Are You at Risk for Pneumonia with this Medication?

One of the foundations of health is a good night's sleep.  Lack of sleep can lead to consequences including obesity, aggravation of pain conditions like fibromyalgia, poor memory, and even increased risk of cardiovascular disease.  With all the benefits of getting a good night's sleep, it might be tempting to do whatever it takes to correct sleep problems -- including taking pharmaceutical sleep aids.  But let's step back and consider the consequences first.

A common class of medications prescribed for sleep (and anxiety) is the benzodiazepines ("benzos") -- with trade names like Xanax and Valium, or generic names alprazolam, diazepam, and others.  The main problem with these drugs is well known:  they're addictive, and can lead to physiological dependence.

A new study published this month (1) found an unexpected danger with benzos:  a 54% increased risk of pneumonia.  Pneumonia is one of the more serious complications of seasonal influenza, which I wrote about last week.  If you're currently taking benzos for sleep, or considering them, think about all the natural ways you can improve sleep instead.  Of course, discuss changing your medication with the prescribing physician, since it's best to wean down carefully on this type of drug.  Now if you're thinking, "I've tried all that natural stuff before!  It didn't work," my response is... really?  Everything?  Review the list below, and give these suggestions an honest try for a period of several weeks.


IMPROVING THE QUALITY OF YOUR SLEEP

1. Maintain consistent sleep and wake times. Do not push yourself to stay up past the initial signs of sleepiness. This can create epinephrine production, causing more difficulty getting to sleep later. It is good to have a “getting ready for bed” routine to relax and prepare your body for sleep. Avoid taking naps if you have trouble sleeping at night.

2. Reserve the bed for sleep and sex only. Do not read, watch TV, eat, or worry in bed. Solve daily dilemmas outside of the bedroom. If you find that you’ve been lying awake in bed for 15-20 minutes, get out of bed.  Do something mundane until you feel sleepy, and then go back to bed. Repeat this as often as needed.

3. Your sleeping environment should be quiet, cool (70 degrees or less), and comfortable. The room should be clutter-free. Reduce the amount of ambient light as much as possible. Electronic devices such as clocks, stereos, TVs and computers generate electromagnetic fields that can disturb sleep for some people. Experiment with moving these into another room or using EMF shields. Feng Shui, the Chinese art of placement, can be valuable in creating an optimal sleeping environment.

4. Exercise regularly. Exercising during the day or early evening decreases the time it takes to get to sleep and increases the amount of deep sleep obtained. Most people do better avoiding exercise late in the evening.

5. Exposure to sunlight early in the morning and late in the afternoon or evening encourages a strong circadian rhythm. The hormone melatonin, which helps create a sleep state in the body, is suppressed in light and secreted in darkness.

6. As much as possible, ensure complete darkness at night.  Darkness encourages your body’s natural production of melatonin.  Do not fall asleep with the TV or lights on.  Turn off all screens (TV, computer, video games, etc.) 30-60 minutes before bedtime.  If you wake at night to go to the bathroom, do not turn the light on.  Even this brief exposure to light at night may suppress your melatonin significantly, drastically reducing the quality of your sleep.

7. If you have problems with waking during the early hours of the morning, have a small protein snack just before bed to ensure consistent blood sugar levels throughout the night. Consistently get exposure to sunlight as late in the day as possible.

8. Improving overall health will improve the quality of your sleep. Work towards improving or eliminating health problems. Treatment modalities such as Neurostructural Integration Technique will help to relax the body. Effective stress management is essential.


THINGS THAT RELAX THE BODY AND PREPARE IT FOR SLEEP

• Warm baths, possibly adding Epsom salts or lavender oil
• Meditating for 5-30 minutes
• Breathing exercises, progressive muscle relaxation (various recordings are available) or any other means of inducing the “relaxation response”.  Daily practice brings greater results.
• Special acoustic recordings that increase specific brain wave patterns for relaxation and sleep
• Botanical treatments and aromatherapy using herbs and their essential oils (examples include chamomile, valerian, vervain (verbena), hops, lavender, passionflower, avena (oat straw), lemon balm and scutellaria (skull cap).  Consult Dr. Peters for dosages and recommendations.
• Calcium and magnesium supplementation.  Consult Dr. Peters for dosages and recommendations.
• 5-hydroxytryptophan (5-HTP) or melatonin supplementation may be necessary in individual cases.  Consult Dr. Peters for dosages and recommendations.

