Remember this service is free so if you are wanting to throw away any medicines, do your bit for the environment and return them to us – keep our waterways clean J

I had a customer come in yesterday asking about CoQ10 – he had been recommended by a friend to help with muscle pains.

“I’ve been getting pains all over my body…it feels like it’s in my muscles – it’s really troubling me”.

I questioned him about any new medicines that he had started recently.

“My GP had given me something for my cholesterol last week…a statin I think it’s called.”

Ah-ha! I knew the reason immediately…

But before I finish my story, I thought I would share with you some interesting information. I had been thinking about supplements and how common they are today. A quick search brought up data from a 2012 National Health Interview Survey (NHIS) in alternative medicine supplement which showed that 17.7% of United States adults had used natural products in the previous year!

· Fish oil (7.8%) · Glucosamine or chondroitin (2.6%) · Probiotics or prebiotics (1.6%) · Melatonin (1.3%) · Coenzyme Q-10 (1.3%) · Echinacea (0.9%) · Cranberry (0.8%) · Garlic (0.8%) · Ginseng (0.7%) · Ginkgo biloba (0.7%)

Wow, that’s a large amount – and I think that the proportion has probably grown over the past 7 years since the survey was completed. This highlights the importance of getting sound advice when taking supplements. Would you throw $30, $50 or $100 a month down the drain? Then why would you spend on supplements that you might not necessarily take! It can lead to some expensive urine 😉 or even worse accumulate and cause problems if there was no deficiency.

That’s why I think your local pharmacist is so important to give you the right guidance on supplementation – or if you even need them at all. Your medicines can also frequently change – we have a record of what you’re taking to make sure there are no interactions or problems with the supplement.

So back to my patient with muscle pain: Statins (medicines used to treat high cholesterol) can reduce the production of CoQ10 (also known as ubiquinone) which assists in the production of energy within cells and can help protect cells. Organs with the greatest energy requirements such as the heart, lungs and liver have higher concentrations of CoQ10. Over half of CoQ10 is obtained through our diets – in the fat we consume. The remainder is synthesised by our bodies.

If we need to take statins they can sometimes cause muscle pain, although the exact reason for this is unclear. Studies have shown that this can occur in up to 25% of people. There are lots of conflicting research about this though. A small clinical trial in 2015 included 201 participants who had muscle pain with statins. Co-Q10 was given to half of them, however, it didn’t matter if they took the supplement or not – both groups reported the same amount of pain. The people in this group were only given low doses of the statin, other studies have shown with higher doses of statins, there may be an improvement in pain.

So what’s the bottom line here?

There are lots good dietary sources of CoQ10 including oily fish, offal (e.g. liver, kidney), nuts, soy, sesame and some vegetables (spinach, cauliflower and broccoli) that would be my first recommendation – make sure your diet is up to scratch. With that being said, there’s no evidence at the moment that CoQ10 is harmful – if you’re taking a statin (particularly if it’s a high dose – e.g atorvastatin 40mg or higher, simvastatin 80mg) and are experiencing muscle pain you could trial CoQ10 and see if it helps after about a month.

More research is definitely required to see for sure if CoQ10 helps for muscle pains. You may have also seen CoQ10 recommended for other conditions such as Parkinson’s disease and congestive heart failure – the same is also true – it is a matter of waiting for more trials to be completed and analysed to fully determine if there are any benefits.

If you think CoQ10 might be worthwhile trialling CoQ10, come in and have a chat with me or the team – there are differences in quality and strengths – we can help find the best one for you.

To you and your families health,

Chris

Pharmacist

The post Finding it a pain to take cholesterol medicines? appeared first on Eastmed Pharmacy.

Last week, we touched based on fish oil with a focus on the oxidation and freshness of them. It was astonishing to find out how many of you read it and based on the requests from some of you, I’ve decided to look at the evidence behind using fish oil this week and whether you can benefit from taking it. Because it seems like a common question, I’ve been getting from some of you in the past week.

Before we dig deeper, we need to know what we mean by “fish oil” and why it is so special. Well, first, fish oil consists of omega-3 fatty acids. The 2 primary omega-3 fatty acids that we will be talking throughout this email are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).

Fatty fish such as salmon, sardines and mackerel are packed with those omega-3s. Our body does not produce omega-3 fatty acids; hence the only way we could obtain it is through the food that we eat.

