Last week's article drew some attention on social media from both individuals open to the information presented and others who were not in favor of it. If the information gave you heartburn, my apologies, as that was never the intention. In writing these articles, I aim to provide not mainstream information but more outside-the-box information. Thinking outside the box is to think differently, unconventionally, or from a new perspective and to explore creative and unusual ideas. If you were to come to my pharmacy and had a consultation about whatever issue or condition you are looking for help with, you will likely walk away with potential solutions to your problem that are often outside the box ideas. We like to think of ourselves as problem solvers. The good news is, patients who choose to seek out our services are exposed to multiple tools, including conventional medications, compounded medications, and dietary supplements. Conventional medications are FDA-approved drugs that have passed the FDA's approval process, rendering them safe and effective for their intended uses. Compounded medications are FDA-approved drugs prescribed for off-label use. Off-label use refers to prescribing a medication for a different purpose than those formally approved by the FDA and found in the drug's package labeling. Providers might prescribe medications off-label for a medical condition because the use is well-known and has been done for many years without concerns, or there is a lack of safe or effective alternatives. An example of off-labeled prescribing is the drug Trazodone, an FDA-approved anti-depressant that has a side effect of drowsiness. Trazodone is often prescribed off-label for insomnia. In the compounding world, the majority of medications that we make fall into the off-label use category. An example of a compounded medication is taking a commercially available tablet like carvedilol a cardiovascular drug, crushing the tablets, and making a liquid suspension for a small child. The drug is only available in tablet form, yet the provider would like the child to have the drug in a much lower pediatric dosage. The child cannot swallow a tablet, so a suspension is formulated based on the provider's prescription. One off-labeled medication that has evolved since we first started investigating its use is naltrexone. Fifteen years ago, a handful of studies looked at the benefits of using low doses of naltrexone to treat pain. Research has mapped out naltrexone's effect on different receptors in the body, which have multiple mechanisms of action. When looking at different disease states, you can see which receptors are associated with the disease state and then work backward to consider prescribing the medication for a specific specific condition. There are no large-scale studies to prove effectiveness of naltrexone for specific conditions, but theoretically, the medications could benefit a multitude of conditions. For some who prescribe compounded medications, this may be a sticking point or an area they may not feel comfortable venturing into, and we respect that opinion. When compounding a specific medication, we ensure that the product is safe at the prescribed doses. The tenant of "first do no harm" is an important part of the process that goes into a compounded medication. If we are uncomfortable with a dose of a particular medication, we will visit with the prescriber to ensure dosage is appropriate. On some occasions, new information has come out to warrant a dose we may not have seen previously. Learning is a big part of what we do as we try to provide the best therapies for our patients. Once we have received a prescription for a compounded medication, if it is something we have not made previously, we begin the formulation process. In the case of carvedilol that was previously referenced, how will we best make a liquid suspension for a child? Choosing the right liquid base has us looking at studies and formulas for the best preparation. After formulation, the medication needs to be compounded, which requires another set of education and equipment to make that happen. Both FDA-approved and compounded medications need to be prescribed by a licensed provider for an individual patient . The exceptions to this rule are when pharmacists have limited prescriptive authority, such as with naloxone, an opioid antagonist, vaccines, and smoking cessation medications. The third tool, dietary supplements , fall into a different category of regulation by the FDA. The FDA has established good manufacturing practices (GMPs) that companies must follow to help ensure their dietary supplements' identity, purity, strength, and composition, and they periodically inspect manufacturing facilities. Supplement companies are responsible for having evidence that their products are safe and that the label claims are truthful and not misleading. The FDA does not determine whether dietary supplements are effective before marketing. The title of this article is Living Outside the Box . I t is truly the direction my team and I have chosen to help our patients differently. We are helping both patients and prescribers in our community and beyond, with difficult medication problems. There are many great pharmacists in our community who can fill your prescriptions and provide consultative services to help you with conventional medications, however not many have the tools we have to offer. Irsfeld Pharmacy is on the path least traveled, and at times, that can be a rocky path that many don't want to venture on. It is a path that has been helpful to so many in our community while being professionally rewarding. My hope is that most of you won't need to utilize our services but know that if you do, our team is committed to helping you on your journey to optimal health. If you want help with outside-the-box options in your health journey, please call the pharmacy @ 701-483-4858 or stop in to schedule a consultation. Please visit my website at www.irsfeldpharmacy.com to find this and other archived articles in the blog section. Until next time, be vigilant about your health!!!

