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| Transcript Madrid, Spain November 3-5, 2006 |
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Lecture: Eat and Train to Win!!! Biochemistry and Biomechanics, The "inflammation" link to accelerated aging.
International Congress of Anti-aging Medicine, Society of Anti-aging and Longevity
November 3 - 5, 2006
Madrid, Spain
Lecture by Dr. James Stoxen DC
Team Doctors
Treatment and Training Center of Champions
6432 S Pulaski, Chicago Il 60629
To contact Dr James Stoxen DC
teamdoctors@aol.com
(773) 735-5200
Diet and Exercise
Biochemistry and Biomechanics
The "inflammation" link to accelerated aging..
How to begin your anti-aging practice on Monday morning!!!
Anti-aging medicine is an extension of preventive health.
This form of medicine is based on the very early detection, prevention, and reversal of age-related disease. It believes that 90% of all adult illness is due to the degenerative processes of aging and can be slowed, stopped or reversed if caught soon enough.
The American Heart Association and the Centers for Disease Control and Prevention recently published a joint scientific statement about using inflammatory markers in clinical and public health practice. This statement was developed after systematically reviewing the evidence of association between inflammatory markers (mainly CRP) and coronary heart disease and stroke.
What is Inflammation?
Inflammation is a complex orchestration of events mediated by eicosanoids
The two types of eicosanoids are:
Pro-inflammatory eicosinoids
Anti-inflammatory eicosinoids
Patients can get inflammation from many sources, such as…
Environmental Inflammation - Not associated with pain and related to foreign materials such as smoke and other products
Biomechanical Inflammation - may be associated with stress or strain causing wear and tear leading to inflammation and pain or are injury related
Biochemical Inflammation – This source of inflammation is not associated with pain but it is thought that it can add to existing forms of inflammation leaving the patient in more pain that without biomechanical inflammation and can slow or stop the healing process. It mainly forms what we call “silent” inflammation or systemic inflammation which is not painful.
Sources of Inflammation
Environmental Inflammation - Infection, Smoking, Pollution, Cleaning Products, Air Fresheners, Carpets Flooring Paints, Dry Cleaning, Fumes, Molds, Dust
Mechanical Inflammation - Acute injury, Chronic arthritis, Walking arthritis
Dietary Inflammation - Inflammation related the diet of food allergies
So diet and exercise are the fundamentals of anti-aging medicine
Biochemical Inflammation (silent inflammation)
• High levels of Arachadonic Acid
• High glycemic Index Carbohydrates
• Saturated Fats
• Overeating
Biomechanical Inflammation
This could come from not enough exercise to support the framework or exercising with abnormal biomechanics
The combination of Poor Diet, Chronic Arthritis causes a large amount of inflammation leaving the patient’s body in a Toxic Soup!
Testing for Inflammation
C-Reactive Protein
Non specific inflammation marker
AA/EPA (arachidonic acid /eicosapentanoic acid)
More precise marker of eicosanoids
Cytokines
IL1, IL6, TNF alpha, IL10
17KetoSteroids:Total OH Steroids
Anabolic : Catabolic Ratio
What Are Eicosanoids?
• *Prostaglandins
• *Leukotrienes
• Thromboxanes
• Lipoxins
• Hydroxylated Fatty Acids
• 15-epi Lipoxins
• Prostamides
• Isoprostanoids
Wellness Requires Eicosanoid Hormone Balance
Good Eicosinoids
• Inhibit platelet aggregation
• Vasodilators
• Anti-inflammatory
• Control cellular proliferation
• Enhance immune function
Bad Eicosinoids
• Promote platelet aggregation
• Vasoconstrictors
• Pro-inflammatory
• Increase cellular proliferation
• Suppress immune function
Inflammation and Osteoarthritis
The cytokines increased with osteoarthritis are:
• IL-1b
• IL-6
• TNF-a
• IL-8
• IL-6 is the primary activator of the C-reactive protein gene in the liver
• IL-6 inflammation is the common causative origin for atherosclerosis, dementia, osteoporosis, Alzheimers disease and type 2 diabetes.
