Happy Sunday Folks,On the blog today we have a few "off topic" heatlh related entries along with hepatitis C wellness links, which I hope you find interesting.
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Healthy You
Healthy You
August 2011
Q: Are hyaluronic acid supplements effective against joint pain?
A: Hyaluronic acid (HA), also called hyaluronan, is produced in the body, particularly in the skin, eyes and joints. But that doesn’t mean swallowing it will do anything or is safe.
HA acts as an antioxidant and modifies inflammation. In joints, it cushions and lubricates. Levels of HA in joint fluid can be significantly reduced in people with osteoarthritis. So the substance (extracted from rooster combs or made by bacteria in a lab) is sometimes injected into joints to reduce arthritis pain and improve function.
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The Natural Medicines Comprehensive Database says that HA is “possibly effective” for osteoarthritis when injected, though results have been mixed. It’s also injected as a facial filler.
More dubious is the use of oral HA, available in gel caps and liquid forms. The supplements are touted to treat arthritis and delay aging (the “key to the fountain of youth”). They are said to promote healthy skin, stabilize vertebrae in the spine, promote recovery from sports and so on.
There are different sources and types of HA, with different biological effects. It’s unknown which, if any, supplement might work. The only published human research we could find was a 2008 study that gave an HA supplement to people with knee osteoarthritis. It was very small and had questionable findings. And aside from some animal research, it’s uncertain whether the substance is even well absorbed, much less that it makes it to the intended part of the body.
Last year the FDA warned one company that it was illegally marketing HA products as drugs and making unsubstantiated health claims. Be aware that some HA supplements also contain other questionable and potentially harmful ingredients.
Until there are larger, well-designed, published clinical trials showing safety and effectiveness, skip hyaluronic acid supplements.
Q: Can drinking oxygenated water have any health benefits?
A: No. Makers of oxygenated water claim the water is infused with 7 to 40 times more oxygen than regular water. This, supposedly, will help your muscles, improve athletic performance and “purify” the body.
But this makes no sense. First, there’s little free oxygen gas in water to begin with; adding more doesn’t amount to much. A bottle of oxygenated water has less oxygen than what you get taking a single breath.
Most important, it doesn’t matter how much oxygen is in the water, because we absorb oxygen into our blood through our lungs, not our digestive tracts. And, in
general, healthy people’s blood already contains all the oxygen it needs.
general, healthy people’s blood already contains all the oxygen it needs.
Oxygen water is a scam.
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Q: I’ve heard that tart cherry juice has all sorts of health benefits. But a cup has 125 calories, almost all from sugar. Is it worth drinking?
A: It’s okay in moderation, but don’t count on it to prevent or treat any medical condition.
Many health claims have been made about cherries, especially tart ones: that they can lower blood sugar, regulate sleep, restore energy, and relieve arthritis and gout, among other conditions. A few years ago the FDA warned some companies to stop making such unproven claims.
Cherries are rich in antioxidants, particularly anthocyanins—pigments that give red, blue, and purple fruits and vegetables their intense color. Lab studies show that these anthocyanins help block inflammation. Other lab studies have suggested that compounds in cherries may lower cholesterol and blood sugar, inhibit cancer cell growth, and protect brain cells. But what happens in animals and in test tubes may not happen in people. The few human studies have been small, usually used large amounts of cherries or juice (in some cases supplying 250 calories or more a day), and showed modest benefits (helping older people with insomnia sleep a little better, for instance). Even if the results are confirmed by larger studies, the calories can be a problem.
Keep in mind, too, that much of the research has been funded by the cherry industry. It may be good research, but such sources are not likely to publish negative findings. Moreover, many red/blue/purple foods—including blueberries, blackberries, raspberries, and pomegranates—are also rich in anthocyanins (and other antioxidants) and have similar potential benefits.
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Q: Does i-flex really help relieve arthritis pain?
A: Maybe. Several small studies suggest that i-flex, a standardized extract made from rose hips and seeds, may provide some relief from chronic pain, at least in the short term. The evidence, though not consistent, seems strongest for osteoarthritis, but the supplement may also benefit people who have rheumatoid arthritis and low back pain.
