SUPERmarket PHARMACIST

A pharmacist's look at the supermarket and beyond

Month: August 2014

Updates & Tidbits

I am finding that writing a blog can have some unexpected results. Most of these are good, the best of which is the rebirth of my professional writing. I also tend to see plenty of new material relating to previous posts and I’ve commented on my own posts to add interesting updates. Right now I’m flooded with new info on previous posts so I’m using this post to rattle off a few…

Mosquitoes are being genetically modified to stem the spread of diseases like malaria, Dengue fever, and West Nile virus. The latest attempt is being made by a British firm working in Brazil with hopes of stopping the spread of Dengue fever by inserting a genetic stop sign into Aedes Aegypti mosquitoes. Oxitec is creating male mosquitoes that can be released into the wild where it is hoped that will mate with many females and sire hundreds of offspring. These youngsters will have a self-destruct gene that will cause them to die before reaching sexual maturity. We’ll see how that works out, although I fear a Michael Crichton-like thriller on science gone wrong.

In July, FDA recommended that companies testing new products for “low-T” use sperm concentration and responder rates as good clinical measures of treatments under study. Now a company called Repros Therapeutics says it has an oral product called Androxal that is superior to all of the testosterone gels crowding the market and my pharmacy shelves. They claim higher sperm concentrations in a higher proportion of patients. They hope to apply for FDA approval by the end of the year.

Ina new report Business Week identifies the 60 separate government contracts, awarded to 33 companies, that contributed to building healthcare.gov in this article, with chart and PDF. Total cost is in the neighborhood of $800 million.

Does the pairing of Burger King and Tim Horton’s mean we’ll be seeing donut burgers, cruller fries and glazed chicken nuggets soon?

Not everything coming out of the VA is negative. A new JAMA article from VA researchers finds that states with medical marijuana laws had fewer overdose deaths from Rx drugs and street drugs! They cite a 25% decrease. This builds on a 2011 UCSF study that showed patients got better pain management when prescribed marijuana to augment their narcotic analgesics. Nearly half of our states have some sort of law allowing access to marijuana.

WHO announced that they desire countries to regulate e-cigarettes and ban their indoor use until studies show that second hand vapor will not harm others in the area. This will be met with strong resistance by the profiteers in this growing $3 billion market.

IBM’s Watson, of Jeopardy fame, is being employed by big pharma to help identify new avenues for drug development. The big brain is on the job! Watson can not only understand the jargon of chemistry, biology, and pharmacology as it reviews thousands of research papers it can also consider legal ramifications such as intellectual property rights.

I think it’s pretty cool that 3-D printers are being used in medicine.

Baylor College of Medicine says it is close to having a vaccine for Chaga’s disease which is transmitted by the kissing bug.

With football season starting, FDA warns that dietary supplements are being marketed that may claim to prevent or alleviate the effects of concussion that are, in fact, untested, unproven, and ineffective if not downright dangerous. You may see these products being offered in your Facebook news feed if you’ve posted about football. Anything for a buck.

Milk of the Poppy

Two years since the original idea was floated, the DEA, FDA and Department of Health Services are all on the same page when it comes to Hydrocodone combination products. Generic Vicodin, hydrocodone and acetaminophen, in its various iterations is the number one drug in America! In 45 days these HCPs will be on Schedule II of Controlled Substances. That’s the schedule which contains oxycodone, amphetamines, morphine, fentanyl and lots more. That means no more Rxs with refills, no more getting additional refills over the phone, it does mean getting a new written Rx each and every time. The doc can write 3 Rxs, each for a 30 day supply but for no more than a 90 day total.

We’ve come full circle with hydrocodone, which was paired with acetaminophen in 1978 with the launch of Vicodin. Previously, hydrocodone was in schedule II as a single entity with the dawn of the Controlled Substances Act in 1971. The first Vicodin contained 5mg of hydrocodone and 500mg of acetaminophen and was granted schedule III status which gave it the accessibility needed to become dominant in the marketplace. It was not until 2012 that the amount of acetaminophen per tablet was limited to 325mg. All of the new Vicodins have 300mg of acetaminophen, Vicodin with 5mg, Vicodin ES, 7.5mg and Vicodin HP, 10mg hydrocodone.

