James B. LaValle R.Ph

Osteoarthritis affects more than 80 percent of the U.S. population over the age of 50. It accounts for 26 million days of lost work annually. It is estimated that arthritis-related health costs will exceed 95 million dollars in the next few years. With someone turning 50 every few seconds in this country, there is an obvious interest in the treatment of this condition. Several factors, including wear and tear from active lifestyles, previous injury and diet can all play a role in the evolution of this disease. There are several objectives with therapy: decrease the severity of symptoms (including a reduction in pain and inflammation), improve joint function, prevent joint destruction, control the evolution of the disease and, most importantly, maximize mobility and improve the quality of life. Historically, there have been few options other than to recommend OTC NSAIDs initially and then eventually placing the individual on prescription agents. As many of you know, finding the nonsteroidal anti-inflammatory drug (NSAID) that works can involve a great deal of trial and error, and its effectiveness often wears off.

In addition to filling prescriptions, pharmacists have the opportunity to play a key role in their communities as health educators. Osteoporosis is an excellent example of a disease process that can be substantially altered by diet and life style factors. This course will review the factors that impact osteoporosis and how pharmacists can counsel customers in the prevention and treatment of this chronic degenerative disease.

Osteoporosis is a complex, multi-factorial disease that results in thin or porous bones, which are more prone to fracture. Osteoporosis is called the “silent killer” because it develops over time without noticeable symptoms. Although it doesn’t attract media attention like cancer and cardiovascular disease, osteoporosis is an enormous health problem in the United States. Expect to see osteoporosis occurring earlier in men and women because of the poor nutritional status and lack of exercise of today’s youth. Consider the following facts about this disease:

James B. LaValle R.Ph.

Kava kava root preparations are quickly becoming one of the best-selling botanical agents on the market; sales of kava preparations have risen 116% in the past few years!   Pharmacists can expect a sharp rise in questions from customers and patients regarding this botanical supplement, such as what happened with St. John’s wort in the past year.   Anyone with stress and anxiety in their life is a potential customer!   Supplement companies are boosting manufacturing and advertising of various kava supplements, predicting the “wave” of success.

In recommended doses, kava produces relaxation and a tranquil state of being without the unwanted side effects which most pharmaceutical anti-anxiety agents such as benzodiazepines have.

Historical Perspective
Imagine sitting around a campfire on one of the exotic Polynesian islands; native peoples surround a large bowl containing a strange liquid. The chants become louder and louder as a religious ceremony unfolds.  After chewing and grinding a knotted root, the pulp is spit into a traditional vessel where coconut milk is added and the mixture strained.  Each male member of the tribe now drinks the soapy, pungent liquid from the bowl, becoming relaxed and sociable as the calming effects of the mixture begin to take effect.

The mixture is made from the root of the sacred Kava or Awa plant kava (Piper methysticum), a member of the pepper family.  Kava was made known to the New World in 1768 when Captain James Cook wrote of a strange ceremony in which the natives routinely participated.  The use of kava on South Pacific islands, including Fiji and Vanuatu, is as common as drinking coffee in our society.

Kava is used religiously by natives of these islands as an intoxicating beverage, causing visions and hallucinations in high doses and bringing the individual “closer” to their God.

James B. LaValle R.Ph.

Fibromyalgia is a soft tissue, non-articular rheumatic syndrome with symptoms of chronic aches, pains and stiffness with trigger points or specific sites of exaggerated tenderness. With as much as 4 percent of the population suffering from this disease, modern medical science has yet to find a cure or to even treat this problem effectively.  Fibromyalgia bears a striking resemblance to chronic fatigue syndrome (CFS) and mainly affects women aged 25-50 years with the female to male ratio being approximately 5:1.

Fibromyalgia symptoms may be triggered by a number of factors, including overexertion, stress, lack of exercise, anxiety, depression, lack of sleep, trauma, extreme temperature and/or humidity changes and infectious diseases.

