Archive for the ‘Pharmacy and health e-zine’ Category

Cystic Fibrosis … in search of a cure ……

February 8, 2016

Some of these names for health challenges sound ….. scary? Not to worry …. research is being conducted worldwide to combat the scariest sounding diseases!

Cystic fibrosis – how does it happen? It’s a genetic disorder which creates a build-up of thick mucus in the lungs, the pancreas as well as liver, kidneys and intestine. Hmmm ….. why does the disorder occur?

Our genetic code is a blueprint for everything that happens in our body. Okay! We know that mucus is produced in the body – it’s produced in the respiratory tract, in the mouth, stomach, intestine, reproductive system, eyes, ears and so on. It’s a protective fluid, one of its important functions being preventing infection. Healthy mucus is usually clear and thin. When there is threat of attack from an infectious agent like a virus or a bacteria or an allergy-causing agent, more mucus is secreted …. and it can get thick and green or yellow in color from the body fighting infection.

How is mucus formed? It is secreted by mucous membranes. The membrane has a protein called CFTR (alright, the full form is Cystic Fibrosis Transmembrane Conductance Regulator) which regulates the transport of chloride and thiocyanate ions across membranes.

Oof!!!! Enough of big words. Sometimes there are defects in the way CFTR is formed in the body, because there are defects in the genetic blueprint. As a result, the mucus is thick. This condition is called Mucoviscidosis or Cystic Fibrosis. The thick mucus can clog up the lungs and create an environment for bacterial infections, leading to respiratory failure if the infection is not controlled. In the pancreas, it can manifest itself as the ducts being blocked, leading to cyst formation and fibrosis (formation of scar tissue) – that’s the origin of the name “cystic fibrosis”. Male infertility because of failure of sperm transportation is another way the disease manifests itself.

Over the years, Cystic Fibrosis has been treated by treating its symptoms. So, when there is infection of the respiratory system, it’s treated with antibiotics. Saline is inhaled to clear the airways. Pancreatic enzymes are used to help digestion in the absence of proper pancreatic secretion. Regular exercise improves lung function.

Okay, that’s symptomatic treatment. Is there a cure on the horizon? Well, there’s good news!

There have been a couple of thousand identified mutations or defects in the genetic blueprint that cause defects in the CFTR protein. About 4 per cent of identified Cystic Fibrosis cases are due to a specific defect called the G551D mutation. A drug called Ivacaftor (brand name Kalydeco) was launched in the year 2012 as a CFTR potentiator. It binds to membrane channels in Cystic Fibrosis due to the G551D mutation in such a way that the defective channel of transport of chloride ions is opened up. As a result, the mucus is not thick any more.

The same drug also had some efficacy in a few more defects of the CFTR protein.

Wait … there’s more ….

Ivacaftor is a CFTR potentiator. In 2015, it was launched as a combination drug with the drug Lumacaftor, which is a CFTR corrector, which increases the traffic of CFTR to the cell surface. Ivacaftor/Lumacaftor is marketed as brand name Orkambi. The combination makes it useful for more patients,

Gene therapy is another field where research is being carried out, where the normal CFTR gene is introduced in the cells to create normal function. Not much success yet.

And, there’s a drug called Ataluren that is being tested rather successfully to treat Cystic Fibrosis. It works by taking the mutant genetic code and manipulating it to create normal CFTR protein. More results are awaited.

As can be seen, the treatment for Cystic Fibrosis is getting better and better. Breakthrough research creates better outcomes and greater maintenance of health and longevity. And with the best minds in research cerebrating together, a cure is on the horizon ….. that’ll be joyful news indeed!!

Wishing you increasingly good health,

Dr. Ajit Damodaran

Questions to ask about your vitamins

June 6, 2010

Hello friend,

Long time, eh? … as my folks say up north, the true north.

Have you wondered about vitamins? Are they necessary? About twenty years ago, I figured ….. I eat plenty of vegetables and fruits, I’m sure I get all the vitamins I need from my diet. As time went on, I read scientific articles about nutrition, dug deeper into the subject, and here’s what I found.

Over the years, there has been a decline in the nutritional quality of fruits and vegetables – this is per data collected by the U.S. Government from 1950 to 1999. And although there are dietary recommendations for vitamins and minerals, these are just to prevent deficiency of nutrients in the body. Optimal nutrition requires an intake of multivitamins and other supplements.

With all that’s available in the market, how would you choose a quality vitamin? I list below ten questions from the book “Secrets of Supplements” by Gloria Askew, RRN and Jerre Paquette, Ph.D. As you can gather, this is not an original write-up from me, however the information that I reproduce below is of paramount importance in choosing the right vitamins for yourself.

” …. Every question on this list should be answered with “yes.” If not, you haven’t found a totally terrific product.

1: Is your multi-supplement primarily a plant-based product that includes vitamins, minerals and phytonutrients? [Phytonutrients means plant nutrients. Only whole plants can provide all the nutrients your body demands].

2. If the multi-supplement is plant-based, is it derived from a variety of plants? [Phytonutrients vary from plant to plant].

3. If the multi-supplement is plant-based  and derived from a variety of plants, does the manufacturer own its own land and grow, harvest, and concentrate its plants? [A rich, broad-spectrum soil is required to produce healthy plants. The more a company out-sources its products, the greater the chances of loss of nutrients and quality control].

4. Does the vitamin supplement contain the whole-plant concentrate, including associated phytonutrients? [Vitamins and minerals and phytonutrients work in partnership with one another, in synergy].

5. Are the supplements certified organic from the soil and seed up?

6. Is the disintegration time on the tablet about 30 minutes or less? [For optimum digestion, they must be broken down and prepared in the stomach, just as food is].

7. Does the manufacturer voluntarily adhere to Good Manufacturing Practices from seed to end product and The Council for Responsible Nutrition for its fish oil products? [The Council’s “Omega-3 Monograph” is the base line for toxin-free, toxic products. The standards cover raw materials, manufacturing, packaging and nutrition].

