All posts by RX Integrative Solutions

Energy Drinks – Are Those Shots Really Safe?

Beverages like Red Bull, Rockstar, Monster Energy, 5-Hour Energy, Mountain Dew Kickstart, and Full Throttle are touted to increase energy, improve mental alertness, and enhance physical endurance. Some of these products are marketed as beverages while others are marketed as dietary supplements.

According to the Center for Disease Control and Prevention, between 2007 and 2011, the number of energy drink-associated emergency room visits doubled. In 2011, one in 10 of them resulted in a hospitalization. Some college students will unsafely consume energy drinks along with alcohol or other products/drugs (e.g., marijuana, OTC or prescription medications).

Ever looked at the nutrition label on the back of one of these products? They contain more than just caffeine and sugar, namely B vitamins, amino acids (taurine and carnitine), and other dietary supplements -> green tea extract, guarana, yohimbine, green coffee bean extract, bitter orange, glucuronolactone, ginkgo biloba, and ginseng. A single 16-oz bottle may contain up to 62 grams of added sugar, more than the maximum amount recommended in one day (15 teaspoonfuls – 250 calories).

In smaller quantities, caffeine may boost energy and alertness. In larger quantities, caffeine can negatively affect the cardiovascular system. Taurine may boost metabolism. In theory, extra carnitine may impact fat burn. The body is typically not deficient in endogenous carnitine, so it’s a waste of your money. Guarana contains caffeine. Green tea extract contains caffeine and the antioxidant EGCG. Green coffee bean extract contains caffeine. Yohimbine and bitter orange are central nervous system stimulants.

Ginseng does not impact energy and may lower blood sugar in diabetics – diabetics should be careful with its use. Ginkgo biloba has not been clinical proven to improve energy. Water soluble B vitamins protect nerves but may not improve energy. Thankfully, they will be eliminated by the kidney if taken in excess.

Glucuronolactone, a component of connective tissue, is metabolized into glucuronic acid and is touted to ‘detoxify’ (what?) in the body, a nebulous claim that is unproven in humans. It has no impact on energy.

Possible side effects from energy drinks include, but are not limited to, rapid heartbeat, heart palpitations, heart attack, and headaches. Caffeine and other stimulants may also be associated with anxiety, sleep problems, digestive problems, and dehydration.

If you feel you need to consume energy drinks, a good health rule is to consume them in moderation and remember that there may be negative outcomes. Talk it over with your primary care physician. Be healthy, eat whole foods, get ample restorative sleep, and stay safe.

REFERENCES:

Higgins. Energy beverages: content and safety. May Clin Proc 2010:85:1033-1941.
Sankararaman. Impact of energy drinks on health and well-being. Current Nutrition Reports 2018;7:121-130.
Uliah. Energy drinks and myocardial infarction. Cureus 2018;10;e2658

___________________________________________

Cathy Rosenbaum PharmD RPh MBA CHC 10/12/18©

 

 

Overview of Biofeedback

By Dr. Cathy Rosenbaum, Holistic Clinical Pharmacist, Founder & CEO, Rx Integrative Solutions, www.rxintegrativesolutions.com

By tapping into our mind body connection, we can learn how to heal! Biofeedback is a non-pharmacologic mind body technique taught by a trained practitioner that can help a person improve her/his physiological function (e.g., heart rate, blood pressure, breathing rate, skin temperature, muscle tone).  This practice can be used to help manage conditions such as headaches, anxiety, high blood pressure, and stress, among others.

Certified biofeedback practitioners follow a standard of care based on scientific evidence.  They can use different methods involving electrodes and sensors in their 30-minute to one-hour session (e.g., electrodermal test, thermal biofeedback, and electromyogram for muscles).  It may take several sessions before progress is seen.  One could learn how to relax using deep breathing, progressive muscle relaxation, guided imagery, and/or mindful meditation.

Computer graphics help visually guide relaxation so one can see progress made toward the health goal.  Wearable devices with sensors worn around the waist are also available. RESPeRATE is an FDA approved device for decreasing stress and lowering blood pressure that uses a downloadable app. Not all home use biofeedback devices are regulated by the FDA, so buyer be ware!

Consider adding biofeedback to your health tool kit.

Blessings for better health.

References:

McKee. Biofeedback: an overview in the context of heart-brain medicine. Cleve Clin J Med 2008;73(Suppl 2): S31-S34.

Gevirtz.  The promise of heart rate variability biofeedback: evidence-based applications. Biofeedback 2013;41(3):110-120.

Mayo Clinic. Biofeedback. www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664.  Accessed September 1, 2018.

 

Lyme Disease

Background

Lyme disease is caused by a spirochete  called Borrelia burgdorferi  that is carried by blacklegged ticks (vector) found on deer (reservoir host).  The Center for Disease Control (CDC) tells us that more of these ticks are expected this summer due to reforestation and climate change across the country, including in Ohio.  While the majority of reported cases are from the Northeast and Upper Midwest, other cases have been reported as far south as Florida. Adult blacklegged ticks (Ixodes scapularis)  are the size of an apple seed so they are visible to the naked eye.

Symptoms

Symptoms can occur within 3 to 30 days after a bite. Ticks must be attached to the human for at least 36-48 hours to transmit disease.  If the human removes the tick within 48 hours, he/she probably won’t get the disease. Lyme disease is diagnosed by symptoms which can include chills, fever, headache, muscle and joint pain, and swollen lymph nodes. For many infected individuals, the classic red bull’s-eye round rash is one of the first symptoms.  Up to 30% of those bitten will not get a rash.

