Last week's article covered the basics of uric acid, what happens when it is elevated, the causes of the elevation, and how to decrease uric acid in your system. Today's article will cover another the dark side of uric acid from the book Drop Acid by Dr. David Perlmutter, looking at the evolution of uric acid and some surprising influences that affect its level. May the force be with you, as you venture into more information!! Uric acid has been downplayed as a little know metabolic waste product that has little to do with our overall health unless it becomes so high that gout and renal stones occur, as discussed last week. Based on that statement, that is many providers today have been educated on the effects of uric acid in our bodies, including my pharmacy education. We are going to take a step backward and look at the inner workings of our bodies and the formation of uric acid, and what happens when it starts to increase. Purines are directly converted into uric acid , our body naturally produces about 2/3 of them, and the other 1/3 is obtained externally in our diet. Purines alone are not bad, but when they become elevated, they become a concern. A study looking at heart disease found that elevated uric acid correlated with increased blood pressure. The high uric acid causes oxidative stress, constricts blood vessels, and constant elevation of uric acid causes lasting injury and inflammation in the kidneys, making them unable to ride our bodies of excessive salt, causing increased blood pressure. They found that 90% of patients with newly diagnosed high blood pressure had high uric acid and when treated with allopurinol, 85% of the patient's blood pressure normalized. The study and ongoing research prove that high uric acid is a problem for all of us. Our bodies have evolved, and most mammals have an enzyme called uricase which breaks down uric acid so that elevations don't occur. Humans do not have that enzyme, and here is the reason why. Thousands of years ago, when food was not always available like today's, man would eat as much as possible when food was plentiful. During times when fruit and meat were abundant, they would gorge themselves. Meat contains purines, and the fructose in fruit is converted to purines as well, elevating our uric acid. Without uricase to break down uric acid, our bodies would start to store the excess calories from fructose into fat. This excess fat would allow us to survive during lean times. A yearly cycle of increased fat, then fat is used for survival, and the cycle continues. Herein lies the concern, we do not have times when food is unavailable for us to eat. There are no lean times where we need to draw on our fat stores because food is always plentiful, so our bodies continue to pack on fat that never gets tapped into unless we consciously try to eliminate the fat. A major hit to our dietary habits was the increased consumption of high fructose corn syrup from 1970 to 1990, which increased by 1000% during this period. This surge coincided with increased obesity and other health conditions aggravated by elevated uric acid levels. Consuming fructose is associated with impaired glucose tolerance, insulin resistance, high blood fats, and high blood pressure. Fructose does not trigger the production of insulin and leptin, and these two hormones are responsible for regulating our metabolism; therefore, diets containing high amounts of fructose lead to obesity and the metabolic backlash that follows. Fructose also increases uric acid, which leads to other health issues. Studies show that men with a uric acid above 7mg/dl and women above 5mg/dl significantly increased all-cause mortality and cardiovascular mortality, meaning those with increased uric acid are more likely to die from diseases than those with a lower uric acid level. However, the optimal level seems to be less than 5.5mg/dl. Elevated uric acid = inflammation, and as you know, inflammation is a driver for most diseases and illnesses, from cardiovascular disease to Alzheimer's disease. What do we do with this information? The first thing would be to measure our uric acid and find out if you are a person that has elevated uric acid without the typical gout symptom. Testing can be done in your doctor's office with a blood test. They now have at-home uric acid monitors like those used to test blood glucose. Simple steps that apply to anyone, not just those with high uric acid, include exercising, getting adequate sleep, staying hydrated by drinking ½ your body weight in ounces of water per day, reducing stress, and decreasing sugar and processed food consumption. Last week I talked about using allopurinol and febuxostat, prescription medications, to lower uric acid. There are natural products that can also help reduce levels. Quercetin is a polyphenol with an antioxidant and anti-inflammatory benefit that is helpful in the fight against inflammation. Quercetin can be used as a natural xanthine oxidase inhibitor, like allopurinol. Any product inhibitor of xanthine oxidase will naturally lower uric acid levels. A dose of 500mg of Quercetin daily should get the job done. Luteolin is another natural xanthine oxidase inhibitor; additionally, it has been shown to prevent the dysfunction of beta cells in the pancreas. If the effects of the beta cells diminish, your body's ability to produce insulin helps with blood sugar regulation. Taking 100mg daily seems to be a good dose for luteolin. You all know of my love for omega 3 fatty acids, and DHA or docosahexaenoic acid is the omega 3 that can be beneficial for patients with elevated uric acid. DHA has anti-inflammatory benefits and is especially helpful in treating the brain. Fructose can harm the brain, and it appears that DHA is protective for the brain and offsets the destructive effects of fructose. A dose of 1000mg per day is recommended. Vitamin C at a small dose of 500mg per day helps lower uric acid levels by increasing urinary excretion and decreasing kidney reabsorption. Because it is a potent antioxidant, it can help lower the tissue damage caused by high uric acid. In summary, elevated uric acid is a huge health concern, you need to get it tested, high fructose corn syrup should be avoided at all costs, and there are ways to lower the uric acid burden and gain back your health. My staff and I would like to help you with questions regarding uric acid and inflammation, finding suitable treatment options to lower the burden, so call or stop to schedule a consultation. Please visit my website at www.irsfeldpharmacy.com to see this and other archived articles in the blog section. Until next time, be vigilant about your health!!

