All posts by jtrister

Dietary Management of Diabetes mellitus Type 2 ( brief version)

By Renata Trister DO
Low Carbohydrate diet is advised to improve your health,reduce inflammation associated with your weight, reduce weight, decrease triglycerides level and increase good cholesterol (HDL) level.Proteins are good for you! Amino acids ( composition of proteins) regulate insulin release from the pancreas and improve insulin sensitivity of the muscles, liver, heart etc.Reduction of the weight will help reduce needs for medications! Reduction of the 7% of body weight is equivalent to reduction 50% of medication dose!

Eat no more than 20-30 grams of carbohydrates per day in the form of green vegetables (about 6-8 cups) per day.
You may have 1-2 eggs/day, one handful of berries.
Eat meat and fish without limitations.Add Cod Liver Oil -1 tea spoon and Virgin Olive Oil -1 tea spoon to your supplements.
Cheese (4 oz)/ day.Coffee 2 cups per day, better in the morning.
Black tea in the morning and green tea in the evening.

Absolutely no: Juices, sodas (including “diet”),alcohol, aspartame, MSG.
No milk or yogurt ( they have a sugar).
No bread, No pasta, No potato,No rice or other grains. Drink plenty of fresh spring water. Use lemon juice, olive oil, pepper and salt instead of dressings. You may use cream instead of milk with your coffee or tea.
Get ketone body strips in your pharmacy to monitor your progress: Expect positive result of the test 5-6 days after starting diet. Stay on this regimen 5-6 weeks, monitoring your weight and ketone bodies in the urine.Presence of ketone bodies indicate that you actively “burn” you fat.
Walking 1-3 miles per day will help a lot. After 3 wks start gradually to increase your carbohydrates intake by adding more berries and small amount of rice or other starchy carbohydrates, while monitoring presence of ketone bodies in your urine. When you reach the point when ketone bodies become negative-this will be your critical amount of carbohydrates you may consume without gaining weight again.Stay with this regimen as long as you can.This will be your life style which will help you to maintain a good health for many years.
Check your cholesterol level , chemistry profile and hsCRP in 4-6 weeks. Call office if any questions or concerns.


Allostasis, Form, Function

By Jon Trister MD

Allostasis , Form, Function and Connective tissue status

The Concept of allostasis was proposed by Sterling and Eyer in 1988 as a process of reestablishing stability in response to a challenge.

The biological system (s) ( System) must be able to adapt to external and internal stresses.

Form and function are indivisible.

Form, Function, and  Mechanical property of the connective tissue determine the purpose of the System.

Mechanical properties of the connective tissue, Form, and Function are influenced by external and internal events.

Form, Function, and Quality of the Connective Tissue are changing under stresses, and System underwent Allostatic response.

Ability to change Form, Function, and  Mechanical property of the connective tissue-determine success of Allostasis.

Successful Allostasis – is a successful change of Form, Function, and Connective Tissue Quality to secure the Vitality of the System.

Alteration of the System (Form, Function and  Mechanical property of the connective tissue) caused by external and internal events (Congenital anomaly, Infectious process, Autoimmune reactions, Metabolic, Pharmacological and Surgical alterations, Various injuries, Environmental factors, Psychological factors, etc) will lead to an Allostatic response.

The ability of the System to change (Form, Function, Quality of the connective tissue) will determine the survivability of the System.

Allostasis allows the System to return to vitality through the change in Form, Function, and Quality of Connective tissue.

Allostasis begins at birth (or even before and after conception) and continues throughout the life of the System.

Life is impossible without Allostasis.

Death is a cessation of Allostatic response.

The System is not uniform in its ability to adapt to changes.

Rigid parts are less capable of Allostatic response but more stable.

Flexible parts are less stable but capable of adaptation better than rigid.

The entire system participates in allostatic responses.

All parts of the System contribute to Allostatic response with high variability.


Connective tissue.Vitamin C.Linus Pauling: Increase longevity

Linus Pauling, American chemists, awarded Nobel Prize in Chemistry, 1954 and Nobel Peace Prize, 1962, one of the 20 greatest scientists of all time.
This is his formula for connective tissue health:
Vitamin C: to bowel tolerance – as much as you can take without diarrhea. For most people this will be in the range of five to ten grams (5,000-10,000 mg.) each day. Spread this amount into two equal doses 12 hours apart. (Vitamin C prevents further cracking of the blood vessel wall – the beginning of the disease.)
L-Proline: 3 grams twice per day (acts to release lipoprotein(a) from plaque formation and prevent further deposition of same).
L-Lysine: 3 grams twice each day (acts to release lipoprotein(a) from plaque formation and prevent further deposition of same).
Co-enzyme Q10: 90-180 mg twice per day (strengthens the heart muscle).
L-Carnitine: 3 grams twice per day (also strengthens the heart muscle).
Niacin: Decreases production of lipoprotein(a) in the liver. Inositol hexanicotinate is a form of niacin which gives less of a problem with flushing and therefore allows for larger therapeutic doses. Begin with 250 mg. at lunch, 500 mg. at dinner and 500 mg. at bedtime the first day; then increase gradually over a few days until you reach four grams per day, or the highest dose under four grams you can tolerate. Be sure to ask your doctor for liver enzyme level tests every two months or less to be sure your liver is able to handle the dose you are taking.
Vitamin E: 800-2400 IU per day. (Inhibits proliferation of smooth muscle cells in the walls of arteries undergoing the atherosclerotic changes.)
Cod liver oil: 1 table spoon daily.


