How Does Exercise Improve Brain Function?
We all know that exercise is good for us. We know that it tones, builds muscle, increases strength and stamina. For many of us though, exercise is the medicine one swallows while holding our noses. Its drudgery, monotonous and we often don’t see the results we envision or expect. If physical attributes weren’t enough to get you to exercise routinely, if your desired results aren’t being realized, here’s some exciting information that just might inspire you to commit to exercising and it has nothing to do with transforming yourself into Adonis.
Allen Bowling, MD, PhD has been researching the relationship between exercise and neurological function. More and more research is now showing that it plays an important if not essential role in treating neurological conditions. We can grasp how exercise helps strengthen muscle which protects our bones, improving fatigue seems reasonable; intuitively these make sense, but what about depression and neurological conditions? How can exercise directly and positively affect the brain? Until recently I thought it was simply mind over matter. You get yourself up and get going and by doing so you get your mind going in a more positive thinking pattern. Although this cognitive approach to exercise is helpful there is a lot more going on here than we ever imagined. In fact, Dr. Bowling says that if exercise were a medication it would be the number one prescription he would write.
If you’re anything like me, you are not satisfied with what you should do. You ask why and soon to follow is how does it work? The following information is based on ground-breaking research and should be taken seriously by everyone, not just those with neurological conditions. You will see that it is beneficial for overall neurological health.
The Proof is in the Pudding or in This Case the Brain.
There are important proteins found in the brain and the spinal cord known as Nerve Growth Factors (NGF). There are multiple NGF’s that have been identified over the years. NGF was the first. Another commonly studied NGF is Brain Derived Neurotrophic Factor (BDNF). NGF’s do exactly as their name implies, they stimulate nerve cells to grow. They’re the Miracle Gro of the neurological landscape. They have the following characteristics:
1) Nerve-regenerating Effects: BDNF significantly change the structure and function of the nervous system
2) Nerve Protecting Effects: Protect nerve cells from various types of injury
3) Anti-inflammatory Effect: Affect immune system in such a way that they decrease inflammation
Hardwired vs Plasticity
Hardwired, inflexible and undeviating view of brain function is outdated dogma. Our brain is capable of adapting quite well and efficiently. It was once believed to have specific areas which performed specific functions and although this is true, it is not written in stone as it was once thought. This process of adaptation is called plasticity.
MRI’s of some cadaver’s brains have been found to contain multiple plaques. Based on the location of these plaques one would expect that the individual in question would have had symptoms during their lifetime and in fact in many cases there is no correlation with MRI results post-mortem and clinical symptoms when the person was alive. We now know that it is possible for the brain to regain previously lost function through the process of plasticity. It is able to duplicate that lost ability, at times on the opposite side of the brain.
Exercise stimulates the production of various growth factors; it causes brain levels of growth factors to increase. Not only does it improve physical function, these studies show that it also improves non-physical function such as sensation or thinking processes. Thirty minutes of exercise was shown to increase the blood levels of BDNF.
I find when I understand the evidence; I can more easily commit myself to a challenge. I no longer walk aimlessly hoping for positive change but rather with a purpose and clear goal and expectation. Beyond faith, I now have the vision of a truly powerful healing experience. Every step I take I add a bit more miracle gro.
Wednesday, April 1, 2009
Wednesday, June 4, 2008
Remove Bisphenol A Plastics from Your Cupboards: Endocrine Disrupters with Serious Health Consequences
".............bisphenol A, a compound detected in the urine of 93% of Americans recently tested. An overwhelming majority of these studies show that the chemical is harmful----causing breast cancer, testicular cancer, diabetes, hyperactivity, obesity, low sperm counts, miscarriage and a host of other reproductive failures in laboratory animals."
Susanne Rust at the Milwaukee Journal Sentinel ( http://www.jsonline.com/ ) and staff researched 258 scientific studies from around the world concerning the safety of bisphenol A. It is used to make polycarbonate, the plastic most commonly used to make baby bottles and much more. It is ubiquitous in our environment and a serious threat to our health. The government of Canada has already banned the substance completely. This article is thorough and comprehensive. I would highly recommend that you read it if your looking for more information on what this is and where it is found.
In addition, I am including a link below to a handout that clearly lists harmful plastics and the various ways you can identify them. In the meantime a good rule of thumb would be to avoid plastic containers, NEVER heat food in plastic of any kind, including plastic wraps and be especially vigilant with your infants and young children. Some scientists are comparing this to the lead and asbestos crisis of this generation!
http://www.healthobservatory.org/library.cfm?refid=77083
Susanne Rust at the Milwaukee Journal Sentinel ( http://www.jsonline.com/ ) and staff researched 258 scientific studies from around the world concerning the safety of bisphenol A. It is used to make polycarbonate, the plastic most commonly used to make baby bottles and much more. It is ubiquitous in our environment and a serious threat to our health. The government of Canada has already banned the substance completely. This article is thorough and comprehensive. I would highly recommend that you read it if your looking for more information on what this is and where it is found.
In addition, I am including a link below to a handout that clearly lists harmful plastics and the various ways you can identify them. In the meantime a good rule of thumb would be to avoid plastic containers, NEVER heat food in plastic of any kind, including plastic wraps and be especially vigilant with your infants and young children. Some scientists are comparing this to the lead and asbestos crisis of this generation!
http://www.healthobservatory.org/library.cfm?refid=77083
Friday, March 14, 2008
Pharmacogenomics: A Tailored Approach to Therapy
Pharmacogenomics is a new scientific discipline made possible by the genome project. The mapping of the human genome has opened up enormous possibility for the identification and treatment of disease. Pharmacogenomic research focuses on the relationship between genes and drugs. One such example is a look at drug side effects and adverse reactions. We are beginning to identify why some individuals experience side effects to some drugs while others respond favorably with no adverse reaction to the very same drug. Some side effects can be life threatening, in fact, adverse drug reactions are a major cause of hospitalizations.
Stevens-Johnson syndrome (toxic epidermal necrolysis) is a severe and potentially life threatening reaction. It is now known that individuals of Asian descent have a gene referred to as HLA-B 1502. HLA's are human leukocyte antigens, proteins on white blood cells, that are responsible for recognizing foreign invaders. Some HLA subtypes see a particular drug as harmful and start an immune reaction. In the case of HLA-B 1502 it perceives carbamazepine (a popular seizure medication) as a foreign invader. Five percent of individuals that test positive for this gene will develop Stevens-Johnson Syndrome. It is recommended that individuals of Asian descent be offered other alternatives until genetic testing is made available to all and becomes more affordable.
