Defeat Gestational Diabetes With These 6 Nutritional Tips

About 10% of pregnancies in the United States are affected by gestational diabetes.1 It affects millions of women, so you are not alone. Unfortunately, you cannot tell you have it without getting tested and may not know it. It can be scary, but is it treatable? What does it mean for your new, precious baby? It is not because of something you did before being pregnant and it does not mean that you cannot have a healthy baby. It is often managed with a few changes to your diet and activity. To defeat gestational diabetes, follow these 6 nutritional tips to not only better your health, but also for you to have a healthy pregnancy and baby! 

What is gestational diabetes?2-5

Gestational diabetes is a type of diabetes or high blood sugar condition that happens during pregnancy to women that did not already have diabetes. This means your body is unable to use or store the glucose or sugar from your meals, so more stays in your blood than normal. Gestational diabetes typically happens during the second part of your pregnancy or at 24 to 28 weeks. Insulin is a hormone that is released to lower your blood sugar, but with gestational diabetes, you are not able to make or use enough of it. You need glucose for energy and your baby’s health, but too much is not good. 

Although gestational diabetes does not have really symptoms other than increased thirst or urination, there are a few risk factors which include 

  • Had gestational diabetes during a previous pregnancy
  • Given birth to a baby who weighed over 9 pounds
  • Overweight
  • Older than 25 years old
  • Family history of type 2 diabetes
  • Hormone disorder called polycystic ovary syndrome (PCOS)
  • African American, Hispanic/Latino American, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander

However, gestational diabetes is treatable! You can keep you and your baby healthy by following a nutritious diet, increasing your activity level, and monitoring your blood sugar. Even just biking or walking 30 minutes a day is helpful to lower your blood sugar and keep a healthy weight! This will help you to have a safe and smooth delivery. If you think you are at risk, talk to your doctor before trying to become pregnant.

What type of diet should I follow if I have gestational diabetes?2, 6

The key to controlling gestational diabetes is managing your blood sugar by following a nutritious diet. Here are a few tips on how to maximize the benefits for you and your baby.

  • Monitor your carbohydrates: Carbohydrates become glucose, so monitoring your intake is important. Foods like milk, soda, rice, sweets, bread, pasta, juice, potatoes, peas, and corn all have carbohydrates. Your doctor and dietitian will help you create a carbohydrate goal and demonstrate how to count your carbohydrates. You can see how many carbohydrates and sugars there are in a food by reading the Nutrition Label.
  • Not all carbohydrates are equal: Try to consume more nutritious carbohydrates like whole grain bread instead of white bread, sweet potato instead of a baked potato, brown rice instead of white rice, shredded wheat cereal instead of sweet cereal like cornflakes.
  • Do not forget that sodas, fruit juices, and energy drinks are high in sugar: Try to drink more water, flavored water, unsweetened tea, or use artificial sweeteners.
  • Limit your sweets: You can still have your cake and eat it too, but try to stay away from cookies, pastries, and candies since they are typically high in sugar, fat, calories, and carbohydrates. When you have a ‘sweet tooth,’ fix your craving by eating fruit and low-fat yogurt, sugar-free cookies, or small amounts of dark chocolate.
  • Distribute your food between 3 meals and 2 or 3 snacks per day: Eating too much at one time can increase your blood sugar, so try to divide up your food during these eating times. Remember, do not skip meals! You and your baby both require high nutritional needs.
  • Breakfast is important: Since cereals and milk are sources of carbohydrates, your blood sugar after breakfast may be high. If so, try to eat protein and starch like eggs and toast for breakfast.

This may seem overwhelming, but you may find it helpful to record your meals in a food log. It is also best to measure out your servings with measuring cups when needed to make sure you do not go above your blood sugar or nutritional goals.

How does it affect my baby?3

Not only does it affect you, but also your baby. Gestational diabetes typically goes away after childbirth, but it may put your baby at risk of type 2 diabetes and obesity (remember, you can reduce the risk with activity and diet changes). After your baby is born, your doctor will monitor your baby’s blood sugar to make sure it is not too low. Gestational diabetes may increase the chance that your baby is larger than normal, or develops jaundice or yellowing of the skin. Jaundice can be treated and typically goes away after birth.

Am I likely to get type 2 diabetes?4, 7

About 50% of women with gestational diabetes develop type 2 diabetes. It will not definitely happen, but you can prevent it! Your blood sugar should become normal 6 weeks after childbirth, then you will get your blood sugar checked every three years. To lower your risk or prevent type 2 diabetes, talk with your doctor about maintaining healthy weight; eating a diet full of vegetables, fruits, lean protein, and whole grains; and increasing your activity level.  If you become pregnant again, you are likely to have gestational diabetes again.

If you may be at risk or have gestational diabetes, talk with your doctor or pharmacist today about a treatment plan that is right for you and your healthy baby.


  1. Gestational diabetes. American Diabetes Association website. Accessed December 21, 2021.
  2. Rethinking nutrition for gestational diabetes. Fullscript website. Accessed December 21, 2021. 
  3. Gestational diabetes. Mayo Clinic website. Accessed December 21, 2021.
  4. Gestational diabetes. Centers for Disease Control and Prevention website. Accessed December 21, 2021.
  5. PSA: Prenatal nutrition. Penn State University website. Accessed December 21, 2021.
  6. Dietary recommendations for gestational diabetes. University of California San Francisco website. Accessed December 21, 2021.
  7. Gestational diabetes. WebMD website. Accessed December 21, 2021.

The 6 Best Vitamins For Glowing, Youthful Skin

Nothing is more frustrating than trying several vitamin products that are supposed to have anti-aging effects, but really did not work. These products may not be cheap and having several failed attempts might be ‘breaking your bank.’ With so many skin care products available and all claiming to give your healthy skin, it can be challenging to determine which vitamins are best. So what are you to do now? Have no fear because we present the best vitamins for glowing, youthful skin without going over budget! 

Do oral vitamins help your skin?1-4

Oral vitamins do help your skin, but not as well as topical creams and ointments. When vitamins are taken orally, their benefits are sent all over your body, not just to your skin. Therefore, their ability to help decrease your fine lines, wrinkles, and pores; and combat dry skin is minimal. 

You may think going over your daily intake of vitamins will boost your skin, but it actually does the opposite. Any excess water-soluble vitamins like vitamins B and C will not hang around since your body already has what it needs, so the excess is excreted. Excess fat-soluble vitamins like vitamins D, E, K, and A are more dangerous since they stay in your body’s fat areas longer and can cause stomach problems, appetite loss, clotting, or irregular heartbeat.

What are the key vitamins for glowing, youthful skin?

You may already know vitamins are key to overall health of your body and functional processes, but do not forget about your largest organ, your skin! Whether you want to reduce fine lines and wrinkles, have more moisturized skin, or clear up redness, the best vitamins to meet your needs include vitamins E, C, A, D, B, and K. 

Vitamin E1

Vitamin E is an antioxidant that helps protect your skin from the sun’s rays that can lead to skin cancer and wrinkles, and it hydrates your skin. Your body makes vitamin E from sebum, an oily substance in your pores. So if you have dry skin, you may not be getting enough vitamin E. Adding a topical cream of vitamin E can help your skin obtain more moisture, so your skin is less cracked, rough, and dry. It even helps with healing skin burns, wounds, and scars! A great source of vitamin E includes nuts and seeds which can be incorporated into your diet during your snack breaks or with a cup of yogurt. 

Vitamin C1,5

Vitamin C is another antioxidant that helps collagen production, smoothes skin hyperpigmentation, and reduces environmental stress. Collagen is a protein that is responsible for skin stretchiness, so it has a major role in decreasing the signs of aging, like wrinkles and fine lines. It is largely found in foods like citrus-based foods, supplements, and topical creams. As a topical cream, it can be applied to reduce hyperpigmentation and help your sunscreen protect you from the sun’s harmful rays. These harmful rays damage your skin which can show signs of premature or accelerated aging.  

Vitamin A1,5

Another name for vitamin A is retinol. Like vitamins E and C, vitamin A is an antioxidant that protects you from sun damage, protects collagen, and speeds up cell turnover. This helps your skin make new blood vessels, and smooths and evens skin tone. Without vitamin A, your skin may look bumpy and dry. It even fights acne and clears up those pesky scars which may be a big problem for your teenagers. This product can be obtained over-the-counter or with a prescription. If you are looking for a product that helps with wrinkles called tretinoin, it is obtained with a prescription. 

However, these products are very powerful, so be careful when you first use them. You may notice redness and dryness at first because vitamin A increases your skin cell production at such a high rate. If you have any of these side effects, try using the product every other day. Try to use a lower concentration and apply at night to minimize irritation. If you use this product in the morning, it may make your skin more sensitive to the sun’s rays which is damaging to your skin.

Vitamin D1,5

You may be familiar with vitamin D’s ability to help strengthen your bones, but did you know it helps with evening your skin tone and treating psoriasis? Vitamin D is made by your body when you are exposed to sunlight, but you should not spend a lengthy amount of time outside without sunscreen – all you need is 10 minutes of sun exposure between 10 am – 2 pm. This vitamin product stands out from the others since it is not typically found in over-the-counter topical products. To increase your vitamin D production, try eating more foods like low-fat dairy, salmon, and tuna. If you have psoriasis, talk with your dermatologist about getting a prescription for a product with vitamin D in it.

Vitamin B1

Vitamin B is not a single vitamin, but several of them that include, thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), B6, biotin (B7), folate (B9), and B12. For skin care, vitamin B3 or niacin is commonly used to smooth skin, decrease dryness, and help treat eczema. Niacin works by increasing the number of lipids in your skin which helps your skin maintain its moisture and texture. It even has an added bonus of helping dark spots and wrinkles. It is found in many topical products too!

Another common vitamin B is B5 or pantothenic acid. The role of vitamin B5 is to keep your skin moisturized and hydrated while reducing skin inflammation. This is another reason why it is used to decrease skin redness. 

Vitamin K1,5

Do you have stretch marks, spider veins, dark spots, or scars? Vitamin K will be your best friend! Vitamin K has an important role in your body’s clotting process which is vital for when you have injuries and healing wounds. This may be why it can help clear your dark under-eye circles too. Topically, it is commonly used after surgeries to reduce swelling and heal wounds, but products can also be picked up over-the-counter for your skin care needs. It is even found in leafy greens like kale, spinach, and green beans.

So you may think these products may not be friendly to your budget, but they are over-the-counter and affordable at your local Josefs Pharmacy! A pharmacist would be glad to assist you with selecting the right products and counseling on proper usage.

How do I know what vitamins I may be lacking?1,2

Vitamins are needed for proper skin care, but you may be getting enough from your diet. The best way to determine if you are getting your adequate vitamin intake is by taking a blood test. Talk to your doctor about performing this test if you think you may have vitamin insufficiencies. Some of the lotions or creams you already use may have these key vitamins too! 

How do I select the best skin care products for me?1,2

When you are looking at skin products on your next trip at your local drugstore or Josefs Pharmacy, always review the product ingredients, pricing, and any potential interactions they may have with your current medications. Many companies claim to provide products that will help your skin needs, but that is not enough. If you are interested in getting the proper vitamins and products for your skin care needs, talk with your dermatologist or pharmacist today.


  1. The science of beauty: The complete guide to vitamins for skin health. Allure website. Accessed December 15, 2021.
  2. The 4 best vitamins for your skin. Healthline website. Accessed December 15, 2021.
  3. Can you overdose on vitamins? Healthline website. Accessed December 15, 2021.
  4. Sticker. My Loview website. Accessed December 15, 2021.
  5. Which vitamins are best for healthy skin? Apothecopharmacy website. Accessed December 15, 2021.

