My thanks to Janet Parshall and Talking it Over for a great conversation today about protecting the rights of conscience for health care workers.  The best source of information that I have found on this issue is Freedom2Care.  Visit this website to learn more about this important issue and to find out what you can do to ensure that our health care system preserves your right to receive care from a physician or health care worker who is freely able to practice according to their deeply held beliefs, whatever those may be.

On Saturday Jan 16th I will appear on Talking It Over with Janet Parshall a nationally syndicated radio program on the Moody Radio Network.  We will discuss the earthquake in Haiti and also talk about health care reform.  Tune in at 12:30pm Central Time on 90.1FM in Chicago and on stations across the country.  Visit the link above to find a station near you.

Tuesday morning on WMBI a caller asked if there was something safe that her daughter could take in her 7th month of pregnancy to help her sleep.  In the midst of a busy morning of calls, I gave her a kneejerk response by recommending the antihistamine diphenhydramine, the active ingredient in Benadryl.  This approach is safe, as diphenhydramine is a pregnancy category B medication (meaning that studies in humans have proven it to be generally safe for the unborn child).  However, I did not take the opportunity to discuss other natural remedies, as well as behavioral strategies for sleep in the later stages of pregnancy.  My response brought to light one of the problems in our health care system, namely, that the increasing demands of insurance companies and health care systems force doctors to rush through an office visit, and we often fall back to the old playbook of the most commonly recommended pharmaceutical solution, rather than exploring other ‘natural’ and behavioral remedies. I felt like I did the radio equivalent of a rushed office visit on Tuesday. Thankfully, I have the opportunity to follow up and explore those alternatives here.

Sleep patterns are clearly altered for pregnant women as they approach the birth of their baby.  The expanding uterus presses on the surrounding organs, making it difficult to last the night without having to get up to empty the crowded and shrunken bladder.  The sheer discomfort of the expanding abdomen, and the often corresponding back pain, make it difficult to sleep comortably, especially if the woman is used to sleeping on her stomach.  I believe that the disturbed sleep can help prepare an expecting mom for motherhood.  Once the baby is born, new moms are called upon to spend odd hours nursing and caring for their baby.  Every new parent knows that while their newborn may sleep 18 out of 24 hours, the sleep usually comes in 90-120 minute spurts followed by 1-2 hours of wakefulness.  Furthermore, newborns tend to have an opposite sleep cycle after birth, spending more time sleeping during daytime hours and more time awake at night.  In a way, the woman who has to adapt to irregular sleep patterns is being trained for the physical demands of early motherhood.

That being said, there are some simple ways to improve sleep during pregnancy.  The basic behavioral recommendations to improve sleep still apply.  Try to wake up and go to bed around the same time every day.  Avoid caffeine in general, but especially in the afternoon and evening.  It is important to continue to drink plenty of water during pregnancy, but try to limit your intake for 2-3 hours prior to sleep, and be sure to empty your bladder fully before bed.  Many women state that sleeping on the side and placing a pillow between the legs provides additional comfort.  Continuing to exercise during pregnancy is safe, and regular exercise has a positive impact on sleep.

Regarding “natural” sleep aids, some are safe in pregnancy and some are not.  It is important to remember that herbal and ‘natural’ remedies are not regulated by the FDA, so they can claim anything they want on their packaging without having to prove their claims with scientific studies.  Also, the FDA does not test the products to ensure that the ingredients listed on the label are actually contained in the supplement.  Some of the more popular sleep aids are below.

Melatonin is a chemical that resets the body’s 24-hour clock, called the Circadian rhythm.  Pregnant women have naturally lower melatonin levels, and these lower levels may be important to the baby’s development.  Therefore, I would not recommend melatonin durnig pregnancy.

Chamomile is commonly used to make tea that is used by many as a sleep aid.  Most would consider chamomile tea to be safe, but probably not the more concentrated chamomile oil.  I can safely recommend chamomile tea during pregnancy.

Valerian is an herb that has a mild effect on the body and is one of the safer herbal sleep aids, however, there is conflicing evidence about whether it is safe during pregnancy.  Therefore, I would play it safe and not use valerian during pregnancy.

5-HTP is a supplement used for depression that can also aid in sleep.  It affects serotonin levels, and while many doctors consider serotonin-altering medications to be generally safe in pregnancy, we do not have convincing evidence that it is completely safe.  Therefore, I would not recommend 5-HTP.

Kava was once a popular herbal supplement used for anxiety symptoms and insomnia.  Many problems with kava have been uncovered, including its harmful effects on the liver.  I do not recommend taking kava for any reason.

Tryptophan is not available as a supplement but is present in turkey, cheese, nuts, beans, eggs, and milk.  High levels have induced fetal tumors in laboratory animals, so seeking out tryptophan in high doses is not advised.  The amount of tryptophan in a glass of warm milk would be safe, and it may be enough to assist with falling asleep.

