If you want to reduce the number of opioid prescriptions and pills being used, and potentially misused, you need alternative pain management. And chiropractors say that�s what they�ve been providing for decades.
�It gives people options, and that�s probably the most important thing right now is to give people options for treatment,� Dr. Mark Stagnone, president of the New Hampshire Chiropractic Association said.
At its annual meeting, the association is pointing to a trio of recent studies showing that chiropractic care cuts down on the use of opiate pain medicines.
In one of the studies, a former Dartmouth doctor analyzed 33,000 cases of lower back pain in a New Hampshire database.
�His preliminary research is indicating that there�s about a 56-57 percent reduction in opioid use when chiropractic care has been utilized in a patients treatment,� Stagnone said.
James Vara, the governor�s adviser on addiction and behavorial health, said the state needs more alternative pain management.
�It becomes a question of what insurance covers it and how long they cover it for, and that�s certainly something I�ve looked at and will continue to,� said Vara.
The Current Insurance Model Puts Patients On A Path To Prescription Drugs
�The problem that it produces is that the average individual who�s trying to treat a condition is faced with paying a high co-pay to visit a chiropractor or paying a considerably lower one to see a primary care physician,� Stagnone said.
Changing that dynamic will require legislation that has failed in the past. But chiropractors said in this ongoing addiction crisis, it�s time for adjustment.
Chiropractic care is covered under the New Hampshire Health Protection program, or expanded Medicaid. And if the program lapses, so does that coverage.
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Painkillers Sometimes Increase Chronic Pain
We’re facing an opioid addiction crisis in America. Opioid (narcotic) pain medications killed an estimated 14,000 people in the U.S. in 2014 through overdose. A further 14,000 people overdosed on heroin, another opioid that many people turn to when they can’t access prescription painkillers.
This epidemic is why physicians and pharmacists are increasingly raising the bar on who can receive opioid medications, how much, and for how long. It’s not just the addiction risk that calls for caution when using opioids to treat chronic pain though�long-term use of opioids can actually make pain worse.
Becoming addicted to pain medication is a disease. This is because these painkillers (oxycodone, hydrocodone, methadone, fentanyl) cause a change in your brain chemistry that is not under your control.
Most people who take opioids for more than 2 to 4 weeks will develop a tolerance to the medication. Tolerance means your body may need an increased dosage to feel the same effect. Opioid tolerance can cause withdrawal symptoms when the medication is stopped. This is a natural process, and it is not to be confused with addiction.
In his recent blog on the subject, Dr. Ullrich explains: “Pain medication addiction is a more complicated process. It involves manipulative behavior to obtain narcotic medications and a refusal to discontinue a medication even though it is no longer being used for a medical purpose. Some, including those at significant risk of overdosing, will go to multiple doctors to get medications.”
For those who are addicted to opioid medications, a detoxification program is often needed. Painkiller addiction is a chemical, physical disease, one that requires expert medical treatment in a safe, humane environment.
Most people know that painkillers can be addictive, but they don’t know that taking opioids over a long period of time may in fact increase a patient’s sensitivity to pain (hyperalgesia). This happens because long-term use of opiate painkillers causes a decrease in your ability to tolerate pain and an increase in sensitivity to pain. In fact, people taking opioids long term may keep having pain, or may see their pain increase, long after the original cause of pain has healed.
Stopping opioid use can solve this problem�but it may not seem as if the pain is gone at first, because the discomfort of withdrawal can mimic the original pain. Dependency is not easy to deal with, but it shouldn’t be an excuse to stay on the opioid medication and raise the risk for addiction. This is why physicians are encouraged to only prescribe opioids for short durations and be cautious when using them to treat chronic pain.
Since long-term use of opioid painkillers is a risky option for controlling chronic pain, patients are often advised to focus on other safe, proven methods for managing chronic pain, such as:
Exercise to maintain motion and release endorphins
Cognitive therapy to develop coping techniques
Relaxation and meditation techniques to distract the brain from pain
Six Things Every Chiropractor Should Know About Opioids
Men health concept. Portrait of 50s mature Asian man reading the label on bottle medicine, sitting on sofa at home.
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
1. What Are Opioids?
Opioid medications are prescribed to reduce pain; however, they are addictive and can be dangerous. Although some suggest there is �no safe dose� for opioids, these drugs may be helpful for people with severe pain, such as those experiencing pain from cancer. However, over the past several decades, more patients have been prescribed opioids for musculoskeletal pain, such as back or neck pain, instead of being provided with nondrug therapies.
As with any drug, opioids have side effects and may �adversely affect respiratory, gastrointestinal, musculoskeletal, cardiovascular, immune, endocrine, and central nervous systems.�1 �As the dose increases, the risks for overdose and health concerns also increase, including �fractures, addiction, intestinal blockages, and sedation.�1 If too high a dose is consumed or if opioids are taken with certain other drugs or alcohol, death may result.
2. Why Is Opioid Use / Overuse Problematic?
Since 1999, prescription opioid sales have increased fourfold, along with a surge in the use of opioids as a first line for pain management, rather than only for severe cancer-related pain. This trend has led to burgeoning opioid prescribing in the U.S.:2
? One in five people with non-cancer pain have been prescribed opioids.
? More than 165,000 prescription opioid-related deaths occurred between 1999 and 2014.
? An estimated 2 million people were addicted to opioids as of 2014.
3. Who Is Addressing This Health Crisis?
Currently, many professions are seeking ways to address this national epidemic. The medical profession has launched various initiatives to help medical doctors (MDs) reduce prescriptions. These include an initiative to remove pain as the 5th�vital sign, and promoting guidelines for when to prescribe and how to better manage patients in pain without the use of opioids.
The Centers for Disease Control and Prevention (CDC) has�released guidelines�to curb opioid prescriptions, with the following categories of recommendations to those who prescribe opioids: 1) determine when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, discontinuation, and assessing risk; and 3) addressing harms of opioid use.
In addition to these efforts, even more focus is needed to assist people who seek help for pain and to provide them with nonpharmacological alternatives.
4. What Can Doctors of Chiropractic Do?
Chiropractic care can be part of the solution. DCs can work with other health care providers and support policy to offer alternatives to opioids for addressing patients in pain, especially chronic non-cancer pain.
