Categories
Treatment

Supplements for Fibromyalgia that help with Sleep

Written by Sandy Cho, MD and reviewed by Julie A. Cerrato, PhD

These two supplements have shown to help people with Fibromyalgia get a restful night’s sleep.

Melatonin

Melatonin is a natural hormone that is helpful in helping you achieve a good night’s sleep. In those with FMS, one research article points out that melatonin levels are lower at night when sleeping compared to someone who does not have fibromyalgia. Supplementation with melatonin may also help pain in addition to improving the quality of sleep.

  • Start at low doses of 1-2 mg each night before going to sleep each night and increase slowly.

Valerian root

Valerian root is an herb that can help you get a good night’s rest. There have been several studies examining the efficacy of valerian root in the treatment of insomnia. In one review, the authors concluded that while further study was needed, valerian root seemed to able to improve the quality of sleep without experiencing any significant side effects.

Agosti R, Duke RK, Chrubasik JE, Chrubasik S. Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine 2006;13(9-10):743-6.
Dall’Acqua S, Viola G, Giorgetti M, Loi MC, Innocenti G. Two new sesquiterpene lactones from the leaves of Laurus nobilis. Chemical & pharmaceutical bulletin 2006;54 (8): 1187–1189.
Gilmore B, et al. Treatment of acute migraine headache. American Family Physician. 2011;83:271-280.
Hildreth C, Lynm C, Glass R. Migraine Headache. Journal of the American Medical Association. 2009;301(24):2608.
NINDS Migraine information page. National Institute of Neurological Disorders and Stroke
Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998 Feb;50(2):466-70.
Vaughan T. The role of food in the pathogenesis ofmigraine headache. Clin Rev Allergy. 1994;12:167-180.

Categories
Treatment

Supplements for Osteoarthritis that Support Bones and Joints

Written by Sandy Cho, MD and reviewed by Julie A. Cerrato, PhD, AP, CYT, CAP
Many over-the-counter nutritional supplements have been used in the treatment of osteoarthritis.

To ensure safety and avoid drug interactions, consult your doctor or pharmacist before using any of these supplements. This is especially true when you are combining these supplements with prescribed drugs.

Adding the right supplements to your treatment plan is important for providing nutrition to your joints.

Vitamin D

Being deficient in Vitamin D is associated with the development of worsening hip and knee pain. Given that millions of people are deficient in this important vitamin, supplementation is vital. The usual recommended dose is 1000 units of Vitamin D3 taken with food to enhance absorption. Remember that your healthcare provider can measure levels of Vitamin D3 and adjust the amount you need to take.

Vitamin C

Remember that Vitamin C is an antioxidant; in terms of cellular health, because it is an electron donor, it helps to reduce oxidative stress and keep the cells in a reduced or natural state. In one study, it was felt that Vitamin C may have a role in preventing osteoarthritis of the knee.

  • The ester form of Vitamin C is better absorbed than other formulations.
  • Vitamin C at a dose of 2000 mg a day is a good starting dose.

Vitamin K2

Vitamin K2 is very beneficial for bone health. It helps in maintaining the integrity of the bones and joints. It is integral in preventing calcium loss from the bone. It also helps to maintain the health of the blood vessels by preventing calcium influx into the blood. It also is very likely to be helpful in the treatment of osteoarthritis. One study demonstrated that joints that were affected with advanced OA were associated with lower levels of Vitamin K2.

Trace Minerals

Be aware that in addition to Vitamins C, D and Vitamin K2, that trace minerals are also important for bone health. These include Boron, Selenium, Zinc, Manganese, and Magnesium.

As you can see, there are several good supplements out there that are good for bone health.

References

  • Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate, and the two in combination for painful knee osteoarthritis. Drugs Aging. 2007;24:573-580.
  • Cledd DO, Reda DJ et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New England Journal of Medicine. 2006 Feb 23;354(8):795-808.
  • Debbi AM, Agar G et al. Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study. BMC Complementary and Alternative Medicine. 2011 Jun 27;11:50.
  • Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF. Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med. 1988;109:18–24.
  • Googs R, Vaughn-Thomas A et al. Nutraceutical therapies for degenerative joint diseases: a critical review. Critical Reviews in Food Science and Nutrition. 2005;45(3):145-64.
  • Gruenwald J Petzel E et al. “ Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis.” Advances in Therapy. 2009 Sep; 26(9): 858-71.
  • Hochber MC, Clegg DO. Potential effects of chondroitin sulfate on joint swelling: a GAIT report. Osteoarthritis and Cartilage. 2008;16 Suppl 3:S22-4.
  • Ishi Y, Noguchi H et al. Distribution of vitamin K2 in subchondral bone in osteoarthritic knee joints. Knee Surgery, Sports Traumatology and Arthroscopy: 2012 Oct 16. (Electronic Publication)
  • Jager C, Hrenn M et al. “Phytomedicines prepared from Arnica flowers inhibit the transcription factors AP-1 and NF-kappaB and modulate the activity of MMP1 and MMP13 in human and bovine chondrocytes.” Planta Medica. 2009 Oct;75(12):1319-25.
  • Kim LS, Axelrod LJ et al. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osterarthritis and Cartilage. 2006 Mar;14(3):286-94
  • Laslett LL, Quinn S et al. Moderate vitamin D deficiency is associated with changes in knee and hip pain in older adults: a 5-year longitudinal study. Annals of the Rheumatic Diseases. 2013 Apr 17. (Electronic Publication)
  • Lequesne M, Mahey C et al. Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hip. Arthritis and Rheumatism. 2002 Feb;47(1):50-8.
  • Li LC, Lineker S, Cibere J, Crooks VA, Jones CA, Kopec JA, Lear SA, Pencharz J, Rhodes RE, Esdaile JM. Capitalizing on the teachable moment: osteoarthritis physical activity and exercise net for improving physical activity in early knee osteoarthritis. JMIR Res Protoc. 2013 May 9;2(1):e17.
  • Manek N, Lane N. Osteoarthritis: Current Concepts in Diagnosis and Management. Am Fam Physician. 2000 Mar 15;61(6):1795-1804.
  • Maheu C, Cadet C et al. Randomised, controlled trial of avocado-soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study. Annals of the Rheumatic Diseases. 2013 Jan 23. (Electronic Publication)
  • Messier SP, Loeser RF, Miller GD, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004;50:1501-1510.
  • Peregoy J, Wilder FV. The effects of vitamin C supplementation on incident and progressive knee osteoarthritis: a longitudinal study. Public Health Nutrition. 2011 Apr;14(4):709-15.
  • Ross SM. “Osteoarthritis: a proprietary Arnica gel is found to be as effective as ibuprofen gel in osteoarthritis of the hands.” Holistic Nursing Practice. 2008 Jul-Aug;22(4):237-9.
  • Shakibaei M, John T et al. Suppression of NF-kappaB activation by curcumin leads to inhibition of expression of cyclo-oxygenase-2 and matrix metalloproteinase-9 in human articular chondrocytes: Implications for the treatment of osteoarthritis. Biochemical Pharmacology. 2007 May 1;73(9):1434-45.
  • Shehzad A, Ha T et al. New mechanisms and the anti-inflammatory role of curcumin in obesity and obesity-related metabolic diseases. European Journal of Nutrition. 2011 Apr;50(3):151-61.
  • Shen CL, Hong KJ, Kim SW. Effects of ginger (Zingiber officinale Rosc) on decreasing the production of inflammatory mediators in sow osteoarthritic cartilage explants. J Med Food. 2004;6:323-328.
  • Tammareddi K, Morelli V, Reyes M. The Athlete’s Hip and Groin. Prim Care. 2013 Jun;40(2):313-33.
  • Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil’s claw (Harpagophytum procumbens DC.). Phytotherapy Research. 2003 Dec;17(10):1165-72.

