Search for tag: "inflammation"

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Troy, Mitch, have you ever seen someone in an article or an ad or on social media and they talk about inflammation? Have you ever heard of this?

Mitch: Yes. Yes, I have. On TikTok every so often there will be someone trying to tell me what I should and shouldn't be eating.

Troy: That's funny, because I'm a physician, and I've probably heard about it less than Mitch has. And I'll clarify, I'm not on TikTok.

Scot: All right. And oftentimes, after you heard about inflammation, then there's some story that follows about how somebody stopped eating bread, or using seed oils, or dairy, or red meats, or other foods, and now they feel better. Maybe they were bloated for a long time, and now they're not, or their skin has cleared up, or their migraines have gone away, or they used to be congested all the time and that went away, or they've got more energy, their mood is better.

So the question is, are these health risks and benefits overblown? I mean, is this a legitimate thing, this inflammation, and can the foods we eat really impact us in these ways? And there are a lot of ads online claiming that that's super important. There are supplements or diets that tell you, "This is a legitimate deal." But we want to find out if it's true, and we're going to dive into that topic today.

This is "Who Cares About Men's Health," providing information, inspiration, and a different interpretation to men's health. I bring the BS. My name is Scot Singpiel. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: A guy who is working hard on his health and is always bringing his unique perspective, Mitch Sears.

Mitch: Hey, there.

Scot: And Thunder Jalili, who is a professor of nutrition and integrative physiology at the College of Health at University of Utah. Thunder, how are you doing today?

Thunder: Hey, I'm good. I'm happy to be back on the podcast.

Scot: Is inflammation a real thing? That stuff I talked about at the top of the show, is that what's going on? That's what we want to dive into. Let's just start with that. I mean, is it legit? Because it seems a little crazy to me that changing my diet or getting rid of some of these foods is going to clear up all these health issues that I've had.

Thunder: So to answer your first question, yeah, inflammation is definitely a real thing. It's like a normal physiological process. And it has a purpose for wound healing and immune response and things like that.

But I guess what we're talking about here is kind of a low-grade, chronic inflammation that could increase your risk of unhealthy things, like maybe increase your risk of artery disease, or make your headaches or your arthritis worse, or things like that. So that's how I kind of look at this inflammation as we're talking about it.

Scot: How is the inflammation caused by the foods we eat different than the inflammation that's caused by other causes? I twist my ankle, and that gets inflamed. How is that different?

Thunder: You're talking probably an acute stimulus for inflammation with the ankle twist versus a more low-grade, systemic inflammation that's much lower level. So it takes longer for it to have a physiological impact. That would be my take on it.

Scot: And with a twisted ankle, though, I can look at it and see it's inflamed because it's swollen or it's hot. I mean, can I tell that with food as well, or is the other symptoms that I know that maybe something might be up?

Thunder: No, you can't really . . . I mean, it's different with food. It's a low-grade, systemic type of inflammation. A little bit more cytokine activation, a little bit more oxidative stress.

In the short term, it's not going to do much. In the long term, having it exist month after month after month can exacerbate other things that are already going on. So in someone who has high LDL levels or someone who has diabetes, and now you throw on this systemic inflammation, this low-grade, systemic inflammation, it could accelerate underlying artery disease, for example.

Scot: Yeah. So digestive problems, joint pain and stiffness, skin problems, fatigue, lack of energy, headaches and migraines in some people, even mood changes, anxiety, depression, irritability, allergies, erectile dysfunction, low testosterone levels, increase the risk of certain cancer and other chronic disease. This is all true, huh?

Thunder: Yeah. In a way, it's all true. I mean, maybe not exactly the way most people think of it, like there's a direct cause and effect of these inflammatory foods in every single condition you mentioned. But I think it's more that if you have these conditions, what you eat could exacerbate it and make it more difficult to deal with.

Whether there's a direct cause of eating these foods and then developing all those conditions you said, that's debatable. But they definitely don't help if this is one of the things that you're trying to deal with.

Troy: And I think too, Thunder, you talked about some conditions like coronary artery disease. And there, we're talking about longer-term effects rather than eating something and then an hour later, I have a heart attack because of it, things like that.

I agree, there are definitely inflammatory properties of certain foods. Again, we know certain triggers for migraines from certain foods. But yeah, like you said, it seems like a lot of these you've got an underlying condition, or it's long-term effects of maybe some of the food you're eating or some of the processes that can go on chronically.

Thunder: Yeah. And if we could just pick up the example of the coronary artery disease that you just mentioned, Troy, yeah, it's long-term. It so turns out that these foods that everyone . . . and I'm doing air quotes, okay? You guys can't see the air quotes. These foods that everyone labels "inflammatory," well, they also turn out to be the same foods that may increase your LDL and maybe make you more prone to diabetes. And these are risk factors for developing atherosclerosis, right?

