Self Care Pharmacy Blog

Strike a Pose to Lower Your Blood Pressure

November 23rd, 2015
Image courtesy of arztsamui at

Image courtesy of arztsamui at

By Kathrine Distel, PharmD Student Cedarville University School of Pharmacy

Hypertension or, as it is more commonly known, high blood pressure, is a chronic disorder that is becoming increasingly prevalent. It can be caused by a number of different factors, including a sedentary lifestyle, poor sleep habits, food choice and smoking. The most common treatment for high blood pressure is medication geared toward lowering blood pressure along with a suggestion to make some lifestyle changes. Unfortunately, those changes—namely diet and exercise—are unappealing at best to most people. Few people want to drastically alter their eating habits and rearrange their schedule so they can go to the gym every other day. Fortunately, there are plenty of other options that are emerging as effective ways to lower blood pressure without endlessly circling a track. One such option, yoga, has been in practice for many years.

Many people balk at the idea of doing yoga because it brings to mind impressive flexibility, leggings, and a room full of yoga mats. However, that doesn’t have to be the case. Thanks to the internet, you can pick a yoga instructor who moves at your pace in the privacy of your living room, avoiding all of the unappealing aspects of the exercise. A study1 conducted in India, a country that has been practicing yoga for centuries, found that regular yoga combined with blood pressure medications can produce significant decreases in blood pressure.

Study participants were divided into two groups. The first group, the control, continued to take their blood pressure medications as they had been with no changes besides instructions to avoid smoking, alcohol and any medications that may interfere with the study. The second group, besides the same set of instructions, began practicing yoga with trained yoga therapists three times a week. The sessions were about 45 minutes long and included preparatory practices, static postures, pranayama—exercises that focus on breathing control—and relaxation techniques. Participants were also encouraged to practice what they had learned throughout the rest of the week. 1

The study lasted for 12 weeks and, while the control group had no significant changes from its original measurements, the group practicing yoga showed some interesting results. When compared with both their own original measurements and the end results of the control group, the group practicing yoga had a significant decrease of both components of blood pressure (p < 0.05)—systolic and diastolic pressures— as well as mean arterial pressure (MAP) (p < 0.001). MAP is influenced by several different components, including blood pressure, heart rate, how much blood the heart is pumping every minute, and how much resistance the blood vessels are offering to the heart. When these values are low, the heart doesn’t have to work as hard and risks such as heart attack and stroke are decreased.1

There were two main limitations to this study. The sample size—70 people split evenly between the two groups—was a small one. Additionally, the study only lasted 12 weeks which did not allow it to assess the long-term effects of yoga on high blood pressure. However, other studies2-7 have also found yoga to have positive effects on blood pressure. One systematic review6 of 32 articles found that yoga could lower blood pressure in both healthy and hypertensive patients. Another study5, a year-long study in Hong Kong consisting of 182 participants, found that regular yoga practice could lead to decreased blood pressure, resting heart rate and waist circumference.

When the exercises for these studies were designed, the instructors kept in mind the group they would be teaching. The exercises were geared toward beginners and seniors. One case study, 7 which used resources such as a DVD and a YouTube video, evaluated the effectiveness of a modified chair yoga. This program increased safety for participants with decreased mobility or balance while still effectively lowering blood pressure. Participants also reported decreased anxiety and joint pain.

Results of systematic reviews3,6,8 have been mixed on the effects of yoga. Many, but not all of the trials found positive effects on blood pressure, some of those results were statistically significant while others were not. With so many varying results, there is still more research that needs to be done to determine a true measure of the effect of yoga on blood pressure.It is important to note that, because research into the effects of yoga on blood pressure is still relatively new, this practice has not yet been shown be effective in replacing blood pressure medications. Rather, it works well in conjunction with those medications.

So if your doctor has recommended a lifestyle change to aid in controlling your blood pressure, yoga may be a great place for you to begin. There are many free resources available, ranging from DVDs at the library to videos on YouTube, and it doesn’t require any equipment besides an open floor and perhaps a chair.

What do you think? Will you try yoga to assist in controlling your blood pressure?



1. Pushpanathan P, Trakroo M, RP S, Madhavan C. Heart rate variability by poincaré plot analysis in patients of essential hypertension and 12-week yoga therapy. National Journal of Physiology, Pharmacy & Pharmacology. 2015;5(3):174-180.

2. Centre for Reviews aD. Yoga and hypertension: A systematic review (provisional abstract). Altern Ther Health Med. 2014:32-59.

3. Cramer H, Haller H, Lauche R, Steckhan N, Michalsen A, Dobos G. A systematic review and meta-analysis of yoga for hypertension. Am J Hypertens. 2014;27(9):1146-1151.

4. Hagins M, Rundle A, Consedine NS, Khalsa SBS. A randomized controlled trial comparing the effects of yoga with an active control on ambulatory blood pressure in individuals with prehypertension and stage 1 hypertension. J Clin Hypertens (Greenwich). 2014;16(1):54-62.

5. Siu PM, Yu AP, Benzie IF, Woo J. Effects of 1-year yoga on cardiovascular risk factors in middle-aged and older adults with metabolic syndrome: A randomized trial. Diabetology & Metabolic Syndrome. 2015;7(1):1-12.

6. Yang K. A review of yoga programs for four leading risk factors of chronic diseases. Evidence-based Complementary & Alternative Medicine (eCAM). 2007;4(4):487-491.

7. Awdish R, Small B, Cajigas H. Development of a modified yoga program for pulmonary hypertension: A case series. Altern Ther Health Med. 2015;21(2):48-52.

8. Centre for Reviews aD. Yoga for hypertension: A systematic review of randomized clinical trials (provisional abstract). Complement Ther Med. 2014:511-522.

Can Exercising Every Day Keep Your Allergy Symptoms Away?

November 13th, 2015

By Nicholas Rudy, PharmD Student Cedarville University School of Pharmacy

Recently, many magazines and online publishers have written articles indicating the benefit of exercise in the alleviation of allergy symptoms. The website Total Gym Pulse reports that the American Academy for Allergy, Asthma and Immunology (AAAAI) indicates warm-up exercises can improve allergy symptoms.1 According to the site, a blood-pumping workout promotes the removal the allergen from the body.1 Additionally, Total Gym Pulse along with Fitness Magazine propose that exercise relieves allergy-related congestion by reducing swelling in the nose.1, 2 While the use of warm-up exercises are approved for the control of allergy symptoms by AAAAI, there is insufficient clinical evidence to conclude that moderate to intense exercise is directly linked to allergy symptom relief.

