Wellness by Designs - Practitioner Podcast

Integrative Pharmacy Meets Nutrition: Insights from Jacqui Coote

• Designs for Health • Episode 115

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Explore the integration of conventional pharmacy and natural medicine with Jacqui Coote, owner of Whole Life Pharmacy in Brisbane. This episode delves into innovative approaches for digestive health, migraines, and mental wellbeing, combining pharmaceutical expertise with nutritional interventions. Discover evidence-based strategies for managing common health issues and learn about the importance of personalised treatment plans in integrative healthcare.

Episode highlights:

  1. Integrating natural medicine with pharmaceutical treatments
  2. Digestive health: Bitters, PHGG, and alginates for reflux and constipation
  3. Probiotics and antibiotic treatments: Focus on Saccharomyces boulardii
  4. Histamine intolerance and its connection to migraines
  5. Iron deficiency anaemia management: Beyond iron supplementation
  6. Personalised treatment plans in integrative pharmacy
  7. Interprofessional collaboration and patient advocacy
  8. Quercetin and fermented foods: Balancing for optimal health

. Tune in to gain valuable insights from her experiences and learn how you can access additional resources on the Designs for Health website.

About Jacqui
Jacqui is an experienced Integrative Pharmacist and Nutritionist with extensive experience in helping people with a variety of conditions through her work as a pharmacist and also in a clinic setting. She loves taking a holistic approach with clients and will bring the wisdom of medical science and complementary medicine together to find a solution to suit your needs.

Jacqui has been a sought after clinician for many years and enjoys a variety of clinical cases, including helping people with: Pain Management; Mood disorders; Insomnia; Digestive health (including Irritable Bowel Disease and Reflux) and optimising medication management. Jacqui runs a busy Wholelife Pharmacy and Healthfoods store and creates a warm and inviting space for people to continue their healing journey.

Shownotes and references are available on the Designs for Health website


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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health




Speaker 1:

Music. This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook. This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook. Joining us today is Jackie Coote, a pharmacist and nutritionist who owns the Whole Life Pharmacy in Strathpine, brisbane, and today we'll be discussing patient-centred care. Welcome to Wellness by Designs, jackie. How are you?

Speaker 2:

Very well, thank you for having me.

Speaker 1:

Thank you so much for taking time out of your busy day. I know how busy it can get in pharmacy, so I think, first to start off, did you do nutrition or pharmacy first? What drive you?

Speaker 2:

I did pharmacy first and, to be honest, I picked pharmacy because I loved science but I also loved people, so it seemed like a natural fit for me.

Speaker 1:

But I was very young, so I didn't know what I was getting into. Oops, what about nutrition then? Why go further into?

Speaker 2:

nutrition. It's not the obvious step that most people make, no, so it was definitely nothing that I'd ever really forward planned to do that either. But throughout my pharmacy journey I'd really grown to love helping people and that's what made my job rewarding. And it was actually my customers that wanted to know more about health, natural health, and how that would benefit them, and I really felt like I had to do further study to be able to answer those questions effectively and really make a difference in people's lives, and that's why I chose nutrition, but from a natural medicine perspective, because that's what I was interested in learning the philosophies behind natural medicine therapies and learning it from that perspective. So that's why I picked nutritional medicine rather than, you know, going into dietetics, for instance.

Speaker 1:

Gotcha yeah, gotcha Okay, but that's a big leap, like when you not sure about nutrition, but certainly naturopathy. It was a big leap for me from a paradigm perspective, if you like, to go from a disease model to a wellness model, or a rather instead of a diagnosis model to a problem solving model, if you like, with natural medicine. With natural medicine, Big issue for me like, instead of saying there's lupus, a naturopath would say there's a patient, their diagnosis is lupus, but they've got problems with their skin integrity and that's linked to gut dysbiosis and inflammatory markers and things like that. So, instead of tackling the diagnosis per se, a naturopath will tackle the body systems that are out of alignment if you like, are out of balance.

Speaker 2:

How did you? How did?

Speaker 1:

you grasp that?

