A Safe Way to Manage Obesity

Over two thirds of Americans are overweight and over one third are defined as obese and the number of people with obesity in the world now exceeds those with malnutrition (1).  Being overweight or obese significantly increases your risk of heart disease, diabetes, high blood pressure and arthritis.  Yet despite the public’s awareness of these issues, obesity remains an epidemic.

People often describe the frustrations of trying to lose weight, whether it is through failed diets or exercise programs.  They either don’t lose weight at all or lose only to gain it back a month or two later. Effective weight loss programs that allow for long term success are desired but many patients struggle despite the available resources. The time constraints of work and family are difficult to overcome and patients often need help or a jump start to get their weight loss regimen going.

The cornerstones of an appropriate diet to lose weight include lowering caloric intake, decreasing complex carbohydrate ingestion, avoiding “empty calories” such as processed sugars and regular aerobic exercise. Fad or gimmick diets that help you to lose weight fast often lead to rebound weight gain and psychological distress.  Healthy weight loss should be targeted for 1-2 pounds per week over the course of many weeks.  The first five pounds usually come off fast and then the weight loss slows down.  People get discouraged and give up during this phase as it can be the most difficult part of the process.  Additionally, many patients suffer from uncontrollable appetite while dieting and this limits the effectiveness of the diet.

5 tips for weight loss

Recent data points to unique nutritional deficiencies as a contributing factor to Obesity. The medical foods  Apptrim and Apptrim-D  are specifically designed to treat these specific nutrient and  micro-nutrient deficiencies by supplying obese patients with a bioavailable source of amino acids and nutrients.  AppTrim and AppTrim-D contain the amino acids that specifically produce the neurotransmitters that are involved in controlling appetite, hunger and satiety.  Neurotransmitters are the brain’s messengers that tell the nerves what to do and help your stomach and brain communicate with each other. Obese patients often lack the neurotransmitters required to suppress appetite and food cravings. AppTrim helps to decrease appetite, carbohydrate cravings and improves early satiety thus helping an individual maintain a diet and weight loss goals.

Several double blind placebo controlled trials using AppTrim have been performed.  These studies have demonstrated that patients taking AppTrim along with diet and exercise lost more weight and felt less hungry than patients using diet and exercise alone.  Also, since AppTrim is a medical food, it contains only ingredients that are Generally Recognized as Safe (GRAS) by the FDA. Obesity is a very complex disease and effective management requires a comprehensive approach that includes addressing the distinct nutrient and micro-nutrient deficiencies in addition to diet and exercise. 

1. Ogden C. L., Carroll, M. D., Kit, B.K., & Flegal K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814

Safer Options for Pain Management

Pain is complex and there are several treatment options to choose from depending on the type of pain you are experiencing including medications, therapies and mind-body techniques.  The most common treatment consists of analgesics:  narcotic (opioid) and non-narcotic (non-opioid) analgesics.

Narcotics vs NSAIDS
Primary Differences Between Narcotics and NSAIDs

Narcotic analgesics are derived from or related to opium.  Opioids bind to opioid receptors which are present in many regions of the nervous system and are involved in pain signaling and control.  Opioid analgesics relieve pain by acting directly on the central nervous system.  They block incoming pain signals but also work in other parts of the brain, modulating pain receptors in the nervous system, primarily located in the brain and the spinal cord.

Non-opioid analgesics or NSAIDs work by blocking the production of prostaglandins by inhibiting the cyclooxygenase enzyme and therefore decreasing the formation of pain mediators in the peripheral nervous system.   Non-opioids work more directly on injured or inflamed body tissue. In a basic sense, opioids decrease the brain’s awareness of the pain whereas the non-opioids affect some of the chemical changes that normally take place wherever body tissues are injured or inflamed.

