The Seven Risk Factors of Autoimmune Thyroid Diseases

Autoimmune diseases affect over 24 million Americans, with thyroid disease responsible for about 20 million cases.1 Autoimmune thyroid diseases can be underdiagnosed and many people may not know that they are affected. Do not let that scare you!1 Look no further to learn about autoimmune thyroid diseases, risk factors, and the importance of early diagnoses.

What are autoimmune thyroid diseases?1-3

Our immune systems are largely responsible for protecting us from infection, toxins, and other foreign substances. Autoimmune diseases like rheumatoid arthritis and lupus occur when the immune system begins to attack your body because it thinks your own cells are intruders and do not belong. The auto-antibodies produced cause inflammation and damage your body’s tissues, organs, and hormone production. When this occurs at the level of the thyroid, a butterfly-shaped gland at your neck, it can cause several effects to increase or decrease thyroid hormones. The thyroid’s job is to regulate your mood, metabolism, temperature, heart rate, breathing, and growth. The two chief autoimmune thyroid diseases include Hashimoto’s thyroiditis and Graves’ disease. Medical professionals and scientists are unsure why exactly these conditions occur, but they believe a dysfunctional immune system is a key cause. 

Hashimoto’s thyroiditis causes hypothyroidism or a decrease in thyroid hormone production. With Hashimoto’s thyroiditis, your body thinks your thyroid cells are foreign invaders. The immune system sends thyroid peroxidase antibodies (TPOAb) to attack your thyroid with the goal of weakening and killing the ‘foreign invaders.’ If you develop Hashimoto’s thyroiditis, you may experience the following signs and symptoms: enlarged thyroid or goiter, weight gain, muscle pain, depression, hair loss, brittle nails, constipation, swollen face, and cold sensitivity. 

Graves’ disease results in hyperthyroidism or an increase in thyroid hormone production. In Graves’ disease, the body spontaneously attacks itself and produces an antibody known as thyrotropin receptor antibody (TRAb) that stimulates thyroid hormone production. This results in an excess of thyroid hormones and inflammation of the thyroid. Common signs and symptoms include insomnia, anxiety, weight loss, goiter, irregular menstrual cycle, rapid heartbeat, frequent bowel movements, bulging eyes, fatigue, and heat sensitivity or increased sweating. 

It is important to note that these symptoms develop slowly over time, so talk with your doctor or pharmacist if you experience them. Your doctor may decide to run thyroid hormone and antibody blood tests, and inspect your thyroid to determine if you have an autoimmune thyroid disease.

Risk Factors for Autoimmune Thyroid Diseases2-8

  1. Autoimmune disease – If you have a current autoimmune disease like Type 1 diabetes, this increases your risk of having an autoimmune thyroid disease. This is the primary risk factor because if your immune system is already not functioning properly, then it may cause other organs and glands to malfunction. Therefore, it is important that you regularly visit your doctor to check your thyroid gland functioning and know the symptoms. 
  1. Sex – Females are more likely to develop autoimmune thyroid diseases than males as it occurs in one out of eight females. They are more likely to develop after pregnancy or menopause due to hormonal imbalances like with estrogen, the main female sex hormone. A thyroid disorder can cause irregular periods or menopause symptoms like hot flashes and mood swings, so contact your doctor or pharmacist if you experience these symptoms. Yet, males with low testosterone levels, the main male sex hormone, have a higher risk of autoimmune thyroid diseases too.
  1. Age – Although Hashimoto’s thyroiditis and Graves’ disease can occur at any age, they are most commonly developed between the early 40s and 60s. This is because the body undergoes many changes as we continue to age which can affect our hormone levels and regulation processes. Sadly, these conditions may be harder to diagnose as we age because of a lack or overlap of symptoms between the conditions. 
  1. Chronic stress – As the amount of chronic stress you are under over a long period of time increases, you have a higher chance of developing a thyroid disorder. Examples of chronic stress include job loss, death of a loved one, marriage, depression, anxiety, and financial instability. The increase in cortisol or the body’s stress hormone inhibits the production of thyroid hormones which can lead to Hashimoto’s thyroiditis. Even infections can affect your thyroid functioning. Increased stress can lead to reactivation of viruses that may have been inactive in your body like Epstein-Barr virus or mononucleosis. This is why it is crucial that you manage your stress with activities like mediation or walking and visit your doctor regularly.
  1. Food sensitivity – Food sensitivities like with gluten and inflammatory foods such as processed foods increase inflammation and antibody production in your body. This can lead to thyroid dysfunction if your thyroid is attacked. Gluten is one of the most common food sensitivities and affects about 15% of the United States population. It is a protein found in wheat, barely, rye, and oats that make up common foods such as pasta, beer, and bread. If you have a food insensitivity and eat that food, the food tricks your body into thinking that it is harmful. This causes your body to make antibodies and become inflamed to fight it off that can lower your thyroid’s hormone production. Removing these foods from your diet may improve your thyroid functioning.
  1. Toxins or radiation – Exposure to toxins like pesticides, excess contrast dyes like iodine from x-rays, mercury, and radiation can cause your thyroid to release minimal thyroid hormones. This leads to poor metabolism, fatigue, and weight gain that are signs of Hashimoto’s thyroiditis. Minimizing your exposure to these harmful chemicals may benefit your overall energy, development, and body process regulations. 
  1. Heredity – Unfortunately, we cannot change our family history or genes, but this may play a role in autoimmune thyroid disease. If someone in your family like your sister, grandfather, or mother has Hashimoto’s thyroiditis or Graves’ disease, then you have a higher chance of developing the condition.

Heart Disease in Autoimmune Thyroid Diseases2,3

By not regularly taking your thyroid medication, modifying your risk factors, or having an undiagnosed autoimmune thyroid disease, you may increase your risk of developing serious health problems. These include myxedema coma and thyroid storm that were discussed in last week’s article. Additionally, a common issue that both conditions can cause is heart disease. Heart disease is the leading cause of death in the United States, so it is vital you take steps to lower your risk. With Hashimoto’s thyroiditis, your low-density lipoprotein (LDL) or bad cholesterol blood levels may increase since the body’s metabolism ability is low. This can cause your heart to work harder to pump blood throughout the body as the walls of your arteries become clogged, causing heart failure. Graves’ disease can also lead to heart failure and irregular heart rhythms because an overactive thyroid increases your heart rate. As the blood is pumped at a faster rate, it can damage your arteries and distort your heart’s shape or functional ability.

Be sure your doctor knows your medical history and risk factors to determine if you should be tested for autoimmune thyroid disease. Hashimoto’s thyroiditis and Graves’ disease can be simply treated with an appropriate thyroid therapy to regulate thyroid hormone production, but they require lifelong treatment and follow-up. Fortunately, these medications can help you continue to live your life and perform your day-to-day activities!


  1. Milas K. Risk factors of Hashimoto’s Thyroiditis. Endocrineweb website. Accessed August 1, 2021. 
  2. Hashimoto’s disease. Mayo Clinic website. Accessed August 1, 2021. 
  3. Graves’ disease. Mayo Clinic website. Accessed August 1, 2021. 
  4. Seed S. What is autoimmune thyroiditis? WebMD website. Accessed August 1, 2021. 
  5. Grunewald J. Why do thyroid disorders affect women more often than men? Experience Life website. Accessed August 1, 2021. 
  6. Older patients and thyroid disease. American Thyroid Association website. Accessed August 1, 2021. 
  7. Klimenko E. Functional medicine approach to autoimmune thyroid disease. Dr. Klimenko website. Accessed August 1, 2021.
  8. Hyman M. A 7-step plan to boost your low thyroid and metabolism. Dr. Hyman website. Accessed August 1, 2021.

Balancing the All-Controlling Thyroid

Thyroid disease affects all ages and can be present at birth, inherited, medication-induced, related to a past thyroid or inflammatory condition like lupus or Type 1 diabetes, or develop over time like after menopause. Additionally, females are about seven times more likely to have thyroid disease than males.1 An imbalanced thyroid may have a large effect on your overall mental, physical, and emotional health, but it can be restored with natural and chemical thyroid medications.

What is the thyroid gland?1,2

The thyroid, a butterfly-shaped gland in the front of the neck, plays a crucial role in regulating the body’s growth, development, and metabolism or creating energy from food. It releases chemical signals or hormones called T3 (triiodothyronine) and T4 (thyroxine). T3 is the active form of thyroid hormone produced from T4 to help with your body’s functioning. T3 and T4 are released into the bloodstream to control weight, body temperature, breathing, and energy. Hormonal release by the thyroid is ultimately controlled by the pituitary gland, a bean-shaped gland located below the brain. The pituitary gland releases thyroid stimulating hormone (TSH) to increase T3 and T4 when it senses levels are low. Hormonal feedback to the pituitary gland plays a role in how many hormones need to be released by the thyroid. However, an improper thyroid functioning can greatly affect your body’s processes. Releasing too much thyroid hormone is known as hyperthyroidism while releasing too little thyroid hormone is called hypothyroidism. 


 Types of Thyroid Diseases1-4

When too much thyroid hormone is released, this is known as hyperthyroidism. This means that the body will use energy too fast, causing you to feel tired, lose weight, and intolerant to heat. Graves’ disease, an autoimmune disease where the body suddenly attacks itself and produces an antibody like TSH, is a common cause of hyperthyroidism. When the thyroid is attacked, excess thyroid hormones are released and the thyroid swells due to the antibodies. Rarely, thyroid cancer or abnormal growth of the thyroid and hormone production leads to thyroid disease. 

The opposite of hyperthyroidism is hypothyroidism. Too little release of thyroid hormone causes you to feel tired, gain weight, and affect your sensitivity to coldness. It can be caused by removal of the thyroid; excess hyperthyroidism treatment; too much iodine from contrast dyes for x-rays; amiodarone, a heart rate-controlling medication; and lithium, a mood disorder medication.

Thyroiditis results when the thyroid gland is inflamed or swollen, leading to an increase or decrease in thyroid hormone release. It is characterized by the following three phases: thyrotoxic, hypothyroid, and euthyroid. After the thyroid swells and over produces thyroid hormones in the thyrotoxic phase, there becomes a low supply of thyroid hormones to release or the hypothyroid phase. The hypothyroid phase is longer-lasting and can be permanent. Once the thyroid has recovered and hormone levels are normal, this is known as the euthyroid phase. 

Hashimoto’s thyroiditis is an inherited and autoimmune disease where the body thinks the thyroid cells are harmful invaders. This causes the body to attack, damage, and kill your thyroid cells to end hormone production. The causes of Hashimoto’s thyroiditis are unclear, but it is likely related to a family history of thyroid or autoimmune diseases, excess iodine or radiation, and sex hormones since it is more common in females.

Thyroid Disease Symptoms2

An irregular thyroid gland includes a wide range of symptoms from difficulty breathing to hair loss. Yet, it can be difficult to diagnose since the symptoms appear in many other conditions. Hyperthyroidism and hypothyroidism are the two most common thyroid diseases that best categorize the symptoms of disease. Symptoms of excess thyroid hormones or hyperthyroidism include a rapid heartbeat, sweating, bulging eyes or exophthalmos, difficulty sleeping, nervousness, irritability, weight loss, muscle weakness, frequent bowel movements, heat sensitivity, and irregular menstrual periods. The symptoms of a lack of thyroid hormones or hypothyroidism can mostly be thought of as the opposite of hyperthyroidism. Hypothyroidism symptoms include a slow heart rate, hair loss, fatigue, constipation, depression, dry skin, hoarseness, cold sensitivity, and frequent or heavy menstrual periods. Yet, both conditions can result in an enlarged thyroid or goiter due to an imbalance of thyroid hormones.

Thyroid Disease Diagnosis2,5,6

Diagnosing thyroid disease is done through measuring your symptoms and blood levels of T3, T4, and TSH. If TSH is found to be abnormal, your doctor may assess your blood levels of T3 and T4. A normal TSH level is between 0.4 and 4.0 mIU/L, total T4 is between 5 and 11 mcg/dL, and total T3 is between 100 and 200 ng/dL. Normally when T3 and T4 are low, more TSH is produced to stimulate the thyroid to make more hormones. In the case of hypothyroidism, T3 and T4 are low while TSH is high because the thyroid is abnormally inactive. When excess T3 and T4 are in the blood, they feedback to the pituitary gland to decrease the amount of TSH. If you have hyperthyroidism, T3 and T4 are elevated while TSH is low. This is because the thyroid is overproducing hormones by itself regardless of TSH level regulation. 

