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!
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!
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!
Wednesday, March 25, 2015
Could It Be My Thyroid?
Hypothyroidism symptoms can mimic many other disorders, with fatigue, dry skin, changes in hair texture, and weight gain as the early symptoms. If your hormones are declining, these symptoms may sound familiar.
Hashimoto thyroiditis is an autoimmune disease of the thyroid and is the most common cause of hypothyroidism in the United States in patients over 6 years old. Originally thought to be rare, the incidence seems to be increasing, and it has probably been under diagnosed. It is 15 to 20 times more common in women than men.
On initial exam, simple thyroid testing may present as normal. Thyroid testing can include TSH (Thyroid Stimulating Hormone), T3, T4, and if ordered separately, Thyroid Antibody Testing. Usually, TSH is elevated in Hashimoto patients because the body is desperately trying to keep the thyroid levels normal in the serum, so Thyroid Stimulating Hormone is increased by the body and lab values will detect this. The trick is that in some individuals, TSH levels will appear normal, and even 10 to 15% of Hashimoto patients can test negative for thyroid antibodies.
This is when a good patient history can help. Make sure that your doctor knows if your mom, aunt, or other relatives were diagnosed with low thyroid. Treatment is simply taking supplemental thyroid for the majority of patients and this continues for life. If this is not effective, some patients may require dessicated thyroid or even compounded low dose naltrexone therapy to help balance the immune system cell response.
We recently had a patient with normal thyroid levels who was treated with hormone therapy but continued to have symptoms. Fortunately, the patient remembered her family history and asked her doctor to run thyroid antibody testing. She tested positive for thyroid antibodies, and was started on thyroid medication and is feeling much better.
The bottom line is that we are all more than the sum of our lab values. It is important to be an active partner on your health care team. Make sure that your doctor knows your full family history.
Healthy living with John Hollis Pharmacy!
Friday, March 20, 2015
Stress and Dementia
I have to veer slightly off topic today as I found a troubling article in the Wall Street Journal that arrested my attention. We all know that stress is bad for us and we know the detrimental impact on immunity and blood pressure and chronic disease states. This has always disturbed me; however, new information points to a relationship between stress and dementia.
This news should not be surprising based on information we already have. I think it comes down to this: dementia scares me. Other disease states can be managed, and while not always pleasant, symptoms can be diminished. Dementia is a beast.
Apparently, with uncontrollable stress, there is a significant increase in risk for developing dementia and other memory-related illnesses. Research using brain scans shows us that branches of brain cells can shrink and even disappear after traumatic events.
Neuroplasticity is the term to remember. This refers to the ability of the brain to regroup and form new neural connections. The brain is dynamic and damage can be reversed. The recipe for doing this will sound familiar:
Drink plenty of water.
Eat a healthy diet.
Exercise.
Manage your stress by reducing multi-tasking.
Get outdoors whenever possible.
Limit electronics.
Remember that your cell phone is not an appendage. We survived for many years without 24/7 connectivity. We all need downtime. Reverse that damage! Remember that a little stress keeps us sharp. Unmanageable stress is a killer.
More on stress management to follow!
Healthy living with John Hollis Pharmacy!
Wednesday, March 11, 2015
Adrenal Fatigue: Fact or Fiction?
We are hearing from more patients who are concerned about "adrenal fatigue." The symptoms can include:
-fatigue
-body aches
-sleep disturbances
-weight loss or gain
-dry skin
-low sex drive
While adrenal fatigue is not an accepted medical diagnosis, alternative healthcare providers have estimated that it impacts up to 80% of the population and is a treatable condition. This is a huge disconnect, so let’s start with background information. The adrenal glands are composed of two parts: the adrenal medulla, which secretes epinephrine, norepinephrine and dopamine and then, the adrenal cortex, which releases aldosterone, cortisol, corticosterone and androgens (sex hormones). Epinephrine is also known as adrenalin and helps produce the "fight or flight response" in the body. It increases alertness, moves the body’s attention away from digestion and prepares it for a quick run, and stimulates heart rate. Norepinephrine is the precursor for epinephrine, and a depletion of norepinephrine is associated with depression. Cortisol prepares the body for stress and can concentrate fat stores in the abdominal area.
In adrenal fatigue, the theory is that the body is in a constant state of stress. This, in turn, depletes the adrenals of the normal operating levels of neurotransmitters with resulting symptoms of fatigue, sleep disturbances, and weight changes among others. Diagnosis is usually made with salivary testing and treatment often involves adrenal supplements.
We recognize that patients are coming in with very real symptoms that are often untreated with conventional means. One of the primary reasons for undertreatment is that our current medical system does not allow enough time for patients to review lifestyle, dietary habits, and other contributing issues during a 15-minute appointment. Decades ago, the family practitioner could more accurately diagnosis patients because of the communal relationship…when Jane Doe complained of a lack of energy and sleep loss, the doctor could take her level of community involvement, her concern over an aging parent and her anxiety over a rebellious teen into the equation. Our stress-laden, transient 21st century lifestyle has replaced community relationships, and it is to our detriment. So, what to do?
