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.
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.
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.
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.
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.
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.
Haas, H. S. (2008). Histamine in the Nervous System. Physiol Rev, 1183-1241.
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.
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:
And please read this recent article on the newest attack against compounding pharmacies,
which could put thousands of small pharmacies out of business:
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?
Definitely get magnesium containing foods in your diet.
You can absolutely consider a piece of dark chocolate a daily magnesium vitamin
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.
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!
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.
Certain foods may contribute to a yeast infection by
promoting the growth of Candida by increasing amount of sugar in your bloodstream
suppressing your body’s immune system, or
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!
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:
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.
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.
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.
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!
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:
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.
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!
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.
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.
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.