“The majority of patients with diabetes, about 70%, will die from heart disease rather than diabetes itself,” explains cardiologist Marwah Shahid, MD, UCLA Division of Cardiology. “People with diabetes are more likely to have high blood pressure, high cholesterol levels, and heart failure. This is why if you have diabetes, you should ask your doctor to screen you for heart disease as well.”

Diabetes and Heart Disease Connections

The connection between the two conditions stems from various factors, including:

Elevated blood sugar levels: In diabetes, the body either doesn’t produce enough insulin or cannot effectively use the insulin it produces. This leads to high blood sugar levels. Over time, elevated blood sugar levels can damage blood vessels and the lining of the arteries, promoting the development of atherosclerosis (hardening and narrowing of the arteries). Atherosclerosis is a primary cause of heart disease.

Increased risk factors: Diabetes is often accompanied by other risk factors for heart disease, such as high blood pressure, high cholesterol levels (especially elevated levels of LDL cholesterol, often referred to as “bad” cholesterol), and obesity. These factors contribute to the progression of atherosclerosis and the increased likelihood of heart disease.

Diabetic complications: Diabetes can lead to several complications that impact the cardiovascular system. For instance, peripheral artery disease (PAD) can occur, which involves the narrowing of blood vessels supplying the legs and feet. Additionally, diabetic neuropathy (nerve damage) can affect the nerves controlling the heart and blood vessels, impairing their function.

Inflammation and oxidative stress: Chronic inflammation and oxidative stress, both of which are associated with diabetes, can further damage blood vessels and promote the development of atherosclerosis. Inflammatory markers and free radicals contribute to the initiation and progression of cardiovascular disease.

Poorly controlled diabetes: If diabetes is poorly managed, with consistently high blood sugar levels, the risk of heart disease increases even further. It highlights the importance of proper diabetes management, including lifestyle modifications, medication adherence, and regular monitoring.

Treatments for Both Conditions

If you have diabetes or are at a heightened risk, it is crucial to take proactive measures to prevent heart disease due to the strong connections between the two conditions. “Improving your lifestyle has immeasurable benefits and will help improve your diabetes control and your heart,” says Dr. Shahid. “The majority of lifestyle interventions, including quitting smoking, engaging in moderate exercise at least three times a week, and focusing on a diabetic and heart-healthy diet, are fundamental for anyone with either diabetes or heart disease, and critical for those people with both.”

There also are medications that can treat both conditions. You may have seen television commercials advertising these claims.

“We have incredibly powerful medications that can help us manage and even reverse our diabetes and heart disease,” says Dr. Shahid. “Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) can help with both conditions. This class of medications, which includes Jardiance, works at the kidneys and blocks the reabsorption of sodium and glucose back into the body. This helps lower blood sugar levels for patients with diabetes and prevents the accumulation of sodium, a key component of heart failure management.”

© Jamie Grill Photography | Getty Images
In addition to lifestyle changes, there are medications that treat both diabetes and heart disease. However, they may not be right for everyone.

Dr. Shahid further explains that some people only with heart failure or diabetes may be on these types of medications because they work so well. However, these medications do not treat all types of heart disease. There are several different types of heart disease that are linked to diabetes, and you may need additional medication to help treat and manage those other types (e.g., statins to lower cholesterol).

“The ideal patient for an SGLT2 inhibitor is generally younger than age 65, has normal kidney function, and may be overweight, have high blood pressure and heart failure,” Dr. Shahid explains.” We tend to avoid giving these medications to patient with type 1 diabetes or those who have type 2 diabetes with poor blood sugar control. We also avoid these medications in patients who have poor kidney function, since the medications work at the level of the kidney, as well as those who are at risk of frequent urinary tract or perineal infections.”

In addition, she says that glucagon-like peptide 1 (a.k.a. GLP-1) class medications (e.g., Trulicity, Ozempic) are typically for people with diabetes when the primary goal is weight loss,

as well as in people with risk factors for coronary artery disease. There has been more hype in the media about “off-label” use of GLP-1s for weight loss. These medications are not FDA approved for weight loss only and should not be used in those without diabetes. Furthermore, these medications are avoided in those who have reduced kidney function and a history of gastric surgery, gastroparesis, pancreatitis, or certain types of familial cancers.

If you have diabetes, it’s wise to see your doctor regularly, especially when starting any new medications. Periodic checkups allow health-care providers to assess the effectiveness of the prescribed medications, adjust dosages if necessary, and address any potential side effects or interactions with other medications.

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Pain is classified according to its duration. Acute pain has a clear onset and cause and resolves in three to six months, when the cause has been addressed—for example, when a cut or fracture heals. Persistent pain—the subject of one of our cover articles this month—usually lasts more than six months. Possible causes of persistent pain include tissue injury, inflammation, nerve damage, blockages in blood vessels, and tumor growth.

