Zinc Deficiency: Taste Buds Stop Working, & When Severe, Food is Revolting


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Hypogeusia

A Case Report

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The diagnosis came from a non-medical book:

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Remove zinc from your diet and you will get a condition known as hypogeusia, in which your taste buds stop working, making food boring or even revolting, but until as recently as 1977 zinc was thought to have no role in diet at all.The quote leaped from the page of a book “At Home” by Bill Bryson.

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Food aversion. Revulsion toward food.

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Hypogeusia is a diminished sense of taste resulting from zinc deficiency. The patient slowly, week after week, developed a severe aversion to all food groups except cappuccino (arginine).

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Month after month it became severe before the patient was finally able to identify a descriptive term “food aversion.” Hunger was severe. Patient was desperate to find fuel for body that was not revolting.

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Not anorexia – means loss of appetite. The patient was starving.

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Not anorexia nervosa – a distorted body image in which patients severely restrict food intake and can starve to death.

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Not depression – depressed mood often associated with poor appetite or stress eating.

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Food aversion was bizarre, going to bed starving while the best foods were sitting in the fridge untouched and literally repulsive even to think about. For months, walking up and down grocery aisles, repulsed by the thought of the finest foods despite hunger, craving to find some form of fuel that was not revolting. Months and months went by as it became severe. Past favorite foods might as well have been poison. Flavor was wanting.

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Specialists and literature searches commonly view food aversion as psychosomatic or the bizarre cravings of pregnancy. Females are at particular risk of being assigned psychological diagnoses. We do our patients a disservice failing to appreciate the complexity of human physiology with our limited understanding of evolving science. The human body is complex.

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To complicate matters, it’s not easy to diagnose depression – not all patients recognize it in themselves. Further, zinc deficiency induces depressive behaviors, plays a major role in major depressive disorder and is a risk factor for treatment resistance — referenced below at end. 

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Aversion became extreme before the patient could name the correct term: food aversion, no doubt why it is barely mentioned in medical searches: a condition must have a name before it can exist, before it can be identified and understood as a symptom. Hunger at times was severe, but just the thought of driving to the grocery store was troubling and wasted hours. Complicating the picture, the coexisting autoimmune disorder also caused anorexia, i.e. loss of appetite.

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Then that sentence leaped from the page naming the cause: Zinc deficiency. What causes zinc deficiency? Malnutrition, medications. You have to string together the right words in order to search the publication leads. Thus, when you specifically search food aversion and prednisone:

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“Food aversion is found among people who take Prednisone, especially for people who are female, 60+ old , have been taking the drug for 1 – 6 months, also take medication Methotrexate, and have Osteoporosis.”

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There it was: prednisone and methotrexate, elderly female. Prednisone depletes zinc.

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The patient stopped methotrexate. Six weeks went by before a small number of foods could be added to milk and eggs. Unfortunately, the only foods tolerated were easily digestible ice cream (protein), pasta and sweets, which leads me to recall patients with autoimmune disorders whose diet consisted of processed carbs such as English Muffins, bread, pasta, who complain they cannot eat anything yet they are obese. They cannot seem to change food choices. How many cancer patients have this problem from chemotherapy?

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Vegetarians are at risk of zinc deficiency since Zinc is available primarily in oysters, meat, and poultry. Among the many causes of gustatory (taste) dysfunction in Table 6 from 2013 American Family Physician, besides malnutrition are cancer, radiation, etc, a long list of medications are listed:

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Medications

Intranasal zinc, chlorhexidine (Peridex), chemotherapy, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, diuretics, antimicrobials (macrolides, terbinafine [Lamisil], fluoroquinolones, protease inhibitors, griseofulvin, penicillins, tetracyclines, nitroimidazoles [metronidazole (Flagyl)]), antiarrhythmics, antithyroid agents, antidepressants, anticonvulsants, lipid-lowering agents

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Chemotherapy, statins, antidepressants, blood pressure medications, antibiotics – many commonly used medications can cause deficiency, yet zinc deficiency is said to be rare. Are we failing to recognize this in our patients?

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If dysfunction occurs, stop the offending medication. Regarding chemotherapy, “These effects are usually transient and resolve within three months of treatment cessation. This adverse effect is most likely caused by toxicity to olfactory and gustatory receptor cells that have the ability to regenerate.”

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“Zinc is involved in numerous aspects of cellular metabolism. It is required for the catalytic activity of approximately 100 enzymes [1,2] and it plays a role in immune function [3,4], protein synthesis [4], wound healing [5], DNA synthesis [2,4], and cell division [4]. Zinc also supports normal growth and development during pregnancy, childhood, and adolescence [6-8] and is required for proper sense of taste and smell [9]. A daily intake of zinc is required to maintain a steady state because the body has no specialized zinc storage system [10].”

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Immune function

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“Severe zinc deficiency depresses immune function [48], and even mild to moderate degrees of zinc deficiency can impair macrophage and neutrophil functions, natural killer cell activity, and complement activity [49]. The body requires zinc to develop and activate T-lymphocytes [2,50]. Individuals with low zinc levels have shown reduced lymphocyte proliferation response to mitogens and other adverse alterations in immunity that can be corrected by zinc supplementation [49,51].”

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DIAGNOSIS

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Serum levels of zinc and copper can be tested but do not reflect levels in the body as they are stored in tissue.

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Information below is from a review in J Clinic Toxicol by Osredkar J, Sustar N (2011) Copper and Zinc, Biological Role and Significance of Copper/Zinc Imbalance. 

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“The ratio of copper to zinc is clinically more important than the concentration of either of these trace metals. Zn is the second most abundant transition metal in organisms after iron and it is the only metal which appears in all enzyme classes, while copper is present in every tissue of the body, but is stored primarily in the liver, with fewer amounts found in the brain, heart, kidney, and muscles.”

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…The optimal plasma or serum ratio between these two elements is 0.70 – 1.00 [1]….

