Author: sunshineneutraceuticals

I have been a clinical pharmacist for 31 years. In that time period I have worked with a vast group of patients. My goal is to help people live a happy, healthy life. I am board certified in pharmacotherapy as well as psychiatry.

Garcinia Cambogia Medication Interactions, Contraindications, Safety, Effectiveness and Use in Pregnancy and Lactation.

Posted on by sunshineneutraceuticals

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Garcinia cambogia (Malabar tamarind) is a fruit tree found in the evergreen and semi-evergreen forests of southwest India. The fruit of this tree resembles a small pumpkin and comes in a red, orange, or yellow variety. This fruit ripens during the rainy season, and the rind contains large amounts of hydroxycitric acid (HCA). The dried fruit rinds have been used for centuries as a flavoring agent.  

 

In Ayurvedic medicine, Garcinia is used to promote general health. It has also been used for rheumatism and bowel symptoms — an oral rinse containing G. cambogia has been used by veterinarians to treat mouth diseases in cattle.

 

HCA, which is related to citric acid, is a common ingredient in weight loss products. G. cambogia is available as a weight-loss supplement, either alone or mixed with other ingredients.   

 

Garcinia Cambogia Dose

Doses of Garcinia cambogia extract in clinical trials ranged from 1500 to 4667 mg per day. The supplement offered by Sunshine Nutraceuticals contains 700 mg Garcinia cambogia extract, and the recommended dose is one capsule by mouth twice daily 20-30 minutes before a meal with eight ounces of water.

Garcia Cambogia Side Effects

Side effects of Garcinia Cambogia are generally mild and include:

  • Dry mouth
  • Headache
  • Diarrhea
  • Dizziness
  • Nausea

Since Garcinia Cambogia is not centrally active, it should not cause anxiety, hypertension, or problems with sleep. 

Garcinia Cambogia in Pregnancy and Lactation

In my professional opinion, Garcinia cambogia should not be used by pregnant women or those who are breast-feeding. We do not have sufficient evidence to assure its safety; therefore, the risks outweigh the benefits.

 

Garcinia Cambogia Medication Interactions

Antidepressant Drugs and Serotonergic drugs

There has been a case report of serotonin syndrome being caused by a combination of Garcinia extract and escitalopram (Lexapro). The patient was re-challenged with sertraline (Zoloft) and again experienced serotonin syndrome.1

For this reason, caution should be exercised when taking G. Cambogia with any antidepressant medication. Monitor for signs and symptoms of serotonin syndrome.  These include:

  • Headache
  • Agitation
  • Restlessness
  • Confusion
  • Shivering
  • Increased heart rate
  • High blood pressure
  • Dilated pupils
  • Loss of muscle coordination
  • Muscle rigidity
  • Muscle Twitching
  • Heavy sweating
  • Diarrhea
  • Goose bumps

Serotonin syndrome may also occur when G. Cambogia is taken with other drugs that have serotonergic properties such as:

  • Tramadol (Ultram)
  • Pentazocine (Talwin)
  • Dextromethorphan (present in some OTC cough and cold preparations) 

Anti-diabetic agents

G. cambogia may increase the hypoglycemic effects of anti-diabetic agents. It is suggested that blood sugars be closely monitored when using both Garcinia and anti-diabetic medications. 

Statins and other hepatotoxic medications

There was a case report of rhabdomyolysis being caused following the ingestion of an herbal medicine containing G. Cambogia.2Caution is recommended when administering statins with other medications which may cause rhabdomyolysis.

Use caution when combining Garcinia with other drugs that negatively affect the liver. Some examples include

  • Acetaminophen (Tylenol)
  • Amiodarone (Cordarone)
  • Carbamazepine (Tegretol)
  • Isoniazid (INH)
  • Methotrexate (Rheumatrex)

Safety of Garcinia Cambogia

According to the TRC Natural Medicines Research Collaboration, Garcinia Cambogia gets a “possibly unsafe” grade. This is due to numerous case reports of liver toxicity. Most of these reports were the result of combination products that included G. Cambogia as one of the ingredients. There were at least two reports where the patient was taking Garcinia alone. Although the casualty was likely or probable, this is still concerning.

 

Effectiveness of Garcinia Cambogia

Obesity

There is conflicting evidence regarding the effects of Garcinia on treating obesity. Some studies show a significant weight loss while others do not. As mentioned in some of my previous posts, I prefer to consult meta-analyses when available. One such study was published by Onakpoya, et al in 2011 in the Journal of Obesity. 

 

The investigators of this meta-analysis did not believe the studies were of sufficient length to assess the effects of HCA on body weight. These studies ranged from two to twelve weeks. There were also different strains of Garcinia used in the studies. We are unsure what impact this might have on bioavailability. 

 

Finally, there was a difference in caloric intake in the various studies. 

 

Calories eaten ranged from 1,000 kcal, to as high as 3,009 kcal per day. This would certainly have an impact on weight loss.

 

The conclusion of this meta-analysis was that Garcinia extracts generate weight loss on the short term. 

 

They point out that the effect is small, and is not statistically significant when only rigorous random controlled trials are considered.3

Garcinia Cambogia Contraindications

The only known contraindication at this time, according to Lexicomp (accessed 1/12/2020), is a known allergy or hypersensitivity to any components of Garcinia Cambogia.

After researching Garcinia cambogia, many questions remain. 

Can this supplement be effective for weight loss long-term?

Does Garcinia cambogia cause liver damage or contribute to increased liver enzymes in some patients?

Is this supplement safe and effective?

The answers to the above questions cannot be answered until new research is available.  The current studies were of insufficient length and not well designed.  The liver damage side effect must be examined more closely before I can recommend starting this supplement for weight loss.

As I have explained in the past, the best way to lose weight is to eat whole foods, avoid fast food, drink plenty of water, and exercise.  You will feel substantially better if you follow these simple rules.  Supplements can help reduce hunger but exercise and proper food intake will get you much better results. 

At this time, my recommendation is to use Garcinia cambogia only if you have had success with it in the past.  If you have had no negative effects and have lost weight, it may be a reasonable option.

 

I will continue to research this supplement.  As new research is available, I will decide whether to keep it, or remove it from our product line.

If you want a safer alternative, I recommend our Keto Ultra supplement.  This contains raspberry ketones, African mango, green tea extract, caffeine, apple cider vinegar, kelp and grape seed extract.  You can order this supplement below.

Our goal is to give our readers the best information available to live a happy, healthy lifestyle.  Sometimes, the information I present to you will not be positive.  I want to remain unbiased with regard to the products I offer for sale.  If you have any questions, please click on the link next to my picture below to send a message.  I will respond!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

The Cyclical Ketogenic Diet and Beta-Hydroxybutyrate (BHB) Salts

Posted on by sunshineneutraceuticals

The ketogenic diet is one of the most popular weight-loss strategies today because those who stay on the diet are able to lose weight and keep it off.   It works by limiting carbohydrates.  The traditional ketogenic diet consists of approximately 75% of calories as fat, 20% as protein, and only 5% carbohydrates.  This results in a daily carbohydrate intake of around 50 grams.  With the amount of carbs being limited, the body becomes more efficient at breaking down fat into ketones for energy.

The body uses two main sources of fuel; glucose and ketones.  Glucose is obtained when the body breaks down carbohydrates including sugars.  The energy obtained from glucose makes one feel energetic initially but often leads to “crashing” soon after, causing hunger and weakness.  If more carbohydrates are ingested than can be used by the body, the excess is stored as glycogen in the muscles and liver.  When glycogen stores are full, the excess glucose is stored as fat.

If there isn’t enough glycogen or glucose available to provide energy, ketones are utilized.  This energy source is steadier and doesn’t lead to cravings or the crash that often occurs with glucose.   The traditional ketogenic diet is not without adverse effects.  Two of these side effects are discussed below.

 

The Keto Flu

The keto flu can happen during the first couple weeks of starting the diet.  This is your body’s response to changing from glucose to ketones for energy.  The keto flu symptoms are:

  • Nausea
  • Stomach cramps
  • Chills
  • Muscle cramps or aches
  • Irritability
  • Sore throat
  • Poor sleep
  • Trouble concentrating

 

These symptoms typically start twenty-four to forty-eight hours after beginning the diet.  The more your diet was previously high in refined sugars and carbohydrates, the more severe these symptoms will likely be.

Keto Breath

Another common side effect of the keto diet is keto breath.  This “bad breath” symptom will be experience by most people who put their body into ketosis.   It can occur during the first week and is the result of acetone being released from the body.  This side effect is often accompanied by a metallic taste in the mouth and should go away when the body becomes accustomed to being in ketosis. Until this happens, there are some steps that can be taken to help with this pesky problem.

  • Carry Breath Mints: You may not be able to get rid of the acetone on your breath, but you can mask it with breath mints. Sugar-free mints are preferred.
  • Drink More Water: Drinking more water causes more ketones to be released from the body in the urine resulting in less elimination by breathing. Drinking water has other health benefits as well that I have discussed in previous posts.
  • Brush Teeth Frequently: This is another simple strategy to help keep your breath fresh.

The Cyclical Ketogenic Diet (CKD)

The cyclical ketogenic diet is a variation of the ketogenic diet where you follow the 50 gm/day carb diet for 5-6 days per week followed by a higher carb diet for 1-2 days.  This variation is a popular tactic for those trying to build muscle and improve exercise performance as the higher carb days or “refeeding days” replete glucose reserves.  This is important as glycogen is what the body uses for energy during workouts.  These “carbohydrate days” will give your body the glucose it needs during workouts while reaping the benefits of ketosis.

This type of diet has many benefits.  If you don’t ever get to eat carbohydrates, you may feel deprived of some of your favorite tasting food.  The CKD allows you to enjoy these foods one or two days per week.  The body needs carbohydrates to function properly and carb loading keeps the body functioning smoothly. 

The microbiome of the gut will be healthier if you eat more carbs.  This leads to a better functioning gut-brain axis which provides several benefits.   

The keto flu and keto breath are usually less severe with CKD. 

It is important to be selective in the carbohydrates you consume during the CKG.  Try to eat fruit, lentils, sweet potatoes, rice and oatmeal, limiting fat intake during your carbohydrate days.  This is important as the body is only able to utilize one energy source at a time.  Since glucose is the preferred energy source, excess fat consumed during these days will be stored as body fat.  The goal should be to burn all of the glycogen consumed during the refeeding days so ketones are used as energy the rest of the week.

 

One Benefit of CKD - A Higher Level of Anabolic Hormones

Testosterone

 

Testosterone is one of the most important hormones for muscle growth.  A high fat diet increases the concentration of testosterone in the blood.  It has been shown that diets with less than 20% fats can inhibit testosterone production.  This is especially true when compared to diets containing 40% fat. 4

A study by Wang et al. showed a low-fat diet decreased testosterone levels by 12%. 5

A low fat diet decreases the level of testosterone in the bloodstream which, in turn, may lead to a decrease in muscle-building capability.

 

Growth Hormone

Growth hormone (GH) also known as somatotropin or human growth hormone (HGH), stimulates growth and the reproduction and regeneration of cells.  Low levels of this hormone may increase risk of disease and increase body fat. 6

Carbohydrates and sugar increase insulin levels.  More insulin leads to less HGH so reducing carbohydrates in the diet may help to increase human growth hormone. 7

8

 

Insulin-like growth factor 1 (IGF-1)

The deficiency of Insulin-like growth factor 1 (IGF-1) is associated with metabolic syndrome.  Metabolic syndrome leads to insulin resistance, increased glucose levels, impaired lipid profile, cardiovascular disease and obesity.  All of these effects are undesirable.  The ketogenic diet increases IGF-1 which may lessen the chances of contracting metabolic syndrome and the negative effects described above. 9

A Great Supplement For Keto Dieters

If there isn’t enough glycogen or glucose available to provide energy, ketones are utilized.  This happens even when we consume a regular diet during the night as we sleep.  As mentioned above, this energy source is steadier and doesn’t lead to cravings or the crash that often occurs with glucose.  There are three ketone bodies.  These are acetoacetate, BHB, and acetone.   Beta-hydroxybutyrate is a great energy source when eating a ketogenic diet.  When glucose is limited, mental concentration can be negatively affected. 10

BHB salt supplements can be used when energy levels are low while on the ketogenic diet. 

Michael Brown pictured with Final Thought written

The ketogenic diet has become very popular.  This diet works by forcing the body to break down fat for energy.  For those who work out, the cyclical ketogenic diet is likely a better option.  This diet allows for one to two days per week of carbohydrate loading to build up glycogen stores for quick energy supply during physical exertion.  It is important to eat “clean” carbohydrates rather than junk food.  Remember when carb loading to avoid too many fat calories because the body can only utilize one energy source at a time.  Finally, consider utilizing BHB salts for energy during the beginning of your keto diet and anytime you feel sluggish.  This supplement can get you over the hump without resorting to eating too many carbohydrates.  If you have any questions regarding the ketogenic or cyclical ketogenic diet, please feel free to contact me.  If I don’t know the answer to your question, I will research it and get back to you as soon as possible.  Thank you for reading my post.

