Guys should not take this medicine because it could cause male infertility

Anabolic steroids and male infertility

How many more medicines will be found to cause male infertility or ruin a male’s reproductive health? Male infertility is the inability of the male to cause pregnancy in a fertile female.

Male infertility statistic

           WHO who conducted a survey from 1990 to 2004 and found out that male infertility in developing countries affects one in every four couples. In a study published by BMC on April 2015, it stated that male infertility affects an estimated 48.5 million couples globally and male infertility factors are responsible for 20-30% infertility cases and contribute to 50% cases overall. However, it does not represent all cases in all regions of the world thus the male infertility statistic presented is inaccurate.

            If you have read the previous blog linking acetaminophen and decreased testosterone production in unborn baby boys which could make it hard for these babies once adults to make their partners pregnant, unfortunately another medicine adult males take could make them infertile.

Male infertility causes

            According to American Pregnancy there are four causes of male infertility:

·         Sperm transport disorder (10-20%)

·         Gonad disorder (30-40%)

·         A hypothalamic or pitituary disorder (10-20%)

·         Unknown causes (40-50%)

            40-50% unknown causes don’t sound good thus, studies and researches are being conducted on this subject to determine these unknown causes.  In one of the researches that can be found at NCBI titled, “Anabolic steroids abuse and male infertility”, it found out that there is a higher aromatization of male testosterone when there is an excess use of anabolic steroids.  Aromatization means it is the process that converts testosterone into estrogen.  Estrogen plays an important role in men in the regulation of testosterone, sexual function/libido, cardiovascular function, cholesterol regulation, bone health and skin health however when the normal level of estrogen is elevated it could decrease testosterone leading to negative side effects like enlarged breasts, male infertility and erectile  dysfunction.

            Anabolic Androgenic Steroids are prescribed by physicians to men who don’t produce enough testosterone on their own and to help people with certain kinds of anemia. Anabolic steroids are synthetic derivatives of testosterone used to increase testosterone production thus it mimics the natural testosterone. When the testosterone levels in the blood are raised by use of anabolic steroids, it would cause the testicle to produce testosterone which is vital for sperm production. The effect is reversible when usage is stopped in three months to a year but if used for a long time and in high doses, it can damage fertility permanently.

            In a news article published by NHS on August 2016, it stated that one of the emerging main causes of preventable male infertility factor is the use of anabolic steroids. There is an increasing number of men as well as teenagers who opt in the use of steroids to help build up muscle bulk and most are not aware of the side effects that this could lead to male infertility.

          

 Natural Aromatase Inhibitors

            There are studies showing that estrogen level can be decreased naturally like red wine and cruciferous vegetables. A study titled, “Natural Product as Aromatase Inhibitors” was published in Bentham Science on 2008 evaluated nearly 300 natural products in their ability to inhibit aromatase.

            It is best to avoid steroids just to have big bulky muscles and should be only used when advised by a physician. For people who can’t be stopped from taking steroids just to look manly it is better to consult urologist-andrologist for advice.

Acetaminophen (Paracetamol) Linked to Decreased Vaccine Response and Low Testosterone Level in Men

Acetaminophen side effects on pregnant women and children

             Acetaminophen also known as paracetamol outside the United States is one of the leading over-the-counter drug globally. Tylenol the leading brand of acetaminophen in the United States sold more than 330 million dollars in 2018. Acetaminophen is the most commonly used fever reduction for infants and a drug of choice for pain on pregnant women.

            Acetaminophen side effects are one of the researches that are constantly being conducted. Acetaminophen at a recommended dose has established its safety and efficacy but when acetaminophen maximum daily dose which 4 grams is exceeded and the usage is prolonged it could lead to liver damage. The FDA is now asking drug manufacturers to limit acetaminophen’s strength in prescription drug products to 325 mg per tablet or capsule making these products safer for patients.   

             In the United States acetaminophen overdose is the second most common cause of liver failure requiring transplantation and it has replaced hepatitis as the most common cause of acute hepatic failure. In Great Britain, acetaminophen overdose is the most common cause of liver failure requiring liver transplantation.