5 Ways to Treat Your Adrenal Fatigue Naturally

Do you constantly feel tired, stressed, and have muscle aches? Seem to always be craving salty or sweet foods? You might feel like you have ‘brain fog’ and cannot remember things. You may have talked to your doctor and it appears nothing is wrong with you. It is frustrating to have these problems without knowing what it is or how to fix it. You may blame it on your busy and fast-paced lifestyle, but it actually could be a syndrome called adrenal fatigue. Most doctors do not think this is real, but functional medicine doctors have a different approach. Here are 5 nutrition, stress management, and supplement tips on how to help your adrenal health! 

What is adrenal fatigue?1-4

Your adrenal glands sit right above your kidneys and are responsible for releasing cortisol, the stress hormone, and adrenaline. They are part of the ‘fight or flight’ response that help to increase your heart rate and blood pressure in stressful situations. These help give you the energy to complete your daily tasks and power to overcome stress situations like dealing with work deadlines. 

Adrenal fatigue is a syndrome that is associated with several symptoms like extreme tiredness and mood swings. It often comes from chronic stress like the loss of a loved one or worsening of a preexisting condition like diabetes. This results in a greater release of cortisol until the stress is too much and your adrenal glands get tired. The hormone release becomes irregular and lower than it should be, leading to symptoms.

Here are the symptoms:

  • Constantly feeling tired or struggling to wake up in the morings
  • Difficulty sleeping
  • Muscle aches
  • Weight gain
  • Brain fog
  • Depression
  • Anxiety
  • Lightheadedness
  • Hair loss 

The symptoms of adrenal fatigue are nonspecific and you may notice you have quite a few of them. That is what makes it so hard to determine if you have poor adrenal health or if it is another condition like depression or entering menopause.

How do I know if I have adrenal fatigue?1-3

If you have some signs or symptoms of adrenal fatigue, you might want to consider getting an adrenal fatigue or cortisol test. This test measures the level of cortisol in your blood or saliva. Cortisol is typically higher in the mornings to give you energy to tackle your day and lower in the evening, so you can sleep. If you have adrenal fatigue, your body is not producing enough cortisol which can lead to limiting symptoms like constantly feeling tired or anxious, or other health issues.

If you think you might have adrenal fatigue, talk to your doctor or functional medicine doctor about obtaining an adrenal fatigue test. 

What are the treatment options?3,5

  • Improve your diet – Your diet affects your energy level and sleep quality. By focusing on a diet full of healthy fats like monounsaturated and polyunsaturated, vegetables, and grass-fed or wild-caught meat. Healthy fats include nuts, fish, avocado, seeds, olive and oil. Try limiting your intake of inflammatory foods like processed snacks, sugar, and alcohol. This diet decreases inflammation that may be affecting your symptoms, so try to incorporate a few of these foods into your daily meals.
  • Stress management – This is one of the most important ways to promote adrenal health – fix the problem at the main source! Lowering your stress calms you and promotes your well-being. You could try mediating a few minutes a day, yoga, or listening to a podcast on an afternoon walk. Really, just whatever makes you calm and relieves your worries.
  • Get quality sleep – If you do not have good sleep, it is definitely difficult to concentrate and go about your day. When your cortisol levels are irregular, this makes it even more difficult to sleep and adds to your stress. Aim for at least 7 to 8 hours of sleep per night, but quality sleep is more important than the quantity of sleep.
  • Decrease caffeine intake – This includes your daily cups of coffee! Coffee boosts cortisol levels which adds to your already abnormal levels. It is recommended to avoid coffee if you drink it every now and then, but if you already drink it daily, you are already tolerant of this ability. Try limiting your intake after 2 pm to avoid more sleep problems since caffeine can keep you awake.
  • Nutritional supplements – Supplements like magnesium, inositol, L-theanine, and ashwagandha promote stress reduction and improving mood. If you need more muscle pain, magnesium may be a better choice while L-theanine can easily be found in green tea to help relaxation. Choosing a supplement can be overwhelming, but you should not select a product alone. Josefs Pharmacy offers a variety of quality and affordable supplements. A pharmacist would be happy to help choose the safe and effective supplement for you.

Could it be something else?3,7

If you think something is wrong with your adrenal glands, think, is there a stressor in your life? What could be causing it? Even if you do not have adrenal fatigue, stress management is key for prevention and lowering your risk of health diseases like heart disease.

If you have any of those symptoms mentioned earlier, it could be something else. The symptoms of anxiety and depression mirror these symptoms which can be treated with antidepressants and counseling. Other possible conditions include anemia; sleep apnea; menopause; autoimmune diseases; and heart, kidney, or liver problems. 

If you think you have adrenal fatigue or want to learn more about natural and pharmacological treatments, talk with your doctor or pharmacist today.


  1. Anderson, P. Adrenal functional medicine. ZRT Lab website. Accessed November 23, 2021.
  2. Adrenal fatigue: What causes it? Mayo Clinic website. Accessed November 23, 2021.
  3. You might have adrenal fatigue, here’s how to treat it naturally. Dave Asprey website. Accessed November 23, 2021.
  4. Adrenal fatigue symptoms and treatment. Enjoy Natural Health website. Accessed November 23, 2021.
  5. Adrenal fatigue: Tired, wired, foggy & fat. Arbor Health website. Accessed November 23, 2021.
  6. Adrenal fatigue: Is it real? WebMD website. Accessed November 23, 2021.
  7. Is ‘adrenal fatigue’ real? Harvard Health website. Accessed November 23, 2021.

Slowing Down Feline Hyperthyroidism: Is Methimazole Worth It?

Your cat has been your best pal for years. You make sure your cat is pampered and feels loved. It hurts you that your furry friend no longer wants to play and constantly feels fatigued with hyperthyroidism. Your veterinarian may prescribe the only antithyroid medication known as methimazole. What is methimazole and will it work? What do I do if my cat will not take the tablets? Compounded medications can save the day and help your cat get back to long days of playtime and meowing. Purr-fect! 

What is hyperthyroidism?1-3

When the thyroid gland, a butterfly-shaped gland in the neck, is enlarged and over produces thyroid hormone, this is known as hyperthyroidism. Thyroid hormone is responsible for the body’s metabolism, growth, and development, so it has a huge effect all over the body. It is one of the most common diseases in cats that typically occurs during their middle ages. No breeds are at a greater risk, but Siamese, Persian, and Himalayan cats have less of a risk. 

Symptoms include weight loss, increased appetite, frequent urination, increased thirst, weakness, greasy hair, restlessness, aggressive behavior, depression, difficulty breathing, and stomach problems. The symptoms may be mild at first, then they become more severe over time. If you notice these signs in your cat, you may want to check with your veterinarian about performing a thyroid test.

If your cat is diagnosed with hyperthyroidism, your veterinarian may prescribe methimazole. The prognosis for cats being treated with hyperthyroidism is promising. Your cat will have a better quality of life and can continue to be your snuggle buddy, so it is worth getting treatment! 

What is methimazole?2,4

Methimazole is an antithyroid medication, so it works by suppressing your cat’s thyroid to release a normal amount of thyroid hormone. Since the thyroid works all over the body, this medication helps decrease the risk of your cat getting high blood pressure and heart disease. Thyroid hormones increase your cat’s heart rate, so more blood is pumped faster around the body which can damage the eyes, liver, and other organs. This would require more medications and even surgery. Methimazole helps your cat continue to live a healthy and long life by managing the thyroid, but it is not a cure. This medication is given for the rest of your cat’s life. 

Josefs Pharmacy offers the generic version, methimazole, that is less expensive than the brand name, Felimazole, and will work with your pet’s insurance to give you an affordable price.

Does methimazole work?5

In a 3-year study with 60 cats with hyperthyroidism, methimazole compounded transdermal gel was shown to have less side effects and lower thyroid levels within a normal range with regular monitoring. The pet owners found the gel to be easier to give than the manufactured oral tablets. The tablets were also associated with more side effects like stomach issues. However, this medication is given lifelong and dose adjustments may be needed after getting an established dose. 

How do I give methimazole to my cat?4,6

Administer methimazole just like your veterinarian told you. Always wash your hands before and after giving this to your pet. The oral tablet and oral compounded liquid can be given to your pet on an empty stomach or with food. Giving it with food helps your pet feel less sick. Never crush or break the oral tablets. 

This medication also comes in a compounded transdermal gel that can be applied on hairless skin like the inside of the ears. Rubber gloves should be worn when applying the gel. It is important you measure the liquid and gel doses properly to give your cat the correct dose. Giving your cat too much or too little can cause the medication to fail or be toxic. 

It takes a couple of weeks for this medication to work, so you will not notice improvement in signs immediately. If you miss a dose, give it to your cat as soon as you remember unless it is close to the next dose. Then, skip the missed dose and return to the normal dosing schedule. Never double up on doses. 

What are the side effects?4,5

Your cat may experience tiredness, vomiting, and weight loss within the first 3 months of treatment. Your veterinarian may shortly stop the medication and prescribe a lower dose. Less common side effects include upset stomach, itchiness, and low blood cell counts. In cats with liver or kidney disease, this medication may cause more side effects. Let your veterinarian know if your pet experiences any of these effects. 

Is there any special monitoring with this medication?5,6

Your veterinarian will check your cat’s thyroid levels before starting treatment, then every 2 weeks for the first 3 months of therapy. This is to make sure the medication is working right without limiting side effects. Once the appropriate dose is determined, thyroid levels are checked every 3 to 6 months. Even after the dose is established, it may need to be adjusted as your cat continues long-term treatment. It is crucial your cat is regularly monitored to make sure the medication is working and your cat is not at risk of toxic effects. 

What is the difference between the manufactured and compounded methimazole?5,6

The compounded forms, liquid solution and transdermal gel, work just like the compounded oral tablet. The tablet has a bitter taste, so it may be difficult giving this to your cat. Your cat may not like the taste, have trouble chewing, or have trouble swallowing, so a liquid or gel may be better. The gel is applied inside the ears, so it may be easier for both you and your pet. That is the beauty of compounded medications, they make it easier for your fur baby!  

 A pharmacist at Josefs Pharmacy can help you make this switch to a formulation that is both easier for you to give and your cat to take. Compounded medications can be more expensive, but Josef’s Pharmacy will help you get the best treatment in a form your pet will enjoy with the best price.

Can I share my thyroid medications with my cat?6

If you have a medication that is for treating your thyroid or for your child, do not share them with your cat. We may think of our pets as our children, but they do not get the same medications as us or respond to them like us. Human medications are different from vet medications and they can be toxic to your cat. It is only legal to use medications in the people that are prescribed them. You may take your daily thyroid medication and think you can split the tablet with your cat, but it actually could be too much for your cat since thyroid medications are highly personalized.

Methimazole Safety Tips4,5

  • Keep this drug out of reach of children and pets.
  • Let your veterinarian know if your cat takes any vitamins, supplements, or medications that may affect methimazole.
  • Methimazole tablets should be stored away from light in a dry place at room temperature. Compounded products should be stored according to the compounding label.
  • Do not use this medication if your cat is pregnant or nursing.

If you have questions about treating your cat’s hyperthyroidism with compounded or manufactured medications, talk with your veterinarian or pharmacist today.


  1. Cat hyperthyroidism (overactive thyroid). WebMD website. Accessed November 14, 2021.
  2. Hyperthyroidism in cats. Cornell University website. Accessed November 14, 2021.
  3. Caring for an ill senior cat and the lessons I learned along the way. Ethos website. Accessed November 14, 2021.
  4. Methimazole. VCA hospitals website. Accessed November 14, 2021.
  5. Methimazole: Management of feline hyperthyroidism. Today’s veterinary practice website. Accessed November 14, 2021.
  6. Methimazole transdermal gel and cream for cats. Avriorx website. Accessed November 14, 2021.

