Holistic Health Blog
Dr. Cathy Rosenbaum

Using Neti Pots – Be Safe!

Neti pots can be used to clean out mucus, allergens, and debris that build up on the nose and sinus cavity. They are safe if used correctly. A recent case report involving a woman who allegedly passed away from an amoeba acquired from unsterile water used in her neti pot over many months reminds us to do diligence when preparing saline water and cleaning pots to stay safe.

Please:

* Keep your neti pot clean regardless of whether it is made of plastic, ceramic, glass, or some other material.

* Use a safe water source for the saline solution you prepare for your pot (e.g., preferably sterile or distilled water).

* Use proper technique with your neti pot to get a good rinse. If you are unsure of how to use it, contact your favorite pharmacist for a quick demo.

The Center for Disease Control tells us to wash our neti pots after each use. Some of these pots are dishwasher safe, but not all. Please read the directions on the box.

Neti pots can be hand washed with dish soap and hot water and air dried. Don’t use hand towels that contain lint to dry them, as the lint can go up your nose and cause other issues.
If you think your neti pot is contaminated, you can use a chlorine bleach solution to cleanse it, but be careful to thoroughly rinse out any soap or bleach from the pot before you reuse it. This will prevent unwanted residue getting into your nostrils.

Don’t use tap water run through a Brita filter or any home filter unless you boil it for 3 to 5 minutes and then cool it down to room temperature first. Boiled water is storable for up to 24 hours.

For more information, please visit www.apha.us/CDCSafeNetiPots.

To schedule a one hour health & wellness consultation with Dr. Cathy Rosenbaum, please visit www.rxintegrativesolutions.com or email drcathy@rxintegrativesolutions.com. Be mind body spirit healthy.

Probiotic Dietary Supplement Safety & Efficacy Is in Question

Probiotic dietary supplements have become quite popular in recent years, touted for such conditions as general health (prevention), immune health (prevention), leaky gut, diabetes mellitus, and dysbiosis from antibiotic overuse, among others.

Probiotics are generally safe for a heathy person (Generally Recognized as Safe [GRAS] per the FDA classification).  However, some live  probiotic strains may negatively play on a weakened immune system in at-risk persons,  allowing unwanted organisms to enter the body and cause pneumonia, endocarditis, or sepsis.  Probiotic supplements are not for everyone!

Activia yogurt, Yakuit yogurt, Dannon Probiotic yogurt, kefir, kimchi, sauerkraut, tempeh, miso, and kombucha are examples of food sourced-probiotics. Culturelle and Align are popular probiotic dietary supplements. Florastor is a prescription medication.  Examples of probiotic strains include, but are not limited to, bacteria (e.g. Lactobacillus, Lactococcus, Leuconostoc, Pediococcus, Bifidobacterium, Bacillus) and yeast (e.g., Saccharomyces).

It’s important to choose the right probiotic product for your health needs with the help of your pharmacist, who can thoroughly evaluate the product  before recommending it to you.  Product criteria:

  • strain identification by genome sequencing
  • transmissible antibiotic resistant gene profile
  • toxicology in vitro and in vivo studies
  • clinical studies on efficacy (how well does the product work)
  • target population (healthy  vs sick)
  • product formulation and labeling (product purity, contaminants)

If probiotic manufacturers claim to treat/prevent disease, their probiotics should be studied and marketed as drugs, rather than as  supplements, upholding FDA regulation.  Probiotics are not drugs, not magic bullets, nor are they universally safe and effective.

The appropriate probiotic strain and formulation should be recommended by your healthcare professional based on your individual health needs.

For more information or to schedule an integrative health and wellness consultation with Dr. Cathy Rosenbaum,  holistic clinical pharmacist, Certified Health Coach, Certified Dementia Practitioner, and Tai Chi Easy Practice Leader in Blue Ash OH,  please visit www.rxintegrativesolutions.com.

–Dr. Cathy Rosenbaum

 

 

 

Kothari.  Probiotic supplements might not be universally-effective and safe: A review.  Biomed Pharmacother 2019;111:537-547.

Energy Drinks – Are Those Shots Really Safe?

Beverages like Red Bull, Rockstar, Monster Energy, 5-Hour Energy, Mountain Dew Kickstart, and Full Throttle are touted to increase energy, improve mental alertness, and enhance physical endurance. Some of these products are marketed as beverages while others are marketed as dietary supplements.