Thyroid antibodies like thyroglobulin (TG) antibodies can be measured in your blood to determine if you have an autoimmune condition like Graves’ disease or Hashimoto’s thyroiditis.

An imaging procedure like an ultrasound can also be used to view the thyroid gland. After applying a gel and probe to the area, high frequency sound waves are transmitted to show the size of the thyroid. If you are experiencing any of the symptoms or think your thyroid is swollen, you can simply check your thyroid in the comfort of your home. First, locate your thyroid that is above your collarbone or under your Adam’s apple. Then, drink a cup of water while tilting your head back. Look at your thyroid in the mirror as you swallow to see if you notice any lumps. If you notice any lumps, reach out to your doctor for further evaluation.

Thyroid Disease Treatments5,6

Treatments for thyroid disease have the common goal to either manage symptoms like lowering heart rate or affect the amount of hormones based on hormone levels. Hypothyroidism, Hashimoto’s thyroiditis, and the hypothyroid phase of thyroiditis are mainly treated with levothyroxine, a chemical thyroid hormone to restore your low T3 and T4 levels. If you prefer more natural treatments, medications with pig thyroid gland extracts are available. Furthermore, some dietary supplements you may already be taking like omega-3 fatty acids, zinc glycinate, Withania somnifera, tyrosine, selenium, and vitamins A, D, and E can assist with having a balanced thyroid.

Hyperthyroidism is treated with medications to stop excess thyroid hormone production. Since radioactive iodine can damage your thyroid, leading to hypothyroidism, it can surprisingly be used to treat hyperthyroidism. A more irreversible option to decrease hormone production includes a thyroidectomy or removal of the thyroid, but this requires lifelong thyroid hormone treatment. Since the thyrotoxic phase of thyroiditis is typically short-lived, medications to manage symptoms like rapid heart rate, anxiety, sweating, and inflammation are used.

These conditions are treatable, but therapy is likely lifelong and may change based on your thyroid hormone levels and symptoms. By following an appropriate treatment plan, you will be able to live a normal, healthy life with a controlled thyroid. 

Thyroid Disease Complications5,6

By not taking your medication as prescribed or left untreated, you are at risk for serious complications. If hypothyroidism is not treated, your metabolism slows down and puts you at risk for myxedema coma. This is a medical emergency and can leave you with hypothermia and altered mental status. If hyperthyroidism is not treated, your metabolism is overactive and could lead to thyroid storm. Because of excess thyroid hormones without regulation to keep levels within a normal range, your heart rate, blood pressure, and temperature increases to risky levels. Thyroid storm can lead to fever, psychosis, delirium, and dehydration. 

For more information and support, visit the American Thyroid Association (ATA) and Centers for Disease Control and Prevention (CDC) websites or talk with your doctor or pharmacist today. 


  1. Thyroid cancer. Centers for Disease Control and Prevention website. Accessed July 26, 2021.
  2. Thyroid disease. Cleveland Clinic website. Accessed July 26, 2021.
  3. Hypothyroidism (underactive thyroid). Mayo Clinic website. Accessed July 26, 2021.
  4. Picture of the thyroid. WebMD website. Accessed July 26, 2021.
  5. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid. 2014; 24(12): 1670-1751.
  6. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016; 26(10): 1343-1421. 

Don’t Let Your Life Go Up In Smoke: Ways to Quit Smoking

Smoking is still the leading cause of preventable diseases and death in the United States, killing more than 480,000 Americans each year. The United States spends more than $300 billion on smoking related illnesses. These illnesses include lung cancer, coronary heart disease, stroke, diabetes, chronic obstructive pulmonary disease (COPD) and many more, leading to a decreased life expectancy of approximately 13 years for these people. Secondhand smoke also kills about 41,000 Americans, as well as 400 infants each year.1 Despite these unfortunate statistics, there are plenty of methods to quit smoking and improve overall health.

Nicotine has been proven to be an addictive chemical, which makes quitting so difficult. This is why there are so many methods and supporting resources available to help smokers quit. The first step in quitting is to pick and commit to a quit date. This part seems simple but is very important to the entire process. If a person cannot commit to a quit date, life will continue to happen and quitting will continue to be delayed. When picking a quit date it is important to give yourself plenty of time to prepare, so you can be fully committed to your plan. If you are having difficulty picking a quit date, click here for a resource to help get started. It is also important to know why you are quitting. Smoking can cause life threatening diseases like lung cancer, stroke, diabetes and much more. It can also harm others around and take time away from you and your family. There are multiple reasons to quit smoking, but finding the ones that hit home for you are great to hold on to. Learning how to handle triggers is also an important step in the process of quitting. Making a list of things to distract you from these cravings, like putting a puzzle together or taking a walk, are great ways to reduce the urge to smoke. Quitting can also save you a bunch of money over time. It may not seem like much at the time when you buy cigarettes, but a one pack per day smoker can save approximately $2,200 annually.1 Finally, it’s vital that you tell your friends and family that you are quitting. Do not be afraid to ask for help either. If you explain the reasons why you want to quit, your family will understand better and want to help any way they can. Support is a key aspect to the process of quitting, so involving loved ones will only help. 

Along with all of the preparation done to quit smoking, there are also nicotine replacement therapies (NRT) to help patients stop smoking. These options try to replace the nicotine from cigarettes with other forms of nicotine delivery and help slowly reduce the amount of nicotine that enters the body every day.

Nicotine Replacement Therapies

Nicotine Patch

A nicotine patch is an adhesive bandage that attaches to the skin and delivers small, constant amounts of nicotine to your bloodstream. This method mimics the feeling of smoking a cigarette, so you do not feel withdrawal symptoms, but allows your body to get accustomed to less nicotine per day. The first step in choosing your nicotine patch is figuring out what strength should be used. If you smoke more than 10 cigarettes per day, you start with the highest strength patch or “step 1”  which is 21mg. The total duration of therapy is 10 weeks but the 21mg patch will be worn for 6 weeks. If these 6 weeks are successful, you will wear a 14mg patch for 2 more weeks after that. Finally, a 7mg patch will be worn for the remaining 2 weeks of therapy. If you smoke 10 or less cigarettes per day, your therapy will be a little different. The total duration will only be 8 weeks and begins with the 14mg patch for 6 weeks and finishes with the 7mg for the remaining 2 weeks. The patches can be worn for up to 24 hours at a time but if you have trouble sleeping at night, it can be removed before bedtime.2 This is a great method if you want to be able to slap something on every morning and not have to worry about it the rest of the day. It is also a discreet product because it can be worn in multiple places on the body that can easily be hidden with clothes. It is also easier to use for many people because they do not have to think about when to use it like other products. 

Nicotine Gum

Nicotine gum is another nicotine replacement therapy that mimics the effects of smoking cigarettes. The gum is dosed based on when the first cigarette of the day is. If you smoke your first cigarette within 30 minutes of waking up, you will need the 4 mg pieces of nicotine gum. If your first cigarette is after 30 minutes of waking up, you will need the 2 mg pieces of nicotine gum. The gum needs to be chewed using the “chew and park” method. This method is when you chew gum for about a minute or until you feel a tingling sensation in your mouth, then park the gum in the side of your mouth between your teeth and cheek until the tingling sensation goes away. Once the tingling goes away, you will begin chewing again. Repeat this process for about 30 minutes and then throw the gum away. Do not eat or drink 15 minutes before or while chewing the gum. The duration of this treatment is 12 weeks with the first 6 weeks allowing 1 piece of gum every 1 to 2 hours as needed, the next three weeks allowing 1 piece of gum every 2 to 4 hours, and the final three weeks allowing 1 piece of gum every 4 to 8 hours.3 Nicotine gum is a great choice of therapy if someone needs to keep their mouth active because they are used to smoking cigarettes. It may not be a great choice if you have dental problems or difficulty chewing but if this is not an issue, nicotine gum can be a great way to alleviate the cravings by simply chewing some gum. 

Nicotine Lozenge

The final nicotine replacement therapy is nicotine lozenges. The lozenges are dosed based on the first cigarette of the day exactly like the nicotine gum with the strengths being 2 and 4 mg. The duration of treatment is also 12 weeks and each treatment interval is the same as the gum. The maximum lozenges to be used in a day is 20 or no more than 5 within 6 hours. Like the nicotine gum, there is a technique that needs to be used to ensure you are using the lozenges correctly. This technique is called the “roll technique”. To do this, a lozenge is put in the mouth between the gum and cheek and simply rolled around for about 20 minutes so it can completely dissolve. The lozenge should not be chewed, swallowed or sucked on because this can alter the rate at which the body is absorbing the nicotine. Do not use the lozenge while eating or within 15 minutes of drinking coffee, fruit juice, beer or soft drinks.4 Like the gum, lozenges are a great option to eliminate cravings while still being discreet in the process. Many people say the lozenges taste better than the gum as well and it is not as big of a burden on the mouth.

While all of these options are proven to support people in the process of quitting smoking, they do come with some adverse effects. The patches have been known to cause some shoulder or arm pain and itching. The gum can cause some sore throat, hiccups and itching. The lozenge can cause mouth irritation, nausea and heartburn. While side effects are expected but not necessarily ideal, the long term benefits of quitting smoking will definitely be worth it in the long run. The patient should NOT smoke while on any of these therapies due to the risk of nicotine overdose. You and your doctor or pharmacist can weigh the risks and benefits of each option to help pick the correct nicotine replacement therapy for you.

Along with nicotine replacement therapies, there are medication therapies as well. Varenicline and Bupropion are both proven therapies to aid in the process of quitting. Each therapy is unique and has its pros and cons just like the patch, gum and lozenges. 

Medication Therapies

Varenicline (Chantix)

Varenicline, better known by its brand name Chantix, is a non-nicotinic medication that works by mimicking the effect of nicotine in the brain. Chantix is dosed over a 12 week period with the patient getting 0.5 mg daily on days 1 to 3 and 0.5 mg twice daily on days 4 to 7. The maintenance dose of 0.5 mg twice daily is then continued for 11 weeks. Smoking should be decreased by 50% every 4 weeks with total abstinence by week 12. Some common adverse effects include nausea, abnormal dreams, headache, irritability, suicidal ideation and depression. One differentiator of Chantix that many patients enjoy is the fact they do not have to quit smoking “cold turkey” on their quit date like other therapies.5 As long as the patient has enough willpower to slowly taper off smoking while on Chantix, this can be a great choice of therapy. 

Bupropion SR (Zyban)

Bupropion sustained release (Zyban) is a non-nicotine medication that was originally indicated for the treatment of depression but now has an off-label use for the treatment of tobacco dependence. Bupropion is dosed over a 12 week period with 150 mg given once daily, initially, for 3 days, then increased to 150 mg twice daily based on response and tolerability. Therapy should begin at least 1 week before the scheduled quit date to ensure the medication has time to begin working. Bupropion can cause some nausea, vomiting, weight loss, increased heart rate, constipation and dry mouth. A benefit of this medication is that it can be used in combination with a nicotine replacement therapy which has shown increased efficacy when compared to nicotine replacement therapy alone.6

All of these are effective and proven options to help quit smoking. Each method has its pros and cons but the key is picking the right one for you. An attempt to quit smoking is a step in the right direction and can change your life forever. Don’t be afraid to reach out to your doctor or a pharmacist here at Josefs Pharmacy for more information on quitting or to help you get started. 


  1. Centers for Disease Control and Prevention. (2021, April 7). Burden of Cigarette Use in the U.S. Centers for Disease Control and Prevention.
  2. 2021. Nicotine Patch Package Insert. [online] Available at: <> [Accessed 23 May 2021].
  3. 2021. Nicorette Gum Labeling. [online] Available at: <> [Accessed 23 May 2021].
  4. 2021. Nicorette Lozenge Labeling. [online] Available at: <> [Accessed 23 May 2021].
  5. 2021. Varenicline. [online] Available at: <> [Accessed 23 May 2021]. 2021. Bupropion. [online] Available at: <> [Accessed 23 May 2021].

The Latest on Vitamin D: It’s Not Just for Your Bones!

