Vitamin C in Facial Serums and Creams

I like to use vitamin C on my face in the form of a serum as it helps with collagen production and because it seems to decrease age spots (which I started getting in my 30s!) and redness. I was frustrated when my expensive name brand vitamin C serum gradually turned from clear to a deep yellow, and even more frustrated when I was told that it was simply oxidation and not to worry. As a pharmacist, I know that oxidation decreases effectiveness, so I have been on a search for a vitamin serum.

All vitamin C is not the same.

There are some versions that are more safe than others.

Some versions of vitamin C actually become toxic when exposed to ultraviolet radiation (the sun) and can contribute to formation of skin cancers.

The safest form to use is the water soluble L-ascorbic acid or ascorbic acid, which is the form of vitamin C found in nature and used by the body to repair wounds, build skin, and protect the body from disease. Magnesium or sodium ascorbyl phosphate or ascorbic acid phosphate is also safe as it has simply had a phosphate added for preservation.

The form to avoid is ascorbyl palmitate or any version of this, especially in liposome form. Ascorbyl palmitate (also known as tetrahexyldecyl ascorbate) is an oil soluble derivative. While the idea of making an oil soluble form seemed sound because it would increase penetration of the layers of the skin, studies have shown that ultraviolet exposure makes this form toxic to skin cells. Using the liposome form means that the palmitate is wrapped in lipids so that it is even further absorbed in the skin, which in this case, is a bad idea.

Read the labels and look for either L-ascorbic acid or the phosphate form.

At John Hollis Pharmacy, we use the sodium ascorbyl phosphate version. I started using this and my vitamin C serum no longer oxidizes, so I am delighted.

Also, oral vitamin C 500 mg daily is great for skin integrity. If your skin on your arms seems more fragile, vitamin C can help!

Healthy living and more vibrant skin with John Hollis Pharmacy!

Sunscreen and Sun Safety

It is that time! Warm weather has arrived, and I know that all of you are looking at your white legs and your summer shorts and skirts and thinking that you need color! This is the time of year when I am relentlessly hounding my children with a tube in my hand, with those famous words…."You’ll thank me when you’re thirty!!!" They won’t.

All this to say, wear sunscreen. Twenty minutes is the maximum outside without it.

Wear sunglasses. I have too many friends developing macular degeneration and having to have shots in the eyeball to preserve vision.

As for sunscreen types, I have strong opinions. Surprised? Hah! The skin is the largest organ of your body. Therefore, what you put on it matters. There are chemical sunscreens and there are physical sunscreens. I prefer physical sunscreens because these do not introduce a chemical into your body and I really do believe that the fewer chemicals introduced into our systems, the better. Doesn’t this simply make sense? The physical sunscreens are inert minerals that stay on the surface of the skin and actually form a physical barrier to UV radiation. The two minerals used are titanium dioxide and zinc oxide. And yes, that was the icky white paste that lifeguards once spread on their noses to prevent sunburn. It works! Now there are different forms of these minerals that are more cosmetically appealing. Look for the micronized form of zinc oxide or titanium dioxide. I DO NOT want you to use the nano-particles of these minerals. This form is too small and could potentially be absorbed in the body. The jury is still out on this formulation. Cosmetically, it is transparent on the skin, which is great, but I have concerns about absorption into the body. The micronized version will look a little white on your skin, but we are talking about preventing cancer and reducing chemicals in the body, so give a little, okay?

These sunscreens are more expensive than the familiar brand name sunscreens, but are a healthier choice. Reading the label is essential. Do not be mislead by the marketing label that says "Mineral Sunscreen" when the label on the back reads "zinc oxide 1%, oxybenzone 9%, etc." This is not what you want. Also, the SPF is not as important as re-applying. Sweating and swimming remove sunscreen, so re-apply regularly. As for brand recommendations, Costco carries The Honest Company brand of sunscreen with zinc oxide as the primary ingredient. It is PABA and dye free, and I use it at home. Blue Lizard is a good brand that most drug stores carry. This web address http://www.ewg.org/sunsafety/astore.php is a link to the Environmental Working Group and contains both a link to specific sunscreen products and more information on sun safety. I know that a thicker sunscreen is more of a pain to use, but this is important. Introducing fewer chemicals into your body is important. Stay safe!

