Acupuncture for Back Pain

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

 

3

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.

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.

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!  

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.

 

 

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

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, SpavatoTM (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.  

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

8

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.

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:

  1. You may receive the infusions as an outpatient or inpatient. Several facilities offer ketamine infusions as an outpatient procedure.
  2. You may be asked to fill out a questionnaire to determine your depression level before the procedure.
  3. You will need to arrange for transportation as you will be unable to drive after the infusion.
  4. 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:

  1. The ketamine infusion will likely last about 40 minutes.  
  2. Vital signs (heart rate, blood pressure, oxygen blood levels, etc) will be monitored during the infusion.
  3. 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:

  1. Twice a week for 2-3 weeks (not less than three days apart)
  2. 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.
  3. Ketamine infusions should be tapered when discontinued.
  4. 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.

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 SpavatoTM, 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!!

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.

 

 

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.

CBD Oil for Parkinson’s Disease Treatment

Parkinson’s disease and other movement disorders have been linked to oxidative stress and neurodegeneration.  Parkinson’s disease is progressive, and initial symptoms vary based on the individual.  It is the second most common neurodegenerative disease worldwide, and its prevalence is increasing.1

This disease is thought to affect 0.3% of the entire population and about 1% of those over 60 years of age.2

Risk factors associated with Parkinson’s disease are shown in the table below.3

Non-motor symptoms often appear years before the diagnosis of Parkinson’s disease.  Some of these symptoms include:4

  • Constipation
  • Fatigue
  • Hypotension
  • Dizziness
  • Apathy
  • Sleep problems
  • Erectile dysfunction
  • Depression
  • Anxiety

The motor symptoms associated with Parkinson’s disease are often referred to as the “classical triad”.  These symptoms as well as others are shown in the table below:5

Classic Treatment of Parkinson's Disease

There is no cure for Parkinson’s disease at the current time.  The medications we use help mitigate the symptoms.  This disease is the result of a decreased level of dopamine in the brain.  Most of the drugs utilized for Parkinson’s either increase dopamine concentrations in the brain or substitute for dopamine.  Some examples of these agents are listed below:

Carbidopa-levodopa – This is the most effective treatment currently available for this disease.  Once this medication arrives in the brain, it is converted into dopamine.

Dopamine agonists – These medications don’t work as well as carbidopa-levodopa, but they are longer acting.  Examples include:

  • Pramipexole
  • Ropinirole
  • Rotigotine – Available as a patch.
  • Apomorphine – Short-acting injectable form.

MAO-B Inhibitors – These agents help increase dopamine concentrations by decreasing its metabolism.

  • Selegiline
  • Rasalagine
  • Safinamide

Entacapone – This medication prolongs the effect of levodopa by blocking an enzyme that metabolizes it.

Anticholinergic drugs – These are used to decrease the tremors caused by Parkinson’s disease.  These medications possess several side effects that are unfavorable for elderly patients.  Anticholinergics cause blurred vision, confusion, dry mouth, constipation and increase risk of falling.

  • Benztropine
  • Trihexyphenidyl

Amantadine – This medication is sometimes used in the early stages of Parkinsonism to relieve mild symptoms.

Cannabidiol (CBD) and Parkinson’s Disease

Cannabidiol was first studied in Parkinson’s patients to verify its antipsychotic properties.  When these patients were treated with CBD for four weeks, symptoms of psychosis decreased without an increase in adverse effects or worsening motor function.6

In 2014, a case series involving four patients with Parkinson’s disease, showed the ability of CBD to reduce the frequency of the events related to REM sleep behavior disorder.7

 It was also noted that CBD was able to improve the quality of life of the Parkinson’s patients when used over a six week period.8

 Although these results are promising, CBD has not been shown to improve the motor symptoms of PD.  Animal models have shown CBD to be beneficial only prior to or immediately following manipulation that causes PD-like symptoms.  If CBD is given one week after the manipulation, protective effects are not observed.9

 These findings suggest that CBD may be more effective in preventing motor symptoms than treating those that are already occurring.  By the time a patient is diagnosed with PD, it is estimated that approximately 60% of the dopaminergic neurons have already been lost.10

 This gradual neuronal loss can occur up to 10 years after the onset of non-motor symptoms.11

Michael Brown pictured with Final Thought written

Parkinson’s disease is a debilitating illness that affects approximately 1% of those over 60 years of age.  It is a difficult disease to treat because the agents we use to control the symptoms often lead to other conditions.  By increasing dopamine in the brain, we can make the patient more prone to hallucinations and other psychiatric issues.

