Wisdom Wednesday: Taking Four or More Prescription Meds? Consider Scaling Back

More than half of Americans regularly take about four prescription medications, increasing the likelihood that mistakes could occur, according to Consumer Reports.

People taking multiple prescription medications should visit their doctor for a “medication checkup.”

By showing their doctor or pharmacist a comprehensive list of every drug they are taking, including vitamins and other dietary supplements, patients can be warned about potentially harmful interactions. They can also find out if any of these medications are no longer necessary, which would save them money.

Consumer Reports encourages patients to have this type of medication review at least once a year.

“Much medication use is lifesaving, without a doubt. But some drugs can potentially do more harm than good,” said Lisa Gill, deputy editor of Consumer Reports. “Our concern is that inappropriate prescribing can lead to unnecessary risk, including trips to the emergency room,” she said in a news release from the organization. “We hope to encourage consumers to talk with their health care providers about the meds and supplements they take, so they can ultimately lower their risk,” Gill said.

Use of prescription drugs has surged over the past 20 years. The U.S. population has increased just 21%, but the total number of prescriptions filled by Americans has surged 85% - from 2.4 billion prescriptions in 1997 to 4.5 billion in 2016, Consumer Report said.

“There are many root causes, including a ‘culture of prescribing.’ Perhaps most worrisome is prescribing for pre-disease stages of a condition, such as pre-osteoporosis or pre-diabetes, where the medications offer limited benefit for people,” Gill said. “And we’ve seen a push to treat common problems like back pain, heartburn and insomnia with medication before trying effective, non-drug measures first,” she said.

People who are on multiple medications also need to be extra careful about possible interactions.

These Foods May Help Ease Rheumatoid Arthritis Pain

Have rheumatoid arthritis? Treat yourself to some blueberries and a cup of green tea. They’re among the foods that could ease the pain, swelling and stiffness in your joints and even slow progression of the disease, researchers say.

Dried plums, pomegranates, whole grains, the spices ginger and turmeric, and olive oil may also help. These foods appear to reduce inflammation, as well as joint stiffness and pain, according to the authors of a paper published Nov. 8 in the journal Frontiers in Nutrition.

“Regular consumption of specific dietary fibers, vegetables, fruits and spices, as well as the elimination of the components that causes inflammation and damage, can help patients to manage the effects of rheumatoid arthritis,” study author Bhawna Gupta said in a journal news release. Gupta is an assistant professor in the School of Biotechnology at KIIT University in Odisha, India.

“Patients suffering from rheumatoid arthritis should switch from omnivorous diets, drinking alcohol and smoking to Mediterranean, vegan, elemental or elimination diets, as advised by their doctor or dietitian, Gupta said. An omnivorous diet includes foods from both plant and animal sources. Incorporating probiotics – foods like yogurt and dietary supplements that contain beneficial microorganisms – can also help, she said.

Treatment of rheumatoid arthritis includes anti-rheumatic drugs, which can be costly.

“Supporting disease management through food and diet does not pose any harmful side effects and is relatively cheap and easy,” Gupta said.

My Take:
This report is interesting, but a little confusing. The Mediterranean diet is an omnivorous diet, including fish and occasional lean meats. It also includes wine, they drink quite a bit of wine in the Mediterranean region. The kids start about the age of seven.

The blueberries, green tea, dried plums and pomegranates are all good sources of anti-oxidants that limit or prevent damage to the body. The spices ginger and turmeric are both anti-inflammatory but turmeric reduces prostaglandins not typically found elevated in rheumatoid arthritis. Prostaglandins are frequently increased in musculoskeletal injuries, like osteoarthritis.

Ginger does reduce leukotrienes, inflammatory chemicals from the immune system that increase in autoimmune disease like rheumatoid arthritis. However, ginger is typically not very effective in treating true rheumatoid arthritis. In fact, when ginger tests well and helps reduce the inflammation associated with rheumatoid arthritis, I question the diagnosis (which I often do).