Categories
Treatment

Supplements for Osteoarthritis that Reduce Inflammation and Pain

Written by Sandy Cho, MD and reviewed by Julie A. Cerrato, PhD, AP, CYT, CAP

Glucosamine and Chondroitin

A large clinical trial called the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) that examined whether or not Glucosamine/Chondroitin together were effective in treating the pain associated with knee arthritis and if they could be used to treat the structural damage associated with OA was conducted. The authors concluded that these supplements were as effective as NSAIDS in treating pain. They also found that that they provided benefit for those experiencing moderate to severe pain. Another study concluded that chondroitin and glucosamine also helped reduce joint knee swelling. Glucosamine and chondroitin can also reduce total body inflammation, including lowering C-reactive protein levels.

Methylsulfonylmethane (MSM)

The use of this supplement, especially when used in combination with Glucosamine and Chondroitin, has been shown in studies to reduce the pain of osteoarthritis as well as help restore clinical functioning. In one clinical trial, the effects of 3 grams of MSM taken twice a day compared to placebo demonstrated a significant improvement in pain and clinical functioning.

Arnica Montana

Arnica montana may be especially effective for the treatment of knee and hand osteoarthritis. It has been demonstrated for reducing inflammation of the joints. The application of Arnica topically to the hands or knees can be very effective in reducing pain and inflammation.

Avocado-Soybean Unsaponifiable (ASU)

Several clinical studies have demonstrated the efficacy of ASU for the treatment of OA, especially hip OA which can be especially debilitating. In one study, approximately 400 patients were randomized to be given either 300 mg of ASU or placebo and followed over a three-year period. The authors felt that the ASU helped to reduce the joint space narrowing in the hip, meaning that it helped to reduce the degree of structural damage when compared to the placebo group.

Curcumin

The main ingredient of the commonly used spice turmeric, this antioxidant can help reduce the pain and inflammation associated with OA. It helps to reduce inflammation by reducing certain cellular pathways of inflammation, including Nf-KappaB. Another inflammatory pathway that Curcumin can inhibit is the cyclooxygenase enzyme, which is the same enzyme that is inhibited by NSAIDS. Curcumin also has other potential effects including improving heart health and has anti-cancer properties as well.

Antioxidants

The use of antioxidants are important in reducing inflammation and combating the free radical load and oxidative stress that can accompany osteoarthritis. Consider adding a supplement high in antioxidant value to your daily regimen.

Devil’s Claw

This herb has also demonstrated effectiveness for the treatment of OA. In one study examining Devils’ Claw in the treatment of hip and knee OA, the authors noted the effectiveness in reducing pain and improving joint mobility.

Omega 3 fish oil

Supplementation with Omega 3 fish oil can decrease the inflammation and reduce the pain associated with OA. In one study, the use of Omega 3 fish oil and glucosamine together markedly showed a decrease in stiffness and pain compared to those who just received glucosamine.

  • A good anti-inflammatory dose is at least 3-4 grams a day to start and slowly increase to a maximum of 7-8 grams.
  • As this supplement can thin the blood, if you are on any blood thinners, you may wish to start at a lower dose and increase upwards.

Morinda citrifolia (Noni)

This is a tropical plant from East Asia that has been used for many years. It has anti-inflammatory properties and can help in the treatment of pain due to osteoarthritis.

  • Noni can come in capsule or juice form. If you take the juice form, consider beginning at 1 oz twice a day and increase slowly to 4-6 oz a day.
  • Some forms of Noni can have a high potassium content so if you have kidney disease you need to be mindful of this.
  • Extremely high doses of this may have an adverse effect on the liver, although this is controversial. The several ounces a day that we mention here is very low dosage of this supplement.

Boswellia extract

This is an herb that has anti-inflammatory properties, especially in the treatment of arthritis. It can help maintain the structural health of the joint cartilage.

