by Alex Vasquez, DC, ND
Generally speaking, the
allopathic/pharmaceutical paradigm of anti-inflammatory intervention is
forced to be ineffective and dangerous by the very
nature of the pharmaceutical agents that are relied
Since the vast majority of drugs are single molecules that intervene at a specific part of a
complex inflammatory phenomena, the end result often is
similar to throwing a monkey wrench into a machine that
is malfunctioning a single aspect of inflammation might be
stopped, but the system continues to malfunction and
might become even more imbalanced as a result of the
Of course, the most recent and most tragic example of this iatrogenesis is the recent Cox-2-inhibitor (coxib) and Vioxx
catastrophe, which injured or killed more than 139,000
Americans.1 Any student of nutritional biochemistry could have anticipated the problems
years before these drugs caused their first deaths and
injuries.2 Indeed, the alarms were sounded within the first few years after the first coxibs were unleashed onto
the "health care" market,3 but these alarms were ignored in favor of the most
aggressive and successful drug-marketing campaign that the world had ever seen one that made celecoxib/Celebrex the most successful drug launch in
U.S. history, with more than 7.4 million prescriptions written within its first
six months.4 The obvious problem with these drugs is that by targeting the Cox-2
enzyme, they block formation of prostacyclin, long considered "the good prostaglandin" due
to its vasodilatory and antithrombotic actions, which are cardioprotective.
Furthermore, any inhibition of cyclooxygenase tends to shunt arachidonic acid into the
formation of leukotrienes, which
promote painless inflammation and the acceleration of
The failure of the coxibs exemplifies a major failure of the drug paradigm;
namely that excessive focus on the inhibition of isolated pathways creates additional
imbalance due to its failure to appreciate the multifaceted and interconnected nature
of physiologic systems and biochemical pathways. On the contrary, our holistic
perspective holds that inflammation is most effectively treated by focusing not on
isolated pathways per se, but on the patient's overall health. Using an
effective'overall approach allows specific pathways to be nutritionally supported and modulated,
rather than pharmacologically inhibited. In other words, whereas anti-inflammatory drugs
are specific and inhibitory of normal
function, the natural approach is more
general and supportive of optimal
How can clinicians orchestrate a practical nutritional wellness protocol that
specifically alleviates pain and inflammation? If you've read the first two articles
of this series ("A Five-Part Nutritional Wellness Protocol That Produces
Consistently Positive Results," Sept. 2005, and "Implementing the Five-Part Nutritional
Wellness Protocol for the Treatment of Various Health Problems," Nov. '05), then you
already know how to implement my five-part nutritional wellness protocol, and you
already have a sense for how powerful these basic interventions can be. In essence, we
start by getting the pro-inflammatory junk out of the diet, because we realize that
high-fat and high-carb meals are pro-inflammatory.
Once we've created some space for healthy foods, we encourage consumption
of anti-inflammatory foods such as low-carb, phytonutrient-rich fruits,
vegetables, nuts, seeds and berries. We correct general vitamin and mineral
insufficiencies with a multivitamin and multi-mineral supplement (which provides an
anti-inflammatory benefit6), and we ensure that the daily vitamin D requirement of
3,000-5,000 IU is met by ensuring daily full-body sun exposure or by using a
supplement that provides the appropriate
amount.7 We replace the
health-promoting fatty acids that are missing from the American diet by supplementing with
ALA, GLA, EPA and DHA, and we recommend probiotics to counteract the barrage of
antibiotics that most patients have had to endure during the course of their
viral infections, allergies, and other non-bacterial ailments. Weight loss and the attainment of optimal weight are the natural results of proper diet and
frequent exercise; adipose tissue is inherently
pro-inflammatory,8 and its "replacement" by lean muscle tissue (which is
anti-inflammatory9) helps shift the balance away from inflammation and toward homeostasis and healing. Up to
this point, we merely have turned off the gas lines that were fueling the
inflammatory fire; we have not yet done anything specifically anti-inflammatory per se.
