A Silent Killer: High Blood Pressure

Hypertension, or high blood pressure, is a common disease in both men and women. Hypertension is called the “silent killer” because it generally produces no obvious symptoms even while it causes widespread damage to the heart, brain, kidneys, and other vital organs. Although it can strike anyone at any time of their life, it’s most commonly seen in older individuals. In fact, over 70% of American women and 50% of American men over the age of 70 have hypertension. Other risk factors for this disease include high cholesterol levels, smoking, obesity, and diabetes.1

Normal blood pressure is defined as a systolic pressure of 130 mm Hg or below and a diastolic pressure of 85 mm Hg or below. High normal is pressures of 131-139 systolic and 86-89 diastolic. Hypertension is defined as a pressure of 140 systolic over 90 diastolic and above.

Blood pressure generally rises and falls throughout the day in a cyclic rhythm and is influenced by many factors, such as exercise and emotional stress.  To get the most accurate picture of your blood pressure, take numerous measurements at different times and average them.

Although doctors still don’t know what causes this most common type of hypertension, current research indicates that a complex interaction between genetic, environmental, and other variables is a significant factor. Secondary hypertension, which is much less common, is high blood pressure caused by known medical conditions, such as kidney disease, pregnancy, and sleep apnea.

The real dangers arise when blood pressure is elevated over a period of years or decades. Over such a time span, hypertension can cause significant damage to blood vessels that supply life-giving oxygen and nutrients to all parts of the body. The heart, brain, and kidneys, along with all other major body parts, can suffer irreparable harm from long-term hypertension.

It’s important to remember that an unhealthy elevation in just one of the two pressures (systolic or diastolic) can have disastrous long-term health consequences. Isolated high systolic pressure, which is the most common form of high blood pressure in older adults, is thought by many to be a significant indicator of heart attacks and strokes in people middle-aged and older. Isolated high diastolic pressure is a strong risk factor for heart attacks and strokes, especially in younger adults.

Hypertension Can Be Controlled Naturally

For those who hesitate to use anti-hypertensive drugs for whatever reason, non-drug strategies may significantly help in supporting healthy blood pressure. The Dietary Approaches to Stop Hypertension (DASH) diet is now recommended as a first-line approach in managing the disease. The DASH diet is high in fruits, vegetables, and other nutritious foods that are rich in potassium, calcium, and magnesium. People following the DASH diet are encouraged to decrease their saturated fats and replace them with foods that are high in monounsaturated fats and omega-3 fatty acids.

Other natural ways to control hypertension include not smoking, obesity control, and salt restriction – the current recommendation is for people with hypertension to limit their salt intake to 2400 mg (about 1 teaspoon) per day.

Arginine – The Source of Nitric Oxide

Another natural way to help support healthy blood pressure is through the use of L-Arginine based supplements.  L-Arginine is an amino acid that plays a vital role in promoting vascular health through the production of Nitric Oxide (NO).

Nitric oxide penetrates and crosses the membranes of almost all cells in the body, and it helps regulate many functions. It is even involved in memory function. In blood vessels, NO is vitally important because it regulates the tone of the endothelium, the layer of smooth cells that line the inside of the vessels. If these endothelial cells become dysfunctional, they can cause spasms or constrictions of the blood vessels that can then lead to hypertension.

Learn more about your options today. Visit www.hypertensa-adv.com for more information. 

  1. https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer/know-your-risk-factors-for-high-blood-pressure

5 Reasons Most Diets Fail (and How to Succeed)

How to Achieve Your Diet Goals

It is very important to know the facts of how to properly diet. On average, a person gains about 11 pounds for every diet they go on. In addition, the person loses both muscle and fat while on a diet, only to gain back the fat. Ultimately, this leads to a slower metabolism and more difficulty maintaining weight.

There are 2 crucial components to sustaining weight loss through a healthy diet.

  1. Reduce appetite in a slow and measured way by regulating the neurotransmitters in your gut and brain that drive hunger and overeating.
  2. Increase your metabolism so you are burning more calories throughout the day than you are consuming.

Here are 3 simple ways to achieve these 2 components:

Eat the Right Food at the Right Time:

Eating whole, fresh food to satisfy your appetite can cut down on the carbs and sugary foods that increase hunger and slows metabolism. Never skip breakfast and avoid eating 3 hours before bed.

Less Calories is not Always Good:

Eating fewer calories to lose weight is an idea that is quickly fading. Recent studies have shown that some calories make you fat while others can make you thin. The staples of your diet should be low-glycemic foods. For example, nuts, seeds, chicken, fish, grass fed meat and greens. Grains and bean consumption should not exceed more than half a cup once a day each. Use sugar sparingly in small doses and avoid artificial sweeteners.

Low-Fat is not Always Good:

Eating fat is not what makes you fat but eating sugar does. Studies have shown that low-carb, high-fat vegan diets were more effective at weight loss than a low-fat vegan diet. Also, eating more fat and less carbs is shown to increase metabolism. Good fats makes you feel full faster and should be eaten at every meal. Examples of good fats include avocado, nuts, seeds, coconut oil, organic eggs, chicken, grass fed meats and fish.

