The Importance of An Anti-Inflammatory Diet, Part 1

February 2, 2016 / Thomas Cohn, MD

The diet we eat appears to have more and more significant influence on how healthy we are overall. Diet crazes come and go, but more research is showing that the food we eat does affect many aspects of our life. The main problem is that it is easier to eat whatever foods are available than to choose things that are healthy and helpful to us.

Furthermore the food we eat is processed differently at least initially in each and every person depending on our own genetics and the bacteria that happens to be in our gastrointestinal tract. Lastly, if we are overweight, the fat in our body may be contributing to inflammation. Losing excessive fat, exercising and eating healthy foods are all part of controlling inflammation in our bodies, and that too can contribute to a healthy lifestyle.

Researchers have identified certain foods and diet characteristics that seem to help control inflammation. Below are some suggestions with regards to a diet to control inflammation.

Anti-Inflammatory Diet

1. Start eating fish regularly – At least two meals a week should contain fish that are rich in omega-3 fatty acids. These fatty acids are the ones that are good for you by reducing C-reactive protein and interlukin-6, two proteins that enhance inflammation in the body. Eating a portion of fish like salmon, tuna, sardines, or other cold water fish is ideal.

2. Eat more fruit and vegetables because they are packed with antioxidants – These are compounds that support your immune system and help protect it from dangerous compounds in the environment. They also may help prevent inflammation by protecting compounds in the body from breaking down and needing to be removed and destroyed. The best sources are fresh fruit and vegetables, and when cooking vegetables, just lightly steam or cook them, keeping them crisp. The daily amount should be at 2-3 cups of each a day, that would likely equal at least 2-3 pieces of fresh fruit plus your vegetables. This could also include your salads.

3. Try eating nuts and seeds more often – They are great to substitute for snacks instead of empty calories like sweets. Nuts are full of anti-inflammatory monosaturated fats and are high in protein and fiber. Nuts also tend to fill you up and decrease the desire for more calories. A quarter cup of nuts, such as almonds, walnuts, sunflower seeds or pecans are great for snacks. Keep a jar available and take a few when hunger strikes. Stay away from coated or salted nuts.

4. Beans are often known as the “magical” fruit – They have some unwelcomed properties for some people, producing gas since they may be hard for some to fully digest, but beans have several anti-oxidant and anti-inflammatory compounds. They are also a low cost source of protein, packed with minerals like magnesium, iron and zinc and are high in fiber. Cooked beans can serve as a substitute for meat in sauces, and can be used as a main protein source if properly balanced in a diet. Many vegetarians use beans as their main source of dietary protein and extensive recipes are available in how to incorporate them into meals.

5. Use olive oil as one of your main monounsaturated sources of heart healthy fats – This compound is rich in antioxidants and oleocanthal, a compound that can lower inflammation and pain. The Mediterranean region uses olive oil in most of its cooking, and many use it for salad dressing. It is fine for coating hot pans, but do not try to fry foods with this oil.

On Thursday, we’ll share part 2 which includes five more tips on how an anti-inflammatory diet can help prevent chronic pain.

5 Ways to Eat Better in the New Year

January 25, 2016 / Thomas Cohn, MD

It is a New Year and a lot of people have made resolutions to eat better and lose weight. There are countless diets one could follow and everywhere you turn someone has a suggestion on what to do to become healthier. In reality, as science becomes more involved in understanding obesity and weight, the more complex the whole subject becomes. People originally thought taking in fewer calories than you burned was all you needed for weight loss, but unfortunately it is now much more complex. However there are some simple rules that may improve your diet and health.

Diet Rules To Remember

1. Eat more plants – As your mother said, eat your vegetables, especially fresh vegetables. Add in more whole grains, fresh fruit, and beans. Maintain a variety of these items in your daily intake. All these plants have essential nutrients and many contain compounds that bolster the immune system, improve digestion, fill you due to fiber and contain healthier varieties of carbohydrates that foster less weight gain. From the wide variety of plants and vegetables available, there should be a number of things that are tasty to eat.

2. Don’t eat more calories than you need – If you fill full at a meal, stop eating, even if your plate is not empty. Wait a little time after you eat before deciding on a dessert, since it takes time for the signals from your stomach to get to the brain and to tell it you did eat enough. Along the same line, slow down your eating, this will also give the brain time to determine it has had enough nutrients. Drinking more fluids also gives the stomach a feeling of fullness and may decrease the need for more food. Lastly, track your weight on a weekly basis (daily monitoring is deceptive and can vary) and if it is trending up, decrease the food intake. Tracking your exercise also may be helpful, a fitness tracker will give you a baseline level, if you are not moving you will not burn the calories you take in.