So, in that sense, it's kind of hard to separate out. Yeah, they're inflammatory foods, but they also increase your risk for artery disease as well.

And that's kind of how this goes. It's not like, "I'm going to eat a cookie, and then have a heart attack or develop cancer in the next 30 minutes." But if that's my eating pattern, then by definition, I'm probably eating kind of more processed, high-sugar foods, foods with less healthy fatty acids, etc., which sets me up for all these other chronic diseases over the long term.

Mitch: So if I'm understanding this right, you're saying that having these foods is not necessarily directly causing, say, maybe the inflammation or the whatever, but it is definitely exacerbating problems that you might already have?

Thunder: Yeah, or it causes a very temporary inflammatory response that goes away after the food is processed. So that brief, mild inflammatory response, is that damaging? Probably not. If it happens all the time and the foods that you're eating are more in that processed food category, then yeah, that kind of increases the risk.

And remember at the same time, if you're eating a lot of inflammatory foods, then by definition, you're probably not eating a healthy diet with vegetables and other plant-based products and whole grains and things like that. So it's not just the addition of the inflammatory foods. It's that we're making a substitution of those types of foods and not eating the healthy foods.

Scot: So let's jump in here with some of the foods that are — I'll use Thunder's air quotes here — that are "inflammatory foods." Actually, I shouldn't use air quotes because they are, right?

Refined grains, bread, cereals, white flour, refined sugar, especially that added sugar that we've talked about before on the podcast that you want to avoid, sodium, red and different processed meats. The processed meats because they tend to have a lot of salt and other types of preservatives in them that are inflammatory. Trans fats, ultra processed foods also make the list, and then finally alcoholic beverage.

Did we cover most of the foods that are considered inflammatory, Thunder?

Thunder: Did you mention refined carbohydrates and monosodium glutamate, MSG?

Scot: Talked about refined grains like breads and cereals and white flour, but not MSG.

Thunder: Yeah. So let's just add MSG to that list. That can cause a little inflammation as well.

Mitch: Wait a minute. Didn't I read a study recently that said that alcohol is anti-inflammatory, like red wine and stuff?

Thunder: It depends how you take your alcohol. Is it in the form of Everclear or red wine?

Mitch: Oh, okay. Sure. Yeah, it depends on the night, but . . .

Scot: All right. Which one is inflammatory and which one isn't then? Is red wine is inflammatory and Everclear isn't, or what?

Thunder: So one of the things that we're doing, all of us, is we're oversimplifying this.

Scot: AIt's what we like to do.

Thunder: Yeah. Here's a dose response. If you have a glass of red wine or a small alcoholic drink, that's really not a big deal. If you pound half a liter of vodka a day, or you have a bottle or two of wine a day, that's a different ballgame. So we have to be mindful to dose. So a glass of red wine is actually anti-inflammatory. A bottle of red wine, probably not so much.

Mitch: Okay. All right.

Scot: So with inflammatory foods, it sounds like dose response and time, like how consistent have you been consuming these foods, those things start to add up then to possibly some of the negative effects that we talked about.

Thunder: Yeah, and let's add one other thing to that. How much of the anti-inflammatory foods are you consuming? So, yeah, you may be having some of these inflammatory foods, but are you eating a lot of anti-inflammatory foods? Because it's not like we wake up in the morning and flip a switch and decide which way we're going to go. We're probably all having a mix of inflammatory and anti-inflammatory. It just comes down to what's predominating.

Scot: All right. I mean, it really comes back to this notion of a balanced diet then, right? Pragmatically, in real life, sometimes we want to have some of these foods that might be labeled as inflammatory, but in moderation, that's fine as long as we're not going crazy with the dosage or the time. But we also need to look at how much of the good foods we're eating. What are some of those foods that reduce inflammation?

Thunder: So pretty much anything from the plant world, any plant-based foods. Whether it's a whole grain, or a vegetable, or a fruit, or a plant oil, those will all fall into that anti-inflammatory category.

And remember, really what we're talking about is eating patterns. If somebody is used to eating healthy and is trying to avoid processed foods and going after those plant-based foods, that's kind of an eating pattern, a lifestyle.

On the other hand, you can have an individual that doesn't really cook, they're not much into food preparation, they buy a lot of packaged foods, it's convenient, it's fast. That's kind of how a lot of people eat. And yeah, they may have an apple once in a while, but the dosage of the anti-inflammatory side isn't the same. So the balance shifts towards inflammatory foods.

Troy: See, Thunder, I'm hearing all this and it really makes perfect sense in terms of the balance, and some foods may be more promoting inflammation where others are anti-inflammatory. But then I think getting to what Mitch talked about is . . . Again, he's probably read more about it on TikTok than I have.

Mitch: You don't read TikTok. You guys understand that?

