Mixtures Pharmacy

Mixtures Pharmacy & Compounding Center


At Mixtures, our compounding specialties include, but are not limited to; anti-aging, bio-identical hormone replacement therapy, dental preparations, dosage forms, flavoring, pain management, and veterinary care.

What is Compounding?


The compounding of medications is an age-old art dating back as far as the ancient Egyptians. A compounding pharmacy uses raw chemicals, powders, and special equipment to make medications. This allows the medication to be made according to a doctor’s directions to meet an individual patient’s needs. A compounding pharmacist is a problem-solver who works with patients and physicians to deliver a positive therapeutic outcome. There are many situations in which only a compounded medication can accommodate a patient; when a varied strength or dosage form (ie. a liquid rather than a tablet) of a medication is needed, a patient has allergies or disabilities, and when conventional treatment is ineffective, to name just a few.

At Mixtures Pharmacy, we have the ability to customize the dosage forms of your medications, making them easier to administer. No matter the typical dosage form, we can make just about any medication as a capsule, cream, gummy/chewable, lozenge, lollipop, nasal spray, and oral suspension/solution. Our pharmacists understand that each patient has special needs, and unique likes and dislikes, so we also have a choice of many flavors and colors to match to customize medications. We want to make it easy for everyone (children, adults, and even animals) to take needed medications as directed. The patient can choose from one of over 20 different flavors (watermelon, grape, raspberry, etc.)

We can also flavor medication for your 4-legged family member. Many times, as people age or develop a chronic illness, their taste preferences can change. Sweetness may no longer be tolerable. Coffee or bitter flavors, or perhaps no flavor at all may be more pleasing. We compound dosage forms that make it easier to take medication while at school or traveling, such as chewable troches or lozenges that will not require refrigeration! Talk to our pharmacists and see what we can do for you. For more information, head to our services page.

Prescribers:


If you're a prescriber or work in a medical office and are looking for more information about common compounds and their dosing, log into our prescriber portal! You can find prescriptions with pre-filled dosing suggestions and common ingredients for hormone replacement therapy, pediatrics, pain management, and more. Just let us know what office you're from.

Consultations:


If you and/or your provider feel you are experiencing symptoms of hormonal imbalance, we can help! Schedule a consult and we will work with your provider to write a prescription that covers your exact needs. All that is needed is recent bloodwork and 30 minutes of your time.

Partners:


Quotes:


If you have received a prescription for a compounded medication or are considering requesting one, but are looking to get an idea of the cost before filling it, either call your nearest Mixtures Pharmacy, or click the button below to head to our quote submission form.

What is Compounding?

The compounding of medications is an age-old art dating back as far as the ancient Egyptians. A compounding pharmacist uses raw chemicals, powders and special equipment to make medications. This results in a customized medication made by a pharmacist according to a doctor’s directions to meet an individual patient need.

Why do I Need Compounded Medications?

A compounding pharmacist is a problem-solver working with the patient and physician to gain a positive therapeutic outcome. The profession of pharmacy has always been based on this triad relationship. There are many reasons to use compounded medications, including the following: Need for varied dosage form (liquid vs. tablet or capsule) Strength needed not commercially available Patient allergic to dyes or fillers Medication of choice has been discontinued Problem not responding to conventional treatment Bad taste prohibits patient from taking medication Difficulty or inability to swallow Need to incorporate more than one drug in a dosage form

What Dosage Forms are Available?

At Mixtures Pharmacy, we have the ability to customize the dosage forms of your medications, making them easier to administer. We compound the following dosage forms:

  • Capsules: Extended release formulations
  • Emollient Cream: Helpful for dermatological conditions
  • Gummy Gels & Chewable forms: great with kids
  • Lip Balm Applicators: Super for spot application
  • Lollipops: Convenient dosage form for extended delivery and local effect
  • Otic Medications: PLO Transdermal Gel, Great alternative to oral forms
  • Troches & Lozenges that dissolve in the mouth

What Flavors Can I Choose From?

Our pharmacists understand that each patient has special needs, and unique likes and dislikes. That is why we have a choice of many flavors and colors to match to customize medications. We want to make it easy for everyone (children, adults, and even animals) to take needed medications as directed. The patient can choose from one of our 150 different flavors (watermelon, root beer, grape, raspberry, etc.). We can also flavor medication for your 4-legged family member. Working together with your doctor, we can even change the dosage form from a liquid to a “gummy square,” lollipop, freezer pop or lozenge! Many times, as people age or develop a chronic illness, their taste preferences can change. Sweetness may no longer be tolerable. Coffee or bitter flavors, or perhaps no flavor at all may be more pleasing. We compound dosage forms that make it easier to take medication while at school or traveling, such as chewable troches or lozenges that will not require refrigeration! Talk to our pharmacists and see what we can do for you.

What are Estrogens?

Estradiol, estrone, and estriol are predominately female hormones, and in adults, they are important for maintaining the health of the reproductive tissues, breasts, skin and brain. Excessive estrogens can cause fluid retention, weight gain, migraines and over stimulation of the breasts, ovaries and uterus, leading to cancer. Insufficient estrogen levels can lead to hot flushes, vaginal dryness, rapid skin aging, urinary problems, excessive bone loss and possible acceleration of dementia. An excess of estrogen, relative to testosterone, is thought to play a role in the development of prostate problems in men. Most scientists now agree that by-products of estrogen metabolism are the cause of both breast and prostate cancers.

What is Progesterone?

Progesterone can be thought of as a hormonal balancer, particularly of estrogens. It enhances the beneficial effect of estrogens while preventing the problems associated with estrogen excess. Progesterone also helps create a balance of all other steroids. It also has intrinsic calming and diuretic properties. It is important in women, but its importance in men for the maintenance of prostate health is only now being appreciated.

What are Androgens?

Testosterone, DHEA, and androstenedione are considered androgens and they play an important role in tissue regeneration, especially the skin, bones, and muscles. The principal androgen in both men and women is DHEA. DHEA levels decline with age, and in some cases, supplementation with DHEA can restore energy, improve immune function, lift depression and improve mental function. Testosterone is involved in maintenance of lean body mass, bone density, skin elasticity, sex drive and cardiovascular health in both sexes. Men make more of this hormone, accounting for their greater bone and muscle mass. Androstenedione is a precursor for both estrogens and testosterone, especially in females. It can be produced in excess by the ovaries, especially during early menopause, and can cause some of the “androgenic” symptoms such as scalp hair loss and facial hair growth as well as acne along the chin.

What are Glucocorticoids?

Glucocorticoids, primarily cortisol, are produced by the adrenal glands in response to stressors such as emotional upheaval, exercise, surgery, illness or starvation. Cortisol plays an essential role in immune function, mobilizing the body’s defenses against viral or bacterial infection, and fighting inflammation; however, chronic elevated cortisol levels suppress the action of the immune system and predispose to frequent infections. Cortisol levels are highest first thing in the morning, to combat the stress of overnight fasting and to animate the body for the day’s activities.

The brain derives most of its energy from glucose, so maintenance of adequate blood levels is a top priority. After a period of fasting, cortisol output increases, and this initiates catabolism, or the breakdown of protein into simple amino acids and their conversion into glucose to feed the brain.

Chronic, excessive stress (emotional or physical), protein deficiency, and lack of nutrients including Vitamins A,C and Pantothenic acid (B5) can cause the adrenal glands to become exhausted, so that they can no longer produce adequate cortisol. This leads to low blood glucose (hypoglycemia), excessive fatigue, and increased susceptibility to infection.

Tightly coordinated production of adrenal glucocorticoids is essential for optimal health. In normal individuals, the breakdown or catabolism of tissues by glucocorticoids is followed by the building up or anabolism of tissues by androgens. As we grow older, an excess of catabolic hormones over anabolic hormones develops, and this is in part responsible for the aging of all the body tissues, and the loss of our ability to repair damaged tissue. The same thing happens under chronic, excessive stress, and contributes to premature aging. Stress can literally burn our bodies out prematurely.

August 2020
  • FDA: “Bioidenticals are Public Health Concern” …We Need to Protect Compounded Bioidentical Hormones!
  • April 2018
  • Adrenal Fatigue – The Stress is Killing Me!
  • Pre and Pro-Biotics – Bacteria for Brunch?
  • March 2018
  • Histamine – What are you doing to me?
  • February 2018
  • What is Low Dose Naltrexone (LDN)?
  • March 2015
  • The Media Catches a Clue… And, Naturally, Comes to the WRONG Conclusion
  • January 2015
  • The FDA vs. Compounding Pharmacies: a Case of Blinders and Bias
  • December 2014
  • Magnesium and Diabetes: Delicious Treatment
  • September 2014
  • What is Low Dose Naltrexone Treatment, What Can It Do For You, and What Can You Do For Research?
  • August 2014
  • What is Sugar? by PharmD Candidate V. Chyan
  • Yeast Infections: Treatments and Prevention by Student Guest Blogger
  • October 2012
  • Magnesium Deficiency: The Mineral for What Ails You
  • September 2012
  • Does My Liver Make Me Look Fat: Non-Alcoholic Fatty Liver Disease
  • Food Allergies and Rheumatoid Arthritis: One of the Missing Links?
  • July 2012
  • Probiotics: Necessary or Just Another Fad?
  • GERD: The Hell of Heartburn
  • June 2012
  • Polycystic Ovarian Syndrome: Fighting for a diagnosis
  • May 2012
  • Work It ‘Cause You’re Worth It!
  • April 2012
  • Fructose vs. Sucrose: Is there a difference between “Corn Sugar” and “Real Sugar”?
  • March 2012
  • “The Change,” Why Does It Sound So Pleasant When All I Want To Do Is Scream? Non-hormonal Treatment of Menopause Symptoms
  • Ideas for Management, Questions to Ask Your Doctor & Pharmacist, and Diabetes Resources
  • February 2012
  • Hypoglycemia: When Low Sugar isn’t Good Sugar
  • Diabetes: Hyperglycemia as the Elephant in the Room
  • January 2012
  • Diabetes: Complications, Risk Factors, and Prevention
  • Diabetes: First the Basics
  • Out With the Old and In With the New: Detoxing the RIGHT Way
  • December 2011
  • Salt, Water Retention, Weight Loss
  • Lean, Mean, Protein… Confusing?
  • November 2011
  • Does This Fat Make Me Look Fat?
  • Are You a Good Carb or a Bad Carb?
  • Winter Sunscreen
  • October 2011
  • Cold Season Home Essentials
  • September 2011
  • How Does the Thyroid Work?
  • Osteoporosis: How to NOT Give Yourself a Break
  • Depression: Is there really a pill for that?
  • August 2011
  • Not Right Now! I have a headache: Migraines, their causes, and their treatments
  • Let’s get together! Or not… drug-mineral interactions
  • UTIs and Yeast Infections: When fun in the sun gets uncomfortable
  • Seasonal Allergies and Sweet Treatments
  • July 2011
  • Week 2: Traveling, Eating, and Staying Motivated
  • Week 1- Tracking and Motivation
  • June 2011
  • Water, Water Everywhere, but I Think I’ll Have a Latte
  • Over-The-Counter Medication Safety: the Knowledge Gap
  • Sleep Hygiene: What it means and how it can improve your rest
  • Herbs: The Good, the Bad, and the Complicated
  • April 2011
  • Vitamin D – Why do I need it?
  • August 2010
  • Welcome to Mixtures Blog
  • FDA: “Bioidenticals are Public Health Concern” …We Need to Protect Compounded Bioidentical Hormones!

    ACT NOW TO PROTECT COMPOUNDED BIOIDENTICAL HORMONES!!

    Please share your story! We need to collect as many positive stories about cBHRT as possible before the FDA decides to ban these crucial hormones and our quality of life! Please send your testimonial right away to Lori@MixturesRx.com!

    We appreciate your support!

    The FDA’s announcement regarding bioidentical hormones came just hours after the National Academy of Sciences, Engineering, and Medicine (NASEM) released their report reviewing the “clinical utility” of compounded bioidentical hormone therapy (cBHT). Because the report views the widespread use of cBHT as a public health concern, the FDA will likely move fast to ban these critical medicines. It is imperative that we mobilize a strong grassroot response to meet this threat and save access to estriol and other compounded hormones.

    The agency has latched onto this false conclusion from a report it commissioned, and it is another direct threat to estriol and compounded bioidentical hormones’ future.

    To quote the FDA’s announcement on the report release: “Given the lack of high-quality clinical evidence and minimal oversight of cBHT, NASEM concluded that their wide-spread use poses a public health concern.”

    This has no factual basis at all. A review of the clinical literature concluded that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more effective than synthetic or animal-derived hormones. What seems to be underway is an attempt to create drug company monopolies. The result may be that women may not be able to obtain estriol at all, even though estriol protects against cancer.

    The report’s conclusion deals a real blow to the future of patient access to cBHT, but it is hardly a surprise. We said before that the FDA stacked the deck against cBHT as the NASEM committee was gathering information. It’s no surprise that the recommendations and conclusions of the report mirror the FDA’s interests.

    Specifically, the committee’s recommendations include:

    • Restricting cBHT use to patients with a documented allergy to an ingredient in FDA approved BHT products or a documented requirement for different dosage form.
    • Patient preference alone is not enough to justify cBHT use.
    • cBHT doses should not exceed FDA-approved product dosages.
    • The FDA’s Pharmacy Compounding Advisory Committee (PCAC) should review select hormones for the Difficult to Compound list, including estradiol, estrone, estradiol, progesterone, estriol, testosterone, and the pellet dosage form.
    • The federal government and State Boards of Pharmacy should expand and improve oversight of 503A “traditional” pharmacies to ensure quality standards for every cBHT preparation dispensed.

    Again and again in the report, members of the NASEM committee acknowledged that many women express a distinct preference for cBHT, but that this wasn’t enough to justify its use. We can only expect the FDA to parrot this message. It’s a clear signal: we know better than women and their doctors. This is government paternalism at its worst, and it cannot be allowed to stand.

    To briefly recap how we got here: estriol and other bioidentical hormones have been nominated to the FDA’s Demonstrably Difficult to Compound List; items that appear on the list when it is final will no longer be able to be made at compounding pharmacies. ANH-USA and other stakeholders pushed back forcefully against the nomination of estriol and other compounded hormones, so the FDA convened a NASEM committee to study cBHT and aid in the agency’s final determination.

    Our interpretation: the FDA wants to ban hormones but knew they couldn’t do it quietly due to the large consumer response, so they commissioned NASEM to study the matter and give them cover to ban these hormones.

    The FDA still has hurdles to overcome before a ban can be issued: the agency has to issue a proposed rulemaking to add these hormones to the Difficult to Compound List. It’s also possible that the FDA issues draft guidance that restricts the use of cBHT as outlined by NASEM’s recommendations.

    The time to send a clear message to Congress and the FDA is now.

    We beat the FDA when they tried to ban estriol in 2008, and we can beat them again, but only if the entire community rises up and holds the agency’s feet to the fire. We cannot let the federal government interfere with women’s health.

    Attacking estriol and compounded hormones is just one of the ways the FDA and the federal government bolster drug monopolies and undermine natural health options. The FDA is trying to create insurmountable barriers to access homeopathic medicines. The FDA and FTC and some state’s attorneys general have also recently told doctors they can’t advise both their patients and the public about natural prevention and treatment for COVID-19. This is unacceptable.

    We must demand that Congress reform a healthcare system that not only bars the use, but even the mention, of natural remedies like compounded bioidentical hormones that have not been, and never can be, put through the multi-billion-dollar FDA approval process.

    Action Alert! Write to Congress and the FDA, telling them that patients have a right to choose the medicines right for them, including cBHT. Please send your message immediately.

    CLICK HERE TO TAKE ACTION!

    Adrenal Fatigue – The Stress is Killing Me!

    Is this the latest buzz word in the naturopathic community? What exactly does this mean? Why doesn’t my “regular” doctor look for this? If I have this, how can I heal? These are all legitimate questions that I will try to answer.

    It’s a buzz word!? There are lots of different names for Adrenal Fatigue which has been recognized, discussed, written about and treated for over 100 years! Thousands of doctors deal with it, personally and clinically. Endocrinologists deal with the extreme versions of this known as Addison’s disease and Cushing’s disease. The clinical terminology for those who aren’t “normal” but aren’t to the extreme ends of Addison’s or Cushings are: hypoadrenia, hyperadrenia, sub-clinical hypoadrenia, non-Addison’s hypoadrenia, subclinical adrenal exhaustion and neurasthenia.

    Wow, there are lots of names but what is Adrenal Fatigue? The definition is a sub-optimal functioning of the adrenal glands at rest, under stress and in response to constant, intermittent or sporadic demands. What it looks and feels like to those who have adrenal fatigue: decreased ability to handle stress and pressure, less productivity at work/home, symptoms of burnout (life isn’t fun anymore, can’t get out of bed), decreased cognitive ability among the other symptoms on the hand picture below. You don’t need to have all of these symptoms, but if you are suffering from many of these issues, it is worth talking to someone with experience in Adrenal Fatigue. From there, the correct labs can be requested to determine what is really going on.

    Testing for Adrenal Fatigue: The typically requested lab work is a 4 point salivary cortisol level with a DHEA sulfate level. There are several labs that can do this testing for you and saliva is the preferred method. You can get blood testing, but there are limitations to the results. Some of the limitations include testing time and the stress of needles and waiting. I’ve been victim of these labs and it isn’t the needles that scare me (although for some it is the added cherry on top of the blood draw sundae), it is the prolonged wait time. Ideally we want your level within 30 minutes of waking. I typically get up at 5:30am but the lab doesn’t open until 7am and even if I get there at 7am, I probably won’t see the phlebotomist until 10am at best! The other limitation is the multiple data points. They can probably get your lunchtime and before dinnertime draw, but there won’t be anyone in the lab to tuck you in with your before bedtime draw. The pattern of your cortisol can help pin point what is going on and helps with treatment decisions.

    Another, less accurate but valid tool, is the adrenal fatigue questionnaire found on Dr. Wilson’s website AdrenalFatigue.org. This gives comparisons of past to present and the quiz can be done to see progress of treatment. It is a great tool because many times we don’t notice the small incremental improvements.

    The best news regarding adrenals, your body wants to heal them! There are nutritional supplements we use to fuel the healing process of the adrenals. We use Vitamins B5 and B6 along with a complex of additional Bs. Vitamin C is also important for the healing. Adaptogenic herbs assist your body with the production of the stress hormones and adapt the production by increasing or decreasing the levels. If you under produce the stress hormones, the adaptogens will help increase the production and if you over produce they also work to decrease the over production. The last part of the healing puzzle is the glandular support. Glandulars can provide micronutrients and “building blocks” to support the healing process.

    There is a lot involved with healing the adrenal glands and seeking guidance from your doctor or pharmacist who is knowledgeable in this arena will move you toward healing. Stop by our locations and present code Stress15 to receive 15% off our adrenal supplements.

    Pre and Pro-Biotics – Bacteria for Brunch?

    So let’s start at the beginning: Our gut. Our intestines are known as our second brain. It contains neurotransmitters, like serotonin, just like the brain, and is very reactive to our emotions. Our gut also controls what goes in and out of our bodies. This means that our intestines not only control the nutrition entering into our body and eliminates waste, but also acts as a gatekeeper for bacteria and viruses, thus being an active participator in our immune system. Our gut controls so many aspects of our health that it is imperative to keep it healthy. This is why exercise (to keep the intestines moving) and proper nutrition (to feed our body, but also the good bacteria in our intestines) are so important. But what role to probiotics play and what good can they do?

    Antibiotics: Antibiotics aren’t very smart. Sure, they work great. A couple days on antibiotics and you start feeling normal again… oh yeah, except that you feel nauseous, your intestines are all in knots, and food isn’t exactly appetizing. This is because the antibiotics, on top of attacking your infection, have also attacked the bacteria that you need to digest. On top of that, if you’re a woman, the antibiotics have also destroyed your vaginal flora. This is where those fun yeast infections creep in. What to do? Probiotics!

    Poor diet: If you’re trying to jump start that new diet or you’ve been naughty for a couple weeks because everyone’s birthday is in July you may be having difficulty digesting the healthier foods. You’ve, basically, starved the bacteria in your gut avoiding the healthy foods (MURDERER!) and so now there aren’t enough good bacteria to digest these new healthier foods. What to do? Probiotics!

    Diarrhea: I’ll be honest… this is the discussion in my job that I hate the most. I sometimes get weekly reports on my family, friends, and patient’s bowel movements. Diarrhea is the most common complaint. Usually this is caused by something infective or questionable food (anything buffet style I file under questionable). When you have diarrhea you don’t have time to reabsorb the water in your large intestine or properly digest your food. Everything just moves out in as quickly as it moves in. This means you are also losing the good bacteria that should be helping you to digest. After the infection or disagreement is over you could still have diarrhea simply because you have no bacteria to help you digest your food properly. What to do? Probiotics!

    GERD: Are you getting a lot of heartburn? Your stomach might be working overtime to try to digest the food that you are eating. This means more churning and more acid. Try taking some probiotics for a couple weeks and see what happens.

    “Stomach Flu”: If you seem to be getting a lot of stomach bugs the bacteria that usually act as the Marines in your body may be depleted or weakened. Remember, your intestines house a pretty big part of your immune system. Part of your immune system, ironically, is bacteria. If your bacteria have been destroyed by a bug, bowel abnormalities, or poor eating habits your immune system is at risk. What to do? Probiotics!

    Now here is the next problem. Which probiotic to choose from… Where do we even start!? There are foods that are more likely to contain probiotics, like yogurt, kefir, fermented vegetables (like kimchi and sauerkraut), kombucha, natto, kvass, raw cheese, apple cider vinegar, and tempeh. Typically you aren’t going to find a measurement of the quantity of probiotics because many times these food sources are from small food manufactures and even many of the large manufacturers claim they contain probiotics, but don’t provide any label information on how much. As far as yogurts go… grass fed animals that give milk that isn’t pasteurized is the best and the less sugar the better (This is why I hate Activia). But these foods are small potatoes if you are looking to really make a change. You can find lots of different strains to target specific areas of the body. The strengths are typically measured as Colony Forming Units (CFU) which can range from the millions to the billions. Be aware that if the label measures as milligrams (mg) they are probably in the hundreds or thousands, which in your gut isn’t very much.

    But I tried probiotics and it made everything worse! You are one of the rare ones, but it does happen. Sometimes increased gas and bloating is a transitional stage that your body will pass through. This is where prebiotics come in. Prebiotics are non-digestible carbohydrates that nuture and feed the probiotics, this combination is called synbiotics. Fiber is one of the best sources of prebiotics! We like Acacia fiber, Inulin, and various vegetable fibers. We also like Fructooliogsaccharaides (FOS) which are short and medium chain non-digestible sugar molecules. They are slightly sweet (30-50% of the sweetness of sugar) and found in Jerusalem artichoke, chicory root, leeks, bananas, asparagus, onions and garlic. You can also take the short cut and buy FOS as a powder or capsule.

    Where to use caution : If you have been diagnosed with Small Intestinal Bacteria Overgrowth (SIBO), have had previous intestinal or weight loss surgeries, have a weakened immune system, or are taking any immunosuppressant medications, talk to your doctor or pharmacist before adding probiotics to your health regimen.