Sudden breakouts

Sudden breakouts

Renata Trister DO

This is a quick emergency guide for an occasional break out. It may help some of you who suffer from those extremely irritating red spots/welts/cysts/whiteheads/swellings – anything really that comes on in a hurry. If the cause is unrelated to food/changes in diet or routine or you simply don’t know why your skin is reacting…try this anyway.

First things first – food:

• Be honest about any dietary changes you’ve had and make adjustments. For a lot of the people it means the following. Coffee (especially the extravagant kind that involves sugar/cream/syrups), soda and sugar.
• Drink water lots of it.
• Ingest fish oil and salmon. One example diet is the Dr Perricone 3 Day Diet. Dr Perricone really pioneered of the anti-inflammatory diet for skin care. He pioneered it when everyone thought he was crazy and has stuck to his guns to be proven correct. He has several books and the quick 3day diet plan is free on line.
• If you are vegetarian and fish isn’t an option you need flax/Udo’s oil and can snack on seeds and nuts high in omegas. Flax, walnuts and soy are examples.
• No sugar.
• Minimal dairy – and dairy should always be organic.
• Anti-histamine (assuming you have no medical contraindications). Anti-histamines job is to calm the redness and ‘put out the fire’. These can make one drowsy so make sure you follow all instructions. These can help temporarily with very swollen, welts and should only be used on rare occasions.

• Evening cleanse is key. Balm/oil cleanse the skin. Make sure you’ve rinsed properly.
• Acid tone. Make sure you go over the spots/cysts really well. If they are bleeding, go over them until the acid quells the bleeding, which it should.
• Apply something topically to the area – various products are available at the drug store. Proactiv solution system is also good to use occasionally. A more natural spot treatment is made by Aesop – It contains vit c, niacinamide and salicylic acid but its in an aloe base so it calms, gets rid of the redness and hydrates – as opposed to harsher products designed to ‘dry-out’ spots. They don’t need drying out, they need nourishment.
• Apply facial oil. One designed for a combination /oily skin is ideal but in all honesty, most oils will do the trick (assuming you personally are not allergic/intolerant to them). Ren omega oil and Lotus oil from Clarins are just 2 examples. Use 3-4 drops into your palm, swipe across the other palm, apply to the areas affected first, then elsewhere. Don’t saturate your skin. Less is more. Layer. Don’t suffocate.
Now you need to monitor the situation. Keep the spot gel to hand, and reapply after you’ve used the oil. Leave it half an hour or so, check your skin, reapply the oil if its absorbed. You can apply 3 times over the space of a couple of hours. Especially if your skin was drinking it. Alternate: Control gel (your spot treatment)/Oil/Control gel/Oil.
Before you go to bed check your skin. Apply a last hit of Control gel, followed by your oil. Moisturize if needed. This routine works best with little or no silicone. Layer upon layer of silicone gives you ‘rolling’ and gets in the way of absorption of the gel/oil.

In the morning:
• Light cleanse
• Acid tone any toner with salicylic or glycolic acid
• Hydrate tone – Pure simple Rosewater is great
• Control gel
• Couple of drops of facial oil
• Moisturizer

You should find the redness has subsided a little and the spots have either come to a head or started to go down.
Keep an eye on your diet, check your skin regularly throughout the day – the Control gel is clear and can be used over makeup etc. if you want to – and repeat the process the next evening until you start to see results.

This may not work for everyone – but it’s worth trying!



Acne Quick Guide
Renata Trister DO

One of the biggest concerns in skin care seems to be problems related to acne/bad spots and ‘raised red bumps’.

Adult onset acne – along with food allergies is becoming a more common occurrence than ever before.

There is no magical ‘cure’ for acne. There are different types, yes, but no one-dose-fits-all cure. So do read the below – but bear in mind that acne is different for everyone. You may have one type – or 3 types.
You need to know your skin, your body, your state of mind, and your ‘system’ inside out to truly see results.

Types/causes of acne:

Hormones – just starting periods, just finishing periods, peri-menopause, menopause (all of them), for boys – raging androgen
Can cause over production of oil, slow shedding of dead skin cells, increases in the mount of androgen in your system – all creating the perfect breeding ground for acne.

Bacteria – Propionibacterium Acnes is the bacteria that gives/gets acne its name.

Inflammation – illness, foods, stress – a system fighting illness is inflamed on its own, add medication and you are doubling your potential problems, foods can cause inflammation (especially food allergies) and stress always causes inflammation – again, all breeding grounds for acne.

Sensitivities – allergies, reactions to products, reactions to foods/environment.

Looking at the above you may see where your skin fits in – and why antibiotics just don’t always work for some people when fighting acne.

Myths and Old Wives Tales:

