Drug Metabolism (When You’re Not Average!)
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When Your Medications Run Out… Of You
Everybody knows that alcohol can affect medications’ effects, but what of smoking, and what of obesity? And how does the alcohol thing work anyway?
It’s all about the enzymes
Medicines that are processed by the liver (which is: most medicines) are metabolized there by specialist enzymes, and the things we do can increase or decrease the quantity of those enzymes—and/or how active they are.
Dr. Kata Wolff Pederson and her team of researchers at Aarhus University in Denmark examined the livers of recently deceased donors in ways that can’t (ethically) be done with live patients, and were able to find the associations between various lifestyle factors and different levels of enzymes responsible for drug metabolism.
And it’s not always how you might think!
Some key things they found:
- Smokers have twice as high levels of enzyme CYP1A2 than non-smokers, which results in the faster metabolism of a lot of drugs.
- Drinkers have 30% higher levels of enzyme CYP2E1, which also results in a faster metabolism of a lot of drugs.
- Patients with obesity have 50% lower levels of enzyme CYP3A4, resulting in slower metabolism of many drugs
This gets particularly relevant when we take into account the next fact:
- Of the individuals in the study, 40% died from poisoning from a mixture of drugs (usually: prescription and otherwise)
Read in full: Sex- and Lifestyle-Related Factors are Associated with Altered Hepatic CYP Protein Levels
Read a pop-sci article about it: Your lifestyle can determine how well your medicine will work
How much does the metabolism speed matter?
It can matter a lot! If you’re taking drugs and carefully abiding by the dosage instructions, those instructions were assuming they know your speed of metabolism, and this is based on an average.
- If your metabolism is faster, you can get too much of a drug too quickly, and it can harm you
- If your metabolism is faster, it also means that while yes it’ll start working sooner, it’ll also stop working sooner
- If it’s a painkiller, that’s inconvenient. If it’s a drug that keeps you alive, then well, that’s especially unfortunate.
- If your metabolism is slower, it can mean your body is still processing the previous dose(s) when you take the next one, and you can overdose (and potentially die)
We touched on this previously when we talked about obesity in health care settings, and how people can end up getting worse care:
As for alcohol and drugs? Obviously we do not recommend, but here’s some of the science of it with many examples:
Why it’s a bad idea to mix alcohol with some medications
Take care!
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Why Fibromyalgia Is Not An Acceptable Diagnosis
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Dr. Efrat Lamandre makes the case that fibromyalgia is less of a useful diagnosis and more of a rubber stamp, much like the role historically often fulfilled by “heart failure” as an official cause of death (because certainly, that heart sure did stop beating). It’s a way of answering the question without answering the question.
…and what to look for instead
Fibromyalgia is characterized by chronic pain, tenderness, sleep disturbances, fatigue, and other symptoms. It’s often considered an “invisible” illness, because it’s the kind that’s easy to dismiss if you’re not the one carrying it. A broken leg, one can point at and see it’s broken; a respiratory infection, one can see its effects and even test for presence of the pathogen and/or its antigens. But fibromyalgia? “It hurts and I’m tired” doesn’t quite cut it.
Much like “heart failure” as a cause of death when nothing else is indicated, fibromyalgia is a diagnosis that gets applied when known causes of chronic pain have been ruled out.
Dr. Lamandre advocates for functional medicine and seeking the underlying causes of the symptoms, rather than the industry standard approach, which is to just manage the symptoms themselves with medications (of course, managing the symptoms with medications has its place; there is no need to suffer needlessly if pain relief can be used; it’s just not a sufficient response).
She notes that potential triggers for fibromyalgia include microbiome imbalances, food sensitivities, thyroid issues, nutrient deficiencies, adrenal fatigue, mitochondrial dysfunction, mold toxicity, Lyme disease, and more. Is this really just one illness? Maybe, but quite possibly not.
In short… If you are given a diagnosis of fibromyalgia, she advises that you insist doctors keep on looking, because that’s not an answer.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Managing Chronic Pain (Realistically!)
- How To Eat To Beat Chronic Fatigue ← yes, including how to do so when you are chronically fatigued. In other words, this isn’t just dietary advice, but rather practical advice too
- When Painkillers Aren’t Helping, These Things Might
Take care!
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The Coffee-Cortisol Connection, And Two Ways To Tweak It For Health
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Health opinions on coffee vary from “it’s an invigorating, healthful drink” to “it will leave you a shaking frazzled wreck”. So, what’s the truth and can we enjoy it healthily? Dr. Alan Mandell weighs in:
Enjoy it, but watch out!