As promised, today’s article will focus on inflammation in the GI tract also known as Gastritis . Inflammation is often the root cause of many diseases, and that concept is no different in the GI tract. The two areas most affected by inflammation are the stomach, where we can have gastritis, and the colon, where inflammatory bowel disease can occur. Today’s article will focus on inflammation of the stomach today. Have you ever had an endoscopy? An endoscopy is where the doctor puts a camera down your throat and looks at your esophagus, stomach, and sometimes your small intestine or duodenum. They are looking for damage or inflammation of the stomach lining or mucosa. Gastritis is when the stomach lining or mucosa is inflamed. Think of gastritis as a sunburn on the lining of the stomach. The stomach lining contains special cells that produce acid and enzymes, which help break down food for digestion, and mucus, which protects the stomach lining from acid. When the stomach lining is inflamed, it produces less acid, enzymes, and mucus. Gastritis is sometimes mistakenly used to describe any symptoms of pain or discomfort in the upper abdomen. Many diseases and disorders can cause these symptoms, and most people who have upper abdominal symptoms do not have gastritis. Gastritis may be acute or chronic. Sudden, severe inflammation of the stomach lining is called acute gastritis. Inflammation that lasts for a long time is called chronic gastritis. Chronic gastritis may last for years or even a lifetime if it is left untreated. Two of the more common types of gastritis are non-erosive and erosive. The most common cause of non-erosive gastritis is H. pylori infections. H. pylori is an opportunistic infection in the stomach that I discussed in last week’s article and has a link to low stomach acid. Other causes include autoimmune disorders affecting the stomach lining, Crohn’s disease, pernicious anemia, and some pathogens, bacteria, virus, fungi, and parasites. Erosive gastritis is a type of gastritis that can wear away the stomach lining without causing significant inflammation. Bleeding, erosions, and ulcers are the results of erosive gastritis. The chronic overuse of NSAIDs can cause erosive gastritis. NSAIDs are products like ibuprofen and naproxen that at one time were only available by prescription but now can be purchased over the counter. It is not uncommon for people with pain and inflammation to take NSAIDs routinely, unaware of the potential side effects that can occur over time. There is some irony to the fact that you consume something to help with pain and inflammation, yet it can cause inflammation to the lining of your stomach . Additional causes of erosive gastritis include alcohol, cocaine, and radiation. One of the crazy things about gastritis is that the symptoms don’t always make sense. Some patients experience pain and discomfort, while others don’t have any symptoms. The most common symptoms include upper abdominal discomfort or pain, nausea, and vomiting. Erosive gastritis is a little more violent as the lining of the stomach can bleed, causing bloody vomit, black and tarry stools, and blood in the stools. Conventional treatments for gastritis are relatively limited, focusing on eradicating H. pylori if it is present and making the pH of the stomach less acidic by taking antiacids, H2 blockers (famotidine), and Proton Pump Inhibitors (omeprazole). When the pH of the stomach is less acidic, it will not be an irritant to the inflamed tissue or sunburn, and the hope is that healing will take place. When it comes to non-conventional treatments, one of the most common is zinc carnosine, which is well-documented in scientific research to support GI integrity and intestinal permeability. Zinc carnosine has been studied in Japan for years and has studies showing that it can improve the integrity of the stomach lining and offset the side effects of NSAIDs. We are familiar with the properties of zinc and that it is an essential mineral that plays vital roles in the GI tract, gene expression, stabilizing cell membranes, immune function, reproduction, sexual maturation, and other biological processes. When zinc is attached to carnosine, the resulting complex supports gut ecology, permeability, and the mucosa. Research suggests zinc-carnosine stimulates healthy gut reactions and helps a healthy gut response to everyday life. Carnosine is a dipeptide (made up of the amino acids beta-alanine and L-histidine) in muscle cells and nerve cells. It is suspected that carnosine supports tight intercellular junctions and cell-mediated immunity. L-glutamine is a crucial amino acid for supporting a healthy GI tract, notably by maintaining the integrity of the intestinal wall. L-glutamine is the most important fuel for intestinal tissue, with research showing it is imperative for gastrointestinal integrity and a healthy immune response. Glucosamine HCl is an amino sugar precursor to many glycosylated proteins and lipids throughout the body. A recent study suggests that supplemental glucosamine HCl modulates the inflammatory response in the gastrointestinal tract, which may promote a healthy gut environment. Licorice root is abundant with novel phytochemicals that help soothe the gastrointestinal tract by supporting the mucosal lining of the intestines and stomach. Deglycyrrhizinated (DGL) licorice, free from substantial parts of glycyrrhizin that can affect blood pressure, is a safer option for long-term use. Additional natural ingredients that help to soothe the GI tract are apple pectin, aloe vera leaf extract, slippery elm, and mucin. These plant-derived biologically active constituents support and comfort the gastrointestinal tract. The benefit comes from the ingredients contained in each nutrient, such as vitamins, enzymes, minerals, mucopolysaccharides, fiber, lignin, saponins, and amino acids. There is a combination product that we use for this. I hope this article sheds some light on gastritis and what might be going on you're your gut if you have been diagnosed with that condition. While conventional products address the symptoms, natural products may be a better option to help deal with inflammation in the GI tract and they have excellent data to support their recommendations. If you are not getting the results you would like with conventional treatments, these are options in your healthcare journey. For more information on gastritis and gut health, call the pharmacy @ 701-483-4858 or stop in to schedule a consultation. Please visit my website at www.irsfeldpharmacy.com to find this and other archived articles in the blog section. Until next time be vigilant about your health!

It has been a while since I wrote about stomach acid a huge component into having an optimal gastrointestinal tract. You may find this tidbit of information interesting, the very first article that the pharmacy did for the Dickinson Press was back in 2013 with the title “The Crimes We Commit Against Our Stomachs”. It was written by Scott Frank PharmD who worked at the pharmacy at that time. The article was a dive into stomach acid which will be discussed in today’s article. How many of you are bombarded by information about having too much stomach acid? Many ads promote products designed to lower the amount of stomach acid and they include products like proton pump inhibitors, H2 blockers and antiacids. How do we know if we have too much stomach acid? Hippocrates, the father of medicine, once said that “all disease begins in the gut.” If he knew about this problem thousands of years ago, we should probably take notice and take care of our guts. When we think about the start of digestion, it starts in our minds and noses. Thinking about and smelling food starts the process of saliva production. One of my favorite things is to walk in the door after a long day at work and to be greeted with the smell of food, which always gets my digestive juices flowing. Saliva, acid, and enzymes are ramped up by these sensory stimuli so that when we put food in our mouths, the food can be broken down easily. The act of chewing is such an important part of digestion and chewing your food 20-30 times with each bite is optimal, but it takes time and effort . Unfortunately, most of us don’t take the time to chew our