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  Fundamental MedicineTeresa Gryder, ND

How to Swallow a Fistful of Pills

6/10/2015

 
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Swallowing isn’t easy to do when you’re thinking about it.  When you eat it happens automatically.  When you have a fistful of medications or supplements to get down, it can be unpleasant.  There are few things worse than getting a large bitter pill stuck in your craw.

A 2015 study showed that 3/10 adults averaging age 50 would rather die than take a daily pill for the rest of their lives, and another 1/5 would gladly pay $1,000 to avoid having to take a daily medication.  If taking pills is this undesirable, why don’t more people make the diet and lifestyle changes that would free them from pill taking?  The answer is of course complex.  During our lives, almost all of us will choose to swallow pills, if not longterm, at least long enough to give us relief from a temporary ailment.

At some time in your young life, someone asked you to swallow a pill.  Children don’t know how, and are usually given chewable or liquid medicines until they learn.  In old age it gets harder to swallow pills, so we end up looking for liquids and chewables again.  In the meantime, between childhood and old age, we’re supposed to be able to swallow them.  There are tricks.  Here is a primer.

There are two main kinds of pills that you’ll be asked to swallow; capsules and tablets.  Capsules are a little cylinder usually containing a powder.  Usually they float, though some of them sink.  Tablets, on the other hand, are made of a substance that is caked together into a mold.  They can be any shape but smart designers make them round or oblong.  Capsules are easier to split, and they usually sink.

It helps to know if your pills are floaters or sinkers.  It’s easier to swallow the same kind together.  You can test each pill in a glass or water, or in your mouth, to detect if it floats or sinks. Putting pills in a glass is a good way to see how long it takes the pill to dissolve, too.  (Aside: If you put a pill in a glass of water and it doesn’t dissolve in a day’s time, you probably aren’t getting anything out of it.)  Pay attention to which pills float or sink, and take the same kind together.

SWALLOWING PILLS THAT SINK

Sinkers are the easiest to swallow because they behave like food does, sitting on your tongue.  All you have to do is tilt your head back a little bit and let them slide to the back of your tongue, and then take a sip of water and swallow it.  It is also possible to simply place the pill(s) at the back of the tongue using your hand, then drink.  They will go down.

SWALLOWING PILLS THAT FLOAT

Floaters are tricker.  They are easiest to swallow with a bite of pre-chewed food.  If you need to swallow them with liquids, here is a trick.  With the pill(s) and a modest swallow of water in your mouth, assume your best military posture, with your neck long and chin tucked.  The pills will float to the roof of your mouth (your soft palate), and the good posture with chin tuck helps them move to the back.  When you feel the pills on the roof of your mouth, distract yourself and swallow, or take another sip to push them along.

WHEN YOU CAN’T SEEM TO MAKE YOURSELF SWALLOW

This usually happens when you are trying to swallow too many pills at once, or a pill that is so big that it scares you.  It floats around and threatens to dissolve and taste horrible.   It’s OK to swallow pills one at a time until you are ready to try more.

WHEN A PILL DOESN’T GO DOWN

Usually what happens, at least in younger folks, is that the pill gets stalled out in the throat somewhere, and the natural peristaltic movements of the esophagus bring it back into your mouth.  Slippery pills (like gel caps) slide back up easily.  Grainy or sticky tablets can get hung up and make you gag.  When a pill feels stuck, keep swallowing.  Take swallows of your drink or bites of of food, and keep doing it until it goes all the way down.  Some pills (like osteoporosis drugs) can hurt your esophagus if they get stuck.  Your doctor will warn you if your medications have this risk.

DISTRACT YOUR MOUTH

To swallow a bunch of pills at once, put them all in your mouth with a bit of water, and then using your tongue place one pill between your teeth and gums, and swallow the rest.  Something about storing the one pill distracts your mouth enough to get the rest of the swallow to happen normally.

