Bacteria can synthesize a variety of biopolymer products from basic building blocks, such as polysaccharides from sugars, protein chains from amino acids, or other organic chains like polyamides, polyesters, or polyphosphates.
In nature, the synthesis of biopolymers allows bacterial colonies to generate protective biofilms that enable sharing resources deep into the otherwise nutrient-poor center, making infection notably more persistent. However, bacterial biopolymers possess several intriguing properties with useful applications in biomedicine, and to this end, biopolymer factories featuring bacteria engineered to optimize production are increasingly utilized in the pharmaceutical industry.
Importantly, bacteria are adapted to generate biofilm under conditions specific to the strain, allowing bacteria in biopolymer factories to be manipulated into production. For example, some bacteria produce biofilms better in high-shear environments, as found within blood vessels, while others prefer stagnant conditions.
Polysaccharides
Polysaccharides are produced by a diverse range of bacteria that either store them inside the cell or secrete them to contribute to the biofilm. Many pathogenic bacterial strains demonstrate a switch to a sessile lifestyle upon incorporation into the biofilm matrix, which protects the bacteria from phagocytotic cells during infection and promotes a chronic condition.
Polysaccharides provide a physical barrier to phagocytotic cells beyond the physical structure of the molecule itself; for example, Pseudomonas aeruginosa incorporates alginate within its biofilm, which strongly absorbs water to provide a greater physical impediment. These biopolymers have applications as biocompatible hydrogels and other types of films, which are used to enhance the bioavailability of poorly soluble drugs or for other specific drug delivery applications. Besides several commercial cosmetic applications, they may also be used as wound dressings and surgical implants.
Bacteria also incorporate chemical components of defense into the biofilm, which is why human pathogenic bacteria are of great interest in biomedical polymers. For example, Streptococcus pyogenes produce a linear negatively charged heteropolysaccharide with a similar structure to human hyaluronate, while Neisseria meningitides produces a polysaccharide containing sialic acid, both of which mask the invading bacteria from human host phagocytotic cells. Polysaccharides are difficult to manufacture synthetically with such high molecular weight, and production by bacteria is currently the only way to obtain many in reasonable quantity. Hyaluronate is already commercially available for arthritis pain management, produced by Streptococcus zooepidemicus.
Polyamides, polyesters, and polyphosphates
Polyamides also possess many potential applications as biocompatible surgical implants or wound dressings, as in nature, they are generally incorporated into the biofilm to aid in immune avoidance. Polyamides originating from bacteria are also used in place of chemically synthesized polymers as a biodegradable and renewable alternative. Polyesters similarly have applications in industry in replacing oil-based manufacturing of polymers, generally being more rigid structures.
With regards to biomedicine, polyesters originating from bacteria have been used as biocompatible delivery platforms for drugs and functional biomolecules such as enzymes. Interestingly, engineered bacteria have been able to produce polyesters already coated with the protein of interest, unlocking almost unlimited applications in immunodiagnostics, vaccine production, protein therapy, recombinant protein manufacture, and more.
Bacteria generate polyphosphates as a form of energy storage that can be utilized by several metabolic processes within cells and may be stored internally or contribute to the biofilm to provide nutrients to neighboring cells. They interact strongly with positively charged species, including inorganic ions such as Fe2+ and K+, and thus have intriguing applications in heavy metal removal from the environment and during industrial processes. This property may be used in biomedical applications such as bone re-mineralization if incorporated into a hydrogel containing Ca2+ or as a component of nanomaterials and surgical polymers for strengthening or chelating purposes.
Polyphosphates also play diverse roles in fundamental cellular processes such as motility and gene expression, having evolved to fulfill numerous roles, and thus polyphosphates originating from specific strains of bacteria may have particular applications outside of general use.
Functional biomolecules
Some bacteria secrete DNA into the biofilm, where its strongly negative charge can provide stability and promote cellular adhesion, also acting as a nutrient source and fulfilling signaling functionality in some cases. DNA has been widely explored as a component of biomedicines with numerous applications, and thus mass production of a specified strand from bacterial culture is highly advantageous to research and clinical use. DNA is a useful linker for nanomaterials, providing a tunable, biocompatible, and severable tether upon which drugs or functional biomolecules can be grafted.
Further, DNA itself may be used as a therapeutic if it can be delivered into the target cell, correcting or promoting proper cell function. Similarly, proteins are biopolymers constructed of amino acid monomers in highly specific order and orientation with the aid of cellular machinery that has many applications in the clinic and biomedical research. Bacteria have been engineered to produce a wide variety of functional recombinant proteins that are regularly used in biomedical research and the clinic.
High blood sugar is one of the root causes that can lead to several health issues and impact organs. It’s important to holistically manage diabetes and practising yoga asanas regularly can be very helpful. Here are 5 asanas that are particularly beneficial for people with diabetes.
If the body has too little insulin or if it can’t use insulin properly, it leads to high blood sugar or diabetes
Yoga asanas can help those with diabetes to maintain their blood glucose levels and lead a healthy life
Experts suggest to practise these asanas regularly but one should check with medical experts before starting a new exercise regime
Diabetes occurs when glucose or sugar levels in the blood remain elevated. The food we eat gives us glucose and the insulin hormone helps transport this glucose into our cells so they can get energy from it. If the body has too little insulin or if it can’t use insulin properly, it leads to high blood sugar or diabetes.
Apart from your diet and medicines, practising yoga can go a long way in managing your diabetes. Himalayan Siddhaa Akshar, founder, Akshar Yoga Institutions, Himalaya Yoga Ashrama, World Yoga Organisation, shares, “Yoga asanas stretch the internal organs with a range of twisting poses. As a result, blood flow increases and the organs receive more oxygen, which enhances their functionality. The endocrine system performs better as a result.”
High Blood Sugar: Here are some Yoga Asanas to practise if you have diabetes
Yoga expert Himalayan Siddhaa Akshar lists the following Yoga asanas for diabetes:
1) Marjariasana (Cat-Cow Pose)
Urdhva Mukhi Marjari Asana
Kneel down with your knees under your hips and your palms under your shoulders. Breathe deeply, arch your back, and look upward.
Adho Mukhi Marjari Asana
Breathe out, arch your back, and tuck your chin into your chest. Fix your attention on your navel.
2) Paschimottanasana (Seated Forward Bend)
The first thing to do is to extend your legs forward. When doing this, make sure your knees are slightly bent. Lift your arms up while maintaining a straight spine. Start bending forward at the hips as you exhale, placing your upper body on your lower body. Put your fingertips everywhere you can reach, such as your big toes.