When you are in pain, nociceptors— microscopic nerve endings that are present throughout the body—send messages about the intensity and location of a painful stimulus to the brain via your spinal cord. Prolonged painful stimuli, such as inflammation and tissue damage, are thought to sensitize nociceptors so that they fire spontaneously. This results in a greater barrage of nerve impulses that may cause neurons (nerve cells) in the spinal cord and brain to become so sensitized they respond to non-painful stimuli and/ or respond more strongly than expected. For example, diabetes can damage nerves in the feet, leading to a condition known as diabetic neuropathy. For some people with diabetic neuropathy, simply covering their feet with a bedsheet can cause pain.

While it may be tempting to reach for the painkillers, managing persistent pain usually isn’t as simple as taking a pill. You likely will achieve far greater relief by combining nonpharmacologic strategies with medication—indeed, the former may relieve your pain to the extent you don’t need medication. Our article includes plenty of tips for easing persistent pain, but it’s also important to right-size your expectations. Recognize that if you try to do everything you used to be able to do 10 or 20 years ago, you’re more likely to injure yourself. Arthritis, decreased range of motion in your joints, and impaired balance are just some of the age-related conditions that increase the possibility of injury while doing things you were able to do previously. Be smart and ask for help or use adaptive equipment when needed.

Lastly, if you are caring for a loved one who is living with dementia, keep in mind that they may not be able to tell you when they are in pain. Instead, stay alert for clues like facial grimaces, refusal to eat, and agitation, and contact their doctor to arrange an evaluation if you are at all concerned.

The post Pain Is a Warning Sign appeared first on University Health News.

“As an example of just how common these are, my practice is built around seeing non-diabetic neuropathies,” says Dr. Halabi. “For scale, the scientific literature has demonstrated that idiopathic (cause unknown) neuropathies outnumber the diagnosis of Alzheimer’s by up to threefold. Awareness of neuropathy has increased in part because we are becoming more comfortable with talking about the relevance of nerve health, just like we talk about heart health or brain health. We also have real interventions, depending on the type of neuropathy a patient may have.”

Persistence and Fortitude

Discovering the origin of non-diabetic neuropathy is akin to a detective investigating multiple possibilities and suspects. It is often a ruling out process that requires multiple doctors and visits, various blood tests, and physical exams. Seeing it through, however, is well worth the effort because finding a way to manage the disease can improve quality of life.

Classifying Nerve Damage

There are hundreds of types of peripheral neuropathies and symptoms vary, depending on the type of nerves damaged. Typically sensory nerves are affected the most and the earliest, followed by motor nerves, although this is not always the case.

Motor nerves  move muscles that are under your conscious control, for example walking, talking, and chewing. When these nerves are damaged, muscles can become weaker. People may report tripping or stumbling over their feet. More severely, there can be “foot drop,” a condition in which the foot drags on the floor because it’s difficult to lift.

Sensory nerves  transmit information such as the feeling of a light touch, vibration, position sense, temperature, and pain. Sensory nerves are classified into two types and have a broad array of functions and a multitude of possible impairments.

Large-fiber sensory nerve damage impairs proprioception (the ability to sense where you are in space). This affects coordination and balance (especially when your eyes are closed or if you are in a dimly lit space). Obviously, this increases fall risk. Damage to these fibers also makes it feel like you’re wearing gloves and stockings, even though you are not.

Small-fiber sensory nerve damage can interfere with the ability to accurately sense temperature and pain. People can experience loss of pain or hypersensitivity to it. There can be tingling, burning, and feelings of coldness and swelling. Sometimes pain can get worse at night because the pain receptors erroneously fire. For example, a light bedsheet can feel painful.

Autonomic nerves are those that work automatically to control organs and regulate vital functions such as digestion, breathing, and the heart. Damage to these nerves can cause such problems as digestive issues, excessive sweating, difficulty breathing, bladder dysfunction, and the inability to  regulate blood pressure.

Many Risk Factors

Genetic neuropathies are increasingly being found. Symptoms can be begin any time from infancy to well into adulthood. For example, Charcot-Marie-Tooth disease, also known as hereditary motor and sensory neuropathy, is one of the most common inherited neurological disorders.

Most instances of peripheral neuropathy, however, are acquired. They can result from another disease or condition, or the disease orgin may be unknown. To follow are the more common causes and risk factors for non-diabetic peripheral neuropathy:

Physical traumas  from sports injuries, repetitive physical actions, car accidents, medical procedures, and falls can stretch, crush, or compress nerves. For example, a slipped vertebral disc can compress spinal nerves, resulting in back and leg pain, this is called a radiculopathy. Carpal tunnel is an example of a trapped and compressed nerve in the wrist.

Vascular and blood problems  that decrease oxygen supply can damage nerves. This can be caused by smoking, which inflames cells that line blood vessels; atherosclerosis (fatty deposits along artery walls); and high blood pressure.

Systemic (body-wide) autoimmune diseases,  in which the immune system mistakenly attacks a number of the body’s own tissues, can directly target nerves or cause problems when surrounding tissues compress or trap nerves. Sjögren’s syndrome, lupus, and rheumatoid arthritis are some systemic autoimmune diseases that can have associated neuropathies.

