Whether you have recently started a new medication or have been taking one for a while, it’s important to fully understand the medication’s side effects, any interactions, and the proper instructions. To help you ask the right questions, continue reading! Any medication, whether it is a prescription, over-the-counter option, herbal/complementary therapy, or vitamins and supplements, can have unwanted side effects, called adverse effects.¹ Adverse effects may vary between each patient depending on weight, age, gender, general health, and the state of their disease. These adverse effects may also vary between mild, moderate, or severe.  Some common, mild adverse effects include: ·         Constipation ·         Skin rash ·         Diarrhea ·         Dry mouth ·         Headache ·         Nausea A few effects that are more serious include: ·         Suicidal thoughts ·         Abnormal heartbeat ·         Internal bleeding Make sure to discuss any potential side effects from your medications with your pharmacist, especially if you are taking other medications. You should always report new side effects to your pharmacist or primary care provider. What Should I Avoid While on this Medication? When starting a new medication, it is important to know if it has any potential interactions with any other medications you are taking, food, alcohol, or even sunlight exposure. According to MedlinePlus.org , “A drug interaction is a change in the way a drug acts in the body when taken with certain other drugs, foods, or supplements or when taken while you have certain medical conditions.” A few of these examples include: ² ·         Aspirin and blood thinners ·         Statins and grapefruit ·         Gingko and blood thinners ·         Aspirin and peptic ulcers Certain Medications and Certain Foods Some foods are best to avoid when taking certain medications, as it may reduce or increase the effectiveness of the medication or cause other side effects. Certain vitamins and supplements, including essential oils, may also interact with medications. Alcohol Another harmful drug interaction includes drinking alcohol while taking medication. Most medications, whether over-the-counter or prescription, include a warning on the label indicating not to consume alcohol while taking this medication. Mixing alcohol with medications may cause mild to severe side effects such as: ⁴ ·         Nausea and vomiting ·         Headaches ·         Drowsiness ·         Fainting ·         Loss of coordination ·         Internal bleeding ·         Heart problems ·         Breathing difficulties ·         Increased risk for overdose ·         Memory problems Alcohol may also make your medication less effective or cause the medication to become toxic or harmful to your body. Some medications, such as cough medicine or laxatives, may contain up to 10% alcohol and when mixed with alcoholic beverages, may become extremely dangerous. Even if you don’t consume the medication and alcohol at the same time, medication is designed to stay in your system, meaning it may still be around by the time you decide to take a drink. Sun Exposure Did you know that some medications may cause adverse effects when you are exposed to sunlight? Photosensitivity is a chemically induced change in the skin due to certain ingredients in medications. This chemical change may cause sunburn-like symptoms, rash, or other unwanted side effects and may appear days after sun exposure or right away. A few examples of medications that may cause sun sensitivity include: ³ ·         Antibiotics ·         Oral contraceptives ·         Retinoids ·         Sulfonylureas for type 2 diabetes Not everyone who takes these medications may experience photosensitivity, but it is good to ask your pharmacist if it is a possible side effect. How Do I Take This Medication? When talking to your pharmacist about your medication, you should ask them how to administer it, how long to take it, the time of day to take it, whether to take it with or without food, and how much to take. Administration Taking medications correctly and understanding the right way to administer them can help reduce risks and possible further problems. There are many different ways to administer medications. Some common ways include: ⁵ ·         Inhalable:  breathed in through a tube or mask ·         Intravenous:  injected in a vein or IV line ·         Nasal:  given into the nose by spray or pump ·         Oral:  swallowed by mouth ·         Rectal:  inserted into the rectum ·         Sublingual:  held under the tongue ·         Transdermal:  given through a patch placed on the skin The type of administration depends on the part of the body that is being treated, how the drug works within the body, and the formula. Duration Each medication comes with different instructions on how long to continue a medication. Some prescriptions will say to continue a medication until symptoms go away, some have specific time periods (e.g. take once a day for 2 weeks), and others note to take as needed. Time of Day Taking medication at night versus in the morning can make a huge difference. Some medications are prescribed to be taken at night because they contain ingredients that may cause drowsiness, while others may have beneficial effects if taken in the morning. With or Without Food Knowing whether or not to take your medication with food is important for a few reasons. It may help ease side effects such as upset stomach or nausea if you take your medication during a meal. Taking medication on an empty stomach may help with absorption of the drug, as the presence of food may reduce the absorption in the body. Dosage Amount Taking the correct amount of medication is important to avoid a potential overdose. In contrast, if not taking enough of the medication, it may not work properly and produce the desired results. Other Ways We Can Help We are here to be more than just your place to get prescriptions. We are your source for trusted healthcare! We offer services to help you understand your medications and stay on track. Talk to us today about how we can help you! Also, as an additional resource, Drugs.com  ⁶ offers a full library of medications, symptoms, interactions, and more. Sources 1.      https://www.medicalnewstoday.com/articles/323485 2.      https://medlineplus.gov/drugreactions.html 3.      https://www.fda.gov/drugs/special-features/sun-and-your-medicine 4.      https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines#:~:text=You've%20probably%20seen%20this,problems%2C%20and%20difficulties%20in%20breathing . 5.      https://www.healthline.com/health/administration-of-medication 6.      https://www.drugs.com/

We are now officially in spring, which means it’s time to take stock, clear out, and get rid of things that no longer serve us. When thinking about things cluttering your countertops, bathrooms, or medicine cabinets, a perfect place to start is checking your over-the-counter medicines and prescriptions. But before we get there… Why is it important to clear out our medicine cabinets? Peace of Mind Many of us have the tendency to keep things around “just in case” or to over-purchase when items go on sale. If we’re not careful, this inevitably means these medications will expire no matter how well-intentioned we may have been in saving money or thinking ahead in the first place. Taking stock of what we have and use frequently can help us make room for things we need. It also doesn’t hurt to get rid of things to reduce clutter: a win-win!   Safety Keeping around expired medications or medications you no longer take may not seem like a huge deal, but the repercussions of accidentally taking an expired medication or one you shouldn’t be taking in the first place can be serious and have major negative effects. An easy way to know when you should get rid of medicines: 1.       Your doctor changes your prescription but you have some left over 2.       You are no longer sick and your doctor says you should stop taking the medication 3.       The over-the-counter medications you have you no longer use or need 4.       The medications are expired ³   How to safely dispose of medications? Do NOT flush MOST medications While flushing medicines is an easy option, it is not always a safe option. Medications contain elements like hard-to-break-down chemicals that negatively impact the environment, polluting water resources, and affecting fish and other aquatic life. These chemicals can also end up in your drinking water, affecting your local community.⁴ There are, however, exceptions to be aware of. The FDA has a comprehensive list of medications that can be flushed because they are “sought-after for their misuse and/or abuse potential” and “that can result in death from one dose if inappropriately taken. If children, adults, or pets in your home accidentally or intentionally ingest, touch, misuse, or abuse a medicine on the flush list, they can suffer serious consequences including death.”⁵ A full list of medications that can be flushed can be found here: https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines#FlushListLinks Take advantage of drug take-back programs Twice a year, the U.S. Drug Enforcement Administration (DEA) sponsors National Prescription Drug Take Back Day nationwide. On April 26th, participating pharmacies are accepting unused prescription medications on-site, but many accept medications all year. During the last National Take Back Day on October 26, 2024: 4,425 law enforcement participated, there were a total of 4,644 collection sites, and a total of 629,953 pounds of medications collected.¹ Give us a call today to see how we can help you safely dispose of your prescriptions!   Long-term Solutions: Keeping on top of your medications Yearly taking stock of your medicine cabinets is a great way to consistently check what you use, what you need to repurchase, and what you need to dispose of. But, what if you could have a better long-term system in place?   Medication Reviews Sitting down with a pharmacist and reviewing your medications is a great way to mitigate any unnecessary medication interactions, causing an excess of unneeded and unused medicines cluttering your counters and shelves. Your pharmacist can make sure that all your medications are working for you as they should as well as checking to see if there are any areas of improvement, such as adding or subtracting over-the-counter vitamins and supplements.   Medication Compliance Packaging and Med Sync Services A great way to cut down on pill bottle clutter overall is to take advantage of any medication packaging and med sync services the pharmacy can provide. This can mean compiling your medication into one easy-to-use packaging system that indicates time and day, decreasing the chance of missed doses; downsizing the number of containers to take when you’re traveling; and eliminating the need to sort pills. Medication synchronization services can also decrease the number of times you have to stop at the pharmacy to pick up your meds. This not only saves you time, gas, and energy, it also can help simplify and, in a sense, declutter your to-do list. Get in touch today to see how our services can make your life simpler! Sources: 1-      https://www.dea.gov/takebackday 2-      https://www.dea.gov/sites/default/files/2024-11/NTBI27%20Totals.pdf 3-      https://medlineplus.gov/ency/patientinstructions/000943.htm 4-      https://medlineplus.gov/ency/patientinstructions/000943.htm 5-      https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines

The kidneys play a crucial role in maintaining good health and proper bodily function. Every 30 minutes, they work to remove waste, toxins, and excess fluid from the body. Additionally, they help regulate blood pressure, signal the production of red blood cells, keep bones healthy, and balance blood chemicals vital for life. ¹  According to the National Library of Medicine in an online article titled, Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease, “About thirty-seven million US adults are estimated to have chronic kidney disease (CKD), which is more than one in seven. Even more astonishing, nine in ten adults do not know they have the disease, and half of the adults with little kidney function who are not on dialysis are unaware they have CKD.” ²  CKD often goes undiagnosed due to lack of apparent symptoms. How to check your kidney health: Understanding how your kidneys function is crucial for maintaining a healthy lifestyle that meets your specific needs. Regular physical exams can help detect any signs of kidney disease by checking various indicators such as blood pressure, heart rate, swelling, pain, and skin changes. These exams can sometimes reveal subtle symptoms of kidney issues. It is recommended to have a physical exam every 1-2 years if you are between 20 and 50 years old, and annually if you are over 60. If you suspect that something might be wrong with your kidney function, you can ask your primary care doctor for a urine test. Be alert for symptoms such as foamy or bubbly urine, blood in the urine, swelling in the feet, ankles, legs, or face, excessive fatigue, nausea, vomiting, lack of appetite, shortness of breath due to fluid buildup in the lungs, itching or rashes, and anemia caused by a low red blood cell count. ³  Keep in mind that these symptoms could also indicate different underlying conditions. If you experience any of these symptoms, it is important to consult your healthcare provider for an accurate diagnosis and appropriate treatment. If you have a medical condition or a family history of kidney disease, your doctor may recommend regular monitoring, including blood pressure checks and urine tests during your office visits. Early detection of kidney disease can help slow or prevent the progression to kidney failure. Who is at risk? Certain medical conditions or lifestyle habits can make individuals more at risk for CDK. This includes: ³ Type 1 or 2 diabetes High blood pressure Inherited kidney disease (polycystic) Prolonged obstruction of the urinary tract (kidney stones, enlarged prostate and some cancers) Recurrent kidney infection Conditions that cause kidney inflammation Heart disease Smoking Obesity Older age Frequent use of medications that damage the kidneys Alcoholism What if I have or am at risk for kidney disease? If you discover that you have kidney disease or are at risk due to conditions affecting your kidneys, there are habits you can adopt to promote kidney health, such as following the renal diet. The renal diet is specifically designed for individuals with kidney disease. Before diving into the details of the renal diet, it’s important to consult your healthcare provider if you do not have kidney disease but have a condition that impacts your kidneys. They can help you determine whether this diet would be beneficial for you. However, if you do not have kidney disease or any related conditions, the renal diet is not recommended, as it restricts certain nutrients that are essential for your overall health. What is the renal diet? A renal diet aims to decrease the amount of waste in the blood by limiting sodium, phosphorus, and protein intake. Individuals with compromised kidney function have difficulty removing these waste products from their blood, so reducing specific nutrients in their diet can help preserve kidney function. Additionally, some patients may also need to limit their intake of potassium and calcium. ⁴  Since each person's body is unique, it is essential for each patient to collaborate with a renal dietitian to create a diet tailored to their specific needs. Key points about the renal diet: ⁴ Limit processed foods and limit sodium intake to 400 mg per meal and 150 mg per snack.  Restrict milk and dairy products to a total of 8 oz per day.  Limit potassium-rich foods, including fish, citrus juices, beans, spinach, potatoes, bananas, and avocados.  Manage protein intake according to the stage of CKD you are currently in.  Fluid control is crucial for individuals in the later stages of CKD. Only drink the amount that your doctor recommends, including any food that can melt at room temperature and fluids used in cooking.  Avoid high-phosphorus foods, such as meat, fast food, seeds, milk, canned fish, cola, and cheese.  Focus on fresh, high-quality whole foods, including lean proteins and fresh fruits and vegetables. If you're unsure where to begin, consider starting a food journal. Make it a habit to pay close attention to food labels, and work with your doctor and renal dietitian to understand the specific portions and dietary recommendations tailored to your unique needs and the stage of CKD you are in. What about vitamins and supplements? When following a renal diet or taking medications for CKD, you may need to add vitamins to your daily routine to compensate for any deficiencies in your diet. It's important to avoid herbal remedies and over-the-counter nutritional supplements unless your healthcare provider or CKD dietitian recommends them. Below is a list of vitamins that you may need to take, as well as those that should be avoided. Recommended Supplements ⁵ Depending on your health and other factors, your healthcare provider may recommend the following vitamins: B Complex:  works to help prevent anemia Other B Vitamins:   thiamine, riboflavin, pantothenic acid and niacin  may assist your body in converting food into usable energy. Iron:  If you are taking a medication to prevent anemia, you may need to add an iron supplement. Only take iron if your healthcare provider prescribes it to you. Vitamin C:  Supports healthy tissue and promotes faster healing from wounds, bruises and infections. Since the renal diet lacks nutrients, your healthcare provider may recommend this. Vitamin D:  Vitamin D is important for maintaining healthy bones. Your healthcare provider may prescribe this to you in the later stages of CKD. You should only take this supplement if your healthcare provider tells you to. Supplements to Avoid ⁵ Fat-soluble vitamins like vitamin A, E, D and K: These vitamins are likely to do more harm than good by building up in your body which can cause issues over time. If you are living with CKD, the renal diet may be beneficial for you. If you have a higher risk of developing kidney disease, it’s important to schedule regular check-ups with your healthcare provider and stay informed about the vitamins you should include in your diet. You can find high-quality vitamins at your local pharmacy. Don’t hesitate to ask our pharmacy team how we can support your health journey. Sources: https://www.cdc.gov/kidney-disease/about/index.html https://pmc.ncbi.nlm.nih.gov/articles/PMC8467342/#B1-nutrients-13-03277 https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521#:~:text=Generally%2C%20earlier%20stages%20are%20known%20as%201,urinating%20either%20too%20much%20or%20too%20little . https://nephcure.org/managing-rkd/diet-and-nutrition/renal-diet/ https://www.kidney.org/kidney-topics/vitamins-and-minerals-chronic-kidney-disease

If you recently have been diagnosed with a heart disease or experienced a heart attack, you may have been prescribed some medications to treat symptoms, such as hypertension, blood clotting, arrhythmia, chest pain, high cholesterol, and more. It’s important to understand why you have been prescribed certain medications and how those medications work. Anticoagulants Anticoagulants are medications used to prevent the forming of blood clots in the bloodstream and may prevent clots from becoming larger. While anticoagulants are commonly referred to as “blood thinners”, these medications do not thin the blood, nor do they completely stop blood from clotting. Patients taking anticoagulant medication may experience wounds that take longer to stop bleeding due to the medication’s anticoagulating effects.¹ Commonly Prescribed Blood Thinners² Apixaban (Eliquis)  Dabigatran (Pradaxa) Edoxaban (Savaysa) Heparin Rivaroxaban (Xarelto) Warfarin (Coumadin) Antiplatelets are a group of anticoagulants that work to prevent blood platelets from sticking together and forming a blood clot. Antiplatelets are more suitable for patients who have experienced a heart attack or stroke due to narrowing of blood vessels. ¹ Commonly Prescribed Antiplatelet Agents² Aspirin Clopidogrel (Plavix) Dipyridamole (Persantine) Prasugrel (Effient) Ticagrelor (Brilinta) ACE inhibitors Angiotensin-converting enzyme (ACE) inhibitors are medications that help relax the veins and arteries by widening blood vessels to lower blood pressure, reducing the workload of the heart. ACE inhibitors are commonly used to prevent, treat, or improve symptoms in conditions such as: hypertension, coronary artery disease, heart failure, diabetes, chronic kidney disease, heart attacks, and more. ³ Commonly Prescribed ACE Inhibitors² Benazepril (Lotensin) Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil, Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)  Angiotensin II receptor blockers Used to treat high blood pressure, angiotensin II receptor blockers, or ARBs, block the chemical angiotensin II from narrowing blood vessels. As a result, the medication relaxes and widens blood vessels to lower blood pressure. ARBs are commonly used to prevent, treat, or improve symptoms in patients with chronic kidney disease, heart failure, and kidney failure.⁴ Commonly Prescribed ARBs² Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan) Beta blockers Beta blockers are medications used to treat high blood pressure by blocking the effects of epinephrine. This slows heart rate and causes the heart to beat with less force. This helps lower blood pressure and improves blood flow by widening veins and arteries. Beta blockers are commonly used to treat high blood pressure when other medications have not worked and are used to prevent, treat, or improve symptoms in conditions, such as: arrhythmia, heart failure, chest pain, heart attacks, and more.⁵ Commonly Prescribed Beta Blockers² Acebutolol (Sectral) Atenolol (Tenormin) Betaxolol (Kerlone) Bisoprolol/hydrochlorothiazide (Ziac) Bisoprolol (Zebeta) Metoprolol (Lopressor, Toprol XL) Nadolol (Corgard) Propranolol (Inderal) Sotalol (Betapace) Calcium channel blockers Calcium causes the heart and arteries to squeeze strongly. To lower blood pressure, calcium channel blockers stop calcium from entering the cells of the heart and arteries, allowing blood vessels to relax and widen. Calcium channel blockers can also slow heart rate, further lowering blood pressure. In addition to treating high blood pressure, calcium channel blockers are commonly used to prevent, treat, or improve symptoms in patients with coronary artery disease, chest pain, arrhythmia, and blood vessel conditions.