Although non-opioids are often preferred for certain types of chronic pain, they have two serious drawbacks.  The first is the ceiling effect; Non-opioids have an upper limit of pain relief that can be achieved.  Once the upper limit is achieved; increasing the dosage will not provide any further pain relief but may exacerbate side effects.  Opioids on the other hand tend not to have a ceiling.  The more you take, the more pain relief you will get.  The second major drawback of non-opioids is the side effects profile.  The side effects of NSAIDS make it impossible for certain patient populations to use NSAIDs such as those with history of peptic ulcer disease, cardiovascular disease and the elderly. In 2014, the American Academy of Neurology determined that the risks of opioids outweigh the benefits for certain chronic pain conditions.

Treatment of pain with the use of medical foods gives patients a safer option for pain management by approaching pain from a new perspective.  Medical foods treat the nutritional deficiencies that are found in patients with acute and chronic pain.  By restoring an optimal balance between the chemicals in the body, substances called neurotransmitters, that are responsible for transmitting and dampening pain signals, one can better manage pain.

Research has found low levels of the amino acids gluatamate, tryptophan, arginine, serine, and histidine in patients with chronic and acute pain.  The perception of pain can be modified by providing amino acids and nutrient precursors to the key neurotransmitters involved in the pain process. Amino acids are able to cross the blood brain barrier and are necessary to produce the appropriate neurotransmitters needed to reduce pain signals and lower inflammation. Increasing the intake of amino acids and nutrients lead to an increase in neurotransmitter levels [1].

The theory that the body’s need for amino acids and nutrients are modified by a disease has been long recognized and is supported by studies that reflect changes in plasma, urinary and tissue levels of nutrients with modified intakes of these nutrients [2].   There are various reasons for depletion of nutrient levels including diet, metabolic demands and genetics.  The required amount for each patient varies depending on the duration and severity of pain. Addressing the increased demand for amino acids and nutrients is a key component for improving clinical outcomes.

Two double-blind clinical trials compared Theramine, a medical food specially designed to address the increased amino acid and nutrient requirements of pain syndromes, to low dose naproxen and ibuprofen.  In both studies, Theramine showed statistically greater pain relief than either naproxen or ibuprofen.  This was measured by patient report and a reduction in the inflammatory markers C-reactive protein (CRP) and interleukin-6 (IL-6) [3, 4].  Treatment with amino acid precursors was associated with substantial improvement in chronic back pain and a reduction in inflammation.

Pain Reduction with TheramineThe improvement in pain directly correlated with increased amino acid precursors to neurotransmitters in the blood.

Theramine is designed using Targeted Cellular Technology (TCT), which facilitates the uptake and utilization of the neurotransmitters precursors that are used in the modulation of pain.  TCT allows for the production of neurotransmitters from ingestion of smaller amounts of amino acids to elicit the same response as larger amounts, making daily dosing more feasible and reducing the potential for tolerance.

At least 100 million adult Americans suffers from chronic pain, a safe and effective treatment option such as medical foods that do not treat symptoms alone but addresses the distinctive nutritional needs of adults who have different or altered physiologic requirements due to pain is vitally needed.

To date, Theramine has been in clinical use for over 10 years with no report of GI bleed or adverse side effects and the clinical trials of Theramine clearly support the theory that the nutritional management of pain syndromes is a safe and effective treatment for pain.

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.

The Second Brain

It’s 10 pm and you are stressed.  All of the sudden your stomach starts churning and you remember that half eaten carton of Ben and Jerry’s left in your freezer.  Before you know it the ice cream is gone and you are left hoping that it will settle the butterflies in your stomach.  We have all had that feeling, but then the question arises.  What makes us have that “gut feeling”?  Why are our stomachs controlling our emotions, and therefore controlling our eating patterns?

Your gut can work independently without any input from your brain, unlike any other organ in the human body.  This is how the stomach got its name of “the second brain”.  The stomach is controlled by the enteric nervous system (ENS) which is made up of 100 million neurons.  The ENS is used to control the movement and absorption of food through the intestines.  The stomach has the ability to send signals to the brain that can affect certain feelings, such as sadness or stress, as well as influence memory, learning, and decision-making.  The stomach relies on 30 neurotransmitters in order to function that are identical to those in the brain.  The ENS communicates with the central nervous system (CNS) through the parasympathetic and sympathetic nervous system, but does not rely on it in order to function.  Studies have shown that the ENS continues to function, even after the vagus nerve, which connects the CNS to the ENS, has been severed.

