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I No Longer Love a Parade

Parade magazine is the most widely read periodical in the US, with a circulation of 32 million and a readership of 71 million (1). They get that readership by placing it, free for readers, in over 400 newspapers.

The column in question is “Ease The Aches Of Arthritis” By Dr. Vijay Vad, published 09/28/2008. Dr. Vad is a physiatrist (a rehabilitation doctor) who has published several books on arthritis for the the public.

In the article, Dr. Vad discusses ways to decrease arthritis pain. Like most popular summaries, it is without references, so I used Pubmed and Google for each of his suggestions to look for the evidence to support the advice he offers. I tried to use both narrow and broad search terms in Pubmed, but I do not doubt I missed key articles. I have confidence that the readers of the blog will show me the error of my ways.

There are many types of arthritis: there is inflammatory arthritis, like rheumatoid arthritis, and osteoarthritis, due to wear and tear. There is crystalline arthritis like gout and there is infectious arthritis, due to staphylococcus or other bacteria. Most people have osteoarthritis, or degenerative joint disease. These are different diseases, and studies that evaluate the pathophysiology and treatment of one do not necessarily apply to the others. Dr Vad does not distinguish between the different types of arthritis in his article, broadly suggesting interventions for ‘arthritis’ as if all types of arthritis are equal. It is like suggesting penicillin for ‘infection’, paying no attention to the type of infection and whether the use of penicillin is applicable.

Watch your diet. Eat foods that reduce inflammation, and avoid those that cause it. Red meat, which contains omega-6 fatty acids, and high-fructose corn syrup promote inflammation.

I cannot find a clinical trial where omega-6 fatty acids promote arthritis or increase arthritis pain. I can find no trials that show an association between increased red meat consumption and increased osteoarthritis pain. There is one epidemiologic study (2) that finds an association between high red meat consumption and developing inflammatory arthritis. Note: developing and inflammatory arthritis, not osteoarthritis. It was a mild association. Association is not causation, and as the authors say “A high level of red meat consumption may represent a novel risk factor for inflammatory arthritis or may act as a marker for a group of persons with an increased risk from other lifestyle causes.”

Double blind studies with diet are particularly difficult to perform as people tend to be able to identify what they eat. The one study I could find showed no benefit of a low meat diet and the symptoms of rheumatoid arthritis (3).

Using “high fructose corn syrup” and either arthritis or inflammation yields no clinical trials or basic science articles on a Pubmed search. Nothing. I can find no credible science to support the assertion that high fructose corn syrup promotes inflammation or increases arthritis pain directly. Use of high fructose corn syrup is associated with gout, which is a form of arthritis where uric acid crystals precipitate into the joint and it is the crystals that cause inflammation. But there is no (4) data I can find to suggest that high fructose corn syrup will make your joint pain worse or avoiding it will make your joint pain better.

Instead, to reduce inflammation, consume more foods that are rich in omega-3 fatty acids, such as deep-sea fish, flaxseed, brightly colored fruits, dark-green leafy vegetables, and olive oil.

True, but the data for the benefit of fish oils is valid only for rheumatoid arthritis. If fish oil clinical trials are available for osteoarthritis, I could not find them on Pubmed. Also there are no clinical trials that support the efficacy of flaxseed, green leafy vegetables or olive oil in improving joint pain. In the Adventist Health Study, fruit consumption was weakly associated with increased osteoarthritis, as was the consumption of red meat (9) and a few studies suggesting benefit from avocados, which, I believe, is not a leafy vegetable.

Our prehistoric ancestors, to whom arthritis was virtually unknown…

A quick Google finds reports of ancient human remains with rheumatoid arthritis and osteoarthritis, some dating back 40,000 years ago. I found the information in less than a minute. Why the editors of Parade cannot fact check with similar alacrity I do not know. I thought that’s what editors did: they edit. Prior to modern society, most people didn’t live past their mid twenties to mid thirties, hardly time enough to develop widespread evidence of degenerative arthritis. If you die young, as most people did until the last 100 years, you do not have degenerative diseases that take a long life to develop.

Recent scientific data indicate that the use of ginger, glucosamine, and chondroitin sulfate may be helpful for moderate to severe knee arthritis.

Glucosamine may have some modest effects on joint pain. The results of clinical trials with chondroitin suggests that it is not effective (this is a huge and messy literature fraught with poor studies). I have always thought, since these products are synthesized onsite by the joint, rather than imported whole, that it is a therapy like eating hair for baldness. Which I wish would work.

As to ginger, there are two studies, one shows moderate efficacy for decreasing joint symptoms (5) the other doesn’t (6). Hardly compelling trials, although there are some intriguing in vitro studies to suggest that ginger has some anti inflammatory properties; it is a long way from inhibiting sow cartilage explants (7) in a test tube to recommending routine use of the spice. Unless.

It should be mentioned that Dr. Vad has been responsible as the “leading physician researcher in arthritis” for the development of Gingerflex ™, a supplement with ginger, glucosamine, and chondroitin sulfate. I cannot find his name directly associated with the product and only discovered it from a direct inquiry to the company. The company has not responded to my inquiries as to whether he is still actively involved with Gingerflex, although he recommends the product in his books and his books are sold on the same page as the product on the gingerflex.com website. The editors of Parade do not seem to be interested that the medical advice offered in the periodical may have a conflict of interest.

BTW, Dr Vad has 13 references in low impact journals in Pubmed, a solid resume, and much better than my own resume, but hardly a “leading physician researcher in arthritis.”

Use your body. Some people with arthritis are afraid that exercise can hurt them. But it’s just the opposite.

Given the wide ranging benefits of regualr exercise, I cannot argue with this advice, although the data suggest that the benefits of exercise are short term and minimal for effects on joint symptoms and function. There is surprisingly little data to suggest exercise is of benefit for the narrow indication of relieving joint pain and increasing function in a variety of different types of arthritis, although this literature is huge. As one representative meta analysis said, “For pain assessed using the 0 to 10 visual analog scale, the average effect amounts to a mean of 3.78 for treatment subjects versus 4.33 for control subjects. Control group subjects experienced statistically significant improvements in pain and, to a lesser extent, objectively measured functional ability during study participation. CONCLUSIONS: Physical activity interventions resulted in moderate positive effects on physical activity behavior and small positive effects on pain and physical function outcomes (10)”.

Breathe properly. Proper breathing in a slow, controlled rhythm is the fastest pain reliever I know of, because it shifts the mind’s attention away from the pain.

I agree with this. All my patients who have stopped breathing have done poorly. I have to admit I do not understand this advice. Breathing is for gas exchange; there is no proper way to breath unless you have Ondine’s curse. While focusing on breathing can be distracting, so can many other activities, from TV to a good beer. To be complete, I looked for breathing and changes in arthritis symptoms or pain. I found nothing.

