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.

Fibromyalgia Causes And Treatment With Guaifenesin, Amitriptyline, Kratom, Flexeril, And Others.

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Fibromyalgia (FM) is a disorder affecting approximately 2% of the world’s population. FM is characterized by musculoskeletal pain occurring throughout the body. Patients with this condition may also suffer from:

 

  • Fatigue
  • Mood problems
  • Memory issues
  • Sleep disturbances
  • Headaches
  • Anxiety
  • Depression

  

FM is a chronic disorder with subjective symptoms making diagnosis difficult. At present, FM cannot be diagnosed based on objective data.

 

Fibromyalgia has previously been thought of as a diagnosis to use when symptoms did not fit any other condition. Some physicians are still unsure whether this is an actual disorder. Patients may become depressed or frustrated due to a lack of compassion from various caregivers. 

Previously, many physicians believed patients were using fibromyalgia as an excuse to obtain pain medication. We are now finding that changing one’s lifestyle may be more effective than drugs. 

Suspected Causes of Fibromyalgia

The exact cause of fibromyalgia remains a mystery. It is most likely due to several factors. We believe some of these include:

  • Genetics: Fibromyalgia is more prevalent in people who have genetic relatives with the disorder. This leads us to think it may be due, at least partially, to a genetic mutation.
  • Trauma: This may be emotional or physical. We know that in some cases, fibromyalgia occurs after the person sustains an injury or experiences emotional stress. Victims of child abuse have a higher incidence as do those with posttraumatic stress disorder (PTSD). The brain may react differently to stress and pain in these individuals which may explain this link.
  • Mood disorders: Individuals with any mood disorder, including anxiety and depression, are more likely to suffer from fibromyalgia. 
  • Gender: Women are three times more likely to be diagnosed with fibromyalgia compared to men. 1This may be due to a difference in how women react to pain or society’s expectations of how women should respond to pain.
  • Sedentary lifestyle: People who don’t exercise are much more likely to suffer from fibromyalgia. Exercise is one of the main treatments.

There is some thought that FM may be the result of the body overreacting to pain signals. This could be due to an imbalance of neurotransmitters in the brain.

 Even weak signals may be perceived as pain if this is true.

The main obstacle in determining fibromyalgia’s cause is the fact that most people with this disorder also suffer from other conditions. 

Many have rheumatoid or osteoarthritis, migraine headaches, various mood disorders, and other maladies that cause pain. It is challenging to separate FM from these coexisting conditions.

A large number of the studies conducted on this subject have a small sample size, or patients are lost to follow up. More well-designed studies are needed to determine the causes of this debilitating condition.

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Cymbalta for Fibromyalgia

A meta-analysis was performed using data from the year 2000 until March of 2019.  The purpose of this analysis was to determine efficacy and proper dosage of Cymbalta (duloxetine) in the treatment of fibromyalgia. This included seven studies with 2642 fibromyalgia patients. The results showed duloxetine was more efficacious than a placebo for pain control in these patients. 

The standard mean difference between duloxetine and placebo was -0.26 or 26% better pain relief. 

There were more adverse effects suffered by the duloxetine group, and withdrawal effects were more significant in those receiving 120 mg/day. The study concluded duloxetine was a great choice for relief of pain in fibromyalgia patients

 2

A study published in June of 2019 compared duloxetine (Cymbalta) with pregabalin (Lyrica) in the treatment of fibromyalgia. 

All subjects were women with FM between 18-65 years of age. They were each assigned either duloxetine 30-60mg daily or pregabalin 75-150 mg daily for four weeks. 

The Widespread Pain Index (WPI) was used to measure pain severity. This scale quantifies body pain by asking patients if they have pain or tenderness in 19 body regions. The higher the score, the more widespread the pain. Duloxetine was significantly better in improving the WPI score with a mean difference of (-2.32) when compared with pregabalin.

The prevalence of nausea and the dropout rate was significantly higher in the Duloxetine group as compared to the pregabalin group.

 3

A Cochrane database review was published in 2018 titled “Serotonin and noradrenalin reuptake inhibitors (SNRIs) for fibromyalgia.” This was a comprehensive study focusing on the efficacy of SNRI’s on numerous FM symptoms.

This study concluded that only a minority of patients might benefit from treatment with duloxetine or milnacipran. Most patients will not gain relief from FM symptoms, or they will experience adverse effects leading to drug discontinuation. 

There is no evidence to support the use of other SNRIs such as venlafaxine or desvenlafaxine in the treatment of FM.

 4

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Lyrica and Neurontin for Fibromyalgia

There was a Cochrane review published on the effects of anticonvulsants on FM. Since the lead author received financial support from commercial sponsors, this review has been withdrawn from publication.  

 

This study was, however, listed as a reference in the European League Against Rheumatism (EULAR) revised recommendations for the management of fibromyalgia. 

 

Pregabalin is listed as a pharmacotherapy for severe pain and severe sleep problems. Neurontin (gabapentin) is not recommended in the treatment of FM, according to EULAR.

 

Amitriptyline for Fibromyalgia

There is evidence that amitriptyline can help with sleep, fatigue and pain in FM at low doses. Five reviews involving 919 subjects found those receiving amitriptyline were 60% more likely to acheive a 30% reduction in pain. A moderate improvement in sleep and a small effect on fatigue were also shown.

 5

Guaifenesin and fibromyalgia

Guaifenesin is an expectorant used primarily to loosen mucous in the airways. This helps the patient cough up the mucous and remove it from the body leading to more effective breathing. Guaifenesin is sold under the popular brand name Robitussin. It is also available under the brand name Mucinex as a 12-hour tablet formulation.

 

There is a protocol available on line that promotes the use of guaifenesin in the treatment of fibromyalgia. I do not see any harm in trying this method if you suffer from FM. Guaifenesin has few side effects. It is important to note that this protocol states that salicylates of any kind must be avoided for guaifenesin to be effective. This includes aspirin and all topical salicylate formulations. The protocol can be found at the link listed below:

 

http://www.fibromyalgiatreatment.com/the-guaifenesin-protocol.html

 

A study conducted in May of 2009 used a telephone survey of 632 women to gain insight into the subjective pain relief obtained by several agents in the treatment of FM. 

 

Of the women surveyed, 434 claimed to have FM while 198 denied having the condition. The women had an age range of 18-80 years. 

 

The results of this study showed that half of the FM group were taking antidepressant medication. Tri-cyclic antidepressants (TCA’s) had strong effectiveness while serotonin reuptake inhibitors (SSRIs) had only moderate effectiveness in treating FM. Few were taking SNRI’s at this time. 

 

Almost 30% of the FM sample were taking non-steroidal anti-inflammatory drugs (NSAIDS). 

 

I included this study because even though it was conducted in 2009, it showed that the most effective medications to treat FM according to the subjective reports of the patients were opiate narcotics and guaifenesin. The narcotics aren’t surprising, but guaifenesin is.

 6

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Kratom for Fibromyalgia

Kratom is a substance obtained from a tropical evergreen tree found in Southeast Asia. This substance has been used for centuries to improve stamina and increase the energy of workers in its native region.

Kratom is available as a supplement in the US. People utilize it to treat diarrhea, pain, and to decrease the symptoms of opiate withdrawal.

An anonymous national survey was conducted in 2016 in an attempt to discover the usage patterns of Kratom in the US. This survey included 8049 Kratom users.

It is known that Kratom is used as an alternative to opiates. Fibromyalgia had the lowest proportion of “significant improvement” responses in this survey. This is expected as opioids are not recommended as a treatment for FM

 7

Flexeril for Fibromyalgia

Cyclobenzaprine (Flexeril) is a muscle relaxant used for various musculoskeletal disorders.  

A systemic review of 312 patients taking cyclobenzaprine for FM found 85% suffered side effects and only 71% of the subjects were able to complete the studies.  

This review concluded sleep was slightly improved, but pain was not.  

Cyclobenzaprine can be used for severe sleep problems in FM

 8

Trazodone is an antidepressant used mostly for insomnia at the current time.  This medication was not mentioned in the EULAR revised recommendations for the management of fibromyalgia.  

If other sleep agents recommended fail, I would not be opposed to trialing trazodone. This drug is effective for sleep at low doses.  Getting the proper amount of sleep is very important.

Celexa and Fibromyalgia

Citalopram belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). Seven systematic reviews were conducted looking at this drug class for the treatment of fibromyalgia. These medications may have a small effect on pain and fatigue but do not help with sleep. Since SNRI’s discussed above are more useful for FM, SSRIs are not recommended.

The EULAR revised recommendations for the management of fibromyalgia were published in 2017

 9

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The EULAR recommendations for the treatment of fibromyalgia maintain that prompt diagnosis and patient education are critical. The patient should be assessed for pain, level of function, and management should be geared towards improving the quality of life.

Non-pharmacological treatments should be initiated first. These include physical therapy with an emphasis on individualized exercise. Other therapies, such as acupuncture and hydrotherapy, may also be tried at this stage.

Psychological therapies should mainly consist of cognitive-behavioral therapy. If depression and anxiety are severe, psycho-pharmacological treatment can be utilized.

Recommendations for pharmacotherapy, according to EULAR, are as follows:

Drugs that should not be used:

  • Strong opioids
  • Sodium oxybate
  • Corticosteroids
  • Growth hormone

Drugs recommended for severe pain:

  • Duloxetine
  • Pregabalin
  • Tramadol

Drugs recommended for severe sleep problems:

  • Low dose amitriptyline
  • Cyclobenzaprine
  • Pregabalin

I have attempted to review the most up to date medication treatments for fibromyalgia in this post. I have included the recommendations from EULAR as well as information on Kratom, guaifenesin, and trazodone.

I do not recommend the use of Kratom at this time. I believe guaifenesin may have a benefit, and it has very few side effects. Trazodone is a good drug for insomnia at low doses, so it may be tried if other treatments fail.

After researching this subject, it seems that exercise, hypnosis, guided imagery, and other non-pharmacological treatments are the preferred treatment of fibromyalgia.

More research will surely be done on this subject, and hopefully we will obtain better treatments in the future.   

Thank you for reading my blog, and please contact me with questions.

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.

 

 
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Undereating Weight Loss, Intermittent Fasting, And Other Tips for Slimming Your Body

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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.

How can I lose weight quickly?

Are there any tricks?

Nothing ever works for me!

This week I am going to give you some solid advice on losing weight. I went from 240lbs to around 180lbs and have kept it off for several years by using many of the tactics discussed in this post. These are not all my ideas. I have learned them from personal trainers and health coaches throughout my adult life. 

We are coming into the holiday season which makes dieting very difficult. Someone is always bringing goodies to work, the kids will have way too much Halloween candy, and Thanksgiving will surely come with way too many calories. 

The following ideas are certainly not the only options available to keep looking your best, but they are the ones that have worked for me. Everyone is different so if another plan is working for you, stick to it.

So how do we keep looking our best year-round?

Remember, looking good and feeling good go hand in hand!

Exercise

I put exercise first because it is the most important. We all know the importance of keeping active but don’t always do it. Like many of you, I need to get back into the routine myself. 

Getting up early and exercising, even for thirty minutes, makes a huge difference. If you can do this the first thing in the morning, it will jump-start your metabolism for the rest of the day. It will also make you feel better.

Don’t try to kill yourself. Especially when first starting, go slow! 

I suggest checking in with your doctor if it has been a while since you have exercised. Be sure to stretch before and after, and drink plenty of water.

It is better to do light exercise than none at all. Try to pick something you enjoy. If you hate it, you probably won’t continue. If you can find a friend to join you, it can be much more enjoyable.

An early morning daily walk is a good start. Getting outside will also improve your mood. I once worked with a psychiatrist who prescribed outdoor morning walks for all of his depressed patients.

