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Tips on a Locked Knee due to Meniscus Tear

Posted on: January 25th, 2015 by Richard Malik No Comments

A locked knee due to meniscus tear can be terribly painful and difficult to deal with. Trust me, I know. I have some looseness of my left knee from a sports injury that happened almost 25 years ago that has left me with a torn meniscus. Through an active lifestyle and sometimes strenuous physical activity (including running a half-marathon and intense hiking in the Rocky Mountains) it is often not a problem, but last weekend my knee locked up – I could not straighten it past 45º.

It is sadly funny that in spite of my active lifestyle, I felt my meniscus slip and my knee locked not while doing not much of anything at all; I was trying to meditate in a full lotus position. I knew I was in trouble when I tried to straighten my leg and I could only get it to a right angle. I was on the floor on a yoga mat and I could not get my self up onto a couch or a chair even though they were only a foot or two away. I was on my own because I knew that I would be home alone for at least 45 minutes. Fortunately, the knee was not painful and I could bend it all the way – I was surprised that I could sit on my knees on the yoga mat.

While waiting for my wife to come home and help me, I grabbed my computer (it was within arms reach) and tried to find on the internet how to unlock a knee with a torn and displaced meniscus. I found plenty of advice on the necessity to have arthroscopic surgery for a locked knee, but I could not find any advice on what to do to improve my knee before making an appointment with an orthopedic surgeon or going to the emergency department.

So, without Google’s help, I discovered several things that were very helpful to first unlock my knee and then help it feel better quickly before going to the orthopedic doctor.

  1. Let the lower leg of the affected knee hang while sitting on a tall chair like a bar stool for as long as you comfortably can (30 to 60 minutes at a time worked well for me). Spacing or distraction of the affected joint creates space for the impinging meniscus fragment to return to its normal position.
  2. Apply cold to the knee joint to prevent inflammation that can occur with a displaced or torn meniscus. 10 to 20 minutes of cold application per hour is adequate. A cold wet compress will be more penetrating and effective than an ice pack.  The application of cold will help to reduce inflammation in the joint that can cause pain and restricted range of motion.
  3. Apply heat to the muscles of the lower leg (calf) and upper leg (thigh) to encourage the muscles to relax and allow spacing in the knee joint, reduce pain from muscle spasm, and increase range of motion. CAUTION: apply heat ONLY to the muscles of the calf and the thigh. DO NOT APPLY HEAT TO THE INJURED KNEE until 72 hours have passed.
  4. Starting 72 hours after the injury, use contrast hydrotherapy to decrease the pain and improve the range of motion. Contrast hydrotherapy is the application of heat, then cold to an injury. Any form of heat is fine as long as it is safe for you. I used a sauna set to 175ºF for 30 minutes, then submerged the entire affected leg for 3 to 4 minutes in a bathtub filled with cold water. CAUTION: if heat is applied too soon to the injured tissue, it will increase swelling, cause more pain, and slow your recovery. You MUST wait 72 hours after an injury before considering applying heat to the injured tissue.

I am very happy with the improvement I have seen from implementing these steps. I hope they support others as well.

Be Well,

Richard Malik, ND

Naturopathic Doctor in Salisbury, CT

Naturopathic Doctor in Manchester Center, VT



Benefits of Exercise

Posted on: December 1st, 2014 by Richard Malik No Comments

It is common wisdom that exercise is healthy. A few of the benefits of exercise include: reduced cardiovascular risk, reduced diabetes risk, prevention of several types of cancer, improved mood, and reduced risk of Alzheimer’s disease.

But, how much exercise at what intensity is most helpful? Simple, clear guidance on the benefits of exercise is difficult to find.

Fitness sport couple running jogging outside on trail

When assessing a patient’s cardiovascular risk, I like to use a global risk assessment calculator that factors in age, gender, cholesterol ratio, blood pressure, smoking status, and diabetes status. My favorite cardiovascular global risk assessment tool can determine the benefits of various treatments (including exercise, Mediterranean diet, or statin therapy) on cardiovascular risk. Unfortunately, in this calculator (which is better than any other I have seen) the effect of physical activity is absolute – “physical activity” reduces cardiovascular by about the same amount as statin therapy. But it can’t be this simplistic; physical activity once a week must be less effective than daily physical activity; running for an hour must have a different benefit than walking for an hour.