Acetaminophen overdose

            According to the American Academy of Pediatrics there is a very low incidence of toxic effects on children but acetaminophen toxicity remains a concern because it is used widely in children. Way back in 1997, a data collected by 66 US regional poison control centers, of 94 fatal acetaminophen overdose cases, 25% of it were associated with unintentional therapeutic error and intentional misuse thus it indicates the lack of understanding on the part of caretaker or patient regarding acetaminophen therapy.  Over the years a lot of researches about acetaminophen side effects and acetaminophen toxicity have been conducted. To avoid acetaminophen overdose in children, dosing should be based on weight of the child using 10-15 mg/kg/dose.

           

             A study published in the British Journal of Clinical Pharmacology on March 2018 revealed that unintentional overdose of acetaminophen happens during cold and flu season. A lot of people taking over-the-counter cold and cough remedies that contain acetaminophen take it routinely with Tylenol or other acetaminophen brands for pain or fever thus ingesting excessive amount.

           

Prophylactic acetaminophen in infants reduces vaccine response

            The Lancet published a research sponsored by Belgium based Glaxo Smith Kline Biologicals which showed that acetaminophen administration decreases antibody responses to several vaccine antigens. Investigators randomized healthy infants in the Czech Republic and involved more than 400 healthy infants who are received vaccines against Pneumonia and Influenza co-administered with a diphtheria, tetanus, acellular pertussis, hepatitis B, inactivated poliomyelitis, and Haemophilus influenzaetype b (Hib) conjugate vaccine and oral human rotavirus vaccines (prevention of diarrhea to infants and children caused by rotavirus which is the common cause of diarrhea in children and infants globally).

            The study concluded that administration of acetaminophen at the time of vaccination should not be routinely recommended since it reduces vaccine response.

Prenatal acetaminophen exposure and language delay in girls

            In a study published on European Psychiatry on January 2018, researchers from the Icahn School of Medicine at Mount Sinai found an increased rate of language delay in girls at 30 months born to mothers who used acetaminophen during their early pregnancy.  There were 754 women on their 8-13 weeks of pregnancy were enrolled into the study. The participants were asked to report the number of acetaminophen tablets they had taken between conception and enrollment and tested the acetaminophen concentration in their urine at enrollment.  Their child’s language milestone at 30 months were assessed by nurses and follow-up questionnaire completed by participants regarding their frequency of language delay which is defined as the use of fewer than 50 words. Those parents who took acetaminophen more than six times in their early pregnancy were nearly six times more likely to have language delay than girls born to mothers who did not take acetaminophen in their early pregnancy. 

            The Study concluded that the use of acetaminophen in pregnant women should limit their use of the analgesic during pregnancy. The study’s senior author, Shanna Swan, PhD, Professor of Environmental and Public Health at the Icahn School of Medicine at Mount Sinai stated that it is important to look at the language development because it has shown to be predictive of other neurodevelopmental problems in children.

High acetaminophen level in men may delay pregnancy

            Couples in which the male partner had high levels of acetaminophen in his urine took longer to achieve pregnancy than couples in which the male had lower levels of acetaminophen in his urine. Prolonged acetaminophen use may reduce testosterone produce in unborn baby boys; a research has found which was published at Science Translational Medicine on May 2015. The study was funded by the British Society of Paediatric Endocrinology and Diabetes, Wellcome Trust and the Medical Research Council. The authors found that a single acetaminophen therapeutic dose had no effect on testicular development but continued dosing of acetaminophen for a week could reduce fetal testosterone by 45 percent. The authors recommended that that the lowest effective dose of acetaminophen should be taken for the shortest possible time by pregnant women.

            It should be noted that these acetaminophen side effects can happen when not used with caution and be always reminded that a very high fever and pain in pregnancy could put the baby at risk. The preferred antipyretic is still acetaminophen. A pregnant woman should not take aspirin or ibuprofen, taking ibuprofen regularly in the first trimester may increase the chance of having miscarriage. The baby could also develop cleft palate, heart defect or defects in the abdominal wall. Though a single dose of ibuprofen at any stage of pregnancy is unlikely to cause the mother or the baby harm, it is still best to be cautious and stick with acetaminophen being far safer.

           

            Don’t be afraid to take acetaminophen but be cautious. Do not take acetaminophen when not needed and do not prolong the use. All drugs have side effects and acetaminophen which is considered to be a very safe drug is not an exception.

            Perhaps you can manage common pains such as back pain which is one of the most common among pregnant women, in non-pharmacological way and not take acetaminophen. You can always talk to your Doctor on whatever recommendations she/he may have.

What You Need To Know About Vaccines and Vaccine Schedule..

