Holistic Health News
Dr. Cathy Rosenbaum

Tai Chi Easy Classes at Miami Township Civic Center Milford OH

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 Tai Chi Easy™, a type of meditation, involves a series of slow, rhythmic movements accompanied by deep breathing, performed in a slow, repetitive manner.  Each one-hour session consists of gentle physical exercise and mental focus (6).  You will need the physical ability to stand unassisted for at least 20 minutes.

Tai Chi Easy™, a combination of Tai Chi and Qigong, builds strength without much exertion and recovery time.  Gentle stretching, breathing, and mental focus are deepened and broadened during each successive class. Some squatting, lunging, and turning are incorporated in these classes.

Both Tai Chi and Qigong are ancient Chinese exercises that promote optimal health and vitality.  In general, Tai Chi (pronounced tie-chee) emphasizes balance, harmony, and stress reduction (1-5, 8, 11, 12).  Qigong (pronounced chee-gong) is the practice of harnessing your life energy (Qi).

Four Parts to Your Tai Chi Easy™ Classes:

  • Breathing practices – designed to trigger relaxation responses, increase oxygen flow, and provide energy
  • Mindful movements – five gentle exercises (see below) that relax, flex, and stretch your body to help improve balance and coordination, increasing blood and lymph flow (7)
  • Self-applied massage – emphasis is placed on reflex points on hands, ears, feet, neck and scalp; intended to relax your whole body (9)
  • Meditation – focused, intentional centering of your mind on the present to calm your emotions and with Spirit (10)

Five Mindful Movements Per Set (Your Choice of Moving, Standing, or Sitting):

  • Harmonizing Yin and Yang (Active/Passive Energy) (Parting the Wild Horse Mane)
  • Brush Knee, Send Chi
  • Cutting Through to Clarity (Repel the Monkey)
  • Cloud Hands
  • Gathering Energy from the Earth and Heavens

Clothing and Footwear:

Comfortable loose (casual wear) clothing, comfortable flat sole shoes (e.g., Moccasins or sneakers).   Some of your classes may end outside, but most will be held indoors.

 Pre-Work:

None.  Come ready to have some fun!  Please call Dr. Cathy Rosenbaum, Tai Chi Easy Practice Leader at 513.607.3495 or Beth at 513.248.3727 at Miami Township Civic Center 6101 Meijer Drive Milford OH for more information and to pre-register for the next session.

“When you cultivate balance and harmony within yourself, or in the world – that is Tai Chi.  When you work and play with the essence and energy of life, nature and the universe for healing, clarity and inner peace – that is Qigong.”  – Roger Jahnke

References

  1. Harner et al. Tai Chi: Moving for better balance- development of a community-based falls prevention program.  J Physical Activity Health 2008; 5:445-455
  2. Health benefits of tai chi: what is the evidence? Can Fam Physician 2016 Nov: 62 (11): 881-890.
  3. Zou et al. Tai chi for health benefits in patients with multiple sclerosis: a systematic review.  PLoS One 2017 Feb 9:12(2) e0170212
  4. Benefits of tai chi for fibromyalgia.  Pain Manag 2018 Jul 1:8(4): 247-250.
  5. Murley et al. Influence of tai chi on self-efficacy, quality of life, and fatigue among patients with cancer receiving chemotherapy: a pilot study brief.  J Holist Nur 2019 Dec; 37(4): 354-363.
  6. Jor’dan et al. Long-term tai chi training is associated with better dual-task postural control and cognition in aging adults.  Adv Mind Body Med 2018 Summer;32(3):4-11
  7. Klein et al. Qigong and tai chi as therapeutic exercise: survey of systematic reviews and meta-analyses addressing physical health conditions. Altern Ther Health Med 2019 Sept;25(5):48-53.
  8. Conboy et al. Tai chi for heart attack survivors: qualitative insights. BMJ Support Palliat Care 2019 Apr 4.
  9. Powerpak CEU for Pharmacists and Pharmacy Technicians 2019. Augmenting pain therapy with self-massage.
  10. Chen et al. Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials.  Depression and Anxiety 2012: 29:545-562.
  11. Convergence of the Nobel fields of telomere biology and DNA repair.  Photochem Photobil 2017; 93:229-237.
  12. Protocol for the MATCH study (mindfulness and tai chi for cancer health): a preference-based multi-site randomized comparative effectiveness trial (CET) of mindfulness -based cancer recovery 9MBCR) vs tai chi/qigong (TCG) for cancer survivors.  Contemp Clin Trials 2017; 59:64-76.
  13. Curry et al. Case series of multiple health benefits in those undertaking extended Qigong practice as a complementary self-care practice in an outpatient pain clinic.  OBM Integrative Complement Med Pain Management June 28, 2019.