    Go with your gut!

    Stop into the store and see the selection of Probiotics and Prebiotics. Our knowledgeable staff can assist you with your questions. Please present code GUT15 for 15% off the purchase of any of our Probiotic or Prebiotic products.

    Histamine – What are you doing to me?

    I think most of us are pretty comfortable with the fact that when we have an allergy, histamine is the primary culprit that causes our eyes and skin to itch. This little protein molecule is stored primarily in Mast Cells and when released (through degranulation) can signal an inflammatory response and itching. Histamine is found almost everywhere in the body and is particularly abundant in tissue prone to injury like our extremities and blood vessels.

    We have antibodies in our system called immunoglobulin E (IgE) that are released in response to an invading pathogen like a virus or bacteria, pollen or when responding to an injury caused by toxins (think about your itchy mosquito bites). The IgE then causes the flood of histamine in the area. The reaction of histamine depends on the receptor it binds.

    There are 4 different histamine receptors in our body conveniently numbered 1 through 4. (Don’t you love when scientists keep things simple and straightforward and don’t add to the complication by coming up with names that only Dr. Seuess could make up?) The H1 receptors are primarily found in the capillaries, which allows the capillaries to become more permeable and can make the area appear puffy. The H1 receptor also works on smooth muscle contraction, primarily in the digestive and bronchial muscles, which presents as breathing and stomach issues. When you take an OTC or prescription antihistamine like diphenhydramine or chlorpheniramine, the target receptor is H1. The H2 receptors cause an increased secretion of hydrochloric acid in the stomach. There can also be a slight increase in vasodilation, but slower than the H1 receptors. H2 stimulation may also inhibit the release of prolactin. Most of the H2 blockers are used for acid reflux and are available as OTC items, like cimetidine, famotidine, ranitidine, nizantidine. We also have H3 and H4 receptors. The H3 receptors will reduce histamine release in the central nervous system (CNS) and in the periphery. We do not have any drugs developed that affect this receptor, but researchers suspect that H3 inhibition may be useful in certain neuropsychiatric conditions. The H4 receptors seem to have some involvement in immune reactions, but further research is required.

    (Used with permission from Dr Sandeep Gupta and Dr Jill Carnahan http://www.moldillnessmadesimple.com/mims/mast-cells-and-mold-illness-with-dr-jill-carnahan)

    Now I have painted a picture that makes histamine out to be a pretty good villain. But like some of our favorite villains they can also have a good side – many are just a little reluctant to show it. Histamine can also act as a neurotransmitter in our brain. This can increase and decrease the other neurotransmitters like norepinephrine, serotonin, dopamine and acetylcholine. Histamine is also important in controlling our sleep-wake cycle. It may decrease GABA levels and increase norepinephrine and epinephrine levels. Histamine is also noted to influence neuroendocrine control including behavioral state, biological rhythms, energy metabolism, thermoregulation, fluid balance, stress and reproduction. Elevated histamine may affect thyroid function. Histamine may play a role in neurocognitive function as well. (Haas, 2008) Histamine also reduces the seizure activity in humans and animals that have an increased number of H1 receptors in some types of human epileptic foci. Histamine has also been found to contribute to the physiological control of appetite. (Hough, 1999) So we don’t want to completely get rid of the villain, not only does our story become pretty boring but we also miss out on the benefits.

    How does our body control histamine? It is broken down through either oxidative deamination or N-methylation. There are enzymes that control the breakdown of histamine in different areas of the body. In the gut, our body makes an enzyme called Diamine Oxidase (DAO). The job of DAO is to break down the histamine and keep it from binding to too many of the receptors. If your body doesn’t make enough DAO or it can’t keep up with the demand after eating something that causes a food allergy, there are OTC products that contain DAO to help counter the histaminic allergic reaction. Our body typically limits DAO to our gut. The enzyme that processes the N-methylation is N-methyltransferase. There are some self-help strategies to support and improve your body’s methylation process. Diet: eliminate sugar and alcohol and packaged/processed foods. Sleep: your body needs that time to rest and restore. Stress reduction: the methylation cycle is very sensitive to stress, take the questionnaire on Dr Wilson’s Adrenal Fatigue site. Add a good B Complex and minerals: this provides the nutrients needed for the enzymes to work, the cofactors to support the methylation cycle and the methyl groups to methylate the histamine. Plus a good B complex can give you a nice boost of energy, just remember to take it with food.

    What about keeping the histamine from being released from the mast cells? We have medications for that too! These are called Mast Cell Stabilizers. There are several drugs that can be used systemically: cromolyn sodium, ketotifen and tranilast. There are other medications that are more localized treatments for the eye and sinus areas. There are also several natural supplements that can be very effective. There is a lot of attention and research on quercetin and vitamin C. There is no issue with using these together. Just make sure you get a quality professional supplement! Curcumin is another natural supplement, but this isn’t as universal as the quercitin and vitamin C. Some people find that curcumin makes the histamine problem worse instead of better.

    Most of us will have the temporary discomfort of seasonal allergies or a particular food or foods that cause us some reaction and can be dealt with on a seasonal or occasional basis. If you are one that eats a low histamine diet and avoids your triggers but still has lots of issues, know there are people out there that will help you. As with all medical conditions, it is important to find the right practitioner who can help figure out a treatment plan for your Histamine Intolerance (HIT) or Mast Cell Activation Syndrome (MCAS). ISEAI is a wonderful source to search for a practitioner to guide you through finding answers and living your life to its fullest.

    1. Haas, H. S. (2008). Histamine in the Nervous System. Physiol Rev, 1183-1241.

    2. Nakazawa, H. S. (1994). Viral respiratory infection causes airway hyperresponsiveness and decreases histamine N-methyltransferase activity in guinea pigs. American Journal of Respiratory and Critical Care Medicine, 1180-1185.

    3. Hough LB. Histamine Actions in the Central Nervous System. In: Siegel GJ, Agranoff BW, Albers RW, et al., editors. Basic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th edition. Philadelphia: Lippincott-Raven; 1999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK28245/ *All rights reserved to Mixtures Pharmacy and Lori Allen, RPh.

    What is Low Dose Naltrexone (LDN)?

    Low Dose Naltrexone (LDN) is a much smaller dose of naltrexone than what is offered commercially. You can go to any pharmacy and get naltrexone in a 50mg tablet, but we are working with doses from 1.5-4.5mg. There is a lot of ongoing research into this medication at the micro doses, but we will probably never see this as a commercially produced drug. It has a low potential to make money with the drug companies because it is long past it’s patent. Compounding pharmacies can compound this for you if your doctor feels this is an appropriate treatment.

    Naltrexone is an “opiod receptor agonist” which blocks alcohol and opioids from getting to the receptor. This is why it is used as a management tool for alcohol dependence and opioid dependence. We are not using it for the management of dependence when we use such a low dose.

    We use a low dose to help interrupt the body’s immune system. This is helpful when someone has an autoimmune condition. Some examples of autoimmune conditions are: Hashimoto’s Thyroiditis, Lupus, fibromyalgia, rheumatoid arthritis, Crohn’s disease, and multiple sclerosis.

    The mechanism is postulated on the site www.lowdosenaltrexone.org as blocking the opioid receptors between 2am and 4am (when taking the LDN at bedtime) and allowing the body to “produce a prolonged up-regulation of vital elements of the immune system by causing an increase in endorphin and enkephalin production.” Another visual of this is:

    This means the side effect most commonly reported is more vivid dreams, typically at the time of highest activity of the LDN. This usually goes away and dissipates after the 1st week.

    If you think you may benefit from this treatment, please talk to your doctor. If you need additional help, please contact Mixtures Pharmacy. We are here to help discuss in more detail treatment options with your doctor.

    The Media Catches a Clue… And, Naturally, Comes to the WRONG Conclusion

    Recently, CBS News posted an investigative report about a TELEMARKETING SCAM. Yes, yelling capital letters on the word “Telemarketing.” The original story can be found here, but here’s the breakdown. A telemarketing company has been calling people over the phone and asking whether they are in pain and whether they think this requires medications or not. If the person answers in the affirmative the company then asks if they can speak to their doctor. Most of us would say , “Absolutely not. I’ll speak to my physician at my next appointment,” but this is not the case with everyone. After obtaining personal information the telemarketing company then contacts the person’s physician (please notice I am using the word “person” NOT “patient”) and obtains an order for compounded pain medication without the knowledge of the person. Weeks later the person receives compounded pain medication that they didn’t ask for, which is billed to their insurance company for an exorbitant amount of money (about $18,000 in the one example). The middle man in all of this is a compounding pharmacy in Utah who made the compound and billed the insurance company without having a relationship with the people they were “treating.” That is why these people are not patients. They did not have a relationship with the people, but were trying to treat them.

    Compounding pharmacies have come under quite a bit of scrutiny by the media and the FDA in recent years. Between manufacturing companies posing as compounding pharmacies selling contaminated pharmaceuticals, the FDA looking out for Big Pharma by slandering good companies with strong science behind them, and now this, there is a lot of bad media about compounding. We, however, know and believe that compounding is safe, effective, and important to patient care. The Express Scripts CEO’s statement on the efficacy of topical pain medications is ignorant and false. There are topical pain medications that were used in compounding that have now gone to market because of there efficacy (Voltaren gel anyone?). They are safe, effective, and don’t cause the psychological and mental side effects that oral medications can. This, however, does not mean that topical medications are for everyone, WHICH IS WHY A PATIENT, PHYSICIAN, PHARMACIST RELATIONSHIP IS SO IMPORTANT (I’m a little riled up. Can you tell?). The funny thing about all of this is that my mother and I BOTH received phone calls from the telemarketing company in this story and we both told the company to sod off because if we had problems we would speak to our physicians ourselves. If you want your health information to be private and between you and your health care team then they are the only ones you should be talking to. We, as ethical health care professionals, are not only obligated, but thoroughly determined, to making your health and privacy our number one priority. The pharmacists at Mixtures are not the only ones with these standards. Here is the reply to the CBS report by the International Academy of Compounding Pharmacists:

    “CBS News has exposed a practice that is in many cases both illegal and unethical: providing medication to an individual in the absence of a relationship with that patient and the patient’s physician. Pharmacists are responsible and obligated to work closely with prescribers and the patients they treat to assure that the right medication is being provided to meet that individual’s health care needs. The violation of that sacred relationship by a marketing firm – especially one that engages in questionable telemarketing practices such as the one identified in this story – is reprehensible and cannot be condoned.

    Patients have both a right and a responsibility to have complete information about their medications. That includes not only what the medication is for, how it is supposed to be used, and what questions to ask of their physician and their pharmacist, but also the cost of the medication to both themselves and their employer or insurer. The submission of a bill to any payor – either public or private – must be done in full compliance with the contractual terms between the pharmacy, the patient, and the payor.

    Legitimately prescribed and dispensed compounded pain creams and gels bring tremendous relief to those suffering from bone and joint pain. They have the added – and very significant – benefit of being non-addictive. This not only helps patients to enjoy normal activities of daily living, it spares them the destruction of drug addiction. These medications prevent millions of dollars in abused and diverted oral pain medications, and access to pain creams and gels must be maintained. The decision to use a compounded pain cream should only be made based upon a patient’s direct examination by, and consultation with, their physician.

    IACP believes public and private health care payers should aggressively address health care fraud, including taking action against any health care provider that has allegedly broken the law. If a provider has misrepresented what they have dispensed or has not followed law or regulation, they should be held fully accountable.”

    We heavily support this statement by IACP and believe the telemarketing company AND the compounding pharmacy should be investigated and prosecuted for their crimes. And shunned by the pharmacy community for their violation of the sacred relationship between patients, physicians, and pharmacists (I love a good shunning). Please, continue to support compounding as we support you AND if this makes you as irate as this makes all of us please feel free to comment on the CBS site. If you would like to receive updates on compounding and join the fight for unbiased information and compounding rights please read and sign up for updates at protectmycompounds.com

    I’m not promising this will be my last protest blog, but I promise for my next blog to be less politics related and more healthcare related.

    The FDA vs. Compounding Pharmacies: a Case of Blinders and Bias

    All of you who follow our page have been impacted by our compounding pharmacy or are curious about what compounding can provide to you. Let me first define what compounding is. Compounding is making small batches of medication for personalized care for their patients. When you bring us your prescription we make it for YOU. Personalized medications sound like a luxury, however, we believe it is the right of every patient to receive personal medical treatment because every patient is an individual. Whether it is for patient comfort, pain management, dosage form, hormone replacement, or any other need that you and your physician decide is necessary we believe you have the right to receive the purest and safest treatment available. There are many medications that can be purchased from large manufacturers that are perfectly reasonable as one size fits all product, but when you need something special, that’s what compounding pharmacies, like us, are for.

    In the past couple of decades compounding pharmacies have been under attack by the FDA. The FDA and compounding pharmacies are supposed to be separated unless the medications that compounding pharmacies are using are found to put the public at risk. Drug companies can only produce medications if allowed by the FDA after they have supplied years of work and evidence proving that the drug is effective and safe. In this way the FDA’s job is clear and VERY important. The beauty of compounding is that we are not limited to studies here in the United States. Many compounds are based off of old medications and combinations that have simply been “grandfathered” and do not have any profit benefit for large pharmaceutical companies. Other compounds are based off of other studies that have not been submitted to the FDA and other studies are from other parts of the world, like Europe. By no means are the treatments we use in compounding pharmacies snake oil or hocus pocus.

    I’m not really a huge fan of conspiracy theories. I am a pharmacist. I like evidence based medicine. I like evidence in general. I cannot say whether the FDA is just loving the money they are getting from the large drug manufacturing companies (often called Big Pharma) or if they are just so closed minded to evidence that is from other libraries other than their own. Imagine the ignorance of an individual who considers only what is contained in their personal library the truth.

    I remember when I was are pharmacy student a man from the FDA came to us and was telling us how there is no evidence for estriol use or Bio-Identical hormone replacement. Lori was my boss, but she was also my teacher and I asked him about other studies that were being done in the United States and other countries showing the benefit of compounded hormone replacement therapy. I asked why the FDA thought that women’s hormones were one size fits all and, if they really thought it was best to have the lowest doses for hormone replacement therapy why they had a problem with compounding, which uses micrograms dosing and allowed the makers of Premarin to continue to use 1mg (1000 micrograms) for menopause symptoms. I received no answer.

    The FDA has been trying to stop the usage of estriol by compounding pharmacies for almost a decade, but they have been unable to succeed because they cannot find anything unsafe about the product used in our compounds. In fact, the FDA is looking over the approval of a new medication for the use of Multiple Sclerosis. The drug? Estriol. Estriol 8mg (again, compounding pharmacies use micrograms)! So why are they trying to remove it from compounding pharmacies, but allowing a large pharmaceutical company to use doses a thousand times larger than what is used in compounding? The numbers aren’t adding up, but it definitely looks like the FDA is trying to protect Big Pharma from compounding pharmacies creating knock-off products. By the way, it is illegal for compounding pharmacies to do this. The only time we can make a product similar to a manufactured product is if the product is not available or if, for some reason, the available product is not suitable for the patient for some reason (allergies, etc.). Reputable compounding pharmacies do NOT create knock-offs. Our business is in custom products for our patients. Of course the humor and sadness in all this is “who is more afraid of who?”

    The FDA continues to selectively warn against compounding pharmacies. Especially our work with hormone replacement therapy. The odd thing is that the FDA hasn’t updated its site on compounding in five years. So much has happened and been discovered in 5 years (the breakthroughs in male hormone replacement and in estriol), but the FDA site still states:

    “Some pharmacies promote hormone therapy for men in the form of testosterone to treat a decline in the level of testosterone in older men, sometimes referred to as andropause. There are currently no FDA-approved products for the treatment of andropause. In addition, there are no FDA-approved testosterone drugs for women.”

    Of course, now we have the product Androgel… Which the FDA was approving when this site was last updated… awkward. The site also states that it has tested hormone medications from 29 compounded drugs and all of them were found to fail and only 2 compounds had some hormone in them. Wait?! Compounding pharmacies are trying to rip you off?! No. If you read the survey the FDA ordered these compounds from 12 online pharmacies. Wait a dang minute? A compounding pharmacy that you can order medication from online? Most pure online compounding pharmacies are questionable. I mean, if you look inside your email’s spam box right now there are tons of online pharmacies telling you medications are available without prescriptions. They are a scam! You cannot order compounds from us over the internet. You need a prescription. You may RENEW your prescription via our website (because we’re fancy like that). The FDA took a biased sample. All of our raw materials are tested for purity and provided to us by reputable wholesalers. We take GREAT pride in our compounding practices. Our pharmacy is actually a teaching pharmacy for multiple universities including the University of Arizona, Midwestern University in Glendale, and the University of New Mexico. We follow all purity and safety standards. Why? Because we like to protect our patients and our staff. It pays to do things the right way.

    Clearly this is a subject that is near and dear to our heart and we hope that it is important to you too. In fact, I encourage you to do your research and ask questions. Whether you are our patient or looking for a good compounding pharmacy you have the right to research and ask questions. We are here to guide you to the right treatments for you, whether compounded or manufactured. Here are the links to the FDA websites that I quoted:

    fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm183088

    www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm155725

    We encourage you to also subscribe and become a member of our cause by subscribing to the Alliance for Natural Health:

    https://anh-usa.org/

    And please read this recent article on the newest attack against compounding pharmacies, which could put thousands of small pharmacies out of business:

    www.anh-usa.org/compounded-medications-even-more-at-risk

    Magnesium and Diabetes: Delicious Treatment

    Recently an article was posted on WorldHealth.net on preventing Type II Diabetes with increased magnesium intake. You can read the short article here. Four medical journal articles on the subject have been published in Diabetes Care (a medical journal funded by the American Diabetes Association) on the subject, including a Meta-Analysis (a study made up of other studies so that the significants of the statistics in the studies are stronger) and another prospective study (a study specifically designed to only study dietary magnesium and its effect on diabetes) where thousands of patients were studied over a period of over twenty years. All the studies show that patients who take in more magnesium are less likely to get diabetes regardless of age (although women seem to have a little more success than men and the overweight had more luck than the ideally weighed patients). None of the articles are quite sure what the reason for this is. There are, however, some theories. For one thing, magnesium helps the body communicate along the insulin pathway. It basically acts like the telephone cord between cells and the pancreas (the organ that produces insulin). If you have low magnesium your body may have increased insulin resistance because the cells aren’t communicating to tell the pancreas it needs more insulin . Magnesium may also prevent the absorption of fat into the body, which could prevent some of the metabolic syndrome (weight gain around the waist ), which can lead to type II diabetes. There is also a dietary component to consider. The studies didn’t have patients specifically taking a magnesium supplement. Most magnesium was taken as part of the patients’ diets.

    So where does magnesium come from? Dark leafy greens are a great source. Kale, spinach, and chard made up in a salad or steamed is a great way of adding magnesium to your diet without having to add a lot of calories. Nuts and seeds are also a great way of getting your magnesium. One cup of pumpkin seeds actually provides a whole day’s supply of magnesium, but nuts also very calorie dense (600 calories in one cup of roasted pumpkin seeds). Fish contain quite a bit of magnesium so get those omega-3s in and you’ll have a double whammy of magnesium too! Avocado is high in good fats also, and contains a good amount of magnesium. If you like a little mayo on your sandwich, try avocado as a creamy alternative and get some minerals in there. If you’ve got a sweet tooth bananas and chocolate also contain a healthy dose of magnesium! If you look at the foods I listed above these foods are jam-packed full of healthy fats and fibers that also help keep your blood sugar steady and also stave off hunger. The studies were stratified and specifically showed that magnesium containing foods seem to help more than other mineral containing foods like calcium, but all the foods are part of a healthy diet.

    So what can you take away from these studies?

    1. Definitely get magnesium containing foods in your diet.

    2. You can absolutely consider a piece of dark chocolate a daily magnesium vitamin

    3. The same thing is true that we have been saying for years: a healthy diet will always help with diabetes prevention.

    So why not get started! Slowmag.com actually has a database full of magnesium containing recipes (including dessert!). Check out this delicious magnesium rich salad for your next lunch: Spinach and Avocado Salad.

    Or this dessert for the holidays without the adding a lot of sugar: Chocolate Banana Pudding

    Just a warning, however, there is such a thing as too much of a good thing. The human body requires approximately 400mg of magnesium daily. Taking too much (especially as a supplement) can cause problems like diarrhea, and if you REALLY over do it, heart arrhythmia.

    What is Low Dose Naltrexone Treatment, What Can It Do For You, and What Can You Do For Research?

    Low Dose Naltrexone (LDN) is a much smaller dose of naltrexone than what is offered commercially. You can go to any pharmacy and get naltrexone in a 50mg tablet, but we are working with doses from 1.5-4.5mg.

    Naltrexone is an “opioid receptor antagonist” which blocks alcohol and opioids from getting to the receptor. This is why it is used as a management tool for alcohol dependence and opioid dependence. We are not using it for the management of dependence when we use such a low dose.

    We use a low dose to help interrupt the body’s immune system. This is helpful when someone has an autoimmune condition. Some examples of autoimmune conditions are: Hashimoto’s Thyroiditis, Lupus, fibromyalgia, rheumatoid arthritis, Crohn’s disease, and multiple sclerosis.

    The mechanism is postulated on the site www.lowdosenaltrexone.org as blocking the opioid receptors between 2am and 4am (when taking the LDN at bedtime) and allowing the body to “produce a prolonged up-regulation of vital elements of the immune system by causing an increase in endorphin and enkephalin production.” This means the side effect most commonly reported is more vivid dreams, typically at the time of highest activity of the LDN. This usually goes away and dissipates after the 1st week.

    For a further explanation please view this YouTube Video:

    If you think you may benefit from this treatment, please talk to your doctor. If you need additional help, please contact Mixtures. We are here to help discuss in more detail treatment options with your doctor.

    Please download your LDN Health Tracker App for free to take part in the worlds largest anonymous LDN Survey! The goal is to find out how many people around the world are using LDN . Please share and take part. The links below will help you download the App!

    For Apple Devices: iTunes

    For Android Devices: Google Play

    For Kindle Devices: Amazon

    What is Sugar? by PharmD Candidate V. Chyan

    Overview

    Carbohydrates, or sugars, are made up of molecules that are known as monosaccharides (mono=one, saccharide= sugar compound). These monosaccharides are simple sugars and consist of glucose, fructose, and galactose. The 3 molecules are the building blocks of carbohydrates. Glucose can be found in a variety of food and fruits and is primarily used in the body for energy. Fructose, or fruit sugars, is found in honey, fruits, and some vegetables. Galactose is primarily found in milk.

    When two of these molecules link together, this is known as a disaccharide (di=two, saccharide=sugar compound). An example of this is sucrose, which consists of glucose plus fructose. Sucrose is known as table sugar (beet, cane sugar). Lactose, which is glucose plus galactose, is found in milk products. Maltose, which is glucose plus glucose, is found in yeast-fermented products such as breads and brews.

