Month: November 2016

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COLD SORES

Cold sores may occur anywhere on the body, but they most often appear on the gums, lips, around the mouth, nose, cheeks or fingers. Infection begins with a prodrome (tingling, burning or stinging sensation) which may last two hours to two days, followed by redness, swelling and blisters that break and ooze, forming a crust that eventually sloughs off. The entire cycle usually lasts seven to 10 days.

Ninety percent of people get at least one cold sore in their lives. The initial infection, which most often occurs between six months and three years of age, is generally worse than reoccurrences. The first episode usually occurs inside the mouth and can involve pain, fever, and swollen lymph nodes. It may be severe enough to cause difficulty swallowing. With both initial infections and cold sore reoccurrences, symptoms last about a week and resolve spontaneously.

Outbreaks can be triggered by trauma to the skin, menstruation, sun exposure, stress, illness, fever and other causes that contribute to reduced immune system activity. Most people have about two reoccurrences per year, but 5-10% of sufferers have more than six episodes yearly.

“Once a person has been exposed to the herpes simplex virus, it remains in the body and can be reactivated at any time.”

Cold sores are contagious and can be spread by direct contact with infected saliva or skin, or by contact with an item (such as a towel) that has been contaminated with the infection. There are two variations of the Herpes Simplex virus, called Type I (HSV-1) and Type II (HSV-2). Initially, HSV-1 was found on the face, while HSV-2 was found only in the genital area of patients. Now, however, both variants can be found in either location, but HSV-1 is most common. This article will discuss only oral infections.

Treating cold sores
Treatment approaches include reducing reoccurrences, decreasing pain, preventing secondary infection and reducing duration of the infection.

One approach to reducing the frequency of these embarrassing, unsightly infections is to identify and avoid triggers. General measures to maintain a healthy immune system, such as getting plenty of rest and paying attention to good nutrition, particularly during periods of increased stress, can be suggested. Sun exposure is a common trigger, so reducing UV light exposure by applying a sun block to the affected area year-round can help prevent outbreaks. In patients with a reduced immune response, prescription antiviral medications may be required.

A novel approach to preventing cold sores is the use of “thermal defence technology.” The Intercept-CS device uses the “heat shock” response to thermal stimulation (given in three 30-second treatments at five-minute intervals) to promote the production of heat shock proteins. These react with the immune system to help recognize and kill virus-infected cells without damaging healthy cells. It’s recommended that the treatment be performed within the first three hours of the prodrome phase of cold sore development. A clinical study cited on the product website demonstrated that this treatment could prevent 46% of cold sores from developing further. The downside is the cost: $99.00 per unit plus two treatment activators, and $45.00 for two replacement treatment activators. It is also only available through selected retail outlets.

Many OTC cold sore preparations are aimed mainly at reducing discomfort. These products contain a local anesthetic (such as benzocaine, lidocaine, benzyl alcohol, camphor, menthol or phenol) to decrease pain and itching, or are designed to form a protective film over the sore to reduce contact with irritating substance. Products of this type include Zilactin, Anbesol, Orajel, Tanac and Fletcher’s Sore Mouth Medicine.

Two products, Abreva and Lipactin, have been shown in clinical studies to shorten the duration of cold sores. Abreva contains docosanol 10%, an active ingredient that blocks viruses from penetrating into cells, reducing their ability to replicate. It has been shown in a large clinical study to shorten healing time by one to four days and to reduce discomfort. It should be applied as early as possible in the prodromal stage, and used five times a day for up to 10 days.

Lipactin contains heparin 17.8 units per gram and zinc sulfate 0.56 milligrams per gram as active ingredients that are also understood to reduce viral replication. It is recommended that the product be applied three to six times daily, beginning as soon as an outbreak is detected.

Natural alternatives
One alternative approach to preventing and treating cold sores takes into account the fact that the amino acid lysine inhibits the growth and spread of herpes simplex virus. Increasing consumption of lysine-rich foods (red meat, milk, eggs, cheese, wheat germ, brewer’s yeast, and fish) or taking supplements (e.g. 1000 mg three times daily) may help reduce the occurrence and shorten the duration of cold sores. The ratio of lysine to arginine is also important, as arginine inhibits absorption of lysine. Reducing consumption of foods rich in arginine, such as chocolate, peanuts and almonds, would increase the absorption of lysine. A pilot study conducted at the University of Southern California found that lysine ointment produced full resolution of cold sores in 40% of participants by the third day, and in 87% by the sixth day.

