CBD Oil – Is It Legal?

Lincoln is a young patient of mine who suffers with a number of medical problems.  He sees a host of physicians who haven’t had much success in controlling his symptoms.  Lincoln finds it very difficult to manage his life day-to-day.  He has a history of addiction problems and recently confided that smoking marijuana helps with his pain, his anxiety and with sleep.

I’ve advised him that, particularly as an asthmatic, smoking marijuana isn’t a smart idea.  At his last visit, he was proud to tell me that he had switched to using marijuana edibles rather than cigarettes, and was looking into CBD oil.  He assured me that CBD oil was legal to use in all 50 states and that it did not contain THC so there were no concerns about drug testing.

Is this true?

Well, in a word, no.  If it sounds too good to be true, it probably is, right?  Cannabidiol (CBD) oil from cannabis is legal over-the-counter only in states that have legalized recreational marijuana, and can be legally used by prescription in states that have legalized medical marijuana.  17 other states have CBD-specific laws, the list can be seen here on WebMD.

Hemp oil, which is legal, has only very small and inconsistent levels of CBD.  Most supplements don’t tell you what amounts of CBD are in them.  There’s a good reason for that.  According to the FDA, CBD oil cannot be sold as a dietary supplement.  Companies are hoping that by NOT labeling their products as containing CBD they will escape the FDA’s oversight.

I checked with Amazon and found a HUGE number of hemp oil supplements being marketed for reducing chronic pain, anxiety, insomnia and other symptoms.  THIS IS ILLEGAL.  As someone who markets supplements, I was cringing as I was reading the Amazon listings.  These companies are asking for HUGE fines from the FDA.

Another issue with CBD oil is that there is very little evidence that it works for anything.  The best evidence is for treating certain severe types of seizures, and in fact there is a formulation called Epidiolex which is working its way through the FDA approval process as a new drug.

There is only weak evidence for CBD oil helping anxiety, insomnia, chronic pain, inflammation or any other problem in humans.  Some animal trials have been done but they are of limited use.

Also, testing of CBD oils from cannabis showed over 60% of products didn’t have the amount of CBD shown on the label.  Some had more, some had less.  Worse, 20% of tested products were contaminated with THC, which is psychoactive (causing the “high”) and potentially causing positive drug tests.  Those who must take random drug tests as part of their employment should not use CBD oils.

CBD oils are not perfectly safe either.  It is fairly common to have increased liver enzymes, and the products can interact with medications too.

In Ohio, medical marijuana has been legalized but the infrastructure isn’t in place with dispensaries and training for medical personnel yet.  Everything is targeted to be in place later this year.  Presumably at that point those who are trained to prescribe medical marijuana will also be able to prescribe CBD oil for those who prefer a treatment with no risk of intoxication or dependence.

In the meantime it is important to remember these points:

  • CBD oil use without a prescription is against the law in states without legalized medical marijuana, recreational marijuana use, or special state provisions.
  • CBD oil cannot be sold as a nutritional supplement by FDA regulations
  • Hemp oil, which is legal, has very inconsistent levels of CBD and cannot be marketed with drug claims (such as reducing anxiety or pain or fighting cancer)
  • There is no consistent evidence that CBD is effective for anything other than intractable seizures
  • CBD has side effects of its own and can interfere with medications

QUESTION:  Have you or someone you love tried CBD oil?  What was your experience?

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Tick Bites and Lyme Disease

It’s summertime!  Time to play outside, hike and swim and sail and kayak and camp and do all the fun things you love to do outdoors.

Say you and your family travel to Michigan to go camping and kayaking.  You’ve spent the day playing in a beautiful meadow with your kids and as you’re changing your 3-year-old into her pajamas you find this in her armpit:

Credit: www.co.ontario.ny.us

Credit: www.co.ontario.ny.us

What do you do?  (Aside from panicking and calling the doctor, LOL.)

This is an Ixodes tick, commonly called a deer tick.  It is this species that transmits Lyme disease.  Luckily this particular tick has NOT fed from your toddler, so she is safe from Lyme disease.