    Polysaccharides (poly=many, saccharide= sugar compound), or complex sugars, are formed when many simple sugar units are linked together. Examples of these include starch, dietary fibers, and glycogen. Starch is found in breads, pastas, rice, and potatoes. The dietary fibers include cellulose, and pectin. Cellulose is found in plant products like wheat, rice, vegetables, and rye. Pectin, another dietary fiber, is available in fruits, like citrus, and oats and beans. Glycogen, unlike other polysaccharides, is found in human and animal bodies. Glycogen is a storage sugar that is used in times when the body is low on glucose and energy.

    Type of Sugar Examples Where it's Found in Nature
    Simple Sugars (monosaccharides) Glucose Variety of foods, primary source of energy in human body
    Fructose Fruit, honey, some vegetables
    Galactose Dairy products
    Disaccharides Sucrose (glucose+fructose) Beet/cane sugars, table sugar
    Lactose (glucose+galactose) Milk sugar
    Maltose(glucose+glucose) Molasses, yeast-fermented breads and brews
    Complex Sugars(Polysaccharides) Starch Potatoes, breads, pasta, rice
    Cellulose Wheat, rye, rice, vegetables
    Pectin Citrus, fruits, oats, beans
    Glycogen Human and animal bodies(stored and made in liver)
    Types of Sweeteners

    Sweeteners are sugars that are added to edible products that may or may not already have natural sugars. There are generally 2 classes of sweeteners: nutritive and non-nutritive.

    Nutritive sweeteners can provide nutrition or energy (calories). These sweeteners are usually mono and disaccharides and have 4 calories per gram. Examples include: corn syrup, agave nectar, honey, brown sugar, turbinado sugar, molasses, and maple syrup. Corn syrup is generally made up of glucose molecules. The difference between corn syrup and high fructose corn syrup is that high fructose corn syrup is made via chemical processing that converts the glucose molecules to fructose molecules. The end product is sweeter, which allows manufacturing companies to use less syrup to achieve the same sweetness.

    Another nutritive sweetener group is sugar alcohols or polyols. These provide anywhere from 1.5 to 3 calories per gram. Sugar alcohols have fewer calories because they are structurally different from normal sugar. This means only some of the compound can be broken down or metabolized by the body. Therefore, the body cannot extract as much energy from it. Sugar alcohols do not contain ethyl alcohol which is found in alcoholic beverages. Examples include: xylitol, mannitol, sorbitol, and maltitol. Products containing sugar alcohols include toothpaste, mouth washes, cough drops, chewing gums, and some candies.

    Nutritive Sweeteners Calories per gram Examples
    Mono and Disaccharides 4 Corn syrup, molasses, honey, brown sugar, turbinado sugar, agave
    Sugar Alcohols 1.5-3 Xylitol, mannitol, maltitol, sorbitol

    Non-nutritive sweeteners are artificially made and do not provide energy or calories. The reason why there are zero calories is because the structures of these sweeteners cannot be broken down by the body. This group is generally much sweeter than normal sugars. All sweeteners listed below are approved by the Food and Drug Administration (FDA).

    Saccharin (Sweet ‘N Low®, Necta Sweet®, and Sweet Twin®), is one of the oldest artificial sweeteners ever made. It is in foods, beverages, pharmaceutical products, and gum. This sweetener is stable at baking temperatures and is around 200 to 700 times sweeter than normal sugar.

    Acesulfame-K or acesulfame potassium (Sunett®, Sweet One®, Sweet & Safe®), is made up of organic acid and potassium. This is found in oral hygiene, pharmaceutical products, and boxed good packages. This sweetener is stable at baking temperatures and is 200 times sweeter than normal sugar.

    Sucralose, or Splenda®, is made up of sucrose molecules that have been modified to contain chlorine molecules. The chlorine makes the body unable to break down the compound. This is found in a variety of beverages and foods. Sucralose is stable at baking temperatures and is 600 times sweeter than normal sugar.

    Aspartame (NutraSweet®, Equal®, Sugar Twin®) consists of two amino acids which are building blocks of protein. These amino acids are aspartic acid and phenylalanine. Aspartame is found in food and beverage products but is however unstable at baking temperatures. Therefore it is not found in boxed baked goods or dry mixes. Products containing aspartame must have a warning label for people with phenylketonuria. Phenylketonuria is a genetic disorder where the body lacks the normal amount of a certain enzyme that breaks down phenylalanine. Aspartame is 200 times sweeter than normal sugar.

    Neotame is a fairly new additive that is 7,000-13,000 times sweeter than normal sugar. Since it is new, it does not have a brand name. Neotame has a similar structure to aspartame except it contains very small insignificant amounts of phenylalanine. Therefore, neotame products do not need a warning label. Neotame is found in some packaged foods and beverages.

    Stevia, or Truvia®, consists of stevioside molecules which are extracted from the Stevia rebaudiana, an herb from the chrysanthemum plant family. Stevia products are found in a variety of foods, beverages, and pharmaceutical products. This sweetener is stable at baking temperatures and is 10 to 15 times sweeter than sugar.

    Non-nutritive Sweeteners Brand Names How much Sweeter than Sugar
    Saccharin Sweet ‘N Low®, Sweet Twin®, Necta Sweet® 200-700 times
    Acesulfame-K Sunett®, Sweet One®, Sweet & Safe® 200 times
    Sucralose Splenda® 600 times
    Stevia Truvia® 10-15 times
    Aspartame NutraSweet®, Equal®, Sugar Twin® 200 times
    Neotame No brand name 7,000-13,000 times
    Are Artificial Sweeteners Safe?

    There is some controversy that artificial sweeteners have been linked to cancer. However, in 2009, the National Cancer Institute found that there is no clear evidence or studies that show FDA-approved artificial sweeteners are associated with cancer risk in human beings.

    What is used at Mixtures Pharmacy

    Mixtures Pharmacy and Compounding Center mainly compounds with stevia, acesulfame-K, and regular table sugar. Here at the facility, xylitol is also sold but is not used in any of the compounding products. If you have more questions or concerns about the sugars used here, feel free to speak with one of the pharmacists.

    Sources
    • Fitch C, Keim KS. (2012). Position of the academy of nutrition and dietetics:use of nutritive and nonnutritive sweeteners. J Acad Nutr Diet. 112:739-758. doi: 10.106/j.jand.2012.03.009

    • Chattopadhyay S, Raychaudhuri U, Chakraborty R. (2014). Artificial sweeteners- a review. J Food Sci Technol, 51(4), 611-621. doi: 10.1007/s13197-011-0571-1.

    • Anderson J, Young L (2010). Sugars and sweeteners. Retrieved from Colorado State University Extension Office of Engagement Web site: http://www.ext.colostate.edu/pubs/foodnut/09301.html

    • Harnden, T. Carbohydrates. Retrieved from Georgia Highlands College division of Science and Physical Education Web site: http://www.highlands.edu/academics/divisions/scipe/biology/faculty/harnden/2190/notes/5.htm.

    • National Cancer Institute. (2009). Artificial Sweeteners and Cancer. Retrieved July 28, 2014 from: http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners.

    • The Sugar Association. Artificial Sweeteners. Retrieved July 28, 2014 from: http://www.sugar.org/other-sweeteners/artificial-sweeteners/.

    Yeast Infections: Treatments and Prevention by Student Guest Blogger

    If you’ve ever experienced the uncomfortable symptoms of a vaginal yeast infection, you’re not alone: approximately 75% of all women will experience at least one episode throughout their lifetime, and 40-50% of them will have at least one recurrence. Yeast infections are one of the most common vaginal infections, particularly in women of childbearing age. The most common culprit is the fungus Candida albicans, which normally exists in harmony with the other microorganisms that make up the vagina’s natural flora. However, under certain conditions Candida may grow uncontrollably and cause the symptoms of a yeast infection, which may include intense itching, redness, soreness, a thick white vaginal discharge, and/or a breadlike odor. There are many potential causes of yeast infections identified in the medical literature, including:

    • Increased estrogen levels (e.g. from pregnancy, high-dose oral contraceptives, or during certain phases of the menstrual cycle)
    • Recent use of broad-spectrum antibiotics
    • Suppression of the immune system (e.g. from corticosteroid treatment, HIV)
    • Poorly controlled diabetes mellitus

    Wearing tight underwear in non-breathable fabrics, poor hygiene, and routine douching have also been linked to an increased risk for developing yeast infections. While a yeast infection is generally not a serious illness, it can cause significant discomfort. Fortunately, many over-the-counter and natural remedies are available to help resolve the infection or alleviate symptoms.

    Disclaimer – Other types of organisms may cause symptoms resembling that of a yeast infection. If you have thin, foamy, grey or yellowish discharge without much irritation, notice a fishy odor, or have abdominal pain, be sure to see your physician to rule out a bacterial infection or other condition requiring prescription medication treatment.

    Antifungals

    A variety of anti-fungal drugs are available without a prescription, taken orally or as a cream to be applied vaginally. Either approach is highly effective, with an 80% cure rate. The intravaginal anti-fungals may cause some local irritation, burning, or itching as side effects, while oral preparations may be slightly more expensive and cause systemic effects such as gastrointestinal discomfort or headache. Treatment courses of 1, 3, or 7 days are available, and all are equally effective. However, the CDC does recommend the longer treatment courses for pregnant women, in order to keep a lower average concentration of medication.

    Example products:

    • Canesten (clotrimazole)
    • Eckerd (clotrimazole)
    • Equate (tioconazole, micoconazole)
    • Gyne-Lotrimin (clotrimazole)
    • Monistat (micoconazole)
    • Vagistat (tioconazole)
    • Vaginal Anti-Itch Creams

    Several vaginal creams also available to help relieve the intense itching associated with yeast infections. Unlike the antifungals, these products are not curative and will only provide symptomatic relief while your body clears the infection. Still, these products are an option to help manage discomfort for women who do not want to use antifungals.

    Example products:

    • Equate vaginal cream (benzocaine, resorcinol)
    • Summers Eve (paramoxine, glycerin)
    • Vagi-gard (benzocaine, benzalkonium)
    • Vagisil (benzocaine, resocinol)
    Homeopathic Treatments

    These over-the-counter homeopathic products targeting yeast infections have less evidence supporting their use than the antifungal regimens, but are relatively inexpensive to purchase and may be an option if you are looking for a remedy that is not medication based.

    Example products:

    • Yeast-Away (Borax, Calendula officinalis, Candida albicans)
    • Yeast Guard (Pulsatilla, Candida parapoilosis, Candida albicans)
    • Azo Yeast Tablets (Boneset, mistletoe leaf , Lactobacillus sporognes)
    Nutritional Therapy

    Certain foods may contribute to a yeast infection by

    1. promoting the growth of Candida by increasing amount of sugar in your bloodstream
    2. suppressing your body’s immune system, or
    3. altering vaginal flora.

    If you have recurrent yeast infections, you may consider avoiding:

    • Sugars (including artificial sweeteners, honey, fruit juice, and maple syrup)
    • Cheese
    • Dried fruit
    • Alcohol
    • Mushrooms
    • Meat, poultry, and milk (from antibiotic-fed livestock)
    Deficiencies in nutrients such as vitamins A and B6, zinc, magnesium, and essential fatty acids may also contribute to the overgrowth of fungus. Talk to your doctor if you think you may require the addition of a supplement. Unsweetened cranberry juice may also help prevent uncontrolled fungal growth by acidifying vaginal secretions. Generally, a well-balanced diet rich in whole foods and vegetables will help ward off and combat infections by building a strong immune system for your body.
    Probiotics

    Probiotics may be helpful in yeast infections, curbing Candida growth by promoting the colonization of the vaginal tract by “good” bacteria such as Lactobacillus acidophilus and certain Bifidobacterium species and restoring a healthy acid-bacteria balance. Here are some ways probiotics may be used to help fight or prevent yeast infections:

    • Eating yogurt containing live cultures (Remember to choose a brand low in sugar!)
    • Taking Lactobacillus acidophilus capsules or powder either orally or inserted vaginally like a suppository
    • Inserting 1 – 2 tablespoons of plain yogurt containing live cultures into your vagina, or diluting it with warm water to create a douche
    Herbal Remedies

    There are many herbal remedies and supplements that have been proposed for use in yeast infections to fight off excess fungus, strengthen the immune system, or relieve symptoms. Generally, the evidence supporting such therapies is limited, but the following herbs and supplements have shown the most promise:

    • Calendula
    • Caprylic acid
    • Cedar
    • Echinacea (purple coneflower)
    • Garlic (1-2 raw cloves daily; if you are taking anticoagulants, do not take without first consulting your doctor)
    • German chamomile
    • Ginger
    • Goldenseal (do not use if pregnant)
    • Grapefruit seed extract
    • Lapachol
    • Myrrh
    • Rosemary
    • Tea tree
    • Thyme (as a tea using 1 teaspoon dried thyme per 1 cup boiling water)
    • Undecenoic acid
    They can be taken in the form of capsules, extracts, or teas, and some may be used in douches.
    Other Prevention Strategies

    The following strategies may also help prevent the growth and spread of Candida:

    • Wear breathable cotton underwear and loose-fitting pants
    • Dry your vaginal area thoroughly after showering, bathing, or swimming
    • Avoid spending prolonged periods of time in wet clothing (e.g. swimsuits)
    • Wash your hands frequently with soap and water
    • Wash clothing in hot water
    • Avoid routine douching and harsh soaps and feminine hygiene products that alter the vagina’s natural pH balance
    If you are having recurring yeast infections and are taking oral contraceptives or using contraceptive sponges, discuss the possibility of switching to an alternative birth control method with your doctor.

    Magnesium Deficiency: The Mineral for What Ails You

    A couple weeks ago I put out a shout out for help choosing a new topic for the blog. I have tons of opinions and lots of things that I’m interested in, but I want to write about things that interest you, as my readers. A pharmacist friend of mine suggested that I write about magnesium deficiency and I thought, “Hm, that could be interesting. I know some things about it and that could be an interesting blog…” Little did I know. Ashley is a fellow naturopathic medicine enthusiast and has been a huge help doing research for this blog. Ashley, if you’re reading this I (and my readers) thank you!

    Magnesium deficiency is fairly common here in the United States. This has a lot to do with our poor diet choices. Magnesium is found in green leafy vegetables, nuts, and lean dairy products. We are very much a “meat and potatoes” society, which don’t contribute much to replacing the magnesium that we lose every day. Patients with GI problems tend to have low magnesium also. We’ve talked about calcium, sodium, and a few other minerals, but what in the heck does magnesium do? The doctor doesn’t talk about it. It hasn’t been in the news. So how can it possibly be important?

    Magnesium contributes to over 300 enzymes and their functions. It is necessary to maintaining healthy cell structures, muscle, and heart function. Magnesium is basically used in every cell and almost every process in the body to function.

    Magnesium deficiency can cause muscle cramping, lethargy, heart arrhythmias, tinnitus, mental abnormalities, tremors, esophageal spasms (which can lead to heart burn), low calcium levels (which can effect bone strength), and other mental and musculoskeletal problems. These things seem to be what ails America the most and, yet, this mineral is mostly ignored.

    Treating magnesium deficiencies have shown positive effects in migraines and fibromyalgia (of course this doesn’t work for everyone, but it doesn’t hurt to try). Heartburn may be helped by magnesium. Depression and hearing loss have sometimes responded well to magnesium supplementation. PMS and restless leg syndrome respond to magnesium. If you are taking medications for osteoporosis, magnesium may be just the thing you need to help maintain your bone density (that’s right, it’s found in your bones too!).

    Part of the reason magnesium deficiency seems to be ignored is because the symptoms are so general and can be caused by other disease states that are easier to detect. Many times blood tests are inaccurate in magnesium deficiency because what is in the blood does not correlate to the amount of magnesium hiding in your cells. Magnesium test, however, do correlate well to symptomology. If you’re sleepy or having muscle spasms and aches it may be in your interest to have your magnesium levels tested.

    The big question with a magnesium deficiency is how to treat it once it is discovered. Many doctors prescribe Mag-Ox or magnesium oxide. This, however, isn’t the best replacement. Magnesium oxide has a very low bioavailability. This means that it doesn’t get absorbed by the body well. In fact in order to take enough to get decent absorption most people will get diarrhea.

    Well shoot. Now what? Magnesium chloride (also known as milk of magnesia) and magnesium citrate have very good absorption, but it can also cause diarrhea. Magnesium oroate seems to also absorb well, but doesn’t seem to cause the GI upset of the other oral medications. You can also apply magnesium topically, whether as a supplement or relax cramping muscles, but it doesn’t seem to cause the GI upset either. At Mixtures we carry a very good product called “Ancient Minerals,” which has good absorption and comes in a gel, which is easy to apply and use, but does not leave an oily residue. Need something to relieve achy joints after a long workout? How about an epsom salt bath? That’s right folks! Epsom salts are magnesium sulfate! It absorbs well, but I wouldn’t suggest taking it orally unless you really knew what you were doing. Because it absorbs so well it can cause diarrhea within 30 minutes of ingesting… not something to do before that dinner party with your boss. Of course if you don’t want to supplement, may I suggest a lovely spinach or kale salad topped with walnuts and a greek yogurt dressing? In order to improve absorption it is normally suggested to take vitamin B6 (pyridoxine).

    Magnesium is a little tricky. Because it is a mineral it binds up with certain antibiotics and thyroid hormones. It can interact with some heart medications (calcium-channel blockers). It should not be used in patients who have renal (kidney) insufficiency because it isn’t excreted and can then cause arrhythmias. Generally, this is a safe supplement, but it’s always a good thing to check with your doctor before you use the medication in yourself or a child, just to make sure that it won’t worsen any conditions. Also, please ask your pharmacist if this mineral will interact with any of your medications. We would love to help. I’m happy to do the interaction check for you or you can stop by mixtures to see if there are any interactions as well.

    Does My Liver Make Me Look Fat: Non-Alcoholic Fatty Liver Disease

    I’m just going to point out that, just because you’re a healthcare professional doesn’t mean that you’re an expert at everything and you aren’t beyond being surprised when medical conditions show up in your friends and family. Recently I’ve had a couple friends that have presented with cases of non-alcoholic fatty liver disease (NAFLD). I was a little shocked. Is this normal? Do a lot of people have this or do my friends just have rotten luck? Is it dangerous? I have quite a bit of experience treating Hepatitis caused by viruses and alcohol, but what causes these individuals do have an unhealthy liver? Thoughts to ponder. So here you are. Research I have done for my friends I am now passing down to you.

    First, what in the world is the liver and what does it do? The liver is this huge organ that sits on the right side of your body and filters your blood, metabolizes drugs, food, toxins, and helps with nutrient and hormone utilization storage. This organ is so often ignored, but it is basically your body’s processing factory. It is incredibly important to how your body functions.

    So what is NAFLD. This is a disease of the liver in which more than 5-10% of the liver is made up of fat cells. It is normal for the liver to have some fat cells. This is where the liver stores some of it’s nutrients, but over 10% the liver can become fatty and oversized. This occurs in 10-25% of the American population. Waaaay more common than I would have thought.

    What are the symptoms of NAFLD? There really aren’t many. Your liver is one of the most resilient organs in the human body. The biggest complaint that most people have is fatigue, quick weight loss, and pain in the upper right hand part of your abdomen. Some patients even present with elevated liver enzymes (see how important those yearly check-ups are now?). If the fatty cells of the liver progress it can cause non-alcoholic steatohepatitis (NASH). NASH can lead to cirrhosis, where the liver becomes fibrotic and can no longer function adequately. When this occurs spider veins, swollen limbs, yellowing skin and eyes, itching, and various other lovely symptoms that would be difficult (and ridiculous) to ignore. Only 2-3% of the population will end up with NASH so this is much less common than NAFLD.

    So what can cause NAFLD? Well, we’re not 100% sure. There are definitely things that put you at risk. Obesity, diabetes, and insulin are always risk factors, but so is weight loss that moves too quickly (gotta love starvation mode). Metabolic syndrome (a lot of weight around the middle) is a risk. Women are at higher risk for NAFLD and so are those with genetic mutations. High blood pressure, cholesterol, and triglycerides, and certain drugs also put you at risk. These are all risks, however, and even patients with these risk factors may not get NAFLD, let alone progress to NASH. So what seals the deal? Who will definitely not get NAFLD. No idea. Patients who don’t drink, are at a good weight, free of mutation, and are in perfect health may still get NAFLD. Chock it up to the idea that you’re liver just feels like hoarding fat. Some people collect cats. Maybe your liver just wants to collect fat? This is guided by the assumption that your liver has a personality. Maybe it does. Don’t judge.

    How does your doctor diagnose NAFLD? Well, they usually will notice elevated liver enzymes and then do an ultrasound, an MRI, or some other imaging, and ultimately do a liver biopsy to see how the tissue in the liver is holding up. This sounds horrible, but they just knock you out (with drugs, not a baseball bat) and push a large needle into your abdomen (you won’t feel a thing). Those of you who have had a thyroid needle biopsy… its way less painful to test your liver.

    What do we do to prevent or treat NAFLD? This is usually where the “Well isn’t there a pill for that?” question comes in and my face turns bright red and I bash my head onto the counter to prevent me from totally losing my mind. I can honestly say that, “No, there is not a pill that cures NAFLD.” If the NAFLD is being caused by high triglycerides, blood pressure, cholesterol, or insulin resistance then treating these things may help. Controlling your diabetes will certainly help. Exercise and a diet high in fruits, vegetables, and good fats to reduce weight, central obesity, and introduce antioxidants to the system seem to help. Plant sterols will help control your lipids and may help, but there are no oral antioxidants that show any promise in healing the liver. In fact, introducing too much medications and supplements to the system may make things worse. LESS IS MORE. Here’s the other funny thing… your liver may also decide to just give up on its habit of hoarding fat and regenerate into a healthy liver again. Ooooo it’s a tricky organ isn’t it? Worst case scenario it may progress and you may need a liver transplant, but this is INCREDIBLY CRAZY INSANELY RIDICULOUSLY RARE.

    So there it is folks. Non-alcoholic fatty liver disease. The quick and the dirty.

    Food Allergies and Rheumatoid Arthritis: One of the Missing Links?

    These are questions that I get asked quite a lot: Do food allergies, intolerances, or glutens make rheumatoid arthritis worse? Is there anything that can be done to ease arthritis pain or prevent flair ups that doesn’t involve taking more medications?

    Let us, first, remember that rheumatoid arthritis is caused by the immune system. If the immune system is irritated by illness or stress then it only makes sense that the immune system on the march will only continue to attack the its original target with new fervor.

    Studies have shown that food does play an important role in rheumatoid arthritis management, but in more ways than the what. How much food is eaten is important. Weight loss has been shown to decrease stress on the joints and being overweight has been shown to increase the body’s inflammatory response and, thus, increasing the inflammation of the joints and concentrating the immune system so it attacks the joints further.