Speaker 2:

um, I think well, I mean, I guess I live in both worlds, so I guess I still think both ways. But um, the more you see people and the more you delve into your own health journey as well, you realise that people are not just body systems or a disease, and we are complex beings. And you know it's not just about the process that's going wrong in that one little area, it's about the whole person. So I think it fits quite naturally once you start to think about, you know the, the things that can lead to disease, for instance, um, you know, even lack of sleep or living in such a stressful environment that you're not taking time to break that cycle and help your body to maintain its integrity, so to speak.

Speaker 1:

Um, yeah, I think it fits quite well hand in hand those two so so this need, or this, this interest, if you like, that drove you to study nutrition. It was indeed patient driven. It was the demands of the patients wanting more info. Yeah, what were they after?

Speaker 2:

uh well, I think at the time because I'm going back maybe at least 10 years probably, when I first started getting really interested in it, um, I'd say it was probably more digestive health was probably a big one at the time that really got me interested. But probably because I I think I had some of my own issues that I was like delving into as far as like, oh well, what could these probiotics do, for instance? It's a very simple thing, but you know, even back then I mean, they're way more complex now the research that's been done on probiotics. But back then there wasn't huge amount of choices, but even the few that were available I wanted to know a bit more about why you would pick one thing over another. So I started going to natural medicine conferences and I just found this whole other world and it was way more detailed and researched than I had been led to believe.

Speaker 1:

Basically, Same here. I went through that exact same discovery um what are the most common inquiries that you get from customers, patients that you feel you have the greatest impact on yeah, uh.

Speaker 2:

Well, I guess I'm in a fortunate position where people are walking through my door. I get to see hundreds of people every day, so there's a huge variety of things that people ask for help for. But I guess we see definitely a lot of digestive health issues is a really common one. Headaches and migraines and mental health they're probably three big ones that we see a lot of and they're three big ones that I feel works really well for integrative medicine and helping people with a natural option as well as whatever else they're doing. It can work in quite well with what they've been prescribed. It's really helpful being a pharmacist so I can have a look at their regular medications and provide advice on what is going to be safe to use with those combinations. But yes, I'd say they're the three big areas that I feel we can have big impacts in.

Speaker 1:

Sticky situation sometimes, though, in that you know it's not really our place, your place to sort of, take patients off medicines, that's the doctors. So sometimes, though, you get patients who start to refuse medication.

Speaker 1:

that may be, indeed, life saving refuse medication that may be indeed life-saving. So let's say and I know this is opening up I'm going to be kicked in the head for this, for suggesting that statins might even be of benefit to somebody. But it's not our place to necessarily take patients off statins, but if their lipid profile is such that it's low, then of course the doctor should be in the position, therefore, to say listen, maybe we can cease this, but let's if we take a step back. Do you actively say OK, doctors, put you on a statin. This is great for lowering blood cholesterol levels, but it doesn't look at this, this and this. Do you activate the the conversation or do you wait for the patients to activate the conversation?

Speaker 2:

Look, I probably more. So wait for the patient to activate the conversation, in the sense that pharmacy has been under a lot of scrutiny in the past with like, do you want fries? With that type of nutritional recommendations, you know, just definitely recommending certain things with each prescription. It's not really what I want to be seen to be doing, but I think I think the ideal scenario with with pharmacy is that we're going to be seeing people, usually on at least a one to two monthly basis, for instance, if they are on a medication. So it's about for me, developing that relationship with the person so that when they're ready to discuss, you know their health concerns, then I'm there to be able to step in and give that advice.

Speaker 2:

Um, so I, yes, I don't actively discourage. You know, yeah, I would be very quickly actively discouraged. You know certain prescriptions being filled or things like that. I don't take people off medication, but, um, no, I guess I like to think that, um, the relationship is the most important thing, so that when people are ready or they've got a query about something and they want to address it from a different perspective, then I'm well placed to help them.

Speaker 1:

Yeah, so conditions like if we go through. You mentioned digestive health, headaches and migraines, so actually let's start at digestive health, because it's a huge one. So are we talking about things like you know the old salt, you know the antibiotics with probiotics and things like that, or do you do your patients ask you about more complex issues?

