“I would argue,” says pharmacist Jennifer Burch, “that one of the most potent health hazards—and the one to which we have the most exposure—is misinformation. Environmental pollutants are certainly an issue, but in a world dominated by the Internet and social media, ‘toxic information’ may be the most pervasive threat to our health.”

Dr. Burch, owner of Central Pharmacy and Central Compounding Center in Durham, sees every day the risks that widespread misinformation poses to our health. “There is good, helpful information to be found on-line,” she acknowledges. “And exploring a health condition or symptoms on-line can help a patient’s understanding of their own issues. However, a lot of information is confusing, contradictory, and—too often—flat-out wrong.

“What’s dangerous is to rely on Dr. Google’s diagnosis without the benefit of your provider’s advice or testing. And still worse is to self-remedy, following the likes, advice, and promotions of friends and celebrities on social media. Those ‘advisors’ will happily tell you how great X is for your condition, without any guidance from anyone about how to use it, or how it fits your body specifically.

“This is especially concerning when it comes to complex health issues such as hormone imbalances,” notes Dr. Burch. “On-line advice—even from physicians—on hormone replacement therapy (HRT) is full of confusing and misleading information. That is because hormone imbalances are complex, and therapy needs to reflect that complexity, addressing not only hormone levels, but their interactions, and appropriate delivery methods. One size never fits all.

“An good example of the risks of on-line HRT is a client who had gone on-line to get an HRT prescription, rather than from her local doctor. She was sent oral estrogen and oral progesterone—a real problem. It’s been over 25 years since we’ve given people oral estrogen—which increases the risk of myocardial infarction, stroke, and blood clots in menopausal women. And not only did they start her with oral estrogen, they started her with four times a normal initial dose. She was lucky not to have a blood clot!”

“Just Ask!”

“Health care advice—from guidelines to prescriptions—needs to be taken in context,” emphasizes Dr. Burch. “Medicines—prescription and over the counter—and supplements do not work in isolation. They influence and are influenced by your diet, your allergies, your physiology, your health issues, and more. Proper, safe dosing of prescription medications requires testing. And indiscriminate use of non-prescription drugs and supplements can also pose risks. An herb or medicine that addresses a specific symptom, for example, might trigger a different problem or contribute to excess dosing.

“Simply put,” says Dr. Burch, “health care should be ‘local’—specific to you and guided by the local providers and experts who know you.”

That doesn’t mean that you need a doctor’s appointment for every symptom or to check out everything you find on-line, she adds. “What most people don’t appreciate is that quality health care guidance is readily accessible at their local pharmacy. Pharmacists, in fact, are ideally suited to serve as the knowledgeable bridge between trying on-line or over-the-counter options and seeking medical care.

“This is especially true for compounding pharmacists. Everything we do is about adjusting medications to meet specific individual needs. And at Central Pharmacy and Central Compounding Center we offer both what I call ‘curbside’ consulting as well as in-depth counseling.

“We’re happy at any time to answer questions about the prescription drugs you’re taking or about supplements to help address common health issues, including questions about information you’ve found on-line. Just ask! And, if your situation is complex, or you’re on multiple medications, or want to explore HRT, we encourage you to schedule an in-depth consultation session, where we can review questions and concerns in the context of your health issues, lifestyle considerations, health history.”

Dr. Burch and her staff are ready to tackle any questions, but she points to four areas where even a brief consultation is advisable: polypharmacy, supplements, CBD oil, and hormones.

Polypharmacy

“Polypharmacy,” explains Dr. Burch, “refers to the problems that arise from interactions between multiple medications and supplements. Surprisingly, it’s fairly common for someone to be on a dozen medications. Sometimes it’s because of a complex, chronic health condition. But the relentlessly stressful nature of our smart-phone/social media culture can also be toxic. It’s one more stress on top of another stress, on top of another stress. Then, all of a sudden, you’ve got a health condition. Then you need a prescription. You start with one, now you’re on three; or maybe twelve! That piling on of prescriptions is something we see all too often.

“So, if you are taking multiple medications and supplements and symptoms persist, you may want to schedule a consultation to evaluate them along with the full context of your health history and lifestyle.”

Supplements

“Supplements and over-the-counter remedies can be enormously helpful in addressing many symptoms and health issues. They also may support the effectiveness of prescription medications. But supplements are not neutral; they interact with your body chemistry, food, and medicines. So, the most important advice I can offer is to choose professional grade supplements. That means that that supplement has been tested—generally by a physician or naturopath—to prove it is what it says it is. This is especially important for nutritional supplements, because not many professional grade products are sold on-line. So you need to walk in and have a conversation with the pharmacist.

“That conversation is also important when choosing a specific supplement,” says Dr. Burch. “There are dozens of OTC remedies for sleep issues, for example, but they’re not all the same and they use different mechanisms and interact with other supplements and medications differently. So, we’ll want to know: Are you have trouble getting to sleep, or are you just having trouble staying asleep? What medications are you taking? What other health issues are you dealing with? And labels can be confusing. Magnesium of often recommended for sleep issues. But magnesium glycinate is a highly absorbable form of magnesium commonly used to support sleep; magnesium oxide is a laxative. So, ask us!”

CBD: Help With Pain and More

Since its approval in 2014 for over-the-counter sale in North Carolina, Cannabidiol (CBD) has been widely used as an effective non-pharmaceutical treatment for managing pain—including musculoskeletal,  neuropathic, even vaginal pain. “CBD also helps with a range of mood disorders, including anxiety, panic, and PTSD,” notes Dr. Burch. “And I have found it particularly useful for patients who are on medications for anxiety.

“However, while CBD doesn’t require a prescription, its effectiveness does depend on guidance and education. “We have learned the importance of careful, individualized dosing,” says Dr. Burch. “And we work closely with our patients to find the ‘sweet spot’ that produces the desired result. More is not necessarily better with CBD,” she emphasizes. “We start everyone on a lower dose and teach them how to titrate until they get the appropriate effect.”

Just as important as the dosage is the quality of the product. “The hemp plant—which is the source of CBD—is much like a sponge. So, you don’t want to use CBD from hemp planted in toxic soil. We carefully vet all products to ensure they have the appropriate level of CBD and are not contaminated with pesticides, herbicides, or heavy metals.”

Hormones

“Our hormones,” explains Dr. Burch, are catalysts for chemical changes at the cellular level that are critical for growth, development, and energy—and for maintaining homeostasis. They regulate and control just about every aspect of human function. When they’re out of balance, the impact can be significant—affecting sleep, weight, fertility, mental function, energy, even healing.

“And while an imbalance can be too much or too little of a given hormone,” she explains, “it is rarely that simple. Hormones work together—so imbalances are complex, what I would describe as ‘hormone symphonies.’ Too little of one might also impair the effectiveness of another. So, it’s essential to tease out the precise nature of the imbalance in order to treat it effectively. (see box, right)

“On-line and social media advisors may emphasize the value of hormone replacement therapy,” says Dr. Burch, “but this is one area that requires local diagnosis and treatment. Effective HRT is a perfect example of the importance of the patient-pharmacist-provider triad. Working together, we can design and implement the precise therapy for each individual.”