Limiting Side Effects

February 13, 2012 Written by JP       [Font too small?]

Health care consumers have greater access to information about drug safety than ever before. A recent edition of the Wall Street Journal illustrates this reality in a piece entitled, “Searching for Side Effects”. A few highlights from the article reveal that medications used to treat diseases including arthritis, diabetes and osteoporosis are associated with hundreds of thousands of adverse reactions. Point taken. Over-the-counter and prescription drugs can be hazardous to your health. But, what in the world are you supposed to do if you present symptoms that seem to require a pharmacological intervention? I suggest seeking out evidence-based alternatives and/or complementary therapies as the first step.

In “Searching for Side Effects”, it describes how two popular drugs (Enbrel and Humira) that treat rheumatoid arthritis (RA) are responsible for over 150,000 documented adverse reactions alone. Fortunately, there are other therapeutic modalities worth considering. A study appearing in the August 2011 issue of The Israel Medical Association Journal reports that combining pomegranate extract with conventional RA care reduces disease activity, oxidative stress and supports cardiovascular health in this at-risk population. Another recent trial conducted in Germany informs that dietary supplements such as fish oil and GLA (gamma-linolenic acid) also safely lower inflammation in those living with rheumatoid and psoriatic arthritis.

According to the Wall Street Journal, Chantix, a medication that supports smoking cessation, is responsible for over 47,000 reported side effects. Practicing mindfulness and/or yoga can also help “kick the habit” – the difference being that the two mind-body approaches confer numerous “side benefits”, including “reduced anxiety and improvements in perceived health and well-being”. Did I mention that they’re both exceedingly safe as well?

This same pattern holds true for medications used to manage multiple sclerosis (MS), an autoimmune disease. MS patients are frequently prescribed the drugs Avonex and Tysabri, which have been linked to more than 77,000 adverse effect reports. Increased fatigue and risk of falling top the list. Once again, a prescription isn’t the only option. A strong body of evidence is building with respect to the use of hydrotherapy or water-based exercise for MS patients. Thus far, some benefits that have been recorded include a decline in fatigue, pain and spasms and improvements in autonomy, mood and physical performance (balance, gait and grip strength).

If none of the previously mentioned conditions or medications apply to you or your loved ones, please take note of the following: Drugs used to treat other prevalent diseases such as diabetes and osteoporosis are also being carefully scrutinized for safety concerns. For instance, many type-2 diabetics use a medication known as Byetta. In an odd turn of events, the most common complaint about the drug is an increase in blood sugar. Forteo, an anti-osteoporotic agent, has been associated with a higher risk of falls. This is the last thing someone with brittle bones needs! On the other hand, effective and safer remedies for both diseases are available and backed by current scientific studies. Two cases in point: diabetics can use fish oil and Vitamin C to lower fasting and long term blood sugar, cholesterol and triglycerides; women concerned about osteopenia and osteoporosis can strengthen their bones by using a supplement containing omega-3 fatty acids, a purified soy extract and Vitamins D3 and K1.

None of this is to say that all natural remedies are always safe and that drugs are never appropriate. In fact, adverse reactions to holistic treatments do occur and are probably underreported in some instances. My point is simply that you inquire about and seek out the safest possible treatment options currently available. This will likely require that you broach this topic of alternative and complementary medicine with your physicians and pharmacists and then do some research on your own. The added effort may just pay off in a more positive healing experience that limits side effects to an absolute minimum.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Consumption of Pomegranate Decreases Serum Oxidative Stress and (link)

Study 2 - Incorporation of N-3 PUFA and Linolenic Acid in Blood Lipids and (link)

Study 3 – Mindful Attention Reduces Neural and Self-Reported Cue-Induced(link)

Study 4 - Yoga as a Complementary Treatment for Smoking Cessation in Women (link)

Study 5 - Hydrotherapy for the Treatment of Pain in People w/ Multiple Sclerosis (link)

Study 6 - Community-Based Group Aquatic Program for Individuals with Multiple (link)

Study 7 - Effects of Eicosapentaenoic Acid and Vitamin C on Glycemic Indices (link)

Study 8 - Effect of a Combination of Genistein, Polyunsaturated Fatty Acids and (link)

Study 9 - Adverse Drug Reactions in a Complementary Medicine Hospital (link)

Study 10 - Complementary Medicine and Safety: A Systematic Investigation of (link)

Dietary Supplements Can Improve Bone Mineral Density (BMD)

Source: Eur J Nutr. 2012 Feb 3. (link)

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Posted in Alternative Therapies, Bone and Joint Health, Diabetes

7 Comments & Updates to “Limiting Side Effects”

  1. Dr Shreya Deshpande Says:

    Very nice post. Exactly it is true that we should seek first the alternative therapies that cause least or no harm to the patient in short and long run. One must also stress on promoting positive health through changing the lifestyle and cutting on to the stress that is the worst culprit in today’s scenario. Thanks for the wonderful post!

