Glucosamine Chondroitin for Osteoarthritis

What are glucosamine and chondroitin?

Glucosamine and chondroitin sulfate are compounds that are thought to have a protective effect on the cartilage, as well as to help manage osteoarthritis, particularly of the knee. Currently there are still many controversies around the effectiveness glucosamine and chondroitin sulfate in actually preventing the degeneration of joint cartilage. In Europe, glucosamine is a prescription drug with a standardized formula. In the United States and some parts of Asia, glucosamine is sold over-the-counter as dietary supplements.

Both glucosamine and chondroitin sulfate are found in normal joint cartilage and synovial fluid. Researchers proposed that glucosamine may stimulate production of cartilage-building proteins. Glucosamine in supplements is extracted from animal tissues such as crab, lobster or shellfish and marketed as glucosamine sulfate or glucosamine hydrochloride. They are considered to be equally effective, but the hydrochloride form is absorbed more easily by the body and can be taken in lower dosage than glucosamine sulfate.

Chondroitin sulfate is part of a protein molecule that maintains cartilage elasticity and is also thought to have an anti-inflammatory effect. Chondroitin sulfate in supplements is extracted from animal cartilage such as trachea or shark cartilage.

Do glucosamine and chondroitin really work for osteoarthritis?

In reality, some studies have found that either glucosamine or chondroitin sulfate given together or separately may relieve osteoarthritis pain with fewer side effects than conventional arthritis drugs. However, there are also studies that have shown no benefit. Although currently positive reports outnumbered negative ones, the negative ones have been larger and better designed.

The largest clinical trial that studies the effect of glucosamine and chodroitin sulfate is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), which is funded by the National Institutes of Health. In 2006, the researchers reported that glucosamine and chondroitin, alone or together, did not reduce osteoarthritis knee pain more effectively than a placebo. Follow up reports from this study also failed to show any promising result.

However, despite this discouraging result many people who take glucosamine and chondroitin sulfate supplements did report subjective reduction in arthritis pain. There are preliminary reports that suggest addition of vitamin C, bromelain, or manganese may enhance the effectiveness of glucosamine and chondroitin sulfate. And because these supplements are thought to have very few side effects, people keep taking them anyway.

Be wise if you decide to take glucosamine and chondroitin supplement.

Severe form of osteoarthritis may require surgery.

So, what to do? If you decide to try glucosamine and chondroitin sulfate supplements after all, give it three months time to evaluate their efficacy. The typical initial dose is 1500 mg of glucosamine and 1200 of chondroitin daily for 6 to 8 weeks. If a response is obtained, the dose can be reduced to 1000 mg of glucosamine and 800 of chondroitin or less. If you feel there is no change in symptoms after three months, these supplements should be discontinued.

If your symptoms are severe, you should stay on your usual arthritis medications even while you are taking glucosamine and chondroitin. As always, consult your physician before taking any form of supplements. Common side effects include stomach upset, gas, soft stools, drowsiness, headache, racing heart, and skin reactions. Patients with diabetes should pay extra caution because glucosamine is an amino sugar that may affect blood sugar levels. Also, because these supplements contain shellfish and other possible allergens, watch out for allergy symptoms.

Premenstrual Syndrome: Men's Worst Nightmare?

It's a common belief (among the guys, of course) that man suffers whenever a woman is having premenstrual syndrome. This is not entirely accurate. True, emotional irritability is one of the many symptoms of PMS, but not every women with premenstrual syndrome experience this problem. And if PMS was to be someone's worst nightmare, it would be more likely to be a woman's.

Premenstrual syndrome: men's worst nightmare?

What is premenstrual syndrome?

Premenstrual syndrome (PMS) involves a variety of physical, mental, and behavioral symptoms related to a woman's menstrual cycle. These symptoms occur during the two weeks before a woman's period starts, known as the luteal phase of the menstrual cycle. Three out of four menstruating women have at least one symptom as part of their monthly cycle. PMS symptoms characteristically become more intense in the 2-3 days prior to the period and usually resolve after the first day or two of flow.

