The miraculous properties of cod liver oil

omega-3-fish-oil-healthy-life

The health benefits of adding cod liver oil to your diet for the purposes of improved physical well-being have been well-documented, but did you know that cod liver oil could also be beneficial to your mental health and well-being?

Cod liver oil is massively nutritious, containing omega-3 fatty acids, Vitamin A and Vitamin D.  It is generally recognised as having the potential to provide a variety of health benefits, the best-known being stronger bones, reduced inflammation and less joint pain, but there are also arguments claiming that cod liver oil also improves brain function, can reduce symptoms of depression and anxiety, improves cognitive function and impacts on mood.  The arguments for the miraculous properties of cod liver oil are as follows:

  • Inflammation

Cod liver oil contains omega-3 fatty acids which could suppress the production of bodily proteins which create chronic inflammation.  Vitamins A and D possess high antioxidant properties, which can reduce inflammation by impacting on harmful free radicals.

  • Bone Health

Bone mass begins to decrease at around the age of 30; this can become problematic in later life and the possibility of bone fractures can increase, especially in post-menopausal women.  It has been argued that Vitamin D can decrease the likelihood of age-related bone loss because it facilitates the absorption of calcium into the body.

  • Joint Pain

A variety of studies into Rheumatoid Arthritis and joint pain have revealed that patients who regularly take cod liver oil supplements reported a reduced level of joint pain and were subsequently able to reduce their intake of prescription anti-inflammatory medication.

  • Symptoms of Anxiety and Depression

Research into the impact of cod liver oil on mental state is on-going and inconclusive; however, what the research does suggest is that there is ‘something’ in cod liver oil which can alleviate symptoms to some extent.  It seems more plausible that this is due to the Vitamin D content which, it has been argued, can stimulate the production of hormones such as seratonin, and it is generally accepted that higher levels of Vitamin D in the blood can reduce minor symptoms of depression.  Click here for an article on the impact of fish oil and Vitamin D on brain function and mood.  It has also been argued that there is a link between chronic inflammation and anxiety or depression, and although some studies claim that cod liver oil could reduce symptoms of low mood, more research is needed before a reasonable conclusion can be reached; although inflammation can decrease and some improvement in mood has been acknowledged, the level of improvement is very small.

  • Other health benefits

Eye Health: The omega-3 fatty acids and Vitamin A present in cod liver oil have been shown to offer some level of protection against, for example, glaucoma and age-related macular degeneration, by reducing inflammation in the body.

Heart Disease: incorporating omega-3 fatty acids into the diet can reduce the risk factors of heart disease, although it is important to note that it cannot prevent heart disease developing.  The presence of omega-3 fatty acids can lower blood pressure, increase HDL cholesterol (the ‘goodie’), prevent plaques forming in the arteries, and reduce the production of triglycerides.

Stomach and Gut Ulcers: results of animal studies are suggesting that cod liver oil could enable the healing of stomach ulcers by reducing inflammation in the gut, and it has also been argued that cod liver oil can suppress genes which create inflammation of the gut.  Users of prescription anti-inflammatory medication can be at risk of developing stomach ulcers, as can smokers and individuals who experience acid reflux.

Ok, so how much should I take?

One teaspoon of cod liver oil contains 90% of the RDI for vitamin A, and 113% of the RDA for Vitamin D.  Taking 1000mg capsule has long been the advisable daily dose for individuals with arthritic conditions, however, research from 2005 has concluded that higher doses appear to be extremely beneficial to individuals awaiting joint replacement surgery.  In this study, the higher dose resulted in two specific changes in the body: firstly, a huge reduction in the production of an enzyme which can cause damage to the cartilage, and secondly, a reduction in certain enzymes which cause joint pain.  Click here for this research article.

NSAIDs

Personally, I’m a big fan of anti-inflammatories, and have used them long-term with no problems so far.  What I really like about them is that they actually DO something!  NSAIDs reduce inflammation in the body, thus reducing the level of arthritic pain, and for me this is extremely important – OK, so the level of pain isn’t massively reduced, but it’s something, it’s physical, it’s real, and it’s progress of sorts.  The main reason for this little outburst is that there are so many drugs which DON’T actually do anything for your body – for example, painkillers.  Painkillers lie.  They lie to your brain, telling you that you have no pain which, to a point, is good because it takes the pain away if only temporarily, but only (and this is important) because you believe it to be so.  In the meantime, there is absolutely no progress or healing going on, and in some cases further physical damage is taking place but is unrecognised.

