Long-term high-dose use of painkillers such as ibuprofen or diclofenac is “equally hazardous” in terms of heart attack risk as use of the drug Vioxx, which was withdrawn due to its potential dangers, researchers said on Thursday.
Presenting the results of a large international study into a class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), the researchers said high doses of them increase the risk of a major vascular event – a heart attack, stroke or dying from cardiovascular disease – by around a third.
This means that for every 1,000 people with an average risk of heart disease who take high-dose diclofenac or ibuprofen for a year, about three extra would have an avoidable heart attack, of which one would be fatal, the researchers said.
This puts the heart risks of generic NSAIDs on a par with a newer class of NSAIDs known as COX-2 inhibitors or coxibs, which includes Vioxx – a painkiller that U.S. drugmaker Merck pulled from sale in 2004 because of links to heart risks.
Other drugs in the coxib class include cerecoxib, sold by Pfizer under the brand name Celebrex, and etoricoxib, sold by Merck under the brand name Arcoxia.
“What we are saying is that they (coxibs, ibuprofen and diclofenac) have similar risks, but they also have similar benefits,” said Colin Baigent of the clinical trial service unit at Britain’s Oxford University, who led the study published in The Lancet medical journal on Thursday.
He stressed that the risks are mainly relevant to people who suffer chronic pain, such as patients with arthritis who need to take high doses of painkillers – such as 150mg of diclofenac or 2400mg of ibuprofen a day – for long periods.
“A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous,” he said.
BALANCING RISKS AND BENEFITS
The study team gathered data, including on admissions to hospital for cardiovascular or gastrointestinal disease, from all randomized trials that have previously tested NSAIDs.
This allowed them to pool results of 639 randomized trials involving more than 300,000 people and re-analyze the data to establish the risks of NSAIDs in certain types of patients.
In contrast to the findings on ibuprofen and diclofenac, the study found that high doses of naproxen, another NSAID, did not appear to increase the risk of heart attacks. The researchers said this may be because naproxen also has protective effects that balance out any extra heart risks.
Baigent said it was important patients should not make hasty decisions or change their treatment without consulting a doctor.
“For many arthritis patients, NSAIDs reduce joint pain and swelling effectively and help them to enjoy a reasonable quality of life,” he said. “We really must be careful about the way we present the risks of these drugs.
“They do have risks, but they also have benefits, and patients should be presented with all those bits of information and allowed to make choices for themselves.”
Donald Singer, a professor of clinical pharmacology and therapeutics at Britain’s Warwick University, who was not involved in the study, said its findings “underscore a key point for patients and prescribers: powerful drugs may have serious harmful effects”.
“It is therefore important for prescribers to take into account these risks and ensure patients are fully informed about the medicines they are taking,” he said in an emailed comment.
With the public’s growing awareness of the deadly side effects associated with the regular use of synthetic painkillers like ibuprofen, the need for natural, evidence-based alternatives has never been greater
People generally think that over-the-counter drugs are safer than physician-prescribed ones. Unfortunately that does not hold true for drugs like ibuprofen, consumed at a rate of billions of doses, annually, and responsible for thousands of cardiovascular disease-related deaths each year.
Did you know that Merck’s blockbuster drug Vioxx caused more than 27,000 deaths and heart attacks between 1999 and 2003? In fact, it was the FDA’s own drug safety researcher, David Graham, who blew the whistle on the agency in 2004 at a Congressional hearing, estimating that over 60,000 Americans died as a result of its use, and the FDA’s inaction around their well-known side effects.
What does this have to do with ibuprofen? Researchers have known that ibuprofen is at least as dangerous as Vioxx for at least six years. But millions continue to take this drug, daily, without receiving adequate warning, while heart disease and cardiac mortality statistics continue to expand unabated.
For further background on the severe and still underreported dangers of ibuprofen, consult the following articles:
You can also view our ibuprofen database which presently collates the peer-reviewed research on the link between ibuprofen use and over 30 different conditions.
Considering the veritable nightmare of adverse effects associated with ibuprofen use — the “pain killer” that that is ‘so effective’ it permanently cures pain by killing the patient — it behooves both the medical profession and the health consumer to find safer alternatives, even if that means going back to the time-tested, multi-culturally validated tradition of herbal medicine.
Here are a 6 clinically validated, natural alternatives worth considering:
Arnica: a 2007 study found that arnica, applied topically, was as effective as ibuprofen for relieving symptoms associated with osteoarthritis of the wrist, and with less side effects.
Ginger: a 2009 study found that ginger was effective as ibuprofen for pain symptoms associated with difficult menstrual cycles (dysmenorrhea).
Turmeric: a 2014 study found that turmeric extracts were as effective as ibuprofen for relieving symptoms of knee osteoarthritis.
Thyme: 2004 study found that an extract of thyme was as effective as ibuprofen in reducing pain and spasm symptoms associated with difficult menstrual cycles (dysmenorrhea).
Omega-3 fatty acids: a 2006 study found that omega-3 fatty acid supplementation with fish oil helped neurosurgery patients reduce their need for medications, and experienced results consistent with previous research indicating palliative effects at least as effective as ibuprofen.