8. Does the manufacturer assay its entire line for heavy metals, microbiological contaminants and pollutants, and desirable nutrient compounds? [In the United States, supplements are regulated by the Food and Drug Administration (FDA), but they are regulated as food, not drugs. In 2007, the FDA stated that a company manufacturing supplements “does not have to provide FDA with the evidence it relies on to substantiate safety or effectiveness before or after it markets its products.”].

9. Does the manufacturer have published Bio-Assays that I can easily access? [Toxins are common-place in our environment and can overwhelm any goodness present in organic compounds].

10 Does the manufacturer publish an ORAC score (oxygen radical absorbance capacity, a measure of anti-absorbant capacity) on its anti-oxidants that is based on a wide range of free radical groups?

Hope that helps, my friend.

Until next time …. live healthy, live well.

Warm regards,

Dr. Ajit Damodaran

Health education web tutorials

April 1, 2010

Hello friend,

Alright, there is nothing original about the following post. But it is AWESOME!

It’s a link to an interactive web site that gives you all you wished to know about various disease states and treatment. It’s a service provided by the U.S. National Library of Medicine and the National Institutes of Health. There’s a whole bunch of individual tutorials, click on any of them to learn a lot about it. The topics are broadly divided into four categories – Diseases and Conditions, Tests and Diagnostic Procedures, Surgery and Treatment Procedures, and Prevention and Wellness.

The tutorials listed below are interactive health education resources from the Patient Education Institute. Using animated graphics each tutorial explains a procedure or condition in easy-to-read language. You can also listen to the tutorial.

NOTE: These tutorials require a special Flash plug-in, version 6 or above… If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial.

  • Diseases
    and Conditions

Ain’t it great?

Until next time, my friend, take care of yourself and your health.

Warm regards,

Dr. Ajit Damodaran

Chantix – Project Smoking Cessation!

February 11, 2010

Hello my friend,

I trust you’re having a wonderful beginning of the year! Today’s blog is directed at those of your kith and kin who have resolved to quit smoking, and may require some pharmaceutical help to boost their resolution.

The chief drug in cigarette smoke is nicotine, which has addictive characteristics similar to cocaine and heroin. How does nicotine make you feel good? Let’s look at the neurochemical mechanisms involved.

Acetylcholine (ACh) is a principal neurotransmitter in our body, both in the central and peripheral nervous systems. In the central nervous system, Ach is involved with memory and learning (damage to the system that releases Ach is likely involved with Alzheimer’s disease), as well as with arousal and reward pathways. In the peripheral nervous system, Ach activates muscles, and regulates respiration, perspiration, pupil dilation and constriction, digestion, urination and sexual arousal.

Ach produces its effect by stimulating Ach receptors. There are two kinds of Ach receptors, the nicotinic receptors and the muscarinic receptors, named for the fact that the plant alkaloid nicotine has an affinity for the former receptors and another plant alkaloid muscarine has an affinity for the latter receptors.

So, when you smoke a cigarette, how does nicotine act? When you inhale a puff, the nicotine in the smoke is absorbed in the lung and reaches the brain within a few seconds. It binds to the nicotinic receptors in the brain and activates several neurotransmitters in the brain, including dopamine that leads to euphoria, relaxation and later, addiction. Nicotine also binds to nicotinic receptors in the adrenal medulla, stimulating the release of adrenaline leading to increased pulse rate and blood pressure, quicker breathing and increased glucose release into the blood by the liver. This can lead to cardiovascular disease.

By virtue of its increased cholinergic activity, nicotine inhibits programmed cell death, one of the processes by which the body destroys damaged and pre-cancerous cells. Other ingredients of cigarette smoke can be carcinogenic or cancer-producing.

Obviously, it’s a good idea to stop smoking. In recent times, there have been several aids to help us achieve this goal. Chantix (generic name varenicline, it’s known by brand name Champix in Europe) is the most effective prescription medication available since 2006 to help us stop this habit. It comes in the form of tablets, approved for use for a period of 12 weeks. If, during that time period, the individual stops smoking, it has been approved for an additional 12 weeks.

Chantix is a nicotinic receptor partial agonist. It is a derivative of the natural plant alkaloid cytisine. It is a partial agonist of some kinds of nicotinic receptors, which means it binds to the receptor and produces effects that are not quite the entire spectrum of effects produced by nicotine at that receptor. By so doing, it decreases one’s cravings for nicotine and reduces the feel-good euphoria and relaxation produced by the drug. A year-long scientific study shows successful smoking cessation in 23 per cent of the subjects in the study.

Any negatives? Yes. In July 2009, the FDA required its strongest warning, the “black box warning” to be issued with Chantix, warning of possible side-effects of depression, and suicidal thoughts and actions, due to various reports of the same.

On the other hand, a study published in the British Medical Journal in October 2009 studied 10,973 individuals who were using Champix to quit smoking and found insignificant increase in depression or suicidal ideation or actions. This was part of a larger cohort study (also called panel study) of 80,660 individuals who were using various methods of smoking cessation. However, as we dig into the details of this study, the authors do list 18 episodes of self-harm in the 10,973 subjects. Also, the data was collected from a large population of general practitioners in the U.K. All of the deaths did not have full death certificates, so the number of suicides were likely under-reported, per the authors’ admission. In spite of these limitations, thorough statistical evaluation still indicates no significant increase in depression, self-harm or thoughts of the same.

Here are my thoughts. Every drug out there, yes even routine over the counter medication like Advil or ibuprofen, has side effects, some of which can be fatal. We still continue to use these meds as and when necessary. The medical establishment and the citizen evaluates and balances the pros and cons of the medicine and use it as needed.

We apply the same standard to Chantix. The health advantages of smoking cessation are well worth the risks of using pharmaceutical aid to do so. If while using the drug, we feel not-so-good thoughts and feelings, we inform our doctor. The doctor can take us off the medication if that’s the best course of action.

I wish you the best with your resolutions. Until next time, my friend, I wish you good health.

Dr. Ajit Damodaran

Keeping it cheerful!

December 27, 2009

Hello my friend,

Before I launch into this blog ….. I won’t be writing hard science this time. This is more about practical mind stuff, using popular works of psychology.