    As far as food allergies and food intolerances go the evidence is good that the immune system reacting to food can cause rheumatoid arthritis to flair. There are tests that can be done to rate food intolerances and allergies, but these tests are not wholly reliable. Sometimes an allergy is present, but won’t test positive on a skin or blood test. The most accurate way of testing an allergy is to actually ingest the food. For potentially severe allergies this is usually done in your doctor’s office so that emergency care can be provided in the case of anaphylaxis. The other way to discover food allergies is to keep a food journal. If stomach upset or an arthritis flair up occurs after eating a certain food it is good way to discover allergies and intolerances. This can sometimes be complicated by the fact that a lot of our modern food is processed and contains many different chemicals which can also cause food intolerances. I normally suggest that people go on a fresh food diet and gradually add food back into the diet to eliminate any confusion of food allergies. Eliminating these allergies and intolerances may help reduce flair ups.

    There have been suspicions of some grains and glutens causing rheumatoid flair ups, but unless you have allergies or intolerances to these food products, then there really isn’t any reasons to believe that these are causing additional joint pain.

    Low impact exercise has been shown to reduce joint pain and rheumatoid arthritis flairs, but the one that seems to reduce joint paint he most seems to be Tai Chi. Not only does it stretch and build muscle, but it also seems to reduce the stress that can cause exacerbations.

    Probiotics: Necessary or Just Another Fad?

    Last blog we discussed GERD and eating a healthy diet, as well as a few medications used to treat GERD. We even touched on probiotics for a moment, but one of our reads screamed out “MORE!!” (Okay so she wasn’t that demanding, but that was the basic message).

    So lets start at the beginning: Our gut. Our intestines are known as our second brain. It contains neurotransmitters, like serotonin, just like the brain, and is very reactive to our emotions. Our gut also controls what goes in and our of our bodies. This means that our intestines not only control the nutrition entering into our body and eliminates waste, but also acts as a gatekeeper for bacteria and viruses, thus being an active participator in our immune system. Our gut controls so many aspects of our health that it is imperative to keep it healthy. This is why exercise (to keep the intestines moving) and proper nutrition (to feed our body, but also the good bacteria in our intestines) are so important. But what role to probiotics play and what good can they do?

    Antibiotics: Antibiotics aren’t very smart. Sure, they work great. A couple days on antibiotics and you start feeling normal again… oh yeah, except that you feel nauseous, your intestines are all in knots, and food isn’t exactly appetizing. This is because the antibiotics, on top of attacking your infection, have also attacked the bacteria that you need to digest. On top of that it, if you’re a woman, the antibiotics have also destroyed your vaginal flora. This is where those fun yeast infections creep in. What to do? Probiotics!

    Poor diet: If you’re trying to jump start that new diet or you’ve been naughty for a couple weeks because everyone’s birthday is in July you may be having difficulty digesting the healthier foods. You’ve, basically, starved the bacteria in your gut avoiding the healthy foods (MURDERER!) and so now there aren’t enough bacteria to digest these new healthier foods. What to do? Probiotics!

    Diarrhea: I’ll be honest… this is the discussion in my job that I hate the most. I sometimes get weekly reports on my family, friend’s, and patient’s bowel movements. Diarrhea is the most common complaint. Usually this is caused by something infective or questionable food (anything buffet style I file under questionable). When you have diarrhea you don’t have time to reabsorb the water in your large intestine or properly digest your food. Everything just moves out in as quickly as it moves in. This means you are also losing those bacteria that should be helping you to digest. After the infection or disagreement is over you could still have diarrhea simply because you have no bacteria to help you digest your food properly. What to do? Probiotics!

    GERD: Are you getting a lot of heartburn? Your stomach might be working overtime to try to digest the food that you are eating. This means more churning and more acid. Try to take some probiotics for a couple weeks and see what happens.

    “Stomach Flu”: If you seem to be getting a lot of stomach bugs the bacteria that usually act as the Marines in your body may be depleted or weakened. Remember, your intestines are where part of your immune system lives. Part of your immune system, ironically, is bacteria. If your bacteria have been destroyed by a bug, bowl abnormalities, or poor eating habits your immune system is at risk. What to do? Probiotics!

    Now here is the next problem. Which probiotic to choose from… There’s Align, there’s Activia, there’s Pearls, there’s Florastor… where do we even start!? As usual the easiest answer is the best answer. You don’t need to buy anything expensive and you don’t need to buy anything fancy. Good old acidophilus capsules you can get from the refrigerator section are really the best, but the ones sitting on the shelf will work just fine. All those big brand names really don’t get you additional bang for your buck. As far as yogurts go… the big cheap tub yogurts are the best. The more whey the better (that’s where the bacteria live) and the less sugar the better (This is why I hate Activia). Another good food to help replace gut bacteria is kefir (it’s great by itself, as a dip for fruit, or in smoothies).

    Go with your gut!

    GERD: The Hell of Heartburn

    Some of the medication most prescribed in the United States are to help treat heart burn. Proton Pump Inhibitors (PPIs like protonix, omeprazole, aciphex, etc.) and Histamine 2 Blockers (H2Blockers like ranitidine) are part of, what pharmacists call, the Top 200 (the top 200 medications that we dispense each year. I, myself, take omeprazole. Chronic heartburn, or gastroesophageal reflux disorder (GERD), can be caused by multiple things:

    • Asthma
    • Connective Tissue Disorders
    • Obesity
    • Smoking
    • Poor Eating Habits
    • Hiatal Hernia
    • As well as some medications (check with your doctor or pharmacist to see if your medication could be causing your GERD)
    GERD can rear its head with many side effects:
    • Dry cough
    • Hoarse Voice
    • Chest Pain
    • Chest Tightness
    • Hiccups
    • Foul Taste
    • Dental Damage
    • Dry Cough, etc.
    GERD may seem like an inconvenience. Heart burn can definitely cramp your style when your out to dinner with friends, but it can even make chores difficult. Bending over to do the laundry or tie your shoes can be painful, taste gross, and can make you want to vomit. These are short term problems, but in the long run you can end up with ulcers in your esophagus, esophageal strictures (or scar tissue), which can make it difficult for you to swallow food, or even cancer! These aren’t the long term side effects you want to deal with! There isn’t much you can do about having asthma or a connective tissue disorder other than getting treated by your doctor, but a hiatal hernia can be fixed with a fairly simple surgery. Smoking, obesity, and poor eating habits are definitely modifiable. Smoking and obesity are relatively simple. Stop smoking and lose weight. It can take awhile, you can have a few slip ups, but in the end everyone is capable of living a healthier life (please see previous blogs for healthy weight loss). Eating correctly for acid reflux is a bit tricky. Everyone has their own trigger. I’m from New Mexico and I can eat chile until it comes out of my ears! Onions and peanuts on the other hand… ugh! Reese’s peanut butter cups make me want to down a whole container of Tums. What set’s off your heartburn?

    The one trigger that I usually find that most people have is greasy fatty food. The fat lubricates that muscle that keeps your esophagus separate from the stomach, thus allowing the acid to escape. Food intolerances can cause acid reflux as well. Poor eating habits can really set you up for some horrendous acid reflux. Not only can it lead to weight gain, which has be proven to cause GERD, but it also destroys the health of your intestines. Your small intestine helps you digest your food, but digestion actually begins in your mouth and stomach. When your small intestines lose some of their flora the stomach has to kick it into overdrive to help digest your food correctly. This means more mobility of our stomach and more acid, which can definitely lead to acid reflux. How do we fix this? Oh my God I’m going to harp on having a better diet again:

    • More fiber (scrubs your intestines and feeds those good bacteria)
    • Less simple sugars (this is quick energy, but it doesn’t really improve the health of your intestines)
    • Probiotics (love yogurt, capsules work too, just watch how much sugar or fake sugar is in your yogurt)
    • Move (This isn’t eating, but this will get your intestines moving, which will help with digestion)
    If your heartburn isn’t better after modifying your lifestyle it is definitely time to go see you doctor.

    Polycystic Ovarian Syndrome: Fighting for a diagnosis

    Polycystic Ovarian Syndrome (PCOS) is a disease affecting many women that, I believe, is misdiagnosed or goes undiagnosed. Much of this can stem from embarrassment or from the fear of “complaining” about “woman problems.” So lets do something that doesn’t happen often. Let’s talk about it.

    PCOS is an endocrine (hormone) dysfunction that can present in many ways. As the name seems to point out, multiple cysts on the ovaries can be a symptom, but not in everyone. Acne, oily skin, excess hair growth, and male pattern baldness (in a woman) are embarrassing side effects that appear in women, but the severity generally depends on a woman’s genetics and ethnicity. Central obesity (or an apple figure), uncontrolled weight gain, and difficulty conceiving a child are also symptoms that effect many women with PCOS. Menstrual irregularities, however, occur in all women, including elongated periods, skipped periods, etc. This list sounds very sterile and clinical, but these are people we’re talking about here. These are mothers, sisters, and daughters. As “enlightened” as our society would like to believe itself to be, “The Angel in the House” standard still lives on, placed on us by society, but also by ourselves. No complaining, Hellenistic beauty, and fertility. PCOS effects all these standards and, if we are crushed by them, these standards can cause depression, misdiagnosis, or no diagnosis at all. So is this one of those diseases that was “made up” so someone has an “excuse” for their body? No. Why should you talk to your doctor? Because it’s not just about looks and fertility folks. It’s about health.

    In a physician’s defense, PCOS can sometimes be very hard to diagnose. PCOS is marked by the production of too much androgen and estrogen by the body. The androgen excess is what causes many of the physical symptoms of PCOS and the estrogen surges effect fertility and cause the menstrual abnormalities. We’re still talking about appearance and fertility, I know, but these are the symptoms we can see. If there is one thing I want us learn from this blog it is that your body is complicated and you have little control over what it decides to do sometimes. Hormones control everything.

    PCOS can put you at risk for high cholesterol, high blood pressure, heart disease, and type II diabetes. These are disease states that should not be trifled with.

    PCOS can be caused by many things:

      Heredity: If your mother or sister have PCOS it is important that you also watch for signs and symptoms.

      Abnormal fetal development: Being exposed to excess androgen while in utero may produce these effects, but researchers are still digging in this direction.

      Low-grade inflammation: Certain foods can cause inflammation in certain people (this is why I stay away from certain food preservatives). Inflammation can set off any sort of autoimmune domino effect (asthma, rheumatoid arthritis, etc.). In this case inflammation can cause insulin resistance, which seems to lead to PCOS in some people.

    Excess insulin (from resistance or excess pancreatic production or both): The possibility is that the excess insulin may somehow boost androgen production in the ovaries. The other possibility is that insulin resistance may translate to other hormone resistance, increasing the amount of androgens in the blood stream.

    So what can be done? There are, of course, medications that should be taken to help with symptoms, but also to help prevent the other disease states that PCOS is associated with (diabetes, high blood pressure, etc.). The first medication that women are usually placed on is a diabetes medication called metformin. Metformin is a medication that will help the bodies insulin resistance, thus decreasing excess insulin, and decreasing the excess androgen in the body. Spironolactone is a medication used with metformin that helps reduce androgens in the blood stream, but also helps to decrease high blood pressure associated with PCOS. Spironolactone is also more effective in reducing the oily skin, excess, hair, and acne associated with PCOS. To treat the male pattern baldness a drug called finasteride can be used, but it is tertiary to the metformin and spironolactone. Low-dose birthcontrol is effective in women not wishing to become pregnant because it helps regulate the menstrual cycle and decreases the excess estrogen and androgens typical in PCOS. For women wishing to become pregnant it is important to understand that first the disease should be stabilized, spironolactone stopped, and clomiphene started (to help the body ovulate). There is a trade off and there is no guarantee.

    Medications are a great tool and can help with the other disease states associated with PCOS, but here is that lifestyle change thing again. Will I ever stop harping on it? Nope. Exercise and a low carbohydrate diet are what is called for! Weight loss is associated with better control over PCOS. Treating your PCOS symptoms is exactly like living like a diabetic (which is handy since PCOS can lead or be caused by type II diabetes).

    Womenshealth.gov also has a nice summery page for PCOS here.

    Just remember. This isn’t complaining about “woman problems.” This is a disease state that can effect your life expectancy if it is not treated and controlled. It can strike young or old. You know your body more than anyone else. If something isn’t right, something isn’t right. Fight for yourself because you deserve it.

    Work It ‘Cause You’re Worth It!

    Summer is on it’s way! How can I tell? Is it that the days are longer? Is it that it is getting hot? Is it that I’m getting fewer and fewer prescriptions for antibiotics? Nope! It’s that the bloody Sensa and Hydroxycut commercials seem to be playing back to back. I completely understand that fitting back into that summer dress or your favorite swim suit is important. Trust me… I’ve got before and after pictures coming up in the next couple weeks to prove to all of you that I practice what I preach. The one thing that I have been hammering at for months is that changing your diet is not enough. Taking a pill will not make you healthy. Being or becoming thin will not make you healthy. If you are thin, but do not exercise you are what we call a skinny fat person. You are at risk for diabetes, high blood pressure, high cholesterol because thin does not always mean healthy. Cardiovascular exercise and toning exercise, together, can really give you the best results (damn, there’s that “balance” thing again).

    Cardiovascular exercise, whether its swimming, running, walking, dancing, etc, increases your heart rate. What does the heart use for energy again? Oh yeah, fat. Cardiovascular exercise can help tone you as well, but it’s major purpose is to burn fat. HIIT, or high intensity interval training, is most effective at burning fat. It works off of intense cardiovascular exercise to medium or mild exercise. For example: Sprinting for 2 minutes and jogging or walking for 2 minutes. It keeps the muscles confused and revs up the metabolism for longer than just the work out. This means extra toning, extra fat burning, and, my personal favorites, it’s a shorter workout (usually) and it keeps me engaged (a boring workout will shoot my motivation faster than chocolate mousse). Cardiovascular exercise doesn’t need to be high impact either. You can do it on a bike, some forms of yoga can be primarily cardiovascular, swim, hula-hoop, whatever gets your heart rate up!

    Toning exercises build up muscle strength. Free weights, yoga, kinesthetics, resistance training, and weight machines. You don’t need big fancy machinery though. Using your own body weight, soup cans, resistance bands, or some cheap weights from Target… all of these things will do the same thing! They’ll increase your stamina and make sure that you build lean muscle (If you don’t want to get bulky, use smaller weights and more reps). Circuit training is one of my favorite ways to tone. It works multiple muscle structures, you can do as many or as few circuits as you want, and you can do the circuit as fast or as slow as you want. If you’re really challenged, just remember: stop, take a breather, and take your time. Just get through one circuit, you can work up to two or three later.

    Still not convinced? Do you seriously want to keep shaking your Sensa instead of your booty? Here’s some more reasons to exercise:

    • Increase your HDL (good cholesterol)
    • Decrease your LDL (bad cholesterol)
    • Decrease your blood pressure
    • Decrease your risk for Type 2 Diabetes (or manage your diabetes)
    • Increase your metabolism (Pills don’t do this, action does)
    • Increase your stamina
    • Decrease your risk for heart disease
    • Boost your mood (that’s right, a dopamine AND serotonin boost without going to the pharmacy!)
    • Boost your energy
    • Decrease your risk for osteoporosis
    • Manage arthritis
    • Decrease your risk for falls
    • Decrease your risk for stroke
    • Decrease your risk for certain types of cancer
    • Control your weight
    • Sleep better
    • Have better sex (if that’s not motivation I don’t know what is)
    • Improve your focus as you get older (Squirrel! Let me tell you, I’ll take any help I can get…)
    • It can be soooo much fun (Jump rope and tag were my favorite childhood memories)
    • And most important: You are 100% worth the work.
    My favorite cardio and strength training exercises are Zumba, Tone It Up, and Self’s Drop 10. They’re fun, very positive, and have a great community!

    Zumba is done in YMCA’s, gyms, and community centers all over the US! It’s based off Latin dancing and I have patients who pay $30 a month at the gym and I have other patients who pay $2 a class at the community center! They even have Water Zumba for lower impact… oh yeah, and you get to dance. How much fun is that?! Dance party!!! Check out the many different classes available (even for kids) and locations: zumba.com

    Tone It Up puts out a monthly calendar and try to keep things positive. You can get as involved or uninvolved as you want. I love to brag about my successes and even though I am not a frequent commenter on their Facebook I always get positive feedback. Now, some of you might have met me (especially if you’ve been coming to Mixtures for a long time), but I’m not a perky, giggly person. I’m pretty sarcastic (I know, you’re shocked) and blunt, but when it comes to working out I really need for someone to be positive and these girls (as smiley and irritatingly happy as they are) are incredibly supportive to their followers and make a point that no matter what size your are, you are worth the work. When I started following them I couldn’t run worth beans. A year + later I’m running and using heavier weights and able to do all the circuits. It’s all about building up to it. Follow them on facebook, twitter, and their blog and watch for their free workout videos (with accompanying PDFs) and HIIT workouts: http://toneitup.com/index.php Trust me kids, man or woman, young or old, their workouts are great for working at your own pace.

    Self magazine released in April and May a Drop 10 eating and workout program! The eating program even includes on the go items from Subway and Starbucks! The best part? It allows for fun calories like french fries and ice cream and chocolate (oh my!). The workouts include cardiovascular three times a week and toning twice a week. Even with my insane schedule I can fit it in AND I even followed the plan on vacation! What you need? Weights and your cardio of choice. The girls at Tone It Up helped arrange the program too so it’s all very positive and if you can’t do something? Just ask them what to substitute. You may have a hard time with some of it, but you’re worth trying SOME of it. The down side? You have to sign up. The upside? Ummm losing at least 10 pounds. Yes please: self.com/drop10.

    Remember, you’re worth it!

    Do you have a favorite workout, video, or trainer? Please share with the readers! I know you people are reading and I’m dying for some real live comments (not just the bizarre spam that I filter out daily).

    Fructose vs. Sucrose: Is there a difference between “Corn Sugar” and “Real Sugar”?

    So we’ve all seen those commercials where someone is panicking about death and dying because their loved one is trying to feed them a popsicle laced with… high fructose corn syrup dun dun dun. Their loved one then begins to tell them how corn sugar is the same as any other sugar blah, blah, blah.

    Unfortunately, this isn’t entirely accurate in one way or the other. As you will recall from the blog on carbohydrates, not all sugars are created equal. The same is true with high fructose corn syrup and sugar (sucrose). The main difference is how the body metabolizes fructose and sucrose. Sucrose that we as our every day kitchen sugar is the most readily available form of energy. The body will use it the minute it hits blood stream. In fact, the moment that sucrose hits the tongue it is broken down into glucose for the body to use immediately. This is why we use sucrose in diabetics to revive them during low blood sugar. It is not only found in candy, but also in breads and fruits.

    Fructose is also found in fruits, but not in such high concentrations as in soda and as a sweetening additive in so many other processed foods. This additive that we know as “high fructose corn syrup” cannot be broken down into glucose like sucrose can. Its simply a matter of breaking sucrose into its parts, glucose and fructose. Since fructose is not concentrated the quantities of each, in moderation don’t cause as much of a problem. Fructose, especially the concentrated sort, can be very dangerous in the doses that we consume it here in the United States. Fructose must first be metabolized into fat before it can be transformed into glucose. This is why people tell you that drinking soda is literally pouring on the pounds. High fructose corn syrup is usually the first ingredient in soda and is often found in processed breads and sweets so instead of getting a little fructose from adding a cup of sugar to an ENTIRE batch of cookies we are drinking or eating a massive quantity of fructose from our processed foods.

    I want something to be noticed in what I just said. Fructose, sucrose, and glucose are all apart of normal every day foods, but it is the quantity that makes it dangerous. It is the quantity of everything we eat that has lead us to be a more unhealthy nation. I’m going to say it again: “Everything in moderation!” So go and have that popsicle on a hot day! Have a root beer float for dessert or a ginger ale when your stomach hurts, but don’t chug down one soda after another and don’t make a habit of eating processed food every time you want a treat. Treat yourself with some strawberries or a home made cookie. Stay active and you can always enjoy life and your favorite treats, but do it all in moderation.

    “The Change,” Why Does It Sound So Pleasant When All I Want To Do Is Scream? Non-hormonal Treatment of Menopause Symptoms

    We live in a wonderful time where hormones are readily available to women for the treatment of menopause symptoms. Hot flashes, fatigue, weight gain, hair loss, and low libido can all be treated with hormone replacement of estrogens (yes that’s plural), progesterone, and testosterone. It’s all about balance, but sometimes the hormones cause undesirable side effects, sometimes hormones can’t be used (because of cancer or other health reasons), and sometimes the effects of menopause are mild enough that the blood tests and daily hormone replacement aren’t worth it to the woman. Today I want to go over the top 5 most complained about menopause symptoms and non-hormonal ways to help make them more manageable.

    Hot Flashes:
    Hot flashes are caused by the body’s inability to thermoregulate because the hormone ratio’s are off. This can be one of the most uncomfortable symptoms of menopause because it can effect someone at social events, it can effect sleep, and its just plain annoying. You’re hot, you’re cold, you’re hot, you’re cold. Oh my God MAKE IT STOP! There are a few things that can help:
    • Watch your stress levels. High stress can set off a hot flash. That’ll teach you to lose your temper (hee hee).
    • Watch out for certain foods. Caffeine and high sugar diets can set off hot flashes (that makes a frappuccino a bit of a no-no). Spicy foods can also set off a hot flash. To a degree it will take you figuring out what your own triggers are and avoiding them, if possible.
    • Dressing in layers can help because as you warm up you can peel the layers off and as you cool down you can restore those layers.
    • Keeping a cool rag handy, especially at night for those hot flashes that pop up and wake you up.
    • If you’re looking for supplements to help, taking 400IU of vitamin E a day can help and, if not, you can always add Evening Primrose oil supplements to the mix.
    Fatigue:
    This is being caused by the hormone changes and those wicked hot flashes that are keeping you up at night. It also is probably being caused because of the type of people menopausal women are. At this point in your life you are running around taking care of your significant other, children, work, friends, the dog, and pretty much everyone else but you.
    • Remember to take 10 minutes for yourself every day at least. Sit down and relax and take some deep breaths.
    • Remember to eat healthy because this will help with your hormone balance and energy levels and start exercising to help with hormone regulation and boost your body’s energy levels. Yoga is GREAT for this. Deep breathing, stretching, and some really good kinesthetics! It’s a great workout and also helps with relaxation. It can be that workout you can squeeze in before bedtime without winding yourself up!
    • Remember, you can’t take care of anybody if you don’t take care of yourself!
    Weight Gain: I think this one really bothers women the most. Your whole body changes in menopause and that belly fat that you may not have ever dealt with starts to creep in. It’s hard and its frustrating. Your body’s hormones change and your body becomes stressed. Stress means that your body goes into starvation mode (Damn those animal instincts) and so it begins to store fat that we really don’t need.
    • The best way to handle this is to change your lifestyle. Stay away from refined carbohydrates.
    • Lots of fruits, lots of veggies, lean protein, fiber, and portion control. It’s not easy. I hammer on it a lot (Yes I can feel you glaring at me right now).
    • If you mess up for a day don’t worry.
    • If you want a naughty day, that’s okay.
    • If your husband and kids don’t like spinach, tough cookies. If Mama ain’t happy ain’t nobody happy.
    • Get out and exercise. Take a bike ride, go for a walk, jump rope (so much fun!), do yoga, do tai chi, but do something.
    Hair Loss:
    This is an imbalance in the ratio between testosterone and estrogen. This is so frustrating because women really define their femininity by their hair.
    • Make sure you are taking a multivitamin at this point. I don’t suggest multivitamins normally, but prenatal vitamins can be really helpful for women suffering from this problem.
    • Add in Omega-3 fatty acids. Fish oil and chia seeds are my favorite. If those fish burps are bothering you put your fish oil in the fridge and remember taking over 1200mg can also decrease your risk for heart disease, help your skin and your memory.
    Low Libido:
    This is the thing that a lot of women don’t want to talk about. Don’t worry. You’re still dead sexy! Menopause can really take a toll on your energy levels (see tips above), your confidence because of your body changing (pretty dang sure that person you’re sleeping next too doesn’t look the same as the day you met them either. Remember you’re growing old together and that’s just bloody romantic), and you may be suffering from vaginal dryness. Vaginal dryness can really make sex painful and then it’s no wonder you don’t want to get intimate. Ouch!
    • Get those omega-3 fatty acids in your diet again.
    • Do some kegels to strengthen up (yes it counts as working out) and encourage healthy cells.
    • Lubrication helps, but so would vitamin E suppositories and Cocoa Butter suppositories. These things can be compounded fairly easily.
    • Just don’t be embarrassed to ask and talk to your doctor and your partner!
    Remember, Mixtures Pharmacy is here to answer all your questions. We can help you find the right supplement, find a great doctor, compound your medication, and try to make menopause as easy a transition as possible. Just remember you need to take care of YOU.

