Monthly Archives: October 2015

Zinc levels and Erectile Dysfunction and Low Libido
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With the erectile dysfunction (ED) market expected to reach 3.4 billion dollars (USD) by 2019, this is a lucrative area to invest in, and not much grabs the attention of a guy watching a commercial during a Monday night football game than the promise to easily cure this problem with one pill as needed.  But is this the answer for everyone?  What causes ED?  For the guy with no apparent risk factors like depression or diabetes, hypothyroidism, injury or stress issues, erectile dysfunction or loss of libido (which don’t necessarily go hand in hand) can be confusing and frustrating for a guy as well as his partner.

What if we look at erectile dysfunction as something that can be addressed as a condition other than a “pill for every ill”.   What if we actually look at a nutrient level that directly correlates to a medical condition and follow the science to give a directive on its recommendation?  Well it turns out taking a simple zinc supplement won’t help 100% of the time, but it certainly helps some of the time.

There are two things that need to be looked at in recommending a supplement for a medical condition: what is the physiology of the medical condition and what is the pharmacology of the supplement you are using.  There then is a search for a link between the two that leads to a tie in with a therapeutic approach.  In some ways this is like a logic course that says A causes B, B causes C therefor A causes C.  We then must apply this to the scientific method and finally the ultimate test: clinical response and safety.  This is often made out to be the gold standard for our typical Rx meds that I dispense every day, but often ridiculed when it crosses the barbed wired “nutraceutical” boarder.  If it is a nutrient then we must be getting the right amount in our food after all right?  Regardless of 1)what the real amount is in the food we eat, not to mention 2)the depletion that may be taking place of that nutrient due to a prescription drug we are taking (an absolute science based cause and effect) – we blindly accept what our food has in it and the level our bodies maintain – this is an incorrect assumption.  In fact it is quite ironic that the anti-nutraceutical court is still hanging onto this assumption when both are established by science.

So what causes erectile dysfunction?  Sometimes it is a circulation problem.  Sometimes it is a low testosterone issue.  Sometimes it is not.  Testosterone (T) supplementation can help ED and low libido in cases of low T and even if there is a normal T level at baseline, ED can be helped.  In cases where thyroid under or overactivity is causing T levels to be less than optimal.  Aging is also a problem as T levels drop after mid 20’s and as adipose tissue increases and aromatase enzyme conversion of T to Estrogen correspondingly increases.  This causes an unfavorable E:T ratio which equates to low T.

When men are given supplemental testosterone it can have positive effects on erectile dysfunction as well as the “grumpy old men” syndrome of low energy, loss of drive, low libido, and loss of endurance as well as “man boobs”.  Zinc has a direct effect on the two main enzyme systems that act on testosterone: conversion of testosterone to estrogen via aromatase and the conversion of testosterone to DHT by 5 alpha reductase.   Zinc blocks the testosterone to estrogen pathway leading to more testosterone.  It turns out that only at really high zinc levels does zinc inhibit the 5 alpha reductase enzyme so when we give mild to moderate zinc supplements, DHT actually increases because there is more testosterone to feed into this pathway.   This actually benefits things because DHT has 2-3 times the times the androgen receptor affinity than testosterone.  In any case, we see an increase of testosterone and androgenic activity from DHT with zinc supplements and whether a guy has low or normal T to begin with, there is a positive change in erectile dysfunction and libido in some men due to the increased androgenic activity and less estrogen pulling in the opposite direction.  Conversely we see testosterone levels drop when a diet is low in Zinc as well as a drop in DHT.  It is important to note that this effect of increased testosterone with zinc supplementation, while well established, does not always lead to an improvement of ED and increased Libido.

Clinically I have seen these results in doses of just 20 mg twice daily.   It is important to note that prolonged zinc supplementation can lead to lowered copper levels so it is not advisable to continue this therapy unless it is in a cyclical nature.  For those on long term zinc there are combination products with Zinc and Copper.   In cases where some prescriptions that lower zinc are given, like acid lowering meds, thiazide diuretics and ACE inhibitors, or in renal dialysis patients, this chronic monitoring of zinc may lead to longer term supplementation.

