Your Pain is Not Because You’re “Fat”

Your Pain is Not Because You’re “Fat”

What do I know about the struggle to lose weight? Not much and I don’t pretend to. That is a genetic “crap shoot” that I came out on the lucky side of.

What I DO know is that pain does not happen to overweight people alone.

The other thing I know and hear about more often than I should, is how doctors of all specialties commonly and unabashedly display extreme prejudice against people who are overweight.  Numerous patients of mine tell me similar stories about reaching out for help with their pain and being met with a host of physician encounters that leave them feeling judged and ashamed.  So many doctors are quick to blame the weight and slow to investigate past the fat.

Anyone in this day and age knows about the correlation between obesity and disease and mortality.  I’ll go out on a limb here and suggest that the majority of overweight patients know that it’s not ideal to be on the heavy side.  The last thing they need to hear is that everything wrong with them is because of their weight. First of all, that’s just not always true and more importantly, blaming their weight is certainly not something they need a doctor’s help doing.

When has fat-shaming ever helped anyone make positive lasting change? Being judged by careless strangers is one thing but by your own healthcare provider is quite another and shouldn’t be allowed.

If someone has been steadily on the heavy side for the majority of their lifetime and there hasn’t been a sudden recent change in weight, then the skeleton – while perhaps stressed in ways that lighter people aren’t – has had years to adapt.  Our bodies are pretty amazing that way and given years to slowly get used to something, we just do.  The likelihood that suddenly the weight is the main problem is unlikely for this sort of scenario.
I see plenty of lean and “fit” looking people who just wake up one day in pain and have no idea why.  We don’t say to those people: “Well it’s obviously because you’re too skinny.  Come back and see me when you’ve gained some weight.”

Here’s another problematic drawing of parallels that seems to happen quite a bit…

Any sized woman who experiences a 9 month gain of pregnancy weight should never be compared with someone who is chronically overweight.  It is completely different. Not only do most overweight people not gain that quickly but they also aren’t experiencing the unique destabilizing and mechanically disorienting effects of massive hormonal and blood volume changes.

If weight is legitimately suspected as the cause for pain, then the last thing you should do as a doc is dismiss the patient with a sweeping prescription for exercise and calorie restriction when the more likely chronic weight-related risk is cardiovascular.  If anything, this person needs to have a heart health check first.

When a patient feels alienated from their physician due to the shame over their weight, it creates a dangerous  barrier to receiving true healthcare solutions.

I hear first-hand from patients that they will simply not return for care when they feel unfairly judged and dismissed and this can be more dangerous than the weight itself.

We do need to be clear with our patients about the facts:

But facts can be shared without judgment and blame. Higher body fat percentage is a real health risk. Abdominal fat is the worst. It predisposes us to higher levels of chronic inflammation which can manifest in many ways – not just through pain.  Evidence shows that it’s inflammation that is the huge risk factor and linked with a host of diseases.

Doctors and patients alike need to be aware of the cold hard fact that body fat percentage can be dangerously high in underweight, average weight and overweight people.  This is why everyone of absolutely any size, needs to avoid being sedentary, eliminate inflammatory foods and care for their stress levels and stress coping – all of which have been shown to play a role with inflammation which is the ultimate killer.

It’s never just the weight alone.

When there is pain, the pain chemistry needs to be addressed first and foremost.  Yes, fat cells contribute to inflammation which can stack the deck against us and cause pain, but every person’s situation is unique.  Look at the mechanics.  Consider individual body chemistry.  Inquire about psycho-social factors.  These are the inroads to better, more compassionate self-care which is where weight loss can begin if indeed that is appropriate for that patient.

We are emotional creatures first.  The physical body is a reflection of who we are.  All bodies need to be greeted with kindness and respect first before change can be made.


image credit: By Peter Paul Rubens – The Prado in Google Earth: Home – 7th level of zoom, JPEG compression quality: Photoshop 10., Public Domain, https://commons.wikimedia.org/w/index.php?curid=22620913

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How Does Self Image Affect Your Pain?

How Does Self Image Affect Your Pain?

An excerpt from my book as seen over at InnerSelf Publications website.

Timely for the season of self reflection and internal work.

 “by Ya-Ling Liou, D.C. If you’ve only ever seen yourself as unsure and perhaps your self-esteem is not strong, you may be more vulnerable to becoming overwhelmed by fear—stressed by the worry that your pain might devolve into a worst case scenario of unknown proportions.”

