Sep
24
2022

When is Someone at Risk for Suicide?

By | Anxiety, depression, Drugs, Mental Health, suicide

We are asking ourselves: When is someone at risk for suicide? This year’s National Suicide Week was from Sept. 4 through 10, 2022. Every day of each year it is important to be aware of signs and symptoms of impending suicide. However, the purpose of the yearly National Suicide Week is to really bring it to everyone’s attention how common deaths by suicides are. We all can contribute to improve the situation by increasing our awareness.

Some suicide statistics

In the US alone nearly 46,000 persons died by suicide in 2020. This means that there is one death by suicide every 11 minutes. In 2020 nearly 800,000 died by suicide worldwide. About 1.2 million attempted it. The hope is that the public will learn through education to recognize the signs of an impending suicide. This way the suicidal person can get counselling and hopefully not commit suicide.

Abnormal behaviors to watch out for  

People who are getting suicidal may practice with guns, overdosing with pills or handle potentially lethal items. Other behavioral red flags could be giving away cherished items. The suicidal person may sleep too much or not enough. Isolation or withdrawal may be another pointer in a previously sociable person that he or she is becoming suicidal. Revenge thinking, reckless driving, agitation can all be pointers as well that the person is preparing for suicide. Justin Baker is the clinical director of The Suicide and Trauma Reduction Initiative for Veterans at The Ohio State University Wexner Medical Center. He said: ”A lot of times people need to kind of work up to that actual making an attempt because it’s a biologic thing you have to go against, your own survival”.

Watch what people say

When people become suicidal their words often indicate what they want to do. It is a warning sign, if someone is talking about wanting to die, by suicide or otherwise. Some people state that they feel like they have no reason to live. This is an alarm signal that they may be suicidal. Some people say that they feel like they are a burden for the people living around them. Other problematic statements are: “You don’t need me for this anymore” or “I feel like it’d be better if I just wasn’t here.” Someone uttering statements like these should get counseling. This allows them to vent their feelings and to reassess their situation.

Suicide risk factors

Hopelessness: People may express that they feel the future won’t be any better. Or they do not see a way out of the pain that they are in.

Obsession with death and dying: Some people ruminate about dying and they develop a plan what they may want to do to themselves.  

Extreme mood swings: When somebody who usually is depressed and stressed behaves calm or cheery, this is an alarm sign that the person may be suicidal. They may have struggled with their decision to kill themselves, but when they accepted that this is what they want to do it calms their mind.

Past trauma: Abuse, trauma and neglect in the past are risk factors for suicide in the future.

Drug abuse: substance abuse predisposes a person towards being suicidal later on in life.

More suicide risk factors

Severe chronic illness with chronic pain: when a person has a chronic illness, and it is difficult to treat, people lose hope and they feel trapped. At this point suicide appears to be an option.

Mental disorders: people with schizophrenia, anxiety, depression or personality disorders are at a higher risk to turn suicidal. This is particularly so when they did not receive treatment and their mental condition deteriorates.

Family history, other factors and teen suicides

Family history of suicide: when there is a family history of suicide or a personal history of failed attempt of suicides the risk of suicide is much bigger than in the general population.

Other factors: There are many more factors that all can have a bearing on the risk for suicide. Financial loss and loss of a job are examples, but also prolonged stress from bullying or harassment. Divorce, breakup of a relationship, insufficient social support and many other negative emotions can contribute to a risk for suicide as well. A lot depends on the emotional make-up and the resilience of a person.

Teens: Teens are particularly vulnerable to commit suicide. It is important to listen to the teen in trouble and to arrange for counseling and support. More on teen suicide here.

What to do when faced with a person who contemplates suicide?

There are several crisis phones that are important to remember. In 2019 congress in the US has proposed to establish crisis lines with a simple 3-digit number: 988. But not all states have this number activated yet. The national crisis line in the US is: 1-800-273-TALK (1-800-273-8255).

In Canada the crisis hotline is: 1-833-456-4566.

There are counselors who have experience in listening to people in distress and talk to them.