Cinnamon: a 2015 study found that cinnamon was as effective as ibuprofen for pain associated with difficult menstrual cycles (dysmenorrhea).
As part of its on-going work to track variants, WHO’s Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) met yesterday to discuss the latest evidence on the Omicron variant of concern, including its sublineages BA.1 and BA.2.
Based on available data of transmission, severity, reinfection, diagnostics, therapeutics and impacts of vaccines, the group reinforced that the BA.2 sublineage should continue to be considered a variant of concern and that it should remain classified as Omicron. The group emphasized that BA.2 should continue to be monitored as a distinct sublineage of Omicron by public health authorities.
The Omicron variant of concern is currently the dominant variant circulating globally, accounting for nearly all sequences reported to GISAID. Omicron is made up of several sublineages, each of them being monitored by WHO and partners. Of them, the most common ones are BA.1, BA.1.1 (or Nextstrain clade 21K) and BA.2 (or Nextstrain clade 21L). At a global level, the proportion of reported sequences designated BA.2 has been increasing relative to BA.1 in recent weeks, however the global circulation of all variants is reportedly declining.
BA.2 differs from BA.1 in its genetic sequence, including some amino acid differences in the spike protein and other proteins. Studies have shown that BA.2 has a growth advantage over BA.1. Studies are ongoing to understand the reasons for this growth advantage, but initial data suggest that BA.2 appears inherently more transmissible than BA.1, which currently remains the most common Omicron sublineage reported. This difference in transmissibility appears to be much smaller than, for example, the difference between BA.1 and Delta. Further, although BA.2 sequences are increasing in proportion relative to other Omicron sublineages (BA.1 and BA.1.1), there is still a reported decline in overall cases globally.
Studies are evaluating the risk of reinfection with BA.2 compared to BA.1. Reinfection with BA.2 following infection with BA.1 has been documented, however, initial data from population-level reinfection studies suggest that infection with BA.1 provides strong protection against reinfection with BA.2, at least for the limited period for which data are available.
While reaching the above determination, the TAG-VE also looked at preliminary laboratory data from Japan generated using animal models without any immunity to SARS-CoV-2 which highlighted that BA.2 may cause more severe disease in hamsters compared to BA.1. They also considered real-world data on clinical severity from South Africa, the United Kingdom, and Denmark, where immunity from vaccination or natural infection is high: in this data, there was no reported difference in severity between BA.2 and BA.1.
WHO will continue to closely monitor the BA.2 lineage as part of Omicron and requests countries to continue to be vigilant, to monitor and report sequences, as well as to conduct independent and comparative analyses of the different Omicron sublineages.
The TAG-VE meets regularly and continues to discuss available data on transmissibility and severity of variants, and their impact on diagnostics, therapeutics, and vaccines.
Celia Escamilla-Rivera is combining large data sets with supercomputers to test general relativity against its little-known competitors.
Celia Escamilla-Rivera leads the department of gravitation and field theory at the National Autonomous University of Mexico.Meghan Dhaliwal for Quanta Magazine
During a solar eclipse in 1919, Arthur Eddington observed light bending around the sun just as predicted by general relativity, Albert Einstein’s new theory of gravity. Since then, general relativity, which says that massive objects like stars warp the fabric of space-time around them, has passed increasingly precise tests. A year rarely goes by without a new experiment or observation confirming Einstein’s theory. But there’s a hitch.
Invisible substances known as dark matter and dark energy seem to make up some 95% of the content of the universe. The working assumption is that dark matter consists of nonluminous elementary particles, and that dark energy is the energy of space itself. But it’s also possible that they are illusions that appear because gravity works differently from how Einstein thought about it. “We’re invoking these mysterious things,” said the cosmologist Celia Escamilla-Rivera.“I am strongly convinced that alternative theories of gravity are needed.”
Escamilla-Rivera is searching for another, more complete theory. A bewildering array of alternatives to general relativity have been put forward over time, from “teleparallel gravity” to “complex quintessence” and “negative-mass cosmology,” but they long seemed like theoretical fancies. With cosmologists unable to create experiments that can distinguish these theories from general relativity, the ideas have gathered dust.
According to Escamilla-Rivera, that’s beginning to change in this new era of precision cosmology, a field she is pioneering in her home country of Mexico. Precision cosmology combines large and diverse data sets with new statistical methods, machine learning and supercomputers. “Thanks to this data you can open a door and classify all these theories and say which ones work and which ones don’t,” she said.
Escamilla-Rivera looks at astronomical images at Universum, the Museum of Science of the National Autonomous University of Mexico.Meghan Dhaliwal for Quanta Magazine
By scouring the early universe and the extreme environments of black holes, Escamilla-Rivera thinks we can find cracks in general relativity, which will make way for something else. This isn’t conventional wisdom among cosmologists, but Escamilla-Rivera’s path to becoming a cosmologist hasn’t been conventional either.
Escamilla-Rivera grew up in Ciudad del Carmen, a city on a small island in southern Mexico. She remembers walking along the beach at night under a full moon at age 4, wondering: Why is the moon very round? And why does it only come out at night? “I thought I needed to become an astronaut,” she said.