Autoimmune diseases  that attack only nerves can be triggered by recent infections. They can develop quickly or slowly, while others can become chronic and fluctuate in severity. For example, damage to sensory and motor fibers results in the muscle weakness and loss of muscle bulk seen in Guillain-Barré syndrome. Multifocal motor neuropathy is a form of inflammatory neuropathy that affects motor nerves exclusively. Some autoimmune neuropathies attack the small fibers, leaving people with unexplained chronic pain and autonomic symptoms.

Kidney and liver disorders can lead to abnormally high amounts of toxic substances in the blood that can damage nerve tissue. Many patients with chronic kidney disease that are on dialysis can develop neuropathy.

Nutritional or vitamin imbalances, alcoholism, and exposure to toxins  can damage nerves and cause neuropathy. Vitamin B₁₂ deficiency and too much or too little vitamin B₆ are the best-known vitamin-related causes. Chronic, significant alcohol use is also a common culprit of neuropathies in older adults.

Infections  that can attack nerve tissues include viruses such as varicella-zoster virus (which causes chickenpox and shingles) and herpes simplex. Both target sensory fibers, causing sharp, lightning-like pain. COVID-19 also has been implicated as a possible cause.

“The literature surrounding peripheral nervous system problems stemming from COVID-19 is largely observational,” says Dr. Halabi. “While certain patterns have been observed, whether or not these associations are secondary to COVID-19 versus a reflection of the body’s immune response triggered by COVID-19 is still under active investigation. Our understanding of this will be relevant as we begin to unravel what COVID-19 long-haulers are enduring.”

Diagnoses and Treatment

A detailed medical and lifestyle history is the first step in diagnosis. It’s important to be honest, clear and as thorough as possible. For example, an injury, even one that occurred years ago, can be the cause of peripheral neuropathy. Likewise, excessive and longstanding alcohol consumption, even if a person drinks less now, could be a factor. While the initial appointment should be to a primary care physician, people with ongoing symptoms of neuropathy are usually referred to a board-certified neurologist. If an identifiable cause is still unclear, or the underlying cause is complex, the next step is a board-certified neuromuscular neurologist who specializes in nerve and muscle diseases.

Diagnosing peripheral neuropathy includes a physical and neurologic exam that includes testing reflexes, walking tests, light touch and pinprick tests, use of a tuning fork to test for vibration sense, and manual muscle testing. In certain circumstances, to better characterize the type or category of neuropathy, a nerve conduction study with electromyography (EMG/NCS) can be performed to evaluate the integrity of the nerves. In other cases, imaging studies including magnetic resonance imaging (MRI) or computed tomography (CT) scans can show narrowing of the spinal canal (stenosis) and herniated discs that impinge upon nerves. Blood tests can also screen for vitamin deficiencies, kidney and liver dysfunction, infections, and signs of abnormal immune system activity.

Identifying the underlying cause will dictate the management and treatment. “To help manage symptoms, we certainly have several topical and oral neuropathic pain agents that are well-tolerated and non-habit forming in our armamentarium,” explains Dr. Halabi. “It’s important to distinguish between disease-modifying therapy and symptom management. Neuropathic pain management does not target the root cause, but it does help manage symptoms and discomfort. With regard to restoring function, this again goes back to identifying the cause of the neuropathy.”

While it’s not always possible to prevent all neuropathies, Dr. Halabi says that nerve health is optimized in the same way that heart and brain health are optimized: A healthy diet and regular aerobic exercise at least five days a week are evidence-based means by which you can maintain your nerve health.

The post Burning, Numbness or Tingling in Your Legs and Feet? appeared first on University Health News.

Neuropathy and Vitamin B12. Vitamin B12 is required for the proper development and function of nerves, so vitamin B12 deficiency can cause neurological symptoms, including nerve numbness, tingling, or pain. Causes of deficiency include poor absorption, stomach and small intestine disorders, bariatric surgery, and prolonged use of certain medications such as metformin and proton pump inhibitors.

Peripheral neuropathy is commonly a complication of diabetes or other health problems, but it can also be caused by vitamin B12 deficiency. Accordingly, vitamin B12 has been proposed as a treatment for pain related to neuropathy— even when there’s no deficiency—but a 2020 systematic review found that research in this area, while promising, is still preliminary. The best evidence to date suggests that vitamin B12 may help in the treatment of diabetic neuropathy and nerve pain related to shingles.

Nerve Health and Inflammation. Nerve compression is caused by direct pressure on a nerve. For example, carpal tunnel syndrome is a form of nerve compression caused by pressure on the median nerve as it passes through the carpal tunnel in your wrist, causing numbness, weakness, and tingling in the fingers or hand. Causes of nerve compression include injury or repetitive stress, chronic illnesses that contribute to nerve damage, or swelling and inflammation due to autoimmune disorders or other causes.

