Monday, December 10, 2012

Acupuncture for Arthritis

By: Diane Joswick, L.Ac., MSOM

Arthritis is one of the most pervasive diseases in the United States and is the leading cause of disability. According to the Centers for Disease Control and Prevention one out of every three Americans (an estimated 70 million people) is affected.
For most people arthritis pain and inflammation cannot be avoided as the body ages. In fact, most people over the age of 50 show some signs of arthritis. Joints naturally degenerate over time. Fortunately, arthritis can often be managed Acupuncture and Oriental Medicine.

What is Arthritis?
Arthritis isn't just one disease; it's a complex disorder that comprises more than 100 distinct conditions and can affect people at any stage of life. Two of the most common forms are osteoarthritis and rheumatoid arthritis. While these two forms of arthritis have very different causes, risk factors, and effects on the body, they often share a common symptom—persistent joint pain.

Osteoarthritis (OA) is the most common form of arthritis in the United States, affecting an estimated 21 million adults. OA begins with the breakdown of joint cartilage, resulting in pain and stiffness.
OA commonly affects the joints of the fingers, knees, hips, and spine.
Other joints affected less frequently include the wrists, elbows, shoulders, and ankles.
When OA is found in a less frequently affected joint, there is usually a history of injury or unusual stress to that joint. Work-related repetitive injury and physical trauma may contribute to the development of OA.
If you have a strenuous job that requires repetitive bending, kneeling, or squatting, for example, you may be at high risk for OA of the knee.

Rheumatoid arthritis (RA) can affect many different joints and, in some people, other parts of the body as well, including the blood, the lungs, and the heart.
Inflammation of the joint lining, called the synovium, can cause pain, stiffness, swelling, warmth, and redness.
The affected joint may also lose its shape, resulting in loss of normal movement.
RA can last a long time and can be a disease of flares (active symptoms) and remissions (few to no symptoms).

Diagnosis and Treatment of Arthritis with Acupuncture and Oriental Medicine
According to Chinese medical theory, arthritis arises when the cyclical flow of Qi in the meridians becomes blocked. This blockage is called, "bi" type pain and is widely studies and successfully treated using a combination of acupuncture and/or Chinese herbs.

Acupuncture and Oriental Medicine have been found to be extremely effective at treating the pain and inflammation associated with all types of arthritis. The acupuncture points and herbs that are used depend on if the blockage of Qi (arthritis) is caused by the pathogen wind, cold, damp or damp-heat.
Traditional Chinese Medicine does not recognize arthritis as one particular syndrome.
Instead, it aims to treat the specific symptoms that are unique to each individual using a variety of techniques such as acupuncture, Chinese herbs, bodywork, lifestyle/dietary recommendations and energetic exercises to restore imbalances found in the body.
Therefore, if 10 patients are treated with Oriental medicine for joint pain, each of these 10 patients will receive a unique, customized treatment with different acupuncture points, different herbs and different lifestyle and diet recommendations.
Your acupuncturist will examine you, take a look at the onset of your condition and learn your signs and symptoms to determine your Chinese diagnosis and choose the appropriate acupuncture points and treatment plan.

The Acupuncture Treatment
Acupuncture points to treat Arthritis are located all over the body, not just directly over the affected area. During the acupuncture treatment, tiny needles could be placed along your legs, arms, shoulders, and perhaps even your little toe!
There seems to be little sensitivity to the insertion of acupuncture needles. They are so thin that several acupuncture needles can go into the middle of a hypodermic needle. Occasionally, there is a brief moment of discomfort as the needle penetrates the skin, but once the needles are in place, most people relax and even fall asleep for the duration of the treatment.
The length, number and frequency of treatments will vary. Typical treatments last from five to 30 minutes, with the patient being treated one or two times a week. Some symptoms are relieved after the first treatment, while more severe or chronic ailments often require multiple treatments.