However, the adverse effects of exercising outside with airborne, outdoor allergies are clear. A 2010 study found that those with airborne allergies (i.e. pollen) had increased levels of IgE after exercising outside.3 IgE is a type of antibody that plays a key role in allergic reactions. Accordingly, increased levels of IgE are indicative of a heightened allergic response. Yet, the study stated that further evidence is needed to form a conclusive connection between airborne allergies and exercise.3 Similarly, the International Forum of Allergy and Rhinology published a study on the differences in nasal obstruction between seasonal allergy sufferers and healthy patients after exercise. Children who had an allergy to pollen were compared to children who did not during a time outside of pollen season. No child had obstructed nasal passages at the beginning of an exercise challenge. By the end of the challenge, children with a pollen allergy had greater nasal obstruction than children without the allergy.4 But again, further evidence is required to link airborne, outdoor allergies to exercise.

But don’t be discouraged, allergy sufferers! Exercising, regardless of the benefits, does not have to be an uncomfortable burden during allergy season. In fact, there are many credible suggestions for managing your symptoms in order to achieve a great workout. So don’t let that stuffy nose, sneezing or those itchy, watery eyes get in the way of staying fit during allergy season!

First, be sure to take your allergy medication as prescribed. It is hard to focus on exercising when allergy symptoms feel unbearable. Using your medication as prescribed can relieve the nasal congestion associated with allergies that makes exercising difficult.5  Breathe through the nose as much as possible. Your nasal passages are designed to function as humidifiers and filters. They warm and moisten air while stopping allergens and other irritants.5

Be strategic about where you workout! If exercising outdoors with an airborne allergy, choose a time and location to minimize exposure to allergens. The pollen count tends to be highest in the morning and early afternoon. Avoid areas with lots of trees and fields as these areas may exacerbate your symptoms.5

Set an intensity that feels right for you. You can best determine what your body can handle. Take into account the severity of your symptoms and the activeness of your lifestyle. Start your aerobic workout off slow and gradually build intensity to avoid exhaustion.6  

Don’t forget the warm-up! Like the AAAAI, the American College of Sports Medicine (ACSM) claims that a low-intensity warm-up may help relieve allergy symptoms. The ACSM suggests that a warm-up lets the lungs adjust to a new environment and reduces the chances of inflammation, thus making breathing easier and exercising in allergy season more bearable.6

Perhaps most importantly, talk to your doctor about your specific allergies, how they might affect your workout and what adjustments you can make.

There is no reason to fear, allergy sufferers! Your symptoms can be controlled. If you keep taking your allergy medications, working out at your own pace and minimizing your exposure to allergens, you’ll be more comfortable during your workout! Though no definitive connection between exercise and allergy relief is currently available, exercise is good for your health. There is no need to let allergy season crumble your determination to stay fit and be healthy!


  1. Salada L. Fighting allergies and asthma with exercise. Total Gym Pulse Web site. Published March 20, 2014.
  1. Greenfield P. 5 seasonal allergy remedies. Fitness Magazine Web site. Published May, 2011.
  1. Aldred S, Love JA, Tonks LA, Stephens E, Jones DS, Blannin AK. The effect of steady state exercise on circulating human IgE and IgG in young healthy volunteers with known allergy. Journal of Science and Medicine in Sport. 2010;13(1):16-19.
  1. Harmancı K, Urhan B, Anıl H, Kocak A. Nasal and bronchial response to exercise in children with seasonal allergic rhinitis out of the pollen season. International Forum of Allergy & Rhinology. 2015;5(2):143-148.
  1. Sorace P. Exercising with allergies and asthma. ACSM Fit Society Page. 2014;16(2):4-5.
  1. Briner W. Action plan for allergies. Champaign, IL: Human Kinetics; 2007.

Caffeine intake & bone density..what’s the scoop?

November 11th, 2015

By Morgan Bailey, PharmD Student Cedarville University School of Pharmacy

In college and even in the workplace, caffeine has consumed our lives. Our generation turns to caffeine to give us the burst of energy that we need to make it through the day. According to, almost 90% of people in the world consume at least one beverage with caffeine in it daily.1 These beverages would include coffee, energy drinks and soda or pop. Caffeine is considered to be a stimulant to the body, which is why whenever you drink a lot of caffeine you tend to feel more energized and awake. Even though we may get a great feeling from these drinks, are they really being beneficial to our bodies? Recent evidence debates whether consuming large amounts of caffeine can increase your risk for osteoporosis.

Image courtesy of samuiblue at

Image courtesy of samuiblue at

Osteoporosis is condition where your bones become brittle and can make you become more at risk of breaking or fracturing your bones. Research on this topic leads some to believe that the caffeine stops the absorption of calcium in the bones, therefore causing them to become thin. Studies have also shown that caffeine acts on the bone promoting an increase of calcium excretion, inhibition of osteoblast proliferation and delay in tissue repair process, raising the risk of fractures, osteoporosis, periodontal disease and affecting the success of bone reconstructive procedures.2, 3

In 2015, The European Journal of Clinical Nutrition published a study looking at the influence of dietary patterns on bone mineral density and osteoporosis. This was a cross-sectional study that looked at Brazilian women aged 45 and over. The five categories retained were; “healthy”, red meats and refined cereals”, “low-fat dairy”, “sweet foods, coffee and teas”, and “western”. After analyzing that data that they received, they found that excessive sweet foods and caffeinated beverages appeared to have a negative affect on the bone mineral density. Although the study did find a negative effect on the bone density, they could not make a direct link to increased risk of osteoporosis. This was also a cross-sectional study, which was only looking at a specific time period; other results may have been revealed with a longer follow up study.4 In addition, recall bias may have affected the results due to patients self-reporting diet. There was also not any specific type of caffeine separated out (ie is there a difference between coffee, tea, or soda).