When a person wants to commit suicide call 911. Sometimes a person in mental distress needs to be hospitalized and treated by a psychiatrist. Some people may benefit from electroconvulsive therapy, others from antidepressants. Cognitive therapy and behavioral therapy have a place as well in treating depressed patients. Close follow-up is important to prevent a relapse.

When is Someone at Risk for Suicide?

When is Someone at Risk for Suicide?

Conclusion

This year’s National Suicide Week was from Sept. 4 through 10, 2022. In the US alone nearly 46,000 persons died by suicide in 2020, nearly 800,000 died by suicide worldwide. It is important to recognize the signs of impending suicide. There are several high-risk factors that point to impending suicide, such as hopelessness, obsession with death and dying and extreme mood swings. There are certain constellations that are associated with a high risk for suicide: a history of a mental disorder, a break-up of a relationship, a severe illness with chronic pain and others. It is important to get the person at risk to a counselor or psychiatrist.

Treatment intervention for suicidal person

By talking it out, the pain of suffering gets eased. If there is an underlying depression it can be treated with various treatment modalities. Cognitive behavior therapy may help to change the negative thought patterns. It is important to intervene early. Close follow-up to prevent a relapse is also important.

Dec
25
2021

Drugs that May be Useful in the Treatment of Covid-19

By | Drugs, immune system, vaccinations, Vitamins and supplements

This article deals with drugs that may be useful in the treatment of Covid-19. There are several drugs that may be useful in the treatment of Covid-19. Lately an antidepressant like Luvox has been in the limelight. But antiviral drugs like ritonavir from Pfizer and remdesivir from Gilead Sciences also reduced the number of hospitalized patients with Covid-19. Finally, Merck introduced molnupiravir, an antiviral drug against Covid-19. The health authorities in Great Britain recently approved this drug for use in Covid-19 patients in Great Britain. Apart from drugs, vitamin D3 is still an important factor in preventing and treating Covid-19 as I will mention below.

Luvox for better survival from Covid-19

The Lancet published a study on January 2022 about the effect of Luvox on patients with Covid-19 symptoms. 741 patients received the antidepressant Luvox, 756 received placebo pills. In the Luvox group patients received 100 mg of Luvox twice per day for 10 days. From the Luvox treated patients only 11% had to go to tertiary care for treatment. In contrast, from the placebo group 16% had to go to tertiary care. There were 17 deaths in the Luvox group and 25 deaths in the placebo group. The Luvox group definitely showed a positive effect, although the results were not outstanding. In the following I am discussing other drugs that may be useful in the treatment of Covid-19.

Antiviral agent Remdesivir Improving survival from Covid-19

Here is a run-down of the survival statistics with remdesivir. This drug is manufactured by Gilead Sciences in cooperation with Pfizer. 541 patients received a loading dose of 200 mg on day 1. Subsequently they received 100 mg daily for another 9 days. 521 received placebo pills. The median recovery time in patients with remdesivir was 10 days. Those on placebo pills recovered only after 15 days. The mortality rates were 6.7% with remdesivir and 11.9% for the placebo group on day 15. There was a mortality of 11.4% with remdesivir and mortality of 15.2% with placebo pills on day 29. Although the effect between the remdesivir group and the placebo group was significant, the effect would not be enough to stop transmission of the virus on a population basis. Health Canada made the decision to use remdesivir in severe COVID-19 disease cases.

Merck introduced molnupiravir, another antiviral drug against Covid-19

Molnupiravir was approved in the UK as an antiviral drug for early and moderately severe cases of Covid-19. It is difficult to get data on the Merck’s molnupiravir drug. But this publication states that there is a 50% reduction of mild to moderate cases of Covid-19 cases with molnupiravir. Professor Peter Horby from the University of Oxford pointed out “the proportional reduction in the risk of hospitalisation or death is impressive. But it is important to remember that the absolute risks were 14% reduced to 7%, so quite a lot of people need to be treated to prevent one hospitalisation or death.” Others pointed out that the side-effects are very similar between placebo pills and molnupiravir pills. Overall molnupiravir appears to be a useful addition in the treatment of Covid-19.

