Crohn’s Disease Dietary Restrictions and Natural Remedies

Posted on March 26, 2020July 2, 2022 by Michael Brown

Crohn’s disease is an inflammatory bowel disease (IBD) resulting in chronic inflammation of the gastrointestinal tract. IBD encompasses Crohn’s disease and ulcerative colitis. Crohn’s disease is associated with distinct granulomas and inflammation which may also affect lymph nodes.¹

Ulcerative colitis is a milder disease that is characterized by continuous inflammation affecting the colon. Both of these conditions lead to extensive epithelial damage.

Inflammatory bowel disease may cause a variety of symptoms including:

Loss of appetite
Fever
Weight loss
Diarrhea which may contain blood
Abdominal pain and cramping
Anemia due to blood loss
Urgency to defecate

I thought I would write a post on ways to combat this disease other than the traditional medication therapy.

Remember, if you suffer from IBD, it is important to visit your physician on a regular basis. Since bleeding and GI blockages are possible, tests may need to be performed by a professional to keep you as healthy as possible.

You may require medication depending on how severe your symptoms are. This disease may also cause a decrease in the absorption of vital vitamins and nutrients the body needs for proper functioning.

The recommendations in this article should only be considered in combination with the advice of a physician. I am a strong advocate of yearly check-ups. Preventative medicine is vital to health.

What Foods Cause Crohn's Disease Flare-ups

Although there is no particular diet that has been scientifically proven to prevent inflammatory bowel disease, there are some trigger foods that may cause flare-ups. My advice is to keep a food journal and this should help you determine which foods tend to cause problems. If you find a certain food or food group appearing often before flare-ups, you may consider eliminating that item from your diet. Some of the possible “problem items” include:

Corn, including popcorn
Dairy products – if lactose intolerant- consider supplementing with lactase or eliminating
Foods that cause increased gas production in the gut (onions, broccoli, cabbage, beans, legumes, lentils, etc.)
High fiber foods (chia seeds, avocado, pasta, chickpeas, quinoa, oats, almonds etc.)
Fried foods
Nuts and seeds, including peanut butter
Some raw fruits
Coffee and tea
Chocolate
Fats (butter, mayonnaise, cooking oils)
Alcoholic beverages
Red meat
Pork
Spicy foods

As you can see, there are many foods on this list, and others may also cause irritation and flare-ups. This is why a food journal is essential. It is worth the effort!

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Another strategy is to try an elimination diet. The way this works is you start by eliminating many foods and if your symptoms improve, you begin to add foods back one at a time. This can help identify which foods should be avoided in the future.

There are several elimination diets available today. The Whole30 is a diet my family and I tried last October. I have written about this in a separate post if you are interested in the specifics. I highly recommend trying it.

I was also able to locate a specific diet and cookbook on Amazon written by Patty Catsos, MS, RD, LD. I have not tried this diet yet, and don’t suffer from IBS, but this book has great reviews. I do not have any association with this product but will list the link below for your convenience.

https://www.amazon.com/IBS-Elimination-Diet-Cookbook-Low-FODMAP/dp/0451497724

FODMAPs

Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) are short-chained carbohydrates. These make their way to the end of the intestinal tract where large amounts of bacteria reside. The bacteria break these substances down causing the release of gas which may lead to digestive issues in some individuals. These FODMAPs also draw liquid into the intestines which can lead to diarrhea. Most individuals with IBS are sensitive to FODMAPs and these substances can lead the flare-ups. Examples of FODMAPs include:

Lactose – Milk sugar contained in dairy products.

Galactans – Legumes have large quantities of these.

Fructose – This is the sugar contained in fruits and vegetables. You also find this in many packaged products.

Fructans – These are found in many grains including wheat, spelt, barley and rye.

Polyols – These are sugar alcohols and are also used in processed foods as a sweetener. Examples include sorbitol, mannitol, xylitol and maltitol.

These substances are resistant to digestion and are passed through the intestinal tract unchanged. FODMAPs cause an increased hydrogen concentration in the intestines of those with IBS. They also influence the quantity of methane gas and may cause gastrointestinal symptoms in IBS patients.²

Curcumin for IBS

One of the most effective and popular herbal medicines available is turmeric. This herb contains curcumin which has many beneficial properties. Curcumin is known to have a wide range of effects on the gastrointestinal system. This substance has been shown to inhibit the growth of H. pylori in both mice and on agar plates.³

Curcumin is thought to kill bacteria by inhibiting cell division.⁴

A study by Niamsa and Sittiwet in 2009, demonstrated the antimicrobial activity of curcumin several commonly encountered pathogenic Gram-negative and Gram-positive bacteria.⁵

Curcumin has also been shown to regulate the gut microbiota. This is important because inflammatory bowel disease is partially defined by an altered, pathogenic microbiome.⁶

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One of the changes that occur in the gut is the increase in adherent invasive E. Coli (AIEC) which can promote gut inflammation.⁹

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Curcumin has also been shown to inhibit signaling that initiates the inflammatory process in the intestinal tract.¹¹

A study published in 2006 found the addition of curcumin, 1 gram after breakfast and 1 gram after dinner, plus sulfasalazine or mesalamine was more effective than placebo combined with one of these two medications. The mesalamine group had a 4.65% relapse rate (2/43), whereas the placebo group had a relapse rate of 20.51% (8/39). A six month follow-up found eight more patients relapsed in the curcumin group and six additional patients relapsed in the placebo group.¹²

For additional information on curcumin, please refer to my blog post on turmeric below.

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Turmeric Health Benefits

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Plantago Ovata

Plantago ovata, also known as Desert Indian wheat or psyllim husk has been used as a medicinal plant. Psyllium is often used as a bulk forming laxative to support normal bowel movements. Psyllium is marketed as Metamucil. We also have this product available in capsule form in the Sunshine Store. There have been studies showing psyllium to be useful in the treatment of UC.¹³

Probiotics in Inflammatory Bowel Disease

Probiotics would seem to be helpful in IBD. Ingesting “good” bacterial should fend off some of the “bad” gas-producing bacteria. At the present time, the studies show that probiotic supplementation is a promising adjuvant treatment in ulcerative colitis. It is best to use a combination Probiotic such as Probiotic-40 available below. There is not enough clinical evidence to support the use of probiotics for Crohn’s disease at the present time.¹⁴

Probiotic-40

Contains four different probiotic strains

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Inflammatory bowel disease can be a debilitating illness and may be dangerous in some cases. This condition may lead to a decrease in the absorption of critical nutrients and can also lead to bleeding and/or intestinal obstructions. I suggest visiting your physician on a regular basis, keeping a food journal, and consider adding nutritional supplements to your medication regimen. Your physician can tell you if you are deficient in vitamin B-12 or other necessary vitamins or minerals. I strongly recommend a turmeric supplement. This is one of the healthiest natural herbs available today. Psyllium may also be beneficial but caution should be observed as large fiber loads can increase IBS symptoms in some individuals. Be sure to check with your physician before starting this or any other supplement.

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L-Arginine and Cardiovascular Disease, IVF, PCOS, and More..

Posted on March 17, 2020March 17, 2020 by Michael Brown

What is L-Arginine

L-Arginine is an amino acid made naturally by our bodies and is used in protein biosynthesis. It is also found in foods such as fish, poultry, red meat, and dairy products. L-Arginine is vital to overall health. It is associated with the Krebs Cycle and is a part of the urea cycle where it carries nitrogenous waste. This amino acid also causes vasodilation by its conversion to nitric oxide (NO).¹

It is important in maintaining the acid-base balance of the body as the urea cycle is a significant consumer of bicarbonate.

We have recently added this supplement to our product line mostly to be used by athletes. I will cover this, as well as some uses of L-Arginine in this post.

L-Arginine and in vitro fertilization (IVF)

In vitro fertilization has become increasingly popular for couples who struggle to become pregnant. This is often attempted during the later child-bearing years after the woman has failed to become pregnant. There is some research to suggest L-Arginine can increase the number of oocytes collected in women attempting IVF. This, however, has yet to be shown to improve the viable pregnancy rate.²

L-Arginine and Polycystic Ovary Syndrome (PCOS)

A small study of eight patients with polycystic ovary syndrome was published in December of 2009. This study showed that a combination of L-arginine 1600 mg daily combined with N-acetylcysteine 1200 mg daily for a period of six months resulted in moderate improvement of menstrual function and decreased insulin resistance.³

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L-Theanine Effects on Cardiovascular Disease and Exercise

L-Arginine may lessen angina symptoms and improve exercise and quality of life in angina patients according to a study published in 2002.⁴

Another randomized, double-blind cross-over study published in September of 2000, found that, although L-arginine supplementation did not affect exercise-induced changes in QT interval, QT dispersion, or the magnitude of ST segment depression, it significantly improved exercise tolerance. This is most likely the result of improved peripheral vasomotion.⁵

Many studies have found L-arginine to be effective and decreasing both systolic and diastolic blood pressure. This has been shown in healthy individuals, those with pulmonary hypertension, as well as patients with type 2 diabetes.⁶