This will be painful for all involved. This country consumes an abundance of pain meds and now a clamp is being placed on the legal distribution of the most widely used narcotic analgesic in the country. Are we in that much pain? Are we a nation of cry-babies? Or do we just like getting high? Does our nanny government think that NOW is the time to stop our sniveling and buck the Hell up?

This is a change that will have significant ramifications at many levels of our society. We are already scrambling on where to secure the HCPs in our pharmacy. Our safe is full already! We have lots of large, 500-count bottles of HCPs, several of them in our “fast mover” section! So yes, a burden on pharmacies, and on prescribers to be sure. The patients in need of pain relief will be the ones to suffer the most, of course, with more frequent doctor visits, tightened access in supply, likely price increases, and that often-inferred stigma, whether self-imposed or seen in others’ suspicious looks, of being a narcotic user, and still little hope of effective pain management. I do know that we are far from the imagined Game of Thrones where knights and kings were only offered the milk of the poppy after having a limb lopped off or their guts spilled by a wild boar. Here in our own version of Westeros, our pain is chronic! For most, it is because we cannot undo or even identify the root cause of the pain, while for others it is just too damn much fun to keep that narcotic buzz going.

In my setting I am expecting some major shifts in my inventory, starting with a major move toward generic Tylenol #3 and #4 as they remain outside the C2 realm. Just a few days ago, on August 18, tramadol moved from a regular Rx to a controlled substance. The choices for prescription pain relievers are dwindling fast, especially for those that want to avoid addictive opiates. Most of what is left as a regular prescription drug is not far different from what you can buy over-the-counter. Fact is, people prefer hydrocodone over codeine, not for the analgesia (30mg of codeine as in T#3 is about equal to Hydrocodone 5mg for pain relief) but for the euphoria that can be achieved with hydrocodone. This change in schedule will make those fun-loving patients a little more obvious, especially when they start whining about having to take codeine. I expect it will be similar to the people who tell the ER doc that “um, oxy, um what is it?, oh, oxycodone is the only thing that works for me, I can’t take codeine, morphine, or whatever that shit is you’re trying to give me now.” Speaking of ER visits, it is expected that the new restrictions will decrease the too-prevelant abuse of HCPs by teens.

I expect to see increases in other categories of drugs, particularly the benzos like alprazolam (Xanax) and lorazepam (Ativan) to deal with all that anxiety of not getting hydrocodone as easily as before. Lidocaine patches, newly OTC TENS (Transcutaneous Electrical Nerve Stimulation) units, more and more NSAIDS, more tramadol and more “natural” remedies. It could get ugly. Many people in New Hampshire and elsewhere have turned to heroin as a cheaper alternative to oxycodone already. I’m sure big Pharma has scientists slaving away, tinkering with the molecular chemistry of opium-based narcotics hoping to find “the next big thing.” For now, the trend is to recycle old drugs by creating new delivery systems that offer longer dosing intervals, less GI upset, and even less abuse potential. Oh! These, of course, are usually ten times the price of the original drugs.

So here we go into a brave new era of battling pain with little more than new flavors of poppy milk. Somebody fetch Maester Luwin!

Dr. Bronner’s Magic Soap

I’ve had a quart of Dr. Bronner’s Pure Castile Soap sitting on my desk all weekend as I was preparing to blog about this amazing, quirky company and its impressive cast of characters. Then, this morning I happened upon a blurb from Food Safety News that the FDA had sent a warning letter to David Bronner about the labeling of their new Fresh Pressed Virgin Coconut Oil. Seems the label makes some claims for conditions that would make the product more a drug than a food. The letter goes on to state that this is misbranding. Furthermore, the label does not disclose the presence of trans fat in its coconut oil. If you look at the castile soap labels you would see that they are packed tight with Dr. Bronner’s philosophical and religious proselyting, referencing “America’s Founding Father,” Thomas Paine, “teacher of Jesus,” Hillel, Mao’s Redbook 51, and recommends only two cosmetics; enough sleep and Dr. Bronner’s “Magic Soap.” The directions for proper use of the soap end with the exhortation “ALL-ONE! ALL-ONE! ALL-ONE! So I’m not surprised by this latest coconut oil brouhaha.

The company is based in Escondido, CA and has contributed to many GMO labeling efforts including California’s Prop 37 and this year Oregon’s “GMO Right to Know” campaign. It’s estimated that they have given close to $3 million to this cause.

