Being a hormonal condition, PCOS affects many parts of the reproductive system and can cause disruption to a woman’s “menstrual cycle, skin and hair, as well as causing cysts to develop on the ovaries”.¹ According to Healthdirect, PCOS is “one of the leading causes of infertility, yet many people don’t know they have it – many females with PCOS aren’t diagnosed”.¹

No cure for this condition currently exists, making effective management crucial. One of the aims of PCOS management is health outcome control, which often includes diet and healthy lifestyle advice, plus counselling support, as well as guidance around appropriate medications to manage fertility issues and surgery.³

PCOS signs and symptoms
The signs and symptoms of PCOS may vary between women, but typically include:

• Irregular periods or no periods.
• Hair growth on face, stomach and back.
• Loss or thinning of scalp hair.
• Acne that can be severe.
• Weight gain.
• Emotional problems (anxiety, depression, poor body image).
• Difficulties becoming pregnant.
• Increased risk of type 2 diabetes, with earlier onset.³

New international PCOS guidelines
Given its wide-ranging health effects, effective PCOS management often requires a multidisciplinary approach and up-to-date management guidelines for health professionals to follow.

To improve the lives of those living with PCOS, a Monash University-led partnership has developed international guidelines: the ‘2023 International Polycystic Ovary Syndrome Guidelines’.

These include recommendations for diagnosis, lifestyle, wellbeing, fertility and treatment, as well as improved care and support. They aim to address the priority needs of those with PCOS and are supported by significant freely available resources for women and their healthcare providers, to optimise health outcomes. They also address the need for new approaches to care, personalised healthcare experiences, evidence-based therapies, and optimised pregnancy care.

Monash University’s Professor Helena Teede, a leading global academic in PCOS and the driving force behind the new guidelines, says they highlight priority areas such as higher weight gain, diabetes and heart disease risk, and effective treatments, including those for infertility.

“The guidelines bust myths around higher weight and lifestyle and seek to support those with PCOS and reduce stigma,” she said. “Australians are exposed to an environment that drives rapid weight gain due to failures in policy, regulation and financial constraints, with women with PCOS at even higher risk.

“The focus is often on ineffective individual behavioural solutions, further impacting health and fertility. Limited access to effective therapies and fertility services leaves women with poorer health outcomes, especially [those in] underserved populations, presenting a health equity issue.”

The new PCOS guidelines aim to deliver timely diagnosis, accessible information and education, support, and optimal models of care. They also aim to enhance healthcare professional education, awareness and support, while fostering partnerships and shared decision-making with those affected by PCOS globally.

For more information and to access the guidelines, visit:

References 

1. healthdirect.gov.au/polycystic-ovarian-syndrome-pcos
2. racgp.org.au/newsgp/clinical/pcos-guidelines-shine-light-on-neglected-condition
3. jeanhailes.org.au/resources/pcos-fact-sheet

Full Article availalble in Retail Pharmacy December magazine

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NSW Health describes integrated care as the provision of seamless, effective and efficient care that reflects the whole of a person’s health needs, from prevention through to end of life, across physical, psychosocial and mental health, and in partnership with the individual, carers and family members.

GP staff shortages, particularly in rural and remote Australia, an ageing population, and an increase in medicine use are among the major challenges affecting healthcare.

This is an opportune time for a review of how health professionals could work more effectively together to improve the care Australians receive.

A more integrated healthcare approach may be the solution and is one being explored through an independent review recommended by the federal government’s Strengthening Medicare Taskforce.

‘Unleashing the Potential of our Health Workforce’, an independent review led by Professor Mark Cormack, will examine opportunities and obstacles in Australia’s health professionals working to the full scope of their practice.

The government recognises that health professionals working to their full capability can significantly benefit both patients and the healthcare system.

For pharmacists, working to their full scope of practice means they add to health system capacity through helpful services within their pharmacies and working with other health professionals across different health settings. Their accessibility in the community is also key to the effective integration of their services into primary healthcare settings.

Medicine management 

Pharmacists are the custodians of medicine safety, not only in community pharmacies, but also in hospitals, aged care facilities, general practices, Aboriginal Community Controlled Health Organisations, and as independent consultants.

“We know that complex medicine use is on the rise, that more Australians are hospitalised due to medication misadventure, and that these trends will continue as our population ages,” PSA National President Dr Fei Sim said. “Allowing all pharmacists to work to our top of scope is critical to reducing medicine harm across the health system.”

According to the Society of Hospital Pharmacists of Australia (SHPA), collaboration is key to medicine safety.

SHPA Specialty Practice Chair Dr Minyon Avent says antimicrobials are life-saving medications, but not without risk.

“Pharmacists need to work with doctors and nurses to ensure they know how to optimise antimicrobials,” she said. “Every pharmacist has a role to play to ensure that the right antibiotic, at the right dose, for the right duration, is applied for every patient. Pharmacists play a vital role in optimising antimicrobial therapy, which can minimise antimicrobial resistance, preserving the longevity of antibiotics as a reliable and effective treatment.”

Dementia 

Dementia Australia CEO Maree McCabe says pharmacists play a critical role in the health of people living with dementia, adding that the organisation supports recommendation 38 (‘Residential aged care to include allied healthcare’) from the Royal Commission into Aged Care Quality and Safety, and the proposed measure of locating an on-site pharmacist in every residential aged care facility.

“As an important member of the aged care multidisciplinary team, we believe an on-site pharmacist will play a valuable role in ensuring the safe and appropriate prescribing, monitoring and administration of medications in residential aged care,” she said.

“Pharmacists play a role in creating dementia-friendly communities. This includes pharmacies that are accessible and welcoming to people living with dementia, their families, and carers. We encourage all pharmacists to find out more about how they can work towards becoming a dementia-friendly pharmacy by visiting our website or calling the National Dementia Helpline.”

Generally, a pharmacist provides a medication management review every two years. However, by being present in the aged-care facility, pharmacists can undertake on-the-spot medication reviews and follow-up based on resident needs, improving the safety and care of residents.

The PSA’s residential aged care pharmacist foundation training program is available as a short online CPD training course.

GP body backs collaboration on diabetes

The Royal Australian College of General Practitioners has urged the federal government to boost investment in general practice to provide more time to care for people with diabetes, with RACGP President Adjunct Professor Karen Price saying coordinating care with other health professionals is also important in such complex chronic conditions.

The Department of Health and Aged Care’s Workforce Incentive Program offers financial incentives to practices across Australia to do this, she adds, which could enable practices to work more closely with allied health professionals such as general practice-based pharmacists.