“There are 2-4 grams of Zn distributed throughout the human body [2]. Most zinc is in the brain [primarily hippocampus, the limbic system], muscle, bones, kidney and liver, with the highest concentrations in the prostate and parts of the eye [3]. It is the second most abundant transition metal in organisms after iron and it is the only metal which appears in all enzyme classes [2,4].

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Copper is also a vital dietary nutrient, although only small amounts of the metal are needed for well-being [5]. Although copper is the third most abundant trace metal in the body [behind iron and zinc], the total amount of copper in the body is only 75-100 milligrams [6]. Copper is present in every tissue of the body, but is stored primarily in the liver, with fewer amounts found in the brain, heart, kidney, and muscles [7]….

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Diagnosing zinc deficiency is a persistent challenge. Zinc nutritional status is difficult to measure adequately using laboratory tests due to its distribution throughout the body as a component of various proteins and nucleic acids [18,136].”

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Plasma or serum zinc has poor sensitivity and specificity – these levels do not necessarily reflect cellular zinc status due to tight homeostatic control mechanisms.”

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Zinc and Vegetarian Diets is reviewed in 2012 with recommendations to minimize deficiency.

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“Since plant sources of zinc contain phytate and other inhibitors of zinc absorption, vegetarians and vegans may potentially be at risk of zinc deficiency.”

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Special cases such as those with inflammatory bowel disease, those with profuse diarrhea, or who have had bariatric surgery should consult with a nutritionist.

 

Zinc Therapy in Dermatology: A Review from 2014 is an open access PDF. Zinc is discussed in various conditions including eczema, psoriasis & psoriatic arthritis, acne, alopecia, seborrheic dermatitis, dandruff, etc.

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“It maintains macrophage and neutrophil functions, natural killer cell activity, and complement activity. It activates natural killer cells and phagocytic function of granulocytes and stabilizes the plasma subcellular membranes especially the lysosomes. It inhibits the expression of integrins by keratinocytes and modulates the production of TNF-𝛼 and IL-6 and reduces the production of inflammatory mediators like nitric oxide. It is also proposed that it is toll-like receptors mediated regulation of zinc homeostasis which influences dendritic cell function and immune processes [2]. Zinc also possesses antioxidant property and has been found useful in preventing UV- induced damage and reducing the incidence of malignancies. It has also been demonstrated to possess antiandrogenic properties as it causes modulation of 5𝛼-reductase type 1 and 2 activity [1, 3, 4].”

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2. H. Kitamura, H. Morikawa, H. Kamon et al.,“Toll-like receptor-mediated regulation of zinc homeostasis influences dendritic cell function,” Nature Immunology, vol. 7, no. 9, pp. 971–977, 2006.

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TREATMENT

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Based on limited reading, for zinc deficiency – NOT routine use – consider 20 to 50 mg zinc with 2 mg copper for a limited time. Follow cautiously for toxicity. HIGH AMOUNTS OF ZINC ARE UNSAFE.

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From Penn State Hershey Medical Center

 

Available Forms

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Zinc is available in several forms….

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More easily absorbed forms of zinc are zinc picolinate, zinc citrate, zinc acetate, zinc glycerate, and zinc monomethionine. If zinc sulfate causes stomach irritation, you can try another form, such as zinc citrate.

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The amount of elemental zinc is listed on the product label (usually 30 – 50 mg). To determine the amount to take in supplement form, remember that you get about 10 – 15 mg from food. [if you eat oysters, meat, poultry]

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Zinc lozenges, used for treating colds, are available in most drug stores. There are also nasal sprays developed to reduce nasal and sinus congestion, although they may have some safety issues (see “Precautions”). [Avoid nasal sprays as it destroys the olfactory nerve, the sense of smell.]

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How to Take It

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You should take zinc with water or juice. If zinc causes stomach upset, it can be taken with meals. Don’t take zinc at the same time as iron or calcium supplements.

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A strong relationship exists between zinc and copper. Too much of one can cause a deficiency in the other. If you take zinc, including zinc in a multivitamin, you should also take copper..

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Take copper on an empty stomach. The tablets I have seen are so tiny they stick in the throat. Copper is water soluble but dissolves better in hot water.

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Memorial Sloan Kettering Cancer Center [MSKCC] has important Cautions not to take, and also Warnings on taking zinc if you have certain medical conditions or take certain medications. Bear in mind, the highest concentration of zinc is the prostate. I strongly recommend reading all zinc sections from MSKCC.

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“Consumption of zinc >100 mg/day may increase the risk of prostate cancer (31).

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Although human studies have been equivocal, patients should take zinc 2 hours before or after foods that are high in calcium, phosphorus, bran fiber, or phytate to avoid nonabsorbable complexes (45) (67).

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When taken orally at large doses (100-300 mg/day), zinc can cause chronic toxicity including copper deficiency, depressed immune function, headache, chills, fever, and fatigue (58) (59).”

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“Intake recommendations for Zn are provided in the Dietary Reference Intakes developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies…. U.S. National Research Council set a Tolerable Upper Intake for adults of 40 mg/day[82,83].

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Zinc Fact Sheet for Health Professionals, NIH Office of Dietary Supplements  

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Recommended daily allowance for Zn

RDAs 8 mg/day for female, 11 mg/day for male

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Recommended intake for copper

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The 10th edition of Recommended Dietary Allowances (RDA) did not include an RDA for copper; rather a safe and adequate daily intake was suggested…. The following Table 2 provide the Recommended daily dietary intake (RDI) of copper for children and adults and Tolerable upper intake levels for copper [83,85].

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Recommended daily intake RDI’s

90 mcg

Tolerable upper intake levels TUL
10,000 mcg”

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Of interest, a 2005 publication, Re-establishment of olfactory and taste functions describes results of treatment. Very small numbers were tested limiting interpretation. Were large doses complicating the results, causing toxicity and/or copper deficiency?