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L-arginine also appears to have an additive vasodilation effect when combined with angiotensin converting enzyme (ACE) inhibitors and nitrate vasodilators when used for the treatment of hypertension.¹⁰

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Intermittent claudication associated with peripheral arterial disease symptoms have also been shown to improve with the administration of oral or intravenous L-arginine for short term periods (up to eight weeks). ¹⁵

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Although this is promising, walking speed, walking distance, or absolute claudication distance does not seem to improve with long-term (up to six months) administration of L-arginine. ¹⁸

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L-Arginine and Erectile Dysfunction (ED)

L-arginine has shown some promise in the treatment of erectile dysfunction. A double-blind, placebo-controlled study of 50 men with organic ED showed significant improvement in sexual function in 9/29 (31%) of the treatment group but only 2/17 (11.8%) of the placebo group. The nine patients in the treatment group that showed improvement all had initially low NOx but this level doubled by the end of the study.²⁰

L-arginine seems to be effective in men with mixed-type impotence when combined with Pycogenol at 1.7 grams daily or when combined with both Pycogenol and aspartic acid when dosed at 0.69 grams daily.²¹

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L-Arginine and Statins

The combination of L-arginine and atorvastatin (Lipitor) has been shown to have a significant positive effect on the progression of atherosclerosis. A study utilizing rabbits found this combination to achieve a 21% decrease in the total area of lesions and a 44% reduction in the area of abdominal lesions compared to the control group.²³

A two-arm, randomized, double-blind study on 33 hypertriglyceridemic patients reported that L-arginine alone had no effect on serum lipids compared to placebo. When combined with simvastatin, however, led to a significantly larger reduction in triglycerides compared to placebo plus simvastatin. This study also found L-arginine attenuated simvastatin-induced increases in aspartate transaminase and fibrinogen.²⁴

L-Arginine and Body Building

L-arginine is popular with body builders because it helps in the synthesis of proteins. As muscle mass increases, L-arginine helps signal muscle cells and encourages growth hormone release and the metabolism of fat. This leads to a more defined, stronger, well-defined physique. L-arginine can also improve endurance and muscle conditioning due to its vasodilation effects. This increases blood flow to muscle during workout periods.

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L-Arginine Drug Interactions

ACE inhibitors, Angiotensin Receptor Blockers (ARBs) and other antihypertensive agents – The combination of L-arginine and ACE inhibitors may lead to increased vasodilation and a larger decrease in blood pressure. When combined, the risk of hypotension exists. Examples include benazepril, captopril, Ramipril, losartan, valsartan, diltiazem, amlodipine, and many more.

Anticoagulants and Antiplatelet Drugs – L-arginine may decrease platelet aggregation in humans. Caution should be exercised when combining L-arginine with medications that increase bleeding risk. Some examples are warfarin, apixaban, rivaroxaban, enoxaparin, clopidigrel, ticlodipine and others.

Isoproterenol and Nitrates – L-arginine may lead to increased vasodilation when combined with vasodilators leading to hypotension and dizziness.

Sildenafil (Viagra) – Although not reported in humans, combining L-Arginine with sildenafil may lead to increased vasodilation and dizziness as well.

Potassium-sparing diuretics – There have been some reports of L-arginine causing hyperkalemia in some patients. Combining L-arginine with these medications may increase the risk of hyperkalemia. Examples of these medications include amiloride, spironolactone, and triamterene.

Adverse Effects of L-Arginine

L-Arginine is generally well tolerated. The most common side effects reported for this supplement are:

Abdominal pain
Bloating
Diarrhea
Nausea
Gout
Allergic reactions
Exacerbation of airway inflammation in asthmatic patients

L-arginine is an amino acid which helps in the synthesis of proteins. It also leads to vasodilation and, in doing so, can be beneficial for relieving chest pain. When combined with a statin, L-arginine leads to a decrease in atherosclerosis which may help prevent heart attacks. It has also been shown to decrease both systolic and diastolic blood pressures. Due to its vasodilation properties, L-arginine may help with the symptoms of erectile dysfunction. It may also help with some of the symptoms of polycystic ovary syndrome when combined with N-acetylcysteine.

We recently added L-arginine as a dietary supplement to our product line with the thought of making it available to body builders. It can increase exercise tolerance and help create a sculpted, muscular body. As it turns out, many other uses are possible with this substance.

L-arginine is relatively safe and well tolerated as it is an amino acid found in the human body. As with any other medication or supplement, allergic reactions are always a possibility. These reactions are often due to fillers and other substances used to produce the dosage form rather than the active chemical. Gastrointestinal side effects are always a possibility as well.

If you have any questions about L-arginine or any other medication or supplement, please feel free to send me an email. I have spent over half of my life working with medications and supplements. As I have expressed in the past, if I do not know the answer to your question, I will find it. Have a great week and live a happy, healthy life. Get plenty of exercise, drink adequate amounts of water, and eat whole foods. You are worth it.

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Michael J. Brown, RPh, BCPS, BCPP

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14 Surprising Berberine Uses

Posted on February 22, 2020August 18, 2020 by Michael Brown

The newest supplement available in the Sunshine Store is berberine. We chose to add this product based on the evidence available on its usefulness. As you will learn from this article, berberine may be useful for a variety of health-related conditions. It is one of the few herbal supplements that can have similar effects on the body as prescription medications.

Berberine has been used in Chinese and Ayurvedic medicine for thousands of years. This yellow, bitter alkaloid is found in the roots, bark, and rhizomes of plants such as Oregon grape, goldenseal, European barberry, and tree turmeric, among others.

What is berberine used for?

Is it safe?

Are there drug interactions?

As mentioned above, berberine has a variety of uses. Some of the most popular are listed below.

Berberine for Diabetes

Berberine has been shown to have a positive effect on diabetes in several studies.

Some of these effects are listed below.

Taking 500mg of berberine twice daily for three months in patients with type 2 diabetes may reduce glycated hemoglobin (HbA1c), post-prandial glucose (PPG), and fasting plasma glucose (FPG).¹

Taking berberine 500mg two to three times daily for two to three months works as well as metformin two to three times a day or rosiglitazone 4mg daily in the regulation of glucose metabolism in type 2 diabetics.

Berberine for Hypertension

Hypertension is a growing problem. Approximately one million visits to emergency departments listed hypertension as the primary diagnosis in 2016.

This condition often does not have symptoms associated with it and can go unnoticed for years.

Hypertension can damage your arteries, heart, kidneys, eyes, and brain. It may lead to stroke, dementia, kidney failure, and blindness.

A meta-analysis showed that combining berberine with amlodipine is more effective at reducing blood pressure than taking amlodipine alone.

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Source: ⁵

Berberine for Polycystic Ovary Syndrome (PCOS)

There have been studies examining the use of berberine in women with PCOS who were attempting to become pregnant. Although there are mixed results, one study showed that 500mg of oral berberine taken three times daily for three months before IVF increased pregnancy and live birth rate. These results were similar to those obtained when taking oral metformin 500mg three times daily for three months before IVF.

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Berberine for Hyperlipidemia

Meta-analyses show that berberine may reduce total cholesterol (TC), triglycerides (TG), and LDL (bad) cholesterol.

It can also increase HDL (good) cholesterol levels. It also leads to a more significant reduction in TC and LDL when combined with lipid-lowering medications.

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Berberine may also be useful for the following conditions, although less quality evidence is available to support its use for these.

Congestive heart failure (CHF) – May reduce premature ventricular contractions and lower mortality.

Burns – As an ointment in combination with beta-sitosterol.

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Cholera

Coronary heart disease (CHD) – See hyperlipidemia above.

Diarrhea – May be effective for diarrhea caused by E. coli.

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Glaucoma – As eyedrops in combination with tetrahydrozoline.

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Hepatitis B and C – Berberine decreases triglycerides and blood glucose. It also reduces markers of liver damage, including aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

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Irritable bowel syndrome (IBS) – May reduce the frequency of abdominal pain, diarrhea, and defecation frequency when compared to placebo.

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Symptoms of menopause – When taking berberine along with soy isoflavones, vasomotor symptoms in menopausal women may be decreased when compared to calcium plus vitamin D administration.

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Obesity – Berberine has been shown to decrease weight by 2.3 kg (~5 lbs) in obese patients compared with a control group when ingested for twelve weeks.

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Berberine interactions with Drugs:

Drugs used to treat diabetes – Do not use berberine with antidiabetic medications. There is substantial clinical evidence suggesting this combination increases the risk of hypoglycemia. Berberine should not be used with any drug that lowers blood sugar.

This includes insulin as well as other oral and injectable diabetes medications.

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Amlodipine and other drugs for high blood pressure – Combining berberine with amlodipine may result in a decrease in both systolic and diastolic blood pressure.

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This effect may also occur with other antihypertensive medications.

Anticoagulants – Since berberine may inhibit platelet aggregation, caution should be used when combining it with antiplatelet or anticoagulant medications.

The risk of bleeding may be increased.

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Cyclosporine – Do not combine berberine with cyclosporine. This combination may result in an increased level and increased adverse effects of cyclosporine.

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Drugs that may cause sedation – Use caution when combining berberine with medications that produce sedation.