Try massage and acupuncture. Because mainstream medicine has not provided enough arthritis treatments short of drugs and surgery, many arthritis sufferers have turned to alternative treatments such as massage and acupuncture. Specifically, massage therapy has been shown to be beneficial for arthritis of the spine and hip, and acupuncture has yielded promising results for knee arthritis in clinical trials.

One trial I found for massage and osteoarthritis of the knee (8) demonstrated benefit, and I do not doubt that massage makes anyone feel good, although I am at a loss as to how to do a placebo trial for this type of intervention. As to acupuncture, the data for this intervention has been discussed at length in this blog. Compared to sham acupuncture, ‘real’ acupuncture is no better and in one study was worse for arthritis pain. The clinical trials do not support he use of acupuncture for any disease, much less arthritis. Acupuncture is worthless to all but the acupuncturist.

So what can you say about the advice offered in Parade for suffers of arthritis?

Much of what is said does not seem to be supported by the published medical literature or is widely extrapolated from minimal or contradictory data. No effort is made to distinguish the various kinds of arthritis so there can be appropriate application of what minimal data exists. All arthritis is treated the same.

There is a suspicion of conflict of interest in the article. I always find it ironic that while I am the pawn of big pharma, it is the promoters of nutraceuticals who sell the products on their websites and from their offices and reap the profits. I have never made dime one from any drug I have ever prescribed.

As I wrote this I ran the basic ideas by one of our rheumatologists to make sure I wasn’t missing any important information. It led to an interesting discussion of how he applies this kind of information to his patients. The practice of medicine is often messy, especially with rheumatologic illnesses. He told me it is part of the general culture of rheumatology where you discuss these interventions with patients using terms like ‘may help’ and ‘people find it useful’. Not exactly recommending them, but not discouraging them either. Red meat, high fructose corn syrup and fish oils are part of the ‘popular culture’ of the treatment of joint disease, irrespective of the data, and are casually given the same consideration as NSAID’s and prednisone, especially in patients with refractory disease. Shruggies, I suppose, but there is that feeling that we should do something, anything, but not nothing, as long as there is the whiff of a hint of a suggestion of a possibility that maybe possibly it might do something good for someone somewhere sometime. We all want to help, don’t we?

A common complaint in the skeptical literature is the poor job done by mainstream media in covering science. Here is another example. The most widely read magazine in the US apparently lacks the ability for simple fact checking and insuring that the medical advice they offer is free of potential financial conflict. Parade contains a column by Marilyn vos Savant, who holds the record for the worlds highest IQ. Perhaps they should take advantage of this prodigious intellectual power to help edit the medical columns. The editors need help from someone.

—-

1. http://en.wikipedia.org/wiki/Parade_(magazine)

2. Arthritis Rheum. 2004;50:3804-3812

3. Scand J Rheumatol. 2000;29(5):302-7. Diet therapy for rheumatoid arthritis. A controlled double-blind study of two different dietary regimens.

4. as in zip, zilch, nil, nothing, nada, zero

5. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum. 2001 Nov;44(11):2531-8.

6. Osteoarthritis Cartilage. 2000 Jan;8(1):9-12. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis.

7. J Med Food. 2005 Summer;8(2):149-53. Comparative effects of ginger root (Zingiber officinale Rosc.) on the production of inflammatory mediators in normal and osteoarthrotic sow chondrocytes.

8. Arch Intern Med. 2006 Dec 11-25;166(22):2533-8.Massage therapy for osteoarthritis of the knee: a randomized controlled trial.

9. J Nutr Health Aging. 2006 Jan-Feb;10(1):7-14. Associations between meat consumption and the prevalence of degenerative arthritis and soft tissue disorders in the adventist health study, California U.S.A.

10. This is a huge literature, Pubmed arthritis and exercise to review the references. Semin Arthritis Rheum. 2008 Apr;37(5):307-16. Epub 2007 Sep 21 Physical activity interventions among adults with arthritis: meta-analysis of outcomes..

Posted in: Herbs & Supplements, Nutrition, Science and the Media

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55 thoughts on “I No Longer Love a Parade

  1. Harriet Hall says:

    Thank you for raining on their Parade. They deserved it.

    I particularly liked your analogy of eating hair for baldness. Magical thinking at its best.

    As for proper breathing, there is a whole alternative medical mythology surrounding breathing. Andrew Weil recommends various breathing exercises. Some of the claims for breathing exercises are really pretty funny. I’d love it if you would tackle that subject in a future post.

  2. Peter Lipson says:

    Hmmm…Dr Val, Dr Vad…both physiatrists…ever see them both together? Not me.

  3. Ticki says:

    “BTW, Dr Vad has 13 references in low impact journals in Pubmed, a solid resume, and much better than my own, but hardly a “leading physician researcher in arthritis.””

    Much better what than your own? Please complete that sentence and then remove this.

    Oh, and thanks for a good post. It´s too bad stuff like this doesn´t get read by 71 million.

  4. I never bother to read Parade myself. There’s rarely anything in it of interest to me. Maybe I should add it to my media woo watch.

  5. Jules says:

    1) It’s Parade. I.e., for the general public. I.e., the longest word you’ll find there is “inflammation”, and most of the readers don’t understand what it really means. Apologies to all the smart folks here–but blaming Parade for misinforming the general public is like ranting about the Metro publishing photos of Brit’s “twit” rather than an article about the presidential debates.

    2) Absence of evidence is not evidence of absence. I don’t mean to sound like I’m defending the guy, but one, two studies do not a definitive conclusion make, either for or against a hypothesis. There are only three crystal structures for membrane proteins: does this mean that we don’t know what membrane proteins look like? Does this mean that all the science we’ve been doing for the last 15 years based on these structures is wrong? The science, might I add, that’s given us drugs like buprenorphine? Nutritional science is an oxymoron, in the sense that the best we can do is approximate and correlate. Just because nobody’s thought to correlate omega-6s with arthritis doesn’t necessarily mean it’s not the case–even the best hypotheses require someone to think of them, and someone else to find the money to fund a study (thanks, Bush). (see also pt 4)

    3) I recommend looking at Dr. David Coulter’s Anatomy of Hatha Yoga for a few breathing exercises and what they can do for the mind. And trying them–it’s really cool, I promise. For a science geek, it doesn’t get much better than this. Although ostensibly breathing is for gas exchange, how we breathe can greatly affect our autonomic responses. Granted–this probably wasn’t what Dr. Vad has in mind, but standing up straight, getting your body and joints back into alignment, so that you can breathe “properly” is probably going to have some benefits, no?