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In an open study (n=119; idiopathic taste disturbance, n=45; drug-induced taste disturbance, n=38; zinc deficiency, n=36), taste improvement by 50% was achieved after 4 weeks and by 80% after 8 weeks of treatment with zinc sulfate (100 mg, three times daily) [201]. In a double-blind, placebo-controlled study (n=73; idiopathic taste disturbance, n=48; lowered zinc levels, n=25), treatment with zinc picolinate (30 mg, three times daily) for 3 months did not improve subjective taste assessment or taste performance in the entire mouth, although the group receiving zinc picolinate performed significantly better than the placebo group in the filter paper test [202]. However, both the double-blind study by Henkin et al. [171] and the double-blind study in 65 patients by Yoshida et al. [203] failed to confirm this difference. Nevertheless, if the patients with drug-induced taste disturbances were excluded and only the patients with idiopathic taste disturbances and zinc deficiency were analyzed, the result was significant [203]. A double-blind study in hemolized patients (n=22) with low zinc levels demonstrated a significant improvement in response to zinc (50 mg/day) given for 12 weeks [204]. Similarly, preliminary findings from a double-blind study with zinc gluconate by Heckmann et al. seemed promising in idiopathic dysgeusia [205], [206].

 

 

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Zinc: an Antidepressant by a psychiatrist writing in Psychology Today in 2013,  zinc is anti-inflammatory and antidepressant. “Inflammation is the primary driving mechanism behind the whole shebang and may decrease brain zinc levels all on its own.”

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“300 or more enzymes in our bodies use zinc as a buddy to help them do their thing, making DNA, protein synthesis, cell division, all hugely important stuff. Zinc is also critical to cell signaling (a major receptor motif, the “zinc finger” is as famous as the G protein in cell biology circles). The highest amount of zinc in the body is found in our brains, particularly in a part of our brains called the hippocampus [limbic system]. Zinc deficiency can lead to symptoms of depression, ADHD, difficulties with learning and memory, seizures (2), aggression, and violence (3).”

 

“…As always, there is a sweet spot of zinc consumption, and more is not always better. More than 50 mg a day can lead to improper copper metabolism, altered iron function, and reduced immune function. We need enough zinc in the right place at the right time…a typical zinc supplement pill of 25-50mg is probably best taken only every few days, unless you are an oyster connoisseur, in which case no supplementation is necessary.” [oysters are highest in zinc]

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That author reviews this 2013 publication: Potential roles of zinc in the pathophysiology and treatment of major depressive disorder.

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Abstract

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Incomplete response to monoaminergic antidepressants in major depressive disorder (MDD), and the phenomenon of neuroprogression, suggests a need for additional pathophysiological markers and pharmacological targets. Neuronal zinc is concentrated exclusively within glutamatergic neurons, acting as an allosteric modulator of the N-methyl D-aspartate and other receptors that regulate excitatory neurotransmission and neuroplasticity. Zinc-containing neurons form extensive associational circuitry throughout the cortex, amygdala and hippocampus, which subserve mood regulation and cognitive functions. In animal models of depression, zinc is reduced in these circuits, zinc treatment has antidepressant-like effects and dietary zinc insufficiency induces depressive behaviors. Clinically, serum zinc is lower in MDD, which may constitute a state-marker of illness and a risk factor for treatment-resistance. Marginal zinc deficiency in MDD may relate to multiple putative mechanisms underlying core symptomatology and neuroprogression (e.g. immune dysfunction, monoamine metabolism, stress response dysregulation, oxidative/nitrosative stress, neurotrophic deficits, transcriptional/epigenetic regulation of neural networks). Initial randomized trials suggest a benefit of zinc supplementation. In summary, molecular and animal behavioral data support the clinical significance of zinc in the setting of MDD.

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please IGNORE THE ADS BELOW. They are not from me.

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Zinc Blocks Copper – Use with Extreme Caution. Copper is Essential to Life.


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I see too many people who are taking zinc. Why?

Why are they combined in multivitamins?

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 Zinc blocks copper – use with extreme caution.

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Copper is essential to life.

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Copper is involved in neuronal transmission, oxygenation, mitochondrial function, and the formation of connective tissue. So inhibiting copper must be done with extreme care. Treatment that involves removing copper is tricky.

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The brain needs copper. You have to be careful about pulling copper out of tissues because copper is essential for life. It is a chelator that may pull too much copper out of tissue. That could disrupt neurotransmitters and thereby affect behavior, health, pain, mood, tissues.

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And high dose zinc is a risk for aggressive prostate cancer.

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Zinc is present in many foods which are the best source of nutrients.

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Memorial Sloan Kettering Cancer Center has a more comprehensive review of zinc, its toxicities, drug interactions, and adverse reactions:

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Adverse Reactions

Oral, Common: Taste disturbances, nausea, vomiting, dyspepsia, and diarrhea.
Oral, Toxicity: Copper deficiency, depressed immune function, headache, chills, fever, and fatigue.

Topical: Itching or pain, hypopigmentation, erythema, swelling, scaling, blackening.

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That list understates the devastating neurological damage of a person presented at the Academy of Neurology annual meeting in 2013.

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Soothamide (PEA) Cream Helps Psoriasis & Seborrheic Dermatitis


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I have posted on PEA (palmitoylethanolamide) for several years on this site – use the search function top left above photo and type in PEA. No prescription is needed. Before it was available in the US, patients ordered it from the Netherlands where it is sold as PeaPure. One whose neuropathic pain was finally relieved by it, ran out, flew to the Netherlands just to pick up an emergency supply and flew back immediately. Thankfully Vitalitus began offering PEA capsules in the US a few years ago, and then made the 2% cream called Soothamide, which I have also posted on this site. It may even relieve the neuropathic pain of Complex Regional Pain  Syndrome (CRPS).

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Palmitoylethanolamide (PEA, or PeaPure in Netherlands) is nontoxic, anti-inflammatory, analgesic, and has no side effects. Your body makes it; plants make it. Years ago the publications on it were extensive. A Nobel Prize winner published on it in the early 90’s. When taken in capsule form for CRPS, I have seen it take 6 or 8 weeks to be effective, but when it relieved pain, it lowered pain from very severe to mild in a patient bedridden for 6 years. I have seen the cream relieve neuropathic pain instantly in a couple minutes in some with CRPS. I have seen the cream fail to relieve CRPS pain in one patient, who then wiped the remainder of the cream along the lumbar spine of her dad who had been groaning with pain, who had instant relief. And I have published on its use for vulvodynia, discussing its autocoid mechanism.

