Monday, November 19, 2018

Does Ketamine Work for Depression Or Are Its Risks Too High

Environmental Working Group (EWG) just released its second round of 2018 test results measuring glyphosate, the active ingredient in Monsanto’s Roundup weed killer, in popular oat-based cereals and foods.

The nonprofit organization released the new results after two companies, Quaker and General Mills, told the public it has no reason to worry about traces of glyphosate in its products.

Seems that’s not the case.
Glyphosate in Cereal

In the latest batch of testing, all but two of the products tested contained levels of the potentially-carcinogenic weedkilling chemical above 160 parts per billion (ppb), the health benchmark set by EWG.

These findings come two months after EWG released its first series of tests measuring glyphosate in popular children’s breakfast products. Still, General Mills and Quaker Oats Company immediately went on the defensive, claiming glyphosate levels found in its foods fell within regulatory limits set by the Environmental Protection Agency (EPA).

That may be true, but many public health experts believe the levels of allowable glyphosate in food are far too high and don’t properly protect human health. Previously, Environmental Protection Agency (EPA) calculations suggest that 1- to 2-year-old children likely experience the highest exposure to glyphosate, the potential cancer-causing chemical used in Monsanto’s Roundup. And according to the agency’s risk assessment, the exposure level is 230 times greater than EWG’s health benchmark of 160 ppb.

In the October 2018 batch of testing, EWG commissioned Anresco Laboratories to test a range of oat-based products, including 10 samples of different types of General Mills’ Cheerios and 18 samples of Quaker brand products. These included cereals, snack bars, granola and instant oats. Of the 28 products tested, those with the highest levels of glyphosate include: (1)

The tested products contain glyphosate at levels well above EWG’s safety standard of 160 ppb; Quaker Oatmeal Squares breakfast cereal contained levels of glyphosate 18 times higher than the benchmark.
A Look at Previous Glyphosate in Cereal Testing

Earlier in the year, EWG set a more stringent health benchmark for daily exposure to glyphosate in foods than the EPA and tested an initial batch of products. Considering EWG’s standard of 160 parts per billion (ppb), the following products exceeded that limit in one or both samples tested, with the starred products exceeding 400 ppb: (2)

Companies negatively affected by these tests may point to the EPA’s legal limit for glyphosate in oats, which is 30 parts per million. But since this outdated standard was set in 2008, the International Agency for Research on Cancer labeled glyphosate as “probably carcinogenic” and the California Office of Environmental Health Hazard Assessment categorized it as a “chemical known to the state to cause cancer.”

EWG suggests that the solution is simple – keep chemicals linked to cancer out of children’s food. This may start with the EPA sharply limiting glyphosate residues allowed on oats and prohibiting the chemical’s use as a pre-harvest drying agent.

Earlier in the year, a jury found Monsanto liable in a $289 million-dollar-cancer verdict, independent lab tests.

What does this mean for our children? Without some serious changes made to the food industry and EPA standards, they’ll continue to ingest potentially toxic levels of glyphosate for breakfast. Maybe this will be the last straw for consumers?

EWG turned to Eurofins, a nationally recognized lab with extensive experience testing for chemicals. This testing involved measuring the amount of glyphosate found in popular products containing oats. What is this a big deal? I’m glad you ask …

Previous research suggests that glyphosate, the active ingredient in Monsanto’s Roundup, is linked to the development of non-Hodgkin’s Lymphoma. The bad news? The latest testing detected it in all but two of 45 non-organic product samples. The list of products tested includes Cheerios, Lucky Charms, Nature Valley granola bars and Quaker oats.

Alexis Temkin, PhD, an EWG toxicologist and the author of the report, expressed her concerns about these findings. “Parents shouldn’t worry about whether feeding their children healthy oat foods will also expose them to a chemical linked to cancer. The government must take steps to protect our vulnerable populations,” she said.
Why Is Glyphosate in Our Food?

Why is there glyphosate in our food? According to the U.S. Geological Survey, 250 million pounds of glyphosate are sprayed on American crops each year. Glyphosate is primarily used on Roundup Ready corn and soybeans that are genetically modified to withstand the herbicide.

Glyphosate is a systemic herbicide, meaning it’s taken up inside of the plant, including the parts livestock and humans wind up eating.

