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The Not –So- Sweet Truth about What You’re Drinking

Friday, December 4th, 2015
soda

fig 1

By Liz Aziz, PharmD Student Cedarville University School of Pharmacy

Many Americans have grasped the warning on excessive sugar intake. The problem is, these sugary calories often creep into the average American’s diet through drink, not food. Sugary drinks have already been tied to an increased risk of Type 2 diabetes as well as weight gain.­1 But just this month, a study published by the British Medical Journal has now found that sweetened beverages can also be associated with increase heart failure.2  Life with heart failure is nothing to take lightly, that’s why this gives the nation all the more reason to twist the cap shut on sweetened beverages and to choose healthier habits.

Increased prevalence of heart failure and other heart complications.chf As mentioned above, the recent study found a correlation between frequent consumption of sugary drinks and heart failure.2 These drinks include any beverage sweetened by sugar including soda, fruit juice/punch, lemonade, powdered drinks, or energy drinks.2 The study was a 12-year long population based study on 42,000 men ages 45-79. Researchers tracked incidents of heart failure between 1998 through 2010. Using food-frequency questionnaires, they found that men who drink two or more drinks a day were 23% more likely to develop heart failure. 2 Men who did not consume such beverages did not experience as many incidents of heart failure.2 Though the study has its limitations, such as survey bias and outside variables affecting study subjects, there are other literature that support the declining heart health of sugary-drink consumers.

In a similar study published by Circulation, researchers discovered a 20% increase in coronary heart disease in those who drink sweetened beverages.3  This study took into account age and family history when considering the correlation.3 They also concluded that the association had to do with sugar-sweetened drinks, not artificially-sweetened drinks (no-calorie sugary drinks).3  The study found sugar to be the underlying problem. Women are not excluded from this risk. The Nurses’ Health Study tracked the health of over 90,000 women during a time period of twenty years.4 They found similar results as the studies done on men, however the results were even more severe. Women who drank more than two servings of sugary drinks each day had a 40 % higher risk of heart attacks or death from heart disease in comparison to women who were rare consumers.4

So what is heart failure and heart disease? Heart failure is essentially when the heart is too exhausted or damaged to pump blood and oxygen to the rest of the body.5 Those that suffer from heart failure live a very difficult and limited life.5 Daily tasks become a struggle due to shortness of breath.5 This can further result in a sedentary lifestyle which is associated with its own health problems.5 Illnesses that can lead to heart failure are coronary heart disease as well as diabetes.5 The issue with excess sugar is that the build-up of the glucose metabolite in the body and frequent insulin spikes can cause significant damage and stress to the heart, leading to heart failure and heart disease.5 According to the Center of Disease Control, there are already 5 million Americans suffering from heart failure and more and more each year are adopting habits that put them at risk. soda

Sugary drinks overload your diet with sugar. A statement made by the American Heart Association recommended that the average adult should not consume more than 5 to 9 teaspoons of sugar. 7 However, the average 20-ounce bottle of a sugary drink contains 16 teaspoons of sugar.8 That almost TRIPLES the amount of sugar a person should consume in one day. With individuals having two or more of these drinks a day, it’s no wonder it is having a detrimental impact on Americans’ health.

What is the take home message? Those that regularly consume sugary drinks should set goals and limit their consumption.9 Though this is not the answer to all heart-related problems; it is definitely a start. There is plenty of research that supports this recommendation not only when it comes to heart failure but also diabetes and obesity. However, the question remains: Is this enough to get Americans to put down that can?

 

References

  1. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84:274–288.
  2. Rahman I, Wolk A, Larsson SC. The relationship between sweetened beverage consumption and risk of heart failure in men. Heart. 2015;
  3. De koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB. Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation. 2012;125(14):1735-41, S1.
  4. Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89:1037-42.
  5. nih.gov. What Is Heart Failure? – NHLBI, NIH. 2015. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/hf. Accessed November 11, 2015.
  6. en S, Kundu B, Wu H et al. Glucose Regulation of Load-Induced mTOR Signaling and ER Stress in Mammalian Heart. Journal of the American Heart Association. 2013;2(3):e004796-e004796. doi:10.1161/jaha.113.004796.
  7. Johnson RK, Appel LJ, Brands M, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association.Circulation. 2009;120(11):1011-1020.
  8. Wang YC, Coxson P, Shen YM, Goldman L, Bibbins-Domingo K. A penny-per-ounce tax on sugar-sweetened beverages would cut health and cost burdens of diabetes.Health Aff (Millwood). 2012;31(1):199-207.
  9. Sandee LaMotte C. Study links sweetened soda and heart failure – CNN.com. CNN. 2015. Available at: http://www.cnn.com/2015/11/03/health/soda-heart-failure-study/. Accessed November 11, 2015.
  10. Sugary Drinks.; 2014. Available at: http://www.rethinksugarydrink.org.au/go-free. Accessed November 11, 2015.
  11. CHF.; 2015. Available at: http://pharmacologycorner.com/drug-therapy-heart-failure-ppt/. Accessed November 11, 2015.
  12. Creative Commons. Vending Machine.; 2015. Available at: http://www.wikihow.com/Buy-Something-from-a-Vending-Machine-That-Demands-Exact-Change-when-All-You-Have-Is-Bills#/Image:Vending-Step-2.jpg. Accessed November 11, 2015.

