Note From Dr. C
February 11, 2016
Grass-Fed Steaks with Tomato Vinaigrette and Smashed Sweet Potatoes
February 11, 2016

Are your meds helping or hurting?

pillsBy: Dr. Alan Christianson

It’s no surprise medications can cause side effects. Commercials have made us numb to them. Still, we rarely hear how dangerous common medications can be, even for those who carefully follow the directions.

RETHINK YOUR MEDS

I’ve been blessed to have a patient population I enjoy spending my time with. Doug was no exception. I had cared for him, his wife, and their adult daughter for over a decade. One day, Doug came to see me because his back hurt. I noticed he was also retaining fluid; his face was puffy. The pain didn’t seem to feel worse when he bent or moved—it just always hurt. I had a small suspicion his kidneys were a culprit, so I did a simple urine test. I had examined Doug and done blood tests just over a year prior, and he had no signs of kidney problems.

The urine test showed his kidneys were not filtering protein at all. A few more tests confirmed Doug was in late-stage kidney failure. He spent four months on dialysis in hopes of receiving a kidney transplant. It never came, and he died just before his 51st birthday.

The nephrologist who treated Doug attributed his death to ibuprofen use.

Doug didn’t mention it to me, but he’d developed tendonitis and was regularly taking ibuprofen for several months. He never exceeded the recommended dosages. The first sign of there being a problem was his fluid retention. By then, it was too late. Kidneys can lose 80% of their working cells, called glomeruli, before there is any symptom or measurable change in function.

In the last decade, the rate of death from prescription medications has gone up 2.8 times.

cdc-us-overdose-deaths-2014_jr-1

Both prescription and over-the-counter medications have become a leading cause of early mortality, and the trend is only worsening.

Below is a quick list of the top offenders. If you see any of these names in your medicine chest, please work hard to explore your options.

Over-the-Counter Medications

NSAIDS

Generic                                   Brand Name(s)

Ibuprofen                                   Advil, Motrin

Naproxen sodium                     Aleve

Aspirin                                        Ascriptin, Bayer, Ecotrin

Acetaminophen

Generic                                   Brand Name(s)

Acetaminophen                         Tylenol

Antihistamine/Sedatives

Generic                                   Brand Name(s)

Diphenhydramine                    Benadryl, Tylenol PM, Advil PM

Prescription Medications

Sleep Aids

Generic                                   Brand Name(s)

Zolpidem                                    Ambien, Intermezzo

Eszopiclone                                Lunesta

Ramelteon                                 Rozerem

Zaleplon                                     Sonata

Doxepin                                     Silenor

Benzodiazepines (see below)

Opioid Narcotics

Generic                                   Brand Name(s)

Hydrocodone                             Vicodin, Lortab

Oxycodone                                 OxyContin, Percocet

Morphine                                   Kadian, Avinza

Benzodiazepines

Generic                                   Brand Name(s)

Alprazolam                                 Xanax, Restyl

Clonazepam                               Klonopin, Paxam

Diazepam                                   Valium

Lorazepam                                 Ativan

Temazepam                               Restoril

Triazolam                                   Halcion

Let’s go a little deeper into each of these categories.

NSAIDS

These are nonsteroidal anti-inflammatory drugs. The best known are Advil and Aleve. There are also many prescription NSAIDS. Some are the same medicines as the nonprescription ones (but in higher potencies), and others are different medicines. In terms of dangers, the differences between nonprescription and prescription are only related to the dosage used.

Bleeding Ulcers

Nearly 40% of the American population take ibuprofen or aspirin on a regular basis to help with aches and pains.[1] Each year, 1-2% of those who take NSAIDS have side effects bad enough to warrant hospitalization, mostly related to bleeding ulcers. In 2000, this was 103,000 people with 16,500 of them dying from taking these medicines responsibly.[2]

This does not take into account harm from intentional overdoses, from those who take NSAIDS with incompatible medications, or in cases of the recommended dosages being exceeded.[3]

Stroke

NSAIDs also raise the risk for heart attack, heart failure, and stroke. This risk begins as early as two weeks of starting regular use. The longer you take them and the more you take, the more these risks increase.[4]

Weight Gain

Is it hard to get to your favorite weight? Ibuprofen may be to blame. Studies show it can mimic the effects of diabetes and cause a higher amount of insulin to be released.[5]

Liver Failure

Liver damage with acute liver failure is the most common complication with acetaminophen (Tylenol). These risks are higher for those who use alcohol.[6] One estimate is that of the 2000 Americans who have liver failure each year, 38% of the cases are caused by acetaminophen with 28% of the cases resulting in fatality.[7]

A special concern with acetaminophen is that it is a secondary ingredient in many over-the-counter and prescription medications. This raises the potential for unintentional overdose for those who take it by itself while unknowingly taking it in other products as a secondary ingredient.