And on top of that, glyphosate is sprayed on other non-GMO crops, like wheat, oats, barley and beans, right before harvest. Farmers sometimes call this “burning down” the crops and do this to kill the food plants and dry them out so that they can be harvested sooner.
How Much Glyphosate Is Too Much?

Why do we have to pay attention to glyphosate levels in our food? The simple answer is that glyphosate is linked to an elevated risk of cancer. In fact, the World Health Organization categorizes the weed-killing chemical as “probably carcinogenic in humans.”

So, really, any amount of glyphosate in our food is concerning, especially when it’s found in our children’s food. (And especially since children consume it during critical stages of development.)

So how did EWG come up with the limit for child glyphosate exposure? Using a cancer risk assessment developed by California state scientists, EWG calculated that glyphosate levels above 160 parts per billion (ppb) are considered too high for children. To break that down into simpler terms — a child should not ingest more than 0.01 milligrams of glyphosate per day.

How did tEWG come up with this health benchmark? Under California’s Proposition 65 registry of chemicals known to cause cancer, the “No Significant Risk Level” for glyphosate for the average adult weighing about 154 pounds is 1.1 milligrams per day. This safety level is more than 60 times lower than the standards set by the EPA.

To calculate the recommendation for children, EWG took California’s increased lifetime risk of cancer of one in 1 million (which is the number used for many cancer-causing drinking water contaminants), and added a 10-fold margin of safety, which is recommended by the federal Food Quality Protection Act to support children and developing fetuses that have an increased susceptibility to carcinogens. This is how EWG reached the safety limit of 0.01 milligrams of glyphosate per day for children.

EWG’s health benchmark concerning the amount of glyphosate that poses a threat in our food is much more stringent than what the EPA allows. Although this amount of glyphosate present in oat products doesn’t seem like much in one portion, imagine consuming that amount every day over a lifetime. Exposure to this toxic herbicide will certainly accumulate over time, which is worrisome, to say the least.

“The concern about glyphosate is for long-term exposure. As most health agencies would say, a single portion would not cause deleterious effects,” explains Olga Naidenko, PhD, EWG’s senior science advisor for children’s health. “But think about eating popular foods such as oatmeal every day, or almost every day — that’s when, according to scientific assessments, such amounts of glyphosate might pose health harm.”

And there is some controversy over whether or not we can trust government regulators to make sure the food we eat is safe. This past April, internal emails obtained by the nonprofit US Right to Know revealed that the FDA has been testing food for glyphosate for two years and found “a fair amount.” But these findings haven’t been released to the public. According to The Guardian, the news outlet that obtained these internal documents, an FDA chemist wrote: “I have brought wheat crackers, granola cereal and corn meal from home and there’s a fair amount in all of them.” (3)

According to Naidenko, “It is essential for companies to take action and choose oats grown without herbicides. This can be done, and EWG urges government agencies such as the EPA, and companies to restrict the use of herbicides that end up in food.”
Glyphosate in Cereal: Organic vs. Non-Organic Products

What about organic cereals and oats? EWG findings suggest that organic products contain significantly less glyphosate that non-organic products. To be exact, 31 out of 45 conventional product samples contained glyphosate levels at or higher than 160 ppb, while 5 out of 16 organic brand products registered low levels of glyphosate (10 to 30 ppb). Of all the organic products tested, none of them contained a level of glyphosate anywhere near the EWG benchmark of 160 ppb.

Glyphosate can get into organic foods by drifting from nearby fields that grow conventional crops. Organic products may also be cross-contaminated during processing at a facility that also handles conventional crops.

While glyphosate was detected in some organic oat products, the levels were much, much lower than conventional products, or non-existent. So it looks like the rule still stands — to avoid increased exposure to cancer-causing chemicals like glyphosate, choose organic.
Although antidepressants are such a commonly prescribed group of medications, studies show that a large percentage of patients with depression do not get an adequate level of relief from using these drugs. Even patients who try several different types of antidepressants over the course of years are unlikely to experience significant improvements in their symptoms.

Currently, most approved medications for depression have similar mechanisms of actions and roughly the same limited efficacy — however, a drug called ketamine, which has been around since the 1970s but is now being used in new ways, may change the way depression is treated forever.