 

Goodnight, Sleep Tight, Make Sure Your Blood Pressure is Right

Friday, October 30th, 2015

By: AJ OliverMoon_by_Adam_Cebula

Take a quick moment to think about your typical nightly routine. It most likely includes actions such as washing your face, showering, brushing your teeth or setting aside your outfit for the next day. If you are someone who has been diagnosed with high blood pressure (hypertension), adding the task of taking your medication may prove more beneficial to your health. In 2011, a new study reported by Harvard Health Publications claimed that taking your daily blood pressure medications at night will help lower the reading in those diagnosed with high blood pressure.1 Although that sounds like a no brainer, it is important to note that those not diagnosed with hypertension experience blood pressure readings that alternate based on the time of day. Getting out of bed is the hardest part of the day but once you do get out of bed, blood pressure rises. Before you start getting scared that your blood pressure will reach sky high before you start eating lunch, do not worry because your blood pressure will remain steady. Guess when your blood pressure will be at its lowest? Yep, you guessed it – it is lowest at night, usually between midnight and three or four o’ clock in the afternoon.1 This phenomenon is called “dipping”. However, people with high blood pressure experience “non-dipping,” meaning their blood pressure does not decrease at night – making the finding above important.2

Unfortunately, the same hormone that contributes to hypertension also increases the release of sugars from the liver and lowers insulin sensitivity.2 The combination causes an increase of risk for Type 2 diabetes in those who have hypertension. This was investigated in a study published in the Journal of Human Hypertension.3  In the study of 2,012 people with high blood pressure, half of the participants were instructed to take their blood pressure medications at night while the other half were instructed to take these medications in the morning.4 They monitored the participants for six years over which time 171 of the participants developed Type 2 diabetes.2 The researchers found that the half who took the blood pressure medications at night before going to bed had lowered their blood pressure more than those who took it in the morning.4 Additionally, these same participants also had a 57 percent lower risk for diabetes. Therefore, study authors concluded that taking a blood pressure medication before going to bed could benefit those who have hypertension by lowering blood pressure readings at night and decrease the risk of developing diabetes.1 However, with these studies there is a point that is important to note. Authors found that some older participants taking their blood pressure medications at night had critically low readings in the morning when trying to rise out of bed causing an increased risk of falls.1

Considering the evidence, taking blood pressure medication at night appears to be effective for improvement in blood pressure and risk of diabetes. However, it is necessary to take the proper precautions before starting blood pressure medications at night. Contact your doctor and pharmacist to see if you are suitable for taking blood pressure medications at night. Also, make sure that you use the same methods as you would use if you were to take these medications during the day. For instance, be sure to make a list of all the blood pressure medications taken.5 Also, try to get a good understanding of the side effects of your medications, not all blood pressure medications should be taken at night. For example, blood pressure medications like hydrochlorothiazide and Lasix are within a class of medications called diuretics.6 One of the side effects of diuretics is an increase in the volume of urine, which may result in multiple trips to the bathroom throughout the night.  For the medications you do take at night, make it a routine to take it at the same time every day.5 Do not alternate between taking the medications at night and during the day. Finally, keep your doctor informed and get your blood pressure checked regularly. If your primary care physician says you are good to go for taking your blood pressure medications at night then get to it! This may be a hard change and a lot to keep in mind. What are some ways to remind yourself to take these medications at the same time every night as well as reminding yourself to check your blood pressure? Do you think that taking blood pressure medication at night would be helpful for you?

References:

  1. LeWine H. Taking blood pressure pills at bedtime may prevent more heart attacks, strokes. Harvard Health Publications. October 25, 2011. http://www.health.harvard.edu/blog/taking-blood-pressure-pills-at-bedtime-may-prevent-more-heart-attacks-strokes-201110253668. Accessed October 29, 2015.
  2. Thompson D. Timing your blood pressure med right might prevent diabetes. News & View. September 24, 2015. http://news.health.com/2015/09/24/taking-blood-pressure-drugs-at-night-may-help-prevent-type-2-diabetes/. Accessed October 29, 2015.
  3. Hermida RC, Ayala DE, Mojón A, Smolensky MH, Portaluppi F, Fernández,J.R. Sleep-time ambulatory blood pressure as a novel therapeutic target for cardiovascular risk reduction. J Hum Hypertens. 2014;28(10):567-574. Accessed October 29, 2015.
  4. Bakalar N. Hypertension drugs may be more effective if taken at night. Well. October 2, 2015. http://well.blogs.nytimes.com/2015/10/02/hypertension-medicines-are-best-taken-at-night/?ref=health&_r=1. Accessed October 29, 2015.
  5. Web M. D. Taking high blood pressure drugs properly. http://www.webmd.com/hypertension-high-blood-pressure/how-take-blood-pressure-medicine-properly-why-you-should. Accessed October 29, 2015.
  6. Drugs.com. Diuretics. http://www.drugs.com/drug-class/diuretics.html.