    Ideas for Management, Questions to Ask Your Doctor & Pharmacist, and Diabetes Resources

    Ideas For Management:
    • Food Journals: Write down what you ate, when it was, when you took your insulin, how much you took and your blood sugars. If you do not use insulin a food journal will still be helpful for your doctor and diabetic educator.
    • Use measuring devices: Humans are HORRIBLE at estimating quantity. Scales are relatively inexpensive and who doesn’t have measuring cups and spoons?
    • Watch your carbs: Shoot for ONE SERVING per meal (read that nutrition label)
    • Exercise: Chart this in your journal too. This will help you see your progress and help you figure out how it helps your blood sugars and which ones are better for your sugars. For example: I do much better with toning workouts because they keep my blood sugars steady. If I do too high intensity of a workout my blood sugars crash (and then I raid the fridge). No one says you need to run or do high intensity interval training. Just go for a walk or do some weight lifting with some soup cans. Something is always better than nothing.
    • Stick yourself: I know it isn’t pleasant to poke yourself with your lancets or your insulin needles. I have an uncle who doesn’t like needles and he told my Grandmother (a long time diabetic) “Oh I’d die if I had to do that all the time.” She told him “No, you’d die if you didn’t.” If you don’t test when your doctor wants you to test then you’re ignoring your body. Your pancreas and liver can’t keep track of your sugars anymore so it’s time for YOU to do it.
    • Read, read, read: Knowledge is power. Don’t believe everything you read, but take what you read and ask for help deciphering its significance.
    • Communicate with your doctor and pharmacist: We’re here to help you. If you don’t know how to read a nutrition label, ask! If you want to know if those FiberOne Bars really are better for you, ASK! No one is going to make fun of you. If something about your treatment is frustrating you, tell us.
    Questions to Ask:
    • How does my medication work?
    • When should I take my blood sugar?
    • Why should I take my blood sugar at that time?
    • How am I doing?
    • What can I do to lose weight?
    • What can I do to my diet to help manage my blood sugar better?
    • I have an injury and I don’t know how to exercise. What can I do?
    • I feel overwhelmed. Explain what is going on.
    • What are my goals?
    • How do I meet my goals?
    • What goal should be my biggest priority?
    Resources:
    • Calorie King: This is an internet site that also has books and apps that helps you figure out serving sizes, carbs, and calories. It contains regular food AND restaurant food! So handy to go out to dinner!
    • The American Diabetes Association: It is fairly easy to navigate and contains everything from diet, to fitness, to diabetes basics. It is an AMAZING resource. The only thing I don’t like is that sometimes they utilize the fake sugars too much, which have been clinically shown to cause weight gain.
    • Live Strong: This has food information, recipes, getting fit tips, help with smoking cessation, apps, food journals, articles. Lots and lots of info and ideas!
    • The American Heart Association: has health tips, recipes, and getting fit tips.
    • There is so much information out there! Go out and take diabetes by the horns. Remember, you’re the boss!!

    Hypoglycemia: When Low Sugar isn’t Good Sugar

    Last blog we talked about hyperglycemia (or high blood sugars) and the risks you take on when you allow your blood sugars to get too high. Hypoglycemia is low blood sugars. Patients with Type I diabetes and Type II patients on certain medications are at higher risk for hypoglycemia. So what’s the big deal? You aren’t supposed to have high blood sugar! Low is better right?! Wrong. Low blood sugar can be dangerous. More people die of hypoglycemia than from hyperglycemia. It can push you into a seizure or a coma. And this makes sense.

    Let’s take a trip down memory lane in the Carbohydrates Blog. Remember that your body needs carbohydrates to function. Sugar is what your brain needs to function. If your blood sugar is low, then your brain has nothing to work on and it shuts down. No brain function means unconsciousness and even organ failure. Here is a visual (please print it out) of signs of hypoglycemia and hyperglycemia.

    Hyperglycemia is marked by:
    • The Frequent Need to Urinate
    • Dry Skin
    • Extreme Thirst
    • Hunger
    • Change in Vision
    • Drowsiness
    • Slow Healing Wounds
    If you see this happening to you or someone you know, even if they are not a diabetic, its time to test! If the blood sugars are high for 3 days and you don’t know why its time to call the doctor.
    Hypoglycemia is marked by:
    • Shakiness
    • Fast Heartbeat
    • Dizziness
    • Anxiousness
    • Hunger
    • Sweating
    • Vision Changes
    • Weakness or Fatigue
    • Headache
    • Irritability
    If these things occur it’s time to check your blood sugar. If it’s less than 70mg/dL it’s time to treat. If you can’t check your blood sugar it’s time to treat it anyway because higher blood sugar is far less dangerous than low blood sugar. You treat by taking 3 to 4 glucose tabs, 3 to 4 hard candies (NOT sugar free), 4 oz of juice, or 1/2 a can of soda (NOT diet). Candy bars are really not the best thing to use because the fats stop you from absorbing the sugar fast enough. You will probably be starving when this happens, but try to not eat everything in site (this is soooo hard). After 15 minutes retest. If you are still low treat again. If you have come up over 70 mg/dL then have a small meal like a sandwich.

    When any of these signs occur take your blood sugar and write it down. These are things your doctor needs to know about. If your blood sugar is getting low too often hypoglycemia unawareness can happen, which means that you don’t know when you become hypoglycemic. This is extremely dangerous. What happens if this occurs while your driving or alone? I always tell patients who are prone to hypoglycemia to tell their friends and family members about the signs and then telling them how to handle them. If you are constantly having hypoglycemia it is time to call the doctor.

    Remember it is all about balance. Watch your diet, exercise, and don’t over treat your diabetes. And remember, keep a conversation going with your doctor!

    Diabetes: Hyperglycemia as the Elephant in the Room

    Diabetes is not an easy disease to control. Your blood sugar will be up, it will be down. If you’re stressed or sick you could eat a salad for lunch your blood sugar may still be at 300. It’s annoying and frustrating. My dad says (and pardon the language, but the honesty is key) that diabetes is a “Goddamn guessing game.” There will be times when you want to throw your meter across the room and where it feels like anything you try is futile. Doing something is better for you then simply giving up. Remember, the blood sugar is important to protect your organs, so doing something is better than giving up and doing nothing at all.

    The biggest struggle that most diabetics have is with high blood sugar and there are two schools of thought. One school says that you can eat whatever you want and just cover with insulin and medication. I think this is mostly bogus. Eating whatever we want is what has gotten us into this epidemic in the first place. Non-diabetics shouldn’t even eat whatever they want, whenever they want. I’m tossing that school into the trash. The other school of thought says that you should modify your life to match your blood sugar. If your blood sugar is high at lunch time it just makes more sense to have a salad or some soup instead of a sandwich. If your blood sugar is high at dinner, maybe dessert really isn’t the best idea. Okay, stop it. I can feel you glaring at me. I am not saying you can never have dessert or your favorite sandwich. Having a slice of your best friends birthday cake is a-okay in my book. It’s life and you are allowed to have fun, but fun comes at a cost, whether you’re a diabetic or not. If you eat simple carbs your blood sugar will go up. That is just how it is. Now, you’re pouting. Stop it, it isn’t the end of the world and there is something you can do.

    Exercise is so important. Life is busy and exhausting and there are so many excuses to not exercise. Trust me, I’ve used them all, but it’s about putting yourself first. The goal is to exercise 30 minutes five times a week. That’s the GOAL, but, remember, 20 minutes is better than 0 minutes. You don’t need to go to the gym. You don’t even need workout equipment. Go into your kitchen and grab some soup cans. Do some bicep curls! Do something. Walk around the couch while you’re watching tv and then step it up a notch! Do some jump roping or jumping jacks. Exercise makes your blood sugar go down. As long as you have some insulin in your system your body will suck up those carbs up like a 6 year old on a Mountain Dew. What does that mean? Lower blood sugar means that your body isn’t getting maimed by sugar crystals and it means you can afford to have a little fun! Yum!

    Most diabetics have the hardest time with their blood sugars in the morning. That means that whatever you ate the night before isn’t getting worked off. There are a few things that could be going on there. First, you could be eating and then sitting around before going to bed. That is SOOO relaxing, but very naughty for the blood sugar (Yoga is also relaxing… just saying 😉 ). The other thing that could be happening is that you could be eating too many carbs with your meals. It is fairly normal in our American culture to have multiple carbs with our meals. As a diabetic it is so important to try to limit the carbohydrates to a single serving and to attempt to make sure that the carbohydrates are high in fiber (these are complex carbs and your best friend). Instead of potatoes and a slice of bread with dinner, why not try some long grain wild rice (or jasmine rice is lovely), which is much higher in fiber and amazingly easy to season. Yum! Try switching to whole wheat pasta and skipping the garlic bread. What about garlic chicken instead? Delicious!

    Hyperglycemia is the awkward elephant in the room. It is frustrating and often makes you feel defeat you. Don’t let it defeat you. Take that frustrated energy and move it into something positive and active. Hell, take that anger and do some shadow boxing. Do some kick boxing. Go for a walk. Put your favorite song on your stereo and dance until you can’t dance anymore. You’re worth it. Diabetes doesn’t have to be Hell. It doesn’t have to be a death sentence. You can be diabetic AND fabulous. Just don’t be afraid to try.

    Diabetes: Complications, Risk Factors, and Prevention

    So a couple weeks ago we talked about the difference between Type 1 and Type 2 diabetes. We talked about what puts us a risk for getting the different types of diabetes. But what about your risk factors if you already have diabetes? What about ways to prevent or even cure your diabetes? Nothing like a little motivation to move you in the right direction eh?

    First a little recap:

    Type 1 Diabetes is caused when your body attacks your pancreas and can no longer make insulin. You become insulin dependent. This is linked mostly to genetics and bad luck, but an unhealthy lifestyle has been shown to accelerate the process.

    Type 2 Diabetes is caused when the body cannot can not utilize the insulin that the body makes and when the body cannot make enough insulin to compensate. The most common causes are weight, poor diet, with genetics also playing a factor.

    So, as a diabetic, what are some complications and what puts you at risk for these complications?

    First let’s talk about why a lot of these complications happen. Most of them occur because of high blood sugar. Do me a little favor, grab a sugar packet from the break room or a teaspoon of sugar from your kitchen. Rub some sugar between your fingers (now go wash your hands). Sugar is sharp! It’s crystal and when it is in your blood it is still a very tiny microscopic little ninja star. When your blood sugar is high your blood goes from a teaspoon of sugar in your tea to simple syrup. That is a lot of sugar running around and that little ninja star becomes a wire scrub brush. And that brush is running through your veins honey. Yikes!

    So the major risk you hear about the most as a diabetic is cardiovascular disease. This is very complicated, but let’s at least tackle some of the simple concepts. When you want to paint your bookshelf what do you do first? You sand that baby down! This takes off protective coatings and creates tiny imperfections in the wood. This means the new paint can stick to the surface! Now lets apply this concept to your blood vessels. The excess sugar in your blood scuffs up the inside of your blood vessels. Now that the inside of your vessels are texturized the cholesterol that is also located in your blood grabs a hold and sticks. Your blood vessels then narrow giving you chest pain, blocking off blood to your heart and brain and putting you at high risk for stroke and heart attack. This, of course, is made worse the longer your blood sugar is elevated (because your body has no time to heal) and when your cholesterol is elevated this puts you even more at risk for cardiovascular disease.

    Something else that you might be doing to your body, but you might not feel is kidney damage, or nephropathy. Your kidney has little tiny blood vessels where waste from the body is filtered out. Remember that scrub brush? You are doing two different things to your poor kidneys: First, the scrub brush is poking holes in your filtering system so you are losing blood and vital nutrients. Second, the sugars are scarring up the vessels making it harder for the kidneys to filter, thus causing a backup of waste into your body. Yuck!

    Cancer is another risk factor that increases, especially with Type 2 diabetes. There are still studies being done to try to pinpoint the cause, but it may have to do with the risk factors that cancer and Type 2 diabetes have in common, like obesity.

    Neurological problems have also been linked to diabetes. Alzheimer’s has been correlated to high blood sugars and may be related to the scuffing up of vessels around the neurons, but also to genetics surrounding Type 2 diabetes and Alzheimer’s.

    High blood sugar can also cause some very unattractive problems (and there is nothing wrong with being diabetic, but let’s look fabulous and healthy being one). High blood sugar gives you dry mouth. Dry mouth lets the naughty bacteria running rampant around your mouth. High blood sugar erodes the blood vessels. This means that the body’s ability to heal is diminished. This means that your skin will suffer, your mouth will suffer (nobody likes hillbilly mouth), and so will your feet! All these things put you at risk for massive bacterial infections and amputation. I’ve had family members who needed both legs amputated from uncontrolled diabetes. The amputations don’t heal well, they hurt, they become infected, and they take a huge emotional toll on the diabetic and their family.

    Eye damage can also be devastating. The blood vessels in your eye are so teeny tiny that when those sugar crystals travel through them and cause damage the eye and it’s nerves don’t get the blood and nutrients that you need. This means that the eyes begin to die and blindness becomes a real risk.

    The greatest complaint I get from my patients is about the pain and numbness that they begin to feel in their fingers, toes, legs, and arms. We’ve already talked about how high blood sugar destroys blood vessels and destroys nerves causing blindness. The same thing happens to the nerves over the rest of your body. Those starving nerves can tingle, burn, and eventually die leaving no feeling in those limbs. Neuropathy also effects sexual health and can cause erectile dysfunction in men and sexual dysfunction in women.

    So this all sounds pretty scary. Coming from a family of diabetics some of this makes diabetes sound like a death sentence, but this does not have to be the case. Whether you are a Type 1 or Type 2 diabetic be healthy. Exercise, watch your blood sugar, and your weight. No one wants you to look like Twiggy (eww) and you’re never going to perfect blood sugar all the time, but trying and shooting for being healthy makes all the difference. If you are a Type 2 diabetic then shooting for being healthy can also be your cure. Just remember kids: It’s never too late to get healthy, but we always have to deal with the consequences of our actions. Just don’t lose hope!

    Diabetes: First the Basics

    It’s a new year with new resolutions and I’m sure none of us have been perfect, but trying is what matters. I’m a firm believer that knowledge is power and the best way to succeed is to know as much as you can. Diabetes is a very big issue. Projections have showed that 52% of the population could have diabetes or pre-diabetes by the year 2020! That’s only eight years away folks. Now, I’m not here to judge anyone. Trust me, I understand that sometimes genetics is a beast that looms over your shoulder and sometimes you just want to give up. There are at least three generations of late onset type I diabetics in my family and the odds are not on my side. Depending on the kind of diabetes you see in your family there are tests that can be run and things that you can do to prevent the diabetes (or at least slow it down). If you are already a diabetic and you are wondering how these new year’s diets all fit into your life it’s time to touch on that too. This is waaaaaaaaaaaaaaay too much information to do in one blog. I don’t want your eyes to glaze over and I promise it’s going to be good stuff so I really want you to take it all in. So this is the first blog in the series. Let’s talk about diabetes, the difference between Type I, Type II, and the emerging definition of Type III.

    Diabetes Mellitus (DM), no matter what type you have, is a dysfunction of a hormone, insulin, in the body. Insulin is the hormone that helps your cells absorb glucose (a sugar your body needs to function). The best way to think about insulin is that it is the taxi that delivers glucose into the cell. Depending on what is going on with the taxi, this helps you understand what the difference in the kind of diabetes you have.

    Type I DM is often known as juvenile diabetes because the majority of patients diagnosed with Type I are between the ages of 4 years of age and in their early 20’s. This term, however, is not being used any longer because there are patients with Type I that are diagnosed in their 30’s and 40s (and sometimes later). Also, in the current state of affairs, just because a child has diabetes, does not necessarily mean that they are Type I diabetics. So, what really distinguishes a Type I diabetic from the other types? This is a autoimmune mediated disease where antibodies attack the pancreatic beta-cells and, sometimes, the insulin hormone itself. Okay, WHAT? Now in plain ol’ English: Type 1 diabetes is caused when the body decides it doesn’t like the cells that make insulin in an organ called the pancreas and sometimes doesn’t like the insulin either. This is equivalent to the body’s antibodies blowing up the taxi station and the taxis so that glucose cannot get inside the cells. Now that’s what I call bio-terrorism. Now, here is the good news: if you know that this type of diabetes runs in the family there is a very simple lab test that can be run to test for the antibodies. This can sometimes help catch the disease before it gets ugly, but not everyone produces these antibodies, just the majority. Sometimes you can’t predict if you’re going to get Type I DM. It can be caused by genetics, but also environment, a virus, or even poor eating. And remember what I mentioned before. Just because you are over 30 doesn’t mean you’re out of the woods. LADA, or Latent Autoimmune Diabetes of the Adult, occurs in people over the age of 30!

    Type II DM is more often than not associated with obesity and poor eating. This is true, but individuals at a healthy weight can also get Type II (although their chances are much less likely). Type II diabetes is caused by peripheral insulin resistance and by the beta cells inability to make enough insulin to cover the high glucose that is already present in the body. All overweight individuals suffer from insulin resistance, but only when a person’s beta cells are unable to produce enough insulin does the patient have Type II DM. So in English: The body is unable to absorb the sugars into it’s cells and the pancreas just can’t spit out enough insulin to overcome the resistance. This is equivalent to the taxis not being able to get the glucose into the cells and the taxi station not being able to supply enough taxis to meet the demands of the body. Type II diabetes does have a genetic link (some of the mutations can be screened for), but there is more than just genes involved. People who do not do some sort of exercise, are overweight, have high blood pressure, polycystic ovarian syndrome, or just eat meals high in simple carbohydrates put themselves at high risk for Type II diabetes. Unlike Type I diabetes there is usually a way to prevent the onset or to simply get rid of the Type II DM altogether (more on that later).

    Type III DM is not truly recognized, but people studying the occurrence describe it as a mix of Type I and Type II DM. Not only has the body destroyed it’s ability to make insulin it is also resistant to absorbing the insulin injected. This means the patient must use super high doses of insulin to moderately bring down their blood glucose.

    If you already have diabetes or pre-diabetes (no matter the type) the words you most likely hear from the doctor are “blood glucose levels” and “A1C.” I suspected since these numbers are thrown around so much that the average patient would at least be able to tell me what their goal is or what those numbers mean, but in my experience only a few patients actually understand the numbers and the acronyms and tell me what they mean. This means there is a distinct lack of communication going on between the patient and the doctor, so let me clear some of this up for you:

    Blood Glucose Levels: These are measurements read from the blood by a laboratory or by your glucose monitor to tell you how sugar is in your blood and much insulin to inject or what foods to eat less of. For example, if your blood sugar is reading 200 it is probably not the right time to have a burger or eat some ice cream. A fasting blood glucose level (the level taken after not eating for 6 hours) should be less than 125. If it is between 100 and 125 then pre diabetes is a concern.

    A1C: Your A1C is measured, normally, by your laboratory although there are machines available to the general public for home monitoring. This lab helps figure out an approximate 3 month average of blood sugars. Most people have a goal of less than 7, but if you are 65 or older the American Geriatric Society suggests an A1C of less than 8. Testing your A1C more than once every 3 months is not recommended (and to be honest the home test kits are kind of expensive and not as accurate at the lab).

    I know this is a lot of information so take it in. Ask questions. Read the article a few times and remember that another blog will be appearing soon to discuss more about risk factors and prevention. And just remember, Mixtures Pharmacy doesn’t just compound, we also take care of your regular medications, including your diabetic supplies so if you have questions about your diabetes and treatments just call or stop by and let us know!

    Out With the Old and In With the New: Detoxing the RIGHT Way

    We’ve all heard how important a good detox can be for jump-starting a diet, cleaning the colon, as well as general body health. These things are all true, but the sort of detoxifying regimen and the length of the detoxifying regimen is what is most important. Remember, the way to lose weight and to keep your body healthy is to eat a clean nutritious diet. Lots of fresh foods, plenty of fiber, lean protein, and good fats.

    The cleanse I hear most people talking about is the Master Cleanse. It consists of a laxative tea or water with 2 teaspoons of salt every morning and at least ten days of a lemonade made with water, lemon juice, maple syrup, and cayenne pepper. I know of no medical professional who approves of this cleanse. It contains only simple sugars. There are no essential fats, proteins, or fiber (which is the colon’s toothbrush), although, since you do not eat anything for ten days and take laxatives each morning it can be no wonder why your system is cleaned out, but you are entirely at risk for being malnourished.

    There are some wonderful cleanses out there that can be used as a meal supplement. Used along with a healthy diet these cleanses can help jumpstart your weight loss clean out your old habits while you’re bringing in your new habits. Our favorite at Mixtures is made by a company called Metagenics. Metagenics has a cleanse called the UltraClear RENEW cleanse. It contains good fats, proteins, and fiber and is lower in sodium. It is a perfect meal supplement to take to work and keep you going. It will help cleans your liver (your body’s toxin filter), your colon (without the harshness of diarrhea), and has been shown to help with neuron function. Xymogen Opticleanse is another brand that provides the same benefits and is also available at Mixtures!

    Another great detox that I love for the morning is green tea mixed with Yogi Tea’s detox tea. It is my favorite when I’ve eaten too much salt. If tea is difficult there are other tablet forms of detox (like Metagenics AdvaClear. Metagenics makes a great deal of effort to make their products as hypoallergenic as possible and they are of extremely high quality. If you stop by Mixtures, or call, we can set you on the right track to make your resolutions come true.

    Remember to detox correctly you must support adequate nutrition. Nutrition keeps your body in balance which balances your hormones and, therefore, your metabolism. See our blogs on carbohydrates, fats, proteins, and sodium to help guide you through the new year. If you have questions please tweet, facebook, or comment and we’ll see what we can do to help!