Histamine Intolerance or Allergy?: Solving Your Mystery Symptom

Have you ever had mysterious headaches or skin rashes? Does your nose suddenly begin to run when you eat avocados or bananas? You may have thought it was an allergy, but you also felt the same when you ate other types of food like cheese. You may have histamine intolerance based on those foods having higher amounts of histamine than you are able to break down. Luckily, there are treatment options for you. Read on to learn if diamine oxidase (DAO) supplements could be helpful for you!

What is DAO?1,2

DAO is an enzyme that is used to help break down your foods that contain histamine. Histamine is a chemical released by your immune cells to promote inflammation and respond to allergens. When your body detects something that it thinks is going to harm you like if you eat peanuts and have a peanut allergy, it begins a protective response by releasing histamine. If you do not have enough DAO or your body makes too much histamine, you may feel sick after eating foods that are high in histamine. This is called histamine intolerance

What is histamine?2,3

Histamine is a neurotransmitter released by your immune cells to communicate to your intestines, brain, heart, skin, and lungs. It is a promoter of an immediate inflammatory reaction. Histamine is released when it is triggered by an allergen like dust, pollen, or something that it thinks will harm your body. Histamine levels increase and bind to their receptors for activity which can lead to symptoms of runny nose, sneezing, and difficulty breathing. You may have heard of antihistamines being used for seasonal allergy symptoms. Their role is to prevent the histamine reaction from occuring, not lowering histamine levels. Histamines are also involved in food allergies which trigger allergic reactions.

What is histamine intolerance?1,4

Histamine intolerance is a condition where you have high levels of histamine in your body. It can be caused by over-making histamine, not making enough DAO, eating too many foods high in histamine, drinking alcohol, medication, and genetic mutations. If you do not have enough DAO, your body is not able to eliminate histamine normally, so histamine builds up in your body and may cause uncomfortable symptoms. A high amount of histamine in your body can cause the following symptoms: migraines, bloating, gas, stomach pain, constipation, diarrhea, vomiting, muscle aches, pain, runny nose, difficulty breathing, hives or skin rash, itchy skin, and dizziness.

What foods are high in histamine?1,2,5

The following foods are high in histamine and may be causing your symptoms: avocados, nuts, mushrooms, eggs, shellfish, soybeans, chocolate, strawberries, pineapple, dairy products, food preservatives, and alcohol like beer and wine. Have you noticed any histamine intolerance symptoms when eating these foods? It is helpful to know your food triggers, so removing these foods for a month before reintroducing them may help determine your triggers. Your symptoms may be caused by eating some of these foods and some symptoms may be more severe than others. 

Is histamine intolerance an allergy?6

No, histamine intolerance is not an allergy because it is not caused by one type of food. Histamine intolerance is caused by foods that are high in histamine, so it can be several foods that irritate you. This also makes it harder to figure out what foods are giving you symptoms since there can be several different types of food from bananas to a glass of wine. Histamine intolerance may only occur in 1% of the population, but there are treatment options for you!

What are the benefits of DAO supplements?2,4

DAO supplements provide your body with DAO, so it can break down histamine in your food and help relieve your symptoms of histamine intolerance. Based on research, DAO supplements best help with the following symptoms and issues:

  • Headaches – DAO supplements may help reduce your headache severity based on a study with people who had low DAO amounts after taking them for a month. The length of headaches was reduced by 90 minutes.
  • Digestive issues – The amount of histamine in your body may not only be lowered, but it may promote healing and less inflammation of your gastrointestinal tract. In a four-week study with people that had poor levels of DAO, DAO supplements helped lower the intensity and amount of stomach problems like constipation, bloating, and diarrhea.
  • Skin irritations – If you develop rashes, hives, or itchy skin after eating foods high in histamine, DAO supplements may help reduce these symptoms. In a 30-day study with 20 people, they received relief from itchy skin rashes and ended up needing less DAO supplements later on.

DAO supplements do not cure histamine intolerance and do not lower the amount of histamine your body makes, they only break down histamine you obtain from your diet. These supplements may not provide the same level of benefits or work the same for everyone. Studies have shown the benefits of DAO supplements, but more research is needed to fully understand their effects and usage.

What are the risks of DAO supplements?4,7

One of the risks with taking DAO supplements is that there is not a formal test to diagnose it. The symptoms of histamine intolerance can overlap with symptoms of other conditions too. If you think you may have histamine intolerance and take DAO supplements, but do not actually have it, this may be harmful. That is why it is important that you talk with your doctor or pharmacist if you are having symptoms from eating foods high with histamine, so they can help you create an appropriate treatment plan.

Another risk is that not all supplements are made with the same safety and efficacy standards since they are not highly regulated by the Food and Drug Administration (FDA) like drugs are. It is best to speak with a pharmacist before you select a supplement. One thing to look for when selecting a supplement is to find one that has United States Pharmacopoeia (USP) approval. USP approval means that the supplement contains all the ingredients on its label; has been tested for purity, stability, and potency; and has been made following Good Manufacturing Practices (GMP). Once you find a supplement, you should stick with that brand because not all DAO supplements have the same ingredients or the same dose. 

Are there alternatives to DAO?2,4,8

Yes! Instead of taking DAO supplements, you could manage your symptoms by increasing the amount of copper, vitamin B6, vitamin B12, vitamin C, phosphorus, zinc, magnesium, and iron in your diet. These vitamins and minerals are involved in breaking down the amount of histamine in your body, so if you increase their levels, your body will better be able to eliminate histamine. If you are having trouble eating foods with these vitamins and minerals, you could consider taking a daily multivitamin. Here are some great food sources:

  • Copper – grains, beans, potatoes, and dark leafy greens
  • Vitamin B6 – poultry, oats, tuna, and dark leafy greens
  • Vitamin C – peppers, broccoli, and brussel sprouts
  • Phosphorus – whole grains, chicken, turkey, and lentils
  • Zinc – poultry, beans, and whole grains
  • Magnesium – whole grains, dark leafy greens, and potatoes
  • Iron – sweet potatoes, oatmeal, peas, and chicken

Another way is by following a low-histamine diet. Foods that are low in histamine include vegetables except spinach and eggplant; fruits except berries, citrus, and tomato; olive oil; and grains like rice and quinoa. By limiting your histamine intake, this could improve your symptoms by as much as a 50% reduction. You could also try to eliminate those foods that cause you the most symptoms. A low-histamine diet may help you figure out which foods cause you the most symptoms.

If you are having symptoms of histamine intolerance and are considering taking supplements, talk to your doctor or pharmacist today.


  1. What to know about diamine oxidase (DAO) for histamine intolerance. WebMD website. Accessed October 25, 2021.
  2. Histamine intolerance: All you need to know. Amy Myers MD website. Accessed October 25, 2021.
  3. What are histamines? WebMD website. Accessed October 25, 2021.
  4. What is DAO? Diamine oxidase supplements explained. Healthline website. Accessed October 25, 2021.
  5. Chronic allergies or a histamine intolerance? How to tell for sure. The Demspter Clinic website. Accessed October 25, 2021.
  6. Your mystery food sensitivity might actually be a histamine intolerance. ENT and allergy website. Accessed October 25, 2021.
  7. What you need to know about dietary supplements. FDA website. Accessed October 25, 2021.
  8. The best foods for vitamins and minerals. Harvard website. Accessed October 25, 2021.

Settling Down Your Pet’s IBD With Budesonide

Our pets are like our children, we want the best for them and we do not like to see them in pain. One of the biggest issues our pets can face is having irritable bowel disease (IBD) which affects your pet’s gastrointestinal system in the form of recurrent upset stomach. You may have heard of budesonide being used to treat IBD in humans, but did you know it can be used in our cats and dogs too? How and is it safe? This easy read will break down IBD and its signs, and answer your questions to best help treat your fur-baby.

What is IBD?1-4

Not only is IBD common in humans, but it also is a problem for cats and dogs. IBD is a chronic condition where the gastrointestinal tract becomes inflamed and disorganized due to the body’s immune response. When toxins, bacteria, parasites, or certain proteins your pet digests reach the intestines, it may cause the body to create an inflammatory reaction and irritate your intestines. The genetic make-up of your pet can make them more likely to get IBD. Your pet may be more susceptible to certain triggers or not be able to control the immune response. Breeds like Basenjis, Wheaten Terriers, Yorkshire Terriers, Boxers, German Shepards, and Norwegian Lundehunds are at an increased risk of IBD. The gastrointestinal membranes and cells are highly organized to digest your food, so when this is destroyed, this creates an issue with your pet’s ability to move and absorb nutrients. This is not irritable bowel syndrome (IBS) which is a collection of gastrointestinal symptoms that is linked to stress. Unfortunately, pets are rarely cured of IBD because it is hard to determine the exact cause.

What are the signs of IBD?3,5

IBD affects the gastrointestinal tract, so the signs include diarrhea, vomiting, weight loss, and poor appetite. If the stomach is the issue, your pet will typically experience recurrent vomiting while if the intestine is the issue, your pet will experience recurrent diarrhea. Vomiting and diarrhea will present at least weekly, so this is a chronic condition instead of presenting every now and then. IBD is diagnosed once all other possible causes have been ruled out – it is a tricky diagnosis! Your veterinarian will diagnose it after examining your pet’s blood, feces, and intestine imaging reports.

How is IBD treated?3,5

The treatment goal is to provide relief that can be done through a combination of diet changes and medications. Typically a new diet is started like a high fiber, hypoallergenic, or low residue diet. Many pets start a hydrolyzed protein diet that includes proteins that are already digested and are too small to be recognized by the immune system as a threat. A hydrolyzed diet prevents your pet’s immune system from causing an inflammatory reaction and upset stomach. When starting a new diet, it takes about 6 to 12 weeks to determine your pet’s response and diet changes. After the 12 weeks, your pet may be able to return to the previous diet. When starting a new diet, you should not give your pet other foods or treats. Sometimes a diet alone is not enough and corticosteroid drugs like budesonide are used to help treat your pet’s symptoms. Probiotics may be recommended to restore your pet’s healthy gut bacteria and digestive functioning since IBD disrupts the normal bacteria. Depending on your pet’s vitamin B12 levels, your pet may need vitamin B12 injections to help absorb nutrients from food.

What is budesonide?1

This name may sound familiar to you because budesonide is also used orally to treat IBD, and inhaled to treat asthma and Chronic Obstructive Pulmonary Disease (COPD) in humans. Budesonide is a steroid or glucocorticoid that is used for treating inflammatory diseases like IBD. It is commonly used for pets that do not tolerate other steroids like prednisone. Budesonide works locally in the intestines after giving it instead of traveling all over the body to have effects because of its poor absorption. Budesonide does not cure IBD, but it helps relieve your pet’s symptoms.

How do I give budesonide to my pet?1,6

Give budesonide just like your veterinarian told you. It comes in the form of a tablet, capsule, oral suspension, and gel. If it is a capsule, do not crush or let your pet chew it. If your pet misses a dose, give the dose as soon as you remember it and return to the normal dosing schedule. If it is close to the next dose, skip the missed dose and return to the normal dosing schedule. Never give double doses. After giving the medication, be sure to wash your hands.

What are the side effects of budesonide?1

Side effects include increased appetite, thirst, urination, and hair color change. If your pet shows signs of weakness, black and tarry stools, bloody stools, or an inflated belly while taking budesonide, contact your veterinarian as soon as possible. However, do not stop giving this medication abruptly because it could cause weakness, collapsing, vomiting, and death. This medication should not be used if your pet is allergic to it. 

