Why is it that some people have a normal sense of thirst and drink enough water throughout the day and others don’t have the urge to drink at all?

And more importantly…why don’t the elderly feel thirsty?

So what actually allows us to feel thirsty? It comes from either a low volume of fluids in the body or a higher concentration of certain osmolites, such as sodium. Certain receptors (osmoreceptors) situated in the brain are stimulated by an increase in plasma concentration and causes us to fell thirsty. When the body loses water, it is depleted from both the extracellular and intracellular compartments, but it may not be lost equally from each of those spaces. Regardless of whether the depletion is from the intra- or extracellular compartment, our bodies have a range of compensitory mechanisms that respond. These responses involve certain hormones (Vasopressin), stimulation of certain systems in the kidney to conserve water and sympathetic activation that minimizes changes in body fluid volume and composition mechanism of thirst . These mechanisms are amazing, but they don’t restore body fluids to their original state. For that to happen we have to drink! So when the elderly don’t feel thirsty, it’s important to find ways to help them drink.

Thirst is not always a reliable indicator of dehydration or the bodies need for water. Many people, especially the elderly don’t feel thirsty until they’re already dehydrated. There are many causes for lack of thirst sensation:

1. As we age, the amount of fluid volume in our body decreases.
2. The thirst response in older people becomes weaker, so they may not know they need to drink.
3. The elderly have a decrease in kidney function plus they may be on mediations that lead to more fluid loss, such as diuretics. Dehydration can lead to constipation, electrolyte imbalance, kidney problems, headaches and loss of balance.

Other causes for lack of thirst could be that you are dehydrated and just don’t feel thirsty as dehydration progresses. Your body fails to send signals to your throat and mouth to tell you to drink. Certain illnesses can also reduce the thirst reflex. Diabetes, physical exhaustion and mental disorders are a few examples.

We may also forget to drink due to being too busy, stressed and not paying attention. We know that stress, which stimulates adrenaline (in addition to too much coffee!) can decrease our appetite and sensation of thirst. It can become a bad habit and our bodies can sometimes adapt to this habit.

But the importance of hydration cannot be understated. We need adequate fluids to flush toxins, reduce muscle cramps and headaches, help our mood and energy, think clearly, have healthy skin and hair and improve sleep. Sometimes we can be dehydrated and have nausea so we don’t want to drink or eat and can feel agitated, moody, lethargic and confused.

Needless to say…let’s be more conscious of our drinking habits and stay hydrated.

Suggestions: Drink electrolyte fluids such as sports drinks or electrolyte powders that you put in water. Sparkling water, low sugar fruit juices are helpful if you don’t like the taste of water or mixing water with fruit juice. Reduce tea, coffee and alcohol as they have a diuretic effect. Take small sips instead of large amounts of water all at once.

References: www.next-health.com, news. March 17, 2022. Next Health Staff.

Clevelandclinic.org. Health Essentials. Drink Up: Dehydration is an often overlooked Health Risk for Seniors. Nov 29, 2018.

Ahhh..sugar, how sweet it is. Sugar is the most over-consumed carbohydrate in the world. We can’t live without it, because it has benefits like fueling our body and especially our brain but too much of it can cause multiple heath problems. So how does it all work? We process carbohydrates from the food we eat, such as fruits, vege’s. fiber and dairy products, and turn much of it into glucose. The problem occurs when we eat more foods with added sugar ( donuts, bread, candy soda, sweet fruit punch, etc), vs foods with naturally occurring sugar. The problems and disadvantages with overconsumption of sugars cannot be understated. Risks include metabolic syndrome, high cholesterol, heart disease, fatty liver disease, weight gain, dental cavities, insulin resistance and type 2 diabetes. Plus sugar can make you feel tired, cause headaches and difficulty concentrating after that quick surge of energy has fallen. So are artificial sweeteners the answer?

Certain sweeteners such as fruit juices, molasses, honey and maple syrup contain natural sugars and have some nutritional benefits. Fruits have fiber, vitamins and antioxidants, while honey and maple syrup have antioxidants and minerals such as iron, zinc, potassium and calcium.

In an effort to reduce the long-term manifestations of sugar, many people have resorted to sugar substitutes. The goal is to lower the risk of adverse health conditions but still taste that sweetness in our foods. It may seem like the best of both worlds but it actually is worse for you.

