Dying for an energy drink?

As someone who gets up at 4:30 am most days to go to the gym and who rarely, if ever, eats carbs, I know there is no easy way to stay fit and healthy.  But, there are others who may be tempted to look for an easier or quicker way…and to them we say- beware!

Before you reach for a weight loss supplement, or energy drink, you may want to think again. According to four separate case reports just presented at the American College of Gastroenterology’s 78th Annual Scientific Meeting in San Diego, consumption of some of these can lead to hepatitis, severe liver damage, liver failure and even death.

Use of herbal and dietary supplements is widespread for a variety of reasons. But many patients don’t disclose supplement use to their physicians, and as such important drug side effects can be missed.

The first case report documented a case over liver toxicity and fulminant liver failure associated with the use of SlimQuick™, a weight loss supplement containing green tea extract.

A 52-year old female patient was admitted to the emergency room after one week of vomiting and progressive jaundice. The patient reported she had ingested SlimQuick™ for two days, while fasting three weeks prior to admission. Her liver biopsy was consistent with hepatic necrosis She was started on steroids but these were discontinued after two days, as liver function worsened and mental status deteriorated to the point she needed to undergo liver transplantation two days later.

In the second paper, Khadija Haroon Chaudrey, MD, presented a rare case of black cohosh-induced hepatotoxicity leading to early cirrhosis. Black cohash is often used by menopausal women to control hot flashes and other associated symptons

A 44-year-old female had developed jaundice for one month, and initial lab work revealed elevated liver function tests (LFTs). The patient had no history of alcohol intake, IV drug use, unprotected sex, recent travel outside the United States, NSAID ingestion or blood transfusions. After an unsuccessful outpatient trial of steroids, she was referred for inpatient evaluation because of gradual progression of her symptoms.

The patient then reported she had started taking black cohosh about one month prior. “Her ultrasound abdomen showed nodular contour of liver consistent with cirrhosis,” said Dr. Chaudrey. “Given patient’s history of black cohosh use and the timing of her abnormal liver chemistries, it was clinically evident the culprit agent was black cohosh.”

Once the patient stopped taking black cohosh, her symptoms improved and her LFTs normalized.

The third case described acute liver failure following consumption of Rockstar® Sugar Free energy drink.

Brian Huang M.D., Chief Resident of the Internal Medicine Residency Program at Cedars Sinai Medical Center, presented a case involving a 36-year-old male without prior medical history. He sought medical attention after symptoms of right upper quadrant abdominal pain, jaundice and fatigue. After abnormal lab work, he was brought to the hospital. The patient admitted to binge drinking (10 beers in a three-hour period) prior to symptom onset. He denied consuming herbal supplements, but admitted to having three Rockstar® Sugar Free energy drinks, on a daily basis for the past year. He too, required a liver transplant.

According to Dr. Huang, “The patients’ pathology reports showed massive hepatocellular necrosis and parenchymal collapse consistent with drug-induced liver injury. We believe his prior history of binge drinking may have provided initial damage on his liver, making him more susceptible to develop liver failure. Although the patient had a history of weekend binge drinking, his liver biopsy was not consistent with alcoholic hepatitis. Thus, they determined that the liver failure was linked to the long-term energy drink consumption.

A fourth case of drug-induced liver injury was found to be associated with the advanced weight loss supplement, Ripped Fuel®. This supplement contains herbal extract with 60% flavinoids, caffeine and cacao.

A 36-year old female with history of depression and no prior liver disease was seen after having one week of abdominal pain, anorexia and nausea. On physical examination, she had jaundice and yellowing of her eyes. The patient had started to take Ripped Fuel® three weeks prior to developing these symptoms, to lose weight. She denied use of other herbal medicine, supplements or acetaminophen. There had been no recent changes in her depression medication.

“There is a lack of knowledge about the status of Food and Drug Administration regulation of dietary supplements,” said Dr. Halegoua-De Marzio, author of the first paper. “Currently, dietary supplements are not required to have safety or efficacy studies before they are marketed to the public, and they remain popular among consumers despite reports of hepatotoxicity. 