Different foods can affect emotions differently.  Specific components of food can influence neurohormones in the gut that are responsible for signaling the brain.  What a person eats affects their mood.  Fatty acids reduce feelings of sadness and hunger.  This is why most people in times of stress and sadness will turn to the help of “comfort foods” to help them feel better.  Ghrelin, a hormone manufactured by the gut, stimulates hunger in the brain and is one of the neurochemicals that sends messages back and forth between the ENS and CNS in order to affect mood. Every time a meal is consumed ghrelin levels fall, and then continue to rise again until the next meal. Obese people tend to have higher levels of ghrelin even after eating, which can leave them feeling hungry more often. High-fat foods stimulate dopamine production and can enhance mood/euphoria, thus encouraging the brain and stomach to seek out more high fat food.

Measuring the beerbelly

During gastric bypass surgery, the part of the stomach which produces the most ghrelin is isolated in order to make the patient less hungry.  The doctor then attaches the stomach to a section of the small intestine called the ileum which produces PPY, a hormone that makes you feel full.  PPY typically takes 20 minutes to send the message to the brain to let it know that the stomach is full.  Making these two sections of the stomach closer together allows the brain to receive the signal quicker in order to encourage the body to eat less.

Surgery is an expensive and drastic solution to fighting a problem such as obesity.  People try to diet, which if done safely and combined with exercise can be effective. One important thing to note is that people dieting will also have increased levels of grehlin, increasing hunger levels.   This is one reason why people find dieting to be so difficult. Food affects mood due and increased cravings caused by certain hormones can be difficult to control.  Perhaps this is why your co-worker who is on a 3-day juice cleanse is in such a sour mood.

If exercise and dietary changes fail to make a dent in hunger, weight and BMI then a more targeted approach can help people interested in managing appetite and controlling food intake. Medical foods is certainly one option that should be explored. As a safe and effective class of medications medical foods deliver the specific neurotransmitter precursors required by nervous system to help reduce appetite and promote early satiety As stated earlier, your stomach uses neurotransmitters just as the brain does.  Using these neurotransmitters help your stomach become more satisfied and helps manage your mood and cravings, helping you manage appetite safely and effectively.  Clinical trials show that a medical food as an adjunct to a weight loss diet and exercise plan can help increase weight loss and decrease BMI.

Ten Foods that May Help Curb Appetite:

  1. Avocados – Composed of monounsaturated fats, which take longer to digest, avocados help suppress ghrelin production and appetite.  The soluble fiber in avocados slow digestion by forming a thick gel as it travels throughout the gut.
  2. Greek Yogurt – A high-protein appetite buster.  Since it is thick, you feel fuller faster.
  3. Legumes – High in soluble fiber, resistant starch, and oligosaccharides.  These complex carbs help slow digestion.
  4. Cottage Cheese –  A good source of protein which helps suppress appetite.
  5. Oatmeal – Contains beta-glucans, a soluble fiber, that helps it travel slowly through the digestive track.
  6. Nuts – Nuts contain healthy fats and fiber which help you digest more slowly.
  7. Fruit – high in fiber, which helps to slow digestion and keep you feeling full longer.
  8. Wasabi – suppresses appetite and also contains anti-inflammatory qualities.
  9. Salmon – Salmon is high in omega-3 fatty acids, which helps the body increase leptin, a hormone used for suppressing hunger.
  10. Cinnamon – Cinnamon helps lower blood sugar which helps control appetite.

