downside of marijuana

Be Aware of the Downsides of Marijuana

Concierge Medicine, Medications

Florida legalized the use of medical marijuana this past March. Thirty-four other states have already done so, and 10 states and the District of Columbia have legalized the use of recreational marijuana. But our concierge family doctors at MD 2.0 in Jupiter want to offer a few words of caution about the possible downsides of this increasingly legal drug.

First, be aware that any drug can cause side effects. This includes prescription or over-the-counter (OTC) medications, alcohol, even aspirin. Every body is unique, and reacts differently to different substances. What can cause problems for some people won’t have the same effect in others.

That said, despite many decades of illegal use, little scientific research has been performed on marijuana because until recently federal law has forbidden any scientific studies of the drug. So reports of its effects are largely anecdotal. Many users compare it favorably to alcohol, noting the lack of a hangover after use, the lower potential for addiction, and statistics showing that marijuana rarely results in the violence so often associated with alcohol abuse.

 

What is known, however, is that:

a) today’s marijuana is far more potent that that used by previous generations;

b) the higher THC content can trigger problems not seen in earlier users of the less potent varieties; and,

c) there are more recent reports of adverse effects on younger users, especially teenagers and young adults.

Let’s examine each of these individually.

 

Potency

Due to advanced growing techniques and hybridization, the marijuana available today has a far higher concentration of THC, or tetrahydrocannabinol, than even as recently as the 1980s. (THC is the psychoactive compound that produces the classic marijuana “high.”) Federal officials say the THC potency then averaged around four percent. Today’s levels have been found to be as high as 20-30 percent. In the 1960s it was around two percent.

Some products made from marijuana, often designed to be used with vaping devices—such as some edibles, oils, and substances called shatter, crumble, budder, and crystalline—have an even higher THC concentration, averaging 68 percent and occasionally as high as 95 percent. As the popular expression has it, “This is not your father’s weed.”

 

Side effects

These higher levels can increase the chances of an adverse reaction, either in new users or in those who haven’t used the drug in decades. These side effects can include:

  • anxiety or panic attacks
  • increased heart rate
  • dizziness
  • breathing difficulties
  • impaired memory
  • concentration difficulties

 

Danger to younger users

Other more serious side effects have been reported in younger users, especially in Colorado and Washington, where recreational use was legalized first. Children’s Hospital Colorado in Denver reported 777 cases of cyclic vomiting, paranoia, psychosis, and other acute reactions among their emergency cases in 2015. Heavy use of high-potency marijuana during adolescence up to the age of about 30 has also been associated with creating or worsening such mental health problems as anxiety, depression, psychosis, and suicidal ideation.

This is partly due to the high potency and partly to the incomplete development of the adolescent brain. Most experts consider the brain to reach full development between the ages of about 25 to 30. Until that time, neural pathways are more susceptible to damage from psychoactive substances.

 

Medical marijuana

As noted, medical marijuana (low-THC cannabis or synthetic cannabis) can now be prescribed to legal Florida residents by qualified physicians for certain conditions, including chronic pain, anorexia due to HIV/AIDS or cancer treatment, glaucoma, seizure disorders, terminal illness, and others.

Depending on the type employed, users may or may not experience the “high.” Some medical marijuana has been specially formulated to eliminate the mood-altering effects while still providing relief from symptoms.

However, users may still encounter one or more of the negative side effects listed above. This is why, with marijuana, it is especially important not to self-medicate, but instead allow us to help you find the right symptom relief associated with your condition.

 

While recreational marijuana is still illegal in Florida, we know that some will use it anyway. Just be aware of the potential downsides to this common substance.

jupiter inflammation doctor

Inflammation: The Silent Killer

Concierge Medicine, Disease

If our concierge primary doctors at MD 2.0 in Jupiter could pinpoint a single factor that is responsible for more illnesses than any other, it might be inflammation. This is the result of various attacks on the body by irritating or even harmful stressors on the body, such as pathogens, injuries, or poor lifestyle habits. The body then tries to heal the resulting tissue damage by rushing white blood cells and their protective chemicals to the site.

Thus, inflammation is necessary to keep the body healthy. But when the body is repeatedly assaulted by various harmful stimuli, the inflammation never ends and can eventually cause long-term damage.

 

What is inflammation?

There are two types of inflammation: acute and chronic. Acute is the healthy kind, in which the body mounts a defense against sudden injury or illness like the flu. Chronic is the dangerous kind, in which the body spends months or even years attempting to fight off constant, lower-level threats, such as pollution, poor nutrition, and the effects of ongoing stress.