This combination may lead to an increase in sedative effects. Some examples of sedative agents include.

Benzodiazepines
Narcotics
Barbiturates
Sedating antihistamines such as diphenhydramine and hydroxyzine
Anticonvulsants

There are other sedating medications, please contact your physician or pharmacist or send me a message to me for clarification.

Medications metabolized by Cytochrome P450 – There are several agents in this category. Below is a shortlist but again, if you have questions about what you are taking, please consult a physician or pharmacist, or simply shoot me an email.

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Ibuprofen (Motrin) – May increase ibuprofen levels.

Losartan (Cozaar) – May decrease therapeutic effects of losartan.

Dextromethorphan (Robitussin DM, Delsym, others) – May increase dextromethorphan levels leading to drowsiness, irritability, and confusion.

Lovastatin (Mevacor) – May increase lovastatin levels.

Sildenafil (Viagra) – May increase sildenafil levels.

Tacrolimus – There has been at least one case report of berberine, causing an increased serum creatinine and tacrolimus level in a 16-year-old patient with idiopathic nephrotic syndrome.

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Patients who take berberine along with tacrolimus should have drug levels checked as tacrolimus dose adjustment may be necessary.

Safety of Berberine in Pregnancy and Lactation

Berberine should NOT be used in pregnant or lactating women. Berberine is believed to cross the placenta and may cause kernicterus and harm the fetus. Berberine may also be secreted into breast milk when taken orally, so it should not be used by breastfeeding mothers.

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Side Effects of Berberine

Although berberine is generally well tolerated, the following side effects were the most commonly reported during research studies.

diarrhea
constipation
abdominal pain
abdominal distention
vomiting
flatulence

Berberine is a substance that has been used in other countries for its health benefits for thousands of years. I became interested in it while reading a book I recently purchased on nutraceutical preparation. This herbal product has the best evidence for its use in diabetes, hyperlipidemia, hypertension, and polycystic ovary syndrome. It can also be effective for several other ailments described above.

Berberine should never be used in children or pregnant or breast-feeding mothers. There is some evidence that it may be harmful to the fetus as well as small children. As a pharmacist, I believe in using herbs and medications in pregnancy or children only when absolutely necessary. The risk is just too substantial.

Berberine, along with turmeric and ashwagandha, has effects on the body that can rival prescription medications. It can be beneficial for those who have diabetes, PCOS, or obesity. It is generally well-tolerated and is now available in the Sunshine Store for purchase.

Give it a try and let me know what you think.

Always remember to take care of yourself, eat whole foods, drink plenty of water, exercise, and get adequate sleep. These can significantly help in your quest for happiness.

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Abnormal Condition of Dry or Scaly Skin in Older Individuals

Posted on February 15, 2020February 15, 2020 by Michael Brown

What can be done to prevent dry skin as you age?

The skin is the largest organ of the body. It serves as a barrier and protects us from bacteria.

Skin also helps to regulate body temperature and allows us to respond to heat, cold, and touch. There are three layers that compose the skin.

Epidermis – This is the outer layer that serves as a barrier. The epidermis keeps pathogens from entering the body and regulated water being released from the body.
Dermis – The layer below the epidermis is called the dermis. This layer contains blood vessels, nerve endings, sweat glands, and hair follicles.
Hypodermis – This layer contains fat and connective tissue, and provides cushioning and insulation to the body.

Dermatologists are specialized physicians who diagnose and treat various conditions of the skin. This post will explore dry skin, its causes, treatments, and effects on the aging population.

Effects of Age on the Skin

As we age, our skin becomes thinner. The number of blood vessels, nerve endings, and the amount of connective tissue also decrease. These changes lead to a reduced ability to retain moisture, control body temperature, and sense the environment.

Pruritis, or itching, is the most common complaint involving the skin in older individuals. Short-term itching, less than six weeks, may protect us, but pruritis lasting more than six weeks can be bothersome. Pruritis can effect the quality of life and, in some cases, patients would rather live a shorter life without symptoms than live longer with pruritis.

Dry skin (xerosis) is more common in older individuals and those living in colder climates. Heating homes in the winter months leads to decreased humidity that can dry the skin.

Prevention of Dry, Itchy Skin

The best treatment for most anything is prevention.

Dry, itchy skin is no exception.

The first step is to monitor the health of the skin regularly. This can be done by scanning the body for problem areas. A physician may also perform skin monitoring during a routine physical exam.

Some causes of dry skin include:

Cold, dry air during the winter months
Skin damage from the sun
Use of soaps and detergents that damage the skin
Excessive immersion in water (taking long baths)
Some diseases such as lymphoma, malnutrition, hypothyroidism, eczema, and others
Direct exposure to fan heaters
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One of the best ways to prevent dry to skin is to eat an adequate amount of protein, vitamins, and fatty acids.
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Best Foods to Eat for Healthy Skin

What should you eat to help keep your skin healthy? In general, fresh fruits and vegetables are a good choice because of the vitamins and antioxidants. Below are some great suggestions.

Salmon – Fatty fish, such as salmon, contain omega-3 fatty acids which reduce inflammation and keep the skin moisturized.
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Bell Peppers – Bell peppers are an excellent source of beta-carotene, especially the red and yellow variety. Green bell peppers are picked before they turn color and do not contain as much beta-carotene, which is converted to vitamin A in the body. Bell peppers are also high in vitamin C, which helps keeps the skin healthy by helping form collagen.
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3. Broccoli –

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Probably my favorite vegetable, broccoli, contains many vitamins and minerals necessary for good skin health, including:

Vitamin A
Vitamin C
Zinc

Broccoli, as well as cabbage, cauliflower, and kale, also contains sulforaphane. This substance may protect the skin from the sun’s damage, thus decreasing photoaging.

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Avocados – Packed with healthy fats, this guacamole ingredient can improve skin health by moisturizing and improving flexibility.
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Avocados also contain vitamins C and E, which act as antioxidants. One symptom of vitamin C deficiency is dry, scaly skin. Vitamin C also is needed to make collagen that helps keep skin healthy and strong.

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Tomatoes – Another favorite of mine, tomatoes contain vitamin C, lycopene, and beta-carotene.

These substances can protect skin from the sun and help prevent wrinkles.

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Soy – Isoflavones are contained in soy. These have been shown to improve skin elasticity and decrease fine wrinkles in at least one study.
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Isoflavones can also protect the skin from the sun’s harmful rays.

Sweet potatoes – We started eating more sweet potatoes when consuming the Whole30 diet. These are an excellent beta-carotene source that can protect the skin from the sun. Sweet potatoes are a better option than white or yellow potatoes. Give them a try.

Green leafy vegetables – spinach, kale, and collard greens contain vitamins A, C and E. They are also a good source of protein and spinach contains selenium which can protect the skin from UV rays.

Eggs – These are a good source of protein, selenium, zinc, vitamin A and vitamin C.

10. Healthy oils – Extra virgin olive oil and fish oil can help with keeping the skin moist and pliable.

Best Nutritional Supplements for Healthy Skin

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Dietary supplements may be necessary if you cannot get enough nutrients from the foods you eat.

Some of these can be found in the Sunshine Store. The supplements listed below are the same as those contained in the foods above.

Fish Oil
Vitamin A
Vitamin C
Vitamin E
Zinc
Selenium

Topical Agents for Dry Skin

Daily use of moisturizers that hydrate the skin is important. Some examples of ingredients that can help are:

Topical Urea – This is a molecule produced by our body that is naturally found in the skin. It is generated from the metabolism of proteins and other compounds.

Urea is excreted in the urine and through sweating.

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Urea is one of the best moisturizing agents available to dermatologists today. It has been used safely for over a century and can be utilized for several skin conditions. Urea has different effects on the skin, depending on the concentration employed. At lower concentrations (~10% or less), it acts as a moisturizer, while at concentrations greater than 10%, it has an emollient/keratolytic action. Urea can also enhance the penetration of other molecules through the skin and is used in combination therapies.

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Other skin moisturizers available include glycerin, lactic acid, and petrolatum.

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Other Ways to Help Dry Skin

Avoid traditional soaps – regular soap can alkalinize the skin damaging the moisture barrier. Synthetic cleansers such as Dove, Olay, and Cetaphil are preferred.

Avoid excessive washing – This can worsen dry skin, especially if very hot water is used.

Avoid aggressive scrubbing and use luke-warm water.
Use a Humidifier – Increasing humidity can help decrease skin drying, especially in the winter months.

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As we age, our bodies go through many transformations. Energy levels decrease, our kidneys and liver don’t work as well, and we have a higher percentage of body fat. Our skin also changes and becomes thinner, less pliable, and dry. If we don’t care for our skin, it can crack, leading to pain and possible infection.

One of the best things you can do for your body at any age is to eat fresh, whole foods. If you eat a healthy, balanced diet, you are likely to help your skin stay strong and healthy. Always stay hydrated, exercise, and use high-quality moisturizing lotions.

If you live in the northern part of the country where it is cold in the winter, consider using a humidifier to help decrease the effects of dry air on your skin.

