Swelling isn't too swell!

If you've ever twisted an ankle badly enough to sprain or strain it, you know the routine: RICE: Rest, Ice, Compression, Elevation. The goal is to reduce swelling as quickly as possible in order to help the healing process and reduce pain.

So, inflammation is bad, right? Umm, well, sort of. The discovery of aspirin in the late 1800s, followed by ibuprofen in the 1960s led us all to believe that inflammation, and with it pain, could be easily managed. Over 100 years later (and probably thousands of studies) the medical world is thinking a bit differently about inflammation.

Immediately following an injury, damaged cells produce large quantities of COX enzymes (cylooxygenase-1 and cylooxygenase-2). These enzymes, in turn, produces a type of chemical called prostaglandins, which send a message to the brain signaling that a specific part of the body is in pain. Prostaglandins also cause cells in the injured area to release fluids, leading to swelling and inflammation. Non steroidal antiinflammatory drugs (NSAIDs) irreversibly halt the enzymatic activity of Cox-1 and latch onto Cox-2, preventing them from producing prostaglandins. As a result, less inflammation occurs and fewer pain-signals are produced.

This is all good, right? If the goal is simply to limit inflammation, then yes. But if the goal is healing and recovery from the injury, then no.

Prostaglandins not only lead to the signs and symptoms of inflammation, but they also play a role in healing (actually, Cox-1 and Cox-2 play a role in healing as well). There are countless sites and articles on the web which explain the role of NSAIDS. A great read is this Phd dissertation (read just the first few pages unless you have a degree in bio sciences).

So then, it's pretty well established that using NSAIDs adversely effects the healing process (both via delayed repair and increased scar tissue formation). I absolutely will not tell you NOT to use it: that's a decision for you and your health care provider.

If you opt to avoid NSAIDs during your injury, there are other options. First, back to RICE. Rest: well, duh! Ice: the application of ice over an injury causes a vasoconstriction in that area---literally squeezing accumulated swelling from the area (though be careful here: too much icing actually causes inflammation). Compression: doesn't allow edema/swelling to accumulate in the first place. Elevation: whenever possible, keep the injured area at or above the level of your heart, otherwise gravity will keep the swelling in your body.

And lastly, omega-3 fatty acids (mainly EPA and DHA). Prostaglandins are synthesized from 2 fats: omega-6 and omega-3. A specifice type of prostaglindin from omega-6 fats (largely grains and peanuts) is PRO-inflammatory. Prostaglandins from omega-3 fats (flax, salmon, cod) are ANTI-inflammatory. Our western diets are very high in omega-6 fats and very low in omega-3 fats.

If you are currently injured, increase your omega-3 fat consumption (you should probably do it even if you're not injured). It's thought that omega-3s may be better absorbed if you consume them in REAL food rather than in pill form. If you take your omega-3 in pill form, just be sure it's mercury-free. The issue of how to choose an omega-3 supplement, how much to take and when to take it is complex enough that I intend a follow-up article to this one.

Vitamin D

I haven't written too much on nutrition lately, so here's a little info on one of my favorite vitamins!

Vitamin D is found in significant levels in numerous dietary sources such as fish, eggs, fortified milk, and cod liver oil (yum!). Daily sun exposure also contributes significantly to the daily production of vitamin D, and as little as 10 minutes of exposure is thought to be enough to prevent deficiencies. In fact, it is believed that the general fear of sun exposure and its accompanying skin cancer risk has led to an increasing rate of Vitamin D deficiency.

The major biologic function of Vitamin D is to maintain normal blood levels of calcium and phosphorus. Vitamin D aids in the absorption of calcium, helping to form and maintain strong bones. Recently, research also suggests Vitamin D may provide protection from osteoporosis, hypertension, cancer, and several autoimmune diseases.

There are so many potential benefits to the consumption of Vitamin D, and so many risks associated with a deficiency of it, that I could write pages and pages on the subject. Hmmm, I may have a new idea for a book!

Vitamin D is included in most multivitamins, usually in strengths from 50 International Units (IU) to 1,000 IU as softgels, capsules, tablets, and liquids. The Adequate Intake (AI) levels have been established by the U.S. Institute of Medicine of the National Academy of Sciences.

Recommendations are:

• 5 micrograms (200 IU) daily for all individuals--males, female, pregnant/lactating women--under the age of 50 years-old.
  
• For all individuals from 50-70 years-old, 10 micrograms daily (400 IU) is recommended.
  
• For those who are over 70 years-old, 15 micrograms daily (600 IU) is suggested.

Some authors have questioned whether the current recommended adequate levels are sufficient to meet physiological needs, especially given our society's general lack of fitness and "outdoorsmanship".

The upper limit (UL) for Vitamin D has been recommended as 2,000 IU daily due to toxicities that can occur when taken in higher doses.

Whenever possible, I opt to consume any nutrients, vitamins, et al from whole foods. For a list of foods highest in Vitamin D, click HERE.

Now, if it isn't too late, go get in that swim you've been avoiding all day. Hopefully there's still a little sunlight left. If not, enjoy your cod liver oil tonight!