Should I Give My Child Cough Syrup?

untitledWith the cold and flu season upon us many people come into the clinic with their children because, well, kids cough. No surprises there. I tell parents at least 20 times a day (no joke) about cough syrup. I understand that many parents are what we call “well worry” parents and they want their children to be healthy and happy. Nothing wrong with that. What kills me though is that so many people think drugs are going to be the answer. Some parents will come back and see another doctor to get something if the first one doesn’t prescribe.

*Facepalm*

PIccard

The feeling I get when someone is convinced that the only way to get better is to get medication that has been proven not to be better than placebo.

I think we should probably go over the obvious. Antibiotics don’t do anything to take care of a cough…unless that cough is due to a BACTERIAL infection. Some common signs of bacterial infection include, but aren’t limited to; fever, congestion, thick colored mucus, cough, earache, headache and generally feeling like crap. And these are just for upper respiratory infections.

VIRAL upper respiratory infections can include but aren’t limited to; congestion, thick mucus, cough, headache, earache and generally feeling like crap. Notice how viral infections like a common cold and bacterial infections look similar? That’s because they are, at least in their presentation.

Kids have a hard time and it is no fun for any parent to see their little tykes go through a cold. Draining down the back of the throat at night can cause the throat to become red and irritated and sore. Coughing usually ensues. No bueno.

This is where cough syrups supposedly come into help save the day. Guaifenesin is common and so is dextromethorphan. The two are often combined. You’ll see this as Robitussin DM or Q-Tussin DM. Guaifenesin basically hydrates mucus more so that people can expell it easier and dextromethorphan works in the brain to slow down and stop the coughing reflex.

For people that have this draining issue neither medication works particularly well. The mucus is already thin and the coughing comes from trying to expel it.

I’m not saying these two meds don’t have a place in therapy, but it’s probably not nearly as often as you might think. Heck the FDA doesn’t even recommend them in kids under 2 because they really don’t do anything and there’s the potential for problems.

One study looked at honey vs placebo and found that honey actually relieves cough better than placebo. [1] The funny thing was that placebo actually helped cough too.

A study just came out that looked at the efficacy of agave nectar vs placebo in children with cough. Agave nectar also gave relief to children. [2]

If you’re planning on giving you’re child honey for cough and they aren’t 12 months old, please don’t. Although the risk is low, there is a chance of botulism poisoining with infants ingesting honey and that is far worse than any cough they will have.

If you’re not sure and still want to give your kids diphenhydramine or dextromethorphan, a study from Duke showed that those faired no better than placebo. [3] In fact dextromethorphan actually caused more insomnia so less sleeping and still the chance of coughing.

For anyone interested in the agave nectar the doses were as follows:

3 mL for ages 2 to 5 months

4 mL for ages 6 to 23 months

5 mL for ages 24 to 47 months

The honey dose was about 7.4ml or 10gm.

If you’re kids are having some cough or you yourself are experiencing issues give some agave nectar or honey a try. I prefer honey in some ginger tea. It works great to fight off the beginnings of a cold. Just staying hydrated will also help.

CIAO

 

1.Cohen, Herman Avner, et al. “Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study.” Pediatrics 130.3 (2012): 465-471.

2. Placebo effect in the treatment of acute cough in infants and toddlers, Ian M. Paul, et al., JAMA Pediatr, doi:10.1001/jamapediatrics.2014.1609, published online 27 October 2014.

3.Paul, Ian M., et al. “Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents.” Pediatrics 114.1 (2004): e85-e90.

Are Pre Workouts Necessary?

For the final post in this series I will be brief because there is no need to go into a long post about something that’s rather simple, at least in my brain.

Are Pre workouts necessary to have the most explosive and awesome workouts and to lose weight and look like a fitness model? Of course not. Does that mean you shouldn’t use them? Of course not.

