Mary Lou Compounding

Personalised Compounding for Naturopaths and Pharmacists with Mary Lou Condon

Mary Lou Compounding

Personalised Compounding for Naturopaths and Pharmacists with Mary Lou Condon

In today’s episode, Mary-Louise Condon, a Pharmacist who specialises in Compounding, and we’ll be discussing Personalised Compounding for Naturopaths and Pharmacists.

Mary Lou and Andrew chat on the many aspects of compounding from compounding nutrients, delivery methods, absorption, transdermal creams and more!

 

About Mary Lou Condon:

Mary-Louise Condon the founder, owner and, practising pharmacist of The Compounding Lab in Brisbane and has over 25 years of pharmacy experience. Lou started compounding in  2000 and then went on to study postgraduate studies in Anti-ageing Medicine.

She holds a Bachelor of Pharmacy from The University of Queensland, with a Dean’s Recommendation of Honours. She has studied abroad in the USA at the School of Pharmacy at the University of Iowa and has over 25 years of experience in the field of compounding and health creation. Participating in PCCA Australian Advisory Board further demonstrating her passion for individualising personal health care. Then completing her Diplomate with A4M ( The American Board of Anti-Ageing Health Practitioners) in 2015, and she finds immense satisfaction with consulting, which has resulted in her recent undertaking to complete certification from the Institute of Functional Medicine.

She is a philomath at heart and loves to travel the world learning about better health initiatives, returning with ideas to share with like-minded colleagues. Resulting in 2018 installing a new sterile injectable facility in Brisbane to make bespoke vitamin and amino acid infusions for doctors throughout Australia for health optimisation.

She consults for The Australian Academy of Anti-aging Medicine advisory panel to provide A5M with a strategic overview relating to preventative, integrative and anti-aging medicine for health in her community.

Connect with Mary Lou

website: https://compoundinglab.com.au/

Facebook: https://www.facebook.com/thecompoundinglab

Instagram: https://www.instagram.com/thecompoundinglab/

Email: enquiries@compoundinglab.com.au

References from Podcast: 

A5M: The Australasian Academy of Anti-Ageing Medicine: https://www.a5m.net/start 

Levagen + Superior Palmitoylethanolamide: https://levagenplus.com/

Naturopath Top Compounded Products: https://www.designsforhealth.com.au/wp-content/uploads/Naturopath-Top-Compounded-Products.pdf

Transcript

Introduction

Andrew: This is “Wellness by designs.” I’m your host, Andrew Whitfield-Cook. Today we’ll be talking with Mary-Louise Condon, a pharmacist who specializes in compounding for not just naturopaths, but pharmacists as well. Welcome to “Wellness by designs,” Mary-Lou. How are you?

Mary-Louise: I’m great, Andrew. And thank you for the invite-…

Mary-Louise: Oh, no. Call me Lou. Call me Lou, please. I love it. Very informal.

Meet Mary-Lou

Mary-Louise: Yeah. Look, Andrew, I had a wonderful opportunity. I’ve studied at UQ in Queensland. For those of you who don’t know, I’m a happy Brisbane girl. And at that opportunity, I got a scholarship to go to the U.S. to study. And at that opportunity, I learned a whole new skill of compounding. And look, I’m gonna take you way back. This is 25 years ago. But it sort of opened my eyes to looking at medicines as n equals 1, about the individual, not about a whole bracket of the population. So, I lived in the U.S., and it ignite my passion, came back to Australia. Went on to do diverse things, but, basically, opened up my compounding business over 25 years ago in Brisbane. And then it just morphed into what I’m passionate about. And what happened in my life? So, what am I passionate about? I’m really passionate about nutraceuticals and nutrient-balancing. I’m very passionate about hormone restoration and wellness. So, compounding for me is really looking at an individual and nurturing them to better health. So, it’s just not saying, “Hey, you’re deficient in this.” It’s like, “Well, what else is around that?” So, compounding has come a long way for me. So, it’s just not medicines. It’s nutraceuticals. It’s pharmaceuticals. And it’s looking at the dose, the delivery, and everything. So, I love compounding. I’m a big advocate of not only getting more pharmacists involved in it, but in making sure they’re educated.

Andrew: But indeed, this is the history of pharmacy. I mean, pharmacists used to very commonly makeup, you know, Whitfield’s ointment was a cracker. But there were many that were bespoke medicines.

Mary-Louise: Yeah. Look, compounding is the art of pharmacy or at least we used to be chemists, didn’t we? And now we’re pharmacists because we’re pharmaceutical chemists. But however, it’s the art of…it’s cooking in a dispensary. And I always train my young pharmacists to follow the recipe and then enhance it in the best way they can when they have the knowledge. But obviously, going back to the roots of what we’re doing and how we’re trying to achieve it because, you know, so many things are available to us that are not on prescription. They might be a medical-grade food or a supplement that are at everyone’s fingertips that just knowledge is power. And I wanna get that message out there. So, let’s go back to, yeah, the art of manufacturing or the art of bespoke compounding for the individual is what it’s all about now, but I think probably your podcast is about awareness. And any of you are listening whether they are pharmacists, naturopaths, doctors alike, if they haven’t got a compounding pharmacist in their best friend list, go find one, and, hopefully, maybe today we can just excite your listeners to do that.