The Bronner family has been making soap since 1858 and Emmanuel Bronner brought the formulas and techniques to America in 1929 and by 1948 Dr. Bronner’s Magic Soap was in full swing. Emmanuel Bronner’s parents died in a Nazi concentration camp. The company is now run by the 4th and 5th generations of the family. The current CEO is David Bronner, a beer-drinking hemp fan Harvard grad who reportedly has tripped on LSD at Burning Man and credits a “late night ecstasy and acid trip at a gay trance club” in Amsterdam with having his “life explode on many levels of identity.” He is almost as unusual as Uncle Ralph whose stories and jokes are posted on the company web site and readily admits he is “not normal.”

This is a highly successful company, with annual sales over $60 million. David has done some pretty cool and progressive things at the helm, including: doing no animal testing, using non-GMO ingredients, using ethically-sourced, Fair Trade ingredients, and the most impressive to me, creating a reasonable CEO salary. In 1999, David capped CEO salary at five times what the lowest paid employee makes. For David, that puts him at about $200K per year.

This latest letter from the FDA is not the first brush with authority for these guys. During the Bush years, the company was buying hemp oil for the soaps (made a smoother lather) and the DEA classified almost all hemp products as Schedule I. Hemp oil contains only a trace of THC. The company’s “Director of Social Activism” set up a booth in front of DEA headquarters and gave out poppy seed bagels and OJ to DEA agents on their way to work. Poppy seeds, of course, contain precursors to heroin and orange juice contains small amounts of natural-occurring alcohol. You’ll see that the current products contain hemp oil. The ban was legally overturned in 2004.

Magic Soap

Magic Soap

Bronner could not let other employees have all the fun. In 2009, David was taken into custody for planting hemp seeds on the DEA HQ lawn and in 2012 he set up a oil mill, inside a cage, in front of the White House, and was happily milling hemp oil from seed when police cut through the cage bars to haul him away.

This is fascinating stuff and I encourage you to visit their web site and do some exploring on your own. The company started as Dr. Bronner’s All-One God Faith, which Emmanuel Bronner invented and travelled around preaching to those that would listen. At one point, he had his wife and his three kids put into foster homes so that he could spent more time spreading this new religion. You couldn’t imagine a more complex soap opera than this real American success story, warts and all.

Thanks to Mother Jones and Josh Harkinson for putting me on to this different kind of company several months back.

Alive Inside

Just saw this documentary that follows and expands upon the efforts of volunteer Dan Cohen as he brings the gift of music to patients with Alzheimer’s or dementia in nursing homes. It’s moving stuff. There are amazing examples of people that have been tucked away and “stored” in nursing homes who suddenly come alive when headphones are put on them and the play button on an iPod is pushed. Dan selects the music based on what the patient can tell him or, quite often, what a family member or caregiver can offer for clues.

We hear from a gerontologist, Dr. William Thomas, who adeptly points out that he can easily prescribe a thousand-dollar-a-month drug and nobody bats an eye, but to get somebody to pay $40 for an iPod and headphones is daunting. The film provides plenty of statistics, the most telling for me was the “inversion” of the ratio of old folks to young folks that we are in the midst of right now. Dr. Thomas also retells some of the history of nursing homes and how industrialization and urban growth led to a weakening of the family and a loss of good roles for elders, with many ending up in “the poor house.” Then came great social programs like Social Security, Medicare and Medicaid which improved things somewhat, yet still were based on the hospital model of care not the home model of care as originally created. So, as Dr. Thomas expressed it, we treat these people like patients to the point of ignoring their hearts and souls.

Dan Cohen is the center of the film, though, and his quiet demeanor and obvious compassion shines through in every frame thanks to film-maker Michael Rossato-Bennett. You’ll want to bring a tissue or two because some of the scenes are just so poignant and personal that you cannot help but be moved. Patients that were sitting, immobile, with no affect, quickly smiled, or sang, waved their hands, or even got up and danced! They were still alive inside! They had simply been imprisoned within the system of care that has lost sight of the patient. Tales of sedation of these elders is rampant and even in a supermarket pharmacy, I see old people being chemically straight-jacketed with anti-psychotic drugs, benzos, and other mind and mood altering drugs. It’s big business!

