“Combating Chronic Lyme,” a Presentation by Dr. Gary Kaplan

This is a presentation by Dr. Gary Kaplan that was recorded on Sept. 26, 2019.

To subscribe to the Kaplan Center’s YouTube channel visit http://bit.ly/1N4YqmA.


Dr. Kaplan delves into the very controversial topic of identifying and treating chronic Lyme disease, a tick-borne illness that lingers past standard courses of treatment. Dr. Kaplan discussed the difficulties in correctly diagnosing chronic Lyme as well as new research and treatments that are currently available.

To download the handouts that were provided or a copy of Dr. Kaplan’s powerpoint presentation, we have made them available to download at https://kaplanclinic.com/resources/chronic-lyme-disease-lecture-resources/

 

Dr. Gary Kaplan Featured in Pain Free Living Magazine

Breaking the Cycle of Pain

by Paul Wynn, Pain Free Living Magazine, September 2017
THE FOUNDER OF AN INTEGRATIVE-MEDICINE CLINIC EXPLAINS WHY CHRONIC PAIN SHOULD BE TREATED AS AN INFLAMMATORY DISEASE
IMAGINE TALKING to your doctor and finding out that chronic pain is actually an inflammatory disease. It’s an unconventional idea that sur­prises many people, but it’s slowly gaining traction thanks to the work of Gary Kaplan, D.O., a clinical associate professor at Georgetown University in Washington D.C. (Click here to continue reading this article or use the PDF viewer below.)
 
 
 
 
[gview file=”https://kaplanclinic.com/wp-content/uploads/2017/11/Pain_Free_Living_Breaking_the_Cycle_of_Pain.pdf”]

Essential Turmeric Oils: A Hopeful Treatment For Ulcerative Colitis

The positive health effects of turmeric have long been touted by age-old healers as well as modern science. Turmeric’s active ingredient, curcumin, has powerful antioxidant and anti-inflammatory properties that help prevent free radical damage and calm the inflammatory process at the root of many chronic diseases.

However, the use of turmeric in treating chronic illness on a grander scale has been limited due to its relative low bioavailability, or “the proportion of a drug or other substance that enters the circulation when introduced into the body and so is able to have an active effect.”

Because of this limitation, research has primarily focused on ways to enhance absorption. Past studies have shown that combining turmeric with other compounds, one such example being piperine (found in black pepper), can increase bioavailability, and there are supplements* now available formulated to allow maximum absorption. Adding to this research, a new study authored by Dr. Ajay Goel, director of gastrointestinal research and translation genomics and oncology at Baylor Scott & White Research Institute, and published in Nature: Scientific Reports, confirmed that combining curcumin with essential turmeric oils (ETO-curcumin) significantly enhanced anti-inflammatory efficacy in DSS-induced colitis animal models (dextran sulfate sodium (DSS) is frequently used to induce colitis in experimental animals).

https://kaplanclinic.com/articles/3-reasons-to-include-turmeric-in-your-diet/

Possible clinical applications of curcumin currently include neurodegenerative diseases, osteoarthritis, and rheumatoid arthritis. There is also evidence that curcumin can kill certain types of cancer cells, as well as reduce the development of several forms of cancer in lab animals. Dr. Goel’s research highlights the anti-inflammatory potential of turmeric and suggests it may also have a place in the treatment of large intestinal diseases like ulcerative colitis.

Crohn’s disease and ulcerative colitis are autoimmune, inflammatory bowel diseases (IBD) that can cause a lifetime of painful symptoms. It is estimated that nearly 3 million people in the United States are living with IBD. Conventional treatment typically involves medications such as antibiotics, immunomodulators, or corticosteroids, amongst other types. However, a growing population of patients are exploring natural healing options instead of – or in conjunction with – medications. Our experience with IBD has shown that with the right lifestyle changes and dietary modifications, including supplementation and nutritional support, many people will see an improvement of symptoms.

“The takeaway for patients who want to experience the health benefits of curcumin through a commercially available supplement is to look for products that include additional compounds of turmeric – specifically, essential turmeric oils,” says Dr. Goel.

Remember, supplements are not regulated by the FDA, so before purchasing or taking any commercial supplements, speak to your physician who can recommend trusted sources – and more importantly rule out any possible interactions with other medications.

*Patients of the Kaplan Center can purchase Theracurmin® HP from the Kaplan Medical Center Store.

 

gut microbiome

“Gut Feelings”: An Excerpt From Total Recovery

The following is the first in a series of excerpts on gut health from Dr. Gary Kaplan’s book “Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression.”

“We now know that our intestinal tract has 100 million nerves – more than our spinal cords or peripheral nervous systems. With this radically new understanding, scientists have tentatively begun to refer to it as the body’s second brain.

As Michael Gershon, MD, explains in his book The Second Brain, the intestinal tract is far more independent than anyone had realized. It is even equipped with its own senses and reflexes.1

Surprisingly enough, our digestive systems manufacture just as many neurotransmitters as our brains. With the advent of “designer drugs” – such as selective serotonin reuptake inhibitors (SSRIs) – we have come to think of depression, anxiety, and insomnia in relation to the amount of serotonin circulating in the brain. Only recently has it become apparent that 95 percent of the body’s serotonin is manufactured not in the brain, but in the gut.2

Now it makes sense that the side effects of SSRIs often include intestinal problems.