What happens if my pet overdoses?1,6

If you think your pet has overdosed on budesonide, immediately contact your veterinarian and bring the medication with you or the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Poison Control Center

What could budesonide interact with?1

Budesonide should not be used with the following medications: erythromycin, cimetidine, ketoconazole, itraconazole, fluconazole, and diltiazem. If used with these medications, budesonide could cause toxicity because it will be inhibited from being metabolized and eliminated from your pet’s body.

When will my pet feel better?5

After taking the medication for a couple of days, the medication should start working. It is more difficult to see how your pet is feeling, but your veterinarian will continue to monitor and do tests to see how your pet is improving. Most pets remain on medication and a fixed diet for life.

What other safety information should I know?1,6

  • Be sure you keep this medication out of the reach of children or your pet. Even though budesonide is used in people too, only give this medication to the pet it was prescribed for. 
  • If your pet has an infection, ulcer, diabetes, cataracts, or poor liver function, be sure to tell your veterinarian and use it with caution.
  • If your pet is about to have a surgery, make sure your veterinarian knows your pet is taking this medication.

If you have any questions about treating your pet’s IBD or budesonide use in animals, contact your veterinarian or pharmacist today.


  1. Budesonide for veterinary use – IBD in cats and dogs. Wedgewood pharmacy website. Accessed October 13, 2021.
  2. Inflammatory bowel disease in dogs and cats. Veterinary partner website. Accessed October 13, 2021.
  3. Inflammatory bowel disease (IBD) in dogs and cats. Today’s veterinary practice website. Accessed October 13, 2021.
  4. Irritable bowel disease. Brookfield animal hospital website. Accessed October 13, 2021.
  5. Inflammatory bowel disease in dogs. VCA hospitals website. Accessed October 13, 2021.
  6. Budesonide for dogs and cats. Wedgewood pharmacy website. Accessed October 13, 2021.

COVID-19 Booster Dose: Frequently Asked Questions

Since before COVID-19 vaccines were made available, there has been speculation on if initial vaccination would be sufficient or if there would be recommendations for yearly vaccination, like the flu shot. As the vaccines continue to be studied and more information about COVID-19 becomes available, every effort is being made to ensure that you have the information and tools necessary to protect yourself from COVID-19 infection. Based on the data available, the FDA has recently authorized an additional dose or booster dose of certain COVID-19 vaccines for patients meeting specific criteria. At this time, only one COVID-19 booster dose is recommended. 


The term “booster” is used to describe an additional dose of a vaccine that is given to boost your immune system. The booster shot helps you to maintain immunity and keep you protected against COVID-19 after the immunity from the first two doses begins to naturally decrease over time.1


Studies have shown that COVID-19 vaccines are effective at preventing severe disease and reducing the risk of hospitalization, but protection against the virus may decrease over time. This is due to natural waning of immunity, which is why a booster dose is needed.2 Other routine vaccinations, such as the tetanus shot, require booster doses for the same reason. A booster dose triggers a memory response within your immune system so that your immune system is able to respond quickly if you are ever exposed to the virus.1 With the emergence of COVID-19 variants that are highly infectious, such as the Delta variant, it is extremely important to maintain immunity, which can be done through a booster dose. One study on the Pfizer-BioNTech vaccine showed that a booster dose increased patients’ immune response, which provides increased protection against COVID-19, including variants.2


The FDA has authorized the Pfizer booster dose for those meeting certain eligibility criteria as listed in the next section. For patients meeting this criteria, the booster dose can be given at least 6 months after the second dose. 2  

For patients with moderate to severe immunocompromising conditions, such as those listed in the next section, the FDA has authorized a third dose of Pfizer and Moderna. For these patients, the third dose can be given at least 28 days after the second dose. This additional dose is given sooner because patients with weakened immune systems are more likely to have severe illness if infected with COVID-19 and are less likely to develop sufficient immunity after only two doses of the vaccine.3

Currently, an additional dose of Moderna is only authorized for immunocompromised patients and not yet available for others. The Johnson & Johnson COVID-19 vaccine has not not been authorized for booster doses.

The FDA is consistently reviewing data on COVID-19 vaccines, and booster doses that are not currently available for patients who do not meet the following criteria may become available at a later date. 


According to the CDC, you should get the Pfizer booster dose if you have completed the 2-dose Pfizer series at least 6 months ago and fall into one of the categories below:

  • 65 years of age or older
  • 50-64 years old with underlying medical conditions (obesity, asthma, heart disease, high blood pressure, diabetes)
  •  A resident of a long-term care facility and at least 18 years old

If you do not meet the above criteria but would like to get a booster dose, you may get the Pfizer booster dose at least 6 months after completing the 2-dose Pfizer series if you fall into one of the categories below:

  • 18-49 years old with underlying medical conditions (obesity, asthma, heart disease, high blood pressure, diabetes)
  • 18-64 years old and working in a high-risk setting where you may be exposed to COVID-19 (healthcare workers, first responders, teachers, retail and restaurant workers, public transportation workers, etc.)
  • 18-64 years old and living in a high-risk setting where you may be exposed to COVID-19 (correctional facilities, homeless shelters, college dorms, any group living setting).2,4

If you have one of the following immunocompromising conditions, you should get a third dose of Pfizer or Modera at least 28 days after completing the 2-dose series:

  • Active cancer
  • Organ transplant and taking medication to suppress the immune system
  • Stem cell transplant within past 2 years or currently taking medication to suppress the immune system
  • Advanced or untreated HIV
  • Active treatment with medications that suppress the immune system.3,4


The CDC currently recommends that any additional dose match the vaccine that you initially received. This means that if you completed the 2-dose Pfizer series, your next dose should be the Pfizer vaccine, but if you completed the 2-dose Moderna series, your next dose should be the Moderna vaccine. Some exceptions do exist where your next dose could be different than what you previously received. If you are unsure of which vaccine you should be getting for your booster dose, please contact your doctor or pharmacist.3  


At this time not everyone has been made eligible for a booster dose of the COVID-19 vaccine. However, it is important to stay alert to changes in eligibility as new information is made available often. If you have any questions about eligibility or updates in the media, reach out to your doctor or pharmacist to get the most accurate information. In the meantime, it is important to continue safe practices as recommended by the CDC which include wearing a mask, frequent hand washing, avoiding crowds, and practicing social distancing.5    


  1. Will you need a COVID-19 booster? What we know so far. Published July 27, 2021. Updated September 24, 2021. Accessed October 4, 2021. 
  2. Who is eligible for a COVID-19 vaccine booster shot? Updated September 30, 2021. Accessed October 4, 2021. 
  3. COVID-19 vaccines for moderately to severely immunocompromised people. Updated September 2, 2021. Accessed October 4, 2021. 
  4. COVID-19 vaccine boosters and additional doses. Accessed October 4, 2021.
  5. COVID-19 and your health. Centers for Disease Control and Prevention. Updated 2021. Accessed September 30, 2021.

COVID-19, flu, and common cold: What’s the difference?

It’s that time of the year again – the influenza (flu) and common cold season! The COVID-19 pandemic makes it even tricker to understand their symptoms and know which is which. You may be thinking you have a fever and are wondering if it is flu or COVID-19? Is my cough because of the common cold or COVID-19? How do I treat them and can they be prevented? Here is a simple explanation of their symptoms, what to do if you think you are infected, when to visit your provider, and how to prevent them.

How are COVID-19, flu, and common cold different?1,2

COVID-19, common cold and flu are all caused by different contagious upper respiratory viruses. COVID-19 is caused by the SARS-COV-2 virus. COVID-19 symptoms present between 2 and 14 days of getting the virus. The common cold can be caused by rhinoviruses, parainfluenza, and seasonal coronaviruses, but this is not the COVID-19 virus. Symptoms present between one and three days after being exposed.  The flu is only caused by influenza viruses and symptoms present between one and four days of being infected. COVID-19 is a more serious illness, takes longer to show symptoms, and the contagious period to infect others can last longer than the others. The flu typically has more intense symptoms and can result in pneumonia and bacterial infections, unlike the common cold. Both COVID-19 and the flu can result in hospitalizations. People with colds typically have a runny or stuffy nose than those with the flu. The common cold normally does not have severe complications like COVID-19 and the flu. The flu can be treated with medications prescribed by your physician, but there is no cure currently for COVID-19 and the common cold. Unlike the common cold, COVID-19 and flu have vaccines available to prevent them or protect you against the severity of the illnesses.

How are they alike?1,3,4

Since they are all respiratory illnesses, they can all affect your breathing and blood vessels. They spread by being within six feet of others and by the release of respiratory droplets when you cough, sneeze, or speak. They also spread by touching a surface someone has touched with one of these illnesses, then you touch your nose, mouth, or eyes. You can affect someone a day before you experience any symptoms.

Both the flu and COVID-19 share the following symptoms: cough, fever, chills, shortness of breath, fatigue, sore throat, runny or stuffy nose, muscle pain, headache, loss of taste or smell, and vomiting and diarrhea. The common cold can also causes headache, fever, cough, runny or stuffy nose, fatigue, and sore throat. The loss of taste or smell is more common with COVID-19, but it can occur from the flu or common cold. You could have none, few, or many symptoms that are mild or serious because these illnesses differ in everyone. COVID-19 and flu can cause severe complications like pneumonia, organ failure, heart attack, stroke, respiratory distress, and death. Those at the highest risk for the flu and COVID-19 include pregnant women, people over 65 years old, and those with other medical conditions like diabetes, kidney disease, heart disease, hypertension, cancer, lung disease, asthma, liver disease, immunocompromised, and obesity.

What are the symptoms of each?1,5

The common cold is more mild and can be cleared within a week without treatment. The symptoms include runny nose, fatigue, chills, cough, sneezing, sore throat, and headaches. Fevers are more common in children than adults. You should not feel limited to complete basic tasks, but you may not be able to carry out your daily activities as actively. The flu symptoms are like the common cold symptoms, but include a fever and muscle pain. You may also feel more tired and the symptoms typically last about a week. COVID-19 symptoms may first appear like the common cold or flu with cough, fever, and fatigue. Many people report a loss of taste or smell early on. Later, you may feel shortness of breath or muscle pain which means you should contact your physician. The symptoms can be present for a short or long time depending on the person, but they typically last two weeks.

Testing is needed to confirm a diagnosis since it is not just based on symptoms. Only a doctor can diagnose you of a disease. If you experience symptoms, contact your physician.

What do I do if I have COVID-19, flu, or cold symptoms?3,6

If you end up getting one of these viruses, it is best not to spread the infection to others, stay home from work, and take care of yourself with plenty of rest and stay hydrated. If you have a fever, you should stay home from work and treat it with over-the-counter fever reducing medications. You should not return to work until you have stayed home with your fever and at least 24 hours after the fever without using medication. You could also contact your physician for an appointment and treatment plan or visit the emergency room if you have serious symptoms.

Which symptoms should I immediately tell my provider?5

Regardless of the diagnosis, you should tell your provider of the following symptoms: shortness of breath, chest pain, persistent pain, sudden confusion, pale skin, and trouble falling asleep or staying awake. These may indicate something more serious. If you are over 65 years old or have other conditions like diabetes, cancer, lung disease like asthma, kidney disease, pregnancy, current smoker, or are immunosuppressed, you are at a higher risk of illness complications. If you are fairly healthy without other diseases, the following symptoms can be best taken care of by staying home, wearing masks in public areas, and getting rest: cough, sore throat, fatigue, headaches, loss of taste or smell, and muscle aches. 

Can I have the flu, common cold, and COVID-19 at the same time?3

Yes, these are different viruses, so it is possible to have more than one at the same time.

Can the flu become COVID-19?3

No, the flu and COVID-19 are different viruses, so one cannot turn into the other. 