Similar findings were found in a 2006 study that found women with high coffee consumption, more than four cups a day, had an increase risk of bone fractures.5 On the other hand, a 2012 systemic review of multiple trials, concluded coffee intake did not increase risk of bone fractures, however suggested more research is needed.6 In 2013, a study was conducted on the long-term effects of coffee consumption and how that relates to the risk of bone fractures. The researchers found that there was no increased risk when the women drank low amounts of coffee, but when they drank more than four cups per day then they found that there could be a reduction in density of the bones.7 This cannot be directly linked to osteoporosis, but is considered a possible risk factor.

While it is not completely clear whether or not caffeine intake (or which type of caffeine) can increase the risk of osteoporosis and bone fractures, there is a lot of promising research being done to answer these questions. It appears there is a trend that over 4 cups a day may be an issue. If you are someone that drinks a lot of caffeine throughout the day, you could discuss supplementing with calcium and/or vitamin D and also consider limiting the amount of caffeine that you consume in a day and increase exercise.8, 9

Even though you may not be seeing the results of your caffeine intake now, would you still drink the same amount of caffeine if you knew that it could potentially hurt you in the future?


  1. 25 Shocking Caffeine Addition Statistics. HRF website. August 30, 2014. Accessed October 20, 2015.
  2. Hallstrom H. Coffee consumption in relation to osteoporosis and fractures: Observational studies in men and women. DiVA. 2013.
  3. Vanin, Carla, Harter ,Danielle, Ribeiro RV,Pinto, Kato ,Sergio, Dibi R,Papandreus, Stein ,Airton. Effects of caffeine intake on bone tissue in an animal model of osteoporosis. 2015. 10.1016/j.maturitas.2015.02.185
  4. De Franca N.A.G., Camargo M.B.R., Lazaretti-Castro M., Peters B.S.E., Martini L.A. Dietary patterns and bone mineral density in brazilian postmenopausal women with osteoporosis: A cross-sectional study. Eur J Clin Nutr. 2015; doi: 10.1038/ejcn.2015.27. [Epub ahead of print]
  5. Hallstrom H, Wolk A, Glynn A, Michaelsson K. Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of swedish women. Osteoporos Int. 2006; 17(7):1055-1064.
  6. Huifang L, Ke Y, Wenjie Z, Jun Z, Taixiang W, Chengqi H. Systematic review/Meta-analysis
coffee consumption and risk of fractures: A meta-analysis. Arch Med Sci. 2012;8(5).
  7. Hallstrom H, Byberg L, Glynn A, Lemming EW, Wolk A, Michaelsson K. Long-term coffee consumption in relation to fracture risk and bone mineral density in women. Am J Epidemiol. 2013; 178(6):898-909.
  8. Sanders S, Geraci SA. Osteoporosis in postmenopausal women: Considerations in prevention and treatment: (women’s health series). South Med J. 2013; 106(12): 698-706.
  9. Suzanne Sanders, M.D., Stephen A. Geraci, M.D. Osteoporosis in postmenopausal women: Considerations in prevention and treatment (women’s health series).

The Truth about Calcium That May Leave Supplement Companies in Pandemonium

November 9th, 2015

By: Caleb Tang

Calcium is an essential mineral and contributor to bone health that helps keep bones strong. In fact, 99% of the body’s calcium is found in bon
e.1 The human body is continually removing calcium from bone so that it can be used to aid in blood clots, muscle movement, and nerve messaging. Dietary calcium actually replenishes these losses and prevents bones from becoming weak. So why wouldn’t increasing the amount of calcium intake positively affect bone health? Imagine that your car is low on gas. Wouldn’t it obviously make sense to go to the nearest gas station and fill up your tank? In the case of bone health, the answer is not that cut and dry. Yes, calcium is an important factor, but increasing intake alone will not directly improve bone health.7

800px-500_mg_calcium_supplements_with_vitamin_DJust three weeks ago, the New York Times published an article titled, “Calcium Doesn’t Improve Bone Density, Analysis Finds”. This surprising claim was made by Nicholas Bakalar of the New York Times. He based his claim on two articles published by the British Medical Journal (BMJ) just this summer. The results from articles review made a bold claim that completely defies common household knowledge.  Aside from the fact that the two BMJ articles came to the same conclusion, the two were eerily related. Both were published on the same day (September 29, 2015) and both were associated with the University of Auckland and the University of Otago in New Zealand.

It seems illogical that increasing consumption of a crucial mineral for bone strength would not actually improve bone strength. The apparent paradox lies within biology and culture.9 It is important to realize that one simple dietary change will not affect bone strength. Consuming more calcium means nothing if the body doesn’t absorb it.1,6 Vitamin D increases calcium absorption from the small intestine, into the bloodstream, and finally to the bones. Other factors that positively affect bone health are as follows: weight-bearing exercise, tobacco avoidance, moderate alcohol intake.1

The effectiveness of calcium supplementation on bone mineral density varies according to two factors:  dietary calcium intake and stage of life.8,9 Compared to Western cultures, Asian cultures do not commonly incorporate high-calcium level foods (such as milk, cheese and other dairy products) into the everyday diet.10-12 A study in elderly Thai women found that calcium supplementation of at least 500mg/day for 2 years resulted in noticeable changes in BMD (bone marrow density) at several skeletal study points. The study’s conclusion was this: “Calcium supplementation might be crucial in people who have low calcium intake at baseline”.9 In cases like these, supplementation may be needed, but the first choice is to consume calcium from foods.8

Another important factor that plays a role in the effectiveness of calcium supplementation is the stage in life of the patient, especially if that patient is a woman. Elderly postmenopausal women experience loss of “beneficial effects of estrogen on the stimulation of intestinal calcium absorption and reduction of renal calcium excretion as well as an increase in bone turnover rate.”9 In this case, vitamin D calcium supplementation would actually help to prevent early postmenopausal bone loss.6,9

The human body surely requires at least some calcium, but currently, there is no reliable method to determine an optimal amount of daily calcium intake based on criteria such as age, gender, height, and weight.4 Even in a study where the mean calcium intake was well above the daily recommended amount (1,200mg/day), hip fractures were still evident.4 This seemingly counterintuitive finding begs that further studies explain why meeting or even exceeding a healthy limit will produce a high incidence of hip fractures.