Years later, watching one of her university professors compute the age of the universe directly from Einstein’s equations, she switched her focus to cosmology. “People were like: ‘Why do you want to be a cosmologist? These are careers for people in the United States,’” she said. “It was seen as very weird.”
Escamilla-Rivera completed her doctorate in Europe and the United Kingdom; then, at 29, she was invited back to Mexico to run the theoretical physics department of the Mesoamerican Center for Theoretical Physics. A few years later, she became the first woman to hold a research position in the department of gravitation and field theory at the National Autonomous University of Mexico (UNAM) — as the head of the department.
We spoke for four hours over Zoom. From her office at UNAM in Mexico City, Escamilla-Rivera exuded confidence and enthusiasm, not only about the potential of precision cosmology to overturn Einstein, but also about new prospects for cosmologists in Mexico. The interview has been condensed and edited for clarity.
General relativity and the standard model of cosmology that grew out of it work so well. Why do you think we need to modify or extend gravity?
The problem is that general relativity is not general enough. If you want to explain dark energy, this invisible energy that seems to be accelerating the universe’s expansion, you need an extra component in the equation, called the cosmological constant. This extra component doesn’t exist naturally in general relativity; you need to add it by hand.
Is there a theory that naturally can give you dark energy without invoking mysterious things? That’s why I’m working on these extended or modified theories of gravity.
Other than dark energy, what other puzzles could these theories solve?
General relativity explains a lot about nature, but it doesn’t explain what happened at the Big Bang, or what happens inside black holes. The singularity of a black hole is mathematically very similar to the Big Bang singularity — it’s a point where all the known laws of physics break. A big question is, if we modify or extend general relativity, maybe we can explain this bizarre point that breaks everything.
Video: Celia Escamilla-Rivera discusses how she is using the tools of precision cosmology to hunt for a theory of gravity that incorporates dark energy more naturally than general relativity does.Video cover: Meghan Dhaliwal for Quanta Magazine; Emily Buder/Quanta Magazine; Noah Hutton for Quanta Magazine
General relativity also doesn’t explain the future of the universe. There are interesting theories that say the universe is going to collapse again into another Big Bang, called the Big Crunch universe. But we don’t know because general relativity is incomplete. If we find a complete theory, we could get answers to these kinds of questions.
There’s broad agreement that a fundamental, quantum theory of gravity is needed to describe black hole interiors and the Big Bang. The usual assumption, though, is that quantum gravity looks like general relativity throughout the rest of the universe. But you think a different theory will work better everywhere. Can you give an example of how modified theories differ from general relativity?
There are scalar-tensor theories. These are more general than general relativity. Why? Well, general relativity describes space-time using a mathematical object called a tensor. In scalar-tensor theories, there are also objects called scalars. A scalar can be something physical, like mass or energy, and it permeates space-time.
So it behaves a bit like the cosmological constant in general relativity?
Exactly. Except that in this scalar-tensor theory you don’t add anything, it comes out of the mathematics.
This is not the only alternative. In the 1980s, there was an explosion of these modified-gravity theories. Mathematically these theories are very rich, nothing can stop you, but with so many theories at hand, we were limited by experiments to tell them apart.
Is this what led you into precision cosmology?
When I was awarded my Ph.D., in 2014, that year was the explosion of precision cosmology in Europe. Ten years ago, the standard process was to take a telescope and make observations; with this data you then tested your theory. What happens now is that we have many telescopes collecting data of different types, from different parts of the universe. With machine learning, neural networks and supercomputers we can process all this data together. That makes the test of a theory richer.
Escamilla-Rivera stands among models of rockets at Universum.Meghan Dhaliwal for Quanta Magazine
I was the first person to publish a paper that uses machine learning to study dark energy in cosmological models. Machine learning architectures can now even look at large cosmological data sets and derive a theory of gravity. This is a new era.
Another new way to test these alternative theories is to do simulations on a supercomputer. You can control your own universe and make projections about which theory is going to work.
What brought you back to Mexico after studying in Europe?
I was finishing my postdoc in Nottingham, England, and I received a call saying: “We are opening an institute in Mexico that will be funded by the Abdus Salam International Center for Theoretical Physics, and we need Mexicans that are studying in Europe to come back to Mexico.” It was an obvious choice to come back to my country and pursue the same scientific questions.
At the time, there was no one in Mexico that could do precision cosmology using statistics. So when I arrived it was fresh air for several of my colleagues. I was teaching them all that I’d learnt in these other countries.
Then four years ago I received a call from UNAM. It was very exciting because I knew that I could form a new research group in my country.
What challenges have you faced in building this research group?
Part of the university community thought that cosmologists only need paper and a pencil. It’s more than that. You need supercomputers, you need the chance to travel to meetings, to build relationships and collaborate. All of this requires a lot of financial support.
Last year, I convinced my university that this is the future, that we need to do precision cosmology. And afterward I also received support from the Royal Astronomical Society. Our precision cosmology group is now very strong; we’re 20 people. We can ask Mexican researchers to come back to their home country and offer a permanent job. We also have colleagues and students from all over the world. It’s exciting times.
When do you expect observations will start to disagree with general relativity?
