Drugs that Increase Your Risk of Heat Stroke, Invite Health Podcast, Episode 663

Drugs that Increase Your Risk of Heat Stroke, Invite Health Podcast, Episode 663

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Please see below for a complete transcript of this episode.


Hosted by Jerry Hickey, Ph.

*Intro Music*

InViteⓇ Health Podcast Intro: [00:00:04] Welcome to the InViteⓇ Health Podcast, where our degreed health care professionals are excited to offer you the most important health and wellness information you need to make informed choices about your health. You can learn more about the products discussed in each of these episodes and all that Invite Health has to offer at www.invitehealth.com/podcast. First time customers can use promo code podcast at checkout for an additional 15% off your first purchase. Let’s get started. [00:00:34]

*Intro Music*

Jerry Hickey, Ph: [00:00:40] We’ve had quite a few ultra hot days recently and this is becoming more of the trend, and I know how to get along in ultra hot days. I mean, I’ve had family in southern Texas and Central Florida for decades, so some of the tricks for doing better on an ultra-hot day, do your exercise in the morning, do your outdoor activities like gardening in the morning. I mean, that’s, you talk to a typical Floridian during a hot time of year, and they say, you know, I do everything by 9:00, I’m done. Carry water with you, if you’re taking a walk, if you’re jogging, if you’re taking a hike, if you’re gardening, keep water nearby, you need to hydrate, wear loose fitting clothing and wear a hat. But when you’re in the shade, remove it so your head can cool down and really limit your outdoor activity on these super-hot, ultra hot days, and get wearable sunscreen. I have wearable sunscreen, I have UPF clothing closet, practically. You know, I’ve got that Irish skin thing, so I’ve got to be really careful. Freckles, reddish hair, all that stuff going on. So, UPF stands for Ultraviolet Protection Factor. So, UPF of 50 blocks out about 98% of the sun’s ultraviolet rays. Now in the old days, the UPF clothing kind of trapped in the heat. So, when you’ve got a UPF shirt, you’re overheated pretty quickly. Not like that. The new clothing, the new materials they’re using for the UPF clothing, it’s much more breathable. It allows the heat to radiate out into the atmosphere. And, you know, I tell you, it’s a good thing when I go to Florida in the winter now, I see a lot of people who go fishing, they wear the UPF clothing, and that’s good because when you wear the sunscreens, sunscreens could be toxic to marine life and the coral reefs, etc., so that the plus, you know, the sunscreen wears off. So, if you get a UPF hat, I have UPF hats that block the sun and UPF shirts, it really makes a difference. And then you just, you know, put sunscreen by your ears and by the back of your neck and stuff. You’re really protected. You don’t have to use as much as you used to. But here’s the issue, so, we have these ultra hot days. I mean, you’re seeing records broken all the time with the heat and these heat spells, you get these heat domes over places like Texas and all that heat just last for a long time. Day after day of super high temperatures. So, here’s the issue we’re addressing today. Many important drugs and not all these drugs are prescriptions. Many important drugs heat up your body or make it hard to sweat. And this increases your risk of a heat related heart attack or a heat related stroke. So, hi, my name is Jerry Hickey, I’m a nutritional pharmacist. I’m a licensed pharmacist. But, you know, I’ve been doing nutrition forever, studying nutrition, taking courses, etc. like the certified clinical nutritionist course, you can find all of invites podcast episode for free wherever you listen to podcast, or just go to invitehealth.com/podcast and they ask if you could subscribe and leave a review. I tell you; those reviews are really important to me. I want to know how people feel about these. Are they too long, too short? You know? What do you want me to hit harder, you know, that kind of thing. You can also find Invite on Twitter and Instagram and Facebook at Invite Health and all of the information on today’s episode will be listed in the episode description. † [00:04:26]