⁶ Commonly Prescribed Calcium Blockers² Amlodipine (Norvasc) Diltiazem (Cardizem, Tiazac) Felodipine (Plendil) Nifedipine (Adalat, Procardia) Nimodipine (Nimotop) Nisoldipine (Sular) Verapamil (Calan, Verelan) Cholesterol-lowering medications Cholesterol is a waxy, fatlike substance found in your blood. Low-density lipoprotein (LDL) or “bad” cholesterol can lead to fatty buildups in your arteries, increasing the risk for heart disease, heart attacks, or strokes. To decrease “bad cholesterol” and increase high density lipoprotein (HDL) or “good cholesterol”, your healthcare provider may prescribe a cholesterol-lowering medication. Commonly Prescribed Cholesterol-Lowering Medications Statins² Satins are prescribed to decrease “bad cholesterol” and triglycerides, a type of fat in the blood that increases the risk of heart disease. Statins may also increase “good cholesterol.”⁷ Commonly prescribed statins include: Atorvastatin (Lipitor) Fluvastatin (Lescol) Lovastatin (Mevacor) Pitavastatin (Livalo) Pravastatin (Pravachol) Rosuvastatin (Crestor) Simvastatin (Zocor) Nicotinic Acids² Niacin is prescribed to decrease “bad cholesterol” and triglycerides, while also increasing “good cholesterol.”⁷ Cholesterol Absorption Inhibitors² Cholesterol absorption inhibitors, such as ezetimibe (Zetia), are prescribed to decrease “bad cholesterol” and slightly decrease triglycerides. Cholesterol absorption inhibitors may also increase “good cholesterol.”⁷ Combination Statin and Cholesterol Absorption Inhibitors² Combination statin and cholesterol absorption inhibitors, such as ezetimibe/simvastatin (Vytorin), are prescribed to decrease “bad cholesterol” and triglycerides, while also increasing “good cholesterol.”⁷ Drug and Supplement Interactions Many herbal supplements may interact with medications used to treat heart and blood vessel conditions. Below are some common herbal supplement and drug interactions:⁸ COQ-10  may lessen how well warfarin works and further lower blood pressure if you also take a medication to treat high blood pressure.⁸ Danshen  may interact with blood thinners, blood pressure medications, and digoxin (Lanoxin).⁸ Evening primrose, garlic, ginkgo biloba  may increase your risk of bleeding if you take blood thinners, such as aspirin, clopidogrel, and warfarin.⁸ Ginseng  may lessen how well warfarin works.⁸ Hawthorn  may interact with beta blockers, calcium channel blockers, nitrates, and digoxin.⁸   If you are taking a prescription, heart-related or not, it is recommended to consult with your healthcare team (including our pharmacy team!) before making any major change in diet or supplementation. Your healthcare team can evaluate what may best fit your needs, check for interactions, and more.   If you have any questions about your medication regimen, it is encouraged to consult your healthcare team, including your pharmacist. As your pharmacy, we are dedicated to providing you with the best possible care, beyond just dispensing medications. We are here to address your questions and concerns and support your unique healthcare needs.   Sources 1.      https://www.ncbi.nlm.nih.gov/books/NBK279433/ 2.      https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack/cardiac-medications   3.      https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480 4.      https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/angiotensin-ii-receptor-blockers/art-20045009#:~:text=Angiotensin%202%20receptor%20blockers%20stop,Valsartan%20(Diovan) . 5.      https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522 6.      https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/calcium-channel-blockers/art-20047605 7.      https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/cholesterol-medications/art-20050958 8.      https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/herbal-supplements/art-20046488

If you or someone you know is on Medicare, you might have heard about the changes taking place this year. But first, let’s take a dive into what Medicare is.   What is Medicare? Medicare is a federal health insurance that is offered to adults who are 65 or older. There are four main parts to the insurance program which include: ¹ Part A – covers inpatient care in hospitals, skilled nursing facilities, and home healthcare Part B – covers outpatient care like diagnosis and treatment at a doctor’s office, and preventive services like vaccines and wellness visits Part C – also known as Medicare Advantage, a bundled plan that includes parts A, B, and sometimes D Part D – covers prescription medications Seniors become eligible for Medicare 3 months before their 65th birthday and have up to 3 months after their 65th birthday to enroll. There are some special cases where individuals will automatically be enrolled into Part A and Part B, for example, if they are already getting benefits from Social Security or the Railroad Retirement Board. ² During the initial enrollment period, seniors can choose a plan that best fits their needs for that time being. Each year, those who are already enrolled in a plan can make changes to their current plan during a time period called Open Enrollment. During this time between October 15 and December 7, it is important to review your current plan, current medications, and evaluate other plan options to see if you can find better coverage or even save money. ³ Remember, if your plan works for you now, that doesn’t necessarily mean it will work for you next year.   New Changes to Medicare Beginning this year in 2025, there are seven big changes to Medicare that you need to be aware of.   1. Prescription Spending Cap. For the first time in history, Medicare Part D and drug coverage in Medicare Advantage plans will have a cap on out-of-pocket spending for prescription drugs of $2,000. This cap includes deductibles, copayments, and coinsurance for covered drugs. It does not apply to premiums or to drugs a plan doesn’t cover. ⁴   2. No Part-D "Donut Hole" A major change to Medicare is the removal of coverage gap, often called the "donut hole." Before 2025, coverage had four phases that included deductible, initial coverage, coverage gap, and catastrophic coverage. The deductible coverage phase meant you had to pay the full cost of your drugs until you met your deductible up to $545, then pay copayments until you and your plan spend $5,030 on covered medications bringing you into the donut hole. In the donut hole, plans pay less for drugs, especially brand-names, and you may pay more out-of-pocket for the same meds than in the initial coverage phase. Catastrophic coverage did not begin until $8,000 was reached. ⁴ However, in 2025, the deductible for Part D plans can be up to $590, then you will pay copayments out-of-pocket for medications until the $2,000 cap is reached. ⁴ Once this cap is reached, you enter the catastrophic coverage where the plan pays the entirety of covered prescriptions for the remainder of the year, meaning you pay nothing.   3. Weight Loss Drugs Drugs prescribed specifically for weight loss are prohibited from being covered by Medicare. However, Part D plans can cover popular weight loss drugs if they are prescribed for other purposes like Ozempic and Mounjaro for type 2 diabetes. ⁴ Another popular approved drug is Wegovy prescribed to those with cardiovascular disease who are also overweight. According to Diane Omdahl, it is estimated that those with obesity or who are overweight could be eligible for Wegovy to help reduce the risk of serious heart disease. ⁴ This drug is likely to come at a high cost, but with the new $2,000 cap, those on Part D will greatly benefit.   4. Medicare Advantage Coverage In 2025, Medicare Advantage plans may make changes to help cover their additional expenses. These changes may include changes to the formulary (the list of covered drugs), reduce out-of-pocket maximums, increase coinsurance, or reduce extra benefits. ⁴ As an example, if you have a dental benefit, it may be less generous than it has been in the past.   5. Midyear Medicare Advantage Plan Statement If you selected a Medicare Advantage plan, you will receive a midyear statement that shows available benefits that have not yet been used. Plans are required to send these statements to ensure enrollees are using their plan to the fullest extent possible.   6. Caregiver Services Expansion The program for patients with dementia and their caregivers, called Guiding an Improved Dementia Experience (GUIDE), will be serving more of the country this year than it did in 2024. This program provides: ⁴ 24/7 support Care navigator to find medical services & assistance Caregiver training Up to $2,500 a year for at home, overnight, or adult day-care respite services. GUIDE began with 96 initial organizations, and in July of this year, 294 more will join. These organizations include academic medical centers, hospitals, small and large group practices, and community-based organizations already providing programs for dementia patients. For a participant to qualify for the GUIDE program, they must be enrolled in Original Medicare and have a dementia diagnosis. Those in hospice or nursing homes are not eligible. ⁴   7. More Mental Health Providers As of 2022, only 20 percent of adults 65 and older reported they used mental health services. However, if additional access to these services were available, those numbers may be affected. Mental health counselors, marriage and family therapists, or addiction counselors were unable to bill Medicare before 2024, because they were not allowed to enroll as Medicare providers. Now, more than 400,000 behavioral health clinicians nationwide are eligible to enroll in the Medicare program, including telehealth providers. ⁴   As you look back on the past year and onto this year, it is crucial to fully understand your Medicare plan. You can find and compare health and drug plans on the Medicare website, medicare.gov/plan-compare , or you can sit down with your trusted pharmacist who knows your health concerns and current medications. It is also a good idea to review all your medications at least once a year, or when you get a new prescription.   Sources 1.      https://www.medicalnewstoday.com/articles/medicare-advantage-part-d-2025-changes-costs 2.      https://www.medicare.gov/publications/11220-your-yearly-medicare-review.pdf 3.      https://www.medicare.gov/publications/10050-medicare-and-you.pdf 4.      https://www.aarp.org/health/medicare-insurance/info-2024/medicare-changes-coming-in-2025.html