Everyday Medications that Increase the Risk of Heart Attack

Data out of Stanford University suggest that Proton Pump Inhibitors (PPI’s) such as Prilosec, Prevacid, and Nexium are associated with a higher risk of heart attack.  Published in the journal PLOS One online, researchers looked over 2.9 million patients over a several year period to determine if patients who took PPI’s for gastro esophageal reflux had an increased risk for myocardial infarction than patients who did not.  Concern was raised when scientists discovered that PPI’s potentially reduced the antiplatelet effect of clopidogrel, a drug use to prevent clotting after a heart attack or stroke.  The clopidogrel is used after heart attack to prevent clotting which could lead another heart attack.  They were concerned that if heart attack was raised in this population, it could extend to lower risk patients.

The study showed that patients taking PPI’s had a 16% increased risk of heart attack.  H2 Blockers, such as Zantac and Pepcid were not associated with an increase risk.  Perhaps more importantly, the risk was not just associated with high risk categories such as having had a previous heart attack, the elderly or taking clopidogrel.  It was applicable to all ages and risk groups.

The study has several limitations including the attempt to look back at charts and determine what medications are being taken.  Often patients will take over the counter PPI’s and may not be accurately reporting it to their physician.  Also, retrospective analyses like this are subject to certain biases and are not as valuable as preplanned double-blind clinical trials.  However, the large number of patients reviewed does give the study significant credence.

PPI’s are one the most commonly used medications in the United States and around the world, with over 113 million prescriptions filled globally each year.  PPI’s are used to treat stomach and intestinal ulcers and heartburn, as well as to prevent gastrointestinal bleeding from NSAID’s in higher risk populations.  NSAID’s have been associated with a number of serious complications in addition to bleeding ulcers including kidney and liver issues, fluid retention with swelling in the legs, elevated blood pressure and possibly increasing the risk of heart attack.

Medications that are often used to treat or prevent the side effects of another medication create a potentially vicious cycle for patients who will ultimately end up taking more and more medications to manage an illness. The risk of adverse events increases with the number of medications prescribed, and the number of medications prescribed increases with age.

The avoidance of polypharmacy and therefore reducing the risk of dangerous medication side effects is crucial for patients and providers.  Alternative therapies, such as FDA regulated medical foods, which by definition must be on the FDA GRAS list (generally recognized as safe), may have similar efficacy to standard pharmaceuticals but without the side effects. Understanding the risks and benefits of medications is an important part of being a patient and a healthcare provider. Exploring the medication options that may be better tolerated is something every patient and physician should do.

 

Prescription Drug Overdose Deaths on the Rise

The Trust for America’s Health, a nonprofit organization, reported that in 2013 over 44,000 Americans died as a result of drug overdose.  Drug overdoses have been rising since 2009, despite federal and state efforts to better monitor and control use of narcotics and other potentially addictive medications.  Over half of these deaths were related to prescription drugs and in fact, in 36 states more people died from a Rx drug overdose than from automobile accidents.  These numbers are staggering, especially when you consider that drugs such as narcotics (Vicodin, Percocet, etc.) do not cure any disease, they only mask a symptom, pain.

Physicians are under increased scrutiny for prescribing these dangerous drugs and are constantly looking for reliable, clinically proven alternatives.  Until recently, options were limited to NSAIDs, such as ibuprofen and naproxen, which can have significant side effects most specifically on the gastrointestinal tract, and medications used to treat other conditions such as SSRIs, anti-epileptics, and SNRIs,  but that may also help pain as well. The efficacy of these options are limited at best and often cause significant side effects without providing adequate pain relief.

 

Evidence Based Options for Patients and Providers

Theramine, a amino acid based treatment for pain, has been shown in multi-center clinical trials to significantly reduce pain in patients with chronic low back pain without any appreciable side effects better than over the counter doses of ibuprofen or naproxen.  Theramine is regulated as a medical food by the FDA and is manufactured in the United States at a cGMP facility using ingredients that are Generally Recognized as Safe. As a medical food, Theramine is subject to much tighter regulatory oversight than dietary supplements, providing patients and providers with piece of mind knowing that the formulations are tested and evaluated for efficacy.  There have been over 40 million individual doses of Theramine administered since 2004, without a single reported GI bleed, adverse cardiac event or stroke reported the most commonly known side effects of NSAIDs.  Theramine is not addictive and can be taken with other medications or medical conditions.  Theramine provides chronic pain patients a safe, effective and proven alternative to other potentially more dangerous pain medications.

Is Your OTC Pain Reliever Going to Kill You?

