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Is Vitamin D more important that we think?

Posted on by Dunsborough Pharmacy
Vitamin D Card
23
Jun

“You are my sunshine- my only sunshine. You make me happy, when skies are grey.” by songwriter Charles Mitchell

 

Who would have thought the words of a song could actually contain a message on how to stay healthy during the winter months.

In summer it’s relatively easy to get our share of the Vitamin D. At that time our focus needs to be in reducing UVB exposure and damage caused by UVA rays. 

Whilst studies report that only 6% of us are deficient in sunshine vitamin during the summer months, up to 39% can have sub-optimal levels over the winter months. Luckily, Vitamin D is a fat-soluble vitamin that can be stored for just such a rainy day, but more on that later.

Mom and daughter enjoying sunlight

 

So why is Vitamin D so important to us?

 

Technically, it is not a vitamin and is considered more of a hormone given it uses the same building block (cholesterol) as part of its core structure. We can and do produce minute amounts. In fact, it’s not just one chemical but a group of chemicals, many of which are inactive and must be processed by the body to provide its benefits.

So, essentially it is a fat-soluble nutrient, with the maintenance of strong and healthy bones being its best-known function, through the regulation of calcium levels in the body. It is also important for a healthy immune system and it can help moderate our inflammatory responses to infections. The interest in Vitamin D and the role it plays in other body systems as we discover even more of its influence on our health. 

 

But let’s look into the winter blues.

 

The role of sunshine vitamin in depression has also received increasing research focus. There are 3 reasons the research is focused on finding whether there is a causal link between this vitamin deficiency and depression. 

They are:

  • Vitamin D receptors have been found to be region specific in the body. Parts of the brain known to be associated with mood, show much higher numbers of receptors.
  • Depression is being increasingly linked to levels of inflammation in the body and we are only just beginning to understand this through our focus on gut health. Vitamin D also has anti-inflammatory properties through its modulating effects on our immune system.
  • This anti-inflammatory effect is also stimulating discussion about Vitamin D’s neuroprotective role.

 

Many studies have shown a link between vitamin D deficiency and depression. Researchers behind a 2013 meta-analysis (that’s a bunch of studies thrown together and tested for similarities) noticed that study participants with depression also had low levels of it. The same analysis found that, statistically, people with low vitamin D were at a much greater risk of depression.

The researchers believe that because it is important to brain function, insufficient nutrient levels may play a role in depression and other mental illnesses. Whilst no recommendations regarding supplements have yet been made, we can all ensure we have at least adequate levels of this vitally important nutrient.

Girl at the beach exposed to sunlight

 

Sub-optimal vs Deficiency of Sunshine Vitamin

 

You might be surprised to know that sunshine vitamin deficiency is common in Australia. It is estimated that over 30% of adults have a mild, moderate or even severe deficiency. There is also a difference between clinical deficiency as defined by the text books, and having sub-optimal levels. Severe lack of it causes rickets, which shows up in children as incorrect growth patterns, weakness in muscles, pain in bones and deformities in joints. So, who might be deficient? You could be at risk if you are:

You may be at risk of vitamin D deficiency if you are:

  • Elderly and housebound or in residential care through not being exposed to UVB light 
  • Ageing skin. As our skin ages it begins to lose its ability to convert the chemical in our skin to Vitamin D efficiently.
  • Naturally dark skinned (darker skin reduces the penetration of UV light)
  • Avoiding the sun for skin protection 
  • Covering your body for cultural or religious reasons
  • Affected by other medical conditions that can impact on your ability to absorb / process vitamin D such as liver or kidney dysfunction.
  • Babies of vitamin D deficient mothers

Lack of sunshine vitamin is not quite as obvious in adults. Most adults who are deficient or at the lower end of normal will experience symptoms that might include:

  • Fatigue or drowsiness.
  • Aching bones
  • Muscle weakness, muscle aches, or muscle cramps.
  • Pain in the joints.
  • Mood changes, like depression

 

Vitamin D can affect your mood

 

Getting the right amount

 

Until 1997, the recommended dietary allowance (RDA) for vitamin D was 200 IU for all adults. Faced with growing evidence of deficiencies the RDA for 51- to 70-year-olds was increased to 400 IU daily, and to 600 IU daily for people older than 70. However, this is not sufficient to treat a deficiency.