    4) Most of the advice is advice people should be following, anyway: not too much red meat, lots of omega-3s, plants, exercise, meditation, cut down on processed crap. For the wrong reasons, of course. But don’t the ends justify the means in this case?

    5) Either you dumb down science so that people can understand it, or you lose people as to why their tax dollars should continue to fund your research and they start whining about why they should fund research about drug addicts when their kids are going hungry. PR and looking pretty on tape is all part and parcel of being a scientist–sorry, but it’s true. My PI was just broadcast all over the country (not the US) explaining the important research he did–he did a fairly good job of it, simplifying it without sounding condescending too much. You can bet that when it comes time to renew his grant, he won’t have any problems (papers in PNAS and Nature help, too).

    FTR: Parade is crap, and I wouldn’t trust it any longer than it takes to burn. But I think you’re making a mountain out of a molehill, here–how seriously do you think people take a magazine that opens with the sex scandals of the Hollywood elite?

  6. Harriet Hall says:

    “Parade isn’t important” is a shruggie attitude.

    I’m not planning to read Coulter’s book. Perhaps you could share with us what your breathing exercises can do for the mind and how you know. Perhaps you can cite some scientific studies Dr. Crislip missed.

  7. Sadly, Jules, many older people do take Parade magazine seriously, and these are often the type of folks that sCAM practitioners end up parting from their life savings over dubious remedies. The more media outlets that are taken to task by blogs like this one, the better! For instance, I can print out Dr. Crislip’s well-referenced and well-reasoned entry and show to my husband’s grandmother.

  8. Joe says:

    Jules on 09 Oct 2008 at 5:08 pm wrote “I don’t mean to sound like I’m defending the guy, but one, two studies do not a definitive conclusion make, either for or against a hypothesis. There are only three crystal structures for membrane proteins: does this mean that we don’t know what membrane proteins look like?”

    I am reminded of “Mandrake, do you realize that 70% of the Earth is water … Do you realize that you are 70% water?”*

    * “Doctor Strangelove” the movie.

  9. Matlatzinca says:

    Great article, vintage Mark Crislip.

    I’m totally stealing the line “like eating hair for baldness.” With proper attribution, of course.

  10. Jules says:

    @ Harriet: Shame. Isn’t there something about keeping friends close and enemies closer? And Coulter’s book doesn’t go into the yogic explanations of why the breathing exercises work–he just describes them, how they’re done, and why they enhance a yoga practice. Coulter’s book also doesn’t delve into any of the Ayurvedic medicine principles–he keeps it strictly in the physical, as much as possible.

    All I’m saying is that the “absence of evidence is not evidence of absence” line that we love to throw at creationists cuts both ways. You can’t have your cake and eat it too. Hypothetically, someone could irrefutably and scientifically prove that eating posies will make you turn pink. But if it’s not in some journal (because, let’s face it, who’d publish a study like that?), and one day Crislip decides one day to see whether eating posies will make you turn pink, he won’t find it, and decide that no studies have been done, and call the warning against eating posies a lie.

    As far as being a Shruggie–I see it as being pragmatic about where to set off a rant. It’s not as if the guy is advocating drinking arsenic and running marathons. Generally speaking, most of it is in line with what’s currently recommended as “good nutrition”. I’d much rather someone be deluded as to why something is good for them, than not do that good thing.

    For instance, a lot of people still, despite the loads of evidence, don’t know about spay-neuter procedures, or don’t understand why it’s so important for the health of their pet. I’d rather someone think that getting their dog neutered will prevent it from eating their child–and then get the dog neutered–than cite them statistics, bore them to death with citations, and still not understand why neutering is important, and not do it.

    Which begs the bigger question of where does spin end where do lies and pseudoscience begin?

  11. Calli Arcale says:

    You make good points, Jules, that we need to be careful about not driving away the undecided, though I think you’ve given a few people the impression that you’re in favor of woo. And I tend to disagree with the premise that the ends justify the means. To borrow your analogy, if people don’t understand *why* it’s good to spay and neuter, then it can lead them to some false conclusions. The most pressing is that if they meet an aggressive neutered dog (and yes, I’ve known quite a few), they will conclude that spaying and neutering is a waste of time since obviously it doesn’t work. Or they’ll conclude it’s only necessary on males. Or, worse, they’ll become proponents of judicial castration….

    So while I agree we need to present the science in a manner which is accessible, we need to be sure that we are presenting it in a manner which is factual and which the public can apply on their own. Which gets us back to what you said earlier about the importance of “dumbing down” science so that people understand why it’s important to fund it.

    The trick, I think, is dumbing down science without it being actually wrong, like the cited Parade article. This leaves readers with information that they understand but which will mislead them when they attempt to apply that information outside the context of the article.

    You’re also right, of course, about the absence of evidence not being evidence of absence. We need to be careful not to open ourselves up to that accusation from the pseudoscientists.

  12. qetzal says:

    Absence of evidence is not evidence of absence. I don’t mean to sound like I’m defending the guy, but one, two studies do not a definitive conclusion make, either for or against a hypothesis.

    Jules, are you seriously suggesting that it’s OK to give people medical advice as long as we can’t prove the advice is wrong? More specifically, do you think it’s OK for an MD to say that red meat and high fructose corn syrup promote inflammation if the supporting data is absent?

    I could claim that raising the foot of your bed 6″ higher than the head will reduce inflammation and arthritis pain. I’ll bet you can’t find any evidence that I’m wrong. Does that make my claim OK?

    No, it doesn’t.

  13. Harriet Hall says:

    Jules,

    I said I’m not planning on reading Coulter’s book only because there are thousands of books out there and I have limited time. Why don’t you give me a good reason to put that book at the top of my reading list? Tell us what your breathing exercises can do for the mind and how you know. Cite some scientific studies Dr. Crislip missed. Give us some evidence.

  14. Fifi says:

    May I suggest that one doesn’t have to “dumb down” information to make it accessible, one simply has to translate the information from the specialized language in which it’s encoded (to convey additional meaning and contextual meaning in specialized discussions) into everyday language that preserves the essential meaning but puts it into simpler (aka less specialized) language and explains any concepts or contexts that may be implicit in the specialized language but obscure and esoteric to the general public.

