Lehan Drugs Blog

Swimming pools, barbeques, baseball games, golf… summer is in full swing and for many of us that means spending more time outside in the sun.  At this point, most of us are aware of the benefits of using sunscreen. In addition to preventing painful sunburns, sunscreen also appears to decrease the risk of certain skin cancers and helps prevent sun-related aging.  Unbeknownst to many sunscreen users is that these products also prevent the body from making adequate amounts of the hormone vitamin D.

Vitamin D is a fat soluble vitamin that is found in a variety of plant and animal food sources, as well as vitamin supplements and fortified dairy products.  The fact is, the body most efficiently creates the majority of its vitamin D requirements through exposure to ultraviolet rays (sunlight).  Cholesterol in the skin is exposed to UV light, and it is transformed through a metabolic pathway to the hormone, vitamin D.  A mountain of research has shown the importance of vitamin D in supporting a variety of healthy processes in the body. These include maintaining healthy bones, optimizing brain function, supporting healthy pregnancies, and more.

Our modern lifestyles have moved us indoors and stressed the use of sunscreen, removing us from the most natural source of vitamin D. The resulting epidemic of low levels of vitamin D has been associated with increased risks of cancer, mental illness, and poor bone health, among other things.  One set of epidemiologists estimated that maintaining healthy vitamin D levels in Europeans would save their health care system billions at the rate of $1346 per person every year!¹

Vitamin D may also aid in cancer prevention. One study found healthy vitamin D levels reduced the risk of developing breast cancer.  Women who were exposed to the highest vitamin D levels were 50% less likely to develop breast cancer compared to those in the study who were not receiving adequate vitamin D.²  It also appeared that women who had high vitamin D exposure during the adolescent years were 25-45% less likely to develop breast cancer.³

With this in mind, it is extremely important to ensure that you are receiving enough vitamin D, especially if you are not exposed to sunlight on a regular basis.  According to the Vitamin D Council, if adults and adolescents are not exposed to sunlight regularly, research indicates supplementation with 2-5,000 units (IU) of vitamin D daily. ⁴  To obtain this amount, one would need to consume at least 20 glasses of milk per day or take 10 standard multivitamin tablets.

The skin is capable of producing approximately 10,000 IU of vitamin D in response to 20–30 minutes of full summer sun exposure (no sunscreen) — 50 times more than the US government’s recommendation of 200 IU per day!  Why the big difference?  It turns out the recommended daily allowance is what is required to prevent a disease called rickets (softening of the bones), not what is required to keep other body processes functioning properly.

Come in for a consultation with one of our pharmacists to determine if you are at risk for vitamin D deficiency.  We can help you increase your intake of vitamin D through quality, bioidentical vitamin D supplements to ensure that you are getting all that you need for optimal health. 

For more extensive information on Vitamin D, visit http://www.vitamindcouncil.org/

Yours in Health,

Jon Lehan, PharmD

 1. William B Grant, William B. Grant, Heide S. Cross, Cedric F. Garland, Edward D. Gorham, Johan Moan, Meinrad Peterlik, Alina C. Porojnicu, Jorg Reichrathe, Armin Zittermann, Estimated benefit of increased vitamin D status in reducing the economic burden of disease in western Europe, Progress in Biophysics and Molecular Biology, March 4 (2009) 1–10.

2. Garland CF, et al. The role of vitamin D in cancer prevention. American Journal of Public Health 2006;96:252-258.

3. Knight JA, et al.  Potential reduction in breast cancer risk associated with vitamin D.  Proceedings for the American Association for Cancer Research, Volume 47: 2006.  Abstract #4009.

4. http://www.vitamindcouncil.org/treatment.shtml

**UPDATE**
There have been recent recommendations by the Environmental Working Group on sunscreens.  To read the full report and help select a sunscreen, visit http://www.ewg.org/2010sunscreen/full-report/

I believe the choice to use a community pharmacy over a mail-order pharmacy should belong to patients, not the insurance companies.  This view is also shared by the National Community Pharmacists Association (NCPA).  I will be joining NCPA and other community pharmacists in Washington D.C on May 10^th to discuss this with lawmakers.  Community pharmacies are vital partners in ensuring optimal care for our patients.  Many pharmacies, like ourselves, offer a variety of programs and services in addition to filling prescriptions, such as Medication Therapy Management (MTM), immunizations, health screenings, home medical equipment and services, and more.  Community pharmacists are just that: members of the communities we serve.  We are committed to our patients; we hope to form long-lasting relationships built on trust and the mutual desire to improve health and quality of life.  When patients are forced to fill prescriptions through mail-order pharmacies, these strong ties are severed, and the quality of care is reduced.