The following drugs have a higher rate of causing hypersensitivity reactions: allopurinol, sulfonamides, hydralazine and others. Their HLA substypes are also being identified. In addition, HIV guidelines also urge screening for HLA-B5701 before starting abacavir to avoid a hypersensitivity reaction.
This is an exciting area of research, one which promises a tailored approach to therapy, in this case drug therapy.
Stevens-Johnson syndrome (toxic epidermal necrolysis) is a severe and potentially life threatening reaction. It is now known that individuals of Asian descent have a gene referred to as HLA-B 1502. HLA's are human leukocyte antigens, proteins on white blood cells, that are responsible for recognizing foreign invaders. Some HLA subtypes see a particular drug as harmful and start an immune reaction. In the case of HLA-B 1502 it perceives carbamazepine (a popular seizure medication) as a foreign invader. Five percent of individuals that test positive for this gene will develop Stevens-Johnson Syndrome. It is recommended that individuals of Asian descent be offered other alternatives until genetic testing is made available to all and becomes more affordable.
The following drugs have a higher rate of causing hypersensitivity reactions: allopurinol, sulfonamides, hydralazine and others. Their HLA substypes are also being identified. In addition, HIV guidelines also urge screening for HLA-B5701 before starting abacavir to avoid a hypersensitivity reaction.
This is an exciting area of research, one which promises a tailored approach to therapy, in this case drug therapy.
Monday, February 4, 2008
Milk Thistle: Liver Regenerator
Silymarin is the active constituent of the milk thistle seed. It consists of flavonolignans called: silibinin, silicrystin, and silidianin. Silibinin (also known as Silybin) makes up about 70% of Silymarin. Silymarin undergoes enterohepatic recirculation and has higher concentrations in liver cells. It is a potent inhibitor of tumor necrosis factor (TNF). TNF induces cytotoxicity, inflammation and apoptosis (cell death). These are effectively blocked by Silymarin. TNF is involved in the body's normal inflammation response. However, in certain diseases TNF is working overtime, causing cell death and damages healthy cells. This disregulation often occurs in diseases such as, Rheumatoid Arthritis. The way Silymarin works is unclear, it appears to work by facilitating cellular communication (intracellular signaling).
Silybin is an antioxidant, a free radical scavenger, and an inhibitor of lipid peroxidation. When an oxygen atom loses an electron, that electron floats around the body damaging tissues, cells or anything it comes in contact with. When an appliance, like a computer is plugged in and not grounded, and a power surge occurs, your computer is toast. Similarly, these electrons referred to as free radicals, damage cells and cause cell death.
In vitro, Silybin shows affinity for binding to P-glycoprotein. This protein is thought to be involved in the drug resistance of cancer cells. So by binding to this protein, which in essence protects cancer cells from being affected by drugs, it improves the efficacy of these drugs.
With respect to liver disease, Silymarin seems to cause an alteration of the outer hepatocyte (liver cell) cell membrane, preventing toxin penetration. It increases a protein called ribosomal protein synthesis, which stimulates liver regeneration and the formation of new hepatocytes. Silymarin might have antifibrotic, anti-inflammatory, and immunomodulating effects that could also be beneficial in liver disease.
Silymarin might protect against kidney damage. In vitro, it has been shown to protect the kidney cells from nephrotoxic drugs such as, acetaminophen, cisplatin, and vincristin. Silybin and Silicristin also appear to have a regenerative effect on kidney cells, similar to that on hepatic cells. It also seems to decrease insulin resistance, which in turn reduces blood glucose and lipid levels in patients with diabetes. Some research suggests that oxidative stress can contribute to pancreatic beta-cell dysfunction (these cells are responsible for producing insulin), reduced insulin secretion and insulin resistance. Silymarin is thought to reduce this oxidative stress.
Since so many drugs are metabolized by the liver, it has been a concern that this metabolism might be affected by Silymarin. Although it does seem to be an inhibitor of some liver enzymes, this inhibition does not so far seem significant with respect to drug metabolism.
In review, Silymarin is effective for liver disease, diabetes, and dyspepsia (acid reflux/heartburn). Normal dose is ranges from 100mg to 200mg of Silymarin 2-3 times a day.
Silybin is an antioxidant, a free radical scavenger, and an inhibitor of lipid peroxidation. When an oxygen atom loses an electron, that electron floats around the body damaging tissues, cells or anything it comes in contact with. When an appliance, like a computer is plugged in and not grounded, and a power surge occurs, your computer is toast. Similarly, these electrons referred to as free radicals, damage cells and cause cell death.
In vitro, Silybin shows affinity for binding to P-glycoprotein. This protein is thought to be involved in the drug resistance of cancer cells. So by binding to this protein, which in essence protects cancer cells from being affected by drugs, it improves the efficacy of these drugs.
With respect to liver disease, Silymarin seems to cause an alteration of the outer hepatocyte (liver cell) cell membrane, preventing toxin penetration. It increases a protein called ribosomal protein synthesis, which stimulates liver regeneration and the formation of new hepatocytes. Silymarin might have antifibrotic, anti-inflammatory, and immunomodulating effects that could also be beneficial in liver disease.
Silymarin might protect against kidney damage. In vitro, it has been shown to protect the kidney cells from nephrotoxic drugs such as, acetaminophen, cisplatin, and vincristin. Silybin and Silicristin also appear to have a regenerative effect on kidney cells, similar to that on hepatic cells. It also seems to decrease insulin resistance, which in turn reduces blood glucose and lipid levels in patients with diabetes. Some research suggests that oxidative stress can contribute to pancreatic beta-cell dysfunction (these cells are responsible for producing insulin), reduced insulin secretion and insulin resistance. Silymarin is thought to reduce this oxidative stress.
Since so many drugs are metabolized by the liver, it has been a concern that this metabolism might be affected by Silymarin. Although it does seem to be an inhibitor of some liver enzymes, this inhibition does not so far seem significant with respect to drug metabolism.
In review, Silymarin is effective for liver disease, diabetes, and dyspepsia (acid reflux/heartburn). Normal dose is ranges from 100mg to 200mg of Silymarin 2-3 times a day.