If you make exercise part of your daily routine, it will become a habit. 

There are no shortcuts here!  If you want to lose weight and keep it off, exercise is the best single weapon you have.

Drink a Lot of Water

There are numerous benefits to drinking a lot of water. Most of us do not drink enough. When my patients complain of constipation, the first thing I recommend is more water! This isn’t always what they want to hear, but it is beneficial. 

Water is also the best expectorant. If you have mucus building up in your airways, water will help alleviate the problem.

Drinking water helps you feel full. If the water is cold, your body needs to expend calories to heat it. Cold water can also keep your core temperature lower during exercise, which prevents overheating.

Water helps flush toxins from your body. It also helps your skin look younger by decreasing wrinkles. Drinking water keeps the mouth clean and can help prevent tooth decay. 

Water helps regulate body temperature by producing sweat. This is especially important in hot climates. It can also keep you from becoming dehydrated, which can cause headaches.

 Drinking water daily should become one of your healthy habits. 

Don’t Drink Alcohol!

I am going to continue to write about this subject. There is absolutely no legitimate reason to consume alcohol. When it comes to dieting, alcohol contains empty calories and impairs judgment.  If you are a person who can have one glass of wine at dinner and stop, then skip to the next subject.

If you are like I used to be and love beer, especially the high alcohol-laden microbrews, then you should take a look at the number of calories you are consuming. They don’t call it a “beer belly” for nothing.

I know you will all do what you believe makes you happy.

If you want to look good, alcohol will not help you achieve that goal, especially if you are over forty. It will not make you more healthy, and will not solve any of your problems.

Take it from someone who hasn’t had a drink of alcohol in ten years. You will feel better without it! 

Limit Salty And Sugary Snacks

This has always been my biggest hurdle. If you can stop snacking on junk food, you will lose weight much faster. Cake, candy, chips, ice cream, and pastries are all delicious, but they can be hard to stop eating once you start. 

These foods are loaded with carbs and “bad” fat. We all know what the culprits are. Almost always, they are the things we enjoy the most. If you don’t have the willpower, keep them out of your house.

Stay Far Away From Fast Food

I know it is fast and convenient. You had a hard day and didn’t want to cook. It is so easy to go through the drive-through and pick something up for dinner. 

The problem is a Big Mac has 540 calories, and 260 of those come from fat. Almost half of those calories are fat! If you add a large order of french fries, that’s another 500 calories of which 220 calories are from fat. So even if you drink water or a diet coke, you have just consumed 1040 total calories with 480 calories coming from fat. 

I don’t mean to pick on McDonald’s, most “fast food” joints will overdose you with calories. Skip the drive-through. Go home and make a healthy salad!

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What To Eat

I’m going to share my rules with you.  Again, I don’t always follow them, but when I do, the weight always comes off. This is what I have learned:

Stay away from processed foods. This includes energy bars, boxed dinners, granola bars, and anything that is prepared in advance that has a long shelf life. These foods are full of salt, sugar, and preservatives. 

If you can’t pronounce it, don’t eat it! 

If it won’t spoil, don’t eat it! 

If there are seventy-two ingredients listed on the label, don’t eat it!

Pay close attention to food labels. You may think yogurt is healthy, but many flavored yogurts are full of sugar. It is much better to eat fresh fruit and plain yogurt. Try to find foods with high protein and low carbs. 

Here are some snack suggestions:

  • Peanut butter mixed with plain yogurt.
  • Almonds with blueberries, raspberries or blackberries.
  • Apple slices with peanut butter.
  • Celery sticks with cream cheese.
  • Cottage cheese sprinkled with cinnamon.
  • Bell peppers dipped in guacamole.
  • Cucumber slices with hummus.

Undereating Weight Loss

If you eat fewer calories than you burn, you will lose weight. If you plan on undereating, it is best to do this for a short period of time. Your body needs sufficient fuel to operate efficiently. 

 Undereating for too long can make you sick and negatively affect mood. I only recommend undereating for a brief period to help jump-start your weight loss and get you into a proper mindset. 

Losing weight quickly at first can give you more energy to keep working toward your goal. It is a great feeling to step on a scale and see a lower number pop up!

I once went on a diet where I didn’t eat any meat, no alcohol, no dairy, and no sugar. I survived on mostly broccoli and rice for six weeks. 

During this time, I went to the gym daily and worked out with a trainer. I lost weight so quickly that I had to change my workouts to three times a week. 

I do not recommend eating only broccoli and rice. It is too hard to stick to, it is boring, and it makes you grumpy. If you plan to under eat for a short period, stick to a balanced diet but eat less.

There are plenty of apps for your phone that can help you track your calories. I use MyFitnessPal. 

I want to emphasize that under-eating should only occur for a brief period. If you don’t eat enough calories, your body will go into starvation mode, and your metabolism will decrease. This is our body’s way of maintaining weight during starvation. When this happens, it will be harder to lose weight.

Intermittent Fasting

Intermittent fasting has become a popular weight-loss method. This is where you eat all of your daily calories during a short period. I was introduced to this by a pharmacist colleague. There are many different versions, but I will explain how I have used this method.

I usually skip breakfast anyway, so I skip lunch as well and then eat a large dinner. I did this for several weeks and was able to keep my weight steady without spending a lot of time exercising. I did buy some MCT oil and added it to my coffee in the morning.

MCT oil is a medium-chain triglyceride that is extracted from coconut oil. This oil is promoted to help with weight loss by making you feel full. It can be added to smoothies and coffee. 

MCT oil is also used in those utilizing the ketogenic diet. This is because it is low in carbs and high in fat. Intermittent fasting works for some people, but I have better luck with just skipping breakfast. When I skip breakfast and lunch, I tend to eat more unhealthy foods in the evening.

I

 

Ketogenic Diet

The ketogenic diet is a high fat, low carb diet. It is similar to the Atkins diet. The goal is to put your body into ketosis. This is a metabolic state which makes the body more efficient at utilizing fat for energy. 

This diet works for several people I know personally. I tried it but was unable to limit my carbs to the levels needed to succeed. If you can live on fat and protein, this isn’t a bad solution.

Although it is probably more work, I prefer the next diet.

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Mediterranean Diet

This is the diet recommended by my physician. The Mediterranean diet comes from the food consumed by those living in the countries bordering the Mediterranean Sea. It is more of a cultural way of life than a diet. It was discovered that this population had a lower death rate caused by coronary artery disease.

This diet consists of daily consumption of fruits, vegetables, whole grains, and healthy fats. Red meat is limited to a few times a month, and beans, eggs, poultry, and fish are consumed weekly. Dairy products are also limited to a few times a week. 

Olive oil is the predominant fat consumed in the Mediterranean Diet. If you want to give this diet a try, here are some pointers:

  • Eat more seafood. Consuming fish such as salmon, trout, or tuna twice weekly is sufficient.
  • Use healthy fats such as olive oil. Avocados are also a great healthy fat source.
  • Use spices to improve the flavor of your food. Turmeric, cayenne, cinnamon, etc. all have added benefits.
  • Use whole grains for cereal, bread, and pasta.
  • Make fruits and vegetables your primary food source. It is best if you can consume seven to ten servings daily.
  • Consume raw or roasted cashews, almonds, and walnuts.

If you want an inexpensive cookbook to get you started, I recommend The Mediterranean Diet for Beginners: The Complete Guide. 

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I hope I have given you some useful information to help you shed some pounds and keep it off. 

There are many ways to lose weight. Some are healthy, and some are not. It boils down to planning, portion control, and willpower. 

Most of us know what foods are good for us and which foods to avoid. The problem is it becomes easy to fall into a lazy, comfortable routine.

If you plan your day to fit in some exercise and eat healthy food along with lots of water, it will pay huge dividends. I didn’t mention soda, but it is a weight loss killer.

 I enjoy my Diet Coke, but the evidence shows it leads to weight gain. Water is always the best beverage to enjoy.

Eat right, exercise, feel good about yourself, and have fun! You only get to live your life once. 

Please contact me with any questions or comments.

Live a Happy, Healthy, Healing Life!

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.

 
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Several Vitamin D3 5000 IU Benefits And Why You Should Take This Supplement

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Do you need to take a vitamin D supplement?

Many of us are deficient in vitamin D. The only way to be sure is to have a blood test performed. The test used is the 25-hydroxy vitamin D test. Our hospital lab lists the normal blood level to be 30.0-100.0 ng/ml. The Vitamin D council lists the ideal level between 40-80 ng/ml. I recommend supplementation in patients who have a level less than 30 ng/ml.

 

What’s the big deal? I live where there isn’t much sun! Why do I need Vitamin D?

It turns out that vitamin D performs many important functions in our body. As more research is completed, we are finding this vitamin helps with physical and mental health.

Vitamin D is one of the four fat-soluble vitamins (A,D,E and K). This vitamin is not found in many foods but is added to milk, tofu, and orange juice. Shitake mushrooms are also a good source of vitamin D.

Our bodies synthesize vitamin D when the skin is exposed to ultraviolet light from the sun. If we aren’t getting enough sunlight and eating enough foods rich in vitamin D, we are likely deficient in this vitamin.

 The other way to get this vitamin is to take a supplement. All supplements are not created equal. The Sunshine Nutraceutical Vitamin D supplement is made in the USA in an FDA inspected facility. Our supplement contains 5,000 IU of vitamin D3 in a soft gel capsule.

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Being Deficient In Vitamin D Comes With A Cost. Here Are Several Problems You May Face:

Osteoporosis

Osteoporosis occurs when the body loses too much bone tissue or is unable to replace bone loss efficiently. This causes the bones to become weak and are more easily broken. People with this condition may break a bone simply by bumping into something or sneezing. 

The first sign that you have osteoporosis is usually when you break a bone. People with reduced bone density do not feel any different. The chances of a person with osteoporosis breaking a bone is 50% for women and 25% for men during their lifetime

 1

You have a higher risk of breaking a bone if you:

  • Are a smoker.
  • Have a low body weight.
  • Are female.
  • Have broken a bone previously.
  • Drink three or more alcoholic beverages daily.
  • Have gone through menopause.
  • Are over fifty years old.
  • Have low calcium and vitamin D intake 2

    The most important mineral in your bones is calcium. Vitamin D helps the bones absorb calcium. If you don’t get enough vitamin D, calcium cannot be absorbed for use by the bones. More calcium in the bones increases density which decreases the chance of a bone fracture

     3

    The incidence of broken bones increases during the winter months. Some researchers believe this is due to lower levels of vitamin D

     4

    A study published on August 1st, 2019 examined the effect of vitamin D levels on fractures in 287 elderly women with at least one previous bone fracture. This study concluded that vitamin D deficiency was associated with an increase in fracture severity as well as bone loss.

     5

General Anxiety Disorder

People with Generalized Anxiety Disorder (GAD) spend a great deal of time worrying excessively about many different things.

 

They may be convinced the world is coming to an end or always worry about money, health issues, family members, or their jobs.

 

This disorder can be debilitating if it becomes severe. People with this disorder may be afraid to leave their houses.

 

A study published in 2019 looked at the effects of vitamin D on GAD. Thirty patients with GAD and vitamin D deficiency were split into two groups of 15 patients each. One group received standard of care (SOC) only, while the treatment group received SOC plus 50,000 IU vitamin D weekly for three months.

 

The Generalized Anxiety Disorder 7-Item (GAD-7) scale was used in both groups to measure changes in anxiety levels. The vitamin D group had significant increases in serotonin levels, and their GAD-7 scores also improved. The group receiving SOC only showed no changes in GAD-7 scores or serotonin levels. 