What if it HAD fed and completed a blood meal?  Well, then it would look like this, with a swollen, grayish-blue abdomen:

Credit: www.pbase.com

Credit: www.pbase.com

In this case, your child would need to see the doctor to be treated with antibiotics to prevent Lyme disease.  Luckily Lyme is preventable if treated early.

What if you hadn’t noticed your child had a tick, if it had fed and dropped off?  Lyme disease begins with a bullseye rash that can be easy to recognize.

Credit: www.webmd.com

Credit: www.webmd.com

Sometimes it doesn’t look exactly like this, so if you’ve been out in the woods and see a rash, it’s reasonable to see the doctor to be checked out.  Here are some other examples of how it might look.

Credit: www.bayarealyme.org

Credit: www.bayarealyme.org

Along with the rash (which happens 70-80% of the time), patients generally develop fever, chills, body aches and other flu-like symptoms.  This usually happens a few days to a few weeks after the tick bite.

If not treated, Lyme disease can go on to cause swollen, painful joints (especially large joints such as the knees), neurological problems such as headaches, heart problems, eye problems, and other less common symptoms.

Even though Lyme disease is treatable with antibiotics, it’s much better to avoid tick bites and being infected in the first place.  If you’re going to be in the woods or in grassy areas near the woods (where ticks are likely to be found), wear long sleeves and long pants.  Tuck your pants into your socks and your shirt into your pants so ticks will have a hard time getting to your skin.

After you’ve been outside where you might have been exposed to ticks, check your clothes carefully to remove any ticks.  Wash those clothes to get rid of ticks you might have missed.  Check your body carefully, especially the scalp and any skin folds (ticks like places that are warm, moist and dark).  Check every member of the family thoroughly, including four-legged ones.  Shampoo your hair to dislodge any hitchhikers.

Since a tick must take its blood meal before it can transmit Lyme disease, you have time to find and remove it.  If a tick doesn’t come off easily, put olive oil or another cooking oil on it.  They have pores in their shells that allow them to breathe.  They will let go before they suffocate.

Cleveland itself is not considered a high-risk area for Lyme disease, but we’re not far from areas that ARE considered high-risk.  This is projected to be a bad year for deer ticks and Lyme disease.

Credit: www.cdc.gov

Credit: www.cdc.gov

If you’re traveling it’s good to know how to stay safe!

QUESTION: Have you ever found a tick on yourself or a family member?

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Mental Health Care For Diabetics

Someone very dear to me has diabetes.  She has also been dealing with a lot of stress over the last year or so, and struggles with depression.  While her doctor has been trying to help her, there really aren’t a lot of resources available that specifically provide mental health care for diabetics.

Do you know anyone with diabetes?  Do they struggle sometimes with their mood?  If they seem depressed and anxious, they’re certainly not alone.  Up to 30% of diabetics are depressed at any given time, depending on how it is assessed.

Credit: steptohealth.com

Depression is a big deal for those with chronic illness.  Not only does it steal the fun out of life, but it plays havoc with motivation to keep up with behavior change.  Depression makes it really hard to eat right, to exercise, to take medication properly.

If a diabetic is struggling with depression there is definitely treatment available.  However, that treatment may be hard to find.  Ideally, the person or group treating the diabetes will be able to direct treatment for diabetes.

A group at the University of Massachusetts Medical School just published a study that showed that a lot of diabetes care clinics don’t have good access to mental health services.  Even the highest-ranked care centers didn’t have mental health professionals on staff.

Why is this?  The biggest reason is probably money.  Mental health services in this country are NOT a priority for insurance companies or the government.  Coverage is spotty and there are limits on the number of visits covered.

For a very common problem that has a huge impact on quality of life, limiting treatment is very shortsighted.  Depression impacts diabetics’ health in a number of ways.  For instance, diabetics suffering from depression have more complications, have a harder time controlling their blood sugars, are not as likely to take their medications properly and are more likely to die.

If you know and love a diabetic, make sure to keep an eye on their mood.  If they seem depressed, encourage them to talk to their doctor about it.  See if your loved one will let you go to a doctor’s visit with them.  This will give you an opportunity to talk directly to the doctor about your concerns.

