Blue Light Revisited

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Blue light was the subject of a blog post here a few weeks ago. If you missed it you can access it here:

https://pharmacybrute.wordpress.com/2014/12/23/late-night-reading-and-sleep/

We are finding more and more information on blue light and it’s effects and I wanted to go over a few more studies looking at it.

First, a report discussing the effects of shorter wavelength (blue) light. In the first, blue was compared to green. Exposure to blue light induced a 2 fold greater circadian phase delay than green light. That means that both green light and blue light are resetting your circadian clock. The total amount of reset is dependant on intensity and duration. [1]

Another study found similar results, comparing blue, blue-green, green, red and amber with no light controls. Red and amber were found to not produce any significant difference over control. Blue and green again increased the onset of melatonin. [2]

Another study looked at subjects and their melatonin secretion, as well as perceived sleepiness. Subjects were given either blue, green, or no light after 1.5 hours of light, followed by 2 hours of dark. Light exposure then followed for two hours. 2 more hours of normal light exposure and then sleep. Here a jpeg to get all of that across.

light

 

Researchers found that melatonin was decreased in the blue and green groups, but to a lesser extent in the green group. Blue light also increased heart rate slightly but significantly, to the tune of 4 beats per minute. Core body temp also remained higher in the blue light group over the green and light groups. It appears that blue light increases sympathetic tone. That means that your fight or flight systems are a bit more active in the presence of blue light. [3]

Another study found that REM sleep was reduced by about 10 minutes per night when people were reading on E-readers than a regular book.[4] REM sleep seems to be linked with mood. [5]

Another study looking at 4th graders and 7th graders found that these students had less sleep when sleeping with electronic devices and/or TVs in their rooms than those who didn’t. [6] This of course makes sense. I’m more likely to stay up later and fight off sleep if I’m on the TV or reading than if I just go to bed. Maybe we as a society needs to be more wanting of sleep and not to be entertained.

Lack of sleep is bad for weight, depression, blood sugar, cardiovascular health and a whole host of other things.

Glasses made to filter out blue light seem to help, as noted in one study. [7] I made mention of these in the previous post.

In another study done with glasses to filter out blue light in adolescent males, researchers found that melatonin was increased if the blue filter lenses were used. [8] The authors in this study noted that no circadian rhythm was changed, but they hypothesized that one week, the length of the study, may not have been long enough.

These types of glasses may be useful, especially those that are working night or swing shifts. They can be purchased fairly inexpensively too. Plus you don’t typically have to lug them around everywhere. You can keep them at you desk or by your bed.

Naturally it’s better to just avoid computer and phone use before bed, but that can be very difficult, especially if the job demands it. Try some glasses out or other forms of entertainment at night, like sleep or reading a book.

CIAO

 

1.Lockley, Steven W., George C. Brainard, and Charles A. Czeisler. “High sensitivity of the human circadian melatonin rhythm to resetting by short wavelength light.” J Clin Endocrinol Metab 88.9 (2003): 4502-4505.

2.Wright, Helen R., Leon C. Lack, and David J. Kennaway. “Differential effects of light wavelength in phase advancing the melatonin rhythm.” Journal of pineal research 36.2 (2004): 140-144.

3.Cajochen, Christian, et al. “High sensitivity of human melatonin, alertness, thermoregulation, and heart rate to short wavelength light.” The Journal of Clinical Endocrinology & Metabolism 90.3 (2005): 1311-1316.

4.Chang, Anne-Marie, et al. “Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness.” Proceedings of the National Academy of Sciences (2014): 201418490.

5.Cartwright, Rosalind, et al. “Role of REM sleep and dream affect in overnight mood regulation: a study of normal volunteers.” Psychiatry Research 81.1 (1998): 1-8.

6.Falbe, Jennifer, et al. “Sleep Duration, Restfulness, and Screens in the Sleep Environment.” Pediatrics (2015): peds-2014.

7.Wood, Brittany, et al. “Light level and duration of exposure determine the impact of self-luminous tablets on melatonin suppression.” Applied ergonomics 44.2 (2013): 237-240.

8.van der Lely, Stéphanie, et al. “Blue blocker glasses as a countermeasure for alerting effects of evening light-emitting diode screen exposure in male teenagers.” Journal of Adolescent Health 56.1 (2015): 113-119.

 

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Can I Trust What I Read Online About Health?

Many times I’ve searched high and low for information in the one area where information exists as it has during no other time in human history; the internet. And the internet is a big freaking place.

Falling asleep at the library trying to find information about your health concern? No longer! You have the internet.

Falling asleep at the library trying to find information about your health concern? No longer! You have the internet.

You can find whatever you want. Movies, books, facts, lies, porn, recipes, and of course cat videos. It’s literally all there.

Health facts, diagnoses, treatments, opinions, studies, and yes, blogs (just like this one) are present as well. Many sciences are present on the web. Bill Nye and Neil deGrasse Tyson are personalities that bring science to many a person and make it interesting to learn.

Many people want to believe what they learn online about many different things. After all, if you have a question, it’s ridiculously easy to “research” it online and get an answer. You can even go to places like ask.com and ask questions and have people weigh in.

Questions are the beginning of knowledge. The problem is the knowledge is only good if the answer is truth. If it isn’t truth, even if it is meant with the best of intentions, doesn’t confer any knowledge at all that will be beneficial. Sometimes you get two or more answers that are equally beneficial. Sometimes there are just no good answers.

For example: lets say I make a Google query about how to clean a microwave. One website says fill a microwave safe bowl with water and put it in the microwave for a few minutes and let the steam clean it. Wipe up and be done. Another says that you have to mix vinegar and water for the effect. Both work, at least in my experience.