It is that time of year again when the days are shorter, the weather is colder, and you start to feel gloomy. We all understand the reason behind the shorter days and colder weather, but why do you feel sadder or even depressed in the winter? It could be due to a type of depression called seasonal affective disorder, or SAD for short. Ironic name, isn’t it?   What is SAD? Seasonal affective disorder (SAD) is a type of depression that is related to the change of seasons and lack of sunlight during the winter months. ¹ People with SAD may even feel depressed during other seasons of the year when it is rainy or cloudy, and on rare occasions, SAD may occur in the spring or early summer. To better understand exactly what SAD is, it is important to know what causes it and what it may look like.   What Causes SAD? There have been many causes of SAD observed and researched over the years; however, researchers are still determining these causes. Studies have indicated that those who have SAD are more likely to have reduced levels of serotonin, a vitamin D deficiency, and a disruption of melatonin levels. ² Serotonin:  This chemical, which is responsible for regulating mood, has reduced levels in those who experience SAD. Sunlight has been shown to play a role in serotonin levels, but with shorter daylight hours in the winter, serotonin levels may decrease. Vitamin D Deficiency:  This vitamin may help promote serotonin activity and is produced by the body when the skin is exposed to sunlight. With less sunlight during the day, a vitamin D deficiency may occur. Melatonin:  This hormone is responsible for maintaining the normal sleep-wake cycle in the body. People who experience winter-pattern SAD may produce too much of this hormone which may increase sleepiness, leading to oversleeping.   Symptoms of SAD There are many symptoms of SAD ranging from mild to severe as the season progresses. Here are some symptoms to look out for as the seasons change: ³ Feeling sad or down most of the day, nearly every day Losing interest in activities you once enjoyed Sleeping too much Feeling hopeless, worthless, or guilty Thoughts of death or suicide Appetite changes leading to weight gain Tiredness and low energy It is normal to have down days, but if you experience any of these symptoms for days at a time, talk to your healthcare provider. Knowing and understanding these symptoms, along with speaking to your healthcare provider or mental health specialist, may help prevent a devastating outcome.   Who is Affected by SAD? Just like normal feelings, SAD can affect men and women of all ages. It is estimated that millions of Americans experience SAD, and many may not even know they have it. ² Among those millions of Americans, some individuals are more likely to experience the disorder than others.   Age, Sex, & Geography Age, sex, and geography all play a role in who is affected by SAD. It is common for the disorder to begin in young adulthood, with women experiencing it more often than men. ² Not only do age and sex play a factor, but also geographical area. People who live further north or further south of the equator are at a higher risk of SAD due to decreased sunlight during the winter season. ³   High-Risk Individuals Just like other disorders, some people with pre-existing conditions are at higher risk of developing SAD than others. Those individuals include people who have: ² Family history of SAD Low vitamin D throughout other seasons Major depression Bipolar disorder Other mental disorders such as anxiety, ADHD, or schizophrenia   Prevention & Treatment Although there is no known prevention, taking action prior to the fall and winter months may help you manage the symptoms of SAD and prevent them from worsening over time. Some individuals have found it helpful to start treatment earlier, before symptoms occur and continue when the symptoms would normally ease, while others need continuous treatment to prevent the symptoms from returning. ³ There are various practices for effective treatment including light therapy, antidepressant medications, mood-boosting supplements, therapy, or a combination of these. Light Therapy:  involves sitting in front of a light therapy box, specifically designed to emit bright light and filter out harmful UV rays. Typically, this treatment takes 20 minutes or more per day and is commonly used first thing in the morning. Most people see improvements within the first couple weeks of beginning the treatment. ⁴ If you don’t have access to a light therapy box, try sitting near a sunny window or spending time outside if the weather allows. Medications/Supplements:  selective serotonin reuptake inhibitors are common antidepressants used to help treat SAD. Taking a vitamin D supplement or other mood-boosting supplements may also help boost your mood and support healthy vitamin D levels in the body. Therapy:  psychotherapy specifically may help treat SAD by teaching new ways of thinking and behaving. Focusing on changing unhelpful thoughts and actions may improve depressive and anxious feelings. This may include engaging in pleasant indoor or outdoor activities to refocus lost interests. ²   If you experience SAD symptoms during the fall and winter months, or maybe never noticed but fit the categories for being at risk, try the preventative measures mentioned and seek treatment if necessary. If you feel worsening or severe depression or are experiencing suicidal thoughts, contact your healthcare provider immediately for proper support. You can also use the 988 Suicide & Crisis Lifeline  which provides 24/7, free and confidential support. ⁴         Sources: 1.      https://adaa.org/understanding-anxiety/depression/SAD 2.      https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder 3.      https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651 4.      https://www.psychiatry.org/patients-families/seasonal-affective-disorder

The outside of your body is just as important as the inside, with your skin being the first line of defense against the world. Your skin not only protects you but can also provide clues to your overall health, which is why you should always take good care of your skin. What Does Your Skin Protect You From? While we know that our skin is a barrier against the outside world, what exactly is it protecting us from on a daily basis?¹ Environment Your skin helps to protect you and keep you safe from a variety of different environmental factors. It helps to regulate body temperature and protect against excessive heat and cold, along with the sun’s rays. The melanin in your skin is the first line of defense against the sun, with higher melanin content providing greater protection.²  Infection If you happen to scrap your knee or are healing from surgery, don’t worry because your skin helps to protect and heal you from certain wounds you may get. It helps to heal itself by working with other parts of your body to go through the different stages of wound healing, which allows your body to help fight off germs and any other infections that may arise.³ Chemicals Your skin also helps to protect you against harmful chemicals in the air or that you may happen to encounter. There is a tough outer lay called the “stratum corneum” which acts a barrier that prevents deeper absorption of most chemicals. This layer of skin creates a waterproof like seal that helps to repel these substances.¹¹ How To Keep Skin Healthy Even though your skin does a good job at protecting you, there are ways that you can help yourself and your skin stay healthy. Treat your skin gently You should always make sure to treat your skin gently, since daily cleansing and shaving can often take a toll on your skin. With some ways to be gentler with your skin being: Limiting your time in hot water, as that can remove essential oils from your skin Avoid harsh soaps and perfumes. Pat your skin dry after being in water, since this allows your skin to retain some moisture.¹² Protect your skin from the sun Protecting your skin against the sun can not only help protect you from those painful red sunburns, but help to keep your skin healthy.⁴ Some ways to help prevent damage from the sun would be: Wear sunscreen even if it isn’t sunny outside, and make sure to get the correct type or your skin. Wear clothing that blocks UV rays. Don’t use your vitamin D deficiency as an excuse to go out unprotected in the sun, you can always get a vitamin D supplement from a local pharmacy if needed. Avoid tanning beds, since they expose you to excessive UV radiation in a small period and can have irreversible effects. Manage stress Stress has effects on your whole body, but did you know that stress can affect your skin as well? It can cause a chemical response in your skin that makes it more sensitive and reactive. It can cause skin issues to flare up such as psoriasis, rosacea, and eczema, and make these flare-ups slower to heal. There are ways that you can help keep skin healthy, even when you’re stressed:   Don’t neglect your skin. Taking care of your skin and establishing a solid skincare routine can help keep your skin healthy and happy. Take time for yourself, even if it is just ten minutes to read a book or take a bath, do something that helps to relax you. Get enough sleep every single night. This can help to lower your stress levels Know that you can set limits and boundaries when you’re feeling stressed. It is okay to say no when you’re not feeling well.⁵ Eat a healthy diet What you eat every day can affect your whole body, but especially your skin. Our bodies rely on proper hydration and a balanced diet of fruits, vegetables, grains, healthy fats, and protein to function. ⁶  If you aren’t getting the essential vitamins and nutrients your body needs, then your skin and body won’t function the same. To ensure you’re eating a healthy diet full of essential nutrients, you should:⁷ Follow the recommended portions for fruits and vegetables in every single meal. Cut down on processed foods. These can cause issues with your body and skin. Drink the recommended amount of water for your body weight every day.⁸ Avoid smoking and drinking Alcohol and tobacco are substances that you should avoid if you want to have healthy skin, as they can have adverse side effects. If you drink alcohol regularly, then you may experience a variety of side effects. Short term effects include dry skin and flushing of the skin, or your skin taking on more of a red tint. The long-term side effects are an increased risk of skin infections and skin cancer due to the prolonged alcohol use weakening your immune system.⁹  Regular tobacco smokers may experience different effects, such as yellowing of the fingers and nails, and discoloration of the teeth in the short term.  Long-term tobacco use may lead to dry skin, uneven skin pigmentation, baggy eyes, a saggy jawline, and deeper wrinkles and furrows on your skin. ¹⁰ Your skin is a vital organ and the largest organ that you have, and you should always try to take care of it. No matter your age, there are always little things that you can do to take better care of your skin!   Sources: https://www.ncbi.nlm.nih.gov/books/NBK279255/ https://medlineplus.gov/ency/anatomyvideos/000125.htm#:~:text=Melanin%20protects%20skin%20from%20the,tanned%20cells%20are%20sloughed%20off . https://www.ncbi.nlm.nih.gov/books/NBK534261/ https://healthmatters.nyp.org/6-tips-to-protect-your-skin-from-the-sun/ https://www.webmd.com/beauty/the-effects-of-stress-on-your-skin https://www.myplate.gov/eat-healthy/what-is-myplate https://akronmohs.com/blog/diet-and-skincare-how-big-an-impact-does-diet-have-on-your-skins-health/ https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/eight-tips-for-healthy-eating/ https://www.medicalnewstoday.com/articles/alcoholic-skin#long-term-effects https://www.aocd.org/page/Smoking   https://www.cdc.gov/niosh/topics/skin/default.html#:~:text=How%20fast%20the%20skin%20absorbs,the%20lower%20layers%20of%20skin https://www.cutislaserclinics.com/blog/take-it-easy-5-ways-to-be-gentle-on-your-skin/#:~:text=While%20these%20things%20help%2C%20it,get%20clearer%20and%20healthier%20skin .