It seems that once something has been said in a glossy mag, heard on TV – or both – it becomes the Law. Sad but true. And not helpful to those of us with real problems that we want to fix!
• Acne is caused by dirty skin. Not true. There is a massive difference between bacteria and dirt. Over-washing your face destroys the acid mantle that protects your skin, makes an alkaline environment, makes your acne worse and your skin a dry, dull, sore breeding ground.
• You can ‘dry up’ spots. Not true. A spot is a mixture of oil, inflammation, bacteria and dead skin cells. No water in that list. All you are doing is drying the surrounding area in the hope that it will make the spot look smaller. What it actually does it put the spot on its own ‘look at ME’ platform.
• You can use toothpaste on acne. A one-off spot may have its redness taken down – temporarily – by applying one of the above. If acne could be fixed by Oral-B and Crest all of our problems would be solved.
Things that may help:
Below are some of the things that have helped myself, friends, clients and readers of this blog. It is not a definitive list and is only suggestions.
They may not work for you, they may work brilliantly – unfortunately there is no perfect recipe. If you are on serious medication speak to your consultant before supplementing.
• Avoid mineral oils when cleansing. Natural oils are better for the skin. They just are. (See one exception later on in the list)
• Avoid too much alcohol in products. A ‘tingle’ is ok. A ‘burning’ is not. Products where the main ingredient listed is alcohol will dry out the surface of your skin, destroy the acid mantle and make the perfect breeding ground. However: alcohol is sometimes a necessary evil for suspending things like glycolic acid in a solution – where they would normally not work as well. 
It can be confusing but it’s a case-by-case basis.
• Avoid soaps and foaming washes. These break down the acid mantle of your skin (think: armor) and make your skin a 10 on the 1-10 acid/alkaline scale. Remember litmus paper from science classes? Again – the perfect breeding ground.
• Don’t pick red cysts. A whitehead can be popped in the correct manner (see previous cheat sheets); a cyst is going nowhere and will always, always prevail if you battle it. And then it will scar. Just to teach you who is boss.
• Don’t completely strip your skin of oil and moisture. An acne skin that sticks solely to foaming cleansers and oil-free products is nearly always – always – reddened with inflammation and sensitivity. Thus making more work for you.
• Treat your skin gently and with respect. You know what I mean. Abusing it with harsh products and getting angry with it – like it’s a different person – will make it worse. Your skin belongs to you. Don’t try and disown it when it needs you.
• Cleanse with good quality oils and balm cleansers. There is absolutely no reason to avoid oil when you have acne. Again:
There is absolutely no reason to avoid oil in cleansing when you have acne. Mineral oil, avoid? YES. Good, light, plant-derived oils? – no. They don’t clog pores, they nourish the skin you are now pledging to take care of and they do not break you out. Cheap, nasty, mineral oil used in heavy formulations may break you out when you are cleansing, not good oils. Check labels. Avoid paraffin, paraffin liquidum, mineral oil in ingredient listings. Avoid anything ending with –cone.
• Use topical exfoliants. Acids used topically help alleviate blocked pores, dead skin cells, trapped hair follicles and reduce your acid mantle to the lower end of the scale – usually around a 3/4 – which is in layman’s terms, strengthening your first line of defense to the acne. Think glycolic acid and salicylic acid.
• You can use products like benzoyl peroxide, found in spot treatments, to topically treat bad acne spots. It can penetrate the pore and kill off the bacteria specific to acne, but I prefer the acids in the step above. Sulfur is more commonly used, but a word of warning – in my experience, both can be drying to the skin in high %’s. Go easy.
• Hydrate your skin and consider that it might need oil in places. You can have acne in areas and be really dry/dehydrated in others.
• Consider supplementation. Omega 3 fatty acids – supplement and dietary are great for many skin conditions. It works for acne, psoriasis and eczema – so if you have any of those – or all – I would definitely recommend.
• Probiotics are a must. Especially if you are on antibiotics. Your skin is the first place to show anything going on in the gut. Keep your stomach/intestines as strong as possible.
• Avoid moisturizers with shea butter. Yes it’s natural but it’s harder than most oils for the skin to break down and thus tends to clogs pores and gives you nice whiteheads. 
Buy moisturizers with water as the main ingredient for day. You can use appropriate oils and balms at night.
Unfortunately there really is no definitive list of foods that cause acne.
There is however, awareness of foods that cause inflammation in the system (and therefore the skin) and would thus best be avoided:
• Sugar
The worst. And it’s in everything. Avoid fizzy drinks, fruit juice (OJ breaks me out almost instantaneously), pastries, condiments such as ketchup, salad cream, brown sauce and steak sauce (cries). Get into the habit of reading labels. Fructose, sucrose, maltose, golden syrup, dextrose – all sugar.
• White foods
Everyone laughs when I say it – but Mother Nature made very little white. Avoid white foods. They have, for the most part, been completely bastardized buy the food industry. Bread, pasta, cereals, sugar and cakes – if they are white – they are not real food. Think how fast your car would break down if you used ‘petrol substitute’.
• Red Meat
Red meat is medically proven to cause inflammation. Not just of the skin – it has been linked to cancer, heart disease, obesity and most inflammatory diseases. This includes beef, lamb, venison, veal, pork and all of the subdivisions such as bacon, sausage, sandwich meat, salami etc..
If you eat red meat, try and cut back and eat the best organic quality available. It is less likely to be loaded with hormones that aggravate your acne.
Eat white meat or fish – especially oily fish like salmon. If you eat meat it should swim or fly.
• Dairy
We are the only species that drinks the milk of another species. It’s not natural and you don’t need it. But again, it’s in everything. Dairy contains hormones that can alter our endocrine system and contribute to acne. That includes cheese. If you eat/drink dairy go for organic.
• Fried foods/bad fats
Avoid all margarines, corn oil, sunflower oil, cottonseed oil, grape seed oil, trans fats and hydrogenated oils. This obviously means by association you avoid crisps, French fries and deep-fried anything. Use olive or macadamia oil.