Alternative Therapies for Pain Associated with Peripheral Neuropathy

Diabetic neuropathy can occur when people with diabetes develop nerve damage. Most commonly, the peripheral nerves of the feet are affected first, causing numbness, cramps, loss of balance, extreme sensitivity and pain starting in the toes and over time progressing up the legs. Diabetic neuropathy can affect nerves in hands and arms, as well as parts of the autonomic nervous system that are responsible for regulating heart rate, blood pressure and sleep cycles. Not everyone who has diabetes will develop neuropathy. (1)

Peripheral neuropathy, also known as distal symmetric neuropathy or sensorimotor neuropathy, is the most common type of diabetic neuropathy. Diabetic neuropathy affects 60-70% of diabetics. Certain risk factors increase the chances of developing diabetic neuropathy. These include age, the duration of the disease, and glucose levels in the blood. There are different factors that may lead to diabetic neuropathy. Additionally, certain neurovascular factors, autoimmune factors, mechanical injury to nerves, inherited traits that increase susceptibility to nerve disease, and lifestyle factors can increase the chances of developing diabetic neuropathy.

Preventing diabetic neuropathies is a challenge but is not impossible. Diabetic patients should keep glucose levels as close to the normal range as possible. Maintaining a normal blood glucose level can help protect nerve cells from unnecessary damage and even lesson symptoms associated with diabetic neuropathy.

There are many treatment options currently available to patients for pain relief associated with diabetic neuropathy. Two commonly used medications for pain relief associated with nerve pain are opioids and a class of medications known as anti-epileptics. Opioids were originally developed to help patients manage pain associated with cancer, but have since been incorporated in a number of pain management treatment protocols for non-cancer pain. This class of medications can be a useful for pain relief, but can also lead to addiction and other harmful side effects. Anti-epileptics like gabapentin are also commonly used to manage diabetic nerve pain. This class of medications was originally developed to treat epilepsy, but has since been approved by the FDA to treat nerve pain. Common side effects of gabapentin and other anti-epileptic medications include dizziness, dry mouth, blurred vision, headaches, diarrhea, fluid retention, and weight gain.(2)

Patients and providers have increasingly been looking to certain medical foods as a safe and effective alternative option to some of the more dangerous pharmaceuticals used for the management of pain and numbness associated with peripheral neuropathy. One example is Percura, a medical food that is specially formulated to provide the nervous system with the amino acids and nutrients required to effectively manage the unique nutritional needs of nerve cells. A recent open label study showed that patients with moderate to severe peripheral neuropathy showed improvement in pain after one month taking Percura. Side effects associated with Percura are mild and temporary and include, bloating and diarrhea. Percura and other medical foods may represent a valuable treatment option for patients with diabetic peripheral neuropathy, without the side effects associated with opioids or anti-epileptic medications.


[1] Dyck, Peter J., Feldman, Eva L., Vinik, Aaron I..  “Diabetic Neuropathies: The Nerve Damage of Diabetes”. National Diabetes Information Clearinghouse.  NIH Publication, February 2009. Web. November 26 2013. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/#what

[2]“What are the Real Risks of Antidepressants?”.  Harvard Health Publications.  Harvard Medical School, May 2005.  Web. http://www.health.harvard.edu/newsweek/What_are_the_real_risks_of_antidepressants.htm

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.

Safe Alternative Therapies for Post-traumatic Stress Disorder

Post-traumatic Stress Disorder (PTSD) can occur after a person has been through a traumatic event, such as combat exposure, a terror attack, a serious accident, a natural disaster, or sexual or physical assault or abuse.  Not everyone who experiences a traumatic event will be diagnosed PTSD.  About 60% of men and 50% of women experience trauma in their lives and it is estimated that about  7-8% of the entire U.S. population will have PTSD during their lifetime.[1]  People who have been diagnosed with PTSD can experience  a variety of psychological and physical symptoms which include reliving the event, avoidance, negative changes in beliefs and feelings, hyperarousal, sleeplessness, muscle fatigue, and digestion disorders.

