General Wellness

Hello everyone,

Dr. Chuma here for another health segment.

I received a request to explain the difference between various pain relievers. A great topic since these are misunderstood, are WAY overused, and for the most part, taken without any understanding of how they work or the side effects and complications they cause.

First of all, what causes pain? Pain is a complex, unpleasant sensation that acts as a warning system for the body. It can be acute (short-term) or chronic (long-term) and is influenced by various factors, including physical, psychological, and social elements. There are different kinds of pain

• Nociceptive pain is caused by tissue damage or inflammation for example from banging your knee or having arthritis or an infection.
• Neuropathic pain is caused by nerve damage like you see with shingles or diabetes.
• Nociplastic pain is caused by changes in how the nervous system processes pain signals. This type is the most variable from person to person and is what accounts for pain tolerance.

Treating pain addresses the different origins of pain. Some treat individual aspects and some manage a combination of pain sources.

So let’s talk about a few common drugs.

ACETAMINOPHEN

Tylenol, which is acetaminophen, is a pain reliever and fever reducer. Its exact mechanism of action is still not fully understood, but it is believed to work through a combination of mechanisms. 

1. It inhibits production of compounds called prostaglandins which are part of the inflammatory response, cause swelling and make nerve endings more sensitive.
2. It affects pain pathways by interrupting pain signals in the brain and spinal cord, reducing the perception of pain. 
3. It interacts with the endocannabinoid system, a complex cell-signaling system which is involved in regulating pain and other bodily functions.
   

The mechanism of action may vary depending on the dosage and individual patient. Acetaminophen is overall pretty safe, but it can cause liver damage if taken in excessive amounts. 

STEROIDS

Steroids are hormones which have a myriad of functions, but when it comes to pain, it helps by reducing swelling and dampening down the inflammatory response. The mlst common one is prednisone, however our body also makes the steroid cortisol as part of our normal stress response. They are very potent and do have side effects like raising blood pressure and blood sugar, both normal responses important when there is danger around, however it’s not so good if you already have elevated blood pressure or diabetes or if it occurs too often. Steroids also impair our immune protection, increasing risks of getting an infection.

NSAIDS

NSAIDs stand for nonsteroidal anti-inflammatory drugs. Common ones include Motrin, which is ibuprofen, Aleve, which is naproxen and Relafen, often found as a gel. These also reduce inflammation, pain, and fever and also achieve this by inhibiting the production of prostaglandins, but to a much greater degree than Tylenol does. NSAIDs primarily block 2 enzymes, which are essential for prostaglandin synthesis. One of these enzymes is called COX-1, also protects the stomach lining and promotes healthy clotting which is why using NSAIDs, even short term, can lead to stomach inflammation and ulcers as well as thinning of the blood with excessive bleeding. 

As I mentioned in my last segment on collagen, NSAIDS inhibit collagen repair and formation and actually increase the likelihood of needing a joint replacement. Additionally, they can impair liver function, primarily affecting its production of other clotting factors, adding to the risk of excessive bleeding.

They also increase sensitivity to the sun and raise dementia risk.

Another class of NSAIDS are called COX-2 inhibitors since they selectively inhibit only that enzyme and do not have the same risks of ulcers and bleeding. The main one in this category is Celebrex, or celecoxib.

ASPIRIN

Aspirin, also known as acetylsalicylic acid, or ASA, is also technically an NSAID and also works by inhibiting both cox enzymes, so it too can cause stomach issues and bleeding. Aspirin additionally inhibits clotting by neutralizing our platelets’ ability to clump together. It acts very quickly which is why EMS attendants will have someone chew on an aspirin en route to the hospital if they are concerned about a heart attack. 

Although aspirin can be a great pain reliever and miracle drug for many who have heart disease, it also is the drug which causes the most complications and deaths. These range from allergic reactions to deadly internal bleeding after falls. I see a lot of nosebleeds in aspirin users. Many of these patients really don’t need to be taking it. If you do, please be sure to check with your doctor if you really need it.

OPIODS

Opioids work primarily by acting on nerve cells in the brain, spinal cord, and other parts of the body involved in pain and pleasure.  They do not reduce inflammation. Our bodies make opioids but whether natural or synthetic, like hydrocodone, oxycodone, or morphine, they bind to various receptors and have different effects.

• Opioids bind to pain receptors on nerves blocking or reduce the intensity of pain signals being sent from the body through the spinal cord to the brain.
• They trigger the release of dopamine, a neurotransmitter associated with pleasure and reward.
• Finally, opioids depress the central nervous system in general, slowing down communication between the brain and the body.

There are some serious problems with OPIODS.

• While opioids can be effective for pain relief, they are highly addictive.
• We develop tolerance to it so those addicted to it need more and more to achieve the same level of pleasure and pain relief from it.
• The release of dopamine can reinforce the behavior of taking opioids, and leads to various other addictions, like gambling, drinking or even excessive eating.
• Opioids can have serious side effects, including slowed breathing and heart rate which can lead to overdose and death.

There are other medications which can help with pain. These include things like gabapentin, commonly used for the nerve pain from shingles and cannabinoids, found in marjuana, which is used for a variety of pain syndromes.

NATURAL PAIN RELIEVERS.

Many foods contain significant anti-inflammatory and pain relieving effects as well. The best known is the compound curcumin found in the Indian spice turmeric. Many studies have shown that it can be equally effective as NSAIDS in reducing inflammation and reducing pain. Just beware of supplements which have concentrated curcumin which can cause liver damage.

