Chrononutrition and Nutritional Supplements: The Best Timing for Your Health

Have you ever taken a nutritional supplement like Vitamin B and thought it did not work well one day, then you took it at a different time another day and it helped? You felt more energized and ready for the day! Your body functions in the form of patterns known as circadian rhythms to promote sleep, eating, and other activities. It makes sense to time our nutrients based on our body’s needs and activities like a food clock. So when should I take them? Read on to find out how you can meet your nutritional needs and maximize your health in a timely manner!

What are nutritional supplements?1,2

The nutritional supplement market is expected to be worth over $151.85 billion by the end of 2021 and reach $272.44 billion by 2028. They really are popular among patients! Nutritional or dietary supplements are taken to supplement the diet of essential vitamins, minerals, and nutrients like amino acids and enzymes. They are not meant to replace your diet. Some are used to help you meet your dietary needs and manage health conditions while others promote weight loss or refuel you from sports. People with food allergies, vegetarians, pregnant women, and elderly may need supplements to make sure they reach their daily dietary goals. Nutritional supplements are commonly used in bone, heart, kidney, and cancer diseases. They come in a variety of forms from tablets to powders to drinks and bars. 

How are they different from prescription and over-the-counter drugs?3

Both over-the-counter drugs and dietary supplements are available without a prescription and can be found along the aisles of your local drug store, unlike prescription drugs. Both have to follow good manufacturing practices (GMPs) to make sure their products are pure. Yet, they do not undergo the same regulations as prescription and over-the-counter drugs. They are still regulated by the Food and Drug Administration (FDA), but they do not have to be shown to be safe and effective before entering the market. Therefore, they are not drugs like prescription and over-the-counter drugs. All drugs have to be approved by the FDA prior to being sold at your local drug store and are used to treat diseases. Nutritional supplements are not meant to diagnose, cure, treat, or prevent any diseases. However, they can make health claims like “supports heart health,” but they can not state “treats hypertension.”

What is chrononutrition and when should I take them?4-6

Your body and its functions like sleeping, eating, body temperature, and immune regulations are completed like clockwork or circadian rhythms. Therefore, it makes sense to optimize these patterns by timing our diet too. This circadian diet or chrononutrition includes not only what you eat, but when you eat. You should eat when it aligns with your body’s activities like when you are more active or during the day instead of at night before you sleep. Your body functions better if you eat more earlier in the day than later, even though many people do the reverse. Research has shown that eating out of sync with your body can lead to weight gain, chronic diseases, and premature aging. This may be due to your body better responding to insulin or your hormone that promotes the uptake of sugar and carbohydrates to your tissues during the morning. If more food is consumed later in the day, it is harder for your body to take up the sugars which can lead to insulin insensitivity. This is associated with Type 2 diabetes. This can best be combated by eating based on your food clock!

This approach also works for when you should take your nutritional supplements since they may work better when providing you with more nutrients during a certain time of day. There are specific times when they should be taken to support your sleep and energy patterns. The key to using nutritional supplements is to be consistent and take them when it is convenient for you. This is a better approach than taking them at different times each day which could affect your activity level.

Which dietary supplements are right for me?4,5,7

There are a variety of dietary supplements available and the best ones for you depend on your needs and health conditions. Talk to your provider or pharmacist to determine which supplements may best benefit your health. Listed below are some common supplements for health conditions and the best time to take them based on chrononutrition. 

Fish Oil – Fish oil is a source of omega 3 fatty acids that are needed for your body’s muscles and cell growth. It contains two omega 3 acids called docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) that are commonly found in oysters, salmon, and trout. Fish oil is helpful in reducing inflammation for conditions like rheumatoid arthritis and high cholesterol while promoting heart health. The most common side effects include burping and nausea, but it can best be managed by following the circadian diet. Taking it with food twice a day decreases these effects.

Vitamin D – Vitamin D supports your bones, muscles, heart, calcium absorption, and immune system. It is even obtained naturally from sunlight exposure. It can be obtained from dairy products, orange juice, mushrooms, and fish. Since it can be obtained from sunlight, it is best to take it in the morning with breakfast to mirror sunlight exposure. 

Calcium – Calcium is commonly used to support strong bones, nerve function, and reduce the risks of cancers like breast and prostate cancer. Dietary sources of calcium include milk, cheese, yogurt, okra, and kale. If it is taken with Vitamin D, it enhances the ability of calcium to be absorbed in your body while being taken with iron decreases its absorption.

Magnesium – Magnesium is important for muscle and nerve function, blood sugar regulation, and bone health. Food sources include whole grains, nuts, beans, and spinach. When taken at night, it promotes a more peaceful sleep by stimulating neurotransmitters that relax your body at night. A common side effect is an upset stomach, so it is best to take with food. 

Vitamin B complex – Vitamin B complex includes the following eight types of vitamin B: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin (B7), folic acid (B9), and cobalamin (B12). Vitamin B is found in a variety of foods like poultry, fish, eggs, broccoli, bananas, and whole grains. It supports your overall energy, mood, appetite, digestion, growth of red blood cells, eye sight, nerve function, hormone production, and muscle tone. It is also used by pregnant women to reduce the risk of birth defects and preeclampsia. Since it helps energize you, it may be better to take it earlier in the day to avoid sleeping issues. It is best taken with food to increase absorption.

Probiotics – Probiotics contain the good bacteria that line your digestive tract to promote digestion and immune functions. They can be used to decrease inflammation, improve irritable bowel syndrome (IBS), and protect against an upset stomach. They are commonly taken when you have an infection and are prescribed an antibiotic. Antibiotics can cause an upset stomach because they harm your good and bad bacteria, so probiotics replenish the good bacteria. They should be taken 30 minutes before or during a meal to maximize the ability of the probiotics to reach the gut quickly. They also interact with antibiotics since antibiotics can decrease the concentration of probiotics, so they should be spaced out by at least two hours.