Trust me when I tell you I’m not trying to be Smeagol/Gollum from Lord of the Rings but the two above statements aren’t conflicting. It’s analogous to asking “Do you need to run to be healthy?” Of course not. Does that mean you should never run? Of course not…unless you don’t want to. There’s plenty of other ways to stay healthy in terms of movement. Running is a tool, just like a pre workout. It’s useful when applied or used correctly. But just like a pre workout can mess you up big, so can running if done improperly.

No PREWORKOUT? I'M NOT LISTENING!!

No PREWORKOUT? I’M NOT LISTENING!!

The purpose of the post previously done was to talk about ingredients in pre workouts that are actually helpful rather than ones that probably don’t do much. I realize that I covered the helpful ones. There are lots of other ingredients like aspartic acid which probably don’t do a whole lot that I didn’t cover because writing about pre workout ingredients can get boring over time.

I do realize that I could have done a single post and covered most everything but I wanted to flesh out the evidence and give you readers something to actually consider.

Pre workouts are definitely a great tool to energize and power through a heavy sprint session or help increase gains in strength over time, but at the end of the day you are the person that still has to sprint or lift or yoga or whatever. No one else can do that. Others can encourage and motivate. Others can meet you at the gym and workout along side you. Others can help you navigate proper food choices, but ultimately it rests on you. You are the true vehicle for change. Pre workouts just help that along.

Do I use pre workouts? Yup. But I don’t use them everyday and I respect that they are a tool and nothing more. I made the decision to change my lifestyle. You have the same power. It’s really cool to think about. No one can take that power from you, no one!

If you really want to make some changes then go ahead and do it. Taking a pre workout in the morning isn’t going to change you. It might jump start you and make you feel like you could run 1000 miles, but you still get to decide to do so.

Suggestions

Instead of watching Dr. Oz talk about weight loss, go for a 30 min walk. While I think knowledge is absolutely important, so is keeping your body moving.

You might feel like Homer at first but you'll be glad you're not wasting time watching something lame on TV.

You might feel like Homer at first but you’ll be glad you’re not wasting time watching something lame on TV.

Rather than watching your favorite weekday tv show from the couch, do some 30 sec planks on the floor during commercial breaks. See if you can up it to 1 min over time. 3-4 commercial breaks/30 min equals a couple min of planking. Your core will be strong in no time.

Instead of boringly tossing your salad and putting your casserole into the oven, put on some music and dance in the kitchen. You’ll be burning some extra calories but more importantly you’ll be having some fun. We do this in my home often. It’s fun watching the kids look at their dad and wonder what the heck is going on, but they sometimes join in.

Dance like no one's watching, even if they are.

Dance like no one’s watching, even if they are.

Have fun finding ways to spruce up your life and you’ll be rewarded. Let me know how you all spruce up your lives.

CIAO

Are Pre Workouts Helpful?: Theanine

This will be the last post in this series. If you’ve missed the other posts take a look at them as I covered some of the other supplements that are taken pre workout to help energize and otherwise allow you to increase performance.

Today we’ll take a look at a substance that many people already consume but might not know it. I’m talking aboutL-theanine which is yet another amino acid that some pre-workouts use in their formulations. Theanine is also very common in teas but not found in coffee. Green tea is probably the most popular but not by any means the only source of this stuff.

Theanine...just another white powder? Maybe not!

Theanine…just another white powder? Maybe not!

Theanine is best known for its ability to calm the nerves and kind of acts as a de-stressor. It can also be used for mood enhancement and focus. It even improves the sleep of boys with ADHD. [1]

So why would you want this before going out to pump iron, kick the soccer ball or ride your bike through the hills?

Well to be quite honest you don’t. But to be brutally honest no pre workouts are ever “really” needed. You can work out and progress and do just fine without them. In fact the only things you really need to progress in training are good obtainable goals, good food, good rest and a good attitude. I know that doesn’t sell supplements but I’m not selling supplements.

So should we just stop the blog post there and call it a day. Nope!