In light of these recent scientific findings, one shouldn’t rely on calcium supplements to prevent BMD complications. Furthermore, patients who currently have osteoporosis or a high risk of fracture should never replace prescription medication with calcium supplementation. Until further evidence surfaces, people of all ages hoping to prevent later development of osteoporosis should continue to strive for a balanced diet containing adequate protein, fruits, vegetables, calcium, and vitamin D.8 Would you still consider taking a calcium supplement for the insignificant increase in bone strength it provides?


  1. National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation, 2010;1–56.
  2. Bolland MJ, Leung W, Tai V, et al. Calcium intake and risk of fracture: Systematic review.BMJ. 2015;351. doi: 10.1136/bmj.h4580.
  3. Tai V, Leung W, Grey A, Reid IR, Bolland MJ. Calcium intake and bone mineral density: Systematic review and meta-analysis.BMJ. 2015;351. doi: 10.1136/bmj.h4183.
  4. Cho K, Cederholm T, Lökk J. Calcium intake in elderly patients with hip fractures.Food & Nutrition Research. 2008;52:1-5.
  5. Cosman F, de Beur ,S.J., LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis.Osteoporos Int. 2014;25(10):2359-2381.
  6. Kärkkäinen M, Tuppurainen M, Salovaara K, et al. Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: A 3-year randomized population-based trial (OSTPRE-FPS).Osteoporos Int. 2010;21(12):2047-2055.
  7. Kling, Juliana M.Clarke, Bart L.Sandhu,Nicole P. Osteoporosis prevention, screening, and treatment: A review.Journal of Women’s Health (15409996). 2014;23(7):563-572.
  8. Nieves JW. Skeletal effects of nutrients and nutraceuticals, beyond calcium and vitamin D.Osteoporos Int. 2013;24(3):771-786.
  9. Rajatanavin R, Chailurkit L, Saetung S, Thakkinstian A, Nimitphong H. The efficacy of calcium supplementation alone in elderly thai women over a 2-year period: A randomized controlled trial.Osteoporosis Int. 2013;24(11):2871.
  10. Kim HS, Kim JS, Kim NS, Kim JH, Lee BK (2007) Association of vitamin D receptor polymorphism with calcaneal broadband ultrasound attenuation in Korean postmenopausal women with low calcium intake. Br J Nutr 98:878–881
  11. Lau EM, Woo J, Lam V, Hong A (2001) Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. J Bone Miner Res 16:1704–1709
  12. 12. Chee WS, Suriah AR, Zaitun Y, Chan SP, Yap SL, Chan YM (2002) Dietary calcium intake in postmenopausal Malaysian women: comparison between the food frequency questionnaire and three-day food records. Asia Pac J Clin Nutr 11:142–146

Acetaminophen: Is it Really Your Safest Option?

November 6th, 2015

By Tori Bumgardner, PharmD Student Cedarville University

Acetaminophen has long been a popular over-the-counter product used to treat pain and fever in both adults and children (1). It is recommended to women as the preferred pain medication while pregnant. The FDA has been approved for dosing in individuals of all ages, from infants to adults, who may be suffering from pain or fevers (2). While it is known that acetaminophen causes liver damage to people who take it at high doses for an extended period of time, recent studies have investigated the possibility that it can lead to dangerous levels of toxins in the body, potentially increasing the risk of attention deficit hyperactive disorder (ADHD) and even autism (3,4). The buildup occurs when one of the metabolites of acetaminophen, N-acetyl-p-benzoquinone imine (NAPQI), inhibits the detoxification of reactive oxygen species (ROS) in the body (5). When ROS builds up, inflammation can occur, giving it the potential to cause ADHD or autism. Additionally, a meta-analysis was conducted looking at the correlation between use of acetaminophen during pregnancy and occurrence of asthma in offspring (6). The study found that mothers who used acetaminophen while pregnant increased the risk of their child developing asthma. This blog post will review the recent evidence on the dangers associated with pre-natal exposure to acetaminophen.

Image courtesy of David Castillo Dominici at

Image courtesy of David Castillo Dominici at

A study from 2014 examined the relationship between mothers who took acetaminophen during pregnancy and the subsequent occurrence of ADHD in their children (4). In this study, 1714 European children were followed for 11 years and their mothers were surveyed when the children were newborn, 1, 3.5, 7, and 11 years old. For the newborn interview, information on the mothers’ pregnancy was collected. The other interviews were focused on the child, paying special attention to cognitive development, behavior, and physical activity. In the final interview, at age 11, the children also completed and interview that asked about topics like behavior, emotions, and self-esteem. The investigators examined the relationships between different drugs that were taken during pregnancy with the results of the strengths and difficulties questionnaire that were completed throughout the study. Interestingly, it was found that the group who used acetaminophen showed higher difficulties and lower social scores. The findings of this study indicate that acetaminophen use during pregnancy is correlated with higher rates of ADHD in children. Limitations to the study included a low follow-up rate, lack of generalization since the study was specific to European women and their children, and a possibility of selection bias if both parents were already predisposed to ADHD. Authors concede that additional research should be done to determine the actual risks associated with exposing children to acetaminophen at young ages. Other data found that children whose mothers used acetaminophen while pregnant had a higher incidence of behavior problems and hyperkinetic disorders (HKDs) like ADHD during a follow up when the children were seven years old (7). Due to the safety concern in allowing pregnant women to continue taking acetaminophen, since research seems to suggest its harm, the FDA has begun looking into the issue (8).

Though research is not yet conclusive, they encourage women to talk to their healthcare providers before taking anything.While it is always a good recommendation to talk to a doctor first, what does that leave women to use when they are in pain, but don’t have time to see or call the doctor, and are left with no options to provide relief? There are certainly alternatives available that don’t include drugs and can help relieve pain caused by headaches and aching in other parts of the body. Sometimes headaches are caused by stress and can be helped by practicing relaxation through deep-breathing, yoga, or any other technique that is convenient and will divert their mind off stress-inducing stimulation (9). A regular sleeping schedule is also important and exercise can help to relieve headaches, so taking a nap or a walk are both ways to relieve stress and pain without taking medication. Pain in other parts of the body may be troublesome, but a gentle massage or an external, topical pain relief product can be used to help establish comfort.

The data is still uncertain on the magnitude of risk with acetaminophen use in pregnant women, it is best to err on the side of caution and avoid use if possible. At the end of the day, the question that is left is one of risk versus benefit. Since nothing is conclusive about the danger that acetaminophen may have on babies, is it ultimately worth the risk to use it as a quick fix for a couple of hours free of pain?