Women who are between their late 20s to early 40s, those who gave birth at least once, and those who have a history of mood disorder are more prone to have PMS. Most women have only mild symptoms, but around 3-8% may have a severe form of PMS, called premenstrual dysphoric disorder (PMDD) with disabling symptoms that affect their daily functions.

What are the symptoms of PMS?

Symptoms varies between one woman and the other, but they usually follows a predictable pattern and recur each month with variable intensity. Physical symptoms include fatigue, headache, joint and muscle pain, weight gain, bloating, acne, and changes in bowel movements. Mental and behavioral symptoms include mood swings, anxiety, irritability, depressed mood, poor concentration, cravings, insomnia, and social withdrawal.

The exact causes of PMS are still unknown, but cyclic changes in hormones level seem to play an important part. Low levels of serotonin, a type of brain chemical, may also trigger PMS symptoms. Stress, depression, poor eating habit can make the symptoms worse.

How to manage PMS?

Management of PMS consists of lifestyle changes, behavioral therapy, medications, and vitamin and mineral supplementation. For most women, lifestyle changes are often enough to control symptoms.

• Drink enough fluids, but avoid alcohol, caffeinated drinks, and soft drinks.
• Eat a healthy, balanced diet and divide the portion into small, frequent meals.
• Regular physical exercise throughout the month will help reduce the severity of PMS.
• Aspirin, ibuprofen, and other non-steroidal anti inflammatory drugs (NSAIDs) may reduce back pain, headache, and cramps.
• Nutritional supplements like vitamin B6 (50-100 mg), vitamin E (400 IU), calcium (1000mg), folic acid (0,4 mg) and magnesium (400 mg) may reduce symptoms in general. 
• In severe cases, your physician may prescribe anti-depressant medications.

Rheumatoid Arthritis: More Than Just Aching Joints

Rheumatoid arthritis is more than just aching joints. Unlike osteoarthritis where the primary damage occurs in the cartilage, rheumatoid arthritis is an autoimmune disease where the main problem lies in faulty immune system. Chronic inflammation of the joints and its surrounding tissue are not the only problems because the disease can also cause problems with your lungs, heart, and eyes.

In 2007 about 1.5 million people in the United States had rheumatoid arthritis. It usually starts in the middle ages, between 25 to 55 years old. Incidence increases with age and women are more likely to get it than men.

As with other autoimmune diseases, the exact cause of rheumatoid arthritis is unknown. Genetic factor, infection, and hormones may play a role in the development of this condition. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis causes inflammation on the synovium (the lining of your joints), causing damage to the cartilage that eventually result in bone erosion and joint deformity.

What are the symptoms?

Rheumatoid arthritis begins gradually, affecting small joints of the hands and feet at first, causing minor joint pain and stiffness that are accompanied by fatigue or low grade fever. Over time, symptoms often spread to the knees, ankles, elbows, hips and shoulders. Severity varies and symptoms may come and go. Periods of when the disease gets worse (flare-up), alternate with periods when the pain and swelling gets better (remission).

Joint symptoms may include:

• Joint pain that oftentimes affects the same joint on both sides of the body, accompanied with warmth and swelling.
• Morning stiffness that usually lasts for more than 1 hour. 
• Deformity of joints and the surrounding structure with limited range of motion

small joints of the hands and feet are usually affected first

Systemic symptoms may include:

• Fatigue
• Low grade fever
• Weight loss
• Anemia 
• Chest pain or shortness of breath 
• Dry eyes and mouth 
• Buring sensation and itchiness in both eyes
• Lumps under the skin, called rheumatic nodules.

What are the tests to support the diagnosis?

The two lab tests that often came up with abnormal results are rheumatoid factor test and Anti-CCP antibody test. Complete blood count any show anemia. C-reactive protein and erythrocyte sedimentatio rate may be elevated, a sign of chronic inflammation. Your physician may also preform joint imaging like x-ray, ultrasound, or MRI and synovial fluid analysis.

What are the complications?

Rheumatoid arthritis can affect almost every part of the body. Complications may include:

• Lung damage and scarring causing shortness of breath
• Inflammation of the heart muscle and the outer lining of the heart can progress to heart failure
• Hardening of the arteries which in turn leads to nerve, skin, and brain problems
• Spinal injury if the neck joints are affected
• Osteoporosis

What are the treatment options?