PTSD is such a complex disease, affecting the body and brain in such a way that makes standardizing treatment very difficult.  The current treatment protocols available for people suffering from PTSD can be effective but are also limited.  One of the most effective treatment protocols currently used to manage PTSD, is cognitive behavioral therapy (CBT).  There are different types of CBT, including Cognitive Processing Therapy (CPT) which is used to help a person understand how trauma can change thoughts and feelings. Prolonged Exposure Therapy (PE), which is designed to condition or desensitize a person with PTSD, by helping them relive the experience through talk therapy repeatedly until the memories are no longer upsetting.  This may also include physically going to the location where the traumatic event occurred that may be intentionally avoided.[2]

Medications are often prescribed as an adjunct to CBT and other therapies used for treating PTSD. According to the Department of Veterans Affairs, “Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms.” Pain medications are also often used to treat pain associated with PTSD, but can be very dangerous and addicitve. A recent study by a VA researcher found that veterans with PTSD were two times as likely to be prescribed opioids as those without mental-health problems. They were more likely to get two or more opioid painkillers at the highest doses. Veterans with PTSD were more than twice as likely to suffer bad outcomes like injuries and overdoses if they were prescribed opioid painkillers, the study found.

As the intelligence about the causes and effects of PTSD has improved, attention has been directed towards specific abnormalities associated with the human nervous system, particularly the parasympathetic autonomic nervous system. The parasympathetic nervous system is the “rest and digest” part of the nervous system and it is responsible for many restorative functions. The parasympathetic nervous system is responsible for many of the automatic body functions such as heart rate, breathing and digestion.  According to numerous studies in patients with PTSD, there appears to be a blunting of total autonomic activity, marked in particular by a reduction of nighttime parasympathetic activity. The inability of PTSD patients to effectively initiate parasympathetic activity can lead to an imbalance of nervous system activity and yield symptoms including anxiety, rapid heartbeat, panic spells and increased sweating. Parasympathetic suppression can also cause sleep dysfunction, abnormal dreams and memory disturbances. There is an emerging consensus that sleep disturbance may be a core feature of PTSD.

Improving nervous system health and balancing parasympathetic and sympathetic activity is a key component in the successful treatment of PTSD. Providing clinically validated alternatives to the currently prescribed medications is essential to improving the treatment of PTSD.   There are currently natural medication options available that can help to manage the increased physiologic and metabolic demands of PTSD. Recent studies involving the medical foods  Sentra AM® (acetyl l-carnitine HCL, choline bitartrate, l-glutamic acid) and Sentra PM® (acetyl l-carnitine HCL, choline Bitartrate, 5-HTP, l-glutamic acid)  have yielded very positive results in patients suffering from symptoms related to PTSD. These products are specially formulated using amino acids, nutrients and certain botnaicals and are believed to influence the production and absorption of neurotransmitters essential to autonomic nervous system function. They may be particularly effective at targeting symptoms of PTSD and provide a new, safe treatment option for this condition.[3] Civilians, active service and military veterans are often reluctant to seek treatment for PTSD symptoms because of the perceived stigma associated with a psychiatric diagnosis and psychiatric medications. Medical foods like Sentra AM and Sentra PM provides patients and providers with a safe, effective and reliable therapeutic alternative to the current drug protocols being prescribed.



[1] Gradus, Jamie L. “Epidemiology of PTSD” ptsd.va.gov.  January 30 2014.  Web.  June 2014.  http://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp

[2] “What is PTSD?” ptsd.va.gov. January 17 2014. Web. June 2014. http://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp

[3]Targeted Medical Pharma, Inc.. Administration of an Amino Acid-Based Regimen for the Management of Autonomic Nervous System Dysfunction Related to Combat Induced Illness. Publication Pending. Print.

Pain Management in Lyme Disease

Lyme disease is spread through the bite of infected blacklegged ticks, also known as deer ticks.  Ticks can attach to any part of the human body, but tend to reach areas that are difficult to see such as the groin, armpits, or scalp.  Ticks must be attached for 36 hours or more before the Lyme disease bacterium, Borrelia burgdorferi, can be transmitted.