Speaker 2:

Oh, yes, I mean yes, there is that I wouldn't want to say basic recommendation but it's a very common recommendation and a very necessary one with the antibiotics and probiotics, but I feel like we can help with more complex things. I think you know reflux is one very prevalent condition that we can have a huge impact with, and especially now that PPIs are becoming less popular from a medical perspective, because the side effects of long-term use of PPIs are actually becoming more well-known and seen. So I think that's a really good thing, because then people are coming in wanting to know what else they can try that isn't going to have those negative impacts. And I think you know digestive system, because anything we put into our mouths is touching our digestive system. It is actually a fairly easy system to have an influence on with natural medicine and diet, because you don't have to think about absorption and all those other things that make you know other formulations difficult to perhaps get into the body and get the effect that you're wanting to see with them um.

Speaker 1:

So can you give us a few examples here, though? So let's say you know ppis, you know that one of the classics is things like zinc carnosine, for instance, or even something nice and simple like slippery elm, as innocuous as that. These innocuous fibers, do you tend to favor anything one over the other, or do you use them concomitantly?

Speaker 2:

yeah, I mean digestive health. Yeah, often there is a few different things that you've got to consider and you know if something's going wrong at the top with like reflux, it's not often an isolated issue, like thinking about motility through the whole digestive tract. So if someone's constipated and they don't have good bowel movements and everything else is just not going to work as effectively as it should. But I would definitely consider each person individually, based on what their diet is. Are they drinking a lot of alcohol? What's their stress levels like? But as far as things that I commonly recommend, I do use bitters a lot to help because I think reflux it's not necessarily an acid issue like it's. It's more so an issue with the esophagus being too relaxed and letting things back up where where they really shouldn't. So I do find bitters work really well for constricting the esophagus to make sure there isn't contents refluxing.

Speaker 2:

Um, yeah, we use different fiber supplements. Uh, especially, we use a lot of phgg partially hydrolyzed guar gum um, because I think that has the dual benefit of improving the bacterial profile in the digestive tract as well as um, it can be helpful for both diarrhea and constipation, depending on the dosage. So I use that a lot different probiotics use a lot. Yeah, slippery arms still still widely used, but I probably more so go for the PHGG as something that I gravitate towards, unless there is, um, yeah, burning or something you want to help with coating of the digestive tract like, yeah, and what?

Speaker 1:

what about in the in the pharmacy realm? What about using the alginates at all as a raft antacid? Do you ever employ that with like after meals and so that people can afford some benefit from the actions of that?

Speaker 2:

Yeah, definitely. I mean, that's probably my go-to. If I was going to use an antacid, I'd use one with the alginate. Yeah, definitely.

Speaker 1:

Okay. So antibiotics. Now you know this is a huge issue and I've got to say I've now swung away from this use of probiotics or bacterial probiotics because of compliance. So I tend to just favour Saccharomyces boulardii with the antibiotic, because it's just. There's no issue with compliance. Let's take that with that at the time. You know what do you use, though at the time.

Speaker 2:

You know what do you use, though. Oh, I actually, yeah, I love Saccharomyces boulardii. I've always loved it, but I have moved away from using it, interestingly enough, to using, yeah, normal probiotics, which is it's just based purely on customer feedback and people coming back saying how good they felt on. You know different formulations of of probiotics, and I guess there are some some researchers out there saying that we don't really have to worry about timing, so just giving it at the same time as antibiotics now too, so that that seems to be working fine for people as well.

Speaker 1:

Fair enough, Any any particular genera or species that you've heard of.

Speaker 2:

I must admit I'm terrible at remembering all the specific bacteria.

Speaker 1:

So no, I won't, I won't guess, all right, so okay. So what about you know migraine headaches you mentioned previously? Now you know there's good evidence here. There's a lot of migraineurs that don't do well. Having said, these new calcitonin gene inhibitors are just a game changer, but still there is a section of the community that they just they still have, let's say, breakthrough migraines. What do you do to help these people?