 6

Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of impulsivity, inattention, and or hyperactivity that interferes with occupational, social, or academic functioning. This disorder may begin in infancy and may continue throughout adulthood.

 

The effect of vitamin D on ADHD was studied using fifty ADHD patients and fifty non-ADHD controls. The Conners’ Parent Rating Scale (CPRS) was used to assess ADHD symptoms, and serum 25-hydroxyvitamin D levels were measured using an ELISA kit. 

 

Vitamin D levels were assessed using the following scale:

 

Serum 25OHD less than 10 (severe deficiency)

                                10-29 (mild deficiency)

                                 >30 (sufficient vitamin D level)

 

Patients with ADHD had significantly lower serum levels of vitamin D (16.57 +/- 9.09 ng/ml) compared to the control group (22.01 +/- 12.67 ng/ml).

 

A severe vitamin D deficiency was 3.36 times more likely to be found in the ADHD group. 

 

This study supports the monitoring of vitamin D levels in patients with ADHD.

 7

Tuberculosis

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. This disease mainly affects the lungs but may also affect the kidneys, brain, or spine. It is spread by tiny droplets in the air produced when an infected patient coughs or sneezes. This disease can be life-threatening. 

 

A nested case-control study was conducted looking at the effect of vitamin D on decreasing the progression of tuberculosis (TB).

 

Vitamin D has shown to have some impact on immunity. Vitamin D deficiency may also increase the risk of TB due to its effect on diabetes. Diabetes is a known risk factor for TB, and vitamin D is known to decrease diabetes risk.

 

In this meta-analysis, it was determined that low vitamin D levels were associated with the progression of TB. This effect was found to be dose-dependent. This raises the possibility of using vitamin D supplementation in high-risk populations to help decrease TB risk.

 8

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Alzheimer’s Dementia

A prospective cohort study of 498 older women was conducted in 2012 to determine the effect of vitamin D on dementia. All subjects received baseline cognitive testing utilizing the Pfeiffer Short Portable Mental State Questionnaire. Only those scoring above 8 (normal cognitive function) were included in the study. 

 

After a seven-year period, the Mini-Mental Status Exam (MMSE) and Grober and Buschke test were conducted to screen for dementia. 

It was determined that the subjects with dementia had a lower average vitamin D intake than those without. (50 vs 59 ug/wk).

 

The subjects in the highest vitamin D intake quintile had a lower incidence of dementia than those in the remaining four quintiles combined (4.1% vs. 17%). 

This study did depend on accurate reporting of vitamin D intake by the subjects tested. About half of the subjects were lost to follow-up during the study period.

 

 9

 

Another small randomized controlled study was conducted in 2015 to determine the effect of vitamin D supplementation on the treatment and prevention of Alzheimer’s disease. Subjects were 60 years of age or older with an MMSE score of less than 24. 

 

Two groups were randomized. The active group had a baseline vitamin D level of 8.2 ug/ml. This group received 4,000 IU vitamin D supplementation daily. The control group had a baseline vitamin D level of 9.3 ug/ml and received no vitamin D supplementation.

 

The MMSE was administered every three months. No difference was found between the two groups after three months, but a significant difference occurred after six months (24 vs. 22). Although the sample size was small, a positive effect of vitamin D supplementation was observed.

 10

If you are interested in reading about Lewy Body Dementia follow this link.

 

Depression

I became interested in vitamin D due to its effects on depression. I see a large number of depressed patients and have noticed many have a sub-therapeutic vitamin D level. 

 

People who are depressed feel unhappy most of the time. They may lose interest in things they have enjoyed in the past. Depression can cause the person may sleep too much or too little. They may have a difficult time concentrating and isolate. Depressed patients may have a change in appetite and may have low self-esteem.

 

Researchers believe vitamin D may increase the amount of serotonin in the brain.

 11

 

Increasing serotonin and other monoamines are the mechanisms of action of many antidepressants available today. 

 

Even though there seems to be a link between vitamin D and depression, conflicting evidence still exists.

 12

 

There have been many studies conducted, but it remains unclear whether vitamin D helps treat depression or whether vitamin D levels are just lower in depressed patients. 

 

A study conducted in the Netherlands in 2014 showed low vitamin D levels were associated with the severity and presence of depression. This study followed 1102 depressed patients aged 18-65 years and 790 patients who were not currently depressed but had been in the past.

 13

 

A study in Finland in 2015 found higher serum concentrations of vitamin D were associated with a lower incidence of depression. The investigators believe higher vitamin D levels protect individuals from becoming depressed.

 14

 

I am a firm believer in utilizing vitamin D supplements for those who are depressed. My recommendation is to take 5000 IU daily. Vitamin D levels can be obtained during your yearly health check-up. 

 

Although I am not depressed, I take vitamin D daily to prevent depression. I live in Oregon and don’t get much sun, especially during the winter months. My vitamin D levels have been low in the past. 

 

Can I Take Too Much Vitamin D?

Yes, because vitamin D is a fat-soluble vitamin, it can accumulate. Hypercalcemia, an increased level of calcium in the blood, is the major consequence of taking too much vitamin D. Hypercalcemia can cause nausea, vomiting, frequent urination and weakness. It may also lead to the formation of kidney stones. A person would need to take a very high dose of vitamin D over a long period to become toxic.

Vitamin D is a critical substance used by our bodies in many ways. I have highlighted many uses of this vital vitamin in this post.

 

I have noticed in my practice that a large percentage of depressed patients have a low vitamin D level.  I believe keeping your level therapeutic is a good step in feeling better and helping your body function as efficiently as possible.

I always recommend vitamin D supplementation in any patient with a level less than 30 ng/ml.  It is an easy preventative measure.

If you have any questions or need further information, please feel free to contact me. As always, I want to thank you for reading my blog. If you have any subjects you would like to learn about; please let me know. 

 

We can all live a happy, healthy, healing life! 

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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.

 

 
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Steroid Induced Psychosis

Posted on by sunshineneutraceuticals

Will taking prednisone make you psychotic?

How about other steroids?

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 Psychosis?

Patients with psychosis are not in touch with the real world. They display symptoms of hallucinations and or delusions. They may also speak incoherently or behave in ways that do not fit their current surroundings.

Hallucinations occur when a person senses something that is not there. This can happen with sight, hearing, touch, and smell.

At times, the patient may experience two or more hallucinations simultaneously. For example, a psychotic patient may kneel to pet a dog that doesn’t exist. They can see the dog and feel the dog as they pet it. They may also hear or smell the non-existent animal.

Delusions happen when a person firmly believes something untrue. They may be convinced they are an influential person or someone famous when, in fact, they are not. Delusional patients may think they are younger than their actual age and in better health. They may also suffer from paranoia and swear that people are out to get them.

These patients may only eat packaged food or stop eating entirely due to fear of being poisoned. Delusions are very hard to treat with medication.

Drugs As A Cause Of Psychosis

When a patient presents with new-onset psychosis, it is vital to obtain a thorough history. If a family member has been diagnosed with a psychiatric disorder, there is an increased chance of the illness spreading to other genetic relatives. We also know a patient often responds to the same medications that were effective for family members.

One of the first things I look for as a pharmacist is possible drugs that can cause psychosis. There are several potential agents to consider, but I classify them into two broad groups.

 

 

 

Drugs Of Abuse

These are drugs that are not prescribed by a physician and have a higher incidence of precipitating psychosis. This is true because of the properties of the substance and the erratic dose the patient receives.

Street drugs are not regulated, so drug content is sporadic. The drugs are usually addictive, and individuals take an increasing dose trying to reach the desired effect. Some examples of these agents are:

Cocaine
Methamphetamine
Marijuana
LSD
PCP
Ecstasy
Ethanol

Prescription Medications

The other group contains medications that are available as prescriptions. It is essential to point out that many of these drugs are also available on the street. Any substance that has the ability to alter mood or perception is a candidate for sale on the black market. Some of these agents are:

Antidepressants
Antipsychotics
Anti-seizure medications
Anticholinergic Drugs (Click to read post on anticholinergics)

Isotretinoin
Dopamine agonists for Parkinsons Disease
Corticosteroids

We will concentrate on corticosteroids for this post.

Types Of Steroids

Anabolic Steroids

These include testosterone as well as synthetic substances that are similar in structure to testosterone and have comparable effects. Testosterone is used to treat specific hormone problems in men. The synthetic molecules are often abused by bodybuilders and athletes to build muscle and boost athletic abilities. These are generally not associated with psychosis. Some examples of this type of steroid are:

Dianabol
Winstrol
Deca-durabolin
Equipoise
Anadrol

Corticosteroids

Corticosteroids are used in modern medicine to remedy a variety of conditions.

They are used in the emergency department to treat asthma attacks, COPD, and croup in children.

They can be used to treat Crohn’s disease, gout, lupus, multiple sclerosis, and other autoimmune disorders. Corticosteroids have an important role in reducing inflammation.

These steroids are also utilized in the treatment of skin conditions such as eczema and rash. They play an essential role in some cancer therapies. Corticosteroids come in a variety of forms including injections, tablets, liquids, creams, ointments, and inhalers. Some examples include:

Prednisone
Prednisolone
Dexamethasone
Betamethasone
Triamcinolone
Methylprednisolone

 

 

Corticosteroid Adverse Effects

Unfortunately, although corticosteroids are useful in many of the conditions described above, they can also cause adverse effects. A few common side effects include:

Weight gain
Agitation
Nausea and vomiting
Insomnia
Headache
Mood swings
Euphoria
Psychosis

Steroid Induced Psychosis

Psychosis is a side effect of corticosteroid use and most commonly occurs at prednisone doses above 20mg/day given over a long period. 1 

2 3 

Roughly ten percent of patients remain psychotic after the steroid dose is decreased. 4 

Patients are usually clear after a two-week course of antipsychotic medications.

Although prednisone is often described as the main corticosteroid involved, other members of the steroid family can also cause psychosis.

Dexamethasone

Dexamethasone is often used in place of prednisone due to its longer duration of action. This glucocorticoid is six times more potent than prednisone.

It is unknown what dose of dexamethasone is most likely to cause psychosis, but it has occurred post-operatively after a single dose.

We should anticipate a psychotic reaction after administering dexamethasone, and for surgery cases, it may be prudent to utilize restraints to prevent self-extubation.

Pre-medicating with haloperidol or olanzapine may prove beneficial in this situation. 5 

Dexamethasone will accumulate in the body more quickly than prednisone due to its longer half-life. For this reason, careful monitoring should occur when giving this agent over a more extended period of time.

Methylprednisolone

An article published in European Psychiatry in March of 2016 describes a case where a thirty-year-old female received three, 80mg daily doses of methylprednisolone following lumbar surgery. This patient had no personal or family history of any psychiatric disorder.

One week after the methylprednisolone was completed, the patient was admitted to the hospital for bizarre delusions, visual and auditory hallucinations, and disorganized thinking.

She was treated with risperidone (up to 6mg/day) and a very short course of diazepam (10mg/day). The patient was discharged several weeks later when the psychosis cleared up. 6 

Treatment

The first thing to attempt when treating corticosteroid-induced psychosis is to stop the offending agent. Unfortunately, this is not always possible.

There are circumstances when the steroids must be continued. In these cases, our best option is to treat the patient with an antipsychotic medication.

Which agent we choose is based mostly on the characteristics of the patient. I could write an entire chapter on this subject but will list the agents we utilize most commonly for psychosis on our unit. I will also explain reasons to choose one agent over the other.

Haloperidol

Haloperidol is still widely used due to its familiarity. Physicians like to use what they are most comfortable with.

Some patients should never receive haloperidol. This medication is contraindicated in Parkinson’s patients. Due to its high dopamine (D2) blocking properties, it makes the movement disorder worse.

