Saturday, June 16, 2012

Green Papaya for Uric Acid Problem (with Comments from Dr JB Lim)

The blogger received the following email from a friend offering a cure for uric acid or gout problem:

Dear All,

Just try it if you've got uric acid after all no harm done. This is a really effective, just mix green papaya cubes to the ordinary green tea, my cousin-brother tried and found it very effective.

I have also shared with a friend with gout to try this (his "toe joints" started to deform), after a week of drinking this formula there is significant improvement, and after two weeks the toe joints heal and revert to normal state.

It is almost three years now, the joint pain is gone, but he maintains the intake between 1-3 times monthly to avoid relapse. Other friends suffering from years of gout problem have also recovered.

It is good for all, even those without gout. Good formula! Do share with the people in need!

An improved sequence by Professor Lai from the China School of Pharmacy:

Cut green papaya into small cubes,
place into the water,
bring to boil,
then add tea leaves, similar to the tea-making process.

Clinical tests show that this brings better effects for treatment of gout, subject to frequent drinking of this formula.
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Mr. Liu Qing, Chief of the Rende Town in Tainan, was suffering for years from severe stomach pain around the posterior wall of stomach.

He used green papaya *as a tea pot* to prepare the family tea daily, after a month, his chronic disease condition was much improved. His family members with high uric acid were also healed by the same papaya tea.

For this Mr. Liu planted a lot of papaya to share with relatives and friends with similar sickness.

According to Mr. Liu, in selecting the green papaya as tea pot, pick those the shape of which is fat and short, with larger capacity.

Cut off the top part of the papaya, clear away the seeds, open a small hole at the upper side wall to facilitate pouring of tea.

Create a small ventilation hole at top cover, put in the tea leaves, pour in boiling water, place the top cover back onto the papaya, you may also use the toothpicks to secure the top cover.

Similar to normal process of preparing tea.

Liu like to use* Oolong tea* as the taste is good.

He was pleasantly surprised that the stomach pains he suffered for many years was healed after a month of drinking tea from the green papaya pot, without taking any other medication.

He passed some green papaya leaves to a friend who worked at a Medical Center to test and analyse the content.

The tests confirmed that the healthy enzyme present in papaya is beneficial to human health.

Now as papaya in Mr. Liu's orchard is yielding suitable size fruits, he would share the fruits with family and friends. Xu Fuchang, an experienced papaya farmer, said green papaya means unripe papaya, where the skin is still green in colour.

Generally, the papaya takes about four months to fully mature and ripen, but the healing effect would be lost after it is fully ripe.

Green papaya should be harvested when the papaya is approximately three months old, when the fruit is still firm, and the "papaya milk" contains high papaya enzyme and other healthy ingredients. Not only the green papaya can be used in tea drinking, you may also cut them into cubes, and boil with the ribs, or even slicing the green papaya into fine long pieces and fried with garlic, very tasty, and no adverse effects on the human body.

(Courtesy of forwarded mail from Khor Kean Kar)
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The blogger found a similar report in Chinese from the internet as follows:

青木瓜泡茶治痛風

台南縣仁德鄉後壁村長劉結慶患胃痛多年,把青木瓜當做茶壺泡茶喝,一個月後竟治癒宿疾,家人尿酸過多喝木瓜泡茶也不藥而癒,劉村長因而種了許多木瓜,送給有病的親友鄉親。劉村長說,青木瓜最好選擇果實肥短,容量比較大,將木瓜頂部切開,挖出木瓜內的種籽,再開一個小缺口方便倒茶水,另一邊開個小洞透氣,放入茶葉、倒進沸水後蓋回木瓜頂部,並以牙籤固定,泡茶過程和一般茶葉相同。

劉村長表示,茶葉使用一般品質的烏龍茶即可,味道不錯,他當做茶水喝了一個月,困擾多年無法治癒的胃痛居然不藥而癒,自己也感到驚訝,他把木瓜茶葉拿給在醫學中心任職的友人檢驗,證實木瓜酵素有益健康,現在只要果園木瓜有適合的果實,就拿來與親友分享。

種植木瓜多年的農民徐福昌說,本地民眾所指的青木瓜,就是還未成熟、果皮仍呈青綠色的木瓜,一般木瓜要四個月左右才會成熟,但成熟後就沒有療效,青木瓜大約在三個月大左右採收,這時果實較,果實內的「木瓜奶」含有木瓜酵素、木瓜等有益健康成份,不但可泡茶喝,還可以切塊連同排骨熬,或切細絲加蒜頭炒,都非常可口,對人體也沒有不良影響。
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Another report is found in the investigation on the claim of Green Papaya boiled with tea leaves being able to cure uric acid problem as reproduced below:

網路追追追/降尿酸治胃病 青木瓜泡茶眞神奇?

http://www.nownews.com/2010/04/28/10846-2596731.htm

網路流傳將青木瓜切丁放入茶葉中,如一般泡茶程序泡茶,長期飲用有很好的「治療尿酸」效果,這種方法真的有效嗎?