Speaker 2:

Yeah, I actually feel like sometimes migraine is maybe misdiagnosed. To be honest, I think a lot of people have headaches that are called migraines, but I do believe it might be something else causing them. Yeah, but I like to take a full history with migraines. It is probably something I'd prefer to see in the clinic room rather than just a quick consultation, because I feel like it really depends on the person as to what I'm going to recommend. But I think something that I look for now, more so with migraines as well is someone's histamine tolerance or intolerance.

Speaker 2:

So I think a lot of people in the pursuit of being healthy can sometimes have things that may not be so. They are considered a health food, but they're not actually great for that particular person. So I think you know one example is a lot of kombucha or fermented foods. Yes, they've got great bacteria in there, but they also have a lot of histamines. So I, if I identify that someone's getting quite frequent migraines and they're having a lot of fermented foods, I trial a reduction or removal of those foods to see if that improves the frequency, and I might even look at using quercetin to help with the histamine response as well.

Speaker 1:

Yeah, and any particular dose that you use of quercetin um, I like to use.

Speaker 2:

Well, what is it it's about? I'm trying to think what the supplements dosage.

Speaker 1:

Anywhere between 200 to 600.

Speaker 2:

Yeah, I was going to say 400 to 600. I use that three times a day.

Speaker 1:

Three times a day About 12.

Speaker 2:

Cool, because I love Crescent. Yeah, it's actually. Oh yeah, well, it's actually very versatile nutrient as well, um, extremely extremely, um, okay, so uh, headaches.

Speaker 1:

mental health now, this is an interesting one. So I can remember when I worked full-time in a pharmacy and you know I saw my fair share of mental health issues and people seeking help from that. That was in an era where St John's Wort was the new kid on the block, if you like, and it was in favour. Since then there has been this whole evolution of nutritional, herbal means of helping people with mental health issues and it seems like St John's Wort has fallen out of favour in favour of things like Afron and, I'm going to say, other nerve irons have gone blank, forgive me, lemon, barn, passion Flower.

Speaker 2:

Lemon Barnons have gone blank, forgive me, lemon balm.

Speaker 1:

Lemon balm. Yeah, yeah, passion flower. What's been your experience of what helps and how in depth do you have to get, or do you have to delve with these patients' histories to sort of find out what might be some triggers?

Speaker 2:

these patients' histories to sort of find out what might be some triggers. Yeah, it's interesting because I think St John's has gotten a St John's wort had a bad rap just because of the interactions, you know, and but it is probably one herb that doctors do actually recommend people to use semi-regularly as a starting point before they put them on to medicinal antidepressants. So I think it still has definitely has a place. But yes, it does have more considerations with interactions and so on. But I guess, because a lot of people that I see are already on prescription antidepressants or other medications for mental health, then I love things that I know they can use together with with no issues. So I do use and recommend a lot of saffron and turmeric. You know, explaining that it's working in a different way. It's not just, you know, increasing serotonin, so there's not really that risk there of serotonin storm. But it is going to help people think more clearly because it's working more so with the bdnf, um and and I think a lot of people find that their pharmaceutical medication it is working but it's only really doing. You know one thing it's not helping them overall like it's quite narrow. So yes, they might be able to be, you know, get up and do the things that they need to do each day now, whereas before they were on the antidepressant they couldn't. But they still can't think clearly and they still lack motivation to, um, you know, think longer term and things like that. So that's where I find adding in those other herbs can be really beneficial. Um, you know, sleep patterns are often still disturbed. So, looking at magnesium and passionflower, california poppy all those things that work really well for that deeper sleep, um, you know, it's really good and and that's really improving their mental health as well, because they feel like they have a choice in what they are doing to support their mental health.

Speaker 2:

Yeah, and I mean, there's so many different conditions under that umbrella of mental health too. So we have a lot of population with ADHD. They might be on stimulant medication, but you know they're finding it difficult to relax at night time. So I love being able to use theanine. I don't really see any issues with using that with most things. It's and safe with children as well. So, yeah, there's, there's lots of options, and I think having options makes people excited as well, because customers often come to you because they feel like they've exhausted all the options and then you say oh hey, have you tried such and such?

