Posts Tagged ‘Downside’

WEIGHT LOSS
•    Find a diet plan that fits your style
•    Keep a dietary diary
•    Eat a high-protein breakfast
•    Use a pedometer to reach 10,000 steps
•    Try Alli (orlistat) for an OTC weight loss crutch
By now you are probably sick and tired of hearing about the obesity epidemic in America. You already know that bigger is not better and that a large waist size increases the risk of diabetes, high blood pressure, and heart disease. But shedding pounds—and keeping them off—is one of the great challenges of modern life.
It’s not that there is any shortage of advice. There are dozens of diet programs and probably hundreds of diet books available to help you shed pounds, preferably painlessly. Effortless weight loss seems to be the perennial American dream. Some of the diets keep popping up like perennials, as well.
One of them, misleadingly titled “the new mayo clinic diet,” has been circulating on the Internet for a decade. Even then, it was a resuscitation of the “old” mayo clinic diet that had been passed from person to person since the 1960s. The actual Mayo Clinic has disavowed this diet in any of its incarnations, but that doesn’t stop enthusiasts from claiming that you can achieve weight loss of 50 pounds in 2 months by following the plan. People are instructed to breakfast upon eggs, bacon, and grapefruit. Lunch consists of salad, meat, and the ubiquitous grapefruit. For dinner, the dieter has (you guessed it) half a grapefruit plus as much meat as he or she wants and a green or red vegetable cooked in butter. People are encouraged to eat until they are
full.
The sad and simple truth is that there are no shortcuts to the shape you want. Taking off pounds requires taking in less energy than you are using up.This equation has two parts: how much you eat and how much you exercise. Changing either part calls for more effort than many of us can muster in an environment that encourages us to eat more and exercise less. No doubt that’s why new diets have such appeal, even though they are often a familiar approach recycled with a new twist.
There are so many diet plans out there that we can’t possibly tell you about each one. Instead, we will stick to some general guidelines that may help you figure out the best approach for you. This is an arena in which one size does not fit all and, sadly enough, there is no magic bullet. Getting weight under control can be quite a challenge, but it is also a great Opportunity to improve your health.
Dietary Approaches
There is no question that diet is crucial to weight loss. You may not want, or even need, to count calories. But even if you take a diet pill, you can’t lose weight without paying attention to what you eat. Dietitians are fond of pointing out that losing weight is a simple matter of using up fewer calories than you take in. “Simple” it may be, but it isn’t easy, as too many of us know! For best results, of course, you need to work on both sides of the equation.
Pick a Plan
Which diet is best for weight loss? That is a difficult question to answer. Most of the popular diets have not been subjected to rigorous study. Even when they have been studied, few of them have gone head-to-head with others to determine the better or best one.
Scientists at Tufts University did undertake a comparison of four popular diets under “real world” conditions. They enrolled people in the trial and then assigned them randomly to the low-carbohydrate Atkins diet, the low-fat Ornish diet, the Weight Watchers diet plan, or the Zone diet. Although there were some interesting differences in the blood fats at the end of the stud
in terms of weight loss, the programs were about the same.People on the more extreme diets—the low-carb Atkins and the low-fat Ornish—lost a bit more weight than those on the more moderate diets. But more people dropped out of those diet groups as well, perhaps because the more extreme diets are harder to follow.
The main trick is to figure out what diet plan you prefer. We don’t mean “what you like to eat”; if you use a diet that focuses heavily on what you like to eat, it will be far too easy to eat too much. No, you need to ask yourself what you are willing to eat. If going without a single piece of cheese for a year will be a major deprivation, you might not want to adopt a super-low-fat approach. If your Italian soul can’t survive without pasta, an ultra-low-carb approach is probably out. But don’t fret too much. Either diet will work, if you stick with it. And so will a lot of the more moderate diet approaches. The social reinforcement built into the Weight Watchers plan can be very helpful for some people; it drives others nuts.
A meta-analysis of diet studies shows that both low-carbohydrate and low-fat diets are about equally effective for weight loss.831 The question is, Do you need to raise good HDL cholesterol and lower triglycerides as well? If so, choose a low-carb diet. But if you really need to get your total cholesterol and your bad LDL cholesterol under control, the low-fat diet is a better way to go.
We have a friend who has managed to lose and keep off about 30 pounds over the years. This weight loss has brought his total cholesterol down so well that he does not need a cholesterol-lowering drug. Mis surprised his doctor, who assumed that he would require a prescription for Lipitor (atorvastatin) or Zocor (simvastatin) sooner or later.
What impresses us is his persistence. He is always very careful about what he eats. We asked him how he manages to keep it up day after day, and he said he makes it like a game with himself. He actually shifts back and forth between a lowcmb pattern and a low-fat pattern, which helps him prevent boredom. But on any given day, he decides which diet he is following and challenges himself to see how closely he can adhere to it. We don’t know if he gives himself points or has a reward system set up. But playing the game of eating right has a lot of rewards built into it, not the least of which is weight control.
If you like the idea of a game, then we have a wonderful “diet” book to recommend: Eat, Drink, and Weigh Less, by the fabulous vegetarian cookbook author Mollie Katzen and the respected nutrition researcher Walter C. Willett, MD, DrPH, MPH. They devised a numeric concept, the body score, that makes it easy to measure how well you are eating and challenge yourself to do even better. 832
Write It Down
Aside from getting you to focus more on low-calorie, high-nutrient vegetables and fruits, calculating your bodV score brings another tool into play: the dietary diary. Even if you do nothing else in your weight loss efforts, do this. Get yourself a portable notebook. It can be as nice as you like, or as inexpensive as a little flip pad. But it does need to -be small, because you should take it with you everywhere you go and write down everything you eat. Not just the menus of your meals, though that is necessary and can be fun. You must also note every tidbit, every nut, every chocolate chip that you eat between meals.
***** Dietary Diary
No matter which diet you plan to follow, this allows you to track your progress. The simple act of writing it down can help you become more aware of what you are eating. You learn to ask yourself, Do I really want this?
In addition, you can analyze the information in your dietary diary to see what circumstances conspire against your sticking to your plan. Try to figure out other ways to deal with problems like having to rush from appointment to appointment and therefore missing lunch, then discovering that you are starving before dinner and gobbling down a bag of tortilla chips with nacho cheese, sauce.
Downside: Inconvenience. But if you stick with it, writing down what you eat and what else is happening can be a great way to reinforce your diet.
Cost: It’s up to you. You could spend as little as 69 cents on a small notebook or as much as $30 on an elegant bound diary.
And don’t forget to write down what you drink as well. Some of us get a lot of calories from sweetened beverages like soft drinks, fruit drinks, or sweet teas. In fact, this makes up 21 percent of our national calorie consumption. 833 Switching to water most of the time could make a substantial difference in energy intake for some people.
Eat Breakfast
It might seem like a good idea to save on calories—and time—by skipping breakfast. You’ve got enough trouble just trying to pull
get dressed, putogether everything you’ll need for the day, and get out the door. If you’re a parent, you may need to do all of that for your children, as well! It’s not easy. But going without breakfast, or grabbing just a cup of coffee and a piece of toast, is a bad idea. A study that has looked at people who have successfully lost weight and kept it off found that most of them make breakfast an important meal, or at least a reliable one.”"
There are probably some breakfast choices that might be worse for dieters than no breakfast at all. Coffee and a Danish pastry come to mind, so do orange juice and a big stack of pancakes dripping with butter and maple syrup. Foods like this are high in sugar and refined flour that are quickly absorbed and push blood sugar and insulin up rapidly. (This can be quantified in scientific terms as the glycemic index of a food, which compares the food’s effect on blood glucose to that of table sugar.) The result, though, may be that your blood sugar level will crash in 2 or 3 hours, resulting in fatigue and maybe even hunger. Instead of these high-glycemic-index treats that will send blood sugar and insulin on a roller-coaster ride—first way up, then down, way down—you want a meal that will carry you through until lunchtime. That way you have a better chance of resisting the midmorning siren call of cookies or pastry. Breakfast is especially important for children, who pay better attention in school with a little nutrition under their belts.