Haloperidol is still very effective and is often used for delirium as well as psychosis. It is available in oral, injectable and long-acting injectable forms

Quetiapine

Quetiapine is the first choice in a patient who has Parkinson’s disease. This drug is also helpful in patients who are having trouble sleeping as it is one of the most sedating antipsychotics available. Quetiapine is only available in oral dosage forms which limits its usefulness in acute situations.

Olanzapine

Olanzapine is one of the most effective medications we have for delirium as well as psychosis. Like haloperidol, it is also available in all dosage forms.

The main problem with this agent is weight gain. This can be a positive attribute in patients that have a poor appetite, but these days patients tend to be overweight. Olanzapine is usually the medication I initially recommend.

Risperidone

Risperidone is also an effective agent for psychosis, but it is not available in a quick acting injectable form. It can also cause movement disorder side effects, especially at higher doses.

Ziprasidone

Ziprasidone is popular in the emergency department for acute agitation and psychosis due to its availability as a fast-acting injectable. The powder in the vial does take longer to dissolve than olanzapine, and it has cardiac side effects that make it undesirable for elderly patients.

Final Thoughts

There is evidence linking corticosteroid use to psychosis. These medications are used for a variety of ailments. At times, they are needed to treat life-threatening conditions.

Although prednisone is the agent most commonly associated with corticosteroid-induced psychosis, other agents in this class can also lead to psychotic behavior.

It is essential to be aware of the signs of psychosis and seek treatment if you or someone you know is being treated with any of these drugs.

I suggest having someone check on you periodically if you live alone and are taking these medications. Psychotic patients often have no idea they are having a problem until it is discovered by someone else.

If possible, the corticosteroid should be stopped if psychosis develops. If this isn’t prudent, antipsychotic agents can be used based on patient characteristics.

In severe cases, the patient may need to be hospitalized until stable. Most patients will clear after a few days to a couple of weeks.

I hope you have enjoyed this review of corticosteroid-induced psychosis. If you have any questions or comments, please send me an email.

My goal is to make this site as informative and enjoyable as possible for my readers. We can learn the best way to make that happen together.

As always, live a happy, healthy, healing life and remember to HAVE FUN!

 

 

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Michael J. Brown, RPh. BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Michael – Sunshine Nutraceuticals (sunshinentc.com)


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Weighted Blankets For Anxiety And Insomnia, The Tapping Method, Squashing Thinking Errors, And Other Anxiety Reducers

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.

How Can I Stop Feeling So Anxious And Get Some Sleep?

All of us become anxious throughout our lives for different reasons. We may be thinking about a test or speaking engagement and believe we are not prepared.

Our kids may be late getting home or fail to answer their phones. Many of us are afraid of heights or flying in airplanes. Preparing for surgery, being called into the supervisor’s office, getting lost in the woods, can all cause various levels of anxiety.

Anxiety is just a normal part of life.

When fear and anxiety lead to trouble sleeping or problems functioning in daily life, it is time to think about treatment options.

What are some of the options we can accomplish ourselves?


Can we teach ourselves to be less anxious?

 

The answer is yes, and we can. I am going to teach you some ways to decrease your anxiety level.

I used to be much more anxious than I am today. I have read a great deal about anxiety and work in mental health, so I am surrounded by the subject daily.

Weighted Blankets For Anxiety And Insomnia

Weighted blankets are often used in children with autism spectrum disorder (ASD) to provide a “cocooning” feeling. They have also been used in the elderly.

The weighted blanket’s effectiveness has previously been shown to be related to the mass of the person using it. A blanket that weighs more than ten percent of a person’s body is more beneficial.1 

A study published in the Journal of Sleep Medicine & Disorders on May 25, 2015, found a chain-weighted blanket was able to improve the quality of sleep in patients with insomnia. The subjects who used the weighted blanket had a calmer night’s sleep and exhibited less movement throughout the night. They also believed the blanket provided higher quality and a more comfortable night’s sleep.2 

I have the pleasure of sharing an office with Kendra Munroe, OTR-L. Kendra is an Occupational Therapist (OT). She states weighted blankets should not be used in patients with open wounds, broken bones, or a history of sexual trauma.

Kendra prefers to use blankets that weigh no more than ten percent of the patient’s total body weight. She mainly uses weighted blankets from a company called Salt Of The Earth because she states they are well made.

For a more comprehensive explanation of weighted blankets and how to choose the best type for your situation, click here.

The Tapping Method

I also asked Kendra about “The Tapping Method.” This is something I had not been exposed to before working on our unit.

Munroe states this method is usually used for patients with anxiety or depression. It regulates the body by using its natural rhythms. It is best to match the speed of the heartbeat when tapping, according to Kendra.

Kendra recommends not using The Tapping Method on patients who aren’t open to it. It usually won’t work for them.

She excludes those unable to follow a pattern, such as those with dementia, as well as actively manic patients.

Play the video above to learn more.

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Breathing Exercises

The two breathing exercises below can help relieve tension and make you feel more relaxed:

Square Breathing Or Box Breathing

This is a breathing exercise where you:

  1. Breathe in (through your nose) for 4 seconds.
  2. Hold your breath for 4 seconds.
  3. Breathe out (through your mouth) for 4 seconds.
  4. Hold your breath for 4 seconds. 
  5. Repeat sequence. 

Square breathing can help with anxiety and make you feel more relaxed. It can also help with sleep and lower blood pressure.

 

Resonate Breathing Or Coherent Breathing

  1. Lie down in a comfortable place.
  2. Close your eyes and concentrate only on your breathing.
  3. Slowly inhale through your nose for six seconds.
  4. Breath out through your mouth for six seconds.
  5. Repeat the sequence.

These two breathing techniques can help tremendously if practiced. I suggest taking a few minutes each day on the above exercises until they become second nature.  

When you start to feel anxious, proper breathing is an excellent initial intervention for quick relief.

 

Progressive Muscle Relaxation

Progressive muscle relaxation (PMR) is a technique that was developed in the 1920s by a physician attempting to get his patients to relax. This method works by counteracting the effects of the fight-or-flight response. This response helps protect us from danger. 

 In some people, the fight-or-flight response becomes a problem by creating an increase in unnecessary anxiety symptoms. It may even lead to a panic attack at times. 

The adrenalin released during this response increases the heart rate. Stress hormones are also released. This may cause shortness of breath, sweating, trembling, and at times a feeling of impending doom. 

 

Follow these steps to increase relaxation. This exercise may be especially helpful when feeling highly anxious or having a panic attack.

 

  1. Find a comfortable place either sitting or lying down, close your eyes, and take several deep breaths. Try to concentrate only on the air entering and leaving your lungs. If other thoughts come into your mind, gently push them aside. Continue until you start to feel relaxed.
  2. Concentrate on your feet. Tighten the muscles in both of your feet and keep them tight for 10 seconds. Release the tension and pay close attention to how your feet feel. Only think about your feet. After about a minute, go to step three.
  3. Progressively move up your body and repeat step 2 using different muscle groups. Legs, hips, stomach, arms, etc.…
  4. It is essential to try to concentrate exclusively on the muscle group you are working on at the time.

 

Like the breathing techniques mentioned above, this exercise will become more productive with practice. I recommend doing this a couple of times per day until it feels natural. You can then utilize the technique whenever you feel anxious or stressed.

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Guided Imagery

Guided imagery is the use of words to guide a person to imagine a specific scenario designed to bring about the desired effect. This technique is often used to help with pain relief or to reduce stress and anxiety. 

There are many apps available for the iPhone that utilize guided imagery. I am a firm believer in this technique, and if you want the best results, my suggestion is to click on the link below. Healthjourneys has many products available designed explicitly for anxiety relief.

Like the other skills mentioned in this article, guided imagery will become much more effective with practice. Give it a try! 

I am not affiliated with Healthjourneys in any way.

https://www.healthjourneys.com/audio-library/anxiety-relief

Sleep Hygiene

One thing I have learned while working with psychiatric patients is that lack of sleep can make almost any condition worse. 

We all need adequate sleep to recharge our body and mind. I thought this post would be a great place to remind my readers about how to maximize sleep. Here are the general sleep hygiene standards:

 

  1. Do not sleep too much during the day unless you work nights! If you sleep during the day, you will likely not be tired at night. Short naps to recharge are OK, but avoid sleeping for long periods during the day.
  2. Sleep at the same time each night if possible. Establishing a routine is essential. If you can go to sleep at the same time each night and wake up at a similar time each morning, your body will become used to this sleeping routine.
  3. Use your bed for sleep and sex ONLY. Do not read, watch television or eat in your bed.
  4. Exercise, but no too close to bedtime! This is beneficial in several ways. Exercising helps decrease anxiety and depression and will also promote sleep. Two of the best things you can do for your body are to eat healthily and exercise. You will hear much more about this topic in future posts.
  5. Avoid alcohol and caffeine late in the day. Alcohol decreases sleep quality, and caffeine is a stimulant that may make it difficult to fall asleep. I prefer to avoid alcohol entirely, but that is a subject for another post. I try to cut the coffee off early in the afternoon.
  6. Try not to eat right before sleeping. It is best to give your food a chance to digest before closing your eyes for the night! Many foods can cause heartburn which may impact sleep quality. It is also prudent to avoid large amounts of fluid before sleeping because waking up to urinate interrupts sleep.
  7. Expose yourself to sunlight during the day. This can help with sleep as well as depression. Walking around outside during the day helps to maintain a healthy sleep-wake cycle. 
 

Frequent nighttime awakenings and daytime sleepiness are the main signs that you need to work on sleep hygiene. Getting this down can improve your physical and mental health.

Squash the Self-Defeating Thinking Errors

Thinking errors can turn us all into our worst enemies.

There are three broad types of thinking errors. In this article, I am going to explain some of the most common type 2, or self-defeating thinking errors that can lead to depression, anxiety, and general unhappiness.

Catastrophic Thinking

Catastrophic thinking is where one concentrates on the worst-case scenario. This certainly can increase anxiety and prevent the individual from taking appropriate action.

This type of thinking usually has no basis in reality. Consider the following example: 

You call your daughter, but she doesn’t answer her phone. You convince yourself something horrible has happened to her. Maybe she is in the hospital or was involved in a car accident? You have a hard time concentrating and start to get extremely anxious. In reality, she is just away from her phone.

Fortune Telling

Fortune telling happens when the person assumes they will fail before even trying because they have not succeeded in the past. This thinking error is linked to anxiety as well as depression.

An excellent example of this is thinking is: “I will never get the job I just interviewed for.” Without knowing who else applied and exactly what kind of person the company is looking for, you cannot legitimately conclude you won’t get the position.

Negative Focus

The person focuses only on the negative aspects of a situation or person. They may also think negatively about themselves. We have all been around this type of person. They are always complaining about how bad things are.

Mind Reading

Mind reading occurs when a person thinks he knows another person’s thoughts or intentions.

This person may be convinced his friend is thinking about something negative in regards to him. None of us can read minds, so he should confront his friend if he believes they have an issue.  Chances are, the friend doesn’t have an issue at all.  Don’t waste time trying to guess what others are thinking.

There are other thinking errors, but this gives you an idea of how our thoughts can make us anxious.

Exercise To Battle Thinking Errors

Whenever you find yourself thinking about something that might be a thinking error, write it down.

Then next to it, in a separate column, list the reasons the statement is erroneous.

I have done this, and it helps. You will soon start to correct yourself without needing to complete the exercise. It is possible to train our minds to think differently with a little practice.

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Nutraceuticals and Dietary Supplements

There are also natural substances that can help with anxiety as well as depression.  Turmeric, which is a spice used in many foods, has been shown to have many beneficial health-related properties.  For more information, read the article by clicking the link below.

