Red Yeast Rice to treat high cholesterol?

From Geriatric Pharmacy Intern Yariagna Rollan Pharm.D(c)
University of Florida College of Pharmacy

Statins (3-hydroxy-3-methylglutaryl coenzyme A or HMG-
CoA reductase inhibitors) are the most effective medications to lower low-density lipoprotein (LDL) cholesterol or bad cholesterol and the risk of cardiovascular events. Although generally well tolerated, many patients taking statins may experience adverse effects including statin-associated myopathy and rhabdomyolysis, elevated liver enzyme levels, and gastrointestinal symptoms. In older adults there is a higher risk of cardiovascular events due to accumulated coronary atherosclerosis and also an increased risk for severe myopathy not only from statins but from fibrates as well.

Statin-associated rhabdomyolysis is a rare, life-threatening condition, with a rapid breakdown of skeletal muscle that leads to the release of muscle fiber contents (myoglobin) into the bloodstream causing weakness and diffuse muscle pain. Myoglobin is a protein that is harmful to the kidneys and may result in Acute Kidney Failure. Rhabdomyolysis is dose related and there is no alternative treatment for patients who still require management for hyperlipidemia.
In some cases is possible to reduce the dose of the statin or completely discontinue the medication. However, each patient needs to be treated as an individual, considering the necessary goals in order to continue to reduce the risk of cardiovascular events.

Red yeast rice is the fermented product of the yeast species Monascus purpureus that grows on rice. It could be used as an alternative treatment for patients with statin associated myopathy. It is a readily available dietary supplement that has been used for centuries in China and helps decrease LDL cholesterol levels. Red yeast rice contains monacolin K, a strong HMG-CoA reductase inhibitor. Recent studies have reviewed the effectiveness, safety, and tolerability of red yeast rice in patients with ages ranging from 21 to 80 years of age and with a history of myopathy related to the use of statins.

The studies have shown reductions of approximately 18% of total cholesterol, 22% of LDL cholesterol, and 7% reduction of serum triglyceride levels. No significant effect was seen on high-density lipoprotein (HDL) cholesterol levels or good cholesterol. Most importantly there was no significant difference found between the red yeast rice and placebo groups in adverse events and muscle pain. Further studies are required in order to recommend this treatment as an alternative. There are still concerns with toxicity and the ability of red yeast rice to lower cardiovascular related events effectively. Consult your pharmacist before starting any supplement.

Obesity and Risk for Heart Disease

From Geriatrics Student Dana Ross Pharm.D.(c)
Palm Beach Atlantic University School of Pharmacy

Researchers found that obese patients were two times more likely to develop heart disease and related conditions than their normal-weight counterparts. Researchers looked at patients for 5 years in the United States in office visits. They monitored disease progression and onset of obese patients versus normal weight individuals by chart reviews for certain disease states. These disease states included diabetes, hypertension, and dyslipidemia.

The study looked at patients BMI (Body Mass Index) to classify their weight category.
Investigators claim to have confirmed a correlation between obesity and heart disease related diseases. They found patients with obesity to be at greater than double the risk for developing chronic disease states, specifically relating to coronary, or heart conditions and health.

These findings are important for the medical community because obesity is such a growing health problem in the United States, the Centers for Disease Control says obesity is found in greater than 33% of American adults! This will open the publics eyes about obesity and its health risks and hopefully spark some changes.

Fish Oil Supplement Safe to Use with Other Antiplatelets?

From Geriatric Pharmacy Intern Phuong Pham, PharmD(c)
University of Florida College of Pharmacy

