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Your Health Checkup: Drugs and Daily Activity

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

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Yesterday morning while exercising as usual, I inflamed an old biceps tendonitis that triggered pain whenever I moved my arm. I needed treatment with a nonsteroidal anti-inflammatory drug (NSAID).

While researching which drug to take, I came across an interesting article stating that administering NSAIDs during the daily activity period, i.e., in the morning for most people, resulted in better pain relief and healing than taking the NSAID in the evening prior to retiring.

The reason appears to be based on the body’s circadian rhythm; that is, the cyclical 24-hour period of human biological activity.

The mediators of most wound healing and connective tissue formation occur during the resting phase of the day, while pain and inflammation occur during the active period of the day. It follows that one would want the NSAID impact to occur during the period of pain and inflammation and not during the wound healing phase, hence the recommendation for taking the drug in the morning.

The opposite is true for blood pressure control. As I have written previously, the time to take blood pressure medication is in the evening, not the morning. Nighttime blood pressure is a stronger risk predictor of cardiovascular disease than is daytime blood pressure, and blood pressure control at night works better than control in the morning.

So, take NSAIDs in the morning and blood pressure medicines in the evening.

But here’s a drug you probably should avoid, if possible: azithromycin.

Azithromycin (AZ), an antibiotic in the same class as erythromycin, is one of the most commonly prescribed antibiotics in the U.S. despite an increased risk of cardiovascular death noted in some studies, perhaps related to changes in heart rhythm A recent study of almost 8 million antibiotic exposures (22 percent AZ; 78 percent amoxicillin) from January 1, 1998 to December 31, 2014, in patients with a mean age 51 years, and 62 percent women, found that AZ was associated with about a twofold increased risk of death during the first five days of exposure compared with amoxicillin. I would recommend that AZ be used with caution, particularly in patients who might be at increased risk, such as those with underlying heart disease, electrolyte abnormalities, or those taking other drugs that might affect the heart rhythm in a similar fashion.

Featured image: David Tonelson / Shutterstock.com

Your Health Checkup: Blood Pressure, Kitchen Germs, and Antibiotic Resistance

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I check my blood pressure regularly because I know that keeping it under control reduces my risk for developing cardiovascular diseases such as heart attacks and heart failure, as well as strokes. In my last column, I pointed out that taking blood pressure medication in the evening rather than the morning enhanced its effectiveness.

Whether blood pressure control prevents dementia as well has been more debatable. However, a recent publication combined data from six studies totaling 31,090 dementia-free adults older than 55 years and found that those individuals receiving blood pressure medications had a 12 percent lower risk of developing dementia and a 16 percent reduced risk of Alzheimer’s disease compared with those not using blood pressure medications to treat elevated blood pressure. No particular drug class was more effective than another in reducing risk.

This is one more reason — and a good one — for taking control of your own health and making certain your blood pressure remains under control.

Bugs and Stuff

We live in a world surrounded by a sea of germs. Fortunately, our body has defense mechanisms such as our immune system that most times protects us from getting infected. However, some people are more vulnerable to infection than others, such as children, pregnant women, the elderly, and those with compromised immune systems.

One of the most contaminated places in the home is not the bathroom but the kitchen! For example, the kitchen sponge can be loaded with bacteria from cleaning up raw meat and wiping germ-laden exteriors or other soiled sources. Surfaces contaminated with E. coli, salmonella, yeast, and molds include various refrigerator compartments and refrigerator handles, food storage containers, can openers, spatulas, and cutting boards. The kitchen sink can be loaded with bacteria after cleaning vegetables, rinsing raw chicken, or defrosting meat.

What should you do? Keep clean by performing simple tasks such as changing sponges and towels often and scrubbing cutting boards, the sink, strainers, and drains with bleach. Flush the toilet with the lid closed and keep the toothbrush holder clean. Wash the pet bowl, coffee reservoir, all knobs, handles, and countertops regularly.

Antibiotic Resistance

Most of us deal with such exposures every day without problems. On occasion we do get sick and need antibiotics to combat the infection. But that raises another contemporary problem: antibiotic resistant organisms.

A new Centers for Disease Control and Prevention report noted that, while antibiotic-resistance threats in the U.S. are decreasing, nevertheless antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year.

It stated that some miracle drugs are no longer performing miracles because of antibiotic resistance, now found in every U.S. state and every country in the world. Antibiotic-resistant germs can share their resistance genes with other germs and can make them hard or impossible to kill.

Preventing infections is something we can all help accomplish, from frequent handwashing to everyday cleaning, to using antibiotics wisely and selectively, rather than for every cold and sore throat. Vaccination should be used to prevent infection wherever possible. Antibiotics are critical medicines for treating humans, animals, and crops, but should be used judiciously to fully protect people from antibiotic resistance threats.

Featured image: Shutterstock

Your Health Checkup: 2 Simple Things that Might Save Your Life

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Here are two simple things to do that might save your life or that of a loved one: get your measles vaccination and take your blood pressure pills in the evening rather than in the morning.

Measles and Immune Amnesia

I have repeatedly advocated for the benefits of vaccination to prevent a multitude of infections and have criticized parents who intentionally expose their children to measles so they can acquire the natural infection. A recent report stresses the importance of measles immunization, highlighting the fact that measles is far more devastating than previously considered.

