Helpful Health Blog Written by Bay Area MD

Here is the link to an interesting blog by a Bay Area medical doctor, Shiroko Sokitch, who integrates Chinese and Western medicine in her practice.  Dr. Sokitch has a unique approach to healing that she calls the 20/30/50 healing path, suggesting that 20% of a health issue can be attributed to a physical problem, 30% can be related to lifestyle issues, and 50% can be connected to spiritual and emotional concerns.   Dr. Sokitch’s latest two blogposts address the issues of depression and allergies from a holistic point of view.  Her blog is a great resource!

Healthy Digestion

Healthy digestion is a key component to our overall well-being.  Several common illnesses and conditions, such as food allergies, eczema and psoriasis, rheumatoid arthritis, and Chron’s disease, can actually be attributed to gastrointestinal dysfunction.   Taking specific supplements can be an effective way to address the root cause of some of these health challenges.  Click here to read more about seven supplements that can heal the GI tract by targeting multiple areas where the system might have broken down.

Of course, it is always important to talk with a knowledgeable practitioner when deciding if a particular healing protocol is right for you.  To see a list of Bay Area doctors who specialize in a holistic, integrative approach to health, see Koshland Pharm’s referral page.  Here’s to healthy eating, healthy digesting, and healthy living!  ~Peter

Healthy Weight

Weight loss is something many of us think about, especially as we get older.  As we age, our metabolism often diminishes, which can make it increasingly difficult to maintain a healthy weight.  I am pleased to share here an evidence-based supplement program that I recently learned about that helps address healthy weight management.  This program helps to restore healthy metabolism at the cellular level.  Click here for more information and to find out if this program might be right for you.

Of course, anytime that we are working on our own weight, it is important to think about general practices for healthy living, such as exercise and nutrition.  Click here to go through a checklist to make sure you are on the right track in your daily life with exercise, relaxation, sleep, and nutrition.  –Peter

Thyroid Madness? Apparently so.

Those of us in the pharmacy world have certainly noticed the sporadic availability of Armour Thyroid and Nature-throid, but to those who rely on this form of thyroid supplementation (derived from desiccated porcine thyroid gland), the shortage is nothing less than a threat to their very well-being.

Hypothyroidism is a very common endocrine problem, affecting approximately 11 million people worldwide, and twice as many women as men. Symptoms of hypothyroidism include low energy, fatigue, cold in the extremities and constipation. For a comprehensive symptom checklist for hormone imbalance go to www.koshlandpharm.com/documents/Comprehensive-Symptom-List.pdf As a compounding pharmacist, the thyroid issue has been the number one concern expressed by my patients. I am glad to report that at my pharmacy we have been able to make high-quality desiccated porcine thyroid capsules with great success (patient feedback has been very positive). The thyroid powder has to be mixed with an inactive ingredient in order to properly fill the capsule and ensure that each capsule has the proper amount of active ingredient. We are able to use different inactive ingredients in addition to the standard microcrystalline cellulose (Avicel). These include acidophilus powder, and ginger root powder which have their own therapeutic benefits.

There are a couple of good discussion boards and blogs about the thyroid, namely www.thyroid.about.com and www.stopthethyroidmadness.com. Both of these sites do a good job of expressing the importance of proper thyroid testing and supplementation and hope to answer some of the questions about the current controversy surrounding Armour Thyroid and Nature-throid. Although I don’t have any answers to explain the thyroid shortage, it may be partly due to the FDA’s recent tightening of its definition of Thyroid USP, the active ingredient in these products.

As an experienced compounding pharmacist, I figure it is time to put my own two cents out there on this subject. The standard of care for hypothyroidism taught by the medical schools (and pharmacy schools) is to start a patient with levothyroxine or T4 (aka Synthroid, Levoxyl, etc.). For many patients, this is an effective treatment, but it assumes that the patient efficiently converts the levothyroxine to liothyroinine (T3), the active form of the hormone. Levothyroxine also provides no additional constituents to support the healthy functioning of the thyroid gland itself. For patients who do not respond well to levothyroxine, desiccated porcine thyroid is a viable option, and many patients do significantly better on this supplement rather than levothyroxine. One explanation as to why some patients respond better is that it contains T3 and T4 roughly in physiological doses. It also has many of other byproducts of the thyroid gland that may support healthy thyroid functioning, like T1, T2, iodine, calcitonin, and other glandular fragments. This kind of treatment harkens back to the earlier part of the 20th Century when glandulars were often used to treat many ailments, often with great success. The rise of the pharmaceutical industry in the 1950s and the marketing of single pharmacologic agents greatly diminished the use of many glandular treatments.

For patients worried about obtaining the desiccated porcine thyroid, the good news is that compounding pharmacies have been able to fill in the gap left by the manufacturers of Armour Thyroid and Nature-throid. It is important to choose a compounding pharmacy that is using a high quality form of the Thyorid USP. The FDA states that for Thyroid powder to be considered USP grade (or pharmaceutical grade), it must have between 90 and 110% of the allowed amount amount of T3 and T4. This is a very wide potency range and could potentially account for therapeutic differences between two thyroid products that are labeled as the same strength. For information about selecting a high-quality, professional compounding pharmacy see my blog post, How to evaluate a compounding pharmacy.