‘Tis the season of good cheer, isn’t it? It’s not apparent to everyone though. During this time of the year, some of us are affected by a form of depression called seasonal affective disorder.

There are certainly chemical imbalances and mental disorders that require medical intervention  – absolutely! In addition to medicine, let us consider something else. Every mental disorder is a dis – ease of the emotions. Emotions arise in relationships. So, let’s follow a trend of thought – if we heal our relationships, we would heal our emotions (and vice-versa). If we heal our emotions, we would heal our mind. If we heal our mind, we would heal our life. That opens up a whole realm of possibilities, doesn’t it?

Healing our relationships. Of all the relationships in our life, the one that is probably the most central to each of our families and on which all other relationships are based is the marital relationship. How can we strengthen this pivotal point of life?

We study great marriages. We associate ourselves with couples who have weathered life’s storms and are still devoted to each other. We read from experts how to increasingly improve our communication with each other. We study audio programs. We attend seminars that teach us intimacy in communication.

For the purposes of this article, I shall paraphrase from memory the teachings from two of my favorite books: The Five Love Languages by Dr. Gary Chapman, and Love and Respect: The Love She Most Desires; The Respect He Desperately Needs, by Dr. Emerson Eggerichs.

The premise of the former book is this. Let’s say, for example, that the language that I understand the most is English and the language that my wife understands best is Portuguese. She would much prefer that I speak to her in Portuguese than in English. And vice-versa – I’d like her to speak to me in English – that’s what would speak to my heart. In the same way, there are emotional languages of communication. They are:

1. Words of affirmation – in this, a person understands love best when their partner praises them.

2. Quality time – this involves spending time with your spouse with full, undistracted attention.

3. Receiving gifts – where the love is felt best when receiving gifts from one’s loved one, not necessarily expensive gifts.

4. Acts of service – putting in effort to do what could be just a routine task for your loved one.

5. Physical touch – could be as little as a pat on the shoulder or a squeeze on the arm just to convey that you care.

An individual can have one or two favored love languages. We make an effort to find out our spouse’s favored language(s) and express our love in their favored communication.

I really like one of the exercises Dr. Chapman suggests for couples. At the end of the day, ask each other: “how full is your love tank?” – how much do they feel loved? And if the answer you get is, say, 6 out of 10, it is our duty to express love to the other in their preferred love language until their love tank is at a 9 or 10. It sound so simple, doesn’t it? It works ….. as long as there is a commitment to engage in the exercise regularly, whether you feel in the mood to do it or not ….. especially when you don’t feel in the mood.

In the book Love and Respect: The Love She Most Desires; The Respect He Desperately Needs, Dr. Eggerichs explains with the help of psychological studies how the feminine need is to feel unconditional love and how the ultimate masculine desire is to be magnificently respected.

The above two books are masterpieces in practical psychology. It’s totally worth the investment of time in reading them. If you’re not a reader, listen to them on CD. Or watch them on DVD. Modern technology has its advantages! The principles of communication in these are primarily focused on marriage, but you’ll see that they can be applied to all relationships of life. Once you learn these ways, make sure you enhance your communication with all your near and dear ones – your children, your parents, your close relatives, your friends, yes …… even your workplace colleagues ……. and watch your life expand beyond its limits.

Let’s recap the logic presented above. When we read the above books and similar ones, we learn ideas to improve the quality of communication with our loved ones. We keep studying ways of strengthening our communication skills – it’s a lifelong commitment that keeps increasing our quality of the important relationships in life. When there’s a high quality of communication that fulfills us emotionally, we feel more secure in our relationships. This helps us with our mental health, which can possibly help to decrease our dependence on medical intervention. Does that make sense?

May you and your family be blessed this wonderful season!

Until next time, my friend …. take care of yourself and your health.

Warmest regards,

Dr. Ajit Damodaran

Cancer begone – Cisplatin and Taxol

October 25, 2009

Hello friend!

It’s the beautiful fall season already …… nature is amazing, isn’t it? The vibrant green colors of the powerful summer foliage mellow down into the magnificently muted colors of autumn. And before you know it, the leaves are falling, giving way to the skeletal trees of winter. Come spring, the green blossoms again and the whole cycle presents itself yet again. How does nature do it? What is that amazing universal clock that tells flora and fauna exactly what to do at different times? When do plant cells know how to grow? How to give way to new cells? The moisture? The pigmentation? The seasons ……

It’s the same with life, isn’t it? Seasons of life. Spring, summer, fall and winter leading back to spring again. At times, we are in the pink of health. At other times, we are a bit under the weather. And at other times, we get hit hard and we’re really down and out. But you know what? Winter is followed by spring. The world is now waking up to the golden age of nutrition, medicine, lifestyle, positive energy, and health. Even the most dreaded diseases and conditions of the past are being challenged effectively. It’s up to us as individuals to understand that the mindset of the last century is the distant, distant past. We are now in the age of health.

Cancer has been a scary monster …. in the past. Am I saying we should underestimate cancer? Absolutely not. We most certainly have to take the responsibility of submitting ourselves to preventative and diagnostic measures. But, let’s consider we have come head to head with the fact that a loved one has been diagnosed with cancer. What next? There are options – surgery to remove cancerous tumors and localized growths, as well as radiation and chemotherapy to destroy abnormal cancer cells, both localized and diffuse.

Let’s look at chemotherapy, specifically two chemotherapeutic agents: Cisplatin and Taxol – the combination is used for gynecological cancers.

Before we get into that, back to basics. What is cancer? Cancer is an uncontrolled growth of a group of cells. During this growth, the abnormal cells compete for nutrition with normal cells, with the result that they invade and destroy adjacent normal tissue. As the abnormal cells continue to grow, they spread to other tissues of the body through blood and lymph.

Why does cancer occur? It could be due to genetic reasons or exposure to cancer-producing agents or carcinogens like tobacco smoke, chemicals, radiation and viral or bacterial infection. A genetic predisposition to cancer is fed by carcinogens resulting in abnormality in the genetic material or DNA of the cell – that’s the reason for cancer.

