side effects

Stevia Has Potential Side Effects on Gut Microbiome and Brain, but Experts Explain Bottom Line

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The sugar substitute is known for its potential to lower blood pressure and blood sugar, but some research suggests it may disrupt more than the gut microbiome

Stevia, known for its zero calories and potential benefits, such as lowering blood pressure and blood sugar, is often considered an excellent substitute for sugar. However, is this sweetener—used by Paraguayans for over a thousand years and by the Japanese for several decades—truly free from side effects?

Stevia Is Excreted, but Liver Problems May Pose Issue

Generally, stevia is thought to be metabolized and excreted without accumulating in the body.

Stevia’s sweetness comes from steviol glycosides. Steviol glycosides are a group of substances, among which stevioside and rebaudioside A are the two most common in commercial products.

Our stomachs and upper small intestines cannot break down or absorb steviol glycosides. Therefore, ingested steviol glycosides enter the lower gastrointestinal tract intact. In the colon, gut bacteria break down steviol glycosides into steviol, a process completed within 24 hours. Subsequently, most of the steviol is rapidly absorbed into the bloodstream through the intestinal wall, while any unabsorbed steviol is excreted in feces. The steviol entering the bloodstream is further metabolized into steviol glucuronide in the liver and ultimately excreted in the urine. This is why human experiments have shown no detectable levels of steviol in the blood after consuming steviol glycosides, while steviol glucuronide is detected in urine, and steviol is found in the feces.

“Factors like diet, medication use, or individual differences could potentially impact the metabolism of stevia and its metabolites,” said Lisa Young, an adjunct professor of nutrition in the Department of Nutrition and Food Studies at New York University and a registered dietitian nutritionist, in an email interview with The Epoch Times. She noted that while rare, some individuals may experience adverse reactions or intolerance to steviol, which “could cause gastrointestinal symptoms, allergic reactions, or other health concerns.”

Additionally, she emphasized the crucial role of the liver in the metabolism of stevia, indicating that liver diseases or impaired liver function may impact this process. “Individuals with liver diseases or those taking medications that affect liver function may need to exercise caution regarding the consumption of stevia.”

Potential Impact of Stevia on Gut Microbiome

Some in vitro and animal experiments have found that stevia or steviol may potentially impact the gut microbiome.

An animal study published in Nutrients in 2019 revealed that, compared to those only drinking water, rebaudioside A consumption altered the gut microbiome composition in mice. However, Ms. Young noted that while the hindgut microbiome of mice and humans share some similarities, many bacteria present in the mouse gut are absent in humans. Therefore, there are certain limitations to animal studies

A study conducted by Israeli scientists in 2020 revealed that stevia and steviol do not possess bactericidal properties. However, they may potentially interrupt communication among Gram-negative bacteria in the gut, leading to gut microbial imbalance. Additionally, steviol may also exhibit inhibitory effects on the competition among gut bacteria

Lactobacillus reuteri is often incorporated into food as a probiotic. In an earlier study, stevioside and rebaudioside A were found to inhibit the growth of six strains of Lactobacillus reuteri, with the inhibitory effects varying depending on the specific strain.

An in vitro experiment published in the journal Genes in 2019 suggested that in a simulated human intestinal environment, steviol decreased the population of Bifidobacteria (healthy bacteria), hindered the degradation of bacterial food, and concurrently led to an increase in colonic pH.

Another in vitro experiment, published in the Journal of Agricultural and Food Chemistry in 2019, demonstrated that sweetener products containing steviol glycosides and erythritol altered the structure and diversity of the human gut microbiome to some extent. However, the study concluded that, overall, there was no negative impact on the gut microbial community due to the consumption of stevia.

A review published in Microbiology in 2022 indicated that current knowledge about stevia’s impact on the gut microbiome has primarily come from in vitro and animal studies. Due to a lack of randomized clinical trials conducted in human populations, there is no definitive evidence to elucidate how stevia influences the gut microbiome, and further research is needed.

Ms. Young noted that the impact stevia has on the gut microbiome remains an active area of research, and conclusions may vary. However, she emphasized that “most studies face limitations in terms of biological relevance because it is challenging to directly apply tested concentrations to human exposure levels.”

Gastrointestinal Discomfort Caused by Stevia-Based Products

The adverse effects of stevia-based products often do not stem from steviol glycosides.

As steviol glycosides are several hundred times sweeter than sucrose, most stevia-based products on the market are not 100 percent pure steviol glycosides. Instead, they often consist of a blend of steviol glycosides and some sugar alcohols. For example, you might find a combination of 1 percent steviol glycosides and 99 percent erythritol. These products are commonly found in supermarkets, usually as white crystalline powders, their appearance resembling that of granulated or powdered sugar.

Ms. Young stated that erythritol, present in stevia-based products, is recognized by the U.S. Food and Drug Administration (FDA) as generally recognized as safe (GRAS). However, excessive consumption can result in side effects such as bloating, cramps, flatulence, or diarrhea. Additionally, the inclusion of other substances like sugar alcohol in stevia products may also cause adverse effects, especially for individuals sensitive to these additives.

