The term “side effects” is a euphemism for the adverse, toxic effects of medical drugs. And keep in mind that often the desired, sought-after effects are also toxic. For instance, acid-blockers work by poisoning the cells that produce stomach acid. Impairing the production of stomach acid is certainly a toxic effect in my book, since producing stomach acid is normal and healthy.
But, the biggest problem with the popular understanding of “side effects” is that if they don’t manifest visibly and palpably that they don’t exist. It’s often assumed that if a medical drug is well tolerated in the act of taking it, if it doesn’t cause you pain or discomfort, that it must be safe. That is a delusion. Let’s say, for instance, that a drug is poisoning the cells in your bone marrow which produce blood cells. So, those cells are under attack, and they start producing abnormal, defective blood cells, whether red, white, or platelets, or a combination. Are you going to feel anything? Probably not and for a long time. There are no pain receptors in your bone marrow. And if your blood contains abnormal cells, that is a high number of them, you won’t necessarily feel anything right away either. Eventually, say if you become anemic from the toxic effect of a medical drug, you’ll start experiencing symptoms, such as fatigue, shortness of breath, lack of stamina, paleness, etc. But, by then, by the time symptoms appear, the condition will be advanced. The early and intermediate stages of the drug-induced pathology will probably entail no symptoms at all.
It’s quite true that some people may tolerate a medical drug better than other people. And the converse is also true that some people may not tolerate a medical drug that most tolerate. Take, for instance, statin drugs. Statin drugs cause muscle breakdown which can lead to pain, which is very common. But, in some people, the muscle breakdown is so great that it overwhelms the kidneys with the breakdown products of muscle protein. And, the result is they go into kidney failure. Of course, not everybody goes into kidney failure from taking a statin, but, I think it’s fair to say that everybody heads in that direction from taking a statin. Statins increase the risk of kidney failure, diabetes, and cancer. And that’s in everybody. And that’s in exchange for what? A vanishingly small statistical reduction in heart disease risk? It’s so small that 100 people would have to take statins for 10 years in order for 1 of them to avoid 1 heart attack. The risk/reward ratio for those drugs is absolutely appalling.
Antibiotics are another class of drug that work by poisoning. The whole idea of them is to poison: bacteria. And you hope that that can be done without poisoning you- very much. But, at least with antibiotics, it’s usually a temporary thing. You take them for a week, maybe 10 days; maybe even 2 weeks. But, it’s not a life sentence. However, there are many drugs that are meant to be a life sentence. They put you on blood pressure drugs with the expectation that it is a life sentence. They put you on diabetes drugs with the same expectation. When they put you on drugs for arthritis, they don’t expect you to ever stop taking them. It’s meant to be permanent.
And even drugs that are supposed to be for temporary use often wind up being permanent or at least long-term. For instance, most sleeping pills say that you should only take them for 10 days. But, if people were only going to take them for 10 days, how could the drug company afford the expensive ads? They know very well that people go on Ambien or another sleep drug for years and years and years. That includes drugs that were only tested for 6 weeks, meaning that they tested the safety of the drug over just 6 weeks of use.
So, there is no such thing as a “side effect.” There are only effects. And most drugs not only have toxic effects but work in their desired effect through poisoning something.
The fact is that there are very few drugs in Medicine that anyone with sense should want to take. Almost always, there are alternatives to taking medical drugs. And oftentimes, just living with your condition, whatever it is, is superior to treating it with medical drugs. I kid you not.
The time has come not only to reevaluate medical drugs, but to reevaluate our attitude towards medical drugs. They are, generally speaking, harmful and dangerous, and that is a fact.
People who blame pasta for weight gain have missed the message about the Mediterranean diet, according to Italian researchers. The team from the IRCCS Neuromed Institute in Italy crunched the numbers from earlier studies involving more than 20,000 Italians and discovered that pasta intake was associated both with lower obesity rates and healthier waist-to-hip ratios.
"We have seen that consumption of pasta, contrary to what many think, is not associated with an increase in body weight," researcher George Pounis says in a press release. The team's research was published this week in the Nature journal Nutrition & Diabetes.
The researchers say their findings show that people trying to lose weight are wrong to completely banish pasta from their diets, reports UPI, which notes that pasta sometimes gets the blame for weight gain when it's used as a "vehicle for overly salty, sugary, fatty sauces."
