Meet Dr. Cathy Rosenbaum
Look for the USP Verified Mark located on the front of dietary supplement bottles which represents high quality products (e.g., potency/purity). Use this link below to find out if your supplements measure up.
USP Verified Products Listing (quality-supplements.org)
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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!
The short answer is, ‘Absolutely. Yes!’ In the 1970’s Jeff Bland PhD FACN FACB CNS, former Professor of Chemistry at the University of Puget Sound in Washington state, started his work in Functional Medicine (FM). Ten years later Dr. Bland began teaching practitioners how to implement preventive nutritional medicine in their professional practices. FM, like many health practices, spotlights whole-food nutrition as a cornerstone of healing.
The Institute for Functional Medicine was launched in 1991, with Dr. Bland as the Co-Founder. The organization offers a FM Certification Program for physicians and health care professionals holding at least a Masters’ degree and licensure in their fields.
In 2014, the Cleveland Clinic established The Center for Functional Medicine with the Functioning for Life™ 10-Week Program where patients can select from a disease-specific series of options to meet their individual functional health needs. Please visit https://my.clevelandclinic.org/departments/functional-medicine for more information.
FM is a proactive, personalized care approach that incorporates three distinct paths into a patient’s health assessment/history, namely natural medicine, molecular medicine, and systems biology. FM health practitioners are MDs, DOs, DCs, CNPs, and PharmDs, among others. The University of Western States offers a degree in Human Nutrition and Functional Medicine (see https://www.uws.edu/human-nutrition-functional-medicine/ ).
FM practice attempts to address the underlying root cause of disease rather than just symptoms and symptom management. FM is based on the principle that a diagnosis can be the result of more than one cause, or one cause (e.g., inflammation) may lead to multiple diagnoses over time. The primary FM outcome goal is for a patient to modify as many lifestyle choices as necessary to address the root cause of their issues and to prevent illness as much as possible.
Typical laboratory blood tests ordered by FM practitioners to help assess patterns of imbalance may include, but are not limited to, the following biomarkers:
The FM physician will assess your medical and surgical history, home/life environment, lifestyle choices, possibly your genetics, and how any/each may be influencing your symptoms. An individual FM intervention/treatment plan will be built around your whole-person health needs.
By comparison to Integrative Health and Medicine (IHM), FM embraces much of the philosophy of IHM, while adding a biologic systems-oriented approach to proactive patient care. Comprehensive IHM involves traditional medicine health care plus complementary, holistic, mind body spirit interventions that may include other IHM practitioners on the health team.
Your physician’s IHM care recommendations may include meditation/stress management, acupuncture, Yoga, massage, dietary supplements, nutrition education, exercise, and lifestyle changes to improve your health. For more information about IHM, visit the American Board of Integrative Medicine @ https://www.abpsus.org/aboim/ or the Andrew Weil Center for Integrative Medicine in Tucson AZ @ https://integrativemedicine.arizona.edu/ .
For perspective, the American Academy of Family Physicians does not embrace FM principles in their entirety. Regardless of your preference for FM or IHM, it is important to enlist a trained licensed physician as your gatekeeper to coordinate your health team.
Check with your insurance carrier to see if FM office visits and laboratory tests are covered by your insurance carrier. Several FM practitioners are located within the Greater Cincinnati Northern Kentucky area from which to choose. Holistic pharmacists are becoming more involved in FM practices in the areas of nutrition coaching and pharmacogenomics/nutrigenomic testing 
throughout the country. For more information visit https://wwwifm.org/find-a-practitioner . For more information on FM research, visit www.clinicaltrials.gov.
https://lscarolinas.net/2020/07/24/lsc-volunteer-uses-book-to-comfort-children-impacted-by-disasters/
Lavender is one of many beautiful and fragrant herbs that attracts butterflies and bumble bees, and will repel moths, mosquitos, and flies from the garden. Lavender flowers (buds) can be used as a tea for their relaxing and calming effect (Basch).
There may be as many as 160 active constituents in lavender including linalool (a terpene), linalyl acetate, B-caryophyllene, B-myrcene, alpha-ocimene, B-ocimene, and terpinen-4-ol. Calcium, iron, and vitamin A are also found in lavender.
