Jul
04
2020

Probiotics and a Phage Blend for Digestive Problems

By | Abdominal Pain, antibiotics, diet, Gastrointestinal Disease, immune system

In general, probiotics and a phage blend for digestive problems can help patients with irritable bowel syndrome (IBS). It is important to realize that about ¾ of Americans suffer from digestive problems. They develop symptoms of gas, bloating, diarrhea and stomach pains. To put it another way, about 1 in 7 Americans suffer from the condition, called chronic irritable bowel syndrome. That is to say, he underlying problem is an imbalance of gut bacteria where the bad ones outnumber the good ones. There are a number or reasons why bowel flora gets disrupted. We eat more processed foods, less fiber, and beef products from industry farms contain antibiotic residues. In feedlots for beef cattle antibiotics are fed to the animals as growth promoters. The residues in the meat kill the good bacteria in our guts and the bad ones proliferate. This causes digestive problems, but also weakens our immune system.

How probiotics work

Probiotics can restore our gut flora to a large extent. But some of the probiotic action gets lost in the stomach from the acidic milieu. A recent publication from a panel of gastroenterologists has not supported the wide use of probiotics. They came to the conclusion that probiotics have not shown enough benefit to a number of clinical conditions. The researchers mentioned Crohn’s disease, C. difficile infection, ulcerative colitis and irritable bowel syndrome (IBS) in particular of not responding to probiotics. But this may be because of inactivation of some of the power of the probiotics by stomach acid. In addition, by not using phages to potentiate the probiotic action probiotics may fail to permanently to improve the gut flora. I have previously discussed the importance of probiotics for the gut flora.

History and use of bacteriophages

Bacteriophages are now often just called phages. Dr. Frederick Twort, an Englishman detected phages in 1915 during World War I. Essentially a phage consists of either DNA or RNA and a protein envelope around this. Phages are very specific for certain bacterial strains. They attach to the bacteria and inject their own DNA or RNA into the bacteria. This stops the bacteria from multiplying, but makes the bacteria produce many more identical phages. Phages are useful to control the growth of problem bugs including antibiotic-resistant bacteria. However, the regulatory agencies were slow to approve phages despite a good safety record. Life Extension Magazine recently published a review article about this subject.

Phages helping to protect probiotic bacteria

Phages naturally play a role in keeping the gut flora stable. In this lengthy review, published in January 2020 phage actions are reviewed. It also mentions the connection between the gut flora and the immune system. The Life Extension Magazine article mentioned above describes experiments that show the action of phages. E. coli is the main bacterium in the large intestine. It is also the bacterium that can cause pneumonia, diarrhea and urinary tract infections.

Experiments with bacteria and phages in Petri dishes

According to the Life Extension Magazine article researchers did experiments with Bifidobacterium longum, one of the desirable gut bacteria. This was placed on a Petri dish along with E. coli bacteria. In a second Petri dish Bifidobacterium longum, E. coli and a phage mix were placed. After 5 hours there was hardly any growth of Bifidobacterium longum in the first petri dish, as it was crowded out by E. coli. The result in the second Petri dish was interesting: the Bifidobacterium longum colonies were 7000-times higher in number than in the other Petri dish without the phage mixture. The phages had selectively attacked the E. coli bacteria, which made room for the Bifidobacterium longum bacteria to multiply.

Animal experiments with bacteria and phages

The Life Extension Magazine review mentions animal experiments with phages next. One group of mice received B. longum and the disease-causing E. coli in their food. The other group had the same bacteria plus a mix of phages directed against E. coli. For the phage group the results within 24 hours were as follows.

  • The E. coli count in the small intestine was 10-fold lower, in the large intestine 100-fold lower and in the fecal matter 100-fold lower.
  • The phage group also had a 100-fold increase of the B. longum count in the small intestine. The large intestine also had a 100-fold increase of the B. longum count. And there was a 40-fold increase of B. longum in the fecal matter.