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Skin conditions can be their own constant day and night torment. A patient reports almost complete immediate relief from the itch of psoriasis and seborrhea (around eyes and all over scalp). Itch can be a form of neuropathic pain besides more common causes such as allergy. The rash, the bleeding crusted itchy skin of those two conditions is treated by prescription steroid creams that can thin the skin, and thin skin itself can predispose to bleeding, further discomfort, and frankly did not help this patient. If you use steroid creams, it must be applied 3 or 4 times a day and use gloves or caution where you rub your fingers — risk thinning the delicate skin near eyes and nether regions as weeks and weeks drag on. Soothamide worked quickly, not needing 3 or 4 applications per day.

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Instantly the itch was markedly better. And overnight! the rash was markedly improved. The patient had had some mild relief from the bleeding itchy scabs on scalp with T/Sal shampoo but not great, for weeks and weeks. Before that, DHS Zinc shampoo helped only mild “dandruff”, did not touch the crusts and itch. Aloe Vera helped the itch for a few hours. Steroid creams were no help for itch, for 4 months scratching the delicate skin around eyes with hard scratchy cloth almost like a dry loofah sponge. Soothamide 2% took away the itch around eyes immediately though it can easily get into eyes when washed or when rubbing the eyes, it does not burn. It is truly very soothing.

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It’s also a remarkable moisturizer, absorbs very quickly, is not greasy, and for those whose other skin conditions are unusually thickened, it would likely be worth a try.

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I see Vitalitus now also sells CBD, that is cannabidiol, the cannabinoid from the marijuana plant that has no psychotomimetic properties – does not make you “high”. GW Pharmaceuticals’s “Epidiolex”, their CBD, recently received FDA approved for epilepsy. Imagine! a Schedule I drug received FDA approval! hmmm, must not be deadly after all. Wait til the DEA kills that idea. Does congress make sense when they dictate medicine?

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~

Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please IGNORE THE ADS BELOW. They are not from me.

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Dementia, Memory Loss, Brain Atrophy – not always Alzheimer’s Disease. We are all at risk.


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Dementia

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Alzheimer’s Disease

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Sustained Reversal Published by UCLA

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If you have a medical problem that involves the brain, this may apply to you.

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In a major breakthrough, Dale E. Bredesen reported that 9 of 10 patients with Alzheimer’s Disease were able to return to full time work. His report appeared in the journal Aging, September 2014. A PDF can be downloaded. He is UCLA Augustus Rose Professor of Neurology, director of the UCLA Easton Center Center for Alzheimer’s Disease Research.

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He used a 36 point holistic approach based on published neuroscience research. There is no drug. .

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There is No Magic Bullet – Highly Individualized

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Dementia is the third leading cause of death in the U.S. behind cardiovascular disease and cancer. It affects roughly 25 to 30 percent of the population over 80, with 70 percent of those having Alzheimer’s Disease.

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The number of cases doubles every 5 years in people over 65. By age 85, almost half of all people are afflicted. A family history of Alzheimer’s increases risk. Five percent have onset early in age.

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In other words, once we pass 60, we are all at risk for this disease, but may occur as young as 30 in rare cases.

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What to do?

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1. See a good neurologist for a proper diagnosis. If  dementia, there are at least 9 causes, Alzheimer’s is 40% of those [N.B. source, verify].

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Some are treatable, such as deficiency of vitamin B12 or thyroid. Remember, do not take folic acid unless you are taking adequate B12 as folate will mask B12 deficiency and lead to neurological problems that may be severe.

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2. Read the Alzheimer’s Disease In-Depth Report in the New York Times. It gives clear and comprehensive advice for the patient and the caregiver. It is not a diagnosis.

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3. Memory loss can be reversed and sustained. Dr. Bredeson reports, “Improvements have been sustained, and at this time the longest patient follow-up is two and one-half years from initial treatment, with sustained and marked improvement.”

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He points out the failure of the so called Alzheimer’s drugs, that help little or not at all. Instead, he uses a 36 point metabolic approach, discussed in more detail below. He said the findings are “very encouraging,” but he added that the results are anecdotal, and a more extensive, controlled clinical trial is needed.

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Alzheimers has the potential to devastate the economy worldwide in the near future. The Bredesen report is a first. Ideally it may revolutionize medical research, fiscal budgets, dietary guidelines, policy changes, school lunches, advertizing and foods that promote all the wrong changes in brain. But it involves changing behavior and even simple school lunch programs that improve cognitive function and health have been mercilessly attacked.

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Alzheimer’s Disease is relentless. The causes are not known and there is no cure. Changing behavior is dificult.

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There are three hallmarks of the diagnosis of Alzheimer’s Disease:

  • amyloid plaques

  • neurofibrillary tau tangles, the primary marker

  • loss of connections in the brain

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Plaques and tangles may be present for years and may appear quite early in life, without ever developing Alzheimer’s. We do not have a specific marker for diagnosis, but we can exclude treatable conditions. More importantly, doctors and families need a better tool to monitor cognitive decline so that we may intervene early before the devastating and costly disease captures the lives and finances of patients, caregivers and families alike.

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Risk Factors For Alzheimers Are The Same As For Heart Disease

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Obesity, inactivity, smoking, diabetes, hypertension, hyperlipidemia, low Vitamin D – serum level of 50 ng/mL is ideal.

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Benzodiazepines increase risk of Alzheimers 50%, reported in 2014, particularly with long acting forms (Valium, clonazepam) or long term use. They are widely prescribed for insomnia or anxiety, yet almost 50% of older adults continue to use these drugs. It is unrealistic to think they can be eliminated – they are habit forming after all, but a Quebec study showed that a brochure alone helped 27 percent of elderly users taper down and discontinue their drug in six months. Another 11 percent reduced dosage. Do taper off slowly with proper guidance. Informed consent can help each person to choose the risk or the taper. If the brochure doesn’t scare you, I don’t know what will.