We’re still learning about lavender’s pharmacology from animals. In a study by Harada et al, adult male mice were tested using a linalool scent delivered in a light/dark box. Some of the mice in the study had the sense of smell (active group) and others did not (control group). The mice in the active group that were exposed to the linalool scent over 30 minutes experienced anxiolysis. The control group did not. The positive effect in the active group was negated by flumazenil, a medication that reverses the effects of benzodiazepine anxiolytics like Valium, Ativan, and others. The authors concluded that the linalool effect was mediated by GABA transmission via benzodiazepine-responsive GABA receptors.
Lavender may also work by modulating T-type calcium channels in the body, providing yet another possible therapeutic effect that deserves more research in humans. Calcium channels play a role in neuron excitability, neuroprotection, sensory processes, sleep, and pain (Alaoui, Ayaz, Kopecky).
Lavender side effects may include sun sensitivity, headache, and allergic reaction, among others.
If you are consuming lavender tea, taking lavender dietary supplements, or using topical lavender essential oil in aromatherapy, please be sure to first discuss the appropriateness of this herb/essential oil with your health care provider or pharmacist to determine if it is safe and right for your health goals. This includes a thorough review by your trusted healthcare professional of any drug/lavender interactions and potential side effects.
For more information please visit https://www.drugs.com/mtm/lavender.html and https://www.gardenmandy.com/types-of-lavender-plants/.
Recipe for Lavender Tea
Add the 1 Tbsp fresh, or 1-2 tsp dried, lavender flower buds to a teacup (mug).
Bring 8 oz – 10 oz water to a boil.
Pour the hot water over the lavender flower buds, steep for 5 minutes. Place a small plate or lid over the top of the cup to keep the steam inside, further infusing the tea.
Remove the plate (lid) from the cup and add honey or agave, sweetening to taste.
Drying Out Fresh Lavender Flowers
If you want to dry out fresh lavender flower buds from your garden, harvest the lavender just before it fully blooms, and cut the flowering stalks right above the leaves. Bind the stalks with the buds into bundles and hang them upside-down in a dark, cool, and dry place for 2 and 4 weeks. Lightly brush the stalks and the lavender buds should fall off, to be stored and used later for tea.
References
1. Alaoui. Modulation of T-type Ca2+ channels by lavender and rosemary extracts. PLoS One. 2017 Oct 26;12(10): e0186864.
2. Ayaz. Neuroprotective and anti-aging potentials of essential oils from aromatic and medicinal plants. Front Aging Neurosci 2017; 9:168.
3. Harada. Linalool odor-induced anxiolytic effects in mice. Frontiers in Behav Neurosci 2018;12: Article 241.
4. Kopecky. T-type calcium channel blockers as neuroprotective agents. Pflugers Arch 2014; 466 (4): 757-765.
5. Basch. Lavender (Lavandula angustifolia Miller). J Her Pharmacother 2004;4: 63-78.
Probiotic dietary supplements have become quite popular in recent years, touted for such conditions as general health (prevention), immune health (prevention), leaky gut, diabetes mellitus, and dysbiosis from antibiotic overuse, among others.
Probiotics are generally safe for a heathy person (Generally Recognized as Safe [GRAS] per the FDA classification). However, some live probiotic strains may negatively play on a weakened immune system in at-risk persons, allowing unwanted organisms to enter the body and cause pneumonia, endocarditis, or sepsis. Probiotic supplements are not for everyone!
Activia yogurt, Yakuit yogurt, Dannon Probiotic yogurt, kefir, kimchi, sauerkraut, tempeh, miso, and kombucha are examples of food sourced-probiotics. Culturelle and Align are popular probiotic dietary supplements. Florastor is a prescription medication. Examples of probiotic strains include, but are not limited to, bacteria (e.g. Lactobacillus, Lactococcus, Leuconostoc, Pediococcus, Bifidobacterium, Bacillus) and yeast (e.g., Saccharomyces).