Are there any dangers with nutritional supplements?3

Remember, just because a product says “natural,” it does not mean that it is safe. Its safety can be affected by how much you take and how it works. Nutritional supplements can interact with prescription or over-the-counter medications you are taking. Before taking nutritional supplements, talk with your provider or pharmacist to make sure they are right for your nutritional needs or health conditions.


  1.  Nutritional supplements market report, 2021-2028. Grandview research website. Accessed September 12, 2021.
  2. The truth behind the top 10 dietary supplements. WebMD website. Accessed September 12, 2021.
  3. What you need to know. NIH website. Accessed September 12, 2021.
  4. Chrononutrition: Is there a “best time” to take nutritional supplements? Metagenics website. Accessed September 12, 2021. 
  5. Chrono-nutrition: Personalizing which supplements to take and when. Nutri-facts website. Accessed September 12, 2021.
  6. How to guide chrono-nutrition. Humanos website. Accessed September 12, 2021.
  7. Why is vitamin B complex important, and where do I get it? Healthline website. Accessed September 12, 2021.

CMRs: What is the Comprehensive Medication Review?

A comprehensive medication review (CMR) is an encounter conducted face-to-face or via telephone between a patient and their pharmacist. The pharmacist collects patient-specific information to identify medication-related issues and creates a plan to resolve them, alongside the patient and/or prescriber.1 CMRs allows the patient and pharmacist to work together to improve patients’ knowledge of their medications, empowering patients to take ownership of their health. CMRs, unlike targeted interventions that address one condition or a single medication, are all-inclusive and can be time-consuming. A thoroughly executed CMR can take as long as 45 minutes to 1 hour.2 All medications and relevant medical conditions are evaluated. Action plans are developed, and patients are periodically reassessed. You should receive a CMR at least once a year. If your medications change frequently or you have been admitted to the hospital several times recently, you may benefit from more frequent CMRs. CMRs are a free service offered by your pharmacy. Ask your pharmacist about scheduling a CMR today!

Below are five things to know about a comprehensive medication review…

1.   What are the benefits of a comprehensive medication review?

Each patient is unique, with a different set of health concerns, a list of medications, allergies, social barriers, and needs to be met. Medication reviews allow your pharmacist or another healthcare provider to specifically address your “differences” and optimize your care. In 2019, an online article discussed the following 8 benefits of comprehensive medication management3:

●      Medication Assessment – Patients’ medications, both prescription and over-the-counter, are evaluated to determine if appropriate and effective at treating medical conditions and achieving goals of care.

●     Personalized Therapy — Care is customized to meet the needs of each individual patient.

●      Collaborative Care — Healthcare professionals, including pharmacists, providers, and nurses work together to offer optimal patient care.

●     Patient Engagement — Involving patients in discussions and decisions regarding their medical care allows them to take ownership of their health, promoting improved outcomes.

●      Ongoing Regimen Review — Patients are periodically reassessed for changes in medication regimens, control of symptoms, and progress toward goals. This creates an environment for longitudinal care or care over a period of time.

●     Improved Outcomes — Improved medication adherence and greater control of chronic diseases, reduces hospital admissions/ED visits, and enhances patients’ quality of life.

●     Reduced Costs — Patients only pay for medications that are necessary for their health. Improved medication adherence and decreased adverse events reduce hospital admissions, ED visits, and overall healthcare expenses.

●     Increased Satisfaction — Patients receive better care for a fraction of the price, while providers witness better outcomes for their patients.

2.  Am I eligible for a comprehensive medication review?

In 2015, a study funded in part by the National Institute on Aging looked at the increased prescribing of medications in the older adult population. Nearly 40% of these patients were on at least 5 medications.4 The most common medications noted were statins for high cholesterol, anti-hypertensive agents, diabetic medications, and antidepressants.  Polypharmacy or the use of several medications at once has been shown to increase medication nonadherence and increase the risk of drug duplication, drug-drug interactions, and adverse drug reactions. Patients on numerous medications, regardless of age, are prime candidates for medication reviews. Your pharmacist can help determine if you are taking any unnecessary drugs if your symptoms are controlled on your current regimen, and ensure that each medication is being used properly.

“Transitions of care” has become a hot topic in healthcare in recent years and refers to the movement of patients between multiple providers and settings as their conditions and healthcare needs evolve.5 For example, a patient discharged from the hospital into a rehab facility, then eventually back home following a stroke. These transitions are typically complicated by poor communication between care providers, lack of patient education, and failed collaborative care. Medication reviews in these patients allow the pharmacist to help bridge gaps in care. Your pharmacist can take the time to sit down with you and explain the changes that have been made in your medication regimen. They can develop strategies to help you take your medications as directed and clear up any uncertainties.

Medication reviews are a free service offered by your pharmacy. Although the patients mentioned above may benefit the greatest, anyone who would like a medication review is eligible. 

3. Who will be completing my comprehensive medication review?

Pharmacists pride themselves on being the “medication experts” and are excellent sources of information for both prescription and over-the-counter medications. Their education is focused on assessing medication-use for appropriateness, effectiveness, and safety to help prevent and resolve medication-related problems.6 This training, along with the idea that over 90% of Americans live within 5 miles of a community pharmacy,7 make them an obvious player in medication reviews. Your pharmacist may conduct the review, but a successful review does not stop there. A medication review is an umbrella term, which includes interventions carried out by various healthcare professionals such as providers, pharmacists, nurses and/or medical assistants.8 It is a team effort to ensure each patient receives the best care possible. A nurse may collect a list of your medications during an office visit or at hospital admission to provide to the pharmacy. They may review your discharge summary and notate changes in your regimen. A provider may prompt conversations and conduct examinations to determine which medications should be added, adjusted, or removed based on your current health needs. A pharmacist may review prescriptions prior to dispensing them, assessing for correct dosage and indication, and providing patient counseling when warranted. This integrated approach allows the puzzle pieces to come together so that optimal patient care is provided.