Pediatric Dangers

Children may especially be at risk. Those under the age of six have been shown to have non-fatal liver injuries even when taking doses deemed safe.[8]

Opioid Narcotics Fatalities

In 2014 alone, over 47,000 people died from prescribed opioid narcotics. This represents 61% of all drug overdose deaths, both prescription and illicit. This rate has more than tripled since the year 2000.[9]

cdc-us-overdose-deaths-2014_jr-2Despite the facts that opioids are highly addictive and given routinely, they are often not effective against chronic pain.[10]

Safer and More Effective Options for Chronic Pain:

  • Cognitive behavioral therapy
  • Targeted amino acid therapy
  • Mindfulness meditation
  • Acupuncture
  • Cryotherapy
  • Massage therapy
  • Curcumin alkaloids such as Inflama-Rest
  • Mind body therapies such as John Sarno’s approaches
  • Prolotherapy and PRP therapy
  • Chiropractic and physical therapy

Benzodiazepines

These are medications given for anxiety and sleep. Despite the fact that many people are on these for years, the prescribing labels and practice guidelines recommend them only for short-term use.[11]

The most common brands used are Ativan, Xanax, and Klonopin. The death rate from these medicines has gone up five times in roughly the last decade.

cdc-us-overdose-deaths-2014_jr-3

As of 2013, Medicare started to pay for benzodiazepines like Xanax and Ativan. Since then, they have been prescribed an extra 40 million times.[12]

Dementia

These medications may cause premature dementia,[13] leading to impaired short-term memory, confusion, poor word recall, and lack of mental focus. Similarly, they can raise the risk of developing Alzheimer’s disease with as little as 1-2 months of regular use. Each dose after this showed a higher and higher risk of Alzheimer’s.[14]

Addictive

They are also known to be highly addictive and difficult or impossible to stop after months of regular use.[15]

Long-Term Effects

Some of the long-term effects of benzodiazepines are:[16]

  • Memory loss
  • Confusion and difficulty thinking clearly
  • Lethargy and lack of motivation
  • Fatigue
  • Headaches
  • Drowsiness and sleepiness
  • Difficulty sleeping and disturbing dreams
  • Nausea
  • Personality change and changes in emotional responses
  • Anxiety
  • Irritability, paranoia and aggression
  • Depression
  • Lack of motivation
  • Weakness
  • Fatigue
  • Skin rashes
  • Weight gain

Sleep Aids

Medicines like Ambien and Lunesta are used by 60 million Americans each year. Large studies have shown they don’t work, as they provide only 14-15 minutes of additional sleep.

Death and Cancer

Several studies have shown these medicines are deadly. As few as 19 doses per year can raise the risk of death by nine-fold in those who are obese and 4.5 times in those who are lean.[17] They have also been shown to raise the risks of many types of cancer.[18,19]

Diphenhydramine (Antihistamine)

Diphenhydramine (Benadryl) is commonly used both as a sleep aid and for allergy symptoms. Histamine can be the chemical trigger of allergy symptoms, yet it is also a brain chemical that causes alertness and mental focus. When it is blocked, many feel groggy and sleepy. Diphenhydramine is the active ingredient in many over-the-counter sleep aids such as Tylenol PM and Advil PM.

Dementia

A large study showed that diphenhydramine can cause dementia. A team of researchers tracked 3500 adults, ages 65 and over, for seven years. During that time, those who used medications like diphenhydramine had a 54% higher risk of developing dementia than those who didn’t use the medicine or who used it for under three months.

Weight Gain

Diphenhydramine has been shown to cause dramatic weight gain and insulin resistance with regular use in both genders. Research has shown men who use it regularly are over 19 pounds heavier than similar men who do not. For women, the difference can be over nine pounds.[20]

Safer and More Effective Options for Anxiety and Insomnia:

  • Cognitive behavioral therapy
  • Targeted amino acid therapy
  • Mindfulness meditation
  • Theanine
  • Fish oil
  • Acupuncture
  • Kava extracts

If you are in the habit of taking medications for chronic symptoms like pain, insomnia, or anxiety, please reconsider. In most cases they don’t work as well as expected, and they have major risks. There are so many safe and effective options available for you. Not only are natural treatments lower in side effects, but when you identify and treat the cause, your health improves in other ways you may not expect. Think of it as trading in your risks and side effects for side benefits.


[1] Kaufman DW, Kelly JP, Rosenberg L, et al, “Recent patterns of medication use in the ambulatory adult population of the United States: The Slone Survey,” JAMA 2002;287:337-344.

[2] Ofman JJ, Maclean CH, Straus WL, et al, “A metaanalysis of severe upper gastrointestinal complications of nonsteroidal anti-inflammatory drugs,” The Journal of Rheumatology, 2002;29(4):804-812.

[3] Singh G, “Gastrointestinal complications of prescription and over-the-counter nonsteroidal anti-inflammatory drugs: A view from the ARAMIS database,” American Journal of Therapeutics, 2000;7:115-121.

[4] Mangoni AA, Woodman RJ, Gilbert AL, Knights KM, “Use of non-steroidal anti-inflammatory drugs and risk of ischemic and hemorrhagic stroke in the Australian veteran community,” Pharmacoepidemiol and Drug Safety, 2010 May;19(5):490-8. doi: 10.1002/pds.1945.