 

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

Ashwagandha Withanolides: Uses, Side Effects, and Contraindications

Posted on by sunshineneutraceuticals

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Ashwagandha, or Withania somnifera is an evergreen shrub that grows in hot, dry climates.  This herb is very popular in India and the Middle East.  The shrub produces small greenish-yellow flowers as well as fleshy fruit which is orange-red when ripe.  Ashwagandha is sometimes called “winter cherry”.

Ashwaghanda has been utilized in Ayurvedic medicine.  This “whole-body” healing system was developed in India more than 3000 years ago.  It is used as a Rasayana which is an herbal or metallic substance that increases happiness and helps promote a youthful mental and physical condition.  Withania is the most prominent ayurvedic Rasayana herb and is given to small children as well as middle-aged and elderly in hopes of increasing longevity. Ashwagandha supplements are most commonly recommended for energy enhancement and to boost exercise performance. 11

Withania somnifera contains a group of pharmaceutically active steroidal lactones known as withanolides.  These withanolides are believed to have many positive medical effects including antimicrobial, anti-inflammatory and anti-cancer properties. 12

The word ashwagandha translates to “smells like a horse”.   It not only smells like a horse but is also thought to give those who ingest it the power of a horse.  Ashwagandha is also known as Indian ginseng, even though it is generally used for its calming and anti-stress properties whereas ginseng supports energy and stamina. 13

Ashwagandha and Cognition

Cognition is a complicated process and is performed by our brain.  It includes thinking, communicating, problem solving, memory, judgement, processing information from our senses and more.   It is not surprising that many are interested in obtaining substances which improve cognition.  These substances are known as nootropics.  As we get older, our cognition tends to decline.  A study by Sing-Manoux et.al found this decline often begins between 45 and 55 years of age. 14

A double-blind, placebo-controlled study was performed on a group of subjects with mild cognitive impairment (MCI).  This is a state between normal cognitive aging and dementia.  These people have memory deficits but not to the extent that activities of daily living are adversely affected.  A total of fifty adults were randomized to receive either 300 mg Ashwagandha root extract in capsule form, twice daily, for eight weeks or a placebo. 

The researchers concluded that “Ashwagandha (Withania somnifera) may be useful in enhancing immediate and general memory, executive function, attention, and information processing speed in people with MCI, with few adverse effects.” 15

 

Ashwagandha and Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder (OCD) is a mental illness where the patient to suffers from obsessive, intrusive thoughts.  These thoughts may lead the patient to clean continuously or constantly check light switches to be sure they are off, etc.  This disorder can cause distress to the point that it affects daily functioning.   Selective serotonin reuptake inhibitors (SSRIs) are the medications most commonly used for OCD.  Unfortunately, SSRIs are only mildly effective in treating OCD. 16

17

18

19

A study conducted in 2016 showed Ashwagandha was more effective than placebo in improving Y-BOCS scores in patients with a diagnosis of OCD.  Y-BOCS is the standard test for assessing the frequency and severity of OCD symptoms.  Thirty patients were randomized into two groups and Y-BOCS scores were evaluated in both groups at baseline and after six weeks of treatment.  The treatment group received an evaporated root extract of Ashwagandha obtained from Iran.  Each capsule contained either 30mg of root extract and lactose to a total weight of 250mg, or lactose only (placebo).  The treatment group had Y-BOCS scores improve by 8 units, whereas the placebo group only improved by 2 units.  This was a statistically significant difference. 20

Ashwagandha and Blood Sugar Levels in Schizophrenia

I work as a psychiatric pharmacist so I am concerned about the effects of antipsychotic agents on blood sugar.  A small study was published in the Indian Journal of Pharmacology in 2013.  This study was designed to assess the ability of Ashwagandha to decrease blood sugar levels in schizophrenic patients who were receiving second-generation antipsychotic medications.

This study found a significant improvement in both fasting blood glucose and serum triglyceride levels in the Withania group as compared to the placebo group.  More studies with a larger sample size are needed to establish safety and efficacy of this treatment option. 21

Ashwagandha for Pain and Inflammation

Pain relief has become more difficult in the wake of the opiate crisis.  Many physicians are not willing to prescribe opiates for chronic pain due to the recent guidelines which recommend against this practice.  Unfortunately, other drug classes, such as non-steroidal anti-inflammatory agents (NSAIDs), also can be detrimental, especially if taken over an extended period of time.  Pain can be debilitating for some. It can lead to problems sleeping, decreased mood, and reduced work performance.

A study was performed to see what effects a single 1000 mg dose of Withania somnifera would have on mechanical pain.   In this study a device was set up to measure pain threshold as well as pain tolerance force and time.  The researchers found Withania somnifera increased pain threshold and pain tolerance force and time as compared to placebo.  No adverse effects were reported in this study. 22

W. somnifera has also demonstrated analgesic and antipyretic effects in rat models. A study was done comparing Ashwagandha root powder to indomethacin. This study showed the root powder was able to curb the inflammatory response without causing damage to the GI tract of the rats. 23

 

Ashwagandha for Stress, Anxiety and Cortisol Levels

Ashwagandha is probably most known for its effects as an adaptogen.  These substances (adaptogens) are able to help the body combat physical, chemical, and biological stress.  A study published in 2012 included 64 people who had a history of chronic stress.  These subjects were randomly assigned to two groups.  The treatment group received 300mg Ashwagandha root extract in capsule form twice daily for 60 days.  The other group, placebos.

On day 60, the treatment group displayed a significant reduction in all stress assessment scales relative to the placebo group.   Serum cortisol levels were also substantially reduced in the treatment group.  Cortisol is the body’s main stress hormone.  Increased cortisol levels can be an indication of increased stress. 24

Ashwagandha as a Cancer Treatment

Scientists have been searching for a cure for cancer for many years.  Most of the medications available to treat various cancer types come with a long list of life-changing side effects.  Ashwagandha root extract was first shown to decrease cancer incidence experimentally in vivo in 1967. 25

This has led to an increasing interest in Withania for both cancer treatment as well as prevention.

We know that the carcinogenic process is prolonged.  Is there a way to prevent cancer?  In 1976, the idea of chemoprevention was presented by Michael Sporn. 26

The definition of chemoprevention is the use of natural, synthetic, biological or chemical agents to reverse, suppress, or prevent the process of carcinogenesis.  This has become an increasingly popular area of research.  Natural substances and nutraceuticals are getting a closer look.  Sulforaphane derived from vegetables such as broccoli for prostate cancer and turmeric for colorectal cancer prevention are examples of studies currently under way.

Breast Cancer

A study using mice that were predisposed to developing breast cancer showed a 33% reduction in tumor formation when being fed a diet containing 750mg/kg of Withania root extract for 10 months. 27

Hepatocellular Cancer

Cancer of the liver is aggressive and has a poor response rate to traditional cancer therapies. 28

A study, published in the Journal of International Medical Research in 2018, concluded the water extract of Withania somnifera is a powerful antioxidant and has anticancer effects on HepG2 cells.  They suggest it may be a favorable treatment for hepatocellular carcinoma and should be confirmed in animal studies. 29

There are barriers to using Withania for chemoprotection.  This plant only thrives under specific environmental conditions and is relatively slow growing.  There is also variability in the alkaloids and withanolides produced by each plant, as well as different parts of the plant (leaves vs roots).  This variability requires standardization of the active components of the preparation.  Care must also be taken to not over-utilize fertilizers and pesticides when growing Ashwagandha. 30

Ashwagandha Contraindications

Although Ashwagandha is considered safe for most individuals, there are three groups of people who should avoid it. 

  • Those with hormone-sensitive prostate cancer: Ashwagandha may increase testosterone levels, therefore, it should not be consumed by these patients. 31
  • Those who take benzodiazepines, barbiturates, or anticonvulsants: Ashwagandha may have a sedative effect, as well as effects on GABA, so it should not be used in these patients. 32
  • Pregnant women: Ashwagandha may induce abortion at higher doses. 33

Ashwagandha Side Effects

Ashwagandha has very few side effects when utilized in normal doses.  A study using Sprague-Dawley rats did show some sedation, ptosis and ataxia 15-20 minutes after administering Withania but this was a very large dose 1-2g/kg. 34

Michael Brown pictured with Final Thought written

Ashwaganda is one of the most prized herbs used in Ayurvedic medicine.  This herb contains many substances, including withanolides, which seem to be effective for a wide range of ailments. 

Ashwaganda has been shown to possess chemopreventive as well as chemotherapeutic properties.  Research is being done to assess its use for the prevention and treatment for certain types of cancer.  Ashwagandha has been used for thousands of years in India for its calming and anti-stress effects. 

There is also some evidence to suggest Ashwagandha can improve cognition, help with pain and inflammation and lower blood sugar levels.

This herb may also have a positive effect on certain neurogenerative diseases such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. 35I believe Ashwagandha is a valuable herb which will be more widely utilized as information from clinical trials becomes available.  

Please contact me with any questions.  This has been a complex subject to research and there is much more to learn.  It does give me hope for the future of cancer treatment in the United States.  As always, live a happy, healthy life and most of all, stay happy!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

Blissfulness – My Secrets To Happiness

Posted on by sunshineneutraceuticals

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Is there a secret to happiness?

Why am I always sad?

What can I do to improve my mood?

Is there hope for a happy tomorrow?

We all want to be happy. There is no emotion more sought after than happiness. It is surprising to me that, although we all want it, most of us do not take the time to research ways to obtain happiness. What if I told you it isn’t that hard to achieve? I am going to ask you to read this post, commit to trying some of the simple exercises outlined, and spend some time each day working on your happiness.   

 

I made happiness one of my New Year’s resolutions a few years back. I bought some books, read them, and tried to make Mike a happier person. It was well worth the effort. It has been life-changing for me.   

My goal is to make all of my readers happier and healthier. I hope you enjoy what you are about to learn. 

Practice Mindfulness

Start to be more conscious of your surroundings. Enjoy the beauty of nature and pay attention to the pleasant colors and smells you encounter during the day. Smile as you realize how blessed you are to be part of this gorgeous planet. Be aware of your surroundings without judging. 

 

Spend more time concentrating on the positive aspects of your day. Take a few minutes each day to focus on your breathing. Use this time to relax and relieve any stress you may be feeling. Be aware of your senses by watching a bird in flight, feeling the warmth of the sun on your face, tasting and appreciating fresh water.

 

Being mindful helps put things in perspective. It may help change the way you think. Make it a priority to practice this several times daily. Set the alarm on your phone to remind you. This is the first step to the new you! 

Re-Frame Perceived "Negative" Circumstances and Smile

Have you heard the quote 

 

“If it won’t matter in five years, don’t spend more than five minutes being upset about it”?

 

This little tidbit can save you from countless hours of frustration and decreased mood. There are many things beyond our control. I used to get very upset about traffic and, to be honest, still do at times. I have tried to start using this time in a positive way. 

 

You can, too, by listening to your favorite song or downloading some books to listen to. Always remember, things could be a lot worse. If you can turn negative situations into positive ones, happiness will be more plentiful in your life. 

 

If you have no control over what is happening to you, try to find a positive spin to it. This can take practice, but it can improve your level of happiness.  

 

Force yourself to smile in times of sadness. This helps in two different ways. First, your brain perceives you as being happy when you are smiling. Secondly, people who are around you will tend to smile back. This helps reinforce a positive mood. Try it, smiling works! 

Eat Whole Foods

The main thing I learned while on the Whole30 diet was that if you eat only whole foods, you will feel much better. Your diet has more to do with how you feel than you might think as it can affect your entire body in many ways. If you read my post on the Gut-Brain Axis, you already know how important this is. 

 

I am not advocating staying on a restricted diet such as the Whole30 forever, but try to consume more whole foods and less processed foods. Stay away from fast food, drink a lot of water, and try to get several servings of fruits and vegetables each day. A little planning goes a long way. 

  

You really are what you eat in more ways than one. If you want to know how much better you can feel, try the Whole30 diet. It is not easy but will give you an appreciation of how better eating choices can improve various aspects of your life. I highly recommend the Whole30 experience! 

Happiness Elements

I have written about happiness elements several times. We are all different. What makes me happy likely will not make you as happy.

 

I am going to give you a simple exercise. Take some time to think about the five things that make you the happiest. These can be people, places, activities, etc. Do not list material things on this list.