Patients with cardiovascular disease typically are prescribed an anti-platelet drug, called Plavix, in combination with aspirin, to prevent the formation of blood clots. However, several studies have shown a small increase in the risk for major and minor bleeding when this combination is used. Omega-3 fatty acid, or fish oil, have been popular among consumers as a dietary supplement to lower triglycerides and as a secondary prevention of heart disease. It also has an anti-platelet property, similar to Plavix and aspirin, which raises concern about the increase risk of bleeding. In a study done by Pauline D. Watson and her colleagues at Drexel University College of Medicine in Philadelphia, they set out to study the effects of taking high-dose fish oil, Plavix, and aspirin to see if the addition of fish oil further contributes to an increase risk of bleeding when taken with the other two antiplatelets. They reviewed the medical records of 182 patients, most with coronary artery disease, being treated with high-dose fish oil (mean dose 3 g), aspirin (mean dose 161 mg), and Plavix (mean dose 75 mg), and 182 patients of similar age and gender being treated with aspirin and Plavix alone. During an average follow-up of 33 months, the researchers found one major bleeding episode in the fish oil group, no major bleeding in the control group, four minor bleeding episodes in the fish oil group, and seven minor bleedings in the control group. However, the results were not significantly different between the fish oil and control group. The authors concluded that high-dose fish oil is safe in combination with aspirin and Plavix and does not increase the risk of bleeding compared with that seen with aspirin and Plavix alone.

Tai Chi Can Reduce Osteoarthritis Pain in the Elderly

From Geriatric Pharmacy Intern, Wendy Fisher, PharmD (c)
Nova Southeastern University College of Pharmacy

Tai Chi (pronounced “tie chee”) is an old Chinese practice of martial arts designed to exercise the mind and body. It combines mental concentration with slow, rhythmic movements to challenge the body and focus the mind. Tai Chi helps to stimulate mental relaxation and improves balance, strength and flexibility. Almost anyone can do Tai Chi, even people with conditions that may exclude them from other forms of exercise.
Knee Osteoarthritis (OA) is a common form of arthritis that causes deterioration of joint cartilage. This results in pain, limitations of function and reduced quality of life. The elderly population is at the greatest risk for developing this type of arthritis.
According to researchers, patients over the age of 65 with knee osteoarthritis who engage in Tai Chi exercise improve physical function and experience less pain. "Tai Chi is a mind-body approach that appears to be an applicable treatment for older adults with knee OA," said Dr. Chenchen Wang, M.D., M.Sc. of Tufts University School of Medicine. Researchers have observed an improvement in physical function, depression, health status and a decrease in pain in knee osteoarthritis patients after doing Tai Chi for 12 weeks.
The current exercise recommendations for OA are identical to the physical components of Tai Chi. This seems like a feasible therapy to help ease the horrible pain from OA and it is fun and relaxing. I actually did Tai Chi in China and it felt amazing. J As always, please speak with your Doctor before starting any new exercise programs.

Other Cognitive Abilities Declining in Alzheimer's Disease

From Geriatric Pharmacy Intern, Phuong Pham, PharmD(c)
University of Florida College of Pharmacy

Researchers have been trying to identify the signs and symptoms that can lead to the diagnosis of Alzheimer's disease as early as possible. Alzheimer's disease has been commonly linked to a loss of episodic memory, in which a person fails to remember a past event that has occurred in his or her life. However, according to a study done, they found that other cognitive abilities, besides memory, may start to decline years before the diagnosis of Alzheimer is made. The study had enrolled 444 individuals without dementia between 1979 and 2006. These individuals had a clinical evaluation and a psychometric assessment done, including four cognitive factors: global cognition, verbal memory, visuospatial skill, and working memory. Visuospatial skill means the ability to process and interpret the relationship between objects and their location in space. After an average follow-up of 5.9 years, they found that 134 individuals had developed dementia and 44 with dementia died with a confirmed diagnosis of Alzheimer’s disease. When the researchers graphed the data from the psychometric assessments, they found that there was a sudden and steeper decline in the slope of the visuospatial skills three years before patients with dementia were diagnosed. The global cognition graph showed a steep decline two years before clinical diagnosis of dementia, while verbal and working memory did not show until one year before. The authors concluded, "Some of the earliest signs of preclinical disease may occur on tests of visuospatial and speeded psychomotor skills. Furthermore, the greatest rate of preclinical decline may occur on executive and attention tasks. These findings suggest that research into early detection of cognitive disorders using only episodic memory tasks, such as word lists or paragraph recall, may not be sensitive to either all of the earliest manifestations of disease or the most rapidly changing domain."