We are close to that. I am sure that the recently launched James Webb Space Telescope is going to open a new door with observations closer to the origin of the universe. We’ll see an era when hydrogen and helium are fusing to form the first galaxies in the universe. I suspect general relativity is not going to work at that time because the energy is so high. So that era can give you a very truthful test about which kind of theory of gravity is correct.
“A calculus that took years can take this computer 30 seconds,” Escamilla-Rivera said of UNAM’s computer cluster, as she stepped into the whirring, blinking space.Meghan Dhaliwal for Quanta Magazine
Which alternative theory would you put your money on?
I would put my money on teleparallel gravity.
How does that differ from general relativity?
In general relativity, an important concept is the space-time curvature, which tells you about the distribution of matter. You can see the sun as a big mass that’s put on a sheet, then the sheet starts to curve. Einstein made this relationship between matter and geometry the basis of the universe. Now in teleparallel gravity, the sun is forming something like a tornado. So instead of curvature, the sheet is twisted. This is called torsion.
Teleparallel gravity was actually one of Einstein’s final calculations in the last part of his life. Some people were writing a new mathematics using torsion. When Einstein saw this, he saw a way to connect his theory, general relativity, with another very important force, electromagnetism. He said, OK, maybe we can unify all of the forces. Unfortunately, he wasn’t successful, and his idea started to be forgotten.
But some theorists continued to work on it. Just a couple of years ago, Jackson Levi Said at the University of Malta found that it was possible to transform the language of teleparallel gravity into a cosmology — a set of equations that relate all the parameters that we observe in nature, like the density of matter. We could connect this cosmological model with experiments. I said, “OK, I’ll check it with the current data, for example, the cosmic microwave background radiation,” which is light from the early universe. And we found that the equations could match this data without needing to invoke dark matter or dark energy.
What evidence is there for teleparallel gravity?
It’s very elegant mathematically. But we don’t yet have experiments that prove it, because at a local level, teleparallel gravity is very, very similar to general relativity. The differences are in the very early universe and very far in the universe’s future.
Observations of the early universe with the James Webb will be the first tests of teleparallel gravity. If we can explain the formation of the first galaxies better than general relativity, that will be a beautiful test. Maybe teleparallel gravity can also explain what we see in photos of a black hole horizon.
You mean the Event Horizon Telescope’s recent photographs of the supermassive black hole in the M87 galaxy. What’s puzzling about the photos?
Stripes of polarized light around the black hole at the center of the M87 galaxy, photographed in 2021, reveal strong magnetic fields at work.EHT Collaboration
One of the photographs shows magnetic fields around the black hole. All the field lines are following the same flow; it’s very elegant. With these magnetic field lines, you indirectly know what is happening inside the black hole. A black hole absorbs matter that is near to it, so there is some matter inside the horizon and some that is outside, and the interaction causes the magnetic field. These magnetic fields are the trickiest part to understand.
One of the groups inside the Event Horizon Telescope Collaboration is looking for solutions in general relativity. But another group, which I am part of, is taking another route with modifications and extensions of gravity.
The problem is, to distinguish these possibilities we need more data. The idea now is to take a movie of the black hole to see its evolution. Maybe it will give us better restrictions on the theories we want to test.
When you were a kid, did you ever imagine that you would end up challenging Einstein?
Challenging Einstein? Probably! I think this is the dream of any kid that wants to understand the cosmos.
When many patients undergo abdominal wall reconstruction, usually they do not work with a physical therapist throughout their recovery period. According to Howard Levinson, MD, an associate professor in the Departments of Surgery, Pathology and Dermatology at Duke University Medical Center, in Durham, N.C., this probably should change. At the 2021 annual meeting of the American Hernia Society, Dr. Levinson delivered a lecture on how physical therapy should be an integral part of an abdominal wall reconstruction practice.
“When a patient undergoes hand surgery or leg surgery for musculoskeletal disease, they almost always work with a physical therapist or occupational therapist postoperatively, so it only makes sense for a patient undergoing hernia surgery—which is also a musculoskeletal disease—to also work with a physical therapist postoperatively,” Dr. Levinson said.
At Duke University Medical Center, all patients undergoing abdominal wall reconstruction are offered a physical therapy rehabilitation program postoperatively. At the beginning of the rehabilitation program, patients have an assessment of abdominal wall strength. This involves creating an abdominal wall strength score by scoring trunk-raising and double leg-lowering tests (Figures A and B). Using the strength score and the World Health Organization International Classification of Functioning, Disability and Health for Ventral Hernia, patients are stratified into a low-intensity, medium-intensity or high-intensity rehabilitation program. The frequency, time, type and intensity of exercise increases from low to high. Exercises include single-leg hip bridges, modified planks, modified side planks, clam shells and toe raises.
“If you have a patient [who] comes in who is a runner or very active, they should be able to tolerate a more aggressive rehab program. Based on the simple physical performance tests, we are likely going to find that they have a stronger score,” said Michael Schmidt, PT, DPT, MHA, the clinical coordinator of rehabilitation services in the Department of Surgery at Duke University Medical Center. “If you have a patient that comes in [who] is very deconditioned or medically unstable, they are likely going to have a weaker core based on the tests, and we would do a more lower-intensity rehab program to improve their conditioning.”