Chinese Herbs for Arthritis
There are many Chinese Herbal formulas that are prescribed for arthritis. Your acupuncturist will examine you, take a look at the onset of your condition and learn your signs and symptoms to determine which herbs are best for you.
Here are some commonly prescribed Chinese herbal formulas for arthritis:
  • Remove Painful Obstruction Decoction (juan bi tang)- For joint pain that increases with cold and is possibly accompanied by heaviness and numbness in the limbs.
  • Cinnamon Twig, Peony, and Anamerrhena Decoction (gui zhi shoa you zhi mu tang)- For swollen and painful joints that are warm to the touch and worse at night.
  • Angelica Pubescens and Sangjisheng Decoction (du huo ji sheng tang)- For heavy and painful sensations at fixed locations in the lower back and lower extremities accompanied by weakness and stiffness.

Studies on Acupuncture and Arthritis
Several studies have shown that acupuncture can help people with arthritis and related auto-immune diseases.
In one Scandinavian study 25 percent of arthritis patients who had been scheduled for knee surgery cancelled their operations after acupuncture treatment. In the study, researchers compared acupuncture with advice and exercise for the treatment of osteoarthritis of the hip. Thirty-two patients awaiting a total hip replacement were separated into 2 groups. One group received one 10-minute and five 25-minute sessions of acupuncture, and the other group received advice and hip exercises over a 6-week period.
Patients were assessed for pain and functional ability: Patients in the acupuncture group showed significant improvements, while no significant changes were reported in the group that received advice and exercise therapy. The results of this study indicate that acupuncture is more effective than advice and exercise for the treatment of osteoarthritis of the hip.
Another study at the University of Maryland showed that elderly arthritis patients with knee pain due to arthritis improved significantly when acupuncture was added to their treatment.
The randomized clinical trial, performed at the University of Maryland School of Medicine, determined whether acupuncture was a clinically safe and effective adjunctive therapy for older patients with osteoarthritis of the knee.
The study addressed these questions:
  1. Would the addition of acupuncture to conventional therapy produce an added measure of pain relief?
  2. Would the effects of acupuncture last for 4 weeks following the end of treatment?
  3. Would acupuncture have any side effects?
Seventy-three patients were randomly divided into 2 groups. One group received twice-weekly acupuncture treatments and conventional therapy for 8 weeks, and the other group received conventional therapy only. Patients who received acupuncture had significant pain relief and showed improvement in function. Those who did not receive acupuncture showed no significant change. No patients reported side effects from any acupuncture therapy session.

Safe Alternative to Medication
Even without the studies, the popularity of acupuncture for arthritis continues to grow because more and more people have found significant relief from Oriental Medicine without the negative side effects that come from Western pharmaceuticals.

Lifestyle and Dietary Instructions
Your diet plays a crucial role in helping you avoid or control arthritis. The first objective of a healthy diet is to help you lose weight if you are overweight. Being overweight can cause additional stress to your joints.
The second way a balanced, varied diet can help ease the pain of arthritis is by providing vitamins and minerals that keep your joints healthy and avoiding “damp” foods such as dairy products and greasy or spicy foods.
If you have arthritis or knee or hip pain, vitamin C and vitamin D can help prevent bone and cartilage destruction. And a multivitamin can help ensure that you always get the nutrition you need.
Here are some other healthy (and delicious) choices to include in your diet.
  • Ginger - A natural anti-inflammatory, available as powdered extracts in capsules as well as alcohol-based extracts. Follow the dosing directions on the label. Or make tea by combining one-half teaspoon of grated ginger root with eight ounces of boiling water. Cover and steep for 10 to 15 minutes, then strain and add honey to taste.
  • Fresh pineapple - Bromelain, an enzyme in pineapple, reduces inflammation. Be sure the pineapple is fresh, not canned or frozen.
  • Cherries - Recent research has shown that tart cherries are an excellent source of nutrients that may help to reduce joint pain and inflammation related to arthritis.
  • Fish - Cold-water fish such as salmon and mackerel contain omega-3 fatty acids, which help keep joints healthy as well as reduce pain and swelling. If you don't care for fish, consider supplementing your diet with fish oil capsules.
  • Turmeric - Another natural anti-inflammatory. Look for an extract of whole turmeric, in health-food stores; follow the dosage directions on the label.
Find an Acupuncturist
Today, acupuncture is an acknowledged and respected field of medicine which requires formal training and certification in order to practice. In most States, provinces and countries, acupuncture is legislated in order to assure quality of treatment.
Acupuncture and Oriental medicine is an art and a science that takes years to master. Look for an acupuncturist with formal training and experience in the treatment of Arthritis on