According to Professional Pharmacists Australia, the definition of ‘allied health professionals’ now includes non-dispensing pharmacists who may undertake a range of activities, including medication reviews, patient and staff education and responding to medicine information queries, but not dispensing.

“By incorporating the pharmacist role within the general practice setting, we can offer an alternative model that delivers integrated care, something that’s especially important for people with diabetes,” Professor Price said, adding that this would make a real difference in communities nationwide, especially those disproportionately affected by this condition, such as Aboriginal and Torres Strait Islander people.

Embedding pharmacists into Aboriginal community-controlled health services under the ‘IPAC Project’ has been effective in improving the health of Aboriginal and Torres Strait Islander peoples, including those with conditions such as diabetes, according to Mike Stephens, Director, Medicines Policy and Programs at the National Aboriginal Community Controlled Health Organisation.

Apart from GPs, pharmacists can collaborate with many other health professionals to support the continuity of education and messaging around health conditions.

Associate Professor Liz Marles, Clinical Director at the Australian Commission on Safety and Quality in Health Care, says this is important to dispel myths and support shared decision-making.

“Patients with low back pain are often treated across different healthcare disciplines and can receive conflicting advice,” she said. “Pharmacists can reinforce key messages and reassure patients.”

Adam Monteith, Director and musculoskeletal physiotherapist at Evoker, gives the example of bone health, where collaboration between healthcare professionals allows for a patient-centred approach – a comprehensive assessment through physicians, pharmacists, orthopaedic specialists, and nutritionists.

“In this way, every avenue and facet required to ensure a complete assessment and treatment plan is investigated,” he said. “This allows for early detection of any conditions affecting bone health and thus affords individuals the opportunity to intervene early. Early intervention via tailored treatment from nutritionists, physiotherapists, physicians and other medical professionals who openly collaborate allows for improved continuity of care, and a seamless transition for patients across various healthcare settings.”

In-pharmacy services 

Diabetes patients can access services in pharmacy such as the diabetes MedsCheck, a consultation that provides education and review on medications.

Another successful development in pharmacies has been the take-home naloxone program supporting patients taking prescription opioids. PSA notes that in its first year of national availability, beginning July 2022, the program saved around 3000 lives.

“The role of pharmacists has expanded significantly in recent years, from delivering a wider range of vaccines to the extended supply of oral contraceptives and pharmacist-initiated treatment for urinary tract infections,” Professor Sim said. “These initiatives are critical to ensure Australians can continue to access timely primary healthcare.”

• Screening and triaging 

They can also play an important role in screening for conditions. For example, Professor David Hunter, Florance and Cope Chair of Rheumatology and Professor of Medicine at the University of Sydney, says pharmacists play a very important role when it comes to arthritis –  by screening for the disease and triaging to appropriate health services.

In 2019, University of Technology Sydney researchers evaluated a consultation service for community pharmacists to triage, manage and appropriately refer patients to doctors for common ailments, such as coughs and colds, through agreed referral pathways for the first time in Australia.

It found that patients were 1.5 times more likely to receive an appropriate referral by their pharmacist and were five times more likely to adhere to that referral advice and seek medical practitioner care within an appropriate timeframe (20 per cent of all patients were referred).

• Lifestyle advice 

Many health professionals agree that the accessibility of pharmacists in the community makes them a key point of contact for patients seeking help with their health conditions.

Aside from advising on dosage and educating about possible side effects of medication, pharmacists can offer lifestyle recommendations.

“With cost-of-living pressures, pharmacists have an important role to play in providing accessible, affordable frontline healthcare and healthy lifestyle advice for our community,” a Blooms The Chemist spokesperson said, adding that the group’s outlets can, for example, assist patients with their quit-smoking journey, with information on nicotine replacement therapy and to help create a quit-smoking plan.

• Health promotion 

Pharmacists can also engage in health promotion within the pharmacy, for example by actively promoting wellbeing events and awareness events such as Bowel Cancer Awareness Month.

References: 

1. Department of Health and Aged Care. ‘Have your say on how to unleash the potential of our health workforce’.
2. NSW Health. ‘NSW Pharmacy Trial’. health.nsw.gov.au/pharmaceutical/Pages/community-pharmacy-pilot.aspx
3. Society of Hospital Pharmacists of Australia. ‘Collaboration is key as hospital pharmacists spotlight medicines safety’.
4. Dementia Australia. ‘Immediate coordinated action needed to save lives of people living with dementia’.
5. Pharmaceutical Society of Australia. ‘Pharmacy Fact Sheet’. psa.org.au/wp-content/uploads/2023/09/2023-World-Pharmaicst-Day-Pharmacy-Fact-Sheet.pdf

This feature was written by Tracey Cheung and was originally published in the November issue of Retail Pharmacy magazine. 

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The symptoms of rosacea can come and go, resulting in flare-ups.¹

Flare-ups can be caused by triggers such as excess sun, stress, foods, allergies, medications, etc.⁶

There has also been some suggestion that genetics may play a role.^1,3

No cure for rosacea exists but there are many symptomatic treatments available, including lifestyle factors to prevent flare-ups.

Symptoms 

Rosacea presents as reddened skin across the nose and cheeks and may also affect the eyes. The condition may initially display as a facial blush or flush of the nose and cheeks, which can go away, then may progress to longer-lasting redness with the appearance of a rash and small blood vessels beneath the skin.¹

If this is left untreated, the skin can thicken, leading to firm red bumps (generally on the nose) and may also lead to eye damage or vision loss if eye symptoms are left untreated.⁴

The main symptoms of rosacea include:

• Facial redness, which can begin as a flush or blush.
• Rough scaly skin.
• Rash.
• Visible blood vessels.
• Skin thickening (generally on the nose and mainly affects men).
• Eye irritation.
• Patients can complain about burning, hot, stinging, itchy skin.

Treatment options 

Treatment depends on the type of diagnosed rosacea. It can include topical or oral treatment together with lifestyle modifications. The topical therapies that may be prescribed are metronidazole, brimonidine, ivermectin and azelaic acid, whereas oral treatment can consist of doxycycline, minocycline, erythromycin, or isotretinoin.⁵

Lifestyle modification

• Avoid triggers, which may include hot drinks, spicy food, dairy products, sun or wind, red wine, cosmetics, exercise, and hot baths or showers.²
• Wear sunscreen (broad spectrum, SPF30-plus).
• Avoid abrasive and fragranced face washes and moisturisers.
• Avoid sun exposure and heat.
• Limit alcohol use.

General measures

Patients must be advised of general measures for the treatment of rosacea before they try a medicated treatment.

If treatment is sought for cosmetic reasons (reducing the appearance of redness and inflammation), azelaic acid is available over the counter.³

Ensure referral to a doctor or dermatologist for first-time presentations and severe or refractory forms.

