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.

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.

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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.

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.

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.

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Jun
09
2018

What Makes Chips Addictive?

When you emptied an entire bag of potato chips, you may ask yourself: what makes chips addictive? Scientists talk about hedonic hyperphagia or hedonic hunger. In plain English, it is the pleasure of eating, even when you are not hungry. There are certain foods that seduce you to overeat, and one of these are chips. Chocolate or candy can be other high-hedonic rating foods.

Erlangen experiments

A group of researchers from the Erlangen University in Germany set out to get to the bottom of this addiction eating. 17 healthy subjects with a body mass index of between 19 and 27 were recruited for eating experiments. They got either high calorie chips or low calorie zucchini. The chips created a marked stimulation on a functional MRI scan where the nucleus accumbens was lighting up. When they consumed zucchini no such stimulation could be documented. The researchers had done similar experiments with the same foods on rats. They too had functional MRI scans and the tests showed similar stimulation after the test animals consumed chips, but not after zucchini.

Nucleus accumbens, the addiction center for food

Professor Andreas Hess and his team in Erlangen say that the nucleus accumbens is the addiction center for food. They also did experiments with fat to carbohydrate composition to find the most addictive mixture. There is a certain fat to carbohydrate ratio that triggers food addiction. What surprised the Erlangen researchers was that both in rats and humans the optimal addiction potential was identical.

  • They found that rats preferred 35% of fat and 45% of carbohydrates in their chips. With humans there is the other factor: on top of the fat/carb mixture we like to taste some salt and spices, because this also will stimulate our appetite. The food industry has figured this out long time ago. This knowledge from tasting experiments is built into processed food.
  • The Erlangen researchers  also found that in obese people the nucleus accumbens was lighting up more intensely the higher the BMI was. That means that obese people are more food-addicted!

Triggering the nucleus accumbens

  • Professor Hess postulates that the 35% fat to 45% carb mix in potato chips is ideal for the body. It can mobilize quick energy from carbs, but also have storable energy from fat at the same time. It is this mix, which stimulates the addiction center in the nucleus accumbens.
  • In a study from Bethesda, Maryland researchers found an overlap between food addiction and drug addiction.  The common pathways in both is the release of dopamine in the nucleus accumbens. This dopamine release makes us feel good, and as a result, we want to experience it again.
  • In this study patients with bulimia nervosa were examined. They found that   overconsumption of sugar-laden foods had very similar effects as drugs in drug-addicted patients. It is the release of dopamine, glutamate and the opioid system that are involved in both. The nucleus accumbens is also receiving stimulation in both situations.

What can be done about food addiction?

This publication noted that people who are food addicted eat higher amounts of fat and carbohydrates. With this mix the feel-good nucleus accumbens produces most dopamine, which is the driving force behind the addiction.

  • If you cut out sugar, you find it easier to control your eating portions. But you also must cut out processed food, as this is where a lot of hidden sugar is coming from.
  • Cut down on your fat consumption. Even if you reduce it from 35% to 10% or 15%, this is a huge step forward. It reduces your calorie intake significantly, but also reduces the stimulation of your appetite center.
  • Eat lots of vegetables, salads and some fruit. Be careful with some fruit like grapes, bananas, mangos, papayas and dates. They are all higher in sugars. If you cannot entirely avoid those, use portion control, so you are not overeating on them.

Portion control

Besides changing the food quality, you can reduce the portions of food you are eating. Instead of mindlessly emptying a whole bag of chips, you could get a small bowl and fill part of the bag of chips into it. Remove the bag into a cupboard that is difficult to reach. If you are sitting and watching TV, you could eat one chip at a time, but only during commercial breaks. This way your chip eating becomes more conscious and more controlled, and you set a limit. In time you may find that you can replace the chips with a lower calorie food like slices of apples, celery sticks or carrot sticks.

What Makes Chips Addictive?

What Makes Chips Addictive?