How do we stop cancer? How do we decelerate the abnormal cell growth? Cell growth happens in several steps. The cell skeleton or cytoskeleton is formed of microtubules, and there is DNA replication with DNA precursor nucleic acids and DNA crosslinking. The steps are catalyzed by enzymes of different kinds acting on different kinds of receptors. So, there are drugs that interfere with microtubule formation and drugs that prevent microtubule breakdown so that the cytoskeleton is made rigid essentially freezing the cell into uselessness. Taxol is a drug of the latter kind – it prevents microtubule disassembly. Then there are drugs that inhibit DNA replication either by messing with the precursors, enzymes or crosslinking. Cisplatin works by inhibiting crosslinking of DNA. There are also enzyme antagonists, as well as other anti-cancer drugs with miscellaneous mechanisms of action.

Taxol is known by its generic name paclitaxel. It was first extracted in 1967 by scientists Monroe Wall and Mansukh Wani from the bark of a plant Taxus brevifolia (Pacific yew). Satisfying the world demand that developed required a large number of trees. Later, the same compound was chemically synthesized from petrochemicals – the chemical synthesis did not yield a large enough quantity of the drug to be viable. Today, the drug is primarily made by a biotechnological process called plant cell fermentation. A line of cells from the Taxus plant is grown and fermented in large tanks to produce the drug.

Taxol forms a complex with tubulin, the building block of microtubules and prevents the breakdown of microtubules. In rapidly dividing and growing cells, microtubule formation and breakdown are essential steps of the mechanism. Another mechanism that has been seen with taxol is that it induces programmed cell death or apoptosis, by binding to a protein that would otherwise inhibit this process. Thirdly, taxol forms complexes with free-floating tubulin and prevents the formation of microtubules, the skeleton of the cells. It is used to treat cancers of the ovary, bladder, cervix, breast, head, prostate, neck and lung cancers, as well as Kaposi’s sarcoma (a cancer affecting the skin, mouth, and gastrointestinal and respiratory tracts). It is usually administered by the intravenous route.

Taxol destroys normal cells too by manifesting the above mechanisms, which is why there are side effects. However, cancer cells grow at a more rapid rate than normal cells, so taxol destroys cancer cells much more than normal cells. Side effects include brittle and thinning hair, joint pain, nausea and vomiting.

Cisplatin or cisplatinum is, as the name indicates a platinum compound. It was synthesized in the laboratory initially in the 1960s, and approved by the FDA to treat cancer in 1978. It is used to treat cancers of the connective tissue (cartilage, bone and fat), lymphoid tumors, ovarian cancer and lung cancers among others. It cross-links with DNA and prevents cell division. This activates a mechanism of programmed cell death. Cisplatin is usually administered intravenously.

Side effects of intravenous cisplatin include toxicity to kidneys and nerves, as well as hearing loss. It can cause a high degree of nausea and vomiting – which can be treated prophylactically by a combination of Emend (aprepitant), Zofran (ondansetron) and dexamethasone. Cisplatin does not cause hair loss.

There have been papers published, of localized (in situ) administration, when possible, of both cisplatin and taxol, to target cancer cells and minimize the exposure of other body organs to the drugs. This significantly reduces the side effects, thus treating the disease with minimal discomfort to the patient. The appropriateness of this method is of course determined on a case-by-case basis, depending on how localized the tumor is or the cancer cells are.

If you are reading this article, and you have been diagnosed with cancer, I’d like to say something to you. Every single human being has cancer cells in their body. Natural body mechanisms stop cancer cells from taking over and affecting body health. Sometimes however, by a combination of genetic and carcinogenic factors, cancer cells in your body take on a life of their own and overpower the normal body biochemistry. And you look back and wonder – I’ve done everything right, I haven’t smoked, I haven’t lived a life of unhealthy pleasure, I’ve never wished ill on anyone, I haven’t hurt anyone …. at least, not knowingly ….. why is this happening to me? Stop right there …… what you think and do next is critically important!

“Whatsoever things are true, whatsoever things are honest, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report: if there be any virtue, and if there be any praise, think on these things.” Let’s look at the science behind these words. Every thought we think releases corresponding nerve and body biochemicals. Good, uplifting thoughts release “healing” biochemicals, whereas sad, depressing, complaining thoughts release ….. let’s just say it …… “harmful” biochemicals. Think those awesome, uplifting thoughts and release “healing” biochemicals in your body to produce an environment where cancer cells cannot reside anymore.

Why do bad things happen to good people? I am not going to attempt to take on such a deep philosophical question. Different spiritual traditions can give you that answer. You will find that answer when it’s the right time. The more pertinent question is – when bad things happen, what do we do next?

How about keeping a gratitude journal? Being thankful for all the blessings in your life? For the ones who love you, your family and friends? Now, this might sound strange, but I’ve heard people being thankful for the most difficult times in their life – when they look back, they realize that it’s been the period of maximum growth of character, personality and spirituality.

And when you do have feelings of despair, anger (even if it be righteous indignation at the injustice of it all), frustration, envy or even worse ….. all those negative thoughts, write it on a piece of tissue and flush it down the drain. Replace the thoughts with the corresponding positive thoughts….. the brain can only think one thought at a time – make that a positive one ….. yes, you have the power. Is that a Pollyanna attitude? Brain and body biochemistry respond better to the irrepressibly optimistic Ms. Pollyanna than the lugubriously pessimistic Mr. Misery. Realism? Who defines realism? Realism for the one child that survived a plane crash recently is diametrically opposed to the realism of the hundreds who did not. Who is to say what your realism is?

Believe in your healing. Believe in your good health. In some awe-inspiring way, your thoughts, your neurochemicals, your biochemicals will be commanding the cancer cells from stopping their misbehavior. And ….. at some point, they will listen!

I wish you the best of health. Until next time,

Yours in good health,

Dr. Ajit Damodaran

Alendronate – for bone supremacy

September 21, 2009

Hello my friend,

Here’s a universal truth – every one of us is growing older – constantly. Every minute. Without exception. And although the effects of age show up slower in some of us than others, they do eventually appear, albeit as unwelcome guests. We’ve got to fight for our youth and health. We can’t just let entropy take over.