Word of caution: Practitioners who are pregnant, have sliding discs, suffer from sciatica, have asthma, or have an ulcer shouldn’t perform Paschimottanasana.
3) Ado Mukha Svanasana (Downward Dog)
Begin by getting down on all fours and placing your knees underneath your hips and your palms beneath your shoulders. Extend the elbows and knees while raising the hips. Apply pressure to your palms while opening your shoulder blades. Try to plant your heels firmly on the ground. Keep your focus on your big toes.
Word of caution: Avoid doing this position if you have diarrhoea or carpal tunnel syndrome. Avoid holding this position if you are pregnant or close to becoming pregnant. Avoid this asana if you move slowly, have high blood pressure, have a headache, or have a recent or persistent arm, hip, shoulder, or back injury.
4) Balasana (Child’s Pose)
Kneel on the mat while sitting upright on your heels. Exhale while bringing your arms up above your head and bending your upper body forward. Put your forehead on the ground while supporting your pelvis on your heels. Ensure that your back is not arched.
5) Mandukasana (Frog Pose)
As you sit in Vajrasana, extend your arms in front of you. As you ball your fist, your remaining four fingers should be positioned above your thumbs. Bend your arms at the elbows and put your balled-up fists over your navel. You should have your upper body bowed and above your bottom body. Looking forward while extending your neck.
Word of caution: Pregnant ladies should avoid performing this pose. If a person has ankle pain or injury or has just undergone ligament surgery, they should avoid this position. If one has ulcer issues, this stance must be avoided. If you have knee or back issues, kindly refrain from performing this pose.
Hold each position for three sets of 30 seconds. Practise each of these positions deliberately, take your time, and focus on your breathing while you hold each one.
Moringa leaves offer a host of health benefits. Find out all about it and see how to add the leaves to your diet
Moringa leaves are a rich source of the antioxidant molecule quercetin.
Highlights
Moringa has become more and more popular in the everyday diet.
It is loaded with essential nutrients and vitamins.
Did you know it could help in lowering blood pressure too?
Moringa is derived from the moringa oleifera plant, which is often called the drumstick tree, horseradish tree, or miracle tree. Moringa has become more and more popular in the everyday diet. It is also called survival food since it is loaded with all the nutritional elements such as protein, calcium, iron, 8 of the 9 essential amino acids, Vitamin C, Vitamin A and minerals. Nutritionist Lovneet Batra has been a strong advocate of “eat your greens.” Her “food fact” series focuses on highlighting the key components as well as the health benefits of the various underrated food items. The green in focus today is moringa leaves.
The moringa leaves are a rich source of the antioxidant molecule quercetin, which assists in lowering blood pressure. As per the nutritionist, quercetin acts by conferring anti-inflammatory properties to blood vessels – arteries, veins, and capillaries. It prevents them “from narrowing or widening and decreasing any signs of low BP or high BP,” she added.
Moringa leaves are good for digestion, they also improve sleep and promote healthy skin. Apart from being a powerhouse of antioxidants, they are good for heart health too. Although it is better to eat fresh moringa leaves, Lovneet Batra shared an effective way to consume them which will also ensure that nutrients are absorbed effectively. All you have to do is soak the moringa leaves in water and drink it. Take a look:
Here Are 3 Ways To Incorporate Moringa Leaves Into The Diet:
1. Moringa Tea
Moringa leaves are low-fat and nutrient-dense which makes them an excellent replacement for high-calorie foods. To prepare moringa tea, boil some moringa leaves in water, strain and drink.
2. Murungai Podi
Podi is a dry South Indian masala that is usually served with dosa, idli, vada and more. Today, we have a similar recipe, but with ten times the health benefits with a moringa touch. Mururngai Keerai Podi, which translates to drumstick leaves podi is a lip-smacking dish you cannot afford to miss.
3. Smoothies
Owing to moringa’s nutritional value, adding these leaves to smoothies is a delicious way of consuming them.
Mindfulness is an important part of yoga practice and has been linked to many health benefits.
The popularity of yoga has grown tremendously in the past decade. More than 10 percent of U.S. adults have practiced yoga at some point in their lives. Yoga practitioners spend on average $90 a month, and the yoga industry is worth more than $80 billion worldwide.
Yoga is now a mainstream activity in the U.S. and is commonly portrayed as a healthy lifestyle choice. I am a behavioral scientist who researches how physical activity—and specifically yoga—can prevent and help manage chronic diseases.
Many people attribute improvements in their physical and mental health to their yoga practice. But until recently, research had been sparse on the health benefits of yoga. As the body of rigorous research on yoga grows, more and more work is showing the many health benefits of a yoga practice.
What Is Yoga?
The name “yoga” is derived from the Sanskrit word “Yuj” meaning to unite, join or connect the mind, body, and soul. The first text on yoga was written by the sage Patanjali over 2,000 years ago in India. Patanjali described yoga as “citta-vrtti-nirodhah,” or “stilling the mind.” This was achieved through a mix of breath work, meditation, physical movement, and body purification practices, as well as ethical and moral codes for living a healthy and purposeful life.
Over the years, various yoga teachers have modified the original Patanjali yoga, resulting in different styles that vary in their intensity and focus. For example, some yoga styles such as Vinyasa focus more on intense movements similar to an aerobic workout. Restorative yoga includes more relaxation poses. Iyengar yoga uses props and emphasizes precision and proper alignment of body. These different styles provide options for individuals with different physical abilities.
Generally speaking, yoga instructors in the U.S. today teach styles that incorporate postures, breathing exercises, and sometimes meditation.
As yoga has grown in popularity in recent years, researchers have begun to study its effects and are finding that it has great benefit for mental and physical health.
Yoga involves physical movement, so it is no surprise that most types of yoga can help to improve a person’s strength and flexibility. In one study with healthy untrained volunteers, researchers found that eight weeks of yoga improved muscular strength at the elbow and knee by 10 to 30 percent. Flexibility at the ankle, shoulder, and hip joints also increased by 13 to 188 percent.
Yoga also provides many benefits for mental health. Researchers have found that a regular practice over eight to 12 weeks can lead to moderate reductions in anxiety and depressive symptoms as well as help with stress management.
Yoga mixes physical exercise with meditation and breathing techniques.
More Than Physical Exercise
Yoga is a type of exercise in that it is a form of physical exertion that helps build fitness. A lot of the benefits researchers have found are due to the physical activity component and are similar to benefits from other forms of exercise like running, weightlifting, or calisthenics.