Vaccine-schedule-safety

Not so long ago, I was browsing through my feed on facebook when I read a post:

“If I were you, I wouldn’t have the Japanese Encephalitis Vaccine”

This sparked interest in some of her circles and asked why especially in the midst of measles outbreak on different parts of the globe where authorities are encouraging the public to get vaccinated. As I followed the thread, it was revealed that she is a nurse and she doesn’t recommend following vaccine schedules as well as the use of synthetic drugs and just boost their immune system with vitamin C rich fruits and vegetables.  It is impractical though to be able to obtain the required vitamin C from eating vitamin C rich fruits and vegetables. According to Mark Moyad, a researcher of the University of Michigan, who studied Vitamin C only 10-20% of adults get the recommended nine serving offruits of vegetables daily thus, it is still practical to take vitamin C supplements.

She further commented that there are no researches on the safety of vaccine schedule. Honestly, the statement is unreasonable and it would be a waste of energy digging for links to prove that there were researches done nonetheless; I still left a link about a research conducted on the safety of vaccine schedules for the sake of those who believe too easy on such stupid claims.  

My hunch was right, even if there are researches about the safety of vaccine schedules, people who are really against vaccines will always find something to say against it. She posted links from anti-vaxxer websites and conspiracy theories about the big pharmaceutical industry and government. She and others in her circle believe that all the research articles posted online by big pharmaceutical industries are sponsored by the government since there is conspiracy to inflict diseases as a way to reduce population thus they target the children. Some nurses in her circle refuted her comment and I left my own comment as well however her post already scared some of the mothers to have their kids vaccinated, the survey that new mothers usually resort to social media for health advice is indeed true.

I was shocked on the reaction of others, how easy they can be persuaded. Indeed, we live in an era where the power of social media is undeniable thus everyone should think more than twice about the things being shared on social media platforms especially when it comes to sensitive issues.

What is vaccine schedule?

Vaccine schedule is also known as immunization schedule. These are the schedules of vaccines especially on children at a certain age which actually starts from birth.  It is a guide for health practitioners and parents on what vaccines should be routinely given.

Vaccine schedule for measles on children are being recommended by CDC at two doses and this is in combination with mumps and rubella (MMR). One dose of MMR vaccine is 93% effective while two doses are about 97% effective against measles. The first dose can be given to kids 12 months to 15 months and the second one to kids’ ages 4 to 6 years old.  There is a lifelong protection for measles after completing these vaccine schedules.

Measles vaccine can be given to babies below 12 months on certain conditions such as outbreaks or international travel. When my daughter was 6 months old, there was a case of measles infection in our area so the health care worker gave her measles vaccine, a month after that the number of measles case increased prompting health care workers to launch measles vaccination drive. 

CDC recommends that when children received MMR vaccine before their first birthday they should still follow the vaccine schedule, one when they are 12-15 months and the second dose from 4 years old through 6 years old or 28 days apart from the first dose.  For infants 6 months to 11 months who will be travelling internationally, it is recommended that they should get one dose of measles vaccine and for children ages 12 months. Vaccine schedules for teenagers and adults are 2 doses which are 28 days apart.

There are measles outbreaks in the US, as of this writing, and it was reported by CDC that these outbreaks are linked to travelers coming from countries having large measles outbreaks such as Philippines, Ukraine, and Israel. The majority of people who were infected with measles were unvaccinated. Refusals of vaccines by most of the affected communities were attributed to misinformation about vaccines.

How are vaccine schedules determined?

Robyn Correll, a Master of Public Health (MPH) graduate detailed in his article “how vaccine schedules are determined”. Advisory Committee on Immunization Practices (ACIP), a group of 15 voting members who are experts in the field of public health and medical practice, makes recommendation regarding vaccine schedules which is later adopted by the American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention (CDC) and used by all medical teams in the country to vaccinate patients. Vaccine schedules differ from country to country depending on the factors. Also, schedule doesn’t apply to everyone, a medical condition of a child is just one of the deciding factors if the child should be vaccinated early or there is a need to adjust the dosage.

Why so many vaccine schedules for children under age five?

While it may seem alarming or scary to have the kids vaccinated at an early age especially before the age of two to five, it is at this stage that most kids are vulnerable to some disease and extensive research have been conducted on vaccine schedules. It is at that stage where the vaccine will have great impact in their immune system. It was also found out that most vaccines will work when given more than one dose. American Academy of Pediatrics addressed some of the public’s queries about vaccine and vaccine schedules in their article: The Childhood Immunization Schedule: why is it like that?