Another example might be pseudoephedrine side effects. Say you’re taking some because you are congested. Maybe the pharmacist told you that it might give you insomnia, which is true, it might. Before you take one though, you decide your pharmacist is an untrustworthy idiot (some may be) and so you do some of your own research online and find that pseudoephedrine can cause drowsiness, just the opposite of what the pharmacist said. “That dummy shouldn’t be practicing” is what you’re thinking now and you take some before bed.

What happens? For some, nothing. For some, they sleep better. For others, the have insomnia. For the insomniacs and the people who had nothing happen, they’ll be more likely to believe the pharmacist, and now trust him/her a little more the next time counsel is given. For the others who sleep a little harder, they’ll think that the internet was right and the pharmacist is a dolt. Next time they visit they pharmacy, they won’t trust, or even ask because they can probably do the fact gathering online.

Some people can't sleep at night if they take the wrong drug, even if the pharmacist told them it would

Some people can’t sleep at night if they take the wrong drug, even if the pharmacist told them it would

Another issue that arises is that of bias toward a theory. It’s called confirmation bias. In other words, you seek out information which supports what you believe is true and disregard other data because you don’t agree with the results. On things like recipes, adding cilantro rather than basil might not have serious implications to health policy at large. But if you’re looking at the food recommendations by the government (which just changed by the way) and you agree with them, you can rest easy knowing that your knowledge is sound.

But if you disagree with the food recommendations by the government because you’ve done research and generally think that the whole system is run by idiots, then when anything comes up about the food pyramid or MyPlate, you’ll roll your eyes into the back of your head, facepalm, and switch to another website that supports your dietary view.

Another hot topic these days is vaccinations. If your pro-vaccine, you’ll look at stories and research that is pro-vaccine. If you’re anti-vaccine, you’ll do the same but for anti-vaccine information.

Some people will judge information by the level of sophistication of the “look” of a website. If it looks credible, then it must be. Others will look to see if it’s written by a doctor. If it’s just some blogger then it must be wrong or misguided. The opposite is also true. If it’s written by a doctor, then some will think they are in the pocket of big pharma and only have a vested financial interest to what they write.

So how do you sort through everything?

For starters, it’s not a bad thing to take everything on the internet with a little skepticism. If a claim about natural cancer treatment is available and has unbelievable results, that’s all fine and well, but I need to do some research before it does. I typically ask myself these questions:

Are there studies to back up the results?

Is it a news report that gives generalities or does it give actual explanations? (you have to be careful with these because I’ve seen that new articles can really magnify something that isn’t so big or misquote things that have been said)

Does it give references that I can look up myself to verify what has been written or blogged about?

Does it makes sense? (Sometimes breakthroughs don’t intuitively makes sense, but if the explanation is causing your brain to shut down from over thinking, it is probably a red flag)

Do some homework and think about what it is you read before you make a decision. You have gray matter in your head to think, so think.

Another thing to look for is does what you’re reading about make blanket statements such as “Reduce blood pressure guaranteed” or “Never have another headache again” or “Get rid of arthritis for good”. Others might include “Drug X has no safety problems” or “Drug Y doesn’t cause cancer” or “Cherry Pie doesn’t bring happiness”. Did you notice that last one? That one iscompletely false and shouldn’t ever be a headline. Blanket statements should be a red flag. (Yes I’m aware I just made a blanket statement about cherry pie)

Cherry pie will make you happy. GUARANTEED! This is a blanket statement that should make you think twice about its validity, although cherry pie brings me joy every time.

Cherry pie will make you happy. GUARANTEED! This is a blanket statement that should make you think twice about its validity, although cherry pie brings me joy every time.

As a side note, I try not to make blanket statements, but I probably have. Take those with caution and do some research.

The fitness industry is filled with this kind of crap. “Lose 10lbs in a week” and other such catchy phrases sell billions in the United States alone. Steroid laden models mislead many males about how beneficial testosterone boosters can be. Can acai berries really make you look 20 years younger? Probably, if you live right, reduce stress, drink lots of water, find balance and maybe eat some acai berries. But if you just eat acai berries, probably not.

Lastly I want to return to my first example of pseudoephedrine. In lots of research, especially with physics and chemistry, we can reduce down the number of confounders and variables to get good results. Online we can’t do that so well, especially with treatments such as onion juice for hair growth. Hey, maybe it works wonders for some, but for others it leaves them smelling like onions. I hope they use walla walla sweets.

But that’s my point; with health some things actually do work for some people and for others they don’t. Simvastatin doesn’t prevent 100% of heart attacks or death in people who take it to reduce cholesterol. It reduces the absolute risk by a couple of percentage points, depending on the study. So for a few it will prevent heart attacks, but for the large majority, it won’t. We can argue about the value of that in another post, but it still doesn’t change that it doesn’t work for everyone.

So when looking online for information, take the time to actually research and think about what it is you’re looking at. If putting onion juice on your head for hair growth sounds like it might be a good idea, then go for it and let me know how it works because I have a receding hair-line. Will it harm you? Does it makes sense? Is it backed by anything?

This is my first post in a while that has no references. Does that raise a red flag? Maybe, maybe not. This is my opinion post afterall. So maybe you need to think about it. I hope you will apply some of the principles to everything you read online, not just health.

CIAO

 

Late Night Reading and Sleep

Many people enjoy a good book before going to bed. Some enjoy the news, some enjoy a game and some just enjoy a story. With so much available on tablets and laptops, all from the comfort of your own bed or couch, it’s no wonder that many can be found on devices when the sun goes down.

Having a hard time falling asleep or getting good rest from sleeping? Screens might be the problem

Having a hard time falling asleep or getting good rest from sleeping? Screens might be the problem

Is it all that good though?