THINGS THAT INTERFERE WITH SLEEP

• Although alcohol may make you fall asleep, the sleep obtained after drinking is fragmented and light.
• The stimulating effects of caffeine may last up to 10 hours in some people. Avoid it in the afternoon if getting to sleep is a problem. Caffeine is present in coffee, green tea, black tea, chocolate and some medications (pain relievers, decongestants, thermogenic weight loss products, energy supplements, etc.)
• The stimulating effects of nicotine (first- or second-hand smoke) can last several hours.
• Sleeping pills, aside from being highly addictive and full of side effects, decrease the amount of time spent in deep sleep and only increase light sleep.
• B-vitamin supplements can increase energy that keeps some people awake, if taken before bed. Take B-vitamins earlier in the day.
• Do not go to bed with a very full stomach. Large quantities of protein are stimulating to the body as digestion occurs. It’s best to finish eating at least three hours before going to bed.

1.  The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort.  Thorax doi:10.1136/thoraxjnl-2012-202374.  

Flu Season: Here with a Vengeance

Influenza has arrived early this year, and it looks like it's gearing up to be a nasty one:  both the H1N1 and H3N2 strains of influeza A virus have been identified, as well as influenza B.  According to the Centers for Disease Control and Prevention (CDC), the rate of infection is still low this week in Illinois, but is high in southern states like Alabama and Mississippi.


Remember, this is the respiratory flu we're talking about (sore throat, fever, fatigue, muscle aches), not the "stomach flu" (more properly called gastroenteritis).  The CDC recommends flu vaccines for everyone, though there is no scientific evidence for this approach.  Furthermore, the flu vaccine might prevent flu virus infection, but does absolutely nothing to protect against related viruses that cause flu-like illnesses.  Are there good natural alternatives for preventing and treating the flu?

My first recommendation to everyone at this time of year is to get a blood test for vitamin D levels.  The proper test is called 25-hydroxyvitamin D, and the optimal level should be between 40 and 100 ng/ml.  Research has shown a clear connection between low blood levels of vitamin D and risk of catching the flu.  Flu season can span anytime from October to May – the same time period that we don’t get enough sun exposure to produce vitamin D naturally through the skin.  Coincidence?  If you have low vitamin D levels now, it’s critical to supplement at high doses under a doctor’s supervision.  Without a blood test, a supplement of 1,000-2,000 International Units per day is advisable through the winter.

Remember good hygiene – wash hands frequently, and avoid touching your eyes, nose, and mouth.  There is no need to use antibacterial soap, since this does no better than standard soap in protecting against infection.  Get a good night’s sleep to support your immune system.  For supplemental support, look into herbs such as astragalus, larch, and elderberry, as well as extra vitamin C and zinc.  If you’re exposed to people with flu or other respiratory illnesses, use a neti pot or squeeze bottle with plain salt water to rinse the nasal passages, twice a day.

Flu vaccination is important for those with asthma and other lung problems; for nursing home residents and health care workers; and for those with suppressed immune systems.  For the rest of us, take care of yourself naturally.  At the first sign of illness, use supplemental support often:  elderberry and andrographis every two hours for 24-48 hours can help to shorten the duration and severity of your misery.

Natural Medicine Myth #5: One-A-Day

This is a continuation of my series (in no particular order) on misperceptions in the field of natural medicine.  My previous articles focused on policosanol, cinnamon, systemic candida, and acai berry.

Those of you who know my articles and recommendations will find it no surprise that therapeutic lifestyle changes are the foundation of naturopathic medicine:

• diet
• exercise
• sleep
• stress management

In many cases, though, specific nutritional and herbal supplements can be critical for supporting a patient's vis medicatrix naturae:  the healing power of nature.  Particularly in the case of complex or chronic disease, such supplements are often necessary for a certain period of time.

One thing that often surprises patients is the dosages I recommend for many nutritional and herbal supplements.  I think that many of us have been conditioned by "One-A-Day" multivitamins to think that all supplements work that way.  In fact, this under-dosing is a key reason why many folks find that self-treatment with herbs and supplements is ineffective.

As an example, take one of my favorite supplements:  fish oil.  The beneficial components of fish oil are the long-chain omega-3 fatty acids, EPA and DHA (that's eicosapentaenoic acid and docosahexaenoic acid for you nutritional biochem geeks out there).  Some folks take one softgel a day of fish oil -- 1000 milligrams!  Sounds like a lot, doesn't it?  Well, research shows that for general cardiovascular health, you should take around 1000 mg of omega-3 fatty acids per day.  "Well, great, then," you think, "I guess I'm covered."  Hold it right there:  fish oil supplements are not 100% omega-3 fats; each softgel might have only 300-400 mg of omega-3s.  So now you're faced with 3-4 softgels per day to get the recommended amount.  Do you see why I recommend liquid cod liver oil so often now?  Much easier to blend a teaspoon into a breakfast smoothie, yielding 1200 mg of omega-3s.