These cases serve as a reminder of how even minimal use of dietary supplements can lead to liver failure and liver transplant. It is important that patients talk with their doctors before starting any new dietary supplements.

Or better yet, stick with the old fashioned way of healthy diet and exercise.  So who wants to join me in the gym at 5am tomorrow?

Kudos to Canada

This morning, SRxA’s Word on Health salutes the Canadian city of Hamilton, Ontario, for its pioneering lead in anaphylaxis safety. Hamilton is destined to become the first city in the world to require all food service outlets to have life-saving epinephrine auto-injectors on hand for people with severe food allergies.

The move is being led by Hamilton Councillor  – Lloyd Ferguson, in hopes of avoiding sudden and tragic deaths like one this past spring of a Stoney Creek girl.

Twelve-year-old Maia Santarelli-Gallo had what her doctor said was a mild allergy to eggs and milk that had only ever caused her a runny nose. But last March, while eating an ice cream cone at a Hamilton-area mall with her father and older sister, Maia experienced a sudden, severe allergic reaction.

Her sister found someone with an epinephrine injector, but by the time it was administered, it was too late. Emergency crews took Maia to hospital but she was pronounced dead.

When Councillor Ferguson heard about Maia’s death, he decided to draft a ground-breaking motion to get epinephrine auto-injectors in every restaurant and mall in the city.

He says it’s high time that food providers have access to medicines that could help their customers who develop allergic reactions. He says if automated external defibrillator (AEDs) are now being installed in arenas and other community centers, it makes sense to have epinephrine injectors in areas where food allergy reactions are most likely to occur.

“It took us about 40 years to get defibrillators into public facilities and they have been a great success. This is the next step,” he says.

Allergy specialist Dr. Mark Greenwald, Allergist, and Chief Medical Officer of EpiCenter Medical would like to go further and see public awareness campaigns that would train the public on how to use epinephrine injectors, just as there have been campaigns encouraging people to learn CPR.

Greenwald has developed an online course called EpiPenTraining.com, to offer training on how to recognize allergic reactions, and how to use the injectors. He says such training is vital because during anaphylaxis, seconds count.

And anaphylaxis isn’t rare.  Allergic disease is the 5th most prevalent chronic disease among all ages, and the 3rd most prevalent among children. Every 3 minutes in North America, a food allergic reaction sends someone to the Emergency Room. Every 6 minutes, that Emergency Room visit is for anaphylaxis, that’s 10 patients per hour!

In 25% of people requiring treatment, the reaction is their first episode, and they are completely unprepared.  And for 50% of the people who die from anaphylaxis, the victims had life-saving epinephrine, but it wasn’t used or it wasn’t used in time. The other 50% didn’t carry epinephrine despite their previous allergic episodes.

Participants in the online course become SAVE certified – Save Anaphylaxis Victims in an Emergency.

Debbie Bruce of the Canadian Anaphylaxis Initiative was part of a program this past spring to get epinephrine injectors on all fire trucks in Mississauga. She says that like Maia, up to one-third of people who have allergic reactions outside the home did not realize they had a severe allergy and didn’t carry an epinephrine injector. She is now petitioning politicians  to come up with a national allergy plan.

“I think it is a new reality,” she says. “Reactions happen and we need to be prepared.”

Maia’s mother, Leah Santarelli, backs all efforts to make the public more aware of anaphylaxis and hopes the Hamilton city council passes Ferguson’s motion.

“There’s no guarantee that an EpiPen will save your life 100 per cent of the time, just like a defibrillator won’t save you 100 per cent of the time, but it is there as a safety measure,” she says.

The motion is currently being reviewed by the city’s health team; if approved, it should go before Hamilton city council in October.

We certainly hope that it does and that this trend will rapidly spread across the borders.  As Greenwald says – every second counts!

Avoiding Anaphylaxis this Advent

Christmas parties, meals out with friends and family, stockings full of candy, chestnuts roasting on the open fire…

While all this sounds like great fun, there’s a risk that more people than usual will be accidentally exposed to foods they are allergic too. Food allergies are common. An estimated 9 million, or 4%, of adults and nearly 6 million or 8% of children have food allergies with young children being those most affected.