Researchers at Brigham and Women’s Hospital released a study they conducted with subjects and electronic readers. You can find it here:

http://www.brighamandwomens.org/about_bwh/publicaffairs/news/pressreleases/PressRelease.aspx?sub=0&PageID=1962

During a two week period, subjects read on an iPad for 4 hours before bed. When I initially read this I thought, “Man that is a long time” but then realized that I have been on the computer for several hours before bed and while it doesn’t happen every night, it does happen.

According to the study participants on the iPad, “took longer to fall asleep, were less sleepy in the evening, and spent less time in REM sleep.”

Less REM sleep is no bueno. Also from the study, “Participants who read from the iPad were less sleepy before bedtime, but sleepier and less alert the following morning after eight hours of sleep.” They also stated that this type of light is emitted can come from just about any electronic device including phones, computer screens etc. It is the blue light causing the problem.

Lack of good sleep can increase chance of sickness like the flu and common cold by decreasing the strength of the immune system. It also contributes to cardiovascular disease and just makes life plain miserable if left unchecked.

One software maker, f.lux, has compiled a list of studies that you can visit for yourself if you want to see the effects of blue light on people. You can find it here:

https://justgetflux.com/research.html

f.lux is a program that lowers the amount of blue light coming off a screen and makes everything appear warmer, or with more reds.

Another thing a person could do is snag a pair of orange glasses that filter out the blue light. Here is such a pair:

http://www.amazon.com/gp/product/B000USRG90/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B000USRG90&linkCode=as2&tag=herbkati-20&linkId=ICGPJMPHTSBXIKE6

The other option is just turn off screens at night. I know personally getting on screens anymore than what I do at work contributes to eye strain and gives me headaches. Some of these headaches can last a few days if I don’t peel my eyes from the screen.

The most common sense answer is stop looking at screens late at night. Reading an actual book seems like a better alternative or dare I say actually go to bed. I know too often I stay up wasting time on things that don’t need time wasted on and if I find myself doing that I try to turn it off and sleep. Falling asleep on the couch or computer chair isn’t as comfortable as my bed anyway.

Merry Christmas

CIAO

Are Pre Workouts Harmful or Helpful ? Caffeine

In the previous posts we’ve discussed citrulline, beta alanine, and creatine. You can find those here if you missed them:

https://pharmacybrute.wordpress.com/2014/08/27/are-pre-workout-supplements-harmful-or-helpful-creatine/

https://pharmacybrute.wordpress.com/2014/08/20/are-pre-workouts-harmful-or-helpful-beta-alanine/

https://pharmacybrute.wordpress.com/2014/08/14/are-pre-workout-supplements-harmful/

Today lets talk caffeine. Most people have had some sort of caffeine in their lives. It’s pervasive in many drinks from coffee to soda to energy drinks to gun etc etc etc.

caffeine

No doubt many of you have heard people complain about needing their morning boost and how they can’t think or do anything or maybe they’re just in a bad mood until they get their coffee. Maybe you’re that person. At any rate caffeine is popular and has been so for a really long time.

Does it help the workout though? And is it safe? And can you have too much? There are lots of questions. I’m hoping to answer a few in this post.

First some biology 101. I know that may sound boring but it is much more interesting than organic chemistry. Trust me.

One effect caffeine is thought to exert in the body is the blockade of adenosine in the brain. Adenosine is a neurotransmitter that gives us feelings of sleepiness. Basically it tells us that maybe, just maybe it’s time to go lie down and get some Z’s. Researchers think caffeine exerts its wakefulness effects by blocking adenosine so that other neurotransmitters predominate. This in turn wakes us up.

So caffeine blocks adenosine which is like saying caffeine blocks our “go to sleep signals” in our brain. So far so good.

Like all chemical messengers adenosine has a receptor that it binds to send the signal, like a lock and key. This is where caffeine exerts its effect. By blocking the receptor adenosine can’t bind and transmit it chemical signal.

So caffeine blocks the adenosine receptor which stops adenosine’s signal. Ok still good.

The body doesn’t like it when things get out of balance. By not getting the signal for adenosine, the cells with those receptors upregulate them. It’s like little kids when they aren’t in sugar balance. You know, when kids yell and scream until they get enough sugar. So too do our cells scream they want more adenosine to keep the balance. (Maybe not the best example, but you get my drift)

After a few days of upregulation, more caffeine is needed to achieve the same effects as before. Many people notice this with chronic coffee consumption or other forms of caffeine. One shot espresso just doesn’t seem to cut it anymore and a double shot is needed. More receptors needs more caffeine to block them.

When caffeine isn’t ingested people feel incredibly sluggish and can’t seem to function at all. It’s because adenosine receptors are being met by all the adenosine and the sleep and rest signal is very strong. This is usually coupled with a nagging headache. Yup, use of caffeine regularly will cause this. And the only seeming cure is more caffeine.

Ok so that was today’s biology lesson. What about pre workouts you ask? Well….

Caffeine is definitely present in many preworkouts. Many. In fact it is probably the most used stimulant on the planet. This is the compound in pre workouts that give the boost of energy to really get rolling.

How effective is it?

A review of studies looking at endurance concluded that caffeine does increase endurance in time trial studies. [1] They reviewed 21 studies with 33 different treatments but only 15 had significant effects. The average mean improvement was  3.2%. Not a ton. There was quite a bit of variability between studies including ingestion times and types of exercise employed.

The researchers concluded that doses between 3-6mg/kg were the most effective while doses at 9mg/kg were no more effective and those may be potentially problematic, especially if consumed regularly. That range for a 75kg person is 225-450mg.