 

After you have identified your five happiness elements, devise a strategy to spend more time experiencing them. This one small activity can boost your mood. The more time you spend with the elements that make you happy, the better! This seems simple, but many of us don’t take advantage of it.

 

Most of us are happy spending time with the people and pets we love. Dogs, especially, will give you unconditional love. They can make a difference in your mood. I believe strongly in this process as it has helped me in my quest for happiness. 

Surround Yourself with Positive, Happy People

If you can avoid hanging out with pessimistic, negative people, do it. The negativity will rub off on you.

 

We have all worked with this type of person. Everything is terrible, complaints never stop, and they wear you down.

 

If you do have to work with this personality type, remind them that their life isn’t that bad. Better yet, if they are that unhappy, maybe they should be doing something else. Life is too short to be miserable.

 

Perhaps you can be the catalyst that makes them change for the better.

 

It is known that optimists are happier than pessimists. It is possible to change your mindset to become more optimistic. Optimists also live longer. Always try to find the positive aspects of a situation.

 

When you start feeling pessimistic, practice the mindfulness techniques described above. It takes some work, but you can make yourself happier! 

Start A Gratitude Journal

One of the best perks of working on a psychiatry unit is getting tips from therapists. These professionals are always able to come up with a solution to any problem you might be facing. I was recently reminded of the benefits of a gratitude journal. Just thinking about the things you are grateful for can change your mood.

 

Each night before bed, write a few things in your journal that you are thankful for. This is also a good thing to discuss at the dinner table. Go around the table and have each person talk about something they were grateful for that day. Concentrating on the positive aspects of your life is a great mood booster.   

Money Only Takes You So Far

Studies show that money only increases happiness until you reach about $75,000 per year. This is likely because once basic needs are met, material things only make people happy for a brief period.

 

Many individuals who win the lottery fall back to their baseline happiness level within five years.

 

Most people believe being rich will make them happy but the studies do not support this notion. Think about how you felt when you bought a new car. It feels great at first, but over time, it is just a car. Read this sentence carefully;

  

 Money does not make you happy! 

 

There is an exception to this. If you give money to an organization you believe in, this can make you happy. More money only increases happiness after a point if you give it away!

 

Do not be fooled by the marketing of the large companies brainwashing you into thinking you need “stuff” to make you happy. Possessions lead to clutter, which increases anxiety! 

Help Those less Fortunate

Early in my career, I worked as a nuclear pharmacist. Our boss liked to hire delivery drivers that were retired. One of these drivers was born with no legs so he used ones made of wood and got around the best he could.

 

One summer day after work, I was walking to my car and saw this driver laying on the ground trying to change a flat tire on his car. His hair was all messed up, and his face was sweaty and dirty. Even though I was in a hurry, I had to help. I changed the tire for him. He was delighted with the help and thanked me many times.

 

I remember how that small act of kindness made me feel great. There is something about helping others that makes me happy. 

 

I think this is the main reason I enjoy working in healthcare. Not a day goes by that I don’t feel like I helped someone less fortunate than I. You don’t have to work in a hospital to do this. Make it a point to help someone daily. Something small like giving them directions, buying them a cup of coffee, or just asking how their day is going can make a wonderful difference in both your lives.   

Find a Job You Love

We spend a lot of time working and if you hate your job, being happy is going to be difficult. Remember, money only takes you so far on the happiness scale.

 

I love being a pharmacist. It is mentally challenging, and I help people daily. I work with psychiatric patients who have a difficult life. Many have dementia and assisting this population makes me feel good. 

 

My wife loves to stay at home with our kids. She enjoys taking them to ballet, basketball, horseback riding, and whatever activities they choose to be involved in. She is much more social than I am and likes to visit with the other parents. She would not do well with my job, and I would not do well with hers. We are two different people who enjoy various activities.

 

Even if the pay isn’t as good, find a job that makes you feel good. If you think you need more money, revisit the section on money above! 

Love Yourself

We were all put on this earth for a reason.  Look in the mirror each morning, and appreciate what you have to offer.  Self-esteem is a big part of happiness.  Others like to be around positive, confidant people.  Tell yourself that today is going to be a great day and do everything you can to make that happen.  Remember, optimism is one of the keys to happiness.  You are an awesome person and deserve to be happy.  Keep telling yourself this.   

 

Exercise and Stay in Shape

Keep yourself physically fit. Find an exercise routine you enjoy and stay active. You may enjoy playing tennis or racquetball, swimming, weight lifting, running, or basketball.

 

Exercise will release endorphins, which will improve mood. Staying in shape also enhances your view of yourself. If you are unhappy with your body, you are unlikely to be happy in general. You don’t have to look like a supermodel, but being in shape makes you feel better and improves overall health.

 

If you pick a form of exercise you enjoy, you are more likely to stick with it.   

Unplug!

This is something I need to work on. If you can spend less time on electronic devices, and more time interacting with people in the old–fashioned way, you will likely be happier. Schedule some time each day to turn your cell phone, iPad, or tablet off and interact with your family and friends. Write a letter, read a book, exercise, take a walk. The world will still be there when you turn your phone back on. Many of us have become addicted to our electronics.   

Read My Anxiety Post

The last thing I am going to ask you to do is read my post on anxiety. Pay close attention to the section on thinking errors. This is one of the fastest, easiest ways to improve mood. Thinking errors will cause your mood to deteriorate. Once you learn how to detect thinking errors and practice dealing with them, you can train your mind to think differently. Follow the instructions in the anxiety post to train your brain to squash thinking errors. 

Michael Brown pictured with Final Thought written

Happiness is one of my favorite topics. I have spent many hours reading about it, talking about it, and trying different techniques to improve my mood. For me, spending some time alone, visiting the beach, and going to concerts are some of my happiness elements. Visiting the beach with my wife is my favorite.

 

I also enjoy spending time with my family, writing, playing music, and cooking. Helping people gives my life purpose. Caring for the poor and vulnerable is what I believe I was put on the earth to do.

 

I want to warn you that if you feel depressed often, don’t have energy, have problems sleeping or sleep too much, cry more than usual, or think about hurting yourself, you need to visit your physician.

 

Although this post is meant to help people live a happy life, depression is real and, at times, needs to be treated by a professional.

 

If you think you might be depressed, get help. Mood disorders are no different than any other disease. There are people who specialize in helping those who suffer from depression. 

Sign Up For Our Newsletter

Get up to date information on our company, coupon codes and discounts on our items.
CLICK HERE TO SIGN UP
Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

Probiotics Gut-Brain Axis and Psychiatry

Posted on by sunshineneutraceuticals

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Is it possible to treat mental health disorders by altering bacteria in the gut?

 

What is the Gut-Brain Axis?

 

Can the drugs we use to treat psychiatric disorders make patients worse by altering the bacteria living in the gut?

 

There have been many articles and studies published recently discussing the possible connection between the microflora of the gut and the progression of neuropsychiatric disorders. The bacteria in the gut are affected by many factors, including age, diet, exercise, health, and genetics. Medications can also alter gut bacteria. This post will explore the possible effects of the gut microbiome on various psychiatric disorders. 

 

The Gut-Brain Axis

The Gut-Brain Axis is a network of nerves, hormones, and immunological factors connecting the central nervous system (CNS) to the Gastrointestinal (GI) tract. It appears that the gut flora are involved in this system. An imbalance in the function and composition of these intestinal bacteria is associated with many disease states. 13

The microbes in the gut contain genes that perform metabolic functions. The metabolites resulting from these reactions can produce local effects in the GI environment or gut wall. These microbial metabolites may also be absorbed into the systemic circulation and exert their effects on other organs, including the brain.

It is now known that there is bidirectional communication between the gut and the brain. This communication network is known as the gut-brain axis. 33

Altered microflora of the gut has been associated with depression, other mood disorders, and neurodegenerative diseases. 36

37

 

38

It is known that patients with GI diseases often suffer from mental health issues. 39

40

 

41

 

42

We also know that approximately one-third of patients with irritable bowel syndrome (IBS) have depression. 43

In patients with functional gastrointestinal disorders (FGIDs), 36.5% have comorbid psychiatric disorders. The most common of these are general anxiety disorder and panic. 44

Effects of Medications on Gut Bacteria

Psychiatric medications are known to disrupt the microbiome of the gut. 45

Second-generation antipsychotics, such as olanzapine, change the balance of intestinal bacteria leading to obesity.

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may inhibit Staphylococcus and Enterococcus growth. 46

 

47

 

48

The Belgian Flemish Gut Flora Project found both benzodiazepines and antidepressants affected microbiology. 49

The classes of non-antibiotic drugs that have the highest antimicrobial activity are antidepressants, antipsychotics, and benzodiazepines. 50

 

51

 

52

 

53

The drugs we use to treat these psychiatric disorders may be making the conditions worse by altering the composition of the gut flora.

It may be possible to treat psychiatric disorders with living microorganisms. The goal would be to re-establish the healthy flora in the gut resulting in an improved gut-brain axis relationship. This is a difficult subject to study because once ingested; the living organisms are subjected to many negative environmental factors, including digestive enzymes, competitive microorganisms, and pH changes. Despite this difficulty, studies have been done, resulting in positive outcomes. 

Gut-Brain Axis and Autism Spectrum Disorders

Autism spectrum disorders are developmental disorders that affect communication and behavior. This is known as a spectrum disorder because there is a wide variety of symptoms involved. Patients with autism have a difficult time communicating, may not respond to their name, and often do not find enjoyment in activities others enjoy. They may also display repetitive, stereotyped behaviors.

The exact cause of autism is not known, but children with ASD often suffer from GI symptoms that correlate with the severity of their disorder. Several studies have reported altered gut bacteria in patients with autism.    

A treatment protocol using a fecal transplant was administered to 18 children with ASD (ages 7–16 years). The protocol started with two weeks of antibiotics, followed by a bowel cleanse. The children were then given an extended fecal microbiota transplant (FMT) using a high initial dose followed by daily maintenance doses for 7-8 weeks. 

At the end of treatment, there was an 80% reduction of GI symptoms, as measured by the Gastrointestinal Symptom Rating Scale. This included a significant decrease in abdominal pain, indigestion, diarrhea, and constipation. These improvements were still evident eight weeks after treatment. The behavioral symptoms also improved significantly and also remained eight weeks post-treatment. This procedure seemed to be effective for both ASD symptoms as well as GI symptoms and continued long after treatment was completed. 54

Gut-Brain Axis and Bipolar Disorder

One study showed that patients with bipolar mania were twice as likely to have taken a recent course of antibiotics. 55

It has been suggested that treating bipolar patients with probiotics could help reduce hospitalizations. A small study found treating acutely manic patients with probiotics led to a decrease in the readmission rate. Dr. Faith Dickerson randomized 66 patients to receive a probiotic capsule or placebo for six months after hospitalization for mania. The probiotic, or placebo, were given in addition to the regular medication regimens. Of these 66 patients, 24 or 73% required rehospitalization, while only eight (24%) of the probiotic group was hospitalized. The probiotic patients who were admitted also had a shorter hospital stay than those treated with a placebo.

The probiotics used in this study were Bifidobacterium lactis (bb-12), and Lactobacillus rhamnosus (LGG). These strains are also found in breast milk. 56 

 

 

Gut-Brain Axis and Major Depressive Disorder (MDD)

It has been shown that mice raised in a sterile environment (germ-free mice) have an exaggerated response to stress. This can be reversed by inoculating these mice with feces in their early development. 57

 

This suggests that gut microbial stimulation helps to shape healthy brain development during the early stages of life. 58

 

A review published in 2017 in the Annals of General Psychiatry concluded that treatment with probiotics might improve MDD symptoms. The mechanism is likely a combination of serotonin availability as well as decreased inflammation. More comprehensive studies need to be completed to determine the utility of such a treatment in depression. At the present time, there is likely no harm in supplementing antidepressant medications with probiotics. 59

Psychobiotics

Psychobiotics are substances that alter the bacteria of the gut. These may be live bacteria (probiotics) or prebiotics. Prebiotics are compounds that change bacterial composition or activity when fermented in the digestive tract. 60

In a study of 55 healthy volunteers, subjects received either fermented milk containing Lactobacillus casei Shirota, or a placebo for three weeks. The study subjects falling into the bottom third of mood scores showed significant improvement as compared to the placebo group. There were no overall changes in mood in this study, which may suggest Lactobacillus has a ceiling effect. In other words, people who are already relatively happy may not have an increase in mood after ingesting the probiotic. 61

It is important to note that not all studies have shown benefits regarding probiotics. A recent review found little evidence of positive outcomes from these substances. 62

 

Michael Brown pictured with Final Thought written

The Gut-Brain Axis is a fascinating topic that deserves much more research. I believe we can all benefit from eating a healthy diet, exercise, and possibly probiotic supplementation.