Anti-inflammatories are not a perfect drug, and there are certain issues with their use, especially if it is long-term, as in the case of arthritis.  NSAIDs can impact detrimentally on your stomach, causing damage to the stomach lining and are thought to be responsible for the development of stomach ulcers.  Therefore, monitoring their use is important and I now am required by my GP to have regular blood tests to check that all is well.  However, there are now NSAIDs being manufactured which have a type of ‘coating’ which is said to protect the stomach lining from damage.

Something else worth noting is the impact of NSAIDs on your blood’s consistency and ability to clot.  Last year I was taking anti-coagulents after surgery and was not allowed to take NSAIDs alongside these because, as I understood it, my blood would become too thin.  Here is an article which reiterates this, arguing that anti-inflammatories should not be taken alongside blood-thinners, and how NSAIDs appear to impact on blood platelets.

I see NSAIDs as the unsung heroes of arthritic pain.  They tick over quietly in the background and most of the time you could be forgiven for thinking that they’re not doing anything, but believe me, they are.  They certainly don’t wallop the pain in the heroic manner that painkillers do, but I think it is only when you stop taking anti-inflammatories that you realise how much they actually do for you.  Following an enforced break from them for 8 weeks last year, I really noticed an immediate difference when I was finally allowed to use them again, and if I ever had to make a choice over using NSAIDs or painkillers, NSAIDs would win every time.

“Why me?!” Chapter 3: But arthritis is something old people get, isn’t it?

oldpeople

Well, yes and no…  Osteoarthritis is generally believed to be a degenerative condition which affects older people, an undesirable but natural part of the aging process; it is often described as ‘wear and tear’ on the joints, the direct result of a thinning of the articular cartilage layer.   However, it has also been argued that osteoarthritis develops because the aging of the musculoskeletal system increases susceptibility to osteoarthritic conditions.  Click here for more information about osteoarthritis and age.  Risk of developing the condition certainly increases with age, and most people over the age of 50 will have developed some minor symptoms, which are generally the inconvenience of a few minor aches and stiffness rather than full-blown arthritic pain.  Gender is also a determining factor, with the number of women aged 50+ far outweighing the number of men in the same age group who have the condition.  Click here for an article about women and osteoarthritis.

So, it seems fair to say that the majority of people with an osteoarthritic condition are middle-aged or older, but there are also many others who develop it at a younger age and for a variety of different reasons – in my case, I believe that the surgical removal of articular cartilage from my knee when I was a child is the most obvious reason for me developing the condition.  Being ‘an unusual case’, such as I was, brings with it a number of difficulties which are additional to the condition itself; during the 1990’s, my relatively young age actually prohibited me from obtaining the treatment I needed at that time.

My life as a Juvenile Degenerate continued much as expected.  In my twenties, I walked with a slight limp, I could no longer run but could manage a rather slow and lumbering jog if absolutely necessary, and I experienced manageable pain on a daily basis.  I had finished college, had a couple of jobs, had worked abroad, and become a mother  By the time I was 30, I began to experience much higher levels of pain, my mobility had deteriorated, I now limped badly, I couldn’t move quickly even if my life had depended on it, and I was finding it extremely difficult to fulfill my role as the mother of a busy and energetic pre-school daughter.  I was referred once again to an orthopaedic consultant.

This particular consultant had a reputation which preceded him, not only was he a brilliant surgeon, but was equally well-known for his brusque, if not downright rude, manner.  He was internationally revered and spent much of his time performing orthopaedic miracles around the globe.  I considered myself very lucky to have been referred to him, and was extremely impressed that humble NHS patients such as myself could receive care from such esteemed professionals.   During our first consultation, he announced that I urgently needed a knee replacement.  In those days, ye olde joint replacement surgery was somewhat different to the relatively recent carbon-fibre replacement surgeries of today; outcomes were inconsistent and erred more on the side of ‘unsatisfactory’, some patients experienced more pain and less mobility as a result, and some designs were at best inadequate, or at worst flawed.  It was a challenging surgical procedure, knees being an especially complex joint, the success rate was poor, and they were expensive; most crucially, you could only have one replacement per joint, which was intended to last for the remainder of your life.  For ‘younger’ arthritis sufferers such as myself, this was bad news – I was informed that the procedure would go ahead when I reached the age of 55.  Under normal circumstances, this was the minimum patient age that the surgery could be performed, so I was looking at a further 25 years of waiting until the procedure could go ahead.

