Apr
18
2020

Changes of Metabolism by Inflammation

Dr. James LaValle gave a presentation about changes of metabolism by inflammation in Las Vegas. I listened to this lecture on Dec. 15, 2020. The 27th Annual World Congress on Anti-Aging Medicine in Las Vegas took place from Dec. 13 to 15th, 2019. His original title was: “Innovations in Metabolism and Metaflammation”. This talk was complex and as a result it may not be easy reading. But it shows how various factors can affect our metabolism and our life expectancy.

In the first place he understands “metabolism” as all of the chemical reactions together that make you feel the way you feel today. In the same way metabolism is the chemistry that drives you toward future health. It is equally important to note that disregulation of your metabolism occurs from global metabolic inflammatory signalling. As has been noted he called this “metaflammation” (inflammation affecting your metabolism).

Dr. LaValle said that understanding disruptors of your metabolism can lead to renew your health on a cellular level. The key to achieve this is to remove inflammatory signals.

Factors that accelerate aging and damage your metabolism

It is important to realize that several factors interfere with the normal aging process. Oxidative stress and inflammation are major factors. But hormone disbalance and increased blood sugar values and insulin resistance can also contribute to accelerated aging and damage your metabolism. Certainly, with a disturbance of the immune balance, autoimmune reactions can take place, which also does not help. In addition, pollutants from the environment derange the metabolism due to heavy metals that block important enzymatic reactions. In the minority there are also genetic factors that can interfere with a normal metabolism.

Many of the metabolic changes can lead to chronic inflammation. One source of inflammation can be lipopolysaccharides that stimulate the immune system to start an inflammatory process.

Many conditions are associated with inflammation such as diabetes, obesity, stress, the SAD diet (standard American diet), and liver or kidney damage.

How Metaflammation is developing

Metaflammation can start in the gut with microbiota alterations. The wrong types of bacteria can release lipopolysaccharides, and low grade endotoxemia develops. With obesity inflammatory kinins start circulating in the body. Stress can activate inflammatory substances in the brain and the rest of the body. Major contributors to inflammation in the body come from faulty diets. The Western diet contains too much sugar and refined carbs; it is too high in trans fats and saturated fats. It contains too many artificial additives, preservatives, salt, sweeteners and dyes. And it is too low in nutrients, complex carbs and fiber.

More problems with metaflammation

Kidney and liver illness can contribute to metaflammation. Several diseases come from chronic inflammation, like cardiovascular disease, type 2 diabetes, chronic kidney disease, depression, cancer, dementia, osteoporosis and anemia. Metaflammation alters the methylation patterns, which can slow down your metabolism. Increased blood lipids and chronic inflammation of the blood vessels lead to cardiovascular problems. The liver and kidneys are the major detoxification organs, and their disease leads to more metaflammation. Metaflammation also leads to hormone disbalances, sleep disorders and dysfunction of the immune system. The brain reacts to metaflammation with cognitive dysfunction and mood disorders. Muscle loss (sarcopenia) is another issue, so is osteoporosis. Finally, chronic metaflammation can cause cancer.

Major causes of metaflammation

The three major causes of metaflammation are changes of the gut microbiome, obesity and chronic stress. When the gut bacteria change because of a Western diet, the wrong bacteria release lipopolysaccharides that are absorbed into the blood. The gut barrier is breaking down and a low grade endotoxemia develops. With obesity adipokines, which are inflammatory substances secreted by the fatty tissue, circulate in the blood. Chronic stress activates inflammation in the brain and in the body.

Two major conditions are common with metaflammation: hyperlipidemia (high fat levels in the blood) and hyperglycemia. Both of these conditions change the metabolism and lead to cardiovascular disease (hyperlipidemia) or to type 2 diabetes (hyperglycemia). Both of these metabolic changes lead to one or more of the conditions mentioned above, accelerate the aging process and lead to premature deaths.

Interaction of various organ systems can cause metaflammation

Dr. LaValle stated that it is vital that your hormones stay balanced. With chronic stress cortisol production is high. This causes increased insulin production, reduced thyroid hormone and lowered serotonin and melatonin production in the brain. It also leads to autoimmune antibodies from the immune system and decreased DHEA production in the adrenal glands. In addition, growth hormone production and gonadotropin hormones are slowing down. We already heard that cortisol levels are up. The end result of these hormone changes is that the blood pressure is up and abdominal visceral obesity develops. The brain shows cognitive decline, with memory loss as a result. The bones show osteopenia, osteoporosis and fractures. The muscles shrink due to sarcopenia, frailty is very common. Heart attacks and strokes will develop after many years. The immune system is weak and infections may flare up rapidly. There are also higher death rates with flus.

Other mechanism for pathological changes with hormone disbalances

When Insulin is elevated, inflammatory markers are found in the bloodstream. This elevates the C-reactive protein and leads to damage of the lining of the blood vessels in the body. A combination of insulin resistance and enhanced atherosclerosis increases the danger for heart attacks or strokes significantly.

There is a triangle interaction between the thyroid, the pancreas and the adrenals. Normally the following occurs with normal function. The thyroid increases the metabolism, protein synthesis and the activity of the central nervous system. The pancreas through insulin converts glucose to glycogen in the liver. It also facilitates glucose uptake by body cells. The adrenal hormones are anti-inflammatory, regulate protein, carbohydrate and lipid metabolism and contribute to energy production.

Change of thyroid/pancreas/adrenals triangle when cortisol is elevated

When cortisol is elevated the balance of the thyroid/pancreas/adrenals’ triangle is severely disturbed. Cortisol is high, the T4 to T3 conversion is limited and, in the brain, there is hippocampus atrophy with memory loss and brain fog. The immune system will change with production of inflammatory kinins (IL-6 and TNF alpha). Insulin sensitivity is down, sugar craving up and weight gain develops (central obesity).

Change of thyroid/pancreas/adrenals triangle when the thyroid is depressed

The thyroid activity can be lower because of autoimmune antibodies (Hashimoto’s disease) or because of hypothyroidism developing in older age. This leads to decreased pregnenolone synthesis from cholesterol. As pregnenolone is the precursor for all the steroid hormones, the metabolism slows down profoundly. Mentally there is depressed cognition, memory and mood. The cardiovascular system shows reduced function. In the gut there is reduced gastric motility. The mitochondria, which are tiny energy packages in each cell, are reduced in number, which causes a loss of energy. There is increased oxidative stress, increased lactic acid production and decreased insulin sensitivity.

Cardiovascular disease not just a matter of high cholesterol

Dr. LaValle stressed that a heart attack or stroke is not just a matter of elevated cholesterol. Instead we are looking at a complicated interaction between hypothyroidism, diabetic constellation and inflammatory gut condition. The inflammatory leaky gut syndrome causes autoimmune macrophages and Hashimoto’s disease. The end result is hypothyroidism. The inflammatory kinins (TNF-alpha, IL-6) affect the lining of the blood vessels, which facilitates the development of strokes and heart attacks. You see from this that cardiovascular disease development is a multifactorial process.

Microbiome disruption from drugs

Drugs affecting the intestinal flora are antibiotics, corticosteroids, opioids, antipsychotics, statins, acid suppressing drugs like protein pump inhibitors (PPI’s) and H2-blockers. Other factors are: high sugar intake, pesticides in food, bactericidal chemicals in drinking water, metformin, heavy metals and alcohol overconsumption. Chronic stomach infection with H. pylori, stress and allergies can also interfere with the gut microbiome.

The microbiome disruption affects all facets of metabolism. This means that there can be inhibition of nutrient absorption and this may affect the gut/immune/brain axis. There are negative effects on blood glucose levels and insulin resistance. A disturbance of the sleep pattern may be present. A significant effect on the hormonal balance can occur (thyroid hormones, sex hormones and appetite related hormones). When liver and kidney functions slow down, there is interference of body detoxification.

Dr. LaValle talked more about details regarding the gut-brain-immune pathology. I will not comment on this any further.

Changes of Metabolism by Inflammation

Changes of Metabolism by Inflammation

Conclusion

Dr. LaValle gave an overview in a lecture regarding changes of metabolism by inflammation. This took place at the 27th Annual World Congress on Anti-Aging Medicine in Las Vegas from Dec. 13 to 15th, 2019.