Control mice without the phage mix developed constipation and intestinal segments showed redness, swelling and leaks. In contrast, the phage mix group of mice showed no side effects and had improved digestive function.

Human studies using probiotics and a phage blend for digestive problems

Safety tests of phage therapy were next in 2005 involving 15 volunteers. There were no side effects using two different phage concentrations to diminish E. coli. Researchers had done other safety experiments in Russia and in Poland in the past. Patients with ulcerative colitis responded with improved symptoms and improved endoscopic findings to treatment with two probiotics. They received fermented milk products (Cultura) containing live lactobacilli (La-5) and bifidobacteria (Bb-12) for 4 weeks. There were 51 patients with ulcerative colitis and 10 patients with familial adenomatous polyposis. Abdominal cramps, Involuntary defecation, leakage and the need for napkins were significantly reduced in both groups. An endoscopic score of inflammation showed a significant decreased when the baseline exam was compared to the exam after the 4-week intervention.

Literature review about phages

Here is a thorough review in a publication dated 2011, which describes research from Poland and other countries describing the action of bacteriophages, now simply called phages. It lists many human experiments and shows that phages are safe to use in humans.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) presents with a pathological intestinal function, which can be quite disabling. Another name for it is “spastic colon”, because many patients complain of significant bowel spasms. Some health providers still use this alternative term. This syndrome is more common among women and there is a theory that female hormones may have something to do with the pathophysiology of irritable bowel syndrome. Testosterone on the other hand may have a calming effect on the gastrointestinal tract.

Symptoms and treatment of IBS

Generally speaking, irritable bowel syndrome occurs first in the teens or early twenties, but then frequently tends to become chronic. The patient chiefly complains of abdominal bloating and distension. Bowel movements lead to a marked relief of pain. There is often mucous in the stools. After a bowel movement there is often a feeling that the rectum did not empty entirely, even though it did. Food intake or stress can bring on these symptoms and they always occur during the waking period. At nights most patients have no pain.

Among other measures taking probiotics alone or mixed with phages can normalize the bowel flora. In older men IBS symptoms may indicate a reduction in testosterone production. If the blood contains a low testosterone level, the physician may want to replace the missing testosterone with injections or bioidentical testosterone creams. This can improve IBS in older males.

A safe delivery system for probiotics and a phage blend for digestive problems

Life Extension has developed a dual capsule that brings the inner content safely through the stomach and protects the mix of probiotics and phages from stomach acid. The capsule only opens in the small intestine where it releases its content of probiotics and phages into the gut. This allows the good bacteria like B. longum to multiply and suppresses E. coli, which would otherwise interfere with the beneficial bacteria.

Probiotics and a Phage Blend for Digestive Problems

Probiotics and a Phage Blend for Digestive Problems

Conclusion

About ¾ of Americans suffer from digestive problems. Many have a disbalance of the gut flora. But it is not easy to replace poor gut flora with a healthy one. Recent research showed that a combination of 7 probiotic strains with a mix of 4 E. coli fighting phages can give tremendous relief from bloating, diarrhea and abdominal cramps to patients with irritable bowel syndrome (IBS). Life Extension has developed a special dual capsule that “sneaks” the capsule through the stomach. It will only open in the small intestine. This way the content of the inner capsule with the mix of probiotics/phages stays safe from the stomach acid. At the end many more beneficial bowel-bacteria are growing in the small and large intestine. This normalizes the symptoms of the patient and leads to better digestion of food. Probiotics and phages are the new players in the gut microbiome.

Mar
31
2018

Self-Love Is Important

By | Anxiety, depression

You need to appreciate that self-love is important, if you want stable mental health and well-being. Before you can take care of people around you, you need to practice self-love first. You cannot give love, if you don’t love yourself first. We get so busy in working hard, wanting to achieve goals and then surpass ourselves. We want to be perfect. But this is not possible without first looking after our own needs: again, self-love is important to be able to reach the goals you want to achieve.