Sugar and Spice

Wednesday, October 28th, 2015

By: Micah Bernard800px-Ground_cinnamon

Cinnamon. What comes to mind when you hear that word? Cinnamon buns, cinnamon glazed apples, snickerdoodles? It’s no secret that cinnamon and sugar are a great pair! But is there more to the relationship between sugar and cinnamon than just the great taste?

People with pre­diabetes or type 2 diabetes must be very careful to manage blood sugar levels. This can be achieved by following a special diet, losing weight, exercising, and taking medications such as metformin. Now there is a common spice that is being investigated as a supplement to help control blood sugar. In 2013, NPR published an article stating that cinnamon can help lower blood sugar.1 But is this claim backed up by science? Researchers in the last few years have been studying the impact of cinnamon on the management of blood sugar and have had promising results.
In 2003, researchers sought to determine if cinnamon could improve blood glucose levels in people with type 2 diabetes.2 In this study of 60 people with type 2 diabetes ranging in age from 45 to 58, subjects took either a placebo or one of three amounts of cinnamon: 1, 3, or 6 grams each day. After 40 days, the results showed that cinnamon in any of the three doses helps lower blood glucose levels 18­-29%, while no significant changes were reported in the placebo groups.

Another study in 2006 of 79 diabetic patients looked at whether cinnamon extract helps improve glycemic control in patients with type 2 diabetes.3 Each person either received a capsule of 3 grams of cinnamon or a placebo three times a day for 4 months. The results showed that the reduction in fasting blood glucose levels in the patients receiving cinnamon (10.3%), was significantly greater than in the control group, who had a reduction of only 3.4%. However, no significant differences were seen in hemoglobin A1c, which is an indicator of average blood sugar levels over the past three months.

A recent study that ran statistical tests on data from ten randomized controlled trials studying cinnamon’s effect on blood glucose found that cinnamon decreased fasting blood glucose levels by 24.59 mg/dl.4 There was no significant difference in the patients’ hemoglobin A1c. The study was unable to determine what the optimal dose of cinnamon or duration of treatment; this is an area where further research is needed.

How does cinnamon do it? Researchers do not fully know how cinnamon works, but they believe it may increase the body’s levels of and sensitivity to insulin, the hormone that helps your cells take sugar out of the blood stream, thereby lowering blood sugar levels.5 In addition, cinnamon may slow the emptying of the stomach, so there is less of a spike of sugar in the bloodstream.6 There is debate among researchers about what dose of cinnamon should be used to manage blood sugar.

As with any supplement, it is important to check with your doctor before adding cinnamon to your diet. If, after talking to your doctor, you decide to see if cinnamon works for you, it is important to choose the right kind of cinnamon. Cinnamon comes in two varieties, Cassia and Ceylon. Cassia is the more common type found in many supermarkets, however in higher doses, such as those used to control blood sugar, coumarin isolates (not to be confused with the blood thinner Coumadin) found in cinnamon can cause liver damage.1 The Ceylon variety of cinnamon has only trace amounts coumarin isolates, making it safer for the liver.7 So, if you plan to supplement your blood sugar management with cinnamon, ask a pharmacist to help you correctly select the Ceylon variety.

While researchers still do not fully agree on the effectiveness of cinnamon as a supplement for controlling blood sugar in type 2 diabetics and pre­diabetics, many recent studies show promising results. The effects of cinnamon may not be enough to replace a drug intended to control blood sugar, but those with pre­diabetes or diabetes may find it a useful supplement to help manage their condition.

What are your thoughts on using a natural supplement to manage a health condition?

Sources:

1. Aubrey A. Cinnamon Can Help Lower Blood Sugar, But One Variety May Be Best. NPR 2013. Accessed October 15, 2015.
2. Khan A, Safdar M, Ali khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003;26(12):3215­8.
3. Mang B, Wolters M, Schmitt B, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36(5):340­4.
4. Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon use in type 2 diabetes: an updated systematic review and meta­analysis. Ann Fam Med. 2013;11(5):452­9.
5. Kaiser C. Cinnamon’s Effect in Diabetes Uncertain. Cinnamon’s Ef ect in Diabetes Uncertain 2013. Accessed 2015.
6. Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutr. 2007;85(6):1552­6.
7. Johannes L. Little Bit of Spice for Health, but Which One? WSJ 2013. Accessed 2015.