If you already have conditions such as high triglycerides that can benefit from omega-3 supplementation, now you need to up that dose to 2000-3000 mg per day:  7-10 softgels, or 2 - 2.5 teaspoons of liquid.  Omega-3 fats can benefit so many different conditions, such as autoimmune diseases, skin problems, menstrual cramps, depression, and anxiety -- as long as you're taking the proper dose.

Feel a cold coming on?  Yes, zinc lozenges can help -- as long you get a total dose of at least 75 mg of zinc per day (be sure to take with food, to avoid stomach upset).  Herbs such as echinacea, and my favorite combo of lomatium (Lomtium dissectum) and osha (Ligusticum porteri), are wonderful immune boosters -- just be sure take a dose every 2 hours during those first couple of days of a cold.  Less than that, you might as well skip it.

Nutritional and herbal supplements require these larger doses since they work synergistically to support the body's natural functions, rather than to suppress symptoms like pharmaceuticals.  So shift your mindset, and reap the benefits that nature has to offer.

Are "Superfoods" Really that Super?

You've probably heard of phytonutrients, those beneficial compounds in plant-based foods that help protect us against chronic diseases.  In particular, some foods, such as broccoli and blueberries, are so packed with these phytonutrients (such as polyphenols) that they've been dubbed "superfoods."

New research out of Kingston University in London has challenged this notion, finding that most of these phytonutrients don't even get absorbed from the digestive tract into the bloodstream.  So while they may benefit cells in the test tube, they can't benefit our body's cells if they don't get absorbed.  This has been trumpeted with pithy news articles about "debunking exaggerated health claims and benefits" of phytonutrients.

Before you throw out the broccoli, and start scarfing down the Twinkies you've stockpiled since the demise of Hostess, keep a few points in mind:

• This research was not actually done on people, but on a laboratory model simulating the intestinal wall.  There's no guarantee that the absorption works the same way in humans; if it did, pharmaceutical companies could save gobs of time and money that they spend examining pharmacokinetics -- how substances are actually absorbed and metabolized in living people.
• The researchers say "some compounds may have a local effect in the gut itself..."  This is not trivial.  Much previous research has focused on the relationship between the health of the GI tract and the health of the rest of the body, and the interaction of stuff in our GI tract with GALT (gut-associated lymphatic tissue) influencing inflammation and immune signalling in distant parts of the body.
• Epidemiological studies (looking at populations of real people) have shown that eating greater amounts and more variety of fruits and veggies leads to better health outcomes.  I'll take that over a simulation experiment any day.

Always look beyond the headlines of health news and ask yourself, is this conclusion reasonable?  Does it concur with the rest of the evidence out there?  Is it taking all the variables into consideration?  This seems to be one case where researchers have leaped to conclusions once again.

Researchers challenge super food claims.  Kingston University London, Monday 1 October 2012.

Natural Medicine Myth #4: Acai Berry

This is a continuation of my series (in no particular order) on misperceptions in the field of natural medicine.  My previous articles focused on policosanol, cinnamon, and systemic candida.

If you've been to any sites on the World Wide Web in the past several years, you've probably heard of the miracle fruit called acai berry.  Its touted health benefits range from weight loss to treatment for high cholesterol, high blood pressure, and beyond.  There is no shortage of testimonials about these effects, and the ads about acai are often disguised as phony "news investigations."

The first thing to consider about such claims is that even though testimonials are emotionally compelling, they do not comprise any sort of scientific evidence.  Many of the actual scientific studies about the benefits of acai were done in vitro (that is, in the test tube) -- meaning that any benefits for people actually ingesting acai are purely a guess.

What do we actually know about acai?  This species of palm tree (Euterpe oleracea) is common in South America, and produces an antioxidant-rich fruit.  This fruit is an important staple in the diet of some native Amazonian peoples.  The antioxidant qualities of acai have contributed to its reputation as a "health food."  Howerver, analyses of this fruit show that its antioxidant content is lower than that of blueberries, mango, strawberries, and grapes.

If you've been around the natural health scene for a while, you've seen this before.  Prior to acai, the miracle fruit was goji berry.  Then there was mangosteen, and oh yeah -- noni juice!  Remember that oldie but goodie from the '90s?