Dr. Mandell is speaking only for caffeinated coffee in this video, and to this end, he’s conflating the health effects of coffee and caffeine. A statistically reasonable imprecision, since most people drink coffee with its natural caffeine in, but we’ll make some adjustment to his comments below, to disambiguate which statements are true for coffee generally, and which are true for caffeine:
- Drinking
coffeecaffeine first thing in the morning may not be ideal due to dehydration from overnight water loss. Coffeecaffeine is a diuretic, which means an increase in urination, thus further dehydrating the body.- Coffee contains great antioxidants, which are of course beneficial for the health in general.
- Cortisol, the body’s stress hormone, is generally at its peak in the morning. This is, in and of itself, good and correct—it’s how we wake up.
Coffeecaffeine consumption raises cortisol levels even more, leading to increased alertness and physical readiness, but it is possible to have too much of a good thing, and in this case, problems can arise because…- Elevated cortisol from early
coffeecaffeine drinking can build tolerance, leading to the need for morecoffeecaffeine over time. - It’s better, therefore, to defer drinking
coffeecaffeine until later in the morning when cortisol levels naturally drop. - All of this means that drinking
coffeecaffeine first thing can disrupt the neuroendocrine system, leading to fatigue, depression, and general woe. - Hydrate first thing in the morning before consuming
coffeecaffeine to keep the body balanced and healthy.
What you can see from this is that coffee and caffeine are not, in fact, interchangeable words, but the basic message is clear and correct: while a little spike of cortisol in the morning is good, natural, and even necessary, a big spike is none of those things, and caffeine can cause a big spike, and since for most people caffeine is easy to build tolerance to, there will indeed consistently be a need for more, worsening the problem.
In terms of hydration, it’s good to have water (or better yet, herbal tea) on one’s nightstand to drink when one wakes up.
If coffee is an important morning ritual for you, consider finding a good decaffeinated version for at least your first cup (this writer is partial to Lavazza’s “Dek Intenso”—which is not the same as their main decaf line, by the way, so do hold out for the “Dek Intenso” if you want to try my recommendation).
Decaffeinated coffee is hydrating and will not cause a cortisol spike (unless for some reason you find coffee as a concept very stressful in which case, yes, the stressor will cause a stress response).
Anyway, for more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
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- Drinking
Cilantro vs Parsley – Which is Healthier?
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Our Verdict
When comparing cilantro to parsley, we picked the parsley.
Why?
Notwithstanding that some of our recipes include “cilantro, or if you have the this-tastes-like-soap gene, parsley”, that choice is more for the taste profile than the nutrition profile. Both are good, though, and it is quite close!
Like many herbs, they’re both full of vitamins and minerals and assorted phytochemicals.
In the category of vitamins, they’re both very good sources of vitamins A, C, and K, but parsley has more of each (and in vitamin K’s case, 4–5 times more). Parsley also has about twice as much folate. For the other vitamins, they’re mostly quite equal except that cilantro has more vitamin E.
When it comes to minerals, again they’re both good but again parsley is better on average, with several times more iron, and about twice as much calcium, zinc, and magnesium. Cilantro only wins noticeably for selenium.
Both have an array of anti-inflammatory phytochemicals, and each boasts antioxidants with anticancer potential.
Both have mood-improving qualities and have research for their anxiolytic and antidepressant effects—sufficient that these deserve their own main feature sometime.
For now though, we’ll say: healthwise, these two wonderful herbs are equal on most things, except that parsley has the better micronutrient profile.
Enjoy!
Further reading
You might also enjoy:
Herbs For (Evidence-Based) Health & Healing
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Thinking of using an activity tracker to achieve your exercise goals? Here’s where it can help – and where it probably won’t
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It’s that time of year when many people are getting started on their resolutions for the year ahead. Doing more physical activity is a popular and worthwhile goal.
If you’re hoping to be more active in 2024, perhaps you’ve invested in an activity tracker, or you’re considering buying one.
But what are the benefits of activity trackers? And will a basic tracker do the trick, or do you need a fancy one with lots of features? Let’s take a look.
Why use an activity tracker?
One of the most powerful predictors for being active is whether or not you are monitoring how active you are.
Most people have a vague idea of how active they are, but this is inaccurate a lot of the time. Once people consciously start to keep track of how much activity they do, they often realise it’s less than what they thought, and this motivates them to be more active.