TAKE PILLS WITH BITES OF FOOD

Liquids are harder to swallow than food.  Pills that are best taken with food are also easiest to swallow with food.  Basically you take a bite of food, and chew it until it is thoroughly chewed and ready to swallow.  Then pop a pill or three in there and swallow it.  You can chew a little more if needed to feel ready to swallow it, but try not to break up the pills.

There are more tricks, but those are the basics.  If you are like me, and struggle with swallowing pills, you may need some tricks.  Good luck to you.  May you heal quickly and no longer need pills.  May you find the medicine you need in sunshine and laughter, and the nutrition you need in food.

A Million Infections

11/22/2013

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We humans are part of the web of life in a way that is somewhat unpleasant to consider.  We think of parasites as those things that grow on trees and use the tree's sap for fuel, like mistletoe. We know about the parasites that you can get in your gut from traveling. But we don't like to think about the millions of microbes that live in our guts, on our skin, in our noses, and unfortunately, inside every cell in our bodies.  In fact, at least of quarter of us have Staphylococcus aureus living inside our noses.  This is the microbe that is called MRSA when it has become resistant to the antibiotic methycillin.

Sometimes the things that live on and in us are actually useful.  At that point it is no longer a parasitic relationship, it is more of a synbiosis or eubiosis.  There are bugs (microbes) in our guts that help digest our food, and also that make vitamins that we need.  Mitochondria are organelles inside our cells that were probably parasites at one time, but they were so useful that we came to depend on them.  They make ATP, the cash of energy currency in the body.  We know that mitochondria were most likely independent organisms because they have their own DNA.

Relatively recently in human history, a bold man drank a potion of Helicobacter pylori bacteria, and gave himself gastric ulcers.  Before that we didn't know that particular bug had much to do with ulcer formation.  But now we know.  And most of us have at least a few of this bug in us.  In fact, pretty much all of us have a few of lots of different kinds of bugs that could be dangerous if they overgrew.

We get some microbes from our parents, and gain new ones throughout life. Babies who are born the normal way, through their mother's vagina, get their mother's vaginal flora in their mouths and swallow it.  That sets up the kind of biota that lives in their guts for life.  Usually a child's gut biota is fairly stable by age 3. A lot of our gut biota depends on what we eat.  A sugary diet sets up a whole different community than a vegetable and fiber-rich diet. You can guess at which one is better for you. A stable community in your gut is protective because it stops other kinds from getting established. People with very stable healthy populations of bugs in their guts can eat anything and never get sick from it.


Stomach acid is the other normal way that we prevent new or bad bugs from setting up house inside us.  Infants don't have much acid, so they are especially susceptible to whatever they eat.  Adults normally have such strong acid that not much survives the stomach and gets to the intestines. But if we block our stomach acid with anti-acids, we are at risk for getting the wrong kinds of bugs in our guts.


The fastest way to mess up your microbial communities is to take antibiotics. The more high powered the drugs, the more imbalanced your biota will be as a result. The more often you take antibiotics, the more the remaining community will be antibiotic resistant.  The bug that really hits hard on people who've taken a lot of antibiotics is called Clostridium difficile.  It is on the CDC's list of extremely dangerous antibiotic resistant bugs.


In naturopathic-speak we call your body the "terrain".  It is the ground upon which things grow. The list of possible infections is endless, and the number of bugs on and in you this very moment is also endless. As long as we are strong and relaxed and young enough, we don't get sick.  When we get run down and weak the microbes can get the better of us.  Stress from life events raises our cortisol and decreases our immune response, and the microbial populations start booming.  We feed them sugary junk, and don't exercise enough, and don't keep our bowel movements regular, and they start running the show.  It is possible to end up sick from the same bugs that you've been carrying around for 40 years or more.

There's new research that shows that depression, anxiety, and obesity are linked to particular sets of gut bugs.  Experiments in mice and humans have shown that taking the microbes from an anxious person's gut and putting them in a calm person will make change what we thought was their personality.  And switching gut bugs in mice can make a fat mouse skinny and vice versa.  The wrong gut bugs are linked to all kinds of diseases of the gut, from ulcerative colitis and crohn's disease to IBS.  There's a lot more information coming down the pipe about this.  Supplement companies are trying to figure out how to introduce the right microbes into people's guts to help them heal from various diseases and mental states.