One study looking at these doses saw no difference between 3mg/kg and 6mg/kg but both were significant over placebo. [2]

In another study looking at 5mg/kg in users of caffeine (300mg/day) and non-users (<50mg/day), researchers found that non-users responded more favorably than users. [3] While the heart rate was significantly higher in the caffeine group, it was by 3-6 bpm higher than in the placebo group and to me doesn’t seem like a cause for concern. That is of course provided you don’t have any pre-exisiting heart conditions in which case I’d say stay away from caffeine.

These results lasted  up to 6 hours in non users but were not seen for so long in the regular users.

Remember the adenosine we talked about earlier? It is this blockade of adenosine that seems to be the cause behind the better endurance, or at least perception of it according to the authors. 10 min after the start of exercise perceived exertion was significantly lower in the caffeine group than in the placebo group.

Perceived exertion was also less in the non-user group vs the user group which might indicate the idea of the receptor upregulation talked about. The authors concluded that although blood glucose was increased during exercise in the caffeine group, there wasn’t any evidence that the ergogenic effect of caffeine wasn’t from increase in fatty acid metabolism or utilization as has been previously thought.

What about muscle strength?

Caffeine has been tested on muscle strength in numerous studies. A meta analysis was done to see if there was overall a significant effect. [4] Researchers found that there was a significant increase in strength in knee extensors by about 7%. This effect wasn’t seen in other muscle groups. Endurance was also significant in open end point tests. In other words how long you could hold contraction vs intermittent contraction that you would normally see in regular activity. Doses ranged from 1mg/kg-9mg/kg.

In another study looking at the bench press, subjects were assessed as to their 1 rep max and then separated into placebo and caffeine groups. They were then asked to perform as many reps at 60% 1RM until failure. The caffeine group performed 22.4 +/- 3.0 reps vs 20.4 +/- 3.4 in the placebo group. They also lifted more weight, 1147.2 +/- 261.4 kg vs 1039.4 +/- 231.7 kg over placebo. [5] The dose used was 5mg/kg.

While the results of this study are significant I want to point out that most lifters don’t do one set to failure on bench and stop. While it’s certainly possible that this study could translate over into a more normal regimen of 3 sets of 10 or 5 sets of 5 we can’t be for sure based on this alone. After all if you do 3 sets of 10 reps spaced out with rest you are likely to achieve this same volume without caffeine or more.

In another review caffeine ingestion did increase some measures of sports teams performance. 11 of 17 studies showed beneficial effect of intake but it was more common in the well-trained athletes who hadn’t used caffeine. [6] The mean improvement was 6.5%.

In the strength portion the studies did also show significant improvement. Many endpoints were in the form of torque produced or total number of reps. There is some differences so it’s hard to gauge an overall effect and in what setting that caffeine will definitively produce results.

Other possible confounders are that these studies are free-living which means the subjects intake of food or supplements isn’t monitored. That always increases the chances that the results may be skewed.

It certainly does seem plausible however that caffeine could increase strength or power but the effect doesn’t seem to be as beneficial as with endurance, at least in my view.

Also because individuals are susceptible to caffeine at different levels, it’s hard to know if caffeine will actually make an individual perform better or not based on the studies. It’s like everything else with research; it tells us a good average, but where you as an individual fall on that continuum is up for debate.

Bottom Line

While I know this review isn’t comprehensive, there does seem to be enough evidence for the use of caffeine in performance sports where endurance is required and may be beneficial in overcoming mental blocks. I do have a few words of caution.

Everyone is different but taking caffeine in the evening may not be a great idea if you don’t already. Some people will have little problem getting to sleep but others will be staring at the ceiling making friends with the thousands of sheep they’ll be counting trying to get to sleep.

Most studies with no effect were below 3mg/kg. Many that were at 3mg/kg saw positive outcomes as the 6mg/kg. In other words if this is something to try don’t start at 6mg/kg. Start at 3mg/kg and see what happens.

Also if you are a regular consumer of caffeine, you may need to back off completely from caffeine for a week or two to see any benefit at all. Caffeine intake probably needs to be cycled as well to maintain any benefit. If you do need to stop intake for a bit, it is probably wise to back off over  a few days. A caffeine withdrawal headache might be in your future if you don’t.

People with abnormal heart rhythms would be wise to avoid caffeine, especially in the doses used for these studies. Caffeine is a stimulant and can cause big problems where small ones already exist.

Further caffeine can be taxing on the adrenals if higher doses are maintained over a period of time. This makes cycling a good idea. Be careful with anything that can stimulate your brain that has to be ingested. And having caffeine multiple times per day every day is probably not the best idea.

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.Ganio, Matthew S., et al. “Effect of caffeine on sport-specific endurance performance: a systematic review.” The Journal of Strength & Conditioning Research 23.1 (2009): 315-324.

2.Desbrow, Ben, et al. “The effects of different doses of caffeine on endurance cycling time trial performance.” Journal of sports sciences 30.2 (2012): 115-120.

3.Bell, Douglas G., and Tom M. McLellan. “Exercise endurance 1, 3, and 6 h after caffeine ingestion in caffeine users and nonusers.” Journal of Applied Physiology 93.4 (2002): 1227-1234.

4.Warren, Gordon L., et al. “Effect of caffeine ingestion on muscular strength and endurance: a meta-analysis.” Med Sci Sports Exerc 42.7 (2010): 1375-87.

5.Duncan, Michael J., and Samuel W. Oxford. “The effect of caffeine ingestion on mood state and bench press performance to failure.” The Journal of Strength & Conditioning Research 25.1 (2011): 178-185.

6.Astorino, Todd A., and Daniel W. Roberson. “Efficacy of acute caffeine ingestion for short-term high-intensity exercise performance: a systematic review.” The Journal of Strength & Conditioning Research 24.1 (2010): 257-265.

 

 

Body Image and Eating

I’m going on a different journey in this post. This has been on my mind lately so I figured I might as well write about it because why not?

homer body

Homer has a great self image!

Everyone has a self-image. Everyone! Some have a healthy self-image while others need some help. Some may even have a confident self-image when they really need a revamp and others may have a horrible perception when they are in fact quite capable of many things.

Self-image can become downright destructive when it comes to health. Poor perceptions of body image and self-efficacy (one’s perception of what they are able to accomplish) are strongly correlated with binge eating. [1] Binge eating is bad. I’m not talking about a splurge every now and again which I personally feel is fine, but a full out binge where you eat excessively and usually unhealthy food comprises the meal. I’m not sure that I’ve heard of people overdoing it on celery or broccoli but I suppose it’s in the realm of possiblity.

I also think it a fallacy to think that women are the only ones who suffer from this problem. While the numbers may not be as big they are still a problem. One study looked at high schoolers and found that 85% of young women interviewed wanted to lose weight while only 40% of young men felt the same way. In contrast (and I believe this is the big difference between guys and dolls) 45% of the young men wanted to gain weight. Both sexes shared negative body perceptions if they wanted to lose weight. [2]

It is interesting to note though that as men age they increasingly want to decrease body weight. [3]

Other forces play on both sexes to alter self-image and self-efficacy. Schooling, teasing, health status, health status related teasing, parenting style as well as many other factors contribute to how a person views themself. Weight seems to be a huge factor for many and some feel they can’t be happy until they achieve a magic number where everything will be hunky dory.

While a healthy weight certainly helps one be “healthy”, the magic number in and of itself cannot by definition make a person happy. I was just as happy at 190 as I am now at 240. Unfortunately I can’t help but think that many internet blogs, including this one, while helping others may also be contributing to people’s destructive self-image problems. If for example a person was to read this blog and make the goal of getting “healthy” and then wasn’t able to achieve whatever that specific goal was then they might feel a failure, thus adding to the problem they originally set out to “fix”.

Don't get sucked into the YoYo dieting trap. YoYo doesn't equal YOLO

Don’t get sucked into the YoYo dieting trap. YoYo doesn’t equal YOLO

Most problems with self-image and food or weight go something like this:

1) Person feels that bodyweight is too high and makes decision to lose weight.

2)Person decides that once the magic number is attained happiness will ensue.

3) Person begins exercise, diet or both. While in the thralls of this new diet (rather than lifestyle) person obstains from everything pleasurable about food, thus becomming a food celibate.

4) After some time, be it weeks or months person either

A) Attains desired goal and continues on with new lifestyle

B) Attains desired goal and returns to old lifestyle beginning the vicious yo-yo dieting

C) Feels like garbage because they workout and starve themself and hasn’t lost a pound and throws up their hands and gives up. Depression might set in here and the person goes back to eating garbage with hunger to rival a great white shark (they can eat 400-500 lbs of tuna in one feeding)

D) Doesn’t make it more than a week because the new diet is too hard and gives up before making any progress at all. Feels like a failure, depression sets in and food jumps into the rescue.

Many of us have hit one of these scenarios. Some of us may have only made it part of the way through step 1 before deciding to give up before we even start. Why do we do this to ourselves?

Food is Powerful

Some think that food is the dark side of the force and good for only causing pain and grief. Other believe that food is neutral, only allowing us to have energy to live. For others food is a wonderful part of living. Not only does it provide energy to live but it acts as one way of experiencing life, through enjoying good food.

So what’s the impetus behind a binge? Why do we turn to food when we have these problems of self esteem or self-image or self efficacy?

Like all things we observe in nature, there is a balance of two opposites. Yin and Yang, high tide and low tide, Star Wars prequels and Star Wars originals….they all have an opposite effect.

Admit it...without the prequels you wouldn't appreciate the originals as much

Admit it…without the prequels you wouldn’t appreciate the originals as much

In our brains we have different neurotransmitters that accomplish the same thing, alertness and awakeness as well as calm and sleepiness. Different foods have different building blocks for creating those neurotransmitters. Spinach and kale have high levels of folate which are good for creating serotonin, one of the calming transmitters.

L-tyrosine, an amino acid, is a precursor for dopamine, which in turn is turned into norepinephrine. These are more the excitatory hormones in the brain. Eating complete sources of protein like meat is a source for l-tyrosine. Both kinds of transmitters are required for good mental health, both physically and emotionally.

Dopamine, like serotonin, is required for proper feelings of bliss or pleasure. Another way of saying that you have too little dopamine is colors lose their color, food loses its taste, or relationships lose their love.

An improper diet can affect these neurotransmitters as they may be out of balance. Food can also temporarily increase serotonin and cause feeling of comfort or well being. The specific food, if you haven’t already guessed is carbohydrate.

Judith Wurtzman, a researcher at MIT found that people who crave carbs are trying to give their brains a serotonin boost. She and her husband, Richard Wurtzman found this effect is the greatest when there is little to no protein consumed with the carbs. [4] People that binge on carbs, especially in the afternoons or evenings are apparently trying to increase their serotonin levels.

This act is very much like the behavior of drugs addicts. The brain “knows” that with a hit of drugs, or this case sugar, there is a reward that is expected. It is similar to as one report puts it,

We like to receive gifts, for example, but we want food, sex, and drugs.” [5]

In other words our brains full well know what is coming when they crave sugar, and so we eat some sugar.

Self-Image and Cravings

As discussed at the top of the article self-image can drastically change our outlook. It can cause us depression and in an effort to relieve those feelings some will turn to carbohydrates. Maybe after being teased or harrassed at school or work a person will turn to carbs because they make that person feel better, albeit temporarily.

Another instance in where craving sugar may be explained is the need for energy. Depression can cause a perceived loss of energy and someone may feel the need for carbs as a pick me up to get going, much the same way in which many people need coffee to get going during the day.

What to Do?

For starters I think it important for anyone and everyone to remember that no one controls your happiness. That is hard to believe at times because the things people do can affect us both directly and/or indirectly, intentionally or unintentionally.

Remember that if you’re trying to change your lifestyle, not your diet, please do so in a way that is incremental and progressive. What does that mean? It means making changes that you can handle over time. Going from a garbage diet to a healthy diet can be trying at times. Dont focus on the scale either, focus on how you’re feeling. Dropping weight isn’t as satisfying as not having to take diabetes or acid reflux medication or getting rid of that scaly skin.

Change a few things at a time and get control. Trying to overhaul everything at once for some will be like deciding to play collegiate football after watching Rudy or thinking you can box like a pro after watching Rocky. Did you notice how much training Rocky did? Nope, because training montages from the movies and tv typically last only a few minutes. This is why I have a hard time with things like Dr. OZ and his shows. They market remedies or cures for weight loss like candy. Anything marketed like candy probably should be treated as such.

Choosing to be happy is something that is hard for some to understand, even myself at times. I don’t mean to sound insensitive nor am I trying to be but keeping a stiff upper lip and not letting trends or perceived “beauty” or “accomplishment” is rather important in not succumbing to a poor self-image. This again goes back to not comparing yourself to others.

Women will usually compare bodies or how beautiful they look with other women while for men it is usually more a problem of comparing accomplishment. “Her legs are so much nicer than mine” or “he makes so much more money than me” are destructive and self demeaning just as “my legs are so much better than hers” or “I make way more money than he ever could”.

Comparing yourself to other people is a sure fire way to kill yourself emotionally and increase any perceived need for a binge. It seems like most Hollywood stars, rock stars or anyone else in the limelight has demons they deal with, you just don’t see them.

Remember to thank you legs for all they do for you and be grateful that your paycheck is feeding you at all. And if someone has the audacity to tell you straight up that your legs aren’t all that or that your paycheck is too small….well my advice is to tell them to go pound sand! I don’t have time for negativity in my life and neither should you.

If during a hard day you’re having a craving to eat all things sweet get some support not some ice cream. Call a friend or sit down and write your feelings out. These won’t give you the immediate relief that devouring chocolate will, but it will be a lot healthier in the long run.

Sometimes knowing how the body works is helpful when confronting things like cravings, especially in the wake of something like self-image. It can give you a plan for action. In the grip of something like an all out craving attack it doesn’t do much good though. Knowing that you brain is trying to increase neurotranmitters doesn’t change the fact that the force it has on you is nearly as strong as the impulse to breathe.

Try to splurge from time to time and have some fun with your food, but keep it healthy the rest of the time. Eating a balanced diet that includes carbs is good. Eating a diet devoid entirely of one macronutrient I believe is a bad idea. Not eating carbs, especially for someone who is active can lead to a carb binge day. Some people do it without any problems. I say be cautious.

Be aware of avoiding carbs because sooner or later they will seek you out.

Be aware of avoiding carbs because sooner or later they will seek you out.

Remember to surround yourself with supportive people. If you have to dump someone because of negativity then do it. I don’t want to be surrounded by people that are pulling me down, only pushing me up. And get people that you can call when things get rough. I’m amazed at how a person’s attitude changes after we talk at the pharmacy window. They may be worried or sad or confused and then after venting a little to me they feel much better. Usually all I have to say is “Have a great day”. It really is that simple.

Don’t get discouraged by others thoughts or anything else. If you’re having some issues with some goals you’ve set, reevaluate them and determine what you’ve already accomplished. And don’t let others be the judge of how you look. Contemplating how awesome your next workout will be or how much you can’t wait to see the next Star Wars trilogy is a much better use of brain power than how your legs aren’t forever long or your paycheck not 6 or 7 figures.

CIAO

 

1.Cargill, Byron R., et al. “Binge Eating, Body Image, Depression, and Self‐Efficacy in an Obese Clinical Population.” Obesity research 7.4 (1999): 379-386.

2.Drewnowski, Adam, and Doris K. Yee. “Men and body image: Are males satisfied with their body weight?.” Psychosomatic Medicine 49.6 (1987): 626-634.

3.McCabe, Marita P., and Lina A. Ricciardelli. “Body image dissatisfaction among males across the lifespan: A review of past literature.” Journal of psychosomatic research 56.6 (2004): 675-685.

4.http://newsoffice.mit.edu/2004/carbs

5.http://www.dirkhanson.org/neuroaddiction.html

Pregnancy and Drugs

drugsMany women ask me at the pharmacy counter if a prescription they are picking up is ok during pregnancy or if they can take something over the counter. They wonder about different foods and creams and whether vitamins are ok. There are lots of questions about this so I wanted to address it. Besides, I haven’t done any real pharmacy posts in a while so I figured why not.

Pregnancy Drug Ratings

All drugs are classified within a rating system to determine the safety profile during pregnancy. They are as follows:

A: Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters)

B: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

X: Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

A and B are the drugs that appear to have the best safety profile. Most drugs however fall into category C. A doctor may feel that the benefits of a C drug is better than any potential risk. Some of these C drugs are likely just fine to be used for a short duration, but the reality is the only thing a women should really be putting in her mouth during pregnancy is good whole food. Drugs should be avoided if possible.