A nutrition professor at the University of Reading says that the results appear solid, with pasta intake in this case demonstrating adherence to the Mediterranean diet. "These results clearly show that it is wrong to demonize carbohydrates as the data clearly shows that consumption of a carbohydrate-rich food such as pasta does not have an adverse effect on body weight," he says.
Dr. Cinque: This doesn't surprise me in the least. And two other positive things about pasta are that it's usually is eaten with tomato sauce, which is healthy because of its high lycopene content, that is more available than in fresh tomatoes, and the simple fact that pasta mixes very well with vegetables, such as zucchini, spinach, peppers, etc., and eating more vegetables is absolutely good.
What I do is use half whole wheat and half regular pasta. That way, I get the benefit of some whole grain, yet, it still tastes like pasta, as we know it. Using all whole wheat makes for a much stronger and different taste that some may like and some may not. But, going 50/50 is something that everyone can do- painlessly.
I appreciate seeing articles like this that fight the demonization of carbohydrates. It's perfectly natural and normal to eat some carbohydrates. I don't say you have to eat pasta. Certainly, you can live without it. But, in that case, you should eat other carbohydrates. Avoiding them completely is ridiculous. But, I feel that way just as strongly about fats. Avoiding fats completely is ridiculous. It's perfectly natural and normal to eat some fats. And, would you believe that until a few years ago, it was taught that we can't taste fats, that our experience in eating them is all about "texture" and not taste? Fortunately, a few years ago it was discovered and announced that there are fat-detecting taste buds that are abundant and very sensitive.
Eschewing all carbohydrates or eschewing all fats is an extreme thing to do. Either one may result in some weight loss, and that's because in either case, you are throwing out a major class of food, and it is almost certain that you are going to reduce your caloric consumption. And frankly, it's a shock to your system. What I do is eat healthy carbs and healthy fats, and I round it out with a lot of fresh produce. And doing that, I stay thin. I weigh the same at 65 that I did at 35. I am not the least bit interested in eating a low-fat diet or a low-carb diet. My goal is to eat a healthy diet which includes both carbs and fat, with moderate caloric consumption, and a lot of vigorous exercise. Both carb-avoidance and fat-avoidance are extremely extreme. So, don't do either one.
This is an article about Vitamin D deficiency and its role in heart disease by a leading cardiologist. Note the statistics on Vitamin D deficiency among Blacks and Hispanics, and that's because of their darker skin. She advises that one shouldn't take more than 4,000 IUs without a doctor's approval, but the Vitamin D Foundation, which is run by a doctor, recommends 5000 IUs daily for most people. However, this time of year (summer) if you get plenty of sun, as I do, you should cut back. What I do is take 5000 IUs of Vitamin D3 every day for most of the year, but in June, July, and August, I cut back to 5000 IUs every other day. Dr. Cinque
The author: Dr. Erin Michos, a preventive cardiologist and researcher at Johns Hopkins, has been studying the potential impact of vitamin D and cardiovascular health for over 10 years. Ironically, at her last annual checkup, Michos -- an avid outdoor runner -- was shocked to learn that she, too, was vitamin D deficient with a blood level of only 15 nanograms per milliliter. Should she take a vitamin D supplement for her heart health? In this piece, Michos and her internal medicine colleague Samuel Kim discuss the "sunshine" vitamin.
Vitamin D: Does it Even Matter?
Vitamin D is a hormone that helps control calcium levels in your body, which is ultimately important for your overall bone health. Vitamin D is produced in the skin from exposure to ultraviolet B rays in sunlight or taken in from food or dietary supplements. However, only limited food sources contain vitamin D, such as fatty fish, cod liver oil, eggs, milk, cereal and bread.
It's well-known that vitamin D is important for bone health. Very low levels of vitamin D can cause low levels of calcium in your blood, which can increase your risk of bone fractures, tingling and numbness sensation, and muscle weakness.
Recent research, including many of the studies that Michos conducted, has found that the sunshine vitamin may also be linked to other health conditions, like an increased risk of heart disease, stroke, diabetes, high blood pressure, abnormal cholesterol levels, erectile dysfunction and obesity.
