Drugs in the Water

health.harvard.edu

Drugs in the water
Harvard Health Letter

Pharmaceutical pollution doesn’t seem to be harming humans yet, but disturbing clues from aquatic life suggest now is the time for preventive action.

Although maybe not as tasty as an ice-cold gulp from a mountain spring, the water that flows through most American kitchen faucets is generally clean, clear, and safe. Approximately 170,000 public water systems are monitored for nearly 80 harmful substances. The prohibited nasties include bacteria, viruses, pesticides, petroleum products, strong acids, and some metals.

But water quality experts and environmental advocates are increasingly concerned about another kind of water pollution: chemicals from prescription drugs and over-the-counter medications that get into lakes, rivers, and streams. Water also gets contaminated by perfume, cologne, skin lotions, and sunscreens that wash off people’s skin.

At this point, there’s really no evidence of pharmaceutical and personal care products in the water harming people, but studies are showing adverse effects on aquatic life.

Drug take-back programs, which allow people to drop off their unused medications at central locations, serve two purposes. They keep unused drugs out of the water and prevent diversion of drugs, mainly the opioid painkillers, for recreation and illegal purposes.

Another step in the right direction is new guidelines from the federal Environmental Protection Agency (EPA) that discourage hospitals and nursing homes from flushing unused drugs down the drain or toilet. Guidelines for individuals also discourage flushing most, but not all, unused drugs. The question now is whether these and other efforts will be enough to keep the chemicals out of the water at a time when the use of pharmaceuticals and personal care products continues to grow at a rapid rate.

The sources

Reliable figures are hard to come by, but it’s a safe assumption that we, as consumers, are responsible for a hefty percentage of the pharmaceutical and personal care products that wind up in lakes, rivers, and streams. The typical American medicine cabinet is full of unused and expired drugs, only a fraction of which get disposed of properly. Data collected from a medication collection program in California in 2007 suggest that about half of all medications — both prescription and over-the-counter — are discarded. That’s probably a high-end estimate, but even if the real proportion is lower, there’s a lot of unused medication that can potentially get into the water.

Chemicals also get into the water from the drugs we use. Our bodies metabolize only a fraction of most drugs we swallow. Most of the remainder is excreted in urine or feces (some is sweated out) and therefore gets into wastewater. An increasing number of medications are applied as creams or lotions, and the unabsorbed portions of those medications can contribute to the pollution problem when they get washed off. It’s been calculated, for example, that one man’s use of testosterone cream can wind up putting as much of the hormone into the water as the natural excretions from 300 men.

Health care institutions are another source of pharmaceutical water pollution. Hospitals are probably less of a problem than nursing homes because they typically have on-site pharmacies with arrangements in place to return unused drugs to manufacturers for credit or disposal. Nursing homes, though, have often been guilty of flushing medications down the toilet or drain after a patient dies or is transferred to another facility. Typically, they don’t have the same kind of return arrangements as hospitals. And the rules for getting rid of opioid painkillers, which make disposal down the drain an acceptable option, have inadvertently encouraged some nursing homes to dispose of all their leftover medications that way.

Drug manufacturing also results in some pharmaceutical pollution, although some factories are bigger problem than others. For example, a U.S. Geological Survey study found contamination levels downstream from two drug manufacturing plants in New York State that were 10 to 1,000 times higher than those at comparable facilities around the country.

Agriculture is another major source. The two trillion pounds of animal waste generated by large-scale poultry and livestock operations in this country is laced with hormones and antibiotics fed to animals to make them grow faster and to keep them from getting sick. Inevitably, some of those hormones and antibiotics leach into groundwater or get into waterways.

illustration of garbage dump and sewage treatment plant

How bad is the problem?

A study conducted by the U.S. Geological Survey in 1999 and 2000 found measurable amounts of one or more medications in 80% of the water samples drawn from a network of 139 streams in 30 states. The drugs identified included a witches’ brew of antibiotics, antidepressants, blood thinners, heart medications (ACE inhibitors, calcium-channel blockers, digoxin), hormones (estrogen, progesterone, testosterone), and painkillers. Scores of studies have been done since. Other drugs that have been found include caffeine (which, of course, comes from many other sources besides medications); carbamazepine, an antiseizure drug; fibrates, which improve cholesterol levels; and some fragrance chemicals (galaxolide and tonalide).

Sewage treatment plants are not currently designed to remove pharmaceuticals from water. Nor are the facilities that treat water to make it drinkable. Yet a certain amount of pharmaceutical contamination is removed when water gets treated for other purposes. For example, some research shows that conventional treatment methods result in a 90% decrease in the amount of ibuprofen and naproxen in the water discharged from sewage treatment plants. On the other hand, treatment doesn’t seem to have much effect on the levels of drugs such as carbamazepine and diclofenac (a pain reliever).

