Category: Diseases and Disorders

Michael J. Brown, RPh, BCPS, BCPP

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

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Home Remedies for Trigeminal Neuralgia

Posted on September 4, 2022September 4, 2022 by Michael Brown

Do you suffer from trigeminal neuralgia (TN)?

Are you looking for a home remedy to help with the symptoms?

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerves in the face. These nerves, also called the 5th cranial nerves, are composed of three branches. The three branches V1(ophthalmic), V2(maxillary), and V3(mandibular) are responsible for transmitting nerve impulses from the face to the brain. They also assist with motor functions such as chewing. Trigeminal neuralgia, also known as Fothergill’s disease, usually occurs in those fifty years of age and older and is more common in females.

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Trigeminal Neuralgia Symptoms

Electric shock-like feeling on one side of the face.
Pain may be caused by applying makeup, brushing teeth, chewing, or touching the face.
Painful attacks may become more frequent and worsen over time.
Pain attacks may last from seconds to a few minutes.
Pain that doesn’t respond to traditional pain medication.
Light sensitivity.
Spontaneous facial pain.

Causes of Trigeminal Neuralgia

We are not certain as to what causes trigeminal neuralgia. We think it is the result of trigeminal nerve compression. Blood vessels can press against the nerve and if the nerve is damaged, pain may occur. Other possible causes are:

Facial trauma.
dental procedures.
Tumors or cysts.
Malformed blood vessels.

Trigeminal Neuralgia Treatment

Medications: Traditional painkillers such as acetaminophen and ibuprofen are generally ineffective against trigeminal neuralgia. Prescription medications are often utilized, specifically anticonvulsants. These include:

Carbamazepine (Tegretol)

Phenytoin (Dilantin)

Gabapentin (Neurontin)

Topiramate (Topamax)

Side Effects of Anticonvulsants: The main side effects of these types of medications are drowsiness, dizziness, nausea, and fatigue. Please consult your physician or pharmacist for more specific information.

Surgical Treatment: There are several surgical options available to treat trigeminal neuralgia.

Microvascular Decompression Surgery (MVD): This procedure works by inserting a cushion between the vessel and part of the trigeminal nerve. An incision is made behind the ear and a small portion of the skull is removed. This procedure helps approximately 80% of sufferers and is thought to be the longest-acting treatment. Risks of MVD include:

Hearing loss
Facial numbness
Bleeding
Infection
Paralysis
Leaking of CSP

Rhizotomy: This is an outpatient procedure and is also effective in about 80% of patients. The patient is placed under general anesthesia and a hollow needle is placed through the cheek. The affected nerves are treated with heat (electrical current) or chemicals (glycerin or glycerol). This procedure takes about 30 minutes and pain relief is immediate.

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Prevention: If you know things that cause trigeminal neuralgia flare-ups, avoid them. Examples include windy weather, spicy foods, and rubbing certain areas of the face. Keep a food diary to determine if particular foods can cause pain. Some common culprits are bananas, caffeine, and citrus fruits. Hot and cold liquids can also cause flare-ups. If this happens, using a straw might help.

Medical History and Neurological Exam: One of the best ways to help trigeminal neuralgia pain is to remove the underlying cause. To discover the source of the electric shock-like pain, a medical history should be obtained. Other disease processes such as diabetes can lead to nerve pain and make the symptoms of trigeminal neuralgia worse. A complete neurological exam can help to differentiate trigeminal neuralgia from other types of neuropathic pain conditions.

Electrical Stimulation: Transcutaneous Electrical Nerve Stimulation (TENS) and Transcranial Magnetic Stimulation (rTMS) are treatment options that use electrical current to block pain signals transmitted by damaged nerves. These options are non-invasive, well-tolerated, and can be a good option for trigeminal pain management.

Topical Pain Relievers: Topical agents have the advantage of working locally. This typically leads to fewer side effects. There are several creams, ointments, patches, and rubs that can be used to treat painful episodes. In the hospital where I practice, we use lidocaine ointment and patches, Diclofenac gel, and menthol creams for pain relief.

Nutritional Supplements: Several natural products can help relieve nerve pain. When selecting a pain management strategy, side effects are important. I believe natural supplements should be tried before prescription medications because the side effects of anticonvulsants are usually more severe and can negatively affect the quality of life.

Turmeric: Turmeric contains curcumin which has been shown to help with pain and inflammation. This includes nerve pain. Curcumin may promote the regeneration of nerves after nerve injuries. Curcumin has also been shown to inhibit nerve pain transmission.¹

Another study showed that curcumin can promote nerve regeneration after nerve fibers are damaged.²

Trigeminal neuralgia is a painful condition that can interfere with daily activities and diminish the quality of life. The intense pain of trigeminal neuralgia can be treated with anticonvulsant medication, topical pain relievers, and turmeric. There are also outpatient and inpatient surgical procedures available. Electrical stimulation is a less intrusive option and may also be effective. Always remember to consider natural remedies such as acupuncture as well.

I believe it is always prudent to try natural remedies and nutritional supplements before prescription medications and surgical procedures whenever possible. The side effects of medications and the surgical risks can be extensive.

If you think you may be suffering from trigeminal neuralgia, it is a good idea to visit a neurologist. Review your treatment options and pick the one that best fits your situation. If you have any questions about this topic or any other health and wellness issue, please feel free to contact me using the author box below. I am always willing to help.

Thank you for reading this blog post and enjoy a happy, healthy life.

Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

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9 Useful Tools For Anxiety Relief

Posted on July 23, 2021June 25, 2022 by Michael Brown

We have all experienced anxiety during our lives. Most of us are able to cope with stress and anxiety but it can become problematic and may even cause other more serious medical issues. In this post, I am going to give you 9 ways to obtain anxiety relief without drugs. Most of these techniques can be learned quickly and some you may already know.

1. Take A Walk

One of the quickest and easiest ways to reduce stress and anxiety is to remove yourself from the current situation. I like to take a quick walk outside when possible. Just breathing fresh air can really help. Take some time to appreciate nature. Pick up a leaf and notice how remarkable nature can be. Walk to a river or stream and just watch and listen to the running water. Taking a walk not only helps with anxiety but can also improve blood flow to your brain and help you think more clearly.

2. Exercise

Exercise is one of the best weapons against stress and anxiety. It is so important that it is one of my five pillars of health. We all know the many benefits of exercise. If you find yourself experiencing stress and anxiety, make time for physical activity. It is important that you pick a form of exercise you enjoy. If you don’t like the activity, you probably won’t stick to it. I recommend setting aside at least 30 minutes a day, five days a week for exercise.

3. Be Sure to Get Plenty of Sleep

Sleep is also one of my five pillars of health. I have found that if I don’t get enough sleep, I become more easily stressed and my anxiety level increases. Most of us need at least seven to eight hours of sleep per night. This will vary depending on the individual. When we are under stress, our bodies need more sleep. Be sure to practice good sleep hygiene as well.

4. Watch What You Eat

5. Avoid or Limit Alcohol

Drinking alcohol can make anxiety and stress much worse. It can decrease sleep quality and using it to relax can backfire. Click here for a more in depth discussion on why you should avoid drinking alcohol.

