Medical Articles by Dr. Ray

Jan

2022

Sleep Training to Prevent Insomnia and Depression

By Ray Schilling | depression, Insomnia, sleep

A new study describes that sleep training to prevent insomnia and depression is desirable. Notably, the study published in JAMA Psychiatry took 291 people age 60 years and older and followed them for three years. In this case half the participants received treatment with sleep training, the other half treatment with cognitive behavioral therapy. The other half was the control who received sleep education therapy from a public health educator. It is important to realize that both groups received 120 minutes weekly group sessions for two months. That is to say, following training of 2 months the subjects were followed for 36 months. It must be remembered that they completed monthly questionnaires to monitor for depression and insomnia. At the end of the study almost 1/3 of the cognitive behavioral group still were free of insomnia.

The control group who received sleep education therapy initially showed no longer any

improvement. In other words, the initial progress did not last with sleep education only. The study was also published in CNN.

Results about rates of depression

Those subjects of the cognitive behavioral therapy group who had a sustained remission of their insomnia disorder had a rate of 82.6% less depression. This was in comparison to the subjects who did not sustain their treatment against insomnia. Dr. Pim Cuijpers commented that the results of the study show “a completely new and innovative way” of tackling the growing problem of depression. Dr. Cuijpers is a professor of Clinical Psychology at the Free University of Amsterdam.

A brief background about depression in older patients

Depression is common in people above the age of 60. About 30-50% of this age group develop depression. Part of this could be that older people often do not get enough sleep as middle-age or younger adults do. Melatonin production declines with older age and this may play a role in insomnia of older people. On the other hand, one of the major symptoms of depression is a lack of sleep. It seems that a lack of REM sleep, the deep sleep that makes us dream, is responsible for both troubles, sleeping (insomnia) and depression.

Cognitive behavioral therapy administered by a therapist is effective for insomnia

It is important that a therapist administers the cognitive behavioral therapy. There are recordings available online that provide cognitive therapy, but they are not individualised. Dr. Irwin said: “That’s why CBT-I is so effective in person, because the therapist is helping that individual navigate and negotiate with themselves — and it can be really hard work,” Irwin added. “I believe that’s also why CBT-I apps or online tools often don’t work — people get frustrated, disappointed or angry at themselves, and they basically stop the work.”

The rationale for cognitive behavioral therapy (CBT)

CBT for insomnia has five components: Stimulus control, sleep restriction, sleep hygiene, relaxation and cognitive behavioral therapy. Researchers gave the program the name CBT-I. Sleep hygiene and relaxation involve these sleeping habits: going to bed at the same time every day, eliminating noise and blue light from electronic devices. Also, you want to keep your bedroom cool, take warm baths and do yoga for relaxation.

Stimulus control and sleep restriction

Stimulus control involves getting out of bed, if you can’t sleep. Dr. Irvin said: “Most people stay in bed, fretting about not falling asleep, which then turns the bed into a negative space. Instead, people are taught to get up after 10 minutes of tossing and turning, do quiet, non-stimulating activities, and not to come back to bed until they are sleepy.” Sleep restriction means that a person lies in bed only to sleep plus 30 minutes. It is a way to make people with insomnia get out of bed instead of lying there awake.

Cognitive behavioral therapy

Cognitive behavioral therapy disrupts irrational thoughts and beliefs about sleep. Patients with insomnia often think “I can never sleep” or “I might die if I don’t sleep tonight.” A therapist has training to help the patient find a way back to a more realistic mindset. Eventually the patient accepts the bed as a welcoming place.

Cognitive behavioral therapy is effective in preventing depression

Dr. Irwin pointed out that chronic insomnia often leads to depression. A dangerous consequence of depression can be preoccupation with suicide. A certain percentage of patients with depression in any age group want to kill themselves. This is where cognitive behavioral therapy can intervene and make a huge difference. As mentioned earlier almost 1/3 of patients who received cognitive behavioral therapy for two months retained their normal sleep pattern. It was among this group that 82.6% had no depression compared to a control group. These are very important statistics. Dr. Irwin said: “We have shown that we can actually target insomnia with cognitive behavior therapy and prevent depression from occurring”.

Sleep Training to Prevent Insomnia and Depression

Conclusion

A new study in JAMA Psychiatry describes that sleep training to prevent insomnia and depression is feasible. Sleep researchers used cognitive behavioral therapy sessions for two months on subjects who suffered from insomnia. The treatment group had profound effects with respect to improving insomnia and depression. Almost 1/3 of subjects treated with cognitive behavioral therapy returned to a normal sleeping pattern. And this subgroup of patients had 82.6% less depression. The lead author, Dr. Irwin thinks that cognitive behavioral therapy could become the new way of how to treat and prevent depression.

Dec

2021

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

By Ray Schilling | 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

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.

Dec

2021

Green Light Laser Treatment for an Enlarged Prostate

By Ray Schilling | andropause, Men's Health, prostate hypertrophy

This article describes the use of green light laser treatment for an enlarged prostate. Physicians call an enlarged prostate “benign prostatic hyperplasia” or else “prostate hypertrophy”. When men turn older than 60, they often develop an enlarged prostate gland. This in turn can squeeze the urethra as it travels through the prostate resulting in problems passing urine.

A complication of an enlarged prostate gland can be frequent urinary tract infections

Men who have an enlarged prostate also often develop recurrent urinary tract infections. As a recent example that went through the news, former President Bill Clinton had to be hospitalized for such an infection. However, a simple surgical procedure like the green light laser treatment for an enlarged prostate allows for normal urination. This procedure opens up the previously narrowed urethra and reduces the prostate size to normal. As a result, the recurrent urinary tract infections stop. The green light laser treatment for an enlarged prostate is relatively new. It has much less blood loss than the conventional transurethral resection of the prostate (=TURP). The new laser procedure also goes under the name “green light laser TURP”.