Conclusion

Researchers found that chips were addictive in rats and in humans. Functional MRI scans of brains in rats and humans showed that potato chip eating stimulated the nucleus accumbens. It was lighting up in both species when the test subjects consumed potato chips. Surprisingly, it did not matter, whether these were test animals or humans! A review of several research papers showed a similarity between food addiction and drug addiction. It is dopamine and other brain transmitters that stimulate the nucleus accumbens, which is the addiction center. One of the keys, professor Hess from Erlangen University in Germany found, is the fat/carb mix. When the potato chips contained 35% fat and 45% carbs, this stimulated the nucleus accumbens.

Changing your eating habits

Knowing all of this helps us to be able to change our eating habits. To avoid the pitfalls of food addiction, cut out sugar and starchy foods, and remove processed foods from your diet. Also reduce some of the fat to 10% or 15% fat in your total diet. Eat lots of vegetables and fruit low in sugar. In addition you should also consider with portion control to avoid mindless munching. Before you know it you can shed the pounds that you may have accumulated before. You will be able to reduce your BMI to 21 to 23. Many people have done it before you.

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Feb
24
2018

What Causes Premature Aging?

Some people look 10 years older than their stated age, and we often wonder: what causes premature aging? Accelerated or premature aging can have a multitude of underlying causes. I will list a few here:

1. Weakening hormones

Men go through andropause at around the age of 60 to 65 and women go through menopause around the age of 55 to 65. In both males and females it is the sex hormones that are missing around that age. If hormones replacement follows fairly quickly with bioidentical hormones, this will not affect the visual appearance that much. In contrast, if bioidentical hormones are not the therapeutic choice for  hormone replacement, but synthetic ones, the hormones are not in balance, as synthetic hormones do not restore the hormonal balance. Nothing is gained, as the person will still age prematurely.

Synthetic versus bioidentical hormone replacement

In addition the synthetic hormones will cause heart attacks, strokes, clots, and cancer. Prescriptions for synthetic hormones are often the cause that the aging patient population gets these serious complications. Frequently physicians insist on using synthetic hormones from a “reputable” drug company to replace missing hormones. The reason this does not work is that a male has testosterone receptors. They need to be stimulated by bioidentical testosterone to restore all of his missing functions. Also, the same is true in menopausal females who need stimulation of their estrogen receptors and progesterone receptors. Consequently, only bioidentical hormones will return a postmenopausal woman back to normal. There is a perfect fit between the bioidentical replacement hormones and her hormone receptors. Using synthetic hormones is like trying to unlock a door with a key that does not have a perfect fit: you damage the lock!

2. Missing human growth hormone (HGH) and thyroid hormones

These hormones have a special place in aging.

Human growth hormone deficiency

First, HGH production is running out in many people at age 60. A person with HGH deficiency will have lower muscle mass and strength. Other symptoms are dry and thin skin, particularly at the back of the hands. Men are balding, and they loose interest in sex. There are difficulties concentrating and they may have “senior moments”, which are memory lapses. Often they are prone to depression and anxiety. A blood test will frequently show elevated triglycerides. A blood test (IGF-1) and a urine test exist which make it possible to look for HGH metabolites to assess whether a 40, 50 or 60 year-old person is producing enough HGH. Many may need replacement of HGH. This is administered by injection through a tiny needle into the skin, similar to a diabetic injecting insulin. This will bring back what was missing due to HGH deficiency.

Thyroid hormone deficiency

Thyroid hormones (T3 and T4) are other important factors that could make you look older prematurely. Your hair is getting thinner; your skin turns dry and pale. The nails may be getting brittle. When the outside half of the eyebrows is very thin or missing, this can be a sign of hypothyroidism. In a similar vein the skin in the face may be puffed up due to swelling of the layers under the skin (myxedema). It is important to diagnose hypothyroidism, which is common in the aging population. The physician needs to order a blood tests (TSH, T3 and T4). If TSH is above the upper limit, your physician needs to replace both T3 and T4 by tablets (I prefer Armour as the T3 and T4 is balanced).