6. Just Breathe

The quickest and easiest way to reduce anxiety is to concentrate on your breathing. I like to use square breathing. Breathe in for 3 seconds, hold your breath for 3 seconds, breath out for 3 seconds, hold your breath for 3 seconds, and repeat as many times as necessary. This takes your mind away from whatever it is that is causing the stress.

7. Stay Positive

I believe positivity can improve almost anything. Always remember that things can always be worse. Think of what you are grateful for and consider keeping a gratitude journal. Writing these things down can improve happiness and reduce anxiety.

8. Be Careful With Caffeine

Coffee and caffeinated beverages can keep you alert, but too much caffeine may make stress and anxiety worse. Know your limits. Be sure to stop drinking caffeine several hours before going to sleep.

9. Consider Natural Supplements

Our Anxiety Formula is specifically designed to help reduce the symptoms caused by stress and anxiety. Order yours today by clicking on this link.

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.

Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

Three Specific Types of Eating Disorders, Signs, Symptoms, Risk Factors, and Treatment

Posted on October 29, 2020December 31, 2020 by Michael Brown

Do you or someone you know have an eating disorder?

What are the most common types of eating disorders?

What are the treatments available for eating disorders?

This post will concentrate on the three most prominent eating disorders. These include

Anorexia nervosa (AN)
Bulimia nervosa (BN)
Binge eating disorder (BED

We will explore these disorders one at a time. The most important thing to remember is that getting professional help is crucial if you suffer from any of these conditions. All of these disorders can progress to death if not treated.

Anorexia Nervosa (AN)

Anorexia is probably the most well-known eating disorder. Although estimates vary based on the study, it is estimated that the lifetime prevalence rate of AN is 0.8%.¹

It is important to note that eating disorders are often underreported in the literature because many with these conditions do not seek treatment.

Patients with anorexia have significantly low body weight in relation to age, sex, and physical health. These individuals have an intense fear of gaining weight and becoming fat. They also underestimate the seriousness of their low body weight and have a distorted view of their body shape. There are two types of anorexia.

Restricting type – The patient has not regularly engaged in binge eating or purging in the last three months.
Binge eating/purging type – The patient has regularly engaged in binge eating or purging in the last three months.

Signs and Symptoms of Anorexia

The signs and symptoms of anorexia can be split into three specific categories, as follows:³

Psychiatric symptoms:

Preoccupation with food, cooking, and nutrition
Fear of weight gain
Restlessness
Social isolation and withdrawal
Ritualistic behaviors
Irritability

Many of these patients also suffer from other psychiatric disorders such as depression, anxiety, or obsessive-compulsive disorder.

Eating Behaviors:

Water loading.
Vegan and vegetarian diet.
Skipping meals.
Calorie restriction.
Cutting food into small pieces.

Physical Signs:

Underweight, emaciated
Constipation, abdominal pain
Lethargy
Dry skin, brittle nails
Yellowish skin
Electrolyte imbalances
Hypoglycemia
Infertility, premature births
Bradycardia, hypotension, cardiac arrhythmias
Osteoporosis

Risk Factors for Developing Anorexia

Genetic factors – Some studies suggest genetics may be a factor in the development of anorexia.

Diabetes
Emotional Stress – There is a link between emotional stressors such as the death of a loved one or divorce of parents and the development of AN.
Parental pressure regarding achievement and appearance.
Participation in sports that are associated with thinness, such as ballet, wrestling, or running.
Peer pressure and social media – Young teens are often bombarded with perceived success based on unrealistic body images.
Age – Peak onset is early to mid-adolescence.
Gender – Lifetime prevalence in females is 0.9% and only 0.3% in females.⁴

Treatment of Anorexia Nervosa

Treating anorexia should be accomplished using a team approach. Physicians, nurses, dietitians, therapists, and other health professionals with experience treating eating disorders should be employed.

A dietician should provide nutritional rehabilitation to avoid refeeding syndrome. This is done by slowly increasing the patient’s weight.

The most effective treatment for anorexia in adolescents and young adults is family-based psychotherapy.

The use of medications in the treatment of AN is controversial and should not be started until the patient has gained sufficient weight in most cases. These may include:

Multivitamins
Agents for constipation, abdominal pain and bloating.
Calcium supplements for osteopenia.

Medications used to treat co-existing conditions such as depression, OCD, and anxiety may also be initiated when it is safe to do so.

In severe cases, hospitalization may be necessary to correct dehydration, electrolyte imbalances, cardiac arrhythmias, or severe malnutrition.

One final comment about AN. Many people are unaware that this disorder has a high mortality rate. In fact, a meta-review of all-cause and suicide mortality in mental disorders came to the following conclusion:

Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa.⁵

Bulimia Nervosa (BN)

Bulemia Nervosa (BN) is an emotional disorder that involves an obsessive desire to lose weight. BN is characterized by extreme overeating followed by depression and inappropriate compensatory behaviors to prevent weight gain, such as:

Excessive exercise.
Misuse of laxatives, diuretics, or enemas.
Self-induced vomiting or purging.

The severity of BN can be categorized according to the frequency of these inappropriate behaviors:

Mild – Average of 1-3 episodes weekly.
Moderate – Average of 4-7 episodes weekly.
Severe – Average of 8-13 episodes weekly.
Extreme – Average of more than 13 episodes weekly.

Signs and Symptoms of Bulimia

As with anorexia, the signs and symptoms of BN can be split into categories.

Psychiatric Symptoms:

Substance use disorders
Anxiety disorders
Impulsivity
Depression
Mood fluctuations

Behaviors:

Preoccupation with food and eating
Laxative or diuretic abuse
Compulsive exercise
Poor self-image
Self-induced vomiting or purging

These patients often lose control over food intake. They eat large quantities of high-calorie foods such as cake and ice cream, often attempting to combat dysphoric mood states. Binging helps with anxiety and dysphoria in the short term but makes them feel guilty. Patients with BN often conceal their binging, plan it, and eat until they are uncomfortable.

Physical Signs:

Normal to slightly overweight
Loss of tooth enamel from purging
Increase in dental cavities
Lethargy
Electrolyte imbalances
Amenorrhea
Hypotension, bradycardia, prolonged QTc interval
Osteopenia, osteoporosis

Risk Factors for Developing Bulimia

There is a strong genetic predisposition, according to studies.
Physical and sexual abuse victims are more prone to BN.
Emotional stress.
Participation in sports that are associated with thinness, such as ballet, wrestling, or running.
Peer pressure and social media – Young teens are often bombarded with perceived success based on unrealistic body images.
Those who are impulsive.
Those who have inadequate stress coping skills.
Gender: Incidence is reported to be 2.6% in females and 0.5% in males.

The peak age of onset for bulimia is 16-20 years.

The mortality rate is about 1%.

Early detection is a critical factor in recovery.

Treatment of Bulimia Nervosa

As with anorexia, the treatment of bulimia should involve a multidisciplinary team of professionals.

Psychotherapy has the best efficacy for this disorder. This process can take 4 to 5 months to complete.