If your acne is severe – please contact us


Osteopathy of Cranial Field

Osteopathy of Cranial Field
What is it?
Osteopathy of Cranial Field is an exceptionally gentle yet extremely powerful form of treatment, increasingly recognized for the depth of its influence, the comprehensive range of its therapeutic effects, and its ability to resolve issues that are not helped by other means.
It is a profound healing process which can release the deeply held patterns of disease – both physical and psychological – which accumulate throughout life as a result of injury and illness and become held into the body tissues, leading to ill-health and dysfunction.
It is a therapy whose principal purpose is to establish a strong underlying vitality and the free flow of this inherent vitality throughout the body, thereby enabling the healing forces within to overcome disease and disturbance, and to release tensions and restrictions, so that symptoms, conditions and their underlying causes can be resolved. It can be of benefit to most people and can help in most conditions – from minor aches and pains to severe and persistent chronic health issues.
What does it involve?
Osteopathy of Cranial Field is most often carried out with the patient lying down, fully clothed, in a quiet and peaceful environment. Treatment involves a very gentle touch of the practitioner’s hands. This light contact may be taken up on the Cranium (head) the Sacrum (tail-bone) the feet, the trunk, or any other part of the body as appropriate. Treatment is generally experienced as a profound relaxation which may pervade the whole person, physically, mentally and emotionally, often accompanied by a feeling of lightness and ease.
The gentle approach of this type of OMT is entirely non-invasive. The subtle interaction of the two systems – brought together by this light contact – stimulates and enhances self healing mechanisms within the body to respond, release and open up to a more balanced healthy state.


Irritable Bowel Syndrome

Irritable Bowel Syndrome – Nutritional Management
Article Summary
Renata Trister DO
Irritable bowel syndrome (IBS) refers to a collection of intestinal symptoms that take place in the absence of a particular disease or biochemical abnormality. Its primary symptoms are abdominal pain and altered bowel habits (eg, constipation and/or diarrhea), but these symptoms have no identifiable cause. IBS affects approximately 15% to 20% of the general population, and ranks second only to the common cold as a cause of missed work time. Several treatments and therapies are available for irritable bowel syndrome. These measures help alleviate symptoms, but do not cure the condition. The chronic nature of irritable bowel syndrome and the challenge of controlling its symptoms can be frustrating for both patients and healthcare providers.
Patients with IBS may have painful cramps in the lower abdomen along with diarrhea, constipation, or alternating bouts of both. Typically, the pain flares up after a meal and goes away after elimination. Many patients also experience gas and bloating. The symptoms tend to come and go and can occur in any combination. While many IBS patients have relatively mild symptoms, up to 25% of all patients experience severe symptoms that can have a significant impact on their quality of life. For these patients, the symptoms often cause a withdrawal from normal activities. While symptoms eventually fade completely for about 30% of patients, most live with IBS for their entire lives.
There is no cure for IBS, and conventional treatment generally focuses on the relief of symptoms through the use of drugs such as antidiarrheal agents, laxatives, and antidepressants. However, this method of treatment has been met with limited success in relieving symptoms and, as with many conventional drug therapies, has adverse side effects. Fortunately, there are several natural treatment options that can promote significant relief of symptoms. These natural treatment options, along with a healthy lifestyle, are designed to lessen both the physical and emotional suffering of IBS patients.
The Causes of IBS
There are a number of theories about how and why irritable bowel syndrome (IBS) develops. Despite intensive research, the cause is not clear.
One theory suggests that irritable bowel syndrome is caused by abnormal contractions of the colon and intestines (hence the term “spastic bowel,” which has sometimes been used to describe irritable bowel syndrome). Vigorous contractions of the intestines can cause severe cramps, providing the rationale for some of the treatments of IBS, such as antispasmodics and fiber (both of which help to regulate the contractions of the colon). However, abnormal contractions do not explain irritable bowel syndrome in all patients, and it is unclear whether the contractions are a symptom or cause of the disorder.

Some patients develop irritable bowel syndrome after a severe gastrointestinal infection (eg, Salmonella or Campylobacter, or viruses). It is not clear how the infection triggers IBS to develop, and most people with irritable bowel syndrome do not have a history of these infections.

People with irritable bowel syndrome who seek medical help are more likely to suffer from anxiety and stress than those who do not seek help. Stress and anxiety are known to affect the intestine; thus, it is likely that anxiety and stress worsen symptoms. However, stress or anxiety is probably not the cause. Some studies have suggested that irritable bowel syndrome is more common in people who have a history of physical, verbal, or sexual abuse.

Food intolerances are common in patients with irritable bowel syndrome, raising the possibility that it is caused by food sensitivity or allergy. This theory has been difficult to prove, although it continues to be studied. The best way to detect an association between symptoms of irritable bowel syndrome and food sensitivity is to eliminate certain food groups systematically (a process called an elimination diet), which should only be considered for patients in the care of a doctor or nutritionist. Eliminating foods without assistance can lead to omission of important sources of nutrition. In addition, unnecessary dietary restrictions can further worsen a person’s quality of life.