Over the last year, so much focus has been placed on not getting sick and staying healthy.  We all know that eating well, getting enough sleep, and washing our hands are some of the keys to keeping ourselves healthy.  Part of the reason these elements work is because they affect our immune system.  There are so many factors that go into keeping our immune system functioning properly.  One factor that many may not know about, is maintaining adequate levels of vitamin D.  Vitamin D is most known for helping with bone health but like most nutrients, it has so many other roles.

First, let’s take a quick look at how the immune system works.  Our immune system is divided into two different parts.  The first part of the immune system is innate immunity, also called nonspecific immunity.  You are born with the innate immune system.  This system includes our natural barriers like our skin, mucus in our airways, the cough reflex, tears, and stomach acid. The innate immune system also includes certain types of white blood cells called neutrophils, macrophages, and natural killer cells, along with chemicals produced by our bodies called complement.  All these components are just waiting for pathogens, or germs, to try and enter the body to cause harm. Once these intruders enter, the innate immune system springs into action and tries to kill them.  The second part of the immune system is adaptive immunity, also called acquired immunity.  This system develops over time and responds to specific pathogens.  Adaptive immunity involves a type of white blood cell called lymphocytes.  It is these cells that produce antibodies to help fight infections.  Lymphocytes develop memory, so that if the body ever encounters the same germ it can quickly respond to prevent infection.  This is the idea behind vaccines!  Vaccines act like a “germ” to make your immune system develop a memory of what the germ looks like.1  

So, how does vitamin D fit into all of this?  Vitamin D is involved in both the innate and adaptive immune systems.  The functions of vitamin D in the immune system are:

  • Promoting a healthy environment in the intestines and preventing overgrowth of bad bacteria
  • Promoting skin integrity 
  • Regulating the immune response
    • Enhances the antimicrobial properties of white blood cells, like neutrophils and macrophages
    • Decreases inflammation throughout the body2,3

Lack of vitamin D has been linked to autoimmune diseases like rheumatoid arthritis, psoriasis, multiple sclerosis, irritable bowel syndrome, and type-1 diabetes.  Our immune system walks a fine line between causing enough inflammation to protect us from infections and allowing inflammation to get out of control.  When the inflammation gets out of control, damage and autoimmune diseases can occur.  As stated above, vitamin D helps control the inflammation caused by our immune system.  Maintaining adequate levels of vitamin D can also help with controlling these autoimmune diseases and vitamin D supplements are often used as part of a treatment plan.  While data is limited, maintaining appropriate levels of vitamin D is a good idea for everyone since it plays a role in so many aspects of the body functioning properly.2,3

Studies have shown that maintaining adequate vitamin D levels can also help fight off respiratory infections.  One study showed that those who took vitamin D supplements were about 40% less likely to get the flu than those who did not take vitamin D.  There has also been some evidence that adequate vitamin D levels can help with COVID-19 infections, as well.  While taking vitamin D is not a fool proof method to prevent getting sick, it can certainly help keep your immune system in top shape to fight off infections.  Remember, your body is all about balance and it needs the correct building blocks to perform at its best.4

Now that we know how important vitamin D is to our body, how do we make sure we are getting enough?  One source of vitamin D is sunlight.  Vitamin D is formed in your skin when exposed to the sun.  Unfortunately, the amount of vitamin D absorbed from the skin is variable and excessive sun exposure can increase your risk of skin cancer. We can’t rely only on sunlight to get the amount of vitamin D we need.  Vitamin D is also naturally found in some foods.  These foods include salmon, swordfish, tuna, cod liver oil, sardines, and beef liver.  Many foods, like milk, cereals, and orange juice are fortified with extra vitamin D.  It is hard to get adequate amounts of vitamin D from food alone.  Thankfully, vitamin D supplements are very common and easy to find in any pharmacy or grocery store.  When looking at vitamin D supplements, you will notice that the amount is listed in “IU” or international units. The recommended amount of vitamin D you need daily depends on your age.  For adults aged 19 to 70 years old, it is recommended that you get 600 IU daily. If you are over 70 years old, then it is recommended you get 800 IU daily.  The maximum amount anyone should consume daily is 4,000 units.  One easy way to get enough vitamin D is to take a daily multivitamin.  By taking a multivitamin you are also ensuring that you are getting other needed vitamins and minerals as well!  You can also take supplements that contain only vitamin D or vitamin D and calcium.  Many people take these when they need extra support for bone health.  It is important to talk with your provider about any supplement you take, just to make sure nothing interacts with the medications you are taking.  Also, your doctor may want to check your vitamin D level and if your levels are really low, they may recommend a higher dose to get your levels back up to normal.5  

At the end of the day, the most important thing to remember is that your body is an amazing and complex system that needs the proper building blocks to perform at its best.  So, now go out and get yourself a good multivitamin and help your body do what it was made to do!


  1. Immune response: MedlinePlus Medical Encyclopedia [Internet]. 2021 Feb 26 [cited 2021 Mar 21]. Available from:
  2. Aranow C. Vitamin D and the Immune System. J Investig Med. [Internet] 2001 Aug [cited 2021 Mar 21]; 59(6): 881–886.  Available from:
  3. Charoenngam N, Holick M. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020 Jul 15;12(7):2097. 
  4. Siska, Gunda. Vitamin D Helps the Immune System During Cold and Flu Season: The Pharmacy Times [Internet]. 2019 Sep 20 [cited 2021 Mar 21]. Available from:
  5. Vitamin D: The Nutrition Source [Internet] 2021 [cited 2021 Mar 21].  Available from:

Eat, Sleep, and Be Healthy: Nutrition Basics that Everyone Should Know

Have you ever heard the saying “you are what you eat?” We can take pills all day, however medications often are a quick fix if we are not fueling our bodies properly. Eating healthy can promote weight loss, improve brain function, prevent medical conditions, like heart disease and diabetes, and boost mood or energy level. Nutrition is a key part of our health but getting enough sleep, exercising daily, and drinking plenty of water play an important role as well. 

Let’s take a look at some lifestyle changes you can make to improve your overall health. 

Macronutrients and Micronutrients 

There are two categories of nutrients: macronutrients and micronutrients. Macronutrients include carbohydrates, proteins, and fats. Micronutrients include vitamins and minerals. The body needs larger amounts of macronutrients and smaller amounts of micronutrients to work properly.1 

Carbohydrates, or carbs, are broken down into glucose (sugar) during digestion, providing the fuel your body and brain need to function. We know that foods high in starch contain a lot of carbohydrates, such as potatoes, pasta, and bread, but we often forget that fruit and dairy contain carbs.1 About 45 to 65% of your daily calories should come from carbohydrates. Every 1 gram of carbohydrate equals 4 calories.2 

Proteins build and repair body tissues, help carry out bodily functions, transport nutrients, and keep your immune system strong. Protein-rich foods include legumes (beans, peas, lentils), nuts, whole grains, and lean meats. The amount of protein recommended daily depends on how active you are. Individuals that are sedentary or get very little exercise, need less protein than an athlete or bodybuilder.1 Every 1 gram of protein equals 4 calories.2 

Fats often get the reputation of being “bad” but fat provides your body with energy and transports fat-soluble vitamins. “Good” fats are unsaturated or loosely packed and are mostly liquid at room temperature. Unsaturated fats may help decrease inflammation and lower your risk for cardiovascular disease. Foods high in unsaturated fats include fatty fish, olive oil, avocados, and walnuts. “Bad” fats are trans fats and saturated fats. Saturated fats are tightly packed and are mostly solid at room temperature. These fats may increase bad cholesterol and your risk for heart disease. Foods high in trans and saturated fat include processed foods, red meat, butter, cheese, and coconut oil.3 About 20 to 35% of your daily calories should come from fat. Every 1 gram of fat equals 9 calories.2 

Portion Distortion 

Over the last 40 years, the size of portions have drastically increased, creating a culture of “portion distortion.” For example, a regular soda, 20 years ago, was 6.5 ounces and 85 calories versus 20 ounces and 610 calories today. Supersized portions are now considered the norm. When preparing meals, it is important to consider serving sizes, as stated on food labels. One helping or plateful does not always equal one serving size.4

Controlling portion sizes is only a hand away!5 

  • 3 ounces of meat, fish, or poultry = palm of hand 
  • 1 ounces of meat or cheese = thumb 
  • 1 cup or 1 medium fruit = fist 
  • 1 to 2 ounces of nuts or pretzels = cupped hand 
  • 1 tablespoon = thumb tip (tip to first joint) 
  • 1 teaspoon = fingertip (tip to first joint) 

The Plate Method

One strategy to control portion sizes is the plate method. Using a 9-inch dinner plate, draw a “T” with the top starting half-way down the plate. Fill half of the plate with non-starchy vegetables, including salad greens, broccoli, or brussel sprouts. Fill one-quarter with lean protein such as chicken, turkey, fish, or eggs. The last quarter should include grains or starches, including potatoes, pasta, or rice. If you do not want to include grains or starches, double your serving of non-starchy vegetables.6

Basal Metabolic Rate and Total Daily Energy Expenditure

Basal metabolic rate (BMR) is the amount of calories your body needs to carry out basic activities such as breathing, digestion, and brain function. To calculate BMR, online calculators can be used that factor in sex, age, height, and weight. 

A common question is, “If I eat fewer calories than required by my BMR, will I lose weight?” It is important to remember that BMR is what your body needs to simply function. It does not take into account the calories needed to walk, talk, work, or exercise. If using your BMR as a guide for weight loss, you need to also calculate your total daily energy expenditure (TDEE). TDEE is the total of your BMR multiplied by an activity level factor. In order to lose weight, you need to consume fewer calories than your TDEE. A safe way to calorie restrict, is reduce intake by about 200 calories per day for a week or two, then adjust accordingly.7 

Activity LevelTDEE
Sedentary: little or no exercise; desk jobTDEE = 1.2 x BMR 
Lightly active: light exercise; sports 1-3 days per weekTDEE = 1.375 x BMR 
Moderately active: moderate exercise; sports 3-5 days per weekTDEE = 1.55 x BMR 
Very active: heavy exercise; sports 6-7 days per weekTDEE = 1.725 x BMR 
Extremely active: very heavy exercise; physical job; training twice daily TDEE = 1.9 x BMR 

Reasonable Weight Loss Goals per Week 

If you have ever tried to lose weight, you know how difficult and slow of a process it may be. It’s human nature to want immediate results, however studies have shown that individuals who lose weight steadily (1 to 2 pounds per week) are more successful at maintaining their weight loss. 

In order to lose one pound per week, you should consume 500 fewer calories per day or 3,500 fewer calories per week.8 


The American Heart Association (AHA) recommends that adults get at least 150 minutes of moderate-intensity aerobic activity per week, with 2 days of muscle-strengthening activities, such as resistance or weights. This includes exercises such as brisk walking, riding a bike, hiking, or pushing a lawn mower. If you’re doing moderate-intensity activity, you should be able to talk but not sing.9  


Drinking plenty of water each day is important, since the human body is 60% water and our blood is 90% water. Water keeps our blood the right thickness to carry oxygen and nutrients throughout the body, as well as regulates bowel movements, prevents skin wrinkles, boosts energy levels and controls hunger. A good rule of thumb to follow is the “8 x 8 Rule.” You should drink at least 8 ounces of water 8 times each day. Individuals that are active, in warmer climates, have a faster metabolism, or weigh more may need more water throughout the day.10 


Sleep and nutrition work side by side. Healthy dietary choices can help you fall asleep faster and stay asleep longer, while research has shown that individuals lacking sleep, tend to consume foods high in sugar, fat, and calories. Who hasn’t binged on chips, candy, and soda during a late night? Adults need at least 7 to 9 hours of sleep per night. Sleep helps clear waste that has built up in your brain during the day, allowing you to wake with a fresh mind. Long-term sleep deprivation has also been linked to certain medical conditions including obesity, type 2 diabetes, heart disease, and poor mental health.11 Quality sleep starts with healthy sleep habits or good sleep hygiene. Tips for good sleep hygiene are: 

  • Establish a schedule for going to bed and waking up each day, including the weekends 
  • Exercise regularly 
  • Avoid using electronic devices within 60 minutes of bedtime
  • Limit naps to once daily between 10 am to 2 pm for 30 minutes or less 
  • If you cannot fall asleep, leave bed until you are tired 
  • Avoid alcohol, caffeine, and tobacco after lunchtime 

There are many great resources online that can help you in your journey! Here are some of our favorites: 