You can make your sunshine vitamin the old-fashioned way. The natural type is produced in the skin from a form of cholesterol, 7-dehydrocholesterol present in the skin. Sunlight is the key. Its ultraviolet B (UVB) energy converts the precursor to inactive forms of vitamin D which must then be processed through the liver and then the kidneys to produce active vitamin D3. 

 

But, haven’t we been told NOT to go out into the sun?

 

The good news is that it doesn’t take too much exposure to start this magical process of producing Vitamin D. So how much is enough? As you’d expect it, there are a number of variables and all of these need to be taken into account. 

It depends on:

  • The season- winter vs summer- longer exposure times are required in winter
  • The time of day- we recommend to avoid 10-3pm when UV rays are highest.
  • How much of the body is exposed? Full arms and half legs are the recommended amount of skin exposure. Keep the face covered or use sunscreen. A little difficult in winter.
  • The color of a person’s skin- the darker the skin, the more melanin and the more exposure required.
  • Whether a person is wearing sunscreen- Sunscreens block the UVB (or vitamin D activating) effect on the skin.

 

Recommended sun exposure based on location

 

Exposure to sun by Australian Territory

Image Source – https://www.osteoporosis.org.au/vitamin-d

 

Diet can help, but it’s very hard to reach the recommended levels with food alone. Fish and shellfish provide natural source (oily fish are best), but you’ll have to eat about 100g of salmon, or nearly two cans of tuna to get just 400 IU. An egg yolk will provide about 20 IU, but since it also contains nearly a day’s quota of cholesterol, you can’t very well use eggs to fill your tank with Vitamin D. And although cod liver oil is rich in vitamin D, it has too much vitamin A for regular use.

 

Is more better?…. Not always.

 

Many authorities are recommending 800 or even 1,000 IU a day given the growing evidence of the benefits of this vitamin. Remember, though, that you can get too much of a good thing. 

Like the other fat-soluble vitamins, it is stored in the body’s fat tissue. Excessive doses of Vitamin D can build up to toxic levels. Doses up to 2,000 IU a day are considered safe but we would recommend doing this under supervision of a healthcare professional.

 

 

Your take home messages

 

Our goal is to help you live your healthiest life, and so we definitely DON’T recommend just adding a high dose Vitamin D supplement to your daily intake.  Firstly, we’d rather you just increase your intake a little more through choosing healthy foods or maybe whilst the sun is not so damaging get out and enjoy the sunshine a little more during the winter months. The bonus will be an uptick on your mental health as well as your sunshine vitamin levels.

If you feel that you are experiencing symptoms of a deficiency, please come in and talk to us or arrange a consultation with our nutritionist to assess your personal risk of deficiency depending on your baseline health, food intake and other conditions.

The shortest day of the year, the Winter Solstice has just passed us by and we all know what that means.

We are slowly, but surely making the journey back to those glorious days and the summer vibe we all love. Bring on the sunshine.

 

Linda Keane, Pharmacist

Building a wellness community

 

Extra Information: List of Vitamin D Sources in food. 

Food source of Vitamin D

Fish

  • 100g of cooked salmon: 570 IU or 14 mcg.
  • 100g of drained canned tuna: 240 IU or 6 mcg.
  • 100g of drained canned sardines: 165 IU or 4 mcg.
  • 1 cup of 1% fortified milk: 120 IU or 3 mcg.
  • 200g of yogurt: 80 IU or 2 mcg.

Oily fish, as well as oils from fish, have some of the highest quantities of vitamin D in food sources.

 

Mushrooms

For vegetarians or vegans, specific mushrooms may be an option. Some types of mushroom contain high amounts of vitamin D.

 

Eggs

1 large hard-boiled egg: 45 IU or 1 mcg.

 

Milk

Some milks are fortified with Vitamin D (check the labels)

 

References for Vitamin D blog

 

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Our Services

 

Announcement

Flu vaccine – 5 important facts you need to know

Posted on by Dunsborough Pharmacy
Flu vaccine
16
Apr

FLU VACCINE FACTS VS FICTION

A lot of you have been asking about the flu vaccine, “when, how and who should get it?” That’s why this week’s video update is all about the Flu Vaccine!! Linda discusses the facts and fiction around the vaccine as well as what the risks are of getting both Covid-19 AND Influenza.