According to the Center for Disease Control and Prevention, between 2007 and 2011, the number of energy drink-associated emergency room visits doubled. In 2011, one in 10 of them resulted in a hospitalization. Some college students will unsafely consume energy drinks along with alcohol or other products/drugs (e.g., marijuana, OTC or prescription medications).

Ever looked at the nutrition label on the back of one of these products? They contain more than just caffeine and sugar, namely B vitamins, amino acids (taurine and carnitine), and other dietary supplements -> green tea extract, guarana, yohimbine, green coffee bean extract, bitter orange, glucuronolactone, ginkgo biloba, and ginseng. A single 16-oz bottle may contain up to 62 grams of added sugar, more than the maximum amount recommended in one day (15 teaspoonfuls – 250 calories).

In smaller quantities, caffeine may boost energy and alertness. In larger quantities, caffeine can negatively affect the cardiovascular system. Taurine may boost metabolism. In theory, extra carnitine may impact fat burn. The body is typically not deficient in endogenous carnitine, so it’s a waste of your money. Guarana contains caffeine. Green tea extract contains caffeine and the antioxidant EGCG. Green coffee bean extract contains caffeine. Yohimbine and bitter orange are central nervous system stimulants.

Ginseng does not impact energy and may lower blood sugar in diabetics – diabetics should be careful with its use. Ginkgo biloba has not been clinical proven to improve energy. Water soluble B vitamins protect nerves but may not improve energy. Thankfully, they will be eliminated by the kidney if taken in excess.

Glucuronolactone, a component of connective tissue, is metabolized into glucuronic acid and is touted to ‘detoxify’ (what?) in the body, a nebulous claim that is unproven in humans. It has no impact on energy.

Possible side effects from energy drinks include, but are not limited to, rapid heartbeat, heart palpitations, heart attack, and headaches. Caffeine and other stimulants may also be associated with anxiety, sleep problems, digestive problems, and dehydration.

If you feel you need to consume energy drinks, a good health rule is to consume them in moderation and remember that there may be negative outcomes. Talk it over with your primary care physician. Be healthy, eat whole foods, get ample restorative sleep, and stay safe.

REFERENCES:

Higgins. Energy beverages: content and safety. May Clin Proc 2010:85:1033-1941.
Sankararaman. Impact of energy drinks on health and well-being. Current Nutrition Reports 2018;7:121-130.
Uliah. Energy drinks and myocardial infarction. Cureus 2018;10;e2658

___________________________________________

Cathy Rosenbaum PharmD RPh MBA CHC 10/12/18©

 

 

Overview of Biofeedback

By Dr. Cathy Rosenbaum, Holistic Clinical Pharmacist, Founder & CEO, Rx Integrative Solutions, www.rxintegrativesolutions.com

By tapping into our mind body connection, we can learn how to heal! Biofeedback is a non-pharmacologic mind body technique taught by a trained practitioner that can help a person improve her/his physiological function (e.g., heart rate, blood pressure, breathing rate, skin temperature, muscle tone).  This practice can be used to help manage conditions such as headaches, anxiety, high blood pressure, and stress, among others.

Certified biofeedback practitioners follow a standard of care based on scientific evidence.  They can use different methods involving electrodes and sensors in their 30-minute to one-hour session (e.g., electrodermal test, thermal biofeedback, and electromyogram for muscles).  It may take several sessions before progress is seen.  One could learn how to relax using deep breathing, progressive muscle relaxation, guided imagery, and/or mindful meditation.

Computer graphics help visually guide relaxation so one can see progress made toward the health goal.  Wearable devices with sensors worn around the waist are also available. RESPeRATE is an FDA approved device for decreasing stress and lowering blood pressure that uses a downloadable app. Not all home use biofeedback devices are regulated by the FDA, so buyer be ware!

Consider adding biofeedback to your health tool kit.

Blessings for better health.

References:

McKee. Biofeedback: an overview in the context of heart-brain medicine. Cleve Clin J Med 2008;73(Suppl 2): S31-S34.

Gevirtz.  The promise of heart rate variability biofeedback: evidence-based applications. Biofeedback 2013;41(3):110-120.

Mayo Clinic. Biofeedback. www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664.  Accessed September 1, 2018.