Dispensing medications in our pharmacy for gout attacks isn't common, but we do dispense a fair amount for prevention. One of the talking points I like to discuss with patients is what gout has been referred to over the years, "the rich man's disease" or "the disease of kings." The response from patients is usually one of denying that they are rich or even a king. Gout got these names because it can be attributed to a diet heavy in meat, fish, and alcohol, which were only affordable to wealthy people during specific historical periods. In today's day, many people have access to a diet that could possibly set them up to have an increase in uric acid-causing gout. If you could discuss gout with a person who has gone through a gout attack, they will not speak fondly of the condition as it is extremely painful. Gout is a form of inflammatory arthritis characterized by excessive uric acid in the synovial fluid , which fills the space between our joints. When the concentration of uric acid gets too high, crystals start forming in the joint, and if you can imagine, having a crystal grinding into the bones of your joint will be very painful. The joint most often affected is the big toe, but it is not specific to that joint. Another medical condition caused by elevated uric acid levels is renal stones. Uric Acid renal stones form from the build-up of uric acid in the kidneys, and if the condition is chronic, small stones can develop from the excess. Uric acid is one of four different types of kidney stones. Our bodies get rid of uric acid via our kidneys, so small stones start to form if we have an excess amount. These stones, if small, are readily excreted in our urine, but if they grow to a large size, they can pose quite a problem for removal. Research shows that about 1 in 10 people may develop a kidney stone, with males more likely than females to develop one. Hyperuricemia is the medical term for high uric acid levels, and a study done in 2015-2016 showed that about 20% of the US population suffers from this condition. The incidence of patients with gout from the 1960s to the 1990s has doubled in our country during that time. The increase in gout coincides with the increased consumption of high fructose corn syrup over that same period, which I will discuss later in this article. There are a couple of ways to treat an elevated uric acid level. The first is to decrease the consumption of foods rich in purines and increase the consumption of low-purine foods. Purines are amino acids or building blocks that convert into uric acid; therefore, reducing exposure to foods containing purines can solve the problem in many instances. The most common purine-rich foods include animal proteins, such as beef, poultry, pork, eggs, shellfish, and organ meat. Some vegetables contain purines, but eating too many is impossible to cause a problem. Drinking adequate amounts of water is essential for diluting urine ; it reduces the concentration of waste products. You will want to drink enough fluids so your urine is pale yellow. Alcohol and soda can increase uric acid levels in the blood and should be avoided. Beverages sweetened with high fructose corn syrup can make it difficult for uric acid to be excreted through the kidneys. Another option is to take a medication that blocks the formation of uric acid. Medications that lower uric acid are referred to as xanthine oxidase inhibitors. The most common one that has been around for over 50 years is called allopurinol. A newer one is febuxostat, also known as Uloric. Both medications successfully lower high uric acid levels. I f you get gout, you must take an anti-inflammatory medication to reduce the swelling and address the pain. The two most common medications for this inflammation are colchicine and indomethacin. Both drugs have been around for many years and have been the standard of care in treating pain. They are, however, very potent and can be hard on the stomach, limiting their duration of use. As discussed above, once the pain and swelling are under control, patients are transitioned to the xanthine oxidase inhibitors for prevention. The treatment for decreasing uric acid in kidney stones is the same. The best way to prevent uric acid stones is to stay hydrated. Drinking plenty of water will help reduce the concentration of uric acid in your urine, preventing stone formation. A common question in the pharmacy is, how can I treat my gout naturally? If you were going to treat gout from a natural angle, the most common way is to take a product containing tart cherry extract or drink unsweetened tart cherry juice. Studies show that eating ½ cup of cherries daily can reduce the risk of a gout flare by 35%. Cherries contain anthocyanins and quercetin, which are anti-inflammatory and fight oxidative stress. Eating cherries or taking a product with cherry extract is preferred due to the potential added sugar in the tart cherry juice. Uric acid is being looked at differently these days, with its potential to be an alarm for concerns around metabolic health. Author and neurologist Dr. David Perlmutter wrote a book called "Drop Acid," which examines the health problem that accompanies a person having an elevated uric acid level. Uric acid has been downplayed as a little-known metabolic waste product that has little to do with our overall health unless it becomes so high that gout and renal stones occur, as discussed above. That is the concept I learned in pharmacy school and most others in health care. Next week's article will continue to unfold the metabolic effects of elevated uric acid levels, how to monitor uric acid, and some additional natural ways to address the excess levels before high levels further degrade your health. Please read my next article to receive the rest of the story. My staff and I would like to help you with questions regarding uric acid and finding suitable treatment options to lower the burden, so call or stop to schedule a consultation. Please visit my website at www.irsfeldpharmacy.com to see this and other archived articles in the blog section. Until next time, be vigilant about your health!!

