Ask Mark …

Leila from EFFORTS heard that taking the antibiotic, Levaquin, for her bronchiectasis has many side effects and might not be the best choice for her.

Mark answers, Levaquin, a class of drugs known as fluoroquinolones, has mental health side effects as disturbances in attention, disorientation, ag- itation, nervousness, memory impairment and delirium and serious blood sugar disturbances. A “black box” warning has been added by directive of the FDA. (A boxed warning is a type of warning that appears on the package insert for certain prescription drugs, so called because the FDA specifies that it is formatted with a ‘box’ or border around the text.) They say the use of fluoroquinolones has a place in the treatment of serious bacterial infections – such as certain types of bacterial pneumonia– where the benefits of these drugs outweigh the risks, and they should remain available as a therapeutic option. It is not to be used as a first line or early intervention antibiotic. There are other medications that can and should be used before resorting to Levaquin. Fluoroquinolones are not a good choice for respiratory infections unless the organism is specifically sensitive to them and other classes of antibiotics will not kill the organism.

Discuss your choices with your physician as I think Azithromycin would be much better and safer alternative for you.

Ann B. was warned not to take N-Acetyl-L-Cysteine (NAC) because a new report has found it may cause bronchospasm and asks Mark for his opinion.

Mark tells us, I have promoted NAC for a very long time. NAC, taken orally as a supplement, does not and cannot generate or cause bronchospasm- spasm of the smooth muscles that surround your airways. On the other hand, it has long been known that inhaled NAC (Mucomyst, Mucosol) can cause bronchospasm, as it is irritating to the bronchial mucosa.

Oral supplements of NAC help stimulate the production of glutathione, perhaps the most powerful anti-oxidant and anti-inflammatory molecule in our body. It is produced in the liver as a primary site but can be made by any cell. Several studies have been conducted to determine if there is any beneficial effect of taking NAC as a supplement for those with Idiopathic Pulmonary Fibrosis (IPF), but findings have been disappointing. In my humble opinion, too low a dose of NAC was used in these studies. I recommend 2400 mg/day (1200 mg in the am and 1200 mg in the pm). Taken with meals, any gastrointestinal side effects as gassiness, upset stomach or worst case, nausea, are blocked.

For those with COPD and mucus issues, NAC supplements not only provide the anti-oxidant benefit, NAC helps mobilize and liquefy mucus and change its properties. It has anti-inflamma- tory action for the airways, reducing swelling by natural body processes. Prednisone provides a similar effect in the airways – and theoretically, for some, NAC’s action could reduce the need for or the dose needed of prednisone. It can help inhaled steroids work better or reduce their required doses. So, all in all, there is a much more compelling reason to take NAC – as a nutritional supplement and not as an inhaled medication – than there is any evidence against its use or showing negative benefit from its use. It is import- ant to understand that it doesn’t react with other medications a user might be taking.

N-Acetyl-L-cysteine

N-Acetyl-L-Cysteine (NAC) has many uses as medicine. Besides COPD and lung cancer, it is used to counteract acetaminophen and carbon monoxide poisoning. It is also used for chest pain, Lou Gehrig’s and Alzheimer’s diseases, allergic reactions, and ear and eye infections as well as many, many other indica- tions including as a treatment for hangovers! NAC is given intravenously (by IV), is inhaled by aerosol for lung disorders, and also orally by mouth.

Joy from Missouri asks Mark about the best way to lose weight. She has tried using a salad plate instead of a dinner plate for meals to cut down on portions and chewing slowly while eating.

Mark relates, When I embarked on my weight loss journey, I cut 500 to 700 calories from my diet daily which kept me at about 1500 calories/ day. I also cut the percentage of carbohydrates I ate and increased fat intake and lost 45 pounds. Since then, maintaining about 1600 to 2000 calo- ries/day, I’ve managed to lose and keep off about 57 pounds! I am on what would qualify as a modi- fied Paleo diet – lots of fats, about 30 percent pro- tein and keeping carb intake to between 90 to 120 calories/day. I lost 10 inches in my waist. It has been costly with my wardrobe! I’m on my third round of clothing purchases since beginning to lose weight. But I can easily live with this since I look and feel so much better! My target weight is 135 pounds being 5’ 4”. I’m at about 138 pounds, right now.

I have to say that eating more fat is really satis- fying! I have not been hungry the whole jour- ney. Even though I consume a fair amount of ‘saturated’ fats, my lipids continue to be normal to low normal, with my HDL running around “80”! That’s very high and very good! Normal levels are 40 to 60 milligrams per deciliter (mg/dL). HDL stands for high-density lipoproteins. It is called the “good” cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

For me, as a consummate “foodie” and one who loves to cook, this has been monumental! I continue to eat everything that I love to eat but I eat less than I did for so many years! Fancy diets will not work for life-long changes! One must find a diet pattern and eating habits that are sustainable.