If your loved one needs mental health services, the American Diabetic Association just launched a directory which you can access at this link: https://professional.diabetes.org/mhp_listing.  This link is a searchable directory of mental health providers with experience in treating diabetics.

This directory is brand new and doesn’t contain a lot of names.  The nearest provider to where I practice outside Cleveland is 100 miles away :-/  But hopefully it will grow!

Be persistent in seeking treatment for depression and anxiety.  If you or a loved one has diabetes, treatment will certainly improve quality of life.  It may be the difference between life and death!

QUESTION: Is there a diabetic in your life suffering with depression?  What has been your experience in seeking treatment?

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Fish Oil And Inflammation

Fish.  Everyone knows they should eat more fish, right?  Why is that?  Fish is good for your heart, but why?  And what kind of fish? Turns out FATTY fish intake reduces cholesterol and, more importantly, there is a strong link between fish oil and inflammation.

Seems I have been talking to EVERYONE this week about fish oil, diet and inflammation.  When a patient’s cholesterol is high I often check a profile called an essential fatty acid (EFA) panel which gives a nice peek into their diet.  Often I just get confirmation of what I already know – their diet stinks and we need to get to work ASAP!

Ultimately I really don’t care about an individual’s cholesterol.  I really don’t.  High cholesterol in and of itself is not a disease.  I care about their risk of OTHER diseases either directly related to the high cholesterol levels (like pancreatitis from super-high triglycerides) or for which high cholesterol is a marker (like heart disease).

High cholesterol is like the fire alarm going off.  When the fire alarm goes off, do you just go turn it off and go back to bed?  No, of course not, you go figure out what made it go off in the first place.  Find the fire, right?  When a person’s cholesterol is high, that means we need to go search for the fire, and an EFA panel is one of my first steps in hunting for the fire.

One of the calculations I can make based on the EFA panel is a quick-and-dirty check of overall inflammation levels in the body.  The ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA) is directly tied to inflammation in the body.  The higher the ratio, the higher the levels of inflammation.

Why do we care so much about this ratio?  Higher ratios are also associated with higher risk of heart disease, as reported in the Journal of Cardiology.

I tell patients (and my students) that over the next 10 years I believe we’re going to be paying much less attention to cholesterol and much more attention to inflammation.  Inflammation hurts the cardiovascular system over time.  It damages the insides of the artery walls and when they heal they scar, which causes plaque.

Arachidonic acid is a precursor for a lot of pro-inflammatory signaling molecules in the body.  EPA is a precursor for ANTI-inflammatory molecules.  So you want MORE EPA and LESS AA.

Where does EPA come from?  The richest dietary source of EPA is fatty fish, although it is also found in low levels in seaweed.  When I’m talking to patients I tell them there are 6 fish that are “fatty” fish: salmon, mackerel, anchovies, sardines, herring and tuna.  (The mnemonic is SMASH-T.)  All other fish (like cod, whitefish, tilapia, catfish, etc) are meat and should be eaten sparingly, if at all.  The human body can make small amounts of EPA from alpha-linolenic acid (ALA) which is found in walnuts, seeds like flaxseed and chia seed, and canola oil.

What about arachidonic acid?  AA can be made from another essential fatty acid, linoleic acid, which in humans must come from the diet.  The only dietary sources of AA are animal foods like meat, dairy and eggs.

Here comes the question I keep expecting: Dr. Jen, you keep telling us that the healthiest diet is completely plant-based.  If we need EPA and the best source is fish (which are undoubtedly animals), why is a completely plant-based diet so heart-healthy?

That’s a great question.  First of all, scientists are still working on the “why” but there is no doubt that a completely plant-based, whole-foods diet is the best choice if your goal is overall health and avoiding heart attacks and strokes.  My patients who choose to try a plant-based diet find their blood pressure goes down, they feel better and they usually lose some weight.

