Garlic and Onions and Leeks, Oh my!

Garlic and Onions and Leeks, Oh my!

It isn’t fair to stereotype these wonderful foods as doing nothing more that causing bad breath. There is so much more to these foods than that. Oh, there are more beautiful and more tasty foods out there, but do they really deliver the nutrients as well as this root-based vegetable family? With 1,200 onion varieties in the world, I guess it isn’t such a small family.

Onions are especially valued for their quercetin. This is a powerful antioxidant, rendering harmful compounds unable to cause their damage to human cells. This is why they help our body fight cancer. Quercetin has also been found helpful in lessening allergy symptoms. Onions possess other nutrients such as vitamin C, B6, potassium and manganese.

Research has also uncovered that onions may help alleviate the symptoms of upper respiratory infections. Lowering the risk of osteoporosis is another possible benefit from onions. If the strong flavor of onions decreases your intake of onions, you’ll be relieved to learn that cooking does not affect the flavonoid (including quercetin) or phenol compounds in these wonderful vegetables.

Leeks are related to onions and wonderful too. They are also high in the flavonoids quercetin and kaempferol, making them good antioxidant additions to the diet. They are also high in vitamin C and K, as well as manganese.

Garlic is just plain a superstar. It too is high in manganese, and a good source of vitamin C and vitamin B6. It also contains phytochemicals (chemicals that come from plants) and some of the benefits aren’t available until the garlic is crushed and allowed to sit for ten minutes before being eaten. Garlic also has strong antimicrobial properties, helping to kill bacteria, viruses and even fungi and parasites! Its anti-inflammatory effect makes it a potential aid in treating asthma and allergies. As if that isn’t enough, it can help lower blood pressure and decrease blood clot formation.

All three of these root vegetables (or are they herbs?) have been linked to cholesterol lowering as well. If you add that to the other vitamins in them, and consider their very low calorie content, surely they’ll start to look pretty beautiful. If you like to garden, all three are easy to grow as well. Enjoy these white roots and add all three to your diet on a regular basis.

References:  Tonia Reinhard, Super Foods, the Healthiest Foods on the Planet, 2nd edition. New York:  Firefly Books, 2014.

Dr. Don Colbert, Eat this and Live!  Lake Mary, FL:  Siloam, A Strang Company, 2009.

This information is not intended to replace the care of your Primary Care Provider.

Medications that increase the risk of falling

Medications that increase the risk of falling

There are several ways medications can make a fall more likely to occur. One such way is by causing sedation or confusion. When there is decreased vigilance, things like rugs or clutter are more apt to go unnoticed or interpreted as an obstacle. Alcohol alone or combined with such medications can worsen such hazards. Other medications interfere with a smooth, coordinated gate. Other medications cause orthostatic hypotension. Aging and some diseases can also produce this effect. With changing position to one that is more upright, such as from lying flat to standing, a lot of blood pools in the lower legs. That leads to less blood returning to the heart and thus less pumped to the head and upper extremities. Normally the body can correct for that change quite quickly. Orthostatic hypotension refers to a lack of such a rapid adjustment.

In “Evaluation of the Medication Fall Risk Score” by C. Yazdani and S. Hall (American Journal of Health System Pharmacy, 1/1/2017, e32-39), the medications that are most likely to increase the risk of falls are sedating medications (for example opiates and opioids), some of the antidepressants, certain medications used to treat epilepsy, drugs used to treat psychosis, NSAIDs (non-steroidal anti-inflammatory drugs), and some of the antihypertensive agents.

There are some medications that have what is called an anticholinergic effect. This is a technical term referring to the suppression of the “rest and digest” state of the automatic nervous system. Not many drugs have this as their intended outcome, rather it is a property of a drug that can’t be removed, so to speak. Some of the medication classes listed above have this effect and one member of the drug class may have a stronger anticholinergic effect than another. For example, some tricyclic antidepressants (TCAs) have a prominent anticholinergic effect while another TCA doesn’t. Anticholinergic effects include dry mouth, constipation, sedation, tachycardia (rapid heartbeat) and pain from light from a diminished ability of the pupils to constrict.

Older antihistamines often have such an effect, so keep this in mind when taking diphenhydramine and other such drugs. “Use of medications with anticholinergic-activity and self-reported injurious falls in community-dwelling Elderly” (by K. Richardson, et al, in Journal of the American Geriatrics Society, 63:1561-69, 2015) included research that looked at this important contributor to falls. The authors noted that anticholinergics can increase the fall risk because of sedation as well as possible confusion and blurred vision. They also noted that older individuals tend to have the most problems with anticholinergics.

