A Drink to Your Good Health

I have previously written about the first study to examine the association between alcohol consumption, symptom severity, and quality of life of individuals with FM. 103. drug comboTreatment of FM is challenging because the drug therapies currently available are expensive and associated with numerous undesirable (understatement) side effects and addiction or tolerance issues. Despite undergoing drug treatment, patients are often left with unrelieved pain, restricted mobility, and reduced physical function.

63. vegetables(Unfortunately for some) Lifestyle interventions, including dietary modifications such as alcohol consumption, have gained popularity as explorations in symptom management.

Several studies have examined the association between alcohol consumption and chronic pain conditions. In one study, regular weekly or daily alcohol consumption was shown to be a significant protective factor for the development of chronic pain. Two studies have also shown that moderate alcohol consumption correlates with a reduced risk of rheumatoid arthritis .

In this current study, researchers are the first to examine the association between alcohol consumption and FM symptom severity and quality of life. Among the 946 adult FM patients (94 % women, mean age of 49 years old) reporting low or moderate alcohol consumption (≤3 or >3 to 7 drinks per week), there was lower FM symptom severity and better quality-of-life scores compared with those who reported no alcohol consumption. However, these associations were not observed in patients who were heavy drinkers (>7 drinks per week) compared with non-drinkers. Drinkers had higher education, less unemployment, lower body mass index, and lower frequency of opioid use than non-drinkers. Thus, their analyses were adjusted for these potential confounders.

133. well behaved womenBecause alcohol consumption consists of complex behaviours that intersect with many social, economic, psychological, and demographic factors, disentangling this complex web of relationships is a challenge. Interestingly, after exploring possible mechanisms for their findings, the researchers speculated that alcohol consumption may reduce FM symptoms and improve quality of life by mediating psychological benefits and stress relief or by promoting factors associated with social integration. Another possible mechanism proposed is central nervous mediation via the modulating gamma-aminobutyric acid (GABA) system. Behavioural and pharmacological therapies that modulate or mimic the effects of GABA production can be promising for FM treatment.

This initial exploration into the relationships between alcohol consumption, symptom severity, and quality of life for FM has posed a number of questions that need to be answered by future studies with stronger study designs. There are limitations associated with cross-sectional study design: information bias is not uncommon in cross-sectional studies providing data on both exposure and outcome variables from questionnaires – questionnaires are administered at the same time in a cross-sectional study and rely on respondent recall, the measurement errors of exposure (ie, alcohol consumption) may be dependent on the measurement errors of the outcomes (ie, quality of life or FM symptoms). Where such dependent bias occurs, the association between exposure and outcome is likely to be inflated. This basically means that these preliminary results should not be used as grounds for advising patients to drink alcohol (Bummer!).

70. never aloneThis research sheds new light on plausible hypotheses and mechanisms to consider in future methodologically rigorous studies to improve the well-being of individuals with FM, but does not give us immediate relief.

Social Isolation…or Hibernation?

hibernationI’m hibernating…yes, it’s Winter in Australia. I don’t want to leave the house (not even to step outside to get the mail) and I just want to sit quietly, alone, on my couch.

Avoiding social contact is a common pattern you might notice when falling into depression. Some people skip activities they normally enjoy and isolate themselves from the world. Others turn to alcohol or junk food to mask their pain and unhappiness. I do both.

I’m doing it all at the moment…BUT I don’t feel depressed (I think!) I just want to stop for a little bit – I don’t want to fight at the moment, I don’t want to search for answers at the moment.

So, maybe I am depressed? I just can’t tell anymore.

Depression traps vary from person to person, but what they have in common is that they can serve to worsen your mood:

Trap #1: Social Withdrawal

isolationSocial withdrawal is the most common tell-tale sign of depression.

“When we’re clinically depressed, there’s a very strong urge to pull away from others and to shut down,” says Stephen Ilardi, PhD, author of books including The Depression Cure and associate professor of psychology at the University of Kansas. “It turns out to be the exact opposite of what we need.”

“In depression, social isolation typically serves to worsen the illness and how we feel,” Ilardi says. “Social withdrawal amplifies the brain’s stress response. Social contact helps put the brakes on it.”

The Fix: Gradually counter-act social withdrawal by reaching out to your friends and family. Make a list of the people in your life you want to reconnect with and start by scheduling an activity.

Trap #2: Rumination

A major component of depression is rumination, which involves dwelling and brooding about themes like loss and failure that cause you to feel worse about yourself.

Rumination is a toxic process that leads to negative self-talk such as, “It’s my own fault. Who would ever want me a friend?”

“There’s a saying, ‘When you’re in your own mind, you’re in enemy territory,'” says Mark Goulston, MD, psychiatrist and author of Get Out of Your Own Way. “You leave yourself open to those thoughts and the danger is believing them.”

