breaking the sugar cycle -doughnuts wellrx blog image

By Karen Eisenbraun, CHNC

Giving up sugar is challenging but definitely worth the effort. The American Heart Association recommends limiting added sugars to no more than six teaspoons a day for women, and nine teaspoons for men. However, by some estimates, the average American consumes as much as 17 teaspoons of sugar per day. That’s the equivalent of 57 pounds of added sugar per year. 

All that sugar may taste great, but it wreaks havoc on your health. Eating too much sugar is associated with insulin resistance, weight gain, high blood pressure, fatty liver disease, accelerated aging, a weakened immune system, erectile dysfunction, depression, joint pain, kidney damage, and an increased risk of heart disease and diabetes. 

You might not even be aware of how much sugar you’re eating. Soft drinks, candy, and baked goods are obvious sources of sugar, but added sugar also lurks in dairy products, salad dressing, tomato sauce, and protein bars. 

Continue reading to learn about the benefits of quitting sugar and how to do it. 

Younger-Looking Skin

Sugar in the bloodstream attaches to amino acids found in collagen and elastin, fibers that support skin structure. This process, known as glycation, results in the formation of advanced glycation end products, which cause skin fibers to become stiff and weak. In turn, this leads to wrinkles and sagging skin. Research suggests that cutting your sugar intake can reduce these visible signs of aging. 

Increased Energy

Sugar and other simple carbohydrates—like white bread and white rice—­enter the bloodstream quickly and provide a quick burst of energy. You’ve probably experienced this, along with the energy crash that comes soon after. Foods that are high in protein and healthy fat, on the other hand, are digested more slowly and provide a steadier source of energy. Rather than reaching for some candy for a midafternoon boost, choose a healthier snack, such as a handful of almonds. 

Weight Loss

We tend to think of fat as the culprit behind weight gain, but it’s actually sugar. Sugar and carbs are converted into glucose, which is used for energy. Excess glucose is stored in the liver as glycogen, or distributed to other parts of the body and stored as fat. When you stop eating sugar, these excess fat stores will naturally be depleted, making weight loss easier. 

Reduced Inflammation

Sugar contributes to chronic inflammation, which is linked to numerous health conditions, including heart disease, cancer, diabetes, arthritis, and digestive disorders. To reduce chronic inflammation even further, swap out sugary foods for naturally anti-inflammatory foods like fresh berries, leafy greens, tomatoes, and green tea. 

How to Stop Eating Sugar

Make One Change at a Time

If quitting sugar cold turkey sounds overwhelming and impossible, start by making one change, like giving up soda or candy bars. That alone is a huge accomplishment for many people! Once you’ve mastered one habit, add another. Changing your diet slowly will also help reduce the unpleasant symptoms of sugar withdrawal, which can include headaches, muscle aches, and difficulty sleeping. 

Read Labels

Even seemingly healthy foods, like yogurt and tomato sauce, can be packed with added sugar. Get into the habit of reading ingredients—never assume that a food is low in sugar just because it looks healthy. 

Avoid foods with added ingredients such as sucrose, glucose, maltose, fructose, high-fructose corn syrup, corn syrup solids, cane sugar, cane juice, or any of the other names for sugar

Choose Low-Glycemic Alternatives

Foods like white bread and whole-wheat pasta fall high on the glycemic index, which measures the impact of foods on blood sugar. Choose alternatives such as zucchini noodles or spaghetti squash. 

Other food substitution suggestions:

  1. Order a lettuce wrap or a salad for lunch instead of a sandwich. 
  2. Instead of flavored yogurt, buy plain Greek yogurt and add fresh berries. 
  3. Choose nonstarchy vegetables. Corn, peas, and carrots are all high on the glycemic index. Opt for leafy greens, such as spinach and kale, or cruciferous vegetables, such as broccoli and cauliflower. 

Look For Low-Carb Foods

Low-carb options are everywhere these days, even for foods like bread and ice cream. These foods are often made with sugar alcohols, which do not impact blood sugar the way sugar does. But use caution: sugar alcohols can cause gastrointestinal problems for some people. 

Choose Full-Fat Foods

This may be counter to all the diet advice you’ve read in the past, but many fat-free or reduced-fat foods are laden with added sugar. Plus, your body needs some fat to absorb certain vitamins and for organs to function optimally. Again, read labels—and get out of the habit of reaching for the low-fat foods. 

Don’t Stress Out

It may feel depressing to think that you can never eat some of your favorite treats again, but don’t worry. You can still have a donut or a piece of cake from time to time if you really want. Chances are, however, those cravings will go away. As you become accustomed to eating less sugar, your body will no longer crave it. Just give yourself time. You’ll eventually likely find that you feel completely satisfied with a piece of dark chocolate and some fresh berries. 

Karen Eisenbraun is a Certified Holistic Nutrition Consultant. She holds an English degree from Knox College and has written extensively about topics related to holistic health, clinical nutrition, and weight management.

References:

https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars

https://pubmed.ncbi.nlm.nih.gov/20620757/

https://www.health.harvard.edu/staying-healthy/understanding-acute-and-chronic-inflammation

https://www.virtahealth.com/blog/names-for-sugar

https://www.health.harvard.edu/diseases-and-conditions/glycemic-index-and-glycemic-load-for-100-foods

keto vs paleo - wellrx blog image

By Karen Eisenbraun, CHNC

Curious about adopting a paleo or keto diet? Proponents of these popular diets claim they offer numerous health benefits, including weight loss, increased energy levels, and a lower risk of disease. 

While they may look similar, the paleo diet and the keto diet are different in nature. With each diet, however, you can adapt the exact foods you eat to suit your individuals needs and preferences. 

Continue reading to learn more about these popular diets. 

What Is the Paleo Diet?

The paleo diet is intended to mimic the dietary habits of our Paleolithic ancestors, who lived thousands of years ago. It generally consists of whole, unprocessed foods such as fresh fruits and vegetables, nuts, seeds, eggs, and meat. Processed foods should be avoided, including grains, sugar, most dairy products, and legumes. 

The paleo diet also places a strong emphasis on food quality and recommends eating organic produce, wild-caught game, and grass-fed meat. The idea behind this way of eating is that our hunter-gatherer ancestors likely had lower rates of degenerative diseases such as heart disease, obesity, and cancer. These “diseases of civilization” are often seen in higher rates in areas where people follow the typical Western diet, which is characterized by refined grains, processed meats, dairy products, sugar, and other high-glycemic foods. 

What Can You Eat on the Paleo Diet?

The paleo diet is not an exact list of foods, but rather a set of general guidelines to govern how you eat. As long as you are choosing whole, unprocessed foods, you can adapt the diet to your personal preferences. 

As a general rule, avoid anything that looks like it was made in a factory. If it’s something that would have been available thousands of years ago, it’s fair game. 

What Is the Keto Diet?

The keto diet is different from the paleo diet, although sometimes they may look similar. 

The keto diet, which is short for ketogenic diet, is intended to change the way the body uses energy. The main characteristic of the keto diet is that it is very low in carbs and high in fat. Keeping carbohydrates extremely low causes the body to use up its fat stores and begin using fat for energy rather than glucose. When this happens, the liver produces molecules called ketones, which the body uses for fuel. This is known as being in a state of ketosis. 