Saturday, February 2, 2008
In Charge of Morale: SAMe Improves Health and Mood)
Research is finding more and more a correlation with various health conditions, including heart disease, and depression. Low levels of SAMe may have something to do with these disease states. Perhaps it is the common thread. SAMe is a naturally occurring molecule distributed throughout all body tissues and fluids. The concentration of SAMe is highest in childhood, decreasing with age. It plays an essential role in more than one hundred chemical reactions (involving enzymatic transmethylation). It contributes to the synthesis, activation, and/or metabolism of hormones, neurotransmitters, nucleic acid, proteins, phospholipids, and some drugs.
SAMe is produced endogenously by adenosine triphosphate (ATP) activation of methionine that is synthesized in the body or obtained from metabolism of dietary protein (e.g. meat). SAMe synthesis is closely linked to Vitamin B12 and Folate (also known as folic acid) metabolism. Deficiency of these vitamins can decrease SAMe concentrations in the Central Nervous System (CNS).
Although it seems to have antidepressant properties, its actual mechanism of action is unknown. It is associated however, with an increase in serotonin turnover (facilitates higher levels of serotonin to be found and used outside the cell) and elevated dopamine and norepinephrine levels. These are three major neurotransmitters that are related to mood. By altering cellular membrane fluidity (improves traffic in and out of the cell), it facilitates signal transduction across membranes and consequently increases the efficiency of receptor effector coupling (the neurotransmitter finds a parking space). Neuroimaging studies indicate that SAMe affects the brain similarly to conventional antidepressants.
There appears to be hepatic SAMe deficiency in liver disease. Exogenously, it may act as an essential nutrient by restoring biochemical factors that are depleted in people with liver dysfunction. People with acute or chronic liver disease lose the ability to synthesize SAMe from methionine. This might be due to low activity of methionine adenosyl transferase (MAT), the enzyme that converts methionine to SAMe. As a result, this can lead to deficiencies in cysteine and choline, as well as depletion of glutathione, which plays a major role in liver detoxification and antioxidant reactions (gets rid of free radicals which harm cells and ultimately kills cells). This depletion in turn, exacerbates liver disease. SAMe also has a gastric cytoprotective effect (protects the cells of the stomach).
As was mentioned there are over one hundred chemical reactions in which SAMe is involved in; the following is one of the more important reactions and one that is well understood:
SAMe-------->Homocysteine---->---(remethylated,via folate and B12)---->Methionine
Methionine coverts back to-------->SAMe
Or
Through transulfuration converts to-------->Glutathione
If these reactions are uninterrupted the result is the production of more SAMe and Glutathionine (antioxidant). However, if for example, an individual is deficient in Vitamin B12, Folate or Vitamin B6 (pyridoxine); SAMe will be converted to homocysteine and the reaction ends there. This outcome is unwelcome since high levels of homocyteine are associated with renal and cardiovascular disease. Recent studies show no significant increases however under normal circumstances, to the contrary, adequate levels of SAMe seems to promote the formation of glutathione by converting homocysteine. Low levels of SAMe have actually been correlated with coronary artery disease. Doses of 1200mg per day are used in people with liver disease.
SAMe taken orally has low bioavailability (isn’t absorbed well) because of first pass effect (liver metabolism). That is why higher doses are required and should be taken on an empty stomach. Levels peak 3 to 5 hours post ingestion. Although well tolerated, common side effects may be: flatulence, nausea, vomiting, diarrhea, constipation, dry mouth, and headache. But these are rare and usually seen with higher doses. Clinical trials used a dose of 1600mg/day, but the normal range is between 400mg-1600mg/day in divided doses. People with fibromyalgia take 800mg/day. It is available intravenously, but seldom used, for depression.
Not recommended for bipolar disorder since it can at times exacerbate the mania part of this condition. It should not be used concomitantly with antidepressants. It could potentiate serotonergic effects and serotonin syndrome like effects. Avoid if you have Parkinson’s. It may reduce effectiveness of levodopa given for this disease. Also avoid taking dextromethorphan (cough syrups), meperidine and DO NOT USE with MAO inhibitors. The body must be clear of MAOs for at least 2 weeks. Also avoid tramadol.
SAMe is produced endogenously by adenosine triphosphate (ATP) activation of methionine that is synthesized in the body or obtained from metabolism of dietary protein (e.g. meat). SAMe synthesis is closely linked to Vitamin B12 and Folate (also known as folic acid) metabolism. Deficiency of these vitamins can decrease SAMe concentrations in the Central Nervous System (CNS).
Although it seems to have antidepressant properties, its actual mechanism of action is unknown. It is associated however, with an increase in serotonin turnover (facilitates higher levels of serotonin to be found and used outside the cell) and elevated dopamine and norepinephrine levels. These are three major neurotransmitters that are related to mood. By altering cellular membrane fluidity (improves traffic in and out of the cell), it facilitates signal transduction across membranes and consequently increases the efficiency of receptor effector coupling (the neurotransmitter finds a parking space). Neuroimaging studies indicate that SAMe affects the brain similarly to conventional antidepressants.
There appears to be hepatic SAMe deficiency in liver disease. Exogenously, it may act as an essential nutrient by restoring biochemical factors that are depleted in people with liver dysfunction. People with acute or chronic liver disease lose the ability to synthesize SAMe from methionine. This might be due to low activity of methionine adenosyl transferase (MAT), the enzyme that converts methionine to SAMe. As a result, this can lead to deficiencies in cysteine and choline, as well as depletion of glutathione, which plays a major role in liver detoxification and antioxidant reactions (gets rid of free radicals which harm cells and ultimately kills cells). This depletion in turn, exacerbates liver disease. SAMe also has a gastric cytoprotective effect (protects the cells of the stomach).
As was mentioned there are over one hundred chemical reactions in which SAMe is involved in; the following is one of the more important reactions and one that is well understood:
SAMe-------->Homocysteine---->---(remethylated,via folate and B12)---->Methionine
Methionine coverts back to-------->SAMe
Or
Through transulfuration converts to-------->Glutathione
If these reactions are uninterrupted the result is the production of more SAMe and Glutathionine (antioxidant). However, if for example, an individual is deficient in Vitamin B12, Folate or Vitamin B6 (pyridoxine); SAMe will be converted to homocysteine and the reaction ends there. This outcome is unwelcome since high levels of homocyteine are associated with renal and cardiovascular disease. Recent studies show no significant increases however under normal circumstances, to the contrary, adequate levels of SAMe seems to promote the formation of glutathione by converting homocysteine. Low levels of SAMe have actually been correlated with coronary artery disease. Doses of 1200mg per day are used in people with liver disease.