It’s important to choose the right probiotic product for your health needs with the help of your pharmacist, who can thoroughly evaluate the product before recommending it to you. Product criteria:
If probiotic manufacturers claim to treat/prevent disease, their probiotics should be studied and marketed as drugs, rather than as supplements, upholding FDA regulation. Probiotics are not drugs, not magic bullets, nor are they universally safe and effective.
The appropriate probiotic strain and formulation should be recommended by your healthcare professional based on your individual health needs.
For more information or to schedule an integrative health and wellness consultation with Dr. Cathy Rosenbaum, holistic clinical pharmacist, Certified Health Coach, Certified Dementia Practitioner, and Tai Chi Easy Practice Leader in Blue Ash OH, please visit www.rxintegrativesolutions.com.
–Dr. Cathy Rosenbaum
Kothari. Probiotic supplements might not be universally-effective and safe: A review. Biomed Pharmacother 2019;111:537-547.
Restless Leg Syndrome
By Cathy Rosenbaum PharmD MBA RPh CHC
Founder & CEO, Rx Integrative Solutions
Introduction
Restless leg syndrome (RLS) was first described over 70 years ago. Symptoms can show up as achy or crawling sensations in the resting leg that oftentimes go away with leg movement. RLS can be caused by iron or folate deficiency, kidney problems, pregnancy, rheumatoid arthritis, fibromyalgia, thyroid issues, Parkinson’s disease, and depression, among others. A family history of RLS is common in individuals with idiopathic RLS. Individuals with RLS can have trouble getting a refreshing REM sleep. RLS is often misdiagnosed as a vascular problem in the veins, and that’s why it’s important to get an accurate diagnosis from your PCP first before treating the condition.
Factors that may make RLS symptoms worse include cold, heat, fatigue, and stress. RLS prescription medication treatments can include, but are not limited to, benzodiazepines, gabapentin, clonidine, propranolol, and narcotics, each of which have significant side effects. The use of opioids and benzodiazepines together (e.g., Valium, Ativan, Xanax, clonazepam) is not safe. For perspective, benzodiazepines as a medication class are best avoided in seniors due to drowsiness and increased risk of falls and dementia. Depending on the type of RLS diagnosed, non-prescription medication and/or non-invasive alternatives can be considered to treat symptoms.
Iron Deficiency
Interestingly, there might be less iron in the brain of an RLS individual compared to non-RLS individuals. People with iron deficiency RLS respond well to iron supplementation. Improvement is most often seen in those with the lowest initial serum ferritin levels.
Pregnancy
Pregnant women are more likely to develop RLS than non-pregnant women due to reduced folate levels in the former population. In most instances, symptoms are mild and resolve after delivery. Treatment involves folate supplementation, reassurance, and appropriate food intake.
Medication-Induced RLS
Different medications can either cause or worsen RLS symptoms. Antidepressants like Prozac, Paxil, and Zoloft are three such culprits. One study showed that use of non-opioid analgesics is associated with an increased risk of RLS in individuals on long-term antidepressant therapy (Leutgeb. Eur J Med Res 2002;7:368-379).
Vitamin D and Magnesium Deficiency
Published literature (J Sleep Breath 2016) indicates that low vitamin D levels and/or low magnesium levels may be associated with RLS. Magnesium supplementation makes it easier for leg muscles to relax. Treatment with vitamin D or magnesium dietary supplements with the advice and consent of your PCP or pharmacist are two options to consider if you are suffering from these types of RLS.
Holistic Therapies
For individuals with mild RLS symptoms, other holistic options include relaxation/stress management therapy, acupuncture, and abstaining from caffeine and caffeinated products, nicotine, and alcohol to help improve sleep, help reduce stress, and indirectly lessen symptoms.
Summary
If you are experiencing RLS-like symptoms and are concerned about what to do, the first step is to schedule an office visit with your PCP to get an accurate diagnosis. It is unwise and unsafe to self-diagnose and try various remedies without your PCP’s knowledge.