The evidence suggests that gut bacteria are vital in helping to develop the brain at a very early stage of human development. It is also evident that many of the medications we use to treat mood disorders such as depression, anxiety, and bipolar disorder, have an effect on the microbiome of the gut.

In the future, we may be able to either successfully treat these disorders with specific bacterial agents, or supplement the healthy flora destroyed by the medications we employ to treat these maladies.

I do know that I benefitted from eating a whole food diet during my Whole30 experience. My mood improved; I slept better and was more alert and happier in general. I can’t be sure this has anything to do with the microbiome in my gut, but it is certainly possible. I hope you have learned something from this post. If you have any questions, please feel free to reach out to me.

 

In the next post, I plan to write about happiness. This is something I have been looking forward to. I want to share my secrets for staying happy and improving your mood. I think you will all enjoy it.

 

Have a great day, and stay healthy!

 

 

Get Our Monthly Newsletter Sent to Your EMAIL Sign up Below

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

Electroconvulsive Shock Therapy Indications, History, Side Effects and More

Posted on by sunshineneutraceuticals

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Electroconvulsive therapy (ECT) is a medical treatment performed under anesthesia most commonly used for patients with treatment-resistant depression and catatonia. A generalized tonic-clonic seizure is induced utilizing a small electrical current applied to the head. This seizure lasts from 30-60 seconds. 

ECT is the most rapid and effective treatment available for geriatric patients with psychosis, depression, or bipolar disorder, according to research studies.44

Many believe ECT to be the most effective treatment for depression for all patients. 

This procedure has been a topic of controversy ever since Ken Kesey released “One Flew Over the Cuckoo’s Nest” in 1962. This book was made into a movie in 1975 starring Jack Nicholson and depicted ECT and lobotomies as a method of torture utilized in psychiatric hospitals. This did not sit well with the counterculture movement.

ECT is one of the safest procedures performed under general anesthesia, with only two to four deaths per 100,000 treatments. This is likely because ECT is a short procedure.

History of ECT

The first convulsive therapy was performed in Budapest in 1934 using pentylenetetrazole (Metrazol). Metrazol was used as a circulatory and respiratory stimulant but caused seizures in high doses. It was useful for depression as a convulsant, but side effects and uncontrolled seizures limited its use. 63

Ladislas Meduna gave an IM dose of camphor to a patient who had been in a catatonic stupor for four years in 1934. It is reported that two days after his fifth injection on February 10, 1934, the patient got out of bed, requested breakfast, got dressed, and began to talk. 64

A psychiatry professor, Dr. Ugo Cerletti, induced convulsions by applying electricity directly to the brain at the University of Rome in 1938. Dr. Cerletti achieved success with this method in patients with schizophrenia. 65

In 1938, Cerelli gave the first public presentation on ECT at the Medical Academy of Rome. By 1943, ECT was being used in America. Initially, it was used for schizophrenia, but over time ECT was utilized to treat most psychiatric disorders. After several years, ECT became a common treatment for depression with psychotic features as well as severe mania.

Antidepressants first began to appear in 1958 when an anti-tuberculosis drug, iproniazid (Marsilid), started to be used off-label for depression. This drug was eventually removed from the market due to safety concerns.

 In 1959 imipramine (Tofranil) was approved by the FDA for major depressive disorder (MDD). This was the first tricyclic antidepressant (TCA).

Although the psychiatric community had high hopes following the invention of the TCA’s, these drugs were not 100% effective, and they were associated with side effects. The use of ECT decreased by 46% between 1975-1980, but ECT began to increase in popularity during the 1980s. In the United States in 1980, 2.4% of all hospitalized psychiatric patients received ECT treatment. 66

ECT Safety

As discussed in the introduction, ECT is a safe procedure. Recent studies have suggested depression is associated with a loss of gray and white matter in different parts of the brain. This neurodegeneration is more prevalent in patients with a more extended history of depression, untreated depression, and a larger number of depressive episodes. This suggests rapid treatment of depression as achieved with ECT can reduce the risk of neuropathologic changes. 67

Postmortem studies of ECT patients who had the procedure done with modern techniques do not show brain damage resulting from the ECT itself. 68

ECT for Behavioral and Psychological Symptoms of Dementia (BPSD)

BPSD is a reality for most dementia patients and their families. This is a common reason for hospital admissions. Symptoms of BPSD include agitation, aggression, disinhibition, apathy, depression, sleep and appetite changes. 

There are no medications approved for dementia besides the anticholinesterase inhibitors and memantine. These drugs slow the progression of dementia but usually have little effect on BPSD. We use antipsychotics to treat these behaviors. Antipsychotic agents all have significant side effects associated with them and an FDA boxed warning for increased mortality risk in elderly patients.

A retrospective chart review of sixty elderly dementia patients with BPSD receiving ECT for agitation was published on September 23, 2019. They found ECT to be safe in their population and very effective in reducing agitation and decreasing the psychotropic pill burden as well. There are other hurdles one must consider when utilizing ECT for dementia patients. The largest is that of consent. Most dementia patients are not able to agree with an ECT procedure.

 

ECT for Catatonia

Catatonia is a condition in which the patient has a significant decrease in their reaction to the environment. Catatonic patients are often mute, appear to be in a stupor, and may demonstrate negativism or motor rigidity. 

The initial treatment for catatonia is benzodiazepines. Many catatonic patients initially respond to IV lorazepam. The conversion to oral lorazepam dosing can sometimes lead to rebound catatonia in which the IV form may need to be reintroduced, or the oral dose increased. 

If the patient does not respond to a benzodiazepine in 2 to 3 days, or if the symptoms are particularly malicious, ECT is the best treatment option. Electroconvulsive therapy works synergistically with benzodiazepines and is beneficial in up to 80% of patients. 69

ECT in Clozapine-Resistant Schizophrenia (CRS)

Clozapine remains the drug of choice for treatment-resistant schizophrenia. Because schizophrenia is a chronic debilitating disease, it is crucial to find effective treatment methods. Clozapine is superior to other antipsychotics with regards to improved social functioning, symptom improvement, and reduction of hospitalization and mortality. Unfortunately, clozapine does not work for every patient. In 2018, Wang et al. evaluated the safety and efficacy of using ECT in addition to clozapine in the treatment of CRS. This meta-analysis showed adding ECT to clozapine was superior to monotherapy. The main adverse effects suffered in these trials were memory impairment (24.2%) and headache (14.5%). These side effects were mostly mild and short-lived. 70

ECT VS. Antidepressant Medications

The FDA performed a systematic review and Meta-Analysis of randomized, controlled trials examining the effectiveness of ECT in 2011. They came to the following conclusions with regard to ECT and antidepressant medication.

  • Immediately to one-month post-ECT, there is conflicting evidence that ECT is more effective than antidepressant medications.
  • One-month post-ECT, conclusive evidence shows ECT to be more effective than antidepressant medication. 

 

ECT Delirium

There have been cases of delirium reported after ECT treatments. After medical causes are ruled out, delirium may be effectively managed by changing to unilateral ultra-brief pulse ECT with a greater interval between treatment sessions. 71

Lithium is one of our best treatments for bipolar disorder. It is often used for treatment-resistant major depressive disorder (MDD.) There are times when it is beneficial to use Lithium and ECT together as the combination of the two seems to be more effective than either treatment alone. A study published in August of 2019 found that patients treated with lithium and ECT during an inpatient stay had an 11.7 fold higher risk of delirium than those being treated with ECT alone. 72

Lithium should only be used in conjunction with ECT for severe cases or when the risk of suicide is high to prevent delirium.

ECT and Cognitive Function in Major Depression

A paper published in the Journal of Affective Disorders in 2019, discussed a prospective study following twenty-seven depressed patients before, and two years after ECT. The purpose was to measure remission rates as well as any cognitive changes that may be caused by ECT treatment. 

They found improved neurocognitive function two years after ECT regardless of remission status. The remission rate reached 62.9% at two years. The relapse rate was low; 22% relapsed before the six-week follow-up, and 7.4% between six months and two years after ECT. 73

Although the ECT methods were not uniform in this study, and the sample size was small, the results suggest ECT is beneficial in the treatment of depression without negatively affecting cognitive function.

ECT and Age

A study was done to compare various aspects of ECT on three different age groups:

Young (18-45 years)

Middle (46-64 years)

Old (>=65 years)

A total of 402 patients were evaluated the day before ECT and one-week after. 

One week after ECT, the middle and old age groups showed a significant improvement in the Mini-Mental State Examination (MMSE) score when compared to baseline. Rates of response were not statistically different in the three groups. There was also no difference in premature drop-out rates.

This study concluded ECT was a viable treatment for elderly patients with treatment-resistant depression. Rates of response were near 70%, and no life-threatening adverse events occurred. 74

ECT Contraindications

 

  • Elevated intracranial pressure.
  • Recent myocardial infarction.
  • Heart Failure.
  • Severe Hypertension.
  • Pheochromocytoma.
  • Risk of bleeding.
  • Unruptured aneurysm.
  • Recent stroke.

Side Effects of ECT

  • Memory loss
  • Confusion
  • Nausea
  • Headache
  • Muscle Pain
  • Complications from Anesthesia
Michael Brown pictured with Final Thought written

Electroconvulsive therapy can be a life-changing procedure for many patients. For those who do not experience relief from antidepressant medications, ECT can be their last hope. It is also useful in treatment-resistant catatonia, dementia with BPSD, and clozapine-resistant schizophrenia. 

This procedure has undergone many improvements over the years. No longer do patients have to worry about broken bones caused by seizures. Today, psychiatrists utilize neuromuscular blocking agents which confine seizure activity to the brain. 

The studies support the use of ECT. I have personally viewed several treatments during my Pharmacy Directorship at a private psychiatric hospital in the late 1990s. The procedure is quick, mild, and most adverse reactions are the result of anesthesia. More importantly, ECT is an effective treatment for a vulnerable segment of our population.

As a society, it is our responsibility to take care of our mentally ill population. We should not have these patients living in tents on the side of the road in our major cities. Psychiatric patients are people like us who have a brain disorder. Remember, this can happen to anyone. Electroconvulsive therapy is not a punishment for bad behavior. It is an effective treatment for several debilitating conditions that are resistant to other, less invasive therapies.

If you have any questions or concerns, feel free to contact me. I will answer every message received.

Always strive to live a happy, healthy life.

Sign Up For Our Newsletter

Get up to date information on our company, coupon codes and discounts on our items.
CLICK HERE TO SIGN UP
Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

My Whole30 Summary

Posted on by sunshineneutraceuticals

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

What is the Whole30?
Should I try it?
Is it hard?
Will I lose weight?

Here is my Whole30 summary

 

I discovered the Whole30 while researching the best body detox plans for a recent blog post I was writing. I don’t like to make recommendations to my audience that I am not willing to try myself. That being said, I started the thirty-day program on October 15th, 2019. I was well aware that Halloween would be a bummer (no candy), but I wanted to do this. I set up a Google Doc on my phone and kept notes of what I ate and how I felt during the program. My starting weight was 188 pounds.

What is the Whole30

The Whole30 was created in 2009 by Melissa Hartwig. This is not a diet or a test of willpower, it’s a program designed to change the way you think about food. The basic premise is simple; some foods are not good for your body. Of course, many of these are the foods we crave the most. Eliminating all the “unhealthy” foods removes toxins from your body. Saying goodbye to the “sugar monster” is difficult at first, but as you will see, changes the way you feel. No fast food, no added sugar or sugar substitutes, and no cheese! This program changed the way I plan to eat going forward.


I have to admit I was skeptical.


What you will read in this post is what I went through during the thirty days. Some days were difficult. There was bickering at the dinner table. The kids missed “their food”. Don’t send me messages about child abuse, I did not make them stick to the program, but I didn’t make fancy Mexican and Italian dishes, either. Ashley looked at me one night and said, “I just want my food back”. These kids are not fans of fast food or restaurants, except sushi. They love daddy’s cooking.

Whole30 Rules

The rules seem very simple at first. The problem is there are almost no processed foods that don’t contain an ingredient you can’t have. You are much better off only eating fresh organic food. Fruits and vegetables will become your best friend. Here are the rules:

  • No added sugar or sugar substitutes of any kind. This includes honey and agave nectar.
  • No alcohol! This was the most natural rule for me.
  • No grains. No wheat, corn, rice, barley, oats, millet, quinoa, etc. This covers a lot of foods. I suggest referring to the Whole30 book for a complete list.
  • No Legumes. No beans, peas, chickpeas, lentils, or peanuts. That means no peanut butter. You can easily substitute almond butter or cashew butter — no soy of any kind or tofu, edamame, or tempeh. Soy sneaks into products almost as often as added sugar. Learn to read the labels.
  • No dairy. Another crushing blow to me. No cheese, milk, cream cheese, or sour cream. You can eat clarified butter, but I skipped it. I used olive oil and coconut oil for all of my cooking, a change I plan to continue.
  • No carrageenan, MSG, or added sulfites. Careful with dried fruits and sausage, be sure there are no sulfites added.
  • No junk foods or baked goods made with improved ingredients. This means you can’t make pancakes out of coconut flour. I will give you some suggestions for sweet snacks later in the post.
  • Do not weigh or measure yourself in any way during the program. Just before and after. This is to keep you from concentrating on your weight and missing other benefits.