SAMe taken orally has low bioavailability (isn’t absorbed well) because of first pass effect (liver metabolism). That is why higher doses are required and should be taken on an empty stomach. Levels peak 3 to 5 hours post ingestion. Although well tolerated, common side effects may be: flatulence, nausea, vomiting, diarrhea, constipation, dry mouth, and headache. But these are rare and usually seen with higher doses. Clinical trials used a dose of 1600mg/day, but the normal range is between 400mg-1600mg/day in divided doses. People with fibromyalgia take 800mg/day. It is available intravenously, but seldom used, for depression.
Not recommended for bipolar disorder since it can at times exacerbate the mania part of this condition. It should not be used concomitantly with antidepressants. It could potentiate serotonergic effects and serotonin syndrome like effects. Avoid if you have Parkinson’s. It may reduce effectiveness of levodopa given for this disease. Also avoid taking dextromethorphan (cough syrups), meperidine and DO NOT USE with MAO inhibitors. The body must be clear of MAOs for at least 2 weeks. Also avoid tramadol.
Wednesday, January 30, 2008
Physician Heal Thyself
As a pharmacist I walk a thin line. Morally I feel obligated to offer information to patients about alternative therapies when appropriate. At the same time I feel I hold back for fear of being reprimanded by the board of pharmacy or admonished by disgruntled physicians who may not appreciate my suggestions. "First do no harm", has at times become; first protect yourself legally; and that's unfortunate.We have been forced to practice defensive medicine. Our medical system, as technologically advanced as it is, is in disarray. Thousands of MRI's, CAT scans, X-rays, blood work are being performed every day; many needlessly. Prescriptions are being handed out like candy; at times just to pacify the patient. Unfortunately these patients soon realize just how expensive the piece of paper they hold in their hands really is.
At the pharmacy I'm approached by patients all the time with various questions. In an attempt to more effectively provide them with helpful information, I usually ask brief questions about their conditions and if they had discussed their concerns with their physicians. Often time the answer is no. Excuses may range from, "I could see that he was busy, so I didn't want to bother him" or "We did discuss it, but I'm not sure I understand" or "I'm concerned about any side effects or drug interactions" or "Isn't there anything else I could take that's over the counter" or "This is too expensive, I can't afford it". In addition, many patients are seeing several doctors and often times each doctor is unaware of what the others are prescribing. In an attempt to save money the patient frequents several pharmacies in order to get the best price. All of this leads to a disorganized medical system which leaves the patient in a vulnerable position as well as their health care providers. If Dr. X isn't aware that Mrs. Smith is taking diazepam, he may write for another sedative, alprazolam. If her primary care physician prescribed the diazepam for muscle spasms and her psychiatrist prescribed alprazolam for anxiety, the patient may believe that these two drugs have nothing in common and it doesn't even occur to her to mention it to either doctor.
Time and again I see that physicians are not aware of their patient's complete drug history and even less aware of what they take over the counter. It is our responsibility as pharmacists to bring this to the doctor's awareness, but we are hindered by not having access to the patient's complete medical history, which includes other pharmacies that they go to. In these cases it seems obvious that the person most capable of resolving these issues is the patient herself, by being forthcoming with the information. I'm all for patient responsibility, but what do you do with an elderly population that has a difficult time remembering and understanding medical jargon?And what of individuals whose English is their second language and have difficulty understanding as well? By no means are these the only patients that we have to be concerned with. The population at large still sees the physician as a patriarchal figure, an expert when it comes to their health. They mistakenly assume that practitioners have an ongoing dialogue amongst each other, in which they routinely partake in conversations regarding their patients. This naive understanding of the medical system, contributes to a patient's vulnerability and less than optimal medical care. I am a strong supporter of patient responsibility--to a certain extent. They are responsible for communicating openly with all their health care practitioners and asking questions, until they are satisfied that they understand all options regarding therapy they are receiving.
However how is it possible for someone outside the medical field, to understand completely what is best for them? It seems that every nightly news show is full of contradictory research conclusions. Part of the problem is sensational headlines, whose only purpose it to captivate the audience's attention. Viewers are left with the misleading headline in their minds and aren't aware of the details in the research, which offers a more comprehensive analysis. Of course we are taking for granted that the study itself was well designed and accurate. Patients are bombarded with contradicting information on a regular basis. Even if they want to take an active role in their healing process, they are overwhelmed with questions that seem to have no end. To make matters worse, according to Dr. John Abramson of Harvard Medical School, many popular studies that have been done in the recent past have had significant flaws at best and outright fraudulent at worst. How are patients to know the difference if practitioners themselves have a hard time deciphering the good ones from the bad?
What I once thought to be research that was done impeccably, with the highest scientific standards, published in trustworthy peer reviewed journals, is no longer true. I went to college in the eighties, a time in which I was made to believe that scientific research was almost sacred in nature. Scientists were seen as objective individuals who would above all else do everything within their power to avoid any bias toward a particular outcome. Dr. Abramson explains in his book Overdosed America that we are standing on shaky ground. Research that once was done by nonprofit organizations, such as universities and hospitals, is now being done by drug companies. Our regulatory agencies which once were forbidden to take money from drug companies are now being subsidies by them. The journals that once had my full confidence, are now receiving millions of dollars from drug companies in exchange for advertisements. Physician's prescribing habits are not only being monitored by insurance companies but also by drug companies and their sales people, in order to more efficiently target marketing. In addition, practicing physicians have routinely been recruited to participate in clinical studies. They were modestly reimbursed for their time if at all; now participating in clinical research means big dollars. Not only are the drug companies doing their own research, but they are hiring their own doctors to do the follow-up clinical studies. This does not mean that all results are unreliable, but one has to question the validity of studies financed through private companies. Where are the safeguards against bias?
Practitioners that are hesitant to recommend or merely tolerate the idea of alternative medicine should consider the issues that have arisen over the last few decades within our own medical system. Healthy skepticism is necessary when evaluating any therapy now more than ever before. Fortunately many physicians have the capacity and aptitude to thoroughly evaluate a study. Statistical analysis is now taught at most medical schools. Unfortunately, evaluating alternative therapies is a bit more complex, only because their knowledge base in these therapies is minimal. Most medical schools don't have these courses available.There are some medical school curriculums which offer courses on alternative and complimentary approaches. These are few and are most often offered as electives within the required curriculum. Some schools are on the cutting edge of training their physicians in a more comprehensive fashion. Often these opportunities are available to medical school graduates when they finish their standard training. These already established physicians chose to do a fellowship in integrative medicine. One such school is the University of Arizona Integrative Medicine Program. This program was founded by Dr. Andrew Weil a foremost expert in the field. In an attempt to educate the practitioner at large, the program also offers continuing education courses on various therapies in complimentary and alternative medicine (CAM). Educational institutions such as this one are at the forefront of a changing paradigm in medicine. They are doing much to dispel the negative stereotype that CAM approaches have received over the last forty years or so. They have taken a hard look at CAM therapies and identified those that are efficacious and beneficial.