There are four stages in the progression of Lyme disease.  The first stage, known as the early localized stage, takes place between 3-30 days after the tick bite.  The infected person can experience fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes.  One of the most prominent signs of this stage is the Erythema migrans rash, also known as the bull’s-eye rash for its unique shape.  This rash occurs in 60% of infected individuals. (CDC)

The second stage is known as the early disseminated stage and it occurs days to a week after the tick bite if the bite is not treated within the early localized stage.  During this stage, a person starts to experience more noticeable and serious symptoms.  These symptoms include Facial or Bell’s palsy, additional erythema migrans rashes, and stiffness due to meningitis.  At this point, patients begin to feel shooting pains that can interfere with sleep as well as pain and swelling in the large joints.

If the disease is not treated, 60% of patients enter into the late disseminated stage which happens months to years post-tick bite.  These individuals typically develop arthritis with severe pain and swelling in the joints.  It is typically found in the larger joints, for example the knees.  Arthritis caused by Lyme disease exhibits itself differently than other causes of arthritis.  Lyme arthritis is similar to osteoarthritis because of stiffness due to painful swollen joints.  This happens because Lyme bacteria invade the joints and cause inflammation to the tissue that lines the joints, and eventually, if untreated, can cause the cartilage within the joints to become damaged.[1]

The final stage is the lingering symptoms after treatment.  About 10-20% of patients experience symptoms after the patient has taken antibiotics.  This is called Post-treatment Lyme disease syndrome (PTLDS).  Some evidence shows this is due to an autoimmune response, in which the immune system is continuing to respond after the infection has been cleared, causing damage to be done to a body’s tissues.  Symptoms of PTLDS can include muscle and joint pain, cognitive defects, sleep disturbance, and fatigue. (CDC)

The quicker a doctor is able to diagnose Lyme disease, the quicker they can treat it.  Patients can be prescribed antibiotics in order to rid their system of the bacteria.  Most patients who are prescribed the antibiotic during the early stages usually recover quickly and completely.

With the antibiotics working to take care of the bacteria, what is taking care of the pain associated with Lyme disease?  A patient can still be experiencing pain while taking these antibiotics, which progressively becomes worse throughout all the stages Lyme disease.  Patients who experience pain in association with Lyme disease are less likely to be active, sleep well, or eat properly due to pain.

Commonly prescribed pain medications are opioids and NSAIDs.  Both, although common, can be very dangerous.  According to a report released by the National Institute on Drug Abuse, there can be consequences when choosing to use an opioid.  Opioids are easy to abuse because of their addictive qualities.  Regular or long term use of opioids can lead to physical dependence and addiction. Once a patient stops using opioids, they can experience withdrawal symptoms such as restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements.  An overdose can cause severe respiratory depression and death. [2]

NSAIDs, although effective in treating pain and inflammation, 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 which can lead to costly hospitalizations or death.  A study on the effects of NSAID induced side effects in the elderly reflected the average direct costs of GI side effects per patient-day on NSAIDs were 3.5 times higher than those of a patient-day not on NSAIDs. Seventy percent of the cost was attributed to GI events resulting from NSAID treatment.[3]  Treatment of GI problems alone caused by the use of NSAIDs is estimated to add over 40% to the cost of arthritis care.[4]

Stephen Harrod Buhner’s book “Healing Lyme Disease Coinfections” discusses an alternative to these common pain medications called Theramine®. Theramine is a medical food specifically designed for the dietary management of pain syndromes. This specialized natural product, provides the specific amino acids and nutrients required by the brain and nervous system to effectively reduce pain and inflammation. Theramine is non-addictive and is not associated with adverse GI or cardiovascular side effects.  It is used in clinical practice to reduce inflammation and improve pain perception by addressing the increased nutritional requirements of pain syndromes.  In two double blind, multi-center clinical studies comparing Theramine and an NSAID, Theramine was shown to be more effective at treating pain and inflammation than either naproxen or ibuprofen. Lyme disease can alter the metabolic requirements of the body, leading to specific amino acid and nutrient deficiencies. Effectively managing the increased demand for these essential physiologic components should be an integral part of any pain management protocol.