I-flex is made primarily from the hips (fruit) of R. canina (dog rose). The product originated in Denmark and is marketed under different brand names, typically as capsules.
The Natural Standard, which evaluates research on herbal and other alternative treatments, gave i-flex a B (good) rating for pain relief from osteoarthritis. A 2008 analysis, which looked at three studies funded by the manufacturer, concluded that the extract “seems to have a consistent, small to moderate efficacy” in people with arthritis.
The product is thought to inhibit COX-1 and COX-2 enzymes, which play important roles in inflammation and pain, according to a 2007 review in Phytotherapy Research. More research is needed to test its effectiveness, the authors noted.
If you have arthritis and want to try i-flex, keep in mind that its long-term safety and its interactions with drugs are not known. One concern: because the extract may work similarly to pain relievers such as aspirin by inhibiting COX-1 and COX-2 enzymes, it may have some of the adverse effects of those drugs, notably stomach bleeding.
It’s also not known whether other rose hip supplements would have the same effects as i-flex, though they are not typically marketed for arthritis.
From John Hopkins
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Leg Cramps
A reader of our Health After 50 newsletter asks, "I suffer from frequent leg cramps and I’ve heard that quinine can help. Should I consider taking it?" Here’s what Hopkins recommends.
Muscle cramps are a major problem for people with neurological illnesses such as Parkinson's disease or multiple sclerosis, but muscle cramps also frequently strike otherwise healthy older adults. In fact, it’s estimated that upwards of 50 percent of people older than 65 experience recurring idiopathic (without a known cause) muscle cramps. Quinine is often prescribed off-label for the treatment of muscle cramps.
However, the U.S. Food and Drug Administration (FDA) strongly recommends that people only take quinine for its indicated use -- to treat malaria. Qualaquin, the prescription form of quinine, has been associated with a number of potentially deadly side effects. Between 2005 and 2008, the FDA received 38 reports of quinine-related incidents to its Adverse Event Reporting System.
This may not seem like a lot, but the majority of cases were serious. Many of the people involved developed a condition called thrombocytopenia -- their blood platelets dropped to alarmingly low levels, causing excessive bleeding. Fourteen people had a blood platelet count below 5,000 microliters (normal is between 150,000 and 450,000); five died. A number of other adverse events also were reported, including: GI symptoms, hearing loss, rash, electrolyte imbalance, and drug interactions.
In addition, quinine is only mildly effective at stopping muscle cramps or reducing their severity, according to a recent assessment by the American Academy of Neurology (AAN). Other treatments that also fared poorly in the AAN's analysis include the antiseizure drug gabapentin (Neurontin), magnesium, and basic muscle stretching.
What might work for leg cramps? A host of potential but yet-to-be-proven candidates include muscle relaxers, calcium channel blockers, and even the numbing agent lidocaine. For now, the AAN recommends asking your doctor about B-complex vitamins, diazepam (Valium), or the antiseizure drug naftidrofuryl (Dusodril).
Urgent Care or the ER – Which is the Right Choice?
You've got a sore throat or a deep cut that needs medical attention now, but you don't think it warrants a trip to the emergency room (ER). Is going to an urgent care center a sound alternative?
"In these cases, call your primary care provider first," says Michele Bellantoni, M.D., Associate Professor of Medicine and Medical Director of Johns Hopkins Bayview Care Center. "This is particularly important for patients with chronic conditions, because a healthcare provider familiar with your medical history will be able to tell you whether a problem that appears small actually requires complex care. No matter where you seek medical attention, it's also necessary to keep your primary provider informed about any medical problems you're facing."
Urgent care centers are staffed with licensed physicians (and are not to be confused with retail clinics in pharmacies and chain stores, which are typically run by nurse practitioners and physician assistants who perform screenings and treat minor illnesses).
Many urgent care facilities offer services your doctor's office likely does not provide, including x-rays, on-site lab work, and suturing. Other major advantages of urgent care are speed and cost. In some states, the average wait time in the ER for a patient with a non-emergency ailment is more than four hours, and services typically cost $1,000-plus.
At an urgent care center, the bill may be five times less than the ER, and patients generally wait no more than an hour. That's why thousands of these facilities are springing up throughout the country. In fact, many are affiliated with hospitals (including Johns Hopkins), which have started offering urgent care to expand business and relieve busy ERs.