Although there are no large trials comparing outcomes of chiropractic care to opioids, we do know opioid use is associated with worse functioning in back pain patients at six-month follow-up3 �and greater disability;4 �and that injured workers whose first health care visit is to a DC have better outcomes.5 �We also know that the per-capita supply of DCs and higher use of manipulative therapy is associated with lower rates of opioid prescriptions among Medicare recipients.6
All this suggests chiropractic care may help reduce the use of and need for opioid prescriptions for back pain sufferers; and may play an important role in reducing the opioid epidemic by helping to prevent patients from ever getting an opioid prescription in the first place.
Important resources DCs should be aware of include:
? Chiropractic: A Safer Strategy Than Opioids:�www.f4cp. com/f4cp_opioid_white_paper.pdf
? Centers for Disease Control and Prevention (CDC): Opioid Overdose:�www.cdc.gov/drugoverdose/ Six Things Every Chiropractor Should Know About Opioids By Claire Johnson, DC, MSEd, PhD, Bart N. Green, DC, MSEd, PhD and Michael Haneline, DC, MPH Reprinted with permission from Dynamic Chiropractic, Sept. 1, 2016, Vol. 34, Issue 15 (www.dynamicchiropractic.com/digital/index.php?i=1220&r=t#19)
5. What Can We Do If a Patient Is Already Taking Opioids?
Most chiropractors take a history and ask patients what medications they are taking. The first step is to recognize that the following are opioid-class drugs: hydrocodone (Vicodin), ultram (Tramadol), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza) and codeine.7
Once we know a patient is taking opioids, we must first seek to understand the situation before we provide education.
Questions we can ask include:
? For what condition is the patient taking the medication?
? How long has the patient been taking opioids and at what daily dose?
? Who is the provider watching over their prescription? Is more than one provider prescribing opioids?
? When was the last time the patient saw the prescribing physician and when is the next appointment?
? Does the patient have any safety issues? For example, does the patient operate machinery? Is the patient experiencing side effects such as �sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, or respiratory depression�?8
? What is the patient�s level of function? Are there any psychological flags or addictive behaviors?
? Is the patient taking any other substances or drugs that may have deadly interactions, such as alcohol, benzodiazepines and/or other opioids?
As chiropractors, we can discuss treatment goals, such as reasonable functional activity; and pain goals with and without medication. We also can discuss potential adverse events, including the risks for side effects, addiction and death.
We can inform patients of other dangers they may not be aware of, such as the deadly combination of opioids when combined with other drugs that depress CNS activity (e.g., alcohol or drugs for anxiety such as benzodiazepines). We can encourage patients to contact the prescribing provider to discuss reducing and stopping opioid use, and to ask for safer alternatives for pain control, such as chiropractic care, physical therapy, acupuncture and mind-body methods. If a patient is already addicted, we can encourage the patient to seek a specialist provider and addiction care program. (Note that some patients may need to remain on opioids, such as for cancer pain or end-of-life care.)
Most importantly, we can work with the patient and their prescribing provider to offer them nonpharmacological care to help reduce their pain and help them reach their functional goals.
6. How Can We Collaborate More on Solutions?
As DCs, we can work more closely with local MDs and discuss better ways to collaborate concerning patients with pain. Remember that MDs are not the enemy, but are an essential component of the solution to this epidemic. Most MDs are also extremely concerned about the opioid epidemic, and are looking for efficient and cost-effective ways of helping their patients. We should remain professional when speaking about MDs with our patients, as our patients likely have good relations with them.
We can be part of the safety net to help reduce the number of people who become addicted or die from overdose. As we work with other health care professionals and our patients, we can remind them that the first recommendation per the CDC�s�Guideline for Prescribing Opioids for Chronic Pain�is �Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.�9 �Thus, through collaboration, the chiropractic profession can be a part of the solution.
By now you may have heard the shocking news: Subway’s �chicken� may contain just 50 percent chicken. The rest is filler, according to a report published by Time Magazine.
According to tests performed at Trent University in Canada, the company�s chicken strips and oven-roasted chicken contained just 43 percent and 54 percent chicken DNA, respectively, consisting otherwise of soy and other filler ingredients.
Subway denies the charges and has demanded a retraction from CBC Marketplace, yet admits it is �concerned by the alleged findings.� According to Subway, its chicken strips and oven-roasted chicken contain less than 1 percent soy protein.
The filler, it turns out, is a very long list of ingredients, however, a majority of it is soy protein. John Coupland, president of the Institute of Food Technologists, told Time Magazine.
�Based on the data, that is a surprisingly large amount of soy � And it�s astonishingly high for something that you�re supposed to think is a real, whole piece of chicken.�
On average, fast food chicken contains about one-quarter less protein than home-cooked chicken breast, thanks to water infusions and fillers, and up to eight times more sodium.
Moreover, as noted in the program, while you�d never expect chicken to be a source of carbohydrates, fast food chicken, such as that from Subway, contain surprisingly high amounts of refined starches and sugars.
Soy Protein May be Linked to Health Issues
Based on these test results, there are many reasons for concern. Not only are you being ripped off, paying for chicken that turns out to be 50 percent soy, which is dirt-cheap in comparison, but you�re also eating something that could be hazardous to your health, even if you�re not outright allergic to soy.
Unlike the Asian culture, where people eat small amounts of whole, fermented non-GMO soybean products, western food processors separate the soybean into two golden commodities � protein and oil. And there is nothing natural or safe about either.
Unfermented soy foods contain anti-nutritional factors such as soyatoxin, phytates, protease inhibitors, oxalates, goitrogens and estrogens � some of which actually interfere with the enzymes you need to digest protein.
While a small amount of these anti-nutrients would not likely cause a problem, the amount of soy many Americans now eat is extremely high.
What�s worse, the vast majority of soy grown in the U.S. is genetically engineered (GE) to be herbicide resistant and contaminated with the well-documented carcinogenic herbicide, Roundup.
Soybeans are also processed by acid washing in aluminum tanks, which can leach aluminum into the final soy product, and may contain unsafe levels of manganese as well.
