go to take responsibility for their health. No one wants to give up the things that are making them
sick! Health doesn‘t come in a bottle. It comes from taking control of your life in finances, employment, exercise,
and diet. Treat your human vehicle with respect, and it takes you the places you want to go with no complaints.
5.
Greg Grandgeorge says:
October 20, 2011 at 8:49 am
It is important to watch cholesterol levels when taking Glucosamine supplements, as some people do have
increases in cholesterol levels when taking it. Personally, my total cholesterol jumped over 30 points when
taking Glucosamine supplements, and returned to normal when I stopped taking the product. I think this is
relatively rare, but still worth watching.
http://www.livestrong.com/article/287004-glucosamine-effects-on-cholesterol-count/
o
Sock Doc says:
October 20, 2011 at 10:53 am
Thanks Greg, I assume you‘re referring to LDL cholesterol which would make sense as, per my response to
one of the other comments, glucosamine can cause blood sugar issues, which in turn, will negatively affects
cholesterol levels by oxidizing LDLs. Not a good thing.
6.
Fiona says:
October 30, 2011 at 11:36 am
This is so interesting, and neatly explains my own experience.
I had the beginnings of a DuPutrens contracture on my left hand, and it had begun to progress towards the
‗cording‘ stage. Around this time I was diagnosed with Pre-diabetes and I understand that Dupuytrens
contracture is regarded as an indicator of incipient Diabetes. (My Mom is a Type 2 Diabetic and she has a
Dupuytrens contracture too).
I started eating Paleo about 4 months ago, and along with weight loss, increased energy and improved blood
sugar control, I‘m certain the Dupuytrens contracture is resolving!
I had thought I must be imagining it, but now I know that my body is healing itself. Thanks so much for the
information.
o
Sock Doc says:
October 30, 2011 at 5:22 pm
That‘s awesome Fiona, I love to hear when people take their health into their own hands (no pun intended!).
Many extremity problems are linked to dysglycemia, such as hand numbness (especially when sleeping), carpal
tunnel, and Raynaud‘s ―Disease‖. Even a slight tingling in the fingertips when exercising is a sign of blood sugar
imbalances.
7.
primalpal says:
October 30, 2011 at 11:48 am
Hi Sock Doc,
You mentioned that anticoagulants can interfere with the GAG‘s process. My father had a heart attack at the age
of 41…from the outside he appeared to be in perfect shape…he had low cholesterol…but was under a lot of
stress at work at the time. This happened 10 years ago. He is now off of all statins (typical treatment even
though he didn‘t have cholesterol issues) and most of the other drugs (not sure what these were), but he is still
required to take coumadin, an anticoagulant. This is because he originally went off of everything (including the
coumadin) a year after his heart attack, and a few months later, he had to go to the hospital because a clot had
formed in his damaged ventricle (the blood was just pooling there because the heart is no longer able to pump
there). The doctors decided it was best that he stay on the coumadin indefinitely. Now he complains of sore
joints, stiff legs, etc. Is there anything that can counter the effects of the coumadin on this process without
reducing the benefits it has for preventing clots? I don‘t think he will be able to go off the coumadin unless his
heart can be repaired, but hopefully he can become more mobile than he is now. He loves being active, but the
joint pain and stiffness really prevent him from being able to do these things.
Thank you!
o
Sock Doc says:
October 30, 2011 at 5:44 pm
Hi Primalpal, thanks for comment. I just saw a guy last week in a similar situation. His cholesterol was 118 and
he was taking Lipitor for prevention. It‘s a bit crazy how things are viewed sometimes. You know I‘m happy to
stick my neck out here a bit at times offering people some advice that they‘re not going to get from anyone else,
but this is a tough one. I don‘t need anyone dying, or even coming close. The issue here is that you have to be
careful not to negate the effects of the coumadin, (rat poison) but only its side-effects. The whole coagulation
cascade is very complex; it‘s a lot more complex than most of us know. I‘ve had some PhD coagulation experts
explain to me how it all integrates in the body and my head was spinning for days. You see, you can take
products like fish oil, but its anti-coagulation affects are not exactly the same as the principles that coumadin
works off of. There are other products out there, such as lumbrokinase, (Boluoke), that can help as they are
fibrinolytic agents. I‘d check out this lab called Esoterix, as they specialize in coagulation panels and can often
provide more insight rather than just the blanket treatment of ―stay on coumadin‖ based off results and a
knowledgeable doctor who understands coagulation. Then the other issue to consider is properly detoxifying
the liver as many of drug side-effects are due in part to sluggish livers. I‘m not recommending going to the store
to go on some crazy liver flush diet or supplements (or to take fish oil or Boluoke either), but to find a more
naturally based doc who can help him with these issues and perhaps run a more comprehensive lab test as
mentioned. Shoot me an email if you‘d like and perhaps I know someone out by you guys if you‘re not close to
SockDoc Ville‘
8.
Good luck.
Lizzie B says:
October 31, 2011 at 12:02 am
Just followed the link over from Mark‘s Daily Apple. Amazed that I understood all the biochem, great job
explaining it so all can get it. Was just tickled that you KNOW the history on DMSO. It seems usually people
don‘t know what it is, where it‘s from, or how it has been used for so long. Can‘t wait till they use it IV in people.
Only saying that because it has been run IV in Equines as a last ditch effort and brought the horses out of the
woods.
