April 19, 2018 at 3:06 pm #859Joanna KeoghParticipant
My client presented with seronegative inflammatory arthritis and enlarged prostate (plus degenerative disease of the neck).
The consultant had already prescribed Sulfasalazine, Omeprazole and Naproxen, and Dutasteride (for prostate).
I initially recommended an anti-inflammatory diet, which he has tried to stick to for the past 3 months (not completely as he finds it hard and was initially very reluctant to make too many changes to his diet).
His arthritis symptoms have improved and he reported that he is not troubled by them much anymore. However, I am presuming this is due to the effects of the Sulfasalazine, which can take a few months to take full effect (started in November 2017). His prostate symptoms have worsened over the past few months and his urologist also diagnosed a loss of bladder wall elasticity. He is now on the waiting list to have a prostate gland bore operation.
An OAT done in February 2018 revealed a very significant fungal/yeast overgrowth and I advised Caprin and Oregano Complex to address this (starting slowly and working up to dose of 3/day), plus liposomal glutathione, magnesium and biotin to support detoxification and to minimise die off symptoms. I could not add in any stronger anti-fungals or enzymes due to contraindications with his medications.
He has not experienced any side effects at all from the anti-fungal protocol (after 4 weeks) and I’m not sure where to go next. The sulfasalazine will be compromising his immune response, and I’m therefore not sure of the best protocol to use to try and tackle the overgrowth. And the Omeprazole will not be helping either but he has been told he needs to stay on both.
Any help and advice as to how I should proceed with this case would be gratefully received. Thank you.
Posted by Joanna Keogh 19.04.18
March 5, 2019 at 3:08 pm #860Christine BaileyModerator
Many thanks for your question regarding your client with an enlarged prostate, urinary issues and previous inflammatory arthritic symptoms although negative to RA.
Sulfasalazine, sold under the trade name Azulfidine among others, is a medication used to treat rheumatoid arthritis, ulcerative colitis, and Crohn’s disease. It is often considered as a first line treatment in rheumatoid arthritis. As this medication depletes levels of folate it recommended that people take a supplement of folic acid. A side effect of this medication is also diarrhoea and in such cases, probiotics would be recommended.
Grindulis et al. Does sulphasalazine cause folate deficiency in rheumatoid arthritis? Scand J Rheumatol. 1985;14(3):265-70. https://tinyurl.com/ya44zfsk
Naproxen is a nonsteroidal anti-inflammatory drug of the propionic acid class that relieves pain, fever, swelling, and stiffness. It works as a COX inhibitor. As it can cause water retention it is normally recommended clients keep salt to a minimum.
Be mindful that certain medications can in turn cause damage and inflammation to the gut lining.
Hawkey et al. Less small-bowel injury with lumiracoxib compared with naproxen plus omeprazole. Clin Gastroenterol Hepatol. 2008 May;6(5):536-44. doi: 10.1016/j.cgh.2007.12.023. Epub 2008 Jan 31. https://tinyurl.com/y7bvm57g
Arrieta et al Alterations in intestinal permeability. Gut. 2006 Oct; 55(10): 1512–1520. https://tinyurl.com/ychasa3j
Various supplements such as quercetin and turmeric can be helpful in offering protection
Singh DP, Borse SP, Nivsarkar M. Overcoming the exacerbating effects of ranitidine on NSAID-induced small intestinal toxicity with quercetin: Providing a complete GI solution. Chem Biol Interact. 2017 Jun 25;272:53-64. https://tinyurl.com/ybess9ho
I am not sure why your client has been put on Omeprazole – has he Helicobacter or an ulcer? This can reduce absorption of certain nutrients and can promote bacterial dysbiosis.
Heidelbaugh corresponding author: Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications Ther Adv Drug Saf. 2013 Jun; 4(3): 125–133. https://tinyurl.com/y7kgjeda
If he is suffering with reflux then I would want to investigate the causes further – is it certain foods like caffeine, chilis, chocolate, citrus or an infection for example? Other factors such as eating patterns, not eating late at night etc should also be discussed. While I appreciate you have run an OAT test – you may wish to run a comprehensive stool test with parasitology and including Helicobacter pylori. This may help to decide whether it is appropriate to be including an anti-microbial programme at this stage.
You mention that his prostate symptoms have worsened. As men get older, the cells of the prostate begin to swell, which increases the size of the prostate. This is called benign prostatic hyperplasia (BPH), which means extra growth of normal (non-cancerous) cells. In some cases an operation is recommended – A TURP (trans-urethral resection of the prostate) is an operation to remove the parts of the prostate that are pressing on the urethra, to make it easier to pass urine. It involves a surgeon inserting a special tube down the urethra, through which a heated wire loop is passed. This wire loop is used to shave off the overgrown areas of the prostate.
