HEAT WAVE HAZARDS
Maureen Salamon
With June's arrival, summer heat waves can't be far behind. They're happening more often than ever: according to the Environmental Protection Agency, the average American city experiences six heat waves — prolonged periods of unusually high temperatures — each summer, three times as many as in the 1960s.
Beyond comfort, paying attention to rising mercury levels is vital to our health for a key reason. Certain medications can leave us more vulnerable to heat-related effects or the sun's rays and higher temperatures may render medicines less effective.
Most people don't consider that the weather can amplify drug side effects. "But they should, because it can be dangerous if you don't take the right precautions," says Magie Pham, a primary care pharmacist at Harvard-affiliated Brigham and Women's Hospital.
Tens of millions of Americans take drugs that can change the way they tolerate intense heat and sunshine. Over all, about three-quarters of Americans ages 50 to 64 take prescription drugs, a proportion that climbs to nine in 10 people at 65 and older. The situation is similar with over-the-counter drugs, which adults 65 and up use more than any other age group.
There's no magic number the temperature must reach before this issue becomes relevant. It's relative, Pham says, since people who live in warmer climates year-round typically have different thresholds for how heat affects them compared with those who live in four-season climes. "Every person tolerates heat differently," she says.
Research indicates that people become increasingly vulnerable to heat as they age, since their ability to sweat efficiently and circulate blood to the skin — two key ways the body cools itself — decreases over the decades. (See "Know the signs of heat stress.") Older women are also more physiologically vulnerable to high heat and humidity compared with men of the same age, according to a study published online on August 26, 2024, by the American Journal of Physiology–Regulatory, Integrative and Comparative Physiology.
MEDICATIONS TO WATCH
Known as "water pills," diuretics make us urinate more, removing excess fluids from the body. But these drugs, which are prescribed to manage conditions such as high blood pressure, heart failure, kidney disorders, or glaucoma, can make it more likely you will become dehydrated quickly in extreme heat. They can also lead to imbalances in levels of electrolytes — minerals essential to various bodily functions — which make it harder for the body to regulate its temperature.
"We see many people who've been fine for a long time on diuretics, but then they go somewhere a lot warmer than they're used to and end up becoming severely dehydrated," Pham says. "It's probably the medication I'm most worried about." Other blood pressure drugs. These widely prescribed medications, which include ACE inhibitors, beta blockers and calcium-channel blockers, raise the odds of fainting and falling if they drive blood pressure too low. "If someone is already dehydrated, that can also lower their blood pressure, causing them to faint or fall," Pham says. "It's more of a domino effect from being out in the sun." Doxycycline. This antibiotic is just one example of the many drugs that cause photosensitivity, "meaning you're more likely to get sunburned," she says. "The safest way to avoid that is to make sure you wear sunscreen any time you're going to be outside — even on a cloudy day, because you can still get sunburn." Some antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can make you sweat more and impair your body's ability to regulate temperature, hindering your ability to stay cool. "You don't realise how warm you're getting when you're taking these medications," Pham says. "It's important to be hydrated and wear sun-protective clothing, such as a hat, as well as stay in the shade. These approaches can make a real difference in keeping your temperature down." Thyroid hormone. One of the most frequently prescribed medications in the United States, thyroid hormone — usually in the form of levothyroxine (Synthroid, Tirosint, Unithroid) — treats hypothyroidism (an underactive thyroid gland), a condition far more common among women than men. Like other medications above, thyroid drugs can impair the body's temperature regulation, making people sweat too much and increasing the chance of dehydration. Adding to the risk, older people are less likely to realise thirst and sense the degree of heat.
Some over-the-counter antihistamines. Used for allergies and also as a sleep aid, diphenhydramine (Benadryl) and doxylamine (Unisom) may be helpful during the pollen explosion common to hot weather. But like other medicines, they can also hinder sweating and impair core temperature control. Additionally, they raise your risk of sunburn.
Most medication labels direct us to keep the substance in a cool, dry place. That's because elevated temperatures can damage drugs in ways both known and unknown. Insulin, for example, which requires refrigeration, becomes unusable in the heat; inhalers, which are pressurised, can explode; and EpiPens, used to counter extreme allergic reactions, can malfunction.
But scientific studies don't typically examine the effectiveness of drugs beyond room temperature, Pham notes. "If it's 80° or 85°, we have no idea how effective those medications are," she says. "But it makes sense to believe that they're not going to work as well as if they're kept at a more moderate temperature." Plan ahead to avoid exposing your medications to unstable temperatures while you're travelling. On road trips, place medicines in a cooler, not your car's glove box, which can get too hot even if you have the air conditioning on. For plane flights, stash your medications in your carry-on bag, since checked luggage can get lost or delayed and temperatures in a plane's cargo hold can be variable. "Unfortunately, the temperatures where luggage is stored can be too hot or cold," Pham says.