The keto diet is much more restrictive than the paleo diet. To keep carbohydrates within the desired range — typically 5 percent of total calories — certain foods must be avoided, including most fruit. 

The keto diet also requires an adjustment period during which the body adjusts to using fat as its primary source of energy. This period typically consists of a very low carbohydrate intake of roughly 20 grams per day and may last three or four weeks. 

Because the keto diet trains the body to use fat for fuel, it is often used for weight loss. However, keto advocates maintain that it can lead to other benefits such as increased energy and mental clarity, better sleep, clearer skin, better blood sugar control, and improved hormone levels and cholesterol levels. 

What Can You Eat on the Keto Diet?

A common misconception about the keto diet is that it is nothing but meat and eggs. In reality, the keto diet consists of roughly 75% fat and 20% protein. That means that plant-based fats should also be included, such as nuts, seeds, olives and olive oil, coconut, and avocados. 

Different approaches to the keto diet exist. Some people adhere to a whole foods keto diet, which may look very similar to a paleo diet minus high-carb foods such as fruit and potatoes. 

Other people follow a “lazy keto” approach, which allows some processed foods and ingredients such as artificial sweeteners, as long as they don’t exceed the allotted carbohydrate intake. 

Some people choose to include cheese and other dairy products such as heavy cream, while others avoid dairy products due to their inflammatory properties. 

A keto diet can also include lots of non-starchy vegetables. The body doesn’t absorb fiber, so the fiber in foods such as spinach, broccoli, asparagus, Brussels sprouts, zucchini, and other vegetables can be deducted from the total carb intake. The result is a figure known as net carbs. For example, one cup of spinach contains only 0.4 net carbs, making it an absolutely keto-friendly food. 

Making Better Food Choices

Adopting one of these diets may require a big adjustment to the way you shop for food. Both paleo and keto diets discourage consuming processed foods, which will mean buying most of your food from the outer aisles of the grocery store: meat, eggs, and produce. 

Both diets may also involve venturing into the center aisles for select foods such as coconut oil, olives, and nuts. Most foods in the center aisles, however, are processed and will be off-limits, although increasingly health food brands are offering foods that are paleo- or keto-friendly. If you do buy packaged foods, make sure to read the ingredients. Even foods that claim to be suitable for paleo or keto diets may contain ingredients such as sugar, artificial sweeteners, or other additives. 

This may be confusing at first, but you will eventually find staples you rely on and brands you can trust. Our Grocery Guidance app can help you find alternatives to the foods you buy most often and determine which foods on the shelf are truly good for you. Simply scan the barcode on your food package to reveal its WellRx Health Index and discover “better for you” alternatives. You can also create a list of your favorite grocery items and find foods that support your nutrition goals. Download it on the App Store or Google Play today.

Karen Eisenbraun is a Certified Holistic Nutrition Consultant. She holds an English degree from Knox College and has written extensively about topics related to holistic health, clinical nutrition, and weight management.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362881/

https://pubmed.ncbi.nlm.nih.gov/15148063/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4271636/

sdoh - wellrx blog image

By Jonathan Bosold, PharmD
SinfoniaRx

Every day, people are affected by issues like food insecurity, housing concerns, transportation to and from the doctor and pharmacy, financial strain and more. These types of issues make up what is called “Social Determinants of Health” (SDOH), which are the conditions where people live, learn, work, and play.

How Social Determinants Affect Health

Believe it or not, SDOH have been shown to account for more “unhealthy days” than diagnosed health conditions. For instance, within a given 30 day period, loneliness and food insecurity account for approximately 24 and 26 unhealthy days respectively, whereas health conditions like diabetes and depression account for approximately 15 and 22 unhealthy days respectively. 

Despite this, there is a healthcare gap in managing SDOH. Healthcare providers are trained to identify and treat conditions like high blood pressure, not food insecurity or homelessness. It can also be uncomfortable for both patients and healthcare providers alike to address these issues.

Often times, SDOH are not isolated – meaning people frequently experience more than one of these problems at the same time.

Social Determinants of Health and Medication Adherence

SDOH have a big impact on medication adherence (taking medications as prescribed by a doctor). In a scenario where someone cannot afford basic necessities, medication adherence is on the bottom of the priority list. Ensuring we can feed ourselves ranks higher than taking medications correctly.

If cost is preventing you from taking your medications, know that there are ways to save, even if you don’t have insurance. ScriptSave WellRx offers a prescription discount card at no cost. There are no eligibility requirements. Just download the card or mobile Rx app, and then show it at the pharmacy to save money.

Related: Getting Medication Discounts without Insurance

Addressing SDOH in a Healthcare Setting

Now more than ever, healthcare providers and insurance companies are recognizing the importance of SDOH. They are treating these issues as a healthcare gap, similar to if someone had unmanaged heart failure. One example of this is highlighted by Ohio State University’s Family Medicine practice. Primary care providers at the practice are teaming up with a local foodbank to provide food-insecure patients with greater access to fresh produce. 

Care may also be provided for other SDOH like transportation, housing, and loneliness. In the long run, addressing SDOH may even lower your total treatment costs. Imagine having uncontrolled diabetes and being prescribed well-balanced meals or access to healthy foods at a food pantry. The cost of those meals is quickly offset by the decrease in medication cost, decreased doctor visits, and reduced emergency room visits where care is most costly. 

How to Address SDOH in Your Own Healthcare

If you’re surrounded by negative social determinants, these factors are likely affecting your overall mental and physical health. What can be done to address that? 

First, have a discussion with your doctor about these issues. There are now medical codes where doctors can document SDOH within your patient profile, allowing you to get help from your insurance company. 

Next, you can talk to your insurance provider or Medicare/Medicaid plan to see how you can receive assistance. While many patients within the healthcare system qualify for services, many do not use them. Taking advantage of community or insurance-based programs will contribute to your health in a positive way while potentially saving your insurance plan money. 

Lastly, talk to your doctor or pharmacist about strategies to save on treatment. Medication non-adherence can damage your health and make chronic conditions worse. Be honest with your healthcare providers about your financial situation and don’t be afraid to ask how you can bring medication costs down.




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By Rosanna Sutherby, PharmD

The cold and flu season is in full swing, and hacking, persistent, and annoying coughs are at their peak. If you are suffering from these symptoms, your doctor may prescribe a cough medication, such as benzonatate (Tessalon Perles). Before heading to a pharmacy near you to pick up your medication, here some facts you should know about benzonatate.

What Is Benzonatate?

Benzonatate is a nonopioid (nonnarcotic) antitussive (cough suppressant) that is used to relieve cough if you have a cold or the flu, or if you have a chronic cough that does not respond to opioid cough suppressants. It is not used for chronic cough related to smoking, asthma, or emphysema, or when your cough produces large amounts of phlegm or mucus.

Looking for the best price on benzonatate?

How Does Benzonatate Help with Cough?

Benzonatate is related to a type of drug called ester local anesthetics. It works locally by numbing the stretch receptors in your lungs, throat, and airways. When you breathe, you stimulate these stretch receptors, which causes you to cough. By numbing the stretch receptors, benzonatate inhibits their action and reduces your cough reflex. It begins to work within 15 to 20 minutes of taking the medication and generally lasts for 3 to 8 hours.

What Is the Best Way to Take Benzonatate?

If your healthcare provider prescribes benzonatate, you should follow the instructions on your medicine label. Prescribers may dose this medication differently for different people.