  2. JP Says:

    Thank you, Dr. Deshpande.

    I agree wholeheartedly.

    Be well!

    JP

  3. JP Says:

    Updated 08/06/15:

    Note: This study points out the importance of rigorous testing. Sometimes supplements and other therapies do not work as expected.

    http://www.ncbi.nlm.nih.gov/pubmed/26243373

    J Gastroenterol Hepatol. 2015 Aug 4.

    Preventive use of a hepatoprotectant against anti-tuberculosis drug-induced liver injury: A randomized controlled trial.

    BACKGROUND AND AIM: Hepatoprotectants are routinely prescribed in China to prevent anti-tuberculosis drug-induced liver injury (ATLI). However, their biological mechanisms have not yet been clearly demonstrated. This study aims to evaluate the preventive effects of Silybum Marianum against drug-induced liver injury among tuberculosis patients and to provide clinical guidelines for tuberculosis management in China.

    METHODS: A randomized controlled trial was performed in Jiangsu, China. Tuberculosis patients were randomly allocated to the experimental group (anti-tuberculosis therapy plus Silybum Marianum capsule) or the control group (anti-tuberculosis therapy plus vitamin C tablet). The primary outcomes were the occurrence of probable and possible ATLI, the peak AST/ALT ratio and the maximum altered ALP or GGT.

    RESULTS: The final analysis comprised 183 cases in the experiment group and 187 cases in the control group. The risk of developing probable ATLI was not significantly different between the two groups. During the follow-up period, 43.72% of cases in the experiment group and 35.83% of cases in the control group were determined to have possible ATLI (RR = 1.23, 95% CI: 0.94-1.54). When using a more strict definition of possible ATLI, the adjusted RR (95% CI) was 1.76 (1.14-2.56). The risks of adverse drug reactions, prolonged treatment length, taking second-line tuberculosis drugs and the clearance of tuberculosis bacteria were similar between the two groups.

    CONCLUSIONS: No significant preventive effect of silymarin was found for either lowering the risk of liver injury or boosting the positive outcomes. Worse, we even found a potential risk of liver damage caused by the hepatoprotectant.

    Be well!

    JP

  4. JP Says:

    Updated 08/06/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26242890

    Integr Cancer Ther. 2015 Aug 4.

    Forming a Stress Management and Health Promotion Program for Women Undergoing Chemotherapy for Breast Cancer: A Pilot Randomized Controlled Trial.

    OBJECTIVE: To assess the effects of an 8-week stress management and health promotion program on women undergoing breast cancer chemotherapy treatment.

    PATIENTS AND METHODS: A total of 61 patients were recruited in 2 cancer centers and were randomly assigned to the intervention program (n = 30) or control group (n = 31). The intervention program consisted of different stress management techniques, which were combined with instructions for lifestyle modification. Assessments were carried out through questionnaires and measurement of body mass index (BMI) at baseline and at the end of the 8-week program.

    RESULTS: In all, 25 participants completed the intervention program, whereas 28 participants completed the observational control program. The intervention program resulted in a small effect size on internal dimension of Health Locus of Control (HLC) and a medium effect size on stress, depression, anxiety, night sleep duration, and chance dimension of HLC. A strong effect size was recorded for BMI and sleep onset latency. Self-rated health, spiritual well-being, and powerful others dimension of HLC were not significantly affected. Additionally, some of the participants reported a reduction in the side effects caused by chemotherapy.

    CONCLUSIONS: The intervention resulted in several benefits for the general health status of patients. Therefore, it should be considered as feasible and potentially beneficial for women undergoing breast cancer chemotherapy. However, it is necessary for this intervention to be tested through a randomized controlled trial in a larger sample of patients before adopting this program in standard cancer care.

    Be well!

    JP

  5. JP Says:

    Updated 08/06/15:

    http://ict.sagepub.com/content/early/2015/07/27/1534735415596573.abstract

    Integr Cancer Ther. 2015 Jul 28.

    Acupuncture for Aromatase Inhibitor-Induced Arthralgia: A Systematic Review.