Still, most of these observational studies do not prove a cause and effect because they don't involve intervention to correct low vitamin D levels. Having a low vitamin D level may simply be a risk marker indicating an individual is less healthy from other causes. Further research needs to be conducted to see if treating vitamin D deficiency through vitamin D supplementation can impact vascular disease outcomes. Fortunately, randomized clinical trials to answer this question are ongoing.
Who Becomes Vitamin D Deficient?
There are three major groups of people who develop vitamin D deficiency:
1. People who do not get enough vitamin D either through diet or sunlight exposure. Inadequate sunlight exposure is a problem for many people, especially darker-skinned individuals, those who use sunscreen for skin cancer protection and those who live in sun-limited areas in northern parts of the U.S.
2. Patients with kidney and liver diseases can have low vitamin D levels because they have decreased levels of important proteins that metabolize vitamin D.
3. Patients with bowel diseases, such as celiac disease, Crohn's disease and cystic fibrosis, or who have had any surgery that removes or reconnects the intestines or stomach cannot readily absorb vitamin D.
Who Should Get Tested?
In general, routine testing of vitamin D is currently not recommended except for people with kidney diseases, bowel diseases and a higher risk of osteoporosis, including previous bone fractures and low calcium levels.
When testing for vitamin D deficiency, physicians order the blood test for 25-hydroxyvitamin D concentration. This is the form of vitamin D that is the best measure of vitamin D stores in the body.
There is some controversy though about what is considered a normal amount of vitamin D in a blood test. The Institute of Medicine says that blood levels of 25-hydroxyvitamin D greater than 20 nanograms per milliliter should be adequate. However, many experts, including the Endocrine Society, advocate for levels greater than 30 nanograms per milliliter.
Because of the widespread use of sunscreen and more time spent indoors, particularly for occupational work, vitamin D deficiency is actually quite common. In the U.S. alone, the National Health and Nutrition Examination Survey found that over 40 percent of the American population was deficient in vitamin D (levels less than 20 nanograms per milliliter), with the highest rates seen in African-Americans (82 percent) and Hispanics (69 percent).
How Do You Treat Vitamin D Deficiency?
Vitamin D can be obtained from diet, but food sources generally have small quantities. In the absence of adequate sunlight exposure, it can be difficult to get enough vitamin D from diet alone. As a reference, 1 cup of milk (8 ounces) is roughly equal to about 100 International Units of vitamin D. For individuals with fair skin, 15 to 30 minutes of midday sun exposure during the summer months can give you close to 5,000 IU a day -- the equivalent of drinking 50 glasses of milk! Dark-skinned individuals and the elderly may produce less vitamin D in response to sunlight.
Prolonged peak sunlight exposure is not recommended for patients with a higher risk of skin cancer, especially individuals who are fair-skinned. Vitamin D from tanning beds is also not recommended given the high risk of skin cancer development.
In addition to diet and sunlight, you can get vitamin D from supplements. Vitamin D supplements come in either D2 (ergocalciferol) or D3 (cholecalciferol) forms. We generally recommend D3, since this is the form that is naturally produced in the body by sunlight, but either supplementation is reasonable. Most supplements at lower doses can be purchased over the counter without a prescription.
It is not completely clear what the ideal vitamin D intake goals should be for each individual. The U.S. Preventive Services Task Force recommends that all adults should intake at least 600 to 800 IU daily. The National Osteoporosis Foundation recommends somewhere between 800 to 1,000 IU daily for adults over age 50.
For patients with vitamin D deficiency, the guidelines recommend an initial treatment with a 50,000 IU vitamin D booster pill -- which normally requires a doctor's prescription -- once a week for eight weeks, then transitioning to a once-a-day supplementation between 1,500 and 2,000 IU. Patients on seizure medications, steroids, antifungals and HIV antiviral medications are often recommended to take two to three times more vitamin D because these medications can increase vitamin D metabolism. Personalized vitamin D treatments can be discussed with your doctor.
[See: The 12 Best Diets for Your Heart.]
What Are the Side Effects of Vitamin D Supplements?
In general, the side effects from vitamin D supplements are uncommon and relatively benign. However, high doses could lead to high calcium or phosphorous levels, increased thirst, a metallic taste in the mouth, tiredness, constipation and kidney stones. Although vitamin D toxicity is rare, it's not recommended to take more than 4,000 IU a day, unless a doctor is also monitoring your blood levels.