A Natural Approach to Preventing Gestational Diabetes

Monday, October 26th, 2015
image courtesy of freedigitalphotos.net

By Katie Woodward, PharmD Student

You are having a new baby! Congratulations! You’ve probably already had several opportunities to answer that age-old question, “What gender are you hoping for?” And it is likely you responded with something like, “I don’t care as long as my baby is healthy!” Thanks to new scientific research, your chances of delivering a healthy baby are constantly improving.

We are going to play a quick game of “Bad News/Good News.” The bad news: gestational diabetes may cause complications in your pregnancy. Several factors may put you at risk of developing gestational diabetes. If diabetes runs in your family, if you are overweight, not very active, or over the age of 40 you are at risk of developing gestational diabetes.1 Gestational diabetes can cause jaundice, high birth weight, trauma during birth, increase necessity for C-section, and increase likelihood of obesity or diabetes in the child.1,2 Gestational diabetes also puts a new mother at risk of developing Type 2 Diabetes, which can require insulin injections and other treatments to control.

Now, for the good news: new research has demonstrated that myo-inositol is a supplement you can take which significantly decreases your chances of developing gestational diabetes, even if you are at high-risk.3 For those already diagnosed with gestational diabetes, taking a myo-inositol supplement can help decrease your need for insulin, make you more likely to carry the baby to term, and decrease your infant’s chances of developing hypoglycemia.3 Standard treatment for gestational diabetes requires the patient to check blood sugar levels in the morning and after meals, which can require several needle sticks per day as well as the purchase of a glucometer, test strips, and lancets.4 Insulin injections are also used to help control the blood sugar in up to 20% of women with gestational diabetes.4

A research study published in the Journal of Maternal-Fetal and Neonatal Medicine was designed as a prospective, double-blind, randomized controlled clinical trial which compared a placebo group to a group of mothers who supplemented with myo-inositol twice daily.3 The myo-inositol group had significantly better outcomes including lower maternal BMI, longer gestation at the time of delivery, and decreased abnormal oral glucose tolerance test results. The oral glucose tolerance test is the standard screening measure for gestational diabetes.  One limitation was that the study was relatively small. Some of the data may have been statistically significant if there had been more women involved in the study; for instance, the myo-inositol group had a lower incidence of neonatal hypoglycemia, but the data was not quite strong enough to be statistically significant. Another interesting statistic is that 21% of women in the placebo group required insulin therapy, while only 3% of women in the myo-inositol group required insulin therapy. While larger studies may be needed to validate this data, this study demonstrated that at least 50% of women who take myo-inositol may benefit from the treatment.3 Since the current standard of care for prevention of gestation diabetes is diet change and monitoring blood sugar, myo-inositol may be an easy and beneficial way to minimize complications from gestational diabetes.  It also has a promising potential to minimize the requirement of insulin injections.

Since it is a compound naturally found in both your body and your baby’s body, you can safely consume myo-inositol supplements.5 The product may be a little bit difficult to find in grocery stores, but it can be found in combination products or ordered online. According to research, the supplement is best if taken 2000 mg twice daily (make sure you separate the doses by at least six hours.)One product can be purchased from Fairhaven Health6 where you can get a 60-day supply for less than $20.* Myo-inositol is often combined with another compound called D-chiro inositol, which has also been demonstrated to assist with gestational diabetes.7 The combination product is called Ovasitol and it can be purchased online from Theralogix Nutritional Science Company, but it must be ordered online and can cost up to $1 per day ($90 for a 90 day supply.)8 Another product to consider is called Sensitol, and it contains D-chrio inositol, myo-inositol, and alpha lipoic acid. The product can be ordered online and a thirty day supply is $52.9

Gestational diabetes can have some scary consequences for you and your baby. Based on the evidence, I would recommend that any mother who has increased risk of gestational diabetes should discuss supplementation with myo-inositol with their medical provider.   It could help prevent or minimize problems associated with gestational diabetes. Myo-inositol may be expensive and may not be easily accessible to all; since it is commonly used as a preventative supplement, do you think that pregnant women at high risk for developing gestational diabetes should consider it as an option?

*The manufacturer suggests that the drug be taken four times daily, but in studies, the 2000 mg dose was only recommended twice daily.3 Also, this will help decrease the cost of the drug.

**Note: The Cochrane Collaboration is working on a new study to further describe the dosing and efficacy of myo-inositol as a treatment/ prevention method for gestational diabetes and it should be released soon.