Although the number of clinical trials being conducted on CAM therapies are growing in number, there is an undercurrent of disapproval in order to show that most of these therapies are ineffective at best and harmful at worst. It is logical that given the number of therapies available to the consumer, some will be shown not to work and some may prove to be unsafe, but the amount of negative reports in the media suggest a negative bias. There was a news report a few years ago whose headline read "Study proves that St. John's Wort is no better than placebo". In that same study they also compared the efficacy of a popular antidepressant medication. What the media didn't convey was that this antidepressant, which was widely used, was shown to be less effective than placebo. What would it mean to the drug companies if an herb was found to be effective in mild depression? Millions of dollars would be lost.It is difficult to discern credible reporting from what amounts to be agenda driven advertisement.
It is essential that we understand the obstacles that we are faced with and take it upon ourselves to unscrupulously assess the reliability and credibility of the report, whether it be conventional or alternative. We need the support and guidance of respected institutions to help us lead the way to a more holistic model of medicine. At the same time we need comprehensive resources to be easily accessible. Having these support systems in place would not only afford us the ability of providing quality care, but would simultaneously reduce our exposure to liability. According to the University of Arizona Program in Integrative Medicine (PIM), the legal issues that health care providers face when recommending or discussing complementary and alternative medicine modalities in their office are as follows:
Malpractice liability for inadequate informed consent
Licensure and credentialing
Scope of practice (the legally authorized practice boundaries for providers)
Professional discipline (discipline for professional misconduct)
These concerns are valid and one can understand the hesitancy that many practitioners have. From their perspective they would be jumping in a fire hoping to avoid getting burned. In the midst of these obstacles there are seeds of hope. We as patients and as healthcare providers must not capitulate to this challenge. We must avoid complacency and strive for a healthcare environment that is open to new thought and offers more options. PIM offers suggestions and guidelines to follow which will help in traversing these murky waters. When a patient asks about alternative therapies the following should be considered:
What is the curability rate with conventional care?
Weigh quality of evidence, invasiveness, and toxicities of each therapy.
Patient clearly understands the risks and benefits of each option and accepts those risks.It is also important to familiarize yourself with organizations that have been established, in order to demystify CAM therapies. The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) is an organization responsible for performing rigorous studies on various medical therapies in order to create new models of clinical care, these models would integrate biomedicine, the complexity of human beings, the innate nature of healing, with the diversity of therapeutic systems from all over the world. It understands that the western medical model, although superb at treating many diseases and conditions, also has limitations. At the same time it acknowledges that for millennia there have been effective medical models from around the world. Some of the academic medical centers that are members of CAHCIM include: University of Arizona, Harvard, Georgetown, Duke, and Columbia University to name a few. The following is a list of resources that are also a good place to start:
American Botanical Council
American Herbal Pharmacopoeia
Consumer Labs: Randomly test dietary supplements and release their finding to the public
http://www.drweil.com/: Extensive website with information pertaining to both conventional and CAM treatments.
FDA Food Manufacturing Practices (GMP): Sporadically monitors products off the shelf
Independent Drug Information Service (iDiS)
National Center for Complimentary and Alternative Medicine (NCCAM)
National Institute of Health
National Sanitation Foundation (NSF): Dietary supplement quality verification, they use GMP
compliance standards
Overdosed America, Dr. John Abramson
Powerful Medicines, Dr. Jeffrey Avron
The Association of Official Analytical Chemists (AOAC)
The Compendium of Asian Patent Medicines
University of Arizona Integrative Medicine Program
United States Pharmacopoeia (USP): Dietary supplement quality verification they use GMP compliance standards
World Health OrganizationGiven the available resources and I'm sure there will be more to come, a practitioner who has a sincere interest in offering his patients more options, can feel more comfortable with the use of alternative medicine. It saddens me to think how the western medical community has so often disparaged and looked upon other medical models with disdain and total disregard. We don't have all the answers, far from it. All medical traditions have blind spots, strengths and weaknesses. Western medicine would benefit from a visit to the therapist, there it would hopefully have a revelation, and it would realize that it is not omnipotent. Could it be projecting onto other medical models what it is afraid to accept of itself? We bare and share the same responsibility, which is to provide the best medical care available to our patients.
At the pharmacy I'm approached by patients all the time with various questions. In an attempt to more effectively provide them with helpful information, I usually ask brief questions about their conditions and if they had discussed their concerns with their physicians. Often time the answer is no. Excuses may range from, "I could see that he was busy, so I didn't want to bother him" or "We did discuss it, but I'm not sure I understand" or "I'm concerned about any side effects or drug interactions" or "Isn't there anything else I could take that's over the counter" or "This is too expensive, I can't afford it". In addition, many patients are seeing several doctors and often times each doctor is unaware of what the others are prescribing. In an attempt to save money the patient frequents several pharmacies in order to get the best price. All of this leads to a disorganized medical system which leaves the patient in a vulnerable position as well as their health care providers. If Dr. X isn't aware that Mrs. Smith is taking diazepam, he may write for another sedative, alprazolam. If her primary care physician prescribed the diazepam for muscle spasms and her psychiatrist prescribed alprazolam for anxiety, the patient may believe that these two drugs have nothing in common and it doesn't even occur to her to mention it to either doctor.
Time and again I see that physicians are not aware of their patient's complete drug history and even less aware of what they take over the counter. It is our responsibility as pharmacists to bring this to the doctor's awareness, but we are hindered by not having access to the patient's complete medical history, which includes other pharmacies that they go to. In these cases it seems obvious that the person most capable of resolving these issues is the patient herself, by being forthcoming with the information. I'm all for patient responsibility, but what do you do with an elderly population that has a difficult time remembering and understanding medical jargon?And what of individuals whose English is their second language and have difficulty understanding as well? By no means are these the only patients that we have to be concerned with. The population at large still sees the physician as a patriarchal figure, an expert when it comes to their health. They mistakenly assume that practitioners have an ongoing dialogue amongst each other, in which they routinely partake in conversations regarding their patients. This naive understanding of the medical system, contributes to a patient's vulnerability and less than optimal medical care. I am a strong supporter of patient responsibility--to a certain extent. They are responsible for communicating openly with all their health care practitioners and asking questions, until they are satisfied that they understand all options regarding therapy they are receiving.