A treatment plan usually includes medications, physical therapy, exercise, and even surgery. Early and aggressive treatment can delay joint destruction, but the drugs can have significant side effects especially because they will be used for life-long.

The most important drugs that are used to treat rheumatoid arthritis are the disease modifying antireheumatic drugs (DMARDs) like methotrexate, leflunomide, and chloroquine. Anti-inflammatory drugs like aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are used to reduce inflammation and joint pain. Biologic agents like rituximab, infliximab, etanercept, and tocilizumab may be used when the other drugs failed to give improvements. They work by suppressing the immune system and thus carry risks of infection.

Managing Diabetes

Diabetes management aims to keep your blood sugar in control through various measures, from diet and lifestyle changes to medications and insulin injection. When it comes to diabetes, blood sugar control is often the central theme. After all, keeping your blood sugar level within your target range can help you live a long and healthy life. But do you know what makes your blood sugar level rise and fall?

Dietary Habit

By now you're probably getting bored of me stating the obvious, but healthy eating is the most important part of any diabetes management plan. It's not just about the quality and quantity of the foods you eat, the meal schedule matters too.

Blood sugar level peaks around two hours after meal then begins to fall after that. If you keep to a regular schedule by eating at the same time every day and dividing your total daily calories into several small meals at regular times, you can control the fluctuation of your blood sugar level.

Stick to the DASH (Dietary Approach to Stop Hypertension) eating plan because it's also the best diet for diabetes. It's well balanced, have the right mix of carbohydrate, fruits, vegetable, and lower fat. Always remember to coordinate your meals and your medication, especially if you're using insulin to avoid low blood sugar (hypoglycemia).

Physical Activity

Staying physically active improves your body's response to insulin.

Regular exercise is another important part of your diabetes management plan. Regular physical activity improves your body's response to insulin. This is especially important in people with type 2 diabetes. When you exercise, your muscles take up the excess glucose and turn them into energy.

Pick the type of exercise that is appropriate with your condition. If you have a heart problem or sores in your feet, consult your physician first. Pay attention to your blood sugar levels before, during, and after exercise and recognize the signs of low blood sugar such as hunger, weakness, lightheadedness, anxiety, and fatigue. Bring an emergency snack or glucose pill with you when you're exercising. Drink plenty of water or isotonic fluids to prevent dehydration that can affect blood sugar levels.

Medication

Diabetes medications and insulin are used only when diet and exercise are not enough to control your blood sugar. If you have type 1 diabetes, then insulin must be included in your treatment plan. If you have type 2 diabetes, you may take either oral anti-diabetic medication (as a single drug or in combination) and/or insulin in combination.

pre-filled insulin pen to deliver insulin

Insulin works by increasing glucose uptake into your cells. There are many types of insulin which differ in how they act and how long they stay in your body. Oral anti-diabetic agents may either increase the amount of insulin secreted by the pancreas, increase the sensitivity of your organs to insulin, or decrease the absorption of glucose from the gastrointestinal tract.

Anti-diabetic drugs, like other type of pharmacological agents, may interact with other medications such as anti-hypertensive agents and birth control pills. Always consult your doctor to find the right medications for you and minimize drug interactions and side effects.

Stress

Psychological stress increases the production of stress hormones in body. These hormones may prevent insulin from working properly and increase your blood sugar level. Learn to manage your stress by relaxation techniques, learning coping strategies, setting limits and prioritizing tasks.

Illness, menstruation, pregnancy, and menopause may also put your body under extra stress. Anticipate to take extra measures to control your blood sugar during any of these conditions.

Basic Knowledge About Diabetes

What is diabetes?

Diabetes is a chronic disease in which blood sugar levels are above normal. An organ in our body called the pancreas produces a hormone called insulin. Insulin helps control the sugar level in your blood and help glucose to get into the cells of our bodies. Glucose is the main energy source for our cells. Even though you have high levels of it in your blood, your body cannot make use of it without insulin. In short, your cells are starving even though you have abundant energy source.

diabetes is having too much sugar in your blood

When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. In 2009, diabetes was the sixth leading cause of death in the United States.