There are eight types of sugar alcohols approved by relevant regulatory authorities for use as sweeteners in food, including erythritol, hydrogenated starch hydrolysates, lactitol, isomalt, mannitol, maltitol, sorbitol, and xylitol. Some individuals may experience various gastrointestinal discomforts after consuming these substances.

Specifically, sugar alcohol substances may increase gas production after fermentation by bacteria in the gut, contributing to bloating in the gastrointestinal tract. Additionally, these substances can lead to the retention of water in the small intestine, causing abdominal discomfort. Sugar alcohols also impose a greater osmotic load on the gut, leading to increased water concentration in the colon and resulting in loose stools. Moreover, the fermentation of sugar alcohols in the gut may impact the intestinal environment by altering the gut microbiome and its metabolism, influencing the intestinal immune barrier, and potentially increasing the risk of a so-called “leaky gut.”

However, it is important to note that there is a significant variation in symptoms among those who consume sugar-alcohol substances. Factors such as the type of sugar alcohol, the amount ingested, the consumption of food alongside the substance, and the intestinal ability to reabsorb water can all lead to different outcomes. Moreover, people with lower gastrointestinal tolerance or those with intestinal diseases tend to experience more symptoms than healthy people.

The substances present in stevia-based products may also impact cardiovascular health.

A review published in Nature Medicine in 2023 highlighted a link between erythritol consumption and an increased risk of adverse cardiovascular events (including death or nonfatal heart attacks or strokes) and the formation of thrombosis. The researchers stated that further research on the long-term safety of erythritol is warranted. However, it is important to note that some controversy surrounds this study.

Potential Impact of Stevia on the Brain and Nervous System

Scientists have also assessed the potential impact of stevia and its metabolites on the brain and nervous system. However, due to medical ethical considerations, these studies are primarily conducted through animal experiments.

The previously mentioned 2019 animal study suggested that the consumption of stevia may impact the dopamine reward system in the brain.

In 2020, two clinical doctors jointly published a case report, suggesting for the first time a potential association between the symptoms of restless legs syndrome (RLS) and the consumption of stevia. A patient developed symptoms of RLS while using stevia, and these symptoms resolved after discontinuation. Several months later, upon a trial reintroduction of stevia, the RLS symptoms reappeared within two days. The doctors proposed that stevia might selectively reduce dopamine levels in specific regions of the brain, or the intake of stevia could affect iron absorption. Both factors are considered significant contributors to RLS.

In addition to potentially affecting the dopamine system, animal experiments have shown that stevia may also influence memory.

Researchers at the University of Southern California published a study in 2022 where they provided juvenile rats with either artificial sweeteners or water with added stevia for a month and then tested their memory. The results revealed that both artificial sweeteners and stevia impaired the rats’ memory compared to those only drinking water. These rats were less likely to remember objects or navigate through mazes successfully. A study conducted by Filipino researchers in 2015 revealed that mice consuming stevia or two other artificial sweeteners (aspartame and sucralose) showed no significant difference in their learning ability in a water maze compared to mice drinking only water. However, mice consuming stevia exhibited higher levels of cell death in the hippocampus. Another study also conducted in the Philippines in 2014 found that mice with a higher intake of stevia, compared to those only drinking water, exhibited a longer duration of reaction when subjected to heat, suggesting that stevia might inhibit the sensitivity of the mice’s nervous system.

Stevia May Disrupt Endocrine Function and Affect Immunity

In the body, steviol glycosides are first metabolized into steviol, which possesses a steroid-like structure. Therefore, researchers suspect that stevia may act as an endocrine disruptor.

For instance, a cell experiment demonstrated that a certain concentration of steviol could disrupt the endocrine function of human sperm cells and also impact cell viability.

Another study found that stevia consumption led to changes in the number of immune cells in the lymph nodes of mice. Compared to mice drinking only water, those consuming stevia showed an increase in the count of two types of immune cells and a decrease in another type. Additionally, there were varying degrees of changes in some hormones within the mice’s bodies.

In 2020, Brazilian researchers published an in vitro study in Immunopharmacology and Immunotoxicology, revealing that exposure to steviol led to a decrease in human lymphocyte quantity, accompanied by gradual DNA damage and structural changes. Therefore, the study proposed that, under certain concentrations and conditions, steviol exhibits cytotoxic, genotoxic, and mutagenic effects. An earlier study also suggested that, although steviol glycosides seem not to exhibit cytotoxicity, steviol itself possesses mutagenic properties.

Safety of Stevia in Human Studies

However, the experiments mentioned above, which indicate the effects of stevia or its metabolites, were not conducted on humans. In other words, the experimental conditions and subjects differ from those of the human body.