[00:04:27] So, let’s discuss the drugs that affect you in the summertime, because, you know, drugs fascinate me. I am a pharmacist as well as being a nutritionist. So, drugs fascinate me because they’re super powerful and they have a lot of untoward effects. But, you know, a lot of drugs are lifesaving. I mean, let’s face it, they really are. So many drugs trap heat into your body. Now, this may not normally be an issue. But during these ultra hot days, or just a hot day where you’re doing a lot of outdoor physical activity, this becomes dangerous. It becomes a real issue more than likely. So, some of these drugs are extremely important and they’re not easy to replace. So, if you’re on some of these drugs, I mean, they might be keeping you alive or making your life much better as quality of life goes. You have to be diligent on staying cool so and you could accomplish this. Beta blockers, these are a very important class of drugs. They’ve been around for many, many decades. Doctors know how to use beta blockers. They were originally used for high blood pressure. Now they have many other uses, such as helping people with certain tremors, helping people, migrainers, who suffer migraines frequently. But these drugs are a very important class of drugs for high blood pressure, and they’re a very important class of drugs for people with congestive heart failure. Congestive heart failure is a really scary condition. It’s as scary as advanced cancer because the heart weakens and it’s hard to pump blood. And there’s all kinds of risks with that. And you don’t feel good, I mean, it’s hard to breathe and you’re physically incapacitated because you’re exhausted, etc. And there’s different levels of heart failure, like the lower levels. Stage one and stage two. People do fine with that, but stage three and four, you’re getting the effects of heart failure just sitting on the couch. I mean, it’s really affecting you. So, the beta blockers, beta blocking drugs work by blocking the hormone epinephrine, which is also known as adrenaline. This takes some pressure off the heart and allows the heart to be a little less forceful, fully a little more slowly. So, take pressure off the heart, like in people with heart failure. But also, this lowers blood pressure, so, it’s one of the major categories of drugs used in people with high blood pressure. So, it reduces the working load in the heart and increases internal blood flow. But a side effect of that, a consequence of increasing internal blood flow is a decrease of blood flow to the hands and feet and to the skin. So, what happens with that is you’re not radiating out the heat. The blood vessels near your skin are what allows the heat to escape your body when you’re too hot. That’s one way that we cool down. So, the heat is getting trapped inside your core, your core temperature is going up. Now, examples of these drugs and once again, these drugs save lives. Okay, So they’re not bad drugs. In fact, there’s a lot of other benefits to them, there seems to be benefits for certain types of cancer and benefits for certain viruses to help people withstand certain viruses. So, there’s a lot of things coming out about these drugs that are positive, but they do increase your core temperature. And normally that’s not an issue, but on a super-hot, ultra hot day, that is an issue. So, it’s not like you can just drop these drugs. In fact, if you dropped these drugs, and it’s being used for the heart, that could trigger a heart attack or stroke. So, you know, it’s not something you should just do. So, you know, figure out other ways of staying cool, stay inside, put a fan on, maybe put a damp cloth over the fan. You know that a lot of people have air conditioning or central air conditioning. That’s a good thing. †  [00:08:41]

[00:08:42] So, examples of these drugs would be metoprolol, which is Toprol or Lopressor. Those are other names for it, atenolol, which is Tenormin, nadolol, which is Corgard. So, they are useful for arrhythmias, they are useful for angina. Arrhythmias are when the, that’s a good spelling bee word, arrhythmia. But arrhythmias are when the heart is beating improperly. Maybe it’s racing, you know, like atrial fibrillation. So, these drugs are very useful for that, they’re useful for angina. Angina is that chest pain you get because of poor blood flow to the heart. They’re useful for congestive heart failure. So, another class of drugs that can increase your body temperature are antiplatelet drugs. Now, some of these drugs are obviously lifesaving, like clopidogrel, which is Plavix. These drugs are used to prevent blood clots that are, you know, super risky. You don’t want blood clots inside the body. So, these drugs are used to prevent strokes and heart attacks. But aspirin is another example. And, you know, do you have to take aspirin? Discuss it with your cardiologist if you’re on it for the heart. But no, most of us don’t have to take aspirin. And these drugs reduce the dilation of our blood vessels by our skin, and that increases our temperature. So, in the summer, you have to be more cautious with these drugs. † [00:10:15]


[00:10:17] So, here’s a study that’s backing up what I’m saying. I always like to give some high-quality evidence as from nature cardiovascular research. It’s from August 1st, 22, so it’s a year ago. But it’s Yale School of Public Health, I mean, that’s a top-notch academic research institution. Also, various German research institutions were a part of this study. And it’s almost 2500 people who suffered a heat related heart attack. So, it was like, it was in Germany, and it was a hot time of year, and these people all had heat related heart attacks and they found that the risk of a heat related heart attack substantially increased if you were on an antiplatelet drug or if you were on a beta blocker. This includes, of course, aspirin, right? So, the incidence of a hot day related stroke increased by 63 to 65% if you took either family of these drugs. But if you took both types of drugs, so this makes the evidence even stronger. If you took both categories of these drugs, your risk of having a heat related stroke increased by 70, 75%. Now, this held true even for young people. Well, you know, young people are going to be more physically active, right? They’re going to be the people more likely to play soccer on a hot day or go outside and paint their fence or jog. So, you know, that’s reasonable. But even young, healthy, strong people, if they were on these two classes of drugs, their risk of a heat and ultra hot day related stroke increased dramatically. They also found and I can’t find the mechanism for this, mechanism means why it would happen. But people that were on statin drugs, statin drugs are drugs that lower cholesterol in an attempt to help prevent your heart arteries from clogging preventing coronary heart disease. People on statin drugs were three times more likely to have a heart related heart attack. I’m sorry, a heat related heart attack, if they were on a statin. It seems that statin drugs for some reason somehow make it harder for the body to cool down. According to the researchers, that’s their hypothesis. Of course, that would make sense, but maybe it’s like one of those sick people kinds of effects. Maybe the people on a bunch of these drugs are just really sick people. You know, it’s hard to say. Drugs for psychosis, increased risk of a heat related stroke. Of course, you can’t just drop those that would be dangerous, like Thorazine and drugs for ADHD. You know, there’s a lot to say about that, but they increase your body temperature. Anticholinergic drugs, now that, this is important. Anticholinergic drugs, they’re not really designed to have these effects, but they come out of the pathways that they affect. An example of anticholinergic drug would be an antihistamine. Think along the line of Benadryl, which is diphenhydramine. They didn’t want it to be anticholinergic. They want it to be an antihistamine for people with allergies. The problem is, if you use it all the time, it does affect your body temperature. It does affect your body temperature, because when you block a side effect of these antihistamines, as they have an anticholinergic effect, and when you inhibit that pathway, even though you’re doing it by accident, you’re not looking to inhibit that pathway, it prevents you from sweating. And that’s really important. † [00:14:09]