3. Smoking

The lining of the airways absorb cigarette smoke. The chemicals circulate around in the blood and lead to aging of the skin. Chronic cigarette smoke exposure also melts away the subcutaneous tissue. The end result is a haggard look. The natural glow disappears from the skin and because of carbon monoxide binding to hemoglobin the skin color looks more greyish. In addition the blood vessels are narrowing or clogging. This means that the body cannot absorb nutrients as well, and cells are starving. There is only one remedy for this: quit smoking!

4. Overexposure to ultraviolet light

The radiation of UV light can penetrate deep into and under the skin. This makes the subcutaneous fat melt away. The largest UV exposure is in the facial area. As a result we see aging there. The end result is a sagging appearance of the face. This link has an image of a woman before and after a non-surgical facelift with stem cells and fatty tissue: Stem Cell Treatments That Are Currently Available – Medical Articles by Dr. Ray

In a surgical procedure the physician harvests mesenchymal stem cells from fatty tissue by liposuction. A cell separator separates the mesenchymal stem cells, the connective tissue and the fat cells. The connective tissue is discarded. Mesenchymal stem cells and fat cells are mixed and injected into the thinned subcutaneous fatty tissue until the person’s younger facial contour is back to normal. Typically this will last for 10 years or more.

5. Drugs and alcohol abuse

Both can lead to malnutrition with weight loss and loss of subcutaneous fatty tissue, which causes sagging breasts in women. In men “beer tits” are common. The reason for this is estrogen accumulation, as alcohol interferes with the elimination of estrogen in the liver. Alcohol is a general cell poison. It causes all of the cells to age prematurely. The more alcohol you drink, the faster you age. The skin develops wrinkles, loss of elasticity and collagen, redness and puffiness. In other words chronic alcohol abuse ages you prematurely. The only remedy for this is to quit drinking. Some of your skin vitality may come back. Our body has an amazing capability to heal itself!

6. Medical illnesses

Many medical illnesses like diabetes, mental illness (depression and schizophrenia), multiple sclerosis, inflammatory bowel disease; cancer and others make you look a lot older very fast.

I will briefly explain the reasons for this.

  • Diabetes

With diabetes type 2 the pancreas releases too much insulin after a meal with starches and sugar; think about a sweet muffin or a toast with jam. The extra insulin causes inflammation. This stimulates enzymes that break down elastin and collagen, leading to wrinkles and sagging skin.

  • Mental illness like depression and schizophrenia

We know from studies that depression leads to shortening of telomeres. This in turn causes cell death in the most rapidly dividing cells like in the skin and hair follicles. The end result is prematurely aged hair and skin. Schizophrenia also leads to premature shortening of the telomeres, which causes premature aging, mitochondrial dysfunction, inflammation and oxidative stress. The end result is that the person looks older than what their chronological age is.

  • Multiple sclerosis

It is sometimes difficult to discern in patients with MS what is normal aging and what is aging from the disease. This link gives some background on this. Many MS patients are anxious, and anxiety and stress by itself also leads to premature aging.

  • Inflammatory bowel disease

The chronic inflammation of either ulcerative colitis or Crohn’s disease can lead to premature aging. High doses of vitamin D3 and molecularly distilled fish oil can be useful to help treat the inflammation. Probiotics are also important to restore the bowel flora.

  • Cancer

Cancer leads to cachexia (excessive weight loss). There is also excessive inflammation, which leads to accelerated aging. The inflammation causes increased oxidative stress. This leads to tissue damage and DNA damage, which makes all cells more vulnerable to develop other cancers. Oxidative stress can substantially accelerate telomere shortening. As a result skin can become saggy, wrinkles develop and the person looks prematurely aged.