We like a light scramble made of mostly egg whites plus a whole egg. If that’s too much trouble, how about low-fat cottage cheese with some vegetables? Our quickest breakfast, a smoothie, still has a fair bit of protein in it: a frozen banana (peel it before you put it in the freezer!), a couple of scoops of powdered whey protein, a few teaspoons of powdered egg white, a cup or so of frozen fruit or berries, and about 3/4 cup of yogurt and just enough fruit juice to get the blender to work.
With the juice, you don’t need any sweetener; the whey and egg white are good protein, much better than yogurt alone’, and the berries offer all kinds of nutrients as well as fiber. Anyway, the point here is that you should find a breakfast that fits your tastes and lifestyle and satisfies you so you won’t need a snack before lunch.
Keep Moving
As we pointed out earlier, even the most rigorous diet is only half of the story. The other half is increasing your energy expenditure through physical activity. It needs to be tailored to your lifestyle just as carefully as your meal plan.
The majority of Americans just don’t use their muscles very much. If there were games or sports you enjoyed when you were younger, think about whether you might find the time to dust off the rust and go back to playing tennis, say, or dancing. Choosing something you love means you’ll want to do it frequently, and that is more important than the type of exercise. Gardening, swimming, martial arts, yoga, bicycling, or anything else that gets you moving is fair game. There is definitely some activity that will help you use your muscles; it is up to you to figure out what it is and go for it.
If you can’t think of anything else, consider walking. It’s
Pedometer
This gadget is a favorite at our house. It’s small and lightweight, so you can set it to 0, clip it on your belt, and wear it all day long just to see how many steps you take. Of course, if you have a favorite walking or running course, you can measure the distance in miles or kilometers by wearing the pedometer while you traverse it. The goal of taking 10,000 steps a day is definitely doable, but it provides a good challenge. Public health folks offer it as a starting point.
Downside: it can be tricky to figure out the best place to wear this gadget to get an accurate count. Setting the pedometer so it measures your stride is not as hard as programming a VCR, but it can be a challenge.
Cost: Approximately $25 to $30. You can spend more, but you don’t need to.
cheap and readily available, and it’s good exercise. All you need is a pair of decent shoes and about 20 minutes to spare. If you have been very sedentary, you don’t even want to start with 20 minutes. Begin with 5 minutes and gradually work your way up to longer walks. To give yourself something of an extra challenge, get a step-counting pedometer. Then strive for 10,000 steps a day. Write down your step count every night in your dietary diary. When you can get to 10,000 steps reliably, day after day, set yourself a new challenge.
Herbal Disappointment
Dozens of dietary supplements are promoted as weight loss aids, but the science supporting most of them is lacking. Even when a study is done, the difference between those who took the product and those who took placebo is generally quite modest, possibly just a few pounds over several months. So if someone tries to sell you an all-natural supplement from somewhere exotic—whether it’s the Amazon, Outer Mongolia, or the North Pole—be suspicious. If you are told that the agent will turn on your fat burners or turbocharge your metabolism, double your skepticism. People have been selling herbal diet pills for more than 30 years. If they really worked, we’d all be as thin as we’d like to be. In most cases, the only thing that will lose weight is your wallet.
The track record for herbal diet pills is frankly rather discouraging. For quite a while, ephedra (Ephedra sinica) was promoted as a natural weight loss aid. Companies producing ephedra products made a lot of money until, eventually, the FDA reviewed all the reports of problems with this herb. The agency determined that ephedra was associated with a number of strokes, heart attacks, and other serious complications and called for its removal from the market. Aside from being overweight, some of the people who suffered life-threatening or even fatal side effects were otherwise in good health. This Stimulant might have helped people shed pounds in the short term, but it was not safe enough to be used for the long haul.
Ephedra has stimulant properties, which probably account both for its ability to promote some weight loss and for its potential to trigger a dangerous reaction. A couple of other natural products with stimulant activity have beensu ested for use in weight loss. Green tea835 and yerba matAl
have been considered for this purpose, though the research so far is not impressive. Both contain caffeine, along with other compounds that might be relevant.
Another purported stimulant, Garcinia cambogia (hydroxycitric acid), has also been included in a number of herbal weight loss preparations. A 3-month randomized controlled diet did not demonstrate any weight loss benefit beyond that of placebo.837
Q. What is hoodia? I keep getting e-mail messages that this is a wonderful way to lose weight. Does it work? Is it safe?
A. Hoodia is a cactus that grows in the Kalahari Desert in southern Africa. It is being promoted as a marvelous weight loss agent, but there is very little clinical research to support the claims.
One small, unpublished study (18 obese patients) demonstrated some benefit, but we would need to see far more evidence before recommending this plant product. Questions have been raised about the quality control used in manufacturing hoodia products, and long-term safety has not been established.
Nonprescription Help
One of the reasons that ephedra became so popular was that there were only a few other choices available without a prescription. The most popular over-the-counter (OTC) weight loss ingredient was a decongestant called phenylpropanolamine, or PPA for short. In its heyday during the 1970s and 19805, Dexatrim was one of the most popular brands.
PPA was not as safe as most dieters assumed, however. As early as 1980, British researchers had raised a red flag. When they gave PPA to healthy young medical students, they noted side effects such as an alarming elevation in blood pressure along with dizziness, heart palpitations, headache, insomnia, anxiety, and restlessness. By 1990, doctors in the United States had reported 142 bad reactions to PPA, including bleeding stroke, seizure, and even death. But it took the FDA 10 years to make a move. It requested a study of PPNs safety, particularly with respect to bleeding stroke. Yale investigators found that women who took PPA for the first time in a cough or cold remedy tripled their risk of a stroke. Those using the drug as an appetite suppressant appeared to be at 16 times the stroke risk of a woman not taking
the drug. 8-38
Given these data, FDA staffers estimated that PPA might be responsible for 200 to 500 strokes in people under the age of 50 each year. Extrapolating over all the years it was on the market, PPA could have accounted for as many as 10.000 strokes in people who otherwise would not have been vulnerable to that problem. The agency announced in 2000 that OTC weight loss products would need to be reformulated without PPA.This meant that most dieters could no longer rely on a pill to help them. Ephedra had been taken off the market because it was too dangerous. And PPA was removed as well, also because it was not safe enough.
With the approval of orlistat (available by prescription as
Orlistat (Alli)
This weight loss medication is also available by prescription under the name Xenical. It appears to be one of the few weight loss drugs considered safe for long-term use. Orlistat is intended to be used in conjunction with a reduced-calorie, reduced-fat diet. The drug prevents the absorption of fat from the gastrointestinal tract. Nearly twice as many people on orlistat manage to lose 15 percent of their body weight in a year as people on diet restrictions alone.
Side effects: Most of the side effects are gastrointestinal. Because orlistat prevents the absorption of fat, fat is retained in the imeslines. This may result in stomachache, diarrhea, nausea, flatulence, rectal discharge, and fecal incontinence. Headache is also a possible side effect.
Downside: The drug may interfere with the absorption of fat-soluble vitamins. Take a multivitamin either 2 hours prior to or 2 hours after taking Alli.
Cost: Approximately $50 to $60 per month Xenical) to go over the counter under the name Alli, people finally have a tested do-it-yourself option. The company has chosen the name Alli to imply that it will work best if allied with a full program of dietary and behavior modification approaches. The FDA appears confident that this drug does not pose significant safety issues.
Orlistat is a compound that prevents the absorption of fat. It can help people lose weight, but there are some drawbacks. For one thing, there’s the underwear risk: spotting with oily stool. There also may be increased flatulence, sometimes with discharge. Orlistat doesn’t take you off the hook for eating carefully: The 5- to 6-pound weight loss advantage over placebo occurs only when people eat a reduced-calorie, low-fat diet. Unfortunately, once people stop the medication, they often gain back the weight they lost.
Perhaps Alli would be best used as a “jump start” by someone who’s having a hard time pulling together the pieces of a diet plan. Few people will want to take it year after year, although it does appear to be cost-effective.839
Prescription Weight-Loss Drugs
The history of prescription diet pills in the United States is full of woe and intrigue. Starting in the 1950s, millions of overweight Americans were prescribed amphetamines to help them shed a few extra pounds. Such stimulants were supposed to be taken for only a few months at a time, but they were extremely seductive. Many respectable housewives became dependent on “speed.” This made physicians a bit more cautious about prescribing such medications to help people lose weight.