Although acetaminophen (Tylenol) is heavily marketed for its safety, FDA recommends health care professionals to discontinue prescribing and dispensing drug products with more than 325 mg of acetaminophen due to the high risk of liver injury.  Severe liver injury may occur in patients who:

  • Took more than the prescribed dose of an acetaminophen containing product in a 24 hour period.
  • Took more than one acetaminophen containing product at the same time.
  • Drank alcohol while taking acetaminophen products.

Acetaminophen is widely used as an over the counter pain reliever and fever medication and is often combined with other ingredients such as cough and cold ingredients.  Patients may be unaware that many products (both prescription and OTC) may contain acetaminophen, making it easy to accidentally take too much [1-5]. In fact,  acetaminophen poisoning accounts for approximately one-half of all cases of acute liver failure in the United States and Great Britain[16].

Ibuprofen (Motrin, Advil) is also widely used for pain and inflammation but not without risk.  Ibuprofen carries a black box warning from the FDA regarding the cardiovascular and gastrointestinal risks associated with its use.  Patients taking ibuprofen have an increased risk of serious cardiovascular thrombotic events including myocardial infarction and stroke. Researchers in Denmark observed a nearly threefold increase in the number of deaths from gastrointestinal bleeding within one year of ibuprofen prescription [14].  The risk of side effects is so high for elderly patients the American Geriatrics Society has recommended that patients over the age of 65 avoid NSAID use if at all possible [6-10].  This real risk was studied by RE Tarone who noted a marked rise in baseline rate of gastrointestinal bleed with advancing age with the large majority of cases occurring among persons age 65 or older.  The average relative increase in risk of gastrointestinal bleeding was found to be fourfold or slightly higher in NSAID users and six fold or higher at heavy prescription levels [15].

NSAID High Risk Groups

Medications such as Tylenol and ibuprofen, which are readily available over-the-counter, are perceived to be safe medications; but research has proven that they are not without risk.  Physicians, payers and patients are requesting a safe more effective alternative to treat pain which becomes increasingly important as the population ages.

Medical foods such as Theramine treat the dietary deficiencies that are associated with pain and inflammation.  Pain reduction is accomplished by moderating responsiveness to noxious stimuli, regulating the transmission of pain signals and controlling inflammation. The use of medical foods has been long standing and there have been no reports of GI bleed in over 10 years on the market.

Two multi-center double-blind clinical trials established the safety and efficacy of Theramine in the treatment of chronic back pain.  In a clinical study comparing the medical food Theramine and a non-steroidal anti-inflammatory medication, Theramine was shown to be more effective than low dose NSAIDs in treating low back pain.  Clinical data indicate significant reduction in back pain with the administration of Theramine alone, while administration of a low dose NSAID had no appreciable effect on pain.

An important observation by researchers EL Fosbol and L Kober note that, “Individual NSAIDs have different cardiovascular safety that needs to be considered when choosing appropriate treatment.  In particular, rofecoxib and diclofenac were associated with increased cardiovascular mortality and morbidity and should be used with caution in most individuals.  This notion is also valid for healthy individuals and underlines the importance of critical use of NSAID therapy in the general population and also that over-the-counter retail of NSAIDs should be reassessed.”[13]

 

REFERENCES

 

1.  Wolf M; King J; Jacobson K; et al “Risk of Unintentional Overdose with Non-prescription Acetaminophen Products”  J Gen Intern Med 2012 Dec; 27(12): 1587-1593

2.  “Acetaminophen Toxicity in Children” Pediatrics vol. 108 No. 4 Oct. 1 2001

3.  Farrell S; Tarabar A; et al “Acetaminophen Toxicity” Medscape June 24, 2011

4.  Plaisance K “Toxicities of Drugs Used in the Management of Fever” Clinical Infectious Diseases 2000 31 Supp 5: S219-S223

5.http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm381650.htm

6.http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm085282.htm

7.  Pilotto A; Franceschi M; Leandro G; Di Mario F; “NSAID and aspirin use by the elderly in general practice:  effect on gastrointestinal symptoms and therapies:  Drugs Aging 2003; 20(9): 701-10.

8.  Smith SG “Dangers of Non-steroidal Anti-inflammatory drugs in the elderly” Can Fam Physician vol. 35 March 1989

9.  American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

10.  Gurwitz JH; Everitt DE; Monane M; Glynn RJ, Choodnovskiy I; Beaudet MP; Avorn J; “The impact of ibuprofen on the efficacy of antihypertensive treatment with  hydrochlorothiazide in elderly persons” J Gerontol A Biol Sci Med Sci 1996 Mar; 51 (2): M74-9

11.  Shell WE; Charuvastra E; DeWood M; May L; Bullias D; Silver D “ A Double-blind controlled trial of a single dose naproxen and an amino acid medical food Theramine for the treatment of low back pain”  Am J of Ther 2010

12.  Shell WE; Pavlik S; Roth B; Silver M; Breitstein M; May L; Silver D “ Reduction in pain and inflammation associated with chronic low back pain with the use of the medical food Theramine”  Amer J of Ther 2014

