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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.

SNAKE OIL.

2/4/2015

 
The irony is rich. The term "snake oil" has come to mean everything that is fraudulent. The reference is to the infamous "snake oil salesman" who pitched and sold his wares out of the back of a wagon to the unsuspecting villagers of the American west.

Snake oil has real medicinal value. It was used as medicine before the North American continent was on the map. Centuries ago the Chinese used an oil made from a cold water snake called Enhydris chinensis to treat joint pain and bursitis. It was introduced to the US by Chinese laborers who worked on the Transcontinental Railroad in the mid 1800's. There's evidence that the ancient Egyptians used it too. In the early 1700's the English had a patent medicine made from snake oil. Snake oil was sold here as a panacea in the early 1900's, but the products sold were probably more filler and adulterant than they were actual snake oil.
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So what's in it that's good for you? Snake oil, depending on the snakes used to derive it, can be a rich source of an fatty acid known as EPA, eicosapentanoic acid. EPA is used by the body to synthesize series 3 prostaglandins, which are anti-inflammatory and pain relieving. You can know EPA is important because it's in human breast milk.  EPA is effective for treating depression, improving cognitive function, autoimmune diseases including rheumatism, high cholesterol, hypertension, and more. 

EPA can be derived in the body from other fatty acids, but it's much easier to eat in your food. The richest sources are fish: herring, mackerel, salmon, trout, pilchards, menhaden and sardines. Fish do not make their own EPA. They get it from eating algae like spirulina, which we also can eat. Plant foods don't contain any EPA at all.

Part of the reason it's easier to eat EPA than to make it in your body has to do with human genetics. Some people have the gene to make the enzyme which lets them convert ALA (alpha linolenic acid) into EPA. Other people have mutations in their genes that limit their ability to do the conversion. Diabetes and some allergies also limit a person's ability to convert ALA to EPA. ALA is an essential fatty acid, meaning that no humans can make it; we have to get it from the diet.

If we don't make it very well, and we don't eat much fish, we need to get our EPA some other way to keep our cell membranes happy.  Many healthcare professionals recommend that we take fish oil.  Fish oil contains 12-18% EPA.  Salmon oil tops the list at ~18%.  Chinese water snake oil contains ~ 20% EPA, whereas rattlesnake oil is said to contain 8.5%. Cod liver oil has more DHA than EPA and is best reserved for specific uses, like building baby brains or healing brain injuries.

The reason why some snakes have more EPA than others has to do with the temperatures that they live in. Snakes and fish are both cold blooded, so they have to function with their bodies at the same temperature as their environments. Omega 3 fats like EPA don't harden in cold temperatures like omega 6s do. They help keep cell membranes flexible. Flexible membranes don't get injured as easily, and are able to function better. Cold water fish, or cold water snakes, will have more EPA than those that live in warm sunshine, like rattlesnakes.

The next time someone tells you that a treatment is "snake oil", remember this. Public attitudes and language reflect our history, not our future. Science continues to give us reason to revise belief systems, erase myths, and sometimes to welcome old treatments back into the fold.

Good Fats for Brain Health

5/12/2014

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Recent post by Dr Gryder at the Madness Medicine Blog.
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Macular Degeneration More Common than Young Folks Know

5/8/2014

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Macular degeneration is the #1 cause of visual loss in folks over 55, and it is #2 after cataracts in folks over 65.  Until your 40's, you might never even hear about it.  But if your own vision begins to change and worsen, you might wish you'd started to pay attention sooner.  To that end, here are a few things you can do to keep your eyes healthy.

One of the best things anyone can do for themselves is to eat foods that support health.  Any doctor who is worth her salt will tell you how to optimize your diet for your particular health needs.  The eyes in particular are sensitive to metabolic disease and systemic inflammation, which can be caused by eating bad (trans) fats, having high blood sugar, and not consuming enough antioxidants.

