Wednesday, April 29, 2015

Vitamins and Depression

The current buzz in depression treatment involves L-5 methylfolate. Studies indicate that around 70% of depressed patients have low levels of the enzyme needed to convert folic acid to the active L-5 methylfolate. In the body, L-5 methylfolate is responsible for reducing homocysteine levels and increasing levels of neurotransmitters. Prescription antidepressants work by blocking the uptake of neurotransmitters, but not actually increasing the amount in the body. L-5 methylfolate actually increases the amount of neurotransmitters (like serotonin) that your body makes.

Scanning the literature, it is easy to find information on L-5 methylfolate for treatment for everything from Alzheimer’s disease and dementia to heart disease, including help with short term memory, concentration, sleep, motor control, motivation, mood stability and even hormone levels. I recommend only taking L-5 methylfolate under the care of a physician and this is why: there are medications (like the commonly used pain reliever tramadol) that interact with increased levels of serotonin and can cause serious side effects. Some antidepressants can have serious side effects when used with L-5 methylfolate. With all this being said, I do think that it is an important vitamin to have available, and I would consider this first for mild depression because of the low side effect profile. Any time that we can use the body’s natural resources to overcome disease states, we are moving in the right direction. Your doctor can determine if antidepressants need to be used along with this for optimal results.

On the web, there are several forms of methylfolate for sale. Be aware that not all L-5 methylfolate is the same. Only the LEVO isomer of L-5 methylfolate is effective, and currently, it is expensive. There are two prescription forms available, and at John Hollis Pharmacy, we do compound L-5 methylfolate with other B vitamins for absorption and efficacy. The less expensive forms on the web are the "R" form or D-5-methylfolate. These are NOT effective and should be avoided. If you have a question, ask your pharmacist or physician. Under a physician’s care, doses of 5 to 15 mg of L-5 methylfolate are used. I would allow 90 days of treatment before evaluating effectiveness. Using the natural process of the body is a slower but healthier option. So the bottom line is that L-5 methylfolate (the real kind) is an attractive option for treatment of mild cognitive function issues (including depression) but only under the care of a physician.

Healthy living with John Hollis Pharmacy!

Wednesday, April 22, 2015

Vitamins, Anxiety, and Depression, Oh My!

Second only by a hair in my top vitamin line-up is vitamin B12 which is vital to proper functioning of the brain and nervous system. B12 helps with fatigue, weakness, memory loss, and depression to name just a few. Once again, chemo played the introductory role for me, in that after my final treatment, I found it difficult to walk or to even hold a coffee cup due to the pain in my hands and feet. My internist suggested drawing a B12 level, and while my lab values indicated a low normal, she suggested treatment with an oral tablet. My symptoms went away and my anxiety decreased.

This low normal level is not unusual. The Tufts Framingham Offspring Study found that approximately 40% of patients (age range 26-83) had a low normal and that patients could still have neurological symptoms at a low normal. Interestingly enough, the lab standard used in Japan and Europe doubles the threshold for normal (U.S low is less than 258 picomoles per liter, and European standard is 500-550). Scary. Even levels of 500 have been associated with memory loss.

It is not necessary to hasten to get a B12 level drawn. It can be expensive. Just know that decreased B12 absorption is part of the aging process and there are few of us who get enough in our diets. I suggest supplementing with 1000 mcg B12 along with a B complex vitamin. All the B vitamins help with the nervous system, but B12 is quickly metabolized by the liver when given orally so greater amounts must be taken. The B vitamins are water soluble, so the body eliminates what it does not use. Also, eat fortified breakfast cereal. These are inexpensive and easy fixes. Other dosage options are the sublingual and injectable forms.

Next week, we are going to discuss the role of B12 and another vitamin, L-5 methylfolate, in depression so stay tuned!

Healthy living with John Hollis Pharmacy!

Wednesday, April 15, 2015

Vitamin 101 Continues.....

My first choice in discussing vitamins (and I will use vitamins/supplements/minerals interchangeably for convenience) is one that is close to my heart…hah! Coenzyme Q 10 is an enzyme produced by the body that helps with energy production and supports heart health. I know that everyone is concerned about cancer these days, but heart disease kills more women than all cancers combined. Interestingly enough, cancer led me to CoQ10.