Some say your senior years are the best years: your children are grown, grandchildren are in the picture, and you get to spend countless hours with your close friends doing the things you love. But you may be wondering, how can you stay healthy as you age so you can enjoy all these wonderful things?   What Can I Do? Your health should always be a priority, no matter your age. However, older adults need to pay closer attention to their health to help them live a happy, healthy, independent life. Follow these healthy aging tips to help get you on the right track!   Get Vaccinated Staying up to date on your vaccinations can help protect yourself   and those around you from life-threatening disease and illness. Since older adults are more likely to get certain diseases, your pharmacist or doctor may recommend receiving specific vaccinations as you get older. Below are a few vaccines they might suggest: ¹ COVID-19 Flu (high-dose or adjuvanted) RSV Pneumococcal Shingles The vaccines you should receive depend on your age. Starting at age 50, it is suggested you receive a shingles vaccine to avoid painful rashes caused by the shingles virus. At age 60, getting your RSV vaccine can help protect you and your loved ones, especially babies and young children, from respiratory illness. Once you reach age 65, vaccinating against pneumococcal disease can help prevent pneumonia, meningitis, and blood infections. ² It is also encouraged to get your flu shot every year, and your Td vaccine every 10 years once you’ve received your Tdap vaccine. When you get vaccinated, you are protecting more than just yourself – you also help protect those around you! Those that have weakened immune systems or long-term health issues are often not able to receive the same vaccines as the rest of us. Doing your part and getting vaccinated can help protect them too.   Prioritize Physical Health Staying active as you age is a great way to keep your body in good working order. Physical activity helps to increase mobility, prevent falls, and reduce the risk of certain diseases. Not only that, but it can give your brain a boost! Endurance exercises  like biking, dancing, and swimming help boost circulation and strengthen your heart and lungs. ³ Strength exercises  like weightlifting or resistance band exercises work to keep your muscles strong. ³ Balance exercises  like simply standing on one foot can help improve your coordination and build strength to help reduce the risk of falling. ³ Flexibility & stretching exercises  like barre and yoga help keep you limber. ³ Other ways to keep your physical health in check are to drink less alcohol, prioritize sleep, quit the use of tobacco, and get regular health care checkups. ³   Focus on Mental Health Mental health tends to deteriorate as we get older. Engaging your mind in challenging activities helps to keep your mind active and healthy and may even slow cognitive decline as you age. Learn something new  such as a new skill, game, or language. ³ Get out and about  to visit somewhere new or somewhere you love. Spend time on your hobbies  like reading a book, knitting, cooking, or playing an instrument. ³ Another way to care for your mental health is to keep stress in check. Chronic stress can lead to brain and body damage, which may in turn make you more stressed. Find activities that help to decrease stress levels. Speaking up if you are overwhelmed or feeling down can help save a life. Reach out to friends, family, or an anonymous help line if you are struggling with your mental health. You are never alone!   Fuel Your Body Eating foods that are rich in nutrients, vitamins, and minerals help to keep your brain and body healthy. Nuts, vegetables, and fish are great foods to promote heart health and brain function. ³ Other things to focus on while developing a healthy diet include: ³ Prioritizing nutrient-rich foods Limiting foods with unhealthy additives Saying “yes” to fruits and vegetables Watching your portion sizes Sometimes, diet alone isn’t enough to fuel your body with what it needs. As we age, our bodies go through changes that can alter our nutritional needs, and many medications may increase the risk of nutritional deficiencies. ⁴ Some people may benefit from taking supplements to fill in those gaps. Talk to your pharmacist to see if any of these supplements are right for you. ⁴ Calcium:  may be linked to healthy bone density and lessened bone loss Omega-3 fatty acids:  heart-healthy fats that may help fight inflammation Collagen:  may improve skin hydration and elasticity Coenzyme Q10:  aids in energy production Vitamin D:  may help with muscle mass, enhance immune function, and boost mood B vitamins:  aids in energy production, immune health, and brain function Protein:  may boost muscle mass and muscle function Ginkgo biloba:  may improve cognitive function Saw palmetto:  may support prostate health Curcumin:  helps boost healthy inflammation levels   Just because you are aging, does not mean you can put your health on the backburner. As you age, it is important to keep yourself healthy, inside and out! Getting vaccinated helps protect you and those around you, focusing on your physical and mental health helps keep you active, and fueling your body through diet and supplements may help boost your overall health. If you have any questions about vaccines, diet changes, supplement recommendations, or mental health, talk to our pharmacist!   Sources: https://www.nia.nih.gov/health/immunizations-and-vaccines/vaccinations-and-older-adults https://health.gov/myhealthfinder/doctor-visits/vaccines-shots/get-vaccines-protect-your-health-adults-age-50-years-or-older https://magazine.medlineplus.gov/article/live-long-be-well-science-based-tips-for-healthy-aging https://www.healthline.com/nutrition/a-definitive-guide-to-supplements-for-healthy-aging

We hear that getting enough vitamins and minerals is critical to our health, but we don't always get the full details on what we need and why. Without understanding what each vitamin and mineral does, it can be hard to know if we are getting enough of them. Having a greater awareness of your nutritional needs may help you lead a healthier life.   What's the difference between vitamins and minerals? Vitamins and minerals are often listed together because they are both essential for our bodies. Though similar in what they do for us, vitamins and minerals are different in where they are found.   Vitamins are organic compounds made by either plants or animals. Some species can produce a vitamin naturally while others cannot. For example, dogs can produce their own vitamin C, but humans need to get vitamin C from our diets.¹ As humans, we need to get most of our daily vitamin intake through diet, environmental exposure, or supplementation. This is necessary because our bodies are not capable of producing most vitamins, or we produce too little of them compared to what we need.   Minerals are elements found in the earth and food and are divided into two categories: macrominerals and trace minerals. Macrominerals are beneficial in larger quantities while trace minerals are beneficial in smaller quantities.² We typically get our daily intake of minerals from the foods we consume, such as nuts and seeds, leafy greens, eggs, and more. In some cases, your doctor may recommend consuming more or less minerals; you may need to take a supplement if you don't get enough of a mineral in your diet, but you may need to eat less of certain minerals if they are not healthy in larger quantities or if a medication you are on impacts those levels.³   Not all nutrients actually fit neatly into the vitamin and mineral categories—there's antioxidants, flavonoids, fatty acids, and more—but those all listed out don't roll off the tongue as well. In this case, we use "vitamins and minerals" as a catch-all for the building blocks that our bodies need.   Which vitamins and minerals do I need daily? Depending on your health and your level of activity, you may need more or less of certain vitamins to properly fuel your bodies. Generally, this is a list of some vitamins and minerals that you should be adding to your regimen daily.   It is worth noting here that though these vitamins and minerals have been studied in relation to their benefits, very few have been proven definitively to improve any conditions. If you choose to add a supplement for any of these, remember that supplements are not FDA-approved, and none of the claims that come along with those have been reviewed or verified by them.   Alpha-Lipoic Acid ⁴ This powerful antioxidant is produced in the body and assists in regenerating other antioxidants, like vitamins E & C. Although this antioxidant is naturally produced in the body, some people may need to take an alpha-lipoic acid supplement to help manage a surplus of oxidants caused by chronic diseases or metabolic disorders. Alpha-lipoic acid has been linked to several health benefits and may be used to: Help reduce nerve pain Reduce risk of chronic disease Support healthy levels of inflammation Boost skin health   B12 Vitamins ⁵ Vitamin B12 is an essential vitamin that is not produced naturally in the body but is found in animal products. Consuming meat, fish, and dairy may help provide the daily recommended amount of vitamin B12. Here is a list of potential health benefits from taking vitamin B12: May help red blood cell formation May improve mood May benefit brain and memory May support healthy hair, skin, and nails   Calcium ⁶ The body needs calcium to build and maintain strong bones and is the most abundant mineral in the body. Stored in your bones and teeth, calcium helps your muscles move and your nerves carry messages from the brain. Calcium may have a few positive effects on your health: May increase bone mineral density May reduce risk of preeclampsia in some pregnant women May help muscle growth and recovery May support bone health D Vitamins ⁷ Vitamin D works to help absorb calcium into the body and is actually a hormone (or prohormone), despite the name. Vitamin D is most often acquired through sun exposure—when the skin is exposed to the sun’s UVB rays, the body produces vitamin D. Besides the sun, it can be found in fatty fish, egg yolks, cheese, mushrooms, and more. Vitamin D has similar possible health benefits to calcium and it also may support: Bone and teeth health Healthy immune system Brain health Healthy inflammation levels   Elderberry ⁸ This fruit from the Sambucus  tree has long been used to help ease cold and flu symptoms and help boost the immune system. Elderberry is loaded with antioxidants and contains certain compounds that may be beneficial to your health. Elderberry may help with: Supporting healthy skin Supporting the immune system   Folic