 

A cause, not just a result

Because inflammation is seen with injuries, people used to believe it was the result of disease or illness. But over the years, it became more apparent that inflammation actually caused numerous chronic and deadly diseases.

 

Some of these include:

  • allergies
  • Alzheimer’s
  • anemia
  • asthma
  • cancer
  • Crohn’s disease
  • colitis
  • depression
  • diabetes
  • gout
  • multiple sclerosis
  • Parkinson’s
  • Polycystic Ovarian Syndrome (PCOS)
  • psoriasis
  • rheumatoid arthritis
  • wrinkles and other signs of aging

 

Inflammation linked to heart disease

The deadliest condition that was recently confirmed to be linked to inflammation is cardiovascular disease. Cardiovascular disease (CVD) is the leading killer not only in the United States, but also worldwide, claiming the lives of 634,000 people in this country and 15 million people around the world in 2015.

The connection between inflammation and atherosclerosis (“hardening of the arteries”) has been suspected since the 1800s. No definitive research had actually confirmed this hypothesis, however, until a study released in 2017.

Known as CANTOS, the study included over 10,000 patients who had previously suffered a heart attack and were then were given a drug meant to reduce inflammation. The drug, which costs about $200,000 per year, is not only prohibitively expensive, but its fatal side effects offset any gains in cardiovascular mortality reduction.

So why were cardiologists so excited about this research? Because it proved that reducing inflammation in the body will result in fewer heart attacks. (The drug also proved effective against certain forms of cancer, another illness thought to be tied to chronic inflammation.)

The drug had no effect on cholesterol, which is what is reduced with the use of statins, thus proving that inflammation reduction was solely responsible for the mortality reduction seen in the study. In reducing inflammation and demonstrating a marked decrease (15%) in cardiovascular events or death, it paved the way for possible development of safer, less-costly drugs that can accomplish the same thing.

 

Prevention is the best route

Of course, we can intervene medically with various drugs and treatment that can address all these illnesses and diseases, but the best treatment is to reduce inflammation before it causes a problem.

Some causes of chronic inflammation are beyond our control. These include environmental pollutants and certain genetic factors.

But many other causes are within our control. Here are some steps you can take to reduce chronic inflammation throughout your body.

  1. Quality sleep

Sleep is when the body lowers cortisol and repairs the damage to cells encountered during the day. Seven to eight hours nightly is optimal.

 

  1. Exercise

When you engage in moderate-intensity exercise for two hours and thirty minutes every week, the cells release a protein called Interleukin 6, which has an anti-inflammatory effect throughout the body.

 

  1. Healthy diet

Poor-quality foods—sugar, salt, fats, processed foods—all trigger inflammation throughout the body. Opt instead for fresh fruits and vegetables, nuts, high-quality/low-fat protein, whole grains, beans and legumes, and water.

 

  1. Stress reduction

Chronic stress causes the body to react with chronic inflammation as it tries to “fight off” what it perceives as an invader. Relaxation exercises, deep breathing, meditation, yoga . . . anything that helps reduce stress will also reduce inflammation.

 

  1. Stop smoking

Every puff of a cigarette triggers inflammation throughout the cardiovascular system.

 

If you’d like more information on inflammation’s effect on the body and how to combat it, please talk to us.

heat summer

Beware the Danger of High Temperatures

Concierge Medicine, Health Basics, Lifestyle, Preventative Health

May 30th is Heat Safety Awareness Day, so our concierge family doctors at MD 2.0 in Jupiter want to take this opportunity to acquaint you with this important health concern. The fact is, heat is a killer, and we here in south Florida need to pay particular attention to the danger high temperatures can present.

Heat exhaustion, heat stroke, and dehydration are some of the leading weather-related killers. For example:

  • A 1980 heat wave killed more than 1,250 people.
  • In 1995, a heat wave in Chicago took more than 700 people (the deadliest weather event in Chicago history).
  • In August 2003, a record heat wave in Europe claimed an estimated 50,000 lives.

 

Some people are more susceptible to negative effects from the heat. These include:

  • people 65 and older, who are less likely to sense and respond to changes in temperature;
  • people with chronic medical conditions, who may be taking medication that can worsen the impact of extreme heat;
  • infants and young children; and,
  • outdoor workers and athletes, who may be more likely to become dehydrated, particularly in extreme heat.

It’s vital to know the difference between heat exhaustion and heat stroke, the warning signs for each, and what to do in the event you or someone else experiences them. You should also know how to avoid these serious conditions.