• Elevated IL-6 and CRP are associated with a 2 fold greater risk of death
Anti-Inflammation Diet
• Fruits and Vegetables (5 - 9 servings/day)
• Fish (3 - 5 times a week)
• Olive Oil
• Less red meat and egg yolks
• Eat less
• Avoid foods you are allergic to
• AA producing foods -
(a 4 ounce Atlantic salmon has 1300 milligrams of AA which is 13 x the recommended daily amount)
Fish Oil Omega 3s
• Reduction of Cytokines
• Enders et al. N Engl J Med 320: 265 (1989)
• Reduction of Crohn’s Disease
• Belluzzi et al. N Engl J Med 354: 1557 (1996)
• Reduction of Arthritis
• Kremer et al. Arth Rheum 38: 1107 (1995)
Fish Oil or Omega 3s
• Fish Oil
• Potential contamination with PCB and Hg
• Higher in AA than fish oil
• Crude fish oil
• High contamination
• Health food grade
• Still contaminated with PCB’s
• Ultra-refined EPA/DHA Concentrates
• Removal of monoenes that cause gastric distress
• Virtually complete removal of PCB’s and dioxins
• “Weapons-grade” fish oil
• Can be used in high-dose, long-term applications
How Much Omega-3 Fats Do You Need?
5 grams/day for daily use
5 – 10 grams/day when you have a large amount of inflammation
• Brain function
• Improve Heart Function
• Treat Chronic Pain
• Treat Neurologic Disease
Exercise/Training and or biomechaincs
The Study of Biomechanics leads the Paradigm Shift
A profound paradigm shift comes when we practice analysis of faulty biomechanics for early detection, intervention and prevention of many age related diseases.
With the study of biomechanics you predict where accelerated aging will occur even before it becomes a symptom.
This is the most progressive approach to prevent aging of the musculoskelital system
Analysis of Biomechanics
Biomechanics unites engineering sciences to biological science.
It is the analysis of motion
Gait analysis - where abnormal movement patterns
Movement Patterns
There are two types of movement patterns
1. Generalized movement patterns
2. Specific movement patterns
Generalized movement patterns are patterns of motion developed from birth and through your experiences of daily life
Specific movement patterns are patterns which you practice to change the generalized movement patterns (another name for this is called training or practice)
Abnormal Biomechanics is the Most Common Cause of degenerative joint disease or DJD
Arthritis is the most common cause of disability in the elderly with 43 million cases in 1997
Arthritis is a joint problem initially from mechanical abnormalities.
First Clinical Sign of DJD is not X-rays
50 % by midlife will have visable signs of arthritis on x-rays
85% by the seventh decade
Why?
We are not doing what we should for these patients in their 20s and 30s
Anti-aging Medicine is the the earliest detection, treatment or intervention and prevention of age related diseases
An astute doctor in anti-aging medicine does not wait for pain
RUSH-PRESBYTERIAN-ST. LUKES MEDICAL CENTER STUDY
Cortisone Injections and Analgesics
53 subjects with painful DJD of one knee
Some take acetaminophen
Pain was relieved.
With the pain killers they applied more load to the effected knee
Foot Biomechanics - The Foundation
Right Supination 8%
Left Pronation 92%
Which athlete has abnormal biomechanics
Pronation is normal
The piece of the puzzle that was missing
What scientific literature suggests
1. Varus calcaneus causes collapse of the lower extremity
2. How does it get into the varus position?
3. How does the excessive subtalar motion occur?
the mystery…
The arch of the foot is an engineering marvel
The three arches in the foot have a spring mechanism
• Spring Up
• Spring Down
The arch is an energy savings advancement
Arch Drop & Lock phenomenon
• Aerobic Capacity is exceeded in Pronation Supination Cuff
• The “DROP” causes a LOCK in the first and second metatarsal - cunieform joints
• ARCH LOCK causes excessive motion in the subtalar joint
• Abnormal movement patterns result in the entire kinematic chain
• Evidence is arthritic spurs in the metatarsal cunieform joint
Arch Lock Prevention
Pronator - Supinator Cuff in the foot is like the Rotator Cuff in the shoulder
Pronator-Supinator Cuff Tendon strength requirements - Aerobic capacity and Strength is related to exercise they get
These supportive muscles must be exercised in all ranges
Aging reduces lateral movement and weakness develops
“Arch Lock” - The Causes
• Injury
• Poorly Designed Rehabilitation
• Weakness - Tibialis Posterior Tendon Dysfunction (TPTD)
• No Exercise
• Exercise Program Imbalance
• Poorly Constructed Footwear
• Aging - Testosterone
• Inflammation
• Obesity
Personal Training Programs are Imbalanced
• The foot is not well understood.
