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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
June 7, 2014

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Lunesta Starting Dose Cut in Half
Portrait of the Global Obesity Pandemic
Industry-Funded Study Finds Diet Soda Consumption Didn't Hinder Weight Loss
New Biochemical Explanation for Effects of Bariatric Surgery
FDA Approves New Sugar Substitute
How Does Your Cereal Measure Up?
Drug Makers Move Towards Over-the-counter Cialis
More Time Engaged in Light Physical Activity Is Associated with Less Disability
Long-Term Physical Activity Program Reduces Loss of Mobility in Older Adults
Exercise: Can there Be Too Much of a Good Thing?

MM: Sleep problems are a massive healthcare issue and sleeping aids have been discovered to be a health risk as well. The question arises, "Which is worse? The problem or the treatment?" That is a tough one to answer. I feel that coaxing the system into making its own melatonin and serotonin by modulating their production is the best approach. It resets the body clock, encourages deep REM sleep and has no addictive properties. The problem is that it is a relatively slow approach and may take several weeks to accomplish. Most people with sleep problems are simply not willing to wait. Mark Drugs has a protocol that has demonstrated excellent results in modulating the sleep system and endogenous chemical cues for sleep and wakefulness. Please contact us so we can help to restore your natural sleep balance.
Lunesta Starting Dose Cut in Half
The FDA cut in half the recommended dose of Lunesta, concluding some patients were impaired the morning after taking it even if they felt fully awake. Lunesta, made by the Sunovion Pharmaceuticals unit of Japan's Dainippon Sumitomo Pharma Co., generated U.S. sales in 2013 of $867 million. The drug was introduced in 2005.
About a year ago, the FDA made a similar cut in the recommended dose for zolpidem, sold generically and under brand names including Ambien, made by Sanofi. The FDA says it continues to scrutinize the possible risk of impaired mental alertness with all sleeping aids, including those sold over the counter.
The FDA said data from clinical studies had recently become available that allows the agency to better understand the extent of next-morning impairment.

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MM: We have long suspected that this was a problem not limited to the United States but the insidious nature that this pandemic appears to have manifested is beyond belief. It appears to supersede famine in countries that have a limited source of resources and may mean that it is not the amount of food that one eats but the type that can cause the greatest problems. Empty fat and carbohydrates that lack nutritional value or proteins that can't be well-absorbed may contribute to this problem. It is time to re-examine where we are presenting our energies to fight world hunger and discover if we are doing good or harm. This wouldn't be the first time in history that efforts intended towards good were misdirected.
Portrait of the Global Obesity Pandemic
By Larry Husten
A new, comprehensive analysis published in the Lancet paints a frightening portrait of the worldwide obesity pandemic.
The Global Burden of Disease Study 2013 found that from 1980 through 2013, the worldwide prevalence of overweight and obesity rose by 28% for adults and by 47% for children. The result was an absolute increase from 857 million overweight and obese people in 1980 to 2.1 billion in 2013.
For men, the proportion with a BMI of 25 or greater increased from 29% to 37%. For women, the proportion increased from 30% to 38%. Increases were observed in every country, but in developed countries, there were more men than women who were overweight or obese, and in developing countries, the pattern was reversed.
The biggest gains in overweight and obesity occurred between 1992 and 2002. One hint of good news: The increase in adult obesity appeared to slow starting in 2006.
Adapted from CardioExchange
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MM: If this study does not meet the criteria of the fox guarding the henhouse then I simply fail to understand that old adage. The fact that the beverage industry sponsored and funded this study has to raise eyebrows and if it doesn't then I have to think that whoever ignores this is looking for a self-fulfilling prophecy. Using the scale and weight alone as a measure of obesity is quite typical and a very easy measurement but it is a very poor one since it fails to examine the relative amount of fat, muscle tissue and both intra- and extracellular water. These markers and much better indicat
ors of whether a person is truly healthy. After all, if we measure only weight, how do we know if a person is thin on the outside but fat on the inside?