What can pharmacists recommend for patients with rosacea?

• Azelaic acid. This has been shown in a study to be effective in about 18 per cent of people for reducing inflammation associated with rosacea.⁸ It’s also effective at preventing pores from becoming blocked. In this study, azelaic acid was used on the affected areas twice daily, morning and evening.⁸
• A non-abrasive, fragrance-free facial cleanser and moisturiser.
• Minimising sun exposure and using a low-irritant broad-spectrum sunscreen (SPF30 or higher).²
• Avoiding topical corticosteroids, which can cause a rebound flare-up.⁵
• Green tinted moisturiser, to help mask redness (if patient desires).
• Referral to an eye specialist If the eyes are affected.

Differential diagnosis 

• Acne – can be experienced simultaneously.
• Seborrheic dermatitis – similar presentation with redness but often presents with scaling around the eyebrows, nose and scalp.
• Keratosis pilaris – can be experienced simultaneously. Genetics related. Fixed blush appearance with fine keratotic plugs, which can also affect the upper arms, upper thighs, buttocks and cheeks.⁷
• Periorofacial dermatitis – inflammatory papules around the mouth, eyes and nose. Generally caused through prolonged use of potent topical corticosteroids on the face.

References: 

1. rosacea.org/patients/all-about-rosacea
2. ncbi.nlm.nih.gov/pmc/articles/PMC6281021/
3. racgp.org.au/afp/2017/may/rosacea
4. niams.nih.gov/health-topics/rosacea
5. tgldcdp.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Dermatology&topicfile=c_DMG_Rosacea_topic_1&guidelinename=auto&sectionId=c_DMG_Rosacea_topic_1#c_DMG_Rosacea_topic_1
6. betterhealth.vic.gov.au/health/conditionsandtreatments/rosacea#complications-of-rosacea
7. healthline.com/health/skin/keratin-plugs#appearance
8. ncbi.nlm.nih.gov/books/NBK279475/

This feature was written by Rebecca Miltiadou and was originally published in the November issue of Retail Pharmacy magazine. 

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Thunderstorm asthma events are triggered by high grass pollen and certain types of thunderstorms, during which tiny pollen grains from grasses can be swept up in the wind and carried long distances. Pollen is then breathed in and can trigger asthma and asthma attacks.¹

People with the highest risk of developing thunderstorm asthma are those sensitive to grass pollen and who have seasonal hay fever. Those affected by both hay fever and asthma can suffer severe asthma attacks during the grass pollen season. Also, those who experience wheezing or cough with their hay fever can be especially affected during this season.

People should watch out for symptoms and get tested for rye grass pollen allergy if they’re concerned, according to a media release from Asthma Australia CEO Michele Goldman.

“If in doubt, you should see a doctor and ask about thunderstorm asthma and how to get tested for rye grass allergy,” she said.²

Management 

Ensuring that patients have an asthma action plan or hay fever treatment plan in place is essential to ensure preparedness for treating their asthma and recognising when it’s getting worse.

Ms Goldman says that, additionally, being aware of asthma first aid is important in recognising when an asthma attack may be taking place.

“This season could bring many storms, so please learn asthma first aid and how to recognise an asthma attack,” she said

“Tight chest, difficulty breathing, gasping, wheezing, puffing when speaking, and persistent coughing are all signs someone can’t breathe well.”²

Treatment 

Having access to preventer and reliever medication during thunderstorm asthma season is vital to help control asthma symptoms and asthma attacks. Preventer medication works by averting asthma symptoms, while reliever medications are fast-acting medicines that work to relieve asthma symptoms caused by asthma triggers.³

“Asthma Australia strongly recommends anyone who suspects they have hay fever to discuss their symptoms with their doctor or pharmacist,” Ms Goldman said. “A few months of evidence-based preventer treatment could mean the difference between good health and a catastrophe.”²

High reliance on reliever medications means the symptoms of asthma are treated but not the cause. Therefore, the use of preventer medication is important.

National Asthma Council Australia Director and respiratory physician Professor Peter Wark emphasises that preventer medication should be taken for optimal asthma control.

“Good asthma control is critical during thunderstorm asthma season, so keep taking your preventer medication as prescribed by your doctor,” he advised.

“Most people with asthma over the age of six years should be using a preventer to keep their asthma under control. A blue reliever inhaler doesn’t stop the inflammation that causes asthma and will not prevent an asthma attack.

“If you need a reliever more than a couple of times a month, you should be taking a preventer, and in spring and early summer, and if you’re going to be in an area where there is ryegrass pollen, make sure you talk to your doctor.”

Intranasal corticosteroid sprays are important in the treatment of hay fever and work to reduce the symptoms of nasal inflammation, congestion and runny nose. When used regularly, intranasal corticosteroid sprays are effective in preventing swelling and mucus production.⁴

Professor Wark advises those affected by hay fever that regular use of a nasal corticosteroid spray every day, at least during pollen season, is the best treatment to control allergy symptoms.

“Hay fever can cause upper and lower airway inflammation and result in itchy watery eyes, runny nose and sneezing, but even more concerning, hay fever can lead to an increased risk of serious asthma flare-ups,” he said.⁵

Learn more about asthma first aid: nationalasthma.org.au/asthma-first-aid 

References:

1. Asthma Australia. ‘Asthma Triggers’. 2021. org.au/triggers/thunderstorm-asthma/
2. Asthma Australia. ‘Find out if you are at risk of thunderstorm asthma’. 2022. org.au/about-us/media/find-out-if-you-are-at-risk-of-thunderstorm-asthma/
3. Asthma Australia. ‘Medicines’. 2021. org.au/medicines/
4. Australian Allergy Centre. ‘Nasal sprays and management of allergic and non-allergic rhinitis’. 2015. com.au/nasal-sprays-and-management-of-allergic-and-non-allergic-rhinitis/
5. National Asthma Council. ‘Time to prepare for thunderstorm asthma’. 2022. nationalasthma.org.au/news/2022/time-to-prepare-for-thunderstorm-asthma

This feature was originally published in the November issue of Retail Pharmacy magazine. 

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Thyroid issues usually occur when the gland becomes overactive (hyperthyroidism) or underactive (hypothyroidism). An incorrectly functioning thyroid can lead to hormones not being regulated properly.

Pharmacy plays an important role in the management and correct use of thyroid medications.

Role of the thyroid

The thyroid gland is an integral part of the endocrine system, responsible for hormone production. The hormones it produces help control the body’s metabolic processes. These hormones are thyroxine (T4), triiodothyronine (T3) and calcitonin.