Speaker 1:

and they're like no, no one's ever told me about that before well, it's such an important point you make because, um, I remember an example, um, of a child who was like he was weeping because he felt just so bombed out because of not the first dose in the morning, but it was a second dose at I think it was 10 o'clock or 11 o'clock, and he was saying, please, can we just put it back? Just put it back, that's all I'm asking. I'm not saying I don't want to take it, I'm just saying can we put it back till 12.01? And he was pleading with people who, of course, didn't listen. It was heartbreaking, you know, and if patients are offered or if they can talk to their pharmacist in an open manner with these things that may help their child, you know, god, what a different healthcare system we'd have. I mean seriously, just huge differences. So, l-theanine, I love your use of that, and particularly with kids, because it's safe.

Speaker 2:

It's big yes and it's not hard to give it either, as in it doesn't have the taste issues that a lot of things have either, you know, because you can get it in a powder. It's very easy to you know, adjust dosages and so on. So, yeah, I love the use of theine.

Speaker 1:

Well, practically on that note, what sort of dosages do you use? Obviously, this is something that is not a one-size-fits-all. What's your range of dosages that you use?

Speaker 2:

obviously, this is something that is not a one size fits all. What's your range of dosages that you use with ortho any uh, for kids or adults? Yeah, well, kids, I guess 100 milligrams is probably where I'd start, but you can go higher depending on the age of the child and the circumstances. But yeah, I'd probably start with 100 milligrams.

Speaker 1:

And adults.

Speaker 2:

Adults, I'd start with 200 milligrams a few times a day, depending on what you're actually trying to achieve with it. But yeah, but I also, being a pharmacist every person that I see I usually just do a quick double check of my resources before I decide on a dose. So yeah, I'm always double checking things, yeah.

Speaker 1:

Okay, and with mental health issues like, for instance, so anxiety, for instance, and people who are just absolutely worn out and so they're in this constant sympathetic drive. Is there anything that you favour using in these people?

Speaker 2:

I actually love using ashwagandha in those people.

Speaker 1:

Okay.

Speaker 2:

And then, depending on whether they're, you know, struggling for energy or not, you know you can add in the b vitamins, but sometimes I don't always use b vitamins. I do find ashwagandha very versatile, um. And then again, just looking at their ability to relax at night time, um, that's where I would use, you know, magnesium formula. If they are struggling with sleep or just feeling anxious at night time, you know magnesium formula would be is usually really good as well. But yes, I do like using ashwagandha with them.

Speaker 1:

Gotcha Jackie. Can I ask because I've seen this is just such a huge issue in pharmacy the amount of women particularly, but not solely. But let's just concentrate on the female population, because it's known just how many women suffer from iron deficiency, anemia, and they have real issues getting their iron up like real issues. Is it iron that's the issue? I actually don't think it. It iron that's the issue.

Speaker 2:

There's a I actually don't think it is iron.

Speaker 1:

That's the issue, yeah, so let's delve into this. How do you navigate this? What do you use?

Speaker 2:

Look, putting you on the spot here with this one. It's more just what I've been thinking about. I haven't really researched it, to be honest, but just knowing how the body sequesters iron when it's under attack, say, for instance, with an illness, you think you start to question what long-term stresses is the body under that might be causing it to not, you know, have iron readily available like it should? That's kind of where I've been thinking. Yeah, as far as like how to actually help, I can honestly say I haven't really gone too far into it except to think about maybe. You know You've got me thinking now.

Speaker 1:

Yeah, yes, so you're thinking about the possibility of hepcide and being activated in not just iron insult but also infective insults or stressor insults.

Speaker 2:

Yes, right.

Speaker 1:

But I haven't insults, yes.

Speaker 2:

Right, but I haven't researched it.

Speaker 1:

My next bit project.

Speaker 2:

It's just the way my brain goes with it.

Speaker 1:

No, that's really good, that's really interesting. I'll look into that. That's cool. So, jackie, what else? What else do you use nutrition for? What do you commonly sort of see in the pharmacy?