Typically, patients take 100 mg to 200 mg of benzonatate up to three times per day, or every 8 hours. The maximum dose of benzonatate is 600 mg per day. If you take benzonatate capsules, you should swallow them whole. The capsules should not be opened, chewed, broken, dissolved, cut, or crushed. The liquid inside benzonatate capsules can temporarily numb your mouth and throat, suppress your gag reflex, and place you at risk of choking. If you accidentally chew or break a capsule in your mouth, do not eat or drink until the numbing effects have worn off.

Who Can Take Benzonatate?

Benzonatate is indicated for adults and children 10 years and older. It is vital to keep benzonatate capsules in childproof containers and away from children. The Food and Drug Administration (FDA) warns that benzonatate can cause death in children under 10 years of age who accidentally take the medication. In fact, children younger than 2 years of age have overdosed with as few as one or two capsules.

If your child accidentally takes this medication, call the poison control center (1-800-222-1222) and immediately get emergency care.

You should not use benzonatate if:

  • You are allergic to ester local anesthetics, such as benzocaine, procaine, or tetracaine. Lidocaine is not an ester anesthetic.
  • You are allergic to para-aminobenzoic acid (PABA).
  • You have difficulty swallowing.

Can I Take Benzonatate If I Am Pregnant or Nursing?

If you are pregnant, you should talk with your obstetrician-gynecologist (ob-gyn) before taking any medication.

Benzonatate is pregnancy category C, meaning that it should be used if the potential benefits of the medication outweigh the potential risks. A conversation with your ob-gyn will help you decide if benzonatate is safe for you and your baby.

According to the manufacturer, it is not known if benzonatate passes to breast milk. Given the lack of information, you may prefer to use an alternative cough medication if you are nursing.

What Are the Side Effects of Benzonatate?

All medications have side effects, but not everyone experiences them the same way. If you are taking benzonatate, you should be aware of the following potential side effects:

  • Allergic reactions
  • Headache
  • Drowsiness
  • Dizziness
  • Mental confusion
  • Visual hallucinations
  • Constipation
  • Nausea (upset stomach)
  • Itching or rash
  • Chills
  • Nasal congestion
  • Numbing of the chest
  • Hypotension (low blood pressure)
  • Eye irritation

If any of these side effects are severe or bothersome, let your healthcare provider know right away.

How Much Does Benzonatate Cost?

The cost of benzonatate varies depending on where you live, where you shop, and your insurance coverage. The average retail price for thirty 100 mg benzonatate capsules is about $20. If your insurance does not cover cough medications, you can use a free Rx savings card to get the lowest prescription price.

How Do Prescription Discount Cards Work?

Prescription drug cards, or prescription savings cards, help you obtain the lowest prescription price for your medication. Sometimes, you may find that your insurance plan does not cover your medication or that the price with insurance is higher than the cost with a prescription savings card. Using prescription savings cards may save you up to 80% or more off the retail price. Be sure to compare prescription prices before filling your prescription. You can use ScriptSave WellRx discount card for the best discount at a pharmacy near you.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/011210s053lbl.pdf

https://www.mayoclinic.org/drugs-supplements/benzonatate-oral-route/description/drg-20062223

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415124/

https://www.mayoclinic.org/drugs-supplements/benzonatate-oral-route/proper-use/drg-20062223

https://www.pdr.net/fda-drug-safety-communication/tessalon?druglabelid=1327&id=8411https://www.pdr.net/drug-summary/Benzonatate-benzonatate-3512.5759#11



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dangers of some drugs in older adults - scriptsave wellrx blog image

by Gabriel K. Rallison, PharmD Candidate Class of 2020,
University of Arizona College of Pharmacy

As we age, many of us may struggle to do things that were once so easy. With age, the way your body handles medication can change, too. Side effects may become more noticeable and last longer than they used to.

Potentially Inappropriate Medications for Older Adults

Due to these changes, the American Geriatrics Society published a list of medications that are potentially inappropriate for use by persons over 65 years old, commonly called the Beers Criteria.1

There are several common over-the-counter (OTC) medications on this list that should be avoided.

Antihistamines

The first OTC drug to avoid is diphenhydramine (Benadryl). Diphenhydramine is an antihistamine drug commonly used to treat cold and allergy symptoms and as a sleep aid. However, in older adults, diphenhydramine can cause very unpleasant and sometimes dangerous side effects. Side effects include confusion, dry mouth, difficulty urinating, constipation, and blurred vision.2 Diphenhydramine will often be found alone in products, or in combination with other medications. When buying cold or allergy medicine, make sure to check the active ingredient list to make sure it doesn’t contain diphenhydramine.

A sister drug to diphenhydramine, chlorpheniramine (ChlorTabs), can cause many of the same side effects in older adults and should likewise be avoided.3 As alternatives for treating cold and allergy symptoms, look for products that contain loratadine (Claritin), fexofenadine (Allegra), or cetirizine (Zyrtec).2 These are newer medications of the same type as diphenhydramine, but without the side effects that make diphenhydramine dangerous.

Aside from treating allergy symptoms, drugs from this class are also used to treat motion sickness. These drugs, including dimenhydrinate (Dramamine) and meclizine (Antivert), cause many of the same side effects are diphenhydramine and chlorpheniramine, and should likewise be avoided.1

Non-drug options for prevention of motion sickness should be used instead. To prevent motion sickness, current advice is to keep your eyes closed or looking at the horizon, while avoiding close-up visual tasks like reading when moving.4                      

NSAIDs

NSAIDs, or non-steroidal anti-inflammatory drugs, are a class of medications including ibuprofen (Advil, Motrin) and naproxen (Aleve).2 These drugs are generally used to treat mild to moderate pain, but also have side effects that become more noticeable and dangerous in older adults. NSAIDs can cause stomach ulcers, stomach bleeding, increased blood pressure, kidney damage, and can even make heart failure worse.3 Additionally, these medications can interact with blood thinner medications such as warfarin and increase your risk of bleeding.

While occasional use may not present as great a risk, regular use of either ibuprofen or naproxen should be avoided unless closely followed by your doctor. As an alternative to NSAIDs, you can use acetaminophen (Tylenol). When using acetaminophen, it is important to limit your dose to 1,000 mg or less per dose, and less than 3,000 mg per day to avoid causing liver damage. If you regularly drink alcohol, you should use even less acetaminophen.

Are There Other Medications Older Adults Should Avoid?

The medications mentioned are by no means an exhaustive list, and there may be other medications, OTC or prescription, that should be stopped or adjusted for use in older adults. You should never stop taking a prescription medication without first talking to the doctor who prescribed it, even if it is on the Beers Criteria.

Any questions you have concerning any prescription medication you may be taking should be directed to your doctor or pharmacist. Your pharmacist can recommend OTC medications to help treat what ails you while minimizing undesirable side effects. While we all get older, you can rely on the direction and training of health professionals around you to make the trip as comfortable as possible, helping to minimize the bumps along the way.