  1. Nutrition Basics [Internet]. Pullman (WA): Washington State University; [cited 2021 Marc 22]. Available from:
  2. Mawer R. Healthy Eating – A Detailed Guide for Beginners [Internet]. Healthline Media; 2016 July 5 [cited 2021 Mar 22]. Available from:
  3. Pietrangelo A. What’s the Difference Between Saturated and Unsaturated Fat? [Internet]. Healthline Media; 2019 Dec 11 [cited 2021 Mar 22]. Available from:
  4. Scinta W. The History of Portion Sizes: How They’ve Changed Over Time [Internet]. Tampa (FL): Obesity Action Coalition; 2016 Apr 28 [cited 2021 Mar 22]. Available from:
  5. What is a Serving [Internet]. Dallas (TX): American Heart Association; 2017 Jun 30 [cited 2021 Mar 22]. Available from:
  6. Diabetes Meal Planning [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [cited 2021 Mar 22]. Available from:
  7. How to Use BMR to Hack Your Diet [Internet]. InBody; 2018 Mar 15 [cited 2021 Mar 22]. Available from:
  8. Healthy Weight, Nutrition, and Physical Activity: What is healthy weight loss? [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [cited 2021 Mar 22]. Available from:
  9. Measuring Physical Activity Intensity [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [cited 2021 Mar 22]. Available from:
  10. How Much Water Do you Need Daily? [Internet]. Cleveland Clinic: HealthEssentials; 2020 Aug 6 [cited 2021 Mar 22]. Available from:
  11. Foley L. Why Do We Need Sleep? [Internet]. Sleep Foundation; 2020 Sep 11 [cited 2021 Mar 22]. Available from:

Seven Ways to Help Strengthen your Immune System

  1. Get enough sleep

Sleep and immunity are closely related. Inadequate or poor-quality sleep is linked to a higher susceptibility to illness. Adults need seven to eight hours of sleep each night.

Having good sleep hygiene is important to ensuring a good quality sleep.

  • Set a sleep schedule and follow a nightly routine.
  • Turn off the lights.
  • Limit noise and distractions. Turn off your phone or put it on “Do Not Disturb.”
  • Limit the use of your phone for the 2 hours before you plan to go to bed. Your phone emits a blue light that tells your body to suppress melatonin. Melatonin is an important sleep hormone that helps your body regulate its sleep patterns. See if you phone has a nighttime color setting to decrease the blue light emissions.
  • Set a cool yet comfortable temperature. The ideal bedroom temperature is between 66F and 68F

Still having issues falling asleep? Consider these supplements to help you fall asleep.

  • Best Rest
    • Take one to two capsules 30 to 60 minutes before bedtime
  • Supports a healthy sleep cycle by encouraging an easy transition to sleep and a restful night’s sleep
    • This supplement contains passionflower, chamomile, lemon balm and hops which have been clinically shown to naturally calm and relax the central nervous system
  • Melatonin
    • Take one capsule 30 to 60 minutes before bedtime
  • Melatonin is a naturally occurring hormone that helps promote sleep. This sustained release formulation releases melatonin gradually to help promote extended sleep support
  • Eat a healthy and balanced diet

Healthy foods help provide your body with the vitamins, nutrients, and minerals it needs to stay strong.  Eating high quality whole foods like whole grains, nuts, and fresh fruits and vegetables helps nourish your body. These foods are high in antioxidants and nutrients like vitamin C which may help in preventing the common cold. Healthy fats like olive oil and the omega-3 found in salmon also help your body by supporting heart health and reducing inflammation that can suppress your immune system.

Interested in boosting your immune system further? Try these supplements:

  • O.N.E. Omega
    • Take one capsule daily with a meal
    • A powerful omega-3 fatty acid formula for cardiovascular, joint, skin and cognitive health
  • Vitamin C
    • Take one tablet 1-2 times daily
  • Vitamin C offers broad physiological support, including musculoskeletal, cardiovascular, neurocognitive, cellular, and immune health
    • One tablet contains the same amount of vitamin C found in eight oranges
  • Exercise Regularly

 Moderate exercise can give your immune system the boost it needs to stay healthy. Being active is also associated with many physical and mental health benefits.

Aim for 150 minutes of moderate exercise weekly or about 30 minutes daily five days a week. Moderate exercise includes brisk walking/jogging, bicycling, and swimming.

  • Stay Hydrated

Hydration may not protect you from germs and viruses directly like washing your hands or using hand sanitizer but it is very important in overall health. Dehydration can affect your mood, digestion as well as heart and kidney function. When you are dehydrated these systems do not work well and therefore lower your bodies ability to fight infection. It is recommended that you drink 64oz or ½ a gallon of water daily.

  • Minimize Stress

Long-term stress is harmful to the immune system where short-term stress can be productive as it prepares your body to deal with challenges. However, finding the balance can sometimes be difficult. A few signs that you maybe more stressed than you realize are, hitting a wall in the afternoon, afternoon sugar cravings, feeling tired immediately upon waking, weight gain without a change in eating or exercise habits, a short temper, or dull emotions. (For more information on stress, check out our Adrenal blog) Finding ways to manage your stress is the key to good immune health. Ways to manage stress include meditation, exercise, yoga, adequate sleep, and mindfulness. If your stress is unmanageable, talk to your doctor, pharmacist, counselor, or therapist.

Still struggling with stress? Consider this supplement:

  • Energy Xtra
    • One capsule once daily
    • Contains herbal blends to help promote energy, enhance stamina and help the body adapt and cope with occasional stress
  • Don’t Smoke

Smoking, including vaping harms the overall immune system and can make it more difficult for your body to fight off infections.

  • Supplement Appropriately

There is no FDA approved evidence to support the use of any supplements to treat or prevent COVID-19. However, studies do indicate that some supplements may help boost your bodies general immunity. Have more questions about supplements? Contact us and we will be happy to review your medications and make supplement recommendations.

  • Vitamin D
    • Do not begin a Vitamin D supplement greater than 2,000 IU daily without first consulting a health care provider.
    • Take one capsule once daily
    • Vitamin D naturally supports calcium absorption and retention within the bones to promote optimal bone health
    • Vitamin D also has shown evidence of enhancing immunity.
  • Zinc
    • Take one capsule once daily with a meal
    • Zinc is designed to support your bodies natural defense system as well as enhance digestion and metabolism of important vitamins, minerals, carbohydrates, and other essential nutrients
  • O.N.E Multivitamin
    • Take one capsule once daily with a meal
    • Provides vitamins, minerals, and other essential nutrients to provide a comprehensive once-daily multivitamin.
  • B Complex
    • Take one capsule 1-2 times daily
    • Offers a comprehensive blend of B vitamins designed to support cellular, cardiovascular, neurological, and psychological health


  1. Sleep & Immunity: Can a lack of sleep make you sick? (2020, November 19). Retrieved February 19, 2021, from
  2. What is sleep hygiene? (2020, August 14). Retrieved February 19, 2021, from
  3. Daily nutritional supplements: Pure encapsulations®. (n.d.). Retrieved February 19, 2021, from
  4. E;, H. (n.d.). Vitamin C for preventing and treating the common cold. Retrieved February 19, 2021, from
  5. R;, S. (n.d.). Exercise and the regulation of immune functions. Retrieved February 19, 2021, from
  6. Nieman, D., Henson, D., Austin, M., & Sha, W. (2011, September 01). Upper respiratory tract infection is reduced in physically fit and active adults. Retrieved February 19, 2021, from
  7. Popkin, B., D’Anci, K., & Rosenberg, I. (2010, August). Water, hydration, and health. Retrieved February 19, 2021, from
  8. FS;, D. (n.d.). Effects of stress on immune function: The good, the bad, and the beautiful. Retrieved February 19, 2021, from
  9. Smoking and Overall Health. (n.d.). Retrieved February 19, 2021, from
  10. In the News: Coronavirus and “alternative” treatments. (n.d.). Retrieved February 19, 2021, from
  11. Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881-886. doi:10.2310/JIM.0b013e31821b8755

Everything You Need to Know about COVID-19 Vaccines

For the past year, we have been faced with unprecedented times caused by the COVID-19 pandemic. As of December 2020, we are starting to see the light at the end of the tunnel as vaccines become available.

What are mRNA vaccines?

Traditional vaccines work by using a weakened/inactivate portion of the virus to help our body develop immunity. The COVID-19 mRNA (messenger ribonucleic acid) vaccines contain instructions on how to make a harmless “spike protein” that are unique to the COVID-19 virus.  Our bodies then recognize the protein should not be there and build antibodies that remember how to fight the virus if we become infected with it in the future. 

Will the COVID-19 vaccine alter my DNA?

No. The COVID-19 vaccine is a mRNA vaccine that does not change or interact with your DNA in any way.

What vaccines are available?

There are currently two COVID-19 vaccines (Pfizer and Moderna) that have been approved by the Food and Drug Administration (FDA). There are 3 other vaccines (AstraZeneca, Janssen, Novavax) currently undergoing Phase 3 clinical trials that could become available once they receive FDA approval.

How many doses of the vaccine do I have to get?

Both Pfizer and Moderna vaccines require two doses spaced 21-28 days apart.

Can I get the COVID-19 vaccine if I have had COVID-19?

The CDC recommends that people who have had COVID-19 still get the COVID-19 vaccine. Since re-infection with COVID-19 is possible, getting the vaccine can still help protect you. However, you should not receive the vaccine if you have a current infection with COVID-19, you should wait until you are no longer symptomatic before receiving the vaccine.

Is the COVID-19 vaccine safe?

The FDA, Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices have all been actively involved in the vaccine evaluation process and have deemed the two current COVID-19 vaccines safe.

Can the COVID-19 vaccine make me sick with COVID-19?

No. None of the COVID-19 vaccines contain the live virus that cause COVID-19.

If I get the COVID-19 Vaccine, will I test positive for COVID-19 on a viral test?

No. None of the vaccines currently available for COVID-19 cause you to test positive on a viral test. Getting the vaccine allows your body to develop antibodies against COVID-19 so it is possible to test positive on an antibody test.

How long will the vaccine protect me?

At this time, it is unknown how long protection from the vaccine or from having COVID-19 (natural immunity) will last. More research is needed to know how long the immunity from the COVID-19 vaccine or natural immunity lasts and if a booster dose will be required.

What are the benefits of getting vaccinated?

Both vaccines currently available have shown approximately 95% efficacy 7-14 days after the second dose of the vaccine is received.

Can I get other vaccines along with my COVID-19 vaccine?

The CDC recommends that you do not receive any other vaccines within 14 days of the COVID-19 vaccine.

If I get the COVID-19 vaccine, do I still have to wear a mask?

Yes. Both vaccines currently available are 95% effective meaning that 1 out of every 20 people who have received the vaccine may not have full protection from the vaccine. It is also unknown if you could still be a carrier (have no symptoms) and spread the virus after vaccination. This is why until we know more, you should continue to wear masks and social distance.

How is the vaccine being distributed in North Carolina?

In North Carolina, vaccine distribution is being completed in groups. Availability of the vaccine worldwide is limited, so please be patient. Everyone who wants a vaccine will be able to receive a vaccine, it is just going to take time to get everyone vaccinated since demand is currently higher than the supply.  

  • Group 1
    • Health care workers
    • Long-term care staff and residents
  • Group 2
    • Older adults (65+)
  • Group 3
    • Frontline Essential Workers
      • First responders (firefighters and police officers), correction officers, food and agricultural workers, U.S. postal service workers, manufacturing workers, grocery store workers, public transit workers, and those in the education sector (teachers, support staff and childcare workers)
  • Group 4
    • Adults at high risk for exposure and increased risk of severe illness
      • Anyone 16-64 with high-risk medical conditions that increase the risk of severe disease from COVID-19
      • Anyone incarcerated or living in other close group living situations
      • Essential workers not yet vaccinated
        • Workers in transportation and logistics, water and wastewater, food service, shelter and housing (construction), finance (bank tellers), information technology and communications, energy, legal, media, public safety and public health workers
  • Group 5
    • All persons 16 and older

What should you do while you’re waiting for the COVID-19 vaccine?

Continue to wear your mask over your nose and mouth, social distance at least 6 feet from others that do not live in your household whenever possible, wash your hands often and stay home if you are sick.

What should I expect once I get the vaccine?