The main hormone produced by the thyroid is T4, which is then changed into T3, the active thyroid hormone.² T4 and T3 help to control energy levels, body temperature, metabolism, the health of muscles and bones, and brain development.² Calcitonin aids in controlling the amount of calcium and phosphate within the body.

Thyroid issues 

Common thyroid issues include:

• Hyperthyroidism.
• Hypothyroidism.
• Graves’ disease.
• Thyroid nodules.

Hypothyroidism occurs when the thyroid gland is underactive, meaning it fails to produce enough hormones. Symptoms can include sensitivity to the cold, fatigue, dry skin, constipation, weight gain, depression, irregular periods, swollen face and difficulty becoming pregnant. Hypothyroidism is treated through thyroxine replacement therapy.²

Hyperthyroidism occurs when the thyroid is overactive, meaning that hormones are overproduced. Hyperthyroidism is most commonly caused by Graves’ disease, an abnormality in the immune system.³ The symptoms of Graves’ disease include thyroid eye disease, eye swelling and coarsening, and reddening of the skin on the shins. Hyperthyroidism can be diagnosed through a blood test that measures the levels of thyroid hormones within the body.³

Thyroid nodules are solid fluid-filled lumps, formed within the thyroid, that can cause hyperthyroidism. In most cases, thyroid nodules are not serious. However, a small percentage of them can be cancerous or cause the increased production of the T4 hormone.⁴ This can cause weight loss, increased sweating, tremors, nervousness and rapid and irregular heartbeat.⁴ 

Iodine deficiency and supplementation 

Iodine, an important element in the proper functioning of the thyroid gland, is present in seawater and within the soil. In Australia, a relatively low level of iodine is found within the soil where food is grown and livestock grazes.⁵

Iodine deficiency is the most common cause of thyroid disorders and occurs when not enough iodine is present in the diet. Such deficiency can cause hyperthyroidism, due to the thyroid becoming enlarged.⁵ Iodine can be found within iodine-enriched foods such as dairy products, seafood and iodised salt, and in iodine supplements.

“To protect your family from iodine deficiency and the consequences of a sluggish thyroid function, ensure you include iodine-enriched foods on your shopping list,” Australian Thyroid Foundation CEO Beverley Garside said.⁶

The thyroid hormone has a particularly important role in the normal development of the brain and nervous system before birth, in babies, and in young children.⁷ Taking 220µg per day of iodine is recommended for pregnant women and 250µg per day for breastfeeding mothers.⁷ The National Health and Medical Research Council recommends that all women who are pregnant, breastfeeding or considering pregnancy take an iodine supplement of 150µg per day.⁷

Medicines 

In the management of thyroid issues, medication plays an important role. Thyroid medications work through either replacing the missing hormone in the case of hypothyroidism or blocking the hormone product in the case of hyperthyroidism to prevent the body from producing too much of the thyroid hormone.⁸

There is no cure for hyperthyroidism. However, it can be managed through several medications that block hormone production in the thyroid gland. All these medications are covered under the PBS, but some brands cost more than others.⁸

For those diagnosed with hypothyroidism, medicines are usually prescribed to replace the hormones. Levothyroxine is commonly used to replace the T4 hormone, and liothyronine is used to replace the T3 hormone.⁸ Multiple different brands of levothyroxine tablets are available, but not all brands can be substituted, and some need to be stored in the fridge. Ensuring patients are aware of this is important for the correct use and storage of the medicines.⁸

References: 

1. Hormones Australia. ‘Thyroid gland’. 2023. hormones-australia.org.au/the-endocrine-system/thyroid/.
2. ‘Thyroid gland’. 2023. healthdirect.gov.au/thyroid-gland.
3. Better Health Channel. ‘Thyroid – hyperthyroidism’. 2011. vic.gov.au/health/conditionsandtreatments/thyroid-hyperthyroidism#graves-disease
4. Mayo Clinic. ‘Thyroid nodules’. 2022. org/diseases-conditions/thyroid-nodules/symptoms-causes/syc-20355262.
5. Australian Thyroid Foundation. ‘Iodine Deficiency’. 2023. org.au/Iodine-Deficiency.
6. Australian Thyroid Foundation. ‘Avoid Iodine Deficiency with Healthy Food Choices’. thyroidfoundation.org.au/news/13186421.
7. National Health and Medical Research Council. ‘Iodine supplementation for pregnant and breastfeeding women’. 2010. gov.au/about-us/publications/iodine-supplementation-pregnant-and-breastfeeding-women#block-views-block-file-attachments-content-block-1.
8. ‘Thyroid medicines’. 2023. healthdirect.gov.au/thyroid-medicines.

This feature was originally published in the November issue of Retail Pharmacy magazine. 

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The signs include heartburn, acid regurgitation into the throat and difficulty swallowing.

Reflux can strike when stomach acid rises into the food pipe (oesophagus) and sometimes the throat. A band of muscle, the sphincter at the top of the stomach, normally lets food into the stomach while also stopping food acid from going back up the oesophagus. However, when the (sphincter) at the top weakens, it doesn’t close properly, enabling stomach acid to go up.

While it’s not a pleasant experience after having just finished a delicious meal, it can also be very disruptive and affect quality of life, especially if it is in the more severe form. The condition must be managed well and as early as possible.

Symptoms 

Heartburn is one of the main symptoms of GORD, which feels like burning pain in the chest and feels worse after eating heavy meals or lying down.

Other uncomfortable symptoms of GORD include chest pain, wheezing, a persistent cough, painful swallowing due to ulcers in the oesophagus, vomiting, burping, bloating, bad breath and tooth decay.

Complications of untreated or poorly treated GORD 

The complications that can occur if GORD is not managed or treated include scarring and narrowing of the oesophagus, which can affect the ability to swallow, ulcers and, in a minority of cases, an increased risk of cancer.

Other GORD-related issues include tooth decay, chronic coughs, sinusitis, and vocal cord inflammation.

Causes of GORD

Most causes of GORD are related to a weakening of the lower oesophageal sphincter. Although the exact reason for this is unknown, it’s more likely to happen in people with higher pressure in the abdomen (belly), such as those who are overweight or pregnant.

Pregnancy and the associated changes in hormone levels and pressures in the stomach mean these women have a higher chance of having GORD.

People with a hiatus hernia, where part of the stomach slides up through the diaphragm into the chest, may also have a higher risk of GORD.

Those who suffer from stress or take certain inflammatory medications such as ibuprofen may also have a higher risk of GORD.

Other medical conditions that affect the lower oesophageal sphincter and may have an increased risk of GORD include diabetes and some connective tissue diseases.