Theanine has this ability, when paired with caffeine, to make the caffeine jolt not quite so jarring. For some it can stop the jitters but the science says that’s probably not going to happen. It also stops you from going into full freak out mode when you get the caffeine. I remember the first time I had an NO-Explode. After about 15 minutes I was bench pressing while simultaneously running around the indoor track and doing push ups while squatting, the whole while breathing like I’d just run the fastest 100m in human history. Ok so maybe not quite like that, but it FELT like I was doing that.

Theanine helps level that out. I don’t take caffeine everyday, nor everytime I work out so to help me keep it even keel the theanine is what I prefer.

What does Theanine do?

Theanine actually helps dopamine release in the brain but also releases other chemicals that cause the “restful” effect. In the frontal cortex dopamine is thought to play a role in attention. Some believe that a reduced level of dopamine in this area is part of the cause of ADHD. For myself this is the effect I notice when taken with caffeine. The caffeine amps my brain energy, so to speak, and the theanine is able to focus it or direct it better than with caffeine alone. But this is just my anecdotal experience and may not be yours.

I couldn’t find any studies that show that theanine is an ergogenic aid with one exception in mice. Mice given theanine were able to swim a bit longer than the placebo group. Researchers attributed this effect to increase dopamine and decreased serotonin. [2]

Taking theanine on its own will likely not help you lift more or heavier, run longer or help muscle recover more quickly. The drug to accomplish all of that is called testosterone and I’m definitely not recommending that.

What theanine does do is allow the brain to recover from exercise. [3] When given 50mg theanine after initiation of exercise. Brain wave patterns of cyclists decreased in intensity and shifted to lower frequencies with theanine administration. It decreased the time to onset of mental regeneration. In other words it helped the cyclist calm down their minds more quickly.

Another thing theanine does is help with immune function. In a study done with distance runners, researchers looked at immune function of runners with cystine/theanine combo vs placebo. The combo kept the immune system running better than the placebo after 10 days of training. [4]

Another study shows the same thing in resistance training in men. [5]

It should be noted in these studies that a combination of theanine and cystine was used which means we can’t extrapolate the effect solely to the theanine. We’d need another study using just theanine to be able to say that.

So theanine can help mice swim longer, make people have better immune function in combo with cystine after exercise, helps the brain recover after exercise, and according to yours truly can help focus your caffeine jolt (this last one is unscientific).

Theanine has also been shown to help relieve stress. In a study done with theanine, caffeine and placebo, subjects were given mental tests and their blood pressures recorded at intervals during the tests and after. They were also submitted to a cold pressure test (submerging your hand in ice water for a minute) which is used to raise blood pressure.

In the groups there were high responders and low responders. In the high responder group there was a significantly less increase in blood pressure with the mental tests with both caffeine and theanine, but not with placebo. There was no difference with the cold pressor test. In the low response group there were not differences noted between the 3 groups. [6]

one interesting finding was that in the high responders group caffeine actually reduced blood pressure which is somewhat counterintuitive to what a person might initially think. This didn’t hold with the low responders group. It’d be interesting to do a study and see what mechanisms make those different.

This study shows that there may be some people who just don’t respond to theanine like others which is important to note. Just because you take theanine doesn’t necessarily mean it’s going to help reduce your blood pressure from the pangs of psychological stress.

Another study looked at similar parameters but with the addition of caffeine and theanine together. In this study caffeine alone increased blood pressure, jitteriness and alertness. When combined with the theanine the blood pressure increase wasn’t present but the jitters and alertness persisted.[7] This is similar to what I’ve experienced just less jitters. I don’t really get jittery with caffeine anyway.

On a stress study of pharmacy students going out to do rotations in clinical settings, researchers gave students placebo or theanine to two groups. The baseline stress levels were significantly higher in the placebo group and after use of theanine the subjective stress was less in the theanine group.[8]

The problem with this is the baseline of the 2 groups. If the placebo group had higher initial stress levels it’s possible that the results were due to chance or the treatment group actually just had naturally lower stress levels that the theanine might have accentuated. It would have been a better study had randomization taken place and made the baseline equal between the two groups.