The most common side effect from the vaccine is arm soreness/tenderness. Other symptoms include fatigue, low-grade fever, body aches and mild headaches that last one to three days. Side effects are seen more frequent after the second dose. These mild symptoms are your bodies way of telling you that your immune system is responding to the vaccine and producing antibodies to the COVID-19 virus. Meaning if your body sees the virus again it already has antibodies and knows how to respond, either preventing infection or making your infection less severe.


  1. COVID-19 vaccines. (n.d.). Retrieved February 19, 2021, from
  2. COVID-19 vaccine: What you need to know. (n.d.). Retrieved February 19, 2021, from
  3. Find your spot to take your shot. (n.d.). Retrieved February 19, 2021, from

Everything You Need to Know about COVID-19

What is the Coronavirus?

Coronavirus is a virus that attacks the respiratory tract and causes a flu-like illness. There are many different coronaviruses but the one we are going to focus on today is the 2019 novel coronavirus also known as SARS-CoV-2 or COVID-19. The abbreviated name (COVID-19) can be broken down into its individual parts; “CO” standing for Corona, “VI” standing for virus and “D” standing for disease. This new coronavirus was first identified in December of 2019 hence the “-19” and originated from Wuhan, China.

How does COVID-19 spread?

The coronavirus is a respiratory virus that is spread by droplets or through direct contact. The virus can be spread by people who have COVID-19 but are asymptomatic, meaning they have no symptoms.

What can you do to protect yourself?

Hand washing is one of the best ways to protect yourself from getting sick. Wash your hands with soap and water for at least 20 seconds often throughout the day especially after blowing your nose, coughing/sneezing, going to the bathroom and before eating or preparing food. If soap and water are not available, use an alcohol-based hand sanitizer. Another way to protect yourself and others is to stay home if you are sick. It is also important to cover your nose and mouth if you cough or sneeze. Wearing a mask that covers your nose and mouth in public settings when not around people that live in your household when social distancing is not attainable. Wearing a mask in public settings provides an extra layer of protection against respiratory droplets. Social distancing or staying at least six feet away from others is important since people can have no symptoms and still spread the virus.

What are the symptoms of COVID-19?

Symptoms may appear 2-14 days after an exposure to the virus

  • Cough
  • Fever or Chills
  • Shortness of breath or difficulty breathing
  • Muscle or body aches
  • Sore throat
  • New loss of taste or smell
  • Diarrhea
  • Headache
  • New fatigue
  • Nausea or vomiting

If you have trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake or bluish lips or face, seek emergency medical care immediately.

How is COVID-19 diagnosed?

Diagnosis can be difficult because in some cases COVID-19 may appear similar to the flu or other respiratory illnesses. A laboratory test (nasal swab) is used to confirm the diagnosis of COVID-19.

If you test positive for COVID-19, stay home, take care of yourself by staying hydrated and getting plenty of rest. Stay in contact with your doctor and be sure to seek emergency medical attention if you have trouble breathing or emergency warning signs. Stay away from others as much as possible and tell your close contacts that they may have been exposed to COVID-19. An infected person can spread COVID-19 starting 48 hours or 2 days before they become symptomatic or test positive.

If you test negative for COVID-19, you are probably not infected at the time your sample was collected. However, this does not mean that you will not get sick. You could test negative if the sample was collected early in your infection and then test positive later in your infection. If you develop symptoms later, you might need to be re-tested to determine if you are infected with the virus.

How is COVID-19 treated?

As of now, there is no specific treatments for COVID-19. People who become sick with COVID-19 are treated with supportive measures to treat the symptoms.

What should I do if I have had close contact with someone who has been diagnosed with COVID-19?

The best thing to do if you have been in contact with someone diagnosed with COVID-19 is to stay home for 14 days. Be alert for symptoms associated with COVID -19 and stay away from others whenever possible until your quarantine period is complete.

What individuals are at an increased risk for severe illness if infected with COVID-19?

Severe illness means that a person with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe.

  • Older adults
    • Anyone 65 years of age or older
    • The greatest risk is among those aged 85 and older
  • People of all ages with certain underlying medical conditions
    • Cancer
    • Chronic kidney disease
    • Chronic lung diseases
      • Chronic obstructive pulmonary disease (COPD)
      • Cystic fibrosis
      • Pulmonary fibrosis
    • Dementia
    • Down syndrome
    • Heart conditions
      • Heart failure
      • Coronary artery disease
      • Cardiomyopathies
      • Pulmonary hypertension
    • Immunocompromised (weakened immune system)
      • Solid organ transplant
      • Bone or blood transplant
      • HIV
      • Use of corticosteroids or other immune weakening drugs
    • Liver Disease
    • Moderate to severe asthma
    • Obesity and severe obesity
      • BMI >30kg/m2
    • Sickle cell disease
    • Smoking
    • Type 2 diabetes mellitus
  • Pregnant women

Is there anything I can do to decrease my risk of severe disease?

There are many ways to help strengthen your immune system. Read our blog on “Seven Ways to Help Strengthen your Immune System’ to give your immune system a boost.


  1. Coronavirus (covid-19) frequently asked questions. (n.d.). Retrieved February 19, 2021, from
  2. Sauer, L. (n.d.). What is Coronavirus? Retrieved February 19, 2021, from

Love Your Heart: All You Need to Know About Hypertension

It’s that time of year to raise awareness of how important it is to focus on heart health. Spread the word, motivating each other to make healthy lifestyle changes and prevent heart disease. Heart disease is the leading cause of death in the United States, so let’s fight this together!

What is hypertension?1

Hypertension is abnormally high blood pressure. Blood pressure is the force or pressure of the blood circulating against the walls of blood vessels, and is measured using two numbers. The top number is called the “systolic” pressure, which measures the force in the arteries each time your heart beats. The bottom number is called the “diastolic” pressure, measuring the pressure in the arteries between heart beats, when the heart is resting. Even though our blood pressure varies throughout the day, based on our activities, such as exercise or stress, it should not consistently remain high. A normal blood pressure level is less than 120/80 mmHg.

Types of Hypertension2,3,4

Essential hypertension

This type of hypertension is the most common, affecting about 95% of people with high blood pressure. A diagnosis of essential hypertension requires a high blood pressure reading on 3 or more doctor visits, without any known cause. People diagnosed with essential hypertension usually experience no symptoms, therefore it is important to keep scheduled check-up appointments and physicals.

Secondary hypertension

Secondary hypertension is caused by another medical condition or by an outside source. The most common cause is a defect in the arteries supplying blood to the kidneys. Other causes include obstructive sleep apnea, adrenal gland disorders, hormone imbalances, high salt diet, alcohol, and over-the-counter medications containing ibuprofen or pseudoephedrine. This type of hypertension can be controlled if the cause is found.  

Resistant hypertension

About 25% of people with hypertension have resistant hypertension. This occurs when a person is taking 3 or more blood pressure medications and still has high blood pressure. Resistant hypertension is most commonly seen in the elderly and obese patients.

Isolated systolic hypertension

This type of hypertension is most common among our 65 and older population. As people age, the elasticity in the arteries decrease, causing a rise in the systolic pressure, the top number. If the systolic pressure rises above 140 and the diastolic pressure remains below 90, this is isolated systolic hypertension. This increases the risk for heart disease.

Hypertensive Emergency

A hypertensive emergency is rare, but is considered a medical emergency that should be treated in a hospital. Hypertensive emergency occurs when your blood pressure rises extremely quickly > 180/120 mmHg. A person can experience organ damage that may be life threatening including brain damage, stroke, injury to the kidneys, and heart attack.

Symptoms of Hypertension1,2

Hypertension is considered the “silent killer” because there are typically no warning signs or symptoms associated with it. Some people with hypertension, however, have reported complaints of headaches, feeling tired or dizzy, and nose bleeds. It is very important to periodically check your blood pressure to help your doctor diagnose any health problems early. Additionally, because you cannot feel blood pressure, it is important to take your medications, as directed by your doctor, to prevent complications of hypertension. 

Diagnosing Hypertension3

Diagnosing hypertension should be based on an average of at least two readings, on two separate occasions. Checking blood pressure levels at home, using an automated monitoring device or blood pressure cuff, is preferred. Sometimes blood pressure readings at a doctor’s office tend to be higher. This is known as “white coat syndrome.” This can lead to inaccurate clinical decisions related to needed treatments. 

Risk Factors for Hypertension1,2,3,5,8

  1. Elevated blood pressure (SBP 120-129 mmHg and DBP <80 mmHg) – Hypertension usually develops over time. A borderline high blood pressure, left untreated, could develop into hypertension or chronic high blood pressure.
  2. Obesity (BMI > 30kg/m2) – Research has shown a direct relationship between obesity and high blood pressure and is responsible for 40 to 78% of hypertension diagnoses. When a person is overweight, the heart has to work harder to pump blood throughout the body. This puts more strain on the arteries, causing blood pressure to increase. 
    1. Smoking – Smoking can damage the heart and blood vessels throughout the body. Smoking produces a gas called carbon monoxide. When this gas is inhaled, it reduces the amount of oxygen that the blood can carry. Additionally, nicotine, found in cigarettes,  narrows blood vessels, increasing blood pressure. 
  3. Alcohol – Drinking too much alcohol can increase blood pressure because alcohol causes the body to release proteins and hormones into the bloodstream that make blood vessels constrict or get narrower. When blood vessels constrict, normal blood flow is prevented, which increases blood pressure.

Know the limits:

  • Women = no more than 1 drink per day     
  • Men = no more than 2 drinks per day
  1. Diet – It is important to eat a well-balanced diet that is not too high in sodium (salt) and not too low in potassium. Foods that are high in sodium (canned or boxed foods and restaurant foods) can increase blood pressure. Not eating enough potassium in meals can also cause high blood pressure. Potassium is an electrolyte that our body needs to function properly, especially our heart. Some healthy foods that contain potassium include sweet potatoes, beets, beans, and bananas.
  2. Heredity – Of course, we cannot change our past, but family history can be a contributor to health conditions. If there has been a family history of high blood pressure, this can increase a person’s risk of having high blood pressure themselves. 

Complications of Hypertension1

If blood pressure remains high, it can damage important organs in the body causing serious health conditions.

  • Heart disease (angina, heart attack, heart failure) – High blood pressure makes the heart pump harder, putting extra force on arteries. This can damage the arteries, which decreases blood flow and oxygen to the heart. 
  • Stroke – High blood pressure can cause the pressure in the arteries to be too high. The arteries that supply blood and oxygen to the brain can burst or become blocked from a clot causing a stroke. When the brain stops getting enough oxygen, brain cells die causing disabilities in basic activities such as speech and movement.
  • Kidney disease – The force of high blood pressure can cause damage to the blood vessels and filters making it difficult for the kidneys to do their job of removing waste and toxins from the body and returning important nutrients and vital substances into the bloodstream. 

Treating Hypertension1

There are countless oral medications used today to help treat high blood pressure. Since every person’s body has different needs, the best first step is talking to a doctor about what will work for you. Blood pressure medications work in different ways. Some relax blood vessels, while others cause your heart to beat with less force. Another type causes your body to get rid of excess fluid (water). When your body holds on to more fluid, the heart has to work harder to push blood through blood vessels, causing high blood pressure. Many individuals may need to take more than one medication to control their blood pressure. Talk to the doctor about how long the medication will take to start working and make sure to take the medication exactly how the doctor prescribes it.

6 Ways to Prevent Hypertension6,7

Healthy living is key! 

  1. Healthy Eating — Eating a variety of foods rich in potassium, fiber, protein, low in sodium (salt), and low in saturated fat can help control hypertension. A healthy diet plan called DASH (Dietary Approaches to Stop Hypertension) has been proven to help people lower their blood pressure. 