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Systems Approach – No Silver Bullet

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The small trial published by Dr. Bredesen showed reversal of cognitive decline using an individualized 36 point ‘systems approach’ to memory disorders. Results started to be seen after 3 to 6 months.

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In the UCLA Newsroom interview, he says: “The existing Alzheimers drugs affect a single target, but Alzheimers disease is more complex. Imagine having a roof with 36 holes in it, and your drug patched one hole very well, he said. The drug may have worked, and a single hole may have been fixed, but you still have 35 other leaks, and so the underlying process may not be affected much.”

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It “involves comprehensive diet changes, brain stimulation, exercise, sleep optimization, specific pharmaceuticals and vitamins, and multiple additional steps that affect brain chemistry.” Though each target may be affected in a modest way, the overall effect may be additive or even synergistic.

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The downside is its complexity. No one was able to stick to the entire protocol. The side effect was improved health and improved body mass index. Successful candidates did lose weight. He emphasizes that this small study needs to be individualized and replicated on a large scale. The program for one patient included:

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  • eliminating all simple carbohydrates, gluten and processed food from her diet, and eating more vegetables, fruits and non-farmed fish

  • meditating twice a day and beginning yoga to reduce stress

  • sleeping seven to eight hours per night, up from four to five

  • taking melatonin, methylcobalamin, vitamin D3, fish oil and coenzyme Q10 each day

  • optimizing oral hygiene using an electric flosser and electric toothbrush

  • reinstating hormone replacement therapy, which had previously been discontinued.

  • fasting for a minimum of 12 hours between dinner and breakfast, and for a minimum of three hours between dinner and bedtime

  • exercising for a minimum of 30 minutes, four to six days per week

 

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Diet

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We have known that calorie restriction reverses amyloid deposition.

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One diet was developed by nutritional epidemiologist Martha Clare Morris, Ph.D., of Rush University in Chicago, and her colleagues.

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According to the findings, the MIND diet was able to lower the risk of AD by as much as 53 percent in participants who strictly adhered to the diet, and by about 35 percent in those who followed it fairly well. It was compared to the DASH diet and Mediterranean diet.

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“To follow the MIND diet, a person should eat at least three servings of whole grains, a salad and one other vegetable every day —  along with a glass of wine —  snack most days on nuts, eat beans every other day or so, eat poultry and berries at least twice a week, and eat fish at least once a week.

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However, a person should limit consumption of the designated unhealthy foods, especially butter (less than one tablespoon a day), cheese, and fried or fast food (less than a serving a week for any of the three), to have a real shot at avoiding the devastating effects of AD, according to the study.

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Berries are the only fruit included in the MIND diet. “Blueberries are one of the more potent foods in terms of protecting the brain,” Morris said, and strawberries have also performed well in past studies of the effect of food on cognitive function.”

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I recommend that my patients Google pro and anti-inflammatory foods and move their diet in the direction of lowering the burden of inflammation.

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Supplements

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CurcuViva or Longvida is a special formulation of curcumin, the active ingredient in turmeric spice that is able to cross through the blood brain barrier and reach the brain. I posted on it here and it is reviewed in more detail here. Turmeric does not enter the brain. It was developed by researchers at UCLA Alzheimer’s Research Center showing the relationship between pre-tangle tau, brain cell death, and cognitive function. Full memory was restored in mice that had dysfunction caused by tau tangles. It has been shown to help Alzheimers and joint pain.

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WARNING: Do not take CurcuViva if ulcers or gallbladder disease.

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Supplements Can Harm – Caution Toxic

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Supplements can cause great harm. Many are toxic and deplete the brain of essential nutrients or cause irreparable harm.

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Always research the value and harm of every supplement put into your body. The best site on herbs and botanical I have found is updated regularly by the expert in integrative medicine and alternative therapies at Memorial Sloan Kettering Cancer Center. They research supplements and herbs to show efficacy and how they interact with prescription medications to verify if they may help or harm. Ask, does this drug – yes, vitamins and supplements are drugs but unregulated and untested – cause toxic increase in medication or rapid loss (speeded metabolism) of prescription medications resulting in less effective serum levels and no benefit.

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Metabolism of drugs and drug-drug interactions is critical to know.We do not have enough data on supplements. We ignore behavioral changes such as diet, exercise, stress reduction at our peril in favor of unregulated, unproven, costly silver bullets.

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Reflecting the importance of my interest in supplements since the majority of Americans take so many, one of the first things I did in starting this website is to post on benefit and harms of vitamins and supplements.

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In addition to that detailed list, use the search box just above my photo top left to find other posts on frequently used supplements mentioned below.

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The Good, The Bad and The Ugly

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  • Vitamin B6 in excess can cause irreversible neurological disease – know the safe dose because it is now overdosed in many things.

  • Heavy NSAID use increases risk of Alzheimers.

  • Zinc blocks copper that is essential for every cell in the body.

  • Vitamins A and E have no proven benefit and serious risks.

  • CoQ-10 is essential for every cell. Statins deplete CoQ-10. It is essential in the electron transport chain to make ATP, the energy used by every cell. Research has shown it helpful for mitochondrial diseases such as migraine and Parkinsons Disease though very high doses for the latter. I do not know of any publications for its use in Alzheimers.

  • Fish oil can reduce triglycerides 45%. Adjust dose based upon level of triglycerides – elevated levels increase risk of Alzheimers.

  • Hormones affect function of many organs including brain. If low, then restore at least to low normal. If high, rule out tumor.

  • Low vitamin D doubles the risk of dementia and Alzheimers.

Low Vitamin D Doubles Risk of Dementia & Alzheimers Disease

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That was published in the journal Neurology, August 2014. Vitamin D is a special category and I have posted on its anti-inflammatory and analgesic benefit many times, its effect on the immune system, on pain relief, and on depression. It is important for five cancers, heart disease. Again, use the search function top left by my photo for details.

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WARNING: Make sure before taking any Vitamin D that your MD checks PTH and then if normal, recommend a dose of D3 based upon serum levels of 25(OH)D. I maintain my patients on a serum level of ~50 ng/mL, not more, not less, in accord with the most recent research.