  1. Medline Plus: Trusted Health Information for You Web site. Published 08-15-2014. Updated 2014. Accessed October 16, 2015.
  2. DailyMed (package inserts). National Institutes of Health; National Library of Medicine. (accessed October 26, 2015).
  3. Jennifer Margulis PD. Could A common painkiller cause brain inflammation — and even autism — in children? Published 09-08-2015. Updated 2015. Accessed 10-16-2015.
  4. Thompson JMD, Waldie KE, Wall CR, Murphy R, Mitchell EA, the ABC study group. Associations between Acetaminophen Use during Pregnancy and ADHD Symptoms Measured at Ages 7 and 11 Years. Hashimoto K, ed. PLoS ONE. 2014;9(9):e108210. doi:10.1371/journal.pone.0108210.
  5. Shaw W. Evidence that increased acetaminophen use in genetically vulnerable children appears to be a major cause of the epidemics of autism, attention deficit with hyperactivity, and asthma. Journal of Restorative Medicine. 2013;2:1. Accessed October 26, 2015. doi: 10.14200/jrm.2013.2.0101.
  6. Cheelo M, Lodge CJ, Dharmage SC, et al. Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: A systematic review and meta-analysis. Arch Dis Child. 2015;100(1):81.
  7. Liew Z, Ritz B, Rebordosa C, Lee P,Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatrics. 2014;168(4):313-320.
  8. FDA drug safety communication: FDA has reviewed possible risks of pain medicine use during pregnancy. U.S. Food and Drug Administration Web site. Published 01-09-2015. Updated 2015. Accessed October 16, 2015.
  9. Krinsky D, Ferreri S, Hemstreet B, et al. Headache. In: Young L, ed. Handbook of nonprescription drugs: An interactive approach to self-care. 18th ed. Washington, DC: American Pharmacists Association; 2015:65-83-95. Accessed 10-16-2015.

No Gain, No Brain

November 3rd, 2015

By: Ankit Pandav


When someone mentions to you that they are on a “Mediterranean diet”, what kind of foods come to mind? Many people instantly think a Mediterranean diet consists of gyros, lasagna, pasta, pizza, plenty of meat and a lots of wine. Others simply consider it to be a healthy diet which most people can’t afford. For the most part however, both of these thoughts are incorrect. A Mediterranean diet consists of fish, fruits, vegetables, beans, nuts, and a moderate amount of wine. What’s more, a study run by Mayo clinic and University of Maryland Medical Center recently discovered that a Mediterranean diet has many health benefits such as protecting against type 2 diabetes, preventing heart disease and strokes, it reduces the risk of developing muscle weakness, and it reduces the risk of developing diseases like Parkinson’s disease, Alzheimer’s disease, dementia, and others.1

Another recent study also shows that the Mediterranean diet may reduce brain shrinkage. A greater amount of shrinkage can be linked to cognitive decline.2 The study author, Yian Gu, states that “It was encouraging to see that the more you adhere to this Mediterranean diet, the more protection you get against brain atrophy [shrinkage].” 3 In his study, there were 674 adults without dementia who averaged close to 80 years of age.  They were split into two groups based on how closely their diets aligned with the Mediterranean diet.3 The researcher then scanned the patients’ brains and measured their brain volume.  “The brains of devotees of the Mediterranean Diet were 13.11 milliliters larger on average than those who did not eat that way.”4 The research study was a cross-sectional study and its method of scanning the brain was high-resolution structural MRI.5

This finding is important, as it appears a Mediterranean diet may help prevent brain related diseases. There continues to be a lack of effective pharmaceutical treatment for common types of dementia. Lifestyle changes seem to be the only treatment that can prevent or postpone the growth of the dementia.6  Although this study and many others like it suggest that following a Mediterranean diet can have a significant positive impact on one’s daily life, whether or not it can definitely prevent dementia is still inconclusive and will require further studies. One of the biggest limitations to this study is that it can’t show whether the diet actually caused less brain shrinkage over time. Another is that the researchers might have brought bias when picking the candidates as they only picked candidates from certain financial classes and race. Also, reliability of the patient’s self-reported testimonies regarding eating the Mediterranean diet is poor. However, it is safe to conclude that a diet, like the Mediterranean, is very beneficial for our health and this research provides us with a new and exciting opportunity to live a healthier lifestyle.7

Based on the evidence above, a modification to our American diet can lead to not just weight loss, healthier hearts, and lower cholesterol, but potentially limit the scope of brain related illnesses. So what are some tips on eating more “Mediterranean”? One way is to incorporate eating more fish rather than meat. Another way is to eat nuts instead of unhealthy snacks. Vegetables and beans are important, and even a moderate amount of wine can be beneficial. As with any healthy diet, it is also important to stay active, whether that means taking a regular light jog or pace walking. Also, a very important factor to remember is to have everything in moderation. Going overboard and having too much food of the Mediterranean diet could potentially have the opposite effect and lead to harmful results. Readers should also always be aware of their allergies since the Mediterranean diet does consist of a high amount of nuts. In the end one of the biggest questions that we should ask is that what kind of impact does the Mediterranean diet have when started earlier in life versus later stages?


  1. The Mediterranean Diet. : Myths, Facts, and Health Benefits of a Mediterranean Diet 2015.
  2. Eating a Healthy Diet May Reduce Brain Shrinkage. Eating a Healthy Diet May Reduce Brain Shrinkage 2015.
  3. Mediterranean Diet May Keep Your Mind Healthier in Old Age: MedlinePlus. U.S National Library of Medicine 2015.
  4. Shah A. Mediterranean Diet may protect against age-related brain atrophy, dementia, new study shows. Star Tribune 2015.
  5. Gu Y. Mediterranean diet and brain structure in a multiethnic elderly cohort. Mediterranean diet and brain structure in a multiethnic elderly cohort 2015.
  6. Safaris A. Mediterranean Diet and Risk of Dementia. Latest TOC RSS 2015.
  7. Could A Mediterranean Diet Keep Your Brain From Shrinking? NBC News 2015.