Speaker 2:

that are the big issues facing people oh, there's so many, I think, constipation, and it's very, yes, constipation. I think people very rarely just have one issue too. They, more so, have more than one. So it's, you know, you can. You can go in thinking I'm going to treat this person, you've got the best protocol or recommendation for constipation, but then they'll throw the oh no, I'm allergic to this or I can't tolerate this, and then you have to reinvent your whole. So that's why you can't just go in with like a rule book, for instance, of X, y, z patient has these symptoms, give this supplement, because everyone is so different. And I think that's why I loved nutrition, because it was almost more creative. You've got to be creative to help the individual because you can't just go by a textbook or a rule book because everyone is so different with it.

Speaker 2:

Yeah, but I think, yeah, I mean constipation. We see all the time Diarrhea is actually kind of a fun one to help people with, because it's probably more has such a huge impact on people's social lives. Uncontrolled diarrhoea, then constipation is difficult but it's, you know, more easily managed. I feel like people that have chronic diarrhea is something I feel like a challenge to help people with, because often it's, you know, figuring out the cause of why the body is doing that, and there's multiple reasons why it could be that. Um, and there's multiple reasons why it could be. Um, yeah, I mean, uh, hormones, I feel like I can see you've got the ruth tricky book in the background there.

Speaker 2:

I'm about to reread that because I feel like I need to brush up on. I've got so many, um, you know, perimenopausal and menopausal women that really, really, really want help and I feel like I need to relearn that whole textbook.

Speaker 1:

But yes, they're very common yes. So, yes, okay. So what about? We're talking about people who are very often on medications. You get them to come in. Potentially, you'll say listen, this is complex. We need to have a consult. That may require some dialogue with the medical professions and indeed other professions. How do you respectfully interact with these other professions, because they come from a paradigm where very often they don't believe in nutrition?

Speaker 2:

I think yeah, I think you'd be surprised, though I think a lot of doctors really well, I mean, there's lots of different practitioners we're talking about here, but I think the one I find the most scary to interact with is, you know, doctors, because they do have a respect and a they do, they have done a lot of training to get where they they are, so you don't really want to go against their opinions. So, um, I guess you know what you can do to consult the practitioner. But I think if you do really believe that something strongly should be changed, then you have to write them a letter or give them a call. But I think patients also advocate for what they want. So, you know, I've had people that definitely want to come off medications and I haven't initiated that.

Speaker 2:

That that's what they've come to me wanting help with, and I, you know, tell them.

Speaker 2:

Well, you really definitely need to talk to your doctor about that, because for a number of reasons firstly, they need to be overseeing that, but also, if the doctor keeps prescribing a prescription, thinking that a person is taking it, and then they see them down the track and their condition is worse and they need to know that they haven't been taking that medicine. So, yes, I think I think at the end of the day, we are all people and I think having the ability to just, you know, write letters and pick up the phone, it will surprise you how well you can actually collaborate together, because a lot of times these people have been seeing the doctors and the doctors have actually run out of ideas. So they're actually thankful for, you know, a different perspective on what could be tried, and if the patient's coming and saying that they're getting results from that, then they're often happy to continue. But I think they just want to be informed and know that that's what's happening and I think definitely they should be informed of that.

Speaker 1:

Gotcha Jackie.

Speaker 2:

But as far as working with like natural, as far as other natural medicine practitioners working together, I think that's fantastic and shouldn't really come with too many issues you would hope. I mean I have a naturopath on staff, and I really enjoy collaborating with her too.

Speaker 1:

Right, okay, jackie, there's so much more that we could learn from you, but thank you so much for taking us through some of the essentials that you see in community pharmacy, helping your patients to achieve better health outcomes. I really do appreciate your work. I mean, you've done this for over a decade, I know, but to see your growth and your confidence in what you do, you have become a real, you know, a stalwart, if you like, a vanguard for patient health and patient advocacy in your community. So thank you for all the work you've done over the years.

Speaker 2:

Thank you, thank you for having me and thank you for all the work you've done over the years, thank you.

Speaker 1:

Thank you for having me and thank you everyone for joining us. Remember you can catch up on all the podcast notes. We'll try and put as much information as we can up there on the Designs for Health website and, of course, all the other podcasts. I'm Andrew Whitfield-Cook. This is Wellness by Designs Music.