We at MD 2.0 just wanted to touch base and let you know we are staying on top and trying to make sense of all the confusing information coming your way.
As we’ve mentioned on numerous occasions, you can’t ignore your heart health throughout your life, then pop a pill and expect everything to be fine. Our concierge doctors in Jupiter regularly dispense the same proven recommendations for keeping your heart—and the rest of your body—in tip-top shape:
Wal-Mart, CVS, Rite Aid, and Walgreens this month pulled the over-the-counter (OTC) heartburn drug Zantac from their shelves, over concerns that it contains a chemical possibly linked to cancer. Other countries, including Canada, France, Hong Kong, and India, have issued recalls for Zantac and its generic version, ranitidine.
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.
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.”
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
- 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.
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.
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.
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.
Because dietary supplements are a $40-billion-a-year business in this country, our concierge family practice doctors in Jupiter, want to make you aware of the latest research on these popular products. Numerous studies have found little benefit
The flu killed 80,000 Americans last year and was responsible for the hospitalization of another 960,000. Then there are those whose symptoms didn’t reach such drastic levels, but who spent many miserable days suffering the effects.
So our concierge family practice doctors in Jupiter, FL, at MD 2.0, were pleased to note that last month the U.S. Food and Drug Administration (FDA) for the first time in 20 years approved a new drug designed to help alleviate the symptoms of the flu. Xofluza (baloxavir marboxil) is a single-dose oral prescription drug intended for patients 12 years of age and older who have been experiencing symptoms for no more than 48 hours.
The difference in Xofluza
Just in time for flu season, Xofluza joins other antiviral treatments currently available, including Tamiflu and Relenza. The difference between Xofluza and other antiviral drugs is in the way it’s administered. It is the only antiviral that can be taken as a single dose to be effective. Others must be taken over several days or inhaled as a powder. While Xofluza did not work any better in clinical trials than its competitors already on the market, it’s the convenience of the single oral dose that sets it apart. The most common reported side effects of Xofluza were diarrhea and bronchitis.
“With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical,” FDA Commissioner Scott Gottlieb, M.D., said in a statement. “This novel drug provides an important, additional treatment option.” Xofluza was expected to be available “within the next several weeks.”
“Xofluza is unique in that it acts to inhibit replication of the flu virus in the first place, at a step much earlier than the current medications available . . . which only block release of virus that has already been produced from a host cell,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City told CBS News.
Dr. Debra Birnkrant, director of the Division of Antiviral Products in the FDA’s Center for Drug Evaluation and Research, hailed the addition of Xofluza to the arsenal of weapons against the flu.
“Having more treatment options that work in different ways to attack the virus is important because flu viruses can become resistant to antiviral drugs,” she said on the FDA’s website.
You still need a flu shot
While the antiviral medications, including Xofluza, can reduce symptoms and help them recede faster than a placebo, they are not an instant curative. Nor do they prevent the flu or prevent you passing it on to others. If you contract the flu, you will still have to endure several days of misery, and you will still be contagious while exhibiting symptoms. So it’s best not to catch it all all.
“[S]easonal flu vaccine is one of the most effective and safest ways to protect yourself, your family, and your community from the flu and serious flu-related complications,” Gottlieb said. “Yearly vaccination is the primary means of preventing and controlling flu outbreaks.”
We concur. Last month the Centers for Disease Control and Prevention (CDC) released a report showing that less than 40 percent of adults in the U.S. received flu shots last winter, the lowest rate in seven years and probably one reason that last season’s flu outbreak was the deadliest since the 1970s. Of the 183 children who died last year, 80 percent had not been vaccinated.
You can help boost your immunity by exercising, eating healthfully, washing your hands often, and getting enough sleep, but there’s still no better way to prevent the flu, or lessening symptoms and its complications, than by receiving a flu shot.
“Yearly vaccination is the primary means of preventing and controlling flu outbreaks,” said Gottlieb.
And if you or your children do come down with the flu, contact us immediately. The sooner you receive Xofluza or other antiviral medications, the better they will work.
Some four million Americans consume probiotic supplements thinking they’ll improve their health. Claims for these supplements range from improved digestion and intestinal function to better-looking skin to boosting mood and relieving anxiety. With such wide-ranging health claims, it’s no wonder that consumption of probiotics has surged in recent years.