The last several articles I have written revolved around the concept that inflammation and mitochondrial dysfunction are the possible causes to many forms of disease and illness. Making the changes necessary to offset these issues that may or may not have an adverse effect on your health can be difficult. Some of you may recognize the quote “ The definition of insanity is doing the same thing over and over again and expecting a different result.” The quote has been linked to Einstein and even further back in history and it seems like there is some controversy as to who the quote can be attributed to. In my mind, it doesn’t really matter as the context of the quote is what I would like to focus on. It seems like in society we are always looking for the “magic” pill to solve all of our ills and I think big pharma has done an incredible job of reinforcing this concept. (BTW at the gym I go to one of the other members has given me the nickname “Big Pharma”, it’s really kind of funny.) Change can be difficult but not totally impossible. As a kid, one of my daughters would struggle with this when school started and at the end of the school year. The changes to routine were disruptive and it was something that as parents, we recognized and would try to help her overcome the changes that occurred. Everyone’s definition of change and their comfort level of change can be different. When talking about health and making changes, the conversation can be difficult as change can require that an individual must do something that isn’t the norm and may not be their favorite thing to do. What I find out when visiting with patients is that most know what they need to do but doing it is the difficulty. My hope is that people will understand that small changes, over time, can yield big results. The concept is something that most of us do when we invest money for retirement. The thought of putting money away for the future doesn’t sound so fun but investing $100 starting at 21 years old and getting 5% interest would get you $191,616 at the age of 65. It doesn’t seem like much but having a pot of money at the end would be kind of a nice deal. The same concept can be looked at when considering exercise. I was personally in a little funk last fall so I enlisted a trainer who I work out with for ½ hour 2 days per week which due to both of our busy schedule probably ends up with 5-6 workouts per month. My focus is on strength and stability or balance. It is now 7 months into the process and I feel like I have made some really nice strides in those areas. You might be thinking to yourself, really ½ hour twice a week, like a good friend of mine would say Really!?!? No lie, small steps can make big changes, not only do I work out with him twice a week, but I have incorporated additional workouts and cardio into the mix which has further enhanced the change in my overall health. I am telling you this because small changes in exercise can often be the springboard to additional steps in your journey to become the optimal you. The last thing I would like to see you do is to wait for the perfect time to start incorporating change. Having the mindset that all the stars have to line up for you to start will hamper your ability to take the first step. If your idea is that you need to work out for an hour 5 days per week and trying to find the perfect time to start this regimen, that thought process can be paralyzing. Going to the gym for the first time may be another barrier you may have to overcome. My experience with going to the gym is that most people are more than willing to help you out or answer questions about equipment or proper technique. The people at the gym become a bit like your family or tribe. If all that still is daunting, then maybe consider hiring a trainer so you don’t have to think to much about it, that’s where I was at, I just needed to have someone tell me what to do. Making dietary changes seem to be another big hurdle that people struggle to get over. Back in the day I was a huge soda drinker, before I knew how awful it was for you. This goes back 29 years ago so they might have had good sugar in it as opposed to the high fructose corn syrup it has now. Stopping soda was a big hurdle but I really haven’t looked back but occasionally, I like to feel the burn in the back of the throat. My go to was Mountain Dew which I referred to as “nectar of the gods” or the “golden elixir.” Another area of change was going gluten free . My nice wife was tested for food sensitivities and gluten was one of them, so she tried going gluten free and I went along with it because it would be difficult to go solo and I wanted to support her journey. After removing gluten from my diet, the pain in my knees went away. If I decide to eat gluten, 2-3 days later the pain will return and last a couple of days which simply reinforces my need to not eat gluten. All these changes and many more have made a difference in my overall health. My hope for you is that you can find something small to jumpstart your journey. Some simple suggestions: • Drink more water • Go to sleep earlier • Walk for 15 minutes 3 times per week • Exercise during commercials • Eat a combination of 5 fruits and vegetable daily • Talk and think positively I don’t want you to think that I’m the poster boy for change, but I do want you to think that change is possible and that it can make a difference. Just start, don't wait for the stars to line up and don’t worry if the change you make is perfect. Time to get busy!! Call or stop by the pharmacy if you want help in your journey to change. 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!!