 


[1] American Academy of Orthopaedic Surgeons. “Effective treatment of Lyme-disease-related arthritis depends on proper diagnosis.” ScienceDaily. ScienceDaily, 2 February 2011.

<www.sciencedaily.com/releases/2011/02/110202132605.htm>.

[2] “Prescription Drugs: Abuse and Addiction” NIDA. October 2011. National Institute on Drug Abuse.

[3] Br J Clin Pharmacol. 2001 August; 52(2): 185–192. Cost of prescribed NSAID-related gastrointestinal adverse events in elderly patients

[4] Bloom, BS. Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis. Am J Med. 1988; 84(2A): 20-24

Sneeze-Free Spring

Spring has finally arrived, but with those trees and blooming flowers comes the dreaded spring allergies.   Pollen becomes airborne and allergy sufferers begin sniffling and sneezing.  40 million Americans a year suffer from allergic rhinitis, also known as hay fever.

The main cause of spring allergies is pollen.  Trees, grasses, and weeds release pollen into the air which can be inhaled through the nose.  Most seasonal allergies occur when the immune system mistakes the pollen as a foreign invader and releases antibodies.  These antibodies are typically used in order to attack bacteria, viruses, and other illness-causing organisms.  When the antibodies attack these allergens, they release chemicals called histamines into the blood which can help stop itchy and running nose and eyes, sneezing, and coughing.

The higher the pollen count, the more likely allergies will flare up.  For an accurate pollen count in your area, click here.  On breezy days, allergy symptoms become more prominent due to the wind picking up pollen and carrying it through the air.  On rainy days, most allergens are washed away, reducing the number of allergy symptoms.

Many people turn to the help of both prescription and OTC medications to manage allergy symptoms.  As with all medications, there are risks because of the possible side effects.

Anti-histamines can cause drowsiness throughout the day, increasing the risk of falls in the elderly as well as increasing the probability of a work or auto related accident.  Anti-histamines often lose their effectiveness over time.  Most OTC decongestants should only be used for 7-10 days.

Nasal decongestants are effective because they reduce blood flow to the nose, constricting blood vessels and decreasing inflammation.  If they are used for long periods of time they may cause rebound nasal congestion.  Nasal decongestants have been shown to cause high blood pressure and heart palpitations, putting older adults and people with cardiovascular disease particularly at risk.

The common side effects of the various OTC nasal decongestants and anti-histamines are often unappealing to people suffering from allergies, sinusitis, and nasal congestion, leading people to look for drug-free alternatives.  There are many benefits to choosing a drug-free alternative.  Drug-free alternatives are safer, have fewer side effects, and can last for longer periods.

When choosing a drug-free product for allergies and congestion, people should always look for the ingredients that are well known for their safety profile and anti-inflammatory properties.  Look for ingredients that have been carefully selected based on their history of safety and efficacy for supporting the natural processes that reduce inflammation, sinus congestion, and an overactive immune response.

Grape seed extract, for example, increases levels of antioxidants by destroying free radicals which are known to cause premature cell death.  Another ingredient to look out for is Choline Bitratrate.  Choline Bitartrate is the precursor to Acetylcholine (Ach), an essential neurotransmitter in your nervous system which can decrease levels of inflammation in the body.  Ach is the neurotransmitter that also controls mucous secretion, membrane constriction, and blood supply to nasal and sinus cavities.  L-Arginine is another safe and effective ingredient that promotes the production of Nitric Oxide, a neurotransmitter that causes the smooth muscle in  blood vessels to relax which helps to increase blood flow.

There are a few other precautions that a person can take in order to help avoid spring allergy triggers.  Getting an air filter can help circulate air around the house, as well as help trap and get rid of some of the larger particles of pollen.  Vacuuming twice a week can help get rid of dust mites that have been trapped in the carpet.  Washing your hair after going outside can help get rid of pollen that may have been caught in a person’s hair.  Clean air filters and book shelves in order to clear off dust mites that collect in the home.  When driving, keep windows closed because the car filter helps remove allergens from the air.  For more helpful solutions please click here.