Medication and the Aged
June 30, 2008
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One of the problem with many drugs that are on the market is they were only tested on a certain population. It used to be that drugs were basically tested on white males in their middle years. Now there is much more testing on women but there is still not much testing on the aged. Why does being elderly make a difference? Here are two of the reasons.
As we age there are a range of changes in our bodies. This has implications for the medications we take. One of these is that the relative amount of fluid in our bodies decreases. Most drugs are not evenly distributed throughout the body, but are found either predominantly in either in fluid or in fat. The majority of drugs are in fluids, which includes blood, inside cells, between cells etc.
For a drug that is found in fluids, if the amount of fluid in the body is less, then for the same dose the concentration of the drug will be higher. Same amount in a smaller volume. This can mean that for the same dose the concentration of the drug in the body can be higher.
Additionally, some processes in the body slow down, whereas others do not. There are a range of mechanisms for clearing medications from the body (that’s why we have to keep taking them). Different drugs are cleared by different mechanisms. If one of these mechanisms is slower or does not work as well, for the same dose there will be drug may build up in the body.
Drugs have what is known as a therapeutic window. Below a certain concentration in the body, they have little or no effect. Above a certain concentration in the body, there will start to be serious side effects. Different drugs have different sized windows. If a drug has a narrow window, then an increase in concentration in the body can have serious consequences.
The bottom line is that a drug that works and is well tolerated in a younger person may or may not be suitable for an elderly person. This problem is compounded by the fact that as we age, we usually need to take many more medications. Many physicians do not fully consider the age of the person once they have reached adulthood. If you are involved in the care of any elderly persons, having them see a physician who specializes in gerontology may be helpful for quality of life, including less side effects and potential medication problems.
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Popularity: 32% [?]
Eat Food With Herbs And Spices; Many Contain Beta-Caryophyllene
June 27, 2008
Food that is well seasoned with herbs and spices is probably good for you. A large number of herbs and spices including oregano, rosemary, thyme, cinnamon, ginger, clove and black pepper contain significant levels of beta-caryophyllene. Additionally many plants that are used in “folk medicine” throughout the world are often high in beta-caryophyllene.
Beta-caryophyllene is a volatile aromatic oil. This means that it evaporates (dies up) easily and it has a strong smell. It is used in the perfume industry, and also as a food additive. It is described as smelling like spicy pepper, woodsy with a citrus background.
Researchers have found that the compound beta-caryophyllene has several beneficial properties. Several years ago application to the skin was found to be somewhat numbing, so it may have use as a local anesthetic. There is also data for some antibiotic effects and anticancer effects, in particular, in combination with some anticancer drugs. It may also help slow osteoporosis. Another important property is this compound is that it is an anti-inflammatory. Recent research has investigated the mechanisms of the effects of beta-caryophyllene in the body.
The anti-inflammatory properties of beta-caryophyllene, may help reduce the development of inflammatory diseases. One important inflammatory disease is atherosclerosis (blockage of the arteries). Once atherosclerosis starts there is an immune cascade that causes the lesion to grow and change. It is possible that a significant intake of foods containing beta-caryophyllene may have an anti-inflammatory effect and slow the progression of atherosclerosis. Other inflammatory diseases such as inflammatory bowel disease, chronic obstructive pulmonary disease, osteoarthritis and rheumatoid arthritis may also be slowed by beta-caryophyllene.
Beta-caryophyllene is also found in some fruits including mango, guava, grape, raspberry and black currants. It is also found in cannabis, though it is not psychoactive.
So eat foods that are well flavored with herbs and spices, it may help your cardiovascular system.
Technorati Tags: beta-caryophyllene, atherosclerosis, herbs, anti-inflammatory
Popularity: 50% [?]
Leptin Might Be The Key To Weight Loss and Maintenance
June 25, 2008
One of the problems when dieting is that after the while the body adapts to the lower calorie intake. After a period of restricted food intake the body starts to make changes in some of its systems.
When calories have been in short supply for a while, the body increases the feelings of hunger. This is a basic survival mechanism and would make our prehistoric ancestors go out and find some berries or go hunting a woolly mammoth. We need to eat to survive. Unfortunately dieting also triggers this survival mechanism, and stimulates an overfeeding response.
Additionally, after a period of restricted calories our metabolism slows down. This, too, is a survival mechanism. In times when there is a shortage of food, if the amount of energy that the body uses can be reduced, we are more likely to survive until there is adequate food again.
