Tuesday, October 20, 2020

Short and Long-Term Effects

While looking for something or other, I recently came across this article saying that arginine has no long-term effect on heart health. Arginine is one source of nitric oxide, which dilates blood vessels. Nitroglycerin, used by heart patients for angina, also produces nitric oxide.

 The cited article was published in 2007 and took me back. At the time, arginine was hot stuff among some people concerned with heart disease. Author and blogger David Mendosa wrote about it in 2006, and it was strongly recommended by his endocrinologist, Dr. Joe Prendergast. Sadly, both David and Dr. Joe have since died. Here is a more recent article. 

I won't discuss here the merits of arginine or the arginine-containing Heart Bars (discontinued) that Dr. Joe was so enthusiastic about. What is interesting is the fact that according to the first article, arginine does improve heart health in the short term, but just not in the long term. 

This is true for other treatments and supplements as well. One good example is caffeine. Caffeine binds to a receptor for adenosine and blocks the adenosine from binding. When you need sleep, your levels of adenosine are high, and binding to that receptor makes you sleepy. When caffeine blocks the adenosine you're less sleepy.

Sounds great if you need to stay awake past your usual bedtime, but there's one problem. When you ingest caffeine on a regular basis, your body compensates by making more adenosine receptors. So now you need even more caffeine, and more, just to stay awake during the day. You're addicted.

Thus when you try anything new, you should be aware of the possibility that the short-term benefits, or side effects, may be different from the long-term effects. Metformin is a good example of the difference in negative effects. Many people can't tolerate metformin if they start it at the full dose, because of gastrointestinal problems like diarrhea. But if they start it slowly, it's fine. The body, which is generally smarter than we are, has figured out how to adapt.

I have personal experience with metformin side effects. I'd taken it for about 20 years with no problem, when it occurred to me that instead of taking 500 mg extended release (ER) twice a day, it would be easier to take 1000 mg once a day. My endocrinologist prescribed the 1000 mg without mentioning that it wasn't ER; the 1000 mg doesn't come in ER. I didn't notice that the bottle didn't mention ER, and because the pills were so large, I just assumed that's what it was. Dumb mistake.

After a while I started getting diarrhea. As my water supply isn't perfect (a spring with some surface water), I wondered if it was Giardia. We did tests and more tests. No clues. Finally, it occurred to me that it could just be the metformin, and sure enough, when I stopped taking it, the diarrhea went away.

A dosage that worked when spread out over the day didn't work without side effects when given at one time. I then returned to the 500 mg twice a day, introduced slowly, and had no more problems. 

Sometimes, especially if you find that a drug or supplement that worked wonderfully when you started taking it seems to have lost its oomph, it might make sense to take a vacation from it for a short time. Obviously this wouldn't be a good idea for a life-saving drug like insulin or medication for high blood pressure. But it might work for less essential supplements.

We don't know a lot more than we do know about how the body works, so any treatment is a work in progress. Stay alert to the effects of the drugs and supplements (and food) that you do take. Let your doctor know if prescription drugs seem to be working differently than when they were first prescribed. Maybe, like arginine, the differences are not in your imagination.


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