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B Vitamins

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Brain atrophy occurs in those with aging as well as with Major Depression or Chronic Pain and with aging. They were able to prevent 90% atrophy of the hippocampus and areas targeted by Alzheimers Disease with specific doses of B vitamins, below. The OPTIMA (Oxford Project to Investigate Memory and Ageing) at Oxford University, March 2013. I disagree with their dose of Vitamin B6 as I have seen tragic toxicity in patients that takes at least one year to reverse, if ever.

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These are the doses I suggest:

  • .B12 500 mcg/day

  • Folic Acid 800 mcg/day

  • B Complex —-B6 not to exceed 2 mg ! B6 is one of the vitamins in B Complex and it

    can be toxic to nerve. It is being overdosed in many supplements and energy drinks.

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Inflammation

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If you haven’t gathered by now, the focus is on inflammation. The brain and spinal cord has an innate immune system different than the immune system in the rest of your body. The cells of the innate immune system are called glia, and they produce many chemicals, in particular, microglia and astrocytes produce cytokines. Anti-inflammatory and pro-inflammatory cytokines. They must be in balance.

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Inflammatory cytokines are shown to be involved in almost every known disease including Alzheimers, Parkinsons, ALS, MS, autoimmune disease, chronic pain, major depression, cancer, atherosclerosis.

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Pro-inflammatory drugs: opioids and alcohol for example.

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Anti-inflammatory drugs: low dose naltrexone, dextromethorphan, ketamine, amitriptyline, Vitamin D, melatonin. Again, use the search function above photo for the many posts including case studies. It would be helpful to see more medications studied to show if they are pro- or anti-inflammatory, and to see studies on these medications in persons with memory difficulty. That will not happen since they are generic, low cost.

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Living Wills & Healthcare Power of Attorney

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Be aware of the changing laws in your state. In the event dementia prevents you from choosing your care, if you have asked that no food or water be given, medical staff are not legally permitted to follow that directive. Legal precedent directs that if you reach for food or water, that indicates your intent to be fed, regardless of written requests made when you were of sound mind. It behoves us all to change behavior now.

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Summary

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  • Use an Alzheimers self test for early detection. This is not a diagnosis.

  • Obtain a neurological evaluation.

  • Be aware of the importance of the 36 step metabolic approach.

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please ignore the ads below. They are not from me.

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Vitamin Drinks Risk Serious Harm


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Are Vitamin Drinks a Bad Idea?

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from New York Times

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Free full report below

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I need time to write about so many exciting things I am seeing in my practice, but this is always lurking. Children and athletes are at most risk for growing toxicity from overdosing on supplements. This has yet to be studied. Not just from vitamin drinks but daily vitamins pills too.

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IV Infusion clinics are the rage now popping up all over London. The very luxurious price alone would convince most people that the more they pay, the better it feels. Did it begin in Hollywood? Surely La Jolla will be soon.

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I see so much of the excess. My thoughts are often on the harm of vitamins and supplements and I’ve posted here, here, here, here, here, here, here, here, here, here about their risk to brain, peripheral nerves, heart, hypertension, cancer, interference with chemotherapy and cardiovascular medications, and in some cases risk to every cell of the entire body.

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$18 Billion a year business in the U.S

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This is an $18 billion a year business in the U.S. which explains why, since the 1970’s, Congress shot down the FDA’s authority to regulate dietary supplements and nutrients that could be fortified. Of course, congress restricts and excludes trade of European supplements that have proven scientific value. Usually this would be called unfair trade, but ….

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Forgive me for being superfluous to point out that those who bring in one bottle with 30 ingredients astonishes me. Centrum Silver I’m thinking of you. How much titanium, molybdenum, chromium and zinc do we need every day to go with its toxic doses of B6 and the proven harmful Vitamins A and E? What is so completely lacking in the diet? How easy is this on seniors with reduced capacity to metabolize medications? No studies, thanks.

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I favor several important vitamins for key reasons based on blood work, but known essential supplements seem to lost on many. Zinc is everywhere. This is rarely tested in a patient. Who has ever once tested most things in Centrum Silver? Could the popularity be due to bombardment or with unproven labeling or endless aisles of bottles?

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This is a rich person’s game.Typically female, unless guys are hiding or avoiding them.

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There are those who drag behind them truck loads of large suitcases bursting with expensive supplements. They need to stop the cause of their problems that is in those bags. They may link bags together with cabling like a train or walk back several times to pull in more and more.

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Stop all of them. That is the treatment. That and a long, long drug holiday to wash them out of the system. Eat a basic healthy diet in moderation and always exercise. There is then hope to re-establish equilibrium. Who could swallow that many pills every day and have any room left for food?

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But I digress.

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The Report – free full text.

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An examination of the nutrient content and

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on-package marketing of novel beverages.

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Risks

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46 novel beverages tested

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“there is little evidence that consumers stand to benefit

from the micronutrients most commonly found in these products.”

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But aiyee!!! the problems.

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At long last, after billions spent on vitamin drinks, the risks are addressed by Valerie Tarasuk, lead author of the study. She is nutrition science professor at the University of Toronto faculty of medicine. I quote extensively from the New York Times but recommend the entire article.

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“A nationwide study carried out by the National Institutes of Health in 2012 found that Americans who take vitamins and supplements were already getting large amounts of nutrients from their food, and on top of that they had the lowest prevalence of vitamin deficiencies to begin with. The study found that supplement use put these people at increased risk of potentially excessive consumption of folic acid, calcium, iron, zinc, magnesium and vitamins A, C and B6.”

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 “…for much of the general population today, there is no scientific justification for a high intake of vitamins and minerals, said Mara Z. Vitolins, a registered dietitian and professor of epidemiology and prevention at Wake Forest Baptist Medical Center.”

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“When consumed in excess, some water-soluble vitamins like B and C are excreted in the urine [unless toxic to nerves and kidneys, those of you who develop nerve pain and kidney stones from them]. But fat soluble-vitamins – including A, D, E and K – accumulate in tissues, posing potential risks.”

