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A brief introduction…

When most practitioners talk about “anti-inflammatory” they are generally referring to prescriptions that mask swelling such as NSAIDs like ibuprofen or naproxen.  When functional medicine practitioners talk about anti-inflammatory we are referring to the foods and supplements that prevent the cause of inflammation in the body.

Inflammation is the beginning of all disease states whether acute or chronic.  Obviously acute inflammation is necessary for the body to start repairing damage from some harm inflicted recently such as a sprained ankle or a cut finger.  Chronic inflammation is what you never want your body to experience.

First, how do I know if I have chronic inflammation? 

Chronic inflammation manifests itself in many different ways.  The most common are:

  • Joint swelling & tenderness
  • Muscle aches (not muscle soreness from exercise)
  • Abdominal pain & bloating
  • Chronic headaches
  • Constipation
  • Constant fatigue
  • Any autoimmune disorder

If you have one or more of these symptoms, you are experiencing chronic inflammation.

So I have chronic inflammation, what do I do now?

Step number one when working to combat chronic inflammation is to look at your diet.  I firmly believe that “you are what you eat.”  However, making healthy choices can be confusing.  The media and the internet are filled with conflicting information on “eat this food…but don’t eat this food…no, it’s ok to eat this food in moderation.”  So what’s a person to do?  I’m going to make this relatively simple.

A simple summary of what to eat:

  1. Eat organic, grass-fed/free-range meats or wild-caught seafood/fish
  2. Eat organic produce (this includes all fruits and veggies)

What not to eat:

Avoid as much of these as possible:

  • Grains of any type (yes, that means no bread)
  • Sugar in any form (use Stevia instead)
  • Artificial sweeteners (yes, pink ones, yellow ones & blue ones)
  • Caffeinated beverages (substitute herbal teas or better yet, just drink water)
  • Alcohol in excess
  • All dairy (yes, cheese too)
  • Eggs (food allergy testing can confirm if you must avoid these long-term)

If you have already progressed to an autoimmune disorder, then you need to be especially diligent in your eating habits and avoid everything on this list.

If you would like to get a firm answer on what exactly your food allergies & sensitivities are that are causing your chronic inflammation, see a practitioner that does testing.  In my office, we use Alletess Food Allergy/Sensitivity testing.  We welcome current patients to come in and request the test.

Focus on Curcumin

Once patients have begun to work on their diet to eliminate the foods that are perpetuating chronic inflammation, I look to one of my favorite supplements that can help reduce any remaining swelling & discomfort…Curcumin.

Curcumin is the active compound in Turmeric.  It is yellowish in color and has been a part of Indian and Asian diets for centuries.  Interestingly enough researchers began to notice that those countries had a much lower incidence of arthritis and other inflammatory diseases.  Additional research has found that Curcumin plays a role in decreasing inflammation and protecting the body from inflammation.

I never recommend starting any supplement without speaking with your physician first.  As with all medications your healthcare provider will make sure it will not interfere with any of your other medications.  I also recommend that you consult a physician on what dosage of curcumin would be best for you.


As patients, we all strive to do what is best for our bodies. We eat well, exercise, and take any necessary medications when needed. However, what is not well known is that sometimes the medications we take can cause a depletion of important nutrients.

Don’t get me wrong, prescription medications are a necessity for many people and I am not in any way advising you to NOT take your prescribed medications. I simply would like to educate you on the nutrients you will need additional intake of, when taking certain medications.

Since there are a lot of medications that can cause nutrient depletion, I am going to break them up into a two-part series and only tell you about a couple of drugs at a time. This month I would like to address Antacids and Non-Steroidal Anti-Inflammatories (NSAIDs).


This category includes medications such as Pepcid, Tagamet, Prevacid, Prilosec, and magnesium & aluminum containing antacids (such as Gaviscon, Maalox, Mylanta).
Antacids work by neutralizing stomach acid or by inhibiting the release of a digestive enzyme (like pepcin). Unfortunately stomach acid is necessary to release vitamins from food, and when you decrease or stop the production of it, you absorb fewer vitamins.

These medications can cause deficiencies in the following nutrients:

  • Vitamin B12
  • Folic Acid
  • Vitamin D
  • Calcium
  • Iron
  • Zinc

Most common of these is deficiencies is B12. Vitamin B12 deficiency can cause anemia, depression, tiredness, and weakness. The good news is that Vitamin B12 is easy to supplement. When choosing a B12 supplement, you want to look exclusively for the methylated form…Methylcobalamin. Dosages range from 1 to 5mgs and it can be taken twice daily if needed. I recommend taking it in the morning and around noon. Vitamin B12 provides energy, so never take it too close to bedtime. Vitamin B12 is also “water soluble” meaning that you cannot overdose on it since the body automatically eliminates any excess through urine.