Preparing for the Whole30

I am going to stress this step. Be sure you have an adequate supply of “Whole30 compliant” food in your house before you start. Do not try to wing it! I suggest stocking up on fresh fruits and vegetables, almonds, cashews, eggs, and other sources of protein. If you are vegan, you are in good shape, remember, no grains. There are a few bars you can use that I will get to later.

If you don’t prepare, you probably will fail.

One of the things we ate several times is various forms of curry. This is ideal because not only can you change up the vegetables, the turmeric in the curry is very good for your body. I suggest stocking up on curry powder.

Be ready to spend more time cooking and preparing meals. There are no drive-throughs in this plan. Give yourself an hour for dinner preparation each night. I will share ideas for meals later. My plan was to eat simple things during the day and make a healthy dinner at night.

Restaurants and the Whole30

My suggestion is to plan to stay away from restaurants for thirty days. We went out once, and it was extremely frustrating. There was almost nothing on the menu that fit the plan. It was a horrible experience and, if I do this again, I will prepare every meal myself. I am not a huge fan of restaurants anyway, so this isn’t a significant loss for me.

Whole30 Compliant Snack Bars

There are a few snack bars that are Whole30 compliant and I have listed a few here.  The most inexpensive ones I was able to find are pictured above.  Please note that all Larabars are not Whole30 compliant.  The ones listed above are fine but please read ingredients on anything processed prior to eating.

Some of the EPIC bars such as the one pictured are also Whole30 compliant.  Just a warning, this chicken one is spicy!  Be sure to check all labels because some I found had added sugar.

RX bars are also mostly compliant.  I would not suggest eating any of these bars often.  Just keep them on hand for emergency use.  It is much better to always eat whole foods.

My Experience with the Whole30

My starting weight was 188 pounds on 10/15/19. The first day was excellent. In the morning, I had black coffee only. For lunch, I had cherry tomatoes, blackberries, and raspberries. This was my pattern, although some days, I added almonds or cashews and turkey or tuna to lunch. I skipped breakfast almost every day, which is typical for me. The first night I made chicken primavera from the Whole30 book for dinner.

Day two, I was tired and hungry. I made a spinach frittata for dinner. I am not a fan of eggs, but it was pretty good.

Day three was a good day. I had a false sense that the hard part was over, but I was very wrong. Spaghetti squash with marinara sauce, steamed broccoli, and chicken Italian from 365 was dinner.

Day four, I was sluggish in the AM, but the day got better.

On day five, Luke Combs came to Portland, and Cathy and I went to see him. It was a great concert, and I didn’t think much about food. I made pork meatballs and sweet potatoes with bell peppers, zucchini, and tomatoes in a red curry sauce.

Day six was the WORST day of all, especially in the evening. I ate a lot of food but I felt like my energy was depleted. I wasn’t sure if I could make it. Looking back, I’m glad I pushed through. I worked the evening shift and didn’t get home until after midnight.

Day seven, I slept until 10 am.  I had two poached eggs and stuffed peppers before leaving for work. The worst was over!

Day eight, even with five hours of sleep, I felt amazing all day. I had read about it, but guess what happened next?

Tiger blood

The Whole30 book says this should happen from day 16 to 27 but it occurred for me on day 9. I can’t explain this feeling, but it is terrific. I felt better than I have in years. I attribute it to being detoxed off of all the crap I had been eating. I won’t bore you with all the details of the rest of the days, but they all went pretty well. I did get a little tired of the same food towards the end. In the last couple of days, I wanted to change up the diet a little.

We had curry in one form or another nine different nights. I had it leftover at least twice. I would say one of the main things I learned is that curry is excellent and healthy.

Michael Brown pictured with Final Thought written

I woke up at 2 am on day 31 and weighed myself. I was down to 175.8 pounds, so in 30 days, I lost 12.2 pounds.

I am not sure if I would do this again, but it wasn’t terrible, especially after day six. I did feel great during the last couple of weeks.

My wife also lost weight but struggled at times to find compliant food to eat when I wasn’t around.  Her skin improved, and she experienced no migraine headaches during the thirty days.  

Cathy brought home a pizza for the kids on day 15. This was probably the hardest thing to ignore because it smelled delicious plus I was hungry. I had a few days that I had to pass on Krispy Kreme donuts and candy, as well. I thought I would miss Diet Coke more than I did, but I guess I missed Mexican and Italian food much more.

Here is what I plan to change as a result of this experience; I will continue to drink my coffee black and cut back on soda, I want to continue the habit of drinking a lot of water daily, and fresh fruit and vegetables will always be available. I plan to snack on them often. I will keep monitoring my weight and try to stay where I am currently.

If you are interested in what I ate the other days, feel free to send me a message. I kept track of my meals, so I’d be glad to share that with you. If you have any questions regarding my experience, feel free to ask.

I am creating a diet of my own that I will share will you in the next few months.  One of the new products I have enjoyed is available below.  Give it a try.  Who doesn’t like pizza?  This crust eliminates unnecessary carbs!

I am creating a diet of my own that I will share will you in the next few months.  One of the new products I have enjoyed is available below.  Give it a try.  Who doesn’t like pizza?  This crust eliminates unnecessary carbs!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

Ethanolism – Why You Shouldn’t Drink Alcohol

Posted on by sunshineneutraceuticals

I enjoy a few drinks with friends.

I deserve a drink to calm down after a hard day at work.

Everybody drinks, right?

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

I started Sunshine Nutraceuticals in July of 2019. My goal has always been to help my readers live a happy, healthy, healing lifestyle.

I know a lot, if not most, of my readers, drink alcohol.

Ethanolism – Why You Shouldn’t Drink Alcohol is not about judgment. It is not about right or wrong. This post is meant to give my readers the facts about alcohol. The first fact, and likely the most important is this:

Ethanol is a neurotoxin

 What this means is when you drink alcohol, you are consuming poison.

Is it worth it?

Like most of you reading this, I used to drink alcohol. When my second youngest child was born, I decided to stop. Not because I had to, but because I wanted to be more productive and was sick and tired of wasting money on alcohol. I wanted my kids to grow up in a home without alcohol.

My life today without ethanol is much better. I am in good shape, I think more clearly, my anxiety level has decreased, and I am saving money. 

I have seen hundreds of patients admitted to the hospital because of alcohol intoxication. The nurses in ICU will tell you these are some of the most challenging patients to manage. Alcohol withdrawal is no joke. It can kill you!

I have watched people die of liver failure due to ethanol. This is not a good way to go. Remember, your liver is the primary organ responsible for removing toxins from your body. Imagine living your final days with a body full of byproducts. We have dialysis to help with kidney disease, but if your liver fails, there isn’t much that can be done.

If you want to be healthy, ethanol will not help you achieve the goal.   

Sobering Statistics

It is estimated that 88,000 people die from alcohol-related causes each year.  75

This ranks third as the most preventable cause of death in the United States behind tobacco,  poor diet and physical inactivity. 76

In 2014, thirty-one percent of all driving fatalities (9,967 deaths), were attributed to alcohol impairment. 77

In 2017, 26.4 percent of people over eighteen years of age reported binge drinking and 6.7 percent reported heavy alcohol use in the past month:

Binge drinking: a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. 78

Heavy alcohol use: Binge drinking on 5 or more days in the past month.

Alcohol Use Disorder (AUD) in the United States: According to the 2017 National Survey on Drug Use and Health (NSDUH), 14.1 million adults ages 18 years and older have AUD. 79

Alcohol Use Disorder (AUD): AUD is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild to severe, and recovery is possible regardless of severity. The fourth edition of the Diagnostic and Statistical Manual (DSM–IV), published by the American Psychiatric Association, described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each. The fifth edition, DSM–5, integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder, or AUD, with mild, moderate, and severe subclassifications. 80

Over ten percent of children in the United States live with a parent with alcohol problems, according to a study published in 2012. 81

Drinking alcohol increases the risk of contracting the following types of cancers:

  • Mouth
  • Esophageal
  • Pharynx
  • Larynx
  • Liver
  • Breast 

82

Why Do People Drink Ethanol?

We will now explore the reasons people drink alcohol. Again, no judgment here. I am merely pointing out why you might drink.

Alcohol Gives Me Confidence and Helps With Socialization at Parties.

What alcohol does is dull your sense of apprehension along with other mental capabilities. Our bodies have a method to combat fear, known as the “fight or flight” response. This is the body’s way of protecting us from dangerous situations. Alcohol has a depressant effect on the brain and suppresses this response.

When our “fight or flight” system is diminished or absent, it makes us vulnerable to dangerous situations. If there is a danger, we are less likely to notice and certainly not as able to respond to it. What do we call people who are drunk? Hammered, wasted, tanked, tipsy, plastered. These words describe someone who can quickly be taken advantage of or hurt. This world is full of individuals that can’t wait to take advantage of someone in a vulnerable state. 

As far as confidence goes, I would much rather spend time with a shy person than someone who is drunk and talks nonstop. Drinking to gain confidence can easily backfire, turning the person into a fool. You are much more likely to develop strong friendships if you appear as you are rather than who you are when drunk. 

Intoxicated people also have diminished impulse control. I explain this to my students in the following way:

Suppose someone has just made you very angry. You don’t like this person and think about punching them in the face. 

Most of us would not punch them. We know there are consequences to such actions. This is an example of impulse control. We stop ourselves from doing something that will undoubtedly have negative consequences. Alcohol removes some of this control. Remember, alcohol deadens all senses, good and bad. 

Why do you suppose there are so many fights in bars? 

Alcohol does not give you any special powers, and it takes away your body’s inherent protective mechanisms.

Another thing to consider is the fact that you have to get home from that party! 

Do you have a designated driver? 

How many times have you driven when you have had too many drinks?

I don’t have to tell you what happens if you get pulled over by the police on the way home.

The least you will lose is a night of freedom and a big pile of money. You could also lose your job or even your career in some cases.

Is it really worth it?

Drinking Alcohol Relaxes Me, and I Deserve That After a Rough Day at Work!

Does alcohol relax us? 

What is it doing? 

The truth is alcohol doesn’t remove stress at all. It merely enables us to ignore our body’s innate warning system. If we are genuinely “stressed,” maybe we are trying to accomplish too much. Our body is telling us to slow down.

In fact, alcohol is very good at causing stress. 

What happens when the alcohol wears off? 

We feel anxious. Most of us want more. 

Wanting more causes stress that is only relieved when we continue to drink. The next drink does induce some relaxation, but this is only due to decreasing the withdrawal symptoms caused by alcohol leaving our body.

What will happen is the more you drink, the more stress you will invite into your life. Secondly, any problems you were attempting to forget will still be there when the alcohol wears off.

Finally, if you end up drinking too much to relax, your next day will likely be worse.

Alcohol helps Me Sleep

Not a chance. It might make you think you are sleeping better, but the sleep quality is reduced. 

Ethanol is a typical “over-the-counter” sleep aid. It increases the quality and quantity of NREM sleep during the first half of the night in non-alcoholics, but REM sleep is disrupted later. The REM stage is where we dream and is considered a restful period as our muscle tone is decreased. Do not use alcohol as a sleep aid! There are many other products that work much better with fewer side effects.

Sleep quality in alcoholics is even worse. During drinking periods as well as abstinence, altered sleep architecture leads to profound insomnia and daytime sleepiness. 83 

Alcohol and Dementia Risk

As a Clinical Pharmacy Specialist in Psychiatry, I see the consequences of substance abuse often. This is one of the subjects I am most interested in and will be writing about regularly — the unit where I currently practice has geriatric psychiatric patients. 

A large percentage of these have dementia. There are four basic types of dementia. Alzheimer’s disease, Lewy body dementia, vascular dementia and frontal-temporal lobe dementia.  

We know that chronic alcohol use can lead to dementia. 

Vascular dementia occurs as a result of a stroke. Long-term ethanol use increases blood pressure, increasing stroke risk. Alcohol consumption also increases the risk of developing type II diabetes, obesity, and atrial fibrillation. All of these increase the risk of stroke.