Healthy summer living with John Hollis Pharmacy!

The Pollen Tsunami

It is definitely springtime in Nashville as any item left outside for two hours or more will reappear as a yellow tinged object. This does include children and pets. Even if your loved ones do not look jaundiced, don’t be deceived. They walk in the door with a mother lode of pollen which will wreak havoc on your allergies. We are taking a detour from vitamins today because the lunchroom topic was all about defense mode for the Nashville spring, and the staff agreed that everyone needed a pollen primer.

Take showers at night. Physically removing pollen by washing it down the drain is the first step. At the very least, change the pillow case often. Rolling around in pollen all night helps no one.

We have great over the counter medications, but these need to be started early! It is absolutely okay and even important to begin these medications before symptoms start if you suffer from allergies. One of my physician friends starts her family on a nasal steroid and an oral antihistamine around the time of the Final Four each year and continues until the pollen leaves. Flonase and Nasacort nasal sprays are both available without a prescription, and either one will work. Any of the non-drowsy antihistamines (Zyrtec, Allegra, Claritin) in generic form will be effective. Take it daily. If your antihistamine no longer seems to provide relief, switch from one to another. This usually helps. I have no real preference on brands.

Using a saline spray or Neti-Pot (disgusting, I know, but it works) will also help remove the pollen from the nasal passages. While the pollen count is high, stay inside with the air conditioning on and make sure that your air filters have been changed.

Wrap your mattresses and pillows with allergy covers. These are inexpensive and will help. Wash sheets and mattress pads often. We use a cool mist humidifier with essential oils, also. Get plenty of rest. Going to battle with pollen daily is an exhausting process, and nothing taps out your immune system as quickly as a lack of sleep. Drink fluids, especially water.

If your eyes are prickly feeling or red and itchy, there are several eye drops like Zaditor that were once prescription items but are now available over the counter. Just remember to remove those contacts before using the drops! The bottom line is that there are now a number of medications that were once prescription that are available for use and can help during this rough season. Hang in there!

Healthy living with John Hollis Pharmacy!

Vitamin Confusion

As long as I am pontificating on vitamins, I wanted to take the opportunity to let you know that not everyone needs all vitamins at all times.  There are tons of supplements that can be added to the diet, and we can easily go over the edge trying to keep up with them!  Therefore, I wanted to provide a few hard and fast rules:

1.  Make sure your doctor knows which vitamins/supplements you take daily.  Nothing is completely harmless.  B12 comes close, but we have already covered that.

2.  Recommendations change as information changes.  Remember when vitamin E was all the rage?  New studies associate it with stroke, so only use this if your prescriber directs.

3.  Even aspirin is getting a second look.  Last year, everyone over 40 was supposed to be taking an aspirin a day.  This year, new studies point to the risk of increased bleeding in enough patients that the risk outweighs the benefit in a patient who has not been diagnosed with a medical need.

4.  Remember that all these vitamin suggestions are the equivalent of going to a cafeteria.  Just as no one takes all items from the line, no one needs to take all vitamins.  Take specific vitamins for specific needs based on your prescriber’s recommendation.

5.  Essentials:  In my opinion, it is great to have a vitamin D level and I would suggest vitamin D for anyone over 45 if levels are low.  I think Co Q 10 is great for anyone over 45, and I personally love the B vitamins but if your energy level is fabulous and you have nerves of steel….not necessary!

6.  Other than that, eat a balanced healthy diet and exercise.  More next week.

Healthy living with John Hollis Pharmacy!

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!

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!

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!