These two changes in the body result in it becoming harder to lose weight after dieting for a while. Importantly, it also makes it harder to maintain the weight loss after losing the desired weight.
Leptin is a hormone that is secreted by fat cells. It is involved in a number of processes in the body including energy regulation. During fasting, the levels of leptin circulating in the body drop. This drop in leptin levels has a range of effects that include reduced energy expenditure and the stimulation of overfeeding.
Several studies suggest that a potential treatment option for weight loss and maintenance may be leptin or some future drug that increases the levels of leptin. The studies looked at both energy expenditure and brain activity in response to food stimuli.
The first studies compared markers of energy expenditure, with and without, an injection of leptin under the skin for those on a weight loss program. The leptin injection increased the circulating leptin levels to those pre-diet, and at the same time increased the levels of the markers of the body metabolism. So increasing the levels of leptin reversed the slowing of the body metabolism. This is likely to increase the rate of weight loss, and be important for weight maintenance.
The second study looked at brain activity. In certain areas of the brain after being on a diet for a while there is increased activity, which correlates with an increased appetite. In those who received leptin, the brain activity decreased to the level found prior to dieting. This suggests that increased leptin levels may decrease the feelings of hunger and make overfeeding episodes less likely.
These studies have several potential implications. As stated above, would treatments that increased leptin levels be useful in the latter stages of weight loss and for weight maintenance? (Note: The majority of obese individuals have high levels of leptin and are leptin-resistant so treatment is unlikely to work for them, unless they are on long term calorie restriction. For those who are obese and have low leptin levels, it certainly could be a treatment option.) Additionally, do low levels of leptin predict obesity later in life? Would measurement of leptin levels help target those who have a high likelihood of gaining weight?
It is likely in the future that some form of leptin therapy may be of benefit to a significant number of people, particularly for weight maintenance.
The research has been published in the Journal of Clinical Investigation and is authored by Rosenbaum et al. For more details there is an excellent free access commentary in the issue as the most recent article.
Technorati Tags: leptin, weight loss, weight maintenance, slow metabolism, appetite, overeating
Popularity: 37% [?]
Flip-Flops Are Bad, I’m Devastated
June 24, 2008
The only shoes I like are flip-flops. However you put the two words together, flip-flops, flipflops or flip flops? So I was devastated to read everywhere in the media that they are bad for your feet and legs.
I wear flip-flops as much of the year as I can. I have probably two dozen pairs. I only have ones with good thick soles, so I thought I was ok with plenty of cushioning. I guess not.
In case you have been on vacation and not read about it, research shows that the problem is too great an angle between the foot and leg, i.e. too great an ankle angle, and a shorter stride length that is the problem.
I have stopped wearing them for walking the dog (up to five miles) but still wear them to work. I work in a research lab, and there is definitely no dress code. We range from heels and formal office style attire, to what to look like pajamas, and everything in between.
Recently from a discount store I bought some flip-flop style Earth sandals. These are the sandals with the negative heel. The heel is slightly lower than the toes and is meant to be good for your legs and posture. I wonder, does the negative heel which creates a narrower foot angle compensate for the flip-flop too great ankle angle?
There are some things I will not give up. Flip-flops are one of those things. Perhaps I can take comfort that ballet flats, which I find awkward to walk in, were said to be even worse for your feet.
photo credit: Abbie Treis
Technorati Tags: flip-flops, ankle angle, negative heel
Popularity: 22% [?]
High Carb, High Protein Breakfast For Weight Loss?
June 23, 2008
Should breakfast be a high carb, high protein meal and then the remaining meals low carb, low calorie? A new study suggests that this might be the way to lose and maintain weight loss.
Carb restriction has been shown to be an effective method of dieting. However, there are two common problems. First, it is hard to maintain for extended periods of time, due to the intense carb cravings that most people get. Secondly, once a low carb diet is stopped, there is often a rapid weight gain.
The idea of high carb, high protein breakfast diet is that it reduces the cravings for carbs and increases the sense of fullness. This will then make sticking with the diet easier and not lead to the rebound effect of “carb cramming” after stopping dieting.
A yearlong study compared a low carb diet (not the high protein, high fat Atkins-style) with a diet that had a high carb breakfast. The focus for the first 8 months of the study was weight loss, the next 4 months focused on weight maintenance.
