• How Are Stem Cells Used Now?

    Y’all. If I get one more question about commercials for stem cells fixing intimate issues or stopping the aging process… I will complain aggressively to all my friends. Again.

    It seems like we, humans, have a super obnoxious habit of discovering something awesome and then over-selling it. Did those Ron-Popeil dehydrators ever really make anyone healthier or more energetic? Sure, fruit leather is tasty, but it’s not really altering the status of my tax return or removing all the pro-diabetes DNA from my genome.

    I find it easy to forgive the people at RonCo, because they just sold dehydrators for five easy payments of $9.99. I find my forgiveness skills far more challenged when people start selling stem cells for real problems that they absolutely do not address at this point in time.

    Stem cells do not at this time treat autism. Or cerebral palsy. Or irritable bowel syndrome.

    True story: when I was a wee small child in med devices, I volunteered at a stem cell charity event. And this guy told me that he had gotten shark stem cells in Mexico that cured his IBS.

    I am happy for this man, because IBS makes people miserable. But also, shark stem cells did not cure his IBS.

    Stem cells do address a number of issues though. So let’s dig in and see where physicians use stem cells right this moment.

    Spoiler alert: concentrated bone marrow (containing mesenchymal stem cells) is the most common form of clinical stem cells right this moment.

    Stem Cells From Concentrated Bone Marrow Help Grow Bone

    You’re probably thinking people don’t generally have trouble growing bone. Usually they just fall horrifically from one of those obnoxiously placed rent-a-scooters, snap their radius (forearm bone), pay way too much money for urgent care, get a puke green cast, and then magically have intact bone a couple months later.

    But things don’t always work out that way. Sometimes our bodies get tired of all the abuse and stubbornly refuse to grow back that broken bone.

    Non-Union Fractures: When Bones Just Can’t

    When this happens, the medical community calls it a non-union fracture. It means your body got stalled halfway to fixing that bone, and instead of bone, you get a type of cartilage.

    In the United States, this problem often receives an invasive surgical remedy, but the lovely French doctor I’ve mentioned in a couple of other posts has a simpler solution. For appropriate patients. He uses concentrated bone marrow (containing mesenchymal stem cells) to treat non-unions in average patients, diabetic patients, and even patients whose non-unions are infected.

    Without additional surgery or plates and screws. Just an injection of concentrated bone marrow.

    And it’s not just him. Many US surgeons now offer this option instead of surgery, because it carries less risk and requires less downtime for the patient.

    I have to point out that this isn’t new-fangled technology. The first publication I linked is literally 13 years old. Dubbya lived in the White House back then. So… mesenchymal stem cells have been helping heal broken bones since all of us were living in a very different world.

    Spinal Fusion: Don’t Let Your Hip Pay The Price

    During spinal fusion, a surgeon attempts to replace what they consider malfunctioning soft tissue in the spine with new bone. In ye olden days of spinal surgery, they used to harvest a big chunk (yes, that’s the technical term) of bone from the hip and put it in the spine. For a certain number of patients, this chunk o’ hip would leave them with long term pain.

    How might we fix this?

    Well, we could use concentrated bone marrow again. And it turns out that spine surgeons all over the world do this all the time now, and it works great.

    Plus, patients experience fewer complications and less pain with bone marrow aspiration than with chipping off a chunk of the old hip bone.

    Stem Cells From Concentrated Bone Marrow Help With Knee Stuff

    Sadly, there are a million reasons you might have knee pain. Maybe you played tennis too much in high school. You might have raced your college roommate up the stairs too many times. Or maybe you’ve just been living that rockstar lifestyle too long, and now you’re paying the price.

    Whatever the reason, and however metal it may be, most of us end up with knee pain at some point. So it qualified as good news for me when I finally saw publications coming out about mesenchymal stem cells being used for knee pain. As of right now, here’s where we see them clinically:

    1. Knee Arthritis
      In this study, patients reported improved function and reduced pain after injection of concentrated bone marrow.
      In this 125 patient study, patients experienced an average 71.4% decrease in pain. <– This one also used PRP.
    2. Osteochondral Defects
      *Osteochondral defects happen when joint injury goes all way from the top cartilage surface down to the bone. So both the cartilage and the bone need repairing.
      This study, this one, this one, this one, and this one all used concentrated bone marrow to successfully treat osteochondral defects. I actually don’t have room or time to list all the studies like these. But I do have to say that most of them show superiority of the bone marrow (mesenchymal stem cell) based treatment versus the alternative.
    3. As An Alternative to Total Knee Replacement
      In this landmark study, 30 patients who could have had double knee replacement surgery instead got one knee replacement and one bone marrow concentrate treatment with mesenchymal stem cells. Pain relief was roughly equal for the knee replacement vs. the bone marrow concentrate knee. And more importantly, 21 of the 30 patients preferred the bone marrow concentrate knee to the knee replacement. Probably on account of the easier recovery and fewer side effects.