Also, check with your prescribing doctor or pharmacist about how long medications requiring refrigeration can be safely kept at room temperature. And before you fly, Pham suggests calling the Transportation Security Administration toll-free at 866-289-9673 for guidance about medications you'll be carrying, so no snafus arise as you pass through airport security checkpoints. "Your doctor can also provide you with a travel letter to present to TSA representatives so you have no issues," she says. — The New York Times
SIGNS OF HEAT STRESS
- hot, dry skin or profuse sweating
- confusion
- throbbing headache
- loss of coordination
- rapid heart rate
- extreme weakness
- fast, shallow breathing
- nausea and vomiting
- loss of consciousness
- Heat-related drug damage
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How to manage blood sugar with exercise
These days, more and more of us have to worry about our blood sugar. Some 38 million Americans have diabetes and more than two times that number have pre-diabetes. Many millions more have some form of insulin resistance, which can make you tired, irritable and even dizzy. And all of these conditions become more common as we age. The good news is that exercise can help. It's at least as important as your diet for preventing and treating insulin resistance and diabetes. It can also help you lose weight, which is often the most important step in levelling out blood sugar. Exercise has several unique ways to help your body process glucose, said Dr Donald Hensrud, a specialist in preventive medicine and nutrition; and medical editor of 'The Mayo Clinic Diet.' Although any exercise is good for you, the type of movement you choose and when you do it can play a big role in how much it helps. Here are some things you should think about when planning workouts, according to experts. The causes of diabetes are complex. Family history, genetics, weight and diet certainly play a role. But it's clear that exercise can dramatically lower your blood glucose, regardless of your diagnosis and improve how well your body uses insulin. In fact, research has shown that exercise is generally more effective at preventing diabetes than medication is (though it is important to use all types of treatment). During exercise, your muscle cells can more easily use the glucose in your blood. This lowers blood sugar directly and can also reduce the fat around your organs, an important risk factor for diabetes and insulin resistance, said Dr Gerald I Shulman, a professor of medicine and physiology at the Yale School of Medicine. In particular, studies show that regular high-intensity interval training or moderate continuous exercise can make a difference, reversing pre-diabetes in almost 40% of the participants — although it could take months or even years for many people to see long-lasting changes. Any movement is better than none and simply going for a walk can have benefits. But according to research, the two most effective ways to lower your blood sugar through exercise are high-intensity workouts and strength training. A recent study found that strength training was significantly more effective for controlling blood sugar levels than aerobic exercise for people with Type 2 diabetes and this likely holds true for other people worried about their blood sugar, Shulman said. Also, both aerobic exercise and strength training create more mitochondria, which can help fight Type 2 diabetes, but weightlifting appears to be slightly more effective than aerobic exercise, assuming you are pushing yourself, Shulman said. Strength training is especially important for older people, since insulin resistance and Type 2 diabetes accelerate the normal loss of muscle and strength that comes with age, particularly for women. While walking is good exercise for the heart, it generally won't build much muscle, said Michael Joseph Gross, author of 'Stronger: The Untold Story of Muscles in Our Lives.' The way you strength-train is also important, he added. To be most effective, the weights should feel heavy. A systematic review of the research found that lifting challenging weights helped lower blood sugar more effectively than low-intensity strength training. Consider alternating your strength training session with high-intensity interval training, which has been shown to be especially effective in managing blood sugar for people with pre-diabetes and Type 2 diabetes. If you have diabetes, consult a doctor before radically changing your fitness regimen. If you do not have insulin resistance, the time of day you work out doesn't matter much. But for people with pre-diabetes and Type 2 diabetes, studies suggest that afternoon exercise tends to help reduce blood sugar levels. That's because blood sugar rises and falls in regular patterns over the course of the day and as the day goes on, the body becomes less insulin sensitive. Thus afternoon exercise is typically less likely to cause dangerous glucose spikes. Experts recommend working out at least three days per week, with no more than two days in a row without activity. For people with insulin resistance, including diabetes, the best time to exercise is about 30 minutes after starting a meal to prevent blood sugar spikes. If morning workouts fit better with your schedule, try not to eat too many carbohydrates beforehand and start the day with a small meal of protein and healthy carbohydrates like fruit, vegetables and whole grains. Pre-diabetes and new-onset diabetes are much more responsive to lifestyle changes like diet and exercise than longer-term cases, Hensrud said, so it's important to address insulin resistance as soon as possible. 'I tell people with new diabetes they're in control,' he said, 'and the most important thing to do is decrease weight through dietary changes and exercise.' — The New York Times BLURB The causes of diabetes are complex. Family history, genetics, weight and diet certainly play a role. But it's clear that exercise can dramatically lower your blood glucose, regardless of your diagnosis and improve how well your body uses insulin.