Although the causes of IBS are not well understood, a number of factors have been linked to its onset. Current research indicates that the typical IBS patient has a higher level of sensitivity and reactivity in the colon, with a lower threshold of pain.
In addition, IBS is often thought to be associated with emotional conflict or stress. In fact, a large percentage of IBS patients seeking medical care have comparably higher levels of stress and anxiety. More recent research suggests that IBS may result from a dysregulation of the complex communication pathways between the intestinal tract and the brain. Thus, it is not thought that stress causes IBS, but it does worsen symptoms.
Dietary Changes and Fibers
Dietary factors can trigger symptoms of IBS. For instance, large amounts of fat in a meal often cause the colon to contract more rapidly, which stimulates various IBS symptoms. Foods such as chocolate, dairy products, caffeine, or large amounts of alcohol, as well as certain medicines, may also trigger IBS symptoms. Elimination diet in order to determine possible food intolerances is of the greatest benefit. Please see previous article regarding elimination diet protocol and ask your primary care physician with assistance in starting this protocol.
For many people, eating a proper diet reduces IBS symptoms. A diary of food intake and resulting symptoms can be useful in identifying foods that worsen symptoms of IBS. Because large meals can cause cramping and diarrhea in those with IBS, eating smaller meals more often or eating smaller portions may help ease symptoms. Avoidance of foods that tend to produce gas is also recommended.
Increased dietary fiber may lessen IBS symptoms in many cases due to the fact that fiber may help to normalize and modify bowel and colon movements. It is best to add a small amount of dietary fiber to the diet (5 grams per day) and gradually increase the amount to 25-30 grams per day.
Herbal Remedies that Support the Relief of Symptoms
The following natural remedies often prove effective in relieving potentially debilitating IBS symptoms. These remedies have a long history of use in traditional folk medicine.
Peppermint (Mentha piperita) Evidence of the medicinal use of peppermint dates back thousands of years to ancient Egypt where it was used as a digestive aid and carminative (relief of flatulence). Today, it is still known for its ability to lessen the symptoms of indigestion; hence, the common practice of eating mints after a meal. Peppermint oil can provide significant relief for IBS patients because of its antispasmodic properties. These properties refer to the oil’s ability to relax and restore tone to the intestinal muscles, which in turn reduces abdominal pain.
Chamomile (Matricaria recutita) Chamomile is one of the oldest herbal remedies. Like peppermint oil, chamomile has antispasmodic properties. While researchers have been unable to fully determine the way that chamomile works, animal studies have nevertheless supported chamomile’s potential in relaxing intestinal spasms.
Lavender (Lavendula angustifolia) Lavender is used as a carminative and diuretic; or, to put it more simply, lavender is used to “comfort the stomach.” In addition, lavender oil has been shown to improve sleep, decrease anxiety, and improve mood.
Lemon Balm (Melissa officinalis) The dried leaves of lemon balm are used as digestion promoters, gas relievers, mild tranquilizers, and antispasmodics. Therefore, lemon balm may not only help to relieve IBS symptoms and reduce stress, but may also help to promote a healthy intestinal environment.
Probiotic Support
While the symptoms of IBS are generally associated with altered colon function and hypersensitivity, an overgrowth of harmful bacteria in the intestinal tract may also play a role. Several studies have shown that probiotics work to support a balanced bacterial ecology of the gut, and therefore enhance the health and proper function of the intestinal lining. These include Lactobacillus acidophilus and Bifidobacterium infantis—two common species of “friendly” bacteria that reside in the intestinal tract. These probiotic species can help restore healthy gut ecology and function, and thus may offer an effective therapy in the treatment of IBS.


Fibromyalgia and Nutritional Support

Fibromyalgia and Nutritional Support
Article Summary

Renata Trister DO

Fibromyalgia is one of a group of chronic pain disorders that affect connective tissues, including the muscles, ligaments (the bands of tissue that bind together the ends of bones), and tendons (which attach muscles to bones). It is a chronic condition that causes widespread muscle pain, “myalgia,” and excessive tenderness in many areas of the body. Many patients also experience fatigue, sleep disturbances, headaches, and mood disturbances such as depression and anxiety. Despite ongoing research, the cause, diagnosis, and optimal treatment of fibromyalgia are not clear.

In the United States, fibromyalgia affects about 2 percent of people by age 20, which increases to approximately 8 percent of people by age 70; it is the most common cause of generalized musculoskeletal pain in women between 20 and 55 years. It is more common in women than men. Most people initially develop symptoms between the ages of 30 and 55.

The cause of fibromyalgia is unknown. Various physical or emotional factors may play a role in triggering symptoms. Although the pain is felt in muscles and soft tissues, there are no visible abnormalities at these sites. The muscles and tendons are excessively irritated by various painful stimuli. This is thought to be the result of a change in pain perception, a phenomenon termed “central sensitization.” Other conditions may also develop as a result of central sensitization, including irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), chronic headaches, and chronic jaw and facial pain.
As research studies continue, the factors that lead to chronic pain in fibromyalgia will be better understood, hopefully allowing for the development of better treatments.
Despite the large number of symptoms, there is no generally agreed-upon explanation for how or why central sensitization develops. The most plausible theory suggests that some people have a genetic predisposition to fibromyalgia because of a heightened sense of pain. In other people, various stressors, including infection, physical or emotional trauma, sleep disturbances, or other medical conditions allow for the development of fibromyalgia.
The chance of developing fibromyalgia is increased eightfold in family members of a person with fibromyalgia compared with people in the general population. Similar genetic factors are noted in people with irritable bowel syndrome, depression, and migraines. Various conventional treatment modalities have been tested in fibromyalgia patients; unfortunately, these are often ineffective and may result in adverse side effects. A natural approach that incorporates nutritional support for the body processes implicated in the pathogenesis of fibromyalgia holds great promise for the millions suffering from this chronic syndrome.