SSRI’s such as fluoxetine are also used to reduce binge-purge episodes.

Dietitians can be instrumental in creating nutritional plans for these patients as adequate meals can decrease food craving.

Some organizations can help get bulimia patients the help they need. Two great options are:

Overeaters Anonymous: www.oa.org

Bulimia.com to help locate support groups: www.bulimia.com

Binge Eating Disorder (BED)

Binge eating disorder (BED) is a condition in which the patient eats a more considerable amount of food than most people would in a similar time period. Unlike bulimia, these individuals do not regularly employ compensatory measures such as purging to counter the binge eating. They often eat rapidly until they are uncomfortable. Binge eaters often eat even when they are not hungry and eat alone due to embarrassment. They often feel depressed or guilty after eating.

To be diagnosed with BED, binge eating must occur at least once per week for at least three months.

The severity of BED can be classified as follows:

Mild – Average of 1-3 episodes weekly.

Moderate – Average of 4-7 episodes weekly.

Severe – Average of 8-13 episodes weekly.

Extreme – 14 or more episodes per week.

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Signs and Symptoms of Binge Eating Disorder

The signs and symptoms of BED are as follows:

Slightly overweight to obese.
High level of emotional stress.
High incidence of GERD.
Presence of stretch marks due to weight changes.
Gallbladder disease.
Poor impulse control.
Feelings of guilt.
Comorbid anxiety or depressive disorders.
Cardiovascular disease.
Hyperlipidemia
Hyperglycemia – prone to diabetes.

Risk Factors for Developing Binge Eating Disorder

There seems to be a genetic component with BED. Family and twin studies have shown a 57% heritability.

Females have a higher incidence (3%) than males (2%).

The age of onset peaks at 18-20 years of age, but this disorder may occur later in life.

Many of these patients have a history of “yo-yo” dieting. They have large fluctuations in body weight over time.

There is a strong correlation between binge eating and obesity. About 50% of obese individuals report binge eating as one of their problems.

Treatment of Binge Eating Disorder

As with the above eating disorders, a multidisciplinary team of professionals should be employed in the treatment of BED. Psychotherapy has the most significant effect on BED, but drugs may be added. Some examples of adjunctive medications include:

Lisdexamphetamine is the only medication FDA approved for BED. It has been shown to decrease binge eating days, binge eating cessation, and global improvement compared to placebo.⁶
Topiramte
Zonisamide
SSRI’s (fluoxetine, sertraline, citalopram, fluvoxamine, escitalopram)
Orlistat
Bupropion/naltrexone

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Eating disorders can cause endless problems for patients who suffer from them and the families involved. Our society has caused our young citizens to believe that they need to look a certain way to be popular or successful. Social media has amplified this lie! The truth is, we all have a special gift to give, and it has very little to do with our weight or body shape.

I urge every person reading this to begin to love yourself as you are. Determine your “gift” and take steps to develop it to share this gift with those who will benefit.

Our body shape is something that we are born with. We can’t all have the body type of the stars. The best thing you can do for yourself is:

Eat whole, healthy foods.
Drink plenty of water.
Exercise 5 days per week for at least 30 minutes.
Get enough sleep.

If you think you may have an eating disorder, GET HELP!

There are many sources of help available. Here is one example:

https://www.eatingrecoverycenter.com/

I hope you have learned something from this post. Remember, eating disorders are serious and can be deadly if not treated.

Have a great week, and stay safe out there.

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Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

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.

Acupuncture for Back Pain

Posted on October 17, 2020October 30, 2020 by Michael Brown

Acupuncture is a significant element of Chinese medicine. It has been traditionally used to treat pain and has also been used for stress management and wellness. Acupuncture is used to balance the flow of energy known as chi or qi (chee). This energy may flow through meridians that are pathways in the body. It is believed that this energy can be re-balanced by inserting very thin needles through the skin at specific points along these meridians.

Although acupuncture can be used for many types of pain and other conditions, this post will concentrate on its use for lower back pain.

Lower Back Pain (LBP)

Lower back pain (LBP) affects as many as 70% of adults in industrialized countries during some point in their life.¹

This causes an economic burden on both society and individuals. It is estimated that at least $100 billion is spent due to lower back pain yearly.²

There are many treatments for LBP, but no single remedy appears to be superior.⁴

For this reason, many LBP sufferers turn to alternative treatments, including acupuncture, to relieve pain and discomfort.⁵

Is acupuncture effective for LBP? An overview of systemic reviews looked at this question in 2015.⁶

A total of 16 studies were included in this review. These studies were of variable quality. The researchers came to the following conclusions:

For acute LBP, acupuncture does not appear to be more effective than sham acupuncture in improving function, and inconsistent evidence that acupuncture is more effective at relieving pain than sham acupuncture.
For chronic LBP, there is consistent evidence that acupuncture provides short-term clinical benefits on pain relief and functional improvement compared to no treatment or when added to prevailing interventions.
It appears that acupuncture causes significant pain relief but no impact on the functional limitation on chronic LBP when compared to sham acupuncture.

To summarize this overview of the systemic reviews available, acupuncture can provide short-term clinically relevant improvement in pain and functionality in treating lower back pain when combined with conventional therapy.

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Low Back Pain in Pregnant Women

Many studies have examined back pain in pregnant women. Rates of LBP in these women range from 25% TO 90%, with most studies estimating that 50% of pregnant women will experience it.⁷

One-third of these women will suffer from severe pain. This decreases their quality of life. Eighty percent of women suffering from LBP say it affects their daily routine, and 10% cannot work.⁸

The most common risk factors associated with lower back pain in women include a history of pelvic trauma, chronic LBP, and lower back pain during a previous pregnancy.⁹

Regular exercise prior to pregnancy may reduce the chances of developing LBP during pregnancy.

A study published in 2018 examined the effectiveness of acupuncture in the treatment of back pain in pregnancy. Fifty-six pregnant women at a gestational age between 14 and 37 weeks who complained of lower back pain were included in the study. The subjects received up to six sessions. This study found a statistically significant reduction in lower back pain as early as the second acupuncture treatment. Improvement gradually improved with the number of sessions completed. No serious adverse effects related to the acupuncture were reported.¹⁰

Side Effects of Acupuncture

Acupuncture, like other treatments, can cause side effects. The most common adverse effects include bleeding, soreness, or bruising at the site of needle insertion. Other, less common risks include:

Dizziness
Fainting
Internal bleeding
Convulsions
Hepatitis B
Dermatitis
Nerve damage

With the use of disposable needles, hepatitis B, and other infections are rare. It is important to note that the side effects of acupuncture are uncommon. Most people will tolerate acupuncture sessions with no adverse effects.

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Acupuncture can be used for a variety of conditions, including:

Chemotherapy-induced and postoperative nausea and vomiting.
Dental pain.
Tension headaches and migraines.
Labor pain.
Lower back pain.
Neck pain.
Menstrual cramps.

This treatment is a popular alternative to traditional medications. Acupuncture can be an effective treatment for lower back pain in pregnant individuals and others who suffer from LBP. This treatment seems to work best for short term relief of back pain when combined with traditional therapy. As with most alternative therapies, more research is needed to determine best practices when utilizing acupuncture for back pain.