It is no easy task, but after seeing Alive Inside, I’ll being spending a little more time reviewing the medication profiles of my older patients. It was amazing to see that the clip of one of the patients made it to Reddit and went viral spreading the word of the power of music and gaining thousands of comments from people that were giving the gift of music to their loved ones. If you are not aware of this therapy and have a loved one with dementia you must try it. These folks need creative stimulation, not sitting in a warehouse staring at a wall. Visits from young people, pets, readers, musicians, magicians, or just somebody to interact with would be immensely beneficial and music, as this film astutely demonstrates is at the top of the list.

Ban Triclosan NOW!

More bad news for triclosan. An Arizona State University (Go Devils!) long term research study has strengthened the link between triclosan and fetal risks. Building on research at University of Florida (Go Gators!), the ASU study demonstrates a link between triclosan exposure and lowered birth size (length and weight). The Florida study and others have shown that triclosan disrupts the enzyme estrogen sulfotransferase which helps to metabolize estrogen into a form that can cross the placenta and reach the developing fetus. Estrogen regulates a variety of genes and fetal hormones including cortisol, a steroid hormone critical for maturation of the brain, lungs, liver and other organs and tissues of the developing fetus. The new ASU study data was presented at the annual meeting of the American Chemical Society on August 11, 2014.

In 2013, a USC (Go Trojans!) study showed that triclosan impaired sperm mobility by depolarizing calcium channels. These calcium channels are responsible for flagella motion so triclosan limits the swimming ability of the sperm cells. These researchers suggested that triclosan can be used as a molecular probe to further the study of calcium channels. Good. Keep it in the lab!

This dangerous endocrine disruptor is present in over 2,000 products sold in our marketplaces and I’ve ragged on it in a previous post and in practice.

Triclosan was developed and is manufactured by Ciba Chemical which was acquired in 2009 by BASF. They’ll be happy to note that another use for triclosan has been found as a preservative of evidence of arson accelerants at suspicious fire scenes. CSI take note.

Sorry about the (cheering!), I’m getting prepped for football season.

Healthier Skin, Healthier You.    Bullshit!

“Healthier Skin, Healthier You”
Bullshit!

Take action! Stop buying these products and demand their removal from the marketplace!

Unexpected Side Effects

Parkinson’s disease is treated with an assortment of drugs that are dopamine agonists or increase dopamine levels in the brain. Although we are learning more about our neurotransmitters at a rapid rate, we are still often taken by surprise by side effects of these medications.

A friend of mine takes Mirapex, a dopamine agonist, which is fairly affective in controlling Parkinson’s symptoms, but when put into the marketplace odd side effects were reported. People on Mirapex (pramipexole) were experiencing various “impulse control disorders.” You may have seen reports of folks that gambled away their savings, their cars, even their homes. I recall one report of a priest that used church collection money to gamble in Atlantic City. I asked my friend if he had any of these gambling urges and he said no, but did admit to a new love for internet shopping.

This class of drug has been associated with side effects like gambling, shopping, eating, hyper-sexuality, and other impulse control issues. These are in addition to the more commonly noted dizziness, drowsiness, edema, and cognitive problems.

Another Parkinson’s drug recently made the news when a 42-year-old woman checked herself into a Turkish hospital with a chief complaint of random, uncontrolled orgasms. She had started taking rasagiline, Azilect in the US, seven days earlier and began experiencing hyper-arousal, increased libido, and then orgasms that occurred 3 to 5 times a day and lasted about 20 seconds. There are previous reports of spontaneous ejaculation in a man that was taking rasagiline. Both patients returned to normal after discontinuing the medication. The Turkish woman opted to resume treatment after 15 days and her symptoms returned. Her case study is slated to appear in the journal Parkinsonism and Related Disorders.

Dopamine is a well known neurotransmitter associated with pleasure. It is strongly associated with addictive behaviors from tobacco smoking to heroin addiction. It has different effects depending on what area of the brain it is in, from alertness and motivation to lust and milk production. I think it is important for patients to know that drugs that alter brain chemistry can produce many beneficial outcomes, but many unusual side effects are possible. We simple do not know enough about the brain to accurately predict exactly what a drug will do in a particular patient.