Topics discussed include:

🧪 What are the risks of getting Coronavirus and Influenza at the same time? [1:44]

🧪 Who should get the flu vaccine? [2:38]

🧪 When is the best time to get it? [7:00]

🧪 Can you really get the flu after having the vaccine? [8:30]

🧪 How to book an appointment and the procedure within the pharmacy? [11:13]

You can also read the video transcription

 

🧪1- What are the risks of getting Coronavirus and Influenza at the same time? 

Linda Keane (00:00):
This week, our update is going to be about a different virus. The influenza virus for the last few weeks and months. The covert virus has been the shiny new kid on the block and it’s taken all the limelight. But we want to talk about the influenza virus as we’re coming up into the winter flu season. This infection still causes quite severe illnesses, hospitalizations, and even deaths. And in actual fact, last year there was at least 18,000 people that were admitted into hospital due to influenza. Normally, that’s not serious problem for our healthcare system, but in this kind of pandemic, what we really want to do is minimize the amount of people who are going to hospital for influenza and save the beds for covert patients. Back to covert for a moment, only a few short weeks ago, our rate of infection was doubling every three days.

Linda Keane (00:58):
Um, things looked dire and modeling has that came out just in the last day or so, showed that up to 90% of people in Australia could be affected and that our hospital systems would have collapsed under the load of people all needing health care at the same time. Then flattening the curve entered into our vocabulary and we all learned about social distancing with the aim of reducing transmission and keeping uh, the number of infections and the rate of infections to what our hospital system could cope with. We should probably give ourselves a bit of a Pat on the back because we are making a difference and everyone is doing a good job or at least 90% of you seem to be doing a good job. However, the flattening of the curve has thrown up. An interesting situation with regards to timing. Flu season normally peaks at around August and September and this also looks like it could be the time that the government does start relaxing some of those social restrictions and maybe even some travel restrictions.

🧪 2- Who should get the flu vaccine?

Linda Keane (02:05):
Um, it’s a point where we have to be very careful because there is the real possibility that you could as we’re starting to get a bit of freedom, a bit of normality, we could be hit with a situation of people getting both covert and an influenza infection at the same time. Given that these are both quite severe respiratory infections, the last thing we need is for people to be ending up in hospital having not one but both of these infections. Now that you know there is a risk, how do we reduce the risk? I’ll give you a very short answer. As in if you are over 65 our strong recommendation is that you get the flu vaccine and get it very soon. Being over 65 you do fall into a higher risk category and covert seems to have a more severe effect on the elderly.

Linda Keane (02:57):
In our population, anyone over 65 is entitled to a free flu vaccine through the national immunization program. These free flu vaccines are distributed to both GPS and also pharmacies. If you go to a GP surgery, you will won’t be charged for the flu vaccine because the GPS have the ability to, um, charge you through Medicare consults with our pharmacy. Unfortunately, we don’t have that ability. And so we do have a small charge of $10 to go towards covering our costs of providing what we think is a very valuable and convenient service to people whether they are over 65 or under 65. Why do we strongly recommend that the over 65 get a vaccination? Well, as you get older, just like everything else, um, your immune system gets a little bit sluggish and a bit tired and the response that it can give you is not as strong as what used to happen in a healthy young adult.

Linda Keane (04:01):
That manufacturers of vaccine realize that this occurs and what they do is they try to make the vaccines for elderly people much stronger. It’s this reason that we ask you when you come in, whether you are over 65 or under 65 so that we know whether to give you the stronger vaccine. Last year there was a bit of confusion because the over 60 fives vaccine only contained three strains of influenza virus and the under 60 fives contained four, but this year both vaccinations are exactly the same in the strains that they will cover you for. So be assured that you are getting the same as everyone. You’re just going to get a slightly, um, one that’s got a little more oomph to get your immune system working. But well, okay, so we’ve covered the over 60 fives and we’re saying you definitely should get a vaccine.