There's not much you can do about the fact that you will be exposed to microbes.  No amount of antibacterial soap will protect you.  The thing that will is keeping yourself healthy and calm enough to mount a good immune response.  That way you keep the populations down to reasonable levels, where they may even help you somehow.  Oh, and garlic will help.  Garlic turns out to be the very simplest way to keep your gut biota in line.  If you can stand it, some raw garlic every day kills the baddies and keeps the goodies.  If you can't stand it, you might need some more advanced help.
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Conventional Medicine Not Always Supported by Science

10/10/2013

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Many people have this idea that naturopathic medicine is off in lala land somewhere, and that nothing about it is based on reality.  While this could be true for some practitioners, MY practice is based on what we can deduce from what we know and what we are learning.  I base my decisions on scientific findings, and not just one study, but composites of information that add to the big picture.  I advise against using unsubstantiated treatments, and against using any new pharmaceutical drug until it has been on the market at least 10 years.

Ironically, the treatments given by many conventional doctors are not based in science or even in common sense.  Sometimes a treatment idea gets broadly adopted before it has been really studied.  Once everyone thinks that is what works, they just keep doing it.  Patients demand treatments that have no evidence behind them at all.  It takes a lot of information to turn around public opinion after the people have been brainwashed by doctors.

Take chemotherapy for example.  Chemo is poison intended to kill the cancer.  In many cases chemo causes the death of a cancer-ridden patient.  Sure, there are specific cancers which respond very well to chemo, but there are many more that do not.  Doctors will sometimes give in to a patient's desire to "do anything possible" to help, even when they know that it will not help.  It is in fact easier to give people the poison they demand, than to explain to them why they won't benefit from it.

For another example, take a look at the ACIP schedule for vaccinating babies.  While I agree that vaccination is effective for preventing epidemics, there is little evidence behind the schedule.  Vaccinating a newborn for Hepatitis C is destructive, not helpful.  The schedule for vaccination is based on convenience.  Doctors stick the babies with multiple vaccines at every wellchild visit, and don't worry about possible negative effects (and lack of benefit) from that practice.  The vaccination schedule bears some research to make sure that we are building appropriate herd immunity while also not hurting anyone's baby.

I ran across this post about statins today.  Many people take statins. Statins are drugs that stop your body from making its own cholesterol.  There is no evidence to support the use of statins for preventing heart attacks, and they may actually increase the risk of heart attacks in women.  They're also linked to the formation of cataracts, crippling muscle pain, dementia, fatigue, diabetes and erectile dysfunction.  Doctors give statins when they want to lower someone's cholesterol and don't think they can get that person to change their diet and lifestyle.  The evidence says that diet and lifestyle are FAR more effective for adjusting blood lipids than statins are.

Oh and last but not least in my list of conventional medical madness is the idea that eating cholesterol makes the body's cholesterol go up.  For 20+ years the medical establishment has been teaching that if you eat too much eggs and bacon, you will have high cholesterol.  The truth is that your body MAKES cholesterol from pasta and bread.  Your body makes cholesterol because it NEEDS cholesterol.  Cholesterol is not evil.  If your cholesterol is too low, you are sick.  People get high cholesterol from being sedentary and eating too many carbs, not from having an egg breakfast and a full and active day.

Just because something is widely accepted as the state of medicine does not mean that it is the best we can do.  We can do better.  The status quo is for dead people.  Living people have the capacity to keep learning and trying new things.  I urge you to question everything that you think you know about healthcare and health. Many things that have been accepted for a long time are about to be turned on their heads.
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Cannabis Contemplations

12/6/2012

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My patients often ask if I think medical marijuana might be helpful.  We’ve had some widely ranging conversations about the risks and benefits of this drug.  As a naturopathic physician I may not prescribe cannabis even though it is legal for medical use here in Oregon; it is not in the ND formulary.  The fact that I cannot prescribe it does not prevent me from discussing it.  The issue will not go away, regardless of the laws and the war on drugs.  Cannabis is ubiquitous, even though it is federally illegal with varying levels of state permissiveness.