During the 1990s doctors began to combine two diet pills that had been around for decades. The combination of fenfluramine and phentermine (”fen-phen”) seemed to work better than either drug trouble was, the combination led to heart valve complications. At about the same time, a new appetite suppressant, dexfenfluramine (Redux), was approved. It, too, was associated with heart problems and a potentially life-threatening condition called pulmonary hypertension.
In 1997, the FDA asked the manufacturer to withdraw Redux from the market, although it had been approved only the year before. Fenfluramine was also taken off the market. The fen-phen fiasco was certainly a spectacular disaster. Quite a number of people were left with damaged hearts just because they took drugs to help them lose weight.
Despite this uninspired track record, many people were hoping for the FDA to approve a new diet pill. The claims being made about rimonabant (Zimulti) are extraordinary. It is easy to understand why some people might be eager to try it, even if others are skeptical.
The manufacturer, Sanofi-Aventis, is being especially careful to downplay the cosmetic weight-reducing potential of Zimulti. Instead, they are highlighting other benefits, such as the improvement of lipid profiles. In three large clinical trials, Zimulti resulted in promising metabolic improvements.840,841,842
Good HDL cholesterol rose and bad triglycerides dropped. Insulin efficiency improved and blood sugar levels came down. The positive changes were twice what researchers would have anticipated from weight loss alone. Such metabolic effects may be especially beneficial for people with type 2 diabetes.
What really has millions of people excited, though, is rimonabant’s ability to lower weight. After 1 year on the drug, subjects lost approximately 15 pounds, significantly more than those on placebo. In the world of diet pills, such a loss is impressive.
The buzz surrounding Zimulti is enormous. Weight loss and
iW Rimonabant (Zimulti►
Acomplia is different from other prescription diet pills because it works on an entirely new mechanism. It blocks brain CB0) (cannabinoid 1) receptors that respond to natural marijuana-like compounds. It is more effective than any other medication for weight loss, helping people lose more than 15 pounds over the course of a year.
Acomplia also has beneficial effects on good HDL cholesterol, triglycerides, insulin efficiency, blood sugar level, and blood pressure.
Side effects: Nausea, diarrhea, dizziness, headache, sore throat or flu, anxiety, insomnia, and depression. Most of these were mild and transient, although depression is disconcerting and may lead to suicidal thoughts.
Downside: We don’t have much information on the long-term effects of this new medicine.
improvements in blood glucose, blood pressure, and lipids are certainly much needed. In addition, investigators are studying whether rimonabant may help people quit smoking. There is even some hope that the compound may help people deal effectively with other drug dependencies, including the most prevalent one, alcohol.”
The FDA has delayed approval of rimonabant due to worries about anxiety, depression and suicidal thoughts. It could take years to assess whether the drug is safe enough for longterm use.
Conclusions
Losing excess weight is notoriously difficult, but it can have a profound effect on health. Dropping pounds can help lower blood pressure and get cholesterol under control, as well as alleviating the strain on arthritic joints. Weight loss is probably approached best as a long-term change in lifestyle rather than a short-term goal. If Weight Watchers or a similar program that offers social support appeals to you, by all means try it out. Here are some other suggestions that may help.
•    Find a diet plan that appeals to you. The only program that will work is one that you can stick with long-term.
•    Keep a dietary diary. Write down every single morsel that you stick in your mouth and when. Most of the weight loss gurus that we have consulted over the last few decades emphasize that this one behavior is essential for lasting success.
•    Eat a high-protein breakfast. No more bagels and butter. Skip the orange juice and coffee. A low-glycemic-index meal will carry you through to lunch.
•    Find an exercise you like. Get a pedometer and strive for 10,000 steps a day. Plot your progress in your dietary diary or on a computer.
`If you need a pharmacological boost, consider Alli (orlistat). This fat Mocker may help you lose a few pounds, though the side effects might be embarrassing. Don’t forget to take your vitamins if you take this drug.
•    If all else fails, Acomplia (rimonabant) may provide the help you need to lose weight, improve your cardiometabolic risk factors, and quit smoking. Check with your doctor about the benefits and risks of this prescription drug.

TINNITUS
6 Test drive a hearing aid/masking device    ***
•    Take melatonin at bedtime    **
•    Ask your doctor about misoprostol (Cytotec)
Can you imagine anything more annoying than hearing a mosquito buzzing around your head and not being able to catch it? A dentist’s drill might be a close match. Now imagine what it would be like to have crickets chirping in your ear 24 hours a day, 7 days a week.
Experts estimate that more than 30 million Americans hear a constant noise in their ears.807′Roughly one in eight men between the ages of 65 and 74 experiences some form of tinnitus (pronounced TIN-a-tus or tin-EYE-tus).808 Women and children are not spared the unwanted sound effects, which some describe as hissing, humming, chirping, whooshing, whistling, squeaking, or roaring.
Many tinnitus sufferers hear a high-pitched ringing, while others say it sounds more like steam escaping. Others complain of radio static or an electronic whine inside their head. One person described it this way: “I have aff ocean between my ears every day, 24-7.” Whatever the sound, it never lets up—but nobody else can hear it, either.
My husband has a constant buzz in his ears andalso hears a sound he likens to a dishwasher running. This particular sound bothers him most when he goes to bed or wakes up at night, and it wakes him frequently. The doctor says lots of people have tinnitus and the problem isn’t serious, but it has my husband on the ropes.
According to the medical establishment, “Many patients with tinnitus believe that they have a serious medical prob- lem. This is rarely the case.” 8(3) We beg to differ. People with tinnitus look normal, but the affliction can be as crippling as arthritis. Some individuals are so distressed by the sounds they hear that they become severely depressed and contemplate suicide. A study has found that even moderate tinnitus can interfere with cognitive ability, making it harder to focus and achieve peak performance while working on demanding tasks-810
Tinnitus can be caused by many things, including very loud noises. More than 15 years ago, Joe was preparing to cohost a radio show when a student engineer made an error and created a feedback loop through Joe’s headphones (the kind of screech you sometimes hear through speakers in an auditorium). The sound was so loud and so close to his ears that from that day to this, Joe has heard a ringing and hissing sound. Some days the noise is so overpowering that it is hard for him to concentrate. For people who cannot imagine what you are going through, it is difficult to describe how disconcerting it is to have a fieldful of crickets inside your head all the time.
We fear that millions of teenagers and young adults may be setting themselves up for tinnitus and other forms of hearing loss by exposing themselves to high volume levels while listening to iPods and other music devices. There are so many loud noises in our environment that the cumulative effect can damage our ears and increase our risk of tinnitus. We’re talking about everyday things in our lives like blenders, vacuum cleaners, motorcycles, leaf blowers, and lawn mowers. All of them are loud and can contribute to hearing problems.
G. I have just developed a hissing sound in my ears. The onset was very rapid!
The doctor diagnosed it as tinnitus but would give me no reason for the problem. He said there wasn’t anything I could do. I’ve noticed some days it is less disturbing than others, but some nights it awakens me because it has become so loud.
I was drinking large quantities of tonic water, which contains quinine, when this started. Do you have any suggestions to help me?
A. Stop the tonic water! Quinine gives tonic its distinctive bitter flavor, but it can cause tinnitus, especially at high doses. Hopefully the hissing sound will gradually go away once the quinine is out of your system.
Drugs are another common cause of tinnitus. An amazing number of prescription and over-the-counter medications can cause ringing in the ears. Aspirin is one of the most common culprits, but many other arthritis drugs can also contribute to the problem. If you suspect that a medicine is causing ringing, hissing, or whooshing, please discuss this with your physician promptly.
Drug-Induced Tinnitus
A. 1 am desperate to find some way to alleviate my arthritis pain without experiencing unbearable tinnitus. I have taken aspirin for some time, and it has been quite effective. If a joint flares up, l increase the dose for a few days. Then I heard your radio show where you mentioned that aspirin can contribute to tinnitus.
The noises in my head had been getting worse. I was resigned to this, but after listening to your program I stopped the aspirin. The result for my ears was dramatic! But then the joint pain came back. I feel I am walking a very thin line between arthritis and tinnitus.
A. Sadly, you are caught between a rock and a hard place. Aspirin and other arthritis drugs (nonsteroidal anti-inflammatory drugs, or NSAIDs, like naproxen and ibuprofen) can cause ringing in the ears. Some people are susceptible to even low doses. You may need to investigate other options for arthritis pain. (See page 102 for some nondrug approaches.)