Ginger

Ginger may provide significant pain relief for osteoarthritis. Its effects appear to be attributable to inhibition of the pain pathway involving cyclooxygenase and lipoxygenase. Effective doses range from 170 mg ginger extract 3 times per day to 250 mg 4 times per day.

Note that there are many formulations that combine many of these important supplements that can reduce pain and inflammation. There are also wonderful bone and mineral formulations that can provide the nutrients to the bones that are so desperately needed in OA.

  • Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate, and the two in combination for painful knee osteoarthritis. Drugs Aging. 2007;24:573-580.
  • Cledd DO, Reda DJ et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New England Journal of Medicine. 2006 Feb 23;354(8):795-808.
  • Debbi AM, Agar G et al. Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study. BMC Complementary and Alternative Medicine. 2011 Jun 27;11:50.
  • Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF. Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med. 1988;109:18–24.
  • Googs R, Vaughn-Thomas A et al. Nutraceutical therapies for degenerative joint diseases: a critical review. Critical Reviews in Food Science and Nutrition. 2005;45(3):145-64.
  • Gruenwald J Petzel E et al. “ Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis.” Advances in Therapy. 2009 Sep; 26(9): 858-71.
  • Hochber MC, Clegg DO. Potential effects of chondroitin sulfate on joint swelling: a GAIT report. Osteoarthritis and Cartilage. 2008;16 Suppl 3:S22-4.
  • Ishi Y, Noguchi H et al. Distribution of vitamin K2 in subchondral bone in osteoarthritic knee joints. Knee Surgery, Sports Traumatology and Arthroscopy: 2012 Oct 16. (Electronic Publication)
  • Jager C, Hrenn M et al. “Phytomedicines prepared from Arnica flowers inhibit the transcription factors AP-1 and NF-kappaB and modulate the activity of MMP1 and MMP13 in human and bovine chondrocytes.” Planta Medica. 2009 Oct;75(12):1319-25.
  • Kim LS, Axelrod LJ et al. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osterarthritis and Cartilage. 2006 Mar;14(3):286-94
  • Laslett LL, Quinn S et al. Moderate vitamin D deficiency is associated with changes in knee and hip pain in older adults: a 5-year longitudinal study. Annals of the Rheumatic Diseases. 2013 Apr 17. (Electronic Publication)
  • Lequesne M, Mahey C et al. Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hip. Arthritis and Rheumatism. 2002 Feb;47(1):50-8.
  • Li LC, Lineker S, Cibere J, Crooks VA, Jones CA, Kopec JA, Lear SA, Pencharz J, Rhodes RE, Esdaile JM. Capitalizing on the teachable moment: osteoarthritis physical activity and exercise net for improving physical activity in early knee osteoarthritis. JMIR Res Protoc. 2013 May 9;2(1):e17.
  • Manek N, Lane N. Osteoarthritis: Current Concepts in Diagnosis and Management. Am Fam Physician. 2000 Mar 15;61(6):1795-1804.
  • Maheu C, Cadet C et al. Randomised, controlled trial of avocado-soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study. Annals of the Rheumatic Diseases. 2013 Jan 23. (Electronic Publication)
  • Messier SP, Loeser RF, Miller GD, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004;50:1501-1510.
  • Peregoy J, Wilder FV. The effects of vitamin C supplementation on incident and progressive knee osteoarthritis: a longitudinal study. Public Health Nutrition. 2011 Apr;14(4):709-15.
  • Ross SM. “Osteoarthritis: a proprietary Arnica gel is found to be as effective as ibuprofen gel in osteoarthritis of the hands.” Holistic Nursing Practice. 2008 Jul-Aug;22(4):237-9.
  • Shakibaei M, John T et al. Suppression of NF-kappaB activation by curcumin leads to inhibition of expression of cyclo-oxygenase-2 and matrix metalloproteinase-9 in human articular chondrocytes: Implications for the treatment of osteoarthritis. Biochemical Pharmacology. 2007 May 1;73(9):1434-45.
  • Shehzad A, Ha T et al. New mechanisms and the anti-inflammatory role of curcumin in obesity and obesity-related metabolic diseases. European Journal of Nutrition. 2011 Apr;50(3):151-61.
  • Shen CL, Hong KJ, Kim SW. Effects of ginger (Zingiber officinale Rosc) on decreasing the production of inflammatory mediators in sow osteoarthritic cartilage explants. J Med Food. 2004;6:323-328.
  • Tammareddi K, Morelli V, Reyes M. The Athlete’s Hip and Groin. Prim Care. 2013 Jun;40(2):313-33.
  • Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil’s claw (Harpagophytum procumbens DC.). Phytotherapy Research. 2003 Dec;17(10):1165-72.

Categories
Treatment

Supplements for Fibromyalgia that Relieve Pain and Inflammation

Written by Sandy Cho, MD and reviewed by Julie A. Cerrato, PhD

These three supplements have shown success in helping people with fibromyalgia get relief from the pain and related inflammation.

Bioflavonoids

Good antioxidant support is vital in the treatment of Fibromyalgia. Bioflavonoids are excellent antioxidants that can relieve pain and inflammation. Bioflavonoids that have been studied in the treatment of fibromyalgia include turmeric and quercetin. Quercetin may be especially effective as it has antioxidant, anti-inflammatory and anti-allergenic properties.

    • Turmeric can be taken as a 400 mg capsule daily or as a powder that can be sprinkled on each meal.
    • Quercetin can be taken as a capsule. Usual starting dose is 500 mg a day.

Wobenzym N

This is an enzyme supplement that is used in the treatment of inflammation and pain. Enzymes in this supplement include bromelain (from pineapple) and papain (from papaya).

  • If you have allergies to pineapples or papaya, do not take this supplement.
  • It is best taken on an empty stomach; be aware that you may need to take 6-12 tablets a day for an inflammatory response.

Morinda citrifolia (Noni)

This is a tropical plant from East Asia that has been used for many years. It has anti-inflammatory properties and can help in the treatment of pain.