One of these unwelcome guests is bone fragility. Why is there a greater risk of fracture as we grow older? Here’s why. Our bone tissue is a dynamic environment. There is constant bone-building and bone breakdown. Bone formation results from the activity of cells called osteoblasts – bone-builders, and bone resorption (breakdown and re-assimilation) due to the activity of bone cells called osteoclasts – bone-breakers. Estrogen is a “female” hormone that is formed in the body of both men and women, appropriate to the age and sex of the individual. Obviously, there is more estrogen in the body of a pre-menopausal woman than a man of the same age.

In less amounts than required to create female sex-specific effects, estrogen inhibits osteoclasts, the bone-breakers, thus minimizing bone resorption. It also activates the bone-building processes. In women, estrogen is primarily made by the ovaries. In men, estrogen is mainly formed by conversion of the male hormone testosterone.

At menopause, the ovaries cease to make estrogen. The drop in estrogen levels results in increased bone resorption and decreased bone formation. This leads to reduction in bone mineral density (BMD) and increased risk of fracture. This condition is called osteoporosis. Although most common in post-menopausal women, it can occur in men too, as well as in men or women with hormonal disturbances, or due to some kinds of medicine (specific steroids called glucocorticoids).

Osteoporosis is prevented/treated with lifestyle changes like exercise, nutrition including calcium and vitamin D and medicine. Bisphosphonates are a class of medicine that have been used effectively in preventing and treating osteoporosis. Nitrogen-containing bisphosphonates are more effective than non-nitrogenous bisphosphonates. Alendronate, sold in the generic form as well as brand Fosamax is a widely used nitrogenous bisphosphonate.

When taken orally, less than one-hundredth of the dose is absorbed under fasting conditions, even less when taken with food. Half of the absorbed medicine is excreted unchanged by the kidneys, the other half is rapidly bound to exposed bone surface in the body. Once it’s absorbed by the bone, its half-life is about 10 years. What that means is that half of the alendronate is rid off by the body in 10 years, then half of the remaining half is eliminated by the body in another 10 years and so on.

Alendronate binds to the osteoclasts (the cells responsible for bone resorption, the bone-breakers), specifically inhibits an enzyme, thus blocking a protein transfer pathway within the osteoclasts. This messes with the functioning of the osteoclasts. As a result, the osteoclasts cease to do their job of bone resorption.

Bone-building continues in the presence of calcium, vitamin D and other factors. This results in increased bone density.

Are there side-effects? All drugs have side-effects. Alendronate can cause ulcers – esophageal (gullet), gastric (stomach) and duodenal (the first section of the small intestine). To reduce the incidence of ulcers, it is required that one sit or stand straight or walk for 30 minutes after ingesting the drug. Taking this medicine with a full glass of water on an empty stomach improves absorption. If dental work is done while on this medication, there is a risk of osteonecrosis (literally means bone death) of the jaw – this is rare on oral administration, more likely when alendronate is administered intravenously, mostly seen in cancer patients.

If alendronate is administered with food or a beverage other than water, absorption is reduced – this is more so with calcium, magnesium or aluminum-containing food or drugs – that includes dairy and antacids. Hormone replacement therapy along with alendronate may help with post-menopausal women.

Alendronate is usually administered in a daily dose of 10 mg or a weekly dose of 70 mg for treatment of osteoporosis. It can be administered in a daily dose as low as 5 mg or a weekly dose of 35 mg for prevention of the same. For Paget’s disease of the bone (enlarged or deformed bones – hereditary or due to a long-standing slow viral infection like measles), it’s a daily dose of 40 mg for six months.

We live in good times. Science, nutrition, lifestyle, medicine and technology give us longer and better quality lives. Are the solutions perfect? Certainly not. Does medicine lead to adverse effects. Of course. However, we can discuss options with our professionals and take the best course of action. Awesome!

My friend, until next time, do take care of yourself and your health.

Dr. Ajit Damodaran

Molecules Possessed (science fiction)

August 8, 2009

Hello friend,

Before medicinal drugs enter the marketplace, they are synthesized in a laboratory, tested in controlled environments and disease models and then, once approved by the authorities, released for medicinal use. As a student, I used to work in such a laboratory. To pass the time, I would fantasize talking to molecules (nerd alert!) – the following is a story I wrote in those days.

 

Molecules Possessed


Chin was bewilderment personified. “I’m going crazy …..”

Asked his friend Nat: “Why?”

“It’s this molecule.”

“What molecule?”

“It isn’t behaving like a molecule?”

Nat raised an amused eyebrow, “How can a molecule not behave like a molecule?”

“That is just what has me stumped. I’ll explain. See, it was four and a half years ago that I started off on this task of converting a certain chemical to another – of possible medicinal interest.”

“Hmmmmm. And?”

“And after a series of 23 reactions, I was on the brink of success. The last step was the conversion of a bicyclic compound with a side-chain to a tricyclic one.”

“Carry on.”

“After this last reaction which I carried out two days ago most meticulously, I subjected this compund to different spectroscopic determinations.”

“What are these determinations?”

“Methods of identification of a compound.”

“So you did not get the compound expected, is it?”

“That would merely be a disappointment. It wouldn’t challenge one’s sanity like this. The results we have obtained defy logic.”

“How?”

“Proton N.M.R. spectroscopy, that is one of the kinds of spectroscopy we did on the final compound, gives no signals with this compound – as if there were no hydrogen atoms attached to the carbon atoms in the molecule.”

“What of it? This molecule may not be having hydrogen atoms.”

“Impossible. All other kinds of spectroscopy we did  and the elemental analysis indicates the presence of hydrogen atoms beyond a shadow of doubt. Anyway, as the bicyclic compound I started with in the last reaction has hydrogen atoms, there is no way the product cannot have hydrogen atoms. It defies Chemistry.”

“You do have a problem there.” Pause. “I think the best you can do is get a good night’s sleep, wake up refreshed in the morning, and have a heart-to-heart talk with your molecule.”

“I’m in no mood for your wisecracks.”