OTC Drugs

Acetaminophen (Tylenol) -Class B- is generally considered safe during pregnancy and is the doctors go to for pain relief. There have been problems with acetaminophen though in the last couple of years. In a report of acetaminophen overdose from the late 90’s and early 2000-2001 the data showed that there were at least 458 deaths from overdose and 100 of those were unintentional. [1] That’s approaching 1 in 4. Just because it is sold over the counter doesn’t mean that’s it’s completely benign. Generally a total of less 3 grams/day is recommended.

Ibuprofen, Naproxen -Class C – NSAIDs are actually sometimes used during pregnancy during the first and second trimesters but no the third. There is a risk of closing the ductus arteriosus which is a blood vessel shunt between the pulmonary artery and the aorta. This shunt is necessary in utero because the lungs don’t function until the baby is born. Shutting this prematurely is bad. Babies with high levels of NSAIDs in their meconium also had increased incidence of persistent pulmonary hypertension after birth. [2] Don’t use this unless your doc says to use it.

Diphenhydramine (Benadryl) -Class B- This one can be used although it is generally avoided during the last few weeks due to a possible link with retrolental fibroplasia. It is the antihistamine of choice for acute allergic reactions during pregnancy. While generally safe during pregnancy, talk to your doc before using this.

Tums – Not rated – Caclium carbonate is safe during pregnancy at recommended doses on the bottle. This is a safe choice for reflux.

Ranitidine (Zantac) -Class B – This is the preferred antihistamine for acid during pregnancy. It’s still a good idea to talk with your doc before initiating it.

Pepto Bismol-Class C- This should be avoided. Salicylates are known to cause problems in the fetus including, jaundice, decreased birth weight and perinatal mortality. There is also the risk of fetal or maternal bleeding. [3] Just avoid the pink stuff while pregnant.

Cough Syrups -Class C- These are ok with your docs consent but be careful because many of these contain alcohol which is something you’ll want to avoid while pregnant. Also avoid any syrup that says “D” for decongestant or has pseudoephedrine or phenylephrine as a listed ingredient. This constricts blood flow. Guaifenesin and dextromethrophan are generally ok, but you should still talk with your doc. Many times drinking lots of water will help with thinning secretions and helping as an expectorant.

Antifungal Creams -Clotrimazole-Class B- This is safe even intravaginally although it is recommended that if a women have a yeast infection that she see her doc. Miconazole is similar to clotrimazole but listed as class C. There have been no deformities seen with use of either. Fluconazole, which is prescription only, should be avoided during pregnancy because it can cause skeletal abnormalities and congenital heart disease.

Simethicone-Class B- Simethicone isn’t absorbed and considered safe during pregnancy for gas and bloating. Brands include Maalox and Mylanta. Be careful though with these two brands as they contain aluminum. They are generally ok at doses on the bottle, but aluminum is not generally something that is good in the body. Using a brand like Mylanta which only contains simethicone is the better choice over Mylanta which has the aluminum in it.

Prenatal Vitamins- Not classified but safe because they are dispensed by the millions. A couple of observations here: They do have iron in them which can cause constipation. If you choose to take these, increase vegetable intake (which you should do anyway while pregnant for the vitamins) to help flow of the stool. Vegetable juicing also helps with this. A big concern is the mom not getting enough folate, especially during the first few weeks. All of these vitamins, including folate, can be readily eaten and supplementation isn’t always necessary. The only real exception here is if you have a MTHFR mutation that doesn’t allow you to produce active folate in the body, in which case you might not be able to get pregnant in the first place. Supplementing with L-methylfolate will take care of that. You can find brands with L-methylfolate but right now they will cost more

When in doubt please ask a pharmacist. If the pharmacist just thinks they know, ask them to double check. If they don’t, then fire them and get a new one. Your baby is more important than your pharmacist. Stay with a pharmacist who is willing to look it up and be sure. Remember too that good supplements are no substitute for good nutrition. Get your diet in place and then use supplements if needed.

CIAO

1.Nourjah, Parivash, et al. “Estimates of acetaminophen (paracetomal)‐associated overdoses in the United States.” Pharmacoepidemiology and drug safety 15.6 (2006): 398-405.

2. Alano MA, Ngougmna E, Ostrea EM, et al. Analysis of nonsteroidal antiinflammatory drugs in meconium and its relation to persistent pulmonary hypertension of the newborn. Pediatrics 2001;107:519-23.

3.Mahadevan U, Kane S.American Gastroenterological Association Institute technical review on the use of gastrointestinal medications in pregnancy.Gastroenterology. 2006 Jul ;131(1):283-311.

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.

Raw Milk Safety

WSA_7481In the last article we talked about raw milk and some of it’s benefits. Lets discuss safety of raw milk as it seems to be a topic of controversy for many people. I want to begin by saying that Chris Kresser has done an article on this and it does a great job of explaining the true risk. You can find that article here:

http://chriskresser.com/raw-milk-reality-is-raw-milk-dangerous

I’m going to rehash some of the stats of his article so I can’t say that it is truly my own. In other words he deserves the credit for the research on this one but I’ve looked over the data he’s collected and have come to the same basic conclusion.

In a report done by the Center for Science in the Public Interest (CSPI), they looked at food contaminated outbreaks that caused illness from 1990-2006. Here is the report:

http://www.cspinet.org/new/pdf/outbreak_alert_2008_report_final.pdf

The most amount of outbreaks actually came from seafood, however the most amount of actual illness came from produce, not seafood. Vegetable were linked with 279 outbreaks with 14,743 illnesses. In the report they also show that seafood and produce aside, pork, beef, eggs and poultry also cause more outbreaks and illness than dairy.