How much?

In the stress studies mentioned above 200mg and above were used. In the mental regeneration study a dose of only 50mg was needed to ilicit an effect. In the study of boys with ADHD it was 200mg twice daily with food. i was once listening to a pharmacist at a national pharmacy convention talking about using a couple of grams before her talk to help calm her nerves down. She said it worked!

A dose of 200mg would probably suffice for most people. If you have higher stress levels a higher dose might be required. I haven’t found any real side effects except for maybe nausea but I’ve personally never experienced it and have not heard any complaints from anyone.

Theanine isn’t required for a pre workout to be a great one. But it does seem to have some ability to regulate caffeine and focus. I find the focus helpful during intervals but others may not. Only trying some can really tell you for sure. It shouldn’t hurt you though to try some and if you’re not looking for a pre workout but something else to calm down in the evening or need something to help during the day, theanine may be your answer.

CIAO

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk

 

 

1.Lyon, Michael R., Mahendra P. Kapoor, and Lekh R. Juneja. “The effects of L-theanine (Suntheanine) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial.” Altern Med Rev 16.4 (2011): 348-354.

2.LI, Min, Xin-nan SHEN, and Guo-ying YAO. “Effect of theanine on delaying exercise-induced fatigue and its mechanism [J].” Acta Nutrimenta Sinica 4 (2005): 019.

3.JÃger, Ralf, et al. “Improving mental regeneration after physical exercise.” Journal of the International Society of Sports Nutrition 5 (2008): 1-2.

4.Murakami, Shigeki, et al. “Effects of oral supplementation with cystine and theanine on the immune function of athletes in endurance exercise: randomized, double-blind, placebo-controlled trial.” Bioscience, biotechnology, and biochemistry 73.4 (2009): 817-821.

5.Kawada, Shigeo, et al. “Cystine and theanine supplementation restores high-intensity resistance exercise-induced attenuation of natural killer cell activity in well-trained men.” The Journal of Strength & Conditioning Research 24.3 (2010): 846-851.

6.Yoto, Ai, et al. “Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses.” J Physiol Anthropol 31 (2012): 28.

7.Rogers, Peter J., et al. “Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together.” Psychopharmacology 195.4 (2008): 569-577.

8.Unno, Keiko, et al. “Anti-stress effect of theanine on students during pharmacy practice: Positive correlation among salivary α-amylase activity, trait anxiety and subjective stress.” Pharmacology Biochemistry and Behavior 111 (2013): 128-135.

Are Pre Workouts Harmful or Helpful: Tyrosine and Taurine

Lets talk two amino acids today and kill two birds with one stone. Tyrosine and taurine are up to bat today so lets review them and see what benefit or detriment they may offer.

Tyrosine

Tyrosine is an amino acid that is formed from phenylalanine and thus is not an essential amino acid. It is a precursor for other compounds such as dopamine, norepinephrine and epinephrine.

Tyrosine is marketed as being used for increased cognition and stress intolerance. This makes some sense seeing as how it helps replenish the norepinephrine in the body. Reading comments from people who have bought and used the supplement you are bound to see things like, “It has helped me with morning fog” or “I feel so much more energized in the morning” or “I don’t feel like killing my kids..”. Ok so the last one was made up but you get my drift.

Does tyrosine really help, at least from a scientific standpoint?

In a study of cyclists, researchers gave 4 different drinks; placebo, tyrosine, tyrosine with carbs, and carbs at 6 different times before and during a 60min ride and then a time trial. The tyrosine was dosed at 25mg/kg body weight and the carbohydrate was a 7% solution or 70g/L.