The herb, lemon balm (Melissa officinalis), has antiviral properties. In a study conducted in Germany, lemon balm cream promoted the healing of cold sore blisters in five days compared to 10 days in the control group. Used regularly on the affected area, it may reduce the frequency of recurrences.

Resveratrol, a compound found in red grapes, has also been shown to be active against the herpes simplex virus in laboratory studies. A study at Northeastern Ohio University found it to be as effective as 5% acyclovir ointment in suppressing cold sore development. It was also shown to be effective in animals with herpes simplex virus that was resistant to acyclovir. No side effects were reported.

Peppermint oil, also used in irritable bowel syndrome for its anti-spasmodic activity, also has been shown to penetrate the skin and have a direct virucidal effect against the herpes simplex virus. However, as the degree of absorption is not known it should not be given to patients with gastroesophageal reflux disease due to its ability to relax smooth muscle sphincters. It is also not recommended for patients taking calcium channel blockers as its relaxant action is believed to be similar in mechanism to this class of drug.

Immune stimulating herbs, such as Reishi (Ganoderma lucidum), astragalus and echinacea may be helpful in controlling cold sore outbreaks by strengthening the body defences that normally keep the virus in latent form. As a general caution, any patient with an autoimmune disorder, organ transplant, or liver disorder should consult their doctor before use. Keep in mind that Reishi reduces blood clotting and could affect anticoagulant therapy.

Erpace, marketed by Boiron, is designed to soothe pain and itching and promote healing of lesions. It contains essential oils of chamomile, oregano and marjoram, and lappa major mother tincture in a base of sweet almond oil. Oregano oil and marjoram oil are noted for their antiviral action while chamomile is an anti-inflammatory and an antiseptic. Lappa major (also known as burdock) is an antimicrobial that may also increase immunological activity.

For clients interested in homeopathic options, apis mellifica is recommended for use during the prodromal stage, rhus toxicodendron during the blister phase and mezerium would be suggested once the lesions have crusted over. Homeopathic medications are generally recommended up to 30CH dilution as OTCs (i.e. without the involvement of a qualified homeopath), and are dissolved under the tongue three to four times daily, or as often as every half hour in an acute situation. Homeopathic medication would be administered more frequently, rather than in larger quantities, to achieve a more intense and faster response.

There are many different approaches to treating and preventing cold sores, and they are not mutually exclusive. You may find, for example, that modifying the diet to increase absorption of lysine will complement a topical therapy. So, ask about additional treatment ideas the next time you seek help for a cold sore.

Originally published in Drugstore Canada

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The Politics of Food

What do food and politics have in common? More than you might think…

I recently watched a documentary about food and the obesity epidemic entitled “Fed Up”, available on Netflix and iTunes. Although I probably should have already realized this, I was surprised to learn about some of the ways big business can influence decisions about processing and marketing of food.

A little history…The US McGovern Committee was formed in the late 60’s to investigate the causes of hunger in US, and this mandate eventually expanded to include examination of environmental conditions that affected nutrition and investigation into dietary causes of chronic diseases, such as heart disease, certain cancers, stroke, high blood pressure, obesity, diabetes and arteriosclerosis.

Their 1977 report, “Dietary Goals for the United States”, more commonly known as the McGovern Report, looked at overeating as well as hunger. It suggested that Americans should eat less fat, less cholesterol, less refined and processed sugars, and more complex carbohydrates and fiber. “Complex carbohydrates” indicated fruit, vegetables and whole grains. In other words, they recommended eating more fruits, vegetables and whole grains and less high-fat meat, sweetened foods, eggs and dairy products.

The cattle, dairy, egg and sugar industries reacted strongly to the “eat less” recommendation. Even the American Medical Association opposed the report, saying people should see their doctors for individual recommendations, rather than having a national guide. In response to heavy pressure, the report was watered down, allowing higher sugar, salt, cholesterol and meat intake recommendations. References to processed sugars were removed from some parts of the report.