Pneumococcal vaccine for example, when I was working as a hospital pharmacist, cases of pneumonia on unvaccinated kids below 2 years old are relatively high. Some even are hospitalized before they reach 2 months old. Vaccine schedule of PCV starts at 2 months old then 4 months, 6 months and at 12-15 months.  Kids are most vulnerable to pneumococcal strains before they reach 2 years old. WHO reported that there are about 90 distinct pneumococcal strains and the pneumococcal vaccines available at the present will only protect 13 types which causes the most common pneumococcal infections in kids and one is PPSV23 against 23 types. Estimated duration of protection from pneumococcal vaccine after receipt of all recommended dose is greater than four to five years.

Are there any researches on the safety of vaccine schedules?

The claim that there are no researches on the safety of vaccine schedules is really unrealistic.  Studies on the safety of vaccine schedules are constantly being conducted. In the US, Vaccine Safety Data (VSD), a collaborative project between CDC’s immunization Safety Office and eight health care organizations was created in 1990. They continuously conduct researches on the safety of vaccine schedules. Big pharmaceutical company may have invented vaccines but not only is the FDA involved when it comes to recommendation of vaccine schedules. Researches on the safety of vaccine schedules are continuously conducted by different agencies and groups of experts in the field.

If you still have some doubts you should also read the book “The childhood ImmunizationSchedule and Safety: Stakeholder Concerns, Scientific Evidence and FutureStudies at the National Center for Biotechnology Information (NCBI) resources.

Ignorance or not delving deep to find more information before making judgment is dangerous. The information we need are all there, we just have to dig. If you are too bitter then you would think everything or everyone you don’t like want to harm you and if you are too gullible, giving in so easy without knowing further could put yourself or those people around you on the line.

There are researches about the safety of vaccine schedules so please stop spreading ignorance!

Are herbal medicines safe and effective?

‘He was having dialysis then decided to take herbal medicine someone offered him and after few months he passed away”. It has been years since my brother told me this frightening story but it always comes to mind each time I hear people claim about the safety and efficacy of herbal medicines. We live in a world where there is a continuous epidemic caused by evolution and the never ending deterioration of our environment and so what worked yesterday may not work tomorrow. Healthy living will always be a concern but the strategies will not always be the same. There is a need to embrace some changes.

When it comes to healthy living, herbal medicines are significant but synthetic drug products are significant too. What people fear the most are the side effects and adverse reactions, no known synthetic drug do not have any side effect. It is most unlikely that there will be no drug-drug interaction when taking multiple drugs at the same time and some could be fatal. However, do the noted side effects of synthetic drugs make the herbal medicines more safe and effective? One of the things people fear is damaging their kidneys and liver from synthetic drugs thus resort to herbal medicines. 

This could be true with paracetamol/acetaminopen, an over the counter drug where in overdose of this drug is one of the leading causes of liver failure however when it comes to totally stopping your heart medications and opt to herbal medications instead, it could harm your kidney more. Losartan for example, is an antihypertensive drug which helps in future heart attacks, strokes, and kidney problems related to diabetes. Do not just stop your medications, you have to be open to your health care practitioner because what you think is a bad effect could be otherwise or they will adjust the dosage of your prescribed medication if it is safe to take it with herbal medicine or you don’t have any underlying condition where taking that herbal medicine could have serious side effects.

When you use or decoct herbal plants for example, are you well knowledgeable about doing it or using it? There is proper decoction of herbal plants for you to achieve its potency and efficacy. When using such herbal plants you need to have proper knowledge about the plant. It might do you more harm when you don’t have enough knowledge about the extraction procedure and dosage because some plants are highly toxic. The lack of information about herbal medicines is being taken for granted and some just think it is 100% safe because it is natural.

Before a new synthetic drug product will be out in the market it will undergo 15-20 years or more of study which includes clinical trials on both animals and humans. After the safety and efficacy has been established well then it will be fully approved by the FDA and even if these products are already approved, there will still be continuous monitoring of the drug product, thus you may have heard that some drug products have been recalled in the market.