Rheumatology in Chinese Medicine, 2002. By G. Guillaume & M. Chieu
Chinese Herbal Medicine: Formulas and Strategies, 1990. By Dan Bensky & Randall Barolet
Acupuncture: A Comprehensive Text By Shanghai College of Traditional Chinese Medicine, 1981

Friday, December 7, 2012

 Iron in the Vegan Diet

by Reed Mangels, Ph.D., R.D.

Topics in this article:


Dried beans and dark green leafy vegetables are especially good sources of iron, even better on a per calorie basis than meat. Iron absorption is increased markedly by eating foods containing vitamin C along with foods containing iron. Vegetarians do not have a higher incidence of iron deficiency than do meat eaters.

Heme vs. Non-heme Iron

Iron is an essential nutrient because it is a central part of hemoglobin, which carries oxygen in the blood. Iron deficiency anemia is a worldwide health problem that is especially common in young women and in children.
Iron is found in food in two forms, heme and non-heme iron. Heme iron, which makes up 40 percent of the iron in meat, poultry, and fish, is well absorbed. Non-heme iron, 60 percent of the iron in animal tissue and all the iron in plants (fruits, vegetables, grains, nuts) is less well absorbed. Vegan diets only contain non-heme iron. Because of this, iron recommendations are higher for vegetarians (including vegans) than for non-vegetarians. The RDA for iron is 14 milligrams per day for vegetarian men and for women after menopause, and 33 milligrams per day for women prior to menopause 1.

Iron Status in Vegans

Some might expect that since the vegan diet contains a form of iron that is not that well absorbed, vegans might be prone to developing iron deficiency anemia. However, surveys of vegans 2,3 have found that iron deficiency anemia is no more common among vegetarians than among the general population although vegans tend to have lower iron stores 3.
The reason for the satisfactory iron status of many vegans may be that commonly eaten foods are high in iron, as Table 1 shows. In fact, if the amount of iron in these foods is expressed as milligrams of iron per 100 calories, many foods eaten by vegans are superior to animal-derived foods. This concept is illustrated in Table 2. For example, you would have to eat more than 1700 calories of sirloin steak to get the same amount of iron as found in 100 calories of spinach.
Another reason for the satisfactory iron status of vegans is that vegan diets are high in vitamin C. Vitamin C acts to markedly increase absorption of non-heme iron. Adding a vitamin C source to a meal increases non-heme iron absorption up to six-fold which makes the absorption of non-heme iron as good or better than that of heme iron 4.
Fortunately, many vegetables, such as broccoli and bok choy, which are high in iron, are also high in vitamin C so that the iron in these foods is very well absorbed. Commonly eaten combinations, such as beans and tomato sauce or stir-fried tofu and broccoli, also result in generous levels of iron absorption.
It is easy to obtain iron on a vegan diet. Table 3 shows several menus that would meet the RDA for iron.
Both calcium and tannins (found in tea and coffee) reduce iron absorption. Tea, coffee, and calcium supplements should be used several hours before a meal that is high in iron 5.