You can self-monitor without an activity tracker (just by writing down what you do), but this method is hard to keep up in the long run and it’s also a lot less accurate compared to devices that track your every move 24/7.
By tracking steps or “activity minutes” you can ascertain whether or not you are meeting the physical activity guidelines (150 minutes of moderate to vigorous physical activity per week).
It also allows you to track how you’re progressing with any personal activity goals, and view your progress over time. All this would be difficult without an activity tracker.
Research has shown the most popular brands of activity trackers are generally reliable when it comes to tracking basic measures such as steps and activity minutes.
But wait, there’s more
Many activity trackers on the market nowadays track a range of other measures which their manufacturers promote as important in monitoring health and fitness. But is this really the case? Let’s look at some of these.
Resting heart rate
This is your heart rate at rest, which is normally somewhere between 60 and 100 beats per minute. Your resting heart rate will gradually go down as you become fitter, especially if you’re doing a lot of high-intensity exercise. Your risk of dying of any cause (all-cause mortality) is much lower when you have a low resting heart rate.
So, it is useful to keep an eye on your resting heart rate. Activity trackers are pretty good at tracking it, but you can also easily measure your heart rate by monitoring your pulse and using a stopwatch.
Heart rate during exercise
Activity trackers will also measure your heart rate when you’re active. To improve fitness efficiently, professional athletes focus on having their heart rate in certain “zones” when they’re exercising – so knowing their heart rate during exercise is important.
But if you just want to be more active and healthier, without a specific training goal in mind, you can exercise at a level that feels good to you and not worry about your heart rate during activity. The most important thing is that you’re being active.
Also, a dedicated heart rate monitor with a strap around your chest will do a much better job at measuring your actual heart rate compared to an activity tracker worn around your wrist.
Maximal heart rate
This is the hardest your heart could beat when you’re active, not something you could sustain very long. Your maximal heart rate is not influenced by how much exercise you do, or your fitness level.
Most activity trackers don’t measure it accurately anyway, so you might as well forget about this one.
VO₂max
Your muscles need oxygen to work. The more oxygen your body can process, the harder you can work, and therefore the fitter you are.
VO₂max is the volume (V) of oxygen (O₂) we could breathe maximally (max) over a one minute interval, expressed as millilitres of oxygen per kilogram of body weight per minute (ml/kg/min). Inactive women and men would have a VO₂max lower than 30 and 40 ml/kg/min, respectively. A reasonably good VO₂max would be mid thirties and higher for women and mid forties and higher for men.
VO₂max is another measure of fitness that correlates well with all-cause mortality: the higher it is, the lower your risk of dying.
For athletes, VO₂max is usually measured in a lab on a treadmill while wearing a mask that measures oxygen consumption. Activity trackers instead look at your running speed (using a GPS chip) and your heart rate and compare these measures to values from other people.
If you can run fast with a low heart rate your tracker will assume you are relatively fit, resulting in a higher VO₂max. These estimates are not very accurate as they are based on lots of assumptions. However, the error of the measurement is reasonably consistent. This means if your VO₂max is gradually increasing, you are likely to be getting fitter.
So what’s the take-home message? Focus on how many steps you take every day or the number of activity minutes you achieve. Even a basic activity tracker will measure these factors relatively accurately. There is no real need to track other measures and pay more for an activity tracker that records them, unless you are getting really serious about exercise.
Corneel Vandelanotte, Professorial Research Fellow: Physical Activity and Health, CQUniversity Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Circadian Rhythm: Far More Than Most People Know
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The Circadian Rhythm: Far More Than Most People Know
This is Dr. Satchidananda (Satchin) Panda, the scientist behind the discovery of the blue-light sensing cell type in the retina, and the many things it affects. But, he’s discovered more…
First, what you probably know (with a little more science)
Dr. Panda discovered that melanopsin, a photopigment, is “the primary candidate for photoreceptor-mediated entrainment”.
To put that in lay terms, it’s the brain’s go-to for knowing approximately what time of day or night it is, according to how much light there is (or isn’t), and how long it has (or hasn’t) been there.
But… the brain’s “go-to” isn’t the only method. By creating mice without melanopsin, he was able to find that they still keep a circadian rhythm, even in complete darkness:
Melanopsin (Opn4) Requirement for Normal Light-Induced Circadian Phase Shifting
In other words, it was a helpful, but not completely necessary, means of keeping a circadian rhythm.