To help clarify the benefit of exercise on physical health, I asked my research assistant, Dakota, to summarize a recent systematic review on physical activity and mortality. He summarized the research like this:

  • People of all ages who are able to be physically active will have a reduced mortality rate of 14 to 26% by doing 150 to 300 min of moderate to vigorous physical activity a week, respectively.
  • Doing a certain amount of physical activity a week does not guarantee a longer life and does not reduce the negative affects of smoking or an unhealthy diet.
  • Studies show that the more vigorous the activity the more beneficial it is to the body.
  • Studies also show the more time spent doing physical activity per week the better as long as a healthy diet is maintained and nutrients are not depleted.
  • Physical activity is shown to reduce mortality substantially more in women than men.
  • As a strict relation of risk reduction per calories burned the results were greater than or equal to 10% risk reduction for 1500kcal/week in men and 650kcal/week in women.  Studies support the message that ‘some is good, more is better.’

So, to reduce mortality by about 26%, exercise for 300 minutes per week. Men should burn about 3,750 calories per week and women about 1,600 calories per week. My favorite way to assess calories burned is to use the Runmeter app on my iPhone – it can be used for walking, biking, hiking, or running. Just enter your weight into the app and it will calculate calories burned and help you keep track of your own benefits of exercise!




Be well,

Richard Malik, ND

Naturopathic Medicine in Connecticut, Naturopathic Medicine in Vermont, Naturopathic Oncology in Vermont, Naturopathic Oncology in Connecticut


Curcumin for Joint Pain, Alzheimer’s & Cancer

Posted on: November 24th, 2014 by Richard Malik No Comments

Curcumin is a very popular supplement used for joint pain inflammation and other potential health benefits, including cancer. Much of the information on curcumin’s positive effects comes from in vitro (test tube or petri dish) or animal experiments. Research studies in humans is more scarce and there is reasonable doubt as to whether curcumin is absorbed well enough in humans to make an impact on health.

For years, I have had several concerns about supplemental curcumin.  The first is concern over curcumin extracts being frequently contaminated with toxic solvents.  The second concern is about bioavailability. Do people actually absorb the curcumin supplement they are taking? Do the compounds that show so much promise in vitro actually get into the blood stream and tissues beyond the gastrointestinal tract?

To address this concern, supplement manufacturers have developed curcumin formulations designed to enhance absorption in humans. They include:

  • Turmeric extract with a high concentration of free curcuminoids.
  • Theracumin.
  • BCM-95
  • Meriva
  • Longvida

Curcumin has amazing therapeutic potential.  But a careful look at the research and the data provided by manufacturers of specialized curcumin formulations often leaves me with more questions than answers. Based upon my own reading of the studies available, I have come to the conclusion the Longvida formulation of curcumin is most likely the best absorbed and effective.  It is the formulation that shows the highest levels of free curcumin in the blood of humans and it is the only one with evidence that it crosses the blood-brain barrier in humans (it is being developed for Alzheimer’s Disease by researchers at UCLA).  Over the years, as I have reviewed new studies on this topic I have not seen data to change my opinion.

Clinically, I have seen great results with the Longvida formulation of curcumin improving joint pain and reducing inflammation.

However, explaining the reasoning for this recommendation can be difficult and complicated. I have found a series of blog posts by Josh Trutt, MD that reviews the research and echoes my understanding of this curcumin issue. Conveniently, he comes to a similar conclusion as I do. 🙂 I thought that I would share them with all of you. He probably does a better job than I could of explaining the issues.

Please note that in the third link on Theracumin, he provides an important update in the comments section. The second link also provides a presentation that responds to the multivitamin safety issue that might be interesting for many of you. I don’t agree with everything that Dr. Trutt says, but his use of data is reasonable. And just so you know, I do not have any ties with either Longvida or Dr. Trutt. I have never communicated with Dr. Trutt. I have spoken with Longvida’s technical department, but do not work with or profit from them in any way.

This is not to say that other curcumin formulation are ineffective. Curcumin breakdown products in the bloodstream may work for arthritis, but there is no reason to suspect that curcumin breakdown products are preferable or more powerful than free curcumin.

Be well,

Richard Malik, ND

Naturopathic Medicine in Connecticut and Vermont

Naturopathic Oncology in Connecticut and Vermont

Power Over Breast Cancer Risk

Posted on: November 16th, 2014 by Richard Malik No Comments

The National Comprehensive Cancer Network is an alliance of comprehensive cancer centers that establishes evidenced based guidelines for prevention, detection, risk reduction, and oncology treatment of all different types of malignancy. I was intrigued and happy to see a recent editorial in the Journal of the National Comprehensive Cancer Network that helps put into perspective the power of simple, daily lifestyle choices on the risk of getting breast cancer.

