Category: Medicine Hat News

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Safe Use of Acetaminophen (Tylenol)

Concentration. (Dr. Noorali Bharwani)
Concentration. (Dr. Noorali Bharwani)

Let us start with the use of acetaminophen (Tylenol) in pregnancy. Acetaminophen is generally considered safe in all stages of pregnancy because it doesn’t have the same risks as other over the counter painkillers.

But new animal research says otherwise. Studies following birth outcomes in Denmark and New Zealand have suggested that the use of acetaminophen in pregnancy may be associated with behavioural problems in the new born. Studies carried out in animal models suggest the drug seems to disrupt hormonal function and brain development.

A British study on humans (published in JAMA Pediatrics August 15, 2016) suggests children born to women who used acetaminophen during pregnancy could be at increased risk for several behavioural problems.

The British researchers followed about 14,000 pregnant women who were expected to deliver in 1991 or 1992. They collected detailed information, through clinical visits and questionnaires, about the health and development of the children until the age of seven and looked at the genetic risk factors.

Children born to women who took acetaminophen during the second trimester (18 weeks) and the third trimester (32 weeks) showed emotional problems and behavioural difficulties.

Children born to mothers who took the drug during the third trimester, about six out of 100, had behavioural difficulties – compared with four out of 100 whose mothers did not take the drug.

There was no association with the mother’s use of acetaminophen after giving birth or a partner’s use of acetaminophen. The researchers did not have any information on the dose taken or for how long.

What now?

Some experts believe more research is needed to understand the mechanism of action of acetaminophen during pregnancy. Until we understand this fully, pregnant mothers should follow their physicians’ advice because there is a risk to the fetus of not using acetaminophen when it is required. For example, fever during pregnancy can be dangerous and can lead to pre-term labour.

The bottom line is more research is required. We need to know the dose and duration of acetaminophen use which can be risky. As far as we know, there is no risk when acetaminophen is used during the first trimester.

Under normal circumstances if acetaminophen is taken too often it can cause liver damage. Acetaminophen is a medicinal ingredient in more than 470 products. That is lot of drugs.

There are stricter guidelines and warnings in the U.S. on the safe use of acetaminophen. This move comes as Johnson & Johnson, the makers of Tylenol, face more than 85 personal injury lawsuits in U.S. federal court that blame Tylenol for liver injuries and deaths. The U.S. Food and Drug Administration is planning to curtail the use of some acetaminophen products. The maximum daily dose is 4 grams, in people with healthy liver and kidneys.

Acetaminophen was discovered in 1877. It is used to treat mild to moderate pain and fever. There is poor evidence for fever relief in children. It is typically taken by mouth or rectally, but is also available intravenously. Effects last between two and four hours.

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Eating the Right Kind of Protein

A rock formation in Barbuda! (Dr. Noorali Bharwani)
A rock formation in Barbuda! (Dr. Noorali Bharwani)

A balanced diet consists of carbohydrates, proteins, fats and fruits and vegetables to provide you with vitamins, minerals and other nutrients.

Proteins are considered essential nutrients for the human body. They are one of the building blocks of body tissue, and can also serve as a fuel source. The body needs protein for growth and maintenance. Aside from water, proteins are the most abundant kind of molecules in the body.

There are many sources of protein: grains, legumes, nuts, seeds as well as animal sources such as meats, dairy products, fish and eggs. Vegetarians and vegans can get enough essential proteins (amino acids) by eating a variety of plant proteins.

A recent study from Harvard University and Massachusetts General Hospital in Boston (published in JAMA Internal Medicine) shows people who eat more protein from plants and less from animals may live longer even when they have unhealthy habits like heavy drinking or smoking.

If you like to eat animal protein then you should avoid processed red meat and choose fish or chicken instead.

The Harvard researchers followed more than 130,000 nurses and other health professionals over several decades. Half of the participants were getting at least 14 per cent of their calories from animal protein such as meat, eggs and dairy and at least four per cent from plant protein sources such as pasta, grains, nuts, beans and legumes.

The researchers noted that previous studies have indicated eating fewer starchy foods and more protein can help people manage their weight, blood pressure, sugar and blood lipids. But the Harvard study shows animal protein is deadlier for individuals who were obese or heavy drinkers.

The researchers found that meat eaters with an unhealthy lifestyle and higher mortality risk tended to eat more red meat, eggs and high-fat dairy than the fish and poultry eaters favoured by those with a healthy lifestyle.

The new study also found that meat eaters with a healthy lifestyle tended to consume more fish and poultry, while those with an unhealthy lifestyle and higher mortality risk – such as those who were overweight and drank at least one alcoholic beverage per day – tended to eat more red meat, eggs and high-fat dairy.

The authors say the study cannot prove that the type of protein people eat directly influences how long they may live. It’s also possible that the eating and lifestyle habits of health-care workers (participants in this study) might not be representative of the broader population of adults.

The real risk of mortality from animal protein also appears largely tied to processed meat, such as bacon, salami and hot dogs.

The take-home message here is to eat specific healthier plant-based foods such as fruits, nuts, seeds, beans, and non-starchy veggies. Avoid dangerous plant-based foods such as French fries to soda to white bread and white rice. And pursue a healthier life-style.