References

  1. Available at: http://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014. Accessed October 14, 2015.
  2. Brown J. Myo-inositol for preventing gestational diabetes. Cochrane Database Of Systematic Reviews [serial online]. February 2, 2015;(2)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed October 11, 2015.
  3. Matarrelli B, Vitacolonna E, Celentano C, et al. Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. The Journal Of Maternal-Fetal & Neonatal Medicine: The Official Journal Of The European Association Of Perinatal Medicine, The Federation Of Asia And Oceania Perinatal Societies, The International Society Of Perinatal Obstetricians [serial online]. July 2013;26(10):967-972. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 11, 2015
  4. Available at: http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/treatment/con-20014854. Accessed October 21, 2015.
  5. D’Anna R, Scilipoti A, Di Benedetto A, et al. myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care [serial online]. April 2013;36(4):854-857. Available from: MEDLINE, Ipswich, MA. Accessed October 11, 2015.
  6. Available at: http://www.fairhavenhealth.com/myo-inositol.html?cmp=bing&kw=myo-inositol&utm_source=BingShopping&utm_medium=CSE&utm_campaign=myo-inositol. Accessed October 14, 2015.
  7. Costantino D, Guaraldi C. [Role of D-chiro-inositol in glucidic metabolism alterations during pregnancy]. Minerva Ginecol. 2014;66(3):281-91.
  8. Available at: http://www.theralogix.com/index.cfm?fa=products.ovasitol.default&dvsn=reprohealth. Accessed October 14, 2015.
  9. Available at: http://catalog.designsforhealth.com/Sensitol?quantity=1. Accessed October 21, 2015.

Insomnia: Not just about sleep

Monday, December 2nd, 2013

by Chelsae Ward, PharmD student

Insomnia is one of the most common patient complaints for Americans, third only to headache and the common cold. It is estimated that 33 percent of the United States population experiences insomnia.1 As defined by the CDC, insomnia “is an inability to initiate or maintain sleep.” 2 While the symptoms of insomnia are similar and easily identifiable, the causes can be vast and often hard to determine. Many times insomnia is not the primary condition but the effect of an underlying problem. One of the major causes of insomnia is emotional unrest due to either excitement or stress/worry. Therefore, insomnia is often a tell sign of depression or other emotional disorder. Pain or physical disturbances are also a common cause of insomnia. Other times, sleep disorders, such as sleep apnea cause insomnia.3

Rxdaily.com, a pharmacy news website, reviewed a study on the effects of insomnia in the article, It’s More Than Beauty Sleep.”4 The study was conducted by the CDC and looked at the correlation between insomnia causing diabetes and/or heart disease. Specifically, they focused on insomnia caused by mental distress and obesity. The study used over 50,000 participants who were 45 years and older. It concluded that a majority of people (64.8 percent) were optimal sleepers in terms of amount of time spent sleeping each night. Those who were short sleepers (31.1 percent) were more likely to develop heart disease, stroke, mental disorders, obesity, and diabetes. The authors of the study point out limitations in that it is difficult to determine which of the factors are the cause and which are the effect. For example, does insomnia cause diabetes or does diabetes cause insomnia? Sleep expert, Robert S. Rosenberg, states that the former has been most evidenced in recent studies.4 Another limitation was that the study was open to recall bias because the participants gave their own opinions on their sleep habits. The Rxdaily article concludes that medical professionals need to be more attentive to patients sleep patterns and habits.4

I agree with the Rxdaily article that health care professionals, including pharmacists, need to be attentive to a patient’s sleeping habits. Recognizing insomnia in patients can help identify a possible disease state since insomnia can be either a cause or effect of many disorders.5 Based on this knowledge it would make sense that Health Care Professionals would be attentive to a patient’s insomnia. One way in which this process can be easily implemented is to begin asking patients with a known medical history of heart disease, diabetes, obesity, or stroke of their sleeping habits. Along with this step, health care professionals can stress the importance of quality sleep to all patients, and thus the patient can address insomnia if/when it becomes a problem for them.

Not only is it important to pinpoint insomnia in patients due to its ability to cause medical issues, but many patients attempt to self-treat insomnia with over-the-counter medication (9 percent) or alcohol (11 percent).1 Pharmacists, being the best patient contact for over-the-counter medication, need to be aware of their patient’s insomnia. The pharmacist can then appropriately guide the patient on the best way to treat their insomnia. Benadryl, the most common over-the-counter sleep aid, may be used beneficially in short-term insomnia; but its use is not recommended long term.1 Many patients believe that alcohol will help to solve their sleep insomnia. It is important that alcohol users are aware that while alcohol may initially cause drowsiness and help one get to sleep, it will be more difficult to stay asleep. Many people will wake up more frequently throughout a night with alcohol use.6

The best way that has been found to treat chronic insomnia is through sleep training (also known as sleep hygiene), in which the patient trains themselves in proper sleeping habits.7 Sleep training are basic steps to take in order for one’s body to be in a suitable sleeping environment. It is important to keep a steady sleep schedule in which the patient will go to bed at the same time every night and wake at the same time every morning. The bedroom should be quiet, dark, and a place where the patient feels they can relax. The temperature of the room should not be too hot or too cold. The bed should be comfortable to the patient, neither too soft nor too firm. The bed should only be used for sleeping, making sure activities like reading, watching TV, or completing work, are done outside the bedroom. It would also be helpful to avoid large meals two hours before bedtime. Avoid taking naps throughout the day. If still unable to fall asleep, it is recommended to, instead of trying to force sleep, carry out a relaxing activity away from the bedroom.1,2

With the new evidence linking chronic illness and insomnia as found in the research study reviewed by rxdaily.com, and the high rate of self-treatment for insomnia, it would seem, not only important, but also necessary for health care professionals to be aware of patients sleeping difficulties. Do you think the health benefits of sleep are being under-rated in today’s health system?