Perfectionism can be harmful

Most of us were grew up  in the Western society thinking that perfectionism would be good for us. After all, we achieve things; we criticize ourselves and improve it even more; so finally we end up with our dream goal. What is the downside of perfectionism?

Perfectionism often comes with chronic stress, which can shorten our life span. Perfectionism leads to diseases like irritable bowel syndrome, fibromyalgia, depression and eating disorders. Depression can have a serious complication, namely suicide attempts and actual suicide. Perfectionists also often suffer from anxiety disorders that can make life miserable. Chronic stress together with perfectionism can weaken the immune system, which in turn can cause infections and even autoimmune diseases.

Moving away from perfectionism

The United Nations passed a resolution in 2012 saying, “pursuit of happiness is a fundamental human goal.”

Psychologists also tell us that happiness is something we deserve to have; it is our right. A clinical psychologist in Vancouver, Canada, compares the inner critic of perfectionists to a “nasty adult beating the crap out of a tiny child”. We don’t have to beat ourselves up internally; it is not healthy for us. Don’t let the inner bully put yourself down for a minor thing that went wrong.

Start cultivating self-compassion. Self-compassion is not something that you have or do not have. According to psychologists self-compassion is something that you can learn.

The more you learn self-compassion, the less important perfectionism will be for you. You will still be productive and successful, but you will stop injuring yourself in the process.

Learning about self-compassion

Psychologists have researched how self-compassion can be developed. They even have invented an 8-week program that helps the client to build up self-compassion. These psychologists could measure a significant improvement of the level of self-compassion before taking the course and after completing it. According to Prof. Neff and associates there are three parts to self-compassion.

  • Self-kindness, which means treating yourself with understanding and forgiveness.
  • Recognition of one’s place in the shared humanity. This acknowledges that people are not perfect. It also means that personal experiences are part of the larger human experience.
  • Mindfulness, which means emotional balance and avoiding over identifying with painful emotions.

Listening to yourself

Dr. Kristin Neff has written a book that describes how to change your inner voice from a harsh voice to a softer, kinder internal voice. By becoming aware what your internal thoughts are, you can gradually change your internal talk. Profs. Neff and Germer have developed an 8-week course called “mindful self-compassion training”. In their own words “Self-compassion says, ‘Be kind to yourself in the midst of suffering and it will change.’ Mindfulness says, ‘Open to suffering with spacious awareness and it will change.'”

Part of the course is to learn how to deal with suffering when things go badly. In this case they recommend to their clients to repeat the following 3 phrases: “This is a moment of suffering,” “Suffering is a part of life,” and “May I be kind to myself.” This will take the sting away from the suffering and reduce the emotional pain.

Doubts about mindful self-compassion training?

You may have some doubts whether or not self-compassion training would work. But psychological tests regarding self-compassion ratings before and after the course have found a significant 43% difference. Similar compassion training can be found under this link.

These mindful exercises in self-compassion have been proven to down regulate the stress response. The hormones ACTH and cortisol in the blood were found to be much less in persons who had undergone self-compassion training. The training also was shown to increase heart rate variability, which is the body’s natural way to react to stress.

Not everybody is a good meditator. But apart from meditating there are other methods to recognize that self-love is important, as is self-compassion. You can write a letter to yourself, but pretend it comes from a close, loving friend. You could also write a letter that you pretend comes from you addressed to a person that you show compassion to.

Yoga to help you realize that self-love is important

Yoga is a great way to re-acquaint you with pleasures you experienced in childhood. Part of a yoga exercise can be “Mindful Eating”. You are simply refocusing your attention to the tastes that you may have taken for granted. Such a technique helps you to listen to yourself, become aware of your needs and train yourself in self-love and self-compassion. One of the top recommended Internet accessible yoga classes was this.

Self-love Is Important

Self-love Is Important

Conclusion

Perfectionism is widespread and is often taught in schools to be desirable. However, we become so good at this that it often turns into self-injurious behavior. We become harsh on ourselves and nothing is good enough to please us. And we expect perfection from people around us. We may even become abusive when they do not measure up to our expectations.