In last week’s article, I discussed the state of health in our country and how inflammation, if left unchecked, can be a driver of disease and illness. T oday’s article is going to piggyback off that same concept only coming at it from the stance of cellular or mitochondrial dysfunction . If the cells in our bodies are not functioning optimally, this can be another driver of disease and illness. How many of you reading this article suffer from low energy? I think if we took a poll the number would be quite high. Mitochondrial dysfunction could easily be the cause of low energy. Dysfunction is not a new term in society today, but mitochondria may be a new topic to you. Having mitochondrial dysfunction is a big deal, and I will explain why in the context of this article. First off, let me explain what mitochondria are and what they do in our bodies. Mitochondria are in every cell in your body, but most know very little about them or how to take care of them. Mitochondria are responsible for creating more than 90% of our body's energy needs. The Mitochondria make adenosine triphosphate (ATP), which, when broken down, releases energy. If we don't have energy, we are unable to grow and sustain life. The body's primary energy consumers are muscles, brain, liver, heart, lungs, and GI tract. When mitochondria are not working to their full potential, the systems listed can suffer. This process is referred to as mitochondrial dysfunction, often due to genetic or environmental factors, which can ultimately then lead to cell injury and premature cell death. Think of mitochondria dysfunction like a blackout is to a city. Once the power goes out, nothing seems to work as it should. Aside from being energy factories, more than 95% of the genes that make up the mitochondria are involved with other cell functions. Thus, mitochondrial dysfunction can affect issues related to extreme fatigue, cardiovascular disease, diabetes, Parkinson's disease, depression, chronic fatigue syndrome, Alzheimer's disease, asthma, and diseases of the liver, skeletal muscles, kidney, and hormonal systems. When the mitochondria fail to meet the body's energy needs, symptoms of this energy shortage start to show. These symptoms can include heart and kidney issues, digestion seizures, strokes, developmental delays, speech, and sight problems, and simply walking can be a problem. As you can see from the list, many of these symptoms can overlap with other disease states making it difficult to differentiate between them. Lifestyle assaults like tobacco and excessive alcohol, environmental toxins, poor diets, which generate free radicals, and mismanaged stress can negatively affect the mitochondria. Drug-induced mitochondrial toxicity can create toxicity in the liver, skeletal muscles, kidney, and central nervous system. Medications affect our mitochondria by directly affecting the mitochondria or depleting co-factors that go into the production of ATP. The most common drugs that can cause these include pain medications, omeprazole, and statin medications which many patients routinely take. Statin drugs used to lower cholesterol have been shown to induce mitochondrial dysfunction through the depletion of Coenzyme Q10 (CoQ10). Omeprazole appears to inhibit carnitine absorption. Pain medications like naproxen and acetaminophen directly affect the function of the mitochondria . Avenues to pursue if you think you may have a mitochondrial issue would be an organic acid test, a urine test that looks at metabolites of metabolic pathways. If these pathways are not functioning correctly, the metabolites can overflow into the urine and can be easily measured to correlate to the faulty pathway. Another option is to have genetic testing done. Once you have the test done, you have the results for life, which makes this test an excellent value. Genetic tests can pick up faulty pathways. The most important thing you can do is to improve your lifestyle. Adhering to the tenants of the Magnificent 7 which I mentioned last week, is a perfect way to work on your lifestyle. Eating right and moving right are a great start, especially now that it is nice outside. Quit smoking, limit alcohol consumption, exercise 5 days per week, and eat food loaded with nutrients. When considering supplementation to support your mitochondria, utilizing supplements that help protect the mitochondria would be the goal, and CoQ10 is at the top of the list. If you read this column regularly, then the chances are that you have heard about CoEnzyme Q10 (CoQ10) and its many benefits. The fact that it is the third most popular supplement sold in the United States is a testament to its use. CoQ10 is also one of the most well-studied supplements, and a quality CoQ10 will offer you benefits ranging from mitochondrial support, antioxidant protection, tissue repair, as well as cognitive and cardiovascular support. Choosing a CoQ10 product can be quite a task, as there are many forms and delivery systems. Keep in mind a couple of factors. A dry powder formulation is not easily absorbed through the GI tract since the CoQ10 crystals never fully dissolve. The second confusing issue is whether to buy ubiquinol vs. a ubiquinone formulation. We recommend a Ubiquinone formulation with the crystals fully dissolved, allowing for better absorption, often up to 8 times better than other products on the market. The second product I recommend is designed to increase cellular energy. It is a combination of acetyl L-carnitine, NAC, alpha-lipoic acid, grape seed extract, magnesium, and manganese. These ingredients help are support the healthy functioning of mitochondria and overall cell activity. The product is called Mito-Recharge. In addition to helping our mitochondria increase ATP production, this combination of ingredients helps support the following systems: energy production, cardiovascular function, blood flow, and nitric oxide production, antioxidant support, and body tissue, including epithelial, muscle, connective, and nervous tissues. All this talk about inflammation and mitochondrial dysfunction may sound a bit like chicken little and the sky is falling but it is more of a call to action. You are now armed with information and proven protocols to take back your health. Start now and start small, building off the small steps that you take will yield results over time. Spring is here and there is no better time to use it to dive into a healthy summer. Call or stop by the pharmacy if you want to schedule a consult to help navigate your journey to attacking inflammation and mitochondrial dysfunction. 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!!