The now-common trend with prescription insurance coverage is the ability to fill and pay for a three month supply of medications at one time.  However, many patients are being told they can only receive this benefit through mail-order pharmacies.  Patients still have the ability to fill their medications at their local community pharmacies, but are often penalized with a higher payment.  This is not surprising.  Insurance companies and PBM’s (pharmacy benefit managers) own these mail order pharmacies and use leverage to steal patients away from local pharmacies.  The result: billions in profits for PBM’s (that’s right: billions) without regard to the effect it has on patient care and health outcomes.

Lehan Drugs wants to give you a voice in Washington to help shape the future of pharmacy in America.  I truly believe that community pharmacists are in the strongest position to ensure patients receive the attention that is needed for successful health outcomes.  I will be attending meetings in Washington in May to discuss this issue with our country’s leaders.

If you would like to join the fight to ensure your right to use the pharmacy of your choosing, visit www.Fight4Rx.org.

Tim Lehan, RPh

Here’s a little more information on NCPA’s campaign to protect your right to use your local pharmacy:

NCPA Launches Fight4Rx Online Grassroots Community

ALEXANDRIA, Va.–(BUSINESS WIRE)–The National Community Pharmacists Association (NCPA) has launched Fight4Rx.org, which is dedicated to recruiting and transforming patients into grassroots activists for community pharmacies by educating them on the vital role pharmacists play and the serious challenges they face in the delivery of health care.

“America’s patients and their families greatly value their community pharmacists and the personalized services they provide,” said Bruce T. Roberts, RPh, executive vice president and CEO of NCPA. “Fight4Rx patients will have a new forum during the health care reform debate in Washington, DC. They will be able to research issues and speak directly to their legislators about key concerns affecting their access to prescription medication and services by their local community pharmacies.”

Although the health care bill has passed, debate and changes will continue.  Fight4Rx includes issue briefs on pharmacy patient issues, Medicare and health care news updates, and a video blog on the home page (www.Fight4Rx.org) with regular updates from pharmacy industry experts. Patients will receive a monthly e-mail newsletter that will update them on key pharmacy issues and news about the latest breaking news. When necessary, Fight4Rx will encourage patients to contact their elected officials (via a 1-800 number or e-mail).

“I believe the Fight4Rx online community will lead us to fair and common-sense health care policies in the United States by empowering patients to let their voices be heard in establishing the pharmacy home of their choice,” said Holly Henry, RPh, NCPA president and Seattle, Washington pharmacy owner.

The National Community Pharmacists Association, founded in 1898, represents the nation’s community pharmacists, including the owners of more than 23,000 pharmacies. The nation’s independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation’s retail prescription medicines. To learn more go to www.ncpanet.org.

As promised, here are some very commonly prescribed drugs, and a little about how they can affect a patient’s nutritional status and overall health.   

Acid reducing medicines (Omeprazole, Prevacid, Zantac, Nexium, etc.)

 It seems to me that acid-reducing medications are prescribed more and more often, for a variety of conditions.  They are certainly one of the most commonly prescribed medicines we dispense.  I’m sure you don’t go a day or two without being exposed to an advertisement for Prilosec or Prevacid.  These medicines can relieve discomfort, cure ulcers, and protect the stomach from other medications.

These medicines also affect the absorption of certain vitamins and minerals.  The digestive system has been calibrated over the centuries to efficiently absorb nutrients from food, processes which may be dependent on the pH, or acidity in the gut.  There are several essential vitamins and minerals that might be affected.  

These include:

• Calcium

• Vitamin D

• Folic Acid

• B-12

 Of special note is vitamin D.  A mountain of recent research has shown the importance of vitamin D in supporting a variety of healthy processes in the body.  Low levels are associated with increased risks of cancer, mental illness, and poor bone health, among other things. Vitamin D is obtained in the diet, and through exposure to sunlight.