Not only is ketamine used legally as an anesthetic during surgery, but more recently it’s gained popularity as a party/club/street drug, having earned a reputation as providing users with an “out-of-body experience.” Recently, studies have also focused on the potential use of ketamine as a therapeutic tool for the management of depression. In a May 2018 Business Insider report, it said “Ketamine is emerging as a potential new drug for depression — the first of its kind in 35 years.”
What Is Ketamine?

Ketamine is an FDA-approved anesthetic drug that has been used for nearly 50 years and, overall, has a very safe track record. It was developed in the 1960s and FDA approved in 1970. Ketamine has potent anesthetic effects, which is why it has been used for decades during surgery to provide pain relief and for various veterinary purposes.  Ketamine is considered an NMDA receptor antagonist drug and has been shown to produce minor hallucinogenic/psychotomimetic effects, meaning it results in not only pain relief but also a mild, short psychotic state. (1)

Is ketamine safe? The World Health Organization considers ketamine to be an “Essential Medicine,” and in the U.S., it’s widely administered to children, adults and pets prior to surgical procedures. (2) Ketamine is used around the world and is actually one of the only anesthetic agents available in most developing countries.

Because ketamine has federal approval as an anesthesia agent, clinics are legally able to administer the drug for patients, although it’s used “0ff-label” when given to patients for conditions like depression. It’s estimated that around 100 clinics spanning the U.S. now administer ketamine infusion to patients with depression and pain-related conditions.

Kalypso Wellness Centers is one organization that promotes ketamine as a treatment for more than two dozen conditions, including: depression, chronic pain, migraines/headaches, anxiety, bipolar disorder, PTSD and inflammatory disorders. According to Kalypso’s website, their clinics (run by Board Certified Anesthesiologists and Pain Medicine Doctors) have over 50 years of experience and have administered more than 3,500 ketamine infusions. They claim that their ketamine treatments have a 91 percent success rate and only cause adverse reactions in about 5 percent of cases. (3)

Actify Neurotherapies is another network of clinics that offer the drug via intravenous injection. There’s been growing concern about clinics such as these that may be offering ketamine even though most providers at the clinics (such as nurses or physician assistant) aren’t qualified to provide mental health care on their own without more supervision.
Does Ketamine Work for Depression?

This is the big question. Ketamine is only currently indicated as an anesthetic agent that is intended to be used during surgical procedures, sometimes combined with muscle relaxant medications or other painkillers/anesthetic agents. The analgesic effects of ketamine work by prevention of central sensitization in certain neurons as well as by the inhibition on the synthesis of nitric oxide. Ketamine can also cause cardiovascular changes and bronchodilation (dilation of the airways in the lungs due to the relaxation of surrounding smooth muscle).

There are now dozens of free-standing clinics across the U.S. that provide various “proprietary blends” of ketamine off-label to patients with depression who are “desperate for an effective therapy and hopeful that ketamine can help,” according to an article published by STAT news. (4) Johnson & Johnson is one company who is actively pursuing a nasal formulation of ketamine and is awaiting results from advanced clinical trials in order to widen distribution.

One downside of using ketamine for depression or other mental health problems is that it needs to be injected and comes at a high cost: ketamine can cost about $495–$570 (or sometimes more) per infusion, although some discount programs are now being offered. It ketamine covered by insurance? Not usually. When a drug is used “off-label,” most patients must pay for the treatments out of pocket, which can really add up if treatments last several months or longer.
How Ketamine Works

Ketamine for the use of treating depression has a different mechanism of action compared to standard antidepressants. Regarding how ketamine helps to combat depression, we still have more to learn, but we know that the drugs works in at least several ways:

    it inhibits serotoninergic pathways, which is one way it exerts antidepressive effects
    interacts with N-methyl-D-aspartate (NMDA) receptors, opioid receptors and monoaminergic receptors
    affects calcium ion channels (it does not interact with GABA receptors, unlike many other anesthesia drugs) (5)

According to Kalypso Wellness Clinics, “It functions by ‘re-setting’ nerves and triggers growth of nerve pathways. It is also a very powerful anti-inflammatory medicine, therefore, it helps with both of the main types of pain (nerve pain and inflammatory pain).”

What does the research to date tell us about ketamine’s effectiveness for depression?