Large meals and certain foods can trigger symptoms of GORD, as this makes the stomach expand, making reflux more likely. These include caffeine, alcohol, spicy foods, fatty foods, and tomatoes.

Treatment

Treatment for reflux depends on the severity and frequency of symptoms or if there are any complications. Most people will experience temporary reflux symptoms in their life.

• Lifestyle

Accredited Practicing Dietitian (APD) Jacinta Sherlock recommends the following changes:

• Small meals and snacks to limit the volume of food in the gut.
• Ensure ample time between the last eating episode and sleep to allow for adequate digestion.
• Limit highly processed foods, limit foods high in fat, and limit carbonated beverages, caffeine, and alcohol.
• Avoid tomatoes, citrus fruits, and fruit juices.
• Avoid known triggers, which may be gluten and dairy for some people.
• Routine elimination of foods isn’t recommended.

If people are making changes to their diet, it is recommended to consult an APD to ensure nutritional adequacy and prevent any nutrient deficiencies.

Elevating the head of the bed may be helpful to reduce reflux. Tobacco smoke and alcohol irritate the digestive system, so reducing these habits may assist with alleviating symptoms.

Being overweight can contribute to reflux and losing weight as according to a paper published by the Australian Prescriber, this has the strongest evidence for efficacy.

• Over the counter 

If diet and lifestyle changes alone cannot sufficiently control mild intermittent gastro-oesophageal reflux symptoms, then over-the-counter antacids or H2 receptor antagonists are available to try.

• Proton pump inhibitors

If these do not provide adequate relief, then a visit to the GP may be helpful to assess whether the symptoms are of GORD, after which the doctor may prescribe drugs called proton pump inhibitors (PPI), which reduce the amount of acid the stomach makes.

Treatment should be combined with recommended lifestyle changes, particularly weight loss.

Ms Sherlock explained: “Over-the-counter treatments may aid in the short-term management of symptoms. However, research advises against the long-term use of over-the-counter treatments, as they don’t address the underlying dysfunction in the gut. The body naturally wants to return to homeostasis, and we want to identify why this isn’t occurring. Looking towards lifestyle changes, what I would term medicinal living, also known as natural solutions over pharmaceutical interventions, would be the first line of recommendations in both short-term and long-term management.”

Surgery is only required in a small percentage of cases. Dr George Babalis, a bariatric (weight loss) and upper gastrointestinal surgeon, said: “Acid reflux surgery is beneficial if patients do not respond to medication, experience side effects from anti-acid medications, or prefer to undergo surgery than take medication on a lifelong basis.”

Prevention 

Ms Sherlock explains that as reflux occurs in response to ineffective relaxation of the lower oesophageal sphincter, dietary solutions alone are unlikely to prevent reflux. However, they can be used to help reduce the symptoms someone is experiencing.

Role of pharmacists

If a patient’s reflux presents with weight loss, difficulty or pain in swallowing, or vomiting of blood, a referral to a healthcare provider will be necessary, as The Royal Australian College of General Practitioners (RACGP) reports that these symptoms require further and immediate investigation. This may involve a doctor’s examination of the inside of the oesophagus and stomach through a ‘gastroscopy’ or ‘endoscopy’ to help determine the appropriate treatment.

• Appropriate use of PPIs 

Dr Jill Thistlethwaite, Medical Advisor, NPS MedicineWise, has said: “As PPIs are prescribed frequently and are effective at reducing symptoms, some people may consider them as lifetime medicines. However, long-term regular PPI therapy is generally not necessary nor recommended for most people with GORD.”

This was also discussed in a paper published in the Gastroenterology Report, which states there is widespread overprescribing of PPIs in Western and Eastern nations.

The Australian Journal of General Practice reports that PPIs are generally well tolerated; however, use beyond eight weeks is rarely indicated and increases the risk of adverse events.

Dr Thistlethwaite said: “After completing an initial course of daily PPI treatment, which is usually around four to eight weeks, many people can reduce and step down the amount of medicine they take and still maintain control of their symptoms. Up to six out of 10 people can also step down and stop taking PPIs without their symptoms returning.”

However, she says it’s important that patients have a conversation with their doctor before stopping treatment to ensure this is done safely and effectively.

Choosing Wisely Australia has recommendations from the RACGP and the Gastroenterological Society of Australia (GESA) on the appropriate use of PPIs in clinical practice. One of these recommendations is to only start treatment with a PPI for four to eight weeks with patients diagnosed with GORD.

Pharmacists can play an important role in instructing patients on the correct dosage, as according to an Australian Prescriber paper, there is also poor understanding of the pharmacokinetics of PPIs with nearly 70 per cent of GPs and 20 per cent of gastroenterologists incorrectly instructing patients about when to take doses.

• Discussing deprescribing 

The paper in the Australian Journal of General Practice discusses how patients may feel concerned that symptoms may return when PPIs are discontinued. The paper explains the importance of discussing the possibility of symptom return with patients. It also reports that this can be minimised with gradual dose tapering prior to discontinuation. Patients should be reassured that rebound acid hypersecretion may only last a few days and can often be adequately managed with PPI as needed or non-prescription antacids or H2 antagonists.

The Journal also explains that it would be wise, when initiating a PPI, to provide information about the intended treatment duration and follow-up. Patients who have been using PPI for the long term may not have been provided with or recall information about the intended duration. Engaging patients and carers in shared decision-making increases deprescribing success.

As part of the ‘Starting, Stepping Down and Stopping Medicines‘ program, NPS MedicineWise has also developed a consumer-tested Patient Action Plan. Health professionals can print this out and use it with their patients to help explain the importance of using lifestyle changes together with PPIs to help manage symptoms or to stop the need for future PPI treatment.

If symptoms persist after eight weeks, guidelines recommend that health professionals check adherence and dosing with patients before reassessing the need for continued treatment.

However, if symptoms do not respond to PPI treatment, patients should be referred to a specialist for further investigation.

• Lifestyle advice 

Ms Sherlock says pharmacists can look at ways people can reduce their stress levels and support their nervous system’s relaxation response. “For example, more time in nature, singing, swimming, gentle movement, massage, deep breathing exercises. If people drink and smoke, linking them with adequate support to reduce these behaviours is recommended.”