    Salt, Water Retention, Weight Loss

    So we’ve gone over all the macro-nutrients. Fats, proteins, carbohydrates, but there is one last nutrient that I don’t think we pay attention to enough. Sodium. It’s a mineral that we find in so much of our food. It effects those of us that are trying to lose weight, suffering from high blood pressure, or effected with heart failure. Now many of us, either in our own weight loss attempts or by watching reality TV, have noticed that in the first few weeks of eating healthy a great deal of weight is lost. Most of this weight loss is from water weight. When you start eating more fresh foods and less processed or fried foods you, consequently, eat less salt. This means that all the water weight that the salt was causing you to retain is allowed to leave your body! It’s a little like magic. Now, I like a good handful of salt and vinegar chips myself, but the one thing I am very very careful about is my salt intake.

    Salt isn’t necessarily bad for you. In fact your body needs sodium in order for your heart, nerves, and muscles to work correctly. Eating too much salt, however, can lead to kidney disease, high blood pressure, heart disease, stroke, and congestive heart failure… not to mention it can really block your weight loss goals.

    Here’s the thing: We should really be limiting our sodium intake to 1500 to 2300mg per day. That sounds like a lot… until you find out that one teaspoon of table salt has about 2300mg of sodium and that, on average, Americans eat about 3400mg of sodium per day. Wow! Just to give you a little perspective, who likes Pei Wei or PF Changs? Google their menus. Most of their entrees contain the daily value, if not double the daily quantity of salt in one serving. Holy cow… have you put your eggroll down yet?

    So how do we watch our sodium intake? Well, coming from a family with sodium sensitivity and heart failure I’ll tell you what I do and then share a few internet resources. First, don’t add salt to your food if you can help it. Salt is great for tenderizing meat, but try adding other seasonings other than salt when the food gets to the table. Use foods that have their own salty flavor to your food. Celery, tomatoes, and garlic are great savory examples. Second, make fresh food and eat fresh food. I’ve even gone so far as to make my own broth sometimes. Eat as little processed food as possible (Am I repeating myself? Didn’t I say this in the last few blogs? You bet!). Third, don’t go out to eat all the time. Learn to love your own leftovers! Leftovers, especially soups this time of year, are delicious the second and third days in the fridge. They actually get better. Also remember it doesn’t matter if your salt is pink and Himalayan or white and iodized. Salt is salt is salt is salt so be careful! Keep a food journal to track your salt intake until you get the hang of it!

    Need to eat something packaged? That’s fine! Remember, we love our salt and vinegar chips, but everything in moderation. Just read your nutrition facts:

    The DASH diet is a great way to eat correctly and bring your sodium intake down. I love the Mayo Clinic website for their information:

    Eating Out

    Shopping and Cooking

    Sample Menus

    They also have lots of recipes. Handy!!

    Hopefully I’ve kicked you off in the right direction. Now how about those New Year’s Resolutions? Next week, just to kick everything off in the right direction I’ll be going over cleanses. Safe? Not safe? What’s the right way to do one? Stay tuned!

    Lean, Mean, Protein… Confusing?

    So we’ve all heard about these crazy high protein diets. The Atkins diet seems like a good idea, but is it really? Let’s go over protein, our last macro-nutrient. Protein is a great nutrient, but, as with anything, everything in moderation. Your body uses up it’s own proteins every day and these proteins need to be replenished through our diet. Here in America it is rare that people are protein deficient, but we don’t always use proteins wisely and we also don’t always pick the right proteins. The idea of cutting out an apple (which contains lots of fiber) because it has carbohydrates and eat as much bacon as you want (when it has lots of saturated fats) because it is protein is illogical.

    Life is about balance and so is nutrition.

    Most people aren’t in need of proteins supplements because we don’t do enough to warrant supplements. Too much protein, especially animal proteins, can put a lot of pressure on your kidneys and liver. So lets talk about healthy proteins and not so healthy proteins.

    Lean proteins like plant proteins from beans, nuts, legumes, and soy, as well as protein from fish and poultry are amazing for you. They contain essential amino acids without the saturated fats that we talked about in the previous blog. They have, in some studies, been shown to protect your organs. Soy protein is a little bit of a controversy. Soy protein isn’t bad, there have been no studies that I have found where soy has caused feminization in men and there haven’t really been any studies to backup soy protein causing cancer, but it is recommended that people limit their servings of soy from 1 to 2 servings a day. If you are a survivor or at risk for breast cancer it is best to talk to your physician about using soy in your diet. Studies are mixed and it is better if you and your healthcare provider have a discussion about your lifestyle and individual risk.

    Proteins that come from red meat should be eaten more in moderation. Beef, pork, and lamb are delicious and no one likes anemia, but when you eat these proteins try to stick to leaner cuts (these cuts tend to be less expensive anyway). The amount of fats in these meats tend to be what makes these proteins less healthy. See the “Does this fat make me look fat” blog for additional info.

    Proteins to try to avoid are processed meats. I know you probably don’t get a craving for spam all that often, but take a peak at that turkey sandwich you brought to work. That deli meat is processed. Put the turkey sandwich down and try having a salad with a chicken breast.

    Proteins are amazing for filling you up and keeping you full longer. They are great food for an active body, but one can not live on protein alone. Eat your fiber. I know it’s carbohydrates, but fiber is a toothbrush for your intestines. Eat your fats because they will provide you with vital energy and help your body regulate it’s own cholesterol. And eat your proteins because they will keep you full longer and provide vital energy. Eating these 3 macro-nutrients correctly will help you with your weight loss, regulate your hunger, help your brain work, and help you regulate your own hormones. Also, and never forget this, these nutrients will add variety to your diet. Variety is the spice of life. Balance is, therefore, delicious.

    Does This Fat Make Me Look Fat?

    The answer is… maybe. I know we all just got done with Thanksgiving and now we’re heading into the holidays, which usually means diet doom. It doesn’t have to though. We’ve already discussed my unhealthy love affair with food, but even I have lost weight during Christmas. When we worry about gaining weight we think about eating fat. Fat must make you fat… and it can. But it also can be a very healthy component to your diet.

    So lets talk about what fat is. If you look at the nutritional value of fat it has more calories per gram than any other nutrition component. This can be bad if you have a sedentary lifestyle, but if you are an active person, a little fat will take you a long way. People who live in cold places like Alaska and Mongolia eat a very fat rich diet, but their bodies burn the energy off so they suffer no ill effects. There are also some very important nutritional benefits to fats. Some vitamins (like vitamin D) need fat to be utilized by our body. Some fats can actually increase your HDL (good cholesterol) and decrease your LDL (bad cholesterol). The big difference is the KIND of fat, not that it’s fat itself.

    So lets get the naughty bits out of the way. Now, just remember kids, a little naughty is okay. Everything in moderation.

    Saturated fats are found in butter, cream, the lovely marbling in your steak. These fats, if not eaten in moderation, can increase your LDL and, therefore, your cardiovascular risk. Some studies have also shown that a diet high in saturated fats can increase your risk for type 2 diabetes. Now, that being said, most of the cardiologists I’ve talked to say that they would prefer that their patients would use a little bit of butter and cream rather than using some of the manufactured fats.

    Trans fats can be found in small amounts in animal fats, but it is mostly found in processed foods with processed fats. These fats are particularly harmful. Not only do they increase your LDL, but they decrease your HDL, thus increasing your cardiac risk.

    Okay so lets talk about some good news and some healthy fats.

    Monounsaturated fats are founds in olive oil, canola oil, nuts, and avocados. Monounsaturated fats lower blood cholesterol levels, decrease your cardiac risk factors, and can help regulate your insulin levels. This is great news if you are trying to lose weight or if you are a diabetic.

    Polyunsaturated fats are fats contained in fatty fish, fish oil, walnuts, and seeds. These are the fats that include omega-3 fatty acids. They can improve blood cholesterol, decrease cardiac risk, decrease the risk for coronary artery disease, and may also help decrease the risk for coronary artery disease.

    Many physicians and pharmacists are beginning to recommend plant sterols to decrease LDL cholesterols and fish oils to increase HDL cholesterols.

    See folks? You NEED fats. Don’t be afraid, but also remember, it’s all about balance, watching your nutrition labels, and moderation.

    Are You a Good Carb or a Bad Carb?

    “Christmas is coming and I am getting fat…” Wait. That’s not how the song goes and that is NOT how I want the song to end up. Diabetes is a raging epidemic. Most of my patients have diabetes or pre-diabetes or are at risk for diabetes. Type 1 diabetes is genetic in my family. So with the Atkins diet, the South Beach diet, and all these other diets which do you pick?

    Personally, I’ve never had much time for diets. I can’t stick to them. I get bored, I don’t have that kind of focus, and I LOVE food! The problem with a lot of diets is that they are crash diet. They cut out parts of your food pyramid and that can lead to a lot of deficiencies, which isn’t healthy for your mind or body. So, in honor of the holiday season the next few blogs are going to be about the essentials of healthy eating. Today lets talk about carbohydrates.

    Carbohydrates are the most readily available form of energy. Your brain actually runs off carbs. That’s why when you try cutting out carbohydrates you can get headaches, hypoglycemia, and your head feels fuzzy. So what are we supposed to do? The answer, as with anything, is everything in moderation.

    Now, despite the title above, there aren’t any good or bad carbs, but some carbs are better for you in larger quantities than others. Some of you may have heard of “complex carbohydrates” and “simple carbohydrates,” but what does it all mean? So here is the breakdown and here is the science behind it.

    Complex carbohydrates are anything containing fiber. You can always look at the back of the nutrition label on the box. If you see dietary fiber with a number next to it you’re a step in the right direction. Fiber is great for digestive health, makes you full, and keeps you going longer. It’s like lighting a fire and using wood as a fuel. It burns for quite a long time. A bowl of oatmeal in the morning, a piece of fruit for a snack, a salad with dinner (that’s right folks, veggies have carbs: these things will keep you going and will fill you up so that you are less likely to down that left over box of candy corn sitting on your desk.

    Simple carbohydrates do not contain fiber. You will burn these of quick, they will not fill you up, but they are great for energy you need quickly… and some of them taste pretty good. Hot cocoa for example… yum! If you don’t see any fiber on that food label, it’s a simple carb and you should really use these things in moderation.

    The simple carbohydrate is one sugar molecule, the complex carbohydrate is the chain of sugar (and they do get bigger) and it takes more time and energy for your body to digest it! This is why you stay full longer and why your blood sugar stays more steady. Fiber is slow release carbohydrate!

    It’s all about portion size. You can do it! I would never tell you something that I don’t do myself. A few months ago I told you I was starting on my own health journey and I’m still going. I’ve got my waist AND for the first time ever I was able to buy boots with a leather upper. My fat little calves are shrinking!

    In a few weeks, after I go over all the food nutrients, we’ll throw all this together into a big picture. Stay tuned!

    Winter Sunscreen

    If any of you have met my little sister you know that she is a skin care enthusiast. I admit that when I get questions from patients on skin care sometimes I call her. So when I was trying to figure out what to write the blog on this week she suggested discussing sunscreen during the winter. Genius!

    I know it’s cold and cloudy today, but that doesn’t mean that you should be slumping on your skin care! Time for a story from my friend Evan:

    He was standing in line at some store or another and there were two girls standing in front of him. Now, don’t pretend you don’t do it, but he was listening to their conversation (what else are you supposed to do in line?). One of the girls was talking to the other and said “Well it’s pointless to go tanning today! The wind is blowing and you can’t tan when the wind is blowing.”

    The sun doesn’t cause skin damage because of the heat! We do not live in an oven so by cooling things down you are not going to stop things from cooking. Instead, we live in a microwave. Skin damage is caused by UV radiation. Cloudy days, like what we experience in the winter, can actually make you more prone to sun damage because the blanket of clouds holds the UV radiation in towards the earth instead of letting the radiation escape back into space. And when the snow comes to certain areas of the country? Oh just forget it! If you aren’t wearing sunscreen you are ASKING for a nasty sunburn. And don’t forget, sunburns make you feel cold. Great, so now you’re cold, can’t get warm, AND it’s freezing outside. Put your sunscreen on!

    Okay now that we’ve established that wearing sunscreen no matter what time of year it is is a great idea lets talk sunscreens. If you haven’t been able to tell I am opinionated, and the subject of sunscreen is no exception. In fact it may be a little worse so brace yourself:

    There are two types of sunscreens out there – Chemical and Physical blockers.

    Chemical blockers include dixoybenzone, oxybenzone, cinoxate, ethylhexyl p-methoxycinnamate, octocrylene, octyl methoxycinnamate, ethylhexyl salicylate, homosalate, octyl salicylate, and more.

    Physical blockers include titanium dioxide and zinc oxide.

    I stick primarily to physical blockers and this is why: chemical blockers can irritate skin, acne, dry skin, eyes… their like you’re kid brother. They’re just irritating. Physical blockers aren’t what they were in the 80’s when surfers painted themselves up like men from the Neon tribe. The titanium and zinc are very very finely micronized so that when you spread them on it’s virtually invisible. It tends to stay on much longer as well. It’s a win.

    Now let’s talk about what SPF means. SPF basically tells you how long you can stay in the sun. It really depends more on how much you’re sweating or being exposed to water. I try to reapply every hour and you really should apply 15 minutes to 30 minutes before you walk outside. You should also apply about 2 to 3 tablespoons for your entire body. That seems like a lot, but that’s the only way you are going to make sure that that SPF live up to their numbers. What do those numbers mean? Well, that depends. Between 15 and 50 they mean a lot. I go with the max every time because the idea of sunspots and skin cancer freak out the healthcare professional in me… and I’m a little vain. Under 15? Well, you’re wasting your money. At those levels you might as well not go out with sunscreen at all. Over 50? If you’re paying more for SPF 65 than for 50… you’re wasting your money. There is a ceiling of SPF and 50 is it. There really isn’t anything stronger. It’s marketing. It’s that nasty front label again! Remember our blog on medication safety? Yep, sunscreen has drug facts too! Flip them on their back and do a little light reading. As of next year the FDA will be regulating sunscreen SPF ratings to reflect what I’ve just told you.

    Go outside and enjoy your winter wonderland, but please please PLEASE do not forget the sunscreen folks!

    Cold Season Home Essentials

    Well, it’s flu season again. That means that people are sick with more than just the flu. It is allergy season and cold season as well and you would be surprised how many people don’t have the essentials… or maybe it just surprises me. There are a few things I keep in the house, both medicinal and herbal. First I’ll tell you a few medicines I prefer not to keep in the house:

    I do not approve of combination products. First, people tend to read front of the box, which is mostly advertising. The real information is found on the back. Please see my blog on medication safety for additional information on reading the labels. Combination products also tend to be more expensive and people also tend to use them incorrectly, treat symptoms that aren’t there, and put themselves at risk for overdosing.

    I avoid brand name products if I can. I have never found a difference between brand and generic products other than the cost.

    I never buy Airborne. Now, don’t get me wrong, I have a huge amount of respect for school teachers, but let me ask you this: What does a school teacher know about pharmacology? Not much. Airborne has a group of herbs in it that can cause drug interactions. It also contains glycerol, which can stop you from absorbing the zinc and then what is the point? You can also overdose yourself on the vitamin A it contains. You would do better to take vitamin C and zinc, save yourself some money, and just get down to the point.

    Here are some medications I like to keep on the house:

    • Acetaminophen (Tylenol): It isn’t my favorite for pain, but it is beautiful for taking down a fever when you can’t stand it anymore. The big caution is just to watch it if you have liver problems. I also prefer to smoke my fevers out, but if they get too unbearable: acetaminophen.
    • Ibuprofen (Motrin, Advil): This is my favorite for pain and inflammation. If you have problems with your kidneys, bleeding disorders, or are prone to ulcers, this may not be the best drug for you.
    • Diphenhydramine (Benadryl): This is a great drug for MANY things. If you itch, if you have an allergic cough, if you can’t sleep, this drug can help quite a bit. If you have a cold sore or a fever blister you can dab a bit of it on the sore with a q-tip and it will numb it up. Just be careful if you are elderly because it can put you at a high risk for falling and make you groggier much longer than it will a younger person.
    • Sodium bicarbonate (Tums): This item is great for a sour acidic stomach and is also a good source of calcium.
    • Simethicone (Gas-X): This is also great for a sour stomach and for gas. It is also very safe.
    • Dextromethorphan (Robitussin DM): This is great for a cough, but I find it is best to allow yourself to cough up what you can during the day and then use this medication at night to get some sleep. Please be careful using it in young children.
    • Guaifenesin (Mucinex): I never leave home without this medication. I am very prone to getting respiratory infections and this drug thins the mucus and allows me to clear the mucus in my lungs and nose.
    • Saline Nasal Spray (Ocean or a Netipot): This is the safest way to clear out your nasal passages, for both old and young. It will also help you keep those nasal passages moist.
    That completes my medicine cabinet, but I also keep a stocked tea caddy:
    • Ginger: I use this if my throat hurts, if my chest hurts from coughing, and especially if I am nauseated.
    • Chamomile: I use this herbal tea to help me sleep, settle my stomach, and settle my nerves. I also will combine it with valarian root for something stronger to help me sleep. Peppermint: This will help settle your stomach, especially if it is acidic. It is also very soothing if you have a chest cold.
    • Black tea (of some sort): The caffeine will help keep your lungs open, but I would not advise using it in the evening (it is caffeine. It will keep you up). Tea containing hibiscus: This flower is super high in vitamin C and is great when combined with lemon and honey for that pesky sore throat!
    These are 12 things I keep in my home at all times. They will help treat almost anything and are relatively safe. What are some of your other favorites to help you feel better? Please share!

    How Does the Thyroid Work?

    There are several important pieces in the Hypothalamus-Pituitary-Thyroid (HPT) axis which help regulate our thyroid function. First let’s talk about the flow of the thyroid “conversation” in our body. The pituitary gland is a little gland, about the size of a small pea, in our brain. This gland sends out a messenger, Thyroid Stimulating Hormone (TSH), to our thyroid gland. The thyroid gland is the little gland in your throat shaped like a butterfly. The higher the TSH, the more it “pokes” the thyroid gland to produce thyroid – primarily T4 in this case. Typically if the TSH is high this tells us the body is probably not producing the right amount of T4.

    There are many thresholds of “normal” TSH levels and according to many laboratory companies their maximum is 4.5mIU/L. Your practitioner should have an idea of where they would like to see TSH. I look at thyroid as an issue if the TSH is above 2.0.

    T4, also known as levothyroxine, has a little activity. The majority of activity is with the T3. The thyroid produces a little T3, but the majority of T3 is converted from T4 in the liver. Because the configuration of T4 has 4 iodines on a thyroid, one of the iodines is cleaved off to make T3. There can also be an alternate configuration called reverse T3 (rT3). T3 is 4 times more active than T4. The rT3 does not have any activity. Herein lays the problem with many people, especially those who have a low body temperature. Normal body temperature is 98.6-98.2 F for oral and 98.2-97.8 F for basal (under the arm). Low body temperature is defined as less than 98.2 F using an oral thermometer or 97.8 F using a basal (under the arm) thermometer. When taking your temperature, please try to use a non-battery operated thermometer so the results are more accurate. The theory is your enzymes are not operating at their optimum when your body temperature is lower than normal. This means you will have more inactive rT3 than active T3.

    I look at T3 and rT3 as keys. The T3 is active so it will unlock the door. The rT3 is inactive so it is like the key you take home from the locksmith that fits in your lock, but doesn’t actually unlock the door. If you have more keys that are in the door but don’t unlock it, you will have many symptoms of low thyroid.

    Now that you have an understanding of what your body does to make thyroid, what are the symptoms of too little thyroid? Here are a couple of sites which have checklists for thyroid.
    http://www.thyroid-info.com/chklst.htm
    http://www.hormoneprofile.com/bloodspotkits.htm

    If you find you are suffering from many of these symptoms, I encourage you to enter into a conversation with your doctor or compounding pharmacist to investigate further.

    There are several treatment options once you are diagnosed with hypothyroid or low thyroid. The most standard is a T4 only therapy like Synthroid®, Levoxyl®, or levothyroxine. There is also a commercially available T3, Cytomel®. You can also treat with a glandular like Armour Thyroid®. There are certain areas where one may be better than another. If these commercially available treatments don’t address your issues, you can look into compounding a T4 and/or T3 to suit your individual needs. Because of the small dosing increments, please make sure you work with a compounding pharmacy and pharmacist that does a lot of thyroid compounding. With a willing practitioner, you and a compounding pharmacist, you can fine tune your thyroid treatment to help you feel your best.

    Additional reading resources:

    http://www.stopthethyroidmadness.com/books-on-thyroid/

    Excerpt of Dr Mark Starr discussing hypothyroidism.

    Written by Lori Allen, R.Ph

    Osteoporosis: How to NOT Give Yourself a Break

    Osteoporosis is a really hot topic right now. And it should be. As we get older our bones become more brittle and do not rebuild themselves as they did when we were younger. Part of this has to do with our nutrition and our activity levels. These things are called “modifiable risk factors.” Other things have to do with our genetics and body composition. These are known as “nonmodifiable risk factors.”

    Nonmodifiable risk factors are the worst because we can’t really change them. They include:

    • Being a woman (aren’t we just soooo lucky?)
    • Getting older
    • Having a small frame.
    • If you are Asian or white, you are at higher risk.
    • If there is a family history of osteoporosis.
    • Too much thyroid hormone. If you are hyperthyroid or are over taking thyroid for weight loss you are at risk.
    • Medical conditions that affect the parathyroid, stomach, or intestines (including weightloss stories)
    Modifiable risk factors are the best because you can change them. You can prevent or reduce the “inevitable.”

    Low calcium intake is, of course, a huge contributor. Milk, tofu, broccoli, kale, peas, salmon, spinach, and almonds are great food resources. Also taking a calcium supplement 1000 to 1200mg every day! Don’t take it all at once though. Divide it in 2 to 3 doses a day so that your body can absorb it all. Also remember separate your calcium from some of your other medications.

    Low vitamin D. This can happen pretty easily here in the southwest. We don’t go outside a lot (its too bloody hot during the summer), we wear a lot of sunscreen (which blocks out the UV light that your body uses to convert the vitamin D to it’s active form), or we get really tanned (which also blocks out the UV light). It is quite the catch-22. Try to get out in the sun, with some sunscreen and you will absorb some UV light. Foods that contain vitamin D are some of the same ones that contain calcium like dairy and salmon, but also egg yolks. Try to get about 600 IU of vitamin D a day!

    Tobacco use. The body really should be a non-smoking zone.

    Drinking too much alcohol. It isn’t good for your liver, your bones, your skin, or the rest of your body. Everything in moderation!

    Sedentary lifestyle. It is all about weight baring exercise. Walking is amazing for you and yoga is another way to do gentle weight bearing exercise. Weight training is also another great way to strengthen your bones. You don’t need to do anything dramatic, just some light 2 to 5 pound weights. Less weight = more repetitions. You can do it!

    Medications like corticosteroids, antidepressants, proton pump inhibitors like Protonix and Prilosec, and methotrexate can also cause osteoporosis. I know sometimes it is impossible for some people to get off these medications, which is why it is so important to modify all other risk factors.

