How To Tackle an Ingrown Toenail

The last time I was at a family gathering, my sister asked me, “What’s your favorite over-the-counter product?”

That’s easy to answer: it’s New Skin®. Normally used to seal up cuts and scrapes, I love to recommend it for a completely different condition: ingrown toenails.

I ’ve spent years and years fighting the pain of getting ingrown toenails on both of my big toes. Then, as a pharmacy student sitting in class, one of my professors mentioned a product  called Outgrow® that he recommended for avoiding ingrown toenails. “It’s brushed onto the skin where an ingrown toenail likes to form and like magic, it will “toughen up” the tender skin and keep the nail from cutting into it. Eventually, the nail is forced to grow out straight.”

“Aha!” I immediately went out and purchased a bottle and used it very successfully for years, until I misplaced it somehow during a move out of state. I didn’t worry about it at first, thinking I could just buy another one. But alas, when I went to the pharmacy shelf to pick up another bottle, I couldn’t find it anywhere. Further research revealed that the manufacturer had discontinued their original formulation several years back. I was willing to try anything, so I ordered the new version. Unfortunately for me, the “new” formula proved totally useless, and I was again plagued with painful ingrown toenails.

Years and many ingrown toenails later, I renewed my search for something like the original version of Outgrow® that would  toughen up or protect my skin. I’d used New Skin® before on cuts, and wondered, “Could this work to prevent an ingrown toenail?” Another plus is that New Skin® contains an anti-infective compound called 8-hydroxyquinoline which can help heal your ingrown toenail! When I tried it, it worked so well that I happily recommend it to anyone else needing to avoid ingrown toenails.

Here’s how to use New Skin® to prevent or treat an ingrown toenail:

  1. You’ll need a bottle of New Skin®, a toothpick, a place to apply it that you can wipe up the mess if you spill or drip, and at least 15 minutes of drying time.
  2. Soak your toes in warm water to soften your toenail. You can also do this right after a warm bath or shower.
  3. Dry your foot well.
  4. Brush on a thin layer of New Skin® along the skin of the nail that tends to or which is already curling under your tender skin.
  5. While still wet, use the toothpick to lift up the edge of your toenail just a bit and work some of the liquid New Skin® underneath it so that the liquid is between your nail and your skin. You don’t need a thick coat, just enough to spread along the nail where it likes to curl.
  6. Let it dry for at least 5 minutes.
  7. Repeat if needed with a second “coat”, letting it thoroughly dry before putting on socks.

One 2-coat application lasts me several months. You’ll notice that your toenail will grow out nice and straight instead of cutting into your skin. Enjoy the freedom from the pain of pesky ingrown toenails!

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How to Stay Healthy During Flu Season

February 9th, 2017. Filed Under: Allergies, Cough and Cold, Influenza, Travel.
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It’s been a nasty flu season so far. Over the holidays I see family members that don’t get out too much, and one of my cousins asked me, “How do you avoid getting sick during the winter months, when your job requires you to be exposed to sick people all day long?”

There are two habits that can REALLY help you avoid infections from viruses like colds and the flu. One of the most important is also simple, yet not always easy to do: avoid touching your face with your hands, because that is how viruses can easily infect you. As much as possible, avoid using your hands to rub your nose, rub your eyes, or touch your mouth. I admit, it’s a hard habit to break, but it does cut down on your exposure to viruses.

The second key habit to avoid getting the flu is to wash your hands frequently and EFFECTIVELY. Unfortunately, most people, even medical professionals, don’t wash their hands well enough. Wiping your hands with antibacterial gel is just not good enough if you want to avoid getting sick from viruses.

Friction is more important than chemicals. Washing your hands by lathering with soap, then rubbing the surfaces thoroughly has been proved more effective than using an antibacterial gel or soap. Two of the most neglected areas are between your fingers and along your cuticles.

After years as a hospital pharmacist I’ve developed a serious allergic reaction to triclosan, a common antibacterial chemical used in Liquid Dial® and Softsoap®. To avoid having my hands itch and peel after using soaps containing it, I avoid all antibacterial soaps as much as possible. Instead, I carry a small bottle of liquid shampoo with me to wash my hands in hotels, restaurants, airports and some family member’s homes that still contain liquid antibacterial soaps.