I have recently met a local acupuncturist and plan to get treatment in the next couple of weeks. I will let you all know how that goes. Luckily, the Protandim Tri-Synergizer product has eliminated my back pain. I am always searching for other treatments to help me live a healthier, happier life.

If you have any questions or comments, please feel free to reach out to me. Have a great week, and stay safe!

Update

I decided to try acupuncture for myself on October 29th. This was simply a wonderful experience. My goal was to improve circulation in my hands and feet. I don’t do well with cold weather and in Oregon, the cold season is here.

After a few minutes of standard medical questions, my time had come. I laid on the warmest, most comfortable bed you can imagine. It was beyond relaxing.

Hannah was awesome. I could barely feel the needles, and she was very friendly. She enjoys answering questions and it was clear she enjoyed her profession. I told her I wished I had tried this earlier in my life. It really improved my mood for the rest of the day.

The atmosphere, conversation, and warmth were amazing. If you haven’t tried acupuncture, I strongly recommend it! I will be going back for more sessions.

Take a look at the ad below. If you need any of these services and live in the Portland area, this is a great place to visit. These professionals are friendly and truly love helping people become healthy.

Located in Lake Oswego, Oregon

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Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

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.

Ketamine Infusion Therapy for Depression and Suicidal Ideation

Posted on October 9, 2020October 9, 2020 by Michael Brown

Can ketamine infusion therapy work for depression?

What are the advantages?

Ketamine is a medication that has been traditionally used to induce and maintain anesthesia. This drug is often used off-label for conditions such as pain relief, conscious sedation, and depression.

Ketamine has addictive properties and is a popular drug of abuse. The drug is available as white powder, liquid, and tablets and is known as “K”, “Vitamin K”, and “Special K” on the street. Ketamine can cause hallucinations, out-of-body experiences and temporary paralysis. The user may be awake but unable to move or even talk. These effects have led to ketamine being referred to as a “date rape drug.”

In March 2020, Spavato^TM (Esketamine) nasal spray was approved for adults with treatment-resistant depression. This is an important milestone in paving the way for this drug to be used more commonly in depressed and suicidal patients who have tried other treatments without benefit.

Ketamine is not just another antidepressant. It begins to work right away. Other treatments for depression take weeks to work.

The popular selective serotonin reuptake inhibitors (SSRI’s) must be slowly titrated to the effective dose due to side effects. We must be sure the patient can tolerate the drug and wait weeks to determine effectiveness.

The same is true for other antidepressants currently available.

This post will describe the use of ketamine infusion therapy for the treatment of depression.

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Suicide

Suicide rates have increased over the past two decades and are one of the top three causes of mortality worldwide for those between the ages of 15-44.¹

This has occurred despite efforts to reduce suicide.²

We know that approximately 90% of those who commit suicide suffer from a treatable mood disorder.³

Our current treatment options for those with suicidal ideation consist mostly of hospitalization, psychotherapy, and pharmacotherapy.

Although dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), and treatment with clozapine and lithium have been shown to decrease suicide deaths,⁴

⁵

⁶

as well as attempts,⁷

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They take time to work and have not shown effectiveness acutely. This leads us to a search for an antidepressant that can take effect quickly.

Is ketamine a solution?

Ketamine for Suicidal Ideation and Mood Disorders

There have been studies showing that ketamine infusions are effective in treating suicidal ideation and depression in the acute setting. A meta-analysis published in the American Journal of Psychiatry in February 2018 came to the following conclusions:⁹

Ketamine significantly reduced suicidal ideation. This occurred within one day and continued for one week after the treatment.
The change in the severity of depressive symptoms was strongly correlated with the decrease in suicidal ideation.
Ketamine’s effect on suicidality is only partially due to its antidepressant effects.
54.9% of patients had no suicidal ideation 24 hours after a single ketamine infusion, and 60% remained free of suicidal thoughts one week after the infusion.

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Are you thinking of Getting a Ketamine Infusion?

If you are considering utilizing ketamine infusions to treat depression or suicidal thoughts, here is what to expect:

You may receive the infusions as an outpatient or inpatient. Several facilities offer ketamine infusions as an outpatient procedure.
You may be asked to fill out a questionnaire to determine your depression level before the procedure.
You will need to arrange for transportation as you will be unable to drive after the infusion.
The following conditions may exclude you from receiving the ketamine infusion:

- History of schizophrenia, bipolar disorder, or schizoaffective disorder.
- Dementia.
- Delirium within the last seven days.
- Uncontrolled hypertension.
- Pregnancy.
- Certain heart conditions.
- Positive urine drug screen showing substances of abuse or a previous history of substance abuse.
- An allergy or previous adverse reaction to ketamine.

It is important to note that various facilities will have different protocols. Check with your facility of choice to get their specific guidelines. Here is a few typical guidelines used:

The ketamine infusion will likely last about 40 minutes.
Vital signs (heart rate, blood pressure, oxygen blood levels, etc) will be monitored during the infusion.
As with any medication, you may experience side effects. Some of these include:

- Confusion
- Delirium
- Dream-like state
- Excitement
- Hallucinations
- Irrational behavior
- Vivid Imagery
- Change in heart rate
- Change in blood pressure
- Seizure-like movements
- Rash
- Nausea and vomiting
- Double vision
- Others

Ketamine infusions will normally be given on a pre-determined schedule. A typical schedule may be:

Twice a week for 2-3 weeks (not less than three days apart)
After 2-3 weeks, the infusions should be weekly to every three weeks with a goal to extend the infusions to an interval if possible. This will vary based on patient response.
Ketamine infusions should be tapered when discontinued.
Ketamine infusions range from $400-$800 per infusion, and there may also be an initial consultation fee. These prices are for outpatient procedures. It is important to note that most health insurance plans do not cover these infusions. Inpatient treatment can cost substantially more.

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I am a huge proponent of using ketamine infusions for treatment-resistant depression. I have spent many years caring for psychiatric patients, and some do not respond to conventional therapies.

Depression is a devastating mood disorder that can rob an individual of a fulfilling life. It can ruin careers, relationships, and even result in death.

If you have any thoughts of ending your life or are depressed, GET HELP. Call someone! There are many resources available to help you. You can get better. We can help!

The Suicide Hotline can be reached at:

800-273-8255

With the recent approval of Spavato^TM, my hope is that some of the stigma associated with ketamine will dissipate. Many drugs we use every day have the potential of being abused. The fact is ketamine can help some of our most vulnerable people.

As a society, we have the responsibility to care for our sick individuals. This includes those with mental disorders. Anyone can become depressed! I pray that we will embrace the potential of ketamine infusions. After other treatments have failed, those who need ketamine should have access to it.

Insurance companies should pay for it!

It is more costly to hospitalize someone for weeks while our traditional treatments take effect. One of ketamine’s most important benefits is that it begins to work right away. This can be the difference between life and death!

Ketamine is a subject I have wanted to write about for some time. We are unable to use ketamine infusions in our facility due to a perceived danger. It is possible to refer those patients who might benefit from ketamine to an alternative facility. I plan to continue to lobby for its use within our facility. I believe we owe it to our patients.