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How to manage your blood sugar with exercise
These days, more and more of us have to worry about our blood sugar. Some 38 million Americans have diabetes, and more than two times that number have prediabetes. Many millions more have some form of insulin resistance, which can make you tired, irritable and even dizzy. And all of these conditions become more common as we age. The good news is that exercise can help. It's at least as important as your diet for preventing and treating insulin resistance and diabetes. It can also help you lose weight, which is often the most important step in leveling out blood sugar. Exercise has several unique ways to help your body process glucose, said Dr. Donald Hensrud, a specialist in preventive medicine and nutrition and medical editor of 'The Mayo Clinic Diet.' Although any exercise is good for you, the type of movement you choose and when you do it can play a big role in how much it helps. Here are some things you should think about when planning workouts, according to experts. Exercise is essential for managing blood sugar. The causes of diabetes are complex. Family history, genetics, weight, and diet certainly play a role. But exercise can dramatically lower your blood glucose, regardless of your diagnosis, and improve how well your body uses insulin. Research has shown that exercise is generally more effective at preventing diabetes than medication is (though it is important to use all types of treatment). During exercise, your muscle cells can more easily use the glucose in your blood. This lowers blood sugar directly and can also reduce the fat around your organs, an important risk factor for diabetes and insulin resistance, said Dr. Gerald I. Shulman, a professor of medicine and physiology at the Yale School of Medicine. In particular, studies show that regular high-intensity interval training or moderate continuous exercise can make a difference, reversing prediabetes in almost 40% of the participants, although it could take months or even years for many people to see long-lasting changes. Prioritize strength training and intensity. Any movement is better than none, and simply going for a walk can have benefits. But according to research, the two most effective ways to lower your blood sugar through exercise are high-intensity workouts and strength training. A recent study found that strength training was significantly more effective for controlling blood sugar levels than aerobic exercise for people with Type 2 diabetes, and this likely holds true for other people worried about their blood sugar, Shulman said. Also, both aerobic exercise and strength training create more mitochondria, which can help fight Type 2 diabetes, but weightlifting appears to be slightly more effective than aerobic exercise, assuming you are pushing yourself, Shulman said. Strength training is especially important for older people, since insulin resistance and Type 2 diabetes accelerate the normal loss of muscle and strength that comes with age, particularly for women. While walking is good exercise for the heart, it generally won't build much muscle, said Michael Joseph Gross, author of 'Stronger: The Untold Story of Muscles in Our Lives.' The way you strength-train is also important, he added. To be most effective, the weights should feel heavy. A systematic review of the research found that lifting challenging weights helped lower blood sugar more effectively than low-intensity strength training. Consider alternating your strength training session with high-intensity interval training, which is especially effective in managing blood sugar for people with prediabetes and Type 2 diabetes. If you have diabetes, consult a doctor before radically changing your fitness regimen. When is the best time to work out? If you do not have insulin resistance, the time of day you work out doesn't matter much. But for people with prediabetes and Type 2 diabetes, studies suggest that afternoon exercise tends to help reduce blood sugar levels. That's because blood sugar rises and falls in regular patterns over the course of the day, and as the day goes on, the body becomes less insulin sensitive. Thus afternoon exercise is typically less likely to cause dangerous glucose spikes. Experts recommend working out at least three days per week, with no more than two days in a row without activity. For people with insulin resistance, including diabetes, the best time to exercise is about 30 minutes after starting a meal to prevent blood sugar spikes. If morning workouts fit better with your schedule, try not to eat too many carbohydrates beforehand and start the day with a small meal of protein and healthy carbohydrates like fruit, vegetables and whole grains. Prediabetes and new-onset diabetes are much more responsive to lifestyle changes like diet and exercise than longer-term cases, Hensrud said, so it's important to address insulin resistance as soon as possible. 'I tell people with new diabetes they're in control,' he said, 'and the most important thing to do is decrease weight through dietary changes and exercise.' This article originally appeared in
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HEAT WAVE HAZARDS