In America more than two million people have irritable bowel syndrome (IBS), which may be caused, in part, from too much serotonin in the intestinal tract. As Adam Hadhazy points out in Scientific American, this means IBS – like other diseases caused by an imbalance of neurotransmitters in the gut – could almost be considered “mental illnesses” of the second brain.3

IBS may also signal an inflammatory process in the spinal cord or brain itself. An emergent theory on the cause of IBS is that it is a form of central sensitization. Inflammation in the spine increases sensitivity of the nerves controlling the muscles that line the intestinal tract and ensure the smooth flow of food throughout our digestive system. When the nerve signals from the spinal cord and brain to the intestines are disrupted, it can cause the intestinal muscles to spasm, resulting in pain and cramping. The muscles respond by becoming overactive (diarrhea) or underactive (constipation).4

As researchers have turned their attention to serotonin levels in the gut instead of in the brain, it has led to even more surprises. In a study of rodents at Columbia University Medical Center, scientists found that when they gave rodents with osteoporosis a drug that inhibited the release of serotonin in the gut, the disease disappeared. Gerard Karsenty, MD, lead author of the study and chair of the Department of Genetics and Development at Columbia, admitted, “It was totally unexpected that the gut would regulate bone mass to the extent that one could use this regulation to cure – at least in rodents – osteoporosis.”5

Dr. Gershon says, “We have never systematically looked at [the intestinal tract] in relating lesions in it to diseases like we have for the [central nervous system].”6 Once we have had time to investigate the implications of the second brain, important connections to diseases will be linked to the state of our gut.

We know that problems in the intestinal tract can go much further than heartburn and indigestion or constipation. Crohn’s disease, IBS, and ulcerative colitis also arise from imbalances in the gut.7 Early studies have suggested that imbalances in intestinal bacteria can cause “arthritis, diarrhea, autoimmune illness, B12 deficiency, chronic fatigue syndrome, cystic acne, colon and breast cancer, eczema, food allergy or sensitivity, inflammatory bowel disease, irritable bowel syndrome, psoriasis, and steatorrhea.” None of these conditions were previously recognized as being related to gut bacteria.8

Gradually, physicians reading the latest research are becoming aware that migraines are frequently triggered by food sensitivities that inflame the gut.9

Diseases like chronic fatigue syndrome, asthma, and fibromyalgia have a significant relationship to the intestinal tract. When balance is restored, the symptoms are often resolved. Any improvement in the health of our intestinal tract increases the effectiveness of our immune systems.

The question currently being investigated by researchers is: Can we analyze the stool to create a map of all the different types and amounts of bacteria in the gut and use it to predict illness? We’re hoping it can be done.”


1 Michael D. Gershon, MD, The Second Brain (New York, HarperCollins, 1998).
2 Lipski, Digestive Wellness.
3 Hadhazy, “Think Twice.”
4 Ibid.
5 Ibid.
6 Ibid.
7 Lipski, Digestive Wellness.
8 Ibid.
9 Ibid.

 

Reprinted from Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression by Gary Kaplan, D.O., with permission from Rodale Books. Copyright (c) 2014 by Gary Kaplan, D.O.

The Hidden Risks of NSAIDs

Painkillers: The 14-Day Time-Bomb

What Doctors Don’t Tell You, September 2016
by Celeste McGovern

Although these over-the-counter and prescription pills are the modern standby for every ache and pain, what Big Pharma hasn’t told you about the risks of non-steroidal anti-inflammatory drugs could just kill you, as Celeste McGovern discovers.

When Aaron Marino opened his own gym for business, he thought the stress of running it was giving him tension headaches. Each morning on the way to work at about 5:00 am, and as the dull throb began at the base of his skull, he would reach for one of the world’s most popular over-the-counter (OTC) painkillers for arthritis, headaches, menstrual cramps and more, and wash down two ibuprofen pills with black coffee—and the pain soon melted away.

Popping a couple of Advil — or Motrin or Aleve or other, generic versions of non-steroidal anti-inflammatory drugs (NSAIDs) — was so effective that it became a habit for Marino, a simple reflex to pain and he did it three to five days a week without a thought for years.

“I knew there was a risk to taking them,” says Marino, who had scanned the label and thought the warning applied to people who were gobbling far more than two pills a day. As a ‘superfit’ gym owner in the prime of his mid-30s, he had little reason to worry about a painkiller he could purchase in bulk at Costco — and, besides that, it worked.

Three years into this routine, though, one Tuesday in 2010, Marino rose from the toilet and noticed that his stool was liquorice black. By Friday, he was feeling dizzy when he stood and friends commented on his pallor. A Google search told him his black ‘tarry’ stools were indications of an upper gastrointestinal (GI) bleed, and when he went to the doctor, he was sent for an emergency blood transfusion and surgery to close a perforation in his duodenum.

“I was about two days from actually kicking the bucket,” says Marino, owner of Alpha M men’s image consulting business in Atlanta, Georgia. He wasn’t exaggerating: every year in the US alone, more than 100,000 people are hospitalized for NSAID painkiller-related stomach ulcers and injuries, and thousands die from NSAID-induced GI bleeding.

Silent epidemic of GI bleeds

Way back in 1999, this NSAID-induced GI problem was described in the New England Journal of Medicine as a “silent epidemic” claiming at least 16,500 lives each year in the US alone — and those only among arthritis patients and those taking prescription NSAIDs — not the OTC pills. The report also said that almost 75 percent of those surveyed who ingested NSAIDs regularly were “either unaware of or unconcerned about possible gastrointestinal complications.”

And while nearly two-thirds of regular users indicated that they expected warning signs before the development of serious NSAID-induced complications, in reality, more than 80 percent of patients with serious GI complications experience no prior gut discomfort as a warning.

Current estimates have lowered the NSAID-induced GI-bleed mortality figure to somewhere between 7,000 and 10,000 each year in the US, according to the American College of

Gastroenterology. German researchers have calculated the risk too: just two months of using an NSAID puts your odds of dying from a GI bleed at one in 1,220, which may sound small but is actually, they say, more dangerous than bungee-jumping a few hundred times.1 Use them longer and the odds multiply.

NSAID heart attacks and strokes

GI ulcers and bleeding are only one part of the NSAIDs’ toll. The unwanted side-effect of inducing heart attacks and strokes is now relatively well known to doctors, but these potential dangers and and the drug’s maker Merck’s attempts to deliberately obscure the risk only came to light in courtrooms when the drug Vioxx (rofecoxib) was withdrawn from the market in 2004 after an estimated 120,000 people died taking it.