 

Lyme Disease

Background

Lyme disease is caused by a spirochete  called Borrelia burgdorferi  that is carried by blacklegged ticks (vector) found on deer (reservoir host).  The Center for Disease Control (CDC) tells us that more of these ticks are expected this summer due to reforestation and climate change across the country, including in Ohio.  While the majority of reported cases are from the Northeast and Upper Midwest, other cases have been reported as far south as Florida. Adult blacklegged ticks (Ixodes scapularis)  are the size of an apple seed so they are visible to the naked eye.

Symptoms

Symptoms can occur within 3 to 30 days after a bite. Ticks must be attached to the human for at least 36-48 hours to transmit disease.  If the human removes the tick within 48 hours, he/she probably won’t get the disease. Lyme disease is diagnosed by symptoms which can include chills, fever, headache, muscle and joint pain, and swollen lymph nodes. For many infected individuals, the classic red bull’s-eye round rash is one of the first symptoms.  Up to 30% of those bitten will not get a rash.

There are three stages to the disease:

  1. Early Localized – flu-like symptoms and rash
  2. Early Disseminated – flu-like symptoms with pain, numbness in arms/legs, Bell’s palsy
  3. Late Disseminated- arthritis, fatigue, dizziness, sleep disturbances, mental confusion

Treatment

Lyme disease is treated with antibiotics like doxycycline or others, depending on the patient and upon the physician’s preference, for a period of 2-3 weeks.

Prevention

Clothes treated with permethrin 0.5% make it hard for blacklegged ticks to bite you or stick to your clothes (Eisen. J Medical Entomology July 20, 2016).  In addition:

*Wear socks and pants when you walk in the woods

*Wear a tick repellent on skin and clothes that contains DEET, lemon oil, eucalyptus, or (better still) permethrin

*Take a shower within two hours of coming inside after possible exposure to blacklegged ticks

*Remove ticks from your skin with a pair of tweezers, then clean the area with 70% rubbing alcohol or soap and water

*Check your skin and hair, and wash ticks out of your hair ASAP after walking in the woods

*Place exposed clothing in a hot dryer to kill whatever ticks remain

 

Supplement & Food Labeling Overhaul Coming in 2020

Excerpts from the Nutrition and Supplement Facts Label Final Rule and the Serving Size Final Rule – > Compliance Date Moved from July, 2018 to 2020

Nutrition Facts: Larger, bold font on labels to emphasize calories per serving; elimination of International Units (IU) for fat-soluble vitamins A, D, E (to be replaced with mcg or mg)

Folic Acid: folate will be expressed in ‘mcg Dietary Folate Equivalents (DFE)’ (due to higher bioavailability of folic acid vs food-based folate); new RDI = 400 mcg DFE (same as 240 mcg folic acid in current labeling system)

Vitamin & Mineral Daily Values: new UL for sodium = 2,300 mg; new UL for potassium = 4,700 mg; new calcium daily = 1,300 mg; new choline daily = 550 mg

Sugar Daily Value: new total carbohydrates daily = 275 grams; new added sugars daily = 50 grams

Fiber Daily Value: new = 28 grams

Fat Daily Value: new = 78 grams

 

 

 

Restless Leg Syndrome

Restless Leg Syndrome

By Cathy Rosenbaum PharmD MBA RPh CHC
Founder & CEO, Rx Integrative Solutions

Introduction
Restless leg syndrome (RLS) was first described over 70 years ago. Symptoms can show up as achy or crawling sensations in the resting leg that oftentimes go away with leg movement. RLS can be caused by iron or folate deficiency, kidney problems, pregnancy, rheumatoid arthritis, fibromyalgia, thyroid issues, Parkinson’s disease, and depression, among others. A family history of RLS is common in individuals with idiopathic RLS. Individuals with RLS can have trouble getting a refreshing REM sleep. RLS is often misdiagnosed as a vascular problem in the veins, and that’s why it’s important to get an accurate diagnosis from your PCP first before treating the condition.

Factors that may make RLS symptoms worse include cold, heat, fatigue, and stress. RLS prescription medication treatments can include, but are not limited to, benzodiazepines, gabapentin, clonidine, propranolol, and narcotics, each of which have significant side effects. The use of opioids and benzodiazepines together (e.g., Valium, Ativan, Xanax, clonazepam) is not safe. For perspective, benzodiazepines as a medication class are best avoided in seniors due to drowsiness and increased risk of falls and dementia. Depending on the type of RLS diagnosed, non-prescription medication and/or non-invasive alternatives can be considered to treat symptoms.