Here are a few tips to help you stay healthier during the winter months:

  1. Wash your hands frequently and thoroughly. You DON’T have to use antibacterial soap, just good technique.
  2. The key to good hand washing technique is FRICTION. Lather up and rub every surface well, spreading your fingers apart to get in between them.
  3. When washing your hands, don’t neglect to rub the lather into your cuticles, where viruses can easily hide.
  4. To avoid contact with the chemical soaps found in most airport and restaurant restrooms, carry a hotel-sized bottle of liquid shampoo that you can use instead.


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Is It a Stool Softener or a Laxative?

Q: What’s the difference between a stool softener and a laxative?

A laxative encourages movement of the stool and assists you in eliminating feces. The word laxative means “to loosen” and is related to the word “lax” which means loose or relaxed. A laxative works to “loosen” your bowels and relieve constipation. Stool softeners are actually considered a type of laxative called emollient laxatives.

When you become constipated, it’s often because the muscles of your intestines are not moving as well as they should, slowing down the removal of your feces. The longer it takes your feces to move from your small intestine to your rectum the more water gets pulled out of it along the way, making your stool smaller, harder and more painful to eliminate. An emollient is a substance that works by softening or increasing moisture. Two types of stool softeners that work as emollient laxatives are docusate and mineral oil.

Docusate is a surfactant that acts just like a detergent or soap. Like detergents, docusate decreases the surface tension of water and helps it move water into your stool. Although docusate doesn’t directly stimulate the muscles of your intestines or the movement of stool, it can help avoid and relieve constipation by counteracting how much water your stool loses as it moves through your intestine. Docusate is usually easy to tolerate but may occasionally cause diarrhea or stomach cramps. Unlike mineral oil, it doesn’t interfere with absorption of nutrients or any vitamins.

You’ll find docusate more effective as a preventative than as a laxative because it works more slowly. You should allow 12 to 72 hours for it to work. Most of the time it will give you results within 2 days but can take up to five days for full effect. It’s often combined with a stimulating laxative for a faster effect.

The other emollient laxative is mineral oil. Mineral oil is a liquid that helps to soften the stool but doesn’t change the amount of water in it like docusate does. Mineral oil is not as safe to use as docusate because if you aspirate or inhale it by accident it can cause life-threatening irritation to your lungs called aspiration pneumonitis. Mineral oil interferes with absorption of fat-soluble vitamins like vitamin A, D, E and K, and can cause oily leakage out of the rectum. Avoid taking docusate along with mineral oil as a laxative. Docusate will help mineral oil get absorbed into your body instead of staying in your intestines, where it needs to be to work.

5 Tips for Using Docusate Successfully as a Stool Softener:

  1. Increase your water and fluid intake when taking docusate; this will increase its effectiveness. Because docusate works by helping move water into your stool, drinking more fluids help it do its job better.
  2. If you are on a sodium-restricted diet, look for the calcium form of docusate instead of the more common sodium formulation. Docusate calcium comes as a 240mg capsule instead of 250mg, like docusate. It’s sometimes hard to find; if you don’t see the calcium form of docusate on the shelf, ask your pharmacist.
  3. Docusate sodium comes as liquid-filled capsules in two sizes: a 100 mg size and a much bigger 250 mg size. If you have any trouble swallowing capsules, you should select the 100 mg capsules, but because the 100 mg and the 250 mg are usually about the same price, the 250mg capsules are a better value.
  4. Although I have seen root beer flavored mineral oil, most mineral oil is bland tasting. Docusate is not bland. It tastes just like soap! Avoid biting or cutting docusate capsules unless you like the taste of your mother washing your mouth out with soap. The syrup is nearly as bad; it ranks consistently at the bottom of our liquid taste tests and the soapy taste can linger for hours.
  5. If you need a faster result, combine docusate with a more stimulating laxative like senna or bisacodyl. Senakot-S® and Peri-Colace® are examples of combination products.

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How To Take Your Thyroid Medicine

Q: My husband takes a thyroid medicine called levothyroxine. He went to his doctor last week because he’d been feeling tired and the doctor told him it’s because he’s taking his thyroid pills wrong. All these years he’s taken it with his other morning pills at breakfast, but now he’s supposed to take it 30 minutes BEFORE his breakfast instead. He’s tried to make the switch but it’s really hard for him to remember to take it first thing in the morning. Is there anything we can do?