    • Noni can come in capsule or juice form. If you take the juice form, begin at 1 ounce twice a day and increase slowly to 4-6 oz a day.
    • Some forms of Noni can have a high potassium content so if you have kidney disease you need to be mindful of this.
    • Extremely high doses of this may have an adverse effect on the liver, although this is controversial. The several ounces a day that we mention here is very low dosage of this supplement.
  • Armstrong DJ, Meenagh GK et al. “Vitamin D deficiency is associated with anxiety and depression in fibromyalgia.” Clinical Rheumatology. 2007 Apr;26(4):551-4.
  • Bramwell B, Ferguson S et al. “The use of ascorbigen in the treatment of fibromyalgia patients: a preliminary trial.” Alternative Medicine Reviews. 2000 Oct;5(5):455-62.
  • Bent S, Padula et al. “Valerian for sleep: a systematic review and meta-analysis.” American Journal of Medicine. 2006 Dec;119(12):1005-12.
  • Cordero MD, Cotain D et al. “Oral coenzyme Q10 supplementation improves clinical symptoms and recovers pathologic alterations in blood mononuclear cells in a fibromyalgia patient.”  Nutrition. 2012 Nov-Dec;28(11-12):1200-3.
  • Geenen R, Jacobs W et al. “Evaluation and management of endocrine dysfunction in fibromyalgia.” Rheumatic Diseases Clinics of North America. 2002 May;28(2):389-404.
  • Ki Cha B, Man Jung S et al. “The effect of a multispecies probiotic mixture on the symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial.” Journal of Clinical Gastroenterology. 2012 Mar;46(3):220-7.
  • Lucas HJ, Brauch CM et al. “Fibromyalgia–new concepts of pathogenesis and treatment.” International Journal of Immunopathology and Pharmacology. 2006 Jan-Mar;19(1):5-10.
  • Teitelbaum J, Johnson C et al. “The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study.” Journal of Alternative and Complementary Medicine. 2006 Nov;12(9):857-62.
  • Wikner J, Hirsch U et al. “Fibromyalgia–a syndrome associated with decreased nocturnal melatonin secretion.” Clinical Endocrinology. 1998 Aug;49(2):179-83.
  • Wilhelmsen M, Amirian I et al. “Analgesic effects of melatonin: a review of current evidence from experimental and clinical studies.” Journal of pineal Research. 2011 Oct;51(3):270-7.
  • Younger J, Noor N et al. “Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels.” Arthritis and Rheumatism. 2013 Feb;65(2):529-38.

Categories
Treatment

Biofeedback for Migraines

Written by Sandy Cho, MD and reviewed by Julie A. Cerrato, PhD

Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.

Experts theorize that biofeedback‘s success is related to stress. Many of the ailments it has proven effective for are triggered or worsened by stress so learning to control it is key.

Biofeedback can focus on one or more techniques depending on the issue in question. Electromyography (EMG) biofeedback revolves around muscle tension, temperature or thermal biofeedback measures skin temperature, neurofeedback or electroencephalography records brain wave activity, galvanic skin response training uses the amount of sweat on the skin and heart rate variability biofeedback involves controlling the heart rate.

Sensors are placed on various parts of the body depending on the problem and type of biofeedback. These sensors then give responses from a monitor box in the form of a changing sound, varying brightness or line on a computer screen. The person undergoes a series of mental exercises that affect the feedback.

Biofeedback can be useful at home. A variety of biofeedback options are available with many types of monitors along with audio and/or visual programs.

One of the main benefits of biofeedback is the ability to become more attuned with the body. Many people prefer treatment without using medications while others have found drugs haven’t successfully addressed their problem. Biofeedback can be a viable alternative to explore in these situations.

The Mayo Clinic states, “Biofeedback appeals to people for a variety of reasons:

  • It’s noninvasive.
  • It may reduce or eliminate the need for medications.
  • It may be a treatment alternative for those who can’t tolerate medications.
  • It may be an option when medications haven’t worked well.
  • It may be an alternative to medications for some conditions during pregnancy.
  • It helps people take charge of their health.”

It has shown success in helping a variety of physical ailments including headaches. It has also been useful in emotional issues such as anxiety, stress and depression.

  • May Clinic, Biofeedback: Using your mind to improve your health, http://www.mayoclinic.org/tests-procedures/biofeedback/basics/definition/prc-20020004
  • Gilmore B, et al. Treatment of acute migraine headache. American Family Physician. 2011;83:271-280.
    Hildreth C, Lynm C, Glass R. Migraine Headache. Journal of the American Medical Association. 2009;301(24):2608.
  • The Association for Applied Psychophysiology and Biofeedback, aapb.org
  • National Institutes of Health—Biofeedback, nlm.nih.gov/medlineplus/ency/news-articles/002241.htm

Categories
Treatment

Supplements for Fibromyalgia that Help with Nutrition

Written by Dr. Rich Snyder and reviewed by Julie A. Cerrato, PhD, AP, CYT, CAP

Magnesium, vitamin D and vitamin C supplementation,  have shown helpful to a person with fibromyalgia in balancing their nutrition levels.

Magnesium

The role of low magnesium levels in the body and its importance in inflammation, pain, and fatigue is being researched. In one review article, the authors noted lower levels of zinc and magnesium than in the control groups. Magnesium supplementation is necessary to help counteract the fatigue and pain associated with fibromyalgia. Certain medications, such as diuretics, can lower your magnesium levels. There are several ways to increase your magnesium intake:

  • Increase the amount of leafy green vegetables, seeds (sunflower and sesame for example) and nuts (almonds and Brazil nuts for example) which contain a lot of magnesium. You should strive to at least consume 600-800 mg a day.
  • If needed, magnesium can also be supplemented either orally or in a gel or oil formulation applied directly to the skin. Chelated magnesium is a form of magnesium taken orally without the heavy metals. This can be started once a day and increased to twice a day for a total dose of 400-600 mg. Note that very high doses of magnesium can cause diarrhea. Magnesium Malate is a form of magnesium that is very well absorbed.
  • An alternative is to apply Magnesium gel or oil to your skin once or twice daily. If you have been told that you have kidney problems, you may need to have blood levels of your magnesium level followed and limit your magnesium intake.