The results are very interesting. After 4 months the low carb only group had lost an average of 28 lbs and the high carb breakfast group had lost an average of 23 lbs. However, at 8 months the low carb group had regained an average of 18 lbs, whereas the high carb breakfast group had on average lost another 16.5 lbs!
The authors suggest that “The big-breakfast diet works because it controls appetite and cravings for sweets and starches. It also is healthier than an extremely low-carbohydrate diet, because it allows people to eat more fruit and therefore get enough fiber and vitamins.”
Sounds worth a try since the usual low carb diet does not seem to work long term for the majority of people.
This study was presented last week at the annual Meeting of The Endocrine Society. The press release gives more details including the number of calories, carbs, proteins and fat.
Technorati Tags: low carb, high protein, breakfast, weight loss
Popularity: 43% [?]
LDL Cholesterol Lowering Drugs: The Statins
June 20, 2008
Continuing from yesterday’s theme, I thought I would write a short explanation of the statin family of drugs, that are used for treating bad levels of cholesterol. Statins are the most prescribed drugs in the US. In fact, Atorvastatin (Lipitor), much of the time, has been the most prescribed drug for the last couple of years. (It was toppled by Viagra for a while, but came back.)
It is important to remember that your body has to have cholesterol. The major uses are; as part of the membranes of cells, and in the formation of a number of hormones.
No matter how much cholesterol you eat, your body (mainly the liver) will always make some cholesterol.
LDL (low density lipid) cholesterol contains cholesterol that is made by, or reprocessed by the liver. It is transported by the blood throughout the body, and cells that need some cholesterol will take what they need from the blood. So you need to have LDL cholesterol circulating in your blood. It is just that when there is too much that there may be problems.
Currently, the standard for treating high LDL cholesterol levels are the statins. The statins include lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), atorvastatin (Lipitor) and rosuvastatin (Crestor). The first name of each pair is the name of the drug, the second name in brackets is the commercial name for that drug. Yesterdays post about red yeast rice involves lovastatin.
These drugs are all inhibitors of the enzyme HMG CoA reductase. This enzyme is a major enzyme in the process of making of cholesterol by cells. When the enzyme is inhibited, cells in the body make less cholesterol. Then, when the cells get short of cholesterol they start to take up cholesterol from the blood to meet their requirements, then the level of LDL cholesterol in the blood drops.
(Statins are thought to have a number of other good effects too, independent of their cholesterol lowering ability. These are wide ranging and the subject of much research and controversy.)
To summarize, statins decrease the amount of cholesterol that the body can make, so then to meet requirements cells take up LDL cholesterol from the blood, which cause the level of LDL cholesterol in the blood to decrease.
photo credit: tellumo The sign is in Sausalito.
Technorati Tags: cholesterol, LDL cholesterol, drug, statin, lovastatin, atorvastatin, Lipitor
Popularity: 33% [?]
Red Yeast Rice For Cholesterol Lowering?
June 18, 2008
There has been quite a bit of news lately about red yeast rice and its use for lowering cholesterol. The short answer is yes red yeast rice can lower cholesterol. However, there are some important considerations when deciding whether to use this supplement for cholesterol lowering.
What is red yeast rice?
This is rice that has been mixed with red yeast (Monascus pupureus) and allowed to ferment. The resulting fermentation products include a group of substances that have cholesterol lowering ability. One of these substances is the compound known as monacolin K, also known as lovastatin (Mevacor). Lovastatin was the first of the prescription statins available for lowering cholesterol. The commercial synthesized statins also include Zocor, Lipitor, Pravachol, Lescol and Crestor.
What are the potential problems with taking red yeast rice?
Some brands do not control (or measure) the amount of the active ingredient. Different batches may have almost none, or huge doses of monacolin K. Almost none is obviously not going to be any help with lowering cholesterol. Too much can result in muscle damage, also known as myopathy. (PubMed)
If the red yeast rice fermentation is not properly controlled there can be harmful products made too. When a number of red yeast rice preparation were tested some of them contained citrinin, which is a toxin that will damage your kidneys. (PubMed above)
Red yeast rice can have interactions with other medications. Some which will increase the risk of muscle damage or other side effects. This list of medications that potentially may result in side effects includes all drug interactions and cautions listed for lovastatin. As with the commercial cholesterol lowering statins Mevacor, Zocor and Lipitor, no grapefruit or grapefruit-containing products should be consumed. Grapefruit, also, increases the risk of muscle damage. If you are taking any other medications fully investigate whether combined with red yeast rice there may be side effects.