By the time we've re-established the foundation for health, a large percentage
of patients already are healed of their primary ailments, and inflammation and
pain might be reduced significantly.
For patients who need additional anti-inflammatory interventions and relief
from pain, now we can begin the implementation of
treatment, which is customized to the needs of the patient. For osteoarthritis, we can use the tried-and-true
glucosamine and purified chondroitin sulfates (note that purified chondroitin sulfate
is cardioprotective11), and now that a study has finally been published on the use
of MSM12 we can be confident that it works, even though we've been using it
successfully for years! For pain associated with inflammation and edema (i.e., recent
injury), proteolytic and pancreatic enzymes work well and work
quickly.13 If we are only treating pain (rather than that which is marked by significant inflammation) we can use
a combination of analgesic botanicals, namely devil's
procumbens),14 Willow bark (Salix
spp)15 and Boswellia
serrata.16 If inflammation predominates
over pain, then we might choose to temporarily inhibit NF-kappaB with nutrients and
botanicals such as curcumin17 (requires piperine for absorption in
humans18), lipoic acid,19 green
propolis22 and resveratrol.23,24
Somewhere along the way, when pain and inflammation particularly are severe
or recalcitrant, we need to consider that the inflammation might be being triggered
by an occult or "silent" infection,25,
26 and so we will need to assess and treat
the various foci of dysbiosis.27 Antimicrobial interventions can include
hyperforin33 myrrh (Commiphora
molmol),34 bismuth,35 peppermint, uva
buchu,40 caprylic acid,
javanica,42 and Acacia
catechu.43 The attainment of anti-rheumatic benefits
via the use of antimicrobial treatments, immunosupportive interventions (rather
than immuno-suppressive drugs), xenobiotic detoxification, and the correction of
hormonal imbalances is the leading edge of anti-inflammatory treatments for autoimmune
diseases and other disorders characterized by severe "idiopathic" inflammation.44
Different health care professions are empowered and disabled by their
respective paradigms, and the merits of each can be contrasted by the results they obtain.
Here in America, drug-centered allopathic medicine, (which mislabels itself
"traditional medicine" even though it has existed for only 60 of the 2.5 million years of
human history) is the third or fourth leading cause of death, responsible for more than
1 million iatrogenic injuries and approximately 180,000 unnecessary deaths per
year.45-47 The American medical system also is the most expensive and inefficient "health
care" system in the world, and it burdens and bankrupts our families, businesses, and
communities48-52 while drug companies enjoy record-breaking multi-billion dollar
profits.53-55 Summarizing the situation in 2000, the Director of World Health
Organization's Global Program on Evidence for Health Policy, Christopher Murray, MD,
PhD,56 concluded, "Basically, you die earlier and spend more time disabled if you're
an American rather than a member of most other advanced countries." In contrast,
a lifestyle of healthy living that includes meditation, yoga, herbal dietary
supplements, and a whole foods diet can reduce total medical expenses by 59% over
four years and by 63% over 11 years compared to patients under "conventional"
medical care; hospital admission rates are reduced 11.4-fold for cardiovascular disease,
3.3-fold for cancer, and 6.7-fold for mental health and substance
abuse.57 The nationwide coverage of chiropractic might save our healthcare system as much as $61 billion
per year58 and would reduce the number of deaths and injuries caused by medical and
surgical treatments.59-61 Thankfully, as the chiropractic profession continues to
increase its scope of practice, more and more Americans will be able to experience
true health without lifelong medicalization with the use of proper diets,
nutritional supplements, and treatments that focus on the cause of the problem, not
merely the symptoms.
- Rita Rubin. Scientist says FDA system "broken."
USA Today, Nov. 19, 2004. Click to view it online.
- Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective
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- Topol EJ. Arthritis medicines and cardiovascular events "house of coxibs."