Alcohol abuse has also been associated with Alzheimer’s dementia:

“Research from the University of Illinois at Chicago has found that some of the genes affected by alcohol and inflammation are also implicated in processes that clear amyloid beta — the protein that forms globs of plaques in the brain and which contributes to neuronal damage and the cognitive impairment associated with Alzheimer’s disease.” 84 

Alcohol is bad for the brain. I want nothing to do with any avoidable habit that may lead to dementia.

What Alcohol is Doing to Your Body

Ethanol has an effect on every organ in the body. 

Take a look at this short youtube video on how drinking negatively affects the body:

https://www.youtube.com/watch?v=V2Aj-iJ6p38

 

Life Without Ethanol

Here are a few positive benefits of an ethanol-free life. Some of these have already been described earlier but will be repeated for emphasis.

  • Fewer calories consumed, which may lead to weight loss: It is no secret that alcoholic drinks contain empty calories. Drinking too much can derail any diet plan.
  • Better sleep quality: As mentioned above, ethanol disrupts REM sleep. This often leads to daytime sleepiness. If you combine this with a hangover, it leads to an awful day! 
  • More money to do the things you enjoy: Drinking is expensive, especially if you go to a bar. I once worked with a psychiatrist who told his patients to take half of the money they spent on their addictive substance (alcohol in this case), and spend it on something they enjoyed.
  • Improved interpersonal communication with family, friends, and colleagues: Nobody wants to be around someone who drinks too much. 

 

Michael Brown pictured with Final Thought written

Alcoholism is a significant problem in the United States. This disease leads to lost productivity, broken families, increased medical costs, and unnecessary pain and suffering. People have lost jobs, been involved in accidents, and gone through a painful divorce because of alcohol abuse.

Many drink booze to “have fun.” Is this making the situation more fun? Maybe you are having a good time because you are surrounded by people you like? Why not try to live without alcohol and see how you feel?

Ethanol does not make you sleep better. It changes your sleep patterns and robs your brain of restful REM sleep.

Think about the positives and negatives of drinking alcohol. If you think about it, drinking poison doesn’t make sense. Take it from someone who has eliminated it. You will feel better!

 It is possible to stop drinking. If you have a problem with alcohol, the most critical thing you can do is get help. Being healthy feels much better than being addicted to ethanol. Click on the following link for more information.

https://www.alcoholrehabguide.org/treatment/

This one-click may be the beginning of the healthiest thing you can do for your body! 

Don’t be shy.

You are in control of your life. 

You are responsible for your happiness, and only you can decide what goes into your body.

Eat right, exercise, get plenty of sleep, and do the things that make you happy!!

Sign Up For Our Newsletter

Get up to date information on our company as well as coupon codes for discounts on our items.
I Want The Newsletter
Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

Turmeric with Bioperine Benefits

Posted on by sunshineneutraceuticals

 

Should I take a turmeric supplement?

What is turmeric good for?

Is it safe?

What is Bioperine?

Turmeric is a spice many of us use in cooking. It is one of the main ingredients in curry powder. It has a yellow color and is also used as a coloring agent for foods and cosmetics. Turmeric is a plant related to ginger that is grown in Central America, Asia, and India. The rhizomes of this plant are dried and used as dietary supplements for a variety of health conditions.

This plant has been used in Indian and Asian medicine for thousands of years.

Turmeric may be the most effective nutritional supplement available today. The active component of this plant is curcumin. The polyphenol known as curcumin has been widely studied for many health-related benefits. Some of these include inflammation, arthritis, obesity, liver disease, and several types of cancer. It is thought that most of the positive benefits of curcumin are the result of its anti-inflammatory and antioxidant effects.

 

In this post, several health benefits of turmeric are explored. I have started taking this supplement as my father died from cancer and had two different types of cancer during his lifetime. I also have occasional back pain, which seems to respond to this supplement. Only you can determine if this supplement is for you. 

 

 

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Turmeric (Curcumin) for Various Types of Cancer

Probably the most exciting action of curcumin is its effects on various types of cancers. Cancer is the second leading cause of death worldwide. Although the therapy of cancer has progressed, mortality remains high. Many studies have been published on turmeric (curcumin) in the treatment of different types of cancer

 

 

Turmeric (Curcumin) and Breast Cancer

Breast cancer is the leading cause of death among all cancers in women throughout the world.

  85 

The most effective treatment for breast cancer is early detection. Treatment is much more effective if the cancer is discovered in its early stages.

Traditionally, antiestrogen medications have been used for the treatment of breast cancer as more than seventy percent of these are of the estrogen receptor (ER) positive type. It is now known that combination treatment using various medications, surgery, and chemotherapy is the most effective treatment for this cancer type.

The effects of turmeric (curcumin) on breast cancer cells is complicated. Below are just some of the mechanisms thought to fight this deadly malady.

There is a proinflammatory transcription factor (NF-KB) that controls the genes that regulate proteins resulting in inflammation and the development of cancers. 

Curcumin has been shown to decrease the effect of NF-KB, leading to its possible use in breast cancer.

86   87 

Curcumin may also inhibit human epidermal growth factor receptor 2 (HER2-TK) alone or in combination with its analogs.

 88 

 HER2-TK is a tyrosine kinase receptor. The overexpression of HER2-TK is associated with the progression of many cancer cell types.

 89 

Epidermal growth factor receptor (EGFR) is associated with the development of cancer cells.

 90   91 

 Curcumin inhibits the growth and spread of breast cancer cells by decreasing EGFR signaling.

 92   93 

Curcumin can exert its positive anti-cancer effects on both estrogen-dependent as well as non-estrogen dependent breast cancer cells.

94 

 

Turmeric for Prostate Cancer

Prostate cancer is the second leading cause of death from cancer in men. 95

Curcumin has been shown to kill cancer cells and inhibit cancer cell proliferation both in the laboratory and in human subjects. 96

This is achieved by interfering with many cellular pathways including mitogen-activated protein kinase (MAPK), EGFR, and nuclear factor k (NFkB). 97  98

Curcumin has also been shown to activate protein kinase D1 (PKD1), which attenuates the oncogenic signaling by beta-catenin and MAPK. 

This leads to the inhibition of prostate cancer. 99

Turmeric for Colorectal Cancer

The third leading cause of cancer death in men is due to colorectal cancer. 100 

This cancer is removed surgically, and often radiation therapy is prescribed, but over fifty percent relapse. 101

One of the markers for colorectal cancer is prostaglandin E2 (PGE2). PGE2 is a bioactive lipid that causes a wide variety of biological effects associated with inflammation and cancer.  

A study was conducted on fifteen patients with treatment-resistant adenocarcinoma of the colon or rectum. Subjects received between 0.45 and 3.6 g oral curcumin daily for up to four months.

Intact curcumin and its metabolites were found in the plasma at a concentration of 10 nmol/L and also in the urine.

It was found that the 3.6 g curcumin daily dose led to 62% and 57% reductions in PGE2 levels one hour after administration on days 1 and 29.

This has led to a dosage recommendation of 3.6 g curcumin by mouth daily. 102

 

 

Turmeric for the Prevention and Treatment of Alzheimer’s Disease

Alzheimer’s Disease (AD) is the most common cause of dementia. Currently, we only have medications available to slow the progression of this disease.  

Can turmeric help to prevent AD? 

We know that curcumin has many properties that may help prevent the development of Alzheimer’s disease. These include antioxidant, anti-inflammatory, anti-amyloid, and anti-tau actions that may be neuroprotective. 103  104

It is also known that populations that consume curry have a lower incidence of AD, and older people in this group have better cognitive function. 105

A study of 1010 sixty to ninety-year old’s who were occasional or frequent curry consumers found this population had significantly higher Mini-Mental State Examination (MMSE) scores compared to those who either didn’t eat curry or only consumed it rarely. 106 

Animal studies have also shown that curcumin can improve tasks requiring memory and reverse stress-induced reductions in the production of neurons associated with the brain-derived neurotropic factor (BDNF). 107

An article was published in the American Journal of Geriatric Psychiatry in January of 2018, looking at the effects of curcumin on memory in people without dementia. This study, conducted at UCLA, also explored the effect of curcumin on the plaques and tangles in Alzheimer’s patients. 

This was a double-blind, placebo-controlled study of forty adults between 50-90 years of age with mild memory complaints.

Study participants either received 90 mg curcumin or placebo twice daily for eighteen months. All were given cognitive assessments at the beginning of the study and every six months. 

Curcumin blood levels were obtained at the beginning and end of the study. 

Subjects who received curcumin realized a significant improvement in memory and attention. 

The placebo group did not show significant improvement in either. 

The curcumin group improved their memory scores by 28% over the 18-month period. This group also showed less amyloid and tau plaques in the hypothalamus and amygdala regions of the brain than the placebo group.

This research group is planning a follow-up study with a higher number of subjects. Antidepressant effects of curcumin will also be explored in their future study.

Turmeric for Type 2 Diabetes

There have been several studies evaluating the use of curcumin in the treatment of diabetes. 

A 36-week study followed 240 pre-diabetic patients in 2012. The subjects were split into two groups. One group received 1500 mg curcumin daily while the other group received a placebo. At the end of the study, 16.4% of the placebo group developed T2DM, while no patients in the curcumin group developed diabetes.  108 

A study published in 2008 compared curcumin to atorvastatin (Lipitor) in T2DM patients. In this trial, patients received either 300 mg curcumin supplements daily, 10 mg atorvastatin daily, or a daily placebo. 

The curcumin and atorvastatin group showed significant improvement in endothelial function and also a significant decrease in IL-6, TNF-alpha, ET-1, and malondialdehyde. 

These results suggest curcumin has a positive effect on reducing inflammation and oxidative stress similar to that of the prescription medication atorvastatin. 109

Turmeric for Heart Disease

The number one cause of death worldwide is heart disease, according to the World Health Organization. There are several risk factors that increase the chances of having a heart attack. Some are modifiable, while others are not. Some of the most prominent risk factors, according to the CDC are:

  • High blood pressure (HBP): HBP is a significant risk factor for heart disease. On my unit, pharmacists check blood pressure on each patient daily. A blood pressure that is too high affects not only the heart but also the kidneys and brain. HBP is sometimes called the “silent killer” because patients typically do not feel different. Medications, exercise, avoiding alcohol, and smoking are some methods to help decrease blood pressure.
  • High Cholesterol: This substance is made by our liver in sufficient quantities to fulfill our body’s needs. Unfortunately, poor diet leads to a build-up in the walls of the arteries.  There are different types of cholesterol. The low-density type (LDL) is considered “bad” because it can lead to heart disease.  The high-density type (HDL) is “good” because it provides protection from heart disease.  Changing your diet to include more fresh fruits and vegetables, olive oil, nuts, and lean protein can help improve your HDL/LDL ratio. There are also medications available to decrease LDL levels. If you don’t know these “numbers,” please visit your doctor for a blood test. It may save your life.
  • Diabetes: The risk of heart disease is higher in patients with diabetes. 110This disease causes an increased level of sugar in the blood.
  • Obesity: Excess body fat usually occurs with high LDL cholesterol and triglycerides and lower HDL cholesterol levels. Obesity increases the risks of HBP and diabetes. The best way to combat obesity is with diet and exercise. Always visit your physician before starting a new exercise program.

A study utilizing rats conducted in 2012, found curcumin improved cardiac repair and function after reversible cardiac ischemia. Left ventricle dilation was reduced, and wall thickness increased. This led to the conclusion that curcumin may be useful in the treatment of heart failure caused by ischemia. 111

In 2014, a study performed by Cheungsarman et al. found curcumin showed an improvement in inflammatory and metabolic profiles as well as a significant positive impact on an atherosclerosis marker. 112

Curcumin has been shown to improve disrupted cardiac function caused by cardiac fibrosis using various molecular mechanisms. 113

Turmeric for Osteoarthritis

Osteoarthritis is the most common form of arthritis. This condition affects millions of people worldwide. The joints most affected are in the spine, hips, knees, and hands. Pain and swelling are caused when the cartilage in the joints that cushions the ends of the bones wear out.

The best initial treatment for osteoarthritis is exercise. Medications such as NSAIDs can also be utilized, but they cause some significant side effects, especially if used long-term. 

Since it is known that curcumin has anti-inflammatory properties, its use in this disease process has been studied.

A review article published in May of 2019 evaluated curcumin in the treatment of autoimmune and rheumatic diseases. 

Of the sixteen articles reviewed on osteoarthritis treatment with curcumin, fourteen reported significant improvements in several disease patterns. All studies were randomized, placebo-controlled trials. 114

Curcumin utilized in these studies was most commonly isolated from turmeric rhizomes. The average curcumin dosage reported in the clinically effective studies was 834.29 mg daily. 