    Eating disorders. If you don’t eat right or if you throw up to try to stay thin you are doing yourself more damage than just to your brain and your body. You are also hurting your bones. Try to get help so you can be healthy and happy.

    Hopefully this blog has helped clear up some myths and point you into the right direction for your better bone health!

    Remember, Mixtures Pharmacy has all the supplements you need in order to keep your bones healthy!

    Depression: Is there really a pill for that?

    It’s amazing how fast this year has gone! Look at the calendar folks. It is September! Holy cow. The holidays are coming rapidly. The holidays are associated with a lot of happiness, but unfortunately this is also the time of year when depression begins to creep up on us. There is so much to do and so little time to do it and I’m sure the expectation for perfection is causes quite a bit of stress. This is also a time of year when the days are shorter and our exposure to sunlight can go down (although here in Arizona I do find that I try to spend more time outside in the sunlight, if I get out of work early enough to see the sunshine). This is a perfect storm for glum composure.

    I have had so many questions lately about depression and I feel like patients aren’t really given enough information when they are diagnosed with depression. The majority of the patients I talk to aren’t aware that there are more options than just popping a pill every day.

    Now I’m not saying that antidepressants aren’t a good option for some people. Antidepressants treat a chemical imbalance in the brain. This is why it may take a couple tries to find an antidepressant that works for you. There are many kinds of antidepressants as well. Tricyclics like amitriptyline (Elavil), was used quite a long time ago, although it is mostly used for patients who have difficulty sleeping now. SSRIs, which work purely on serotonin, are the most well known. Fluoxetine (Prozac), citalopram (Celexa), and escitalopram (Lexapro) are the ones I see the most. Budeprion (Wellbutrin) works a little differently. It works on the norepinephrine and dopamine. It can be used on it’s own or in combination with other antidepressants and can be helpful for patients who are experiencing sexual side effects from their other antidepressants. Another group of antidepressants that are being used more are venlafaxine (Effexor) and duloxetine (Cymbalta) which work on both norepinephrine and serotonin. What all of these medications have in common is that you should never stop taking these medications without the help of your doctor otherwise you can experience a pretty nasty withdrawal.

    Many patients ask me about St. John’s Wart, which can be very effective, but the major problem is that St. John’s Wart interacts with soooo many medications and herbs. It also should never be used with other antidepressants because it is an SSRI and there is the potential for serotonin syndrome (which is life threatening).

    The most natural way to treat depression is the following:

    Exercise. It has been shown to increase the number of serotonin and dopamine receptors in the brain. These are our happy neurotransmitters. It’s definitely hard to start a work out routine, but you will feel better afterwards. Just keep fighting for your motivation. You are worth fighting for.

    Eat right. A little malnutrition can really destroy your body’s balance, including the balance in the brain. Lots of fresh fruits and veggies, and watch those simple carbohydrates (although I think a little chocolate helps some 😉 ).

    Positive Self Talk. When you mess up or make a mistake do not beat yourself up. Telling yourself you’re stupid when something happens can really effect you (even if you aren’t aware of it). You can get mad at the situation, but no more beating yourself up. Also, try to say something nice about yourself every day. It will make a difference. Get enough sleep. See our blog on sleep hygiene.

    Talk to someone about what is bothering you. I am not quite sure why doctors think that the best treatment for depression is a prescription. Talking to a therapist can do soooo much good. And money isn’t really a draw back. Many therapists work on a sliding scale according to what people can afford.

    Find a hobby! Get out of the house to watch a live band, take up knitting, take a creative writing class, pick up an old hobby. Do something that makes you look forward to the next day.

    Biofeedback can sometimes be a great option. This form of cognitive behavioral therapy which is amazing for people with depression associated with anxiety. It teach you how to control your body temperature and heart rate so that you can learn to control your bodies reactions to anxiety.

    Get outside and enjoy the sunshine. Exposure to UV light has be shown to naturally elevate mood.

    Check for hormone imbalances including testosterone (yes girls, even for us), progesterone, estrogen, and perhaps even some adrenal fatigue. Treatments are available for these conditions and at Mixtures we are very experienced in treating all these deficiencies.

    Just stop on in or give us a call and we can set up a consultation!

    There are many other options to help treat depression so don’t be afraid to ask and don’t be afraid to try something new!

    Not Right Now! I have a headache: Migraines, their causes, and their treatments

    Do you have that friend that says, “Oh, I just can’t do it it’s giving me a migraine,” but they are out and about doing other things? I am beginning to believe that the word “migraine” is one of the most over used excuses in the English dictionary. Now, I am not saying that there is no such thing as a migraine. There absolutely is! I’ve had them. They are hell on earth! There is, however, more to a migraine than just a “really bad headache.”

    What is a migraine exactly?

    Migraines are caused when the blood vessels in the brain over dilate. There really isn’t that much space between your brain and your skull so when those blood vessels expand they create a lot of pressure within your head. This usually means that certain senses can be effected. Many patients, just before a migraine, get what is called an aura. Some people say that they “just don’t feel right,” while others can get these shiny points of light or can even loose parts of their vision!

    The aura occurs just before the migraine which can last hours to days. The pain is extreme. It is often only felt on one side of the head. It can bring on blindness, nausea, sound sensitivity, and light sensitivity. Often people suffering from a migraine can only lie under a blanket in a cool, quiet, and dark room and pray to fall asleep. There are other headaches like tension headaches and cluster headaches, which are horribly unpleasant, but rarely as debilitating as migraines.

    What causes a migraine and how do you treat them?

    Any number of things can cause migraines. What causes them is usually the best way to treat them, but it’s not the easiest thing to figure out the cause.

    Migraines can be caused my a hormone imbalance which can sometimes be treated by simple hormone replacement therapy, but if done incorrectly it can make things worse. Young girls just entering puberty or women going through menopause often end up with hormone induced migraines. Sometimes birth control can help, sometimes they can make things worse. Women with menopause can sometimes be treated with hormone replacement therapy compounded to their specific needs. The key, as usual, is to find the best balance for each woman.

    Migraines can be caused by low serotonin levels. Sometimes patients see a correlation between depression and their migraines. This is where the use of medications like Imitrex and Maxalt come into use. These medications are great for the treatment of a migraine, especially if caught in it’s aura stage, but there are some problems with the use of these medications. Using them too much can sometimes cause migraines. Medications like Fioricet, Vicodin, Percocet, and Excedrin can cause the same problem. Ideally treating the patients low serotonin levels would be best. SSRIs like Prozac, Celexa, and Lexapro, can be very helpful to these patients, but in some patients it can deplete their serotonin stores further.

    Stress is often associated with migraines although, as I mentioned in the beginning, many times people blame their headaches on migraines, when they are really suffering from a tension headache. If it truly is a migraine that is triggered by stress one of the first things that should be done is to learn to manage stress better. Biofeedback and yoga have been shown to be highly effective. The migraine sufferer should also make sure that they sleep better. If these things do not work beta-blockers (sometimes used for high blood pressure) can help prevent migraines. Amitriptyline may also be used to help increase the patient’s serotonin levels while helping them sleep better (that’s what we call two birds with one stone folks).

    Other things that can cause migraines can be a change in the weather, certain light frequencies, certain sounds, allergies… etc. etc. The brain is a mysterious thing.

    My favorite treatment? The minute I get an aura I pop 3 ibuprofen and toss an ice pack (or frozen peas ) on the back of my neck. The ibuprofen brings down the inflammation of blood vessels and the frozen peas cool the blood entering the brain. The cool blood shrinks the blood vessels and if I cannot completely abort the migraine I can at least shorten it. I’ve also had some patients who told me they get themselves an Icee and give themselves a brain freeze. Same concept!

    Other treatments can include compounded BAK gel (sometimes called ABC gel) which can be treated and used topically. Anti-inflammatory suppositories can be compounded and be very effective. The whole point is finding what works best for you. But as you can see there are many options (and many more. I didn’t want to bore you by writing a novel). If you have exhausted all your options in your local pharmacy I challenge you to try acupuncture, yoga, message therapy, biofeedback, and compounded medications as well. Migraines are complicated and there is no magic pill, but don’t give up and just keep trying.

    Let’s get together! Or not… drug-mineral interactions

    Vitamins and minerals are certainly a great way to keep ourselves healthy. Calcium gives us strong bones and can also be used to treat PMS and iron is how we keep our blood cells healthy and our body oxygenated. These are two minerals I dispense in the pharmacy all the time, but they can cause problems with other medications. These minerals kelate, or bind with other drugs so that neither of them will absorb. Lets go over a few medications that this happens to, the consequences, and ways to prevent this from happening.

    Levothyroxine and liothyronine (or Cytomel) are two thyroid hormones that are used regularly for patients with hypothyroidism. These medications should be taken in the morning, with water, 30 minutes before a meal. They should NOT be taken with your vitamins in the morning. Thyroid hormones are notorious for kelating, which is why they should be taken alone. If you take these medications with your iron, calcium, antacids (Tums and Rolaids), vitamins, milk, or even calcium enriched orange juice they will bind to the minerals and neither will absorb. This means that your hypothyroidism will be undertreated and your body will not be receiving the vital minerals that it needs. At this point its just as effective to throw your pills in the trash.

    How to fix it? Take your thyroid hormones half an hour before anything else like you’re supposed to. With water. Coffee does not count as water, neither does diet coke, milk, or orange juice. You need that clear wet stuff that goes in a glass. Half an hour after you can take your iron or calcium with your meal.

    Antibiotics are also medications that you need to take with caution around minerals. Fluoroquinolones like Levaquin, Cipro(floxacin), and Moxifloxacin kelate and tetracyclines like doxycycline can bind with your minerals just like your thyroid medications do, but they definitely should be taken with food. So be careful with your antacids, calcium fortified foods, and your vitamins and minerals around these guys. If you take them together and they bind to your antibiotics you might not get better and you could end up with some drug resistant bugs.

    How to fix it? Take these medications 30 minutes before your calcium or iron containing products or two hours after. This may mean that you’ll be snacking a bit during the day to stop an upset stomach.

    Bisphosphonates like Boniva, Fosamax, and Actonel all should be taken completely on an empty stomach, just like your thyroid. Actually those two can be taken together. Just keep them away from those minerals and vitamins again. Same guidelines as with the thyroid medications.

    What about your vitamins? The ones that contain calcium? The problem with this is that they usually contain phosphorous. Phosphorous in our blood and bones help us use calcium, but phosphorous in a pill with your calcium? Well that’s just going to bind and not let you absorb it. That is why you need to take an additional calcium supplement if you want your vitamins to have any other effect.

    Remember, just because its over the counter, or a vitamin, or a mineral, or an herb, doesn’t mean that it doesn’t have any interactions. And if your pharmacist doesn’t know about it, it also means that we aren’t checking for interactions either! As always, Mixtures carries a wide variety of high quality vitamins and minerals and there is always a pharmacist present to ask any questions!

    UTIs and Yeast Infections: When fun in the sun gets uncomfortable

    Summer can be a wonderful time, even in Arizona. Swimming, barbeques, fun fruity cocktails… it sounds like a real blast! Unfortunately, for some women, summer can be a time of frustration. Summer time is UTI and yeast infection weather. It is so uncomfortable and it is hard to find time to go to the doctor because you’re busy being an amazing hostess and/or chasing after the kids. So lets break this down and talk about some quick and easy prevention. And Mom’s, this may not be the worst advice to pass on to your daughters.

    First let’s talk about UTIs (urinary tract infections):

    Having to run to the bathroom every few minutes, painful urination, confusion: UTIs are a great way to ruin your fun. Urinary tract infections can be caused by a few things:

    Bacteria from your GI tract. Especially E. coli. E. Coli have these little wiggly things called flagella that allow them to move around and crawl up your urethra. This can happen because of hygiene issues (like rushing in the bathroom or “holding it”) or sometimes after intercourse.

    Dehydration. If you aren’t urinating, you aren’t keeping your pipes clean. This means you are making it much easier for bacteria to crawl upstream and make your life miserable. Here are a couple fixes:

    • Make sure you are going to the bathroom. Don’t hold it. I don’t care how busy you are. Just go.
    • Take your time to get clean in the bathroom. Urine is sterile, but fecal matter certainly is not.
    • If you get UTI’s after intercourse try to go to the bathroom afterwards. This washes out the urethra of anything that might have been introduced during your… activities.
    • Drink plenty of water. If you drink water, you urinate. If you urinate you’re cleaning the pipes.
    • If you are someone that is prone to UTI’s drink or take cranberry capsules. The cranberry juice acidifies the urine and contains d-mannose, which makes the urethra really slippery so those nasty little bacteria can’t swim upstream.
    • If you are watching your sugars or just don’t like cranberry you can get d-mannose powder that you can just add to water and drink! We sell d-mannose powder by Pure Encapsulations at Mixtures and it works WONDERS. And if you’re drinking it in a glass of water you’re also staying hydrated!
    Now about Yeast Infections:

    The vaginal area is all about balance: hydration, hormones, and flora. It all needs to be balanced! The things I just mentioned can cause a yeast infection:

    • Dehydration: If you get dehydrated your vaginal wall becomes dry. This isn’t just uncomfortable for you. This is very uncomfortable for the good natural flora that lives there. If there isn’t enough moisture your flora can die off and become unbalanced. This can lead to bacterial vaginitis or a yeast infection. Drink lots of water! Coffee and soda do not count as water.
    • Hormones: An imbalance in your hormones (like what happens in menopause) can cause a lot of vaginal dryness. If this is a problem it’s time to go to the doctor. There are hormone creams and gels that can be put into the vagina so that you get less of a systemic effect, but they plump up those vaginal secretion cells again. This means no more dry vagina and this means you may contract less vaginal infections.
    • Flora: The natural vaginal flora consists of both fungal and bacterial. Don’t get grossed out, these little guys are there to keep you healthy.
    In order to keep you and your flora healthy there are some things that you need to do to keep things healthy:
    • Watch the carbs: Too much sugar can allow some bacteria to go haywire. Sodas and fruity drinks really make summer feel like summer, but try adding just regular fruit to your water. It’s super tasty and looks beautiful. A little raspberry and mint and you’ve got one sexy looking drink that also keeps you hydrated and keeps your carbs on the straight and narrow. Carbs are great, but it’s all about balance!
    • Cultivate your natural flora: Get some yogurt in your system. ALL yogurts contain good flora (not just Activia). I tell people to stick with lowfat yogurts with low sugars, but no artificial sugars. In fact the big tub yogurts are my favorite. Dannon and Yoplait sound yummy, but they are chocked full of sugar! I love getting plain yogurt (including Greek) and adding a little fruit and honey or agave to it. Just a smidge. That’s all you need. Or granola is great for your GI flora too. Hurray fiber! If you really can’t stand yogurt or can’t work it in daily pick up some probiotic capsules at Mixtures. We’ll set things right again!
    • Change out of your swimming suit and into a sun dress! Swimming suits and high spandex clothes don’t let your skin breath! If your skin isn’t breathing things are getting hot and sweaty and your flora are going to be VERY unhappy.
    I want all of you to have a fun delicious summer! Here are some delicious and healthy ways to flavor your water

    Seasonal Allergies and Sweet Treatments

    Phoenix has been an interesting place to be this monsoon season! With the giant dust storms and the rain that is actually falling in some areas of the valley pollen, dust, and other allergen in the air have sky rocketed. This means everyone is having allergy attacks, sinus infections, dry eye, coughing, and sneezing fits. It’s miserable, and in some cases a lot of the allergy medication companies (like Sudafed) just can’t keep up with demand. So what can you do? There are many many options for the allergy sufferer so let’s take some time to go over them today:

    Oral Antihystamines:

    Zyrtec, Allegra, and Claritin are great for the allergy sufferer and don’t usually make people drowsy, but with these medications come some drawbacks:

      1. Some can be very expensive! I have found that some of the cheaper places for allergy medications are places like Target and Costco (especially Costco). Don’t be afraid to buy generic either! If you can’t find the generic of your favorite brand ask for the pharmacists help or use the knowledge you gained in this article to help you. Remember you want the “Active Ingredients” and strengths to be the same as the brand and often times the store will stick the brand and generic right next to each other.
      1. Taking it one day will not put a band aid on the mess that is seasonal allergies. You sometimes need to take the allergy medications for up to a week before you can receive full benefits. When it comes to your immune system there is no quick fix!

      2. If you’ve got an allergy cough these medications will not take care of it.

    Benadryl and Chlor-Trimeton are great as well and do great things for your allergic cough, but can cause a lot of drowsiness. They are also not recommended for people over the age of 65 or with people with an increased likelihood of falls. Lets avoid that hip replacement surgery if we can, shall we?

    Afrin… do me a favor and don’t you dare touch it. I totally understand that it works well. The unfortunate thing is that you can’t really use it longer than 3 days or else your body becomes dependent on in and the withdrawal symptoms are (drum roll please) the most miserable stuffy nose you have ever had. I never recommend this product for allergies because I have never met anyone who’s stuffy nose lasted only 3 days.

    Well, what can you use for a stuffy nose? Especially if you are a person that is prone to sinus infections.

    Sudafed is the first thing people go for, but there are some things to be concerned about. If you have high blood pressure or congestive heart failure this is a no no. This is also not even close to a first line product for those of you who are pregnant. It is a category C. This means this has to be a decision that you and your doctor need to make together. Oh and there is signing the pesky book at the pharmacy counter (you can thank the meth-heads for that folks).

    Sudafed PE is okay… it doesn’t work as well or as long as the original Sudafed so I don’t usually steer people in it’s direction either.

    A netipot is a great way to clear out your sinuses. It looks like a tea pot, although you can get regular bottles that come with preservative free saline mix. This is great for pregnant women and young children. You basically hold your head over the sink and pour or squirt the saline into your top nostril until things come out the bottom nostril. It’s technically kind of gross, but it’s really better that it’s out than in!

    Another great product that you can use after your netipot or just with a regular stuffy nose is Xlear. It is a xylitol nasal spray and wash. It sounds crazy, but I tried some when I was at Mixtures and it works! It goes into your nose like a regular nasal spray, but it is super moisturizing and also makes your nasal passages super slippery so that the bacteria that normally cause sinus infections can’t stick. True story. It is available for purchase at Mixtures and it is totally safe. The only thing that is disconcerting is that it tastes sweet!

    All these things are great for current allergy issues, but, as always, we try to promote preventative medicine at Mixtures. If you are allergic to pollens and grasses get your hands on some local honey! They usually sell it at places like Whole Foods and farmer’s markets (great places to go exploring). This contains the local pollens that you are allergic to. Have a teaspoon every day (Mary Poppins knew her stuff) and after about a year some people find their allergies subside some, if not completely. Think of it as a super tasty allergy shot.

    I hope these hint’s help you!

    Quick updates:

    We’re on week I can’t remember of my lifestyle modification and so far so good. I’m in my tightest pair of pants comfortably and without muffin top! Very exciting. Something helpful I have found is to really shoot for 5 small meals a day that are high in protein and fiber. I pack an apple, a protein bar, and a salad before I go to work every day and that helps me keep on track. I’ll keep you posted. I was in a size 6/8, but now I’m in a size 6 easy. I’m also not getting as tired so so far so good! I also have been taking the dogs for a walk most mornings of the week (about 1.7 miles) and doing some toning from Tone it Up. How are all of you doing with your getting healthy goals?

    Week 2: Traveling, Eating, and Staying Motivated

    Okay, I admit it. I fell off the wagon this week. This weekend was hard! Between traveling in a car, going out to dinner, and prepping to go to weddings I got a little distracted. I didn’t work out while I was there, I totally crashed on the diet one day. I didn’t have to count calories to know that. I thought about all this on the ride home and so I came up with a few things and some are just a few thoughts:

    1. Just take the time to do your calorie counts. Holy cow it takes one second just do it… we’ll see if me scolding myself works.

    2. Do SOMETHING active. Go on a walk after dinner. Bring a yoga mat and work out in your room if you’re nowhere near a gym. Wo/Man up!

    3.If you get the chance, dance. I danced for 5 hours at the wedding Saturday and my entire body hurts so good. Amazing.

    I’m sorry to keep it short. The week is going to go by quick! I will add more on Thursday. Promise! Just don’t beat yourself up to hard. This is a lifestyle change not a diet. I have no deadline, I just need to sink into the habit of being healthy. Routine routine routine!

    Week 1- Tracking and Motivation

    I know my status changes have made me seem like one of these uber skinny chicks who has never had to struggle with my weight or eating, but I’m here right now to prove you wrong and maybe lend a little assistance to those of you who are struggling. Let me give you a quick run down:

    I am 4’11” and I weight 150 lbs. My measurements are B: 38″ W: 28″ H: 42″.

    According to my Ideal Body Weight I should weigh around 95 lbs. According to my body mass index I’m just crossing the line into obese.

    Now that I’ve thrown a ton of numbers and words at you that don’t seem to mean much. And here’s something I’ve discovered over the years. I’ve been trained in health care. I’ve been between a size 2 and a size 12. Weight doesn’t matter unless I’m dosing drugs for you. Here is what matters: Your health, your muscles, your energy, and your happiness.

    I may never be back down to a size 2 again. When I was that small I was sick. I want to be able to go hiking, rock climbing, and run around without wearing out. I want my waist to be small again because I know the wider my waist the harder it is on my heart. I also want to stop craving food to the point where it’s the only thing I can think of.

    Today I’m going to share with you some of the difficulties and helpful hints from my friends who are doing this challenge with me. So here we go:

    My most difficult challenge is not lying to myself and holding myself accountable. I am lucky enough to have an Ipod and an Itouch so I use the Livestrong Lite App. It’s pretty handy. It takes a running tally of what you’ve eaten, how much you’ve eaten, how you’ve exercised, and how long you’ve exercised. The app tallies the calories for you. The ultimate goal for weight loss is to reach a negative total number. You can always do a total in a little food journal book. You can use Live Strong or Calorie King. (these site are also handy if you are a diabetic and need to find the carbs in food).

    So how did I decide how many calories to cut out of my diet? Well we tell our patients to go between 1200 and 1500 calories for weight loss. I work 10 hour days standing so I know I won’t get a lot of time to exercise. I knew I needed to pick a lower calorie count in order to get a deficit of calories. Not to mention I am in need of more stringent guidelines since I like to cheat.

    I really like to exercise, but here in Arizona at this time of year it is hell on earth to find the right time when you don’t have to wake up at 4 am so you don’t die of heat stroke. And the other problem is that between work and my hobbies sometimes it’s hard for me to make working out a priority. There’s a group I really like that helps a lot though:

    Tone it up is amazing. You can find all their work out videos on youtube and here is the plan I’m following.

    I really enjoy it because you do something different every day and it really works on cardio and toning. There is something the two girl say that I really like: “You’ll never regret a workout.” I think this is important because there are days I’m tired or I don’t want to take 15 minutes and work out because there’s other stuff I want to do, but I have never laid down at night and said “ugh, why did I work out?” I have, however, gone to bed and though “Oi! I forgot to work out!”