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“These fat soluble vitamins are very stable,” she said. “They’re not released in the urine. If you are over-consuming them, you can raise your levels gradually over time and get into trouble with liver function. You have to be very careful with them.”

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Authors should warn be even more cautious when you lose weight, the fat and that giant stash must somehow get out or what harm will they all cause next?

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“Data from clinical trials have highlighted clear risks from excess. A large study published in JAMA in 2009, for example, looked at clinical trial data on more than 6,000 heart disease patients who were treated daily with either B vitamins or placebo over a seven year period. The study found that those who were given folic acid and B12 had higher mortality and cancer rates.”

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“In 2012, a review of 78 clinical trials involving 300,000 people that was published in the Cochrane Database found that antioxidant supplements like beta carotene, vitamin A and vitamin E actually increased mortality. A year later, the United States Preventive Services Task Force concluded that there was “limited evidence” that taking vitamins and minerals could prevent cancer and cardiovascular disease.”

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“The task force noted that two clinical trials had found “small, borderline” reductions in cancer incidence in men who took multivitamins. But the group also said there was good evidence that high doses of antioxidants could cause harm.”

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No one could ever be funded to study the untold combinations of a single bottle that contains 30 ingredients. Studies require placing humans at risk long term, not a quick look at test tubes or a few mice.

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The majority who have finances for these products are often among the best fed in the world if not the the most prosperous.

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If you have read this far, you are not the person lumbering to push these truckloads of supplements ahead like Sisyphus.

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Know hope.

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That readers will read.

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Is there any hope with congress?

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Do not overlook the A, B, C’s

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Balancing the harms, the staggering 90% less atrophy has been shown in areas typically harmed by Alzheimers in the OPTIMA study (Oxford Project to Investigate Memory and Ageing) at Oxford University, March 2013, when they looked at persons with mild cognitive impairment (MCI).

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They looked at brain MRI changes in 156 volunteers before and after two years after placebo vs certain doses of B vitamins. No one has tested these doses long term for toxicity. I would never recommend their dose of B6 that has known toxicity to brain and peripheral nerves, see my post here. And they hold a patent on this vitamin regimen, making the protocol potentially suspect.

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It has been shown a few years before, that size of the hippocampus tends to predict Alzheimers to some extent.

 

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We know that those with Major Depressive Disorder and those with chronic low back pain have been shown to develop brain atrophy and memory loss. It would seem essential to test these vitamins again on those groups and replicate the study on mild cognitive impairment, with placebo controlled double blind testing. Again, caution, B6 can be toxic.

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The material on this site is for informational purposes only.
.
It is not legal for me to provide medical advice without an examination.

.
It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~

This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

 

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please ignore the ads below. They are not from me.

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Vitamins and Herbs – Risks and Benefits


Most doctors have little if any training in vitamins and supplements

except as they relate to their specialty.

My field of neurology concerns itself with metabolic and nutritional diseases more than most areas of expertise, and I have an interest in several vitamins because of research related to major causes of mortality in the United States.

During the period I taught at a cancer center, I was concerned that research protocols may be misleading as these supplements were not accounted for, however since that time in the mid 90’s, I’m glad that public interest has pushed this field into the fore.  Major cancer centers now have active research in Complementary and Integrative Medicine (CAM) because there are risks and benefits, and some have significant herb-drug interactions as discussed below.

Check your vitamins and supplements for toxicity

Because of the growing science on toxicity, usefulness, and drug interactions, if you use vitamins, review each one carefully with your physician and with the websites listed in the column on your right. Some “vitamins” are simply brand names that have over 20 different vitamins, minerals and various ingredients.  This means you must review each one for current research benefits and risks.

At special risk for vitamin deficiencies are those who have highly restricted diets, abdominal resection, intestinal conditions, colitis, Celiac Disease, gastric bypass, HIV, or the elderly.

Pregnant women have special needs that are essential not only for their own health but to reduce the risk of neurological defects in the fetus.  It is essential in their case to work closely with their obstetrician, especially if morning sickness prevents them from taking their daily supplement.

Resources

One of the best resources I have found is Memorial Sloan Kettering Cancer Center’s Herbs and Botanicals, also linked on the column at right.  Their website is updated frequently with an excellent review of the literature.  It is hosted by a senior physician who has specialized in the field for decades and is actively involved in research at their center as well as NIH.

MD Anderson Cancer Center’s Complementary/Integrative Medicine Education Resources website andColumbia University’s Rosenthal Center for Complementary and Alternative Medicine are two others, but there are other resources on the web and books that are excellent.

Recipe for Rum Soaked Salmon with Apple Ginger Puree is found here.

VITAMINS & SUPPLEMENTS

Vitamin D has become a major research topic in recent years.  It may play a more important role than any listed below.   I have written separately on it and its controversy in greater detail.  Please refer to the last post by scrolling down.

Fish Oil

Omega 3 Fish Oils are polyunsaturated fatty acids that are essential for health yet cannot be made by the body.  Unless you eat several servings per week of fatty fish or wild salmon, not farmed salmon, it is one of the most important supplements that any adult of any age can take.  They are needed for building cell membranes in the brain but our body does not make them.   Fish oil helps your lipid profile by reducing triglycerides as much as 45%.  It reduces platelet clotting, lowers risk of heart attack and cardiac arrhythmia, and is an important anti-inflammatory reducing pain for many particularly those with arthritis.  One of thebest references on Omega 3 Fatty Acids is by  Dr. Frank Sacks, Professor of Cardiovascular Disease Prevention, Department of Nutrition, Harvard School of Public Health.   He mentions high doses “are used to treat depression. New studies are identifying potential benefits for a wide range of conditions including cancer, inflammatory bowel disease, and other autoimmune diseases such as lupus and rheumatoid arthritis.”

One high quality fish oil, Lovaza, has been approved by the FDA and is prescription only.  Fish oil and cod liver oil available over the counter should be checked for adequate dosages of EPA and DHA that will vary with your needs as determined by your lipid profile, and should be purified to remove cholesterol, dioxin, PCB’s and other pesticides.