First, get a good medical evaluation with blood (serum) testing including vitamin D, vitamin B12 and homocysteine levels along with electrolytes, cholesterol and standard testing. This does need to be fasting. Many treatable diagnoses can mimic adrenal fatigue, so these need to be addressed first. Also, realize that accurate saliva testing for cortisol needs to be taken between 11 pm and midnight for greatest accuracy according to Dr. Andrew Weill. These are the lowest levels of the 24-hour period and can give the most accurate picture for treatment.
Avoid adrenal supplements as too much cortisol can result in either depression or osteoporosis, and do not use the Internet for diagnosis or treatment of this, even though the ads are tempting!
For further treatment, a comprehensive lifestyle evaluation is necessary. Most women should be on additional B12 1000 mcg at least once daily. Our ability to absorb B12 decreases with age, and the popular gluten free and vegetarian diets can provide insufficient B12.
We will explore each of these suggestions in depth in the weeks to come, but for a quick overview:
-Limiting stress (I know easier said than done!) is essential
- Adequate sleep is vital
-Prayer and/or meditation is a proven stress reducer
-Eating a balanced diet and avoiding sugar can get you started
-Turning off the news and turning on relaxing music or music that makes you sing will help.
Pay attention to your body and listen to the messages…. We have enough stress inducers all around us. Unplug and go outside for a walk. The answer is not as simple as cutting out sugar and going outside for exercise but this is the start. More to follow!
Healthy for life with John Hollis Pharmacy!
We are hearing from more patients who are concerned about "adrenal fatigue." The symptoms can include:
-fatigue
-body aches
-sleep disturbances
-weight loss or gain
-dry skin
-low sex drive
While adrenal fatigue is not an accepted medical diagnosis, alternative healthcare providers have estimated that it impacts up to 80% of the population and is a treatable condition. This is a huge disconnect, so let’s start with background information. The adrenal glands are composed of two parts: the adrenal medulla, which secretes epinephrine, norepinephrine and dopamine and then, the adrenal cortex, which releases aldosterone, cortisol, corticosterone and androgens (sex hormones). Epinephrine is also known as adrenalin and helps produce the "fight or flight response" in the body. It increases alertness, moves the body’s attention away from digestion and prepares it for a quick run, and stimulates heart rate. Norepinephrine is the precursor for epinephrine, and a depletion of norepinephrine is associated with depression. Cortisol prepares the body for stress and can concentrate fat stores in the abdominal area.
In adrenal fatigue, the theory is that the body is in a constant state of stress. This, in turn, depletes the adrenals of the normal operating levels of neurotransmitters with resulting symptoms of fatigue, sleep disturbances, and weight changes among others. Diagnosis is usually made with salivary testing and treatment often involves adrenal supplements.
We recognize that patients are coming in with very real symptoms that are often untreated with conventional means. One of the primary reasons for undertreatment is that our current medical system does not allow enough time for patients to review lifestyle, dietary habits, and other contributing issues during a 15-minute appointment. Decades ago, the family practitioner could more accurately diagnosis patients because of the communal relationship…when Jane Doe complained of a lack of energy and sleep loss, the doctor could take her level of community involvement, her concern over an aging parent and her anxiety over a rebellious teen into the equation. Our stress-laden, transient 21st century lifestyle has replaced community relationships, and it is to our detriment. So, what to do?
First, get a good medical evaluation with blood (serum) testing including vitamin D, vitamin B12 and homocysteine levels along with electrolytes, cholesterol and standard testing. This does need to be fasting. Many treatable diagnoses can mimic adrenal fatigue, so these need to be addressed first. Also, realize that accurate saliva testing for cortisol needs to be taken between 11 pm and midnight for greatest accuracy according to Dr. Andrew Weill. These are the lowest levels of the 24-hour period and can give the most accurate picture for treatment.
Avoid adrenal supplements as too much cortisol can result in either depression or osteoporosis, and do not use the Internet for diagnosis or treatment of this, even though the ads are tempting!
For further treatment, a comprehensive lifestyle evaluation is necessary. Most women should be on additional B12 1000 mcg at least once daily. Our ability to absorb B12 decreases with age, and the popular gluten free and vegetarian diets can provide insufficient B12.
We will explore each of these suggestions in depth in the weeks to come, but for a quick overview:
-Limiting stress (I know easier said than done!) is essential
- Adequate sleep is vital
-Prayer and/or meditation is a proven stress reducer
-Eating a balanced diet and avoiding sugar can get you started
-Turning off the news and turning on relaxing music or music that makes you sing will help.
Pay attention to your body and listen to the messages…. We have enough stress inducers all around us. Unplug and go outside for a walk. The answer is not as simple as cutting out sugar and going outside for exercise but this is the start. More to follow!
Healthy for life with John Hollis Pharmacy!
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