Daily and Weekly DASH Eating Plan Goals for a 2,000-Calorie-a-Day Diet

Food GroupDaily Servings
Meats, poultry, and fish6 or less
Low-fat or fat-free dairy products2-3
Fats and oils2-3
Sodium2,300 mg
Food GroupWeekly Servings
Nuts, seeds, dry beans, and peas4-5
Sweets5 or less
  1. Healthy Weight – Keeping a healthy weight will decrease the risk of high blood pressure. To determine whether a certain weight is healthy, doctors usually calculate body mass index (BMI). If you know your height and weight, you can calculate your BMI using this link.
  1. Physical Activity – Staying physically active can help lower blood pressure. Adults should get at least 30 minutes of continuous moderate-intensity exercise 5 days a week, such as brisk walking or bicycling. Children and teenagers should get at least 1 hour of physical activity every day.
  2. Do Not Smoke – Smoking increases blood pressure and increases risk of heart disease and stroke.
  1. Limit Alcohol Use – Drinking alcohol increases blood pressure. As mentioned above, men should have no more than 2 alcoholic drinks per day, and women should have no more than 1 alcoholic drink per day.
  1. Get Plenty of Sleep – Not getting enough rest can increase your blood pressure. Most adults need at least 7 hours of sleep every night. Sleep helps the body recover and function properly.


  1. High blood pressure symptoms, causes, and problems | Centers for Disease Control and Prevention Web site. Updated 2020. Accessed Feb 11, 2021.
  2. Hypertension types – hypertension center – everyday health. Web site. Accessed Feb 11, 2021.
  3. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the american college of cardiology/american heart association task force on clinical practice guidelines. Hypertension. 2018;71(6):e13-e115. Accessed Feb 17, 2021. doi: 10.1161/HYP.0000000000000065.
  4. Resistant hypertension: Diagnosis, evaluation, and treatment. Circulation. 2008;117(25):e510-e526. Accessed Feb 17, 2021. doi: 10.1161/CIRCULATIONAHA.108.189141.
  5. Facts about moderate drinking | CDC. Updated 2021. Accessed Feb 21, 2021.
  6. Prevent high blood pressure | Centers for Disease Control and Prevention Web site. Updated 2020. Accessed Feb 21, 2021.
  7. DASH Eating Plan | NHLBI, NIH. Published 2021. Accessed February 22, 2021.
  8. Husain K, Ansari RA, Ferder L. Alcohol-induced hypertension: Mechanism and prevention. World J Cardiol. 2014;6(5):245-252. Accessed Feb 24, 2021. doi: 10.4330/wjc.v6.i5.245.

The Highs and The Lows: Living with Diabetes

Diabetes is a metabolic disease, caused by no or too little insulin production that affects millions of Americans. As food is broken down by the intestines, glucose or sugar is released into the blood. In response, insulin is released from the pancreas to help move glucose into your cells. Extra glucose is stored within the liver, muscles, and fat cells. The more glucose in your blood, the more insulin the pancreas produces. In type 1 diabetes, the pancreas is no longer able to produce insulin, therefore glucose freely floats within the blood. In type 2 diabetes, either the pancreas is unable to produce enough insulin to control glucose levels or the body becomes less sensitive to the insulin produced.1

As of February 2020, 11.3% of North Carolina adults have been diagnosed with diabetes, with approximately 250,000 more individuals undiagnosed.2

Types of Diabetes1,3

Type 1 diabetes mellitus, formerly known as “insulin-dependent diabetes” or “childhood-onset diabetes” is caused by an autoimmune or viral destruction of the pancreatic beta-cells (the cells responsible for making insulin), typically caused by a genetic or environmental factor. This means that the pancreas is unable to produce any insulin. Beta-cell destruction can occur at different rates, affecting both adults and children and accounts for 5 to 10% of diabetes.

Type 2 diabetes mellitus accounts for 90 to 95% of diabetes and is caused by poor insulin production, rather than complete absence of insulin with type 1, or poor insulin response (insulin resistance). The exact reason this occurs is unknown, but being overweight, physically inactive, and making poor diet choices are key factors.

Individuals diagnosed with prediabetes are those that have blood glucose levels higher than normal, but not high enough to be considered “diabetic.” Prediabetes greatly increases your risk for both diabetes and cardiovascular disease and is typically seen in obese people with high cholesterol and high blood pressure.

Gestational diabetes is high blood sugar during pregnancy, in women without a history of diabetes. Uncontrolled gestational diabetes can lead to an extra large baby, a higher chance of C-section, or preeclampsia (high blood pressure during pregnancy). Women are routinely screened between weeks 24 and 28 of pregnancy to rule out diabetes.

Diabetes insipidus is a rare inherited disorder, affecting 1 in every 25,000 individuals, that causes the kidneys to produce large amounts of dilute and odorless urine. Typically the kidneys make 1 to 2 quarts of urine per day. With diabetes insipidus, the kidneys can produce 3 to 20 quarts daily. Diabetes insipidus is similar to diabetes mellitus because both cause polyuria or excessive urination, however patients with diabetes insipidus do not have trouble producing insulin and have normal blood glucose levels.

Diabetes Symptoms4

Each individual diagnosed with diabetes may experience different symptoms, however the three main indicators of high blood glucose are polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Other symptoms may include blurry vision, numbness or tingling in hands or feet, and slugginess or fatigue.

Diabetes Diagnosis5

The A1c or hemoglobin A1c (HbA1c) test measures the amount of sugar attached to  hemoglobin, a protein found in red blood cells that moves oxygen throughout the body. The higher your blood glucose, the more red blood cells become covered in sugar. A1c estimates your average blood glucose over 2 to 3 months and is measured with blood work or using a fingerstick A1c test. A normal A1c is less than 5.7%. Prediabetes is an A1c between 5.7 and 6.4%. Diabetes is diagnosed with an A1c greater than or equal to 6.5%.

The fasting plasma glucose (FPG) test determines the blood glucose level after not eating or drinking (except water) within at least 8 hours of testing, usually done first thing in the morning. Typically, blood glucose levels would be low if you are fasting since glucose comes from food breakdown. If you have diabetes, however, these levels may be high. A normal FPG is less than 100. Prediabetes is a FPG between 100 and 125. Diabetes is diagnosed with a FPG greater than or equal to 126. Testing blood glucose at any time is considered a random plasma glucose, which can also be used to diagnose diabetes.

The oral glucose tolerance test (OGTT) shows how well your body processes sugars by measuring your blood glucose before and 2 hours after drinking a sweet drink. This test is commonly used in pregnant women to help rule out gestational diabetes. A normal OGTT would be a blood glucose of less than 140, prediabetes 140 to 199, and diabetes greater than 200.

Diabetes Risk Factors6

Since type 1 diabetes is caused by an autoimmune reaction, risk factors for type 1 diabetes are not well understood. Known risk factors for type 1 diabetes, include a family history, since there may be a genetic link, and age. Type 1 diabetes can develop at any age, but there is a greater chance during childhood and early adulthood.

Risk factors for type 2 diabetes include a diagnosis of prediabetes, older age (45 years and older), obesity, and a sedentary or non-active lifestyle. Type 2 diabetes may also have a genetic link, increasing the risk for individuals whose parents or siblings have type 2 diabetes. African Americans, Hispanic/Latio Americans, American Indians, and Alaskan natives are typically at a higher risk.

Diabetes Complications7

Overtime, diabetes can cause complications throughout the body including the heart, blood vessels, nerves, eyes, and kidneys. High blood sugar, alongside high cholesterol, can clog blood vessels making it difficult for the heart to pump blood. This causes high blood pressure, which increases your risk of heart attack or stroke. High blood sugar can also damage nerves leading to neuropathies or a tingling, burning, or numbness in hands and feet. Diabetes increases risk for cataracts or glaucoma and if poorly controlled, blindness. Diabetes may also lead to irreversible kidney damage, requiring dialysis or kidney transplant.

Diabetes Treatment8,9

Because in type 1 diabetes the pancreas is unable to make any insulin, the primary treatment for these individuals is insulin.

Treatment of type 2 diabetes is much more complex, with countless oral and injectable treatments, and typically depends on what works best for each individual. Oral medications work by increasing the amount of insulin released by the pancreas, decreasing glucose production, decreasing glucose absorption, increasing elimination of glucose, or improving the body’s response to insulin to lower blood sugar. Injectable medications work by increasing the amount of time you stay feeling full after eating, to help promote weight loss and by increasing insulin production. For patients with poorly controlled type 2 diabetes, insulin may also be used. 

Gestational diabetes can often be controlled by eating healthy foods and exercising regularly, however some women may need insulin to lower their blood sugar.

Hypoglycemia Symptoms and Treatment10

Hypoglycemia or low blood sugar can be caused by certain diabetes medications, including insulin, or skipping a meal, and can cause seizures, unconsciousness, or even death, if left untreated. Blood sugar is considered low if less than 70 mg/dL, however symptoms may appear at higher values in some patients. Symptoms of low blood sugar may include sweating, shaking, hunger, or fatigue. When treating low blood sugar, we use the “15-15 Rule” — 15 grams of carbohydrates and recheck blood sugar after 15 minutes. It is important to consume simple sugars because your body absorbs these quickly and helps raise your blood sugar the fastest. This includes things like half a glass of orange juice or soda or 5 pieces of hard candy. There are also glucose tablets that can be purchased over-the-counter to help treat low blood sugar. You should inform your healthcare provider if you experience low blood sugars often.

Diabetes Prevention11

Lifestyle changes are especially important for preventing or treating type 2 diabetes. Losing 5 to 10% of your body weight can lower your risk of developing diabetes by about 50%. The American Heart Association (AHA) encourages individuals with diabetes to exercise regularly and eat healthy. Adults need at least 150 minutes of moderate-intensity physical activity per week, with both aerobic and strength training exercises. Dietary changes may include portion control and limiting added sugars, fatty meats, saturated fats, sodium, cholesterol, and alcohol. A proper diabetic diet is rich in high-fiber whole grains, like oatmeal or brown rice, non-fried fish at least twice weekly, lean meats like skinless chicken or turkey, and fruits and vegetables. The AHA also promotes smoking cessation. Individuals with diabetes that smoke are three times as likely to die of cardiovascular death versus non-smokers and have a more difficult time controlling their blood sugar.

For more information and support, visit the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) websites or talk with your doctor or pharmacist today.

By CaraBeth Harrison, PharmD, PGY1 Resident


  1. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes. Diabetes Care [Internet]. 2020 [cited 2021 Jan 25]; 43(Suppl. 1): S14-S31. Available from:
  2.  The Burden of Diabetes in North Carolina [Internet]. Arlington (VA): American Diabetes Association. 2020 Feb [cited 2021 Jan 25]. Available from:
  3. Diabetes Insipidus [Internet]. Rochester (MN): Mayo Clinic. 2019 Feb 16 [cited 2021 Jan 25]. Available from:
  1. Diabetes Symptoms [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. [cited 2021 Jan 25]. Available from:
  1. Diagnosis [Internet]. Arlington (VA): American Diabetes Association. [cited 2021 Jan 25]. Available from:
  2. Diabetes Risk Factors [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2020 Mar 24 [cited 2021 Jan 25]. Available from:
  1. Type 2 Diabetes [Internet]. Rochester (MN): Mayo Clinic. 2021 Jan 20 [cited 2021 Jan 25]. Available from:
  1. Basina M and Watson S. Everything You Need to Know About Diabetes [Internet]. Healthline; 2018 Oct 4 [updated 2020 Feb 26; cited 2021 Jan 25]. Available from:
  2. Gestational [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2020 Jul 14 [cited 2021 Jan 25]. Available from:
  1. Blood Sugar Testing and Control: Hypoglycemia (Low Blood Sugar) [Internet]. Arlington (VA): American Diabetes Association. [cited 2021 Jan 25]. Available from:
  2.  Living Healthy with Diabetes. Dallas (TX): American Heart Association. 2020 Mar 12 [cited 2021 Jan 25]. Available from:–treatment-of-diabetes/living-healthy-with-diabetes.

COVID-19 Vaccines: What You Need To Know

This year, the pandemic caused by COVID-19, has led to the loss of many loved ones, friends, and acquaintances. We all have been working hard to follow the Centers for Disease Control and Prevention (CDC) guidelines by wearing masks, social distancing, and washing hands to help prevent us from getting sick, and control the pandemic. Lately in the news we have heard about the approval of vaccines against COVID-19, but what does that mean for us? When can we get them? How do we know they are safe? This blog post is meant to help answer some of the questions commonly asked about the vaccine, explain the vaccines that have been approved and their differences, when the vaccines will be distributed, and what to expect when you get the vaccine. 