This article is complex and contains a lot of detail, but there is one simple truth: oxidative stress and inflammation are major factors that influence our health on many parameters and lead to a list of illnesses. They lead to hormone disbalance and increased blood sugars and insulin resistance, which can also contribute to accelerated aging and damage of your metabolism. Dr. LaValle explained how high cortisol from chronic stress can lead to low thyroid hormones and in the brain, there is hippocampus atrophy with memory loss and brain fog. With alterations of the immune system there is production of inflammatory kinins (IL-6 and TNF alpha). Insulin sensitivity is down, sugar craving up and weight gain develops (central obesity). It does not stop there! We put our hope in medications, but the sad truth is that there are

Drugs that change the gut biome

Many drugs that are common also change the gut biome with resulting increased permeability of the gut wall (leaky gut syndrome). This overstimulates the immune system and leads to autoimmune diseases like Crohn’s disease and rheumatoid arthritis. Whenever there is an injury to the gut barrier, the blood brain barrier is following suit. This is how brain disease can develop as a result of a change in the gut biome. Impaired cognition, memory and mood can result from this. Alzheimer’s disease is one of the worst conditions that may be related to a combination of gut inflammation, chronic stress and inflammatory kinins.

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Feb
01
2020

About the Opioid Epidemic

Dr. Anna Lembke gave a talk about the opioid epidemic on Dec. 13, 2019. This was at the 27th Annual World Congress on Anti-Aging Medicine in Las Vegas from Dec. 13 to 15th, 2019. The full title of her presentation was “From Freud to Fentanyl: Update on the Opioid Epidemic.” Dr. Lembke is an associate professor at the Stanford University School of Medicine. From 1999 to 2010 opioid sales went up 6-fold. Opioid treatment admissions and opioid deaths have risen 5-fold in the same time period. Physicians prescribe too many opioid pills. One slide summarized how patients got opioid pills. 53% had pain pills given by friends for free or bought opioids from them. 37.5% received pain pills from a doctor by prescription. 6% bought pain pills from a drug dealer or a stranger. In about 3.4% it was not traceable how the persons using drugs obtained them.

Compassionate doctor and drug-seeking patient

The doctor went through medical school wanting to care about patients. Compassion to help is a powerful motivating force. On the other hand, most patients are glad that the physician wants to help and they do their part to contribute to healing. Except, there is a small percentage of patients who take advantage of a soft-hearted physician. They will demand prescriptions, even if they are not in pain. They may do this to sell the drugs to get some extra income. Others take more pills than what the doctor  prescribed, because they want to get high on the drugs. Patients who have an addiction to pain pills, have a process in their brain, called neuroadaptation. Whenever the dosage in the blood goes down, they are now adapted to taking more pills.

About the opioid epidemic and the role of Big Pharma

Pharmaceutical marketing spent more than 26 billion USD in 2012. This consisted of drug representatives visiting doctor’s offices and giving hand-outs of free samples to physicians. There were promotional mailings, advertisements, direct-to-consumer advertising and educational and promotional meetings. In addition, pharmaceutical marketing included sponsoring clinical trials. In 1980 there was still an opinion that pain drugs would be harmless and in the majority of cases would not be the cause for abuse.

Purdue Pharma, the producer of the pain pill OxyContin, was caught in secretly pushing the sales of OxyContin in order to sell more of their drug suboxone, which helps with drug withdrawal.

A law suit against Purdue Pharma brought the  “project Tango” to light.

Three myths about drug addiction

Myth #1: Opioids work for chronic pain

The pain pill producers have been pushing for the concept that pain pills would work for chronic pain. However, clinical studies showed that pain pills will only work for acute pain and when it becomes chronic pain, pills against pain become less reliable. People who take pain pills for chronic pain enter into a vicious cycle. They need to take more pain pills to experience relief from pain. But they often do not realize that the drug withdrawal pain is what gets them into seeking more drugs.

Purdue stated this:“We now know that many patients with chronic, non-malignant pain respond very well to opioids. The barriers to vastly improved treatment for hundreds of thousands of people in pain, are simply the misinformation and prejudice of doctors, pharmacists and regulatory bodies.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Myth #2: When it comes to opioids, no dose is too high and no duration is too long

This reflects what Purdue says to increase its pain medication sales.“Opioids are effective, easily titrated, and have a favorable benefit-to-risk ratio. Large doses of opioids may be necessary to control pain if it is severe, and extended courses may be necessary if the pain is chronic.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Evidence from unbiased researchers show that opioids taken in high doses and taken over long periods of time harm patients.

Patients develop cardiac arrhythmias, depression and may commit suicide. Other symptoms are  constipation, addiction, cognitive impairment, hormonal imbalances and  death. In addition, opioids can cause an annoying skin hypersensitivity.

Research further showed that gradual opioid withdrawal improves chronic pain (2017 study by Frank et al.)

Myth # 3: Less than 1% will get addicted to pain pills

Purdue stated:
“Contrary to our teaching, addiction is very rare and possibly nonexistent as a result of treating such patients with opioids.” Purdue Physicians’ Pain Management Speaker Training Program, April 1997

Here is the truth: A meta-analysis of 38 studies showed that people abused pain pills on average between 21 and 29%. Addiction rates were between 8% and 12%. These figures likely are under estimates. The authors said that the real figure of opioid abuse is likely about 40%.

Poor people treated differently

Poor people on Medicaid in the US receive twice the rate of opioids as do non-Medicaid patients. But Medicaid patients die at 6-times the rate from prescription overdoses. Often patients receive a prescription for pain pills and also a prescription for benzodiazepines. The doctor prescribes benzodiazepines for sleep problems or anxiety. Drug interactions of two potentially addicting drugs likely are more detrimental on the long-term.

Examples of a doctor’s visit (YouTube display)

Dr. Lembke played a YouTube video where she was role-playing her previous behavior as a supportive physician who prescribed opioids to patients (drug-seeking patient and supportive physician).

However, she said that she learnt from experience. In the meantime, when she finds out from a computer program that a patient is deceiving her, she behaves differently (doctor non-supportive towards a doctor-shopping drug addict).

About the Opioid Epidemic

About the Opioid Epidemic

Conclusion about the opioid epidemic 

The topic of opioid addiction is multifaceted. I summarized a lecture presented at the 27th Annual World Congress on Anti-Aging Medicine in Las Vegas from Dec. 13 to 15th, 2019 by Dr. Lembke. She talked about the opioid epidemic and the difficulties keeping the science of opioids separated from the marketing by Big Pharma. Three myths of Big Pharma were analyzed and on every occasion the truth was the opposite of the myth. Chronic pain does not respond to opioids, yet many physicians keep on prescribing these drugs. Medicaid does not help poor patients. They get twice the opioid prescriptions as non-Medicaid patients get. But Medicaid patients die at 6-times the rate from prescription overdoses. There are many unanswered questions regarding opioids. Hopefully, more judicious prescribing by physicians and alternative ways of treating pain by chiropractors, physiotherapist and acupuncturists will gradually improve the situation.

Nov
09
2019

Non-Drug Treatment For Migraines In Women

In the following I am discussing the non-drug treatment for migraines in women. There are a number of different types of headaches: common headaches, tension type headaches, cluster headaches and migraine headaches. Here I am only zeroing in on migraine headaches.

Introduction

A migraine headache is the second most common headache and occurs with an average frequency of about 12% in the general population. Women outnumber men in the U.S. by a factor of 3 to 1 with migraines. There is a genetic factor as migraine sufferers’ family members are getting migraines about 3-fold more often than the general public. Newer insights into hormonal connections point to the fact that often migraine sufferers are in an estrogen dominant state (Ref. 4). With estrogen dominance there is a disbalance between estrogen production and progesterone production. For instance, many women who develop fibroids miss their ovulation and as a result can have fertility problems (no corpus luteum developed in the ovaries). The reason for infertility, fibroid development and the development of migraines in some migraine sufferers is the lack of progesterone in the second half of the cycle.

