Natural Strategies to Maintain and Enhance Mobility

by Nieske Zabriskie, ND

Anyone who has experienced a painful activity-related injury is all too familiar with its consequences, especially the accompanying unpleasant sensation and impact on mobility. This accompanying discomfort is not a disease, but a symptom of an underlying imbalance. It is defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with actual or potential impact on tissue integrity. Simply stated, pain is a warning mechanism.

Pain is the most frequent reason for physician consultations in the United States, and results in half of all Americans to seek medical care annually. Recurring pain is the third most common healthcare problem and impacts productivity, mobility, and quality of life. More than one-third of the estimated 75 to 85 million persons in the United States who report nagging pain are partially or totally disabled.¹

Joint discomfort is one form of pain that is commonly accompanied by activity limitation and also is characterized by localized pain and swelling. Approximately 46.9 million adults in the United Stated have been diagnosed with arthritis.² The prevalence is increasing, and it is estimated that by the year 2030, 67 million adult Americans will be afflicted with this type of discomfort.³

The most common concern is back and neck aches. According to the National Pain Foundation, approximately 85 percent of Americans will experience backaches by age 50, and more than 26 million Americans between the ages of 20 and 64 experience back pain.⁴

People differ remarkably in their ability to tolerate pain. Tolerance levels can vary depending on several factors including mood, personality and circumstance. Despite its subjective nature, most pain is associated with changes in tissue integrity and has a physiological basis.

Pain is categorized as temporary or recurring. Temporary pain begins suddenly and is short in duration, while recurring pain can spring up every so often for weeks to years. Recurring pain typically lasts longer than expected based on the situation, recurs on and off for months or years, or is associated with a concern or injury that does not heal as quickly as it should. Aches that recur may affect mood, interest in activities, sleep, energy levels, appetite, body weight, and sex drive. This returning discomfort can make the nervous system more sensitive by repeatedly stimulating the nerve fibers and cells that detect, send and receive signals of pain. Repeated stimulation can cause changes in the structure of nerve fibers or make them more active resulting in increased transmission to the spinal cord and brain.⁵

The Physiology of Pain

Pain receptors are located almost everywhere in the body, especially the skin, surfaces of the joints, the lining around the bone, and walls of the arteries. Discomfort from various sources stimulates these receptors, and this stimulus is transferred via specialized nerves to the spinal cord and up to the brain. The brain then processes the stimulus and sends an impulse down the spinal cord that commands the body to respond.

Pain receptors (nociceptors) are nerve fibers with endings that can be excited by three types of stimuli: mechanical, thermal and chemical. Mechanical receptors respond to pressure or stretching. Thermal receptors respond to extreme heat or cold. Chemical receptors react to various stimuli from both internal and external sources including chemical mediators from injury or the inflammatory response. For example, specific prostaglandins are inflammatory mediators that are locally released with stimuli and inflammation and cause increased sensitivity of these receptors. Other chemical substances produced by the body that excite pain receptors include bradykinin, serotonin and histamine. Thus, controlling inflammatory mediators can directly impact pain perception.

Signals of discomfort can also be selectively inhibited in the spinal cord. This natural response is controlled by neurochemicals called endorphins, which are opioid peptides such as enkephalins that are produced by the body. These substances block reception of stimuli by binding to receptors. Supporting this natural pain-modulating pathway also can change the perception of minor aches and pain.

Natural Support for Aches and Discomfort

Pain is clearly one of the most common health worries of our time. However, both clinical practice and research indicates that such a sensation is something that can be conquered. One of the most effective natural approaches involves the amino acid DL-phenylalanine, the botanicals turmeric and Boswellia serrata, and the proteolytic enzyme nattokinase. Unlike other substances such as glucosamine sulfate, which acts to support tissue integrity, these synergistic substances work specifically to support the body’s ability to deal with minor aches and pains.

DL-Phenylalanine

L-phenylalanine is an essential amino acid metabolized into tyrosine, which is a precursor used for the synthesis of the neurotransmitters norepinephrine, epinephrine and dopamine. DL-Phenylalanine is a 50-50 mixture of L-phenylalanine and its mirror image molecule D- phenylalanine. DL- Phenylalanine is among a number of compounds that have been shown to inhibit the break down of enkephalins, which are the body’s natural opioid pain reducers.⁶

DL-phenylalanine has been used successfully for the temporary management of occasionally recurring pain in humans. DL-phenylalanine also exhibits inflammatory-balancing properties. It is proposed that the enkephalinase inhibitors may be effective in a number of human endorphin deficiency states that can impact mood and joint health. DL-phenylalanine may support other aspects of health associated with decreased endorphin levels.⁷ Animal models indicate that DL-phenylalanine supplementation can increase the threshold for sensations of discomfort. It is hypothesized that this effect is induced by phenylalanine blocking enkephalin degradation by the enzyme carboxypeptidase A.

Preliminary studies of patients with inflammatory-response imbalances have shown a response rate to DL-phenylalanine ranging from 32 percent to 75 percent.⁸ Analysis suggests that it may be mediated in part by up-regulation of the endogenous analgesia system (EAS). Since enkephalins are key neurotransmitters in the EAS, it is reasonable to suggest that promoting enkephalin activity by DL-phenylalanine should support EAS-mediated sensations.

Turmeric (Curcuma longa)

Turmeric (Curcuma longa) is used to ease inflammatory responses as it has inflammatory-balancing and antioxidant activity. The primary constituent is curcumin, which is believed to exert these inflammatory balancing properties. Preliminary studies have shown turmeric may be supportive for bowel health, joint function, eye health, pancreatic function, skin integrity and normal lipid levels.⁹

Curcumin has been shown to support normal levels of enzymes that mediate inflammatory processes in the body. These enzymes are cyclooxygenase (COX), lipoxygenase (LOX), and inducible nitric oxide synthase (iNOS).¹⁰ Supporting normal levels of COX-2 and iNOS has been associated with healthy inflammatory responses. A number of studies have been conducted that support curcumin’s effect on COX and LOX pathways at both the cellular and molecular level.¹¹

In one study, the inflammatory-balancing properties of turmeric were evaluated using animal models of joint health. The results showed that turmeric profoundly impacted various aspects of joint health in a dose-dependent manner. Turmeric supported normal levels of local activation of NFkB, which is involved in regulation of expression of the inflammatory-modulating enzymes COX-2 and iNOS. Additionally, inflammatory cell influx, joint levels of inflammatory-related prostaglandin E2, and local osteoclast (cells that resorb bone) formation were impacted by turmeric extract use.¹²

Boswellia serrata

Boswellia serrata, also known as Indian frankincense, is widely used as a traditional herb in Ayurvedic medicine for supporting a balanced inflammatory response and has reported mild discomfort alleviating activity. The resin, or gum, from the plant contains boswellic acids, which produce much of this plant’s ability to support normal inflammatory responses. It is believed that the mechanism of action is the ability to support normal levels of inflammatory-modulating leukotrienes and the enzyme 5-lipoxygenase (5-LOX). Several clinical trials have attributed beneficial effects of this herb in joint health and in supporting normal inflammatory responses in the colon, lungs and brain.¹³

In a randomized, double-blind, placebo-controlled crossover study in 30 people who had knee joint concerns, Boswellia serrata extract or placebo was given for 8 weeks. All of the patients receiving Boswellia supplementation reported enhanced knee health and comfort, and an increase in knee flexion and walking distance.¹⁴

Nattokinase

Nattokinase is a proteolytic (protein-dissolving) enzyme derived from a Japanese food known as natto, a preparation of soybeans that has undergone fermentation with a bacterium known as Bacillus subtilis natto.¹⁵ Proteolytic enzymes have mild discomfort alleviating effects in addition to their well-recognized inflammatory-balancing and circulation supportive properties, indicating they may have a role to play in the management of minor aches. The enzyme-derived effect on aches is based on modulation of the inflammatory cascade as well as exerting a direct influence on nociceptors.¹⁶ Enzymes support healthy healing and ease inflammatory-related discomfort.

Another mechanism by which nattokinase may help enhance comfort is through its actions as a fibrinolytic enzyme, which means it supports normal fibrin protein levels by inactivating plasminogen activator inhibitor 1 (PAI-1).¹⁷ Studies show that it has fibrinolytic activity that supports plasmin, the body’s natural fibrinolytic enzyme.¹⁸ The fibrinolytic system is closely linked to control of inflammation, and plays a role in the continued health of the circulatory system.

In animal studies, nattokinase supports the health of blood vessel walls (endothelium). In addition, nattokinase supports free-flowing blood and healthy clotting mechanisms in the vessels.¹⁹ Enzymes are used to maintain normal levels of fibrin and support a healthy inflammatory response, which is the likely mechanism by which nattokinase may help to reduce mild discomfort.

Conclusion

Controlling pain is a challenge for many individuals. It is a major consideration that affects participation in activities and can significantly interfere with a person’s quality of life and general functioning. Natural substances that support healthy inflammatory response and work directly on the sensitivity of the nervous system may improve the body’s natural mechanisms for dealing with discomfort. Therefore, consuming a synergistic blend of DL-phenylalanine, turmeric, Boswellia serrata, and nattokinase (all found in Back in Action™), which work directly to enhance comfort and provide a normal inflammatory response, may help individuals regain mobility.

References

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