The current state of health in our nation is on a bad path. Some of the statistics will literally make you sick (no pun intended). The US spends more money on healthcare per capita than any other country in the world, $12474 in 2022, almost $4000 more than the next country on the list, unfortunately with all the spending we are not living longer when compared to other countries. Let me summarize that, we spend the most money and get poor results. How does that even happen? I’m not sure it can be answered in this article, but I do have some ideas to improve your health. If you have read this article going way back, you may remember me referencing the Magnificent 7 which is eat right, drink right, think right, talk right, move right, sleep right and poop right. If you are doing all these things “right”, your ability to maintain optimal health should be greatly improved. Dr. Robert Rakowski is the person who came up with the Magnificent 7 and it really cuts to the chase when thinking about how to improve or maintain our health. What happens when we don’t utilize these tenants? One thing for sure is the title of this article, inflammation, a driver to disease and chronic illness. Inflammation is something most of us are familiar with, unfortunately, it can have some of the same characteristics as high blood pressure. You may be wondering how that comparison is possible. Blood pressure is known as the “silent killer”, due to the fact it often has no symptoms. as a person may not know that it is affecting their body adversely until it is too late. However, in severe cases, it causes headaches, shortness of breath, and nosebleeds. Unfortunately, when BP remains elevated for too long, it starts to wreak havoc on certain organ systems like the eyes and kidneys. We don’t really think of inflammation in the sense that it is silent but when it first presents itself, in its infancy, it isn’t something that hits you over the head like a hammer. We have different types of inflammation, one kind is the natural immune response that occurs when we have an injury, or infection. We need this type of inflammation as it is necessary for survival. This type of response is usually a big response that is quite evident. Think of a sprained ankle and what that process looks like. After the sprain, we get immediate inflammation at the site, which is a natural casting mechanism, immobilizing the ankle so that we can’t do further damage to the site. Over time, the ankle heals, and the inflammation dissipates, and the tissue returns to normal. This is a normal and needed inflammatory response. Another form of inflammation is chronic inflammation that is a low level, under the surface, like a smoldering fire. The first type of inflammation is a five-alarm fire, while this is more like the coals left over from a campfire, the bad part is that if it isn’t addressed, it will smolder on for a long period of time. This type of inflammation does not serve a purpose and if it is left unchecked, it can degrade tissue over time. The best example of this is rheumatoid arthritis and what it does to our joints. I was just working with a 28-year-old patient who had a ton of inflammation and one issue that I am pretty passionate about, degenerative disk disease or DDD, because I too have that going on in my body. DDD is the crumbling of your disks in the lower back, kind of like a crumbling foundation of your house, not a good thing. My plight with DDD started around 2000 when my good friend Dr Mike Wolf told me I had the back of a 65yo when I was only 35 at the time, thanks Dr Wolf. Over time, I started to develop some numbness in my left foot, which eventually led me to having an MRI of my back in 2011and seeing a neurosurgeon who told me he would gladly do surgery on me but one of the side effects could be numbness. That surgery never happened. This was a point where I met the fork in the road . Do I keep doing the same thing and expect a different result, the definition of insanity, or do I make some changes to better my situation? I am a bit stubborn in certain areas of my life and this was going to be one of those areas, so I started to get busy working on ways to decrease inflammation and to stabilize my low back. Some of the things I started and continue to do , eating clean food, when possible, organic fruits and vegetables which can be a challenge in western ND, non-seed oils for cooking, clean proteins with organic beef from Odermann Cattle Company, fish and chicken. I try to exercise 3-4 times per week. We do our best to limit toxin exposure. My wife and I have been gluten free for 13 or more years and that has been super helpful for lowering inflammation especially in my knees. If I happen to get into some gluten, my knees will act up about 2 days after and then it takes a couple of day for them to tame down. I take many supplements including Curcumin, Omega 3 fish oil, ProResolving Mediators or PRMs, joint complex with collagen, and D3 + K2 and one prescription called low dose naltrexone. Seven years after my initial MRI, I wanted to have a repeat MRI because my foot still has some numbness however no pain. I specifically asked the neurosurgeon how the new MRI compared with the previous one and he said there was no change from the two MRI’s and to keep doing what I was doing because it was working. The fruits of my labors paid off and continue to do so. If this sounds remotely like what you might going through or maybe yours started with a knee replacement, and then another, and then a shoulder, I challenge you to stop the inflammation . Replacing body parts should be the last resort, changing lifestyle is a solution to stopping the inflammatory progression that might be going through your body. If the inflammation is not stopped, it will continue to smolder under the surface damaging your tissue. You have the ability and now a road map to change. There is no better time than now to get busy and make the necessary changes to turn your situation around because, if nobody has given you tools before, you now have a roadmap. Call or stop by the pharmacy if you want to schedule a consult to help navigate your journey to attacking inflammation. 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!!