Linda Keane (04:56):
There are other two other groups that I actually want to highlight. Um, one of those groups is the people who are under 65 but also have a chronic health condition with these people. Um, one of the startling statistics is that they are 40 times more likely to die of influenza than a young healthy adult. Um, I was pretty shocked at that. Um, stat and unfortunately, only 42% of people with a chronic health condition under 65 actually bother getting a flu vaccine. Um, this year I think might be the year that I would say that it’s time to get one if you need to. The second group I’d like to highlight is, um, our frontline workers both in healthcare and in other essential services. Um, given the pandemic, it’s very, um, important that people get to stay at their jobs and even you’re young and healthy and you’re a delivery driver or you work at a supermarket or you know, you’re a pharmacy worker or you work anywhere where your, what you’re providing is essential for people to live.

Linda Keane (06:11):
When you come into the pharmacy to book, please let us know that you’re a healthcare worker or an essential services worker. We will definitely give you priority if there’s a lack of vaccines or if there seems to be not enough vaccines to go around. Um, because we obviously appreciate the help and that you’re putting yourself on the line. Currently less than 50% of healthcare workers get a flu vaccine each year. If you know someone that works with the sick or the chronically ill, what we want you to do is give them a bit of a prod and say, come on, it’s time. Our own teams, we practice what we preach and we have given flu vaccines to our staff at both nourish and at DUNS bruh. So you can also be assured that they won’t be passing the flu on to you. One of the questions we get asked in the pharmacy all the time is when is the best time to get a flu vaccine?

🧪 3- When is the best time to get it? [7:00]

Linda Keane (07:08):
Now normally we would say that, um, given the peak of the season is in August and September, that April may is generally the best time as you will get at least six months immunity, unity before it starts to diminish. However, this year there’s a couple of confounding factors in that. And the first one is that there is a hyper demand for flu vaccines at the moment. I don’t know if you’ve seen the news today, but apparently, um, pharmacies have vaccinated more people in three weeks than they did for the whole of 2019. The other reason is that as reported by the, um, health department, w H w Y hospitals have been relatively quiet apart from covert patients but relatively quiet with regards to respiratory illnesses. This may tempt people to think that if they’re socially isolating, um, and they aren’t seeing people then do they really need the flu vaccine?

🧪 4 – Can you really get the flu after having the vaccine?

Linda Keane (08:12):
And it is a good question. If you’re going to be around someone who’s immunocompromised pregnant over 65 or with a chronic health condition, then maybe you might consider getting immunized so that you will also act as protecting them from the virus as well. Another question we often get asked to, and all people tell us anecdotally is that they got the flu from the flu vaccine. Um, or that they wonder if they can get the flu from the flu vaccine. That isn’t possible. But I’ll explain that a little bit. When the flu vaccine is produced and the viruses grown and then it’s purified and then it’s chemically killed once it’s chemically killed, it’s broken up into little pieces like a jigsaw puzzle. And what they do is they put little pieces of the jigsaw into the vaccine and that vaccine then when it’s injected into your body, recognizes these little pieces as being foreign and starts that second line immunity where it builds up antibodies to that particular little piece.

Linda Keane (09:22):
Unlike Humpty Dumpty, it can’t be put back together again. And when the little pieces of virus don’t magically form into a whole virus again and they can’t replicate. So this is why scientifically it’s very, it’s impossible to get the flu from this. However, there are two scenarios that I want to go through and these tend to be the reasons why people think that they have get the cold or the flu at the time they get the injection. One of the things that can happen is if you’re unlucky, you may be getting symptoms of a cold or a flu around about the same time that you actually get your flu injection. And so you put two and two together and it seems like that that’s what’s happened to you and we can understand that. But unfortunately I think that’s just a coincidence. The second reason, and the reason I think most is the reason that most people feel is that you will get some tenderness in your arm where you’ve had a flu vaccine and sometimes people get a bit of a lump and some soreness for a couple of days.

Linda Keane (10:33):
Some people even complain about feeling just a little bit flowy, a little bit off, a little bit tired, and sometimes even a sniffle. What this is is that your immune system has already kicked in as, and what is happening is your general FirstLine immunity. So that’s not the immunity that recognizes the flu vaccine.
That’s just your general immunity has picked up that there is something foreign there and it’s sent the troops in to start working. So in fact, this is a good tick for your immune system. And um, I’d be saying, yay. That’s good. You’re doing well. Lastly, I just want to give you a rundown of our immunization service vaccination service this year. Normally we offer a walking service where it’s very convenient and you can just pop in any time and a pharmacist will be able to help you with a vaccination. But unfortunately in this time of when we’re in a pandemic situation, we’ve had to change the way that we do things and we’ve changed to an appointment system and we hope you appreciate why we’ve made these changes.