13.  Fosbol EL; Kober L; Torp-Pedersen C; Gialason GH “ Cardiovascular safety of non-steroidal anti-inflammatory drugs among healthy individuals”  Expert Opin Drug Saf 2010 Nov; 9(6): 893-903

14.  Lipworth L; Friis S; Blot Wj; McLaughlin JK; Mellemkjaer L; Johnsen SP; Norgaard B Olsen JH “ A population based cohort study of mortality among users of ibuprofen in Denmark”  Am J Ther 2004 May-Jun; 11(3): 156-63

15.  Tarone RE; Blot WJ; McLaughlin JK “Nonselective non-aspirin non-steroidal anti-inflammatory drugs and gastrointestinal bleeding:  relative and absolute risk estimates from recent epidemiologic studies”  Am J Ther 2004 Jan-Feb; 11(1): 17-25

The Problem with Prescription Pain Killers

Pain is a big deal. On one level, it’s very useful. It tells us when there’s something wrong, and is pretty efficient at giving us a handy indication when what we’re doing may not be particularly good for us. Those who cannot feel pain [1] suffer from horrendous associated problems, and frequently damage themselves quite badly without being alerted to the fact that they’re doing so by pain. However, unlike a man-made alarm, the body does not come with an ‘off’ switch which one can hit once one’s been made aware of the problem. Chronic pain is a major issue, and one of the most troubling symptoms of a great many medical conditions. It’s a factor which seriously affects people’s lives, and good pain management is recognized as being vital to the all-important quality of life [2] experienced by those needing medical treatment. Having said this, however, it is also being increasingly recognized that the people of North America are becoming dangerously dependent upon prescription painkillers. All too often, we pop a pill when we do not really need to, and plenty of us are relying on prescribed narcotic painkillers when we would undoubtedly be a lot better off with some other method of pain-relief. While there is certainly a place for narcotic painkillers in the management of seriously painful conditions, it needs to be recognized that these drugs do come with a major health warning – and alternatives or avoidance should be the preferred options if at all possible.

Narcotic Painkillers

Opioid painkillers were originally designed for cancer pain and somehow over time have become a first line therapy for many physicians despite the potential for addiction. What may be lesser known, however, are the dangers inherent within these drugs, and the startling scope of America’s dependence upon them. Put simply, opioids such as Vicodin and codeine bind to opioid receptors within the brain, which dulls the brain’s pain response. These receptors are designed to work with the body’s natural opioids – endorphins [3]. Endorphins are released during exercise, and numb pain as well as promoting a feeling of wellbeing, enabling and motivating us to stay on the move and thus potentially to survive for longer. Narcotics fulfil the same role – but in hyper-exaggerated form. Narcotic analgesics swamp our opioid receptors, saturate them to the point where we’re utterly numbed and frequently rather high. They’re very effective as a method of pain relief, but also quite dangerous and are associated with a host of dangerous side effects.

Painkiller Addiction

It’s very easy to develop a taste for opioid painkillers. Why wouldn’t you? They keep pain at bay, and they make you feel good. They’re also, unfortunately, highly addictive. Their very nature means that you’re inclined to seek out more and more – and America’s healthcare system doesn’t exactly discourage you from overdoing it. Big pharmaceutical companies do, after all, stand to make a lot of money from plenty of pill-popping patients. North America has the world’s worst rate of prescription painkiller addiction by a long, long way [4]. Places with nationalized healthcare (in which pharmaceutical companies would have nothing to gain from touting their product to the public) are not in any more pain than the people of America, but they’re far less addicted to painkillers. The solution for someone from the USA to the slightest malady invariably involves popping a pill, while those from other countries are put on courses of pills only when necessary, and given alternative pain-relief methods more often. Each system obviously has its pros and cons – but in this particular case the figures concerning painkiller addiction speak for themselves. More overdose deaths in the USA have been caused by prescription narcotics since 2003 than cocaine and heroin put together – partly (if not wholly) because narcotic prescription rates have increased enormously in this time [5].

An Easy Death

A major issue with opioid painkillers is that they’re not only all too easy to get hold of, and highly addictive – they’re also unpredictable killers. While medical science is pretty good at estimating doses according to body weight and so on, the problem of tolerance is always going to rear its ugly head. The body develops a resistance to opioids over time which means that one must take a higher and higher dose in order to achieve the desired effect. And, at any moment, that dose might prove just too high for the body to cope with. Opioids kill in a number of ways. The most common of these is respiratory depression. This can be reversed – but only if the overdose is low and medical aid arrives quickly [6]. If this is not the case, then the overdoser finds themselves unable to adequately fill their lungs and essentially starves of oxygen. It is far better not to risk this, not to get addicted, and to seek alternatives to narcotic analgesics whenever possible!