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Meeting Dr. Joseph Pizzorno

Meeting Dr. Joseph Pizzorno

Last month I was in San Diego attending a week long conference of the Academy of Integrative Health and Medicine (AIHM). What a refreshing gathering of so many different health specialists and generalists, truly representative of my ideal in holistic and integrative care of patients.

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Dr. Joseph Pizzorno at the AIHM conference 2016 – Looking dapper as ever despite three consecutive lectures without break!

One of the highlights for me was to attend a set of lectures given by Dr. Joseph Pizzorno and then to meet him for the first time. He is one of the founders of Bastyr University. I’ve been in touch with him for the past couple of years now because of his kind willingness to pen the foreword of my first book in the Every Body’s Guide to Everyday Pain series, Volume One – Put Out the Fire. Until now we had only corresponded remotely and so this was the first chance I’d had to meet in person this man I’m so grateful to.

I was in disbelief for quite some time that this natural health care giant was willing to associate his name with a project like mine – very much still in its infancy.

What I’ve learned about him during the process is how generous, gracious and humble he is and all of this was just confirmed by our in-person meeting in San Diego. He was practically mobbed by eager attendees after his lectures and despite being worn out from travel and an unusually long consecutive series of lecture hours without a break, he responded with patient kindness to everyone’s questions.

The topic of Dr. Pizzorno’s most recent research and writing work is environmental health.

The area of study referred to as “environmental health” concerns itself with the effect that inorganic compounds in our environment  exert on our overall well-being, whether those be naturally occurring or human-made.

It is an essential piece to the puzzle when considering the three possible triggers of everyday pain.  Exposure to these compounds can be one of the significant influences responsible for triggering an imbalance in our biochemistry – the precise factor that can add to our inflammatory toxin load and set us up for pain.  When chemistry is out of balance it can profoundly change our emotional coping and in turn our mechanical stressors as we translate emotion into posture.

Environmental toxin exposure is an awesome topic demanding supreme command of the research which Dr. Pizzorno clearly has with unique affinity.  He is in the process of preparing for the release of a new book on the topic:

The Toxin Solution: How Hidden Poisons in the Air, Water, Food, and Products We Use Are Destroying Our Health, and What We Can Do to Fix It

And there is another book in the works for a few years down the road of a more didactic nature.  I’m very excited to see both and will be heavily referencing this work for Volume Two – Fix the Fire Damage of my pain book series.

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Stretching Out the Pain: Feels Good But is it Good FOR You? – Stop Everyday Pain

yoga-dancer-1024x855Recently I’ve had a few questions from patients who are reading the book.  One that keeps coming up is about whether or not stretching is good or bad for us.  Stretching is a very confusing topic and has been one of scientific controversy for years which makes the answer not so straightforward.

In this first volume of my book series Every Body’s Guide to Everyday Pain™, Put Out the Fire I spend some time explaining that stretching is actually a mechanical stressor and therefore risky for people dealing with everyday pain.  This means that the elongation we cause by stretching can result in stress to the underlying structure.  Usually  when all things – mechanical, biochemical and emotional – are in balance, a reasonable stretch doesn’t cause any trouble.  However, when we are out of balance in any one of these areas and if we are already in pain, then stretching the compromised area is a terrible idea.

We often get away with stretching without consequences during times when we are not in crisis. Unfortunately with this sort of benign experience in mind and due to the fact that stretch-sensation neurologically eclipses the pain of inflammation, the concept that stretching is not good for your pain, is a very puzzling one to accept.

If you stretch a muscle in distress, you are basically signalling to your body that the tightening over-reaction – the one you are trying to find relief from – is indeed justified.  In this case, your stretch will perpetuate the underlying reason for muscle pain and tightness instead of resolving the problem.

The reason muscles grab and get tight is 100% protective in nature.  It is always the most reasonable response to unreasonable conditions.  You may not agree that the conditions are “unreasonable” but your brain and body’s assessment is all that matters during times like this.  If you don’t stop and find out what they’re protecting you from, there may be much worse discomfort lurking around the next corner.

Another interesting point is that the elongation stress associated with stretching can happen without, what looks to us like, a traditional intentional stretch.  Lengthening stress to muscle fibers is something that can be produced with sustained pressure on a muscle or a tendon.  When a muscle bundle is made to deform in this way it’s perceived by the brain as elongation. If that area is already inflamed, it will be a problem.  So, all of you foam rolling or ball rolling advocates beware!