My personal interpretation of current research is that if you give the body ALA and LA from plant sources, it will manufacture the EPA and AA that it needs for its purposes.  The ratio of AA to EPA will be low because the body won’t make extra AA.  However, if you eat a lot of meat you get a lot of AA from the diet and the body isn’t so much in control of how much is floating around.

The best choice for those who want to reduce their risk of heart disease is to eat NO animal foods at all.  Adding a small amount of fish oil as a supplement is good insurance to further reduce inflammation in the body.

If you have high cholesterol, ask your doctor to order an Essential Fatty Acid profile or a Boston Heart Diagnostics panel.  If it is coded with a high-cholesterol or high-triglyceride diagnosis code, it will almost certainly be covered by your insurance.The results should look something like what is shown at this link.  Calculate the ratio of arachidonic acid to EPA.  The goal is <3, an elevated level is >10 and a high level is >15.  I’ve seen it over 30.

Then look at the ratio of omega-3 to polyunsaturated fatty acids (w3:PUFA).  The healthiest people in the world have a ratio of about 50%, but we eat so many omega-6 oils in the USA that I’m usually content with a ratio of 15-20%.

The last thing to look at is the total saturated fat level.  If it is high you REALLY need to think about how much meat you’re eating.  The main sources of saturated fat in the body are animal foods (meat, dairy and eggs).  Palm kernel oil is found in many processed foods and is also a big dietary source of saturated fat.  Read your ingredient lists.  There is currently a big craze to eat coconut oil, which is also a rich source of saturated fat.  No research suggests adding more coconut oil to your diet improves health at all.

You are what you eat.  Your body is 100% created from the food and drink you put in your mouth.  Your health is 90% determined by lifestyle factors, mostly diet.  Now is the time to look at what you’re choosing to feed your body and make good choices.  It’s up to you!

QUESTION: Will you change your diet based on this information?

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Less Saturated And Trans Fat Intake Recommended

What should we eat to be healthy?  This is the ultimate question that EVERYONE is trying to answer and nobody really has a good handle on it.

Our diets are getting worse and worse.  We are eating more processed foods, more convenience foods, more sugar and fat and salt.  Our risks of diabetes, heart disease and cancer are climbing.  Our kids are the first generation that has a shorter life expectancy than their parents.

The World Health Organization is intensely interested in these worrisome trends.  They are trying to analyze the confusing array of nutritional research coming out to make recommendations to help people all over the world live longer, healthier lives.

Recently the WHO came out with a report recommending less saturated and trans fat intake in the diet.  The goal is to reduce saturated fat intake to less than 10% of daily total calorie intake, and trans fats to less than 1% of calories.

Saturated fat and trans fats are both largely found in animal foods.  Animal flesh from all species, eggs and dairy are rich sources of both saturated and trans fats.  While many people know to avoid partially hydrogenated vegetable oils which are added to processed foods to make them taste better, surveys suggest that trans fat intake from animal foods is greater than that from industrial sources.

If you’ve been following my blog for any length of time, you know I recommend that the whole-foods plant-based diet is the healthiest diet for humans.  This type of diet has the best research showing reduced heart risk and reduced cancer risk.  It has been shown to decrease diabetes risk (a major risk factor for cardiovascular disease and cancer).  In fact, switching as little as 5% calorie intake from animal protein to plant protein reduced diabetes risk by 20-25%.  This translates to 25 grams of protein from plant sources rather than animal for someone who eats 2000 calories per day.

I get that not too many of my readers are going to switch tomorrow from a Standard American Diet to a whole-foods plant-based diet and never look back.  I’m about progress, not perfection.  Hey, my husband calls me “vegan-ish!”  I avoid animal foods as much as I possibly can but every once in a while I have ice cream or macarons for a treat.

So gradually substituting plant-based meals for ones with meat and dairy will reduce your heart and cancer risk.  Reducing animal foods to have less saturated and trans fat intake in the diet is a good step to take for improving your health.  You’ll feel better, and your body will thank you!

QUESTION: Do you try to reduce animal foods in your diet?

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“Adrenal Support” Supplements Contain Hormones

Yet again we have evidence that supplement companies are either not testing their products or are deliberately adding pharmaceuticals to their supplements.

