Month: May 2020

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Severe COVID-19…who is at most risk?

Why do some people get sick and die from COVID-19 while others don’t know they’ve even had it? While we still don’t know all the answers, researchers are learning why this happens and who is at higher risk.

As we start to open businesses, it will be important to protect those at greater risk of the severe form of COVID-19 infection. So, who is at risk? And is there anything we can do to increase the chance of having a mild case of the virus when exposed? Knowing who is at higher risk of dying from this disease means we can take extra precautions to prevent them from exposure to this deadly virus. We can also ensure they are tested and treated at the first sign of symptoms.

Potential risk factors identified so far include age, gender, some medical conditions, certain medications, poverty and crowding, certain occupations, and pregnancy. It is likely that more risk factors will be identified as research progresses.

Age

First, we know that those over age 65 are at higher risk and those in care homes are at further increased risk. We have painfully watched, seemingly helpless, while the coronavirus has swept through too many nursing homes. In Canada, 82% of deaths from COVID-19 have occurred in long-term care residences as reported on May 7th, 2020. In the US, percentages of long-term care home deaths range from 20 to 80% by state, averaging 42%, based on data reported by May 22th, 2020. Clearly, we need to improve systems in our seniors’ residences to better protect our vulnerable elderly population.

Gender

While equal numbers of men and women contract COVID-19, several studies show men have been more affected with the severe form than women. Experts say one reason is that women tend to have stronger immune systems. Another is that men are more likely to not take early symptoms as seriously, on average, resulting in seeking treatment when the infection is more severe.

Medical conditions and medications

People with underlying medical conditions are also at increased risk of more severe viral infections, especially if not well controlled. These conditions include lung diseases, like emphysema and asthma, serious heart conditions and those whose immune system is weakened (“immunocompromised”). Conditions that affect the immune system include cancer treatment, smoking, organ or bone marrow transplantation, poorly controlled HIV or AIDS, and long-term use of corticosteroid treatment and other medications that reduce the immune response. The immune system generally weakens with age, which may explain the vulnerability of the elderly.

Even having low vitamin D, a vitamin that is essential for a properly functioning immune system, is thought to be a risk factor for more severe illness. Keeping up your general health by eating a healthy diet and getting exercise is a good recommendation to ensure your best chance at fighting the virus if you should catch it.

Being severely overweight (Body Mass Index “BMI” over 40) increases the risk of the severe form of COVID-19 and people with diabetes, chronic kidney disease requiring dialysis, and liver disease are also at greater risk. Even having insulin resistance, a pre-diabetes condition where higher amounts of insulin are needed to allow sugar into the body’s cells, has been noted as a risk factor. It is very important to continue medications and treatment, including emergency care, for these diseases during the pandemic to enable the maximum resistance should you contract the virus.

Poverty, overcrowding, homelessness

Those living in overcrowded or homeless situations have difficulty maintaining physical distancing, putting them at increased risk of contracting the coronavirus. As well, staying at home when there is little space and no access to outdoors creates stress for families. Elderly living alone can suffer from severe isolation.

Poverty is known to be a risk factor for poor health in general and having poor health status puts people at greater risk of the severe form of COVID-19. Being unable to afford good quality food and medicines, and, in some countries, health care increases the chance of a person having poor health and being less able to fight off infection.

One article I read suggested that the most likely place to catch the coronavirus was within your own residence! Essential workers are more likely to live in overcrowded living conditions and can be a source introducing the virus into the home. Many households do not have enough space to allow physical distancing and self-isolation when necessary allowing infection to easily spread to others living there. We have seen the result of living conditions in long-term care situations, with many sharing the same living space.

Occupations

Three factors are used to determine the amount of risk a worker faces:

  1. Contact with others – How much contact is required to perform the work?
  2. Physical proximity – How close does the worker need to be to others while working?
  3. Exposure to disease – How often is the worker exposed to hazardous conditions?