Now I just need to use up the mineral supplement I have that includes MSM with Glucosamine. Then switch to
the stuff that is just minerals. (Still working on eating a better diet… until I get that leveled out, the minerals seem
to help fill in the gaps.)
o
Sock Doc says:
October 31, 2011 at 9:36 pm
Thanks Lizzie B! They already do use it in IVs! I once went in a local MDs office who uses it in his patients and I
could literally taste it when I walked in the door. The guy getting the IV drip was 3 rooms back! The doc thought
it was pretty funny that I knew he had the drip going just from opening the front door.
9.
brian p says:
November 13, 2011 at 9:53 am
Do the same issues apply to disc damage such as a bulging disc in the lower back?
Will prolonged use of NSAID‘s slow the healing of disc tissue?
and lastly, would cortisol injections (to control inflammation in a disc) also impair the tissue regeneration?
Great article, thanks for all the interesting info!
o
Sock Doc says:
November 13, 2011 at 10:21 am
Thanks Brian. Yes the same issues do apply for a couple important reasons. One is that the outside of the disc
(called the annulus fibrosus) is made up of thick collagen fibers that hold the inner nucleus intact. So the health
of that area is important with GAGs. The other is that disc issues often result from poor biomechanics – muscle
imbalances and joint dysfunctions either directly or indirectly affecting the disc. Manganese is perhaps the most
important nutrient needed for our spinal discs.
Yes, both NSAIDs and cortisol can and will impair healing. Taking NSAIDs, especially when you don‘t need
them, can cause a chemical reaction in your body that will create 10 to 100 times more inflammation than the
original inflammatory reaction you may be trying to fight. This is called a leukotriene reaction. Cortisol injections
are known to impair GAGs synthesis and result in joint weakness.
brian p says:
November 13, 2011 at 10:29 pm
Thank you for the quick reply. It is all very helpful!
10.
Feetqi says:
April 1, 2012 at 10:59 pm
I am in ―WOW‖ but not finished the article let alone the posts! TCM ( chinese medicine) links the liver with joint
problems. But I have never found any other corroborative info!
I have history of tendon / ligament damage since taking up running 35 years ago, orthotics for 32, MCS for 30
years and recent diag. of pre-diabetes (insulin resistance).
I have dealt with these piecemeal as the holistic practitioners were not holistic enough! I have been on glutamine
supplements for the liver abnormality for 5 years- personally i think they stimulate appetite. But did not prevent
current foot injury! We really have to understand that we have to remove the bad things as well as put in the
good things. Piecemeal cannot work.
I so agree with your views Mr SocDoc !!!
11.
Cheryl says:
September 8, 2012 at 10:52 pm
Hello,
I was wondering if you have any recommendations for Morton‘s Neuroma. I injured BOTH feet this past January
and have had 1 Cortisone shot, TENS, ultrasound, and massage therapy all to no avail. I started in June taking
serrapeptase, B-50, and Tumeric.Curcumin which seems to have provided some relief, however, if I am walking
for any length of time over a half hour the cramping nerve pain returns. I amalso receiving HPLT (high powered
laser treatment) once a week that supposedly will help. What is your take on these modalities? I am terrified of
the ‗alcohol shots‘ an or thee surgery the podiatrist mentioned if conservative measures failed; it being only 70%
effective. I don‘t like those odds!!
I appreciate your comments.
o
Sock Doc says:
September 9, 2012 at 7:11 pm
I discuss Morton‘s Neuroma here: http://sock-doc.com/2012/05/foot-injuries/
All those modalities treat the symptom (at best) and not the cause, including the laser treatment, hence I would
never use any of them personally.
12.
Lisa Quenon says:
January 11, 2013 at 6:37 am
Hello Doc! Thank you for this article! It helped me tweak some things I‘m doing…add some other…subtract a
few…been working on healing the cortisol thing for a while…years and years and years of cumulative stressshock-obesity-trauma (you get the picture)…much more in tune with what‘s going on now yet still have a
significant way to go. Was on tremendous western meds (huge variety) and now on none…liver was damaged
and had spots…off all meds 6+ months (a 3 year process)…last liver test came out healthy and clean (per the
western doc). Thank you thank you thank you for your awareness and life experience and for sharing all of
this…
13.
cliff chen says:
March 8, 2013 at 10:47 pm
hi dr gangemi,
1st and foremost, thank you so much for creating such a comprehensive and informative website. it has helped
me SO much through my recent injury. i wish i could see you in person but i‘m all the way in san diego, ca.
what do you think about osteo bi flex & it‘s ingredients (i read the side effects, and based on my family
history/personal history, im pretty sure im safe):
http://www.costco.com/Osteo-Bi-Flex%C2%AE-Triple-Strength,-170-Caplets.product.100013549.html
in 2008 an MRI stated i have intense bone marrow edema, chondral fissuring, interruption of subchondral bone
plate @ the end of the big toe proximal phalanx. my 2008 flare up was pretty bad (it prevented dorsi flexion).
2010 it flared up mildly. 2012 it flared up lightly. i noticed that there was a correlation with eating foods high in
uric acid too, my blood tests confirmed that i had slightly high uric acid levels to which im now taking allipurinol. i
never had a gout outbreak though. i have been going 2-3 years strong of increasing my diet to alot of
fruit/veggies/no gluten. i take fish oils daily. ive also been controlling my stress alot.
main reason for inquiring about osteo bi flex is that i want to thicken the cartilage at the end of the proximal
phalanx since there was intense wear and tear in 2008 and i‘ve had mild flare ups since. if you do not
recommend osteo bi flex, is there any supplement out there that can increase my cartilage and create
healthiness between my 1st meta and proximal phalanx of my big toe? thank you so much dr gangemi!
sincerely,
cliff
o
Sock Doc says:
March 10, 2013 at 8:09 pm
I would never take anything from Costco; I don‘t trust them and there‘s usually a reason their supplements are
so cheap.