How can I avoid the flu and COVID-19?3,5

Last year, social distancing and wearing masks helped the flu season be more mild than it normally has been, but as restrictions lift, the flu season this year may be more intense. There will likely be an increase in flu cases, so it is important to get your flu vaccine this year. Research has shown that getting the flu vaccine may reduce your risk of getting COVID-19, but the flu vaccine does not prevent COVID-19. According to the Centers of Disease Control and Prevention, “Getting a flu vaccine is more important than ever during 2020-2021 to protect yourself and the people around you from flu, and to help reduce the strain on healthcare systems responding to the COVID-19 pandemic.”

If you have not already gotten your COVID-19 vaccine, this would also help reduce your risk of getting COVID-19 and the severity of its complications. Other precautions include avoiding large gatherings; staying within six feet of others outside of your household; wash your hands with soap and water for 20 seconds or use a hand sanitizer with at least 60% alcohol; wear a face mask in public spaces; avoid touching your eyes, nose, and mouth; cover your mouth and nose when you sneeze or cough with your elbow; and clean high-touch surfaces like doorknobs and counters daily. For all of them, social distancing, wearing masks, and limiting time in public areas helps reduce the spread of them.

Josefs pharmacies offer COVID-19 and flu vaccines. COVID-19 vaccines are by appointment only and are free, so click here to schedule an appointment. Click here to find a location near you to reserve your appointment online or walk-in for flu vaccines. You can get the flu vaccine free of charge with participating insurances. 


  1. Similarities and differences between flu and COVID-19. CDC website. Accessed October 1, 2021.
  2. Cold versus flu. CDC website. Accessed October 1, 2021.
  3. COVID-19 vs. flu symptoms: How can you tell the difference? Health partners website. Accessed October 1, 2021.
  4. COVID-19 vs. flu: Similarities and differences. Mayo clinic website. Accessed October 1, 2021.
  5. Coronavirus, the flu or the common cold? Here’s what to know. Global news website. Accessed October 1, 2021.
  6. How to tell the difference between COVID-19 and flu symptoms (because they can look very similar). Real simple website. Accessed October 1, 2021.
  7. COVID-19, cold, allergies, and the flu: What are the differences? Mayo clinic website. Accessed October 1, 2021.

Combating the Opioid Epidemic with Innovative Treatments

Everyday in the United States, 41 people lose their lives due to opioid prescription overdose.1 National Pain Awareness Month is not only a time to bring awareness that chronic pain is real and that it can affect you emotionally, physically, and mentally, but that opioid abuse and misuse exists. Opioids are often prescribed after surgeries and trauma events like car accidents and to treat chronic pain, but they can have dangerous side effects. How can this be prevented? These effects can be avoided by using innovative, non-drug treatments that are safer!

What are opioids?2

Opioids are related to the opium poppy that comes from the opium plant that has pain relieving effects. Opioids act centrally at opioid receptors to affect your brain and spinal nerves by blocking pain signals from reaching your brain. They reduce the release of painful chemical signals, so pain is not felt. However, they come with risks of abuse, dependence, addiction, respiratory depression, confusion, restlessness, and euphoria or extreme pleasure. Opioids change how your brain functions, so they can lead to tolerance where you will need more of the drug to reach the same level of effect or dependence which is when you start to feel sick if you do not take them regularly. You do not know how opioids will affect your brain before you take them and not everyone on them becomes addicted. Addiction can even result from taking them as prescribed. 

Addiction or Opioid Use Disorder is associated with compulsive behaviors to continue getting and taking opioids. You continue to take them even when you know they hurt your relationships and damage your ability to perform your work, school, and home tasks. It is treatable through the use of recovery programs and medication-assisted treatments to reduce your cravings and withdrawal effects. Since opioids affect the part of the brain that is responsible for controlling your respirations, they can slow your breathing or cause death if a dose is too high. Since they can make you sleepy or sedated, they should not be combined with alcohol and other sedating medications like sleeping medications. Another limiting side effect of opioids is constipation, so if they are prescribed long-term, they are often taken with medications to stimulate your bowel movements. 

What is the opioid epidemic?1-3

The opioid epidemic is a result of the increased opioid prescriptions that occurred during the 1990s when pharmaceutical companies reassured providers that they were not addictive. As they began to be misused, both prescription and non-prescription opioids, it was clear these drugs had dangerous effects like leading to addiction. Opioids are effective for treating pain, but they can result in misuse, overdose, and addiction if used for long periods of time or at high doses. 

According to the Centers for Disease Control and Prevention, about $78.5 billion is the “economic burden” of opioid misuse in the United States. The economic effects of opioid misuse include healthcare costs, loss of productivity, addiction treatment, and criminal justice involvement. It is estimated that over 650,000 opioid prescriptions are filled, but are not being used for medical purposes like moderate to severe pain relief. For people that are using opioids for long-term pain relief, about 1 out of 4 struggle with opioid addiction. Even during the COVID-19 pandemic, opioid-related overdoses and deaths continue to increase which could be related to mental health and financial issues. This really shows how big of a harmful impact opioids have!

How big of an issue is pain?1-5

Over 30% of Americans live with chronic pain and it is the most common disability that affects daily activities and relationships in the United States. A 17-year study found that the prevalence of pain in adults of all ages is increasing in the United States. Joint pain cases have increased by 21%, neck pain cases have increased by 16%, and low back pain cases have increased by 15%. As pain continues to be an issue and opioid-related overdoses and addiction across the United States continue to rise, it is important that alternative and safe pain treatments are considered. 

What are other non-drug treatment options?1,6

Continuous peripheral nerve block (cPNB) – cPNB utilizes a catheter to place at the target nerve that is causing pain, so it reduces the pain impulses that go to your brain for you to feel pain. It works by providing pain relief locally to the area by using non-opioid drugs that decrease the pain at that area. This treatment can be used during and after surgery to reduce the severity of post-surgical pain and the need for opioids. By reducing the need for opioids, this protects you from their addicting, dangerous, and unwanted side effects.

Peripheral Nerve Stimulation (PNS) – PNS is a unique way to provide pain relief because it occurs by using an electrical device. The small device is a wire that is implanted next to a peripheral nerve or a nerve that reaches beyond your brain and spinal cord. The device sends quick electrical pulses to your nerves to block pain signaling from reaching your brain. It is a quick and simple procedure that is likely painless due to the small size of the device. PNS is commonly used for diabetic peripheral neuropathy, and pain in the neck, back, and face. 

Deep Transcranial Magnetic Stimulation (TMS) – Deep TMS is a non-invasive procedure that involves using magnetic technology. Magnetic fields are created by a coil that is placed on your head to stimulate your brain to block pain signals from reaching your brain. As a result, your brain will not begin the process for you to feel the pain you are having. It only requires a few 20 minute sessions each week over six weeks to reach its full effects. Deep TMS has also been used for treating depression and obsessive compulsive disorder.

Pulsed Electromagnetic Field (PEMF) Therapy – PEMF therapy works by using electric and magnetic energy to stimulate your body to increase its pain relief mechanisms while decreasing the pain and swelling mechanisms. It flushes out toxic cells that cause inflammation while increasing the delivery of nutrients to your tissues. It is commonly used for neuropathic pain that is created within nerves, not from an injury like stomping your toe. This therapy is also non-invasive and can even be used at home.

Cryotherapy – Cryotherapy or cold therapy is typically used for treating warts and some cancers, but it has been shown to reduce pain for osteoarthritis and rheumatoid arthritis. Cryotherapy stimulates your body’s response to extremely cold temperatures which increases cell survival and strengthens your immune system. This results in decreased inflammation and swelling that can cause pain. The cold therapy is delivered to your peripheral nerves through a small, handheld device which reduces nerve activity of transmitting painful signals. It also reduces the use of opioids after surgery while increasing your body’s ability to reduce inflammation and promote healing. 

Botox – You may think of this as only for a cosmetic procedure or for treating migraines, but it can be used for pain too. Botox is a weak form of botulinum toxin type A that is produced from bacteria to block muscle contraction. For pain, it blocks the release of chemical signals and messengers that stimulate your brain to respond to pain. Research is still on-going with this therapy, but it has been shown to be useful in providing temporary pain relief for nerve and back pain.

If you currently take opioids, talk with your provider or pharmacist if you have questions or concerns about their effects. If you or someone close to you needs help for a substance use disorder, talk to your doctor or call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline at 1-800-662-HELP or go to SAMHSA’s Behavioral Health Treatment Services Locator.


  1. Pain awareness month: Innovations in Pain. A4M blog website. Accessed September 27, 2021.
  2. Opioids. Centers for Disease Control and Prevention website. Accessed September 27, 2021.
  3. Opioid overdose crisis. NIH website. Accessed September 27, 2021.
  4. 10 facts about pain – National pain awareness month. Reinhardt chiropractic website. Accessed September 19, 2021.
  5. Americans in pain. McShane Welding website. Accessed September 27, 2021.
  6. Botox for pain relief. Regional Neurological website. Accessed September 27, 2021.

National Pain Awareness Month: Breaking the Painful Stigma

It may seem odd that September is National Pain Awareness Month since you know when you are in pain. This is a time to bring awareness to not ignore your pain, accept it as a valid problem, and seek treatment to maximize your quality-of-life. Pain is the most common cause of disability in the United States, that is more than cancer and heart disease combined!1 Over 100 million people in the United States experience chronic pain or pain that does not completely go away and can result from other chronic diseases like diabetes and arthritis.1 Chronic pain not only affects you physically and can limit your activities, but it affects you emotionally, behaviorally, and mentally. The pain is real and not an attempt to get powerful medications like opioids. Let’s bring the stigma associated with chronic pain!

What is pain?2-4

When you stomp your toe or pull a muscle, your pain receptors in that area send a message to your central nervous system. This message acts as a signal to warn your body of danger. The central nervous system includes the brain and spinal cord. The message is delivered to your spinal cord through many nerves until it reaches your brain. Your brain interprets the signal and sends a message to that area to make you feel pain. This pathway typically ends when the pain is resolved such as when your wound has healed. With chronic pain, your nerves continue to fire to make you feel pain even when the injury is not present.

Acute pain is sudden and results from an illness or injury like cutting your finger or a mild headache. It typically lasts no more than a few weeks and the pain resolves with healing. Sub-acute pain lasts between six weeks and three months. 

Chronic pain is persistent and recurring pain that lasts over three months. It can result from an illness like cancer or injury with the pain still being felt in “on” and “off” episodes or continuous long after it. Other examples or conditions that can cause pain include migraines, headaches, nerve damage, arthritis, shingles, osteoporosis, peripheral vascular disease or poor blood flow, and back pain. Back pain is one of the most common health problems that greatly affects everyday functioning. It can also be caused without an illness or injury in the form of its own syndrome. It affects 28% of people between the ages of 46 to 64 years old, and over 65% of those over 65 years old and older. Unlike the other types of pain, chronic pain affects you from your daily activities to your social life. Pain is real and there is a need to bring awareness to its effects on the mind and body!

How does chronic pain affect me?2,5

Chronic pain can make you feel frustrated, depressed, anxious, and stop you from completing your daily activities or things you enjoy like traveling. It is a continuous cycle of pain and uneasy feelings, so it can do more harm than just physical pain. When you feel pain, you may feel depressed or anxious that you are not able to complete your activities as easily. Performing these activities can even make your pain worse. You may feel stressed as you focus on your problem and have trouble sleeping which increase your pain. As you limit your activities, you may feel more depressed and anxious that you can not perform as well or do what you want to do. The pain continues which starts the cycle all over again.

What are the treatment options?1,2,4-6

Acute pain is normally treated with rest, time, and over-the-counter pain medications while chronic pain requires an approach to treat the body, mind, and spirit. Acute pain is resolved upon healing while the pain never completely goes away with chronic pain. Therapies for chronic pain aim to improve you mentally, socially, emotionally, and physically, just minimizing the pain you feel for you to carry out your daily activities. The treatments include self-care, mental health, and pharmacological treatments. The encouraged treatment for chronic pain is self-care which include the following: 

Activity and stretching – Participating in workout classes, strength building, physical therapy, or even simply walking helps strengthen your muscles and lowers your pain. If you experience pain during your activities, the activities may be too intense. Just stop before it gets worse and build your way to doing more advanced activities.