“When people are clinically depressed, they will typically spend a lot of time and energy rehearsing negative thoughts, often for long stretches of time,” Ilardi says.

The Fix: Redirect your attention to a more absorbing activity, like a social engagement or reading a book.

Trap #3: Self-Medicating With Alcohol

cocktailsTurning to alcohol or drugs to escape your woes is a pattern that can accompany depression, and it usually causes your depression to get worse.

Alcohol can sometimes relieve a little anxiety, especially social anxiety, but it has a depressing effect on the central nervous system, Goulston says. Plus, it can screw up your sleep.

“It’s like a lot of things that we do to cope with feeling bad,” he says. “They often make us feel better momentary, but in the long run, they hurt us.”

The Fix: Talk to your doctor if you notice that your drinking habits are making you feel worse. Alcohol can interfere with antidepressants and anxiety medications.

Trap #4: Skipping Exercise

If you’re the type of person who likes to go the gym regularly, dropping a series of workouts could signal that something’s amiss in your life. The same goes for passing on activities – such as swimming, yoga, or hydrotherapy – that you once enjoyed.

When you’re depressed, it’s unlikely that you’ll keep up with a regular exercise program, even though that may be just what the doctor ordered.

Exercise can be enormously therapeutic and beneficial, Ilardi says. Exercise has a powerful antidepressant effect because it boosts levels of serotonin and dopamine, two brain chemicals that often ebb when you’re depressed.

“It’s a paradoxical situation,” Ilardi says. “Your body is capable of physical activity. The problem is your brain is not capable of initiating and getting you to do it.”

The Fix: Ilardi recommends finding someone you can trust to help you initiate exercise — a personal trainer, coach, or even a loved one. “It has to be someone who gets it, who is not going to nag you, but actually give you that prompting and encouragement and accountability,” Ilardi says.

Trap #5: Seeking Sugar Highs

When you’re feeling down, you may find yourself craving sweets or junk food high in carbs and sugar.

Sugar does have mild mood-elevating properties, says Ilardi, but it’s only temporary. Within two hours, blood glucose levels crash, which has a mood-depressing effect.

The Fix: Avoid sugar highs and the inevitable post-sugar crash. It’s always wise to eat healthfully, but now more than ever, your mood can’t afford to take the hit.

Trap #6: Negative Thinking

NTWhen you’re depressed, you’re prone to negative thinking and talking yourself out of trying new things.

You might say to yourself, “Well, even if I did A, B, and C, it probably wouldn’t make me feel any better and it would be a real hassle, so why bother trying at all?”

“That’s a huge trap,” says Goulston. “If you race ahead and anticipate a negative result, which then causes you to stop trying at all, that is something that will rapidly accelerate your depression and deepen it.”

The Fix: Don’t get too attached to grim expectations. “You have more control over doing and not doing, than you have over what the result of actions will be,” Goulston says. “But there is a much greater chance that if you do, then those results will be positive.”

 

Blaming Fibro Fog?

8 Other Reasons You May Be Forgetful…

forgetfulSo, you know you were supposed to be doing something – but you just can’t remember what it was. Or, in the middle of a conversation, you can’t remember the words you need. Don’t necessarily put it down to age, working too hard, having an overloaded mind or Fibro Fog. There are other common health problems that can cause forgetfulness.

High Blood Pressure

The REGARDS study in the US found people with high blood pressure perform worse in memory tests and their memory shows greater deterioration over time. The study involved more than 30,000 people over four years. “The increase in blood pressure can mean structural changes in the blood vessels, making them thicker and making it harder to get blood around your body,” says Dr Gavin Lambert, from the Baker IDI Heart & Diabetes Institute. “As a result, you can get organ damage. That can be in the brain as well and affect your recall and cognition.” So eat a balanced diet, maintain a healthy weight, exercise regularly, don’t smoke and if you are on blood pressure medication, take it as prescribed.

Chemotherapy

A study at Stanford University in the US found breast cancer patients who had chemotherapy suffered some impact to the parts of the brain responsible for memory and planning.

“One of the potential undesirable side effects of chemotherapy is what we loosely call ‘chemo brain’ or ‘chemo fog’,” says Dr Helen Zorbas, CEO of Cancer Australia.

“It can be mild or more significant in effect. While there’s nothing that can be done to help it, I think just knowing it’s a common side effect is important for women and they should be reassured that in most cases it’s mild and self-limiting.”

Menopause

A 2008 study at the University of Illinois found a link between hot flushes and poor verbal memory. The study followed other research that found about 40 per cent of women report becoming more forgetful around menopause.

“The more hot flushes a woman had, the worse her memory performance,” says researcher Professor Pauline Maki. Maki found women whose hot flushes disturbed their sleep suffered even worse memory problems.

