Chiropractic Treatment: Ankylosing Spondylitis

00:02-07:00What is Ankylosing Spondylitis?
07:02-12:38Examining Ankylosing Spondylitis
13:06-19:57Diagnosing Ankylosing Spondylitis
20:00-29:26Managing Ankylosing Spondylitis
31:45-37:00Omega 3 Supplements

What is Ankylosing Spondylitis?

Dr. Ben Boudreau: [00:00:05] Tonight, ankylosing spondylitis, so ankylosing means stiffening, and it comes from the Greek word Ankylos, which means bent, and so spondylitis means inflammation of the spine. So together we are done having this spinal stiffening caused by inflammation. A chronic inflammatory condition of the axial skeleton, which is your spine and the pelvis there, results in new bone formation, bone formation in areas where you otherwise wouldn’t get that type of inflammation. It usually starts in the lower part of the pelvis and then begins to make its way up the spine there. And I’ll just let Dr. Roach jump into the x rays now and explain what we mean by that.

Dr. Clayton Roach: [00:00:58] Yeah. So with ankylosing spondylitis and people typically will be abbreviated AS, so don’t confuse it with ALS or MS. This is AS for ankylosing spondylitis and ankylosing meaning fuzing. I think you said, Ben. Yeah. Bent spondylitis inflammation. You are going to get what’s called the formation of what’s called syndesmophytes. And if you remember looking at some of the x rays that we share with you and actually you can kind of see a normal-looking lower back here, right here and here, you can see that there’s like a candle wax dripping appearance.

Over here and over here, and you can tell that the spacing over here is being connected by bone on either side, that is what we call those syndesmophytes. So imagine now a spine that’s meant to bend and rotate that now has vertebrae connected to one another. Obviously, the mobility is not going to be great. So we have what’s called syndesmophytes started to fuze the spine where you’re going to start seeing that is an area called the pelvis, specifically the SI joint. So I’m going to orient you a little bit as to where we’re looking at here.

Dr. Clayton Roach: [00:02:27] This is called the S.I. joint right here. It stands for Sacro. And that’s the sacrum iliac, which is the big bone over here. So right over here. You will see. The joint, and it’s right over here as well, I’ll just make two dots right here, you can follow the line of that S.I. joint right in through here. The first thing you’re going to see with somebody who has AS is starting to fuze these joints called the SI joints. So as you can tell by these arrows right over here. There is no joint there, so now that person doesn’t have the ability to move in through these joints right over here.

So that is crucial because what ends up happening is typically low back pain. And then, later on, you’re going to start to see fuzing these things over here a little bit further up and it’s going to start at around T12 and it’s just going to spread throughout the entire spine. Ben, do you want to talk about the ALL Anterior Longitudinal Ligament?

Dr. Ben Boudreau: [00:03:42] Yeah, sure. So ALL anterior longitudinal ligament is the ligament that lies on the anterior the front aspect of the vertebral bodies. And so it’ll create this this sign on x ray, a trolley track sign or a bamboo spine. But essentially that area will get targeted and it’ll begin to Ossify and Fuze to one another. And so when you’re looking at the spine from front to back, it’s difficult to make out. But you can make out some of that fusion like where Dr Roach drew there.

And that’s actually the fibres of the disc fuzing, which is pretty, pretty cool, bad for the person who has it, but cool for us chiropractors because the ossification starts from the bottom of one vertebra, bodying runs right to the top of the other, which is really uncharacteristic and of anything else besides just this condition, which is really, really, really interesting.

Dr. Clayton Roach: [00:04:43] Yes, if you’re looking straight on at somebody, the part of the spine that’s facing the organs, there’s a long ligament that goes all the way down the spine. So as that ligament starts to ossify, you can imagine that you start to get the appearance of being Bent forward because the ligament is able to move when it does not ossify. But when you start to turn that ligament into bone, it starts to bring you forward so that ligament would lie right in front. Of here, see, the ligament would go all the way down, and when that ligament starts to ossify, the vertebrae start to bend. Towards the middle and you would start to see a curve.