Another interesting one is extra virgin olive oil. One recent study compared rubbing a teaspoon of EVOO onto arthritic knees and it having the same pain relieving effects as the topical NSAID gel medication Relafen. EVOO is rich in anti-inflammatory plant compounds.

Many fruits, vegetables, herbs and spices contain ASA, even at levels which rival taking an aspirin a day, just without the complicating risk factors.

Lastly, exercise itself can have pain relieving effects. When we exercise, our muscles generate compounds called myokines, which are opioid like compounds which help relieve pain.

See you next time.

Hello everyone,

Dr. Chuma here for another health segment.

Hype for collagen has resulted in an explosion of supplements, leading to a billion dollar industry. A dizzying array of products now proudly promote collagen as a key ingredient, hoping to entice customers with the promise of eternal youth and wellness. It’s been shown that just putting the phrase “contains protein” on a package label increases sales by 30%. So does splashing the word “collagen”. 

Collagen is a fibrous structural protein found in just about all tissues of all animals, making it  the most abundant protein on Earth. It accounts for 30% of the protein in humans. It is essential to overall joint, bone, muscle, skin and hair health. The human body produces collagen naturally but its production slows with age and as a result, skin loses elasticity leading to wrinkles, bone and muscle mass decline leading to weakness, and hair growth slows leading to thinning hair. In addition to aging, there are many modern factors which accelerate collagen breakdown. These include things like dehydration, excessive sun exposure, air pollution, smoking, lack of exercise and a poor diet. Chronic stress leads to inflammation and cortisol production, both of which break down collagen and impair its formation and repair.  Certain diseases, deficiencies and medications can also hamper the body’s innate ability to make and repair collagen.

For example, commonly taken non-steroidal medications for chronic pain include Motrin, which is ibuprofen and Aleve, which is naproxen. Ironically, although these medications may reduce pain and inflammation in the short term, they also inhibit our natural collagen production and bone remodeling, significantly increasing the risk of needing a joint replacement and developing osteoporosis.

So how can we improve collagen health?

First of all, you can stop damaging what you have left. Avoid behaviors which destroy collagen and do the things which promote its maintenance and production like not smoking, limiting unprotected sun exposure, exercising more, crucial for tendon and bone health, getting good sleep which is when our bodies repair themselves and eating a healthier diet, avoiding foods which cause inflammation, especially sugar, processed and fried foods and minimizing animal products. YES, a whole foods, plant based diet is the best in this regard.

But most people want a quick fix with a supplement. On a purely scientific level, it doesn’t make a lot of sense that consuming collagen would improve our own collagen. All proteins we consume are broken down into individual or very small chains of amino acids (AAs), otherwise, we can’t absorb them. ALL foods, be they animal or plant contain all 20 AAs. Different foods contain different concentrations of them, but once absorbed, our bodies use those AAs in a prioritized manner to build whatever our bodies need, from hormones to cell walls to blood and muscle cells and this also includes collagen. Collagen from animal tissue may have a slightly greater proportion of the same amino acids that our own collagen contains so there may be some minimal theoretical advantage, but if our body needs the AAs to make depleted hormones for example, it will use them first for that anyway. 

Collagen is derived almost entirely from the “throw away” parts of animals, left over after all the meat has been removed from their bodies. This includes skin, bones, hooves, tails, hair and tendons. In fact, these other body parts are more valuable to the meat industry than the meat itself. More than 66% of the profits come from them.

Once these left over animal components are ground up and mixed together, they are hydrolyzed, a process that breaks down long molecules into shorter strands of amino acids, essentially pre-digesting them for us. 

Despite the claims made by collagen companies, the science on collagen is far from clear. Though some trials have found that collagen supplements improve skin elasticity, hydration and wrinkling, almost all of these studies were funded by collagen companies or related industries. Research is inconclusive on whether these improvements were due to collagen alone or the other substances they contain like minerals, vitamins like vitamin C known to be great for collagen health and compounds like hyaluronic acid, which helps maintain cellular hydration. There are some well done, academically funded studies that have shown some benefit of collagen supplementation in severe burn victims.

On another front, the collagen industry is disastrous for the environment. As demand for collagen has boomed, more and more rainforests, especially the Brazilian Amazon, are being destroyed to make way for cattle pastures, as well as land to grow the grains we feed them. Indigenous communities are displaced. Areas rich in biodiversity are destroyed and all of this destruction fuels climate change.

Marine collagen, derived from fish skins, bones, entrails and fins, isn’t much better in terms of its environmental, human rights and animal welfare impact. Marine collagen relies on a vast and corrupt industry linked to lethal bycatch, animals like dolphins, sharks and turtles, caught by accident. This collateral bycatch accounts for almost half of the sea life which is caught and killed in the fishing industry.

Plant-based foods like soy and legumes are known to help stimulate collagen production in the body. You can also boost collagen production by increasing your intake of zinc, found in foods like legumes, whole grains and nuts, and vitamin C, found in citrus fruits, leafy greens, peppers and tomatoes. As already mentioned, simple life-style changes like exercising more and managing stress and sleep can protect the collagen already in your body.

Despite the fervor from the beauty and pharmaceutical industry, collagen is not some holy grail offering eternal health and youth in the form of a single, lab-made supplement or powder. Collagen production poses a direct threat to animals, people and the environment, all when the evidence is still lacking that it can deliver on any of the questionable promises the industry makes to consumers.

Stop the damage and focus on healthful habits.

If you still want to supplement, there are plenty of ethically produced plant-based collagen products out there.

As July 4th is fast approaching, I would like to thank all those who serve and have served in the past, protecting our freedoms as well as fighting for justice worldwide.

Stay well and be safe.