References

  1. For Older People, Medications Are Common; Updated AGS Beers Criteria® Aims to Make Sure They’re Appropriate, Too. (n.d.). Retrieved October 10, 2019, from https://www.americangeriatrics.org/media-center/news/older-people-medications-are-common-updated-ags-beers-criteriar-aims-make-sure.
  2. Eng, M. (2008, June 19). Potentially Inappropriate OTC Medications in Older Adults. Retrieved October 11, 2019, from https://www.uspharmacist.com/article/potentially-inappropriate-otc-medications-in-older-adults.
  3. Ten Medications Older Adults Should Avoid or Use with Caution. (n.d.). Retrieved October 11, 2019, from https://www.healthinaging.org/tools-and-tips/ten-medications-older-adults-should-avoid-or-use-caution.
  4. Brainard, A., & Gresham, C. (2014, July 1). Prevention and Treatment of Motion Sickness. Retrieved October 24, 2019, from https://www.aafp.org/afp/2014/0701/p41.html.


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patient doctor communication image - scriptsave wellrx blog

by Gabriel Rallison, PharmD. Candidate, Class of 2020
University of Arizona

Have you ever left your doctor’s office feeling more confused than when you arrived? Maybe even felt like your doctor didn’t understand your concerns? You’re not alone. When over 300 patients were interviewed after being released from the emergency room, only 6 in 10 patients were able to correctly describe their doctor’s directions.1

Good healthcare begins with good communication. If the doctor doesn’t understand your concerns and you don’t understand the doctor’s directions, you may not be getting the best care possible.

There’s a growing awareness in the medical community regarding the need for effective doctor-patient communication. We have several simple recommendations to help you in that process.

Eight Things to Consider on Your Next Doctor Visit:

  1. Write down your concern(s). When thinking about your health concerns, write down when it started, what you think may have caused it, how often it happens, what it feels like, things that make it better, things that make it worse, in as much details as possible.

    Having written notes will help you organize your thoughts during the short time you have with the doctor. Additionally, they will help you better answer the questions your doctor will have. The more information you can give them, the better they will be able to help you.
  2. Consider bringing someone who can support you. A friend or family member can help catch things that might otherwise be missed, ask questions you may have not thought of, and help keep track of the information and instructions shared by the doctor.
  3. Be honest and straightforward about any concerns you have. Your doctor is required to protect your privacy and will only share your information with other healthcare professionals as required for your care. Even if it may be embarrassing, or you feel it may be irrelevant, it is important to share everything. Your doctor should be nonjudgmental and understanding. When you share openly, it will help the doctor see the full picture and catch things that may otherwise be missed.
  4. Don’t be afraid to ask questions! Doctors can sometimes use terms that are overly complex and hard to understand. It’s perfectly okay to ask for clarification in simpler terms or ask them to explain it again. Then, once you think you understand, repeat the information back to your doctor in your own words. This technique, called teach-back, can help you to internalize information and let the doctor know if anything was missed.
  5. Create and maintain a medication list. It can be frustrating for everyone (healthcare team and patients alike) when in response to the question “What do you take?” the answer is, “the little round white pill.” Hospitals can, and do, call pharmacies to find out what patients are taking, but having a list up front can save time and prevent potentially harmful prescribing.

    In not knowing what you are taking, your doctor may mistakenly prescribe medication that could interact with what you are already taking. This could lead to your medications being less effective or additional side effects, so it’s important to create and maintain an up-to-date medication list.

    When making your medication list be sure to include, at a minimum:
    – medication name
    – strength, dose, and frequency of dose
    – reason for taking, and any special instructions that medication may have.

    For example:
    – levothyroxine (name)
    – 125 mcg (strength)
    – One tablet (dose) every morning before breakfast (frequency)
    – For low thyroid hormone (reason for taking), take levothyroxine by itself ½ hour before any other food, medicine or drinks (special instructions).

    When making your list, make sure to include any medicated creams, patches, inhalers, implants, suppositories, or any other less conventional forms of medications, like medical marijuana (MMJ).

    Make sure to include any over the counter medications and supplements you take as well, as many of these may interact with other medications you are taking. 
  6. Consider any language barriers. There can often be language barriers between a doctor and their patient. This can lead to problems in receiving quality medical care.

    In the United States, you have a legal right to oral interpretation and written translation of any medical communication into your preferred language. This may take the form of written instructions or drug labels in your language or having an interpreter in the room or on the phone when you are with your doctor. These resources can help break the language barrier that could otherwise make it hard to get care.
  7. Include other members of your healthcare team. Questions about a medication? Talk with your pharmacist, especially when starting a new medication! Your pharmacist can advise you about side effects to watch out for, possible issues with other medications or supplements you may be taking and give you additional advice about how to improve your medication regimen.
  8. Work together with your doctor for the best outcome. If you have concerns with the treatment plan, ask about them! Work actively with your doctor to decide the plan that will work best for you.

Good medicine is not one size fits all, and as you voice your concerns and strive for better communication, you and your doctor can work as a team to make sure you get the best care possible.

References

  1. Crane, J. A., Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997 Jan-Feb;15(1):1-7. https://doi.org/10.1016/S0736-4679(96)00261-2 Accessed Sep 24 2019.
  2. Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner journal, 10(1), 38–43. Accessed Sep 24 2019.
  3. Clancy, C. M. How to Talk to — and Understand — Your Doctor. American Association of Retired Persons. https://www.aarp.org/health/doctors-hospitals/info-09-2010/finding_your_way_how_to_talk_to_8212_and_understand_8212_your_doctor.html Accessed Sep. 25 2019.
  4. Howley, E. How to Make Sure Your Doctor Understands Your Medical Condition. U.S. News. Jan. 16 2018. https://health.usnews.com/health-care/patient-advice/articles/2018-01-16/how-to-make-sure-your-doctor-understands-your-medical-condition Accessed Oct 1 2019.
  5. Don’t Be Shy: 4 Tips for Talking to Your Doctor. Johns Hopkins Medicine. N.d. https://www.hopkinsmedicine.org/health/wellness-and-prevention/dont-be-shy-4-tips-for-talking-to-your-doctor Accessed Sep 24 2019.
  6. Health Literacy | Understanding What Your Doctor Is Saying. American Heart Association. N.d. https://www.heart.org/en/health-topics/consumer-healthcare/doctor-appointments-questions-to-ask-your-doctor/health-literacy–understanding-what-your-doctor-is-saying Accessed Sept 25 2019.
  7. Executive Order 13166. Limited English Proficiency (LEP).gov. https://www.lep.gov/13166/eo13166.html Accessed Oct 2 2019.


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by Misgana Gebreslassie, PharmD Candidate,
Class of 2020 University of Colorado

Roughly 18 to 26% of Americans have GERD, and the majority are adults between the ages of 30 to 60 years. GERD is a short for gastroesophageal reflux disease, a condition where stomach fluid (acid) backs up into the esophagus (the tube connecting the mouth and the stomach) and causes aggravating symptoms.

Other names that you may have heard for GERD are acid reflux or heartburn. Often acid reflux is caused by muscle weakness of the lower esophageal sphincter, a valve that lets food and drinks into the stomach. [1,2,6]

What are the symptoms of GERD?

Symptoms are typically present after eating and can be different from person to person. The most common ones are: [1,6]

  • Heartburn or burning in the chest
  • Sour taste or burning feeling in the throat
  • Stomach pain
  • Difficulty swallowing food or choking
  • Sore throat or hoarse voice
  • Cough that is not relived by anything
  • Spitting up
  • Frequent burping
  • Asthma

How is GERD treated?