Ice/heat – Ice and heat help relieve stiffness and pain, especially with arthritis and other joint conditions. Alternate sessions with ice or heat by applying for 20 minutes, then 20 minutes off a few times a day. 

Mindfulness and relaxation – Taking time for yourself to practice mindful meditation requires slowing your thoughts, taking deep breaths, and destroying your negative thoughts. This calms your body and mind down, so you can relax. Yoga is another technique that is used to reduce your stress levels which eases your pain.

Sleep – A lack of sleep affects your mood, relationships, and ability to function. Creating a sleep routine to get a good night’s rest, about seven hours a night consistently can help reduce your stress and pain. This will also make you feel more empowered to tackle your day!

Nutrition – A nutritious diet full of whole grains, fruits, vegetables, and lean meats while limiting your intake of processed/sugary foods, white bread, red meat, and salt gives your body more nutrients that can fight off inflammation and help your pain flares. Some key vitamins include iron, folic acid, and vitamins A, B6, C, and E. These are commonly found in nuts, leafy greens like spinach, berries, and whole grains.

Smoking cessation – Research has shown that smoking increases your risk of back pain and can increase the intensity of neck pain. Those that are smokers have reported that their pain is more intense than those that have never smoked.

Weight management – If you are overweight or obese, gradually losing about 5 to 10% of your weight can lower the amount of pain you are feeling. This is especially true if you have knee or hip pain since more weight adds pressure to the joints and stimulates pain.

Engaging in meaningful activities – Do not let chronic pain stop you – performing activities you enjoy increases your body’s natural painkillers while boosting your overall mood!

Family/friends support – Not only having the support of your family is helpful, but also sharing your experiences and learning from others in group or rehab programs. It may provide you comfort knowing that other people understand your experiences, fears, and discussing your worries. 

If these are not enough for pain relief, pharmacological treatments can be started or along with self-care measures. Pharmacological treatments include over-the-counter and prescription medications depending on the type of pain. Opioids are not a first-line treatment. Transcutaneous electrical nerve stimulation (TENS) is an alternative option that involves sending tiny electrical impulses to the painful area, so less pain signals are sent to your brain to make you feel pain. Regardless of the approach, self-care measures should be started to enhance your quality of life and limit the need for medications.

The Dangers of Alcohol For Pain Relief7

From the damaging effects of chronic pain on the mind, body, and relationships, about 28% of people use alcohol as a way to ease their pain. Mixing alcohol with pain medications can increase your risk of liver toxicity, gastrointestinal bleeding, or sedation. Alcohol does not treat the pain. Alcohol only depresses you from feeling the pain temporarily while it actually makes the condition worse. The Dietary Guidelines (2020-2025) recommend that females drink no more than one drink and males drink no more than two drinks daily, regardless of health conditions. Depressing your mind to interpret the pain requires a greater intake, so over time, your body becomes tolerant and requires more to lessen the pain. This increases your risk of developing dependence and experiencing withdrawal when you do not drink. If you misuse alcohol, this can cause peripheral neuropathy. Peripheral neuropathy is a painful neurological condition that causes chronic pain, tingling in the limbs, and disability. 

If you are experiencing pain and it does not get better, contact your physician or pharmacist today. 


  1. 10 facts about pain – National pain awareness month. Reinhardt chiropractic website. Accessed September 19, 2021.
  2. About chronic pain. PDM healthcare website. Accessed September 19, 2021.
  3. Chronic pain. NHS inform website. Accessed September 19, 2021.
  4. September is national pain awareness month. PDM healthcare website. Accessed September 19, 2021.
  5. Chronic pain conditions. Metropolitan institute of pain website. Accessed September 19, 2021.
  6. Can diet heal chronic pain? Harvard website. Accessed September 19, 2021.
  7. Dangers of using alcohol to dull the pain. PDM healthcare website. Accessed September 19, 2021.

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.

The Breakdown of Animal and Plant Proteins: Benefits and Risks

Did you know 100 calories of broccoli has more protein, vitamins, minerals, and less fat than 100 calories of steak? But which protein source is better – animal or plant? Does it matter? Does animal protein increase the risk of cardiovascular disease? Is plant protein a poor source? There is conflicting research and information on this topic, but like how your body uses protein, we break down all the nutritious facts here!

What is protein?1,2

Protein is a macronutrient that is involved in many of your body’s functional processes such as muscle and tissue repair, enzymatic reactions, hormone production, and transport of molecules like oxygen. Over 20% of your body is made of protein. Protein is made up of amino acids, but they are not stored in the body. Instead, amino acids are either made by your body or obtained from your food. The following nine amino acids are only obtained from your food: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.

Protein is a component of the three macronutrients, along with carbohydrates and fat, that are essential in a healthy diet. Although the optimal diet type differs for everyone, diets should include a variety of whole foods like vegetables, fruits, whole grains, dairy, beans, seafood, lean meat, and nuts/seeds with minimally-processed foods like hot dogs, bacon, and ice cream. This method is called the Healthy Eating Plate. For more information on incorporating nutritious foods into your diet, servings, and meal examples, click here.

How much protein do I need?2

Without enough protein, your body becomes weaker and you lose muscle mass. This makes it harder to carry out normal functions like growth and breathing. Too much protein becomes stored as fat which can make you gain weight. According to the National Academy of Medicine, for every 20 lbs of body weight, you need 7 grams of protein. If you are more physically active, you may require higher amounts of protein. Protein is found in a variety of foods, but not all sources are equal. 

How are animal and plant protein sources different?1,3,4

Animal protein sources are known as complete while plant sources are incomplete. This means that animal sources have the nine essential amino acids we mentioned earlier, unlike the plant sources. The chart below displays examples of each type, along with some of their key points to remember when selecting a protein. Most sources of protein are from animals, but be careful because some animal sources may be packaged with higher amounts of saturated fat, cholesterol, calories, and poor fiber. Plant sources have many other nutrients like plenty of fiber, antioxidants, vitamins, and minerals! 

Risk vs. Benefit1-3,5

You may have heard that plant protein sources are higher in nutrients and can lower your risk of diseases while animal protein sources may increase your risk of diseases. Yet, this is not exactly true. Plant sources include more fiber, minerals, antioxidants, and vitamins. Animal sources can include more zinc, vitamin D, vitamin B12, heme-iron, and docosahexaenoic acid (DHA) which is important for brain health. They also add some protection against diseases, but it is all about the specific food. Foods contain other components like fat, calories, and cholesterol. Like getting the right amount of protein, it is important you are getting it from a nutritious source.

When considering the risk of certain diseases like diabetes and cancer, the section below indicates how your risk is affected by your selected protein sources.

  • Diabetes – Research has shown that a diet higher in red-meat increases your risk of type 2 diabetes while your risk can be lowered by eating more nuts and legumes. One study found that those who ate more red-meat had a higher risk of type 2 diabetes than those that rarely ate red or processed meat. The risk increased about 20% for each additional daily serving of red or processed meat. However, the risk lowered by 10% if a serving of nuts, whole grains, or low-fat dairy was consumed instead. Those that consume more plant protein sources tend to be less overweight which is another risk factor for type 2 diabetes.
  • Cardiovascular disease – In the 20 year-long Nurses’ Health Study and Health Professionals Follow-Up Study, the risk of dying from cardiovascular disease such as heart disease, stroke, or heart attack increased by 13% for each additional daily 3 oz serving of red-meat the participants consumed. With each additional 1.5 oz serving of processed meat, the risk increased to 20%. However, this study did find that eating poultry, fish, and low-fat dairy was associated with a lower risk of cardiovascular disease. These results were mirrored by a meta-analysis with data from over 38 trials and 1,803 participants. Higher blood pressure, and levels of cholesterol, low density lipoprotein (LDL) or ‘bad’ cholesterol, and triglycerides were higher in those that consumed larger diets of red-meat than chicken, fish, or plant proteins.
  • Cancer – Plant protein sources like vegetables and seeds contain phytochemicals which are chemicals that may protect you against cancer. A study conducted by the World Health Organization’s (WHO) International Agency for Research on Cancer (IARC) stated that processed meat is ‘carcinogenic to humans’ based on data from over 800 studies. These studies mainly showed an increased risk of colorectal cancer, but there were also associations with prostate, pancreatic, and stomach cancers. Even how the meat is cooked can affect the risk of cancer since grilling at high temperatures can release cancer-causing compounds.
  • Premature death – From the Nurses’ Health Study and Health Professionals Follow-Up Study, the researchers found that a greater intake of red or processed meat like deli meats, sausage, and bacon was associated with a higher risk of death than plant protein sources. Eating processed or red-meat increased the risk of death by 13% to 20% in a study with data from over 21 countries.
  • Weight control – After performing a 20 year-long study with 120,000 participants, the Harvard Chan School of Public Health found that those who ate more nuts lost about half a pound more weight every four years than those who ate more red and processed meats. Those that ate more red and processed meats gained an extra pound every four years. This study also found that eating more yogurt, chicken without skin, low-fat cheese, and peanut butter was associated with less weight gain than chicken with skin, regular cheese, and red-meat. Another study reported that by eating a daily serving of legumes, peas, or beans, this can increase fullness which may help with weight loss. Even eating eggs for breakfast has been shown to make you feel fuller.

What about vegans and vegetarians?1,3

If you are vegan or vegetarian, it’s possible to have a nutritious diet with all of your protein from plants. However, be sure you are consuming enough protein by calculating your protein intake with the formula discussed earlier. It is unclear if a higher protein intake is needed due to the lower digestibility of plant proteins, but it can be improved by boiling, fementing, or soaking them. Research also shows that combining incomplete protein sources to equal a complete protein is not necessary. As long as you consume enough variety of plant protein throughout the day, you do not need to combine incomplete sources at your meal.

Plant sources of protein can be poor in zinc, vitamin D, vitamin B12, heme-iron, DHA, and calcium. Try to eat dairy, leafy greens and drink plant milk to increase your vitamin D and calcium intake. To increase your zinc, eat more whole grains and beans in your diet. Lentils, spinach, and tofu are great sources of heme-iron. To increase your DHA, this can be done through eating algae or dietary supplements.

Do animal proteins really affect the environment?1

Greenhouse gases are those that are able to trap heat and radiation from Earth’s surface, creating a ‘greenhouse effect.’ About 17% of those gases come from nitrous oxide of fertilizers and irrigations, cutting down large areas of trees to make room for livestock, and methane from the manure of cattle, sheep, goats, and deer. As these effects increase, this contributes to climate change and destruction of ecosystems. It may seem like there is not much you can do to help this issue, but just by opting to eat less animal protein or eat more fish and chicken can make a difference!

Key Takeaways

Incorporating a variety of animal and plant protein sources are key for a nutritious diet. If you are vegan or vegetarian, be sure you eat a variety of plant protein sources to maximize your health. If you consume mostly animal, red-meat, or processed protein sources, try replacing some of those foods with plant proteins like beans, spinach, or nuts to lower your chance of diseases. You could even simply start with ‘Meatless Mondays!’ Before you make big changes to your diet or your protein intake, contact your health care provider or pharmacist today to ensure you are meeting your dietary needs.


  1. Best protein sources: Comparing animal and plant-based protein. Fullscript website. Accessed September 1, 2021.
  2. Protein. Harvard University website. Accessed September 1, 2021.
  3. Animal vs plant protein – What’s the difference? Healthline website. Accessed September 1, 2021.
  4. Nutrition – Plant vs animal protein. Dr. Hillel Harris website. Accessed September 1, 2021.
  5. The difference between animal protein and plant protein. WebMD website. Accessed September 1, 2021.