There are no specific laboratory or imaging tests used to diagnose fibromyalgia. Thus, the diagnosis is typically based upon a thorough patient history, a complete physical examination, and blood tests, which are used to exclude conditions with similar symptoms.
The American College of Rheumatology (ACR) developed classification criteria for fibromyalgia in 1990 that have often been used to help make the diagnosis. According to the ACR, people can be classified as having fibromyalgia if they have the following symptoms and findings:
●Widespread musculoskeletal pain
●Excess tenderness in at least 11 of 18 specific sites known as “tender points”

Fibromyalgia can be diagnosed by a tender point examination. Mildly irritating to completely debilitating tenderness in at least 11 of 18 defined points, such as in the neck, spine, shoulders, and hips, signifies FM.

Nervous System: Toxin Exposure

Every day we are exposed to numerous toxins such as pesticides, food additives (e.g., MSG, aspartame), and chemicals that can adversely affect various bodily functions, including nervous system function. Excessive toxin exposure can result in increased and prolonged pain sensation by the nervous system, contributing to the chronic pain associated with FM.

Digestive System: Intestinal Tract Abnormalities

Data suggest that up to 70% of patients with FM complain of symptoms associated with irritable bowel syndrome (IBS), such as chronic abdominal pain, alternating diarrhea and constipation, morning stiffness, and fatigue. Since IBS and FM have overlapping symptoms, it has been suggested they may have a common cause.

It is further theorized that dysfunction in nerve pathways between the intestinal tract and the brain help to explain the increased pain sensitivity and fatigue in FM.

Muscular System: Mitochondrial Dysfunction

Mitochondrial dysfunction is thought to be a possible cause of FM. Mitochondria are found in all cells of the body, but a re highly concentrated in muscle cells. They are responsible for cellular energy production. Decreased cellular energy production in muscle cells can result in increased muscle stiffness, pain, and fatigue in FM patients.

Endocrine System: Hormone Imbalance

Many patients with FM have experienced significant amounts of stress, which can contribute to abnormalities in the endocrine system. The endocrine system regulates hormone (e.g., serotonin, cortisol, thyroxine) production by portions of the brain, as well as by the adrenal and thyroid glands. Imbalanced hormone production caused by stress can contribute to the increased fatigue, sleep disturbances, and psychological distress experienced by FM patients.


Conventional Medical Approaches

Doctors may prescribe antidepressants, sleeping pills, muscle relaxants, and/or pain-relief medications. Unfortunately, none of these medications have been shown to be of significant benefit and they can cause adverse side effects (e.g., headache, nausea, stomach bleeding).

A Natural Treatment Approach

In addition to a healthy diet and regular exercise program as prescribed by your healthcare provider, incorporating a basic nutritional regimen that addresses the abnormalities previously discussed may be of benefit.

What a Basic Nutritional Supplement Program for FM Patients May Include.

Nutritional Supplement / Area of Support

Multivitamin/Mineral Formula / Overall health and energy levels

Mitochondrial Antioxidant Formula / Muscular system: comprehensive mitochondrial support

Malic Acid/Magnesium Complex OR Magnesium/Potassium Aspartate Complex / Muscular System: mitochondrial energy production

Bifunctional Detoxification Support Formula / Nervous system: elimination of toxins

L. Acidophilus NCFM and Bifidobacteria / Digestive system: intestinal health and function


Most people with fibromyalgia continue to have chronic pain and fatigue. After an average follow-up of 14 years, one study found that there is usually little change in the patient’s symptoms. However, two-thirds of patients reported that they were working full-time and that fibromyalgia interfered only modestly with their lives. These studies are from specialists; there is evidence that people with fibromyalgia in the general population often get better with little or no treatment.
Many people with fibromyalgia worry that their symptoms represent the “early stages” of a more serious condition, such as lupus. Long-term studies of people with fibromyalgia do not indicate that there is an increased risk of other rheumatic diseases or neurologic conditions. Fibromyalgia is not life-threatening, although it can affect the quality of day-to-day life. The severity of this impact depends upon a number of factors, including the patients’ medical, family, and social supports; their financial status; and their past experiences.
One of the most important factors in a person’s long-term prognosis is the person’s ability to take charge, to avoid “catastrophizing,” and to learn to cope well with symptoms while remaining as active as possible.
Staying active, avoiding toxins and nutritional support can improve and help manage the symptoms.


Four R Program

By Renata Trister DO
Four R Program (Remove,Replace,Reinoculate,Repair)*
The digestive system is the center of the immune system.
The digestive system, nervous system, immune system and hormone-producing system all function together in an interconnected way.
Nutritional deficiency can result from poor digestion or ineffective or incomplete assimilation of the nutrients.
The digestive system is inhabited by millions of different species of bacteria and microbiota that influence health and disease patterns.
Specific foods affect a secretion of substances from the digestive system and in so doing can influence the risk of various chronic diseases.
The Four R program represents a clinically proven approach to managing complex health problems associated with imbalances of the assimilation-elimination processes.

Step One: Remove
Simply put, get rid of all food allergens or food substances producing sensitivities. Start by evaluating the reaction to gluten in grain products; to casein protein in dairy products; and to soy products,citruses products,peanuts, eggs, and shellfish – all classic producers of immune response.Be careful also to reduce exposure to moldy foods and fermented foods.

Step Two: Replace
If the stool contains undigested food materials or fat, that is a telltale sign that the enzymes normally released during the digestive process may not be adequate for proper function. take a digestive enzyme supplement before meals to improve digestion and absorption. A Pancreatine-digestive enzyme tablet that can break down protein, carbohydrate, and fats may help in improving assimilation when taken along with meals.