[00:14:11] I think it was Portland, Oregon. There was a heat wave there in June several years ago, and a large number of people died during the heat wave. And it was surprising because it was only in the nineties about it’s not like it was 115 degrees. It was in the nineties. So, they did a study, why would people die, so many people, such a large number of people die from a heat wave in the nineties in June when you don’t really see that happening in the end of July or through August. So, here’s what they found. It takes about a month of hot weather for your body to acclimate to the heat. So, they found in June, people up near Portland, Oregon, sweat about a liter of water per hour. But by the end of July or mid-August, etc., they’re sweating three liters per hour. So, that well, maybe three I’m sorry, three liters per day, so, that’s a big difference. That’s a big difference. So, you’re trapping the heat if you’re not sweating. So, you know really, heatwaves are more dangerous than the heat wave, when people have had hot weather for an extended period of time, like by mid-summer. So, sweating is so important. So, they found that these drugs, the antihistamines because they also have anticholinergic effects, make you heat up because you can’t sweat. Now there are options for antihistamines. You don’t have to have an antihistamine. First of all, if you go on a good probiotic over time, probiotics chip away at allergies. There’s a lot of good data on this where if you have allergies like food allergies and pollen allergies and rose allergies, etc., get on a good combination of probiotic bacteria. Some good strains are a lactobacillus plantarum, lactobacillus rhamnosus, Bifidobacterium animalis, subspecies lactis, these all help with allergies to a degree, and over time they chip away at the level of the allergy response, so your allergies become milder and milder over time. It’s pretty interesting, but if you need something right away for allergy symptoms, you can get one of those nasal pumps that are sodium chloride saline, like salt water, that’ll rinse out your sinuses. There are eyedrops that you can use because most allergens, believe it or not, are not entering through your nose and mouth. They’re entering you through your eyes, so there are allergy eye drops, but get supplements, stinging nettle root, vitamin C and Quercetin. Quercetin is found in really good foods, but you don’t get a lot of it, so you get a little bit in broccoli and spinach and kale and oranges and apples and blueberries, but you don’t get enough to make a difference. So, if you get some quercetin about 500 milligrams three times a day, you get some stinging nettle root, you take that along with the quercetin and you get some vitamin C, maybe 250 milligrams, 300 milligrams three times a day. That’ll really help you with your allergy symptoms. It’ll help a great deal. And if you get on that probiotic over time, it’ll chip away at the allergies. † [00:17:12]