For people who dislike fish, DHA and EPA can be obtained from plant-based food that is rich in another type of omega-3 fatty acid, alpha-linolenic acid (ALA) because our body can theoretically convert ALA to DHA and EPA. An excellent example of these include flaxseeds, chia seeds, walnuts, pumpkin seeds and canola oil.

Some of you might ask me if our body can convert ALA into DHA and EPA, does that mean that I can obtain my omega-3s from purely plant-based products because I don’t like fish?

My answer to this question might not be as straight forward as it might seem. Although, our body can convert ALA into DHA and EPA, relying heavily on plant-based food rich in ALA has 2 problems:

1. Every omega-3 clinical study to date is conducted on DHA and EPA from either fish or fish oil. In other words, there isn’t any evidence suggesting ALA has the same benefits as EPA and DHA.
2. Although our body can convert ALA into EPA and DHA, the conversion rate is very low for it to be significant. Studies have shown that approximately 8% of dietary ALA is converted to EPA and only up to 4% is converted further to DHA.

Hence, I would say the answer is no. I believe oily fish or omega-3 supplements are still the best sources in delivering omega-3s.

Now, we all have an of understanding of what omega-3s are, let’s dig deeper and look at some of the evidence available out there regarding the beneficial effect of omega-3s.

Fish oil first captured the attention of scientists when research suggesting Scandinavians and Japanese had lower rates of heart disease. The scientists thought it had to do with their diet as they were the cultures that ate more fish than others. This eventually led to researchers wanting to know whether taking fish oil without eating fish might produce the same effect.

The clinical trials suggest mixed results. Some studies suggesting fish oil can help with heart problems while some didn’t prove the same results. 2 factors could contribute to these mixed findings:

1. A lot of people who are diagnosed with heart problems are already on multiple medications that are prescribed to treat or manage their conditions and hence may obscure the potential benefits of omega-3s supplements.
2. Many people these days are aware of the benefits of eating fish and are eating more today than they once did and hence could hinder the real effect of omega-3 supplements.

Although results are mostly varying between studies, the evidence for fish oil can still be found. In an observational study in someone who has already had a heart attack or at high risk of having one, a modest consumption (approximately 250mg/day EPA & DHA) of fish oil may reduce the risk of future heart attacks and death from sudden cardiac arrest.

For the prevention of death caused by a heart attack, the evidence suggests that some consumption of fish oil (approximately 250mg/day EPA & DHA) is better than none, but a higher consumption may not substantially reduce the risk further.

A similar study found that people with high cholesterol and is taking cholesterol-lowering medication, the odds of having heart attacks can be cut by taking a high dose of EPA only supplements.

Besides heart health, fish oil is also found to a slight benefit in relieving symptoms of rheumatoid arthritis by having an anti-inflammatory effect. The study also indicates that high doses of DHA in people who have a higher risk of getting Alzheimer’s disease may be beneficial.

Some of you might ask me if the evidence of the benefit of fish oil is there, then wouldn’t it be better than just eating fish?

Eating fish is a fantastic way of increasing your omega-3 intake. I usually strongly suggest my patients to try to consume omega-3 through their diet. According to the heart foundation, an adult should consume 2 to 3 servings of oily fish per week. Adults who eat less than the recommended weekly intake may consider taking a daily fish oil supplement (approximately 1g/day). When fish oil is used, it should contain both EPA and DHA. A 1g/day supplement usually contains between 200mg to 800mg of EPA &DHA.

It is crucial to bear in mind that even for people who eat seafood regularly, it can be challenging to get enough omega-3 from diet alone. Unless you are eating oily fish such as salmon, mackerel or sardines, seafood options such as prawns, mussels or cod contain almost no omega 3 fatty acids.

The bottom line is that if you’re already taking fish oil at a recommended dose, and you are benefiting from it, then there’s no research to suggest you should not to take it. But make sure you don’t overdo it. However, if you are not taking fish oil but are thinking of increasing your EPA and DHA intake, then I would strongly recommend trying it from your plate first.

Whatever you do, it is always a good idea to talk to your doctor or pharmacist before starting fish oil. This is because sometimes, fish oil may not be suitable in certain conditions or with certain medications.

To your health,

Chris

Pharmacist

The post Is fish oil supplement a waste of time? appeared first on Eastmed Pharmacy.

While my regular patient was waiting for her prescription, she asked me whether I have watched the most recent episode of “The Check-Up” from TV One.