🧪 5- How to book an appointment and the procedure within the pharmacy?

Linda Keane (11:42):
By sticking this appointments, what happens is we can spread out the flow of patients coming in and um, minimize any cross infection and spread of any kind of illness. Not only just influenza by keeping the numbers inside the shop down. We also are following the rules that have been suggested with how many people should be in enclosed spaces. When you do come for an appointment, we will give you a form to fill out and ask you to sit in our waiting chairs which outside the pharmacy and fill out that form for us. Then you will be bought into the pharmacy where the pharmacist who will be wearing a mask and take you into the consult room. They will give you the injection within a two minute timeframe and then you are able to go outside and sit on our chairs again waiting for the observation period of 15 minutes after your injection.

Linda Keane (12:42):
Just to make sure that everything is okay and you’ve suffered no adverse effects. The 15 minute time gap between patients allows us to follow some strict cleaning and disinfecting procedures between each patient patient. We’re very focused on reducing your chance of infection and this is a priority for us in offering this service to you. We appreciate your patience and understanding and one of the, this is one of those times where we ask you to turn up exactly on your appointment time. There’s no brownie points for being early because it’ll also avoid people waiting outside and forming cues. If you would like to book a flu vaccination through the pharmacy, the Dunsborough pharmacy will be the one that is doing all the flu vaccines. What you need to do is either call us on the telephone or come in and let us know and we can put you on our waiting list and we will as we work through our list, we will space ever and out over the next few weeks to make sure that you do get the flu vaccination. So that’s it from me for this week’s update. I hope you found this information to be of some use to you. Um, it’s, uh, thank you for watching through to the end. Of course. Um, please contact our pharmacists if you have any questions about anything that we have said in this video or that I’ve said in this video and till next update, um, take care and stay safe.

You can also watch this video on Youtube and if there are any other topics you would like to know more about please let us know. We are here to help you.

To book an appointment email us at [email protected] or call on 08 9755 3272.

Take care and stay safe.

Be wise

Reasons why you should beware of expired medication

Posted on by Dunsborough Pharmacy
Expired medication?
14
Apr

Why you shouldn’t take expired medication and what’s the ONE medication we recommend you keep past its expiry date?

We’ve all done it. You’ve got a headache, you’ve rummaged around your medicine cabinet and found something that’s been there for months (or years!), but before you pop that expired medication read on. 

In this blog we explain the difference between BEST BEFORE, USE BY, DISCARD AFTER and EXPIRY DATES and explore the reasons some medications have shorter expiry dates than you would expect.

Firstly, what about food?

On food products you will often see BEST BEFORE dates. These dates refer to the quality of the product, not its safety. Food may no longer be at its freshest or best and may be beginning to lose its flavour, texture or nutrients. It doesn’t necessarily mean that the food is no longer safe to eat. Foods with a BEST BEFORE date can be legally sold after that date. Many of you will have seen and grabbed the grocery bargains that are heavily marked down once this date is reached.

USE BY dates on food are different. These foods must be eaten before this time for health or safety reasons. Foods can’t legally be sold if their USE BY date has passed and should be avoided.

Ok. Got it. So, what about my expired medicines?

Most medications, last for years and years. A study by the American Military showed many medications were still as effective 15 years after manufacture, with some 80-90% potent after 30 years. 

What this doesn’t consider is storage conditions. Yes, we mean those musty mouldy bathroom cabinets, those hotter than hell car glove boxes and now we have climate change to worry about. 

What we have is a safety issue and a need for consistency trumping long expiry dates.  Once a medication leaves the controlled environment of a manufacturer or pharmacy, the temperature variations, exposure to light, air, water and bacterial contamination pose too many variables for companies to risk guaranteeing the safety and effectiveness of their product.  

To this end an arbitrary expiry date of 5 years from manufacture has been chosen as suitable for all long-term stable medications.

Two parameters must be considered with medication – potency and safety. 