The process of working towards better or optimal health, in my opinion, requires small steps or changes that over time , turn into big results. An example would be changing your diet, which can be as simple as removing processed foods or trying to decrease the amount of fast food that you consume. The next step in the process may be to incorporate more fresh fruits and vegetables into your diet. You can see that over time, these little steps continue to grow and change occurs. The problem can often occur with simply starting the process. A common question at the pharmacy is, “I don’t take any vitamins, so where should I start?” That is an excellent question for a couple of reasons. First, it indicates that the patient is interested in bettering their health; secondly, they see value in supplements helping in that change. The answer to their great question is quite simple, and we refer to it as the core 4. We call it “foundational nutrition” because it is the foundation of health; without a strong foundation, the structure or body can easily crumble. The four supplements that comprise the Core 4 are Multivitamins/minerals, Vitamin D, omega-3 Fatty Acids, and Probiotics. Multivitamin: A multivitamin fills in the gaps our diets don’t meet. Documentation shows that our food supply does not contain the same nutrients as 40-50 years ago. By taking a multivitamin, we exceed levels that prevent disease and illness. The goal is optimal health, and providing nutrients is essential for making that happen. A micronutrient test to determine if you are deficient in nutrients can be done for $400. Vitamin D : Vitamin D 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-round. 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 in our neck of the woods, we won’t get 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. I recommend 5000IU/day with K2 for adults to aid absorption. Testing can be done 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 omega 3’s to help support cell structure. It is anti-inflammatory, essential for the brain, skin, and eyes, and has cardiovascular benefits. Omega 3’s are one of the few supplements that cost less to buy a supplement than if you were going to get it from a food source. Depending on the treatment plan, the dosage ranges from 1000 to 4000mg per day of EPA + DHA. You must read the label to make sure you are getting the proper dose, as some companies label their product as 1000mg of fish oil, yet the actual amount of EPA + DHA is 25-30% of that figure. If you burp up fish, your product is either rancid or poor quality. Testing your levels is an option and can be done for as little as $75. Probiotics: It seems a little weird that we would add bacteria to our systems, and good would come from it, but yes, that is the case. Healthy (and unhealthy) gut flora affects so many things. The immune system, skin conditions, aging, digestive disorders, mood and brain function, weight gain, fatigue, and more. It is almost impossible to help anyone not feeling optimal if they have unaddressed dysbiosis. Believe it or not, you can have a stool test done to find the makeup of bacteria in your feces, providing information about what might be happening in your colon As stated above, the Core 4 is foundational nutrition, and building a regimen on 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 trying to meet the patient where they are. Here are a few examples of that: • What kind of change are they willing to make? Can they change their diet or exercise for 30 minutes at least three times a week? • 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 the patient’s expectations? Today, we expect you to make that happen by taking a magic pill. I hope I don’t burst anyone’s bubble, but changing the trajectory of your health 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. If you are considering starting the process, implementing the Core 4 foundational nutrition is a great way to start. I would challenge anyone who is not currently taking vitamins to try this for 30 days and see if this regimen makes a difference. You may find yourself with more energy and mental clarity, both are things most of us would appreciate. Stop by the pharmacy if you need help navigating the Core 4 or are looking for help designing 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!!