Some aspects of sewage treatment may remove pharmaceuticals from the water, but as a result, concentrations in sludge increase. Some of that sludge is used as fertilizer, so the pharmaceuticals are getting into the environment in another way.

Drinking-water treatment may also get rid of some pharmaceutical contamination. Chlorine is used to kill bacteria and other pathogens, but it also seems to degrade or remove acetaminophen, codeine, and the antibiotic sulfathiazole. A 2007 study of one drinking-water plant found that conventional treatment methods reduced the concentrations of several important medications (acetaminophen, carbamazepine) by 75%.

Still, there’s really not much question that some pharmaceutical pollution persists and does wind up in the water we drink. In 2008, the Associated Press published a series of investigative articles about pharmaceutical contamination in drinking water. The journalists uncovered test results that showed the water supplies for 24 major metropolitan areas had detectable levels of pharmaceuticals. Scientists from the Southern Nevada Water Authority and other organizations reported results in 2010 from a study analyzing drinking water from 19 treatment plants. Their tests found antidepressants, antipsychotics, antibiotics, beta blockers, and tranquilizers, although only in trace amounts and far below levels thought to have an effect on humans.

It’s possible that there’s a cumulative effect on people from even tiny amounts of these and other pharmaceuticals in drinking water, but this hasn’t been proven. And perhaps vulnerable populations (pregnant women, people with disabilities) are affected, although that’s also unproven.

Effects on fish and wildlife

In contrast to the uncertainty about human health effects, there’s quite a bit of evidence for pharmaceuticals in the water affecting aquatic life, particularly fish. Numerous studies have shown that estrogen and chemicals that behave like it have a feminizing effect on male fish and can alter female-to-male ratios. Sources of estrogen include birth control pills and postmenopausal hormone treatments, as well as the estrogen that women produce naturally and excrete. Intersex fish — creatures with both male and female sex characteristics — have been found in heavily polluted sections of the Potomac River. Studies of fish upstream and downstream of wastewater treatment plants have found more female and intersex fish downstream from the plants, presumably because of the higher estrogen levels in the downstream water. Other research has uncovered popular antidepressant medications concentrated in the brain tissue of fish downstream from wastewater treatment plants.

4 ways to reduce your pharmaceutical footprint

Limit bulk purchases. Volume discounts make the price attractive, but big bottles of unused pills create an opportunity for medications to end up in the water.

Use drug take-back programs. A federal law went into effect in 2010 that makes it easier for those programs to be organized at a local level, so you may see one in your community. The federal Drug Enforcement Agency has held two national drug take-back days and is likely to organize some more.

Do not flush unused medicines or pour them down the drain. This is the very least you can do. But the FDA advises that certain powerful narcotic pain medications should be flushed because of concerns about accidental overdose or illicit use unless you can find a drug take-back program that will accept them. We’ve posted a list of the narcotics on our Web site at http://www.health.harvard.edu/healthextra.

Be careful about how you throw medications into the trash. Medications thrown into the trash end up being incinerated or buried in landfills, which is preferable to flushing them or pouring them down the drain. If you put them in the trash, remove them from the packaging, crush them, and seal them in a plastic bag with some water. You’re supposed to add sawdust, cat litter, coffee grounds, or some other unappealing material to the bag. That isn’t for environmental reasons, but to cut down on the chances that a child or animal might eat the contents. You should also be careful to peel off any identifying information from containers of prescription medicine.

What is being done

There are several things we can do as individuals to limit pharmaceutical water pollution (see “4 ways to reduce your pharmaceutical footprint”).

On a larger scale, the EPA has taken a four-pronged approach that involves public education, stepped-up monitoring of water supplies, partnerships with health care facilities and agribusinesses to reduce waste, and eventually, perhaps, new regulations. As an introductory step toward possible regulation, the EPA has added 10 pharmaceutical compounds — one antibiotic and nine hormones — to its watch list of potentially harmful contaminants that warrant greater investigation.