A large part of my mission in educating patients is to highlight the subtleties in movement and posture that matter when we are in pain, but which often don’t seem very obvious to us.  By learning about these not so obvious contributions to pain, we can stop berating ourselves for “falling apart” and acknowledge the way forward. Recognizing the validity in our pain is a vital step towards feeling better and staying out of pain in the future.

An important part of Volume Two – Fix the Fire Damage will include information about exactly how and when to stretch safely and how to solve the problem of muscle tightness for the long term.

Click on this link for more at the original article Source: Stretching Out the Pain: Feels Good But is it Good FOR You? – Stop Everyday Pain

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Taking My Own “Medicine”

Taking My Own “Medicine”

Dobbins'_medicated_toilet_soap,_advertising,_1869When you’re a chiropractor, what does it mean to “take your own medicine” ?

“Walking my own talk” consists of more than just making sure I receive chiropractic care myself.  It’s about seeking balance in all areas of health.  With balance in sight, the need for professional treatment decreases.

My motivation is maybe a bit more intensely fueled than for most people because my body is my essential work tool.  If mechanical, biochemical or emotional balance is off, it directly affects the ability to fulfill my commitment to patients which in turn could potentially risk my livelihood.  This is an intense interdependence that I would never trade for anything but it can be more than stressful to be even just a little bit laid-up.

In last week’s post I alluded to a recently renewed return to health by restoring balance to my own life, after a year of pushing to get my book out, followed by the release and adventures in promotion.

Block Quote 4I cannot emphasize enough how much this pursuit of balance can differ from person to person.  I am taking a moment to briefly outline what this looked like for me at this particular juncture, to give you a very general idea of the factors to consider when thinking about your own balance in wellness.  In particular I want to illustrate some of the principles outlined in my book (Every Body’s Guide to Everyday Pain, Volume One – Put Out the Fire). Don’t wait until you’re in pain to find your true healthy balance. The everyday variety of pain is always a sign that something has fallen by the wayside in one of the three main categories (mechanical, biochemical or emotional) but things can be “off” long before pain strikes.

In my case, this time I needed first to focus on returning to a more regimented sleep/wake schedule.  I’ve learned that my body and mind operate optimally with 6,1/2 – 7 hours of sleep per night and this means I need to exercise a little discipline about getting to bed on time because I am not willing to get up late.  The morning hours are treasured time and important to my emotional well-being.  I’m very lucky to have good sleep hygiene and my body cooperates well when put to bed.  For times when that’s not the case (as everything ebbs and flows), I reach for homeopathic remedies, herbal teas or magnesium to calm the nervous system before bed.  A controversial trick that isn’t advisable for everyone but that works well for me, is to have a small bite to eat before bedtime as well.

Test tubes science backgroundRe-balancing my biochemistry is something that I dedicated the better part of two consecutive months to. Resetting my organ systems and aiding the natural detoxification, involved some herbal and food therapy.  I returned to eating simply by avoiding my known sensitivities: dairy, all animal protein, simple starches (sugar), nightshades and a few other specifics that I’ve come to recognize over the years as taxing to my system.  I’ve since then slowly returned to more variety based on what my appetite dictates.

Block Quote 2Some signs that will tell you about your sensitivities can be as subtle as an increase in heart rate within 1/2 hour of eating. Sometimes it’s just a little tickle in the back of the throat that passes quickly but is still a significant sign of intolerance.  Other times it can be a generalized increase in mucous production and that might be harder to spot.  The need to clear your throat or blow your nose in the morning might be signs of excess mucous production in response to a food trigger from the day before.  The point is that foods (sometimes very delicious food), not overtly considered as “allergenic” like peanuts, can still be considered by your body as a burden for your biochemistry.  So, it’s always important to pay attention to subtle reactions.

When I commit to helping my body unload excess waste, I also utilize dry sauna sweats, infrared if possible and pay extra attention to optimizing kidney and bowel function.  This makes a big difference in the associated discomfort of “detox”-related headaches and body aches that can happen when large amounts of waste are mobilized throughout the body for elimination.

My herbal and nutrient based regimen was also targeted, in part to facilitate elimination via the kidneys, liver and colon.  There are many different philosophies on which herbs are most appropriate and this is something that is best done with the advice of a natural health care doctor.  Focusing on aiding natural elimination is the best way to help decrease your body’s chemical burden from exposure to complex molecules in our air, food and water.