What is fascinating to me, is that when these surprise side effects occur it is often a catalyst for new studies that explore how to take advantage of the side effect in a positive way. This is how we got Viagra, studied for blood pressure, making billions as a erection aid; Zyban, being used as the antidepressant Wellbutrin and patients were spontaneously quitting smoking; the SSRIs help with PMS and have been studied and tinkered with in attempts to use them for menopausal symptoms and premature ejaculation. There are many other example but I think you get the idea. Pharmacy can be so much fun!

Pop Quiz

Popcorn is a great snack! Popcorn is a wholesome, nutritious, whole grain food. At least it starts out that way. Sales in pounds have been in the neighborhood of one billion per year for the last couple of decades, meaning plenty of people are eating plenty of popcorn. In the US, over 200 cups of popped corn is consumed, on average, for each and every one of us, every year. If that was just straight, air-popped corn it would amount to around 6,000 healthy calories per person. Megan and I went out into the market aisles to see what sort of popcorn was available. Little did we know that we would spend most of our time doing math to see what healthy or unhealthy choices were available.

For pre-popped popcorn, the nutrition labels had the serving size listed in grams and cups. With amounts usually 28 grams which can range from 3/4 of a cup for caramel corn to 3+3/4 cups for Skinny Pop.

Skinny Pop

Skinny Pop

The variety of serving size and the variation in the grams to cup ratio makes for some very challenging math when trying to compare products in the chip/popcorn aisle.

A bag of Chester’s popcorn sells for $3 and proclaims that it has 7 servings per bag. Amazingly, the cheddar cheese variety list a serving size as 3 cups while the butter flavored variety list a serving a 2+1/2 cups. The cheddar lists the serving weight as 28 grams, while the butter has it as one ounce! Despite this, each claims to have 7 servings per bag, although both appeared to be the same size to us. So, let’s eat the whole bag! Megan will eat the cheddar kind and I will eat the fake butter stuff. We assume the 7 servings per bag. Megan gets 1,050 calories, 63 grams of fat, 21 grams of fiber, 21 grams of protein, and 1.68 grams of sodium. I consume 1,120 calories, 70 grams of fat, 21 grams of fiber, 14 grams of protein, and 1.47 grams of sodium. Butter is fattier, cheese is saltier. Is that an attempt to meet customer taste expectations? No actual popcorn was harmed during this experiment!

Microwave popcorn is extremely popular. Remember the news stories about plant workers having severe respiratory problems from inhaling the fake butter chemical? That was diacetyl, an organic compound with a buttery taste and aroma. Seems plant workers inhaled the stuff and started showing up with a condition called bronchiolitis obliterans which is the inflammation and destruction of the bronchioles resulting in scarring, narrowing and loss of pulmonary function. According to OSHA this loss of function is NOT reversible and some of these workers ended up on lung transplant waiting lists. IMG_2025
The causative connection was established by The National Institute for Occupational Safety and Health (NIOSH) in 2003. Now we are told that these plants use proper ventilation and provide workers with proper personal protective equipment. In 2012, Dr. Robert Vince of the University of Minnesota Center for Drug Design found that diacetyl also had some troubling neurological effects. Risky business, indeed, although, to be fair, diacetyl is also found in real butter.

The nutrition info on microwave popcorn is just as confusing as popped corn labels, with a serving size usually 33 grams, but again yielding different cupful amounts, with more math needed to determine meaningful data for comparison. There are various iterations of 94% fat-free and these are the closest thing to “real” popcorn at about 25 calories per cup.

Smart Pop

Smart Pop

Adding butter flavor (diacetyl is unidentified within the “flavoring”) and fats can bring the calorie count as high as 40 per cup. The sodium content is again higher with cheesy kinds and can range from 80 to over 100mg per cup. Added fat is the big calorie boost to watch for on these products.

Finally, I checked actual movie popcorn. Harkin’s Theatres lists their medium as containing popcorn, salt, and canola oil, and comes in at 500 calories, with 32 grams of fat and 720mg of sodium. I was told that was with the standard “buttering,” not “layered butter” as many customers request. So that’s my calories for lunch! If you add more salt, you are quickly over a gram in that bag. By the way, Junior Mints are about 10 calories each. Popcorn and movie theaters began their love affair during the depression when vendors would sell nickel bags just outside the movie house. If you were to eat an entire extra large popcorn at the movies, you would get 1120 calories, 72 grams of fat, 1.6 grams of sodium. and a belly ache!