4. How to prepare for a comprehensive medication review.

You have been scheduled for a medication review with your pharmacist, either in-person or via telephone… now what? Preparing for a medication review, as a patient, is simple. Collect and bring all of your medications, both prescription and over-the-counter, and any devices, such as inhalers or insulin pens with you.9 It is important to include all vitamins and herbal supplements, as some of these cause significant drug-drug interactions. “Over-the-counter” does not always mean “safe.” Prior to the review, think about how you take each medication. Are they effective or do they make you feel worse? Have you noticed any side effects? If you regularly monitor your blood sugar or blood pressure, what are your recent readings? Are you having difficulty remembering to take your medications? Write all of this down, as well as any questions you may have and prepare to be honest with yourself and your pharmacist.

Your pharmacist has likely prepared for the medication review, as well. They may have already gathered a comprehensive medication list from your providers, confirmed disease states, evaluated fill history, and identified potential medication-related issues.10 This allows the pharmacist to establish a game plan and prioritize the objectives of the review to create an effective and efficient encounter.

5. What to expect following a comprehensive medication review.

Follow-up is a key component of a medication review. Your pharmacist may elect to follow-up within a few days or months, depending on the severity of issues identified during the review. Follow-up allows the pharmacist to monitor progress towards goals, ensure resolution of issues, and identify any new medication-related problems.10

Many pharmacists will create a handout or takeaway for you at the conclusion of your encounter, including an up-t0-date medication list and medication action plan (MAP). The MAP provides an overview of what was discussed and guidance on how to achieve patient-centered goals, including non-pharmacological options or  lifestyle changes.10 


1.        Gamble K. MTM Advisory Board Updates Definition of Key Pharmacist Role [Internet]. Cranbury (NJ): Pharmacy Times; 2011 Aug 8 [cited 2020 Aug 24]. Available from:

2.       Smart Retailing Rx. How to Conduct Comprehensive Medication Reviews [Internet]. [place unknown: Health Mart ® Pharmacy]; 2017 Dec 1 [cited 2020 Aug 24]. Available from:

3.       Ross SM. 8 Benefits of Comprehensive Medication Management [Internet]. [place unknown: Cureatr ©]; 2019 May 2 [cited 2020 Aug 24]. Available from:

4.       Charlesworth CJ, Smit E, Lee DSH, et al. Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1998-2010. J Gerotolog A Biol Sci Med Sci [Internet]. 2015 Mar 1 [cited 2020 Aug 24]; 70(8):989-995. Available from:

5.       Joint Commission (US). Transitions of Care: The need for a more effective approach to continuing patient care [Internet]. [place unknown: Joint Commission]; [cited 2020 Aug 24]. Available from:

6.       Kehrer JP, Eberhart G, Wing B, et al. Pharmacy’s role in a modern health continuum. Can Pharm J [Internet]. 2013 Nov [cited 2020 Aug 24]; 146(6):321-24. Available from:

7.       Twigg G, David T, Taylor J. An Improved Comprehensive Medication Review Process to Assess Healthcare Outcomes in a Rural Independent Community Pharmacy. Pharmacy (Basel) [Internet]. 2019 Jun 17 [cited 2020 Aug 24]; 7(2):66. Available from:

8.      Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol [Internet]. 2012 Oct [cited 2020 Aug 24]; 74(4):573-80. Available from:

9.       Sunderland CCG Medicines Optimisation Group. Medication Review [Internet]. Switzerland: PSNC; [cited 2020 Aug 24]. Available from:   Angaran D, Whalen K. Medication Therapy Management: A comprehensive approach [Internet]. New York: McGraw-Hill Education; 2015 [cited 2020 Aug 24]. Available from:

Author: CaraBeth Harrison

Everything You Need To Know About Ranitidine (Zantac) Recall

Introduction about Zantac Recall

If you or someone you know takes the medication ranitidine for occasional heartburn or gastroesophageal reflux disease (GERD), you may be aware that the Food and Drug Administration (FDA) has recalled and removed the medication from the market due to concerns of a cancer-causing impurity. However, you may be wondering what that means and what you need to do. We hope this article helps you understand why the recall and what you need to do.

What is ranitidine?

Many people take over the counter (OTC) Ranitidine or commonly known as Zantac to prevent and relieve occasional heartburn. It is also available as a prescription for the treatment and prevention of ulcers as well as the treatment of gastroesophageal reflux disease (GERD).

Ranitidine was available in three strengths; 75mg, 150mg and 300mg. People who have been taking this medication, generally take it once or twice daily. The OTC labeling of this medication indicates a short course of treatment of no more than 14 days for relief or prevention of heartburn. If one requires further relief, one could see their primary care physician for evaluation to determine the root cause of their heartburn.

Ranitidine is classified as a histamine-2 (H2) blocker which works by reducing gastric acid in the stomach. Histamine is a chemical that naturally occurs in one’s body and encourages the stomach to produce acid when one eats to help digest the food. By taking a H2 blocker, one can reduce the amount of histamine produced in turn reducing the amount of acid produced.

Why did the FDA recall ranitidine and then remove it from the market?

In September of 2019, the FDA announced that preliminary tests of ranitidine contained low levels of a probable human carcinogen or a substance that is known to cause cancer. The substance found in these batches of ranitidine was N-nitrosodimethylamine (NDMA).  However, at that time, the FDA did not recommend discontinuation but did recommend talking with your doctor about alternatives.