Xenoestrogens

Xenoestrogens (pesticides, artificial hormones like Provera, the birth control pill etc.) can also function as a contributor to the estrogen load as a woman’s estrogen receptors will have a partial fit with them. The resulting hormone disbalance can trigger migraines in migraine sufferers. The trigger is the relative lack of natural progesterone. This may also be the reason why migraines are much more common in woman than men. On the other hand Dr. S.A. Dugan has done hormone studies on both male and female patients with migraine. He found that both sexes are often also suffering from fibromyalgia, chronic fatigue syndrome, and lipid disorders including high cholesterol, sleep disorders, gastrointestinal problems and depression. When these patients had hormone tests were done on these patients the majority had what Dr. Dzugan called “steroidopenia” (low levels of estrogen, progesterone, testosterone and DHEA). This is discussed in more detail under Ref. 3.

Symptoms

Migraines present in 85% without an aura (formerly called “common migraines”) and in 15% with an aura (formerly called “classic migraines”). An aura consists of changed behaviors such as pacing, yawning, craving of certain foods, lethargy, depression or mild euphoria. These symptoms are separate from the migraine aura, which consists of neurological symptoms such as visual symptoms arise 1 or 2 hours before the migraine headache starts and disappear about 1 hour after the start of the migraine.

Types of migraine aura symptoms

These migraine aura symptoms are quite varied and can include numbness of the skin in a hand or a foot on the side where the migraine is and around the mouth area. Spotty eye field defects can also occur immediately prior to the onset of the headache and there may be deficits in language expression and pronunciation. Other such migraine aura symptoms can consist of double vision, ringing in the ears, balance problems, a gait abnormality and decreased levels of consciousness.

Typically a migraine is confined to one side of the head

The actual migraine headache is on one side of the head, can last 4 hours to 3 days, is throbbing in nature, moderately to severe in intensity and is made worse by physical activity, light or noise. The patient is complaining of nausea and might be vomiting with a severe migraine. In a small percentage of patients a more severe form of complicated migraine (or “migraine with prolonged aura”) can develop where the patient has prolonged symptoms of a migraine aura for more than 1 hour, but usually less than 1 week. These patients should be investigated thoroughly by a neurologist as a small percentage of these patients can develop persistent neurological symptoms including a “migraine stroke ” (=a stroke like clinical picture) (Ref. 1, p. 2067).

Conventional treatment of migraines

Medication that is used is quite different between attacks as compared to during an attack. During a migraine attack non-steroidal anti-inflammatory drugs (=NSAIDs) and dihydroergotamine or Sumatriptan, which stimulate serotonin receptors, are common medications. Drug dependency issues on narcotics have to be discussed frankly with the patient because of the danger of rebound migraines that are triggered by the continued use of narcotics. Sumatriptan can be given intranasally, but it is important for the physician to monitor overuse and dependency on this medication. In males there is a higher risk for heart attacks as a side effect of the medication. The patient can also receive Prochlorperazine (brand name: Stemetil or Compro) intravenously as a drip in an Emergency room setting. This can abort a migraine.

Preventatives of migraine attacks

Between migraine attacks there are a number of preventatives that are effective. They consist of beta-blockers such as propranolol, metoprolol, Timolol and others; NSAIDs such as ASA, naproxen or ketoprofen; calcium channel blockers such as Verapamil or Flunarizine, also antidepressants such as amitriptyline.

Gabapentin is the latest medication that research found to be useful in several smaller studies. Gabapentin (brand name: Neurontin) releases GABA in some parts of the brain and inhibits the NMDA pain receptors. Dr. Stephen Clarke, Clinical Assistant Professor in the Div. of Neurology of the University of BC/Vancouver/Canada, reviewed the use of gabapentin at a conference in Vancouver/BC in November 2004 (Ref. 2).

Other medication for headache prevention are the anticonvulsant gabapentin; the MAO inhibitor phenelzine and the serotonin stimulating drugs methysergide and cyproheptadine. Unfortunately many of these medications do not work 100% and there is a lack of good randomized studies to prove effectiveness.

Non-conventional, but effective treatment of migraines

Bioidentical progesterone treatment

In light of what I explained above with regard to a hormone disbalance in women migraine sufferers, it is logical that Dr. Lee suggested (Ref. 5) using 20 mg of a bioidentical progesterone cream applied to the skin during the second half of the cycle (day 12 to 26 of the cycle). After three months there is usually a significant improvement of the migraines. With only a partial response to this low dose of progesterone cream, the doctor can increase the progesterone dosage temporarily to 40 or 50 mg per day from day 12 to 26 of the cycle for several months. If there is a response, the doctor continues treatments with bioidentical progesterone cream until menopause. An alternative to bio-identical progesterone cream is Prometrium (micronized progesterone) by mouth, 100mg or 200mg at bedtime. Discuss this with your doctor. You will need a prescription from him/her for Prometrium.

Avoid migraine triggering factors

It is important to include in the regimen of anti-migraine measures non drug regimens such as avoidance of triggering factors like certain foods (chocolate, red wine, certain cheeses and strong smells) or bright lights and noises. It is important to pay attention to consistent sleeping patterns and meal times. When emotional factors play a role, counseling, relaxation techniques like yoga, self-hypnosis and biofeedback methods are all helpful as well. The doctor refers more complex migraine cases to a neurologist or a multidisciplinary headache clinic.

Dr. Dzugan’s “correction of steroidopenia” approach

Since Dr. Dzugan published the results of treating migraine sufferers with the Dzugan method, it is important to look at all of the hormones including steroid hormones as mentioned above. Any hormone deficiency is rectified using bio-identical hormones; then the doctor repeats hormone levels to verify hormone balance. Dr. Dzugan found that following “correction of steroidopenia” after 9 to 12 months at the latest almost all of his patients were migraine free and lost all of the other accompanying symptoms.

Non-Drug Treatment For Migraines In Women

Non-Drug Treatment For Migraines In Women

Conclusion

Many women suffer needlessly from migraines because of estrogen dominance. Estrogen dominance occurs when they miss an ovulation (because of a lack of the corpus luteum that manufactures progesterone in the second part of the menstrual cycle). But taking the birth control pill or taking HRT with synthetic hormones in menopause can also cause estrogen dominance. This is when bioidentical progesterone replacement can help to rebalance progesterone and estrogen. Migraines often disappear in the process of this approach. If you have migraines, you should discuss the bioidentical progesterone approach with your doctor.

References

  1. Goldman: Cecil Textbook of Medicine, 21st ed.,2000, W. B. Saunders Company
  2. The 50th Annual St. Paul’s Hospital Continuing Medical Education Conference for Primary Physicians, Nov. 16 – 19, 2004, Vancouver,BC, Canada
  3. http://www.ncbi.nlm.nih.gov/pubm…: Dzugan SA, Rozakis GW, Dzugan KS, Emhof L, Dzugan SS, Xydas C, Michaelides C, Chene J, Medvedovsky M.: “Correction of steroidopenia as a new method of hypercholesterolemia treatment.” Neuro Endocrinol Lett. 2011;32(1):77-81.
  4. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 256 and 257 Dr. Lee describes how he uses progesterone as a cream to treat PMS.
  5. Dr. John R. Lee: “Natural Progesterone- The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.

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Jul
20
2019

Common Drugs Have A Connection To Dementia Risk

A recent publication stated that common drugs have a connection to dementia risk. The study had an observation time of 12 years (from 2004 to 2016) and involved 284,343 patients in the United Kingdom. There is a group of drugs, namely anticholinergic drugs, that were particularly strong with regard to causing side effects of dementia. A variety of anticholinergic drugs exist, such as antidepressants like paroxetine or amitriptyline. But there are other anticholinergic drugs like bladder antispasmodics (they also go by the name bladder antimuscarinics, such as oxybutynin or tolterodine). Other anticholinergic medications are antipsychotics that are in use for psychotic diseases. Examples are chlorpromazine or olanzapine. Anti-epileptic drugs also belong into the anticholinergic drug group. Common anti-epileptic drugs are oxcarbazepine or carbamazepine.

The researchers found that 58,769 of the patients that took strong long-term anticholinergic medication developed a dementia diagnosis.

