Wednesday, July 27, 2016

EFFECTS OF DRINKING ALCOHOL ON HEALTH

HARMFUL EFFECTS OF ALCOHOL

1. Increased risk of road traffic accidents: Road traffic injuries account for 1.25 million deaths per year. They are the leading causes of death in young age group (15-29 years). Drink driving is a major risk factor for road traffic accidents. Driving under the influence of alcohol accounts for about one-third of all deaths in road accidents. It should be noted that the victims are most often the passengers, pedestrians or children, who have not consumed alcohol.
2. Increased risk of cancer: Alcohol drinking is significantly associated with cancer of seven sites in body. These are throat, larynx (voice box), esophagus (food pipe), liver, colon, bowel and breast. Drinking just 50 grams of alcohol per day can increase the risk of mouth cancer by seven times (as compared to non-drinkers). About 6% of all deaths due to cancer can be attributed to alcohol intake. This study was recently published in the Journal Addiction. The full test of the article can be accessed at the following link: http://onlinelibrary.wiley.com/doi/10.1111/add.13477/epdf
3.  Increased risk of stroke: Alcohol consumption increases the risk of high blood pressure, diabetes, obesity, atrial fibrillation and liver disease; all of these increase the risk of stroke. Alcohol consumption also leads to higher death rates in patients with stroke. People drinking alcohol more than twice a week (irrespective of the amount) have a 3-fold higher risk of death due to stroke as compared to non-drinkers.
4. Memory impairment: Consuming too much alcohol leads to severe memory impairment and dementia in later life. Alcohol causes brain shrinkage (atrophy), malnutrition, deficiency of thiamine and vitamin B12; all of which contribute to memory loss.
5. Damage to peripheral nerves: Alcohol use, if regular and heavy, can lead to damage of nerves in arms and legs, leading to numbness, weakness, burning, pain, etc.
6. Seizures (fits or convulsions): Heavy alcohol drinking can lead to seizures. Sudden withdrawal in a person dependent on alcohol can also lead to seizures.
7. Headache: Alcohol consumption can lead to hangover (with a prominent symptom of headache); worsening of migraine; or headache as a direct effect of alcohol (due to vasodilation and dehydration).
8. Liver disease: Alcohol is a leading cause of liver disease. This includes fatty liver, alcoholic hepatitis and cirrhosis.
9. Pancreatitis: Inflammation and damage of pancreas occurs in about 5% of alcoholics after 5-10 years of alcohol drinking.
10. Sexual dysfunction: Heavy alcohol drinking can lead to sexual dysfunction in about 75% of people. The most common symptoms are premature ejaculation, low sexual desire and erectile dysfunction.
11. Marital discord and divorce: Alcoholism adversely affects relationships and marriage. Alcoholics are two times more likely to have a divorce as compared to non-alcoholics. In addition, suspicion, infidelity and arguments are more common with if one or both spouses consume alcohol. People consuming alcohol also have delayed marriage.
12. Increased crime rate: Alcohol consumption leads to increase in crime rate. Most states report that alcoholism is involved in 70-85% of crimes, especially against women. These include violence, sexual exploitation, rape, kidnapping, murder, robbery, etc.
13. Increased death rate: 15 people in India die everyday due to alcohol related effects, which means every 96 minutes, one person dies due to alcohol use.

BENEFICIAL EFFECTS OF ALCOHOL
I have enumerated the harmful effects above. I am sure there are many people (especially the ones who drink), who are eager to know the beneficial effects. There are some benefits of alcohol too.
1. Feeling of euphoria and elation: Alcohol has a depressant effect on brain. So, drinking makes one carefree, elated and free from all worries. However, these effects are for short term and are seen with small amounts of alcohol. Heavy alcohol intake leads to sleepiness and confusion.
2. Reduced rate of heart attack: Moderate alcohol consumption may reduce the risk of heart attack by increasing the amount of good cholesterol (HDL). However, exercise can also have the same effect. At present, American Heart Association does NOT advise people to start drinking, if they do not already drink alcohol.
3. Increased sexual desire: Alcohol intake may reduce the inhibition and increase the sexual desire; however, it reduces the testosterone level and hence, the performance. So, the overall effect of alcohol on sex is negative. In addition, alcohol may promote the risk-taking behavior such as not using condoms.