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- Monsanto, Pfizer celebrate Celebrex. St. Louis Business
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- Dwyer JH, Allayee H, Dwyer KM, et al. Arachidonate 5-lipoxygenase promoter genotype,
dietary arachidonic acid, and atherosclerosis. N Engl J
Med, Jan. 1, 2004;350(1):29-37.
- Timms PM, Mannan et al. Circulating MMP9, vitamin D and variation in the TIMP-1 response with
VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 2002;95:787-96.
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- Fain JN, Madan AK, Hiler ML, et al. Comparison of the release of adipokines by adipose tissue,
adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese
humans. Endocrinology May 2004;145(5):2273-82. Click to view it online.
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- Vasquez A. Integrative Orthopedics: The Art of Creating Wellness While Effectively Managing Acute
and Chronic Musculoskeletal Disorders.
- Morrison LM, Enrick N. Coronary heart disease: reduction of death rate by chondroitin sulfate
A. Angiology May 1973;24(5):269-87.
- Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters RF. Efficacy of methylsulfonylmethane (MSM)
in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis Cartilage, Nov. 22, 2005.
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safely and effectively treating musculoskeletal pain. Nutritional Perspectives 2005;28:34-38, 40-42. Available
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- Chrubasik S, Junck H, Breitschwerdt H, Conradt C, Zappe H. Effectiveness of Harpagophytum
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- Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low-back pain exacerbations with willow
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- Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata
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- Curcumin, EGCG and resveratrol have been shown to suppress activation of NF-kappa B;
Surh YJ, Chun KS, Cha HH, et al. Molecular mechanisms underlying chemopreventive activities of
anti-inflammatory phytochemicals: down-regulation of COX-2 and iNOS through suppression of NF-kappa B
activation. Mutat Res, Sept. 1, 2001;480-481:243-68.
- Shoba G, Joy D, Joseph T, et al. Influence of piperine on the pharmacokinetics of curcumin in
animals and human volunteers. Planta Med May 1998;64(4):353-6.
- Lee HA, Hughes DA. Alpha-lipoic acid modulates NF-kappaB activity in human monocytic cells
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- Yang F, Oz HS, Barve S, et al. The green tea polyphenols epigallocatechin-3-gallate blocks
nuclear factor-kappa B activation by inhibiting I kappa B kinase activity in the intestinal epithelial cell line
IEC-6. Mol Pharmacol Sept. 2001;60(3):528-33.
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suppresses inducible nitric oxide synthase through down-regulating nuclear factor-kappaB in mouse
macrophages. Carcinogenesis 2002;23(6):983-91.
- Caffeic acid phenethyl ester (CAPE) is an anti-inflammatory component of propolis (honeybee
resin). CAPE is reportedly a specific inhibitor of nuclear factor-kappaB (NF-kappaB);
Fitzpatrick LR, Wang J, Le T. Caffeic acid phenethyl ester, an inhibitor of nuclear factor-kappaB, attenuates bacterial
peptidoglycan polysaccharide-induced colitis in
rats. J Pharmacol Exp Ther, December 2001;299(3):915-20.
- Resveratrol's anticarcinogenic, anti-inflammatory, and growth-modulatory effects may thus be
partially ascribed to the inhibition of activation of NF-kappaB and AP-1 and the associated kinases;
Manna SK, Mukhopadhyay A, Aggarwal BB. Resveratrol suppresses TNF-induced activation of nuclear
transcription factors NF-kappa B, activator protein-1, and apoptosis: potential role of reactive oxygen intermediates
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- Both resveratrol and quercetin inhibited NF-kappaB-, AP-1- and CREB-dependent transcription to
a greater extent than the glucocorticosteroid, dexamethasone;
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Dr. Alex Vasquez began his professional studies at Texas Chiropractic College and later graduated from Western States Chiropractic College in 1996. He then attended the naturopathic medicine program at Bastyr University in Seattle. A complete biography of Dr. Vasquez and a printable version of this article are available online at www.nutritionalwellness.com/columnists/vasquez.
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