When I use (give to a patient) either glucosamine or chondroitin, they typically only get one bottle because I‘m
more concerned with the substrate(s) they are most likely missing to make the final product. That‘s different for
everybody – one person I might give manganese, another B12, and another magnesium.
And of course you have to clean up your diet which usually means dealing with insulin issues, so the cartilage
no longer becomes inflamed and can hopefully heal.
14.
Andrea Jones says:
April 24, 2013 at 6:03 pm
Hi up until 6 years ago the only thing I have had done was my gall bladder removed. Then I broke my leg ,and
had to have it plated. Since that everything seems to have gone wrong. I have had a torn rotor culf in my right
shoulder, laser treatment on my throat (nodule build up) had the plates removed then to top it of last year
stepped awkward and popped my acl in my right knee. and my cartilage flipped over inside my knee.. Had the
acl repaired, cartilage taken out and having a monovisc injection in my knee next week… oh and I am a fitness
instructor who loves her job…
Can you please recommend if there is any supplements I should be taking.
Than you
Andrea Jones
o
Sock Doc says:
April 26, 2013 at 5:04 pm
Please read this; thanks!
http://sock-doc.com/sock-doc-questions-comments/
15.
duke says:
May 12, 2013 at 9:07 pm
Thanks for the post doc. I believe In what you are saying. I was recently told I have two disk protrusions in
lumbar. I was hurt while training jiu jitsu-as I was put in body lock. Disks are showing signs of degeneration. Pain
is mild without exercises. When I exercise I get increased pain and tightness. I went through heavy break up and
am a pretty stressed worried individual. I usually handled this stress via excercise. I have been a vegetarian my
whole life,I am currently 27. My Pt gave me McKenzie stretches for my posterior bulges along with sstretches. I
am going to purchase glucosomine and chondroitin in hopes of slowing or arresting disk degeneration. You say
that stretching is bad. Do you have any advice? Obviously I need to destress. Having a ―degenerative‖ condition
doesn‘t help. Thanks very much for your time.
o
Sock Doc says:
May 13, 2013 at 8:59 am
Please read this; thanks!
http://sock-doc.com/sock-doc-questions-comments/
16.
KL Lim says:
May 31, 2013 at 9:47 am
Some supplement claims that thier supplement provides necessary nutrition for body to produce glucosamine. I
like to know how much supplement is sufficient for body to produce enough glucosamine for the body? will there
be a case that the body cannot produce glucosamine or little amount of glucosamine even with ample supply of
the necessary nutrition?
Is it possible that the body may have difficulty to produce glucosamine? What will be the causes? Is age one of
the causes? How to find out if the body having this difficulty?
If body is having difficulty to produce glucosamine, what can be the solution? Take the ready made glucosamine
pill like Viatril-s or bio-calth?
Thank you very much.
o
Sock Doc says:
June 2, 2013 at 8:51 pm
That‘s a very involved question as for the supplement, it depends on how well it is manufactured. I use some
glucosamine products, but often give my patients the precursors to make it within their body.
Trackbacks
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[...]
October 19, 2011 by Sock Doc
Joint and tissue health is an important topic among many
people, especially athletes. Supplements such as glucosamine, chondroitin, MSM, and
other products are often taken when there is joint pain or degeneration, in hopes that a
cure can be found in a bottle. Sometimes these substances work and sometimes they
don‘t. Some research says they may help, other studies say otherwise. But whether you
should take these supplements or not for your joint pain or injury is not the point of this
article, but rather what brought you to even consider taking such a supplement is. You
see, you‘re supposed to make these compounds naturally in your body every day, and
even consume some of them in the foods you should be eating. But first, a little bit of
biochemistry to get you up to speed…
GAGS: Glycosaminoglycans
Making new connective tissue is all about something called GAGs. That stands for
glycosaminoglycans which are primarily a bunch of sugar molecules linked together.
They come from what is known as the glycolytic pathway – that‘s the same pathway you
use to make energy from sugar in your body.
Connective tissue is fibrous tissue found throughout your body in the form of tendons,
and the framework of fibers in muscles, ligaments, bone, cartilage, and even blood and
lymph tissue. Connective tissue not only connects body tissue together, but it protects
organs and even stores energy. All tissues in the body, with the exception of teeth, can
be repaired. Some tissue, such as liver tissue and bone, can even be regenerated.
Glucosamine’s Role in Tissue Repair
In order to make GAGs you need the main precursor, which is glucosamine.
Glucosamine is high in the shells of shellfish as well as animal bones, which is why our
grandparents who used to make soup with the animal bones in the pot received many of
the necessary bone-building nutrients we lack today because most of us just buy the
broth. But you also make glucosamine naturally through the glycolytic pathway
(mentioned previously) with nutrients such as vitamins B1, B2, B3, and B5, as well as
magnesium, lipoic acid, and potassium. Glutamine, which is an amino acid our bodies
can synthesize, is also necessary and added into this step. Let‘s learn more!
Glutamine
Glutamine is the most abundant naturally occurring, non-essential amino acid. It‘s been
shown to be useful in the treatment of serious illnesses, injury, trauma, and burns.
Glutamine is also used by many athletes as a supplement because evidence indicates
that glutamine may increase plasma human growth hormone levels by stimulating the
pituitary gland, which in turn increases muscle growth. A healthy individual has plenty of
glutamine.