 

Heat exhaustion

The Centers for Disease Control and Prevention (CDC) says muscle cramping might be the first sign of heat-related illness. It lists the warning signs of heat exhaustion as:

  • heavy sweating
  • weakness
  • cold, pale, clammy skin
  • fast, weak pulse
  • nausea or vomiting

If you or someone you’re with experiences these symptoms, you should move to a cooler location, lie down and loosen your clothing, apply cool, wet cloths to as much of your body as possible, and sip water. If you have vomited and it continues, seek medical attention immediately.

 

Heat stroke

The signs of heat stroke are:

  • high body temperature (above 103 degrees)
  • hot, red, dry, or moist skin
  • rapid and strong pulse
  • possible unconsciousness.

This is a medical emergency. Call 911 immediately. While waiting for the ambulance, move the person to a cooler environment, and try to reduce the person’s body temperature with cool cloths, or if possible, a cool bath. Do NOT try to give fluids.

 

Stay safe in the heat

Following are steps you can take to avoid experiencing either of these potentially deadly conditions.

Limit outdoor activity. The sun is hottest from 11 a.m. (D.S.T.) to 3 p.m., so try to stay indoors, or at least in shaded areas, during those times. If you must be outdoors, take frequent breaks, preferably in air-conditioned environments, and, if possible, take cool showers or baths to cool down.

Dress appropriately. Wear loose, lightweight, light-colored clothing. Wear a hat with wide brim.

Stay hydrated. Drink water frequently, from two to four cups of water every hour. Don’t wait until you’re thirsty to drink, because by then you’ve already started to dehydrate. Monitor urine color: If your urine is dark, you’re not drinking enough water. Urine should be light yellow or clear. And avoid alcoholic drinks, which can not only impair judgment regarding time spent in the heat but also dehydrate you.

Check the car. Despite all the awareness and warnings in the last few years, more children—51—died in hot cars in 2018 than any year on record. It happens to the most conscientious parents who simply have too many things on their minds. When transporting children, place something necessary—a purse or briefcase—next to the child. Keep car doors locked and never allow children to play in a car. And countless numbers of pets die when owners leave them alone in a hot car “just for a couple minutes.” Never leave pets alone in a closed car, even for a few minutes.

 

Check with us to see whether any medical conditions might make you more susceptible to heat.

unhealthy food

Our Diets Are Killing Us

Concierge Medicine, Nutrition, Preventative Health

Question: What causes more deaths worldwide than smoking?

Answer: Food. And it’s not tainted food; it’s the unhealthy food we put on our plates every day.

Our concierge primary care doctors in Jupiter have told you many times about the importance of a healthy diet. Now a new study published this month in the journal Lancet warns that as a species, we don’t eat properly, and we’re paying for it.

“In many countries, poor diet now causes more deaths than tobacco smoking and high blood pressure,” Ashkan Afshin, lead study author, told CNN.

Afshin is an assistant professor at the Institute for Health Metrics Sciences at the University of Washington.

And it’s not just the bad things we eat—salt, red meat, sugar—that are contributing to premature deaths around the world; it’s the good things we don’t get enough of: fruits, vegetables, nuts and seeds, and so forth.

“Poor dietary habits . . . overall cause more deaths than any other risk factors globally,” Afshin told CBS News.

Dietary risk factors

The study took place over 27 years in 195 countries. Israel had the lowest number of diet-related deaths, followed by France, Spain, Japan, and the principality of Andorra. Uzbekistan had the highest, with the U.S. ranking 43rd out of 195.

The study results attributed one in five deaths (about 11 million people) annually around the world to the following dietary risk factors:

  • high sodium
  • low whole grains
  • low fruit
  • low nuts and seeds
  • low vegetables
  • low fiber
  • high trans fats
  • high sweetened beverages
  • low legumes
  • high red meat
  • high processed meat
  • low calcium
  • low milk
  • low omega-3s
  • low polyunsaturated fatty acids

Note: Omega-3 fatty acids are found in seafood. Polyunsaturated fatty acids are found in some nuts and seeds, salmon, and vegetable oils.

Healthy beats unhealthy

In their analysis of the 15 dietary factors, researchers found that the lack of healthy foods was worse than consumption of unhealthy foods. In other words, not eating fruits, vegetables and so forth was responsible for more deaths than eating red meat, processed foods, and the like.

As a result, Afshin recommended that policy makers should not just focus on what not to eat, but what to replace those foods with. The study estimated that three million deaths globally could be attributed to high sodium intake, but another three million were caused by lack of whole grains, with two million more caused by inadequate fruit intake.