[1] Gillian Mahoney, “Meet the Child Who Feels No Pain”, ABC, Oct 2013

[2] Nathanial Katz, “The Impact of Pain Management on Quality Of Life”, Journal of Pain and Symptom Management, Jul 2002

[3] PBS, “Role of endorphins discovered, 1975”

[4] Arnold M. Washington, “America’s Painful Love Affair With Painkillers”, Rehabs

[5] National Safety Council, “Opioid painkillers: How they work and why they can be risky”

[6] Ben Wolford, “Respiratory Depression Reversed In Trials With Drug That Fights Opioid Side Effect”, Medical Daily, Aug 2014

 

The Dangers of NSAIDs

The most commonly prescribed drugs for pain are Non-Steroidal Anti-Inflammatory drugs (NSAIDs).  Approximately 98 million prescriptions for NSAIDs were filled in the United States in 2012 [IMS 2012] and this number does not include NSAIDs that are purchased over the counter.  Although effective in treating pain and inflammation, NSAIDs are linked to adverse side effects which make them inappropriate for use in many patient populations.  There are several serious side effects and toxicity related to use of traditional NSAIDs. Toxic side effects of traditional NSAIDs include:

  • Stomach ulceration and/or bleeding
  • Kidney damage
  • Easy bruising because of loss of platelet function
  • Exacerbation of cardiovascular conditions

Recent studies have also highlighted a higher risk of atrial fibrillation with NSAID use [1] and an increase risk of bleeding and events such as heart attack, stroke or cardiovascular death with the use of NSAIDs in conjunction with antithrombotic therapy [2].

NSAIDs work to reduce pain and inflammation by inhibiting cyclooxygenase, an enzyme.  The action of inhibiting cyclooxygenases, reduces pain and inflammation but is also responsible for many of the side effects of NSAIDs.  This inhibition is problematic because it also inhibits some important functions such as the repair and maintenance of the stomach lining.  This is why stomach ulceration and irritation is so common with the use of NSAIDs.

Inhibition of cyclooxygenase is also associated with reductions in prostaglandin synthesis and is associated with less sodium being excreted in urine and constriction of blood vessels.  This effect of NSAIDs on blood pressure may increase mean arterial pressure by as much as 5 to 6 mm Hg in hypertensive patients.   This consequence may be of particular relevance in patients with preexisting hypertension, edema or congestive heart failure.

One study noted the rate of new-onset hypertension developing in elderly patients for whom nonselective NSAIDs were prescribed was 27% [3]

The extremely high risk of side effects with such commonly used medication resulted in a quest for an analgesic/anti-inflammatory that could provide therapeutic efficacy equivalent to that of traditional NSAIDs but without the gastrotoxicity.

The use of medical foods to treat the dietary deficiencies associated with pain and inflammation has proven to be a safe and effective method for pain control.  Two double-blind, randomized,  trials, which compared Theramine to low dose naproxen and ibuprofen demonstrated statistically significantly reduction in inflammation as measured by inflammatory markers, CRP and IL-6 as well as improvement in low back pain.  Theramine was shown to be an effective pain medication but also an effective anti-inflammatory agent without the risk of gastrointestinal bleeding or other serious side effects.

All of the ingredients in Theramine are GRAS (generally recognized as safe) products and carries no risk of addiction or attenuation.  Theramine has been on the market for 10 years without report of GI bleed or serious adverse side effects.

There are several patient populations that should avoid NSAIDs due to the high risk of side effects.

  • Patients over 65 years of age
  • Previous GI history such as peptic ulcers or previous GI bleed
  • Patients with cardiovascular disease
  • Patients with liver disease
  • Patients with kidney disease
  • Patients on anti-coagulants or low dose aspirin

The cumulative evidence of the danger of NSAIDs is an important reminder that the while NSAIDs can be helpful and at times necessary medications for satisfactory quality of life, use of these medications, particularly among high risk patients must be carefully considered.

 

1.  Gang Liu, MD, PhD, Yu-Peng Yan, MD, Xin-Xin Zheng, MD, Phd, Yan-Lu Xu, MD, Phd, Jie Lu, MD, Ru-Tai Hui, MD, Phd, Xiao-Hong Huang, MD, Phd “Meta-Analysis of Nonsteroidal Anti-Inflammatory Drug Use and Risk of Atrial Fibrillation” The American Journal of Cardiology Nov. 15, 2014 Vol. 114, Iss. 10

2. Anne-Marie Schjerning Olsen, Gunnar H. Gislason, Patricia McGettigan, Emil Fosbøl, Rikke Sørensen, Morten Lock Hansen, Lars Køber, Christian Torp-Pedersen, Morten Lamberts. Association of NSAID Use With Risk of Bleeding and Cardiovascular Events in Patients Receiving Antithrombotic Therapy After Myocardial Infarction. JAMA, 2015; 313 (8): 805

3.  Solomon DH, Schneeweiss S, Levin R, Avorn J. “Relationship between COX-2 specific inhibitors and hypertension” Hypertension. 2004; 44: 140–145