Iron Deficiency
Interestingly, there might be less iron in the brain of an RLS individual compared to non-RLS individuals. People with iron deficiency RLS respond well to iron supplementation. Improvement is most often seen in those with the lowest initial serum ferritin levels.

Pregnancy
Pregnant women are more likely to develop RLS than non-pregnant women due to reduced folate levels in the former population. In most instances, symptoms are mild and resolve after delivery. Treatment involves folate supplementation, reassurance, and appropriate food intake.

Medication-Induced RLS
Different medications can either cause or worsen RLS symptoms. Antidepressants like Prozac, Paxil, and Zoloft are three such culprits. One study showed that use of non-opioid analgesics is associated with an increased risk of RLS in individuals on long-term antidepressant therapy (Leutgeb. Eur J Med Res 2002;7:368-379).

Vitamin D and Magnesium Deficiency
Published literature (J Sleep Breath 2016) indicates that low vitamin D levels and/or low magnesium levels may be associated with RLS. Magnesium supplementation makes it easier for leg muscles to relax. Treatment with vitamin D or magnesium dietary supplements with the advice and consent of your PCP or pharmacist are two options to consider if you are suffering from these types of RLS.

Holistic Therapies
For individuals with mild RLS symptoms, other holistic options include relaxation/stress management therapy, acupuncture, and abstaining from caffeine and caffeinated products, nicotine, and alcohol to help improve sleep, help reduce stress, and indirectly lessen symptoms.

Summary
If you are experiencing RLS-like symptoms and are concerned about what to do, the first step is to schedule an office visit with your PCP to get an accurate diagnosis. It is unwise and unsafe to self-diagnose and try various remedies without your PCP’s knowledge.

Finding Gluten-Free Nutrition, Dietary Supplements, and Medications

Non-celiac gluten intolerance and celiac disease are becoming more common. Celiac disease is a chronic autoimmune disorder caused by a genetic intolerance to gluten. Non-celiac gluten intolerance is diagnosed in people who do not have celiac disease, but have intestinal or extra-intestinal symptoms related to ingestion of gluten-containing grains.

Both conditions are treated by avoiding gluten containing foods. Finding ‘gluten free’ nutrition is becoming easier to do, but eliminating gluten from one’s diet can be a complex and time-consuming process.

Gluten is the protein component of wheat (e.g., including spelt, kamut, semolina, and triticale), barley (e.g., including malt), and rye. When a person with celiac disease or non-celiac intolerance ingests gluten, specifically the antigenic gluten constituent called gliadin, it can cause intestinal inflammation, diarrhea, abdominal pain, bloating, weight loss, fatigue, and iron deficiency anemia. Food malabsorption and nutritional deficiencies result.

Over time, these conditions can cause liver disease, defective gallbladder emptying, and osteoporosis. Celiac disease may be a reversible cause of osteoporosis. Adherence to a gluten-free diet is one way to help suffers minimize overall symptoms and to maintain maximal bone mineral density.

For perspective, oats are considered a type of gluten grain, but do not have the antigen that other gluten grains above do. Thus, oats do not induce an immune reaction in the small intestine of people with celiac disease. However, many commercial oat products are contaminated with wheat, barley, or rye and it’s important to carefully read their labels. Look for products that are certified to contain less than 20 ppm of gluten (FDA’s ‘gluten free’ definition).

Consumption of as little as 10 mg-50 mg gluten daily can lead to a clinical relapse in people with these conditions. Celiac disease may increase the risk of developing some types of cancer (e.g., T cell lymphoma and intestinal adenocarcinoma) if gluten restrictions are not maintained or gluten intake is only partly restricted.

It is important to find out where gluten resides in foods. This means not only reading food labels on products you purchase for home but also on foods you consume from fast food establishments and restaurant dining. Soups, sausages, and ice cream may contain hidden amounts of gluten as fillers. Talk with your grocer and restaurant owners before you consume questionable food items.

Watch out for the gluten content in herbs, other dietary supplements, and medications.