But the NSAID carnage has still not ended as, recently, the US Food and Drug Administration (FDA) upgraded its warning on these drugs yet again. After reviewing new data on the drugs using compounds like ibuprofen, naproxen, diclofenac, ketorolac, celecoxib and more, the US oversight agency required new drug labelling for both the OTC and prescription non-aspirin NSAIDs stating that they increase the risk of heart failure and stroke even within the first week of use, and that the risk may increase further with longer use and higher doses.

It had previously been thought that only people at higher risk of cardiovascular events could possibly suffer vascular injury induced by NSAIDs. But the recent FDA warning makes it clear that the risk is also increased in those with no known heart issues and that injury can happen “without warning.” NSAIDs pose the greatest risk to patients following a first heart attack, with those treated with the drugs being, according to the FDA, “more likely to die in the first year after the heart attack” compared with patients who aren’t taking the drugs.

“For people who have coronary artery disease and have suffered a heart attack, the risk starts with the very first pill, and the risk does not get any better if you wait for a year or even five years after a heart attack,” says pain specialist Gary Kaplan, of Georgetown University School of Medicine and author of Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression.

The new FDA heart and stroke warning is now added atop its GI warning, which states that NSAIDs like ibuprofen may cause ulcers, bleeding or holes in the stomach or intestines which “may develop at any time during treatment, may happen without warning symptoms, and may cause death.” It then adds that the risk may be higher the longer you’ve taken the NSAID, if you are elderly, in poor health or drink three or more alcoholic drinks per day while taking ibuprofen.

Ignorance of the GI risks of NSAIDs is apparently just as widespread as the New England Journal of Medicine described in 1999 because in 2010, the FDA conducted surveys to determine if illiteracy among the elderly was the underlying reason for their lack of awareness of the risks associated with NSAID consumption. It was not.

In the UK, the reason for such ignorance may well be down to the lack of awareness of the National Health Service itself: its current information page on NSAIDs describes the side-effects as “troublesome,” and lists ulcers and GI bleeds below stomach aches and diarrhea, with heart attacks and strokes last of all as “rare” side-effects. The site offers no information on the suddenness with which symptoms can arise.

As for alcohol, while the increased risk of GI bleeding with its greater consumption has been documented in the medical literature since 1999, the NHS blithely states: “It’s usually safe to drink alcohol while taking NSAIDs, but drinking alcohol excessively during treatment may irritate your stomach.”

Other dangers

While heart and GI problems are well documented among NSAIDs’ unwanted effects, there’s more. In 2005, Pfizer pulled its NSAID valdecoxib (Bextra) from the US market because of its high heart risks, but also because it was linked to more than 150 cases of serious and sometimes fatal skin reactions.

Two years later, the UK and Australia abruptly pulled the NSAID lumiracoxib (Prexige) when they discovered that some patients taking it were suffering from severe liver damage as a result; indeed, some patients even required liver transplants. And last year, the drugs regulators reviewing diclofenac-based NSAIDs moved them from the OTC category to prescription-only.

NSAIDs’ risk to kidneys is also well known to regulators. A recent pooled analysis of five earlier studies confirmed that NSAID use significantly increases the risk of acute kidney injury.2 They’ve also been linked to hearing loss in both men and women.3 And while there are conflicting results for NSAID dangers in pregnancy, some researchers have concluded that several NSAIDs can induce “spontaneous abortion.”4 The painkillers can also induce or exacerbate sinusitis and hives, and studies have shown they can increase allergic responses by 10 to 30 percent in asthma sufferers.

NSAIDs can make pain worse

Ironically, for those dealing with pain, NSAIDs may actually interfere with the body’s own painkilling machinery, the long-term effect of which is to sustain pain rather than eliminate it. This is exactly what happened to image-consultant Marino. When his gut problems forced him to stop taking NSAIDs, he noticed that, in less than a week, the headaches he’d been taking
the drugs for in the first place, for years, simply vanished.

“NSAIDs are not truly addictive, but can make you dependent,” explains pain-expert Kaplan. “Regular use, three times or more a week of NSAIDs and Tylenol [not an NSAID, but acetaminophen/paracetamol] can suppress the body’s own natural pain-relieving system. The result can be rebound pain when you stop the medication because your own pain-relieving system has been suppressed. Over time, when you stop the medications, your own system kicks back in and the pain goes away. The problem has been well documented in people with chronic headaches. In some people with chronic headaches, all we need to do to fix the headache is to get them to stop taking NSAIDs and Tylenol for a few weeks, and the body will fix itself.”

In the case of arthritis pain, doctors know NSAIDs do nothing to help the underlying condition, although they can alleviate pain in the short term. But a new study suggests that taking a painkiller like an NSAID can actually make arthritis worse in the long run. Researchers at Johns Hopkins University compared people taking painkillers (two-thirds were taking an NSAID) for knee arthritis with those who weren’t taking any drugs for a matching condition, and followed them all for three years, X-raying their knees at intervals. Those taking the painkillers were more likely to have knee arthritis that had visibly got worse on X-rays and were also more likely to undergo knee replacement surgery compared with those not taking the drugs.5

The COX-2 scandals

COX-2-selective NSAIDs were developed as a way to target pain and inflammation while sparing COX-1 and the gut lining. Merck’s Vioxx (rofecoxib) and Pfizer’s Celebrex (celecoxib) were the first of these COX-2 inhibitors.

Launched in 1999, they quickly became blockbusters; doctors wrote more than 100 million prescriptions for them in the first year and the manufacturers of each raked in billions in dollars. But tens of thousands of patients began dying from heart attacks and strokes.

All of the sordid details of how Merck and Pfizer doctored the data and deliberately concealed the drugs’ dangers eventually trickled out in a myriad court cases years after Vioxx was first pulled from the market in 2004.