The Nutrient Management of Hypertension

Hypertension, or high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is elevated.  Blood pressure measures the force pushing outward on your arterial walls.  Since your body needs oxygen to survive, it is carried throughout the body.  Every time that your heart beats it is pumping oxygen through a network of blood vessels and capillaries.  There are two forces to every heart beat.  The first force occurs as blood pumps out of the heart and into the arteries that are part of the circulatory system, also known as systolic pressure.  The second force is created as the heart rests in between heartbeats, also known as diastolic pressure.  These are the two numbers that a person can see in a blood pressure reading.  Problems arise when there is too much force on the heart.  This can lead to conditions such as vascular weaknesses, vascular scarring, increased risk of blood clots, increased plaque build-up, tissue and organ damage from narrowed and blocked arteries, and increased workload on the circulatory system.  When cholesterol or plaque builds up because of scarring, the heart has to work harder in order to pump blood to the arteries.  This can eventually result in damage to the heart which can ultimately lead to heart failure.  This disease affects 76.4 million adults in the United States and can lead to heart attack, heart failure, stroke, and kidney failure.

Hypertension is usually a symptomless condition with complications.  Usually people only feel symptoms in extreme readings, for example if their systolic reading is 180 or their diastolic is 110.  This is what is known as a hypertensive crisis.  It is important that adults be familiar with their blood pressure numbers on a consistent basis in order to prevent this disease from causing serious health issues.

There are simple ways to help control a person’s blood pressure.  According to the American Heart Association, there are 8 main ways to adopt a healthy lifestyle.  Eat a better diet (including reducing salt), regular physical activity, maintain a healthy weight, manage stress, avoid tobacco smoke, comply with medication prescriptions, limit alcohol, and understand hot tub safety.

Prescription medication is commonly used to help patients manage hypertension effectively.  One of the most commonly prescribed medications is lisinopril, a type of ACE Inhibitor that helps relax blood vessels keeping blood pressure low.  As with any drug therapy, there are good and bad side effects associated with lisinopril.  For example, lisinopril and other ACE inhibitors can cause a wide range of side effects, some less serious than others such as cough, dizziness, weakness, headaches, or nausea.  More serious side effects include swelling, difficulty breathing or swallowing, fever, fainting, and chest pain. Any patient taking this class of drugs should be aware of these side effects and monitor themselves at the onset of therapy and periodically throughout the course of therapy to ensure that the medication is more beneficial than harmful.

Another popular prescription option for patients with hypertension, are calcium channel blockers.  Calcium channel blockers relax and open up narrowed blood vessels by preventing calcium from entering the smooth muscle cells of the heart and arteries. The common side effects of this class of medications include headache, swelling, dizziness, flushing, fatigue, nausea, and palpitations.

Diuretics are also commonly prescribed and help expel excess sodium and fluid from the body in order to help control blood pressure.  Some of the side effects associated with diuretics are arrhythmia, extreme tiredness or weakness, muscle cramps, dizziness, fever, and dehydration.

Beta-blockers are also commonly used to treat hypertension. This class of medication is used to reduce heart rate, the heart’s workload, and the heart’s output of blood by preventing certain hormones from stimulating the heart. Side effects of beta blockers include diarrhea, depression, vomiting, depression, nightmares, and hallucinations.  One of the main dangers of beta-blockers is that if they are withdrawn suddenly conditions like angina can worsen, causing heart attacks or sudden death.

Doctors often hesitated to prescribe ACE inhibitors, beta blockers and diuretics until a patient’s blood pressure reaches 160/100. Anything below that level is deemed “mild hypertension” and not considered imminently dangerous, so a drugs’ potential side effects might outweigh their benefits. For patients with mild to moderate hypertension, nutritional interventions are commonly used in an effort to prevent the disease from progressing to a life threatening state.

A safe alternative for Hypertension is a medical food like Hypertensa® which are commonly used to expand blood vessels and improve blood flow through a natural pathway.  This class of medications addresses the increased nutritional demands of hypertension.  It uses specific amino acids and nutrients that are responsible for regulating blood pressure and vascular function.  Unlike drugs, medical foods address the production of the specific neurotransmitters that drive all the automatic functions of your body including heart rate and blood pressure.  Hypertension and many drugs that treat hypertension can alter the way the body uses these substances which are derived from both the diet and internal metabolic processes, creating deficiencies which cannot be fixed by altering diet alone.  By addressing the increased metabolic requirements of hypertension with nutritional interventions, the body will have the tools that it needs to help regulate blood pressure and heart rate.

Alternatives to Opioid Pain Medications for Injured Workers

Workplace injuries affect approximately 4.1 million Americans annually (1) .  More than half of these injured individuals will have to miss work and receive long-term medical care.  Worker’s compensation plans provide partial wages during the time of injury and recovery period in addition to covering the cost of medical care.  The recent trend among physicians treating work related injuries has been the practice of prescribing high and sometimes dangerous doses of opioid pain medications for extended periods of time.  Data from 2005-2008 in 17 states showed an average number of 1,599 cases requiring narcotics for non-surgical cases, with more than seven work days missed due to injury(2).  Additionally, in an average of 6% of these cases, the narcotics were prescribed for long-term periods of time.  These drugs may include but are not limited to hydrocodone, fentanyl, methadone, and oxycodone.  Approximately 50-90% of injured workers will receive narcotics for chronic pain conditions (3).  Opioid pain medications can have deadly side effects and the increased availability and dosages of these medications can be detrimental to an injured worker and prolong the time it takes to return to work.

