Introduction
Constipation is a common condition that affects people of all ages. It can mean that you are not passing stools (poo) regularly, or you are unable to completely empty your bowels.
Constipation can also cause your stools to be hard, lumpy, large or small.
The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a chronic (long-term) condition that causes significant pain and discomfort and affects quality of life.
Read more information about the symptoms of constipation.
What causes constipation?
It's often difficult to identify the cause. However, there are a number of things that increase the risk of constipation, including:
Not eating enough fibre, such as fruit, vegetables and cereals
A change in your routine or lifestyle, such as a change in your eating habits
Ignoring the urge to pass stools
Side effects of certain medication
Not drinking enough fluids
Anxiety or Depression
In children, poor diet, fear about using the toilet and poor toilet training can all be responsible.
Should I see Dr. B C Shah?
You may be able to help treat constipation yourself by making simple changes to your diet and lifestyle. If these changes do not help, see Dr. B C Shah.
You should also speak to Dr. B C Shah is you suspect your child might be constipated.
Treating constipation
An oral laxative (medication to help you empty your bowels) is usually prescribed to treat constipation.
Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established.
Preventing constipation
Making diet and lifestyle changes, such as eating high-fibre foods, drinking plenty of fluids and regularly exercising will help to prevent or ease your constipation.
It may also help to give yourself enough time and privacy to pass stools comfortably and never ignore the urge to go to the toilet.
Complications
For most people constipation rarely causes any complications, but people with long-term constipation can develop:
Haemorrhoids (piles)
Faecal impaction (where dry, hard stools collect in the rectum)
Faecal incontinence (the leakage of liquid stools)
Who is affected?
Constipation can occur in babies, children and adults, and affects twice as many women as men.
Older people are five times more likely than younger adults to have constipation, usually because of diet, lack of exercise, use of medication and poor bowel habits.
Approximately 40% of pregnant women experience constipation during their pregnancy.
Symptoms of constipation
When you are constipated, passing stools becomes more difficult than it used to be.
Normal bowel habits vary from person to person. For example, some adults normally go to the toilet more than once a day, whereas it's normal for others to go only every three or four days. Some infants pass stools several times a day, while others pass stools only a few times a week.
Difficulty passing stools
Passing stools may feel more difficult for several reasons. For example, you may be going significantly less frequently or much less effectively (you feel you are unable to completely empty your bowel).
Passing stools may also seem more difficult because your stools are:
Dry, hard and lumpy
Abnormally large
Abnormally small
As well as causing a change in your normal bowel habits, constipation can also cause the following symptoms:
Stomach ache and cramps
Feeling bloated
Feeling nauseous
Loss of appetite
Constipation in children
As well as infrequent or irregular bowel movements, a child with constipation may also have the following signs and symptoms:
Loss of appetite
Lack of energy
Being irritable, angry or unhappy
Foul-smelling wind and stools
Abdominal pain and discomfort
Soiling their clothes
Generally feeling unwell
If your child has these symptoms or has spoken to you about having difficulty passing stools, speak to Dr. B C Shah.
Causes of constipation
Most cases of constipation are not caused by a specific condition and it may be difficult to identify the exact cause.
However, several factors can increase your chances of having constipation, including:
Not eating enough fibre, such as fruit, vegetables and cereals
A change in your routine or lifestyle, such as a change in your eating habits
Having limited privacy when using the toilet
Ignoring the urge to pass stools
Immobility or lack of exercise
Not drinking enough fluids
Being underweight or overweight
Anxiety or depression
Psychiatric problems, such as those brought on by sexual abuse, violence or trauma
Medication
Sometimes, constipation may be a side effect of a medicine that you are taking. Common types of medication that can cause constipation include:
Aluminium antacids (medicine to treat indigestion)
Antidepressants
Antiepileptics (medicine to treat epilepsy)
Antipsychotics (medicine to treat schizophrenia and other mental health conditions)
Calcium supplements
Codeine, found in some types of painkiller
Diuretics (water tablets)
Iron supplements
If your constipation is caused by medication, the condition usually eases once you stop taking the medicine. However, under no circumstances should you stop taking your medication unless Dr. B C Shah advises you to.
Speak to Dr. B C Shah if you experience constipation due to a medicine. He may be able to prescribe an alternative.
Pregnancy
About 40% of women experience some form of constipation during their pregnancy, mostly during the early stages of their pregnancy.
Constipation occurs during pregnancy because your body produces more of the female hormone progesterone which acts as a muscle relaxant.