One common question people have regarding the COVID vaccine is how does it work and how is it different from other vaccines? Traditional vaccines work by using a weakened or inactivated virus. The virus is injected into the body, which recognizes it as foreign and works to get rid of it, without getting us sick. This immune response leads to the formation of antibodies which prevent us from getting the disease in the future. The COVID vaccine is different because it does not contain a weakened or inactivated virus at all. Instead, it sends instructions (messenger RNA or mRNA) to cells on how to make a “spike protein,” which is a harmless protein that is found on the COVID virus. When the vaccine is injected into the arm, the immune cells in the body recognize this protein as foreign, and work to get rid of it, just like traditional vaccines. After our immune system has fought off the protein, we are left with antibodies that could prevent us from getting COVID-19 in the future. One concern that has been brought up about the way this vaccine works is whether or not it can interfere with the cells in our body and interact with our own DNA. This is not true, as it does not enter the nucleus of the cell, where our DNA is stored. The vaccine does not interact with DNA at all. The cells that make the protein also break down and get rid of the mRNA once it has finished doing it’s job.1


The first COVID vaccine that was approved was the one developed by the drug company, Pfizer. This vaccine is a 2 dose series that is given once, and then again 21 days later. It is approved for patients age 16 or older. This vaccine has been shown in studies to be 95% effective after both doses, and results from these studies were published on December 10, 2020. In this study, there were 36,621 participants who were randomized to get either the vaccine or a placebo. Of the patients who received the vaccine, only 8 got COVID-19, while 162 in the placebo group got COVID-19. The most common side effects seen in patients who received that vaccine were pain and irritation at the injection site, tiredness, and headache.2 

The second COVID vaccine that was approved was the one developed by the drug company, Moderna. This vaccine is also a 2 dose series, but is given once, and then again 28 days later. It is approved for patients age 18 or older. This vaccine has been shown in studies to be 94.1% effective after both doses, and results from these studies were published on November 30, 2020. In this study, there were 30,350 participants who were randomized to get either the vaccine or a placebo. Of the patients who received the vaccine, only 6 got COVID-19, while 92 in the placebo group got COVID-19. There were no cases of severe COVID-19 in the group who received the vaccine, while there were 30 severe cases in the placebo group. The most common side effects seen in patients who received the vaccine were pain and irritation at the injection site, tiredness, chills, headache, and muscle pain.3


Getting vaccinated against COVID-19 is the best and safest thing you can do to prevent the spread of the virus. COVID-19 can have serious, life-threatening complications, and there is no way to know how COVID-19 will affect you. If you get sick, you could spread the disease to friends, family, and others around you. COVID-19 symptoms can last for months. The virus can damage the lungs, heart, and brain, which increases the risk of long-term health problems. Even young, otherwise healthy people can feel unwell for weeks to months after infection. By getting vaccinated, you are preventing yourself from getting the virus, or are making it less severe if you do get it. You also will be protecting those who are at a greater risk of getting COVID-19 and rely upon others to get vaccinated in order to not get sick. This process is called herd immunity. There have been warnings against certain people getting the vaccine, such as children younger than 16 years of age, pregnant people, people who carry Epipens, and people with certain medical conditions. If you fall under one of these categories, you may need to speak with your doctor to see if the vaccine would be beneficial for you. These patients may have been excluded from studies, therefore more evidence is needed to determine the safety of the vaccines in these patients. Overall, we can control the spread of the virus by following the Centers for Disease and Prevention (CDC) guidelines and getting vaccinated.4


It is hard to say for sure when the vaccine will be available to everyone, but it likely will not be until Spring 2021. The distribution of the vaccine is determined by each state, with recommendations from the CDC on who should get vaccines first. North Carolina has 4 phases of vaccine distribution, and as of December 28th we are in phase 1A. Phase 1A restricts vaccination to healthcare workers and people in nursing homes. Phase 1B will include other frontline workers such as grocery store employees, teachers, firefighters, and law enforcement. Phase 2 will include people who are older than 65 and those with chronic medical conditions. Phase 3 will include students and workers at universities. Phase 4 will include everyone else in the general population who would like to receive a vaccine.5 Moving into phase 1B and the following phases is dependent on the number of vaccines available, therefore it is unknown, at this time, when that will occur.6 As of now, manufacturing companies are working on creating more vaccines so that we can move on to the next phase. This process is expected to take a few months, so it may not be until March or April before most people can receive the vaccine.


With the COVID-19 vaccines, some patients experience no symptoms afterwards, while some patients do. The most common symptoms patients experience after getting vaccinated are pain or swelling in the arm where they were injected, chills, mild fever, tiredness, and headache. Although these symptoms feel like the flu, and can even affect your ability to do daily activities, they are typically mild and last for only a couple of days. It is also important to know that you will need two shots in order for these vaccines to work. Even if you have side effects after the first shot, you should still get the second, so you are protected from the virus, unless advised otherwise by your doctor. Vaccines also do not work right away. It takes 1 to 2 weeks for these vaccines to work fully, so you are not completely protected until that time has passed since being vaccinated.7 Since the vaccine studies are still in progress, we do not yet know how long the vaccines will protect you against COVID-19. However, it is still important to get vaccinated as this is currently the best and safest thing to do to prevent you from getting sick. 


The best thing you can do while waiting for the vaccine to be available to the public is to continue following CDC guidelines to prevent the spread of infection. This includes washing your hands frequently, wearing masks, maintaining social distance, and avoiding large crowds or gatherings.8 While getting vaccinated is a huge step towards ending the pandemic, it is still very important that everyone follows these guidelines to prevent the spread of the virus. 


  1. Understanding and explaining mRNA COVID-19 vaccines | CDC. Updated 2020. Accessed Dec 28, 2020.
  2. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine. New England Journal of Medicine. December 2020. Accessed Dec 28, 2020.
  3. A phase 3, randomized, stratified, observer-blind, placebo-controlled study to evaluate the efficacy, safety, and immunogenicity of mRNA-1273 SARS-CoV-2 vaccine in adults aged 18 years and older. 2020. Accessed Dec 28, 2020.
  4. Benefits of getting a COVID-19 vaccine. Centers for Disease Control and Prevention Website. Updated 2020. Accessed Dec 28, 2020.
  5. COVID-19 vaccine 101. NC Department of Health and Human Services Website. Published Dec 17, 2020. Accessed Dec 28, 2020.
  6. Burns M. When can anyone in NC get coronavirus vaccine? state officials say timeline uncertain. WRAL Website. Updated 2020. Accessed Dec 28, 2020.
  7. What to expect after getting a COVID-19 vaccine. Centers for Disease Control and Prevention Website. Updated 2020. Accessed Dec 28, 2020.
  8. How to protect yourself & others. Centers for Disease Control and Prevention Website. Updated 2020. Accessed Dec 28, 2020.


Let me introduce you to Mary. She wanted to try CBD for sleep, she got so much more than better sleep.

First we have to understand a little about what quality Cannabidiol (CBD) is.

You can’t just go by the milligrams (mg) on the label.

Mary had tried CBD before, but not from a pharmacy. She said she was on 1500 mg of CBD, what she didn’t know was CBD labeling is not consistant across all companies. Some companies report the amount of CBD and some report the amount of CBD oil. Whats the difference? CBD is the active cannabinoid that so many people know and love. CBD oil on the other hand can include all kinds of other cannabinoids and the carrier oil. That means there is a big difference between the two. CBD oil might only contain 30% of the reported CBD.

Always verify before you buy.

Mary had heard things about contaminants in CBD and she was worried about lead the most. Each CBD product you buy must have a certificate of analysis to verify that it contains the stated amount of CBD, the expected amount of THC (either <0.3% or none), no pesticides, heavy metals, or other contaminants. That’s why she went to a pharmacy for her CBD products. She wanted the best and she knew her pharmacist never compromised on quality.

What form of CBD to use?

Once again her pharmacist was happy to help. Together they decided on a Full Spectrum Sublingual oil. Whats that? Full Spectrum means that in addition to CBD and other cannabinoids and terpenes, this oil also contains some THC (<0.3%). A broad spectrum oil contains only CBD and other cannabinoids and possibly very small trace amounts of THC. An Isolate contains only CBD.

How much CBD to take?

Now that Mary had her CBD she had to find her dose. CBD supports your natural endocannabinoid system, which means your body will respond to different amounts of CBD than someone else. Mary started taking 10 mg of active CBD, which is where many people start. She took it for a week and decided it was helping her at that dose, but wanted to see if it could be even better. She went up to 20 mg. Now she was sleeping better and getting better quality sleep. She tried going up to 25 mg a week later and discovered she didn’t feel as good as she did on the 20 mg, so she went back to 20 mg. Mary did what she needed to, she listend to her body and adjusted her dose to suit her needs. Keep in mind that CBD effects everyone differently and it is always best to start low and go slow.

What happened to Mary?

Mary went into the pharmacy after about 3 months to pick up another bottle of her CBD. She called her pharmacist over and told him that she had jogged down the stairs last week.

Her pharmacist was confused and said, “That’s great, I’m glad you were able to get some exercise.”

Mary smiled, “You don’t understand, I used to take the stairs one at a time, sideways, while holding the hand rail. This CBD has changed my life and helped with my arthritis that I’ve had for years.”

Her pharmacist smiled, “That’s amazing. I am so glad to hear that CBD has helped you so much. Do you mind if I tell others your story?”

Mary smiled, “Please do, everyone should get the chance at this kind of relief.” Stories like Mary’s are why Josefs pharmacists only recommend the best CBD.

FDA Disclaimer: These products are not for use or to be sold to persons under the age of 18. This product should be used only as directed on the label. It should not be used if you are pregnant, trying to become pregnant, or nursing. Consult with a medical professional before using if you have a serious medical condition or are taking any prescription medication. A medical professional’s advice should be sought before using this or any other supplement or dietary product. These products and statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease.  By using this site and purchasing products, you agree to follow all Terms and Conditions found on this site.

Jonathan Harward Awarded 2020 National Preceptor of the Year Award by NCPA Foundation

Copied verbatim from > Current Link

ALEXANDRIA, Va. (Oct. 20, 2020) – Jonathan Harward, pharmacy manager at Josefs Pharmacy in Raleigh, N.C., was honored as the recipient of the 2020 National Preceptor of the Year Award by the National Community Pharmacists Association Foundation as part of NCPA’s Annual Convention, which was held virtually. Harward, who is originally from Carthage, N.C. and now lives in Holly Springs, has precepted pharmacy students with Josefs Pharmacy since 2015.

Harward attended Campbell University, completing his undergraduate studies and graduating with his Doctor of Pharmacy degree in 2013. He completed a PGY-1 Community Pharmacy Residency with Kerr Drug and Campbell University.

In nominating him for this award, Dr. D. Byron May, professor and chairman of the Department of Pharmacy Practice at the Campbell University College of Pharmacy and Health Sciences, writes that Harward “understands that students have different learning styles and he cares enough to ascertain how each student learns best in order to maximize their learning experience.” May says Harward knows the importance of individualizing students’ experiences and prioritizes involving them in all aspects of his pharmacy practice. Students say Harward was a mentor to them long after their experiential training ended, giving testament to his compassion and dedication to their personal and professional development.

Harward’s commitment to pharmacy professionalism extends beyond precepting future pharmacists, carrying into his work at Josefs Pharmacy, where he is dedicated to his patients and his community. He has worked to develop and implement a medication synchronization program seeking to promote comprehensive medication reviews, immunizations and assessments in patients with HIV, HCV and rheumatoid arthritis. He worked to develop the ScriptAbility program through which visually impaired patients (using special technology) can hear instructions printed on their medication vial. He also holds immunization clinics at nearby businesses and places of worship for those who are uninsured, and shares his knowledge in presentations to various educational sessions throughout the community.

Harward is involved with efforts to transform community-based pharmacies, working with CPESN® USA and Flip the Pharmacy. These initiatives, among other things, aim to improve medication adherence and lower overall cost of care. Harward is currently seeing patients with hypertension through Flip the Pharmacy with plans to expand this coming year.

Harward says, “It is a privilege to be able to mentor and show students the great services that independent pharmacies have to offer our patients, while sharing with them the challenges we face from pharmacy benefit managers who attempt to undermine our work.” He thanks Dr. May in addition to Dr. Katie Trotta, Dr. Taylor McDaniel, and Dr. Tina Thornhill at Campbell University for nominating him for this award. Harward also thanks Finny and Blessy Joseph, the owners of Josefs Pharmacy, for allowing him to have students in the business.