Conclusions
1. Alcohol has several harmful effects on health.
2. Alcohol leads to increased risk of heart disease, brain stroke, dementia, peripheral neuropathy, liver disease and cancers.
3. Alcohol is directly responsible for increased road traffic accidents and deaths.
4. Alcohol is involved in most of the crimes, especially against women.
5. Alcohol use in moderation may have protective effect on heart attacks.
6. Those who do not drink should NOT start drinking alcohol.
7. Those who drink should drink in moderation.

(Disclaimer: I do not drink alcohol)

Dr SUDHIR KUMAR MD (Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad

Phone: 0091-40-23607777/60601066

Wednesday, July 20, 2016

IMPORTANT INFORMATION ABOUT LEVODOPA USE IN PARKINSON’S DISEASE

IMPORTANT INFORMATION ABOUT LEVODOPA USE IN PARKINSON’S DISEASE


Levodopa is one of the most important medicines used for treating Parkinson’s disease (PD). It is sold in combination of levodopa and carbidopa. The commonly used brand names for this medicine are syndopa, sinemet, tidomet and duodopa. Levodopa is very useful in ameliorating the symptoms of PD, especially the tremors and rigidity. However, there are several important points of note regarding its use. The current article highlights a few of them.

1. Try to avoid levodopa use in early PD: Though levodopa is very effective in controlling symptoms of PD even in early stage, it is better to avoid using it in early PD. This is because the risk of dyskinesia (abnormal movements as a side effect of levodopa) and rapid wearing off (reduced efficacy of levodopa) are more common, if levodopa is started early in the course of disease. Also, levodopa loses the efficacy after longer use, so, it makes sense to start it later.

2. Use the lowest effective dose of levodopa: It may be tempting to use levodopa at a higher dose or more frequently, as the symptom control would be better with that. However, for the same reason mentioned above, it is better to use levodopa at the lowest possible dose, and as less frequently as possible.

3. Take levodopa on empty stomach: Presence of food in stomach may interfere with the absorption of levodopa; so, it is better to take levodopa on empty stomach. In the initial days of starting levodopa, there may be nausea or vomiting, so, it may be taken after food or snacks.

4. Reduce or evenly space the amount of protein intake: High protein diet prevents proper absorption of levodopa. So, the protein intake should be evenly spaced out in the day; or better, it can be shifted to dinner time (as most doses of levodopa are taken before dinner time).

5. Avoid pyridoxine (vitamin B6) intake: Pyridoxine can reduce the effects of levodopa, if taken alone. However, pyridoxine does not interfere with the effects, if levodopa is taken along with carbidopa (as in most cases).

6. Hallucinations and psychosis can be a side effect of levodopa: Use of levodopa does increase the risk of visual and auditory hallucinations, and other psychotic reactions (agitation, anger, irritability, etc). However, it is not a simple relationship. The severity & duration of PD, presence of cognitive impairment and daytime somnolence, all increase the risk of psychotic reactions with levodopa use.

7. Avoid using levodopa in late evenings: The risk of hallucinations and other psychotic reactions are higher if levodopa is used in late evenings or nights. So, avoid it at those times, as much as possible.

8. Avoid breaking, crushing or chewing the controlled release (CR) tablets: Those taking medicines such as syndopa CR, tidomet CR, etc should swallow the entire tablet, without breaking or crushing (which would reduce its efficacy).

9. There is a risk of dependence and abuse with levodopa: Levodopa increases the dopamine levels in brain and may cause effects such as euphoria (feeling of extreme happiness) and other positive mental effects. Therefore, a small group of patients with PD may increase the dose of levodopa by self and take upto 1500-2000 mg per day. These patients accept the side effects of high dose levodopa (such as hallucinations, nausea, loss of appetite), in order to experience the positive mental effects. This behavior (of dependence and abuse of levodopa) should be recognised and treated.