Cannabidiol can help with psychosis, sleep, and quality of life in Parkinson’s patients.  Although it may be too late to treat motor symptoms after a PD diagnosis, CBD products could be a sensible choice for those who show early signs of Parkinson’s disease.

Like many other supplements, more studies need to be completed to learn just how beneficial CBD products can be in this population.  My recommendation is to try them if you are suffering from the early symptoms of PD listed above.  If they help and don’t produce side effects, they might protect you from some of the motor symptoms that occur later in the disease process.  CBD products are generally well-tolerated and don’t produce the euphoria associated with THC. 

If you have any questions or want more information, feel free to send me an email.  I am always happy to share my knowledge about CBD or any medications or natural products.  If I don’t know the answer to your questions, I will find them for you.  Have a great week, and stay healthy.

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.

 

 

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

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. UpToDateTM lists 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.

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!

 

 

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.

 

 

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

Turmeric, Diet, and Boswellia for Arthritis

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

I 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

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

                    8

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 (Voltarentm.) This medication is only available by prescription.

 

Oral NSAIDs – The next step is to utilize oral NSAIDs. Medications in this class include ibuprofen (Motrintm), naproxen (Alevetm), piroxicam (Feldenetm), and others. 

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

 

Duloxetine (Cymbaltatm) – 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.

 Mediterranean vs Ornish Diet

 

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. 

Natural Supplements

Turmeric – The only two nutritional supplements recommended by UpToDatetm 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!

 

 

 

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.

 

 

Crohn’s Disease Dietary Restrictions and Natural Remedies

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!

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

 

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

 

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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.

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

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. 

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.

 

 

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

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

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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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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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

 

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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

 

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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.

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 DrugsL-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 NitratesL-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.

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.

 

 

Bipolar Depression Treatment – Seroquel, Latuda, and Others

The first line medication treatments for bipolar depression are explored along with signs and symptoms of mania and depression.

Abnormal Condition of Dry or Scaly Skin in Older Individuals

What can be done to prevent dry skin as you age?

The skin is the largest organ of the body. It serves as a barrier and protects us from bacteria. 

Skin also helps to regulate body temperature and allows us to respond to heat, cold, and touch. There are three layers that compose the skin.

  • Epidermis – This is the outer layer that serves as a barrier. The epidermis keeps pathogens from entering the body and regulated water being released from the body.
  • Dermis – The layer below the epidermis is called the dermis. This layer contains blood vessels, nerve endings, sweat glands, and hair follicles.
  • Hypodermis – This layer contains fat and connective tissue, and provides cushioning and insulation to the body.

Dermatologists are specialized physicians who diagnose and treat various conditions of the skin. This post will explore dry skin, its causes, treatments, and effects on the aging population.

Effects of Age on the Skin

As we age, our skin becomes thinner. The number of blood vessels, nerve endings, and the amount of connective tissue also decrease. These changes lead to a reduced ability to retain moisture, control body temperature, and sense the environment.

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Pruritis, or itching, is the most common complaint involving the skin in older individuals. Short-term itching, less than six weeks, may protect us, but pruritis lasting more than six weeks can be bothersome. Pruritis can effect the quality of life and, in some cases, patients would rather live a shorter life without symptoms than live longer with pruritis.

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Dry skin (xerosis) is more common in older individuals and those living in colder climates. Heating homes in the winter months leads to decreased humidity that can dry the skin.

Prevention of Dry, Itchy Skin

The best treatment for most anything is prevention. 

Dry, itchy skin is no exception. 