Your bowel normally moves stools and waste products along to the anus by a process known as peristalsis. This is when the muscles that line the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along.
If you are pregnant, there are ways that you can safely treat constipation without harming you or your baby.
Other conditions
In rare cases, constipation can be a sign of an underlying condition, such as:
Colon or rectal cancer
Diabetes
Hypercalcaemia, when there is too much calcium in the bloodstream
Underactive thyroid
Muscular dystrophy, a genetic condition that causes muscle wasting
Multiple sclerosis, a condition that affects the nervous system
Parkinson's disease, a brain condition that affects the co-ordination of body movements
Spinal cord injury
Anal fissure, a small tear of the skin just inside the anus
Inflammatory bowel disease, a condition that causes the intestines to become inflamed (irritated and swollen)
Irritable bowel syndrome (IBS)
Babies and children
Constipation in babies and children is quite common. A Poor diet, fear about using the toilet and poor toilet training can all be responsible.
Poor diet
Children who are over-fed are more likely to have constipation, as are those who do not get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, it is very important that your child has enough fibre in their diet.
Toilet training
Make sure that you do not make your child feel stressed or pressured about using the toilet. It is also important to let your children try things by themselves (when appropriate). Constantly intervening when they are using the toilet may make them feel anxious.
Toilet habits
Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel that they are unable to use the toilets at school.
This fear or phobia may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them for fear of experiencing pain and discomfort. However, this will mean that their condition only worsens.
Other conditions
In rare cases, constipation in babies and children can be a sign of an underlying condition such as:
Hirschsprung's disease, which affects the bowel, making it difficult to pass stools
Anorectal malformation, where the baby's anus and rectum do not form properly
Spinal cord abnormalities, including rare conditions such as spina bifida and cerebral palsy
Cystic fibrosis, a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation
Diagnosing constipation
Constipation is a very common condition. Dr. B C Shah will not usually need to carry out any tests or procedures, but will confirm a diagnosis of constipation based on your medical history and your symptoms.
Dr. B C Shah will ask you some questions about your bowel habits. Do not feel embarrassed about describing your bowel pattern and stools to him. It is important that Dr. B C Shah is aware of all of your symptoms so he can make the correct diagnosis.
Dr. B C Shah may also ask questions about your diet, level of exercise and whether there have been any recent changes in your routines.
Doctors define constipation in a number of ways:
Opening the bowels less than three times a week
Needing to strain to open your bowels on more than a quarter of occasions
Passing a hard or pellet-like stool on more than a quarter of occasions
Physical examination
If Dr. B C Shah suspects that you may have faecal impaction (when dry, hard stools collect in your rectum), he may carry out a physical examination.
A typical examination will begin with you lying on your back while Dr. B C Shah feels your abdomen. You will then lie on your side while Dr. B C Shah performs a rectal examination using a lubricated, gloved finger. He can feel for any stools that may have collected.
Dr. B C Shah will rarely have to conduct an internal physical examination on a child. Instead, the diagnosis can normally be made by feeling their abdomen (tummy).
Further tests
If you are experiencing severe symptoms, your doctor may request further tests, such as blood tests or thyroid tests, to diagnose or rule out other conditions.
As there is an increased risk of colorectal cancer in older adults, Dr. B C Shah may also request tests to rule out a diagnosis of cancer, including a barium enema or colonoscopy.
Treating constipation
Treatment for constipation depends on the cause, how long you have had the condition and how severe your symptoms are. In many cases it is possible to relieve symptoms through dietary and lifestyle changes.
This section covers the following:
Lifestyle advice
Laxatives
Treating faecal impaction
Pregnancy or breastfeeding
Babies who have not yet been weaned
Babies who are eating solids
Children
Lifestyle advice
Dr. B C Shah will first advise you about how you can change your diet and lifestyle, which may mean that your constipation passes without the use of medication.
Some ways you can help treat your constipation are listed below.
Increase your daily intake of fibre. You should eat at least 18-30g of fibre a day. High-fibre foods include fruit, vegetables and cereals.
Add some bulking agents, such as wheat bran, to your diet. These will help make your stools softer and easier to pass.
Avoid dehydration by drinking plenty of water.
Get more exercise by going for a daily walk or run.
If your constipation is causing pain or discomfort, you may want to take a painkiller such as paracetamol. Make sure you always follow the dosage instructions carefully. Children under 16 years of age should not take aspirin.
Identify a routine of a place and a time of day when you are comfortably able to spend time in the toilet. Respond to your bowel's natural pattern: when you feel the urge, do not delay.