Questions regarding the use of peptides for multiple health issues, seem to be more frequent as information about them continues to grow. The most common peptide, insulin, has been around for a long time however the ones getting the most attention these days are the GLP1s, prescription medications like Ozympic and Wygovy to name two of them. I am quite certain we will be seeing more of these as time goes on. Imagine tiny building blocks in your body that help you stay strong, heal faster, and even look younger. These little wonders are called peptides, and they’re making waves in the world of pharmacy and health. But what exactly are peptides? What do they do for us? And which ones are the most popular in medicine today? Let’s dive into this exciting topic and find out! Peptides are short chains ranging from 2 to 50 amino acids. Proteins are also chains of amino acids with 50 or more but their structures are more complex than a peptide. Think of peptides as mini-proteins—smaller and simpler, but still super powerful. Your body naturally makes peptides to do all sorts of jobs, like sending signals between cells, repairing tissues, or fighting off germs. Scientists have figured out how to make synthetic (lab-made) peptides too, and these are now used in medicines, supplements, and even skincare products. Unlike proteins, which can be huge and complicated, peptides are small enough to slip into places where bigger molecules can’t go. This makes them perfect for targeting specific problems in the body, like inflammation or muscle loss. They’re like the special forces of the molecular world—small, fast, and precise! So, why are peptides such a big deal? Fortunately for us, they come with a bunch of benefits that can help people live healthier lives. Here are some of the coolest things peptides can do: Muscle Growth and Repair : If you’ve ever hit the gym, you know how sore your muscles can get. Peptides like growth hormone-releasing peptides can help your muscles recover faster and grow stronger by boosting the production of growth hormone in your body. Anti-Aging : Want to keep your skin looking fresh? Peptides like collagen peptides can improve skin elasticity, reduce wrinkles, and even strengthen your hair and nails. They’re a secret weapon in many anti-aging creams! Weight Loss: Some peptides can help control appetite or speed up your metabolism, making it easier to shed extra pounds. This is a game-changer for people struggling with obesity. Healing and Recovery: Peptides can speed up wound healing and repair damaged tissues. This is why they’re popular with athletes or people recovering from injuries or surgeries. Boosting Immunity : Certain peptides can help your immune system fight off infections by acting like tiny guards that protect your body from bacteria and viruses. Because peptides are so versatile, pharmacists and doctors are finding new ways to use them all the time. They’re safe, effective, and can be tailored to tackle specific health issues. Now that we know how awesome peptides are, let’s meet some of the superstars you might find at the pharmacy or hear about from your doctor. These are the most popular ones making a difference in people’s lives. Insulin: You’ve probably heard of insulin if you know someone with diabetes. Technically, insulin is a peptide hormone made of 51 amino acids. It helps control blood sugar by letting your cells take in glucose (sugar) for energy. Without insulin, people with type 1 diabetes couldn’t survive, and many with type 2 diabetes rely on it too. It’s one of the most famous peptides in medicine! BPC-157 : This peptide is a rising star, especially for healing. BPC stands for “Body Protection Compound,” and it’s known for repairing muscles, tendons, and even your gut. Athletes love it for recovery, and some studies suggest it might help with conditions like ulcers or joint pain. Collagen Peptides: Walk into any drugstore, and you’ll see collagen supplements everywhere. These peptides come from breaking down collagen proteins (found in skin, bones, and cartilage) into smaller pieces. They’re a hit for improving skin health, strengthening joints, and keeping bones sturdy as you age. Semaglutide: This peptide is a lifesaver for people with type 2 diabetes and is also being used for weight loss. Semaglutide mimics a hormone that controls blood sugar and appetite. Semaglutide works best when it is combined with a diet that contains protein and regular exercise program. The key is to lose weight in the form of fat and not muscle. Peptides are changing the game in pharmacy because they’re so adaptable. Scientists can tweak them to do exactly what’s needed, whether that’s fighting a disease or helping someone feel better. Plus, they usually have fewer side effects than traditional drugs since they work with your body’s natural systems. These products are found in oral, topical and injectable forms. They can be purchased in locally or over the internet. A note of caution when sourcing these great products, make certain you are buying from a reputable source as the internet can often be the wild west and the last thing you want to do is buy something that may actually make things worse. In short, peptides are tiny but mighty. They’re helping people build muscle, heal faster, look younger, and stay healthy—all while showing us just how incredible science can be. So next time you hear about peptides, you’ll know they’re the unsung heroes working behind the scenes to keep us feeling our best! If you have any questions about peptides, feel free to stop in or give us a call 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 seems like we are helping more and more patients who suffer from Hashimoto’s Thyroiditis or HT. I have written about this in the past, but it is such an important subject that it needed to be reviewed again. This article will review ways to address HT and the supplements to support this illness. HT is an auto-immune thyroid condition that affects up to 2% of the population . As with all auto-immune states, the body attacks itself through inflammatory processes. In HT, if the inflammatory process goes unaddressed, the thyroid gland will eventually quit