The first step is to monitor the health of the skin regularly. This can be done by scanning the body for problem areas. A physician may also perform skin monitoring during a routine physical exam. 

Some causes of dry skin include:

  • Cold, dry air during the winter months
  • Skin damage from the sun
  • Use of soaps and detergents that damage the skin
  • Excessive immersion in water (taking long baths)
  • Some diseases such as lymphoma, malnutrition, hypothyroidism, eczema, and others
  • Direct exposure to fan heaters

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    One of the best ways to prevent dry to skin is to eat an adequate amount of protein, vitamins, and fatty acids.

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Best Foods to Eat for Healthy Skin

What should you eat to help keep your skin healthy? In general, fresh fruits and vegetables are a good choice because of the vitamins and antioxidants. Below are some great suggestions.

  1. Salmon – Fatty fish, such as salmon, contain omega-3 fatty acids which reduce inflammation and keep the skin moisturized.

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  1. Bell Peppers – Bell peppers are an excellent source of beta-carotene, especially the red and yellow variety. Green bell peppers are picked before they turn color and do not contain as much beta-carotene, which is converted to vitamin A in the body. Bell peppers are also high in vitamin C, which helps keeps the skin healthy by helping form collagen.

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3. Broccoli –

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Probably my favorite vegetable, broccoli, contains many vitamins and minerals necessary for good skin health, including:

  • Vitamin A
  • Vitamin C
  • Zinc

Broccoli, as well as cabbage, cauliflower, and kale, also contains sulforaphane. This substance may protect the skin from the sun’s damage, thus decreasing photoaging.

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  1. Avocados – Packed with healthy fats, this guacamole ingredient can improve skin health by moisturizing and improving flexibility.

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Avocados also contain vitamins C and E, which act as antioxidants. One symptom of vitamin C deficiency is dry, scaly skin. Vitamin C also is needed to make collagen that helps keep skin healthy and strong.

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  1. Tomatoes – Another favorite of mine, tomatoes contain vitamin C, lycopene, and beta-carotene. 

These substances can protect skin from the sun and help prevent wrinkles.

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  1. Soy – Isoflavones are contained in soy. These have been shown to improve skin elasticity and decrease fine wrinkles in at least one study.

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Isoflavones can also protect the skin from the sun’s harmful rays.  

  1. Sweet potatoes – We started eating more sweet potatoes when consuming the Whole30 diet. These are an excellent beta-carotene source that can protect the skin from the sun. Sweet potatoes are a better option than white or yellow potatoes. Give them a try.
  1. Green leafy vegetables – spinach, kale, and collard greens contain vitamins A, C and E. They are also a good source of protein and spinach contains selenium which can protect the skin from UV rays.
  1. Eggs – These are a good source of protein, selenium, zinc, vitamin A and vitamin C.  

10. Healthy oils –  Extra virgin olive oil and fish oil can help with keeping the skin moist and pliable.

Dietary supplements may be necessary if you cannot get enough nutrients from the foods you eat. 

Some of these can be found in the Sunshine Store. The supplements listed below are the same as those contained in the foods above.  

  • Fish Oil
  • Vitamin A
  • Vitamin C
  • Vitamin E
  • Zinc
  • Selenium

Topical Agents for Dry Skin

Daily use of moisturizers that hydrate the skin is important. Some examples of ingredients that can help are:

 

Topical Urea – This is a molecule produced by our body that is naturally found in the skin. It is generated from the metabolism of proteins and other compounds. 

Urea is excreted in the urine and through sweating.

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Urea is one of the best moisturizing agents available to dermatologists today. It has been used safely for over a century and can be utilized for several skin conditions. Urea has different effects on the skin, depending on the concentration employed. At lower concentrations (~10% or less), it acts as a moisturizer, while at concentrations greater than 10%, it has an emollient/keratolytic action. Urea can also enhance the penetration of other molecules through the skin and is used in combination therapies.

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Other skin moisturizers available include glycerin, lactic acid, and petrolatum.