 

References

1) Melton, C. K. Insomnia, Drowsiness, and Fatigue. In: R. R. Daniel L. Krinsky, Handbook of Nonprescription Drugs An Interactive Approach to Self-Care. Washington, DC: American Pharmacists Association; 2012: 867-876.

2) Sleep and Sleep Disorders. Centers for Disease Control and Prevention. http://www.cdc.gov/sleep/index.htm. May, 2012.

3) Staff, M. C. Insomnia. Mayo Clinic. http://www.mayoclinic.com/health/insomnia/DS00187. Janurary, 2011.

4) Robert S. Rosenberg, D. F. It’s More Than Beauty Sleep. Rxdaily.com. http://www.dailyrx.com/chronic-illnesses-may-be-associated-poor-sleeping-habits-study-suggests. October, 2013.

5) Lawrence Robinson, G. K. Sleeping Pills & Natural Sleep Aids. helpguide.org. http://www.helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm. May, 2013.

6) Szalavitz, Maia. Sleeping It Off: How Alcohol Affects Sleep Quality. Time: Health and Family. http://healthland.time.com/2013/02/08/sleeping-it-off-how-alcohol-affects-sleep-quality/. February 8, 2013.

7) Reinberg, S. Prescription Sleep Aids Common Choice for Insomnia. WebMD. http://www.webmd.com/sleep-disorders/news/20130829/prescription-sleep-aids-a-common-choice-for-american-insomnia. August 29, 2013.

Preventative Self-Care for Type 2 Diabetes..Eat More Fruit?

Tuesday, October 22nd, 2013

By McKenzie Shenk, Cedarville University PharmD Student

 

Diabetes mellitus has effected the human population for centuries; however only in recent decades have large strides been made in prevention and treatment.1 Both types of diabetes mellitus – type I and type II – can be manageable for patients with various medication regimens and lifestyle choices once they have been diagnosed. Research has also contributed to understanding of how type II diabetes (T2D) can be prevented. (Type I diabetes is an autoimmune disease, which means your immune system attacks your pancreas cells, so it generally cannot be prevented.2, 3 For more information about type I diabetes, check out this website. Even as our knowledge of T2D and its treatment and prevention has grown, the prevalence and incidence of T2D continues to rise.4

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BBC, a well-respected international news and broadcasting organization based out of Great Britain, recently summarized some research that relates to T2D prevention.5, 6 The research showed that eating certain fruits decreased the participants’ chances of getting diabetes. The fruits with the best results were blueberries, apples and grapes. The study also showed that replacing three serving/week of fruit juice with whole fruit lowered the risk of T2D by 7%.2 The study reiterates that reducing the risk of T2D depends upon a well-balanced, healthy diet in addition to physical activity.

In light of this study, my recommendations to diabetic patients will not change nor does the standard of care change. It is generally understood that healthy lifestyle choices are beneficial on many levels. By eating right and exercising, patients can loose weight or maintain a healthy weight, T2D can be prevented and lower need for medications, and risk for other diseases like heart failure and high cholesterol also decreases. Patients have the choice whether or not they want to change how they are living to make healthier choices. As a pharmacist, I can only recommend and encourage patients to continue to make healthier choices. I need to present patients with the facts, which will allow them to make informed choices.

Like with any study, this research has limitations. First, as the BBC article recognized, the study depended upon self-reported fruit consumption.5 People do not always remember exactly what they eat. People could also try to sound healthier than they actually are and therefore not be entirely accurate. In addition, there is inevitable variability between people, some making healthier decisions than others, often referred to as the “healthy user bias”. The researchers recognized these limitations and controlled for some of these variables in their statistical analyzes. Also, in the study design the researchers tried to minimize bias by doing a prospective study and excluding subjects with other chronic diseases. This choice also limits the generalizability of the data to people with multiple chronic disease states. However, it is important to recognize that the outcomes of the study continue to support the growing body of evidence that eating whole fruit in general contributes to reducing risk of T2D.

While the BBC article does not present other references, much literature is available regarding the correlation between healthy lifestyle choices and prevention of diabetes. In general, the research shows that eating leafy greens and fruit help prevent diabetes.7, 8, 9 Studies have shown that diets with low glycemic indexes help prevent diabetes.10, 11, 12 Glycemic index (GI) refers to the effect different foods have on blood glucose levels. Fruits, such as berries, have lower GIs, while bananas and pineapples have higher GIs, yet the study showed that bananas were helpful in reducing the risk of T2D. 2, 6

A significant study in understanding diabetes prevention was The Diabetes Prevention Program.13, 14 The Program tested various methods for prevention of T2D, not limited to fruit consumption. The results showed that intensive lifestyle changes were the best way to prevent T2D. These changes included losing weight with healthy eating and exercise habits in addition to exercising at least 150 minutes per week.13 The other option was using the medication metformin; however, this preventative measure was not as effective as lifestyle modifications.