According to Kaayla Daniel, Ph.D., author of �The Whole Soy Story,� thousands of studies link unfermented soy to a wide range of health problems, including:
Malnutrition
Kidney stones
Breast Cancer
Reproductive disorders
Infertility
Immune system impairment
Thyroid dysfunction
Heart disease
Cognitive decline (dementia)
Brain damage
Digestive problems
Food allergies
Soy for Dinner
A recent report by Mighty Earth, highlights the environmental impact of soybeans. More specifically, the report accuses Burger King of buying soy from plantations created by burning down tropical forests.
�To examine the impact of Burger King�s operations, we focused on the ultimate source of much of their meat: the soybeans that feed the livestock that the company uses to make its meals. Soy is an important base ingredient of the world�s meat. Approximately three-quarters of the world�s soy goes to animal feed,� the report notes.
��Burger King has a lot to hide: The fast food giant has failed to adopt any serious policies to protect native ecosystems in the production of its food. Despite pressure from consumers, it continues to rank dead last among its competitors � when it comes to protecting the environment.
Companies found in Burger King�s supply chain have been linked to ongoing destruction of forests and native prairies � habitat for wildlife like sloths, jaguars, giant anteaters and other species.
Unlike many of its competitors, Burger King has repeatedly turned down requests from civil society organizations to commit to only buying from suppliers who don�t engage in destruction of forests, or to provide information about where its commodities originate � Burger King scored a zero on the Union of Concerned Scientists� 2016 scorecard of major beef sellers� deforestation profiles, significantly lagging behind other major players like Wal-Mart, McDonald�s and Wendy�s.�
Soy Is Bad, But Roundup Is Even Worse
Glyphosate � the active ingredient in Monsanto�s wide-spectrum herbicide Roundup and other pesticides � is the most widely used agricultural chemical in the world. The first glyphosate-tolerant soybeans were introduced in the U.S. in 1994. By 2015, 83 percent of the soy grown worldwide was GE soy and in the U.S. more than 90 percent of soybeans grown are GE.
Less than 1 percent are organic, with the remaining 9 percent being conventionally grown which, like GE varieties, involves the use of herbicides like Roundup. Glyphosate-contamination is in and of itself a major reason to avoid foods containing soy protein. And if Subway chicken really contains as much soy as the Canadian test suggests, it would be a significant reason to avoid it too. Remember that less than 1 percent of soy is organic and free of pesticides.
In March, 2015, the International Agency for Research on Cancer (IARC), a research arm of the World Health Organization (WHO) and the �gold standard� in carcinogenicity research, reclassified glyphosate as a �probable human carcinogen� (Class 2A). Research scientist and consultant Anthony Samsel has also reported he uncovered evidence showing Monsanto knew glyphosate promotes cancer as far back as 1981.
Based on the IARC�s determination, the California agency of environmental hazards (OEHHA) has declared glyphosate a carcinogen under Proposition 65, and will require all glyphosate-containing products to carry a cancer warning. Monsanto attempted to overturn the OEHHA�s decision, but a Fresno County Superior Court Judge ruled against it.
Where Can You Find Real, Whole Food
We like to think that we can make healthy choices while eating out and save time in our hectic schedules. Afterall, who has time to cook anymore? Well, the reality is that the wool is being pulled over our eyes. It is next to impossible to eat healthy wholesome foods at fast food chains or even upper scale restaurants. There is simply too much out of your control- from MSG, preservatives, trans fats and gluten (these are just a few of the toxins we�re exposed to).
With all the drawbacks associated with conventional agriculture, factory farmed meats and processed fast food, your best bet is to forgo restaurants and choose fresh, locally produced foods. You can also grow some of your own. Remember to choose organic, grass-fed/pasture-raised beef, poultry and dairy, in addition to organic produce. If you live in the U.S., the following organizations can help you locate farm-fresh foods:
American Grassfed Association
EatWild.com
Weston A. Price Foundation
Grassfed Exchange
Local Harvest.org
Farmers Markets
Eat Well Guide: Wholesome Food from Healthy Animals
FoodRoutes
The Cornucopia Institute
RealMilk.com
OrganicPastures.com
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Whole Body Wellness
Overall health and wellness can be achieved by following a proper nutrition and engaging in regular exercise and/or physical activities. While these are some of the most common ways to ensure whole body health and wellness, visiting a qualified and experienced healthcare professional can also grant your body additional benefits. Chiropractic care, for instance, is a safe and effective alternative treatment option utilized by people to maintain well-being.
Drugs that treat hair loss and prostate enlargement are tied to a small increased risk of depression and self-harm, according to a new study from Canada.
The pills were not tied to an increased risk of suicide, however.
The drugs finasteride and dutasteride belong to a class of medications known as 5-alpha-reductase inhibitors (5ARIs). 5ARIs have come under increasing scrutiny in recent years by regulators in the United States and Canada because of a possible link to mental health issues, according to the researchers.
“There wasn’t a lot of good studies in this area, and it’s a very common medication for urologists to use,” said lead author Dr. Blayne Welk, of Western University and the Institute for Clinical Evaluative Sciences in Ontario.
Welk’s team analyzed data from 93,197 men who were at least 66 years old when they received prescriptions for 5ARIs between 2003 and 2013, plus another 93,197 similar men who had never filled a prescription for a 5ARI.
Overall, 5ARIs were not linked with an increased risk of suicide, the researchers reported in JAMA Internal Medicine.
During the first 18 months, however, the men using 5ARIs had an 88 percent higher risk of harming themselves. That risk did not extend beyond 18 months.
Men in the 5ARI group also had a 94 percent higher risk of depression in the first 18 months, compared to men not using these drugs. Beyond 18 months, the increased risk of depression fell to 22 percent.
The type of 5ARI did not appear to significantly alter the results.
Welk cautions that the actual risk of depression and self-harm is very low.
If the drugs were actually causing these side effects – which this study wasn’t design to prove – “you’d need 470 men to take this medication for a full year to have a new case of depression,” Welk told Reuters Health.
That number would have to be even higher to cause a new case of self-harm, since self-harm is less common than depression.
“It is a risk potentially and patients and physicians should be aware of it,” Welk said.
A separate study in the journal PeerJ evaluated another concern about 5ARIs – erectile dysfunction.