A prospective cohort study was done to study the associations between artificial sweeteners from all dietary sources such as sugar drinks, table top sweeteners and dietary products overall and also by certain molecules (aspartame, sucralose, acesulfame potassium) of artificial sweeteners and the risk of cardiovascular disease. A cohort study is a longitudinal study that follows over time a group of similar individuals who differ with respect to certain factors under study to see how these factors affect certain outcomes.

This study included over 103,000 mainly French females that were followed for an average of 9 years. A food questionnaire used 24-hour recalls which recorded what everyone ate or drank for multiple 24-hour periods. The study included all food sources of artificial sweeteners. The endpoints included all cardiovascular disease including heart disease, coronary heart disease and stroke.

The findings suggest a potential direct association between higher artificial sweetener consumption and increased cardiovascular disease risk. This study also broke down which artificial sweeteners had the greatest risk of disease. Aspartame (Equal) was associated with the greatest risk of stroke. This sweetener was found to be metabolized into many compounds, including formaldehyde. This can break down the blood-brain barrier causing risk of CNS toxicity, inflammation and stroke. BMJ Artificial Sweeteners

The other common artificial sweetener was Sucralose (Splenda). This was associated with the highest coronary heart disease risk. It is only partially absorbed chemically and has the largest effect on the microbiome. Avoid Artificial Sweeteners.

There are many harmful effects of artificial sweeteners including weight gain (the main reason people use these products!), metabolic dysregulation, inflammation, dysbiosis and endothelial dysfunction. These substances are often used in combination with other unhealthy lifestyle choices. These substances are being used more and more in our food supply especially for low calorie, low cost processed foods.

There are safer choices that I recommend:

1. Satisfy sweet cravings with fruit such as berries, bananas and mango. Try dehydrated fruits that you can chew on that gives a certain texture that may satisfy you. Skip the sodas, energy drinks and fruit juices.

2. If you must have a sweetener then consider a novel sweetener that’s derived from plants like, Stevia or Monk fruit. Yes, there are other sweeteners that come from plants, but novel sweeteners don’t lead to weight gain or blood sugar spikes and they are less processed.

3. And please…do not use Agave. It is worse than high fructose corn syrup because it is higher in fructose.

4. I would also consider a good local source of honey. It is 25% sweeter than table sugar so you need very little to get that sweet taste.

References: Rakel, D. Association intakes of artificial sweeteners with risk of cardiovascular diseases. BMJ, Practice Update. Sept 22 2022.

Leonard, J. Is honey better for you than sugar? Medical News Today. June 1, 2017.

Ziesel, J. Facts about sugar and sugar substitutes. Johns Hopkins Medicine- Health

For many years now the primary treatment for acne has been over the counter creams and cleansers such as benzoyl peroxide/salicylic acid, Vitamin A derivatives such as Tretinoin (Retin-A), antibacterial soaps, and of course oral antibiotics.  These treatments are still being used today. But now there is new evidence in the literature on the pathophysiology of acne development. This has lead to newer natural acne treatments. We have known that acne patients and healthy controls have different compositions of skin and gut microbiota. Now we see how acne treatment can disrupt the microbiome, especially with the use of oral antibiotics. This can lead to gut dysbiosis which can lead to chronic inflammation, obesity, cancer, cardiovascular disease, neuropsychiatric conditions such as dementia, depression and anxiety. This gut dysbiosis plays an important role in inflammatory skin conditions such as acne.

One way to look at this gut imbalance is to do a stool analysis. I look for nutritional deficiencies and get labwork that includes nutrient levels, inflammatory markers, blood sugars and food allergy tests.  Some patients may have adequate amounts of zinc and omega 3 fatty acids, but many do not. Studies have found significantly lower serum zinc levels in patients with severe acne than in controls. Acne has an inflammatory component, and lower serum zinc concentrations may reflect a response to inflammation rather than a true zinc deficiency. Pantothenic acid (B5), L-carnitine and oral probiotics have also been helpful. For women, Vitamin B6 (Pyridoxine) at 50 mg/day starting 1 week prior to menses and continuing throughout menstruation showed a 72% decease of premenstrual acne flairs.

There are also topical probiotics that can be used to treat acne that use AOB (ammonia-oxidizing bacteria) as the key ingredient which is a type of bacteria already found on the skin. Our natural skin bacteria gets damaged and depleted over time due to harsh soaps and cleansers which many people use to treat acne. This live bacteria (topical probiotic) replenishes what the skin is missing with minimal side effects Mother Dirt. This is a very natural acne treatment.