Dr. Ben Boudreau: [00:05:31] Yeah, yeah, definitely, and then structural changes begin at that point because now respondants out of alignment and so this condition, the onset is usually younger and so you’ll start to notice pain in a younger age group, which should trigger you to think that there’s something weird going on, because it’s you know, it’s not always common to have a lot of back pain in younger individuals. And so you always want to do your due diligence and take an image so you know what’s going on. So the onsets between 15 and thirty five, usually men are targeted much higher than women, three to one ratio. And it’s a it’s a pretty debilitating condition, as you can tell from some of the x ray descriptors here.

Dr. Clayton Roach: [00:06:15] I think that’s a first condition that we’ve talked about, that men are more at risk because we’ve told you that women are more at risk. So again, so this is the kind of intro to ankylosing spondylitis. So the high points, let’s just summarize. We have a bamboo looking spine where you can see. Kind of like the ripple effect of this ossification called syndesmophytes, you have the beginning of a fusion of the side joints over here and the fusion or the ossification of the ligament on the front of the spine that’s now going to start to change your shape and your posture into that bent forward looking position.

Examining Ankylosing Spondylitis

Dr. Ben Boudreau: [00:07:01] So so during the exam, what kind of things what can what are the things that we’d be looking for to help determine if an individual has regular low back pain or if they have a condition and inflammatory condition such as AS so the history will show an insidious onset of low back pain. So no cause, no trauma, nothing like that. That’s not really different because we see a lot of people who have low back pain and have not had trauma and also. Yeah, especially in our clinic and greater than three months. So that means that it’s chronic and this is a chronic inflammatory condition. It has to be greater than three months.

Anything less than that is more acute for patients under 40 years old. And there’s possible eye involvement. AS inflammatory arthritis. We have to think about inflammatory conditions. So other inflammatory conditions are Reiter’s syndrome, rheumatoid arthritis, psoriatic arthritis. Right. So you have to think about the involvement of the organs as well as the soft tissues. And so uveitis, which is inflammation in the eye, a possible condition that may be associated with that. So we have to look out for that.

Dr. Clayton Roach: [00:08:20] Yeah, yeah, so the hyperkyphosis, so we have two types of the curve in the back, one is called lordotic, so that would be the one in the neck and the one in the lower back. And we have to kyphotic curves, which are the one in the middle back and your buttocks, your sacrum. Right. So the spine will take a hyper photic look. So from the side, you’re going to have a large hump from the bottom part of the neck and through the middle-lower back. Definitely inflammation lower back, which when there is inflammation, as we know there is pain.

There is no pain without inflammation. So when there’s pain, there is inflammation and general malaise. Like I’ve noticed that with some of my AS patients that, you know, some days it’s the lower back, some days it joints in the neck. And so it can kind of flip flop and every day can be a little different than the last day.

Dr. Ben Boudreau: [00:09:23] Yeah, yeah. With this condition, I was going to say it’s you know, it’s one of these conditions where you can go up and down some days it’s good and then some days it’s bad. So whenever you’re doing any sort of treatment and especially, you know, taking care of patients like this, it’s it’s always good to make the best of your good days. And that way you can sort of get everything done and get the movement that you need to get through your spine. Just going back. Patients feel really stiff in the mornings usually, and then that tends to to go away throughout the day. Normally in this condition and like we said, we want to be able to check the side joints because that’s where it starts and they’ll likely have pain there.

We also do things like a forward bending test. So we want to see just how far you can bend forward, how much flexion and extension and flexibility do we have in the spine. We’re also checking the cartilage of the ribs because in a condition like this, it affects the joints of the ribcage. And so we want to be able to assess, OK, how is the breathing, how his chest expansion, because as you can see, for our man that’s in that lower photo there, when you’re bent forward, there isn’t a lot of chest expansion that can happen at that point.

