Tuesday, December 29, 2009

ASU or Avocado Soybean Unsaponifiables

If you are from the Southeast ASU likely made you think Appalachian or Arizona State University, but instead it is a type of supplement that I read about today. It MAY be showing some benefit in research studies with regard to osteoarthritis, or OA.

I read a few pages of material today that was presented at a recent American College of Rheumatology Conference. The information that I read was titled Advances in Osteoarthritis Management and it included scientific reports regarding studies in preventing progression or reversing the condition, as well as pain management for it. The basis for the report are conclusions from several clinical studies and the rigorousness of the research was noted as to give sway or pause to the findings.

Just a few points to note from this review:

At this time no treatment, medicinal or otherwise, has been found to reverse the condition which is the most common cause of disability in this country. OA is loss of cartilage in joints and usually effects knees, hips or the spine. There is promising research in regards to preventing further deterioration but more work needs to be done to prove efficacy and safety of the compounds involved. It IS true that ASU has been found to be helpful, however, when I looked up the term I saw an ad that boasted it as the only thing proven effective or some such false statement. ASU stands for Avocado Soybean Unsaponfiable. (an unsaponfiable is a substance, an oily substance, that will not turn to soap when mixed with lye) At this time NO supplement, not even glucosamine is recommended by experts.

It is true that OA is often associated with being overweight, but injury and imbalances can also cause the wear and tear. In regards to treatment of the condition, some additional good points were made.

OA is a debilitating and limiting condition because it is painful. Expert Louis Kuritzky was interviewed by Medscape and he suggests that clinicians first make an assessment of the patients level of pain. OA is different from rheumatoid arthritis and perhaps gets less respect because of the differences, but there is no blood test or scan that will tell how much pain a person is in. Several questionnaires do exist to elicit the information.

The next step according Dr. Kuritzsky is to convince the person that losing weight and participating in physical therapy WILL have a real benefit. He introduced the term proprioception which is a little hard to explain, but it has to do with how our musculoskeletal receptors respond to stimuli or cues in our environments. For instance, we may have this way of sensing that we are walking up an incline and the body automatically adjusts for that so we keep our balance. In patients with OA, proprioception is impaired, but physical therapy and weight loss can have a positive effect on that. So it doesn't lesson the cartilage loss but it DOES improve ones ability to function and thus their quality of life.

Dr. Kuritzky also notes that exercise is important for everyone and that it is especially true here EVEN when use of the joint causes some pain. He worries because we have a growing number of persons with diabetes, hypertension and obesity and physical activity IS a treatment for those conditions. It can reverse them. Often, the patient with osteoarthritis is also suffering another chronic disease and the less active they become the worse all disease outcomes will be.

Medications were also discussed. Most importantly, the clinician should begin with the lowest dose of the least toxic drug and work his way up until the pain is managed. Tylenol can be used as can ibuprofen. Even Cox - 2 NSAIDs and opioids are options, but a clinical decision has to be made with that patients specific needs, history and environment in mind.

I did learn that a topical form of NSAID has been found to be effective in clinical studies, though intuitively it would seem to be less toxic (gi bleeds) than an oral NSAID, that is still under study. The ingredient to look for in a topical, and I do not know if OTC meds are available, is diclofenic sodium at 1%.

Other medicinal therapies for pain management are being created and studied, including medicines that interrupt neurotransmitter uptake in the brain, specifically serotonin and norepinephrine.

I found the material to be quite enlightening and so shared it with you today. Take home messages are that wear and tear may occur in every one's body over time, but the extent is not the same with everyone. Some things that can make it worse are being overweight, being inactive, having had joint injuries and, being out of alignment. Other risk factors include genetics and sex (female).

You do have control over your weight and activity level, even if you have limitations. You may also be able to avoid some sports injuries or accidents, or at the least follow physical therapy recommendations when healing from them, and some imbalances can be corrected by orthotics or therapeutic procedures.

3 comments:

MaxWater said...
This comment has been removed by the author.
MaxWater said...

Hi, thanks for the useful info on ASU. It's new to me and I'll be checking on it soon.

Just a note about diclofenac sodium. Though topical NSAIDs may seem to be safer than oral ones, note that the FDA recently added a new warning to products containing diclofenac sodium after cases of liver damage were reported. (Check out http://trusted.md/blog/wpho/2009/12/11/topical_nsaid_may_cause_liver_damage).

Deirdre Dingman, MPH, CTTS, CHES, PAPHS said...

thanks for your post! I had read about improper marketing of some topical ibuprofen products but not a specific side effect, though you are absolutely correct, the same types of problems are possible with topical as oral...