History of the green light laser treatment for an enlarged prostate

In 2003 the first series of 10 patients with an enlarged prostate received treatment with a green light laser. After one year their prostate glands showed an average of 27% volume loss. This was less than 40-50% prostate volume loss with the conventional TURP procedure. In 2004 and 2005 urologists started larger series with the green light laser treatment were, also with a more powerful laser application. The urologists used 80 W instead of 60 W laser applicators. They achieved a reduction in prostate volume ranging from 37% to 53%. This was comparable to what conventional TURP treatments achieved.

Statistics regarding enlarged prostate glands

Prostate enlargement in older men is very common. By the age of 60 about 50% of men have an enlarged prostate gland. Compare this to men at 85 years: 90% of them have prostate gland enlargement. There is a lack of leadership among physicians regarding prostate hypertrophy. Many physicians consider it a minor nuisance in aging men. However, urinary tract infections that are rare in younger men are found more commonly in men with enlarged prostate glands. Also, urination problems can occur that may lead to bladder wall thickening and hydronephrosis of the kidneys. If no surgery is done for the prostate enlargement, the patient has to do intermittent or permanent urinary catheterization.

Surgical options for an enlarged prostate gland

TURP (transurethral resection of the prostate gland)

When patients have difficulties urinating or get frequent urinary tract infections, the urologist often recommends a TURP, which stands for “transurethral resection of the prostate gland”. This is the oldest form of prostatic surgery. The urologist introduces a resectoscope into the urethra and the prostate and removes bits and pieces of prostatic tissue. Complications can be bleeding, leakage of urine and infections after the TURP.

GreenLight™ laser treatment (Photoselective vaporization of the prostate)

This is a more modern form of the TURP, but the knife is replaced with a GreenLight™ laser. This procedure takes about one hour for most cases of prostatic hypertrophy. The urologist does a cystoscopy. When he views the prostate portion of the urethra a green light laser removes tissue from the prostate gland. This allows for free flow of urine through the urethra after the procedure. The advantage of this procedure is that the laser stops any bleeding right away, so patients lose only very little blood. More than 1 million GreenLight™ laser procedures have been performed around the world and urologists have done it on a large scale for about 15 years.

Water vapor therapy (Rezum™)

With this office-based procedure water vapor is introduced into the prostate gland, which causes some prostate tissue to die off. Over a 3 months period pieces of the prostate gland are shed into the urine. The urethra opens up and the prostate gland decreases in size. Unfortunately, many patients have to wear a urinary catheter for several days and sometimes weeks. Surgeons started to use this procedure on a large scale approximately 5 years ago and the urologist can do it at the office.

As the link shows, there are other treatments that urologists can do to open up the passage for urine and decrease the size of the prostate.

Best approach is the green light laser treatment for an enlarged prostate

Currently the best approach is the green light laser treatment for an enlarged prostate. The original TURP is too aggressive with bleeding complications after the procedure. The Rezum method has a prolonged recovery time and does not always succeed restoring normal urine flow. The green light laser treatment is safe, has a minimal amount of bleeding due to the nature of the laser and allows for a faster recovery. The green laser immediately stops any bleeding from the prostate gland.

Green Light Laser Treatment for an Enlarged Prostate

Conclusion

Many older men beyond the age of 60 develop prostate gland enlargement. The prostate puts pressure on the portion of the urethra immediately underneath the bladder. This results in difficulties urinating and frequent urinations to empty the bladder. Often there are significant amounts of urine that stay in the bladder. This urinary retention predisposes the man to urinary tract infections. In the past urologists did transurethral resections of the prostate (TURPs). But they could be very bloody and in some cases caused leakage of urine or infections. 15 years ago surgeons started to use a new type of TURP, a green light laser treatment for an enlarged prostate. Green light laser stops any bleeding during the procedure right away. Post-surgical complications are minimal. Many urologists and patients prefer this method to treat prostate enlargements.

Nov

2021

Marijuana and Uncontrolled Vomiting

By Ray Schilling | Abdominal Pain, addiction, chronic pain, heart attack, marijuana, schizophrenia

Marijuana was considered safe in the past, but now marijuana and uncontrolled vomiting suddenly make the news. Recently there also were reports of marijuana causing heart attacks and schizophrenia.

Abdominal pain with cannabis hyperemesis syndrome

Cannabis hyperemesis syndrome or cannabinoid hyperemesis syndrome (CHS) is a relatively new disease entity. It occurs in people who use marijuana daily for several years. But people affected by this condition often do not realize that it is an overdose of marijuana that brings on the nausea and vomiting of CHS. When they started marijuana use, they may have used intermittent doses of marijuana to treat nausea and vomiting. In intermittent doses marijuana may have been helpful, however constant use is a different story! During several years of use of marijuana, patients never had abdominal pains or vomiting, until one day CHS started.

Possible mechanisms regarding marijuana and uncontrolled vomiting

The body has its own endocannabinoid system with cannabinoid receptors that are distributed throughout the body. There are two cannabinoid receptors, CB1 and CB2. In the central nervous system, there are mainly CB1 receptors, in the rest of the body CB2. It appears that stimulation with intermittent small doses of marijuana suppresses nausea and vomiting in the hypothalamus area. However, constant stimulation of CB2 receptors in the gut with higher doses of marijuana are the cause of CHS. When a person develops cannabis hyperemesis syndrome, the only permanent cure is to stop marijuana use completely. This eliminates the CB2 receptor stimulation and allows the body to heal the gut. Researcher believe that Tetrahydrocannabinol, or THC is more powerful than the endocannabinoids. THC overwhelms the CB1 and CB2 receptors. When people who were cured of CHS restarted marijuana, their symptoms of nausea and abdominal pain returned.