Vitamin D

The role of Vitamin D deficiency in the development of fibromyalgia is being evaluated; however, in one research article it was noted that in evaluating over seventy-five patients who had been diagnosed with fibromyalgia, over two-thirds had low or low-normal Vitamin D levels. The authors of this study also noted that occurred very frequently in those patients with depression and anxiety. Don’t forget that Vitamin D supplementation is vital for your overall bone and muscle health.

  • Ask your healthcare provider to measure a Vitamin D level, which is a simple blood test.
  • Begin Vitamin D3 at 1000 Units daily with food. Because it is a fat soluble vitamin, it is better absorbed with food.

Vitamin C

Remember that Vitamin C is an antioxidant; in terms of cellular health, because it is an electron donor, it helps to reduce oxidative stress and keep the cells in a reduced or natural state. We think that supplementation with Vitamin C may be beneficial. In one small study, 12 individuals with fibromyalgia were given a combination of 100 mg of Vitamin C and broccoli powder. They were closely followed over a period of one month. By the end of the month the participants in the trial reported an improved quality of life and reduced sensitivity to pain. Deficiency of this vitamin can directly impact adrenal health, and FMS can cause a lot of stress on the adrenal glands and is strongly associated with the development of adrenal fatigue, which is strongly associated with Fibromyalgia Syndrome.

  • The ester form of Vitamin C is better absorbed than other formulations.
  • Vitamin C at a dose of 2000 mg a day is a good starting dose.
  • Armstrong DJ, Meenagh GK et al. “Vitamin D deficiency is associated with anxiety and depression in fibromyalgia.” Clinical Rheumatology. 2007 Apr;26(4):551-4.
  • Bramwell B, Ferguson S et al. “The use of ascorbigen in the treatment of fibromyalgia patients: a preliminary trial.” Alternative Medicine Reviews. 2000 Oct;5(5):455-62.
  • Bent S, Padula et al. “Valerian for sleep: a systematic review and meta-analysis.” American Journal of Medicine. 2006 Dec;119(12):1005-12.
  • Cordero MD, Cotain D et al. “Oral coenzyme Q10 supplementation improves clinical symptoms and recovers pathologic alterations in blood mononuclear cells in a fibromyalgia patient.”  Nutrition. 2012 Nov-Dec;28(11-12):1200-3.
  • Geenen R, Jacobs W et al. “Evaluation and management of endocrine dysfunction in fibromyalgia.” Rheumatic Diseases Clinics of North America. 2002 May;28(2):389-404.
  • Ki Cha B, Man Jung S et al. “The effect of a multispecies probiotic mixture on the symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial.” Journal of Clinical Gastroenterology. 2012 Mar;46(3):220-7.
  • Lucas HJ, Brauch CM et al. “Fibromyalgia–new concepts of pathogenesis and treatment.” International Journal of Immunopathology and Pharmacology. 2006 Jan-Mar;19(1):5-10.
  • Teitelbaum J, Johnson C et al. “The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study.” Journal of Alternative and Complementary Medicine. 2006 Nov;12(9):857-62.
  • Wikner J, Hirsch U et al. “Fibromyalgia–a syndrome associated with decreased nocturnal melatonin secretion.” Clinical Endocrinology. 1998 Aug;49(2):179-83.
  • Wilhelmsen M, Amirian I et al. “Analgesic effects of melatonin: a review of current evidence from experimental and clinical studies.” Journal of pineal Research. 2011 Oct;51(3):270-7.
  • Younger J, Noor N et al. “Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels.” Arthritis and Rheumatism. 2013 Feb;65(2):529-38.

Categories
Treatment

Supplements for Migraines

Written by Sandy Cho, MD and reviewed by Julie A. Cerrato, PhD

These 5 supplements have shown to benefit migraine sufferers.

Riboflavin

Riboflavin (Vitamin B2) is a water-soluble vitamin, which means it is not stored in the body. Therefore, it needs to be replenished in the body every day. Riboflavin is important for body growth and red blood cell production. It is also required for energy metabolism, such as the metabolism of carbohydrates.

Studies show a deficit of mitochondrial energy metabolism may play a role in migraine pathogenesis. Therefore, riboflavin has been investigated as a treatment and/or prevention for migraine.

Studies have found significant reductions in headache frequency with daily pharmacologic doses (400 mg) of riboflavin.  Furthermore, riboflavin was demonstrated to be a safe and well-tolerated alternative in migraine prevention and treatment. It even reduced the number of abortive anti-migraine tablets (ie. Ergotamines, triptans) used in migraine sufferers.

Magnesium

Magnesium is another important mineral to add to your treatment plan. Magnesium deficiency is a major contributing factor to the development of migraine headaches and many of us are deficient in magnesium.The recommended amount of magnesium is 600-800 mg a day, in divided doses throughout the day. Taking it in this manner maximizes its absorption.While there are many different oral forms of Magnesium, one form that be extremely beneficial for migraine sufferers is Magnesium Threonate. This is because it is able to penetrate the brain unlike other forms of Magnesium.

Ginkgolide B

Ginkgolide B is an herbal extract derived from Ginkgo biloba. It is used not only for the acute attack of migraine headaches but is also extremely beneficial for the prevention of migraine headaches.In one study, patients with a history of migraine with auras when given  the combination of Gingkolide B, Coenzyme Q 10 and Vitamin B2 (riboflavin) demonstrated not only a decrease in the frequency of migraines with aura but also their duration.