Compounding Nutrients

Andrew: Well, take us through some of the nutrients you use. And what are the major issues that present to you? Like, for instance, you know, certain B vitamins are sensitive to light, acid, alkaline, that sort of thing. So, can we discuss what you use and the issues around them?

Mary-Louise: Yeah. Look, we’re really fortunate. In my business, we’ve morphed into not just compounding capsules, and tablets, and suspensions, but we do injectables as well. So, there are some nutrients that are just far superior when you give them as an injection versus orally, but even transdermally. We had a chat the other day that so many naturopaths don’t understand. We can do transdermal nutrients, which is just a great opportunity for pediatric populations, geriatric populations, all about the epidemic of people with gut issues who just don’t absorb nutrients. And that’s a whole new story, isn’t it? So, anyway, what’s available to you? We take pride in understanding it is a science and it’s a skill and it’s something that… Look, I’m always…I’m learning still today and I’ve been studying compounding for over 25 years, but it’s understanding we’re looking at the patient’s best outcome and how do we achieve that? So, you mentioned B group vitamins and obviously nutraceuticals. I’m a big fan of B group vitamins. But probably the B vitamins I love would have to be NAD. And that’s a B3 analog, and that’s nicotinamide adenosine dinucleotide. And we had a chat about that. So, that is such a powerful mitochondrial nutrient that really up until recently wasn’t available because it’s highly unstable, it must be refrigerated, and it’s poorly orally absorbed. And here we have it now, we can inject it, we can do it intranasally and we’re just now morphing into precursors, which are oral. So it’s a good one.

Delivery route and absorption

Andrew: Okay. So, there’s another route of delivery that I very often just totally overlook, nasal delivery. But can we first cover… You just mentioned about poor oral absorption. And when we speak about, you know, nutritional compounds like glucosamine, chondroitin, even B6, you know, we’re looking around that 20% to 40% absorption. A, how does that compare to, say, dermal absorption? B, just because it’s 20% or 40% doesn’t mean it doesn’t work. It just means that’s what the percentage absorption is so you’ve gotta adjust the dose accordingly. Correct?

Mary-Louise: Yeah, totally. Look, I suppose every nutrient we can bring out clinical studies to say oral absorption versus transdermal versus intramuscular or IV. Some things you’re just not gonna go transdermal. We do often go to the basic rule of Dalton size. And then even if I make a micronized or on a nanoparticle, it’s still might never get transdermal absorption. However, we’ve moved a long way. Even in oral therapy now, haven’t we talking about liposomal products. And I think the availability of them in so many nutraceuticals companies is just fantastic. I love it. We also have the capability of emulsifying in our laboratory because we’re changing the molecular size of a product, often we might get a raw ingredient and we will micronize it. So, we have equipment that’s available to us now, assuming there’s sound therapy to change that molecule. So, sorry. I had deviated there. For the delivery form, there is certainly distinguishes. And for those listeners that are interested, we actually publish a list to practitioners. And it talks about the difference, just that whatever nutrient you’re looking for.

So, for example, let’s talk about B6, you used it and the oral bioavailability is diminished, and therefore, you have to dose higher. You have to dose more frequently. But an injection, well, that’s nearly, you know, 96% availability to a client. So, of course, for that one, I might say, if you have that available in your own materium or wider refer, that’s obviously gonna be a great opportunity for you. The B6 is also transdermal as well. So, highly bright color, if you know B6, and we’re gonna talk about that. So, therefore, you might look at some methods, and we can do that. We can also use the pessary as well. So, that’s a beautiful compound that you can get many ways. I know we’re also talking about some other B group vitamins. But the combination of Bs. How many times with mental health now? We do many combinational Bs. It’s just not the B6. You might do B1, B2, in particular, with B3 analog if you’re talking about parallel disorders. So, therefore, that nutrient dispensing is looking at the right combination of Bs put together and the dosing of it. I mean, that’s a great question. I hope I sort of covered where we come from that. But the stability of it is so important.

Blending Nutritionals

Andrew: Yeah. So, that’s another area. So, I was just gonna ask. When you’re blending nutritional compounds and you’ve got different technical aspects for each of them. I mean, you’ve even got different match sizes, I would imagine or, you know, you’re talking about Dalton sizes. So, each molecule has got its own particular size, let’s… Forgive me. That’s in the molecule. Let’s say in the powder that you’re administering it. And let’s talk about oral absorption, right? So, if you’re mixing a powder, there are gonna be different weights, different acid, alkali, different, you know, dissociation curves, all of that sort of thing. How do you then sort of maneuver to have not just good oral absorption but good effect?