一般說到青木瓜的功效,除了廣告常提到的豐胸作用,你還想到什麼呢?網路上盛傳一個說法,指出飲用青木瓜切丁加入茶葉煮泡的茶,有「治療尿酸」的效果;而把青木瓜挖空當成茶壺泡茶喝,也可使多年胃病不藥而癒,這個青木瓜泡茶偏方,真的這麼神奇嗎?

尿酸過高=痛風?

原信指出青木瓜泡茶,有很好的「治尿酸」效果,還打著「『痛風』再見了」的標題在網路上廣泛流傳,在探討這種簡單的方式是否有效前,讓我們先來釐清尿酸與痛風之間的關係。

根據中華民國痛風之友協會「認識痛風」一文表示,「痛風」就是人體內尿酸新陳代謝異常,使得尿酸在血液中濃度過高,進而形成尿酸鹽結晶,沈澱在身體各部位所引起的急性關節炎。但尿酸過高就會引起痛風嗎?其實在追追追之前的報告中即有解答,宏恩醫院痛風科暨中華民國痛風協會首席顧問陳峙仰醫師表示,尿酸濃度超過正常國際標準值7.0時,就會變成「高尿酸血症」,其中約有十分之一的人會轉變成痛風。

簡單來說,尿酸過高會引發高尿酸血症,甚至轉變為痛風,也因此,《常春月刊》「偏方解密-青木瓜泡茶 可以降尿酸?」一文指出,降尿酸為痛風患者的長期目標,是進一步控制痛風發作直接的指標。以下我們就來看看,原信說的青木瓜泡茶,是否真的有降尿酸的作用。

青木瓜消腫+茶葉利尿 有助尿酸排除?

原信開頭指出,青木瓜切丁泡茶為「中國藥學院賴教授」改良的新方式。追追追小組查出,這位教授即為中國醫藥大學學士後中醫學系的賴東淵副教授,與熱心網友「破雷萬鈞」提供的線索相同。

進一步與賴東淵教授求證後,他表示,由於曾有尿酸過高的患者,因服用中藥加上飲用青木瓜泡茶而改善症狀,使他好奇:究竟是中藥發揮療效,或是青木瓜泡茶產生作用?便與任職於中興大學食品營養科的友人一起討論;兩人討論後,認為木瓜中所含的木瓜酵素,符合醫學上認為酵素具有的消腫功效,加上茶葉有利尿作用,因此理論上來看,兩者加在一起應有助於尿酸排除,進而降低痛風發作頻率。

事後,賴東淵思考,過去他建議有尿酸過高問題的朋友,使用「青木瓜挖空內籽、再放入茶葉加入熱水沖泡飲用」的方法時,發現有些人效果並不是那麼好,或許正因滾燙的熱水破壞了酵素活性;因此為了增加並加速酵素溶解率,他改建議朋友們以切丁、切片方式煮泡,結果發現效用似乎更好。

而對於原信表示飲用青木瓜泡茶對「治療尿酸」有極佳效果的說法,台北市立聯合醫院仁愛院區過敏免疫風濕科主治醫師蔡明翰表示,雖然在門診中聽過許多患者提及此療法的功效,但以西醫觀點看,目前尚未有學術研究證實青木瓜含有降低尿酸的成份。

話雖如此,蔡明翰醫師從另一角度分析指出,由於酸性體質、尿酸過高者容易因血液中含尿酸濃度高,導致尿酸形成並堆積在體內,而多吃蔬果則有中和作用,因此可慢慢將酸性體質調向鹼性;此外,若是本身有飲用青木瓜泡茶的人,通常也較有養生觀念,飲食習慣會趨於清淡;所以上述兩個方向來看,應該是使用此偏方者,較不易發生尿酸過高問題的原因。

除了降低尿酸,原信標題還標榜「青木瓜泡茶」能讓「痛風再見了」,這起網路偏方是否真能治好痛風呢?

蔡明翰醫師認為,從原信敘述推論,若青木瓜泡茶有很好的控制尿酸效果,對於進一步抑制痛風發作,應該也有幫助;而青木瓜泡茶雖然對身體無害,但畢竟屬於食療偏方,建議當成養生茶飲搭配,而非用來取代醫學治療,目前醫學上主要以藥物控制治療痛風,另外也建議民眾少喝酒、少吃海鮮與動物內臟等高普林含量的食物,並且多攝取蔬果營養。

不藥而癒 青木瓜能治胃病?