[00:17:12] But there are other drugs that have a similar effect and anticholinergic effect like Detrol, Detrol is oxybutynin excuse me, Detrol or oxybutynin, which is Ditropan. My mouth is going faster than my brain. Detrol or oxybutynin which is Ditropan. They used for urgent continence, you know, your bladder can’t hold the urine and you have these accidents. But these drugs have real consequences. They prevent you from sweating. Now, let me say this also, because all of these drugs that I just mentioned in the past couple of minutes are anticholinergic. They mess with a major neurotransmitter in the brain that’s needed for memory and healing the brain, etc., and keeping your memory going, called acetylcholine and this can have an impact on your memory over time. It can reduce memory if you stay on these drugs over time. So, you know, there’s other reasons. There are other reasons to take a close look at these drugs, if you can replace them. There are supplements that help with incontinence, a mixture of like three leaf caper, isoflavones and silica can help you with incontinence. So can certain exercises like Kegel exercises, the floor exercises they use in pregnant women. Now, so another drug that can prevent you from sweating is sinamet, but that’s not something you can easily replace because they use that for Parkinson’s disease, a movement disorder that occurs in the brain that comes out of the brain. It’s a mixture of carbidopa and levodopa. But some of the things like the drug for incontinence, urinary incontinence and the drug for allergies, you don’t have to be on. There are solid supplements that’ll achieve the same thing. Maybe not as strong, but they’ll be good enough. A last group that would cause an issue like this, are tricyclic antidepressants. Once again, these are not something that you could just, you know, shrug off. Tricyclic antidepressants are very powerful drugs. An example would be Elavil, amitriptyline. There are a different class of drugs that cause a problem, are drugs that cause dehydration. And a lot of these drugs are used in older people. So, diuretics like Lasix, which is furosemide or hydrochlorothiazide, these are commonly prescribed drugs for people and diabetics and people with heart disease and people with high blood pressure, etc. They’re commonly used, and these diuretics make you very thirsty. But here’s the problem, all the people already have a decreased thirst reflex, they don’t know there is. If you put an older person on a treadmill for 15 minutes and you put a younger person on a treadmill for 50 minutes doing the same amount of energy. The people who are older will be a lot less thirsty than the younger person. So, all the people who are on these diuretics, they really have to pay close attention to consuming some high-quality liquid like water, you know, green tea. [00:20:34]


[00:20:36] Then there is photosensitivity, many drugs have a side effect of photosensitivity. They increase your sensitivity to the ultraviolet radiation coming from the sun. They make it easier to get a sunburn. When you have a sunburn, your body’s heating up. So, some diuretics, statin drugs, sulfonylurea drugs, those are used in diabetics. So, birth control pills, some antihistamines, some NSAIDS, you know, like, ibuprofen, but they cause a problem. So, if you’re on those drugs, how do you deal with it? You have to get those wearable clothing, that wearable clothing, the wearable sunscreen if you’re on those drugs. You want to wear the UPF shirts, and you want a UPF blocking hat. If you’re on those drugs and you don’t wear, like, I said put some sunscreen in places that are still going to be exposed to the sun like your neck or like, you know, by your, the front of your chest, top of your chest area. By the way, some nutrient, some supplements can help shield the skin from the sun. Milk thistle is excellent. Grapeseed is very good, but it takes time for grape seed to pick up to build up in the skin. The milk thistle seems to be protective a little bit quicker. Now, by the way, what are some signs of an impending heat stroke? Well, obviously, lethargy, you know, weakness, some fatigue, confusion, muscle cramps, you’ll get muscle cramps, dizziness, your skin could get pale and clammy. You could have a headache, very typical. You could have nausea, even vomiting. As far as NSAIDS go, because they do increase the risk of having a sunburn and, you know, some exposure over time, too much sun exposure over time can cause basal cell carcinoma, skin cancer. But sunburns can cause the deadly melanoma skin cancer. So NSAIDS, people commonly consume NSAIDS for arthritic knees, you can get a well absorbed turmeric, a well absorbed turmeric that’s high in curcumin, and that’ll work just about as well as a NSAID for your arthritic knee, and that doesn’t cause photosensitivity. So, like I use a product called a biocurcumin/5-loxin, which is a well absorbed turmeric high in curcumin, along with boswellia serrata, which is frankincense. And this is useful for muscle pain and joint pain and back pain. All the things you would use a NSAID for. So, I would replace my NSAID with like a well absorbed turmeric and like a boswellia serrata combination. Always take that with food. The other problem with NSAIDS is, they raise your blood pressure, they can trigger a stroke, they could cause heart failure, they’re bad for your kidneys. They’re not great for your eyes and your hearing. So, you know they’re not, there’s a lot of older people now, the doctors tell them, don’t use these NSAIDS like Ibuprofen, that you could get, you know, a lot of these drugs, you get without prescription. So, they have all these major side effects and problems, don’t use these drugs, because it’s going to raise your blood pressure and you already have a problem with your heart or your blood pressure. So that’s the crux of it. There are drugs that increase your body temperature or make it harder to sweat or increase your sensitivity to the sun’s ultraviolet radiation or make you dehydrated. And all of these things complicate hot weather, and maybe this is one of those podcast episodes that you should share with some of your friends if they’re on some of these drugs. In any event, I want to thank you for listening today. My name is Jerry Hickey, nutritional pharmacist. You can find all of the Invite podcast episodes for free wherever you listen to podcasts or just go to invitehealth.com/ podcast and subscribe and leave a review if you could. And you can also find Invite on Twitter and Instagram and Facebook at Invite Health. And I want to thank you so much for listening and I’ll talk to you next time on another episode, at InViteⓇ Health Podcast. † [00:20:36]

*Exit Music*

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