Gluten-Free Foods
Consuming foods certified to be ‘gluten free’ will help keep the daily gluten total to under 50 mg and not cause symptoms for most people with celiac disease. Gluten-free grains include rice, millet, corn, quinoa, sorghum, and buckwheat. For more information, visit http://glutenfreecooking.about.com/od/gettingstarted/a/hiddengluten.htm
or http://www.glutenfreeliving.com/nutrition/ingredients.

Gluten-Free Herbs and Other Dietary Supplements
It would be impossible to find information about the gluten content in over 60,000 products on the worldwide market. One can contact dietary supplement manufacturers directly for more information on gluten content before taking any of these products, including vitamins.

Gluten-Free Medications
Over-the-counter and prescription medications may contain gluten in the list of inactive ingredients. For example, sweeteners used in medications may be hidden sources of gluten. Some manufacturers cannot guarantee their medications are gluten-free because the suppliers of raw materials can not do so, making it even more difficult for consumers to figure out what is safe to take and what is not.

A great resource for determining the overall ingredient content in medications, including whether or not gluten is present, can be found online at www.glutenfreedrugs.com .

Another online medication reference comes from the National Institutes of Health at www.dailymed.nlm.nih.gov. Go to the site, type in the generic name of the medication you want to review, then scroll down to the name of the manufacturer of that particular product, then click on ‘description.’ Scroll down to the inactive ingredients and look for gluten.

A third way to find more information about your medication’s gluten content is to call the medication manufacturer directly. Be sure to have the medication’s lot number available when you call.

Finally, click on https://www.ncbi.nlm.nih.gov/pubmed/?term=Gluten+content+of+the+top+200+medications+of+2009%3A+a+follow+up+to+the+influence+of+gluten+on+a+patient%E2%80%99s+medication+choices for “Gluten content of the top 200 medications: follow up to the influence of gluten on a patient’s medication choices” by AR King in Hosp Pharm 2013:48:736-43.

By Cathy Rosenbaum PharmD MBA RPh CHC

OTC Diagnostic Tests – Hair Analysis & Antioxidant Testing – What Can They Tell Us?

There’s been an explosion of “alternative” diagnostic methods claiming to identify nutrient deficiencies, detect environmental toxins, predict serious diseases before they emerge, and help guide health conscious individuals in their diet and supplement choices.

Look through any consumer-oriented health magazine and you’ll likely see lots of ads and articles referencing iridology, bio-impedance testing, hair analysis, applied kinesiology, meridian analysis, oxidative stress measurement and a host of other diagnostics.

The popularity of these alternative self-diagnosis methods is part of the broader movement toward patient self-empowerment, self-care and personal responsibility. Many people know they’re not eating balanced diets rich in vitamins, minerals, and antioxidants. Their concerns for health are warranted, and in many cases nutritional supplementation is reasonable.

But are these testing methods valid? Can they really provide the sort of guidance consumers eek?

Hair Analysis

Techniques for measuring minerals, metals and other substances in hair have been around for decades. Advocates say they can indicate chronic mineral and nutrient deficiencies thus identifying which nutrients should be supplemented. Others use hair analysis to detect toxic heavy metals like mercury or lead, to guide detoxification protocols.

The American Medical Association and other mainstream medical societies have been categorically dismissive of hair analysis. In 1994, AMA issued a statement indicating that it “opposes chemical analysis of the hair as a determinant of the need for medical therapy and supports informing the American public and appropriate governmental agencies of this unproven practice.”

While it is unlikely that hair analysis can accurately detect vitamin/mineral deficiencies or imbalances, it can screen for exposure to heavy metals like mercury, lead, and aluminum.

Normal hair levels for minerals or heavy metals have not been well established. The truth is that over time, heavy metals like mercury, found in the earth’s crust and in our environment, do find their way into our hair, blood, and body. Here’s one scenario. Hair analysis may serve as an initial screen for mercury exposure. Then based on the type of mercury suspected (e.g., organic or inorganic), blood and/or urine levels may more accurately represent potentially toxic amounts in the body. Researchers would use additional tests to confirm these levels (i.e., cold vapor atomic absorption spectrophotometry). Surprisingly, it’s rare to find a person with no mercury in her/his body. Many people without amalgam dental fillings can have a blood mercury level of 5 mcg/L based on exposure from the environment.