Clinical outcomes were measured in most of these studies using:

  • Walking distance. 
  • Lequesne’s pain functional index (LPFI). 
  • Knee injury Osteoarthritis Outcome Score (KOOS).
  • Clinical Global Impression Scale (CGI).
  • visual analog scale (VAS).
  • Karnofsky performance scale.

In thirteen of these studies, dietary intake of curcumin resulted in improvement of at least two clinical measures, 115  116  117  118  119  120  121  122  123  124  125  126  127

While seven studies showed improvement in at least three. 128  129  130  131  132 133 134  

The two clinical outcomes which increased most commonly were walking distance and decreased WOMAC scores.

There have also been studies conducted comparing the effectiveness of curcumin versus NSAIDs in the treatment of osteoarthritis. 

A study in 2014 compared curcumin to ibuprofen. A total of 367 patients with arthritis of the knee were divided into two groups. 

The Ibuprofen group received 1200mg Ibuprofen daily, while 1500mg curcumin daily was administered to the other group. Treatment lasted four weeks. Both groups showed significant improvement in WOMAC pain and function scores, and the ibuprofen group had more complaints of abdominal pain.  135

A similar study was conducted in 2009. Patients received either 800mg ibuprofen daily or 2 grams curcumin extract daily for six weeks. No difference in adverse effects between the two groups was found, and there were no differences in outcomes except for pain on stairs. 136

Turmeric for Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory bowel disease that causes the formation of ulcers and inflammation in the digestive tract. This disease affects the inner lining of the colon and rectum. Since we know curcumin is useful in the treatment of inflammation, it is expected that this substance would have a positive impact on UC.

The symptoms of UC are diarrhea, abdominal pain, fever, weight loss, fatigue, and rectal pain and bleeding.

If the bleeding becomes severe, this disease can lead to death.

There have been positive and negative studies regarding the use of curcumin in the treatment of UC. 

A study in 2017 by Kedia et al. found no difference in patients receiving 450 mg daily of curcumin and placebo in inducing remission in patients with mild to moderate UC. 

This study spanned eight weeks and found no benefit of curcumin for clinical remission rates, clinical response, or mucosal healing when compared to placebo. It should be noted that the dosage of curcumin was low in this study. 137 

By contrast, a 2015 study by Lang et al. found that UC patients who received 3000 mg curcumin daily for one month, along with mesalamine, saw significant improvement in clinical response, endoscopic remission, and rate of clinical remission as compared to a mesalamine-placebo group. 138 

Another randomized, double-blind study of eighty-nine patients with UC was conducted in 2006. Forty-five subjects received curcumin 1000 mg twice daily, plus sulfasalazine (SZ) or mesalamine. The placebo group consisted of forty-four patients who received a placebo plus SZ or mesalamine. 

The results showed only 4.65% of the curcumin group relapsed, whereas 20.51% of the placebo group relapsed during the study.

A six-month follow-up was performed on both groups who were taking either SZ or mesalamine. Eight addition patients in the curcumin group and six patients in the placebo group relapsed. 139 

Safety

The US Food and Drug Administration considers curcumin to be “generally recognized as safe.”  140 

Turmeric should not be used by women who are pregnant or lactating.  It possesses some uterine stimulant effects.  It should also be avoided in people with gall stones or bile duct obstruction. 141 

Side Effects of Turmeric (Curcumin)

Turmeric is generally well tolerated. I have been taking my Turmeric with Bioperine supplement daily for about one month with no noticeable adverse effects. The side effects reported in several clinical trials were mild. Below is a list in decreasing frequency of side effects that may result:

  • Mild gastrointestinal symptoms (dyspepsia, Bloating, GERD)
  • Nausea and vomiting
  • Edema
  • Loose stools
  • Constipation
  • Increased stool frequency
  • Hot flashes

These effects were not statistically different than those of the placebo groups. 142 

Turmeric Drug Interactions

The drug interactions to be aware of all regard the risk of bleeding.  Caution should be exercised when using tumeric with the following drug classes:

  • Anticoagulant/Antiplatelet Agents:  
  • NSAID’s
  • Salicyclates
  • Thrombolytic Agents

143 

Bioavailability Boost

The substance known as piperine is a major component of black pepper. Piperine is marketed under the trade name Bioperine and is added to some turmeric supplements to increase the bioavailability of curcumin. This substance has been shown to increase bioavailability by 2000%.  144 

Michael Brown pictured with Final Thought written

I am very excited about the information I have learned while researching turmeric. It can be consumed in foods and has been used as a medicine in different parts of the world for centuries.

I have been taking this supplement for about a month with absolutely no side effects.

Our family has also been eating curry several times per week. This is an easy way to decrease the odds of contracting cancer or dementia. Working on a unit with dementia patients has taught me I don’t want to burden my family with this disease.

The curcumin in turmeric also helps reduce inflammation, which helps with my back pain.

I firmly believe this is the most versatile supplement available in my store.

I hope you have enjoyed reading this post. Remember to eat a healthy diet, exercise, get plenty of sleep, and spend as much time with your happiness elements as possible.

Please send me a message if you have any topics you would like for me to cover in my blog.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube

Migraine Abortive Treatment Guidelines and Prevention of Migraine Headache

Posted on by sunshineneutraceuticals

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

A migraine is a severe headache, often accompanied by nausea, vomiting, and light sensitivity. These headaches may last from four hours to several days. The American Migraine Foundation estimates that migraines occur in 1 billion people worldwide. Migraine affects adult women about 3.25 more often than men.

 128

 

 This is likely the result of hormone fluctuations occurring in females. The fact that prepubertal children have a migraine incidence of 3-10% regardless of gender also supports the theory that hormones play a role.

 129

 

The incidence of migraines remains relatively equal in boys and girls until the age of nine. After nine, more girls experience these headaches.

 130

 

It is known that estrogen is able to cross the blood-brain-barrier freely. Obese women have a higher risk of developing migraines. This is thought to be due to increased estrogen production in the adipose tissue.

 131  132

Migraine headache ranks seventh globally for years lived with disability.

 133

Migraine Aura Triggers

In fifteen to thirty percent of migraine sufferers, an aura precedes the headache pain.

 

This is most commonly visual but may be a disturbance of speech or motor function as well. This phase generally lasts less than sixty minutes.

 

I am fortunate to have only had a few migraines during my lifetime. My headaches always begin with visual problems, and I am unable to perform simple tasks such as opening a combination lock. I also have trouble speaking and have word-finding difficulties. The symptoms I suffer mimic a stroke.

 

What are the triggers of migraine headaches?

Medication Overuse Headache

Medication overuse headache (MOH) occurs when analgesics, triptans, or ergotamine agents are overused chronically. It is essential to take medications only as prescribed by your physician. There is an increased risk of MOH with opiates, Fiorinal, and analgesic medications containing barbiturates.

 134

Medication less likely to cause MOH are hydroxyzine, metoclopramide and low-dose non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen.

 135

Medications That May Trigger a Migraine

Several drugs have the ability to trigger a migraine. These include oral contraceptives, reserpine, nitroglycerin, cocaine, nifedipine, and hydralazine.

 

 If you suffer from migraines and are taking any of these, ask your physician for a substitute. 

 

If you are using cocaine, either stop on your own or get treatment. Cocaine is very addictive and extremely dangerous.

Diet

Many foods are known to precipitate migraine headaches. Some of these include chocolate (I know, this is sad), processed meats, aged cheeses, onions, oranges, tomatoes, and some dairy products. Red wine and champagne consumption can also lead to migraines.

 

Caffeine is a double-edged sword. It can help with migraine treatment, but caffeine withdrawal can cause headaches in some individuals. For this reason, it is recommended that frequent migraine sufferers stop ingesting caffeine for a two to three month period to determine if headache frequency declines.

 136

Individuals who consume large amounts of caffeine should slowly taper off the drug to decrease the chance of precipitating a withdrawal headache.

 

It is also important to be aware of additives and food preservatives. Substances such as aspartame and MSG can trigger a headache. Whole foods are always the safest option.

 

Environment

Cigarette smoke, perfume, weather changes, loud noises, and bright or flickering lights can cause a migraine. A change in altitude and extreme heat or cold are also culprits. 


Getting too little or too much sleep can be a trigger. If possible, sleep at the same time each night for the same amount of time. Try to eat at regular intervals. Skipping meals has been shown to trigger migraines in some individuals.

Other Migraine Triggers

People with psychiatric disorders are more prone to migraines. Stress and menses also increase migraine risk.

Treatment of Migraine Headaches

It is a pretty safe bet that either you or someone you know suffers from migraine headaches. You are most likely reading this because you want to know how to make them stop! 


I am going to go over abortive treatment as well as prophylactic (preventative) treatment of migraines. My goal is to present the medications with the most evidence to support their use. 


Please remember that different people respond to various therapies. What works for others may not work for you. I am going to present a list of the treatments that are most likely to be effective.

Biofeedback for Migraines

During my research on migraines, I came across an article that discussed the use of biofeedback as prophylaxis for pediatric migraine headaches. Even though I am a pharmacist, I will always recommend non-drug treatments for patients if they are safe and effective. 

 

There is not a single medication that does not possess side effects.

 

Biofeedback is where patients learn to control automatic bodily functions through the use of feedback such as temperature or muscle tension. When properly trained, the patient can control the temperature of their hands, for example, without the use of equipment.

 

When we are under stress, the blood vessels in our hands become smaller. With less blood flowing, the temperature of our hands decreases. By learning to relax using biofeedback, it is possible to lower the stress level, which increases the size of the blood vessels leading to warmer hands.

 

But does this work for migraines?

 

Nesoriuc and Martin published a meta-analysis on the effectiveness of biofeedback for migraine in 2007. They reviewed 55 studies, which included 2229 migraine patients. 

 

The conclusion was that biofeedback significantly and substantially decreases the pain and psychological symptoms after only eleven sessions. This led to the recommendation that biofeedback can be used as an evidence-based behavioral treatment option for migraine headache prevention.

142

A meta-analysis looking at biofeedback as prophylaxis for pediatric migraine was conducted in 2016. The researchers concluded that biofeedback is most likely effective, especially when combined with relaxation therapy. Since the number of studies was small, and they had methodologic issues during the meta-analysis, their recommendation is to continue research on this topic.

 143

Migraine Abortive Treatments According to the Guidelines

When you get a migraine, it can be disabling. Light, noise, and even movement can make the pain worse. 


The first thing most people reach for is Excedrin migraine or ibuprofen. Excedrin migraine is acetaminophen (Tylenol) and caffeine. If this works for you great, but remember, if you get migraines often, you should avoid caffeine. 


The over-the-counter medications with the best data to support use in the treatment of a migraine headache are aspirin, ibuprofen, and naproxen sodium. If these are ineffective, see your doctor.


What are the first-line treatments for migraines?

Triptan Drugs for Migraines

Triptans are first-line for migraine pain relief. There are several drugs in this class. Imitrex (sumatriptan) is the most common. Imitrex comes in a variety of dosage forms, including nasal spray, tablets, transdermal patches, and subcutaneous injection. The injection is the fastest acting and also the most effective. Remember, nausea often occurs with a migraine, so taking anything by mouth can lead to vomiting. 

 

The triptans work by making the blood vessels in the head smaller. These drugs should NOT be used in hemiplegic or basilar migraines.

 

There seems to be a difference in the effectiveness of the triptans in individual patients. My advice is to see what your insurance company covers and start with that. If it doesn’t help, try another agent. The most significant difference in the individual triptans is the dosage forms available and the onset and duration of action.

 

Triptans available are listed below:

 

  • Sumatriptan (Imitrex) – Injectable is ultra-fast acting and the most effective. Also available in tablets, nasal spray.
  • Rizatriptan (Maxalt) – Available in disintegrating tablets and regular tablets.
  • Zolmitriptan (Zomig) – Tablets, disintegrating tablets, and nasal spray
  • Naratriptan (Amerge)- Slow acting/ long-lasting
  • Almotriptan (Axert) – Tablets only.
  • Eletriptan (Relpax) – Tablets only
  • Frovatriptan (Frova): Longest acting triptan

Dihydroergotamine (Nasal Spray) for Migraines

Dihydroergotamine is available as a nasal spray (Migranol), as well as an injection that can be given intravenously, subcutaneously, or intramuscularly.

It works by constricting blood vessels. Like triptans, this medication should not be used in hemiplegic or basilar migraine.

Only the nasal spray received a level A recommendation from the American Headache Society (AHS).


The drugs in this class were the treatment of choice before the triptans were available. Ergot alkaloids such as dihydroergotamine should not be given along with protease inhibitors, macrolide antibiotics, or antifungal agents.

Ask your doctor or pharmacist if you have any questions about this.