Acid ⁹ Folic acid is another term for a type of vitamin B (vitamin B9 to be exact) and is found in leafy greens, citrus fruits, and beans. Extra amounts of this water-soluble vitamin leave the body through urine, meaning the body does not store folic acid. Because of this, it’s important to get a regular supply through diet or supplements. This vitamin may have many functions, including: Supporting cell function and tissue growth Working to create, use and break down proteins (in combination with vitamin B12 and vitamin C) Helping formation of red blood cells   Ginkgo ¹⁰ The leaves and seeds from the Ginkgo biloba tree have often been used in traditional Chinese medicine. In more modern research, ginkgo extract (which is made from the ginkgo tree leaves) is more commonly used. Many ginkgo supplements are rich in antioxidants and may: Support healthy inflammation levels Support circulation and heart health Boost mood Help manage headaches and migraines   Iron ¹¹ Iron is an essential mineral needed to support a healthy circulatory system. The body needs iron to make hemoglobin, which helps red blood cells carry oxygen throughout the body. Without proper levels of iron, the body becomes anemic and can have a host of issues from that, including lack of energy, memory issues, and a lowered ability to fight off infections. Iron can be found in meat and seafood; it is commonly supplemented, especially in those with vegetarian or vegan diets. The benefits of getting enough iron may include: Healthy circulation Healthy energy levels Improved exercise performance Increased cognition   Lutein ¹² Part of the carotenoid family (what gives vegetables their bright orange, red, or yellow color), lutein is full of antioxidants and is known to be used to help boost eye health and vision. Lutein is found in the retina, concentrated mostly in the back of your eye, and may contribute to several health benefits including: Healthy inflammation levels Healthy vision Healthy eye tissue Reduction in cell loss   Magnesium ¹³ Found in leafy greens, nuts, seeds, and beans, magnesium plays a crucial role in brain and body function. It helps with energy production, protein formation, muscle movements, and more. Although this mineral is found in certain foods, it is often supplemented as most people don’t get enough through diet alone. Here are some potential health benefits of magnesium: Supports balanced mood Supports heart health Support healthy bones Supports healthy sleep patterns   Omega-3 Fatty Acids ¹⁴ These “healthy fats” are fatty acids found in foods like salmon, flaxseed, and chia seeds. Omega-3 fatty acids are not produced in the body and need to be obtained from diet or supplementation. ¹⁴ These fatty acids play a vital role in your cell membranes and are concentrated in high levels in your eyes and brain. Other health benefits may include: Supporting heart health Supporting energy levels Supporting endocrine system Lowering risk of blood clots   Probiotics ¹⁵ Probiotics are "friendly" bacteria that live in the gut and can be found in foods like yogurt, sauerkraut, kimchi, and more. Increasing your probiotic intake, including through supplementation, is especially encouraged when taking an antibiotic; antibiotics can often cause the gut bacteria to become imbalanced. Some benefits of consuming probiotics may include: Weight management support Healthy digestion Immune support Healthy skin   Note that probiotics  and prebiotics  are very different and should not be confused. Prebiotics are essentially what feeds the probiotics.   Quercetin ¹⁶ This flavonoid is found in many fruits, vegetables, and drinks and cannot be made by the human body. Quercetin contains powerful antioxidants that may contribute to heart health along with many other health concerns, including: Healthy inflammation levels Healthy allergy response Lowered risk of infections Healthy blood pressure levels   Turmeric ¹⁷ A plant in the ginger family, turmeric is a readily available spice. Both turmeric and its main component curcumin (what gives turmeric its yellow color) have numerous health benefits. Historically, turmeric was used for skin disorders, upper respiratory tract, joints, and the digestive system. Today, turmeric is used in ways that may support: Healthy joints Healthy digestion Healthy allergy response Healthy mood   Zinc ¹⁸ Zinc is a mineral found in the body’s cells and plays a vital role in cell growth, division, and the activity of enzymes, proteins, and DNA. Since the body cannot make zinc, it is necessary to get it from foods like meat, fish, whole grains, dairy, and more. Besides supporting cell health, zinc can help support: Immune health Wound healing Blood clotting Sense of taste and smell   Even with a better understanding of some main vitamins and minerals, we recommend talking with your healthcare team (including your team at our pharmacy!) before making any major change in diet or supplementation. Not only can they help you evaluate what may best fit your needs, they can also discuss how medications you are taking could impact your vitamin and mineral levels. If you are taking any supplements, make sure to tell your pharmacist and doctor!     Sources: 1.      https://www.medicalnewstoday.com/articles/195878 2.      https://www.healthline.com/nutrition/foods-with-minerals 3.      https://medlineplus.gov/minerals.html 4.      https://www.forbes.com/health/supplements/alpha-lipoic-acid-benefits/ 5.      https://www.healthline.com/nutrition/vitamin-b12-benefits 6.      https://ods.od.nih.gov/factsheets/Calcium-Consumer/ 7.      https://www.medicalnewstoday.com/articles/161618 8.      https://www.medicalnewstoday.com/articles/323288 9.      https://medlineplus.gov/ency/article/002408.htm 10.  https://www.healthline.com/nutrition/ginkgo-biloba-benefits 11.  https://www.verywellhealth.com/iron-supplements-benefits-4178814 12.  https://www.healthline.com/health/lutein-for-eyes 13.  https://www.healthline.com/nutrition/magnesium-benefits 14.  https://my.clevelandclinic.org/health/articles/17290-omega-3-fatty-acids 15.  https://www.healthline.com/nutrition/probiotics-101 16.  https://www.medicalnewstoday.com/articles/324170 17.  https://www.nccih.nih.gov/health/turmeric 18.  https://www.healthdirect.gov.au/zinc

Viral Hepatitis is a condition that affects an estimated 354 million people globally,⁶ but hepatitis itself is a general term referring to inflammation or swelling of the liver.² Hepatitis can be caused by a variety of disorders, substances, and infections, and severity may depend on the cause.¹ Because hepatitis can have several root causes, understanding the symptoms and types is important for mitigating your risk and making healthy decisions. The Liver Your liver is the body’s largest solid organ and is located under the ribs on the right side of the body. Many bodily functions rely on the liver, and serious issues can arise if it isn’t in good working order. Some jobs the liver is responsible for include cleaning toxins and harmful substances from the blood, disposing of old red blood cells, bile production, metabolizing nutrients, clotting protein production, blood volume regulation, and glycogen storage for energy.⁷ Two parts comprise the liver: a large right lobe, and smaller left lobe. These are made up of thousands of smaller lobules and blood vessels that allow blood to flow through the liver and be filtered.⁷ Hepatitis Symptoms Hepatitis can vary in severity based on cause and progression of inflammation, and can include the following symptoms:² Fatigue or exhaustion Nausea and vomiting Lack of appetite Abdominal discomfort and pain Light or clay-colored stool Dark urine Fever Joint pain Jaundice (yellow skin or eyes) If left untreated, hepatitis can progress to the point of permanent damage to the liver. Contact a healthcare professional if you experience any of the above symptoms.² Causes of Hepatitis Viral infection is the most well-known cause of Hepatitis, or liver inflammation, but it can have many sources, including but not limited to:¹ The body’s immune system attacking the liver Fatty liver Liver damage due to substances such as poison, alcohol, and in rare cases, illicit drugs High doses of medications like acetaminophen Viral infections such as Hepatitis A, B, and C Bacterial infections   Viral Hepatitis Variants Viral Hepatitis is found in 5 different variants: A, B, C, D, and E, with the most common being A, B, and C. A healthcare professional can administer blood tests to ascertain levels of liver enzymes in the blood and measure liver function. If they suspect hepatitis, additional tests may be performed to detect the viral variants.² Hepatitis A Virus (HAV) is most commonly caused by ingesting contaminated fecal matter. It’s a milder infection and although it can pose a threat to immunocompromised patients, will resolve itself without treatment in most cases.⁸ Treatment will typically entail supportive care and relieving symptoms for healthy individuals while their body fights the infection, or antivirals for high-risk patients.²   Hepatitis B Virus (HBV)  is primarily transmitted via contact with the bodily fluids, such as blood or semen, of infected individuals.⁸ It can also be passed from pregnant patients to their child during birth. HBV can cause both short-lived and chronic infections, and in some cases lead to cirrhosis (severe scarring of the liver) or even liver cancer.⁸ Because the severity of HBV symptoms can vary, some individuals may experience no symptoms for years in chronic cases, despite continuous liver damage from the infection.²   Hepatitis C Virus (HCV) symptoms may not present until it has already affected the liver significantly, making it a common cause of liver damage, cancer, and liver failures leading to transplantation.⁸ Treatments for this variant often utilize antiviral medications with the goal of viral levels below detection in the blood, known as a Sustained Virologic Response (SVR).²   Hepatitis D Virus (HDV), also known as delta hepatitis, is different from other variants in that it is a satellite virus. This means it doesn’t make its own viral shell but consists only of genetic material. Without a shell, it is not capable of causing an infection on its own, and only occurs in those already infected with hepatitis B virus (HBV). Hepatitis D can worsen health outcomes for patients with HBV and can be best prevented by early detection and treatment of HBV.²   Hepatitis E Virus (HEV) is similar to HAV in its infection method, being primarily transmitted through contaminated food and water, especially in regions with poor sanitation measures. HEV is also a milder variant and can often be resolved without treatment in healthy individuals. It can however still pose a risk for immunocompromised individuals and those taking immunosuppressants, such as recent transplant recipients.