food adequately. Chewing also produces the digestive enzyme amylase, which helps to break down carbohydrates in our mouth. If you have ever tried chewing on a cracker and keeping it in your mouth for as long as possible, it will eventually taste sweet. This is the enzyme amylase at work turning starch into sugar. Once the chewed food is ready to be swallowed, it goes thru the upper esophageal sphincter down the esophagus, thru the lower esophageal sphincter (LES), and into the stomach. We have two sphincters or valves attached to the stomach, the LES, connecting the esophagus to the stomach, and the pyloric sphincter (PS), which connects the stomach to the duodenum or small intestine. The LES and PS valves are pH or acid dependent. The information on how these valves are affected by the pH of the stomach contents is hidden away in research dating back to the 1960s; more on that later. Thinking about, smelling food, and now chewing all stimulate acid production in the stomach. The optimal pH of the stomach when it empty is 1.2 to 1.4, the acidity of battery acid. Having an acidic stomach is important and has benefits outside of simply breaking down your food. Stomach acid is on the front line of our immune system killing bacteria, fungi, and viruses in our stomachs. If these microbes get past the stomach unharmed, they can wreak havoc on our GI tract and possibly invade our bodies. A condition where you have inflammation lining of the esophagus and stomach is called gastritis, which I will discuss in depth next week. I want you to think of having gastritis is like having a sunburn on the lining of your stomach. We often hear from patients that they have gastritis being prescribed a proton-pump inhibitor (PPI- omeprazole or Prilosec) or histamine-2 blocker (Pepcid or famotidine), which decreases the production of stomach acid leading to an elevated pH of 4 or greater, which is the acidity of beer. It is now when I ask the patient, “what do you think will digest your food better, battery acid or beer?” No one has ever gotten the question wrong, as battery acid will do a better job. Why do medications that are recommended work so well in reducing discomfort from gastritis? Because now the contents of the stomach are not irritating the inflamed or sunburned tissue. Driving the pH up and making the stomach less acidic is not a fix but a band aide to the problem. Once the band aide is ripped off, we are back to splashing acid on the inflamed tissue creating pain and reinforcing the need to continue treatment, and the vicious cycle continues. If you read the label or look at the package insert, PPIs are indicated for short courses of treatment, typically 4-8 weeks, unless a patient has a specific condition that requires long-term treatment. One of those conditions is called Barrett’s Esophagitis which occurs in about 1-2% of the population in the US. The CDC shows that 16.9% of adults take a prescription PPI, but that doesn’t include patients taking the OTC versions. These numbers don’t add up and way too many patients are taking these medication for longer than they should. Long-term use of PPIs is setting patients up for potential chronic problems, including an increased risk of candida (yeast) infections, H. Pylori (stomach infection), and SIBO (overgrowth of bacteria in the small intestine), all are microbial overgrowth due to a less acidic environment in the stomach. Other concerns come from the lack of nutrients being absorbed due to the less acidic environment, including the inability to absorb vitamin B12, gas, bloating, heartburn, acid reflux, and trouble digesting proteins. One of the problems with low stomach acid, also known as hypochlorhydria, is that we are not checking to see if you have too much or too little acid. The general assumption is that if you have stomach issues, you have too much acid in your gut. Unfortunately, that isn’t always the case, and making the stomach less acidic with medications only fuels the fire. Checking the pH of the stomach with conventional methods can be expensive and I think that is why it is seldomly accessed. Why don’t we know more about the issues surrounding low stomach acid? This question could be pondered or speculated about for a long time. It seems like this information has been hidden since big pharma couldn’t make money by increasing stomach acid or fixing gastritis. The only way to profit from the stomach issues is to say all stomach issues are due to elevated stomach acid and they happen to have a product that will block a receptor or system shutting down the acid production. The good news is that we have tools to get to the bottom of the acid question and protocols to get you feeling better. These tools are cheap ways to access stomach acid and, if needed, support the acid with dietary supplements. If you want help accessing your stomach acid or digestive issues, call the pharmacy @ 701-483-4858 or stop in to schedule a consultation. Please visit my website at www.irsfeldpharmacy.com to find this and other archived articles in the blog section. Until next time, be vigilant about your health!!!

Before diving into today’s article, I want to follow-up on last week’s article covering hydroxyapatite, specifically for dental health. We had many questions about which toothpastes would have hydroxyapatite. The two toothpastes that were recommended by my dental hygienist were Boka and Dr Jen’s, both available online. I am currently using Boka and like how it feels in my mouth, and it has a refreshing mint taste. It is not often that a topic for these weekly articles just drops in your lap, fortunately today’s topic happens to be one of those times. Up until 2 weeks ago, I had never heard of the supplement moringa, but in separate conversations in those 14 days, three people commented that they were currently taking moringa as a part of their supplement regimen. The moringa tree, often referred to as the "miracle tree," is a plant that has been celebrated for centuries for its incredible nutritional and medicinal properties. Native to parts of Africa and Asia, moringa has gained global recognition in recent years as a superfood with the potential to combat malnutrition, support health, and promote sustainability. This article will review the fascinating background of the moringa tree and highlights the numerous health benefits of incorporating moringa into one’s diet. Moringa oleifera, the most widely cultivated species of the moringa tree, originates from the foothills of the Himalayan mountains in northern India. Over time, it spread to Africa, Southeast Asia, and other tropical and subtropical regions. Today, it grows in many parts of the world due to its ability to thrive in harsh climates, including areas with poor soil and limited rainfall. Historically, moringa has been used in traditional medicine and as a food source. Ancient texts from India, such as the Ayurvedic writings, mention moringa’s healing properties. The plant’s various parts—leaves, seeds, pods, flowers, bark, and roots—have been utilized for their diverse applications. In Africa and Asia, moringa is often referred to as the "drumstick tree" because of the long, slender seed pods it produces. One of the reasons moringa is so remarkable is its resilience and rapid growth. It is a drought-resistant tree that can grow up to 10 feet in its first year. This adaptability makes it a valuable resource in regions prone to food scarcity, where it is cultivated as both a nutritional supplement and a source of income. Moringa is packed with an impressive range of nutrients, earning its status as a superfood. Its leaves are especially nutritious, containing high levels of vitamins, minerals, and antioxidants. Here are some of the key components found in moringa: • Vitamins: Moringa leaves are rich in vitamin A, vitamin C, and several B vitamins, which are essential for maintaining healthy skin, immune function, and energy production. • Minerals: It contains significant amounts of calcium, potassium, magnesium, and iron, all of which are important for bone health, muscle function, and oxygen transport in the blood. • Protein: Moringa leaves provide a good source of plant-based protein, containing all nine essential amino acids. This makes it particularly beneficial for