However, you may wish to consider a supplement of Saw palmetto. Two large meta-analyses including more than 7,000 men from 38 studies showed that saw palmetto extracts produced significant improvements in the International Prostate Symptom Score, reductions in frequency of night-time urinations, and improvements in peak urine flow rates. Indeed, saw palmetto produced similar improvements in urinary symptoms and urinary flow compared to the drug finasteride, but with fewer adverse effects.
Based on all of these studies, a 2015 review article concluded that, while drug therapy might be most effective for moderate to severe benign prostatic hyperplasia, herbal medications including saw palmetto are useful for men with mild to moderate symptoms.
Allkanjari O, Vitalone A. What do we know about phytotherapy of benign prostatic hyperplasia? Life Sci. 2015;126:42-56. https://tinyurl.com/ybgy93z9
Boyle P, Robertson C, Lowe F, et al. Updated meta-analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU Int. 2004;93(6):751-6. https://tinyurl.com/yc9u3qtm
Suter A, Saller R, Riedi E, et al. Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Phytother Res. 2013;27(2):218-26. https://tinyurl.com/y7ugbf9b
There are other nutrients to also consider.
Pumpkin seed oil. Studies have shown that supplementation with pumpkin seed led to clinically relevant reductions in the International Prostate Symptom Scores compared with placebo after three to 12 months. One of these studies also showed that the combination of pumpkin seed oil and saw palmetto improved quality of life scores and showed 41.7% reduction on serum PSA levels at the end of the study when compared to baseline.
Vahlensieck W, Theurer C, Pfitzer E, et al. Effects of pumpkin seed in men with lower urinary tract symptoms due to benign prostatic hyperplasia in the one-year, randomized, placebo-controlled GRANU study. Urol Int. 2015;94(3):286-95. https://tinyurl.com/y953pzu9
Hong H, Kim CS, Maeng S. Effects of pumpkin seed oil and saw palmetto oil in Korean men with symptomatic benign prostatic hyperplasia. Nutr Res Pract. 2009;3(4):323-7. https://tinyurl.com/ycmv5bhy
Pollen extracts. A meta-analysis of 444 men demonstrated that rye grass pollen extract significantly improved self-rated urinary symptoms in men with benign prostatic hyperplasia. Men in this study were also more than twice as likely to report improvement in nocturnal urination compared with placebo, and no side effects were reported.
MacDonald R, Ishani A, Rutks I, et al. A systematic review of Cernilton for the treatment of benign prostatic hyperplasia. BJU Int. 2000;85(7):836-41. https://tinyurl.com/y9oyba2a
Flaxseed. Flaxseed is a rich source of dietary lignans. In the intestine, they are converted by bacteria into other bioactive compounds, particularly enterolactone. A human study on dietary flaxseed lignan extract demonstrated significant reductions in the International Prostate Symptom Scores and improvements in quality of life in men with benign prostatic hyperplasia.
Zhang W, Wang X, Liu Y, et al. Effects of dietary flaxseed lignan extract on symptoms of benign prostatic hyperplasia. J Med Food. 2008;11(2):207-14. https://tinyurl.com/y846nv9z
While his joint problems have improved you could certain consider adding in anti-inflammatories and joint support as well. I would also consider avoiding gluten in the diet and including more anti-inflammatory foods such as fermented foods, oily fish, berries, turmeric, garlic and ginger.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. It is not intended for them all to be taken, but rather just those that you select. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
Lowering Inflammation & supporting the gut lining
CurcumRx® (BRC) – 1 with 2 or 3 meals – http://tinyurl.com/yc3yqfwu
KappArest (BRC) – take 1-2 with each meal – https://tinyurl.com/jms9v3n
Arctic Cod Liver Oil (Nordic Naturals) – Lemon Soft Gels – take 2 daily
B vitamin support
B12-2000 Lozenges (With/B6/Folate) – chew 1-2 daily – http://tinyurl.com/m5d2tdb
Arthred Collagen powder (ARG) – take 1tbspn three times daily – https://tinyurl.com/j2arfe4
Chondrosamine-S (BRC) – take 3 daily Comprehensive joint support with Glucosamine sulphate, each 3 capsules supplying 600mg of Glucosamine (as glucosamine sulphate) and 500mg of purified chondroitin sulphates.
Ground Flaxseed (ARG) – take 2tbspn daily
Flow Less (ARG) – contains pumpkin seed extract take 1 three times daily -https://tinyurl.com/yd2f5umx
Palmetto Complex II w/Lycopene (ARG) – take 2 soft gels in the evening – https://tinyurl.com/jzgl2lm
I hope this helps answer your question
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