Unfortunately, I haven’t been watching much TV in a long time. Life has taken its toll on me and I’m still trying to find the sweet spot between work and leisure. So I said to her that I hadn’t even heard of that show!

Anyway, she went on saying she will never take fish oil again after watching the show!

That got my curiosity going and I said to myself…Okay, now I’ve got an excuse to watch some TV tonight..yahooooo!!!

So, I went home immediately after work, took off my shoes, said hello to my wife and jumped straight in front of my computer. I went to the TVNZ on demand site to watch the recent episode of “The Check-Up”.

I fast-forwarded to the segment where it talked about omega 3 fish oil. The scientist on the show discussed how they have tested 36 products on the New Zealand market and 90% of them exceeded at least one of the limits of oxidation that they tested. Also, they found out that most of the products tested contained less than the amount of omega 3 specified on the label and only 3 products had as much as what it claimed to have or more.

Before I move on, we need to make sense of what fish oil oxidation is.

Have you ever come across that old bottle of fish oil capsules that was sitting in your cupboard for years and when you open the lid, there was this strong fishy smell? This is because the fish oil you’ve got is off! Normal fish oil should not have a fishy smell or taste to it. So, this led to the next questions why many fish oil products do not smell nice when they are off? Well, this comes from an element with which we are all quite familiar with: Oxygen.

Fish oil in its raw form is very sensitive to oxygen. If the fish oil is exposed to oxygen over a significant period, it will most likely undergo oxidation and turn rancid. After some research, I found out that when fish oil is wild-caught and harvested, it is usually transported to a factory to be refined and bottled. This process is usually short to prevent oxidation. Some manufacturers will also add antioxidants to prevent the fish oil from being oxidised.

Now going back to the show.

The findings were a huge shock to me. No wonder my patient said she will never take fish oil again! However, my curious mind didn’t stop here. I kept asking myself…” surely there’s more to this”. So, I started searching on the web trying to find out more about oxidation in fish oil and I came across a more recent study that tested 47 fish oil supplements purchased at retail in New Zealand. The study shows that 91% met the amount of DHA & EPA claimed on the label, according to strict Global Organization for EPA and DHA Omega-3s (GOED) standards, while most also met regulatory limits for oxidation.

The results are in stark contrast to findings from the scientist featured in the show, which was published in 2015, which claimed that only 9% of the fish oils in New Zealand market met label claims for EPA and DHA, and 17% were below the oxidation limits.

The author of the new study indicates a high level of confidence in the accuracy of the obtained test results because multiple accredited laboratories tested the samples were able to obtain similar results on oxidative status and omega-3 content.

The author of the new study also suggests that the replication study results show that fish oil supplements in the New Zealand market contain the correct content of EPA and DHA are not excessively oxidised. Hence, consumers can feel confident that fish oils they can purchase are quality products.

The purpose of me sharing my findings with all of you is not to undermine the “The Check-Up” programme. But, what I truly believe is that we should consider all the evidence available before we make our judgement or decision.

So if you ask me is it still worth taking omega fish oil. My answer would be …. Based on available evidence, fresh oily fish such as salmon, mackerel, and sardines are always the best sources of omega 3. According to the heart foundation, it is recommended to eat fish at least twice a week.

For people who are unable or dislike fish then taking omega 3 supplements seems to be a reasonable alternative. Some plants are rich in another type of omega 3 fatty acid, alpha-linolenic acid, which the body can convert to DHA and EPA. Good examples of these are flaxseeds, chia seeds, walnuts, pumpkin seeds, canola oil.

So, shall I ditch the fish oil I’ve got? I’ve had it in my cupboard for at least 6 months

I always ask my patients to do a “sniff test”. The most obvious sign that your fish oil supplement has gone off is when it starts to smell fishy (rancid). If you are still not sure, then another trick is to touch the bottle. Sticky residue is usually a sign of advanced rancidity and could indicate the contents inside are starting to turn on you. The last test you could do is pour out a little oil between your fingers and check for tackiness. If it feels sticky, toss it.

One trick to keep your fish oil supplements for longer is to keep them in the fridge after opening because cold temperature can slow down oxidation.

I hope you are not put off by fish oil. I do believe if it is used correctly, it can be beneficial.

To you and your family’s health

Chris

Pharmacist

The post Is My Fish Oil Supposed to Smell FISHY?? appeared first on Eastmed Pharmacy.