If you have any questions about ketamine or any other medication, health issue, or nutraceutical, please contact me.

I am happy to help whenever I can. That is why I started Sunshine Nutraceuticals in the first place.

Have a great week, everyone, and stay safe!!

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Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

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.

N-Acetylcysteine for Anxiety, Depression and other Psychiatric conditions

Posted on May 19, 2020March 5, 2023 by Michael Brown

N-acetylcysteine (NAC) is an over-the-counter supplement that may be used for several conditions. This molecule is a derivative of cysteine, which is an amino acid. In the hospital setting, it is used by the intravenous route for the treatment of acetaminophen overdose.¹

NAC is also used in chronic obstructive pulmonary disease to break up mucous. It may also be beneficial in the prevention of contrast-induced nephropathy.²

During the last several years, there has been an interest in using acetylcysteine for other ailments.

This post will focus on the use of NAC for depression, anxiety, bipolar disorder, schizophrenia and the treatment of addiction.

Addiction

Acetylcysteine has been studied for its ability to treat several types of addiction. A study conducted on 116 cannabis dependent adolescents and young adults found that those treated with 2.4 grams per day of NAC had a significantly higher incidence of negative urine cannabinoid tests as compared to the placebo group.³

This was a double-blind, randomized controlled trial lasting eight weeks. The NAC group also showed a more considerable decrease in self-reported days of cannabis use than the placebo group, but this was not statistically significant.

There is a possibility that NAC could increase cannabinoid elimination. This would increase the probability of the NAC group having a negative urine test.

More studies are needed to investigate the effects of NAC of cannabinoid metabolism.

Several controlled studies have shown NAC to be beneficial for treating cocaine addiction. The most extensive study showed positive effects only in a small subset of subjects that were abstinent at the beginning of the trial.

The studies for using NAC in other types of addiction, including gambling, were inconclusive.

Anxiety

The treatments currently available for anxiety disorder have limited effectiveness. Several studies suggest oxidative stress has a role in the development of anxiety. These findings have led to studies on the use of antioxidants in the treatment of anxiety.⁴

⁵

There has been a case study of a 17-year-old male with generalized anxiety disorder and social phobia who had failed cognitive behavioral therapy and several antidepressants but responded well to NAC.

Unfortunately, more studies are needed before NAC can be recommended as a treatment for anxiety.

Bipolar Disorder

Bipolar disorder is a mood disorder characterized by periods of depression alternating with periods of mania.

Symptoms of depression include:

Feeling sad or hopeless.
Loss of interest in pleasurable activities.
Sleep disturbances – too much or too little sleep.
Inappropriate guilt.
Unexplained weight changes.
Isolation.
Loss of energy or fatigue.
Restlessness or lethargy.

Manic symptoms are as follows:

Racing thoughts.
Distractibility.
Euphoria and increased self-confidence.
Increased activity and agitation.
Participation in risky behaviors.
Poor decision making.
Unusual talkativeness.

Bipolar disorder can be severe and may also present with psychotic features. Acetylcysteine has been shown to improve depressive symptoms in patients with bipolar disorder significantly.⁶

Unfortunately, this study was not able to show any significant difference in the frequency of new episodes of either depression or mania in the NAC group compared to the placebo group. More research is necessary to determine the role NAC may have in the treatment of bipolar disorder.

Depression

A randomized-controlled trial of 252 patients with major depressive disorder (MDD) showed NAC improved symptoms more effectively than placebo when added to the patient’s usual treatment regimen for a twelve-week period.⁷

There is also a case series of two patients who showed successful and sustained improvement of depressive symptoms when NAC was added to their antidepressant regimen.⁸

Other studies of NAC in the treatment of other disorders have found an improvement in mood and well-being.⁹

The current evidence suggests NAC may be a valuable treatment option either alone, or in combination with other agents for the treatment of mood disorders.

Schizophrenia

There have been positive results obtained when utilizing acetylcysteine for the treatment of schizophrenia.

One such study showed patients receiving NAC improved with regards to schizophrenia symptoms and akathesia.¹⁰

Other studies have also supported the use of NAC as a viable addition to schizophrenia treatment regimens.¹¹

¹²

Although these results are promising, more studies with larger sample sizes are necessary to determine the true utility of NAC in the treatment of schizophrenia.

Mechanism of Action

The proposed mechanisms of action of NAC are too complicated for the scope of this post. This substance is thought to work as an antioxidant and anti-inflammatory. It is also thought to affect several neurotransmitters and mitochondrial function within cells.

Adverse Effects of Acetylcysteine

Acetylcysteine is generally well-tolerated. UpToDate^TMlists the following adverse reactions to oral acetylcysteine:

Chest tightness
Hypotension
Rash (with or without fever)
Urticarial
Nausea and Vomiting
Hypersensitivity reaction
Bronchospasm
Bronchitis

Less than 1%, post-marketing and/or case reports (important or life-threatening only):

Angioedema
Pruritis
Tachycardia

Pregnancy and Breast-Feeding

Since acetylcysteine crosses the placenta, it should only be used in pregnancy when the benefits outweigh the risk. This may occur in the case of acetaminophen overdose.

It is not known whether NAC is excreted into breast milk. Based on pharmacokinetic data, acetylcysteine should be cleared from the body thirty hours after administration.

If NAC is consumed while breast feeding, breast milk should be pumped and discarded for thirty hours after ingestion.

NAC should not be used in pregnant women for depression, anxiety, bipolar disorder or the treatment of addiction.

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Drug Interactions

There are no known drug interactions.

I became interested in N-Acetylcysteine after speaking to a child psychiatrist at the hospital where I practice. She had ordered it for one of her patients, and I was curious as to her reasoning for its use. She believed in NAC’s ability to improve several psychiatric symptoms in children with minimal risk. She sent me an article which detailed much of what I have covered in this post.

NAC has also been studied for use in Alzheimer’s disease, ADHD, autism, epilepsy, neuropathy, traumatic brain injury (TBI), and several impulse control disorders. It is essential to mention that more studies need to be done in all of these conditions before a recommendation can be made to use NAC.

I do believe it is worth trying NAC in patients who present with the disease states covered in this post. There is minimal risk, and the benefits could be significant. This is especially true in conditions such as anxiety disorder, where our treatment options are scarce and often ineffective.

Please feel free to contact me if you have any questions regarding acetylcysteine or any other medication or supplement. I would be happy to get an answer for you ASAP.

As always, have a great week, stay healthy, and stay safe!

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Michael J. Brown, RPh, BCPS, BCPP

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

Feel free to send Michael a message using this link.

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Turmeric, Diet, and Boswellia for Arthritis

Posted on April 14, 2020July 3, 2022 by Michael Brown

I decided to write a post on arthritis because this is a condition I live with every day. Some days are better than others. I have done plenty of research on arthritis with the hope of improving my quality of life and I will share with you what I have learned about medications, foods, and natural supplements. I hope you never have to deal with this on a personal level but if you do, perhaps what I have learned over the last few years will help relieve some of your pain.

