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:

Let’s Shed Some Obesity Myths

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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  • The voice in your head may help you recall and process words. But what if you don’t have one?

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    Can you imagine hearing yourself speak? A voice inside your head – perhaps reciting a shopping list or a phone number? What would life be like if you couldn’t?

    Some people, including me, cannot have imagined visual experiences. We cannot close our eyes and conjure an experience of seeing a loved one’s face, or imagine our lounge room layout – to consider if a new piece of furniture might fit in it. This is called “aphantasia”, from a Greek phrase where the “a” means without, and “phantasia” refers to an image. Colloquially, people like myself are often referred to as having a “blind mind”.

    While most attention has been given to the inability to have imagined visual sensations, aphantasics can lack other imagined experiences. We might be unable to experience imagined tastes or smells. Some people cannot imagine hearing themselves speak.

    A recent study has advanced our understanding of people who cannot imagine hearing their own internal monologue. Importantly, the authors have identified some tasks that such people are more likely to find challenging.

    fizkes/Shutterstock

    What the study found

    Researchers at the University of Copenhagen in Denmark and at the University of Wisconsin-Madison in the United States recruited 93 volunteers. They included 46 adults who reported low levels of inner speech and 47 who reported high levels.

    Both groups were given challenging tasks: judging if the names of objects they had seen would rhyme and recalling words. The group without an inner monologue performed worse. But differences disappeared when everyone could say words aloud.

    Importantly, people who reported less inner speech were not worse at all tasks. They could recall similar numbers of words when the words had a different appearance to one another. This negates any suggestion that aphants (people with aphantasia) simply weren’t trying or were less capable.

    image of boy sitting with diagram of gold brain superimposed over image
    Hearing our own imagined voice may play an important role in word processing. sutadimages/Shutterstock

    A welcome validation

    The study provides some welcome evidence for the lived experiences of some aphants, who are still often told their experiences are not different, but rather that they cannot describe their imagined experiences. Some people feel anxiety when they realise other people can have imagined experiences that they cannot. These feelings may be deepened when others assert they are merely confused or inarticulate.

    In my own aphantasia research I have often quizzed crowds of people on their capacity to have imagined experiences.

    Questions about the capacity to have imagined visual or audio sensations tend to be excitedly endorsed by a vast majority, but questions about imagined experiences of taste or smell seem to cause more confusion. Some people are adamant they can do this, including a colleague who says he can imagine what combinations of ingredients will taste like when cooked together. But other responses suggest subtypes of aphantasia may prove to be more common than we realise.

    The authors of the recent study suggest the inability to imagine hearing yourself speak should be referred to as “anendophasia”, meaning without inner speech. Other authors had suggested anauralia (meaning without auditory imagery). Still other researchers have referred to all types of imagined sensation as being different types of “imagery”.

    Having consistent names is important. It can help scientists “talk” to one another to compare findings. If different authors use different names, important evidence can be missed.

    bare foot on mossy green grass
    We’re starting to broaden our understanding of the senses and how we imagine them. Napat Chaichanasiri/Shutterstock

    We have more than 5 senses

    Debate continues about how many senses humans have, but some scientists reasonably argue for a number greater than 20.

    In addition to the five senses of sight, smell, taste, touch and hearing, lesser known senses include thermoception (our sense of heat) and proprioception (awareness of the positions of our body parts). Thanks to proprioception, most of us can close our eyes and touch the tip of our index finger to our nose. Thanks to our vestibular sense, we typically have a good idea of which way is up and can maintain balance.

    It may be tempting to give a new name to each inability to have a given type of imagined sensation. But this could lead to confusion. Another approach would be to adapt phrases that are already widely used. People who are unable to have imagined sensations commonly refer to ourselves as “aphants”. This could be adapted with a prefix, such as “audio aphant”. Time will tell which approach is adopted by most researchers.

    Why we should keep investigating

    Regardless of the names we use, the study of multiple types of inability to have an imagined sensation is important. These investigations could reveal the essential processes in human brains that bring about a conscious experience of an imagined sensation.

    In time, this will not only lead to a better understanding of the diversity of humans, but may help uncover how human brains can create any conscious sensation. This question – how and where our conscious feelings are generated – remains one of the great mysteries of science.

    Derek Arnold, Professor, School of Psychology, The University of Queensland

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Chipotle Chili Wild Rice

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    This is a very gut-healthy recipe that’s also tasty and filling, and packed with polyphenols too. What’s not to love?

    You will need

    • 1 cup cooked wild rice (we suggest cooking it with 1 tbsp chia seeds added)
    • 7 oz cooked sweetcorn (can be from a tin or from frozen or cook it yourself)
    • 4 oz charred jarred red peppers (these actually benefit from being from a jar—you can use fresh or frozen if necessary, but only jarred will give you the extra gut-healthy benefits from fermentation)
    • 1 avocado, pitted, peeled, and cut into small chunks
    • ½ red onion, thinly sliced
    • 6–8 sun-dried tomatoes, chopped
    • 2 tbsp extra virgin olive oil
    • 2 tsp chipotle chili paste (adjust per your heat preferences)
    • 1 tsp black pepper, coarse ground
    • ½ tsp MSG or 1 tsp low-sodium salt
    • Juice of 1 lime

    Method

    (we suggest you read everything at least once before doing anything)

    1) Mix the cooked rice, red onion, sweetcorn, red peppers, avocado pieces, and sun-dried tomato, in a bowl. We recommend to do it gently, or you will end up with guacamole in there.