Industry-Funded Study Finds Diet Soda Consumption Didn't Hinder Weight Loss
By Kelly Young
Patients may ask about a study in Obesity finding that people who drank diet soda while in a weight-loss program lost more weight than those who drank water. The study was funded by the American Beverage Association.
Roughly 300 adults (mean BMI, 33) who regularly drank diet soda were randomized to either continue drinking diet soda (24 ounces daily) or switch to water. Both groups attended weekly behavioral weight-loss meetings.
At 12 weeks, participants in the diet soda group had lost significantly more weight than those in the water group (5.95 kg vs. 4.09 kg). Weekly hunger scores were slightly lower in the diet soda group.
The authors conclude: "These results strongly suggest that [diet sodas] can be part of an effective weight loss strategy and individuals who desire to consume them should not be discouraged from doing so because of concerns that they will undermine short-term weight loss efforts."
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MM: Again we see a strong relationship between gut flora, probiotic administration and obesity. The evidence continues to mount supporting the use of probiotics, weight loss and weight management. A healthy gut microbial environment has repeatedly been demonstrated to reduce inflammation, enhance the immune system and generally help to stabilize the mammalian organism irrespective of the species.
Nature 2014 May 8; 509:183
New Biochemical Explanation for Effects of Bariatric Surgery
In mice, the gut microbiome changed dramatically in response to surgery when a particular receptor was present
The original theory behind restrictive bariatric surgery was simple and anatomically plausible: Create a smaller, more easily filled stomach, and satiety will lead to decreased caloric intake. However, some beneficial metabolic changes (e.g., glucose tolerance) occur within days after bariatric surgery, before weight loss ensues. A new study confirms that biochemistry might be more important than anatomy.
An international team postulated that binding of bile acids to a nuclear receptor called FXR — which is expressed in metabolically active organs such as liver, adipose tissue, and intestine — was key to many of the benefits realized after vertical sleeve gastrectomy (VSG; resection of about 80% of the greater curvature of the stomach). To test this theory, they conducted either VSG or sham surgery on normal mice or mice without the gene for FXR. VSG in normal mice (but not FXR-deficient mice) led to sustained beneficial metabolic changes and to higher levels of circulating bile acids. As expected, sham surgery was not followed by sustained changes in bile acids or metabolic parameters. In normal mice that received VSG (but not in normal mice that received sham surgery or in any FXR-deficient mice), researchers noted a prompt and dramatic change in gut bacterial flora; other studies have linked such changes in the gut microbiome to the beneficial metabolic changes reported in this study.
Comment: A particular biochemical pathway appears to be central to the sustained beneficial metabolic changes that occur after bariatric surgery. And, these changes are linked strongly to changes in the gut microbiome.
Citation(s): Ryan KK et al. FXR is a molecular target for the effects of vertical sleeve gastrectomy. Nature 2014 May 8; 509:183.
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MM: Do we really believe that this artificial sweetener will be any less hazardous than aspartame? The chemical is very similar and has the same degradation dangers. What is the FDA thinking of with this?
FDA Approves New Sugar Substitute
By Kristin J. Kelley
The artificial sweetener advantame has been approved for use as an all-purpose sweetener, making it the sixth sugar substitute to get the nod from the FDA.
Advantame, which was deemed safe from possible toxic effects in some 35 animal and human studies, does not raise blood sugar levels and adds few calories to food. Like aspartame, it should be avoided by people who can't metabolize phenylalanine, one of the sweetener's ingredients.
The product has no brand name yet.
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How Does Your Cereal Measure Up?
By Kelly Young
A child who eats a bowl of cereal every day could end up consuming 10 pounds of sugar over a year, according to an analysis of over 1500 cereals by the Environmental Working Group.
Some of the winners in terms of low sugar include Rice Krispies, Cheerios, Chex, and Crispix. Cereals that made the EWG's Hall of Shame, which requires that the cereal contain at least 50% sugar by weight, include Honey Smacks, Golden Puffs, and Golden Crisp. Granolas are also high on the sugary list.
The EWG recommends that people consume no more than a teaspoon (4 grams) of sugar per serving. They also tell consumers to keep in mind that serving sizes listed on cereal packaging are notoriously small.
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MM: Eli Lilly, the Indianapolis based pharmaceutical manufacturer was once a giant in the antibiotic and pain management business. In the past decade or so they have fallen to a second tier manufacturer. No new products blockbuster have been introduced and the antibiotic train seems to have left the station for the present. It is no wonder that they would get involved in a "novelty" type of product and present it to the American public with little thought of secondary adverse effects such as masking or ignoring other insidious diseases such as diabetes.
Drug Makers Move Towards Over-the-counter Cialis
By Amy Orciari Herman
The manufacturer of the erectile dysfunction drug tadalafil (Cialis) struck a deal with another drug maker to sell an over-the-counter version of the pill if federal regulators approve, the Wall Street Journal reports.
The manufacturers will need to demonstrate that tadalafil can be used safely and effectively without a prescription. One safety concern: Tadalafil may cause sudden drops in blood pressure when combined with certain heart medications. In addition, if men treat their impotence without seeing a doctor, underlying medical conditions (e.g., diabetes) might go undiagnosed and untreated.
If approved, OTC versions of tadalafil would not hit U.S. and European markets before 2017, when the drug's patents expire.