In some people hot bath and hot showers help uncontrolled vomiting

Researchers noted that people reported how sometimes having a hot shower or a hot bath stopped the vomiting. The hypothalamus controls both body temperature and vomiting. A hot bath may send a signal to the hypothalamus, which interrupts the vomiting for a period of time. But with continued use of marijuana the vomiting reoccurs.

Increased strength of marihuana preparations

Dr. Wang, an associate professor of pediatrics at the University of Colorado Anschutz Medical Campus in Aurora, Colorado noted: “It’s been well documented that the amount of THC that now comes in cannabis is increasing substantially. In the ’90s the average was like 4% or 5%. Now in Colorado, it’s anywhere from 15% to 20%.” This means that THC causes more and more toxicity in patients.

In Colorado medical marijuana was legal since 2009 and recreational marijuana was legal since 2014. Dr. Wang researched the cannabis hyperemesis syndrome in Colorado. He found over 800,000 cases of vomiting in Colorado between 2013 and 2018. This was an increase of 29% from the time before marijuana became legal.

Symptoms of cannabis hyperemesis syndrome

The 5 most common symptoms of cannabis hyperemesis syndrome are continuous nausea, repeated vomiting, abdominal pain, weight loss because of decreased food intake and dehydration from fluid loss. Many people have several showers a day because it diminishes their nausea.

Three phases of cannabis hyperemesis syndrome

The cannabis hyperemesis syndrome often presents in 3 stages: the prodromal phase, the hyper emetic phase, and the recovery phase.

During the prodromal phase symptoms consist of nausea and abdominal pain early in the morning. The eating pattern is still normal in this phase. Some people increase their marijuana consumption as they hope to treat the nausea this way. This phase can last for months or years.

During the hyper emetic phase all of the 5 symptoms mentioned above can occur. This phase often continues until the patient gives up all marijuana consumption. This is when the recovery phase starts.

In the recovery phase the patient returns to a normal eating pattern. All of the symptoms gradually disappear. This phase lasts between days to months. But if the patient starts marijuana again, the symptoms return very quickly.

Treatment of cannabis hyperemesis syndrome

Patients who have severe vomiting require treatment in a hospital. The doctor starts intravenous fluids to treat dehydration. Some medicine to stop vomiting helps in the beginning. The physician must convince the patient to completely stop marijuana use, which helps to treat nausea and abdominal pain. Antacid medication like proton-pump inhibitors is useful to treat stomach lining inflammation. Frequent hot showers help to tone down nausea and vomiting. Hot showers seem to work via the hypothalamic brain center, which is responsible both for nausea/vomiting and heat perception. The physician may prescribe small amounts of benzodiazepams to treat anxiety.

By avoiding marijuana in any form THC, which is a powerful stimulus for CB1 and CB2 receptors gets washed out of the system. This allows the endocannabinoid system to rebalance itself. As long as the patient stays away from marijuana there is usually a complete recovery.

Marijuana and Uncontrolled Vomiting

Conclusion

Since marijuana is legal in many jurisdictions the cannabis hyperemesis syndrome (CHS) occurs more and more often. Emergency teams at hospitals are kept busy treating these types of patients. It appears that CHS develops in patients who use marijuana regularly and use it in higher concentrations. Nausea and vomiting are the most common symptoms. Some patients can cope for a period of time by taking frequent hot showers. But eventually this home remedy does no longer work. A brief hospital stay may help the patient to recover from this syndrome. The patient needs to stay away from marijuana products to recover from CHS completely, otherwise there will be a relapse.

Nov

2021

How to Fall Asleep Quicker

By Ray Schilling | alcohol, Circadian rhythm, Diabetes, Insomnia, melatonin, Pain, sleep, Sleep apnea

Early October 2021 CNN had an article about how to fall asleep quicker. Most people take 15 to 20 minutes to fall asleep.

Sleep environment

It is important to arrange a sleep environment where you can sleep well. This includes bedroom darkening and keeping the room temperature of 60 to 67 degrees Fahrenheit (15 to 20 degrees Celsius). Make sure your bed is comfortable and use your bedroom only for sleeping and sex. Do not read in the bedroom, keep your cell phone in another room and do not have a TV or computer in the bedroom. These produce blue light, which stimulates your brain. This is exactly what you do not want to have in your bedroom.

Normal sleep duration for different ages

There are always exceptions to rules. In this case there is a rare gene that allows the carrier to sleep only 5 hours at night and still have normal energy during the day. It is called short sleep gene.

Here are the hours of sleep that everybody else needs every night in different age groups:

Adults: 7-8 hours
School-age children: 12 hours
Teenagers: 8-10 hours

If you get the proper hours of sleep, but you are still tired during the day, you may have a lack of quality of sleep. Older people often have to go to the bathroom several times during the night. As it takes some time to reach the deepest level of sleep at night (REM sleep) older people often miss significant amounts of REM sleep during which they dream. The end result is a lack of energy during the day.

Conditions that interrupt your sleep

There are some medical conditions that can interfere with a good night’s sleep. Obstructive sleep apnea is one such condition that 25 million Americans have. A person with this kind of condition snores, gasps, chokes or stops breathing periodically during the course of the night. Restless leg syndrome is another condition, which interferes with a restful, deep sleep. Other conditions are chronic pain, heart disease, diabetes, asthma and gastroesophageal reflux. Medication can affect sleep depth as well.