Patients are sent home with instructions on how to do their rehabilitation program. “The benefit of the program that we have developed is that it is mostly independent. We are doing the initial assessment and then really allowing patients to implement the exercises on their own. Many of the patients are traveling to Duke for just one visit. As long as patients are adhering to the exercises, we are seeing good benefit,” said Rebecca Fillipo, PT, DPT, a physical therapist at Duke University Medical Center. She said there have been no recurrences to date in patients who have participated in the rehabilitation program since 2019.
Ms. Fillipo said when they first started their rehabilitation program for hernia, they only had one protocol for every patient, but they found they weren’t dosing people appropriately. “People weren’t being challenged enough, or it was too challenging and people couldn’t get through the program. Each protocol level now increases in difficulty and is based on what the patient is trying to get back to,” she said. “Patients get moving the very first week after their surgery. The first four to six weeks all look pretty similar, just different repetitions or amount of resistance. But then between week 6 to week 12, we get to more activity-specific or sports-specific exercises. Different from a lot of the other programs, we took away lifting restrictions, with the idea of using a pain-guided approach and letting that dictate how they progress. We say they shouldn’t go past a 2-point jump in their pain when lifting.”
Mr. Schmidt said the program incorporates cognitive-behavioral therapy approaches to help with coping after major surgery and trying to help patients reduce their fear of moving after a surgery. “From an outcomes standpoint, we utilize the PROMISE 29 v2.0 measures of patient-reported outcome measures used in the hernia population,” he said.
Mr. Schmidt said clinicians can get more information on their rehabilitation guidelines by contacting him at Michael.Schmidt@duke.edu.
According to Richard Pierce, MD, PhD, an assistant professor at Vanderbilt University Medical Center, in the Division of General Surgery, and the director of the Vanderbilt Center for Hernia Care and Abdominal Core Health, in Nashville, Tenn., the Duke rehabilitation program is only one option for rehabilitation programs after hernia. The Abdominal Core Health Quality Collaborative has published three abdominal core surgery rehabilitation protocol guides on its website (bit.ly/3r3KcA8). There is a patient guide, a guide to be used with a physical therapist, and an in-hospital guide for patients and physical therapists. “The guides are very straightforward. You can print them out and hand them to patients,” Dr. Pierce said.
The U.S. Centers for Disease Control and Prevention has only published a fraction of the data it collected about the COVID-19 pandemic, The New York Times reported, citing several people familiar with the data.
The CDC published information about the effectiveness of boosters for people under 65 two weeks ago but didn’t provide data about people 18-49 years old, the age group least likely to benefit from boosters because they’re already well protected by the first two shots, The Times said.
The CDC recently created a dashboard of how much COVID bacteria has been discovered in wastewater, though state and local agencies had been sending the CDC their own wastewater data since the start of the pandemic, The Times said. The appearance of COVID in wastewater can help health authorities predict outbreaks, scientists have said.
Some outside health experts were stunned to find out the CDC held back COVID information.
“We have been begging for that sort of granularity of data for two years,” Jessica Malaty Rivera, an epidemiologist and part of the team that ran Covid Tracking Project, told The Times. A more detailed picture would have improved public trust, she said.
The Times said the withheld data could have helped local and state health authorities respond during different stages of the pandemic and better protect vulnerable populations. The lack of booster information about 18-49-year-old forced federal health agencies to rely on data collected in Israel on recommendations for booster shots, The Times said.
When asked to comment, CDC spokesperson Kristen Nordlund said the agency held back some information “because basically, at the end of the day, it’s not yet ready for prime time.”
The CDC prioritizes making sure information is accurate, she said, adding that the CDC fears the public might misinterpret some information.
Rivera rejected the idea that information should be withheld to avoid misinterpretation.
“We are at a much greater risk of misinterpreting the data with data vacuums, than sharing the data with proper science, communication and caveats,” she said.
The release of data is also delayed by bureaucratic procedures. The CDC must run information by the U.S. Department of Health and Human Services and the White House as well as different divisions within the CDC before release. Sometimes state agencies need to be briefed before information is made widely available.
Paul Offit, MD, a vaccine expert and adviser to the Food and Drug Administration, urged more openness.
“Tell the truth, present the data,” he said. “I have to believe that there is a way to explain these things so people can understand it.”
The CDC has been criticized other times for lack of transparency. Last year, the CDC released information on breakthrough cases but only when a person was sick enough to be hospitalized. Vaccinated people who tested positive and isolated at home were not included in the count, leading to questions about the effectiveness of the vaccines.
Hot flashes. Night sweats. Waking up at all hours throughout the night. Millions of women battle these stereotypical menopause symptoms for years.
Now, a small study suggests that a drug used for both men and women who have sleep disorders might offer relief. Researchers compared women who took suvorexant (Belsomra) with those who took a placebo and found the benefits for those using the medication went beyond better Zzzs.
Not only were women sleeping better, those using suvorexant also had fewer night sweats than those taking the placebo.
“Together, this makes the findings rather strong for this particular population because it’s not only just improving their sleep, which was the primary thing that we were after, but it’s also improving the frequency of their night sweats,” said lead researcher Shadab Rahman. He is an assistant professor in the division of sleep medicine at Harvard Medical School in Boston.