The editorial states:

  • “15% of overall breast cancer risk is attributable to weight gain in adulthood.”
  • “moderate physical activity is estimated to decrease breast cancer risk by 15% to 25%”
  • alcohol consumption increases the relative risk of breast cancer by about 50% “and this risk increases with increasing amounts.”
  • estrogen/progestin hormone replacement therapy has been shown to increase breast cancer risk by 25%

It also states that only 5% to 10% of all breast cancers are caused by inheritance.

Reducing risk of breast cancer can be straight-forward and manageable:

  • eat plenty of vegetables, fruits, and lean sources of protein.
  • exercise regularly – walking 60 to 90 minutes, using the stationary bicycle for 45 minutes, or jogging for 30 minutes a day is enough
  • maintain a healthy weight or use diet and exercise to achieve slow, but steady weight loss.
  • avoid alcohol.

11-29-2014 Sunrise

Be well,

Richard Malik, ND

Naturopathic Oncology in Connecticut and Vermont

Osteoporosis: A Deeper Look

Posted on: October 6th, 2010 by doctor No Comments

Osteoporosis and the increased risk of fractures affects a large portion of the population over the age of 50.  Osteoporosis is more common in women, but occurs in men, too.  The risk of breaking a bone increases as we get older because bones tend to become less dense as we age.  Calcium from the diet or from supplements is only one of many factors that play an important role in keeping bones strong and preventing fractures.

Current medical research tells us that 1,500 mg of dietary calcium is helpful in treating osteoporosis and preventing fractures.  However, some cultures have a calcium intake that is about one tenth that recommendation and have a lower risk of osteoporosis than we do.  How can that be?

Are You Getting the Calcium You Eat?
The metabolism of calcium is complex.  On average, only about 30% of the calcium that you consume gets into your body.  So an average person that is consuming 1,500 mg of dietary or supplemental calcium is really only getting 500 mg that can be used to strengthen the bones.

Maximizing what your body does with the calcium that you eat is very important.  Vitamin D dramatically improves intestinal calcium absorption.  Did you know that vitamin D deficiency is epidemic in the northeast and is more likely as we age?  Correcting low vitamin D levels not only improves calcium absorption and bone health, but it often helps improve muscle aches and strength in the elderly.  A simple blood test can determine if you are vitamin D deficient – ask your doctor.  In lieu of doing a blood test, a daily intake of 1,000 IU of vitamin D3 is generally recognized as safe.

The absorbability of calcium also depends upon the type of calcium that you eat.  Calcium carbonate which is found in most calcium supplements and in antacids is cheap but poorly absorbed even under the best conditions.  Calcium that naturally occurs in spinach is very poorly absorbed.  The most absorbable form of calcium is calcium citrate-malate (with citric and malic acid) – it is up to 50% more absorbable than calcium carbonate.  Orange juice fortified with calcium citrate-malate is an excellent food-based source of calcium.

Through advertising, we are told how milk is good for healthy bones.  The calcium in milk is well absorbed, but not as well absorbed as the fortified calcium in orange juice or the calcium that is naturally found in kale.  Other vegetables with high levels of well absorbed calcium include: broccoli, kale, kohlrabi, mustard greens, rutabaga, turnip greens, and watercress.  Tofu set in calcium is also an excellent source.  Ten ounces of these foods are approximately equal to one eight ounce glass of milk in absorbable calcium content.

Are You Loosing the Calcium that You Eat?
Milk and other sources of animal protein like meats and other dairy products acidify the body.  When your body is more acidic you lose more calcium in your urine; the consumption of animal protein increases your calcium requirement.  High protein diets may contribute to osteoporosis and explain why some cultures have a very low incidence of osteoporosis while consuming very little calcium.

Other dietary and lifestyle factors encourage urinary calcium loss, including: smoking, excessive alcohol consumption, caffeine, and sugar.  Reducing your intake of these substances will help to improve your calcium status.

Besides Calcium & Vitamin D…
Bones are like muscles – the more you use them the stronger they get.  Weight bearing exercise like running and aerobics or weight training encourage strong bones – they are helpful for treating or preventing osteoporosis.  Even in people with severe osteoporosis, most fractures occur because of a fall.  Exercise reduces the risk of falling by improving coordination, strength, agility, and balance.

Vitamin K is found in abundance in the same vegetables that are good sources of calcium.  The enzymes in your bones that are responsible for taking calcium and putting it into your bone matrix depend on vitamin k; without it, they cannot do their job!  Several studies show aggressive daily dosages of vitamin K being effective for halting or reversing osteoporosis.  Vitamin K can prevent some forms of blood thinning medication from working – a very bad thing.  Aggressive vitamin K therapy should be done with the guidance of a knowledgeable physician.