Mineral and vitamin imbalances in the body (i.e., calcium, zinc, iron, copper, manganese) may be due to multiple factors such as improper diet, medication usage, stress, and genetics. Common medications like birth control pills may deplete zinc and some B vitamins; corticosteroids deplete calcium, selenium, and zinc. Histamine-2 receptor antagonists for ulcers may deplete iron, zinc, and vitamin B12. If the results of a hair analysis indicate a low level of minerals, it is prudent to screen for and address the root cause of the problem before recommending dietary supplements to replace them. An initial next step would be a blood test.

Next, since hair has no blood supply and grows slowly, mineral levels in hair do not correlate with the amount of minerals in other body tissues. Contrary to what consumers may believe, a hair analysis will not reflect a person’s most recent diet or health status. Further, many people color their hair, expose it to sun, chemicals in pool water, and hair dryer heat, all of which can affect the function of the hair follicle as well as alter the analysis of a given hair sample. Traces of substances we eat, drink or breathe may end up in our hair, but so will many other things, making it difficult to glean meaningful information about nutritional needs from hair studies alone (Seidel S. JAMA 2001;285;67-72).

There is also the big question of reference standards. Regardless of the specific analytic techniques used by commercial laboratories, hair analytic techniques must be validated against a standard reference. Not all clinical labs use a reference. Examples of reliable analytical methods used to measure and verify substances in the hair include the following: cold vapor atomic absorption (used for methyl mercury); inductively coupled argon plasma mass spectrometry (methyl mercury); inductively coupled argon plasma optical emission spectrometry (trace elements); neutron activation analysis (trace elements); X-ray fluorescence (mercury); and proton induced X-ray emission spectrometry (good for discerning external hair contamination from internal hair follicle contamination). Only a trained scientist can understand the differences among these tests and it’s important to note which is used when interpreting hair analysis.

A better approach to diagnosing mineral deficiencies involves measuring blood levels of iron, calcium, zinc, plasma copper, and manganese to assist in nutritional recommendations addressing clinically significant deficiencies. Multi-elemental hair analysis may hold a clue or two regarding a person’s heavy metal exposure or nutritional status, but it should not take the place of a thorough health history, medication & dietary supplement history, and physical exam.

Oxidative Stress and Antioxidant Testing

The concept of oxidative stress has gotten a lot of media attention, as researchers learn more about how free radicals contribute to the aging process and chronic diseases. Likewise, the public has shown tremendous interest in antioxidants and their role in preventing free radical oxidative damage. These concerns have spawned wide consumer interest in tests to assess oxidative stress levels and antioxidant capacities.

In principle, there’s nothing unreasonable about this. The body does produce several measurable markers of oxidative stress, including 8-isoprostane, a prostaglandin-like compound; oxysterols (i.e., 7-ketocholesterol, 7B-hydroxycholeserol); allantoin, the product of uric acid oxidation by purine catabolism; Total hydroxyoctadecadienoic acid (tHODE), a measure of hydrogen donor capacity; and thiobarbituric acid reactive substances (TBARS), measured with an assay utilizing malondialdehyde (MDA).

Natural antioxidants found in our bodies, thought to counteract reactive oxygen species, include erythrocyte superoxide dismutase, glutathione peroxidase, lipid hydroperoxide, and selected protein carbonyl groups. Common dietary antioxidants found in foods as well as supplements include vitamin C, vitamin E, vitamin A, beta carotene, and many others, all of which can be measured to some degree of accuracy.

But what can measuring these constituents tell us, and can measurements really be used to guide supplementation regimens?

Blood Antioxidant Measurements: Many consumers are asking about their ‘antioxidant health’ in an effort to stave off free radical cellular damage from high levels of oxidative stress. Clinical testing labs offer a wide range of tests for the various natural antioxidants listed above, as well as exogenous antioxidants from dietary supplements like co-enzyme Q 10, vitamin A, vitamin E, selenium, and beta carotene. Legitimate testing methods may be used to guide a physician, naturopath, or pharmacist to make nutritional or dietary supplement recommendations.

Each of the antioxidant tests could cost you over $100. It’s wise to check with your insurance carrier to find out if tests are covered before your physician prescribes them.