Treatment of acid reflux include lifestyle changes, antacids such as Tums, or stronger stomach acid suppressants like histamine 2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs). [2,3]

Changes to diet or lifestyle can help control symptoms of heartburn and the following changes can be helpful: [2,3,4]

  • Stay away from foods and beverages that can lead to acid reflux or heartburn. Foods and beverages like: coffee, alcohol, chocolate, fatty foods, spicy foods, and citrus fruits/juices
  • Raise the head of your bed 6 to 8 inches
  • Try eating smaller portions and avoid sleeping or lying down within 3 hours of eating a meal
  • Lose weight. Being overweight can contribute to GERD
  • Stop cigarette smoking
  • Wear loose fitting clothes

Do Antacids Treat GERD?

Antacids work by neutralizing or reducing the acidity of the stomach. They are used for milder symptoms and are taken as symptoms occur to relieve heartburn symptoms.  These drugs can affect the absorption of other drugs. Always ask your pharmacist to check for interactions with your current medications as well as how and when to take them.[4]

What Other Drugs Can Treat GERD?

Histamine 2 receptor antagonists (H2RAs) work by suppressing acid secretion in the stomach. They are stronger than antacids in controlling heartburn symptoms. Overall, they are very well tolerated.[3]

Proton pump inhibitors (PPIs) also work by suppressing acid secretion in the stomach. They are used when heartburn symptoms are not well controlled by H2Ras or when symptoms are troublesome affecting quality of life.

PPIs work best when taken on empty stomach half an hour before the first meal of the day. PPIs may alter the way some drugs work. Ask your pharmacist or doctor to check for interactions with your current medications before taking them.[5]

Medicine
Type
Generic
Name
Regulatory
Status
Brand
Name
AntacidsCalcium CarbonateOTCTums
Aluminum hydroxide, magnesium
oxide and simethicone
OTC Maalox
Histamine 2 receptor antagonistsCimetidine OTC Tagamet
Famotidine OTC Pepcid
Nizatidine OTC Axid
Ranitidine OTC Zantac
Proton Pump Inhibitors (PPIs)EsomeprazoleRxNexium
DexlansoprazoleRxDexilant
Lansoprazole15mg – OTC Prevacid
Omeprazole OTC Prilosec
Omeprazole + sodium bicarbonate OTC Zegerid
PantoprazoleRxProtonix
RabeprazoleRxAciphex
OTC = over the counter (without prescription); Rx = prescription only; * Regulatory status obtained from FDA website [7]

All antacids and H2RAs are available over the counter whereas this would only apply to some PPIs. Sometimes these medicines are cheaper without a prescription. If cost is a concern for you ask your pharmacist to help you find ways to reduce your medication cost.[7]

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References:

  1. Gastroesophageal Reflux Disease (GERD). In DynaMed Plus [database online]. EBSCO Information Services. http://www.dynamed.com.proxy.hsl.ucdenver.edu/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated April 26, 2019. Accessed on 8/8/10/2019
  2. Patient education: Acid reflux (Gastroesophageal Reflux Disease) in adults. The Basics. In: UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited date unknown). Available from  https://www-uptodate-com. Accessed on 8/10/2019
  3. Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. In: Talley NJ & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 28, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  4. Vakil NB. Antiulcer medications: Mechanism of action, pharmacology, and side effects. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 22, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  5. Wolfe MM. Proton pump inhibitors: Overview of use and adverse effects in the treatment of acid related disorders. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited Nov 29, 2017]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  6. Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. Gastroenterology. 2008 Oct;135(4):1383-1391
  7. Over-The-Counter (OTC) Heartburn Treatment. U.S. Food & Drug Admiration. https://www.fda.gov/drugs/drug-information-consumers/over-counter-otc-heartburn-treatment. Published date unknown. Updated on March 5, 2018. Accessed 8/10/2019


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by Gabriel Rallison, PharmD. Candidate, Class of 2020
University of Arizona

If you follow recent news, you’ve probably heard about measles outbreaks cropping up in California1, Washington2, and New York.3 The Centers for Disease Control and Prevention (CDC) reports, as of September 2019 there have been 1,241 confirmed cases of measles in the United States this year, a number already higher than the previous four years combined.4 With so many cases, this year marks the largest outbreak of measles in the United States in 27 years.5

What is measles?

Measles, also known as rubeola, is a viral disease that can lead to fever, cough, runny nose, and red, watery eyes.4 These symptoms will usually appear about 7 to 14 days after being infected, before which a person may not even know they are sick.

In addition, a few days after these symptoms start to show, a measles rash will appear. This rash normally starts on the face and spreads down the body, starting with small red spots that will merge over time. The rash will usually remain for about five days before fading away.

Why should I be concerned?

The measles virus is spread when an infected person coughs or sneezes, releasing viruses into the surrounding area. Once in the air, the virus can remain there for up to 2 hours, with anyone passing through the area at risk of breathing in the virus and getting sick.3,4

This virus is very contagious, which means that if exposed people are not protected by a vaccine, they have a 9 out of 10 chance of catching the disease!2 While measles is technically considered eliminated in the US, recent cases come from unvaccinated people traveling outside of the country, catching measles abroad, and bringing it home with them.1,2,4

Measles symptoms generally are not very severe, but this disease can have very serious complications including:

  • permanent hearing loss
  • severe lung diseases
  • swelling of the brain
  • pregnancy complications
  • death.4

Before the vaccine for measles was developed, over 3 million people were infected annually, with 48,000 hospitalized and 400 dying from measles and related complications each year.

How can I protect myself?

The best protection for measles is the vaccination.1,2,3,4 The measles vaccination is available as a combination vaccination with mumps and rubella, together called the measles-mumps-rubella or MMR vaccine.4

This vaccine works by teaching your body’s immune cells what to watch out for and helps prepare the body’s defenses for the viral attack. The vaccine is very effective, and when used as recommended is 97% effective at preventing measles.4

For most adults, the CDC recommends getting one dose of the vaccine, with certain conditions requiring a second dose achieve full immunity.9 In small children, the recommendation is to get one dose at 1 year old, and a second dose between 4 to 6 years old.9 The vaccine can and should be given to children under 1 year of age if planning on traveling internationally.3,9

Is the vaccine safe?

Yes, the MMR vaccine has been shown in repeated studies and trials to be safe and effective.2,3,6 While there have been concerns expressed that vaccines may cause autism, dozens of studies over the last 25 years including tens of thousands of patients have found no link between vaccines and autism.7,8

Additionally, the vaccine component purported to cause harm, a preservative called thimerosal, has never been a part of the MMR vaccine.6 The most common side effect of vaccines is redness and soreness at the injection site, and in rare cases a mild fever or rash may arise.4

Where can I get the vaccine?

The MMR vaccine is available at your doctor’s office or your pharmacy and is free of charge with most insurance plans.  If you don’t have a regular doctor or pharmacy, you can use https://vaccinefinder.org/ to find a location near you.10

Pharmacies are especially convenient, with 9 in 10 Americans living within 5 miles of a pharmacy.  At most pharmacies, no appointment is required, and your pharmacist can have you vaccinated and on your way in mere minutes. So then, what are you waiting for?