    “Dumbing down” does everyone a disservice (and is highly arrogant as a concept to begin with since it assumes superior intelligence just because one knows a specialized language, which isn’t very logical or accurate…and tends to lead to the opposite of “dumbing down” – baffling with bullshit also employed to give the appearance of superior intelligence). Anyone who can’t explain an idea or concept in simple language, or at least the basic premise of an idea or concept, probably doesn’t understand that idea in the first place. Faux complexity and faux simplicity are two sides of the same coin, both are arrogant and ignorantly assume that education or speaking a specialized language equals intelligence, understanding and the ability to think critically. My experience – and stats on CAM use that have been presented here before – show just the opposite, that it’s educated and middle/upper-middle class people who fall for CAM and pseudoscience more often than not (the less affluent and educated just seem to choose religion when they reject science and medicine, though that’s a speculative observation on my part). They’re attracted by the tarted up language of pseudoscience and their own internal discontent (they have stuff, they can’t figure out why their not as happy as on the commercials and TV), and like many educated but not particularly intelligent or critically enabled people they mistake specialized language for actual authority/veracity of content. It’s not the “dumb” people who are the problem (besides, they don’t speak up much), it’s the ones who assume they’re smarter than the average bear who don’t question their own assumptions or those they identify themselves with.

  15. Fredeliot2 says:

    My own experience with PARADE. A few years ago they ran an article on answers to basic science questions. Their answer for “Why is the sky blue” was wrong. I checked their online version and it had the correct answer. I emailed the editor to find out why the difference and the reply was that the article was for children and the correct answer was too advanced for their readership.

  16. Fifi says:

    Fredeliot2 – What a strange response! They’re basically saying they knowingly lie to children! Did you ask them if they consider lying to children to be part of their editorial policy and if this policy also applied to other segments of the public?

    Seriously, the idea that many people hold that the general public is stupid is, well, ignorant and pretty arrogant. (Most people except themselves and their colleagues from the “public is stupid” rule, of course, because journalists/scientists/teachers/advertisers or whatever group the person holding this idea belongs to are exceptions to that rule or, if they also look down on their colleagues, at least they are exceptional and superior individuals). I may well know more about art, cultural theory, communications and even medicine than many other people who aren’t specialized in these areas or familiar with them and my knowledge may inform my intelligence (or not, it’s not a guarantee that knowledge distills into wisdom or expanded intelligence) but it’s not my intelligence itself nor my ability to think. Certainly many people involved with government and industry (the medical industry included), and of course religion and politics, would prefer sheeple but that doesn’t mean everyone’s really that stupid – often it’s just a matter of being a shruggle because other things are more pressing and important in day to day life.

  17. Karl Withakay says:

    If you believe in the bible, (but are not a creationist), your position could be that God made up the story of creation in the bible to provide an explanation that people of the day would understand, much like Parade did for children with the blue sky question.

    If you don’t believe in the bible, you probably believe men wrote the creation account to explain something they didn’t understand.

    If you hold either one of those two positions (which are, of course not the only possible positions), you probably can recognize the problem with putting out bad/unsupported information just to provide a context for people. A whole slew of unexpected/unintended offspring theories and philosophies can spring forth from the original information.

    A large volume of woo and bunk science has been originated by creationists to attempt to support/prove the young Earth hypothesis required by a simple mythological story attempting to explain to people who knew nothing of science or the nature of the the universe where everything came from.

  18. Karl Withakay says:

    I work in the IT field. Any time I give a simplified explanation of a technical issue to a non technical person, I always try to keep the explanation as accurate as possible, and try to consider ways my explanation could be misinterpreted, and what the potential ramifications of those misinterpretations could be. Bad information is a weed, a virus that once released into the wild, is difficult to eradicate.

  19. Jules says:

    @ qetzal: No. I’m saying that, if we can say to CAM practitioners, “You’re wrong because there aren’t any studies proving you’re right,” then they can also say to us, “We’re right because there aren’t any studies proving we’re wrong.” It’s more a matter of rhetoric than science, but good science is a matter of asking precise questions and having precise definitions and not getting caught in rhetorical loopholes. If your argument has room for a rhetorical loophole, then you’ve got to refine it until it doesn’t.

    @ Harriet: At the top of your reading list? It’s not even at the top of mine–I use it as a reference book. It’s of no interest to anybody who doesn’t take yoga (at least the physical practice) seriously, so of course I’m not going to recommend it. Not to mention only Chapter 2 deals with breathing and I imagine the rest of the book is rather boring unless you actually practice yoga and are interested in the finer points of the practice–and if you were, you’d have it in your bookshelf already.

    But since you insist: “The complete breath is one of the simplest and yet most rewarding of all the yoga breathing exercises. To begin, breathe in and out a few times normally and then exhale as much as possible, all the way down to your residual volume. Then for the complete breath inhale as much as possible, which will be your vital capacity. Continue by exhaling and inhaling your vital capacity as many times as you want.
    “This is a lot of ventilation even if you breathe slowly. If you inhale and exhale your vital capacity three times in one minute, your minute ventilation will be 14,400 ml per minute and your alveolar ventilation will be 13,950 ml per minute*. After just six such breaths your blood gases will have shifted perceptibly….”

    And I shouldn’t have to cite a source for what happens when your bicarbonate levels decrease by a few mM (brown paper bag, anyone?), do I?

    *The numbers associated with your standard 70 kg male for all of his measurements.

  20. qetzal says:

    @ Jules:

    I’m saying that, if we can say to CAM practitioners, “You’re wrong because there aren’t any studies proving you’re right,” then they can also say to us, “We’re right because there aren’t any studies proving we’re wrong.”

    You’re not using right and wrong in the same sense Dr. Crislip did.

    He wasn’t saying Dr. Vad’s statements were factually. He was saying Dr. Vad was wrong to present those statements as fact when there is insufficient data to support them. Especially when the statements are being offered as medical advice!

  21. Harriet Hall says:

    Jules,

    I’m afraid I don’t understand why I would want to induce respiratory alkalosis. And if I did want to hyperventilate, why would this particular method be preferable to others. Could you explain?

  22. Joe says:

    qetzal on 10 Oct 2008 at 3:52 pm wrote “He wasn’t saying Dr. Vad’s statements were factually [incorrect].”

    A slight [correction], applied by me. I hope.

  23. weing says:

    I never say to CAM practitioners that they are wrong because of lack of studies proving their right. I tell them, they may be right but they need to prove it. As the saying goes “Show me the money”.

  24. Joe says:

    Jules on 10 Oct 2008 at 3:05 pm wrote “And I shouldn’t have to cite a source for what happens when your bicarbonate levels decrease by a few mM (brown paper bag, anyone?), do I?”

    If you mean breathing into and out of a brown-paper bag, I’ll go out on a limb- and suggest that bicarbonate levels increase. However, I must concede that I have never studied the mystical arts that contravene science.

  25. Joe says:

    Jules on 10 Oct 2008 at 3:05 pm wrote “After just six such breaths your blood gases will have shifted perceptibly… .” I doubt you have refliable data to support this.

  26. qetzal says:

    Joe,

    Thanks for the correction. That is indeed what I meant.

  27. Jules says:

    qetzal: oh, I agree that Dr. Vad should not have presented the statements as facts. I simply feel that if you want to refute something, you should refute that thing, and not refute it because there’s nothing there.