Higher doses of vitamin D3 effective in treating and preventing Covid-19

Higher doses of vitamin D3 will mitigate the course of influenza and of Covid-19 coronavirus. Researchers outlined 3 mechanisms of how vitamin D works:

  • Maintaining tight epithelial junctions making it more difficult for the Covid-19 coronavirus to penetrate.“
  • Killing enveloped viruses through induction of cathelicidin and defensins.” These powerful antiviral polypeptides can kill viruses that have invaded the bloodstream within 1 to 2 days.”
  • And reducing production of proinflammatory cytokines by the innate immune system, thereby reducing the risk of a cytokine storm leading to pneumonia.” It is people who get the viral pneumonia that are at a high risk of death. By bringing the blood level up to the higher range of normal, between 50 and 80 ng/mL, patients that have encountered Covid-19 coronavirus are more likely to survive.
Drugs that May be Useful in the Treatment of Covid-19

Drugs that May be Useful in the Treatment of Covid-19

Conclusion

Beside distancing, the wearing of masks and frequent hand washing other methods are emerging to fight the virus that causes Covid-19. Vaccinations are very effective, although they are less effective in patients with a weakened immune system. But there are also drugs that may be useful in the treatment of Covid-19. Newer studies have shown that the antidepressant Luvox has a mild effect on helping Covid-19 patients. Last year remdesivir came into the market. And this year Merck added molnupiravir, another antiviral pill. We should not forget that vitamin D3 is an effective antiviral vitamin. But it is only effective, provided the patient takes enough vitamin D3. The blood level must reach the high normal level of 50-80 ng/mL vitamin D in the blood. Up to now vaccinations and booster shots are the most effective way to prevent Covid-19 infection. Vitamin D3 and molnupiravir are also very effective.

Part of the above was previously published here.

Oct
30
2021

Acetaminophen Damages the Fetus

By | Autism, Drugs, kidney disease, Mortality, neurological disease, toxins

Many women take acetaminophen when pregnant, but acetaminophen damages the fetus. It is important to realize that acetaminophen is a common over-the-counter pain reliever. In addition, it is also often combined with codeine as headache pills. Acetaminophen goes under these brand names: Tylenol, Tylenol Arthritis Pain, Tylenol Ext and Little Fevers Children’s Fever/Pain Reliever. The international name of acetaminophen is the name “paracetamol”.

An international group of 13 scientists are calling health care professionals to limit the use of acetaminophen in pregnant women. CNN reported about this under this link.

These scientists published an article in the medical journal Nature on the dangers of paracetamol use in pregnancy.  Specifically, they said that acetaminophen can alter fetal development, which includes reproductive, neurodevelopmental and urogenital disorders.

History of acetaminophen

The chemical name for acetaminophen is N-acetyl-p-aminophenol. Acetaminophen is simply a shortened version of that chemical name. It was introduced in the US in 1955 as Tylenol® and in the United Kingdom in 1956 under the brand name Panadol®. In particular, acetaminophen was recommended to control fevers and to help with pain control.

In the 1960’s the Swiss watch industry provided workers who complained of headaches freely with acetaminophen. With this in mind, within a few years studies showed that many of these women who took a lot of this medication developed kidney problems. This led to an increase of the creatinine level in the blood. The kidney damage from acetaminophen was dubbed “phenacetin kidneys”. Outside of the US acetaminophen has the name phenacetin. Many of these patients subsequently had to receive dialysis and later kidney transplants.

Acetaminophen toxicity

The recommended dose of acetaminophen is 650 mg to 1000 mg 4-6 times daily, not to exceed 4 grams/day. The therapeutic window for this drug is very narrow, because 7.5 grams per day to 10 grams per day are already toxic. For children the dose is 15 mg/kg every 6 hours to a maximum of 60 mg/kg per day.

The other known toxicity concerns liver function. This article about Tylenol toxicity explains this in more detail.

Many people do not know about the limit for the over-the-counter acetaminophen and take too much for a fever or a painful condition. Just because a drug is available over the counter does not mean that it is harmless. If you don’t watch for toxic levels, you could end up dead or find yourself waiting for a liver transplant.