Step Three: Reinoculate
Add a prebiotic and probiotic supplement to the daily regimen.Probiotic organisms of the Bifidobacterium bifidum and Lactobacillus acidophilus strains have been proved to be safe and effective for improving digestive function, but do start slowly with these supplements, and increase the dose over two to three weeks. The ideal daily dose consists of 3 grams per day of the prebiotic and a 2 billions probiotic count. The ideal probiotic dose is considerably higher than one can get in a standard dose of yogurt , so it may be more convenient to take in a therapeutic tablets or powdered delivery form.

Step Four:Repair
Take a supplement of the nutrients that can support the healing of the intestinal mucosal barrier.The most important of these are Zinc ( 15 milligrams) daily,Pantothenic acid ( Vitamin B5, 500 milligrams daily), Omega-3 fish oils ( 2-3 grams), and amino acid L-glutamine ( 5 grams) and magnesium ( 200 milligrams), along with B-complex nutritional supplements.

*Adopted from J.Bland “The Disease Delusion”


Treatment and Support of Musculoskeletal Healing

Treatment and Support of Musculoskeletal Healing
Article Summary

Renata Trister DO

An injury stimulates a sequence of events begins that begin healing. This healing process involves inflammation, repair, and remodeling. Tissue repair and wound healing are complex processes that involving interconnected, biochemical and cellular reactions, beginning with inflammation and followed by the repair and remodeling of the injured tissue. Connective tissue repair and remodeling involves chondrocyte reproduction, the formation of collagen fibers and ground substance. The healing process first involves removal of damaged tissue, then the subsequent rebuilding of healthy connective tissue. The redness, swelling, heat, and pain of inflammation are a natural part of the healing process. Prolonged or chronic inflammation, however, can slow down the healing process, causing continued loss of function. Furthermore, suppressing inflammation with drug treatment also results in delayed healing.

The inflammatory response is a critical part of tissue repair and wound healing.

When there is damage to connective tissue it is important to address the nutritional requirements for the synthesis of both the collagen fibers and the proteoglycans must be addressed when damage to connective tissue occurs. Many nutrients are involved in connective tissue repair and wound healing: glucosamine sulfate, D-glucuronic acid, amino acids, bioflavonoids, and select vitamins and minerals. In addition to nutritional support, homeopathy has been used for generations for both acute and chronic injuries.

The Inflammatory Response

Prostaglandins and related compounds are collectively known as eicosanoids. Most are produced from arachidonic acid, a 20-carbon polyunsaturated fatty acid (5,8,11,14-eicosatetraenoic acid).
The eicosanoids are considered “local hormones.” There are anti-inflammatory eicosanoids and inflammatory eicosanoids. The standard American diet promotes the production of those that are inflammatory. Fortunately, many substances inhibit inflammatory eicosanoids or promote the production of anti-inflammatory eicosanoids classic mechanism for controlling inflammation. They have specific effects on target cells close to their site of formation. They are rapidly degraded, so they are not transported to distal sites within the body. But in addition to participating in intercellular signaling, there is evidence for involvement of eicosanoids in intracellular signal cascades.
They have various roles in inflammation, fever, regulation of blood pressure, blood clotting, immune system modulation, control of reproductive processes and tissue growth, and regulation of the sleep/wake cycle.

Nutrients & Herbs That Modulate the Inflammatory Response

Omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are precursors of primarily anti-inflammatory eicosanoids. In addition, the omega-6 fatty acid, gamma-linoleic acid (GLA), also supports the production of anti-inflammatory eicosanoids.

Ginger (Zingiber officinale) and Turmeric (Curcuma longa)These herbs have long been used for acute and chronic inflammatory conditions. Studies suggest that both herbs may block activity of the enzymes cyclooxygenase and lipoxygenase. These enzymes are necessary for the production of inflammatory eicosanoids.

Cayenne Pepper (Capsicum annuum) Capsaicin, the main constituent of cayenne pepper, may play a role in inhibiting inflammatory eicosanoid synthesis by blocking cyclooxygenase activity as well. Capsaicin can reduce tissue sensitivity by selectively depleting a neuropeptide needed to transmit pain impulses to the central nervous system. Thereby changing “the perception of pain”.

Nutrients Involved in Connective Tissue Repair
Controlling inflammation is directly linked to the next phase of the healing process repair and remodeling. Following connective tissue injury, it is critical to supply the raw materials and proper nutrients that support tissue recovery and new tissue synthesis. These include:

Amino Acids Supplying amino acids may support the formation of collagen a critical connective tissue. Collagen fibers are made up of long chains of amino acids, of which one-third is glycine. Proline, hydroxyproline, and hydroxylysine are also prevalent.

Glucosamine and Chondroitin Sulfate are building materials that are vital for the synthesis of new connective tissue as well as for the healing process.

Antioxidants free radical production a major consequence of the inflammatory response—may aggravate an injury and delay or prevent adequate healing. Vitamins E and C are major antioxidants. Vitamin C is required for collagen fiber synthesis, a vital process for tissue repair and healing. Copper, zinc, and manganese further protect tissues by supporting the activity of superoxide dismutase—an enzyme that converts damaging superoxide free radicals into less harmful molecules.
Bioflavonoids see additional section below.

Muscle Mechanics, Relaxation, and Rest

Proper muscle use, joint alignment, and biomechanics during tissue remodeling are critical for preventing reduced range of motion due to scar tissue formation. In addition, injury can give rise to increased anxiety, stress, and poor sleep, resulting in prolonged and unfavorable healing.