After this popcorn investigation, I’m looking into an air popper. I can make my own 30 calorie per cup snack and flavor it in a wild variety of ways, from tame to wicked.

Maple Bacon!

Maple Bacon!

Sushi!

Sushi!


There is a popcorn organization and their web site is quite fun to visit and is packed with info, tips, recipes, and popping videos.

The Probiotic Puzzle

My pharmacy students are great! We were discussing the vagaries of probiotics and wondered what sort of evidence was out there that showed real benefits from taking probiotics and how to select an actual effective product from the multitude of probiotics lining our shelves. The ads we had been seeing made all sorts of promises that we could not rationalize and prescription orders for probiotics concurrent with antibiotics which also seemed futile. One of the questions we came up with was how can taking an oral probiotic promote vaginal health, as more than one advertised product proclaimed. I postulated that the only mechanism that I could imagine involved poor wiping technique. That, it turns out, taint far from the truth.

Our bodies are host to billions of microorganisms, with close to 1,000 species in the GI tract alone, and E. coli one of the prime inhabitants of the colon. Most of these organisms are bacteria, although we do support some fungi too, mostly candida. Many of these organisms are beneficial to us, aiding digestion and keeping pathogenic microbes in check. All told , these “good germs” outnumber our larger-in-size human cells by about ten to one, so it behooves us to be nice to these friendly microbes. In 2008 the Human Microbiome Project was started by the NIH to identify and characterize these tiny critters.

When should probiotics be used to support a healthy microbiome in our bodies? Fortunately there have been many studies that can help answer that question. The World Health Organization has concluded that probiotics are “Live microorganisms which when administered in adequate amounts confer a health benefit on the host,” clearly establishing a healthy impact for probiotic supplementation.

Much work has been done with premature infants. Preemies delivered by Caesarian section are not exposed to mom’s vaginal flora and are often under such intensive medical support are not even able to access natural breast milk direct from the source for days. This gives these kids a greater risk of being “populated” by many microbes with pathogenic potential. A nasty sounding disease called necrotizing enterocolitis can occur in preterm infants and has a mortality rate around 25%. Even 25% of survivors will have long-term problems. Two friendly species have been identified that tend to exclude the Clostridium pathogen in these babies, Lactobacillus and Bifodobacteria. Normally, these are introduced when ingested during vaginal birth and further supported by breast feeding.

WHO estimates that a child dies from diarrheal disease, somewhere in the world, every 15 seconds. Rehydration and probiotic support are recognized as the hallmarks of clinical management of these devastating diseases. Two species have been identified as having the strongest evidence of a beneficial preventive effect, Lactobacillus rhamnosus and Bifidobacteria lactis. I’m thinking that our gut had better have a healthy population of Lactobacillus and Bifidobacteria!

vsl3

Prilosec,Nexium, and other proton pump inhibitors are used to treat GI problems such as Gastro-Esophageal Reflux Disease (GERD) to the tune of $14 billion per year in this country. There’s a gram-negative bacteria called Helicobacter pylori that has been implicated as a contributing factor in GERD, peptic ulcers and even gastric cancer, with a powerful antibiotic regimen often used to eradicate it. Studies show that support with Lactobacillus can help to suppress H. pylori. Probiotic support with VSL#3, an expensive product with very high doses of four Lactobacilli species and three Bifidobacteria species had a significant positive impact on patients with inflammatory bowel disease and Crohn’s disease.

The impact of these microbes is staggering. The Danes have shown that differences in the vaginal microbiome can strongly influence the appearance of allergies and asthma in children. Another study showed that daily intake of Lactobacillus leads to transfer of these friendly bacteria from the rectum to the vagina (remember my earlier supposition?), which lead to a healthier vagina with fewer yeast cells and coliform (like E. coli) bacteria. I feel vindicated, and no, wiping technique does not appear to be a factor.

As we learn more about our microbiome and the various strains of the friendly bacteria available in probiotic products, it is becoming apparent that proper selection is important. This is no easy task. The number of probiotics on the market is legion and spans the vitamin, stomach remedy, and natural product aisles, all the way to the dairy section.