    @ Harriet: Why does anybody do yoga? For that matter, why do people drink, smoke, have recreational sex, jump out of airplanes, run 26.2 miles, or take hash? Because it feels good. The complete breath is one of the most basic yoga asanas–you’d have to have a very poor teacher who doesn’t cover it. There are, of course, a bunch of things about “cleansing the body” and what-all, but the bottom line is that it feels good.

    Look, I never said you should try this (well, I did, but that was meant in a more “check this out!” vein) and like I said, if you’re not into yoga, you probably shouldn’t. And I certainly never said it was for a medical purpose. You asked for evidence of a mind-breathing connection and I gave you one.

  28. Parade is important as a source of information and misinformation about medicine and pseudomedicine. Its circulation is huge. Isadore Rosenfeld, “America’s Most Trusted Doctor,” was Parade’s health editor for years (maybe he still is). In 1998 he wrote a credulous article about acupuncture that became the subject of a critical article by Gary Posner and our own Wally Sampson. [1,2] I’ll discuss that one of these weeks. Rosenfeld is also the author of “Dr. Rosenfeld’s Guide to Alternative Medicine,” which at first glance doesn’t look particularly rigorous.[3]

    1. Rosenfeld I. Acupuncture goes mainstream (almost). Parade. 8/16/98.

    2. Posner GP, Sampson W. Chinese acupuncture for heart surgery anesthesia. Sci Rev Alt Med 3;2:15-19 (1999)

    3. http://www.amazon.com/Dr-Rosenfelds-Guide-Alternative-Medicine/dp/0449000745/ref=sr_1_4?ie=UTF8&s=books&qid=1223706769&sr=1-4

  29. Fifi says:

    I’m curious, has any professional medical organization put out a review of which magazines and/or newspapers provide the most accurate and most inaccurate information? Perhaps the authors here could put their heads together and review and vote on how accurate and useful each publication is. Call out the editors and publishers responsible (they’re the ones making the choices, not the writer) and point out any links the publishers have that may be creating bias (be they Big Pharma or CAM).

    I’m pretty sure a consumers guide to who you can trust to give you the facts about medicine and why would be very popular. If you mark them on a sliding scale, it gives them the opportunity to get better over time (if it was a yearly review). What most people, in my experience, are looking for is accurate information presented in a way that’s easy to understand (well, along with solutions that require no effort).

  30. Val Jones says:

    Lots of smart comments in this thread.

    First, Peter Lipson – it is unfortunate that my first name is only one letter away from the author’s last. But I assure you that I do not subscribe to his beliefs. I would also add that physiatry (both historically and in modern times) has had a special penchant for woo and hardcore shruggieness. I have lots of work to do among my colleagues!

    Second, “…that it is a therapy like eating hair for baldness. Which I wish would work.” Is AWESOME.

    Third, weing’s got a great approach: “I never say to CAM practitioners that they are wrong because of lack of studies proving they’re right. I tell them, they may be right but they need to prove it.”

    Fourth, Fredeliot2, I’m outraged that Parade will “lie to children” because their minds can’t wrap themselves around the whole truth. Surely we can find a way maintain truth in simplicity.

    Fifth, Karl Withakay, “Bad information is a weed, a virus that once released into the wild, is difficult to eradicate.” Nothing truer can be said of the Internet. That’s why I’m a strong advocate of aggressive weeding programs, and at the plants’ earliest stages. While we physicians were rolling our eyes and ignoring snake oil, it got a hold of many of our patients. As Harriet Hall says, we must not have a shruggie attitude towards pseudoscience, no matter how ridiculous it is (or the perceived credibility of the source)… because one person’s ridiculousness is another patient’s treatment option. There is much work to be done. I wonder where we could place a classified ad for health information weeders?

    I guess it starts here.

  31. Joe says:

    Joe on 10 Oct 2008 at 4:16 pm

    Jules on 10 Oct 2008 at 3:05 pm wrote “After just six such breaths your blood gases will have shifted perceptibly… .” I doubt you have reliable data to support this.

    I jumped to a conclusion- I regularly hear that proper breathing can increase the “oxygen” content of the blood. I overlooked the other gasses.

  32. yeahsurewhatever says:

    “There are many types of arthritis: there is inflammatory arthritis, like rheumatoid arthritis, and osteoarthritis, due to wear and tear. There is crystalline arthritis like gout and there is infectious arthritis, due to staphylococcus or other bacteria. Most people have osteoarthritis, or degenerative joint disease. These are different diseases, and studies that evaluate the pathophysiology and treatment of one do not necessarily apply to the others. Dr Vad does not distinguish between the different types of arthritis in his article, broadly suggesting interventions for ‘arthritis’ as if all types of arthritis are equal. It is like suggesting penicillin for ‘infection’, paying no attention to the type of infection and whether the use of penicillin is applicable.”

    I think this is largely due to a terminological problem in American medicine. The word ‘arthritis’ has a particular meaning (“joint inflammation”) that does not apply to all of these diseases. More properly, some of them should be called species of ‘arthrosis’ (“joint disease”).

    The distinction is more common e.g. in British medicine.

  33. yeahsurewhatever says:

    Also I believe the main myth when it comes to olive oil relieving joint pain is that it somehow magically seeps to the joints and lubricates them. This is the sort of logic that is popular in folk medicine. I can’t imagine it being of therapeutic benefit even if one were to directly apply it onto the damaged joint tissue.

    Also, interestingly, the Otzi corpse is thought to have suffered from arthritis before he died. Probably chronically. So that makes it particularly embarrassing that Vad would make such a claim. Otzi is pretty famous.

    The “breathe properly” advice is part of Andrew Weil’s brand of pseudomedicine. It is his expert medical opinion (I almost said that with a straight face) that most disease and discomfort are caused because when it comes to breathing, people are “doing it wrong”. I’m sure he sells all sorts of videos etc that “teach” people the proper way to breathe, which is after all half-reflexive and couldn’t possibly be done wrong unless intentionally.

    As you seem to imply but are wary to state directly, it certainly seems that Vad is using the article as a segue to sell CAM supplement products like his Gingerflex. I assume the CAM supplement industry is willing to pay $Big Money$ for doctors with unquestionable CVs to endorse or otherwise “get involved” with their products. That goes to their general strategy of putting guys in white coats on TV telling people how great their products are.

  34. Harriet Hall says:

    Jules,

    Dr. Crislip questioned the claim that proper breathing can relieve pain. You claimed that it had benefits for the mind. Then you claimed that it had some kind of physiologic benefits due to hyperventilation and respiratory alkalosis. You never explained why respiratory alkalosis would be beneficial. Then you said it can enhance yoga practice. Finally you backed down to saying it just feels good. But you are still calling it evidence of a mind-body connection.