Dietary Supplement Guidelines

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by Dr. Cathy Rosenbaum, Rx Integrative Solutions                                                       

Holistic Clinical Pharmacist

Certified Health Coach

Certified Fitness Nutrition Coach

SUPPLEMENT DEFINITION

A dietary supplement is a vitamin; a mineral; an herb or other botanical; an amino acid; or a concentrate, metabolite, constituent, extract, or combination of any of the above ingredients.

SUPPLEMENT QUALITY                                                                      

The FDA is not authorized to approve dietary supplements for safety and effectiveness. Most dietary supplements can be marketed without notifying the FDA (DSHEA Act 1994).  To ensure supplement potency and purity, look for proof of independent third-party analytical testing on supplement bottle labels (e.g., see the round quality seals):

  • consumerlab.com
  • NSF (National Sanitation Foundation) nsf.org
  • USP-Verified (U.S. Pharmacopoeia) usp.org
  • c-GMP (Good Manufacturing Practice – minimum required by FDA for all dietary supplements)
  • Certificate of Analysis (see store’s website, requested from the supplement’s manufacturer)

 CLINICAL RESEARCH (SUPPLEMENT INDICATION)

Look for research studies in humans with your same condition/health goal, identifying the exact product, dosing, and length of therapy BEFORE you purchase any dietary supplements

  • Visit clinicaltrials.gov (NIH sponsored website for all types of research)
  • Do not be misled by marketing hype/confusing supplement claims by famous people
  • Follow your doctor’s recommendations on the use of dietary supplements is using the latter instead of prescription medications for your health needs – discuss risk/benefits with your pharmacist (e.g., prescription statins vs red yeast rice for cholesterol lowering)

 SUPPLEMENT SAFETY/SIDE EFFECTS

  • Work with your pharmacist to manage unwanted effects and/or drug/supplement interactions
  • Write to FDA for Freedom of Information post-marking reports on supplement side effects
  • Report any unwanted supplement effects to your physician, pharmacist, or directly to the FDA via MedWatch https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program
  • Do not take both dietary supplements and prescription medications for the same indication unless directed by your physician (e.g., diabetes mellitus, high cholesterol, high blood pressure)

SUPPLEMENT LABEL

  • Carefully read all the instructions for supplement usage, supplement facts, active and inactive ingredient list, and warnings, remembering dietary supplements are regulated by FDA CSFAN as nutrition (not medication) and contain ‘nutritional labels’ (e.g., serving size, not ‘dosing’ like OTC medications)

PROPRIETARY BLEND

  • Avoid dietary supplements with ‘proprietary blends’ when manufacturers do not disclose the actual amounts of every active ingredient (amounts considered to be a trade secret)
  • Note the proprietary blends are found in multivitamins, supplements for colds/flu, weight loss, body-building protein formulations, and many more
  • GLUTEN FREE SUPPLEMENTS
  • Prescription and OTC medications are not covered under the FDA’s gluten-free labeling rule whereas dietary supplements are covered. Any foods or supplements that carry the label “gluten-free,” “no gluten,” “free of gluten,” or “without gluten” must contain less than 20 parts per million (ppm) of gluten. For more information, visit the following websites:

*            www.glutenfreedrugs.com 

*            www.dailymed.nlm.nih.gov 

*            www.celiac.com 

ROLE OF THE HOLISTIC CLINICAL PHARMACIST

  • Feel free to consult with your holistic clinical pharmacist as an equal partner on your decision-making team to determine which dietary supplements are appropriate for your individual health goals, health conditions, lifestyle choices, and your value system.