Yogurt, of course, can be a probiotic if it’s a live culture. Interestingly, there are a few studies that seem to indicate that yogurt is not as effective as an oral supplement, although that may have more to do with cell count. In my early years as a consultant pharmacist for a facility for young people with behavioral problems we had a terrible problem with recurring yeast infections in the young ladies and one of the consulting doctors recommended douching with a mixture of plain yogurt and warm water. It seemed to provide some benefit, although this is entirely anecdotal. If you like yogurt there are many good reasons to make it part of your diet. I would still suggest a good probiotic, however.

Florajen3_Probotic_op_724x822

If you have colitis issues, then VSL #3 may be the best choice for you, Florajen 3, although with fewer cells per capsule, is less expensive and gluten-free if celiac disease is a consideration. Remember, the idea is to maintain a healthy GI microbiome and regular use of Culturelle, Align or even a store brand may be of some benefit. I did my research and probiotic selection before I started this blog and have been taking Florajen 3 for many months and I am quite happy with it. My primary reason is to help maintain a healthy weight. The search for the right combo of species started when I read a Mother Jones article on happy gut bacteria. Both VSL and Florajen require refrigeration and are usually found in the pharmacy.

florastor

Probiotics are often used to repopulate the friendly gut bacteria after a course of antibiotics. During my stint in a hospital outpatient pharmacy I learned the importance of Florastor, a fungus-based probiotic. This product was very helpful in maintaining some degree of normal bowel function when treating Clostridium difficile infections with oral vancomycin. Vancomycin tends to wipe out all the bacteria in the GI tract, so using Florastor is a rational way to provide support for a healthier microbiome during treatment with powerful antibiotics.

There is so much more to discuss about probiotics and your health and I may revisit this topic in the future (we didn’t even touch on the new skin spray probiotics!). The paper that vindicated my taint theory was discovered by U of Arizona PharmD candidate Megan Handley and is found in Clinical Microbiology Reviews, October 2003. I have no financial interest in any of the products nor their manufacturers mentioned in this post and provide links only to let you learn more on your own.

Modern Fowls

The FDA just announced modern poultry inspection techniques. How about that? I find it amazing that we are just now implementing science-based methods to detect microbial contamination in poultry destined to be consumed by people. Until now, the inspector essentially stood in one spot looking at chicken carcasses passing by on a conveyor belt trying to spot obvious flaws like broken bones, scabs, or bruising. This made for a more attractive chicken in the poultry case at the market but did nothing to prevent the threat of contamination by Salmonella or Campylobacter. The FDA predicts that the new testing procedures will prevent 5,000 food borne illnesses every year. Considering the cost of a recall, this should be a boon for the chicken industry.

I love this statement from the FDA: “ In 2014, we now understand that since pathogens are microscopic, even our very best inspectors cannot visually identify food borne illness-causing pathogens on a piece of chicken, regardless of how much time they have to inspect it.” I almost choked on my chicken when I read that! How very modern!

The Food Safety and Inspection Service is finally taking action. “FSIS will now require that all poultry companies take measures to prevent Salmonella and Campylobacter contamination, rather than addressing contamination after it occurs. Also for the first time ever, all poultry facilities will be required to perform their own microbiological testing at two points in their production process to show that they are controlling Salmonella and Campylobacter. These requirements are in addition to FSIS’ own testing, which the agency will continue to perform.”

In looking into this, I discovered that the speed of chickens move along that conveyor belt at a rate not to exceed 140 birds per minute! So, under the old rules, inspectors had less than half a second to visually inspect a bird!

Some recent, notable recalls:

March 2014, Foster Farms issues a voluntary recall of chicken prompted by a single illness associated with a specific fresh chicken product.

January 2014, Tyson recalls 34,000 pounds of “mechanically separated chicken products” because of possible Salmonella contamination.

October 2013, A San Francisco Costco recalls 40,000 pounds of rotisserie chicken in connection with an earlier Foster Farms Salmonella outbreak that did not result in a recall because there no clear evidence that it originated at the processing plant. This recall resulted in 30 FDA inspectors being put back to work after being furloughed during economic hard times.

I’m just thankful that after six decades of poultry inspection, the FDA recognizes the need for contamination testing BEFORE the chicken goes to market, rather than reacting after people get sick.