In addition to sound-induced injury (like Joe experienced) and drugs, many other things can cause tinnitus. Impacted earwax is probably the most benign and easiest to correct. Some other contributors include head injury, multiple sclerosis, hypertension, infections (otitis media, Lyme disease), and tumors (acoustic neuroma). That’s why it is important-to be seen by a specialist (an otorhinolaryngologist, or ear, nose, and throat doctor) to rule out any treatable condition. Sometimes there is no obvious reason for the ringing or whooshing.
A few months ago I suddenly developed a case of tinnitus in my left ear It sounds like the high-pitched noise the computer makes when logging onto the Internet I am 36 years old and in extremely good health. I have not experienced any head trauma and am not exposed to loud noises.
I had an MRI to rule out a brain tumor Neither my family physician nor an ear, nose, and throat doctor could find anything wrong
DRUGS THAT CAN CAUSE TINNITUS*
GENERIC    BRAND NAME
Aspirin    Alka Seltzer, Ascriptin, Bayer
Bleomycin    Blenoxane
Bumetanide    Bumex
Bupropion    Wellbutrin SR and XL
Cetirizine    Zyrtec
Chloroquine    Aralen
Cisplatin    Platinol
Diclofenac    Cataflam, Voltdren
Erythromycin    E-Mycin, Ery-Tab, Eryc
Furosemide    Lasix
Ibuprofen    Advil, Motrin
Meloxicam    Mobic
Methotrexate    Rheumatrex
Nabumetone    Relafen
Naproxen    Aleve, Anaprox, Naprosyn
Quinine    Quinamm, Quinerva, QM-260
Risedronate    Actonel
Tetracycline    Sumycin
Valproic acid    DepakeRe,
Vancomycin    Vancocin
Vincristine    Oncovir
*This is just a partial list. Hundreds of drugs can contribute to tinnitus.
with me and they have not suggested any remedies. I currentlyiust barely manage it with white noise (a fan) at night
Treatments for Tinnitus
When everything else has been ruled out and you are left with ringing in the ears, what can be done? First and foremost, do not expose yourself to noise pollution. Chances are good you already have some hearing loss. Be cautious around all appliances (blenders and vacuum cleaners, for example) and power tools. When flying, take along hearing protectors (you can buy earplugs that fit in your ears unobtrusively) to block out some of the jet engine sounds at airports or on loud commuter airplanes. Do the same when attending concerts or sports events. Protect your ears from any further damage.
The official word from the medical establishment is that “most treatments [for tinnitus] are unsuccessful.”811 A review of 69 randomized clinical trials published in 1999 concluded that there was no proof that any therapy provides long-term improvement.812 Investigators have experimented with powerful medications that control irregular heart rhythms (intravenous lidocaine, and oral flecainide and tocainide), but the results were disappointing and the side effects scary. Anti-anxiety agents (benzodiazepines) such as alprazolam (Xanax) may help ease the psychological impact of tinnitus, but when the drug is discontinued, the problem can return with a vengeance. The antidepressant nortriptyline has shown more promise than many other approaches, but the benefits still are not overwhelming.813 Acupuncture, biofeedback, hypnosis, and “tinnitus retraining therapy” have all been disappointing and do not make the ringing go away.
Most physicians will say that the primary goal of treatment for tinnitus is “management.” Usually this means things like masking devices. In its crudest and cheapest form, a masking device is an FM radio tuned so that you do not get a signal, just static. The theory is that this “white noise” will mask the sound of the tinnitus. Some people find this helpful, whereas others report that it just intensifies the annoying sounds.
There are also white noise generators or masking devices that can be “tuned” to an individual’s general noise frequency. There are also sophisticated new hearing aids that both amplify sound in the hearing range that is impaired and  Hearing Aid/Masking Device
High-tech hearing aids that combine frequency-specific amplification and masking in one device may be worth consideration. Some folks report both improved hearing and reduced tinnitus with such equipment. Sometimes the tinnitus relief lasts for some time after the device is turned off or removed .814
Downside: These special hearing aids are pricey, costing several thousand dollars. Insurance is not likely to cover the cost. They require professional fitting. Do not expect them to solve the problem, but they may make it more tolerable.
Cost: Approximately $1,000 to $3,000 per ear. Try to work out a “test drive” to make sure they work well and adequately relieve your tinnitus discomfort. Another option: Lease with an option to buy. If they do not solve your problem, you can at least give them back when the lease is up.
use a masking signal that is adjusted to the specific range of the patient.
My husband has suffered for years from tinnitus and hearing loss (due to his time in Vietnam). He recently found great relief with the new technology in hearing aids. Since getting his hearing aids, the ringing, buzzing, etc., has completely gone away and his hearing is now very acute.
Many folks have tried hearing aids in the past without success. know my husband did. He said they just made the ringing louder! He is thrilled with this new technology. I believe this might help many who haven’t tried the devices.
No one should buy these pricey instruments unless they ac-
tually work. That means you should be able to either test the device for a short while or lease it for somewhat longer before shelling out thousands of dollars to purchase it.
Ginkgo Biloba
There has been some interesting research on this ancient Chinese herbal medicine. From the more than 100 clinical
trials that have been published, there seems to be a reasonable amount of data suggesting that standardized ginkgo extracts (Ginkgold, Ginkoba, and Ginkai) improve circulation throughout the body, in general, and may modestly improve symptoms of dementia.’”‘ A 1999 review of clinical studies of ginkgo concluded that “overall, the results of these trials are favorable to ginkgo biloba as a treatment for tinnitus, but a firm conclusion about efficacy is not possible … the body of evidence is small.„816
Since then, there have been two studies that have not found ginkgo to be an better than placebo for relieving symptoms of tinnitus.”11,81′ At this time it would be fair to say that the evidence is mixed at best and probably not very promising. On the other hand, ginkgo does seem to improve circulation and may be worth a try. Do not expect any miracles, though.
Adding a little zinc to the mix (50 milligrams) might be worth consideration since a small study suggested that this mineral produced some modest clinical improvement.”’ If after several weeks there is no improvement, we would give up on this approach.
Melatonin
One of the least studied but most promising new approaches for the treatment of tinnitus may be melatonin. This natural compound is inexpensive and safe. Melatonin is a hormone that is made primarily by the pineal gland in the brain in response to darkness. During the daytime, the blood level is low, but at night melatonin climbs until it reaches its peak between
** Melatonin
Melatonin is natural, safe, and not very expensive. Although there is some controversy about its effectiveness for insornni8, two preliminary studies suggest that it may help people with tinnitus and sleeping problems associated with ear ringing. The dose that has been tested is 3 milligrams.
Downside: The data are not yet strong enough to elicit a ringing endorsement.
Cost: Approximately $2 to $4 per month when purchased in bulk
2:00 and 4:00 a.m. It is crucial for regulating sleep and wake
cycles.
Some extraordinary claims have been made for melatonin. Some proponents say that it can reverse aging, improve immune function, reduce the risk of cancer, control blood pressure, and lower cholesterol. The best-known use of melatonin is as a sleep aid. An extensive review of the existing studies published in the Cochrane Database concluded, “Melatonin is remarkably effective in preventing or reducing jet lag, and occasional short-term use appears to be safe. It should be recommended to adult travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys
Despite this good news, two reviews of melatonin’s use for easing insomnia were less glowing. They concluded that melatonin does not work for sleep disorders’ 1,822 Nevertheless, a small preliminary study carried out by the Ear Research Foundation in Sarasota, Florida, in 1998 revealed that a dose of 3 milligrams of melatonin was helpful for patients with tinnitus that interfered with their sleep. 823 Following up on this research, investigators at Washington University in St. Louis also found that a dose of 3 milligrams was beneficial for people with tinnitus: “In summary, our study demonstrates that melatonin use is associated with improvement of tinnitus and Sleep.”824 Although the research to date is preliminary, melatonin seems to be worth a try because of its safety and affordability.
Misoprostol (Cytotec)
Sometimes doctors teach old drugs new tricks.’Tbat might be the case with misoprostol (Cytotec), a medication approved more than a decade ago to help prevent stomach ulcers. It was hoped that Cytotec would be especially beneficial for people taking aspirin or other NSAVDs like ibuprofen or naproxen. This medication has become controversial in recent years because some obstetricians have used it to induce labor. Others have combined misoprostol with mifepristone to induce abortion.