“The scandal of the COX-2 inhibitors is really monumental,” says former drug insider and co-founder of the Danish Cochrane Collaboration Peter Gøtzsche in his book, Deadly Medicines and Organised Crime (CRC Press, 2013). “The drugs were approved based on small, short-term trials that didn’t look for cardiovascular harms, in patients with low risk for such events, although nearly half of real-world patients with arthritis have coexisting cardiovascular disease.”

Gøtzsche recounts how Merck employees deliberately manipulated data too, not just by exaggerating the benefits of Vioxx, but also by actually producing a fake peer-reviewed journal just to market pro-Vioxx reports.6 They also did not publish data available in 1999—which clearly showed the increased rates of heart attacks and strokes—until 2006, two years after the drug was pulled from the market. When they did publish data, they distorted the findings: for example, they failed to report three heart attacks during a critical clinical trial, listing one cause of death as “unknown” when it was clearly a heart attack.

But to most of the American public, the true extent of Merck’s ruthless concealment was hidden by the media’s Pharma-friendly reporting. News of the Vioxx ban, for instance, was followed by a 10-minute interview with a Pfizer-funded representative of an American arthritis foundation lamenting the loss of the painkiller for patients. Yet, there was little national reporting in 2007 when the jury in a Vioxx case found that Merck’s conduct was “malicious, oppressive and outrageous.”

And it wasn’t until 2009 in an Australian court that details emerged, such as Merck’s internal emails naming the influential doctors and researchers who were concerned about the drug’s risks. The emails described how company employees intended to “neutralize” and “discredit” these “problem” detractors. Neutralization was apparently achieved through the company’s lengthy list of “opportunities,” which included “Research,” “National Consultant Meetings,” “Program Faculty Training” and “Medical School Grants.” If these bribery tactics failed, schemes that were evidently not discussed via email were then employed to “discredit” the detractors.

Gøtzsche also describes how Celebrex (celecoxib) manufacturer Pfizer similarly contorted data to suit its drug-marketing strategy. Its biggest study, he says, was “fraudulent” and its authors were either employees or paid consultants to the company. When Vioxx was pulled from the market, Pfizer shamelessly seized the moment to promote its own drug.

The next day, the company wrote to Danish doctors that more than 50 million people worldwide used celecoxib and that the company had reviewed clinical trials of more than 400,000 patients. “That’s what they wrote; I suppose they meant 40,000,” says Gøtzsche, “and this had not yielded any sign that celecoxib increased the risk of cardiovascular events. The fine for this ruthless misinformation: $2,000.”

In reality, all COX-2-inhibiting NSAIDs increase the risk of heart attack and stroke. Celebrex, the only one left on the market, has similar cardiovascular risks to Vioxx. Pfizer has awarded millions of dollars in damages to patients who have suffered as a result and has even paid out $164 million to its own shareholders, who claimed the company misrepresented the drug’s safety data.
As Gøtzsche says, “The NSAID story illustrates that drug regulators are consistently willing to award the benefit of scientific doubt to manufacturers rather than patients.

Know your painkillers

As with every other drug, there’s no such thing as ‘safe’. The top five categories of painkillers are rated here for their relative dangers.

Infographic: www.WDDTY.com

Infographic: www.WYDDTY.com

Why COX inhibitors affect your gut

The wide variety of NSAID side-effects has to do with how they work. Our bodies have an enzyme called ‘cyclooxygenase’ (COX), which produces prostaglandins that, in turn, promote inflammation, pain and fever in the body. NSAIDs are believed to block these COX enzymes and so reduce prostaglandin production, thus damping down inflammation, pain and fever.

There are two kinds of COX enzymes: COX-1 and COX-2. COX-1 is known as a ‘housekeeping’ enzyme, as it plays a critical role in regenerating and protecting organs like the kidneys, as well as the mucosal lining of our gut. In fact, this activity is part of the reason why we don’t digest our own stomach every time we eat anything. It is also the reason why ingesting COX-1-disrupting NSAIDs puts our gut lining at risk.

“What people think about with stomach upset for the NSAIDs is stomach ulcers, but the bigger issue is that regular use causes ulcerations in the small intestine in up to 75 percent of people,” explains Georgetown University’s Gary Kaplan, medical director of the Kaplan Center for Integrative Medicine.

“The small intestine is the final arbiter of what substances that we eat are allowed to enter our bodies and what will pass through to be eliminated in the stool. Damage to that filter by the NSAIDs allows substances to be adsorbed that would normally be kept out. This increases the risk of allergic reactions and worsening of food sensitivities.”

The other problem with NSAIDs is that they disrupt the gut microbiome, a mini-ecosystem of microflora that interacts with our nervous system, and helps to determine the health of our body and brain.

“Disrupting the garden of our gut can let weeds overgrow and potentially damage our health the same way weeds overgrowing a garden can damage the flowers and other plants we actually want to thrive,” says Kaplan.

What else can you do?

It’s a fact that more than 100 million Americans and 14 million Brits suffer from chronic pain—whether mild, sporadic, unremitting or excruciating. So the big question remains: what else can they do to deal with the pain?

For acute pain

For acute muscle strain, ice, elevation and rest, and perhaps a muscle relaxant, is recommended by Georgetown University’s Gary Kaplan, an integrative osteopath and one of only 19 US physicians specialized in both family and pain medicine.

After the first 24 hours of an acute injury, he says, apply heat.

The homeopathic combo preparation Traumeel, which comes as a pills, a cream or gel (www.traumeel.com) provides pain relief, as does bromelain (see right).

For chronic pain

As chronic pain is really about inflammation, according to Kaplan, the first place he starts with patients at his pain clinic is their diet.

Eliminate all fatty and fried foods as well as refined sugars and stimulants like coffee and tea.

Eat an anti-inflammatory diet, starting with brown rice, fish, chicken, fresh fruit and vegetables, and eliminate gluten, soy milk and milk products.