Drs. Tina Kiguradze and William Temps of Northwestern University Feinberg School of Medicine in Chicago and colleagues found that when erectile dysfunction occurred in men taking 5ARIs for at least 180 days, the dysfunction was more likely to last at least 90 days after stopping the medication. Erectile dysfunction, when it occurred, resolved faster in men who took the medications for shorter periods.
The proportion of men taking 5ARIs and experiencing erectile dysfunction is likely around 5 percent, according to Dr. Landon Trost, who is head of andrology and male infertility at the Mayo Clinic in Rochester, Minnesota.
But it’s not clear how many men suffer persistent erectile dysfunction after stopping 5ARIs, said Trost, who was not involved with either of the new studies.
“I think it’s important to be educated about the potential side effects,” he told Reuters Health.
Men who are already at increased risk for these potential side effects must weigh the risks and benefits of the drugs, Trost said.
He said older men taking 5ARIs for prostate problems might come to different conclusions than young men taking the pills for hair loss.
Additionally, he said, men should tell their doctors if they experience these symptoms.
Men who see more ads for low testosterone or “low T” on local television channels may be more likely to seek tests or treatments to boost their levels of the hormone, a U.S. study suggests.
Testosterone levels naturally decline with age, and some men with extremely small amounts of the hormone may be diagnosed with what’s known as hypogonadism and prescribed needed testosterone therapy, researchers note in JAMA.
Far more men take testosterone than have hypogonadism or clear evidence of a medical problem tied to low hormone levels, however. Many of them may have been convinced to seek unnecessary treatment by ads promoting “low T” as a health problem associated with issues like reduced libido or fatigue, said lead study author Bradley Layton, a public health researcher at the University of North Carolina at Chapel Hill.
“The original approval for testosterone intended it to be used only in a very narrow group of men with very clearly-defined diseases which stop the production of testosterone,” Layton said by email. “However, much of the use recently has been in men with reduced testosterone levels or some non-specific symptoms like fatigue, loss of muscle mass, reduced libido or lowered mood which may be related to normal aging or other disease conditions,” he said.
“There is very little evidence that testosterone would benefit men without a clear indication for taking it, and there are still unresolved safety concerns about testosterone that just don’t justify widespread treatment of older men with normal age-related reduced testosterone,” Layton added.
In 2014, U.S. drug regulators raised safety concerns about the potential for testosterone to increase the risk of heart problems.
For the current study, researchers examined data on testosterone ad viewership, testosterone testing and prescriptions of the hormone from 2009 to 2013. They looked at insurance claims data for 17.2 million men in 75 distinct television markets nationwide.
During the study period, more than 1 million men got new tests for testosterone levels and more than 283,000 initiated testosterone treatment, the study found.
Among men who started taking testosterone, 59 percent used gels and 36 percent got injections, while a small minority of them got patches or implants.
Prior to 2012, ads for “low T” were the most common type of marketing. Then, after two new products – Axiron and a more concentrated form of Androgel – debuted in 2011, ads for specific products became more common and promotions for “low T” started to decrease.
During some months of the study, there were no ads at all, while in other months some men might have seen as many as 14 ads on average.
The most concentrated advertising efforts occurred in the Southeast and in the Great Lakes region, the study found.
Each additional ad men saw was associated with a 0.6 percent increase in testing as well as a 0.7 percent climb in new prescriptions for testosterone. There was also a 0.8 percent increase in new prescriptions that were not preceded by testing.
Although the impact of a single ad was slight, ads were widespread and frequent during the study period and cumulative exposure was close to 200 ads in some markets, the authors note.
The study wasn’t a controlled experiment designed to prove that ads directly influence whether men get testing or treatment for low testosterone, the researchers caution. They also relied on data for prescriptions, which doesn’t necessarily reflect how often men took the drugs.
Still, the findings should put consumers on alert to be wary of ads, said Dr. Richard Kravitz, a researcher at the University of California, Davis, and author of an accompanying editorial.
“Direct-to-consumer advertising is designed to be persuasive,” Kravitz said by email. “Patients can’t really avoid this. All they can do is reflect on the fact that ads are designed primarily to increase sales, not inform and educate the public, and they should try to present their symptoms and concerns as objectively as possible to their physician.”
Throughout the United States, U.K., and Australia, more and more cases of liver disease are arising in the absence of alcohol abuse. Decades ago, we only saw conditions like Fatty Liver Disease and cirrhosis occur as a direct result of excessive alcohol indulgence, however, this trend has changed in the current day. Today, more and more adults and children are being diagnosed with NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD).
NAFLD is a medical condition that is characterized by an excessive accumulation of fats, within liver cells. This means normal, healthy liver tissue becomes partly replaced with fatty tissue. The fat starts to invade the liver, gradually infiltrating the healthy liver areas, decreasing the amount of healthy active liver tissue.
While it�s normal for your liver to contain some fat, accumulations of more than 5 percent to 10 percent of your liver�s weight are problematic.
70 million Americans have fatty liver disease and don�t even know it.
Anatomy & Function of the Liver
The liver is one of the hardest-working organs in the body, working tirelessly day in and day out. So here�s what your liver does, in a nutshell. Your liver regulates most chemical levels in the blood and excretes bile. Bile is necessary to break down fats. All of the blood leaving the stomach and intestines must pass through the liver for filtering. It�s the liver�s responsibility to detoxify this blood. Here are several other important functions of the liver:
Detoxifies chemicals and metabolizes (breaks down) drugs.
Manufactures proteins important for the regulation of blood clotting
Breaks down excess hormones circulating in bloodstream
Produces cholesterol (necessary for vitamin D and hormone production and for healthy nerves)
Stores and releases glucose, as needed
Stores iron
Converts harmful ammonia to urea (urea is an end product of protein metabolism that gets excreted in the urine)
Clears the blood of alcohol, medications, drugs and other harmful chemicals
Produces immune factors and removes bacteria from the bloodstream
Clears and removes bilirubin (excessive buildup causes jaundice -yellowing of skin and eyes)
It�s the liver�s responsibility to process (store) nutrients, such as vitamins, minerals and iron, so they�re more efficiently absorbed.
Nonalcoholic fatty liver (NAFLD) has become increasingly common in the United States and Western Europe as weight gain, obesity, insulin resistance, diabetes and metabolic syndrome have risen in epidemic proportions. It is now the most common cause of liver disorders in the United States and other Western industrialized countries, such as Australia and the United Kingdom. It�s estimated that 1 in 5 people (25%) throughout these regions have NAFLD.