But unlike these other activities, yoga practice incorporates mindfulness as a key aspect. With its focus on controlling breath, holding postures, and meditation, yoga increases how much a person pays attention to the sensations of their body and the present moment. This mindfulness leads to many benefits not found from other forms of exercise.
Studies have shown that mindfulness training on its own can increase a person’s self-awareness, along with the ability to recognize and skillfully respond to emotional stress. It can even give a person greater control over long-term behavior. One study found that increased mindfulness from yoga can help people better recognize and respond to feelings of being full when eating, decrease binge eating, and alleviate concerns over how their body looks.
My colleagues and I observed a similar effect in a pilot study on the benefits of yoga for individuals with Type 2 diabetes. After doing yoga twice a week for three months, several participants reported paying more attention to their diet, snacking less, and eating healthier, even without any nutrition intervention. Our patients also reported less stress and an increased willingness to engage in other types of physical activities.
Yoga is clearly different from Western exercise in how it approaches mental health. With more research, it may be possible to understand the biological mechanisms as well.
Things to Know If You Want to Start Doing Yoga
Yoga may not be helpful for all medical conditions or right for every person, but people of all age groups, body types, and physical abilities can practice yoga. It can be a form of mental and physical exercise for people who do not enjoy sweating during strenuous forms of exercise or for individuals with medical or physical conditions who find working out in the gym challenging.
It is important to consider that although yoga is generally safe, just as with any other form of exercise, there is some risk of getting injured. Individuals with medical conditions who are new to yoga should practice it initially under the supervision of a trained instructor.
If you do decide to give yoga a try, talk to the yoga instructor first to assess whether the style they offer meets your preference and fitness levels. Remember, you may need to practice a couple of weeks to feel the benefits, physically and mentally.
For men who undergo radiotherapy for localized prostate cancer, the precise targeting capabilities of MRI guidance resulted in fewer toxicities and better quality of life, as judged by patients and the doctors treating them, according to new research from UCLA Jonsson Comprehensive Cancer Center.
Results from the first randomized phase III clinical trial to directly compare MRI-guided stereotactic body radiotherapy (SBRT) with the same therapy guided by CT are published in JAMA Oncology. They confirm interim findings presented at the 2022 ASCO Genitourinary (GU) Cancers Symposium in San Francisco.
“MRI guidance offers several advantages over standard CT guidance, most notably the ability to dramatically reduce planning margins, providing more focused treatment with less injury to nearby normal tissues and organs,” said Amar Kishan, M.D., a radiation oncologist at the David Geffen School of Medicine at UCLA and the UCLA Jonsson Comprehensive Cancer Center and the study’s lead author. “MRI technology is more costly than CT, both in terms of upfront equipment expenses and longer treatment times, which is one reason our study set out to determine if MRI-guided technology offers tangible benefits for patients.”
Stereotactic body radiotherapy for prostate cancer usually delivers radiation in five or fewer precisely targeted doses. It is an established and generally well tolerated form of treatment, but it can cause toxicities resulting in urinary, bowel and sexual dysfunction. This clinical trial, Magnetic Resonance Imaging-Guided Stereotactic Body Radiotherapy for Prostate Cancer (MIRAGE), was led at UCLA and included 154 analyzable patients with prostate cancer who were randomized to either a CT-guidance arm (76 patients) or an MRI-guidance arm (78 patients).
A unique aspect of the study was its inclusion of outcome measures assessed by patients as well as physicians. From both perspectives, MRI-guided therapy was associated with fewer side effects and better quality of life over at least three months of follow-up.
“In this trial, we demonstrated that the reduction in treatment volumes facilitated by MRI guidance leads to a significant reduction in moderate physician-scored toxicity and to a reduction in the proportion of patients noting significant decrements in patient-reported outcome metrics in the near term,” said Dr. Kishan. “Although additional studies will need to confirm these benefits over time, we’re hopeful that these results will lead to better outcomes for men with prostate cancer.”
The 2-millimeter margin used with MRI-guidance in the trial is narrower than has been used in any previous large study. Unlike CT, MRI technology can monitor prostate motion directly, and it offers improved soft tissue contrast, improving the accuracy of alignment prior to radiation.
Researchers were surprised to find pre-surgery immunotherapy for a common type of colorectal cancer was even more effective at early- and mid-stages than the already-proven high rate of success in metastatic disease.
PLYMOUTH MEETING, PA [January 11, 2023] — New research in the January 2023 issue of JNCCN—Journal of the National Comprehensive Cancer Network finds that immunotherapy from immune checkpoint (PD-1) inhibitors prior to surgery was strikingly effective for patients with localized mismatch repair-deficient or microsatellite instability-high (dMMR/MSI-H) colorectal cancer (CRC). Nearly all of the patients studied benefitted from neoadjuvant PD-1 inhibitors, with 1-of-4 experiencing complete response on clinical assessment. In addition to the short-term effectiveness, the findings showed substantial longer survival benefits from neodjuvant PD-1 inhibitors, including a low recurrence rate when compared with historic rates.
The researchers—who are based in Southern China—anticipated PD-1 inhibitors could be at least as effective for locally-advancedbut operable cancer as they have historically been in the treatment of metastatic dMMR/MSI-H CRC, but were surprised to find it so much more effective for this patient population. The study included a retrospective review of 73 patients between ages 18 and 75 with confirmed dMMR/MSI-H CRC who received any type of PD-1 inhibitor prior to surgery between October 1, 2017 and December 31, 2021. Of those 73, 48 were diagnosed with colon cancer, 18 with rectal cancer, and 7 with multiple types of CRC. 84.9% overall experienced an objective response, with 23.3% showing complete response and 61.6% partial response. The 2-year rates for tumor-specific overall survival and disease-free survival were 100% for patients who underwent surgery after PD-1 blockade.
“We need to keep in mind that our final goal is to cure patients long term, not just remove the tumor at the moment,” said senior author Pei-Rong Ding, MD, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine. “I think care providers, especially surgeons, should refrain from scheduling immediate surgery for patients with locally advanced, or even early-stage dMMR/MSI-H colorectal cancer. With such a powerful option at hand, we have the duty to offer a safer surgery with better outcomes or a non-surgical-yet-equally-effective approach for this group of patients, especially for those who might suffer from function damage or organ sacrifice after surgery.”
The study had an average follow-up time of 17.2 months, with 16 patients tracked for more than two years. The researchers call for more studies with an even longer follow-up to confirm these results, especially after treatment ends. There is also more to learn about the long-term safety of this approach and possible implications for limiting or avoiding surgery entirely.