However how is it possible for someone outside the medical field, to understand completely what is best for them? It seems that every nightly news show is full of contradictory research conclusions. Part of the problem is sensational headlines, whose only purpose it to captivate the audience's attention. Viewers are left with the misleading headline in their minds and aren't aware of the details in the research, which offers a more comprehensive analysis. Of course we are taking for granted that the study itself was well designed and accurate. Patients are bombarded with contradicting information on a regular basis. Even if they want to take an active role in their healing process, they are overwhelmed with questions that seem to have no end. To make matters worse, according to Dr. John Abramson of Harvard Medical School, many popular studies that have been done in the recent past have had significant flaws at best and outright fraudulent at worst. How are patients to know the difference if practitioners themselves have a hard time deciphering the good ones from the bad?
What I once thought to be research that was done impeccably, with the highest scientific standards, published in trustworthy peer reviewed journals, is no longer true. I went to college in the eighties, a time in which I was made to believe that scientific research was almost sacred in nature. Scientists were seen as objective individuals who would above all else do everything within their power to avoid any bias toward a particular outcome. Dr. Abramson explains in his book Overdosed America that we are standing on shaky ground. Research that once was done by nonprofit organizations, such as universities and hospitals, is now being done by drug companies. Our regulatory agencies which once were forbidden to take money from drug companies are now being subsidies by them. The journals that once had my full confidence, are now receiving millions of dollars from drug companies in exchange for advertisements. Physician's prescribing habits are not only being monitored by insurance companies but also by drug companies and their sales people, in order to more efficiently target marketing. In addition, practicing physicians have routinely been recruited to participate in clinical studies. They were modestly reimbursed for their time if at all; now participating in clinical research means big dollars. Not only are the drug companies doing their own research, but they are hiring their own doctors to do the follow-up clinical studies. This does not mean that all results are unreliable, but one has to question the validity of studies financed through private companies. Where are the safeguards against bias?
Practitioners that are hesitant to recommend or merely tolerate the idea of alternative medicine should consider the issues that have arisen over the last few decades within our own medical system. Healthy skepticism is necessary when evaluating any therapy now more than ever before. Fortunately many physicians have the capacity and aptitude to thoroughly evaluate a study. Statistical analysis is now taught at most medical schools. Unfortunately, evaluating alternative therapies is a bit more complex, only because their knowledge base in these therapies is minimal. Most medical schools don't have these courses available.There are some medical school curriculums which offer courses on alternative and complimentary approaches. These are few and are most often offered as electives within the required curriculum. Some schools are on the cutting edge of training their physicians in a more comprehensive fashion. Often these opportunities are available to medical school graduates when they finish their standard training. These already established physicians chose to do a fellowship in integrative medicine. One such school is the University of Arizona Integrative Medicine Program. This program was founded by Dr. Andrew Weil a foremost expert in the field. In an attempt to educate the practitioner at large, the program also offers continuing education courses on various therapies in complimentary and alternative medicine (CAM). Educational institutions such as this one are at the forefront of a changing paradigm in medicine. They are doing much to dispel the negative stereotype that CAM approaches have received over the last forty years or so. They have taken a hard look at CAM therapies and identified those that are efficacious and beneficial.
Although the number of clinical trials being conducted on CAM therapies are growing in number, there is an undercurrent of disapproval in order to show that most of these therapies are ineffective at best and harmful at worst. It is logical that given the number of therapies available to the consumer, some will be shown not to work and some may prove to be unsafe, but the amount of negative reports in the media suggest a negative bias. There was a news report a few years ago whose headline read "Study proves that St. John's Wort is no better than placebo". In that same study they also compared the efficacy of a popular antidepressant medication. What the media didn't convey was that this antidepressant, which was widely used, was shown to be less effective than placebo. What would it mean to the drug companies if an herb was found to be effective in mild depression? Millions of dollars would be lost.It is difficult to discern credible reporting from what amounts to be agenda driven advertisement.
It is essential that we understand the obstacles that we are faced with and take it upon ourselves to unscrupulously assess the reliability and credibility of the report, whether it be conventional or alternative. We need the support and guidance of respected institutions to help us lead the way to a more holistic model of medicine. At the same time we need comprehensive resources to be easily accessible. Having these support systems in place would not only afford us the ability of providing quality care, but would simultaneously reduce our exposure to liability. According to the University of Arizona Program in Integrative Medicine (PIM), the legal issues that health care providers face when recommending or discussing complementary and alternative medicine modalities in their office are as follows:
Malpractice liability for inadequate informed consent
Licensure and credentialing
Scope of practice (the legally authorized practice boundaries for providers)
Professional discipline (discipline for professional misconduct)
These concerns are valid and one can understand the hesitancy that many practitioners have. From their perspective they would be jumping in a fire hoping to avoid getting burned. In the midst of these obstacles there are seeds of hope. We as patients and as healthcare providers must not capitulate to this challenge. We must avoid complacency and strive for a healthcare environment that is open to new thought and offers more options. PIM offers suggestions and guidelines to follow which will help in traversing these murky waters. When a patient asks about alternative therapies the following should be considered:
What is the curability rate with conventional care?
Weigh quality of evidence, invasiveness, and toxicities of each therapy.
Patient clearly understands the risks and benefits of each option and accepts those risks.It is also important to familiarize yourself with organizations that have been established, in order to demystify CAM therapies. The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) is an organization responsible for performing rigorous studies on various medical therapies in order to create new models of clinical care, these models would integrate biomedicine, the complexity of human beings, the innate nature of healing, with the diversity of therapeutic systems from all over the world. It understands that the western medical model, although superb at treating many diseases and conditions, also has limitations. At the same time it acknowledges that for millennia there have been effective medical models from around the world. Some of the academic medical centers that are members of CAHCIM include: University of Arizona, Harvard, Georgetown, Duke, and Columbia University to name a few. The following is a list of resources that are also a good place to start:
American Botanical Council
American Herbal Pharmacopoeia
Consumer Labs: Randomly test dietary supplements and release their finding to the public
http://www.drweil.com/: Extensive website with information pertaining to both conventional and CAM treatments.