New evidence that acetaminophen damages the fetus

91 scientists from Australia, Brazil, Canada, Europe, Israel, Scotland, the UK and US have signed a declaration. In it they ask pregnant women not to take acetaminophen “unless its use is medically indicated”. Among the reasons for the declaration is that acetaminophen certainly can cause neural tube defects and cardiovascular disorders in fetuses. Pediatrician Dr. Leonardo Trasande, director of environmental pediatrics at NYU Langone Health, did not partake in this research. He has done safety studies on acetaminophen and pointed out the similarity in chemical structure between acetaminophen and phthalates. Like phthalates acetaminophen disrupts the reproductive development in animals and humans.

Evidence for neurodevelopmental disruption

Dr. Shanna Swan, a professor of environmental medicine at the Icahn School of Medicine at Mount Sinai in New York said: “There’s enough evidence to find increased risk of undescended testicles and a shortening of the anogenital distance, which is a predictive of later decreased sperm count and decreased fertility. We also see impaired ovarian function which has consequences for later fertility, although females have been less studied.”

The conditions that relate to acetaminophen toxicity were attention deficit hyperactivity disorder (ADHD), behavior abnormalities and autism spectrum disorders. In addition, language delays, conduct disorders and decreased IQ were due to neurodevelopment disruption from acetaminophen toxicity.

Mechanism of action of acetaminophen and side effects

Acetaminophen has been on the market for over 60 years. But scientists still don’t know exactly how it acts in the body to help control pain and reduce fever. There is a consensus that acetaminophen acts on the central nervous system inhibiting the synthesis of prostaglandins. These biological compounds have a leading role in causing fever, pain and inflammation. But the scientific proof for this consensus is still outstanding.

Side effects

There are a multitude of side effects that can occur with the use of acetaminophen. Common side effects are hives, itching, swelling of the mouth and throat and tingling in the mouth or throat. Other side effects are swelling in the face or hands, breathing difficulties or chest tightness. Acetaminophen can cause a loss of appetite, nausea and vomiting. Severe stomach pain can be another symptom of acetaminophen side effects. As you can see from the above link there are many more known side effects of acetaminophen.

Acetaminophen Damages the Fetus

Acetaminophen Damages the Fetus

Conclusion

Acetaminophen (=paracetamol, phenacetin) is a popular over-the-counter fever and pain remedy. But a narrow therapeutic width can cause serious overdoses where both the liver and the kidneys suffer irreparable damage. When people unknowingly take too much acetaminophen, they enter into the toxic range. This can cause disability and death. Kidney damage from acetaminophen became known as “phenacetin kidneys” already in the 1960’s in female workers of the watch industry in Switzerland. They developed headaches from constantly working with magnifying glasses and had free access to acetaminophen provided by the employer. Later, in North America liver disease developed when patients overdosed with over-the-counter acetaminophen for fever and pain control.

Interruption of fetal development from exposure of the fetus to acetaminophen 

At the present time the focus is on newer findings of researchers. They noticed that exposure of pregnant women to acetaminophen damages the fetus. This results in undescended testicles and a shortening of the anogenital distance which is a predictive of later decreased sperm count and decreased fertility. These are findings for males. Findings in females are less studied at this point in time. Dr. Leonardo Trasande pointed out the similarity in chemical structure between acetaminophen and phthalates. Like phthalates acetaminophen disrupts the reproductive development in animals and humans. Patients should take acetaminophen only under supervision with doses that are safe. The old notion that acetaminophen would be safe in pregnancy is no longer true in light of the new medical findings. Any pregnant woman should discuss with her physician what she can safely take.

Nov
28
2020

Mental Illness and Covid-19

By | alcohol, Anxiety, depression, Drugs, exercise, food, schizophrenia, Sleeep, stress, Stress management

A topic less discussed is mental illness and Covid-19. Covid-19 has been noticeably around us since March of 2020. With the various social distancing and quarantining methods people become more or less isolated emotionally. Social gatherings are outlawed depending on where you live. This helps to interrupt the spread of the virus, but it makes people feel more stressed as their relationships get interrupted.