Some people suffering from osteoarthritis find that avoiding nightshades (tomatoes, eggplants/aubergines, bell peppers) is helpful. Try it for a month and see if your condition improves.

Take omega-3s for arthritis. These essential fatty acids are essential for your body to fight inflammation—including what’s associated with osteoarthritis and rheumatoid
arthritis (RA).

  • Suggested daily dosage: 200–1,000 mg as fish oil or 1 Tbsp flaxseed oil

Glucosamine has also been shown to help arthritis sufferers because it provides the raw material for rebuilding cartilage and synovial joint fluid. One study of patients with moderate-to-severe hip and knee osteoarthritis found that taking 1,500 mg of glucosamine sulphate plus 200 mg of omega-3 fatty acids had greater pain reduction and less morning stiffness and pain than those who took glucosamine alone.1

  • Suggested daily dosage: 2,500 mg

Take turmeric, the bright-yellow root in the ginger family most familiar as a spice in Indian curry. Hundreds of studies link its active ingredient curcumin to anti-inflammatory activity. It’s also been shown to act specifically as a COX-2 inhibitor—but without the side-effects of drugs like Vioxx and Celebrex.

  • Suggested daily dosage: 1–3 g/day as dried powdered root

A highly bioavailable form of curcumin was more effective in alleviating RA symptoms, including joint tenderness and swelling, than NSAIDs in one study. What’s more, those taking the curcumin without the NSAID diclofenac experienced the greatest improvements overall. Also, those taking turmeric had no side-effects at all, whereas 14 percent of those who dropped out of the study did so because of NSAID side-effects.2

  • Suggested daily dosage: 500–3,000 mg of bioavailable curcumin extract three or four times a day

N-Acetylcysteine (NAC), an amino acid, has anti-inflammatory properties that have been well described, yet only recently did researchers discover in a small preliminary study that its biochemical mechanism also relieves pain, so suggesting its potential in the treatment of chronic inflammatory pain.3

  • Suggested daily dosage: 600–1,200 mg or as directed

Bing cherries and raspberries are examples of Nature’s own COX inhibitors. According to one study, these fruit contain particular antioxidants and anthocyanins that make them capable of inhibiting COX-1 and COX-2 activities comparable to those of ibuprofen and naproxen.4

Pineapple contains an enzyme called ‘bromelain’, shown to reduce inflammation by apparently also blocking the COX-2 enzyme pathway naturally.5 You can take it as a supplement derived from the stems of pineapples, which contain the highest concentration of bromelain.

  • Suggested daily dosage: 200–400 mg/day or 90 mg three times a day

Pine bark extract, or Pycnogenol (French maritime pine bark extract) is another natural COX inhibitor described in dozens of published research papers to have beneficial effects on a wide variety of inflammatory diseases and conditions, including the pain of osteoarthritis. In one study, 100 patients treated for three months with 150 mg/day of Pycnogenol with meals saw a “significant alleviation of pain” and reduced their NSAID consumption compared with those taking a placebo, who saw no improvements and increased their NSAID consumption instead.6

  • Suggested daily dosage: 150 mg/day or as directed

Supplement with magnesium, as muscle twitches, cramps, tension and aches are among the most common signs of a deficiency of this mineral. So it’s no wonder that pain doctors like Kaplan advise patients with chronic pain—from migraines to fibromyalgia—to supplement with magnesium, as it’s hard to eat your way out of a deficiency once it develops. Magnesium oil applied topically is also reported to dramatically relieve some cases of arthritis within minutes. In one study, patients receiving intravenous magnesium after heart surgery had similar pain levels, but self-medicated far less with morphine.7

  • Suggested daily dosage: 400–800 mg

Cayenne or capsaicin topical creams (containing at least 0.075 percent capsaicin), derived from hot peppers, are available over the counter, and alleviate pain by reducing levels of the pain transmitter ‘substance P’, such that the pain messages never reach the brain.8

  • Suggested daily dosage: Apply to painful areas, but never on broken skin; if there’s no improvement after two to four weeks, stop using it. It may also cause skin irritation. After use, avoid touching your eyes and wash your hands carefully.

Sleep is crucial for good pain control, according to pain doctor Kaplan, so anything that helps you get a good night’s sleep is also likely to benefit pain. This includes meditation, yoga, exercise and stretching, while massage, acupuncture and other physical therapies can help tremendously too.

References

Main References:

1 Z Rheumatol, 2001; 60: 288
2 Eur J Intern Med, 2015; 26: 285–91
3 Am J Med, 2010; 123: 231–7; Am J Epidemiol, 2012; 176: 544–54
4 CMAJ, 2011; 183: 1713–20
5 Osteoarthritis Cartilage, 2016; 24: 597–604
6 www.shiftfrequency.com/medical-censorship-of-natural-health/

Know your painkillers References:

1 BMJ, 2011; 343: d5142
2 Presentation by Dr Carl Orr at the Annual Congress of the European League Against Rheumatism, 14 June 2013, Madrid, Spain
What else can you do? References:
1 Adv Ther, 2009; 26: 858–71
2 Phytother Res, 2012; 26: 1719–25
3 Mol Pain, 2015; 11: 14
4 Phytomedicine, 2001; 8: 362–9
5 Cancer Lett, 2009; 282: 167–76
6 Phytother Res, 2008; 22: 1087–92
7 J Cardiothorac Vasc Anesth, 2007; 21: 827–31
8 http://umm.edu/health/medical/altmed/herb/cayenne

Resveratrol brain health

4 Brain Boosting Properties of Resveratrol

What do pistachios, peanuts, blueberries, and grapes have in common? In addition to providing a tasty snack, they are all sources of Resveratrol – a naturally occurring substance found in certain plants that offers a number of health benefits to the brain!