References: 

1. https://www.gastromedicine.com.au/gastro-oesophageal-reflux-disease-gord/
2. https://www.racgp.org.au/getattachment/627a9d88-5ce3-486f-b34e-a09cdaf75e94/20041128piterman.pdf
3. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/indigestion
4. https://aci.health.nsw.gov.au/networks/eci/clinical/ed-factsheets/gastro-oesophageal-reflux-disease
5. https://www.nps.org.au/news/stepping-the-appropriate-path-with-gord-medicines#r2
6. https://www.nps.org.au/media/taking-medicines-for-gastro-oesophageal-reflux-disease-gord
7. https://www.healthdirect.gov.au/gord-reflux
8. https://www.nps.org.au/assets/fecfc44ab4255043-33b874b4f600-00b5f8c0e08edd00daea45f024c52354c593ec0478a723da400d7d598b24.pdf
9. https://www1.racgp.org.au/ajgp/2022/november/deprescribing-proton-pump-inhibitors
10. https://academic.oup.com/gastro/article/doi/10.1093/gastro/goad008/7128280
11. https://www.choosingwisely.org.au/recommendations/gesa#1609
12. https://australianprescriber.tg.org.au/articles/the-management-of-gastro-oesophageal-reflux-disease.html#:~:text=If%20there%20are%20no%20features,to%20withdraw%20acid%20suppression%20therapy.

This feature was written by Tracey Cheung and was originally published in the October issue of Retail Pharmacy magazine. 

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What have been your career and store highlights so far? 

I learnt fast that if you don’t stand out from the crowd, you become another number.  I committed to work on myself and my team to continue to be innovative and provide exceptional experiences to all our customers.

Our biggest store highlight was our first-ever Wizard Pharmacy Health Expo in August 2023. We found a gap in the industry, a blue ocean, as many professionals would describe it. There has never been a health and wellbeing expo in Western Australia, so we created an in-store experience for our patients and healthcare providers. My team did an exceptional job helping set up, working with our supplier partners and being fully present on the day to engage with all the customers. I learnt that you can’t create something so grand without your team’s support. Your team must believe in your shared set of values and the “ why “ behind every task or event we make in-store.

What has the impact of technology been on pharmacy over recent years? 

The impact of technology on our daily lives, specifically pharmacy, has been rapidly growing, but we saw a significant change during the pandemic. Many new innovations were introduced, such as electronic scripts, electronic health records, remote QCPP assessments and QR codes that read out what is on your labels. The latest use of robotics in the dispensary to minimise errors and increase speed in supplying medication to the patient has also made an enormous impact. Another brilliant technology is the programs that we have in-store to analyse customers’ health needs. All of this combined has allowed us to provide trusted and reliable health care at a much more customised level because when it comes to health care, it’s not a one-size-fits-all solution.

How has the pharmacy industry and its approach to health services evolved? 

At the beginning of pharmaceuticals, a pharmacy’s role revolved around compounding medication and supplying prescriptions. As times’ evolve and patients are increasingly educated about their health by pharmacists and doctors, the scope of practice and services has to expand to meet patients’ expectations in a timely and convenient manner. The concept of shared healthcare between pharmacies and medical practices has also made it easier to provide better health services. We now see some pharmacies with full-time naturopaths; others have nurse practitioners to reduce the workload on doctors. The definition of health services has changed from primary demand and supply of a product to providing a complete health solution involving multiple health care practitioners.

Why is looking after your community so important to your pharmacy? What do you think your customer base values the most about your pharmacy? 

Looking after our community is paramount to our pharmacy for several reasons. First and foremost, a strong sense of community engagement fosters trust, mutual support, and a positive reputation. As a local pharmacy, we are not just a place to acquire medications; we are a resource hub for health and wellbeing, and our commitment to the community ensures that we play an active role in enhancing the quality of life for our neighbours.

When we invest in our community, we invest in our customers’ health and happiness. When our community thrives, it creates a positive ripple effect. Healthier individuals contribute to a healthier society, reducing healthcare costs, improved productivity, and enhanced quality of life.

As for what our customer base values the most about our pharmacy, it’s the combination of personalised care and a sense of belonging. We are a source of reliable information and a partner in their journey toward well-being. They value the convenience of a community-centred pharmacy that takes the time to understand their individual health circumstances, offer expert advice, and provide solutions tailored to their needs. 

What are your values at your pharmacy, and why is it essential to maintain core values in community pharmacy?

Wizard Pharmacy’s purpose is to enhance our patient’s quality of life through science and nature-based wellness solutions. Our store culture revolves around growing our knowledge, behaviour and strategies to direct our focus better. The “why” of what we do is the core of our values. Why we care, educate and provide our patients with the best we have aligns with our strategy and approach.

What was the most significant way the COVID-19 pandemic changed how your pharmacy operates? 

The COVID-19 pandemic brought about a fundamental shift in the operations of our pharmacy, with the most significant change being the rapid integration of telehealth services and contactless interactions. Embracing virtual consultations, online prescription orders, and curbside pickups became paramount to ensuring our staff’s and customers’ safety and well-being. The changes revolutionised how we deliver healthcare services and emphasised our commitment to adapting to new challenges while maintaining high-quality patient care. 

How has your team performed during the challenges of the past 18-plus months? 

We had to work with what we had and what we could order in-store to overcome shortages. We constantly updated our local doctors on what was in and out of stock from suppliers and worked with other Wizard Pharmacies to transfer items between stores to continue to provide for our patients as best we could. Being part of the Wizard network, we could promptly supply 90 per cent of our patients with their needs.

Efficient teamwork and clear instructions and regulations that we all followed to work in harmony have made it easier for us to share the load and thrive. Our unwavering commitment to providing essential services, adapting swiftly to evolving circumstances, and maintaining a high level of professionalism has ensured the seamless operation of our pharmacy and reinforced our bond with the community we serve.

Can you please elaborate on what your most popular service is? Why do you think it’s so successful? What is your advice to other pharmacies seeking to strengthen that service in their store?  

Our most popular service revolves around our commitment to innovation and specialised healthcare. We have introduced a unique medication management program that tailors medication regimens to each individual’s needs, fostering greater adherence and efficacy. This service combines cutting-edge technology with personalised consultations, allowing our customers to understand their treatments better and optimise their health outcomes. Our emphasis on innovation has resonated with our customer base as it addresses a pressing need in the healthcare landscape while offering a convenient and user-friendly solution. This success can also be attributed to our team’s dedication to ongoing training and staying updated on the latest advancements, ensuring our customers receive the best care possible.

For other pharmacies seeking to bolster a similar service, I advise investing in continuous innovation and staff training. Stay abreast of the latest technologies and trends in specialised healthcare, tailoring them to meet the unique needs of your community. Building strong relationships with healthcare providers in your area can also help foster referrals and collaboration.

Additionally, I actively seek customer feedback and make adjustments based on their input. Ultimately, success in this realm hinges on combining cutting-edge solutions, personalised care, and a proactive approach to staying ahead of healthcare trends.