除了宣稱「降低尿酸治痛風」,原信也指出台南一位村長飲用青木瓜泡茶,一個月後竟使得多年胃病不藥而癒的例子。對此,追追追小組與劉結慶村長辦公室聯繫;熱心的村長太太告訴我們,劉村長曾患12指腸潰瘍,長年有胃病困擾,後來聽聞其姊夫飲用青木瓜泡茶,確實對於改善尿酸過高問題產生幫助,加上傳統觀念認為青木瓜也有健胃功效,因此劉村長便以青木瓜當成茶壺,挖空內籽、放入茶葉沖泡方式來喝茶,胃痛問題也確實獲得改善。

此外,劉太太表示,由於劉村長本身已有泡茶習慣,除了多年來將青木瓜泡茶當成茶水飲用外,也有至醫院檢查,並非完全依賴此方法治療胃痛毛病,所以更精確來說,青木瓜泡茶是屬於劉村長的日常養生方式。

對於前面提及傳統觀念認為青木瓜能健胃的說法,我們也找到一些現代資料作佐證。農委會「木瓜主題館」網站資料中,顯示木瓜有清理腸胃、減少胃腸病發生的作用;聯合新聞網「青木瓜/豬腳同燉 有助泌乳 未必豐胸」一文裡,台北醫學大學附設醫院營養師李青蓉也表示,從營養學角度來看青木瓜富的白色乳汁,含有膠質與纖維質,膳食纖維有助健胃整腸,而青木瓜本身含有的纖維也有助排便,對胃腸吸收有所幫助。

不過,對於青木瓜泡茶治胃病的說法,賴東淵教授則認為,若本身有胃病問題或慢性胃炎患者,應減少咖啡因的攝取。他進一步說明,因為茶葉浸泡過久會釋放苦味質,入口時會感到苦澀,而苦味質的釋放會刺激胃酸的分泌,使胃酸分泌過多,進而刺激胃壁,其實對於胃部應為負面作用。

綜合以上調查,青木瓜含有木瓜酵素具消腫功效,而茶葉有利尿作用,兩者結合應有助尿酸排泄,然而目前尚未有研究證實青木瓜含有降尿酸成份;至於治療胃病部份,雖有報導表示青木瓜有健胃作用,然而賴東淵教授認為有胃炎問題者,應減少咖啡因刺激。

最後,雖然醫師與學者普遍認為青木瓜泡茶對於身體無害,但套句劉太太的說法:這種傳統的「土方法」可當作日常保健的養生方式搭配,但疾病還是要去醫生,不能僅依賴這種方式。
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The blogger’s most learned e-buddy Dr JB Lim comments as follows:
.
Sunday, 3 June, 2012 6:58 PM

From: lim juboo

Dear Sifu Engineer Lau,

Thanks for your green medicine. Attached my view, but not my knowledge.

I do not say the action of papaya against gout is rubbish. I only wish to say I do not know. I have no knowledge about this. Theoretically there may be a possibility because I notice the words ‘green papaya’ were used.

We know that raw green papaya contains latex which acts as an anti-inflammatory (substance) against red, painful, and swollen tissues, as in gout seen in big toes and in joints of fingers.

The latex contains a substance called ‘papaya proteinase’ or ‘papain’ which can also tenderize meat because of its proteolytic action against proteins in softening and digesting it.

No knowledge:

Add caption
However I have no knowledge if papain would have any action against uric acid by lowering it. Hyperuricemia is the real culprit in clinical gout. I only know papain exhibits analgesic properties (reduces pain). For that, even NSAIDs like Indomethacin (example) can also have the same action. But it is not a ‘cure’.

No cure:

There is no such thing as a ‘cure’. Only a living body if properly nourished, rested, needled, stimulated, etc, can cure itself. Most drugs merely act symptomatically by temporary altering a systemic or local chemistry of the disease. It does not ‘cure’.

Uric Acid:

It is the high levels of uric acid in the blood, clinically called ‘hyperuricemia’ depositing usually into the joints of big toes (but not always necessary) and other joints in the fingers and elsewhere, that gives rise to pain, swelling, redness and tenderness in the clinical presentation of gouty arthritis.

Proteolytic Enzyme in Raw Papaya:

Papain in green, raw papaya, in the latex and seeds may help to reduce the ‘clinical effect’ of hyperuricemia, namely tenderness, swelling redness and pain. But this does not imply that it has reduced the levels of uric acid in the blood which is the real cause.

