Month: March 2018

Categories
Health

Save your smile

Do you often choose fruit tea as a healthier option between meals or in the evening? Do you enjoy swirling the drink around your mouth to really enjoy the flavour before swallowing? If so, you could be damaging your teeth…

Acidic foods and drinks in the diet are associated with erosion of tooth enamel, but some people get more tooth damage than others. A study published in the British Dental Journal in March 2018 looked at what habits you should avoid to save your teeth…

First, it helps to understand that acid in foods softens tooth enamel, while alkaline saliva and “buffering” foods (containing calcium, phosphorous or fluoride) neutralize the acids and protect tooth surfaces. We all know that sugar is bad for our teeth, but did you know that it causes tooth damage by being broken down into acids by bacteria in the mouth? It is the acid, not the sugar, that causes tooth damage, although experts state that sugar is a greater cause of tooth decay than erosion of enamel.

Saliva is alkaline and therefore neutralizes acids, so consuming acidic foods or drinks at meal times, when more saliva is produced, results in less tooth damage. Holding an acidic drink in the mouth increases contact time with teeth and swishing or swirling a drink creates mechanical forces that further increase enamel loss.

Researchers say that when you brush may also make a difference in how much erosion of tooth enamel occurs. Brushing after acid has softened enamel may result in more erosion. In fact, some researchers have suggested that brushing before eating sweets to remove as much bacteria as possible could mean less acid will be produced, and therefore less tooth damage.

The Erosive Tooth Wear Foundation states that tooth erosion has increased in the past 25 years. Up to 30% of adults have signs of tooth wear. Dietary habits, medical conditions, chemical and mechanical factors combine to increase risk.

What are some of the risk factors?

  • Increased abrasion – While regular brushing does not increase enamel loss, using a very stiff brush, or a highly abrasive tooth polish regularly may cause problems. Holding items, like pins or nails, in the teeth or grinding the teeth regularly can also wear away the enamel in those areas.

  • Age – All adults will have increasing signs of wear as they age, due to chewing or speech patterns.

  • Dietary habits – How much and how often you eat acidic foods and drinks, especially between meals has an effect. Remember that swishing, sipping slowly and holding acidic drinks in the mouth dramatically increases the chance of damage due to increased contact time. Adding a buffering, calcium -containing food or consuming at meal time when more acid-neutralizing saliva is produced will lessen the chance of problems. So, add milk to your fruit tea, mix yogurt with your fruit or eat cheese with your wine!

  • Medication – Thick, syrupy medications tend to adhere to the teeth, greatly increasing contact time between the sugar they contain and tooth surfaces. This can be a problem if they are taken frequently between meals. Brushing before taking the medication to remove plaque and bacteria may reduce the amount of acid produced by the sugar. Rinsing the mouth or eating immediately afterward would reduce contact time of the syrup with the teeth.

  • Medical conditions such as gastroesophageal reflux disease (“GERD”) or bulimia nervosa (habitual induced vomiting to lose weight) – Stomach fluid contains hydrochloric acid, a very erosive acid, and digestive enzymes…both are very damaging to the teeth, removing minerals that harden the enamel and the collagen that supports the minerals.

  • Fluoride – Fluoride, as a mouthwash or in toothpaste, hardens tooth enamel and makes it more resistant to erosion.

So, help to save your smile by reducing the effect of acid on the surfaces of your teeth. Avoid tooth erosion caused by acid contact between meals: add some milk to your fruit tea, avoid soft drinks (essentially all are high in acids), drink acidic liquids through a straw to reduce tooth contact and remember that bacteria turn sugar into acids. Balance your acid intake… for example, if you plan to have wine in the evening, choose a non-acidic snack in the afternoon. Alcohol, fruit teas, sodas, sports drinks and flavoured water are all acidic drinks. Water, regular tea, coffee and milk are not. Adding lemon to water or tea makes it acidic too. Most fruits and fruit juices are acidic, with bananas and peaches being less so, and don’t forget about tomatoes, pickles and vinegars which are also acidic. Hot foods and drinks are reported to cause more erosion than cool ones.

Ask your dentist or dental hygienist to show you areas where mechanical erosion has begun so you can change your chewing pattern or other habits that are wearing away enamel. Notice whether you sip drinks slowly or swirl them before swallowing, increasing contact time with teeth.

References:

Nature.com – British Dental Journal study

Erosive Tooth Wear Foundation

Categories
Health

Heel pain – is it curable?

While heel pain can be caused by a problem in the heel, often the pain has nothing to do with the foot… if special shoes, heel cups and anti-inflammatory medications aren’t helping, read on!

In the diagram below, stripes show where pain is felt and the dot is where the problem originates.