    Stem Cells From Concentrated Bone Marrow Help With Hip Osteonecrosis

    Y’all, the privilege of advancing age brings a lot of awesome things. Holographic assistants, Snap Chat filters, and that peanut butter with the jelly already swirled in it, just for starters. But other stuff comes too. The undeniable urge to tell kids to get off your lawn suddenly overwhelms you. Yes, even when you don’t have a lawn. You start saying things like “my dress yoga pants” and “oooh, 9:30 on a weeknight is pretty late.”

    And sometimes your body betrays you and forgets to supply blood to things you feel are fairly vital.

    No, not that thing. You’re looking for a different website altogether if you want to discuss that thing.

    Over here at ISY, I’m talking about your hip joint, specifically the moving part of it.

    When your body fails to bring sufficient blood supply to that bone, it can deteriorate, causing pain and dysfunction. This condition is called osteonecrosis of the femoral head, and it sucks. And is one of the leading causes of hip replacement.

    But not to worry, concentrated bone marrow has treated this condition for more than thirty years now. Just check out this ridiculous list of studies:

    Stem Cells from Concentrated Bone Marrow Help Shoulders

    Rotator cuff repair surgery has a shockingly high failure rate. Of course the failure rate depends on a number of factors. Regardless, 20-50% failure rates would upset even the most unflappable patients.

    Don’t worry though. As with every section in this post, stem cells come to the rescue.

    In this study, bone marrow treated rotator cuff repairs healed faster and were almost twice as likely to remain intact after ten years.

    In this other study, they found concentrated bone marrow effective in reducing pain and improving function in rotator cuff tears.

    Stem Cells from Concentrated Bone Marrow Help Cartilage

    I’ve actually already covered this in the knee section with osteochondral defects, but let’s revisit. Because osteochondral defects, though doctors never call them that to your face, happen more often than you’d think. Mostly in knees and ankles though.

    Osteochondral Defects Happen

    This may seem irrelevant, but just go with me for a second:
    When I was doing gymnastics in the wilds of central Texas, we used to do this super dumb thing called mat crew. See, my high school couldn’t afford a real foam pit for training. So instead, we would make four gymnasts literally hold a big crash mat in the air and try to “soften” the landing for another gymnast throwing a big trick.

    No, it was totally safe, y’all. And also how I dislocated my ankle and become the proud owner of my very own osteochondral defect. I wasn’t sure if I should be proud of losing 40% of the cartilage in my ankle or terrified of it. It sounded kind of epic, but then…

    My pediatric orthopedic surgeon told me, in words I’ll never forget, that I should probably quit gymnastics. And that I was definitely not doing any other sports or running ever.

    You do not run. You do not jump. You do nothing that involves impact on this ankle. You can finish your last two years of gymnastics, but after that it’s over. Unless you want to have arthritis so bad that you feel crippled by the age of 30.

    That’s what he said to me. At 16 years old. And he was right, but he didn’t have concentrated bone marrow back then. And it would have made a world of difference.

    Concentrated Bone Marrow Is Awesome for Cartilage

    Since I’ve already written way too much here, I’m just going to leave you with this list of publications making my point for me. Every one of these publications says I could have run, jumped, and generally abused my ankle for years after that fateful mat crew incident. If only my surgeon had been able to use concentrated bone marrow.

    1. 2010 Study | Knee Cartilage
    2. 2011 Study  | Knee Cartilage
    3. 2011 Study | Knee Cartilage
    4. 2013 Study | Knee Cartilage
    5. 2014 Study | Knee Cartilage
    6. 2015 Study | Knee Cartilage
    7. 2016 Study | Knee Cartilage
    8. 2016 Study | Knee Cartilage
    9. 2017 Study | Knee Cartilage
    10.  2009 Study | Ankle Cartilage
    11.  2010 Study | Ankle Cartilage
    12. 2011 Study | Ankle Cartilage
    13. 2011 Study | Ankle Cartilage
    14. 2013 Study | Ankle Cartilage
    15. 2014 Study | Ankle Cartilage
    16. 2016 Study | Ankle Cartilage

    That was a lot of studies, y’all. But I have one more thing to share, one more clinical use of stem cells that happens pretty much daily in this country.

    Stem Cells from Concentrated Bone Marrow Help Back Pain*

    *A very specific type of back pain called discogenic back pain.

    Please note: that doesn’t mean all kinds of back pain. There are some kinds of back pain, like those resulting from CRPS or other types of nerve injury that probably won’t respond to any currently available stem cell treatment.

    Stem cells aren’t magic, y’all.

    But they have treated discogenic back pain. This study showed a 70% average pain reduction at 3 year follow-up after discs were treated with concentrated bone marrow. And the patients in that study were all spinal fusion candidates. So with 70% pain relief, most of them chose not to go on to surgery. That’s huge in my book.

    This last application has the fewest publications, but we’ll see a lot more in the next couple of years. Because physicians are offering this therapy a lot more than they’re publishing it. I still wouldn’t say this qualifies as a super common use right now, but it is definitely clinically available.

    Well That Took Forever

    When I started this post, I told myself it would be a short one. :: haha ::

    Let’s focus on the positives though. Now you know how stem cells are used clinically today. In orthopedics.