An entirely different use for misoprostol is treating tinnitus. We first stumbled across a pilot study that was published in 1993 in the Archives of Otolaryngology—Head & Neck Surgery.wL’ One of the most prestigious ear clinics in the world (House Ear Institute in Los Angeles) enrolled 24 subjects. These volunteers were given either misoprostol or placebo. Not surprisingly, the placebo did not work. Misoprostol, on the other hand, provided improvement for eight (33 percent) of the subjects. According to the investigators, “Responders reported improvement in tinnitus severity, sleep, and concentration:
More than a decade later, Turkish investigators noted that 13 of 28 patients (46 percent) who were given misoprostol reported a decline in the volume of their tinnitus, compared to only 2 of 14 subjects (14 percent) in the control group. 827 A
Misoprostol (Cytotec)
This prescription medication has FDA approval for the prevention of stomach ulcers. An “off-label” use may ultimately turn out to be for tinnitus. Preliminary studies have found that misoprostol may help roughly one-third to two-thirds ofrr tinnitus sufferers, with those who experienced a sudden onset of tinnitus or who had a history of acoustic trauma getting the most benefit. The dose used by the researchers was “200 micrograms per day for the first week, increased by 200 micrograms every 5 days” to reach a maintenance dose of 800 micrograms per day. This latter amount is also the dosage commonly used in gastroenterology.”828
Downside: Very expensive! Misoprostol must never be taken by a woman who is pregnant or might become pregnant. It can induce premature labor and cause other serious complications. Patients with heart or inflammatory bowel problems should also avoid misoprostol.
Side effects: Common adverse reactions include abdominal pain, indigestion, diarrhea, nausea, vomiting, flatulence, constipation, headache, and menstrual changes. Rare but potentially serious side effects include allergic reaction, irregular heart rhythm, heart attack, high blood pressure, low blood pressure, breathing difficulty, and blood clots.
Cost: Approximately $160 to $300 for a 2-month supply (depending on whether you purchase from a Canadian or US pharmacy)
follow-up study found that 18 of 28 patients “showed improvement in tinnitus loudness, representing an improvement rate of 64 percent. These are all small studies, and larger, more comprehensive, and longer follow-up research is required to prove that misoprostol represents a true advance in the treatment of tinnitus.
Conclusions
Compared to heart disease, diabetes, and cancer, tinnitus seems like a trivial complaint. But ask anyone who suffers from it and you will discover that it can have devastating consequences on the person’s quality of life. The constant ringing or hissing not only affects concentration, it also can interfere with sleep. Many people with tinnitus are depressed, and some even contemplate suicide. There is no cure and no perfect treatment. Nevertheless, there are some options worth considering.
•    Avoid loud noise, including common household appliances like blenders, hair dryers, vacuum cleaners, and power tools. Concerts, sporting events, and airports call for ear protection. Noise can make tinnitus worse.
•    Beware of prescription medicines and over-the-counter remedies that can trigger tinnitus or make it worsee. Even the quinine in tonic water can be a problem for some people.
•    Some people benefit from antianxiety agents like alprazolam (Xanax) or antidepressants such as nortriptyline. These drugs are not without side effects, however.
•    Seek professional advice about new technology that combines a hearing aid with a masking device. This equipment may help improve hearing and reduce the ringing. Try to negotiate for a trial period to test the hearing aid so you can make sure you are satisfied before shelling out thousands of dollars to purchase it.
•    Give ginkgo biloba a try. Although the research is not very supportive, ginkgo may help and it is relatively inexpensive. Make sure that it won’t interact with any other medicine you are taking.
•    Consider melatonin. This natural compound appears to be quite safe and may help tinnitus sufferers get some much-needed sleep.
•    If all else fails, your physician might prescribe misoprostol. A few small studies have found it useful for about one-third to two-thirds of tinnitus patients. Its price and side effects are daunting, however.

MENOPAUSE
*Turn the thermostat down to reduce hot flashes
•    Use the lowest-dose estrogen and progesterone therapy for the shortest time possible
•    Try Remifemin for hot flashes    ***
•    Eat tofu or tempeh or drink soy shakes    **
•    Ask your doctor about Paxil (paroxetine) or Effexor (venlafaxine) for hot flashes
•    Inquire about Neurontin (gabapentin) for hot flashes
•    Apply olive oil topically for vaginal dryness
•    Squeeze vitamin E out of a capsule as a sexual lubricant
•    Experience slippery sex with Sylk
•    Experiment with aloe vera gel
•    Get a prescription for Estring (estradiol)    ***
Decades ago, menopause used to be referred to in whispers as The Change. The mystery surrounding the event gave it a sinister aura. Now, though, more than 5 000 women enter menopause every day in the United States. ~21 That’s because the baby-boom generation is aging. We are not a bashful bunch, and female boomers have brought menopause out in the open. Women refer to hot flashes, somewhat jokingly, as power surges. But few women relish them. Most would like some way W ease this symptom, even it it is the consequence of a perfectly natural biological process.
We ought to begin with some explanation of menopause. Most people know this refers to the time when a woman’s ovaries stop making the hormones that support the ripening and release of eggs. It is a gradual process that may be spread out over years, perhaps even a decade, and is properly referred to as perimenopause. Menopause itself is technically just one point in time: the day when an entire year has passed since the end of a woman’s last menstrual cycle.722 The average age on this day is 51 years, but women may be as young as 40 or as old as 58 and still be within the normal range for menopause.
Just as the timing of this change in ovarian function differs from one woman to another, so do the timing and intensity of menopausal symptoms (yes, we should be calling them perimenopausal symptoms). Some women barely notice a hot flash or two. We’ve even spoken with women who had “cold flashes” rather than hot flashes. Others are distressed by intense heat waves that may plague them daily for years. Most fall between those extremes but would still welcome some respite from the sweating, the flushing, and the distracting feeling that they might spontaneously combust. (Not to worry—that has never happened!)
I hope you can recommend something for my wife, who feels like she is about to burst into flames. Her doctor suggested Premarin, but she refuses to take it because she is worried about the increased risk of breast cancer What other options are there?
If it is any comfort, this period of discomfort lasts about 4 years, on average. That means, though, that some women zip through it much more quickly, whereas others take longer, sometimes much longer, to get through to relief.
The Hormone Controversy
For years, women suffering from hot flashes and other menopausal discomforts were told that their doctors had the magic solution: Just take hormones to replace the ones their ovaries were no longer making. Hormone replacement therapy, or HRT, has had its ups and downs over the decades, beginning with Premarin’s approval in 1942. Since then, more than 30 billion doses of this h101MIOnt di Wled from pregnant mares’ urine have been dispensed.
When doctors discovered that women taking Premarin were at greater risk of developing cancer of the uterine lining, this prescription went out of vogue for a while. But then researchers found that adding progestin, a synthetic form of progesterone (usually prescribed under the brand name Provers), could reduce this risk. In the 1990s, Premarin became the most prescribed pill in history. Besides easing hot flashes,night sweats, and other menopausal problems, HRT was supposed to save women’s lives by reducing their risk of heart disease, colon cancer, osteoporosis, and other serious health
threats.
These days, though, the story has changed, and a lot of menopausal women are feeling confused and betrayed. For years, they were told that they were suffering from an estrogen deficiency syndrome. Replacing the hormones their bodies no longer made was supposed to ease menopausal symptoms. Women who resisted a prescription for HRT were sometimes treated as difficult cases. Some were told that though HRT might raise the risk of breast cancer, it was a much less significant concern than heart disease, which HRT might protect against.
After I was operated on for breast cancer, I was told that I could no longer take estrogen, because my tumor was ‘estrogen-dependent’ My primary physician actually had the gall to tell me: The benefits of estrogen far outweigh the threat of breast cancer, and besides, we can cure breast cancer’
Women have a right to be furious. The hormone hype that lasted for several decades represents one of the biggest scams in modern medicine. Millions of women were guinea pigs in an uncontrolled experiment. Physicians who pride therpselves on practicing “evidence-based medicine” prescribed drugs that were unsupported by data. Many women who expressed their fears to their physicians were told in no uncertain terms that the benefits of HRT outweighed the risks.
