Category Archives: Uncategorized

How To Stop Chronic Daily Narcotic Use

Not your typical street-level drug pusher, but a great source of oxycodone

The mainstream news outlets in the U.S. tell us we are in the midst of a narcotic use epidemic. People are dropping like flies from overdose.

Narcotics are also called opioids. I’m talking about oxycodone, hydrocodone, hydromorphone (Dilaudid), morphine, fentanyl, heroin, etc. Not Xanax, Ativan, or Valium.

On average, it takes three weeks of daily narcotic use to get physically dependent on it. This means that when you stop the drug completely and suddenly, your body may crave it and you could have withdrawal symptoms. The severity of withdrawal symptoms varies from person to person. Possible symptoms include anxiety, sweating, nausea, vomiting, diarrhea, hyperactivity, restless legs, weakness, easy fatigue, shaking, suicidal thoughts, insomnia, and muscle pain or cramps.

Good and bad news, bad news first: Narcotic withdrawal can be very uncomfortable but rarely causes medically serious complications. The serious complications are usually in folks with pre-existing heart disease, high blood pressure, low blood pressure, or heart rhythm disturbances.

Here’s how you stop your chronic daily narcotic habit without suffering a withdrawal syndrome (if needed, see the postscript for an example):

  1. Total up your current total daily dose in milligrams
  2. Determine 10% of the amount by dividing the milligrams by 10
  3. Reduce your daily milligram intake by that 10% every week
  4. Nine weeks later you’ll be off narcotics

Congratulations! You’ve done your part to solve America’s opioid use epidemic. You’ve reduced your drug bill, avoided Opiate Use Disorder, and reduced your risk of narcotic overdose death by 100%. And you did it without political meddling or an expensive stay at a detox center.

Be aware that as you taper off your narcotic, you may have a flare of an underlying psychiatric condition such as depression, anxiety, PTSD, bipolar disorder, panic attacks, or psychosis. If so, see a mental health professional posthaste.

Good luck, America!

Steve Parker, M.D.

PS: Take Percocet 10/325 for example. It’s 10 mg of oxycodone and 325 mg of acetaminophen. Say you’re taking Percocet 10/325, four pills at at time, four times a day. That’s a total daily oxydocodone dose of 160 mg (16 pills x 10 mg). 160 mg divided by 10 = 16 mg. We have to round off 16 mg to 15 mg due to the availability of various strengths of Percocet. So starting today, you reduce your daily oxycontin dose by 15 g, which is one-and-a-half pills. After one week, you reduce your daily pill count by another one-and-a-half pills. Etc.

PPS: Let you’re doctor know what you’re doing beforehand. He’ll be overjoyed and ensure it’s safe for you to do this taper.

Guess What Kind of Diet Can Treat Depression?

 

Olive oil is a prominent source of fat in the Mediterranean diet

From Dr. Emily Deans at Psychology Today:

“This year, finally, we have the SMILES trial, the very first dietary trial to look specifically at a dietary treatment in a depressed population in a mental health setting. Participants met criteria for depression and many were already being treated with standard therapy, meds, or both. The designers of this trial took the preponderance of observational and controlled data we already have for general and mental health and decided to train people using dietary advice, nutritional counseling, and motivational interviewing directed at eating a “modified Mediterranean diet” that combined the Australian Dietary Guidelines and the Dietary Guidelines for Adults in Greece. They recommended eating whole grains, vegetables, fruit, legumes, unsweetened dairy, raw nuts, fish, chicken, eggs, red meat (up to three servings per week), and olive oil. Everyone in the study met criteria for a depressive disorder.

The experimental arm of subjects were instructed to reduce the intake of sweets, refined cereals, fried food, fast food, processed meat, sugary drinks, and any alcohol beyond 1-2 glasses of wine with meals. There were seven hour long nutritional counseling sessions and a sample “food hamper” with some food and recipes. The control group had the same number of sessions in “social support,” which is a type of supportive therapy that is meant to mimic the time and interpersonal engagement of the experimental group without utilizing psychotherapeutic techniques.

*  *  *

Despite the small size, the results were still statistically significant and better than anticipated. The dietary group had bigger reductions in depression scores at the end of 12 weeks. Remission of depression symptoms occurred in 32.3 percent of the diet group as opposed to 8 percent of the control group.”

Source: A Dietary Treatment for Depression | Psychology Today

The Mediterranean diet: Is there anything it can’t do?

Men, Are You Androgen Deficient?

Steve Parker MD, Advanced Mediterranean Diet, Ketogenic Mediterranean Diet

Testosterone is one reason men are better than women at push-ups

I’m running across more middle-aged and older men who are taking testosterone supplements. I don’t know if it’s a national trend or simply a Scottsdale, AZ, phenomenon.

The Endocrine Society in 2010 published guidelines regarding testosterone therapy for men who are androgen-deficient. Here are their recommendations on who should be tested for deficiency, and how:

1.1 Diagnosis and evaluation of patients with suspected androgen deficiency

We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels.

We suggest that clinicians measure serum testosterone level in patients with clinical manifestations shown in Table 1A. We suggest that clinicians also consider measuring serum testosterone level when patients report the less specific symptoms and signs listed in Table 1B.