10. Other side effects of levodopa to watch for:
a.     Dizziness or fainting sensation on standing up (may occur due to fall in BP on standing),
b.     Feeling of nausea, vomiting, loss of appetite
c.      Sudden sleep episodes: Patients taking levodopa may fall asleep without any drowsiness or warning. It can occur while driving or doing other activities needing full concentration, which can be potentially harmful.
d.     Sleep disturbance or insomnia at nights. 

DR SUDHIR KUMAR MD (Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Phone: 0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com
Online consultation: https://www.doctorspring.com/doctors/sudhir-kumar

Friday, July 8, 2016

MEDICINES FOR TREATING ACIDITY COULD INCREASE THE RISK OF DEMENTIA

COMMONLY USED MEDICINES FOR ACIDITY INCREASE THE RISK OF DEMENTIA

Dementia is a condition, characterised by progressive loss of memory and other higher brain functions. It is a common cause of disability and dependence on others in older people. 
Alzheimer's disease and brain stroke are the two most common causes of dementia.
1. In a recent research, medicines commonly used for treating acidity, were found to increase the risk of developing dementia in older people.
2. The effect of medicines belonging to the group of proton pump inhibitors (PPIs) such as omeprazole (omez), pantoprazole (pantodac, pantocid), rabeprazole (razo) were studied.
3. The study population included about 74,000 people from Germany, aged 75 or more.
4. People on regular prescriptions of PPIs (anti-acidity medications) had a significantly higher risk of developing dementia.
5. The possible mechanism is an increase in beta-amyloid in brain (which are involved in causing Alzheimer's disease).
This study was published in JAMA Neurology (April 2016), and those interested in reading further details of the study can access it at the following link:

DR SUDHIR KUMAR MD DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Hyderabad
Ph- 04023607777/60601066
Email: drsudhirkumar@yahoo.com

Tuesday, April 19, 2016

Frequent Coffee Breaks Keep You Healthy Too!

Coffee Breaks Make You Healthier




Coffee drinking is quite popular all across the world. There are many, who have coffee first thing in morning, referred to as bed coffee. Bed coffee is supposed to energize people and get them out of sleepiness. Many others take “coffee breaks” while at work, which relaxes them. Who would have forgotten the student days, when numerous coffee cups kept them awake until late nights just before examinations? Coffee drinking is supposed to increase alertness and concentration. The effects are mainly related to caffeine contained in the coffee.