The consultant did offer a couple of alternatives to tide me over until I was old enough for the surgery.  Firstly, because my x-rays revealed significant quantities of attached and loose osteophytes which were rattling around, he suggested  keyhole surgery to try to clear the joint of bone spurs using a suction tube; this is probably similar to today’s lavage and debridement procedure.  Secondly, he offered to undertake an osteotomy, a procedure where the tibia or femur have a wedge shape removed enabling the leg to be realigned, the purpose of which is to relieve pressure on the affected joint and thus reduce overall pain.  I accepted the hoovering-out option, and several of the offending escapee bone spurs were successfully removed, the biggest offender being 8mm in length which had taken up residence next to a nerve; however, I declined the offer of an osteotomy because I found the prospect quite terrifying.

For about 6 months after the hoovering-out procedure, the pain was reduced and my mobility improved, but it was only a temporary fix and not intended to resolve more serious problems within a joint.  About a year later, the consultant conceded that it would be necessary for me to have a knee replacement before the magical age of 55, and to return to him again to get things started when I could no longer walk or drive or get on with my life.  At the time, I was absolutely appalled at his attitude, but in retrospect I think this was entirely the right thing to do.  As mentioned above, the old type of knee replacements were notoriously unsuccessful, and as an eminent orthopaedic consultant he would have been very aware of the state of progress in the design, materials, and improved surgical procedures for the flashy new carbon-fibre replacements which emerged less than a decade later.  These new replacements had a relatively short lifespan of around 10-15 years in comparison to their rather ineffective predecessors, but the newly emerging replacements had a significant advantage for younger arthritis sufferers – they could be replaced, and you could have as many ‘replacement-replacements’ as was deemed necessary.  I genuinely believe that this consultant’s plan all along was to make me wait as long as possible so that I would, eventually, get a much-improved type of replacement and a far better surgical outcome than if we had rushed into surgery at an earlier stage.  It’s just a pity that he didn’t share this with me at the time, since I was in a state of absolute despair that day when I left his clinic.

 

 

Osteoarthritis and Mental Health

This post is a continuation of the static post which can be found on the Mental Health page where I was undertaking an experiment to examine the potential relationship between arthritis and psychological well-being, using a word cloud programme to create an image using text.  A week has now gone by, I have recorded 12 words or phrases each day relating to the question ‘How do I feel today?’, and this is the resulting image:

wordle-wk1-generic

This image is what I would describe as a ‘generic’ image to reveal the symptoms and emotions I have experienced over the past week.  Word cloud programmes, by default, recognise text as individual words rather than as a complete phrase, and the larger the text, the more frequently a specific word appeared in my lists – for example, the largest words, such as ‘pain’, ‘back’, ‘stiff’, ‘sore’, etc appeared in my list several times, and in various combinations or phrases.  Conversely, the smallest words appeared once only.  This is all well and good, and provides an overall generic view of what I was trying to capture by doing this experiment.  Evidently, the physical symptoms of my arthritic condition dominate in this image, but it is also interesting that several words relating to mood appear in moderately-sized text.

In this second image, I have tweaked the word cloud programme so that phrases are ‘read’ by the programme as complete words – in other words, ‘lower back pain’ will be read as one complete word.  This provides a much more specific image:

wordle-wk1-specific

Interestingly, the words ‘low mood’, ‘sore back’ and ‘cold’ are now the most frequently occurring words and therefore appear in the largest text.  Although the word ‘pain’ no longer dominates the image, it occurs several times in medium and smaller text, but this time specifically relating to the type of pain I experienced: ‘back pain’, burning pain’, ‘hip pain’, ‘sharp pain’, etc.  What this image also reveals is the extent to which symptoms of low mood and depression appear and how they seem to be as prevalent an issue as the physical symptoms themselves.  Additionally, I believe that these images provide a valuable insight into how exhausting it is, both physically and mentally, to experience an arthritic condition.