 

 

Newer Injectable Medications for Chronic Weight Management

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      Newer Injectable Medications for Type II Diabetes or Chronic Weight Management

By Cathy Rosenbaum, PharmD MBA RPh CHC CDP CFNC

The American Medical Association (AMA) officially recognizes type II diabetes mellitus and obesity as complex chronic diseases that require a multifactorial range of treatment and prevention options.

Obesity can be caused by a combination of changes in the environment (family eating habits, lifestyle choices, behaviors), genes/metabolism, and stress and is oftentimes associated with depression in women (Pratt and Brody 2014).

As a certified health coach and certified fitness nutrition coach, I have been helping clients with their chronic weight management journey for many years.  Regarding treatment interventions, use of the prescription phentermine is decreasing due to its side effect profile of increased heart rate, blood pressure, and nervousness. Dietary supplement and OTC medication usage has also decreased due to lack of efficacy.  By comparison, newer injectable prescription medications have dramatically increased in popularity and I’m monitoring their place in weight management therapy.

The two types of injectable medications for weight management are called glucagon-like peptide-1 (GLP-1) receptor agonists or glucose-dependent insulinotropic polypeptide (GIP) receptor agonists.  Consumer demand is causing intermittent supply disruptions and drug shortages for patients needing the FDA-approved indication of type II diabetic management.

Injectable GLP-1 and GIP Receptor Agonists

For perspective, GLP-1 is a hormone produced in the intestine that interacts with our hunger hormones. GLP-1 receptor agonists decrease appetite by slowing gastric emptying and increasing satiety after eating. They increase the pancreas’s production of insulin when glucose levels are high.

GIP is another hormone released from the small intestine. GIP receptor agonists reduce secretion of stomach acid and increase insulin sensitivity to control blood sugar after meal ingestion.

GLP-1 and GIP receptor agonists are combined in the injectable prescription medication, Mounjaro (tirzepatide) that is FDA approved for type II diabetes mellitus but not FDA approved for chronic weight management (e.g., off-label use).

Victoza (liraglutide) is FDA approved to treat type II diabetes mellitus, Saxenda (liraglutide) is FDA approved for chronic weight management in a different dosage regimen.

Ozempic (semaglutide) is FDA-approved for type II diabetes mellitus, and Wegovy (semaglutide) is approved for chronic weight management in a different dosage regimen.

Injectables are covered by insurance for type II diabetics but may not be covered for the weight management indication (cost ~$1000-$1200/month).

 

Generic Drug Name FDA Approved Type II Anti-Diabetic Drug/Brand Name Chronic Weight Management in Adults with or without Type II Diabetes Drug/Brand Name Comments
Semaglutide Ozempic (SQ)

 

Rybelsus (Oral)

 Wegovy* – inject SQ once weekly GLP-1 receptor agonist

 

Is now FDA approved for chronic weight management in children > 12 years old who meet criteria.
Liraglutide Victoza Saxenda* – inject SQ once daily GLP-1 receptor agonist
Tirzepatide Mounjaro No different brand name yet, since it’s not yet FDA approved for this indication- inject SQ once weekly. Combination GLP-1 receptor agonist and GIP receptor agonist

GLP-1 receptor agonist side effects:

  • Nausea & vomiting
  • Diarrhea
  • Constipation & abdominal pain
  • “Ozempic face”

GIP receptor agonist side effect: Anti-emetic (good in combination with GLP-1 receptor agonists that can cause nausea)

Contraindications: Injectable GLP-1 receptor agonists and GIP receptor agonists are contraindicated in pregnancy and with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.

GLP-1 receptor agonists carry a boxed warning about a risk of thyroid C-cell tumors (based on animal data, no corresponding human data).

Length of Therapy for Weight Management

Chronic diseases like obesity may require long-term treatment. The FDA has approved subcutaneous Saxenda and subcutaneous Wegovy for long-term weight management.

Please remember to only use chronic weight management medications after all other options have been exhausted and then only as an adjunct to healthy diet and regular exercise routine. It has been reported that once these medications are discontinued, weight comes back even more than before medication use.

Your health care provider will create a plan tailored to your weight-management goals. You’ll need to visit your health care provider 4 months after you begin taking Saxenda or Wegovy to review your progress and renew your prescription if appropriate.

Dietary Supplements Touted for Chronic Weight Management

In 2015 the NIH Health Office of Dietary Supplements reviewed 19 ingredients in dietary supplements touted for chronic weight management.  None demonstrated significant beneficial effects on weight management or change in body composition.