Levothyroxine is a very potent medicine; even small changes in the dose can create big differences in how much energy you have. How much levothyroxine you need can depend not only on how much medicine is prescribed by your doctor, but also on HOW you take those pills. Your husband may not be getting the entire dose of his thyroid medicine because food can interfere with the ability of levothyroxine to get into your body.

Like most medicines, in order to do its job levothyroxine must first get into your body. It needs to jump from a pill sitting in an amber prescription bottle all the way into your thyroid gland, where it works to support your metabolism and give you energy.

When you swallow a pill it doesn’t magically dissolve in your stomach and do its thing right then and there. Most medicines need to get into your bloodstream first before they can get to where they need to go and do what they are supposed to do. Although your pills dissolve in your stomach they can’t jump into your body from there. Instead, medicines and nutrients have to leave your stomach and move into your small intestine before they can be launched into your body.

Your small intestine is a busy place. Its walls are covered with blood vessels and specialized cells designed to transport nutrients and medicines into your bloodstream, where they get carried on throughout your body and delivered to where they need to be, like levothyroxine going to your thyroid gland.

The process of medicine going from a pill you swallow to entering your bloodstream is called absorption. Some medicines are better at being absorbed than others. While many medicines are completely absorbed after you take them, other medicines like levothyroxine can run into trouble along the way, resulting in less of it getting into your body and doing its job.

Your husband will get more consistent results from taking his levothyroxine on an empty stomach because food and certain minerals can attach themselves to it and prevent it from making the trip through the wall of his small intestine into his bloodstream and on to his thyroid gland.

But the most important thing of all is taking it consistently, every day, the same way. His doctor will use blood tests to adjust his levothyroxine dose if he needs more.

Here Are 5 Tips For Best Results When Taking Levothyroxine:

  1. Levothyroxine is absorbed best on an empty stomach, either AT LEAST 30 minutes before a meal OR 3-4 hours after you’ve finished eating.
  2. If you have trouble remembering to take your levothyroxine first thing in the morning, try taking it at bedtime instead, as long as it’s been at least 3 hours since your evening meal. Taking it at bedtime may be easier to remember than taking it all by itself in the morning, especially if you take other medicines at the same time.
  3. If you forget to take your levothyroxine before breakfast, go ahead and take it anyway. Don’t worry, your stomach is not going to blow up, your intestines are not going to fall apart and your thyroid is not going to die. If you take levothyroxine with your meal you may not absorb the whole dose but if you skip entirely it you won’t get ANY of it absorbed! And that’s worse.
  4. If trying to take levothyroxine on an empty stomach is too complicated to do, don’t panic. It’s perfectly okay to take levothyroxine with your breakfast or other meal, as long as you take it that way all the time. Many patients are perfectly successful taking levothyroxine because they ALWAYS take it with their breakfast and don’t skip any doses.
  5. If you take calcium or iron supplements, don’t take them at the same time as levothyroxine. These minerals can significantly reduce the amount of levothyroxine that you absorb, so it’s best to separate them by at least 3-4 hours.


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Topical NSAIDs for Aches and Pains

December 5th, 2016. Filed Under: Uncategorized.
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Q: I’ve taken Aleve® or Motrin® for years for my bad knee, but now my stomach burns whenever I take them. My doctor tried me on Celebrex®, which didn’t burn my stomach but didn’t work for me. I’ve already tried Icy-Hot® and capsaicin but they burn my skin. Are there any other creams that could help my joint pain?
Yes. Motrin®, also called ibuprofen, is related to Aleve® (naproxen) and Celebrex® (celecoxib) which are Non-Steroidal Anti-inflammatory Agents, or NSAIDs. In the United States most people take NSAIDs by mouth as tablets, but in the UK and Europe they have used NSAID creams, gels, ointments and sprays for many years.

NSAIDs are very good at treating most types of swelling and pain, whether from a sudden injury like a muscle sprain or strain or a chronic inflammation such as arthritis. Using an NSAID cream or gel directly to your sore muscle or joint can relieve pain and inflammation without the side effects that NSAIDs often cause, like stomach burning, stomach pain, kidney or heart problems. For people who take a blood thinner, using a topical form of NSAID helps avoid an increased risk of bleeding.