²   Non-Viral Hepatitis Causes Non-viral hepatitis refers to any form of liver inflammation and swelling that is not caused by a viral infection. Non-viral cases can be more difficult to determine the root cause, and severity may vary. These are the most common types of non-viral hepatitis:² Autoimmune Hepatitis occurs then the body’s own immune system attacks the liver, causing inflammation and potential damage, and extended use of immunosuppressants is often needed for treatment. While specialists don’t know exactly what causes this type of hepatitis, genetic and environmental factors are thought to play a role.²   Alcoholic Hepatitis is brought on by excessive drinking over a prolonged period of time.¹ Since the liver is responsible for metabolizing alcohol, alcohol abuse can lead to inflammation and damage. Treating alcoholic hepatitis is achieved by abstaining from alcohol and making changes to diet.²   Drug-Induced Hepatitis can be caused by an adverse reaction to prescription medications, over-the-counter medications, or herbal supplements. Finding and stopping the medication that is causing the problem is a typical treatment, along with symptom management.²   Ischemic Hepatitis is inflammation resulting from a lack of blood flow to the liver and is also known as “shock liver.” This form of hepatitis can be a complication of several conditions that lead to low blood pressure, such as heart failure, severe infections, and surgical procedures. Treatment takes the form of resolving the root cause and providing care to manage symptoms and improve liver function.²   Metabolic Disorders such as Wilson’s Disease can lead to inflammation and damage in the liver.² Also known as Metabolic Dysfunction-Associated Steatohepatitis (MASH), this type of hepatitis is often associated with excess storage of fat in the liver. Healthy lifestyle changes can halt progress and reverse effects of MASH if damage is not yet severe.⁹       Who is at risk for Hepatitis? Individuals at risk for hepatitis are as numerous as its variants, and different conditions and behaviors will increase risk for different inflammation causes. The following groups may be at greater risk for hepatitis: People born in a country with a medium-to-high prevalence of viral hepatitis are at greater risk for¹⁰ Illicit drug users are at an increased risk for Hepatitis A, B, and C, especially those who inject.³ Sexually active individuals are more likely to be exposed to HBV, particularly partners of HBV positive individuals and people with multiple partners in the past 6 months.⁴ People infected with HIV are more likely to experience severe infections when exposed to viral hepatitis, and HIV shares many infection risk factors with hepatitis.⁵ Mitigating risks Subheads The best prevention for Hepatitis A and B is vaccination.⁸ Other viral variants like Hepatitis C, D, and E do not have vaccines currently available, and it is best to avoid high-risk behaviors for transmission. Some of these behaviors include:⁸ Sharing or reusing needles Having unprotected sex Drinking unsanitary water or water from questionable sources Non-viral hepatitis is often preventable, and you should avoid the following unhealthy behaviors that may put undue strain on your liver:² Alcohol abuse Taking greater than the recommended dose of medications Sedentary lifestyle and poor diet   Sources:   https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/hepatitis https://medschool.ucla.edu/news-article/the-different-types-of-hepatitis#:~:text=Then%20there%20are%20non%2Dviral,or%20certain%20medications%20or%20toxins. https://www.cdc.gov/hepatitis/populations/idu.htm https://www.cdc.gov/hepatitis/populations/stds.htm https://www.cdc.gov/hepatitis/populations/hiv.htm https://www.cdc.gov/hepatitis/statistics/2021surveillance/index.htm https://my.clevelandclinic.org/health/articles/21481-liver https://www.cdc.gov/hepatitis/about/index.html https://my.clevelandclinic.org/health/diseases/22988-nonalcoholic-steatohepatitis https://www.cdc.gov/hepatitis/populations/Born-Outside-United-States.htm

Pool days, grill-outs, boating, vacations – summer is finally here! The summer months come with fun outdoor activities, but precautions need to be taken while enjoying this outdoor time. Staying hydrated is important, especially during the hot summer months. Hydration helps maintain a normal body temperature, lubricates and cushions joints, protects your spinal cord and other sensitive tissues, gets rid of waste through urination, perspiration, and bowel movements, and supports heart and gut health. ¹ Some circumstances require you to hydrate more, such as: ¹ ·         Hot climates ·         Physical activity ·         Running a fever ·         Experiencing diarrhea or vomiting While out and about this summer, it’s important to know and understand the heat related risks associated with high outdoor temperatures. Heat-Related Illnesses Heat-related illnesses can become very dangerous, very fast. From dehydration to heat stroke and more, summer can bring dangerous situations if you aren’t prepared. Many of these heat-related illnesses may sound and look similar, so it’s important to understand the differences to know how to act. Dehydration Dehydration happens when your body is losing more fluids than you take in. ² If not treated, dehydration can lead to more serious problems such as heat exhaustion or heat stroke. Fortunately, it’s not difficult to identify the symptoms of dehydration in children and adults: ² ·         Thirst ·         Dark yellow, strong-smelling urine ·         Urinating less often ·         Dizziness or lightheadedness ·         Tiredness ·         Dry mouth, lips, and tongue ·         Sunken eyes If you find yourself having any of the mentioned symptoms, you should drink fluids, starting with small sips rather than big gulps, and get to a cool area indoors. Heat Exhaustion Heat exhaustion occurs when the body is losing excessive amounts of water and salt, usually through sweating profusely. ³ It can also be due to dehydration, overexercise, or strenuous work in hot weather. ⁴ A lot of heat exhaustion symptoms are like those of dehydration: ³ ⁴ ·         Dizziness or lightheadedness ·         Irritability ·         Urinating less often Aside from those similarities, these are other symptoms to look out for that are different than those of dehydration: ³ ⁴ ·         Headache ·         Nausea ·         Weakness ·         Heavy sweating ·         Elevated body temperature Heat exhaustion needs to be addressed immediately before it worsens. If you or someone around you is experiencing heat exhaustion, remove them from the hot area and give liquids to drink in small sips. Remove any tight clothing or layers, apply a cold compress to the head, face, and neck, and lie them down to reduce risk of injury if fainting occurs. If necessary, call 911 if symptoms do not improve or if the person affected starts vomiting. ⁵ Heat Stroke Heat stroke is the most serious heat-related illness and can cause permanent disability or death if not given emergency treatment. ³ During a heat stroke, the body can no longer control its temperature, causing it to rise rapidly to 106 degrees Fahrenheit or higher within 10 to 15 minutes. ³ Since heat stroke can cause permanent damage if not treated right away, it is crucial to correctly identify its symptoms: ·         Confusion, altered mental status, or slurred speech ·         Loss of consciousness ·         Hot, dry skin ·         Seizures ·         Very high body temperature ·         Rapid and strong pulse or heart rate Call 911 immediately if someone is experiencing a heat stroke as this is a medical emergency and may result in permanent disability or death if not treated right away. Move the person to a cool area and help lower their temperature by applying cool cloths, a cool bath, soaking their clothes with cool water, and circulating air to speed up cooling. It is also noted to NOT give them anything to drink as this may lead to vomiting and convulsions. ⁵ Others There are other heat-related illnesses that are important to learn about even though they may not be as serious as the others mentioned above. Just because these are not as serious, it does not mean they should go untreated. Any heat-related illness needs to be addressed, no matter the severity.  These other illnesses include: Heat Cramps:  occur when the body’s salt levels decrease due to excessive sweating. Symptoms include muscle pain or spasms and heavy sweating during intense exercise. If you are experiencing heat cramps, drink water and eat a snack to replace carbohydrates and electrolytes. ³ It’s also important to move to a cool place and stop any physical activity until the cramps go away. ⁵ Heat Rash:  a skin irritation caused by excessive sweating during hot, humid weather. This can look like red clusters of pimples or small blisters that usually appear on the neck, upper chest, groin, under the breasts, and in elbow creases. ³ To help alleviate heat rash, stay in a cool, dry area, keep the rash area dry, apply powder (e.g. baby powder), and avoid using ointments and creams. Sunburn:  reddening of the skin from being overexposed to the sun or other ultraviolet light. It may take time for a sunburn to first appear and may not take full effect for 24 hours or longer. ⁶ Sunburns look like red, tender skin that is warm to the touch but may later form blisters, cause severe reactions such as fever, chills, nausea, or rash, and skin peeling days after. To help ease pain associated with sunburns, stay out of the sun until healed, put moisturizing lotion on the affected areas, stay hydrated, and do not break any blisters. It is important to note that although sunburns are temporary, the damage they can cause to the skin cells is permanent. Tips to Stay Cool & Hydrated Too much fun in the sun can be dangerous so following these easy tips can help you keep cool and hydrated while still enjoying your summer. Fueling Your Body Eating hydrating foods and drinking appropriate liquids will help keep you hydrated during the day. Some great food options include watermelon, strawberries, tomatoes, soups, bell peppers, low-fat meats like chicken breast, and even spicy foods like salsa. Sipping water throughout the day is a great way to stay hydrated. Don’t wait to drink until you are thirsty! If you prefer something other than water, try a sugar-free juice or if you are participating in physical activity, an electrolyte sports drink may be a good option. Try to avoid alcohol but if you do choose to indulge, drink a bottle of water between brews to stay hydrated. ⁷ Protecting Your Body Wearing the right type of clothing and other protectants can help immensely to keep you cool during a hot summer day. Loose, light-colored, cotton clothing are great options to wear to allow you to sweat. Another great clothing option is sun-protective clothing. This type of clothing uses special dyes and chemicals to block harmful UV rays. ⁷ Hats and sunglasses are functional options to keep the hot sun off your head and out of your eyes. Even if you’re covered up, don’t forget the sunscreen! Give extra care to easily burnt areas such as the nose, ears, shoulders, and back of neck. It’s also a good idea to use a lip balm with SPF to keep your lips from burning. Now you are ready to enjoy your summer while staying safe! If you have any questions about other ways to stay hydrated or safe from the heat, talk to our pharmacist for recommendations.   Sources: 1.      https://www.cdc.gov/healthyweight/healthy_eating/water-and-healthier-drinks.html 2.      https://www.nhs.uk/conditions/dehydration/ 3.      https://www.cdc.gov/niosh/topics/heatstress/heatrelillness.html 4.      https://www.healthline.com/health/heat-stroke-vs-heat-exhaustion 5.      https://www.cdc.gov/disasters/extremeheat/warning.html 6.      https://medlineplus.gov/ency/article/003227.htm 7.      https://www.healthline.com/health/beat-the-heat 8.      Graphic: https://www.weather.gov/wrn/heat_infographics

What is the gut? You often hear how the health of your gut affects your body, skin, and mental health, among many other things. But what exactly does your gut encompass?  Your “gut” refers to your gastrointestinal (GI) system, and it contains all the organs that take in the food and liquids you consume and break them down into substances your body uses for energy, growth, and tissue repair. The gastrointestinal system, also called your digestive system, is comprised of your mouth, throat, esophagus, stomach, small intestine, large intestine, rectum, and anus. It also includes your salivary glands, liver, gallbladder, and pancreas, which make the juices and enzymes that help your body digest food and liquid. ¹ When you consume food, your GI tract breaks it down to the most basic parts and the valuable nutrients are absorbed through the wall of your gut to then be transported into your bloodstream. To be able to do this, the gut uses nerves, bacteria, and hormones. The bacteria in your gut is of significant importance as they form a mucosal layer that strengthens the gut wall. The health of your gut is generally determined by the levels and types of bacteria in your intestinal tract. ² What is the gut microbiome and why is it important? A biome is described as an ecosystem characterized by its environment and inhabitants. Your gut is in fact a miniature biome that is populated by trillions of microscopic organisms. These organisms include over a thousand species of bacteria, viruses, fungi, and parasites. Your gut microbiome is unique to you and is affected by diet and environmental exposures. Most of the microorganisms in our guts have a symbiotic relationship with us meaning we both benefit from each other. We provide them with food and shelter, and they provide important services in our body and the helpful microbes also help to keep potentially harmful ones in check. When your gut microbiome is healthy and thriving, you will thrive, too. If your gut microbiome is unhealthy or out of balance, it can affect your entire body. ³ What is the role of your gut microbiome? Your gut microbiome interacts with many of your systems. In fact, it plays such an important role for your body to function that some healthcare providers have described it as being almost like an organ itself. ³ So how does your gut microbiome affect your body’s other systems? Digestive System Bacteria in your gut help break down certain complex carbohydrates and dietary fibers that your body can’t break down on its own. They produce short-chain fatty acids and the enzymes necessary to synthesize certain vitamins such as B1, B9, B12, and K. Short-chain fatty acids feed the cells in your gut lining and help to keep the overall environment healthy. Gut bacteria also help to create bile in your intestines. Your liver sends bile to your small intestine to help you break down and digest fats so that the bile acids can be reabsorbed and recycled by your liver. If your body became unable to recycle bile acids, your liver wouldn’t have enough to produce the new bile your digestive system needs to digest and absorb fats. This would allow leftover cholesterol to build up in your blood. ³ Immune System “Good” microbes in your gut help train your immune system to tell them apart from “bad” ones. Your gut is your largest immune system organ, containing up to 80% of your body’s immune cells. Helpful gut microbes constantly compete directly with unhelpful types for nutrients and real estate in your body. Some chronic bacterial infections that affect your GI tract are directly related to a damaged gut microbiome. ³ Short-chain fatty acids that are produced by helpful gut bacteria help maintain your gut barrier, keeping toxins out of your bloodstream. These short-chain fatty acids also have anti-inflammatory properties for your gut. Inflammation is a function of your immune system but can become hyper-reactive. Chronic inflammation is a feature of autoimmune disease and may play a role in other diseases such as cancer. ³ Nervous System Certain bacteria in your gut produce or stimulate the production of neurotransmitters that send chemical signals to your brain, such as serotonin. Serotonin plays several roles in your body, including influencing learning, memory, happiness, body temperature, sleep, sexual desire, and hunger. Lack of a healthy level of serotonin is thought to play a role in depression, anxiety, and other health conditions. Researchers continue to investigate how your gut microbiome may be involved in various neurological, behavioral, nerve pain, and mood disorders. ⁴ Endocrine System Your endocrine system consists of tissues that create and release hormones. Hormones are chemicals that carry messages throughout your blood to your organs, skin, muscles, and other tissues. These signals tell your body what to do and when to do it and are essential for life and your health. ⁵ Gut microbes interact with endocrine cells in your gut lining which secrete hormones that regulate aspects of your metabolism. Researchers continue to explore how your gut microbiome might be involved with metabolic syndrome such as obesity, insulin resistance and Type 2 diabetes. ⁵ How do food sensitivities affect your gut health? Healthy and properly tuned GI tracts can break down dietary components from food into nutrients without a dysregulated immune response. However, adverse reactions to food have been steadily increasing and evidence suggests this is due to environmental factors. Adverse reactions to food are known as food sensitivity, food intolerance, or food allergy. ⁶ What is the difference between food intolerance, food allergy, or food sensitivities? Food Intolerance Food intolerance refers mostly to the inability to process or digest certain foods. The most common food intolerance appears to be lactose intolerance, or the inability to digest dairy products. As we age, our intestines make less of the lactase enzyme that processes lactose, resulting in more lactose sitting in the digestive tract causing bloating, inflammation, or diarrhea. ⁷ Food Allergy A more severe problem happens when someone develops a true allergic reaction to certain foods. This causes an overblown response by your immune system against an otherwise harmless substance. With a true food allergy, this can cause potentially life-threatening issues like troubles breathing and low blood pressure. Other severe symptoms may include significant rashes, feeling of passing out, and facial swelling. ⁷ Celiac Disease Celiac disease is not an allergy or food intolerance, but an autoimmune disease which is triggered by the ingestion of gluten. When gluten is ingested, it causes the body’s immune system to attack healthy cells resulting in digestive problems such as stomach pain, bloating, vomiting, diarrhea, constipation, and headaches. Adults may also experience anemia, joint pain, weak bones, numbness in hands and feet, and mouth problems such as canker sores. ⁸ Food Sensitivity A large part of the population experiences symptoms that are not related to food intolerances, allergies, or celiac disease. These symptoms are not life-threatening and can be referred to as food sensitivities. Although not life-threatening, these symptoms can be quite uncomfortable and disruptive and may include joint or stomach pain, fatigue, rashes, and brain fog. Food reactions, especially sensitivities, may fade away with time as our immune system and gut microbiome are constantly changing. ⁷ What can you do for gut health? If you want a healthy gut, you have to feed it well. Your diet should consist of both probiotics and prebiotics, which are two components that are increasingly being recognized as essential to not only your intestinal health, but your overall health. Probiotics can be found in foods such as yogurt and fermented vegetables. Some good prebiotic options are beans, whole grains, fruits and vegetables. ⁹ Having a healthy gut microbiome helps foster a healthy immune system and reduces damaging inflammation in your body. It allows your healthy or “good” bacteria to avoid being overrun by the unhealthy or “bad” bacteria. ⁹ If you have any questions about additional things you can do to maintain a healthy gut, please visit with our pharmacist. If you believe you are experiencing any food intolerances or sensitivities, you can consult with your physician about testing options. If you are experiencing a food allergy and need immediate assistance, please call 911. Sources 1.      https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gastrointestinal-system 2.      https://www.nm.org/healthbeat/healthy-tips/7-reasons-to-listen-to-your-gut#:~:text=The%20gut%20refers%20to%20your,understand%20how%20the%20gut%20works . 3.      https://my.clevelandclinic.org/health/body/25201-gut-microbiome 4.      https://my.clevelandclinic.org/health/articles/22572-serotonin 5.      https://my.clevelandclinic.org/health/body/21201-endocrine-system 6.      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767923/ 7.      https://www.health.harvard.edu/blog/food-allergy-intolerance-or-sensitivity-whats-the-difference-and-why-does-it-matter-2020013018736 8.      https://allergyasthmanetwork.org/health-a-z/celiac-disease/#:~:text=Celiac%20disease%20is%20not%20an,is%20sometimes%20severe%20and%20immediate . 9.      https://www.health.harvard.edu/staying-healthy/feed-your-gut