Symptoms of stress

The CDC sums up that stress during a pandemic can cause the following:

  • Fear of your own health and the health of your loved ones
  • Loss of your job or financial support
  • Changes in eating habits
  • Changes in sleep pattern with lack in concentration
  • Increase in use of tobacco, alcohol or other substance consumption
  • Chronic health problems may deteriorate
  • Worsening of Mental health conditions

The more isolated we are, the more stress we feel. This undermines our stress coping mechanisms, makes us more anxious and more depressed.

Develop coping skills

Taking care of your family and friends may relieve your stress, but it needs to be balanced by taking care of yourself. Although you are physically isolated from others when you are in quarantine, you can stay in contact with others by phone or video chats. This makes you less lonely and isolated.

Take care of yourself. This includes eating well balanced meals, exercising regularly and getting enough sleep. Avoid the consumption of alcohol, tobacco and drugs. Share with a family member or friend how you feel. Maintain friendships through the phone, emails, social media and computer chats. This builds a strong support system for you.

Avoid too much exposure to news stories. Seeing negative stories about Covid-19 over and over again can be undermining, so take a break from the news media. Go for a walk. Take a nap.

Suicide

Sometimes depression can get out of control to the point of driving a person to the brink of suicide. In the US major depression is the leading cause of disability for ages 15-44.  At any given year 16.1 million American adults (about 6.7% of the U.S. population age 18 and older) suffer from major depression. 10.3% of Americans have thought about suicide. If you feel that way, do not act on this impulse. Call 1-800-799-4889. That is the National Suicide Prevention Lifeline & Chat.

Medical literature about the psychological impact of Covid-19

In a July 2020 publication the authors pointed out that Covid-19 infection is a significant psychological stressor. There is the fear of getting the virus and uncertainty about the future. Pre-existing anxiety and depression disorders get accelerated from the stress. In addition, mental disorders like schizophrenia with psychosis may worsen. This may require more antipsychotic medication to control it.

A Kaiser Family Foundation poll found in March 2020 that the Covid-19 pandemic has caused a major impact on US citizens. 45% of respondents said that the pandemic has affected their mental wellbeing significantly. If you are scared, depressed or anxious, you are tense and you have problems falling asleep, you are not alone. You can seek and receive help!

Prevention of mental disease from Covid-19

Here is some practical advice from the World Health Organization.

  • Stay informed.
  • Have a daily routine. Get up and go to sleep at regular times. Eat healthy balanced meals. Exercise regularly. Have your work routine and also find time to rest. Do things that you enjoy.
  • Watch the news only to be informed, but limit news watching to a minimum. This will keep anxiety and depression in check.
  • Stay in contact with close friends by phone and computer technology.
  • Keep your alcohol consumption low. If you did not drink before at all, don’t start drinking in an attempt to deal with boredom, fear, anxiety or social isolation.
  • Take breaks from screen time. This reduces tension.
  • Video games: doing this may relax you for a short time. But longer video game activities can make you tense; you should balance this with the rest of your daily activities.
  • Social media. Use this for honest communication. Keep it brief. If you see misinformation, point out the truth.
  • Helping others: if you can, help others in the community with shopping or other chores.

Treatment for Mental disease from Covid-19

When you notice anxiety, depression or a flare-up of psychotic symptoms from schizophrenia, it is important to see your health professional right away. You may need some counselling. Others may need an antidepressant (for depression) or an adjustment to your antipsychotic medication. Some patients with milder depression or anxiety may benefit from cognitive/behavioral therapy. Most importantly, know that help is available! More info about cognitive therapy for suicide prevention.

Mental Illness and Covid-19

Mental Illness and Covid-19

Conclusion

Mental illness and Covid-19 is a huge topic. People definitely have experienced more anxiety and depression since the Covid-19 epidemic. This is because our lifestyle is suddenly restricted. We may have to go through a 14-day quarantine. But we also cannot participate in large gatherings with more than 50 people. Often, we have to wear masks in stores. In areas with high cases of Covid-19 there is also a severe restriction regarding with whom you can visit, leading to feelings of isolation. All of this can lead to mental illness. Essentially there are two ways of coping with this. First, we need to get a routine that makes us more resistant to mental illness. Secondly, if this fails, seek the advice of a health professional right away.