The Five Benefits of Collagen

What’s the body’s largest organ that offers protection and is your first defense against harm? If you said your skin, you’re correct! The skin is made up of about a trillion cells and gets its strength from a protein called collagen.1 It is important that it is well taken care of. You may be familiar with collagen’s ability to slow down the process of aging skin or reduce wrinkles. Maybe you have lotions or shampoo with collagen. But what exactly is collagen and what does it do? This article gives you a quick overview of collagen and its benefits.

What is collagen?1-4

Collagen, a protein highly produced by the skin, makes up a third of the protein in your body and is responsible for the skin’s flexibility and strength. Collagen is also found in your bones, muscles, tendons, teeth, and blood. Think of it like this, collagen is like a glue. It is strong and provides structure and support to your body’s tissues. 

The skin is made up of the outer epidermis, dermis, and inner hypodermis or the fat layer. Collagen is found on the outer layer of your cells and is greatly involved in the skin’s process of protecting, healing, and regenerating itself within the dermis. You may already know that your skin goes through a cycle to get rid of its old cells and make new ones, but did you know it happens every 27 days? To undergo this process effectively, it is important that collagen and its amino acids or building blocks are available.

Like glue, collagen comes in several types. Type I includes over 90% of your collagen. It is made of densely packed fibers to strengthen your skin, bones, teeth, and connective tissue. Type II is made of loosely packed fibers to provide support to your joints. Type III is found in your muscles, organs, and arteries while Type IV is located in the layers of your skin.

As you age, your body reduces its production of collagen and your skin may start to become more fragile and less firm. This can lead to wrinkles, sagging skin, and aching joints. Without enough collagen in your joints and muscles, your joints may be less flexible and your muscles may weaken. Even your hair can become thinner and start to go slower. That is why it is important that you are getting enough collagen in your life. The benefits of collagen extend well beyond protecting your skin!

What are the benefits?1,2,5,6

  1. Skin elasticity and hydration – As you enter your mid-20s, you begin to lose some of your collagen. For women in the first few years of menopause, they can lose over 30% of their collagen. This explains why collagen is often marketed as an anti-aging supplement. A recent meta-analysis with data from 19 studies and 1,100 patients determined that collagen supplements improved the skin’s hydration and elasticity. There was also improvement in their wrinkles after taking the supplements for four weeks and even four weeks afterwards.
  2. Osteoarthritis – Since collagen makes up your joints and bones to provide support and function, collagen can be used to improve joint function and reduce pain. This was shown in a study with 81 patients that took collagen tablets for two months.
  3. Strong bones – It is no surprise that as we age, our bones become more brittle that can lead to a higher fracture risk. Research has shown that by taking collagen supplements, this makes your bones more dense and stronger. 
  4. Increase muscle mass – Are you trying to gain muscle? A study with physically active men found that taking collagen supplements with a strength training regime increased muscle mass more than men that did not take collagen. 
  5. Healthier nails and hair – You may notice your nails are more brittle than your friend’s or that your hair is thinning. This may mean your body needs more collagen. One study found that collagen improved nail growth and strength, and hair thickness and growth by taking supplements for just a month.

What damages collagen?2,3

  • Sunlight – Excess ultraviolet radiation from the sun can damage collagen and cause it to break down faster. This causes collagen production to decrease, so the skin incorrectly rebuilds itself, causing wrinkles. Be sure to wear sunscreen and proper clothing when going outdoors to reduce your risk of skin damage.
  • Smoking – Harmful chemicals in tobacco products like nicotine destroy your body’s collagen which can also lead to wrinkles. Nicotine causes your blood vessels to constrict, so less oxygen and nutrients is delivered to your skin. This affects your skin’s flexibility and protection from harm.
  • High sugar and refined carbohydrate consumption – A diet high in sugar and refined carbohydrates can come from sodas, potatoes, and cookies can affect your body’s ability to use collagen. When too much sugar is consumed, the sugar begins to stick to your proteins to make advanced glycation end products (AGEs). The sugar affects the function of proteins like collagen, so they become weaker. One way to minimize the production of AGEs is by consuming less foods high in sugar, refined carbs, and processed foods like sugary cereals, white rice, white bread, and sweet manufactured treats. AGEs have been linked to increasing your risk of cardiovascular disease and type 2 diabetes.
  • Autoimmune disorders – Lupus is a common inflammatory disorder where the body mistakenly attacks its own tissues and organs like the skin and joints. This damages your layer of collagen that can lead to fatigue, joint pain, and rashes. Rheumatoid arthritis typically causes inflammation in the joints of the hands and feet because of the body thinking your own cells are harmful. There can be painful swelling and joint stiffness since the protective collagen layer has been destroyed.

How do I increase my intake of collagen?1-3

One of the easiest ways is to consume foods with collagen, its amino acids, or other precursors. You may already be obtaining collagen in your diet! Bone broth is a great source of collagen because it makes up most of the tissues of animals like chicken. Plus it has the extra benefit of hydrating your skin because it is water-based. Other high impact sources can be obtained from foods that directly increase the amount of collagen made by the body including: 

  • Vitamin C – found in strawberries, kiwis, oranges, bell peppers, and broccoli
  • Vitamin A – found in mangos, apricots, carrots, spinach, and sweet potatoes
    • Sources of vitamins, while fun in color, also have the extra benefit of reducing inflammation and harmful chemicals from your body’s regular processes!
  • Proline – found in egg whites, meat, dairy, and cabbage
  • Glycine –  found in chicken, turkey, seafood, peanuts, spinach, and asparagus
  • Leucine – found in eggs, dairy, chicken, pork, pumpkin seeds, oats, and beans
  • Zinc – found in beans, pork, beef, nuts, and seafood
  • Copper – found in nuts, red meat, seafood, cocoa powder, and dark leafy greens

What kind of supplements are available?2

If you are not consuming enough collagen in your diet, then this easy option is for you! Collagen is available in capsule, powder, liquid, and topical forms. The most popular way it is consumed is by the powder form. Many of the powders are tasteless, so they can be simply added to foods and drinks like smoothies, coffee, tea, soups, oatmeal, and cookies. However, caution should be used with the topical creams because they may not work as well. Since collagen is a large protein, it is unlikely its benefits other than being a moisturizer are able to get absorbed through the tiny barriers of the skin. 

Some supplements may be called ‘collagen peptides’ or ‘hydrolyzed collagen.’ This just means that they are smaller strands of amino acids that make it easier for your body to absorb them and use for its strengthening and support benefits. These collagen supplements mainly come from animal skin and bones, so if you are vegan or vegetarian, they may not be suitable for you.

Since supplements like collagen are not Food and Drug Administration (FDA) approved, there are few ways you can make sure you pick a safe collagen. When selecting a collagen, make sure it has the NSF or United States Pharmacopeia (USP) seal on the product. This means the company has done its job to make sure the product is of high quality and safe for your use.

If you have any questions about collagen supplementation or wonder if it is right for you, contact your healthcare provider or pharmacist today.


  1. Greer J. Collagen for your skin. Thorne website. Accessed August 29, 2021. 
  2. Collagen – What is it and what is it good for? Accessed August 29, 2021. 
  3. Collagen: What is it and what are its uses? Medical news today website. Accessed August 29, 2021.
  4. Can collagen supplements really reduce signs of aging? Health matters website. Accessed August 29, 2021.
  5. Health benefits of collagen: Pros and cons, nutrition, and more. Webmd website. Accessed August 29, 2021.
  6. Collagen. Versus arthritis website. Accessed August 29, 2021.

Debunking The Top 7 Diabetes Myths

Being overweight or obese, lazy, acting as a ‘couch potato,’ over-eating, having a ‘sweet tooth,’ causing diabetes on yourself, or doing something wrong during pregnancy – these are common stigmas associated with diabetes. These stigmas are not only socially, mentally, and emotionally damaging to those with diabetes, but they are simply not true and can lead to misdiagnosis. Unfortunately, as diabetes is becoming more common, so are the myths. Diabetes is a highly misunderstood disease. Here, we debunk the top seven diabetes myths to help you or a friend manage diabetes, understand the risk, and break the stigma!

What is Diabetes?1

Diabetes is a long term, complicated disease where your body is unable to properly regulate the amount of glucose or sugar in the blood. Your pancreas normally releases insulin to stimulate your cells to uptake glucose. With type 1 diabetes, your body does not produce insulin. This is because your immune system kills the insulin-making cells since it thinks they are foreign invaders. With type 2 diabetes, the more common condition, your body does not make enough insulin or your cells are resistant to its effects. The disease that includes blood glucose levels above normal, but not high enough to be classified as diabetes is prediabetes. Gestational diabetes occurs when your blood sugars are higher than normal during pregnancy, but it increases your risk of developing type 2 diabetes later in life.

Common Diabetes Myths

  1. Eating too much sugar causes diabetes2,3

Since diabetes is a condition associated with high blood glucose levels, it is no wonder that this is the top myth. However, diabetes is NOT caused by eating too much sugar. According to a large European study, drinking sugary drinks like soda, sweet tea, fruit juice, and energy drinks are linked to type 2 diabetes. These drinks are often high in calories and lack nutritional value, so it is best to drink more water to lower your chance. Eating too much sugar increases your risk of being overweight, obese, or developing type 2 diabetes, but it does not directly cause diabetes.

  1. Being overweight or obese always leads to diabetes2

Being overweight or obese is a contributing factor to developing type 2 and gestational diabetes, but the disease affects you regardless of body weight. It may surprise you that about 11% of people with type 2 diabetes are actually of normal weight or underweight. Type 1 diabetes is not associated with body weight. Additionally, only 13% of the 39.8% of people with obesity have diabetes. This is why it is important for all to take steps to lower their risk of disease, regardless of body weight! 

  1. People with diabetes cannot eat dessert3,4

Have your cake and eat it too! Just because you have diabetes, it does not mean you should entirely cut out eating cookies, cake, and chocolate. Restricting yourself can cause you to binge or over eat. As long as you are following a balanced diet, a small portion of sweets in moderation can be enjoyed by you and your body. Yet, remember to balance your plate by limiting your carbohydrates during your meal to take in account your treat. Another way you could still eat your meal with higher carbohydrates is reaching for lower carbohydrate versions of your treats. There are thousands of these recipes online, like for these peanut butter cookies, cheesecake, and greek yogurt ice cream

  1. Avoid carbs and starchy foods like potatoes3-5

All of the carbohydrates in the food you eat like grains, fruits, dairy, vegetables, and sweets are converted into glucose, your cells’ energy source. Your body releases insulin, so your cells can take up the energy to perform cellular processes. More carbohydrates do increase your glucose levels, but they are needed for your body to carry out its daily functions. All carbohydrates are not equal, so the issues with carbohydrates are the type and amount. Carbohydrates that are lower on the glycemic index (GI) scale like oatmeal, legumes, and whole-grain bread are preferred than foods with higher GIs.

If you want to lower your risk, the key is food portion control. Instead of eating a large plate of fries, try limiting your carbohydrate serving to a quarter of a nine-inch plate by following the Healthy Eating Plate Method. For starchy foods, choose more foods like sweet potatoes and oatmeal that are higher in fiber and less processed to get your nutritional needs. The chart below displays the Healthy Eating Plate Method and examples of nutritious foods to create a balanced diet.

For more information on creating a balanced diet and low GI foods, visit Harvard University’s Healthy Eating Plate website or talk with your doctor, dietitian, or pharmacist about your carbohydrate goal.