Statistics show that by 2020, 1 in 3 Americans will have T2D.4 There is a correlation between socioeconomic status, ethnicity, and insurance status and prevalence of T2D.15,16 Many of individuals at risk come from minority groups which continue to grow in the US, contributing to the larger percentage of Americans with diabetes.4, 16 This is a significant issue facing our society, and you need to be aware of your risk for T2D. But there is hope. By taking preventative measures such as changing diet and exercise lifestyles, you do not have live under the prospective shadow of a life-long disease. Consult your doctor or pharmacist if you have any concerns about T2D or making lifestyle changes.

As I think about my future practice in pharmacy, I should consider how to work with my patients who are at risk for T2D. How can I help my patients be more successful in preventing diabetes? How can I encourage and support them in making healthy choices? How can I work to implement healthy life choices into my own life?

 

References

 

  1. Sattley, M. The history of diabetes. Diabetes Health. 2008(Nov 1996):October 12, 2013.
  2. Muraki, I.; Imamura, F.; Manson, J. et al. Fruit consumption and risk of type 2 diabetes: Results for three prospective cohort studies. BJM. August 29 2013:October 12, 2013.
  3. What is diabetes? BBC Science Web site. http://www.bbc.co.uk/science/0/21704103. Published April 19, 2013. Updated 2013. Accessed October 13, 2013.
  4. Allen, J. Half of americans adults are headed for diabetes by 2020, UnitedHealth says. ABC News Web site. http://abcnews.go.com/Health/Diabetes/diabetes-half-us-adults-risk-2020-unitedhealth-group/story?id=12238602. Published November 25, 2010. Updated 2010. Accessed September 15, 2013.
  5. Blueberries, not fruit juice, cuts type-2-diabetes risk. BBC News Web site. http://www.bbc.co.uk/news/health-23880701. Published August 29, 2013. Updated 2013. Accessed September 10, 2013.
  6. Carter, P.; Gray, L.; Troughton, J.; Khunti, K.; Davies, M. Fruit and vegetable intake and incidence of type 2 diabetes: Systematic review and meta-analysis. British Medical Journal. Accessed: October 12, 2013.
  7. Montonen, J.; Järvinen, R.; Heliövaara, M.; Reunanen, A.; Aromaa, A.; Knekt, P. Food consumption and the incidence of type II diabetes mellitus. European Journal of Clinical Nutrition. 2013:59(3):441.
  8. Schwarz. P.; Reddy, P. eds. Prevention of diabetes. 1st ed. United Kingdom: John Wiley and Sons; 2013. http://books.google.com/books?hl=en&lr=&id=5A1mrowD4RYC&oi=fnd&pg=PP1&dq=prevention+of+diabetes&ots=dMe856xCyl&sig=8JmG86gdc98dLgf70pS5nPYAqbQ#v=onepage&q&f=false.
  9. Preventing diabetes. Harvard School of Public Health Web site. http://www.hsph.harvard.edu/nutritionsource/diabetes-prevention/. Updated 2013. Accessed October 12, 2103.
  10. Thoma,s D.; Elliot, E.; The use of low glycaemic index diets in diabetes control. British Journal of Nutrition. 2010;104(6):797.
  11. Marsh, K.; Barclay, A.; Colagiuri, S.; Brand-Miller, J. Glycemic index and glycemic load of carbohydrates in diabetic diet. Current Diabetes Reports. 2011;11(2):120.
  12. Jenkins DJA, Srichaikul K, Kendall CW, et al. The relation of low glycaemic index fruit consumption to glycaemic control and risk factors for coronary heart disease and type 2 diabetes. Diabetologia Clinical and Experimental Diabetes and Metabolism. 2010:October 12, 2013.
  13. Diabetes Prevention Research Group. The diabetes prevention program. Diabetes Journal. 1999;22:623-34.
  14. Ratner R. An update on the diabetes prevention program. Endocrine Practice. 2006;12:20-24.
  15. Center for Disease Control and Prevention. Diabetes report card 2012. National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation. Web site. http://www.cdc.gov/diabetes/pubs/pdf/diabetesreportcard.pdf. Updated 2012. Accessed October 18, 2013, 2013.
  16. Ali, M.; Bullard, K,; Imperatore, G.; Barker, L.; Gregg, E. Characteristics associated with poor glycemic control among adults with self-reported diagnosed diabetes — national health and nutrition examination survey, united states, 2007–2010. June 2012;61:October 12, 2013. 32-36.

Do Artificial Sweeteners Make Us Crave Real Sugar?