I underwent treatment for Hodgkin’s Lymphoma several years ago, and I was diagnosed with diastolic dypsnea (shortness of breath) as a result of chemo. Not wanting to let cancer "win" another organ system, I began researching and found that the chemo had impacted the mitochondria of the cell. The mitochondria are the energy powerhouses at the cellular level. Further digging revealed that CoQ10 worked at the mitochondrial level to repair and restore. CoQ10 has been used extensively in Japan for years for heart health and has a strong safety record. Also, in patients who are taking statins for cholesterol, CoQ10 levels in the body are decreased and taking supplemental CoQ10 can sometimes help relieve side effects.

Back to the diastolic dypsnea….after taking CoQ10 for several weeks and a return to the cardiologist, I no longer had the diagnosis. While my cardiologist was not willing to give CoQ10 the credit, I am not willing to stop taking it. My heart health is great, the side effect profile of CoQ10 is minimal (usually mild stomach upset at most), it does not accumulate in the body, and, according to Mayo Clinic, there is good scientific evidence to support the use of CoQ10 for heart failure and high blood pressure. The list of other potential benefits of CoQ10 ranges from decreased cancer risk to better eye health and even anti-aging (!) benefits.

As for me, I will continue my 100 mg of CoQ10 daily….without dypsnea. I generally suggest this dose for all aged 45 years and older as the levels of CoQ10 in the body decrease with age.

Healthy living with John Hollis Pharmacy!

Tuesday, April 7, 2015

Vitamins 101

We are going to spend a few weeks on vitamins because there are so many out there! Today, I want to start with supplements for teens as this is easy.

Children and teens are great at getting the majority of what they need from the foods they normally eat along with a good multivitamin. The exception enters the equation when a child is heavily involved in a sporting activity and has a rigorous training schedule. Also, if the family is on a gluten-free or paleo diet, or any diet that is selective in food categories, the teen may not be getting necessary vitamins or minerals.

Teens with a robust training schedule need iron. Teens often drink truckloads of milk. However, milk interferes with the absorption of iron. If you have an active milk-guzzling teen who does not really care for meat, this can create a perfect storm of iron depletion. I experienced this firsthand with my teen who is a competitive rower. Her winter training schedule kicked in and it became more and more difficult to wake her in the morning. We went to her pediatrician (eventually), and she presented with lethargy, fast heart rate, and pallor. Fortunately, her pediatrician is a great diagnostician and did not settle for simply checking her hemoglobin, which was normal. The problem was in her ferritin levels. Ferritin is the iron storage system in the body. Her body was doing everything it could to keep the system as intact as possible which was why her hemoglobin and hematocrit levels were fine. Low ferritin levels are common in young athletes according to our pediatrician. Fortunately, this was an easy fix. She was put on supplemental iron for a few weeks, and she now takes a multivitamin with iron daily. She eats more meat, drinks less milk and more water.

Spring sports are beginning, so this is a great time to make sure your young athlete is well fed, and taking a good multivitamin…with iron as necessary!

We will begin our adult supplements review next week.

Healthy living with John Hollis Pharmacy!

Wednesday, April 1, 2015

Vaginal Dryness: Non-Hormone Option

While not life threatening, vaginal dryness can be like a pebble in your shoe.  It is irritating and unpleasant, but not all women want to go on hormone therapy to address this one issue.  Also, not all vaginal dryness is caused by reduced estrogen levels.  We are often asked about treating individual symptoms, and vaginal dryness can be at the top of the list.

One option is a non-hormonal vaginal maintenance cream.  At John Hollis Pharmacy, we compound a formulation with hyaluronic acid as the primary active ingredient and additional vitamins for increased relief.  Hyaluronic acid is a glycosaminoglycan normally found in our bodies that is part of extracellular maintenance and is secreted by the body during tissue repair.  It has a high safety profile, no hormone-like adverse effects, and it works rapidly to reduce symptoms of vaginal dryness.  This is a safe and effective treatment to restore the moisture barrier.  Have your doctor call us for this natural, non-hormonal alternative!

Happy Easter and healthy living with John Hollis Pharmacy!