Avoid excessive bathing, especially with very hot water, as this may dry your skin. Stick with high-quality synthetic cleansers, and be sure to monitor your skin for dry, scaly areas. If you find problems with your skin, see your doctor. There are medicated creams and lotions available to help relieve the various skin conditions you may be suffering from.

Skin integrity is vital to our overall health. If you have any questions regarding this topic, or any other health or fitness related subject, feel free to contact us. If you have ideas for future blog posts, let me know. My goal is to keep you entertained and informed. Have a great day; be happy, healthy, and keep smiling.

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Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

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Probiotics in the Treatment of Thrush, Cystic Acne, and Atopic Dermatitis

Posted on January 25, 2020January 25, 2020 by Michael Brown

This post explores the use of probiotics in thrush, acne and atopic dermatitis.

Garcinia Cambogia Medication Interactions, Contraindications, Safety, Effectiveness and Use in Pregnancy and Lactation.

Posted on January 19, 2020July 3, 2022 by sunshineneutraceuticals

Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Garcinia cambogia (Malabar tamarind) is a fruit tree found in the evergreen and semi-evergreen forests of southwest India. The fruit of this tree resembles a small pumpkin and comes in a red, orange, or yellow variety. This fruit ripens during the rainy season, and the rind contains large amounts of hydroxycitric acid (HCA). The dried fruit rinds have been used for centuries as a flavoring agent.

In Ayurvedic medicine, Garcinia is used to promote general health. It has also been used for rheumatism and bowel symptoms — an oral rinse containing G. cambogia has been used by veterinarians to treat mouth diseases in cattle.

HCA, which is related to citric acid, is a common ingredient in weight loss products. G. cambogia is available as a weight-loss supplement, either alone or mixed with other ingredients.

Garcinia Cambogia Dose

Doses of Garcinia cambogia extract in clinical trials ranged from 1500 to 4667 mg per day. The supplement offered by Sunshine Nutraceuticals contains 700 mg Garcinia cambogia extract, and the recommended dose is one capsule by mouth twice daily 20-30 minutes before a meal with eight ounces of water.

Garcia Cambogia Side Effects

Side effects of Garcinia Cambogia are generally mild and include:

Dry mouth
Headache
Diarrhea
Dizziness
Nausea

Since Garcinia Cambogia is not centrally active, it should not cause anxiety, hypertension, or problems with sleep.

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Garcinia Cambogia in Pregnancy and Lactation

In my professional opinion, Garcinia cambogia should not be used by pregnant women or those who are breast-feeding. We do not have sufficient evidence to assure its safety; therefore, the risks outweigh the benefits.

Garcinia Cambogia Medication Interactions

Antidepressant Drugs and Serotonergic drugs

There has been a case report of serotonin syndrome being caused by a combination of Garcinia extract and escitalopram (Lexapro). The patient was re-challenged with sertraline (Zoloft) and again experienced serotonin syndrome.¹

For this reason, caution should be exercised when taking G. Cambogia with any antidepressant medication. Monitor for signs and symptoms of serotonin syndrome. These include:

Headache
Agitation
Restlessness
Confusion
Shivering
Increased heart rate
High blood pressure
Dilated pupils
Loss of muscle coordination
Muscle rigidity
Muscle Twitching
Heavy sweating
Diarrhea
Goose bumps

Serotonin syndrome may also occur when G. Cambogia is taken with other drugs that have serotonergic properties such as:

Tramadol (Ultram)
Pentazocine (Talwin)
Dextromethorphan (present in some OTC cough and cold preparations)

Anti-diabetic agents

G. cambogia may increase the hypoglycemic effects of anti-diabetic agents. It is suggested that blood sugars be closely monitored when using both Garcinia and anti-diabetic medications.

Statins and other hepatotoxic medications

There was a case report of rhabdomyolysis being caused following the ingestion of an herbal medicine containing G. Cambogia.²Caution is recommended when administering statins with other medications which may cause rhabdomyolysis.

Use caution when combining Garcinia with other drugs that negatively affect the liver. Some examples include

Acetaminophen (Tylenol)
Amiodarone (Cordarone)
Carbamazepine (Tegretol)
Isoniazid (INH)
Methotrexate (Rheumatrex)

Safety of Garcinia Cambogia

According to the TRC Natural Medicines Research Collaboration, Garcinia Cambogia gets a “possibly unsafe” grade. This is due to numerous case reports of liver toxicity. Most of these reports were the result of combination products that included G. Cambogia as one of the ingredients. There were at least two reports where the patient was taking Garcinia alone. Although the casualty was likely or probable, this is still concerning.

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Effectiveness of Garcinia Cambogia

Obesity

There is conflicting evidence regarding the effects of Garcinia on treating obesity. Some studies show a significant weight loss while others do not. As mentioned in some of my previous posts, I prefer to consult meta-analyses when available. One such study was published by Onakpoya, et al in 2011 in the Journal of Obesity.

The investigators of this meta-analysis did not believe the studies were of sufficient length to assess the effects of HCA on body weight. These studies ranged from two to twelve weeks. There were also different strains of Garcinia used in the studies. We are unsure what impact this might have on bioavailability.

Finally, there was a difference in caloric intake in the various studies.

Calories eaten ranged from 1,000 kcal, to as high as 3,009 kcal per day. This would certainly have an impact on weight loss.

The conclusion of this meta-analysis was that Garcinia extracts generate weight loss on the short term.

They point out that the effect is small, and is not statistically significant when only rigorous random controlled trials are considered.³

Garcinia Cambogia Contraindications

The only known contraindication at this time, according to Lexicomp (accessed 1/12/2020), is a known allergy or hypersensitivity to any components of Garcinia Cambogia.

After researching Garcinia cambogia, many questions remain.

Can this supplement be effective for weight loss long-term?

Does Garcinia cambogia cause liver damage or contribute to increased liver enzymes in some patients?

Is this supplement safe and effective?

The answers to the above questions cannot be answered until new research is available. The current studies were of insufficient length and not well designed. The liver damage side effect must be examined more closely before I can recommend starting this supplement for weight loss.

As I have explained in the past, the best way to lose weight is to eat whole foods, avoid fast food, drink plenty of water, and exercise. You will feel substantially better if you follow these simple rules. Supplements can help reduce hunger but exercise and proper food intake will get you much better results.

At this time, my recommendation is to use Garcinia cambogia only if you have had success with it in the past. If you have had no negative effects and have lost weight, it may be a reasonable option.

I will continue to research this supplement. As new research is available, I will decide whether to keep it, or remove it from our product line.

If you want a safer alternative, I recommend our Keto Ultra supplement. This contains raspberry ketones, African mango, green tea extract, caffeine, apple cider vinegar, kelp and grape seed extract. You can order this supplement below.

Our goal is to give our readers the best information available to live a happy, healthy lifestyle. Sometimes, the information I present to you will not be positive. I want to remain unbiased with regard to the products I offer for sale. If you have any questions, please click on the link next to my picture below to send a message. I will respond!

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Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

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Elderberry for Flu Prevention, Safety in Pregnancy, Drug Interactions, and More…

Posted on December 30, 2019January 15, 2020 by sunshineneutraceuticals

I am excited to be able to introduce an elderberry supplement into the Sunshine Nutraceutical product line. Elderberry is a purple berry produced by the European elder tree, a shrub which grows up to ten meters tall. Elder flowers and berries have been used as medicines and flavorings for centuries and are especially popular as potent cold and flu remedies. These common ailments have few treatments and can be annoying and even deadly in certain individuals. Elderberries have been utilized to treat various health conditions including diabetes, gingivitis, inflammation, acne, and more. This post will concentrate on the evidence available for the use of elderberries as a nutraceutical agent.

Elderberry for Colds, Flu and Bacterial Infections

Probably the most common use for elderberry is as a treatment for upper respiratory infections. Colds and influenza are prevalent especially during the winter months and are often treated with over-the-counter medications to combat symptoms and at times antibiotics are prescribed. Both colds and the flu are caused by viruses. Antibiotics are ineffective in the treatment of viral infections. Taking antibiotics unnecessarily can lead to resistant bacteria so it is important to use antibiotics only when they are indicated. No antibiotic is 100% effective and, if a resistant bacterial strain begins to multiply, it can be difficult to treat the infection.

The real question is whether elderberry will help with upper respiratory symptoms. I know plenty of individuals who swear it works. Before adding the elderberry product to my line, I did some research. I located a meta-analysis published in February of 2019. I have mentioned in previous posts that I like meta-analyses because they have a larger sample size and are generally more accurate than single studies.

