The Simplest Solution for Migraines

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Let’s continue with the theme of the simplest solution often being the correct one. Migraines are a devastating form of headache. While most causes are unknown, people have identified triggers from chocolate to sounds to odors and more. My pretend daughter Jamie suffers from them on a regular basis.

As I researched how to deal with migraine headaches years ago, I found a pilot study that examined whether subjects could reduce the frequency and intensity of migraines by drinking more fluids. The researchers asked the subjects to drink 1.5 liters of water per day for 12 weeks. The subjects managed to increase their average intake to only one liter per day, but total hours with migraines and the intensity of those migraines decreased.

Will it work for everyone? Most likely not, but because there’s no harm in simply drinking more water every day, it will help those who were unaware that they were dehydrated; that’s not the first cause we think of when we think of migraines. It’s worth spending a month drinking more water to see if it has the same results for you or someone you know. For more potential solutions for migraines, see The Bottom Line on Migraines at the DrChet.com Store.

One more simple solution on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: Eur J Neurol. 2005 Sep;12(9):715-8.

 

The Simplest Solution for Fatigue

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One of the basic tenets of health and disease that I’ve learned is this: often the simplest solution is the correct one. Think of it this way. Whether we want to be the healthiest we can be or we have something that afflicts us, we think in terms of elaborate solutions. Instead, think of building a foundation to prevent or cure what ails us.

Let’s begin with something that can affect us all at times and that’s fatigue. The possibilities include an underactive thyroid, an adrenal issue, or pre-diabetes. But before we look at the complex, start with the obvious: drink more fluids. It may be a simple case of chronic dehydration. The lack of fluid can change the ionic balance inside cells, which can inhibit the production of energy by just about every cell including the brain and the muscles. Those two organ systems are most associated with fatigue.

Symptoms of dehydration vary. If an elderly parent seems unusually confused or a small child is drowsy and irritable when he or she is usually going full blast, try fluids first.

Before you try the elaborate solution, begin with the simplest. Drink more fluids, whether coffee, tea, plain water, or even eating more vegetables instead of refined carbohydrates. The simplest solution for fatigue may just be a glass away.

What are you prepared to do today?

Dr. Chet

 

More Reasons to Use Probiotics

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One of the most frequently asked questions I get is this: “Should I take probiotics when I take antibiotics? I don’t want to negate the benefits of the antibiotics.” Based on the summary of the Cochrane Review, I think there’s enough evidence to say that you should take probiotics any time you have to be on antibiotics. The research evidence is not perfect and the authors called for more and better research to confirm the results, but there appears to be no harm when taking probiotics during antibiotic use. If it doesn’t harm, then it’s a good idea to do it, even if the rate of C. diff is relatively low to begin with. But it’s a good idea to clear it with your doctor because reasons for taking antibiotics can be different.

There are a couple of things that we don’t know. What is the best type of probiotics to take? And how much should we take? In spite of those unknowns, when examining the data summary of all the studies, there was an overall benefit when probiotics were used. That means whether it was just one strain or several, in differing quantities, they all seemed to work. Whatever probiotic you typically use, take it during antibiotic use until we know more.

Another Review Paper

I’m currently going through a review paper on the brain-microbiome connection (3), and it’s one of the best reviews I’ve read in a long time. I’m still checking the background research; it’s complicated physiology and biochemistry. I can’t get it into the typical three Memos per week so it will be a new Bottom Line in the near future.

What I’ve taken away so far is that we should all be taking probiotics every day, unless there’s a reason you can’t. If you buy a quality product, they’re not inexpensive, but it’s still a good decision based on the potential benefits. In addition, it would be a good idea to add fermented foods to your diet every day: yogurt, especially Greek yogurt, kefir, sauerkraut, kim chi, and more. They all contain a variety of probiotics that can add to your microbiome.

You should also take a fiber supplement every day. Fiber supplements contain prebiotics that feed the probiotics—you’re feeding the good bacteria. In addition, eat foods with more fiber, and that means vegetables and fruits. Again, they can provide positive bacteria to help the microbiome if you eat them raw as well as the food the bacteria needs to thrive.