Table 1: Iron Content of Selected Vegan Foods

Iron (mg)
Soybeans, cooked 1 cup 8.8
Blackstrap molasses 2 Tbsp 7.2
Lentils, cooked 1 cup 6.6
Spinach, cooked 1 cup 6.4
Quinoa, cooked 1 cup 6.3
Tofu 4 ounces 6.0
Bagel, enriched 3 ounces 5.2
Tempeh 1 cup 4.8
Lima beans, cooked 1 cup 4.4
Swiss chard, cooked 1 cup 4.0
Black beans, cooked 1 cup 3.6
Pinto beans, cooked 1 cup 3.5
Turnip greens, cooked 1 cup 3.2
Chickpeas, cooked 1 cup 3.2
Potato 1 large 3.2
Kidney beans, cooked 1 cup 3.0
Prune juice 8 ounces 3.0
Beet greens, cooked 1 cup 2.7
Tahini 2 Tbsp 2.7
Veggie hot dog 1 hot dog 2.7
Peas, cooked 1 cup 2.5
Black-eyed peas, cooked 1 cup 2.3
Cashews 1/4 cup 2.1
Brussels sprouts, cooked 1 cup 1.9
Bok choy, cooked 1 cup 1.8
Bulgur, cooked 1 cup 1.7
Raisins 1/2 cup 1.6
Almonds 1/4 cup 1.5
Apricots, dried 15 halves 1.4
Veggie burger, commercial 1 patty 1.4
Watermelon 1/8 medium 1.4
Soy yogurt 6 ounces 1.1
Tomato juice 8 ounces 1.0
Green beans, cooked 1 cup 1.2
Kale, cooked 1 cup 1.2
Sunflower seeds 1/4 cup 1.2
Broccoli, cooked 1 cup 1.1
Millet, cooked 1 cup 1.1
Sesame seeds 2 Tbsp 1.0  

Sources: USDA Nutrient Database for Standard Reference, Release 18, 2005 and Manufacturer's information.
The RDA for iron for vegetarians is 14 mg/day for adult men and for post-menopausal women and 33 mg/day for pre-menopausal women.

Table 2: Comparison of Iron Sources
(mg/100 calories)
Spinach, cooked 15.7
Collard greens, cooked 3.1
Lentils, cooked 2.9
Broccoli, cooked 1.9
Hamburger, lean, broiled 1.2
Chickpeas, cooked 1.1
Sirloin steak, choice, broiled 0.9
Chicken, breast roasted, no skin 0.6
Pork chop, pan fried 0.4
Flounder, baked 0.3
Milk, skim 0.1
        Note that the top iron sources are vegan.

Table 3: Sample Menus Providing Generous Amounts of Iron
  Iron (mg)
1 serving Oatmeal Plus (p. 23) 3.8
1 serving Tempeh/Rice Pocket Sandwich (p. 94) 4.7
15 Dried Apricots 1.4
1 serving Black-Eyed Peas and Collards (p. 76) 2.1
1 serving Corn Bread (p. 21) 2.6
1 slice Watermelon 1.4
 TOTAL 16.0

Cereal with 8 ounce of Soy Milk 1.5
1 serving Creamy Lentil Soup (p. 49) 6.0
1/4 cup Sunflower Seeds 1.2
1/2 cup Raisins 1.6
1 serving Spicy Sauteed Tofu with Peas (p. 103) 14.0
1 cup Bulgur 1.7
1 cup Spinach 6.4
sprinkled with  
2 Tbsp Sesame Seeds 1.0
 TOTAL 33.4

Additional foods should be added to these menus to provide adequate calories and to meet requirements for nutrients besides iron.


  1. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2001.
  2. Haddad EH, Berk LS, Kettering JD, Hubbard RW, Peters WR. Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Am J Clin Nutr 1999;70(suppl):586S-93S.
  3. Obeid R, Geisel J, Schorr H, et al. The impact of vegetarianism on some haematological parameters. Eur J Haematol. 2002;69:275-9.
  4. Hallberg L. Bioavailability of dietary iron in man. Ann Rev Nutr 1981;1:123-147.
  5. Gleerup A, Rossander Hulthen L, Gramatkovski E, et al. Iron absorption from the whole diet: comparison of the effect of two different distributions of daily calcium intake. Am J Clin Nutr 1995;61:97-104.

SIMPLY VEGAN COVER This article originally appeared in the book Simply Vegan: Quick Vegetarian Meals by Debra Wasserman. Nutrition section by Reed Mangels Ph.D., R.D. (ISBN 0-931411-30-0)

Thursday, December 6, 2012

How to Lower Stress and Survive the Holidays With Acupuncture

By Sara Calabro
Acupuncture is well known for its ability to lower stress. Many people use acupuncture for stress reduction. And even those who don’t admit to or notice stress in their lives report a greater sense of lightness and evenness to their moods after having acupuncture.
During the holiday season, many of us could benefit from the stress-reduction benefits of acupuncture. But who has the time? Or the money?
If you can swing going for acupuncture this time of year, more power to you—regular acupuncture treatments are the best way to stay healthy and mentally balanced during high-stress times. But if you, like many people, are on a tighter schedule and budget for the coming month, we’ve got the next-best thing.

Top 10 Acupuncture Tips for Handling Holiday Stress

We asked acupuncturists from around the world to share one piece of acupuncture-inspired advice for reducing holiday stress. They had to be self-care tips that can be applied anytime, anywhere, and for free. Here are our 10 favorites:

Appreciate water


In acupuncture, each season has an associated natural element. Winter’s is water. As the holidays cue our wintery instincts, we can use water literally and metaphorically as a natural holiday de-stressor.
Acupuncturist Sara Szmodis of San Francisco recommends starting every day with a large glass of lukewarm water. Fill your favorite glass with water and drink it slowly, followed by taking some deep breaths into your abdomen. This morning ritual helps keep your body hydrated and relaxed at a time when more-than-usual amounts of alcohol and caffeine (both dehydrators) meet higher-than-usual stress levels.
Metaphorically, water serves as a model for coping with holiday stress. When stress starts to mount, close your eyes and imagine yourself as strong, yet fluid and flexible. You are easily able to adjust around whatever gets in your way.


Go with the flow (literally)


We hear this all the time. But from an acupuncture perspective this trite piece of de-stressing advice takes on a whole new meaning.
There is a famous Chinese medical saying: Bu tong ze tong, tong ze bu tong. This is roughly translated as, “If there is not free flow, there is pain. If there is free flow, there is no pain.” In other words, physical and emotional health are achieved when there is free flow throughout the channels of the body. Disease arises when the flow stops.
Portland, Oregon acupuncturist Alexis Goldstein says we can take this thinking and apply it to holiday stress. Things never go according to plan. Whether it’s to do with travel, food or gift-giving, Goldstein suggests trying to focus less on the details and more on your ability to flow through them. Keep flowing forward and you’ll have a less stressful holiday season.


Forget the ‘shoulds’

Acupuncture is centered around the notion that we are ever changing, evolving beings. Nothing is set in stone. There are no golden rules or absolute truths. When we fail to think of ourselves as the constant works-in-progress that we are, there’s a tendency to start imposing a lot of “shoulds” on ourselves.
I “should” invite my neighbor’s second cousin to dinner. I “should” spend at least $50 on a gift for my boss. I “should” have the house decorated by now. I “should” go to that party because the host sent me a card last year when my cat got neutered.
So many of us place undue expectations on ourselves, says New York City acupuncturist Po-Hong Yu. By making a real effort to stop the ‘shoulds,’ it frees you up to live without the pressure and guilt that has a tendency to increase this time of year. You’ll feel lighter and able to live more authentically.


Get out in nature

In acupuncture theory, humans are viewed as microcosms of the natural world that surrounds them. The natural elements are essential parts of all of us, and yet many of us fail to make time to commune with them, especially when the weather turns cold.
According to acupuncturist Annie Porter from Scottsdale, Arizona, taking just three minutes a day to notice the natural world around you can be a refreshing de-stressor amid the holiday madness. Porter recommends picking a piece of nature that inspires gratitude in you. It can be an old tree, a serene pond, or crystal white snow. Maybe it is just standing outside and feeling the solid earth under your feet, or the crisp wind against your face.
Getting out in nature at holiday time is not only a nice break but also a reminder of the magnificent gifts that surround us every day.


