Tuesday, August 28, 2012

Avoid Fluoride Toothpaste and Fluoride-Based Dental Rinses

Dear Readers,

Fluoride has been found in toothpastes since the 1890's and in our water systems since the 1940's.  Despite what we were told about using fluoride toothpaste, dental rinses and fluorinated water etc. with respect to preventing tooth decay, it appears its efficacy is limited and its risks outweigh any potential benefits.  Furthermore, evidence shows that fluoride (if excessively ingested during childhood) can actually damage the enamel of tooth resulting in tooth staining known as dental fluorosis .

Evidence Rejecting the Safety and Efficacy of Fluoride:
  • Fluoride ingestion has been implicated in causing many health-related problems (i.e. thyroid disease, cancers (especially bone cancers in young men), reduced thyroid function, reduced IQ, increased risk for bone fractures, immune deficiencies, arthritis, possibly even atherosclerosis (hardening of the arteries) etc.).  
  • In 1990 forty US dentists brought a case against the American Dental Association contending that the Association purposefully shielded the public from data that links fluoride to genetic defects, cancer and other health problems (Columbus Dispatch, Oct 21, 1990). 
  • Since 1990 over 45 U.S. cities have rejected fluoridation. 
  • Europe has largely rejected fluorination of water since about 98% of Europe’s drinking water is now fluoride free.
  • In 1987 the National Institute of Dental Health did a large study involving over 39,000 school children and found the incidence of cavities in communities that used fluoridated water vs. those that did not use fluoridated water was not significantly different.  (Dr J. Yiamouyiannus Water Fluoridation & Tooth Decay Study, Fluoride 23 : pp 55-67, 1990.).
  • National Cancer Institute did a study and found that as exposure to fluoride increases, so does the incidence of oral cancer; sometimes by as much as 50%.
  • Fluoride in water supplies up to 1 ppm were associated with an increase incidence of hip fractures in women. The study concluded that fluoride may accumulate in the body (reaching toxic levels with age) ultimately increasing the risk for bone fractures. (Danielson, C., et al, "Hip Fractures and Fluoridation in Utah's Elderly Population", Journal of the American Medical Association, Vol 286, No.6, August 1992, pp.746-748)
  • The lethal dose of fluoride is about 5 mg fluoride for every 2.2 lbs. (1 kilogram) of body weight.  However, it is important to note that only one tube of toothpaste if swallowed there is enough fluoride to kill a 60-pound (30-kilogram) child. 
  • Even the National Research Council (NRC) which is the nations primary scientific advisory body states that fluoride has essentially no benefits after age 8 when teeth are fully developed.
  • A review of 11 studies involving more than 7,000 children showed that the effect of fluoride supplements on primary teeth could not be determined. One study even showed that fluoride had no cavity-reducing effect.
  • Unless you are considered by your dentist to be "high risk" for developing cavities, use fluoride-free toothpastes like (Tom's of Maine, Theodent etc.) or brush your teeth using baking soda  
  • If you continue to use a fluoride based toothpaste, use only a very small amount (pea-sized) and rinse out your mouth out not swallow !!!  
  • Avoid using fluoride-based dental is a fluoride-free version for your review .

Informational Videos Regarding the Dangers of Fluoride 

Dr. Osmunson on Fluoride (Very informational discussion)

Fluoride: The Hard to Swallow Truth Documentary 
(An excellent documentary)

Theodent "Chocolate" Toothpaste

Learn More About Safe & Effective Drug-Free Therapies

From Targeted Medical Pharma  

Read our Open Letter and Primer 

Sources for this post include:

Friday, August 10, 2012

Hydrogen Peroxide to Fight Colds and Flu

Dear Readers,

During my literature review, I only found a few articles that support the claim for using hydrogen peroxide as a treatment for the cold or flu.  However, I thought I would mention this treatment to you since I have successfully used this treatment for years.  Note: I usually do not see a complete resolution of my symptoms, but there is significant improvement.  I do think this therapy is definitely worth trying since it appears to be effective, safe and inexpensive !!!  

What evidence supports using hydrogen peroxide in the ear for the cold or flu ?
  • According to a Richard Simmons, M.D. in 1928, he stated that in fact cold and flu viruses could enter our body through the ear canal. (Note: Traditionally, we think of viruses initially entering our system only through our nose, throat or lungs where they multiply and eventually cause a systemic infection.)
  • Bacteria and viruses can multiply in the ear (even on headsets which can contaminate the ears). 
  • Apparently, German physicians often treated cold/flu symptoms successfully using this technique for years in the 1930's. 
  • Hydrogen peroxide does have a wide spectrum of antibacterial and viral activity, thus it can kill the common cold and flu viruses upon contact.
What is the procedure ?