Just last month Colorado and Washington were the first states in America to approve the legalization of marijuana for recreational use.  Those who fear it as a gateway drug, and those who advocate its medical use or broader legalization, are all making noise about it.  The politics often plays more loudly than the facts.  Marijuana is the #1 drug brought our way by Mexican drug cartels, and Mexican weed is likely to contain pesticides and other toxins.  Synthetic cannabinoids are being imported from Asia labelled as bath soaps and sold in convenience stores.  The war on drugs highlights our incarceration problem and the ugly politics of race.  Reasonable medical questions remain unanswered.

Our own government propagated a lot of disinformation back in the 1930’s when the Federal Bureau of Narcotics was created and cannabis was classified as a narcotic (against the advice of the American Medical Association).  The original Greek meaning of “narcotic” was any psychoactive substance that induces sleep, but in more recent times it has come to mean opiates and any drug derived from them.  Opiates are addictive and are carefully regulated by the DEA.  Cannabis is pharmacologically a world apart from opiates, and is no longer thought of as a narcotic, but it is still plagued by the negative reputation engendered by federal prohibition and propaganda, and the War on Drugs.  Cannabis was federally prohibited in 1933, the same year that the prohibition on alcohol was rescinded.

In 2009 the AMA did a review of the scientific literature on cannabis and found a few legitimate clinical trials with a grand total of less than 300 study participants.  The DEA has refused to grant permission to universities or pharmaceutical companies to research it.   The drug is approved by 18 states for medical use, but we have very little scientific information on which to base clinical applications.  Anecdotal information about the indications of various strains guide the choices of medical users.  The federal ban is still in effect, and current federal enforcement efforts are focused on importers and distributors and not on small scale possession (like they were under Reagan).  Employers are within their legal rights to require drug testing.  Law enforcement budgets rely on asset forfeitures (police can seize any cash or items likely to be related to drug trade without proof of guilt) which is incentive for police forces to continue to pursue small scale dealers.  Medical cannabis programs provide a front for a new domestic black market.  That the issue is contentious is an understatement; it is explosive.  And we still don’t know what it is good for.

A future email newsletter will focus on known and theoretical risks and benefits of cannabis use.  Sign up for the monthly missive here. 

 

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Dr Mate gets a great review on his book on addiction

1/29/2011

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http://addictiontreatmentmagazine.com/addiction/hungry-ghosts-book-review/

The book: In the Realm of Hungry Ghosts.  Great synthesis of science and DrM's broad experience.
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Coffee Interferes with the absorption of Thyroid Medication

1/23/2011

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Here's the list of stuff that is so far known to
Decrease your Absorption of Thyroid Medications:

*coffee (decreases absorption by about 1/3)
**antacids containing aluminum hydroxide
***ferrous sulfate (you know, iron supplements)
****calcium carbonate (calcium supplements and high calcium foods)
*****soy protein shakes 
(what about everything ELSE that has soy protein isolate in it?)
******Raloxifene/evista (pharmaceutical for osteoporosis)
*******chromium picolinate (supplement often given to diabetics)

The full scoop including abstracts for the studies can be found at:
http://www.denvernaturopathic.com/thyroidinterference.htm.  There you will also find the abstract of a study that demonstrates that taking your thyroid medication at bedtime may be more effective than taking it first thing in the morning.

Furthermore, I confess that I learn more great new stuff from Jacob Schor's email newsletter than from most of my professors.  You too can get on his email list at: http://www.denvernaturopathic.com/ .
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    Author: Teresa Gryder

    Integrative Physician and Student of Life, Medicine, and the River.

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