7. A chronic lack of physical activity

People who never exercise tend to get overweight and eventually obese. This leads to premature aging. Exercise would elongate telomeres, but inactivity shortens them. Obesity leads to increased oxidative stress and to DNA damage. Obesity also shortens telomeres. All of this leads to premature aging.

What Causes Premature Aging?

What Causes Premature Aging?

Conclusion

These are only a few examples of causes of accelerated aging. The key is to stick to a healthy, balanced diet (like the Mediterranean diet) and exercise regularly. Stop smoking (if you do), don’t take street drugs, and make sure you get enough sleep. Getting enough sleep helps your hormones regenerate overnight. The sympathetic overdrive from your daily activities is counterbalanced by the parasympathetic activities during sleep that causes relaxation. For hormone replacement you may have to see an anti-aging physician, a naturopath or integrative medicine physician. This may be your only chance to address any hormonal deficiencies. Conventional medicine does a very poor job of HRT (hormone replacement therapy) with synthetic hormones. Conventional practitioners want to treat you with synthetic hormones that will make you sick. Hormones for replacement have to be bioidentical! This way you will live 10 to 15 years longer, look younger and stay healthy.

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Feb
03
2018

Drugs Are Not An Escape

We have a drug epidemic, but drugs are not an escape. Along with this epidemic there have been thousands of lethal overdoses. I like to review why so many people use street drugs or prescription pain pills. It started years ago with heroin injections had become more popular. But then heroin was getting a bad name, it became illegal, and prescription pain pills replaced heroin. Percocet, OxyContin and morphine prescriptions took off. Together with it the number of people with addiction increased drastically. The latest fashion craze is Fentanyl.  Fentanyl works faster than morphine, but also wears off faster. One of the deadly side effects is respiratory depression. This  means that a person cannot breathe and as a result will die. This is what is happening right now and what creates the news headlines.

Pain receptors

There are pain receptors all over the body, in muscles, organs and the skin. They are called nociceptors. Many medical conditions lead to pain in various parts of the body. For instance, with end stage degenerative arthritis bone rubs on bone. This causes a lot of pain in joints like the knees or the hips. Physicians often prescribe narcotics like OxyContin to control the pain. It may help for some time. But after a few weeks patients complain that the strength of OxyContin has worn off. The same dosage that gave them relief from the pain initially just does not give them relief any more. This observation is crucial. It is exactly what people who use OxyContin as illicit street drug found as well. The drug wears off, because the opioid receptors are getting weaker.

Pain receptor resistance

Nociceptors or opioid receptors are pain receptors. These receptors report pain to the body, and they have connections through the spinal cord to the brain. When an opioid is interacting with the pain receptor it inhibits acute pain to a large extent. But when the pain becomes chronic, the pain receptor is not working as well. More and more of the pain medication is necessary to achieve pain relief.  Eventually the opioid medication is not working to relieve pain any more. The name for this phenomenon is “pain receptor resistance”. Scientific work behind why pain receptors get lazy in responding to opioids is still ongoing. In the meantime it simply is an observation. This is the reason why drug addicts are tending to increase the dosage of OxyContin or of Fentanyl. The toxic threshold of Fentanyl that is exceeded in the process is the reason for the deaths.

Insulin resistance

You may have heard of insulin resistance in diabetics. This is a very similar problem. With insulin resistance the diabetic no longer has a 100% response to insulin. This means that blood sugar is not going through cell membranes effectively as it should when the insulin receptor is working. The blood sugar values stay high and make the diabetes worse.

With pain receptor resistance the opioid is not giving the relief from pain it used to give. No wonder that the patient is feeling frustrated that the pain medication is no longer working properly.

Therapeutic index

The layperson does not normally know that there is a dosage for any drug where it becomes toxic. There is also a lower dosage where the drug is becoming effective. The difference between the two dosages is the “therapeutic window” or the “therapeutic index”.

Morphine has a therapeutic index of 70:1. Compare that to alcohol with a therapeutic index of only 10:1. Fentanyl has a therapeutic index of 300:1.