Falling asleep naturally

Despite many studies it is not clear why some people have no problem falling asleep while others find it difficult. Taking 10 to 20 minutes of falling asleep is normal. If you cannot fall asleep after 20 minutes of trying, go to a dim room and do something calming until you feel drowsy again. Then return to your bed. Follow the same procedure, if you wake up in the middle of the night and you have difficulties falling asleep again. Deep breathing, yoga and meditation are proven remedies to pipe down and help you to fall asleep.

Monitoring sleep at a sleep clinic

A sleep study can be very helpful in diagnosing sleep disturbances. The sleep expert measures several body functions simultaneously. These are heart rate, air flow, blood oxygen level, breathing rate, brain wave activity, muscle movements and eye movements. During a night sleep study, a polysomnogram records all these body functions automatically. The finding helps the sleep expert to diagnose and treat the sleep disturbance.

Self-help supplements for insomnia

My regular sleep supplement every night is 3 mg of melatonin.

Sometimes this is not enough, because I watched an exciting movie or I wrote too much for Quora online. When I can’t fall asleep within 30 minutes, I take a capsule of 500 mg of valerian root. I would say that this helps in 95% of the nights to fall asleep.

If for some reason I still can’t fall asleep, I use 25 drops of Passion Flower Extract: I find that this is very reliable and puts me to sleep within 15 to 20 minutes of taking it. This way I am avoiding prescription narcotics and I am not getting addicted to benzodiazepines. The last step (Passion Flower Extract) I require only once or twice a month. The chemical in the Passion Flower Extract is very similar to benzodiazepines, which means you don’t want to take this every night or your system could get addicted to it.

How to Fall Asleep Quicker

Conclusion

Falling asleep is something we all can learn. It starts with a quiet and relaxing bedroom ambience. We need to allow for enough sleep duration. Adults need 7 to 8 hours of sleep, children and youth more. Deep breathing, yoga and meditation are proven remedies to prepare you to fall asleep easier. When all fails there are a number of self-help supplements you can take to help you ease into sleep. If you still have problems falling asleep a sleep study can be very helpful in diagnosing sleep disturbances. In a sleep clinic your heart rate, air flow, blood oxygen level, breathing rate, brain wave activity, muscle movements and eye movements are recorded with a polysomnogram. The doctor from the sleep clinic can formulate the diagnosis of the sleep disorder and help you overcome any identified problems.

The subchapter “Self-help supplements for insomnia” was published by me earlier here.

Oct

2021

Acetaminophen Damages the Fetus

By Ray Schilling | 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

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.

Oct

2021

Marijuana Causes Schizophrenia and Heart Attacks

By Ray Schilling | addiction, heart attack, marijuana, schizophrenia, Substance abuse

Two new studies showed that marijuana causes schizophrenia and heart stacks. Marijuana use has been increasing significantly in the general population since the 1990’s. Initially many believed that marijuana would be harmless. But increasingly there are medical publications showing the opposite.

In the following I present data how the use of marijuana causes these two documented side effects, heart attacks and schizophrenia.

Schizophrenia increased since the 1990’s

A July 21, 2021 study from Denmark included all people of Denmark who were older than age 16 from January 1, 1972 to Dec. 31, 2016. The number of participants were 3 ,595 ,910 women (50.0%) and 3 ,590 ,924 men (50.0%). The total number of individuals in the study were 7,186 ,834.

Here are the figures of the percentages of cannabis related schizophrenia cases in Denmark according to the study:

1995: 2% of all schizophrenia cases related to cannabis use in Denmark
2000: 4% of schizophrenia cases due to cannabis use
2010: 8% of all schizophrenia cases from cannabis use

The researchers found that the risk of coming down with schizophrenia heightens with increased cannabis use. Heavy users are more likely to develop schizophrenia than light users.

Cannabis use disorder

One subgroup of cannabis users are people with a cannabis use disorder. They use cannabis, but they become tolerant to it. This requires a higher dose of cannabis to achieve satisfaction. But they are unable to reduce cannabis. They spend more and more time to obtain cannabis, use it and recover from the effect. They give up other activities in favor or cannabis and they continue the use despite negative consequences. Researchers found that this group of individuals had the highest risk to develop schizophrenia. The authors of the Danish study found that patients with cannabis use disorder over the past 2 decades have increased their risk for developing schizophrenia by 3- to 4-fold. They feel it is because of the increase in use and the increase in potency of cannabis.

Heart attacks increased with cannabis use

A Canadian study assessed a cross-sectional study of 2017 and 2018.

The study in question was the American Behavioral Risk Factor Surveillance System survey of US adults. The authors zeroed into young adults (aged 18–44 yr.) with recent cannabis use and a history of a heart attack. Among 33,173 young adults there were 4,610 respondents with recent cannabis use (17.5%). 61 respondents among the recent cannabis users reported that they had a heart attack, which is 1.2%. In comparison non-cannabis users had a heart attack rate of only 0.8%. The adjusted odds ratio for cannabis users compared to non-users was 2.07. This means that the probability of getting a heart attack when using cannabis was 2.07-fold higher when compared to non-users. Also, the investigators found that a history of a heart attack had a probability of being due to cannabis use with a probability of 2.31-fold.

Cannabinoid receptors

Researchers found endogenous cannabinoids in the brain that function as messenger molecules. They need to activate their targets, the cannabinoid receptors, called CB1 and CB2. CB1 receptors are found mainly in the central nervous system. CB2 receptors are located mainly in the immune system. Reproductive organs have their own cannabinoid receptors. The lining of the uterus contains only CB1 receptors. Ovaries and testicles both use CB1 and CB2 receptors. Tetrahydrocannabinol (THC) from smoking or ingesting marijuana is the main psychoactive compound in cannabis. It stimulates these cannabinoid receptors also. But compared to the body’s own cannabinoids THC is much stronger. This leads to more pronounced effects that concern many physicians.