In general, inflammation happens when your immune system reacts to something abnormal. Acute inflammation, which happens after an injury or infection, is an orderly, healthy process with a clear beginning and end. Chronic, or systemic, inflammation is an unhealthy, chaotic process that happens when your immune system is persistently on high alert. It’s well-established that chronic inflammation contributes to many serious diseases, including cardiovascular disease, type 2 diabetes, and cancer. It may also contribute to nerve compression and neuropathy.

Inflammation instigators include an unhealthy diet, lack of physical activity, unmanaged stress, lack of sleep, and environmental pollutants. Addressing these issues and eating a diet rich in anti-inflammatory foods may support nerve health. Conversely, certain foods may also exacerbate nerve conditions by furthering inflammation in the body.

Foods to Choose. If you are experiencing nerve pain, numbness or tingling, be sure to talk to your doctor. But if you want to take an active role in treatment with nutrition, here are some specific foods and nutrients to keep top of mind.

• Healthy fats. An anti-inflammatory diet emphasizes unsaturated fats, especially omega-3 polyunsaturated fats. One of the best sources of omega-3 fats is fish, especially salmon, sardines, mackerel, anchovies and trout. Aim to eat at least two fish meals per week—if you just don’t have a taste for fish, consider taking a good quality fish oil supplement. You can also up your intake of the plant form of omega-3 through nuts and seeds. Walnuts and flaxseeds have the most research showing an anti-inflammatory effect, but almonds are another excellent choice. For cooking and dressing, olive oil is the top pick for its healthy monounsaturated fats and antioxidants.
• Antioxidants. Fruit and non-starchy vegetables offer antioxidants plus fiber. Top anti-inflammatory picks are leafy greens—kale, spinach, and Swiss chard to name a few—and the cruciferous family, including broccoli, Brussels sprouts, cabbage, and cauliflower. Garlic and onions are known anti-inflammatory powerhouses, and for fruit, berries, tart cherries, and oranges have the strongest effect on inflammation.
• Fiber. Whole grains and pulses (beans and lentils) offer fiber and an array of nutrients, including some antioxidants. Pulses are high in fiber and magnesium, and magnesium has been shown to help reduce inflammation. When you go for whole grains, focus on intact whole grains such as oats, quinoa, wheatberries, and brown rice rather than only foods made with whole grain flour, like bread, tortillas, and crackers.
• Vitamin B12. Food sources include fish, meat, poultry, eggs, and dairy products, as well as fortified breakfast cereals and fortified nutritional yeasts if you prefer non-animal sources. Most people in the U.S. get enough vitamin B12 from food, but it’s available in oral dietary supplements as well as sublingual preparations as tablets or lozenges. It can also be administered by intramuscular injection or nasal spray, but these preparations are only available by prescription.

Foods and Beverages to Limit. The primary treatment for diabetes-related peripheral neuropathy is adequate management of blood sugar, and foods and beverages that are high in sugar and white flour can spike your blood sugar and contribute to inflammation. In excess, saturated fat (found in animal foods, palm oil, and coconut oil) and alcohol can both increase inflammation. If you enjoy red meat, do so in moderation and stick to lean cuts. Similarly, keep alcohol intake moderate (one drink per day for women, two for men).

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A Repetitive use is a common cause of a torn rotator cuff. This tendon connects the muscle to the bone around the shoulder joint. Constant and forceful use of the shoulder, such as with tennis, certainly can strain this tendon. As for the seriousness of it, know that a rotator cuff tear can get larger over time. If the pain worsens, is more frequent, and the shoulder feels weaker, those are indicators your shoulder tear is likely expanding. Since your pain sounds like it’s been ongoing, it’s best to have it checked out by your primary care physician or orthopaedic sports specialist. Early diagnosis can help prevent loss of strength and range of motion. Many rotator tears can be treated nonsurgically. Treatments include anti-inflammatory medications, steroid injections, and especially physical therapy. The goal is to restore good function, and physical therapists can ensure correct alignment and help to correct any muscle imbalances. Surgery may be indicated if pain isn’t resolved through other means. People who require surgery often feel pain at night and have great difficulty lifting the arm. As your injury doesn’t sound like it’s reached that stage, you may be able to resolve the issue while it’s still minor. Seek out physical therapists knowledgeable about tennis. They can assess and treat the injury and can also help refine your swing. That not only will reduce potential future injuries, but it may improve your game, too.

Q I was told that taking a prescription “vitamin” called Metanx would prevent diabetic neuropathy. Can you tell me more about this?