You are not alone in noticing side effects from taking an oral NSAID like Aleve® or Motrin®. Many Americans with ulcers, kidney or heart problems could benefit from using an NSAID instead of a dangerous narcotic pain reliever. Sadly, diclofenac is the only commercially available topical NSAID in the United States and it requires a doctor’s visit for a prescription.

With so many other NSAIDs available, why is diclofenac the only one marketed in United States as a cream, gel or spray? I suspect the pharmaceutical companies haven’t bothered to develop or market topical versions of their NSAIDs in America because there’s not enough patent protection to make it profitable.

Another roadblock to the availability of topical forms of NSAIDs is whether it can penetrate the skin. Grinding a medicine up into powder and adding it to a cream or ointment doesn’t guarantee that enough of it will merrily move through the skin to cause a measurable decrease in pain. In some cases, the drug company has decided that the topical version of their NSAID medicine isn’t effective enough to justify the huge investment needed to pursue approval from the Food and Drug Administration (FDA).

Some topical NSAIDs have been shown to ease the acute pain of sprains and strains as well as the chronic pain of osteoarthritis. In September 2012 the Cochran Institute published a review of multiple studies called a meta-analysis on this topic, called Topical NSAIDs for chronic musculoskeletal pain in adults. They collected and evaluated lots of studies done with topical NSAIDs, many of them unpublished work from the files of drug companies. Two NSAIDs stood out as effective in chronic musculoskeletal pain: diclofenac and ibuprofen. Not only that, but diclofenac was shown to be just as effective applied to the skin as in a pill form, and with minimal side effects. Both ibuprofen and diclofenac gel are available without a prescription in the UK and Europe.

While visiting Germany a couple of years ago, I saw Voltaren® gel advertised in the windows of several Apotheks (German pharmacies). The day before we flew home I stopped at a busy Apothek to see if I could purchase some Voltaren®. Pointing at the boxes of gel displayed in their window, I rubbed my elbow and stammered, “Voltaren®, bitte?”

With our daughter Maureen translating, I discovered from the German pharmacist that generic ibuprofen gel had been available in Germany for over 10 years, and neither it nor the Voltaren® gel in the window required a prescription. I walked out triumphantly clutching a tube of each. Too bad the patient information leaflet inside the box was only printed in German.

You can get topical diclofenac in the U.S. in several formulations and brand names, but it is expensive and available only by prescription. Diclofenac comes as Voltaren® 1% gel, applied 4 times daily; Pennsaid® 1.5% solution, applied 3-4 times daily; Pennsaid® 2% solution in a pump applied twice daily; and Flector® 1.3% as a patch applied twice daily. It’s also available as Solaraze® 3% gel for rosacea.

Now, here’s some good news: Voltaren® gel is now available as a generic! This usually means it costs less and will be added to most prescription insurance plans. Check with your doctor for a prescription for generic Voltaren® (diclofenac) 1% gel for your knee pain.

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How To Select An Expectorant

November 28th, 2016. Filed Under: Uncategorized.

When I was at my hairdresser’s last week, he asked me, “I was at the grocery last week looking for Mucinex® but instead of just a couple of choices, I found a whole section of it, all saying Mucinex® on the box! How do I pick the one that’s best for me?”

The original Mucinex® tablets are still out there, containing only one ingredient: guaifenesin, pronounced gweye-FEN-ah-SIN. Guaifenesin works as an expectorant and has been sold for decades as the main ingredient in Robitussin® cough syrup.

Guaifenesin was developed by the A.H. Robbins company in 1949 and introduced as a prescription cough syrup called Robitussin®. By the time I graduated from pharmacy school 30 years later in 1979, Robitussin® was the most popular prescribed cough medicine in the country, with various formulations like Robitussin PE, Robitussin AC, and Robitussin DM. Whether alone or combined with a decongestant, an antihistamine or a cough suppressant, Robitussin was a best seller both as a prescription and non-prescription cough medicine.

Guaifenesin an expectorant. It works by increasing the fluid in your sinuses, throat, and lungs, to help liquefy sticky phlegm and mucus so that you can cough it up and out. Although they are both called cough medicines, an expectorant works differently than a cough suppressant. Cough suppressants dampen down your cough, helping you get much needed rest at night but don’t deal with stubborn gunky phlegm like an expectorant can.