Chondroitin’s Role in Tissue Repair
Now when this glucosamine is linked to a protein it can form substances called
proteoglycans, such as chondroitin and eventually into chondroitin sulfate, which is an
important component of cartilage. Much of chondroitin is made up of more sugar
molecules and glucuronic acid, another amino acid. This amino acid is primarily used in
a process called glucuronidation which is how your body (primarily the liver) detoxifies
certain drugs, pollutants, hormones (especially cortisol and estrogen), and other
substances. Magnesium, manganese, vitamin B2, and vitamin C are all needed here in
order to make this work. Artichokes are naturally high in glucuronic acid. Yum.
So we‘re getting there. We have the amino acid glutamine and the glycolytic pathway
working well so we‘ve made glucosamine. Then we‘ll will bring it down to make
chondroitin as long as our liver hasn‘t used up all our glucuronic acid dealing with a lot of
detoxification. Next, we need some sulfur.
Sulfation and Tissue Health
Sulfation is very important as sulfur is needed to make glucosamine sulfate and
chondroitin sulfate which helps facilitate cartilage repair. The amino acid L-cysteine is
very high in sulfur and can sometimes be of great benefit as a supplement, and it‘s also
high in protein-rich foods like eggs and whey protein. Sulfates are high in foods such as
broccoli, cauliflower, garlic, cabbage, onions, radishes, and mustard. Proper levels of
magnesium, vitamin B12, vitamin B6, (in its active form of pyrodixal-5-phosphate), and
folic acid, (also typically in its active form of 5-MTHF), are also needed for proper
sulfation. Sulfation, like glucuronidation, is another major liver pathway and very
necessary for the detoxification of hormones and drugs, especially NSAIDs. *Note, sulfa,
which is a classification of drugs that many people are allergic to, is not the same thing
as sulfur, the element.
Methylsulfonylmethane (MSM) is a biologically available source of sulfur, like the amino
acid cysteine. MSM is a metabolite of dimethylsulfoxide (DMSO). DMSO is a solvent and
is readily absorbed into the skin so it is often used as a drug delivery system. DMSO, a
byproduct of paper manufacturing, was banned for some time by the FDA and allowed
only in veterinary medicine, primarily equine vet care. It‘s high in sulfur, which is why it
can help with tissue repair and is known for its distinctive smell – some say it smells like
garlic, others say rotten milk, and I‘ve even heard old socks. You will stink! I can attest to
the smell first-hand as I used DMSO a lot throughout my high school and college years
as I was always injured. Skin burns are also very common using DMSO especially if it‘s
mixed with a NSAID and then applied directly to the injured area, as many athletes do.
So if you are having joint pain or a connective tissue problem, especially the common
cartilage degeneration, what do you do? Do you take glucosamine sulfate? Chondroitin
sulfate? MSM? DMSO? Cysteine or glutamine? Taking all the nutrients I just mentioned
won‘t be practical, and multi-supplements won‘t work. It‘s more important to realize how
you got to the point of even seeking out these supplements in the first place, and what
you can do to possibly reverse and prevent further tissue and joint degeneration. Let‘s
look at the anatomy of an injury to understand this more.
Stress and Joint Problems
Chronic stress is the cause of most injuries. You do not just wake up one day with a sore
knee or neck; and you do not ―catch‖ ITB syndrome or pull a hamstring one day while
running because you just overdid it on that particular day. You sure don‘t all of a sudden
develop ―bone-on-bone‖ joint problems or joint degeneration. Chronic stress, whether
from overtraining, lack of sleep, ingestion of too much caffeine or refined sugar, or an
emotionally unstable job or relationship, leads to hormonal imbalances. The hormone
cortisol increases as a result. This decreases tissue insulin sensitivity – a phenomenon
termed ―insulin resistance.‖ It is very important because it leads to the decreased
absorption of glucose into the body‘s cells. When glucose doesn‘t enter the cells, not
only is energy production impaired, but joints ultimately cannot be repaired due to the
inability to make GAGs, as discussed previously.
In insulin resistance, the cells are starving for sugar that is sitting right outside the
doorway in the bloodstream waiting to be let in, and often you will crave sweets. You
may crave something sugary throughout most of day, and usually right after a workout or
a low carbohydrate meal. You may be irritable and moody from the roller coaster blood
sugar levels hitting more highs and lows than most Internet stocks of early 2000. Over
time, your muscles may start to spasm or cramp up. You may also experience what
some physicians describe as ―restless leg syndrome‖ and other sleep problems related
to blood sugar dis-regulation. Insomnia and waking up frequently are very common too.
So in order to properly make the glycolytic pathway work so you have glucose available
to make glucosamine you obviously have to monitor and deal with your stress levels.
High stress = high cortisol = decreased glucose absorption = inability to make
glucosamine = an injured athlete. This may mean training more aerobically rather than
anaerobically, cutting down caffeine, getting more sleep, adjusting your life or work
schedule; you get the idea. Diet plays a huge role here too. More protein, healthy fats
(fish, grass fed beef, flax, eggs, avocado, nuts, seeds, coconut, butter, olive oil), and a
low grain and sugar diet will help you use fat primarily as a fuel allowing the body to
focus on making glucosamine and GAGs. That means the less stress you‘re under and
the healthier you eat, the healthier your joints will be! I think a Paleo-Type Diet is great to
implement here. This GAGs process is not just inhibited by cortisol, but also estrogen as
well as certain drugs such as anticoagulants, immune-suppressive agents, and
antibiotics. Ladies, that means you‘re more susceptible to joint issues than us guys, due
to your estrogen levels, and you‘ll be even more at risk if you take birth control pills or
other hormonal replacement drugs.