This meta-analysis showed that elderberry supplements, when taken at the onset of respiratory symptoms, substantially reduced symptom duration compared to a control group. The investigators concluded that elderberry supplementation reduced influenza virus symptoms substantially more effectively than the upper respiratory symptoms caused by the common cold. It should be noted that this meta-analysis included only one study on elderberry supplementation for the common cold.¹

Elderberries neutralize hemagglutinin spikes found on the surfaces of some viruses. This prevents the viruses from piercing cell walls or entering the cell to replicate. If the viruses are unable to replicate, they cannot spread.²

Elderberries can also increase the antibodies produced by our bodies against the influenza virus. This indicates elderberries may actually be able to prevent the flu from occurring.³

A study published in the BMC Complementary & Alternative Medicine Journal in 2011 concluded that elderberry liquid extract was effective against human pathogenic bacteria and influenza viruses. Many patients develop bacterial infections when ill with the influenza virus. Elderberry may prove to be helpful in fighting both the influenza virus as well as bacterial infections during outbreaks.⁴

Elderberry for Treatment and Prevention of Cancer

A study published in 2007 found extracts of the fruits of both the European elderberry (Sambucus nigra) and American elderberry (Sambucus Canadensis), demonstrated anti-initiation and anti-promotion properties. This may prove to be useful in fighting cancer in the future. However, more studies need to be conducted on this subject ⁵

Elderberry as an Antioxidant

Elderberry may act to protect the body against oxidative stress. Elderberry has been proven to be an antioxidant and free radical scavenger in vitro (outside the body). It has antioxidant activity comparable to other highly antioxidant fruits such as blueberry and chokeberry.⁶

Elderberry Effect on Obesity, Diabetes and Inflammation

Obesity is the result of excessive adipose tissue growth. This can happen through two different mechanisms; Hypertrophy, which is the expansion of existing fat cells, and hyperplasia, which is the addition of new fat cells.

The oxidative stress caused by an increase in fat tissue leads to obesity-related comorbidities including insulin resistance, diabetes, cancer and heart disease.⁷

The accumulation of fat in hypertropic adipose tissue associated with obesity leads to oxidative stress and chronic inflammation.⁸

A recent study found an extract of the elderberry fruit (EDB) was able to decrease reactive oxygen species (ROS) in hypertrophic adipocytes suggesting an antioxidant action. This may be a potential protective mechanism against obesity risk factors such as insulin resistance and chronic inflammation.

This study also suggested that the anti-obesity and anti-diabetic effect of EDB may be due to inhibition of dietary sugar and fat absorption from the GI tract.⁹

Some evidence suggests polyphenols from several berry fruits can inhibit digestive enzymes which are responsible for the hydrolysis necessary for absorption of dietary lipids and carbohydrates.¹⁰

Zielinska-Wasielica et al. cited the following in their study published in August of 2019:

Results of the study indicate that Sambucus nigra fruit extract may offer substantial preventive and therapeutic potential for the treatment of obesity and obesity-related disorders, accompanied by oxidative stress, inflammation and insulin resistance. Moreover, the extract can inhibit digestive enzyme activity, and consequently, significantly reduce the intestinal absorption of dietary lipids and carbohydrates, which is an effective strategy for the prevention and treatment of obesity and metabolic comorbidities.¹¹

Contraindications

No contraindications to elderberry have been identified.

Side Effects

Consuming uncooked leaves, stems, or berries can lead to cyanide toxicity, which may cause vomiting and diarrhea. Commercial preparations generally do not cause adverse effects at prescribed dosages.

Pregnancy and Lactation

I do not recommend taking an elderberry supplement if you are pregnant or breast feeding as there are not enough studies confirming safety in infants and small children. For this reason, I recommend reserving the use of elderberry supplements to those over the age of eighteen.

Elderberry Drug Interactions

Although drug interactions with elderberry are not well-documented, exercise caution when taking the following:

Insulin
Blood pressure lowering medications Chemotherapeutic agents
Laxatives
Theophylline
Caffeine (Elderberry may inhibit the enzyme that metabolizes theophylline and caffeine). ¹²

Our Elderberry Product

Sunshine Nutraceuticals has a brand-new elderberry product that contains 600 mg of elderberry extract per capsule. This supplement is designed to be taken twice daily 20-30 minutes prior to a meal with eight ounces of water. I DO NOT recommend taking this product if you are pregnant, breast feeding or under eighteen years of age. If you have a known medical condition, consult your physician or pharmacist prior to taking supplements containing elderberry.

I expected to find a lot of information on elderberry for the treatment of colds and flu. After all, this is why many utilize this supplement and praise its effectiveness. What I didn’t expect was that elderberry has positive effects on diabetes, insulin resistance, and inflammation. We all know about the positive effects of blueberries as an antioxidant. It appears elderberries are not just good as a flavoring agent

and food source, but also possess medicinal properties beyond treatment of upper respiratory tract infections. As with all nutraceuticals, more studies are needed to determine the exact mechanism of action of the benefits of the elderberry. In the future, we may be able to isolate the active compounds from this plant, and use it not only to treat colds and the flu, but to prevent cancer, help fight insulin resistance, and more.

I firmly believe that, as a society, we under-utilize the natural substances provided to us in favor of chemicals which may help treat diseases but not without serious side effects. If we eat right, exercise, and spend time concentrating on our health, we may be able to avoid ingesting harmful chemicals. I know this sounds odd coming from a pharmacist, but this is the conclusion I have come to. Prescription drugs are absolutely necessary in some circumstances, but with the right lifestyle, we can limit our exposure to them.

Ashwagandha and Cognition

Cognition is a complicated process and is performed by our brain. It includes thinking, communicating, problem solving, memory, judgement, processing information from our senses and more. It is not surprising that many are interested in obtaining substances which improve cognition. These substances are known as nootropics. As we get older, our cognition tends to decline. A study by Sing-Manoux et.al found this decline often begins between 45 and 55 years of age. ⁴

A double-blind, placebo-controlled study was performed on a group of subjects with mild cognitive impairment (MCI). This is a state between normal cognitive aging and dementia. These people have memory deficits but not to the extent that activities of daily living are adversely affected. A total of fifty adults were randomized to receive either 300 mg Ashwagandha root extract in capsule form, twice daily, for eight weeks or a placebo.

The researchers concluded that “Ashwagandha (Withania somnifera) may be useful in enhancing immediate and general memory, executive function, attention, and information processing speed in people with MCI, with few adverse effects.” ⁵

The Anxiety Formula available in our Sunshine Store contains Ashwagandha. This is a supplement I consume daily to keep me focused and to clear my mind. I have had great success with this supplement and have had no adverse effects occurring with its use. You can order this supplement by clicking the box shown below.

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Ashwagandha and Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder (OCD) is a mental illness where the patient to suffers from obsessive, intrusive thoughts. These thoughts may lead the patient to clean continuously or constantly check light switches to be sure they are off, etc. This disorder can cause distress to the point that it affects daily functioning.   Selective serotonin reuptake inhibitors (SSRIs) are the medications most commonly used for OCD. Unfortunately, SSRIs are only mildly effective in treating OCD. ⁶
⁷
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A study conducted in 2016 showed Ashwagandha was more effective than placebo in improving Y-BOCS scores in patients with a diagnosis of OCD. Y-BOCS is the standard test for assessing the frequency and severity of OCD symptoms. Thirty patients were randomized into two groups and Y-BOCS scores were evaluated in both groups at baseline and after six weeks of treatment. The treatment group received an evaporated root extract of Ashwagandha obtained from Iran. Each capsule contained either 30mg of root extract and lactose to a total weight of 250mg, or lactose only (placebo). The treatment group had Y-BOCS scores improve by 8 units, whereas the placebo group only improved by 2 units. This was a statistically significant difference. ¹⁰

Ashwagandha and Blood Sugar Levels in Schizophrenia

I work as a psychiatric pharmacist so I am concerned about the effects of antipsychotic agents on blood sugar. A small study was published in the Indian Journal of Pharmacology in 2013. This study was designed to assess the ability of Ashwagandha to decrease blood sugar levels in schizophrenic patients who were receiving second-generation antipsychotic medications.
This study found a significant improvement in both fasting blood glucose and serum triglyceride levels in the Withania group as compared to the placebo group. More studies with a larger sample size are needed to establish safety and efficacy of this treatment option. ¹¹

Ashwagandha for Pain and Inflammation

Pain relief has become more difficult in the wake of the opiate crisis. Many physicians are not willing to prescribe opiates for chronic pain due to the recent guidelines which recommend against this practice. Unfortunately, other drug classes, such as non-steroidal anti-inflammatory agents (NSAIDs), also can be detrimental, especially if taken over an extended period of time. Pain can be debilitating for some. It can lead to problems sleeping, decreased mood, and reduced work performance.
A study was performed to see what effects a single 1000 mg dose of Withania somnifera would have on mechanical pain.   In this study a device was set up to measure pain threshold as well as pain tolerance force and time. The researchers found Withania somnifera increased pain threshold and pain tolerance force and time as compared to placebo. No adverse effects were reported in this study. ¹²
W. somnifera has also demonstrated analgesic and antipyretic effects in rat models. A study was done comparing Ashwagandha root powder to indomethacin. This study showed the root powder was able to curb the inflammatory response without causing damage to the GI tract of the rats. ¹³

Ashwagandha for Stress, Anxiety and Cortisol Levels

Ashwagandha is probably most known for its effects as an adaptogen. These substances (adaptogens) are able to help the body combat physical, chemical, and biological stress. A study published in 2012 included 64 people who had a history of chronic stress. These subjects were randomly assigned to two groups. The treatment group received 300mg Ashwagandha root extract in capsule form twice daily for 60 days. The other group, placebos.
On day 60, the treatment group displayed a significant reduction in all stress assessment scales relative to the placebo group.   Serum cortisol levels were also substantially reduced in the treatment group. Cortisol is the body’s main stress hormone. Increased cortisol levels can be an indication of increased stress. ¹⁴

Ashwagandha as a Cancer Treatment

Scientists have been searching for a cure for cancer for many years. Most of the medications available to treat various cancer types come with a long list of life-changing side effects. Ashwagandha root extract was first shown to decrease cancer incidence experimentally in vivo in 1967. ¹⁵
This has led to an increasing interest in Withania for both cancer treatment as well as prevention.
We know that the carcinogenic process is prolonged. Is there a way to prevent cancer? In 1976, the idea of chemoprevention was presented by Michael Sporn. ¹⁶
The definition of chemoprevention is the use of natural, synthetic, biological or chemical agents to reverse, suppress, or prevent the process of carcinogenesis. This has become an increasingly popular area of research. Natural substances and nutraceuticals are getting a closer look. Sulforaphane derived from vegetables such as broccoli for prostate cancer and turmeric for colorectal cancer prevention are examples of studies currently under way.