Seek mental illness treatment right away

When you catch mental illness early, it is much easier to treat. Milder cases of depression or anxiety may benefit from cognitive/behavioral therapy. More severe cases often require medication. In this outline I have discussed mental illness during the Covid-19 epidemic. I have not discussed the cases where people came down with Covid-19 coronavirus and got affected in their brain function from the virus. These cases need treatment by a neurologist and psychiatrist, and they are much more complicated.

Apr
18
2020

Changes of Metabolism by Inflammation

By | alcohol, Allergies, Alzheimer’s disease, antibiotics, autoimmune disease, blood brain barrier, Cancer, Cardiovascular disease, cholesterol, diet, Drugs, fractures, heart attack, Hormones, immune system, Inflammation, kidney disease, mitochondria, Mortality, Osteoporosis, schizophrenia, stress, thyroid disease

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

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

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

Factors that accelerate aging and damage your metabolism

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

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

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

How Metaflammation is developing

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

More problems with metaflammation

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

Major causes of metaflammation

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

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

Interaction of various organ systems can cause metaflammation

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

Other mechanism for pathological changes with hormone disbalances

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

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

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

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

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

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

Cardiovascular disease not just a matter of high cholesterol

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

Microbiome disruption from drugs

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

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

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

Changes of Metabolism by Inflammation

Changes of Metabolism by Inflammation

Conclusion

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

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

Drugs that change the gut biome

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

Nov
09
2019

Non-Drug Treatment For Migraines In Women

By | Drugs, headache, Hormones

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

Introduction

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

Xenoestrogens

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

Symptoms

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

Types of migraine aura symptoms

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

Typically a migraine is confined to one side of the head

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

Conventional treatment of migraines

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

Preventatives of migraine attacks

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

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

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

Non-conventional, but effective treatment of migraines

Bioidentical progesterone treatment

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

Avoid migraine triggering factors

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

Dr. Dzugan’s “correction of steroidopenia” approach

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

Non-Drug Treatment For Migraines In Women

Non-Drug Treatment For Migraines In Women

Conclusion

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

References

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

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Jul
20
2019

Common Drugs Have A Connection To Dementia Risk

By | Cancer, Dementia, Drugs, epilepsy, Parkinson’s disease, seizure disorder

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

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

More about the study

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

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

Risk-benefit discussion

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

More statistics

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

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

Serious side effects from other medication

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

Tardive dyskinesia with antipsychotics

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

Side effects from antacid pills

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

A rare side effect: muscle tremor

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

Rhabdomyolysis from statins

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

Cancer and heart attacks from synthetic hormones

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

Synthetic hormones caused estrogen dominance

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

Discussion

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

Common Drugs Have A Connection To Dementia Risk

Common Drugs Have A Connection To Dementia Risk

Conclusion

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

Synthetic hormones causing problems

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

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May
18
2019

A Pill Against Obesity

By | diet, Drugs, exercise, food, Nutrition, Weight loss

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 small 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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Feb
16
2019

The Most Addictive Drugs

By | addiction, alcohol, Drugs, Smoking, Substance abuse

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 under point 5 of the above 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

By | andropause, Anxiety, Drugs, Insomnia, Menopause, Mortality, sleep, stress, telomeres, testosterone

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

Previous review of the topic of insomnia

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

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

Hormone factors of insomnia

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

Stress and insomnia

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

What to do when you are sleepless

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

Melatonin for when you are sleepless

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

Phosphorylated serine (Seriphos)

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

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

Valerian root capsules

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

Other considerations when you are sleepless

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

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

Sleep lab for when you are sleepless

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

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

Treatment for insomnia when over-the-counter remedies fail

Short acting benzodiazepams

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

Longer acting benzodiazepams combined with antidepressant Trazodone

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

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

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

Clonazepam side effects

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

When you are sleepless

When you are sleepless

Conclusion

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

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

Other possibilities to treat insomnia

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

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