Beginning in October of 2019 through February of 2020, some manufacturers of ranitidine implemented voluntary recalls of their product. It was not until April of 2020 that the FDA requested all ranitidine products be removed from the market. The FDA determined that there were only a few cases unacceptable levels of NDMA found in some samples tested. However, they noticed that the levels of NDMA increase overtime when it is stored at higher than room temperatures. Since there was no way of knowing how old the product was and how it was stored, the FDA decided to remove the product from the market due to a concern for safety. As a result of this request, ranitidine products are no longer available to purchase OTC or prescription.

What is NDMA and what does it cause?

NDMA is an environmental contaminant that is found in water and foods. The substance is unintentionally produced in or released from industrial sources through chemical reactions. NDMA is classified as a carcinogen based on animal studies that showed prolonged exposure to NDMA resulted in tumors. Low levels of NDMA can be ingested from our diets and are not expected to lead to an increased risk of cancer. However, prolonged exposure to higher levels of NDMA could increase the risk for cancers.

What should you do if you take ranitidine?

Since the FDA has formally removed ranitidine from the market, if you, a family member or a friend have been taking this medication the FDA recommends that you discontinue and discuss with your primary healthcare provider about options for further treatment. There are other alternative medications available for the treatment of occasional heartburn in the H2 blocker class as well as other classes. There is no evidence that the other H2 blockers or other heartburn medications have been affected by NDMA impurities.


  • Commissioner, Office of the. FDA Requests Removal of All Ranitidine Products (Zantac) from the Market. 1 Apr. 2020,
  • Commissioner, Office of the. “Zantac (Ranitidine): Safety Information – NDMA Found in Samples of Som.” U.S. Food and Drug Administration, FDA, 13 Sept. 2019,

How to Purposefully Meal Prep

Ahh yes, meal prep. The often touted #hashtag of fitness enthusiasts all over Instagram. At first, this might seem like a simple concept. You make food at the beginning of the week; you eat it throughout the week. Yes, at a macro level (oh, the irony) this is what is happening. But a GOOD meal prep takes understanding, consistency, and an ability to eat leftovers and not feel like you are missing out on the finer things in life (for many this is an acquired skill). But seriously, a properly executed meal prep will set you up for nutritional success every day of the week, and that is exactly what we are looking for!

            In order to see the results you are looking for, whether it be losing body fat, gaining muscle, training for sport, etc., consistency is key, and your nutrition HAS to be consistently leading you towards your goals. If it isn’t, you are wasting your efforts over the long term, it will take you longer to reach your goals, and the process will become frustrating. Consistently following whatever nutritional protocol you have aligned yourself with is what will allow you to reap the benefits of said nutritional plan.

            What better way in this busy world to stay consistent than to have all your meals made, put away, and ready to be eaten whenever you decide – especially when you know those meals are helping you get to where you want to be with your health/fitness?

Enter: meal prep.

Nutritionally, your meals should do the following, in general priority of importance:

  • Provide sustenance for you to survive
  • Not cause GI/health issues
  • Help you reach your health/fitness goals in a sustainable manner
  • Make you satiated until the next time you eat
  • Be accessible when you are ready to eat
  • Taste good

            Notice taste good is at the bottom of the list. Now, what you need to understand is that your food CAN and SHOULD taste good. However, if you are looking to achieve any sort of fitness goal, you need to shift your thinking about eating away from it being a short-term comfort or a social activity, and towards it being a means to an end.

Your food is what is getting you to where you want to be. Once you have achieved your goals, or are a healthy, fit individual, you can have the luxury of eating out with friends more frequently or being a bit less strict with what you eat in general. However, if you are just getting started with a nutritional protocol, or are on the path towards a fitness goal that will take time, whatever it may be, I have news for you: you have to have discipline, and often times it is not going to be easy. When people tell you it is, they are lying. Reaching your goals can be hard, and that is what makes it worth it in the end.

            However, don’t get that confused with people thinking your nutrition should be a punishment, or that the harder you are on yourself the more results you will see. This is not the case. The name of the game is sustainability. Your nutrition protocol should be set up to get you in the best shape of your life in a sustainable manner, while not sacrificing any of your mental well being (which oftentimes is an unfortunate byproduct of many fad diets).

            And this is exactly why people meal prep. It is an easy way to make sure they have access to healthy food that will help them reach their fitness goals. Step one is to consider what your nutrition plan is, and what food you need to have access to at specific times throughout the day when you plan on eating. Then, you have to plan if you will have time to make your meal when you will eat it, or prep it before hand. So, for most people, breakfast can be made in the AM (or prepped if you are strapped for time) lunch should be prepped, and dinner is up in the air depending on your schedule.

    Personally, I LOVE the egg meal I make in the morning. I sauté onions, peppers, spinach, tomatoes, mushrooms, a small portion of meat, and sometimes nuts, then add my eggs/egg whites. I get up earlier than I have to each day so I can make and eat this meal fresh. It is my favorite start to my day, it doesn’t interfere with the start of my morning, it is a meal that is helping me reach my fitness goals, and I enjoy it enough to eat consistently seven days a week. Knowing this, I only have to prep lunch and dinner. Before I do this, I consider the following (and encourage you to do the same!):

Will these meals provide with me with the micronutrients and macronutrients I need to maintain proper bodily function and lead me to my health/fitness goals (vitamins, minerals, proteins, carbs, fats, etc.)? Will they help me achieve all the checkpoints on the priority list above?

If not, what needs to change?

If I can’t change anything, what can I supplement to make sure I am staying healthy? (For me, the answer is vitamin D and fish oil. I encourage everyone to have blood work done to check for any deficiencies.)

Will these meals keep fresh throughout the time I plan on eating them?

For me, this is 6 days, and I home cook all meals on Sundays because I have the time and I love spending the day with my little family.
If not, then you should consider doing two meal preps throughout the week: One on Sunday, and one on Wednesday/Thursday depending on your preference in food and your time available. Nobody wants to eat 6-day-old fish.