 

https://lyfebotanicals.com/health/turmeric-benefits/

Anxiety is something that will be with us throughout our lives. Although it serves a purpose in keeping us on track and protection us from danger in some situations, it can become overwhelming and detrimental.

The tactics described above can help reduce anxiety and help to increase the quality of your life.

Please remember, if your anxiety becomes too much to handle, or you are unable to function, seek professional help. An anxiety disorder is no different than diabetes or heart disease. It too can get out of control at times and deserves proper treatment.

Anxiety relief is one of my favorite topics. I have learned over the years to control it using the techniques described above.

If you have any questions, please click the contact me link next to my picture below and send me an email. You may also sign up to receive our newsletter by filling out the form on the top of this page.  This contains news about our company, sales on our products, and links to our blog posts.

Remember to have a happy, healthy, healing life.

 

 

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.

 

 
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Benadryl And Dementia; Can Anticholinergic Drugs Cause Dementia Or Make It Worse?

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.

Can Benadryl and other anticholinergic drugs give you dementia?

Dementia has become a national health care crisis. This Disease affects not only patients but also families and caregivers. Early signs of dementia include difficulty writing and speaking, misplacing items, confusion, frustration, and memory loss.

Brain failure is an easy way to describe this Disease.

Alzheimer’s Disease, the most common form of dementia, progresses very slowly. Other types, such as vascular dementia may strike immediately after a stroke. Unfortunately, we are all just one stroke away from becoming a potential dementia patient.

Dementia patients will eventually depend on others for their complete care.

For More Information On Lewy Body Dementia, See My Previous Post By Clicking The Box Below:

Lewy Body Dementia Prognosis, Causes, And Medications To Avoid

What is an anticholinergic drug?

An anticholinergic drug is one that blocks acetylcholine. Acetylcholine is one of the neurotransmitters located in the brain and other parts of the body.

It is quickly destroyed by an enzyme called acetylcholinesterase and has a very short duration of action.

Acetylcholine has many functions:

  • Decreases heart rate, acts as a vasodilator, decreases heart muscle contraction.
  • Causes urinary smooth muscle contraction of the bladder.
  • Helps move food through the digestive tract by increasing peristalsis. 
  • Stimulates gland secretion.
  • Causes bronchoconstriction in the lungs.
  • Effects memory and learning

Anticholinergic Burden

There is no single scale available to rate medications for anticholinergic burden.

More than 600 medications have various levels of anticholinergic effects.1 

In my practice, I primarily use the Beers List and two research articles to get this information.

I will list a few examples in each category below. Please reference the following articles if you require an extensive list of agents:

 

 

 

The two articles I utilize currently are:

  1. Mohammed Saji Salahudeen, Stephen B Duffull & Prasad S Nishtala.Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systemic review. BMC Geriatrics volume 15, Article number: 31 (2015)

          http://dx.doi.org/10.1186/s12877-015-0029-9

   2.  Durán C, Azermai M, Vander Stichele R. Systematic review of anticholinergic risk scales in older adults. European Journal of Clinical Pharmacology. 2013;69(7):1485-1496. doi:10.1007/s00228-013-1499-3.

          http://dx.doi.org/10.1007/s00228-013-1499-3

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Anticholinergic medications are used for a variety of indications. Some of these are listed below:

Antihistamines

First-generation antihistamines have a high level of anticholinergic activity.

Diphenhydramine (Benadryl) is the most common. This drug is used in its injectable form in hospitals to treat acute allergic reactions along with epinephrine.

It is also used for seasonal allergies, motion sickness, Parkinson’s Disease, and as a sleep aid.

Diphenhydramine is available over the counter (OTC).  Benadryl and memory loss has become a recent study subject.

I tell my patients to steer clear of any OTC medications that end with “PM.”

Most of these products contain diphenhydramine in combination with a pain reliever.

Diphenhydramine is a poor choice to help elderly patients sleep.

Like all anticholinergics, it may lead to blurred vision, dry mouth, and an increased risk of falls.

Antihistamines with high anticholinergic activity:

 

  • Diphenhydramine (Benadryl)
  • Dimenhydrinate (Dramamine) 
  • Cyproheptadine (Periactin)
  • Hydroxyzine (Atarax, Vistaril)

Antidepressants

Antidepressants are primarily used to treat depression and anxiety disorders.

Some antidepressants also possess anticholinergic properties. This is especially true of the older tricyclic antidepressants.

These are rarely used at high doses currently as SSRI’s, such as sertraline (Zoloft) are much safer and have fewer side effects.

Paroxetine (Paxil) is an SSRI that has a higher anticholinergic burden.

It is best to avoid paroxetine in elderly patients.

Antidepressants with high anticholinergic activity:

  • Amitriptyline (Elavil)·
  • Clomipramine (Anafranil)
  • Desipramine (Norpramin)
  • Desipramine (Norpramin)
  • Doxepin (Sinequan)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Paroxetine (Paxil)

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Antipsychotics

All antipsychotics have some anticholinergic activity. Unfortunately, they are the most effective agents we have for the behavioral and psychological symptoms of dementia, so they are often used in this population.

As with the antidepressants, different agents have various levels of anticholinergic activity. Clozapine (Clozaril) and olanzapine (Zyprexa) are the most anticholinergic atypical antipsychotic agents.

Antipsychotics with high anticholinergic activity:

  • Chlorpromazine (Thorazine)
  • Clozapine (Clozaril)
  • Fluphenazine (Prolixin)
  • Thioridazine (Mellaril)

Urinary antispasmodics

Urinary antispasmodics are indicated for overactive bladder symptoms. The most common is oxybutynin (Ditropan). I have personally witnessed these being used in patients who were incontinent. I believe these drugs should be avoided when possible. These medications should not be used in patients with dementia or delirium. The risk in these cases is likely much higher than the benefit.

GI antispasmodics

Drugs such as dicyclomine are used for irritable bowel syndrome. Many dementia patients are incontinent of bowel as well as urine. These medications should be avoided in this population.

Anticholinergic medications for combating antipsychotic side effects

Benztropine (Cogentin) and trihexyphenidyl (Artane) are used to combat dystonia or pseudo-parkinsonism from antipsychotics.  This is a case where benefit outweighs risk.  These side effects can be debilitating and controlling them is a priority.

Muscle Relaxants

Cyclobenzaprine (Flexeril) and methocarbamol (Robaxin) are used to help with pain and muscle relaxation.

Again, these medications are often necessary for patient comfort.  I suggest using the agent with the lowest anticholinergic burden possible.

Unwanted Side Effects Caused By Anticholinergic Drugs

  • blurred vision
  • dry mouth and eyes
  • constipation
  • dizziness
  • confusion
  • urinary retention
  • Increased risk of falls

Treatment Of Anticholinergic Side Effects

  • Exercise to help relieve constipation.
  • Sugarless candy or gum for dry mouth.
  • Increasing fluid intake for constipation and dry mouth.
  • Saliva substitutes, mouthwashes or fluoride rinses for dry mouth.

Effects Of Aging

As we age, our bodies react differently to medications.

Our liver and kidneys are not as efficient, and we are composed of more fat and less muscle.

We have less protein circulating in our bloodstreams to bind to medications.

We do not excrete drugs as well as a younger person.

All of these factors lead to an increased effect from the medications we ingest.

Dementia patients also have lower acetylcholine levels.2

Anticholinergic medications block a portion of the remaining acetylcholine leading to a further decrease in cognition.

There have been several studies linking anticholinergic medication use to impaired cognitive function in elderly patients.
3
4
5
6
7
8

Clinical Studies On Anticholinergics And Dementia

A clinical review of twenty-seven studies, published in 2009, found all but two discovered an association between the anticholinergic burden of medications and either dementia, delirium, or cognitive impairment.9

 

A study of 1473 individuals without dementia was conducted over a six-year period to determine whether anticholinergic drugs had an effect on memory decline. 

The subjects in this study were between the ages of sixty to ninety years. Several aspects of cognition were measured. 

Even though only 2% of the subjects used anticholinergic drugs (n=29), the results indicate these medications may lead to a more rapid cognitive decline in older adults without dementia. 10

The final study I would like to discuss was the subject of our journal club luncheon last week. 

This is a new nested case-control study of 58,769 dementia patients and 225,574 controls.  

These patients were from England, and data was obtained via the QResearch primary care database.

The purpose of this study was to determine the association between cumulative anticholinergic drug exposure and the risk of dementia.

This study found an increased risk of dementia in patients who used the following types of anticholinergic agents:

  • Antidepressants
  • Bladder antimuscarinics
  • Antipsychotics
  • Anti-epileptic drugs

We were surprised to discover they found no significant increase in dementia risk for:

  • Antihistamines
  • Gastrointestinal antispasmodics
  • Antimuscarinic bronchodilators
  • Antiarrhythmics
  • Skeletal muscle relaxants

 

Our journal club group consisting of three psychiatrists, a psychiatric nurse manager and myself.  We discussed the reason for antihistamines not causing a significant increase in dementia risk.  

As a group, we came up with the following possible explanations:

The information obtained was from drugs dispensed. There is no way to determine if the patients ingested the medications.

Patients may not take antihistamines on a consistent basis. Many times they are only utilized for seasonal allergies or to help with insomnia.

  

Diphenhydramine is available over-the-counter and may not be included in the data obtained by the investigators.

The study also found the link between anticholinergics and dementia was stronger before the age of 80 and in those with vascular dementia as opposed to Alzheimer’s disease.

The increased risk of vascular dementia could be attributed to the anticholinergic agents increasing stroke risk.  

We know that antipsychotics increase the risk of heart disease and stroke as well as diabetes.

I want to point out that this study only looked at medications on the Beers list.

 This list is created by The American Geriatrics Society and lists drugs that should be avoided if possible in geriatric patients.

There are several medications that we often use which are not on this list. Almost all of the antidepressants, with the exception of paroxetine, are rarely used first line.  

Several antipsychotics are also not included. This will undoubtedly affect the study results.

The researchers concluded that there was an almost 50% increase in dementia risk in those who took an equivalent of one single strong anticholinergic medication daily for a three year period.

This leads us to the recommendation that anticholinergic drugs should be avoided when possible, especially in middle-aged and older individuals.

  Physicians and pharmacists should look for alternative agents that have fewer anticholinergic side effects in this patient population.11

I practice as a Clinical Pharmacy Specialist on a psychiatric unit which cares for dementia patients.

As a pharmacist on the unit, one of the first tasks I set out to achieve is to minimize the anticholinergic load of the patient.

I have noticed many patients taking anticholinergic medications unnecessarily.

My suggestion is always to eliminate any medications that are not critical to the patient’s health. This applies to all agents, not only anticholinergics.

There are times when anticholinergic drugs must be used. We can employ the strategies described above to reduce the side effects caused by these agents.

There appears to be an increased risk of developing dementia when taking these medications for an extended period of time.

My recommendation is to use anticholinergic drugs only when clearly indicated.

This applies to all individuals, regardless of age.

Sleep aids and allergy medications should only be used when symptoms are present. This also increases the effectiveness of the agents. The body can become tolerant, especially to sleep aids if used chronically.

The main lesson here is to minimize the use of medications possessing anticholinergic properties.

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.

 

 
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11 Awesome Nootropic Brain Booster Substances

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 if I told you it was possible to think more clearly, get more work done and feel more energetic by taking a few supplements?

Nootropics are “smart drugs” or memory enhancers. They may be natural supplements or prescription medications. These substances have the ability to improve memory, cognition, executive function and motivation in healthy individuals. I will present a few of these nootropic supplements in this post.