Eventually guaifenesin moved beyond just Robitussin® syrup and as tablets it was sold as the prescription medicines Entex®, Entex LA®, and Entex® PE, a combination of guaifenesin and pseudoephedrine (Sudafed®). These were very popular in relieving symptoms of throat and lung congestion and sinusitis. When the patent protection on them expired, the company applied to the Food and Drug Administration (FDA) to sell the exact same formulations over-the-counter, and Mucinex® and Mucinex-D® were born.

Adding a decongestant to guaifenesin can help with sinusitis and a stubborn, non-productive cough. Mucinex-D® is the non-prescription equivalent of Entex® PE. It’s available right next to the original Sudafed®, and like Sudafed® you’ll need to sign for it.

Robitussin® and Mucinex® each contain guaifenesin. So, which one should you choose? Robitussin® cough syrup contains 100mg/5ml or 100mg per teaspoonful, while Mucinex® has 600mg per tablet and Mucinex® Maximum Strength has 1200mg in each tablet. Robitussin liquid is designed for children over the age of 2 up to age 12. The adult dose of guaifenesin of 1200mg to 2400mg per day is best supplied by taking tablets of Mucinex®.

Mucinex® tablets are available both as short acting and long-acting forms. I recommend buying the 600mg long acting tablets which last 12 hours. Some people get queasiness at the higher doses, so I suggest you the 600mg tablets so you can see which dose is best for you.

If you need an expectorant, avoid Mucinex® Allergy! One of the reasons there are so many products with Mucinex® on them is that companies often take advantage of the familiarity of popular brand names and use those names on related and sometimes even completely unrelated products. This is called “extending the product line” and can create lots of confusion. Mucinex Allergy® doesn’t have any guaifenesin in it at all. Instead it has fexofenadine, the same antihistamine found in Allegra®.

Here are 5 tips when selecting an expectorant:

  1. Mucinex® contains an expectorant, not a cough suppressant. Expectorants work by increasing fluid in your sinuses, throat and lungs to help liquefy thick sticky mucus, but don’t dampen a cough. If you need to cough less, take a cough suppressant instead, like dextromethorphan (Delsym®).
  2. When you have a cough or cold, drink plenty of fluids to help liquefy your secretions. If you suffer from stubborn thick mucus in your throat or lungs, Mucinex® can help thin and liquefying that sticky phlegm, helping you cough it up and out of there.
  3. Adding a decongestant like pseudoephedrine (Sudafed®) to an expectorant like guaifenesin can to help it work even better. I recommend choosing Mucinex-D®, which you’ll need to sign for at the pharmacy counter.
  4. Avoid Mucinex Allergy® unless you have allergies; it doesn’t have an expectorant in it and so it can’t help relievebyour dry cough.
  5. The best Mucinex® to start with is the 600mg long-acting tablets. Use 1-2 tablets every 12 hours. If your stomach bothers you, decrease the dose.



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Question About Newer Pneumococcal Vaccines

Q: In May of 2014, I was in the hospital for inguinal hernia repair and was offered the Pneumovax® 23, which I had been wanting for some time but none of my doctors would approve it. I did not ask for the Pneumovax® 23 at this time; it was offered to me and I accepted. I recently requested the Prevnar® 13, but my doctor denied it because I am not yet 65 (I understand the usual guidelines). I do have chronic health issues, which I believe would be an exception to the guidelines. What I don’t understand is, why give one without the other? Why be protected by 23 but not the additional 13?

The Pneumovax® 23 and Prevnar® 13 vaccines have 12 serotypes or variations, in common, which protect you against over the same 12 variations of the illness. Prevnar® 13 covers one more serotype, and Pneumovax® 23 covers 11 more serotypes. If you get immunized with Prevnar® 13 you are only getting 1 new serotype compared to the older vaccine.

What’s the main difference between the two vaccines? Although you don’t get as broad of coverage because of only 13 serotypes compared to 23 serotypes, the immune response from the Prevnar® 13 has been shown to be is a little bit better than with the Pneumovax® 23.

The Prevnar® 13 vaccine is recommended for all adults 65 years and older, but for younger adults ONLY IF you have a medical condition that causes you to be immunocompromised, such as removal of your spleen, HIV infection, organ transplant, chronic kidney failure, or long term use of immunosuppressive drugs like cortisone or Humira®. If you have one of those conditions, the Prevnar® 13 would give you a little better protection.