Troy: He's watched more TikTok videos than I have about this. But how much truth is there to that? If someone is saying, "Hey, I eliminated this, and it eliminated my migraines, or I eliminated this, and it eliminated my fatigue," is there something of a placebo effect there? Or is there some truth to saying if you eliminate certain foods, you are going to see a physical effect from that?

Thunder: Yeah, I think we can never discount a placebo effect for sure. But there's definitely truth in there too, because these foods that we do label anti-inflammatory, there's data in cell studies, in animal studies, and even human studies when you eat more of these plant-based foods that have phytochemicals and healthy oils and fiber and things like that, and you measure indices of inflammation or oxidative stress, you see they are lower, right? So there is truth that they have a physiological effect.

Now, the placebo part kicks in, in how good you feel after you eat those foods. I mean, there is probably a role in helping migraines. Definitely if people have gut issues, there's actually a role there in improving that. But how good you feel, I think that's where the placebo part comes in.

So I don't know if you can really separate the two. There's definitely a physiological role, but their mind is a powerful thing, right? So there's definitely going to be placebo in there as well.

Scot: I also feel like maybe some of this effect could be that . . . and I don't want to diagnose people or make assumptions, but when we see these videos on TikTok or hear these stories about people that remove these things from their diet and they felt better, we don't know what life was like for them before.

It might have been really bad. They might have not been eating very well, a lot of inflammatory foods. They might have had other underlying sort of medical things going on that when they eliminated some of these things, that's why they experienced this transformation. Whereas maybe I'm experiencing some bloating or whatever and I quit doing those things, I don't really experience anything, because for the most part, I'm pretty good.

Is that fair? Is that a fair thing to say, or am I just making stuff up?

Thunder: I think that's fair. And throw in "What if people lose a little weight when they're trying to eat the anti-inflammatory foods?" That somehow plays a role, but maybe they don't talk about that. But we know that's in the background.

So, yeah, I think it's all of the above. At the end of the day, I mean, we can try to pin exactly what the reason is, but we do know the long-term effects, right? We know what the result is, and I think that's the thing to focus on.

Troy: I guess so. And that's what I've wondered, too, is if sometimes we can drive ourselves crazy trying to identify every potential piece of our diet that could be causing certain symptoms and eliminating, and adding and eliminating something else, versus just trying to have that balanced diet. I don't know.

I guess if you were to go to someone and say, "Well, whatever symptoms you may be having . . ." Whether it's headaches, fatigue, gut issues, whatever it is, where would you even start? And where would a person even start to try and assess that and eliminate things?

Thunder: I mean, ideally, you would want to have a physician that has patience and is open to dietary experimentation and has time.

Troy: So you're saying not me. No, don't go to the ER for this, please.

Thunder: I mean, our healthcare system in general is not set up for that. Doctors have that 5-minute window, 5, 10 minutes, to talk to you and throw a bunch of things on the computer and then move on. So you've got to have the right healthcare team.

And then you need the dietitian as well who is willing to give you advice, kind of keep a log how you feel after you've taken this out or added this in.

But to get back to your kind of original basic question, "Where do you start?" the easiest thing to start, in my opinion, is try to reduce added sugar as much as possible, and try to increase your intake of vegetables, fruits, whole grain, and oatmeal. Start with that. And then if it comes in a box, try to eat less of it. I mean, that kind of covers a lot of ground.

But if you can do that, you may end up cutting the foods that were giving you problems, and at the same time adding things we know are helpful. And maybe that'll help. Maybe you don't have to go through this systematic thing where you try to identify the one particular food.

I mean, if you want to, great, go for it and have some patience and experimentation. But you can probably get results from just doing that kind of basic across-the-board approach.

Scot: I was going to say I heard one time when you're eating, if you can eat stuff that has one ingredient in it . . . Like, if it does come in a box and it's rice, that's fine, because the ingredient is rice. And that's generally pretty healthy, right? So I started applying that rule.

I know dairy kind of gets a bad rap for being a really inflammatory food, and that has one ingredient. What's your take on dairy in this list?

Thunder: Yeah. I think the dairy story is a little tougher because it could be inflammatory. But when dairy is processed into yogurt, that's actually pretty good. So I think we have to decide what dairy are we talking about? Milk, probably inflammatory. Yogurt, it's actually probably good.

Scot: All right. By the way, Troy, I don't know if you noticed this, but the foods that have the best evidence of being anti-inflammatory are stuff like tomatoes, olive oil, leafy vegetables, nuts, fatty fish, fruits. What does that sound like to you, Troy?

Troy: I was going to say, as soon as Thunder said that, it sounds like the answer is the Mediterranean diet. I just come back to it again and again.

Thunder: It's the answer to everything.

Troy: It's the answer to life, the Mediterranean diet. I do like that, though. It just keeps it simple. Because like I said, that's the thing I worry and I hear people talk sometimes about this. It just seems like they are kind of going . . . it's driving them a little crazy, because they're just saying, "Well, I've got to cut this. Okay, that didn't work. Let me try this."