When it comes to repairing an injury, or making sure an injury doesn‘t surprise you
tomorrow, you‘ve also got to have sulfation and glucuronidation working well for you as
I‘ve talked about. So remember that glucuronidation has to do with liver detoxification of
hormones, drugs, and other pollutants. So the less environmental stress you‘re under
(think air pollution, for example), the less medications you take, and the less cortisol you
make (because you‘ve dealt with stress levels), the more you have glucuronidation
working for you. Now for the sulfation part…
Sulfates as a reminder, are present in foods such as broccoli, cauliflower, garlic,
cabbage, onions, radishes, and mustard. But more importantly, sulfates are also
depleted during high stress levels too because they are needed to detoxify cortisol in the
liver. Do you see a pattern here? I sure hope so. If you are under a lot of stress then
cortisol really makes a mess of every part of this GAGs pathway! The key is to not
deplete more sulfur than you take in. Interesting is the fact that NSAIDs restrict sulfate
availability, so cartilage cannot be repaired. This is a shocking fact for many people who
are trying to help their injury with these drugs, (aspirin and ibuprofen) yet are actually
doing more harm than good by depleting their sulfate levels. Research shows that
NSAIDs are only beneficial 2-3 days after injury. Taking them longer, or for the many
that take them every day, is inviting greater problems later in life. Deficiency of the trace
mineral molybdenum also inhibits sulfate availability.
Once glucose is available, because it was allowed inside the cells since you‘ve
managed your stress, (normal cortisol levels), your body can make glucosamine and
then ultimately make chondroitin, which will happen because you‘ve got good
glucuronidation going on. This all looks for the sulfur, (which is present when there are
also low stress levels and no signs of NSAID abuse), to make chondroitin sulfate – the
ultimate prize in injury repair. And of course we needed some glutamine along the way
but we have plenty of that because a healthy individual naturally makes more than
enough and is getting some in their diet – beef, chicken, fish, eggs, dairy products,
cabbage, beets, beans, spinach, and parsley.
The big idea here is actually very simple in such a complex way. You have to embrace a
healthy lifestyle because it all is going to affect the health of your tissues and joints.
Make sure your diet contains some of the foods mentioned so you have the resources
available to make GAGs happen. Consider looking at individual nutrients you may be
deficient in to help you repair your tissue. Deal with your excess stress whether that‘s
adjusting your training, diet, or lifestyle. If you take one of the joint/cartilage supplements
and it benefits you that‘s fine as it may be very necessary to get you going in the right
direction; it‘s better than taking some drug to deal with your problem, but you should still
investigate why you aren‘t making the substance on your own to truly fix your health
problem. The GAGs lesson is over.
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Filed Under: Diet & Nutrition, Injury Prevention & Treatment Tagged With: aerobic, anaerobic, carbohydrate
intolerance, chondroitin sulfate, cysteine, DMSO, GAGs, glucosamine, Glutamine, glycolytic pathway,
glycosaminoglycans, insulin resistance, MSM, natural running, NSAIDS, sulfation
Comments
1.
Michael says:
October 19, 2011 at 10:31 am
Yet another extremely valuable post by Dr. Gangemi. The internet makes it possible to disseminate so much
mistruth and hype (usually with an ulterior motive) and it is refreshing to know there are still people like Dr.
Gangemi out there who care about our long term well being, health and do not seek to profit from it. While Dr.
Gangemi does make a very nice living through his practice, this is but one example of how he gives back with
no expectation of anything in return. Thank you Dr. Gangemi.
o
Sock Doc says:
October 19, 2011 at 10:59 am
Thank you very much Michael!
2.
Tracy says:
October 19, 2011 at 11:17 am
So, would you think that if I am eating Paleo (8 mo now) and running barefoot and aerobically (using Maffetone‘s
MAF heartrate), I don‘t need to be taking the Glucosamine/Chondroitin I‘ve taken for years? (49 yo female with
history of arthritis and osteoporosis in the family — starting to feel pain in my feet upon waking about 10 yrs ago,
that‘s when I started taking Gluco/Chond).
Obviously not medical advice in this forum, but your general sense?
o
Sock Doc says:
October 19, 2011 at 11:37 am
Correct, in a general sense there should be no reason to take it anymore, unless you have a specific nutrient
deficiency. For example, did you notice how I mentioned the active form of folic acid? 5-Methyltetrahydrofolate
(5MTHF) is what your body is supposed to convert folic acid into when you take it and it‘s the form found
naturally in fruits and veges. But most people don‘t eat enough fruits and veges to get their necessary amounts
AND it is known that at least 10-15% of the population have a genetic mutation that does not allow them to fully
make 5MTHF, and 20-30% of the population is said to have a single gene mutation which makes it more
difficult for them to make 5MTHF. So, in this case a person may not be making enough cartilage repairing
tissue because they aren‘t methylating their folic acid (B12 too) correctly. So if they don‘t get enough naturally
from their diet or from taking 5MTHF (not the typical folic found in most supplements), then there could be
issues. Other genetic issues can occur to making it necessary for individuals to need certain nutrients more
than others.
One more point – an important one I did not address in the post. Taking this stuff month after month, especially
year after year is not healthy. I have seen numerous patients react to these supplements, most often with
problems in their pancreas (blood sugar metabolism – makes sense as you learned from reading the post). So
don‘t think that more is better. It isn‘t. And definitely don‘t think that if it doesn‘t work then it won‘t cause a
problem, because it very well could be, especially after all those years.