The Natural Resources Defense Council, an environmental group, has called on drug manufacturers to design “eco-friendly” drugs that are absorbed by the body more efficiently or will break down in the environment after they’re excreted. The organization has also asked companies to implement techniques to limit bioactive waste generated in their manufacturing processes.

love yourself…

“Being preoccupied with our self-image is like coming upon a tree                                                of singing birds while wearing earplugs”      – Pema Chodron

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…so love yourself… you are beautiful both inside and out

Boost and stimulate your digestion

Drinking a cup of warm lemon water first thing in the morning helps to stimulate your digestion and elimination. It is alkaline to your system which is helpful to keep your system more alkaline than acidic for your bone health. The lemon juice is high in Vit.C and is an antioxidant which aid your liver in it’s functions. In Tiffany Cruikshank’s book Optimal Health for a Vibrant Life she has a recipe I have been loving.

Try it out.

  • Juice of half of a lemon
  • 1 Tbls of Apple Cider Vinegar
  • 1 tsp of Honey ( I use less)
  • Pinch of Cayenne
  • cup of warm water

Drink it 30 minutes before your meal.

Brawn and Brains

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Brawn and Brains

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By GRETCHEN REYNOLDS
NOVEMBER 18, 2015
Sturdy legs could mean healthy brains, according to a new study of British twins.

As I frequently have written in this column, exercise may cause robust improvements in brain health and slow age-related declines in memory and thinking. Study after study has shown correlations between physical activity, muscular health and mental acuity, even among people who are quite old.

But these studies have limitations and one of them is that some people may be luckier than others. They may have been born to have a more robust brain than someone else. Their genes and early home environment might have influenced their brain health as much as or more than their exercise habits. Their genes and early home environment also might have influenced those exercise habits, as well as how their bodies and brains responded to exercise.

In other words, genes and environment can seriously confound experimental results.

That problem makes twins so valuable for scientific purposes. (Full disclosure, I am a twin, although not an identical one.) Twins typically share the same early home environment and many of the same genes, and if they are identical, all their genes are the same.

So if one twin’s body, brain and thinking abilities begin to differ substantially over the years from the other’s, the cause is less likely to be solely genetic or the early environment, and more likely to be attributable to lifestyle, including exercise habits.

It was that possibility that recently prompted Claire Steves, a senior lecturer in twin research at King’s College London, to consider twins and their thighs.

Muscular power, especially in the legs — which are the largest muscles in the body — is widely accepted as a marker of healthy aging. Older people with relatively powerful leg muscles get around better than those with weak legs. They also tend to have sharper minds, studies show.

But whether people’s lifestyles, and in particular their exercise habits, had provided them with good legs and minds, or whether they had won the genetic lottery, remained unclear.

So for the new study, which was published this month in Gerontology, Dr. Steves and her colleagues turned to the TwinUK registry, which includes health and fitness data for thousands of British twins.

The scientists pulled records for 162 healthy, middle-aged, female twin pairs, some of whom were identical and some not.

The scientists looked for twins who, 10 years previously, had completed extensive computerized examinations of their memory and thinking abilities, as well as assessments of their metabolic health and leg-muscle power, which measure muscles’ force and speed.

The scientists focused on the twins’ muscles rather than their exercise habits largely because the power measures were objective, unlike people’s notoriously unreliable recollections of how much they have worked out. (There was a correlation, though, between more self-reported exercise and sturdier legs.)

The scientists then asked the twins to visit a laboratory and repeat the cognitive tests.

Twenty of the identical twin pairs also completed brain-imaging scans.

Then the researchers compared leg power 10 years earlier with changes in brain function over the same time period.

They found that of the 324 twins, those who had had the sturdiest legs a decade ago showed the least fall-off in thinking skills, even when the scientists controlled for such factors as fatty diets, high blood pressure and shaky blood-sugar control.

The differences in thinking skills were particularly striking within twin pairs. If one twin had been more powerful than the other 10 years before, she tended to be a much better thinker now.

In fact, on average, a muscularly powerful twin now performed about 18 percent better on memory and other cognitive tests than her weaker sister.

Similarly, in the brain imaging of the identical twins, if one genetically identical twin had had sturdier legs than the other at the start of the study, she now displayed significantly more brain volume and fewer “empty spaces in the brain” than her weaker sister, Dr. Steves said.

Over all, among both the identical and fraternal twins, fitter legs were strongly linked, 10 years later, to fitter brains.

Of course, this study involved only a single snapshot of the brain health of middle-aged female twins. The scientists did not directly study the effects of exercise on the women’s brains, or look at changes in muscular health over the 10 years and whether that affected how well the twins could think.

The study also was not designed to uncover how muscle power builds brainpower, Dr. Steves pointed out, although she said she suspects that working muscles release biochemicals that travel to the brain and affect cellular health there. And the sturdier the muscles, the more of these chemicals they create.

More experiments obviously are needed, however, to understand these mechanisms.