Product Alleged Pharmacology (Animal/Lab Studies) Side Effects Comments
GTF Chromium May promote glucose utilization and increased sensitivity of insulin receptors Vertigo, N&V Essential trace mineral.

 

Found in broccoli, whole wheat and rye breads, grape juice, potatoes, turkey breast, apples with peels, green beans, bananas, romaine lettuce)
Green Tea Extract –

 

Camellia sinensis

 

 Caffeine may stimulate body’s metabolism Anxiety, irritability, insomnia Caffeine, active

 

Catechins (flavonoids) are antioxidants (general health)

 
Vanadium (vanadyl sulfate – oxidative form) May improve insulin sensitivity and glucose uptake Abdominal discomfort, diarrhea, gas, loss of energy Trace mineral.

 

Found in pepper, dill, radishes
Raspberry Ketones May stimulate the hormone adiponectin, an enhancer of fatty acid oxidation, glucose regulation Jitteriness, increased heart rate, increased blood pressure Found in red raspberries, kiwifruit, peaches, and apples
Green Coffee Bean Extract Possible inhibition of the enzyme glucose-6-phosphatase

 

In vitro, glucose-6-phosphatase induces glucose production in the liver

 Increased heart rate, increased blood pressure Chlorogenic acid (antioxidant)

 

Caffeine, active
Garcinia Cambogia May reduce synthesis of fatty acids and glycogen storage via inhibition of ATP citrate lyase Liver toxicity, long term in higher dose (case studies) Hydrocitric acid, active

Holistic Weight Loss Strategy

Any successful chronic weight management program is first and foremost dedicated comprehensive, healthy lifestyle choices (e.g., walking, exercise, stress management, socialization, sleep hygiene, spiritual health, other healthy food choices and portions).

The initial recommendation for safe weight loss is 5%-10% of body weight over six months to reduce risk of developing type II diabetes mellitus, high cholesterol, and high blood pressure.  This translates into a decrease in daily calorie intake by ~500 below daily energy needs (e.g., 1-2 pounds/week). A greater rate of weight loss does not yield better long-term results.

Evidence-based dietary guidelines (U.S. Department of Agriculture 2015-2020) have given us www.choosemyplate.gov for proper portion control and recommend dividing one’s plate into 4 quarters (1/2 for fruits and veggies, ¼ for lean protein, and ¼ with whole grains, plus milk or calcium-rich foods for bone health).  The Mediterranean Diet is the world’s gold standard for plant-based nutrition.

How to Eat Mindfully (National Society of Health Coaches)

  • Set a mealtime S.M.A.R.T. satisfaction goal with a health coach
  • Create your personal ‘I’m done eating’ signal
  • Sit down to eat and minimize outside distractions with a focus on the present
  • Be mindful of your hunger and fullness level before, during, and after eating
  • Create several mindful pauses before, during and after eating
  • Express mindful attitudes of self-compassion, non-judgment, kindness, patience, joy, and thanksgiving regarding food intake

Take Home Message

  • Physicians and CNP’s with prescribing privileges should be aware of national injectable chronic weight management/type II diabetes mellitus treatment medication supply shortages
  • All medications and dietary supplements can have side effects, and some interact so they are ideally be managed by talking with a pharmacist
  • Work with a health coach to assess your readiness to change and your commitment to change and personal values about taking medications before embarking on a weight loss program
  • Purchase and use a fitness wearable to track steps, calories burned, heart rate, REM sleep
  • Weight yourself once a week; regularly exercise with a routine approved by your physician and guided by a trainer
  • Measure your waistline at least once a month (high risk of developing chronic condition if > 35 inches for women and >40 inches for men)

References

  1.   Reducing risk of obesity: defining the role of weight loss drugs.  Pharmacotherapy 2013:
  2. The safety and effectiveness of natural supplements for weight loss in populations with obesity: a critical review of the literature from 2006 to 2016.  Crit Rev Food Sci Nutri 2019:
  3. Obesity therapy: How and why? Curr Med Chem 2019:26:1-12.
  4. The Medical Letter on Drugs and Therapeutics Volume 64, Issue 1651, May 30, 2022.
  5. The Medical Letter on Drugs and Therapeutics Volume 65, Issue 1670, February 20, 2023.