Strive for balance

Acupuncture is all about balance. The goal of treatment is to tonify (give to) areas of deficiency and reduce (take from) areas of excess. Delphine Baumer, an acupuncturist in Vancouver, British Columbia, reminds us that this principle applies to holiday gift giving and time management.
Think about time and money in terms of balance, says Baumer. If you find yourself with extra time in the coming weeks, offer help to those who don’t. If you’re really strapped for time, ask for help. With gifts, ask yourself what you can offer that will help others without hurting you. Gifts come in all forms and should feel good on the receiving and giving end.


Be like a mountain

In addition to balancing deficiencies and excesses, acupuncture focuses on balancing Yin and Yang. Yin-Yang theory assigns certain qualities to various aspects of our lives, depending on the context within which they reside.
Yin qualities are cold, dark, quiet, contracting, deficient, weak, delicate, soft-spoken, contemplative and introverted. Yang is hot, bright, loud, firm, expanding, excessive, robust, energetic and chatty.
In comparison to everyday life, the holidays are very Yang! They are high energy, fast moving, and filled with constant hustle and bustle. While fun, this can become stressful. It is important to infuse this time of year with Yin qualities so that we remain balanced, says New York City acupuncturist Nancy Byrne.
Byrne suggests a visual meditation where you imagine yourself as a mountain. A mountain is the ultimate Yin, says Byrne—solid, rooted and still, despite the winds swirling around it. When the whirlwind of the holidays seems to engulf you, take a moment to think of yourself as a mountain. This will help you find inner calm despite the frenzy happening around you.


Find middle ground

By encouraging balance—of Yin and Yang, and excess and deficiency—acupuncture teaches us to find middle ground and appreciate moderation. It becomes a metaphor for not over or under doing it in life.
Holidays generally involve a lot of over doing it—too much food, too many drinks, too much spending, too many late nights, too much stress. It happens, but it shouldn’t be used as an excuse for going to extremes in the other direction.
Los Angeles acupuncturist Laura Drago cautions against throwing off your regular routines because of a holiday slip. For example, don’t skip breakfast and try to burn 1,000 calories in a workout because you ate too much at the holiday party the night before. Extreme taxation on your body in either direction will throw things into further imbalance, says Drago. If you have a wild night, take a day to let your body recover and naturally regain its strength. (It might be a good time to try some acupressure for hangover.)


Rub your ears

The ear in acupuncture is a microcosm of the whole body, so ear points are used to address conditions that involve multiple systems. Since stress can wreak havoc throughout the entire body, treating the ears is an effective and efficient counter measure.
Rubbing your ears is a great stress-reduction tool, says San Francisco acupuncturist Eric Kerr. Use your thumb and index finger to apply acupressure to the whole ear, moving from the top of the ear down to the earlobes. You can do this simultaneously on both sides. Kerr demonstrates the technique in this video.


Brush your teeth with purpose

Acupuncture teaches us to tune into the ordinary. It heightens our awareness by requiring us to pay attention to subtle shifts. This is something we can practice on our own, by being more mindful in our daily routines. When we are more present in each moment, we aren’t bogged down by the various holiday stressors that surround us.
To practice this, Jorunn Krokeide, an acupuncturist in Oslo, Norway, suggests picking one seemingly mundane task—brushing your teeth, doing the dishes, taking out the garbage. Do this task with utmost presence. If it’s brushing your teeth, notice the way the brush feels in your hand, how the toothpaste lathers inside your mouth, the sounds of the brush against your teeth.
Presence and mindfulness are not about over thinking, but rather, letting go so that your heart and mind are free to truly experience the joys of the holiday season.


Remember your power

Acupuncture reminds us of our innate power. The driving idea behind acupuncture is that we already have everything we need to be well. We hold the power to heal ourselves. Philadelphia acupuncturist David Schiman says this idea can help us cope with holiday stress.
When you feel stress piling up, says Schiman, take a moment to ask yourself some questions: How am I handling myself? And when I look back on this in 10 years, am I acting like the kind of person I want to see? Schiman recommends reflecting on your answer and then striving to act consistently with your ideal self-image.
There is a tendency during stressful times to feel powerless, but you do have power over how you react to life and to holiday stress. So, who do you want to be?

Happy holidays from AcuTake!

Photo by Sara Calabro