“The treatment of mismatch repair deficient locally-advanced colorectal cancer is a highly active area of research,” commented Dustin A. Deming, MD, University of Wisconsin Carbone Cancer Center, Member of the NCCN Guidelines® Panel for Colon/Rectal/Anal Cancers, who was not involved in this study. “This retrospective analysis highlights the potential for significant treatment responses with limited toxicities for these patients treated with immune checkpoint inhibitors. It will be exciting to see how these results, and other completed and on-going studies, will be utilized to incorporate anti-PD1 treatments into the standard-of-care for locally-advanced colorectal cancers.”
A Mediterranean diet lowers cancer risk and may boost immunotherapy treatment.
The Mediterranean Diet was picked as the best diet overall for 2023, according to new rankings released by US News & World Report.6
The Mediterranean diet consistently has been linked to a lower risk of cancer, cardiovascular disease and mortality. A traditional Mediterranean diet is rich in fish, olive oil, vegetables, whole grains, nuts, and legumes and lower in red meat and dairy with modest alcohol consumption. Studies suggest that adherence to this diet can both reduce an individuals risk of developing cancer and delay the progression of cancer in those with a cancer diagnosis.
Diet Reduces Risk of Prostate Cancer Progression
A study by doctors from the University of Texas suggests that men with early-stage prostate cancer adhering to the Mediterranean diet can reduce their risk of cancer progression to a higher grade. The delay in prostate cancer progression was observed in both Caucasian and “non-white” men which is especially promising for Black men, who have a higher rate of prostate cancer diagnosis and age-adjusted prostate cancer mortality rates than white men.3,4
Reducing Risk of Developing Cancer
Research also suggests that postmenopausal women who consume a traditional Mediterranean diet may have a lower risk for breast cancer, according to a study published in the American Journal of Clinical Nutrition.1
Researchers followed approximately 15,000 women in Greece for almost 10 years. Participants’ diets were assessed by questionnaire, and a score ranging from 0 to 9 was given based on the extent to which the women followed a traditional Mediterranean diet. A higher score indicated greater adherence to the diet. During this time, 240 women were diagnosed with breast cancer.
Postmenopausal women with greater adherence to the diet (a score between 6 and 9) had a reduced risk of breast cancer of 22%.
Among premenopausal women, greater adherence to the diet was not associated with a lower risk for breast cancer.
The researchers concluded postmenopausal women who follow a traditional Mediterranean diet may have a decreased risk of breast cancer. There is a lower incidence of breast cancer in Mediterranean countries, which may be partially explained by the traditional diet.
Mediterranean Diet May Improve Response to Immunotherapy
Immune Checkpoint Inhibitors (ICIs) drugs are a standard treatment for melanoma and other cancers. They work by blocking immune system checkpoints, which then force the body’s own T-cells to attack their cancer. A multi-centre study by researchers from the UK and the Netherlands, recorded the dietary intake of 91 patients with advanced melanoma, who were treated with ICI drugs. The researchers found and improved overall response to treatment and delayed cancer progression at 12 months in individuals on the Mediterranean diet. The study also found that eating whole grains and legumes reduced the likelihood of developing drug induced immune-related side effects, such as colitis. In contrast, red and processed meat was associated with a higher probability of immune-related side effects. The study underlines the importance of dietary assessment in cancer patients starting ICI treatment and supports a role for dietary strategies to improve patient outcomes and survival.5
Healthy Diet and Lifestyle Reduces Risk of Pancreatic Cancer
According to the results of a study published in the Archives of Internal Medicine, individuals with the healthiest lifestyles cut their risk of pancreatic cancer by more than half.2
The causes of pancreatic cancer remain uncertain. Factors that increase the risk of developing pancreatic cancer include cigarette smoking, increasing age, certain dietary characteristics, obesity, diabetes, and chronic pancreatitis.
To explore how combinations of healthy or unhealthy behaviors influence pancreatic cancer risk, researchers evaluated information from 450,416 participants in the National Institutes of Health-AARP Diet and Health Study. Study participants were between the ages of 50 and 71 at the time of study enrollment in 1995-1996. From the time of enrollment through 2003, 1,057 of the study participants were diagnosed with pancreatic cancer.
For the current analysis, study participants were graded on five positive lifestyle factors: not smoking, limited alcohol use, Mediterranean diet pattern, body mass index between 18 and 25, and regular exercise. Each factor was given a value of 1 for healthy and 0 for not healthy.
Compared with individuals with the least healthy combination of behaviors, those with the most healthy combination cut their risk of pancreatic cancer by more than half.
These results suggest that the risk of pancreatic cancer can be substantially reduced by not smoking; limiting alcohol intake; maintaining a healthy weight; engaging in regular physical activity; and eating a diet that’s rich in fruits, vegetables, whole grains, fish, and healthy fats such as olive oil and canola oil
Boost your overall health by adding more fruits and vegetables to your diet.
“Eat plenty of fruits and vegetables”; we’ve all heard this message repeatedly—and for good reason. Not only does current research show that a diet high in fruits and vegetables can help lower the risk of cancer and many chronic diseases, but eating a larger number of fruits and vegetables can be the key to achieving and maintaining a healthy body weight.
Eat More (Fruits and Veggies)
Consuming large quantities of produce can help us maintain a healthy weight. One reason for this is the low-calorie density of fruits and vegetables—meaning they provide a high volume of food with a low calorie count. A cup of vegetables, for instance, averages 20 to 60 calories per cup, and a cup of fruit averages approximately 70 calories—a large volume for so few calories. They are also water-rich and full of fiber, both of which mean they fill us up quickly. And because research shows that people feel full based on the amount of food eaten, not the number of calories consumed, eating fruits and vegetables allows us to cut calories without eating less. What’s not to love?
To put the high-volume, low-calorie principle to work in the kitchen, try replacing some of the volume of high- calorie foods, such as pasta, chips, crackers, and animal protein, with more fruit and vegetables. For example, for a standard 3-cup serving of pasta with turkey meat sauce (900 calories), replace the three cups of cooked pasta and sauce with one cup of pasta combined with two cups of vegetables and turkey meat sauce (450 calories). This simple switch results in a meal that has half the calories of the original without decreasing the volume of food at all.
Fill Your Plate
So how many servings of fruits and vegetables should we strive for to reach and maintain a healthy weight? More than you might think. Recommended levels vary according to body size, but the general recommendation is seven to 10 servings per day. To put this in perspective, consider that a serving of fruit is ½ cup (except for berries and melons, which are 1 cup or 1 medium piece); a serving of vegetables is ½ cup cooked or 1 cup raw. Therefore a seven-serving day might include three pieces of fruit, a couple of handfuls of baby greens and raw vegetables, plus a cup of cooked broccoli.
