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CHAPEL HILL COMPOUNDING


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CHAPEL HILL COMPOUNDING

Zoe Stefanadis, RPh

105 Conner Drive, Suite 1200
Wilshire I Building

Chapel Hill, NC 27514

Telephone: (919) 967-8805

Fax: (919) 967-8205

www.chapelhillcompounding.com

Nutrition and the Healing Process

“Our diet certainly has a significant impact on our health,” agrees Pharmacist Zoe Stefanadis, founder of Chapel Hill Compounding. “And it also affects how we heal. Our principal job in a compounding pharmacy is to design medications that optimize the healing process—whether by preventing problems caused by drugs or improving their effectiveness. And dietary issues are always important considerations in our work.”

Pharmacist Zoe Stefanadis

These issues take many forms. “Allergies and food sensitivities pose real challenges for people needing to take medications,” says Ms. Stefanadis. “For example, we are frequently called on to prepare medications for people with gluten sensitivity or alpha-gal allergy. Alpha-gal is a recently discovered food allergy that is transmitted to humans from a tick bite, triggering a severe allergic reaction to mammalian meats and by-products such as beef, pork, or lamb. Gelatin capsules—which are commonly used for dispensing medications—can be problematic because they may be derived from beef bone. In those cases, we substitute veggie caps, which are cellulose-based.

“That’s just one example. By compounding medications,” she explains, “we can offer alternative, safe options for patients with a wide variety of food sensitivities. We provide alternative fillers, for example, to avoid common fillers that aggravate allergies. Some people may have sensitivities to certain dyes, which we can address. That’s the beauty of compounding— we can prepare medications uniquely suited to each individual patient. That can mean creating a more palatable medicine, one that avoids side effects, or one that delivers the drug more efficiently. We can change flavors, textures, and dosages, as well as finding better options for transmitting the drug more effectively. The medications manufactured by big pharma companies, in contrast, are mass produced, and can’t adjust to accommodate individual allergies and sensitivities.

“So, when counseling our patients,” she says, “it’s important to discuss food issues and identify any sensitivities. As a compounder, we look for the simplest approach to solving a patient’s medical needs. That way, we have fewer complications and, if a patient does have a reaction, we’re able to pinpoint the problem more easily.”

Diet and Hormone Balance

“Diet plays an important role in hormonal balance,” notes Ms. Stefanadis. “And that’s something we often see when working with patients needing hormone support. Further, we find that hormone imbalances not only affect how you metabolize food, but also how you metabolize medications.

“For example, one issue faced by people diagnosed with hypothyroidism is the inability to lose or gain weight. The problem has to do with converting the T4 thyroid hormone to T3. You can be producing plenty of T4, but if you’re not converting to T3, then you have symptoms of subclinical hypothyroid. And that conversion problem doesn’t show up on your traditional lab reports. Nutrition is an important part of this conversion process,” she explains. “You have to have plenty of vitamin C and selenium. Many of these nutrients you can get either in the food you eat or supplements. But if they’re missing from your diet, or there are other hormonal imbalances, the hypothyroidism will persist. The hormone testing we offer provides the level of understanding to help pinpoint the nature of a thyroid problem—and, thus, a way to resolve it.”

Medications, Gut Health, and “Leaky Gut”

“Today,” says Ms. Stefanadis, “there is an increased focus on digestive health, because that’s where the immune system is centered. And medications, especially antibiotics, can really disrupt the GI system. Multiple medications and dietary stress can lead to an imbalance in the digestive system—immune stressors that lead to leaky gut.

“The first time I heard the term ‘leaky gut,’ I was horrified,” says Ms. Stefanadis. “It sounds awful. But, basically, what it means is that the gut doesn’t form a normal barrier. The GI system is designed not only to absorb nutrients, but also to eliminate toxins, and ‘leaky gut’ means that toxins are being absorbed into the body, rather than eliminated, creating autoimmune disorders.”

Issues related to gut health, says Ms. Stefanadis, can often be addressed by compounding. “In preparing medications, we look for ways to prevent the GI problems caused by drugs—often by altering the dosage method. For example, a transdermal drug—applied through the skin—can bypass a sensitive GI tract, or protect the liver and kidneys. Additionally, it may be better absorbed.

“Testosterone is an example of a hormone that can’t be absorbed orally—it’s very rough on the liver—so we make a transdermal application. Similarly, it’s safer to avoid any type of oral estrogen—bypassing the GI system entirely.

“And some drugs, such as thyroid medications, need to be taken on an empty stomach for better absorption; this has to do with the stomach pH, and a number of other things. Then there are some foods that interfere with medications—grapefruit is a classic example, because it actually raises the dosage of certain medications significantly because it prevents them from being broken down.”

COVID-19 From a Public Health Perspective

Pharmacist Zoe Stefanadis observes the current pandemic less through the eyes of a pharmacist and more from the perspective of public health. “I began my training in public health,” she explains. “And that perspective has shaped my practice and my understanding of health care. On the one hand, I understand the connection between all care components. In my practice the triangle of doctor-patient-pharmacist, for example, is critically important. And I also understand the essential role of education—whether it’s counseling a single patient or sharing information broadly in a pandemic.

“From that point of view, I look at the new stages in the COVID-19 pandemic with both optimism and caution. I’m delighted that a vaccine is now being distributed. But I want people to be aware of legitimate cautions and concerns. In particular, people need to understand the logistical challenges of achieving the ‘herd immunity’ possible through vaccination. This vaccine has to be able to reach 330 million people. And already we’re challenged with important questions: How do we distribute this? How do we choose who gets it first, and second?

“We need to recognize that the vaccines went through a significant trial to have a 95 percent success rate. But there are still questions, because 20,000 versus 330 million is a completely different study group.
“These vaccines are good news, to be sure,” she says. “But people need to realize that just because there’s a light at the end of the tunnel, we’re still in the tunnel, and we still have a long way to go. It may take a year to get a significant amount of vaccine to the public. Wearing masks, physically distancing, and washing hands are still vitally important. These are our responsibilities to each other. And we’re going to have to be doing this for some time.”