    A 2015 report published in The Lancet explains that so far, findings suggest that ketamine can lead to sustained improvements in depressive symptoms that last a year or more. (6)
    The drug typically acts quickly (sometimes within hours), can have powerful effects and even offers hope to patients who have not seen improvements with other antidepressants. Ketamine may also help individuals who experience severe depression and suicidal thoughts.
    Early results of a clinical trial of the nasal-spray formulation of the drug suggest that the formula is well-tolerated by patients and linked with long-lasting improvements in depressive symptoms.
    In 2016, the FDA awarded the drug esketamine, an investigational antidepressant medication with the same effects as ketamine that is made by Janssen Pharmaceutical Companies of Johnson & Johnson, the status “Breakthrough Therapy Designation.” This was meant to highlight the drug’s potential as a treatment for patients with major depressive disorder who are at imminent risk for suicide. (7) The company’s press release states that, “If approved by the FDA, esketamine would be one of the first new approaches to treat major depressive disorder available to patients in the last 50 years.” A major advantage that esketamine will have is that it’s taken as a nasal spray, eliminating the need for infusions.
    Data that is available so far from the esketamine clinical study suggests that patients with one of the hardest to treat forms of depression (known as treatment-resistant depression) on average tolerate the drug well and experience sustained improvements in depressive symptoms over more than 11 months.
    Ketamine/esketamine are also valuable because they seem to work within days, rather than the 4–8 weeks that most antidepressants usually take to kick in. (8)

Ketamine Infusions

Ketamine is typically given as an infusion, or intravenously via a needle. Infusions usually last about 45–60 minutes. Most patients receive 10 infusions over the course of about 10 weeks, with more frequent infusions administered during the first several weeks.

During a ketamine infusion, patients might feel symptoms including: disorientation, floating sensations, feelings of intoxication, seeing lights or colors more vividly, blurred vision, or tingling in the toes, lips and mouth. These symptoms usually start about 20 minutes into an infusion and diminish approximately 10–15 minutes after the infusion ends. Ketamine infusions are described as being relaxing and usually involve the patient laying down comfortably in a relaxed position that allows their body to unwind.

The fact that ketamine needs to be injected means it is much harder to get and take regularly than a typical antidepressant pill. This, along with the high cost, is a major downside to using ketamine on an ongoing basis for conditions like depression or pain management.
Ketamine Dosage

The optimal dose of ketamine is still under investigation. Currently, the goal is to find a dose that provides antidepressive effects but does not cause addiction or adverse side effects. In studies, ketamine has been shown to help decrease depression symptoms even when used in small amounts, such as concentrations that are ten times lower than the amount that would be needed for anesthetic proposes. Ketamine is absorbed rapidly and highly bioavailable. It is eliminated relatively quickly through urine, bile and feces.

Reports show that there is currently inconsistencies in the dosage and frequency of ketamine infusions that are being recommended to patients, especially those with depression. Most clinics will recommend dosages that are very low and considered sub-anesthetic, meaning only a fraction of the dose a patient would get in the hospital for surgery is given to help manage depression. However, because there is no standard dose that has been established or approved by the FDA, there may be risks involved with meeting with an unexperienced practitioner who offers ketamine.

If a patient with depression is taking other medications (antidepressants) to manage their condition, ketamine might be given in addition to these medications, but does not necessarily take the place of them. It’s up to the individual patient and their doctor to determine if current medications are still needed.
Precautions & Side Effects of Ketamine

In general, ketamine is widely used around the world, has been studied extensively since the 1960s, and is usually well-tolerated. However, ketamine side effects are still possible, especially when it’s taken illegally and in high doses.

Critics warn that ketamine has not been studied sufficiently for the use of depression and similar conditions. It also has a high cost that is a barrier for many patients. There’s also concern that off-label use of ketamine is not being properly monitored, and that we don’t know enough about the potential for addiction.

It’s possible that ketamine tolerance may develop, especially if it’s used very frequently or for long periods. It’s also important to point out that ketamine is not intended to become the sole source of mental health care for patients with depression; therapy and working with a professional is still recommended. If you do visit a clinic in hopes of receiving ketamine, it’s critical that you choose a clinic with qualified caregivers. Many working at these clinics have not been trained to handle patients at risk for behavioral problems and are not doctors, so do your research.