This figure represents alterations that occur in the joints during the onset of Oseteoarthritis¹

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.

Overview

Osteoarthritis (OA) is the most common joint disorder in the United States.²

It is also known as degenerative joint disease or “wear and tear” arthritis. This most often occurs in the joints of the hands, knees and hips. Osteoarthritis affects 32.5 million adults in the United States.³

OA is characterized by joint stiffness, swelling, pain and loss of mobility resulting from the breakdown of articular cartilage and synovial inflammation.

Here are a few facts about OA:

88% of OA patients are 45 or older and 43% are 65 or older. 62% are women and 78% are non-Hispanic Caucasians.⁴

OA patients experience more pain and have more activity limitations than other people in their age group. They are also more prone to fatigue and disability.⁵

One-third of those with arthritis over the age of 45 suffer from anxiety or depression.

Approximately one million knee and hip replacement surgeries are completed each year due to OA.⁶

By 2040, approximately 11.4% of all adults will have some activity limitations as a result of arthritis.⁷

Risk Factors

Mediterranean vs Ornish Diet

Medications

Like most other ailments, osteoarthritis is initially treated by modifying risk factors. Losing weight, eating healthier foods and exercise are all excellent strategies. It may also help to optimize your workspace, especially if you sit for long periods of time. When these fail, medications may be necessary to relieve pain and inflammation. Most of the medications listed should only be used when symptoms are present since none of these agents have been shown to modify disease progression.

Topical NSAIDs – This class is the starting point, especially when few joints are affected. These work well in arthritis occurring in the hands and knees. They have similar efficacy to oral NSAIDs and have a better safety profile.⁹

The drug most utilized in this class is diclofenac gel (Voltaren^tm.) This medication is only available by prescription.

Oral NSAIDs – The next step is to utilize oral NSAIDs. Medications in this class include ibuprofen (Motrin^tm), naproxen (Aleve^tm), piroxicam (Feldene^tm), and others.

Caution must be exercised as these agents can cause GI bleeding, kidney disease and cardiovascular complications. COX-2 inhibitors, such as celecoxib (Celebrex^tm) may also be used.

Duloxetine (Cymbalta^tm) – This is an antidepressant medication known as an SNRI (serotonin-norepinephrine reuptake inhibitor.) These drugs increase the amount of serotonin and norepinephrine available in the brain. My physiatrist (pain specialist) informed me that 90% of his patients responded to duloxetine. It works very well for both nociceptive and neuropathic pain.

Glucocorticoid (Steroid) intra-articular injections – Steroid injections are sometimes utilized for OA of the knee. These have a short duration of action (approximately four weeks) and may have adverse effects on the hyaline cartilage.¹⁰

Opiates – Due to the recent changes in opiate use guidelines, these drugs should generally not be used for arthritis. Opiates have many side effects, including increased risk of falls, sedation, nausea and dizziness. They are also habit-forming and may cause hyperalgesia leading to an increased sensitivity to pain.

Effect of Vitamins and Diet

Arthritis is associated with inflammation, so foods known to decrease inflammation should help relieve pain due to this disease. My recommendation is to stick with the Mediterranean diet as much as possible. This diet has the most evidence to support various health-related benefits.

Many of the foods that help with inflammation are part of the Mediterranean diet. Some examples of these include broccoli, tomatoes, whole grains, nuts, blueberries, avocados and many others. You can learn more about this diet by reading my post at the link below.

Nightshades – Some people with arthritis believe eating plants from the nightshade family worsen arthritis pain. Nightshades contain solanine, which is a neurotoxin at high doses. Some examples of nightshade foods include white potatoes, eggplant, tomatoes and bell peppers. There is no scientific evidence to support the notion that eating plants from this family makes arthritis symptoms worse. If, however, you notice a negative change when eating these foods, you should avoid them.

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Natural Supplements

Turmeric – The only two nutritional supplements recommended by UpToDate^tm at the current time are curcumin, the active ingredient in turmeric, and Boswellia serrata. Curcumin has been used in Ayurvedic medicine for thousands of years for arthritis, respiratory infections, GI problems and even cancer treatment.

A review of the efficacy of curcumin in the treatment of osteoarthritis was published in The Journal of Evidenced-Based Complementary & Alternative Medicine in 2017. The conclusion was that curcumin-containing products demonstrated statistically significant improvements in osteoarthritis compared to placebo in four out of five studies.¹¹

¹²

¹³

¹⁴

Boswellia serrata – A randomized, double-blind placebo-controlled study of 30 patients with osteoarthritis was published in 2003. The investigators found a statistically significant improvement in knee pain, knee flexion and increased walking distance in patients receiving Boswellia extract compared with placebo. Swelling in the knee joints was also improved. There were no changes that could be seen on x-rays. The Boswellia extract was well tolerated, with the exception of minor GI symptoms. ¹⁵

Vitamin K2 – There is some evidence suggesting vitamin K may be important in preventing arthritis. A longitudinal study compared patients with vitamin K deficiency to those who had adequate levels. The vitamin K deficient group had a 56% higher risk of developing knee osteoarthritis than the control group. ¹⁶

Vitamin K2 supplementation may also reduce inflammation in rheumatoid arthritis by lowering CRP levels.¹⁷

Ashwagandha

Ashwagandha is frequently used to treat both osteoarthritis and rheumatoid arthritis in Ayurvedic medicine. Several anti-inflammatory pathways may be affected by withanolides, the active ingredients in ashwagandha.¹⁸

Arthritis and the Weather

We have all known people who believe they can predict the weather based on their arthritis pain. Scientists have been searching for a link between the weather and arthritis pain for years. Unfortunately, no definitive results have been obtained.

Colder weather may cause people to be less active and this may lead to stiffer joints. Lower barometric pressure may cause the nerve endings in joints where cartilage is worn away due to arthritis to be more sensitive, resulting in increased pain.

Finally, these changes in barometric pressure could cause expansion and contraction of scar tissue, muscles, and tendons leading to increased pain in these areas. Even though there hasn’t been any scientific proof, my arthritis pain is worse during the winter months. As long as I don’t try to lift heavy items, or cause increased strain on my back, I have very little pain during the summer months.

Arthritis is a painful disease affecting millions of people in the United States alone. It is a common cause of disability and has been linked to anxiety and depression. This condition not only causes pain but can limit physical activity as well. I have experience with this disease myself.

I suffered for years before finally visiting a pain specialist. Presently, my pain is under control most of the time as I have learned several things over the years that have helped. I try to get up to walk around often, I sit in comfortable chairs, and when my pain flares up, I take a turmeric supplement.

If the pain gets worse, I take naproxen but try to limit its use. I watch what I eat and have found that if I sleep too long the pain is worse. I have also learned some exercises that relieve the pain.

My pain seems to be worse in the winter months which may lead to our family relocating to a warmer climate in the future. Although science has not found a direct link between the weather and arthritis pain, I can feel a difference based on the temperature. When it is cold, my pain is worse!

If you have any questions regarding this subject, I would be happy to answer them. Stay safe, stay healthy and follow your dreams!