The subject of drug induced nutritional deficiencies (DINDs) highlights another area of pharmacy care where the pharmacist can play a key role in patient counseling and, hopefully, improve health outcome and reduce potential side effects related to prescription and OTC medications.   Although this seems to be a hot new topic, a great deal of research concerning DINDs has been going on for the past twenty years.  More studies need to be done to increase our understanding of this important area of pharmacologic relationships.  There are a number of ways drugs could negatively affect the nutrient status of the body.  Mechanisms of action for nutrient depletion include changes in absorption, biosynthesis, transport, storage, metabolism and excretion.  As pharmacists learn about the various nutritional deficiencies that may occur from the use of medications, they will be in a better position to advise consumers on the need for nutrient repletion.  

To fully comprehend drug nutrient depletion, it is essential to understand that there are many other factors that may contribute to nutrient depletion besides drugs.  These factors, when combined with drug therapy, could result in a frank nutritional deficiency or, at the very least, a functional deficiency.  These factors include:  food processing, poor food selections, hypocaloric or poor dieting practices, alcoholism, smoking, drug addiction, age or lack of interest in food due to loneliness or illness.  Only 9 percent of Americans eat the recommended five fruits and vegetables daily  and, for the average American, two-thirds of the diet consists of alcohol, refined carbohydrates, sugars and fats.   In a USDA food consumption survey, 21,500 people were examined for dietary nutrient intake.  It was found that not one person got the RDA for 10 essential nutrients.   This means that deficiency is the norm for the average American.  This could potentially add to the whole problem of drug nutrient depletions. It could well be that at least some of the adverse effects or long-term side effects could, in fact, be due to nutrient depletion.  Limiting deficiencies through supplement recommendation could very well limit potential adverse effects, and therefore, possibly improve compliance.

One example of this is the use of oral contraceptives.  Deficiencies that may result include: folic acid, pyridoxine, riboflavin, vitamin B12, zinc and magnesium.  These deficiencies could lead to elevated homocysteine, compromised immunity or reduced healing.  Folic acid alone plays a key role in the cells of the intestinal tract, the cervix and the vagina. With folic acid deficiency being a key concern in our country, we need to be aware of the potential for depletion in individuals who are most likely already at risk. The accompanying chart is meant to be  a quick reference to get you started in counseling.  Good luck and, as always, good health. 

As seen in a popular commercial, a young man on a windsurfer soars through a field of grasses and ragweed.  He appears healthy, without the usual symptoms (itching, sneezing, watery eyes, runny nose and nasal stuffiness) that accompany seasonal allergy hypersensitivity.  His doctor has prescribed a novel pharmaceutical antihistamine (and probably also a decongestant) without the drowsiness caused by other drugs on the market.  Still, these can have serious adverse drug reactions that we as pharmacists must remember to counsel the patient about. These pharmaceutical products may be beneficial in some patients with classic symptoms of seasonal allergies, but others may be very sensitive to them, or may have jobs that require mental alertness or driving or operating heavy machinery.  Infants and children who are already hypersensitive should not take OTC antihistamine products.   However, there are adjunctive products that pharmacists may recommend to these individuals. Natural support products have been reported to help alleviate the symptoms of seasonal allergies.  These products are available in the Pharmacy without a prescription.

Cardiovascular disease remains the leading cause of death in the United States, with an estimated 57,490,000 Americans having some form of cardiovascular disease.   The American Heart Association’s most recent annual statistics (1994) reported that 954,720 Americans died from cardiovascular-related diseases (41.8 percent of all deaths).  It is staggering to realize that over 2,600 people die from cardiovascular disease EVERY DAY in the United States.

There are numerous nutritional influences to cardiovascular disease, including magnesium, vitamins E and C, coenzyme Q10, folic acid, niacin, chromium, omega-3 fatty acids and potassium. Other factors include: dietary factors  (consumption of salt, saturated fats and hydrogenated or partially hydrogenated oils) and lifestyle factors (exercise, use of estrogens, smoking and psychological stress).  Epidemiological studies clearly show that higher consumption of fresh fruits and vegetables (rich in phytochemicals) is associated with a reduced risk of cardiovascular disease.   Biological risk factors include elevated blood pressure, cholesterol, homocysteine, lipoprotein(a), diabetes/hyperinsulinemia and free radical damage.  Although there are some genetic components to this condition, the majority of risk factors for cardiovascular disease are associated with diet, nutrition and lifestyle, all factors largely within an individual’s control. These risk factors will be reviewed in this article.