"Stem Cells" by Dr. Brad Abrahamson MD (excerpted from Chapter 4 of his book: Get. Better. Faster. Integrative Sports Medicine as a Transformative Approach to Body, Bone, & Joint Health)
Researching this topic should be more straightforward than it actually is.
Please know at the outset that when it comes to “stem cells,” claims made on the internet are not to be trusted without a thorough vetting. There’s a colossal heap of confusion surrounding this subject, and that’s to say the very least of it.
Historically speaking, “stem cells”—or, more accurately, mesenchymal stem cells (MSCs)—have been classified as cells that by and large differentiate into a type of tissue and have a high rate of implantation. We now know that this is not entirely accurate. Though some of these cells may differentiate and implant, the majority do not. We now understand that what stem cells mainly do once implanted into a joint is communicate back and forth with that joint’s living cells—this via a mechanism called paracrine signaling. They send packets of information, as it were, back and forth.
The benefit of this is that the MSCs can send a genetic signal called messenger RNA (mRNA) to the injured cell in your joint and thereby provoke a healing response. They do not, for the most part, differentiate and implant as cartilage in your joint. They can reduce pain and they can help the joint to heal in such a way as to increase function, often powerfully so.
It is my conviction that in the year 2020, MSCs must be reimagined: they are simply not what we once thought, even ten years ago. MSCs are pericytes acting as Medicinal Signaling Cells—and in acting as such can still be called MSCs. Doctors in the orthobiologics field, myself included, are finally starting to grasp and accept this.
My real hope is that the term “stem cell” will gradually, inexorably fade away. But this is not likely to happen any time soon, since doctors and patients must communicate with one another, and in this day and age patients are researching much more on their own. Thus patients more than doctors perpetuate the stem cell myth. Who, after all, is Googling “Medicinal Signaling Cells”?
Let us, then, call them “stem cells,” but with this important qualification: we understand that they are living cells which do indeed help, and yet though don’t by conventional definition actually act as “stem cells”—i.e. most of them don’t transmute into a specific type of tissue.
For here on out, with perhaps a few exceptions, I’ll refer to “stem cells” as Medicinal Signaling Cells, or MSCs.
* * *
A second area of confusion concerning this subject is the source of autologous MSCs—i.e. MSCs from your own body. At this time, the only FDA-compliant live autologous MSC is derived from bone marrow.
There are MSCs in fat as well, but the FDA is leaning towards the processing of fat as being less compliant—specifically, less compliant of the FDA mandate that the cells be “minimally manipulated.”
There is also rampant misinformation about non-autologous products—which to the general public is extraordinarily confusing.
To begin with, all cryopreserved stem-cell products (like amniotic or other frozen and purchased products) have cells that are: (1) from someone else’s body; (2) only alive for a few hours at most after thawing. The cells are dead! The result is that now dead cells are injected, which can hardly be defended as being actual stem-cell therapy.
We’ve extensively studied these products—studied them under the microscope—and no organization more so than the Interventional Orthopaedics Foundation (IOF), which has unquestionably done the most thorough and extensive research to date. Make no mistake: these are one-hundred percent dead cells—dead within a few hours of thawing.
In fact, companies selling these products to practitioners are not legally allowed to sell them as “stem cells.” Unfortunately, though, the modus-operandi of “regenerative” companies offering these fake “stem cells” is to rebrand them as “stem cells.” But they are not, I repeat, living MSCs; they all die within minutes (hours, at most) following the “flash thawing” that happens clinically—as against placing them on culture media for a week or two, until they can be shown as living.
What these frozen, purchasable products do possess is growth factors and cytokines (like PRP), so that what consumers are actually getting is a PRP-like product, yet with an outrageously inflated price-tag, matched by outrageously inflated expectations.
Another form of confusion comes when clinics use non-cellular products (such as exosomes), yet still refer to exosome treatment as “stem-cell therapy.” Indeed, this is not merely confusing: it is also fraudulent. In my opinion, exosomes are a treatment modality that will in time either become proven or exposed; yet in any case, they are not cells and therefore they are not stem cells.