Goodnight, Sleep Tight, Make Sure Your Blood Pressure is Right

October 30th, 2015

By: AJ OliverMoon_by_Adam_Cebula

Take a quick moment to think about your typical nightly routine. It most likely includes actions such as washing your face, showering, brushing your teeth or setting aside your outfit for the next day. If you are someone who has been diagnosed with high blood pressure (hypertension), adding the task of taking your medication may prove more beneficial to your health. In 2011, a new study reported by Harvard Health Publications claimed that taking your daily blood pressure medications at night will help lower the reading in those diagnosed with high blood pressure.1 Although that sounds like a no brainer, it is important to note that those not diagnosed with hypertension experience blood pressure readings that alternate based on the time of day. Getting out of bed is the hardest part of the day but once you do get out of bed, blood pressure rises. Before you start getting scared that your blood pressure will reach sky high before you start eating lunch, do not worry because your blood pressure will remain steady. Guess when your blood pressure will be at its lowest? Yep, you guessed it – it is lowest at night, usually between midnight and three or four o’ clock in the afternoon.1 This phenomenon is called “dipping”. However, people with high blood pressure experience “non-dipping,” meaning their blood pressure does not decrease at night – making the finding above important.2

Unfortunately, the same hormone that contributes to hypertension also increases the release of sugars from the liver and lowers insulin sensitivity.2 The combination causes an increase of risk for Type 2 diabetes in those who have hypertension. This was investigated in a study published in the Journal of Human Hypertension.3  In the study of 2,012 people with high blood pressure, half of the participants were instructed to take their blood pressure medications at night while the other half were instructed to take these medications in the morning.4 They monitored the participants for six years over which time 171 of the participants developed Type 2 diabetes.2 The researchers found that the half who took the blood pressure medications at night before going to bed had lowered their blood pressure more than those who took it in the morning.4 Additionally, these same participants also had a 57 percent lower risk for diabetes. Therefore, study authors concluded that taking a blood pressure medication before going to bed could benefit those who have hypertension by lowering blood pressure readings at night and decrease the risk of developing diabetes.1 However, with these studies there is a point that is important to note. Authors found that some older participants taking their blood pressure medications at night had critically low readings in the morning when trying to rise out of bed causing an increased risk of falls.1

Considering the evidence, taking blood pressure medication at night appears to be effective for improvement in blood pressure and risk of diabetes. However, it is necessary to take the proper precautions before starting blood pressure medications at night. Contact your doctor and pharmacist to see if you are suitable for taking blood pressure medications at night. Also, make sure that you use the same methods as you would use if you were to take these medications during the day. For instance, be sure to make a list of all the blood pressure medications taken.5 Also, try to get a good understanding of the side effects of your medications, not all blood pressure medications should be taken at night. For example, blood pressure medications like hydrochlorothiazide and Lasix are within a class of medications called diuretics.6 One of the side effects of diuretics is an increase in the volume of urine, which may result in multiple trips to the bathroom throughout the night.  For the medications you do take at night, make it a routine to take it at the same time every day.5 Do not alternate between taking the medications at night and during the day. Finally, keep your doctor informed and get your blood pressure checked regularly. If your primary care physician says you are good to go for taking your blood pressure medications at night then get to it! This may be a hard change and a lot to keep in mind. What are some ways to remind yourself to take these medications at the same time every night as well as reminding yourself to check your blood pressure? Do you think that taking blood pressure medication at night would be helpful for you?


  1. LeWine H. Taking blood pressure pills at bedtime may prevent more heart attacks, strokes. Harvard Health Publications. October 25, 2011. Accessed October 29, 2015.
  2. Thompson D. Timing your blood pressure med right might prevent diabetes. News & View. September 24, 2015. Accessed October 29, 2015.
  3. Hermida RC, Ayala DE, Mojón A, Smolensky MH, Portaluppi F, Fernández,J.R. Sleep-time ambulatory blood pressure as a novel therapeutic target for cardiovascular risk reduction. J Hum Hypertens. 2014;28(10):567-574. Accessed October 29, 2015.
  4. Bakalar N. Hypertension drugs may be more effective if taken at night. Well. October 2, 2015. Accessed October 29, 2015.
  5. Web M. D. Taking high blood pressure drugs properly. Accessed October 29, 2015.
  6. Diuretics.

Darker Isn’t Always Better

October 29th, 2015

By: Maame Debrah-Pinamang, PharmD Student

ChocolateFor years, the scientific world has been shouting to the masses about the benefits of eating dark chocolate. The health benefits of dark chocolate have been extensively studied to provide us with the knowledge that habitual consumption of dark chocolate will lead to lower risk of cardiovascular disease, raise your high density lipoprotein levels (good cholesterol), as well as provide antioxidant properties to keep you looking younger, longer.1 Evidence such as this has led people to choose dark chocolate over regular milk chocolate. What if that’s not necessarily the case? Recently, there was an article stating that milk chocolate provides the same benefits of dark chocolate, as well as an increase in research on what the health benefits of dark chocolate come from, and whether the heart benefits that dark chocolate has is present in other types of chocolate.2 Besides color and taste, there is very little difference between dark and milk chocolate. Different companies include different levels of sugar and cocoa powder in their formulations, although the FDA sets standards for what cocoa levels constitute each type of chocolate. In order to be considered milk chocolate, the piece of chocolate must not contain less than 10% chocolate liquor, and at least 12% milk ingredients. For dark chocolate, the required amount of chocolate liquor is greater than or equal to 35%.3

A recent study analyzed the chocolate consumption of over 20,000 people for a period of 11 years, on average. Participants consumed a median of 4.6 grams (about 1.25 individual squares on a standard bar of Hershey’s chocolate) of chocolate per day, and had their cardiovascular health assessed.4 The data used in the first study looked at the effects on HDL and LDL with the participants self-reporting their consumption of chocolate. Participants that consumed a higher amount of chocolate had an increase in cardiovascular health, a lower body mass index (BMI), as well as lower blood pressure. However, the self-reporting of chocolate consumption leads to errors in reporting and inconsistent measurements. The study also failed to report the specific type of chocolate the participants consumed, making it difficult to pinpoint the exact cause of the reduced health risks. In order to produce a more reliable study, the researchers should have produced a specified amount of chocolate to each participant as well as recording the specific kind of chocolate.