Although research has shown that NAFLD is most commonly caused by excess weight & obesity, metabolic syndrome and diabetes, studies have also revealed that the excessive use of prescribed medications and pain killers (or the toxicity of these) can lead to fatty liver disease, as well.
Symptoms of Liver Disease
A non-alcoholic fatty liver is often referred to as a �Silent Disease�. Initially there may be no symptoms, meaning, you can live with the condition for many years, even decades, and not realize it. Over time, however, some signs may begin to surface. These symptoms include:
feeling tired
fatigue
weight loss
loss of appetite
weakness
nausea
confusion
trouble concentrating
pain in the center or right upper part of belly
enlarged liver
bloating and gas
dark urine
bruising easily
sweating, excessively
constipation
dry and dark patches on neck and under arms
Over time, fatty liver disease can lead to cirrhosis of the liver. This occurs when scar tissue develops in the liver, preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs and naturally produced toxins, as well as the production of proteins and other substances made by the liver. Symptoms of cirrhosis are severe and include the buildup of fluid in the body (especially the abdominal cavity called ascites), muscle weakness, internal bleeding, yellowing of the skin and eyes, and liver failure.
Fatty Liver Diagnosis
The best way to diagnose a fatty liver is with an abdominal ultrasound or a biopsy, although an ultrasound is far less invasive. Often, people with NAFLD will not have elevated liver enzymes, so the blood tests may look normal. Elevated liver enzymes however, do indicate that you have inflammation of the liver which may be do to NAFLD or a more serious condition called NASH.
Root Causes & Risk Factors of Liver Disease
There are a number of risk factors that increase your chances of having NAFLD:
Obesity
Gastric bypass surgery
High cholesterol
High levels of triglycerides in the blood
Type 2 diabetes
Metabolic syndrome
Medications
Sleep apnea
Polycystic ovary syndrome (PCOS)
Underactive thyroid (hypothyroidism)
Underactive pituitary gland (hypopituitarism)
Hemachromatosis (excess iron accumulation)
A 2006 review published in the Journal of Clinical Gastroenterology states that NAFLD is a common finding among patients undergoing bariatric surgery, with an occurrence ranging between 84 percent to 96 percent. The review also noted that the disease seems to be most common among men, and it increases with menopause in women.
Foods That Can Lead to Fatty Liver Disease
High-Carbohydrate & Refined Foods
Foods such as bread, rice, and corn should be avoided. All white bread and carbs should be eliminated or significantly, reduced from your diet, and even whole grains should be consumed in moderation (because grains convert to sugar). All refined When we consume too many refined carbohydrates, insulin levels spike, and insulin sensitivity is a major factor in the cause of liver disease.
Sugary Drinks
Sports drinks (Gatorade/powerade), soda, energy drinks and fruit juices are full of sugar and artificial sweeteners. This sugar that enters your body causes fatty liver disease. The average 12-ounce can of soda, for example, has 10 teaspoons of sugar! Your body isn�t able to break down the amount of sugar that most Americans consume every day, and it�s impacting the liver, big time.
The American Heart Association (AHA) recommends no more than 6 tsp (25g) of sugar per day for women and 9 tsp (38g) per day for men. A child�s sugar intake should not exceed 3 tsp per day.
The average person consumes 20 tsp or more of sugar per day � equating to 66 pounds and more of sugar per year.
According to a study conducted at Emory University School of Medicine in Atlanta, sugars, particularly fructose, are suspected to contribute to the development of NAFLD and its progression. Fructose has been shown in research to do extensive damage to liver cells. There have also been substantial links between increased fructose consumption and obesity, dyslipidemia and insulin resistance.
Processed Foods
Hydrogenated oils, refined sugar, convenience foods and lunch meats are notoriously toxic to your system. Nitrates and nitrites, for example, are commonly found in processed foods and lunch meat, and they have been linked to serious conditions, including cancer. The high fructose corn syrup found in our processed foods is the single biggest cause of fatty liver; you must stay away from these products in order to heal liver disease.
Foods That Improve Fatty Liver Disease
A review published in the European Journal of Medicinal Chemistry states that natural enzymes found in vegetables, as well as fruits, plant extracts and herbs, have been traditionally used for treating liver diseases. It�s incredibly important to add vegetables to your everyday diet.
An easy way to do this is by juicing vegetables for near-perfect health. With impaired liver function, juicing vegetables has the added benefit of making the vegetables easier to digest and more readily available for absorption. Vegetables ideal for a liver detox include kale, cabbage, lettuce, cauliflower, broccoli, Brussels sprouts, asparagus, beets and celery.
Beets
Beets naturally cleanse and purify the blood, which boosts liver function and nutrient production in your body. Beets are also high in antioxidants, folate, iron, fiber and betaine (a natural digestive enzyme). Beets go great in juicing recipes and thrown into smoothies (a little goes a long way). Shred some beets and throw on your salads, daily.
Broccoli
Broccoli and other members of the cruciferous family (brussel sprouts, cauliflower, arugula, cabbage, collard greens, kale, bok choy) are high in fiber and glucosinolates, which help the liver naturally cleanse the body of carcinogens and other toxins.
Ginger Root
Ginger has powerful antioxidant and anti-inflammatory properties, especially necessary with a dysfunctional liver due to NAFLD. Ginger has also been found to drastically lower blood sugar levels. Elevated glucose and insulin resistance are 2 key factors in the development of a fatty liver. Make ginger tea by boiling ginger slices in green tea or water. You can also add ginger to a stir-fry, salad or smoothie.
Sweet Potatoes
Sweet potatoes, along with carrots, butternut squash and pumpkin) are rich in beta-carotene, a natural anti-inflammatory. A deficiency of potassium can disrupt liver function. Sweet potatoes, naturally high in potassium, are beneficial because they help support liver function. One sweet potato contains nearly 700 milligrams of potassium! It�s also rich with vitamins B6, C, D, magnesium and iron. Sweet potatoes are easy to eat because they�re naturally sweet, and the sugars are slowly released into the bloodstream through the liver, so it won�t cause a spike in blood sugar.