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Michael J. Brown, RPh, BCPS, BCPP

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

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Crohn’s Disease Dietary Restrictions and Natural Remedies

Posted on March 26, 2020July 2, 2022 by Michael Brown

Crohn’s disease is an inflammatory bowel disease (IBD) resulting in chronic inflammation of the gastrointestinal tract. IBD encompasses Crohn’s disease and ulcerative colitis. Crohn’s disease is associated with distinct granulomas and inflammation which may also affect lymph nodes.¹

Ulcerative colitis is a milder disease that is characterized by continuous inflammation affecting the colon. Both of these conditions lead to extensive epithelial damage.

Inflammatory bowel disease may cause a variety of symptoms including:

Loss of appetite
Fever
Weight loss
Diarrhea which may contain blood
Abdominal pain and cramping
Anemia due to blood loss
Urgency to defecate

I thought I would write a post on ways to combat this disease other than the traditional medication therapy.

Remember, if you suffer from IBD, it is important to visit your physician on a regular basis. Since bleeding and GI blockages are possible, tests may need to be performed by a professional to keep you as healthy as possible.

You may require medication depending on how severe your symptoms are. This disease may also cause a decrease in the absorption of vital vitamins and nutrients the body needs for proper functioning.

The recommendations in this article should only be considered in combination with the advice of a physician. I am a strong advocate of yearly check-ups. Preventative medicine is vital to health.

What Foods Cause Crohn's Disease Flare-ups

Although there is no particular diet that has been scientifically proven to prevent inflammatory bowel disease, there are some trigger foods that may cause flare-ups. My advice is to keep a food journal and this should help you determine which foods tend to cause problems. If you find a certain food or food group appearing often before flare-ups, you may consider eliminating that item from your diet. Some of the possible “problem items” include:

Corn, including popcorn
Dairy products – if lactose intolerant- consider supplementing with lactase or eliminating
Foods that cause increased gas production in the gut (onions, broccoli, cabbage, beans, legumes, lentils, etc.)
High fiber foods (chia seeds, avocado, pasta, chickpeas, quinoa, oats, almonds etc.)
Fried foods
Nuts and seeds, including peanut butter
Some raw fruits
Coffee and tea
Chocolate
Fats (butter, mayonnaise, cooking oils)
Alcoholic beverages
Red meat
Pork
Spicy foods

As you can see, there are many foods on this list, and others may also cause irritation and flare-ups. This is why a food journal is essential. It is worth the effort!

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Another strategy is to try an elimination diet. The way this works is you start by eliminating many foods and if your symptoms improve, you begin to add foods back one at a time. This can help identify which foods should be avoided in the future.

There are several elimination diets available today. The Whole30 is a diet my family and I tried last October. I have written about this in a separate post if you are interested in the specifics. I highly recommend trying it.

I was also able to locate a specific diet and cookbook on Amazon written by Patty Catsos, MS, RD, LD. I have not tried this diet yet, and don’t suffer from IBS, but this book has great reviews. I do not have any association with this product but will list the link below for your convenience.

https://www.amazon.com/IBS-Elimination-Diet-Cookbook-Low-FODMAP/dp/0451497724

FODMAPs

Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) are short-chained carbohydrates. These make their way to the end of the intestinal tract where large amounts of bacteria reside. The bacteria break these substances down causing the release of gas which may lead to digestive issues in some individuals. These FODMAPs also draw liquid into the intestines which can lead to diarrhea. Most individuals with IBS are sensitive to FODMAPs and these substances can lead the flare-ups. Examples of FODMAPs include:

Lactose – Milk sugar contained in dairy products.

Galactans – Legumes have large quantities of these.

Fructose – This is the sugar contained in fruits and vegetables. You also find this in many packaged products.

Fructans – These are found in many grains including wheat, spelt, barley and rye.

Polyols – These are sugar alcohols and are also used in processed foods as a sweetener. Examples include sorbitol, mannitol, xylitol and maltitol.

These substances are resistant to digestion and are passed through the intestinal tract unchanged. FODMAPs cause an increased hydrogen concentration in the intestines of those with IBS. They also influence the quantity of methane gas and may cause gastrointestinal symptoms in IBS patients.²

Curcumin for IBS

One of the most effective and popular herbal medicines available is turmeric. This herb contains curcumin which has many beneficial properties. Curcumin is known to have a wide range of effects on the gastrointestinal system. This substance has been shown to inhibit the growth of H. pylori in both mice and on agar plates.³

Curcumin is thought to kill bacteria by inhibiting cell division.⁴

A study by Niamsa and Sittiwet in 2009, demonstrated the antimicrobial activity of curcumin several commonly encountered pathogenic Gram-negative and Gram-positive bacteria.⁵

Curcumin has also been shown to regulate the gut microbiota. This is important because inflammatory bowel disease is partially defined by an altered, pathogenic microbiome.⁶

⁷

One of the changes that occur in the gut is the increase in adherent invasive E. Coli (AIEC) which can promote gut inflammation.⁹

¹⁰

Curcumin has also been shown to inhibit signaling that initiates the inflammatory process in the intestinal tract.¹¹

A study published in 2006 found the addition of curcumin, 1 gram after breakfast and 1 gram after dinner, plus sulfasalazine or mesalamine was more effective than placebo combined with one of these two medications. The mesalamine group had a 4.65% relapse rate (2/43), whereas the placebo group had a relapse rate of 20.51% (8/39). A six month follow-up found eight more patients relapsed in the curcumin group and six additional patients relapsed in the placebo group.¹²

For additional information on curcumin, please refer to my blog post on turmeric below.

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Turmeric Health Benefits

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Plantago Ovata

Plantago ovata, also known as Desert Indian wheat or psyllim husk has been used as a medicinal plant. Psyllium is often used as a bulk forming laxative to support normal bowel movements. Psyllium is marketed as Metamucil. We also have this product available in capsule form in the Sunshine Store. There have been studies showing psyllium to be useful in the treatment of UC.¹³

Probiotics in Inflammatory Bowel Disease

Probiotics would seem to be helpful in IBD. Ingesting “good” bacterial should fend off some of the “bad” gas-producing bacteria. At the present time, the studies show that probiotic supplementation is a promising adjuvant treatment in ulcerative colitis. It is best to use a combination Probiotic such as Probiotic-40 available below. There is not enough clinical evidence to support the use of probiotics for Crohn’s disease at the present time.¹⁴

Probiotic-40

Contains four different probiotic strains

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Inflammatory bowel disease can be a debilitating illness and may be dangerous in some cases. This condition may lead to a decrease in the absorption of critical nutrients and can also lead to bleeding and/or intestinal obstructions. I suggest visiting your physician on a regular basis, keeping a food journal, and consider adding nutritional supplements to your medication regimen. Your physician can tell you if you are deficient in vitamin B-12 or other necessary vitamins or minerals. I strongly recommend a turmeric supplement. This is one of the healthiest natural herbs available today. Psyllium may also be beneficial but caution should be observed as large fiber loads can increase IBS symptoms in some individuals. Be sure to check with your physician before starting this or any other supplement.