While the volume of fruits and vegetables we eat is key, so is the variety we choose. This is because there are thousands of phytonutrients that contribute to our health across a broad range of fruits and vegetables—there is no one-size-fits-all solution. While blueberries are touted for their high level of antioxidants, for instance, there are nutrients in carrots and apples that are not found in blueberries. The more variety you consume, the more likely you are to get what you need. The bottom line? Eat the rainbow!
Enjoy Nature’s Bounty
All of us probably have one childhood memory of pushing our vegetables around the dinner plate—maybe they were overcooked or underseasoned, too mushy, or too crunchy. Now is the time to leave those experiences in the past and reach out for more and different fruits and vegetables. And, yes, it’s okay to add a little Parmesan cheese, a small amount of olive oil and kosher salt, some light soy sauce, or a dollop of marinara sauce if you’d like—none of which will dramatically increase the calorie count. After about three weeks of incorporating more produce in your diet, you’ll find yourself amazed at how delicious nature’s bounty can be.
Tips for Boosting Fruit and Vegetable Consumption
Eat seasonally. Not only does it improve your nutrition, but what is in season tastes the best, too.
Serve fruit right along with the salad and the vegetable on the dinner table. Many are willing to consume what is right in front of them, already peeled and cut.
Bring two pieces of fruit to work with you daily. It’s great for the midmorning or late-afternoon pick-me-up—and it helps to keep that sweet tooth in check.
Keep dried fruit with no added sugar in the car or at the office; four apricot halves, prunes, or apple slices are equal to one fruit serving.
Make a smoothie with 1 cup of frozen berries, peach slices, pineapple chunks, or mango slices; nonfat Greek yogurt; and a banana. Try adding a handful of spinach or kale or a carrot to boost your vegetable intake.
Keep a supply of frozen fruits and vegetables for backup for the week you didn’t get to the market to restock fresh produce.
Take baggies of prewashed baby carrots, cherry tomatoes, sliced cucumbers, or any other favorite veggie to work for a low-calorie snack that is equal to a vegetable serving.
Make puréed vegetable soups, such as carrot ginger, roasted tomato, or cream of broccoli; skip the cream and add fat-free half-and-half or 1 percent milk.
Chop an unpeeled apple, sprinkle with cinnamon, and cook in your oatmeal for real apple-cinnamon oatmeal.
Add grilled vegetables to salad and sandwiches for delicious flavor and a nutrient boost.
Mix all grains with lightly sautéed onion, celery, and carrots for more volume and more nutrition.
Marinate raw vegetables such as carrots, mushrooms, peppers, cauliflower, and cucumbers in light balsamic dressing, drain, and serve cold as an appetizer.
Buy inexpensive pre-shredded carrots and red cabbage; add to salads, stir-fry, and sandwiches.
Stellate ganglion blocks appear to reset the sympathetic nervous system and deliver powerful results for those suffering with PTSD.
A stellate ganglion procedure performed at Joy Wellness Partners.
For most of his life, Isaiah Heller has oscillated between panic and prescriptions, alcohol, and marijuana to numb difficult emotions and a mind that “moved at 100 miles a second.”
The U.S. Army veteran tried to take his own life twice. He couldn’t keep a job, and his driver’s license was once revoked after he suffered a trauma-induced seizure disorder. He attempted—but walked out of—cognitive processing therapy, a specialized clinical treatment to reframe past events and gain emotional freedom.
Heller suffered from shame and trauma due to experiences in foster care, a near-death hate crime assault as a young teen, and sexual abuse in the military. But his silent suffering echoed in the walls of his own home with night terrors, paranoia, and his inability to be present—psychological symptoms that bled into the lives of his wife and children.
And then, one day, these symptoms came to a grinding halt; his nervous system relaxed like a rubber band that loses tension. He was miraculously present and at peace when he walked out of the Joy Wellness Partners clinic after getting his first stellate ganglion block (SGB).
“It was almost like the weight of the universe lifted up off my body. It was such a euphoric feeling,” he said. “I am getting time back in my life because I’m enjoying the moment.”
Trauma isn’t rare. Heller is among the 6 percent of the population that experiences post-traumatic stress disorder (PTSD)—about 12 million adults in a given year. At some point in their lifetime, half of all adults will have trauma, a shocking event witnessed or that happens to them.
SGBs are simple procedures that take minutes, involving an anesthetic injected into the stellate ganglion, a bundle of nerves in the cervical spinal column associated with the sympathetic nervous system.
Guided by sonogram imagery, a physician inserts a small needle of medicine that temporarily dulls this starburst of nerves connecting the body to the brain. The block lasts for about eight to 10 hours with a similar mechanism as an epidural, which blocks sensation from the belly button to the upper thighs for pregnant women in labor.
It’s a well-established procedure anesthesiologists have used for a century for pain. A case report of PTSD in 1990 inspired its “off-label” use for trauma.
In most cases, SGBs offer instantaneous relief to burdened nervous systems that have become stuck in “fight-or-flight.” But rocky reviews and murkiness over its mechanism have stalled wide acceptance of the procedure. Research hasn’t pinpointed why it doesn’t reboot everyone’s nervous systems. Also, among those who enjoy its benefits, the longevity of the reset varies extensively. It may last a decade or only a few months, with no foreknowledge on factors that make it more effective.
“Certain people just don’t respond to the block, and we don’t know why,” Dr. Eugene Lipov, pain specialist and early pioneer of the procedure, told The Epoch Times. Lipov—the chief medical officer for Stella clinics across the United States, Australia, and Israel that offer the procedure—said his research includes looking into genetic and other explanations for differences in patient response.
How SGB Works
It’s theorized that the reason SGBs work is because they reset the nervous system to its state before the trauma. The sympathetic nervous system is a component of the autonomic nervous system that’s designed to unite the brain and body for effortless, instantaneous responses to threats, whether physical or emotional.
Dr. Frank Ochberg, a pioneer in trauma science, has petitioned for years to reclassify PTSD as post-traumatic stress injury (PTSI) because improved brain scans now reveal that trauma can be healed, boosting the validity of biological interventions such as SGB. He argues a change in name could remove the stigma attached to trauma and better allow the injured to seek help.
One simple theory is that SGB works by calming the nervous system. The cervical sympathetic trunk is the link between the body and the brain, holding polysynaptic neurological connections from the stellate ganglion leading to the amygdala, the part of the brain associated with anxiety and trauma.