Dr. Kristin Neff has written a book that describes how to change your inner voice from a harsh voice to a softer, kinder internal voice. She also teaches an 8-week course at Harvard University how to develop self-compassion and self-love.

Mindful exercises in self-compassion

Mindful exercises in self-compassion have been proven to down regulate the stress response. It teaches you to deal with suffering when things go badly.

The bottom-line is to find your path away from perfectionism to a feeling of wholeness. And by achieving this we will free the negative energy of harsh and often unjustified criticism to give our best and succeed.

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Nov
25
2014

Gluten Intolerance Or Food Sensitivities?

By | heart attack, Nutrition, Prevention, Skin Disorders, Stroke

A report about gluten free food is circulating in the media based on this publication. It points out that gluten-free food is not as healthy as the companies want you to believe it to be.

Wheat is the source of gluten, so rice, potato, corn and sugar are used to replace wheat. Corn is deficient in niacin leading to B3 deficiency; and the amino acids lysine and tryptophan (missing in corn) are needed for production of serotonin in the brain, which prevents you from getting depressed.

The reference cited above points out that rice can be contaminated with arsenic, which is a toxin.

Gluten-free food is a special form of processed food. Any processed food is not as good as natural food that you buy from the periphery of the grocery store.

So, what do we know about gluten sensitivity?

Causes of increased diagnosis of gluten sensitivity

Only 1% of people are gluten sensitive at this point. Just 30 years ago this number was 0.025%. 10 years ago 0.04% of people were thought to have gluten sensitivity. The difference may be due to improved sensitivity of the testing methods. But another factor is the new wheat, called Clearfield wheat, which was obtained through chemically forced hybridization of wheat resulting in significant genetic modifications from the original wheat. This type of wheat is now grown all over the world. As I explain in this blog Clearfield wheat has a significantly higher percentage of gluten, which likely contributes to the increased gluten sensitivity in the population at large and particularly among patients with irritable bowel syndrome (IBS).

Irritable bowel syndrome and other food sensitivities

According to Ref. 1 among patients with irritable bowel syndrome (IBS) 4 to 5% have true gluten intolerance (celiac disease). In the general population (without IBS) the gluten sensitivity percentage is less than ¼ of that. On the other hand lactose intolerance in the US is found in 25% of all adults and in 35% to 45% of IBS patients. Another common food sensitivity is fructose and sorbitol intolerance, which occurs in about 40% of patients with IBS and about the same percentage in non-IBS controls. This means that if you leave out sorbitol and fructose, about 40% of people will find relief from abdominal cramps or bloating. A common item that people chew on, according to Ref.1 is sorbitol-containing chewing gum. If this type of chewing gum is eliminated, 40% of people will feel better in their gut. So, keep in mind that the majority of people with food sensitivities do not have gluten sensitivity, but lactose intolerance and allergies to fructose and sorbitol.

Other manifestations of celiac disease

Celiac disease is not only a disease that manifests itself in a skin rash (as originally described in celiac patients). It is responsible for a significant amount of ADHD (attention deficit hyperactivity syndrome) or ADD (attention deficit syndrome) and can even cause Parkinson’s disease. It stands to reason that these conditions can be improved with an appropriate diet.

 

Gluten Intolerance Or Food Sensitivities?

Gluten Intolerance Or Food Sensitivities?

Gluten-free foods often contain problematic replacements

When you go to a grocery store or health food store and look at their gluten free shelves, they offer you an array of products like gluten-free bread and bakery items, cereals, cookies, pastas and many other processed foods. As explained above wheat is the main source of gluten and when you replace it, the substitutes are rice, tapioca starch, quinoa, potato, corn and sugar. We already pointed out some deficiencies of corn. There are also concerns of toxicities as in rice, particularly if it comes from imported material (arsenic). As the majority of people with food sensitivities are allergic to milk sugar (lactose), fructose and sorbitol, these items have to be screened carefully by reading all of the details on the food labels of the products. If you suspect other food allergies, see your primary care physician doctor for testing to these allergens and also have several of the gluten sensitivity tests done. If the gluten sensitivity tests are all negative, you only need to pay attention to milk sugar, fructose and sorbitol, particularly, if you have been diagnosed with IBS.