The FDA has banned some brands of red yeast rice products. However, it is likely in the future that products with strict manufacturing guidelines and extensive analysis will eventually be available.
As always caveat emptor (buyer beware).
Technorati Tags: red yeast rice, lovastatin, citrinin, cholesterol lowering
Popularity: 37% [?]
Bodylastics Variable Resistance Bands
June 17, 2008
Thinking about resistance training of some type? Not a bad idea since strength training has been shown to be important for healthy aging. Thought I had a post on sarcopenia but can’t find it. Must have dreamed it. Will write one. There is a post on resistance (weight training) revving up the metabolism, though.
The Bodylastics system with variable resistance bands is one alternative. It consists of a number of color coded resistance bands with different strengths, handles, door anchors, a manual, a DVD and one year membership to the “Strength Band University”, which has videos and instruction for exercises. As the website says, Bowflex, Total Gym and even Bally’s have a $50 alternative - Bodylastics!
The main reason I bought the basic set was for something to take with me when I travel. Stuck in a hotel room, bored, with time on my hands is one time that I really do manage to do some workouts. At home there always seems to so much competing for attention, and so it is so very easy to put off trying to keep in shape. Spending my hard earned cash I want to get something that was not heavy or bulky, so I could use it at home or anywhere.
The one negative for me was that though the bands are very smooth there was one exercise, that I tried, where the bands under tension moved over the skin on the back of my arms that I found unpleasant. Must have wimpy skin.
Take a look at the website. It is a well laid out site and shows a range of exercises. If you are in the market a resistance type product, for the quality, I don’t think you could do better than these for $49.95.
In summary: This product pretty much lives up to the hype. It is not unique; there are certainly other resistance band systems out there. However it is very well designed and sturdy, and excellent value for money. Certainly worth considering.
Technorati Tags: resistance bands, variable resistance
Popularity: 31% [?]
Japan Aims To Measure 56 Million Waists
June 16, 2008
Japan now has a national law that all adults between 40 and 72 must have their waists measured. This is 56 million waists, or 44% of the population. Those whose waists are too big will get diet and exercise advice, and follow-up visits.
Like all countries Japan is concerned about the expanding waistlines of the population. The national program is an attempt to see if they can stop and reverse the trend. Read the good article about this in the NYTimes health section.
The article describes how the Japanese Health Ministry started to educate the populace about metabolic syndrome [where a person has 3 or more of the following, high levels of blood glucose, high levels of triglycerides, low levels of HDL (good) cholesterol, high blood pressure, abdominal obesity] several years ago. The aim being to try make sure that everybody knows about metaobolic syndrome.
The name metabolic syndrome was shortened to “Metabo”. Apparently there are anti-Metabo songs, one of which includes “the warning against trouser buttons popping and flying away”.
I think Japan is to be congratulated for trying to do something about the growing problem (pun intended), before it becomes very serious. Investment now in the program may save them a lot of money in healthcare costs down the road.
An important question that may be answered by this is whether a program such as this one, actually has any effect on peoples behavior and whether in the long run it will make any difference at-all. Will Japan fall prey to the scourge of Metabo?
Technorati Tags: Japan, waists, metabolic syndrome, metabo
Popularity: 38% [?]
Dissolving Glass For Bone Replacement
June 13, 2008
Aging takes a toll on our bones. Eventually, there are many people who need some form of bone replacement such as in a knee or hip. Dissolving glass may be the new answer. Further, after accidents or some diseases new bone is required for people of all ages.
Researchers at the Universities of Kent and Warwick have developed a new form of glass that will after a period of time in the body dissolve. The glass provides a structure for bone cells to attach too, so new bone can grow.
The glass can be made to contain calcium and other substances that will promote new bone growth. This new glass has been demonstrated to activate bone cells causing them to migrate, grow and increase in number to make new bone.
As the new bone grows the glass will dissolve away, leaving the new bone. The glass does not contain any toxic chemicals and effectively just disappears.
A report of this ongoing research is in Science Daily and has a picture of the bone cells grown on the glass.
The researchers are working on making new stronger versions that would be strong enough for joint replacement. They say that clinical trials could be expected to start with 5 years.
I think this is really exciting and may overcome many of the problems associated with bone replacement particularly in joints. Your own new bone has to be better, in many cases, than the metal or other foreign substances used for bone replacement.
photo credit: lavandarfields
Technorati Tags: bone replacement, bone growth, dissolving glass, joint replacement
Popularity: 29% [?]
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