When the National Institutes of Health announced a huge, long-term study of hormone replacement therapy, advocates of HRT were thrilled. They anticipated that the best available science would support their convictions that HRT had many health benefits, far beyond simply easing hot flashes. Thousands of women were recruited to the study and randomly assigned to take either Prempro or a look-alike placebo pill.
When the results of this study—called the Women’s Health Initiative (WHI)—were announced in 2002, many physicians were surprised and women were shocked to learn that instead of protecting women from heart disease and cardiovascular complications, HRT actually increased their risk. A few doctors had anticipated that the study might show an increased risk of breast cancer. As early as 1995, the Nurses’ Health Study, which followed more than 100,000 women, had confirmed that estrogen replacement therapy significantly increased the risk of breast cancer in postmenopausal women and demonstrated that progestin did not diminish that risk 723 If anything, the data suggested that adding progestin could increase the risk .721
Although there had been hints from previous research that estrogen, with or without progesterone, might increase a woman’s risk of breast cancer, such concerns were mostly downplayed. Opinion leaders reminded physicians that the leading cause of death in postmenopausal women is heart disease. (Breast cancer  comes in second.) Some eminent gy- necologists opined that if breast cancer was a risk, it was a minimal one, associated only with long-term HRT use. Such cancers were thought to be “good” cancers in that they were “early” cancers, easily detected and treated and not associated with increased mortality.
Further results from the WHI gave the lie to that claim. The investigators found that women taking combined HRT (Prempro) were more likely to be diagnosed with breast cancer than those on placebo and were more likely to have invasive, more advanced cancers. They concluded, “These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.”115
As a result of these new findings, doctors may also be feeling betrayed. They too were sold a bill of goods that did not turn out to be as advertised. It is now clear to all that HRT is not a panacea for the miseries of menopause. But what remains unclear is exactly how women should cope with hot flashes, night sweats, sleep disruption, and vaginal dryness. Finding out that estrogen doesn’t really prevent heart disease still leaves women with plenty of options for reducing their risk of heart trouble. And there are other possible treatments for osteoporosis, another condition for which women were given long-term estrogen treatment. But what can be done for those annoying, sometimes debilitating hot flashes?
Alleviating Hot Flashes
Certain simple lifestyle adjustments might be all that some women need to make hot flashes tolerable. First, turn down the thermostat. This seems too simple to work, but many menopausal women are less uncomfortable when the temperature is cooler.726 Second, dress in layers that can be easily removed. ‘Ibis is simple common sense.Third, follow the Southern belles’ example and keep a fan and a nice coot (nonalcoholic) drink handy. Fourth, keep exercising. Or if you are not already walking, swimming, or dancing, start. It’s not a miracle, but women who exercise regularly seem to have fewer hot flashes or find them less bothersome. Besides, exercise eases depression and anxiety and is beneficial for the heart and the bones as well.
Hormone Replacement Therapy
When it comes to taming hot flashes, estrogen is undeniably the gold standard. Estrogen, either alone or in combination with progestin, clearly reduces the frequency and severity of hot flashes by about 75 percent.727 This is significantly better than placebo, although women with hot flashes are susceptible to the placebo benefit.
In most studies of HRT or herbal alternatives, women taking the placebo had nearly 60 percent fewer hot flashes per week at the end of the studies, on average, than at the beginning. 721 Women on HRT, either estrogen alone or estrogen together with progesterone, also seem to have less trouble with night sweats that awaken them and disturb their sleep. There’s little evidence that herbal treatments have much effect on menopausal sleep problems, which many women find extremely disdirbing.
If it weren’t for the WHI, doctors would still be prescribing Prempro (a combination of Premarin and Provers) to virtually every menopausal woman who would take it. And they would still be encouraging women to keep taking it long after menopausal symptoms faded away, as a general-purpose “health and beauty aid.”
The characteristics of the women who were willing to use HRT before the WHI results were available probably accounted for many of the benefits seen with HRT in earlier, observational studies. Women were told that HRT was good for their health, so those who chose to take it were more likely to be the health-conscious, careful eaters, regular exercisers, nonsmokers, and occasional drinkers. Their healthy behaviors, rather than the HRT per se, are now believed to be responsible for their lower rates of heart attack, stroke, and many other problems.
The WH I put the issue of HRT and heart attack prevention to  Estrogen and Progesterone
Hormone replacement therapy reduces hot flashes significantly for most women. Women who still have a uterus need to take progesterone along with estrogen to protect themselves from endometrial cancer.
The risks of this therapy rise significantly at 5 years of use. For most women, intense hot flashes last less than 5 years. Ask for the lowest possible dose, and increase the dose only if that does not adequately relieve the hot flashes and night sweats. Hot flashes may return if HRT is stopped abruptly, so gradually tapering off it may be more successful. Transdermal estrogen (Climara, Estraderm) may be less likely to trigger nausea, but there haven’t been good headto-head comparisons.
Side effects: Breast tenderness, nausea, gallbladder problems, migraine headaches, intolerance to contact lenses, elevated blood sugar. If progesterone is given only 1 week a month, vaginal bleeding resembling a menstrual period is common.
Downside: HRT increases the risks of breast cancer and blood clots that could trigger heart attacks and strokes. These risks increase over time. HRT should be used only as long as it is needed for perimenopausal symptoms.
Cost: Approximately $40 to $75 per month for brand-name HRT; generic is available for $12 to $20 per month
the test with more than 16,000 postmenopausal women. Unfortunately, HRT did not pass. Women who had never undergone hysterectomy were randomized to Prempro or placebo, but the study was stopped early when it appeared that the women taking HRT were at greater risk than those on placebo .129 Although Prempro had been expected to protect women from heart attacks and strokes, the results showed that women taking this HRT were nearly 30 percent more likely to develop coronary heart disease and twice as likely to come down with a pulmonary embolism, a dangerous blood clot in the lung.730
None of this has much bearing, though, on the use of hormones to treat hot flashes. The risks are primarily for women who take Prempro or other forms of estrogen and progester-one for extended periods of time.The most recent recommendations, based on subanalyses of the WHI data, suggest that women just entering menopause (ages 50 to 54 in particular) may be more resistant to the dangers of estrogen and might even get some protection from heart attacks by taking it. 31 Short-term use (for a few months up to a couple of years) to get through the worst of the hot flashes doesn’t seem to pose an excessive risk for most women. Those who have previously had dangerous blood clots or breast cancer or who have a strong family history of breast cancer should probably avoid estrogen even in the short term, however.
O. 1 took hormones for 4 years and then discontinued them for a year. Now I have started again, at the urging of my doctor. While I was not taking hormones, I had hot flashes, night sweats, and vaginal dryness.
I stopped taking hormones because the progesterone component made me irritable and depressed. (I was taking Premarin and Provera.) My doctor put me on Estrace and Prometrium this time, but I still feel prickly and sad.
I’m convinced progesterone is the problem, so I wonder if I can take the estrogen alone. I recently read that estrogen has heart benefits.
A. The hormone controversy has heated up again. A study showed that women between the ages of 50 and 59 taking estrogen alone were not at increased risk of heart attacks (Archives of Internal Medicine, February 13, 2006►. These women had previously undergone hysterectomies, so they did not need progesterone.
Estrogen alone is not safe for a woman who still has her uterus since it increases the risk of endometrial cancer. Progestins like Provera protect against this kind of cancer. When added to estrogen, however, they may increase the risk of heart attacks and strokes and possibly breast cancer as well. For some women, progesterone lowers libido and leads to depression.
Doctors have followed the practice of prescribing progestin along with postmenopausal estrogen for many years, since research determined that estrogen alone increased the risk of cancer of the lining of the uterus (the endometrium). Endometrial cancer is not an issue for women with no uterus, and in the WHI study, these women were randomized to Premarin (estrogen alone) or placebo. This works just fine for hot flashes. Don’t count on it to provide any cardiac benefits, though. Overall, women in the WHI study were not protected from heart attack or stroke by HRT whether they took Prempro or Premarin alone.32
Some critics of the WHI have objected to the use of Premarin or Prempro, and suggested that other forms of postmenopausal estrogen replacement therapy would be preferable. There aren’t studies to prove or disprove that idea. Epidemiologists at Group Health Cooperative, a big health maintenance organization in Washington, compared rates of heart attack and stroke among women taking Premarin and those taking another form of estrogen such as Estratab or Menest. They found a hint that the other forms of estrogen might be somewhat less likely to trigger a heart attack or stroke, but these data need to be confirmed.733
Bioidentical Hormones
0 0 0
Q. I am a family physician. Back when we were prescribing HRT regularly, I used to offer women the option of plant-based estrogens instead of synthetic hormones. Since we learned the results of the Women’s Health Initiative (WHI), though, I’ve viewed all estrogens as carrying similar risk until proven otherwise.