A Metanx capsules include a combination of B vitamins. Because neuropathy issues may be related to vitamin B deficiencies, supplementation with vitamin B₁₂, vitamin B₆, and folate (vitamin B₉) may improve diabetic peripheral neuropathy, but more research is needed to say definitively. Studies suggest that people who have a vitamin B₁₂ deficiency may have a reduction of symptoms, but it hasn’t been shown to benefit those who do not have a deficiency. That said, taking the vitamins is generally considered to be safe, but as they can interact with medications, do so only if your physician recommends it. Metanx is what’s called a “medical food” for use only under the supervision of a physician. A medical food, according to the U.S. Food and Drug Administration (FDA), is meant for the specific dietary management of a patient who, because of therapeutic or chronic medical needs, may not be able to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or who has other special medically determined nutrient requirements that cannot be achieved through diet alone. Because it is considered a medical food and not drug, it is not regulated by the FDA. According to a 2012 double-blind, placebo-controlled study published in the American Journal of Medicine, participants taking Metanx reported symptom relief and quality of life improvement. The study author also stated that it appeared to be a safe and effective therapy for alleviation of peripheral neuropathy symptoms, at least in the short term. The trial was 24 weeks and included 200 participants. A 2015 survey study conducted via automated phone prompts included 544 people taking Metanx. Researchers similarly reported reduction of pain and less disruption in work/school, and social/family life over the 12-week trial period. In 2020, researchers analyzed 24 published articles, called a systematic review, and reported that both B_12, taken alone or in combination with other vitamins or conventional treatments (such as gabapentinoids), showed some evidence of neuropathic pain relief. The article appeared in the July 25, 2020, issue of Nutrients. So while Metanx may ptoduce positive outcomes in some people, other vitamin B formulations may worksimilarly to reduce symptoms. But just because medical foods contain vitamins, it doesn’t mean they are completely safe for everyone. Allergic reactions have been reported. Use only with a physician’s supervision, especially if you are taking other medications.  

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Who Is Vulnerable to PN? You’re most likely to develop PN if you have diabetes. “Over time, high blood sugar damages the blood vessels that supply oxygen to the nerves, and this interferes with their ability to transmit information from your brain to the rest of your body,” explains Mount Sinai neurologist David M. Simpson, MD. “Blood vessel damage also can result from high blood pressure, and narrowing of the arteries due to cholesterol deposits.”

Other conditions associated with PN include rheumatoid arthritis, kidney failure, HIV/AIDS, underactive thyroid, certain medications (especially those used to treat cancer), and deficiencies in certain vitamins, including B₁₂ (a fairly common deficiency in older adults). However, in about 23 percent of people with PN there is no obvious underlying cause. This type of PN is most likely to affect older adults.

Consequences Can Be Severe PN starts in the toes and feet. Initially you may not notice any problems, but as the condition progresses you’ll begin to notice tingling, burning, chronic pain, or numbness in your hands and feet, especially at night. As the condition progresses, you also may experience muscle weakness and cramping, and a loss of balance and coordination.

If you have PN in your hands it may limit your manual dexterity, making it harder to carry out activities of daily living, such as dressing, bathing, toileting, and preparing meals. If your feet are affected, your mobility may be reduced and your risk of falling will increase. Having little or no sensation in your feet also can cause you to miss cuts and sores that may become infected. People with diabetes are at high risk for this because diabetes also impedes blood circulation, which limits the body’s ability to heal wounds and fight infections. In a worst-case scenario, what starts as a small cut could result in amputation.

Helping Yourself Eating a healthy diet, quitting smoking (see our cover story), and limiting alcohol consumption can reduce your risk of PN. Physical activity can help you avoid or manage obesity, which is another PN risk factor and also may worsen the discomfort associated with PN. In a study presented at the American Neurological Association’s annual meeting in October 2020, obese participants with PN who lost weight reported less pain and better quality of life.

Follow your doctor’s advice when it comes to managing health conditions that may underpin your PN. If the condition is related to diabetes, maintain good blood sugar control and also be sure to protect your feet. Don’t walk around barefoot, in case you step on a sharp object that cuts the sole of your foot without you realizing. Avoid excessively tight socks, and choose comfortable, cushioned footwear (Medicare covers the cost of one pair of “therapeutic” shoes if you have diabetes). Get into the habit of examining your feet daily for blisters, calluses, cracks, and cuts, and tell your doctor if you hurt your foot, however minor the injury may seem. See a podiatrist for regular foot examinations and toenail trimming.

Managing Pain No medications have been proven to reverse PN, but anti-seizure drugs such as gabapentin (Neurontin®) and pregabalin (Lyrica®), as well as antidepressants like nortriptyline (Pamelor®), and duloxetine (Cymbalta®) may ease the pain it causes.

Another option may be topical products containing capsaicin, which is the active ingredient in chili peppers. Capsaicin is available in ointment and patch form and although it isn’t clear how it works, it seems to inhibit pain messages from nerve fibers. In July 2020, the Food and Drug Administration (FDA) approved a prescription-strength capsaicin patch for treating painful diabetic neuropathy. The patch—Qutenza®—was initially approved by the FDA for treating postherpetic neuralgia (prolonged nerve pain that can develop after shingles). Dr. Simpson led the study that established the efficacy of the patch for treating diabetic neuropathy. “The patch isn’t for home use—it is applied in in a clinical setting for 30 to 60 minutes,” he says. “This can result in up to three months of pain relief.”