Although many workers have started to work from home (estimated at about 1/3 of workers), essential workers such as those in retail and health care are forced to risk their health and that of their families. Front line health care workers, of course, are at the top of the list but I was surprised to see that the dentistry profession was at greater risk than doctors and nurses, with dental hygienists at the top of the list (see reference below for details).

But as stores begin to reopen, the safety of retail workers and those who use their services depends on the preparations made by the employer. Will they be able to maintain physical distancing? Are there increased cleaning and hygeine procedures in place? Are the staff provided with masks and will customers also be required to wear masks?

And risk and pay are not aligned. Some of those at greatest risk because of an inability to avoid close contact with others include bus drivers and cashiers, while most jobs that can be performed at home are higher-paying ones.

Pregnancy

Because COVID-19 is such a new infection, we are still learning whether pregnant women or their unborn babies are at increased risk of complications if the mother becomes infected. While information is limited, so far there does not seem to be any indication that they are at higher risk of getting the infection or having more serious illness if they do. However, as pregnant women are at increased risk with other infections, like the flu, caution is recommended.

Additionally, a small study has noted some damage to the placenta caused by blood clots in pregnant women who contracted COVID-19, but most delivered healthy babies. This is an area that doctors and researchers will be watching closely.

The advice for pregnant women is to stay home as much as possible; avoid visitors, public transit, and crowded places; wash hands often, avoid touching frequently touched surfaces and don’t touch your face; and practice physical distancing. Talk to your doctor about whether you can have appointments by phone or videoconference. And check for updates as researchers gather evidence in the coming weeks and months (see reference below for the Public Health Agency of Canada or verify with your country’s health agency’s recommendations).

The bottom line?

Of course, these are things we all need to continue doing. While we may be able to loosen restrictions for periods of time while the virus isn’t present in our area, experts say it is almost certain that there will be a second wave of infection that will require us to self-isolate again. This will be our life for a while and the more we can do to limit the spread of the virus, the more freedoms we can earn for ourselves.

In my province, New Brunswick, Canada, we are in “Phase Yellow” which allows us to have gatherings of up to 10 people indoors or up to 50 outdoors (where sunlight, open air and wind lower risk). My friends are happy that their hairdressers are allowed to open too! We’re seeing only 1 or 2 new cases every couple of weeks here, but still unfortunately rates in neighbouring provinces rates are still higher so borders remain closed. I miss seeing family in Nova Scotia and Quebec, but we all need to do what we can to limit the spread of the coronavirus. We’ll get through it eventually, but it will take time and patience.

And I’m still making masks, although not as many these days, especially as the weather is warmer and we are allowed to join friends at our beach. I’ve lost track of how many masks I’ve made but it’s over 200 now. And I’ve been painting designs on them, now that I have more time.

I’m having some fun while still helping friends and family… and I hope you are all doing the same. Take care of your health, protect each other, and stay safe!

#COVID19risk #covid19 #coronavirus

References:

82% of Canada’s COVID-19 deaths have been in long-term care, new data reveals – The Star

Nursing Homes & Assisted Living Facilities Account for 42% of COVID-19 Deaths – FREOPP

Why COVID-19 is Hitting Men Harder Than Women – Healthline

Coronavirus Disease 2019—People Who Need Extra Precautions – Centers for Disease Control and Prevention

Poverty advocates call for protection of vulnerable amid COVID-19 pandemic – The Globe and Mail

Overcrowded Housing and COVID-19 Risk among Essential Workers – PPIC

These are the occupations with the highest COVID-19 risk – World Economic Forum

Pregnancy, childbirth and caring for newborns: Advice for mothers during COVID-19 – Public Health Agency of Canada

Insulin resistance marker correlates with COVID-19 morbidity, mortality – Univadis

How COVID-19 might affect a pregnant woman’s placenta – Live Science

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I’ve been talking to myself lately…

Years ago, when I was a pharmacy student, we did formal training with various pharmacists. One of the first I worked with, Carl, talked to himself. At first, I thought he was talking to me… “Excuse me?”, I’d say. But he explained that all pharmacists talked to themselves—some just did it silently, not out loud as he did. It kept him organized, helped him focus on the work, kept him “sane”, he said, or some such words. That was over 40 years ago…

After a while, I realized I was doing it too! Talking to yourself helps you organize your mind… OK, what’s next? What problems need to be resolved? Which are most important and need to be done first? I was consciously prompting myself to get organized and concentrate on what was most important.