The danger of Fentanyl

One would think that Fentanyl should be safer than morphine, because the therapeutic index is larger. But the onset of Fentanyl is much faster than that of morphine and by the time drug users take Fentanyl they often are desperate for the drug to take their pain away and they overdose, which causes respiratory depression. If they are not intubated by an anesthetist and connected to artificial respiration, they die very quickly. Janssen Pharmaceutica first developed Fentanyl in 1959. Fentanyl was strictly part of the pre-anesthetic medicine for patients before going into surgery requiring a general anesthetic. The anesthetist was right there and would intubate the patient. That’s why we never heard of deaths from Fentanyl in the past.

If a person gets no pain relief from any opioid because of receptor resistance, the tendency is to increase the dosage. But this is what pushes the person into toxic ranges and this is what causes death from inadvertently suppressing the ability to breathe. People can get into trouble with alcohol overdoses, but the ordinary person usually knows how to handle alcohol. Fentanyl is a lot different due to the fact that respiratory depression (not being able to breathe) is one of the early symptoms that hits you suddenly.

What drugs do to your brain

Dr. Daniel Amen, a psychiatrist and brain researcher has used SPECT brain scans to produce images of different clinical conditions. This link shows the effect of a stroke, of Alzheimer’s disease and of drug abuse on the brain. Dr. Amen says that a brain can be rehabilitated. He has other SPECT images showing the images of an addicted brain and that of a rehabilitated brain. Spect scans are expensive.  But they may be worth it, to impress a drug addict to stop the drugs and get rehabilitated.

Big Pharma and opioid drugs

In 1995 the FDA approved the use of OxyContin for chronic pain. Perdue Pharma, the drug company that had developed this opioid convinced the FDA that OxyContin stayed in the blood for 12 hours and they claimed that by being active longer than other opioids this would lead to better pain control and less addiction. It turns out that this was a slick sales pitch, however it was not true. Pain receptor resistance is as much a problem with OxyContin as with any other opioid. And the drug is as addictive as all the others. But the problem is that the FDA had approved OxyContin. What’s more, Purdue Pharma sent aggressive drug representatives to all the practicing physicians misleading them as well as the FDA that OxyContin would not be as addictive as other opioids.

Penalty for misrepresentation of OxyContin

In 2007 Purdue Pharma had to pay a fine of 634 million $ for misrepresenting the addiction potential of OxyContin. But the drug company was allowed to continue to market OxyContin. Since 2015 Purdue Pharma has been cashing in 2.4 billion $ annually from the sales of opioids including OxyContin. In the meantime Fentanyl, despite its danger of suppressing the ability to breathe, has taken off with regard to sales. Fentanyl also has taken over in terms of causing deaths across the US and other countries.

Alternative treatment of pain

According to Ref. 1 chances are that 70% of patients with back pain will get better with a few visits to an acupuncturist. In 1972 Dr. Ulett’s laboratory at the University of Missouri succeeded in getting the first NIH research grant for the study of acupuncture in the US. During these studies they found remarkable facts, the most important perhaps that electrical stimulation of acupuncture needles resulted in a doubling of the effectiveness of traditional Chinese acupuncture. After extensive research Dr. Ulett stated: ”The ancient practice of traditional Chinese acupuncture is now obsolete” (Ref.1). in the meantime the more effective electro-acupuncture has replaced acupuncture needles with the use of electrical skin pads.”

Other applications for electroacupuncture

Beside pain relief many other applications exist for electro-acupuncture. Addiction medicine makes use of electro-acupuncture in weaning people from morphine or heroine etc. It is effective to treat psychiatric illness, particularly depression. It is useful in relieving nausea and vomiting due to chemotherapy with cancer treatments or associated with pregnancy without affecting the pregnancy.