• The World is covered with concrete
• Training is not well understood
• Hollywood “How To” Guides Emphasize Appearance
• Minimal Equipment for Training
“Cascade Effect” or Downward Spiral
• Weak Pronator Supinator Cuff
• Arch Drop and Lock (Metatarsal Cunieform Joint)
• Arch Lock Prevents Toe Off
• No Toe Off (Shortened Gait)
• Toe Out
• Combined Toe Out and No Toe Off
• Reduced Calf Contraction
• Illiopsoas Lift and Tibial-Thigh torsion
• TFL Spasms, Gluteus Medius Spasm and Weakness
• Reduced venous return
• Poor Circulation
• Increased risk of infection to the foot
• Reduced Heart Filling
• Systemic Inflammation
• Accelerated aging effects.
Excessive Pronation Causes Tibial Torsion
Tibia rotates internally by 20 degrees in less than a .10 second.
Muscles work to dampen this torque
Compensations cause damage
• Foot & Ankle Symptoms
Plantar Fascitis
• Heel spurs
• Shin splints
• Foot and ankle pain
• Adductovalgus muscle strain
• Bunions and claw toes
• Achilles tendon strain or tear
Achilles Tendon Tears
Pronator supinator weakness shifts load to the Achilles
Achilles tendon overload and tear
Knee Symptoms
Knee cap does not stay aligned with Trochlear Grove causeing friction or cracking This syndrome is called Chondromalacia patella. It causes a basic periarticular pain around the knee cap in various areas
• Lateral Calf Muscle Strain
• Pronation/Supination Cuff Spasms and weakness
• Higher risk for knee injury
• TFL spasms
• Lateral hamstring tightness
Thighs, Hips and Lower Back Symptoms
(Patients suspected of having abnormal biomechanics of walking)
• Legs are tired and ache
• Leg cramps
• Illiotibial band syndrome
• Crepitus in the hip
• Hip pain and arthrosis
• DJD of Hip
• Lower back pain
• Frequent back injuries
• Herniated discs that don’t improve
Lower back x ray findings
(Patients suspected of having abnormal biomechanics of walking)
• Disc degeneration
• Arthrosis of facets
• Disc herniation on MRI
Is it Fibromyalgia? Chronic fatigue syndrome? or Over pronation syndrome?
Symptoms of fibromyalgia and chronic fatigue syndrome
• I ache all over
• Legs feel heavy
• Brain Fog
• Negative laboratory
• Decreased sex drive
• Poor sleep
• Patients are tired all the time
• Chronic coffee drinkers
• Many of these patients have resorted to stimulants to supplement for a lack of energy
• Diagnosis becomes confusing
• Misunderstood by doctors
There is almost a direct coorelation between excessive pronation/supination and lower back complaints.
Treatment Phases
Phase I to Phase II
Orthodics and Wedges - The Positives
Foot orthodics have a significant effect on calcaneal eversion but shoes should be considered in conjunction with foot orthodics
Forefoot and rear foot wedge posting is helpful in reducing pronation
Arch Spring Mechanism The key!!
Exercise to redevelop arch muscles to give the patient the spring back in the arch mechanism This is the key to long term reversal of arthritis problems in patients.
Phases of Care for an Anti-aging Practice
Disease Based Medicine to Anti-Aging Medicine
• Patients must be explained the paradigm shift in your approach
• Charts help you and patents make and achieve goals
• Use Inflammation Biomarkers
• A planned anti-aging approach gets the patient focused
Rehabilitation/Training Exercises
• Isokinetic and nonisokinetic strength training programs (Inversion and eversion muscles)
• Three times a week for 8 - 12 weeks
• The isokinetic group showed significantly concentric and eccentric strength increases for all the inversion for all inversion test conditions and three of the four eversion conditions.
• They also demonstrated significant decreases in the rearfoot and pronation and supination angles at heel strike.
• Isokenitic strength-training program for the inversion and eversion muscles can treat over pronation/supination.
Phase IV –
Very Little Inflammation - Resistance Exercise and Cardio Healthy
Exercise and Sports Participation - Stretching - Anabolic Phase
• A stable kinematic chain
• Anaerobic Exercise
• Aerobic Exercises
• Active Lifestyle, tennis, dancing, “tag”, socccer, hiking, frisbee, volleyball, yoga, tai chi and many others
• Anabolic phase
Living an Anti-aging Lifestyle!
Fun exercise activities that rebuild the foot in multiple directions:
• Walking
• Playing tag
• Dancing
• Tennis
• Yoga
• Tai Chi
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