Coenzyme Q10

Supplementation with Coq10(Ubiquinone) has demonstrated to decrease the frequency of migraines headaches.Because ubiquinone can have a blood pressure-lowering effect, it is recommended to begin at low doses. Begin at 50 mg twice a day and increase slowly over the next few weeks.

Omega 3 Fish Oil

Adding Omega 3 fish oil can help  in the prevention of migraines, especially in adolescents and young adults. In one study, Omega 3 supplementation decreased the recurrence of migraines in adolescents.Begin at a dose of 1000-2000 mg a day. This can  be slowly increased to 3-4 grams a day. As Omega 3 fish oil can thin the blood, talk with your healthcare practitioner if you are taking blood-thinning medications such as Coumadin.

Seek the advice of a health professional to see if these treatments are right for you.

Agosti R, Duke RK, Chrubasik JE, Chrubasik S. Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine 2006;13(9-10):743-6.
Dall’Acqua S, Viola G, Giorgetti M, Loi MC, Innocenti G. Two new sesquiterpene lactones from the leaves of Laurus nobilis. Chemical & pharmaceutical bulletin 2006;54 (8): 1187–1189.
Gilmore B, et al. Treatment of acute migraine headache. American Family Physician. 2011;83:271-280.
Hildreth C, Lynm C, Glass R. Migraine Headache. Journal of the American Medical Association. 2009;301(24):2608.
NINDS Migraine information page. National Institute of Neurological Disorders and Stroke
Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998 Feb;50(2):466-70.
Vaughan T. The role of food in the pathogenesis ofmigraine headache. Clin Rev Allergy. 1994;12:167-180.

Categories
Treatment

Supplements for Fibromyalgia that Boost Energy

Written by Dr. Rich Snyder and reviewed by Julie A. Cerrato, PhD, AP, CYT, CAP

Two supplements have shown promise in increasing the energy in a person with fibromyalgia.

D-ribose

There are studies concerning fibromyalgia that tout the energy boost of D-ribose. D-ribose increases the energy to all of the cells of the body, especially the muscle cells. Supplementing with D-ribose can provide your heart with the energy boost that it needs.

  • D-ribose commonly comes in capsule or powdered form. The powdered form is preferred as you can add it to your morning drink.
  • Even though ribose is a “sugar” it will not raise blood glucose levels.
  • The recommended starting dose is 2500 mg. Increase by 2500 mg every few weeks to reach a maximum dose of 10,000 mg.
  • Higher doses than 10,000 mg can cause diarrheal symptoms in some people.

Coenzyme Q10 (Ubiquinone)

Replacement of this antioxidant can help improve fibromyalgia symptoms. It has been reported that those with fibromyalgia, as well as other chronic illnesses, can have lower than normal levels of ubiquinone in the body.

  • Begin with low doses at 50-100 mg daily and increase to twice a day after several weeks. Smaller doses taken during the day maximizes its absorption.
  • As ubiquinone can lower blood pressure, you need to closely monitor your blood pressure
  • If you have diabetes, monitor your blood glucose levels as ubiquinone can lower blood glucose levels as well.
  • Armstrong DJ, Meenagh GK et al. “Vitamin D deficiency is associated with anxiety and depression in fibromyalgia.” Clinical Rheumatology. 2007 Apr;26(4):551-4.
  • Bramwell B, Ferguson S et al. “The use of ascorbigen in the treatment of fibromyalgia patients: a preliminary trial.” Alternative Medicine Reviews. 2000 Oct;5(5):455-62.
  • Bent S, Padula et al. “Valerian for sleep: a systematic review and meta-analysis.” American Journal of Medicine. 2006 Dec;119(12):1005-12.
  • Cordero MD, Cotain D et al. “Oral coenzyme Q10 supplementation improves clinical symptoms and recovers pathologic alterations in blood mononuclear cells in a fibromyalgia patient.”  Nutrition. 2012 Nov-Dec;28(11-12):1200-3.
  • Geenen R, Jacobs W et al. “Evaluation and management of endocrine dysfunction in fibromyalgia.” Rheumatic Diseases Clinics of North America. 2002 May;28(2):389-404.
  • Ki Cha B, Man Jung S et al. “The effect of a multispecies probiotic mixture on the symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial.” Journal of Clinical Gastroenterology. 2012 Mar;46(3):220-7.
  • Lucas HJ, Brauch CM et al. “Fibromyalgia–new concepts of pathogenesis and treatment.” International Journal of Immunopathology and Pharmacology. 2006 Jan-Mar;19(1):5-10.
  • Teitelbaum J, Johnson C et al. “The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study.” Journal of Alternative and Complementary Medicine. 2006 Nov;12(9):857-62.
  • Wikner J, Hirsch U et al. “Fibromyalgia–a syndrome associated with decreased nocturnal melatonin secretion.” Clinical Endocrinology. 1998 Aug;49(2):179-83.
  • Wilhelmsen M, Amirian I et al. “Analgesic effects of melatonin: a review of current evidence from experimental and clinical studies.” Journal of pineal Research. 2011 Oct;51(3):270-7.
  • Younger J, Noor N et al. “Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels.” Arthritis and Rheumatism. 2013 Feb;65(2):529-38.

Categories
Treatment

Herbs for Migraines

Written by Sandy Cho, MD and reviewed by Julie A. Cerrato, PhD

Herbs are commonly used to provide relief from migraines. Feverfew and butterbur are remedies for a migraine in either preventing them or reducing their severity. Seek the advice of a health professional to see if these treatments are right for you.

Feverfew

Feverfew is an herb with anti-inflammatory properties. A study shows that feverfew extract of 6.25 mg three times a day decreased migraine attacks by nearly half.

The primary active ingredient in feverfew can be found in some other plants such as artichoke, sunflower, lettuce, spinach, and ginkgo biloba.

Feverfew action appears to affect a wide variety of physiologic pathways. Some of these mechanisms include inhibition of prostaglandin synthesis, decrease of vascular smooth muscle spasm, and blockage of platelet granule secretion.