vegetarians and vegans. • Antioxidants: Compounds like quercetin and chlorogenic acid in moringa help neutralize harmful free radicals in the body, reducing oxidative stress. Moringa is a powerhouse of nutrients that can help address malnutrition, especially in developing countries. Its leaves can be dried and ground into a powder that is easily stored and added to food. This powder is used to supplement diets lacking essential vitamins and minerals, particularly for children and pregnant women. The high levels of vitamin C and other antioxidants in moringa enhance the body’s immune response. These nutrients help protect against infections, promote faster recovery from illnesses, and maintain overall health. Moringa contains fiber, which aids in digestion and prevents constipation. Additionally, it has natural antibacterial properties that can help combat harmful bacteria in the gut, contributing to a balanced digestive system. Research suggests that moringa can help regulate blood sugar levels, making it beneficial for people with diabetes. Compounds in moringa, such as isothiocyanates, have been shown to reduce insulin resistance and lower blood sugar levels after meals. Moringa’s antioxidants, combined with its ability to lower cholesterol and reduce inflammation, support cardiovascular health. Regular consumption may help lower the risk of heart disease and improve overall heart function. The vitamins and antioxidants in moringa nourish the skin and hair, promoting a healthy complexion and stronger hair. Its oil, extracted from the seeds, is commonly used in skincare products for its moisturizing and healing properties. Moringa is believed to improve brain function and mental clarity due to its high content of antioxidants and essential nutrients. It may also help protect against neurodegenerative diseases by reducing inflammation in the brain. The patients I referenced who were using moringa as part of their supplement regimens were using the product as part of a cancer treatment protocol. There are several studies looking at the use of moringa for both cancer prevention and treatment. Moringa is incredibly versatile and can be consumed in various forms. Fresh moringa leaves can be cooked like spinach or added to soups and salads. Moringa powder, made from dried leaves, is a convenient option for smoothies, teas, or baked goods. The seeds can be eaten roasted or pressed to extract oil, which is used in cooking and cosmetics. Sourcing fresh moringa might be a difficult task, however it is easily obtained in powder form. When incorporating moringa into your diet, start with small amounts to allow your body to adjust, especially if you’re using the powder. While moringa is generally safe, consuming large quantities may cause mild side effects such as digestive discomfort. Beyond its health benefits, moringa has significant environmental and economic advantages. Its fast growth and ability to thrive in challenging conditions make it a sustainable crop. The tree also helps improve soil quality and provides shade for other plants. For many communities, cultivating and selling moringa products offer a vital source of income, empowering farmers and boosting local economies. The moringa tree is a remarkable gift from nature, offering a wealth of nutrients and health benefits. From boosting nutrition and supporting immunity to promoting sustainability, it’s no wonder moringa has earned the title of "miracle tree." By adding moringa to your diet, you can take a step toward better health while supporting a sustainable and impactful plant that benefits communities worldwide. Sourcing products that are not readily obtainable is something we do for many of our patients and moringa may be one of those. Please reach out to my staff at the pharmacy, as they would be more than willing to help you out at 701-483-4858. All my articles can be found online at our website, www.irsfeldpharmacy.com. My podcast, "The Irsfeld Pharmacy Optimal You Podcast," can also be accessed through the website. Until next time, be vigilant about your health!!

Hydroxyapatite Many of you have seen our posts on Facebook or read the last article I wrote on detoxing however there is another side of the toxin equation and that is toxin avoidance. Cleaning up your environment and limiting exposure of toxins. One are I have focused on is selfcare, which has a ton of chemicals in many of the products we use every day. I have been using a clean toothpaste for a while now, but my recently retired dental hygienist offered me a couple of options to consider, with each of these options containing the active ingredient hydroxyapatite (HA). Today’s article is an overview HA and its use in the areas of dentistry and bone support. Hydroxyapatite is a naturally occurring mineral that plays a vital role in the human body, especially in our teeth and bones. It is a form of calcium phosphate with the chemical formula Ca₅(PO₄)₃(OH). This mineral is known for its hardness and biocompatibility, making it essential for maintaining strong teeth and bones. Hydroxyapatite is a key component of tooth enamel and bone mineral, providing structural support and protection against damage. Hydroxyapatite was first identified in 1808 by a German chemist named Berzelius. It was initially discovered in rocks and later recognized as a crucial part of human skeletal tissue. The word "apatite" comes from the Greek word "apatē," meaning deceit, as the mineral was often mistaken for other stones due to its varying appearance. Over time, researchers began to study the properties of hydroxyapatite more closely, leading to its use in medical and dental fields. By the mid-20th century, synthetic hydroxyapatite was developed for various applications, including bone grafting and dental care. Hydroxyapatite is a major component of tooth enamel, the outermost protective layer of teeth. Enamel is the hardest substance in the human body, primarily composed of hydroxyapatite crystals. These crystals give teeth their strength and ability to withstand chewing forces. However, enamel can become damaged due to acidic foods, poor oral hygiene, and bacterial activity, leading to tooth decay and cavities. Hydroxyapatite has gained attention in modern dentistry as a natural way to protect and repair tooth enamel. Benefits for Dental Health: Remineralization: Hydroxyapatite can help repair minor enamel damage by depositing calcium and phosphate ions back into the enamel structure, reversing early stages of tooth decay. Plaque Reduction: Studies show that hydroxyapatite can reduce bacterial adhesion on teeth, lowering the risk of plaque formation and gum disease. Whitening: Hydroxyapatite can gently polish teeth without the harsh abrasives found in some whitening products. Sensitivity Relief: It can help reduce tooth sensitivity by sealing exposed dentin tubules, which are microscopic channels leading to the tooth nerve. Hydroxyapatite is commonly used in toothpaste and mouth rinses due to these benefits. Some natural and fluoride-free toothpaste options use hydroxyapatite as the primary protective agent. Hydroxyapatite also plays a crucial role in bone health as it makes up about 70% of bone material by weight. Bones require both strength and flexibility to support the body and protect vital organs. Hydroxyapatite provides the hardness and density bones need to fulfill these functions. In the medical field, hydroxyapatite is used in orthopedic procedures and bone repair treatments. Since it is similar to the body's natural bone mineral, synthetic hydroxyapatite can be safely used in surgeries and treatments. Benefits for Bone Health: Bone Grafts: Synthetic hydroxyapatite is often used in bone grafting procedures to promote bone regeneration. It serves as a scaffold where new bone cells can grow. Fracture Healing: Hydroxyapatite-based materials can assist in healing bone fractures by providing structural support while natural bone tissue regenerates. Osteoporosis Treatment : Some treatments for osteoporosis use hydroxyapatite to increase bone density and reduce fracture risk. Research has consistently shown the effectiveness of hydroxyapatite in both dental and bone health applications. Dental Health : A 2019 study published in the Journal of Clinical Dentistry compared