The cyclists who had the carb solution finished the time trial in 27.17 ± 0.92 min while the carb/tyrosine group finished in 26.11 ± 1.01 min. These times were significantly lower than performance times for placebo (34.44 ± 2.89 min) and tyrosine (32.64 ± 3.05 min) [1]

This study makes it look like carbs are likely the key to increased performance, which would make sense especially in a sport like cycling where many calories are being burned. The authors were careful not to conclude that tyrosine has no effect since it’s possible that the manner in which it was dosed might give diminishing returns.

In another study of men performing different activities, tyrosine was administered at 150mg/kg of body weight 30 min before exercises were performed. These included load carriage treadmill sessions, pull-ups, stair stepping with weight and handgrip strength. There were not significant differences between groups. [2]

Tyrosine is often noted in marketing to help with recovery or mental alertness. One study shows this latter effect in military personnel who were subjected to high altitude and low temperatures. Subjects were given 50mg/kg tyrosine just before tests and 40 min later. They were subjected to multiple tests and their reaction times as well as tolerances to multiple things were measured as compared to placebo.

Cold tolerance was improved as well as muscular fatigue, perceived distress, sleepiness and headache. [3] So, at least in conditions of cold and high altitude, tyrosine may benefit an athlete from a fatigue perspective as well as focus, but for the rest of us not studying or running stairs in the inter-mountain west, tyrosine may not be super beneficial.

In another look at psychological factors, women were given a stress test 5 hours after having been given a drink with amino acids. The “placebo” contained all essential amino acids, 1 group had no tryptophan, and the 3rd had no phenylalanine or tyrosine. Women in the 3rd group experienced more feelings of depression, anxiety, feeling tired, hostility, being unsure and confusion. [4] The change was noted only after the stressors.

So again tyrosine may be beneficial for some focus and/or good feelings, but it doesn’t appear that it will help you lift more or run any faster. It may help you push through a workout much like caffeine may help a person perceive less exertion and push through a tough workout.

Because of how tyrosine works, it’s a good idea to avoid it if you do decide to take it if you have heart problems. Because it increases norepinephrine and epinephrine the potential to cause problems in people predisposed to them is higher. I read one report once about a man who took tyrosine 500mg with his Adderall on accident and his blood pressure and heart rate went up significantly. While this supplement has been used for things like ADHD it is something that should be respected. Consult a competent medical provider who has experience with these before doing something you might regret if you have heart problems.

Taurine

Taurine is an amino acid that plays a role in facilitating the digestion/absorption of fats (via formation of bile salts), maintaining cell volume (osmoregulation), neurotransmission/neuromodulation, antioxidant functions, anti-inflammatory/immune functions, anti-arrythmic/cardiac functions and neurological/retinal development.

To say it’s unimportant is like saying pies don’t need filling. It’s utter nonsense and will likely have you thrown out of my house, especially around my birthday because hey, cherry pie. (During this time of year I’ll also accept peach, strawberry rhubarb, pumpkin, coconut cream and a whole host of others, just no pecan)

Even with all of these important functions will taurine give you that edge that you so desire on the field or in life?

Red Bull is a popular drink that markets taurine as part of the formula to help with energy and focus. I think it’s funny that there is the myth that taurine is from bull’s testicles. Definitely “broscience”.

Some people actually think taurine comes from bull testicles. Mmmmm no.

Some people actually think taurine comes from bull testicles. Mmmmm no.

There was a study done by some researchers who had been working with Red Bull and showed that taurine with caffeine increased stroke volume and diastolic inflow (the heart was working more efficiently) compared to two other drinks, one containing no taurine and the other without caffeine or taurine (placebo). [5]

This study had the drinks supplied from the Red Bull company which is a ginormous red flag. Only 12 participants were in the study which doesn’t lend a lot of credence because of the small size and the fact that in the group that took the placebo had a higher diastolic inflow velocity than the caffeine group. That’s almost like comparing two camaros, one with nitrous and one without and saying the camaro without is creating more horsepower. Is it possible? Well if the workers at Chevrolet decide they’re gonna start putting corvette engines in the base camaro model I guess it could happen.