Per Bendix Jeppesen, who is currently studying stevia extract as an anti-diabetic drug and as a healthy sweetener and is an associate professor in the department of endocrinology and diabetes at Aarhus University in Denmark, told The Epoch Times that stevia is safe, stating, “It is the most researched sweetener in the world.” He elaborated: “The European Food Safety Authority (EFSA) are using 10 years to go through all materials. All kinds of studies and publications have been really looked into and they gave this permission (to use stevia).”

Mr. Jeppesen also pointed out, “Cell studies will never be able to replace in vivo studies as animal or human intervention studies.” This is because, in in vivo studies, the human body functions as a whole organism, with different organs working together, whereas in cell studies, it typically involves cells from a specific organ and cannot fully reflect the overall complexity of the organ.

Jan Geuns, a professor in the Department of Biology at Katholieke Universiteit Leuven in Belgium, who has researched stevia for many years, expressed in an email to The Epoch Times that extensive experiments have been conducted on animals as well as healthy subjects. Throughout the process, “we hoped to find other metabolites than steviol or steviol glucuronide. However, no other metabolites could be found.” He also pointed out that steviol glycosides and their metabolites do not accumulate in the human body.

Mr. Geuns also mentioned that “steviol glycosides are not easily absorbed in cells and, therefore, cell studies have nothing to do with the way steviol glycosides behave in man.” Additionally, he explained that once excreted from the body, steviol glucuronide continues to be further degraded by microorganisms, including those in the soil, and does not accumulate in the environment. “This cannot be said about compounds like sucralose, which has recently been proven to be carcinogenic and which is accumulating in surface waters and occurs in tap water.

“I think that sufficient studies have been done on the safety of steviol glycosides (and stevia),” he concluded.

A 2021 review recognized the safety of stevia, citing as primary evidence its historical use in the Paraguayan population for over 1,500 years and decades-long consumption by the Japanese without any reported side effects.

A study published in Nutrition Today in 2015 proposed that there were over 200 studies at that time confirming the safety of stevia. Additionally, a review published in 2023 in the journal Molecules also asserted that most existing human experiments suggest the safety of stevia consumption for the general population—“Although neither the applicability of stevioside in children, pregnancy, nor lactation has been evaluated, preclinical and clinical evidence of its safety allows it to be recommended, respecting the [acceptable daily intake

Words Matter: Unintended Side Effects of “Financial Toxicity”

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High out-of-pocket costs of treatment in the United States are a major driver of health disparities. The financial burdens associated with medical care are frequently referred to in the literature as “financial toxicity.” This term was popularized after articles by Zafar and Abernethy in 2013 highlighted the growing out-of-pocket costs borne by patients with cancer.1,2 They describe financial toxicity as consisting of both “objective financial burden” and the subjective distress resulting from that burden. The authors attribute increasing costs to 4 factors: “an aging populace, more patients with access to treatment, innovation, and overutilization.”

Since 2013, the concept of financial toxicity has gained significant popularity in the oncology literature and has been adopted in other specialties, such as neurology.3 The reasons for this are understandable. Clinicians are familiar with the notion of unintended and sometimes serious noxious side effects of treatments. Chemotherapeutic agents powerful enough to slow or eradicate cancerous cells often are just as powerful in damaging healthy tissue. Thus, explanation of potential toxicity is routinely included in discussions with patients about recommended treatment. “Financial toxicity” is a useful idiom that encourages clinicians to screen for, identify, and attempt to manage treatment-induced financial problems just as they do for other treatment-related toxicities. However, this choice of language may obscure rather than illuminate causes of the problem and our responsibility to work toward solutions.

Language and Cognition

The words we choose and the way we think are intimately connected. Since the time of Noam Chomsky, philosophers and neuroscientists have explored the many ways in which language influences thinking. Researchers even have found differences in ability to perceive color based on language.4 Language also can affect how we analyze an event and assign blame. For example, a cross-cultural study found differences between the ways English and Japanese speakers describe an accidental event and ascribe agency.5 English speakers used more agentic language and had better memory of who was at fault for an accidental event than Japanese speakers, who described the event more passively. The researchers also found differences within English speakers by priming them with either agentic (“He burned the toast”) or nonagentic (“The toast burned”) language. Those exposed to the agentic description of the event were more likely to recall who caused the event.

Thus, the language we choose to name a problem not only frames our thinking but also influences how those we talk with understand causes of the problem and targets for solutions. Labeling the excessive cost of treatment as “toxicity” leads us to analyze and understand the problem through a biomedical lens of diagnosis and treatment. Like any drug toxicity, financial toxicity becomes an unavoidable side effect of treatment and simply leads to difficult cost/benefit analyses. Applying this familiar medical framing places a problem within our realm of comfort and expertise, empowering us to use our particular skillsets to find solutions. However, “financial toxicity” medicalizes a problem that is fundamentally socioeconomic—the development of a system that distributes health care as a discretionary consumer good, subject to the laws of supply and demand. When insulin prices skyrocketed, causing numerous avoidable deaths in patients with diabetes who were unable to afford it,6 it was not caused by any change in the toxicity profile of the drug. Labeling this price-gouging as a “toxicity” obscures the intentionality of actions by pharmaceutical companies to increase profits. Drug prices certainly are not the sole cause of high out-of-pocket costs, but are one common example of an imbedded characteristic of our complex health care system that results from perverse profit incentives. Numerous other factors contribute to out-of-pocket costs, such as the ability of health insurance companies to deny claims at will, complicated hospital system billing practices, and the power of “relative value unit” (RVU) metrics to constrain physician time with patients.