Breast Cancer

A study using mice that were predisposed to developing breast cancer showed a 33% reduction in tumor formation when being fed a diet containing 750mg/kg of Withania root extract for 10 months. ¹⁷

Hepatocellular Cancer

Cancer of the liver is aggressive and has a poor response rate to traditional cancer therapies. ¹⁸
A study, published in the Journal of International Medical Research in 2018, concluded the water extract of Withania somnifera is a powerful antioxidant and has anticancer effects on HepG2 cells. They suggest it may be a favorable treatment for hepatocellular carcinoma and should be confirmed in animal studies. ¹⁹
There are barriers to using Withania for chemoprotection. This plant only thrives under specific environmental conditions and is relatively slow growing. There is also variability in the alkaloids and withanolides produced by each plant, as well as different parts of the plant (leaves vs roots). This variability requires standardization of the active components of the preparation. Care must also be taken to not over-utilize fertilizers and pesticides when growing Ashwagandha. ²⁰

Ashwagandha Contraindications

Although Ashwagandha is considered safe for most individuals, there are three groups of people who should avoid it.
Those with hormone-sensitive prostate cancer: Ashwagandha may increase testosterone levels, therefore, it should not be consumed by these patients. ²¹
Those who take benzodiazepines, barbiturates, or anticonvulsants: Ashwagandha may have a sedative effect, as well as effects on GABA, so it should not be used in these patients. ²²
Pregnant women: Ashwagandha may induce abortion at higher doses. ²³

Ashwagandha Side Effects

Ashwagandha has very few side effects when utilized in normal doses. A study using Sprague-Dawley rats did show some sedation, ptosis and ataxia 15-20 minutes after administering Withania but this was a very large dose 1-2g/kg. ²⁴

Ashwaganda is one of the most prized herbs used in Ayurvedic medicine. This herb contains many substances, including withanolides, which seem to be effective for a wide range of ailments.
Ashwaganda has been shown to possess chemopreventive as well as chemotherapeutic properties. Research is being done to assess its use for the prevention and treatment for certain types of cancer. Ashwagandha has been used for thousands of years in India for its calming and anti-stress effects.
There is also some evidence to suggest Ashwagandha can improve cognition, help with pain and inflammation and lower blood sugar levels.
This herb may also have a positive effect on certain neurogenerative diseases such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. ²⁵I believe Ashwagandha is a valuable herb which will be more widely utilized as information from clinical trials becomes available. This herb has few side effects and is well tolerated. It is one of the ingredients in the Sunshine Sleep Aid as well as our Anxiety Formula, and I also have a single ingredient Ashwagandha product as well.
Please contact me with any questions. This has been a complex subject to research and there is much more to learn. It does give me hope for the future of cancer treatment in the United States. As always, live a happy, healthy life and most of all, stay happy!

Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Read Michael’s story here.
Feel free to send Michael a message using this link.

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Posted in NutraceuticalsTagged ashwagandha, Ashwagandha contraindications, ashwagandha side effects, withanolides

Probiotics Gut-Brain Axis and Psychiatry

Posted on December 2, 2019April 29, 2020 by sunshineneutraceuticals

Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Is it possible to treat mental health disorders by altering bacteria in the gut?

What is the Gut-Brain Axis?

Can the drugs we use to treat psychiatric disorders make patients worse by altering the bacteria living in the gut?

There have been many articles and studies published recently discussing the possible connection between the microflora of the gut and the progression of neuropsychiatric disorders. The bacteria in the gut are affected by many factors, including age, diet, exercise, health, and genetics. Medications can also alter gut bacteria. This post will explore the possible effects of the gut microbiome on various psychiatric disorders.

The Gut-Brain Axis

The Gut-Brain Axis is a network of nerves, hormones, and immunological factors connecting the central nervous system (CNS) to the Gastrointestinal (GI) tract. It appears that the gut flora are involved in this system. An imbalance in the function and composition of these intestinal bacteria is associated with many disease states. ¹
The microbes in the gut contain genes that perform metabolic functions. The metabolites resulting from these reactions can produce local effects in the GI environment or gut wall. These microbial metabolites may also be absorbed into the systemic circulation and exert their effects on other organs, including the brain.
It is now known that there is bidirectional communication between the gut and the brain. This communication network is known as the gut-brain axis. ²
Altered microflora of the gut has been associated with depression, other mood disorders, and neurodegenerative diseases. ³
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⁵

It is known that patients with GI diseases often suffer from mental health issues. ⁶
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⁸

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We also know that approximately one-third of patients with irritable bowel syndrome (IBS) have depression. ¹⁰
In patients with functional gastrointestinal disorders (FGIDs), 36.5% have comorbid psychiatric disorders. The most common of these are general anxiety disorder and panic. ¹¹

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Effects of Medications on Gut Bacteria

Psychiatric medications are known to disrupt the microbiome of the gut. ¹²
Second-generation antipsychotics, such as olanzapine, change the balance of intestinal bacteria leading to obesity.
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may inhibit Staphylococcus and Enterococcus growth. ¹³

¹⁴

¹⁵
The Belgian Flemish Gut Flora Project found both benzodiazepines and antidepressants affected microbiology. ¹⁶
The classes of non-antibiotic drugs that have the highest antimicrobial activity are antidepressants, antipsychotics, and benzodiazepines. ¹⁷

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The drugs we use to treat these psychiatric disorders may be making the conditions worse by altering the composition of the gut flora.
It may be possible to treat psychiatric disorders with living microorganisms. The goal would be to re-establish the healthy flora in the gut resulting in an improved gut-brain axis relationship. This is a difficult subject to study because once ingested; the living organisms are subjected to many negative environmental factors, including digestive enzymes, competitive microorganisms, and pH changes. Despite this difficulty, studies have been done, resulting in positive outcomes.

Gut-Brain Axis and Autism Spectrum Disorders

Autism spectrum disorders are developmental disorders that affect communication and behavior. This is known as a spectrum disorder because there is a wide variety of symptoms involved. Patients with autism have a difficult time communicating, may not respond to their name, and often do not find enjoyment in activities others enjoy. They may also display repetitive, stereotyped behaviors.
The exact cause of autism is not known, but children with ASD often suffer from GI symptoms that correlate with the severity of their disorder. Several studies have reported altered gut bacteria in patients with autism.
A treatment protocol using a fecal transplant was administered to 18 children with ASD (ages 7–16 years). The protocol started with two weeks of antibiotics, followed by a bowel cleanse. The children were then given an extended fecal microbiota transplant (FMT) using a high initial dose followed by daily maintenance doses for 7-8 weeks.
At the end of treatment, there was an 80% reduction of GI symptoms, as measured by the Gastrointestinal Symptom Rating Scale. This included a significant decrease in abdominal pain, indigestion, diarrhea, and constipation. These improvements were still evident eight weeks after treatment. The behavioral symptoms also improved significantly and also remained eight weeks post-treatment. This procedure seemed to be effective for both ASD symptoms as well as GI symptoms and continued long after treatment was completed. ²¹

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Gut-Brain Axis and Bipolar Disorder

One study showed that patients with bipolar mania were twice as likely to have taken a recent course of antibiotics. ²²
It has been suggested that treating bipolar patients with probiotics could help reduce hospitalizations. A small study found treating acutely manic patients with probiotics led to a decrease in the readmission rate. Dr. Faith Dickerson randomized 66 patients to receive a probiotic capsule or placebo for six months after hospitalization for mania. The probiotic, or placebo, were given in addition to the regular medication regimens. Of these 66 patients, 24 or 73% required rehospitalization, while only eight (24%) of the probiotic group was hospitalized. The probiotic patients who were admitted also had a shorter hospital stay than those treated with a placebo.
The probiotics used in this study were Bifidobacterium lactis (bb-12), and Lactobacillus rhamnosus (LGG). These strains are also found in breast milk. ²³

Gut-Brain Axis and Major Depressive Disorder (MDD)