Some people gain relief from PN symptoms through acupuncture—if you opt to try this, consult a qualified practitioner (the Acupuncture Referral Service has a physician-finder at www.acufinder.com), and keep in mind that it may take several sessions before you notice any difference in your pain.   

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Overview: Evening primrose (Oenothera biennis) is a tall plant native to North America that also grows in Europe and
in the Southern hemisphere. It is named for the yellow flowers that bloom in the evening from June through September. Native Americans purportedly used the leaves and roots for a wide range of ailments including skin disorders and wounds, digestive complaints, and sore throats. The evening primrose seeds contain several nutrients including antioxidants and omega-6 essential fatty acids (linoleic acid and gamma-linolenic acid). The dietary supplement evening primrose oil (EPO) is obtained from these seeds through extraction and is available in capsule form.

Evidence: EPO supplementation is most commonly used as a complementary treatment for conditions associated with chronic inflammation such as eczema or rheumatoid arthritis though there are conflicting results. In the most comprehensive review of the literature to date, a 2013 Cochrane review assessed the effects of EPO and borage oil on the symptoms of atopic eczema. This review
concluded that EPO and borage oil do not effectively relieve the signs and symptoms of eczema and any observed improvement were similar to placebo. The use of EPO has also been studied in other conditions including diabetic neuropathy, menopause, and allergies. As a whole, the scientific data do not support the use of EPO for the above-mentioned health conditions.

Safety and Interactions: The National Center for Complementary and Integrative Health states that EPO is “probably safe for most people” when taken for short periods of time. Data on long-term safety is limited. High doses of EPO may cause headaches or mild gastrointestinal symptoms. The Mayo Clinic advises that individuals with schizophrenia or epilepsy, especially those taking anticonvulsants or neuroleptic agents, not to take EPO as it might increase risk of seizure. Use caution if you take an antihypertensive, anticoagulation, or antiplatelet medication since high doses of EPO may also inhibit platelet aggregation and increase risk of bleeding. Please consult with your physician before starting any new diet or supplement.

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Q: Sometimes I feel a fluttering in my chest that just doesn’t feel quite right. By the time I realize it happened, it’s gone. I’ve tried to track when it occurs to see if it’s related to any particular activity I engage in or any specific thing that I eat or drink, but there doesn’t appear to be a pattern. Should I be concerned?

A: The only time it’s perfectly normal for someone to feel like their heart is skipping a beat, or beating too rapidly, is if they are a character in a love song or romance novel. If you are neither and you have experienced similar sensations, you’ve probably had heart palpitations.

Any sensation that makes you aware of your heart beating is a type of palpitation. Thinking that something could be wrong with your heart can be frightening. but palpitations are actually quite common and usually nothing to worry about. That said, you probably shouldn’t ignore them because in rare instance they can be a sign of a more serious condition, such as atrial fibrillation, or A-fib.

A-fib is a common condition that causes the upper chambers of the heart (the atria) to quiver irregularly instead of beating at a regular pace. Untreated, A-fib can increase a person’s risk of stroke, so being able to recognize the early warning signs is important. Those most at risk for A-fib include people 65 and over, as well as those with high blood pressure, a family history of A-fib; hyperthyroidism, and a history of heart disease or previous heart surgery.

Common Triggers: Knowing when to worry about heart palpitations can help you catch certain conditions early so that you can seek treatment. Most palpitations are not caused by heart-related issues. Instead, they are commonly triggered by exercise, stress or anxiety, alcohol, stimulants such as caffeine, nicotine withdrawal, and even low blood sugar. If you feel your heart race or flutter only when you’re anxious or stressed, relaxation techniques like meditation and deep breathing could be the key to reducing these palpitations. Likewise, a thumping heart caused by stimulant use can be calmed by reducing intake of tobacco products and caffeine. If you’re taking any medication, tell your doctor about the palpitations to find out if your medication could be causing them.

When to See a Doctor: Nearly everyone will experience heart palpitations at some point. Usually they’re completely benign, but other times they could be your heart trying to tell you that something’s wrong. It’s a good idea to monitor your palpitations and keep track of how often they happen and how long they last. This way, when you do visit your doctor, it will be easier to get an accurate diagnosis.

Q: As we consider retirement destinations, we are wondering: Do some health issues make it harder to renew a driver’s license, and do these vary from state to state?

A: When choosing a retirement locale, most people factor in climate, affordability, and proximity to loved ones. Kudos to you for thinking ahead about the health-associated implications of applying for a license in a different state.

Greater Scrutiny. A history of stroke, epilepsy, and even diabetes can potentially put the brakes on license renewal. Hypoglycemia, retinopathy, and neuropathy are among the reasons that diabetic patients may be under greater scrutiny. When reduced sensation affects the lower limbs of people with diabetic neuropathy, they may find it more difficult to gauge pressure on the accelerator, brake or clutch pedals. In addition, agents used for neuropathic pain, such as gabapentin or amitriptyline, can have a sedative effect.