Although childhood allergies to milk, egg, wheat and soy generally resolve in childhood, they appear to be resolving more slowly than in previous decades, with many children still allergic beyond age 5 years. And allergies to peanuts, tree nuts, fish, or shellfish are generally lifelong.

If you’re one of those affected by food allergy, what can you do to avoid accidental exposure this holiday season?

Remind people! Sure you might once have told your hosts that you have an allergy, but a gentle reminder is always helpful, especially at Christmas when things get busy and the alcohol starts flowing!

Just say ‘no’ – if you don’t know what’s in it, don’t eat it. And even if you do, can you really be sure there was no cross-contamination in the kitchen.

Bring snacks, rather than rely on your hosts to have food you can eat…or

Stay home. Host the party yourself – then you know it’s safe.

Bring your epinephrine auto-injector with you –and keep it close to hand! Make sure somebody else at the party knows you have food allergies, where your auto-injector is and how to use it.

Know the Symptoms – within minutes, an allergic reaction may turn into a life-threatening severe allergic reaction. Sometimes the reaction can occur in two phases, with another reaction occurring up to 48 hours after the initial reaction.

Use epinephrine immediately after you have been exposed to your allergy trigger – it may prove to be life-saving.  If you are even thinking should I give myself epinephrine, the answer is almost certainly yes!

After giving epinephrine, seek emergency medical attention – call or have someone else call 9-1-1 or your local emergency medical services.  In most individuals, epinephrine is effective after one injection. However, symptoms may recur and further injections may be required to control the reaction. Epinephrine can be re-injected every 5 to 15 minutes until the severe allergic reaction stops completely.

Do you have your anaphylaxis Action Plan ready?  If not, make it part of your holiday preparations. It could be the best Christmas present you give yourself this year.

Wishing You a Safe and Healthy Thanksgiving

On the eve of Thanksgiving, we are thankful for many things not least you – our readers. So we’d like to help keep you and your family safe and healthy this holiday with a few seasonal safety tips.

While we all know the dangers of Thanksgiving over-indulgence, did you know that cooking, rather than eating is the number one cause of accidents and illness over the holiday!  So whether you plan on deep frying the turkey or stuffing it, here’s some basic advice to help keep you safe.

Food Poisoning 

• Wash hands thoroughly when handling uncooked meat
• Keep cooked and uncooked meats separate from each other…and other food
• The turkey should be completely thawed before cooking
• When oven cooking a turkey, the oven temperature should be no lower than 325^°
  
• Ideally, cook stuffing outside the turkey, but if you choose to stuff, make sure the stuffing reaches a minimum temperature of 165^°

Burns 

• Turkey fryers should always be used outdoors, on a solid level surface a safe distance from buildings and flammable materials.
• Never use a fryer on a wooden deck, under a patio cover, in a garage or enclosed space.
• Don’t overfill the fryer.
• Never leave the fryer unattended because, without thermostat controls, the oil will continue to heat until it catches fire.
• Never let children or pets near the fryer when in use or after use as the oil can remain hot for hours.
• Use well-insulated potholders or oven mitts and safety goggles to protect from splatter.
• Keep all-purpose fire extinguishers nearby.
• If a turkey fryer fire occurs, call 911 immediately.
• Avoid wearing lose clothes. A dangling sleeve can easily catch fire.
• Make ovens and fryers a “Kid Free Zone”.
• Keep pot handles toward the back burners to reduce risk of knocking pots over.

Cuts

• Stay focused when slicing food.
• Give the carving duty to the most experienced carver. No first timers allowed!

Heartburn – many people eat too much, too fast on Thanksgiving which can quickly cause heartburn, indigestion and create chest pain. This can feel like a heart attack which leads people to seek medical attention.

• Eat slowly
• Take breaks in between courses
• Keep antacids on hand

A happy and healthy Thanksgiving to all!