Mary-Louise: Yeah. You know what? That’s the perfect question there, isn’t it? Because if we’re looking at n equals 1, and that’s the individual and the client that whether naturopath, where you’re gonna help them nutrient balance or we’re gonna do it, we’re gonna test pre and post. So, knowing that… Obviously, knowing how they go into the scenario and what I’m trying to achieve to balance them back, I’m gonna re-test three months after to see if I’ve actually validated and got the answer I need and that’s nutrient balance. However, what you’re actually saying is when we make a product, to make sure it’s the best product for the person. We have a huge library internationally with compounding that when I often do a formula, it’s not me making a formula. I’m going to the whole world of the library. And through the internet and through databases, we collaborate and we do this all the time, particularly when we have new compounds and nutraceuticals. And often you find it’s this early innovation that you then find vitamin companies picking it up and running with it as a commercial product. So, I think the validation of compounders in this world is really, really important. But saying that how we mix it, we’re very anal So, if I’m looking at a mixed powder, I’m gonna make sure they’re pretty much all similar size. And we can do that by sheer force now, sound wave therapy, and then we then remix and we do So, we do sound wave technology. I would love to think I’ve still got the classic mortar and pestle. I’ve

Mary-Louise: Yeah, yeah, totally. Well, look, if you wanna do it, I suppose

Andrew: More for culinary. Yeah.

Mary-Louise: Yeah. So, therefore, we use sound wave therapy now for mixing.

Andrew: Tell me more about that. That’s really interesting. Sound wave therapy or sound wave mixing. Sorry.

Sound wave mixing

Mary-Louise: Sound wave mixing. So, obviously, the electric mortar and pestle. We actually do have an electric mortar and pestle. So, we never would use a traditional one. And its force and it agitates the product so they emulsify or they blend. So, we might use that for a powder, or an emulsion, or a suspension. However, now, this is actually NASA technology, we have a device that we could put powders or an emulsion into it that it’s called a resonated sound wave that mixes at shear force. So, it vibrates so fast, Andrew, your eye would not see it. It actually looks often that it doesn’t even move, but you can hear the vibrations.

Andrew: That’s fascinating.

Mary-Louise: I can Andrew: So, do you then…

Mary-Louise: So

Andrew: Do you then encapsulate the product so that it’s in a dose format?

Creams and Bases

Mary-Louise: Yeah. Perfect example. Every product we do we’d always then go on to do something to it. So, we’re gonna mix it by sound wave therapy or sound wave, to make it easier for you, then we’re gonna encapsulate or then we might suspend it into a suspension or whatever we intend to do the ultimate product. It might go into transdermal, oral, however we end up doing it. So, for particularly, you know, let’s bring it down to what we do compound a lot. We spoke about nutrient therapy, particularly, for transdermal. We would mix, micronize those products, mix them uniformly using sound, and then we put them into a vehicle that allows better penetration. And this is actually a wonderful area too, Andrew. I love these bases. It is a lot about the base now. Okay. So, I would love to say aqueous and sorbolene were common words. They are not. We just don’t use them. We have so many wonderful bases at our fingertips. And we now would know, through education, which product we wanna mix, and then incorporate into the right base. And you know what? For many of you naturopaths listening, we are very passionate about the microbiome on the skin. And that means making the pH of the transdermal product match that of the client. And, you know, as much as I say I love anti-aging and we do a lot of nutrient therapy, your skin biome, particularly, is such an important part of your body. So, therefore, we would also incorporate a skin biome-friendly formula. And yes, we put probiotics in them very much. So, we add a lot of probiotics to formulations with capsules now and we use many probiotics in combination with skin therapy.

Andrew: Just to point of the cream. When we’re delivering oral vitamins or minerals, we get hung up on the mineral itself and pay very little attention to the ligand that it’s attached to, which can have dramatic consequences in how that mineral is used. For instance, you know, magnesium oxide is a classic versus magnesium orotate plus glycinate. They have different actions. What about the carrier of a cream? Does that have a different action for the mineral within?

Mary-Louise: Absolutely. So, we might use a cream that is a very plasticized base, meaning heavily in the fat. So, therefore, that’s gonna be an optimal vehicle if I wanna drive it through the epidermis and get it into a blood level. Okay? If I want something to sit on the skin, I’m probably gonna use more of a water-based product. But we actually are really fortunate now, we have so many versatile bases. And we actually call them that. And a versatile base is that actually is a bit forgiving. You can use a bit of both. And what would that be, for example, if I was gonna use a nutraceutical cream for treating pyrolles? That has a combination of fat-soluble vitamins A, Ds, and Es. It’s got water-soluble vitamins, you know, your Bs, your B2, your B6, and it’s got minerals such as zinc. So, therefore, this cream has to be quite versatile. And we would use one. But it would be the process and the time we add them in together to make sure they’re encapsulated and they’re carried uniformly throughout that cream. So, I hope that answered that. But we do many different bases there.

And, of course, testing. I gotta say I’m very passionate about education and testing. It’s testing the product in the day. So, the testing is not just at a patient level to make sure it’s working. And often they will tell you before you test, but also to see the cream. And it’s stable in a format. So, we do a lot of testing that the product is stable for at least, obviously if it’s transdermal. And of course, it doesn’t have any microbial growth. And that’s often just achieved by simply balancing the cream back to a microbiome-friendly pH, maybe 4 now or 5. And then the other addition might be looking at probably just how they’re stored at home. Obviously, when we compound a product, we have different regulations with our complex compounding rules. And, you know, that’s a really interesting space. We are under huge changes in our industry. And I think, therefore, good and bad reasons. The good reason is, I don’t think you can come into this industry now being uneducated and a bit of a cowboy. I think now we understand we have complex compounding rules.