People like a good story -- really, it's what makes us human.  We like stories of exotic fruits from faraway lands with mysterious-sounding names.  Does that mean all those anecdotes about health benefits are false?  Maybe not -- if folks are eating the Standard American Diet (S.A.D.) of fast food, processed food, and junk food, then consumption of any fruit or vegetable is bound to improve their health!

Wouldn't it make more sense to eat some healthy fruits grown locally in our own region, like blueberries?  Without the thousands of miles of transportation, they retain much higher levels of their nutrients and antioxidants.  Enjoy the abundance we have right here of colorful fruits and veggies.  Save the exorbitant cost of acai and other miracle fruits; enjoy a good book or movie for your story.

Did You Enjoy that Extra Hour of Sleep this Weekend?

Welcome back to standard time, folks... did you remember to set your clocks back this weekend?
One more question:  did you notice it was much easier to adjust to the time change this weekend than to the switch to daylight savings time in the spring?  It seems logical, since we "gained" an hour of sleep on Saturday night.  But even beyond that, this is the one weekend out of the year when the external clocks match most closely to our internal biological clocks.

Yes, we do have a biological clock -- a part of the brain called the suprachiasmatic nucleus (SCN); its job is to keep track of the daily cycle of our body's functions (also known as our circadian rhythm).  Research has shown that for most folks, the SCN is actually set to a 25-hour cycle, which means that we have to reset it every day based on cues in our environment.  That's why it's easier to stay up late, but harder to wake up earlier in the morning.

Up till about 200 years ago, our biological clocks mostly relied on the signals of sunlight to reset ourselves each day.  With the advent of reliable timekeeping, we now go by a strict 24-hour day; with electric lights, we can give in to our tendency to want to stay up later, if we choose.

Use the "extra" sleep you got this weekend to honor your body's natural circadian rhythm.  Don't complain about the early sunset, but rather use it as a signal to get to bed at a reasonable time -- and enjoy the earlier sunrise these days.  Sleep is one of the foundations of health, and most adults need around 7-8 hours per night.  Getting adequate sleep helps not only with our daytime energy, but also with preventing diabetes, cardiovascular disease, and obesity.

This is a repost of an article that appeared in 2011.

Is Vitamin D Good for the Heart or Not?

Based on much recent research linking low levels of vitamin D to increased risk of heart disease, this is something I measure in all of my older patients.  If low, supplementation is simple, cheap, and can effectively raise those levels back up.  This is especially important at this time of year, since the sun is not strong enough to produce any vitamin D from skin exposure at our latitude.

A recent study in the Journal of Clinical Endocrinology & Metabolism (1) looked at the question of whether or not supplementing with vitamin D can change cardiovascular risk.  This was one of the first actual placebo-controlled clinical trials to examine the question.  Half the participants got vitamin D3 (a good quality form of vitamin D), and the other half got placebo.  At the end of the study, they examined cardiovascular risk markers, such as blood cholesterol, blood pressure, and C-reactive protein, and found no significant difference between the groups.  The conclusion?  Quoting from the New York Times:

“The study actually shows that vitamin D does not protect you against heart disease,” said Helen M. Macdonald, a senior lecturer at the University of Aberdeen in Scotland, who led the study. “That’s not what people want to hear, but it’s true.”

Now hold on a minute.  The researchers are making a huge assumption:  that the risk markers of cholesterol, C-reactive protein, etc., are synonymous with heart disease.  The thinking is that if something (in this case vitamin D) does not affect those traditional risk markers directly, there is no impact on heart disease.   However, it is well known that a significant percentage of heart disease and heart attacks occur in people with normal cholesterol levels and blood pressure.  Perhaps vitamin D is an independent risk factor -- that is, it could protect against heart disease without changing those other parameters.

The way to  really tell this for sure experimentally would be to use actual cases of heart disease as the end point of vitamin D supplementation.  This study was a good first step, but the error in logic on the part of the researchers is glaring.  In the meantime, I'll keep checking blood levels of vitamin D on my patients over age 40 as part of an overall cardiovascular risk assessment, using the naturopathic principle of "Treat the whole person."

1.  Vitamin D₃ Supplementation Has No Effect on Conventional Cardiovascular Risk Factors: A Parallel-Group, Double-Blind, Placebo-Controlled RCT.  Published online before printAugust 3, 2012, doi:10.1210/jc.2012-2126
The Journal of Clinical Endocrinology & Metabolism, October 1, 2012 vol. 97 no. 103557-3568