Top 10 exercises for weight control

1. Walking
2. Crunches/sit-ups
3. Jogging
4. biking
5. Swimming
6. Resistance training
7. Dancing
8. Aerobic exercise
9. Yoga
10. Hiking
    

My first 5K road race in two years

Sunday morning, the day after Halloween, I awoke at 4am to drive up to Boca Raton for the Citibank 5K- in conjunction with the PBA Half-Marathon. since the start time was 6:30 am, I needed to be up early. As you know, Sunday began Eastern Standard Time, so I set my alarm an hour early, just in case the clock wasn't smart enough to change on it's own. My wife's alarm clock changed last week- it's a little older and has the old dates built in.

So, what about the race? I arrived in Boca on time. But I was so worried about being there at the right time, I forgot to wear my watch. More about that in a bit.

It's great to run a road race. On most days, I run in my neighborhood, and many days in the dark, before sunrise. I only pass by a few people on my route- doing my best to avoid cranky dogs! But at a road race, there are hundreds of people all out there to run the same route with you. It's encouraging to see all these people. There are even children that run with their parents!

Back to my watch. When I train, I wear my watch and my iPod. I know how I'm doing by how my split times are at 1/2-mile, 1 mile, 2 miles, etc. Sunday I didn't have either with me. I pace myself with some folks that ran slower than my normal pace, but I didn't know it until I heard my 3 mile time. That's when I sprinted to the finish. Since Sunday, I've sliced over 2 minutes off my best time. It pays to keep track of your progress. Something I always stress in my Health & Wellness Coaching

My next race will be the Turkey Trot 5K at Tropical Park in Miami. I can bet I'll wear my watch!

Why should I care about dietary fiber?

My coaching clients often ask me this question during sessions. "'Cause it keeps ya regular," your grandpa may have told you. There are many more reasons to get enough fiber in your diet, but I'll get into that in a minute. First, let's talk about what dietary fiber is and how it works.

So, what is dietary fiber?

Dietary fiber is all the plant material your body cannot absorb or digest. Also known as bulk fiber or roughage, fiber passes through your body, basically unchanged. Although counted as a carbohydrate, it does not really contribute to your calorie count, since the intake equals the output.

There's SOLUBLE fiber and there's INSOLUBLE fiber.

• Soluble fiber becomes a gel-like substance in water. Foods higher in soluble fiber include peas, apples, citrus fruits, oatmeal, beans, carrots, oats and psyllium.
• Insoluble fiber, as the name implies, is not soluble and includes wheat bran, nuts, whole-wheat flour and several vegetables.

So, what's the difference?

• Soluble fiber helps lower cholesterol and control blood sugar levels
• Insoluble fiber helps keep bowel function, well, functioning optimally. It also helps with watery or loose stools by absorbing water.

In general, dietary fiber is also an excellent part of any weight loss strategy. In fact, Weight Watchers considers fiber in the calculation of all food point values in their Momentum program. Foods high in fiber are "filling," allowing you to feel fuller longer and less likely to snack on foods high in sugar, fat or salt.

How much do you need?

The latest recommendations for women are 25 grams per day if 50 or younger and 21 grams per day for women over 50. For men, it's 38 grams if under 50 and 30 grams if over 50. Sadly, few Americans even come close and may explain why two-thirds of the population is overweight or obese.

One final word of caution: When increasing the amount of fiber in your diet, do it gradually. Too big of a change may cause flatulence and abdominal discomfort, which may lead to giving up prematurely on a fiber-rich diet. Start low, go slow, but GO!

SMART Goals in Health & Wellness

All of us have set goals for ourselves at some point. Those who are most successful at achieving their goals utilize SMART goals. The acronym "SMART" is broken down this way:

• S is for SPECIFIC. If you have a certain amount of pounds to lose- name it. Instead of saying "I want to lose weight," a specific goal is a goal of losing 10 lbs., etc.
• M is for MEASURABLE. If your goal is weight loss, use a scale to measure your progress. A fitness goal might be running 1 mile in under 10 minutes.
  
• A is for ATTAINABLE. Is running a 4-minute mile possible for you?
  
• R is for REALISTIC. Be realistic about the goals you set. Getting down to your high school weight after having 3 children may not be realistic. Set a goal that you can not only attain, but is in reason for you. You know yourself best.
  