There are three stages to the disease:

  1. Early Localized – flu-like symptoms and rash
  2. Early Disseminated – flu-like symptoms with pain, numbness in arms/legs, Bell’s palsy
  3. Late Disseminated- arthritis, fatigue, dizziness, sleep disturbances, mental confusion

Treatment

Lyme disease is treated with antibiotics like doxycycline or others, depending on the patient and upon the physician’s preference, for a period of 2-3 weeks.

Prevention

Clothes treated with permethrin 0.5% make it hard for blacklegged ticks to bite you or stick to your clothes (Eisen. J Medical Entomology July 20, 2016).  In addition:

*Wear socks and pants when you walk in the woods

*Wear a tick repellent on skin and clothes that contains DEET, lemon oil, eucalyptus, or (better still) permethrin

*Take a shower within two hours of coming inside after possible exposure to blacklegged ticks

*Remove ticks from your skin with a pair of tweezers, then clean the area with 70% rubbing alcohol or soap and water

*Check your skin and hair, and wash ticks out of your hair ASAP after walking in the woods

*Place exposed clothing in a hot dryer to kill whatever ticks remain

 

Supplement & Food Labeling Overhaul Coming in 2020

Excerpts from the Nutrition and Supplement Facts Label Final Rule and the Serving Size Final Rule – > Compliance Date Moved from July, 2018 to 2020

Nutrition Facts: Larger, bold font on labels to emphasize calories per serving; elimination of International Units (IU) for fat-soluble vitamins A, D, E (to be replaced with mcg or mg)

Folic Acid: folate will be expressed in ‘mcg Dietary Folate Equivalents (DFE)’ (due to higher bioavailability of folic acid vs food-based folate); new RDI = 400 mcg DFE (same as 240 mcg folic acid in current labeling system)

Vitamin & Mineral Daily Values: new UL for sodium = 2,300 mg; new UL for potassium = 4,700 mg; new calcium daily = 1,300 mg; new choline daily = 550 mg

Sugar Daily Value: new total carbohydrates daily = 275 grams; new added sugars daily = 50 grams

Fiber Daily Value: new = 28 grams

Fat Daily Value: new = 78 grams

 

 

 

Restless Leg Syndrome

Restless Leg Syndrome

By Cathy Rosenbaum PharmD MBA RPh CHC
Founder & CEO, Rx Integrative Solutions

Introduction
Restless leg syndrome (RLS) was first described over 70 years ago. Symptoms can show up as achy or crawling sensations in the resting leg that oftentimes go away with leg movement. RLS can be caused by iron or folate deficiency, kidney problems, pregnancy, rheumatoid arthritis, fibromyalgia, thyroid issues, Parkinson’s disease, and depression, among others. A family history of RLS is common in individuals with idiopathic RLS. Individuals with RLS can have trouble getting a refreshing REM sleep. RLS is often misdiagnosed as a vascular problem in the veins, and that’s why it’s important to get an accurate diagnosis from your PCP first before treating the condition.

Factors that may make RLS symptoms worse include cold, heat, fatigue, and stress. RLS prescription medication treatments can include, but are not limited to, benzodiazepines, gabapentin, clonidine, propranolol, and narcotics, each of which have significant side effects. The use of opioids and benzodiazepines together (e.g., Valium, Ativan, Xanax, clonazepam) is not safe. For perspective, benzodiazepines as a medication class are best avoided in seniors due to drowsiness and increased risk of falls and dementia. Depending on the type of RLS diagnosed, non-prescription medication and/or non-invasive alternatives can be considered to treat symptoms.

Iron Deficiency
Interestingly, there might be less iron in the brain of an RLS individual compared to non-RLS individuals. People with iron deficiency RLS respond well to iron supplementation. Improvement is most often seen in those with the lowest initial serum ferritin levels.

Pregnancy
Pregnant women are more likely to develop RLS than non-pregnant women due to reduced folate levels in the former population. In most instances, symptoms are mild and resolve after delivery. Treatment involves folate supplementation, reassurance, and appropriate food intake.

Medication-Induced RLS
Different medications can either cause or worsen RLS symptoms. Antidepressants like Prozac, Paxil, and Zoloft are three such culprits. One study showed that use of non-opioid analgesics is associated with an increased risk of RLS in individuals on long-term antidepressant therapy (Leutgeb. Eur J Med Res 2002;7:368-379).

Vitamin D and Magnesium Deficiency
Published literature (J Sleep Breath 2016) indicates that low vitamin D levels and/or low magnesium levels may be associated with RLS. Magnesium supplementation makes it easier for leg muscles to relax. Treatment with vitamin D or magnesium dietary supplements with the advice and consent of your PCP or pharmacist are two options to consider if you are suffering from these types of RLS.

Holistic Therapies
For individuals with mild RLS symptoms, other holistic options include relaxation/stress management therapy, acupuncture, and abstaining from caffeine and caffeinated products, nicotine, and alcohol to help improve sleep, help reduce stress, and indirectly lessen symptoms.

Summary
If you are experiencing RLS-like symptoms and are concerned about what to do, the first step is to schedule an office visit with your PCP to get an accurate diagnosis. It is unwise and unsafe to self-diagnose and try various remedies without your PCP’s knowledge.