Will I get sick of eating these meals throughout the week?

I’m a creature of habit, so the answer for me is no.
If the answer is yes, consider the following:

Meal prep for Sunday-Wednesday, and Wednesday-Saturday to spice things up
Cook more than one option of each food source when you meal prep
Cook a base item, like chicken, and then add various seasonings or toppings throughout the week. You could have chicken and veggies with salsa, with hummus, with hot sauce, and with curry all using the same meal prepped chicken.

Will I have access to a refrigerator at work/during my travels to keep these meals fresh throughout the week?

If not, then get a lunch box (like you had in third grade before it was cool to take paper bags), get an ice pack or three, and bring this with you wherever you go. When I finish my morning training sessions, I go home, write programs and articles, and then pack my cooler for the afternoon/evening I spend at the gym.

            Boom boom boom and boom. Once you have all of these questions answered, it’s time to start your actual meal prep. Knowing exactly what you need is step one, and step two is making it! For most people, you will want to base your meals around protein and vegetables, and you can add in starch from there if it’s necessary depending on your goals. So, for lunch and dinner, your best bet is to do the following:

Pick at least two proteins that keep well (chicken, beef, turkey, and all their variations are a good bet)
Pick at least two vegetables that you enjoy eating with your proteins (broccoli, cauliflower, asparagus, and spinach are some of my favorites)
Cook them. It’s very easy to bake chicken, oven-roast vegetables, and cook ground turkey/beef on the stove all under an hour.
Put them in your tupper ware containers, portioned out by meal. And you are set! You have your protein and veggies for lunch, and you have a different protein and veggies for dinner. Need a starch? Chef up some rice and you are ready to rock!

            Just like that, you are part of the #fitfam that meal preps. You are ready to CRUSH your week of eating, training, and getting to whatever fitness goal you are chasing! As always, don’t focus so much on the little things, like:

“What spices should I use?”
“Should I put my meals in one big container or little ones at the beginning of the week?”
“How many preps should I do in a week? 1? 2? 3?”

            The answer to most of the questions is as follows: Pick your foods, prep them, and see how it goes. Don’t like pre-portioning your meals and you would rather keep them in one big container and portion them as you go? Remember that for the next week. Find yourself enjoying chicken every week? Keep making it. The answer is to see what works for you, and keep doing that. As always, don’t worry about being perfect, worry about getting started, and from there, perfect your meal prep as you go!

Yours in health,

-Max Gordon, CSCS, FNS, Nutrition Coach, Fitness Instructor & Coach

Josefs Pharmacy Offers Free Flu Shots

Major media reported this week the flu season is already “moderately severe” and may get worse. Josefs Pharmacy is hosting a Free Flu Shot event at each of our stores for 1 day only. 100 free flu shots are available at each store. Pre-registration is required. Ages 14 and up only.

Event Dates

Monday January 22, 2018, 10:00am-5:00pm: Josefs Pharmacy, 2100 New Bern Ave, Raleigh, NC, 919.212.2555

Tuesday January 23, 2018, 10:00am-5:00pm: Main Street Pharmacy, 213 West Main Street, Durham, NC, 919.688.1368

Wednesday January 24, 2018, 10:00am-5:00pm: Josefs Pharmacy, 3421 North Roxboro St, Durham, NC, 919.680.1540

Register here:

To prevent lines and long waits, flu shots are only available with advance registration. The
registration link is at Walk-ups will not be accepted.  If the booking link is down, please call the desired pharmacy location to register.

Back to School: A Handy Health & Safety Checklist

It’s just about that time again: Time to switch from swimsuits to school clothes and from beach bags to backpacks. That’s the easy part. What about preparing your child to have the healthiest and safest school year possible? Here’s a handy checklist to help.

  1. Schedule medical, eye, and dental checkups. Before school starts, check with the pediatrician to see if your child needs any immunizations. Vision and hearing tests are also a good idea, although schools perform hearing tests during certain grades.1 If your child is playing sports, ask the pediatrician whether a special checkup is needed. With certain sports, concussions can be a serious problem. Talk to the doctor about ways to protect your child.2                                                                                                                                                                                                                                                                                                                                             
  2. Organize your child’s medical history records. Provide copies to your child’s school or daycare providers. I can help you pull some of this together, but the list should include your child’s:
  • Prescription medications
  • Medical problems such as asthma or allergies
  • Previous surgeries
  • Emergency contacts2
  1. Communicate about transportation. Some kids get dropped up and picked up by parents. Others carpool. Still others walk, bike, or take the bus. And, of course, teens may have their own wheels. Regardless, it’s important that your kids be—and feel—safe getting to and from school.
  • If you or another adult picks up your child, agree on a time and place for pickups. Explain what to do if the driver is running late.
  • If your child walks or bikes, do a dry run and explain any potential traffic hazards.
  • If your child or teen takes the bus, find a safe route and agree on a visible pick-up and drop-off spot. Ideally, this is a place where other kids are around and adults can clearly see them.
  • If your teen drives to school, be crystal clear about safe driving—including ditching that teen temptation: texting while driving.

Create an emergency plan in case anything goes awry. In fact, make sure your child knows what to do in an emergency—whether at home or at school or anywhere in between.2

  1. Remember that there’s more to school than hitting the books. For example, good nutrition and exercise are essential for brain health. Here are a few other reminders:
  • Be consistent about bedtime and wake-up times. Growing kids need at least 8 hours of sleep—and teens need even more.1
  • Make homework a habit by having clear routines. But don’t overlook free time and friend time.
  • Explain ways to prevent infection such as by regularly washing hands and by not sharing hats or other clothing. That’s one way lice get around!
  • Keep lines of communication open. Listen for signs of bullying or other concerns. Many parents find that car rides are a great time to have nonthreatening conversations with their kids. Contact the school if a problem like bullying does arise.3,4

Now about those school supplies…. Come by the store to stock up. And while you’re here, we can talk over your health and safety plans for the school year.