The Bottom Line

There is a long way to go until we have enough research that identifies the best strains and amounts of probiotics to take as well as the best sources. There’s always the possibility we’ll find a better way, such as eating specific varieties of fruit grown in a specific region of the world that has the right strains of bacteria. We just don’t know. But what we do know is that there are benefits to taking probiotics every day right now. I think that’s the path forward at this point for almost everyone.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.
3. Cell Mol Gastroenterol Hepatol 2018;6:133–148.

 

Probiotics Can Cut C. Diff Rates

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The authors reported that there were 39 studies included in the Cochrane review; 33 on adults and six on children. They included studies that were in-patient, out-patient, and using varying strains and quantities of probiotics. Here’s what they found.

There was moderate evidence that the use of probiotics together with the administration of antibiotics did reduce the occurrence of C. diff. The risk of getting the C. diff infection was reduced by 60% when compared to control subjects or those who were not treated; typically about 4% of the subjects got C. diff when treated by antibiotics, and it was reduced to 1.5% when probiotics were given concurrently. The phrase “moderate evidence” is one I haven’t used before. It’s generally specific to Cochrane Reviews and is assessed using various factors, ending with a number that reflects the quality of studies included in the analysis.

There was also a reduction in abdominal cramping and diarrhea in those subjects who were given probiotics with their antibiotics compared to those who didn’t get probiotics. In this case, the quality of the research was considered of poor quality. Does that mean that the probiotics were ineffective? No. More than likely it was due to the subjective assessments of pain by individuals. You can test stool to see if C. diff is present, as would have been done in the other part of the research, but relying on people’s self-assessment of pain is less objective. (That’s why my website offers the pain scale developed by the Missoula Project; it has physical activity descriptors that make it easier to determine where you are on the scale. Look for it on the Health Info page.)

Where does that leave us? I’ll finish on Saturday with some recommendations for the use of probiotics.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Can Probiotics Prevent C. Diff?

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Probiotic research is hot right now. Researchers are trying to figure out what these beneficial microbes can do for our health for a number of reasons. What types of infectious diseases can be prevented, whether food-borne or not? What are the best microbes to treat specific conditions? After all, there are estimated to be around 5,400 different bacteria, yeasts, and fungi. Which ones are best for an E. coli infection? Or salmonella? How about inflammatory bowel disease? Can probiotics benefit other organs in the body by not allowing negative bacteria to enter the blood stream? The questions are almost endless at this point.

We may be starting to get some answers. This week I’m going to focus on the role probiotics may play in preventing clostridium difficile, commonly known as C. diff, infections in people who’ve had to take antibiotics for different diseases. Antibiotics are beneficial when we need them but they do not discriminate; they kill microbes whether they’re beneficial or not. As a result, our gut bacteria—our microbiome—can be decimated. As a result, people who are on heavy doses of antibiotics are prone to C. diff infections. While treatable in most cases, it can have devastating effects on some people including severe pain, cramping, and uncontrolled diarrhea. Not fun!

The authors of a recent paper examined whether probiotics, administered with courses of antibiotics, helped to reduce the rate of C. diff in patients. A Cochrane Review paper examines all available studies from around the world, ranks the quality of the research, and analyzes all the data. Some of the authors of that paper published a summary of that review in JAMA. We’ll take a look at the results on Thursday.

DrChet.com

Tomorrow is the anniversary of the launching of the new DrChet.com website. This past weekend I was speaking in Texas, and several people who are Insider members said that the free monthly Insider Conference Calls were very informative and helped their personal health and the health of their family and clients. Think about becoming an Insider as we begin our second year of memberships.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Digital Media and Relationships

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In observing the people at Paula’s high school reunion, the one thing that stood out was that the relationships the classmates had formed during their time together had endured. True, they had a small graduating class with fewer than 75 students, but even in bigger schools with hundreds of graduates, there are groups of students who still know each other well because of activities they participated in together.

What impact would digital media have had back then? Paula was asked to speak as a representative of her class and in looking back, she said this:

We didn’t have an amazing computer in our pockets that we use for vital things such as taking pictures of our food and watching cat videos and texting each other: “What do you want for dinner?” “I don’t know, what do you want?” But we had down time, free time to spend just being a teenager. No one stared at the phone—that would have been silly. We looked at the scenery and at each other.