More about the study

The researchers found that the risk of developing dementia for those who consumed only a few anticholinergic drugs was low. It amounted to only 6%. In contrast, patients who took a lot of anticholinergic drugs at least for 3 years or more developed dementia in 49% of all cases, which is quite a significant amount.

Dr. Douglas Scharre, director of the division of cognitive neurology at the Ohio State University Wexner Medical Center in Columbus was not involved in the study. He said: ”I spend a lot of my time in the memory disorder clinic seeing geriatric patients and taking people off medications, mostly those medications that have anticholinergic properties. Many times there can be another drug out there that has less anticholinergic impact or is non-anticholinergic that may work.”

Risk-benefit discussion

He went on to say that some drugs are really necessary to control a psychosis or seizures, so it is a matter of discussing with the physician whether it is worth taking a risk of possible dementia versus a risk of a flare-up of psychosis or of a seizure.

More statistics

Patients who received treatment for depression with anticholinergic antidepressants had a risk of 29% of developing dementia. Anticholinergic anti-Parkinson drugs had an association of a rate of 52% of dementia. Anti-psychotic drugs led to dementia in 70% of the treated cases. Bladder relaxing medications (medically called antimuscarinic drugs) had a risk of 65% to cause dementia. Finally, anti-epileptic drugs had a risk of causing dementia in 39%.

The researchers noted that these findings highlight how important it is reducing exposure to anticholinergic drugs in middle-aged and older people.

Serious side effects from other medication

Unfortunately there is a history of serious side effects regarding several medications.

Tardive dyskinesia with antipsychotics

Long-term treatment of schizophrenia with antipsychotic drugs can cause severe side effects. One of the more severe side effects is tardive dyskinesia, which occurs in 5% per year of antipsychotic medication use, and in about 1%-2% of these it is severely disfiguring the face. Tardive dyskinesia can lead to permanent involuntary movements of the muscles around the mouth and the eyes. The jaw and the tongue may also show involuntary movements, and in time this leads to a disfigured look of the face, often with asymmetries between the right and left side of the face. Unfortunately, withdrawal of the antipsychotic medications will not improve the tardive dyskinesia. Often expensive lifelong Botox injection therapy every 6 to 8 weeks is necessary to alleviate some of the effects of this devastating dyskinesia.

Side effects from antacid pills

Lansoprazole (Prevacid) belongs to the proton pump inhibitors and is a very strong acid production inhibitor. Because it is so reliable in suppressing stomach acid, it is popular with the public. What is not so well known are the side effects of this drug. The most common side effects are about bone fractures, severe diarrhea, kidney damage, systemic lupus erythematosus and fundic gland polyps. These polyps can later turn into stomach cancer. Unfortunately, drug companies do not always report about the less frequent side effects.

A rare side effect: muscle tremor

One of these side effects is a muscle tremor (jerking movements or shaking). It is listed under the side effects way down the list where you may overlook this. To the patient it can be devastating as the symptoms are very similar to Parkinson’s disease. Imagine a 40-year old man taking this medicine for stomach acid and coming down with these muscle tremor symptoms! Fortunately, when you recognize the connection, you can stop the medication and the symptoms frequently go away or at least diminish.

Rhabdomyolysis from statins

When a patient is receiving statins because of high cholesterol, one of the possible side effects can be rhabdomyolysis. This typically presents with muscle weakness, fatigue, and lower urine output. The urine may be of a dark color. Confusion, vomiting and agitation can also set in. It is necessary to immediately recognize these type of side effects, and the statin drugs should be stopped. The patient requires a kidney specialist to watch the kidney function. Often these patients need treatment in hospital. 

Cancer and heart attacks from synthetic hormones

The “Women’s Health Initiative” with a study on 16,000 postmenopausal women had to be stopped prematurely in 2002. This was a study that examined the effects of two synthetic hormones, the estrogen Premarin and the progesterone-like substance Provera. The purpose of the study was to show whether heart attacks, osteoporosis and strokes would be reduced on hormone replacement compared to controls. But the results were shocking: the opposite was true! The risk in the treatment group for strokes was 41% higher than for the controls and for heart attacks it was 29% higher! But this was not all. The treatment group had twice as many blood clots in their legs and 26% more breast cancer. Colorectal cancer was 37% higher and Alzheimer was a whopping 76% higher than in the controls.

Synthetic hormones caused estrogen dominance

The synthetic hormones functioned like xenoestrogens, meaning that there was a partial resemblance of the synthetic hormones to estrogen and progesterone, blocking their hormone receptors, but not stimulating them. The end result was an estrogen dominance state in the blood, which caused all of the problems. When bioidentical hormone replacement is done with bioidentical estrogen and progesterone, the opposite is the case. Women live longer because they get less heart attacks and strokes; they also get less cancer. In Europe bioidentical hormone replacement has been in use for over 50 years, and in the US physicians who use bioidentical hormone replacement have experience for almost 30 years.

Discussion

We started this article describing side effects of anticholinergic drugs and how this can bring on dementia. Other researchers have noted that dementia and strokes can be brought on by diet drinks. We then got into side effects of other drugs like tardive dyskinesia with antipsychotic drugs. We discussed the possibility of tremors from antacid drugs. A rare side effect of statins is rhabdomyolysis. And we talked about cancer and heart attacks from synthetic hormones in postmenopausal women. We need to be aware that any chemical brought into our system can cause undesirable side effects. Chemicals like drugs can interfere with biochemical reactions in the body that ultimately result in side effects including cancer and heart attacks.

Common Drugs Have A Connection To Dementia Risk

Common Drugs Have A Connection To Dementia Risk

Conclusion

In a recent publication we learnt that patients who took a lot of anticholinergic drugs at least for 3 years or more developed dementia in 49% of all cases, which is quite a significant amount. But there are other drugs that have serious side effects. For instance, there is tardive dyskinesia, a disfiguring condition in the face that can develop with antipsychotic medicine for schizophrenia. Statins can cause a painful muscle condition, rhabdomyolysis. The “Women’s Health Initiative” showed a study that examined the effects of two synthetic hormones, the estrogen Premarin and the progesterone-like substance Provera.

Synthetic hormones causing problems

The purpose of the study was to show whether heart attacks, osteoporosis and strokes would be less on hormone replacement compared to controls. Unfortunately quite the opposite happened. The risk in the treatment group for strokes was 41% higher than for the controls and for heart attacks it was 29% higher! But this was not all. The treatment group had twice as many blood clots in their legs and 26% more breast cancer. Colorectal cancer was 37% higher and Alzheimer was a whopping 76% higher than in the controls. Only bioidentical hormones are tolerated without any side effects. We need to treat our bodies with respect and stay away from noxious substances.

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May
18
2019

A Pill Against Obesity

At the 26th European Congress on Obesity in Glasgow, Scotland a pill against obesity was introduced. Here is a report about this on CNN. The biotechnology company, Gelesis had funded the research. This company also developed the product. The FDA has accepted this product, which is marketed under the name “Plenity”. The FDA gave clearance for Plenity as a prescription weight loss product for use in overweight adults with a body mass index above 25.0. Genesis has announced that Plenity will be available in the US by 2020. The cost of it is yet unknown.

How Plenity, a pill against obesity, works

Plenity actually is a medical device. It is a capsule that contains tiny little gel pieces that dissolve in the stomach. Patients take one capsule with water before lunch and dinner. When the gel pieces swell it gives a fullness feeling that limits calorie intake. The hydrogel pieces increase the volume of the stomach and small intestine. By the time the gel particles arrive in the large intestine, enzymes have partially broken down the hydrogel, water is released and the rest is expelled in the feces. Dr. Ken Fujioka, a weight loss expert, endocrinology researcher at Scripps Clinic and scientific advisor to Gelesis said: ”The most compelling aspects of this approach are its effectiveness, novel mechanism of action and impressive safety data. This approach creates another arm in the treatment algorithm of weight management and could be used by an overwhelming majority of people struggling with weight issues”.

Randomized placebo controlled weight loss study with Plenity

Gelesis sponsored a weight loss study with 223 patients in the experimental group and 213 in the placebo group. The length of the weight loss study was 171 days. The placebo group lost 4.39% body weight, while the group on Plenity lost 6.41%. There were very few side effects, like an abdominal fullness or bloating.