FRAP Test: The total antioxidant “power” of blood plasma can be defined by way of an assay called the FRAP test, measuring ferric reducing/anti-oxidant power in µmol/L. There are several published clinical studies of FRAP testing. One small study indicates the need to differentiate test results by gender (Chung W. Atherosclerosis 1998;136:78). Another demonstrates how the FRAP test may be used to evaluate the antioxidant effectiveness of wine (Katalini V. Food Chemistry 2004;86:593-600). Results of the FRAP test may have more application to food analysis than clinical practice, and may not correlate well with antioxidant deficiencies in the body.

Skin Carotenoid Test: This test has been widely popularized in recent years by Pharmanex, a multi-level, network-marketing supplement company that has made biophotonic scanning of carotenoids in the skin a cornerstone of its sales strategy.

The test, called “Bioscan,” makes use of the fact that carotenoids in human skin resonate with a certain wavelength of blue laser light, releasing a light signal of altered wavelength that can be easily measured.

Pharmanex representatives use the Bioscan as a way of detecting antioxidant deficiencies in their prospective clients. The client receives a piece of paper, a Bioscan Certificate, with his/her “Skin Carotenoid Score.” The score is mapped on a color bar ranging from low to high, then given a numerical value. Generally, if the value is low, the individual’s intake of carotenoid-containing food and/or supplements is low, and the representative encourages the prospective client to increase their intake, preferably with Pharmanex products. The Bioscan is a legitimate test for skin carotenoid levels but cannot predict total body stores or nutritional deficiencies.

Leaving aside the ethical question of using a test like this to sell supplements, there is the clinical question of whether the level of skin carotenoids, a single class of antioxidant compounds in our diets, accurately represents an individual’s overall dietary intake of foods containing potentially thousands of different flavonoid-like constituents found in nature? Further, can carotenoid levels alone be used to guide nutrition-based strategies? The carotenoid test is a snapshot of one nutritional day not a trend over months or years and may have little clinical bearing beyond an initial screening tool regarding your nutritional status.

A well-balanced diet including vitamins and minerals, while imperative for optimal health seems to be difficult for most Americans to maintain. Dietary supplements do offer an alternative, and research tells us that antioxidant-rich dietary supplements or foods have promise in the area of cancer prevention, cardiovascular health, and memory health. However, we do not know the optimal dose for each nutrient/ingredient for prevention of these conditions according to a National Institutes of Health-funded study (Huang H. Ann Intern Med 2006;145:372-385.).

There are legitimate reasons to question some of the testing methods that have captured consumers’ interest. But it is also important to recognize that in seeking out these tests, consumers are revealing their health concerns and demonstrating a wish to make changes.

More long-term research is needed to confirm endogenous (internal) as well as exogenous (from our diet) baseline antioxidant status, as well as confirm the magic combination of antioxidants, doses, and duration of therapy necessary to help prevent certain diseases. A lot of the tests consumers are seeking are probably not able to provide them the guidance they need.

Rather, seek out well-trained clinical pharmacists and naturopathic physicians, as well as clinical laboratories with high integrity and solid analytical testing methodologies to help better serve you in your health journey. Of course, start with good nutrition including colorful fruits and vegetables high in antioxidant value.

Contributing Author: Cathy Rosenbaum PharmD MBA RPh CHC

Grapefruit Interactions with Medication

Certain prescription and/or OTC medications and dietary supplements may negatively interact with grapefruit juice, grapefruit, Seville oranges, pomelos, and tangelos due to chemicals in the fruits.

Fruit chemicals are thought to block enzymes in the body that metabolize medication in the small intestine, thereby causing the medication to hang around longer than expected. Interestingly, these fruits may also interfere with transporters in the body, causing medication to be less well absorbed into the bloodstream, and may reduce medication or supplement effects. Sound confusing? It’s complicated.

Product classes involved in unwanted interactions include, but are not limited to:

-Antihistamines (e.g., Allegra)
-Antianxiety
-Antihypertensives
-Cholesterol-lowering ‘statins’
-Corticosteroids for Crohn’s disease and ulcerative colitis
Dietary supplements

Only some of the medications and supplements in each of the categories can be affected by the fruit/juices. Every person may react differently based on the amount of fruit they consume, the medication or supplement type/dose taken, and the individual’s natural ‘enzyme levels.’

Don’t worry, but do get educated about how and when to properly take your medications and supplements to be safe. Enjoy healthy nutrition. Talk with your pharmacist about what’s best for you!