Let us return for a moment to the subject of autologous MSCs. They should first of all still be considered experimental—as, in general, many orthopedic treatments should be considered experimental—and this fact must always be fully explained to the patient during the consent process. In addition to which, the patient should be continuously and carefully observed and even studied. Patients should be followed over the course time, the better to track and know the outcomes. My practice—Integrative Sports Medicine LLC—does all this and more: we operate under an IRB-approved study, via the American Orthopaedic Society for Sports Medicine (AOSSM), and among those of us participating in this ongoing study, the totality of this data collection constitutes the actual experiment. Then, of course, there’s the many possible mechanisms of action among MSCs, at both the cellular and also subcellular level, and this in turn raises complex questions: what is happening in any given tissue milieu?
I mentioned earlier the cell-cell signaling. This is really just a simplified version of the mechanism of action. Since there are hundreds of molecule receptors on the surface of most cells and hundreds of cytokine and growth factor molecules—as well as packets of mRNA floating around in a joint that’s been treated with MSC injection—it will take years to tease out precisely why MSCs help tissues heal in such a deep and specific way.
Clinical Efficacy of “Stem Cell” Therapy
Right now, in the early part of 2021, the primary thing to understand when it comes to MSC therapy is this: Those of us studying and practicing orthobiologics are witnessing excellent results the majority of the time.
We know that in certain clinical orthopedic situations “stem cell” therapy is incontrovertibly effective—because we see it every day. We are furthermore continuously working to better understand and determine other mechanisms of action, in addition to those we already have a pretty good understanding of.
There’s another important thing upon which most of us agree: some patients are Responders. Other patients are Non-responders. Responders are those for whom the treatment works. For Non-Responders, the treatment is largely ineffective, sometimes entirely ineffective.
At a recent Interventional Orthopedics Foundation conference, virtually all the doctors with whom I spoke agree that approximately one out of nine are Non-Responders, although at my clinic, Integrative Sports Medicine, it’s near one out of twelve.
The ongoing AOSSM study will undoubtedly shed light on this subject, so that soon we’ll know better in advance who is likely to respond to the therapy and who not.
Here are three actual case examples from my clinic:
1. CS is a forty-year-old male with a long history of contact sports. He’s now a salesman who also enjoys hunting and other outdoor activities. He presented with knees that felt slightly unstable and ached a little bit every day. So did his hips and shoulders. He considered these symptoms mild enough to ignore—at first—and he kept going to work every day. Eventually his joints began interfering with hunting and heavy lifting, and so he decided at last to come in for treatment. By this time, both his shoulders, both his knees, and both his hips were intermittently sore on a daily basis. It turned out that he had arthritis in both knees and severe arthritis in both hips. He should have come sooner. We’d have been able to rescue his shoulder (rotator cuff tendons) and both his knees. Since he waited so long, however, both his hips will need replacement. He is only forty-years-old.
2. JM is a fifty-seven-year-old who teaches six-to-eight martial arts session per week. He also, on weekend, participates in dog trials. He’s not been able to do either activity the past few months because of the pain, stiffness, and swelling in both his knees. Up until a few weeks ago, he’d only notice stiffness and mild pain the first couple of hours in the morning; moderate pain with his rigorous schedule of physical activities. He’s lost income from not being able to teach martial arts. He finally came to me and was surprised to hear there was something else other than cortisone injections and knee replacement, which he emphatically did not want. Based on his X-rays and general health, I thought him a good candidate for stem-cell therapy. He had his bone-marrow and stem-cell procedure and was pleased to be able to walk out and drive himself home that same morning. Approximately six weeks post-procedure, he was able to walk without any pain, and he also started easing back into his dog trials. By month three, he told me he was, in his words, “one-hundred percent better” and back to his full schedule of martial arts. One year later, he denied needing any further treatment at all and he still maintained that he felt one-hundred percent.
3. JS is a sixty-seven-year-old long-distance horse-racer, serious about her sport, in contention to be national champion. Before coming to me, she had over the course of the previous year mild yet near-constant knee pain, during and also after riding. She ignored it as long as she could. Long-distance athletes who last more than a year in their sport almost always have an authentically high pain tolerance. She was hesitant to have her bone marrow drawn, but on the day of the procedure she remarked how surprised she was to have almost no pain with the procedure. She wondered why in her head it was such a big deal, and she marveled at the fact that after she’d finally gone through with it, she wasn’t down for even twenty-four hours. Within weeks of having stem cell and PRP therapy, she was regularly getting comments from her competitors: “You’re riding so well! You look so much more fluid—so smooth and in control. What did you do?” During the year following her stem cell and PRP treatment, her knee function dramatically improved, and her pain scores went from an 8/10 (high being most painful) to about a 1.5/10. One year after treatment, she was training outrageously hard, and she began regressing. She repeated PRP treatment and was back to competing in a matter of mere weeks.