Tracy says:
October 20, 2011 at 4:29 am
That is interesting. I must say, I‘ve definitely taken the ―it can‘t hurt‖ approach. My problem now is that I am
working as a volunteer and where I live, it is very expensive. This month, I‘m skating on the edge of running
out of food. So buying an expensive supplement that might not be necessary doesn‘t seem wise. I think I‘ll
finish what I have and then stop it for awhile and see what happens.
Now, any opinions about Vitamin C?
Sock Doc says:
October 20, 2011 at 8:17 am
Vitamin C for another day, but I don‘t use or recommend the highly synthetic and isolated form of vitamin C
we are all familiar with and are told is ―vitamin C‖ – ascorbic acid. It‘s best in its whole, natural form with all its
cofactors as found in whole foods, and some whole food supplements too.
sqt says:
October 30, 2011 at 8:25 pm
I think I have one of those genetic mutations you speak of (Ehlers Danlos syndrome). I‘ve been going Paleo for
a few months and have seen a significant reduction in pain. But I wonder if my body is capable of rebuilding
itself thanks to my faulty genetics. Supplementation doesn‘t really work for me because my system is very
sensitive and I react badly to most of them. Do you have any experience with collagen disorders and/or have
any suggestions?
Sock Doc says:
October 31, 2011 at 9:33 pm
Other than the suggestions I note in the post, it would be hard to advise where to look in a more specific case
for you. Yes, I‘ve seen some people with collagen disorders and like you, they tend to do much better with a
Paleo-Type diet. Lots of antioxidants from fruits, veges, and herbs are a must too. I‘m not sure how much you
can rebuild, if any, but I‘m sure you can limit (perhaps significantly) the disorder by living as much of a healthy
life as you possibly can.
3.
Nick says:
October 19, 2011 at 11:47 pm
You should add that oral glucoseamine –> glucose as well. To big a bolus its a pretty good OGTT
4.
Andrew Klein says:
October 20, 2011 at 12:01 am
Doc! What a great post! Every day I hear ―Well, I‘m getting old, I guess I‘ll just have pain‖, but that is the furthest
anyone will go to take responsibility for their health. No one wants to give up the things that are making them
sick! Health doesn‘t come in a bottle. It comes from taking control of your life in finances, employment, exercise,
and diet. Treat your human vehicle with respect, and it takes you the places you want to go with no complaints.
5.
Greg Grandgeorge says:
October 20, 2011 at 8:49 am
It is important to watch cholesterol levels when taking Glucosamine supplements, as some people do have
increases in cholesterol levels when taking it. Personally, my total cholesterol jumped over 30 points when
taking Glucosamine supplements, and returned to normal when I stopped taking the product. I think this is
relatively rare, but still worth watching.
http://www.livestrong.com/article/287004-glucosamine-effects-on-cholesterol-count/
o
Sock Doc says:
October 20, 2011 at 10:53 am
Thanks Greg, I assume you‘re referring to LDL cholesterol which would make sense as, per my response to
one of the other comments, glucosamine can cause blood sugar issues, which in turn, will negatively affects
cholesterol levels by oxidizing LDLs. Not a good thing.
6.
Fiona says:
October 30, 2011 at 11:36 am
This is so interesting, and neatly explains my own experience.
I had the beginnings of a DuPutrens contracture on my left hand, and it had begun to progress towards the
‗cording‘ stage. Around this time I was diagnosed with Pre-diabetes and I understand that Dupuytrens
contracture is regarded as an indicator of incipient Diabetes. (My Mom is a Type 2 Diabetic and she has a
Dupuytrens contracture too).
I started eating Paleo about 4 months ago, and along with weight loss, increased energy and improved blood
sugar control, I‘m certain the Dupuytrens contracture is resolving!
I had thought I must be imagining it, but now I know that my body is healing itself. Thanks so much for the
information.
o
Sock Doc says:
October 30, 2011 at 5:22 pm
That‘s awesome Fiona, I love to hear when people take their health into their own hands (no pun intended!).
Many extremity problems are linked to dysglycemia, such as hand numbness (especially when sleeping), carpal
tunnel, and Raynaud‘s ―Disease‖. Even a slight tingling in the fingertips when exercising is a sign of blood sugar
imbalances.
7.
primalpal says:
October 30, 2011 at 11:48 am
Hi Sock Doc,
You mentioned that anticoagulants can interfere with the GAG‘s process. My father had a heart attack at the age
of 41…from the outside he appeared to be in perfect shape…he had low cholesterol…but was under a lot of
stress at work at the time. This happened 10 years ago. He is now off of all statins (typical treatment even
though he didn‘t have cholesterol issues) and most of the other drugs (not sure what these were), but he is still
required to take coumadin, an anticoagulant. This is because he originally went off of everything (including the
coumadin) a year after his heart attack, and a few months later, he had to go to the hospital because a clot had
formed in his damaged ventricle (the blood was just pooling there because the heart is no longer able to pump
there). The doctors decided it was best that he stay on the coumadin indefinitely. Now he complains of sore
joints, stiff legs, etc. Is there anything that can counter the effects of the coumadin on this process without
reducing the benefits it has for preventing clots? I don‘t think he will be able to go off the coumadin unless his
heart can be repaired, but hopefully he can become more mobile than he is now. He loves being active, but the
joint pain and stiffness really prevent him from being able to do these things.