  1. Having diabetes means you have to have a special diet3,6

Just because you have diabetes, it does not mean you need a special sugarless diet or only eat ‘diabetic friendly’ foods. Be careful when eating foods that mention being ‘diabetic friendly’ because they can still raise glucose levels, contain sugar alcohols that may upset your stomach, and be more expensive. You eat the same foods as everyone else, but the American Diabetes Association (ADA) recommends that you mainly get your carbohydrates from non-starchy vegetables like broccoli, whole grains, and fruit. In fact, the right amount of carbohydrates, fat, and protein in your diet better manages your glucose levels and meets your body’s needs. The ADA recommends that those with diabetes follow the Diabetes Plate Method to better manage their condition and consume about 45 to 60 grams of carbohydrates per meal. Just use a nine-inch plate to fill half of it with non-starchy vegetables, a quarter with protein, and a quarter with carbohydrates. Add water or a low-calorie drink. It’s easy, as shown below!

For more information, visit the ADA website to learn more about the Diabetes Plate Method, types of foods, portion control, and meal plans.  Talk with your doctor, pharmacist, or dietitian before making changes to your diet to ensure you are meeting your nutritional needs.

  1. Diabetes is not a serious disease1,7-9

Diabetes is a very serious disease that is responsible for about four million deaths per year. About 10.5% of the United States population or 34.2 million people have diabetes. Of those 34.2 million people with diabetes, 7.3 million people do not realize they have the condition. Diabetes affects not just your blood sugar, but can increase your risk of high cholesterol, hypertension, stroke, heart attack, kidney disease, glaucoma, cataract, and neuropathy or tingling in your hands or feet. Luckily, whether you live with diabetes, know someone who does, or want to lower your risk of disease, there are steps you can take to lower your risk of complications. These include losing 5 to 10% of your body weight, getting 150 minutes of moderate-intensity activity each week, smoking cessation, and following the Healthy Eating Plate.

Talk to your pharmacist, fitness coach, or doctor before you engage in physical activity to create a gradual activity plan or check that the activity is right for you.

  1. There is a cure for diabetes7

Diabetes is a complex and highly prevalent disease, but there is currently not a cure. Many herbal and natural products like cinnamon and turmeric may help your body use insulin in type 2 diabetes, but they do not cure the disease. There is also not a cure for type 1 diabetes. Yet, prediabetics can actually reverse it before it develops into full diabetes by changing their diet and lifestyle. 

If you use natural medicines, be sure to speak with your pharmacist or doctor to ensure your medications are not interacting with your diabetic medications, or increasing your chance of hypoglycemia or low blood sugar. 


Diabetes is a chronic disease that can affect your entire body system. Almost everyone either knows someone who has the condition or has it. As the condition grows, it is crucial we spread awareness and the truth about its causes, complications, risks, prevention, and lifestyle changes. Let’s break the stigma!


  1. American Diabetes Association. Classification and diagnosis of diabetes: Standards of medical care in diabetes. Diabetes Care. 2020;43(1): S14-S31. 
  2. Newman T. Diabetes: Dispelling 11 common myths. Medical news today website. Accessed August 6, 2021.
  3. Myths about diabetes. American Diabetes Association website. Accessed August 6, 2021.
  4. McDermott A. 10 Diabetes diet myths. Healthline website. Accessed August 6, 2021.
  5. Healthy eating plate. Harvard University website. Accessed August 6, 2021.
  6. Eat good to feel good. American Diabetes Association website. Accessed August 6, 2021.
  7. Snouffer E. Top 5 greatest myths about diabetes. Diabetes voice website. Accessed August 6, 2021.
  8. National diabetes statistics report, 2020. Centers for Disease Control and Prevention website. Accessed August 6, 2021.
  9. Diabetes myths and facts. MedlinePlus website. Accessed August 6, 2021.

Boosting The Thyroid: A Functional Medicine Approach

The thyroid gland is the primary regulator of cholesterol, blood sugar, temperature, reproductive health, growth, and weight. Hypothyroidism or underactive thyroid affects over 30 million females and 15 million males in the United States.1 No wonder this highly affects the population since it is common to have lifestyles with high stress, poor sleep, minimal exercise, and diets high in processed foods.2 The most common type of hypothyroidism is Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an autoimmune condition where your body wrongly attacks your thyroid cells, resulting in cell death and improper thyroid hormone regulation.3 Lifelong pharmaceutical treatments are available to boost your thyroid, but can it be healed naturally through diet or lifestyle changes? The good news is that by identifying the culprit, you can incorporate the needed foods, vitamins, and wellness approaches into your lifestyle to support your thyroid naturally via functional medicine! 

The Functional Medicine Approach

Are you a fan of optimizing your lifestyle to promote your health? If so, a functional medicine approach is right for you in treating your thyroid! Once you determine your cause of hypothyroidism, take the necessary steps to modify your diet and lifestyle. This will increase your metabolism and overall thyroid wellbeing. This approach is different from conventional pharmacological therapy because it considers your disease-causing, lifestyle, and diet factors. The diagram below displays the main differences between the two approaches for hypothyroidism.4


Did you know that nutrient-dense foods can boost your thyroid’s health while processed, inflammatory foods promote harmful effects? Listed below are a few diet changes you can make to benefit your thyroid.

  1. Remove gluten – Foods with gluten like bread, cookies, and crackers may be contributing to your thyroid issue if you have a gluten sensitivity.5 A gluten sensitivity blood test can be performed by your doctor to see if an inflammatory reaction occurs when you consume those foods, resulting in weight gain, fatigue, and headaches. You could also remove the foods with gluten for three weeks to see if any symptoms go away.5 If they do, this could indicate a diet lacking gluten may be right for you.
  2. Increase anti-inflammatory and nutrient-dense food intake – Anti-inflammatory foods like leafy green vegetables, fruits, and healthy monounsaturated and polyunsaturated fats are beneficial for lowering your risk of heart disease and decreasing inflammatory reactions.6 Furthermore, these foods include vitamins that help make your thyroid hormones active to carry out metabolism. Healthy fats can be found in avocados, olive oil, cheeses, eggs, nuts, seeds, and peanut butter.6 Foods with refined sugar, refined vegetable oil, cow’s milk, and unhealthy trans and saturated fats should be avoided in your diet because they promote inflammatory processes.2 These unhealthy fats are found in many processed foods, fried foods, red meats, ice cream, whole milk, and butter.


If you find it difficult to consume foods with crucial vitamins for thyroid functioning or your vitamin levels are still low, you may consider adding nutritional supplements to your diet. However, it is best to start with increasing your intake of nutritious foods to limit excess supplementation side effects. 

  1. Iodine – You may recall that too much iodine damages your thyroid, but too little iodine inhibits the hormonal conversion of inactive thyroxine (T4) to active triiodothyronine (T3).7 Without T3, your thyroid is unable to regulate your temperature, weight, growth, and energy. Iodine is highly found in seaweed, shellfish, and eggs. It can be dangerous to increase your iodine intake, so be sure your iodine blood levels are monitored by your doctor.
  2. Selenium – Selenium is vital to kick-starting the conversion of T4 to T3 and decreasing inflammation. The best options for selenium-dense foods include salmon, turkey, grass-fed beef, shrimp, and Brazil nuts. Yet, too much selenium is damaging because it causes upset stomach, fatigue, and nerve damage.7
  1. Magnesium – Magnesium is needed to increase your T3 levels. If you experience constipation which is a common symptom of hypothyroidism, asthma, or muscle pain, you may have poor magnesium intake.7 The following foods are high in magnesium: nuts, dark chocolate, avocados, and spinach.
  2. Omega-3 fatty acids – Like iodine and magnesium, omega-3 fatty acids are needed for active thyroid hormone production. Omega-3 fatty acids are polyunsaturated fats that decrease inflammation and relieve fatigue.6 Key foods include flax seeds; walnuts; and fish like salmon, sardines, and trout. Remember, you want to avoid fish that are high in mercury content because it can damage your thyroid’s ability to function.6
  3. Vitamin A – Without enough Vitamin A, T3 is unable to be produced. The best foods for increasing this vitamin include liver, carrots, sweet potatoes, and kale. Keep in mind that too much Vitamin A can lead to stomach problems.7
  4. Vitamin D – Low Vitamin D levels are associated with Hashimoto’s thyroiditis.6,7 Vitamin D helps make T3, reduces inflammation, and relieves muscle pain. Even spending more time in natural sunlight can increase your levels. If your schedule does not allow for more outdoor time, you could increase your intake of dairy products, mushrooms, eggs, and salmon.

Wellness Approaches

Like treating many health conditions, lifestyle modifications play a role in stimulating your health and reducing risk of further complications. 

  1. Stress relief – In today’s fast-paced world, you may find it hard to limit stressful situations or find stress relief. Increasing cortisol or the body’s stress hormone suppresses your thyroid hormones and promotes inflammation. You are at a higher risk of infection if you have chronic stress, so managing your stress and following-up with your doctor are beneficial.5 However, there are a few ways you can learn to manage your reaction to stress like joining a stress management program or finding things to do that make you calm. Some activities that can lower your stress include walking, working-out, drawing, journaling, and baking. The options are limitless, so find what works for you!
  1. Activity – By participating in activities that stimulate movement like walking, running, playing with your pets, or participating in sports, this encourages your thyroid to function properly and makes it easier for your hormones to work.5 The activity does not have to be performed all at once or be a strenuous activity. If you are not used to exercising, try walking 10 minutes a day for three days a week. Gradually increase your time each week to work towards a goal of 150 minutes a week.2
  1. Adequate sleep – By establishing a sleeping routine to get quality sleep, this can help your overall health and thyroid functioning. According to the Centers for Disease Controls and Prevention (CDC), adults should get at least seven hours of sleep per night.8 If you are having trouble falling or staying asleep, you may find it helpful to meditate, read, or drink a cup of hot tea to relax your mind for a good night’s sleep.
  1. Minimize toxin exposure – Excess exposure to toxins not only increases inflammation and your risk of health conditions, but it harms the thyroid. Limiting your exposure to radiation, contrast dyes, and pesticides can keep your thyroid hormones intact.5 Mercury, a common metal found in saltwater sea creatures, is highly toxic and affects your body’s regulation and development processes.2 Therefore, you may need to reduce your intake of high mercury-containing foods like king mackerel and bigeye tuna.6 Other changes include avoiding tobacco products, eating organic foods, and using natural cleaners. One way that both reduces stress and toxins is using a sauna because it removes toxins from your fat cells while you relax.5

Insteading of solely treating you based on your hormone levels, signs, and symptoms, a functional medicine approach considers your physical, social, environmental, and nutritional needs. Assessing you fully helps to identify the primary cause of your thyroid disorder that may be a mystery if only conventional treatments are used. For more information on the functional medicine approach to hypothyroidism, talk with your doctor or functional medicine specialist. 


  1. Hyman M. A 7-step plan to boost your low thyroid and metabolism. Dr. Hyman website. Accessed August 3, 2021.
  2. Klimenko E. Functional medicine approach to autoimmune thyroid disease. Dr. Klimenko website. Accessed August 3, 2021.
  3. Hypothyroidism (underactive thyroid). Mayo Clinic website. Accessed August 3, 2021.
  4. Los angeles functional medicine doctors of holistic and integrative medicine. Southern california center for anti-aging website. Accessed August 3, 2021.
  5. Hyman M. 6-Steps to heal your thyroid. Dr. Hyman website. Accessed August 3, 2021.
  6. Hyman M. The functional medicine approach to hypothyroidism and hashimoto’s disease. The doctor’s farmacy. 2021. Accessed August 2, 2021.
  7. Drecher L. Supporting the thyroid: Food as medicine. Ultrawellness center website. Accessed August 3, 2021.
  8. Are you getting enough sleep? CDC website. Accessed August 3, 2021.