“Financial toxicity” implies an unavoidable, unintended side effect that is a necessary risk of treatment. This directs clinical thinking toward standard approaches. First, the clinician would assure that the patient understands the risks during informed consent. This approach is suggested in Zafar and Abernethy’s 2013 article—they argue that potential financial toxicities need to be incorporated into the treatment decision-making process by making costs of treatment more transparent.2 Patients can then weigh the benefits of treatment against the risks of toxicity to make a fully informed choice. After treatment has started, clinicians monitor for signs of toxicity and palliate to the extent possible should the toxicity arise. Within the context of an unfortunate but unavoidable treatment-related toxicity, this is the best we can do.

Finding New Language

But this is not the best we can do. In the decade since financial toxicity has been popularized, health care costs borne by patients have only grown. The label of “financial toxicity” may make this problem feel more manageable, but it also obscures the underlying causes and constrains our imagination regarding potential solutions. As we emerge from a pandemic that disproportionately killed poor and minority populations, it has never been more clear that alternative strategies are needed to achieve health equity.

The authors do not claim that clinicians and researchers using the language of “financial toxicity” are acting in bad faith. Rather, we aim to highlight the implicit meaning attached to this choice of language and suggest an alternative framing. Labeling high treatment costs as a side effect—or worse, treating financial vulnerability as a comorbidity—guides clinicians to offer cheaper, potentially suboptimal treatments, which would worsen health disparities. Patients with poor renal function are not candidates for certain types of chemotherapy; that is unfortunate, but access to those therapies is a function of medical facts and guided by assessment of the best interest of the patient. Inability to receive optimal treatment because of poverty is an injustice. When we recognize that high treatment costs are modifiable harms inflicted on patients by a health care system that is designed to create profit, “toxicity” language no longer fits. Instead, we propose that “financial exploitation” should take its place (or “financial abuse,” as suggested by Lyman and Kuderer7). How different would conversations with colleagues and trainees feel if the exploitative nature of our health care system was regularly named as such? Shifting from “financial toxicity” to “financial exploitation” changes implicit assumptions and broadens the scope of potential solutions.

Conclusions

Shifting our language from “toxicity” to “exploitation” is a small step, but an important one. This shift in framing demands solutions beyond discussing costs of treatment during informed consent. It requires a reckoning with our roles as clinicians and researchers in a health care system that exploits the sick for profit. We do not blame physicians, nurses, and other health care workers for this—they too are victims of a for-profit health care system. Widespread burnout and staffing shortages, even before the COVID-19 pandemic, were signs of the strain faced by those working in this system. Many efforts are being made on a local level to lessen the financial burden caused by our health care system, such as providing financial counseling, free screening programs, community health fairs, and so on. We are in full support of those initiatives, but broader change is needed to break the cycle of exploitation that is built into our health care system.

Decisions made by pharmaceutical companies, hospital systems, health insurance companies, and politicians to maintain this exploitative system may be out of our direct, individual control. Although changing such a deeply entrenched system may feel impossible at times, health care clinicians, faculty, and researchers are an integral part of this system and have the power to change it. Collective action will be necessary to make the kind of systemic changes that would prevent further financial exploitation of our patients. Such collective action may take the form of political activism, leveraging the influence of professional societies, and taking on leadership roles in health organizations. The label of “financial exploitation” reminds us that intentional actions, not innate properties of treatments, are harming our most vulnerable patients. We hope that this change in language can spark more discussion about ways to disrupt a profit-driven health care system that desperately needs to be changed.

Are Your “Side Effects” Symptoms of Illness or Healthiness?

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Our current medical paradigm is incomplete and insufficient. Clinical studies treat symptoms* as ‘bad’, to be ‘treated’ or minimized. This failure is at the core of many of the systemic medical problems we face today. It is a reason we have ‘given up’ trying to cure many chronic illnesses. It is also a reason we don’t test conventional nor alternative medicines adequately.

Most medical studies completely ignore symptoms of health and healing. All medications list ‘side effects’ on the packaging.  Every medicine has a design effect. Other effects are listed as ‘side effects’.

Side effects can be symptoms of healing and healthiness.  They might be symptoms indicating further, or different, unhealthiness or illness. The packaging, and our current medical systems do not distinguish between these two – and other symptoms.  We will have a better, more effective, medical system when we learn this distinction.