Discussion regarding Plenity, a pill against obesity

Along with taking Plenity the investigators asked the patients to also stay physically active and adhere to a sensible diet. I know from my own experience that a change in diet can make you shed significant weight and you can keep it down. In 2001 I lost 22.7 kg (=50 pounds) over 3 months, down from 85.5 kg. I weigh now 62.8 kg. With this data you can calculate that I lost 22.7/85.5=26.5% of my original weight. I did so in 90 days, not in 171. It was the difference in food intake that enabled me to lose this weight. I had cut out all sugar, starchy foods, processed food and wheat.

The pill will help patients feel full after smaller helpings, instead of having hunger pangs, and this can be valuable and will contribute to being successful with losing weight. But long-term weight control only works with an adjustment of dietary habits and lifestyle choices. 

Keeping weight loss in perspective

The authors stated that their best patients were losing 5% and 10% when they watched their diet and exercised. When I compare my own data (26.5% weight loss) and theirs I conclude that they did not try hard enough. And they did not have to rely on any diet pills. It is clear from the data that the placebo group had significant weight loss with just watching their diet and exercising. I do acknowledge that Plenity has a slightly better effect. However, when people complete with their weight loss program, they will continue to eat their former diet regimen. This will make them gain everything back what they have lost.

For 18 years I have not gained back what I lost in 2001 because I have stayed on the same diet that some people may label as “radical”. There is nothing wrong with vegetables, salads, lean poultry, fish, nuts, fruit etc. I suspect that people could easily lose 10% to 20% of weight without any weight loss pills, if they took a similar approach as I did.

A Pill Against Obesity

A Pill Against Obesity

Conclusion

Weight loss seems to be a topic that is of interest to many people. There is the expectation that the new weight loss pill Plenity will be the solution to people’s diet problems. However, the difference in weight loss between the placebo group and the experimental group was only 2.02%! It took the researchers 171 days to be able to say that there was a significant difference between the Plenity group and the placebo group.

Cutting out junk foods

When I did my own weight loss program based on dietary changes alone I had lost 26.5% in only 90 days. I suggest that people should not forget to change their food intake, cutting out junk food and adopting a healthy food intake. They may not require Plenity pills at all or for a much shorter time. Preparations for the time after the weight loss achievement are necessary or else there will be rebound weight gain. Long-term success is only possible with sensible dietary choices and lifestyle choices, such as regular physical activity.

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Apr
27
2019

Mayo Clinic Could Become A Health Care Model

I watched the movie “Mayo Clinic: Faith-Hope-Science”, which suggested that the Mayo Clinic could become a health care model. The movie aired originally on Sept. 25, 2018. It is a fascinating presentation of the history of the Mayo Clinic.

Historical facts

The Mayo Clinic is well known for its surgeries. In the beginning there were only 3 surgeons, Dr. William Worrall Mayo and his two sons, Dr. Will and Dr. Charlie. In 1904 alone they performed more than 3000 surgeries at St. Mary’s Hospital. Today 255 Mayo Clinic surgeons do more than 76,000 surgical procedures for patients.

The original Mayo Clinic was built in Rochester (Minnesota). Later two more Mayo Clinics were added, in Jacksonville (Florida) and Phoenix (Arizona). Here is a link that shows more historic facts.

Involvement in Wars

The Mayo Clinic provided medical care during WWI, WWII and during the Korean War. Management of the Mayo Clinic decided to erect portable clinics close to the battlefields. Treatments for the injured soldiers were free.

Mayo Clinic Involved in Research

From early on in the development of the Mayo Clinic research played an important part. Now there are three Mayo Clinics, each with their own research facilities. There is a campus of a Medical School connected with the Rochester Mayo Clinic. The Medical School puts emphasis on medical research.

Organization of the Mayo Clinic

The organization of the Mayo clinic was initially based on a handshake between the Sisters of Saint Francis who provided nursing skills and the medical staff that provided diagnoses, surgeries and investigations. The movie reported that the handshake philosophy lasted for over 100 years, but eventually the administration came up with a formalized agreement.

A few peculiarities are worth noting.

Doctors on salaries

All doctors working for the Mayo Clinic are on salary. This is in stark contrast to the rest of the medical system in the US. The US medical system is a fee-for-service system. The problem is that fee-for-service clinics rush patients through their appointments. In the past one patient was seen on average every 15 minutes, then every 10 minutes, and now often there are only 7 minute time slots. The more patients a doctor sees in an hour, the more money he/she makes. With a complicated patient at the Mayo Clinic a doctor may take 2 yours to see such a patient. It makes no difference in term of salary to the doctor, but the quality of care and thoroughness of examining a patient can make a huge difference.

Proton therapy made affordable

When proton therapy was first introduced in the Mayo Clinic for cancer therapy, patients could not afford the higher costs of proton therapy versus conventional radio beam therapy. The Mayo Clinic resolved this problem simply by charging the same cost for both procedures. This way the doctor decided, which approach was more appropriate for a particular patient, but there was no financial hardship as a result of this decision.

When poor people cannot afford health care

Another peculiarity evolved when it became apparent that some very poor people could not afford the treatment. The nurses and the doctors consulted about this problem and decided that nobody should suffer diseases because of financial hardship. The minority of these patients received free treatments from the Mayo Clinic. To correct for the difference the administration was charging the well-to-do people a little bit more. Over the years the Mayo Clinic had made enough profit that they could expand and build bigger clinics. There are now three Mayo Clinics, namely in Arizona, Florida and Minnesota.

Other health care jurisdictions

I have worked in the Canadian health care system for 16 years as a general practitioner. Like in the US this is based on a fee-for-service system. Subsequently I worked as a Medical Advisor for the Workers’ Compensation Board of British Columbia (“WorkSafeBC”). This was a salaried position. The advantage of being in general practice is that you are in charge of your practice. You can decide how many hours in a day you work and how many patients you will see on average in an hour. Because of the fee-for-service remuneration from the government this determines your annual income. It also determines your income tax status, so that the take-home pay may not be that much larger than the take-home pay as a salaried physician.

The system in Germany is similar. Most patients have coverage by the regular insurance company (AOK patients). But there is a two tier system, where private patients have insurance coverage by a private insurance carrier, called DKV. They experience a different treatment. Unlike the AOK patients (fee-for-service) there is no rush when the doctor examines a private patient. The doctor takes a lot more time to see a private patient and is more thorough with the examination. The remuneration for the private DKV patients is 3 to 4-times as much as for an AOK patient.

Mayo Clinic could become a health care model for the US

The Mayo Clinic has been in existence for 150 years. It has achieved the highest level of care in the US and many physicians refer their difficult to diagnose patients to this clinic. It seems that financially the clinic is also on solid grounds.

Could this system be transferred to the US health care system at large? Several points have to be considered regarding this.

Health care should be administered by each state separately

Health care is administered by each of the separate states. But federally the United States Department of Health & Human Services (HHS), also known as the Health Department should be responsible for health care in the US. This means that there has to be consultation between the Federal and the state level.

Biggest problem to convince all practicing physicians to be on salary

The biggest problem would be to convince that all of the practicing physicians should be on salary. For centuries patients paid for physicians’ services by using a “fee for service” payment schedule. For physicians this is the gold standard. They perceive the payment for their services as independent from the government. They have a deep distrust whether the government will treat them fairly. Another complicating factor are very high liability insurance payments, and medical lawsuits are common. How can a physician afford sky-high insurance rates? It is only possible with an agreement that pays a fair salary to all physicians. This will stabilize the healthcare system.

Escalating drug costs curtailed by generic drugs

Regarding the escalating costs of brand name medicines a solution is to allow generic drugs. They are chemically identical to brand name drugs. They are often 1/3 or ½ the cost of brand name drugs. Many non-US countries have used generic drugs for many years with no problems. But in the US pharmaceutical companies that produce brand name drugs have maligned generic drugs. They call generic drugs to be inferior.