  • With regards to potency, the expiry date is calculated to be when the loss of active drug is less than 10% of the medications stated strength.
  • Safety must be considered by weighing up the risks. When do the adverse effects or risks start to outweigh the benefits? 

That’s all good and well, but what expired medication shouldn’t I take?

We strongly recommend you don’t take or use the following medications or groups of medications beyond their expiry date.

  1. Antibiotics. Most antibiotics have a shorter shelf life than the five-year maximum and often struggle to get to two years. There are some reports of toxic effects which have occurred with patients taking old antibiotics and with infections it is better to get a new infection checked to make sure you are treating the infection with the right antibiotic and not just any antibiotic.
  2. Reconstituted medications. Some medications have had water added by the pharmacy.  These often include antibiotic mixtures for children. The clue here is if they are so unstable that the pharmacy must add water at the very end of the manufacture process, they aren’t going to be last long. Pharmacists will add a DISCARD AFTER date to the label, based on days AFTER it reconstituted. They can become contaminated with bacteria or may lose their effectiveness after the DISCARD DATE, so out they go. The discard date in these cases overrides the manufacturer’s expiry date.
  3. Eye drops, eye ointments and some ear drops. Although, these products contain preservatives to reduce bacterial growth, they keep concentrations low to minimise eye irritation.  With these products the exposure to air and the possibility of introducing bacteria into the bottle through accidental touching of the infected eyes or lids mean the risk of using them after their expiry is much higher. These medications will often have DISCARD DATES added by the pharmacist based on time from when they are opened. Again, the DISCARD DATE trumps the manufacturer’s expiry date.
  4. Nasal sprays. A bit like eye drops, nasal sprays are used where levels of resident bacteria are high and regular use opens the door to contamination with bacteria getting into the liquid inside the spray.
  5. Products containing ASPIRIN. Aspirin is highly unstable when exposed to air, hence they are usually wrapped in foil. Taken out of the foil the tablets rapidly degrade to acetic acid and begin to smell like vinegar. Great for your salad dressing but not so effective for your headache.  Those of you still cutting aspirin tablets in half to help thin the blood, take note. That second half should be thrown away.
  6. Tablets for Angina or Chest Pain. These medications need to be carried with patients so that if they develop chest pain, the medication can be used in an emergency.  The problem is they degrade quickly in the heat and even body temperature (think pockets of your clothing) is not really a suitable storage environment. Don’t rely on these past their USE BY date which will have been added by the dispensing pharmacy. Read the label on the bottle and mark your calendar, so that you don’t run short of these vital medications.
  7. Refrigerated items. There are also many other drugs with short use by dates, that can be stored in the refrigerator at the pharmacy long term but once home have a much shorter expiry date when stored below 25 degrees as a concession to your convenience. If you want to prolong the expiry of these medications, then you can do this by popping them straight back into the fridge when you get home from the pharmacy. These include common medications such as hormone patches, thyroid tablets and even insulin which can all be safely used out of the fridge. Check each individual medication for specified dates that relate to non-refrigerated expiry dates, or ask the pharmacist if you are unsure.

So, what’s the ONE expired medication you should keep?

EPIPENS

Shortages and an inconsistent supply have plagued the whole of Australia for the last couple of years for the life-saving adrenaline filled pen. 

WE RECOMMEND

  • The safest way is to always renew your Epipen when it expires. Keep a note or reminder to replace your Epipen whether it’s on an old school calendar or on a phone app. Put this date in as soon as you pick up new pens from the pharmacy.  Epipens have an Expiry Date that is barely 12 months from the date of manufacture and let’s be honest, they are expensive, but worth it if you need to use them.
  • In times of shortage, an expired pen is still better than no pen when it comes to saving a life, so keep them on hand until you get a chance to replace it with a fresh batch.  Depending on the emergency, one pen also may not be enough, or may be used incorrectly, so in a panic situation, it is handy to have a backup even if it is expired.  Please check to see that the liquid is still clear and colourless before you use it. 

If you have any questions, about taking any expired medication, please contact our Dunsborough pharmacists before you take the dose. We are happy to help you with guidance and the best storage conditions for your medications, just ask. No question is a silly one, and it’s better to make informed decisions specific to your situation.

 

Check our video on Flu Vaccine. Till our next blog. Be Wise Be Well.