Column: The People's Pharmacy

FROM KING FEATURES SYNDICATE, 300 W. 57TH STREET, 41ST FLOOR, NEW YORK, NY 10019 CUSTOMER SERVICE: (800) 708-7311 EXT. 236 FOR THE WEEK OF JULY 12, 2021 (COL. 2 OF 3) GRAEDON—THE PEOPLE’S PHARMACY The pros and cons of immune modulating drugs

BY JOE GRAEDON, M.S., AND TERESA GRAEDON, Ph.D. Some of the most expensive drugs in the world are used to dampen down the immune system. The top seller for years has been adalimumab (Humira). It earned more than $10 billion in the U.S. alone last year and has been a perennial moneymaker for the manufacturer.

Humira is prescribed for rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, plaque psoriasis and a few other inflammatory conditions. Similar drugs such as etanercept (Enbrel), certolizumab (Cimzia), golimumab (Simponi) and infliximab (Remicade) are also big moneymakers. Collectively, they are called TNF-alpha blockers.

When a doctor offers to prescribe one of these medications, weighing the potential benefit against the risks is challenging. That’s because they can be very helpful in controlling dreadful symptoms of these hard-to-treat diseases. On the other hand, they can also cause some serious complications.

In one TV commercial, a father is missing too many events in his young daughter’s life. The voice-over announces that “Humira is for people who still have symptoms of Crohn’s disease after trying other medications, and the majority of people on Humira saw significant symptom relief and many achieve remission in as little as four weeks.” That certainly sounds appealing to someone suffering with this severe bowel disorder.

Perhaps you’ve seen golfer Phil Mickelson in another television commercial.

He talks about his problem with serious joint pain from psoriatic arthritis. He closes the commercial suggesting: “Get back to the things that matter most. Ask your rheumatologist if Enbrel is right for you.”

Both ads contain a long list of frightening side effects. Tinkering with the immune system can stir up some pretty scary problems at the same time it helps others. For example, some Humira ads caution: “Humira can lower your ability to fight infections. Serious and sometimes fatal infections including tubercu-

losis and cancers including lymphoma have happened as have blood, liver and nervous system problems, serious allergic reactions and new or worsening heart failure.”

This is not a complete list. We recently received a note about a little-known adverse effect. “Our daughter is currently taking leflunomide for multiple sclerosis and ankylosing spondylitis.

Before her MS was diagnosed, she was taking Humira for ankylosing spondylitis. It worked well for controlling symptoms, until it didn’t. A couple of physicians speculate that Humira may have been a factor in causing her MS.” In fact, the official prescribing information for Humira warns that it has been associated with demyelinating disease, including multiple sclerosis. When we reviewed the medical literature, we found numerous case reports of multiple sclerosis beginning after a person had been taking one of the TNF-alpha blockers (Therapeutic Advances in Neurological Disorders, Jan. 2, 2020).

Such cases are rare, but for the individuals involved they can be lifealtering. People are more likely to be warned about the possibility of serious infections, including tuberculosis and hepatitis B. In addition, patients are at higher risk for certain cancers. There’s also the chance of heart failure.

The benefits of these drugs are very tangible. Who wouldn’t want to get back to the things that matter most? The risks, on the other hand, seem remote — until one happens. *** Joe Graedon is a pharmacologist.

Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. © 2021 King Features Syndicate, Inc.

FROM KING FEATURES SYNDICATE, 300 W. 57TH STREET, 41ST FLOOR, NEW YORK, NY 10019 CUSTOMER SERVICE: (800) 708-7311 EXT. 236 FOR THE WEEK OF JULY 12, 2021 (COL. 3 OF 3) GRAEDON—THE PEOPLE’S HERBAL PHARMACY Can carotenoid supplement replace sunscreen?

BY JOE GRAEDON, M.S., AND TERESA GRAEDON, Ph.D. Q. My “healthy neighbor in the know” swears that astaxanthin is a better alternative to chemical-laden sunscreens. What say you?

A. Astaxanthin is a type of carotenoid derived from marine organisms. Generally, carotenoids are produced by plants and serve as precursors to vitamin A in animals. However, astaxanthin is not converted to this vitamin. It has antiinflammatory and immune-modulating activity (Journal of Cosmetic Dermatology, January 2020). As a result, dietary supplements containing this ingredient have been promoted for skin health.

We were excited to learn that many carotenoids help protect skin from sun damage (Photodermatology, Photoimmunology & Photomedicine, online, May 5, 2021). According to the scientists, “Oral supplementation with multi-carotene supplements may provide incidental photoprotection with a more uniform coverage over the total body surface area and could potentially help maintain a healthylooking skin.” However, they warn that supplements are not a substitute for effective sunscreens but should be used in addition for complementary photoprotection.

Q. I spent all day yesterday moving furniture and heavy boxes, so by bedtime I fell asleep exhausted. In the middle of the night, I woke with a massive cramp in my right leg, starting with the foot and moving all the way up to the knee, on both the front and back of the leg. It was much more than a standard charley horse!