In 2002, the World Health Organization (WHO) and UN Food and Agriculture Organization (FAO) jointly issued a document labeled “TRS 916” suggesting sugar is a major, if not the major, cause of chronic metabolic disease and obesity. It recommended that less than 10% of calories should be consumed in the form of free sugars: those added to food or in the form of refined sugar, syrup, honey or fruit juices.

According to the documentary, “Fed Up”, the American government resisted publication of the report, concerned it would harm the sugar industry in US. Reportedly they threatened to withdraw funding to the WHO if the recommended limit for added sugar wasn’t increased to 25%. The final report downplays added sugar and, in fact, appears to leave sugar out of much of the discussion altogether.

The result of all this was an increased focus on fat content of food and little or no attention to sugar. The food industry responded by creating “low fat” products, and many were labeled as being healthier choices. Sales of these specialty foods soared.

However, when fat is removed from food, much of the flavour is removed also. To improve the taste of low-fat and fat-free foods, sugar was added, and between 1977 and 2000 sugar consumption in US doubled.

Sugar has been described as a “chronic dose-dependent liver toxin”, and is considered 8 times more addictive than cocaine, according to one source. Eighty percent of processed foods have some form of added sugar, and white flour starchy foods are almost immediately changed into sugar in our digestive systems.

A few other interesting points:

  • Fibre slows the absorption of sugar, so whole fruits with their natural fibre, have much slower absorption of the sugar they contain than fruit juices with little or no fibre.

  • Artificial sugar substitutes have been found to trigger release of insulin, a mechanism believed to be connected to the sweet taste, and this triggers increased hunger.

  • Government regulations allow food that is actually hazardous to health over the long term to be marketed as a healthy option. “Healthier low fat” products with high amounts of unhealthy sugar are really not healthier for us.

  • Large food companies are often controlling food choices for children in school cafeterias. The rate of childhood obesity and related chronic diseases, like diabetes and heart disease, in children is rising at an alarming rate.

  • It is not required to indicate the percent of daily recommended intake on the nutrition label, drawing less attention to products with excessive amounts of added sugar. Note the image above, downloaded from the internet, and how it simply skips over providing information on sugar…

Even though most of these food lobbies operate in US, we in Canada are highly influenced by American products and advertising. Governments should be taking actions to protect the health of their populations, but powerful lobbies backed by industry money are influencing important decisions about food content, labeling and marketing.

So, take time to check product labels. Be aware that sugar comes in many forms and includes names such as cane extract, corn syrup, concentrated fruit juice, dextrose, diglycerides, disaccharides, Florida crystals, fructooligosaccharides, galactose, glucitol, glucoamine, hexitol, inversol, isomalt, maltose, mannitol, nectars, pentose, sorbitol, sorghum, xylitol, zylose….and more. Ingredients are listed in order of highest to lowest weight so a product with a sweetener as one of the first 5 ingredients likely has a large quantity of sugar.

The solution is education about healthy food choices. Choose whole foods rather than processed, and prepare meals at home as much as possible. And avoid foods with unfamiliar ingredients and added sugar.

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Health

The Mind/Body Connection

Researchers have shown that the mind and the body are connected in several ways… What we think and believe, and our attitudes and moods can actually have physical effects… and physical processes, for example exercise, can affect how we feel. There is actually two-way communication between the conscious part of the brain and the rest of the body through nerves, hormones and the immune system.

A good example of beliefs creating a physical change is the “placebo effect”. A placebo is a tablet, capsule or injection that contains no medication – basically a sugar pill. The placebo effect is a phenomenon where a person receiving a placebo has an improvement in their condition, either actual or perceived. The size and colour of the placebo can even make a difference, with larger coloured capsules found to have greater effect than small white tablets. Studies have shown that placebos can even have an effect when the person knows the pill contains no active ingredient.

This phenomenon is so widely known in the science community that all properly conducted studies must be “placebo controlled”. This means, in order to be considered a valid study, the drug or treatment needs to be compared to a sham equivalent, usually without the patient or the researcher knowing whether the placebo or the active treatment is being given to avoid reporting bias.