For applicants who have these or other conditions, medical evaluation procedures vary from state to state and range from a simple physician confirmation of the person’s condition to medical advisory board hearings and assessment of medical evidence.

State Variations. In California, licenses are renewed every five years, and until age 70 drivers may automatically be granted two five-year renewals by mail or online. Starting at 70, drivers must renew in person, taking a written test and eye exam. California is one of the few states that requires doctors to report certain medical conditions that could impact driving ability. Conditions that commonly result in California driver’s license restrictions or suspensions include cataracts, diabetes, and macular degeneration.

For a state-by-state list of license renewal procedures and U.S. driving restrictions for specific medical conditions, visit https://bit.ly/2BXZz6o and https://bit.ly/2CswVdi.

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Multiple Sclerosis

MS occurs when the body destroys the myelin insulation that surrounds the axons of many neuron cells. Over time, this causes scarring to build around the nerve and to develop into lesions, which impair nerve communication, cause pain, and affect vision and hearing.

Research indicates that patients with progressive MS who receive 60 mg per day of methylcobalamin for 6 months experience stronger neuron signaling in the visual and auditory parts of the brain._[7,8] This is the result of the regeneration of myelin, which allows chemical signals to travel faster and more efficiently through brain cells.

Treatment For Fibromyalgia And Rheumatoid Arthritis

Methylcobalamin has been shown to reduce chronic pain in fibromyalgia and rheumatoid arthritis. Although the causes of both conditions are uncertain, the restoration of neuron cells is known to improve their symptoms. In one study, patients with fibromyalgia who received 1.5 mg per day of the vitamin experience significantly less pain._[9] This is potentially the result of the repair of small nerve fibers close to the skin._[3] Similarly, nerve regeneration is shown to relieve pain in rheumatoid arthritis, likely due to the stronger nerve fibers being more resistant to irritation from inflamed joints._[7]

Neurological Conditions That Can Benefit From Methylcobalamin Treatment

Additional studies are showing some of the same symptom relief benefits of methylcobalamin in the following neurological condition:

• Neuropathy
• Diabetic neuropathy
• Impaired visual function
• Bell’s palsy
• Glutamate toxicity
• Sleep wake rhythm disorders _[10]

How To Use Methylcobalamin As Treatment For Fibromyalgia, MS, And Rheumatoid Arthritis

Anyone with the listed neurological conditions can benefit from methylcobalamin. Even people who acquire B12 in their diets and from supplements are likely to be deficient in methylcobalamin. Vitamin supplements and enriched foods contain vitamin B12 in the form of cyanocobalamin, which is not nearly as biologically active._[10] In comparison, methylcobalamin is used more efficiently and is retained in the body at levels 66% higher than cyanocobalamin._[11] Most importantly, methylcobalamin is the only neurologically active form of B12._[9]

When choosing a supplement, look for either methylcobalamin or methyl B12. Studies have found that oral, intravenous, and intramuscular administration provide the same results._[11]

• Treatment for fibromyalgia and rheumatoid arthritis, studies noted clinical benefits using between 1.5 and 6 mg per day._[11] Capsules typically contain between 1 and 5 mg and must be taken at least twice per day to deliver benefits for fibromyalgia and rheumatoid arthritis. Some methyl B12 supplements are designed to be taken sublingually, that is dissolved under the tongue. These can have the added benefit of absorbing directly into the bloodstream.
• For multiple sclerosis, studies suggest 60 mg per day. Up to 12 capsules per day may be necessary.

These are all considered to be very high doses and cannot be acquired from normal B12 supplements of cyanocobalamin. As a water-soluble vitamin, methylcobalamin is excreted in urine and cannot accumulate in the body beyond what is naturally stored in the liver, creating little chance that high doses will cause negative side effects._[12]

If you have tried using methyl B12 for a neurological condition, share your experience in the comments section below.

Originally published  in 2014, this post has been updated.

The post Vitamin B12 May Help Treat Fibromyalgia and Rheumatoid Arthritis appeared first on University Health News.

Types of Excessive Sweating

People with hyperhidrosis do not have more sweat glands than others. In fact, excessive sweating usually is caused by an oversensitive sympathetic nerve.

Primary hyperhidrosis mostly affects the hands, feet, and the face—the areas involved in emotional sweating. It is not caused by a preexisting medical condition, nor does it affect people while sleeping. Sometimes a genetic mutation plays a role.