Ketamine may not be safe to take long-term. Studies related to the blocking of NMDA receptors have shown an increase in apoptosis (cell death) in the developing brain, which results in cognitive deficits when ketamine is used for longer than three hours.

Ketamine is also mood-altering; it’s a psychedelic drug that makes people mildly hallucinate, and some “bad trips” have been reported. While most people find ketamine to have a calming or even “spiritual effect,” some become anxious and feel very “out of touch” after using the drug. (6)

When used a street/party drug, ketamine has been used to commit sexual assaults due to its ability to sedate and incapacitate victims. Therefore, some consider ketamine to be a “date rape” drug and warn that its distribution should be more tightly-controlled. There have also been reports of ketamine side effects when used at high doses that include:

Ad of December 2015, the World Health Organization (WHO) recommends that ketamine should not be placed under international control, after concluding that ketamine abuse does not pose a global public health threat and that the medical benefits of ketamine far outweigh potential harm from recreational use.

The WHO states that ketamine is one of the only anaesthetics and painkillers available in large areas of the developing world and that “controlling ketamine internationally could limit access to essential and emergency surgery, which would constitute a public health crisis in countries where no affordable alternatives exist.” (2)
As we excitedly watched the 2018 Olympic games and were amazed by the progression of many of the winter sports like snowboarding, skiing, hockey and many others, I continue to be amazed at the ability of the human body to adapt and recover. The impact that these athletes can withstand and their body’s ability to absorb impact is mind-blowing.

As they are pushing their sports and bodies to the next level, I think of the physics of it all and how amazing the human body really is. Let’s go back to our grade school song “the hip bones connected to the leg bone” and take a look at our natural shock absorbers: the SI joint, alongside the tricky issue of sacroiliitis.
The SI Joint: Connection Between the Sacrum and the Iliac

The sacroiliac joint, also known as the SI joint, connects the pelvis with the lower spine. It carries the weight of the upper body and bridges it to the lower body. The sacrum or lower section of your spine is made of five non-moveable vertebrae alongside the two large hip bones called the ilium or iliac crests. (1)

The SI joint is an essential shock absorber during weight-bearing activities and also relieves some strain on the lower lumbar.  According to a sports medicine study by Jack Harvey and Suzanne Tanner, “Lumbar spine pain accounts for 5 to 8% of athletic injuries. Although back pain is not the most common injury, it is one of the most challenging for sports physicians to clearly diagnose. Athletes who participate in sports involving repeated and forceful hyper-extension of the spine may suffer from lumbar facet syndrome, spondylolysis, or spondylolisthesis.” (2)

The sacroiliac joint is surrounded by strong ligaments and muscles such as the erector spinae, psoas, quadratus lumborum, piriformis, abdominal obliques, gluteal muscles and hamstrings, all of which strengthen the SI joint. These surround and encapsulate the sacroiliac joint and all can be affected in sacroiliitis.
What Is Sacroiliitis?

Medically speaking, the suffix “itis” refers to inflammation, while sacroiliitis refers to inflammation of the sacroiliac joint. Sacroiliitis is pain that could be dull or sharp and starts in your hip joint but can move to your buttocks, thighs, groin or upper back.

The pain may worsen when sitting for prolonged times and stiffness can be felt in the hips and lower spine. Sacroiliitis is a term that is sometimes used interchangeably with the term sacroiliac joint dysfunction. This can also lead to lower back pain and/or leg pain and can be caused by lumbar disc herniation or sciatica pain.
Why does sacroiliitis happen?

Pain usually starts when your sacroiliac joint is inflamed or irritated. This inflammation is then classified as either acute or chronic. Acute inflammation is typically intense, short-lived and can be caused by an injury that heals in times as the pain gradually subsides. This can last anywhere from 10 days to six months. Chronic inflammatory pain is ongoing and may be mild or intense.

Sources of sacroiliac joint dysfunction usually include hypermobility/instability or opposite hypomobility/fixation. This pain can spread throughout your lower back, hips and legs. This pain becomes chronic after a patient experiences a prolonged level of pain that surpasses the acute phase.

There are several diagnostic tools that can be used such as x-rays, CT scans or MRI’s that can show the narrowing of the joint space or erosion of the bone area.

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