Menopause, the end of a woman’s monthly period, is a major transition, with hormone changes and other changes that can adversely affect their health and quality of life, Rahman said. It typically occurs after 45 years of age.
About 40% to 60% of women report significant sleep disruption during menopause, Rahman said. Typically, they say it’s hard to stay asleep.
“What motivated us to do this study was this is a major health concern, as well as impairment of quality of life for half the population in the world, so what can we do to make it better?” Rahman said.
Getting enough sleep is a vital part of well-being and health. Disrupted sleep has been linked to various health problems, ranging from depression to diabetes, he noted. A woman’s risk of developing these conditions rises significantly during menopause.
“The question is now, if we can improve sleep in these women with this particular medication, is it effective in attenuating the risks of developing these adverse health outcomes?” Rahman said. “Can you lower the risk of developing diabetes, for example? Can you lower the risk of developing depression or even improving depression in perimenopausal women who do go on to have active disorders, mood disorders or depression? If you improve their sleep, do you also improve their mood and then their general well-being in the long term?”
While the trial appeared to reduce night sweats and insomnia, it did not appear to impact other menopause symptoms, such as daytime hot flashes, the investigators found.
More research would be needed to confirm the findings of this trial, which included 56 women between 40 and 65 years of age. It was conducted over a four-week period.
Rahman said future research could include a trial designed to look specifically at using suvorexant to fight night sweats, rather than insomnia. Studies of health outcomes are a logical next step, he added.
Women experiencing typical menopause symptoms can use hormone replacement therapy, but some choose not to because of concerns about whether it might increase their risk of other health conditions, such as cancer.
Cognitive behavioral therapy can be a solution for sleep disorders, as can some other insomnia medications, but some drugs can be sedating and cause drowsiness.
Suvorexant works by blocking the receptors for a chemical in the brain known as orexin, which is involved in wakefulness and waking up. It may also contribute to hot flashes.
Dr. Stephanie Faubion is medical director of the North American Menopause Society. She said, “Hormone therapy isn’t for everyone, but for the majority of healthy women who are under the age of 60 and within 10 years of menopause, the benefits typically outweigh the risk. Now there’s always going to be a group of women who either can’t use it for medical reasons or choose not to use it for personal reasons. And for that group, it’s always a good idea to have other options available.”
Though suvorexant did not appear to ease daytime hot flashes, Faubion said it could be what women who have more nighttime symptoms need.
As many as eight in 10 menopausal women experience hot flashes and night sweats for an average of seven to nine years, she said. About one-third experience moderate to severe hot flashes for a decade or more.
“The sleep disturbance associated with this is not insignificant. When you add all that up, if you’re not sleeping at night, you’re not functioning during the day, it probably contributes to women having that sensation of brain fog during the day,” Faubion said. “If you look at the global impact of menopausal symptoms and the economic burden associated with not treating those, it’s substantial.”
When you’re trying to lose weight, eating healthful foods and working out regularly are important things to do. But there are also small changes you can try at night to help you slim down.
Keep Evenings Busy
Sometimes people overeat at night because they’re bored. If that’s you, try to fit in some activities before bed. Walking, journaling, chatting with a friend, or reading a book can help distract you from binge eating. Picking up a new hobby — like painting, playing music, or knitting — is another great way to distract yourself from chowing down when you’re bored.
Sleep Well
Believe it or not, getting enough sleep can help you when you’re trying to lose weight. Having a schedule that you stick to and getting the right amount of shut-eye can help a lot.
Work Out (but Not Too Late!)
Physical activity in the early evening can be helpful. Just make sure it’s not too vigorous. High-intensity exercise like interval training could affect the quality of sleep you get. It can also make it harder to fall asleep at bedtime. Don’t work out too late, either. Stop at least an hour before you go to sleep.
Don’t Eat Before Bed
If you have dinner or snack too close to bedtime, it might hinder your weight loss efforts. Although the actual time doesn’t really matter, many people who eat late at night choose high-calorie foods, which brings weight gain. Late meals and snacks can also make it harder for you to fall asleep. Aim to stay out of the kitchen from a couple of hours before bedtime until you wake up the next morning.
Pack Your Lunch for the Next Day
Instead of going out for your midday meal, save some money and pack your lunch the night before. Eating out usually means more fat and sodium. But when you pack your own food, you’ll have healthier options. Go for proteins like almonds or turkey slices, whole grains, low-fat dairy, and plenty of fruits and vegetables.
Stick to a Schedule
If you notice you’re overeating at night, it could be because you haven’t eaten enough during the day. The best way to combat that is to make sure that you eat your meals regularly. That way, your body will know when to anticipate food. Eating a snack between lunch and dinner is totally fine, too — just try not to overdo it.
Turn Off the TV
Although you might like to watch television during dinner, screen time while you eat could cause you to accidentally overindulge. It can distract you from how much and what you’re eating.
Brush and Floss Right After Dinner
To encourage yourself to avoid nighttime eating, make it a habit to brush and floss your teeth after dinner. If your teeth are already clean, you’ll probably think twice before grabbing a snack close to bedtime. Remember to wait at least 60 minutes before brushing—especially if you have had something acidic like lemons, grapefruit or soda.