    2) Mix the olive oil, lime juice, chipotle chili paste, black pepper, and MSG/salt, in another bowl. If perchance you have a conveniently small whisk, now is the time to use it. Failing that, a fork will suffice.

    3) Add the contents of the second bowl to the first, tossing gently but thoroughly to combine well, and serve.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Dates vs Figs – Which is Healthier?

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    Our Verdict

    When comparing dates to figs, we picked the dates.

    Why?

    Dates are higher in sugar, but also have a lower glycemic index than figs, which makes the sugar content much healthier. On the flipside, figs do have around 3x more fiber.

    So far, so balanced.

    When it comes to micronutrients though, dates take the prize much more clearly.

    Dates have slightly more of most vitamins, and a lot more of most minerals.

    In particular, dates are several times higher in copper, iron, magnesium, manganese, phosphorus, selenium, and zinc.

    As for other phytochemical benefits going on:

    • both are good against diabetes for reasons beyond the macros
    • both have anti-inflammatory properties
    • dates have anticancer properties
    • dates have kidney-protecting properties

    So in this last case, another win for dates.

    Both are still great though, so do enjoy both!

    Want to learn more?

    You might like to read:

    Which Sugars Are Healthier, And Which Are Just The Same?

    Take care!

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  • What you need to know about endometriosis

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    Endometriosis affects one in 10 people with a uterus who are of reproductive age. This condition occurs when tissue similar to the endometrium—the inner lining of the uterus—grows on organs outside of the uterus, causing severe pain that impacts patients’ quality of life.

    Read on to learn more about endometriosis: What it is, how it’s diagnosed and treated, where patients can find support, and more.

    What is endometriosis, and what areas of the body can it affect?

    The endometrium is the tissue that lines the inside of the uterus and sheds during each menstrual cycle. Endometriosis occurs when endometrial-like tissue grows outside of the uterus.

    This tissue can typically grow in the pelvic region and may affect the outside of the uterus, fallopian tubes, ovaries, vagina, bladder, intestines, and rectum. It has also been observed outside of the pelvis on the lungs, spleen, liver, and brain.

    What are the symptoms?

    Symptoms may include pelvic pain and cramping before or during menstrual periods, heavy menstrual bleeding, bleeding or spotting between periods, pain with bowel movements or urination, pain during or after sex or orgasm, fatigue, nausea, bloating, and infertility.

    The pain associated with this condition has been linked to depression, anxiety, and eating disorders. A meta-analysis published in 2019 found that more than two-thirds of patients with endometriosis report psychological stress due to their symptoms.

    Who is at risk?

    Endometriosis most commonly occurs in people with a uterus between the ages of 25 and 40, but it can also affect pre-pubescent and post-menopausal people. In rare cases, it has been documented in cisgender men.

    Scientists still don’t know what causes the endometrial-like tissue to grow, but research shows that people with a family history of endometriosis are at a higher risk of developing the condition. Other risk factors include early menstruation, short menstrual cycles, high estrogen, low body mass, and starting menopause at an older age.

    There is no known way to prevent endometriosis.

    How does endometriosis affect fertility?

    Up to 50 percent of people with endometriosis may struggle to get pregnant. Adhesions and scarring on the fallopian tubes and ovaries as well as changes in hormones and egg quality can contribute to infertility.

    Additionally, when patients with this condition are able to conceive, they may face an increased risk of pregnancy complications and adverse pregnancy outcomes.

    Treating endometriosis, taking fertility medications, and using assistive reproductive technology like in vitro fertilization can improve fertility outcomes.

    How is endometriosis diagnosed, and what challenges do patients face when seeking a diagnosis?

    A doctor may perform a pelvic exam and request an ultrasound or MRI. These exams and tests help identify cysts or other unusual tissue that may indicate endometriosis.

    Endometriosis can only be confirmed through a surgical laparoscopy (although less-invasive diagnostic tests are currently in development). During the procedure, a surgeon makes a small cut in the patient’s abdomen and inserts a thin scope to check for endometrial-like tissue outside of the uterus. The surgeon may take a biopsy, or a small sample, and send it to a lab.

    It takes an average of 10 years for patients to be properly diagnosed with endometriosis. A 2023 U.K. study found that stigma around menstrual health, the normalization of menstrual pain, and a lack of medical training about the condition contribute to delayed diagnoses. Patients also report that health care providers dismiss their pain and attribute their symptoms to psychological factors.

    Additionally, endometriosis has typically been studied among white, cisgender populations. Data on the prevalence of endometriosis among people of color and transgender people is limited, so patients in those communities face additional barriers to care.