In a report released in March, researchers at the Mayo Clinic purchased bottles of the twelve most popular “adrenal support” supplements at a “popular online shopping website.”  The publication does NOT specify which website or which supplements were tested, more’s the pity.

The researchers analyzed the products and found that ALL of the products contained thyroid hormone.  UNDISCLOSED thyroid hormone.  This means that if someone who took these products was also taking thyroid medication for hypothyroidism, the supplement may very well disrupt their treatment and make adjusting their medication dose very difficult.  For instance, one of the supplements contained 1.2 mcg of liothyronine per recommended daily dose.  Those who take liothyronine (brand name Cytomel) will know that the smallest dose tablet is 5 mcg which means this particular supplement DEFINITELY would have affects on someone’s thyroid function.

Other hormones found in these “adrenal support” supplements include pregnenolone and 17-hydroxyprogesterone (female hormones), androstenedione (male hormone), budesonide, cortisone and cortisol (adrenal hormones).  These hormones are present in biologically meaningful amounts.  They are NOT just contaminants and unimportant.  These hormones will change the way the body functions.

I know WHY they are in these supplements.  A number of these supplements have declared animal gland extracts documented on the labels.  (I wrote in a previous post about why this is problematic.)  However, a number of these are considered “herbal” adrenal support supplements with NO gland extracts.  There is NO way these hormones got into “herbal” supplements by accident.

Why would a supplement company “dope” their adrenal support supplements with hormones?  Easy.  They can improve fatigue symptoms, which is what these supplements are marketed for.  However, the hormonal environment in the body is very finely balanced, and supplements with undisclosed and unregulated hormone ingredients are NOT the way to go about treating fatigue!

If you have fatigue symptoms PLEASE see your doctor, nurse practitioner or naturopath and have testing done BEFORE starting any supplement that promises to fix your “adrenal fatigue.”  Especially beware of and avoid any product that has the words “bovine,” “porcine” or “ovine” anywhere on the label, because those indicate ingredients that come from cow, pig or sheep body parts.  (Ewww…)

If you choose to use supplements (and I definitely recommend that you do, because only 5% of Americans get all the nutrition they need from their diet on a daily basis), be sure to choose a company with a long track record of safety, quality testing, and a commitment to advancing the understanding of human nutrition for the benefit of all humanity.  This is why I partner with the Shaklee Corporation!

Want to see if you would benefit from Shaklee supplements (and get personalized recommendations for diet and lifestyle changes to get and stay healthier)?  Click this link to get your HealthPrint today!

QUESTION: Do you have fatigue?  Have you tried supplements to improve your symptoms?  What was your experience?

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Waist Circumference Predicts Heart Risk

When you step on the scale, do you see a normal weight?  When you check that BMI chart by the scale at the doctor’s office, are you reassured to see your score is under 25?  That means you’re good, right?

Not so fast.  There’s another measurement to take.  Your waist circumference also says a lot about your heart risk.

Carrying body fat around your middle, called abdominal adiposity, is a marker of higher heart risk.  For women, a waist circumference over 35 inches is a risk factor for heart disease.  (That’s assuming she’s not pregnant, of course!)  For men, the threshold is a waist circumference over 40 inches.

A study published recently in the European Heart Journal shared some interesting insights.  The authors analyzed data from almost 300,000 people to see what waist circumference and other measures of “fatness” tell us about heart risk.

They found that there was a linear increase in heart risk with increasing waist circumference.  Also, body fat percentage, waist-to-hip ratio and waist-to-height ratio also gave almost a linear increase in heart risk with increasing values.

BMI did NOT give a good correlation to heart risk.  I’ve always hated the BMI.  It’s stupid and doesn’t account for body composition.  Someone with a lot of muscle, like LeBron James, is NOT obese but you can’t tell that from the BMI.

So when you go to the doctor and he or she measures your weight and height, don’t stop there.  Ask to have them measure your waist circumference too.  Better yet, see if they have a body fat analyzer.  I have a handheld unit in my office that isn’t perfect, but it does give a much better estimate of whether someone is overweight or obese than BMI does.

