A pharmacist's look at the supermarket and beyond

Month: February 2015

CTRL ALT Diabetes

Many patients with type two diabetes are searching for help. Unfortunately, many of them are only treading water or stuck on the hamster wheel of mixed messages, misleading product claims, and our profit driven medical-pharmaceutical marketplace.

Before I delve into the morass of diabetes treatment claims, let me first state that type two diabetes is often preventable if you can do these three things in a cohesive, enduring way: maintain a healthy weight, eat healthy foods, enjoy healthy activities. You might notice that those three things are pretty simple and you might even consider me naive for stating the obvious, but for someone struggling with metabolic syndrome, syndrome X, pre-diabetes, or type 2 diabetes these simple things can prove a difficult challenge. For many, getting healthy means a major upheaval in their daily lives, including dietary changes, time management, budgetary adjustments, and personal attitude.

In our culture, we are continuously bombarded with advice. In the pharmacy, our patients often ask about the latest and greatest “thing” that they saw on TV or the internet, promoted by some guru, doctor or expert. Usually, they don’t want to know what a pharmacist might think of this particular product, only where to find it. Stories told by your hairdresser, nail technician, masseuse, or bartender are not reliable sources of health information. We would love for all our problems to be solved by taking one little pill.

I’ll grant that scientific studies are not always completely unbiased, but scientific research is certainly superior to the opinions of most of the hucksters out there trying to make a buck off people desperate to improve their health.

Before looking at some of the supplements suggested for controlling diabetes, remember that the supplement industry is NOT regulated by the FDA and analysis of supplements sold in the marketplace have found up to 80% of products with little or no ingredient listed on the label and/or adulterated with worthless or harmful ingredients. I’m going to leave the prescription drug side of this issue for a later post. It has its own dark side.

So what is worth trying? Not much.

Chromium continues to be promoted as a great way to control blood sugar. Yes, chromium is a necessary trace mineral for your metabolism. Trace means we are talking about micrograms. Chromium is best consumed in your food and more than adequate amounts are in most Americans’ diets. Do not buy a chromium supplement! Buy some green vegetables!

The NIH states that “High-quality clinical evidence (i.e., studies in people) to support the use of cinnamon for any medical condition is generally lacking.” ‘Nuff said. A little cinnamon in your diet is great, but choose healthy sources. That Cinnabon with its 900 calories and 36 grams of fat is not the way to go!

A pharmacist writing in a national pharmacy magazine recently touted berberine as the equal to metformin for reducing blood sugar. Much of the research on this plant alkaloid examines its antibiotic properties but some do suggest that it can help regulate blood sugar. The natural sources include Goldenseal, the Oregon grape, and the Indian barberry root, none of which are commonly found in the produce section of your market. A 2008 study in the journal Metabolism is often cited as strong support for the use of berberine for diabetes. The authors updated their findings in a 2010 study in that same journal finding “The fasting blood glucose and hemoglobin A(1c)-lowering efficacies of berberine were similar to those of metformin and rosiglitazone.” Other data seems to indicate very little liver toxicity from berberine. The key to all this is to find a reliable berberine product. Alas, I can really offer little help with that. There are a variety of berberine capsules on the market but I could not find one that was USP quality. One Chinese company offers USP grade berberine in bulk at $1,600 per kilogram. Caveat Emptor!

Magnesium is another mineral essential for proper metabolic function. Getting enough magnesium from natural sources is easy when you eat a healthy diet. If you must take a supplement, you may have more GI problems with the oxide or sulfate forms, as well as less absorption of actual magnesium. Just eat a balanced diet and you’ll get plenty of magnesium.

There are a seemingly endless array of other alternative or complimentary supplements that have been proposed as treatments for type 2 diabetes and I really believe many of them such as another trace mineral, vanadium, and things like omega-3 and L-carnitine are already part of a normal diet. The NIH recently updated its information on diabetes and dietary supplements and concludes: “Other herbal supplements studied for diabetes include aloe vera, bitter melon, Chinese herbal medicines, fenugreek, garlic, Gymnema sylvestre, milk thistle, nettle, prickly pear cactus, and sweet potato. None have been proven to be effective.”