What are the types of diabetes?

There are two types of diabetes. Type 1 diabetes, previously known as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, account for about 5% of all diabetes cases. In this type of diabetes, the cells of the pancreas can no longer make insulin because the body's immune system has destroyed them. Type 2 diabetes, previously known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, account for about 90% to 95% of all diabetes cases. This type of diabetes usually begins with insulin resistance in which the body can not properly use insulin. Over time the pancreas loses the ability to secrete enough insulin in response to meals.

What are the risk factors for diabetes? 

• Being overweight or obese.
• Having a parent, brother, or sister with diabetes.
• Being African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino heritage.
• Having a prior history of diabetes in pregnancy or birth of at least one baby weighing more than 9 pounds.
• Having high blood pressure measuring 140/90 or higher.
• Having abnormal cholesterol with HDL ("good") cholesterol is 35 or lower, or triglyceride level is 250 or higher.
• Being physically inactive—exercising fewer than three times a week.

blood sugar monitor

When should I be tested for diabetes?

 

Anyone aged 45 years or older should consider getting tested for diabetes, especially if you are overweight. If you are younger than 45, but are overweight and have one or more additional risk factor, you should consider getting tested.

What are the symptom of diabetes?

Many people have no signs or symptoms of diabetes. The symptoms can also be very vague that you might not notice them until you have suffered the complications. Initial signs of diabetes are

• increased thirst
• increased hunger
• fatigue
• increased urination, especially at night

Over time, you may also develop weight loss, blurred vision, slow healing sores. More serious findings are kidney problems, heart problems, or loss of consciousness.

What is the treatment for diabetes?

Type 1 diabetes is treated by healthy eating, exercise, and insulin injections. For type 2 diabetes, the treatment consists of healthy eating, exercise, routine blood glucose testing. In addition, people with type 2 diabetes often requires oral medication, insulin, or both to control their blood sugar levels.

People living with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.

Understanding Hypertension (High Blood Pressure) Part 2: About Treament

Continuing from Part 1: How high is high? This entry is all about the treatment of hypertension.

What is the goal of hypertension treatment?

The goal of treatment is to reduce blood pressure to <140/90 mmHg in otherwise healthy subject and to <130/80 in patients with diabetes or chronic kidney disease. Even though lifestyle modification is an important part in the treatment plan, most people with high blood pressure will require medication to achieve this goal.

Lifestyle modification

Lifestyle modification, however, remains as the first and most critical step in managing hypertension. Examples of changes you can try to help reduce your blood pressure are as follows:

• Eat healthy diet, including the DASH (Dietary Approaches to Stop Hypertension) diet which consists eating more fruits and vegetables, reduce fatty foods and eating less red meat.
  

  

  reduce salt intake

  Reduce the amount of sodium in your diet to less than 1500 milligrams a day (less than two-third teaspoon of salt).
• Try to lose some weight if you are overweight or obese.
• Quit smoking.
• Exercise regularly, especially aerobic exercise such as brisk walking or jogging at least 30 minutes a day
• Limit alcohol consumption to two drinks a day for men and one drink a day for women. Drinking red wine in a small amount helps maintain cardiovascular health due to its antioxidant properties.

Medications

If lifestyle modification fails to control the blood pressure, then starting medication is the next step. Depending on the stage of your hypertension, usually your physician will start giving a single drug or a combination of two drugs. Diuretics (a type of drug that makes you urinate a lot) are almost always the first choice regardless what your initial condition is. Listed below are the common medications for hypertension:

take your medicine regularly

• Angiotensin-converting enzyme (ACE) inhibitors 
• Angiotensin receptor blockers (ARBs)
• Alpha blockers
• Beta blockers
• Calcium channel blockers
• Central alpha agonists
• Diuretics
• Renin inhibitors
• Vasodilators

The most important thing to be aware of when you're starting medication is to always remember to monitor your blood pressure regularly to avoid sudden drops in your blood pressure.