working, leading to full blown hypothyroidism. An important statistic is that 25% of patients with an auto-immune condition have a second AI condition. There is also the possibility of multiple auto-immune diseases characterized by patients having three or more AI conditions. These statistics reinforces the need for stopping the inflammation in its tracks and it should be the primary goal. When searching for treatment options for Hashimoto’s in conventional medicine, you won’t find information on treating this condition differently than treating hypothyroidism. The current treatment or standard of care for HT is levothyroxine. If we look at other auto-immune disorders, they all seem to have a treatment option, but not with HT. I find this to be rather intriguing, and I wouldn’t be surprised if they come up with a drug soon that is the cure for HT but carries a ginormous price tag. In my experience, It is not uncommon for patients with HT to express frustration with the treatment options presented. The most common statement is, “my thyroid labs are all normal, but I experience fatigue, and I don’t feel normal.” Often these patients are left with the options to “buck up” and “deal with it.” I think we as a medical community can do better in helping these patients struggling with HT. If you suspect you have a thyroid condition based on how you feel, some symptoms are low energy, dry skin, cold hands and feet, weight gain, brain fog, constipation, infertility, GERD, and hair loss, you can take a no-cost questionnaire at the pharmacy to see if a person should have thyroid levels tested. The standard thyroid test is TSH, and additional testing can include Free T3 and Free T4. These three tests are great if you have hypothyroidism but to find out if you have HT, you will need to test thyroid peroxidase anti-body and TPO Antibody. These two tests will give you an idea if your body is mounting an inflammatory response to the thyroid gland. With any auto-immune condition, t he easiest and most common test to check and track inflammation is C-reactive protein , an inflammatory marker tested in your blood and monitored. If this is something you haven’t done and you are being treated for a chronic condition, I would request it at your next office visit. You can have this done for as little as $60 with a fingerstick test if you are curious about your level. Another test you could look at will be an IgG food sensitivity test to see if you have foods that may be causing inflammation in your system. If you do this and have multiple food sensitivities, avoiding the foods you are reactive to will decrease your inflammatory burden. Besides avoidance, healing a leaky gut so that the food proteins are not absorbed would help reduce the inflammation created by these proteins. You have done your testing and have been diagnosed with HT; now, what do you do ? Keep in mind that HT is an auto-immune process resulting from inflammation that is out of control. The thoughts and ideas presented are an effort to halt the process, decreasing overall inflammation. Start with simple lifestyle modifications , which include cleaning up your diet. Consider a gluten-free diet that may sound like a mountain too big to climb, but it is a small hill today vs. years ago. Consumer demand has created many good options for people looking to keep gluten out of their diet. Other dietary considerations include eliminating sugar, quitting processed foods, and avoidance of fast food. The second thing, as mentioned above, would be to work on healing the gut . This healing can be accomplished by eating a gut-healthy diet and incorporating supplements to help the healing process. The following are gut-healthy supplements; glutamine, zinc carnosine, bovine colostrum, aloe vera, and other sticky, mucus-like nutrients. Along with dietary modifications and gut healing, several supplements can be helpful to take. Omega 3 fatty acids , also known as fish oil, can help reduce inflammation and are essential building blocks for cell structure and gut healing. Taking 2000mg of EPA + DHA is a good starting dose. Curcumin , the most studied active ingredient in turmeric, has been shown to have anti-inflammatory, antioxidant, antibacterial, and antiviral activity, all of which can provide benefits to those suffering from Hashimoto’s-related symptoms. Selenium (combo product pictured) in the form of selenomethionine at 200mcg per day is a necessary nutrient for the conversion of T4 to T3. This conversion is facilitated by the de-iodinase enzyme, which requires selenium to make this conversion happen. Vitamin B12 and all of the B vitamins are important for energy production and cellular and metabolic functions. Taking a quality multivitamin with high amounts of B vitamins is essential. The last nutrient is a part of foundational nutrition, Vitamin D. It is an essential nutrient to support your immune system, and the optimal level would be 50-80ng/ml. Getting this level is not difficult in the summer as Vitamin D is synthesized in the skin with UV light. As little as 15-20 minutes in the sun without sunscreen between the hours 10 am and 2 pm is all it takes. Winter is the opposite, and supplementing with 1000-5000IU’s is necessary to maintain these optimal levels. Many of our practitioners who work with HT utilize a prescription medication called low-dose naltrexone (LDN) to help with this condition. There is no indication for its use in HT, but LDN works on the immune system to lower inflammation. The mechanism of action that increases endorphins seems beneficial to improve overall energy in patients, a symptom that plagues patients with HT. It is crucial to keep in mind that auto-immune conditions, like HT, are not healed in a short time, and it is often necessary to continue following a healing regimen throughout your life span. The byproduct of a plan that decreases overall inflammation is the potential for disease prevention and a better quality of life. My staff and I would like to help you with questions regarding Hashimoto thyroid issues that you might be having, so call 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!!

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!!!