So, what would be the difference for someone listening? I could be a simple compounder. Many of you walk into my pharmacy and I just did a simple cream on the bench. There are limitations on what you can do now. I sit in this is space for complex compounding. And what that means for complex compounders out there is that we know the validation of what a hazard is to our…risk to our clients, risk to our patients, that is, risk to the prescriber, and risk to, obviously, my staff and my A-team because I don’t want them at risk either. And a natural example of that might be if I’m working with a hormone, which is a hazard, isn’t it, through, breathing, transdermal, and whatnot. So, we’d have to make sure the risk is looked after there. But even micro-dosing. If I’m making something micro-dosed, I wanna make sure what’s in there is really in there. And the classic example for that, Andrew, you may be familiar with would be thyroid extract or T3. A highly unstable hormone. And normally, that’s micro-dosed. So, I would want to validate, when I make a T3 capsule it exactly has what’s in it. So, we send it off for post-testing. That’s validation testing. And we do that with every team leader in a section every year to make sure that we can endorse them as a good technician and they make a quality product. And that’s really important for this prescriber to know, the patient to know, and the industry as a whole.

Andrew: I was gonna ask a 20-pronged question now, but I’ll try and keep it… With regards to accreditation issues. I mean, obviously, safety issues are a huge issue. But also, you’re talking about competency and mixing standards and not just putting stuff in but actually measuring that they’re at the end and for the patient to be able to use.

Mary-Louise: Exactly.

Andrew: So, can you take us through accreditation and what that entails?

Mary-Louise: Sure. So, this is, as I said, a really dynamic area. So, I know I spoke a little bit about where I see the future of pharmacy. I’ve been passionately involved in compounding pharmacy in Australia for 25 years and I hope to not retire in the near future, maybe 10 or 20 to go. We collectively, as a group, are uniting. And we’re actually gonna come back and really put our stripes on the table to patients, and physicians, and referrers such as naturopaths or physios or whatever and say we are about training. And we are, actually, formulating a group called Formulae, which means any complex compounding pharmacists can join at free of charge and they will have access to this wealth of information. So, education is at the forefront of that. And then knowing that there are procedures and standard operating procedures that they must adhere to to make sure everyone is doing it safely. And risk management is the front of everyone’s mind, isn’t it, everything we do now. But I don’t wanna see us over-regulated to think that we get to a point that we become a pharmaceutical company because we’re not. We’re about the individual. We’re about you have a client, Andrew, that you have a problem that you need to solve, and I hope you pick up the phone and you reach out to your compounding pharmacist and go, “Look, help me. How do I get this active whether it be a nutraceutical or a pharmaceutical into my patient effectively, safely, and have a positive outcome?” So, we’re very aware of those. So, we see them with these regulations. I hope I’m not talking on, it’s a bit boring. It’s a story that you and I could sit down in a year’s time and say, “Look, this is happening. Industry has changed.” And it will and it’s happening. But it’s not supply-driven. It’s not someone who I buy my ingredients from telling me, “Of course, they tell me how to store it. Of course, they told me the shelf life and the expiry. And of course, we would adhere to that any day. And now we’re gonna pass them to patients.” But it’s about looking at my brethren, my fellow compounders, my pharmacist, and walk beside them and say, “There’s a better way, but do it safely and make sure we all unite on this way.” And I think we’ve learned from international trends that you just can’t be rogue and you’ve gotta do it safely.

Andrew: I think what you’re talking about is some accreditation without pecuniary interest in it. Is that right?

Mary-Louise: Yeah, exactly.

Andrew: Yeah, yeah. Can I just go back to something you said… Oh, sorry. Sorry, Lou.

Mary-Louise: No, no. In elaborating from that, it would be mandatory education, but not an expense for money. It’s about educating for the right reasons. And to be honest, I have the opportunity of working with a lot of pharmacy programs in this country. And the amount of time spent on teaching compounding as an art is really limited. Now, I’m not here to mag pharmacy at all, because I love pharmacy. I’m very passionate. But unfortunately, in a four-year course, you can only learn so much. You have to learn about the actives, you have to learn about nutraceuticals. And at the end of the day, how much time is spent on compounding is limited. So, I’m very proactive in taking pharmacists in their final year. And we have a rotational program where they come into our facility and they learn and they spend six weeks with me. And it’s unfortunate that the main pharmacist who do it, the one studying Ph.D. who go on to work for Big Pharma. I wanna see more community pharmacists get involved. Of course, hospital pharmacy do all the time, but not community. But community is where the growth in compounding is. So, they need to know more about it. And sorry for interrupting you.

Andrew: No, that’s okay. Is the APF text still used in the pharmacy course at UQ?

Mary-Louise: Yes. It is.

Andrew: It is?

Mary-Louise: We still use the APF. It’s limited. The APF is used. However, I suppose in my facility, we do many types of compounding. So, we grade them into different areas. So, of course, we do sterile compounding. We do hazardous compounding like the hormones. We also do your non-hazardous and then basic nutraceutical. The APF doesn’t pick up all those areas into its entirety. So, we have many different bodies that we lean on to guide us to get the best outcome. But the APF is still, yes, very much used and it still has an effect on how we often might do a basic formula.

Andrew: Good old Tinc Benz Co.

Andrew: Just coming back to what you said earlier, and you were talking about the creams and the stability of the nutrients in it. I remember, this is some years ago now. And it was a hospital pharmacist looking at the vitamin D that they used to make for their kids. And they found that they had, I think it was a 12-week expiry date because they didn’t use preservatives in the formula and so, therefore, I think it was bacteria kept on eating or, you know, disintegrating the vitamin D into its base complexes. I think that was the story. So, how do you get around that or do you have to work within that? Like, if you made it, let’s say, vitamin D for the skin, do you have to say, “Okay. It’s only valid for 12 weeks and after that, the drop-off is just too much.”?

Mary-Louise: Very much so. So, these are the groups that we align with internationally. So, if I was gonna use an APF-guided formula, I’m only gonna give 28 days because that wouldn’t have any extended expiry or stability on it. But vitamin D…

Andrew: Gotcha.

Mary-Louise: …is such a beautiful product and it can be given orally. It can be given transdermally. It can be given intramuscularly. Biggest growth for us is vitamin D injections now. So, looking at that vitamin D cream, I actually have the pleasure of working with a New Zealand pharmacist who is no longer with us, Mike, and he actually has stability of vitamin D cream up to 12 months, but it’s very much on how you get that preparation. Yeah, I know. So, unfortunately, it never got to the market because by the time you make that product, and vitamin D is very well taken orally and it’s absorbed at the right dose that it was not a commercial venture. However, you do actually have a stable vitamin D called solid D on the market, which was actually designed by a compounding chemist at birth. I don’t know if you’ve heard of it.

So, what would we do? We have a bank. So, using vitamin D as an example. If I think I wanna go out there and find a formula, I’m not gonna sit down… Obviously, I’ve got a lot of knowledge with compounding. However, I will use a resource for me. So, I would use my supplying companies who help us do stability testing all the time. So, it might be PCCA. It might be MEDISCA or it might be an international compounding society, which I get involved with very often. If I can’t find a legacy or formal from the or one of those groups, I might put it out to the big bad world and ask my peers. And we do that often on a networking group. And I might say, “Look, I’m challenged by this formula. I wanna get some stability data that’s greater than 28 days.” Now, if I was to dispense that and have 28 days, I would have to then validate that internally. So, meaning, at 28 days I’d make it and I would resend it off for testing. But I think the intent with compounded products is to make and use straight away. The intent is not to make a compound and have it sit on the shelf to dispense or sell on at a later date because that really is manufacture. We are clearly different from manufacturing.

Andrew: Of course.

Mary-Louise: Code. We’re gonna say why didn’t you say that beforehand?

Andrew: No, I was just, “Why wasn’t my mind there?” It’s, of course.

Mary-Louise: Oh, no. But the thing is, what if it’s… It would be the volume of the product because, obviously, if you’re only using a gram a day and I’m giving you a 100-gram tube, well, that’s three months’ supply. So, that product, in particular, I may wish to go and search the big internet and all our journals of literature and formulation to find one which lasts at least three months. And that’s what I would do. So, therefore, when you purchase the product, it’s gonna last three months. Many of the creams we do, do last for three months. And I would say, probably, in saying that, with your pH, with the type of preservative we use, we get asked so often now, Andrew, for natural preservatives. So, that would be a real growth with compounding. I think people are very aware of we don’t want these preservative products that are not really made for a microbiome skin-friendly person. So, that, you know, we often use basic citric acid or a product that we bring the pH down to. And we use some low-dose probiotic therapy in that cream to make it more modified and friendly. And therefore, and it tends to be stable. So, most of the creams we do would have three months.

Transdermal creams

Andrew: I’ve gotta say, when I first heard about transdermal absorption of nutrients, I was blown away because I thought, “No. No way can it get through the skin.” But I’m wondering if you do baseline testing and then treatment-level testing to prove that you’ve gotten that formula through the skin and are affecting the serum levels of the patient. Do you enter into that at all, or is that rather done by the practitioner?

Mary-Louise: All the time. Well, no. They’re done by both. We offer both services, but we also love to align with practitioners. So, a practitioner is always gonna retest after three to six months. But look at zinc, for example. There are so many chelated versions of zinc out there whether you’re doing transdermal or oral. But if we’re gonna use zinc transdermally, you can see a clear difference after six weeks of therapy. So, how we might do a quick test is we use a device called an OligoScan. And that just looks at refractive light that comes out through the skin itself. And it gives you a clear  I would say within three months with zinc, you know, and iron, some of the heavy minerals. So, you can see a difference, absolutely, from transdermal therapy. The question I would say, if you don’t, I would go back to dosing and I’d go back to the integrity of the skin. And this is often when we do nutraceutical compounding. It’s just about the person as the entirety, not just about the nutrient. So, fix their fatty acid synthesis. You might wanna pick something to rehydrate the skin layer from internally and externally and then look at nutrient therapy.

We often use it with kids. There’s an old adage, love a good story, because some of these creams are quite bright in colour. We get them to put it on the soles of their feet and wear a sock. So, they’re warm at night. Winter is great. They’re not gonna stain their sheets at all. And they get great absorption. And mums will tell you that, certainly, we’re talking about mood or mental health and anxiety, they see kids settle within two to three weeks. So, that’s just a beautiful outcome. So, really, testing for the sake of the improvement, I would go on symptoms more than that, but we offer testing for our facility here to our clients. And we also work with practitioners all the time. And they might send us an update and they go, “Look, we started with this formula.” If they’re gonna use bloods, for example, “We’ve got to this level.” They tell us their desired outcome. And we might write down a strategy of how they can best get there. It might be going back to a liquid in a zinc format. Sometimes going to concentrated liquid when someone has a lot of gut issues, you know, the epidemic of IBS and gut overgrowth whether it be Helicobacter pylori with triple staph, wonderful opportunity to go back to a liquid dropper form.

Andrew: Do you ever use a very rarely talked about form of zinc acetate? It’s normally reserved for Wilson’s disease? Have you ever used it in Australia?

Mary-Louise: We certainly stock it. There you go. I’ll give you that answer. Do we use it? No. We don’t use it often. But it’s probably just…probably, you could tell me why we don’t use it. I think it’s an opportunity to use. I think what we do, we go back to our practitioners and they get often very comfortable in the zinc form, chelate they understand and they know

Andrew: Yeah. To me…

Mary-Louise: But it’s mostly…

Andrew: Sorry. It’s curious to me why zinc acetate was the form preferred for Wilson’s disease. Obviously, that’s a copper overload condition. And copper accumulates in the brain tissue. But to me, it’s very interesting why it was never investigated for disorders like, for instance, anorexia nervosa where there is allegedly, and I may be wrong here, allegedly a flip in the zinc absorption mechanism. Is it in the brain? I don’t know where they’ve looked. This was Reading University Research many, many years ago.

Mary-Louise: I love it.

Andrew: I just don’t know why it’s never been investigated for other uses.

Mary-Louise: Yeah. Would it be to the conversion of formaldehyde? Would it be something about then the usage and the uptake of zinc itself? Yeah. I know…

Andrew: I don’t know.

Mary-Louise: Look, I’m gonna find out for us. That’s a great question. At the moment, probably the main zinc we do, we do a lot of a…zinc picolinate tends to be or zinc glycinate tends to be where people sit these days for safe chelated zinc. But the zinc acetate, we do have. So, anyone listening and they wanna formulate a zinc acetate product, send it on over and we’ll certainly get something for you. The Wilson’s disease with the copper. Copper and zinc ratio has really hit the forefront with nutraceutical compounding because of pyrolles and nutrient balancing. And this is where you can really see a difference with symptom control. And I always challenge certainly naturopaths or practitioners to use multi-modalities, just not one, because often you don’t know. And I think the biggest value we have as consultants and clinicians is people who don’t get an immediate response, don’t come back, or they don’t get an immediate response and they’re not gonna tell you, and you don’t get the outcome you want for what you’re treating, whether it be anxiety, or mood disorders, or some sort of eating disorder. So, using a multi-modality whether it be a cream or capsule, drops is sometimes not a bad idea because we all know, particularly, for zinc, if I was gonna dose it, the best therapeutic dosing is gonna be a three-times-a-day interval, not a once-a-day. And it’s gonna be a smaller dose because we know the uptake of oral zinc. Look, I really after about 13 to 15 milligram. The oral uptake of zinc has really diminished. And you could certainly challenge and bring some great studies and educate me and I love it. But therefore, if you’re gonna do it three times a day dosing, compliance becomes an issue, so you might morph into a program where you can have a cream, a drop, and a capsule, bringing in many ways.

Andrew: Okay. So, I’ve gotta ask, do you have a favourite condition that you love to manage with compounding?

Compounding Nutrients for Thyroid health

 Mary-Louise: Yeah, I do. Well, I suppose for my journey, I love a good story, Andrew. But my story is that I tragically about 10 years ago… I say tragically, got diagnosed with Hashimoto’s. And it came to the point, I always joke, I was in the dispensary one day. I was so fatigued. I had brain fog. I kept going to the doctors and they said, “You’re fine. You’re beautiful. You’re healthy.” And I said, “There is something wrong.” And I even live in this space. I was making thyroid extracts and whatnot. Eventually, did the antibodies level and said, “Wow.” So, for thyroid, for me, it’s a big passion. I love thyroid, and then hence why the nutraceuticals, I love vitamin D. We all know the interconnection with autoimmunity and vitamin D, you know, VDR, receptor genetic receptors. I love balancing back the vitamins that you need. And the number one mineral most people forget with thyroid is iron. Iron can be infused. Iron can be taken orally. You get a six-month window. You can use iron transdermally. You can have iron in a pessary and, of course, a liquid. And it’s using different forms to nutrient-balance these people. And then it’s using anti-inflammatories which are natural, and that’s morphing into what do I see with thyroid clients is pain, you know, fibromyalgia, other autoimmunity.

Compounding PEA

So, I have been really fortunate to work with clinical trials with a beautiful product called PEA. I know we spoke about that. I think you know. PEA is available with many great companies out now. But go eyes wide open. There are many forms of PEA. You get micronized. You get a PEA which is emulsified called Levagen. You get a PEA Plus which is more water-soluble with someone who has a gut dysbiosis you’d go for. So, PEA is certainly a beautiful product. I’ve had the privilege of doing clinical trial work out of UQ with Dr Beth Steels. So, a lot of the papers you’re reading now with help bring that product to the market. So, I’ve been working with the PEA for eight years. And to see it now commercially available by many nutraceutical companies is really just so wonderful. So, where I stem that back to thyroid disorders, we see so much inflammation that sometimes doesn’t have to be treated with thyroid hormone. Treat the inflammation. Treat the root cause. And PEA and now CBD are wonderful products. So, I love thyroid.

Andrew: Tell us a little bit more. Tell us a little bit more about PEA because you’re talking about different absorptions here or different formulations. And if you’re giving all of them orally, do you find, like you mentioned, that one form might be better suited to somebody with SIBO, whereas another one would be better suited for somebody with, let’s say, gallbladder insufficiency or a history of gallbladder disease?

Mary-Louise: Yeah. I love the way you’ve hit on the head. So, those different forms of PEA. That’s perfectly the answer. Some of the gallbladder… I’m probably not gonna give a liposomal or Lypo-Spheric PEA. I’d probably do the water-soluble version because their ability to break down fat generally is reduced. The SIBO… Isn’t this wonderful? They’re actually doing a trial now on PEA on SIBO as an anti-inflammatory. So, understanding PEA if you’re anyone listening, and I’m sure you might be doing another podcast on it, but it works like a cannabidiol, a CBD1 agonist. And we all know now our general acceptance of CBD, not just CBD itself, but supporting your cannabidiol system for anti-inflammatories because it’s natural to us as what we have. So, we’re very privileged in our business that we compound a lot of CBD products now. We just don’t do them orally, we do them transdermally. And they work. But bringing back the PEA, you’ve got your different formalities, so please any clinicians ask, reach out. We can tell you the types of PEA you can get. And if you’re gonna look at a commercial product, just check what type it is. But I’m a big supporter of Levagen. And they now have a Levagen+ because I’ve done the clinical work trials on it. But you’ve got one, which is a fatty base, and one which is water-soluble. So, you’re sort of getting both for

Andrew: Gotcha.

Levagen+ PEA

Mary-Louise: So, the fatty base Levagen, we do put in a transdermal product. And I really hope to see that commercially available on the market in the next few years. At the moment, it is readily compounded by us, but it will evolve into a product that will be so head to head to Nurofen topically. I mean, how often do people go into a pharmacy, Andrew, and grab Voltaren or grab Nurofen?

Andrew: With ibuprofen.

Mary-Louise: No. It’s just the wrong answer. I know I’m pretty… I’m talking to the converted, which is you and you’re passionate about half as much as I am. You’re not deficient in Nurofen receptors. Help your own anti-inflammatories. Help them. And that’s PEA. And that’s CBD1.

Andrew: Just a practical thing on the application of PEA topically. One of the TV ads that used to annoy the hell out of me was a locally applied nonsteroidal anti-inflammatory gel or cream which purported to go directly to the site of action. The inference was that it didn’t go anywhere else in the body. Any hospital pharmacist will tell you about the issues of ulcers in kids that they’re having to see…

Mary-Louise: Absolutely.

Andrew: …because the well-meaning parents have rubbed, you know, these creams or gels on the rheumatic joints of these children. So, tell us a little bit more about PEA. Can you get, let’s say, more of local action? And let’s say it’s a sore elbow. If you applied a PEA cream locally, can you get more of action locally as well as dispensing around the body?

Mary-Louise: You can and you’d obviously do that. So, if we’re gonna use it for a muscular or a joint inflammation condition, you would certainly apply it directly to the root cause of the part of the body which is in pain. But there’s nothing stopped. We can use it as a delivery vehicle as well, but I would use a powder with a child as well. So, I’d use both. I’d use topical and the oral supplement, knowing that your body naturally makes this compound. Okay. So, all doing it is enabling your body to reduce inflammation. So, absolutely. And look, this is a great question, so I might have to go back to Dr Beth and go, “Hey, look, when we do this transdermal trial, maybe we should put in rather than just doing symptomatic improvement, maybe we should look at blood levels,” which we did with our oral therapy. But a lot of the trials had really done on pain modulation, but it’s a compound that’s just got no… I can’t see any indications. It’s neuropathic pain. It’s joint pain, muscular pain. We’re now seeing it in gut inflammation disorders. We’re seeing for dental pain. We’re seeing it for fibromyalgia pain. We’re seeing it for, give me an inflammation condition that you wanna treat eczema, you know, skin dermatitis. Many, many areas that we’re using PEA that, you know, I think… And now the combination with turmeric or curcumin is certainly a wonderful sort of advancement on that. So, that is what you’re now gonna be seeing in nutraceutical land, commercially available, which is a liposomal, turmeric, or curcumin with it.