One or more nootropics are often taken together. This practice is known as “stacking”. By combining agents, a synergistic effect is obtained where the combined results are greater than the sum of the individual parts.

I get my nootropics from coffee, energy drinks, and the Sunshine Nutraceutical anxiety formula which I have a link to later in this post. My anxiety formula takes advantage of the stacking principle by combining Rhodiola, lemon balm, L-Theanine, passionflower, bacopa, St. John’s Wort, Vitamin B1, B5 and B6.

I am a firm believer in cognitive enhancers, including caffeine. Since I spend so much time working, I like to be as productive as possible. The substances listed in this post can make us all more efficient.

Rhodiola Rosea

Rhodiola Rosea, also known as golden root or arctic root, is an adaptogen which has been well studied.

Adaptogens can protect organisms from toxic, hypoxic, environmental, chemical, and infectious stressors, among others.

R. rosea grows in the high altitude northern regions of Canada, Europe and Asia.

This substance is currently in high demand due to its nootropic properties.

Scientists have extracted hundreds of compounds from the root of this plant, including organic acids, essential oils, phenolics, fats, and sterols.

1

Studies have suggested Rhodiola may increase levels of the neurotransmitters dopamine, norepinephrine, and serotonin.

 2

 3

4

 

 

 

This suggests Rhodiola may have the potential to help with anxiety and depression. R. rosea also helps limit the release of stress hormones such as cortisol during the fight-or-flight response.

 5

Rhodiola has demonstrated the ability to improve memory, attention and accuracy in high school and college students. It has also shown the ability to enhance physical performance.

 6

 7

 8

 9

A study conducted in 2009, suggested Rhodiola can also decrease mental fatigue

 10

The extracts used in the studies above were all well tolerated even in elderly subjects.

There have been no reports of significant drug interactions.

R. rosea does have a mild anti-platelet effect, so caution should be exercised when combining it with anticoagulants and other antiplatelet agents.

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Lemon Balm

Lemon balm (Melissa officinalis) is native to West Asia, North Africa and Europe. It is part of the mint family of plants. This herb has lemon-scented leaves and has been used to boost mood and cognitive function.

A small study, conducted in 2004, showed 600mg of lemon balm was able to improve the negative mood effects of the Defined Intensity Stressor Simulation (DISS) battery. 

The study subjects felt more calm and less anxious. The 300mg dose was shown to increase mathematical processing rates with no reduction in accuracy significantly.

 11

Sleep disorders and anxiety are common after coronary artery bypass surgery.

A double-blind, randomized placebo-controlled trial evaluated the efficacy of Melissa officinalis in improving these effects. The results showed an improvement of 49% in anxiety and 54% in sleep quality in the M. officinalis group as compared to the placebo group.

 12

A study published in 2006 demonstrated the efficacy of lemon balm and valerian to treat restlessness and sleep problems in children.

Nine hundred eighteen children were evaluated. The combination of these herbs was very well tolerated.

An improvement in dyssomnia occurred in 80.9% of the subjects and 70.4% had an improvement in restlessness13

A study conducted in 2019 found no difference between Lemon balm and placebo in treating agitation in forty-nine nursing home residents.

Thirty-nine of these subjects had dementia, and ten did not.

 14

Lemon balm has also been studied for its anti-cancer properties.

A study conducted in May of 2018 found both the leaves and stems of M. officinalis demonstrate cytotoxic effects. 

It appears the leaf extracts are more selective against cancer cells, whereas the stem extracts have higher cytotoxic activity against breast cancer cells.

Unfortunately, these stem extracts display less selectivity compared to healthy cells15

L-Theanine

L-Theanine (LT) was discovered in 1949 as a compound present in green tea. This substance can help with sleep, relaxation and the ability to focus. 

L-Theanine increases alpha activity in the brain and has a significant effect on mental alertness and arousal

16

LT may inhibit glutamine receptors. Glutamate is an excitatory neurotransmitter in the brain.

 17

 18

 It may also increase GABA concentrations in the brain. GABA is an inhibitory neurotransmitter. 

 These two actions lead to a calming effect and reduced anxiety.

 19

 A study of forty-six General Anxiety Disorder (GAD) patients published in March of 2019, found L-Theanine was no better than placebo in reducing anxiety.  

It should be noted that the patients in the LT group did report greater sleep satisfaction than the placebo group.

 20

A double-blind study of sixty patients with schizophrenia or schizoaffective disorder found anxiety symptoms in the L-Theanine group were significantly less than those in the placebo group.

These patients received 400mg  of L-Theanine or placebo daily over eight weeks

 21

Other studies have found L-Theanine can produce calming and anti-anxiety effects without causing sedation.

 22

Passion Flower

Passionflower has been used for anxiety, insomnia, ADHD, pain, menopausal symptoms and diabetes.

There are approximately 500 species of the genus Passiflora. These vine-like plants can grow up to five meters in height and produce bright, colourful flowers.

An Australian study found passionflower tea improved subjective short-term benefits in sleep quality. This was a small study with forty-one participants ages eighteen to thirty-five.

 23

Another study showed improvement in anxiety symptoms in patients scheduled for surgery. This occurred without inducing sedation

 24

More studies are needed to determine the potential benefits of passionflower.

Bacopa

Bacopa monnieri is a herb which has been used for centuries in Ayurvedic medicine. 

This is a holistic (whole-body) healing system developed in India. B. monnieri has been used either alone or in combination with other herbs as a sedative, memory enhancer, and anti-epileptic agent. 

Benefits of B. monnieri may be the result of its many closely related saponins. These vary only slightly in structure.

 25

Animal studies have shown Bacopa possesses cognition-enhancing effects such as improved motor learning.

 26

It has also been shown to improve memory retention in rats.

 27

Bacopa demonstrates great potential in treating cognitive disorders.

It may also prove to be beneficial in reducing oxidative damage and improving cognition in healthy individuals. 

More long-term studies are needed on Bacopa combined with other substances to determine if synergistic effects on cognition are possible. This herb does show great promise for the future

 28

Caffeine

Caffeine is one of my favourite subjects. In today’s society, we are constantly reminded of its existence.

There are Starbucks coffee shops on every corner, and we see coworkers drinking energy drinks at break time daily.

Caffeine is now put into Cliff bars and is found in soda pop.

We all know how caffeine makes us feel.

I use it mostly to help with concentration and focus. I can get more work done when consuming drinks containing caffeine.

There is a limit, though. Too much of this wonderful substance can make a person anxious and jittery.

It may also cause insomnia, and blood pressure and heart rate may increase.

It is essential to know your limit.

I have found most people believe dark roasted coffee has a higher caffeine content than lighter roasts.

This is not true. Coffee beans that are roasted for more extended periods contain less caffeine.

The heat of the roasting process destroys some of the caffeine.

There are plenty of charts available on the internet to reference for caffeine content of various foods and drinks.

A review of caffeine’s effects on cognitive, physical and occupational performance was published in 2016.

This review confirms what most of us already know:

  • Caffeine in doses up to ~300mg enhance many basic cognitive functions with limited side effects
  • The ability of caffeine to improve physical and cognitive functions is dose-dependent.
  • Physical performance enhancement generally requires a higher dose.
  • Caffeine is useful in improving physical and cognitive deficits associated with sleep loss.

 29

Caffeine is a great pick-me-up.

It has saved me several times after sleepless nights.

Be sure not to consume too much.

Like everything else in this life, moderation is key!

Ginkgo Biloba

Ginkgo Biloba has been used for thousands of years in Chinese medicine to treat memory and cognitive impairment.

This substance is one of the top-selling herbal medications available today.

 30

 31

 32

It also Improves blood perfusion,

 33

And can reduce reperfusion injury due to ischemia.

 34

Many studies have been conducted on G. Biloba.

A meta-analysis by Diamond and Bailey in 2013 found Ginkgo significantly improved executive function, memory, processing speed and fluid intelligence compared to placebo.

 35

An overview of the systematic reviews of Ginkgo biloba extracts (GBE’s) for mild cognitive impairment and dementia found clear evidence supporting GBE use in these conditions.

Adverse effects and severe side effects were comparable to placebo in these studies. 

 

G. Biloba may interact with antiplatelet drugs, calcium channel blockers, and some antidepressants

 36

Because of these interactions, I recommend speaking with a doctor or pharmacist before taking this supplement if you are currently being treated with prescription drugs. 

Ginkgo should be stopped two weeks before surgery to decrease bleeding risk. 

 

Ginkgo Biloba Drug Interactions

G. Biloba may interact with antiplatelet drugs, calcium channel blockers, and some antidepressants.

 37

Because of these interactions, I recommend speaking with a doctor or pharmacist before taking this supplement if you are currently being treated with prescription drugs. 

Ginkgo should be stopped two weeks before surgery to decrease bleeding risk. 

 

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Citicoline

Citicoline was first developed in Japan for the treatment of stroke. This substance is a naturally occurring chemical present in the brain and sold as a dietary supplement in the US. 

It can be used for dementia, stroke, Parkinson’s disease, and memory loss. 

Citicoline works by increasing levels of phosphatidylcholine in the brain.

 It may also limit tissue damage occurring from a brain injury.

Some small studies have shown citicoline to be beneficial in Alzheimer’s Disease (AD) patients.

 38

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 41

Observational studies have also demonstrated the effectiveness of citicoline in AD patients over a nine month period.

 42

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More studies are needed to confirm citicoline’s effects on healthy functioning individuals.

Racetams

Aniracetam, piracetam and pramiracetam are synthetic substances belonging to a group known as racetams. 

These may act as stimulants and can improve memory and concentration. 

They may also prove to be useful for the treatment of ADHD in the future. 

Piracetam was the first racetam synthesized. It is the least potent racetam available. 

Since then, stronger and more effective molecules have been produced. 

Most studies have been performed in animal models and patients with mental conditions such as stroke, dementia, and schizophrenia.

 Aniracetam seems to be the most effective of the racetams for decreasing anxiety and depression. This has been shown in animal studies.

 44

Racetams modulate the function of acetylcholine and glutamate receptors. 

These chemicals may release brain-derived neurotrophic factor (BDNF) which may convey neuroprotective properties.

 45

A randomized, double-blind, placebo controlled trial was conducted in 1987 on 225 children ages seven to twelve with dyslexia. This study showed piracetam improved reading ability significantly. It was well tolerated and no serious side effects were noted.

 46

 

Creatine

Creatine is a substance found in the muscles and brain. 

It has gained popularity as a supplement to help increase muscle mass, enhance strength and improve performance in athletes. Creatine also has nootropic properties. 

It has the function of helping to produce energy for cells by aiding in the formation of adenosine triphosphate (ATP). 

  A systematic review of six studies conducted in 2018 found creatinine may improve intelligence and reasoning as well as short term memory in healthy human subjects.

Results were conflicting regarding other cognitive domains.

 47

It is known that the brain uses large amounts of ATP when performing demanding tasks.

 48

 A study in 2007 showed creatine supplementation in elderly individuals improved cognition.

 49

 It may also improve brain function, limit the loss of muscle and strength, and protect against neurological diseases in this population.

 50

 

Creatine has been shown to be safe in doses up to five grams per day. Larger doses, although effective, have not been adequately studied for long-term safety.

 51

Panax Ginseng

Panax Ginseng has been used in traditional Chinese medicine since ancient times. Its original use was for boosting the immune system and increasing energy and stamina.

This herb was shown to improve cognitive performance and decrease fatigue in healthy adults.

 52

It is unknown how Ginseng improves brain function.

One thought is it may protect the brain from oxidative stress due to its potent anti-inflammatory effects.

 53

There have been studies suggesting the body may adapt to ginseng after a few months of use.

More research is needed to determine the long term benefit of this herb for cognitive enhancement.