hydroxyapatite toothpaste to fluoride toothpaste and found both equally effective in preventing cavities and re-mineralizing enamel. Bone Health : A 2020 study in the Journal of Materials Science: Materials in Medicine demonstrated that hydroxyapatite-coated implants improved bone growth and integration in patients undergoing joint replacement surgeries. Biocompatibility: A review in the International Journal of Nanomedicine highlighted hydroxyapatite's biocompatibility and safety, emphasizing its use in both dental and orthopedic fields without adverse effects. Fluoride has long been the standard in dental care for preventing cavities and strengthening teeth. However, hydroxyapatite offers a natural alternative with some unique advantages. Hydroxyapatite is non-toxic , even if swallowed, making it a safer option for children and individuals concerned about fluoride toxicity. Clinical studies have shown hydroxyapatite to be as effective as fluoride in preventing cavities and re-mineralizing teeth. While fluoride strengthens enamel by forming a fluorapatite layer, hydroxyapatite works by directly integrating with the enamel structure. Many of the products we recommend for bone support contain microcrystalline hydroxyapatite concentrate (MCHC). The reason we recommend this is because there are no published studies that show that calcium alone will regenerate lost bone density; only stop the bone loss where it is caught, and/or accelerate bone healing, post-fracture. The MCHC is the only natural substance documented to regenerate lost bone, (even in post-menopausal women), also MCHC has been documented to accelerate recovery, assisting the body's repair naturally, (in the case of a fracture and / or bone loss). Hydroxyapatite is a remarkable mineral with a long history of use in dental and bone health . Its ability to strengthen tooth enamel, reduce sensitivity, and promote bone healing makes it invaluable in modern healthcare. As scientific research continues, hydroxyapatite is likely to gain even more prominence as a natural, effective solution for maintaining strong teeth and bones. We would love to have you join our detox journey. Please reach out to my staff at the pharmacy, as they would be more than willing to help you out at 701-483-4858. All my articles can be found online at our website, www.irsfeldpharmacy.com . My podcast, "The Irsfeld Pharmacy Optimal You Podcast," can also be accessed through the website. Until next time, be vigilant about your health!!

The start of any year often begins with resolution and even though we are already a week into the New Year, it’s not too late to propose another option. When you think about a resolution, the focus is usually to make a change or do something to better improve our quality of life. Most often resolutions revolve around health and exercise but today I am going to talk about the Core Four and why, if you don’t take a dietary supplement, it can provide great benefit in overall health. A common question I hear at the pharmacy is, “I don’t take any vitamins, so where should I start?” That is an excellent question for two reasons; first, it is an indication that the patient is interested in bettering their health, and secondly, that they see value with supplements helping in that change. The keyword in that last statement is value. The definition of value is; the importance, worth, or usefulness of something. Another word that fits into this conversation is quality. I have written articles on value and quality in the past, and they are essential attributes when choosing a supplement that you will be taking for many years to come. You get what you pay for in this arena. The answer to their great question about where to start is quite simple, and we refer to it as the core 4. We call it “foundational nutrition” because it is the foundation of health, and without a strong foundation, the structure or body can easily crumble. The four supplements that comprise the Core 4 are Multivitamin/mineral, Vitamin D, Omega 3 Fatty Acids, and Probiotics. Below is an explanation of the Core 4, along with a way to monitor levels in your body. Multivitamin: This is to fill in the gaps that our diets don’t meet. It is well documented that our food supply does not contain the same amount of nutrients as it did 40-50 years ago, and that is if we are eating a balanced diet. The goal is optimal health and providing nutrients is essential for making that happen. A micronutrient test can look at the levels of critical nutrients, and the cost is $400 Vitamin D: This is formed when your skin is exposed to sunlight. Unfortunately, we live too far from the equator to allow the sun to make this happen year around. If it’s warm enough in April, the sun is potent enough, and getting 10-15 minutes of exposure should cover us until about mid-September. That means that we won’t be getting our daily dose of Vitamin D for 6-7 months out of the year. It only makes sense for us to supplement, and if you are like me, my tan usually comes from the fluorescent lights of the pharmacy. 5000IU/day is the adult dose that I recommend. You can test Vitamin D for as little as $50. Omega 3 Fatty Acids or Fish Oil: Unless you eat fish twice a week, you probably are not getting the necessary amount of omega 3 to help support cell structure. Omega 3’s are anti-inflammatory, essential for the brain, skin, and eyes, and have cardiovascular benefits. Omega 3’s are one of the few supplements that cost less to buy as a supplement than if you were going to get it from a food source. Dosing ranges from 1000 to 4000mg per day of EPA + DHA depending on the treatment plan. You can find these amounts under the supplemental Facts on the label. Testing your levels is an option and can be done for $75 Probiotics: It seems a bit weird that we would add bacteria to our systems, and good would come from it, but yes, that is the case. Having a healthy gut flora, the combination of bacteria, fungus, and viruses line our intestinal tract, affects so many things: immune system, skin conditions, aging, digestive disorders, mood, and brain function, weight gain, fatigue, and more. It is almost impossible to help anyone who is not feeling optimal if they have an unhealthy gut that remains unaddressed. Many companies will look at stool bacteria for under $200. As stated above, the Core 4 is foundational nutrition, and building a regimen off of that is where a personalized protocol comes into play. That protocol could include joint health, gut health, inflammation, stress, or immune health, to name a few Treating each patient as an individual needs to happen because we are unique. One of the challenges is meeting the patient where they are at in their health journey. Here are a few examples of that: • How often can they take their supplement? I can usually convince them that if they brush their teeth twice a day, they can take supplements twice a day, and I know this because I fall into this category. • What can they afford to spend on a regimen? Trying to work within the confines of this because if you bombard them with too much product they can’t afford, they can shut down and quit. • And lastly, what are their expectations? Regarding expectations, consider the following: “Your health is like a train speeding down the track at top speed. If you are in poor health, the train is going in the wrong direction. My job is to help you go from top speed, slowly decelerate until you come to a stop, change tracks, turn around, start moving, and get you back to top speed on the healthy track.” How long do you think it will take for this to happen? Today, you often expect to make that happen by just taking a magic pill. I hope I don’t burst anyone’s bubble, but that train analogy will not happen by simply taking a pill. It requires hard work and commitment, something very different than a magic pill, and it may cost you more than that perceived magic pill, but, in the end, you will be better off for it. Please stop by the pharmacy or call to schedule an appointment. Let us help you navigate the Core 4 or design a protocol to meet your needs. Please visit my website at www.irsfeldpharmacy.com to view this and other health-related articles in the blog section. Until next time, be vigilant about your health!!