All antioxidants, including the ones you get from eating berries and bright colored vegetables, are fair game.  The more the merrier, in fact, because they seem to have synergistic effects.  The specific antioxidants that are protective pigments in the eye are lutein and zeaxanthin.  You can buy supplements that have these things in them, but you don't have to.  The best way to get these may be by eating good food.  Dark leafy greens are an excellent source of these and of vitamin A. Spinach salads, kale, turnip greens and collards are best, but anything green probably has some of it in there.  If you're not wild about greens, maybe you can find some other way to get a daily dose of them, such as putting them in casseroles and blending them up in a yummy fruit smoothie.  Other vegetable sources of are broccoli, pumpkin, brussel sprouts, and sweet yellow corn.  Anything that is brightly orange or yellow-colored has a chance of containing some.

One of my favorite sources is egg yolks.  Each egg yolk contains approximately 210 micrograms.  You'll notice, if you're an egg-eater, that egg yolks are not all the same color.  The ones you want are the brightest, orangiest ones you can find.  Usually organic eggs have better color, but they are so expensive that many people balk.  You can scope out the best source of eggs from your grocery store by noting the yolk color each time you break some open.  If you have two different brands, break open one from each dozen and compare.  When you go shopping again, bias your buying toward the brighter yolks.  They're good for your eyes.  Eggs also happen to contain B vitamins and choline which are good for your brain and liver and most everything else.  And in case you hadn't heard yet, eggs do not drive up your cholesterol, so if you stopped eating them for that reason, you can start up again now.

Another dietary addition that is great for the eyes is Brazil nuts.  They contain just enough selenium that eating 2/day will keep you replete for the nutrient.  If these nuts aren't your favorite, try chopping them up and mix them into your breakfast oatmeal.  You won't even notice them, but they will help your eyes and support many other body systems as well.

Aging gentlemen need to be aware that taking a lot of zinc, without also consuming plenty of antioxidants, could actually cause macular degeneration.  Zinc is great for the guys because it helps prevent BPH, so lots of men take it later in life.  Make sure you're also eating colorful fruits and berries to prevent this possible negative effect!


One last suggestion that might help you keep your vision longer is to always protect your eyes from the sun.  This means buying quality sunglasses and using them when you're in bright sun.  Never stare directly at the sun (just like your momma said), and use hats to help protect your eyes when you're out for a long time.
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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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On Waiting vs Taking Action

7/29/2011

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They aways say time 
changes things 
but actually you have to 
change them yourself.
--Andy Warhol

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Eating Fish: Healthy or Toxic?

7/25/2011

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There's a debate raging about fish---whether or not we should eat it, what kind, and what we should do about the toxic mercury that contaminates much of the world's fish supply.  There are some who say don't worry about it, fish is so good for you that you should just eat it and don't worry about the mercury.  There are others who say that fish is so dangerous that you shouldn't eat any, and that you should supplement fish oil that has been tested and is free of mercury instead.  There is no doubt that most Americans don't get enough omega 3 fatty acids, and that we can get them from eating more fish.  So where do I fall?  Somewhere in the middle.  Because really, like all diet and lifestyle choices, it is a personal decision.

For the last century fish have carried increasing levels of mercury and other contaminants.  Carnivorous fish have more, because many toxins bio-accumulate.  Equatorial fish have more, because there are more people and hence more pollution around the midsection of the planet.  Interestingly, since the economy took a dive a few years back, the mercury levels in fish have declined.  Some say that it is because there is less coal being burned in China.  Most environmental mercury comes from coal smog.  All this is debatable, but the fact that there is mercury in fish, and that mercury is bad for people, especially people's brains, is very well documented.

So what do I do?  I eat fish 1-2 times a week, and supplement fish oil, ideally every day, though I often fall short of that goal.  I choose fish that are less likely to have a high mercury load---less carnivorous fish, smaller fish, more northern fish, instead of tuna from near the equator.  I supplement zinc, because being replete for good metals reduces one's absorption of bad metals when introduced.  And I support my liver's detoxification mechanisms in many ways, not the least of which is eating sulfur rich foods like cilantro and garlic.  I don't know exactly what balance will be right for you, but it is worth being conscious of the toxic challenges that may be in your food, and acting intentionally about it.