While having the measles infection itself is no picnic and can even be deadly, killing more than 100,000 people (mostly children) annually worldwide, two recent studies in Science and Science Immunology have shown that the impact of the disease remains months to years after apparent recovery, helping explain why survivors of a measles infection experience increased morbidity and mortality compared to the noninfected population.

How does this happen? The measles virus, by infecting immune cells, suppresses the body’s immune response to a variety of pathogens, causing what scientists label “immune amnesia.”

Consider, for example, a 15-year-old boy whose body has synthesized an array of antibodies that have successfully fought a host of infections he’s experienced over his relatively short life span. These antibodies protect him against future infections. The measles virus can wipe out this immune defense system, erasing 11 percent to 73 percent of its history and making the boy vulnerable to the infections all over again, as well as to new ones. In fact, the measles virus can even eliminate antibodies he developed in response to other vaccinations and require him to be revaccinated.

Importantly, the measles, mumps, rubella (MMR) vaccine does not cause this response, underscoring its importance as protection not only against measles, but against a myriad of past and future infections as well. There is no excuse not to vaccinate against these and other infections.

Blood Pressure Medications

High blood pressure is one of the seven major risk factors for developing cardiovascular disease (CVD). Because nighttime blood pressure is a stronger risk predictor of CVD than daytime blood pressure, investigators tested whether it might be better to treat blood pressure at night rather than in the morning. In the the Hygia Chronotherapy Trial, they randomized over 19,000 hypertensive patients (Caucasian Spanish men and women over 18 years old) to receive their total daily dose of one or more hypertension medications at bedtime or upon waking.

They found that those randomized to bedtime dosing had better blood pressure control without any adverse effects, as well as a 45 percent reduced risk of CVD death, heart attack, coronary revascularization, heart failure, stroke, and total mortality. Since these results are so striking, they probably should be replicated in another trial to be sure the conclusions are widely applicable to other ethnic groups. Nevertheless, there would seem to be very little downside to taking blood pressure medications in the evening rather than in the morning, and it would seem a reasonable practice for patients to follow.

Featured image: Shutterstock.com.

Your Health Checkup: The Risk of Caffeinated Energy Drinks

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I exercise every morning before I begin work. Some mornings I just feel beat, too tired to pump iron or bike, so in addition to my usual yogurt, banana, and cup of morning coffee, I’m tempted to chug down an energy drink to prime my motor. However, knowing how dietary supplements can be adulterated with unwanted and even dangerous contaminants, I’m leery of doing that. In addition, I’ve written that “Energy drinks are in a different class [of dietary supplements]. They often contain caffeine at significantly higher concentrations than coffee and tea, along with other energy-boosting substances, such as guarana, sugar, ginseng, yohimbine, and ephedra … Multiple reports relating the temporal association between ingesting energy drinks and heart rhythm problems, including sudden death, are of major concern.”

More and more people are consuming energy drinks; their market value is projected to increase to more than $60 billion by 2021. About a third of U.S. teenagers aged 12-17 consume energy drinks regularly. The number is even higher – 45 percent — for military personnel. Energy drinks sent more than 10,000 people to emergency departments in 2007. That number had doubled by 2011. The Food and Drug Administration has attributed over 30 deaths to energy drinks.

What is it about energy drinks that makes them dangerous? A new study helps answer that question.

Researchers at the University of the Pacific in California had 34 young (22 years old) healthy volunteers consume two 16-ounce bottles of one of two brands of caffeinated energy drinks or lime juice with cherry flavoring placebo on three successive days with a six-day washout period in between. The researchers measured blood pressure and recorded an electrocardiogram (ECG) every half hour for four hours after drink consumption.

They found that the caffeinated energy drinks increased systolic blood pressure (top number) by five mmHg and diastolic blood pressure by four mmHg compared with placebo. While the blood pressure change may seem small, a sustained increase in systolic blood pressure of only two mmHg is associated with a seven percent increase in the risk of dying from a heart attack and a ten percent increased risk of dying from a stroke.

After each heartbeat, the heart requires a rest period to prepare for the next contraction. This time period measured on the ECG is called the QT interval and when prolonged, can increase the risk of sudden cardiac arrest. In the study, caffeinated energy drink A prolonged the QT interval by 6.1 msec compared with placebo and caffeinated energy drink B prolonged the QT interval by 7.7 msec compared with placebo. Once again, the changes may seem trivial, but in susceptible individuals, that increase in QT may be just enough to tip the person into having a life-threatening rapid heart rhythm leading to sudden cardiac arrest and death.

What’s the take-home message? My advice is to avoid consuming ALL caffeinated energy drinks. If you feel tired, your body is “talking to you” and you should listen to it. Rest, or if you must be active, pace yourself. Between consuming plastic and ultra-processed foods, skipping breakfast, and eating eggs, we have enough risks on our plates —literally! Why add more by consuming caffeinated energy drinks? Avoid them.

Featured image: Shutterstock

Flaxseed Slashes Blood Pressure

Flaxseed

Tiny seeds of the flax plant, high in fiber and omega-3s, produce big drops in blood pressure and may prevent heart attacks and stroke, according to new research.

In the study, people with clogged leg arteries taking flaxseed supplements reduced their top blood pressure (systolic) reading by 10 points and the bottom (diastolic) by seven after six months. This change is the largest decrease in blood pressure ever shown by a dietary intervention, says Dr. Delfin Rodriquez of Cuba who presented the results at the American Heart Association 2012 Scientific Sessions.

The promising findings suggest that people with hypertension turn to the safe and inexpensive dietary supplement before starting drug therapy.