Gut Bacteria May Change Rapidly After Severe Injury

After a severe traumatic injury, the composition of a patient’s intestinal bacteria quickly changes – a phenomenon that could affect the patient’s prognosis, new research suggests.

The finding that the gut’s so-called “microbiome” experiences a depletion in the presence of some bacteria and an increase in the presence of others came from a small investigation, involving 12 critically injured adults. The patients were aged 20 to 85.

Stool samples were collected from each person three times: when they were admitted to the hospital, and then 24 and 72 hours later. The samples were compared with those from 10 other patients who had not sustained traumatic injury.

Samples taken at the time of admission were similar in both groups. But within 24 hours, differences started to show, the investigators found. By 72 hours, three types of bacteria were depleted in the traumatic injury group, relative to the non-injury group, and the levels of two other types of bacteria had risen.

“The short time-course in which such alterations occur is also notable – such relatively rapid alterations in intestinal microbiota represent a critical and previously unrecognized phenomenon that may influence clinical course and outcomes after severe trauma,” the study authors wrote in the report.

The study was published online Oct. 23 in Trauma Surgery & Acute Care Open.

The study team, lead by Dr. Benjamin Howard from the department of surgery at San Francisco General Hospital, said more research is needed to further explore the phenomenon. But the researchers added that the findings so far point to the possibility that intestinal bacterial composition could in some way be critical to patient outcomes after a traumatic injury.

Wisdom Wednesday: Definition of High Blood Pressure Drops

Nearly half of all adult Americans will be considered to have high blood pressure under new guidelines issued Monday by the nation’s top health organizations.

The new guidelines lower the diagnostic threshold for stage 1 high blood pressure to 130/80, down from the previous level of 140/90, according to a joint statement from the American Heart Association and the American College of Cardiology.

Further, the guidelines also call for more aggressive treatment of high blood pressure, asking doctors and patients to set 130/80 as the new goal of therapy.

High blood pressure can lead to heart attacks, strokes and heart failure.

But the guidelines also press for more judicious treatment of high blood pressure – sometime called hypertension – and an emphasis on lifestyle risk factors. Prescriptions for blood pressure drugs are not expected to leap under the guidelines, experts said.

The two heart organizations announced the new guidelines Monday at the American Heart Association’s annual meeting, in Anaheim, Calif. The guidelines were last revised in 2003.

This change means that 103 million Americans well be considered to have high blood pressure, or about 46% of the adult population, said Dr. Paul Whelton. He is chair of the 2017 Hypertension Practice Guidelines and a professor of Global Public Health at Tulane University School of Public Health and Tropical Medicine in New Orleans.

The impact of the new guidelines is expected to be greatest among younger people. High blood pressure is expected to triple among men under age 45 and double among women under 45, according to the guidelines report.

Are Some Heartburn Meds Tied to Stomach Cancer?

Popping certain heartburn drugs like they’re candy might up your odds for stomach cancer, new research suggests.

The risk was proportionate to how long and how often these drugs, called proton pump inhibitors (PPIs), were taken. That risk increased anywhere from two to eight times, the study authors said.

Although the relative risk seems high, the absolute risk was small. But it was statistically significant, especially for people infected with Helicobacter pylori, a bacteria linked to stomach cancer, the researchers explained.

“While PPIs are one of the most commonly used medications for treating reflux disease as well as dyspepsia, clinicians should exercise caution when prescribing long-term PPIs, even to patients who have H. pylori eradicated,” said lead researcher Dr. Wai Keung Leung. He is a professor of gastroenterology at the University of Hong Kong.

PPIs include commonly used drugs like Prilosec, Nexium and Prevacid.

Eliminating H. pylori lowers the risk of stomach cancer significantly, Leung noted. But even after the bacteria is treated, many people still develop stomach cancer.

Stomach cancer is the third leading cause of cancer death in the world and earlier studies have found a link between PPIs and stomach cancer. But the role of H. pylori was less clear.