If these diet and lifestyle changes do not help, Dr. B C Shah may prescribe an oral laxative.
Laxatives
Laxatives are a type of medicine that help you pass stools. There are several different types and each one has a different effect on your digestive system.
Bulk-forming laxatives
Dr. B C Shah will normally start you on a bulk-forming laxative. These laxatives work by helping your stools to retain fluid. This means they are less likely to dry out, which can lead to faecal impaction. Bulk-forming laxatives also make your stools denser and softer, which means they should be easier to pass.
Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids. Also, do not take them before going to bed. It will usually be two to three days before you feel the effects of a bulk-forming laxative.
Osmotic laxatives
If your stools remain hard after you have taken a bulk-forming laxative, Dr. B C Shah may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. This helps to stimulate your body to pass stools and also softens stools.
Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be two to three days before you feel the effect of the laxative.
Stimulant laxatives
If your stools are soft but you still have difficulty passing them,Dr. B C Shah may prescribe a stimulant laxative. This laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus.
The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they will usually start to work within 6 to 12 hours.
According to your individual preference and the speed with which you require relief, Dr. B C Shah may decide to combine different laxatives.
How long will I take laxatives for?
If you have only experienced constipation for a short time, Dr. B C Shah will normally advise you to stop taking the laxative once your stools are soft and easily passed.
However, if you have constipation due to a medicine or an underlying medical condition, you may have to take laxatives for much longer, possibly many months or even years.
If you have been taking laxatives for some time, you may have to gradually reduce your dose rather than coming off them straight away. If you have been prescribed a combination of laxatives, you will normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months.
Dr. B C Shah will advise you when it is best to stop taking them.
Treating faecal impaction
Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.
If you have faecal impaction, you will initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using this laxative, you may also have to start taking a stimulant laxative.
If you do not respond to these laxatives, you may need one of the medications described below.
Suppository: this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl and glycerol are two medicines that can be given in suppository form.
Mini enema: this is when a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.
Pregnancy or breastfeeding
If you are pregnant, there are ways for you to safely treat constipation without harming you or your baby. Dr. B C Shah will first advise you to change your diet by increasing fibre and fluid intake. You will also be advised to do gentle exercise.
If dietary and lifestyle changes do not work, you may be prescribed a laxative to help you pass stools more regularly.
Lots of laxatives are safe for pregnant women to use because most are not absorbed by the digestive system. This means that your baby will not feel the effects of the laxative.
Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these do not work, Dr. B C Shah may advise a small dose of bisacodyl or senna (stimulant laxatives).
However, senna may not be suitable if you are in your third trimester of pregnancy (27 weeks to birth) because this medicine is partially absorbed by your digestive system.
Babies who have not yet been weaned
If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make the formula as directed by the manufacturer and do not dilute the mixture.
You may want to try gently moving your baby's legs in a bicycling motion or carefully massaging their abdomen (tummy) to help stimulate their bowels.
Babies who are eating solids
If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pureed or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:
Apples
Apricots
Grapes
Peaches
Pears
Plums
Prunes
Raspberries
Strawberries
Never force your baby to eat food if they do not want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience.
If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives are not suitable for babies, so they will usually be given an osmotic laxative. However, if this does not work, they can be prescribed a stimulant laxative.
Children
As with babies and adults, children with constipation will first be advised to change their diet. If this does not work, laxatives can be prescribed, usually an osmotic laxative followed, if necessary, by a stimulant laxative.
As well as eating fruit, older children should have a well-balanced diet, which also contains vegetables and wholegrain foods such as wholemeal bread and pasta.
Try to minimise stress or conflict associated with using the toilet or meal times. It is important to be positive and encouraging when it comes to establishing a toilet routine. Your child should be allowed at least 10 minutes on the toilet to make sure they have passed as many stools as possible.
To encourage a positive toilet routine, try making a diary of your child's bowel movements linked to a reward system. This can help them focus on using the toilet successfully.
Top tips for parents