“Alright. I’ll leave you alone. Relax, pal. You’ll think of an explanation in due time.”

After Nat left, Chin tried to sleep, but to no avail. Acting on an impulse, he left his room in the hostel and made his way to the laboratory.

The sample of the compound was just where he had left it – on his table. He pulled up a stool and gazed at his sample tube. The words of Nat came back to him. “Have a heart-to-heart talk with your molecule.” He smiled despite himself. How silly? Or was it? Just suppose it were possible? 

And there – like Alice in Wonderland he found himself growing smaller and smaller (no, there was no cake on the table). He slipped into the sample tube. Smaller and smaller. Curiouser and curiouser. 

He could not pinpoint any solid masses. He was in an atmosphere where there clouds of varying densities, sometimes so dense that they were almost solid masses and sometimes so rare that it almost looked as if there were only empty space there.

Chin could sense thoughts. No, they were not thoughts from his own mind. They were from somewhere around. They seemed to be addressing him.

“Hello! You’re new here, aren’t you?”

“I’ve come to meet your hydrogen atoms,” Chin found himself speaking.

“Why?”

“Why are they not giving signals?”

Laughter. All around. No sound, like human laughter. Chin could only sense it. 

“Dash it, this is frustrating.”

“Are you a scientist?”

“A student.”

“And your Ph.D. degree depends on our hydrogen atoms here?”

“I am not really worried about my degree. But that four and a half years of work should go to waste just because some hydrogen atoms want to go to sleep is…. is….” Chin could not find words to express his anguish.

“Don’t get excited. You’ll get all the signals you want.”

“Will you kindly explain what has been going on? And may I know who I am speaking to?

“You are speaking to what IS – to EXISTENCE.”

“Eh?”

“It is time your concepts were made clear. How do you define life?”

“I’m not very sure.”

“What is the structural and functional unit of the human body?”

“The cell.”

“What is the cell made of?”

“Atoms and molecules.”

“What are atoms and molecules made up of?”

“Smaller particles – protons, electrons, neutrons …”

“What is the nature of these sub-atomic particles?”

“In what sense?”

“You must be knowing about the dual nature of sub-atomic particles.”

“Yes – these ‘particles’ behave sometimes like particles and sometimes like waves of energy.”

“Okay. You know Einstein’s theory of relativity – about mass and energy being interconvertible; of mass and energy being different personifications of the same thing.”

“Yes.”

“So, in essence, your body is made of cells which are made up of atoms and molecules, which are in turn made up of subatomic particles – these particles are not strictly particles – just clouds of dense energy. Ultimately, what do we come to? Your body is made up of dense clouds of energy, as is every object in the universe, as is the universe – only the density is variant. Very, very dense energy projects itself as having mass. Therefore, EXISTENCE is ENERGY, ENERGY is EXISTENCE.”

Chin started feeling giddy. “Do you mean to say that there is no difference between a living body like mine and an inanimate object?”

“Essentially, no. But apparently, yes. What is the difference between a living human body and a dead human body? A living human body performs a multitude of functions in co-ordination. That is, there are countless molecules in the body performing in co-ordination – the body has ‘life’. When this co-ordination is lost at some stage, the body ceases to live. Yet, all the molecules continue to exist. Only the co-ordination is lost. Now, the question is – what causes this co-ordination? The answer is – a certain force.”

Chin was excited. This could be the answer eluding man through the ages. “What is this force?” he asked eagerly.

“A force. It is difficult to explain. You have not quite reached the level of intelligence required to grasp the idea. It will be something like trying to explain Einstein’s theory of relativity to a monkey.”

“Hey!” Chin turned purple with indignation.

“Suffice it to know that it’s some kind of a life-force, a different embodiment of the same energy which holds the sub-atomic particles together in proper order in an atom of a molecule. This ‘life-force’ exists in all living beings. When the life-force goes away, there is no ‘life’ as you know it.

“Okay! I’ve swallowed all this. But in what way is all this connected with my not getting proper signals in the spectrum?”

“It has all the connection. Do you know the theory of N.M.R. spectroscopy?”

“Yes. N.M.R. or Nuclear Magnetic Resonance spectroscopy is based on the principle that in the presence of an external magnetic field, nuclei of atoms absorb electromagnetic radiation of different specific frequencies to undergo transitions among specific orientations. It is this absorption of radiation that gives rise to signals.”

“Right. You see, what happened was this. Some life-force moving around in the vicinity was entrapped by the hydrogen atoms of this molecule. That is, according to your definition of life and death, these hydrogen atoms started having life – and started acting with a will of their own. They occupied the orientation of the lowest energy and refused to absorb electromagnetic radiation. With the result that you go no signals.”

Within Chin’s breast, the initial wonderment gave respectful right-of-way to exasperation, which burst out as a cry. “So, what do I do?”

“Don’t worry. You’ll get your signals tomorrow morning. This ‘life’ was only transitory. The hydrogen atoms are already ‘dead’ according to your definition.”

Chin arose from his slumber. Recollecting his nocturnal experiences, he started wondering, “Was this a dream?” It seemed likely.

Then he remembered that he had been told that he would be getting signals this morning.

Feeling like a fool, he took his sample to the instruments’ room and recorded the spectrum. Perfect. The hydrogen atoms had started giving signals. More puzzled than ever, he wondered what he would tell his Professor and colleagues. All that had happened? They would laugh at him. He was not so sure whether or not to laugh at himself.

 

Until next time, my friend, take care of yourself and your health.

Dr. Ajit Damodaran

Life is always fair!

June 25, 2009

Hello my friend,

Time for philosophical cerebrations. Logically presented, nevertheless they are just my opinions. Makes perfect sense to me ….. however, you may have a different take on the subject. Isn’t that what makes life beautiful?

To quote Napoleon Hill, “Thoughts are things.” What is the science behind that statement? Where does a thought from? It could be triggered by an event that is perceived by one of our five senses. Or, it could be triggered by a memory. Thirdly, it could be a creative thought, like they say …. from the Universe. Associated with every thought are neurotransmitters and hormones …….  natural brain and body chemicals that are released by nerve cells and other cells. Chemicals are “things”. So …… thoughts are things.