 54

 

Final Thoughts

I have covered eleven nootropics in this post. I believe most of these substances can be beneficial if used correctly.

Initially, I had planned to cover nootropic stacks here as well. Since there is so much information on that topic, I have decided to write a separate post on nootropic stacking. Look for it in the next couple of months. When finished, I will include a link to it in this post.

As mentioned earlier, I do consume nootropics daily — coffee and energy drinks, as well as the Sunshine Nutraceutical anxiety formula. Just remember not to consume too much of any of these products. More is not always better.

Always have a happy, healthy, healing life and be sure to contact me with any questions or comments.

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.

 

 
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Apple Cider Vinegar Genital Wart Removal, Weight Loss, Sebaceous Hyperplasia, And More Surprising Uses

Posted on by sunshineneutraceuticals

Are you ready to get your hands on one of the hottest supplements available today?

 

Apple cider vinegar (ACV) has traditionally been used in cooking, but is currently a popular health food supplement. It has many different uses. In this post, I will discuss some of the possible applications. ACV is available in liquid and capsule form. Sunshine Nutraceuticals has an ACV capsule preparation available for purchase on this website.

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.

Diabetes

Individuals with type-2 diabetes have increased blood sugar levels due to their decreasing capacity to secrete insulin or an increase in insulin resistance.

 1

A systematic review was conducted in 2018 to evaluate the effects of vinegar on blood glucose control. The focus was on both short-term and long-term effects.

 

This study found vinegar did have a statistically significant effect on long term blood sugar levels as measured by HbA1c. The reduction was small (-0.39%)

 

Short-term outcomes were only statistically significant at 30 minutes. These showed the postprandial (after meal) glucose levels to be almost one mmol/L lower than the control group.

 

Vinegar does seem to have a positive effect on blood glucose levels in patients with type-2 diabetes. More studies are needed to determine its usefulness as an adjunctive agent in these patients.

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Weight Loss

Apple cider vinegar has been used as a weight-loss agent. There have been small studies supporting this. A review of 175 obese individuals in 2009 showed daily supplementation with ACV led to weight loss and a decrease in fat mass as well as triglycerides:

 

15ml – loss of 2.6 lbs

30ml – loss of 3.7 lbs

 

This occurred over twelve weeks, so it is not a rapid weight loss.  ACV may have a positive effect on weight loss when used in addition to a well-balanced diet and exercise3

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Genital warts

Genital warts are caused by the human papillomavirus or HPV. This is a sexually transmitted disease. Warts generally appear in the pubic region and are small, pink or grey, fleshy growths. 

 

Apple cider vinegar can be used to treat genital warts. A cotton ball or Q-Tip can be soaked in the vinegar and then applied to warts. A waterproof bandage is then placed over the wart after the application. 

 

It may take up to three weeks for warts to disappear. ACV contains acetic acid, which helps to kill the virus. If warts remain after three weeks, a physician should be consulted.

Gargle For Sore Or Strep Throat

Streptococcus pyogenes is a bacterium that causes strep throat. This condition usually presents with a sore throat and painful swallowing. Other symptoms include:

  • White spots in the throat
  • Fever of 101 degrees or higher
  • Swollen tonsils
  • Headache
  • Loss of appetite
  • Lethargy

Apple cider vinegar can kill bacteria in the throat due to its acidity. ACV should be diluted before gargling. One teaspoonful (5ml) should be mixed with 8 ounces of water. A teaspoonful of salt may also be added, and the mixture warmed.   ACV may also help soothe a sore throat.

I strongly suggest seeking medical care if your sore throat is accompanied by a high fever or the other symptoms listed above. The doctor can do a quick test to determine if you have strep throat. If you do, antibiotics can be prescribed to alleviate the infection. 

Strep throat can make you very sick if not properly treated. This is especially true in pediatric and geriatric patients, as well as patients who are immunocompromised.

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Tinea Versicolor

Tinea versicolor is a fungal infection of the skin caused by an overgrowth of yeast. This yeast is known as Malassezia furfur. This condition commonly affects teens and young adults.

 

  Symptoms of tinea versicolor include:

 

  • Itching
  • Scaling of the skin
  • Skin patches that are discoloured and appear darker or lighter than usual
  • Usually occurs on the chest, neck, back and upper arms.

The risk of contracting tinea versicolor increases in hot and humid climates. Individuals who sweat a lot also have a higher risk.

 

It is best to have a physician confirm the diagnosis of tinea versicolor. Other, more severe skin conditions have similar symptoms. A physician may look at the scaly patches using an ultraviolet light or may view a skin sample under a microscope to confirm the diagnosis.

 

ACV helps to control the growth of the fungi. It can be useful if rubbed on the affected skin after diluting with equal parts of water. Oral ACV capsules may also help by controlling the gut flora.

Sebaceous Hyperplasia

Sebaceous hyperplasia is a condition of the skin characterized by small yellowish bumps usually occurring on the face.  Occasionally, they may be found in the groin area, armpits, back, shoulders or on the nose. 

 

The sebaceous glands in the skin secrete a protective oily substance known as sebum. When sebum becomes trapped inside the gland, the buildup of sebum forms a bump. These bumps have a depression in the center, unlike acne pimples. 

 

This skin condition is most common in people over the age of 40 with fair skin.  Overexposure to sunlight is known to facilitate this ailment. Sebaceous hyperplasia is harmless, but the patient may feel the need to treat it for cosmetic reasons.

 

Apple cider vinegar can be used to treat sebaceous hyperplasia. Soak a cotton ball in ACV and gently dab it onto the bumpy areas of the skin. ACV can prevent as well as manage the condition. It works by balancing the pH of the skin and helping to dissolve the bumps. 

 

ACV may also be mixed with peppermint oil. This may help clean out the unwanted sebum as well as reduce inflammation.  If you do not see any changes within a week, consider visiting a doctor or dermatologist.

Athletes Foot

Many believe soaking their feet in a mixture of vinegar and water can cure athletes foot. This will not harm your feet, but there isn’t enough scientific evidence to prove its effectiveness. 

 

It is possible that cleaning your feet and keeping them dry after the soak is what helps cure the athlete’s foot. I have always had the best luck with clotrimazole.

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Actinic Keratosis

Actinic Keratosis (AK), or solar keratosis is the most common precancer which develops on the skin. It is caused by long-term exposure to UV radiation from the sun or indoor tanning salons. 

 

AK results in rough, scaly patches on the skin’s surface.  This condition progresses to squamous cell carcinoma (SCC) in about 5-10% of cases. 

 

The best way to prevent this condition is to limit sun exposure. It is also best to avoid tanning beds. Be sure to wear proper clothing when engaging in outdoor activities.

 

If you suspect you have actinic keratosis, consider visiting your physician. They will be able to determine whether SCC is present. Yearly check-ups are suggested.

 

Proper diet is essential to maintain healthy skin. People with AK should be sure to get enough vitamin A and zinc in their diet. Omega-3 oils, as well as fatty acids, are also helpful.

 

ACV can be dabbed onto the skin using a cotton ball to help relieve the dryness in AK.  The treated area should be covered tightly with a waterproof bandage overnight. This must be done regularly to be effective.

Granuloma Annulare

Granuloma Annulare is a skin condition that is often mistaken for ringworm. It usually causes a rash and is not contagious. The cause of this condition is not known, but it can be triggered by:

 

  • Exposure to the sun
  • TB skin tests
  • Some drugs
  • Animal or insect bites
  • Vaccinations
  • Some skin injuries

 

Some reports are suggesting ACV can be helpful for this condition. Although apple cider vinegar can be tried, I was not able to find evidence to support its use. 

 

If this condition does not resolve after a few months, or it is bothersome, I suggest visiting your doctor.

 

There are creams available by prescription that can help the condition heal more rapidly.  

Side Effects of Apple Cider Vinegar

Apple cider vinegar does have side effects, especially if used chronically. Some of these include:

 

  • Burns and irritation if applied to the skin undiluted
  • Erosion of tooth enamel
  • Hypokalemia (low potassium level in the blood)
  • Delayed gastric emptying
  • May cause a decrease in appetite
  • Esophageal burns (when used in an undiluted form)
  • May interact with some drugs (digoxin, diuretics, some anti-diabetic agents) 

Apple cider vinegar is being used for a variety of health-related benefits. It is thought to help control blood sugar, aid in weight loss, help reduce itching from bug bites and bee stings, and ailments described above.

 

I do believe ACV is a beneficial supplement when appropriately used. It is important to dilute the liquid product before ingestion to prevent burns. The capsules may be taken whole.

 

As with any supplement, ACV is not intended to be a replacement for traditional health care. I recommend visiting your doctor yearly for a check-up. 

 

If you suffer from any of the conditions discussed in this post, and they don’t resolve, or get worse after using ACV, a physician should be consulted.

 

This blog is about living a happy, healthy, healing life. Supplements can help us to achieve that goal. Remember to use common sense and always eat right, exercise, and get plenty of sleep.

 

If you have any questions or comments, please feel free to contact me. I would be happy to answer questions or give my opinion on any subject.  

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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.

 

 
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Nature’s Aphrodisiac Horny Goat Weed; History, Uses, Side Effects and Interactions

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.

Horny goat weed is a perennial herb. Its scientific name is epimedium grandiflorum.  This plant is from the Berberidaceae family and is found in the high elevations of Asia. There are approximately 50 species in this plant family, and most possess similar qualities.

 

 Horny goat weed is also known as Yin-Yang-Huo, bishop’s hat, fairy wings, and arrow-leaf barrenwort. This herb has historically been used as an aphrodisiac and to treat impotence and premature ejaculation in men

 1

The substance known as icariin is thought to be the active ingredient in horny goat weed. Icariin is a flavonoid and possesses antioxidant properties. It has also been used in China, Japan and Korea to support the kidneys and improve circulation.

History of Horny Goat Weed

Horny goat weed received its name from a Chinese goat herder. The goats would become sexually excited “horny” during certain times of the year. After closely monitoring the goats, the herder discovered the behaviour occurred while the goats were feeding on a particular type of flowering plant. This plant later became known as horny goat weed. 

Horny Goat Weed Uses

Treatment of Erectile Dysfunction (ED) and Improvement of Libido

Icariin has shown weak phosphodiesterase 5 (PDE-5) inhibitor effects in vitro (outside of the body).  This is the mechanism of action of the prescription drug sildenafil (Viagra) for treating ED.

 2

It should be noted that Viagra is approximately 80 times more potent than icariin as a PDE-5 inhibitor and has FDA approval for erectile dysfunction.

 

Icariin can increase levels of testosterone in the bloodstream.3

Increased levels of testosterone increase sexual desire in both men and women as they age, so horny goat weed could help with diminished libido when used as a supplement.  

Atherosclerosis (Hardening of the Arteries)

Atherosclerosis is the buildup of fatty deposits (plaque) adhering to the walls of the arteries. This plaque can reduce blood flow through the vessels of the body. This plaque hardens over time. Pieces of the plaque may break off, causing a stroke or a pulmonary embolus.

 

In a study published in 2017, Fang et al. concluded icariin possesses antioxidant, anti-inflammatory, and lipid modulating effects. These properties may prove useful in the treatment of atherosclerosis in the future. 4

Icariin has also been found to reduce the total serum cholesterol, LDL cholesterol (the bad type), and atherosclerotic burden in rabbits fed a high cholesterol diet.5

Possible Adjunct in the Treatment of Cancer

Icariin has been shown to enhance the antitumor activity of gemcitabine in gallbladder cancer. The combination of gemcitabine and icariin resulted in significantly smaller tumor size in mice than either drug used alone.6

 

Icariin inhibited cell growth and induced apoptosis in Burkitt lymphoma cells. More research is needed to ascertain the exact mechanism by which this effect can be explained.7

 

Icariin may also be beneficial when added to arsenic trioxide in the treatment of hepatocellular carcinoma. This cancer type is aggressive and arsenic trioxide has a very narrow therapeutic window which reduces its benefit.8

Treatment of Osteoporosis

Osteoporosis is a disease characterized by weak bones. Progressive bone loss leads to fractures. This is most common in the elderly population and patients receiving chronic steroid therapy. Icariin has been used in traditional Chinese medicine for centuries in the treatment of bone fractures. 