3. Eat less junk – This is food that is full of empty calories with no nutritional value. Start easy by eliminating candy, cookies, and things like energy drinks, or sugary donuts, pastries or desserts. These foods all are high in calories and carbohydrates. Yes they give you a quick dose of energy, but they are all easily converted to fat in the body. An occasional reward is ok, but small amount is more beneficial. The one exception may be to have a small piece of dark chocolate, this actually does have health benefits.

4. Eat a variety of foods you enjoy – Look at your current diet and determine what foods are healthy, and what you enjoy. Increase the amount of food that is healthy such as fish, chicken, turkey, and lean meats as well as vegetables, fruits and grains. Lower the amount of refined carbohydrates like white rice and pastas. Control the total portion size you eat, but you do not have to rid yourself of anything bad. The most important thing is increase healthy food you like,

5. Learn to cook yourself – Prepared meals and restaurant food is often not the healthiest. Most commercially made meals have high sodium amounts, refined carbohydrates, high calories from fats, and are not particularly good besides the taste. Restaurant meals and fast food is often high in fat, carbohydrates, and calories with few nutrients for the portion size. Cooking at home teaches one to use fresh ingredients, and it is much easier to institute healthier choices. Choosing fruits and vegetables, small portions of whole grain carbohydrates, and leaner cuts of meat or fish becomes much easier. Taste of the food may also improve, and cooking can be extremely relaxing and a time to interact with others.

In the New Year take a step forward toward a healthier lifestyle. Make some changes in your life and enjoy the changes you see in yourself. If you keep everything the same, your life will be the same. If you make some changes toward a healthier lifestyle, eating better, and exercising, the results over time should be evident.

Finding A Good Pillow For Neck Pain

January 20, 2016 / Thomas Cohn, MD

As Shakespeare once said “Sleep, per chance to dream” is the aspiration of everyone. Having a good pillow is the often the key. If you have neck pain, finding a comfortable pillow is a challenge. There are multiple options in size, stiffness and materials that must be considered. The wrong pillow just makes everything worse from neck pain and headaches, to shoulder and upper back pain. Furthermore, a pillow that is over two years old will often be full of dead skin cells, and possibly mildew, mites, or fungus.

Finding The Perfect Pillow

The first thing in getting a pillow is to determine the position you sleep in such that the support will keep your head in a “neutral alignment” position. If you sleep on your back, a thinner pillow with a possible extra bit of cushioning in the bottom third cab help maintain the curve of the neck. A side sleeper will need a fuller and firmer pillow to keep the head from tilting. Sleeping on the stomach often requires only a very thin pillow for the head position. A second pillow that helps maintain body position may also be helpful to improve comfort and to prevent pain. If you change your position during the night, you may have to decide how to combine features to maintain the most neutral alignment.

Pillows are also filled with a variety of different materials. The most common are a variety of feathers, foam, polyester fiberfill, and some are filled with weird materials like water, rice or beads. Classically, pillows used to be either feathers and down, or cotton with wool. A 50-50 mix of down and feathers has been traditionally considered one of the best to provide comfort, support, and allow for adjustments of the cushioning to provide a quality sleep. However, for those with allergies and asthma, down or feathers may cause difficulties. A mix of cotton/wool is another traditional material, but tends to be quite firm and not very adjustable. Polyester fiberfill is an artificial hypoallergenic material that can be designed to mimic down pillows in comfort, and memory foam has become popular over the last several years. Memory foam can continuously mold and adjust to the neck and body position. Today, there are a bunch of different types of foam including cool foams, mold resistance foam and hypoallergenic foam.

Specialty Pillows

Specialty pillows are often expensive and have many designs, shapes, claims and materials. Cervical pillows are made in shapes to cradle the neck supposedly in a neutral position, but studies have usually shown these to be no better than regular designs. Water pillows recommended by some professionals supposedly can be adjusted to customized density and support, but may have odd motion. Bead, wheat or rice pillows claim to provide customized position into a neutral position, but tend to be quite firm and heavy.

The bottom line in choosing a pillow is that everyone has different preferences that may be the best for you. The fancy claims and expensive costs do not make a perfect pillow. First, determine your sleep position, as this will give you an idea of the thickness you might like, then find your preferred firmness. Stay away from down/feathers if you have asthma or allergies. The best option often is trying out various types of pillows at the store if at all possible while lying down. Have someone with you to make sure your neck is in a good neutral position, and if it is the right comfort level, you may have found the winner. Remember, it is comfort and not necessarily cost that is key.