How would social media have affected the class of 1967? They were a social network. They were involved in each other’s lives during school, sports, and other activities, live and in person. I’m sure it would have had an impact; I just don’t know if it would have been in a positive way. There would most likely have been less live social contact and instead a lack of human contact. There would have been less time to talk face to face because there would be so much more access to more people, even in a very impersonal way.

The irony of digital media today is that social media is how many members of the class reunion found each other; it certainly helped spread the word of the reunion itself. They had gotten reacquainted before they got together in person and had seen pictures of each other’s spouses and kids and grandkids on Facebook and Instagram. Digital media are just tools of communication, and that’s how the reunion class uses them.

Digital Media and the Class of 2018

Don’t for a minute think I’m a Luddite. After all, I’m communicating with you three times a week via email and many of you read this on your cell phones.

Whether the use of digital media contributes to ADHD is not certain, but it does contribute to one thing for sure: isolation. A 2016 article in Psychology Today said:

Humans are hardwired to interact with others, especially during times of stress. When we go through a trying ordeal alone, a lack of emotional support and friendship can increase our anxiety and hinder our coping ability … Other studies confirm that loneliness isn’t good for anyone’s health. It increases levels of stress hormones in the body while leading to poor sleep, a compromised immune system and, in the elderly, cognitive decline.

Texting and commenting on social media platforms cannot convey true emotion, no matter how many emojis you use. The only way that works is live social interaction where you can look someone in the eye when you talk to them or at the very least hear their tone when speaking on the phone.

When you think about health and what can impact it, the bonds we make with other humans is important. It can help our mental health in many ways and that can impact our physical health. To me, that’s what the class of 2018 might be missing: the social interaction and personal bonds that transcend decades. When they meet in 50 years, will they talk about the great text or Tweet someone sent or the excellent Instagram story someone put together? I doubt it. And that’s their loss.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. 2018;320(3):255-263. doi:10.1001/jama.2018.8931.
2. https://www.psychologytoday.com/us/blog/out-the-ooze/201611/the-perils-social-isolation

 

Is There a Link Between Digital Media and ADHD?

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Today it’s difficult to find teenagers who don’t have their eyes glued to a cell phone. They’re texting, checking social media, playing games, or doing just about anything other than talking to other teens—even if they’re sitting across the table from one another. Researchers from California universities wanted to find out if the digital media today has a measurable impact on the behavior of high school students. Here’s what they did.

The researchers recruited over 3,000 students in 10th grade to participate in a two-year study of digital media use and symptoms of attention deficit hyperactivity disorder. The teens reported their use of all forms of digital media including phones, computers, and gaming devices. They were tested every six months for symptoms related to ADHD using standardized tests.

Researchers found that as the use of digital media increased, so did the symptoms of ADHD. The type of activity didn’t matter: texting, checking social media, playing games, listening to music. The more time they spent on digital activities, the more ADHD symptoms. That doesn’t mean they had ADHD; they exhibited symptoms.

Before you take away your teen’s media devices, let me add that this was not a perfect study; studies that rely on surveys and questionnaires have their issues. Still, it does indicate that as reliance on digital devices increases, attention to the world may decrease, and that’s no surprise. How is this related to Paula’s high school reunion? I’ll wrap it up on Saturday.

What are you prepared to do today?

Dr. Chet

 

References: JAMA. 2018;320(3):255-263. doi:10.1001/jama.2018.8931.

 

50 Years of Friendship

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Paula and I attended her high school class reunion this past weekend. It was great to see people reminisce and catch up; some of them hadn’t seen each other for 40 or 50 years or more. Some still live in the same community, some left but came back to live near where they grew up, and some, like Paula, have bounced all over the U.S. There were marriages, births, divorces, and deaths as you might expect and an incredible diversity of careers. But there were also enduring connections between human beings from different backgrounds who were thrown together in school. This was an example of a true social network, and it has endured for over 50 years.

I also noticed that just about everyone had a cell phone. I watched a group of men standing around talking and one began to show pictures. It could have been of grandchildren or even great-grandchildren. One comment I heard was “If we’re looking at pictures, I’m getting my phone, too.” The technology of today hasn’t escaped this Baby Boomer generation.

It made me wonder how things would have been different if they had today’s technology back then. A recently published study on the use of digital media by teenagers could give us some insight. We’ll take a look on Thursday.

What are you prepared to do today?