If you're not sure whether you or a companion is experiencing an emergency, play it safe and go to the ER -- particularly for symptoms of a heart attack (like chest pain) or a stroke (like sudden vision changes, slurred speech, one-sided weakness, or mental confusion).
Practicalities. Research urgent care facilities in your area so if you face a non-emergency problem, you'll know where to go. The website www.findurgentcare.com will give you a list of centers in and near your zip code. Find out which accept your insurance and when they're open. While urgent care centers have expanded evening and weekend hours, most aren't open 24 hours a day like ERs.
Info To Bring Along
Whether you're visiting an urgent care center or the ER, always bring a copy of your essential medical information. Make a list with the following items and keep it in an accessible place (like on the refrigerator), so you can grab it quickly before you seek medical attention:
- The name, address, phone number, and fax number of your primary care provider
- Your current medical conditions
- Your current medications, along with dosages
- Drug allergies
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Pill Splitting Advice
Pill Splitting Advice
Prescription medication is expensive, so many patients split their pills to save money. Is this a good idea? Here’s advice from Johns Hopkins.
Pill splitting is a good way to save on the cost of prescription medication, since a 200-mg dose typically costs the same as a 100-mg dose of a particular drug.
But it is essential to ask your doctor and pharmacist whether your medication can be split safely, because it is very easy to split pills unevenly. For people with certain medical conditions, like epilepsy and some heart problems, an inadequate dose can be dangerous. Correct dosage is also essential for hormone medications. Other medication that shouldn't be split:
Extended-release pills that deliver medication over time
Combination tablets that contain more than one medication
Pills coated to protect the stomach from irritation
Pills that crumble easily or are awkwardly shaped
Pills that are difficult to swallow because of bitter taste
Powder or gel capsules
That said, other medications can be split, like sildenafil (Viagra), certain blood pressure medications, many antidepressants, and most statins. Pills that are scored to make cutting easier indicate approval from the U.S. Food and Drug Administration to split the tablets.
Don't split pills with your hands or a knife -- this could lead to inaccurate doses. Buy a pill splitter at your local drugstore. Most cost $5-10; ask your pharmacist for a demonstration.
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How Long Do Medications Last?
How Long Do Medications Last?
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Readers want to know: Are medications that have passed their expiration dates good to use, or should they be discarded? Here's the answer from Johns Hopkins.
Think of expiration dates -- which the U.S. Food and Drug Administration (FDA) requires be placed on most prescription and over-the-counter medications -- as a very conservative guide to longevity. The expiration date is a guarantee from the manufacturer that a medication will remain chemically stable -- and thus maintain its full potency and safety -- prior to that date. Most medications, though, retain their potency well beyond the expiration date, and outdated medications, whether prescription or over-the-counter, are not usually harmful.
In a study conducted by the FDA on a large stockpile of medications purchased by the military, 90% of more than 100 medications were safe and effective to use years after the expiration date. The drugs in the FDA study, however, were stored under ideal conditions -- not in a bathroom medicine cabinet, where heat and humidity can cause drugs to degrade.
If your medications have been stored under good conditions, they should retain all or much of their potency for at least one to two years following their expiration date, even after the container is opened. But you should discard any pills that have become discolored, turned powdery, or smell strong; any liquids that appear cloudy or filmy; or any tubes of cream that are hardened or cracked.
To help maintain potency, store your medications in a closet or cabinet located in a cool, dry room. Also, don’t mix medications in one container: chemicals from different medications can interact to interfere with potency or cause harmful side effects. If two or more medications have been mingled for any period of time, discard them.
A few medications, like insulin and some liquid antibiotics, do degrade quickly and should be used by the expiration date. Also, consider replacing any outdated medications that you’re taking for a serious health problem, since its potency is more critical than that of an over-the-counter drug you take for a headache or hay fever. If in doubt, consult a pharmacist.
Antibiotics: How They Can Cause Diarrhea
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Antibiotics have been widely used since World War II, and they've saved countless lives since then. Bacterial illnesses such as strep throat and urinary tract infections can be easily treated, often in three to 10 days. But as with any medication, antibiotics carry the risk of digestive side effects. People taking antibiotics may develop mild diarrhea or a more serious bowel inflammation.
