Prolotherapy for Knee Pain

If knee pain is stopping you from exercising, then you can expect your knee pain to get worse, not better. Studies have shown that exercise is crucial for people with arthritis. Prolotherapy can help people with knee pain get back to an exercise routine.

Prolotherapy is safe injection technique that can significantly decrease the pain of knee arthritis.

A study looking into the therapeutic effects of prolotherapy for moderate knee osteoarthritis appeared in the April 2015 issue of Therapeutic Advances in Musculoskeletal Disease. The study found that knee pain, range of motion, and function were all improved after 3 monthly prolotherapy sessions, and the benefit was maintained throughout the 6-month study duration.

Osteoarthritis (OA), the most common form of arthritis, typically onsets after age 40.  OA is due to the gradual loss of joint cartilage which can lead to bony endplate changes.

The most important thing we can do to delay or prevent OA is to keep our body mass index (BMI) in the ideal range from 18-25. You can calculate your BMI using your height and weight here:
Our body is just a skeleton frame and was not meant to carry lots of extra weight. Imagine if you had to carry 20 lbs of bricks strapped to your back at all times.  That is no different than being 20 lbs overweight.  Extra weight is going to wear down your knees, hips, and the discs in your lower spine.

Keeping your muscles strong and limber is critical for joint health. Muscles, tendons, ligaments, cartilage, and joint-space fluid are the only things standing between bone-on-bone. When you keep the supporting structures in prime health, you protect the intraarticular surface inside the joint.  If you cannot pound the pavement due to knee pain, you can use swimming or a recumbent bicycle to achieve optimal muscle strength and cardiovascular fitness.

Other things we can do to prevent osteoarthritis include eating a healthy diet filled with nourishing antioxidants, amino acids, and nutrients. An anti-inflammatory diet with organic vegetables, fruits, beans, herbs, nuts, seeds, and whole grains like quinoa (not flour products) should make up the bulk of your food choices.  Healthy sources of fats like avocado, coconut, olive oil, nuts, and wild salmon should replace the unhealthy sources of fats found in processed foods.

Staying hydrated is necessary to avoid drying out the cartilage inside the joints. The synoviocytes (the cells that line the weight-bearing joints) produce a fluid that helps buoy the bones like hydraulic fluid.  When this fluid dries out, the joint is more likely to have bone-on-bone friction. The spinal discs contain a gel-like center that tends to desiccate with age, and benefit from daily hydration. Men should drink 3 liters water/day and women should drink 2 liters water/day.

Supplements can be helpful for joint health.  Glucosamine sulfate 1500 mg/day with Chondroitin 1200 mg/day has been shown to help reduce cartilage loss in several studies.  Resveratrol is an antioxidant derived from the skin of grapes that is associated with longevity and may protect joints.  Fish oil (omega 3) has an anti-inflammatory effect.  Anti-inflammatory herbal blends like Akasha’s InflaRegulator are a healthy way to decrease your joint swelling.  Akasha’s Joint Ease is a selective kinase response modulator that is useful for flares of joint pain.

Treatment focus has shifted away from removing damaged cartilage, to preservation of as much cartilage as possible while enhancing the healing cascade.

Prolotherapy is injections of a proliferative fluid to the intra-articular joint space and the extra-articular supporting structures where tendons and ligaments attach to the bone surrounding the joint.  The result is a stimulation of the body’s natural healing cascade and a stabilization of the supportive structures of the joint.

Prolotherapy is available at the Akasha Center for Integrative Medicine in Santa Monica, CA.  Call 310-451-8880 to make an appointment with Dr. Boston.

Gluten: Evil or Not?

Gluten is a hot topic, and this is a great article (“Should We All Go Gluten-Free,” by W. Balistreri, MD, see link below). My quick summary is that 1% of the population has celiac disease, and these folks absolutely need to be gluten-free all the time.

For the rest of us, you need to understand that processed foods are the greatest evil, so if you switch from wheat-flour cookies to gluten-free rice flour cookies, you are still just eating processed food cookies. Gluten-containing foods also tend to be high in sugar, and easily converted to more sugar once you eat them, spiking your insulin and leading to food coma and other negative effects.

The best approach would be to strive for a diet rich in plants that still look like plants (organic vegetables, fruits, beans, nuts, seeds, grains that look like grain, NOT FLOUR – think quinoa). No matter how many vegetables you eat daily, you could benefit from eating MORE VEGETABLES in place of what ever other food you are eating.

Does this mean you have to avoid all gluten all the time? Not necessarily. It means to minimize all flour-based products, even gluten-free ones, to the margins of your diet.

If you have gastrointestinal problems, then you should test for celiac antibodies before you go gluten-free, and then do a 1-month food elimination diet (including eliminating gluten), to see if you improve. Food sensitivity blood tests can guide your elimination diet. After a month, you can see how your symptoms have responded to the elimination and re-introduction of foods.

I love to guide people through this process at the Akasha Center for Integrative Medicine in Santa Monica.


Hydration…I consider it my 3rd full time job after being a mom and a doctor. That’s how important it is, and also how much of a hassle.