For female hormonal acne and especially women who have polycystic ovarian syndrome (PCOS), I recommended D-chiro-inositol which is an isoform of inositol that reduces hyperandrogenism better than myo-inositol. D-chiro-inositol helps regulate cycles while reducing symptoms of acne and hirsutism.

Diet is extremely important when it comes to acne. I discuss when and what people eat and drink and then review their stool test results to allow a more complete understanding of what factors shape the microbiome. Common deficiencies I see in the gut is low fiber, low bacterial (probiotics), low stomach acids and low pancreatic enzymes. Acne has been associated with a diet high in refined sugar and fatty foods including processed foods and alcohol. Exacerbations of acne can result from allergic food reactions or from the effects of biologically active substances in certain foods, such as hormones in cow’s milk or amines and other chemicals in chocolate. Eating whole foods is best, in which there are no labels or ingredient lists on products such as fruits, vegetables, lean proteins, and healthy fats such as avocado, olive oils, fish and nuts/seeds. The gut is an important ecosystem that can cause non-GI symptoms such as acne, eczema, fatigue and nutrient deficiencies.

Last but certainly not least is thyroid. The thyroid gland is the “control tower” of your endocrine system. It secretes hormones into the circulatory system that regulates and controls metabolism. The endocrine system is responsible for growth, repair, metabolism (the rate at which food is burned for energy), energy and reproduction. If that system is out of balance, it can significantly effect your health. When thyroid hormone is deficient (known as hypothyroidism) the body cannot convert cholesterol to other steroids such as Pregnenolone, Progesterone and DHEA. Of all of these…Progesterone is the most important when it comes to acne.

Women have thyroid receptors on their ovaries. So if there is an underachieve thyroid, women will not ovulate as effectively and as a result will not produce adequate amounts of progesterone. This may be why many women suffer from premenstrual acne among other symptoms such as anxiety, irritability, breast tenderness or headaches. Yes, all a result of low progesterone and possibly due to a hypothyroid condition. Low thyroid function increases inflammation because it regulates skin function and how much oxygen the skin absorbs. Thyroid levels can be checked with a simple blood test. Talk to your practitioner to get tested.

Acne can be treated in a ‘wholistic” and integrative way vs mainstream pharmaceutical methods. Treatment can also give you additional benefits that you can see and feel besides clear skin.

References: InYoung, K. Recent updates in pathophysiology and treatments in adult acne. Dermatology, Primary Care, May 25, 2022. Elsevier Inc.

Gaby, A. Acne Vulgaris. Nutritional Medicine, Second edition, 2017. Fritz Perlberg Publishing, Concord NH. pp 707-210.

Villett, M. Is low thyroid causing your “hormonal” acne? The Skincare Edit. 2019.

Amer M. Bahgat MR, Tosson Z, et al. Serum zinc in acne vulgaris. IntJ Dermatol 1982; 21: 481-484.

Snider B, Dieteman DF. Pyridoxine therapy for premenstrual acne flair. Arch Dermatol 1974; 110:130-131.

Nutrients that sound the same can be very confusing. Niacin, niacinamide, nitrates, and nicotinamide adenine dinucleotide can have differences in how they function, yet be similar in how they assist in healthy aging. So let’s start with niacin and niacinamide which are 2 forms of water soluble vitamin B3.

Niacin, also known as nicotinic acid is a vitamin essential for energy metabolism. It helps in the functioning of the digestive tract, skin and nervous system. It is also known for its benefits in reducing cholesterol, particularly people with elevated triglycerides and low HDL (good cholesterol). It is found in food sources such as fish, meat, eggs, milk, yeast, nuts, green vegetables, and beans. Niacin as a supplement can cause blood vessels to dilate which results in flushing for some people. If that’s the case, then I recommend using an extended release form that causes less flushing.

Niacinamide is the other form of B3 (Niacin) that was initially used to prevent a condition know as pellagra- a disease causing dermatitis and red lesions due to B3 deficiency. Today it is used in many skin care products to prevent acne, wrinkles and skin damage. Our body has the ability to convert niacin into niacinamide in large amounts. In high doses, niacinamide can cause skin irritation, burning, itching or redness. Topical niacinamide skin products can be as high as 10%, but studies show that there is no additional benefit compared to doses as low as 2%.