Opioid pain medications are the most commonly prescribed medication in the United States(4).  They work to decrease the perception of pain and increase pain threshold.  While these drugs are helpful to decrease overall pain of various injuries and conditions, they are highly addictive and only address a portion of the pain process.  Common side effects may be mild such as constipation and fatigue, however, they have also been linked to more severe side effects including sleep apnea, decreased hormone production, and increased falls and broken bones among the elderly population(4).  Additionally patients taking opioid pain medications for long periods of time can become addicted and experience serious symptoms of withdrawal which include nausea, shaking, chills, and sweating when finishing a course of these medications (5).  Lately there has also been in an increase in drug overdose leading to death.  In a study that observed 10,000 patients who were prescribed opioids for 90 days, 51% experienced at least one overdose, and six individuals died as a result of overdose 6.  In 2008 the number of deaths resulting from overdose reached nearly 15,000 individuals(1).

Increased availability and access to opioid pain medications is one of the main problems leading to addiction and overdose among injured workers.  Some physicians are prescribing these medications to treat acute and long-term pain disorders such as arthritis and musculoskeletal pain.  Oftentimes high doses are prescribed and the dosage continues to increase over time as tolerance to the effects of the medications increases.  Instead of treating the underlying physiological conditions causing the painful condition, opioid pain medications are prescribed to help manage and mask the pain associated with a work related injury. They are prescribed for many reasons, however, a few of the most common are pressure from patients to prescribe a strong medication that will lead to decreased pain, as well as pressure from insurance companies to prescribe the most cost-effective generic pain medications. Patients may experience temporary pain relief while on these medications, however chronic pain may persist long after the injury has healed.

Prescribing high dose opioid pain medications for work related injuries often leads to other injuries and physiologic impairments.  In many cases, patients remain out of work for much longer than individuals who are not prescribed opioids, as they often develop new health conditions and require more medications.  In the study conducted by the Danish Health Interview Survey in 2000 observing 10,434 individuals, patients who were not prescribed opioid pain medications to treat their injuries recovered four times more often than individuals prescribed opioid pain medications(7).  Additionally, in this study patients taking opioid pain medications were shown to have a lower quality of life and higher death risk than those patients managing pain without opioids.

Some patients who are prescribed opioid pain medications, especially long-term, may develop other serious conditions such as obesity, mood disorders, and depression.  An injured worker who is taking medication for a pain condition may not be able to exercise regularly and weight gain is fairly common.  Opioid pain medications can also have an effect on overall mood and quality of life.  If an individual takes these medications long-term it can be very hard to stop taking them.  The patient can experience large amounts of anxiety and depression when decreasing the dosage or attempting to discontinue the medication all together.  Research has found that of the 1.9 million workers claims that were filed between 2007-2008, those who previously had or developed a co-morbidity as a result of injury such as depression, obesity, or hypertension, experienced more costly treatments and often longer treatment plans all together(8).

Work related injuries will continue to be an issue for insurers and employers.  The overprescribing of opioid pain medications in this country must be addressed by physicians, insurance companies, and drug manufacturers.   The conversion of acute pain to chronic pain associated with a work related injury can be managed in a more efficient way that will allow an injured worker to return to work as soon as they are healed without the burden of addiction or other opioid pain medication related side effects.  Theramine can be used as a complimentary or standalone therapy among this vulnerable population and can provide treating physicians with the ability to prescribe the lowest effective dose of an opioid pain medication while addressing the underlying pathology of the pain process.

Theramine is a prescription only medication regulated by the FDA as a medical food. Medical foods are prescription only medications which address the underlying pathology of pain associated with the work related injury or illness.  Theramine is clinically proven to correct amino acid deficiencies associated with chronic pain syndromes, and improve the overall perception of pain(9).  Theramine is designed to manage the increased nutritional requirements associated with acute or chronic pain conditions.  Theramine is a proprietary amino acid formulation that, by providing neurotransmitter precursors, helps stimulate production of neurotransmitters that are often deficient in pain conditions.  The ingredients in Theramine are Generally Recognized as Safe by the FDA, and are specially formulated utilizing a proprietary Targeted Cellular Technology to facilitate the uptake and metabolizing of milligram quantities of amino acids and other nutrients.  There have been no reported adverse side effects associated with the clinical application of over 50 million individual doses of Theramine. The most common side effects associated with amino acid therapies are headache, dry mouth, and upset stomach and are often short term, and can be decreased with increased fluid intake.  Theramine can be administered in conjunction with the lowest effective doses of an opiate or NSAID pain medication without loss of efficacy(10).  Treating work related injuries with Theramine may prove to be one possible medication solution to control pain and help decrease the quantity and dosages of opioid pain medications administered in the United States.