So What Does All This Mean for Me?
Vitamin D deficiency is common in the U.S., especially because many of us stay indoors and do not eat vitamin D-rich foods. There are reasonably good data to support the use of vitamin D supplementation by patients with a higher risk of osteoporosis. However, the benefit of supplementation in the normal aging population remains unclear.
Although there are more data to suggest that vitamin D deficiency may increase the risk of heart diseases, high blood pressure and obesity, it is not unclear at this time if and how vitamin D treatment will improve the development or progression of these diseases. More research is needed. Also, vitamin D treatment may only benefit those with deficiency, not individuals who already have adequate levels from sunlight and diet.
Back to our case about the author: Despite her physical activity levels, perhaps it isn't so surprising that Michos ended up vitamin D deficient. She eats a largely vegetarian/vegan diet, does most of her outdoor physical activity in the early morning, avidly uses sunscreen in the summer and lives in the northern part of the U.S. -- all known risk factors for deficiency.
In the end, Michos decided take a vitamin D supplement for her bone health, particularly because of her family history of osteoporosis. But at this time, despite her own research, she cannot recommend vitamin D for the sole purpose of preventing heart and related vascular diseases. As mentioned, there are several large randomized clinical trials ongoing now to test whether vitamin D treatment can reduce the risk of heart disease, cancer, diabetes and death. Hopefully, the results of these trials will inform future recommendations to patients.
Dr. Erin Michos is a cardiologist and associate professor of medicine at the Johns Hopkins University School of Medicine with a joint appointment in epidemiology at the Johns Hopkins Bloomberg School of Public Health. She is the associate director of preventive cardiology for the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Her research interests focus on general preventive cardiology, cardiovascular health in women, vitamin D and management of lipid disorders.
Did you know that a tall Starbucks has about 7.6 times the caffeine of a can of Coke and 5.8 times that of a Diet Coke? That’s a flood of caffeine. A tall 12 ounce regular Starbucks coffee has 260 mgs. But, a Grande has 340! And a Venti has 420! Yikes!
A 12 ounce Coca Cola has 34 mgs of caffeine. A Diet Coke has a bit more: 45 mgs.
So you’d have to drink 8 Cokes or 6 Diet Cokes to equal the amount of caffeine that you get from one Starbucks coffee.
Coffee actually varies a lot in how much caffeine it contains. Typically, a 12 ounce cup of regular non-Starbucks coffee has 100 to 260 mgs caffeine. The average works out to 180 mgs caffeine.
A 12 ounce can of Red Bull (which is the larger one) contains 114 mgs of caffeine.
Decaf coffee is not completely devoid of caffeine. The average cup of decaf has 5 mgs. However, Starbucks decaf has 9 to 12 mgs of caffeine.
A two-ounce 5-hour energy has 138 mgs of caffeine. That’s in the same ballpark as a cup of coffee, but remember, it’s just 2 ounces. Imagine if you drank 6 of them to equal the 12 ounces. You’d get 828 mgs of caffeine, which could actually be lethal.
Two tablets of Excedrin has the same amount of caffeine, essentially, as one 5-hour energy. So, if you take two tablets, the standard dose, it’s like drinking one 5-hour energy.
Coffee ice cream is pretty darn caffeinated. 8 ounces has 45 to 75 mgs of caffeine, so more than a can of soda.
Chocolate is relatively low in caffeine, but it does have some. Each Hershey’s kiss has 1 mg. Each Reese’s peanut butter cup has 4 mgs. Each Milky Way candy bar has 14 mgs of caffeine.
Tea has less caffeine than coffee but more than chocolate. Each 12 ounce cup of tea has 72 mgs of caffeine. You can get rid of most of the caffeine in tea by steeping it the first time, discarding that liquid, and then steeping it again with the used tea bag. Most of the caffeine comes out in the first steeping, so this is an easy, practical way to decaffeinate tea.
Each little No-Doz pill (the over-the-counter stimulant drug) has 200 mgs of caffeine, and the same is true for Vivarin.
I thank Dr. Linda Carney, MD of Buda TX for this information.