Unlike synthetic medicines herbal medicines are not required to undergo rigorous scientific research and study using clinical trials to establish the safety of the drug. There are some that have undergone clinical trials but not all herbal medicines went through the process. I have seen some people who are against synthetic drug products and post on social media platforms encouraging others to always read the drug inserts of drug products which will prove to them that vaccines or synthetic drugs are not safe because of the listed side effects. Studies on the safety of vaccine schedules are constantly conducted! (but wait! you better click and read this if you believe the stupid rumor)....... 

It is true, it is always best to read drug inserts especially those of over the counter drugs since 90-95% of the information you need to know are already there, those inserts are there to help the public. However it doesn’t mean that because most of the herbal medicines don’t have drug inserts which indicates the side effects, it is already safe and effective. It may be a safer alternative to pharmaceutical drugs on some health conditions like colds, arthritis and cough but there are so many health conditions where it has no therapeutic effect at all and only synthetic medicine can do the work.

Ironically, people in some networking companies especially in developing countries selling herbal medicines with “No Approved Therapeutic Claims” written on the boxes would pitch those medicines could cure serious diseases. Herbal medicines that have no therapeutic claims are excellent supplements and help in the prevention of diseases however these could not treat serious diseases such as life threatening diseases. It is unethical to interfere someone’s medical treatment that was advised by a physician or health care practitioner and tell them to use herbal medicines instead. An expert practitioner in the field of Complementary and Alternative Medicine (CAM) will never tell you to abandon your conventional medical treatment prescribed by a physician and use herbal or natural products instead.

The proper use of complementary and alternative medicine; and conventional medicine are all essential in healthy living. Complementary and alternative medicines are used to prevent diseases and should not be used alone to treat serious or life threatening illnesses. You cannot just give a dose of herbal medicine to someone who is having a heart attack for example however; herbal medicine can improve heart health and prevent the occurrence of heart attack. 

Though high quality herbal medicines are known to treat some health conditions, one should still consult a physician or a practitioner in the field before using herbal medicines together with pharmaceutical products or before refusing conventional medicine and opting to herbal treatment especially if you have multiple illnesses. For example, one of the uses of garlic is to lower cholesterol level however it is not recommended to use this together with antithrombotic drugs because it could increase bleeding. That is why this is not recommended to people who are scheduled to have a surgery because it might prolong bleeding same with people who have bleeding disorders. These is just one of the things one should know when taking garlic but there are more one needs to know.

If we are to study healthy living, complementary and alternative medicines are one of the strategies including herbal medicines however the claim of some that this is 100% effective and safe is too good to be true. Herbal medicine can be a safe alternative and can be as effective or more effective than other synthetic medicine on some health conditions only. 

The integration of complementary medicine and conventional medicine are being integrated recently which is called integrative medicine. More studies and researches are being done in this field on the integration of both practices in various health conditions. After all, balance is what we need.

Binge Eating and Diarrhea

binge-eating-and-diarrhea

It wouldn't surprise me if for the past few days a lot patients have been going to the emergency room for diarrhea, nausea and upset stomach, after all, long holidays just passed by and a lot have been binging on food. Large meals, chocolates, fatty foods, alcohols and sweets could exacerbate irritable bowel syndrome causing diarrhea on patients. It could be bacterial infection as well caused by contaminated food or water ingested. As a hospital pharmacist, I have received a lot of prescriptions for oral rehydration salt from patients who just had their check up at the emergency room.

During festivities, a lot of people have erratic and irregular eating habits causing a lot Gastrointestinal problems including diarrhea. The first thing that would come to mind when someone begins to have a diarrhea after eating a large meal is that the person must have eaten something that doesn't agree with their stomach or it could be contaminated, however, when they are used to eating small amount of meals it could put a strain on their digestive system to process what they have ingested faster which could eventually irritate the digestive system and lead to forceful expulsion of the excess food either by vomiting or diarrhea. Stretching of the stomach or upper bowel can stimulate the contractions in the colon that lead to bowel movement. The bowel movement may not be always diarrhea but if overeating continues or is really excessive and if there are other factors that alters stool formation then it could result to diarrhea.

Diarrhea due to eating excessive amount of food does not require antibacterials. You just need to be hydrated and get some bed rest. You have to ensure adequate oral rehydration and fluid intake. You can buy oral rehydration salts over the counter and this should within 24 hours upon mixing. Any excess should be discarded. You can also prepare your own homemade solution by adding 1 teaspoon of salt and 4 teaspoon of sugar to 1 liter of water. If it persist then you have to consult a physician or go to the hospital.