Here is a site where you can find out how much of what is in the fish you eat:
http://www.howmuchfish.com/

Edit 11/28/11: I just heard that fish have high enough selenium levels to bind up most of the mercury that they ingest, and possible render the majority of it non-absorbable to us.  I have not confirmed this yet, but it brings up the question: would repletion for selenium benefit humans with regard to avoiding mercury toxicity?  I do know that most humans are deficient in selenium.  And I also know that selenium is a key cofactor in the activation of thyroid hormone; if you don't have enough selenium, you will feel tired.  So it's worth considering both selenium and zinc as nutrients to bulk up on if you want to eat fish.  More updates as I learn more!
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Epigenetics and Culture

4/25/2011

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The word is getting out.  On my plane ride home yesterday I sat next to a chiropractor who was in the process of reading a book about human health.  She was very excited about what she was learning, and told me all about it.  She told me about how human genes can be turned on and off by our environment---what we eat and what we are exposed to influences the way that our genes are expressed.  It's called epigenetics, and it's a fast-growing new area for research and rumination.  This is not news to me, but it was good to realize that there are popular books out there inspiring people to eat apples and get exercise.  People want to be healthy, but after several generations of trusting in technology and medicine, we have forgotten how.  We have come to rely too much on external sources that tell us not to worry about our ailments because technology will patch us up.  We have forgotten to listen to our own internal intelligence.  The time is right for teachings of an old kind, that we are mammals not machines, and that to thrive we need to treat our bodies with respect, even love.
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Iodine for Thyroid and Breast Health: Regardless of Nukes

3/21/2011

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Because of the nuclear meltdown threat in Japan, lots of people are talking about taking iodine.  The point is to top off your body's stores of healthy iodine so that if there is any radioactive iodine in the atmosphere, your body doesn't take it up.  But there is risk in taking iodine, and there is a lot of conflicting information out there.  So here's just a tiny primer on what to do--or rather, what NOT to do.

The US RDA for iodine is 250 micrograms per day.  Notice: MICROgrams, not MILLIgrams or mg.  The RDA is based on preventing goiters, not on optimal health, so don't assume (ever) that the RDA is actually how much of anything you want to get.  There's more to it than that.  The Japanese RDA is 800 micrograms.  The actual Japanese daily intake of iodine is more like 25-50 MILLIgrams per day, because they eat so much fish and seaweed.  And the Japanese have lots less cancer than Americans.

It turns out that breast cancer is associated with low iodine levels, especially during a woman's teens and twenties.  This is not about radiation, it's just about not getting enough of a nutrient that the breasts need.  Breast cancer is terribly common.  The thyroid uses the most iodine in the body, and here in the US there is an epidemic of hypothyroidism.  It could be argued that we would be well served by taking in more iodine, like the Japanese do.  And obviously we're not getting enough from our iodized salt.  Some argue that we don't absorb iodine very well when it's mixed with salt.

The CDC and other sources are recommending that people who are exposed to radiation take 150 MILLIgrams of iodine a day.  But 300 milligrams of iodine has the potential to suppress the thyroid gland, to shock it, if you will.  And not all of us are directly exposed to radiation levels that high.  So we probably don't need to take that much.

If you decide to supplement iodine, make sure you look at all your supplements and add up the amounts in each.  There is iodine in my multi, and in my thyroid support supplement.  The cheap and easy way to just get more iodine is the liquids in dropper bottles that you can find at the health food store.   One drop is usually all you need for a day.  You do not want to overdose!!  There could be iodine in lots of supplements, so check!

Personally, I have been taking somewhere close to 1 milligram (mg) of iodine a day, and at that level, I think that my receptors are full of good iodine, and I am at a low risk of uptaking radioactive iodine.  I'm paying attention to all the information that comes my way about it, and I will give you an update if there's anything that convinces me that for my own health, I want to take more or less.
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    Author: Teresa Gryder

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

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