Lemons
Lemons are great for your liver. They provide a wealth of antioxidants and help your liver produce more enzymes giving you more energy and help with digestion.. Lemons are also naturally high in electrolytes. Although lemons are acidic, once they enter the body they become alkalinizing, which helps neutralize toxins, excrete wastes. Juice 1 fresh lemon, daily and drink-undiluted on an empty stomach every morning.
Bananas
Containing 470 milligrams of potassium, banana nutrition is also great for cleansing the liver and overcominglow potassium levels; plus, bananas assist in digestion and help release toxins and heavy metals from the body. A great way to decrease the liver�s burden.
Garlic, Whole Cloves
Garlic is rich in allicin and selenium, two powerhouse nutrients for your liver. They act in cleansing and in nourishing the entire body, especially the blood. Selenium is a naturally detoxifying mineral and allicin helps ward off immune system invaders, which helps lighten the load on your liver. Garlic also activates enzymes in the liver which help with overall digestion and flushing out toxins. Use whole garlic cloves as the best option, instead of processed minced garlic or powder.
Leafy Greens
The nutritional all-star ingredients for just about every health issue are leafy greens. Spinach, kale, chard, romaine, arugula, and collards are all some of the most nutrient dense leafy greens to enjoy. They�re packed with chlorophyll, which assists in liver function by purifying the blood, alleviating toxins, decreasing inflammation and promotes wound healing. Chlorophyll is also amazing at neutralizing heavy metals, toxic chemicals, and even pesticides that burden the liver.
Supplements That Improve Fatty Liver Disease
Dandelion Root
The vitamins and nutrients present in dandelions help cleanse our livers and keep them working properly. Dandelions also aid our digestive system by maintaining the proper flow of bile. They�re natural diuretics and allow the liver to eliminate toxins quickly. Dandelion tea or stems are also high in vitamin C, which helps with mineral absorption, reduces inflammation and prevents the development of disease.
Milk Thistle
As a liver support and aid, milk thistle is a powerful detoxifier. It helps rebuild liver cells while removing toxins from the body that are processed through the liver. According to a study published in Digestive Diseases and Sciences, milk thistle has the power to improve mortality in patients with liver failure; it�s able to naturally reverse the harmful effects of alcohol consumption, pesticides in our food supply, heavy metals in our water supply, pollution in the air that we breathe in and even poisons. According to a 2010 study, milk thistle benefitshelp treat alcoholic liver disease, acute and chronic viral hepatitis, and toxin-induced liver diseases.
Vitamin D
Recent studies have indicated that deficiencies in vitamin D can result in Non-alcoholic fatty liver disease (NAFLD). Vitamin D deficiency was shown to cause severe degrees of NAFLD along with liver inflammation and liver fibrosis (hardening). This research also revealed that vitamin D deficiencies also resulted in insulin resistance and metabolic syndrome. All of these factors play a significant role in the development of peripheral neuropathy (nerve damage). Optimum vitamin D levels should be between 70-100 ng/ml.
Curcumin
Curcumin, the active component of turmeric is arguably the most powerful herb on the planet at fighting and potentially reversing disease. Currently there have been over 6,000 peer-reviewed published articles proving the health benefits. Studies have also shown that curcumin may prevent the progression of fatty liver disease and reduces inflammation of the liver and body.
Black Seed Oil
This amazing oil can greatly speed the healing process for people with fatty liver disease. A study published in the European Review for Medical and Pharmaceutical Sciencesmeasured black seed oil�s ability to inhibit liver oxidative stress markers. The results of the study indicated that black seed oil benefitsliver disease patients because it�s able to reduce the complications and progression of fatty liver disease.
The best thing you can do to treat fatty liver disease is maintain a healthy diet. Many people with fatty liver disease are overweight and malnourished. A healthy diet that provides the vitamins and nutrients that your body needs to function is very important.
The number one treatment of fatty liver disease is weight loss and a healthy diet. It�s essential that you eat a well-balanced diet that is predominately plant-based; plus, you should exercise regularly � shoot for doing physical activity for at least 30 minutes a day, even if it�s taking a walk.
Sources:
Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005;42:44�52. [PubMed]
Adams LA, Lymp JF, Sauver J, St, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129:113�121. [PubMed]
Peripheral Neuropathy and Fatty Liver Disease
Nonalcoholic fatty liver disease (NAFLD) is considered the most common liver disorder in the Western world. It�s recognized as one of the most common forms of chronic liver disease across the globe.
A study published in the Journal of Gastroenterology and Hepatology (2003) reported a link between non-alcoholic fatty liver disease (NAFLD) and peripheral neuropathy. The research revealed that 73% of people with NAFLD would develop peripheral nerve damage leading to the symptoms of peripheral neuropathy.
As if the development of peripheral neuropathy isn�t bad enough, science shows that the longer you have NAFLD, the more likely it is to progress into liver fibrosis (accumulation of abnormal fibrous tissue), cirrhosis (accumulation of scar tissue in the liver) and NASH (severe liver inflammation and cell damage).
Although, NAFLD is most likely to happen in people who are overweight with metabolic syndrome or type 2 diabetes, recently there are more and more cases of children with NAFLD. This is a direct result of the standard American diet. Pediatric NAFLD have been reported in children as young as 3 years old.
If you have been diagnosed with NAFLD or are overweight, suffer from metabolic syndrome, insulin resistance or diabetes, it�s important to take action. The good news is � The liver is the only organ capable of fully regenerating itself. As long as you have at least 15% of your liver that is working and functional, your body can repair and regenerate your liver.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Whole Body Wellness
Following a balanced nutrition, participating in regular physical activity and getting plenty of rest are fundamental factors for maintaining whole body wellness. While all of these can make you look and feel healthy, its also essential to address the health of your spine in order to maintain the proper function of all the body�s structures. Chiropractic care is a well-known alternative treatment option utilized by many individual�s to restore the health of the spine as well as maintain it. Chiropractic can also help prevent complications related to spinal injuries and conditions.
You add it to your morning cup of coffee or tea. You bake it into pastries, cakes, and cookies. You even sprinkle it all over your breakfast cereal or your oatmeal.
But that�s not all. It�s also hidden in many of our favorite �treats� that people consume on a daily basis, such as sodas, fruit juices, candies, ice cream, almost all processed foods, and even condiments like ketchup.
But how exactly does sugar work in our body, how much sugar is acceptable and what are the side effects of eating too much sugar on people�s health?
How Excessive Sugar Affects Your Health
Today, an average American consumes about 32 teaspoons (126 grams) of sugar per day or 134 pounds per year, based on the latest research released in February 2015.
What�s even more disturbing is that people are consuming excessive sugar in the form of fructose or high-fructose corn syrup (HFCS). This highly processed form of sugar is cheaper yet 20 percent sweeter than regular table sugar, which is why many food and beverage manufacturers decided to use it for their products, as it would allow them to save money in the long run.
The bad news is that the human body is not made to consume excessive amounts of sugar, especially in the form of fructose. In fact, your body metabolizes fructose differently than sugar. Fructose is actually a hepatotoxin (toxic to the liver) and is metabolized directly into fat � factors that can cause a whole host of problems that can have far-reaching effects on your health.
Effects of Consuming Too Much Sugar
Dr. Robert Lustig, a professor of Clinical Pediatrics in the Division of Endocrinology in the University of California and a pioneer in decoding sugar metabolism, says that your body can safely metabolize at least six teaspoons of added sugar per day. But since most Americans are consuming over three times that amount, the majority of the excess sugar becomes metabolized into body fat � leading to all the debilitating chronic metabolic diseases many people are struggling with.
Here are some of the effects that consuming too much sugar has on your health:
It overloads and damages your liver. The effects of too much sugar or fructose can be likened to the effects of alcohol. All the fructose you eat gets shuttled to the only organ that has the transporter for it: your liver. This severely taxes and overloads the organ, leading to potential liver damage.
It tricks your body into gaining weight and affects your insulin and leptin signaling.Fructose fools your metabolism by turning off your body�s appetite-control system. It fails to stimulate insulin, which in turn fails to suppress ghrelin, or �the hunger hormone,� which then fails to stimulate leptin or �the satiety hormone.� This causes you to eat more and develop insulin resistance
It causes metabolic dysfunction. Eating too much sugar causes a barrage of symptoms known as classic metabolic syndrome. These include weight gain, abdominal obesity, decreased HDL and increased LDL, elevated blood sugar, elevated triglycerides, and high blood pressure.
It increases your uric acid levels. High uric acid levels are a risk factor for heart and kidney disease and also the cause of Gout. In fact, the connection between fructose, metabolic syndrome, and your uric acid is now so clear that your uric acid level can now be used as a marker for fructose toxicity. According to the latest research, the safest range of uric acid is between 3 to 5.5 milligrams per deciliter. If your uric acid level is higher than this, then it�s clear that you are at risk to the negative health impacts of fructose.
Sugar Can Increase the Risk of Disease
One of the most severe effects of eating too much sugar is its potential to wreak havoc on your liver, leading to a condition known as non-alcoholic fatty liver disease (NAFLD).
Yes, the same disease that you can get from excessive alcohol intake can also be caused by excessive sugar (fructose) intake. Dr. Lustig explained the three similarities between alcohol and fructose:
Your liver metabolizes alcohol the same way as sugar, as both serve as substrates for converting dietary carbohydrate into fat. This promotes insulin resistance, fatty liver, and dyslipidemia (abnormal fat levels in your blood)
Fructose causes superoxide free radicals to form, resulting in inflammation � a condition that can be also caused by acetaldehyde, a metabolite of ethanol
Fructose can directly and indirectly stimulate the brain�s �hedonic pathway,�(addiction pathway) creating habituation and dependence, the same way that ethanol does
But if you think that�s the only way eating too much sugar wreaks havoc on your body, you�re dead wrong. Research from some of America�s most respected institutions now confirms that sugar is a primary dietary factor that drives obesity and chronic disease development.
One study found that fructose is readily used by cancer cells to increase their proliferation � it �feeds� the cancer cells, promoting cell division and speeding their growth, which allow the cancer to spread faster.
Alzheimer�s disease is another deadly illness that can arise from too much sugar consumption. A growing body of research found a powerful connection between a high-fructose diet and your risk of developing Alzheimer�s disease, through the same pathway that causes type 2 diabetes. According to some experts, Alzheimer�s and other brain disorders may be caused by the constant burning of glucose for fuel by your brain.
Other diseases that are linked to metabolic syndrome and may potentially arise because of too much sugar consumption include:
Type 2 Diabetes
Hypertension
Heart Disease
Peripheral Neuropathy
Polycystic Ovarian Syndrome
Lipid (cholesterol) problems
Dementia (Alzheimer�s disease)
Cancer
Reducing Your Sugar Consumption
Sugar, in its natural form, is not inherently bad, as long as it�s consumed in moderation. This means avoiding all sources of fructose, particularly processed foods and beverages like soda. According to SugarScience.org, 74 percent of processed foods contain added sugar stealthily hidden under more than 60 different names. Ideally, you should spend 90 percent of your food budget on whole foods, and only 10 percent or less on processed foods.
I also advise you to severely limit your consumption of refined carbohydrates (waffles, cereals, bagels, etc.) and grains, as they actually break down to sugar in your body, which increases your insulin levels and causes insulin resistance.
As a general recommendation, I advise you to keep your total fructose consumption below 25 grams per day, including that from whole fruit. Keep in mind that although fruits are rich in nutrients and antioxidants, they also naturally contain fructose, and if consumed in high amounts may actually worsen your insulin sensitivity and raise your uric acid levels.
Remember that artificial sweeteners like aspartame and sucralose are also a no-no, as they actually come with a whole new set of health problems that are much worse than what sugar or corn syrup can bring.
KICK THE CRAVINGS!
We continue to see emerging evidence in the literature (research) that obesity, pre-diabetes and diabetes are driving factors not only for chronic conditions like Peripheral Neuropathy, but also for a slew of other chronic diseases, including cancer. It�s important to realize that you don�t have to give up sugar completely but you must reduce it substantially in your diet. Research has shown that no one should be consuming more than 6 teaspoons of sugar per day, and this includes fruit sugar, as well.
In order to get healthy and fight off chronic illness, here are some additional dietary tips to remember:
Increase your consumptionof healthy fats, such asomega-3, saturated, and monounsaturated fats. Your body needs health-promoting fats from animal and vegetable sources for optimal functioning. In fact, emerging evidence suggests that healthy fats should make up at least 70 percent of your diet. Some of the best sources include organic butter from raw milk, (unheated) virgin olive oil, coconut oil, ghee, raw nuts like pecans and macadamia, free-range eggs, avocado, and wild Alaskan salmon.
Drink pure, clean water. Simply swapping out all the sweetened beverages like sodas and fruit juices for pure water can go a long way toward improving your health. The best way to gauge your water needs is to observe the color of your urine (it should be light pale yellow) and the frequency of your bathroom visits (ideally, this is around seven to eight times per day).
Add fermented foods to your meals. The beneficial bacteria in these healthful foods can support your digestion and provide detoxification support, which helps lessen the fructose burden on your liver. Some of the best choices include kimchi, natto, organic yogurt and kefir made from grass-fed milk, and fermented vegetables.
How to Get Rid of Your Sugar Cravings
Sugar is highly addictive and affects depency centers in the brain but it can also have an emotional component, as well. In order to squelch sugar cravings, it�s important to detox. Here at our clinic we utilize a 21 day Jump Start program. This is a great program for detoxing your body from unwanted chemicals and sugar addiction and for decreasing inflammation.
The temptation to eat or indulge in sugary foods will always be there, especially with the abundance of processed foods and fast foods everywhere. However, most sugar cravings arise because of an emotional challenge. If this is what causes you to crave sugar, the best solution I could recommend is the Emotional Freedom Technique (EFT). This technique is a simple and effective strategy to help control your emotional food cravings.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Whole Body Wellness
Following a balanced nutrition, participating in regular physical activity and getting plenty of rest are fundamental factors for maintaining whole body wellness. While all of these can make you look and feel healthy, its also essential to address the health of your spine in order to maintain the proper function of all the body�s structures. Chiropractic care is a well-known alternative treatment option utilized by many individual�s to restore the health of the spine as well as maintain it. Chiropractic can also help prevent complications related to spinal injuries and conditions.
Peripheral neuropathy may be more common in patients with pre-diabetes than previously thought, and early interventions may be warranted in this patient population, according to researchers from the University of Utah.
Currently, 86 million adults � more than one in three U.S. adults � have prediabetes, according to CDC estimates. Without weight loss and moderate physical activity, 15% to 30% of these people will develop full-blowntype 2 diabetes within 5 years.1
�We know now a lot more than we did 3 or 5 years ago about neuropathic pain in patients with prediabetes. Neuropathy affects patients with prediabetes in a continuum,� said J. Rob Singleton, MD, who is a professor of neurology at the University of Utah in Salt Lake City. �We think it is more obesity and dysfunction of lipids (fats) that is causing the problem.�
Research Shows the Link between Obesity, Pre-diabetes and Neuropathy
In another study conducted by researchers from the University of Michigan, peripheral neuropathy was also common in obese patients, even if they had normal blood sugar levels, when compared with lean control participants. This same study also confirmed that rates of neuropathy were increased in participants with prediabetes and diabetes, leading the researchers to conclude that diabetes, prediabetes, and obesity are likely metabolic drivers of peripheral neuropathy. The findings were published in JAMA Neurology.1
Dr. Singleton and his team have been studying peripheral neuropathy associated with prediabetes and metabolic syndrome as well as what treatments may work best. Metabolic syndrome is the name for a group of risk factors that raise the risk for heart disease, diabetes and stroke. Risk factors include high blood pressure, elevated blood glucose, elevated cholesterol, and abdominal fat. Through their research, they have found that many patients with metabolic syndrome have pre-diabetes and peripheral neuropathy. Therefore, a multi-pronged approach to managing these patients is essential.
�We have shown that, in pre-diabetics with neuropathic pain, exercise reduces neuropathic pain and increases the intradermal nerve fibers in the thigh and ankle. We are in the process now of replicating that study,� Singleton said in an interview withEndocrinology Advisor. �You need to improve lipid (cholesterol) function and glucose levels. So, lifestyle issues have to be addressed.�
Relationship Between Nerve Damage and Pre-diabetes
New studies evaluating the link between prediabetes and peripheral neuropathy are filling in some of the gaps in knowledge.
In a study recently published in Diabetes Care, C. Christine Lee, PhD, of the University of Toronto, and colleagues reported that prediabetes was associated with similar risks for nerve dysfunction and damage leading to peripheral neuropathy as one develops with �new-onset� diabetes.2
While the exact mechanisms behind these associations are unclear, a growing body of evidence suggests that peripheral neuropathy begins in the early stages of diabetes pathogenesis, the researchers noted.
Lee and colleagues analyzed data on 467 individuals. The researchers found that the prevalence of peripheral neuropathy was 29% in adults with normal glucose levels, as compared with 49% in adults with prediabetes and 50% in adults with new-onset diabetes.
The researchers also found that progression of elevated glucose (pre-diabetes) over 3 years predicted a higher risk for peripheral neuropathy and nerve dysfunction.
Early intervention with lifestyle changes involving diet and exercise may be vital to preventing the severity of nerve damage, Dr. Lee stated. This had previously been backed up by another study published in 2006 in Diabetes Care, by Dr. Singleton. Singleton and his colleagues found that dietary changes and exercise can result in cutaneous reinnervation and improved pain in patients with prediabetes.3
Nerve Damage Occurs Long Before Diabetes
It is imperative to realize that the nerve damage seen in peripheral neuropathy can actually occur long before diabetes sets in. In fact the most current research has shown that obesity, even with normal glucose (blood sugar) levels has been linked with causing peripheral neuropathy as well as pre-diabetes. Although it is important to strive for maintaining fasting glucose levels between 70 � 80 mg/dL, it is equally important to keep your weight down, lower LDL cholesterol and triglycerides. All of this can be accomplished without the use of medication or bariatric procedures.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Neck Pain and Auto Injury
Neck pain is characterized as the most prevalent symptom after being involved in an automobile accident. During an auto collision, the body is exposed to a sheer amount of force due to the high speed impact, causing the head and neck to jolt abruptly back-and-forth as the rest of the body remains in place. This often results in the damage or injury of the cervical spine and its surrounding tissues, leading to neck pain and other common symptoms associated with whiplash-related disorders.
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