Of the more common types of chocolate, dark chocolate is more extensively studied for the benefits that it may provide, but that kind of chocolate may be irrelevant. In a similarly conducted study in Japan, researchers gave participants 13, 19.5, and 26 grams of chocolate per day.5 Similar to the first study, those who ate more chocolate saw a greater increase in cardiovascular health. Those who ate at least 13 grams of chocolate per day found approximately 3.23 mmol/L decrease in LDL cholesterol. Some limitations of the study was that the study participants were given cocoa powder, which is not readily available to most people, as well as the cocoa powder being added to hot water, and not taken as a piece of chocolate that is easily available to all people.

In order to gain all the heart benefits of chocolate, each person should attempt to get approximately 1.5 grams of chocolate per day. Although a consistent consumption of chocolate could provide an increase in heart health, the benefits may not apply to everyone. Different health conditions may not allow for self-care with chocolate consumption. Given the results of the research, it is inconclusive that the impact of dark chocolate on heart health is greater than milk chocolate. The studies performed in the articles allow a safe assumption that either kind of chocolate would provide the same benefits.  The health benefits stemming from cocoa powder and not from the color of the chocolate allow for a greater range of chocolate that will provide heart healthy benefits. The recommended daily amount of chocolate from The Cleveland Clinic Wellness is 1.5 to 3 ounces to ensure maximum heart benefits from chocolate (Godiva sells chocolate in 1.5 ounce size).6 The small amount of chocolate provides us with right correct amount of chocolate to ensure heart health, without the excess sugar that comes with eating too much chocolate. Although it is important to take self-care measures to reduce your risk of heart disease, do not rely solely on chocolate as your cardiologist. Before beginning any self-care regimens, contact your primary care provider to ensure that the measures you are starting are safe and the best options for your needs.



  1. Kwok, C. S. et al. Habitual Chocolate Consumption and Risk of Cardiovascular Disease Among Healthy Men and Women. British Medical Journal. 2015.
  2. Wanjek, Christopher. “Even Milk Chocolate is Good for you, According to new Study” Huffington Post. June 16, 2015. Accessed October 14, 2015.
  3. Hershey’s. Types of Chocolate. Available at: Accessed October 28, 2015.
  4. Smit, H. J., Gaffan, E. A., Rogers, P.J. Methylxanthines are the psycho-o Kondo. pharmacologically active constituents of chocolate. 2004; (176)3-4:412-19.
  5. Baba, S, et al. Plasma LDL and HDL Cholesterol and Oxidized LDL Concentrations Are Altered in Normo- and Hypercholesterolemic Humans after Intake of Different Levels of Cocoa Powder. The Journal of Nutrition. 2007;137(6): 1436-1441.
  6. Cleveland Clinic Wellness. Eating Chocolate can be Healthy. Available at: Accessed October 28, 2015.

Sugar and Spice

October 28th, 2015

By: Micah Bernard800px-Ground_cinnamon

Cinnamon. What comes to mind when you hear that word? Cinnamon buns, cinnamon glazed apples, snickerdoodles? It’s no secret that cinnamon and sugar are a great pair! But is there more to the relationship between sugar and cinnamon than just the great taste?

People with pre­diabetes or type 2 diabetes must be very careful to manage blood sugar levels. This can be achieved by following a special diet, losing weight, exercising, and taking medications such as metformin. Now there is a common spice that is being investigated as a supplement to help control blood sugar. In 2013, NPR published an article stating that cinnamon can help lower blood sugar.1 But is this claim backed up by science? Researchers in the last few years have been studying the impact of cinnamon on the management of blood sugar and have had promising results.
In 2003, researchers sought to determine if cinnamon could improve blood glucose levels in people with type 2 diabetes.2 In this study of 60 people with type 2 diabetes ranging in age from 45 to 58, subjects took either a placebo or one of three amounts of cinnamon: 1, 3, or 6 grams each day. After 40 days, the results showed that cinnamon in any of the three doses helps lower blood glucose levels 18­-29%, while no significant changes were reported in the placebo groups.

Another study in 2006 of 79 diabetic patients looked at whether cinnamon extract helps improve glycemic control in patients with type 2 diabetes.3 Each person either received a capsule of 3 grams of cinnamon or a placebo three times a day for 4 months. The results showed that the reduction in fasting blood glucose levels in the patients receiving cinnamon (10.3%), was significantly greater than in the control group, who had a reduction of only 3.4%. However, no significant differences were seen in hemoglobin A1c, which is an indicator of average blood sugar levels over the past three months.

A recent study that ran statistical tests on data from ten randomized controlled trials studying cinnamon’s effect on blood glucose found that cinnamon decreased fasting blood glucose levels by 24.59 mg/dl.4 There was no significant difference in the patients’ hemoglobin A1c. The study was unable to determine what the optimal dose of cinnamon or duration of treatment; this is an area where further research is needed.

How does cinnamon do it? Researchers do not fully know how cinnamon works, but they believe it may increase the body’s levels of and sensitivity to insulin, the hormone that helps your cells take sugar out of the blood stream, thereby lowering blood sugar levels.5 In addition, cinnamon may slow the emptying of the stomach, so there is less of a spike of sugar in the bloodstream.6 There is debate among researchers about what dose of cinnamon should be used to manage blood sugar.

As with any supplement, it is important to check with your doctor before adding cinnamon to your diet. If, after talking to your doctor, you decide to see if cinnamon works for you, it is important to choose the right kind of cinnamon. Cinnamon comes in two varieties, Cassia and Ceylon. Cassia is the more common type found in many supermarkets, however in higher doses, such as those used to control blood sugar, coumarin isolates (not to be confused with the blood thinner Coumadin) found in cinnamon can cause liver damage.1 The Ceylon variety of cinnamon has only trace amounts coumarin isolates, making it safer for the liver.7 So, if you plan to supplement your blood sugar management with cinnamon, ask a pharmacist to help you correctly select the Ceylon variety.

While researchers still do not fully agree on the effectiveness of cinnamon as a supplement for controlling blood sugar in type 2 diabetics and pre­diabetics, many recent studies show promising results. The effects of cinnamon may not be enough to replace a drug intended to control blood sugar, but those with pre­diabetes or diabetes may find it a useful supplement to help manage their condition.

What are your thoughts on using a natural supplement to manage a health condition?