The overwhelming response of the cannabinoid receptors to THC leads to a blunting of the signals of the body’s own cannabinoids. This causes a breakdown in communication between neurons and body cells.

Marijuana Causes Schizophrenia and Heart Attacks

Conclusion re. marijuana causes schizophrenia and heart attacks

Legislators in Canada and many of the states in the US legalized the use of marijuana. As a result, the cannabis use in the younger age group of adults (between 18 to 44 years) has increased significantly. This means that more and more people are exposed to THC from cannabis, which overstimulates the body’s own endocannabinoid system. As explained this leads to a breakdown of communication between neurons and body cells. In time diseases like heart attacks and schizophrenia can develop, a fact overlooked by the media and the public. The overuse of marijuana leads to more than a 2-fold risk to get a heart attack and a 3- to 4-fold risk of coming down with schizophrenia. These are the facts right now. But with further increased use of cannabis researchers will likely find many other diseases that THC can trigger.

Sep

2021

World Suicide Prevention Day is on September 10

By Ray Schilling | alcohol, Anxiety, depression, Pain, Prevention, stress, Substance abuse, suicide

A CNN article points out that world suicide prevention day is on September 10.

Some statistics regarding suicides

According to the WHO more than 700,000 People die from suicide every year.

In the US suicide rates have risen between 1999 and 2018. President Joe Biden stated: “In 2019, suicide was the 10th leading cause of death in the United States, and the second leading cause of death for young people between the ages of 10 and 34.”

This was further underlined by a study from the CDC. It pointed out the emergency room visits started to climb in May 2020 for attempted suicide in youth. The CDC stated: “The mean weekly number of these visits was 26.2% higher during summer 2020 and 50.6% higher during winter 2021 compared with the corresponding periods in 2019”.

Triggering factors that make people commit suicide

Suicidal thoughts start when a vulnerable person encounters stressful events. The life situation can become so painful that in their way of thinking suicide is the only way to stop the pain. There are huge differences of opinions: what may be meaningless to one person, may feel devastating to another.

Common triggering factors are as follows.

Illness and physical discomfort
Conflicts with family or friends
Illness of family members
Death of family member or friend
Loneliness

In a study 50% expressed two of these 5 triggers, 37.5% expressed one of the 5 triggers. 12.5% expressed three of the 5 triggers.

With the Covid-19 epidemic there are new pressures on people. They cannot freely move around or travel. He/she may have lost a friend or relative to Covid. And people may be anxious about their own survival. I described this here before.

Biochemical changes in the brain with depression

In the past low serotonin levels in the brain were thought to be the main cause of depression. But researchers realized later those medications that increased serotonin levels did not always help depression. They found that dopamine and norepinephrine are also important brain transmitters that play a role in depression. When dopamine levels are low, depression occurs. Similarly, when norepinephrine is low, the patient can develop depression. On the other hand, in bipolar disorder the brain produces too much norepinephrine, which causes manic episodes. https://www.verywellmind.com/the-chemistry-of-depression-1065137 The physician needs to take a thorough history and note from that which brain transmitter system would be mainly affected. This helps the physician later to decide which antidepressant to choose from to rebalance the brain transmitters.

How to detect stress signals

There are a number of risk factors, which the CDC has outlined, for which the health professional or a family member wants to look in order to assess the suicide risk.

Does the patient have a history?

People with a mood or anxiety disorder, or with an alcohol or substance abuse disorder are at a higher risk of developing depression and suicide.

Did the person experience a loss?

A loss can be a death in the family, a loss of a job or the loss of an important person in a relationship. This is particularly bad when there is social isolation and a lack of support. With Covid-19 millions of people have suffered the loss of a job, social isolation and having to quarantine.

Is it easy for the distressed person to get a gun?

Firearms are a common means for people to kill themselves. When there is easy access to a gun, there is a high probability that the person uses it in times of distress.

History of previous suicide attempt

When a person attempted to commit suicide, but failed, there is a higher risk for them to repeat a suicide attempt and succeed. Also, there is a copycat phenomenon when the news comes out that a famous personality committed suicide. For instance, when the comedian Robin Williams committed suicide in 2014 there was a 10% rise in suicides in the following months all over the US.

Belief system that honours personal sacrifice

Some religious or cultural groups consider suicide a noble solution to a personal dilemma.

A person from this background is at a much higher risk to commit suicide.

Warning signs of pending suicide attempt

There are a number warning signs that point to a higher risk of possibly planning suicide.

A person may talk about wanting to die or kill themselves.
Searching online for ways to kill oneself or buying a gun.
Feeling trapped or feeling unbearable pain.
Talking about feeling hopeless and having no reason to live.
Stating that they feel they are a burden to others.
Drinking more alcohol and using more drugs.
Acting agitated or anxious. Reckless behavior.
A person withdrawing or isolating themselves.
A person sleeping too much or too little.
Extreme mood swings.
Talking about seeking revenge or showing rage.

These are all red flags that should alarm you to ask for help. Not all of these alarm signs are present all the time with people who are considering to attempt suicide. When you have suicidal thoughts in the US, call the National Suicide Prevention Lifeline at 800-273-8255. For Spanish crisis support call: 888-628-9454.