Another hypothesis is the injection could be suppressing nerve growth factor, which lowers norepinephrine and mutes physiological symptoms like rapid heart rate, shallow breathing, sweaty palms, and brain fog. The activation of the fight-or-flight system elevates norepinephrine in the brain, a neurotransmitter that leads to arousal, selective attention, and vigilance.
Those with PTSD have high levels of norepinephrine in their cerebrospinal fluid. High norepinephrine symptoms are associated with sleep dysfunction, impulsivity, anxiety, depression, and sexual dysfunction.
Finally, additional evidence indicates SGB might work as a sedative due to the reduction in norepinephrine. The nervous system then “boots up” back at baseline.
Assessing Risks and Side Effects
Until the development of fluoroscopy, SGBs were performed by using vertebrae as landmarks to guide the injection. Now, sonograms are used for the procedure, which lowers many risks by helping doctors guide the needle to the anterior lateral C6 vertebrae and allowing them to watch the administration of medication using dye.
Risks associated with SBG include a small chance of infection. There are very rare occurrences of the injection hitting a blood vessel and forming a hematoma, which is why it’s not done on those taking blood thinners. Temporary side effects such as droopy eyes or a hoarse voice are common.
Prevalent, but rarely a significant problem, is the rush of emotions and memories that happens after the procedure. Heller believes the effect is what enabled him to talk about his trauma and process it in healthy ways. He re-entered therapy, this time successfully. Eight weeks in, he told his wife about the sexual abuse.
“That was a breakthrough for me, and I never thought I was ever going to get there. It doesn’t affect me anymore,” Heller said. “It’s crazy what you can do when you’re in the right phase of mind.”
Lives Changed
The number of clinics specializing in SGBs is growing, as are non-profit organizations that offset costs. A mix of studies and proponents claim a success rate claim of about 75–90 percent. But while some patients rave about the results, it isn’t always a one-and-done fix.
Dave Conley, U.S. Navy veteran and founder of One More Day Inc., is a pragmatic advocate. Focused on the prevention of veteran and military suicide, One More Day helps connect veterans to The Stellate Institute, run by veteran physicians Drs. Sean Mulvaney and James Lynch, among other providers.
“You’ve got to still put the work in,” said Conley, who had an SGB followed by two weeks of intensive PTSD therapy in 2022. He lost four friends to suicide after they returned from serving. After his own attempt at taking his life, he started the organization and then a podcast.
Conley’s nightmares eased up significantly after his SGB. He said the procedure stirs a lot of excitement, but people should be wary of false hope. Many need a follow-up procedure, oftentimes because of re-exposure to new trauma or intense triggers.
Heller opted for two follow-up procedures after a car accident introduced new stress. His experiences overall have motivated him—to find a job he loves, dig into his school work, and enjoy every moment with his three children.
“People that say they want to change, they act on it. I’ve worked for everything I’ve gotten,” Heller said. “This is my life, and it’s amazing.”
That tenacity to stick with therapy is a key component of the SGB success story, Conley said. He was ready to quit after three days, but by the second week, it all began to click.
A randomized study of 113 active military personnel published in 2019 in JAMA found a significant improvement in symptoms in the group that had SGB. The author wrote that the procedure buoys therapy for patients with barriers to cognitive-based therapies because of concentration and hyperarousal issues, which can affect the brain’s ability to function normally.
“Specifically, encoding and retrieving memories or integrating new learning becomes very challenging,” wrote Kristine L. Rae Olmsted, a behavioral epidemiologist whose focus is military mental health. “As a psychologist who has deeply collaborated with physicians who provide SGB, I have observed that many of the insights discussed prior to SGB have been more easily applied following the procedure.”
Broader Reach
Conley believes the use of this novel trauma treatment could expand dramatically, though SGBs haven’t garnered sweeping support from governmental agencies. Doctors have spent years seeking more veteran access to SGBs, but legislation to expand the treatment option—the Treat PTSD Act—died in committee during the last two congressional sessions.
The bill would require the Department of Veterans Affairs and the Department of Defense to provide SGBs for qualified military and veterans, as well as updating clinical practice guidelines to include it as a PTSD treatment option. Support has come from both sides of the aisle.
There’s another hiccup in SGB’s history. A study published in 2016 Regional Anesthesia and Pain Medicine—a double-blind, randomized controlled trial—concluded there’s no evidence to support SGB for PTSD. The study, authored by Dr. Steven Hanling who didn’t reply to a request for an interview, “did not demonstrate any appreciable difference between SGB and sham treatment on psychological or pain outcomes.”
However, a Department of Defense analysis that looked at this study and the 2019 JAMA study noted that the 2016 study “had a number of methodological limitations, including high attrition, absence of key outcomes, and deviance from commonly used administration techniques for SGB.” The 2016 study also had a smaller sample size of 42 participants while the 2019 study that found evidence of efficacy had 113 participants.
The 2019 study also had its own issues, including a lack of blinding of treating physicians, meaning they knew which patients got the real treatment. There was also a possible unblinding of participants due to side effects of SBG, meaning some patients may have figured out if they got the real treatment or the sham treatment.
Proponents have questioned the reliability of the 2016 study in light of other evidence, including an analysis published in 2021 of 205 patients that showed 90 percent responded positively to the procedure. Of the 20 who didn’t receive a reset, 10 had the procedure done on the other side of their neck, and nine of those patients had a favorable outcome.
Lipov admits the limited acceptance of SGB could simply be because it’s a “weird concept,” a disruptive use of technology that doesn’t fit medical training and thinking. His career pivoted to focus on it only because of his own observations of its efficacy.
Patients who want an SGB must pay out-of-pocket, which can limit the market size for interested physicians. But the treatment may also rub up against the pharmaceutical industry, which sells billions of dollars in drugs used for PTSD and anxiety disorders.
“The main problem it’s not accepted I think is there’s no pharmaceutical dollar behind it,” Lipov said. “There’s no patent on the drug, and the distribution process is a complex undertaking.”
A stellate ganglion procedure performed at Joy Wellness Partners. A stellate ganglion procedure performed at Joy Wellness Partners. A stellate ganglion procedure performed at Joy Wellness Partners.
Arthritis pain can be debilitating. Including a few simple foods in your day may not only help lower your pain, but also may help slow the progression of the disease. Prepare this food only one way or it can damage your health.
Article Summary
Arthritis is a general term that refers to more than 100 different types of arthritis and related conditions; the four most common categories are osteoarthritis, autoimmune inflammatory arthritis, infectious arthritis, and gout.
