probiotics - yogurt image - scriptsave wellrx blog

by Terra Leon, PharmD Candidate 2019

Bacteria in food might not sound like a good thing, but probiotics are good bacteria that mimic the natural bacteria you have in your gut. The bacteria that naturally occurs in the gut supports proper gastrointestinal health and digestion. Different strains of probiotics can also support other functions in the body such as reduce vaginal infections, prevent autoimmune disease, reduce urinary tract infection rate, and ease skin ailments2.

Sources of Probiotics

Probiotics can be taken in several ways. As supplements, much like vitamins, or in dairy products, like yogurt, cheese, lactobacillus milk or kefir.

When choosing a dairy product like yogurt for your intake of probiotics it is important to choose a yogurt that has “Live and Active Cultures” on the product label. This statement means that the yogurt has at least 100 million active cultures per gram of yogurt1.  If you choose to use supplementation in the form of a capsule you should try and choose a product with a strain of probiotic that aids in the reason you are taking it. To start, most patients use a probiotic supplement that has both species of Bifidobacterium and Lactobacillus because these species are most commonly found in the gastrointestinal tract and aid in digestive health1. A commonly prescribed probiotic is VSL #3. Ask your doctor or pharmacist if this could be right for you.

What are Antibiotics

Antibiotics are widely used when a patient has a bacterial infection in the body. They work by inhibiting growth and replication of the bad bacteria that has infected your body. Different antibiotics target different bad or foreign bacteria in your body. Some even have a wide spectrum of activity and can wipe out the bad bacteria and the beneficial.

Purpose of Combined Use

When a patient receives a new antibiotic from their doctor, they are often told at the pharmacy that this medication has the potential to cause stomach upset or diarrhea for up to a month after use. The reason this happens is the antibiotic taken for an infection is powerful enough to kill off most bacteria in the body during the period it is being consumed. This includes the normal flora in your gut which helps with digestion and stool formation. Taking a probiotic with the species Bifidobacterium and/or Lactobacillus can greatly help reduce the likelihood of prolonged diarrhea and stomach pain. Once the antibiotic is consumed it will wipe out the bacteria in your stomach (good and bad) so taking a probiotic to help replace the good digestive bacteria can help reduce stomach upset. When using probiotics with antibiotics it is important to separate the two by 2 hours to ensure the antibiotic doesn’t wipe out the probiotic you just consumed. Using probiotics during antibiotic treatment and up to 3-7 days after antibiotic treatment can reduce the likelihood of stomach upset5. Always check with your doctor or pharmacist to ensure the use of probiotics is appropriate.

Risk vs Benefit

Probiotics are great in aiding in digestive health and preventing unwanted disorders. However, for those who are immunocompromised the risk can out weigh the benefit. Since the majority of probiotics work in the digestive tract side effects like gas and bloating are a possibility. Patients who have a compromised immune system, have certain bowel problems or are severely ill need to consult their doctor before starting a probiotic. Pregnant women and young children need to consult their doctor before starting probiotics.

Common Species/Strains of Probiotics Available

Species

  • Bifidobacteria (B.): commonly used in food and supplements to support your immune system, decrease growth of harmful bacteria in gut, and help breakdown lactose into nutrients2.
  • Lactobacillus (L.): produces lactase to breakdown lactose and produce lactic acid. Lactic acid helps reduce the amount of harmful bacteria and can fuel the body’s absorption of minerals2. This species of bacteria is commonly found in the mouth, vagina and small intestines.