    BACKGROUND: Aromatase inhibitors (AIs) are commonly used as adjunctive hormone treatment for early breast cancer patients. The major side effect of AIs is arthralgia, which affects adherence. Previous reviews suggested that acupuncture is effective in the management of cancer-related pain. The aim of this review is to evaluate the effects of acupuncture on arthralgia caused by AIs.

    METHODS: This article examined randomized controlled trials (RCTs) measuring the effects of acupuncture on joint symptoms caused by AIs within 8 medical databases till May 2014. The quality of the articles was evaluated according to the Cochrane risk of bias (ROB) tool.

    RESULTS: Four RCTs were identified in medical journals. Two studies were conducted with manual acupuncture and 2 studies were electroacupuncture. The range of sample size was between 32 and 67. One RCT showed significant improvement in the acupuncture group compared with the sham control group and another RCT showed a statistical difference between the electroacupuncture and waitlist group. The other 2 studies showed no statistical differences between control and acupuncture groups. Two studies conducted blood analysis to elucidate the mechanism of efficacy of acupuncture for arthralgia. The 2 positive studies had a lower ROB and 2 studies had a high ROB.

    CONCLUSIONS: The systematic review suggests that acupuncture has potential benefits to improve arthralgia caused by AIs. However, further trials of adequate sample size, appropriate control group, and longer follow-up are necessary to investigate the efficacy of acupuncture in AI-induced arthralgia.

    Be well!

    JP

  6. JP Says:

    Updated 08/06/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462721/

    World J Gastroenterol. 2015 Jun 14;21(22):6817-9.

    What are the effects of proton pump inhibitors on the small intestine?

    Generally, proton-pump inhibitors (PPIs) have great benefit for patients with acid related disease with less frequently occurring side effects. According to a recent report, PPIs provoke dysbiosis of the small intestinal bacterial flora, exacerbating nonsteroidal anti-inflammatory drug-induced small intestinal injury. Several meta-analyses and systematic reviews have reported that patients treated with PPIs, as well as post-gastrectomy patients, have a higher frequency of small intestinal bacterial overgrowth (SIBO) compared to patients who lack the aforementioned conditions. Furthermore, there is insufficient evidence that these conditions induce Clostridium difficile infection. At this time, PPI-induced dysbiosis is considered a type of SIBO. It now seems likely that intestinal bacterial flora influence many diseases, such as inflammatory bowel disease, diabetes mellitus, obesity, non-alcoholic fatty liver disease, and autoimmune diseases. When attempting to control intestinal bacterial flora with probiotics, prebiotics, and fecal microbiota transplantation, etc., the influence of acid suppression therapy, especially PPIs, should not be overlooked.

    Be well!

    JP

  7. JP Says:

    Updated 12/27/15:

    https://www.jstage.jst.go.jp/article/tjem/237/3/237_183/_html

    Tohoku J Exp Med. 2015;237(3):183-91.

    Blueberry Improves the Therapeutic Effect of Etanercept on Patients with Juvenile Idiopathic Arthritis: Phase III Study.

    Juvenile idiopathic arthritis (JIA) is the most common arthritis in the adolescents under the age of 16. Etanercept, an inhibitor of tumor necrosis factor, is often used to treat JIA despite its significant side effects. Homeopathic remedies, such as blueberries, have anti-inflammatory properties with fewer unwanted effects and should be considered as a primary treatment. We aimed to explore the efficacy and safety of combination therapy of blueberry and etanercept for JIA. Two hundred and one JIA patients were selected, and randomly and evenly assigned to three groups: ETA (50 mg of etanercept twice weekly), ETABJ (matched etanercept and 50 ml blueberry juice daily) and ETAPJ (matched etanercept and placebo juice). The severity of JIA was measured using American College of Rheumatology scales (ACR) 20, 50 and 70. The levels of pro-inflammatory cytokines, interleukin-1 (IL1) alpha and IL1 beta, and interleukin-1 receptor antagonist (IL1RA) were measured by qRT-PCR and ELISA. After a 6-month follow-up, the ACR20, ACR50 and ACR70 in an ETABJ group were higher than those in other two groups (P < 0.05), suggesting clinically meaningful improvement in JIA. Meanwhile, the symptoms and side effects were reduced significantly or absent in an ETABJ group, including mental diseases, retrobulbar optic neuritis, gaining weight, infection, cutaneous vasculitis, diarrhea, uveitis and pancytopenia. Blueberries reduced the levels of IL1 alpha and beta, and increased the level of IL1RA. Thus, a combination therapy of blueberry and etanercept can reduce the severity of JIA and should be developed as a new method for JIA therapy.

    Be well!

    JP

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