    It seems to me that you are using mind-body connection in such a broad sense that it makes the whole concept meaningless for any practical purpose.

    I suppose anything that people enjoy causes a mind-body connection and could be recommended as treatment for the pain of arthritis. In fact, I remember a study showing that arthritis patients benefit from frequent sex. Which is probably more fun than breathing exercises. :-)

  35. Pnakotus says:

    Then with frequent sex as an arthritis treatment, insurance companies should pay for prostitutes. Sex therapy for arthritis sounds like a new business venture to me.

  36. Fifi says:

    Well breathing does generally have benefits for both the mind and body, like keeping us alive ;-) Seriously, even talking about mind/body connection seems kind of redundant – all of human experience is about mind/body connection (just because one isn’t consciously aware of something going on in one’s body, it doesn’t mean one’s mind isn’t being influenced and is separate from one’s body). Though, I guess, for people who believe that the mind is separate from the body – and who have the experience of their mind and body being disconnected from each other or not integrated – creating mind/body connections is very important. Certainly many people ARE quite unaware of even the most simple messages from their body and misread them – but that doesn’t mean the connection is severed, it just means they’re unaware (usually because they’ve been trained to ignore their discomfort, hunger, sadness or whatever).

    Really, at this point, no one can conclusively claim anything about breathing and meditation and whether it’s useful for chronic pain management. I can offer anecdotes about my experience working at a pain clinic teaching people relaxation and meditation techniques, about how our physical and emotional states are interconnected, about certain specific attributes and physical habits/reactions of the majority of pain patients, how people from different cultural backgrounds contextualize and experience pain, and so on but they’d be anecdotal and I’m waiting for the evidence to come in. There currently seem to be quite a few studies being conducted regarding meditation and pain management – I know of at least one in Quebec (not by some specialize CAM research group, research in Quebec isn’t divided up like that). There’s also research going on here about how pain is culturally contextualized, reacted to and spoken about – a very relevant thing since we’re a bilingual province with a culturally diverse population – and important to understand when treating and diagnosing pain patients (since pain is subjective, as are the methods used to measure it).

    There are some very simple, common sense reasons why relaxation could help some chronic pain patients (and chronic pain is a different thing than immediate transitory pain) but until the evidence is in we won’t know how effective awareness meditation (which doesn’t involve hyperventilating as many trance meditations designed to create euphoria do). One thing people often forget is that our bodies are as much agents of communication as verbal speech – we communicate certain moods through assuming certain postures and the tone of our voice (body language comes in universal, sociocultural and family culture varieties – vocal intonation is influence by how we hold our body, it’s phyiscal). When we feel a certain way, we assume certain postures. Conversely (since the mind/body connection isn’t a one way street), when we assume certain postures we start to feel a certain way (basic behavioral psychology in action). Many people suffering from chronic pain due to one-off accidental injuries also have PTSD (SRIs tend to be a different story).

    As far as I know, there’s no one involved in pain research who’s seriously claiming that breathing exercises or meditation can cure chronic pain, it’s being investigated for its usefulness as a pain management technique. At this point, from what I understand, there are no “cures” for chronic pain on the horizon but it’s been shown that immediate prevention of pain is the best course of action to prevent chronic pain developing – though US policies regarding prescribing pain medications probably make this impossible. There are some very weird cultural beliefs around pain, people with chronic pain and treating pain that have little to do with best treatment and a lot to do with religious morality (tending towards the stoic rather than the compassionate).

  37. Fifi says:

    Dr Hall – Sure, pleasurable activities of any kind release endorphins, which in turn combat pain. Also, changing our focus can diminish our experience of pain. Both of these factors do point to meditation potentially being useful as a tool in pain management.

    Also, one thing many people don’t realize vis a vis chronic pain and relaxation is that people with PTSD have difficulty relaxing, that many people “protect” their injury (thereby creating a domino effect and psychologically privileging their wound) and it’s just very stressful and tiring to be in (and anticipating, even more exhausting!) pain all the time. If people don’t have tools to help themselves relax, it can often mean they don’t sleep, which also has a domino effect on all aspects of health, one’s ability to withstand and manage pain and one’s ability to enjoy life and combat depression (since most people also lose income, personal identity as defined by their job and ability to provide for their family, and have to deal with reconstructing their sense of self, value and abilities).

    Certainly it’s healthy to take a deep breath and relax, and developing patience and concentration/focus through practice is good for patience and concentration/focus, meditation isn’t magic however and it isn’t a panacea. Awareness meditation is merely observing one’s thoughts (so as to better understand cause and effect in regards to one’s own thoughts and feelings, cognitive psychologists are working from the same basic idea that we change habits through being aware of them) and exercising one’s brain/mental abilities.

  38. Fifi says:

    As for all the esoteric claims made for breathing exercises, certainly trance meditations tend to create euphoric and hallucinatory states (not surprisingly they often involve spinning around, hyperventilating, endurance or fasting, and other activities likely to produce euphoria and hallucinations) and one suspects that many of the grand claims associated with meditation arise out of people mistaking these experiences for some esoteric alternative reality.

    What awareness meditations can potentially do is make you more aware – of your own unconscious and entrained habits and reactions, and the world around us, which many of us rarely actually see as it is because of the quirks of human cognition, our beliefs and the symbolic shortcuts we/it employ.

  39. daedalus2u says:

    There is a great deal of involvement of nitric oxide in all of the body/mind cross-talk. To a large extent this is not appreciated because the levels that are important are very small, on the order of nM/L or about 30 parts per trillion. This is the level where sGC becomes activated and causes vasodilation in the brain where it is responsible for the fMRI BOLD signal used as the marker for local brain activation at sub second time scales (it is neurogenic vasodilation by NO that causes the increased oxyhemoglobin levels observed in BOLD). The relaxation response and mindfulness meditation both increase NO levels. So does having sex. Which probably explains why it is good therapy for arthritis and hot flashes. NO is a good anti-inflammatory agent.

    http://www.ncbi.nlm.nih.gov/pubmed/17874489

    Likely sex will be good for any disorder that is characterized by low NO.

    NO physiology is highly coupled to O2 levels in quite complex ways. Not everything that feels good is actually good for you. Sufficiently severe hypoxia does trigger euphoria, and is the mechanism behind autoerotic asphyxiation. I have no doubt that certain breathing patterns can induce euphoria by the same mechanism.