When we have an illness, there are many symptoms to consider:

a) There are symptoms caused by the illness, or the damage it is doing. If you have a bacterial infection, the bacteria could be releasing toxins that cause pain or discomfort.  Discomfort from an illness is immensely varied, and can range from a minor feeling of unease, to unrelenting pain from a serious cancer.

b) There are symptoms that indicate your body is fighting the illness.  Inflammation, pain, swelling, vomiting, etc.

c) There are symptoms of healing, when your body is replacing cells that were damaged by the illness. These may include itching, swelling, even discomfort and pain. When your body is clearing out toxins from the illness there may be many more symptoms.  These symptoms might start – as soon as the illness is present. When your body detects an illness, it starts to feel the illness, to fight the illness, and to heal from the illness – all at once.

d) There are also symptoms that appear when you have recovered.  If you were sick for a while, your body might feel agitated, eager to get moving, stretching, etc.

It can be very difficult, for each illness, to determine which symptoms are symptoms of illness, which are symptoms of your body fighting the illness, which are healing and which are renewal. An interesting example is influenza.  Many researchers believe that most of the symptoms of the flu – are actually symptoms of your body fighting the virus.  Some people who are infected by the same virus have no symptoms, because their body does not react.  And they don’t know they are infected, they don’t feel ill. Others, who receive a vaccination – might have more severe symptoms than some who actually contracted the flu.

When you take medications for an illness – it gets even more complicated. There are many possible symptoms that might result from the medication.  Some aspects of medication might make you ‘healthier’, which will cause specific symptoms.  Many medicines are toxic – and have a wide variety of possible symptoms as a result.

Clinical testing of medications does not attempt to distinguish between ‘healthy’ effects and ‘unhealthy’ effects of a medicine. Side effects are listed, often without judgment or analysis of their cause or meaning.  The only effects studied are effects on the ‘illness’ being treated – effects on patient healthiness are ignored and not tested.

Most medicines are toxic, and as a result they have side effects. One of the most challenging problems faced by doctors and patients, when considering drugs is the frequency and dangers of ‘side effects’ of various alternatives.  Every drug lists many side effects on the packaging, and some can be very serious – even causing death, while others can be symptoms of healing and improved healthiness.

The vast majority of drugs sold today do not actually ‘cure’ disease, they are designed to ‘treat the illness’ and not expected to cure.  I demonstrated this in a recent blog post, where I simply read the descriptions of the top ten best selling drugs in 2011.  Not one was designed to cure the illness they were recommended for.  Even drugs that cure the illness, often cure by killing – antibiotics kill invading bacteria, but also kill many healthy cells at the same time, resulting in other illnesses, which are generally described as ‘side effects’.

Does this mean that we have cured all of the easy diseases – and now must settle for ‘treating’ diseases that can’t be cured?  Today’s chronic diseases – from arthritis to cancer, are not cured, they are ‘treated’ with drugs, each of which have different side effects.

We can learn to cure them, in many cases. The problem lies in our medical view of symptoms of illness and disease.  Our limited view distorts our objectives, our clinical studies and ultimately our treatment options. We need to expand our view of symptoms.

The medical systems views ‘symptoms’ according to the first definition by Merriam-Webster:

SYMPTOM a : subjective evidence of disease or physical disturbance; : something that indicates the presence of bodily disorder

All symptoms are viewed as ‘bad’ or indicating a problem. However, the word symptom is not judgmental or negative. Merriam-Webster lists the second meaning as:

SYMPTOM : something that indicates the existence of something else

Symptoms can indicate illness.  But they can also indicate healthiness.  Symptoms can indicate worsening of an illness. And they can also indicate healing or improvement of an illness.

Wikipedia, also defines symptoms as “a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality.”  Wikipedia lists many distinctions between different types of symptoms – but all symptoms are defined as ‘bad’

Thus, medical systems, and the clinical studies we use to measure medicines (and placebos), tend to treat all symptoms as bad, indicating illness. A clinical study might actually give the best result to a medicine that improves, or removes ‘good symptoms’ while it does nothing, or worse for ‘bad symptoms’.  This medicine would make the illness appear ‘better’, while actually making it ‘worse’.  The used car salesman of medicines. It’s not hard to find examples where this happens.

There are many ‘symptoms’ which, when observed from a health view – can be seen to be aspects of health, not illness – even though they might be commonly named as symptoms of illness.

Vomiting – is often called ‘getting sick’. Vomiting is a ‘symptom’ of illness. Or is it? If you drink too much alcohol or consume other toxins, your body will become toxic and you will – hopefully – vomit.  Vomiting is a healthy, healing act to remove the toxins from your stomach before more are absorbed, causing further damage.  If you are to unhealthy to vomit properly, eg. unconscious, you might die from swallowing your vomit, or from alcohol poisoning.  A ‘medicine’ that suppresses vomiting might make death by alcohol poisoning more likely, because although it makes you feel ‘not sick’, it actually makes you ‘less healthy’.

That’s one example, very specific. But there are many examples.  Many common symptoms, itching, pain, sweating, numbness, etc can by symptoms of illness – but they can also be symptoms of healthiness.