Remember that the longer a patient has been living with type two diabetes, the longer it may take to gain control and eventually reverse the negative effects of this disease. Lifestyle changes are always part of a newly diagnosed patient’s prescription and yet when I see what these folks have in their shopping carts, I know they are in for a bumpy ride. Too many of us make poor nutritional choices, rarely exercise, poorly manage stress, and generally do not understand how all of that leads to poor health. We can do a whole lot better!

What a Lovely Face!

Most of us spend plenty of time, energy, and money on our faces. We are encouraged by advertising and aisles and aisles of face care products, and although we may achieve some degree of pulchritude, we are mostly blissfully unaware of the playground that our faces are for the unseen inhabitants of our most visible aspect.

If they only knew...

If they only knew…

I’m sure we have all heard of dust mites and the wonderful statistic that if your pillow is 2 years old, then 10% of its weight is dead mites and mite dung. That’s dust mites, scourge of asthmatics and almost impossible to avoid. Mites are found in all kinds of environments and many enjoy a nice host. Like you.

Which brings me to face mites. These tiny creatures, demodex foliculorum, reside in human hair follicles and raise their families on your face, mostly on cheeks, chins and wherever there are hair follicles, whether hairy or not. When I say tiny, I’m talking as small as 0.1mm in length. They are not normally parasites, instead we provide a nice habitat for them. Biologically speaking they are commensals. There’s another mite species, demodex brevis, that inhabits sebaceous glands near hair follicles.

At night these critters, they are arthropods, have a party on your face. Yes, a party on your face, complete with intricate (bizarre?) movements leading up to an orgy of wild sex, as males run from pore to pore, mating when they can or maybe having a sebum snack. When hurrying, these mites can reach the dazzling speed of 16mm per hour, which means they can visit a lot of pores in one night. Exhausted by these shenanigans they crawl back into a hair follicle to spend the day in its dark, warm, moist comfort, gorging on nutrients (mostly in dead skin cells) that you provide for free.

It’s quite a life, although brief at about 3 weeks. Once the female is fertilized, she lays a bunch of eggs deep in the hair follicle where they become larvae that are swept toward the light by your sebum. It takes about a week for the larvae to develop into a sexually capable young adult. The cycle continues through days of feast and nights of festival. Until the end.

Eating dead skin for fuel and fluids is not 100% effective and these mites do produce waste. Fortunately for you they do nor spend their brief lives pooping on your beautiful face. Unfortunately for them they do not have an anus! After a couple more weeks as adults they are literally so full of crap (FOS, as my friend Dr. Levey has diagnosed) that they die an ugly death and rot away right there on your face.

These guys are not the cause of scabies, which is caused by a burrowing cousin. Occasionally, though, they may get out of hand and over-populate your lovely habitat, causing an itchy, irritating condition called demodicosis. If your mites are out of control you can try a massage with tea tree oil followed by a wipe down with 70% isopropyl alcohol, avoiding eye contact. If the eyelashes or brows are heavily involved, daily cleaning with diluted baby shampoo may help control the population. Insecticides like lice treatments are a last resort.

These mites are rare in young children but are more common as we age, to near universality. I got started looking into this after reading a National Geographic article by Rob Dunn where he postulated that mites could be found on most humans and proved that theory to be true. You can see him and learn more by watching this video.

What wonderful hosts we are! The NIH sponsored Human Microbiome Project has shown that the total number of cells of microorganisms outnumber human cells ten to one, on average. It looks to me that we give the island of Hawaii, with its 11 climate zones, a run for its money with our various internal, external, and body cavity habitats, each with its own flora and fauna. What amazing creatures we are. Although many of you may be on the way to take a shower, or at least wash your face, before running over to Target for a new pillow!


My experience as a tobacco treatment specialist led to an article in the February 2015 issue of Pharmacy Today. I think it came out pretty good although the unedited version leaned a little heavier on the importance of behavioral modification as a critical strategy for lasting success. Anyway, give it a read while you wait for the next post.