I also want to mention another compounded thyroid product that may be useful for some patients and has been largely been left out of the current thyroid discussion. This is a compounded capsule that has the thyroid hormones T3 and T4 in a sustained-release form. This product is similar to the off-the-shelf products like Synthroid (T4) and Cytomel (T3) with 2 distinct advantages. The first is that the T3 and T4 can be combined into a single dose and customized to a strength that perfectly suites a patient’s needs. The second advantage is that by making these capsules sustained-release, the hormones are absorbed more steadily minimizing the potential of having any low thyroid symptoms hours after taking the tablets. Since the thyroid gland produces both T3 and T4 in a steady release, this product more closely mimics natural thyroid production.

The thyroid controversy is undoubtedly going to continue for the foreseeable future. Patients educating themselves about this issue are in a good position to advocate for their health and demand relief from hypothyroid symptoms, especially if their current medications are not meeting their needs. At Koshland Pharm: Custom Compounding Pharmacy, we want to be a resource for patients and providers, as well, helping facilitate optimal health and well-being of our patients. Don’t hesitate to call us at the pharmacy if you have any questions (415-344-0600).

Live well.

Black Cohosh for Menopause

Black cohosh is a popular natural remedy for menopausal symptoms and I am often asked of my opinion of it.  Having looked at the literature and from my personal experience with patients, I generally have a positive view of black cohosh.  However, I have had many patients who said that it didn’t work for them or only had a minimal effect.  The literature supports this observation. 

Black cohosh is modestly effective for menopausal symptoms like hot flashes.  The most studied brand is Remifemin, so I usually recommend this brand and which seems to be widely available.

Black cohosh is considered generally safe although some case reports of liver damage have been reported.  There is no conclusive evidence that black cohosh was the cause of those reports, it is generally a good idea to have your doctor include a liver function panel with your routine blood tests.  The flashfree blog has an excellent posting on the liver toxicity risks of black cohosh at http://flashfree.wordpress.com/2009/04/27/erring-on-the-side-of-black-cohosh/. 

Black cohosh should be avoided in pregnancy and lactation due to its hormonal and uterine stimulant effects.  It should also be avoided in women with a history of breast cancer or other hormone-sensitive cancers.  It does interact with a handful drugs, as well, including Lipitor, Elavil, Paxil, Ultram and some others.  It is a good idea to talk with a pharmacist if you are on prescription drugs to make sure there are no interactions before taking black cohosh.

The normal dose of Remifemin is 2 tablets twice daily (other brands may require a higher dose).  Often, it can cause upset stomach and can be taken with meals to help lessen this side effect.  Less commonly, black cohosh can cause rash, headache, dizziness, weight gain, cramping, breast tenderness or vaginal spotting.

The bottom line is that like soy, black cohosh is a viable natural remedy for mild to moderate menopausal symptoms.  (For more information about Soy, see my previous posting Soy For Menopause.)  Concerns about liver toxicity with black cohosh haven’t been proven but it’s still a good idea to have your doctor monitor liver function while on it.  It does tend to cause upset stomach so it’s a good idea to take it with meals.

Just like prescription drugs, natural remedies are not without risks, so I always recommend keeping your doctor and pharmacist in the loop if you are taking any supplements.  If you have any questions about black cohosh or any other natural remedy, I’d be happy to try to address them.

Thank you and live well!

Soy for Menopause?

I get lots of questions from women asking if it’s a good idea to take soy to help with menopausal symptoms.  Many women have heard that soy contains estrogen-like compounds and wonder if it is safe and effective.  The short answer is yes.

The long answer is a bit more nuanced.  First, soy contains isoflavones which are compounds that act like estrogens in the human body (i.e. they stimulate estrogen receptors), but these compounds are technically not bioidentical because their chemical structure is different from human estrogens.  Here’s what we know and don’t know about the health benefits of soy so far:

• hot flashes – soy seems to have a modest effect in reducing hot flashes in some women, but many women see no effect
• lipid levels – a meta-analysis of 38 studies (mostly in men) showed that consuming soy protein reduced cholesterol levels
• bone density – early studies showed that soy may increase bone density, but a later well-designed clinical trial showed no increase in bone density in women over 60 taking 100mg of soy isoflavones daily
• cognitive function – soy doesn’t appear to improve cognitive function or prevent Alzheimer’s disease
• breast cancer – we don’t know how soy affects breast cancer risk – it may have protective effects as the soy isoflavones compete for the estrogen receptor sites of more potent estrogens, but that notion is strictly theoretical
• endometrial hyperplasia – this is a thickening of the endometrial lining and is something to be avoided - a study that looked at women taking a supplement containing 150mg of soy isoflavones for 5 years had an increased incidence of endometrial hyperplasia.

The bottom line is eating soy containing foods or soy beans is safe and may have modest beneficial effects.  If supplementing with soy isoflavones, stay below 80mg per day to avoid an increased risk of side effects. 

My take on soy is that it doesn’t really address the most common hormone imbalance I see in my practice, namely estrogen dominance (for more information see my postings What is Estrogen Dominance? and The Power of Progesterone!).  Most women need to balance out their estrogen levels, not with more estrogen like substances, but with progesterone.  With that said, I would never discourage anyone from taking soy who feels they are benefiting from it or are adding soy as part of a healthy diet.

If you want to post comments or questions (including requests for citations on some of these clinical trials), please do so.

Thanks and live well!