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.



1. WebMD: Back-to-School Health Checklist. Available at: Accessed 7/3/16.

2. EmergencyCareForYou: Homework for Parents—Your Child’s Back-To-School Health Checklist. Available at: Accessed 7/3/16.

3. National Association Of School Nurses: Back to School Family Checklist. Available at: Accessed 7/3/16.

4. CDC: Back to School Health & Safety Checklist. Available at: Accessed 7/3/16.

Fun in the Sun—or Defeat in the Heat?

Did you know that the number of hot days—and warm nights—is increasing? In the U.S., record high temperatures now outnumber record lows at least two to one.1 What can you do to protect yourself in a heat wave—or simply in the hot summer sun?

Know signs of trouble. Heat cramps are an early sign that your body is suffering from the heat—they’re more likely with heavy exercise or work. Along with muscle cramps, you may sweat heavily and feel very thirsty or fatigued.2

Heat exhaustion can happen when you lose lots of fluids from heavy sweating.3 These are a few other signs and symptoms of heat exhaustion:

  • Headache
  • Dizziness or feeling weak or confused
  • Nausea or vomiting
  • Fast heartbeat
  • Cool, moist skin
  • Dark-colored urine, a sign of dehydration2,4

If not treated, heat exhaustion can develop into heatstroke, which can be deadly because the body loses the ability to cool itself. Call 9-1-1 if someone shows signs of shock, becomes very confused, has a seizure, has a fever over 102 degrees F, breathes rapidly or has a rapid pulse, or loses consciousness. 2,3

Nip problems in the bud. If you have symptoms of heat exhaustion, get out of the heat as quickly as you can. Rest in a cool, shady place with your feet raised. Drink plenty of fluids, but avoid alcohol or caffeine. Apply cool compresses or take a cool shower or bath. Contact a doctor if you don’t feel better within 30 minutes.4

Beat the heat. In a heat wave, take these steps:

  • Avoid taxing activities if you can.
  • Stay indoors during the hottest hours of the day. The sun’s ultraviolet (UV) rays are strongest between 10 am and 4 pm.5
  • If you don’t have air conditioning, go to a library, mall, or other public place to cool down for a few hours.
  • Wear lightweight, loose-fitting clothing. Avoid dark colors, which trap the heat.
  • Use a hat or umbrella outdoors.
  • Allow your car to cool off before you get in.
  • Drink water and eat small meals often. Drink less alcohol and fewer caffeinated drinks.
  • Don’t take salt tablets unless your doctor tells you to.2,3,4

Protect those at increased risk. Help protect those who are most vulnerable in the heat. That includes children, older adults, and people who are obese, ill, exercising vigorously, or not used to the heat or high humidity.2 For example, make sure young ones drink plenty of water. And you might check in on your elderly neighbor once in a while.

It’s important to know that certain medicines can also increase your risk of heatstroke. This includes allergy, blood pressure, and seizure drugs as well as medicines used for mental health conditions. Let’s talk this over to make sure you stay safe and know the signs of problems. And, if you have a chronic condition, it’s a great idea to ask
your doctor about other ways to lower your risk of heatstroke. 4

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.


  1. Climate Communication: Heat Waves. Available at: Accessed 5-23-16.
  2. MedlinePlus: Heat emergencies. Available at: Accessed 5-23-16.
  3. Healthy Roads Media: Heat Waves. Available at: Accessed 5-23-16.
  4. Heat exhaustion and Heatstroke. Available at: Accessed 5-23-16.
  5. FDA: Sun Protection. Available at: Accessed 5-23-16.


9 Screening Tests for Men

Are you one of those guys who can’t remember the last time you stepped foot in a doctor’s office? Sure, maybe you’ve gotten in for something urgent, but what about scheduling an annual exam or screening tests? Maybe you simply forget, think you already have healthy habits, or insist that you “feel just fine.” Sorry, guys…. Not quite good enough.

Regular checkups and screening tests aren’t something you can afford to ignore. Baseline tests can help your doctor know how your health is changing over time. Plus, silent killers such as high blood pressure or high cholesterol can wreak havoc—and you wouldn’t have a clue without being tested.

Here’s a simple screening cheat sheet to make your life easier.

Abdominal aortic aneurysm. If you have ever smoked, get this ultrasound test one time between ages 65 and 75. This test will show whether or not your largest artery (abdominal aorta) is bulging. If it is, it may burst, putting you at risk for bleeding—and even death.

Blood pressure. Starting at age 18:

  • Get tested at least every 2 years if your blood pressure is lower than 120/80.
  • Get tested once a year if your blood pressure is between 120/80 and 139/89.
  • Discuss treatment with your doctor if your blood pressure is 140/90 or higher.

Cholesterol. From age 20 to 34, get a regular cholesterol test if you are at increased risk for heart disease. At age 35, get a regular cholesterol test. Ask your doctor how often you need to do this.

Colorectal cancer. Get screened for colorectal cancer from age 50 to 75. This screening may include one or more tests, such as fecal occult blood testing, sigmoidoscopy, or colonoscopy. Ask your doctor which test is best for you and how often you need it.

Depression. Ask your doctor about being screened for depression if over the past weeks:

  • You have felt sad or hopeless
  • You have lost interest or pleasure in doing the things you normally enjoy

Diabetes. Starting at age 18, get screened if your blood pressure is higher than 135/80 or if you take high blood pressure medicine.

Hepatitis C virus (HCV). Get screened once if you:

  • Were born between 1945 and 1965.
  • Have ever injected drugs.
  • Received a blood transfusion before 1992.

Lung cancer. Ask your doctor whether or not to be screened if you:

  • Are between 55 and 80.
  • Have a 30 pack-year smoking history. (This is the number of packs smoked per day times the number of years you smoked.)
  • Smoke now or quit within the past 15 years.