For dairy, a total of 221 outbreaks with 6364 illnesses occurred. Milk was responsible for 79 outbreaks with1889 illnesses. That’s total milk, not raw milk. According to the report close to 30% of all dairy outbreaks were from milk. So out of the total 168,898 illnesses reported, milk was responsible for 1.1%. Compare that to produce which causes nearly 21% of these illnesses. I haven’t seen any campaigns recently telling people to back off on veggies.

I’m not trying to make light of the fact that some of these illnesses can be life threatening or altering, but the numbers show that you’re much more likely to get sick eating fruits and veggies than milk.

In one report there were 39 deaths from 2009-2011 from peanuts, eggs and cantaloupe. [1]. The CDC, from what I’ve been able to find only has 2 reported deaths from raw milk or raw milk products consumption. [2] They didn’t specify if it was milk or a cheese or something else so I can’t say for sure that milk did it.

On a side note, many Mexican cheeses like queso fresco are associated with illness, probably due to the conditions they are made in like bathtubs. There are others that are made in better environments but be careful if you want to buy from something made in Mexico if you’re on a trip south of the border. Some of these homemade cheeses are actually illegal.

In a report released by the CDC, raw milk was instigated in several outbreaks and illnesses and even 3 deaths. [3] One problem with the report was that it lumped raw milk with milk products like yogurt and cheese. As noted above some of these cheeses are illegal.

Another issue is the report claims only about 1% of the population actually consume raw milk. According to a Foodnet survey [4], done by the same CDC, they reported that about 3% of the population is drinking unpasteurized milk. Why would they say 1% when they had access to their own records showing it was probably triple that?  Decreasing the pool of people that actually drink raw milk would make the number of events be larger.

For example, if there are 300 people who eat ice cream and 7 of them get sick, it looks like a 2.3% illness rate. But if the number reported was only 100 people the rate increases to 7%. Does the CDC have an agenda against raw milk? Maybe, maybe not.

Real Risk

Here is a chart showing raw milk consumption illness:

http://33q47o1cmnk34cvwth15pbvt120l.wpengine.netdna-cdn.com/wp-content/uploads/raw-milk-data.pdf

The average amount of illness is 100 cases per year. As Chris Kresser points out, using data from the Foodnet Survey, about 3% of the population consumes raw milk. With 313,900,000 people approximately in the USA, that is 9,417,000 people drinking raw milk. At an average of 100 cases of illness per year, that put the chance of getting sick on raw milk at around 1 in 94,000.

Now for pasteurized milk. Here’s the chart just like for raw milk:

http://33q47o1cmnk34cvwth15pbvt120l.wpengine.netdna-cdn.com/wp-content/uploads/pasteurized-milk-data.pdf

About 78.5% of Americans drink pasteurized milk according to the Foodnet Survey. That’s around 246,411,500 people. With 277 illnesses per year with pasteurized milk the odds are 1 in almost 890,000. This is a relative risk increase of about 9.4 times. So you are 9.4 times mores likely to get sick drinking raw milk over pasteurized milk. But remember that this is relative risk.

Absolute risk, the risk that really matters, tells us the true story. If you are drinking raw milk the chances of illness are 0.00106%. That’s pretty small. Divide that by 9.4 and you have your risk for pasteurized milk. Even smaller.

Bugs

One of the major causes of the illnesses seen were from Campylobacter jejuni and E. coli O157:H7. Both of these bugs can cause serious problems. No one is disputing that. The problem as Chris Kresser points out, and one that I completely agree with is illness from food born pathogens can be considered an episode of diarrhea or some bad stomach pains and maybe acid reflux. It may last a day or two. I know I’ve had my share and while it wasn’t pleasant I certainly didn’t call the CDC to report my problem.

The facts I think are pretty clear. Raw milk consumption is pretty safe. Again I don’t want to downplay the fact that you can get sick from drinking it, but according to the CSPI 2008 report:

Seafood causes 29x more illness than dairy

Poultry causes 19x more illness than dairy

Eggs causes 13x more illness than dairy

Beef causes 11x more illness than dairy

Pork causes 8x more illness than dairy

Produce causes 3x more illness than dairy.

Yup looks like dairy is hardly a heavy hitter when it comes to creating food related illness. I think I'll have better chances getting sick from my two year old than my milk.

Yup looks like dairy is hardly a heavy hitter when it comes to creating food related illness. I think I’ll have better chances getting sick from my two year old than my milk.

Like Chris Kresser, this isn’t intended to convince you to drink raw milk, but to give you the facts. I love raw milk. We’ve made cream cheese with it which by the way is amazing. I love chugging it with just about anything when it’s ice cold and the cream….oh man the cream! Why so many people are calling it so unsafe is probably because of agenda or fear. I once felt the same way about it years ago. There was no way you were going to get me to drink milk straight from the cow.

As I grew up my grandma would tell me about getting milk from cows for the family and my dad had to milk the cows when he was a kid. Older men at church would tell me if they had chocolate they’d sometime mix it in a small glass on colder days when milking to make “hot chocolate”. I figured if all these people had been drinking milk straight from the cow with no problems something had to give. I got the courage to try it a couple of years ago and I never looked back. I can report no illness either. In fact just the opposite, it makes my mood better, kind of like after eating ice cream.

This is a Cliff’s Notes version of Chris’ article but I think it gets the point across.

Check out the Nathan Spinelli PharmD Health Coach page on Facebook.

CIAO

1.http://www.marlerblog.com/lawyer-oped/2792-sickened-and-39-deaths-by-foodborne-illness-demand-accountability/#.UyHfxYVUaac

2.http://www.cdc.gov/foodsafety/rawmilk/raw-milk-questions-and-answers.html

3.http://www.cdc.gov/media/releases/2012/p0221_raw_milk_outbreak.html

4.http://www.cdc.gov/foodnet/surveys/FNExpAtl03022011.pdf

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.