To try to assess the role the bacteria played, Leung and his colleagues compared the use of PPIs with another class of drugs used to lower stomach acid – histamine H2-receptor antagonists (H2 blockers). The study followed nearly 63,400 patients treated with a combination of a PPI and two antibiotics to kill H. pylori. The treatment was given over seven days between 2003 and 2012. The patients were followed for an average of seven years, until the participants either developed stomach cancer, died, or the study ended.

Are Artery-Opening Stents for Chest Pain a Waste of Time?

A new study suggests that the placebo effect of stents in heart patients with chest pain may be far more pronounced than thought. That could mean that drug therapy alone, rather than the pricey, artery-opening devices, is all that’s needed for certain patients, the researchers said.

“The most important reason we give patients a stent is to unblock an artery when they are having a heart attack. However, we also place stents into patients who are getting pain only on exertion caused by narrowed, but not blocked, arteries. It’s the second group that we studied,” explained lead author Rasha Al-Lamee, from the National Heart and Lung Institute at Imperial College London.

The study included 200 patients with stable angina who received six weeks of intensive drug treatment for their angina. After that, they either received a stent or underwent a simulated procedure where no stent was implanted.

Patients who received stents did not have more improvements in angina or quality of life than those who did not receive a stent. Angina is the medical term for chest pain. It is typically caused by the build-up of fatty plaques in the arteries.

Stents aren’t cheap, either: The devices and their insertion coasts from $11,000 to $41,000 at hospitals in the United States.

The study was published online Nov. 2 in The Lancet medical journal, to coincide with a presentation at a cardiology meeting in Denver.

Wisdom Wednesday: Endangered Plants with Medicinal Properties

Humans have used plants as medicine from the beginning of our time on Earth. The “doctrine of signatures” says that for every ailment there is a plant and the characteristics of that plant will tell you how to use it. However, the popularity of using these plants has grown exponentially in recent years. This has led to heavy pressure on the native population plants when they are collected from the wild. In some cases, overharvesting of a particular plant has led to their endangerment.

This is a list of just some of the endangered plants on our planet that are highly valued for the medicines that they provide:

Black Cohosh:
used by Native Americans to support women’s health during menopause and for menstrual issues. I use it for the same purposes. Studies indicate that its’ estrogenic activity is restricted to secondary sites like bone but I still avoid use with any history of breast cancer. Harvesting pressures, habit loss and invasive species have all contributed to its’ decline.

Goldenseal:
another North American herb. The root was used by indigenous tribes along the east coast to support the immune system. I use it for acute infections. Overharvesting is the major issue.

American Ginseng:
a perennial herb also native to Eastern North American. The root has many healing properties, including adaptogenic, cardiotonic, sedative and immune support. Overharvesting and habit loss are the primary issues.

Asian Ginseng:
The root has been used for thousands of years in China. It boosts many of the same properties as its’ American cousin. Due to overharvesting the majority of Asian Ginseng on the market today is cultivated.

Wild Yam:
native to North America, Mexico and Asia. The roots and stems are used for inflammation, as a digestive aid, to support healthy blood sugar, and as an antioxidant. I use it as a natural source of progesterone as the precursors found in the plant are converted in the stomach. Topical Wild Yam has no progesterone activity. It also has been overharvested.
Slippery Elm – native to Eastern and Central U.S. and into Canada, the mucilaginous inner bark of the tree has many uses, including soothing coughs, sore throat, and digestive inflammation. I use it as a prebiotic with its high soluble fiber content and as an anti-inflammatory for the gut. Dutch elm disease and aggressive harvesting practices have severely threated this tree.

What can you do to help endangered medicinal plants?

First, purchase them only from well-respected sustainable companies, preferably those who cultivate rather than harvesting in the wild. Medi-Herb, my favorite herb company has discontinued the use of certain herbs on the endangered list.

Second, you can learn to grow many medicinal plants yourself. Most of the plants listed above are native to the U.S. Please visit www.crimson-sage.com to view and purchase herbs that are endangered or at risk. Black cohosh, Echinacea angustifolia, Goldenseal, and Slippery Elm are all available and reasonably priced.

The Bottom Line:
Please do what you can to preserve herbal plant life. Your health may depend on it someday.