Hidden sugar and starch content of gluten-free food

What has not been mentioned so far is the sugar and starch content, which eventually leads to higher calories. Sugar is easy to spot on the food label as this is usually listed clearly. I stopped buying dark chocolate, even the 85% variety as they are selling me 10 grams of sugar in a 40 gram helping (25% of sugar). All the health benefits are no longer applicable when you consume that much sugar with a supposedly healthy food item. So add up the sugar you are getting and add up the calories you are seeing listed. Usually, if the sugar content is high, the calories are high.

As an example, when you research on Google regarding gluten-free corn chips, the food content of a typical product is listed as follows: 12 chips (28 g) contain 0 g glucose, 7 g fat, 14 g carbohydrate, 4 g protein, 100 mg sodium and 250 mg of potassium. It also lists that the total calories are 140, of which fat contributed to it 60 calories. 78% of the 80 calories left (namely 62.4 calories) came from the carbohydrate (starch in corn) and 22% of the remaining calories were protein derived (this I had to calculate). As the stomach digests the corn chips within half an hour into sugar, you really have eaten 62.4 calories from sugar. The Internet tells you that 2.3 g of sugar from a sugar cube are the equivalent of 9 calories. Our “sugar math” can be completed by doing this: 62.4 / 9 x 2.3 g = 15.94 or 16 grams of sugar. So, the food industry actually lied to you by saying that there was 0 g sugar in the 12 corn chips. What happened is that your body digested the 14 grams of carbohydrates and converted it into sugar, which was absorbed into your blood stream. Your pancreas could tell you a story, because it had to produce insulin to keep your blood sugar level in balance!

You may wonder how I solved the dark chocolate problem, which by the way would double as a gluten-free food: You buy 100 % unsweetened Baker’s chocolate (0 g sugar on the label) and liquefy it in a little bowl in a pot with hot water. Add a tiny bit of stevia sweetener and add a tiny bit of vanilla extract into the well-stirred chocolate liquid. Prepare a form out of aluminum foil with a rim. Pour the content carefully into this (watch it, hot!) and let it sit to cool down. When it is at room temperature, cut into smaller pieces, which you keep in a glass jar. This is 100% gluten-free chocolate, 100% chocolate and 100% healthy.

Conclusion

Not all is well in the gluten grocery row of your friendly super market. There are problems in that 20 to 25% of people believe they may have gluten sensitivity when in reality only 1% have it. But the majority of people have not done a gluten-screening test, which would confirm that they have indeed celiac disease. As pointed out above, it is much more likely that a food sensitivity may be caused by another offending agent rather than gluten (milk sugar, fructose and sorbitol). Avoiding the offending food components is the treatment protocol.

Those who take in gluten-free food will expose themselves to unnecessary toxins, to extra sugar leading to obesity and metabolic syndrome that leads to premature heart attacks and strokes. For those who do need to be on a strict gluten-free diet, they can safely do so by following a strict gluten free diet at home (preparing your own meals from healthy ingredients), preferably with organic foods. There are many websites that you can find online that have meal suggestions.

More information about celiac disease.