Even with active medications, an increased effectiveness has been noted when patients know they are receiving a medication than when they are not aware they have been treated. So, the placebo effect is part of the response to active treatments as well. The manner in which a treatment is given can also affect the response. Administering a treatment with concern and caring can actually result in better results for the patient.

Your emotions can also affect your health. Sadness, stress or anxiety can result in physical effects…even good stress, like having a baby or moving to a new home, can take its toll on your health.

The list of health effects that can be caused by emotions is long, and includes back pain, change in appetite, chest pain, constipation or diarrhea, extreme tiredness, general aches and pains, headaches, high blood pressure, insomnia, heart palpitations, sexual problems, shortness of breath, stiff neck, upset stomach and weight gain or loss.

So, what can a person do to improve emotional health? Of course, if your physical problem is severe or if your negative feelings are extreme, it’s advised to discuss the problem with your doctor. You also want to determine whether it is caused by emotions or a disease process.

Familydoctor.org has some suggestions for what you can do yourself to prevent health problems that might develop due to emotions or stress. The first step is to recognize your emotions, the effects they are having and why you are having them. I recall an interesting book on back pain by Dr. John Sarno I read several years ago, where he reported significant numbers of patients whose back pain resolved once they realized it was a manifestation of their stress. This supports the idea that acknowledging the influence the mind can have on health can be an important step in healing.

The FamilyDoctor site also suggests several other helpful tips to minimize negative health effects due to stress and emotions:

  • Express your feelings – Keeping feelings inside may make you feel worse. It’s OK to let loved ones know there is something bothering you or to discuss the issue with a friend, doctor or counsellor and ask for advice and support.

  • Keep your emotions in perspective – Live a balanced life, let go of unimportant issues and accept things you can’t change. Try to focus on what is positive in your life. Be like the little girl in the YouTube video doing her morning affirmation in front of a mirror: “I love my family, I love my house, I love my life!” Dwell on the positive, not the negative.

  • Calm your mind and body – Find relaxation methods, such as meditation, music, yoga, breathing exercises or whatever works for you.

  • Take care of yourself – Keeping a healthy routine with balanced meals, enough sleep and exercise can reduce the physical impact of stress and other emotions.

Consciously changing the way you think and feel takes time, effort and practice, but maintaining a positive outlook can maximize the benefit you receive from your medication and improve your health!

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Health

The Vaccine Debate

Vaccines are described as the single most effective medical intervention in history…more lives have been saved by vaccines than by any other treatment. In fact, vaccines have been so effective in preventing diseases that many people alive today do not realize how severe diseases like polio, measles, mumps, diphtheria, tetanus and pertussis can be.

I should confess that I am biased in favour of vaccinating – I was one of the first pharmacists to be certified to give vaccines in the province of New Brunswick and continued on to work with a team of nurses and pharmacists who taught and certified hundreds of pharmacists in several Canadian provinces. To do this, I studied large amounts of scientific information about many aspects of vaccines and their use.

Vaccines are overwhelmingly safe…most reactions are minor, such as a sore arm or mild fever. All reactions are carefully tracked and documented to detect any potential problems as soon as possible. Severe anaphylactic (allergic) reactions occur less than 2 times per million doses given, but every person administering vaccines is trained to detect and treat these severe reactions and must be equipped with medications needed to do so.

Concerns have been expressed about the possibility that giving several vaccines at once could overwhelm the immune system, but scientists confirm our immune systems have the capacity to handle several thousand vaccines at once. They point out that during a normal day, a child is exposed to several hundred different antigens that trigger the immune system into action, and this is what a vaccine does.

An article in 1998 suggested that the measles vaccine was causing autism, but this has been disproven long ago. In spite of this, some parents still refuse to vaccinate their children based on this and other misinformation.

The mercury-containing preservative, thimerosol, has also been of concern to some parents. Although it was never demonstrated to cause a mercury-related health problem, it has been removed from all child vaccines manufactured since 2001, except flu vaccine that comes in multi-dose vials, most likely due to the number of allergies to this ingredient. Note that single-dose influenza vaccine does not contain this ingredient.