  40. Jules says:

    @ Harriet:

    I never said I actually believed Dr. Vad’s claim that breathing “properly” is good for paid relief. Secondly–go through my arguments again: Coulter claims that there are benefits, I merely acknowledge an effect. And thirdly: inducing a physiologic state of respiratory alkalosis is indeed the part that actually affects the mind. Not to mention that it acts to release the CO2 built up by working muscles, while the act of exhalation reduces the pressure built up around the heart (why they always tell you never hold your breath while lifting weights–and don’t attribute that one to me, I’m just passing along what I’ve heard). And I never suggested that there would be any physiologic benefits to this, aside from adding another dimension to one’s yoga practice, which you clearly think is crap so of course I’m not going to press that issue.

    My point is simply that breathing can indeed affect your mind. After all, we tell cranky people to “take a deep breath”. We remind ourselves “breathe” in moments of panic and stress. Both of which are calming, otherwise such advice would be useless. Surely this everyday example hadn’t escaped you?

    And y’know, for a bunch of scientist-worshippers, y’all show a dismally low sense of curiosity.

  41. Calli Arcale says:

    I think proper breathing can help control pain — but not in the way the woo-woos seem to be implying. I think it’s the actual discipline of doing it that makes the difference. Oh, the pain isn’t any less, but if you’re concentrating on breathing a particular way, that might help you keep it together, emotionally speaking. Same would be true for meditative techniques (praying to God, running through the times tables in your head, reciting poetry, whatever). I’m not sure a physiological mechanism is even necessary, because I think that in a lot of cases, the actual experience of pain isn’t changed — it’s just one’s subjective reaction to it that changes.

  42. Calli Arcale says:

    And BTW, I don’t think Jules is a woo-woo. I just noticed that my comment appeared right after he posted, so I want to make it clear I was replying generally, not specifically to him.

  43. Fifi says:

    daedelus – As you know, I can’t speak to your NO theories (though I’d love it if someone who is qualified to do so would since I find your thoughts on many topics I can understand and assess from my own knowledge base to be very interesting and insightful). It’s just common sense (not that common sense is always correct but it’s often a good place to start) that any activity which releases endorphins would have a dampening effect on pain. Hot flashes are related to hormones (are they also related to inflammation?), since having sex influences hormonal levels it helps (as does exercise, which is why exercising helps mitigate the effects of PMS).

    One thing I’ve noticed is that people tend to use “meditation” in a very generic sense when there are many different forms, with different traditions, that employ different methods with different results. Not surprisingly, the most esoteric, ornate and deity based branches usually engage in rituals and ecstatic meditations that are designed to produce trances and euphoria (and hallucinations, drugs are also often employed, along with other methods to induce altered states). The more minimalist branches (more often likely to be godless or at least not to personify a god or gods) tend to practice awareness meditation. Prayer and contemplation, and walking meditations, are some Christian versions of the same thing – though Christianity never really grappled with the innate qualities of mind and perception like Buddhism did. Awareness meditation really is just observing one’s self and practicing not getting caught up in internal narratives, dialogue or experiences – not necessarily easy in practice but it is simple conceptually – in many ways cognitive therapy is a similar process simply guided by someone else (which can be very useful at times). Some people meditate upon love/compassion and focus on generating and maintaining that feeling – I’d distinguish this from basic awareness meditation, even though many studies are done using monks who practice this sort of meditation. The monks have built holding compassion into their awareness meditation, it’s an evolution of awareness meditation. Unfortunately many ordinary people work on the love part without the awareness part if they’re trying to avoid or deny their own unloving feelings (denial is obviously not a very good way to foster awareness!)

  44. Fifi says:

    Calli – Pain IS a subjective experience (it’s measured subjectively, there is no objective measure of pain), that’s why methods that manage experience can be potentially useful. This is not to say that there isn’t a physiological basis for pain, just that experiencing it (like experiencing joy, sadness or any “feeling”) is subjective and there are clearly neurobiological and psychological components to chronic pain. (There are some fascinating studies that have been done with people with pain in phantom limbs using mirrors to fool the mind into “seeing” the missing limb.) Chronic pain is a different beast than immediate, transitory pain. With chronic pain there are also aspects to consider like anticipation/expectation of pain (we all know from experience how anticipation heightens an experience), psychological attachment to the rewards of disability and/or PTSD in some cases, and so on.

    Personally, I think that in areas where science is still feeling it’s way through and still in a discovery period – as it is with chronic pain and neurobiology in general, not to mention all kinds of other areas of medical research that have only really started to get a grasp of what’s going on – it’s important to listen to patients and what they say works for them and then figure out why. While a researcher’s job is to do research and is really pretty abstract and about proving or disproving theories, a doctor’s job is practical and about treating their patient’s suffering in the best and most effective way possible (with benefit outweighing harm). I’ve found there’s a tendency to dismiss things that have potential physiological underpinnings as being a placebo effect at times simply because people are responding reactively rather than thoughtfully. Not to mention that there are certain unconscious cultural biases for or against certain things or the emotional tone of certain interactions that seem to cause people to be reactionary rather than thoughtful. Pain is one of those areas where cultural beliefs and habits have a huge influence on how we experience pain and respond to it in ourselves and others. (Do we listen to our body or force it to continue? Do we recognize the difference between “good” and “bad” pain? And so on…)

    So, yes, I think you’re right about the discipline of focusing attention being a factor but pain IS an experience (so you’re changing your experience, chronic pain is usually sort of an “echo”…think of pain in a phantom limb for an extreme illustration of this). The other factor for chronic pain patients seems to be that many just don’t relax or get enough sleep – and we know the snowball effect of not getting adequate sleep – because they’re always anticipating pain and protecting their injury. Relaxation techniques are useful to promote sleep, to remind people of what relaxation feels like (some people seem to never truly relax and are even hypervigilant and tense in their sleep, it’s an aspect of PTSD).

    Really, I’m not sure why people have a hard time accepting that meditation changes the brain when they understand that doing crosswords, playing music or being a London cabbie does! Or that breathing patterns are related to emotional and mental states – it’s really pretty much established basic physiology and easily observable, no? And, because breathing is one of those areas of physiology that is both autonomic and potentially within our control (when we’re awake/conscious), it’s actually an area where we can quite directly influence our physical and associated emotional/psychological state. It will be interesting – no matter the results – to see what further research reveals.

  45. qetzal says:

    Jules wrote:

    And y’know, for a bunch of scientist-worshippers, y’all show a dismally low sense of curiosity.

    LOL. You mean like the way Dr. Hall devoted 3 successive comments to ask you about the supposed benefits of proper breathing?

    Or maybe the way Dr. Crislip invited readers to point out any errors or key research he missed in his analysis of Dr. Vad’s claims (paragraph 3 of the opening post)?

    We science worshippers have plenty of curiosity. It’s credulity that we lack.

  46. Fifi says:

    qetzal – Actually I think most people tend to be low on curiosity and high on dismissiveness when they’ve already formulated an explanation (myself included). I catch myself doing it, and I’ve seen both supporters of CAM and SBM do it here.