Strains

  • animalis: helpful in supporting digestion, supporting immune health and fighting food borne bacteria2.
  • breve: works in the digestive tract and vagina to reduce yeast and ferments sugars to help your body absorb the nutrients2.
  • lactis: improves digestion, lower cholesterol and enhances immunity and fights tumor growth3.
  • longum: found in the GI tract and aids in the breakdown of carbohydrates and has antioxidant properties2.
  • acidophilus: found in the small intestines and the vagina. Helps to improves blood pressure and cholesterol, fights off bacterial/viral/fungal infections, aid in digestion and even reduce allergy severity3.
  • reuteri: found in the mouth and intestines. It helps fight off gingivitis by reducing oral bacteria that causes tooth decay and can help re-establish the pH of the vagina and aid in the digestive system2,3.
  • rhamnosus gg: boost immune system, reduce allergies and inflammation and can aid in digestive support by decreasing constipation, leaky gut symptoms and IBS symptoms3.
  • plantarum: can improve your overall health by improving your digestion and immunity. This strain of probiotic has a growing temperature that is very close to our body temperature allowing it to thrive3.
  • gasseri: found in the digestive and vaginal tract. This strain can assist with weight loss by possibly suppressing dietary fat absorption in the small intestines and in turn inhibiting calorie intake4.
  • casei: improves immunity, allergies (pollen), digestion (fights diarrhea) and can improve cholesterol levels3.
  • brevis: can reduce mouth ulcers and periodontal disease. This strain has also been seen to reduce urinary oxalate levels (kidney stones) and decrease H. pylori colonization3.
  • salivarius: found in the colon, vagina, small intestines and mouth. This strain can improve dental health, immunity and digestion3.

Resources:

  1. “What are probiotics?” Mayo Clinic. 14 Apr. 2017. Mayo Foundation for Medical Education and Research. 23 Jan. 2019 <https://www.mayoclinic.org/what-are-probiotics/art-20232589>.
  2. “6 Most Common Types of Probiotics.” Healthline. Healthline Media. 23 Jan. 2019 <https://www.healthline.com/health/types-of-probiotics#benefits>.
  3. Jerkunica, Evan. “About Top 15 Most Researched Probiotic Strains.” Lactobacillus plantarum Benefits & Side Effects – Probiotics.org. 2014. 23 Jan. 2019 <http://probiotics.org/strains/>.
  4. Leech, Joe. “Probiotics and Weight Loss Review: Microscopic Miracle or Mirage?” DIET vs DISEASE. 17 Dec. 2018. 23 Jan. 2019 <https://www.dietvsdisease.org/probiotics-and-weight-loss-review/>.
  5. Sherman, Max. “Probiotics and Microflora.” U.S. Pharmacist – The Leading Journal in Pharmacy. 17 Dec. 2009. 23 Jan. 2019 <https://www.uspharmacist.com/article/probiotics-and-microflora>.

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activated charcoal image - scriptsave wellrx blog

by Terra Leon, PharmD Candidate 2019

With all the new diet and detoxification trends arising from celebrities and the media, it’s hard to know harmful from helpful. Activated charcoal has been portrayed as the new “magic bullet” for multiple health issues. Activated charcoal’s popularity is quickly spreading and turning up in supplements, juices, hangover remedies, face masks and even toothpaste. The media and celebrities promise it will reduce bloating, clear skin, whiten your teeth, and detox your organs for a healthier life. But does it work?

What is Activated Charcoal

Charcoal is a fine black powder made from bone char, coal, saw dust, olive pits, coconut shells or petroleum coke4. The charcoal becomes activated when it is heated at a high enough temperature the structure changes and provides a higher surface area for substances to bind to4. Activated charcoal’s oldest use is in medical practice in the Emergency Room as a treatment to detox patients who over dose on certain medications. When a patient over doses on a medication like Tylenol or Aspirin, activated charcoal is utilized to help trap toxins and gases in the gut. Since activated charcoal is not absorbed by the body it carries the toxins bound to its surface area out of your body through feces like a big drug sponge. Due to its highly negatively charged surface, activated charcoal attracts positively charged molecules for excretion, like toxins and gases but it can also have an effect on other medication and lead to lower absorption4.

Alternative Options

An alternative to activated charcoal to reduce gas and bloating, is to stick to a whole food plant-based diet, avoid products with artificial sweeteners, avoid carbonated drinks, and beer, which can release carbon dioxide gas, Also, be sure to eat and drink slowly1. Taking your time eating and drinking can help you swallow less air and reduce gas. Consult your health care provider for other alternative over-the-counter options, such as Gas-X, if natural options still don’t provide relief.