Let’s talk about nitrates. These are compounds found in beetroot and dark leafy greens like spinach and arugula. When you consume nitrates, your body converts it to nitric oxide, which allows blood vessels to dilate and lowers blood pressure. Nitric oxide is an important molecule in all aspects of aging. It increases blood perfusion and not only delivers nutrients and oxygen to tissues including the heart, but also removes waste products. It also suppresses coagulation and stops blood from getting “sticky”. Be careful because nitrates can come from processed foods, such as preservatives in bacon, cold cuts and hot dogs. You want to stay away from them due to their risk for cancer. But vegetable nitrates, such as celery, cress, lettuce, rugula and spinach are harmless and these along with other antioxidants help neutralize free radicals.

The other N-compound that assists in the aging process is Nicotinamide adenine dinucleotide (NAD+). The reduced form of NAD+ is NADH which is critical for mitochondrial production of ATP, which serves as fuel for the cells of the body. NAD+ levels decrease with age. Low levels make mitochondria more vulnerable to damage.  Low NAD+ also occurs in many neurodegenerative diseases including Alzheimer’s, Parkinson’s, cardiovascular disease and muscle atrophy. Sirtuins, which increase lifespan, need NAD+ to function properly. Sirtuins are a class of enzymes that influence aging and longevity through multiple pathways. These enzymes stop the decline in vascular endothelial function, metabolic syndrome, ischemic injury, obesity and cardiomyopathy. NAD+ can be activated with lean diets, exercise, intermittent fasting, and supplementing with NADH 5-10 mg daily. Resveratrol which is a polyphenolic compound produced in plants has been shown to activate Sirtuin. Sources are grapes and berries.

Nutrients that sound the same can be very confusing. By understanding and incorporating these nutrients in our life we can improve healthy blood flow and mitochondrial rejuvenation to help us feel healthier and more energetic as we age.

Reference: Van De Walle, G. Niacinamide: Benefits, Uses and Side effects. Healthline.com. Nov 16, 2018.

Natural Medicines Comprehensive Database: NADH. natural database.com

Meletis, C. Wilkes, K. The critical role of NAD+ and nitric oxide replenishment in anti-aging medicine. Townsendletter.com. Dec. 2021, Issue #461. p. 48-51.

There has been growing interest in the interaction between the gut microbiome (genes of gut bacteria) and medications. Some medications are known to effect the gut in certain ways. For example, antibiotics tend to change the amount and types of bacteria in the gut which can cause side effects such as nausea and diarrhea. The drugs associated with lowering stomach acids such as PPIs (protein pump inhibitors), is associated with an increase in oral bacteria (that’s right…bacteria that’s found in the mouth) and potential pathogenic bacteria in the gut. There are interactions between the gut microbiome and medications.

Researchers studied the effects of 15 drugs on 25 strains of human gut bacteria and found a variety of drug-bacteria interactions. Some bacteria store the drug without chemically changing it while other bacteria chemically modify it to make it more or less bioactive. In other words, the gut bacteria can determine the amount of a drug (or an active drug metabolite) that is available to the body.

The opposite is also true. A particular drug can also affect a patient’s gut bacteria, both the number and function of that bacteria. For example, the build-up of a drug within a strain of bacteria can change the growth rate of those bacteria. Sometimes a drug can even change the molecules that are secreted by bacteria. This doesn’t sound like a big deal until you understand that the molecules can include hormones, neurotransmitters and molecules of inflammation that effect our physiology. There are clearly interactions between the gut microbiome and medications.

The drug variability can be due to either a person’s genetics or due to the person’s gut flora. Association studies have shown changes in the abundance of various gut bacteria in individuals with inflammatory bowel disease, irritable bowel syndrome and colorectal cancer.  This has also been found in other systemic diseases such as cardiovascular, metabolic conditions, autoimmune and psychiatric disorders.

As you can see here, there is a complex bidirectional interaction between commonly used drugs and the gut microbiome. This means that among people who have the same disease, a particular drug can vary greatly in its effectiveness and adverse effects. Perhaps this will help us in finding interventions to modulate the gut microbiome and optimize effectiveness of treatment.

Reference: Klünemann, M et al. Bioaccumulation of therapeutic drugs by human gut bacteria. Nature 2021 Sep; 597:533

Weersma, R et al. Interaction between drugs and the gut microbiome. Gut 2020 Volume 69, Issue 8. gut.bmj.com