Saturday, June 15, 2019

Journal Watch June 2019



 PAIN
App helps improve pain control and reduce opiate use after surgery: Patients who underwent total knee replacement and used a smartphone app (PainCoach) at home after surgery consistently reduced opiate painkiller use and improved pain control. The more the study participants used the app, the more likely they were to lower pain scores and decrease their use of opioids.Euroanaesthesia Congress

Smartphone relaxation app helps some manage migraine: Migraine sufferers who used a smartphone-based relaxation technique at least twice a week experienced on average four fewer headache days per month, a new study shows. Developed in part by researchers at NYU School of Medicine, the app, called RELAXaHEAD, guides patients through progressive muscle relaxation, or PMR. In this form of behavioral therapy, patients alternately relax and tense different muscle groups to reduce stress. The study authors say their work, publishing in the journal Nature Digital Medicine online June 4, is the first to evaluate the clinical effectiveness of an app for treating migraine, and adding an app to standard therapies (such as oral medications) under the supervision of a doctor. 

Emotional Awareness and Expression Therapy for Chronic Pain: Patients with chronic pain, especially primary or centralized pain, have elevated rates of psychosocial trauma and intrapersonal or intrapsychic conflict. To address these risk factors and potentially reduce pain, the authors developed emotional awareness and expression therapy (EAET). This article presents the rationale for EAET, describes its principles and techniques, reviews its development and early testing as well as recent clinical trials, and critically analyzes the evidence base. Four initial trials (between 2006 and 2011) demonstrated the efficacy of earlier versions of EAET. Four recent randomized, controlled trials of different EAET durations (1 to 8 sessions) and formats (individual or group) in patients with fibromyalgia, irritable bowel syndrome, pelvic pain, or medically unexplained symptoms support the earlier findings. EAET reliably reduces pain and interference, although improvements in anxiety and depression are less reliably achieved and may be delayed. The largest and best conducted trial found superiority of EAET over cognitive-behavioral therapy for fibromyalgia. Patient retention in EAET is high, and adverse events are rare. EAET merits inclusion as a treatment option for primary pain conditions, and it may be the preferred treatment for some patients. Research is needed on EAET with other pain conditions and samples, using better controls and comparison conditions, and on additional ways to motivate and help patients engage in successful emotional processing. Current Rheumatology Reports


Vagus nerve stimulation study shows significant reduction in rheumatoid arthritis symptoms: Initial pilot data support the use of new neurostimulation treatment in a larger study in patients who have failed current standard of care. Science Daily


COMPLEMENTARY & ALTERNATIVE MEDICINE
Growing up high: Neurobiological consequences of adolescent cannabis use: Cannabis use was linked to impairments in working memory and inhibitory control, which is required for self-control. Cannabis use was also linked to deficits in memory recall and perceptual reasoning. Alcohol use was not linked to impairments in these cognitive functions, suggesting cannabis could have more long-term effects than alcohol. Preliminary data indicates that cannabis use had a stronger effect on the memory functions of male students than female students. Both sexes were however, equally affected by cannabis on inhibitory control. Canadian Neuroscience Meeting

FDA ACTION
• Approved NovoTTF-100L, which uses electric fields to stop solid tumors from mesothelioma from dividing.
Seized more than 300,000 containers of dietary supplements, including tablets, capsules, and teas from Life Rising Corporation due to poor manufacturing practices

• Finalizes guidance for premarket tobacco product applications for electronic nicotine delivery systems as part of commitment to continuing a strong oversight of e-cigarettes

Approves first chemoimmunotherapy regimen, Polivy,  for patients with relapsed or refractory diffuse large B-cell lymphoma

Permits marketing of first medical device for relief of pain associated with irritable bowel syndrome in patients 11-18 years of age

Approves first treatment, Emgality, for episodic cluster headache that reduces the frequency of attacks

Approves new treatment, Zerbaxa, for hospital-acquired and ventilator-associated bacterial pneumonia

• Issued warning for women of childbearing age about possible safety risks of dietary supplements containing vinpocetine

Announces Project Facilitate to assist physicians seeking access to unapproved therapies for patients with cancer

Puts R3 Stem Cell, LLC on notice for marketing unapproved stem cell products for treating serious conditions