A diet rich in fibre and with plenty of fluids will help, even if your child is being treated with laxatives.
Children with chronic (long-term) constipation do not normally have anything physically wrong with them. However, it can take time to correct the problem, so be patient.
Encourage your child to have a regular toilet habit and allow them plenty of time.
A reward chart for passing a stool can be useful if your child tends to ‘hold on’.
Complications with constipation
Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if it is started promptly.
However, if you have chronic (long-term) constipation, you may be more at risk of experiencing complications.
Haemorrhoids
If you continually strain to pass stools, it can cause pain, discomfort and bleeding. Excessive straining can also lead to haemorrhoids (piles). Haemorrhoids are swollen blood vessels that form in the lower rectum and anus.
Haemorrhoids can cause:
itching around the anus
swelling of the anus
pain
bleeding from the anus
Faecal impaction
Chronic constipation can increase the risk of faecal impaction (where dried, hard stools collect in your rectum and anus). Once you have faecal impaction, it is very unlikely that you will be able to get rid of the stools naturally.
Faecal impaction worsens constipation because it makes it harder for stools and waste products to pass out of your anus as the path is obstructed.
If you experience faecal impaction, it can lead to a number of other complications. These include:
Swelling of the rectum
Losing sensation in and around your anus
Faecal incontinence, when you uncontrollably leak soft or liquid stools
Bleeding from your anus
Rectal prolapse, when part of your lower intestine falls out of place and protrudes from your anus
Psychological effects
If your child experiences faecal incontinence, it may affect them psychologically.
Faecal incontinence can be very upsetting and embarrassing for children. If they are at school, they may find themselves teased or socially excluded. This can make a child feel withdrawn, alone and unable to talk about what they are experiencing.
If you notice a change in your child's behaviour, talk openly and honestly with them and encourage them to tell you how they are feeling.
Also try to speak to your child's teacher to make sure they understand the situation. The teacher can help ensure your child is not upset or left feeling excluded by other children.
Preventing constipation
Although constipation is common, you can take several steps to prevent it, including making diet and lifestyle changes.
Fibre
Make sure you have enough fibre in your diet. Most adults do not eat enough fibre. You should have approximately 18g of fibre a day. You can increase your fibre intake by eating more:
Fruit
Vegetables
Wholegrain rice
Wholewheat pasta
Wholemeal bread
Seeds
Nuts
Oats
Eating more fibre will keep your bowel movements regular because it helps food pass through your digestive system more easily. Foods high in fibre also make you feel fuller for longer.
If you are increasing your fibre intake, it is important to increase it gradually. A sudden increase may make you feel bloated. You may also produce more flatulence (wind) and have stomach cramps.
Fluids
Make sure that you drink plenty of fluids to avoid dehydration and steadily increase your intake when you are exercising or when it is hot. Try to cut back on the amount of caffeine, alcohol and fizzy drinks that you consume.
Toilet habits
Never ignore the urge to go to the toilet. Ignoring the urge can significantly increase your chances of having constipation. The best time for you to pass stools is first thing in the morning, or about 30 minutes after a meal.
When you use the toilet, make sure you have enough time and privacy to pass stools comfortably.
Exercise
Keeping mobile and active will greatly reduce your risk of getting constipation. Ideally, do at least 150 minutes of physical activity every week.
Not only will regular exercise reduce your risk of becoming constipated, but it will also leave you feeling healthier and improve your mood, energy levels and general fitness.

