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Complex Regional Pain Syndrome (CRPS / RSD)

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Complex regional pain syndrome (CRPS) is a chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet), usually after an injury or trauma to that limb. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and mild or dramatic changes in skin color, temperature, and/or swelling in the affected area.

There are two similar forms, called CRPS-I and CRPS-II, with the same symptoms and treatments. CRPS-II (previously called causalgia) is the term used for patients with confirmed nerve injuries. Individuals without confirmed nerve injury are classified as having CRPS-I (previously called reflex sympathetic dystrophy syndrome). Some research has identified evidence of nerve injury in CRPS-I, so the validity of the two different forms is being investigated.

CRPS symptoms vary in severity and duration. Studies of the incidence and prevalence of the disease show that most cases are mild and individuals recover gradually with time. In more severe cases, individuals may not recover and may have long-term disability.

What are the symptoms of CRPS?

The key symptom is prolonged pain that may be constant and, in some people, extremely uncomfortable or severe. The pain may feel like a burning or “pins and needles” sensation, or as if someone is squeezing the affected limb. The pain may spread to include the entire arm or leg, even though the precipitating injury might have been only to a finger or toe. Pain can sometimes even travel to the opposite extremity. There is often increased sensitivity in the affected area, such that even light touch or contact is painful (called allodynia).

People with CRPS also experience constant or intermittent changes in temperature, skin color, and swelling of the affected limb. This is due to abnormal microcirculation caused by damage to the nerves controlling blood flow and temperature. An affected arm or leg may feel warmer or cooler compared to the opposite limb. The skin on the affected limb may change color, becoming blotchy, blue, purple, pale, or red.

Other common features of CRPS include:

  • changes in skin texture on the affected area; it may appear shiny and thin
  • abnormal sweating pattern in the affected area or surrounding areas
  • changes in nail and hair growth patterns
  • stiffness in affected joints
  • problems coordinating muscle movement, with decreased ability to move the affected body part, and
  • abnormal movement in the affected limb, most often fixed abnormal posture (called dystonia) but also tremors in or jerking of the affected limb.

How is CRPS diagnosed?

Currently there is no single diagnostic test to confirm CRPS. Diagnosis is based on the affected individual’s medical history and signs and symptoms that match the definition. But because several other conditions can cause similar symptoms, careful examination is important. Since most people improve gradually over time, diagnosis may be more difficult later in the course of the disorder.

Testing also may be used to help rule out other conditions, such as arthritis syndromes, Lyme disease, generalized muscle diseases, a clotted vein, or small nerve fiber polyneuropathies (such as from diabetes), because these require different treatment. The distinguishing feature of CRPS is usually a history of earlier injury to the affected area, as most of these other conditions are not triggered by injury. Individuals without a history of injury should be carefully examined to make sure that another treatable diagnosis is not missed.

Magnetic resonance imaging or triple-phase bone scans sometimes identify CRPS-characteristic changes in the bone metabolism. CRPS is often associated with excess bone resorption, a process in which certain cells break down the bone and release calcium into the blood.

How is CRPS treated?

The following therapies are often used:

Rehabilitation therapy. An exercise program to keep the painful limb or body part moving can improve blood flow and lessen the circulatory symptoms. Additionally, exercise can help improve the affected limb’s flexibility, strength, and function. Rehabilitating the affected limb also can help to prevent or reverse the secondary brain changes that are associated with chronic pain. Occupational therapy can help the individual learn new ways to work and perform daily tasks.  

Graded motor imagery : The strongest evidence is for graded motor imagery, which led to significant reductions in pain and swelling in patients with CRPS in three small single-center randomized controlled trials . However, a prospective observational study from two centers with a special interest in CRPS found no improvement in pain despite the use of graded motor imaging , suggesting it does not translate well into clinical practice . Physical Therapy, which can be performed twice daily at home for patients in all stages of disease, should ideally begin before limitation of movement occurs in order to maintain range of motion and prevent contractures. Resting splints for the affected limb are sometimes used with a goal of preventing progressive joint contractures.

Psychotherapy. CRPS and other painful and disabling conditions often are associated with profound psychological symptoms for affected individuals and their families. People with CRPS may develop depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult. Treating these secondary conditions is important for helping people cope and recover from CRPS.

Medications. Several different classes of medication have been shown to be effective for CRPS, particularly when used early in the course of the disease. No drug is approved by the U.S. Food and Drug Administration specifically for CRPS. No single drug or combination of drugs is guaranteed to be effective in every person. Drugs to treat CRPS include:

  • non-steroidal anti-inflammatory drugs to treat moderate pain, including over-the-counter aspirin, ibuprofen, and naproxin
  • corticosteroids that treat inflammation/swelling and edema, such as prednisolone and methylprednisolone (used mostly in the early stages of CRPS)
  • drugs initially developed to treat seizures or depression but now shown to be effective for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine.
  • Bisphosphonates — Bisphosphonates may be effective for reducing pain in patients with early CRPS who have abnormal uptake on bone scan, even though their positive effects in this condition are probably not related to their antiresorptive properties . Supporting evidence comes from several small placebo-controlled randomized trials, including trials of intravenous and oral alendronate, intravenous neridronate, intravenous pamidronate, and intravenous clodronate. Four of these trials enrolled only patients who had evidence of osteopenic or osteoporotic changes in the affected limb .
  • botulinum toxin injections
  • opioids such as oxycontin, morphine, hydrocodone, fentanyl, and vicodin
  • N-methyl-D-aspartate (NMDA) receptor antagonists such as dextromethorphan and ketamine
  • nasal calcitonin, especially for deep bone pain, and
  • topical local anesthetic creams and patches such as lidocaine.
  • Alpha-adrenergic antagonists and agonists – Sympathetically maintained pain may respond to the addition of an alpha-1 adrenoceptor antagonist, which is supported by the clinical experience of the author and other experts . Some benefit in some patients with the use of either prazosin (1 to 6 mg/day as tolerated) or phenoxybenzamine (10 to 30 mg/day as tolerated). Hypotension can be a limiting side effect of alpha-adrenergic blockers. The author has also treated patients using a clonidine patch (0.1 mg), which is changed every seven days, usually in combination with anticonvulsants and/or antidepressants; this approach has generally not resulted in significant side effects.

All drugs or combination of drugs can have various side effects such as drowsiness, dizziness, increased heartbeat, and impaired memory. Inform a healthcare professional of any changes once drug therapy begins.

Sympathetic nerve block. Some individuals report temporary pain relief from sympathetic nerve blocks, but there is no published evidence of long-term benefit. Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow.

Surgical sympathectomy. The use of this operation that destroys some of the nerves is controversial. Some experts think it is unwarranted and makes CRPS worse; others report a favorable outcome. Sympathectomy should be used only in individuals whose pain is dramatically relieved (although temporarily) by sympathetic nerve blocks. It also can reduce excess sweating.

Spinal cord stimulation. Placing stimulating electrodes through a needle into the spine near the spinal cord provides a tingling sensation in the painful area. Typically the electrode is placed temporarily for a few days to assess whether stimulation will be helpful. Minor surgery is required to implant all the parts under the skin on the torso. Once implanted, the stimulator can be turned on and off, and adjusted using an external controller. Data shows that about one-fourth of individuals develop equipment problems that may require additional surgeries.

Other types of neural stimulation.Neurostimulation can be delivered at other locations along the pain pathway, not only at the spinal cord. These include near injured nerves (peripheral nerve stimulators), outside the membranes of the brain (motor cortex stimulation with dural electrodes), and within the parts of the brain that control pain (deep brain stimulation). A recent option involves the use of magnetic currents applied externally to the brain (called repetitive Transcranial Magnetic Stimulation, or rTMS). The advantage is that no surgery is required; the disadvantage is need for repeated treatment sessions.

Intrathecal drug pumps. These devices pump pain-relieving medications directly into the fluid that bathes the spinal cord, typically opioids and local anesthetic agents such as clonidine and baclofen. The advantage is that pain-signaling targets in the spinal cord can be reached using doses far lower than those required for oral administration, which decreases side effects and increases drug effectiveness. There are no studies that show benefit specifically for CRPS.

Emerging treatments for CRPS include:

  • Intravenous immunoglobulin (IVIG). Researchers in Great Britain reported that low-dose IVIG reduced pain intensity in a small trial of 13 patients with CRPS for 6 to 30 months who did not respond well to other treatments. Those who received IVIG had a greater decrease in pain scores than those receiving saline during the following 14 days after infusion. A larger study involving individuals with acute-phase CRPS is planned.
  • Ketamine. Investigators are using low doses of ketamine—a strong anesthetic—given intravenously for several days to either reduce substantially or eliminate the chronic pain of CRPS. In certain clinical settings, ketamine has been shown to be useful in treating pain that does not respond well to other treatments. Dr. Sendi is the leading provider of Ketamine Therapies in Virginia. NOVA Health Recovery 703-844-0184

Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists.AUCohen SP, Bhatia A, Buvanendran A, Schwenk ES, Wasan AD, Hurley RW, Viscusi ER, Narouze S, Davis FN, Ritchie EC, Lubenow TR, Hooten WM SOReg Anesth Pain Med. 2018;43(5):521. BACKGROUNDOver the past 2 decades, the use of intravenous ketamine infusions as a treatment for chronic pain has increased dramatically, with wide variation in patient selection, dosing, and monitoring. This has led to a chorus of calls from various sources for the development of consensus guidelines.METHODSIn November 2016, the charge for developing consensus guidelines was approved by the boards of directors of the American Society of Regional Anesthesia and Pain Medicine and, shortly thereafter, the American Academy of Pain Medicine. In late 2017, the completed document was sent to the American Society of Anesthesiologists’ Committees on Pain Medicine and Standards and Practice Parameters, after which additional modifications were made. Panel members were selected by the committee chair and both boards of directors based on their expertise in evaluating clinical trials, past research experience, and clinical experience in developing protocols and treating patients with ketamine. Questions were developed and refined by the committee, and the groups responsible for addressing each question consisted of modules composed of 3 to 5 panel members in addition to the committee chair. Once a preliminary consensus was achieved, sections were sent to the entire panel, and further revisions were made. In addition to consensus guidelines, a comprehensive narrative review was performed, which formed part of the basis for guidelines.RESULTSGuidelines were prepared for the following areas: indications; contraindications; whether there was evidence for a dose-response relationship, or a minimum or therapeutic dose range; whether oral ketamine or another N-methyl-D-aspartate receptor antagonist was a reasonable treatment option as a follow-up to infusions; preinfusion testing requirements; settings and personnel necessary to administer and monitor treatment; the use of preemptive and rescue medications to address adverse effects; and what constitutes a positive treatment response. The group was able to reach consensus on all questions. CONCLUSIONS Evidence supports the use of ketamine for chronic pain, but the level of evidence varies by condition and dose range. Most studies evaluating the efficacy of ketamine were small and uncontrolled and were either unblinded or ineffectively blinded. Adverse effects were few and the rate of serious adverse effects was similar to placebo in most studies, with higher dosages and more frequent infusions associated with greater risks. Larger studies, evaluating a wider variety of conditions, are needed to better quantify efficacy, improve patient selection, refine the therapeutic dose range, determine the effectiveness of nonintravenous ketamine alternatives, and develop a greater understanding of the long-term risks of repeated treatments.

  • Hyperbaric oxygen. Several studies have investigated the use of hyperbaric oxygen therapy for chronic pain. Individuals lie down in a tank containing pressurized air, which delivers more oxygen to the body’s organs and tissues. Although research is still experimental, some researchers report hyperbaric oxygen can reduce swelling and pain, and improve range of motion in individuals with CRPS.

Several alternative therapies have been used to treat other painful conditions. Options include behavior modification, acupuncture, relaxation techniques (such as biofeedback, progressive muscle relaxation, and guided motion therapy), and chiropractic treatment.

Depression Esketamine Ketamine

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Is a Club Drug the New Holy Grail for Depression Treatment

Clinical depression is a mental health condition that affects millions of people every year and is commonly found in those with a substance use disorder or addiction. Very often, people use drugs or alcohol as a coping strategy for dealing with the psychological pain and sadness of depression.

Yes, I am not a great fan of these lifelong clinical diagnoses and yes, there are also many other reasons why people are depressed and/or use drugs and alcohol, but I’ve seen this specific combination hundreds of times. Nevertheless, the unique combination of causes and circumstances means that, oftentimes, the presentation in one individual is somewhat distinctive.

And the same can be said for the appropriate treatment approaches. What works for one person and fits their needs may not work for another. For instance, treatments may depend on socioeconomic circumstances – someone who is living comfortably might do well focusing solely on their mental health and on methods to avoid and reduce the impact of temptation, while someone who is homeless and unemployed might need help with practical resources like housing and food in addition to treatment. A single treatment that will help everyone will likely never be found.

Fortunately, there are many different forms of treatment available for depression and addictionMedication, for example, is one option that can help with some of the symptoms of depression. Certainly, medication alone is rarely the answer (although for a subset of people it does an incredible job), but there is little question that for a large proportion of people short-, or long-term pharmacological help for depression and addiction are helpful. Due to the vast differences in individual physiological and neurological makeup, two people may respond very differently to the same medication. This means that medications that work well in some situations (and for some people) may produce little response for others.

What Exactly Is Depression?

Major depressive disorder (MDD) is a mood disorder that affects a person biologically, psychologically, emotionally and socially. It is important to note that, while everyone has bad days, and everyone will feel down at some point, MDD refers to much more substantial mood dysregulation. This is depression that has lasted several weeks with essentially daily symptoms and which is debilitating and interfering with normal life. Some of the symptoms include:

  • Depressed mood, sadness, or no emotion at all (anhedonia)
  • Unreasonable or uncalled for guilt
  • Agitation or sudden angry outbursts
  • Significant changes in sleep or weight
  • Loss of interest in things that were once found to be enjoyable, no joy in life
  • Isolation
  • Vague complaints about health with no medical problems to explain them
  • Thoughts of suicide

Depression is a relatively common condition, with 17% of the population meeting criteria for MDD at some point in their life and about 7% experiencing MDD in any given year. And people who struggle with an addiction are about five-times more likely to also struggle with depression or another mental illness (80% of our IGNTD Recovery participants report struggling with depression). They need treatment options that work for them.article continues after advertisement

Depression Treatments

If you take anything away from this article, it should be that treatment for depression IS available. The sooner that you reach out for help, the easier finding the right solution will be. Traditional treatment comes in the form of support, talk therapy and medication, among other options.

One of the first steps in any type of treatment should be a thorough understanding of who you are and what is going on for you. Depression can look different in different people, and not everyone will present with the same symptoms. For example, men often appear angry or agitated while women experience guilt and appear sad. Understanding your own symptoms may help tailor the treatment to your specific needs.

Person-centered treatment focuses on what you need and rarely forces (or even cajoles) clients to participate in treatment they’re not inclined to take part in. Not everyone will need or want medication for their depression, but it is available. Because different types of bodies react differently to medication, options are necessary for effectively treating everyone.

Ketamine as a Depression Treatment Method

Ketamine is one such option that may prove to be useful in treating depression. It is a “club drug” that has long been known for its recreational use in the club scene. It is also medically used as a surgical sedative for both animals and children. And for the past few year it has been looked at as a potential antidepressant.

The most unique aspect of this is that pharmaceutical companies are testing Ketamine as a fast-acting antidepressant. This is in contrast to traditional antidepressants that take weeks to produce their therapeutic effect. This delay in action for traditional antidepressants has been one of the major obstacles and complaints associated with their use for decades. Being able to eliminate this gap could prove incredibly useful for millions. Ketamine has been primarily used in clinics that employ intravenous methods, which can be incredibly intrusive and create a real barrier to use. However, in clinical trials going on right now, the introduction of Ketamine in a nasal spray is being investigated. And early evidence suggests that Ketamine can be effective in mere hours! it has been shown to be better at relieving depression that traditional antidepressants.

An exciting potential path forward

Ketamine presents the potential to be a very exciting new medication for depression. It is in the beginning stages of trials and it does come with side-effects. People report feeling nausea, disoriented, and feel like they are having an out of body experience. It does work very differently from traditional antidepressants, because it is unlikely that serotonin activity is involved in its action. Ketamine’s mechanisms of affecting depression are being explored and it likely has to do with its NDMA receptor activity. While Ketamine’s use for depression is still relatively limited, this gives people a lot of hope for the future of effective depression treatment and there has been some serious excitement building over the past few years that it could usher a new age for MDD sufferers.

Depression can be a painful and crippling illness. Combined with an addiction, it can even be deadly, leading to suicide. Those who suffer from depression come from all walks of life, all ages, races, and social statuses. The increasingly large number of people effected means that we need to increase options for treatment as well. Ketamine is an exciting possibility that may give relief to millions who suffer from depression and proves that hope and healing are available. Either in combination with traditional medication and therapy or by itself, Ketamine’s fast action on depression could mean the difference between recovery and suicide. Still, it’s important to be cautiously optimistic and resist the urge to believe that Ketamine will be the silver bullet against depression.

References

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593-602.

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I tried ketamine to treat my depression. Within a day, I felt relief.

I am going to die in this dentist’s chair.

My eyes are closed, but I can still see skulls outlined with white against a black background. I have an epiphany: God is death. I’m in the midst of a real-life version of the hallucinogenic ride in Willy Wonka and the Chocolate Factory, all in my own mind.

A monitor emits a steady beep, and for a second, I think I’m flatlining. But no: I’ve just completed my first infusion of ketamine, a veterinary anesthetic (often used on cats and horses) sometimes used illegally as a club drug called Special K.

I am here because I cannot stop thinking about suicide. I’ve been in therapy on and off for more than 30 years, since I was 5, and on depression medication for more than a decade. Nothing seemed to work. I couldn’t stop imagining killing myself in increasingly vivid daydreams.

As a journalist who covers health and medicine, I had read about the success of experimental trials that used ketamine to treat depression. My therapists had recommended extreme treatments like electroshock therapy, a procedure that frightened me due to reports of memory loss from those who had undergone it, but had never mentioned this. But I was getting desperate for a serious intervention.

After some research, I concluded that ketamine was not only more affordable but just as effective as sending electrical pulses through my brain. (About 70 to 85 percent of patients with severe depression who try ketamine treatment say it’s effective, compared with 58 to 70 percent of ECT patients.) I told my doctor I wanted to try it.

It wasn’t my goal to be on the vanguard, just to get better, but I am an early adopter of a treatment that could one day help millions of people with chronic depression. After a full treatment cycle, my suicidal thoughts went away. And depression isn’t the only psychiatric illness the drug may combat. Studies are being conducted on ketamine’s efficacy on anxiety, bipolar disorder, post-traumatic stress disorder, and even obsessive-compulsive disorder.

That’s how I wound up glued to that dentist-style chair at a clinic in Houston envisioning skulls, as an IV drip steadily infused me with a drug I’d thought was reserved for rave-goers.

An anesthetic that triggers happiness

Most people familiar with ketamine know it as either a veterinary medicine or an illegal street drug. But it’s been approved by the Food and Drug Administration for anesthetic use for humans since 1970. Its rise as a treatment for depression, a legal but off-label usage not yet approved by the FDA, is even more recent. On Tuesday, the FDA approved the use of the drug for depression treatment.

Ketamine’s antidepressant effects were revealed in a Yale study in 2000. Over the next decade, researchers continued to explore its potential as a treatment for major depressive disorder. Asim Shah, a professor and executive vice chair at Baylor College of Medicine who co-led several of these studies, told me that doctors have long been curious about the euphoric effects of ketamine. A lot of people given ketamine as an anesthetic “would start smiling or laughing,” he says. “That’s the reason that many people before have said, ‘Oh, maybe it can be used for depression.’”

As of now, selective serotonin reuptake inhibitors (SSRIs) like Prozac and multiple-receptor antidepressants such as trazodone are among the most commonly prescribed drugs to treat depression. Yet studies show that only around 37 percent of people who use these drugs experience full remission. The number drops past the first year of use.

Ketamine is an NMDA (N-methyl-D-aspartate) receptor antagonist, which means that it targets glutamate absorption in the nerve cells, unlike traditional antidepressants, which raise serotonin levels by blocking the reabsorption of the neurotransmitter. Glutamate is associated with excitability — among many other brain functions such as memory. Researchers like Shah believe that as the brain metabolizes the ketamine, new neural pathways are created that help restore function obliterated by depression. It’s this effect, not the experience of hallucinations or dissociation, that can help treat depression.

Despite its association with the platform sneakers and vinyl pants of the 1990s club scene, ketamine abuse began in the ’80s. People who take ketamine recreationally do so for its fast-acting high, which is typically a floating or out-of-body experience coupled with euphoria. But it’s not the kind of party drug that will bump up your social skills. After all, it is an anesthetic: Users retreat into their minds and experience hallucinations, sometimes reporting religious experiences or even a feeling some compare to rebirth. Drawbacks of recreational use of the drug include risk of overdose, dependence, and high blood pressure.

Butfor someone experiencing intense depression, that “rebirthing” can be therapeutic.

Depression feels like blunt force trauma

What people who have never battled depression don’t understand is that it has little to do with “feeling sad.” Sadness is a flesh wound, a knife cut that might sting but eventually heals. Chronic depression is blunt force trauma to the head, locking you into a pattern of negative thought and throwing away the key.

On my quest to find a fix for my depression, I was shuffled from practitioner to practitioner like a poorly behaved foster kid. By the beginning of 2018, my psychiatrist said I had tried (and failed) nearly every class of drug aimed at treating depression. I was fresh out of options and desperate enough to try something more experimental.

When I decided I wanted to try ketamine, I went to the Menninger Clinic in Houston, a respected psychiatric clinic I had written about, to figure out next steps. I was an obvious candidate, as I had been on antidepressants for more than a decade and had shown little improvement; I just needed to be approved for the treatment after a consultation.

I met with Justin Coffey, the medical director of Menninger’s Center for Brain Stimulation Services, to discuss my history and we reached an agreement: I’d try two infusions of the drug, and if it had a positive effect, I’d do four more. At Menninger, this cost $600 for each session, and it’s not covered by insurance. If not, electroshock therapy would be my next step.

I arrived and got a basic work-up in the pre-treatment room. In addition to weighing me and taking my blood pressure, a nurse tested my reading ability, memory, and basic awareness (the date, where I was). Dr. Coffey came in to discuss what to expect over the course of my six treatments. That number is typical for this treatment, but because it’s still experimental, so is the number of doses necessary to work. Coffey was open to the idea of me needing more if six didn’t provide lasting results.

His frightening warning: Since ketamine is a dissociative anesthetic, I might feel like I’m leaving my body and experience a “bad trip,” as opposed to a more euphoric hallucinatory state. But if I were to go into this state, I could tell my nurse, who would stop the infusion or add a counteractive drug, the anesthetic midazolam, to lessen that effect.

The nurse inserted an IV and flushed it with saline to make sure it was flowing correctly; then we moved into the treatment room with its dentist-style chair for my infusion to begin. I would receive half a milligram of the drug for every kilogram of my weight, a very low dose compared to what recreational users inhale or inject. About 10 minutes into the treatment, the tree I was watching through the window separated into two. Soon, it was difficult to keep my eyelids open at all.

And then I was gone, down the rabbit hole of hallucination. My mind skipped through grid-style maps of city parks. I occasionally took a deep breath or wiggled my fingers just to remind myself I still could. I later learned that what I was experiencing is known as a “K-hole,” which is rare at the low dose I took.

Hope for the future at last

Each infusion lasted 45 minutes. After my first one, I had a nurse play the cast album of my favorite musical as the drip began. Instead of running wild, my mind became immersed in the music, albeit in a deeply dreamlike state. Each time, it took about 15 to 20 minutes after the effects of the treatment wore off for me to be able to open my eyes and start walking. Afterward, I was exhausted. The half-hour Uber ride home felt like hours as I longed for the warm embrace of a nap.

Immediately after each treatment, I felt down. But by the time I woke up the next day, I was in less psychic pain and had more purpose. I would start the day on my long-neglected spin bike, feeling motivation that I’d lacked for months. Lunches with friends no longer felt like they existed just to show them I was still alive and making an effort to get out of the house. I was beginning to connect with the world outside my head again. I noticed myself smiling more. According to Shah, feeling the effects of ketamine within 24 hours of treatment is typical. “It is the most rapid-acting treatment for depression,” he said.

After the final infusion, I had the initiative to start writing again. The following week quickly filled up with activities, both work and fun. I was living for the first time in months. It’s been three months since my last treatment, and I’ve even started to feel excited about my future. Shah says I am unlikely to need another dose — I was in the roughly 70 percent who achieve remission after one series of ketamine infusions.

In technical terms, as I’ve said, taking ketamine had caused my brain to release glutamate, the neurotransmitter responsible for “excitatory” responses. But despite all his years of research into the drug’s chemistry, Shah admits, “No one knows the exact mechanism of any medicine.”

If I do need additional doses of ketamine, it probably won’t be an infusion. Thanks in part to Shah’s work, an intranasal version of the drug is expected to receive FDA approval as soon as next year. The side effects of the nasal inhaler, known as esketamine, are practically nonexistent next to the K-hole I experienced; patients would even be able to take the treatment at home. I’m a testament that it can work. And soon, ketamine will be accessible to people (who can afford it, since it likely will be expensive and not necessarily covered by insurance) who have all but given up on fixing their depression.

I had come to believe that my depression was a terminal illness. But the so-called party drug may have saved my life.

Neurotransmitter Boosting Foods:
How to Balance Your Brain Naturally and Improve Your Mood Through Simple Diet and Lifestyle Changes

The Mind, The Body & Neurotransmitters

Unless we feel strong, energetic and healthy, we can’t really derive any pleasures from the joys of life and the world. Even a simple cup of coffee has no aroma and little joy if your nose is blocked, for example. Having said that, body and mind are interlinked though. If body is the vehicle then mind is the driver.

How you feel mentally affects your body and the balance of your neurotransmitters in the brain and your physical health influences your emotional and mental health. You can eat all the right foods and exercise well, which are ways to increase neurotransmitter levels, but if your mind is not supporting your body with positive thoughts and attitudes, such measures show no improvement in your physical health. It is one of the primary reasons, I observed, that why a majority of people are unable to lose weight even though they stick to a strict diet and exercise routine— because what’s in your mind matters as much as what’s in your stomach. If you are seeking to balance neurotransmitters in the brain naturally, you need to consider not only the foods you eat and the lifestyle you live, but the thoughts you think as well!

Ayurveda believes that the same food can have different impact on different individuals based on their constitution (prakriti). The assessment is based on three humors of wind (vata), bile (pitta) and phlegm (kapha). Further, it states that beyond just being heavy or light on digestion, or being acidic (ushna or amala) or alkaline (sheeta or snigdha), foods can be full of goodness (sattvic), passion (rajasic) and ignorance (tamasic). It means that certain foods can have balancing effects on neurotransmitters in your brain that make you feel calm and composed, while some others can infuse passion in you and make you agitated and some can flare you up in other ways.

Ayurveda believes that food is your first and foremost medicine for all things—and that includes increasing and balancing neurotransmitters in the brain. Ayurveda puts the role of right diet at par, if not above, the consumption of medicine. The two are intricately linked, especially when it comes to mood and brain health.

Foods For Balancing Brain Neurochemicals

There are many sattvic (which loosely translates to inherently healthy and good) foods that are mostly alkaline and are extremely good for depression and other similar disorders because they balance and increase neurotransmitters in the brain naturally. Before I share those foods, I would like to remind you that neurotransmitters are chemical agents made from amino acids. Proteins are the source of amino acids and to manufacture neurotransmitters they require vitamins and minerals.

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Protein, B Vitamins, Vitamin C and minerals (calcium, magnesium, selenium, etc.) are needed to produce serotonin and increase neurotransmitters in the brain in general. Green leafy vegetables (especially spinach), brown rice, tofu, sunflower seeds, sesame seeds are full of ingredients required for the production of serotonin, which is an important neurotransmitter for positive mood. Walnuts, flaxseeds, hemp and chia seeds contain Omega-3 fatty acids that are excellent for raising serotonin levels and balancing neurotransmitters naturally. While eggs and fish are also good for serotonin production, yogic scriptures classify all meat and poultry as tamasic food. Tamasic foods are acidic and promote aggression in the body and so should be limited in the frequency they are eaten.

Almonds, lentils, brown rice, beans, melons, cantaloupes are sattvic and alkaline foods that are excellent for increasing and balancing neurotransmitter production in the brain, especially GABA. GABA is the most powerfully calming and relaxing neurotransmitter the brain produces. Oranges are also good in GABA production and regulation.

Ripe bananas are an excellent source of dopamine and work to powerfully increase neurotransmitter levels in the brain naturally. Free radicals deplete dopamine levels. So, if you eat food rich in antioxidants, they protect your dopamine stores. Dopamine is important for feelings of pleasure and happiness as well as generally supporting healthy mood and energy levels. Most citrus fruits and berries are packed with antioxidants. Besides, the vitamins these fruits contain combine with the amino acids to produce and balance neurotransmitters naturally. Sesame seeds also help in dopamine production. Coffee, alcohol and sugary drinks have a negative impact on dopamine levels. If you are not lactose intolerant then milk and other dairy products also help in balancing neurotransmitter production. Wheat germs are rich in nutrients that raise acetylcholine levels in the brain, which is another important neurotransmitter that affects mood, memory, anxiety and more.

Eggs are also good for acetylcholine. Yogurt aids in production and balance of neurotransmitters but according to Ayurveda it has a negative impact on the cellular excretory system. Ayurveda states that each cell in the body has an inlet and an outlet and that yogurt blocks the outlet of the cells creating a breeding ground for numerous ailments. Yogurt is also acidic in nature. But if you feel good after eating yogurt, you should feel free to eat it to help increase neurotransmitters in your brain. In any case, it’s not good to eat it after sunset (or before going to bed) as it vitiates the three humors of wind, bile and phlegm.

To sum up things up in regards to increasing and balancing neurotransmitters in the brain naturally, your dietary focus should be on consuming mostly alkaline foods. Antidepressants often have devastating side-effects whereas your food, especially those that are alkaline, is mostly free of such damning side-effects. The type of food you eat has an immediate impact on your mental and physical state almost instantly, with powerful effects on your brain’s neurotransmitter levels.

For treating depression naturally, certain foods stand out. One of them is mango. It boosts serotonin in your body and helps balance your brain’s neurotransmitter levels naturally. While you should generally avoid tea and coffee because they are highly acidic, in depression, coffee can be actually helpful if taken in moderate quantity, of course. It lifts your mood due its powerful effects increasing neurotransmitters like dopamine and acetylcholine in the brain. If you get used to eating mango, even that can lift your mood just as well.

Folic acid found in spinach (boiled spinach) is very good for balancing neurotransmitters in the brain too. A glass of orange juice has a positive impact. Besides the standard nutritional benefits, alkaline foods boost your neurotransmitters. Here’s a food chart for your quick reference:

Serotonin: Mangoes, walnuts, flaxseeds, hemp and chia seeds, green leafy vegetables, tofu, sunflower seeds, brown rice, sesame seeds.

Dopamine: Sesame seeds, citrus fruits and berries, bananas.

GABA: Almonds, lentils, brown rice, beans, cantaloupes, oranges.

Acetylcholine: Poultry, wheat germs.

Tea and coffee are stimulants and deplete neurotransmitters in the longer term, but if taken in moderation, they can lift your mood.

Yogurt also aids in production of neurotransmitters in the brain naturally but should be limited in consumption as mentioned above as well, unless you find it to be very beneficial—then feel free to eat it more often. Try to eat organic and alkaline foods as much as possible as these types of foods more powerfully increase neurotransmitters.

Let me remind you that neurotransmitters are made from amino acids that are naturally found in the protein we consume through our diet. Protein alone can’t manufacture neurotransmitters in the brain though. In addition, you need the vitamins and minerals that are found in large amounts in most alkaline and wholesome foods. If you eat wholesome foods and you eat organic as much as possible, you can’t go wrong… and your body and brain will reward you with robust neurotransmitter production.

Lifestyle Changes You Can Make to Increase Neurotransmitter Levels in the Brain

Ideally, no more than twenty percent of your diet should be acidic. Most of your diet should consist of vegetarian food items because they are living foods that help to naturally increase and balance neurotransmitters. You might wonder what’s a living food? Any food that can sprout has living energy in it. Eating living foods brings you one step closer to nature and the closer you are to nature the faster you will heal. Here are some golden pointers for you to combat depression and maintain high levels of neurotransmitters in the brain at all times:

1. Try to eat vegetarian, organic and whole foods whenever you can.

2. Avoid processed, canned, acidic and starchy foods.

3. Eating strictly at the same time every day has a remarkable effect on the body. Above all, it keeps the metabolic processes in check including acid production in the body. It has a direct and instant effect on your health and increases neurotransmitter levels naturally.

4. Avoid large gaps between your meals because, among other perils, this ultimately results in raised insulin level. Eating wholesome foods at the same time every day and avoiding large gaps between your meals can also help you overcome binge-eating and bulimia and maintain high levels of neurotransmitters in the brain throughout the day.

5. Go to bed at about the same time every day. Even if you have insomnia or you can’t go to sleep for any other reason, don’t be stressed about it. Just take shower, freshen up, and lie down in your bed. Don’t worry about being unable to fall asleep. Just take deep breaths. It is best to sleep to your right as this will start the left nostril which is the lunar channel. Resting and sleeping have powerful effects on brain neurotransmitter levels as well.

6. Breathing through the left nostril has a cooling and a calming effect on the body and mind and breathing can absolutely affect and increase neurotransmitter levels.

7. No matter what, don’t replace your sleeping time with screen time. So, if you can’t go to bed, don’t get up and either start watching TV or go online and surf the net. Trust me on this one (or validate it for yourself). You can put some light music or best is just listen to your breath. If you get disturbing thoughts, pay no attention as a matter of principle and resolution and simply listen to your own breath. Staring at synthetic blue lights from screens can reduce neurotransmitter levels, melatonin levels and make it harder to sleep.

8. Make sure that you eat around four hours prior to going to bed. This is absolutely critical for a sound, rejuvenating and nourishing sleep and balanced neurotransmitter levels in the brain. If you find it hard to go to bed empty stomach, you can have a wholesome light snack (like a fruit or a piece or two of whole-wheat bread with a slice of cucumber or so — without cheese) an hour before you go to bed.

9. The most important principle of diet is: don’t be obsessed. Listen to your body and eat in moderation.

10. Light to moderate exercise and movement are integral to increasing neurotransmitter levels in the brain naturally. Walking, yoga and low-impact sports are ideal.

If you worked out physically during the day, and you ate the right diet, no matter what your state of mind, you will have a sound sleep and have done most everything in your power to balance your brains neurotrnasmitters naturally.

5 natural ingredients that work together to aid your body’s natural production of GABA and serotonin.* 5-HTP, L-Theanine, Ashwagandha, Passion Flower, and Lemon Balm have been clinically proven to boost GABA and serotonin levels in the human body.  Redi-calm

Your mood is strongly influenced by two key neurotransmitters, GABA and serotonin. When levels are low, anxious thoughts fill your mind and you don’t you feel like yourself.

But promoting healthy levels of GABA and serotonin helps restore your mind to a state of calm. More importantly, this feeling is maintained even when you are faced with a stressful situation.

Prescription medication is often considered the only treatment for anxiety. However, a new group of doctors are advocating for a more natural approach.

Mucuna Pruriens:
The Mood Boosting Superherb

t first glance it would seem that the Mucuna Pruriens plant was doing everything in it’s power to keep from being eaten. After all, it’s covered in thousands of tiny hairs known to cause intense pain and itching in those unlucky

enough to be stung. But for anyone tenacious enough to pry a pod of the Velvet Bean plant open, there lies great reward inside.

Tucked away in the caterpillaresque pods of the climbing Mucuna vine lie one of nature’s most unusual and interesting medicinal beans. Like coffee, Mucuna Pruriens is psychoactive, but in a far more medicinal and absolutely non-addictive way. Fortunately the aggressive pods are only something you’ll need to worry about if you insist on heading to the equatorial jungle regions, where the plant grows wildly, and harvesting it yourself. Mucuna has gained substantial popularity in recent years, and it is now widely available in health food stores and many places online in a perfectly safe, although still quite potent form.

But what exactly is Mother Nature hiding inside those pods that makes it worth all the trouble? Well, for starters, Mucuna Pruriens is one of the only naturally occurring (and certainly most concentrated) sources of L-Dopa—as in dopamine. In fact, Mucuna is so rich in the dopamine precursor L-Dopa that it is used as an alternative treatment for Parkinson’s disease, which is believed to be caused (in part) by a lack of the essential neurotransmitter. With 7% to 10% by weight, Mucuna Pruriens is a powerful natural source of dopamine, and serotonin, and tryptamine… and just about every other mood-influencing neurochemical known to man. Seriously. This is the closest thing that exists to a natural, safe non-addictive antidepressant or mood enhancer (depending on how you prefer to look at it… glass half full, half empty, no?).

“Mucuna Pruriens is one of the only naturally occurring (and certainly most concentrated) sources of L-Dopa—as in dopamine.”

With all those mood-enhancing, pre-hormonal natural neuropeptides floating around in the Velvet Bean pods, it also doubles as a powerful aphrodisiac. The high concentrations of L-Dopa cause the brain to release dopamine, in turn stimulating the pituitary gland to produce human growth hormone, which promotes muscle growth, increased strength, and has been proven to raise levels of testosterone. Mucuna also simultaneously lowers levels of prolactin, which can reduce menstrual discomfort and associated weight gain in women and increase sperm motility, and hence fertility, in men.

Mucuna-Pruriens-Velvet-Bean-Pods

spiky velvet bean pods of the mucuna pruriens plant hiding their prized, hormonal and psychoactive beans within. mucuna vines are actually quite common in many parts of the world and their beans have been long used as a food and medicine. photo: shutterstock

Mucuna Pruriens is classified as a jing enhancing herb in the Daoist herbal tradition, which means that it is nourishing at the most fundamental levels to the body. Jing loosely translates to “vital essence” or “life force” and in the case of Mucuna, can clearly be understood in terms of its restorative effects on the brain, nervous, and hormonal systems. Jing is believed to be depleted as we age, so plants like Mucuna that act to replenish it are prized in many herbal traditions.

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In the ancient Indian system of Ayurvedic medicine, Mucuna Pruriens is widely respected as a powerful anti-inflammatory and purifying herb, and it is frequently used for treatment of arthritis and general pain relief, as well as blood purification, and even in the rare case of snakebite, parasites, or other types of poisoning in addition to all of the previously mentioned uses.

Psycho-Spiritual Effects of Mucuna Pruriens

But perhaps the most interesting property of the Velvet Bean is its content of exotic compounds such as dimethyltryptamine (DMT), 5-MeO-DMT, nicotine, and bufotenine in trace amounts, which just happen to be the active ingredients in such sacred medicinal plants as ayahuasca, tobacco, and peyote, among others. While Mucuna Pruriens is most definitely not a psychedelic plant on its own (it can easily be purchased at your local health food store), it clearly does share many interesting properties with them, albeit in extremely minute quantities. For this reason, it is safe to classify Mucuna as a particularly spiritual and consciousness-enhancing plant. DMT, for example, is secreted by the pineal gland, which is the master regulator of consciousness in the body and is believed to control our perception of time as well as our circadian rhythms (sleep/wake cycles). In fact, many who take Mucuna Pruriens report more vivid dreams and deeper sleep with regular use but often times after just a single dose.

“Regular consumption of Mucuna Pruriens will have a gentle balancing effect on the brain and hormonal systems.”

Regular consumption of Mucuna will have a gentle balancing effect on the brain and hormonal systems associated with such powerful compounds. For this reason it is often used in cases of depression and anxiety, which may be in part related to the depletion of these essential neurotransmitters.

Mucuna Pruriens History

Indigenous cultures worldwide consume Velvet Beans as an integral part of daily life. In Central America it is used to this day as a coffee substitute and in certain areas of Guatemala as a staple food in tribal diets. The beans are also immensely popular throughout India and Southeast Asia. In fact, nearly every tropical culture on the planet uses Mucuna Pruriens in some way, either medicinally, ornamentally or as food in daily life; however, when used as food, the Velvet Beans undergo a special process to remove much of their psychoactive compounds, as large doses can cause unwanted effects. Even without these compounds, the Velvet Beans of the Mucuna Pruriens plant are rich in amino acids, making them a useful vegetarian source of protein.

Mucuna Pruriens Usage Guidelines

Most often in the West, Mucuna is sold as a dietary supplement with its medicinal compounds intact either in pill or powder form. Like anything with a powerful psychoactive effect, Mucuna is best used sporadically or situationally as needed for restorative purposes. The 2:1 rule of two weeks on one week off is a reasonable dosing schedule, although long-term usage is still considered generally safe. Like everything in life, it is about balance.

Quality Mucuna Pruriens is orange-brown in color and has a slightly bittersweet, smoky caramel flavor, which makes it a delicious addition to many recipes or simply taken straight up in a glass of lukewarm water. For maximum medicinal effects, it is best to take Mucuna away from food.

As with any herb, quality, potency, and purity are of utmost importance. Always choose organic, biodynamic or wild-harvested Mucuna Pruriens whenever possible. Mucuna often is standardized to various concentrations for more precise and controlled dosing due to its high levels of powerful medicinal compounds. However, full spectrum extracts are always a good choice as well and most closely mimic the natural balance of the plant.

As with any new herb, it’s best to start slow with Mucuna and work up to higher doses until you understand how your body reacts.

Note: Pregnant women and persons on pharmaceutical anti-depressants or hormonal modulators of any kind should consult with their physician or naturopath before using Mucuna Pruriens.

 Recommended Mucuna Pruriens Products

banyan-mucuna-pruriens

ORGANIC MUCUNA EXTRACT (KAPIKACCHU) POWDER

Banyan Botanicals

Banyan Botanicals Mucuna Pruriens extract powder (of which the traditional Sanskrit name is Kapikacchu) is an organically grown, ultra-pure and highly concentrated powder providing high levels of L-Dopa and other synergistic plant nutrients and medicinal compounds.

click here to learn more

Himalaya-mucuna

ORGANIC MUCUNA CAPLETS

Himalaya Herbal Healthcare

Himalaya Herbs offers convenient, pure, additive-free organic Mucuna pruriens caplets as an extract of both the bean and stem, standardized to 6% L-Dopa.

click here to learn more

Paradise-Herbs-Mucuna

ORGANIC MUCUNA CAPSULES

Paradise Herbs

Paradise Herbs offers a potent, full spectrum, organic 10:1 Mucuna Pruriens concentrate without binders or fillers in a special vegan capsule made from pine cellulose.

click here to learn more

Banyan-Botanicals-Mucuna

ORGANIC MUCUNA LIQUID EXTRACT

Banyan Botanicals

Banyan Botanicals offers an organic Mucuna pruriens extract in non-gmo, gluten free grain alcohol. Alcohol is an ancient herb carrier fluid that is deeply penetrating and tends to increase the absorption of the herb in the body.

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Shilajit: The Ancient Yogic Superfood That Rebuilds Your Body

Shilajit-Resin

Treasures may be found everywhere for those who have eyes to see—a perfect example of this being Shilajit, one of the most prized medicines throughout Asia for the last few thousand years. In its “wild habitat” you could be forgiven for simply thinking that it was a tar-like substance.

Over 6,500 different species of ancient plants spent many millennia in a sort of geological alchemy that created a thick, black, resin-like substance trapped deep within the Himalyan, Caucasus, and other famous mountain ranges in the region. The relentless monsoons and ever-increasing pressure eventually caused this “tar” to begin seeping from cracks in rocks in the sides of the mountains.

“Intense scientific analysis and study have revealed that Shilajit is one of the most nutrient-dense substances on the planet.”

Laboratory analysis of Shilajit reveals a complete spectrum of every essential mineral on the planet in ionic form—the most easily absorbable and assimilated by the human body. Scientists also found amino acids, fulvic and humic acids, ellagic acid, fatty acids and plant sterols, which tend to have a harmonizing effect on the hormonal/endocrine system, among many others.

Shilajit-Benefits-Your-Body

purified ladakhi shilajit resin from a tenth-generational family of herbal alchemists, considered by many to be some of the world’s best shilajit. it can be cut with a knife and is similar in texture to a hard candy, although more pliable. photo: lerina winter

Although shamans and medicine men of the time could not possibly have understood its complex and unusual composition, they could easily discern the beneficial effects Shilajit was having on the people they treated, which was a massive restoration of health and wellbeing.

The Benefits of Shilajit

Reduces Stress and Improves Sleep and Endurance

Shilajit acts on many different systems in the body, earning it a place among the prized natural medicines known as adaptogens, meaning it helps to restore balance to one’s system, whether that is through reducing excess (stress and cortisol, for example) or nourishing deficiencies (promoting sound sleep and giving endurance, strength and stamina) within the body’s various systems [2].

Balances Hormones, Boosts Libido and Supports Longevity

One of the primary ways it does this is through its action on the endocrine system [3]. As the master controllers of the body’s thousands of delicately tuned processes, hormones—or the lack thereof—have a very large influence on your health. They control mood, libido, sleep-wake cycles, hair growth, cognition, energy, consciousness and much more. Therefore it should come as no surprise that Shilajit has long been valued for its ability to restore sexual function, promote cognitive abilities, reduce anxiety and stress, improve mood and generally extend one’s lifespan. Quite impressive, to be sure.

Reduces Pain and Inflammation, Promotes Healing and Detoxifies Heavy Metals

However, Shilajit’s beneficial medicinal properties are not solely limited to the endocrine system. It has also been shown to reduce pain and inflammation, making it one of the most sought after remedies for those suffering from arthritis.

oozing from the cracks in between rocks high up in the Himalayan Mountains. And the locals did for many thousands of years; however, in ancient times one had to look for clues from nature to better understand their natural habitat—particularly what was safe and what was poison.

The Fascinating History of Shilajit

Upon seeing packs of native chimps snacking on the Shilajit tar and further observing that those who did seemed to be the strongest, most intelligent and long-lived of the bunch, the indigenous people began ingesting the night-black mineral pitch themselves. When they too began experiencing the benefits:—a rapid restoration of their health and enhanced cognitive and physical abilities—they knew they had stumbled on a great discovery.

Oral tradition has it that this is how Shilajit was originally discovered. Maybe so, maybe not, but either way decades of intense scientific analysis [1] and study have revealed that Shilajit is one of the most nutrient-dense substances on the planet. And what’s more, is that the nutrients it contains, such as naturally occurring humic and fulvic acids—two of nature’s most potent detoxifiers of heavy metals and other pollutants that disrupt the natural function of the body, and are quite rare to boot.

Known euphemistically as the “destroyer of weakness,” much can be learned about the incredible properties and benefits of Shilajit by understanding the process of how it is created. Over the course of millions of years, the lush primeval vegetation that once blanketed Asia was decomposed by the forces of nature, eventually becoming highly compacted under the weight of the mountains, which later formed as continental plates collided.

It also has a healing effect on the digestive tract, with the notable ability to repair ulcerated intestines and keep harmful bacteria in check.

And, of course, it is also a great remineralizer and detoxifier, removing heavy metals and replacing them with those the body needs for health and wellbeing. It has also been used to treat allergies, malnutrition, anemia, and broken bones. It’s kind of like water: life is just better when you consume it regularly.

How to Take Shilajit: Selecting a Quality Product

Shilajit can be found seeping wildly in many mountain ranges across Asia, although each culture tends to have its own name for the substance. In Western and Central Asia it is typically referred to as Moomiyo, but in the areas in and around the Himalayas, it is referred to as Shilajit. While this may seem semantical, it is an important distinction due to the fact that, depending on the source, Shilajit/Moomiyo will have different compositions. Generally speaking, the best quality Shilajit is believed to originate from the Himalaya area.

Himalyan-Mountain-Shilajit

shilajit is harvested in remote regions of the himalayan mountains.

However, because Shilajit is somewhat rare and difficult to collect, as well as the fact that the world’s supply originates in developing countries, the quality varies widely in the products currently available through various health food stores and websites worldwide.

The most sought after and rare form is the night-black mineral resin, with only a handful of companies selling it worldwide. It is a sticky, wet-looking “tar” that is an intensely concentrated and purified form of Shilajit. It can be pricey, although a little goes a long way, making even a small amount last for months, even at higher dosages.

That being said, there are many excellent, more affordable Shilajit products that come in a powdered form—though they will generally be slightly less concentrated and potent than the pure resin. The primary benefits of the powder are the ease of use, price, and the ability to measure precise amounts, if needed, as the resin itself is quite sticky.

When using a powder discernment is needed, as not all brands are equal. (In the section that follows we recommend some high quality, potent and high integrity Shilajit powders that are not adulterated). The vast majority of products available worldwide are actually diluted Shilajit powders. Pure Shilajit resin is composed of approximately 2% to 10% naturally occurring humic and fulvic acids with the remaining portion composed of minerals and other medicinal substances. However, adulterated products are typically 10% to 30% actual Shilajit powder and about 70% to 90% extracted humic and fulvic acids, which can be produced cheaply in a lab and added afterwards. While not dangerous, the adulterated Shilajit powders do not posses the same powerful medicinal properties.

Authentic, quality Shilajit always has a distinct, strong piercing tar-like odor that is unmistakable. If the product you have does not have a noticeably intense smell or seems ‘faint’, then it is likely old or diluted Shilajit.

Shilajit is not grown like most herbs and foods, so there are no organic or conventional distinctions. If authentic and unadulterated, Shilajit is wildcrafted, which is truly what lends it such incredible healing properties.

 Recommended Shilajit Products

lotus-blooming-shilajit-resin

Pure Himalayan Shilajit Resin

Lotus Blooming Herbs

Lotus Blooming Herbs offers an ultra-high quality, health activating shilajit resin that is hand-harvested according to traditional Tibetan methods at high altitudes in the Himalayan mountains. It is a highly potent, ultra pure shilajit resin that has been meticulously third party tested to be free of all contaminants. Highly recommended.

click here to learn more

purblack-shilajit

Siberian Shilajit Resin

PÜRblack

PÜRblack offers a meticulously crafted Shilajit concentrate harvested from a pristine, uninhabited area of Siberia. PÜRblack has developed a special low-temperature processing and purification method that ensures all naturally occurring compounds are kept intact and bioactive.

click here to learn more

omica-shilajit

Raw Himalayan Shilajit Powder

Sunfood Superfoods

Sunfood Superfoods offers a water-extracted Shilajit powder that is hand harvested under tightly controlled conditions at a minimum 6,000 ft. altitude in the Himalayan Mountains. Particularly high in fulvic acids, this is an excellent Shilajit for those interested in detoxification and cleansing.

click here to learn more

dragon-herbs-high-mountain-shilajit

Himalayan Shilajit Tablets

Banyan Botanicals

Banyan Botanicals offers their Shilajit in highly convenient tablets without loss of quality or potency. Harvested in the remote Western Himalayas, Banyan Shilajit undergoes further purification and extraction to produce a balanced, highly concentrated product.

click here to learn more

Uncategorized

Supplements for Pain

Reviewing the Efficacy of Dietary Supplements to Manage Chronic Musculoskeletal Pain

The 7 Best Natural Muscle Relaxers Known to Man

For further discussion regarding these findings and related clinical implications, Clinical Pain Advisorinterviewed Patricia Deuster, PhD, MPH, CNS, professor and director of the Consortium for Health and Military Performance in the department of military and emergency medicine, director of the Human Performance Resource Center at Uniformed Services University, and one of the review authors.

According to a report from the Centers for Disease Control and Prevention, the prevalence of musculoskeletal (MSK) disorders among adults in the United States was 54.5% in 2012.1 These conditions represent a substantial burden for patients, societies, and healthcare systems, and it is anticipated that the prevalence will continue to rise as populations age.2

The use of dietary supplements to manage pain is common in individuals with MSK disorders, including those serving in the military, a population in which MSK injuries resulting from training and missions account for the majority of pain complaints and related medical consultations.1,3 In the absence of expert guidelines supported by evidence, consumers may choose to use dietary supplements based on questionable information. To address this gap, researchers from Uniformed Services University of the Health Sciences in Bethesda, Maryland, conducted a systematic review and meta-analysis on dietary supplements used for the relief of MSK pain.3

Using the Grading of Recommendations, Assessment, Development and Evaluation framework to analyze relevant study results, the review authors formulated conditional, evidence-based recommendations for 8 dietary ingredients that may be used as supplements to alleviate chronic MSK pain and associated symptons.3 This review does not constitute a formal practice guideline.

·         Avocado soybean unsaponifiables: 300 to 600 mg/d

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·         Capsaicin cream: 0.025% to 0.075% applied 3 to 4 times per day

·         Curcuma (as a food source when available)

·         Ginger (as a food source when available)

·         Prescription patented crystalized glucosamine sulfate: 1500 mg/d

·         Melatonin: 3 to 5 mg/d

·         Polyunsaturated fatty acids: 1200 mg/d

·         Vitamin D: 2000 mg/d

The most frequent adverse effects reported in the studies included in the review were minor gastrointestinal complaints. 

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“Although uncertainties remain, thereby precluding any strong recommendations for immediate use, these dietary ingredients, when taken as part of a balanced diet, applied as a cream, or administered as a supplement, may help alleviate pain from chronic MSK conditions and are suggested for use,” the authors concluded.3 “In these cases, health care providers should be prepared to help individuals make decisions consistent with their own values.”

Clinical Pain Advisor: What are some of the reasons underlying the high rates of dietary supplement use to manage MSK pain? 

Dr Deuster: Current pain management options such as nonsteroidal anti-inflammatory drugs, injections, and physical therapy may be perceived as either ineffective or associated with multiple side effects. Dietary supplements are now being marketed as solutions to mitigate or combat MSK pain. Quick-fix claims like “Stop pain now” are advertised on products to the public. Most consumers believe that taking dietary supplements is a low-risk action, so trying them out as a way to reduce pain and/or enhance performance seems logical when other options may not seem to be available.

Clinical Pain Advisor: What were some of the most important findings from your review?

Dr Deuster: We identified several dietary ingredients that may help alleviate MSK pain with little to no risk of harmful side effects. Some of these dietary ingredients can be taken as part of a balanced diet, others as a dietary supplement, and some as a topical application, such as a cream or a patch. These include avocado soybean unsaponifiables, capsaicin, curcuma, ginger, glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D.

Other dietary ingredients have also been marketed as being effective for reducing MSK pain; however, there is insufficient reliable evidence to support such claims regarding their effectiveness and/or safety. These include boswellia, collagen, creatine, devil’s claw, l-carnitine, methylsulfonylmethane, pycnogenol, rose hip, s-adenosyl-L-methionine, vitamin E, and willow bark extract. Note that our analyses focused solely on MSK pain relief; these ingredients may be effective for other uses. Providers can read more about our analyses and recommended ingredients at https://www.hprc-online.org/articles/dietary-ingredients-to-relieve-musculoskeletal-pain and also within our recent series of papers.3-6

Clinical Pain Advisor: Based on these conclusions, what are your main recommendations for clinicians?

Dr Deuster: Supplements offered on the market and claims made on their labels may not always align with the scientific evidence regarding benefit and/or potential risks. The article mentioned above includes the body of reliable evidence, based on our in-depth analyses of the scientific literature. It highlights ingredients that may be effective for MSK pain as well as factors — including potential side effects and quality of the scientific evidence — to consider when selecting nondrug products. Clinicians can use this evidence to help patients make better informed decisions. We also recommend checking for verified/certified products at the NSF International Certified for Sports or United States Pharmacopeial Convention websites.

Clinical Pain Advisor: What are remaining needs in this area in terms of research and education?

Dr Deuster: Our analyses identified safety reporting of dietary ingredients as the highest priority to address in future research, followed by dosing/formulation of ingredients and data on additional outcome measures. Other priority research areas include the study of specific ingredients — such as boswellia and curcuma — given their potential benefit for pain relief, as well as the nature of combinations of selected dietary ingredients that would be most beneficial with minimal adverse events. A full list of research priorities is noted in our series of papers.3-6

Education is of utmost importance. Because dietary supplements are not regulated by the US Food and Drug Administration in the same manner that drug products are, they are not evaluated for their safety or effectiveness before they reach the consumer. Manufacturers of the products are responsible for ensuring that the ingredients used are safe and that the labeling and claims made are truthful and not misleading. We offer simple tips on how to spot potential red flags on product bottles on our Operation Supplement Safety Score Card.  

1. Clarke TC, Nahin RL, Barnes PM, Stussman BJ. Use of complementary health approaches for musculoskeletal pain disorders among adults: United States, 2012Natl Health Stat Report. 2016;(98):1-12.

2. Palazzo C, Ravaud JF, Papelard A, Ravaud P, Poiraudeau S. The burden of musculoskeletal conditions.PLoS One. 2014;9(3):e90633.

3. Boyd C, Crawford C, Berry K, Deuster P; HERB Working Group. Conditional recommendations for specific dietary ingredients as an approach to chronic musculoskeletal pain: evidence-based decision aid for health care providers, participants, and policy makers. Pain Med. 2019;20(7):1430-1448.

4. Crawford C, Boyd C, Paat CF, et al. Dietary ingredients as an alternative approach for mitigating chronic musculoskeletal pain: evidence-based recommendations for practice and research in the militaryPain Med. 2019;20(6):1236-1247.

5. Crawford C, Boyd C, Berry K, Deuster P; HERB Working Group. Dietary ingredients requiring further research before evidence-based recommendations can be made for their use as an approach to mitigating pain [published online April 15, 2019]Pain Med. doi:10.1093/pm/pnz050

6. Cota S, Williams N, Neff R, Deuster P. How evidence-based recommendations may direct policy decisions regarding appropriate selection and use of dietary ingredients for improving pain. Pain Med. 2019;20(6):1063-1065. 

Link: https://academic.oup.com/painmedicine/article/20/8/1619/5464928 https://academic.oup.com/painmedicine/article/20/8/1619/5464928

Dietary ingredients to relieve musculoskeletal pain

Many over-the-counter products are available for relief of musculoskeletal pain. Some are based on “dietary ingredients”—substances the Food and Drug Administration (FDA) has accepted for use in foods or dietary supplements. Such products are available in the form of capsules, tablets, powders, liquids, topical creams, and patches. The first 4 potentially qualify as dietary supplements, which (by definition) must be taken by mouth; the last 2 do not. How well do they work? Researchers at the Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University recently conducted an in-depth search of the scientific literature to gather all the reliable evidence together into a resource to help you make informed choices when considering non-drug products for musculoskeletal pain.

Below are lists of ingredients grouped according to whether they have sufficient reliable evidence of possible effectiveness, lack such evidence, or have evidence showing that undesirable effects outweigh any possible benefit with regard to relieving musculoskeletal pain. Some of these ingredients do have potential benefits for other uses, so it’s important to keep in mind that this discussion is limited to the effects on musculoskeletal pain.

What’s the evidence?

A diverse group of experts, both military and civilian, with expertise in human performance, dietary supplements, nutrition, and pain reviewed the results of CHAMP’s evaluation of the literature and developed evidence-based recommendations for the Special Operations community. The results, summarized here, are also useful for Warfighters in general. The study was sponsored by the U.S. Special Operations Command’s Preserva­tion of the Force and Family Behavioral Health Program (POTFF).

Possibly effective dietary ingredients 

The following dietary ingredients might help alleviate musculoskeletal pain with little to no risk of any harmful side effects (adverse events). Some can be taken as part of a balanced diet, others as a dietary supplement, and some as a topical (cream, patch) application. Note: They should be used only after consulting a healthcare provider.

  • Avocado soybean unsaponifiables (ASU) are made from one-third avocado oil and two-thirds soybean oil. ASU might reduce pain and improve function for some users. Studies have used 300–600 mg per day of ASU for 3 months to 3 years, although this is based on research with a single commercial product. Reported side effects include minor gastrointestinal complaints.
  • Capsaicin is a primary constituent of the Capsicum species of chili peppers. Capsicumis grown worldwide and adds color, pungency (“heat”), and aroma to food. Studies have reported significant pain reduction within 4 weeks from using a capsaicin cream applied to the skin. Most creams contain 0.025–0.075% capsaicin and can be applied 3 or 4 times a day. Some users report burning, itching, and irritation, especially when used at higher doses such as 0.25%. Initial use should begin at a lower dose.
  • Curcuma, or turmeric, is a spice that comes from a plant grown throughout India, other parts of Asia, and Central America. Turmeric root and powder are available as grocery items for cooking. Research studies using doses of 700–2,000 mg per day over 6–12 weeks have shown significant pain reduction. The only reported side effects are minor gastrointestinal complaints. Insufficient evidence exists for its effectiveness as a dietary supplement, but 500 mg 2 or 3 times a day can be incorporated into cooking.
  • Ginger is a tropical plant widely used as a flavoring or fragrance in foods, beverages, soaps, and cosmetics. Common forms include fresh or dried root, tablets, capsules, liquid extracts, and teas. As a dietary supplement, it doesn’t appear to be as effective as other ingredients listed here, but it poses no additional risk when used in food or tea to help with pain. Minor complaints of bad taste or stomach upset have been reported. In research, doses of 250–1,000 mg per day over 3–12 weeks have been used, with higher doses producing greater benefits. As with curcumin, it can be incorporated into cooking.
  • Glucosamine is produced naturally in the human body, but it is also available in prescription and over-the-counter products. The most effective form to reduce pain seems to be crystalline glucosamine sulfate (pCGS) at a dose of 1500 mg per day. Little reliable evidence is available for over-the-counter versions, for which dosing and formulas vary. Side effects of 1,500 mg pCGS include nausea, heartburn, diarrhea, constipation, drowsiness, skin reaction, and headache. Effectiveness and tolerance are similar to 1200 mg per day Ibuprofen, but pCGS takes longer to be effective. (The effectiveness of pCGS combined with prescription chondroitin is still unknown. Controversy concerning the use of glucosamine sulfate and combination products containing glucosamine largely reflects the differing regulatory status, labeling, and availability of medications in different regions of the world.)
  • Melatonin is produced by the pineal gland and plays a role in sleep, with production and release related to time of day (that is, rising in the evening and falling in the morning). It is available as both prescription and over-the-counter sleep aids. However, the research into its use to relieve musculoskeletal pain is very limited. Studies have used 3–10 mg per day over 4–8 weeks, but lower doses of 3–5 mg per day are preferred until better evidence is available. Side effects are uncommon but include drowsiness, nausea, and headache.
  • Polyunsaturated fatty acids (PUFA): Fish oil comes from a variety of fish that provide PUFAs known as omega-3 fatty acids, (alpha-linolenic acid [ALA], eicosapentaenoic acid [EPA], and docosahexaenoic acid [DHA]). Fish oil supplements contain varying amounts of EPA and DHA (18–51% and 12–32%, respectively). ALA is mainly found in green vegetables, canola oil, and soybeans. EPA and DHA almost exclusively come from fish oil and other seafoods. Omega-3 fatty acids might help relieve pain. Studies have used various combinations and doses of PUFAs (300–9,600 mg per day over 4–48 weeks). Reported side effects include fishy aftertaste, gastrointestinal complaints, and rash. Since PUFAs are already available in food, it should be considered as a dietary source. As a supplement, one should not to exceed 1200 mg per day until we have a better understanding of the various formulations.
  • Vitamin D is a fat-soluble vitamin that can be obtained from sun exposure, food, and dietary supplements. Vitamin D promotes calcium absorption, is necessary for bone growth, and appears to affect skeletal muscle, immune regulation, cardiovascular health, and metabolic activities. However, some limited evidence suggests it can help reduce musculoskeletal pain when used in doses of 2,000 IU per day (but not over 4,000 IU per day). Higher doses should be used only as prescribed by a healthcare provider, since excess use can lead to vitamin D toxicity. In research studies, it has been used safely up to 2 years.

Buyer beware!

Other dietary ingredients have been marketed to reduce musculoskeletal pain, but some lack sufficient reliable evidence of effectiveness or information enabling us to weigh the desirable against undesirable effects. Among these are:

  • Boswellia
  • Collagen
  • Creatine
  • Devil’s claw
  • L-carnitine
  • Methylsulfonylmethane (MSM)
  • Pycnogenol
  • Rose hip
  • S-adenoysl-L-methionine
  • Vitamin E
  • Willow bark extract

Keep in mind that the above applies only to the use of these ingredients to relieve musculoskeletal pain. At least some of them are possibly effective for other uses.

The bowls at Chipotle and Sweetgreen are supposed to be compostable. They contain cancer-linked “forever chemicals.

he biggest culinary star of the past five years isn’t a chef, or a restaurant group, or the author of a cookbook. It’s a bowl, a humble piece of take-out packaging that’s taken the world of commercial foodservice by storm, rising so quickly that few have noted its troubling secret. 

If you live in an American city and dine out with any frequency, you’ve almost certainly encountered one: a beige, earthy-looking receptacle, thicker than paper and thinner than cardboard, with a wide mouth and a base small enough to cradle in your palm. In a few short years, bowls like these—known as “molded fiber” bowls in the food-service sector—have become nothing short of a phenomenon. They’re the standard unit of measurement in fast-casual restaurants, which design whole menus around their proportions. They’re a staple for higher-end restaurateurs of the Caviar set, who use them to give take-out orders a touch of panache. And they’re ubiquitous in food halls, where often, no other form of plating is used.

PFAS model in compostable fiber mold bowl.

PubChem, Kritchanut / iStock

Unlike styrofoam clamshells or wax-lined soup cups, fiber products are a way to abate the guilt that comes with getting food to-go

If molded fiber bowls have become a kind of status symbol in the restaurant world, conferring a fuzzy sense of corporate, social, and environmental responsibility onto the companies that use them, it’s probably because they’ve been positioned as an antidote to the industry’s alarming take-out waste problem. Many varieties are explicitly pitched to food-service buyers as compostable, certified by third-party assessors like the Biodegradable Products Institute (BPI). Unlike styrofoam clamshells or wax-lined soup cups, fiber products feel like they’d turn into mush on a leaf pile. They seem to offer convenience without the karmic debt, a way to eat that leaves no trace. 

But these products, for reasons that have slipped under the radar until recently, are instead contributing to a growing environmental crisis. 

According to experts consulted for this story, all molded fiber bowls contain PFAS, or per- and polyfluoroalkyl substances, a broad class of more than 4,000 fluorinated compounds that do not biodegrade naturally in the environment. This means that the bowls used at restaurants like Chipotle and Sweetgreen aren’t truly compostable, as has been claimed. Instead, they are likely making compost more toxic, adding to the chemical load of the very soil and water they were supposed to help improve. And rather than degrade quickly, they contain potentially hazardous ingredients that never break down. Not in five years, and not in 500.In the rush, few noticed that these fiber bowls came with a hearty side of unintended consequences.

The New Food Economy tested fiber bowls from 14 locations of 8 different New York City restaurants, including multiple outposts of Chipotle, Dig Inn (which has since changed its name to Dig), and Sweetgreen. All of the samples tested contained high levels of fluorine, which experts including Notre Dame chemist Graham Peaslee, who conducted the testing, say indicates treatment with PFAS compounds. These powerful compounds are what allow these bowls to hold hot, wet, and greasy food, which would quickly destroy any untreated paper product. PFAS is what keeps your lunch from falling into your lap. 

The public health implications of this finding are not yet clear. The very worst PFAS chemicals are linked to a range of serious health outcomes, from colitis and thyroid disorders to kidney and testicular cancers, and have been mostly phased out of production in the U.S. These bowls are more likely to contain newer varieties that are just as persistent in the environment and are of grave concern to scientists, but have not been studied as closely for potential health effects.

The discovery that fiber bowls contain PFAS, which has not been reported until now, is especially surprising given that many restaurants have explicitly marketed them as compostable. Sweetgreen, for instance, uses prominent signage to inform its customers that its bowls “are plant-based, which means they go in the compost bin, along with any leftover food.” In an indicative recent tweet, Sweetgreen told a curious customer that all of its take-out containers are “100% compostable!” 

Ed Campaniello@edcampaniello · Jun 6, 2017

@sweetgreen how about compostable bowls? They sell online for 10 cents each. I’d come more often if they weren’t plastic. Thanks.

sweetgreen@sweetgreen

all our takeout bowls, utensils, straws, and napkins are 100% compostable!78:02 PM – Jun 6, 2017Twitter Ads info and privacySee sweetgreen’s other Tweets

While this messaging suggests that Sweetgreen’s bowls dissipate quickly and harmlessly into the environment, the very opposite is true. PFAS are colloquially called “forever chemicals” for a reason. You might only handle your salad bowl for five minutes, but the chemicals inside it, as far as we know, will stick around for countless generations. 

Fiber bowls were pitched as the take-out world’s ecological savior‚ becoming a global superstar in the process. But in the rush, few noticed that they came with a hearty side of unintended consequences. This revelation has recently thrown municipal composters, food-service manufacturers, and restaurants into a panic. And at least one U.S. city is on the verge of a logistical and public relations nightmare. On January 1, 2020, San Francisco, one of the nation’s biggest incubators of fast-casual dining, will effectively ban bowls that have been intentionally manufactured with PFAS. While that’s good news for public health, it’s also bad news for the growing number of restaurant groups who rely on the broad range of molded fiber products in their daily operations.

Manufacturers are scrambling to develop a replacement that doesn’t include PFAS by San Francisco’s deadline. As of this writing, no such alternative exists. 

From pie plates to burrito bowls

M

olded fiber products are nothing new. In 1903, after years of experimentation, the Keyes Fiber Company successfully used molded wood pulp to make pie plates, creating a new genre of disposable goods. Today, standard egg cartons, which are also made from mashed-up wood fiber, are commonly used in the U.S. More recently, companies have started to make molded fiber dishware from other plant materials, including bamboo and wheat straw. One leading approach is to use bagasse, the dry, pulpy material left over after juice is extracted from sugarcane. At first glance, that method appears to be a clear sustainability win. Compared to plastic and polystyrene foam, which tend to be made from virgin petroleum, bagasse-based bowls are fashioned from a renewable byproduct of the sugar-making process, material that might otherwise be wasted. “It’s a feel-good product that makes the guest feel virtuous.”

Despite this advantage, molded fiber products long owned only a fraction of the overall take-out market. A decade ago, the foam clamshell still reigned supreme. Cheap, sturdy, heat-resistant, and impervious to grease, it was a stalwart ally of restaurants across the country. That relationship only started to shift in 2013, when New York City enacted an influential ban on single-use foam products. As dozens of other cities followed suit, many restaurateurs were forced to look for a replacement. 

According to Lynn Dyer, president of the Foodservice Packaging Institute, a trade group representing take-out packaging manufacturers, foam bans led directly to the rise of molded fiber. Today, molded fiber bowls and other containers are the take-out packaging of choice for fast-casual eateries, higher-end restaurants, food halls, and other establishments that want to telegraph green values. They come in many varieties—not just 48-ounce deep bowls, 8-ounce soup bowls, and oblong burrito bowls, but clamshells, platters, plates, and cups.

“In short, it’s a feel-good product that works for the operator—less waste, halo branding, a product that makes the guest feel virtuous,” Arlene Spiegel, a New York City-based food-service consultant, told me by email. 

In a few short years, molded fiber bowls became so ubiquitous and so recognizable that they’re now almost a cuisine unto themselves. In 2018, The Wall Street Journal published a piece on the rise of “bowl food,” which it defined, somewhat tautologically, as a new American tendency to “put all manner of things in bowls that once had no place there.” I’d define it somewhat differently. Today, “bowl food” tends to refer to a genre of high-concept, chef-driven, eco-friendly-esque cheap eats, one that’s growing rapidly thanks to a community of deep-pocketed investors who hope to own a piece of the next Chipotle.

A chipotle located in midtown Manhattan

Jessica Fu

Chipotle is one of many fast-casual restaurants that uses molded fiber bowls

A key part of this appeal—the “halo branding” Spiegel refers to—is the supposed compostability of molded fiber. But the suggestion that these products biodegrade turns out to be deeply misleading (even when they do end up in appropriate composting facilities, which is by no means guaranteed). Yes, the plant fibers used to make these products often dobreak down under the right conditions. But these products, even when certified “100-percent compostable” by independent assessors like BPI, contain chemicals that stay in the environment forever, ruining compost, tainting soil, and polluting water in the process. 

“Companies really can’t claim they didn’t use PFAS”

I

started wondering if fiber bowls contain PFAS late last year, when a cohort of nonprofit advocacy groups released a report on PFAS chemicals in supermarket take-out packaging. Their study, which was first noted by Bloomberg, didn’t look at bowls. Instead, it looked at the kinds of packaging you’re more likely to encounter at salad bars and deli counters: wax paper, sandwich wrappers, and cardboard take-out boxes. Some of those products turned out to contain PFAS. One surprising detail was that Whole Foods, a retailer that routinely touts its certified compostable packaging, was the worst offender in the study, with PFAS detected in five of 17 items tested. Trace amounts of fluorine occur everywhere. High levels prove that a product was intentionally manufactured with PFAS.

Whole Foods has since pledged to remove PFAS from its packaging supply chain. Still, if the company’s “compostable” take-out boxes had been treated with PFAS to make them more grease-resistant, what about the fiber bowls at restaurants like Sweetgreen and Chipotle—the kinds of places where I eat during my office lunch break? The more I thought about it, the more it seemed strange that those lightweight containers never seemed to leak grease, or fall apart while holding a dressed salad.

In May, I sent Graham Peaslee, the Notre Dame chemist, 19 samples to test at his at his lab. The first sample was a control: a square cut from an everyday sheet of printer paper. The other samples were unused molded fiber bowls collected from New York City eateries—including multiple locations of Chipotle, Dig, and Sweetgreen—restaurants that actively claim to compost their materials. 

These bowls were gathered by New Food Economy staffers on their lunch breaks. Back at the office, I cut out a small piece from each one, a square roughly the size of the lens on a pair of sunglasses. Peaslee had made two other requests. He’d asked me to cut the curved edge of each bowl, rather than the bottom—this made it easier for him to determine which side was the food contact surface, since he wanted to test both the inside and the outside of each bowl. He also asked me to sterilize the scissors with rubbing alcohol after each cut. Fluorinated chemicals can migrate from one surface to another, and he wanted to be sure I hadn’t cross-contaminated my samples. 

Fiber molded bowls stacked on top of one another with a PFAS model inside one of them.

Gam1983, Dmytro Synelnychenko / iStock, Pub

As a class, PFAS compounds tend to become problematic at very low concentrations

Peaslee’s test doesn’t measure PFAS per se. His lab uses a technique called Particle-Induced Gamma-ray Emission (PIGE, pronounced “piggy”), a form of ion beam analysis more typically used on rocks by geologists, to measure the total amount of fluorine in the product. Because there are thousands of PFAS chemicals in use, each one with its own unique molecular structure, it’s difficult, if not impossible, to test for every conceivable chemical. So while Peaslee’s test doesn’t show which specific compounds have been used, it’s an effective, quick, and relatively inexpensive way to determine whether a product has been treated with fluorochemicals. Though trace amounts of fluorine naturally occur in the environment, high levels prove that a product was intentionally manufactured using PFAS. 

“The test Graham does is a great screening tool,” says oceanographer Rainer Lohmann, director of the University of Rhode Island’s Lohmann Lab, which studies the way that toxic, man-made chemicals including PFAS move through waterways. “If a product is showing really high fluorine levels, companies really can’t claim they didn’t use PFAS.”

A bathtub with no drain

W

hen I received my test results back from Peaslee in June, only one sample showed low levels of fluorine: the square of printer paper. At only 33 parts per million (ppm), the level was low enough to suggest no intentional treatment. It’s possible that the paper picked up some naturally occurring organic fluorine, or was contaminated with tiny amounts of PFAS at some point on its journey to the New York City office where I work. 

But the bowl samples were another story. Each one contained much higher amounts of fluorine, levels that Peaslee says can only be achieved through intentional PFAS treatment. In general, the bowls’ outsides gave a higher reading—1,740 ppm across the samples—than the food contact side of the bowls, which averaged 1,599 ppm. Together, the samples averaged 1670 ppm fluorine, or about 50 times what Peaslee found on my sample of printer paper. (A chart of the full findings can be found here.)

The highest overall reading (2,167 ppm) was found from Urbanspace Lexington, a food hall where I gathered five bowls from the different restaurants inside. (The lowest overall reading, 826 ppm, was also taken from Urbanspace.) Sweetgreen’s bowls showed slightly lower fluorine levels than Chipotle’s or Dig’s—about 200 ppm lower on average. Peaslee considers all of these samples to be “highly fluorinated,” though it’s worth noting that the levels seem to vary somewhat. 

Remember that Peaslee’s test doesn’t measure PFAS, only total fluorine. That means a bowl containing 1670 ppm fluorine will contain more total PFAS, since every molecule of the chemical compound contains multiple atoms—not just of fluorine, but of carbon, and other elements. Though it’s impossible to say for sure due to the wide variety of PFAS chemicals, Peaslee tells me that, according to a rough calculation, a bowl with 1670 ppm fluorine would likely contain about 2000 ppm total PFAS. Put another way: A bowl with 2000 ppm total PFAS might be mostly made from sugarcane fiber, but 0.2 percent of its total material would be made from fluorinated chemicals. 

That might not sound like very much. But due to the unique properties of fluorinated chemicals, it turns out to be a significant number, and an alarming one. The Centers for Disease Control and Prevention (CDC) maintain that drinking water can only contain infinitesimal amounts of fluorinated chemicals before health concerns arise. Not all PFAS are created equal, and the most obviously dangerous varieties have been phased out of production, meaning they’re not likely to be the kind found in the bowls we tested. Still, as a class, PFAS compounds tend to become problematic even at the very lowest concentrations. 

That’s where our testing comes back into play: 2000 ppm PFAS seems minor, since it’s just 0.2 percent of each bowl. But, unlike solvents and pesticides, which have been regulated for decades at parts-per-million levels, PFAS can become a concern in drinking water at parts per trillion(ppt) levels. For example, the federal government advises that children should not drink water with concentrations of 140 ppt or higher of PFHxS, a PFAS still approved for use in some forms of food packaging. The PFAS concentrations found in the molded fiber bowls we tested were more than 10 million times that level.

To be very clear, not all PFAS are created equal. The varieties in the CDC chart above, for instance, are not likely to be those used in the bowls we tested; PFOA and PFOS are no longer allowed to be produced in or imported into the U.S. But the point is this that all PFAS are highly persistent chemicals, which stick around in the earth, and in our bodies, for a very long time. 

Furthermore, any product that contains PFAS can’t really be compostable, let alone biodegradable, despite restaurants’ claims to the contrary. Though fiber products have benefits from a greenhouse gas emissions standpoint, the bowls we tested are likely making soil and water quality worse. 

Rhodes Yepsen, president of BPI, the leading third-party certifier, points out that the food-service is only a small part of a larger problem. “Compostable products make up less than 1 percent of all food-service products,” he tells me, “which make up less than 1 percent of all applications that PFAS is used on.” As the Associated Press points out, PFAS are commonly used—often at even higher concentrations—in carpets, couches, outdoor gear, and even dental floss.The bowls we tested are likely making soil and water quality worse.

But researchers who study fluorochemicals have a favorite metaphor: When it comes to PFAS, the earth is a bathtub with no drain. Because these chemicals have no known half-life, and will never go away naturally, they remain part of the earth’s ecology forever. The supply never dwindles. Every drop ever produced will slosh around eternally inside the clawfoot tub that is this planet. The fire-fighting foam, carpet, and textile industries, by far the worst PFAS offenders, account for the steadiest flow from the faucet. The world of take-out restaurants might be more of a constant trickle. Still, the bowls prized for their benign, guilt-free ephemerality are helping to fill the basin—which will remain just as full for the next generation, and the one after that, and the one 50 generations into the future, if we should be so lucky. 

So, the question remains: If the earth is a tub with no drain, how much toxic bathwater can our bodies take? Because when even small amounts of PFAS chemicals go into a take-out bowl, they inevitably leach out into the environment. And from there, they inevitably make their way into us. 

Long chains, short chains 

O

nce molded fiber manufacturers have mashed raw plant-based fibers—typically processed sugarcane, but also cornstalks, sorghum, or recycled newspaper—into a pulp, PFAS is added in a process called a “wet-end” application. In other words, the fluorinated compounds are stirred into the pulpy mass, until they’re distributed somewhat evenly throughout the final product, before being pressed into shape.

Sweetgreen salads in molded fiber bowls sit on a shelf

Jessica Fu

Sweetgreen salads in molded fiber bowls sit on a shelf

That’s a necessary step. Without PFAS, which has extraordinary water- and grease-repelling properties, fiber products would fall apart upon contact with hot or wet food. PFAS are great at repelling water, because they’re strong, well-defended molecules that only break down in the most extreme, man-made circumstances. I asked Lohmann, the oceanographer who runs his eponymous lab at the University of Rhode Island, to explain why these chemicals are so tenacious. He says that, while PFAS molecules can contain atoms of oxygen, hydrogen, sulfur, and/or nitrogen, their hallmark is a tight fluorine-carbon bond, a tank-like kind of molecular armor that makes them virtually indestructible. 

“The carbon-fluorine bond is very, very strong,” Lohmann says. “It’s difficult to make, but once you’ve made it, it’s difficult to break apart. There’s no angle of attack anymore for enzymes, microbes, or even radiation. There’s just no natural way to break them down. We can use incinerators or other very harsh conditions to break them down, but those are technical solutions.” 

Their impermeability means PFAS make a great grease barrier. But what’s the tradeoff for our health? Experts agree, and our testing corroborates, that virtually all molded fiber take-out packaging still contains PFAS—just of a different variety.

That’s harder to say. After all, we don’t know which specific PFAS are being used in these bowls. And restaurants themselves may not know either. Sweetgreen did not respond to repeated requests for comment. Dig was unable to provide more information by press time, though a company spokesperson expressed the desire to do so in the near future. In a phone call, representatives from Chipotle acknowledged the use of PFAS in the company’s burrito bowls, but declined to answer emailed questions about which specific compounds are present. Instead the company emailed a written statement: 

“Chipotle is committed to safe and sustainable food packaging solutions and takes great care in how its packing is sourced, made and used—in addition to its end-of-life impact. Chipotle only partners with suppliers who make fluorochemical sciences and food safety a top priority. These suppliers operate under strict guidelines set forth by the FDA, and have provided Chipotle with certification that all raw material and finished pulp products fully meet the FDA regulatory guidelines for the safe use of only approved PFAS. Specifically, Chipotle does not use any of the three long-chain PFAS compounds (C8 or greater) prohibited by the FDA’s 21 code of Federal Regulations (C.F.R) Part 176. Chipotle will continue to collaborate with industry partners who invest in the research and monitoring of fluorochemical research for all packaging.”

According to Maricel Maffini, an independent researcher and former senior scientist for the Natural Resources Defense Council, there are currently 62 PFAS approved for use by FDA in food. Chipotle appears to be saying that it might be using any of the PFAS that are legally allowable in food packaging. Unsurprisingly, the company says its suppliers do not use the most dangerous PFAS compounds, known as “long-chain” PFAS, which were phased out by FDA starting in 2011. In its systematic review of available research, FDA had found that these chemicals—also known as “8C” PFAS, due to having eight carbon molecules—were linked to a variety of serious health outcomes. “If your option is eating a cheeseburger versus a salad in a bowl that might have some PFAS’s, you’re probably okay with that salad.”

A 2017 study published in the peer-reviewed journal Environmental and Science Technology Letters, co-authored by Graham Peaslee, summarizes some of those possible adverse health effects. It’s a disturbingly long list: kidney and testicular cancer, low birth weight, thyroid disease, decreased sperm quality, pregnancy-induced hypertension, and immunotoxicity in children. Animal studies have found additional linkages, including altered mammary gland development, reproductive and developmental toxicity, obesity, and immune suppression. 

Of extreme concern is the “biopersistence” of PFAS chemicals, their tendency to linger for long periods inside the body. According to a fact sheet published by CDC, it can take our bodies anywhere from four to 18 years to completely excrete long-chain PFAS chemicals. Compare that to another chemical of health concern, bisphenol-a, or BPA, which only remains in the body for a few hours

The good news is that, starting in 2000, chemical industry groups began agreeing to phaseouts of the most commonly used long-chain chemicals. Then, starting in 2016, FDA outright banned the manufacture and import of five other types long-chain PFAS. These varieties are still being made outside the U.S., which means they’re still getting into American bodies (the earth is just one bathtub). But experts I spoke to generally agreed that FDA’s decision has reduced our exposure to the most dangerous class of chemicals.

Molded fiber clamshell

Eyepark iStock

While short-chain PFAS are already widely dispersed throughout the environment and in our bodies, the longer-term sublethal effects of this dispersal simply are not known

They also agree, and our testing corroborates, that virtually all molded fiber take-out packaging contains PFAS—just of a different variety. Foodware today is more likely to contain “short-chain” PFAS, which consist of molecules with fewer than eight carbon atoms. Less is known about the health effects of these replacement chemicals. They simply haven’t been in use long enough to be evaluated thoroughly. A 2018 study in Environmental Sciences Europe pointed out that, while short-chain PFAS are already widely dispersed throughout the environment and in our bodies, the longer-term, sublethal effects of this dispersal are not known. 

That said, short-chain PFAS—the kind most likely to be present in the bowls we tested—are still classified by the European Union’s Registration, Evaluation, Authorisation, and Restriction of Chemicals (REACH) law as chemicals of “very high concern.” 

The good news is that short-chain PFAS are less biopersistent than their longer-chain counterparts. According to Laurel Schaider, a research scientist and water quality specialist at the Silent Spring Institute, an anti-pollution non-profit, the shorter-chain alternatives stay in the body for a matter of days or months, not years. That’s a crucial difference when it comes to evaluating their safety. Unfortunately, the problems with PFAS don’t stop with direct food exposure.

Even so, a one-month half-life is still an extraordinarily lengthy interval. “If you are a pregnant woman, a month or two is a long time,” says Maffini. “And that’s just one exposure. You have to keep in mind that exposures are ongoing. It’s not one shot and you’re done.” In other words, even though short-chain fluorochemicals are less biopersistent, they’re still likely to be entering our bodies much faster than we can excrete them. 

The Environmental Sciences Europe study also pointed out a number of other factors unique to short-chain PFAS, many of which are not encouraging. Short-chain varieties are just as indestructible as their longer-chain siblings. The shorter molecular structure that makes them easier to excrete also makes them harder to screen out. While water treatment facilities can use activated carbon capture to filter long-chain PFAS, this technique doesn’t work as well with the short-chain variety. They’re also more mobile, traveling with ease through waterways and through the bloodstream, which means they have the potential to disperse more widely through our individual bodies and across the globe. 

Their ability to travel could also mean that you’re more likely to be eating small amounts of PFAS along with your grain bowl. According to Schaider from Silent Spring, short-chain PFAS are even more likely to migrate into food than long-chain, especially when that food is hot. Salad dressings also contain emulsifiers, she says, that have been shown to increase migration.As the plant-based material degrades, the forever chemicals seep out—ending up in public waterways, where we drink them directly from the tap.

According to FDA guidelines, food packaging can include approved PFAS in various concentrations ranging from about 0.25 percent to 1.5 percent, depending on the chemical. At 2,000 ppm, or 0.2 percent of material, none of the bowls we tested seem to have exceeded those thresholds, though it’s hard to say that for sure without knowing more about specific chemicals. Still, remember that short-chain PFASs can stay in the body for months. I eat out of a fiber bowl nearly every day—which the Sweetgreen iPhone app makes it unnervingly easy to do, and which some sources tell me is an unwise idea. 

Marty Mulvihill, co-founder of Safer Made, a venture fund that invests in eco-friendly businesses, tells me that he’s looked everywhere for a molded fiber bowl made without PFAS, to no avail. A former chemist who used to run the University of California, Berkeley Center for Green Chemistry, Mulvihill is concerned that routine daily exposures aren’t a good thing. He compares molded fiber bowls to Twinkies. They won’t kill you. But, in his view, they’re not a healthy everyday choice either.  

“If it’s possible to avoid them, avoid them,” he says, speaking specifically of molded fiber bowls. “But if your option is eating a cheeseburger versus a salad in a bowl that might have some PFAS, you’re probably okay with that salad. You just don’t want to be eating it all the time, or taking them and microwaving things in it, or eating off of them on a daily basis.” 

Unfortunately, the problems with PFAS don’t stop with direct food exposure. The real issue, Peaslee tells me, is the way they contaminate water. When molded fiber products end up in a landfill, they’re sequestered briefly. But as the plant-based material degrades, the forever chemicals seep out, ending up in public waterways, eventually making their way into the taps we drink from every day. 

A Sweetgreen location in New York

Jessica Fu

Lunchtime outside a crowded Sweetgreen on 55th St. in Manhattan, where a bowl tested by The New Food Economy came back positive for PFAS

When a product that contains PFAS decomposes in a landfill, Peaslee says, “that means 100 percent of the chemicals are coming off. Not just the one-tenth or one-hundredth of a percent that comes off in food contact, but 100 percent of it you’ll be drinking in two months. Because it goes right through the landfill treatment.” The leachate that seeps out of landfills is treated, but sincer short-chain PFAS means can’t currently be screened out, they go straight through the filtration systems into the water.

“That’s the biggest issue with PFAS in my mind,” Peaslee says. “The fact that we are now contaminating our waterways. If you don’t eat it off your wrapper, you and your kids will be drinking it out of municipal water in two months. That’s the scary part.”

Of course, some fiber bowls don’t go into the landfill at all. They’re thrown into compost facilities, where their toxicity has caught an entire industry by surprise.

“As soon as I found out, I was horrified” 

I

n late 2015, Jen Jackson started hearing about fluorochemicals in molded fiber food packaging, and was immediately worried. A former water quality scientist who now works as the toxics reduction manager for the city of San Francisco’s Department of the Environment, she’d helped to develop the city’s pioneering composting rules, including a program that aggressively targets restaurant waste. “I think now we’ve done a bad thing.”

“I was concerned,” Jackson says, “particularly because we have requirements in San Francisco that food-soiled paper and fiber products go to our compost stream.” 

To try to get a handle on the problem, Jackson arranged to test the foodware being used in two city hospitals—San Francisco General and Laguna Honda, a nursing facility—both of which used compostable packaging in their cafeterias. While some of the paper and cardboard products contained PFAS, many of them were PFAS-free. But, she found, all of the molded fiber products were fluorinated. The surprising thing, in Jackson’s view, was that many of those products were certified compostable. 

This meant that the bowls, dishes, and clamshells San Francisco had diverted to compost facilities were instead likely contaminating the compost—and eventually the food crops that it was used on—with PFAS.

“As soon as I found out, I was horrified,” Jackson says. 

This class of products has likely been contaminating compost sites for years. Experts I spoke to said that PFAS have long been present in molded fiber dishware. There’s also some more concrete evidence. In June of this year, the first-ever study of PFAS in municipal compost facilities was published in the journal Environmental Science and Technology Letters. The study was prompted in 2018 by Heather Trim, executive director of Zero-Waste Washington, a non-profit advocacy group. When she began to hear rumors about PFAS chemicals in compostable bowls, the revelation shocked her. Sites that accepted foodware showed PFAS levels that were about 10 times higher than the sites that didn’t.

“I did not know that these chemicals were being used extensively in products that come into contact with food,” she says. 

Trim reached out to Linda Lee, a Purdue University agronomist who’d studied PFAS in biosolids, the nutrient-rich organic matter created by wastewater treatment plants when they treat domestic sewage. 

“We’re really proud, in the state of Washington, that we push everything to go into the compost, so we can keep things out of landfills,” Lee remembers Trim saying. “But I think now we’ve done a bad thing.” 

Trim wanted to help Lee design a study that would establish whether—and to what degree—compostable food products are adding to the toxic load of the compost created at municipal facilities. The two didn’t want to point the finger at any one operator, so they decided to look at a range of different facilities, ultimately gathering data from composting locations in Washington, Oregon, California, Massachusetts, and North Carolina. Nine of them were commercial facilities; one was a backyard compost pile. Out of the 10 locations Trim and Lee sampled from, seven sites accepted compostable foodware, while three (including the backyard pile) did not. 

The results were striking. Samples from the sites that accepted foodware showed PFAS levels about 10 times higher than from the sites that didn’t. Specifically, two kinds of PFAS, PFHxA and PFBS—both shorter, 6- and 4-carbon chain compounds commonly used to increase grease and stain resistance in food packaging—were detected at much higher levels.

Fiber molded plates stacked on top of one another with a PFAS model inside one of them.

Gam1983, Anastasiia_Guseva / iStock, PubChem

Research shows PFAS can easily be absorbed by fruit and vegetable crops, where compost is likely to be applied

Lee is clear that the study doesn’t prove causation, and she can’t say for sure that the higher PFAS levels were definitely due to the presence of compostable food packaging at those sites. (The study didn’t ascertain how much compostable plateware was in each facility.) The sites that permitted dishware also contained more of the long-chain PFAS that should no longer be in use—a rise in toxicity assumedly due to substances other than food packaging, since those compounds should not be permitted in their manufacture. Still, the study suggests that the presence of compostable plateware is highly correlated to a dramatic overall rise in PFAS levels. It’s a finding that warrants further study, especially considering that research shows PFAS can easily be absorbed by fruit and vegetable crops, where compost is likely to be applied. 

After her own discovery in San Francisco, Jen Jackson wanted to act quickly. The city had insisted that its restaurants use compostable dishware to make them more environmentally friendly. If there was any chance that molded fiber products were actually making compost moretoxic, the city had to act. 

In 2016, she called Rhodes Yepsen, who had just become president of BPI, to ask if he knew that BPI’s certified compostable molded products contained PFAS. Jackson says Yepsen had not been aware of the issue.“No one ever thought that the manufacturing world would come up with fiber-based bowls, and put fluorinated chemicals in them.”

It’s not all that shocking that PFAS caught BPI by surprise. Like other third-party certifiers in the biodegradability space, BPI was originally founded to assess plant-based plastics, the PET bowls and clamshells that dominated the first wave of plastic replacement products. BPI had developed standards that ensured those products broke down fully into compost, not just tiny plastic pellets. It wasn’t testing for PFAS. No one in the food packaging industry was.

“No one ever thought that the manufacturing world would come up with fiber-based bowls, and put fluorinated chemicals in them,” Jackson says. “It wasn’t on BPI’s radar either.” 

Jackson tells me that, in her experience, even some of the companies selling fiber bowls didn’t know they contained PFAS. Though many food-service packaging companies are headquartered in the U.S., the products themselves are often made in other countries, especially in China. But she felt it wasn’t right for those products to be marked “100 percent compostable” if they contained forever chemicals. She wanted to convince Yepsen that highly fluorinated products should no longer carry BPI’s certification. 

Ultimately, Yepsen agreed that BPI should eliminate fluorinated products from those it certifies. In December of 2017, BPI announced a coming change to its standards. Beginning on January 1, 2020, it will not certify any product that contains over 100 parts per million of total fluorine. Jackson says she gives Yepsen a lot of credit for implementing the standard, which she feels is sufficient to help screen out products made with PFAS. 

“We want to make sure that the products that are going to composting facilities are safe for those composting facilities and not negatively impacting their compost quality,” Yepsen says. For now, there is no commercially viable plan B.

For context, the bowls tested by The New Food Economy showed fluorine levels 10 to 20 times higher than the 100 ppm cutoff that BPI established. The new requirement will ensure that future molded fiber products, if they’re going to be certified by BPI, will be more like the piece of printer paper we tested: not zero total fluorine, but only enough to suggest the presence is accidental. 

Untill a viable PFAS-free alternative is developed, then, San Francisco’s new rule amounts to an effective ban on molded fiber products. And while the law will take effect in a few short months, the city’s restaurants really not ready for it. Jackson’s Zero Waste Team is currently providing outreach materials to restaurants, and letting them know to expect the change. City-owned properties have already switched from molded fiber bowls and clamshells to wax-paper-lined shallow cups (“like a cup, but short,” Jackson says), as well cardboard takeout boxes lined with plant-based plastic. 

Solutions do already exist, Jackson says. “There are safer alternatives out there. We can buy them. They’re on the market. They’re scalable. Distributors can accept them. So there’s no reason not to change what is allowed in San Francisco.” 

But what about the businesses who have built their brands around bowls—and the message they’d hoped those receptacles would convey? For now, there is no commercially viable plan B. The food-service packaging giant Sabert, for instance, has convened an internal PFAS task force dedicated to solving the issue, but hasn’t yet announced a new alternative. Sabert declined to respond to my list of written questions, after first indicating it would. That silence may be revealing, illustrating how unprepared the food-service industry is to take this topic on. If companies like Sabert and Sweetgreen don’t even know how to talkabout their fluorinated products publicly, they’re a long way from being able to provide a suitable replacement. 

Doing the right thing 

After the Toxic-Free Future report revealed PFAS in Whole Foods’ deli papers and hot bar boxes, Rhodes Yepsen says he sat down with company representatives to discuss BPI certification and the future of the supermarket’s products. He was asked a number of questions about BPI’s process and testing methods. But at the end of the conversation, Yepsen had a question of his own.

Why does Whole Foods, he remembers asking, care about compostable products in the first place? When commercial composting facilities are not available, as is the case in many regions throughout the countrythe company doesn’t collect takeout boxes for composting. It asks people to throw them in the garbage can, where they’re taken to the landfill. But if those boxes often aren’t composted, even if they’re technically compostable, why the emphasis on BPI certification? 

“They didn’t really have an answer,” Yepsen tells me.

He says he often has conversations like this one with retailers and food-service companies who want to be assured their products are compostable, even though they’re not actually composting. He’s often given vague assurances. “We just want to do the right thing,” is a sentiment he says he hears a lot. It feels so good to believe our throwaway items will have only brief lives beyond us.

“It’s important to give companies like Whole Foods credit for moving in the right direction, even if it’s incremental change, because they have really been forerunners in setting up organics diversion programs at stores across the country,” Yepsen says. “But when you’re weighing the sustainability pros and cons of choosing a product, you have to ask—well, what problem are you trying to solve?”

That’s what retailers and restaurants don’t seem to be able to answer. Does doing the “right thing” mean only reducing waste? If so, Yepsen thinks companies should work harder to start composting, or else transition to recyclable products. Not all of them want to do that. Yepsen says that some companies tell him they care, more generally, about the life cycle of their products in the environment. But if that’s the case, he asks, why aren’t they doing more to take on PFAS? Why aren’t they taking products known to contain PFAS at even higher levels—microwave popcorn, for instance—out of their stores entirely? Perhaps more broadly, Yepsen wonders why they aren’t using their clout to lobby FDA and EPA, and encouraging them to take these compounds out of the supply chain in the first place? 

If companies won’t answer Yepsen directly, it could be because they sense their efforts are facile, more about optics than real-world results. And when it comes to easy virtue, the fiber bowl makes a wonderful ally. The word “compostable” is profoundly comforting in our world of obscene waste. That molded piece of sugarcane looks so earthy and delicate. Its hollow the color of something you might find in a forest, ready to turn into mulch with rain and time. If this impermanence is a fiction, it’s an intensely reassuring one. 

It’s easy to sneer at the magical, self-serving logic of corporations. But as citizens, we’re not really all that different. Rather than engage in a sustained, searching way with the challenges we face, we too often place blind trust in apparent quick fixes. We want to believe our throwaway items will have only brief lives beyond us. It feels so good to let those lingering worries about the earth, and our place in it, get hauled away with the trash. This has always been the promise of bowl food. It’s also been the lie: That plant-based disposables offer a more enlightened kind of eating, a way to escape the dark connections our hunger implicates us in. 

Turn to nature

If you have a toothache, backache, or any other type of pain, your first impulse may be to reach for a pill. Many people rely on medications, but they come with the risk of side effects, drug interactions, and habitual use or addiction.

You may find the relief you need from a variety of natural painkillers instead.

Many herbs and spices can treat inflammation and other related conditions. These plant-based options fall under a category of treatment known as alternative medicine, which also includes acupunctureyoga, Reiki, and other practices. When it comes to pain relief, you may be surprised by what might help you feel better.

Willow bark

willow bark

People have been using willow bark to ease inflammation, the cause of most aches and pains, for centuries. The bark of the white willow contains the chemical salicin, which is similar to the main ingredient in aspirin (Bayer).

Originally, people chewed the bark itself to relieve pain and fevers. Now willow bark is sold as a dried herb that you can brew like tea. It also comes as a liquid supplement or in capsule form. You can use willow bark to help relieve discomfort from headacheslow back painosteoarthritis (OA), and many other conditions.

However, willow bark comes with its own risk of side effects. It can cause stomach upset, may slow down your kidneys, and can prolong bleeding time, just like aspirin. It should only be used by adults. Similar to how aspirin taken in large quantities can be harmful for children, willow bark could be poisonous to children.

If you’re sensitive to aspirin, or if you’re taking any over-the-counter (OTC) anti-inflammatory drugs (like aspirin, ibuprofen, or naproxen), you should avoid willow bark. You should also avoid taking it if you’re taking warfarin (Coumadin) or other anticoagulant treatments, as salicin could increase the risk of bleeding. Talk to your doctor before taking willow bark if you’re taking other anti-inflammatory or pain medications.Shop for willow bark supplements.

Turmeric

turmeric

Turmeric is the spice that gives curry its yellow color and unique flavor. It contains the compound curcumin, an antioxidant that helps protect the body from free radical molecules that can damage cells and tissue.

Turmeric can also be used for the treatment of many conditions, including:

Some people with OA also turn to turmeric as a natural pain reliever because it helps relieve inflammation.Shop for turmeric supplements.

G

Cloves

ground cloves and whole cloves

Whole cloves are often used to spice up meat and rice dishes. Ground cloves are used in pies and many other foods. As a medicine, cloves can be found in capsule or powder form. Clove oil is also available.

Like other herbal supplements, you can use cloves to treat a wide range of conditions. Cloves may help ease nausea and treat colds. They may also help relieve the pain associated with headaches, arthritic inflammation, and toothaches. Cloves can also be used as part of a topical pain reliever.

One study suggested that cloves could be used to treat fungal infections, but further research is needed.

The active ingredient in cloves is eugenol, a natural pain reliever that’s also used in some OTC pain rubs. Rubbing a tiny amount of clove oil on your gums may temporarily ease toothache pain until you can get to a dentist. But too much undiluted clove oil may actually hurt your gums, so discuss this approach with your dentist before trying it at home.

People with bleeding disorders or who are taking blood-thinning medication should be careful when consuming clove products. Clove oil can increase the risk of abnormal bleeding.Shop for clove oil.

Acupuncture

acupuncture needles

This ancient Chinese medical practice seeks to relieve pain by balancing the body’s natural energy pathways. The flow of energy is known as qi (pronounced CHEE).

For this practice, acupuncturists place tiny, thin needles into your skin. The location of the insertion is related to the source of the pain. Based on the qi, a needle may be inserted far from the part of the body experiencing pain.

Acupuncture may relieve pain by causing the body to release serotonin, a “feel-good” chemical that eases pain.

2012 study found that acupuncture helped relieve pain associated with OA, migraines, and various locations of chronic pain.

Heat and ice

heat and ice

Among the most common home pain remedies is applying heat and ice directly to sites of pain. While this treatment may seem obvious, not everyone’s clear on exactly when to use ice versus heat.

Applying an ice pack to reduce swelling and inflammation shortly after you experience a strained muscle, tendon, or ligament may bring relief. Interestingly, once the inflammation has disappeared, heat may help reduce the stiffness that comes with sprains and strains.

cold pack used briefly on the head may also help take away the pain of a headache.

If your painful problem is arthritis, moist heat applied to the affected joint will help more than ice. Moist heat packs can be warmed in the microwave and used many times, making them effective and easy to use.

If you get injured, talk with your doctor or pharmacist about how to best use heat or ice to help ease the pain.

Be careful when managing pain

The natural painkillers described above may only be effective for specific causes of pain. It’s possible that not all of the suggestions on this list will work for you. However, these natural alternatives to prescription or OTC medications may at least give you some decent options to try before you turn to pharmacological solutions.

Remember, pain is the body’s signal that something is wrong. It may be temporary, as with a strained muscle. But pain can also mean you have a serious health problem that needs professional medical evaluation. Don’t hesitate to seek out a healthcare provider to diagnose the source of your pain, and discuss some natural options for treating it.

Does Arnica Help with Pain?

Pain management isn’t easy. The side effects of prescription painkillers can make this option less appealing for many people. There’s also the very real possibility of getting hooked on the drugs, as underscored by the current opioid crisis. It makes sense to find alternative, nonaddictive ways to manage pain and avoid taking prescription pain medications in the first place.

One potential alternative is homeopathic medicine. While low on scientific evidence, homeopathic medicine has been in use for centuries. Arnica is one such example.

What is arnica?

Arnica comes from the perennial Arnica montana, a yellow-orangish flower that grows in the mountains of Europe and Siberia. It’s sometimes called the “mountain daisy,” because its color and petals look like the familiar flower. Creams and ointments made from the flower head can be used to address the following ailments:

What the research says

Arnica is commonly used to treat bruises, so it’s popular among people who’ve recently undergone surgery, especially plastic surgery. Although scientific research is inconclusive on the matter, topical creams and gels containing arnica are said to help with pain and bruising of the skin.

2006 study on people who underwent a rhytidectomy — a plastic surgery to reduce wrinkles — showed that homeopathic arnica can significantly boost healing. Arnica has proven effective during the healing of several postoperative conditionsTrusted Source. These include swelling, bruising, and pain.

Other research has provided mixed results regarding its effectiveness. A study published in Annals of Pharmacotherapy found that arnica increased leg pain in people 24 hours after a routine of calf exercises.

How it’s administered

If you choose to use the herb arnica for pain, never take it orally. It’s meant to be applied to your skin and is typically used as a gel. Arnica isn’t used very often in internal medicine, as larger doses of undiluted arnica can be fatal.

You can dissolve a homeopathic remedy of arnica under your tongue. However, this is only because homeopathic products are highly diluted. The herb itself shouldn’t be put into your mouth.

Precautions and side effects

Doctors don’t recommend using arnica on broken skin or for extended periods of time, because it can cause irritation. Additionally, pregnant or breastfeeding women should consult with a doctor before using arnica.

Some people can have allergic reactions to arnica or show hypersensitivity. If this occurs, you should stop using arnica. Individuals who are allergic or hypersensitive to any plants in the Asteraceae family should avoid using arnica. Other members of this family include:

The takeaway

As with most homeopathic remedies, the scientific “jury” is still out, despite studies that show it to be an effective treatment for arthritis and postsurgery bruising. Talk to your doctor if you’re interested in using arnica.

Can Essential Oils Relieve Inflammation?

Understanding inflammation

You can’t escape essential oils these days, but can you actually use them? People who use essential oils claim that they are helpful for everything from relaxation and sleeping to reducing inflammation in the body.

Inflammation occurs in the body when the immune system is activated. Inflammation can have many different causes, such as from an infection or even a reaction to a food allergy. The body senses that something is wrong, so it sends blood cells to that area to help heal what’s wrong and kill off any “invaders.”

However, not all inflammation is good. Your body can’t necessarily tell whether something is wrong or if you’re just stressed because of a big work project. Either way, it will produce inflammation to try to help in any way it can. Over time, this may tire out your immune system or cause problems in other parts of your body.

What the research says

Antioxidants can reduce the harmful effects of inflammation in the body. This may be why you hear a lot about the importance of eating antioxidant-rich food to keep you healthy. Some researchers have also looked at whether essential oils can be used as antioxidants to help reduce inflammation. Although research is limited, there’s some evidence to suggest that essential oils help.

2010 studyTrusted Source found that the following essential oils had anti-inflammatory properties:

  • thyme
  • clove
  • rose
  • eucalyptus
  • fennel
  • bergamot

Researchers found that these oils reduced the expression of the inflammatory COX-2 enzyme by at least 25 percentTrusted Source. Thyme essential oil had the most effects, reducing COX-2 levels by nearly 75 percentTrusted Source.

The National Association of Holistic Aromatherapy also lists many oils that may reduce inflammation, including:

  • roman chamomile
  • ginger
  • helichrysum
  • patchouli

How to use essential oils for inflammation

Because inflammation affects the whole body, essential oils can be used in a few different ways to treat it:

Diffusion: You can buy an essential oil diffuser online or even at stores such as Wal-Mart or CVS. A diffuser will allow essential oil particles to disperse directly into the air. Inhaling the scent may help you relax. If your inflammation is stress-related, this may be beneficial.

Massage: You can apply diluted essential oil directly to the affected area to help reduce swelling and pain.

By mouth: Although rare, there are some types of essential oils that are meant to be gargled. Researchers in a 2011 reviewTrusted Source found that using an essential oil mouthwash was helpful in reducing gum inflammation caused by gingivitis. Be sure to consult your doctor before trying this method. Essential oils aren’t meant to be swallowed.

If you plan to use essential oils topically, there are a few things that you should keep in mind. You should never apply undiluted essential oil to the skin. Be sure to add 1 ounce of carrier oil, such as coconut or jojoba, to every dozen drops of essential oil.

Before application, do a skin patch test. This is generally done on the inside of the arm. It will allow you to determine whether your skin is going to react poorly. If you don’t experience any irritation or inflammation within 24 hours, it should be safe to use.

Risks and warnings

Using an essential oil to ease inflammation isn’t a first-line treatment. If you have inflammation in your body, it means that somewhere, something in your body is crying out for help.

In order to really treat the inflammation in your body, you have to go to the source. Consult your doctor so they can help you figure out what’s wrong. You don’t want to “mask” the inflammation with essential oils without first fixing the underlying medical issue.

In some cases, if you’re sensitive to a certain essential oil or have an allergic reaction, you may make your inflammation worse. Use caution if you have asthma or another respiratory condition.

If you’re pregnant or breast-feeding, you should exercise caution when using essential oils of any kind.

What you should do now

If you’re experiencing unusual or persistent inflammation, consult your doctor. They can work with you to determine the cause and figure out how to best ease any discomfort that you may be experiencing.

In the meantime, you can try using essential oils or more traditional remedies for inflammation. These include taking an anti-inflammatory medication, such as ibuprofen, or using heat or cold therapy to relieve discomfort.

Aromatherapy LINK

Why Pain Levels Get Worse or Better Depending on Time of Day

How much pain you feel varies throughout the day. This rhythm can also be shifted in chronic pain conditions.

Toothaches are worse in the morning and cancer-related pain is worse at night. Getty Images

If it feels like you’re more sensitive to post-workout aches at certain times of day, or your sore back or headache worsens just as you’re trying to fall asleep, it’s probably not your imagination.

We sometimes think that pain is controlled by an on/off switch — sit at a computer too long and you get a headache, take an ibuprofen and it goes away.

But the reality is much more complex, especially for people with chronic pain conditions.

“Pain is a little bit more complicated than ‘you have pain’ or ‘you don’t have pain,’” said Dr. Mark Burish, MD, PhD, assistant professor in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at UTHealth in Houston. “With episodic things like headaches or back pain, people often talk about the pain fluctuating — it comes and then it goes away over time.”

Burish works as part of a research group at UTHealth with Zheng “Jake” Chen, PhD, an assistant professor of biochemistry and molecular biology and Seung-Hee “Sally” Yoo, PhD, an associate professor of biochemistry and molecular biology.

Daily rhythms of pain

Pain isn’t just controlled by external factors such as injuries or overwork. More research is showing that sensitivity to pain and pain conditions follow a 24-hour — or circadian — rhythm.

The whole body has a circadian rhythm, which is set by the cycle of day and night, along with other factors. But individual cells, including neurons, can have their own circadian rhythm — and these may or may not be in sync with the body.

Different pain conditions show different patterns of pain throughout the day.

Morning pain is found in people with inflammatory conditions, including migraine, rheumatoid arthritis, and toothache. But people experiencing neuropathic pain, as in postherpetic neuralgia, diabetic neuropathy, or cancer are more likely to have worse pain in the evening or at night.

“For these types of conditions, there is a circadian pattern to the pain,” said Burish. “The pain tends to be worse at certain times of day than others.”

Sometimes the pain isn’t so bad, but at other times it’s severe enough to prevent people from going to work, exercising, or even visiting with friends.

Pain at night can also disrupt sleep, which may make the pain worse.

In healthy people, sensitivity to pain also fluctuates throughout the day.

Some studies show that, “if you take a normal patient without any kind of pain condition, and you stimulate, for example, a nerve in the leg … their thresholds for pain are a little bit lower, they’re more sensitive, at certain times of day,” said Burish.

In a 2015 study, Israeli researchers exposed a group of men to heat and cold pain at different times of the day. They found that men were least sensitive to the pain during the morning.

Other studies have found that people are less sensitive to electrical pain and ischemia paincaused by cutting off the blood to the forearm. These studies included both men and women.

Modeling pain rhythms

Pain sensation involves many components — the pain receptors in the skin and other parts of the body that sense the initial stimulus, the neurons that process these signals, and the brain which interprets the signals.

To gain a better understanding of how we experience pain, a group of researchers from the University of Michigan and New York University developed a mathematical model of how pain signals are processed in the spinal cord.

Their results were published July 11 in PLOS Computational Biology.

Burish said what’s unique about their approach is that the researchers include multiple schools of thought — the gate theory of pain, molecular circadian mechanisms, and behavioral data on pain sensitivities — in their model, and try to “marry” the three.

In the gate control theory of pain, the signals for pain traveling along certain nerve fibers are inhibited by other nerve fibers. This keeps the neurons that send pain signals to the brain from firing all the time.

When a painful stimulus reaches a certain level, it overrides the inhibition and the “gate” opens. This activates neurons running to the brain — creating the experience of pain.

Some scientists have proposed that this normal balance of inhibition/excitation is thrown off in conditions like neuropathic pain.

Neuropathic pain is caused by conditions involving the brain, spinal cord, or nerve fibers. It may show up as burning, electric, or shooting pain. In these cases, even a nonpainful stimulus like putting on your socks can cause severe pain.

When the authors of the new study ran their model with normal inhibition or excitation of pain signals in the spinal cord, their results matched what is seen in experimental studies — including the daily fluctuations.

“They showed that heat pain, cold pain, and mechanical pain seem to have the same rhythm throughout the day,” said Nader Ghasemlou, PhD, an assistant professor and director of the Pain Chronobiology & Neuroimmunology Lab at Queen’s University, in Kingston, Ontario.

When they ran the model again with disrupted inhibition or excitation signals, their results matched what is seen in studies looking at the daily rhythms of neuropathic pain.

Treating pain by its rhythms

This research points the way toward a different way of treating pain, one that accounts of the daily fluctuations in pain.

This is known as chronotherapy, which Ghasemlou said, “is the easiest way of using circadian rhythms to our advantage.”

Patients are often given medications so the amount of drug in their blood remains above a certain level.

“Usually if a patient gets prescribed drugs, it’s going to be something like ‘take two pills in the morning, take two pills at night,’” said Ghasemlou.

But because their pain fluctuates throughout the day, they might do better with one pill in the morning and three at night.

This approach has been used with some success for rheumatoid arthritisTrusted Source. It has also been tested for non-pain conditionsTrusted Source, such as with blood pressure medications or chemotherapy.

“By shifting the time at which the person receives the dose,” said Ghasemlou, “you can actually have a greater effect on the outcome.”

The 7 Best Natural Muscle Relaxers

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Have you ever felt an involuntary tightness, hardness, or bulging in a muscle? That’s called a muscle spasm. This type of cramping can happen to anyone for a variety of reasons and in many areas of your body.

Spasms are common in the abdomen, arms, hands, and feet. You can also feel them in your calves, hamstrings, and quadriceps, and along the rib cage. Many cases of simple muscle spasms are caused by heavy exercise and vigorous sport. Patience, rest, gentle stretching, and massaging the muscle can help alleviate the pain.

People with acute neck and back painTrusted Source often suffer from muscle spasms. Pregnant women are also prone to muscle spasms because of the sudden increase in weight. Menstruating women experience muscle cramps due to uterine contractions, though the severity of the pain varies by person. Muscle spasms are a common side effect of chronic conditions like multiple sclerosismuscular dystrophy, and McArdle’s disease.

While muscle spasms can be painful, relief is available with these seven natural muscle relaxers.

1. Chamomile

Chamomile tea

ChamomileTrusted Source is an ancient herb that’s used to treat a variety of ailments, including muscle spasms. It contains 36 flavonoids, which are compounds that have anti-inflammatory properties. You can massage chamomile essential oil onto affected muscles to provide relief from spasms. Chamomile tea can also help relax sore muscles.

Shop for chamomile tea.

2. Cherry juice

Cherry Juice

People who sign up for marathons train vigorously, often causing a lot of stress on their muscles. Cherry juice can help combat the inflammation and muscle pain that is so common in runners. StudiesTrusted Source reveal that drinking tart cherry juice can minimize post-run pain. The antioxidant and anti-inflammatory qualities in the fruit help to relax muscles naturally.

Shop for cherry juice.

3. Blueberry smoothies

Blueberry Smoothies

Another sweet and natural way to relax your muscles is by eating blueberries. A recent studyTrusted Sourcesuggests that having a blueberry smoothie before and after exercise can help accelerate recovery from muscle damage. Blueberries have antioxidant powers and have been shown to decrease oxidative stress and inflammation.

4. Cayenne pepper

pepper

Capsaicin, a substance found in cayenne pepper, is a natural muscle relaxant that’s often recommended to people who live with fibromyalgia and rheumatoid arthritis. It can be added to food, like in this grilled shrimp with lime cream recipe, or you can find cayenne pepper in capsule form and as a cream. When used as a cream, you can apply it to areas affected by muscle spasms.

Shop for cayenne pepper.

5. Vitamin D

Boiled eggs

People who have regular muscle pain or spasms might be deficient in vitamin D. This vitamin comes in many forms, including liquidstablets, and capsules. You can also get it in foods like eggs, fish, and fortified milk. Getting regular exposure to sunlight is another way to get vitamin D!

Shop for vitamin D supplements.

6. Magnesium

Almonds

Magnesium is vital for human nutrition, as it maintains normal muscle and nerve function. Although it’s rare, early symptoms in people who are deficient in this mineral include muscle pain. This mineral is mostly found in foods such as bananas, almonds, legumes, and brown rice. It’s also available as a supplement.

Shop for magnesium supplements.

7. Rest

pillow

Perhaps the best and most natural way to relax your muscles is to rest. Make sure to get lots of sleep, drink plenty of fluids, and try not to overwork the affected muscle. Using heat pads or ice packs on the muscle can provide immediate relief. Sometimes muscle spasms are due to over-stimulated muscles, and ice can help calm down the transmission of impulses from the brain to the overactive muscle.

 7 sourcesexpandedHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Spices

Inflammation

Inflammation is the body’s natural response to injury or infection, often causing localized redness, swelling, pain, or heat. It may cause loss of function of the involved tissues. Acute inflammation is typically a protective and localized response to infection or injury. It’s designed to heal the body and restore normal tissue function.

Inflammation of the joints, including stiffness and swelling are common symptoms of arthritis.

If inflammation persists for a prolonged period of time, it becomes chronic inflammation. Chronic inflammation can be the result of an infection, autoimmune reaction, or allergy.

Anti-inflammatory foods and spices

Certain foods have been identified as anti-inflammatory. They may help to reduce chronic inflammation and pain. Omega-3 fatty acids found in fishcertain nuts, and even chocolate have all been acknowledged for their anti-inflammatory properties.

Research into exactly how well these foods reduce inflammation in the body is mixed, but promising. One easy way to incorporate anti-inflammatories into your diet is through the use of spices.

Turmeric

Turmeric is a brilliant yellow spice common in Indian cuisine that you can find in any grocery store. Turmeric has been used as a medicine for centuries to treat wounds, infections, colds, and liver disease.

StudiesTrusted Source have shown that curcumin, a compound in turmeric, may reduce inflammation in the body.

Ginger

Ginger is a zesty spice used in many cuisines. You can buy it powdered or as a fresh root in most supermarkets. Ginger has been used as a traditional medicine to treat stomach upset, headaches, and infections.

The anti-inflammatory properties of ginger have been praised for centuries, and scientific studiesTrusted Source have confirmed it.

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Cinnamon

Cinnamon is a popular spice often used to flavor baked treats. But cinnamon is more than just a delicious additive in our cakes. StudiesTrusted Source have shown that the spice has anti-inflammatory properties, which can ease swelling.

Keep a good supply of cinnamon on hand and sprinkle it in your coffee or tea, and on top of your breakfast cereal.

Garlic

The anti-inflammatory properties of garlic have been proven to ease arthritis symptoms. A little bit can go a long way. Use fresh garlic in almost any savory dish for added flavor and health benefits.

If the taste is too much for you, roast a head of garlic for a sweeter, milder flavor.

Cayenne

Cayenne and other hot chili peppers have been praised for their health benefits since ancient times. All chili peppers contain natural compounds called capsaicinoids. These are what give the spicy fruit its anti-inflammatory properties.

Chili pepper is widely considered to be a powerful anti-inflammatory spice, so be sure to include a dash in your next dish. It has long been used as a digestive aid as well, so that’s an added benefit.

Black pepper

If cayenne is too hot for your liking, you’ll be happy to know that the milder black pepper has been identified for its anti-inflammatory properties as well. Known as the “King of Spices,” black pepper has been valued for its flavor and antibacterial, antioxidant, and anti-inflammatory benefits.

Studies have shown that the chemical compounds of black pepper, particularly piperine, may be effective in the early acute inflammatory process.

Clove

Cloves have been used as an expectorant, and to treat upset stomachnausea, and inflammation of the mouth and throat. Research is still mixed, but evidenceTrusted Source suggests that they may have anti-inflammatory properties.

Powdered clove works well in baked goods and in some savory dishes, like hearty soups and stews. You can also use whole cloves to infuse both flavor and nutrition into hot drinks like tea or cider.

 8 sourcesexpandedHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

  • Akhtar, N., & Haqqi, T.M. (2012, June). Current neutraceuticals in the management of osteoarthritis: A review. Therapeutic Advances in Musculoskeletal Disease, 4(3), 181-297
    ncbi.nlm.nih.gov/pmc/articles/PMC3400101/
  • Bon, J.O., Oh, J.H., Kim, T. M., Kim, D. J., Jeong, H., Han, S. B., & Hong, J.T. (2009, September 30). Anti-inflammatory and arthritic effects of thiacremonone, a novel sulfur compound isolated from garlic via inhibition of NF-κB. Arthritis Research and Therapy, 11, R145
    arthritis-research.biomedcentral.com/articles/10.1186/ar2819
  • Buzzed on inflammation. (n.d.)
    healthletter.mayoclinic.com/editorial/editorial.cfm/i/163/t/Buzzed%20on%20inflammation/
  • Grzanna, R., Lindmark, L., Frondoza, C. G. (2005). Ginger—an herbal medicinal product with broad anti-inflammatory actions. Journal of Medicinal Food, 8(2), 125-32
    ncbi.nlm.nih.gov/pubmed/16117603
  • Jungbauer, A., & Medjakovic, S. (2011, December 26). Anti-Inflammatory properties of culinary herbs and spices that ameliorate the effects of metabolic syndrome. Maturitas, 71(3), 227-239. Retrieved from 
    maturitas.org/article/S0378-5122(11)00438-5/fulltext#sec0035
  • Lee, S. H., Lee, S. Y., Son, D. J., Lee, H., Yoo, H. S., Song, S., Oh, K. W., Han, D. C., Kwon, B.M. & Hong, J. T. (2005, March 1). Inhibitory effect of 2’-hydroxycinnamaldehyde on nitric oxide production through inhibition of NF-kappa B activation in RAW 264.7 cells. Biochemistry Pharmacology, 69(5), 791-799. Retrieved from 
    ncbi.nlm.nih.gov/pubmed/15710356
  • Meghwal, M. and Goswami, TK. (2012. June 26). Nutritional constituent of black pepper as medicinal molecules: A review. Open Access Scientific Reports, 1(129)
    omicsonline.org/scientific-reports/srep129.php
  • Taher, Y. A., Samud, A. M., El-Taher, F. E., ben-Hussin, G., Al-Mehdawi, B. F., & Salem, H. A. (2015, September). Experimementalwvaluation of anti-inflammatory, antinociceptive and antipyretic activities of clove oil in mice. Libyan Journal of Medicine, 1(10), 28685
    ncbi.nlm.nih.gov/pubmed/26333873

What is new in pain management

20 Powerful Natural Remedies for Healing and Eliminating Inflammation and Pain

Healing Natural Remedies for Inflammation and Pain

Natural supplements are not the same as chemically manufactured medicines. To begin with, they are made of natural ingredients and are less toxic and therefore less harmful to the body, if taken as directed. Even in

ow doses, many prescription and over-the-counter drugs are toxic and have short-term negative effects on the liver, kidney and digestive tract. When taken over the long term, or not as directed, the pharmaceutical meds can cause serious organ damage. Why?

Because drugs, unlike natural remedies for inflammation and pain, are created in a lab and our bodies are not equipped to digest and process them. Moreover, drugs are incredibly powerful which gives them the ability to offer fast relief of symptoms, like pain and inflammation. This is good for short-term use, but can be harmful over time. The body just can’t metabolize these drugs sufficiently to prevent them causing new damage and side effects.

Natural remedies, on the other hand, are made from the stuff of nature. This includes leaves, twigs, berries, bark, roots, vines, vitamins and minerals. They are natural substances that can’t be regulated by the FDA because they are technically foodstuffs. If you understood herbology you could, as many traditional cultures do, adjust your diet to include the herbals in your meals. However, for painful and chronic conditions, like arthritis, this would mean at every meal. Taking these ingredients as supplements to your diet is the way to go.

In addition to the other methods and strategies discussed throughout my book, I recommend taking natural remedies that reduce pain and inflammation, protect joint health and promote healing without side effects. Below I offer an overview of 20 different supplements formulas or ingredients often found within such formulations. Read each, keeping in mind your specific condition and how some may be more effective for you than others.

1. Avocado Soybean Unsaponifiables (ASU)

ASU is a vegetable extract made from the oil of avocados and soybeans that is said to slow the progression of osteoarthritis. It slows down the production of inflammatory chemicals in the body and thus the breakdown of cartilage in the joints. It has also been found to spur new cartilage cell growth. It is available in capsule form at a recommended 300 mg daily.

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2. Boswellia Serrata

Boswellia serrata is a traditional Indian Ayurvedic remedy for inflammatory conditions. It is extracted from the gum of the Indian boswellia tree and has been in use for centuries to treat joint pain and inflammation. It provides anti-inflammatory activity in areas where there is chronic inflammation by turning off the pro-inflammatory cytokines that begin the inflammatory process. Moreover, research shows that the acids contained within boswellia extract stop the formation of immune cells known as leukotrienes, which are responsible for inflammation. This then allows blood to flow unobstructed to the joints for healing and improved mobility.

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3. Burdock Root

Burdock root is a natural botanical for that is in wide use for many conditions, among them arthritic pain, swollen joints and rheumatism. More than anything else, clinical studies have found it most effective as a blood purifier that helps to rid the body of deleterious toxins and clear congestion from the circulatory, lymphatic, respiratory and urinary systems. Burdock is said to cleanse and eliminate long-term impurities from the blood very rapidly through its action on both the liver and kidneys. For those who suffer from arthritis and have taken too much Tylenol, burdock root has been clinical proven to protect the liver cells from the damage of taking acetaminophen. It is believed to stimulate the gallbladder and encourage liver cells to regenerate.

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4. Cetyl Myristoleate (CMO)

Cetyl myristoleate (CMO) is a fatty acid, an ethylated esterified fatty acid derived from bovine tallow oil. Though it is similar to fish oil, it is made specifically to help joints through its action as a cellular lubricant. Clinical studies show CMO to be an effective natural anti inflammatory compound that promotes healthy joint function. It increases joint flexibility and range of motion by lubricating the joint at a cellular level. It works to decrease inflammation specifically in the joints and lubricate their movement. In other words, it increases the fluids that cushion the space between the joint bones. CMO is reported to effect change at the cellular level, within the cell membranes themselves. It assists in the reduction and prevention of breakdown in joint cartilage. This can be especially helpful for those suffering degenerative osteoarthritis. The Journal of Rheumatology reported on a double-blind study of patients with chronic knee osteoarthritis where the CMO group saw significant improvement while the placebo group saw none. In fact, the scientists were so impressed with the results they concluded CMO “may be an alternative to the use of non-steroidal anti-inflammatory drugs for treatment of osteoarthritis.”

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5. Chondroitin Sulfate

Within the cartilage around your joints is a chemical known as chondroitin. Chondroitin is naturally produced by the body. As you age, your natural supply starts to plummet. And a loss of chondroitin from cartilage is linked to a major cause of joint pain. Moreover, through wear and tear the joint cartilage breaks down, resulting in the condition of Osteoarthritis. We can’t regenerate cartilage on our own, but we can take a supplement called chondroitin sulfate which, studies show, can help slow down this degenerative process and help naturally reduce arthritic pain. Chondroitin sulfate is made from the cartilage of cows and other animals, and is often used in combination with other products including glucosamine and manganese.

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6. Citrus Bioflavonoids

Sometimes referred to as vitamin P, citrus bioflavonoids enhance the absorption of vitamin C and act as important antioxidants. Flavonoids also inhibit collagenase and elastase, the enzymes responsible for the breakdown of connective tissue. Connective tissue breakdown is one of the factors that may cause arthritis. Flavonoids reinforce the natural structure of collagen, improve the integrity of connective tissue, protect against free radical damage and are a great natural remedy for inflammation and pain.

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7. Devil’s Claw

Direct from the Kalahari Desert comes devil’s claw, a claw-shaped fruit that has been used for centuries by the South African tribes as a natural remedy for inflammation and to treat arthritis pain. Numerous studies carried out on devil’s claw show it to have powerful natural NSAID-like properties. In fact, the journal Phytomedicine reported that it is just as effective as the osteoarthritis medication Diacerein. What’s more, studies carried out in both France and Germany pointed to devil claw’s effects being similar to cortisone.

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8. Fish Oil / Omega-3 Fatty Acids

The omega-3 fatty acids found in abundance in fish oil derived from cod, trout, herring, salmon and other coldwater fish are proven natural remedies to reduce inflammation. Research from Cardiff University in Great Britain found that cod liver oil not only relieves pain, but also stops and even reverses the damage caused by osteoarthritis and rheumatoid arthritis. Omega-3s help morning stiffness, regenerate joint tissue and have been shown to also aid in autoimmune disease like RA, lupus and psoriasis.

According to recommendations of the Arthritis Foundation, when treating conditions related to arthritis it is best to use “fish oil capsules with at least 30 percent EPA/ DHA, the active ingredients. For lupus and psoriasis, 2 grams EPA/DHA three times a day. For Raynaud’s phenomenon, 1 grams four times a day. For rheumatoid arthritis, up to 2.6 grams fish oil (1.6 grams EPA) twice a day.”

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9. Glucosamine Sulfate

Glucosamine is one of the most-studied supplements around the world for relief of arthritis symptoms and joint health. Sulfur is produced naturally in the body and is an essential component to joint health. Glucosamine sulfate is a type of glucosamine that is most useful in the support of joint mobility and pain relief because it absorbs well. Conversely, glucosamine chondroitin does not absorb in an amount significant enough to create enough of a change to make taking it worthwhile. Glucosamine sulfate works as well as NSAIDs for some people but without the negative effects to the gastrointestinal tract or liver.

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10. Hydrolyzed Collagen Type II

Collagen—particularly Type II collagen—is the main structural building block of joint cartilage. The human body is made up of 60 percent Type II collagen, and Hydrolyzed Type II collagen contains the amino acids found in human cartilage. Your body uses these amino acids to create new collagen—and repair your cartilage and connective tissue throughout your body. Hydrolyzed Collagen Type II also contains Hyaluronic Acid, which lubricates your joints and makes it an effective natural remedy for inflammation.

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Ultra-high quality, 100% pure type II hydrolyzed collagen also naturally delivering and containing hyaluronic acid, glucosamine, and chondroitin, all of which are powerful natural remedies for inflammation, joint health and pain.
 

11. Ionic Minerals

The human body is a miracle of electrical impulses that keep it functioning and make life possible. Ionic minerals are an essential part in this process, as the body relies on them to conduct and generate electrical impulses. Without the correct balance on ionic minerals in the body, your brain and muscles could not function properly and cells could not properly absorb nutrients.

There are over 70 trace minerals that are important to cellular, neurologic, joint and bone health. Taken together, ionic minerals balance and replace electrolytes, maintain pH balance, improve circulatory health and aid absorption of vitamins and nutrients.

Since most people do not live by the sea and much of our soil is depleted of minerals, many are deficient in these essential elements. Taking natural remedies containing ionic minerals can help arthritis in many ways, as long as the minerals are produced in water soluble form. A few of the most important ionic minerals are:

Boron
helps metabolize calcium and magnesium and is critical for healthy membrane function.

Calcium
is important for healthy teeth and bones and helps regulate nerve function.

Copper
is essential for healthy function of proteins and enzymes and aids in the absorption of iron.

Iron
is needed to transport oxygen to the cells in your body.

Magnesium
helps relax muscles and stimulate enzyme production, in addition to regulating bowl function to help eliminate toxins.

Manganese
promotes healthy bone formation, supports growth of healthy connective tissue and boosts calcium absorption.

Phosphorous
helps repair damaged cells and promotes healthy new cell growth.

Selenium
is a powerful antioxidant that helps vitamin E protect cells and connective tissue by destroying free radicals.

Zinc
helps boost white blood cell production in your immune system.

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12. L-glutathione

Glutathione is a natural protein found within every cell in the body and consists of the amino acids Glutamic acid, L-cysteine, L-glycine. It is produced by the liver and is also found in fruit, vegetables and meats like mutton, lamb and beef. It is the most powerful antioxidant in the body and helps protect cells from free radical damage and oxidative stress, thereby improving cellular health and strengthening the immune system. As such, in addition to a host of other diseases, L-glutathione is useful in the natural treatment of rheumatoid arthritis.

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13. Methylsulfonlylmethane (MSM)

MSM is a potent sulfur naturally found in plants, animals and humans that helps rebuild the connective tissue in your joints and is a powerful natural remedy for inflammation and pain. What’s more, MSM has the unique ability to improve cell permeability. This allows harmful toxins to flow out, while allowing health boosting nutrients to flow in to feed your joints, cartilage and connective tissue. It is used for hundreds of symptoms related to a myriad of health diseases and conditions, and is especially effective as a natural remedy for relieving inflammation for improved joint function, and pain associated with joint inflammation, osteoarthritis, rheumatoid arthritis, osteoporosis and tendonitis. One study published in the Journal of AntiAging Medicine found that MSM provides an 80 percent greater reduction in pain compared to the placebo.

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14. Paractin

Paractin is a clinically proven extract of the medicinal herb Andrographis Paniculata, which helps correct an imbalanced immune system. This helps cut off the signals that cause inflammation and significantly decrease joint pain, which makes it a great ingredient in supplements for arthritis.

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Clinically proven formula and one of nature’s most potent herbal COX-2 inhibitors, Paractin is a powerful natural remedy for inflammation, pain and overall health, wellness and joint support.

15. Proteolytic Enzymes

For arthritis relief, it is important to have proteolytic activity on the systemic level. Known as protease, this category of enzymes acts as a catalyst in the breakdown of proteins into peptides or amino acids. This helps control both systemic inflammation and inflammation resulting from soft tissue injuries, like those associated with both rheumatoid and osteoarthritis. Proteolytic enzymes also provide essential antioxidant and cardiovascular support. I will discuss two of the more potent ones here:

Bromelian is a mix of proteolytic enzymes (those found in pineapples), which have been used for centuries to help indigestion and reduce inflammation. Studies indicate this product helps reduce pain associated with arthritis, especially when used in combination with some other natural pain-relieving agents making it a great natural remedy for inflammation and pain.

Papain contains a wide array of proteolytic enzymes, incorporating a broad range of substrate specificity and optimum environments. Because of this attribute, Papain easily and efficiently hydrolyzes most soluble protein, yielding peptides and amino acids. Papain has an effective pH range of 3.0 to 10.5.

garden-of-life-wobenzym-n-inflammation-enzymes

Conscious Lifestyle Recommends:
Garden of Life Wobenzym N Proteolytic Enzyme Tablets

Used by millions of people worldwide to successfully treat inflammation and pain, Wobenzym is backed by decades of clinical research and endorsed by the German government for its effectiveness.
 

16. Rutin

Rutin is a flavonoid composed of the flavonol quercetin and the disaccharide rutinose. Rutin is found naturally in a variety of plants, and dietary sources include black tea and apple peels. Rutin’s natural anti-inflammatory potential is attributed mainly to its powerful antioxidant activity. Rutin also helps maintain the levels of reduced glutathione, which is a powerful biological antioxidant. The combination of these activities helps to minimize the cellular damage and resulting inflammation caused by the various oxidative processes.

now-foods-rutin-bioflavonoid

Conscious Lifestyle Recommends:
Now Food’s Rutin Capsules

Sourced from sophora japonica flower buds, Now Rutin capsules are a gentle but powerful natural inflammation remedy. Free of chemicals, synthetics and binders, Now Rutin is hypoallergenic and pure.
 

17. SAMe (S-Adenosyl methionine)

SAMe is one of the natural chemicals made within the body that science has been able to duplicate in a lab, and make into a supplement. Studies have shown SAMe supplementation to be comparable to the pain-relieving effects of Celebrex by the second month of taking the product, without the side effects. The SAMe chemical has a role in pain, depression, liver disease and has been shown effective when used for relieving the symptoms of osteoarthritis, fibromyalgia, bursitis, Alzheimer’s disease, multiple sclerosis (MS), migraine headache, depression and more, making it a great natural remedy for inflammation.

pure-encapsulations-same

Conscious Lifestyle Recommends:
Pure Encapsulations SAMe (S-Adenosylmethionine)

Ultra-high quality, ultra pure, stabilized SAMe (S-Adenosylmethionine). A powerful natural remedy for arthritis, pain and mood enhancement, among other things. Free of all binders, fillers and chemicals.
 

18. Thunder God Vine

China, Korea and Japan grow a vine known as Thunder God, which is one of the powerful natural relievers of arthritis, especially rheumatoid arthritis. It has properties that regulate the immune system and naturally reduce inflammation, thus being good for autoimmune diseases. One clinical trial carried out at the University of Texas Southwestern Medical Center discovered that roughly 80 percent of those patients who were given a high dose of the plant supplement found that their rheumatoid arthritis symptoms got better considerably making it well worth a try for those looking for natural remedies for inflammation and pain.

thunder-god-vine-root

Conscious Lifestyle Recommends:
High Potency Thunder God Vine Root Capsules

Ultra-high quality, 100% pure, highly concentrated Thunder God Vine Root 5:1 extract. Free of all binders, fillers and additives this is a powerful ancient remedy for inflammation, pain and immunity.
 

19. White Willow Bark

Since the time of Hippocrates white willow bark has been in use as a natural means of reducing inflammation and pain, specifically associated with osteoarthritis and rheumatoid arthritis, as well as headache, backache, gout and PMS. The bark of the willow tree contains the chemical salicin, which has a similar effect in the body as acetylsalicylic acid (aspirin). But it’s better than aspirin, because it has none of the gastrointestinal side effects, and it naturally contains flavonoids (anti-inflammatory compounds found in plants).

white-willow-bark-extract-organic-pain-inflammation

Conscious Lifestyle Recommends:
Oregon’s Wild Harvest White Willow Bark Extract

This premium, ultra-high quality extract was made using fresh, organic White Willow bark which is harvested at its peak potency and immediately processed into organic alcohol to ensure maximum levels of valuable medicinal constituents. Used for centuries to treat inflammation, arthritis, pain and more.
 

20. Vitamins

Vitamins are essential to health. Every natural thing that you eat contains the vitamins needed for growth, repair, bone density, pH balance and hormone regulation. The problem is that many people don’t have access to organic whole foods, so vitamin supplementation is important. When suffering from inflammation, pain and arthritis, the following vitamins may help.

Vitamin B12 is a nutrient that promotes healthy blood cells, prevents anemia and naturally fights off inflammation of the joints and helps make DNA. It is essential for the normal functioning of the cells, nervous system and gastrointestinal tract.

Vitamin D3 is a fat soluble vitamin that promotes calcium absorption and enables normal mineralization and growth of the bones. Deficiency of Vitamin D3 (the active source of Vitamin D) can lead to loss of bone density, brittle bones or misshapen bones. Ample levels can help prevent osteoporosis. It is important that you ask your healthcare provider to test your Vitamin D blood levels, to ensure you do not get too much.

Vitamin E is a fat-soluble and essential nutrient for humans. The most important components of vitamin E appear to be the tocopherols. All four forms of tocopherol have been shown to have antioxidant activity, but alphatocopherol is the strongest antioxidant. Alpha-tocopherol inhibits the oxidation of LDL, which can help prevent LDL from sticking to the arterial walls. In addition to its antioxidant properties, vitamin E also acts to reduce blood coagulation and may help to lower blood pressure by eliciting endothelial relaxation.

Vitamin K2 helps prevent osteoporosis by keeping calcium in your bones where it belongs. Without vitamin K2, calcium floats through your bloodstream and sticks to places it doesn’t belong, like your blood vessels.

pure-encapsulations-multivitamin

Conscious Lifestyle Recommends:
Pure Encapsulations Nutrient 950 Vitamin & Mineral Formula

Ultra-high quality and 100% pure, this high potency multivitamin and mineral formula uses only research backed, highly active and bioavailable forms of vitamins and minerals, many of which are powerful natural remedies for inflammation, pain and overall health and wellness.
 

How to Take Natural Remedies

Because natural supplements are made of organically existing substances, they affect the body in gentle ways—without side effects. The ingredients within natural remedies for inflammation, pain and anything for that matter often do not work as quickly as drugs do at relieving pain or inflammation. However, they do offer acute relief in the short term while working more powerfully over time to create a gradual and lasting change in condition. In other words, natural supplements need to build up in your system to get to a level where more significant change occurs, which is why you often will need to take them several times per day, over periods of weeks and months or even longer.

The best way to take natural remedies for inflammation and pain is by following the guidelines on the label. These guidelines are often the minimal doses and therefore for acute conditions the doses can be increased, sometimes doubled or tripled. However, in high doses even natural substances can become toxic in the body. In all cases, it is necessary to use caution and to take supplements and medications as directed on the bottle or as suggested by a professional healthcare provider.

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An Ingredient in Cough Syrup Could Work as an Antidepressant

Everything from shrooms and weed to molly and ketamine—once known mainly as party drugs—are finding a place in clinical trials for depression and other mental health conditions. Precisely how they work on the brain, however, strays wildly from prescription antidepressants. In doing so, these drugs are challenging traditional ideas of how we understand and treat depression.

You’ve probably heard bits and pieces of the traditional theory behind what causes depression: In short, neurotransmitters like serotonin and dopamine play a crucial role in making us feel good. When we don’t have enough of them, we start to feel depressed. That’s why doctors prescribe what are known as SSRIs—selective serotonin reuptake inhibitors—to increase serotonin availability. Many studies support this theory, but while it may seem fairly straightforward, the drugs we use to treat the symptoms of depression are anything but.

For one thing, they’re slow—taking roughly four to six weeks to kick in. They’re not always all that effective, either: Only a third of people get better on the first antidepressant they take, while less than two-thirds of people get better after trying four different antidepressants. That’s one reason researchers continue to look for surprising alternatives to treat depression. And the most recent one to be considered can be found on nearly every drug store shelf: cough syrup.

Over the past three years, clinicians at several universities have begun experimenting with hallucination-inducing doses of the drug dextromethorphan (DXM), a common ingredient in several over-the-counter cough medicine brands. One reason the researchers think DXM has potential for treating depression is that it works a little like ketamine, perhaps the most successful street drug thus far repurposed for treating depression. Where other antidepressants fail, ketamine appears to work—not in weeks, but days, sometimes even hours. Its effects also last long after the drugs leave the body. Preliminary data show DXM acts just as quickly.

DXM and ketamine are part of a drug family called glutamate blockers. Glutamate is the chemical responsible for 90 percent of brain activity. For reasons unknown, slowing down glutamate activity with DXM or ketamine appears to ease symptoms of depression, says Adam Kaplin, an assistant professor of psychiatry and behavioral sciences and researcher who specializes in experimental antidepressants at Johns Hopkins.

The US government first chanced upon DXM about 50 years ago while researching a non-addictive replacement for codeine in cough syrups. Researchers were looking for molecules that shared codeine’s molecular structure. DXM molecules looked like codeine and stopped the cough well enough, but otherwise couldn’t be more different, Kaplin says. Codeine is a narcotic, which in high doses leads to a sense of euphoria, sleepiness, and calm. DXM, on the other hand, is a hallucinogen that can trigger psychosis in high doses. But that didn’t stop the government from allowing its use: The drug remains over-the-counter, even though studies have suggested DXM might not helpwith cough at all.

Cough suppressant or not, DXM is particularly attractive as a potential antidepressant because it’s a glutamate blocker (like ketamine) and a serotonin booster (like normal antidepressants). In other words, it seems to be the best of both worlds, and its legal status and established safety only add to its promise as a novel antidepressant.

“Given that it was approved in 1958, over-the-counter for cough no less, it’s has a proven record as relatively safe,” Kaplin says. “Research says DXM has both serotonin and glutamate actions, it’s well worth a try as a new antidepressant.”

Unfortunately, what sounds good in theory does not always translate to patients. Kaplin is one of the first people attempting to find out how DXM works in practice to help treat depression. Soon, his team at Johns Hopkins hopes to explore how long and at what dose DXM might have antidepressant effects. Kaplin has a long history with ketamine, having run five trials in ten years—long before it was accepted as an antidepressant. But when it comes to DXM, he encourages caution, adding that even he is skeptical. “Historically, there are many things that made total sense until we tried them,” he says. “Until you see double-blinded studies, I wouldn’t bet the farm.”

Two firms—Axsome and Avanir—have initiated double-blind studies for different formulations of DXM. Axome is trying a two-in-one pill of DXM and the common antidepressant bupropion. Avanir is repurposing an existing drug called Nuedexta, which is a mix of DXM and quinidine, a chemical used to block the liver’s ability to break down drugs. Adding quinidine to DXM keeps it in the body for a longer period of time. As he awaits the results of those studies, however, Kaplin is maintaining a conservative outlook. He says ketamine, in spite of all its good, still isn’t a sure shot—to his mind, at least.

“Even with patients on ketamine, 40 percent of the time its [success] is the placebo effect,” he says. “In some of these studies, patients we knew were getting the placebo still claimed they were tripping. And they’d get better, too.”

Dextromethorphan: An update on its utility for neurological and neuropsychiatric disorders

Background. Dextromethorphan is a noncompetitive N-methyl D-aspartate receptor antagonist that is clinically feasible for relieving the opioid withdrawal symptoms. This study compares the efficacy of a combination therapy with dextromethorphan and clonidine to treatment with clonidine alone. Methods and Materials. In this double-blind randomized clinical trial, patients were selected from inpatients of detox and rehabilitation ward of Razi Hospital, Tabriz, Iran. They were randomly allocated to two groups receiving either clonidine (0.4–1.2 mg/day) or clonidine and dextromethorphan (300 mg/day). Withdrawal symptoms were evaluated in the first day of admission and again 24, 48, and 72 hours later. Results. Thirty male patients completed the trial in each group. Withdrawal symptoms began to decrease in the second day in patients receiving dextromethorphan and clonidine while patients receiving clonidine experienced the more severe symptoms in 72 hours. Analysis of variance of the symptom severity score revealed a significant group × time interaction (F = 14.25; P < 0.001), so that patients receiving dextromethorphan plus clonidine had milder symptoms during three days in all of the measurements compared to clonidine group. Conclusion. Combination therapy of dextromethorphan and clonidine would result in milder opioid withdrawal symptoms compared to clonidine alone with a reduction beginning at the second day.

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