Group Detox--Let's talk this thru. Welcome to 2025. When I hear that number, it seems like yesterday we were talking about Y2K and how it would shut down the world. Well, here we are, and the world didn't get shut down with Y2K. I love the holidays and everything that goes with them, but if you are like me, you may have let the holidays get the best of you, and it's time to make some changes to "right the ship." I have a proposition for you: an invitation to join me and many of the Irsfeld Pharmacy employees in a group detox. You may be wondering what this entails. The detox is a 10-day program that uses specific detox products combined with a diet spelled out in the protocol. It is not a weight loss program, but most lose weight due to a clean diet and the removal of toxins. I like this protocol because it is only 10 days, and it is an excellent jump-start to getting you on a better path to improving overall health. The word "toxin" doesn't describe a specific class of compounds but rather something that can cause harm to our body. If you look up the definition, you will get this: A poisonous or harmful nonbiological substance, such as a pollutant. Toxins can also be a byproduct of a living cell or organism that, when released, can cause disease when introduced to the bodily tissue. The focus of this article will be on toxins as pollutants. Toxins can be detrimental to our systems. A growing body of literature suggests that there may be an association between toxin exposure and some long-term health conditions, such as chronic fatigue syndrome, fibromyalgia, and atherosclerosis, along with many other chronic diseases and illnesses. Our bodies are amazing detoxifiers. However, some toxins can build up and be stored in our fat tissue. Eventually, if these toxins are left unchecked, they can be sources of inflammation, and as we know, inflammation can promote chronic disease and illnesses, as discussed above. Toxins can also affect our microbiome, the bacteria littering our intestinal tract, disrupting it, or killing it off. Knowing that toxins are in the environment is the first step in understanding that toxins are a problem. When our bodies deal with toxins, we have two options to consider: decreasing exposure to toxins and enhancing their removal. When reducing exposure, here are some common and not-so-common toxins that you might want to avoid: cash register receipt tape, non-organic fruits and vegetables, swordfish and tuna, electromagnetic fields (EMFs), and plastic. Self-care products are another source of everyday toxins. Estimates show that we are exposed to 127 toxins before we leave the house in the morning, and many of them involve things we spray and apply while standing in front of the mirror. Here are some products to consider avoiding: deodorant, lipstick, and antibacterial soap. The Environmental Working Group has a site called Skin Deep that can help you choose safe products for you and your family. Here is the site: https://www.ewg.org/skindeep/ The body's natural detoxification process occurs in three phases. Phase I: Reaction —The first phase of metabolic detoxification occurs when your body utilizes enzymes to turn toxins into free radicals. Free radicals commonly occur in our systems, and our bodies are designed to process them, but they are a problem when we have too many. In this conversion process, toxins are transformed into water-soluble molecules that are easier for our bodies to get rid of via our kidneys and eventually removed in our urine. Phase II: Neutralization —After phase I, some toxins can be more reactive and not easily removed via the kidneys. In Phase II, these toxins are attached to other water-soluble substances, making them easier to eliminate in the urine and bile. This process is called conjugation (connecting) and requires certain enzymes to make it happen. Phase III: Transportation - Transporters ensure that the water-soluble compounds created in the first two phases are excreted from your cells. Before this occurs, Phase III neutralizes the compounds, binds them with dietary fiber in the gut, and is excreted in our feces. Let me simplify the previous paragraphs. Toxins like fat and our tissue cell walls are made from fat; toxins can readily enter our cells. The more fat we have on our frame, the more toxins can be stored in this tissue. Detoxification is done by pulling toxins out of our tissue and making them water soluble in our liver through specific metabolic reactions. Once these toxins are water soluble, our bodies have an easier time eliminating them from our systems via our urine, sweat, and feces. Other things to consider to ensure the elimination systems are also working optimally include whether you are drinking enough water. Staying hydrated is essential to helping with toxin elimination. Do you have daily bowel movements? Detoxing for a constipated patient can make the person not feel very well. The toxins are removed in the gastrointestinal tract, and if a person is constipated, the toxins we are removing can be reabsorbed back into the system. Our bodies now reprocess those toxins along with the toxins we are freeing up. When detoxing, ideally, you would want a formula that has select liver-supporting nutrients and cofactors, including taurine, N-acetylcysteine (NAC), methylsulfonylmethane (MSM), medium-chain triglycerides (MCT), trimethylglycine (TMG), quercetin, curcumin, green tea extract, milk thistle extract, grape seed extract, and methyl folate, to name a few. These ingredients have been shown to support healthy phase I and phase II detoxification in the liver. You also want gut-friendly ingredients that support the GI tract and add plenty of fiber to help latch onto toxins for easy removal. Most detox products come in powder form that can be mixed with water to get all these ingredients. They are also available in capsules for those who don't like the shake format; however, you will need to take many capsules to get an appropriate dose. We have an excellent detox questionnaire that patients can take to evaluate their need for detox. The questionnaire is free, and it provides some excellent information based on your answers that you can act on. We would love to have you join our detox journey. Please reach out to my staff at the pharmacy, as they would be more than willing to help you out at 701-483-4858. All my articles can be found online at our website, www.irsfeldpharmacy.com . My podcast, "The Irsfeld Pharmacy Optimal You Podcast," can also be accessed through the website. Until next time, be vigilant about your health!!