A couple of additional thoughts relating to this experiment and the resulting images.

Firstly, at the time of writing, it is a typically cold and damp January, and as arthritis sufferers are well aware, this is the absolutely worst time of year for us regarding our experiences of pain and is also the most problematic with regard to managing our pain and symptoms adequately.

Secondly, although I am firmly of the belief that osteoarthritis and reduced levels of mental well-being are intrinsically connected, I would also argue that low mood and symptoms of depression cannot be solely attributed to arthritic conditions, and that there are many other factors at play in our lives which influence our moods and well-being.  Having said that, however, I have been extremely pleased to discover that during my medical appointments over the past couple of years, arthritis sufferers are now routinely asked to complete mental health questionnaires.  I am assuming that this is an extremely positive step forward in better managing arthritic diseases – after all, how can individuals experience chronic pain on a regular basis, without also experiencing low mood and symptoms of depression?

“Why me?!” Chapter 2: A Juvenile Degenerate

In 1977, I underwent my first orthopaedic surgery, fully believing that it would also be my last.  Keyhole surgery was in its infancy, so I emerged after a traditional surgical procedure sporting a 10cm scar across my knee which looked strikingly similar to a question mark.  The cartilage in its entirety had been removed from the outer side of the knee joint, and  the answer to the “Why me?!” question was self-evident – I had damaged my knee, most likely due to an overzealous approach to athletics, and had earned myself a scar.  In those days, scars were not considered to be cool or something to be proud of with a heroic or amusing tale attached to them, and my reaction to it was one of deep shame and embarrassment.  I covered it up whenever possible, and have continued to do so ever since.

Following the recuperation period, I was told that all had apparently been successful, or at least as successful as could be expected.  After a few weeks of using a walking stick, I learned to walk independently and finally learned to run again, but now it was purely for fun rather than speed, and the exhilaration I had felt before no longer existed.  I was noticeably slower than before, but still participated in PE lessons and played in school teams, although I was no longer considered physically well enough for anything too strenuous or demanding.  Occasionally, however, the leg would ‘collapse’, but these incidents were rare, and almost always when I was doing something physically strenuous.  I also noticed that ‘high impact’ or sudden movements highlighted the fact that it was now significantly weaker than my other leg, so after a few years, I became  less interested in sports and running, possibly because I’d morphed into a sullen teenager, or perhaps because I was experiencing increased pain within the knee and left leg and had developed a slight limp so was no longer an enjoyable experience.

By my mid-teens, the knee had earned itself its first name: Knaughty Knee, the first of several names I have had for it over the years.  Psychologically, I had begun to disassociate with and even disown it – I now referred to it either with a derogatory name, or it was spoken of passively, using ‘the’ rather than the usual possessive adjective, ‘my’.  Following more pain and consistent problems with it, I was eventually referred to another orthopaedic consultant who informed me that I had developed mild osteoarthritis in my left knee cap.

It was official, I was now a Juvenile Degenerate, my new name for myself.  My knee had also earned itself a new name, Bastard Knee, and I now referred to my left leg as Stupid Leg, as I slowly disassociated myself from both whenever possible.  The “Why Me?!” question had also acquired several somewhat different answers: because the surgery didn’t work?  because that particular surgery was the wrong thing to do?, or because by removing the cartilage, my knee was left wide open to the development of osteoarthritis?  My conscious attitude to this new situation was one of disdain, regarding it all as a rather bad joke; I continued to sneer at my body and regularly made deprecating remarks about it – after all, who needs a leg that works properly anyway, and hey, I’ve got another one and it’s much more co-operative than that stupid left one!  Subconsciously, I was furious.  I had always held consultants and surgeons in high regard, and continue to do so; after all, they possess reams of knowledge I couldn’t even begin to comprehend and skills which I could never acquire.  I wasn’t looking to apportion blame, however, something had gone badly wrong here; rather than resolving the specific issue of dealing with a raggedy cartilage, I appeared to have gained a medical condition which had the potential to be far more damaging and enduring.