The human body is 60% water, and all of our cells function optimally when we are well-hydrated. When we don’t drink enough water, our brain feels tired, foggy, and headachy; our muscles and joints feel sore and unlubricated, and our skin looks dry and papery. Our body’s ability to detox is hampered when we don’t drink enough water to flush through our kidneys and liver. Water is also imperative for healthy gut function, avoiding constipation and the build-up of toxic sewage in our large intestines when things aren’t moving along.

So, how much water should you drink? In general, a good rule of thumb is that women should drink about 2 liters of water a day, and men should drink about 3 liters a day.

I use a 20-oz glass water bottle that has a silicone sleeve, and I drink about 4 refills a day of filtered tap water. I make sure I drink my first 20 oz of water before my cup of coffee in the morning as a reward. It is time-consuming and makes me have to stay close to a bathroom, but I notice immediately if I don’t drink enough water…by feeling sluggish, brain-foggy, and tired.

You need even more water when exercising. The American College of Sports Medicine says that you should drink 3-8 oz water every 15 min while exercising for less than an hour, or 3-8 oz of a sports drink every 15 min if exercising for more than an hour.

Can you drink too much water? Yes. If you drink too much water, you can dilute your electrolytes which can be dangerous.

So, stick to the guidelines, and rejuvenate your dry cells to a nourished state every day.

Do I Need Heavy Metal Detox?

Could my headaches, mood swings, insomnia, nervousness, irritability, joint pains, tingling, or fatigue be from exposure to heavy metals?  The answer is possibly.

Heavy metals, like mercury, arsenic, and lead, surround us in our environment.  Our body’s internal detoxification process can handle a certain low level of exposure to heavy metals.  If the level of exposure overwhelms our ability to excrete the metals, then we can be left with symptoms that require treatment.

In order to estimate the likelihood that you have been exposed to heavy metals, it is important to understand the common sources of metals in our environment.

MERCURY:  The most common source of mercury is seafood in our diet.  Larger fish (that eat smaller fish) tend to have more mercury.  The EWG (environmental working group) has a great consumer guide to mercury in seafood.  (  Other common sources of mercury include fossil fuel combustion, cement plants, waste incineration, steel production, thermometers, preservative thimerosal in multi-dose vaccines, and amalgam fillings for teeth.

ARSENIC:  Arsenic is a metal present in the earth’s crust, and can leach from soil and rocks into drinking water.  It can be found in some soil-derived foods like rice and grains.  Shellfish and seafood from arsenic contaminated water.  Pesticides and herbicides can contain arsenic (another reason to choose organic, no-spray produce).  Chicken that has been fed arsenic supplements for intestinal parasites (another reason to eat organic, free-range chicken).  Pressure treated wood and fossil-fuel combustion are also sources.

LEAD:  In the USA, the main sources are contaminated water or soil, lead paint, lead pipes, brass plumbing fixtures, and lead solder on copper pipes.  The plumbing sources cause lead-contaminated drinking water.  Lead is also in leaded gasoline, batteries, ammunitions, cables, wires, kohl eyeliner, glazes on some ceramics, and sometimes contaminated products from overseas.

You might have just one or multiple signs and symptoms of heavy metal toxicity.  Signs and symptoms of mercury exposure can include headache, insomnia, mood swings, nervousness, irritability, tremors, weakness, tingling, skin rashes, abnormal kidney or lung function. Signs and symptoms of arsenic toxicity include numbness, tingling, weakness, drowsiness, confusion, white lines in fingernails, darkening of skin, diarrhea, abnormal liver and kidney function tests, or cancer of skin, bladder, kidney, or lung.  Signs and symptoms of lead toxicity include irritability, fatigue, sluggishness, loss of appetite, learning difficulties, developmental delay, abdominal pain, vomiting, constipation, numbness, tingling, hearing loss, or joint pain.

The CDC recommends using blood levels or 24-hour urine collection levels to determine your how much heavy metals are in your body.  I recommend adding a heavy metal panel to your annual blood work if you eat fish more than twice a week, or if you have any concern about heavy metals in your environment.  Provoked urine tests in which a chelating agent is given prior to urine collection, are not recommended as they will show too many false positives.

Treatment is needed for anyone who is symptomatic or whose labs reach a certain threshold.  Treatment must start with removing the source of the heavy metals in your environment.  This might entail eating less seafood, choosing low-mercury fish, having your mercury amalgam fillings removed and replaced with resin-based composite fillings.  Investment in a water filtration system for your tap water is worth every penny, to ensure you are not drinking heavy metals.  Filtered tap water is preferable over water bottled in plastic due to plastic chemicals leaching into water, as well as the environmental impact of plastic waste.

A comprehensive heavy metal detox plan is available at the Akasha Center for Integrative Medicine.  Depending on your symptoms and labs, you might require chelation medication to help pull the metals out of your system.  Supporting the channels of elimination during the detox period is important in order to effectively reduce your metal burden.  Recommended supportive treatment includes supplements to boost glutathione which is the most important detoxifying molecule in your body, supplements to support the health of your liver which will be sent to task getting rid of your metals, a natural supplement to help bind the metals prior to elimination, fiber support to help you eliminate the metals effectively in your stool, colonics to remove toxic residue from your colon after the detox process has begun, and intravenous Myers cocktails with glutathione to optimize your immune system and hydration during the process of detoxification.

If you are interested in having your heavy metal labs checked or treated, you can call the Akasha Center for Integrative Medicine at 310-451-8880.  You can read about the Akasha Center at