When I am working on weight loss with patients, I target 30% body fat in women and 25% in men.  That’s just a starting point, people may need a different individualized target.

A third of Americans die of cardiovascular disease, and two thirds of Americans are obese or overweight.  Waist circumference can help determine whether you are at higher risk for a cardiovascular event.

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What Parents Need To Know About E-Cigarettes

You see them everywhere.  Adults walking in no-smoking zones exhaling huge clouds of white with ball-point-pen-shaped devices in their hands.  My patients often tell me they’re switching to e-cigarettes when I remind them that they need to quit smoking.

Are e-cigarettes safer than regular cigarettes?  Do they help smokers quit?  What impact are they having on our teenagers?

As parents, we need to understand the appeal of e-cigarettes to our teenagers and what the health risks are.

E-cigarettes are electronic devices that provide a vapor that contains carrier chemicals, nicotine and flavorings.  They don’t contain tobacco and therefore don’t expose the user to the carcinogens and other harmful additives in traditional cigarettes.  They are seen as a safer alternative to traditional cigarettes.

But are they really safer?

According to the American Lung Association, the chemicals in e-cigarettes are largely untested.  Because they are usually marketed without drug claims, companies don’t have to disclose or test their ingredients for safety.  One chemical, called diacetyl, is associated with a lung condition called popcorn lung.

Nicotine itself is NOT safe.  It doesn’t matter whether a user gets nicotine from patches, gums, lozenges, e-cigs or traditional cigarettes, it is harmful to the brain and to the circulatory system.  Nicotine is harmful to developing fetuses and therefore pregnant women should NOT smoke or use e-cigarettes.

Newer research shows that the brains of young people continue developing far longer than was previously thought.  (This is not a surprise to those of us raising teens, right?)   Use of nicotine is associated with problems of working memory and attention in adolescents.

Do e-cigarettes help smokers quit?

Credit ComplianceSigns.com

No, they don’t.  Evidence is pretty clear that using e-cigs actually REDUCES the likelihood of quitting smoking.

There was a survey done in North Carolina of middle- and high-school students about the use of cigarettes and e-cigarettes.  It found that use of e-cigs increased 4-fold between 2011 and 2013.  Those who used both cigarettes and e-cigarettes were actually LESS likely to quit (and less likely to try to quit) than those who smoked cigarettes alone.  Teens who use e-cigs are more likely to start smoking traditional cigarettes as well.

An study published in the American Journal of Preventive Medicine last month reported that those who use e-cigs are about half as likely to quit smoking cigarettes as those who don’t.  Using e-cigs keeps people from quitting smoking!

There has never been any evidence that e-cigarettes help smokers quit.  They cannot be marketed as a smoking cessation aid, but that doesn’t stop people from believing they will help.

As parents raising teenagers it is important we talk to our kids about e-cigs.  They will hear that e-cigs are safe, that they are just a fun, tasty way to get a little nicotine buzz.  E-cigs are heavily marketed to the adolescent age group.

The truth is that they are addictive, dangerous drugs that should be considered a gateway to traditional cigarettes.  They hurt teenagers’ ability to learn and process new information.  They are harmful to the lungs and circulatory system just as traditional cigarettes are.

When we’re talking to our kids about smoking, alcohol, drugs and sex, we can’t forget to cover the dangers of e-cigarettes because marketing messages and their friends certainly won’t give them the whole story.

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Food Addiction

Do you struggle with your weight?  Are you obese?  Have you tried again and again to lose weight, and had short-term success but then slip back into old patterns?  Have you lost weight only to find yourself gaining the weight back with interest?

As a physician who enjoys helping people lose weight, I am almost as frustrated as my patients when things aren’t going well.  One thing that makes weight loss particularly difficult is food addiction.

Food addiction is just starting to be recognized as a major underlying factor in overweight and obesity.  Just like alcoholism and drug addiction, there are changes in the brain in some overweight and obese people that make it difficult or impossible for them to lose weight without help.