Resveratrol is a type of phytoalexin – a substance produced by plant tissues that promotes disease resistance. Medical researchers are still exploring the mechanisms by which Resveratrol works but it has clearly proven its impact on reducing inflammation in the central nervous system (inflammation of this nature is a major contributor to chronic pain, depression, and neurodegenerative diseases).

A well-balanced diet that includes lots of fruits, vegetables, and nuts is a wonderful way to obtain Resveratrol. Other food sources include mulberries, raspberries, red wine, pomegranates, dark chocolate, and soy beans.

In Vitro vs In Vivo

Successful in vivo studies (involving animals or humans) are more limited but also show promise. One reason for their limited success is that Resveratrol has low bioavailability. Merriam-Webster defines bioavailability as “the degree and rate at which a substance is absorbed into a living system or is made available at the site of physiological activity.” In other words, before our bodies are able to reap its benefits, Resveratrol is rapidly absorbed and eliminated. Researchers continue to look for ways to enhance its bioavailability through dosage concentrations and combinations with other compounds. For example, a 2011 study concluded that, just as piperine can improve the bioavailability of curcumin, it also “significantly improves the in vivo bioavailability of resveratrol .“

Possible Clinical Applications of Resveratrol
  1. Resveratrol has demonstrated neuroprotective qualities post-stroke, post-Traumatic Brain Injury (TBI), and/or post-spinal cord injury. A 2015 review published in Neurochemistry International, which looked at both in vivo and in vitro studies, confirmed that Resveratrol “can induce a neuroprotective state when administered acutely or prior to experimental injury to the CNS.”
  2. Resveratrol can potentially lower a person’s risk of opioid dependency. A 2015 study concluded that “Resveratrol restores the antinociceptive effect of morphine by reversing morphine infusion-induced spinal cord neuroinflammation.” In other words, this study suggests that it’s possible that Resveratrol, when taken with morphine, can prevent the development of hyperalgesia (increased sensitization to pain) – a condition that often leads to opioid dependency. Furthermore, Resveratrol acts without compromising the morphine’s effectiveness.
  3. Resveratrol can improve age-related mood and memory function. Resveratrol’s anti-aging and anti-inflammatory properties seem to protect cells in the hippocampal region of the brain from damage. This region of the brain converts short-term memory to long-term memory, and is part of the limbic system, which regulates emotion.

    A study published in Scientific Reports showed that middle aged, Resveratrol-treated rats had “improved learning, memory and mood function” in older age than their “vehicle” (a substance usually without therapeutic action) or control-treated counterparts.

  4. Resveratrol reduces amyloid plaque formation. Amyloid plaques present as a sticky buildup that accumulates outside nerve cells or neurons, and they have been linked to Alzheimer’s disease.

    Researchers in a 2009 study published in Neurochemistry International, were able to show that Resveratrol significantly inhibited plaque formation in certain areas of the brain by as much as 90%!

Supplementing with Resveratrol

Resveratrol supplements are available in pure form or combined with other compounds. Dosages are typically somewhere between 5mgs and 5gms, depending on the individual’s medical condition.

* If you are considering taking a supplement, make sure to talk with your physician about possible interactions with other medicines.

In sum, Resveratrol is a powerful anti-oxidant with a demonstrated potential to nurture and even heal the brain. With many delightful sources available in food, supplementing with Resveratrol can ensure that our bodies get even more of this wonderful gift from nature!

References:
Bioavailability (n.d.) Merriam-Webster.com. Retrieved from //www.merriam-webster.com/dictionary/bioavailability.

turmeric benefits

Turmeric – Miracle Spice or a Bunch of Hype?

Q. Dr. Kaplan, you have recommended using turmeric regularly to reduce inflammation and improve health. What puzzles me is this: regardless of their continued, lifelong consumption of turmeric, the number of people in India suffering from Chronic Fatigue Syndrome and fibromyalgia continues to spiral upwards. Can you comment on this?
 
 
 
Gary Kaplan, D.O.: The issue with inflammation in the body as a whole, and the brain in particular, is a complex issue. Before you can successfully address the inflammation that is involved in the disease processes of many chronic illnesses, such as Chronic Fatigue Syndrome and Fibromyalgia, you have to remove all of the factors that are causing the inflammation in the first place. So, for example, if you are living in a highly stressful environment that is polluted and toxic, with poor sleep habits and/or poor nutrition or other health issues, thinking that turmeric is going to fix you is whistling through the graveyard.
Turmeric is useful as an antioxidant and for reducing the inflammatory activity of the microglia, the innate immune cells of the central nervous system. However, addressing the issues of inflammation requires a comprehensive approach that begins with good nutrition, sleep, and exercise habits as well as regular meditation. After that, we have to work with individuals to help each person find their pathway to health.
– Dr. Kaplan

Elevated C4A? This Is What It Means

Q: I was in a life-threatening car accident 15 years ago that resulted in multiple pelvic fractures, a burst bladder, several other fractures and a mild TBI (traumatic brain injury). There have been a number of other physical and emotional traumas throughout my life and I have received MANY treatments, including years of physical therapy, psychotherapy, medications, osteopathic treatments, acupuncture, herbs, homeopathy, prolotherapy, and others. Recently, my osteopathic doctor (who is also an acupuncturist) suggested that I read Total Recovery. I found this book extremely helpful, mostly as it helped me feel not quite so isolated.

My doctor is proceeding through many of the protocols you suggested that we have not already tried. He recently found that my C4a result was 5 times the normal high limit. We are continuing further testing based on this result, but I wondered what next steps you would suggest. I have a diagnosed gluten intolerance, IBS, fibromyalgia, tested negative for Lyme disease, and positive for Epstein Barr (not currently active). I take magnesium (glycinate and threonate), calcium, fish oil, pantothenic acid, prebiotics, probiotics, etc. I also take Cymbalta. I believe most of the other tests you recommend I have had, and there does not appear to be an issue. Thank you for your time and attention, keep up the great work!