Since you received the Pneumovax® 23 before age 65, you should get another dose of it at or after age 65. However, for the best protection you should wait at least 11months or 1 year before getting the other pneumococcal vaccine. This means that if you get the Prevnar® 13 at age 65, you should wait a year before getting the Pneumovax® 23.

According to the Centers for Disease Control and Prevention (CDC), the maximum number of pneumococcal vaccines needed three: up to 2 doses of the older Pneumovax® 23 vaccine and only 1 dose of the Prevnar® 13. Most pharmacies carry both vaccines and can administer them to you. If your doctor declines to give you Prevnar®13, you have the option of going to your local pharmacy and having them give it to you.

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Do You Need a Vitamin E Supplement?

November 14th, 2016. Filed Under: Uncategorized.

Vitamin E is a fat-soluble vitamin that helps protect your cells from damage. It does this by acting as an antioxidant. Antioxidants counteract the damage to your cells caused by compounds called free radicals, which are produced in your body during metabolism. Free radicals are very reactive compounds. They move around and interact with your cells in ways that can cause cancer, cataracts, heart disease or stroke.

With the 3 leading causes of death in America heart disease, cancer and stroke, there’s lots of interest in finding ways to decrease the risk of these, including reducing the negative effect free radicals have on your cells, either by generating fewer free radicals or increasing the antioxidant compounds available to counteract them.

Would supplementing with Vitamin E, an antioxidant, protect your cells and help reduce the incidence of these 3 top killers? Unfortunately, the results of carefully designed clinical studies clearly show that Vitamin E supplementation does not provide any clear benefit and in fact is associated with an increased likelihood of either dying, having a stroke caused by bleeding into the brain, or developing prostate cancer.

How much Vitamin E do you need? The National Institutes for Health (NIH) recommends that adults get 22.5 International Units (IU) of Vitamin E daily. Although most Americans get only about half that amount from their diet, Vitamin E deficiency is not very common. Vitamin E needs fat for it to be well absorbed, so eating a very low fat diet or having a disease that interferes with digestion or absorption of fat such as Crohn’s disease or cystic fibrosis can increase your risk of being deficient in Vitamin E. Vitamin E deficiency may cause nerve and muscle damage with numbness in your arms and legs, muscle weakness, vision problems and reduced effectiveness of your immune system.

Should you take a Vitamin E supplement?

There are 2 common forms of Vitamin E: alpha-tocopherol and gamma-tocopherol. Vitamin E as alpha-tocopherol exists in higher concentrations in the body than its cousin gamma-tocopherol, and until recently was assumed to be responsible for Vitamin E’s antioxidant effects. Most multivitamins include 30 IU of Vitamin E as alpha-tocopherol, considered to be 100% of the daily requirement for adults by the NIH. High dose Vitamin E supplements of 400 IU contain over 13 times that amount.

While alpha-tocopherol is found in vitamin supplements, gamma-tocopherol is found in foods rich in Vitamin E such as nuts, seeds, oils and green leafy vegetables such as spinach and broccoli.

Recent research has uncovered evidence that the key to the antioxidant potency of Vitamin E is the level of gamma-tocopherol in the tissues and blood, not the amount of alpha-tocopherol. Taking a supplement of alpha-tocopherol will actually DECREASE the level of gamma-tocopherol, suppressing Vitamin E’s beneficial antioxidant action. This may explain why alpha-tocopherol supplements have produced negative instead of positive results in controlled research studies.

One study where Vitamin E supplementation helped is the Age-Related Eye Disease Study, or AREDS. In the 5-year study, a formulation of Vitamins A, C and E combined with zinc and copper including 400 IU of Vitamin E was used. The most severely affected study participants showed a 25% decrease in the progression of age-related macular degeneration (AMD), a common cause of blindness in the elderly. However, for those with mild or no AMD, there was no benefit.

Most Vitamin E supplements contain alpha-tocopherol as either the natural form (d-alpha-tocopherol) or synthetic form (dl-alpha tocopherol). The main difference between them is their potency. The natural (d-alpha-tocopherol) form is 1.5 times as potent as the synthetic (dl- alpha-tocopherol) form. Gamma-tocopherol Vitamin E supplements are now available but it’s too early to know if they can prevent cancer, stroke or heart disease where the alpha-tocopherol form could not.