Maureen Salamon With June's arrival, summer heat waves can't be far behind. They're happening more often than ever: according to the Environmental Protection Agency, the average American city experiences six heat waves — prolonged periods of unusually high temperatures — each summer, three times as many as in the 1960s. Beyond comfort, paying attention to rising mercury levels is vital to our health for a key reason. Certain medications can leave us more vulnerable to heat-related effects or the sun's rays and higher temperatures may render medicines less effective. Most people don't consider that the weather can amplify drug side effects. "But they should, because it can be dangerous if you don't take the right precautions," says Magie Pham, a primary care pharmacist at Harvard-affiliated Brigham and Women's Hospital. Tens of millions of Americans take drugs that can change the way they tolerate intense heat and sunshine. Over all, about three-quarters of Americans ages 50 to 64 take prescription drugs, a proportion that climbs to nine in 10 people at 65 and older. The situation is similar with over-the-counter drugs, which adults 65 and up use more than any other age group. There's no magic number the temperature must reach before this issue becomes relevant. It's relative, Pham says, since people who live in warmer climates year-round typically have different thresholds for how heat affects them compared with those who live in four-season climes. "Every person tolerates heat differently," she says. Research indicates that people become increasingly vulnerable to heat as they age, since their ability to sweat efficiently and circulate blood to the skin — two key ways the body cools itself — decreases over the decades. (See "Know the signs of heat stress.") Older women are also more physiologically vulnerable to high heat and humidity compared with men of the same age, according to a study published online on August 26, 2024, by the American Journal of Physiology–Regulatory, Integrative and Comparative Physiology. MEDICATIONS TO WATCH Known as "water pills," diuretics make us urinate more, removing excess fluids from the body. But these drugs, which are prescribed to manage conditions such as high blood pressure, heart failure, kidney disorders, or glaucoma, can make it more likely you will become dehydrated quickly in extreme heat. They can also lead to imbalances in levels of electrolytes — minerals essential to various bodily functions — which make it harder for the body to regulate its temperature. "We see many people who've been fine for a long time on diuretics, but then they go somewhere a lot warmer than they're used to and end up becoming severely dehydrated," Pham says. "It's probably the medication I'm most worried about." Other blood pressure drugs. These widely prescribed medications, which include ACE inhibitors, beta blockers and calcium-channel blockers, raise the odds of fainting and falling if they drive blood pressure too low. "If someone is already dehydrated, that can also lower their blood pressure, causing them to faint or fall," Pham says. "It's more of a domino effect from being out in the sun." Doxycycline. This antibiotic is just one example of the many drugs that cause photosensitivity, "meaning you're more likely to get sunburned," she says. "The safest way to avoid that is to make sure you wear sunscreen any time you're going to be outside — even on a cloudy day, because you can still get sunburn." Some antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can make you sweat more and impair your body's ability to regulate temperature, hindering your ability to stay cool. "You don't realise how warm you're getting when you're taking these medications," Pham says. "It's important to be hydrated and wear sun-protective clothing, such as a hat, as well as stay in the shade. These approaches can make a real difference in keeping your temperature down." Thyroid hormone. One of the most frequently prescribed medications in the United States, thyroid hormone — usually in the form of levothyroxine (Synthroid, Tirosint, Unithroid) — treats hypothyroidism (an underactive thyroid gland), a condition far more common among women than men. Like other medications above, thyroid drugs can impair the body's temperature regulation, making people sweat too much and increasing the chance of dehydration. Adding to the risk, older people are less likely to realise thirst and sense the degree of heat. Some over-the-counter antihistamines. Used for allergies and also as a sleep aid, diphenhydramine (Benadryl) and doxylamine (Unisom) may be helpful during the pollen explosion common to hot weather. But like other medicines, they can also hinder sweating and impair core temperature control. Additionally, they raise your risk of sunburn. Most medication labels direct us to keep the substance in a cool, dry place. That's because elevated temperatures can damage drugs in ways both known and unknown. Insulin, for example, which requires refrigeration, becomes unusable in the heat; inhalers, which are pressurised, can explode; and EpiPens, used to counter extreme allergic reactions, can malfunction. But scientific studies don't typically examine the effectiveness of drugs beyond room temperature, Pham notes. "If it's 80° or 85°, we have no idea how effective those medications are," she says. "But it makes sense to believe that they're not going to work as well as if they're kept at a more moderate temperature." Plan ahead to avoid exposing your medications to unstable temperatures while you're travelling. On road trips, place medicines in a cooler, not your car's glove box, which can get too hot even if you have the air conditioning on. For plane flights, stash your medications in your carry-on bag, since checked luggage can get lost or delayed and temperatures in a plane's cargo hold can be variable. "Unfortunately, the temperatures where luggage is stored can be too hot or cold," Pham says. Also, check with your prescribing doctor or pharmacist about how long medications requiring refrigeration can be safely kept at room temperature. And before you fly, Pham suggests calling the Transportation Security Administration toll-free at 866-289-9673 for guidance about medications you'll be carrying, so no snafus arise as you pass through airport security checkpoints. "Your doctor can also provide you with a travel letter to present to TSA representatives so you have no issues," she says. — The New York Times SIGNS OF HEAT STRESS - hot, dry skin or profuse sweating - confusion - throbbing headache - loss of coordination - rapid heart rate - extreme weakness - fast, shallow breathing - nausea and vomiting - loss of consciousness - Heat-related drug damage