Researchers at Yale developed a questionnaire, published in 2009, to assess food addiction.  This questionnaire, the Yale Food Addiction Scale, is a 25-question tool that helps dig into symptoms and behaviors of food addiction.

What is addiction?  Psychiatrists and psychologists recognize addiction as a persistent pattern of abnormal behavior that results in significant distress in the patient.  Abnormalities include

  • Tolerance (needing more of the substance in question to get the same effect)
  • Cravings and withdrawal symptoms when not using
  • Consuming larger amounts than intended
  • Unsuccessful attempts to cut down in spite of wanting to cut down or abstain
  • A lot of time spent using or recovering from use
  • Continued use or overuse in spite of known consequences
  • Giving up important activities in order to use

You may already recognize some of these markers in yourself.  I certainly do.  For instance, I have a really bad sweet tooth.  I sometimes find myself eating more sugar than I know is good for me.  If I stop eating sugar, I will have sugar cravings, headaches and body aches.  Sugar is addictive and I know I have withdrawal symptoms if I overuse it for awhile then stop.

The same group that developed the Yale Food Addiction Scale published an article looking at almost 200,000 people, and found that about 25% of people who were overweight or obese met the criteria for food addiction.  Food addiction was more common in women, those over 35 years of age and those with clinically disordered eating, like binge eating, anorexia and bulimia.

Addiction is a complicated topic and I could write for days about it.  A VERY over-simplified explanation of addiction is that the reward centers of the brain have low levels of dopamine, the pleasure hormone.  Using the drug of choice (opiates, food, sex, sugar, etc) raises dopamine levels in these areas.  Also, these substances interact with the endogenous opioid (endorphin) systems, giving a morphine-like “high.”

Taken together, the presence of the “high” with use and low dopamine levels without use make it very difficult to resist the urge to overeat and very difficult to stop overeating once started.

Do some foods trigger food addiction more than others?  Well sure, nobody really binges on green beans and broccoli, right?  So called “highly palatable” foods are much more likely to trigger overeating.  The food industry knows this, and adds saturated fat, salt and sugar to processed foods to create this super-tasty addiction trigger.  Chips, cookies, candy, soda, cheeseburgers, French fries, white bread and ice cream are examples of foods likely to trigger an addiction response and binge eating behavior.

My personal belief is that weight loss is much harder than dealing with alcoholism, smoking, even heroin addiction.  You can’t just not eat, right?  However, when you understand what foods and situations trigger addiction, you can avoid them like an alcoholic avoids beer and stays out of bars.

What about people who are motivated to kick their food addiction for good?  What is available to help them?  There are twelve-step programs for food addicts, similar to Alcoholics Anonymous.  One such program is Food Addicts In Recovery Anonymous.  (I have no experience with this program, I just know it exists.)  And like alcoholism and opiate addiction, medications can help.

There is a medication called Contrave which has been shown to promote weight loss.  When you understand food addiction, it’s easy to see how Contrave would be helpful.  Contrave is a combination of bupropion, which raises dopamine levels, and naltrexone, which blocks the endorphin response.

Bupropion, an antidepressant, is well known to help people quit smoking and is the only antidepressant that promotes weight loss.  Raising dopamine levels decreases the need to eat, or smoke, or do other things to raise these levels in the brain.  Naltrexone blocks the “high” from drinking alcohol, using opiates like heroin, or binge eating.

While Contrave is very expensive and only rarely covered by insurance, both bupropion and naltrexone are available in generics and are inexpensive to purchase if not covered.  GoodRx.com can give you an idea what prices would be like near you.

If you believe you may be a food addict, please print and fill out the Yale Food Addiction Scale and take it to your doctor.  You can also print out the scoring instructions, it’s a little tricky to score.  This will help your doctor help you.

Like many similar problems, a combination of medication and counseling is going to be the most effective way to deal with food addiction.  If you are overweight or obese and feel out of control with respect to your eating, don’t give up!  See your doctor and ask for help.  If he or she isn’t comfortable diagnosing and treating food addiction ask for a referral to a bariatric center near you.