Feverfew supplements are available fresh, freeze-dried, or dried and can be purchased in capsule, tablet, or liquid extract forms.

Feverfew supplements with clinical studies contain a standardized dose of parthenolide. Feverfew supplements should be standardized to contain at least 0.2% parthenolide. Parthenolide is central to the biological effects of feverfew.

Butterbur

Butter (a.k.a. Petasites hybridus root) is an ancient plant which has been used for medical and edible purposes.

50-75 mg twice a day have demonstrated significant reduction in migraine frequency. The mechanism by which butterbur may reduce migraine includes inhibiting the inflammatory effect of chemicals like leukotrienes and prostaglandin E2 in the pain pathway.

Another mechanism of butterbur may be its ability to function as a natural beta blocker whose action results in the normal flow of blood to the brain. This helps control blood pressure and spasmodic capillary action, which can also contribute to the onset of migraine headaches.

When purchasing butterbur products, be sure to choose a brand labeled PA-Free. This means the product was processed to remove potentially harmful, toxic chemicals found in the butterbur plant known as pyrrolizidine alkaloids (PA). The special butterbur extract is prepared by having all liver-toxic alkaloids removed.

Agosti R, Duke RK, Chrubasik JE, Chrubasik S. Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine 2006;13(9-10):743-6.
Dall’Acqua S, Viola G, Giorgetti M, Loi MC, Innocenti G. Two new sesquiterpene lactones from the leaves of Laurus nobilis. Chemical & pharmaceutical bulletin 2006;54 (8): 1187–1189.
Gilmore B, et al. Treatment of acute migraine headache. American Family Physician. 2011;83:271-280.
Hildreth C, Lynm C, Glass R. Migraine Headache. Journal of the American Medical Association. 2009;301(24):2608.
NINDS Migraine information page. National Institute of Neurological Disorders and Stroke
Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology. 1998 Feb;50(2):466-70.
Vaughan T. The role of food in the pathogenesis ofmigraine headache. Clin Rev Allergy. 1994;12:167-180.

Categories
Treatment

Vitamins C, D and K2 for Osteoarthritis

Reviewed by Dr Jeffrey Lederman, DO

Osteoarthritis, the most common form of arthritis, is the breakdown of the cartilage tissue that cushions the ends of the bones between the joints to prevent the bones from rubbing against each other. When the cartilage breaks down, bone ends make direct contact, which can result in bone spurs, abnormal bone hardening, inflammation and pain. Bones can become more brittle and fracture more easily.

Osteoarthritis is often called “wear and tear” arthritis because its onset is usually gradual, over the course of many years, and often due to an unhealthy aging process, such as a poor, high-inflammatory diet, obesity and intensive, repetitive motions from manual labor or certain athletic activities. Osteoarthritis also can occur as a result of trauma or injury.

Vitamins C, D and K2 could help prevent osteoarthritis or mitigate its effects.

Vitamin C helps develop, protect and repair the body tissue, and as a result, may help prevent or reduce the severity of osteoarthritis.

Vitamin C helps the body make collagen, which is part of the cartilage tissue that cushions the ends of the bones between the joints. Without enough Vitamin C, the body cannot properly repair and maintain the collagen tissue, which may lead to the breakdown of cartilage in osteoarthritis.

Vitamin C also is an antioxidant that helps protect the body’s cells from free radicals, which are highly reactive, destructive molecules that cause inflammation and that can damage body tissues including cartilage. Protecting the body’s cells from free radicals may also defend it against osteoarthritis.

Foods high in Vitamin C include oranges, lemons, chili peppers, dark leafy green vegetables like kale and spinach, and herbs like parsley and thyme.

Vitamin D and Vitamin K2 work together to maintain bone health, which is important in warding off osteoarthritis. Vitamin D promotes bone strength because it helps the body absorb calcium. Vitamin K2 helps direct the calcium to the bones and helps prevent calcium loss from the bones. Vitamin K2 helps direct calcium to where the body needs it – the skeleton – and helps prevent the calcium from being deposited where the body doesn’t want it, such as into the blood and arteries.

Sources of Vitamin D include sunlight, mushrooms, salmon, tuna, mackerel and fish liver oils. Vitamin K2 is found in sauerkraut, fermented cheeses, dairy foods like grass fed butter and organ meats.

Written by Jessica Braun
Jessica is a writer and an editor at WholesomeOne. She can be reached at jessica.braun[at]wholesomeone[dot]com.

References

  • WholesomeOne.com
  • Alternative Medicine, the Definitive Guide
  • Holistic Anatomy
  • Photo credit: flickr.com/photos/drb62/480699341

Categories
Treatment

Simple Lavender Oil Treatments for Eczema

If you suffer from eczema and are sick of taking medication that only provides short-lived relief, lavender oil may be a new option for you. As an alternative to conventional treatments that merely suppress symptoms, lavender oil can be used as an all-around restorative agent.

The oil’s antiseptic, antibacterial, and anti-fungal properties benefit mild cases of eczema (atopic dermatitis), as well as create a sense of stability for balanced skin. Lavender oil has been valued for hundreds of years as a natural remedy for skin conditions, as it brings circulation to skin cells that suffer from irritants and stress. It is especially rich in aromatic molecules called esters, which are antispasmodic, tonic, and pacifying. Its cicatrizant properties, which assist restoration through formation of scar tissue, help heal all kinds of wounds and burns. It is a powerful anti-inflammatory for the skin and was even used as an antibacterial in hospitals during World War I.

Lavender oil is effective at soothing eczema and the variety of symptoms that accompany it. While the most common sign of eczema is an itchy rash, eczema sufferers also exhibit bumps, blisters, redness, scaling, and abnormal pigmentation. Doctors usually treat these symptoms with prescription creams that contain steroids and antibiotics. They also recommend antihistamines, immunosuppressants, hydrocortisone, immunomodulators, prescription-strength moisturizers, corticocosteroids, and ultraviolet light therapy to patients who need more support.