Thank you!
o
Sock Doc says:
October 30, 2011 at 5:44 pm
Hi Primalpal, thanks for comment. I just saw a guy last week in a similar situation. His cholesterol was 118 and
he was taking Lipitor for prevention. It‘s a bit crazy how things are viewed sometimes. You know I‘m happy to
stick my neck out here a bit at times offering people some advice that they‘re not going to get from anyone else,
but this is a tough one. I don‘t need anyone dying, or even coming close. The issue here is that you have to be
careful not to negate the effects of the coumadin, (rat poison) but only its side-effects. The whole coagulation
cascade is very complex; it‘s a lot more complex than most of us know. I‘ve had some PhD coagulation experts
explain to me how it all integrates in the body and my head was spinning for days. You see, you can take
products like fish oil, but its anti-coagulation affects are not exactly the same as the principles that coumadin
works off of. There are other products out there, such as lumbrokinase, (Boluoke), that can help as they are
fibrinolytic agents. I‘d check out this lab called Esoterix, as they specialize in coagulation panels and can often
provide more insight rather than just the blanket treatment of ―stay on coumadin‖ based off results and a
knowledgeable doctor who understands coagulation. Then the other issue to consider is properly detoxifying
the liver as many of drug side-effects are due in part to sluggish livers. I‘m not recommending going to the store
to go on some crazy liver flush diet or supplements (or to take fish oil or Boluoke either), but to find a more
naturally based doc who can help him with these issues and perhaps run a more comprehensive lab test as
mentioned. Shoot me an email if you‘d like and perhaps I know someone out by you guys if you‘re not close to
SockDoc Ville‘
8.
Good luck.
Lizzie B says:
October 31, 2011 at 12:02 am
Just followed the link over from Mark‘s Daily Apple. Amazed that I understood all the biochem, great job
explaining it so all can get it. Was just tickled that you KNOW the history on DMSO. It seems usually people
don‘t know what it is, where it‘s from, or how it has been used for so long. Can‘t wait till they use it IV in people.
Only saying that because it has been run IV in Equines as a last ditch effort and brought the horses out of the
woods.
Now I just need to use up the mineral supplement I have that includes MSM with Glucosamine. Then switch to
the stuff that is just minerals. (Still working on eating a better diet… until I get that leveled out, the minerals seem
to help fill in the gaps.)
o
Sock Doc says:
October 31, 2011 at 9:36 pm
Thanks Lizzie B! They already do use it in IVs! I once went in a local MDs office who uses it in his patients and I
could literally taste it when I walked in the door. The guy getting the IV drip was 3 rooms back! The doc thought
it was pretty funny that I knew he had the drip going just from opening the front door.
9.
brian p says:
November 13, 2011 at 9:53 am
Do the same issues apply to disc damage such as a bulging disc in the lower back?
Will prolonged use of NSAID‘s slow the healing of disc tissue?
and lastly, would cortisol injections (to control inflammation in a disc) also impair the tissue regeneration?
Great article, thanks for all the interesting info!
o
Sock Doc says:
November 13, 2011 at 10:21 am
Thanks Brian. Yes the same issues do apply for a couple important reasons. One is that the outside of the disc
(called the annulus fibrosus) is made up of thick collagen fibers that hold the inner nucleus intact. So the health
of that area is important with GAGs. The other is that disc issues often result from poor biomechanics – muscle
imbalances and joint dysfunctions either directly or indirectly affecting the disc. Manganese is perhaps the most
important nutrient needed for our spinal discs.
Yes, both NSAIDs and cortisol can and will impair healing. Taking NSAIDs, especially when you don‘t need
them, can cause a chemical reaction in your body that will create 10 to 100 times more inflammation than the
original inflammatory reaction you may be trying to fight. This is called a leukotriene reaction. Cortisol injections
are known to impair GAGs synthesis and result in joint weakness.
brian p says:
November 13, 2011 at 10:29 pm
Thank you for the quick reply. It is all very helpful!
10.
Feetqi says:
April 1, 2012 at 10:59 pm
I am in ―WOW‖ but not finished the article let alone the posts! TCM ( chinese medicine) links the liver with joint
problems. But I have never found any other corroborative info!
I have history of tendon / ligament damage since taking up running 35 years ago, orthotics for 32, MCS for 30
years and recent diag. of pre-diabetes (insulin resistance).
I have dealt with these piecemeal as the holistic practitioners were not holistic enough! I have been on glutamine
supplements for the liver abnormality for 5 years- personally i think they stimulate appetite. But did not prevent
current foot injury! We really have to understand that we have to remove the bad things as well as put in the
good things. Piecemeal cannot work.
I so agree with your views Mr SocDoc !!!
11.
Cheryl says:
September 8, 2012 at 10:52 pm
Hello,
I was wondering if you have any recommendations for Morton‘s Neuroma. I injured BOTH feet this past January
and have had 1 Cortisone shot, TENS, ultrasound, and massage therapy all to no avail. I started in June taking
serrapeptase, B-50, and Tumeric.Curcumin which seems to have provided some relief, however, if I am walking
for any length of time over a half hour the cramping nerve pain returns. I amalso receiving HPLT (high powered
laser treatment) once a week that supposedly will help. What is your take on these modalities? I am terrified of
the ‗alcohol shots‘ an or thee surgery the podiatrist mentioned if conservative measures failed; it being only 70%
effective. I don‘t like those odds!!