Balancing RocksFor me, restoring mechanical balance can’t happen without first adequate rest and attention to nutrition.  After re-setting sleep and nutrition I found my energy returning and started to increase activity based on that, but not until then.  If fuel or rest and recovery are lacking, then the exercise output ends up adding stress to the system instead of strengthening it.  This is why sleep and nutrient intake is first priority. It sets the stage for successful return to exercise.  Without this in place, workouts are pointless and counterproductive, potentially resulting in inflammation-causing stress.

Block Quote 3What my body and mind are willing and able to do changes with the seasons, years and stages in life.  This Spring, yoga was the doorway back to physical empowerment.  It helped me begin to feel able to return to swimming and weightlifting.  Now, my routine includes one yoga class per week and two other days of gym workouts which consist of a warm-up swim followed by an upper body or lower body weight resistance workout.  That’s three days a week of 1-2 hours of exercise. They are strategically spaced from my days with patients so that I am not too sore to be effective in the office, but also to avoid muscle fatigue related injuries.

There’s nothing rigorous about this current exercise schedule which is what makes it completely sustainable.  When starting a new routine, being consistent is more important than making a huge impact.  Come wintertime, it’s possible that my needs will change and I will change my exercise accordingly.  Perhaps in a future post I will take some time to address the how of tuning in to your own changing needs from season to season or depending on life and work situations.  It’s mostly a lifelong process of trial and error.

It can be tricky to walk the fine line between the intended exertion of exercise and inescapable demands of work life. But as you slowly increase physical activity, what always holds true is that you increase your body’s capacity for emotional, chemical and physical stress to keep from rebounding into exhausted inactivity.  It must be done in a loving way. Self-care routines are best implemented with gentle caring instead of harsh reprimands.  If you’re someone who thrives on hard line tactics for motivation – find a trainer or someone outside of yourself to play that role.

Even though it’s not an easy daily practice for many, being loving and yes even permissive with yourself makes room for healthy choices.  Remember real health can and does exist in imperfect bodies everywhere.  It’s about balance, not perfection.

Block Quote 1Lastly, you should know that it takes at least two full months – often three months – of consistent activity in order to surpass the “transition reaction” of new exercise.  When introducing a change in routine or physical demands, the brain and body will express themselves by exhibiting physical sensations that aren’t always 100% comfortable.

Sometimes the transition to a better balance in life includes re-visiting old pain that might feel like re-injury as we work to strengthen around these old vulnerabilities.  This is why it’s important to line up some outside help during these transitions either via massage, acupuncture, or chiropractic.  It’s the time when I see the greatest need for support in my patients.

Food for thought while you consider your own healthy balancing act: When we act in reaction or opposition to an idea or a feeling, we set the stage for inevitable failure. When we act out of caring and acceptance for the imperfection that is, we make good and sustainable choices.


Image Credits: Wikimedia Commons, Fotolia

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A Return to Writing (Health)

A Return to Writing (Health)

IMG_3980What an encouraging 3-4 month-long “trip” this has been since the release of my first book Every Body’s Guide to Everyday Pain Volume One – Put Out the Fire.  You may have heard that it’s now available through Amazon.com, Barnes & Noble, at the book website StopEverydayPain.com and for bookstores and libraries through the major distributor Ingram.

That first volume lays the important groundwork behind the reasons and causes for our everyday aches and pains. Now it’s getting to be time that I start piecing together the much anticipated Volume Two – Fix the Fire Damage.  This next book will continue striving to mirror the ideal experience of a typical patient under my care.  The next step after gaining an understanding of the pain is to repair and rehabilitate.  Everyone’s path looks a little different based on their individual situations but there are some common principles that apply to all of us, based on what is revealed in Volume One.

I’m excited to share those insights with more people now that I see and hear how helpful this first book has been.  There are more photos to organize and action steps to share with readers.  Another exciting feature to this next volume will be interview material that I am preparing to gather from outstanding complementary healthcare professionals.

To truly reflect the multi-pronged approach to everyday pain that I advocate for in my practice, there is just no way that I could consider moving forward with this project without reflecting the voices of a larger healthcare community.  Stay tuned for how that unfolds through some fun video sneak-peeks of my progress with willing participants!

There is also a wealth of experience and perspective that I gained while doing a short publicity tour of podcasts and radio shows over the past several months.  I’ll be sharing some of my thoughts about those in this blog feed throughout the next year or so.  The many gracious hosts who took an interest in myself and my project inspired me to elaborate further on some book matter and I’ll be addressing some of that here as well as in my next two volumes.