Osteoarthritis, for example.  Arthritis is a joint disorder characterized by inflammation. The inflammation might, depending on the type of arthritis, be a cause of the arthritis – or it might be a reaction to some unhealthiness in the joint.

The joint is inflamed. The inflammation can be a healing reaction to damage, with symptoms of stiffness, swelling, redness and pain.  Swelling and redness are healthy reactions – pain is a reaction to the damage.  The area might also be itchy – an indication of healing.

We can see that it is very difficult to determine which symptoms are ‘healthy’, which are ‘illness’ and which are ‘unhealthy’. Inflammation might be protecting the joint from further damage – or it might be causing further damage.

Medicines for arthritis treat all symptoms as bad. No effort is made to determine whether the symptoms, in a specific case, are symptoms of healing.  No effort is made to ‘enhance healing’ in the hope that the arthritis is ‘cured’.  As a result, there are no medications to ‘cure’ arthritis – only medications that ‘lessen symptoms of arthritis’. It is assumed that all arthritis symptoms are bad’.  No one is attempting to ‘cure’ arthritis. Visit your local arthritis society to learn that have lots of information about ‘Living With Arthritis’, but nothing about healing or curing arthritis.

Until we learn that symptoms of arthritis can also be ‘healthy’, we will never learn to ‘cure’ arthritis.

We need to improve our ‘clinical studies’ methodology.  If we want to heal and cure chronic diseases, we must learn to monitor and improve symptoms of healthiness, and decrease symptoms of unhealthiness.

When we develop clinical techniques to monitor healthiness and unhealthiness – and the effects of medications on healthiness as well as their effects on unhealthiness, we will begin to move past our current medical paradigm – and will learn to resolve problems that cannot be solved by our incomplete paradigm.

When we learn to study medication effects on healthiness, as well as their effects on illness, green medicines, alternative medicines, open source medicines will clearly be seen as more effective in many cases.  We will learn that healthy medicines are ‘natural’ and less likely to be ‘patent medicines’.

Kava: A Natural Alternative To Anxiety Medication?

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Kava (Piper Methysticum), also known as awa, ava and yaqona, is a crop native to the South Pacific and is a member of the pepper family. The plant sports relatively large, heart-shaped leaves, which accompany slender flower blossoms that reside at the intersections where the branch and stems meet. However, the kava plant has earned its status due to what resides within its hairy, woody roots.

Photo by Simpler Days.

Kava has been used in traditional, tribal settings on the islands of Fiji, Micronesia and Polynesia for hundreds of years. These cultures use the psychoactive beverage as a social and ceremonial offering in a way that’s often compared to how wine is used and consumed in European countries. Traditionally, after being harvested, the root is then pulverized, ground (often by mouth) and shredded. The herbal preparation is then repetitively strained into a bowl using a cold water extraction method, before being served in, and drunk out of, a half coconut shell. This preparation is enjoyed reverently due to its calming and sedating qualities. Because of these effects, growing evidence is starting to support claims that kava is useful for those suffering from insomnia, high stress, depression and anxiety. Interestingly, kava is proving to be as effective as dissolving anxiety as pharmaceutical drugs that are often prescribed for this condition.

The array of active ingredients responsible for the psychoactive effects of kava are known to science as kavaclones. These chemicals include compounds such as dihydrokavain, methysticum and kawaii, all of which have been thoroughly studied in laboratory settings. As a result, there’s empirical evidence that these compounds promote sleep, decrease convulsions and relax muscles in animals. The chemicals described have also shown to be effective painkillers, which is associated with the temporary numbness of the tongue that kava beverages induce when drunk. A double-blind, randomized, placebo controlled study conducted by The University of Melbourne in Australia found kava to be significantly more effective than a placebo at reducing anxiety in a group of 75 participants, all of whom were diagnosed with GAD (General Anxiety Disorder).

Lead researcher, Dr. Jerome Sarris, believes GAD to be a complex and potentially debilitating disorder that can significantly effect the daily lives of those affected, with existing medications only showing modest clinical results. Sarris was quoted by News Room in reference to the study, stating: “We have recognized that plant based medicines may be a viable treatment for patients with chronic anxiety. In this study we’ve been able to show that kava offers a potential natural alternative for the treatment of chronic clinical anxiety. Unlike some other options it has less risk of dependency and less potential side effects.”

Another study carried out at The School of Veterinary Medicine in Berlin, Germany found kava to have very similar anti-anxiety effects to the drug diazepam (Valium) when it was administered to animals. The authors of the study claim that the data supports the use of kava in treating anxiety disorders. Additionally, researchers at the University of Hertfordshire in the United Kingdom and the University of Zurich in Switzerland set out to explore how kava can affect mood and emotions, measuring the three areas of seriousness, cheeriness and bad mood. After a single dose of kava, an increase in cheerfulness was observed in the volunteers and they even performed better when given certain cognitive tasks. This led the researchers to draw a comparison between kava and conventional prescription drugs used to treat anxiety. Conventional drugs often cause unwanted mental side effects and cognitive impairment, whereas kava has been found to actually promote brain function while providing strong anti-anxiety effects and positive feelings such as exhilaration.