Glucosamine in Osteoarthritis and other Food Supplements

Introduction

Osteoarthritis (OA) is the commonest form of arthritis found worldwide that can affect the hands, hips, shoulders and knees. It is responsible for the largest burden of joint pain and is the single most important rheumatological cause of disability and handicap.1,2 In Osteoarthritis, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. Drug and non-drug treatments are used to relieve pain and/or swelling. Osteoarthritis commonly affects the hands, feet, spine and large weight-bearing joints, such as the hips and knees. Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis. These are food supplements show promise for helping people with osteoarthritis, those are Glucosamine sulphate, Chondroitin sulphate, SAMe (s-adenosylmethionine), Vitamin C ( ascorbic acid), Beta Carotene3 and many more.
Glucosamine
Glucosamine is almost synonymous with osteoarthritis as it has benefits for osteoarthritis. It can be found naturally in the body and is used by the body as one of the building blocks of cartilage.Glucosamine is an amino sugar produced from the shells of shellfish (chitin) and it is a key component of cartilage. Glucosamine (C6H13NO5) is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. Glucosamine is part of the structure of the polysaccharides chitosan and chitin, which compose the exoskeletons of crustaceans and other arthropods, cell walls in fungi and many higher organisms, glucosamine is one of the most abundant monosaccharides.3
Glucosamine is necessary for the construction of connective tissue and healthy cartilage. It is the critical building block of proteoglycans and other substances that form protective tissues. These proteoglycans are large protein molecules that act like a sponge to hold water giving connective tissues elasticity and cushioning effects. This also provides a buffering action to help protect against excessive wear and tear of the joints. Without glucosamine, our tendons, ligaments, skin, nails, bones, mucous membranes, and other body tissues can not form properly.

Glucosamine works to stimulate joint function and repair. Everyone produces a certain amount of glucosamine within their bodies. Normally we generate sufficient amounts of glucosamine in our bodies to form the various compounds needed to generate connective tissue and healthy cartilage. But gradually the rate at which our bodies use glucosamine begins to gradually change with our increased athletic activity, injuries, burns, arthritis and other inflammatory disorders, age and other chronic degeneration.3 In such situations our bodies may not be able to keep up with the demand for glucosamine, leading to a decrease in the amount of proteoglycans produced. This can lead to a decrease in the amount of protective lubricating substances like the synovial fluids, which cushion our joints, and protects them from damage. In a nutshell, more glucosamine is needed but less is produced.
As the age advances, body loses the capacity to make enough glucosamine. Having ample glucosamine in the body is essential to producing the nutrients needed to stimulate the production of synovial fluid, the fluid which lubricates cartilage and keeps the joints healthy. Without enough glucosamine, the cartilage in weight-bearing joints, such as the hips, knees, and hands deteriorates. The cartilage then hardens and forms bone spurs, deformed joints, and limited joint movement. This is how the debilitating disease of osteoarthritis develops.4
Therefore, in short, glucosamine is a major building block of proteoglycans needed to make glycosaminoglycans, proteins that bind water in the cartilage matrix which also acts as a source of nutrients for the synthesis of proteoglycans and glycosaminoglycans. It is also a stimulant to chondrocytes and playing key factor in determining how many proteoglycans are produced by the chondrocytes needed to spur chondrocytes to produce more collagen and proteoglycans acts as a regulator of cartilage metabolism which helps to keep cartilage from breaking down. 5
Glucosamine is the supplement most commonly used by patients with osteoarthritis. It is an endogenous amino sugar that is required for synthesis of glycoproteins and glycosaminoglycans, which are found in synovial fluid, ligaments, and other joint structures. Exogenous glucosamine is derived from marine exoskeletons or produced synthetically.