So, in establishing physiology, pharmacology, clinical results and safety, zinc is a good choice when you look at cost and side effect profile as well as ease of availability and interaction profile with other meds and other medical conditions.  Having said all of this, there is no bulletproof evidence out there guaranteeing that increasing your zinc consumption either in food or via a supplement will improve ED or increase libido.  Even if a patient experiences an increase in testosterone from such a supplementation, this is not a certain gateway to resolution of theses symptoms as there is more to it than just one hormone level.  However for those that are experiencing problems in these areas, it is certainly worth a try for them.  The patient should be mindful however that supplements should be treated like any other medication and trying to increase your testosterone shouldn’t be done without consultation with your doctor and pharmacist.  You should also check for any interactions with any meds or medical conditions before trying any supplement as well.

 

Khedun SM1, Naicker T, Maharaj B. Zinc, hydrochlorothiazide and sexual dysfunction. Cent Afr J Med. 1995 Oct;41(10):312-5.

 

Prasad AS1, Mantzoros CS, Beck FW, Hess JW, Brewer GJ Zinc status and serum testosterone levels of healthy adults. Nutrition. 1996 May;12(5):344-8

 

Chang CS1, Choi JB, Kim HJ, Park SB Correlation between serum testosterone level and concentrations of copper and zinc in hair tissue.  Biol Trace Elem Res. 2011 Dec;144(1-3):264-71.

 

Jalali GR1, Roozbeh J, Mohammadzadeh A, Sharifian M, Sagheb MM, Hamidian Jahromi A, Shabani S, Ghaffarpasand F, Afshariani R.  Impact of oral zinc therapy on the level of sex hormones in male patients on hemodialysis.  Ren Fail. 2010 May;32(4):417-9.

 

Michael F. Leitzmann, Meir J. Stampfer, Kana Wu, Graham A. Colditz, Walter C. Willett and Edward L. Giovannucci Zinc Supplement Use and Risk of Prostate Cancer  journal of the National Cancer Institute. Volume 95 , Issue 13 pp 1004-1007

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Treating Pain Without Oral Systemic Side Effects

IMG_2313[2]You may be the last person to side with even listen to something that isn’t taught in Med School or Pharmacy School or in Nursing School or perhaps you are one to be weary about snake oil or getting hoodwinked on some “holistic scam”.   As it turns out there is an established way of treating pain of all kinds.  Personally I felt the same way before I started compounding.  As a student I worked for a Compounding Pharmacy and was exposed to many aspects of individualized therapy.  Ironically, none of that had anything to do with topical pain relief beyond menthol and camphor, although there were plenty of compounds for other health issues that helped countless patients in my time there as a student.

Luckily there is a Physician that is involved with palliative care and general pain clinic work that visited my Pharmacy when it was renovated with my compounding lab in plain view.  It takes a physician like this to really result in patients receiving pain relief with a lack of systemic side effects that can burden long and short-term pain patients.  These patients have a wide range of medical issues; cancer, arthritis, nerve pain, soft tissue pain, back pain, headache, fibromyalgia, lupus, pulled muscle, sprains, athletic injuries, and other types of pain that most always has been getting treated with conventional oral NSAIDS, Acetaminophen, and Narcotics in varying amounts, sometimes all at once.  It is hard to picture even one of these moderate to severe pain patients that does not experience a side effect that is at the level of at least a nuisance and quite often more than that.  Chronic constipation, nausea, sedation and GI ulceration/bleeding being the most common side effects we see.  Added to this is the complication of drug-drug and drug-disease interactions that allow perhaps the patient to be on the drug but watchful for potential adverse reactions or periodic monitoring and follow up.

One thing I have realized as a Pharmacist is that nothing can replace clinical experience, especially when it comes to future recommendations to patients and Physicians.  After years of doing this it has now become a go to recommendation for pain relief.  This physician that originally began writing for these pain compounds wrote an article in Rehab and Community Care to help educate caregivers on the active pharmaceutical ingredients used with these compounds.   I often educate physicians and patients on the benefits of these compounds.  Without a doubt, one of the best contributions I have seen my pharmacy have towards the overall wellbeing of patients, even if it isn’t curing them of anything at all, just relieving a symptom.

