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Addressing drug-related nutritional deficiencies

BY Michael Johnsen

As more Americans are prescribed medicines to alleviate their chronic metabolic conditions, more Americans are exposed to common drug-induced nutrient depletions, noted pharmacist and supplement expert James LaValle, CEO of Integrative Health Resources.

Drugs can inhibit the absorption of a nutrient, LaValle noted. “It can change its metabolism, its synthesis, the way it’s transported, the way it’s excreted,” he said. Another compounding factor is that each patient is unique, he added. “The problem is issues [with prescribed medicines] don’t pop up in a linear fashion because people are complex.”

Another problem contributing to nutrient depletion is the adoption of new drug therapies as patients age because they never adequately addressed the underlying cause of their chronic condition through better health choices, meaning diet and exercise. Lavalle uses the example of “Patient Joe” to illustrate the impact the layering on of additional drug therapies can have on the patient’s total health over the course of adulthood. “Patient Joe” might start out on a statin, a proton-pump inhibitor and ace inhibitor at age 35, but if he doesn’t lose weight, quit smoking and exercise more, then he may pick up prescriptions for metformin for diabetes and/or an NSAID for osteoarthritis in five to 10 years, or a calcium channel blocker for blood pressure and/or a beta blocker for arrhythmia in another five years beyond that.

So given the complexity of the patient, the objective at any health consultation touchpoint is to evaluate what medicines a particular person is taking and the nutrients that are depleted by them. “The reality is this — people are put on medications every day,” LaValle said, and unless they present with something like a physically-evident allergic reaction “we assume that when somebody goes on a medication that it’s OK. That they’re doing fine on that medication. No big adverse event happened,” he said.

It’s important to know which medicines deplete which nutrients.
“A statin depletes Co Q-10, but it also depletes [vitamin] C, selenium and omega-3 fatty acids,” he said. “Proton-pump inhibitors we know deplete vitamin D and calcium; it’s a warning [on the drug facts label],” LaValle said. PPIs cause bone loss. “Two-in-10 cases of osteoporosis are now men. Now we’re putting men in their 30s on drugs like PPIs, and we’re keeping them on them for decades,” he noted. “Are we screening our men at 45 years when they’ve been on PPI therapy for 10 years?”

Many prescription medicines include information regarding increased risk for other disease states, such as diabetes or cardiovascular disease, LaValle said. “What they don’t tell you is ‘why?’ A lot of it is nutrient-related.”

Nutrient depletion can exacerbate underlying conditions. For example, men on statins are two times more likely to have low testosterone, LaValle noted. “Low testosterone is now a big risk factor for men as it relates to their cardiovascular risk,” he said. “So if I take their cholesterol down, but I take their testosterone [down too], that’s a big problem.”

To make testosterone, men need magnesium and zinc. To help control high blood pressure — another factor that can lead to increased cardiovascular risk — physicians may prescribe a thiazide, which depletes magnesium and zinc. So prescriptions for a statin and thiazide can lead to increased cardiovascular risk due to underlying nutrient depletions, LaValle noted.

Patients on these nutrient-depleted therapies may need to supplement with the depleted nutrients — it may not be good enough to improve diet and increase exercise, LaValle suggested. “The issue is we’re not realizing that all of the trace minerals and nutrients that people aren’t getting in their diet are what are regulating our genomic expression,” he said. “It’s not just eating right and exercise. It’s about understanding these complications when people are on medications, understanding that they’re individuals and they need individual evaluation,” LaValle noted.

“I’m passionate about the patients [with whom] I come in contact,” LaValle added. “I want to make a difference in their life and I’m going to do anything I can to convince them … into feeling a little bit better,” he said. “If you have patients who are in a polypharmacy event with multiple nutrients that have been depleted over a long period of time” then take care of them, LaValle said.

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CDC reports strong flu season

BY Michael Johnsen

The Centers for Disease Control and Prevention in early January reported a slight drop in influenza-like illnesses across the country, but even so the season was still going strong. The proportion of outpatient visits for influenza-like illness for the week ended Jan. 19 was 4.3%, above the national baseline of 2.2%.

“About halfway through [the flu season], it’s shaping up to be a worse than average season, and a bad season particularly for the elderly,” noted Tom Frieden, director of the Centers for Disease Control and Prevention during a Jan. 18 press conference. “Seasonal influenza always takes the heaviest toll on seniors when it comes to deaths, particularly during seasons when H3N2 is the predominant strain — as it is this year,” he said. “In general, we estimate that about 90% of flu-related deaths are in people 65 years and older.”

The predominant strains this year do not appear resistant to antiviral treatments. “For high-risk patients antiviral treatment really can mean the difference between a milder illness and a stay in the hospital or in the intensive care unit, or even death,” Frieden said. “The drugs clearly work much better if they’re started soon after onset of illness in the first 48 hours.”

“I also want to assure patients that Tamiflu (oseltamivir) 30-mg and 40-mg capsules remain available, and pediatric patients 1 year of age and older can be dosed correctly using the 30-mg and 40-mg capsules,” noted Food and Drug Administration commissioner Margaret Hamburg, addressing reports of shortages of pediatric antiviral medicines. “Tamiflu 75-mg capsules are currently available, but supplies may run low if many pharmacies have to use the capsules to prepare an oral suspension for pediatric patients or to fill large numbers of prescriptions for adult patients. So to help avoid a shortage, the FDA is now allowing Genentech to distribute 2 million units of Tamiflu at the 75-mg capsule level that have an older version of the package insert. … It’s important to note that this medicine is fully approved. It is not outdated.”

The high incidence of flu has prompted a run on available immunizations. According to Frieden, flu shot manufacturers had allotted for distribution of up to 145 million doses this season. As of Jan. 18, 129 million of those doses had been distributed, meaning some 14 million vaccinations had yet to be ordered.

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SCIO, Walgreens partnership makes ROI picture even clearer for big employers

BY Antoinette Alexander

SCIO Health Analytics and Walgreens have teamed up to help employers gain maximum return on investment through worksite health centers. Through the partnership, SCIO will provide actionable data and reporting to demonstrate the value and impact of worksite health centers, while giving Walgreens’ clients areas of opportunity to further improve employee health and reduce costs.

More and more, companies like BMW and United Airlines get it, and there is growing belief that as the clock ticks down to 2014 and full implementation of the Patient Protection and Affordable Care Act, even more employers will get it. In the meantime, projects like this that help provide outcome reporting will help make the ROI picture even clearer for big employers who still might be on the fence.

Those Take Care worksite clinic patients are part of the Walgreens universe — where is your brand’s messaging in the minds of those patients?

Expect a lot of growth in worksite clinics in the years to come.

In fact, Tower Watson’s 2012 survey of employers that have established or are planning to establish onsite health centers found that, overall, both employers and employees throughout the organization continue to view centers positively.

The survey also found that most companies establish an onsite health center to enhance worker productivity (62%). And most employers (62%) said a key reason they keep their centers open is improved employee productivity that comes from eliminating visits to offsite medical providers. Another important reason for establishing a center, according to the survey, is cost reduction, including lower cost per service performed, improved health outcomes, reversal of health risk, and fewer ER visits and hospitalizations.

The online survey, which took place from May 3 to May 25, had 74 respondents representing 1.7 million employees and operating in a variety of industry sectors.

 

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M.Atherton says:
Jun-24-2013 10:11 am

SCIO Health Analytics and Walgreens have teamed up to help employers gain maximum return on investments through work site health centers. Both of them helping the employees in the areas like: Health Insurance in low costs. Companies like: BMW and United Airlines supporting them in these innovative works. BMW service and repair in Thousand Oaks

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