Overweight and obesity. This is a test you can do yourself. Find your body mass index (BMI) by entering your weight and height into an online BMI calculator.

Discuss with your doctor whether you are at increased risk for any other diseases. If so, you may need other tests.

Be honest with your health care provider and me. Be sure to let us know what worries you—whether it’s your weight, alcohol use, or challenges with anxiety. Think of us as your partners in health. We can do a much better job of helping you if we fully understand your health challenges and concerns.

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.



  1. AHRQ: Men: Stay Healthy at Any Age. Available at: Accessed 5-4-16.
  2. OWH: Screening tests for men. Available at: Accessed 5-4-16.



Heart Health: The Facts of Woman’s Heart Attack

Did you know that the symptoms of a woman’s heart disease are different and atypical than a man’s?  For example, chest pain may not be a described symptom for women experiencing a heart attack.  Examples of most common symptoms experienced by women include:

  • Pain, heaviness, discomfort, or pressure in the chest/abdominal area – Pain that extends to the jaw, neck, shoulder, inner arm, and upper back.
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Unusual, extreme fatigue
  • Dizziness or lightheadedness

For more information, visit

New U.S. Dietary Guidelines

Based on the most recent science, the 2015-2020 Dietary Guidelines for Americans were released at the beginning of 2016. Before you say, “here we go again,” let’s take a closer look. The guidelines may sound familiar, but there are some differences from years past.1

Overall guidelines. For the most part, these guidelines don’t advise you about how much to eat of different foods, such as vegetables or meat. Instead, they focus on helping you fit healthy eating into their own unique lifestyle. To that end, they provide three examples of healthy eating plans: a healthy American diet, a Mediterranean-style diet, and a vegetarian diet.

What these three types of diets share is an emphasis on more plant-based foods, healthy fats, and whole grains. The guidelines also suggest making meals and snacks from scratch. That helps avoid the common pitfalls of processed foods, such as high levels of salt and sugar.

Overall, a healthy eating pattern includes:

  • Any vegetable, but preferably a wide variety
  • Fruits, especially whole ones
  • Grains—with at least half being whole grains
  • Fat-free or low-fat dairy
  • A variety of protein sources, including seafood, lean meat, poultry, eggs, beans, peas, nuts, seeds, and soy products
  • Oils1

Specific guidelines. The last set of guidelines came out in 2010. They simply advised people to reduce their intake of added sugars, without giving numbers. The newest guidelines, however, are more specific. They suggest you limit added sugars to fewer than 10 percent of your daily calories. Right now, added sugars account for more than 13 percent of Americans’ daily calories. 1

Soft drinks, fruit drinks, sweetened coffee or tea, flavored waters, and alcoholic beverages account for nearly 50 percent of all added sugars we consume. A recent study revealed that people who drink sugary drinks daily tend to put on more deep belly fat over time.2 That’s the kind of fat that surrounds vital organs and is linked to type 2 diabetes and heart disease. Other sources of added sugars are snacks and sweets, as well foods like bread and prepared meals.

                        The new guidelines also suggest that you limit saturated fats to no more than 10 percent of your daily calories. That’s a goal that fewer than a third of Americans meet. Sadly, these fats can increase levels of bad cholesterol, and your risk of stroke and heart disease.4 About a third of saturated fat comes from prepared foods containing cheese or meat—foods like burgers, tacos, and pizza—as well as dairy products, snacks, and sweets.1

Finally, the guidelines advise eating fewer than 2,300 milligrams per day of salt—a little less than a teaspoon. That’s a guideline that nearly all Americans are failing to meet. But it’s not something to ignore. That’s because too much salt can increase blood pressure, which also increases risks of heart disease and stroke.3

Don’t know where to begin? Stop by and we’ll have a chat. I can offer you a tip or two!

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.




Ask Your Pharmacist About The Warning Signs Of Diabetes

Hello, this is Finny Joseph, your Pharmacist at Josefs Pharmacy.  Did you know that an estimated 30 million people in the US have been diagnosed with diabetes; many are our family, friends and neighbors. That’s about 1 out of every 11 people or over 9% of the population. What you may not know is that all people with diabetes have a higher risk for eye disease.  1 out of 4 people don’t even know they have diabetes. We are shining a light on this lifetime disease by informing you about the symptoms and warning signs of diabetes.

The warning signs for diabetes are often missed because they can be mild. Some don’t discover the disease until it has caused long-term damage.  Common symptoms and warning signs of diabetes include:

  • Frequent urination
  • Increased thirst
  • Increased hunger despite regular meals
  • Extreme fatigue or tiredness
  • Blurry vision
  • Headaches
  • Cuts and/or bruises that are slow to heal
  • Weight loss despite regular meals

Early detection and treatment is key.  Research shows you can lower your risk 58% by losing 7% of your body weight and exercising moderately (e.g. a brisk walk) for 30 minutes a day, five days a week.

If you have questions or want a free diabetes consultation, please call us to schedule an appointment or stop by and see us. We can inform you about the risk, warning signs and way to prevent the onset of this disease. We look forward to helping you.

Stay healthy and happy this winter!

What You Need To Know About The 2016 Influenza Season

  • It takes abouflu shots 2t two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.
  • Flu activity most commonly peaks in the United States between December and February.
  • CDC recommends yearly flu vaccines for everyone 6 months of age and older as the first and most important step in protecting against this serious disease.
  • Talk to the pharmacist about the immunizations available to you.  919-212-2555


The Facts about Good Mental Health

The term “mental health” encompasses our emotional, psychological, and social well-being. Included are our abilities to handle stress, interact with others, and make decisions. Mental health problems can affect your thinking, mood, and behavior.