Dr Elizabeth Farrell, consultant gynaecologist with Jean Hailes for Women’s Health, says while there is no conclusive evidence that menopause triggers memory loss, women do report feeling more muddled sometimes.

Thyroid problems

If you have hypothyroidism – an underactive thyroid – your thyroid gland doesn’t produce enough thyroid hormone. This leads to a slower metabolism and tiredness, and can lead to some forgetfulness.

Hypothyroidism is more common after the age of 40 and affects about six to 10 per cent of women and a smaller number of men.

“When you have a medical condition that causes fatigue, it’s easy to become forgetful. But when hypothyroidism is treated, people recover well and memory recovers, too,” says Dr Ronald McCoy, a spokesman for the Royal Australian College of General Practitioners. Hypothyroidism can be treated with medication.

Long-Haul Travel

Memory can start to be affected after a flight lasting more than four hours – such as a Melbourne to Perth trip, McCoy says. “It’s similar to people having a knock on the head and suffering short-term memory loss. They recover but may not remember what happened at the time,” he says. “People function well at the time but the day later they have problems recalling what happened at certain times.”

Pregnancy

It’s true – pregnancy can affect memory. “Well practised memory tasks, such as remembering phone numbers of friends and family members, are unlikely to be affected,” says researcher Dr Julie Henry, who was involved in a University of New South Wales study that found pregnant women do suffer some temporary forgetfulness.

“It’s a different story, though, when you have to remember new phone numbers or hold in mind several different pieces of information.” She says the upheaval that comes with pregnancy may be the reason.

Vitamin B12 Deficiency

“Vitamin B12 is essential for normal neurological function,” says Denise Griffiths, a spokeswoman for the Dietitians Association of Australia. “Deficiency of vitamin B12 can result in cognitive changes, from memory loss to dementia.” Scientists believe vitamin B12 may safeguard the myelin sheath – a layer that insulates our nerves. If the sheath is damaged it can affect the transmission of messages to and from the brain.

Alcohol

“Alcohol prevents the storage of the short-term memory into the long-term memory,” McCoy says. “So people drink and function but can lose memory of what happened during the time they were drinking. ”Too much alcohol has a negative impact on the hippocampus – a part of the brain involved with recording and storing memories.

 

Reprinted from Volume 2: Issue 1 of LIVING WELL with FIBROMYALGIA

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Cheers!

Alcohol is reported to have both positive and negative effects on health. Moderate drinking is thought to reduce risks of cardiovascular disease especially when in conjunction with a healthy lifestyle, regular exercise and not smoking.

Researchers from the Mayo clinic in the US and the University of Michigan surveyed patients with FM to examine the association between alcohol and their severity of symptoms and quality of life.

Low and moderate drinkers had better scores for physical function, ability to work, the number of work days missed, fatigue and pain, than people who abstained completely.

So what is a moderate drinker?

Moderate drinkers have between three and seven standard drinks a week. But too much alcohol reversed this effect, the research found.

A standard drink is equivalent to 12 American oz / 355ml (1.25 units) of beer, 5 oz/ 148ml of wine (1.8 units), or 1.5 oz/ 44ml (1.8 units) of distilled spirits.

std-drinks-large

Moderate drinkers seemed to have less pain than low or heavy drinkers, even when the results were controlled for confounding factors.

Similar results were seen for the quality of life scale including social functioning, vitality and general health.

imagesDiscussing why moderate drinking may have this effect Dr Terry Oh, who led this study said, “Gamma-Aminobutyric Acid (GABA), an inhibitory neurotransmitter, is low in the brain in fibromyalgia, which may go some way to explain why the nervous system reaction to pain is amplified. Alcohol binds to the GABA receptor in the central nervous system that in turn may turn down pain transmission. However the effects of alcohol may also be due to improved mood, socialization and tension, and while moderate drinkers have fewer symptoms there are still many questions about how this happens.”

But, before all of you go out and fill the fridge with wine, make sure you check the effects of alcohol with your medications.

Pain Pill Mistakes that may lead to a Ketamine Infusion

As regular readers know, about 3 weeks ago, I had a ketamine infusion. Part of the reason for this was I was addicted to codeine-based painkillers. I was unable to go cold-turkey and undertook the infusion to avoid all those horrible withdrawal symptoms.

Basically, this addiction came about because I made some pretty common pain pill mistakes.

Mistake No.1: If 1 Is Good, 2 Must Be Better

Doctors prescribe pain pills at the doses they believe will offer the greatest benefit at the least risk. Doubling or tripling that dose won’t speed relief. But it can easily speed the onset of harmful side effects.

“The first dose of a pain medication may not work in five minutes the way you want. But this does not mean you should take five more,” Kristen A. Binaso, RPh, spokeswoman for the American Pharmacists Association, says. “With some pain drugs, if you take additional doses, it makes the first dose not work as well. And with others, you end up in the emergency room.”