How I learned about it…

Years ago, I was diagnosed with plantar fasciitis (inflammation of the fascia covering the bottom of the foot). I bought new expensive shoes, bought heel cushions, took Advil and rubbed anti-inflammatory cream on the bottom of my feet. It seemed to help but the problem never went away.

Then my brother-in-law, also a pharmacist, told me sometimes heel pain can be caused by a muscle spasm in the calf. Really? Hard to believe, but I was ready to try anything… walking was so painful. Instead of rubbing anti-inflammatory cream on the soles of my feet, I rubbed it on my calf muscles. I massaged my calves and stretched the back of my legs. And, wow, it worked! Whenever I felt any pain in my heels, I stretched my calf muscles and it disappeared right away.

Later I read how a muscle spasm or damage can “refer” pain to a different area of the body, making you think your problem is somewhere else. All your careful treatment of the painful area gives little relief because the source of the pain is elsewhere. A heart attack is a classic example of this – damage to the muscle of the heart (caused by lack of oxygen when a clot blocks its blood supply) is often felt in the jaw or left arm instead of in the chest where the problem really is.

The pain from a particular muscle tends to form a consistent pattern. Doctors Travell and Simons mapped out these pain patterns in the 1950’s and their work formed the basis of massage therapy. Unfortunately, most health professionals do not learn about muscle pain and its quirks. This means muscle pain is frequently misdiagnosed.

Fast forward to this year…

Now I have an odd pain near the toe joints of one foot. Some days it’s so bad I can hardly walk but it gets better once I walk (limp!) around a bit, and if I wear soft padded shoes. My doctor diagnosed it as arthritis, but that doesn’t seem to fit (or maybe I’m just too stubborn to accept a diagnosis that has no cure and no treatment other than pain medication). She suggested I consider custom orthotics and physiotherapy…

My physiotherapist figured out that my beautiful (and expensive) sandals were the problem – and I walked over 150km in them while in Spain. One sandal tilts slightly to one side causing me to do strange things with my foot (picture hanging on with your toes while your foot is slipping to one side…). I immediately threw them in the garbage and faithfully did the exercises she gave me. My foot was better but it didn’t clear up completely.

It took me a while, but eventually I realized there could be a similarity to the heel pain I had years ago. I dug out my trusty manual that is based on Travell and Simons and flipped to the section on feet… and there it was! A muscle spasm in the “flexor digitorum longus”, a muscle in the back of the calf. When I press on the area it is very tender, but I feel no pain in my calf at all when I walk. The pain all “referred” to my foot… The dot in the diagram is called a “trigger point” – an area where a muscle spasm is focused, and it’s the best place to treat a spasm. Often a muscle will relax if the trigger point is pressed and massaged.

This calf spasm was very likely a second way my body was trying to compensate for a tilted shoe. My physiotherapist once told me that there is rarely only one trigger point… the body eventually creates several spasms as it tries to adjust to a weak or injured area.

So, now I’m stretching my calf and rubbing my anti-inflammatory/muscle spasm cream on my “flexor digitorum longus” muscle that is causing so much pain. It will take a while to work out the “trigger point” knot deep in the muscle, but my foot is starting to feel much better already.

Custom orthotics?

As for custom orthotics (insoles), a new study published in the British Journal of Sports Medicine this week says expensive custom ones are no better than “off-the-shelf” insoles for plantar fasciitis foot pain. After my experience, I can’t help wondering if any insoles really help–especially when the problem originates in the calf muscles–but they feel nice when you have them in your shoes…

If you have stubborn foot pain that won’t go away, no matter what you try, see a physiotherapist or massage therapist that follows the work of Travell and Simons. Muscle pain is tricky and often disguises itself as “joint pain” or “arthritis”. Knowing where your pain originates and treating the source can make all the difference in finding a cure. Too often we treat the symptoms and not the cause in our medical system.

By the way, my favourite book on all this is The Trigger Point Therapy Workbook by Clair Davies. It explains trigger points, where their pain is referred, and how to treat them. It’s designed as a self-treatment guide you can use yourself. I added links to sources of the book in the references, if you’re interested.

References:

The Trigger Point Therapy Workbook – Amazon Canada ; Amazon US ; or AbeBooks

CTV News – article on custom orthotics study

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Categories
Environment Health

Plastic? Think twice…

Plastic doesn’t decay…it breaks into smaller and smaller bits until you can no longer see it. We call these microplastics. And these tiny particles are making their way into our drinking water—and our bodies. They can take hundreds of years to decompose, if they do… Plastics have only been around for 50 years, so that’s just an estimate. The bigger problem is that they are not inert…plastics contain substances that can compete and interfere with our hormones.