For now, she said, the results imply that whatever your genetic make-up, building muscles can strengthen your mind, and should your legs currently be spindly, you might want to consider walking, running, standing or dancing more often.

“I was quite surprised by the strength of the findings,” Dr. Steves said, “because to be honest, I am someone who has always in the past prioritized work of the mind over work of the body. This study brings home to me that the brain needs exercise to keep fit.”

Carrot and sweet potatoe soup

This was an adaptation from The Simple Kitchen.

2 Tbs coconut oil                                                 2 cloves garlic                                                       1 inch grated or diced fresh ginger                 1 tsp turmeric                                               Sauté the above ingredients for a few minutes then add                                               5 cups organic  carrots (they are so sweet and flavorful) and sweet potatoes.  I used 1/2 carrots and 1/2 sweet potatoes                2 cups vegetable broth                                 salt and pepper to taste

Cook all of the above for about 25 minutes either mash with a spoon to keep the soup thick and chunky or purée in blender.

Top with sunflower seeds for a little crunch.

Serves 4

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Yoga for Arthritis

Yoga for Arthritis: New Study Shows Yoga Reduces Arthritis Pain and Improves Well-being               YogaUOnline post Nov 9, 2015
Discomfort while walking. Pain in your hip, neck, or other joint area that wakes you up at night. Morning stiffness that can take over an hour to subside. These experiences are all-too-familiar for the one in five Americans who suffer from arthritis. However, according to a recent study yoga can help arthritis sufferers, and with more than just the pain. The study’s yoga program was designed by registered yoga therapist Steffany Moonaz, who is also a teacher at YogaUOnline.com.

It is well known that light exercise is one of the best remedies for arthritis, but for those who live with the almost constant pain and limitations of the condition, the thought of taking up a full-body exercise can be daunting. Exercise classes, even gentle ones, often take a “one size fits all” approach that simply doesn’t work, and finding a program that addresses the specific needs of your condition can be a challenge.

It was with this in mind that Dr. Susan Bartlett, faculty member at the Johns Hopkins School of Medicine and McGill University, began to consider whether yoga might be able to offer something unique for those with arthritis. Bartlett was interested in yoga’s focus on “listening to the body:” instead of assuming a baseline level of ability, yoga takes the attitude that we bring a changing set of limitations to the mat each day; an attitude perfect for those dealing with arthritic flare-ups. Yoga is also a “mindful exercise,” where the mind and the body work together, as opposed to exercise styles where the mind is distracted from the sensations of the body.

And indeed, Bartlett’s recent study, published in Journal of Rheumatology, found that the practice of yoga for arthritis produced significant positive results in patients that went beyond what one might expect.

The randomized, controlled study followed seventy-five patients dealing with osteoarthritis or rheumatoid arthritis. During the two-months of the study, half of the group practiced yoga adapted to their specific needs while those in the control group maintained their usual lifestyles. The researchers were looking to see two things: first, was yoga safe for those suffering from arthritis, and secondly, could the practice benefit those with the condition.

The researchers found that not only was the practice safe (yoga produced no adverse effects), but that it significantly decreased pain levels. Furthermore, the researchers were interested to find that yoga for arthritis improved energy, overall physical health, and psychological well-being as well. Not only this, but the positive effects of the eight-week yoga practice lasted, for some, up to nine months.

The researchers wrote: “We recently spoke with several participants… Now (five years later), they commented that yoga had played a pivotal role in changing how they viewed their function, and capabilities and attitude toward living with [arthritis]; they credited yoga with helping them maintain a more active lifestyle.”

Several of the participants were themselves surprised by the experience. “When I was diagnosed in 1995,” one study participant told The Baltimore Sun, “I honestly never thought I could do something like yoga. But [the trial] showed me I could, and I’ve found it makes a significant difference in my life living with arthritis.”

This participant commented that the yoga she learned in the study improved her balance, her flexibility, and the strength of the muscles around her joints in ways she hadn’t thought possible. She credited this with improving her quality of life: “Yoga strengthened the joints, and that helped me use the joints,” she said. “That reduced my pain level, which kept me more active. And my quality of life gradually started to improve. That’s the most important thing — improving the quality of life. Without yoga, mine would not be what it is today.”

The study’s yoga program was designed by yoga therapist Steffany Moonaz, a long-term researcher in the benefits of yoga for arthritis. To maintain the purpose of each yoga posture but remove potential for injury or flare ups, Moonaz, who has spent many years teaching yoga to chronic pain sufferers, developed pose modifications specific to the needs of those with arthritis. Props such as wedges and chairs were also brought in to help reduce pressure and adjust the angle of certain poses.