They estimated that cardiovascular disease (CVD) was the leading cause of diet-related deaths around the world, followed by various cancers and diabetes, all of which were attributed to diet. Of course, other factors—including physical inactivity, environmental, economic, and social factors—contribute as well, according to Bruce Lee, associate professor of international health at Johns Hopkins Bloomberg School of Public Health.

“Diet can contribute to noncommunicable disease (NCDs) via increased body weight and obesity, elevated blood pressure, hyperlipidemia or high levels of fat in the blood, and conditions that lead to high blood sugar levels,” he told The Washington Post. Lee, who is also executive director of the Global Obesity Prevention Center, added that another problem is that “unhealthy foods such as those that are highly processed with artificial ingredients are often cheaper to make, store, ship, and prepare. Therefore, such foods have replaced more natural and healthy foods in foods systems around the world.”

Another factor is the profit motive.

“Refining grains is highly profitable,” Corinna Hawkes, director of the Centre for Food Policy at the University of London, told CNN. “Take corn, for example. You can refine it into different ingredients: animal feed, refined flours, and high-fructose corn syrup, to name three. So manufacturers are generating multiple value streams from this refining process.”

What you can do

As much as possible, try to adhere to a Mediterranean-style diet: abundant amounts of nuts, seeds, fresh fruits and vegetables, use of olive oil in cooking, moderate portions of fish and poultry, and little red meat.

Also beware of marketing claims that a product is “whole grain,” because often a whole grain has been stripped of one or more of its components: the bran, the germ, or the endosperm. Look for the stamp provided by the Whole Grains Council that certifies a product actually contains all three of these components.

And as always, check with us for any questions or concerns you may have about the food your family eats.

protect child from drowning

How To Protect Your Child From Drowning

Children, Concierge Medicine, Healthy Living, Lifestyle

Drowning is one of the leading causes of death in children. Our concierge primary care doctors in Jupiter, want to emphasize the importance of teaching children not only the rules associated with being in and around water, but how to swim at an early age.

The American Academy of Pediatrics (AAP) recently released updated guidelines recommending swimming lessons for toddlers, revising long-standing guidance against swimming lessons for children under age four.

Start early

The earlier guidelines were based on the belief that children under four could not master the skills required to hold their breath and coordinate their limbs properly to develop adequate swimming skills. There was also a lack of evidence that swimming lessons would help prevent drownings in the under-four age group, as well as the suspicion that swimming lessons for such young children might confer a false sense of security in their parents.

But one study reported that lessons between the ages of one and four produced an 88 percent reduction in drownings. These findings, coupled with the fact that children between the ages of one and four are at the highest risk for drowning, eventually changed the thinking and led to the revisions. Of course, they’re not all going to be mini-Michael Phelps, but the AAP stresses that they can be taught basic water skills and water safety skills.

“Floating, grasping the wall, climbing in and out of the water, turning back to the wall . . . a lot of times children end up falling into the water and they look to the furthest point, and if they just turned around they would be better off,” Katie Lee of the Goldfish Swim School in Long Island, New York, told CBS News.

It’s a matter of allowing very young to feel comfortable in the water, and not panic if they find themselves in it unexpectedly. You can start by holding your baby in your arms, moving them slowly back and forth, allowing them to feel the silky sensation of water on their skin. You can sing to them, and even bob them up and down, reinforcing the feeling that being in water is fun.

Slightly older children can be taught to blow bubbles in the water, thus learning how to avoid swallowing water. You can also teach them how to float on their backs and kick their legs as you hold them up. Formal swimming lessons with a certified swimming instructor can start as early as age one, depending on the child’s physical abilities and emotional development.

Reduce risk

In addition to teaching your child basic water skills, it is critical to be vigilant at all times to prevent a tragedy. Young children can drown in as little as two inches of water, and within 90 seconds without breathing, oxygen in the brain begins to drop. Other experts cautioned that the perception of children flailing around in the water when they fall in is largely myth. Very young children tend to fall in and immediately sink.

“Don’t even run into the house for a second to go to the bathroom or grab the phone,” Dr. Mark Waltzman, a pediatric emergency medicine expert, told CBS News.

Other suggestions from AAP to prevent drowning include the following:

  • Parents should never leave children alone or in the care of another child while in or near bathtubs, pools, spas, or other open water.
  • Empty water from buckets and other containers immediately after use.
  • Never leave young children alone in the bathroom. Toilet locks can prevent drowning of toddlers.
  • Even with older children and better swimmers, the supervising adult should focus on the child and not get distracted with other activities.