Prolotherapy

Prolotherapy has been successful for the treatment of back and neck pain, for arthritic pain and pain from chronic muscle spasm. When prolotherapy is done by itself 12.5% Dextrose is injected into the area of injury. Dr. Fields said that the reason it works is that there is activation of local stem cells in the injured area in the area of the Dextrose injection site. These stem cells will do the healing (details explained in an interview with Dr. Reeves). Further improvement of this technique and better results are possible by injecting a small amount of platelet rich plasma (PRP) very focally to an area of ligament rupture. PRP is obtained by centrifuging blood from the patient’s vein. The red blood cells are not necessary, but the platelet fraction and some of the plasma are part of the the PRP preparation.

It is often striking how much pain control occurs after only one or two prolotherapy treatments.

Stem cell therapy with PRP and low-dose laser therapy

This is a more direct way to get stem cells where the doctor wants them to do their work. Stem cell therapy with PRP and low-dose laser activation is the latest in terms of controlling pain. At the 22nd Annual Anti-Aging Conference in Las Vegas (Dec.10 to 14, 2014) Dr. Purita gave an overview of this method of pain control. He discussed the importance of the proper harvesting of PRP. He explained that apart from white blood cells (WBC) and platelets an important component of PRP are very small embryonic like stem cells (VSELs). They are visible through the microscope. The missing link has been the observation that white blood cells produce inflammatory substances, which have been detrimental in stem cell injections with PRP in the past. There was a poor survival rate of stem cells.

Low dose laser activation of stem cells and PRP

Photo-activation of the PRP before injection leads to anti-inflammatory behavior of the WBC in PRP. Dr. Purita calls this “light activated PRP”, which leads to the best results with stem cell/PRP injections.

Soft laser stimulation with red, green and blue soft lasers have also been effective to improve tissue healing significantly when stem cells and PRP are used together with light activation. The main sources for good stem cells are the fat tissue (from the “love handles”) and the bone marrow (obtained from pelvic bone). The stem cells mesenchymal stem cells (from fatty tissue) and bone marrow stem cells. The mix of all of this can mend osteoarthritic joints, degenerative disc of the spine, in short all musculoskeletal injuries that may be painful. The hallmark of healing with stem cells is that chronic pain disappears.

Curative treatment versus symptomatic treatment

It is one thing to treat a patient for pain symptomatically by prescribing OxyContin or other opioids. It is a completely other thing when the physician cures the pain by one of these alternative methods. Let us assume that a patient has a fall of a few step from a ladder and sustains a contusion of the lower back. This can be painful and may require a few pain pills. But if it does not improve within one week and diagnostic tests show that there is no fracture, electroacupuncture may be the solution to treat the pain rather than the use of an opioid. If this does not help, consider the combination stem cell/PRP/low-dose laser therapy. Chances are better than 80% that this will help. The patient will no longer suffer of pain. With healing life can go on: no pain pills. No addiction. No death.

Drugs Are Not An Escape

Drugs Are Not An Escape

Conclusion

Conventional medicine treats pain symptomatically instead of treating the cause. It gets the physician to prescribe opioids, which can be the beginning of a series of tragic events. It can lead to drug addiction, dose acceleration, toxic effects of opioids including possible death through asphyxiation from no longer being able to breathe.

Stem cell therapy

The physician who concentrates on treating causes will use alternative methods to treat pain. The most effective of these methods is stem cell therapy. It is a mixture of adipose mesenchymal stem cells with bone marrow stem cells that are part of the therapy. The addition of platelet rich plasma is another part of the mix, and the final step is activation of stem cells with low-dose laser therapy. The cell mix is injected in the critical area. The end result is that the patient’s pain disappears, and it leads to a cure. The only situation where short-term opioids are justifiable is following surgical procedures. But even in these cases the narcotics should only be necessary for a few days to avoid serious side effects.

Reference 1: George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

More info about electroacupuncture: https://www.askdrray.com/electro-acupuncture-twice-as-effective-as-conventional-acupuncture/

More about prolotherapy stem cell therapy: https://www.askdrray.com/prolotherapy-and-stem-cell-therapy/

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