References:

1. Rakel: Integrative Medicine, 3rd ed. Patrick J. Hanaway, MD: “Chapter40: Irritable Bowel Syndrome. Integrative Therapy”. Copyright 2012 Saunders, An Imprint of Elsevier

Last edited Nov. 25, 2014

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Sep
28
2013

Sleepless Nights

By | Health, Hormones, Insomnia, Mental Health, Pain, Prevention, Sleep apnea, Substance abuse, Vitamins and supplements

Sleeping problems (insomnia) are very common. About 10% of the population suffers from chronic insomnia; 30% of the population suffers from occasional sleep problems. In a large outpatient population of a clinic consisting of 3500 patients who had at least one major clinical condition, 50% complained of insomnia, 16% had severe symptoms, 34% had mild symptoms (Ref.1). Insomnia is more common among women, and older people as well as in people with medical or psychiatric illnesses. Long-term studies have shown that the same insomnia problems persist throughout many years. It is not possible to offer a simple remedy for insomnia, because insomnia is a complex problem. Here I will discuss some of the causes of insomnia and also discuss some of the treatment options.

Symptoms of insomnia

The person who suffers from insomnia will usually state that they have problems falling asleep. Worries of the day suddenly circulate through their thoughts and they toss and turn nervously looking at the clock from time to time and getting more and more anxious that they cannot sleep. Others fall asleep OK, but in the middle of the night they wake up perhaps to visit the restroom, but then they cannot go back to sleep. Others wake up 2 hours before their normal alarm clock time and they feel their stomach rumbling making it impossible to fall back to sleep. Older people with chronic diseases and general poor health suffer more from insomnia. In this setting insomnia may be more related to the underlying disease rather than old age. Psychiatric disorders also are associated with more insomnia. Treat the underlying psychiatric illness, and the insomnia disappears.

Although insomnia is a sleep disturbance during the nighttime, people who are affected with this complain of daytime fatigue, of overstimulation, yet they catch themselves making frequent mistakes, and their inability to pay attention gets them involved in accidents and falls. Longitudinal studies have shown (Ref. 1) that people with chronic insomnia are more likely to develop psychiatric disease, such as major depression,  anxiety disorder and alcohol and substance abuse. Unfortunately these disorders can by themselves again cause insomnia, which reinforces chronic insomnia. Insomnia leads to poorer social and physical functioning, affects emotions, leads to a lack of vitality and physical endurance, contributes to worsening of pain and can affect general and mental health.

Research about insomnia

Much has been learnt from sleep studies using polysomnography monitoring during a full night’s sleep. These studies have been used mainly as a research tool. In such studies eye movements, brain wave activity, muscle activity, chest movements, airflow, heart beats, oxygen saturation and snoring (with a microphone) are all simultaneously recorded. This way restless leg syndrome, sleep apnea, snoring, seizure disorders, deep depression etc. that can all lead to insomnia can be diagnosed and separated from insomnia. The stages of sleep (wakefulness, stage 1 to 3 sleep and the REM sleep stage) can also be readily measured using polysomnography (Ref.2). According to this reference the majority of insomnia cases do not need this complex procedure done.

Sleepless Nights

Sleepless Nights

Causes of insomnia

Traditionally insomnia cases are classified into primary insomnia and secondary insomnia. Secondary insomnia is caused by all of the factors discussed below. When they are dealt with, we are left with cases of primary insomnia.

The following medical conditions can cause insomnia: heart disease, pulmonary diseases like asthma and chronic obstructive pulmonary disease (COPD); gastrointestinal disease like liver cirrhosis, pancreatitis, irritable bowel syndrome, ulcers, colitis, Crohn’s disease; chronic kidney disease; musculoskeletal disease like arthritis, fractures, osteoporosis; neurodegenerative disease like MS, Parkinson’s disease, Alzheimer’s disease; endocrine disease like diabetes, hyper- or hypothyroidism, adrenal gland fatigue and insufficiency; and chronic pain conditions. Also, psychiatric conditions like major depression, schizophrenia and anxiety disorders can cause insomnia.

This list in not complete, but it gives you an idea of how complex the topic of insomnia is.
The physician who is seeing a patient with insomnia needs to rule out any of these other causes of insomnia to be certain that the only condition that is left to treat in the patient is insomnia itself. The other diagnoses have to be dealt with separately or else treatment of insomnia will fail.

Ref. 1 points to a useful model of how to think about causation of insomnia: there are three points to consider, namely predisposing, precipitating, and perpetuating factors. Let’s briefly discuss some of these.