FDA Food Manufacturing Practices (GMP): Sporadically monitors products off the shelf
Independent Drug Information Service (iDiS)
National Center for Complimentary and Alternative Medicine (NCCAM)
National Institute of Health
National Sanitation Foundation (NSF): Dietary supplement quality verification, they use GMP
compliance standards
Overdosed America, Dr. John Abramson
Powerful Medicines, Dr. Jeffrey Avron
The Association of Official Analytical Chemists (AOAC)
The Compendium of Asian Patent Medicines
University of Arizona Integrative Medicine Program
United States Pharmacopoeia (USP): Dietary supplement quality verification they use GMP compliance standards
World Health OrganizationGiven the available resources and I'm sure there will be more to come, a practitioner who has a sincere interest in offering his patients more options, can feel more comfortable with the use of alternative medicine. It saddens me to think how the western medical community has so often disparaged and looked upon other medical models with disdain and total disregard. We don't have all the answers, far from it. All medical traditions have blind spots, strengths and weaknesses. Western medicine would benefit from a visit to the therapist, there it would hopefully have a revelation, and it would realize that it is not omnipotent. Could it be projecting onto other medical models what it is afraid to accept of itself? We bare and share the same responsibility, which is to provide the best medical care available to our patients.
Monday, January 28, 2008
Are Supplements and Vitamins Necessary?
The word vitamin comes from the Latin words, vital (life) and amine (building blocks of DNA). Most vitamins we take in from dietary sources. In an ideal situation (when we're young, disease free, healthy diet), our body receives and manufactures all the essential vitamins and minerals that it requires for maintaining physical, emotional and mental health. However, for various reasons vitamin deficiency has been a significant problem, mostly due to poor diet. Although agricultural practices have increased the world's food capacity, there are still to this day many areas of the world in which food is not readily available. Thus, these societies do not receive important nutrients simply due to starvation. In addition to present day famines , western cultures have developed unhealthy lifestyles, specifically with respect to diet and exercise.
The fact that we are becoming obese and live sedentary lifestyles is not earth shattering news. What has not been emphasized enough however, is that while we are taking in more calories, they are not necessarily healthy ones; in fact the opposite seems to be true. Less than a century ago, we were more active. Having to walk to where ever it was we had to go, exposed us to the outdoors, which in turn increased our bodies ability to produce its own vitamin D; a vitamin that research is looking more and more into and finding benefits for use in various diseases. The point is this: yes it's true that if (and in this day and age, it's a big if), you are a healthy person, with a healthy lifestyle, most likely you don't require supplements of any kind. But if you fall into the group of people, who have not been able to maintain a healthy diet regimen due to long hours at work, busy schedule at home and overall lack of knowledge on what it constitutes to eat healthy, then more than likely you could benefit from some supplements added to your diet.
Which supplements to consider, will be age specific and also dependent on your physical, emotional, and mental condition. Are you looking for supplementing overall health? Or do you have specific illnesses and symptoms you want to target? Supplement selection should be carefully researched on an individual basis and discussed with your physician or health practitioner. What I see most often in the pharmacy are clients who come to the counter and ask about a particular supplement in which someone they know has recommended. There is nothing wrong with listening to suggestions as long as you do the follow up which is to ask if that particular supplement would be of benefit to you. Supplements can be expensive, especially if your personal physical condition warrants that you take more than one, so it becomes imperative from a health stand point but also a financial stand point that you take the time to educate yourself thoroughly about which supplements would be of most benefit to you.
There are many places to educate yourself. The internet is a great source if you know where to look. You can ask your doctor or a pharmacist. A pharmacist who specializes in Integrative Medicine would be especially appropriate. They can guide you through what can be at times an overwhelming plethora of information. This is a fairly new field of medicine, but an invaluable one. The role of an Integrative Pharmacist is to evaluate your circumstances and educate you as to what options you might have or would be most appropriate for your condition and your financial situation. It may be as simple as making you aware of less expensive alternatives. For example, I have had several clients who have been switched from antidepressant to antidepressant, it isn't unusual for someone to be on two at a time, only to be switched yet again to a more expensive drug new to the market. In frustration, they tell me they can't afford the medication and that as soon as the doctor finishes handing out his samples, they will have to stop taking it. I explain that very often patients who don’t respond well to antidepressants, especially if they have already tried several, might have low levels of folate or folic acid. More often than not folic acid supplementation along with vitamin B6 (pyrodoxine) and vitamin B12 (cyanocobalamin) significantly improves their response to a less expensive generic drug. This is merely one example of how supplements, in this case vitamins, can make a significant impact on therapy response and effectiveness.
Contemporary medicine is more and more complex. Physicians are finding it necessary to specialize more and more, being able to keep up with the most recent research, and understanding in depth what therapy will be most effective for each individual can be an overwhelming if not impossible task. The benefit of this specialized approach to medicine would seem to be obvious. A physician is able to be an expert in his field. But this has also created a problem in our medical system. So many medical students today are specializing, that we are losing the glue that holds it all together. This glue that I'm referring to, which is essential to practicing good medicine, is our front line doctors and practitioners. The family physicians and pediatricians for example, who are responsible for practicing preventive medicine (educating the patient on staying healthy), identifying and treating diseases when they arise, but they are also the ones responsible for collecting all the data and reports that are being produced by the specialists that their patients have been referred to. If this seems like a mouthful, it's more than that, it's more than a handful. Because of the increase in rate of physicians who become specialists, there are less and less front line physicians. The ones that remain are overworked and at times overwhelmed.
There is a medical crisis in this country for various reasons, but substandard communication between health professionals and their patients is of major concern, in part because there is so much information to keep track of. We need an integrative approach to medicine. Dr. Andrew Weil is a physician who has developed an Integrative Medicine program at the University of Arizona Medical School and there are other universities across the country that have begun to incorporate this idea into their medical schools. The basic philosophy is this: you treat the body as a whole and you treat the patient with a team of physicians that work closely together. Their clinic works with family practitioners, specialists, as well as alternative practitioners; acupuncturists, massage therapists, physical therapists, psychotherapists, pharmacists, nutritionists, etc. Although integrative medicine is becoming prevalent, it is by no means a part of mainstream medicine.