Dr. Chet

 

Getting What You Need from Your Office Visit

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Here’s what we know. Patients get frustrated with office visits because they don’t always feel that they’re being heard. Research confirms that even when the physician asks “What brings you in today?” patients are usually interrupted before they can finish their reason. Where does that leave us?

Let’s take a look from the physician’s perspective. They have a limited amount of time to determine what the problem is, and they’re faced with patients who may take a long time to explain their problem. They may interrupt to ask a question about a symptom. While the physician may ask it with good intentions and think it will save time, it may redirect the patient to somewhere other than their main issue.

Don’t forget that physicians are trained to be problem-solvers. That’s different from being trained to take a healthy person and help them to attain optimal health. They’re trained that when people come to their office, something’s wrong and they need to fix it. Nothing wrong with that approach, but it’s also possible they miss issues during that process.

What can you do? Here are three steps to getting what you need from your office visit:

  1. Be organized before you go to the office. You’re going to be asked what medications you’re taking and any dietary supplements you’re taking. Write them all down, names and dosages, preferably in a printable document separating prescriptions from supplements. You’ll be asked about other doctors you’ve seen and why, plus any medical tests or procedures you’ve had. Note them on your list. Then write down the most significant symptom or symptoms you have.
  2. Take control of the visit. If you’re not asked, state as succinctly as possible what’s bothering you. Then answer the questions that are most likely to be asked. When did this begin? How bad is the pain? What have you already tried? You can anticipate questions and be prepared to answer them. If you’re interrupted, there’s nothing wrong with saying, “Please let me finish before I lose my train of thought.” Keep it on point; don’t stray into health issues that aren’t your objective that day.
  3. When you both decide on a course of action, get a verbal summary and written instructions if necessary. Ask questions. “We’re doing this blood test in order to test whether my blood sugar level is high? Do I have that right?” You want to leave that office with a plan of action. Understand that this visit may not completely resolve your issue until there’s more information to evaluate, but it starts the process. It’s up to you to follow through on what the doctor ordered and the steps you agreed to take.

The Bottom Line

Being healthy—and that includes when you’re not healthy and need to get back to it—requires teamwork. You have to find a way to make your physician listen to you, and you have to be precise in how you talk to him or her; remember they’re scientists at heart.

In my observation, many physicians haven’t been trained to treat patients as human beings. It isn’t that they can’t, it’s just the inherent weakness in their training as problem-solvers. Some doctors will be naturally good at listening and understanding, but it’s probably their personal instincts or experience rather than training.

Understand one thing about this process: you’re the customer and they’re selling their services. Patient satisfaction is becoming an important measure of how healthcare services of all kinds are evaluated. You’re the one in charge. I don’t say this lightly because I know access to healthcare can be challenging in some areas, but if you don’t get the service you need, fire that doctor and find another who will listen to you as a human who needs his or her expertise. Then do your job to be ready to help them do theirs. It’s the only way this crazy system will ever work.

What are you prepared to do today?

Dr. Chet

 

References: J Gen Intern Med (2018). https://doi.org/10.1007/s11606-018-4540-5

 

You Have 11 Seconds: Go!

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Did you ever leave a doctor’s appointment feeling that you never really described what the problem was or that you got sidetracked onto less important issues? Even if you went in organized to the extent that you could, your real concerns were shoved aside? I know hundreds of people who’ve felt that way. Let’s get back to the study I described Tuesday.

The researchers examined a randomized sample of the office visits, which were viewed independently and then ranked as to the nature of the visit. They first looked at whether the physician attempted to elicit a reason for the patient’s visit or not: turns out that the physicians asked only about a third of the time.

If they did ask, the researcher then timed how long the patient was given to explain their health issue before the physician interrupted the patient. The average was 11 seconds. The researchers did not explain the reason for the interruptions, but that’s all the time the patient had. Only the speedy patients who could somehow get it said in six seconds weren’t interrupted. The researchers concluded that not asking why the patient was in the office may not have set the priority of the visit towards what mattered most to the patient. Easy to see how that could happen.

What can you do to make sure that doesn’t happen to you? I’ll give you my thoughts on Saturday.

What are you prepared to do today?

Dr. Chet

 

References: J Gen Intern Med (2018). https://doi.org/10.1007/s11606-018-4540-5