There’s much anecdotal evidence related to kava on the internet, many of which can be found in Erowid’s user experience vaults. One user has detailed kava’s ability to cease their anxiety and depression. Another contributor to Erowid gave details of theirexperience claiming: “The quieting of my conscious mind and the total clarity of thought I was experiencing was nothing short of wonderful.”

Kava has seen a recent surge in popularity in the Western world in the areas of medicine and recreational activity. It can be obtained in many different forms from the dried roots, condensed capsules and more potent tinctures. However, users looking for more of a social and recreational setting may want to pay a visit to the growing number of kava bars erupting across the U.S. — from California, to Florida, to Hawaii and elsewhere. In such establishments, both experienced and novice kava drinkers can enjoy the anxiety-easing yet clarity promoting substance legally in the company of friends, sipping from a half coconut shell surrounded by tiki statues, palm leaves, gentle laughter and easy smiles.

Much like practically every medicinal and recreational substance, kava does not come without its fair share of controversy. There are some safety concerns that link kava usage to possible liver damage, which has led to some governments, such as Poland‘s, to ban and control it. However, Dr. Sarris, a professional who has studied kava in-depth points out: “When extracted in the appropriate way, kava may pose less or no potential liver problems. I hope the results will encourage governments to reconsider the ban.”

Also, many Erowid users speak of using kava extensively for many years without any detrimental side effects, such as this user who has been a frequent drinker for three consecutive years. The author takes a liver test every three months and has reported perfectly safe medical results.

Ultimately, kava is another example of an effective plant medicine that could potentially offer individuals a natural and safer alternative to often dangerous and addictive conventional treatments.

Skin Cancer Drug Opdivo Wins FDA Approval

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Seventh new melanoma drug OK’d since 2011..

Patients with unresectable or metastatic melanoma not responding to current drug therapies now have another option, with the FDA’s approval Monday of nivolumab (Opdivo).

The drug, which blocks the so-called programmed death-1 (PD-1) pathway, is the seventh new agent to be approved for treating melanoma in the past 4 years, the FDA said in announcing the decision.

Approval was based on trial data from 120 patients evaluated for efficacy and 370 for safety.

In the efficacy studies, 32% of participants receiving nivolumab achieved objective responses (at least 50% shrinkage in tumor volume). The benefit lasted for more than 6 months in approximately one-third of the participants who experienced tumor shrinkage, the FDA said.

Safety analyses indicated that the most common side effects of the drug were rash, itching, cough, upper respiratory tract infections, and edema. The most serious side effects were severe immune-mediated side effects involving healthy organs, including the lung, colon, liver, kidneys, and endocrine glands, according to the agency.

Nivolumab, to be sold by Bristol-Myers Squibb, was cleared under the FDA’s accelerated approval program. Normally such approvals come with requirements for follow-up studies to confirm the clinical benefit, but the agency’s announcement did not specify what they would be.

Poisonous mushrooms could be key to drugs without side effects

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mushrooms
Some species of mushroom are perfectly safe to eat, but others that look very similar can land you in the hospital or worse. In studying how these fungi manage to be so poisonous, a team of Michigan State University researchers may have found a way to create a new generation of pharmaceuticals with highly targeted effects. Imagine chemotherapy drugs with no side effects, or antibacterial agents that can clear out severe infections without damaging other tissues. That’s what poisonous mushrooms could do for medicine. Specifically, it’s an enzyme used by these fungi to manufacture poisons.

This research used mushrooms of the genus Amanita, which includes the notorious death cap mushroom. These fungi produce quite a lot of proteins, but a few are incredibly toxic if ingested. Not only that, but these are hearty little proteins. They can survive cooking and exposure to stomach acid just fine, then pass into the bloodstream. It isn’t until they reach the liver that their deadly effects are felt. The hepatotoxic effects of α-amanitin proteins can cause permanent liver damage, as well as death without treatment. You definitely don’t want to get α-amanitin anywhere near your mouth, but it’s the way this protein survives all the way to your liver that has scientists interested.

Toxic compounds like α-amanitin are what are known as cyclic peptides. Like all proteins, they are composed of chains of amino acids, which are assembled in cells. However, a cyclic peptides are linked together by a strong covalent bond in a ring orientation rather than being folded up and held together by weaker interactions. This makes a cyclic peptide extremely durable, ensuring it can survive the journey through your digestive track and end up wherever it needs to go.

Alpha-Amanitin

The MSU team was able to pull apart the Amanita toxin and study the way they are produced. This led to the discovery of a second enzyme used in the mushroom’s cells called POPB. This is what takes the freshly produced linear chain of peptides and converts it into a nearly indestructible ring that delivers a deadly payload to your liver. Of course, that’s not the goal of the medical research. Pharmaceutical researchers want to use POPB to create new drugs that can carry therapeutic compounds through the body instead of deadly toxins. You have to admit, that sounds better.