[5] Li J, Zhang N, Ye B, Ju W, Orser B, Fox JE, Wheeler MB, Wang Q, Lu WY, “Non-steroidal anti-inflammatory drugs increase insulin release from beta cells by inhibiting ATP-sensitive potassium channels,” British Journal of Pharmacology, 2007 Jun;151(4):483-93. Epub 2007 Apr 16.

[6] Sinclair J, Jeffery E, Wrighton S, Kostrubsky V, Szakacs J, Wood S, Sinclair P, “Alcohol-mediated increases in acetaminophen hepatotoxicity: role of CYP2E and CYP3A,” Biochemical Pharmacology, 1998 May 15;55(10):1557-65.

[7] Larson AM, Ostapowicz G, Fontana RJ, et al, “Outcome of acetaminophen-induced liver failure in the USA in suicidal vs accidental overdose: Preliminary results of a prospective multi-center trial,” Hepatology 2000;32(4 pt 2):396A.

[8] Heard K, Bui A, Mlynarchek SL, Green JL, Bond GR, Clark RF, Kozer E, Koff RS, Dart RC, “Toxicity from repeated doses of acetaminophen in children: assessment of causality and dose in reported cases,” American Journal of Therapeutics, 2014 May-Jun;21(3):174-83. doi: 10.1097/MJT.0b013e3182459c53.

[9] Mancano MA, “Risk Factors for Androgen Deficiency with Daily Opioid Use; Co-trimoxazole and Sudden Cardiac Death in Patients Receiving ACE Inhibitors; Clindamycin-Induced Myelosuppression; Apixaban-Induced Diffuse Alveolar Hemorrhage; DRESS Syndrome Induced by Allopurinol,” Hospital Pharmacy, 2015 Mar;50(3):189-93. doi: 10.1310/hpj5003-189.

[10] Giron SE, Griffis CA, Burkard JF, “Chronic Pain and Decreased Opioid Efficacy: An Inflammatory Link,” Pain Management Nursing, 2015 Oct;16(5):819-31. doi: 10.1016/j.pmn.2015.04.001. Epub 2015 May 9.

[11] “Short- and Long-Term Use of Benzodiazepines in Patients with Generalized Anxiety Disorder: A Review of Guidelines,” [Internet] Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2014 Jul 28

[12] “One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013,” June 10, 2015, https://www.propublica.org/article/medicare-paid-for-nearly-40-million-tranquilizer-prescriptions-in-2013.

[13] Barbui C, Gastaldon C, Cipriani A, “Benzodiazepines and risk of dementia: true association or reverse causation?” Epidemiology and Psychiatric Sciences, 2013 Dec;22(4):307-8. doi: 10.1017/S2045796013000358. Epub 2013 Jul 3.

[14] Billioti de Gage S, Moride Y, Ducruet T, Kurth T, Verdoux H, Tournier M, Pariente A, Bégaud B, “Benzodiazepine use and risk of Alzheimer’s disease: case-control study,” BMJ, 2014 Sep 9;349:g5205. doi: 10.1136/bmj.g5205.

[15] Tan KR, Rudolph U, Lüscher C, “Hooked on benzodiazepines: GABAA receptor subtypes and addiction,” Trends in Neurosciences, 2011 Apr;34(4):188-97. doi: 10.1016/j.tins.2011.01.004. Epub 2011 Feb 25.

[16] “Benzodiazepine Facts,” http://www.druginfo.adf.org.au/drug-facts/benzodiazepines (accessed Jan 2013).

[17] Lan TY, Zeng YF, Tang GJ, Kao HC, Chiu HJ, Lan TH, Ho HF, “The Use of Hypnotics and Mortality – A Population-Based Retrospective Cohort Study,” PLoS One, 2015 Dec 28;10(12):e0145271. doi: 10.1371/journal.pone.0145271. eCollection 2015.

[18] Kripke DF, Langer RD, Kline LE, “Hypnotics’ association with mortality or cancer: a matched cohort study,” BMJ Open, 2012 Feb 27;2(1):e000850. doi: 10.1136/bmjopen-2012-000850. Print 2012.

[19] Kripke DF, “Possibility that certain hypnotics might cause cancer in skin,” Journal of Sleep Research, 2008 Sep;17(3):245-50. doi: 10.1111/j.1365-2869.2008.00685.x.

[20] Ratliff J, Barber J, Palmese L, Reutenauer E, Tek C, “Association of prescription H1 antihistamine use with obesity: Results from the National Health and Nutrition Examination Survey,” Obesity (Silver Spring), 2010;18(12):2398-2400. doi:10.1038/oby.2010.176.

 

Dr C full res

(c) 2015- Integrative Health Care, PC

Would you like to use this article? You may as long as you use the following information along with the article:

Dr. Alan Christianson is an Arizona-based Naturopathic Physician who helps
people overcome adrenal and thyroid disorders and achieve lasting fat loss.  He
authored the New York Times’ bestselling Adrenal Reset Diet, and The Complete
Idiot’s Guide to Thyroid Disease.  Dr. Christianson is the founding physician
behind Integrative Health. Dr. Christianson can be reached at www.MyIntegrativeHealth.com, www.DrChristianson.com and 480-657-0003.

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