While pharmaceutical treatments are helpful, they only suppress symptoms and do not heal the root of the problem. As a result, patients tend to rely on medication for symptom alleviation.

Lavender oil can provide a broader spectrum of relief to eczema sufferers. Unlike the common antibiotic and steroid creams that can be addictive for people with eczema, lavender oil addresses the skin from the inside out. Lavender oil gently eases irritation, works to promote a healthy balance of nutrients on the skin, and acts as an effective stress-reducer. This powerful healing property of lavender oil is due to the aromatic compounds that enter into the bloodstream and travel to the limbic system, the part of the brain that is often called “the emotional brain.” Lavender oil’s treatment of stress is especially vital as stress is one of the primary causes of eczema skin flare-ups.

For a simple eczema treatment, make a homemade spray following three simple steps.

  1. Add 10 drops of essential oil to one cup of water (distilled or tap water work fine).
  2. Pour the mixture into a spray bottle and close tightly.
  3. Shake well and spray on affected areas.

Or make lotion supplemented with lavender oil.

  1. Buy a fragrance free lotion containing Shea butter or vitamin E (Burt’s Bees Fragrance Free Shea Butter & Vitamin E Body Lotion works well).
  2. Add 10-15 drops of lavender oil to the container.
  3. Mix well with a spoon.
  4. Rub lotion into the skin gently.

In addition, you can also make a vegetable oil-based treatment.

  1. Purchase a nut or vegetable oil (coconut or sesame oil, for example) to use as a base.
  2. Add 15-20 drops of lavender oil to the container.
  3. Shake well and use the mixture topically on eczema when needed.

While you could also apply pure essential oil in ‘neat form’ directly to small affected areas without dilution, this may be too harsh for skin due to the oil’s strength and purity. Start with one of the techniques that combines lavender oil with a water or oil-based substance, and see how skin reacts from there.

Keep in mind, too, that lavender oil should be avoided for people who are pregnant, have epilepsy, or a fever. Some essential oils contain miniscule amounts of neurotoxins, which may have a convulsant effect. Because essential oils are potent and highly concentrated, they can have a significant impact on a system prone to sensitivity. As always, be sure to consult your physician before use.

Lavender oil’s multifaceted healing properties—whether antispasmodic, antibacterial, or anti-fungal—can be used to supplement existing eczema treatments. Lavender oil allows skin to restore, renew, and heal in a natural and gradual way.

[themedy_toggle icon=”” heading=”References” onload=”closed”]

Written by Nicole Kagan

  • Lavender uses. (n.d.). Retrieved from www.netherfield.co.nz/lavender-uses.php
  • The Franklin Institute Resources for Science Learning (2004). The Human Brain-Stress. www.fi.edu/learn/brain/stress.html

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Categories
Treatment

Yoga for Fibromyalgia

Fibromyalgia is a syndrome that involves widespread muscle pain that appears to be a result of the tightening and thickening of the myofascia, which is the thin tissue that holds the muscles together. Symptoms of fibromyalgia include fatigue, muscle and joint pain, trouble sleeping, and digestive problems. One way to holistically manage fibromyalgia is with yoga.

Yoga is one of the oldest known health practices in the world. It teaches mind and body unity through physical postures, breathing exercises and meditation to help reduce stress, lower blood pressure, regulate the heart rate and even slow the aging process.

A main symptom of fibromyalgia is chronic muscle pain and tightness. Yoga increases muscle endurance and flexibility through simple poses and focused breathing that gently stretch the muscles and create a condition of ease throughout the body.

While yoga may involve little movement, the mind is connected to every pose, which provides discipline, awareness and a relaxed openness, all of which help regulate functions like the heartbeat and the breath. Physical tensions in the body, such as the pain and tightness of fibromyalgia, then ease into a state of relaxation.

Fibromyalgia also can cause fatigue and trouble sleeping. As yoga’s gentle stretching and focused breathing help soothe the pain of tight muscles and create a sense of calm throughout the body, it becomes easier to sleep more soundly. This solid night’s sleep leads to more energy and less fatigue.

People who have fibromyalgia might experience feelings of anxiousness or depression and decreased energy. Yoga helps create a heightened sense of peace and awareness, which may help reduce stress and tension, both physically and emotionally. Yoga breathing practices help get rid of any choppiness in the breath and promote a smoothly flowing breath. The smooth breath results in the smooth flow of thoughts, which calm the restlessness of the mind and create clarity, improved focus and more energy.

Tension or migraine headaches are another symptom of fibromyalgia. Yoga helps ease headache pain because yoga promotes vascular and muscle relaxation. Simple yoga breathing practices such as slow, deep breathing for as little as five minutes can trigger a relaxation response in the muscles throughout the body.

Janet McKenzie, Naturopathic Doctor of Summit Natural Health Centre adds, “Yoga is a fantastic treatment for those with fibromyalgia because it addresses all the areas fibromyalgia impacts: body, mind and spirit.  Because yoga can easily be adapted to a person’s limitations, it is particularly well-suited for those whose pain or fatigue prevents them from engaging in more strenuous activities, while still allowing progress to more physically demanding routines over time.  If you could only use one natural treatment for your fibromyalgia, this would be the one to choose.”

A regular yoga practice can help people with fibromyalgia gain muscle flexibility, feel less pain and tightness, achieve greater focus, gain energy, sleep more soundly and more. The emotional, physical and psychological benefits of engaging in a regular yoga practice are worth exploring for fibromyalgia relief and beyond.

 

REFERENCES

Reviewed by Janet McKenzie, ND

Written by Jessica Braun
Jessica is a writer and an editor at WholesomeONE. She can be reached at jessica.braun[at]wholesomeone[dot]com.

  • Alternative Medicine, the Definitive Guide
  • Photo credit: flickr.com/photos/grandvelasrivieramaya/3179397829

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