Small food choices can significantly impact pain from arthritis. For example, choosing cruciferous vegetables that are high in sulforaphane, an organic sulfur that supports cell function, helps block the enzymes linked to joint destruction, and lowers inflammation that drives pain.
Anthocyanins found in purple- and red-colored berries lower oxidative stress and inflammation and support gastrointestinal health, which is crucial to lowering inflammation and improving pain control.
Marine-based fatty fish are rich in long-chained omega-3 fats that are highly bioavailable and essential to lower the inflammatory response driven by an imbalance between omega-3 and omega-6 fats.
When used correctly, food is medicine. Put another way, you are what you eat. You can’t get away from the fact that your body requires nutrients to function optimally, and those nutrients come from the food you consume.
The small choices you make each day, such as having a donut as a midday snack or a bowl of ice cream each night after dinner, have a way of catching up with you. One of the ways where food packs a powerful punch is in arthritis pain control.
Food impacts several pathways that make a difference in your pain level and even in the progression of the disease. Food manufacturers want you to believe that a calorie is a calorie—and that calories are all your body needs to survive. But if there is one thing the past years have taught us, it’s that food makes a significant difference to your health.
Before discovering some of the foods that can lower pain, let’s take a minute to explore the term “arthritis.”
Arthritis Is Not a Single Painful Disease
It is crucial to understand several facts about arthritis. For example, the word arthritis is a general term that refers to more than 100 different types of arthritis and related conditions. Arthritis can permanently damage your joints and the symptoms of common arthritis include pain, stiffness, and swelling.
People may experience mild to severe forms of the disease and the symptoms can come and go. For some, the symptoms remain the same for years, but for others, the disease progresses and gets worse over time. There are four major categories of common types of arthritis.1
1. Osteoarthritis
This is the most common type and can be found in nearly any joint of the body. More frequently, it appears in the knees, hips, spine, and hands. It used to be known as a wear-and-tear disease, but current evidence shows that it affects the whole joint and not just the cartilage, making the bone weaker and deteriorating the connective tissue.
2. Autoimmune inflammatory arthritis
This is a global term that includes rheumatoid arthritis, psoriatic arthritis, juvenile arthritis, and axial spondyloarthritis. Although an exact cause has not been identified, your gut microbiome plays a critical role.
3. Infectious arthritis
This painful condition is triggered by an infection that usually begins in another part of the body and travels to a joint. The symptoms can appear suddenly and cause intense swelling, pain, and fever. Treatment usually resolves the condition.
4. Gout (metabolic arthritis)
This is the result of a buildup of uric acid crystals in the joints, more commonly in the big toe. Uric acid crystals are a byproduct of the breakdown of purines, which are substances found in organ meat, red meat, some seafood, and alcohol. There is some evidence to suggest that osteoarthritis or gut dysbiosis can also contribute to gout.
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Sulforaphane Has Healing Properties
Cruciferous vegetables like broccoli, Brussels sprouts, cauliflower, and cabbage contain a compound called sulforaphane. This is an organic sulfur that has been shown to support cell function and division while at the same time causing apoptosis programmed cell death in certain cancers.2, 3, 4
When sulforaphane was tested in mice and human cell cultures,5 it was shown to target and kill breast cancer stem cells, which prevents the formation and spread of tumors. But the benefits of sulforaphane don’t stop there. It has been shown to reduce inflammation by reducing reactive oxygen species by as much as 73 percent,6 which in turn reduces cell damage.
Sulforaphane can also help reduce the risk of osteoarthritis,7 in part by blocking enzymes that are linked to joint destruction.8 A team of researchers from the University of East Anglia published a study9 in the journal Arthritis and Rheumatism that showed substances in cruciferous vegetables could slow the progression of osteoarthritis, or possibly prevent it.
Sulforaphane did this by inhibiting metalloproteinases that have been implicated in the development and progression of osteoarthritis. The researchers found it also blocked inflammation to protect against cartilage destruction both in the lab and animal models.
Anthocyanins Play an Anti-Inflammatory Role
Research has demonstrated that there is power in the color purple.10 Purple- and red-colored berries are high in anthocyanins, which are secondary metabolites that plants produce to defend against predators. Anthocyanins work through a variety of pathways to exert beneficial effects on human health.
They’re primarily known to address oxidative stress and reduce inflammation, which in turn helps pain control in patients with an inflammatory-driven condition, such as arthritis. The science also demonstrates the power of anthocyanins in lowering the progression of cognitive decline and protecting the heart, kidneys, and gastrointestinal tract.
Researchers have demonstrated that anthocyanins, found in cherries and other berries, help regulate lipid and glucose metabolism. Elderberries are high in anthocyanin, vitamin C, and zinc. These berries have anti-inflammatory modulating activity11 that may support pain control in patients with arthritis. They also became known for their ability to boost immune function and inhibit colds and flu long before the COVID-19 pandemic.
One 2004 study12 found 15 milliliters (just under 1 tablespoon) of elderberry syrup, four times a day for five days, eased the symptoms of influenza four days faster than a placebo. In 2019, research13 detailed the mechanism through which elderberry protects against viral attacks. As reported by Science Daily:14
“… the study showed that compounds from elderberries can directly inhibit the virus’s entry and replication in human cells and can help strengthen a person’s immune response to the virus.”
Let’s Spice Up Your Food
Bland food is never fun to eat. But did you know that by adding a few spices, you may reduce your pain level? Researchers have discovered that garlic, ginger, cinnamon, and turmeric are compounds that may improve pain control in people with arthritis.
One 2018 study15 found that cinnamon supplementation was a safe adjunctive treatment in women who had rheumatoid arthritis. The randomized double-blind clinical trial included a small group of 36 women who were divided into two groups: those receiving cinnamon and those receiving a placebo for eight weeks.
While the study was small and only included women, the results showed that it had a significant impact on tender and swollen joints with no changes in liver enzymes, lipid profile, fasting blood sugar, or erythrocyte sedimentation rate (ESR).
Ginger is another spice that has been under investigation for the effect it has on reducing the symptoms of osteoarthritis. A 2001 study16 found using a highly purified and standardized extract could significantly reduce those symptoms and had a good safety profile.
More recently, a 2020 paper17 confirmed the use of ginger as a safe and promising strategy to lower pain. The researchers reviewed eligible random controlled trials where ginger was used to relieve pain, including from osteoarthritis. They concluded that ginger was safe and promising, but more studies were needed to analyze the amount required for useful long-term therapy.
Garlic is a staple ingredient in cuisines found in many countries, including Italy, China, and Mexico. But it’s much more than a common spice. Data from a 2020 study18 of 62 women with rheumatoid arthritis suggested that garlic supplementation over eight weeks improved oxidative stress and health assessment questionnaires.