Dr. Clayton Roach: [00:10:38] Yeah, and that brings a point to that. You can’t forget the rib cage articulates with the spine. So there’s a joint. So why do you take a deep breath in that expansion’s needs to be a certain amount centimeters. And when it’s short of that, you have the question, why is that? Right. So definitely COPD, chronic obstructive pulmonary disorders can also cause that. But then you go with your health history and see what else is going on. And one thing to not forget about is because this is affecting the spine and you’ve got major syndesmophytes, and fusions happening all over the place.

These types of people can get stuff like sciatica, pain going down the arm so they can present just like any other person would with neck pain that’s radiating to the hand and fingers and no back pain that’s really into the lower back or sorry to down the leg, because you can have nerve roots that are irritated because of the amount of ossification that’s now happening at the spine.

Dr. Ben Boudreau: [00:11:35] If you’re not being careful, you could treat the condition, think that it’s an S.I. joint. This happens in chiropractic offices all over the world. Since we treat an SI joint commonly with most sciatic conditions. And, you know, so it’s very important that if you have any hallmark signs of an inflammatory condition, that further investigation is warranted. And I think that’s what the next slide is about.

Dr. Clayton Roach: [00:12:05] Yeah. So one more thing is typically when these conditions get a little bit further, we would ask because of the fusion of the ligament, if you were to lay down on your back, which you will not be able to do a sit up because your spine can’t Bend because the ligament is fuzed, you don’t have the ability to roll yourself up. So with you’re almost like a turtle on its back and you can’t you can’t get out of that position because of basically the physiology of what’s happening with that condition.

Diagnosing Ankylosing Spondylitis

Dr. Ben Boudreau: [00:12:39] So just as a little break, I hope everyone’s enjoying this presentation so far, this is a really cool condition, something that we talk about oftentimes in chiropractic colleges. And it’s also there are courses offered out there to help medical professionals be able to determine much faster these types of conditions. And so if you guys are enjoying this, give us a like and share. So thank you very much. So when diagnosing the condition, the first thing that you would do is likely image, and so you want to be able to check to see, OK, are the S.I. joints fused, do I see any of these syndesmophytes in the low back in the next place so you can check?

Clearly is the neck, and as you can see in the photo to the left there, you see how that ALL as well as the PLL, there’s fusion. So the anterior longitudinal ligament and the posterior longitudinal ligament, as well as ossification of the disks.

Dr. Clayton Roach: [00:13:47] So it’s a really cool all here. Which one do you think. Yes. And which one do you think is osteoarthritis. So in the comments section. We want you guys to tell us which one is just degenerative this disease, not AS is it the one on the right? So put our four right or L for left for osteoarthritis, degenerative diseases. Not AS. So we’re just going to wait for a few seconds here to see. How many of you have become radiology experts,

Dr. Ben Boudreau: [00:14:26] Little participation, right or left, L or R,

Dr. Clayton Roach: [00:14:33] Which one is osteoarthritis, the one on the right or the one on the left are or L.

Dr. Ben Boudreau: [00:14:48] And so we got right.

Dr. Clayton Roach: [00:14:53] All right, who agrees? Good job, guys. Excellent. So, yes, it is indeed the one on the right. So if you recall, I’ll just do a few little annotations here. This is the disk space. This is the vertebra. We have seven vertebrae in the neck, two, three. Four, five, six, seven. This guy is not fair and to hell, and the reason I say that is because you’ve got very, very thin spacing right there, very thin spacing right here. And you’ve got what’s called spondylolisthesis here. Anterior spondylolisthesis right there. And you’ve got scalping here. This guy probably has some numbness and tingling going down the hands, he’s got absolutely no curve in his neck. He’s actually got a reverse curve going this way.

So this is a good review for some of our other conversations. Here is his hyoid bone right over here just as an anatomy thing. And this guy, you can tell, has a lot of forwarding head posture, which is the inside of the ear. It’s hard to tell here. It’s called over here and you draw a line all the way down. Here’s the top of the shoulder, so his head is probably at least two to three inches forward. So not a great look at x-ray here, but definitely this is the one with. Yes, and what Ben was saying is that the ligament on the front here is all fused and you don’t see the opening of the disk space, right? There’s no opening because this is fuzed right here. This spine does not move.