Should you take a Vitamin E supplement?

  1. YES, if you have age-related macular degeneration. The AREDS formulation is proven to help, such as in PreserVision® AREDS. Another supplement recommended by eye care professionals is Ocuvite®. Ask your eye care professional which would be best for you.
  2. NO, if you are taking a blood thinner like warfarin (Coumadin®), aspirin or clopidogrel (Plavix®). Vitamin E supplementation can actually cause bleeding problems in high doses or in people who take blood thinners.
  3. The BEST way to get the antioxidant benefits of Vitamin E is to eat plenty of green leafy vegetables such as spinach and broccoli.

There’s more information about Vitamin E at

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Which Sweetener Do You Prefer?

November 7th, 2016. Filed Under: Uncategorized.

November is National Diabetes Month, reminding me of candy, sweet treats and sweeteners. Reaching for a packet of sweetener for your cup of coffee or glass of iced tea, which color do you look for? White, pink, blue, yellow, or green? You can choose a white packet containing sugar or various colored packets, each with their own sugar substitute.

We also buy foods that contain sweeteners. One study looked at sweeteners in foods purchased by Americans between the years of 2005 and 2009. The researchers tracked the purchase of “uniquely formulated foods”, meaning foods that did not include any raw foods or food with only one ingredient, such as apples or eggs. This study found that 75% of those “uniquely formulated foods” had some type of sweetener added to them. Yikes!

In that study, sweeteners were divided into two types: caloric sweeteners (CS) and non-caloric sweeteners (NCS). The five most common caloric sweeteners found in the “uniquely formulated foods” in order of most common to least common were corn syrup, sorghum, cane sugar, high fructose corn syrup, and fruit juice concentrate. 53% of baby food formulas, 75% of salad dressings and dips and 78% of vegetable juices contained at least one added sweetener.

The non-caloric sweeteners included saccharine, known as Sweet’N Low® and packaged in pink packets, sucralose or Splenda® which is sold in yellow packets, and aspartame or NutraSweet® available in blue packets. Although NCS sweeteners were found in only 1% of foods and beverages, over the course of the study Americans chose more NCS-containing foods and beverages every year. In 2006 Americans selected food products with NCS 13.3% of the time in 2006, increasing to 15.2% by 2009.

Non-calorie sweeteners have been used for decades as food additives and are considered safe. Research published in the October 2014 issue of Nature magazine shows disturbing new information that may challenge that assumption. Samples of three commonly used non-calorie sweeteners and sugar were given to mice. Aspartame, saccharine and sucralose somehow changed the makeup of intestinal bacteria of the mice while sugar had no effect. But the startling finding was the mice that had their gut bacteria change also showed changes in their ability to handle sugar. In the affected mice, their blood sugars rose higher after they ate and dropped back to normal levels much more slowly, a pattern called glucose intolerance associated with an increased risk of becoming diabetic.

When researchers introduced samples of the changed mice’s gut bacteria into normal mice, the new mice’s gut bacteria changed too. And when it did, so did the same pattern of glucose intolerance occurred. Trying the same experiment on a small group of humans, only a few of them showed changes in their gut bacteria. But the ones who did also showed the same pattern of glucose intolerance seen in the affected mice. Although the effect of these sweeteners on gut bacteria doesn’t happen consistently in humans it could explain why switching from using sugar to a NCS have not had consistently helpful effects in weight reduction or controlling blood sugars in diabetics.

Today, new options like stevia and xylitol join older sweeteners like saccharin, sucralose, and aspartame. Stevia is a calorie-free sweetener from a plant native to South America in the crysthanthemum family, related to ragweed. Originally approved as a dietary supplement to improve blood pressure and diabetes control, stevia was approved for use as a food additive in 2008 and is marketed as the sweetener Truvia®. Often blended with other sweeteners stevia also comes as individual servings in green packets.

Xylitol is a low-calorie sweetener extracted from natural sources such as corn. Because of its protective effect on tooth enamel, xylitol is added to sugarless gum and mints and is marketed as a sugar substitute for baking. Xylitol may be a dentist’s friend but it’s a dog owner’s nightmare. Xylitol is deadly to dogs, causing very low blood sugar, liver damage and liver failure. In dogs, eating xylitol triggers their pancreas to dump out insulin, which drops their blood sugar so low they have seizures. There is no safe dose for dogs; even a small amount can be fatal.