Staying Healthy this Halloween

SRxA’s Word on Health wishes all of our readers a Happy and Healthy Halloween.  For the 50 million or so people living on the Atlantic Seaboard of America affected by Mondays’ Frankenstorm we hope you are staying safe and recovering from the devastation wreaked by Sandy.

Although the United States experiences hurricanes almost every year and most people have a rudimentary knowledge of the dangers, there are a number of health risks that people seem to forget about in every storm. And frequently, it’s these things that cause unnecessary deaths, injuries, and illnesses.

While many people believe that high winds are the greatest risk from a hurricane, that’s simply not true. According to Ready.gov the majority of deaths are from flooding.   Flooding deaths often result from people trying to wade or drive through moving water or water of unknown depth.  Six inches of water will stall most vehicles – a foot of water may float a vehicle. Sadly, many flood deaths happen as a result of misadventure. Victims who chose to ignore warnings and drive around barricades set up to restrict travel in flood danger areas.

Other deaths happen when people walk or drive through flood water and discover that the ground has been washed away or the water is too deep to cross. Falling trees and tree limbs are another cause of hurricane deaths and injuries. Wait until the storm passes to begin any work on these hazards, even if they have fallen on a house or car. And even then take extreme care.  The Centers for Disease Control (CDC) warns that tree parts can move without warning by a mistaken cut of a saw.  If in doubt call your local fire department or check out the CDC’s advice on preventing chain saw injuries.

High winds and flood produces power outages and electrical dangers. Electrical providers suggest that all downed wires should be considered as live. Stay ten feet away, at minimum. And remember don’t touch tree limbs, fences or other objects that a power line is touching since they can conduct electricity, sometimes for hundreds of feet.

Flooded homes and flooded appliances inside homes represent another electrical hazard. Don’t use power outlets or lights in a building that was flooded until the electrical system has been inspected by an electrician. Carbon monoxide poisoning is another oft overlooked danger after a hurricane. Carbon monoxide is colorless and odorless and exposure can be deadly. Please remember that generators, charcoal grills, hibachis and other similar cooking methods should only be operated outside.

And even when the worst of the storm is over, as things start to dry out, those that got wet in the flooding will begin to mold. The CDC offers a web page about how to reenter a flooded home and another on dealing with the dangers of mold. You should also keep in mind that any surface that was flooded, especially basements may be contaminated with sewage.

Also consider the dangers from food spoiled by loss of power. If the power is out for less than 2 hours, then the food in your refrigerator and freezer should be safe to consume. However, if the power is out for longer than 2 hours, then you should remember the following:

A freezer that is half full will only hold food safely for up to 24 hours. A full freezer will hold food safely for 48 hours. Beyond that you will need to toss the contents.

So whether you hunkering down, bailing out or trick-or-treating today, please stay safe and healthy.

Allergic to Valentine’s Day?

Does Valentine’s Day make you sick?

Those of us who don’t expect to receive cards and flowers tomorrow, would probably rather fast-forward to February 15^th than endure a day of being surrounded by loved-up romantics.

However, it seems that it’s not only singletons who want to forget the 14^th. People with food allergies may also want to give cupid a wide berth.

“Having an allergic reaction immediately after kissing someone who has eaten the food or taken the medication that you are allergic to isn’t highly unusual,” says allergist Sami Bahna, MD. “However some patients react after their partner has brushed his or her teeth or several hours after eating. It turns out that their partners’ saliva is excreting the allergen hours after the food or medicine has been absorbed by their body.”

Symptoms of kissing allergies include swelling of the lips or throat, rash, hives, itching and wheezing.

When things turn more intimate, allergies can be even more disruptive. Allergists have seen cases of people experiencing allergies to chemicals in spermicides, lubricants, latex or even a partner’s semen. Some people even develop hives or wheezing from the natural chemicals released by their own body during sexual interaction.

So what are lovebirds to do?

If you suffer from food or medication allergies, before puckering up you should ask your partner to brush his or her teeth, rinse his or her mouth and avoid the offending food for 16 to 24 hours before smooching.  For people allergic to their partner’s semen, we suggest the use of condoms or better still, that you visit your allergist to discuss immunotherapy or allergy shots.