The only place you see that there’s actually an articulation is actually right here between C1 and C2. And the defence is a little bit more advanced, but you can’t really see it here too much. But C1 and C2usually are not involved with AS as well as C0 C1. But from C2 down, this is one vertebra really moving all as one unit. And you can see it here in the back as well. You can see some Forsett arthritis over here. You can still see the line there. So this is a mess. Yeah.

Dr. Ben Boudreau: [00:17:30] Yeah. And that was a great explanation. So, yeah, we use X-rays to help compare. We want to compare it to normal. And those are hallmark signs that we look for on imaging. So the first thing that somebody would do is send you for an X-ray, see if there’s any involvement and joint involvement and any signs of ask. The next thing that a prudent doctor would do after doing such a thing is they would then send you for blood work. And so the first one that’s very common among people, what they ask to check for is HLA B27. It’s used as a marker for spondylo arthropathies. And so these are arthritis in the spine. So things like inflammatory arthritis, reactive arthritis, psoriatic arthritis.

So they’re looking for proteins on top of white blood cells, the B27 protein, and so somebody who has AS will test positive for HLA B 27 ESR. Yeah. Just to talk about blood Work quickly Here, these are two other ones as well. That prudent doctor would also send you for ESR, which is a marker of increased inflammation. It’s not a Test for AS It’s just to tell you, OK, yes, there’s increased inflammation in the body here. So there’s likely an inflammatory condition involved

Dr. Ben Boudreau: [00:18:53] And then rheumatoid factors. Again, it’s not a test for AS specifically, but it can help rule out other conditions and spondylarthropies things like psoriatic arthritis. If you test positive for the rheumatoid factor, you could test it means that you could have an inflammatory condition, but not necessarily as cause as doesn’t like it, AS is the only inflammatory spondyloarthropathy that tests negative for rheumatoid factor. So if you have an inflammatory condition and test negative for rheumatoid factor, you likely have AS.

Managing Ankylosing Spondylitis

Dr. Clayton Roach: [00:19:31] that’s a great point. That’s a great differentiator there. And ESR guy stands for erythrocytes sedimentation rate. Basically, to make a long story short, if you had blood cells in a vial and it’s how quickly the red blood cells fall to the bottom if they’re thick and molasses-like then we have inflammation is very, very slow. Right. So, yeah, great. This is how we differentiate diagnose a condition like AS. Yes, so I can touch base on this Ben addressing the whole person, you know, I always tell people that we don’t treat the condition, we treat the human being. We don’t treat an x-ray. We don’t judge the x-ray and assume that a person is going to be a certain way because you know, what’s lying on our table is not an x-ray.

It’s a person. So one of the things that we can definitely do with, AS suggests, dietary changes to be a more anti-inflammatory diet, because obviously, AS is an inflammatory condition, that basically no one here that Ben put in. The study published in February in twenty nineteen Journal and Advances in Rheumatology found that high-fat diets resulted in worse disease outcomes for patients. With AS now we have to clarify that those are not good fats like avocados and stuff like that. These are like trans fats and stuff that we are not supposed to eat, but definitely reducing your intake of any of the white stuff like flour and sugar, processed foods and going towards more a paleo style diet is definitely going to help reduce the amount of inflammation your body.

And one thing you can do very easily goes on Google and type in inflammatory foods. And those are the foods you’re going to want to avoid. Some of those might be nightshade vegetables. So it depends on the body in terms of how you’re reacting, because some people know when they eat certain foods that they become inflamed and people that pay attention, that have inflammatory conditions can most of the time point out and say, you know, when I eat that, I feel like crap the next day. Right?

Dr. Ben Boudreau: [00:21:44] Yeah, for sure. It has a lot to do with the breakdown. They’re not fully understood why it is that you know, it leads to that increased inflammation, but it has shown that high-fat diets, the bad fats, the sugars, alcohol, can inflame these specific conditions. It’s prudent to avoid any sort of inflammatory food when you have a condition such as this because one flare-up or a few flare-ups in a row can really put you down a bad path. Anyone who has asked knows that it’s a condition where you have to watch where you’re eating and you have to watch what you’re doing and you have to make the best of the good days.