The NCPA Foundation is a nonprofit 501(c)(3) organization established in 1953 to honor the previous incarnation of NCPA, the National Association of Retail Druggists (NARD) Executive Secretary John W. Dargavel. Contributions to the foundation are tax-deductible as charitable donations to the extent permitted under federal tax law. The NCPA Foundation supports the growth of independent community pharmacy through scholarships to pharmacy students, critical research/programs to improve the success of independent pharmacy and patient care, community service programs, and financial aid to community pharmacy owners for their recovery in the event of disaster or other adverse circumstances. For more information, go to

Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing over 21,000 pharmacies that employ approximately 250,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit

CMRs: What is the Comprehensive Medication Review?

A comprehensive medication review (CMR) is an encounter conducted face-to-face or via telephone between a patient and their pharmacist. The pharmacist collects patient-specific information to identify medication-related issues and creates a plan to resolve them, alongside the patient and/or prescriber.1 CMRs allows the patient and pharmacist to work together to improve patients’ knowledge of their medications, empowering patients to take ownership of their health. CMRs, unlike targeted interventions that address one condition or a single medication, are all-inclusive and can be time-consuming. A thoroughly executed CMR can take as long as 45 minutes to 1 hour.2 All medications and relevant medical conditions are evaluated. Action plans are developed, and patients are periodically reassessed. You should receive a CMR at least once a year. If your medications change frequently or you have been admitted to the hospital several times recently, you may benefit from more frequent CMRs. CMRs are a free service offered by your pharmacy. Ask your pharmacist about scheduling a CMR today!

Below are five things to know about a comprehensive medication review…

1.   What are the benefits of a comprehensive medication review?

Each patient is unique, with a different set of health concerns, a list of medications, allergies, social barriers, and needs to be met. Medication reviews allow your pharmacist or another healthcare provider to specifically address your “differences” and optimize your care. In 2019, an online article discussed the following 8 benefits of comprehensive medication management3:

●      Medication Assessment – Patients’ medications, both prescription and over-the-counter, are evaluated to determine if appropriate and effective at treating medical conditions and achieving goals of care.

●     Personalized Therapy — Care is customized to meet the needs of each individual patient.

●      Collaborative Care — Healthcare professionals, including pharmacists, providers, and nurses work together to offer optimal patient care.

●     Patient Engagement — Involving patients in discussions and decisions regarding their medical care allows them to take ownership of their health, promoting improved outcomes.

●      Ongoing Regimen Review — Patients are periodically reassessed for changes in medication regimens, control of symptoms, and progress toward goals. This creates an environment for longitudinal care or care over a period of time.

●     Improved Outcomes — Improved medication adherence and greater control of chronic diseases, reduces hospital admissions/ED visits, and enhances patients’ quality of life.

●     Reduced Costs — Patients only pay for medications that are necessary for their health. Improved medication adherence and decreased adverse events reduce hospital admissions, ED visits, and overall healthcare expenses.

●     Increased Satisfaction — Patients receive better care for a fraction of the price, while providers witness better outcomes for their patients.

2.  Am I eligible for a comprehensive medication review?

In 2015, a study funded in part by the National Institute on Aging looked at the increased prescribing of medications in the older adult population. Nearly 40% of these patients were on at least 5 medications.4 The most common medications noted were statins for high cholesterol, anti-hypertensive agents, diabetic medications, and antidepressants.  Polypharmacy or the use of several medications at once has been shown to increase medication nonadherence and increase the risk of drug duplication, drug-drug interactions, and adverse drug reactions. Patients on numerous medications, regardless of age, are prime candidates for medication reviews. Your pharmacist can help determine if you are taking any unnecessary drugs if your symptoms are controlled on your current regimen, and ensure that each medication is being used properly.

“Transitions of care” has become a hot topic in healthcare in recent years and refers to the movement of patients between multiple providers and settings as their conditions and healthcare needs evolve.5 For example, a patient discharged from the hospital into a rehab facility, then eventually back home following a stroke. These transitions are typically complicated by poor communication between care providers, lack of patient education, and failed collaborative care. Medication reviews in these patients allow the pharmacist to help bridge gaps in care. Your pharmacist can take the time to sit down with you and explain the changes that have been made in your medication regimen. They can develop strategies to help you take your medications as directed and clear up any uncertainties.

Medication reviews are a free service offered by your pharmacy. Although the patients mentioned above may benefit the greatest, anyone who would like a medication review is eligible. 

3. Who will be completing my comprehensive medication review?

Pharmacists pride themselves on being the “medication experts” and are excellent sources of information for both prescription and over-the-counter medications. Their education is focused on assessing medication-use for appropriateness, effectiveness, and safety to help prevent and resolve medication-related problems.6 This training, along with the idea that over 90% of Americans live within 5 miles of a community pharmacy,7 make them an obvious player in medication reviews. Your pharmacist may conduct the review, but a successful review does not stop there. A medication review is an umbrella term, which includes interventions carried out by various healthcare professionals such as providers, pharmacists, nurses and/or medical assistants.8 It is a team effort to ensure each patient receives the best care possible. A nurse may collect a list of your medications during an office visit or at hospital admission to provide to the pharmacy. They may review your discharge summary and notate changes in your regimen. A provider may prompt conversations and conduct examinations to determine which medications should be added, adjusted, or removed based on your current health needs. A pharmacist may review prescriptions prior to dispensing them, assessing for correct dosage and indication, and providing patient counseling when warranted. This integrated approach allows the puzzle pieces to come together so that optimal patient care is provided.

4. How to prepare for a comprehensive medication review.

You have been scheduled for a medication review with your pharmacist, either in-person or via telephone… now what? Preparing for a medication review, as a patient, is simple. Collect and bring all of your medications, both prescription and over-the-counter, and any devices, such as inhalers or insulin pens with you.9 It is important to include all vitamins and herbal supplements, as some of these cause significant drug-drug interactions. “Over-the-counter” does not always mean “safe.” Prior to the review, think about how you take each medication. Are they effective or do they make you feel worse? Have you noticed any side effects? If you regularly monitor your blood sugar or blood pressure, what are your recent readings? Are you having difficulty remembering to take your medications? Write all of this down, as well as any questions you may have and prepare to be honest with yourself and your pharmacist.

Your pharmacist has likely prepared for the medication review, as well. They may have already gathered a comprehensive medication list from your providers, confirmed disease states, evaluated fill history, and identified potential medication-related issues.10 This allows the pharmacist to establish a game plan and prioritize the objectives of the review to create an effective and efficient encounter.

5. What to expect following a comprehensive medication review.

Follow-up is a key component of a medication review. Your pharmacist may elect to follow-up within a few days or months, depending on the severity of issues identified during the review. Follow-up allows the pharmacist to monitor progress towards goals, ensure resolution of issues, and identify any new medication-related problems.10

Many pharmacists will create a handout or takeaway for you at the conclusion of your encounter, including an up-t0-date medication list and medication action plan (MAP). The MAP provides an overview of what was discussed and guidance on how to achieve patient-centered goals, including non-pharmacological options or  lifestyle changes.10 


1.        Gamble K. MTM Advisory Board Updates Definition of Key Pharmacist Role [Internet]. Cranbury (NJ): Pharmacy Times; 2011 Aug 8 [cited 2020 Aug 24]. Available from:

2.       Smart Retailing Rx. How to Conduct Comprehensive Medication Reviews [Internet]. [place unknown: Health Mart ® Pharmacy]; 2017 Dec 1 [cited 2020 Aug 24]. Available from:

3.       Ross SM. 8 Benefits of Comprehensive Medication Management [Internet]. [place unknown: Cureatr ©]; 2019 May 2 [cited 2020 Aug 24]. Available from:

4.       Charlesworth CJ, Smit E, Lee DSH, et al. Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1998-2010. J Gerotolog A Biol Sci Med Sci [Internet]. 2015 Mar 1 [cited 2020 Aug 24]; 70(8):989-995. Available from:

5.       Joint Commission (US). Transitions of Care: The need for a more effective approach to continuing patient care [Internet]. [place unknown: Joint Commission]; [cited 2020 Aug 24]. Available from:

6.       Kehrer JP, Eberhart G, Wing B, et al. Pharmacy’s role in a modern health continuum. Can Pharm J [Internet]. 2013 Nov [cited 2020 Aug 24]; 146(6):321-24. Available from:

7.       Twigg G, David T, Taylor J. An Improved Comprehensive Medication Review Process to Assess Healthcare Outcomes in a Rural Independent Community Pharmacy. Pharmacy (Basel) [Internet]. 2019 Jun 17 [cited 2020 Aug 24]; 7(2):66. Available from:

8.      Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol [Internet]. 2012 Oct [cited 2020 Aug 24]; 74(4):573-80. Available from:

9.       Sunderland CCG Medicines Optimisation Group. Medication Review [Internet]. Switzerland: PSNC; [cited 2020 Aug 24]. Available from:   Angaran D, Whalen K. Medication Therapy Management: A comprehensive approach [Internet]. New York: McGraw-Hill Education; 2015 [cited 2020 Aug 24]. Available from:

Author: CaraBeth Harrison

Everything You Need To Know About Ranitidine (Zantac) Recall

Introduction about Zantac Recall

If you or someone you know takes the medication ranitidine for occasional heartburn or gastroesophageal reflux disease (GERD), you may be aware that the Food and Drug Administration (FDA) has recalled and removed the medication from the market due to concerns of a cancer-causing impurity. However, you may be wondering what that means and what you need to do. We hope this article helps you understand why the recall and what you need to do.

What is ranitidine?

Many people take over the counter (OTC) Ranitidine or commonly known as Zantac to prevent and relieve occasional heartburn. It is also available as a prescription for the treatment and prevention of ulcers as well as the treatment of gastroesophageal reflux disease (GERD).

Ranitidine was available in three strengths; 75mg, 150mg and 300mg. People who have been taking this medication, generally take it once or twice daily. The OTC labeling of this medication indicates a short course of treatment of no more than 14 days for relief or prevention of heartburn. If one requires further relief, one could see their primary care physician for evaluation to determine the root cause of their heartburn.

Ranitidine is classified as a histamine-2 (H2) blocker which works by reducing gastric acid in the stomach. Histamine is a chemical that naturally occurs in one’s body and encourages the stomach to produce acid when one eats to help digest the food. By taking a H2 blocker, one can reduce the amount of histamine produced in turn reducing the amount of acid produced.

Why did the FDA recall ranitidine and then remove it from the market?

In September of 2019, the FDA announced that preliminary tests of ranitidine contained low levels of a probable human carcinogen or a substance that is known to cause cancer. The substance found in these batches of ranitidine was N-nitrosodimethylamine (NDMA).  However, at that time, the FDA did not recommend discontinuation but did recommend talking with your doctor about alternatives.

Beginning in October of 2019 through February of 2020, some manufacturers of ranitidine implemented voluntary recalls of their product. It was not until April of 2020 that the FDA requested all ranitidine products be removed from the market. The FDA determined that there were only a few cases unacceptable levels of NDMA found in some samples tested. However, they noticed that the levels of NDMA increase overtime when it is stored at higher than room temperatures. Since there was no way of knowing how old the product was and how it was stored, the FDA decided to remove the product from the market due to a concern for safety. As a result of this request, ranitidine products are no longer available to purchase OTC or prescription.

What is NDMA and what does it cause?

NDMA is an environmental contaminant that is found in water and foods. The substance is unintentionally produced in or released from industrial sources through chemical reactions. NDMA is classified as a carcinogen based on animal studies that showed prolonged exposure to NDMA resulted in tumors. Low levels of NDMA can be ingested from our diets and are not expected to lead to an increased risk of cancer. However, prolonged exposure to higher levels of NDMA could increase the risk for cancers.

What should you do if you take ranitidine?

Since the FDA has formally removed ranitidine from the market, if you, a family member or a friend have been taking this medication the FDA recommends that you discontinue and discuss with your primary healthcare provider about options for further treatment. There are other alternative medications available for the treatment of occasional heartburn in the H2 blocker class as well as other classes. There is no evidence that the other H2 blockers or other heartburn medications have been affected by NDMA impurities.


  • Commissioner, Office of the. FDA Requests Removal of All Ranitidine Products (Zantac) from the Market. 1 Apr. 2020,
  • Commissioner, Office of the. “Zantac (Ranitidine): Safety Information – NDMA Found in Samples of Som.” U.S. Food and Drug Administration, FDA, 13 Sept. 2019,