Sign up for Dr. A's newsletter!
What's your REAL body age? Take my quiz!
Does Keto work?
Keto is everywhere; it's the new buzzword, the new favorite among those looking to shed pounds, and the new hate victim of the food-pyramid-spouting-eat-your-whole grains mainstream medical industry. The keto diet, while it is not the magic cure-all for every single disease on the planet, does a pretty dang good job at being the potential causer of healing many horrible conditions. So let's cut through the science, separate fact from fiction, and look at the benefits of the keto diet.
Benefit #1: Weight Loss
Okay, so this one isn't so astounding, but it is one of the most common reasons people embark on the keto diet. So why is weight loss usually so easy on the ketogenic diet instead of other regular diets? For all of the following reasons:
• The keto diet is composed of approximately 75% fat, 20 % protein, and 5% or less carbohydrates. The high fat content and lack of sugar means diminished cravings, lack of blood sugar swings and binges, and increased satiation. Increased satiation=eating less. Many people also have food sensitivities to grains, even gluten-free ones, so eliminating them may lead to an increased ability to absorb minerals like magnesium and potassium, which in turn means your body is more nourished and you have fewer cravings
• Ketones. When your blood sugar is running low, your body turns to its glycogen stores for energy. Typically glycogen stores house about 2000 calories of "backup" energy for when you run out of glucose. Like the intelligent machine it is, your body depletes the glycogen stores and then turns to your own body fat for fuel.
IMPORTANT: The ketogenic diet is not a free-for-all eat however much cheese or super low-carb fat bomb treats you want diet. If you are eating way more calories than you need, you will not lose weight. So focus on keeping your diet around fatty cuts of grass-fed meat, butter, eggs, avocados, lots of green veggies and cruciferous, and be modest with the keto desserts, dairy, and sweets.
Benefit #2: Brain Function
A poorly functioning brain, as you may have already experienced, leads to lessened work productivity, which in turn means an unhappy boss, lack of job satisfaction, sugar cravings for energy, and depression. It's a horrible domino effect. The original ketogenic diet was formulated by Dr. Russell Wilder in the early 20th century to treat epilepsy. The success rate was phenomenal and it is still used today to treat epilepsy and other brain disorders. Research also indicates that ketones are more efficient brain fuel than glucose. (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102124/)
Benefit #3: Potential Cancer Benefits
One study showed implementing the ketogenic diet led to a dramatically increased survival time and slower tumor growth. (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450454/)
If you're reading this article now, chances are you are in some sort of pain, whether physical and/or mental (being overweight, struggling with autoimmune disorders, thyroid disease, fatigue, brain fog) and want to change. Use this information, don't just skim through it and store it in the back of your brain and say "that's nice for some people", motivate yourself to change.
A small-town boy with a passion for books, black coffee, health, fitness, free thought. I'm the author of nine books and counting.
"There's something refreshing about an independent thinker – and more: something life-affirming, life-giving. It may be the courage it takes to assume responsibility for the ultimate contents of one's own mind, especially when everyone about you disagrees... Ray Harvey's literature captures that."
"Like a hyena writing poetry on tombstones, Ray Harvey's literature is a howling cry and call for anyone who would undertake the task to do this: think for yourself – and in so doing, make the unimaginable imaginable, the impossible possible, the unthinkable thinkable."
– James Cole, Professor Emeritus in poetry, University of Wyoming
"By turns witty, mordant, bitter, and lyrical, Ray Harvey's latest is one of the most unexpected yet most refreshing books I've read all year."
Author of "Mexico Way" and "Desert Light"
"Ray Harvey is a special writer, whose work will do what fine fiction must: take you on a journey from which you return transformed and renewed, seeing this world differently because of the world he has created. It is always heartening to find a new storyteller, and we can only hope that there will be more stories to come."
Author of "Veronica" and "A Trip to the Stars" and "Haley's Comet"
Thank you for getting in touch!
I'll get back to you shortly.
Have a great day!