• T is for TIME-BOUND. Give your goal a deadline. A dream is merely a goal without a deadline. Spending 45 minutes working out 4-5 times a week is timely.

Finally, I recommend stating your written goals a certain way, which gives them even greater power. Notice I said "written." State your SMART goal in the 1st person, present tense and in the affirmative. For example: "I exercise 45 minutes per day, 4 times per week." Write the goals so it stretches you a little but doesn't snap you. Stating your goals in this manner gives them much greater power- so much that your brain takes them as commands!

Let me know how this works for you.

Avoiding Emotional Eating

Wow! What a week it's been. Four screws in three different tires of our two family cars, including one flat. A fender-bender with my wife's car (not her fault!) Medicare-Medicaid re-certification inspection at one of the nursing homes I consult. Company last weekend. A two year old with endless energy and curiosity.

All of this can lead a man (or woman) to hit the Checker's Drive Thru pretty hard. And I've done that countless times in the past. The short-term satisfaction of a creamy shake, greasy fries and mouth-watering burger soon lead to indigestion, a little (or a lot) guilt and added pounds.

Being more mindful of my feelings and emotions helps me to nearly eliminate these fast food runs and stay aligned with my health, wellness and fitness goals. One of my best strategies is to always carry portable, healthy snacks- sort of like a survival kit. Having these treats available at arms-reach buys me enough time to think twice about the consequences of making a very poor food choice. Try it on for yourself!

Consuming Fiber from Whole Grains May Reduce More Fat

From Pharmacy Intern, Lynda Pardo, Pharm.D.(c)
Palm Beach Atlantic University, Lloyd L. Gregory School of Pharmacy

In an observational study conducted by Tufts University researchers published in the October issue of Journal of Nutrition, it was discovered that subjects who had a higher intake of whole grain fiber, as opposed to fiber found in fruit and vegetables, had a lower overall percentage of body fat. The subjects included in the study where mainly women and men who were an average of 70 years old and whose dietary habits were closely observed and measured. The participants' fat was measured both in the abdominal area and total body to determine if the consumption of whole grains and fiber made a difference in where more fat loss tended to occur. The investigators separated the subjects according to how much grain and fiber, in grams, was consumed daily and they were also monitored for other possible confounding variables such as exercise, gender, alcohol intake, and smoking habits.
Even though most of the fiber intake came from breads and cereals, participants still did not meet the USDA's daily requirement of fiber and whole grain servings which is at least 21-30 grams of fiber and greater than or equal to three servings of whole grains. But regardless of these findings, researchers discovered that although their intake of these foods was low, subjects who ate a greater quantity of whole grains as opposed to fiber from fruits and vegetables had a lower percentage of both abdominal fat and total body fat. This occurred even in men and women who tended to be older and heavier.
Despite the positive outcomes of this trial investigators concluded that more studies like this one are required to accurately agree on which fiber containing foods reduce the most fat and from what part of the body.

Losing Weight to Maintain Kidney Function in Overweight Patients

from Pharmacy Intern Lynda Pardo, Pharm.D.(c)
Palm Beach Atlantic University, Lloyd L. Gregory School of Pharmacy


In a study conducted through a meta-analysis and systematic review published in the Clinical Journal of the American Society of Nephrology, it was found that patients who were overweight or obese and lost weight using either surgical or non-surgical procedures decreased the decline of the functions of their kidneys. The subjects under investigation were patients who had mild to moderate CKD (Chronic Kidney Disease), not dependent upon dialysis, and the filtration rate of their kidneys was higher than normal.
The researchers found that overweight patients with declining kidney function who lost weight utilizing non-surgical procedures where able to bring down their BMI (body-mass index), protein in their urine, blood pressure, and halt the decline of their glomerular filtration rate. Long-standing hypertension (high blood pressure), proteinuria, and a disfunctioning filtration system can potentially lead to end-stage renal failure if not controlled properly and promptly.
For obese patients in whom surgical procedures where used to assist in their weight loss and who suffered from overfiltration by the kidneys, these patients also had a decline in their BMI, blood pressure, protein in the urine, and the glomerular filtration rate.
Although researchers discovered some further benefits of losing weight as it relates to improvement of renal function, they feel that long-term, as opposed to their short term studies are needed to evaluate the results of possible progression to end-stage renal disease.
This study was also able to show that decreasing variables such as blood pressure and microalbuminuria can not only prevent cardiovascular diseases but also renal diseases as well.