Approves first PI3K inhibitor for breast cancer

Approves innovative gene therapy, Zolgensma, to treat pediatric patients with spinal muscular atrophy, a rare disease and leading genetic cause of infant mortality

Permits marketing of first diagnostic test, Synovasure, to aid in detecting prosthetic joint infections

Clears first diagnostic tests for extragenital testing for chlamydia and gonorrhea

• Warns of fecal transplants after one death


PREVENTION
Blood pressure and glucose control may prevent common arrhythmia: Blood-pressure and glucose control may be effective in preventing heart block, a common form of arrhythmia, and the subsequent need for a pacemaker. JAMA Network Open 

High-intensity exercise may restore heart function in people with type 2 diabetes: The study found that three months of high-intensity interval training (HIIT) improved heart function in adults with type 2 diabetes, without any change in medications or diet. University of Otago

Seniors who feel their life has purpose may live longer: Seniors who feel their life has purpose may be less likely to die from heart, circulatory and digestive diseases and more likely to live longer, new data suggest. In a study that followed nearly 7,000 people over age 50 for more than a decade, researchers determined that people were more likely to die at a younger age if they felt their lives had little purpose, according to the report published in JAMA Network Open. 

Roundup Linked to Human Liver Damage: A group of patients suffering from liver disease had elevated urine levels of glyphosate, the primary weed-killing ingredient in Roundup, according to researchers at the University of California, San Diego (UCSD).

Brush your teeth --postpone Alzheimer's: Researchers have determined that gum disease (gingivitis) plays a decisive role in whether a person developes Alzheimer´s or not. the bacteria is not causing Alzheimer´s alone, but the presence of these bacteria raise the risk for developing the disease substantially and are also implicated in a more rapid progression of the disease. However, the good news is that this study shows that there are some things you can do yourself to slow down Alzheimer´s. "Brush your teeth and use floss". Mydel adds that it is important, if you have established gingivitis and have Alzheimer´s in your family, to go to your dentist regularly and clean your teeth properly. 

10,000 Steps A Day? How Many You Really Need To Boost Longevity: A study of 17,000 older women (average age 72), women who took 4,400 steps per day, on average, were about 40 percent less likely to die during the follow-up period of about four years compared with women who took 2,700 steps. The benefits of walking maxed out at about 7,500 steps. In other words, women who walked more than 7,500 steps per day saw no additional boost in longevity. This study only measures walking. It didn't measure things that many of us do that don't require steps, things like gardening, swimming or biking. And it's safe to assume some women in the study were doing these other things that can influence health as well. JAMA International Medicine

Two-Hour Weekly Dose of Nature May Aid Health, Well-Being: Spending at least two hours a week in nature may promote health and well-being, according to a study published online June 13 in Scientific Reports


Irregular Sleep Patterns May Increase Risk for Metabolic Syndrome: Variability in sleep duration and timing is associated with higher odds of metabolic syndrome, according to a study published online June 5 in Diabetes Care. 

Exercise, Therapy May Improve Depression, Diabetes Outcomes: Exercise and cognitive behavioral therapy can improve depression outcomes in adults with type 2 diabetes. Diabetes Care

NUTRITION/SUPPLEMENTS/VITAMINS
Intracranial Hemorrhage Risk Up With Low-Dose Aspirin: For individuals without symptomatic cardiovascular disease, the use of low-dose aspirin for primary prevention of cardiovascular events is associated with an increased risk for intracranial hemorrhage, according to a review and meta-analysis published online May 13 in JAMA Neurology. 

Coffee not as bad for heart and circulatory system as previously thought: The research from Queen Mary University of London has shown that drinking coffee, including in people who drink up to 25 cups a day, is not associated with having stiffer arteries. British Cardiovascular Society (BCS) Conference 

• Millions of Cardiovascular Deaths Attributed to Not Eating Enough Fruits and Vegetables.
Do Policies Targeting Sugary Drinks Pay Off? New research suggests that taxes and health warnings could bring significant health and economic benefits by cutting consumption of sugar-sweetened beverages
• Eating More Vitamin K Found to Help, Not Harm, Patients on Warfarin: Contrary to common wisdom, increasing vitamin K intake helps stabilize anticoagulation
• Sun-Exposed Oyster Mushrooms Help Patients Fight Tuberculosis: Bread containing the low-cost mushrooms increased vitamin D levels and boosted immune response of TB patients
In a study of 2,717 young adults in the U.S. with long-term follow-up, people who increased the amount of fruits, vegetables, whole grains, nuts and vegetable oils in their diet over 20 years had a 60 percent lower risk of type 2 diabetes compared to those with a small decrease in plant foods.
• Findings from a study examining three large cohorts of U.S. health professionals suggest that people with higher intakes of vitamins B2 and B6 from food or supplements have a lower risk for type 2 diabetes. The study, which included more than 200,000 people, also revealed that consuming higher levels of vitamin B12 from foods was associated with a higher type 2 diabetes risk, which may be due to consumption of animal products.
• A new study reveals that changing the order in which food is eaten could reduce post-meal blood sugar spikes. The researchers found that eating rice first and then a vegetable and meat caused significantly higher blood sugar levels after eating compared to other sequences. The results point to a simple but effective way to lower blood sugar levels after eating, which could prevent the transition from prediabetes to diabetes.
• Fewer new type 2 diabetes (T2D) cases are seen in adults who eat more plant-based foods, and intake of vitamins B2 and B6 is also associated with a reduced risk for T2D, according to two studies

Red and white meats are equally bad for cholesterol: Contrary to popular belief, consuming red meat and white meat such as poultry, have equal effects on blood cholesterol levels, according to a study published today in the American Journal of Clinical Nutrition.

Cholesterol in eggs tied to cardiac disease, death: Research that tracked the diets, health and lifestyle habits of nearly 30,000 adults across the country for as long as 31 years has found that cholesterol in eggs, when consumed in large quantities, is associated with ill health effects. One large egg contains nearly 200 milligrams of cholesterol, roughly the same amount as an 8-ounce steak, according to the USDA. Other foods that contain high levels of cholesterol include processed meats, cheese and high-fat dairy products. While the new research does not offer specific recommendations on egg or cholesterol consumption, it found that each additional 300 milligrams of cholesterol consumed beyond a baseline of 300 milligrams per day was associated with a 17 percent higher risk of cardiovascular disease and an 18 percent higher risk of death.  Journal of the American Medical Association.

Mediterranean diet linked with improved cognition in people with diabetes: Analyzing two years’ worth of data from 913 participants in the Boston Puerto Rico Health Study, researchers found that people with diabetes who followed a Mediterranean diet had bigger gains in memory and other types of cognitive function than those who didn’t eat that way. Reuters

Vitamin D does not prevent type 2 diabetes in people at high risk : Taking a daily vitamin D supplement does not prevent type 2 diabetes according to a study of 2,423 adults. NEJM 

Eating blueberries every day improves heart health: Eating a cup of blueberries a day reduces risk factors for cardiovascular disease -- according to a new study. Eating 150g of blueberries daily reduces the risk of cardiovascular disease by up to 15 per cent. The research team say that blueberries and other berries should be included in dietary strategies to reduce the risk of cardiovascular disease -- particularly among at risk groups. American Journal of Clinical Nutrition 

Vitamin D and estradiol help guard against heart disease, stroke, and diabetes: Vitamin D and estrogen have already shown well-documented results in improving bone health in women. A new study from China suggests that this same combination could help prevent metabolic syndrome, a constellation of conditions that increases the risk of heart disease, stroke, and diabetes in postmenopausal women. Menopause

Increases in Red Meat Intake Linked to Increased Mortality: Increases in red meat consumption over eight years are associated with an increased mortality risk during the subsequent eight years, according to a study published online June 12 in The BMJ.

Dietary Supplements May Up Risk for Severe Medical Events: Consumption of dietary supplements, specifically those sold for muscle building, energy, and weight loss, is associated with an increased risk for severe medical events among individuals aged 0 to 25 years, according to a study published online June 5 in the Journal of Adolescent Health. 

Low vitamin K levels linked to mobility limitation and disability in older adults: Low levels of circulating vitamin K are linked to increased risk of mobility limitation and disability in older adults, identifying a new factor to consider for maintaining mobility and independence in older age. The Journals of Gerontology: Series A


TREATMENT
Diuretic withdrawal is safe for stable heart failure patients: Drug therapy for patients with stable heart failure can be simplified by stopping diuretics, according to late breaking results from the ReBIC-1 trial. European Society of Cardiology 

Nerve stimulation could provide new treatment option for most common type of stroke: A study of 1,000 patients found evidence that the technique, called active nerve cell cluster stimulation, reduced the patients' degree of disability three months after they suffered an acute cortical ischemic stroke, which affects the surface of the brain and is the most common type of stroke. UCLA

Statin Use With Colorectal Cancer Lowers Risk for Early Death: Use of statins before or after colorectal cancer (CRC) diagnosis is linked to a lower risk for premature death, from either cancer or other causes, according to a review published online May 8 in Cancer Medicine. 

International clinical trial of new drug for men with advanced prostate cancer yields strong result: The New England Journal of Medicine published the first results of a phase III international clinical study called TITAN (National Clinical Trials Number 02489318), which evaluated the effectiveness and safety of a new drug, apalutamide, to treat advanced prostate cancers. This publication accompanies a presentation today that outlines the study results at the American Society for Clinical Oncology (ASCO). Researchers found that treatment with apalutamide significantly improved overall survival, with a 33% reduction in risk of death compared to standard-of-care therapy. Additionally, this study showed apalutamide significantly delayed disease progression and increased the amount of time until a patient has to receive chemotherapy.

New Breast Cancer Drug Boosts Patients’ Survival Rates by 30%: Researchers say a new form of drug improves survival rates of patients with the most common form of breast cancer. The findings, presented at the annual meeting of the American Society of Clinical Oncology in Chicago, showed that the addition of a drug known as a cyclin inhibitor increased survival rates to 70 percent. The mortality rate was 29 percent less than when patients were given a placebo.

Beta blockers reduce stress-induced irregular heart rhythm: Taking beta blockers -- medications that reduce blood pressure and treat many heart conditions -- can blunt the negative effects of stress and anger on people with a history of atrial fibrillation, or irregular heart rhythm, said Yale researchers. This strategy could potentially improve quality of life for many of the 2 million Americans with the condition, according to a new study. HeartRhythm

Long-term islet transplant recipients show near-normal glucose control: Continuous glucose monitoring (CGM) evaluations in islet transplant recipients who have been insulin independent for an average of 10 years show near-normal glycemic profiles and time-in-range metrics, according to data presented by the Diabetes Research Institute at the University of Miami Miller School of Medicine. The findings, which were accepted as a late-breaking poster at the American Diabetes Association (ADA) 79th Scientific Sessions, June 7 - 11, 2019 in San Francisco, CA, demonstrate that islet transplantation can be a successful long-term cell therapy for select patients with type 1 diabetes.

 

Combo Injectable Controls Blood Glucose Longer in T2DM: Compared with insulin glargine, initial injectable therapy with a combination of insulin degludec and liraglutide aids achievement of blood glucose goals for a longer period of time in patients with uncontrolled type 2 diabetes on oral antidiabetic drugs, according to a study published online June 9 in The Lancet Diabetes & Endocrinology

 

Weight Loss Surgery May Not Relieve Acid Reflux: Reflux symptoms return in about half of patients who undergo gastric bypass, according to a study published online June 4 in Alimentary Pharmacology & Therapeutics.


Hot Water Therapy Aids Patients With Peripheral Arterial Disease: Heat therapy can improve functional ability and also has potential to be an effective cardiovascular conditioning tool for people with peripheral arterial disease (PAD), according to a small study published online June 5 in the American Journal of Physiology-Heart and Circulatory Physiology.


Antibiotic Prophylaxis Before Dental Work Often Unnecessary: Antibiotic prophylaxis before dental procedures is unnecessary more than 80 percent of the time, according to a study published online May 31 in JAMA Network Open.

 

Excess Cause-Specific Mortality Tied to Chronic Proton Pump Inhibitor Use: Taking proton pump inhibitors (PPIs) is associated with an excess of cause-specific mortality, according to a study published online May 30 in The BMJ.

OTHER
Women's Facial Moisturizers Cost More Per Ounce Than Men's: Facial moisturizers marketed to women are more than $3 more per ounce, despite similar ingredients. Journal of Cosmetic Dermatology 

Industry uses non profit organizations to campaign against public Health policies: A new study shows how a non-profit research organization has been deployed by its backers from major food and beverage corporations to push industry-favourable positions to policy makers and international bodies under the guise of neutral scientific endeavour. Globalization and Health

Most Older Adults Would Have to Liquidate Assets for Home Care: Researchers found that 74 percent of adults (nationally representative sample of non-Medicaid, community-dwelling adults age 65 years and older) could fund at least two years of a moderate amount of paid home care if they liquidated all their assets, and 58 percent could fund at least two years of an extensive amount of paid home care. However, among older adults with significant disabilities, only 57 percent could fund at least two years of moderate paid home care and 40 percent could fund at least two years of extensive paid home care by liquidating all their assets. "Home care is less affordable, however, for those most likely to need it, including older adults with significant long-term services and support needs, single adults, and those ages eighty-five and older," the authors write.


Wednesday, June 12, 2019

Take a Break: Make Non Alcoholic Cocktails



 Summer is finally here in Vermont so time to think about BBQs, being outside, and sipping something cold and delicious. More and more people are forgoing the alcohol but they like the look of a cocktail and all the cool glasses just made for them. Truth be told, in the 802 (Vermont’s area code) Mason Jars are the glass of choice. Even the restaurants offer them.

Pina Coladas: This can be as simple as 1 cup cream of coconut (be sure to mix before measuring), ¾ cup pineapple juice, and 2 cups of ice  Put the ice in a blender or food processor and process until ice is crumbly. Add the juice and coconut milk and blend until is a slushy consistency.

Can’t find coconut milk?  Pick up a can of frozen Pina Colada mix in the freezer section where they sell juice. Use a lot more ice  and less water (usually it’s a can of water for the virgin variety) and let the blender work its magic.


 Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Saturday, June 8, 2019

Life with Chronic Disease: Internet Safety


NEVER TRUST AND ALWAYS VERIFY

A few weeks ago, we held a "Tech Cafe" in my town,  which began with a presentation on Internet safety. No matter how tech savvy you are, there is always something new to learn and/or benefit from a reminder. 

Living in a “wired” society is a double-edged sword. Many things are a lot easier because of it, and we’ve become very dependent on it.  We text, call, book appointments, bank, share files, pay bills, surf the web for the best deals and the list goes on. At the same time these various devices-computers, tablets and phones-are vulnerable to security threats.

Don’t despair. Some very practical steps will help minimize your exposure

1. Check sites for SSL Certification (Secure Sockets Layer): Does it start with “http://” or “https://”? If you notice an s at the end, that means your connection is encrypted and secure, so any data you enter is safely sent to the website. Not all sites have SSL certification. While they may be fine to browse, avoid sharing any financial or personal information on websites without this added layer of security.

2. Passwords
• Create unique passwords: Make your password a sentence: A strong password is a sentence that is at least 12 characters long. Focus on positive sentences or phrases that you like to think about and are easy to remember. On many sites, you can even use spaces. Read How to Create a Strong Password (and Remember it).

• Do Not use the same password for multiple accounts. Why You Should Use a Password Manager and How to Get Started.

• Use biometric features, such as fingerprint authenticators. This makes unauthorized access nearly impossible.

3. Change the default password of your internet router and IOT devices. Make it harder for hackers or even snoopy neighbors. Most router manufacturers configure their new routers with the same default username and password. The default usernames and passwords for popular models of wireless network gear are well known to hackers and often posted on the internet. Why You Should Change the Default Password on a Wi-Fi Router.

4. Connect to the Right Wi-Fi: Many free Wi-Fi points are not encrypted. These open networks allow malicious people to eavesdrop on the network traffic and easily get your passwords, usernames and other sensitive information. To protect against Wi-Fi hacking, use applications that secure your connection or at least tell you the status of the Wi-Fi to which you are connected. WPA (Wi-Fi Protected Access) is more secure compared to WEP (Wired Equivalent Privacy). Consider investing in a Virtual Private Network (VPN). A VPN is a piece of software that creates a secure connection over the internet, so you can safely connect from anywhere.

5. Click Smart: Don’t invite danger with careless clicking. Many of today’s online threats are based on phishing or social engineering. This is when you are tricked into revealing personal or sensitive information for fraudulent purposes. Spam emails, phony “free” offers, click bait, online quizzes, texts from people you don’t know, and more all use these tactics to entice you to click on dangerous links or give up your personal information. If it sounds too good to be true, it probably is. Avoid links asking for personal information and Do Not Click on Website Ads!
10Ways to Avoid Phishing Scams

6. Be a Safe Shopper
• Remember to follow Step 1 and only use sites whose address starts with “https.”

• Don’t Save Financial Information on Shopping Sites: Even sites with SSL certification can be hacked. Many shopping sites let you save your credit card information in your online account. This setup makes it easier to make purchases in the future and it also makes it easier for hackers to access your information. Spend the extra minute to enter your information each time you make a purchase.

7. Know your “friends:” Whether it’s on Facebook, other social media sites or texts via your mobile device, if you don’t know the person sending you a text, e-mail or a friend request, don’t respond. Use your spam filter.

8. There’s an App for That: Only download apps from official app stores after reading other users’ reviews first.

9. Stay current and be alert: Keep all your software updated so you have the latest security patches. Online threats are evolving all the time, so make sure you know what to look out for. Make sure that your security software is enabled on your mobile, just like your computers and other devices.

10. Careful What You Post : There are no “take backs” with what you post, or even what’s posted about you. Don’t put anything on line you wouldn’t want your current or prospective employer to see.


Wednesday, June 5, 2019

Take a Break: Create Luminaries and lanterns


Midsummer Night’s Eve isn’t far off so now is a good time to make lanterns and luminaries. It’s a great way to reuse tissue paper, milk cartons, beads, paper bags and whatever else you have on hand. Of course, luminaries can be as simple as paper lunch bags, filled with 2” of sand, kitty litter or gravel, sufficient to weigh down the bag and secure space for a Tea light. However, you can dress up the bags by cutting out shapes and designs or even gluing pieces of a paper doily to them. Below are some videos to help inspire you.











Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Saturday, June 1, 2019

Life with Chronic Conditions: CBD Oil


Does it seem like everywhere you turn there are stores, friends and articles promoting cannabidiol (CBD)? 

In the last few weeks I had a friend ask if it would be good for his arthritis because his pharmacist friend said it helped him. Others have told me it had done wonders for their dogs.

CVS is now carrying CBD products (creams, sprays and lotions) from Curaleaf Holdings in 800 stores in eight states (Alabama, California, Colorado, Illinois, Indiana, Kentucky, Maryland and Tennessee). Walgreens is following CVS’s lead and will sell CBD infused products in 1,500 stores in nine states (Oregon, Colorado, New Mexico, Kentucky, Tennessee, Vermont, South Carolina, Illinois and Indiana).

The FDA held its first public hearing on CBD to help to better regulate CBD products this past week. The take home message from the hearing appears to be the public wants CBD products and too many manufacturers are delivering shoddy goods.  5 Take aways From the FDA’s Hearings on CBD.

So is there science to back up the hype?

What is CBD?
The second most active ingredients of cannabis (marijuana), it is derived from the hemp plant and it does not cause a “high.” CBD can have no more than 0.3% THC (tetrahydrocannabinol the active ingredient in cannabis), while medical marijuana oil may contain up to 5%.

In the late 19th century, cannabis was an important component of British and American physicians’ pharmacopoeia. It’s suspected that the cannabis of this era, and the tinctures made from them, probably contained much more CBD than modern varieties.

Are there proven health benefits?
CBD has been shown to treat some severe childhood epilepsy syndromes. The FDA has approved the first cannabis derived drug for this condition, Epidiolex, which contains CBD.

A double-blind placebo-controlled study published on May 21, 2019 in the American Journal of Psychiatry demonstrated that Epidiolex can reduce cue-induced craving in individuals that had been former heroin users. Furthermore, in these individuals, the drug reduced reports of anxiety, and blood levels of cortisol, a hormone known to increase under conditions of stress and anxiety.

Zynebra Pharmaceuticals recently tested a topical CBD product for osteoarthritis knee pain with mixed results. The Phase 2 clinical study did not meet its primary endpoint of reducing the average pain score, although there were some indications it improved function and reduced pain severity.

A small clinical trial of CBD for Crohn’s disease in Israel in 2017 was also negative, finding “CBD was safe but had no beneficial effects.”

A recent review of studies on CBD oil and other forms of cannabis for the management of neurologic disorders was more positive, finding “there is strongest evidence to indicate benefits in treatment of spasticity and neuropathic pain in multiple sclerosis.”

Animal studies suggest that CBD might be beneficial for some conditions including pain, inflammation, arthritis and anxiety. Note that there is a big difference between animal studies and clinical trials on humans. Some organizations and promoters of CBD refer to “studies” without noting these involved animals. This is the case for Does CBD Oil Really Help Treat Arthritis Pain? April 14, 2019 from the Rheumatoid Arthritis Support Network   

There is a growing body of scientific literature critically assessing the validity of animal experimentation and raises important concerns about its reliability and predictive value for human outcomes and for understanding human physiology. In short, just because it worked in an animal model doesn’t mean it will be equally successful in humans.

However, there are studies underway where CBD is being evaluated for a range of conditions including: addiction, Parkinson’s Disease, schizophrenia, diabetes, MS, autism, cancer, graft-host disease, anxiety and more.

If you are wondering how one product could be such a miracle cure, the author of the recent NY Times Magazine article asked the same question.

How could one family of molecules help so many maladies? The most obvious response is that they might not; all this research is preliminary and might not pan out. But scientists often propose a counter-explanation: Many chronic disorders, even though they seem distinct, are characterized by dysfunction in the same few pathways. Inflammation and oxidative stress, for example, occur in schizophrenia, metabolic disorders, heart disease and other ailments..... There are other examples of a single drug being able to help meliorate a variety of conditions. We know aspirin as a treatment for fever and headache, for example, but in low doses it is also used to reduce the risks of stroke, heart attack and pre-eclampsia in pregnant mothers; it even figures as an adjunct treatment for schizophrenia. Aspirin has its own downsides — an elevated risk of bleeding, for instance — but like CBD, its broad utility may be partly explained by its anti-inflammatory effects. New York Times

Risks?
Though it's often well-tolerated, CBD can cause side effects, such as dry mouth, diarrhea, reduced appetite, drowsiness, difficulty with sleep, weight loss, stomach pain or discomfort, drooling or excessive saliva, problems with walking and fatigue.

CBD can also interact with other medications, primarily those that are changed or broken down by the liver. Medline lists a number of drugs that can interact with CBD including: blood thinners, codeine, Paxil, ibuprofen, Celebrex, Elavil, Prevacid, Valium Priolosec, testosterone, Allegra, morphine and various other drugs, plus possibly caffeine, nicotine, vitamins and nutrional supplements

In addition there are legal issues in some states, but most importantly is the quality control of the product itself. In 2015, the FDA found that many CBD labeled products, actually contained very little CBD. Two years later, a study published in JAMA documented that in 84 products sold online, 26% had less CBD than advertised and 43% had more. As noted above, this was a major issue discussed at yesterday's FDA hearing on CBD.

A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication, which means it’s not regulated by the FDA. In addition to not knowing therapeutic doses for various conditions, it’s difficult to know exactly how much CBD you are actually getting in a product and if there are additives that could be problematic.

Legality
The 2018 Farm Bill was signed into law in December 2018, effectively legalizing hemp at the federal level by removing it from the federal list of controlled substances and classifying it as an agricultural commodity. As a result, CBD from hemp is legal nationwide at the federal level.

Just this week the Transportation Security Administration has changed its cannabis policy to allow passengers to travel with Epidiolex, the FDA version of CBD that is used to treat epilepsy in children, as well as some CBD oil, "as long as it is produced within the regulations defined by the law" under the 2018 Farm Bill, which legalized hemp and hemp derivatives. The TSA's new rules still ban other forms of marijuana, including CBD oils that have THC, and cannabis-infused products that are still illegal under federal law.

All 50 states have laws legalizing CBD with varying degrees of restriction. You will need to do the research to see how it applies to the state you live in.

Considering CBD?
Be aware that wild claims, such as an effective cancer treatment, are just plain bogus. While more research is needed in humans, there are indications that CBD may be a useful treatment for managing anxiety, insomnia and chronic pain. That said, science needs to be the driving force behind new treatments, not a marketing campaign. People with chronic conditions are often targeted by marketers, so buyer be ware.

Before trying CBD, it’s imperative that you talk to your medical provider in order to understand drug interactions with current treatment regiments. Talk with them about dosing and the most reliable source possible for purchasing CBD. Finally, there are CBD clinical trials that are open and seeking patients. Check https://clinicaltrials.gov to see if you qualify.

Further Reading











Wednesday, May 29, 2019

Take a Break: Create a Spa/Zen Space



 Ideally it would be a room, but it can also be a sun porch, backyard patio, or the corner of bedroom, where you can create your “moment of Zen”. Include yoga mat, blankets, soft music, soothing sounds, simple furniture and soft lighting. Make sure it’s free of distractions such as phones, tablets and computers. Add things like:
• Aromatherapy-scents of lavender or chamomile are relaxing. Use essential oils

• Water feature-These are easy to create but a sound machine can duplicate the sound of the ocean or rain falling

• Elements of nature-Use only natural textures for things like blankets.  A wooden bowl full of pebbles is restful on the eyes and you can use the stones for gentle self-massage. Art can reflect various aspects of nature. A noise machine to duplicate whispering winds and other sounds can be very soothing. Plants have a very calming effect and provide oxygen

• Candles-Use soy or beeswax

• Hide the electronics-If your TV room is going to double as your spa space, find a way to hide the TV (cabinet, screen)

• Include a Zen Garden: Make your own. Use a shallow container, such as a bowl or tray. Fill it with fine sand- playground sand is fine or check your local craft store or even local gardening center.  Select an odd number of small polished stones for the garden. A tiny rake can be found at hobby and craft shops, should be placed by the side of the garden so you can rake different patterns. You can also make your own rake with dowels. In a pinch, use a small fork.

The view outside a window can be enhanced with bird feeders as well as shrubs and flowers that attract bees and birds.

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Monday, May 27, 2019

Life with Chronic Conditions: What Sunscreen Should I use?




May is  Skin Cancer Awareness Month and the Environmental Working Group (EWG) has recently released its annual guide to  sunscreens. They report that two-thirds of the more than 1,300 sunscreens on the market either don’t provide enough protection or contain ingredients that are especially worrisome — such as oxybenzone, which may have hormone-disrupting qualities dangerous for kids.

There has also been a lot in the news lately about how sunscreen can end up in a wearer’s blood. The US Food and Drug Administration recently reported that the chemicals are present at much higher levels than current government health rules permits. Before you panic and decide not to use sunscreen, recognize that the volunteers in this study put on two times as much sunscreen as people usually apply in everyday use.  JAMA Network

Practice Safe Sun
Using common sense can help reduce risks of a burn and the increased risk of skin cancer. So before discussing what to look for in a sunscreen, make sure you follow the basics:
- Avoid getting burned by covering up
- Stay in the shade
- Plan your day so you avoid being out in midday sun when UV radiation is the highest.
- Don’t forget the sunglasses

Be mindful that certain medications may make you more sensitive to the sun, so be sure to talk to your medical provider and/or pharmacist about your medications and sun sensitivity.

Picking the right sunscreen for you
• Avoid any skin or lip product whose label includes retinyl palmitate, retinol or vitamin A.

Avoid oxybenzone, a synthetic estrogen that penetrates the skin and can disrupt the hormone system. Other chemicals identified by the FDA for more research include avobenzone, ecamsule and octocrylene. 

• Don’t combine sunscreen with repellent

• Don’t use sprays

• Apply cream often

• Don’t use old sunscreen. If there is no expiration date on the sunscreen you just purchased, write the date you bought it on the bottle. Sunscreens are required to retain their original strength for at least three years.

• Look for products with
-       zinc oxide, 3 percent avobenzone or Mexoryl SX. They protect skin from harmful UVA radiation.
-       SPF between 15 and 50+

• Check your sunscreen with the EWG sunscreen database.  You don’t have to spend a lot of money for a product that will have an excellent EWG rating. For example, Equate Baby Zinc, available from Walmart for about $5, has an excellent rating from EWG.

• Because of skin sensitivity, particularly if you are on medications, test any new product on a small patch of skin.

• If you use a dermatologist, check with them about recommendations that work for your skin.