“Sometimes the modification looks nothing like the original pose,” Moonaz said. “I might take the pose and flip it over on its back, or I might take a downward dog” — a pose with hands and feet on the floor — “and [move] it against the wall. You’re still getting that lengthening of the hamstring and elongated spine, but you won’t be putting pressure on painful joints.”

By adapting the poses in this way, Moonaz was able to help each participant strengthen and lengthen the muscles supporting their joints while protecting inflamed areas.

“We’ve seen countless people and their lives transformed by yoga,” Moonaz said, “and not just because they have less pain or more flexibility, but because the way they see things has changed. The main idea is yes, you have this disease, but no, it does not dictate what the rest of your life will be like.”

YogaUOnline is proud to feature Dr. Steffany Moonaz as a teacher on yoga for arthritis. To learn more about her course, which shows how to tailor a yoga practice to the specific needs of those suffering from the condition, go here: Yoga for Arthritis: The Evidence and the Promise.

Restore and detox yourself with a Lavender Bath

We are moving into hectic and a stressful time of year. Rejuvenate and detox yourself with a Lavender Epson salt bath.

1 cup Epson salts

5-10 drops of Lavender doTerra essential oil

1/2 cup baking soda

Add lavender essential oil and Epson salt to the tub. Slowly pour into the running warm/hot water while the tub is filling. Add 1/2 cup baking soda to help neutralize any chemicals, primarily chlorine, and also increase mineral absorption. Soak for 20 minutes, get out and dry off. Avoid soap or shampoo after detox bath.

Enjoy!

YOGA FOR HEALTHY AGING: Proof of the Effectiveness of Reducing Chronic Stress!

Partial repost from Yoga for Healthy Aging: Proof of the effectiveness of reducing chronic stress!  Posted 15 October 2015

by Nina

According to a new study “Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization” by James E. Stahl, et al, published in the journal PLOS one, practicing Relaxation Response techniques, such as meditation and yoga, could reduce the need for health care services by 43 per cent. To me, this was really exciting news (and not just because I’m not very fond of going to the doctor or the emergency room). I feel it’s solid scientific proof that using yoga’s stress management techniques will be very likely to improve your health. The authors of this study decided to do a thorough study of the effects of mind-body interventions on health care services because stress-related illnesses are “drivers” of healthcare use. Here is how they put it:

“In primary care, stress-related illnesses are known drivers of healthcare resource utilization in the US. Health care expenditures attributable to stress-related disorders, such as, depression and anxiety, were over 80 billion dollars/year in 2012. These have been the third highest cause of healthcare expenditures after heart disease and cancer in the US; each of which carries their own substantial stress burden. Over 90% of people suffering from stress or stress-related problems seek help through primary care and tend to be frequent healthcare utilizers. These visits can comprise as much as 70 percent of physicians’ case- loads. In addition, more than 80% of patients presenting to general practice evidence lack of resiliency and psychological stress. Common physical manifestations of stress, e.g., headaches, back pain, insomnia, gastroesophageal reflux disease, irritable bowel, chest discomfort, are among the most frequent reasons people seek care.”

To conduct this study, the researchers tracked all 4452 patients who received training at the Relaxation Response Resiliency Program at the MGH Benson-Henry Institute from 1/12/ 2006 to 7/1/2014 for a median of 4.2 years. They then compared the usage of health care resources by this group against that of the control group of 13149. Total utilization of health care resources for patients with Relaxation Response training decreased by 43% compared with the control group. Here’s the breakdown:
Clinical encounters decreased by 41.9%
Imaging by 50.3%
Lab encounters by 43.5%
Procedures by 21.4%
In addition, the intervention group’s Emergency Department visits decreased from 3.6 to 1.7 per year (although Hospital and Urgent care visits converged with the controls).

Pretty impressive, isn’t it? Using mind-body techniques to manage chronic stress keeps you healthier in a whole range of ways. And the training that these people received at the MGH Benson-Henry Institute was in using meditation and similar techniques to trigger the Relaxation Response, all of which are similar to, if not exactly the same as, the techniques that yoga provides.

In fact, the researchers were so encouraged by the study results they proposed that mind-body interventions should be instituted across the board as a “form of preventative care, similar to vaccinations or driver education.” With that, all I can say, is that if you’re practicing yoga solely as “exercise” and not exploring the stress management tools because “relaxing” feels like wasting time, you’re missing out on some valuable health promotion activities (not to mention that peace of mind stuff).

“Everyone has inside them a piece of good news. The good news is you don’t know how great you can be. How much you can love. What you can accomplish. And what your potential is.”    -Anne Frank