Non-celiac gluten intolerance and celiac disease are becoming more common. Celiac disease is a chronic autoimmune disorder caused by a genetic intolerance to gluten. Non-celiac gluten intolerance is diagnosed in people who do not have celiac disease, but have intestinal or extra-intestinal symptoms related to ingestion of gluten-containing grains.
Both conditions are treated by avoiding gluten containing foods. Finding ‘gluten free’ nutrition is becoming easier to do, but eliminating gluten from one’s diet can be a complex and time-consuming process.
Gluten is the protein component of wheat (e.g., including spelt, kamut, semolina, and triticale), barley (e.g., including malt), and rye. When a person with celiac disease or non-celiac intolerance ingests gluten, specifically the antigenic gluten constituent called gliadin, it can cause intestinal inflammation, diarrhea, abdominal pain, bloating, weight loss, fatigue, and iron deficiency anemia. Food malabsorption and nutritional deficiencies result.
Over time, these conditions can cause liver disease, defective gallbladder emptying, and osteoporosis. Celiac disease may be a reversible cause of osteoporosis. Adherence to a gluten-free diet is one way to help suffers minimize overall symptoms and to maintain maximal bone mineral density.
For perspective, oats are considered a type of gluten grain, but do not have the antigen that other gluten grains above do. Thus, oats do not induce an immune reaction in the small intestine of people with celiac disease. However, many commercial oat products are contaminated with wheat, barley, or rye and it’s important to carefully read their labels. Look for products that are certified to contain less than 20 ppm of gluten (FDA’s ‘gluten free’ definition).
Consumption of as little as 10 mg-50 mg gluten daily can lead to a clinical relapse in people with these conditions. Celiac disease may increase the risk of developing some types of cancer (e.g., T cell lymphoma and intestinal adenocarcinoma) if gluten restrictions are not maintained or gluten intake is only partly restricted.
It is important to find out where gluten resides in foods. This means not only reading food labels on products you purchase for home but also on foods you consume from fast food establishments and restaurant dining. Soups, sausages, and ice cream may contain hidden amounts of gluten as fillers. Talk with your grocer and restaurant owners before you consume questionable food items.
Watch out for the gluten content in herbs, other dietary supplements, and medications.
Gluten-Free Foods
Consuming foods certified to be ‘gluten free’ will help keep the daily gluten total to under 50 mg and not cause symptoms for most people with celiac disease. Gluten-free grains include rice, millet, corn, quinoa, sorghum, and buckwheat. For more information, visit http://glutenfreecooking.about.com/od/gettingstarted/a/hiddengluten.htm
or http://www.glutenfreeliving.com/nutrition/ingredients.
Gluten-Free Herbs and Other Dietary Supplements
It would be impossible to find information about the gluten content in over 60,000 products on the worldwide market. One can contact dietary supplement manufacturers directly for more information on gluten content before taking any of these products, including vitamins.
Gluten-Free Medications
Over-the-counter and prescription medications may contain gluten in the list of inactive ingredients. For example, sweeteners used in medications may be hidden sources of gluten. Some manufacturers cannot guarantee their medications are gluten-free because the suppliers of raw materials can not do so, making it even more difficult for consumers to figure out what is safe to take and what is not.
A great resource for determining the overall ingredient content in medications, including whether or not gluten is present, can be found online at www.glutenfreedrugs.com .
Another online medication reference comes from the National Institutes of Health at www.dailymed.nlm.nih.gov. Go to the site, type in the generic name of the medication you want to review, then scroll down to the name of the manufacturer of that particular product, then click on ‘description.’ Scroll down to the inactive ingredients and look for gluten.
A third way to find more information about your medication’s gluten content is to call the medication manufacturer directly. Be sure to have the medication’s lot number available when you call.
Finally, click on https://www.ncbi.nlm.nih.gov/pubmed/?term=Gluten+content+of+the+top+200+medications+of+2009%3A+a+follow+up+to+the+influence+of+gluten+on+a+patient%E2%80%99s+medication+choices for “Gluten content of the top 200 medications: follow up to the influence of gluten on a patient’s medication choices” by AR King in Hosp Pharm 2013:48:736-43.
By Cathy Rosenbaum PharmD MBA RPh CHC