• Group of plant pigments that are largely responsible for colors of many fruits and flowers
• Useful in treatment and prevention of many health conditions
Four categories:
• PCO (Proanthocyanidins)
• Most potent PCOs are those bound to other PCOs
• Exist in many plants and red wine
• Commercially available sources are from grape seeds and bark from the maritime pine
• Quercetin
• serves as backbone for other flavonoids such as citrus flavonoids: rutin, quercitrin, hesperidin
• these derivatives have sugar molecules attached to the backbone
• most active of the flavonoids
• Citrus bioflavonoids
• include rutin, quercitrin, hesperidin, naringin
• standardized mixture of rutinosides known as hydroxyethylrutosides (HER)
• clinical results have been obtained in treatment of capillary permeability, easy bruising, hemorrhoids, and varicose veins
• Green Tea Polyphenols
• derived from tea plant camellia sinensis
• produced by steaming the fresh cut leaf
• polyphenol indicates presence of phenolic ring in the chemical structure
• polyphenols = flavonoids
• polyphenols in green tea: catechin, epicatechin, epicatechin gallate, epigallocatechin gallate, and proanthocyanidins
• epigallocatechin gallate = most significant active compound

Dietary Sources
• Citrus fruits
• Berries
• Onions
• Parsley
• Legumes
• Green Tea
• Red Wine
Average Daily Intake = 150-200 mg

Beneficial Effects
• referred to as “nature’s biological response modifiers” – modify body’s reaction to compounds such as allergens, viruses, and carcinogens
• powerful antioxidants by giving protection versus oxidative and free radical damage
• prevents formation of oxidized cholesterol through antioxidant effects
• greater antioxidant effects than Vitamins C, E, Selenium, and Zinc
• increase intracellular Vitamin C levels
• decrease capillary permeability and fragility
• scavenge oxidants and free radicals
• inhibit destruction of collagen
• crosslinks collagen fibers to reinforce the natural crosslinking
• prevents free radical damage
• inhibits enzymatic cleavage of collagen by enzymes secreted by leukocytes in inflammation and microbes in infections
• prevents release and synthesis and compounds that promote inflammation and allergies (histamines, prostaglandins, leukotrienes)
• antioxidant effects are beneficial in:
• aging process
• chronic degenerative diseases (heart disease, arthritis, and cancer)
• fat and cholesterol oxidation
• antioxidants are produced by:
• inhibiting xanthine oxidase noncompetitively(oxygen free radicals)
• on the cellular level: PCOs are incorporated into the cell membranes along with the antioxidant effects offer great protection to cells against free radical damage.
• anti-inflammatory activity due to inhibition of initial processes of inflammation
• inhibits manufacture and release of histamine
• potent antioxidant activity and Vitamin C sparing action
• beneficial effects for diabetics
• helps prevent diabetic cataracts, and retinopathy
• enhances insulin secretion
• protects pancreatic beta cells from free radical damage
• antiviral activity
• activity vs. herpes virus type 1, parainfluenzae3, polio virus type 1, and respiratory syncytial virus
• in vivo, inhibits viral infection
• may be of some benefit in the common cold
Citrus Bioflavonoids
• antioxidant effects
• increase intracellular Vitamin C, rutin, hesperidin, and HER
• beneficial effects on capillary permeability and blood flow like PCOs
• anti-allergy and anti-inflammatory effects like quercetin
Green Tea Polyphenols
• potent antioxidant effects
• increase activity of antioxidant enzymes in the small intestines, liver, lungs, and small bowel
• inhibit formation of cancer causing compounds like nitrosamines in vitro
• suppressing activation of carcinogens
• trapping cancer causing agents
• forms of cancer that green tea prevents best:
1. cancers of GI tract (stomach, small intestine, pancreas, colon)
2. cancer of the lungs
3. estrogen related cancers (inhibits estrogen interaction with its receptor)
• consumption of green tea with meals inhibits formation of nitrosamines (nitrites combined with amino acids)

Principle Uses
• Treatment of venous and capillary disorders
• venous insufficiency
• varicose veins
• capillary fragility
• Diabetic retinopathy and macular degeneration
• Prevention of heart disease and strokes
• Lowers blood cholesterol levels
• Shrinks size of cholesterol deposits in the artery
• Inhibits platelet aggregation and vascular constriction
• In vitro, helps virtually all inflammatory and allergic conditions
1. asthma
2. hay fever
3. rheumatoid arthritis
4. lupus
• Beneficial in diabetes and cancer
Citrus Bioflavonoids
• Venous insufficiency
• Improve microvascular blood flow and clinical symptoms (pain, tired legs, night cramps, and restless legs)
• Improve venous function
• Relieve hemorrhoidal signs and symptoms in pregnant women
Green Tea Polyphenols
• Used principally to prevent cancer

Available Forms
• Grape seed extract (92%-95%) and pine bark extract (80%-85%)
• Used interchangeably, but grape seed extract is preferred
• Grape seed extract is considered more potent and more effective than pine bark extract because only grape seed extract has gallic esters of proanthocyanidins which are the most active free radical scavenging PCOs
• Available in powder and capsule forms
• For anti-inflammatory effects, combination of Bromelain (pineapple enzyme) may provide additional benefit by enhancing absorption of quercetin
• Amount of Bromelain should equal quercetin
Citrus Bioflavonoids
• Mixed preparations are most widely used
• Least active and quantified source of flavonoids
Green Tea Polyphenols
• Commercial preparations that have been decaffeinated and concentrated for polyphenols (60%-80%)
• 1 cup = 300-400 mg of polyphenols
Downside = this dose also contains 50-100 mg of caffeine