I tried to stretch it, but nothing would move. So I limped to the kitchen for a spoonful of yellow mustard. The refrigerator shelf was empty! I had pitched the past-date bottle two weeks ago and not replaced it.

I keep mustard powder in the pantry, so I mixed up a spoonful with vinegar and Tabasco sauce. I must say it tasted vile, but within two minutes my leg relaxed, and I slept the rest of the night without a problem. The muscles weren’t even sore

when I woke up. Tell me again why this worked.

A. Muscle cramps associated with unaccustomed exertion seem to be caused by a glitch in the connection between neurons and muscles. Transient receptor potential (TRP) channels in nerves can override and correct that when activated.

Your concoction contained three different compounds that can trigger TRP channels: vinegar, mustard and capsaicin from the Tabasco. Congratulations on coming up with an innovative mixture to take care of the crisis.

You can learn more about the science behind mustard for muscle cramps and other home treatments for common problems in our eGuide to Favorite Home Remedies. This online resource is found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. When you write about coffee, does instant coffee automatically qualify? I drink instant and worry I may be missing benefits.

A. Many studies showing that coffee can help the heart, for example, don’t separate instant coffee from other preparation techniques. However, a recent analysis found that instant and decaf coffee both provide liver protection similar to that from regular brewed coffee (BMC Public Health, June 22, 2021).

Instant coffee, like filtered coffee, has very little kahweol and cafestol, compounds that can raise cholesterol if consumed in large quantities. That makes instant coffee a reasonable choice. *** In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.” © 2021 King Features Syndicate, Inc.

FROM KING FEATURES SYNDICATE, 300 W. 57TH STREET, 41ST FLOOR, NEW YORK, NY 10019 CUSTOMER SERVICE: 800-708-7311 EXT. 236 FOR THE WEEK OF JULY 12, 2021 (COL. 1 OF 3) GRAEDON—THE PEOPLE’S PHARMACY What makes toenails thick?

BY JOE GRAEDON, M.S., AND TERESA GRAEDON, Ph.D. Q. Not long ago, you wrote about toenails that were too thick to clip. I’ve had this problem and use a wide-jaw toenail clipper by Mehaz. It does the trick.

Not all hard, thick toenails are caused by fungal infections. I’ve been dealing with this for seven years on both my big and little toes.

My primary physician wasn’t concerned, saying it’s just cosmetic. Nonetheless, I tried lots of prescription and nonprescription medications, to no avail.

Recently, I saw a podiatrist who took specimens of the nails for analysis. The problem wasn’t fungal, but rather bacterial. He recommended an inexpensive antibacterial ointment such as Neosporin.

It’s working wonders. Three of the nails are clear, and the fourth, the worst, has but a speck remaining.

A. The medical term for thickened nails is a tongue twister: onychauxis.

Although thick, discolored nails are often caused by fungal infections, other conditions, such as psoriasis, can also create this problem.

One study found that 32% of patients with nail disorders did not have detectable fungi (Journal of Cosmetic Dermatology, July 2021). In a different study, researchers used DNA sequencing and found that half of the toenail infections were bacterial (Journal of the American Podiatric Medical Association, March 1, 2021).

A diagnostic workup makes sense, especially if the nail problem has not responded to standard treatments. Toenails grow slowly, so it can take months for them to grow out healthy. You can learn more about various remedies for nail fungus in our free eGuide to Hair and Nail Care. This downloadable PDF can be found in the Health eGuides section of www.PeoplesPharmacy.com.

Q. I’m wondering if you have seen any evidence of a correlation between statins and pleural effusions. I have been taking rosuvastatin for a year. In March I developed a pleural effusion and have had

recurring breathing problems since then.

Multiple tests have not detected a cause.

I stopped taking statins two weeks ago after reading there might be a connection.

A. You took us by surprise with this question. After 30 years of studying statins, we thought we knew every possible side effect associated with these cholesterol-lowering drugs. We were wrong.

The lungs are covered by a thin layer of tissue (pleura). The chest wall is also covered by pleura. The Mayo Clinic describes the process this way: “Normally, these layers act like two pieces of smooth satin gliding past each other, allowing your lungs to expand and contract when you breathe.” When patients develop pleurisy and pleural effusions, there is a buildup of fluid between these layers of tissues. Symptoms may include shortness of breath, cough or chest pain.

There is nothing in the official prescribing information about this. A search of the medical literature, however, turned up cases of pleural effusions linked to drugs such as atorvastatin, pravastatin, rosuvastatin and simvastatin (European Respiratory Journal, November 2007).

We also discovered this: “Statininduced lung injury (SILI) is an uncommon but serious complication of statins” (Postgraduate Medical Journal, January 2013). Scarring of the lungs, while rare, is a serious complication of statins.

Thank you for alerting us to this problem.

Linking pleural effusions or interstitial lung disease with a statin may not be obvious to many doctors. *** In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.” © 2021 King Features Syndicate, Inc.

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