But it seems like if you can just try the Mediterranean diet, like you said, Thunder, you're cutting a lot of that stuff that could be potentially bad and adding the anti-inflammatory properties of all the great stuff in the Mediterranean diet.

Thunder: Yeah, very well said.

Scot: It keeps coming back to just a . . . This is feeling like a familiar conversation now, right? Try to eliminate some of the stuff that's not great for you. And I think most of us are pretty good at knowing what that is. Are we eating processed foods? Are eating fast foods? Are we eating boxed foods? Try to add in some vegetables and fruits and nuts, if we're not doing that. Try to get rid of some of the red meat, if you're doing that. I mean, this is just the familiar refrain that we hear.

And over time, you'll hopefully start to feel better. Maybe then if you're not feeling better, that's when you might want to talk to somebody to drill down a little bit deeper, because that might get 80% of the people there.

Mitch: Sure. And I guess that leads to a next question. I don't know if this is something that Troy or Thunder could answer. At what point is gassiness, bloating, these different kinds of inflammatory responses, at what point is it something you should probably go see your doctor and not just, "Oh, I had a bad meal," or, "Oh, my diet isn't super great," but you should probably go to a doctor?

Troy: Yeah, that's a tough question, Mitch. It's something I see so often in the emergency department. The most common complaint I see is abdominal pain, and it includes all those symptoms. Maybe it's constipation. Maybe it's other things that are causing it.

But I think if it's becoming a chronic issue there, and more chronic issue is we're talking three months or more, then it's probably worth seeing your doctor, the idea being that you may have underlying conditions. And particularly if you're having any bleeding. I mean, that's a big red flag. Any blood in your stool, you probably need a colonoscopy to look for underlying conditions like ulcerative colitis or Crohn's disease, things like that.

Once you get past that three-month mark, it's a good idea to really go see your doctor rather than trying to figure it out on your own.

Thunder: Yeah. And I would also maybe add to that it depends on someone's personal discomfort tolerance. If it's bad enough, maybe some people after a month, they would want to do something about it. But it can be kind of a lower grade, but lasting more than three months, and I know people who would probably just continue to try to walk it off. It all has to do with your personal tolerance for pain.

Troy: Yeah, exactly. And when I say three months, I don't want to necessarily imply you should suffer for three months with severe abdominal pain, have your appendix burst, or something.

Like Thunder said, and I think like you implied, Mitch, kind of those low-grade symptoms where it's bothersome, and maybe it's some discomfort and some gassiness, things like that, once you hit the three-month mark, it's probably worth just seeing your doctor to get some other input, if not sooner.

Scot: So inflammation caused by the foods we eat, inflammatory foods versus foods that are anti-inflammatory, that's all real.

Thunder: Yep. It's all real, and it can all be traced back to dietary patterns. If you're kind of in that dietary pattern that favors processed foods, you're going to be eating a lot of these inflammatory foods we've mentioned. If you have a dietary pattern that favors more natural plant-based foods, whether it's a Mediterranean diet or a vegetarian diet, or just even omnivore diet, but just choosing healthy stuff, I mean, that's an eating pattern.

So we've got to always remember, at the end of the day, we're coming back to an eating pattern not targeting specific foods, but more a pattern of habitual eating.

Scot: Mitch, takeaway from today's episode?

Mitch: I'm shocked. I've been quiet because I'm sitting here being like, "No, these people on TikTok can't be . . ." They stopped eating bread, and all of a sudden, their skin is better and their mood is better. It just seemed too extreme, right? And it just seemed too simplistic, too everything.

So I guess it's yes, inflammatory and anti-inflammatory food exists. But I do really like that takeaway where if it's part of a larger change in your diet, yeah, maybe you can see these sorts of things, right? But this idea that you stopped eating bread for a week, and all of a sudden, you've got perfect skin, it still feels weird to me.

Thunder: Yeah. If you have celiac disease and you stop eating bread, you'll see immediate effects. But otherwise, yeah, it's not going to happen.

Scot: Yeah. So I think, Mitch, what I take from that is, again, you just can't tell. You don't know what the backstory is there, right? You don't even know if what they're saying is true. Do they have some other sort of agenda why they're saying these things?

Mitch: They're anti-bread.

Scot: Maybe they are. Yeah, I don't know. But my takeaway is it comes back to try to eat more of the good stuff and less of the bad stuff, right? And you're going to be okay. That's where I'm at.

Troy, takeaway?

Troy: My takeaway also is just balance. I think, Thunder, you really emphasized that. And I think if you're looking for anything, try to just achieve that balance rather than focusing on very specific foods and I think you'll see improvements by doing that. Again, Mediterranean diet. If you can do that, I think you're going to see improvements.

Scot: Have you ever experienced what we're talking about eliminating some inflammatory foods and you had a sudden change in your health? Do you have a question about the food you eat? Have you found a diet claim on the internet that just seems too bizarre to be true, and you want to know what's really going on? We would love to hear from you. You can reach out to us via email at hello@thescoperadio.com.