 

In an article published in 2018, Wang et al. concluded icariin may be used as a future treatment for postmenopausal osteoporosis. This is based on its bone-promoting activity.9

 

Icariin also appears to inhibit osteoclasts, which are bone cells that break down bone tissue. This action would also be a positive attribute in the treatment of osteoporosis.10

 

Effects on Alzheimer's Disease and Dementia

Dementia is a failure of the brain. Patients with dementia lose the ability to remember things, become progressively confused and eventually will be dependent on others for their total care. 

Although the exact cause of dementia is unknown, we know that stroke can lead to vascular dementia.   Protein deposits cause Lewy body dementia in the brain. 

Click Here to read my Lewy Body Dementia Post

 

The most common form of dementia, Alzheimer’s disease, is thought to be at least partially caused by beta-amyloid plaque formation in brain tissue.

Icariin has been reported to have significant effects on Alzheimer’s disease. This may be accomplished by regulating calcium homeostasis, inhibiting hyperphosphorylation of tau protein and anti-inflammatory effects.11

Menopause symptoms

Icariin has been shown to promote estrogen biosynthesis in vitro, which may explain its positive effect on postmenopausal woman.12

 

In a study by Yan, et al. published in 2008, icariin was found to lower total cholesterol and triglyceride levels.  It was also found to significantly increase estradiol levels leading to the conclusion that icariin may benefit post-menopausal woman.

13

Horny Goat Weed Side Effects

Breathing problems may result if high doses of horny goat weed are ingested. If you experience any trouble breathing, stop taking the supplement and consult a physician

As with any drug or supplement, allergic reactions are possible.   The allergy may be due to the active ingredient or any substances used in the production process.  If you experience hives, itching, a rash or breathing problems, stop the supplement.  If these symptoms are severe, consult a physician.

Stomach upset, or vomiting may occur. These effects may be transitory, but if they persist or are problematic, the supplement should be discontinued.

Dry mouth and excessive thirst may be experienced, especially at high doses.  These side effects are generally mild.

Changes in mood, sweating, racing heartbeat and hypotension are listed as side effects to horny goat weed in some references.

Drug Interactions

Reliable information regarding drug interactions with horny goat weed is lacking.  If you are taking prescription medications, always consult a doctor or pharmacist before starting any dietary supplement.

Horny goat weed contains icariin, which is a flavanol glycoside compound. This substance has been studied for multiple medical conditions.

 It appears to be useful as an erectile dysfunction agent.  It is less potent than prescription drugs used to treat ED. Icariin may build up over time, so it may be more effective if used chronically.

Icariin also shows promise for the treatment of some cardiac disorders, osteoporosis and dementia.  It may also be useful as an adjunct combined with chemotherapeutic agents in some types of cancer.

 

Horny goat weed is well tolerated.  I have personally used this substance and have suffered no adverse effects.  I am most interested in its use as a cognitive enhancer and its possible impact on dementia.  I do offer this supplement in the Sunshine Store if you would like to give it a try.

CLICK TO PURCHASE HORNY GOAT WEED

Michael Pharmacist

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

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Hemiplegic Migraine Causes, Treatment, Triggers And Disability

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.

Hemiplegic migraine is a severe headache which leads to weakness on one side of the body. As is typical with other migraine headaches, nausea and light sensitivity are also present.  The average frequency of these headaches is three per year.   Some patients experience a few hemiplegic migraines during a lifetime while others get them up to 250 times per year. 

The symptoms of this headache type may lead the sufferer to believe they are having a stroke. The standard stroke symptoms are:

  • Numbness on the side of the body affected
  • Drowsiness
  • Dizziness
  • Visual disturbances, also known as an aura
  • Slurred speech or other speaking difficulties
  • Tingling or numbness on the face, arm or leg of the affected side of the body

In severe cases, patients may need to be hospitalized due to high fever, changes in consciousness or seizure activity.

Two Types Of Hemiplegic Migraine

Familial Hemiplegic Migraine

This type of migraine runs in families and can persist for several generations.  Familial hemiplegic migraine is an autosomal dominant form of migraine. This means the patient may get the abnormal gene from only one parent. It is common for only a single parent to suffer from hemiplegic migraine.

 The following genes are associated with hemiplegic migraine:

  • ATP1A2
  • CACNA1A
  • PRRT2
  • SCN1A

 Mutations in these genes affect neurotransmitter release in the brain. Mutated genes interrupt communication between nerve cells. This lack of communication may lead to visual disturbances and severe migraine headaches.

CLICK HERE

Sporadic Hemiplegic Migraine

This type happens to only one individual and is not passed down to future generations. This migraine type is rare. If you experience weakness or other stroke symptoms described above with your headache, seek immediate medical attention.  The headache may be a symptom of a more severe disorder.

Both types of hemiplegic migraine typically begin in childhood. The diagnosis may be difficult because other conditions such as stroke and certain seizure types have similar symptoms.

Patients should visit a neurologist who will obtain a thorough family history, perform imaging tests of the brain and get lab tests as necessary.

Hemiplegic Migraine Triggers

The triggers for these migraine types are thought to be similar to those of other migraines. These triggers include:

  • increased stress
  • consuming caffeine and alcohol
  • intense emotions
  • sleep disturbances
  • not eating regular meals
  • certain food types: processed foods, salty foods, aged cheeses, chocolate, and foods with added MSG
  • changes in the weather
  • bright or flashing lights

It is essential to be aware of the triggers that cause the headache as the most effective treatment for this condition is prevention.

Hemiplegic Migraine Treatment

Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin) and naproxen (Aleve) can be used for acute pain relief. If the pain does not respond to NSAIDS, narcotic analgesics such as Norco (hydrocodone/acetaminophen) or oxycodone may be utilized. 

 Ondansetron can be used for nausea associated with hemiplegic migraine.

 Intranasal ketamine has been shown to decrease the severity and duration of visual disturbances associated with hemiplegic migraine.1

Ergotamines and triptans should not been used for hemiplegic migraine. The FDA has mandated that package labelling for ergotamines (DHE) and triptans (Imitrex) state a contraindication for use in basilar and hemiplegic migraine. This is due to their vasoconstrictive properties, which may lead to vessel spasm and concerns about precipitating a stroke.

  A small study conducted by Mathew et al. in May of 2016 stated the following: BM refers to basilar migraine and HM refers to hemiplegic migraine in the following study conclusion:

“in this retrospective study, triptans and DHE were used with no reported, subsequent acute/subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic-type features. Although the small sample sizes generated theoretical statistical event rates of 4.5% for BM and 23% for HM, there has been no clear evidence that BM and HM carry an actual elevated risk for vascular events compared with migraine with aura”.

2

This study raises the possibility of utilizing triptans and DHE in the future for hemiplegic migraine treatment. More studies are needed to confirm the safety of these agents for the treatment of this condition.

Prevention

Hemiplegic migraines can be debilitating. If these headaches occur often, it may be necessary to take daily prophylactic medication. There are no randomized controlled trials for hemiplegic migraine prevention, but there are some case reports available. The following drugs have the best evidence for hemiplegic migraine prevention at the current time:

Verapamil

Verapamil has been studied in a limited number of patients for the treatment and prevention of hemiplegic migraine. Four patients with sporadic hemiplegic migraine were given verapamil 120mg one to three times daily. The attacks resolved within two months in two of the patients. A third patient had greater than 50% reduction in headache severity and frequency,

and the fourth patient improved with 5mg verapamil IV followed by 120mg PO verapamil daily. The verapamil had to be discontinued in this patient due to side effects, and the headaches slowly returned to baseline frequency.

3

  It is important to note that other studies have found little to no benefit of verapamil for hemiplegic migraine treatment. 4

Flunarizine

Flunarizine has some evidence for its use in hemiplegic migraine but is unavailable in the United States and Japan.  It is a calcium channel blocker and was originally used to improve blood flow.  It is marketed as the brand name Sibelium.

5

Acetazolamide

Acetazolamide is a medication that has many uses.  It can be used as a “water pill” to help the body excrete excess fluid.  It is used for glaucoma, some types of seizures, and can also be used to prevent altitude sickness in mountain climbers.

Acetazolamide was shown to improve hemiplegic migraine in several case reports. Acetazolamide was dosed at 250 mg twice a day in these studies.

6 7 8

Lamotrigine

Lamotrigine is an anticonvulsant medication used to treat certain types of seizures. It is also used to treat bipolar disorder. Lamotrigine must be started at low doses and titrated to the target dose slowly due to the danger of life-threatening rashes.

Lamotrigine showed benefit in a majority of patients suffering from migraine with aura in a case series of 47 patients. In this study conducted in 2004,  Lamotrigine was reported to be beneficial in the majority of patients, including two who had hemiplegic migraine.

9

In other studies, lamotrigine has had mixed evidence regarding its usefulness in decreasing migraine attack frequency and intensity.

10 11

Based on the data above, the drugs with the best evidence for hemiplegic migraine prevention are verapamil and acetazolamide. Flunarizine may also be used if available. If these agents are ineffective, lamotrigine is an alternative, although evidence is limited to support its use in this condition.

Hemiplegic Migraine Disability

Patients who suffer from hemiplegic migraine headaches may qualify for social security benefits. The Social Security Administration (SSA) does not specify exact guidelines to qualify for benefits regarding migraines.  If you can prove that your headaches prevent you from performing necessary work duties regularly, you may be eligible for SSA benefits.

Some factors the SSA will take into consideration are the following:

  • Ability to concentrate
  • Ability to walk, stand, and lift items
  • Ability to interact with other employees
  • Ability to understand instructions

It is critical to convey the frequency and duration of attacks and the symptoms experienced, which limit the ability to perform any job.

The SSA will also evaluate the severity of the headaches, other medical conditions present, and how often the conditions keep the individual from performing a job.  

This is accomplished by evaluating medical records and a functional report completed by the patient and physician.  It is essential that this form contains a detailed description of how headaches affect job performance.

Keep in mind that the SSA will make their determination based on the ability to perform any full-time job, not necessarily the current position held. If the SSA determines the patient is capable of holding a full-time position, the claim will be denied.




Hemiplegic migraine is a rare condition that can be detrimental to a patient’s life. There are two types, familial which is the genetic form and sporadic. Both types have symptoms similar to a stroke.  If this is a new condition experienced, the sufferer should seek medical attention immediately.

As with classic migraines, there are triggers which may cause headaches. Hemiplegic migraines can be challenging to treat. 

For this reason, I suggest keeping a headache journal. Keep track of activities and food intake before the headache occurred. If specific foods, drinks or activities are found to precipitate migraines, these can be avoided in the future. 

Pay attention to the time of day the headaches occur.  Are there more headaches at different times of the year or when the weather changes?  Do the headaches seem to happen after experiencing loud noises or bright lights?  This information can be important in helping reduce the number of attacks.

Some patients may experience debilitating headaches frequently. It may not be possible for these individuals to perform primary job duties.  It is possible to qualify for SSA disability benefits in some cases.  

As with any medical condition, if the headaches become debilitating, seek medical attention. There may be medications available that can help patients live happier, healthier lives.

Michael Pharmacist

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


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