Provisions need to be made to cover poorer people

Provisions for poorer people allow them to not have to suffer from untreated illnesses. The Healthcare Plan can take care of this in a similar fashion as the Mayo Clinic did. The health care premiums to be paid by every citizen in the US would be dependent on what your annual income is. People in higher income groups would pay a slightly higher premium than low- income people or middle-income people. Special provisions would apply to cover healthcare costs for people in training who do not yet have an adequate income. But essentially everybody would pay something into the health care plan. This way there would be enough funding for the health care system.

Will all the players accept that the Mayo Clinic could become a health care model?

Whether or not the US public at large would ever accept this proposal, all of the physicians and all of the major players of the health care industry remains to be seen. It would contain the healthcare costs and would cover every US citizen for healthcare expenses.

Mayo Clinic Could Become A Health Care Model

Mayo Clinic Could Become A Health Care Model

Conclusion

The Mayo Clinic has provided 150 years of healthcare coverage and provided excellent medical service. There is no reason why this type of system would not work for the general public. Healthcare coverage would be provided for everyone, regardless of their income. The high-income group would pay more than the middle income and those with low incomes. But everybody would receive the same healthcare service. Physicians would be on salary. Drugs would be largely generic drugs, but would also be trademark drugs, if no generic drugs are yet available.

100% enrolment ensures full funding of healthcare plan

By having 100% enrolment into the healthcare plan there would be no shortage of funding as healthcare costs average out when everybody -young and old people, rich and poor -are all included. It would require negotiations of the United States Department of Health & Human Services (HHS), backed up by the president and including the health departments of all of the states in the US. The Mayo Clinic succeeded achieving all of this within the US. Why should the US at large not be able to copy that system in all of the states?

Feb
16
2019

The Most Addictive Drugs

Recently CNN reported about the most the 5 most addictive drugs. Before I review these drugs I like to briefly describe the dopamine reward system in the brain.

Introduction

The pleasure center consists of the nucleus accumbens, the amygdala and the hippocampus. Together they contain dopamine neurons that communicate with the grey matter nerve cells in the prefrontal cortex. A pleasurable meal, sex, winning a video game, listening to music, earning money and reading a funny cartoon can all cause dopamine release that is perceived as pleasure. But so can drugs, such as smoking cigarettes, drinking alcohol and taking street drugs. The problem is that these latter dopamine releasing substances and drugs cause stronger activation of the dopamine system than natural rewards. But unlike natural rewards they do not cause satiety. This is the basis why drug addiction can kill.

Review of the five most addicting drugs

The neuropsychopharmacologist David Nutt has been part of a committee that decided what the five most addictive drugs are.

Heroin

This is the most addictive drug. It is an opiate that causes the dopaminergic neurons to release up to 200% more dopamine than usual in experimental animals. Heroin is dangerous, because the dose that kills a person is only five times higher than the dose that leads to a high. Most deaths occur because of overdoses.

Cocaine

This drug turns dopamine neurons on, but prevents them from turning the dopamine signal off. In animal experiments cocaine caused the dopamine level to get elevated three times the normal level. 21% of people will become dependent on cocaine sometime during their life when they try it. Methamphetamine, another street drug, is similar to the strength and addictive qualities of cocaine.

Nicotine

When a person smokes a cigarette, the nicotine in it reaches the brain quickly as it is absorbed through the lungs and transported in the blood vessels to the brain. In 2002 there were about 1 billion people on earth who smoked. Every year about 8 million people die from smoking. It was shown in rats that smoking causes dopamine levels in the reward system to rise 25% to 40%.

Barbiturates

This class of drugs also has the name “downers”, because they calm you down and put you to sleep. But they also killed Elvis Presley and Michael Jackson. Both died from an overdose, which suppressed their respiratory center, and they stopped breathing. In low doses barbiturates stimulate the brain and they cause euphoria, but higher doses cause respiratory failure. Nowadays barbiturates are more difficult to get, because physicians prescribe different drugs for insomnia. When a drug is not easily obtainable, it tends to fade in importance in the addiction scene.

Alcohol

In contrast to barbiturates alcohol is readily available. When a person consumes alcohol, the dopamine neurons release between 40% and 360% more dopamine than usual. 22% of people who consume alcohol develop a dependency problem later in life. The WHO estimated that about 2 billion people are addicted to alcohol and 13 million are dying from it every year. The causes of death are varied: car accidents, cirrhosis of the liver, alcohol induced dementia and various cancers.

Dr. Amen’s brain scans

Dr. Amen is a psychiatrist who specializes in SPECT scan technology. SPECT stands for Single Photon Emission Computerized Tomography. This is summarized in this review.

Briefly, a SPECT scan shows where the blood flows in the brain and where it doesn’t flow. People who abuse drugs or nicotine develop areas that have a lack of perfusion. It looks like holes in the brain as depicted in this link, which can create abnormal thinking patterns. Fortunately with drug rehabilitation the brain pattern can normalize again.

The Most Addictive Drugs

The Most Addictive Drugs

Conclusion

The hallmark of drug and nicotine addiction is that the addicted person relies on using a drug to release dopamine from the reward system. Normal pleasures that would do this such as good food, sex or exercise are no longer acceptable to the addicted person. They need drugs, alcohol or nicotine to experience a stronger response. Dr. Amen’s work has shown that this behavior leads to altered brain function with holes visible on SPECT scans (Single Photon Emission Computerized Tomography). Rehabilitation from drug use normalizes the findings on SPECT scans and helps the patient to return to normal functioning.

Nov
03
2018

When you are sleepless

You are not alone when you are sleepless. Insomnia is a widespread problem in society.

Previous review of the topic of insomnia

I have reviewed the topic of insomnia before in a blog.

Briefly I pointed out that in some people there is a mutation of the gene that controls the circadian sleep rhythm. It is called the CRY1mutation. Some people have sleep disturbances from working night shifts. I mentioned the blue light of electronics that is produced by the TV screens or computer screens. The more you are exposed to it, the more it stimulates the brain to produce serotonin. This undermines the melatonin production, and as a result the person finds it extremely difficult to fall asleep. Children playing with i-phones, tablets or watching children’s programs on television can have sleep disturbances from the blue light. Blue has the frequency that over stimulates the brain and interferes with melatonin production. Drug and alcohol abuse can also interfere with the normal circadian sleep rhythm and cause insomnia.

Hormone factors of insomnia

For natural sleep to occur, we need melatonin which the pineal gland releases in the evening. It initiates and maintains sleep during the night. The natural opponent of melatonin is cortisol, the stress hormone, from the adrenal glands. Both hormones need to be in balance to allow you to sleep normally. Shortly before we wake up in the morning melatonin production goes down and cortisol production is up. Cortisol levels are low at night and high during the day. So it is cortisol that keeps us going throughout the day. But an excess of cortisol from chronic stress can also interfere with falling asleep and sleeping through the night.

Stress and insomnia

When we feel stressed, cortisol production goes way up. This has consequences regarding our sleep pattern. It can interfere with falling asleep, causes us to wake up from a deep sleep in the middle of the night and can give us problems falling asleep again. Chronic stress exposure leads to high cortisol production by the adrenal glands, which in turn will lower melatonin and cause sleep disturbances. Older people (above the age of 50) have very little melatonin production left, as there is an age-related decline of melatonin production. The melatonin production is highest in younger years and lowest in older age.

What to do when you are sleepless

There are several over-the-counter remedies, which in combination can be quite effective.

Melatonin for when you are sleepless

Melatonin (3 mg at bedtime) is a good start to see what it does for your sleeplessness. Taking a small amount of melatonin at bedtime we can re-establish the balance between cortisol and melatonin, which helps the circadian hormone rhythm and sleep pattern to come back. Some people wake up in the middle of the night and find it difficult to fall asleep again. If this happens at 3 AM, a good remedy at this time is to take another 3 mg of melatonin. Melatonin stays in the system for about 4 hours. Light during the day de-activates the effect, when light hits the retinas upon opening your eyes. You should not exceed 6 mg of total melatonin overnight. Otherwise it will interfere with the balance of cortisol and melatonin, lowering cortisol levels, which would rob you of energy during the day.

Phosphorylated serine (Seriphos)

A supplement that is freely available in the US (but not in Canada) consists of a simple amino acid. As this link shows (second item in the link) phosphorylated serine Seriphos) helps to down-regulate cortisol levels (lowering them). This means that melatonin gets the upper hand and you can sleep again.