Talk to your doctor about the proper dosing for you when supplementing for Folic Acid, Vitamin D, Calcium, Iron, and Zinc. Vitamin D is a fat-soluble vitamin. You can take too much of it, so be sure to have your blood tested to keep your levels in check.


This group includes medications such as Motrin, Aleve, Advil, Anaprox, Dolobid, Feldene, and Naprosyn.

These are all known to cause folic acid deficiency due to a decrease in the body’s ability to absorb folate from the intestine.

Folic acid deficiency can cause birth defects, anemia, and a higher risk of cardiovascular disease.

Also in this group is aspirin and other salicylates.

Long term use of aspirin is linked to deficiency in the following nutrients:

  • Vitamin C
  • Calcium
  • Folic Acid
  • Iron
  • Vitamin B5 (Pantothenic Acid)

Aspirin can cause the body to expel more Vitamin C in urine than normal and Vitamin C is essential for a healthy immune response. Calcium is necessary for bone, heart & dental health. Iron prevents anemia, weakness, fatigue, hair loss, and brittle nails. Vitamin B5 helps with fatigue and listlessness.

Most of these nutrients are available in a high-quality multivitamin, however if you are on an aspirin therapy regimen, I recommend talking to your doctor about dosage to replenish these nutrients.

Now let’s address anti-depressants, antibiotics, cholesterol lowering drugs, and diabetic drugs.  I would like to stress that I am NOT advocating that you stop taking any medication that your doctor has prescribed, only letting you know that you may require additional amounts of these nutrients to stay healthy while on that medication.


Anti-depressants include Prozac, Effexor, Lexapro, Wellbutrin, and many more.  With long-term use of anti-depressants, you are going to deplete two things:  Coenzyme Q10 (CoQ10) and Vitamin B2 (Riboflavin).  You can get some CoQ10 from your diet, but most patients require a supplement.  Natural sources are: red meat, oily fish, and some nuts.  When choosing a CoQ10 supplement, make sure the manufacturer is reputable (preferably pharmaceutical grade).  Your doctor can help you understand what dose of CoQ10 is right for you.

Vitamin B2 (Riboflavin) is found in foods such as beef liver, lamb, mushrooms, spinach and almonds.  You can also find B2 as a supplement alone or in a B-Complex.


Antibiotics include medications such as Gentamycin, Neomycin, Streptomycin, Cephalosporins, Penicillins, and Tetracyclines.  Most antibiotics are used only for a short amount of time.  However, some patients are put on long-term antibiotic therapies.  This long-term use can lead to depletion of:

  • B Vitamins
  • Vitamin K
  • Calcium
  • Magnesium
  • Iron
  • Zinc

You can increase intake of these vitamins and minerals through a healthy diet, but some patients will need to incorporate a high-quality multivitamin daily.  No matter what choice you make for vitamin repletion, every patient will require a high-dose probiotic to recolonize the bacteria in the gastrointestinal tract.  Talk to your doctor about what probiotic is right for you.

Cholesterol Drugs

Drugs in this category are collectively called “statins” and include names like: Lipitor, Crestor, Zocor, and others.  They too deplete Coenzyme Q10.  Low energy is a common complaint from patients on statins and this can be partially due to depleted CoQ10.  Seek a high-quality CoQ10 supplement to fight this fatigue.

Diabetic Drugs

Metformin and Sulfonylurea drugs are used to manage Type 2 Diabetes.  Metformin being the oldest and most common drug in this category, depletes: Coenzyme Q10, Vitamin B12, and Folic Acid.  All three of these directly affect energy levels, cardiovascular health, and the immune system.  Since most patients continue with long-term Metformin therapy, I recommend repletion with high-quality supplements for these nutrients.  When purchasing your supplements, be sure that your Vitamin B12 and Folic Acid are in the active/bioavailable form.  Look for “methylcobalamin” for B12 and “5-methyltetrahydrofolic acid” for Folic Acid.

Want to know if you are nutrient depleted?  We offer Spectracell Micronutrient Testing.  This test looks at your nutritional status from a cellular level checking vitamins and minerals such as: B Vitamins, Vitamin K, Vitamin D, Selenium, Coenzyme Q10, Copper, and many more.  Test results come with repletion suggestions for foods or supplements and the appropriate dosing.

If you currently take any of these medications and want to know if you are nutrient deficient, we offer testing in our office through a company called Spectracell. You can call any of our offices to request Spectracell testing.


Dr. Melissa Miskell

There are hundreds of clinics attempting to treat hormone imbalance. What makes us different? We listen, then we take action. Our business model makes it possible for us to start your treatment on day one. Faster treatment = feel better faster.
Hormone Replacement Therapy in San Antonio, Waco, and Boerne

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