I am discovering how much I love wearing these new hats: Indie Publisher and Indie Author.  Creatively speaking, it’s extremely rewarding to me and I never shy away from the challenge of hard work – which it has definitely been. IMG_4113A steep learning curve but, much like what classroom teaching offered me years ago,  this process provides invaluable perspective to my one-on-one time with patients and vice versa.

The whirlwind of the past year took its toll on my self-care as can be expected.  But now I’ve had my turn at returning to my own health by applying some of the principles in my book – restoring my physical, chemical and emotional balance – I live fervently by the conviction to “begin again” without judgement or guilt any time I stray from healthy routine.  Ups and downs are such a part of life.  I embrace it all and I hope you will too.

I’m ready now, to buckle down with the creation process again and return to writing.  Thankfully this stage won’t take 5 years like the first book did.  My publishing team is firmly in place and the book production path has been forged.  It’ll be easier to find again during the next round.

Onward.

Tissue Acidity is Real. Debunking the “Debunkers”.

Tissue Acidity is Real. Debunking the “Debunkers”.

strumenti laboratorio chimicoThe controversial issue concerning the role of pH in health is one with heated opinions on both sides of the fence. But what are those sides of the fence? Well, there is a strong cohort opposed to the concepts that acidity or alkalinity (measured on a scale of pH) is in some form or another related to health and, in particular, that the food we eat has any bearing on our body’s pH value. The other side is preoccupied with promoting products like pH-regulated water that will supposedly “cure” you of all diseases. Neither position on the matter is doing justice to the facts.

I write about the influence of pH in my book Every Body’s Guide to Everyday Pain. There is no scarcity of research to support the fact that low tissue pH (acidity) is associated with inflammation, which can lead to pain.1-6 This is an extremely relevant point when considering the paradigm shift necessary to recognize early indicators of dysfunction and imbalance — these will help us learn to avoid the perplexing everyday variety of pain that often seems to appear out of nowhere.

Block Quote #1The science of pH in human physiology is complex. There is no easy cause-and-effect scenario to follow, and no straightforward way exists to measure pH in the body in real time. For example, urine pH values do not accurately represent the pH values in your joints and tissues, and salivary pH is not directly representative of your intestinal pH status because normally food is processed by your gastrointestinal tract and, in doing so, the composition of what you ingested has changed. The reality is that the acid/alkaline status of your body is a moving target and is not uniform across all systems.  These crude measurements (urine and saliva) act as red herrings and provide—at best—educated guesses about what the body is actually going through at any particular moment.

One very important truth that every pH “debunker” gets right is that blood pH does not fluctuate. This tight control over blood pH levels is essential to keeping us within the very narrow parameters needed by our cardiovascular system to keep us alive. Keeping our blood pH from fluctuating is so important that, when we are exposed to acidifying influences that could disrupt our blood chemistry balance, an elaborate biochemical dance occurs in all other body systems in an effort to “take the hit” for us. Our body copes in other ways to handle the stress and temporarily becomes compromised in some way to protect the blood pH from potentially life-threatening fluctuations.

What sorts of things cause this kind of pH-shifting biochemical stress? Anything that our cells are exposed to in the course of daily life can cause a shift—air, food, and water act as the three main vectors. Our air is filled with byproducts of industrial exhausts and at different times of the year with complex plant proteins that become airborne and act as allergens. Food comes in many formats in our society of “now” and modern conveniences. Packaging, processing, and preservatives introduce chemical compounds that our bodies were not Block Quote #2designed to tolerate on a regular basis, and what we think of as water is no longer just H2O (two molecules of hydrogen and one of oxygen). Water is generally considered safe, but the measures needed to create safe drinking water in developed countries may also introduce miniscule amounts of foreign molecules into the water supply.

The key realization here is to understand that the issue isn’t necessarily exclusively about the pH value of these substances themselves, rather that, in large part, it’s the body’s protective responses in the face of biochemical stressors that change our tissue chemistry

Let’s look at a common response to biologic “invaders”: Histamine. Histamine is an irritant produced in response to a wide array of allergens, and evidence suggests that histamine itself presents an acidifying effect.7-9 These inevitable acidic influences have to hit us somewhere and, if not the blood, then where?