Ease Stress
Stress can lead to weight gain. Try to take time to relax at night. Deep breathing techniques and mindfulness meditation are great ways to chill out. Lowering your stress levels can also do wonders for the quality and amount of sleep you get.
Turn the Lights Out
Sleeping in a dark room is another habit to add to your list. It helps you get better sleep. If you’re trying to lose weight and get better ZZZs, Cover the windows to block out light. (Try blackout curtains if your blinds don’t block light well.) and put your phone and laptop away at least 30 minutes before bedtime. An eye mask can help, too.
It’s a gorgeous day. But if the pollen count is high, keep the windows and doors closed to protect your indoor air. You can also install a HEPA filter on your air-conditioning system and a flat or panel filter on your furnace.
2. Consider Alternative Treatments
Butterbur is one of the most promising and well-researched. Some studies suggest that a butterbur extract called Ze 339 may work as well as antihistamine medicines. Other studies show that plant-based Phleum pratense and pycnogenol may be helpful, too.
3. Wash Up
Each time you walk into your home, you bring small pieces of the outside world with you. After being outdoors, your clothes, shoes, hair, and skin are covered with tiny particles from everywhere you’ve been. Take a shower and change your clothes to wash away any allergens. Leave your shoes at the door, too.
4. Wear a Mask
It’ll keep allergens from getting into your airways when you can’t avoid certain allergy triggers, like when you work in your yard or vacuum. An N95 respirator mask, available at most drugstores and medical supply stores, will block 95% of small particles, such as pollen and other allergens.
5. Eat Healthy
In one study, children who ate lots of fresh vegetables, fruits, and nuts — particularly grapes, apples, oranges, and tomatoes — had fewer allergy symptoms. Researchers are still trying to figure out the link. But there’s no doubt that a healthy diet is good for your whole body. Add at least one fresh fruit and veggie to every meal.
6. Rinse It Out
A nasal rinse cleans mucus from your nose and can ease allergy symptoms there. It also can whisk away bacteriaand thin mucus and cut down on postnasal drip. Buy a rinse kit or make one using a neti pot or a nasal bulb. Mix 3 teaspoons of iodide-free salt with 1 teaspoon of baking soda. Store this in an airtight container. To use, put 1 teaspoon of the mixture into 8 ounces of distilled or boiled then cooled water. Lean over a sink and gently flush one nostril at a time.
7. Drink More
If you feel stuffy or have postnasal drip from your allergies, sip more water, juice, or other nonalcoholic drinks. The extra liquid can thin the mucus in your nasal passages and give you some relief. Warm fluids like teas, broth, or soup have an added benefit: steam.
8. Go Natural
Keep your home clean. It’s one of the best ways to avoid indoor allergens. But harsh chemicals can irritate your nasal passages and aggravate your symptoms. So make natural cleaners with everyday ingredients like vinegar or baking soda. Use a vacuum cleaner that has a HEPA filter to trap allergens. If you have severe allergies, ask someone else to tidy up.
9. Get Steamy
Inhale some steam. This simple trick can ease a stuffy nose and help you breathe easier. Hold your head over a warm (but not too hot) bowl or sink full of water, and place a towel over your head to trap the steam. Or sit in the bathroom with a hot shower running.
10. Avoid Cigarette Smoke
It can worsen your runny, itchy, stuffy nose and watery eyes. Choose smoke-free restaurants, nightclubs, and hotel rooms. Avoid other fumes that can make your symptoms worse, too, like aerosol sprays and smoke from wood-burning fireplaces.
11. Consider Acupuncture
This ancient practice may bring some relief. The way acupuncture affects nasal allergies is still unclear. But a few studies show that it may help. Ask your doctor if it would be good to try.
12. Know Your Triggers
You may think you know what the problem is. But are you sure? Make an appointment with an allergist for an allergy skin test to pinpoint your triggers. Then you can make a plan to avoid them.
What Is Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)?
ME/CFS is a complex illness. The severity is variable, but the symptoms are real. The condition can be completely incapacitating and includes debilitating fatigue along with other symptoms. The fatigue is severe enough to interfere with daily activities and is not relieved by bed rest. Though there is no cure for ME/CFS, improvement and recovery are possible with comprehensive treatment.
ME/CFS Puzzles
ME/CFS can now be diagnosed by looking for a pattern of specific symptoms . But the causes of the illness are still a mystery. Possible culprits include a faulty immune system, infections, or alterations in body chemistry, particularly the chemistry by which the body’s cells make energy.
ME/CFS Symptoms: Intense Fatigue
Everyone feels sluggish now and then. The difference with ME/CFS is that the fatigue is overwhelming and has lasted for at least 6 months. It may get worse after physical or mental exertion, and a full night’s sleep provides no relief. The fatigue is often accompanied by other troubling symptoms, such as chronic pain.
ME/CFS Symptoms: Recurring Pain
Many people with ME/CFS develop recurring pain, including headaches, sore throat, muscle pain, and joint pain. The joints may hurt without showing signs of redness or swelling. The cause of these symptoms is not well understood, but the pain can often be managed through medication or physical therapy.