Thunder, thanks for being on the show.

Thunder: Yeah. It was a pleasure to be on and talk with you all.

Scot: And thanks for caring about men's health.
Relevant Links:

Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth

Many kids, especially athletes, will complain that their feet hurt at some time. Heel pain is especially common and especially during growth spurts.

Heel pain in athletes who are growing actually has a name. It's called calcaneal apophysitis, otherwise known as Sever's disease. It is most common between the ages of 9 and 14 and is seen in athletes who do a lot of running and jumping. My teenage soccer player has this and actually so do several of his teammates, or the teammates of my younger son who will probably end up having this also. Basically, what it is, is inflammation of the growth plate of the heel bone. The bones, muscles, and tendons in that area all grow at different rates during puberty. And when they're out of sync, the muscles and tendons pull too hard on the growth plate and that causes the inflammation.

So what can your child do to help once the pain has started? Well, to be honest, the pain will improve most once your child is done with their growth spurt. Also, it's best to stop any activities that cause pain. But, of course, we know that's not going to happen, especially if your child is on a competitive or a school athletic team.

So other things that help include having an ice pack in a towel and icing the heel for 15 minutes every one to two hours during flare-ups. Have your child take an anti-inflammatory pain medicine, like ibuprofen or naproxen. But be sure to check with your child's pediatrician on dosing. Gel heel cups and shoes with good support are also helpful. They help put less pressure and less stress on the heel. Your child's pediatrician can also give you exercises that can help with stretching and which can help with the pain and help keep the condition from getting too bad.

If the pain continues, your child may be referred to a physical therapist. And if all else fails, then your child will be put into a walking boot and referred to an orthopedic specialist for management of severe cases. Eventually, Sever's disease gets better, but not really until your child has stopped growing and that growth plate closes. Until then, manage the pain and follow the advice your child's doctor gives them.

Interviewer: How e-cigarettes affect your heart and it's not in a good way, and it might not be better than smoking after all. We're going to find out more about that next with cardiologist, Dr. John Ryan on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Before we get into the conversation about e-cigarettes and how they affect your heart health, I think it's important that we say that cigarettes and e-cigarettes are linked to many different health problems. But today, we're just focusing on one particular and that's issues related to the heart. So, Dr. Ryan, how do e-cigarettes affect a person's heart health and are the threats real?

Dr. Ryan: I think the threats are real. I think the concerns are legitimate. One particular concern with e-cigarettes is that it's really re-normalizing cigarette smoking, nicotine consumption, and tobacco use within North America. Some of it, the science is uncertain. We are not sure of the long-term effects of e-cigarettes, either on heart or lung disease. And then legitimate concerns get raised because of this chronic exposure to nicotine, chronic and also varying exposure to nicotine. One of the particular issues there seems to be marked variation in how much nicotine is being consumed with each vape.

Interviewer: Because when you get the little vapor things, it tells you how many milligrams per whatever, but that's not regulated so we don't know if that's accurate or not.

Dr. Ryan: Exactly. And the anticipated is .05 is what's often quoted. It can really range up to 15 whereas where your cigarettes would be about two to three. So in that regard, there's variation there that's concerning. Also, some of the physiologic effects that e-cigarettes and nicotine consumption, in general, are concerning, in particular, high blood pressure, fast heart rate, endothelial dysfunction, which is the lining of the blood vessels of the heart, in particular, which can be a trigger for atherosclerosis and coronary artery disease.

And all of these things are affected by the nicotine consumption and, in particular, by the e-cigarette nicotine consumption as well as other chemicals that are in the e-cigarettes. And as you rightly pointed out, the regulation of this is difficult and not as robust as many physicians and scientists would like. And that just raises further concerns.

Interviewer: So you mentioned a lot of different bad things that can happen from e-cigarettes, and it's related to nicotine primarily, the raising your heart rate, the blood pressure, your blood vessels narrowing, high risk of hardening of the arteries. What does that do, then, that causes heart failure or heart attack or stroke?

Dr. Ryan: So a lot of it we don't know, first of all. That specifically raises concerns, but the issues, in particular, that are raised with high blood pressure, with fast heart rates, with narrowing of the blood vessels of the heart, the coronary arteries, as you mentioned, this puts extra strain on the heart. The heart obviously depends on blood flow in order to get oxygen, and in the setting of high blood pressure, fast heart rate, decreased vessel size, you do raise the risk of having a heart attack.

So the essential concern, in particular, is for heart attacks, that the use of nicotine, e-cigarettes, and cigarettes raises your risk of having a heart attack. And also, it's not necessary, and that's where I got back to the normalization of tobacco consumption and nicotine consumption within North America. This is not a necessary thing that we need to do. This distinguishes it from . . . and there's controversy of this as well, but diet consumption, fat consumption, etc. However, we do need to eat. We don't need to smoke and we don't need to vape.

Interviewer: So for sure, we know nicotine causes these negative effects to the heart.

Dr. Ryan: Exactly.

Interviewer: What about the other chemicals, like . . . I've heard the flavoring chemicals. Even if you're getting the dose without the nicotine, they've found that it can cause other diseases.

Dr. Ryan: Yeah, so the flavoring has recently been associated with what's called popcorn lung or bronchiolitis obliterans, which is a form of inflammatory and fibrotic lung disease. The reason this raises concerns is, first of all, lung disease, therefore, puts a strain on your heart. And secondly, if there's chronic inflammation, which we see in the setting of poor air quality and stress, it can result in triggering heart attacks or heart disease. So I think there are two main concerns with the chemicals that you bring up in terms of e-cigarettes.

Interviewer: If you've got a patient that's right in front of you now that smoked e-cigarettes, how would you convince them that they shouldn't? Because a lot of people get enjoyment out of it, or it's an addictive habit that they can't stop. It takes a lot of willpower to quit.

Dr. Ryan: Being sensitive enough in terms of convincing people to do things. Ultimately, I think you have to introduce the risks associated with the disease, the risks associated with the risk factors, and hope that they make an informed, educated decision about their habits. And so I try and present to them the uncertainty about e-cigarettes. I try to present them with some of the concerns that I have about e-cigarettes and nicotine consumption in general. And then, hopefully, when they leave the clinic and when they go home, they're able to access resources themselves and make good decisions themselves and be comfortable with the decisions they're making.

Interviewer: And I think, essentially, it comes down to this is something that you don't have to do to your heart.

Dr. Ryan: Exactly, yeah. You don't have to do it to your heart. You don't have to do it to your lungs.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: January 8, 2019
originally published: January 26, 2016

Interviewer: You found out you have tendonitis. Probably wondering what treatments are available, what do you need to know about them and what to expect afterwards. We're going to talk about that next, on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. David Petron is an orthopedic sports medicine specialist at University of Utah Health Care and is also the chief medical officer for the Utah Jazz basketball team. So he knows what he's doing and today we're going to talk about tendonitis.

Dr. Petron: Well first let me say what tendonitis is. There can be confusion about it. Tendon is muscle connected to bone. So at the end of the muscle, that's where the tendon is and then the tendon ultimately attaches to the bone. -Itis infers that it's an inflammation problem, when in fact most tendonitis is really what we call tendonosis because it ends up being a chronic problem. Usually in the first few weeks or maybe the first month we might call it tendonitis. After that it really is not an inflammatory problem, but it's more of a tissue break down problem and then we call it tendonosis.

Interviewer: And that's something that's not going to go away without some sort of intervention. Is that correct?

Dr. Petron: Frequently that's the case and generally the older the patient is, the longer it can take to go away. But even sometimes with prolonged rest, as soon as somebody goes back to doing their usual activity, the tendonosis problem comes back again.

Interviewer: So something's going to have to happen, what are the options? Typically are there a lot?

Dr. Petron: There a lot of options. The one thing that all these options have in common is they do something to disturb the tissue. So it gets in a chronic pattern where it won't heal itself and we need to do something to disturb that tendon to try to get the body to feel like it's an acute injury so that it can ultimately heal itself.

• Rest and ice

  Early on the treatments are conservative, later on they can become more interventional. Some of the early treatments of course are just rest and ice, and relative rest. So say it's a swimming problem and a shoulder problem, you might be able to stay in aerobic shape by running or riding a bike, working on some shoulder exercises while you ease your way back into the pool. So that can be some of the most simple treatment, just relative rest and then gradual return to activity.

• Anti-inflammatories

  Frequently people take anti-inflammatories and they're helpful for the pain, but they're not really helpful for healing. In fact there are some studies that show that they may actually slow down healing. Cortisone is something that people frequently may run into at their doctor's office. And I think that's okay when you're in the -itis phase, so the inflammatory phase. But later on we actually know that cortisone can slow down healing and cortisone in a tendon can actually weaken the tendon, so we've got to be careful about that.

Some of the more advanced treatments I'll just talk about briefly.

• Focused aspiration of scar tissue (FAST)

  There's something called FAST or focused aspiration of scar tissue. This is a newer treatment where you use a percutaneous needle that vibrates about 2000 times a second and then it has irrigation that goes in and fluid that sucks out the necrotic tissue. So it's a way of removing the scar tissue just kind of through a poke hole through the skin's surface.

• Platelet rich plasma (PRP)

  Some of you may have heard of PRP or platelet rich plasma. That's where we draw your own blood off, spin it down, remove the platelets, which have some healing properties, and then re-inject that back into the tendon. Again to disturb the tissue and try to give it a jump start to ultimately heal itself. Even some use of stem cells now using in a similar way as PRP.