Exogenous glucosamine may have anti-inflammatory effects and is thought to stimulate metabolism of chondrocytes.
Glucosamine is available in multiple forms. The most common are glucosamine hydrochloride and glucosamine sulfate. Some products contain a blend of these, and many combine one of the forms with a variety of other ingredients. Glucosamine has been safely used in long-term clinical trials Overall, the evidence supports the use of glucosamine sulfate for modestly reducing osteoarthritis symptoms and possibly slowing disease progression.
Chondroitin
Chondroitin, an endogenous glycosaminoglycan, is a building block for the formation of the joint matrix structure. Chondroitin sulfate is a sulfated glycosaminoglycan (GAG) composed of a chain of alternating sugars (N-acetylgalactosamine and glucuronic acid). It is usually found attached to proteins as part of a proteoglycan.6 Chondroitin sulfate is an important structural component of cartilage and provides much of its resistance to compression. Along with glucosamine, chondroitin sulfate has become a widely used dietary supplement for treatment of osteoarthritis. Chondroitin is a molecule that occurs naturally in the body. It is a major component of cartilage,the tough, connective tissue that cushions the joints. Chondroitin helps to keep cartilage healthy by absorbing fluid (particularly water) into the connective tissue. It may also block enzymes that break down cartilage, and it provides the building blocks for the body to produce new cartilage.
Chondroitin sulphate Chondroitin is the most abundant glycosaminoglycan in cartilage and is responsible for the resiliency of cartilage and it has various effects in relieving symptoms of osteoarthritis and those are its anti-inflammatory activity, the stimulation of the synthesis of proteoglycans and hyaluronic acid, and the decrease in catabolic activity of chondrocytes inhibiting the synthesis of proteolytic enzymes, nitric oxide, and other substances that contribute to damage cartilage matrix and cause death of articular chondrocytes. chondroitin sulfate reduced the IL-1β-induced nuclear factor-kB (Nf-kB) translocation in chondrocytes. In addition, chondroitin sulfate has recently shown a positive effect on osteoarthritic structural changes occurred in the subchondral bone.7 A number of scientific studies suggest that chondroitin may be an effective treatment for osteoarthritis
Therefore, overall effects of chondroitin sulphate are; reduces osteoarthritis pain, improves functional status of people with hip or knee osteoarthritis, reduces joint swelling and stiffness and ultimately provides relief from osteoarthritis symptoms for up to 3 months after treatment is stopped
S-Adenosyl methionine
S-Adenosyl methionine (SAM, SAMe, SAM-e) is a dietary supplement that has been clinically shown to support and promote joint health, mobility and joint comfort.It is a compound produced by our bodies from methionine. Methionine is an amino acid found in protein-rich foods and a common co-substrate involved in methyl group transfers. SAM-e is critical in the manufacture of joint cartilage and in the maintenance of neural cell membrane function.8
Administration of SAMe exerts analgesic and antiphlogistic activities and stimulates the synthesis of proteoglycans by articular chondrocytes with minimal or absent side effects on the gastrointestinal tract and other organs and improving pain and stiffness related to osteoarthritis
Vitamin C( ascorbic acid)

Vitamin C( ascorbic acid) may help reduce the progression of osteoarthritis. Vitamin C is involved in the formation of both collagen and proteoglycans (two major components of cartilage, which cushions the joints). Vitamin C is also a powerful antioxidant that helps to counteract the effects of free radicals in the body, which can damage cartilage. Ascorbic acid(vitamin c) is a sugar acid with antioxidant properties. Its appearance is white to light-yellow crystals or powder, and it is water-soluble. One form of ascorbic acid is commonly known as vitamin C. In human plasma, ascorbate is the only antioxidant that can completely protect lipids from detectable peroxidative damage induced by aqueous peroxyl radicals. Ascorbate appears to trap virtually all peroxyl radicals in the aqueous phase before they diffuse into the plasma lipids. Ascorbate is a highly effective antioxidant, as it not only completely protects lipids from detectable peroxidative damage, but also spares alpha-tocopherol, urate, and bilirubin.Ascorbic acid stimulates collagen synthesis and modestly stimulates synthesis of aggrecan (a proteoglycan present in articular cartilage), Sulfated proteoglycan biosynthesis is significantly increased in the presence of ascorbic acid thus it may offer some protective effect against the super oxide and free radicals and limiting and delaying the osteoarthritis progression

Beta-carotene
. Beta-carotene belongs to a family of natural chemicals known as carotenoids. Widely found in plants, carotenoids along with another group of chemicals, bioflavonoids, give color to fruits, vegetables, and other plants.
Beta-carotene is another antioxidant that also seems to help reduce the risk of osteoarthritis progression. Beta-carotene is a particularly important carotenoid from a nutritional standpoint, because the body easily transforms it to vitamin A. While vitamin A supplements themselves can be toxic when taken to excess, it is believed (although not proven) that the body will make only as much vitamin A out of beta-carotene as it needs. Assuming this is true, this built-in safety feature makes beta-carotene the best way to get your vitamin A. A high dietary intake of beta-carotene is associated with a significantly slower progression of osteoarthritis, according to a study in which researchers followed 640 individuals over a period of 8 to 10 years .10
Conclusion
In conclusion,there are nutrients and foods that may help to halt the progression osteoarthritis before it becomes severe as well as helping to reduce the pain and inflammation associated with it.














REFERENCES

1) Clinical Practise Guidelines. Management of Osteoarthritis http://www.msr.org.my/html/Bookleta.pdf accessed on 13 February 2010
2) Cochrane Library. Glucosamine Therapy for Treating Osteoarthritis http://www.cochrane.org/reviews/en/ab002946.html accessed on 13 February 2010
3) Spark People Life. Dietary Supplement for Osteoarthritis
http://www.sparkpeople.com/resource/nutrition_articles.asp?id=865 accessed on
14 February
4) Horton D, Wander JD (1980). The Carbohydrates. Vol IB. New York: Academic
Press. pp. 727–728.
5) Glucosamine and Osteoarthritis,How it works
http://www.arthritis-glucosamine.net/glucosamine-osteoarthritis.php accessed on
14 February 2010
6) Jamie G. Barnhill, Carol L. Fye, David W. Williams, Domenic J. Reda, Crystal L. Harris, and Daniel O. Clegg. Chondroitin Product Selection for the Glucosamine/Chondroitin Arthritis Intervention Trial. J Am Pharm Assoc. 2008; 46:14–24.
7) Davidson EA, Meyer K (2007). "Chondroitin, a mucopolysaccharide". J Biol Chem 211 (2): 605–11.
8) S-adenosyl methionine [SAMe]. Research Reports http://www.oralchelation.com/technical/SAM.htm accessed on 15 February 2010
9) McAlindon TE, Jacques P, Zhang Y, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996;39:648-656.
10) iHerb. Com. Beta Carotene http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21547 accessed on 16 February 2010

Our bodies are designed to be used, not to be abused! What do I mean by use and abuse?
A simple way would be to look at our body, see how it moves, how it is shaped. It is designed for an incredible variety of movements, from delicate, hair splitting surgery to harsh grinding mountain climbing.
Our bodies are meant to be used, while we are alive!
What is abuse?
Any use of the body which results in harm, either to self or others, would be one way of looking at it.
The more common way we abuse our bodies is by not using it at all!
We love comfort and pleasure, so would rather use the elevator or lift rather than our legs.

Eating a Balanced Diet:

• Diet plays a major role in keeping you healthy.
• Avoid eating fatty, fried and high calorie food.
• Carry home cooked food for lunch.
• This helps you in avoiding many illnesses and maintaining optimal weight.

Exercising Daily:

• Fitness tips for men include exercising regularly up to four times in a week for an hour to help improve the overall condition.
• A good fitness regime can prevent the incidence of back injury, and in the longer run lower the risk of osteoporosis.
• Thus resulting in a health living.
• Simple activities like jogging, swimming, bicycling, etc. can all help to improve muscle strength and tone the body.

Stop Smoking and consuming Alcohol:

• It would be best to avoid both alcohol and smoking as they were proved as harmful elements.
• You have to get rid of them if you cannot, then do it in moderation.
• Because smoking increases the risk of cancer, drinking on the other hand could spill out of control and turn you into an alcoholic, and simple ruin your health, professional and personal life

Maintain Personal Hygiene:

• Have bath twice in a day once in morning and then returning from work.
• It helps you stay away from illness and enjoy a healthy life.
• Regularly shave your underarm and pubic hairs.

Have a Healthy Sexual Life:

• Sex is a very good stress buster.
• A healthy sexual life helps you relax and keeps you energized.

Compartmentalize Work and Family Life:

• Do not get work tension at home and vice versa.
• It not only disrupts your life but also life of people around you.
• Mixing up work and family life creates lot of stress and confusion leaving you dissatisfied in both the areas life.

Spend Time with Family:

• Make a point to strengthen ties with your family and friends.
• Volunteer work, religious ties, even pets–anything that keeps you involved with others–reduces stress and enhances health.
• You family needs you more than your work.

Don’t Ignore ill Health and Symptoms:

• Whenever ill immediately meet the doctor making a delay might cost you a high price.
• Precaution is always better than cure.

Sleep:

• Having a sound sleep keeps you healthy, happy and refreshed.
• It gives you energy for a long day.