My own lifestyle changes lead to new service offerings

Welcome. I’m Brian Wolstenholme and I’d like to share part of my life with you.

I’ve developed an absolute passion about helping people make enduring lifestyle changes because, from several areas of my own life, I know how difficult and important change can be. In fact, as a Consultant Pharmacist, my primary work is to help people improve their lives.

My personal lifestyle challenge has been in the area of weight. Each time I attempted to change, I tackled it wholeheartedly. I tried controlling portions, I tried Weight Watchers, I tried exercising more, and I even tried a few fad diets. They all worked—temporarily. I found out that, for me, something was missing in each program I tried. What I discovered missing was a close personal relationship with a person who would coach me through my difficulties to achieve my ultimate goal.

As a Board Certified Geriatric Pharmacist I know better than most what havoc poor lifestyle choices can wreak on the human body by the time the body reaches old age. I also knew if I didn’t make a permanent change in my weight, I was easily cutting ten years off my life. Not to mention that it was getting difficult to play with my child.

So the last time I resolved to lose weight, I took stock of everything I’d tried before. After some thought it became clear that the three times in my life I had successfully lost weight and maintained the weight loss, I was coached—first by my high school football coach and later by my Army Drill Sergeant. Later in life I was informally coached by a fellow pharmacist. It was while reviewing the weight lost achieved with my co-worker that I realized coaching was such an integral part of making permanent lifestyle changes.

I did some research. Being a pharmacist I was drawn to what the medical profession had to recommend. I found that the American College of Sports Medicine endorses wellcoaches©.

I signed up. I started losing weight. My coach helped me to achieve realistic goals in health, fitness, and wellness.

I became so enthusiastic I took their training to become a certified health and wellness coach—which led to the expansion of Medisort’s service offerings.

As I said, my passion is helping people. For years I’ve been reviewing patients’ medications and recommending potentially life-saving changes. (See our companion website and my credentials at www.Medisort.net.) Once I realized how powerful a coach was in creating permanent lifestyle changes I had to become one to share with others the way to improve their lifestyle and life span.

If you choose me to be your coach, I pledge to you I will be nonjudgmental while giving you guidance and support which will enable you to achieve your goals. I will be much more than a cheerleader; I will be your advocate.

Introducing MediSort Health and Wellness Services

Are past lifestyle choices causing you problems in your life today? Are you overweight? Do you have one or more chronic medical conditions? Has your doctor said you must:

· Lose or gain weight

· Reduce stress

· Exercise more

· Quit smoking

· Stop drinking

· Take your medication properly

So, you make up your mind: I will change.

A few people will, all by themselves. Scientific studies have proven, time and time again, that one out of ten people can change their behavior and lifestyle on their own. That means that nine out of ten people will not be able to change permanently.

Bad news, isn’t it? People do make changes, especially after their body drives the doctor’s point home by means of a heart attack, stroke, diabetes, or some other debilitating disease. People make changes for a few weeks, months, or even a year or two. Then people gradually revert to their old lifestyle.

However, the good news is scientific studies have also shown that working with a coach greatly increases the probability of your making permanent behavioral and lifestyle changes. I, personally, can attest to the fact that having a coach makes a tremendous difference in making a permanent lifestyle change.

Is it possible to greatly improve your quality of life and add at least a decade to your life span? Is it possible to have more energy to do the things you want? The answer is a resounding “Yes.”

For those of you with a chronic health condition, additional questions may be: Is it possible to stop taking so much medicine? Can I really improve to the point of feeling better and doing more? “Probably” is the answer to the first question and “yes” the answer to the second.

The vital point is take action now.

When you read my story (my next post), you’ll understand why I am so personally invested in advocating a coach. Over my life span I’ve tried a number of different venues to change and having a coach is the one that worked. You’ll also understand why my professional credentials make me uniquely qualified to help you develop the lifestyle you’ve always wanted.