References

  1. Disneyland, Universal Studios Hollywood Visitors Reportedly Exposed to Measles. TIME. Aug 24, 2019. https://time.com/5660904/new-zealand-teenager-measles-southern-california/ Accessed Sept 20, 2019.
  2. Measles Cases Mount in Pacific Northwest Outbreak. NPR News. Feb 8, 2019. https://www.npr.org/sections/health-shots/2019/02/08/692665531/measles-cases-mount-in-pacific-northwest-outbreak. Accessed Sept 23, 2019.
  3. US in danger of losing measles-free status, a ‘mortifying’ effect of anti-vax movement. USA Today. Sept 13, 2019. https://www.usatoday.com/story/news/nation/2019/09/13/us-could-lose-measles-free-status-if-outbreak-continues-new-york/2300281001/ Accessed Sept 19, 2019.
  4. Measles (Rubeola). Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/measles/index.html Accessed Sept 19, 2019.
  5. U.S. measles cases reach highest level in 27 years. NBC News. May 31, 2019. https://www.nbcnews.com/health/kids-health/u-s-measles-cases-reach-highest-level-27-years-n1012401 Accessed Sept 23, 2019.
  6. Vaccine Safety. Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/vaccinesafety/index.html Accessed Sept 20, 2019.
  7. Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. Journal of the American Medical Association. April 21, 2015. https://jamanetwork.com/journals/jama/fullarticle/2275444 Accessed Sept 23, 2019.
  8. MMR Vaccine Does Not Cause Autism: Examine the evidence! Immunization Action Coalition. N.d. http://www.immunize.org/catg.d/p4026.pdf Accessed Sept 23, 2019.
  9. Immunization Schedules. Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/vaccines/schedules/index.html Accessed Sept 19, 2019.
  10. Vaccine Finder. HealthMap.  N.d.  https://vaccinefinder.org/


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stress hurts your health image

by Cherokie Dyer, PharmD Candidate,
Class of 2020, University of Florida

When was the last time you felt stressed?

Stress is so common that there is an organization called, “The American Institute of Stress.” According to this group, there are 50 common signs and symptoms of stress. Many of the signs we think about when it comes to stress are difficulty making decisions, excessive anxiety, worry, guilt, and nervousness. Other common signs include increased frustration, irritability, and edginess. We can determine these signs based on our interactions with people. But… did you ever think about what stress is doing to your body on the inside?

How does Stress affect the body?

Stress can be a good thing in an emergency. It turns on your ‘fight or flight’ response. This gives you that ‘adrenaline rush’ feeling, which is the release of cortisol and epinephrine. Stress raises your blood pressure, makes your heart beat faster, and boosts sugar levels in your blood. It can also slow down your digestive tract, make your muscles tense up, and make your breathing become more rapid. All these bodily reactions are great to help you act during a crisis.

However, it’s not good when our bodies are constantly flooded with stress for a long period of time.

  • Heart racing and blood rushing may cause inflammation in arteries and lead to heart attacks or strokes.
  • Constant boosts in blood sugar can affect insulin and lead to pre-diabetes.
  • An impaired digestive tract can keep the body from getting valuable nutrients and lead to hard or loose stools.
  • Constantly tensed muscles can cause tension headaches and migraines.
  • Rapid breathing can cause hyperventilation and lead to panic attacks.
  • Increased cortisol may cause the body to hold on to belly fat.
  • These reactions can start to make the menstrual cycle irregular or lower sperm counts.
  • Stress can also affect eating patterns making us want to eat more or less than usual.

Believe it or not, constant stress can wreak havoc on our body in a multitude of other ways. Especially if you already have medical conditions like heart disease, diabetes, irritable bowel syndrome, or obesity. Your constant stress could very well be the thing that’s preventing your medications from helping you get better.

Two Key Strategies to Manage Stress

Try to prevent it and cope with it when it comes. Figure out the things that trigger your stress. Do your best to avoid them or work around them. For instance, if leaving on time for work stresses you out, invest in a new alarm or get up even earlier to give yourself more time.

There are other ways to prevent stress besides just avoiding your triggers.

  • Carve out some more alone time for yourself
  • Do more of the things that you bring you joy
  • Make the effort to get near 8 hours of sleep
  • Eat more fresh foods and whole foods
  • Avoid stimulants like caffeine.

If you are already feeling stressed out, then there are a ton of options that you can try:

  • Calming activities like prayer, yoga, massages, and/or deep breathing
  • Active movements like going for walks, jogs, lifting weights, or taking group classes like kickboxing
  • More of your favorite hobby, listen to music you like, play with your pet more often, or participate in volunteer work.

The options are endless and there is no correct answer!

Bottom Line

Stress can be negative for both our sanity and our bodies. There are a variety of ways to deal with stress. Identify when you feel the most stressed out. Do your best to avoid that trigger and/or cope with those feelings, and your body will thank you in return.


Cherokie Dyer is a PharmD candidate of 2020 who is also pursuing a career in nutrition and holistic wellness. She founded Healthy La Vie, a wellness platform aimed to help people live healthier lives through health education, nutrition and holistic wellness tips. She’s written many articles bringing the world of medicine and nutrition together on the Healthy La Vie blog.

References

https://www.stress.org/stress-effects
https://www.stress.org/military/combat-stress/management
https://www.stress.org/daily-life



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steroid inhaler image - scriptsave wellrx blog

by Cindy Cho, PharmD Candidate Class of 2019,
The University of Arizona College of Pharmacy

Are You Doing This Important Step After Using Your Inhaler?

If you use an inhaler for a breathing condition, like asthma, you may have been told by your doctor that you will need to rinse your mouth with water and spit after you use your inhaler. It may seem like a cumbersome additional step, especially since it already takes time out of your day to use your inhaler, so why is it important to spend time to rinse and spit after using your inhaler?

Not All Inhalers Require You to Rinse and Spit

Just to clarify, you don’t need to rinse and spit with every inhaler. There are numerous inhalers on the market with different active ingredients and different purposes (For more on this, refer to this post on the difference between rescue and controller inhalers: (https://news.wellrx.com/2016/08/18/breathing-condition-meet-lifesaver/).

However, a common type of inhaler that does require you to rinse your mouth after each use is called an inhaled corticosteroid (ICS) inhaler. ICS inhalers contain small amounts of steroids to help people breathe easier. Other types of inhalers have different active ingredients (e.g., albuterol, formoterol, tiotropium), so it is not necessary to rinse your mouth after using those.

Common ICS Inhalers

Examples of common ICS inhalers, or combination inhalers that contain a corticosteroid, are:

  • Advair Diskus & Advair HFA (fluticasone/salmeterol)
  • Aerobid (flunisolide)
  • Alvesco, Omnaris, Zetonna (ciclesonide)
  • Arnuity Ellipta (fluticasone furoate)
  • Asmanex (mometasone)
  • Azmacort (triamcinolone)
  • Dulera (mometasone/formoterol)
  • Flovent, Flovent HFA (fluticasone)
  • Pulmicort, Rhinocort (budesonide)
  • Qnasl, Qvar (beclomethasone)
  • Symbicort (budesonide/formoterol)

If you are using one of these inhalers or have been told that your inhaler contains a steroid in it, you will need to rinse your mouth with water and spit after each use.

Why do I Have to Rinse and Spit with ICS Inhalers?