    I talked to a couple of my friends that are doing this plan with us and here are some things they told me. They’re both in way more amazing shape than I am, but they both struggle too so getting their feedback helps, I think!

    Rachael said that doing this week was harder for her because, even though she doesn’t have the problem that I do with invading the fridge, she has a harder time getting motivated to work out. She just moved all the way to New York and the bipolar weather has been making life a little harder. One day the weather is nice so she wants to go outside and exercise and the next day it’s raining. She said it is a little more helpful that she knows I’m working out too, but it would be easier if I was in the same place so we could work out together.

    I totally agree. I really wish she was here to work out with because doing it by myself and working it around my and my families schedule can be rough.

    Yousuf said that each persons weight loss needs to be individual. Some people want to get ripped. Some people just want to get in good shape. It’s best to understand what you want and go for that goal, but you have to keep your eyes on what you want. That can help keep you motivated.

    Keeping my eye on what I want has definitely helped this week.

    What helps you? What have you been doing to keep yourself on task? What do you have the hardest time with?

    Water, Water Everywhere, but I Think I’ll Have a Latte

    It is truly summer. Today it is supposed to be 115 degrees here in Phoenix! I’ve already had quite a few patients stop by the pharmacy with signs of dehydration so I think it is important to talk about how to keep ourselves hydrated correctly.

    The correct way to keep yourself hydrated is to drink water. This seems obvious right? Considering what I see people drinking in this heat… maybe not. Quite a bit of our bodies are made up of water (55-60%). It is needed to keep the chemical balances working in perfect order in our bodies. The body’s chemical balance effects your brain, your heart, your kidneys… every organ in your body including your skin! If you become dehydrated the chemicals in your body become imbalanced and your whole body can go haywire. When dehydrated you may experience weight loss (not the good kind), decreased skin turgor (your skin doesn’t bounce back, it hangs), dry mucous membranes (that feeling of being thirsty, sometimes leading to sores in your mouth), tachycardia (increased heart rate), orthostatic hypotension (that feeling of being dizzy when you stand up, sit up, or move too fast), and in the worst case scenario obtundation, stupor, coma, and seizures. Here is the problem: if you are already having these symptoms (including being thirsty) you are already dehydrated.

    Lots of things can lead to dehydration:

      1. Drugs: hydrochlorothiazide and furosemide (Lasix) are both used for high blood pressure and to take down excess water weight. Lots of people call them their “water pill.” If it makes you pee it can make you dehydrated. If a drug gives you dry mouth it doesn’t necessarily mean you’re dehydrated. I hear a lot of people talk about how benadryl makes them dehydrated. If you don’t have water coming from your body it isn’t dehydrating you. We call this dry mouth effect an “anticholinergic” reaction. It’s normal, but if you’re thirsty, drink!
      1. Exercise: If you are doing any sort of exercise it is important to drink lots of water. If you are sweating you are losing water.

      2. Caffeine: Okay I love my green tea. I do. I have a major weakness for green tea lemonades with no classic pump. I have one a day. But I don’t count them towards my water intake. Same things go for red bulls, lattes, coke, mountain dew, coffee, pick your poison. These things all contain caffeine. Caffeine is a natural diuretic. If you drink caffeine you are going to have to pee and that means you’re forcing yourself to lose water. This means you are increasing your chance for dehydration.

      3. Diarrhea and Vomiting: When you get sick, have an upset stomach, get a migraine, and have diarrhea or vomiting your body evacuates water at a rapid pace.

    So what to do? Very simple: Drink lots of water. Get a container with a straw if you have to. What does lots of water mean? I have met some people who think that two 8 oz glasses of water are enough. Here is your goal: Whatever you weigh in pounds, divide it in half and that is what you need to drink in ounces. For example: I weigh 140 lbs. That means I need to drink 70 oz or 1.2 L of water.

    Being dehydrated and feeling sick is awful. So just remember that your water bottle takes priority this season. It will keep your body working, your skin supple, and (even better) fill up your stomach.

    Drink up and good luck!

    PS: I have found sometimes when I think I’m hungry that I’m just dead thirsty. If you get hungry soon after a meal try drinking some water. You may be craving water more than you think!

    Over-The-Counter Medication Safety: the Knowledge Gap

    I love my job as a pharmacist and I have met some amazing people. Whether my patient’s have a third grade education or a doctorate they all have their own expertise and their own knowledge gaps. No one can know everything and I don’t expect my patients to be experts in pharmacology. That’s my niche. There is just one little problem: Over-the-counter (OTC) medications.

    Here is the problem with OTCs:

    There is a public misconception that OTCs are extremely safe for everyone because they don’t need a prescription and they don’t have to be signed for at the pharmacy. Advertising for OTCs is big business and they can be so incredibly confusing. The labeling required for OTC medications by the FDA is new, difficult to read, and some people don’t know it exists.

    Some pharmacies are located incredibly far away from the OTC section of their store so that patients can’t get the help they need to pick the correct medications. Some patients are not aware of the knowledge possessed by pharmacists. So let’s get down to business.

    Item 1:

    There is a public misconception that OTCs are extremely safe for everyone because they don’t need a prescription and they don’t have to be signed for at the pharmacy.

    This is a very understandable, but very dangerous assumption. Some of these drugs have been determined to be “generally” safe, but some of these medications were grandfathered in when the FDA came into existence. Acetaminophen, well known as Tylenol, is a great example of this.

    Acetaminophen is very dangerous, partially because people are not aware that there is a very tight limit to the amount of acetaminophen they take every day. In general, the limit is, at the most, 4000 mg. This seems like a lot, except when you take into account that there is at least 500mg in each Tylenol tablet and the label instructs to take 2 tablets at a time. That’s 1,000mg right there. You only have 2 more doses left according to the package insert. By the end of the day you will have taken, at the least, 3000mg . That may not be a big deal, except that you may be on hydrocodone/APAP (Vicodin) or oxycodone/APAP (Percocet) for that dental appointment or surgery you had. The APAP, by the way, stands for acetaminophen (that doesn’t make much sense does it?). Those tablets can have 325mg, 500mg, or 750mg of acetaminophen per tablet. You decide to take 2 tablets that contain 500mg each before bed to help with the pain. If you haven’t had any other of these prescription pain killers during the day you are now at mg of acetaminophen. But the pain is making it hard for you to sleep so you decide to have some Tylenol PM. The box tells you to take 2 tablets. Well that is another 1000mg of acetaminop hen. You have now taken enough acetaminophen to send you into liver failure. But what if you feel stuffed up and you also decide to take NyQuil. You take 2 capsules and now you’ve taken another 650mg. 5650mg without even trying.

    Okay that sounds scary. But here is the other scary part: You may not know you are in liver failure for another 2 days. You may feel totally normal. By then it is too late for the emergency room to administer the antidote. That means you have two option: See if your liver recovers or go in for a transplant.

    This proves that not all over the counter medications are safe, but aren’t OTC medications, taken properly, safe for everyone? No. Sudafed PE contains phenylephrine. Unless your physician says it is okay patients with heart disease, high blood pressure, thyroid disease, diabetes, or an enlarged prostate should not take these medications. This is only one example of a medication. Every medication has warnings like this at the bottom of the box.

    Your confusion as a consumer is, however, understandable. This leads to:

    Item 2:

    Advertising for OTCs is big business and they can be so incredibly confusing.

    How many drug commercials do you see a day for medications? Cold and sinus, PM, AM, Dayquil, Nyquil, 12 hour, 24 hour, Cold Multi-Symptom, Cold and Cough, etc., etc. They even confuse me! The major problem is many of these medications contain some of the same medications so you can get a lot of overlap. Ibuprofen, anti-hystamines, anti-cough, acetaminophen… you can give yourself a double dose of a medication so easily it is not even funny. The best strategy, as suggested by the FDA, is to only buy medications with one drug in them and then to combine as needed. This does three things: prevents you from over dosing, under treating, and over treating. Why are you taking Mucinex DM is you don’t have a cough? Because most people don’t have an idea for what to look for. The advertisements are confusing and the OTC isle is just plain overwhelming.

    There are some tools to help you choose the right medication.

    Item 3:

    The labeling required for OTC medications by the FDA is new, difficult to read, and some people don’t know it exists.

    The new nutrition labels and drug labels can make life a little easier, but there are some problems with them. Some people don’t know how important and informative the labels are. The labels are wordy so it is hard to figure out what you need to read. The labels are very small and difficult to read. The hardest part is that the labels use medical language that can be very difficult to understand. So let’s go over a label really quick. Tylenol and the FDA also have some great overviews: here and here.

    Here is an example of a label from the back of a Chlor-Trimeton container:

    These labels are required to be on the back of all OTC medications (not herbals) and so all the information you need is at your fingertips. So let’s take a walk through the label:

    Active ingredient (in each tablet): This is the quantity of medication per one tablet not one dose. This is where you can find how many medications are in the product, the name of the medication, and what it is used for. This can get a little confusing because antihistamine may mean something to you or it may not. Same with the word analgesic. Depending on your health literacy these words could totally throw you for a loop.

    Uses: These are the uses, in normal terms, that the medication(s) have been proven to treat. If you have these signs or symptoms this may be the right medication for you.

    Warnings: This is a very important section. This is where you may find a health problem you have where you need to talk to your physician before starting the medication. This is also where you might find possible drug interactions that you should discuss with your physician or pharmacist. Side effects are listed here. This section will tell you what you should do if you are pregnant or breastfeeding, although most labels will tell you to speak to a healthcare professional (physicians, pharmacists, physicians assistance, nurse practitioners, etc.) . All the labels will tell you to keep them out of the reach of children and if they take them to call poison control.

    Directions: This is where you will find patient ages and the quantity of medications you should take without healthcare professional guidance.

    Other Information: This area usually contains storage information. This one says not to store in your hot car or in your fridge or freezer. It also request to keep from excessive moisture. DO NOT store this medication in a bucket of water. Especially a frozen or boiling one.

    Inactive Ingredients: These are the other non-medication ingredients. If you are severely allergic to lactose then some medications may not be good for you (this doesn’t mean lactose intollerance). The same may go for people who are allergic to food coloring. If you have allergies this a good place too look.

    Items 4 and 5:

    Some pharmacies are located incredibly far away from the OTC section of their store so that patients can’t get the help they need to pick the correct medications.

    Some patients are not aware of the knowledge possessed by pharmacists.

    So here is the deal. I am not trying to tell you that your health care isn’t in your own hands, but professionals are available to help you make the best decisions. I don’t care where the OTC section is in relation to the pharmacy in your store. Please go over and bother your pharmacist. I love being bothered! It means I get to take a field trip away from my box. It’s awesome. Can you trust your pharmacist though? I mean, didn’t they just take a test or go to trade school? Oh hell no. Trust me. There are two sets of pharmacists out there. RPh and PharmDs. You can’t get your RPh degree anymore. We HAVE to get our doctorates now. But that doesn’t mean that PharmDs are better than RPhs. RPhs have a degree, had to take the same test that PharmDs do and have had to attend the same continuing education classes. The world just moved forward and required a higher degree, but there is no substitute for life experience. The big sum up: Talk to the pharmacist. Make sure it is the pharmacist. The pharmacy technician can’t tell you which medications to take. They can lose their license. So be patient and wait for the pharmacist. It’s your health though. You have time for your health right?

    I hope this blog helps and I hope you can feel confident to ask questions and talk to your pharmacist and physicians. No one is going to think you’re incompetent if you ask. Actually I think very highly of people that ask questions. No one knows it all right? If any of you have any questions in regards to this blog or have questions you would like me to blog about please feel free to comment, ask on our Facebook page, or follow us on Twitter.

    Sleep Hygiene: What it means and how it can improve your rest

    How many of us really wake up feeling rested? Life has so many demands that getting to bed on time is a second thought and the act of falling

    asleep is a battle. Get the kids up, get everyone breakfast, send everyone to work, go to work, work out, get dinner ready, clean the house, help the kids with the homework, get quality time with the significant other, answer the rest of those pesky emails, pay the water bill, oh my gosh and now I have to sleep?! And then, of course, repeat this all the next day, with some of the things you didn’t finish today added to the list. Oh, and now you’re tired because you didn’t sleep well, and thus the cycle repeats itself. It is no wonder that under eye creams and sleep medications are advertised on the television so often!

    So what can be done about all this? How, in this crazy busy world of ours, are we supposed to get good restful sleep? The doctor says, “Get 8 hours of sleep every night,” but this can seem impossible. There are actually some very simple steps that you can do, no medications involved, that can help you get to sleep and sleep well!

    Don’t look at me like I’m crazy folks, I’m serious. I have tried all these things myself and while not all of these things together have helped, but I was able to fit many of these lifestyle modifications into my busy schedule with significant impact.

    What we are talking about is improving your “sleep hygiene” with “cognitive behavioral therapy.” Oh yes. We are getting fancy. Sleep hygiene is kind of how it sounds. It is a healthy maintenance of your sleep. Cognitive behavioral therapy is a very wide category where the patient consciously changes their behavior in order to help improve their health state. It sounds very complicated, but it’s actually very simple and CBT (cognitive behavioral therapy) has been found to be at least as effective than medications, more sustainable, and can be much cheaper!

    Set a bedtime for yourself. Our parents did it when we were kids because someone told them that “kids crave structure.” Well so do adults. Make a schedule for yourself in the day, but be realistic, but make sure not to forget to schedule that bedtime! This will help you to get that much needed 8 hours you need a day. Sleep is just as important as your work out, your dinner, and that morning meeting.

    Do not take naps during the day. If you’ve got little ones or did not get enough sleep the night before it may be tempting to curl up and take a nap, but resist the urge! Your body and brain have their own natural rhythm and taking a nap throws that rhythm off. You will have a harder time getting to sleep that night and may not sleep well during the night. Watch the alcohol. We’ve all heard that a glass of red wine at night is good for your heart, but there are some things you should be aware of: 1 serving of wine is 5 fl. oz or 150 mL. Most people pour themselves two servings thinking that it is one serving so don’t be afraid to measure. The other thing to take into account is that that night cap may make you feel sleepy, but alcohol (whether it’s wine or beer or vodka) has a stimulating effect on the brain so you may be crashing in the beginning, but be prepared to bounce of the walls later!

    Midnight snack anyone? Resist the urge! Eating just before bed can stimulate your brain. You are just throwing off your poor brain’s groove. It’s also not very good for you if you are trying to lose weight.

    Exercising during the day can really help you with your sleep routine, but be careful about what sorts of exercise you do around bedtime. Exercise like jogging may energize you and not allow you to sleep, but exercises like yoga can help promote sleep because stretching can be very relaxing.

    Keep the bed for bed (and other “intimate” activities). If you are a person that get’s riled up fairly easy don’t watch TV in bed or read in bed. If you are a student don’t study in bed. The bed is a place to relax.

    Once you have set a bedtime for yourself set up an evening sleep prep routine. DO NOT watch the news before you go to bed. Don’t do it in your living room and for pete’s sake do NOT do it in your bed. It will wind you up, stress you out, and you will not be able to sleep. Do something relaxing. Take a hot bath, read a book in a chair (not in the bed), listen to music, and if you have kids, read THEM to sleep.

    Keep the bedroom relaxing. Too much noise, light, and bright colors could really disturb your sleep. Also, lower the blinds or draw the curtains before bed, that way if any light tries to peak in your window to throw you off, you’ve blocked it.

    Avoid caffeine and nicotine around bedtime. Both these things are energizers. If you are trying to quit smoking and you find the nicotine patch will not let you sleep, remove it before you go to bed. It may help you avoid those strange nicotine dreams as well.

    White noise can be helpful for some people so if you are one of those people that has issues with dead silence, put some white noise like water running, thunderstorms, or ocean waves.

    If these things don’t work you should speak to your physician, but there are some herbal remedies that you can try, as long as your doctor is aware.

    Chamomile and/or Lavender tea: This is a very safe alternative that can work in both adults and children. Chamomile is a natural sedative and lavender is known for its calming effects. A warm cup of tea before bed is also a great way to wind down. The teas are available separately or in combination together. You can find chamomile at pretty much any grocery store, but I found the combination tea at a health food store like Whole Foods. Just remember, use common sense. If you are allergic to either of these flowers, don’t drink the tea. Also if you have hay fever, you and chamomile may want to stay away from each other, but give that lavender a try!

    Melatonin: This is a medication that can be very safe, especially in patients with insomnia from jet lag or if you are a night shift worker. If you want to use it in a child I would advise speaking to their doctor. You might feel a little drowsy or dizzy when you take this drug so just be aware. Also you may also have some really vivid dreams, so just be aware. Also be aware that melatonin can interact with anticoagulants like Plavix and Warfarin. It may increase insulin resistance in patients taking anti-diabetic medications. Melatonin can interfere with immunosuppressants like corticosteroids or injectables. Also understand that if a medication like birth control already makes you drowsy that the chances for dizziness and daytime drowsiness could be made much worse. 5-HTP: This is also not as 5-Hydroxytryptophan. This is the chemical that tryptophan turns into when you eat that turkey during Thanksgiving. It makes you sleepy. There are some controversies with this herb, but adverse effects are rare and the most common side effect may be some basic stomach upset. The biggest thing with this supplement is that you should NOT take it with antidepressants and tramadol. This supplement could cause a dangerous problem called serotonin syndrome.

    Magnesium: This is a common mineral that can help relax your muscles and, therefore, help you sleep. You can find magnesium in almost every multivitamin so before you start taking this it’s best to be aware if you are already taking a supplement with magnesium in it. Magnesium can also give you an upset stomach, especially if you are taking too much. Be aware that if you already take a muscle relaxant that magnesium and make your muscles even more relaxed. Also be careful if you are on certain diuretics you can end up with more magnesium than you want in your body. Be careful if you are on antibiotics as well because you won’t absorb enough of your antibiotics. If you are on a calcium channel blocker (a medicine for your heart and sometimes high blood pressure) do not take magnesium unless it is okayed by your cardiologist. If you are on vitamin D alone (without calcium) or boron, let your physician or pharmacist know and we willhelp you figure out if the combination is safe.

    Just remember kids more is not always better. More can equal stumbling around into walls and falling. EVERYTHING in moderation. If you still can’t sleep you really need to speak to your physician just in case something else is wrong. If you are pregnant or have a child who has trouble sleeping it is very important to speak to your physician before you try treating with any herbs or medications.

    I know some of these things can be confusing and you wonder where you can get high quality herbs and supplements. The correct answer is call your pharmacy or you can always call us at Mixtures. We can search for drug interactions for you and your physician and counsel you on the best way to take these supplements and once we find the perfect one for you we can also ship something from our high quality stock of natural supplements that we sell over the counter in our pharmacy. The number one rule is to not be afraid to ask questions!

    Also check out the National Sleep Foundation for both patients and Health Care Professionals!

    Herbs: The Good, the Bad, and the Complicated

    Most of us grew up on our mother’s and grandmother’s home remedies. In our home we always had an ample supply of chamomile, peppermint, lavender, and aloe vera. I fell in love with herbal remedies because my Mom was quite the gardener and tea lover and her remedies worked! Herbal remedies have really come into their own and are even provided to our patients in local pharmacies, like Mixtures. We are a compounding, regular, and naturopathic pharmacy. We provide quality herbal remedies to our patients, but most importantly we make sure the herbal blends our patients use are safe with their other medication. Being a one stop shop may seem like a great marketing gig, but, truly, it is the safest and most effective way for us to care for our patients.

    So why is it so important that we are involved in our patient’s use of herbal medications? Herbal medications are NATURAL. Natural = safe right? Wrong. Medicine men and women were the original pharmacists. They knew that each herb and supplement had its own potency, benefits, and dangers. Let’s not forget that cyanide is also totally natural folks. Herbs, just like food, shoes, cars, and pretty much anything else in life should be invested in with a little guidance, moderation, and intelligence. Herbals and supplements are available over the counter and often far away from the pharmacy, thus giving the consumer a false sense of security. You will not find your medicine woman in the supplement aisle, but you can always find your pharmacist very close by!

    Here are some things to keep in mind when you come to your pharmacy in search of an herbal or supplement:

    • Bring a list of all medications, including over the counter medications, that you have had in the past month.
    • Bring a list of the herbals (including teas) that you have used in the past month.
    • Bring a list of your current health conditions (no matter how embarrassing you think they are we are professionals and we have seen it all… trust me)
    • Bring a list of drug and food allergies if you have them.
    With all this information we should be able to help you make the right choice for the herb you are curious about.

    Also remember that not all herbs and supplements are created equal. They are not at all regulated by the FDA. Some brands of herbs have contained ingredients that are not on the label. Some other herb preparations don’t even contain the correct parts of the plant. With chamomile, for example, the important part of the plant for it’s properties are the flowers. Some manufacturers, however, will primarily contain the stem and root of the plant. This is of no use to us as practitioners or to our patients as consumers.

    So please, whether you can come to our pharmacy at Mixtures, or stop by your local pharmacy or grocery store, bring the 4 bits of information about and an idea of an herb or issue you would like to treat and we will help you to the best of our ability to make the best decision for you.

    Vitamin D – Why do I need it?

    Vitamin D has been overlooked as an aid to health. There are so many areas of health Vitamin D can contribute.

    Mental health: Have you ever wondered why Thanksgiving and Christmas can be difficult for some? It may have something to do with the Vitamin D levels. In the areas of the country where we soak up the sun during the “nice” months we create a storage of Vitamin D. When we stop spending as much time outside because of school, weather, etc. we utilize these stores until there aren’t any stores remaining. This depletion happens typically around the holidays. The holiday blues may not be caused by the excess exposure to family, but possibly to low Vitamin D levels.

    Bones: Vitamin D plays a very important role in the creation and maintenance of bone. It is vital to the uptake of calcium. It also maintains levels of calcium and phosphate concentrations in the serum so the body can build and maintain bones.

    Cancer: Vitamin D promotes cell differentiation throughout the body and is a key factor in maintaining hormonal balance and a healthy immune system. There are clear links to Vitamin D deficiency and certain types of cancer; particularly breast cancer, prostate cancer and colorectal cancers.

    Diabetes: In a study published in 2004, the authors saw a 60% improvement in insulin sensitivity in health, vitamin D deficient adults. They concluded Vitamin D was more potent than 2 prescription medications commonly used to treat type 2 diabetes.

    Vitamin D requirements: The USRDA has recommended 200IU/day for adults 19-50 years, 400IU/day for those 51-70, and 600IU/day for people over 70 years. Experts now agree that these values are too low!

    Studies have shown that adults need 3000-5000IU/day and others indicate heathy adults can easily metabolize 10,000IU/day without harmful side effects. The European Union’s Scientific Committee on Food has recommended 2000IU/day as does our US Food and Nutrition Board. Testing and monitoring are strongly suggested. The average healthy body can synthesize about 10,000 to 15,000IU of Vitamin D3 in the skin within just minutes of sun exposure – without any ill effect.

    Symptoms of Vitamin D deficiency: may be characterized as muscle pain, weak bones/fractures, low energy and fatigue, lowered immunity, symptoms of depression and mood swings, and sleep irregularities. If you have renal problems or intestinal issues (like IBS or Crohn’s disease), you may be Vitamin D deficient because of issues absorbing and converting the Vitamin D.

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