Health-Related Benefits of Drinking Coffee

1. Lower risk of diabetes: In a Dutch study done on 40,000 people, it was found that drinking at least 3 cups of coffee or tea per day reduced the risk of developing diabetes by 42%. (Diabetologia 2009). The anti-diabetic effects are related to polyphenols found in coffee.
2. Lower risk of coronary heart disease: Moderate habitual coffee consumption (3-4 cups per day) lowers the risk of coronary heart disease, especially in women. (International Journal of Cardiology)
3. Coffee improves headaches and migraine, if taken alone or along with other painkillers.
4. Lower risk of brain stroke: Middle aged people in Japan, who drank 3 or more cups of coffee per day had lower rates of silent brain infarctions (strokes without symptoms, picked up on MRI scan of brain). Lesser brain infarctions would also lead to lesser incidence of dementia. (Journal of Stroke and Cerebrovascular Diseases, 2016)
3 or more cups of coffee intake per day reduced the risk of brain stroke (despite smoking tendency in coffee drinkers). A lower incidence of heart failure, diabetes and hypertension was also observed. (Nutritional Neuroscience, 2015)
5. Reduced risk of Alzheimer’s disease: Alzheimer’s disease is the commonest cause of dementia (memory loss and loss of other higher mental functions) in the world. Based on the meta-analysis of 11 research studies, it was found that higher coffee consumption reduced the risk of Alzheimer’s disease. (Nutrition, 2015)
6. Reduced risk of Parkinson’s disease: Parkinson’s disease is the commonest cause of movement disorder, characterized by tremors, rigidity and slowness of movements. Based on meta-analysis of 26 studies, increased caffeine/coffee consumption was associated with reduced risk of Parkinson’s disease. (Journal of Alzheimer’s Disease, 2010)
7. Reduced risk of multiple sclerosis: Researchers in USA and Sweden have found that drinking at least 900 ml (six cups) of coffee per day has protective effects against multiple sclerosis. Caffeine has neuroprotective properties and suppresses inflammation. (JNNP, 2016)
8. Reduced risk of depression and suicide: A meta-analysis of 11 studies showed a protective effect of coffee against depression. The relationship between coffee intake and depression was linear; for each cup/day increase in coffee intake, the risk of depression reduced by 8%. (Australia NZ Journal of Psychiatry 2016)
In addition, increased coffee consumption was also associated with reduction in incidence of completed suicides. (World Journal of Biol Psychiatry, 2014)
9. Reduced risk of cancer: Various studies have shown that regular coffee consumption is associated with lower risk of cancers. 5 or more cups per day reduced the risk of colorectal cancer (Oncotarget, 2016). Other studies have shown reduced risk of cancers of oral cavity, pancreas, urinary bladder, breast, uterus, and liver among regular coffee drinkers.
10. Lesser incidence of erectile dysfunction: Coffee can provide a boost to sexual health too. Men with coffee intakes of 2-3 cups of coffee/ day reported significantly lesser incidence of erectile dysfunction, as compared to those with no coffee intake or only 1 cup/day. (PLos One, 2015)
11. Lower death rates: Regular intake of coffee can increase longevity and prevent deaths too. Recent research has shown that people drinking 2-5 cups of coffee/day had significantly lower deaths from heart disease, chronic lung diseases, diabetes, pneumonia and influenza, and intentional self-harm. Coffee may reduce mortality risk by favorably affecting inflammation, lung function, insulin sensitivity, and depression. (American Journal of Epidemiology,

Possible Health Hazards of Coffee Drinking
1. Poor control of BP in patients with hypertension:  A recent study showed that older people with hypertension, who consumed 3 or more cups of coffee per day, had higher BP (systolic and diastolic). Coffee drinking, however, does not lead to an increased risk of developing hypertension (in people with normal BP).
2. Increased cholesterol levels: Drinking unfiltered or boiled coffee may cause an increase in the levels of LDL cholesterol and triglycerides.
3. Increased risk of coronary heart disease: Drinking 3 or more cups of Italian-style coffee (espresso or mocha) is associated with increased risk of coronary heart disease. (PLoS One, 2015). This effect was independent of cholesterol levels, as the cholesterol levels did not increase in this study.
4. Sleep problems: Caffeine is a brain stimulant and after consuming it, people feel alert. People sensitive to the stimulant effects of caffeine may not get proper sleep, if they drink coffee close to bedtime. Since, the effect of coffee may last for 5-6 hours, people sensitive to it should avoid coffee after 6 PM.
5. Not recommended for children: Coffee suppresses appetite, and may cause children to eat less. Also, after having coffee, children feel full, and avoid nutritious foods such as milk.
6. Pregnant and nursing women should have coffee in moderation: There is no restriction of coffee in pregnant or nursing mothers. However, they should restrict the coffee intake to 2-3 cups per day.

So, what is the final take home message?
1. Coffee is good for health, and can be safely consumed by adults.
2. For optimum benefits, it should be restricted to 2-5 cups per day.
3. The maximum safe limits for caffeine/coffee intake is 200 mg in one sitting (around 2½ cups of coffee) or 400 mg daily (around 5 cups of coffee). 
4. Coffee (without sugar and milk) has zero calories; and hence, people on strict diet too can freely have coffee.

DR SUDHIR KUMAR MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Jubilee Hills, Hyderabad
Phone: 040-23607777/60601066
Online Consultation: http://bit.ly/Dr-Sudhir-kumar