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Michael J. Brown, RPh, BCPS, BCPP

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

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L-Arginine and Cardiovascular Disease, IVF, PCOS, and More..

Posted on March 17, 2020March 17, 2020 by Michael Brown

What is L-Arginine

L-Arginine is an amino acid made naturally by our bodies and is used in protein biosynthesis. It is also found in foods such as fish, poultry, red meat, and dairy products. L-Arginine is vital to overall health. It is associated with the Krebs Cycle and is a part of the urea cycle where it carries nitrogenous waste. This amino acid also causes vasodilation by its conversion to nitric oxide (NO).¹

It is important in maintaining the acid-base balance of the body as the urea cycle is a significant consumer of bicarbonate.

We have recently added this supplement to our product line mostly to be used by athletes. I will cover this, as well as some uses of L-Arginine in this post.

L-Arginine and in vitro fertilization (IVF)

In vitro fertilization has become increasingly popular for couples who struggle to become pregnant. This is often attempted during the later child-bearing years after the woman has failed to become pregnant. There is some research to suggest L-Arginine can increase the number of oocytes collected in women attempting IVF. This, however, has yet to be shown to improve the viable pregnancy rate.²

L-Arginine and Polycystic Ovary Syndrome (PCOS)

A small study of eight patients with polycystic ovary syndrome was published in December of 2009. This study showed that a combination of L-arginine 1600 mg daily combined with N-acetylcysteine 1200 mg daily for a period of six months resulted in moderate improvement of menstrual function and decreased insulin resistance.³

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L-Theanine Effects on Cardiovascular Disease and Exercise

L-Arginine may lessen angina symptoms and improve exercise and quality of life in angina patients according to a study published in 2002.⁴

Another randomized, double-blind cross-over study published in September of 2000, found that, although L-arginine supplementation did not affect exercise-induced changes in QT interval, QT dispersion, or the magnitude of ST segment depression, it significantly improved exercise tolerance. This is most likely the result of improved peripheral vasomotion.⁵

Many studies have found L-arginine to be effective and decreasing both systolic and diastolic blood pressure. This has been shown in healthy individuals, those with pulmonary hypertension, as well as patients with type 2 diabetes.⁶

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⁹

L-arginine also appears to have an additive vasodilation effect when combined with angiotensin converting enzyme (ACE) inhibitors and nitrate vasodilators when used for the treatment of hypertension.¹⁰

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Intermittent claudication associated with peripheral arterial disease symptoms have also been shown to improve with the administration of oral or intravenous L-arginine for short term periods (up to eight weeks). ¹⁵

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¹⁷

Although this is promising, walking speed, walking distance, or absolute claudication distance does not seem to improve with long-term (up to six months) administration of L-arginine. ¹⁸

¹⁹

L-Arginine and Erectile Dysfunction (ED)

L-arginine has shown some promise in the treatment of erectile dysfunction. A double-blind, placebo-controlled study of 50 men with organic ED showed significant improvement in sexual function in 9/29 (31%) of the treatment group but only 2/17 (11.8%) of the placebo group. The nine patients in the treatment group that showed improvement all had initially low NOx but this level doubled by the end of the study.²⁰

L-arginine seems to be effective in men with mixed-type impotence when combined with Pycogenol at 1.7 grams daily or when combined with both Pycogenol and aspartic acid when dosed at 0.69 grams daily.²¹

²²

L-Arginine and Statins

The combination of L-arginine and atorvastatin (Lipitor) has been shown to have a significant positive effect on the progression of atherosclerosis. A study utilizing rabbits found this combination to achieve a 21% decrease in the total area of lesions and a 44% reduction in the area of abdominal lesions compared to the control group.²³

A two-arm, randomized, double-blind study on 33 hypertriglyceridemic patients reported that L-arginine alone had no effect on serum lipids compared to placebo. When combined with simvastatin, however, led to a significantly larger reduction in triglycerides compared to placebo plus simvastatin. This study also found L-arginine attenuated simvastatin-induced increases in aspartate transaminase and fibrinogen.²⁴

L-Arginine and Body Building

L-arginine is popular with body builders because it helps in the synthesis of proteins. As muscle mass increases, L-arginine helps signal muscle cells and encourages growth hormone release and the metabolism of fat. This leads to a more defined, stronger, well-defined physique. L-arginine can also improve endurance and muscle conditioning due to its vasodilation effects. This increases blood flow to muscle during workout periods.

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L-Arginine Drug Interactions

ACE inhibitors, Angiotensin Receptor Blockers (ARBs) and other antihypertensive agents – The combination of L-arginine and ACE inhibitors may lead to increased vasodilation and a larger decrease in blood pressure. When combined, the risk of hypotension exists. Examples include benazepril, captopril, Ramipril, losartan, valsartan, diltiazem, amlodipine, and many more.

Anticoagulants and Antiplatelet Drugs – L-arginine may decrease platelet aggregation in humans. Caution should be exercised when combining L-arginine with medications that increase bleeding risk. Some examples are warfarin, apixaban, rivaroxaban, enoxaparin, clopidigrel, ticlodipine and others.

Isoproterenol and Nitrates – L-arginine may lead to increased vasodilation when combined with vasodilators leading to hypotension and dizziness.

Sildenafil (Viagra) – Although not reported in humans, combining L-Arginine with sildenafil may lead to increased vasodilation and dizziness as well.

Potassium-sparing diuretics – There have been some reports of L-arginine causing hyperkalemia in some patients. Combining L-arginine with these medications may increase the risk of hyperkalemia. Examples of these medications include amiloride, spironolactone, and triamterene.

Adverse Effects of L-Arginine

L-Arginine is generally well tolerated. The most common side effects reported for this supplement are:

Abdominal pain
Bloating
Diarrhea
Nausea
Gout
Allergic reactions
Exacerbation of airway inflammation in asthmatic patients

L-arginine is an amino acid which helps in the synthesis of proteins. It also leads to vasodilation and, in doing so, can be beneficial for relieving chest pain. When combined with a statin, L-arginine leads to a decrease in atherosclerosis which may help prevent heart attacks. It has also been shown to decrease both systolic and diastolic blood pressures. Due to its vasodilation properties, L-arginine may help with the symptoms of erectile dysfunction. It may also help with some of the symptoms of polycystic ovary syndrome when combined with N-acetylcysteine.

We recently added L-arginine as a dietary supplement to our product line with the thought of making it available to body builders. It can increase exercise tolerance and help create a sculpted, muscular body. As it turns out, many other uses are possible with this substance.

L-arginine is relatively safe and well tolerated as it is an amino acid found in the human body. As with any other medication or supplement, allergic reactions are always a possibility. These reactions are often due to fillers and other substances used to produce the dosage form rather than the active chemical. Gastrointestinal side effects are always a possibility as well.

If you have any questions about L-arginine or any other medication or supplement, please feel free to send me an email. I have spent over half of my life working with medications and supplements. As I have expressed in the past, if I do not know the answer to your question, I will find it. Have a great week and live a happy, healthy life. Get plenty of exercise, drink adequate amounts of water, and eat whole foods. You are worth it.

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Michael J. Brown, RPh, BCPS, BCPP

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