Yeah, the next thing I mean, there are things you can do like postural and mobility exercises. You want to keep your joints healthy, you want to keep your joints moving and you want to keep your chest moving as well, because, again, it’s one of the conditions that attack the ribs. And so chest expansion will be reduced. So you want to make sure that you’re doing deep breathing exercises, thoracic spine mobility exercises like camels and fire hydrants, kickbacks, pelvic tilts, gentle, gentle Asanti, very, very gentle. Some moving the joints through a passive range of motion, getting that movement there and as well doing a little bit of soft tissue. Dr. Roach do you want to come in? And a few other notes?

Dr. Clayton Roach: [00:23:22] One thing that I would say, you know like I’m fairly aggressive on like my patients that I’ve seen once, you know, the x-ray and where the patient is fused because of the AS to the parts of the spine that aren’t. I mean, they’re just fair game and what you want to do is through chiropractic, maintain the mobility there because you know that part of the spine is working extra hard because none of the vertebrae below that are few are have any mobility. So if you’re fuzed from T12 down to your pelvis, you know T11 is moving a heck of a lot more to try to compensate for all the movement that you do throughout the course of the day. So that would be one thing that I would recommend with people that have a yes.

Find out exactly through the chiropractic examination and X-ray and everything that we do, exactly which vertebrates are actually fuzed and the rest we need to keep mobile to find out an exercise regime that is the right amount for you. Because what you what we know with the AS is that when you do too much, you run the risk of inflaming things and people get discouraged to say, oh, I was doing biking, I was doing that and I can’t do that anymore. Well, it might just have been that they were doing too much.

You got to find a routine that you’re able to do on a daily basis, whether it’s just spinal mobility thing, but even aerobic exercise and stuff that you can do that’s a little bit more advanced. You got to find a way to do that in a way that it’s not too much every single day. So the word pacing is very important where you pace yourself and doing stuff that, you know is a routine that is doable for you every single day.

Dr. Ben Boudreau: [00:25:00] Mm hmm. Yeah, great point. I was. And just to move on to the next bullet point here, ergonomic changes. If your environment isn’t proper and your environment encourages this curve, encourages this structural malalignment, then things need to be changed because you have a condition that’s also working against you. So you have to be in control of the things that the other stressors are more controlled or controllable than an intermittent inflammatory condition. So changing the environment to help meet the needs of your body is hugely important.

Dr. Clayton Roach: [00:25:37] One of my patients that I had about 10 years ago, his name was Jim. And then Jim came in, was asked, you know what? His job was used to work in a crane. High up in the air where everything was below him, so all day long, he was looking down in between his legs, running the control right in terms of getting that rope down exactly where the people underneath needed it to carry stuff. So definitely an ergonomic position that fed the ankylosing spondylitis because he spent the whole day with his head down, looking down at the ground from three hundred feet above.

Right. Definitely, a great point where you need to make changes to your lifestyle and your job and your position every day so that you’re not fast-forwarding this whole process quicker than what you what it can go when it’s naturally going to go if you make those changes.

Dr. Ben Boudreau: [00:26:37] Yeah. So diets just to touch on that top point, again, I have a few bullets for you guys. Diets with omega 3s are really good. There was some research conducted that it does help people with AS. And so foods that you can get omega 3s in flax seed, walnuts, soy beans, cold water, fish like salmon and tuna. And you also might want to maybe practice a regime where you’re trying to figure out which foods are causing your inflammation. Again, we can go back to an inflammatory diet and antiinflammatory diet or an elimination diet where you’re trying to eliminate out certain foods and then adding them back in to figure out which one was causing that inflammation. So it’s a little tip and trick to try and try and reorganize your diet a little bit.