Strontium – a mineral similar to calcium – is used in a prescription form in Europe to effectively reduce the risk of osteoporosis and to prevent losses in bone mineral density.  The prescription form is not available in the United States, but, based on the research I have done, there is no reason to expect the prescription form to work better or be safer than the forms available in supplements.  Strontium should still be used with the guidance of a knowledgeable physician.

Responsible & Effective Osteoporosis Prevention:
The development of osteoporosis occurs over decades and involves many factors.  The treatment and prevention of osteoporosis, from a natural perspective, are very similar:

  • Participate in physical activities that encourages strong bones;
  • Consume absorbable forms of calcium that do not encourage calcium loss;
  • Eat adequate, but not excessive amounts of animal proteins;
  • Make sure to get adequate daily vitamin D (about 1,000 IU);
  • Eat plenty of vegetables that are rich in vitamin K;
  • Don’t smoke
  • Consume small amounts or no alcohol, caffeine, and sugar.

Anyone can do their best to prevent fragile bones following the guidelines provided here.  However, osteoporosis and its precursor, osteopenia, are important medical conditions and should be addressed and monitored with the assistance of a doctor.

Be Well,


Single Payer Health Care

Posted on: September 5th, 2009 by doctor No Comments

Some people in my local community have been advocating for single payer health care reform; a system like the British health care system where all covered medical services are paid by the government.

In my opinion, it is not acceptable for any fraction of U.S. citizens to not have access to basic health services. Reform of our system is important.

But, I think it is important to know that a single payer system will result in far fewer options in alternative medicine. Many alternative & natural medicine providers that now rely on patients with private health insurance would see their patient lists shrink as our current government run insurance programs (medicare, the VA, and health care on Indian reservations) provides limited – if any – coverage for alternative or natural health care.

While far from perfect, covering natural medicine is one area where insurance companies provide the best option currently available to Americans. Some national health care systems (in other countries) provide the basic health services and allow citizens to purchase supplemental coverage for alternative or elective health services. Private insurance companies can and should be a partof health care reform.

Be Well,

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Back from Vacation

Posted on: September 1st, 2009 by doctor No Comments

The summer has been a wonderful opportunity to take a break from some of my responsibilities (website responsibilities), care for myself and get a new perspective on things. With the resumption of the school year for my children, I will resume publishing regular posts.

Be well,

Childhood Vaccinations Podcast

Posted on: May 28th, 2009 by doctor No Comments

Many families struggle with the decision to vaccinate their child. While the Centers for Disease Control vaccine recommendations and schedule are very clear, there is plenty of scary information on the internet linking vaccinations to neurological disorders, attention deficit disorder, autism, auto-immune disease, and chronic health concerns. This podcast lays out the known benefits and risks of vaccinations and explains what we don’t understand. It also includes information about optimizing your child’s immune function through nutrition and common sense recommendations for the prevention of infection.

You can listen to it in iTunes or in your web browser. Enjoy.

Be well,

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How to be Happy, Successful, Healthy, and Have a Long Life

Posted on: May 16th, 2009 by doctor No Comments

Well that about covers it all.  How much money, energy and time do we spend trying to attain these things, figuring out how we are going to attain them, or worrying about our failures in these areas? 

I just ran across some very interesting work by a Harvard researcher that actually may answer the question: What can we do to ensure happiness, success, health, and longevity?

According to George Vaillant’s research, the answers are: 

  1. have a good marriage before the age of 50
  2. be ingenious when coping with difficult situations
  3. be altruistic
  4. don’t smoke
  5. consume moderate (or less) amounts of alcohol
  6. maintain physical activity
  7. maintain a healthy weight
  8. get the most education your intelligence allows
  9. stay creative after retirement
All of this sounds like reasonable advice.  It’s good to have some scientific confirmation of good and practical common sense.
Be Well,
Richard Malik, ND
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Tea is Great, but Keep it Cool

Posted on: April 2nd, 2009 by doctor No Comments

I love my green tea.  I buy it several pounds at a time.  My favorite is Rishi Emerald Lilly with a little bit of cut peppermint leaves in a tea basket steeped for 5 minutes.  The green tea is smooth and full tasting while the peppermint reduces the tendency for stomach ache and nausea when green tea is consumed on an empty stomach.

I was very interested to find a long-term and large study done in Iran has found that drinking hot tea dramatically increases the risk of esophogeal cancer compared to drinking it luke-warm or cool.  The study was published in the British Medical Journal and the BMJ website has an interesting 8-minute video that you can link to here.  Enjoy!

Be well,

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