Tips for homes with pools include these useful guidelines:

  • Never turn your back on a child in the water, even for a moment.
  • Be sure to install child-proof fencing all the way around the pool. Fences should be at least four feet high, with self-closing and self-latching doors that open outward. Consider door alarms for those that open directly into the pool area.
  • Also remove any structures that would allow them to circumvent the fence, such as ladders and toys.
  • If a child is missing, always check the pool first—seconds count.
  • Empty portable pools when not in use.
  • Always make sure a responsible adult is watching the children playing in or near the pool area (with no distractions, e.g., smartphones off).

If you have questions about age-appropriate swimming lessons and activities for your child, don’t hesitate to contact us.

New Findings Change Aspirin-a-Day Guidelines

Concierge Medicine, Medications, Preventative Health

Our concierge family practice doctors in Jupiter understand the temptation to pop a pill—whether a prescription medication or a supplement—to stay healthy, instead of following more difficult suggestions regarding exercise and diet.

And to be sure, the long-standing belief that taking a daily low-dose aspirin can prevent heart attacks has some scientific basis for those who’ve already suffered a heart attack. In addition, some earlier research did seem to support daily aspirin use for reducing the risk of numerous cancers as well as Alzheimer’s disease.

Latest findings

But the good thing about science in general and medical research in particular is that researchers are constantly reviewing and refining established knowledge. In the case of the aspirin-a-day approach, for example, several new studies in the last year have challenged the practice of taking a low-dose (81 mg.) aspirin to prevent cardiovascular disease (CVD). And this month the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines recommending against the use of daily low-dose aspirin, based on these studies.

One study published last month in the Journal of the American Medical Association (JAMA), for example, found that people without heart trouble who took a daily dose of aspirin had a lower risk of heart attack, stroke, and death. These benefits, however, were canceled out by the increased risk of bleeding in the intestinal tract or the brain, which can often be deadly.

Researchers in that study performed a meta-analysis of 13 studies that included 164,225 participants, none of whom had CVD when the studies began.

“For every 256 patients treated with aspirin for five years, one heart attack, stroke or death from cardiovascular disease would be prevented,” Dr. Sean Zheng, lead author of the study and and academic clinical fellow in cardiology at King’s College Hospital in London, told CNN. “On the other hand, for every 210 patients treated with an aspirin over the same period, one would have a serious bleeding event.”

“This calls into question the net benefit of taking aspirin, and whether people who have not previously had cardiovascular disease should take aspirin,” Zheng said.

Another study published last fall in the New England Journal of Medicine (NEJM) reported similar results, even finding that older patients experienced no health benefits at all from daily aspirin use. These and other recent studies are what led to this month’s revised recommendations from the AHA/ACC.

“We knew there would be an increased risk of bleeding with aspirin, because there has always been,” recommendations co-author Dr. Anne Murray told NBC News. “But not only did it not decrease risk of disability or death, it did not decrease the risk of heart attack and stroke, and there was an increase in the rate of death.” Murray is also a geriatrician and epidemiologist at the Hennepin Healthcare Research Institute and the University of Minnesota, Minneapolis.

In their statement, the AHA/ACC advised against taking a preventive aspirin a day, saying it may actually cause more harm than good.

“We’re talking about healthy people who don’t have known heart disease or stroke, who might have been considering or [are] already taking an aspirin to prevent that heart attack or stroke in the first place,” said Dr. Erin Michos, another of the authors of the new AHA/ACC guidelines.

The AHA stressed that the new recommendations do not apply to people who have already had a heart attack or stroke, or who have undergone such procedures as receiving a coronary artery stent or bypass surgery. But for the elderly (people over 70) and those with a high risk of internal bleeding, the AHA cautioned that “aspirin may do more harm than good, but there are no absolutes, so these decisions need to be tailored to individuals.”

Another co-author of the revised recommendations suggested that doctors might advise their patients who have a strong family history of heart disease to take a daily aspirin. This could also apply to those whose tests reveal considerable plaque build-up in their arteries. But for those with a low or moderate risk, lifestyle changes could have a more salient effect.

“Eat a heart-healthy diet, get regular physical activity, control blood pressure and control cholesterol,” Michos said. “If [people] need a statin, take it. Those are much more important when compared to recommending aspirin.”

As with so many other over-the-counter remedies, we always recommend you check with us before taking them. Each person is different and their needs and sensitivities are also different. We can help determine the best course for you.

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