Each year, I like to look back at the different topics discussed in this weekly article. This year is no different. Here are some snippets of what I think are the most important or impactful ideas that have the greatest potential to help you become the optimal you. When looking at memory, genetics can play a part in this process, but it is not the only factor that influences what goes on in our brains. We cannot control the genetic aspect and the fact that we are increasingly aging, but we do have some tools to help avoid or delay the onset of cognitive decline. Blood flow, toxins, nutrition, and dietary supplements can impact how our brain processes information. Taking supplements like Omega 3 fish oil and Curcumin is a great start in improving memory, but they are not the only way you can decrease your risk. First, improve your diet, an area you can easily control and significantly benefit from. Avoid ultra-processed food. Eat nuts, fish, minimal grains, vegetables, and lean proteins. Don't drink sodas or pop. If you like wine, drink wine, but only a little. Second, try to incorporate quality fish into your diet. Omega-3s may not delay your dementia, but they certainly won't hurt you and have plenty of other benefits. If you are prone to dementia, omega-3s may give you an extra two years of life without dementia, which is a big deal for many patients. Stopping smoking if you are a smoker is critical. Getting adequate sleep and decreasing stress are two prominent ways to improve cognitive function. Stimulate your brain with healthy dialogue with friends. Stimulate your brain with reading, learning, games, or whatever floats your boat. We talk about sitting as the new smoking; sitting can also influence your brain. We need to watch less TV or get caught up with social media for our brains. Important information on the vaginal Microbiome includes how hormones change the pH of the vagina. As women ages, specifically postmenopausal women, they make fewer and fewer hormones, negatively affecting the pH of the vaginal cavity. If the pH is off, women have the potential for increased risk of vaginal infections. The acidic environment is part of our immune system, protecting women from infection. A lactobacillus deficiency can cause opportunistic bacteria to flourish. Vaginal dysbiosis is almost always results from a lack of lactobacillus. As a person ages, lactobacillus naturally decreases, setting the patient up with an increased risk of a bacterial infection of the vagina. Lactobacillus acidophilus is broken down into lactic acid, eventually affecting the pH of the vaginal cavity. Lactobacillus also has both an antimicrobial and anti-inflammatory benefit to both the gut and the vagina. We have tests that can see what type of good bacteria is populating both the gut and the vagina. This is super interesting as traditionally, you would test these areas to find out what kind of harmful bacteria are growing in them. Remember, we all have good and bad bacteria in our microbiomes; keeping them in balance is the key to maintaining health in these areas. Synthetic progestins in oral contraceptives are not suitable for the vaginal Microbiome and can disrupt the balance. Akkermansia is a bacterium that lives in the mucus layer of the gut, which might sound a bit gross, but it's actually very important. This mucus layer protects the gut lining from harmful bacteria and toxins. It has a unique ability to break down mucus and use it as a food source, helping maintain the mucus layer and ensuring it stays thick and healthy. The benefits of Akkermansia include strengthening the gut barrier, reducing inflammation, boosting metabolism and weight management, enhancing immune function, and improving gut health and digestion. A diet rich in fiber is crucial. Foods like fruits, vegetables, whole grains, and legumes provide the necessary nutrients for Akkermansia. Specific foods such as cranberries, pomegranates, and certain types of tea (like green tea) have increased Akkermansia levels. Understanding tocotrienols requires understanding the vitamin E family first. Vitamin E is a fat-soluble vitamin that dissolves in fats and oils. It is necessary for many bodily functions, particularly for protecting cells from damage caused by oxidative stress. Tocopherols were the first type of vitamin E discovered and are commonly found in foods like almonds, sunflower seeds, and spinach. Tocotrienols, however, are less common and are mainly found in certain plants like annatto, palm oil, and rice bran oil, with the best source being annatto, a seed derived from a tropical shrub, for those who might not get enough food, supplements are available. Delta-tocotrienol is an impressive nutrient with potent antioxidant and anti-inflammatory properties. Research has shown that delta-tocotrienol may offer several health benefits. First, it has been associated with lowering cholesterol levels. Its benefits in heart health, cholesterol management, and potential cancer-fighting properties make it an exciting area of research. The glycocalyx is a thin, gel-like layer made of proteins and sugars that coats the outer surface of cells, particularly endothelial cells that line the blood vessels. It acts as a protective barrier between the blood and the walls of the blood vessels. The glycocalyx serves several critical functions, including regulating blood flow, preventing blood clot formation, and protecting the walls of blood vessels from damage. The glycocalyx plays a critical role in maintaining cardiovascular health by protecting blood vessels, regulating blood flow, and preventing clot formation. When the glycocalyx is damaged, it can lead to the development of cardiovascular diseases such as atherosclerosis, heart attack, and stroke. By making healthy lifestyle choices, such as eating a nutritious diet, exercising regularly, and avoiding smoking, individuals can protect their glycocalyx and reduce the risk of cardiovascular disease. The gut-vascular axis is an area of research that explores how gut health impacts blood vessels and overall cardiovascular health. Scientists have discovered that specific chemicals produced by the gut can affect blood vessels, leading to increased or decreased risk of diseases like heart disease. Two of the most studied molecules related to the gut-vascular axis are short-chain fatty acids (SCFAs) and lipopolysaccharides (LPS). The gut-vascular axis shows how gut health directly impacts blood vessel health. Maintaining a balanced diet rich in fiber, reducing intake of red meat and animal products, and adding targeted nutrients can help promote a healthy gut and protect our cardiovascular system. Scientists are exploring specific nutrients that target the gut-vascular axis to prevent and manage heart disease. These topics may have given you insight into health issues you want to address in 2025. It is an honor to provide you with information about different ways to obtain optimal health, and I hope to continue to do that in the new year and for many years to come. All my articles can be found online at our website, www.irsfeldpharmacy.com , or our Facebook page. If you want the article emailed to you directly, call the pharmacy and request to be added to our email list. My podcast, "The Irsfeld Pharmacy Optimal You Podcast," can also be accessed through the website. Until next time, be vigilant about your health!!