• Astym

  Sometimes physical therapists will do something called Astym where they're using—I call it a butter knife—but it's basically some tools that they're rubbing, kind of like a deep tissue massage. Again to try to disturb that tendon to try to get it to turn over and heal itself.

• Extracorporeal shock wave therapy

And then one other thing that we do is called extracorporeal shock wave therapy, which is kind of like a de-tuned lithotripsy. Same kind of technology used to break up a kidney stone. But you do that on the skin surface, again to disturb the tissue, break up the degenerative tissue along the tendon to get that to heal. So there are a few of the more advanced treatments that are being used now for tendons to heal.

Interviewer: My head's spinning. There's so many of them.

Dr. Petron: There's a lot out there, and like most things when there's a lot of different ways to approach it, not one way is perfect. So the physician needs to evaluate the patient and see what might be best for their situation.

Interviewer: Yeah that really sounds like you do need an expert. I mean you can do a little reading on the internet, but it sounds like an expert really needs to decide what is going to be best for your situation.

Dr. Petron: Right, in the early phases though relative rest and gradual return to activity in a lot of patients do well. But once you've had this for three months or six months or longer, probably ought to see a physician.

Interviewer: So getting in early is always the better option.

Dr. Petron: Right, if you start to feel some breakdown say in an Achilles tendon or a rotator cuff in your shoulder, stop. Because once you get into that tendonosis phase, it can be very difficult to get better.

Interviewer: What are some common questions people have about these treatments?

Dr. Petron: One of the common things is when one of these treatments is done, is it going to instantly be better? And the answer to that is no. So some of that might be lowering the expectation. Because again, really the body still has to heal itself. So even with these treatments, it can usually be three months or so until they're healed.

Interviewer: So in three months, back to 100%? I mean is that fair?

Dr. Petron: Usually at least back to activity, their usual activity.

Interviewer: And then how do you prevent—

Dr. Petron: But there are some areas that really have a lousy blood supply, like the Achilles tendon. Once that's really inflamed, that can be even longer than that to return to play.

Interviewer: So I get the treatment, I'm back to activity. How do I prevent this from now happening again and being a vicious circle?

Dr. Petron: Well the most important thing is start out slowly. All of these problems are not traumatic injuries, they're overuse injuries. So it's doing too much too quickly. So in general, the older the athlete, the slower you ought to ease into your particular sport.

Interviewer: And then eventually your body is going to be able to handle anything you throw at it?

Dr. Petron: The body adapts to the stresses put upon it. So just like a weight lifter gradually lifting more and more weight, muscles get bigger, tendons get stronger. That can happen to every part of your body. Bones get stronger, tendons get stronger, ligaments get stronger as you put stress on it. But the key is you need to do that in a controlled manner.

Interviewer: Let's wrap this up with the final thought. What do you think the big takeaway is?

Dr. Petron: Prevention is always key, so if you start to get feeling of tendon pain then back off on that activity. Relative rest, which means you can still stay active but don't overuse that tendon. If you do overuse it and you have the symptoms for say three months or longer, probably should seek the care of a physician.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: February 12, 2019
originally published: April 8, 2015

Host: Fall? Dry eye season? What do you do about it? First of all, we're going to find out what causes it. Second of all, we're going to find out what you can do about it, including maybe some things you've never heard of before.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Host: We're talking to Dr. Majid Moshirfar from the Moran eye center. So tell me, dry eye syndrome. I know this seems like a simple question and a silly question but, what is it?

Dr. Majid Moshirfar: No, there is no silly question. Indeed, dry eye syndrome, or what people call dry eye disease, is an inflammatory disease process. Very interestingly, we all thought that if somebody had a dry eye, it simply meant that they have insufficiency of their tear film. That was the naive thinking that we all had in the 1960's and 1970's and 1980's. But thanks to some very good clinicians and symposiums, now we believe that dry eye disease is an inflammatory process that happens on the surface of the eye on the ocular surface.
It doesn't have to do necessarily with lack of tear film, but it can be also the poor quality of the tear film. It could be that the electrolytes, or the sodium or the potassium that are in our tear film, they could be abnormal. Or the immunoglobulins that are in our tear film could be abnormal. So this naive thinking that dry eye is simply a lack of tear is a very wrong misconception that we all have. I think that we should believe that this is an inflammatory process that requires us to pay a lot of attention to how to prevent it or how to improve it.

Host: That's interesting. It's a disease; it's not just a condition.

Dr. Majid Moshirfar: No, it is actually a disease.

Host: So, redefining what it is really probably redefines what I would do about it. I would think, if I have dry eyes, I go to the store, I get some eye drops. I keep dropping them until I feel better.

Dr. Majid Moshirfar: And that's actually the wrong that you can do. Because when you go into the store and you look in the hygiene section and look at the eye section, and you choose some of those artificial tears, that's what you're talking about. Some of those artificial tears, many of them actually have preservatives in them. And if you keep putting those artificial tears with the preservative inside your eye, you're actually going to create a secondary allergic reaction to the preservatives that are inside it.