I appreciate your comments.
o
Sock Doc says:
September 9, 2012 at 7:11 pm
I discuss Morton‘s Neuroma here: http://sock-doc.com/2012/05/foot-injuries/
All those modalities treat the symptom (at best) and not the cause, including the laser treatment, hence I would
never use any of them personally.
12.
Lisa Quenon says:
January 11, 2013 at 6:37 am
Hello Doc! Thank you for this article! It helped me tweak some things I‘m doing…add some other…subtract a
few…been working on healing the cortisol thing for a while…years and years and years of cumulative stressshock-obesity-trauma (you get the picture)…much more in tune with what‘s going on now yet still have a
significant way to go. Was on tremendous western meds (huge variety) and now on none…liver was damaged
and had spots…off all meds 6+ months (a 3 year process)…last liver test came out healthy and clean (per the
western doc). Thank you thank you thank you for your awareness and life experience and for sharing all of
this…
13.
cliff chen says:
March 8, 2013 at 10:47 pm
hi dr gangemi,
1st and foremost, thank you so much for creating such a comprehensive and informative website. it has helped
me SO much through my recent injury. i wish i could see you in person but i‘m all the way in san diego, ca.
what do you think about osteo bi flex & it‘s ingredients (i read the side effects, and based on my family
history/personal history, im pretty sure im safe):
http://www.costco.com/Osteo-Bi-Flex%C2%AE-Triple-Strength,-170-Caplets.product.100013549.html
in 2008 an MRI stated i have intense bone marrow edema, chondral fissuring, interruption of subchondral bone
plate @ the end of the big toe proximal phalanx. my 2008 flare up was pretty bad (it prevented dorsi flexion).
2010 it flared up mildly. 2012 it flared up lightly. i noticed that there was a correlation with eating foods high in
uric acid too, my blood tests confirmed that i had slightly high uric acid levels to which im now taking allipurinol. i
never had a gout outbreak though. i have been going 2-3 years strong of increasing my diet to alot of
fruit/veggies/no gluten. i take fish oils daily. ive also been controlling my stress alot.
main reason for inquiring about osteo bi flex is that i want to thicken the cartilage at the end of the proximal
phalanx since there was intense wear and tear in 2008 and i‘ve had mild flare ups since. if you do not
recommend osteo bi flex, is there any supplement out there that can increase my cartilage and create
healthiness between my 1st meta and proximal phalanx of my big toe? thank you so much dr gangemi!
sincerely,
cliff
o
Sock Doc says:
March 10, 2013 at 8:09 pm
I would never take anything from Costco; I don‘t trust them and there‘s usually a reason their supplements are
so cheap.
When I use (give to a patient) either glucosamine or chondroitin, they typically only get one bottle because I‘m
more concerned with the substrate(s) they are most likely missing to make the final product. That‘s different for
everybody – one person I might give manganese, another B12, and another magnesium.
And of course you have to clean up your diet which usually means dealing with insulin issues, so the cartilage
no longer becomes inflamed and can hopefully heal.
14.
Andrea Jones says:
April 24, 2013 at 6:03 pm
Hi up until 6 years ago the only thing I have had done was my gall bladder removed. Then I broke my leg ,and
had to have it plated. Since that everything seems to have gone wrong. I have had a torn rotor culf in my right
shoulder, laser treatment on my throat (nodule build up) had the plates removed then to top it of last year
stepped awkward and popped my acl in my right knee. and my cartilage flipped over inside my knee.. Had the
acl repaired, cartilage taken out and having a monovisc injection in my knee next week… oh and I am a fitness
instructor who loves her job…
Can you please recommend if there is any supplements I should be taking.
Than you
Andrea Jones
o
Sock Doc says:
April 26, 2013 at 5:04 pm
Please read this; thanks!
http://sock-doc.com/sock-doc-questions-comments/
15.
duke says:
May 12, 2013 at 9:07 pm
Thanks for the post doc. I believe In what you are saying. I was recently told I have two disk protrusions in
lumbar. I was hurt while training jiu jitsu-as I was put in body lock. Disks are showing signs of degeneration. Pain
is mild without exercises. When I exercise I get increased pain and tightness. I went through heavy break up and
am a pretty stressed worried individual. I usually handled this stress via excercise. I have been a vegetarian my
whole life,I am currently 27. My Pt gave me McKenzie stretches for my posterior bulges along with sstretches. I
am going to purchase glucosomine and chondroitin in hopes of slowing or arresting disk degeneration. You say
that stretching is bad. Do you have any advice? Obviously I need to destress. Having a ―degenerative‖ condition
doesn‘t help. Thanks very much for your time.
o
Sock Doc says:
May 13, 2013 at 8:59 am
Please read this; thanks!
http://sock-doc.com/sock-doc-questions-comments/
16.
KL Lim says:
May 31, 2013 at 9:47 am
Some supplement claims that thier supplement provides necessary nutrition for body to produce glucosamine. I
like to know how much supplement is sufficient for body to produce enough glucosamine for the body? will there
be a case that the body cannot produce glucosamine or little amount of glucosamine even with ample supply of
the necessary nutrition?
Is it possible that the body may have difficulty to produce glucosamine? What will be the causes? Is age one of
the causes? How to find out if the body having this difficulty?
If body is having difficulty to produce glucosamine, what can be the solution? Take the ready made glucosamine
pill like Viatril-s or bio-calth?
Thank you very much.
o
Sock Doc says:
June 2, 2013 at 8:51 pm
That‘s a very involved question as for the supplement, it depends on how well it is manufactured. I use some
glucosamine products, but often give my patients the precursors to make it within their body.
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