  47. daedalus2u says:

    fifi, I would love it if someone who could understand my ideas about NO would look at them in depth too. ;) I would be happy to explain them to you at any level that you would find interesting. Lately I have been thinking a lot about the physiology behind what happens to the hero in Joseph Campbell’s monomyth, but slogging through the myth literature is quite difficult for me.

    There has to be a lot of cross talk between energy physiology and mammalian bonding because maternal bonding is the archetypal form of mammalian bonding and because lactation is so energy intensive it has to be coupled to energy status. I am pretty sure that NO is what mediates that linkage. NO is what triggers mitochondria biogenesis, and sufficient mitochondria in the liver to support gluconeogenesis to support lactation is an absolute requirement for lactation to be sustainable.

    I suspect that the reason there is a lot of involvement of NO in mammalian bonding and social interactions relates to NO involvement in the archetypal maternal bonding associated with lactation. Many mammals only mate a single time to achieve a pregnancy. Oxytocin is involved in many aspects of reproduction and social interactions and has effects mediated through NO. All the steroid hormones are metabolized by cytochrome P450 enzymes, and all of them are regulated by NO. The estrogen receptor does cause activation of nitric oxide synthase and the production of NO. I think that a lot of the different health effects observed around a woman’s cycle relate to changes in basal NO level mediated through the changes in hormone levels. The reduction in seizures and migraines around the time of ovulation is I think due to higher NO levels and PMS is due to low NO levels.

    I think that is why mindfulness meditation that specifically includes a component of compassion works better for some things because there is feedback in that feeling good about other people and being connected to them increases NO levels and vice versa. Social isolation decreases the number of NO producing neurons in rodent brains.

    I think this is also why (sometimes) food intake is often coupled with stress levels. Stress causes low NO, and low NO causes low ATP, and low ATP (sometimes) activates pathways to increase ATP supplies, as by increasing food intake (especially carbohydrates). I don’t mean to minimize that there may be some conditioning effects too, from parental use of food as comfort (i.e. nursing) and as rewards.

    Once you have enough ATP, you don’t need anything else, which is why (I think) truly spiritual individuals are always thin and poor. The mindset to be driven to acquire excess wealth and excess food is triggered by low ATP which is caused by low NO.

  48. apteryx says:

    I had stopped reading this site after a period when work took me away from internet access over the summer, and to be honest, I didn’t miss it. I returned out of idle curiosity, and was immediately confronted with a reminder of why I haven’t been missing much, to wit:

    Dr. Crislip, above, says that because glucosamine is synthesized within the joint itself rather than being imported from other parts of the body, consuming glucosamine is “like eating hair to cure baldness.” Others applaud this wit, and Dr. Hall sneers that the practice is “magical thinking.” Now, ignoring the question of whether or not increased glucosamine prevents joint deterioration, the question of whether oral glucosamine increases the quantity available to the joints is easily testable. And it has been tested. A human study, previously referenced in a comment on this blog, has shown that glucosamine supplementation increases the amount of glucosamine in the synovial fluid by twenty times (i.e. 2000%).

    This is a fact that has not been challenged, yet keepers of this blog prefer to dismiss it with the suggestion that consumers who think such an effect might exist are cognitively inferior. How, then, can readers rely upon you for unbiased information? I can’t say that I learned nothing when I was reading this site; however, I also got to the point where I wouldn’t accept any controversial statement as factual unless I could see independent confirmation elsewhere. This is why.

  49. Harriet Hall says:

    I don’t know how to interpret the study cited by apteryx; I am reserving judgment pending more information. I am not an expert in this field, but I have been told by experts that there are serious concerns about the plausibility of glucosamine and chondroitin for the reasons I explained in another post. http://www.sciencebasedmedicine.org/?p=27

    At any rate, this study must be considered in perspective with other information. Here’s a study that indicates something very different:

    “Clinically relevant dosing of glucosamine HCl in this large monogastric animal model results in serum and synovial fluid concentrations that are at least 500-fold lower than those reported to modify chondrocyte anabolic and catabolic activities in tissue and cell culture experiments.”
    http://www.ncbi.nlm.nih.gov/pubmed/15641100?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    It you proved that eating hair increased the amount of hair precursors available to the scalp, that still wouldn’t mean a bald man’s hair would grow back.

  50. The “eating hair” point brings up the extreme scarcity of examples of eating a molecule or a precursor of a molecule that, in the absence of specific malnutritional states, is useful as a treatment for a disease that involves a local, as opposed to a general, deficiency of that molecule or precursor. A few years ago, motivated by the simplistic glucosamine/chondroitin claims, a few of us tried to think of such examples. We could only come up with one: L-DOPA (the precursor of dopamine) as a treatment for Parkinson’s Disease (which involves a regional deficit of dopamine-producing neurons in the brain).

    I’m sure there are others, and I’d love to hear about them, but there aren’t many. Please don’t include vitamins or minerals or amino acids or carbs or fat, or even folate, iron, etc., in pregnancy; those are excluded by the conditions stated above.

  51. daedalus2u says:

    How about nitrate as a precursor of nitrite and nitric oxide?

  52. Mark Crislip says:

    “Now, ignoring the question of whether or not increased glucosamine prevents joint deterioration, the question of whether oral glucosamine increases the quantity available to the joints is easily testable. And it has been tested. A human study, previously referenced in a comment on this blog, has shown that glucosamine supplementation increases the amount of glucosamine in the synovial fluid by twenty times (i.e. 2000%).

    This is a fact that has not been challenged, yet keepers of this blog prefer to dismiss it with the suggestion that consumers who think such an effect might exist are cognitively inferior.”

    My memory is faulty and my search skills lacking. What ref has the 2000%? I cant find it. I am not ignoring it, either I have never read it or cannot remember it.

    There is a difference between being cognitively inferior and doing something cognitively inferior.

  53. Harriet Hall says:

    I think he was referring to this study: http://www.ncbi.nlm.nih.gov/pubmed/17353133?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumI t

    I don’t know what to make of this study in the light of other apparently conflicting studies and the information from elsewhere that the oral dose of glucosamine is so small in relation to the total amount already produced by the body. And the fact that a large well-designed study at NCCAM showed no clinical effect. And that another study of apparent responders showed they couldn’t tell when their glucosamine was replaced by placebo. And then some of them are saying it’s the sulfate.

    If the stuff doesn’t really WORK in the first place, arguing about how much gets to the synovial fluid is beside the point. And if there is already “enough” there, it’s hard to understand how “more” could relieve arthritis pain. There are too many unanswered questions. I’ll keep an open mind, but I’m not buying it yet.

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