There are several factors that contribute to mental health problems:

  • Genes
  • Brain chemistry
  • Life experiences, such as trauma and abuse
  • Family history of mental health issues

Many people suffering from mental health problems completely recover with treatment. There are many early warning signs, including eating or sleeping too much or too little, being reclusive, having low energy levels, feeling like nothing matters, feeling helpless, substance abuse, and severe mood swings. Contact your physician if you believe you or someone else displays these warning signs. Help is available for mental health problems.


Medical Information Disclaimer

The health-related information and linkages to other sites on the Josefs Pharmacy website is meant for basic informational purposes only. Josefs Pharmacy website is NOT designed or intended to provide medical advice, professional diagnosis, opinion, treatment, services, or substitute for a doctor’s appointment or medical care. Due to the ever changing nature of medical information, information on this site or linkages to other sites should NOT be considered current or exhaustive or be relied on for any recommendation.  Josefs Pharmacy does not recommend or endorse any products or services or information provided on linked websites.  The linked websites may have graphics or content you find offensive: Josefs Pharmacy, its affiliates, and vendors, have no control over such content and accept no responsibility for such materials.  Josefs Pharmacy is NOT liable for any advice, information, products, or services you obtain through this site.

Users of this website are advised to consult with their physician before making any decisions concerning their health. IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN

Let’s Talk About Aging and Sleep

September is National Healthy Aging Month, in addition to serving several other nationally recognized health awareness causes, as well. Part of every person’s general health is getting adequate sleep. Clear signs of inconsistent sleep include irritability, inattentiveness, and increased chance for accidents.

There are two types of sleep: non-rapid eye movement (NREM sleep) and rapid eye movement (REM sleep). When falling asleep, we first go through the four stages of NREM sleep, ranging from light to deep sleep. After completing the fourth stage, one enters REM sleep, when dreaming often occurs. The name “rapid eye movement” describes the back and forth motion of the eyes under the eyelids during this stage of sleep. Muscles also become immobile in REM sleep. We cycle through the stages of NREM and REM sleep approximately every 90 minutes throughout the night.

Sleep needs and patterns change with age. For instance, children and adolescents need more sleep than do adults. Older adults need seven to nine hours per night, the same amount of sleep young adults require. Many older adults report difficulties falling asleep. Additionally, older adults tend to sleep less soundly and wake up more frequently throughout the night than do younger adults. The body’s regulation of sleep also changes with age, as older adults tend to be sleepier earlier in the evening and wake earlier in the morning.

Several potential causes could explain these changes. Older adults may produce more melatonin, the hormone responsible for controlling sleep. They may also have increased sensitivity to changes in their environment, such as to noise and temperature. If you have trouble sleeping, see your doctor or a sleep specialist. Despite the fact that the ways in which our bodies sleep change with age, all age groups should be getting adequate sleep. Age does not diminish the quality of your sleep.


Medical Information Disclaimer

The health-related information and linkages to other sites on the Josefs Pharmacy website is meant for basic informational purposes only. Josefs Pharmacy website is NOT designed or intended to provide medical advice, professional diagnosis, opinion, treatment, services, or substitute for a doctor’s appointment or medical care. Due to the ever changing nature of medical information, information on this site or linkages to other sites should NOT be considered current or exhaustive or be relied on for any recommendation.  Josefs Pharmacy does not recommend or endorse any products or services or information provided on linked websites.  The linked websites may have graphics or content you find offensive: Josefs Pharmacy, its affiliates, and vendors, have no control over such content and accept no responsibility for such materials.  Josefs Pharmacy is NOT liable for any advice, information, products, or services you obtain through this site.

Users of this website are advised to consult with their physician before making any decisions concerning their health. IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN

Summer Cold or Seasonal Allergies?

It is typical for people to associate the winter months with catching the common cold. However, summer presents many conditions and situations that make it easy to catch a cold virus. The symptoms such as sneezing, sniffling, and fatigue are all the more frustrating during the summer months, when people would prefer to be outside enjoying the warm weather. We have some tips for avoiding summertime sickness.

Catching a cold virus in the summer is made easier by the fact that people tend to be more active this time of year, especially out in the heat. Possible fatigue and dehydration resulting from this activity can weaken the immune system and make symptoms of a cold worse. Additionally, travel is much more common in the summer. Travel on airplanes can expose people to the cold virus as they fly with hundreds of others who could be sources of the virus.

However, many are prone to seasonal allergies in the summer and may mistake allergy symptoms for a cold. There are two easy ways to tell the difference. First, a cold’s symptoms typically appear one at a time and last around ten days. Allergy symptoms typically manifest all at once. Second, while both produce nasal discharge, a cold will produce yellow discharge and allergies usually produce clear, watery discharge. As always, if you have questions about your symptoms or are concerned about them, consult your physician.

The treatment for the summer cold is the same as for a winter cold. Despite the fact that people want to return to their summer activities as quickly as possible, it is recommended that you rest as much as possible. Additionally, be sure to drink plenty of fluids. For any questions or for other treatment considerations, contact your physician.



Medical Information Disclaimer

The health-related information and linkages to other sites on the Josefs Pharmacy website is meant for basic informational purposes only. Josefs Pharmacy website is NOT designed or intended to provide medical advice, professional diagnosis, opinion, treatment, services, or substitute for a doctor’s appointment or medical care. Due to the ever changing nature of medical information, information on this site or linkages to other sites should NOT be considered current or exhaustive or be relied on for any recommendation.  Josefs Pharmacy does not recommend or endorse any products or services or information provided on linked websites.  The linked websites may have graphics or content you find offensive: Josefs Pharmacy, its affiliates, and vendors, have no control over such content and accept no responsibility for such materials.  Josefs Pharmacy is NOT liable for any advice, information, products, or services you obtain through this site.

Users of this website are advised to consult with their physician before making any decisions concerning their health. IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN