Jacqui: 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. But I was very young, so I didn’t know what I was getting into.

Andrew: Oops. What about nutrition, then? Why go further into nutrition? It’s not the obvious step that most people make.

Jacqui: 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, and 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 going into dietetics, for instance.

Andrew: Gotcha. Yeah, gotcha. Okay. So, 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. 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, or out of balance.

Jacqui: Hmm. Yeah. It’s a very

Andrew: How did you grasp that?

Jacqui: I think, well, I mean, I guess I live in both worlds, so I guess I still think both ways. But the more you see people and the more you delve into your own health journey as well, you realize that people are not just body systems, or a disease. And we are complex beings. And 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 the things that can lead to disease, for instance, 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. Yeah, I think it fits quite well hand-in-hand, those two.

Andrew: So, this need, or this interest, if you like, that drove you to study nutrition, it was indeed patient-driven.

Jacqui: Yes.

Andrew: It was the demands of the patients wanting more info. Yeah.

Jacqui: Yeah.

Andrew: What were they after?

Jacqui: 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, 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 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, is a very simple thing. But 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, 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, basically.

Andrew: Same here. I went through that exact same discovery. What are the most common inquiries that you get from customers, patients, that you feel you have the greatest impact on?

Jacqui: Yeah. 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 biggest areas that I feel we can have big impacts in.

Andrew: Sticky situation sometimes, though, in that, you know, it’s not really our place, your place, to sort of take patients off medicines. The doctor’s. So, sometimes, though, you get patients who start to refuse medication that may be indeed life-saving. So, let’s say, and I know this is opening up, I’m gonna be kicked in the head, I know, for this, for suggesting that statins might even be of benefit to somebody. But, you know, 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, “Okay, doctor’s 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 conversation, or do you wait for the patients to activate the conversation?

Jacqui: 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 the ideal scenario with pharmacy is that we’re gonna 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. So, 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.

Andrew: No.

Jacqui: But I guess I like to think that 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.

Andrew: 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 the old salts, you know, the antibiotics with probiotics and things like that, or do your patients ask you about more complex issues?

Jacqui: Oh, yes. I mean, yes. There is that, I wouldn’t wanna 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 gonna 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.

Andrew: 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, is innocuous fibers. Do you tend to favor anything one over the other, or do you use them concomitantly?

Jacqui: Yeah, I mean, digestive health, yeah, often, there is a few different things that you’ve gotta 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, then everything else is just not gonna work as effectively as it should. But I would definitely consider each person individually, based on what their, you know, 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 more so an issue with the esophagus being too relaxed, and letting things back up 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.

Yeah, we use different fiber supplements. Especially, we use a lot of PHGG, partially hydrolyzed guar gum, because I think that has the dual benefit of improving the bacterial profile in the digestive tract, as well as 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 elm’s still widely used, but I probably more so go for the PHGG as something that I gravitate towards, unless there is burning, or something you want to help with coating of the digestive tract, like, with slippery elm.

Andrew: Yeah. And what about in the pharmacy realm? What about using the alginates as a raft antacid? Do you ever employ that with, like, after meals, and so that people can get, afford some benefit from that, from the actions of that?

Jacqui: Yeah, definitely. I mean, that’s probably my go-to. If I was gonna use an antacid, I’d use one with the alginate. Yeah. Definitely.

Andrew: Okay. So, antibiotics. Now, you know, this is a huge issue, and I’ve gotta say, I’ve now swung away from this use of probiotics, or bacterial probiotics, because of compliance. So, I tend to just favor Saccharomyces boulardii, with the antibiotic, because it’s just, there’s no issue with compliance.

Jacqui: Yeah.

Andrew: It’s, “take that with that, at that time,” you know? What do you use, though?

Jacqui: I actually, yeah, I love Saccharomyces boulardii. I’ve always loved it. But I have moved away from using it, interestingly enough, to using 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 probiotics. And I guess there are 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 seems to be working fine for people as well.

Andrew: Fair enough. Any particular genera or species that you favor?

Jacqui: I must admit I’m terrible at remembering all the specific bacteria, so, no. I won’t guess.

Andrew: 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?

Jacqui: 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. 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. 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 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, if I identify that someone’s getting quite frequent migraines, and they’re having a lot of fermented foods, I trial a reduction or a 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. Yeah.

Andrew: And any particular dose that you use of quercetin?

Jacqui: I like to use… Well, what is it? I’m trying to think what the supplement’s dosage. I think

Andrew: Anywhere between 200 to 600, I’ve seen.

Jacqui: Yeah, I was gonna say 400 to 600. I use that three times a day, so…

Andrew: Three times a day.

Jacqui: …about 12.

Andrew: Cool.

Jacqui: Yeah.

Andrew: Because I love quercetin.

Jacqui: And then it can be… Yeah, it’s actually [crosstalk 00:17:23] Oh, yeah. Well, it’s actually a very versatile nutrient as well.

Andrew: Extremely.

Jacqui: Yes.

Andrew: Extremely. Okay. So, headaches. 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 favor. 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 favor, in favor of things like affron, and…I’m gonna say, other nervines. I’ve gone blank. Forgive me. But…

Jacqui: Lemon balm, passion flower.

Andrew: Yeah,  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?

Jacqui: Yeah, it’s interesting, because I think 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 onto medicinal antidepressants. So, I think it still 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 no issues. So, I do use and recommend a lot of saffron and turmeric, explaining that it’s working in a different way. It’s not just increasing serotonin, so there’s not really that risk there of serotonin storm, but it is gonna help people think more clearly because it’s working more so with the BDNF. And I think a lot of people find that their pharmaceutical medication, it is working, but it’s only really doing one thing. It’s not helping them overall. Like, it’s quite narrow. So, yes, they might be able to 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 think longer-term and things like that, so that’s where I find adding in those other herbs can be really beneficial.

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.

Andrew: Yes.

Jacqui: You know, it’s really good. 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. 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 nighttime. 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 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?” And they’re like, “No, no one’s ever told me about that before.”

Andrew: Well, it’s such an important point you make, because, I remember an example 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 wanna take it. I’m just saying, can we put it back till 12 or 1?” And he was pleading with people, who, of course, didn’t listen. It was, it’s always 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. It’s big.

Jacqui: Yeah. And it’s not hard to give it, either. I think that 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 being able to have the use of theanine.

Andrew: 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 with L-theanine?

Jacqui: For kids or adults?

Andrew: Yeah. Kids.

Jacqui: 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.

Andrew: Cool. And adults?

Jacqui: But yeah, I think it’s… Adults, I’d start with 200 milligrams…

Andrew: Gotcha.

Jacqui: …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.

Andrew: Right. 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.

Jacqui: Yes.

Andrew: Is there anything that you favor using in these people?

Jacqui: I actually love using ashwagandha in those people.

Andrew: Okay. Yep.

Jacqui: And then, depending on whether they’re struggling for energy or not, you can add in the B vitamins. But sometimes I don’t always use B vitamins. I do find ashwagandha very versatile. And then again, just looking at their ability to relax at nighttime. That’s where I would use a magnesium formula, if they are struggling with sleep, or just feeling anxious at nighttime. You know, a magnesium formula is usually really good as well. But yes, I do like using ashwagandha with them.

Andrew: Gotcha. Jacqui, 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?

Jacqui: Oh, yeah.

Andrew: And they have real issues getting their iron up. Like, real issues. Is it iron that’s the issue? There’s a

Jacqui: I actually don’t think it is iron that’s the issue.

Andrew: Yeah. So, let’s delve into this. How do you navigate this? What do you use?

Jacqui: Look, putting me 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, and you think…you start to question what long-term stresses is the body under, that might be causing it to not have iron readily available like it should. That’s kind of where I’ve been thinking.

Andrew: Yeah.

Jacqui: But 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…

Andrew: You’ve got me thinking now.

Jacqui: Yeah. Yes. I

Andrew: So, you’re thinking about the possibility of hepcidin being activated, in not just iron insult…

Jacqui: Yeah.

Andrew: …but also infective insults, or stressor insults.

Jacqui: Yes. Yes.

Andrew: Right.

Jacqui: But I haven’t researched it, so don’t quote me.

Andrew: My next big project.

Jacqui: It’s just where my brain goes with it.

Andrew: No, that’s really good. That’s really interesting. I’ll look into that. That’s cool. So, Jacqui, what else? What else do you use nutrition for? What do you commonly sort of see in the pharmacy, that are the big issues facing people?

Jacqui: Oh, there’s so many. I think…

Andrew: Constipation.

Jacqui: …and it’s very… Yes, constipation. I think people very rarely just have one issue, too. They more so have more than one.

Andrew: True:

Jacqui: So, you can go in thinking I’m gonna 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. 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 diarrhea, than… Constipation is difficult, but it’s 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 figuring out the cause of why the body is doing that. And there’s multiple reasons why it could be. Yeah, I mean, hormones, I feel like… I can see you’ve got the Ruth Trickey book in the background there. I’m about to reread that because I feel like I need to brush up on… I’ve got so many, you know, perimenopausal and menopausal women that really, really want help, and I feel like I need to relearn that whole textbook.

Andrew: She’s a goddess.

Jacqui: But yes, there’s Yes. So, yes.

Andrew: 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.

Jacqui: 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 are, so you don’t really wanna go against their opinions. So, I guess, you know what you can do 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 wanna come off medications, and I haven’t initiated that. That’s what they’ve come to me wanting help with. And I tell them, “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, then they need to know that they haven’t been taking that medicine.

So, yes, 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 in saying that they’re getting results from that, then they’re often happy to continue. But I think they just wanna be informed, and know that that’s what’s happening, and I think definitely they should be informed of that.

Andrew: Gotcha. Jacqui,

Jacqui: 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.

Andrew: Right. Okay. Jacqui, 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. 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.

Jacqui: Thank you. Thank you for having me.

Andrew: 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.”