In summary, about the only “natural” sleep aids that I recommend are warm milk or chamomile tea.  Making some behavioral changes may also help with sleep during pregnancy, but in the later stages, it is probably unrealistic to maintain normal sleep patterns.  If you find yourself wide awake and frustrated as your due date nears, take a moment and pray for your baby.  It’s a great way to prepare yourself spiritually and emotionally for the arrival of your child, while your body trains itself physically for more sleepless nights ahead.

A caller to my Tuesday morning appearance on WMBI asked a question about chia seeds, and I had to admit that I did not know much about what they had to offer. If you’re like me, the word “chia” conjures up images of pet-shaped terra cotta pottery with green sprouts. It turns out that eating chia seeds can have some positive health benefits.

Chia seeds contain a high amount of omega-3 fatty acids, which are beneficial for brain and heart health. Chia seeds apparently contain more omega-3 per ounce than flax seed. Chia seeds also contain some calcium, and high levels of magnesium. The recommended dosage of chia is 2 tablespoons per day. They can be eaten straight, mixed in water, or ground and added to baked goods like muffins. As with any supplement, it is important to remember that these are not regulated by the FDA, so if you are going to purchase chia seeds, try to do so from a reputable source.

I was unable to find any major medical studies on chia. It has been reported to benefit those with diabetes, but so far there are no studies to back this up. I expect that some studies will emerge over the next few years, especially now that Dr Mehmet Oz mentioned chia seeds on the Oprah show.

While some have suggested chia seeds as an alternative treatment for hair loss, I do not recommend this course of action.

This morning on WMBI I talked about a recent study on the popular Proton Pump Inhibitor (PPI) medications and their potential to cause “rebound” acid reflux. This could lead to a dependence on these medicines. Many callers and e-mailers have questions about this. If you are on these medicines, should you stop them? If so, what is the best way to stop? Is there any risk to staying on the medicine?

The PPI medications are commonly known as Prilosec, Prevacid, Nexium, Aciphex, and Protonix. The generic names have the common ending “-prazole”. These medicines block the stomach’s production of acid. They are useful for people with acid reflux disease, or gastroesophageal reflux disease (GERD). This class of medicines is one of the most commonly prescribed group of drugs in the world. Many doctors prescribe them the first time their patient reports symptoms of heartburn. Some of these drugs are now available over-the-counter without a prescription.

The problem that is now coming to light is this: it turns out that while these medicines are in the system, the stomach responds by attempting to crank up acid production. When the medications are stopped, the floodgates open and heartburn symptoms return, possibly in a more severe form than previous. This study actually placed people with no heartburn symptoms on a PPI medication for two months, and when the medicines were stopped, the patients with no history of GERD developed symptoms of heartburn within a few weeks.

So what are the implications? First, if you are on a PPI, there is no documented long-term risk of staying on the medicine. That being said, it is best to use these medications for the shortest time possible in order to avoid the “rebound” effect. The recommended time frame is 2-3 weeks, in order to treat a severe flare-up of GERD. During that trial, there are lifestyle modifications that should be tried. These include limiting the intake of alcohol, tobacco, caffeine, and spicy foods. Stress can also contribute significantly to GERD.

If you are already on these medicines, and you have been taking them for some time, talk to your doctor about stopping. One way to do this is to wean yourself off by cutting your dose in half, then going to every other day, then every third day, etc. Do this over the course of 4-6 weeks. What may happen, as suggested by this study, is that your symptoms may return when the dose is reduced. I would encourage you to try to ride this out over 1-2 weeks, because the stomach may re-calibrate its acid production on the new lower dose. This may need to occur over several weeks and multiple, step-down dose reductions.

For those who cannot manage their GERD through lifestyle modifications (mentioned above), another medication option is ranitidine (brand name Zantac). This medicine is available over the counter in a 75mg tablet. The maximum dose is 150mg (two tablets) twice a day. Start by taking one tablet at night, go to two if needed, and then add a morning dose if necessary. It is safe to start on the ranitidine while you are weaning yourself off the PPI’s, and this may help with any “rebound” heartburn you may experience.

There is a group of patients that should be on PPI medications for life. These are people with something called “Barrett’s esophagus”. This occurs when the acid reflux is so severe that it causes tissue damage to the esophagus. This damage can progress to esophageal cancer and can be deadly. Barrett’s esophagus is diagnosed by esophagealgastroduodenoscopy (EGD), a test in which a GI specialist passes a small camera down the esophagus and can look at or biopsy the tissue. Anyone with a positive test should stay on PPI’s. For the rest of us, it seems best to limit the use of these medications.