There are practitioners who are saying that bioidentical hormones are safer. They encourage women to use them as an alternative for treating menopausal symptoms. Is there any research that shows that the risks are lower for plant-based HRT than for synthetic?
A. There is no comparable study of plant-based estrogens, and there is not likely to be one. The WHI was a very large and expensive study funded by the National Institutes of Health. Women were randomly assigned to receive Prempro or placebo. The results showed that postmenopausal hormones increased the risk of breast
cancer, heart attack, and stroke.
Women’s health expert Susan Love, MD, responded
to a question like yours: “I think that it is very unlikely that bioidentical hormones, as they’re called, will be any safer than Prempro.”
0 * *
The American College of Obstetricians and Gynecologists (ACOG) came out with a very strong caution about bioidentical hormones in 2005. Michele Curtis, MD, is associate professor of obstetrics and gynecology at Houston’s University of Texas Medical School. On behalf of ACOG she said. “There are a growing number of women who are seeking therapy with bioidentical hormones, but there is a lot of misinformation about the assertion that these are plant-derived and therefore more closely mimic the estrogen that is in a woman’s body….. These are hormones. They act just like estrogens that are 34    commer-
cially produced.,,7
The obstetricians and gynecologists of ACOG are concerned that plant-based hormones are unregulated and, as a result, women may not be informed about risks. In addition, lack of oversight may mean that it is hard to guarantee quality. Many of these products are made in small compounding pharmacies that act like micro–drug companies but escape the kind of regular FDA inspections one might expect a bigger manufacturer to undergo. When the FDA did check on samples from 12 compounding pharmacies, ACOG reports that “34 percent of them failed one or more standard quality teStS.!,131
Progesterone
Kau Nwmnwe intrigued by the possibility that a progesterone cream derived from plant sources can be applied to the skin to relieve hot flashes naturally. Although wild yam can be used as a raw material for the manufacture of progesterone-like compounds, the human body can’t convert wild yam to progesterone. A controlled study suggests that a cream containing wild yam extract is not much better at reducing hot flashes than a placebo.736 Other creams formulated to contain progesterone can provide a dose comparable to taking progesterone by mouth.”‘ Progesterone pills or long-lasting injections such. as Depo-Provera can ease hot flashes, but questions remain about the long-term safety of this hormone for postmenopausal women. 738
0 0 0
0. A nasty divorce has left me feeling slightly depressed, despite the relief of being out of a bad marriage. At times my heart races and then I break out in a sweat. I don’t know if these episodes are just anxiety or if they are hot flashes, since I am menopausal.
I am reluctant to take estrogen because I’ve heard about negative effects. IV rather use a more natural approach. Would a progesterone cream be safe?
A. Many women experience hot flashes much as you have described them, with an accelerated heart rate, a vaguely anxious feeling, sweating, and feeling too warm. Progesterone cream may help reduce hot flashes. Women’s health expert Susan Love, MD, points out, however, that high levels of progesterone are not natural after menopause. She worries that potential side effects might arise with long-term progesterone use. In addition, progesterone has been linked to depression.

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Magnesium is another mineral that is frequently overlooked and in short supply in the diet buspar and substance abuse . People on diuretics may be especially low in this crucial nutrient health net viagra non-formulary cost . Not only is magnesium essential for normal muscular contraction, it also plays a crucial role in heart health, blood pressure control, and hundreds of enzymatic reactions in the body captopril time to lower hypertension . It also helps reduce the risk of kidney stone formation enzyme immunoassay celecoxib .
People have been using magnesium for decades (as milk of magnesia) to counteract constipation amoxicillin causes liver . The normal dose ranges between 300 and 500 milligrams daily dosage for lexapro . One study demonstrated moderate effectiveness in battling nighttime leg cramps at 300 milligrams” Pregnant women are especially vulnerable to leg cramps adderall aciphex zoloft heartburn . Another study concluded that “magnesium supplementation seems to be a valuable therapeutic tool in the treatment of pregnancy-related leg cramps maxolon side effects .”"‘ Be aware that too much can cause diarrhea, and people with kidney problems should take magnesium only under medical supervision hair loss and cymbalta .
Some people are equally enthusiastic about calcium for preventing leg cramps panasonic br2330 lithium cell . The research that has been done on this remedy has been equivocal lithium manganese oxide . In one study, pregnant women with nighttime leg cramps were given calcium supplements or vitamin C as a “control paroxetine brain zapps .” Since there is no evidence that vitamin C can reduce leg cramps, it seemed that the difference between the two groups would be readily apparent if calcium worked well nasal decongestant risperdal . Both groups did equally well, however, suggesting that
715
calcium really didn’t make much difference ipratropium bromide long acting . A systematic review of the research on calcium for nocturnal leg cramps concluded that the evidence for its effectiveness is weak, at least in pregnant women how amoxicillin is produced . The reviewers found more support for supplemental magnesium tofranil pm for fibromyalgia . 716
One way to get extra minerals is with a special pediatric formulation called Pedialyte avandia problems . It was developed to “quickly replace fluids and electrolytes lost during diarrhea and vomiting to help prevent dehydration in infants and children quitting effexor weight .” Pe-Pedialyte
This rehydration solution for babies and children provides a balance of electrolytes that may help adults avoid muscle cramps trazodone and lung problems . Drinking about 4 ounces after exercising should help,
Downside: Somewhat expensive
Cost: Approximately $8 for a liter, or about $1 per “dose”
diatricians frequently recommend this ready-to-use liquid for sick children instead of juice or other beverages effect of clomid on progesterone . Ingredients include water, dextrose, potassium citrate, sodium chloride, sodium citrate, and citric acid zyprexa anorexia . Pedialyte is sold in drugstores and supermarkets in the baby section cyclosporine lipid emulsion . One athlete offered an amazing testimonial for its benefits against leg cramps coumadin interaction with foods and vitamins .
I have experienced a fair amount of cramping in my legs at night after I play tennis man dies from viagra overdose . The cramps occur more during the hot summer months when I perspire more melatonin while on zoloft .
I tried a lot of the sports drinks, but they didn’t seem to help with the cramping methotrexate ectopic . Someone suggested that I either eat bananas or drink tomato juice doxazosin mesylate msds . Unfortunately for me, I don’t like either food blood cozaar pressure .
I was told that the cramping was due to a loss of potassium in the body hsv i treating with valtrex . An assistant tennis pro suggested I try drinking the infant solution called Pedialyte rimonabant indication confusion . I thought that was a crazy idea, but I tried it because I didn’t like waking at midnight with a leg cramp depot provera pregnancy . To my surprise, the Pedialyte has worked like a charm and has eliminated my cramping micronase diabeta .
Pedialyte has one other unexpected benefit I usually play singles tennis, and I am usually pretty worn out after / play order viagra without prescription . Like a lot of people my age, my middle-aged body is usually pretty darn sore after playing, particularly the next day national geographic caffeine . Like everyone else, I take Morin for sore muscles phenergan injection adverse reaction . The Pedia(yte has substantially reduced The Soreness that I experience, and I don’t need to take Motrin the next day n1 3 lithium battery tester 3v .
B Vitamins
B vitamins have become the superheroes of nutrients cefuroxime axetil and symptom relief . Not only do compounds like folic acid, B6, and B12 have cardiovascular benefits, folic acid and niacin may help reduce the risk A combination of B vitamins may reduce nighttime leg cramps relicore zantac dieting combo . Keep the dose of vitamin B trileptal withdrawal how to .,below 100 milligrams per day to avoid nerve damage from long-term use cocaine and lexapro .
Downside: The B-complex formulas available are not specifically designed to prevent leg cramps generic viagra available .