So… What else is going on?
Dr. Panda and his team did a lot of science that is well beyond the scope of this main feature, but to give you an idea:
- With jargon: it explored the mechanisms and transcription translation negative feedback loops that regulate chronobiological processes, such as a histone lysine demathlyase 1a (JARID1a) that enhances Clock-Bmal1 transcription, and then used assorted genomic techniques to develop a model for how JARID1a works to moderate the level of Per transcription by regulating the transition between its repression and activation, and discovered that this heavily centered on hepatic gluconeogenesis and glucose homeostasis, facilitated by the protein cryptochrome regulating the fasting signal that occurs when glucagon binds to a G-protein coupled receptor, triggering CREB activation.
- Without jargon: a special protein tells our body how to respond to eating/fasting at different times of day—and conversely, certain physiological responses triggered by eating/fasting help us know what time of day it is.
- Simplest: our body keeps on its best cycle if we eat at the same time every day
This is important, because our circadian rhythm matters for a lot more than sleeping/waking! Take hormones, for example:
- Obvious hormones: testosterone and estrogen peak in the mornings around 9am, progesterone peaks between 10pm and 2am
- Forgotten hormones: cortisol peaks in the morning around 8:30am, melatonin peaks between 10pm and 2am
- More hormones: ghrelin (hunger hormone) peaks around 10am, leptin (satiety hormone) peaks 20 minutes after eating a certain amount of satiety-triggering food (protein does this most quickly), insulin is heavily tied to carbohydrate intake, but will still peak and trough according to when the body expects food.
What does this mean for us in practical terms?
For a start, it means that intermittent fasting can help guard against metabolic and related diseases (including inflammation, and thus also cancer, diabetes, arthritis, and more) a lot more if we practice it with our circadian rhythm in mind.
So that “8-hour window” for eating, that many intermittent fasting practitioners adhere to, is going to do much, much better if it’s 10am to 6pm, rather than, say, 4pm to midnight.
Additionally, Dr. Panda and his team found that a 12-hour eating window wasn’t sufficient to help significantly.
Some other take-aways:
- For reasons beyond the scope of this article, it’s good to exercise a) early b) before eating, so getting in some exercise between 8.30am and 10am is ideal
- It also means it’s beneficial to “front-load” eating, so a large breakfast at 10am, and smaller meals/snacks afterwards, is best.
- It also means that getting sunlight (even if cloud-covered) around 8.30am helps guard against metabolic disorders a lot, since the light remains the body’s go-to way of knowing the time.
- We realize that sunlight is not available at 8.30am at all latitudes at all times of year. Artificial is next-best.
- It also means sexual desire will typically peak in men in the mornings (per testosterone) and women in the evenings (per progesterone), but this is just an interesting bit of trivia, and not so relevant to metabolic health
What to do next…
Want to stabilize your own circadian rhythm in the best way, and also help Dr. Panda with his research?
His team’s (free!) app, “My Circadian Clock”, can help you track and organize all of the body’s measurable-by-you circadian events, and, if you give permission, will contribute to what will be the largest-yet human study into the topics covered today, to refine the conclusions and learn more about what works best.
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Watermelon vs Grapes – Which is Healthier?
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Our Verdict
When comparing watermelon to grapes, we picked the watermelon.
Why?
It was close! And certainly both are very healthy.
Both fruits are (like most fruits) good sources of water, fiber, vitamins, and minerals. Any sugar content (of which grapes are slightly higher) is offset by their fiber content and polyphenols.
See: Which Sugars Are Healthier, And Which Are Just The Same?
While both are good sources of vitamins A and C, watermelon has about 10x as much vitamin A, and about 6x as much vitamin C (give or take individual plants, how they were grown, etc, but the overall balance is clearly in watermelon’s favor).
When it comes to antioxidants, both fruits are good, but again watermelon is the more potent source. Grapes famously contain resveratrol, and they also contain quercetin, albeit you’d have to eat quite a lot of grapes to get a large portion.
Now, having to eat a lot of grapes might not sound like a terrible fate (who else finds that the grapes are gone by the time the groceries are put away?), but we are comparing the fruits here, and on a list of “100 best foods for quercetin”, for example, grapes took 99th place.
Watermelon’s main antioxidant meanwhile is lycopene, and watermelon is one of the best sources of lycopene in existence (better even than tomatoes).
We’ll have to do a main feature about lycopene sometime soon, so watch this space
Take care!
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