What do you predict the future has in store for pharmacy? 

Pharmacy continues to be an extremely fast-paced, changing industry where you need to remain adaptable. We are looking forward to continuing to increase our scope of practice, especially with the announcement that West Australians can now receive treatment for UTIs through community pharmacies. It will also be interesting to see how the industry adapts to 60-day dispensing. Innovation will be key as we implement ways to minimise its effects. The team at Wizard Pharmacy Services have already provided us with recommendations, so I look forward to seeing how they go.

What do you look forward to the most in the future?  

I look forward to all of our hard work and initiative being recognised when we get an e-mail letting us know we are a finalist for Guild Pharmacy of the Year 2024!

This feature was originally published in the October issue of Retail Pharmacy magazine. 

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To preserve eye health and comfort the film needs to remain intact between every blink. When this function is impaired, through not producing enough tears or through the tears not remaining in place between blinks, this causes dry eye and over time can damage the surface of the eye.¹ 

Dry eye is common in older people, although can affect anyone and while it cannot be cured there are methods to alleviate the discomfort and relubricate the eyeball. Often when patients experience dry eye the pharmacy is the first place, they go to seek advice to manage the condition.

Causes of dry eyes 

Dry eyes can be caused by a variety of reasons. However, certain factors increase your risk:

• As we age our tear production reduces meaning dry eyes are more common in older people.²
• Women two times more likely to develop dry eye disease.³
• Wearing contact lenses can limit oxygen flow interfering with tear production.
• Using the computer or screens for a prolonged period can interfere with blinking patterns.²
• Some medications.
• Certain autoimmune diseases increase the likelihood of dry eyes.²
• Being exposed to wind, smoke, or dry air.²

Pharmacy’s role 

Wizard Professional Services, Chief Pharmacist, Jeanette Drury says that pharmacy plays an important role in managing dry eyes.

“Dry eye is common and can affect anyone and Pharmacy is often the first port of call for patients experiencing this uncomfortable condition,” Ms Drury said.

“A pharmacist will assess the symptoms and ask questions to help determine the cause. They can offer suitable solutions for everyday conditions such as hay fever or conjunctivitis and refer patients to their GP for more serious conditions.”

OTC management 

Dry eyes can be managed through a range of OTC products, and all should be recommended based on the individual needs of the patient. “There are a range of artificial tears, gels, and ointments to help manage the symptoms of dry eye. A Pharmacist can recommend and advise on the best type for a patient’s individual needs,” Ms Drury said.

Patient use 

“Artificial tears, gels or ointments come in bottles, single vials or tubes,” Ms Drury said, advising the following steps will help patients to use these products:

1. Firstly – wash your hands to prevent the spread of germs.
2. Tilt your head back, look up and pull down your lower eyelid with your finger.
3. With the other hand, position the bottle over your open eye and squeeze out the correct number of drops or gel drops recommended by your Pharmacist or GP.
4. To avoid contamination, do not touch the tip of the bottle or let it touch your eye.
5. Close your eye and keep it closed for a little while.
6. Avoid rubbing your eyes.

Ms Drury says it is important to remind patients “that thicker gels or ointments may cause blurred vision for a short period of time”.

Additionally, some medications can contribute to dry eye symptoms. “If you think your medication may be causing dry eye symptoms, talk to your pharmacist or GP. Some prescribed medicines can contribute to dry eye e.g., antidepressants, oral contraceptives, and antihistamines. It is important that you do not stop taking any prescribed medicine without getting medical advice from your health professional first,” she said.

GPs and pharmacists are appropriate health professionals to manage mild dry eyes. However, for dry eyes that cause severe symptoms such as pain, it is important to refer the patient to an optometrist to investigate the condition further.³

References: 

1. Better Health. ‘Dry eye’.2021. <vic.gov.au/health/conditionsandtreatments/dry-eye#what-is-dry-eye>.
2. Health Direct. ‘Dry eye disease’. 2022. <gov.au/dry-eye-disease>.
3. Quan Findlay and Kate Reid. ‘Dry eye disease: when to treat and when to refer’. Australian Prescriber 41(5). <ncbi.nlm.nih.gov/pmc/articles/PMC6202299/>.

This feature was originally published in the October issue of Retail Pharmacy magazine. 

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What have been some of your career and store highlights?

We’ve been fortunate enough to win Priceline’s Store of the Year award twice, in 2015 and 2018, and I won the Priceline Pharmacist of the Year award in 2016. Those experiences taught me magic can happen when the entire team is engaged and united in its shared goals and the leadership skills required to achieve that culture. It also taught me the value of making time to work ]on the business. Making time to think and strategise can feel like a luxury, but it’s a necessity to thrive.

What has been the impact of technology on pharmacy over recent years?

Technology provides so many efficiencies for us working in-store and for our patients. We have a Consis in our dispensary, and I underestimated how much it would improve our workflow. eScripts are also a game changer – even when they’re ‘lost’ they’re super easy to access via MySL, meaning patients can access their medication without waiting for a GP appointment to get a new paper prescription. eScripts, coupled with the Priceline Pharmacy app and MedAdvisor, means we often have 30 to 40 orders waiting for us in the morning, which is convenient and efficient for both our patients and us. Our ‘health station’ allows patients to perform their own health checks and receive their results via email or within their SiSU Health app for easy access. The use of technology also decreases paper waste, which is just one of the ways we’ve improved the sustainability of our pharmacy.

How has the pharmacy industry and its approach to health services evolved over the years?

Services are becoming the rule rather than the exception, with all pharmacies now offering some level of service as we look to further develop our professional fulfilment and tap into additional funding sources. The industry has split into two streams: a low-cost/high-volume model and a consultation-based model, and those distinctions are becoming more disparate. Some pharmacies have developed a specialised consultation model and others take more of a retail focus. There’s room for many different models, but the key is to be clear in what you want your store to be and what your community needs.

Tell us about the ethos of your pharmacy and how it differs from other pharmacies in your view?

Our community is at the centre of any decision made in our stores, so we give as much support to our community as we can. Practising rurally presents its own challenges, but being able to see the difference pharmacy makes every day is inspiring. We also respect and value the retail offer. With Priceline, we can provide a retail offering that our community would otherwise have to travel to Ballarat or Melbourne to get [Horsham is 300km from Melbourne]. I love retail as its own discipline and consider myself very lucky that I get to combine my passion for pharmacy and retail in one career.

Why is looking after your community so important to your pharmacy? What do you think your customer base values most about your pharmacy?