The dosage for phosphorylated serine (Seriphos) varies from person to person, but will be in the range of 1000 mg to 3000 mg in the evening. After about 30 days the circadian rhythm may have recovered and you can stop the Seriphos. A one-day pause is required once a month for resetting the hormone receptors. Should you still have problems sleeping, you can continue with it for another month and pause again for a day. Seriphos has very few side effects.

Valerian root capsules

Another useful sleep aid is valerian root (as capsules). 500 mg to 1000 mg will help you to relax. It does not have the side effect of feeling groggy the next morning.

Other considerations when you are sleepless

Hormone problems like thyroid abnormalities (too much or too little thyroid hormones) are issues that your doctor has to investigate. Women in menopause often have sleep disturbances due to a lack of estrogen and progesterone. A knowledgeable healthcare professional is able to take care of that by prescribing bioidentical hormone creams.

When men approach andropause (the equivalent of menopause in women), they lose testosterone production. This can cause insomnia. The doctor can verify the hormone loss by a blood test. Replacement with either bioidentical testosterone cream or injections will rebalance testosterone levels. Insomnia may disappear. It is essential not to overdose testosterone, as this can also cause insomnia.

Sleep lab for when you are sleepless

When home remedies do not help, it may be time to check into one of the sleep labs to diagnose the kind of sleep disorder you are suffering from. Here is an overview what is happening there.

Essentially you get hooked up to monitors and are encouraged to just sleep as you would normally do. The physician in charge of the lab will later explain to you what the monitors showed, and tell you what type of sleep. According to the findings your doctor will recommend what measures are appropriate to remedy the situation.

Treatment for insomnia when over-the-counter remedies fail

Short acting benzodiazepams

When anxiety is not a problem, but only insomnia is (falling asleep or staying asleep) lorazepam 1 mg (Ativan) or temazepam 10 mg (Restoril) are shorter acting benzodiazepams that will help. It is not a permanent but a short “emergency break” for intermittent use, so that the GABA benzodiazepine receptors have time to recover. Otherwise, with continuous use tolerance would set in. This means higher and higher doses of the sleep medication would be necessary to achieve the same effect. Another non-benzodiazepine is Zolpidem 5 mg (Ambien). Even though this medication is not a benzodiazepine, it works on stimulating the same GABA benzodiazepine receptors.

Longer acting benzodiazepams combined with antidepressant Trazodone

For several years the combination of a small amount of the longer acting benzodiazepams, clonazepam (Rivotril) at 0.5 mg combined with a small amount of the anti-depressant trazodone (Oleptro or Desyrel) at 50 mg at bedtime has been has been in use quite successfully.

But there is a concern of drowsiness caused by Rivotril as this link shows.

Trazodone, which is an antidepressant has a sleep cycle restoring effect at low doses and has less side effects, because it is used at ¼ the dose for a full-blown depression. Males are often complaining that it reduces their sex drive, and it may cause erectile dysfunction.

Clonazepam side effects

Rivotril was originally in use to control epileptic seizures and anxiety. The combination therapy for sleep disorders uses Rivotril at ¼ of the regular dose. Although it is good as a sleep aid, it has a long half-life and stays in the system well into the next day. This may present as sleepiness and cause falls in elderly patients because of clouded attention. Replacement by one of the medium long acting benzodiazepams could be the solution. A drug pause for 1 day will help to reset the GABA benzodiazepine receptors and prevent tolerance from happening. Knowing all those effects and side effects it is wiser to reserve the use of these medication strictly when everything else has failed!

When you are sleepless

When you are sleepless

Conclusion

As I mentioned before, you are not alone when you are sleepless. Insomnia can present as having problems to fall asleep, but it may present in others as a problem in the middle of the night waking up and having problems going back to sleep again.

I described non-conventional methods to help you to sleep using melatonin, Seriphos and valerian root capsules. If this fails, a sleep lab investigation may be necessary to get to the bottom of your insomnia problem. Physicians often prescribe short acting benzodiazepams like lorazepam (Ativan) and temazepam 10 mg (Restoril).

Other possibilities to treat insomnia

There are other possibilities to treat insomnia, with a combination of a low-dose antidepressant (trazodone, brand name Oleptro in the US) and low-dose anti-seizure and anti-anxiety drug clonazepam (Klonopin or Rivotril). Anxiety can often be a big component in insomnia and this treats both. On the other hand, anxiety is a separate problem, which needs professional treatment. There can be side effects of sleepiness from clonazepam and men complain of a lack of sex drive and erectile dysfunction from trazodone. Help is available when you are sleepless. But you need professional help to work on the problem and find the solution.

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Aug
25
2018

The Downside Of Living To 100

A review article has examined longevity and reviewed the downside of living to 100. In their 80’s about 10% of the population live in nursing homes, but among centenarians 55% are residing in nursing homes. They are often very lonely, as their social circles have shrunk as they aged.

Common diseases of older people

Osteoarthritis makes it difficult for people to get around, it causes chronic pain and it can also be the reason for falls. In 1990 there were 213.4 cases of osteoarthritis per 100,000. 26 years later, in 2016 there were 232.1 cases of osteoarthritis per 100,000 people.

Chronic obstructive pulmonary disease (COPD) has been falling, because less people smoke cigarettes now. Statistics show 1667 cases of COPD per 100,000 in 1990, but only 945 cases of COPD per 100,000 in 2016.

Diarrhea and common infections have dropped sharply from 8951 per 100,000 in 1990 to 3276 per 100,000 in 2016.

What other common diseases do older people get?

There are a number of common diseases that affect the elderly.

Osteoarthritis

Osteoarthritis of the hips and the knees are common, but it can affect every joint in the body. In the end stage knee replacements or hip replacements may be necessary. But before a total knee replacement or total hip replacement can even come into consideration, the person’s heart needs a thorough checkup to ensure that it is safe for the patient to undergo surgery under a general anesthetic.

Heart disease

Older people often have heart disease.

When coronary arteries are narrowed, heart attacks occur. Cardiologists can place stents, so that previously narrowed coronary arteries receive normal blood flow. Following such a procedure the patient may live for another 10 to 15 years.

There are also heart valve calcifications. The aortic valve is particularly endangered. A heart surgeon may be able to replace a diseased aortic valve by a porcine valve.

The nervous system of the heart transmits electrical signals from the sinus node to the muscle fibers, which can get diseased. Heart rhythm problems may necessitate the insertion of a pacemaker.

Finally, the heart may enlarge, but pump less blood than before. This condition is congestive heart failure. The 5-year survival for this condition is only 50.4%. Unfortunately there is very little the doctor can do for patients like this.

Cancer

The older we get, the more DNA mutations we accumulate. At one point cancer develops. If the diagnosis happens at an early stage there is a good chance that surgery can remove a cancerous growth, and the patient survives. But there are cancers that are notoriously difficult to recognize in the early stages. These are: cancer of the pancreas, kidney cancer, stomach cancer and certain types of leukemias.

Respiratory diseases

Those who smoked earlier in life may develop chronic obstructive pulmonary disease (COPD). It is a chronically disabling lung disorder. Often these individuals have to carry an oxygen tank with them wherever they go. The 5-year survival rate for people with COPD is 40 to 70%.

Osteoporosis

Osteoporosis is a disease where the bone is brittle. Spontaneous bone fractures can occur at the wrists, the upper thigh bone (femoral fractures) or in the vertebral bones. Women in menopause are hormone deficient and this contributes to calcium depletion of the bones. Lately research has shown that vitamin K2 and vitamin D3 are necessary for a normal calcium metabolism. Briefly, 200 micrograms of vitamin K2 and 5000 IU of vitamin D3 every day are the necessary dosage that the body can absorb calcium from the gut, eliminate it from the blood vessels and deposit it into the bone. Calcium is present in milk products and milk. If a person does not consume enough milk products a supplement of 1000 mg of calcium daily does make sense.