  • Thoroughly wash your hands first.
  • Using a dropper, place one or two drops of hydrogen peroxide into one ear. Wait a few minutes at which time the bubbling sound will stop or diminish, drain and repeat with the other ear.  
  • Personally, what I do is get a small piece of a cotton ball and saturate it with hydrogen peroxide then place the small piece of saturated cotton ball in my ear and wait until the bubbling noise is gone (usually about 3-5 minutes).  Then I get a Q-tip or cotton swab and clean-out and dry-out the ear.  Then, I repeat with the other ear.
  • The important thing to remember is that you utilize this method early-on when cold or flu symptoms first appear for maximal benefit.
  • You may need to repeat this process several times a day for the first couple of days.  
  • One thing to point out is that I noticed the bubbling noise is usually only found in the infected ear(s) and when the therapy is completed the bubbling noise no longer exists.
  • Do not try this method if you have a perforated ear drum.

Informational Video by Dr. Mercola that gives some great advice how to treat flu or colds and mentions the hydrogen peroxide ear treatment. 

Learn More About Safe & Effective Drug-Free Therapies

From Targeted Medical Pharma   

Read our Open Letter and Primer 

Sources for this post include:

Tuesday, August 7, 2012

OTC Medication Safety with the Elderly

General Information Regarding Medications In The Elderly

  • The term "elderly" is defined as any person age 65 or older. Some studies show that elderly are 2-4 times more likely to have adverse drug reactions as compared to non-elderly. In addition, some reports estimate that up to 30-50 percent of all hospital admissions involving the elderly are due to some sort of drug-related problem (especially if they are in poor health and are taking multiple medications).
  • As we get older, our body composition changes(less body water, less body weight, more body fat, fewer protein stores, etc.) which can in effect increase the amount of drug exposure per body weight. 
  • In addition, the elderly also have less ability to clear drugs via the liver and the kidneys which may lead to drug accumulation.
  • Elderly also have less ability to compensate or tolerate drug side effects as compared to non-elderly. 
  • As we age, levels of a chemical messenger or neurotransmitter known as "Acetlycholine" in our nerve cells which is responsible for memory, learning and concentration, in addition to, supporting the function of the heart, blood vessels, airways, and urinary and digestive organs reduces as we age. Thus, medications that alter acetylcholine levels in any way often can have a profound effect on the function of brain and other organs.
  • Furthermore, the elderly often suffer from several chronic disease states and take multiple prescription medications which can increase the risk for adverse side effects and drug interactions(especially with OTC drugs). Thus, all these factors mentioned above may contribute to causing adverse drug events in the elderly.

Which OTC Medications Do I Need To Be Especially Cautious With In The Elderly And Why ?
  • First Generation antihistamines and OTC Sleep aids(i.e. diphenhydramine(Benadryl), chlorpheniramine (Chlortimeton, Allerest), clemastine fumarate (Tavist), dimenhydrinate (Dimenhydrinate), brompheniramine(Dimetapp) and doxylamine(Nyquil, Alka-Seltzer Plus Night-Time Cold Medicine)....commonly used as a OTC sleeping aid .

First generation antihistamines cause a marked reduction in levels of a chemical messenger (neurotransmitter) found in nerve cells called acetylcholine.  Side effects are often referred to as "anti-cholinergic side effects".  Common anticholinergic side effects include: confusion, dry mouth, constipation, urinary retention, cognitive impairment, blurred vision and delirium. Also, these drugs can increase the risk for "falls" in the elderly. Note: Antihistamines may accumulate in the elderly due to reduced body clearance which may cause more pronounced "anticholinergic side effects"compared to non-elderly. Recommend using second generation "non-sedating" antihistamines particularly cetirazine(Zyrtec), fexofenadine(Allegra) or desloratadine (Aerius) instead.  Note: Although, loratadine(Claritin) is also a second generation antihistamine it has been reported to also worsen delirium, confusion, urinary retention and constipation in the elderly (especially in people who already experience delirium, confusion and urinary retention). I will talk about natural alternatives in a future blog (i.e Quercetin).

  • H2 Blockers (famotidine (Pepcid AC), cimetidine (Tagamet HR), nizatadine (Axid AR), ranitidine (Zantac 75). 

