Q: I have been a heavy drinker for 35 years — just in the evenings, after work. I would take six or eight drinks nightly, waking with a hangover almost every morning.
I spoke to my doctor last year about naltrexone. Since starting naltrexone, I have been able to manage my drinking. I limit it to no more than one or two drinks daily.
On some days, I have skipped alcohol completely. My prescription ran out a couple of months ago. At first, I was able to limit my intake. However, it has increased to the point where I am returning to my previous consumption levels. I will be seeing my doctor in a few days, and, as much as I hate relying on a drug for help, I will be asking for a renewal on the naltrexone prescription.
A: Naltrexone (ReVia, Vivitrol) is an opioid antagonist. That means it blocks the effects of opioid medication, as well as natural opioids (endorphins) in the brain. Scientists think it is these endorphins that are responsible for the pleasure some people get from drinking alcohol.
Studies show that naltrexone can be effective, especially when combined with counseling (New England Journal of Medicine, Aug. 14, 2008; Journal of Substance Abuse Treatment, February 2018).
Q: I have been diagnosed with Type 2 diabetes. I’ve been trying to control my blood sugar levels with the help of a nutritionist for about a year now. I am thin, work out regularly and eat really well. It’s not enough.
My doctor has now prescribed metformin. What are your thoughts on this drug? And do you know of anything else I could try? I am still asymptomatic and feel great. I wish I could help myself through diet and exercise.
A: Don't give up on your good diet and exercise habits! They will help with the effectiveness of your treatment, even if you haven't been able to control your blood sugar with them alone.
Metformin is a first-line drug for Type 2 diabetes, as well as one of the oldest and best-studied. It improves the body’s response to insulin and can be quite effective. In addition to its ability to keep blood sugar down, metformin also has shown promise for its anti-cancer activity (Acta Biochimica et Biophysica Sinica, online, Oct. 7, 2017).
There are potential side effects, however. The most common are digestive: nausea, stomachache, indigestion, loss of appetite, diarrhea and flatulence. The most serious side effect, lactic acidosis, is rare, but you should be alert for the symptoms: abdominal pain, irregular or rapid heart rate, low blood pressure and anxiety. Such symptoms signal a medical emergency.
We are sending you our “Guide to Managing Diabetes,” which has more information on metformin and other treatments, including many natural approaches. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. DM-11, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
Q: I took hydrochlorothiazide (HCTZ) for about 15 years to lower my high blood pressure. Soon after I started taking it, I began experiencing episodes of gout.
Belatedly, I put the pieces together and realized that HCTZ was a major contributor to my gout.
Now I take tart cherries to lower my chances of gout, and I have lost weight to bring my blood pressure down into normal range.
A: Gout is caused by a buildup of uric acid crystals in the joints. Since HCTZ can raise uric acid levels in the blood, it may contribute to gout. Congratulations on the healthy weight loss.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”
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