For clear skin try over the counter or prescription products that help reduce oils and clear bacteria on the skin surface. Make sure you wash your face every day and avoid high in oil foods to reduce surface oil1. Consult your healthcare professional if blemishes continue to arise.

If its whiter teeth you seek, try over the counter whitening kits that have hydrogen peroxide. Rinse your mouth after consuming coffee, soda or teas. Activated charcoal lacks published studies on being beneficial for teeth whitening. In fact, the fine black charcoal powder can potentially become embedded into cracks or small holes in the teeth producing the opposite effect1. Consult your dentist for alternative whitening procedures.

Not So Harmless?

Using activated charcoal supplement as a detoxification method is not as harmless as some may think.  Activated charcoal does not have the ability to suck out toxic chemicals from your body, its effects are limited to the GI tract3. Furthermore, it does not discriminate against helpful chemicals in food you consume and can remove beneficial nutrients such as Vitamin C, B6, Thiamine, Biotin and Niacin from the body3. In line with this, there are also concerns that activated charcoal can make medications less effective. In short, to “detox” or cleanse the body make sure to drink plenty of water each day and eat a high in fiber diet to help naturally remove waste from the body.

Medication Interactions

Activated charcoal can reduce the absorption and interrupt the circulation of certain medications and should only be used under the supervision of a health care professional2. If you are taking any prescription medication consult your doctor before using charcoal as a supplement or any other oral ingestible form. Due to its possibility of decreasing absorption of other medication it is recommended to take activated charcoal at least 1 hour before or 2 hours after taking other drugs if approved by your doctor2.

Bottom Line

With all the new health fads and trends offering a one supplement solve all solution or “magic bullet” it is easy to get sucked into the excitement of this new trend. When it comes to activated charcoal there are no strong studies supporting these benefits and weaker studies are not supported by science. Always consult your doctor or health care professional to gain all the information you need about a new product to determine if this product will be helpful or harmful to your personal health.

References:

  1. Calderone, Julia. “Activated Charcoal Isn’t a Magic Health Bullet.” Product Reviews and Ratings – Consumer Reports, Apr. 2017, consumerreports.org/dietary-supplements/activated-charcoal-fad-not-a-magic-health-bullet/.
  2. Charcoal Oral, Facts & Comparisons, 2018, https://fco.factsandcomparisons.com/lco/action/search?q=activated%2Bcharcoal&t=name&va=activated%2Bchar.
  3. Gavura, Scott. “Activated Charcoal: The Latest Detox Fad in an Obsessive Food Culture.” Science-Based Medicine, 28 Jan. 2016, sciencebasedmedicine.org/activated-charcoal-the-latest-detox-fad-in-an-obsessive-food-culture/. https://sciencebasedmedicine.org/activated-charcoal-the-latest-detox-fad-in-an-obsessive-food-culture/
  4. Petre, Alina. “What Is Activated Charcoal Good For? Benefits and Uses.” Healthline, Healthline Media, June 2017, www.healthline.com/nutrition/activated-charcoal#section10.

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Treating and preventing osteoporosis - image - wellrx

by Tek Neopaney, University of Arizona College of Pharmacy Student

Each year, millions of Americans, who may otherwise feel fine, are diagnosed with Osteoporosis. Developing osteoporosis puts people at higher risk for fractures, especially in the hips, spine, and wrists. Women are at much higher risk, with 10 percent of women age 50 and older affected by osteoporosis, compared with just two percent of men that age.

What is Osteoporosis?

Osteoporosis is defined by low bone mass that results in decreased bone density, and bones become more prone to fracture. Osteoporosis often has no symptoms until there is a bone fracture. Bone strength decreases with the loss of bone mass, which is related to many factors such as, a decrease in bone mineral density, rate of bone formation and turnover, and the shape of the bones.