Monday, October 14th, 2013

By Julie Cummings, PharmD Student Cedarville University School of Pharmacy

Since Adam took a bite of the apple, we have been self-conscious about our bodies.  Weight management, a good diet and exercise will help the body stay lean.  But what if there is still a problem with diabetes or weight management?  How can one eat better today?  One of the many helpful inventions has been artificial sweeteners.  “Artificial sweeteners are attractive alternatives to sugar because they add virtually no calories to your diet. In addition, you need only a fraction compared with the amount of sugar you would normally use for sweetness”.(1)   They have been used for decades to help with diabetes maintenance and weight management.

Recently, an article about a study on mice and artificial sweeteners called “The Brain Cannot Be Fooled By Artificial Sweeteners – Leading To a Higher Likelihood Of Sugar Consumption Later”  was published on AlphaGalileo’s website.(2) The study was performed at Yale University by Professor de Araujo.  He wanted to study the brain signal that is critical in the choice between artificial sugar and real sugar.   When the body ingests real sugar, the brain sends signals that allow dopamine to rise.  Dopamine is a chemical in the body that makes the person feel “happy”.  When real sugar is broken down in the body into a useable fuel, dopamine is released.  In the study, the mice were given a choice to ingest an artificial sweetener or real sugar.  At the same time, their chemical responses for reward were measured in their brains.  Professor de Araujo found that when the mice were given a choice between real sugar, a substance that required their body to break down for fuel, and an artificial sweetener, they switched to the real sugar instead.  He went on to say that even when the artificial sweetener was sweeter than the real sugar item, they still switched to the real sugar item.  He felt the study would achieve the same results in humans.(2)

The human body is a miraculous invention.  This evidence really doesn’t surprise me that the brain is unsatisfied when not given something it wants.  We see this in instances when our brain is telling us it needs some hydration (water) and our human choice is something other than water, like coffee, tea or soda.  This choice, a lot of times, does not satisfy the brain’s command to hydrate and we remain in a condition of thirst.  A study done in 2010 on the effects of weight gain in children who consumed artificial sweeteners couldn’t find a plausible metabolic effect from the consumption of artificial sweeteners, but concluded that more research should be done on the subject.   Another study, observing girls ages 9 to 10, found the consumption of diet sodas was significantly associated with higher calorie intake.(3)   I do believe that Professor de Araujo may have a point that needs further research.   I would like to see a study performed in adult humans, maybe even with a disease state of diabetes or obesity to truly clarify if these disease states could be affected by the artificial sweetener/real sugar debate.

My thoughts on recommending artificial sweeteners are these:

  1. If the patient’s diabetes or weight management is in control, I would allow my patient to moderately utilize some real sugar with their artificial sweeteners for a trial period.  If they noticed a problem arising with their medical conditions, I would tell them to stop taking the real sugar.
  2. I wouldn’t allow this article to convince me to tell all of my patients to do this.  I may ask them if they notice they are craving “sweet” food or drink items, even though they are utilizing artificial sweeteners.  If they are and are satisfying this craving with binge-full sugar consumption, I would definitely ask them to start mixing artificial sweetener with a little bit of real sugar throughout the day in a more managed fashion.
  3. If my patient is new to the artificial sweetener world, I would rather them use the artificial sweetener for a couple of weeks and ask them to come back or call me about how it is going and then go from there on how to manage their sweetener/sugar intake.
  4. Make sure my patients know the FDA regulates artificial sweeteners and has an acceptable daily intake (different per product) each day for a lifetime.(4)

What would you recommend to your diabetic patient bringing you a box of Sweet-N-Low?  Do you tell her to take it by itself and significantly reduce her sugar intake?   Do you tell her to NOT take artificial sweetener or sugar at all, because she doesn’t need to have anything sweet and see a HUGE reduction in her sugar intake? (She left the pharmacy and probably won’t be back to see that psycho pharmacist, (her words, not mine)!)  Or, do you tell her that there may be a chance that she may need some real sugar with it?

 

References

 

1.  Mayo Clinic Staff. Mayo Clinic Health Information. http://www.mayoclinic.com/health/artificial-sweeteners/MY00073.  Published October 9,2012 Retrieved September 27, 2013.

2.  Wiley. (2013, 9 20). Alpha Galileo Foundation. Retrieved 9 26, 2013, from http://www.alphagalileo.org/ViewItem.aspx?ItemId=134681&CultureCode=en.  Published September 20, 2013 Retrieved September 25, 2013.

3. Brown, R. J., De Banate, M. A., & and Rother, K. I.. Artificial Sweeteners: A systematic review of metabolic effects in youth. International Journhal of Pediatric Obesity, 2010;305-312; doi: 10.3109/17477160903497027.

4. ADAM editorial team). Medline Plus. http://www.nlm.nih.gov/medlineplus/ency/article/007492.htm. Published January 23, 2012 Retrieved September 27, 2013.