Gary Kaplan, D.O.: This is a very difficult and challenging case and fortunately it sounds like you have had some excellent care. It takes a great deal of courage to persevere in circumstances such as yours. The approach to dealing with a case like this is to first identify all of the issues that are fueling the fire in your brain. Once those are identified you can then work towards putting that fire out.

What I mean by this is that you have to address all the factors that are continuing to cause damage to the neurons in the brain, such as infections, mycotoxins, hypoxia secondary to sleep apnea, etc. These factors stimulate cells called microglia. Microglia are immune cells in the brain and central nervous system that respond to stressors by producing inflammatory chemicals designed to help with healing. Once the stress is resolved, the microglia should return to a resting state until the next time they are needed. If too many stressors occur, the microglia can remain in an up-regulated state, producing unwanted inflammation that can be the cause of your symptoms. So, addressing any infection, injury or other physical stressors should allow the microglia to down-regulate. The microglia up-regulation can also be addressed with meditation, exercise, low dose naltrexone, turmeric, and other supplements.

At this time in your treatment process, I would step back and reassess. I would begin with the gut and make sure that any issue with leaky gut is resolved and that there is no evidence of bacterial overgrowth. Specifically, I would get an Organic Acid Test (OAT). The OAT is a metabolomics test from Great Plains Laboratory that assesses a number of metabolic pathways in the body, as well as checks for any bacterial and yeast overgrowth in the GI tract.

The elevated C4a suggests mycotoxins and I would recommend contacting a lab that is proficient in this type of testing. If your C4a is persistently elevated despite the elimination of all mycotoxins then I would consider the use of Vasoactive Intestinal Peptide (VIP) spray which has been helpful in reducing brain inflammation for people suffering from mycotoxicity. I would also recommend that you cultivate a regular meditative practice as this has been shown to decrease inflammation as well. There is more that can be done but I hope this will offer you some insight into your next step.

There is still a great deal that we need to learn about neuroinflammation and to this end, I have created a charitable foundation for education and research dedicated to finding a cure for individuals such as yourself who are suffering from chronic pain. To learn more about The Foundation for Total Recovery, please visit www.BrainOnFire.org. I hope you will consider participating in our efforts to find a cure.

With my best wishes for your optimal health,
– Gary Kaplan, DO

Is Depression Ever Just Depression?

A modified model for understanding depression and anxiety ought to involve a whole person, integrative approach.

by Gary Kaplan, DO
Article reprinted from US News and World Reports, May 12, 2015
Public acts of violence seem to fill the news media streams these days and are typically followed by outcries for greater access to mental health care for those that need it most. And although most individuals with serious mental illness are not dangerous, many of the perpetrators of these heinous crimes later turn out to have a documented history of depression or mental illness, which often went untreated. So, what can we do to stop the anguish? What is it that we are missing?
The Cost of Failure
Unfortunately, the number of Americans affected by serious depression and anxiety disorders is enormous, as are the costs to society due to failure to treat and/or treatment failure. The National Institute of Mental Health reports that each year, approximately 57 million Americans suffer from depression, including chronic, low-grade depression (dysthymia) and anxiety, and some 14.8 million of those are dealing with major depressive disorder, the leading cause of disability for people ages 15 to 44.
The cost of failing to effectively treat these conditions is not just the individual’s inability to complete college, hold a job or cultivate positive relationships; it also includes the toll taken on an entire family and community when a despairing person takes their own life. And in the most extreme cases, the costs of acts of public violence – in terms of suffering, municipal expenses, personal medical and legal expenses, and lost human potential – are immeasurable.
Several months ago, Michael, a 17-year-old high school student, came to see me. Michael had a long history of hospitalizations after attempting to take his own life, and despite undergoing intensive psychiatric treatment, he remained depressed and suicidal. Like 40 percent of those who suffer from major depressive disorder, Michael was not responding to treatment.
When contemplating a situation like Michael’s, the question “What am I missing?” is never far from my mind. Statistics show that only about one-third of patients with MDD respond to antidepressant medication, with about the same number responding to psychotherapy alone. If we combine the two approaches the numbers improve slightly, but the fact remains that most people with MDD respond only partially to medical interventions, with almost half remaining entirely unresponsive.
A Central Nervous System in Turmoil
A mountain of scientific research over the last 10 years has demonstrated that neuropsychiatric conditions such as depression, anxiety disorders and possibly bipolar disease are, in a very high percentage of cases, the result of inflammation occurring in the brain. In the past few years, there’s been a great deal of publicity linking generalized inflammation to heart disease, chronic pain and obesity. Inflammation in the body takes many forms: When we have an allergic response to pollen or food, our bodies’ inflammatory response includes the release of histamine, which makes our eyes itch and noses run; we see the inflammation associated with a skin wound when the white cells of our immune system respond to a bacterial infection. Inflammation in our brains, however, is unique in that it is mediated by tiny cells called microglia.
Microglia are the innate immune system of the central nervous system. Their job is to respond to trauma and damage to the brain. In response to brain injury, the microglia release a virtual symphony of chemical mediators that orchestrate the destruction of bacterial invaders, the elimination of damaged neuronal tissue and the initiation of the repair process.
After responding to an assault on the brain, microglia typically return to a resting state. But ongoing and cumulative assaults to the brain (e.g., fever, physical assault and emotional trauma) will cause the microglia to remain chronically up-regulated, causing them to continuously spew out inflammatory, tissue-destroying chemicals. This brain inflammation produces a wide range of symptoms including depression, anxiety, chronic pain, difficulty focusing and concentrating, fatigue and sleep disturbances. Further compounding the issue is the fact that a solid understanding of the role of microglia in brain health is sadly lacking among most medical professionals, with the result that they continue to treat what are in fact “symptoms” as separate and unique “diseases.”
Looking Beyond the Symptoms
A new framework, where physicians look beyond the symptoms, would involve giving priority to discovery of the root causes of an individual’s depression or anxiety. This would primarily require an understanding of what caused the microglia to up-regulate. Research has shown that anything that can damage neuronal tissue can be a trigger. So, an exploration of a patient’s depression may include asking them about possible traumatic head injuries, psychological traumas (acute events and chronic stress), infections (e.g., tick-born diseases, other bacteria and viruses), and even biotoxins that may have entered the body from exposure to toxic molds, celiac disease and hypoxia (usually related to sleep apnea). The list of triggers is long, and as such, the process of identifying the possible underlying causes of the disease requires putting together a thorough medical health timeline for each patient. With this new approach, treatment options expand due to the greater understanding of the origin of the illness, thereby increasing prospects for recovery.
As for Michael, my 17-year-old patient who was depressed and suicidal, it turned out that he has celiac disease. Now gluten-free, he is no longer depressed, he has re-engaged in life and he’s looking forward to going to college. He is still taking antidepressant medications, but under medical supervision is slowly weaning himself from them (it takes time for the brain to heal after the assault is removed). His life has been changed, for the better, forever.
It is my hope that, with a modified model for understanding depression and anxiety, involving a “whole” person, integrative approach, more patients will be correctly diagnosed and treated, as Michael was. In his case, and I suspect in many more, we’re learning that all too often, depression is not just depression.