Stressful thoughts release natural chemicals like cortisol and adrenaline that, in excess, can hurt the body. Oh yes, we need cortisol and adrenaline for fight-flight-fright situations. They give us almost superhuman power to react to stressful situations. But if we get into that “hyper” mode at all times, that can create effects like lowered immunity, high blood pressure, increased abdominal fat leading to cardiovascular problems, diabetes, thyroid problems and decreased bone density.

Here’s the problem. In modern society, we live busy lives. As we live our hectic lives, our stress levels are at a constant high, at least moderately high ….. like, we have redefined what normal stress should be.

A majority of stress comes from our judging our own circumstances and others’. We believe that we deserve certain events in our lives. And we want certain events to happen to others, and certain other events not to happen to others. Why? Because we have our own perspective on what we deserve and what others deserve. When we believe we are “good” and yet these “bad” things happen to us. And when we believe someone else has been “bad” and yet “good” things happen to them.

If an individual has good fortune in any area of life, it is because of certain virtues they possess. Let’s take a simple example. Say, a person works hard and smart and becomes a billionaire (millionaire doesn’t cut it anymore, huh?). It’s basic cause and effect. The cause was good work, and the result was good rewards. In another area of life, the same person eats unwisely, does not exercise and suffers ill-health. Here, the cause was bad food and bad lifestyle and the effect was ill-health. It makes perfect sense, doesn’t it?

Let’s extend it. Say, the same person in the example above is not ever charitable. Not charitable with his money, his actions or his words. In fact, he is incredibly rude and even cruel to his employees. We are disgusted by his bad character. We start gossiping about him. Somehow, the story comes down to the fact that he is a horribly bad man and yet the Universe rewards him with good fortune. No, we got it all wrong. His good fortune results from his hard work.

On the other hand, we look at ourselves and see that we are good people. We are kind to our employees, we give to charity and so on. And yet, we are not as rich as the person above. So we come to the erroneous conclusion that our goodness is not being rewarded.

That is not the case at all. Every event in our life is perfectly fair. Every event in everyone’s life is perfectly fair. Does that give us an excuse to be not sympathetic to the troubles that our fellow humans go through? Certainly not. When we share others’ griefs, when we help people face their challenges, we are thinking charitable thoughts, we are doing charitable deeds, and that builds our own character. Good, strong character builds peace in our hearts. Scientifically, that means we develop neurochemical patterns in our brains and bodies that are beneficial to us.

I’m sure a thought must have come to your mind – yes, it’s come to my mind too. Am I saying that it is fair that a child is born in wonderful circumstances and another child is born into misfortune? I cannot make a cruel statement. I do not know the exact reason why one child was placed in the first situation and the other child in the second. Let’s send that question out to the Universe. What I am totally convinced of is that the Universe is in perfect order. We might not be able to see the order, but underlying what could be considered chaos, is a perfect world that works like clockwork. We might not know why the past was, but we can do all that we can to manifest a wonderful future.

Take the example of Oprah Winfrey. Born to a poor, teenage single mother in rural Mississippi, Oprah suffered through many struggles. In spite of her difficult beginnings, she decided to make something of herself. She started her career in a radio station. She then became a local TV co-anchor, and gradually grew to be a brilliantly successful media personality, one of the most influential people on the planet. Oprah is a role model not because of her troubled beginnings, but because she was an overcomer.

Can we assume that there is someone out there who shares Oprah’s birth day and was born in better circumstances? Is it possible that they are not as successful as Oprah? Is it possible that there is someone who was born with a silver spoon and became a total failure in life? You bet.

As we move forward into an awesome future, will there be obstacles? Absolutely. My belief is that the obstacles are the means by which we build the qualities to manifest the magnificence of our future. The heavier the weights we lift, the greater the resistance. The greater the resistance, the more the muscles build. Similarly, the heavier the obstacles in our path to our goals, the more we build mental muscle and character muscle.

The faster we move into the future, the more the obstacles. Another analogy will explain what I mean. If your car is parked in the driveway, and you put your hand out of the window, do you feel the wind? (I’m assuming a non-windy day). Take the car out on a drive through city streets at 25 miles an hour. Do you feel a gentle breeze? Yes. Take the exit onto the highway. You’re now driving at 65 mph. That’s quite a wind, isn’t it?

Obstacles and difficulties are part of the beautiful framework of the perfect Universe. However unfair it might seem, there is a purpose for every event in our lives.

What was the purpose of this philosophical treatise? Just this. When we develop an underlying belief that everything is fair in our world, we stop trying to be the manager of the world. We stop wasting our thoughts on wishing others ill. We stop frustrating ourselves with righteous indignation.

We learn to accept what we have, and we work calmly toward even better, in a spirit of inspirational dissatisfaction or divine discontent. We accept the truth of the Serenity Prayer, “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

As we increasingly manifest this wisdom in our being, our health keeps improving. Isn’t that good?

Do take care of yourself and your health. Until next month, G’bye!

Your friend,

Dr. Ajit Damodaran

Omega-3 fatty acids

May 31, 2009

Hello friend,

As we, followed by the rest of the world, increasingly invite creature comforts into our sedentary lifestyles, there is a tendency to obesity. Associated with obesity is metabolic syndrome leading to increasing diabetes and cardiovascular disease, leading to death or at best a decreased quality of life.

Something I read quite some time ago … I think I first read of it in Deepak Chopra’s book Perfect Health …… improving health, slowing the aging process and increasing longevity by caloric restriction. There have been anecdotal reports of individuals practicing this through history. Recently, diets have been developed based on this principle, like the Okinawa diet and the CRON (calorie restriction with optimal nutrition) diet.