In the meantime, patients need to do the best with what they have available to them. Towards that goal is familiarizing yourself with what types of therapies are available and being able to decide which ones are credible and which ones aren't and that most certainly includes supplements. Knowledge is power. It is not enough to explain the benefits and risks of taking supplements. We are people first and patients second and we are responsible for our own health. In order to make informed decisions we need to understand why vitamins are necessary or "essential" to good health and how they work. The words essential and non-essential are often used to describe vitamins. These terms can be misleading. An essential vitamin is one that can only be found in the diet. A non-essential vitamin is also necessary for good health, but it can be manufactured by the body through other biochemical reactions. This however does not mean that non-essential vitamins are less important or that additional supplementation is never required. There are conditions in which the pathways in which these non-essential vitamins are formed are inefficient. Under these circumstances additional supplementation would be necessary. For example, a supplement and vitamin-like substance called Coenzyme Q is necessary for the proper cell function. The levels of CoQ diminish with age and are also diminished in people who take cholesterol lowering drugs called statins. In this case and there are others, external supplementation could be helpful in maintaining overall health. It is not possible to explain in detail all of the various vitamins, supplements, and vitamin-like substances in the scope of this article. I have thus focused on the most important and effective supplements; supplements that also are backed with a significant amount of credible research.
The fact that we are becoming obese and live sedentary lifestyles is not earth shattering news. What has not been emphasized enough however, is that while we are taking in more calories, they are not necessarily healthy ones; in fact the opposite seems to be true. Less than a century ago, we were more active. Having to walk to where ever it was we had to go, exposed us to the outdoors, which in turn increased our bodies ability to produce its own vitamin D; a vitamin that research is looking more and more into and finding benefits for use in various diseases. The point is this: yes it's true that if (and in this day and age, it's a big if), you are a healthy person, with a healthy lifestyle, most likely you don't require supplements of any kind. But if you fall into the group of people, who have not been able to maintain a healthy diet regimen due to long hours at work, busy schedule at home and overall lack of knowledge on what it constitutes to eat healthy, then more than likely you could benefit from some supplements added to your diet.
Which supplements to consider, will be age specific and also dependent on your physical, emotional, and mental condition. Are you looking for supplementing overall health? Or do you have specific illnesses and symptoms you want to target? Supplement selection should be carefully researched on an individual basis and discussed with your physician or health practitioner. What I see most often in the pharmacy are clients who come to the counter and ask about a particular supplement in which someone they know has recommended. There is nothing wrong with listening to suggestions as long as you do the follow up which is to ask if that particular supplement would be of benefit to you. Supplements can be expensive, especially if your personal physical condition warrants that you take more than one, so it becomes imperative from a health stand point but also a financial stand point that you take the time to educate yourself thoroughly about which supplements would be of most benefit to you.
There are many places to educate yourself. The internet is a great source if you know where to look. You can ask your doctor or a pharmacist. A pharmacist who specializes in Integrative Medicine would be especially appropriate. They can guide you through what can be at times an overwhelming plethora of information. This is a fairly new field of medicine, but an invaluable one. The role of an Integrative Pharmacist is to evaluate your circumstances and educate you as to what options you might have or would be most appropriate for your condition and your financial situation. It may be as simple as making you aware of less expensive alternatives. For example, I have had several clients who have been switched from antidepressant to antidepressant, it isn't unusual for someone to be on two at a time, only to be switched yet again to a more expensive drug new to the market. In frustration, they tell me they can't afford the medication and that as soon as the doctor finishes handing out his samples, they will have to stop taking it. I explain that very often patients who don’t respond well to antidepressants, especially if they have already tried several, might have low levels of folate or folic acid. More often than not folic acid supplementation along with vitamin B6 (pyrodoxine) and vitamin B12 (cyanocobalamin) significantly improves their response to a less expensive generic drug. This is merely one example of how supplements, in this case vitamins, can make a significant impact on therapy response and effectiveness.
Contemporary medicine is more and more complex. Physicians are finding it necessary to specialize more and more, being able to keep up with the most recent research, and understanding in depth what therapy will be most effective for each individual can be an overwhelming if not impossible task. The benefit of this specialized approach to medicine would seem to be obvious. A physician is able to be an expert in his field. But this has also created a problem in our medical system. So many medical students today are specializing, that we are losing the glue that holds it all together. This glue that I'm referring to, which is essential to practicing good medicine, is our front line doctors and practitioners. The family physicians and pediatricians for example, who are responsible for practicing preventive medicine (educating the patient on staying healthy), identifying and treating diseases when they arise, but they are also the ones responsible for collecting all the data and reports that are being produced by the specialists that their patients have been referred to. If this seems like a mouthful, it's more than that, it's more than a handful. Because of the increase in rate of physicians who become specialists, there are less and less front line physicians. The ones that remain are overworked and at times overwhelmed.
There is a medical crisis in this country for various reasons, but substandard communication between health professionals and their patients is of major concern, in part because there is so much information to keep track of. We need an integrative approach to medicine. Dr. Andrew Weil is a physician who has developed an Integrative Medicine program at the University of Arizona Medical School and there are other universities across the country that have begun to incorporate this idea into their medical schools. The basic philosophy is this: you treat the body as a whole and you treat the patient with a team of physicians that work closely together. Their clinic works with family practitioners, specialists, as well as alternative practitioners; acupuncturists, massage therapists, physical therapists, psychotherapists, pharmacists, nutritionists, etc. Although integrative medicine is becoming prevalent, it is by no means a part of mainstream medicine.
In the meantime, patients need to do the best with what they have available to them. Towards that goal is familiarizing yourself with what types of therapies are available and being able to decide which ones are credible and which ones aren't and that most certainly includes supplements. Knowledge is power. It is not enough to explain the benefits and risks of taking supplements. We are people first and patients second and we are responsible for our own health. In order to make informed decisions we need to understand why vitamins are necessary or "essential" to good health and how they work. The words essential and non-essential are often used to describe vitamins. These terms can be misleading. An essential vitamin is one that can only be found in the diet. A non-essential vitamin is also necessary for good health, but it can be manufactured by the body through other biochemical reactions. This however does not mean that non-essential vitamins are less important or that additional supplementation is never required. There are conditions in which the pathways in which these non-essential vitamins are formed are inefficient. Under these circumstances additional supplementation would be necessary. For example, a supplement and vitamin-like substance called Coenzyme Q is necessary for the proper cell function. The levels of CoQ diminish with age and are also diminished in people who take cholesterol lowering drugs called statins. In this case and there are others, external supplementation could be helpful in maintaining overall health. It is not possible to explain in detail all of the various vitamins, supplements, and vitamin-like substances in the scope of this article. I have thus focused on the most important and effective supplements; supplements that also are backed with a significant amount of credible research.
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