Predisposing factors

We are all different in our personal make-up. If you are well grounded, chances are you are not susceptible to insomnia. Anxious persons or persons who have been through a lot of negative experiences in life will have personality traits that make them more prone to insomnia. Lifestyle choices such as late nights out, drinking with the buddies in a bar (extreme circadian phase tendencies) will have an impact on whether or not you develop insomnia.

Precipitating factors

A situational crisis like a job change or the death of a loved one can initiate insomnia.  However, there could be a medical illness such as a heart attack, a stroke or the new diagnosis of a psychiatric illness that has become a precipitating factor. Sleep apnea and restless leg syndrome belong into this group as well as would the stimulating effect of coffee and caffeine containing drinks. Jet lag and nighttime shift work can also be precipitating factors.

Perpetuating factors

Daytime napping to make up for lost sleep the night before can undermine sleep initiation the following night, which can lead to a vicious cycle. Similarly, the use of bedtime alcoholic drinks leads to sleep disruption later that night and can become a perpetuating factor, if this habit is maintained. Even the psychological conditioning of being anxious about whether or not you will fall asleep easily or not the next night can become a perpetuating factor.

I will return to this classification and the factor model of causation of insomnia when we address treatment options.

Drugs that can cause insomnia

One major possible cause for insomnia  can be side effects from medications that patients are on (would belong to the ‘perpetuating factors’ among causes). Physicians call this “iatrogenic insomnia”. The antidepressants, called selective serotonin reuptake inhibitors (SSRI’s) like Prozac are particularly troublesome with regard to causing insomnia as a side effect. Other antidepressants like trazodone (Desyrel) are used in small doses to help patients with insomnia to fall asleep. Some asthmatics and people with autoimmune diseases may be on prednisone, a corticosteroid drug. This can cause insomnia, particularly in higher doses; so can decongestants you may use for allergies; beta-blockers used for heart disease and hypertension treatment; theophylline, an asthma medication and diuretics. Central nervous stimulants like caffeine or illicit drugs can also cause insomnia. Hormone disbalance in general and hyperthyroidism specifically as well as Cushing’s disease, where cortisol levels are high will cause insomnia.

Treatment of insomnia

So, how should the physician approach a patient with insomnia? First it has to be established whether there is secondary insomnia present due to one of the predisposing, precipitating or perpetuating factors. In other words, is there secondary insomnia due to other underlying illnesses? If so, these are being addressed first. Lifestyle choices (staying up late every night) would have to be changed; alcohol and drug abuse and overindulging in coffee or caffeine containing drinks needs to be dealt with. Cognitive therapy may be beneficial when mild depression or anxiety is a contributing factor to insomnia.

The remaining insomnia (also medically termed “primary insomnia”) is now being treated.

The following general points are useful to get into the sleeping mode (modified from Ref. 3):

  1. Ensure your bedroom is dark, soundproof, and comfortable with the room temperature being not too warm, and you develop a “sleep hygiene”. This means you get to sleep around the same time each night, have some down time 1 hour or so before going to bed and get up after your average fill of sleep (for most people between 7 to 9 hours). Do not sleep in, but use an alarm clock to help you get into your sleep routine.
  2. Avoid caffeine drinks, alcohol, nicotine and recreational drugs. If you must smoke, don’t smoke later than 7PM.
  3. Get into a regular exercise program, either at home or at a gym.
  4. Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
  5. Do not use your bedroom as an office, reading place or media center. This would condition you to be awake.  Reserve your bedroom use only for intimacy and sleeping.
  6. If you wake up at night and you are wide awake, leave the bedroom and sit in the living room doing something until you feel tired and then return to bed.
  7. A self-hypnosis recording is a useful adjunct to a sleep routine. Listen to it when you go to bed to give you something to focus on (low volume) and you will find it easier to stop thinking.