Dr. Clayton Roach: [00:27:29] And FYI. Conditions like AS not to. Not too different than rheumatoid, which are now being called autoimmune. It is not uncommon for these conditions to be with autoimmune disorders from the thyroid, so to speak, as something like Hashimoto’s with Hashimoto’s if you are Gluten sensitive or you have a gluten intolerance. Any amount of gluten will basically destroy your thyroid even faster because with Hashimoto’s right, it’s an autoimmune disorder of the thyroid. The reason I say that is because. Typically, autoimmune disorders hang around other autoimmune disorders, so if you have AS or rheumatoid arthritis, it’s not uncommon to see other things.

If that’s the case, then any amount of gluten you’re going to eat is usually going to create an inflammatory response that your body is then going to try to fight and then you start to run the gamut of having inflammation throughout the entire body. So. You know, definitely, the same cells that will attack the gluten will attack your thyroid because you have an autoimmune disorder called Hashimoto’s, which tends to run with other autoimmune disorders, which could be rheumatoid arthritis and MS and all these autoimmune disorders. So just wanted to point out,

Dr. Ben Boudreau: [00:29:00] You know, diet plays a hugely important role, and that’s something that should always be considered. You should always look towards eating a healthier diet or eating healthier foods. I should say diet is a word that’s thrown around way too much. But eating healthier foods make an effort to to adopt better foods that are good for you. Good stuff.

Dr. Clayton Roach: [00:29:26] Cool. Give us a few hard stares, guys, if you like this information so far and definitely make a comment if you know somebody that has a voice because it is not that uncommon. Just comment. Yes. If you do know somebody who has a voice and that would be greatly appreciated because it gives us an idea of, you know, how good our topic choices are because we want to definitely talk about stuff that’s common. And lastly, at this point, before we forget, let’s have you share this episode because you might have somebody that you know or somebody that you just want to know about us. So thank you. We got to feel important.

Dr. Ben Boudreau: [00:30:12] Yeah. Sonia. Yeah, a great point. Something that works for one person may not work for something else. There’s a famous quote from one of my process chiropractic colleges. He used to say, different people are different. If people are different and in chiropractic, we know that one adjustment with one person might cause the issue to resolve quickly, whereas sometimes it takes a few adjustments for an issue to resolve. We understand different people are different. When it comes to diet, most importantly, one regime might not work for one person as it did for somebody else. And so that needs to be considered totally and accountability partners again. Great point, Sonya. Great point. Having somebody, especially when we were doing this in the beginning, we were talking about New Years’. What was it, Clayton? The New Year.

Dr. Clayton Roach: [00:31:10] I forget what did I say

Dr. Ben Boudreau: [00:31:12] That was so clever, the new year, but the New Year new me, right? When you go into New Year, you got to have accountability partners that are on the same level as you. Right. And so if you have one person who’s gung ho to go to the gym that next morning or, you know, to go for that walk at six a.m. and then they go and they message them at a 10 to six and they say, you’re ready and the person doesn’t wake up. Well, that’s not really the right partner that you want. Right? You want somebody who’s going to hold you accountable. So, yes, accountability, hugely important.

Omega 3 Supplements

Dr. Clayton Roach: [00:31:45] All right, so the supplement of the month we’re going to talk about to make it through here. We’ve done some before, but we thought it would be very important being the topic that we’re talking about tonight, which is an inflammation or arthritis. Definitely omega 3s can play a role in that. This is one of the supplements where I kind of tell people to spend money on because the last thing you want is to be taking a omega three that has rancid fish oils in there and fish oils become rancid very, very easily just by exposing them to oxygen. It’s a process called oxidation and the process from catching a fish to extracting the omega three and putting it into a fish so that we can take takes time.

The short amount of time that is, the more fresh the fish is going to be in the supplement. And I can tell you without a doubt, if you are taking an Omega-three that you are burping or that has a smell, it is not a good omega three. So some omega three companies take a boat 12 nine to 12 months to go from catching the fish to the pill. You break that pill open and it smells rotten. OK, so be very careful where you’re buying your omega-three. Make sure you take a very good Omega three.

And there are actually companies right now that are working into one of my patients is working on it to make it three from algae, which is very sustainable instead of killing fish, which actually don’t have a lot of omega-three. And you need to kill a lot of fish in order to get omega-three. So definitely antiinflammatory, very, very good for brain health as well.