Turmeric is well known for its anti-inflammatory properties. A 2016 analysis of randomized clinical trials19 evaluated the use of turmeric extract and curcumin in the treatment of arthritis symptoms. While the results were positive, the researchers found the total number of trials and the total sample size were not sufficient to draw a definitive conclusion.
Another review of the literature published in 202120 compared turmeric against placebos and found a benefit on osteoarthritis pain and function in the knee. Based on the small number of studies, they believed the effects were similar to those that analyzed nonsteroidal anti-inflammatory drugs (NSAIDs).
A 2021 randomized trial21 compared turmeric against paracetamol, a painkiller also known as acetaminophen. The results from this study demonstrated that bioavailable turmeric extract was as effective as paracetamol against osteoarthritis pain and symptoms in the knee and was safe and more effective in reducing tumor necrosis factor alpha (TNF alpha) and C-reactive protein (CRP).
Balance Your Omega-3 and Omega-6 Fat
Historically, the human diet had an omega-6 to omega-3 ratio of close to 1:1. Yet the current Western diet is closer to a ratio of 20:1,22 which increases the inflammatory response and therefore has an impact on pain.
Most processed foods and seed oils are high in omega-6 fatty acid. While there are omega-3 fats found in some plants, only marine-based fatty fish have long-chained omega-3 fats eicosatetraenoic acid (EPA) and docosahexaenoic acid (DHA) that are highly bioavailable and essential to good health.
When your omega-6 to omega-3 ratio is out of balance, it increases your risk of obesity23 and the inflammatory response, both of which affect pain control in arthritis. The only way to know if you have enough omega-3 is to take a simple blood test—an omega-3 index.24 This measures EPA and DHA on red blood cell membranes and provides feedback on your dietary choices.
Food Addresses Gut Health and Lowers Arthritis Pain
Finally, while no single food completely addresses gut health, most of your food choices will either support good gut health or harm it. For example, a diet high in ultra-processed foods is known to change your gut microbiome, which promotes the development of inflammatory diseases.25
The Arthritis Foundation recognizes that your gastrointestinal tract plays a crucial role in some of the most common types of inflammatory arthritis.26 Researchers have discovered that people with rheumatoid arthritis have different levels of bacteria in their gut and babies who are breastfed have a lower likelihood of developing ankylosing spondylitis, as breastfeeding is known to positively affect the gut microbiome.27
A 2021 paper28 analyzed the association between the gut microbiome and symptoms of osteoarthritis. Researchers summarized the evidence that supports a gut-joint axis and the interactions between the gut microbiome and factors that affect osteoarthritis, including gender, age, metabolism, and joint injury.
Interestingly, data showed that an individual’s gut microbiota can potentially predict the progression of osteoarthritis, indicating that monitoring the gut microbiome may also help monitor the efficiency of therapeutic intervention. Broccoli is one food that helps support good gut health and may impact the pain of arthritis, as it is also a source of glucosinolate, a precursor to indole-3 carbinol (I3C).29
In the stomach, I3C generates 3,3′-diindolylmethane (DIM). I3C is a powerful antioxidant and in an animal model, those fed cruciferous vegetables with I3C had healthier guts and were less likely to have inflammation.30 I3C also works by activating a protein called aryl hydrocarbon receptor (AhR), which communicates with immune and epithelial cells in your gut lining, thereby helping to reduce inflammation caused by pathogenic bacteria.
AhR also helps stem cells convert into mucus-producing cells in your gut lining. These cells also help extract nutrients from the foods you eat, all of which translate into improved gut function and health.
As you’ll note, there are several groups of foods that support pain control by lowering the inflammatory response and improving your gut health. Arthritis can be a difficult and life-changing condition that affects your daily activities. Consider taking these small steps to help improve your pain control without medication and take greater control of your life.
Nonsteroidal anti-inflammatory drugs (NSAIDs)- NSAIDs are the most effective therapy when initiated within 48 hours of the onset of gout symptoms. For initiation, the potent oral NSAIDs are Indomethacin (50 mg thrice daily) or Naproxen (500 mg twice daily). Other NSAIDs include Meloxicam (15 mg daily), Diclofenac (50 mg two to three times daily), Ibuprofen (800 mg thrice daily), and Celecoxib (200 mg twice daily). The NSAID treatment for gout flares typically lasts for five to seven days. NSAIDs are usually prescribed in full doses for the first three days. It is subsequently tapered based on the progress.
Febuxostat- Febuxostat is a selective xanthine oxidase inhibitor. It occupies the entry channel to the Molybdenum-Pterin active site of the enzyme. United States Food and Drug Administration (USFDA) has provided approval for Febuxostat to treat patients with gout and hyperuricaemia at a daily dosage of 40 mg, and if the urate levels do not normalise by two weeks, then the dosage is increased to 80 mg daily. Cardiovascular as well as hepatic abnormalities are reported with Febuxostat. In patients with chronic kidney disease, the urate-lowering effect of Febuxostat is considered to be superior to Allopurinol. Patients under the treatment of 6-Mercaptopurine (6-MP), Azathioprine, and Theophylline are considered to have contraindications to the use of Febuxostat.
Management of acute flares aims at reducing the inflammation and the resulting pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs)- NSAIDs are the most effective therapy when initiated within 48 hours of the onset of gout symptoms. For initiation, the potent oral NSAIDs are Indomethacin (50 mg thrice daily) or Naproxen (500 mg twice daily). Other NSAIDs include Meloxicam (15 mg daily), Diclofenac (50 mg two to three times daily), Ibuprofen (800 mg thrice daily), and Celecoxib (200 mg twice daily). The NSAID treatment for gout flares typically lasts for five to seven days. NSAIDs are usually prescribed in full doses for the first three days. It is subsequently tapered based on the progress.
Febuxostat- Febuxostat is a selective xanthine oxidase inhibitor. It occupies the entry channel to the Molybdenum-Pterin active site of the enzyme. United States Food and Drug Administration (USFDA) has provided approval for Febuxostat to treat patients with gout and hyperuricaemia at a daily dosage of 40 mg, and if the urate levels do not normalise by two weeks, then the dosage is increased to 80 mg daily. Cardiovascular as well as hepatic abnormalities are reported with Febuxostat. In patients with chronic kidney disease, the urate-lowering effect of Febuxostat is considered to be superior to Allopurinol. Patients under the treatment of 6-Mercaptopurine (6-MP), Azathioprine, and Theophylline are considered to have contraindications to the use of Febuxostat.
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