Cost: Approximately $11 for 100 tablets, or a 3-month supply
of Alzheimer’s disease paroxetine and 5ht . One study from Taipei offers evidence that a B-complex vitamin formulation can reduce nighttime leg cramps tranny taking viagra . “After 3 months caffeine drinks . 86 percent of the patients taking vitamin B had prominent remission of leg cramps, whereas those taking placebo had no significant difference from baseline,”71 reported the study’s authors lipitor zocor news . This study used a formulation that is not available in the United States fosamax d generic . It contained vitamins B, (50 milligrams), B, ~5 milligrams), B6 (30 milligrams), and BIZ (250 micrograms) fda topamax warning .7 8
My husband has suffered horrible leg cramps at night all his life kidney infection and ibuprofen . He would writhe in pain amiodarone blood levels .
/ read that 8 vitamins might help uk imitrex . He now takes multiple B-100s every day and has no leg cramps naproxen and nursing babies .
We found a “dose-response curve caffeine makes me panic now .” With B-50s, he’d still have cramps, but they were less severe toradol and orange urine . With B-75s, he wouldn’t have cramps, just twinges in his legs ultram the medicine . At the 100 level, he has not even a twinge how to make prednisone .
A B-complex with 100 milligrams of vitamin B6 may be too much zetia buyback . We worry that regular consumption of th, s nutrient may lead to nerve damage lamisil side effects for women . Anyone who contemplates taking, more than 50 milligrams of vitamin B, should be under medical supervision synthroid phentramine .
Quinine
If you tell your physician that you suffer from frequent leg cramps at night, you may be offered a prescription for quinine depakote with tramadol . This botanical medicine (derived from the bark of a South American tree) has been used against malaria since a monk
B Vitamins sent a sample to Spain in 1633 avapro with dieuretic . (At that time, the diagnosis was probably “fever” or “the ague” rather than malaria gi lithium batteries .)
Doctors began using quinine against leg cramps in 1940 experience with lexapro . Despite this long history, there is still some controversy over whether its effectiveness outweighs the risks of side effects 19 In the 1990s, the FDA determined that the possibility of a susceptible individual experiencing a life-threatening blood reaction (idiopathic thrombocytopenic purpura, or ITP) was just too great cheapest diflucan online w o prescription . OTC sale was banned home coumadin testing . Now the FDA has forbidden doctors to prescribe quinine for leg cramps rifampicin isoniazid pyrazinamide ethambutol . One reader reported that a single glass of tonic water (which contains quinine) put her in the hospital with an almost fatal anemia flomax dosages .
It is hard to predict ahead of time whether a person might react to quinine by developing severe anemia erythromycin resistance peptide . Pregnant women should stay completely clear of quinine (even though they may suffer leg cramps) because it could cause birth defects and induce premature labor about penicillin capsules . Other side effects from quinine include ringing in the ears, rash, changes in color vision, headache, nausea, diarrhea, liver damage, low blood sugar, life-threatening anemia (ITP), vomiting, and trouble breathing prescribed premarin . Anyone experiencing such symptoms should get medical attention promptly meloxicam tab .
The amount of quinine in tonic water may vary from one brand to another discount digoxin . Some brands contain as much as 80 milligrams in a quart of tonic pseudoephedrine hydrochloride tablets canada . The dose that proved effective in preventing muscle cramps in one placebo-controlled study was 400 milligrams cialis tadalafil cialis tadafil tal .720 That suggests that a person would have to drink more than a gallon to get an effect, but many readers report that they notice a benefit from one or two glasses of tonic why hairloss with zetia . The
* Quinine
This traditional prescription for leg cramps is probably effective zocor causes ed . One or two glasses of tonic water may contain enough gui(xi(
Downside: Tinnitus (ringing in ears), rash, changes in color vision, headache, nausea, diarrhea, liver damage, low blood sugar, life-threatening anemia (ITP), vomiting, and trouble breathing are possible reactions atomic model of lithium .
Cost: Approximately $65 in the United States for 100 pills or $33 from a Canadian pharmacy prescription dose used to be 260 to 300 milligrams-, older people should generally start with a’lower dose warfarin graph .
I used to take quinine, but then it became unavailable over the counter My doctor recommended that I drink a glass of Schweppes Tonic Water lasix diabetes . It has enough quinine that it might help long terra omeprazole .
I tried it and it works methanphetamine ephedrine or pseudoephedrine . I have recommended this to others bothered with cramps after exercising, and they have been pleased procardia sr .
One word of caution is probably unnecessary triamcinolone .1 . Even though some people are accustomed to putting gin in their tonic water, the alcohol does nothing to prevent leg cramps resonance caffeine . If it is taken shortly before bedtime, alcohol can disrupt sleep—the last thing a sufferer wants swelling that is helped by prednisone .
Conclusions
Health care professionals generally consider leg cramps more of a nuisance than a serious health problem free live online zoloft help . Nonetheless, anyone who suffers from nighttime leg cramps knows that they can disrupt sleep, and that can eventually have consequences for health as well as mood is prazosin compatable with prozac . Finding the remedy that suits you best may require some trial and error increase free testosterone females . Don’t be afraid of the home remedies: They may seem silly, but since the only prescription treatment, quinine, can have such serious adverse effects, we think they are worth considering teva pantoprazole december .
I had terrible leg cramps, and nothing helped prozac action . Then my husband got some liquid calcium, and that worked immediately olympus li 10b lithium batteries . I have not had another leg cramp women’s international testosterone .
He decided to try mustard for leg cramps, but he still had leg cramps and really did not savor the mustard cat soma . He decided to try turmeric, an ingredient in mustard lithium batteries for electric automobiles . He took’/, teaspoon at bedtime and ‘/;, teaspoon at breakfast xenical side efftects . BINGO! This worked great price of prevacid . Not only did it cure his leg cramps, but it also eased the pain in his hip and feet
He recommended I try it for my awful loot problems valtrex capl . It felt like an ice pick was stuck in the ball of my foot As soon as I started taking the turmeric, I had no more pain ephedrine caffeine stack . I can now wear my lovely high-heeled shoes on Sunday without suffering celebrex qoclick .
e Ibck a bar of ordinary soap under the bottom sheet when you make the bed tricor side . It should be near your legs, and may need to be replaced every 6 weeks or so buying generic zoloft . We don’t know why it would prevent leg cramps, but many readers report success—and we know of no side effects naproxen and methylprednisolone .
• Swallow a teaspoonful of yellow mustard—the inexpensive kind sometimes dispensed in individual packets cyclosporine ointment . We think it may be the turmeric in the mustard that helps lexapro peak . This remedy can work very quickly, though some readers have reported heartburn as a result wellbutrin xl prozac weight loss .
• Sip about an ounce of pickle juice medroxyprogesterone acetate anorexia . Some pickles may contain turmeric, so perhaps that explains why this helps some people fight off muscle cramps so quickly procardia sr . Or, it may provide some missing minerals salbutamol inhaler medication information . Pickle juice is high in sodium, so this home remedy is not for anyone on a low-sodium diet buy viagra on line .
• Baking soda, ‘44 teaspoon in 8 ounces of water, is reputed to fight painful leg cramps quickly prozac video for dogs . Baking soda contains sodium, so it is not for anyone on a low-salt regimen viagra sports .
• Pinch your upper lip firmly between your thumb and forefinger until the cramp eases veterinary ranitidine pricing . This may have the effect of providing a distracting pain that is under your control testosterone injections chronic fatigue . Many readers claim it is helpful, although we have not been impressed information lipitor prescribing .
• Stretch leg muscles for several minutes before bedtime toprol xl 50 mg .
• Consume plenty of potassium-rich vegetables, especially low-sodium V8 juice doctors give shots of penicillin . Increasing potassium intake seems to help prevent leg cramps hydrid technologies lithium power .
• Take a supplement of 300 to 500 milligrams of magnesium a day atacand picture . Reduce the dose if this gives’you diarrhea viagra gif . Avoid magnesium if you have kidney disease can i take accutane and bactrim .
• Try 4 ounces of Pedialyte after vigorous exercise to replenish minerals and prevent muscle cramps decadron vs prednisone .
• Consider B-complex vitamins to prevent cramps oxycoton compared to tramadol . Keep the dose of vitamin B,, under 100 milligrams per day to avoid nerve damage cialis patent expiration wikipedia .
• Ask your doctor about quinine beers effect on levitra . it is available by prescription (or at low doses in some brands of tonic water) how long before wellbutrin kicks in . Severe side effects are uncommon but may be life-threatening, especially a blood disorder called ITP carafate suspension pets .