Host: You're making it worse.

Dr. Majid Moshirfar: Yes. You did the right thing by choosing artificial tears, but you have been putting in tears that have a lot of preservatives in them and that is not the right thing to do. You need to look for artificial tears that are preservative-free.

Host: And those are okay?

Dr. Majid Moshirfar: Those are absolutely what we recommend our patients, that's our first line of defense against dry eye disease.

Host: So then would you, if you had dry eye disease and this is the first line of defense, is this something that you would use for the rest of your life then, or just as...

Dr. Majid Moshirfar: It's very interesting, because it's just like any disease, any prevention that we can do. I think nowadays medicine is about prevention and about educating. If you see my patients who are in their 30s and 40s, if these individuals approached them nicely in the beginning, all you need is maybe one or two drops a day. Maybe in the morning and maybe in the afternoon. But when you see somebody who is 80 years old, and they've had all these problems for years and years, they've already destroyed a lot of the surface integrity, a lot of those stem cells, a lot of those what we call goblet cells or mucocele cells. So what happens is that it's very important that we start tackling ocular surface inflammatory disease early on.

Host: I had Lasik done, and they did something. They plugged my tear ducts. Is that something that can be done?

Dr. Majid Moshirfar: Right. And as I told you, when people have dry eye disease because of whatever reason, whether it was Lasik, or thyroid eye disease. When you have a bad flu or pneumonia and you're taking a lot of sinus medications to get rid of your nasal congestion.

Host: What about foods that you eat? Could that cause dry eyes? Alcohol? Stuff like that?

Dr. Majid Moshirfar: Absolutely. Poor diet. I really really believe that people who have a very poor diet with a poor balance of their nutrition can have dry eyes. And I see this many times. Patients who come to me and they've been on a rigorous diet, to lose 50, 60, 100 pounds. And I see them, they actually develop what I call a secondary ocular surface dryness. So you need to have a well-balanced diet. We recommend a lot of our patients to take fish oil in order to improve the status of their tear film.

Host: Okay, so we talked about the proper eyedrops, without the preservatives, we've talked about possibly plugging the tear ducts which is something else that can be done. What are some other procedures if those aren't working?

Dr. Majid Moshirfar: One of the things that we do is first of all you need to catch the patients at the earlier stages of dry eye, and then -

Host: Yeah, because it gets worse as you go on.

Dr. Majid Moshirfar: Absolutely.

Host: I mean, if you don't catch this right away, it's just getting worse and worse.

Dr. Majid Moshirfar: It's like a patient who has a bad joint or a bad rheumatoid arthritis.

Host: That's new, that's news to me.

Dr. Majid Moshirfar: Yes. And so rheumatoid arthritis, if you don't take care of them, they get to a point where they need to have a total knee replacement and more. So it's important to catch that earlier stage. So to answer your question, we are very fortunate because now we have some medications that we actually prescribe by prescription that you can actually pick up from a pharmacy, and these medicines are very good at improving the secretion of your tear film. So we are actually not encouraging people just to use artificial tears. We actually make your own glands to make tears in your eyes. And one of them is called Restasis. We use very safe cortical steroids to put inside your eyes to encourage the secretion of your tear film and also reduce the inflammation of the ocular surface. So, yes, there are medications we can implement, there are punctal plugs, humidifiers at the working environment or at home, some little humidifier next to your bedside. A lot of these things can also help as well.

Host: And I read, this sounds crazy to me, about an implant that actually, you called it a little gummy bear.

Dr. Majid Moshirfar: That's right. They're called Lacrisert, and they're amazing. There are some patients that need this little tiny gel, almost like a little tiny capsule if you want to think about it. Like a very small, small, small, small gummy bear that you actually put underneath your lid. You tuck it underneath there, and it's like a little tiny capsule of gel that secretes a lubricating substance throughout the day and keeps your surface completely moist. And all you have to do is, you put this Lacrisert in at the beginning of the day, and it goes all the way, 24 hours. So they're very rewarding for some patients.

Host: Oh, so that's just something that a person puts in every day.

Dr. Majid Moshirfar: That's right. Yes.

Host: So I go into my eye doctor, what do I need to tell them so they know what I'm talking about?

Dr. Majid Moshirfar: First of all, I think when you see your doctor, most of the eye care physicians are very astute about this. They know what to do, they have some tests.

Host: It's a fairly common thing now.

Dr. Majid Moshirfar: Yes. As a matter of fact, 80% of most ophthalmologic visits, one of the complaints that the patients have is in a way related to ocular surface dryness. Now maybe not the disease, but a mild spectrum of that.

Announcer: We're your daily dose of science. Conversation, medicine. This is the Scope. University of Utah Health Sciences Radio.