ICS inhalers have a small amount of corticosteroid medication that reduces inflammation in your bronchial tubes and ultimately open your airways to help you breathe easier.1 These medications can be delivered through metered dose inhalers, dry powder inhalers, or through a nebulizer. When you breathe in your steroid inhaler medication, a small amount of steroid can stick to your mouth and throat as it makes its way into your lungs to help you breathe. If this small amount of steroid is not rinsed out from the inside of your mouth or throat, it can cause a fungal infection known as thrush.2

What You Need to Know About Thrush3

Oral thrush in adults generally looks like thick, white or cream-colored spots inside the mouth. The inside lining of your mouth may appear swollen and slightly red and may feel uncomfortable or a burning sensation. The good thing is that thrush is a treatable infection. Your doctor will prescribe an antifungal medicine in the form of a tablet, gel, lozenge, or mouthwash to help treat it. The better news is that this condition is preventable with proper rinsing and spitting.  

What You Can Do

Make sure to rinse your mouth with water and spit after using your ICS inhaler to prevent thrush. Another way to make it easier for you to incorporate rinsing your mouth after using your ICS inhaler is to brush your teeth after using your inhaler. As a friendly reminder, your ICS inhaler should be used on a routine basis, unless your doctor tells you otherwise, even when your breathing seems better. These inhalers will help maintain your breathing over time to prevent breathing-related complications and keep you out of the hospital.

References:

  1. Barnes PJ. Inhaled Corticosteroids. Pharmaceuticals (Basel). 2010;3(3):514-540. Published 2010 Mar 8. doi:10.3390/ph3030514
  2. Shuto H, Nagata M, Terashi Y, Yamaguchi M, Takizawa T, Shuto C, Watanabe K, Tosaka K, Okano M, Noguchi H. Esophageal candidiasis as complication of inhaled steroid therapy. Arerugi 2003; 52(11)1053–1064
  3. Oral thrush – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533. Published March 8, 2018. Retrieved February 22, 2019.

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saturated fat type 2 diabetes image - scriptsave wellrx blog

by Cindy Cho, PharmD Candidate Class of 2019,
The University of Arizona College of Pharmacy

When most people think of a diet that leads to poor diabetes control, they may think of a diet high in carbs and sugar. While those types of food do impact your blood sugars, consuming too many saturated fats can be an enemy against diabetes control,too. This is because a hallmark of pre-diabetes, type 2 diabetes, and worsening type 2 diabetes is insulin resistance.

Saturated Fat and Insulin Resistance

First, what is insulin? Insulin is a hormone produced by your pancreas to control your blood sugar levels. Insulin helps move the sugar from the blood into your cells for storage and energy. In other words, insulin is the key that unlocks the door of our muscle cells to let sugars in. Insulin resistance in the state of your body where insulin is not responding properly to move the sugar into the cells, which causes a rise in blood sugars as a result. The pathophysiology of insulin resistance is somewhat convoluted, but what is known is that saturated fat plays a role. It has been known since 1927 that increased consumption of fat delays the process of blood sugars going into the cells, which means that sugars hang around longer in the bloodstream.1 The results of both animal and human studies also show that a high intake of saturated fat is associated with insulin resistance and development of type 2 diabetes.2 This is because an uncontrolled state of insulin resistance leads to a higher risk of getting type 2 diabetes. People are also at higher risk of insulin resistance if they are overweight or obese.

Not All Fats are Bad

Contrary to the connotation of the word, not all fats are unhealthy. Two main sources of fat that we will focus on are saturated and unsaturated fats. Saturated fats are found commonly in animal products, such as red meats and dairy products. On the other hand, unsaturated fats come from mainly plant based sources and consists of foods like olive oil, nuts, and avocados. Studies have shown that in people with diabetes, saturated fats cause insulin resistance whereas unsaturated fats can improve insulin sensitivity.3 Because of this, the consumption of vegetables fats is favored in place of animal fats and processed grains.3 Not only are plant based foods lower in saturated fats, they are generally lower in calories and jam-packed with nutrients and fiber to nourish the body.

Ways to Improve Insulin Resistance

Lifestyle changes, particularly diet, address ones of the root causes of type 2 diabetes: insulin resistance. Following a plant-based diet can be a solution since animal products can contain a high amount of saturated fat. A plant-based diet generally includes legumes, whole grain, fruits, vegetables, and nuts, and discourages most animal products and refined foods.4 The Adventist 2 study, which included about 89,000 people extended across 50 years, demonstrated a substantial decrease in diabetes incidence in those who ate a vegetarian diet. The study also suggested that those who eat meat once or more days a week have significantly higher rates of diabetes.5 Plant-based diets also have been shown to work better in reducing blood sugars, body weight, and cardiovascular risk compared to diets that include animal-based products.6

Plant-based eating patterns, such as the DASH diet, healthy Mediterranean, and healthy vegetarian diets, have been shown to be associated with better health and lower risk for disease according to nutritional epidemiology, randomized controlled intervention trials, and most literature.7 These diets are also appropriate for the vast majority of people. Furthermore, exercise, with or without weight loss, helps improve insulin sensitivity so your body can use the insulin it naturally produces better.8 That in turn can mean lower doses of your diabetes medications, or even coming off the diabetes medications altogether, which can lower your costs on how much you spend on diabetes care. It is shown that after adjusting for population age and sex differences, the average medical expenses for people living with diabetes were about 2.3 times high than people who do not have diabetes.9

Dangers of Uncontrolled Blood Sugars

Controlling blood sugars is important because the longer a high amount of glucose is in the bloodstream, the more damage it can cause to your blood vessels, nerves, and tissues. Therefore, it is very important to have your doctors check your feet, eyes, and kidneys at least yearly if you have diabetes. People with uncontrolled blood sugars are also at higher risk for cardiovascular complications like heart attacks and strokes and are more prone to infections.10 Plant-based diets have demonstrated improvements in blood sugar control, which can possibly reduce or prevent the incidence of long-term complications of type 2 diabetes.

What You Can Do

Talk to your doctor or dietitian about eating more plant-based foods. It may also be easier to think of changes to what you eat as a lifestyle choice instead of as a diet. Small changes to the foods you consume can make a big impact on your health in the long run. Eating healthier doesn’t mean it has to be more expensive either. Shopping for produce in season, or even visiting your local 99 cent store that carries groceries can be helpful methods to save you money and keep you healthy too. You don’t have to be vegan to experience the benefits of a plant-based diet either. Any steps you take to adding more plant-based foods onto your plate can improve your blood sugars.5

Key Takeaways

To summarize, striving to increase the amount of plant-based foods you eat, minimize consumption of animal-based foods, increase your physical activity, along with taking your diabetes medications regularly, can make a positive impact on your blood sugars and overall health!