Postmenopausal women often have low bone density due to estrogen deficiency. With early diagnosis of bone loss and fracture risk, available therapies can slow or even reverse the progression of osteoporosis and help prevent bone fracture1. Vertebrae and hip fracture is common in osteoporosis patients. About two-thirds of the bone fractures are asymptomatic2, meaning patients won’t even be aware they have a fracture. Many patients without symptoms assume they don’t have osteoporosis, so it’s important for all post-menopausal women to get an osteoporosis evaluation.

Calcium Vitamin Supplements

If you are unable to achieve adequate amounts of calcium and vitamin D from diet alone, you should take supplements for bone growth and development. Children ages 9 to 18 should consume approximately 1300 mg of calcium per day from calcium rich food sources, and 600 mg of vitamin D from vitamin D-fortified food. Children who have a wide variety of foods in their diet, and are growing well, should not need calcium and vitamin D supplementation3. Calcium and vitamin D supplementation likely only benefits children with inadequate calcium and vitamin D intake3.

Most postmenopausal women with osteoporosis, 1200 mg calcium (total dietary and supplement) and 800 international units of vitamin D are recommended. Although optimal intake of calcium (diet plus supplement) for pre-menopausal women and men with osteoporosis is not established, generally suggested doses are 1000 mg of calcium (diet and supplement) and 600 international units of vitamin D4.

Exercise – It’s Important!

Exercise is strongly associated with a reduction in hip fractures in older women5. Regular exercise has shown to have positive effect on bone mineral density (BMD). BMD is the measure of calcium in your bone. In studies, a variety of exercises such as, jogging, resistance training, swimming, and walking were effective. Women with osteoporosis should exercise for at least 30 minutes a day, three days a week, to build bone strength and help prevent fractures. Exercise helps to increase muscle strength, reducing the risk of fracture from fall.

Pharmacological Therapy

In addition to lifestyle measures and calcium and vitamin D supplementation, patients at high risk for fractures should also receive drug therapy. Patients with a history of fragility fracture or osteoporosis based on BMD, benefit from medication. All patients treated with medication should have a normal calcium and vitamin D level prior to starting drug therapy, and should also receive vitamin D and calcium supplements if their dietary source is inadequate6.

Oral bisphosphonates such as, alendronate (Fosamax), ibandronate (Boniva) are the first line of therapy for postmenopausal women. These agents decrease the rate of bone breakdown leading indirectly to an increased BMD. Bisphosphonates are effective, inexpensive, and have long-term safety data on preventing hip and vertebrate fracture6. These drugs are usually taken once a weekly.

Putting it All Together

With so many Americans developing osteoporosis, it’s important to realize it could happen to you, so talk to your doctor about your risks. To help prevent, and possibly reverse Osteoporosis:

  • Bond density screening is important to detect osteoporosis
  • Get enough calcium and Vitamin D in your diet or take supplements to help prevent osteoporois
  • Exercise helps build bone mass and strengthen your bones
  • There are available drugs to treat osteoporosis that are inexpensive and have proven safe to take over time.

References:

  1. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014; 25:2359.
  2. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva 1994. https://whqlibdoc.who.int/trs/WHO_TRS_843.pdf  (Accessed on March 09, 2012).
  3. Winzenberg TM, Shaw K, Fryer J, Jones G. Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 2006; :CD005119.
  4. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014; 25:2359.
  5. Gregg EW, Cauley JA, Seeley DG, et al. Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 1998; 129:81.
  6. Crandall CJ, Newberry SJ, Diamant A, et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med 2014; 161:711.

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Role of vitamin d and statin induced muscle pain

by James Ketterer, PharmD

Statins are a class of drugs used to lower cholesterol and decrease the risk of cardiovascular events. They work by inhibiting an enzyme from completing an early step in the body’s process of synthesizing cholesterol. Statins are among the most commonly prescribed medications in the country. Approximately 1-2% of patients on statins report experiencing muscle pain. This pain can present itself in a variety of ways but most often results in flu-like aches and pains. The muscles may feel stiff or sore like the feeling after working out. This usually effects the larger muscles of the body such as parts of the back or thighs. This side effect is often responsible for patients discontinuing the use of these drugs.

Does Vitamin D Play a Role in Statin-induced Muscle Pain?