1)      http://www.workers-comp-news.com/injury_stats.php

2)      http://www.wcrinet.org/studies/public/books/WCRI_2012_Annual_Report.pdf

3)      http://ehstoday.com/health/workers-compensation/injured-workers-opiate-addiction-0209/

4)      http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions-pose-danger-without-oversight.html?pagewanted=all

5)      http://www.opiates.com/opiate-withdrawal.html

6)      http://www.crcotp.com/crcotp_featured/even-when-prescribed-opioids-can-cause-addiction-and-overdose.php

7)      A Population-based Cohort Study on Chronic Pain:The Role of Opioids Per Sjøgren, MD, DMSC,* Morten Grønbæk, PhD, Vera Peuckmann, PhD,  and Ola Ekh-+olm, PhDw, Lippincott Williams & Wilkins, 2010.

8)      http://coventrywcs.com/web/groups/public/@cvty_workerscomp_coventrywcs/documents/webcontent/c054910.pdf

9)      Shell WE, Silver D, Charuvastra E, Pavlik S, Bullias D; “Theramine and Ibuprofen for the treatment of chronic low back pain double blind clinical trial”, 2010 Targeted Medical Pharma Inc.

10)   Shell WE et al.; “Theramine and Naproxen for the treatment of low back pain, a double bind clinical trial”; Americal Journal of Therapeutics April,2012.

The Dangers of Sleep Aids

Quality sleep is necessary not only for proper concentration and daytime alertness, but impacts health a variety of positive ways, including improved immune function, better memory, and decreased risk of obesity.[1]  Commonly used sleep aids such as Benzodiazepines and Zolpidem, help you to fall asleep faster and stay asleep longer, but do not improve deep sleep or REM (dream) sleep and often leave people groggy in the morning.[2]

Benzodiazepines are a type of hypnotic medication that is used by the body to increase the rate at which GABA is used.  GABA is a neurotransmitter that is known for inducing sleep and reducing anxiety.  Short term, these drugs have been shown to be an effective and helpful way to facilitate sleep.  Long term, on the other hand, the use of these medications is not recommended by doctors.  Benzodiazepines are associated with many risks including drug dependence, withdrawal symptoms, drug tolerance, dizziness, and risks of falling.  Rebound insomnia, which causes the symptoms of insomnia to worsen after stopping medications, is also common when people stop taking benzodiazepines.  According to the American Geriatric Society BEERS Criteria, a clinical tool that addresses potentially inappropriate medication use in older adults, the use of benzodiazepines should be avoided due to geriatric patient’ increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents.[3]

The most commonly prescribed sleep aid in the United States is zolpidem (ambien).  The FDA has recently issued additional warning for drugs containing zolpidem (ambien, ambien CR, Edluar, and zopimist) recommending the bedtime dose be lowered especially for women. New data shows that blood levels in some patients can still be high enough in the morning to impair activities that require alertness including driving.

The impact of AM grogginess on function cannot be understated.  Kevin Wright, PhD published a study in JAMA in 2006, showing that patients who suffered with AM grogginess scored worse on cognitive and memory tests than patients who had stayed awake for more than 24 consecutive hours.[4]

Options to improve the quality of sleep without causing AM grogginess are more prevalent now than ever before and are a much safer and more effective way to manage insomnia and other sleep disorders.  Studies show that people can improve their insomnia by changing sleep habits.  Examples of this include going to bed consistently at the same time, having a darkened room, not using your bedroom for non-sleeping activities, and avoiding stimulants about 3 hours before bedtime.

Medical foods are a safe and effective option for patients with insomnia and other sleep disorders. Medical foods are amino acids and other nutrients, that when combined, correct the metabolic deficiencies of diseases and conditions.  They provide a solution that cannot be obtained from diet alone or supplements. They have been found to improve the quality of sleep without the morning grogginess or side effects of other prescription sleep medications. Medical foods may make getting a good nights’ sleep an achievable goal.



[1] Arch Dis Child 2006;91:881-884 doi:10.1136/adc.2005.093013

[2] Zolpidem Containing Products: Drug Safety Communication- FDA Requires Lower Recommended Doses (2013). Retrieved April 23, 2014. http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm334738.htm

[3] AGS BEERS Criteria for Potentially Inappropriate Medication use in Older Adults (2012). Retrieved April 23, 2014. http://www.americangeriatrics.org/files/documents/beers/PrintableBeersPocketCard.pdf

[4] Adam T. Wertz, BS; Joseph M. Ronda, MS; Charles A. Czeisler, PhD, MD; Kenneth P. Wright, PhD

JAMA. 2006;295(2):159-164. doi:10.1001/jama.295.2.163.