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Other Ways to Help Dry Skin

  • Avoid traditional soaps – regular soap can alkalinize the skin damaging the moisture barrier. Synthetic cleansers such as Dove, Olay, and Cetaphil are preferred.
  • Avoid excessive washing – This can worsen dry skin, especially if very hot water is used. 
  • Avoid aggressive scrubbing and use luke-warm water.
  • Use a Humidifier – Increasing humidity can help decrease skin drying, especially in the winter months.

 

 As we age, our bodies go through many transformations. Energy levels decrease, our kidneys and liver don’t work as well, and we have a higher percentage of body fat. Our skin also changes and becomes thinner, less pliable, and dry. If we don’t care for our skin, it can crack, leading to pain and possible infection.  

 

One of the best things you can do for your body at any age is to eat fresh, whole foods. If you eat a healthy, balanced diet, you are likely to help your skin stay strong and healthy. Always stay hydrated, exercise, and use high-quality moisturizing lotions. 

 

If you live in the northern part of the country where it is cold in the winter, consider using a humidifier to help decrease the effects of dry air on your skin.  

 

Avoid excessive bathing, especially with very hot water, as this may dry your skin. Stick with high-quality synthetic cleansers, and be sure to monitor your skin for dry, scaly areas. If you find problems with your skin, see your doctor. There are medicated creams and lotions available to help relieve the various skin conditions you may be suffering from.

Skin integrity is vital to our overall health. If you have any questions regarding this topic, or any other health or fitness related subject, feel free to contact us. If you have ideas for future blog posts, let me know. My goal is to keep you entertained and informed. Have a great day; be happy, healthy, and keep smiling.

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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.

 

 

Female Pattern Hair Loss, PCOS Alopecia Treatment, What Works?

Female pattern hair loss (FPHL), also called female androgenic alopecia is a diffuse, non-scarring loss of hair.  The hair loss is most apparent in the frontal, central, and parietal scalp regions.  This condition is most common in adult females and its incidence increases with age.  Unfortunately, this disease shows variable responses to treatment.

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Not surprisingly, FPHL can lead to low self-esteem, poor body image, depression, and a lower over-all quality of life.

We know that the hair follicle changes in alopecia are similar for men and women, but the presentation and response to therapy is different. 

FPHL normally occurs during the reproductive years.  The second peak occurs at menopause (50-60 years of age).  A study conducted in 2001 found a 3% incidence of FPHL among 1008 Caucasian women in their 30’s.  This prevalence increased slowly with age and was 32% in the ninth decade of life.  The combined prevalence was 19%.

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Minoxidil

The first line of treatment for FPHL is Minoxidil (Rogaine).  Many are familiar with Rogaine as it has been approved for use in men’s hair-loss since 2006.

We are not completely sure how minoxidil works but it is thought to promote the growth phase of the hair follicle, shorten the resting phase, and enlarge miniaturized follicles.

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 In 2014, 5% minoxidil was approved for FPHL.  Before this, only 2% minoxidil solution was approved for use in women.  Studies have shown that once daily application of a 5% foam is as effective as twice daily application of a 2% solution.  This is important because once daily application is more convenient for the patient. 

There are side effects associated with the use of minoxidil.  During the Rogaine clinical trials conducted by Johnson and Johnson, the following side effects were reported in at least 2% of the study participants.

  • Weight Gain
  • Headache
  • Itching
  • Nasal and upper respiratory tract infections        4

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One of the common concerns among women using hair growth products is the worry of hair growing in the wrong places.  Hypertrichosis has been reported with both strengths of minoxidil but is significantly less with the 5% foam.

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It is recommended that minoxidil be applied at least 2-4 hours prior to bedtime with hands thoroughly washed after application to limit unwanted hair growth on the face.

Although I do own stock in Johnson and Johnson, I currently am not paid for promoting their products.  I have included the link to the Rogaine site below as a convenience to my readers.  Both 2% solution and 5% unscented foam are available at:

https://www.rogaine.com/products/womens-hair-regrowth-solutions#women

Other Treatment Options

If Minoxidil is ineffective, other medications may be tried.  It is important to note that although these secondary treatments may be tried, no conclusive evidence supporting their effectiveness is available.  In fact, a Cochrane Review including 47 trials with 5290 subjects, found only minoxidil to be effective for FPHL.