Another common vaccine ingredient that has drawn concern from parents is formaldehyde, used to inactivate viruses and bacterial toxins in vaccine manufacturing. Although most is removed from the final product, a very small amount remains. The human body actually produces its own formaldehyde when proteins are processed, and a baby’s body at any given time will contain 10 times the amount that would be in a vaccine. This small amount has been shown to be completely safe and our bodies have mechanisms to eliminate it, along with the formaldehyde we regularly produce ourselves. Far more dangerous amounts are found in second-hand cigarette smoke and car exhaust, and most dangerous are the workplace exposures to formaldehyde, such as hairdressers exposed to some hair smoothing products that produce formaldehyde when used.

Although we rarely see many of the childhood diseases we vaccinate against now, they still exist and could quickly become commonplace again. We saw this with pertussis (whooping cough) in our province. Because of higher rates of reactions from a vaccine that contained whole inactivated viruses, immunization rates dropped and over a thousand cases were documented in one season. Pertussis is similar to a mild cold in a healthy adult, but can be fatal to a small baby. Government’s response was to inform the public and step up vaccine availability to bring the disease under control again. There is ongoing research to ensure that the resurgence is not due to decreased effectiveness of a newer improved vaccine with fewer reactions.

It is true that some vaccines are more effective than others. The shingles vaccine, for example, only reduces occurrence of the disease by about 50%, although it is pointed out that cases tend to be less severe in those who have been vaccinated, and “post herpetic neuralgia”, pain that can continue for weeks or months after a bout of shingles, was also reduced. Many feel that even this level of resistance to getting shingles makes it worthwhile taking the injection.

It’s flu season now, so let’s talk about the flu vaccine… The severity of influenza will vary from year to year, depending on the nature of the strains going around that particular year. Because the flu virus changes frequently, researchers track influenza cases around the world and choose 3 to 4 strains that they expect could cause the worst illness, creating a new combination each year.

The flu is not just a bad cold…it kills 300,000 to 500,000 people in an average year around the world, mostly the elderly. Young children are also at increased risk, as are pregnant women, and those already in poor health or with chronic conditions like asthma or heart disease. Vaccinating a pregnant woman also gives protection to her baby, a definite plus since the vaccine cannot be given to children under 6 months of age.

Some don’t bother getting the vaccine, stating they are healthy and not worried about catching the flu, but we all need to keep in mind that we could pass the illness on to someone who is more vulnerable than we are. If more people are vaccinated, it is less likely we will have a large epidemic – this is referred to as “herd immunity”…the whole community is protected because there are fewer people who can spread the virus to others.

I have had clients claim that they “caught the flu” from the flu vaccine, but this is not possible. The pieces of virus in the vaccine are dead and cannot start to grow causing an infection…it’s just not possible. It is possible, however, to catch the flu from someone else in the first 2 weeks after a flu shot because it takes 2 weeks for antibodies that protect us from the virus to develop in our bodies.

However, I did read about one incorrectly made batch of vaccine that reached the market in the ‘90s that actually did cause some severe illness. The manufacturing problems were detected and corrected to avoid recurrence of a similar problem. The manufacturing of vaccines is highly regulated to ensure “bad batches” do not occur today.

Vaccines containing an “adjuvant”, an extra ingredient designed to increase response to the vaccine in those with weaker immune systems, are also known to have somewhat increased reactions such as pain in the area of the injection and mild fever. The special vaccine produced to fight the H1N1 flu epidemic of 2009 contained an adjuvant to ensure the highest level of immunity possible would be produced. This H1N1 virus was similar to the one that caused the Spanish Flu of 1918. That epidemic killed 50 to 100 million people, about 3 to 5% of the world’s population at that time, many of them young healthy adults.

Again this year, experts are predicting a flu season that could be more severe than others. Getting a flu shot is free for many, and takes just a few minutes. And it’s available as close as your neighbourhood pharmacy or doctor’s office. So why not take a few minutes and protect yourself and others around you from a preventable illness!

If you have any questions about vaccines that I haven’t answered, click the “Comments or Questions” button, or ask your pharmacist or doctor!