POPB itself isn’t a drug that will cure anything. It’s like you had a missile carrying a nuclear warhead, but you were able to pry out the nuke. Now you’re left with a missile that could be used to deliver something other than unstoppable atomic fire. The problem is figuring out how to formulate the payload to do the most good. The team has already designed several hundred compounds that could be transformed into cyclic peptides, but that’s only the start. There could be billions of potential variants, and most of them won’t be of any clinical significance. One of them might be the magic bullet, though.

 

 

The ‘Real’ Side-Effect Cost of Statins: Sorting Fact from Fiction.

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For patients treated with statins, only a very small minority of side effects reported can be directly attributed to the drugs, according to the results of a new study[1]. In primary prevention, the risk of developing diabetes with statins is real, but just one in five cases of new-onset diabetes suspected to be caused by statins  is likely caused by the drugs, while the risk of developing diabetes in secondary prevention is offset by the reduction in cardiovascular deaths, report investigators.

Speaking with heartwire , the researchers, including lead and senior authors Dr Judith Finegold and Dr Darrel Francis (National Heart and Lung Institute, London, UK), said that in clinical practice, patients frequently report side effects such as muscle aches, fatigue, and gastrointestinal distress when started with statin therapy, and this poses a problem for doctors looking to keep patients on the drugs.

However, Francis said the rationale for the analysis stems from the problem that physicians have in communicating the true risk of side effects to their patients. The package insert for statins lists a multitude of possible side effects, a list that contains nearly every side effect reported in clinical trials, including those reported in the placebo arms, but physicians have no way to determine whether those side effects are caused by the medication, would have happened anyway, or are derived from the nocebo effect, a term given to side effects experienced by patients if they anticipate a medication might be harmful.

“It was frustrating to have no reliable information to give to patients quite rightly asking about side effects from statins,” said Francis. “If the patient has a side effect, how can I tell them that it’s probably not from the tablet? I know from reading the trials, but how is the patient supposed to know? All the patient has is the strip of paper that comes with the tablets and lists every imaginable side effect. Having read that, why would anyone in their right mind take the tablet for an asymptomatic condition? How is the patient supposed to know which of those are significantly increased by the drugs, decreased by drugs, or left unchanged?”

The study is published online March 13, 2014 in the European Journal of Preventive Cardiology.

Side Effects Equally Common in Placebo Arm

To address the proportion of symptomatic side effects in statin-treated patients caused by the medication, the researchers analyzed randomized, controlled clinical trials that compared statin therapy with placebo for primary and secondary cardiovascular disease prevention. In total, 14 primary-prevention studies with 46 262 participants and 15 secondary-prevention studies with 37 618 participants were included in the analysis. To calculate the risk for symptomatic side effects, the absolute increase in risk observed in the placebo arm was subtracted from the risk observed in the statin arm.

In primary prevention, statin therapy increased the absolute risk of diabetes by 0.5% and decreased the risk of mortality by 0.5%. In secondary prevention, treatment with statin therapy decreased the risk of death by 1.4%. In both primary and secondary prevention, statin therapy was associated with an asymptomatic, 0.4% absolute increase in liver enzymes.

“We found that the majority of side effects in primary- and secondary-prevention patients were as common in the placebo arm as in the statin arm, with the exception of asymptomatic liver enzyme elevations and an increase in diabetes in the primary-prevention population,” Finegold told heartwire .

In calculating the proportion of symptoms that were not attributable to the statin, the researchers estimated 80% of the new diagnoses for diabetes were not attributed to the medication. As Finegold pointed out, even though one in five cases of new-onset diabetes is attributed to the drug, there has been no clinical trial to date where the use of statins in diabetic patients caused harm. In fact, statins in this patient population have always been shown to save lives. For Francis, he points out that the absolute increase in new-onset diabetes in primary prevention was 0.5%, the same as the absolute reduction in the number of deaths.

“To express this in a simplistic but memorable way, for every primary-prevention patient in whom we cause diabetes, we save one life, prevent two heart attacks, and half a stroke,” said Francis. “To me, that is a good deal. But a patient may feel otherwise, and we must respect their preference and just focus on making sure we have given them correct information.”

To heartwire , Finegold and Francis said they would like to see the side-effect profile of drugs, including statins, written in a way patients can understand. If the package insert listed commonly reported side effects, as well as the likelihood that such events were caused by the drugs, patients might be more likely to choose to persist with medication rather than give up.

“If you’re a patient and you feel any new symptom, the first thing you do is open the drug box and look at the side effects,” said Finegold. “And that, to be honest, seems to list every symptom that has ever been reported in the statin and placebo arms of the clinical trials. There is very little reliable side-effect information given to patients. If you read that leaflet you would assume it was due to the medication.” For physicians, they face the same problem, with little information to rely on in terms of determining real vs fictitious side effects reported in the clinical trials.

“We think it’s very important that just as we calculate benefit using scientific randomized controlled trials, we should be equally careful to make only true statements about side effects. Ultimately, patients should decide using genuine information,” said Finegold.