How Antibiotics Work.
Many different species of bacteria live in your digestive tract. Most are helpful, others are harmful, but in healthy people the good bacteria far outnumber the bad. This balance is delicate, however, and it can be easily disrupted.
When you take an antibiotic for an infection, it doesn't just target the problem bacteria. The antibiotic can kill off both good and bad bacteria in your digestive tract. Often the strongest, most treatment-resistant harmful bacteria are the ones that remain, and as they're allowed to multiply unchecked they can wreak havoc on your digestive system.
Most people taking an antibiotic will be fine, but the accompanying diarrhea that affects the other 20 percent can range from a mild, short-lived bout of diarrhea to colitis, an inflammation of the colon. Some people may experience a more serious, perhaps even life-threatening, form of colitis caused by the bacterium Clostridium difficile (C. difficile).
People over age 65 are more prone to develop antibiotic-associated diarrhea (AAD) and colitis, as are those who have recently stayed in a hospital or nursing home, have had surgery on the intestinal tract or have another illness affecting the intestines, such as inflammatory bowel disease or colon cancer.
While any antibiotic, oral or injected, has the potential to cause diarrhea, the most likely candidates are stronger, broad-spectrum antibiotics, which include:
- cephalosporins like cefixime (Suprax) and cefpodoxime (Vantin)
- extended-coverage penicillins like amoxicillin
- erythromycin
- quinolones such as ciprofloxacin (Cipro) and levofloxacin (Levaquin)
- tetracyclines
- clindamycin
Antibiotic-associated diarrhea (AAD) involves occasional loose stools or mild diarrhea for several days. The problem typically begins five to 10 days after starting an antibiotic; however, in 25 to 40 percent of cases, symptoms don't appear until up to 10 weeks after treatment ends. Most cases of AAD do not require treatment and will resolve on their own within two weeks after finishing an antibiotic.
From Mayo
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Vitamin water: Better than plain water?
Is vitamin water a healthier choice than plain water?
from Katherine Zeratsky, R.D., L.D.
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Vitamin water: Better than plain water?
Is vitamin water a healthier choice than plain water?
from Katherine Zeratsky, R.D., L.D.
Vitamin water is fortified with various vitamins and other additives, and some include sweeteners that add calories. If you're eating a balanced diet or taking a multivitamin, you won't likely benefit from drinking vitamin water. If you're trying to lose weight, the calories in vitamin water will only work against you. As always, it's important to check the label for ingredients. Remember, fruits, vegetables and other whole foods are the best sources of vitamins and minerals. And it's tough to beat plain water as a healthy, no-calorie drink. If you don't care for plain water, try sparkling water or a squirt of lemon or cranberry juice in your water.
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Vitamin D toxicity: What if you get too much?
What is vitamin D toxicity, and should I worry about it since I take supplements?
from Katherine Zeratsky, R.D., L.D.
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Vitamin D toxicity: What if you get too much?
What is vitamin D toxicity, and should I worry about it since I take supplements?
from Katherine Zeratsky, R.D., L.D.
Vitamin D toxicity, also called hypervitaminosis D, is a potentially serious but treatable medical condition that occurs when you get too much vitamin D.
Vitamin D toxicity usually results from taking an excessive amount of vitamin D supplements — not from your diet or too much sun exposure. That's because your body regulates the amount of vitamin D produced from sun exposure, and even fortified foods don't contain large amounts of vitamin D.
Although vitamin D toxicity is rare even among people who take supplements, you may be at greater risk if you have health problems, such as liver or kidney conditions, or if you take thiazide-type diuretics. As always, make sure your doctor is aware of any vitamins or supplements you take.
The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), causing symptoms such as:
- Nausea
- Vomiting
- Poor appetite
- Constipation
- Weakness
- Confusion
- Heart rhythm abnormalities
- Kidney stones
Treatment of vitamin D toxicity may include stopping vitamin D supplements and restricting calcium intake, as well as taking medication. In severe cases, hospitalization may be necessary.