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MM: Once again, another study that supports the premise that the human body is designed to be mobile and not sedentary. Light to moderate activity seems to be a very important part of health and of lifestyle management. Numerous studies support that longevity, quality of life and general happiness are improved by regular exercise of virtually any type.
BMJ 2014 Apr 29; 348:g2472
More Time Engaged in Light Physical Activity Is Associated with Less Disability
Even small increases in activities such as casual walking or light housework might confer substantial benefits.
Physical activity improves health outcomes and lowers disability risk. Current guidelines recommend 150 minutes weekly of moderate-to-vigorous–intensity activity, but whether light-intensity activity lowers risk for disability is unclear. In this prospective study, investigators determined whether time spent in light-intensity activity (e.g., casual walking, pushing a grocery cart, light housework [personal communication from an author]) was associated with incident disability (i.e., limitations in instrumental or basic activities of daily living) or disability progression in 1814 adults (age range, 49–83) with or at high risk for knee osteoarthritis. Physical activity was measured using accelerometers.
During 2 years of follow-up, the incidence of new disability was 33% to 49% lower among those in the three highest quartiles of daily light-activity time (>229 minutes) than among those in the lowest quartile (<229 minutes) after adjustment for various factors (including time spent in moderate-to-vigorous activity). Additionally, in analyses that included participants with mild-to-moderate disability at baseline, those in the upper quartiles of light-activity time were at lower risk for disability progression.
Comment In this study, greater time spent in light physical activity was associated with lower risks for disability and disability progression, independent of moderate-to-vigorous activity. This was an observational study, so it does not prove that light physical activity protects against disability. As the authors and an editorialist note, small increases in light physical activity might confer substantial benefits: The difference in mean time spent daily in light physical activity between the lowest and second lowest quartiles was only 1 hour, yet the latter group had much lower disability risks.
Citation(s): Dunlop DD et al. Relation of physical activity time to incident disability in community dwelling adults with or at risk of knee arthritis: Prospective cohort study. BMJ 2014 Apr 29; 348:g2472.
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MM: It is important to be consistent with having physical activity. It is more beneficial to walk, run, jog or do an activity of moderate intensity 3-5 times a week rather than simply an intense activity 1-2 times weekly.
Long-Term Physical Activity Program Reduces Loss of Mobility in Older Adults
By Amy Orciari Herman
A long-term, moderate-intensity physical activity program reduces major mobility disability among at-risk older adults more effectively than a health education program, a JAMA study finds.
Some 1600 adults (aged 70 to 89) who had physical limitations but were able to independently walk 400 m in under 15 minutes were randomized to an activity or education group. The activity intervention included walking (goal, 150 min/week) plus strength, flexibility, and balance training; exercises were performed in a center and at home several times a week. The education group attended frequent workshops focused on "successful aging."
The study lasted roughly 2.5 years. Major mobility disability — loss of the ability to walk 400 m in under 15 minutes — occurred significantly less often in the activity versus education group (30% vs. 36% of participants). Serious adverse events did not differ significantly between the groups.
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MM: Moderation seems to be the key to getting the greatest effects from exercise. If the physical activity is extremely great, it acts as an added stressor to the body thereby increasing cortisol production, diminishing immune function and increasing adrenal fatigue leading to an increased risk of metabolic syndrome.
Exercise: Can there Be Too Much of a Good Thing?
By Larry Husten
Two studies in the journal Heart suggest that health benefits may be curtailed in people who exercise very frequently or very intensely.
In the first study, researchers analyzed data from exercise questionnaires and hospital records of nearly 45,000 Swedish men. Men who exercised intensively more than 5 hours a week at the age of 30 were more likely to develop atrial fibrillation (AF) than men who exercised less than 1 hour a week. Their risk was even higher if they subsequently quit exercising later in life.
In the second study, researchers followed more than 1000 patients with coronary heart disease. Overall, patients who exercised strenuously 2–4 days a week had the lowest risk for death and cardiovascular events. But there was an increase in risk in both the group who rarely exercised and in those who exercised every day.
Editorialists speculate that intensive exercise may have a proinflammatory effect that may be especially harmful in some people with atherosclerotic disease.
Adapted from CardioExchange.

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