Drugs and supplements for insomnia

1. In the past benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), fluorazepam (Dalmane), temazepam (Restoril), triazolam (Halcion) and others were and still are used as sleeping pills. However, it was noted that there are significant side effects with this group of drugs. Notably, there is amnesia (memory loss), which can be quite distressing to people such as not remembering that someone phoned while under the influence of the drug, you promised certain things, but you cannot remember the following morning what it was. Another problem is the development of addiction to the drugs with worse insomnia when the drugs are discontinued. Many physicians have stopped prescribing benzodiazepines.

2. There are non-benzodiazepines drugs that are used as sleeping pills (hypnotics), such as Zaleplon (Sonata), Zolpidem (Ambien) and Eszopiclone (Lunesta).  They seem to be better tolerated.

3. Ramelteon, a melatonin agonist, is available by prescription in the US. It probably is the best-tolerated mild sleeping pill and works similar to melatonin, but is more expensive. Chances are that your physician likely would prescribe one of the non-benzodiazepines drugs or Ramelteon for you as they do not seem to be addicting.

4. However, there is an alternative: Many patients with insomnia tolerate a low dose of trazodone (Desyrel), which is an antidepressant with sleep restoring properties. A low dose of 25 to 50 mg at bedtime is usually enough for insomnia. This allows the patient to fall asleep within about 30 minutes of taking it, and sleep lasts through most of the night without a hangover in the morning. Many specialists who run sleep laboratories recommend trazodone when primary insomnia is diagnosed. However, this is still a drug with potential side effects as mentioned in the trazodone link, but 50 mg is only ¼ of the full dose, so the side effects will also be less or negligible.

5. I prefer the use of melatonin, which is the natural brain hormone designed to put us to sleep. Between 1 mg and 6 mg are sufficient for most people. We know from other literature that up to 20 mg of melatonin has been used in humans as an immune stimulant in patients with metastatic melanoma with no untoward side effects other than nightmares and some tiredness in the morning. A review from the Vanderbilt University, Holland found melatonin to be very safe as a sleeping aid. There are several melatonin receptors in the body of vertebrates (including humans), which are stimulated by melatonin.

6. Other natural methods are the use of L-Tryptophan at a dose of 500 mg at bedtime, which can be combined with melatonin. It is the amino acid contained in turkey meat, which makes you tired after a Thanksgiving meal. GABA is another supplement, which is the relaxing hormone of your brain, but with this supplement tolerance develops after about 4 to 5 days, so it is only suitable for very short term use. Herbal sleep aids are hops, valerian extract and passionflower extract. They are available in health food stores.

Conclusion

A lack of sleep (insomnia) is almost a given in our fast paced lives.

When it comes to treatment, all of the other causes of secondary insomnia need to be treated or else treatment attempts would fail. What is left is primary insomnia. This is treated as follows:

We need to review our sleeping habits, lifestyles and substance abuse. Remove what is detrimental to your sleep. Start with the least invasive treatment modalities such as self-hypnosis tapes, melatonin, L-Tryptophan or herbal extracts. Should this not quite do the trick, asks your doctor for advice. The non-benzodiazepines drugs or Ramelteon would be the next level up. It may be that an alternative such as low dose trazodone would be of help. Only, if all this fails would I recommend to go to the more potent sleeping pills (keep in mind the potential for addiction to them).

References

1. David N. Neubauer, MD (John Hopkins University, Baltimore, MD): Insomnia. Primary Care: Clinics in Office Practice – Volume 32, Issue 2 (June 2005)  © 2005, W. B. Saunders Company

2: Behrouz Jafari, MD and Vahid Mohsenin, MD (Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA): Polysomnography. Clinics in Chest Medicine – Volume 31, Issue 2 (June 2010), © 2010 W. B. Saunders Company

3. Jean Gray, editor: “Therapeutic choices”, 5th edition, Chapter 8 by Jonathan A.E. Fleming, MB, FRCPC: Insomnia, © 2008, Canadian Pharmacists Association.

Last edited Sept. 28, 2014