The reason that last point is so interesting is because you would’ve expected it to be lower than the caffeine group because we know caffeine has this effect by itself.

In a similar study, caffeine was given with glucoronolactone and taurine (essentially Red Bull) and compared to placebo while looking at stress tests with motor reaction times and also recorded feelings of well-being. Not surprising, the active group reported more feelings of well-being and had quicker reaction times. [6] But again this doesn’t prove that taurine does anything beneficial as it’s mixed with the other two components.

Another study showed that a drink containing a combination of branched chain amino acids, creatine, taurine, caffeine, and glucuronolactone increased the total reps and volume of exercise. But again in this study the effect cannot be attributed to taurine alone.[7]

Some studies show that taurine may help reduce muscle damage and oxidative stress. [8-10]

One study shows there may be benefit to people with heart failure who exercise if taurine is used.[11]

Taurine doesn’t seem to be quite the ergogenic aid that the supplement companies want you to believe it is. One benefit of taurine is that it can help you keep your levels up if you constantly use beta alanine as they both compete for the same receptors. So if you decide to use beta alanine it might be beneficial to use taurine to keep from becoming depleted. If you have a healthy diet including plenty of quality meat and liver and fish this may not be an issue.

So tyrosine may help with some focus and mental energy and taurine may help with exercise if you have some heart failure. I’m not discounting the fact that having a mental energy jolt isn’t helpful while doing things like lifting heavy or sprints, but it’s possible to get the same effect from caffeine. This is where N=1 studies come in handy. You can try both or one or the other to see if a difference exists. If not you can change it up accordingly.

I personally don’t use either of these. I think the benefit of both can be had from proper diet and/or the right pre workout. But you be the judge. If you have any experiences let me know in the comments.

CIAO

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk

 

1.Chinevere, Troy D., et al. “Effects of L-tyrosine and carbohydrate ingestion on endurance exercise performance.” Journal of Applied Physiology 93.5 (2002): 1590-1597.

2.Sutton, Erin E., M. R. Coill, and Patricia A. Deuster. “Ingestion of tyrosine: effects on endurance, muscle strength, and anaerobic performance.” Int J Sport Nutr Exerc Metab 15.2 (2005): 173-85.

3.Banderet, Louis E., and Harris R. Lieberman. “Treatment with tyrosine, a neurotransmitter precursor, reduces environmental stress in humans.” Brain research bulletin 22.4 (1989): 759-762.

4.Leyton, M., et al. “Effects on mood of acute phenylalanine/tyrosine depletion in healthy women.” Neuropsychopharmacology 22.1 (2000): 52-63

5.Baum, Michael, and M. Weiss. “The influence of a taurine containing drink on cardiac parameters before and after exercise measured by echocardiography.” Amino Acids 20.1 (2001): 75-82.

6.Seidl, R., et al. “A taurine and caffeine-containing drink stimulates cognitive performance and well-being.” Amino acids 19.3-4 (2000): 635-642.

7.Hoffman, Jay R., et al. “Effect of a pre-exercise energy supplement on the acute hormonal response to resistance exercise.” The Journal of Strength & Conditioning Research 22.3 (2008): 874-882.

8..Dawson Jr, R., et al. “The cytoprotective role of taurine in exercise-induced muscle injury.” Amino acids 22.4 (2002): 309-324.

9.Silva, Luciano A., et al. “Taurine supplementation decreases oxidative stress in skeletal muscle after eccentric exercise.” Cell biochemistry and function 29.1 (2011): 43-49.

10.Zhang, M., et al. “Role of taurine supplementation to prevent exercise-induced oxidative stress in healthy young men.” Amino acids 26.2 (2004): 203-207.

11.Beyranvand, Mohamad Reza, et al. “Effect of taurine supplementation on exercise capacity of patients with heart failure.” Journal of cardiology 57.3 (2011): 333-337.