Alzheimer’s

The older we get, the more likely it is an onset of Alzheimer’s or dementia. Between the ages of 90 to 94 there is a yearly increase of Alzheimer’s of 12.7% per year. The group from age 95 to 99 years has a yearly increase of Alzheimer’s of 21.2% per year. Persons aged 100 years and older have an increase of Alzheimer’s by 40.7% per year. What this means is that essentially there is a doubling of Alzheimer’s every 5.5 years. We do not have all of the answers why this is happening and why Alzheimer’s develops. But we do know that diabetics are more likely to develop Alzheimer’s. High blood sugar levels and high insulin levels seem to lead to the precipitation of the tau protein in the brain, which causes Alzheimer’s.

Diabetes

When diabetes is not well controlled, there is accelerated hardening of the arteries. This can cause heart attacks and strokes. Longstanding diabetes can affect the kidneys (diabetic nephropathy, kidney damage) and can lead to hardening of the leg arteries. Often the only treatment left is a below knee amputation. Blindness from uncontrolled diabetes is common and pain from diabetic neuropathy as well.

Diabetics have an average life expectancy of 77 to 81 years. However, if they pay attention to their blood sugars and manage their diabetes closely they can live past the age of 85.

Falls and balance problems

As people age, their balance organ is not functioning as well. Also, people with high blood pressure medication may have postural hypotensive episodes that can lead to falls.

There may be a lack of cognitive functioning and misjudging of steps, ledges and irregularities in the floor. When a person has brittle bones from osteoporosis and they fall, a hip fracture is very common. At a higher age surgery for a hip fracture is dangerous. It can have a mortality of 50%.

Obesity

A person with obesity has a life expectancy that is 10 years less than a person without obesity. The reason for this is that with obesity This is so, because the risk of heart attacks, strokes, cancer, arthritis and diabetes is increased.

Depression

Older people often get depressed. It even has its own name: involutional depression. People can get into a state of mind, where they think negatively. Depressed people feel that they have nothing to live for. They lost friends; they are shut in because they can’t drive a car any more. This type of depression needs treatment by a psychologist or psychiatrist. The danger of leaving depression untreated is that the person may get suicidal. In older people depression is often precipitated by physical health problems.

Oral health

When teeth are not looked after, gingivitis and periodontitis can develop. Infected gums can shed bacteria into the blood and this can affect the heart valves. Endocarditis, the infection of heart valves, is a cardiological emergency. Prolonged antibiotic therapy is necessary to overcome this condition.

Poverty

Poverty has real consequences. The aging person may not have access to the optimal medical care facility because of a lack of funds. But even at a younger age there is evidence that people are healthier when they are wealthier.

Shingles

Older people often get shingles, even if they had chickenpox or shingles as a child. This is evidence that the immune system is getting weaker. Shingles in an older person should alarm the treating physician that there could be an underlying cancer. Due to that knowledge a cancer-screening tests should be part of the medical exam. In addition, a varicella vaccine should be offered to the patient to build up immunity.

The Downside Of Living To 100

The Downside Of Living To 100

Conclusion

Living to 100 is often glorified in the press. Maybe you have seen a 90-year old jogger completing a marathon, or you saw an 85-year old couple ballroom dancing. But what they don’t show you is what I summarized here, the less glamorous things about living to 100. You may get a heart attack or a stroke. Osteoarthritis may affect you how you walk. Congestive heart failure may make you get short of breath when you walk upstairs. Then there are various cancer types that are difficult to diagnose early.

If you have smoked in the past, you may suffer from chronic obstructive pulmonary disease (COPD), which leaves you breathless.

Other illnesses

Osteoporosis can lead to spontaneous fractures. Because the bone has a lack of calcium, this is difficult to treat and takes a long time to heal.

Alzheimer’s is ever so much more common when you approach the year 100. There are other medical conditions you can get: obesity, diabetes and depression. When you get shingles for the second time, it may mean that your immune system is getting weak and a cancer-screening test should be done.

There are some downsides when you approach the age of 100.

Know your risks and be vigilant

You may keep your physician busy checking out various age-related illnesses, but more importantly, get regular check-ups and tests. Any condition is easier to treat with an earlier diagnosis! The message for anybody reading this is very simple. Prevention through healthy living is something you can actively pursue. Keep your body and your mind busy. Enjoy time with friends and family instead of living a solitary existence. See the glass that is half full instead of viewing it as half empty. Stick to a healthy diet. Knowing all the risks is not a scare but a call to being vigilant. Knowledge is powerful and will help you to enjoy your golden years feeling well and happy.

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Jul
07
2018

Asthma In Adults

On April 6, 2018 CNN published an article about asthma in adults. It was called “Developing Severe Asthma in Adulthood”.

Asthma in adults occurs with a frequency of about 2.3 per 1000 people per year. This publication also noted that women suffer from this condition more often than men. For both sexes the occurrence of asthma in adults peaks at 35 years of age.

Symptoms of asthma

The triggering factors for asthma can be infections, allergies, or the condition can come on spontaneously. Coughing is one of the main symptoms. You may be breathless when walking stairs. You may feel weak or tired when exercising. After exercise you may be wheezing or coughing. If you measure your breathing capacity with a peak flow meter, the values are lower than normal. Cold air or irritants like cigarette smoke may trigger coughing or wheezing. In industrial workers the trigger for asthma can be noxious fumes.

Diagnosis of asthma

Spirometry

Your doctor likely will order a test, called spirometry. You are breathing into a tube with a connection to a spirometer. A technician will instruct you to breathe out to the max (maximal exhalation). Next you will have to breathe in as quickly as you can. These breathing activities translate into a breathing curve on the read-out of the spirometer. With asthma there is a certain degree of restriction of airflow due to spasms in the smaller bronchial tubes, called bronchioles. This will be obvious from the breathing pattern of the spirometry read-out.

Methacholine challenge test

When the spirometry test is normal or near normal, a Methacholine challenge test can be another diagnostic tool. If this produces an asthma attack, it is clear that the person does indeed have asthma.

Measuring nitric oxide in your breath

Our bodies normally produce nitric oxide, and a small amount of it appears in your breath. But if there is a large amount of it present in your breath, it indicates chronic inflammation in your airways, which can be one of the causes of asthma.

Other tests to rule out other related diseases

Your doctor may want to order sinus x-rays to rule out sinusitis or a chest X-ray to rule out pneumonia. If he suspects allergies a referral to an allergist sill be next. The specialist will do skin prick tests to see what you are reacting to.

Differential diagnosis of asthma and other diseases

When the physician is thinking about an asthma diagnosis, it will be necessary to exclude other diseases first. It is important to exclude a bronchial or lung infection as well as the presence of emphysema or chronic obstructive pulmonary disease (COPD). Clots in the pulmonary vasculature (pulmonary emboli) have to be ruled out. When there is a history of gastroesophageal reflux, tests should exclude that there is aspirated gastric contents into the lung. Another condition that could bring on wheezing is chronic congestive heart failure, where the heart fails to pump enough blood, and shortness of breath is a consequence. Tests are available to exclude all of these conditions.

Treatment of asthma in adults

Anti-inflammatory medication

As all patients with asthma have inflammation in the airways, it is important to use corticosteroid inhalers that will control this. These inhalers will control the swelling and mucous production in the lining of the bronchial tubes. With the daily use of these inhalers the airflow improves, the airways become less sensitive and the patient experiences fewer asthma episodes.

Bronchodilators

Bronchodilators are inhalers that will relax the muscle bands around the bronchial tubes. This allows the patient to breather easier. The mucous flows more freely and can be coughed up easier. There are short-acting and long-acting forms of bronchodilators. Your physician will instruct you which one to use.

Asthma In Adults

Asthma In Adults

Conclusion

Adult onset asthma is separate from asthma of childhood. Often the triggers are allergies or irritants, including industrial irritants. With a proper diagnosis and treatment adult asthmatics have a normal life expectancy. It is important to control the inflammation of the airways with anti-inflammatory corticosteroid inhalers. For acute asthma attacks a bronchodilator must be used right away to ensure normal airflow is restored. The patient learns how to modify the asthma therapy. As a result there are very few occasions where the patient would need treatment in a hospital. Most patients can treat an asthma attack quickly and they respond very well to the treatment. As a result adult asthmatics can lead active lives and have no physical limitations.