1. Aubrey A. Cinnamon Can Help Lower Blood Sugar, But One Variety May Be Best. NPR 2013. Accessed October 15, 2015.
2. Khan A, Safdar M, Ali khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003;26(12):3215­8.
3. Mang B, Wolters M, Schmitt B, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36(5):340­4.
4. Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon use in type 2 diabetes: an updated systematic review and meta­analysis. Ann Fam Med. 2013;11(5):452­9.
5. Kaiser C. Cinnamon’s Effect in Diabetes Uncertain. Cinnamon’s Ef ect in Diabetes Uncertain 2013. Accessed 2015.
6. Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutr. 2007;85(6):1552­6.
7. Johannes L. Little Bit of Spice for Health, but Which One? WSJ 2013. Accessed 2015.

A Natural Approach to Preventing Gestational Diabetes

October 26th, 2015
image courtesy of

By Katie Woodward, PharmD Student

You are having a new baby! Congratulations! You’ve probably already had several opportunities to answer that age-old question, “What gender are you hoping for?” And it is likely you responded with something like, “I don’t care as long as my baby is healthy!” Thanks to new scientific research, your chances of delivering a healthy baby are constantly improving.

We are going to play a quick game of “Bad News/Good News.” The bad news: gestational diabetes may cause complications in your pregnancy. Several factors may put you at risk of developing gestational diabetes. If diabetes runs in your family, if you are overweight, not very active, or over the age of 40 you are at risk of developing gestational diabetes.1 Gestational diabetes can cause jaundice, high birth weight, trauma during birth, increase necessity for C-section, and increase likelihood of obesity or diabetes in the child.1,2 Gestational diabetes also puts a new mother at risk of developing Type 2 Diabetes, which can require insulin injections and other treatments to control.

Now, for the good news: new research has demonstrated that myo-inositol is a supplement you can take which significantly decreases your chances of developing gestational diabetes, even if you are at high-risk.3 For those already diagnosed with gestational diabetes, taking a myo-inositol supplement can help decrease your need for insulin, make you more likely to carry the baby to term, and decrease your infant’s chances of developing hypoglycemia.3 Standard treatment for gestational diabetes requires the patient to check blood sugar levels in the morning and after meals, which can require several needle sticks per day as well as the purchase of a glucometer, test strips, and lancets.4 Insulin injections are also used to help control the blood sugar in up to 20% of women with gestational diabetes.4

A research study published in the Journal of Maternal-Fetal and Neonatal Medicine was designed as a prospective, double-blind, randomized controlled clinical trial which compared a placebo group to a group of mothers who supplemented with myo-inositol twice daily.3 The myo-inositol group had significantly better outcomes including lower maternal BMI, longer gestation at the time of delivery, and decreased abnormal oral glucose tolerance test results. The oral glucose tolerance test is the standard screening measure for gestational diabetes.  One limitation was that the study was relatively small. Some of the data may have been statistically significant if there had been more women involved in the study; for instance, the myo-inositol group had a lower incidence of neonatal hypoglycemia, but the data was not quite strong enough to be statistically significant. Another interesting statistic is that 21% of women in the placebo group required insulin therapy, while only 3% of women in the myo-inositol group required insulin therapy. While larger studies may be needed to validate this data, this study demonstrated that at least 50% of women who take myo-inositol may benefit from the treatment.3 Since the current standard of care for prevention of gestation diabetes is diet change and monitoring blood sugar, myo-inositol may be an easy and beneficial way to minimize complications from gestational diabetes.  It also has a promising potential to minimize the requirement of insulin injections.

Since it is a compound naturally found in both your body and your baby’s body, you can safely consume myo-inositol supplements.5 The product may be a little bit difficult to find in grocery stores, but it can be found in combination products or ordered online. According to research, the supplement is best if taken 2000 mg twice daily (make sure you separate the doses by at least six hours.)One product can be purchased from Fairhaven Health6 where you can get a 60-day supply for less than $20.* Myo-inositol is often combined with another compound called D-chiro inositol, which has also been demonstrated to assist with gestational diabetes.7 The combination product is called Ovasitol and it can be purchased online from Theralogix Nutritional Science Company, but it must be ordered online and can cost up to $1 per day ($90 for a 90 day supply.)8 Another product to consider is called Sensitol, and it contains D-chrio inositol, myo-inositol, and alpha lipoic acid. The product can be ordered online and a thirty day supply is $52.9

Gestational diabetes can have some scary consequences for you and your baby. Based on the evidence, I would recommend that any mother who has increased risk of gestational diabetes should discuss supplementation with myo-inositol with their medical provider.   It could help prevent or minimize problems associated with gestational diabetes. Myo-inositol may be expensive and may not be easily accessible to all; since it is commonly used as a preventative supplement, do you think that pregnant women at high risk for developing gestational diabetes should consider it as an option?

*The manufacturer suggests that the drug be taken four times daily, but in studies, the 2000 mg dose was only recommended twice daily.3 Also, this will help decrease the cost of the drug.

**Note: The Cochrane Collaboration is working on a new study to further describe the dosing and efficacy of myo-inositol as a treatment/ prevention method for gestational diabetes and it should be released soon.


  1. Available at: Accessed October 14, 2015.
  2. Brown J. Myo-inositol for preventing gestational diabetes. Cochrane Database Of Systematic Reviews [serial online]. February 2, 2015;(2)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed October 11, 2015.
  3. Matarrelli B, Vitacolonna E, Celentano C, et al. Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. The Journal Of Maternal-Fetal & Neonatal Medicine: The Official Journal Of The European Association Of Perinatal Medicine, The Federation Of Asia And Oceania Perinatal Societies, The International Society Of Perinatal Obstetricians [serial online]. July 2013;26(10):967-972. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 11, 2015
  4. Available at: Accessed October 21, 2015.
  5. D’Anna R, Scilipoti A, Di Benedetto A, et al. myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care [serial online]. April 2013;36(4):854-857. Available from: MEDLINE, Ipswich, MA. Accessed October 11, 2015.
  6. Available at: Accessed October 14, 2015.
  7. Costantino D, Guaraldi C. [Role of D-chiro-inositol in glucidic metabolism alterations during pregnancy]. Minerva Ginecol. 2014;66(3):281-91.
  8. Available at: Accessed October 14, 2015.
  9. Available at: Accessed October 21, 2015.