Secondary hyperhidrosis develops due to malfunction of the peripheral or central nervous system. Secondary means it is caused by something else usually due to a medical condition or side effect of medication. _[1,2,3,5,9]

Excessive Sweating Causes

The following are some of the common excessive sweating causes. Your doctor can help you determine which apply to you:

• Tuberculosis is mostly associated with night sweats. HIV can also cause excessive sweating.
• Neurological disorders. Parkinson’s disease may affect the autonomic nervous system, which is responsible for sweat regulation, which can cause you to either sweat too much or too little. Many times, a prescribed medication used to treat Parkinson’s can contribute to excessive sweating. _[7] In people with multiple sclerosis, night sweats can occur due to problems with the central nervous system.
• Endocrine disturbances. Hormonal changes, pregnancy, and menopause could be to blame. The hot flashes accompanied with menopause can lead to excessive sweating. When the estrogen levels drop it can also lead to sweating. There are a variety of treatments and supplements that can potentially help with that.
• Hyperthyroidism. The thyroid controls metabolism within the body. It is responsible for your body’s use of energy. When the thyroid gland is overactive, it makes excessive amounts of the thyroid hormone. It causes the body’s processes to speed up, which results in nervousness, rapid heartbeat, anxiety, hand tremors, and excessive sweating. _[13]
• Diabetes. In some cases, diabetes can cause damage to the autonomic nervous system, including the nerves that control the sweat glands, over time. This condition is known as diabetic neuropathy. Hypoglycemia can also trigger a fight-or-flight response in the body, which can cause excessive sweating. Some medications used for diabetes can be a cause of excessive sweating. To avoid excessive sweating, it is important to keep your glucose levels in check. _[10]
• Medication. Twenty-two percent of people notice excessive sweating as one of side effects of taking antidepressants. _[12] Sometimes sweating can be so severe that people decide to discontinue their treatment, which can result in negative consequences. _[12]
• Anxiety. Stress hormones can cause profuse sweating due to water being eliminated through the skin instead of the kidneys, thus, preventing the need to urinate in a potentially dangerous situation. The severity of perspiration depends on the degree of an anxiety. _[6]
• Heart attack. One of the symptoms of a heart attack is excessive sweating.
• Heat exhaustion. Hot weather, of course, is one of the main causes of heat exhaustion. The increase in moisture on a humid day slows down the process of dissolving sweat, which helps to cool the body. When your body can’t cool itself, you can become ill. Therefore, it’s important to stay in the shade during hot days and limit your time in the sun.
• Exercise. While exercising, it’s important to stay hydrated and take a break to cool off if it is needed.
• Spinal cord injury. Excessive sweating can be caused by neurovascular instability syndrome.  

Treatments for Excessive Sweating

There are a number of ways to treat excessive sweating. Consult with your doctor as to which one works best for you.

• Antiperspirants are the most popular method used for treatment for excessive sweating. They are the least invasive and inexpensive. Antiperspirants are available over the counter or by prescription by your dermatologist. Most antiperspirants use aluminum-based compounds that reduces moisture from sweating. As the sweat interacts with the compounds, it then turns into a gel that covers up or blocks the sweat glands, which reduces further sweating. The process only lasts for a little while, so antiperspirants must be periodically reapplied. Antiperspirants are available over the counter or by prescription by your dermatologist.
• Botox injections can be effective when administered by experienced practitioner. Botox injections are most effective on the head and face. A chemical in the body responsible for stimulation of the sweat glands is temporary blocked by Botox. It takes about two weeks for the full effects and the first noticeable results are visible after two to four days. When used on palms, however, it can cause temporary pain and weakness.
• Laser therapy is used to directly target and destroy sweat glands. Tiny incisions are made in the underarms, so a laser can penetrate the skin. The procedure takes about an hour. It’s still new, however, and the results have not yet been proven by controlled studies. _[9]
• Oral medications can be prescribed by a doctor when other treatments have failed. Anticholinergics are the most commonly used. These kinds of medications do not target a specific area of the body. It decreases sweating in general. It can lead to overheating of the body, which can be dangerous. There are certain risks involved, especially when it comes to patients over the age of 65. It can also increase the risk of developing dementia or brain atrophy.

For related reading, visit these posts:

• Heat Rash: The Hot Weather Condition for All Ages 
• The Best Natural Deodorant Options Are Free of These 4 Ingredients 

[1] https://www.popularmechanics.com/science/health/a23922/the-science-of-sweat/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695293/

[3] http://www.antiperspirantsinfo.com/en/all-about-sweat/why-does-sweat-smell.aspx

[4] https://www.snopes.com/fact-check/false-goldfinger-death/

[5] https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/hyperhidrosis#causes

[6] https://www.anxietycentre.com/anxiety-symptoms/sweating-anxiety.shtml

[7] https://www.epda.eu.com/about-parkinsons/symptoms/non-motor-symptoms/skin-and-sweating/

[8] https://familydoctor.org/condition/heat-exhaustion-heatstroke/

[9] https://www.sweathelp.org/hyperhidrosis-treatments/treatment-overview.html

[10] https://dlife.com/causes-excessive-perspiration-people-diabetes/

[11] https://www.mannaplus.co.za/menopause-sweating/

[12] https://www.sweathelp.org/where-do-you-sweat/sweaty-armpits/170-media-contacts/307-common-consequence-of-taking-antidepressants-excessive-sweating.html

[13] https://www.endocrineweb.com/conditions/hyperthyroidism/hyperthyroidism-overview-overactive-thyroid

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