Minnesota Doctors Not Sold on Marijuana

January 18, 2016 / Thomas Cohn, MD

The Minnesota medical community is, according to January 12, 2016 article in the Star Tribune, not sold on medical marijuana. In reality, this is not very surprising. There are probably many reasons, but the most obvious reason is the idea that medical professionals like to base all their care on a scientific basis. From taking a history, to performing an exam and determining the tests and treatment, medicine is more of a science and depends on evidence for diagnosis and treatment of problems. If there is not evidence to support a treatment, medical professionals are trained to be skeptical of its use and purpose. Currently, medical marijuana definitely falls into this category.

Most important to the debate on medical marijuana is that there is very limited scientific research supporting many of the claims of usefulness. The research with regards to the management of most medical problems is related to a few small studies, and there are hardly any definitive studies that show significant positive value, and the study designs are often not blinded/controlled with any large number of participants. For pain management there is mostly incidental case report-type studies without mentioning which specific cannaboids are effective. Since cannabis plants contain over 100 different cannaboids and other compounds, using so many chemicals at once in a relative uncontrolled mixture is not a scientific approach to treatment. In a way it is like throwing a grenade at a problem and hoping everything does not blow up in your face.

Fixing The Marijuana Issues

The proponents of medical marijuana often bring to the table multiple examples of the wonderful help that various individuals have experienced with its use. However these are individual cases, and not necessarily what will occur with every individual. When a new drug is brought to market, we all want to have extensive testing performed to make sure it is safe, to ensure it performs correctly and that the same effect will occur each time it is taken. With medical marijuana we do not know most of these things. We have no idea what exactly is in the extracts, and we have no studies on how animals or humans will react to the compounds over time. Any other drug besides marijuana with this lack of scientific research would never even be considered to be used widely as an intervention. It is not surprising most medical professionals have a huge degree of skepticism about certifying patients to use medical marijuana and endorsing treatment.

In pain management there are many treatments available that have been shown to be reasonably effective. A pain management expert often can help a person through the maze of management options and help find an effective plan. There are a portion of patients with extremely complex problems without great solutions to control symptoms at this time. Failure of standard treatments may be a reason to want to try medical marijuana. Those who do go this route need to know at this time it should be considered truly an experimental treatment, and that the short and long term side effects and problems are not really known. There are a huge number cannaboids contained in medical marijuana, and while some may be helpful, others can be harmful. It may be a significant risk to use these compounds and until they are better studied and understood, and it is unlikely that the medical field will endorse such treatment without serious reservation.

MRIs Can Predict Chronic Pain After Whiplash Injury

January 15, 2016May 10, 2016 / Thomas Cohn, MD

Whiplash occurs when a person’s head is thrust forward or backward in a violent motion, over stressing the muscles and soft tissues in the area. The most common cause of whiplash is a car accident, especially accidents involving a rear-end collision. In this scenario the person who gets rear-ended will be thrust forward, but their head will usually snap backwards as their body is propelled forward.

Depending on the severity of the whiplash, most patients recover from their injury within 1-2 months, but others aren’t so lucky. For some, neck pain due to a whiplash injury becomes chronic, and symptoms remain for months or even years.

Luckily, we’re getting better at assessing whiplash symptoms and predicting who may suffer from long-term symptoms. With help from special MRI imaging, doctors are able to pinpoint with a fair degree of certainty which patients will develop chronic pain, disability and PTSD in the wake of a whiplash injury.

Chronic Pain Prediction

According to researchers at Northwestern Medicine, doctors can predict which patients will develop long-lasting symptoms within the first 14 days from the date of injury. By pinpointing which patients are likely to suffer long-term symptoms, doctors can better treat patients and help prevent potential setbacks down the road.

“This opens up a new door for research on whiplash,” said lead researcher James Elliott said. “For a long time whiplash has been treated as a homogenous condition. Our study has shown these patients are not all the same; they have different clinical signs and symptoms.”

The special MRI technique measures the fat/water ratio in the muscles of a person’s neck, and scientists uncovered that patients who would go on to suffer long-lasting symptoms had larger ratios of fat in their neck muscles. They believe this fatty infiltration could lead to atrophy of the muscles, and their findings were consistent no matter the size or BMI or the patient.

Elliot believes the findings may be most significant for individuals who suffer from PTSD in the wake of a whiplash injury or a traumatic car crash. If a person is deemed at-risk for emotional instability after an accident, doctors can help them get the treatment they need earlier, which can lead to better outcomes.

“These patients have shown to not respond well to traditional rehabilitation such as physical therapy,” Elliott said. “It appears that they may require a more concerted effort for pain management from their physician and help from a psychologist.” Emerging, yet preliminary evidence suggests this to be a reasonable strategy.