It has been shown that mice raised in a sterile environment (germ-free mice) have an exaggerated response to stress. This can be reversed by inoculating these mice with feces in their early development. ²⁴

This suggests that gut microbial stimulation helps to shape healthy brain development during the early stages of life. ²⁵

A review published in 2017 in the Annals of General Psychiatry concluded that treatment with probiotics might improve MDD symptoms. The mechanism is likely a combination of serotonin availability as well as decreased inflammation. More comprehensive studies need to be completed to determine the utility of such a treatment in depression. At the present time, there is likely no harm in supplementing antidepressant medications with probiotics. ²⁶

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Psychobiotics

Psychobiotics are substances that alter the bacteria of the gut. These may be live bacteria (probiotics) or prebiotics. Prebiotics are compounds that change bacterial composition or activity when fermented in the digestive tract. ²⁷
In a study of 55 healthy volunteers, subjects received either fermented milk containing Lactobacillus casei Shirota, or a placebo for three weeks. The study subjects falling into the bottom third of mood scores showed significant improvement as compared to the placebo group. There were no overall changes in mood in this study, which may suggest Lactobacillus has a ceiling effect. In other words, people who are already relatively happy may not have an increase in mood after ingesting the probiotic. ²⁸
It is important to note that not all studies have shown benefits regarding probiotics. A recent review found little evidence of positive outcomes from these substances. ²⁹

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The Gut-Brain Axis is a fascinating topic that deserves much more research. I believe we can all benefit from eating a healthy diet, exercise, and possibly probiotic supplementation.
The evidence suggests that gut bacteria are vital in helping to develop the brain at a very early stage of human development. It is also evident that many of the medications we use to treat mood disorders such as depression, anxiety, and bipolar disorder, have an effect on the microbiome of the gut.
In the future, we may be able to either successfully treat these disorders with specific bacterial agents, or supplement the healthy flora destroyed by the medications we employ to treat these maladies.
I do know that I benefitted from eating a whole food diet during my Whole30 experience. My mood improved; I slept better and was more alert and happier in general. I can’t be sure this has anything to do with the microbiome in my gut, but it is certainly possible. I hope you have learned something from this post. If you have any questions, please feel free to reach out to me.

In the next post, I plan to write about happiness. This is something I have been looking forward to. I want to share my secrets for staying happy and improving your mood. I think you will all enjoy it.

Have a great day, and stay healthy!

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Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
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Posted in Diseases and Disorders, Mental Health, NutraceuticalsTagged Gut Flora, Gut-Bain Axis, Microbiome manipulation, Probiotics, Probiotics in mental health2 Comments

Turmeric with Bioperine Benefits

Posted on November 4, 2019July 3, 2022 by sunshineneutraceuticals

Should I take a turmeric supplement?
What is turmeric good for?
Is it safe?
What is Bioperine?

Turmeric is a spice many of us use in cooking. It is one of the main ingredients in curry powder. It has a yellow color and is also used as a coloring agent for foods and cosmetics. Turmeric is a plant related to ginger that is grown in Central America, Asia, and India. The rhizomes of this plant are dried and used as dietary supplements for a variety of health conditions.
This plant has been used in Indian and Asian medicine for thousands of years.
Turmeric may be the most effective nutritional supplement available today. The active component of this plant is curcumin. The polyphenol known as curcumin has been widely studied for many health-related benefits. Some of these include inflammation, arthritis, obesity, liver disease, and several types of cancer. It is thought that most of the positive benefits of curcumin are the result of its anti-inflammatory and antioxidant effects.

In this post, several health benefits of turmeric are explored. I have started taking this supplement as my father died from cancer and had two different types of cancer during his lifetime. I also have occasional back pain, which seems to respond to this supplement. Only you can determine if this supplement is for you.

Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Turmeric (Curcumin) for Various Types of Cancer

Probably the most exciting action of curcumin is its effects on various types of cancers. Cancer is the second leading cause of death worldwide. Although the therapy of cancer has progressed, mortality remains high. Many studies have been published on turmeric (curcumin) in the treatment of different types of cancer

Turmeric (Curcumin) and Breast Cancer

Breast cancer is the leading cause of death among all cancers in women throughout the world.
¹
The most effective treatment for breast cancer is early detection. Treatment is much more effective if the cancer is discovered in its early stages.
Traditionally, antiestrogen medications have been used for the treatment of breast cancer as more than seventy percent of these are of the estrogen receptor (ER) positive type. It is now known that combination treatment using various medications, surgery, and chemotherapy is the most effective treatment for this cancer type.
The effects of turmeric (curcumin) on breast cancer cells is complicated. Below are just some of the mechanisms thought to fight this deadly malady.
There is a proinflammatory transcription factor (NF-KB) that controls the genes that regulate proteins resulting in inflammation and the development of cancers.
Curcumin has been shown to decrease the effect of NF-KB, leading to its possible use in breast cancer.
² ³
Curcumin may also inhibit human epidermal growth factor receptor 2 (HER2-TK) alone or in combination with its analogs.
⁴
HER2-TK is a tyrosine kinase receptor. The overexpression of HER2-TK is associated with the progression of many cancer cell types.
⁵
Epidermal growth factor receptor (EGFR) is associated with the development of cancer cells.
⁶ ⁷
Curcumin inhibits the growth and spread of breast cancer cells by decreasing EGFR signaling.
⁸ ⁹
Curcumin can exert its positive anti-cancer effects on both estrogen-dependent as well as non-estrogen dependent breast cancer cells.
¹⁰

Turmeric for Prostate Cancer

Prostate cancer is the second leading cause of death from cancer in men. ¹¹
Curcumin has been shown to kill cancer cells and inhibit cancer cell proliferation both in the laboratory and in human subjects. ¹²
This is achieved by interfering with many cellular pathways including mitogen-activated protein kinase (MAPK), EGFR, and nuclear factor k (NFkB). ¹³ ¹⁴
Curcumin has also been shown to activate protein kinase D1 (PKD1), which attenuates the oncogenic signaling by beta-catenin and MAPK.
This leads to the inhibition of prostate cancer. ¹⁵

Turmeric for Colorectal Cancer

The third leading cause of cancer death in men is due to colorectal cancer. ¹⁶
This cancer is removed surgically, and often radiation therapy is prescribed, but over fifty percent relapse. ¹⁷
One of the markers for colorectal cancer is prostaglandin E2 (PGE2). PGE2 is a bioactive lipid that causes a wide variety of biological effects associated with inflammation and cancer.
A study was conducted on fifteen patients with treatment-resistant adenocarcinoma of the colon or rectum. Subjects received between 0.45 and 3.6 g oral curcumin daily for up to four months.
Intact curcumin and its metabolites were found in the plasma at a concentration of 10 nmol/L and also in the urine.
It was found that the 3.6 g curcumin daily dose led to 62% and 57% reductions in PGE2 levels one hour after administration on days 1 and 29.
This has led to a dosage recommendation of 3.6 g curcumin by mouth daily. ¹⁸

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Turmeric for the Prevention and Treatment of Alzheimer’s Disease

Alzheimer’s Disease (AD) is the most common cause of dementia. Currently, we only have medications available to slow the progression of this disease.
Can turmeric help to prevent AD?
We know that curcumin has many properties that may help prevent the development of Alzheimer’s disease. These include antioxidant, anti-inflammatory, anti-amyloid, and anti-tau actions that may be neuroprotective. ¹⁹ ²⁰
It is also known that populations that consume curry have a lower incidence of AD, and older people in this group have better cognitive function. ²¹
A study of 1010 sixty to ninety-year old’s who were occasional or frequent curry consumers found this population had significantly higher Mini-Mental State Examination (MMSE) scores compared to those who either didn’t eat curry or only consumed it rarely. ²²
Animal studies have also shown that curcumin can improve tasks requiring memory and reverse stress-induced reductions in the production of neurons associated with the brain-derived neurotropic factor (BDNF). ²³
An article was published in the American Journal of Geriatric Psychiatry in January of 2018, looking at the effects of curcumin on memory in people without dementia. This study, conducted at UCLA, also explored the effect of curcumin on the plaques and tangles in Alzheimer’s patients.
This was a double-blind, placebo-controlled study of forty adults between 50-90 years of age with mild memory complaints.
Study participants either received 90 mg curcumin or placebo twice daily for eighteen months. All were given cognitive assessments at the beginning of the study and every six months.
Curcumin blood levels were obtained at the beginning and end of the study.
Subjects who received curcumin realized a significant improvement in memory and attention.
The placebo group did not show significant improvement in either.
The curcumin group improved their memory scores by 28% over the 18-month period. This group also showed less amyloid and tau plaques in the hypothalamus and amygdala regions of the brain than the placebo group.
This research group is planning a follow-up study with a higher number of subjects. Antidepressant effects of curcumin will also be explored in their future study.