You don’t have to ingest the actual plastic for it to affect your health either. Substances, sometimes called “plasticers” that keep the plastic soft and flexible can be transferred into your food when you cook, store or serve food in plastic. These fat-soluble chemicals can mix with oily or fatty foods and your body can store them in fatty areas. Hot food, fat or oils, and damage to the surface of the plastic makes it easier for chemicals to transfer into food. Softer plastics are thought to transfer their chemicals more readily.

Plastic in our food

Sometimes you can even taste the plastic…coffee in a Styrofoam cup, a dairy that always sold their chocolate milk in glass bottles because they noticed plastic ones affected the taste. I even noticed water, served in a scratched plastic pitcher at a conference, tasted strongly—unpleasantly—of plastic. I didn’t drink it.

We’ve all put tomato sauce into a plastic container and noticed the orange colour became imbedded into the walls of the container. Plastic takes up oily substances, just as its chemicals pass into fatty foods. Questions have been raised about other substances plastics in the environment could be absorbing and transporting. The United Nations Food and Agriculture Organization is concerned that some plastic particles may be small enough to pass into our bloodstream and collect in our organs where chemicals they contain can gradually leach into our system.

Plastic can affect our hormones

Some of these chemicals are “hormone disruptors”…chemicals that interfere with how your hormones act in your body. And some, like bisphenol A (BPA) have been linked to hormone-related cancers and possible effects on unborn babies because of their hormone-like activity. More study is needed on the health effects of plastics.

Results of a new study conducted by Orb Media, a partner of CBC News, found microplastics in 93% of 11 brands of bottled water they tested from 9 different countries. They were only able to identify particles 100 microns (0.1mm) or larger. It seems likely that there were more smaller particles they were unable to detect.

They defined microplastics as pieces of plastic 5mm or smaller. They are created when plastic waste disintegrates and were also manufactured for use in exfoliant skin care products. The European Food Safety Authority has suggested that most swallowed microplastics are excreted by the body, but researchers have found microplastic beads from skin care products in stomachs of fish in the Grand Lakes. This has lead to banning of these beads in commercial products.

Plastic “islands”

Plastic waste continues to build in coastal waters. Researchers estimate that by 2050 there will be more plastics in the oceans than fish. Ocean currents cause them to collect in some areas, creating plastic “islands”. They block the sun’s rays from entering the water and trap sea life.

It’s easy to think we can’t be ingesting enough plastic to harm us. But we humans are at the top of the “food chain”—everything our food sources take up we consume and concentrate. We need to pay attention to what we put into the environment…and to what we are essentially “feeding” our food!

You can help…

This weekend, go buy yourself a water bottle made of glass, metal or ceramic and stop buying bottled water. If your tap water at home has an unpleasant taste, get a water filter. It’s a simple thing you can do to save the environment, save money, and save your health at the same time.

References:

Exposure to Chemicals in Plastic – Breast Cancer.org http://www.breastcancer.org/risk/factors/plastic

CBC: Microplastics article http://www.cbc.ca/news/technology/bottled-water-microplastics-1.4575045

Categories
Health

Could calcium pills be risky?

In the past decade, a debate has developed over calcium and vitamin D supplements–should everyone older than 50 take them to prevent osteoporosis (weakened, porous bones)? The amount of calcium in our diet, the quantity of vitamin D we make in response to sunlight, and the amount of exercise we get are important factors in preventing bone loss.

Lots of questions…

Can calcium and Vitamin D supplements take the place of a healthy diet and exercise? Can we get enough of these nutrients without supplements? How much is enough? Can too much be dangerous?

Here’s the controversy:

Several years ago, the US Preventive Services Task force issued a statement saying there was not enough evidence to support a need for calcium supplements in older adults who did not have osteoporosis or vitamin D deficiency.

In December 2017, the Journal of the American Medical Society published an analysis of 33 trials on older adults not living in nursing homes. It found no clear benefit from these supplements.

Another concern with supplements is the large “bolus” of calcium that floods the blood stream after a tablet is taken. Studies suggest that this could increase the risk of heart disease, with some showing up to 30% increased risk in those taking calcium supplements. Recommendations now suggest dividing calcium supplements over the day if they are being taken to avoid a spike in blood calcium. However, the problem is that researchers did not design these studies to look for potential heart problems, so we cannot completely trust these results. We need more research to confirm this.

Vitamin D–more controversy

The official recommended daily amount (or “RDA”) of vitamin D is 400iu per day, but this is the quantity needed to avoid Rickets, a disease of softening of the bones. As discussed in an earlier blog, we now know that we need larger amounts of vitamin D for a healthy immune system. Experts suggest 800 to 1000iu daily for those who are not making their own vitamin D due to lack of sunlight exposure, but researchers are still trying to decide how much is ideal. If you missed that article, click HERE to link to it.