Do statins cause muscle pain? The exact cause of this phenomenon is not completely understood, but many researchers have hypothesized that vitamin D levels may play a role. Vitamin D is mainly produced in the skin from sun exposure. However, this source is not active. The liver and kidneys are responsible for activating the vitamin D which then plays a role in facilitating intestinal absorption of essential nutrients as well as balancing bone health homeostasis. Vitamin D deficiencies often present with similar muscle pain as those found as a side effect in statins.

Some researchers have theorized that statins could reduce vitamin D levels because certain types of cholesterol carry vitamin D and when the cholesterol is reduced, less vitamin D could be transported. On the other hand, many have theorized that since both vitamin D and statins are metabolized by the same enzyme in the liver, the use of statins could delay metabolism of vitamin D, thus increasing levels in the blood.

Muscle Pain in Clinical Trials

Clinical trials and various other studies and reports have yielded mixed results on muscle pain in statin users with low compared to high levels of vitamin D. A large analysis of these trials showed that more studies resulted in statin users having higher levels of vitamin D on average. One retrospective study divided statin users into 4 groups, 1 being the lowest vitamin D levels and 4 being the highest. Group 1 was 1.21 times more likely to develop muscle pain than group 4. Another study showed statin users with vitamin D levels of less than 15 ng/mL were 1.9 times more likely to experience muscle pain compared with non-statin users. The statin users with higher levels of vitamin D did not have higher risk for muscle pain compared with non-statin users.

When a patient experiences what is believed to be the side effect of a drug, they are often taken off of the drug to see if the symptoms resolve. If they do resolve, sometimes the patient is started back on the drug to see if the symptoms return. This a referred to as a “rechallenge”. One chart review showed that returning vitamin D levels to a sufficient level before a rechallenge in statin users who had experienced muscle pain, increased their tolerability to statins.

Do Vitamin D Supplements Help Reduce Statin-induced Muscle Pain?

Some studies have given vitamin D supplements to statin users experiencing muscle pain. While these studies were uncontrolled, they did show improvement in muscle pain in nearly 90% of patients.

These are just a few of the examples of research looking at the correlation between stain use and vitamin D levels as a possible cause of muscle pain. While nothing is definitive at this point, patients on statins that are experiencing muscle pain may want to explore vitamin D supplementation as a possible resolution plan. The benefits of statins are well documented in patients with heart risks. Any side effects should be attempted to be overcome before giving up on the statin and assuming it is the cause.

References:

Gregory, Philip J. ” Vitamin D and Statin-Related Myalgia”. Medscape. 2017. Web. 10 Mar. 2017.

Simvastatin.  Micromedex Solutions.  Truven Health Analytics, Inc. Ann Arbor, MI.  Available at: https://www.micromedexsolutions.com.  Accessed March 20, 2017.


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photo ScriptSave WellRx vitamin supplements

by Sandra Leal, PharmD, MPH, CDE, FAPhA

The US supplement industry is a $30 billion dollar business.1 The Council for Responsible Nutrition estimates that almost 70% of US adults use dietary supplements.2 Before I continue, I must state that I do not have any conflicts of interest and rest assured, although I am a pharmacist, I do not support ‘Big Pharma’ when it comes patients unnecessarily being prescribed medication.

Personally, I use caution when it comes to dietary supplements for one simple reason – they are not regulated like prescription medications. The FDA is the administration that regulates the approval and use of prescription medication. What this means is that on a prescription bottle labeled with a specific amount of ingredients, you can be certain that the actual amount in a given tablet, capsule, cream, suppository, solution, etc. is between about 95% and 105% of what the label actually states. As an example, if you are prescribed to take a tablet that is 100mg in strength, then you can be certain that the amount is between 95mg and 105mg of that medication.

On the contrary, dietary supplements are regulated by the Dietary Supplement Health and Education Act of 1994. Since they are not regulated like drugs, companies that manufacture and produce dietary supplements are able to put whatever claims they want on their bottles. It is possible and highly likely that what is stated on the supplement label is not what is in the actual tablet or capsule. In fact, the New York Attorney General and the Federal Trade Commission have recently filed suit against Prevagen for their claims of memory boosting.