Considering that one-third of those over age 65 fall each year, this is no small matter. This 2013 CDC fact was noted in “Urological Implications of Falls in the Elderly:  Lower Urinary Tract symptoms and alpha-blocker medications” (L. and J. Schimke, Urologic Nursing, September and October, 2014, pages 223-229). Nocturia – having to get up at night to urinate, as well as urge incontinence (having a sudden intense need to urinate) make falls more likely. Unfortunately, a medication sometimes prescribed for older men with prostate problems – alpha blockers, can cause orthostatic hypotension and thus also contribute to falls. Some of the medications used for urge incontinence have anticholinergic properties that can increase the fall risk. So be careful not to substitute one cause of falls for another.

This article is not intended to replace your health care provider. The intent is to make important

Pumpkin

The Power of Pumpkin

You really can’t judge a book by its cover, or a food by its outward appearance. Pumpkin may look like a blank canvas of autumn artists or an iconic Thanksgiving star but it deserves better. Here are some of the benefits of pumpkin:

  • High in fiber (5 grams per half cup serving)
  • Low in calories (83 calories in one cup)
  • Rich in alpha- and beta-carotene which the body converts to vitamin A

The carotenes in pumpkin make it particularly powerful. Beta-carotene has been extensively studied. One benefit of it that

scientists have discovered is that this antioxidant helps prevent oxidation of cholesterol, and this effect keeps arterial plaque from getting larger. Carotenes also have an anti-inflammatory property.

What diseases can the nutrients in pumpkin help prevent?

  • Arterial diseases that lead to a stroke or heart attack
  • Cataracts and macular degeneration
  • Lung, colon, bladder, cervical, breast and skin cancer
  • Population studies suggest it may also protect from esophageal, stomach, prostate and laryngeal cancer as well
  • Recent research offers hope that it may support the insulin-producing cells in the pancreas, helping to prevent diabetes, or, if its developed, slow the progress of type 2 diabetes

In Jean Carper’s The Food Pharmacy (New York, 1988), pumpkin seeds have also been found to have some cancer-fighting powers. This book includes some interesting information on the correlation between regular pumpkin intake and lower lung cancer rates in smokers and those exposed to cigarette smoking on a regular basis.

Another advantage of pumpkin is that it is inexpensive. Pumpkin season has just ended so fresh pumpkin isn’t as widely available. In Steven Pratt, MD, and Kathy Matthews’ book SuperFoods Rx (New York, 2004), canned pumpkin is just as nutritious as fresh pumpkin. It doesn’t contain the seeds but it is convenient and fairly inexpensive. Avoid canned pumpkin pie filling since it has sugar added to it and that is one food that not only doesn’t prevent disease but can cause it.

Regular soft drinks linked to many health hazards

Regular Soft Drinks – a particularly dangerous source of sugar

Sugar is not just a quick source of energy, it is truly hazardous to health. Soft drinks are one of the most common sources of it, and because fluids don’t fill one up and provide a source of fullness, it is easy to take in too many calories. But perhaps the most concerning aspect of soft drinks lies in the other ingredients, including the artificial sweeteners in diet beverages. This latter topic is proving worthy of a separate blog article so that will follow in the near future.

This is an important topic not just because sugar is linked to the start of so many chronic illnesses, but also because soft drink consumption is still so high. In Angela Epstein’s article on fizzy drinks, found in the February 10, 2015 issue of Daily Mail, the average American drinks 25 gallons of soft drinks a year. An older article by Karina Hamalainen in the 2012 issue of Scholastic Choices, close to 25% of high school students drink at least one soft drink a day. Sugar activates the reward system in the brain, contributing to cravings for it. Because of this property, foods high in sugar become hard to resist (from Kelly Brownell’s “In your face – how the food industry drives us to eat,” in the May, 2010 issue of Nutrition Action Healthletter).

The high fructose corn syrup (HFCS) in regular soft drinks has been linked to weight gain that is greater than what would be produced by table sugar (from Killer Colas by N. Appleton and G.N. Jacobs, Square One Publishers, 2011). This sweetener has also been linked to abdominal obesity, insulin resistance and a decrease in the appetite suppressing hormone leptin. Other possible soft drink ingredients that are harmful:

  • phosphoric acid – added to create a tangy flavor and maintain carbonation pulls calcium out of bone contributing to osteoporosis, kidney stones, weakens tooth enamel and can worsen GERD (esophageal reflux, AKA heartburn).
  • carbon dioxide – used for carbonation – contributes to GERD and tooth enamel damage.
  • ascorbic acid – added to preserve flavor and coloring – sounds beneficial but in a beverage that also contains sodium benzoate can lead to the formation of the carcinogen benzene if exposed to heat and light.
  • caffeine – found in colas as well as other beverages – can be too stimulating to the nervous system and contribute to anxiety and insomnia. Consuming it can also contribute to soft drink addiction. In high amounts, it can also further osteoporosis.