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Regular Walking Prevents Memory Loss and Delays Alzheimer’s Disease

Sunset in Calgary, Alberta. (Dr. Noorali Bharwani)
Sunset in Calgary, Alberta. (Dr. Noorali Bharwani)

There are many health benefits to regular walking. It helps your heart, lungs, joints and muscles. It may even regulate your bowel movements. You can add one more benefit to that list. According to a recent Australian study, regular walking is the best defense against age-related memory loss.

The researchers at the University of Melbourne followed 387 women for two decades. They found that participants who did some form of movement every day were less likely to suffer memory loss in their 60s and 70s, compared to their sedentary peers.

The article, published in the American Journal of Geriatric Psychiatry, shows that little physical effort like walking can go a long way in improving cognition in old age. Dementia is one condition that affects older individuals and affects their cognition.

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Memory loss is an example. Alzheimer’s is the most common type of dementia. It accounts for 60 to 80 percent of cases.

The Australian researchers set out to find risk factors for dementia that could be changed. The study participants were between the ages of 45 and 55 when the study began in 1992. The researchers tested their cognitive abilities at the outset to get a baseline measure.

In the study, regular physical activity had the most protective effect on short-term memory. But aerobic exercise – the kind that makes you breathe heavily – proved less important than frequency of movement. If a person walked more then the benefit was greater.

Researchers concluded that physical activity has a direct relationship with cognition, over and above any influence on weight and cholesterol. The idea is to move more and move often. If you have difficulty walking then take up swimming or other activity that will keep you moving.

A study published in 2014 says if you take your brain for a brisk walk three times a week then it delays dementia. Studies on men and women aged 60 to 80 found that taking a short walk three times a week increased the size of brain regions linked to planning and memory over the course of a year.

The results suggest that brain and cognitive function of the older adults remain plastic and highly malleable. We used to think that as you get older there is inevitable decline in your brain function. That is not true. Don’t give up on your brain.

Reports indicate there is a desperate need for any approach that could slow the rising epidemic of dementia. An estimated 44.4 million people now have dementia worldwide, and that number is expected to reach 75.6 million in 2030, according to figures from Alzheimer’s Disease International.

If you are able to walk then keep walking. If not then do some other physical activity that will keep your brain busy. Move more, move often.

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Smart Sunscreen Strategy Needed to Prevent Skin Cancer

Sunset in Hawaii. (Dr. Noorali Bharwani)
Sunset in Hawaii. (Dr. Noorali Bharwani)

There are three types of skin cancers. Basal cell cancer (BCC) and Squamous cell cancer (SCC) are not lethal but can leave you with scars and deformities on your face and other parts of the body. Then there is melanoma. If not detected early and treated melanoma can be lethal.

When exposed to sunrays, some people burn easily and others slowly. Those who burn easily have a higher risk of skin cancer than others. But everybody is at some risk of getting skin cancer. So be smart and prevent skin cancer. Here are some guidelines.

Minimize sun exposure. Avoid the sun or stay in the shade when the sun is the strongest (10 a.m. to 4 p.m.), and dress right for the occasion. Wear a hat and clothing that’s made from tightly woven fabric.

Use appropriate sunscreen. The American Academy of Dermatology (AAD) guidelines recommend people use sunscreens with three important qualities:

  1. Use broad-spectrum sunscreen to protect against ultraviolet A rays and B rays. Ultraviolet A rays make up 95 percent of the UV spectrum and are most associated with wrinkling. Ultraviolet B rays, cause sunburn and are stronger at midday and in the summer. Both types of rays can cause skin cancer.
  2. Use water resistant sunscreen – no sunscreen is “water proof” but water resistant means you can go up to 80 minutes in the water before you need to reapply.
  3. Use sunscreen with SPF of at least 30.

To understand what sunscreens people actually use compared to what they need to prevent burning, the researchers looked at the most popular sunscreens on Amazon – the top one per cent, or 65 products.

The researchers found 40 percent – 26 of 65 – of the products did not meet AAD requirements. Most products that failed to meet the standards, 72 percent, did so because they were not water resistant.

A Consumer Reports study (May 2016) found only the following five met the AAD criteria:

  1. Hawaiian Tropic Sunscreen Silk Hydration SPF 30
  2. Neutrogena Age Shield Face Lotion Sunscreen SPF 110
  3. EltaMD UV Physical SPF 41
  4. Neutrogena Ultra Sheer Dry – Touch Sunscreen SPF 55
  5. Neutrogena Sunscreen Ultra Sheer Stick SPF 7

Make sure you use enough sunscreen. Apply sunscreen 15 to 30 minutes before you go outside. For lotions, a good rule of thumb is a teaspoon per body part or area.

For sprays, apply as much as can be rubbed in, then repeat. Regardless of which kind you use, reapply every two hours and after swimming or sweating. Use spray sunscreens carefully. Sprays are flammable; so let it dry before going near an open flame.

Consumer Reports article concludes by saying, “Tests over the past four years indicate that choosing a chemical sunscreen with an SPF of 40 or higher will give you a better chance of getting at least an SPF 30. Using any sunscreen is better than using none, but it’s just one part of a smart sun protection strategy.”

Take care and enjoy the summer.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!