The following is a mechanism that is brought into play in caloric restriction. As less food is absorbed from the gastro-intestinal tract into the blood, there is less need for insulin. As a result, there is a decrease in insulin and insulin-like growth factor 1 (IGF-1). By a cascade of cellular mechanisms, this leads to an increase in the activity of a protein in the cell nucleus, called peroxisome proliferator-activated receptor (PPAR) gamma co-activator 1 (PGC-1). PGC-1 and other PPAR activators increase the activity of nuclear receptors that play a major role in the effects of caloric restriction (The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60:1494-1509 (2005) © 2005 The Gerontological Society of America). They activate lipid transport and lipolysis (fat burning mechanisms). The resulting beneficial effects include decrease in blood pressure, decrease in total and bad cholesterol (LDL), decrease in triglycerides, increase in good cholesterol (HDL), decrease in blood glucose, and through all these, increased longevity.

It has now been shown that omega-3 fatty acids in our diet activate the same factors above that are activated by caloric restriction. In addition, omega-3 fatty acids decrease the levels of  hepatic sterol regulatory element binding proteins (SREBP). These proteins are genetic  transcription factors that are master regulators of lipid homeostasis. Reduction in SREBP results in a decrease in the activity of enzymes responsible for fat biosynthesis and storage. Bottom line, omega-3 fatty acids decrease fat synthesis and storage. So, it may be said that instead of starving yourself, just pop some omega-3 (read the book The Omega Diet by Dr. Artemis Simopoulos). No, please don’t take this as license to be corpulent …. the ill effects of obesity are not cancelled by omega-3 fatty acids.

Alright! What are omega-3 fatty acids? Let’s get back to basics. The macronutrients we ingest in our diet are proteins, carbohydrates and fats. (Fats are a part of a larger group of compounds called lipids. Also, lipids include sterols like cholesterol, phospholipids and others). Fats are a very concentrated form of energy. A gram of fat gives the body more than double the energy of a gram of carbohydrate or a gram of protein. Chemically, all fats are a “three-pronged” glycerol molecule linked via those three “prongs” (ester bonds) to long chain fatty acids. Each long chain fatty acid is a long chain of carbon atoms with hydrogen atoms bonded to the chain of carbon atoms. Each carbon atom (except the one forming the end of the chain) can be bonded to a maximum of two hydrogen atoms. When all the carbon atoms constituting the chain is bonded to the maximum number of hydrogen atoms they can be bonded to, it is called a saturated fatty acid. The triglyceride (that is, the glycerol linked by ester bonds to three fatty acids) is then called a saturated fat molecule. Too much saturated fat, obtained in the diet from dairy products, lard, coconut oil and cottonseed oil, is bad for the cardiovascular system. High levels can also cause breast cancer and prostate cancer. Smoking and regular alcohol ingestion increases the levels of saturated fat in the blood.

In monounsaturated fats, two of the adjoining carbons in the long chain fatty acid are not saturated with hydrogen atoms. They are each attached to only one hydrogen atom and double-bonded to each other. So, two carbon atoms saturated with hydrogen atoms would be bonded as -CH2-CH2-, whereas unsaturated double-bonded carbon atoms would be bonded as -CH=CH-. In polyunsaturated fats, there are more than one double bond in the fatty acid chain. “Omega” is the last letter of the Greek alphabet. Omega means the end. In our discussion, the omega carbon atom is the last carbon atom in the fatty acid chain. Omega-3 fatty acids are those that have a double bond at the carbon atom which is third away from the end of the fatty acid chain. Aha!

Essential fatty acids (EFAs) are those that cannot be synthesized by the human body from other components of the diet or body biochemistry. So, EFAs are required to be part of our diet. There are two groups of EFAs, the omega-3 fatty acids that we discussed above. and the omega-6 fatty acids. The latter are of course those that have a double bond at the carbon atom sixth away from the end of the fatty acid chain.

The balance of omega-3 and omega-6 fatty acids is important in the body. The ideal ratio of omega-6 to omega-3 in the diet is said to be less than 4 is to 1. In the diet of industrialized nations, the typical ratio is 10 to 1 or more. This could be cause for cardiovascular events, arthritis, cancer, depression and other mood disorders, osteoporosis and inflammation. In fact, cumulative research suggests that a lot of modern health conditions have inflammation as the underlying cause. There are signaling molecules in the body called eicosanoids, derived from omega-3 and omega-6 fatty acids. Eicosanoids from omega-6 fatty acids are pro-inflammatory, whereas those derived from omega-3 fatty acids are anti-inflammatory. To maintain equilibrium in these body processes, both omega-3 and omega-6 fatty acids are required, in the right ratio.

The important omega-3 fatty acids in our diet are eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). Research supports the use of EPA and DHA to prevent cardiovascular disease. EPA and DHA are biosynthesized by sea-water microalgae. Fish consume these microalgae and retain large amounts of these omega-3 fatty acids in their bodies. So, consuming fish or omega-3 fatty acids extracted from fish is ….. good for health. Plant omega-3 fatty acids are not EPA or DHA, but ALA. The human body is able to convert ALA to EPA and DHA. Flaxseed is commonly used as a vegetarian alternative to fish oil.

Omega-3 fatty acids have been shown in various research studies to be beneficial against cancer as well as developmental disorders like ADHD and autism. There have also been benefits to the immune system. When given to pregnant women and lactating mothers, the babies were shown to have higher IQs. More and more scientific research gives us greater insights into the benefit of omega-3 fatty acids. We do have to be careful, though, of not slipping into one of our weaknesses in modern society. Excess! If something is good for us, well, more of it must be better. Not really.

Moderation is important. Very large doses of omega-3 can cause hemorrhagic stroke. Also, when someone has congestive cardiac failure, chronic recurrent angina or any condition where the heart is not getting enough blood flow, the normally beneficial stabilizing effect of omega-3 fatty acids is a negative because it slows down the few hyperexcited cells of the heart. This can lead to sudden cardiac death. Bleeding can be excessive in a patient who is already on aspirin and/or warfarin.

Bottom line – omega-3 fatty acids are a blessing. However, excess can be a curse. Balance, balance in everything. So ….. what should the dose be? The National Institutes of Health recommend between 650 and 900 mg daily of EPA and DHA combined, or 2.2 gm of ALA (for vegetarians). Two tablespoonsful of flaxseed contain about 3 gm of ALA.

Be well, my friend. Until next month, take care of yourself and your health.

Warm regards,

Dr. Ajit Damodaran