Treating a symptom is not a cure:

In short, raw papaya may have treated ‘the effect’ (symptoms) of hyperuricemia, but it still may not have treated the ‘root causes ’ which normally is the result of eating purine-rich foods like ikan bilis, sardines, organ meat, beans, peas, bayam and spinach, mushrooms, etc.

So a patient with gout may still have high uric acid in his blood even after consuming raw papaya even though he may not suffer from pain.

Masking a warning symptom is a danger:

Hiding the swelling and pain with any drug or with green papaya is a real hidden danger to a patient because suppressing the pain rather than getting rid of the real root causes caused by eating the wrong foods (briefly listed above), being overweight, being a male, and on certain medication like aspirin that blocks the normal excretion of uric acid through the urine.

If a patient merely suppresses the symptoms of gout with pain killers, anti-inflammatory drugs like aspirin and NSAID (non-steroidal anti-inflammatory drugs) and green papayas, he is actually putting himself in danger. This is because without the pain as a warning symptom, his uric acid continues to rise without control and he does not realize it because there is no more pain.

The accumulated and rising uric acid not just get deposited in the joints, but also into the muscles and other organs as well, the worse of which, it gets deposited into the kidneys and block its function, and damage the kidneys.

This is a real danger if we suppress the cause (the pain) with drugs and green papaya without wanting to treat the root causes such as bad nutrition and eating habits.

Only research can tell:

The only way to find out is by investigation through medical research. If green papaya is really effective in removing the cause (high uric acid), then we need to conduct a study on this over a large population on those with clinical gout and hyperuricemia.

How to study?

We divide a population with gout into two groups – the test and control groups. We standardize them by age, gender, body weight, ethnic groups, dietary and food intake, medical history and current medications, and all other confronting factors, etc, etc.

We then give one group green papaya and / or with green tea, and the other group without any green papaya. We then monitor their response by looking at their serum uric acids levels over time, and also their clinical dose-related response to papaya. We can also do a switch-over (cross-over) study on the two groups without compromising the numbers and study design. It may be a short, random cross-sectional study, or even a very long term longitudinal cohort study.

Statistical Analysis:

After the data has been collected, the researchers give them to a biomedical statistician to analyze and interpret the results. But the most important thing is not the data collected, but the study design which must be flawless from the very beginning itself so that there is no criticism in the study such as the selection of the study group, the population size, how we divide them, etc, etc.

Only using a well-designed study over a very large population (the larger, the better) can we know whether or not green papaya has any therapeutic effect on gouty arthritis? At the moment we (I, especially) do not know.

Biochemical parameters, not just clinical:

We need to look at the biochemical levels of serum uric acid most importantly, and not just the clinical signs and symptoms. I have already explained that papaya enzymes like all other analgesic drugs (pain suppression drugs) may have pain suppressing actions on the symptoms, but this does not mean papaya has ‘cured’ the patient. The uric acid may still be high even with high consumption of green papaya.

Standard Management:

Normally for the treatment of acute gout, we start off with cocochine (actually a herbal medicine) every hourly or 2-hourly initially until diarrhea set in. We then follow cocochine up with 50 – 100 mg of Allopurinol. Giving Allopurinol straight away may cause the gout and pain to suddenly flare up even more. Start off with cocochine first, then only gives Allopurinol for maintenance.

It may be necessary to take Allopurinol for a year or so until no symptoms (or signs) of gout appear within that year of treatment. A lot of water has to be drunk with allopurinol to ensure the uric acid is flashed out in the urine, and not get stuck inside the meshwork of tubules inside the kidneys as urate stones.

Even with this treatment regime, we cannot guarantee the gout will not flare up again. The only way is to control purine rich, and uric acid-rich foods. It is part of a nutrition therapeutic program. This regime is the best way, and not just swallowing synthetic Allopurinol or eating natural green papayas or drink its papaya juice. Take care of your food first, not swallow drugs. Food is your medicine.

No knowledge again:

Again, I have no knowledge on the effects of green papayas on gout without research findings. Other than what I have explained here, I really do not know if green papaya can ‘cure’ gout. Only a well-designed and un-bias study can tell.

Symptoms are warning bells, not disease:

In short, high uric acid, and the disease is still there even if we take green papaya plus green tea. It has not gone away, except the warning symptoms.

This is a serious warning from me never to mask the symptoms of any underlying disease, but always treat the root causes. Once the root causes are removed, the disease automatically disappears as the body begins its natural process of healing, and is permanent short of dying of other causes.

This can only be accomplished by cultivating good dietary practices, good nutritional habits, food choice, and other lifestyle modifications. There is no other way.

This is the only way.

jb lim

Nutritionist, Physician and former Medical Researcher

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