We don’t exist without our community, but we also offer something valuable to our community. Horsham matters to me because this is where I grew up. It’s full of people who’ve supported me to become the person that I am, and now I get to repay that by looking after them. It’s not uncommon for people to travel long distances or wait for lengths of time to access healthcare, so us providing expertise closer to home can be a relief for customers. I think our patients value friendly faces they know and trust, extended opening hours, and a wide range of products.

What are the values at your pharmacy and why is it so important to maintain core values in community pharmacy?

Our pharmacies operate with the values of respect, trust, problem-solving and leadership. We’re motivated by wanting to help people, and care about health and wellbeing. Maintaining values in community pharmacy provides a foundation we can return to when days are tough, and we need a reminder of why we’re here. It also provides a clear expectation of the standard we expect from our team, what they can expect from each other and what they can expect from us as their employers.

What are the ways in which the COVID-19 pandemic most changed how the pharmacy operates?

COVID-19 cemented community pharmacy as the preferred location to receive vaccines, which changed our scope from a seasonal run of flu vaccines to a core part of our business. It’s given our patients easier access to healthcare via telehealth, and we now work with prescribers around the state as a result. The introduction of eScripts has reduced paperwork, decreasing the number of faxed scripts and our reliance on Australia Post. Hopefully, that will continue to improve.

How has your team performed during the challenges of the past few years?

It’s a terrible feeling telling people they can’t have something they need, due to stock shortages, and then having to explain to their prescriber why we cannot supply. Our technicians do a fantastic job sourcing product. Our team has developed greater flexibility and problem-solving skills to overcome challenges that can feel unrelenting at times. We try to look after each other and create team bonding situations, celebrating our successes, and try to limit our worries to what we can control.

What is your pharmacy’s most popular service and why do you think it’s so successful? What’s your advice to other pharmacies seeking to strengthen that service in their store?

Our most popular service is vaccinations. The public (generally) engages with vaccinations because they’re relatively inexpensive, easy to access with limited to no waiting time, and provide benefits to them individually and their wider community. Everyone knows someone who is vulnerable to vaccine-preventable disease, so customers are often receptive to ‘doing their bit’ to help the community.

What do you predict the rest of 2023 has in store for pharmacy?

The rest of 2023 will be shaped by the outcomes of 60-day dispensing and what an early eighth Community Pharmacy Agreement will look like. Cost of living constraints are expected to continue impacting customers’ discretional spend. Any further interest rate increases before the end of the year could affect Christmas retail trade.

What do you look forward to most in 2023/24?

I’m looking forward to the increased scope of practice activities in October as announced by the Victorian government. It will be great to join other states in providing services that take up space in other areas of the healthcare system, to the benefit of our community. I’m excited to provide easier access to healthcare for women by facilitating access to continued supply of the oral contraceptive pill and antibiotics for uncomplicated UTIs.

This is an extract from Retail Pharmacy September, Pharmacy Profile.

For full article visit retailpharmacymagazine.com.au/magazine/retail-pharmacy-september-2023/

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Iron: the mighty mineral 

Iron’s importance in red blood cell function includes its role in oxygen transportation in the blood and storage of oxygen in the muscle cells. Iron is a key component of enzymes found throughout the body and contributes to proper immune function.¹

For men aged 19 to 50 years, the daily recommended intake is 8mg a day, but for women, it’s 18mg a day. This increases to 27mg a day during pregnancy, when the baby’s iron stores also build up. For breastfed babies, 0-6 months, 0.2mg is recommended. For babies who are formula-fed, iron is absorbed less, and therefore formula (in Australia) is iron-fortified to ensure babies gain the recommended daily intake.¹

Iron is found in food sources and comes in two types: haem and non-haem. Haem iron is easily absorbed by the body, but for non-haem iron, this is more difficult to achieve. Non-haem iron is found in plant-based foods. Those following a plant-based diet need to consume up to 80 per cent more iron than those with meat in their diets, to reach the recommended daily intake.²

Haem iron sources include meat, poultry, seafood, and organ meats. Non-haem iron sources include nuts and seeds, dried fruit, wholemeal pasta and bread, legumes, dark leafy green vegetables, and tofu.²

Iron deficiency 

Developing when not enough iron is being consumed, iron deficiency often causes tiredness and headaches, and makes concentration difficult. It can also cause anaemia.

If a patient is worried about iron deficiency, they should speak with a doctor, who can prescribe iron supplements. These are also available OTC in tablet and liquid forms, but it’s important that iron deficiency isn’t self-diagnosed, as too much iron within the body can interfere with its absorption of other vitamins and minerals, and in some cases can be toxic to the body.²

Folate: the B vitamin for growth and development 

The body needs folate, the natural form of vitamin B9, to grow and develop. In food, folate occurs naturally. When in supplement form, it’s known as folic acid.

Folate is important to everyone, but especially pregnant women, because a lack of folate can cause abnormalities in the development of the brain and spinal cord in babies.

Folate is also important for making DNA, forming red blood cells, and growing and repairing cells and tissues.

Unless one is pregnant, folate can be obtained through diet. It’s added to many foods, such as cereals, bread, juices, and Vegemite. In Australia, flour manufacturers are required to add folic acid to wheat flour used in bread.³

Folate is also found in green vegetables, legumes, rice, avocado and fruit.

Folate deficiency is rare in Australia, but some people don’t get enough. Supplements are available OTC and through prescription.⁴ However, the dosage differs depending on the person, so talking to a GP about folate deficiency is recommended to ensure the correct dose is being administered.

Folate for a healthy pregnancy 

Folate is essential in the growth and development of the baby during pregnancy. It’s recommended that a folic acid supplement be taken one month before conception and for the first three months of pregnancy.⁵

Pregnant women are advised to look for supplements containing at least 400mcg of folic acid, and the American College of Obstetricians and Gynaecologists recommends that all pregnant women should get at least 600mcg of folic acid daily. Although pregnancy multivitamins contain folic acid, it’s important for optimal effectiveness that they contain a high enough dose of folic acid.⁴

References:

1. Better Health Channel. ‘Iron and Iron Deficiency’. 2022. vic.gov.au/health/conditionsandtreatments/iron#what-is-iron.
2. ‘Foods high in iron’. 2023. healthdirect.gov.au/foods-high-in-iron#contain.
3. NSW government. ‘Folate’. 2021. com.au/wp-content/uploads/2021/02/Good-Bite-No69-at-home_webOpt.pdf .
4. Australian government. Pregnancybirth&baby. ‘Folate and pregnancy’. 2021.org.au/folate-and-pregnancy.
5. Government of Western Australia. ‘Folate and pregnancy’. 2022. wa.gov.au/Articles/F_I/Folate-and-pregnancy.

This feature was originally published in the September issue of RP magazine. 

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