If you’ve given your pain medication time to work, and it still does not control your pain, don’t double down. See your doctor about why you’re still hurting (and, hopefully, there is something that will help more).

pills“This ‘one is good so two must be better’ thing is a common problem,” says pain specialist Eric R. Haynes, MD, founder of Comprehensive Pain Management Partners in Trinity, Fla. “Patients should follow the instructions their doctor gives. Ask before leaving the office: Can I take an extra pill if I still hurt? What is the upper limit for this medication?”

Another bad idea is trying to boost the effect of one kind of pain pill by taking another.

“There may be Advil, Tylenol, Aleve, and ibuprofen in the house, and a person may take them all,” Binaso says.

This can escalate into a very bad situation, Haynes says – welcome to a fast-forward approach to end up with a cannula in your arm and a week worth of ketamine!

Mistake No. 2: Duplication Overdose

People often take over-the-counter pain drugs – and even prescription pain drugs – without reading the label. Never a good idea – it means that you often don’t know which drugs you’re taking.

And if you take another over-the-counter drug – for any reason – you could wind up in a hospital ER with an overdose. That’s because many OTC drugs are combination pills that carry a full dose of pain pill ingredients.

Mistake No. 3: Drinking While Taking Pain Drugs

Pain medications and alcohol generally enhance each other’s effect. That’s why many of these prescription medications carry a “no alcohol” sticker.

“A common misperception is people see that sticker and think, ‘I’m OK as long as I don’t drink liquor – I can have a beer.’ But no alcohol means no alcohol,” Binaso says.

“The patient should heed that alcohol warning, because it can be a major problem if they do not,” Haynes says. “Alcohol can make you inebriated, and some pain medications can make you have that feeling as well. You can easily get yourself into trouble.”

Drinking alcohol can be a problem even with over-the-counter pain drugs.

Mistake No. 4: Drug Interactions

PILLSBefore taking any pain pill, think about what other medicines, herbal remedies, and supplements you are taking. Some of these drugs and supplements may interact with pain medications or increase the risk of side effects.

I suggest you try a drug interaction checker, if in doubt; and/or keep an updated list of your medications on your phone or computer so you can give your doctor a complete list of all the drugs, herbs, and supplements you take – before getting any prescription.

If buying over-the-counter medications, Binaso recommends showing a list of everything else you’re taking to the pharmacist.

Mistake No. 5: Drugged Driving

Pain medications can make you drowsy. Different people react differently to different drugs.

“How I react to a pain medication is different from how you react,” Binaso says. “It may not make me drowsy, but may make you drowsy. So I recommend trying it at home first, and see how you feel. Don’t take two pills and go out driving.”

Mistake No. 6: Sharing Prescription Medicines

Unfortunately, it’s very common for people to share prescription medications with friends, relatives, and co-workers. Not smart, Haynes and Binaso say – particularly when it comes to pain medications.

“If a fairly healthy person is taking a medicine because she is in pain, and wants to give some pills to Uncle Joe because he is hurting – well, this is a potential problem,” Haynes says. “Uncle Joe may have a problem that keeps his body from eliminating the drug, or he may have an allergic reaction, or the drug may interact with a medication he is taking, with life-threatening results.”

Mistake No. 7: Not Talking to the Pharmacist

22. pillIt’s not easy to read drug labels, even if you can make out the small print. If you have a question about either a prescription or OTC drug, ask the pharmacist.

“That’s why I’m in the store,” Binaso says. “You may have to wait a couple of minutes for me to finish what I’m doing. But you’ll get the information you need to take the right medicine the right way. Just say, ‘Tell me about this medicine; what should I be on the lookout for?'”

Mistake No. 8: Hoarding Dead Drugs

Pills stored at home start breaking down soon after their expiration date. That’s especially true of drugs kept in the moist environment of the bathroom medicine cabinet.

“People say, “That drug is only a year past its expiration date; isn’t it good?” But if you take a pill that’s broken down, it may not work – or you may end up in the emergency room because of reaction to a breakdown product. That is really common,” Binaso says.

Another reason that it’s dangerous to hoard is that the drugs may tempt someone else (your son or daughter?) into making a very bad choice.

Mistake No. 9: Breaking Unbreakable Pills

Pills are actually little drug-delivery machines. They don’t work the way they’re supposed to when taken apart the wrong way.

“Scored pills should be cut only across the line,” Binaso says. Those without scoring should not be cut at all, unless you’re specifically instructed to do so.

“When you start chopping up pills like that, the pill may not work,” she says. “We find more and more people are doing this. And then they say, “Oh, that pill had a really bad taste. That is because they cut away the coating.”