Whether you’re celebrating  Valentine’s Day tomorrow or not, SRxA’s Word on Health wishes you a happy and healthy February 14^th.

Be S.A.F.E.

SRxA’s Word on Health was deeply saddened to hear of the seven-year-old girl from Chesterfield County, Virginia who died this week after suffering an allergic reaction at school.  According to news reports she was given a peanut from another child who was unaware of her allergy.

Our heartfelt condolences go out to her family and friends. We dedicate this blog as a tribute to her and all the other children who have lost their lives to anaphylaxis.

Although there’s no cure for food allergies, as we’ve reported in the past, such deaths are almost entirely preventable with proper education and immediate treatment with epinephrine.   And even though we don’t know all the details of this case, what we do know is that food allergies are on the rise. 8% of children under age 18 in the United States have at least one food allergy.

Now, we’d like your help to prevent a similar tragedy from happening in the future.

The American Academy of Allergy, Asthma and Immunology’s  Be S.A.F.E. campaign is dedicated to educating patients and healthcare professionals on the steps needed to save lives. We urge you to read the campain’s action guide and share it with your colleagues, friends, and relatives. If you have kids in school, make sure the teachers are aware of it. If you use a gym, make sure the trainers know. Tell your favorite restaurant, share with your employer…the list goes on and on.

Seek immediate medical help. Call 911 and get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine.

Identify the Allergen. Think about what you might have eaten or come in contact with – food, insect sting, medication, latex – to trigger an allergic reaction. It is particularly important to identify the cause because the best way to prevent anaphylaxis is to avoid its trigger.

Follow up with a Specialist. Ask your doctor for a referral to an allergist/immunologist, a physician who specializes in treating asthma and allergies. It is important that you consult an allergist for testing, diagnosis and ongoing management of your allergic disease.

Carry Epinephrine for emergencies. If you are at risk for anaphylaxis, make sure that you carry an epinephrine kit with you at all times, and that family and friends know of your condition, your triggers and how to use epinephrine. Consider wearing an emergency medical bracelet or necklace identifying yourself as a person at risk of anaphylaxis. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and know what to do in an allergic emergency.

So there you have it. 4 simple steps that could save lives. Go share them!

Leave No Egg Uncooked

In recent months, SRxA’s Word on Health has noticed a flurry of Internet sites touting raw egg drinks or shakes as “primal and powerful,” with others suggesting uncooked eggs be blended with vanilla or avocado for a tasty, healthy snack.  Such sites are rife with comments insisting that the connection between raw eggs and salmonella is a myth.

Suzy Weems, Ph.D., a national food expert and chair of Baylor University’s family and consumer sciences department, has this advice for health-seekers: “Under no circumstances eat a raw egg.”

While only a tiny percentage of eggs are contaminated, virtually every egg has had some contact with salmonella. Because the bacteria can lead to food poisoning and the fever, diarrhea and dehydration that accompany it “it’s best to be proactive,” cautions Weems.

Extolling the virtues of raw eggs is nothing new.  Nutrition guru Bernarr Macfadden advocated them as far back as the 1890s while modern proponents claim that heating the egg changes its chemical shape and destroys many of its nutrients and proteins.

Although relatively few people are tempted to wolf down raw eggs, those who love eating raw cookie dough need to be aware that it too is risky because it contains uncooked eggs.

“There are a lot of old recipes floating around that call for raw eggs, but people need to realize if the recipe is based on one from when Grandma gathered her eggs, then Grandma gathered them locally. There wasn’t much of a time lag,” Weems said. “Now, eggs are much more likely to sit for a time before being used, and that gives salmonella the chance to grow.”

Risk of salmonella contamination lessens with eggs from cage-free, organically fed chickens, and salmonella generally is not life-threatening. Most at risk are children, senior citizens, pregnant women and people with compromised immune systems.

So, the bottom line – eggs can still be incredible, just make sure they’re cooked.