Though, these agents have relatively weak anti-cholinergic activity, it seems that cognitive impairment is enhanced in the elderly possibly due to drug accumulation, increased drug sensitivity or lack of B12 absorption in the elderly (especially if they have existing cognitive impairment and use the drug long-term).  Thus, caution should be placed if you intend to use H2 Blockers to treat heartburn or upset stomach in the elderly long-term.  Recommend using oral antacids to temporarily treat symptoms instead (i.e. Gaviscon (contains alignate, aluminum and in some formulas magnesium, Tums etc.) Try to implement lifestyle (i.e. lose weight if needed, exercise, reduce stress, stop smoking) and dietary changes (eat smaller meals, avoid trigger foods, avoid alcohol etc.) Would not recommend using antacids that contain sodium bicarbonate (i.e. Alka Seltzer) since it may further elevate blood pressure in patients with existing hypertension.  Also, would not recommend long-term use of aluminum containing antacids long-term since they have been noted to weaken bones and be associated with Alzheimer's disease. Also, be careful using magnesium containing antacids in elderly with poor kidney function. Consider treating heartburn naturally using probiotics, digestive enzymes, betaine, ginger or apple cider vinegar etc. (I will talk about these remedies in more detail in a later blog).  You may refer to my article about H2 Blockers use in the elderly .

  • Proton Pump Inhibitors (omprazole (Prilosec OTC), omeprazole/sodium bicarbonate (Zegerid OTC), lansoprazole(Prevacid OTC),  esomeprazole magnesium (Nexium OTC)

Long-term use may cause bone fractures which is already a concern in the elderly.  In my opinion, may consider for short-term use only.  Also, proton pump inhibitors may be reduce B12 levels that can cause cognitive problems and increase risk for a serious condition called C. Difficile diarrhea .

  • NSAIDS (Nonsteroidal anti-inflammatory drugs) ibuprofen (Advil, Motrin), naproxen sodium (Aleve), ketoprofen (Orudis KT, Actron), aspirin (Bayer, Ecotrin).

Use sparingly in the elderly since they can increase the risk for GI bleeding, ulcers, can elevate blood pressure and may reduce kidney function.  These medications inhibit a chemical called prostaglandins that are involved with causing inflammation and pain.  It is important to note, prostaglandins also play a role in the stomach to reduce acid secretion, needed for the production of  protective mucus in the stomach, help regulate blood pressure and are needed for blood clotting. Thus, when you inhibit them you can expect the side effects as mentioned above.  If you are using aspirin, use less than 150mg/day suggest using 81mg/day (since it is no less beneficial than 150mg/day and has fewer side effects). May consider taking a a proton pump inhibitor daily short-term to reduce risk of GI bleed (stomach bleed) if a NSAID is needed to temporarily control pain (I am not referring to low dose aspirin in this case).  May consider using a topical NSAID (i.e. diclofenac sodium (Voltaren Emulgel),Ibuprofen 5%(Nurofen Gel) etc.) since very little of the topical form of the drug is absorbed into the blood stream this reduces risks for side effects. (Note: Topic NSAIDs may also be less effective than their oral counterparts.) May also consider using acetaminophen (Tylenol) at doses not greater than 3 grams/day for temporary pain relief.  I will talk about natural alternatives like glucosamine, omega-3 fish oil, bromelain etc. in future blogs.

  • Oral decongestants (i.e pseudoephedrine (Sudafed Congestion), phenylephrine HCl (Sudafed PE) etc) or Antihistamine/decongestant combinations (i.e. pseudoephedrine/chlorpheniramine (Allerest), pseudoephedrine/triprolidine (Actifed) acetaminophen/chlorpheniramine/phenylephrine (Alka-Seltzer Cold Plus) etc.
In general, the side effects of decongestants are more pronounced in the elderly.  Decongestants relieve nasal stuffiness by constricting the vessels in the nose, but they can also do this systemically causing hypertension, nervousness and insomnia. In some instances, myocardial infarction and stroke have been reported when the oral decongestants were given to the elderly.  Thus, if possible avoid the use of oral decongestants in elderly (especially if they a have poorly controlled hypertension, anxiety, insomnia or palpitations).  If a decongestant is needed, I would recommend using a nasal decongestant (i.e. Oxymetazoline (Dristan, Afrin), phenylephrine hydrochloride (Neo-Synephrine) etc.) since they have fewer systemic side effects by working more locally in the nasal passage....use short-term only (no longer than 3 days).  

Informational Video Regarding Drug-Induced Side Effects in the Elderly

Learn More About Safe & Effective Drug-Free Therapies

From Targeted Medical Pharma  

 Read our Open Letter and Primer 

Sources for this post include:
Enclyclopedia of Elderly of Elder Care Second Edition 2008.