plenty of traditional asian spices in wooden bowls

3 Reasons to Include Turmeric In Your Diet

Native to southwest India, and known for its radiant golden color and unique taste, turmeric has been used as a culinary herb for thousands of years, and is found in abundance in many Indian dishes, especially curries. But it is its role as a healing herb that has caused scientists to take a closer look at this “miracle spice.”
The magic of turmeric resides in the roots, specifically in the chemical compound called curcumin. Curcumin is a polyphenol – a chemical compound found in plants with antioxidant properties, and myriad therapeutic attributes. In 2007, a study in Advances in Experimental Medicines and Biology, went so far as to state that “Curcumin has been shown to exhibit antioxidant, anti-inflammatory, antiviral, antibacterial, antifungal, and anticancer activities and thus has a potential against various malignant diseases, diabetes, allergies, arthritis, Alzheimer’s disease, and other chronic illnesses.”
#1 – Defense against cognitive decline
A 2008 study in the Annals of Indian Academy of Neurology explored curcumin’s potential for use in the treatment for Alzheimer’s disease (AD). Some of the key points included:

  • Curcumin may help the macrophages, which play an important role in our immune system, to clear the amyloid plaques found in Alzheimer’s disease.
  • Curcumin has anti-proliferative actions on microglia. Microglia are immune cells of the central nervous system that become active in response to any number of stressors on the body. However, if the microglia have been stimulated to react too often they become hyper-reactive, which can trigger system-wide inflammation that can be difficult to stop.
  • Curcumin has powerful antioxidant and anti-inflammatory properties. “Overall, curcumin decreases the main chemical for inflammation and the transcription of inflammatory cytokines… The exposure to curcumin also impaired the production of pro-inflammatory cytokines (IL-1, IL-6 and TNF-).”

As chronic neuro-inflammation is considered one of the major factors in the development of Alzheimer’s, it’s possible too that curcumin may also help in the treatment of other inflammatory disorders.
#2 – Defense against cancer
According to the American Cancer Society, tests have shown that curcumin can kill cancer cells in laboratory dishes, and also slow the growth of the surviving cells. Furthermore, it has been found to reduce the development of several forms of cancer in lab animals, while also shrinking various animal tumors. A 2003 review – Anticancer Potential of Curcumin: Preclinical and Clinical Studies – in Anticancer Research concluded that, “…it is quite apparent that curcumin has tremendous potential for prevention and therapy of various cancers.”
Another study on the role of curcumin in cancer therapy found that, “Research over the last few decades has shown that curcumin is a potent anti-inflammatory agent with strong therapeutic potential against a variety of cancers. Curcumin has been shown to suppress transformation, proliferation, and metastasis of tumors,” and called for additional & larger controlled studies to determine its full potential.
#3 – Treatment of Osteoarthritis
Curcumin’s anti-inflammatory properties also make it a strong candidate for treating inflammatory diseases such as osteoarthritis. A 2017 study in the Journal of Exercise Rehabilitation found that supplementation with a bioavailable form of curcumin “appeared to be effective in reducing the pain and enhancing muscular and balancing function” in patients with knee osteoarthritis.
How should you add curcumin to your diet?

  • Supplementation: Curcumin is not a major component of American diets, so supplementation could be considered. Unfortunately, because curcumin is not easily absorbed in the bloodstream, its bioavailability is diminished. Bioavailability can be increased, however, by partnering the extract with another compound to enhance its absorption. Piperine, a compound found in black pepper, is one such example. At the Kaplan Center, the curcumin supplement* we prescribe is micronized in colloidal particles and as a result has significantly higher plasma concentration of over other leading brands.
     
    Remember, supplements are not regulated by the FDA, so make sure to purchase your supplement from a trusted source. And, speak to your physician before you begin taking any supplement to rule out any possible interactions with other medications.
  • Eat more curry! Eating more curried dishes that are rich in turmeric spice as well as black pepper regularly can be a good source of curcumin.
  • Enjoy a cup of turmeric milk: End your day with a cup of this delicious Golden Turmeric Milk (curcumin is fat-soluble, therefore combining it with milk will help to make the curcumin more readily absorbed into the body).

Although studies on curcumin are still in their early stages, the research looks quite promising, and additional studies to establish its efficacy in humans are ongoing. What we do know is that, with very few side effects, powerful anti-inflammatory, anti-cancer, and antioxidant properties, and a long history of medicinal use, curcumin can play an important role in maintaining the body’s normal inflammatory response, while also supporting healing and relieving pain.
This article first appeared in Dr. Kaplan’s column on US News & World Report.
*Patients of the Kaplan Center can purchase Theracurmin® HP from the Kaplan Medical Center Store.