    What treatment options are available?

    Treatment for endometriosis depends on its severity. Management options include:

    • Over-the-counter pain medication to alleviate pelvic pain
    • Hormonal birth control to facilitate lighter, less painful periods
    • Hormonal medications such as gonadotropin-releasing hormone (GnRH) or danazol, which stop the production of hormones that cause menstruation
    • Progestin therapy, which may stop the growth of endometriosis tissue
    • Aromatase inhibitors, which reduce estrogen

    In some cases, a doctor may perform a laparoscopic surgery to remove endometrial-like tissue.

    Depending on the severity of the patient’s symptoms and scar tissue, some doctors may also recommend a hysterectomy, or the removal of the uterus, to alleviate symptoms. Doctors may also recommend removing the patient’s ovaries, inducing early menopause to potentially improve pain.

    Where can people living with endometriosis find support?

    Given the documented mental health impacts of endometriosis, patients with this condition may benefit from therapy, as well as support from others living with the same symptoms. Some peer support organizations include:

    For more information, talk to your health care provider.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • Stay off My Operating Table – by Dr. Philip Ovadia

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    With heart disease as the #1 killer worldwide, and 88% of adults being metabolically unhealthy (leading cause of heart disease), this is serious!

    Rather than taking a “quick fix” advise-and-go approach, Dr. Ovadia puts the knowledge and tools in our hands to do better in the long term.

    As a heart surgeon himself, his motto here is:

    ❝What foods to put on your table so you don’t end up on mine❞

    There’s a lot more to this book than the simple “eat the Mediterranean diet”:

    • While the Mediterranean diet is generally considered the top choice for heart health, he also advises on how to eat healthily on all manner of diets… Carnivore, Keto, Paleo, Atkins, Gluten-Free, Vegan, you-name-it.
    • A lot of the book is given to clearing up common misconceptions, things that sounded plausible but are just plain dangerous. This information alone is worth the price of the book, we think.
    • There’s also a section given over to explaining the markers of metabolic health, so you can monitor yourself effectively
    • Rather than one-size-fits-all, he also talks about common health conditions and medications that may change what you need to be doing
    • He also offers advice about navigating the health system to get what you need—including dealing with unhelpful doctors!

    Bottom line: A very comprehensive (yet readable!) manual of heart health.

    Get your copy of Stay Off My Operating Table from Amazon today!

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  • Test For Whether You Will Be Able To Achieve The Splits

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    Some people stretch for years without being able to do the splits; others do it easily after a short while. Are there people for whom it is impossible, and is there a way to know in advance whether our efforts will be fruitful? Liv (of “LivInLeggings” fame) has the answer:

    One side of the story

    There are several factors that affect whether we can do the splits, including:

    • arrangement of the joint itself
    • length of tendons and muscles
    • “stretchiness” of tendons and muscles

    The latter two things, we can readily train to improve. Yes, even the basic length can be changed over time, because the body adapts.

    The former thing, however (arrangement of the joint itself) is near-impossible, because skeletal changes happen more slowly than any other changes in the body. In a battle of muscle vs bone, muscle will always win eventually, and even the bone itself can be rebuilt (as the body fixes itself, or in the case of some diseases, messes itself up). However, changing the arrangement of your joint itself is far beyond the auspices of “do some stretches each day”. So, for practical purposes, without making it the single most important thing in your life, it’s impossible.

    How do we know if the arrangement of our hip joint will accommodate the splits? We can test it, one side at a time. Liv uses the middle splits, also called the side splits or box splits, as an example, but the same science and the same method goes for the front splits.

    Stand next to a stable elevated-to-hip-height surface. You want to be able to raise your near-side leg laterally, and rest it on the surface, such that your raised leg is now perfectly perpendicular to your body.

    There’s a catch: not only do you need to still be stood straight while your leg is elevated 90° to the side, but also, your hips still need to remain parallel to the floor—not tilted up to one side.

    If you can do this (on both sides, even if not both simultaneously right now), then your hip joint itself definitely has the range of motion to allow you to do the side splits; you just need to work up to it. Technically, you could do it right now: if you can do this on both sides, then since there’s no tendon or similar running between your two legs to make it impossible to do both at once, you could do that. But, without training, your nerves will stop you; it’s an in-built self-defense mechanism that’s just firing unnecessarily in this case, and needs training to get past.

    If you can’t do this, then there are two main possibilities:

    • Your joint is not arranged in a way that facilitates this range of motion, and you will not achieve this without devoting your life to it and still taking a very long time.
    • Your tendons and muscles are simply too tight at the moment to allow you even the half-split, so you are getting a false negative.

    This means that, despite the slightly clickbaity title on YouTube, this test cannot actually confirm that you can never do the middle splits; it can only confirm that you can. In other words, this test gives two possible results:

    • “Yes, you can do it!”
    • “We don’t know whether you can do it”

    For more on the anatomy of this plus a visual demonstration of the test, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Stretching Scientifically – by Thomas Kurz ← this is our review of the book she’s working from in this video; this book has this test!

    Take care!

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