Montgomery City Leadership Academy Class of 2023

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We are Montgomery (Ohio)! I’m excited to learn more about our awesome community and its resources during the upcoming 10-week class geared toward Montgomery business leaders like Rx Integrative Solutions https://lnkd.in/dCD9-XF. Let us know if your community has a similar program. We will compare best practices, helping one another build better communities across our country because it takes a village…. Happy New Year!

Functional Medicine Pharmacists Alliance Membership

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I am pleased to announce that I am a new member in the Functional Medicine Pharmacists Alliance (FMPHA).  Membership allows me to incorporate key FM principles and comprehensive FM tools into my client ‘root cause’ health & wellness evaluations as well as subsequent health recommendations for more sustainable, positive patient outcomes.

As a Certified Fitness Nutrition Coach, Certified Health Coach, and FM Pharmacist, I emphasize the importance of incorporating ‘food as medicine’ nutrition along with lifestyle modifications into any health change regimen.

As a Holistic Clinical Pharmacist, I may refer clients to other healthcare providers for optimal whole-person healing (e.g., acupuncture, guided imagery, aromatherapy, music therapy, and FM or Traditional, Integrative & Complementary Medicine physicians).

For information, to refer a client, or to schedule an in-person/Zoom virtual health & wellness evaluation, please visit www.rxintegrativesolutions.com or contact me at [email protected] . 

 

Dr. Cathy’s Speaker’s Bureau

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This is a short list of topics that Dr. Cathy, a Holistic Clinical Pharmacist, from Rx Integrative Solutions, offers to communities, corporations, support groups, and workshops upon request.  Please email her at [email protected] for more information, course descriptions, or to schedule an event.

  • The A to Zzz’s of Sleep Health
  • Memory Health: Even Elephants Forget Sometimes
  • Bottled Water: What You Don’t Know May Harm You
  • FDA and PhRMA: dance Partners or Double-Edged Swords?
  • Caregiving: From Compassion Fatigue to Compassion Satisfaction
  • Homegrown Medicinal Herbal Teas
  • Debunking Myths About Dietary Supplements
  • Hemp Cannabinoids: The Healthcare Professional’s Perspective
  • Antioxidants, Multivitamins, and Health: Insurnace Policies to Healing?
  • Managing Polypharmacy in Seniors
  • The Eight-Balance Point Model for Integrative Health and Healing
  • Integrative Health & Wellness Trends 2023-2028
  • Managing Stress: Holistic Interventions, Health Coaching
  • Functional Medicine
  • Primer of Integrative Health & Wellness Systems (TCM, Ayurveda, Naturopathy)
  • Let’s Have Some Applause for Menopause

 

Upcoming Events on Facebook.com/RxIntegrativeSolutions

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Please visit Facebook.com/rxintegrativesolutions and ‘like’ us for an up-to-date listing of upcoming traditional, complementary, and integrative health & wellness events and classes with Dr. Rosenbaum, holistic clinical pharmacist.   We’re over the moon with excitement about your health and wellness!

The Role of Prunes in Modulating Inflammatory Pathways to Improve Bone Health

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Damani et al.  The role of prunes in modulating inflammatory pathways to improve bone health in postmenopausal women. Adv Nutr 2022;Jan 3: 162 doi. 10.1093/advances/nmab162

Who knew!  New pre-clinical and clinical research indicate prunes (Prunus domestica) are a fruit that might be more than a nutritious antioxidant and anti-inflammatory-rich food as well as one that helps keep us regular.

Two of these clinical studies looked at the effects of prune consumption  (50-100 grams/day) for 6-12 months on bone mineral density and blood biomarkers in postmenopausal women and in postmenopausal women who did not consume prunes.  Results in the former group indicate some improvement in both outcome measures.

We already know that calcium, vitamin D3, vitamin K2, magnesium, and other nutrients in food and dietary supplements (e.g., strontium ranelate) may help strengthen bones.  Prunes cannot take the place of adequate nutrition and bone-stressing exercise, like weightlifting, for maintaining bone health and in preventing osteopenia or osteoporosis.

Health Tip:  Eat more prunes, eat a balanced diet, and keep exercising!