Andrew: I just hope that PEA, unlike curcumin, avoids the pigeon-holing that curcumin got, like, it’s for joints, whereas curcumin is just for so much more as PEA.

Mary-Louise: Absolutely. Yeah, absolutely. I think it is. And I think, you know, the beautiful thing we’re seeing is long-term use of PEA, there’s been no downside. I think on one of the trials earlier on which was done, there was one lady that we were suspicious was having an effect on her white blood cells. And at the end of the day, it was polypharmacy that did it. So, we couldn’t even definitively say the PEA had an influence, which is really encouraging. And I think that’s important to know anyone who’s using PEA. The other thing is the dose spectrum is quite broad. This is something that you could use with 150 milligrams 3 times a day, up to 600 milligrams 3 times a day. So, therefore, and even the higher doses, you’re not seeing any side effects. So, probably the only side effects you might get is the loose stool, and therefore you would not have the typical down.

Andrew: Yeah. Anything we give like that.

Mary-Louise: Yeah, exactly. So, that’s gastro intolerance. So, therefore, that’s really encouraging. So, we always have the mantra start low and go slow, but you’d find the dose. So, certainly for pediatrics, you can suspend it in water, you get the powder, you put on water, you can open the capsules and put them on water, and the most important thing is transdermally now it’s another option, certainly for kids with… I’m gonna say, you know, we didn’t probably not pigeoning your turmeric, which you spoke about. But we are actually doing a study with PEA and mood, because mood and anxiety is an inflammation disorder. So, we know oral PEA is a systemic anti-inflammatory. So, why not? Why do we often get so fixated with… Obviously, nutrient balancing parallels is important, but PEA, I know, for mood disorder, we’ll watch this space for any clinicians watching. Give it a go.

Compounding resources

Andrew: Okay. So, for anybody out there wanting to learn more about compounding, what sort of resources do you have? Where would you recommend? Given that you’re a pharmacist, so you’re in really that pharmacy arena, but what about naturopaths? Can they learn about this?

Mary-Louise: Oh, my goodness. So, we do a lot of education with educational bodies that align with where you’re from. So, my background from when I finished compounding pharmacy, I went on to do a course with anti-aging medicine, and that was an advanced diploma I did in the U.S. So, we align with a company in Australia called A5M which is an A4M feeder. We also will align with people like ACNM and the Australian Society of Integrative Medicine or wherever you’re aligned with. So, for naturopaths at the moment, most of the naturopaths it’s whatever body you’re aligned to. They would then align with a compounding… Now, I’m gonna say probably the easiest way is these courses are run probably not as frequently as we’d like because of COVID. And so I would say at the moment, a lot of it’s gone on to telehealth or webinars or podcasts like this. However, we have a whole gamut of educational videos with our business that we always share.

So, on our website, you log in as a practitioner and there’s a resource area that you log into and access. So, we don’t sort of discriminate for different modalities at the moment. So, we ask for your app or registration so we know you’re fully-fledged and you’re passionate about this. And then once you log in, you would see resources. And if there’s not the resource that you’re looking for, we encourage you to send us an email and we might have had a past tutorial. So, this is that the group that I sort of expressed to you where we’re heading with compounding called Formulae, is these videos will be very much marketed to every health practitioner, so it’s not just pharmacists because they’re about looking at the whole symptom and the person and what age they’re at. So, when we talk about PEA or CBD it’s a stage of life and the disorder you bring with that. And that’s also quite important. And what rocks your boat, you know, what you’re trying to achieve.

Andrew: There would be…

Mary-Louise: But educationally speaking.

Andrew: There’s probably-… Sorry, you go on.

Mary-Louise: Oh, no. So, yes, we have resources. You’re compounding pharmacies that are complex compounders. Many of us have resources and it’s who we align with. So, if you would send us an email, we could direct you to who we align with education. In addition, if we don’t have a video in our resource library, we would certainly send them out to you. But education is a big part. And to partner with someone who you can get the right answers for with your clients is really, really important.

Andrew: Great. Lou, there is so much more to cover here. I would love to delve into another area if you’d be amenable to join us back on “Wellness by designs” at another time. Pretty, please?

Mary-Louise: Oh, I’d love that. Oh, I’d love it. I had the opportunity with DFH to talk about the thyroid last year and the feedback was phenomenal. But I’m gonna go away and do my homework on the zinc part.

Andrew: All right. Cool. Maybe we can delve further into thyroid a little bit later and we can, as a sideline, we’ll delve into what are various…I was gonna say chelates but compounds of zinc that are…and how you utilize them.

Mary-Louise: Yes. Yes.

Andrew: Great.

Mary-Louise: Please do.

Andrew: Mary-Louise Condon, thank you so much for joining us on “Wellness by designs” today and sharing just a little bit of the expertise and passion that you have for compounding and how we can use it to help…