Supplements can be a reasonable way to meet recommended levels — as long as you pay attention to how much you take. The Institute of Medicine currently recommends that children and adults up to age 70 get 600 international units (IU) of vitamin D daily. The recommendation for adults over age 70 is 800 IU daily.
Finally, keep in mind that doctors may recommend higher does of vitamin D for a short time to treat an underlying medical problem such as vitamin D deficiency. However, such therapeutic doses are given under the care of a doctor.
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Is it possible to take too much vitamin C?
from Katherine Zeratsky, R.D., L.D.
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Is it possible to take too much vitamin C?
from Katherine Zeratsky, R.D., L.D.
Vitamin C (ascorbic acid) is an essential nutrient. Still, it's possible to have too much vitamin C.
Vitamin C is a water-soluble vitamin that supports normal growth and development. Vitamin C also helps your body absorb iron. Because your body doesn't produce or store vitamin C, it's important to include vitamin C in your diet. For most people, a small glass of orange juice plus a serving of strawberries, chopped red pepper or broccoli provides enough vitamin C for the day. Any extra vitamin C will simply be flushed out of your body in your urine.
For adults, the recommended upper limit for vitamin C is 2,000 milligrams (mg) a day. Although too much dietary vitamin C is unlikely to be harmful, megadoses of vitamin C supplements can cause:
- Diarrhea
- Nausea
- Vomiting
- Heartburn
- Abdominal cramps
- Headache
- Insomnia
- Kidney stones
Remember, for most people, a healthy diet provides an adequate amount of vitamin C.
Grapefruit juice: Dangerous medication interactions
Researchers have known for twenty years that taking medications with grapefruit juice can increase the absorption of certain drugs — with the potential for turning normal doses into toxic overdoses.
However, a few years ago a study found that consuming grape, apple or even orange juice can affect the absorption of other drugs, potentially wiping out their beneficial effects and in some cases causing toxic side effects.
The juice from these fruits often interferes with the way the body metabolises some medications. Usually enzymes lining the small intestines destroy a certain portion of the medication taken, causing only a limited amount from making its way to your blood stream.
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However, grapefruit juice wields the power to prevent your intestinal lining from working appropriately. Grapefruit is metabolised in the liver by an enzyme that also metabolises close to half the drugs consumed by people today. What happens is when the grapefruit keeps the enzyme busy, it is unable to break down the drugs, causing the drug to accumulate in the bloodstream. Depending on the drug , an individual will have a variety of side effects due to the “overdose”.
The first controlled human studies on this potentially dangerous interaction took place in 2008 by University of Western Ontario, headed up by David G. Bailey, Ph.D., a professor of clinical pharmacology.
According to the study grapefruit, orange and apple juice have been shown to lower the absorption of etoposide, an anticancer agent; also certain beta blockers (atenolol, celiprolol, talinolol) used to treat high blood pressure and prevent heart attacks; cyclosporine, a drug taken to prevent rejection of transplanted organs; and certain antibiotics (ciprofloxacin, levofloxacin, itraconazole). Medications taken for depression, seizures and abnormal heart rhythms were also listed as likely candidates.
A Few Examples of grapefruit-medication interactions
Anti-anxiety; Buspirone (BuSpar)
Anti-arrhythmia; Amiodarone (Cordarone)
Antidepressant; Sertraline (Zoloft)
Antihistamine; Fexofenadine (Allegra)
Anti-retroviral Saquinavir; (Invirase), indinavir (Crixivan)
Anti-seizure Carbamazepine; (Carbatrol, Tegretol)
Calcium channel blocker; Nifedipine (Procardia), nimodipine (Nimotop), nisoldipine (Sular)
Immunosuppressant; Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf), sirolimus (Rapamune)
Statin; Simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor)
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"List of drugs affected by grapefruit"
.Covered in the December 2010 online issue of "Today's Dietitian" is a comprehensive article on food and medication interactions, entitled; "When Foods and Drugs Collide — Studies Expose Interactions Between Certain Foods and Medications."written by Denise Webb, PhD, RD
.Covered in the December 2010 online issue of "Today's Dietitian" is a comprehensive article on food and medication interactions, entitled; "When Foods and Drugs Collide — Studies Expose Interactions Between Certain Foods and Medications."written by Denise Webb, PhD, RD
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Hepatitis C Wellness
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