Turmeric for Type 2 Diabetes

There have been several studies evaluating the use of curcumin in the treatment of diabetes.
A 36-week study followed 240 pre-diabetic patients in 2012. The subjects were split into two groups. One group received 1500 mg curcumin daily while the other group received a placebo. At the end of the study, 16.4% of the placebo group developed T2DM, while no patients in the curcumin group developed diabetes. ²⁴
A study published in 2008 compared curcumin to atorvastatin (Lipitor) in T2DM patients. In this trial, patients received either 300 mg curcumin supplements daily, 10 mg atorvastatin daily, or a daily placebo.
The curcumin and atorvastatin group showed significant improvement in endothelial function and also a significant decrease in IL-6, TNF-alpha, ET-1, and malondialdehyde.
These results suggest curcumin has a positive effect on reducing inflammation and oxidative stress similar to that of the prescription medication atorvastatin. ²⁵

Turmeric for Heart Disease

The number one cause of death worldwide is heart disease, according to the World Health Organization. There are several risk factors that increase the chances of having a heart attack. Some are modifiable, while others are not. Some of the most prominent risk factors, according to the CDC are:
High blood pressure (HBP): HBP is a significant risk factor for heart disease. On my unit, pharmacists check blood pressure on each patient daily. A blood pressure that is too high affects not only the heart but also the kidneys and brain. HBP is sometimes called the “silent killer” because patients typically do not feel different. Medications, exercise, avoiding alcohol, and smoking are some methods to help decrease blood pressure.
High Cholesterol: This substance is made by our liver in sufficient quantities to fulfill our body’s needs. Unfortunately, poor diet leads to a build-up in the walls of the arteries. There are different types of cholesterol. The low-density type (LDL) is considered “bad” because it can lead to heart disease. The high-density type (HDL) is “good” because it provides protection from heart disease. Changing your diet to include more fresh fruits and vegetables, olive oil, nuts, and lean protein can help improve your HDL/LDL ratio. There are also medications available to decrease LDL levels. If you don’t know these “numbers,” please visit your doctor for a blood test. It may save your life.
Diabetes: The risk of heart disease is higher in patients with diabetes. ²⁶This disease causes an increased level of sugar in the blood.
Obesity: Excess body fat usually occurs with high LDL cholesterol and triglycerides and lower HDL cholesterol levels. Obesity increases the risks of HBP and diabetes. The best way to combat obesity is with diet and exercise. Always visit your physician before starting a new exercise program.
A study utilizing rats conducted in 2012, found curcumin improved cardiac repair and function after reversible cardiac ischemia. Left ventricle dilation was reduced, and wall thickness increased. This led to the conclusion that curcumin may be useful in the treatment of heart failure caused by ischemia. ²⁷
In 2014, a study performed by Cheungsarman et al. found curcumin showed an improvement in inflammatory and metabolic profiles as well as a significant positive impact on an atherosclerosis marker. ²⁸
Curcumin has been shown to improve disrupted cardiac function caused by cardiac fibrosis using various molecular mechanisms. ²⁹

Turmeric for Osteoarthritis

Osteoarthritis is the most common form of arthritis. This condition affects millions of people worldwide. The joints most affected are in the spine, hips, knees, and hands. Pain and swelling are caused when the cartilage in the joints that cushions the ends of the bones wear out.
The best initial treatment for osteoarthritis is exercise. Medications such as NSAIDs can also be utilized, but they cause some significant side effects, especially if used long-term.
Since it is known that curcumin has anti-inflammatory properties, its use in this disease process has been studied.
A review article published in May of 2019 evaluated curcumin in the treatment of autoimmune and rheumatic diseases.
Of the sixteen articles reviewed on osteoarthritis treatment with curcumin, fourteen reported significant improvements in several disease patterns. All studies were randomized, placebo-controlled trials. ³⁰
Curcumin utilized in these studies was most commonly isolated from turmeric rhizomes. The average curcumin dosage reported in the clinically effective studies was 834.29 mg daily.
Clinical outcomes were measured in most of these studies using:
Walking distance.
Lequesne’s pain functional index (LPFI).
Knee injury Osteoarthritis Outcome Score (KOOS).
Clinical Global Impression Scale (CGI).
visual analog scale (VAS).
Karnofsky performance scale.
In thirteen of these studies, dietary intake of curcumin resulted in improvement of at least two clinical measures, ³¹ ³² ³³ ³⁴ ³⁵ ³⁶ ³⁷ ³⁸ ³⁹ ⁴⁰ ⁴¹ ⁴² ⁴³
While seven studies showed improvement in at least three. ⁴⁴ ⁴⁵ ⁴⁶ ⁴⁷ ⁴⁸ ⁴⁹ ⁵⁰
The two clinical outcomes which increased most commonly were walking distance and decreased WOMAC scores.
There have also been studies conducted comparing the effectiveness of curcumin versus NSAIDs in the treatment of osteoarthritis.
A study in 2014 compared curcumin to ibuprofen. A total of 367 patients with arthritis of the knee were divided into two groups.
The Ibuprofen group received 1200mg Ibuprofen daily, while 1500mg curcumin daily was administered to the other group. Treatment lasted four weeks. Both groups showed significant improvement in WOMAC pain and function scores, and the ibuprofen group had more complaints of abdominal pain. ⁵¹
A similar study was conducted in 2009. Patients received either 800mg ibuprofen daily or 2 grams curcumin extract daily for six weeks. No difference in adverse effects between the two groups was found, and there were no differences in outcomes except for pain on stairs. ⁵²

Turmeric for Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory bowel disease that causes the formation of ulcers and inflammation in the digestive tract. This disease affects the inner lining of the colon and rectum. Since we know curcumin is useful in the treatment of inflammation, it is expected that this substance would have a positive impact on UC.
The symptoms of UC are diarrhea, abdominal pain, fever, weight loss, fatigue, and rectal pain and bleeding.
If the bleeding becomes severe, this disease can lead to death.
There have been positive and negative studies regarding the use of curcumin in the treatment of UC.
A study in 2017 by Kedia et al. found no difference in patients receiving 450 mg daily of curcumin and placebo in inducing remission in patients with mild to moderate UC.
This study spanned eight weeks and found no benefit of curcumin for clinical remission rates, clinical response, or mucosal healing when compared to placebo. It should be noted that the dosage of curcumin was low in this study. ⁵³
By contrast, a 2015 study by Lang et al. found that UC patients who received 3000 mg curcumin daily for one month, along with mesalamine, saw significant improvement in clinical response, endoscopic remission, and rate of clinical remission as compared to a mesalamine-placebo group. ⁵⁴
Another randomized, double-blind study of eighty-nine patients with UC was conducted in 2006. Forty-five subjects received curcumin 1000 mg twice daily, plus sulfasalazine (SZ) or mesalamine. The placebo group consisted of forty-four patients who received a placebo plus SZ or mesalamine.
The results showed only 4.65% of the curcumin group relapsed, whereas 20.51% of the placebo group relapsed during the study.
A six-month follow-up was performed on both groups who were taking either SZ or mesalamine. Eight addition patients in the curcumin group and six patients in the placebo group relapsed. ⁵⁵

Safety

The US Food and Drug Administration considers curcumin to be “generally recognized as safe.” ⁵⁶
Turmeric should not be used by women who are pregnant or lactating. It possesses some uterine stimulant effects. It should also be avoided in people with gall stones or bile duct obstruction. ⁵⁷

Side Effects of Turmeric (Curcumin)

Turmeric is generally well tolerated. I have been taking my Turmeric with Bioperine supplement daily for about one month with no noticeable adverse effects. The side effects reported in several clinical trials were mild. Below is a list in decreasing frequency of side effects that may result:
Mild gastrointestinal symptoms (dyspepsia, Bloating, GERD)
Nausea and vomiting
Edema
Loose stools
Constipation
Increased stool frequency
Hot flashes
These effects were not statistically different than those of the placebo groups. ⁵⁸

Turmeric Drug Interactions

The drug interactions to be aware of all regard the risk of bleeding. Caution should be exercised when using tumeric with the following drug classes:
Anticoagulant/Antiplatelet Agents:
NSAID’s
Salicyclates
Thrombolytic Agents
⁵⁹

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Bioavailability Boost

The substance known as piperine is a major component of black pepper. Piperine is marketed under the trade name Bioperine and is added to some turmeric supplements to increase the bioavailability of curcumin. This substance has been shown to increase bioavailability by 2000%. ⁶⁰

I am very excited about the information I have learned while researching turmeric. It can be consumed in foods and has been used as a medicine in different parts of the world for centuries.
I have been taking this supplement for about a month with absolutely no side effects.
Our family has also been eating curry several times per week. This is an easy way to decrease the odds of contracting cancer or dementia. Working on a unit with dementia patients has taught me I don’t want to burden my family with this disease.
The curcumin in turmeric also helps reduce inflammation, which helps with my back pain.
I firmly believe this is the most versatile supplement available in my store.
I hope you have enjoyed reading this post. Remember to eat a healthy diet, exercise, get plenty of sleep, and spend as much time with your happiness elements as possible.
Please send me a message if you have any topics you would like for me to cover in my blog.

Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Read Michael’s story here.
Feel free to send Michael a message using this link.

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Posted in NutraceuticalsTagged alzheimers disease, cancer, cucumin, curry, diabetes, osteoarthritis, turmeric, ulcerative colitis1 Comment

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