Saturday, August 4, 2012

Breastfeeding and OTC Drugs

General Information 
  • In general, breast milk is considered a superior form of nutrition to ensure the health of the infant when compared to infant formulas. However, if a medication is needed to control a symptom, caution may be necessary to prevent exposure to infant during breast-feeding. 
  • In most cases, only a small amount of drug (1-2%) ends up in breast milk which is usually harmless to the infant.
  • Although, adverse drug reactions during breast feeding are rare, they are more likely to occur in premature infants or in infants 2 months or younger.
  • Despite the common misconception the breast is like a bladder where drugs just accumulate, it is a compartment where drugs can diffuse out over time. Thus, in most cases you can minimize exposure to the infant if you just take the medication right after you have breast-fed the baby or right after the baby is due for a long sleep. Note: It is rarely necessary to pump and discard breast milk after a medication has been taken by the mother to reduce infant exposure (only in exceptional circumstances involving a contraindicated drug).
  • The drug's characteristics determine how much of  the drug will pass into the mother's breast milk.  For instance, drugs that have a low molecular weight (MW<500), are very lipid soluble, have low protein binding, are weak bases and drugs with long half-lives are more likely to accumulate in breast milk. 
  • Read the "Warning" section of the OTC product label for information regarding use of drugs during breastfeeding.
General Guidelines Involving OTC Medication Use During Breastfeeding
  • If possible, try not to use any OTC medications to treat symptoms first.
  • Avoid alcohol containing medication preparations when possible.
  • If you cannot avoid medication therapy, try to use single ingredient OTC products to treat your symptom(s), avoid extra-strength and long-acting/sustained release formulations of the medication to reduce number of medications and overall exposure to the breastfeeding infant.
  • Watch the infant closely during breast-feeding to see if adverse reactions occur (i.e. changes in behavior such as irritability, loss of appetite, sleepiness or other reactions like skin rash, vomiting, diarrhea, colic etc.).
  • Time medication administration after breast feeding is completed or just after the baby is put to bed for an extended period of time.
  • Vitamin and mineral administration is generally fine if taken within normal dosage ranges.
  • Please check with pharmacist or doctor regarding all medications and herbal remedies if you do not know the safety of the product during breastfeeding. 
  • You may use the following websites to check the safety of common medicines and herbal products during breastfeeding. Drugs and Lactation Database (LactMed) (a peer-reviewed and fully referenced database) along with the following websites that give some basic information about safety of medications/herbal products during breastfeeding,
  • In general, avoid aspirin and all aspirin containing products (i.e. Pepto Bismal, Alka Seltzer, Anacin, Excedrin, Bayer Aspirin etc.) due to risk of bleeding  and  Reye Syndrome in the infant .
  • Use acetaminophen (Tylenol) or ibuprofen (Advil) for pain/fever relief since they both have a shorter half-life, enter breast milk at very small concentrations and are considered by most experts to be drugs of choice while breastfeeding. 
  • Loratidine (Claritin) is considered by many experts to be the OTC antihistamine of choice. Other antihistimines may decrease milk supply and cause adverse side effects (i.e. drowsiness, irritability, colicky symptoms, refusal to feed etc.). Although not contraindicated, limit exposure to other antihistamines (i.e. chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl), doxylamine (Nyquil).
  • Nasal decongestants (i.e. phenylephrine (Neo-Synephrine), oxymetazolone (Afrin) are preferred over oral decongestants like pseudoephrine (Sudafed) because nasal decongestants are locally administered and have limited absorption into the maternal blood stream.
  • Antacids like aluminum hydroxide (Alternagel, Amphojel),magnesium hydroxide, calcium carbonate (Tums) and combinations with simethicone are all compatible with breastfeeding (i.e. Mylanta, Maalox).
  • Although H2 antagonists (i.e. ranitidine(Zantac), famotidine(Pepcid), cimetidine(Tagamet), nizatidine(Axid) are not contraindicated during breastfeeding, however, antacids are preferred to treat heartburn/upset stomach symptoms since oral absorption is quite limited.
  • Proton pump inhibitors (i.e. omeprazole (Prilosec OTC)) are generally not recommended as a first line treatment during breastfeeding and should be reserved if only deemed necessary by your physician. 
  • Antitussives/expectorants (i.e. guafenesin (Robitussin), dextromethorphan (Robitussin DM))are generally compatible with breastfeeding.
  • Most topical OTC creams and ointments when used short term are compatible with breastfeeding (except acne creams which have not been studied extensively). Note: If the area of use is the breast itself wipe the area clean prior to breastfeeding.
Lactation Risk Categories

L1 Safest
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.

L2 Safer
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3 Moderately Safe
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

L4 Possibly Hazardous
There is positive evidence of risk to a breastfed infant or to breastmilk production, bu the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant. (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5 Contraindicated
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Informational Videos About Breastfeeding and Medications

Learn More About Safe & Effective Drug-Free Therapies

From Targeted Medical Pharma   

Read our Open Letter and Primer 

Sources for this post include:

Briggs GG,Freeman RK, Yaffe SJ, Drugs in Pregnancy and Lactation 6th edition,Baltimore, MD: Williams & Wilkins,2002.'s_health