World Suicide Prevention Day is on September 10

Conclusion

World suicide prevention day is on September 10. This reminds us every year that suicide is a colossal problem of society. Stress, loss of health, losing a loved one, a broken marriage and financial loss can all contribute to depression. If patients with mental distress do not receive timely intervention and treatment, the life situation can become so painful that in the patient’s way of thinking suicide is the only way to stop the pain. The key is for the loved ones in the circle of friends to pay attention to the warning signs and bring the suicidal person to the attention of the psychiatric health professionals. Sometimes an in-patient admission to a psychiatric facility may be required to interrupt the negative thinking pattern. Ignoring the warning signs can have devastating consequences. Prevention is the only way to avoid suicide.

Sep

2021

Effects of a Plant-centered Diet on Cardiovascular Disease in Midlife

By Ray Schilling | Cancer, Cardiovascular disease, cholesterol, diet, exercise, heart attack, Mortality, Nutrition, olive oil, omega-3 fatty acids, Processed food

A study followed younger patients for 32 years looking for the effects of a plant-centered diet on cardiovascular disease in midlife. The researchers determined the heart attack and stroke rates when the participants were in their 50’s to 60’s. When on a plant-based diet cardiovascular disease rates fell by 52% compared to a control group with a meat containing diet. One subgroup changed the diet from a regular diet to a plant-based diet over 13 years. This reduced the risk ratio by 61% for heart attacks and strokes when assessed later.

Details of this study

There were 4946 adults as participants of this 32-year study. They were recruited in 1985 and 1986, at which time none of them had cardiovascular disease. The study completed in 2018. The results were published on Aug. 4, 2021. The researchers assessed the plant-centered diet quality using a tool with the name “A Priori Diet Quality Score” (APDQS). The higher the score, the higher the quality of the food. This means the person consumed nutritionally rich plant foods, limited amounts of high-fat meat products and less healthy plant foods.

Although a plant-rich diet consisted primarily of nutritionally rich plant foods, small amounts of animal products were also allowed. This involved low-fat dairy products, non fried poultry and steamed or grilled fish. This made the diet tastier and ensured that people would stick to this diet for decades.

Improvements of heart attack rates with plant-centered diet

After 32 years 289 cases of cardiovascular disease developed. The researchers compared participants with the highest food quintile to participants with the lowest food quintile. As mentioned, the risk for participants on a plant-based diet was 52% lower to get a cardiovascular disease. Moreover, a subgroup changed from a higher risk (fatter meals, meat, less vegetables) diet to a lower risk diet (lean fat, lean poultry, vegetables). Physicians followed this subgroup for 13 years and the risk ratio for heart attacks and strokes fell by 61%.

Comparison to other diet studies

There are other studies that looked at the effect of diet changes on the risk of developing heart disease. One such study examined 86 cross-sectional studies and 10 prospective studies in a meta-analysis. Vegetarian diets reduced deaths from heart attacks by 25% and brought down the incidence of total cancer rates by 8%. A vegan diet reduced the risk of total cancer by 15%.

In a study from the United Kingdom dated March 2019 several clinical trials were analyzed regarding non-diabetic populations. The question came up, what the effect of a Mediterranean diet was on cardiovascular disease incidence and mortality. The authors reviewed 30 RCTs (49 papers) with 12,461 randomized participants and seven ongoing trials. In one study the observation time was 46 months. A Mediterranean diet reduced the cardiovascular disease mortality by 65%!

Another study from Spain

Another study from Spain published in 2019 examined 7356 older adults (average 67 years) and followed them for 6.8 years. The investigators kept track of the physical activity and put everybody except the controls on a Mediterranean diet. The group on the lightest leisure-time physical activity consuming a Mediterranean diet had the lowest mortality. The all-cause mortality of this group was 73% lower than the control group.

What is so healthy about the Mediterranean diet?

Despite a wide variation between all the 15 countries bordering the Mediterranean Sea, there are common characteristics: an abundance of vegetables and fruit, along with nuts and legumes. Cereal products are largely whole grain. Olive oil is the principal fat source, and people eat fish, seafoods and poultry in moderation. They consume red meat rarely. Cheese and yogurt can be part of the diet, depending on the region.

The first clinical evidence supporting the health benefits of the Mediterranean diet came from the Lyon Heart Study. The researchers placed patients who had a heart attack either on the diet designed by the American Heart Association or a Mediterranean style diet. After a follow-up of 27 months, the group eating the Mediterranean diet had a reduction of heart attacks by 73% and a decreased mortality by 70% compared to the other group.

More detail on the ingredients of the Mediterranean diet

An analysis of the various foods of the Mediterranean diet shows the reasons for the health benefits clearly. The fats that people on a Mediterranean diet eat are heart-healthy monounsaturated fats like olive oil or fats that contain omega-3 fatty acids. They come from fish (tuna, salmon, trout, sardines) or from plant sources (walnuts, other tree nuts and flax seed).

As there is an emphasis on natural foods, the diet is extremely low in trans fatty acids (hydrogenated fats), which otherwise increases the risk for cardiovascular disease. As people consume more than 300g of vegetables per capita daily, the contents of antioxidants and other beneficial plant chemicals is much higher in comparison to Western diets. There are many individual components of the Mediterranean diet that contribute to the reduction of disease. This is particularly true for heart disease. It also is apparent, that there is not one single food or nutrient that is responsible for the health benefits. What matters are the interactive effects of all the nutrients that lead to the health benefits.

No processed food means healthier living

The practical application does not mean deprivation and starvation, but a move away from processed fats (margarine), baked goods (donuts, muffins, pastries), and high saturated fat snacks and trans fats (chips, crackers, cookies, pies). Food choices move towards those of fresh fruit and vegetables, nuts, fish, and olive oil. Portions or servings have to be adequate to maintain a healthy weight.