The timing of this article is perfect as we head into Christmas and New Years as we tend to eat more than we should this time of year. One thing many of us do is to overeat and when we do, taking a digestive enzyme helps breakdown this ball of food you have just eaten making it easier to absorb. My family will attest that I have handed out digestive enzymes at the beginning of a holiday meal and yes, they thought it was odd, but they have grown to expect that sort of thing from their father. Our digestive tract is a fantastic system being responsible for many functions. One of the primary responsibilities is the breakdown of food from a macronutrient to a micronutrient. The ability to take a bite of chicken or steak and break that down into an amino acid that is absorbed through and between our cells which line the stomach, is an incredible transformation from beginning to end. The process of digestion starts in the kitchen as we smell the food cooking. The smell of food hits our brain and we start to produce saliva and stomach acid. Taking a bite of food, chewing it 20 to 30 times, and swallowing it are the next steps of digestion. When this broken-down food hits the stomach, hydrochloric acid, and pepsin help to digest this food even further. Once our bodies are done breaking down food in our stomach, it is passed on to the duodenum and small intestine. The small intestine is the area of our digestive tract that breaks down the food into nutrients easily absorbed in the small intestine. The pancreas excretes enzymes that support the breakdown, absorption, and utilization of macronutrients from a broad spectrum of foods, including proteins, complex carbohydrates, disaccharides and sugars, lipids/fats, vegetable fibers, virtually anything that needs to be broken down into a smaller form. Some of the enzymes that the pancreas makes are amylase, lactase, sucrase, cellulase, phytase, and lipase, to name a few. The second part in this area of the gut is the gall bladder . The liver is responsible for bile production, which then transfers to the gall bladder for storage. The gall bladder pushes out bile as needed, which breaks down and emulsify fats so that they absorb readily. For whatever reason, many patients have had this organ removed and have an ongoing issue with breaking down fats. This inability to break down fats can lead to them not tolerating fats or limiting the amount of fat in their diets. Some issues that can affect the production of these digestive enzymes include: • Age – the older we get, the less our body produces • Poor eating habits – eating too fast, poor dietary and lifestyle choices • Certain medical conditions – pancreatitis and celiac disease • Stress – when we are in fight or flight mode, our body isn't concerned about digestion, so acid and enzyme production decrease Who should take digestive enzymes? If you have gas, bloating, abdominal pain, or fatigue, you may be a candidate for taking digestive enzymes. Keep in mind that taking a digestive enzyme will help you better absorb nutrients, so conditions linked to nutrient deficiencies like acid reflux, food cravings, thyroid problems, heartburn, indigestion, burping, dry skin, thinning hair, morning fatigue, brain fog, trouble sleeping, arthritis, joint pain, mood swings, irritability, depression, headaches including migraines, and worsening PMS may benefit from a digestive enzyme. The list is relatively large, but low levels of nutrients in our systems can cause all these issues. Did you know that if you have gluten sensitivity, there are digestive enzymes to break down the gluten protein? The gluten protein comes from wheat, and the design of human bodies makes it challenging to break down this protein. Unlike a cow with seven stomachs, humans have one stomach, and we are not as efficient in breaking down gluten. Can you imagine if you currently suffer from bloating? What would it be like if you had seven stomachs that were all bloated? That would be miserable. My wife and I have led a gluten-free diet for over 12 years now, and we use digestive enzymes when we choose to eat gluten or are in a situation like going to a restaurant or eating at someone’s house, where we aren’t entirely sure we are getting gluten-free food. Taking the enzymes is easier than making a fuss about the food. Taking gluten digestive enzymes has served us well over the years. Product selection is not a one size fits all and can be customized for your issue. If you are a patient who does not have a gall bladder, we will recommend products that help break down fat. You may need extra acid in your stomach to aid in digestion; we can include acid in the formula. We are all unique, and your needs are also unique; this is why we carry so many kinds of digestive enzymes . (A basic digestive enzyme is linked but please call for specific concerns.) Some of the benefits of taking digestive enzymes include: • Treating leaky gut – nutrients are broken down, making them more digestible, so they don’t create systemic inflammation. • Digestible nutrients support the balance of microbes and bacteria in the gut. • Aiding the body in breaking down difficult-to-digest proteins like gluten. • I mprove symptoms of digestion, including GERD, gas, and bloating • Better absorption equals less chance of nutrient deficiencie s. I f you suffer from one of the symptoms that might require a digestive enzyme stop by, and we will get you a free sample for you to try. For patients with many GI issues, we recommend taking our GI Quiz. The quiz is helpful in guiding us on product recommendation. Please request the quiz and allow us to help you with any underlying issues. I hope you find this information helpful during the holidays but also after the holidays and into the new year. Gut health is such a critical component to overall health and ignoring the symptoms or masking them can only make matters worse. If you have been dealing with a bad gut for many years, don’t expect a miracle overnight, fixing a gut takes time and effort on your part but know that we have many tools to help you out. If you are having gut issues and want a different look at treatment options, call the pharmacy at 701-483-4858 or stop in to schedule a consultation. Please visit my website at www.irsfeldpharmacy.com to view this and other health-related articles in the blog section. Until next time, be vigilant about your health!!