TABLE 1.
Symptoms and signs suggestive of androgen deficiency in men
A. More specific symptoms and signs
Incomplete or delayed sexual development, eunuchoidism
Reduced sexual desire (libido) and activity
Decreased spontaneous erections
Breast discomfort, gynecomastia
Loss of body (axillary and pubic) hair, reduced shaving
Very small (especially <5 ml) or shrinking testes
Inability to father children, low or zero sperm count
Height loss, low trauma fracture, low bone mineral density
Hot flushes, sweats
B. Other less specific symptoms and signs
Decreased energy, motivation, initiative, and self-confidence
Feeling sad or blue, depressed mood, dysthymia
Poor concentration and memory
Sleep disturbance, increased sleepiness
Mild anemia (normochromic, normocytic, in the female range)
Reduced muscle bulk and strength
Increased body fat, body mass index
Diminished physical or work performance
We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test.

We recommend confirmation of the diagnosis by repeating measurement of total testosterone.

We suggest measurement of free or bioavailable testosterone level, using an accurate and reliable assay, in some men in whom total testosterone concentrations are near the lower limit of the normal range and in whom alterations of SHBG are suspected.

We suggest that an evaluation of androgen deficiency should not be made during an acute or subacute illness.

Harriet Hall thinks testosterone is being over-prescribed.

Less Writing, More Speech…

I need to reach more people. Last fall I tripled my blogging frequency and it did nothing to increase viewership. I plan to cut back on written blogging and Tweeting, but will be doing more videos. It’s an experiment.

I’ll try to keep all videos under six minutes out of respect for your time.

This video mentions the topics I’ll be covering. If they sound interesting, please subscribe to the pxHealth YouTube Channel.

From Health Correlator: Blood glucose variations in normal individuals are a chaotic mess

“Many people measure their glucose levels throughout the day with portable glucometers, and quite a few are likely to self-diagnose as pre-diabetics when they see something that they think is a “red flag”. Examples are a blood glucose level peaking at 165 mg/dl, or remaining above 120 mg/dl after 2 hours passed since a meal. Another example is a level of 110 mg/dl when they wake up very early to go to work, after several hours of fasting.

As you can see from the picture above, these “red flag” events do occur in young normoglycemic individuals.If seeing “red flags” helps people remove refined carbohydrates and sugars from their diet, then fine.

But it may also cause them unnecessary chronic stress, and stress can kill.”

Source: Health Correlator: Blood glucose variations in normal individuals: A chaotic mess

Sheila Kealey on Turmeric: Healthy or Hype? 

“Although many studies have investigated turmeric/curcumin, and some have shown promise, at this point these findings aren’t good enough evidence to suggest that consuming turmeric improves any health condition.  It’s important to consider the preliminary nature of the research and recent review questioning of curcumin’s biological activity. Turmeric is certainly not a cure-all panacea as some have touted.  More research may help uncover specific benefits to curcumin or other compounds in turmeric.”

Source: Healthy or Hype? Turmeric – Sheila Kealey

How a single high-fat “meal” (palm oil) affects liver metabolism 

I thought we were through demonizing saturated fats.

I put my headline’s “meal” in quotes because the only item in the meal was palm oil. That doesn’t look like one of my meals.

From MNT:

“Individuals who consume higher levels of saturated fats are more likely to feel the effects of a range of health conditions, including non-alcoholic fatty liver disease. Although this link is well-known, exactly how and why it develops is not yet clear.

Recent research investigates the effects of a single high-fat meal on the liver.Non-alcoholic fatty liver disease (NAFLD), as the name suggests, is a condition in which excess fat is stored in the liver of an individual who drinks little or no alcohol.

Marked by liver inflammation, NAFLD most commonly affects people in their 40s and 50s, and especially those who are obese. It can cause scarring of the liver and permanent damage. At its worst, it can lead to liver failure.NAFLD is primarily characterized by an increased buildup of fat in the liver, and this buildup is often accompanied by insulin resistance, thereby increasing the risk of type 2 diabetes and cardiovascular disease.”

Source: How a single high-fat meal affects liver metabolism – Medical News Today

German researchers fed a single palm oil meal to 14 healthy men, and some mice.

The article writer doesn’t make it clear whether results apply to the men, the mice, or all combined. Anyway, they found

  • Elevated blood triglycerides
  • Increased glucagon (a pancreas hormone that raises blood sugar)
  • Whole body insulin sensitivity decreased 25 percent
  • Hepatic insulin sensitivity decreased 15 percent
  • Adipose (fat) tissue insulin sensitivity decreased 34 percent
  • Triglycerides in the liver – the main constituent of body fat in humans  – also rose by 35 percent

All of these changes would tend to promote not only NAFLD but also type 2 diabetes.

Whether these adverse changes would be see with other saturated fats or polyunsaturated fats is left unstated in the report.

From UpToDate.com: “The pathogenesis of nonalcoholic fatty liver disease has not been fully elucidated. The most widely supported theory implicates insulin resistance as the key mechanism leading to hepatic steatosis, and perhaps also to steatohepatitis. Others have proposed that a “second hit,” or additional oxidative injury, is required to manifest the necroinflammatory component of steatohepatitis. Hepatic iron, leptin, antioxidant deficiencies, and intestinal bacteria have all been suggested as potential oxidative stressors.”

I’ve been hearing for years that NAFLD is going to be a big deal. At least every other shift I work in the hospital, I see someone with evidence for fatty liver on ultrasound or CT scan.

The mainstay of therapy for NAFLD is weight loss for those who are obese or overweight. It’s probably a good idea to avoid all alcohol consumption, too.

If you need to lose weight, check out my books.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one