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Why do the arguments concerning e-cigs and organic have different standards
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01e95f139e13890126eb803e3b7d577aThere seems to be no bigger a disconnect than the opinions between the camps that are either for or against organic food.  Virtually anything one reads on the topic sets its tone early on the purpose of the article so as to give you have a pretty good idea of what side they will be taking.  There is always a sort of subjective vibe you get based on the author or the early wording.  I often refer to science as a puzzle that needs all of the pieces included to get a full picture of what it is trying to tell us.  A key piece to the puzzle that we often don’t have available to us is time.  While it is true that fruit flies have given us the luxury of accelerated generations in a usable period of time in scientific discovery, in the field of GMO products, time is the one variable we need (and don’t have) in order to make a full discovery of how this new food affects humans.  I am the first to agree that we are not getting slammed in the face with blatantly obvious effects of GMO foods, but we cannot hide the fact that studies to date are not completely one sided in declaring these foods safe yet.  “Safe”: meaning long-term health effects.

So, to sum up, the pro GMO side says no evidence against so they are safe and/or they are safe because studies show no harm is caused (the null hypothesis pushes through), and the con GMO side says there is evidence suggesting harm and/or there hasn’t been enough time to determine an effect medically so we should err on the side of caution (much like the way we were told to eat back in the late 70’s and early 80’s regarding carbs and fat which has been shown to cause more than a generation of obese North Americans).  The same species of beings reading the same studies can lead to different results, or maybe some read what they want and promote certain conclusions.

As there is always something new around the corner in science to cause quarrels because we find the need to have an answer immediately, enter e-cigarettes.  If there ever was something out there that seemed like a bad idea from the start this could be it.  But let’s look at the science before we jump to any conclusions.  I recently read an article by Joanna Cohen, the director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg Schools of Public Health.  She is and has been quite involved with tobacco policy research for quite some time.  Even she cannot come to a conclusion based on the available science that e-cigarettes are good or bad.   Despite the fact that nicotine, carcinogens and chemicals considered toxic to humans are found in these devices and the vapor, we still must wait on science to tell us whether there is harm or not; and until we find out how to teach fruit flies to use these devices, we are left testing slow breeding human beings and looking for the development (short and long term) of adverse medical effects.  In fact we are already seeing a ban on use of these products sometimes in areas where traditional cigarettes are banned.  Seems fair enough when you try to use logic before a scientific study (which seems like an oxymoron) given what little we know about e-cigarettes.  In fact I almost hit the floor when visiting a pharmacy in the US when an employee was actually using an e-cigarette at work in the aisle!  After all where does all of that material go when it is vaped into the air?  Outer space?  More likely it goes into someone else’s lungs eventually.  Isn’t this how the widespread acceptance of tobacco smoking developed into last century?

So to sum up, the pro e-cigarette side says no evidence against so they are safe and/or they are safe because studies show no harm is caused (the null hypothesis pushes through), and the con-e-cigarette side says there is evidence suggesting harm based on what is in the vapor and/or there hasn’t been enough time to determine an effect (much like the way we were told to back in the late 40’s’s and early 50’s regarding smoking tobacco which has been shown to cause more than a generation of lung cancer stricken North Americans).  The same species of beings reading the same studies can lead to different results, or maybe some read what they want and promote certain conclusions.

Does that last paragraph sound familiar?  It should since it is almost word for word the same as the second paragraph written here.

So then why are you normal and logical when you think e-cigarettes should be restricted in whom they are sold and marketed to and where they are used as well as how your national health watchdog regulates them; however, you are a quack, fear monger and a charlatan when you even suggest a conclusion about GMO foods by using the same analytical thinking?   While I am not suggesting the health effects, if any, are even remotely linked between these two things, the logic of how we argue for or against them and openly ridicule each other on our stances follows a different set of standards between them.

Countries that label GMO food as such and yet ban the use of e-cigarettes in enclosed spaces in truth are likely following the same thought process for both decisions.

 

http://bmjopen.bmj.com/content/5/4/e007197.long

http://www.ncbi.nlm.nih.gov/pubmed/26322924

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952409/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2288773/

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