Like alcoholism and opiate addiction, food addiction can impact every part of your life.  It can alienate you from friends and family, and can even take your life.  Proper treatment starts with recognizing the problem and asking for help.

QUESTION: Do you or someone you love have a food addiction?  Will you do something differently based on the information in this post?

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Managing Urge Incontinence

Have you seen that cute commercial with the little red “bladder” character who pesters the woman until she takes it to the bathroom?  Imagine that little guy just grew horns and a bad attitude.  It doesn’t pester.  It gives one warning and then unless she finds a bathroom RIGHT NOW it makes an embarrassing mess all over.

That’s urge incontinence.

Frequent urination.  Strong urges which quickly morph to an irresistible urge to void. Accidents.  Getting up at night frequently to pee.

Can you imagine if this was you?  Wouldn’t you be hesitant to leave the house?  I would.  It would be hard to go to the grocery store or do any other shopping, go to church, or function at work, let alone travel anywhere.

It’s hard to turn on the TV anymore without seeing ads for adult briefs and constipation products.  The large number of such ads would make it easy to assume this is a “normal” part of aging.  But it’s not.  Urge incontinence is NOT normal.  And it is definitely treatable.

My friend and colleague Dr. Holly Wyneski is a urologist in practice in Richfield, Ohio.  She specializes in female pelvic and bladder problems.  I reached out to her to get a little information about management of urge incontinence.   Please check out her website at www.hollykaywyneskimd.com 🙂

When dealing with urge incontinence, Dr. Wyneski’s advice is to start with behavioral change.  First, take a close look at diet (including fluid intake) and avoid foods and beverages that irritate the bladder.  Dr. Wyneski’s website has a list you can download here.  Examples include alcohol, caffeine, carbonated beverages and spicy and acidic foods.  Next, do your best to get enough sleep, and be aware of your stress level.  In addition to helping with stress and sleep, a number of my patients have found that magnesium supplementation helps calm the bladder.

In addition, your weight also influences how well your bladder works.  (Go figure, right?  Your weight affects everything ELSE in your body so why not your bladder!)  If you are overweight or obese, losing as little as 5-10% of your body weight can go a long way towards getting your bladder working better.

If the above measures don’t correct your bladder problem, bladder training is a very important behavioral treatment.  This starts with listening to your body.  Dr. Wyneski advises that you should empty your bladder every 2-3 hours.  It is also not considered abnormal to get up one time at night for every decade over age 70.  If you’re drinking enough fluids you will need to go at least that frequently.

Are you holding your bladder for 5-6 hours?  (HELLO all my nurses and teachers out there!)  If so, you are setting yourself up for problems down the road.  If the bladder gets stretched out it will get weak and not empty as well as normal.  This can lead to incomplete emptying (where there is still urine left in the bladder after voiding) and can cause infections and kidney damage.

The other side of the coin is the overactive bladder, where every time the bladder gets a little urine in it you feel like you need to go.  People with overactive bladder may need to go every hour, or even more often.  If you know every gas station with a clean bathroom on the east side of the city, this may be you!

Some people are very sensitive to the “stretch” sensation and may feel they need to go even if it’s not needed.  You may also have a bladder that tends to spasm and contract when it’s not time to go.  Men may have problems with their prostate that make it feel as if they need to go more frequently than normal.

Bladder training for the overactive bladder consists of waiting a few minutes after it feels like you need to go.  This will gently “stretch” the bladder and de-sensitize the urgency sensation.  Even starting with just a two-minute timer will make a difference.  You can gradually lengthen the time you wait.  It takes patience, but it is so important!

If these behavioral changes don’t help, please see your doctor.  Also, if you develop sudden bladder symptoms you should see the doctor, this may be an infection that needs treated right away.

If you’re like the woman in the commercial and you feel like you’re a prisoner of your bladder, there are things you can do to improve your symptoms yourself.  Your doctor can help too, and if all else fails, urologists like Dr. Wyneski have got lots of tools in the toolbox!

QUESTION: Do you have problems with your bladder?  What has helped you?

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