What color packet should you reach for to sweeten your coffee or tea? Non-calorie sweeteners, long considered a safe alternative to sugar might actually cause problems in some of us, and xylitol definitely causes trouble for dogs.

You can also check out Kenneth Chang’s post in the New York Times’ blog Well, as he comments about the effects of some artificial sweeteners in humans here:

And if you have dogs as pets, PELASE say NO to xylitol.

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Bone Health: Is a Fracture in Your Future?

Osteoporosis is a condition of weak bones, which makes them more likely to break. Ten million Americans have osteoporosis and 44 million have thinning bones, according to the National Osteoporosis Foundation (NOF), a health organization dedicated to preventing osteoporosis and broken bones though awareness, education and research.

In the United States, one out of every two women and one in four men over age 50 will have an osteoporosis-related fracture in their lifetime. Twenty-four percent of seniors who suffer a hip fracture will die within one year of the event. If you are female your risk of having a bone break from osteoporosis is equal to your risks of breast, uterine and ovarian cancer COMBINED.

My mother died of complications from osteoporosis. She broke her left wrist when she was 74 years old, tripping in downtown Seattle when trying to catch a bus. Four years later she fell onto her right when getting out of bed in the middle of the night. Her right knee swelled up and she insisted it was “just my knee”, refusing to go to the doctor. Nearly 2 weeks later when the pain hadn’t gone away she finally agreed to get it checked but by that time the ends of her broken bones had slipped down and were already knitting back together. She suffered from the discomfort and inconvenience of her right leg one inch shorter than her left one for the rest of her life.

Although its complications show up in old age, osteoporosis starts in childhood. Nearly 90 percent of our peak bone mass is built before we turn 20 years old. At middle age that begins to reverse and we lose 1% of our bone mass per year, doubling to 2% per year for women after menopause. The thinner your bones are to start with, the more likely you’ll eventually experience a fracture.

Here are 5 tips to help keep your bones healthy and strong:

  1. Get the calcium and vitamin D you need every day. Eating a variety of foods rich in calcium is a critical step to building and maintaining strong bones. Green leafy vegetables like broccoli, Brussels sprouts and kale are good sources of calcium, as are dairy products like milk and yoghurt. Calcium and Vitamin D supplements are also helpful.
  1. Do regular weight bearing and muscle-strengthening exercises. Getting up and moving is one of the best things you can do for your bones. Weight-bearing activities like walking, cycling or dancing help signal your body to keep your bones strong.
  1. Don’t smoke.My mother smoked since she was 18 years old. Quitting smoking could have helped her avoid the fractures that plagued her final years.
  1. Talk to your doctor about your chances of osteoporosis and ask about bone density testing.If you have passed menopause or have taken certain drugs, especially prednisone or corticosteroids, you may have thin bones without knowing it. Testing your bone density helps determine how likely you are to have a bone break in the future and if you are at risk, your bone loss can be slowed with medicine and other strategies. My mother never realized she had thin bones until she broke her wrist. With screening and the bone-building drugs available today she may have avoided the hip fracture that shortened her life.
  1. Try eating prunes every day. A recent study showed that eating prunes every day could make your bones stronger. The study participants ate 100 grams (about 10 prunes) every day for a year. Luckily,   you don’t have to eat quite that many to benefit your bones. I suggest taking it slowly and building up to what you can manage, as prunes are a natural stool softener. I weighed out 100 gm of dried plums (prunes) and found that 100 grams is 9 of the Mariani® brand of dried plums sold by Costco. With my family history, I decided to eat at least 5 prunes a day, and see if I could work up from there.

Is there a fracture in your future? Keeping your bones strong and healthy includes getting enough calcium and Vitamin D, doing some weight bearing exercise every day, quitting smoking and asking your doctor or medical provider about bone density testing. If you do have osteoporosis, there are bone building drugs available, from tablets you take every week or every month like alendronate (Fosamax®), Actonel® or Boniva®, to injections given daily, every 6 months or even once a year. And even prunes!

To find out more about osteoporosis and how you can prevent it, check out the National Osteoporosis Foundation website at

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