Mediterranean food is not the heaping plate of pasta with an afterthought of vegetables. It also is not the super-size fast food pizza with pepperoni and cheese. Mediterranean food incorporates fresh food rather than fast food. It entails a shift from large portions of red meat to smaller portions of fish, a transition from highly processed foods to ample helpings of dark green vegetables with a dose of olive oil. Low amounts of alcohol, especially red wine can make a meal enjoyable, which means that the limit is one drink per day for women, and two drinks per day for men. After dinner go for a walk!

Olive oil is one of the reasons why the Mediterranean diet is so healthy

In the past it was thought that the monounsaturated fatty acids in olive oil would be the reason why it is protective of the heart. However, newer studies have shown that it is the polyphenols and among these in particular hydroxytyrosol that lower blood pressure and protect you from hardening of the arteries.

A 2012 study from Spain has found that mortality from heart attacks was 44% lower than that of a control group who did not incorporate olive oil in their diet.

How polyphenols in olive oil work for you

Only two tablespoons of extra virgin olive oil per day protect you from heart disease. It does so by reducing the total cholesterol level in the blood as well as the LDL cholesterol level. When there is more polyphenol in olive oil (such as in extra virgin olive oil), the body produces more HDL, which is essential to extract oxidized LDL from arterial plaque. On top of that polyphenol rich olive oil increases the size of the HDL particles (these larger particles have the name HDL2), which are more efficient in extracting oxidized LDL from arterial plaques. A Sept. 2014 study in humans showed that higher polyphenol olive oil as found in extra virgin olive oil caused an increase in the more effective HDL2 particles. This cleans out plaques from arteries more effectively than the regular, cheaper olive oil.

Effects of a Plant-centered Diet on Cardiovascular Disease in Midlife

Conclusion

Several large, well-controlled studies showed that there are pronounced effects of a plant-centered diet on cardiovascular disease in midlife. Heart attack rates and mortality rates were reduced by 25% to 73% on a Vegan diet or a Mediterranean diet. When people combine a plant-centered diet with regular physical exercise they also live longer. One of the ingredients of a Mediterranean diet is extra virgin olive oil. It contains polyphenols that lower total and LDL cholesterol. It also increases the larger particles of HDL cholesterol with the name HDL2. HDL2 is more efficient in extracting oxidized LDL cholesterol from arterial plaques.

What you can eat on a plant-centered diet

A plant-centered diet incorporates fresh food rather than fast food. It entails a shift from large portions of red meat to smaller portions of fish, a transition from highly processed foods to ample helpings of dark green vegetables with a dose of olive oil. Instead of large portions of beef and sausages shift to seafood (tuna, salmon, trout, sardines), walnuts, other tree nuts and flax seed. The statistics clearly showed the effects of a plant-centered diet on cardiovascular disease in midlife with a reduction of heart attacks and mortality.

Some of the text above was published previously here.

Aug

2021

When Stress Becomes Abnormal

By Ray Schilling | alcohol, Alzheimer’s disease, Cardiovascular disease, Diabetes, heart attack, Hormones, Smoking, Stroke, thyroid disease

Recently CNN published an article that dealt about when stress becomes abnormal.

We all have experienced stress. It makes our heart beat faster and our breathing speeds up as well. But when the stressful situation is over, stress usually subsides also. Some people though have so much stress in their lives that they never completely recover from any stressful situation. They develop chronic stress, which can lead to physical illnesses or mental disease. I have previously written about “stress drives our lives”. In the following I am reprinting the next 5 paragraphs.

Heart attacks and strokes when stress becomes abnormal

In a 2015 Lancet study 603,838 men and women who worked long hours were followed for an average time of about 8 years with respect to heart disease or strokes. All of the subjects were free of heart attacks and strokes when they entered into the study. There was a total of 13% more heart attacks in those who worked extra hours in comparison to those who worked 40 hours per week or less. With respect to strokes there were 33% more strokes in those who worked long hours. Researchers noted a dose-response curve for strokes in groups with various workloads. Compared to standard working hours there were 10% additional strokes for 41-48 working hours, 27% for 49-54 working hours and 33% for 55 or more working hours per week.

Stress drives some of us to substance abuse

In order to cope with stress many of us “treat” daily stress with alcohol. It makes you feel good subjectively, but it can raise your blood pressure causing heart attacks and strokes down the road. A low dose of alcohol may be healthy, but medium and high doses are detrimental to your health.

Next, many people still smoke, although scientists have proven long time ago that it is bad for your health. It can cause heart attacks, various cancers and circulatory problems leading to leg amputations.

Overeating is another common problem. Comfort food relieves stress, but it causes us to put on extra pounds. As you know it is easier to put weight on than to take it off. Being overweight or being obese has its own problems: arthritis in the hips and knees makes walking more difficult. The metabolic syndrome sets in, which is a characteristic metabolic change causing diabetes, high blood pressure, heart attacks, strokes and certain cancers. The more weight you carry, the less likely you are to exercise. This can lead to further deterioration of your health.

Diabetes can occur when stress becomes abnormal

Stress causes too much cortisol secretion from the adrenal glands. This raises blood sugar, and when chronic can cause diabetes. In addition, unhealthy eating habits in an attempt to cope with stress can cause weight gain. Insulin resistance causes high blood sugars and diabetes.

Korean immigrant study

In a 2012 California study 148 adult Korean immigrants were examined. They all had elevated blood sugars confirming the diagnosis of type 2 diabetes. They had an elevated waist/hip ratio.