    That’s an important caveat. I skipped over stem cells in cancer and immunotherapy. I’ll have to cover those in another post, because this one is already out of control.

    Do you know someone who received a stem cell treatment not listed here? Have questions about any of the million things I said?

    Get your two cents into the comments, or leave some feedback directly in my inbox!

    Photo by rawpixel on Unsplash

  • Iron Rich Foods: Quick Read

    Y’all, one of my readers has a bun in the oven! And I am SO excited about it!

    Her meat aversion displeases me though. Because she needs to function and continue being a badass while also growing a tiny, complete person. And all that requires energy, which her red blood cells will not facilitate well without a solid dietary source of iron.

    So this week’s quick read is a list of iron rich foods that do not come from cows. Or meat of any kind.

    First things first though.

    Iron Is Important

    I just read about 30 pages worth of material detailing why we need iron in our lives. It was like the Charles Dickens of nutrition, y’all. And you know what it all lead up to?

    Humans need iron in their diet. For living. And breathing. And forming tiny humans.

    Importantly, science tells us that iron deficiency in pregnant ladies increases the risk of preterm delivery and low birthweight. So I’d like my lovely reader to get all her iron. And deliver a full term chubby cheeked cutie.

    Iron Needs Vary With Age

    But don’t worry. The CDC has an awesome table that spells it all out. And if that’s not enough for you, you can read the encyclopedia of iron science I just read.

    Yes children, encyclopedias are books from olden times. It’s where the internet lived before Al Gore put it in computers.

    Anyway, back to iron requirements (courtesy of the CDC):

    Table 1: Recommended Dietary Allowances (RDAs) for Iron [5]
    Age Male Female Pregnancy Lactation
    Birth to 6 months 0.27 mg* 0.27 mg*
    7–12 months 11 mg 11 mg
    1–3 years 7 mg 7 mg
    4–8 years 10 mg 10 mg
    9–13 years 8 mg 8 mg
    14–18 years 11 mg 15 mg 27 mg 10 mg
    19–50 years 8 mg 18 mg 27 mg 9 mg
    51+ years 8 mg 8 mg

    * Adequate Intake (AI)

    So my pregnant reader needs to find a way to get 27 mg of iron every day from foods that don’t activate her hurl receptors. As long as she hasn’t gone full vegetarian.

    If meat makes a complete exit from my reader’s diet, then she needs 1.8 times the regular amount of iron. Because iron derived from plant sources is harder to absorb. So she’d have to get more of it for the same nutritional effect.

    Let’s see how she can do that.

    Many (Non-Beef) Foods Are Iron Rich

    The USDA has this amazing database that lets you search any food by a nutrient. If you look up iron in this database, you’ll find out that dried thyme is the most iron-rich food in the whole database. It has 123.6 mg of iron per 100 g.

    I don’t think my reader wants to exist on thyme alone though. I know I don’t. So I’ve listed what look like the most appetizing and convenient non-cow-derived foods and their iron content below.


    Now I personally have been looking for an excuse to eat exclusively Honey Bunches of Oats for most of my life. That stuff is addictive like Netflix.

    But, I would caution any reader against that, even tough it’s on this list. Most breakfast cereals have pretty high levels of aluminum. And since y’all know how I feel about unnecessary aluminum in your body, you can probably guess what I’m about to say.

    Breakfast cereals shouldn’t replace meat if you’re trying to supplement iron.

    But mint, seaweed, and spinach can. Plus lentils and chickpeas. And chocolate.

    So my pregnant reader can skip the burgers and head straight for the tofu with brownies for dessert. Because it’s good for her and her little nugget.

    Track Your Nutrients

    One other note here. There are certain nutrients that you want to get not too little, not too much, but just the right amount. You want to hit that Goldilocks Zone.

    But that’s so hard to keep track of!!

    I know. Believe me. That’s why I LOVE this new app I’ve been using for the last several months – Cronometer. They have free and paid versions – I use the free one.

    I love that in either version you can input your food and drinks, and it tracks everything. So you can see when you have a headache, Gatorade will fix it on account of your electrolytes being low. Or that your afternoon fatigue is probably because your B vitamins are missing today. And inconveniently, that you should lay off the doughnuts because your calories today have come 95% from carbs.

    For my reader, this is probably the easiest way to track her iron intake, folic acid, calcium, postassium, magnesium. Basically all the things you’re trying to pay attention to as a healthy pregnant lady. Or a healthy non-pregnant person.

    So I highly recommend it for making your life easier and helping you feel better by allowing you to really optimize your nutrition.

    Alright, that’s it for this week’s quick read. But let’s sum it up real quick for people who are lazy like me.

    Quick Read in a Nutshell

    Pregnant ladies need 27 mg of iron daily if they’re eating meat, and 48.6 mg of iron daily if they’re not eating meat.

    The CDC has a great list of iron-rich foods <–here.

    Cronometer will track nutrients, minerals, calories, carbs, and pretty much anything else you eat.

    Alright, that’s the whole shabang. Did I miss anything or confuse you? Let me know in the comments or send your feedback straight to my inbox.

    Y’all have a great weekend!

    Photo by Mike Kenneally on Unsplash