I was an unlikely ‘candidate’ for osteoarthritis.  The contributory factors for developing the condition are as follows: genetic predisposition, age and gender, obesity, physical activity levels, joint injury, joint alignment, and abnormal joint shape.  As stated previously, I appeared to have no genetic disposition towards it, and as a woman, my likelihood of developing it before the age of 50 was significantly lower than if I had been male.  The only contributory factor which I appear to have met at this point, was that of joint injury, and the inevitable answer to the “Why me?!” question was now “because I had a surgical procedure which creates more problems than it resolves”.

It is reassuring to know that this particular surgery is no longer practised; interestingly, I can’t even find the correct name for it or details of it online, so presumably medical professionals have realised that it is not simply an inappropriate course of action to take, but it has the potential for creating further, more extensive damage to an individual’s joints.  However, a modified version does still exist; surgery is still undertaken to deal with rogue bits of knee cartilage, but it is restricted to simply trimming away any torn areas and no attempt is made to remove the cartilage in its entirety.

For more information about cartilage damage and NHS care and procedures, click here

 

 

Cabbage compress, anyone?

hhl-reframes_nov-29_14_wrap-your-leg-with-cabbage-728x381According to this article, red cabbage possesses Anthocyanins which, it is claimed, reduces joint pain and inflammation.  If you fancy testing this theory, follow the link below for information and details of how to make and administer a cabbage compress.

Obviously, this is more suitable for some areas of the body rather than others – for example, if your arthritis is in your legs or arms, this seems a promising thing to try out; if however, you have pain in your hips, you could be looking at making a pair of  very big cabbage pants…

Click here for the article and instructions.

 

 

 

 

“Why me?!” Chapter 1: Early Years

I have experienced chronic pain and intermittent reduced mobility resulting from osteoarthritis since childhood.  Four decades and a couple of joint replacements later, the arthritis continues to spread and I have further orthopaedic surgery to look forward to in previously healthy joints.

“Why me?!” is a question which has haunted me for a long time, although in my youth, it pertained simply to considerations of my own sheer carelessness, bad luck and frustration, rather than a more serious consideration of the likelihood of why a particular individual might develop arthritis.

I was born ‘healthy’ with no known physical abnormalities, and was sufficiently fortunate to be born into a family with no history of juvenile arthritic conditions.  I enjoyed sports at school, practised gymnastics and athletics, and had a passion for running, especially 400m sprints;  I loved the freedom, weightlessness and exhilaration that always came with running.

This is the first time I have recorded any of these experiences, and am already amazed at how vivid my memories are.

By the time I was about 9 years old, I began having problems with my left leg; it would ‘collapse’ (as I used to describe it) when I was doing PE, I would find myself sprawled on the ground, there was an intense burning pain inside my knee, and I was unable to stand or walk for several minutes.  These experiences were both painful and humiliating; the intensity of the pain always made me cry, and then I felt really ashamed in front of my classmates, firstly for crying in front of everyone, but also for being unable to stand or walk.  The knee itself was red, hot and very swollen and it took some time before it would straighten again and function normally.  It might then be several days before the next episode.

After several visits to the family doctor, our GP declared that he couldn’t find anything wrong with my knee or my leg (although, of course, it never ‘collapsed’ in his presence) and he suspected that I was lying to gain attention for some reason (!).  However, he did finally refer me to an orthopaedic consultant at the local hospital.  After further x-rays, the consultant declared that he ‘suspected’ that I had torn part of the cartilage on the outer side of my knee; it isn’t possible to see cartilage on an x-ray, but his clue was that the spacing between the bones was inconsistent, and he could also feel something moving around inside my knee cap, which he thought was probably a piece of cartilage which had torn or detached.  He recommended surgery to remove the cartilage from the outer side of my knee, and added that if this surgery wasn’t undertaken, I would be unable to walk and using a wheelchair by the time I reached the age of 20.  It seemed a situation with everything to gain and nothing to lose, so the consent papers were signed and surgery went ahead.  I was then 10 years old.

 

The Stuff of Subjectivity…

I feel that I should perhaps add some sort of disclaimer at this point.  It is important to note that this blog will be written from a purely subjective perspective.  I do not have any medical training or specialist knowledge in this area, and what will be recorded here will be my own memories, experiences,  responses and personal ideas regarding specific medications, surgical interventions, etc.  We are all different,   there is no magic wand, and one size never did fit all…