And,a new concern…

This week, a new study published in the journal “Gut” suggests calcium supplements may increase the risk of polyps in the colon after 6 to 10 years of therapy… and polyps are important “precursors” to colon cancer (meaning: polyps are a stage in the development of cancer). Again, researchers said that more research is needed to confirm their results—being the first study to suggest this connection—but are concerned since millions of people take them.

Supplements versus food

One difference between getting calcium from a supplement rather than food, is that most common supplements contain calcium carbonate. Even when taken with food, this form of calcium is only 20% absorbed. The other 80% remains in the bowel where it causes constipation and, perhaps, also polyps.

Calcium in food, on the other hand, can be much more highly absorbed, especially when you have adequate vitamin D. I have read studies that found as little as 300mg of absorbed calcium a day in the diet can keep bone healthy, compared to 1000 to 1200mg recommended in supplement form. The difference, however, is likely due to the low level of calcium absorption from tablets.

A broken bone, like a hip or the spine, can devastate the life of an elderly person. And drugs for osteoporosis are expensive, difficult to take and have serious side effects. The best way to prevent osteoporosis and bone fractures is to exercise at least 3 times a week, don’t smoke, get adequate sunshine (or supplement vitamin D in a northern winter), and eat calcium-rich foods. Examples of these foods are dairy products, vegetables, fish (especially with dissolved bones), mineral water, and even tap water! See the reference “Calcium in food information” below for more details.

If you’re curious about your bone health, you can calculate your risk of a fracture here. (Note: conversion tool on the right to change pounds and inches to kilograms and centimeters)

References:

JAMA article

Gut online

Calcium in food information

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Categories
Health

Forget about the calories…

Which is better… a healthy low-fat diet or a healthy low-carb one? A new study published in the Journal of the American Medical Society (JAMA) this month asked this question. The answer was: no difference. But participants all lost weight without restricting calories. How did this happen?

The DIETFITS study (the Diet Intervention Examining the Factors Interacting with Treatment Success) studied 609 overweight adults aged 18 to 50 for one year. Participants attended classes with dietitians every 2 weeks to learn healthy eating habits, with half learning ways to achieve a lower fat content in their diet and the other half learning to lower their dietary carbohydrates. All participants were encouraged to focus on eating plenty of vegetables and whole foods, to eat at home whenever possible, and to avoid processed foods and added sugar. They were encouraged to follow accepted physical activity guidelines, but most did not increase their exercise. They were not instructed to count calories or record what they ate and were encouraged to eat until they were satisfied.

The result?

The result was: both groups lost significant weight. Their success in reaching a healthier weight was not influenced by their genetics or insulin-response to carbohydrates, contrasting with other theories that suggest a person’s diet should be recommended based on their DNA or ability to metabolize fat or carbs.

Some people lost as much as 50 to 60 pounds, and reported they had “changed their relationship with food”. The average weight loss was 5.3 kg (11.7 lb) for the low-fat group and 6.0 kg (13.2 lb) for the low-carb group. Both groups noted other improvements in health factors, such as reduced waist size, body fat, blood sugar and blood pressure.

And the conslusion from this?

Researchers concluded that it is the quality, not the quantity, of the diet that helps people manage their weight in the long run. A key factor is learning to avoid adding sugar and eliminating processed foods that often have sugar and other additives hidden in them – relying instead on more plant foods to satisfy the appetite. Sounds very much like Michael Pollan’s Food Rules that I’ve discussed before:

  • Eat real food (not processed),

  • Mostly plants, and

  • Not too much!

It’s good to see that different researchers are coming to the same simple conclusion about what makes a diet healthy, after so many years of practically needing to be a chemist to understand the various chemicals and components of our food that we were supposed to include or eliminate. A good, healthy diet should be easy to follow… and eating a diet that is focused on plants and whole foods, with just enough to satisfy your hunger, is about as simple as it can get, I would say!

The photo above is my homemade seafood pizza – no additives, made from scratch! Nothing processed, no added sugar, and a few veggies added for balance. After years of counting calories and carbohydrates, scrutinizing food’s fat content for “good” omega fats or “bad” saturated fats, or checking the “glycemic index” measurement (how quickly the carbohydrates were converted to sugar) of various foods, I find it refreshing to finally have a simplified way to achieve a healthy diet. If you think so too, feel free to share with someone else who wants to simplify their life!

References:

https://jamanetwork.com/journals/jama/article-abstract/2673150?redirect=true

https://www.irishtimes.com/life-and-style/health-family/want-to-lose-weight-new-study-says-reducing-calories-not-the-answer-1.3400119