A high percentage of the study subjects had risk factors for type 2 diabetes. This included being overweight or obese and having high blood glucose readings. 66% of them said that they were feeling stressed, 51% reported feeling anxious, 38% said they were feeling restless, 30% felt nervous and 3% said they were feeling hopeless. It is easy to see the connection between stress and disease!

Australian study showed that anxiety can cause diabetes

An Australian long-term follow-up study computed risk factors for developing type 2 diabetes. Stress was a major contributor to diabetes.

A 30-day episode of any anxiety disorder had a 1.53-fold risk to cause diabetes. A depressive disorder had a 1.37-fold risk to cause diabetes and posttraumatic stress disorder had a risk of 1.42-fold to cause diabetes.

Infertility may develop when stress becomes abnormal

Stress changes hormones in women causing ovulation problems and infertility. 1 in 8 couples in America have problems getting pregnant. Physicians identified stress as at least one of the contributing factors. But in men stress can also reduce sperm count and semen quality as this study describes.

Alzheimer’s disease and stress

A 2010 study from Gothenburg University, Sweden examined 1462 woman aged 38-60 and followed them for 35 years.

Psychologists assessed the stress score in 1968,1974 and 1980. 161 females developed dementia (105 Alzheimer’s disease, 40 vascular dementia and 16 other dementias). The risk of dementia was higher in those women who had frequent/constant stress in the past. Women who had stress on one, two or three examinations suffered from higher dementia rates later in life. Researchers compared this to a group of women who did not have any significant stress. Specifically, dementia rates were 10% higher after one stressful episode, 73% higher after two stressful episodes and 151% higher after three stressful episodes.

Hormone system affected by stress

I have written an article before about how stress affects our hormone system.

I am reprinting excerpts from this here (the next 4 paragraphs).

Dr. Andrew Heyman gave a talk about how stress affects our hormone system. He presented his talk at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. It was entitled “Understanding the Stress, Thyroid, Hormone Connections & Prioritizing Systems”.

Dr. Heyman emphasized in particular that there is a triad of hormonal connections that is important to remember: the thyroid hormones, the stress hormones (adrenal glands) and the pancreas (insulin production). It seems like we need a balance of these hormones for optimal energy production and circulation. Under stress our sugar metabolism can markedly derail, we develop obesity and fatigue. But when balanced, we experience vitality and wellbeing.

Metabolic activation pathways

Dr. Heyman projected a slide that showed the metabolic activation pathways. Likewise, he stated that a number of different factors could influence the hormone system:

Diet: trans fats, sugar, too many carbs, food allergies.
Drugs: drug-induced nutrient depletion (over-the-counter drugs, prescription drugs).
Physical exercise: frequency and type matters.
Environmental exposure: chemicals, pesticides, herbicides, heavy metals, plastics, molds, and pollens.
Stress: physical stress, psychogenic stress.
Genetics: methylene-tetra-hydro-folate reductase enzyme deficiency (MTHFR mutation), APOE genes, lack of vitamin D
Disease: past or present conditions, active disease or syndromes.

Target areas within your system

The target areas in your system are the

Pancreas, where blood sugar can rise because of insulin resistance. In particular, too much insulin production causes inflammation, hormone disbalances, kidney damage, and hardening of the arteries through plaque formation.
Thyroid gland, which depends on TSH (thyroid stimulating hormone) for activation. Autoantibodies can also affect it negatively.
Brain: decrease in serotonin resulting in anxiety, depression and food cravings; decreased melatonin causing sleep disturbances; increased ghrelin and decreased leptin secretion leading to overeating and obesity.

Other target areas of stress

Liver/kidneys: both of these organs are important for detoxification; the liver produces thyroid binding globulin, which when increased can lower the free thyroid hormones.
Immune system (gut, lymph glands): the Peyer’s patches in the gut mucosa produce a large portion of the immune cells; lymph glands, the bone marrow and the spleen supply the rest. A leaky gut syndrome can affect the whole body, in addition causing inflammation and autoimmune reactions.
Hypothalamus/pituitary/adrenal glands: this is the main axis of the stress reaction. A brain under stress activates the hypothalamus. It sends a cascade of activating hormones via the pituitary gland and likewise activates the adrenal glands. Finally, this leads to cortisol overproduction, and release of epinephrine and norepinephrine from the center of the adrenal glands. High blood pressure, anxiety, heart palpitations, arrhythmias and more can finally develop from this.

Treatment suggestions to cope with stress

There are thyroid supplements that can support the function of the thyroid gland. Similarly, there are several supplements to support the adrenal glands.
Chromium, vitamin D, magnesium, alpha-lipoic acid, fish oil and others are useful to support the pancreas. Relaxation methods like self-hypnosis, meditation, yoga, Tai-Chi and others are very useful to counter stress. If you can change your job to evade stress, take the opportunity and find another job with less stress. See a health professional and discuss what you can do to become more stress-resistant. If you are overweight or obese, see a dietitian to help you lose weight. Aerobic exercises like running for 30 minutes on a treadmill can help reduce stress. Various relaxation methods mentioned earlier also can counter stress. They help you to block out worrying about the past and the future, but instead focus on what is positive in the present.

When Stress Becomes Abnormal

Conclusion

I have described what stress can do to your body. It can give you heart attacks and strokes. Stress in some people can lead to substance abuse. It can cause diabetes, infertility and even Alzheimer’s disease. I described how thyroid hormones, insulin and brain hormones are interconnected and suffer with stress. Other factors can make the effects of stress worse or better as I discussed in detail. Treatment of stress-induced conditions requires a combination of preventative steps and medical therapies. Ignoring stress is not an option as this could lead to premature death. Managing stress, as mentioned before, and keeping it to a minimum is the answer.