Co-Enzyme Q10 is also called CoQ10.  CoQ10 is present in every cell of the body which is why it is also called ubiquinone.  It is important in the electron transport chain to produce intracellular energy.

Statins deplete CoQ10. Vitaline’s CoQ10 product has been used in NIH funded trials for cardiovascular, neurological and brain disorders. Two mitochondrial disorders have been shown to benefit from Co-Q10: migraine and Parkinsons Disease.

My preferred manufacturer is Vitaline because of their research with NIH which requires that they validate and verify dosages.  Their website discusses other advantages and gives guidance on dosages that have shown benefit for various conditions. They offer a discount of 25% if you request scheduled delivery every 3 months.  Use the code code DEF25.  Their product is in the form of wafers that are about the size of a quarter and are very easy to break into 2 or 4 with your hands.

Vitamin B supplements in the elderly may help reduce the risk of dementia and B12 deficiency may result in neurological conditions such as peripheral neuropathy, dementia, hematologic and psychiatric disorders, Subacute Combined Degeneration of spinal cord & brain, increased fracture risk, and may increase the risk of cardiovascular diseases.  A good B complex vitamin is not likely to harm and may benefit.    The best source of all is food:  leafy green vegetables, beans and peas.

Thiamine (Vitamin B1) in high doses of 300 mg per day may reduce kidney disease in type 2 diabetes and may prevent early diabetic cardiomyopathy (heart disease).  As many as 70% to 90% of people with diabetes, both type 1 and type 2, are thiamine deficient.  The research is still a little early to draw firm conclusions.  It is being done by Charity Diabetes UK which finds that thiamine works by helping protect cells against the harmful effects of the high blood sugar levels.”

Vitamin A is associated with a 45% risk of hip fracture.  There are four major adverse effects of high levels: birth defects, liver abnormalities, reduced bone mineral density that may result in osteoporosis, and central nervous system disorders.

Vitamin E may actually increase mortality and there are significant risks to its use including increased risk of some cancers.  Several studies were reviewed by one of the foremost science writers, Jane Brody, in the New York Times on March 23, 2009.  It does not reduce the risk of cardiovascular disease, stroke, dementia, mild cognitive impairment, and there is no evidence that it slows the progression of macular degeneration.  In thePhysicians’ Health Study II it has been shown to actually increase the risk of hemorrhagic stroke since it decreases the clotting tendency of blood.

Vitamin C was recently shown to markedly increase the growth of cancers. It’s healthy for them too.  It blunts the effect of cancer drugs by as much as 30 to 70% depending upon the drug tested.

Zinc may prevent the absorption of copper which is necessary for the brain and spinal cord thus resulting in progressive neurological conditions.  Herb-drug interaction reduces the bioavailability of some antibiotics, tetracycline and fluoroquinolones.  Intake of 100-300 mg/day may result in chronic toxicity including copper deficiency, depressed immune function, headache, chills, fever, and fatigue.  It concentrates in the prostate and consumption of more than 100 mg per day may increase risk of prostate cancer.

It may be useful for tinnitus and for short term use to reduce symptoms of the common cold when used topically or in lozenges

HERBS & BOTANICALS

Don’t forget seeds, beans and whole grains that help digestion and keep the system moving!

This is a very brief summary of a few of the more commonly used herbs.  Please refer to Memorial Sloan Kettering Herbs and Botanicals website for detailed information on risks and benefits.

Arnica – a topical anti-inflammatory may help sprains and osteoarthritis.

Aloe Vera – apply immediately after sunburn or burning the skin to prevent blister formation

Chamomile – calming sedative, may use for intestinal colic or gas

Cat’s Claw – anti-inflammatory activity may be caused by the inhibition of TNF-alpha production.  It may be useful for refractory oral ulcers of unknown etiology in persons with HIV/AIDS that have not responded to other known remedies.

Echinacea may shorten the duration of common cold, useful in sinusitis, and respiratory infections.  Because of the lack of standardization of various products, I recommend a high quality organic liquid product by HerbPharm. Avoid use in autoimmune conditions, Multiple Sclerosis, HIV/AIDS.  “Echinacea was shown to stimulate phagocytosis, enhance mobility of leukocytes, stimulate TNF and interleukin 1 secretion from macrophages and lymphocytes, and improve respiratory activity… both in vitro and in vivo.”

Goldenseal is anti-inflammatory, antimicrobial with activity against pathogens such enterotoxigenic E. coli and V. cholera that may be useful for bacterial sinusitis and respiratory infections.   Warning it may prolong the QTc interval in persons with heart disease or those on methadone and it is contraindicated in persons with hypertension.  A high quality organic liquid product is made by HerbPharm.

Medicinal Marijuana is a vast subject. I would be happy to schedule time to discuss its medical use with you. Refer here for some of the known research and patient information.

Red Yeast Rice, a naturally occurring statin, the same as Lovastatin, often used in China.   Make sure your doctor knows this and monitors liver function.  Statins may cause severe muscle and joint pain that may potentially lead to rhabdomyolysis (sudden death of muscles), kidney failure, vasculitis, lupus-like syndrome, and many other symptoms, however most people tolerate them without side effects and they have dramatically reduced the incidence of heart attacks and stroke.  They may also reduce the risk of dementia including Alzheimer’s type dementia.

Turmuric (Curcumin) – may alleviate irritable bowel syndrome and ulcerative colitis.  There is a suggestion of improved cognitive performance from epidemiology studies but studies show no benefit for Alzheimer’s Disease.  Avoid use if you have gallstones.  It may inhibit the action of some chemotherapy drugs, such as used for breast cancer, but may be beneficial for certain cancers and other chemotherapy drugs.

Wheat grass– a natural source of vitamins and minerals (Chlorophyll, Vitamins A, C, E, K and B-complex, Iron, Calcium, Magnesium,  Selenium,  Amino acids); may have antioxidant effects.

Willow Bark – contains salicin, the precursor of aspirin.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

To Find My Home Page, click here:  

Welcome to my Weblog on Pain Management!

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