Moreover, many weight loss dietary supplements contain botanicals and plant-derived ingredients that can cause and make health problems worse. Sometimes, these supplements can interact with prescription medicines that you are prescribed. St. John’s wort, in particular, can negatively interact with a number of medications, including Statins (Crestor, Simvastatin), Warfarin (Coumadin), and Tricyclic antidepressants, like Elavil or Pamelor.

I believe there are great health benefits and medicinal properties of nutraceuticals, however there is a great need for credible research and evidence before I would be comfortable recommending these products to my patients. Throughout my years of practice, I have found that many patients do not consider dietary supplements, OTC products, and vitamins as medications. I would recommend that the next time you have an appointment with your doctor, inform him/her of everything you take, even those that you purchase in a store or online, just to ensure that they are safe for you and do not interact with your prescription medications.

The next time you think of taking a supplement, remember that right now you have no way of knowing for sure what’s really in your supplement bottle. And despite the promising on the labels, the pills probably won’t make you any healthier (unless you have a medically diagnosed deficiency), and they might even be hurting you.

 

References:

  1. https://www.vox.com/2016/3/10/11179842/dietary-supplements-medical-evidence
  2. https://www.crnusa.org/CRNPR14-CRNCCSurvey103014.html
  3. https://annals.org/article.aspx?articleid=1789253
  4. https://www.iflscience.com/health-and-medicine/23000-people-us-end-er-annually-because-supplements

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Folic acid info for expectant mothers

The truth about folic acid

Folic acid supplementation has always been regarded as the key to natal wellness. However, recent studies have linked high levels of this vitamin to autism. So this may have you wondering what is a sufficient amount and where can I obtain it? First, you should be aware of the difference between folate and folic acid. Folate is the naturally occurring form of the vitamin which is found in foods such as dark leafy greens and legumes. On the other hand, folic acid is the synthetic form of the vitamin that you will find in over the counter supplements and fortified foods. There are many sources of folic acid which you may not have thought contained this pertinent vitamin (See Table 1). Depending on your diet, you may be able to obtain the daily requirements of folic acid from everyday foods. The daily requirement for adults is 400 mcg per day, for pregnant women it is 600 mcg per day and for breastfeeding women it is 500 mcg per day.

Folic acid containing foods

●     Dark leafy greens- spinach (1 cup raw = 110 mcg folate)

●     Asparagus- (1 cup raw = 122 mcg folate)

●     Broccoli- (½ cup cooked = 50 mcg folate)

●     Citrus Fruits- oranges (1 medium = 40 mcg folic acid)

●     Strawberries- (8 medium = 80 mcg folate)

 

●     Okra- (½ cup cooked = 135 mcg folate)

●     Beans-(black, kidney, pinto), ½ cup = 115-145 mcg folate

●     Peanuts- (¼ cup dry roasted, unsalted = 166 mcg folate)

●     Avocado- (1 cup = 386 mcg folate)

●     Banana Pepper- (1 cup raw = 443 mcg folate)

●     Salmon- (1 filet = 881 mcg folate)

Folic acid dietary intake is important because it aids in the development of the brain and spinal cord of the developing infant. Therefore, it is crucial that you are getting the correct amount either from the foods you eat or through supplementation. A recent study by ConsumerLab tested multivitamins and discovered that many vitamins did not match label claims, so you may be getting too much or too little of the desired vitamin. As always, it is important to discuss supplementation with your doctor and also consider blood work to determine your current levels of folic acid prior to adjusting your daily intake.

Although the prevalence of autism is at an all-time high, with careful monitoring of your daily folic acid intake you can avoid getting too much of this vitamin.

References:

  1. USDA.gov/food-sources
  2. Wiens D, DeWitt A, Kosar M, et al. Influence of Folic Acid on Neural Connectivity during Dorsal Root Ganglion Neurogenesis. Cells Tissues Organs 2016:1-12.

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