 In northern areas, such as ours, we don’t have the benefit of sun exposure many months out of the year.  If you’d like to learn more about Vitamin D, check out www.vitamindcouncil.com for more information, or contact a Lehan’s pharmacist.

 Antibiotic therapy (Levaquin, Amoxicillin, etc.)

Antibiotics have revolutionized healthcare, saved countless lives, and battled some of the most deadly diseases known to man.

 They are also quite effective in destroying the microbes in our intestines that we rely on for proper digestion, intestinal health, vaginal health, and even proper functioning of our immune systems.

Supplementing with a high-quality probiotic helps maintain the correct intestinal flora and can prevent antibiotic side effects.  Ask one of our pharmacists how to tell the difference between higher and lesser quality products to ensure you are getting optimal benefit.

Cholesterol-lowering drugs (“Statins” i.e. Lipitor, Crestor, Simvastatin, Lovastatin, etc.)

Statins, or HMG Co-A reductase inhibitors, lower cholesterol.  There is evidence they can improve cardiovascular health and reduce major health events.

 They also deplete Coenzyme Q10.  CoQ10 is a substance vital for normal functioning of the mitochondria, or the “engines,” in every cell of our body.  Healthy levels of coenzyme Q10 are critical in supporting the normal functioning of those energy pathways.  One patent application by a major drug manufacturer for their product references this depletion, and even goes so far to recommend replacement for all patients!

There are other benefits from taking taking CoQ10.  A review of clinical trials in 2007 also showed CoQ10 may help lower blood pressure..

 Note: Coenzyme Q10 is not well absorbed when taken orally.  Certain formulations can provide more efficient absorption.  Ask one of our pharmacists for recommendations.

 Beta blockers (atenolol, metoprolol, propranolol, etc.)

 These medicines help control blood pressure, heart rate, and can improve survival in certain chronic heart conditions.

 They also reduce levels of coenzyme Q10, and they deplete melatonin, a hormone vital in the normal functioning of our sleep-wake cycle.

 We’ve provided you a very short list, and many other medications may cause nutritional deficiencies.  Sometimes nutritional supplementation with vitamins or minerals is an effective means to help combat drug-induced deficiencies.  Don’t hesitate to contact a Lehan’s pharmacist for more information, or for other recommendations to help you maintain optimal health and nutrition.

Until recently, I’d never really been into “vitamins.” I eat a fairly well rounded diet. OK, I eat a lot of food, and I’m well rounded. I’ve been fortunate to have good health and even better genes. So, like many healthcare professionals, to some extent I probably take for granted the nutritional status of my patients.

I attended a conference a few weeks ago on nutritional and hormone balance in healthy aging, however, and my eyes were really opened to the importance of nutrition in all aspects of health. Often times we as health care professionals give lip service to a healthy diet, or a multivitamin, but don’t spend the time emphasizing specific nutritional changes or needs that can ensure optimal health in our patients.

In all truthfulness, I didn’t learn a lot about nutrition in pharmacy school. I did, however, learn a lot of biochemistry and pharmacology. It turns out that understanding those disciplines is key in understanding the importance of nutrition.

In pharmacy school ,we were forced to memorize mountains of equations and biochemical pathways. To be honest, I figured I would never use that information again. It turns out, understanding those pathways is crucial in understanding nutrition’s role in health. So as I’ve dredged my memory remembering things like the “Kreb’s cycle” or “liver enzymes,” I’ve really gained a new appreciation for our bodies’ reliance on proper nutrition.

So, since I’m a pharmacist, the follow-up question might be as follows: do medications affect our overall nutritional health?

Simply put: Yes! Medications can cause deficiencies of nutrients necessary for the normal functioning of the human body.

One estimate suggests that 25% of all adverse reactions to medications are caused by nutrient depletion!

Medications have great potential to improve our health, cure diseases, and improve our quality of life. However, medicines are rarely “magic bullets.” My high school social studies teacher, Mr. Nakonechny once said “You can figure out how to dig a perfectly square hole, but you still have to find someplace to hide the dirt.” In my next post, we’re going to examine the dirt: several commonly prescribed medications and nutritional depletions they may cause.

If you just can’t wait, feel free to contact us for more information about the importance of recognizing drug-induced nutritional deficiencies and how they can be corrected to achieve wellness.  You can e-mail me at jon@lehandrugs.com or give us a call at 815-758-0911 or 815-217-3890 for more information!