Other Symptoms of ME/CFS
Beyond fatigue and pain, people with ME/CFS may experience:
More than a million Americans have ME/CFS. Most studies find that women are more likely than men to develop the illness. Although people of any age can get ME/CFS, it occurs most frequently in people in their 40s and 50s. There may be a genetic component, but there is no evidence that ME/CFS is contagious.
ME/CFS in Children and Teens
ME/CFS is very rare in children and only slightly more common in teenagers. The good news is young people with ME/ are more likely to improve than older patients. If your child is diagnosed with ME/CFS, consult a specialist to create an individualized exercise and management program. Find constructive ways for your child to cope, and seek out support groups.
Diagnosing ME/CFS
There are no accurate diagnostic tests as yet for ME/CFS, but your health care team may run blood tests or brain scans to rule out other conditions. ME/CFS is diagnosed when you have a moderately severe degree of:
Severe fatigue that has lasted more than 6 months, is not explained by another condition and is not substantially alleviated by rest AND.
Post-exertional malaise (Worsening of ME/CFS symptoms after physical or mental activity that would not have caused a problem before illness. This is known as post-exertional malaise (PEM) AND
Unrefreshing sleep/usually awakening unrested
AND
Cognitive impairment and/or
Orthostatic intolerance- feeling much better when laying down compared to standing up
How ME/CFS Impacts Daily Life
ME/CFS tends to follow a cyclical course. You may experience periods of intense fatigue followed by periods of well-being. It’s vital not to overdo it when you’re feeling well, because this may trigger a relapse. Most people with ME/CFS experience symptoms that worsen after strenuous physical or mental activity. Work with your health care team to determine the right activity level for you.
Treatment Options for ME/CFS
There is no cure for ME/CFS, and no prescription drugs have been developed specifically for its treatment. There are treatments to help reduce your symptoms (such as pain or poor quality sleep). Work with your health care team to develop coping strategies, such as managing your activity level and taking medications to control symptoms. Focus on feeling better rather than feeling “normal.”
Medications
Medications are primarily used to relieve symptoms, such as sleep problems and chronic pain. Some medications, such as tricyclic antidepressants, can reduce pain and improve sleep with just one pill. (In the low doses used, these drugs do not treat depression, just sleep and pain). Non-steroidal anti-inflammatory drugs (NSAIDs) can help with pain. Be sure to ask your doctor about the benefits and side effects of any drugs you take, even if they are over the counter.
Counseling
A counselor can help you to cope with the burdens of your illness. Although some studies have concluded that a particular form of therapy called cognitive behavioral therapy (CBT) may be helpful, serious questions have been raised about the conduct of the largest of these studies. It not been proven, or disproven, that CBT is beneficial.
Complementary Therapies
Complementary treatments — sometimes called alternative therapies — – appear to have helped some people manage the pain caused by ME/CFS. These include stretching therapies, toning exercises, massage, tai chi, yoga, hydrotherapy, and relaxation techniques. Acupuncture may also treat pain. Make sure to seek out qualified practitioners who are knowledgeable about ME/CFS.
Herbs and Supplements
Talk with your doctor about which supplements, if any, are helpful and safe for you. A few studies have suggested that supplements rich in omega-3 fatty acids, like fish oil, may be helpful in people with ME/CFS. Remember that supplements may interact negatively with prescribed medications, so check with your doctor before starting them.
Scam Alert
Many nutritional supplements and vitamins are targeted toward people with ME/CFS. Keep in mind two things. First, the manufacture of supplements is not regulated to the same degree as prescription medications; as a result, some can contain dangerous impurities. Second, virtually none of the supplements have been tested in scientifically rigorous studies involving large numbers of people.
ME/CFS and Diet
Doctors recommend a well-balanced diet for people with ME/CFS, but no specific dietary strategy has been widely accepted. Foods rich in essential fatty acids (particularly omega-3 fatty acids)—for example, nuts, seeds, and coldwater fish—may reduce fatigue. Some people with ME/CFS notice their symptoms are triggered by certain foods or chemicals, including refined sugar, caffeine, and alcohol.
ME/CFS and Sleep
Most people with ME/CFS experience sleep disturbances that leave them awakening unrested almost every morning. The most frequent abnormality is frequent awakening for no apparent reason. In addition, people with ME/CFS may have difficulty falling asleep, restless legs and vivid dreaming. To create healthy sleep habits, establish a regular bedtime routine (going to bed and awakening at about the same time every day).
ME/CFS and Depression
ME/CFS is not a psychiatric illness, nor a form of depression. However, up to half of people with ME/CFS become depressed during the course of their illness. This may be the result of the difficulty in adjusting to life with a debilitating, chronic condition. If a person with ME/CFS also develops depression, it generally responds well to treatment. Getting it under control can make ME/CFS easier to cope with.
Tips for Family Members
Chronic illnesses like ME/CFS may impact the whole family. Consult with a mental health professional to learn how to cope with changes in family dynamics. Don’t expect your loved one to “snap out of it” and return to their usual activities. Try to be supportive, because emotional health is vital for anyone coping with ME/CFS.
Outlook for ME/CFS
The percentage of people who make a full recovery from ME/CFS is not known. But some people enjoy long periods of remission, especially by learning to manage their activity levels – keeping active, but not pushing themselves too hard.
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