An important distinction often missing from these discussions about pH is that blood pH is not the same as tissue pH. Tissues are bathed in interstitial fluid made up of lymphatic and cellular materials (amino acids, hormones, sugars, fatty acids, coenzymes, neurotransmitters, salts, and cellular waste)—none of which equates to blood. In processing biochemical stress from any source—whether dietary, environmental, or emotional—it turns out that the tissues of the body, not the blood, are the most affected.

Armed with these facts about pH in the body and its association with inflammation, it’s compelling to consider the following possibility: It seems that every food theory that aims at decreasing inflammation and enhancing gut and brain health (based on the acidity/alkalinity of your food or not) are successful to at least some degree. Could the true reason for this be because of the net effect on tissue pH? Well, it’s not quite that simple. There’s a catch: People report a wide variety of results. So, does that mean all this food hype is bunk?

It’s certainly not “bunk,” per se, but it’s worth remembering that, if no measurable correlation exists between the acidifying influence of the food itself and a particular person’s body pH, then any results seen (whether good or bad) are likely a factor of that person individual’s biologic response based on his or her unique genetic profile. So, what does that mean? It means that results are highly variable.

Which foods or airborne particles do your cells consider to be allergens (ie, foreign)? Firstly, this is something that changes as we age; secondly, it’s dictated by your genetic profile; and, thirdly, to complicate matters, outside influences (environmental, including stress) can change the responses of your genes to allergens.

These are the facts:

  1. In general, inflammation is at the root of dysfunction and disease.10
  2. Tissue acidity provides an environment conducive to inflammation.11

If we can avoid providing the perfect playground for pain and disease, then why shouldn’t we try? Exploring the foods and substances that expose your cells to the least amount of acidifying stress is a very personal journey. The array of widely touted food theories may be appropriate for some people and represent a good place to start, but you may find you’ll require some guidance from a natural medicine practitioner at some point to help you pinpoint what your specific situation calls for and the individual needs of your body.

For professionals in the dietetics field or those in the food industry to claim that what we eat doesn’t affect our health in this way seems a bit ironic and counter to the mission. I hope the conversation continues for the sake of shedding light on ways to minimize biochemical stress—whether that be through dietary changes, lifestyle modification, or in other ways—with the ultimate goal being to increase quality of life for all.

 

References

  1. Bray GE, Ying Z, Baillie LD, Zhai R, Mulligan SJ, Verge VM. Extracellular pH and neuronal depolarization serve as dynamic switches to rapidly mobilize trkA to the membrane of adult sensory neurons. J Neurosci. 2013;33(19):8202-8215.
  2. Ugawa S, Ueda T, Ishida Y, Nishigaki M, Shibata Y, Shimada S. Amiloride-blockable acid-sensing ion channels are leading acid sensors expressed in human nociceptors. J Clin Invest. 2002;110(8):1185-1190.
  3. Wu WL, Cheng CF, Sun WH, Wong CW, Chen CC. Targeting ASIC3 for pain, anxiety, and insulin resistance. Pharmacol Ther. 2012;134(2):127-138.
  4. Birklein F, Weber M, Ernst M, Riedl B, Neundorfer B, Handwerker HO. Experimental tissue acidosis leads to increased pain in complex regional pain syndrome (CRPS). Pain. 2000;87(2):227-234.
  5. Lin CC, Chen WN, Chen CJ, Lin YW, Zimmer A, Chen CC. An antinociceptive role for substance P in acid induced chronic muscle pain. Proc Natl Acad Sci USA. 2012;109(2):E76-E83.
  6. Steen KH, Steen AE, Kreysel HW, Reeh PW. Inflammatory mediators potentiate pain induced by experimental tissue acidosis. Pain. 1996;66(2-3):163-170.
  7. Uvnäs B, ed. Histamine and Histamine Antagonists. New York: Springer-Verlag; 1991.
  8. Hiller A, The effect of histamine on the acid-base balance. J Biol Chem. 1926;833-46.
  9. Rocha e Silva M, Rothschild HA. Histamine. Its chemistry, metabolism and physiological and pharmacological actions. Springer-Verlag Berlin Heidelberg GmbH. 1966:233.
  10. Cohen S, Janicki-Deverts D, Doyle WJ, Miller GE, Frank E, Rabin BS, Turner RB. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci U S A. 2012;109(16):5995-5999.
  11. Jankowski JA, ed. Inflammation and Gastrointestinal Cancers. New York: Springer; 2011.