Ergot alkaloids have many side effects, but the most common is nausea and vomiting. The nasal spray is the preferred route of administration due to less nausea.

Other Level A Recommendations for Aborting Migraines

Acetaminophen (Tylenol): Good choice for pain, especially in older individuals or those with kidney problems.

 

NSAIDs: Aspirin, ibuprofen, and naproxen sodium have the most evidence.

 

Opiates: May be useful but not recommended for chronic use. Side effects and addiction potential may outweigh benefits.

 

Sumatriptan/naproxen (Treximet)-A combination product promoted by the drug company. 

 

Acetaminophen/Aspirin/Caffeine (Extra strength Excedrin)-Works very well for some but careful with caffeine.

Migraine Prevention Treatments According to Guidelines

If you experience migraine headaches often or are having to miss work on a regular basis, you may wish to take something to help prevent the headaches.

Which therapies are recommended?

Aniticonvulsants

Depakote for Migraine Prevention

Divalproex (Depakote) has substantial evidence to support its use in the prevention of migraine headaches. A Cochrane review published in 2013 found patients taking Depakote were twice as likely to decrease migraine frequency by 50% or more than those taking placebo.

 145

 

Depakote does have adverse effects and risks associated with its use. It can cause congenital disabilities and should be used with caution in women of childbearing age. It also may cause weight gain, nausea, hair loss, and dizziness. Depakote has also been associated with liver failure, but this is uncommon. 

Topamax for Migraines

Topamax also has a Cochrane review that supports its use in migraine prevention.

 

This review looked at seventeen trials and found topiramate to be two times more likely to decrease the frequency of migraines by 50% or more when compared to placebo.

 146

 

Topamax can decrease appetite and commonly causes a burning or prickling sensation in the feet, arms, legs, and hands. It may also cause nausea, difficulty with memory and concentration, kidney stones, and word-finding problems.

 

 

Other Level A Recommendations to Prevent Migraines

For women who suffer from menstrually associated migraines (MAM), frovatriptan (Frova) should be offered for short-term relief.

 147

 

Treatment of Nausea Occurring with Migraine

More than two-thirds of patients who experience migraine headaches vomit during their attack.

 148  149

Many drugs used for nausea and vomiting can also be used to treat migraines. Below is a list of the most popular agents that fit this category.

Promethazine for Migraines

Promethazine is a drug used primarily for nausea and vomiting. It can also be effective in the treatment of migraine and received a level B recommendation (probably effective) from the AHS.

 150

 

This medication is available in multiple dosage forms such as tablets, injection, syrup, and suppositories. This makes promethazine useful during a migraine accompanied by nausea and vomiting. 

 

Promethazine has the potential to be abused due to its sedative effects and its ability to cause delirium. It is also known to increase euphoria when combined with opiates.

The recreational drug “purple drank” is a mixture of promethazine with codeine, hard candy, and carbonated soft drinks.

 

This mixture is popular among the hip-hop culture.

 

Promethazine should not be used in patients with asthma.

It can cause many side effects such as nausea and vomiting, dry mouth, problems breathing, dizziness, and sedation.

Chlorpromazine for Migraines

Chlorpromazine (Thorazine) is also a level B recommendation, according to the AHS. This medication is a phenothiazine that blocks dopamine receptors. This is how it works as an antipsychotic agent.

 

Chlorpromazine also possesses anti-nausea effects.

A study conducted in 2002 found chlorpromazine to be significantly better than a placebo in treating migraine headaches in the emergency room.

 151

 

 Chlorpromazine does cause a high level of sedation and postural hypotension. It is a highly anticholinergic drug leading to dry mouth, blurred vision, constipation, and confusion. It is available as a tablet and injectable form.

 

Droperidol for Migraines

Droperidol is also probably effective in the treatment of migraines, according to the AHS.

 

I have spent countless hours working in the hospital setting, and I definitely received complaints when droperidol was on back-order.

 

It is undoubtedly one of the favorite agents used for migraine at my institution. 

 

Droperidol can have some pretty severe cardiac side effects. It may also cause anxiety, restlessness, and a dysphoric mood. 

 

This drug is normally used as a pre-anesthetic agent for sedation before surgery. Droperidol has a very short duration of action. 

 

It is only available in an injectable form.

Metoclopramide for Migraines

Metoclopramide (Reglan) is also classified as probably effective by the AHS. It is available as a tablet and as an injectable form. Reglan should not be used in patients with epilepsy. Headaches may be caused by Reglan in some individuals. Drowsiness, nausea, vomiting, and movement disorders may also occur with its use.

Alternative Migraine Treatments

There are migraine treatments available that utilize dietary supplements and other medications such as Botox.  I have included some of the most popular and effective therapies below.

Botox Shots for Migraines

Botulinum toxin type A (BTX-A) was approved for the treatment of adult chronic migraine headaches in 2010.

 

Most of the data which led to this approval was obtained from two randomized, placebo-controlled, double-blind studies also published in 2010.

 152   153

BTX-A is administered intramuscularly at a dose of 155 units once every twelve weeks. Each dose should be equally divided and administered to thirty-one specific muscle regions of the head and neck, as shown below.

 

 

 

 

 

The images above were taken from the Botox package insert by Allergan, 2019

According to the American Academy of Neurology (AAN), BTX-A is safe and effective for chronic migraines and is probably effective for improving health-related quality of life (QOL) for these patients. They recommend offering BTX-A to chronic migraine sufferers to increase the number of headache-free days and improve QOL. 

 

Chronic migraine is defined as fifteen or more headaches per month for at least three months. These headaches must last four hours or more.

The AAN recommends against the use of BTX-A for episodic migraine and considers it ineffective for this population.

 154

 

 An updated Cochrane systematic review was published in the British Medical Journal in 2019. This review included twenty-eight trials, which included 4190 subjects. 

 

I prefer to cite Cochrane reviews whenever possible as they are reliable, and their evidence has the most impact on the scientific community.

 

They also update their studies when new information becomes available, as is evidenced in this subject.

 

Of the twenty-eight trials identified, twenty-three compared BTX-A with placebo injections. Three of the trials compared BTX-A with other migraine prophylactic drugs.

 

The studies comparing BTX-A to placebo included 23 trials with 3912 subjects. The analysis showed a reduction of 3.1 days of migraine occurrence per month in the BTX-A group.

 

In an episodic migraine subgroup of 418 subjects, no difference was found between the two groups.

 

It should be noted that BTX-A is very expensive compared to other treatment options.

 

It should be reserved for those with chronic migraine headaches who do not respond or cannot tolerate other therapies.

Butterbur for Migraine Headaches

Petasites hybidus, or butterbur, is a shrub that grows in wet, marshy soil. The large leaves have traditionally been used to wrap butter during warm weather to prevent melting.

This plant has been used to treat fever, cough, asthma, and wounds of the skin.

It is important to note that unprocessed butterbur contains pyrrolizidine alkaloids (uPA). These may be harmful to the liver if ingested over a prolonged period.

Butterbur, which has been processed to remove uPA is safe to consume.

 155

 

There have been studies comparing butterbur to placebo.

In one study conducted in 2000, sixty men and women who suffered from a least three migraines per month were given either 50 mg butterbur extract or placebo twice daily for three months. Seventy-five percent of the butterbur group reported improvement in the number of attacks and total number of days with migraine pain, compared to only twenty-five percent of the placebo group.

 156

Another study administered either 50 mg butterbur extract twice daily, 75 mg butterbur extract twice daily, or placebo twice daily to 202 people with migraines for three months. Patients in all three groups saw improvement in their headaches, but the 75mg butterbur group saw significant improvement as compared to the placebo group.

 157

 

Magnesium and Riboflavin for Migraines

A meta-analysis published in 2014 compared IV magnesium with placebo in emergency room patients presenting with migraines.

 

Subjects received either IV magnesium, a dopamine antagonist, or a placebo.

More patients experienced pain relief in the magnesium group than in the placebo group, but it was not statistically significant. 

 

This study also discovered magnesium works better in patients who have migraine with aura. There was no difference in effectiveness between magnesium and placebo in patients with migraine without aura.

 

It was also discovered that the magnesium-metoclopramide combination led to more pain relief than the placebo-metoclopramide combination.

 158

 

Riboflavin has been found to be effective at reducing the number of migraines when taken at a dosage of 400 mg per day.

 

In a study of fifty-five patients, 400 mg of riboflavin daily was found to be superior to placebo at reducing both the number of headache days and the frequency of migraines.

 159

 The most common side effects of riboflavin are diarrhea and increased urination. 

 

Both magnesium and riboflavin can be found in many foods:

Feverfew and Ginger for Migraines

Feverfew (Tanacetum parthenium) is a plant with flowers resembling daisies that grows wild throughout the world. This plant has previously been used for its anti-inflammatory properties and pain related to menses in women. 

Tanacetum has been used to prevent migraine headaches. The flowers contain a compound known as parthenolide, which is thought to decrease the incidence of migraines utilizing multiple mechanisms of action.

Inhibition of cyclooxygenase-2, tumor nucrosis factor-alpha, interlukin-1, 

 160

and serotonin

 161

are all thought to be involved.

A systematic review of the literature regarding feverfew and migraine was published in the Journal of Dietary Supplements in 2009.

 162

Some interesting information was gleaned from this study. It is possible that other compounds contained in the feverfew leaves assist in parthenolide’s mechanism of action. 

 

One of the studies found no benefit of an alcohol extract of parthenolide, while two other studies using dried leaves found a statistically significant decrease in migraine severity and frequency.

 

These studies found feverfew to be safe with no difference in adverse effects as compared to placebo.

 

It is important to note that feverfew is a supplement which is thought to prevent migraine, not treat the actual headache. For this reason, patients will be taking the supplement over an extended period.

 

More studies are needed to assess the long-term safety and recommended dosage of this supplement.

 

Can ginger fight a migraine headache?

 

Ginger is a common spice used in cooking. It is also used to cleanse the palate in between the consumption of various types of sushi.  Ginger is native to southeastern Asia.

 

This plant has been used for many medical purposes, including treatment of motion sickness, generalized pain, vertigo, arthritis pain, and dyspepsia.

 

One study conducted in 2005 found Gelstat (an OTC drug containing ginger extract) completely alleviated migraine pain in forty-eight percent of patients within two hours.

 

Thirty-four percent achieved partial relief during the same period.

 163

 

In a study published in May of 2013, Maghbooli et al. compared ginger to sumatriptan in the treatment of migraine headaches.

 

One-hundred patients were selected to either receive ginger or sumatriptan if a headache occurred. 

 

Twenty-two percent of the sumatriptan group and twenty percent of the ginger group had a severe headache during the study and were treated. 

 

Seventy percent of the sumatriptan group and sixty-four percent of the ginger group had their headache pain decrease by at least ninety percent two hours following drug administration.

 

There was not a significant difference between the two treatments regarding migraine pain relief.

 

The only side effect reported by the ginger group was dyspepsia. Alternatively, the sumatriptan group reported dizziness, dyspepsia, vertigo, and sedation.

 

Although this study had a limited number of subjects, it shows promise in ginger’s ability to fight migraine headache pain.

 164

A dosage recommendation of 500 mg ginger taken at headache onset and repeated every four hours up to 2 grams daily for three to four days has been recommended by Mustafa and Srivastava.

 165

 

Michael Brown pictured with Final Thought written

Migraine headaches are a common health problem today. They lead to decreased productivity, increased health care costs, and a lower quality of life. 

 

There are many treatments for this disorder. Choosing the right therapy depends on several factors. Patients who have nausea and vomiting occurring with their headaches may benefit from an agent that is available as a non-oral dosage form. 

 

Elderly patients or those with kidney disease should be careful with NSAIDs. These drugs can damage the kidneys, especially if taken over a long period.

 

Those who suffer from multiple monthly migraine attacks may want to consider preventive drug treatment. Again, there are many options to accomplish this, and they are patient-specific.

 

I suggest keeping a headache journal. Write down what you eat each day, your activity level, exposure to smoke or strong odors, and hours of sleep as well as the level of stress. Try to find a pattern that leads to your headaches. It may be easier to avoid foods or other factors that cause your headaches than to use medications. 

 

Consider biofeedback. It does take an initial time commitment but may pay off in the future if you can learn to master it.

 

Other alternative therapies, such as vitamins and nutraceuticals, may also decrease headache frequency. It is possible to get some of these just by eating certain foods.

 

More studies should be done in the future regarding these agents in the treatment and prevention of migraine.

I have covered the medications with the most evidence in this post. There are many more second and third-line agents available as well.

 

At times it may be necessary to combine medications to get the desired effect.

 

If you have any questions regarding migraine headaches or any other topic, please feel free to send me a message. I am always happy to help whenever possible.

 

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
Pinterest Instagram Youtube