Limit work stress:

• It’s been proven that chronic stress harms the body.
• Tension elevates the blood pressure and makes the blood thicker.
• Although we don’t want to endorse a lazy lifestyle, too much stress can hurt your body organs like the heart, brain, and stomach.
• Take it easy sometimes.

Get an Annual Health Checkup done:

• This is a must as it helps you in knowing if you are suffering from any illness well in advance so that you can fight it easily.
• Males are more prone to have prostate cancer, high blood pressure, cardiac illness and liver disorders.

If you’re feeling sluggish, then your body is most likely signalling an overload! Detox your body and feel light once again!

Include high-fibre fruits and veggies in your diet to aid toxin removal
Skin problems, digestive problems, pains and aches could all mean that you have accumulated toxins in your body. In that case, a good detox programme is all you need to get back on track.
Body detoxification has been in practice for centuries across many cultures around the world, including Ayurvedic, Tibetan and Chinese medicine systems advocating it. By flushing out toxins from your body and feeding it healthy nutrients – detoxification – you can boost your immunity, aid weight loss, and ease digestive problems and skin ailments.
What is detoxification?
The body eliminates toxins through the liver, kidneys, lymph, lungs, kidneys and skin. Our diet, lifestyle and many other factors can clog the system, preventing it from filtering out toxins, thereby effecting body function. Detoxification means cleaning the body from inside. It mainly involves clearing impurities from the blood. It boosts liver function, thereby eliminating impurities from the blood. It also enables more efficient toxin filtration in other organs.
A detox programme aids the body’s cleaning process by:
• Giving body organs rest through fasting
• Boosting liver function to drive toxins out of the body
• Stimulating toxin removal in other organs like intestines, kidneys and skin
• Improving blood circulation
• Body regeneration through intake of healthy nutrients.
When to detoxify?
Experts recommend detoxification at least once a year for all adults. There is a heavy load of toxins in the environment today; therefore experts recommend detoxification at least once a year. A whole system cleanse is good for everyone. However, pregnant women, nursing mothers, kids and those suffering from serious diseases like cancer and tuberculosis are advised against it.
Some symptoms that could suggest you could use a detoxification programme include:
• Fatigue
• Irritated or tired skin
• Allergies and frequent infections
• Menstrual difficulties
• Digestive problems
• Mental confusion
A simple detoxification programme:
• Start with food: Eat plenty of fibre. Substitue white rice with unpolished rice or brown rice; include fresh fruits and veggies in your diet (if you can source organically-grown varieties, even better!). Radish, cabbage, spirulina are known to be good detoxifying foods — include them in your diet.
• Reap benefits from green tea: Green tea is known to be an excellent cleanser. Sip on at least 4 cups of green tea a day. It will help flush out toxins from the liver and give you better health.
• Vitamin-C please: Take vitamin-C everyday. It helps the body produce glutathione, a liver compound that eliminates toxins. Squeese half a lime in hot water and drink first thing in the morning.
• Adam’s ale: Drink at least 2 litres of water a day, there is nothing better than H2O to clean your system.
• Stop and breathe: Breathe deeply and slowly, allowing the blood to absorb more oxygen and circulate in your body. Consiciously breathe throughout the day. Rf that seems too much, at least do some breathing exercises on rising and before going to bed.
• Stress relief: Meditation, visualisation, talking to friends — do whatever you need to release stress.
• Exercise: Choose from dance, yoga, cardio or jump the rope. Exercise is a key aspect of detox programme. Try Qigong, a martial-arts based exercise system that includes exercises specifically for detoxifying or cleansing. This is now becoming popular in Indian cities like Bangalore. Check your city listing to see if they offer this style of exercise.
• Water therapy: While taking a shower, alternate between hot and cold water. Take a hot shower for 5 minutes, allowing the water to run on your back, follow with cold water for 30 seconds. Do this 3 times, and then rest your body for 30 minutes before you head out (So best done before going to bed at night).
• Sweat it out: Allow your body to sweat. Perspiration helps eliminate toxins. Sit in sauna room.
• Brush it: Dry-brush your skin with a loofah or soft-bristled brush to remove toxins through pores. Add salt in your bath — it can go a long way in cleansing your body and mind. Make sure you shower after the salt bath.