References:

  1. Dietary Factors That Influence The Dextrose Tolerance Test, J. Shirley Sweeney MD, Archives of Internal Medicine, December 1927
  2. ARIC Study Investigators; Plasma fatty acid composition and incidence of diabetes in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study, The American Journal of Clinical Nutrition, Volume 78, Issue 1, 1 July 2003, Pages 91–98, https://doi.org/10.1093/ajcn/78.1.91
  3. Rachek, L. (2014). Progress in Molecular Biology and Translational Science (pp. 267-292). Elsevier.
  4. McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017;14(5):342-354.
  5. Tonstad, S., Stewart, K., Oda, K., Batech, M., Herring, R., & Fraser, G. (2013). Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutrition, Metabolism and Cardiovascular Diseases,23(4), 292-299. doi:10.1016/j.numecd.2011.07.004
  6. Trapp, Caroline B., and Neal D. Barnard. “Usefulness of Vegetarian and Vegan Diets for Treating Type 2 Diabetes.” Current Diabetes Reports, vol. 10, no. 2, 2010, pp. 152–158., doi:10.1007/s11892-010-0093-7.
  7. Laddu, D., & Hauser, M. (2019). Addressing the Nutritional Phenotype Through Personalized Nutrition for Chronic Disease Prevention and Management. Progress In Cardiovascular Diseases, 62(1), 9-14. doi: 10.1016/j.pcad.2018.12.004
  8. Duncan GE, Perri MG, Theriaque DW, Hutson AD, Eckel RH, Stacpoole PW: Exercise training, without weight loss, increases insulin sensitivity and postheparin plasma lipase activity in previously sedentary adults. Diabetes Care 26:557–562, 2003
  9. Economic Costs of Diabetes in the U.S. in 2017. (2018). Diabetes Care, 41(5), 917-928. doi: 10.2337/dci18-0007
  10. American Diabetes Association. 2019 Standards of Medical Care in Diabetes. http://care.diabetesjournals.org/content/42/Supplement_1. Published December 17, 2018. Accessed December 17, 2018.

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hypothyroidism - dr. checking patient - scriptsave wellrx blog

by Jamie Voigtmann, PharmD Candidate

Your body has a number of glands, but the thyroid gland is the small gland at the base of your neck that makes hormones to regulate your metabolism. This impacts your body’s metabolic rate (how you burn calories) as well as heart and digestive function, mood, and more. But what happens if something impacts the thyroid?

How Does the Thyroid Work?

First, the hypothalamus releases TRH which activates the pituitary to release TSH.1 This in turns activates the thyroid to produce and release T4 and T3 into the body but at an approximately 14:1 ratio, with T4 being 14 and T3 being 1.2 Then T4 and T3 bind to proteins and travel to other tissues in the body. There, the T4 will be changed to T3 by removing one molecule iodine.1 This is important because T3 is the active thyroid hormone unlike T4, which is inactive; T3 allows the body to control metabolism, temperature, and heart rate.1 Finally, the T4 and T3 in the body cause a negative feedback loop to the hypothalamus and pituitary. This can make the hypothalamus and the pituitary produce more hormones when T4 and T3 are low or produce less hormones when T4 and T3 are high.1

thyroid process - diagram - scriptsave wellrx blog image

What are the Causes and Symptoms of Hypothyroidism?

Hypothyroidism is most commonly caused by an autoimmune disorder which is when the body’s immune system attacks its own tissues rather than infections. Because of this, the autoimmune disorder causes a decreased amount of T4 and T3 being made.3 Other causes, although unlikely, include a low amount of iodine through diet, removal of the thyroid, radiation therapy for cancer treatment, and certain drugs (amiodarone, lithium, iodine, and rifampicin). Signs and symptoms of hypothyroidism are commonly dry skin, sensitivity to the cold, constipation, poor memory, fatigue, weight gain, puffiness around the eyes, and a slowed heart rate. These signs and symptoms are highly suggestive of hypothyroidism, but alone cannot diagnose this condition. Diagnostic measures most commonly include high TSH levels and low T4 levels.

What are the Treatment Options?

Synthetic T4 Replacement

The most common T4 replacement medication is levothyroxine, and it is recommended as the first treatment option for hypothyroidism.2 Although it is not the active form (T3), it can be made into T3 in the body’s tissues and is generally well-tolerated by many patients. Benefits of levothyroxine include normalizing thyroid function, once daily dosing, few side effects, low cost, and safety in pregnancy.2 But one thing that is very important and specific about levothyroxine is how it is taken. Levothyroxine must be taken on an empty stomach so that it can be appropriately absorbed by the body.3 This is easiest to accomplish in the morning right after waking up, at least 30 minutes before eating breakfast; but, it is possible to take levothyroxine before bedtime as long as it is 4 hours after eating.2 Levothyroxine must also be taken separately (approximately 4 hours before or after) from products such as calcium, iron, and antacids that contain aluminum or magnesium in order to optimize its absorption and efficacy.3 These products are commonly in the form of vitamins or supplements, as well as Tums, Mylanta, Milk of Magnesia, Alka-Seltzer, Maalox, and Rolaids.

Synthetic T3 Replacement

Hypothyroidism therapy also can consist of liothyronine, which is the active form of thyroid hormone: T3. Liothyronine has some disadvantages for the treatment of hypothyroidism when compared to levothyroxine. Currently it is only approved for once daily dosing, but this does not mimic the true release pattern of T3 from the thyroid.4 One small, randomized study showed an improvement in weight loss and decreased lipid profile compared to levothyroxine, but only if liothyronine was taken three times daily.4 Because of this, liothyronine is not currently recommended over levothyroxine because it’s once daily dosing does not provide better results.2 But, it is possible an extended-release formulation of liothyronine can prove to be clinically beneficial in the future.2 Overall, liothyronine has some disadvantages for the treatment of hypothyroidism when compared to levothyroxine such as unknown dosing schedule for best effect and increased cost.

Synthetic Combination Therapy

Some medications used to treat hypothyroidism have a mixture of T4 and T3. Unfortunately, there are many differing studies with different T4:T3 ratios and have unclear results.3 But, many of these clinical trials do not show benefit of T4 and T3 over T4 alone (levothyroxine).2 It has been reported that few patients taking levothyroxine alone still experienced signs and symptoms of hypothyroidism, although their TSH level was corrected to its normal value; and it has been discussed that these patients could potentially benefit from combination T4 and T3 therapy, but evidence is limited.2,3 Overall, levothyroxine remains the standard of care when treating hypothyroidism, with combination therapy of T4 and T3 only being considered after a patient tries levothyroxine and it does not work effectively.2

Natural Desiccated Therapy

This type of hypothyroid medication is also a combination of T4 and T3 but instead of being synthetic (made from chemicals), it is naturally obtained. This is because it is derived from thyroids of animals, particularly domesticated pigs.2,5 The common name of this type of medication is Armour Thyroid.5 The T4:T3 ratio is always 4:1, unlike the natural body’s ratio of 14:1.2 This can lead to an increased level of T3 at once and can result in adverse effects including increased heart rate and anxiety.2 But, there was one minor study completed that reported results of patients preferring desiccated therapy over levothyroxine due to decreased symptoms of hypothyroidism.5 Because this study was small, did not use appropriate questionnaires, and did not assess safety, it does not warrant its use over levothyroxine for hypothyroidism.2 Natural desiccated therapy falls into the same category of combination therapy . It should only be considered for patients who have tried levothyroxine and did not correct his/her thyroid function.2

References

  1. Yen PM. Physiological and molecular basis of thyroid hormone action. Physiol Rev. 2001; 81(3): 1097-1142.
  2. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014; 24(12): 1670–1751.
  3. Chakera AJ, Pearce SHS, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Devel Ther. 2012; 6: 1–11.
  4. Celi FS, Zemskova M, Linderman JD, et al. The pharmacodynamic equivalence of levothyroxine and liothyronine. a randomized, double blind, cross-over study in thyroidectomized patients. Clin Endocrinol (Oxf). 2010; 72(5): 709–715.
  5. Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2013; 98(5): 1982-1990.
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