The information on these ingredients and their effects are from Killer Colas. The authors also note that it is hard to tell what soda components cause what negative effects. In addition to the above health threats, regular soft drink consumption is linked to an increased risk of metabolic syndrome (including type 2 diabetes and coronary artery disease as well as hypertension). Specific cancers associated with regular soft drink intake include primarily gastrointestinal cancers:  esophageal, colon, gastric and pancreatic.

A link between soft drinks and asthma has been suggested by research including what was reported in S. Park, et al, in “Association of sugar-sweetened beverage intake frequency and asthma among U.S. adults, 2013 (Preventive Medicine, October, 2016, Vol. 91). Of note, this correlation was found for higher intake, that is, those consuming more than one sugar-sweetened beverage a day.

 

Medications used to treat type 2 diabetes

Oral Medications for Diabetes

There are two major types of diabetes, type 1 which was once called juvenile diabetes, and type 2 diabetes – previously referred to as adult-onset diabetes. Type 1 affects about 1 in 100 Americans “Diabetes Medications:  The next Generation of Oral Agents, Insulin and more” by Donna Ellis in MedSurg Nursing, July/August 2013, volume 22, issue #4); it is usually diagnosed in children, thus its original name. It starts with the body’s immune system attacking and destroying the cells in the pancreas that make insulin. Because insulin is needed to allow glucose to move into muscle and fat cells, without it those cells burn fat for energy and the pH level of the blood drops dramatically. This is an emergency. Those with this type of diabetes require insulin replacement and the oral diabetes medication would not help them.

Type 2 diabetes is much more common, affecting about 10% of Americans (Ellis, 2013). It develops much more slowly and there is often a long period before diagnosis when the pancreas makes too much insulin. This occurs because the insulin receptors, molecules on fat and muscle cells that the insulin fits into to have its effect, are not working properly. This abnormality in the receptors is called insulin resistance.  The extra insulin helps get the glucose into cells and prevents the buildup of glucose in the bloodstream where too much glucose can damage arteries and other tissues. The high levels of insulin make it difficult to lose weight since insulin enhances fat storage.

When the pancreas can no longer keep up with the excess insulin production, the blood glucose (also called blood sugar) level rises. It is at this point that diabetes can be diagnosed. Treatment may include diet changes, weight loss, and exercise. Medications can be started to help lower the blood sugar level.

One group of medications used is the sulfonylureas. These medications increase production of insulin by the pancreas. They have been used for years but the newer, second generation sulfonylureas are most often used. Because they increase insulin secretion, they can cause hypoglycemia, an abnormally low blood sugar. This is a dangerous situation because the brain relies on the glucose in the blood. Not surprising, many of the symptoms of hypoglycemia are caused by the lack of glucose in in the brain such as headache, irritability, shakiness, and even confusion if it gets severe, confusion. It has to be treated quickly with something high in sugar such as orange juice or regular soda. Per an article in Diabetic Medicine (C. L. Edridge et al, March 2015) about hypoglycemia caused by diabetes medications, in a one month period more than 50% of those with type 2 diabetes had an episode of hypoglycemia in the month before the study was conducted.

Sulfonylureas can also contribute to weight gain. Because of these side effects and the way these drugs can advance pancreatic beta cell burnout, some recommend the use of sulfonylureas (“A dynamic duo for T2DM” by C. Winter, in Nurse Practitioner Perspective, July/August 2015).

Biguinides in another class of oral medications for diabetes. This has become first-line treatment. It lowers the blood glucose level by decreasing the breakdown of the storage form of glucose in the liver. Because it doesn’t increase insulin production, it doesn’t cause hypoglycemia. It can cause diarrhea, especially when treatment is started at a high dose.

Glitazones are medications that make the insulin receptors more sensitive to insulin. They can cause the body to retain fluids and this can potentially worsen heart failure.

Alpha glucosidase inhibitors decrease the breakdown of complex carbohydrates like bread into simple sugars like glucose. These drugs are particularly helpful in decreasing the after meal rise in blood sugar. Side effects they can cause include flatus and diarrhea. They don’t lower the average blood sugar as much as the other oral diabetes medications. This is measured by a test called a hemoglobin A1C. It measures how much glucose is attached to red blood cells and the level goes up the more glucose the cells are exposed to so it is much better at gauging diabetes management.