Dr. Ben Boudreau: [00:33:33] Yeah, yeah, and they’re actually recommending that children have enough omega-three during their developing years up until the age of 12 and even continuing on for that proper brain development. Just as an example, I have the nutrition omega-three product right here. As you can see, it is a fairly large bottle. And this is the liquid version. You can get the capsule versions like Dr. Roach was talking about. But this is the liquid option and it is a great, great, great product. Again, all of our products are that you can get at the clinic are our high absorption absorbency rates and great quality products. And so if you have questions about these and how to get them. Contact the office.

Dr. Clayton Roach: [00:34:20] And with you know, you’re exposing everything, so basically, if it’s rancid, you wouldn’t be able to hide it if it’s not a capsule. So, you know, the product is going to be good. And definitely, one thing to do with the bone density. Right. Very important as well in terms of bone health. And actually, they use a lot of it, make it through. This company actually does a lot of omega 3s for animals, for dogs.

Dr. Ben Boudreau: [00:34:50] So. Yeah, because, see, Claydon is a is this a Canadian company, Nova Scotia

Dr. Clayton Roach: [00:34:56] it used to be called Ocean Nutrition and they were bought over an ocean. Nutrition was basically founded by a local person here, names called John Riseley, who used to own started Clearwater Clearwater Seafood to start ocean nutrition and then sold it off to another company. But in terms of where people get their omega-three for the supplements, the biggest company is actually in Denmark. So a lot of the better companies deal with Denmark and some of the other followers. You just don’t want to buy them, so. Yeah, so, yeah, definitely for kids, very important, I mean, we eat less and less fish in our diet, so it’s kind of second nature to us being from Cape Breton or if you’re raised up close to the water, fish is a big staple in our diet.

So maybe it’s a little bit more forgivable there if you’re not taking the omega-Three if you are taking a lot of fish in your diet. But it’s definitely not common now, especially not something that’s not farmed. So you don’t want to be taking farmed salmon, you want to eat wild fish. So how would you many Omega 3 Should you take daily if you’re taking this supplement? It would be about a teaspoon a day, right. So this the one that Ben showed you would last you around two to three months. Yeah, and if I’m not mistaken, it’s about a per teaspoon,

Dr. Ben Boudreau: [00:36:20] It’s twelve fifty twelve fifty or one hundred and fifty milligrams.

Dr. Clayton Roach: [00:36:24] So they’re right, they’re

Dr. Ben Boudreau: [00:36:25] Right on the bottle there. Tells you the exact equivalent that you should take. It is one teaspoon a day. Alicia just wrote in the comment section there, we also have this product in capsule forms, but it takes more capsules to get the equivalent of one teaspoon of liquid. We normally recommend liquid.

Dr. Clayton Roach: [00:36:48] Now, somebody with AS I would tell him to take two teaspoons a day. Like, it’s just. It’s a no-brainer, right? You need to get that as well as other anti-inflammatory things, but definitely a lot of the concepts that do apply to ask also apply to other things, because a lot of things that we spoke about are generic eating, an anti-inflammatory diet. Do you really want to wait till you’re full of information to figure out that you need to eat an anti-inflammatory diet like that’s something you should be doing every day, exercising good nutrition? And all we want to do is speak about this because it is somewhat fairly common and a lot of people don’t find out to us until they’ve eliminated everything else.

Then down the road, Figueiredo that they’ve had it. But you can short that diagnostic process if you somewhat follow what we’ve talked about tonight. So, yeah. I hope you appreciated this. If there are any questions throughout the weeks, guys never hesitate. We are here for you guys. We’re doing this for you. We obviously know this information and we’re sharing it so that you become a little more aware, aware of your world. And if something is asked of you by friends or colleagues, you can refer them to Humpday conversations.