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Although evidence is lacking, these systemic treatments are still utilized in some situations.  They will be briefly discussed here.

Spironolactone

Spironolactone is an aldosterone antagonist.  It works by blocking androgen receptors and has some inhibition of androgen synthesis.

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It is usually the initial second-line agent employed for FPHL because it is often used in women for other indications such as acne, hirsutism, and polycystic ovarian syndrome.  This gives providers more confidence in regards to side effects and tolerability.  Spironolactone has limited positive data available for its use in FPHL.  One open-label study treated patients with either spironolactone or cyproterone.  The average duration of treatment in this study was 16 months.  There was not difference between the groups.  Forty-four percent of the patients experienced regrowth of hair, forty-four percent showed no change, and twelve percent had continued hair loss.

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Finasteride

Finasteride is often used to treat baldness in men.  It works by inhibiting the conversion of testosterone to dihydrotestosterone.  This medication is usually well tolerated in females and because of the limited options for women who fail minoxidil, it may be another option.

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Flutamide

Flutamide has a few studies supporting its usefulness in FPHL.  In one prospective cohort study of 101 premenopausal women, flutamide was associated with an average of 15% improvement of hair thickness at six months and 28% at two years.

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Another case study found flutamide reversed hair loss in a patient who had failed treatment with a combination of spironolactone and topical minoxidil.

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Flutamide is associated with side effects such as decreased libido, GI distress and rarely liver failure.  The threat of liver failure has limited flutamide’s use in FPML.

Low-Level Laser Light Therapy (LLLT)

Photobiomodulation therapy, or low-level laser light therapy has also been used to treat FPHL.  A study published in 2014 in The American Journal of Clinical Dermatology found a clinically significant difference in terminal hair density between an FDA approved low-level laser product (Lasercomb) and a sham device.  This was a randomized, double-blind sham device controlled study of 128 male and 141 female subjects. 

The patients who used the Lasercomb also reported an improvement in hair thickness and an overall improvement of their hair loss condition as compared to the sham treated patients. 

There were no serious adverse effects reported with the use of the Lasercomb.  This device may be a good alternative for hair-loss patients who either do not respond to medications or have adverse effects or contraindications to available treatments.

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More information on the Ultima 9 Classic LaserComb can be found at:

https://hairmax.com/products/ultima-9-classic-lasercomb?variant=30328901664886&currency=USD&gclid=Cj0KCQiApt_xBRDxARIsAAMUMu_CUgG6KDzv5d4DMnuOrpiGeL5NHVb0edgODpcXETrwB8E1rGCknE8aArzhEALw_wcB

Surgery

When all other treatments fail, hair transplantation surgery is an option.  Unfortunately, this is not always effective as transplant failure is possible.  This procedure is also costly and time-consuming for the patient.  There may also be an increased amount of hair loss early on and pain and infection is also a risk.

 

PCOS Alopecia Treatment

Polycystic ovarian syndrome (PCOS) alopecia is caused by an increase in male hormones.  Treatments for this are the same as those listed above.  In addition, birth control pills may be used to help decrease androgen levels.  Oral contraceptives not only help with hair loss but also can be effective for the treatment of other PCOS symptoms such as acne and irregular menstruation.  

There is evidence that weight loss in women with PCOS can also decrease androgen levels.  Even a loss of five to ten percent of body weight can have a significant effect on PCOS symptoms.14

Female pattern hair loss is an unfortunate ailment that increases in prevalence with age.  This condition leads to poor self-esteem, a distorted body image, and may even lead to depression.  Unfortunately, the treatments available for this disorder are scarce.  The only scientifically proven method is topical minoxidil, or Rogaine.  Other treatments have been used with some success but are not well supported by the clinical literature. 

Please leave any questions or comments below.  Thanks for reading, and have a great day!

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.

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