Adherence is a common issue for the treatment of many chronic illness. In “Failure to Reach Target Glycosylated A1C Levels Among Patients with Diabetes Who Are Adherent to Their Antidiabetic Medication” by D. Juarez, et al (Population Health Management, Volume 17, number 4, for 2014) the compliance rate for diabetes medication use ranges from 67 to 85%. This article studied the records of thousands of patients that were deemed adherent to their medication regime. Adherence was assessed based on patients getting their medications refilled. 56.1% of such compliant patients were deemed to have poor control of their diabetes. This was quantified as having a hemoglobin A1C of >7%. One of the responses to this low rate of success was that diet, weight management and/or exercise were not being fully attended to. There are certainly other possibilities, some of which they suggested. But, as was noted in C. Winter’s article, diet and exercise can lower the glycosylated hemoglobin (hgb A1C) by 1 to 2%. This is a significant decrease and perhaps an area that needs to be emphasized.

This article is not intended to replace your health care provider. The intent is to make important information about medications available.

Over-the-counter medication labeling dangers

Over-the-counter medication label dangers

The words medication and drugs usually are assumed to refer to prescription medications. But here are some statistics from Lehne’s Pharmacology for Nursing Care, 9th edition (2016) that could change that.

60% of medications taken every day are over-the-counter

On average, there are 24 such non-prescription medications per home medicine cabinet

40% of Americans take an OTC medication every other day

Since 1970, one hundred drugs have been changed from prescription to over-the-counter status. The Food and Drug Administration (FDA) decides which medications can be sold without a prescription. About fifty prescription drugs are being evaluated for OTC sale.

Labeling requirements enacted in 2006 have paved the way for easier to understand information on OTC drugs as well as printing large enough for most people to be able to read. We still have a long way to go. In “Readability and comprehensibility of over-the-counter medication labels” by Hariprasad Trivedi, Akshaya Trivedi, and Mary F. Hannan (Renal Failure for 2014), forty nonprescription medication labels were analyzed and found to have “poor readability and comprehensibility characteristics.” Even more concerning, OTC drugs that were considered “high risk” were deemed to be the worst. Nonsteroidal anti-inflammatory medications were included in this group and noted to be among the most difficult for people understand.

The authors of this article included data to support their prediction that the segment of the population that is over 65 is growing rapidly and by 2030 twenty percent of the population will be 65 and older. By then, they’ll be 30% of the nonprescription market. Considering the decreased metabolism and elimination of drugs that usually accompanies aging, combined with the lack of clarity of such OTC information, adverse effects from these medications will continue to rise. Improved labelling can reverse this terrible trend. It is hard to believe the pharmaceutical producers will do this. Learning about OTC medications or not taking them are other options. Remember too that pharmacists are knowledgeable about these medications as well and can answer your questions about them. This is one situation where ignorance is not bliss!

This article is not intended to replace your health care provider. The intent is to make important information about medications available.

Adolescent Drug Abuse Prevention — Does it really help?

Adolescent drug abuse prevention programs – do they really help?

At the risk of “giving away the ending,” the answer to the title of this article is “Yes, but…” The “but” is that not just any intervention will be effective. In the book Dangerous Drugs:  an easy-to-use reference for parents and professionals by Carol Falkowski, drug and alcohol use are a leading cause of preventable death for those 15 to 24 years of age. Focusing on the word preventable, it is vital to appreciate that there are factors that can increase the risk for drug use and addiction plus protective factors that can lower it the chance of drug addiction and alcoholism. Drug abuse is associated with underachievement in school, delinquency, teenage pregnancy and depression so that is further motivation to prevent such abuse.

In “Adolescent drug abuse – Awareness and Prevention” by B. Chakravarthy, et al (The Indian Journal of Medical Research, 6/1/2013 issue) it is noted that children that have experienced more than several adverse childhood experiences (ACEs) have an increased risk of abusing drugs. Such ACEs include neglect, as well as living in a home where adults abuse drugs or are criminals or have mental illness. Those teens who have experienced more than a few ACEs should be selected for interventions such as mentoring and tutoring.

The above article also notes that poverty, unless extreme, isn’t an ACE. It is also important to recognize factors that decrease the risk for drug use and abuse. Included in this list are parental involvement, school success, and clear expectations and consequences for teen behaviors.

Beyond targeting those at high risk for drug abuse and providing appropriate intervention, what else works to prevent this deadly problem? Per the Chakravarthy article, multiple exposures on drug abuse, interactive methods information delivery, social skill training, culturally sensitive materials, and presentations of familiar topics. Also, enhancing protective factors.

Per the United Nations Office of Drugs and Crime (INODC), one in twenty adults aged 15-65 abuses heroin, cocaine or other illegal drugs. Per Carol Falkowski, most adult drug users started their inappropriate drug use as teens.

Information in this article and other sources should lead to optimism since this is a problem we can do something about. The National Institute of Drug Abuse (NIDA) stresses that prevention can decrease the chances an adolescent will try illegal drugs or become addicted. In Dangerous Drugs, the author notes that parents often incorrectly believe their teens don’t care what they think, but that isn’t true. If you’re a parent or other caring individual, make the precious investment in a teen.