Or maybe you can answer them because they’re asking you a question that we’ve touched on in the previous Sunday conversation. It might be even for you when you go to your medical doctor, maybe you are no more engaged. You’re asking better questions because some of the things that we’ve discussed that have been our goal all along are to educate you because with more knowledge comes more power and more power comes better decision-making processes. So, yeah, I know what your thoughts are on that, Ben. But that’s what I want to do.

Dr. Ben Boudreau: [00:38:36] Yeah, that’s that’s definitely why we do Humpday conversations. And for those that are new to Humpday conversations, welcome to the conversation. This is the twenty six week that Dr. Clayton Roach and myself Dr  Ben Boudreau. I’ve been doing these conversations informing and educating patients on the positive aspects of learning and asking good questions and having better conversations with your health care providers so that they can give you the answers that they want to give you as well.

At the same time, I mean, these topics are coming because of the organic nature of the way the conversations are flowing and where you guys are directing us to go. Question Nights are a great night because they help us sort of getting into your heads and see, OK, well, where’s everybody at? Because we don’t want to meet you where we are. We want to meet you where you are. Right.

Dr. Clayton Roach: [00:39:32] And just to touch on that a little bit more is the reason we’re doing this talk tonight is because of a question that came up the other day that we felt we needed to expand on on a type of arthritis that are out there. So. Please tonight, guys, if we can just as a group, go out and share this episode, every single one of you just hit share no excuse. You now have an obligation because you know more than your neighbor, you know more than your friends. You now have an obligation to share. Right. It does nobody any good to hold on to this information because you’re now being selfish, because you might help actually somebody by disseminating this information out there.

There is somebody out there looking for the information we share tonight because they might not know what’s going on, but they know they have some kind of inflammatory arthritis and tonight might be able to clarify that process for them. So please, please, please go ahead and share this episode. We could share something with somebody who’s living in Ontario. But if they’re getting help, that was our goal, is to help somebody get the information, get further help, that what we can provide here because they’re just not here. So I want to thank you guys for everything you’ve done so far and to share the episodes because definitely, something is growing more than we thought it was going to grow. And we actually enjoy Wednesday nights and. Yeah. So thank you so much.

Dr. Ben Boudreau: [00:40:57] Yeah, definitely. Thank you, guys. And just to just a quick before we get going. Yeah. We want you guys to share these conversations because, you know, our deepest desire is that someone sees this. They say, oh, I have something like this or I’ve been feeling this way and I just haven’t had the confidence or had maybe I didn’t think there was really something that seriously wrong with me. Our deepest desires that they go and get checked and that they find out that they have something wrong. This is what they can do about it to help improve their quality of life. And so at the end of the day, we just want to improve the quality of lives of people near and far, people that we meet and even people that we don’t. So this is what it’s all about.

Dr. Clayton Roach: [00:41:46] Perfect. Well, said Ben, so we are leaving you tonight with a big thank you from the bottom of our hearts for being here every night we see people again and again that I don’t think I’ve missed one episode. So beautiful to see. And yeah, so if you’re looking at this on YouTube, make sure you subscribe. We’re getting more and more subscribers on YouTube, which is great because it is another way to view our episodes. We’ve posted the following morning on YouTube. Please make sure you subscribe on YouTube. If you are watching tonight, if you haven’t done it yet, make sure you share the episode. And if you’re watching this later on Facebook, make sure you share it again. OK, so thank you so much, Ben.

Thank you so much for the presentation tonight and some of the information. And we’re getting close to solidifying the interview or the guests, special guests for our next interview type of Humpday conversation. So stay tuned for that. Thank you, guys. Have a great night and we will see you soon. What’s up? Listen, if you like this episode, you’ll probably like the other ones. The chances are pretty good. So here’s what you need to do. You need to like us and follow us on Facebook. Following means, you get notified when these two guys are alive. Next, family, friends, you need to share these episodes because you never know. You might help them because they need this information as well. And guys,

Dr. Ben Boudreau: [00:43:10] If you ever miss an episode, make sure you subscribe to us on YouTube. That way, you can watch the episode over and over and over again.

Dr. Clayton Roach: [00:43:16] Guys, we love you and appreciate you. Take care.