Not just for work…

Now I realize this works, not just for work issues, but for the rest of my life too. Especially in this time of social distancing and isolation, we need to keep ourselves going, to plan ways to connect with others, to find new ways to make things happen. This is particularly true for connecting with family and friends that are farther away who we can’t visit due to travel restrictions.

And rather than puttering away the time, waiting for COVID restrictions to be lifted (which may last months at various levels!), talking to ourselves about what we’d like to get done helps to motivate us and prioritize what is most important right now.

But beyond using self-talk to help organize activities and communications, I’ve realized that you can change your thoughts by talking to yourself. Our subconscious mind loves to pull up unpleasant thoughts from time to time and it’s easy to focus and dwell on these thoughts. But unless there is something you need to do about those thoughts, problems or situations, why not just tell yourself to move on? Think about something pleasant instead?

Brain research tells us, the more we think about something, the better we remember it. Our brains build stronger memory connections to the information we think about most. While this is a useful practice to help learn a new skill, it can work against our overall happiness if we let our brains build stronger connections to bad memories. Do we want to remember the unpleasant experiences or the happy satisfying ones? Consciously turning off thoughts of unpleasant memories and turning them toward better ones can improve our mood and overall happiness. Similarly, doing what we need to do these days to stay safe then dwelling on how to make our situation better can prevent unnecessary anxiety.

Talk to yourself about what you want to happen…

Years ago, I stumbled across a book called The Secret. The basic message of the book was: if you want something, focus on it and think about it and it will magically appear in your life. At the time, I thought this was silly…things don’t just conjure up because of thoughts. But now I think I understand the idea. When you focus on something and think about it often, it can change your actions. You do what you think about. And actions make things happen. So, thinking about your goals or desires helps to direct your actions and increases the chance of achieving what you want. It’s not 100%, of course, but if you don’t think about what you want to accomplish, you’re unlikely to take any action to get there and chances are slim that what you want will happen.

Of course, the extreme version of this type of thinking—wishing for something impossible—isn’t productive either. The idea is to stop thinking about upsetting past events that can’t be changed, enjoy the present moment for all it has to offer, and to consciously direct your thoughts and actions to creating a happier healthier future.

We’ve seen dramatic changes in our lives over that past couple of months. It’s easy to dwell on the negative side of all this, but why not talk ourselves into finding some positive. I was touched by Andrew Cuomo, Governor of New York, talking about how he was creating a closer relationship with his adult children during the pandemic. Rather than a quick “How are you doing?”, then “Busy…have to go” conversation, he talked about how he was taking time to really understand how the crisis was affecting his children’s lives, getting to know them better as the adults they had become. They were having conversation on a much deeper level and it was improving their relationship.

Viral change

Last week, my youngest daughter sent me a letter…a real letter on paper. We text almost every day and video chat often, but a letter is something different, something special, a surprise! It was a Mother’s Day letter that arrived late—deliveries are slow these days—and she expressed the love and pride she had for her Mama, and how much she missed being able to come to visit. She lives in Nova Scotia—and like so many, has been laid off due to the coronavirus—and the border to New Brunswick where we live is closed. So, we can’t be together, but reading her letter makes me feel closer. I’ve re-read it a lot…

She inspired me to try to give this same feeling to others…pay it forward. I decided to send some homemade cookies to my son and his family. I added a note to say how much we miss them and to ask my grandchildren to pretend that each cookie is a hug from Memere and Pepere. Today I watched a live “unboxing” video of our grandchildren opening the package, reading my note and enjoying the cookies, as my daughter-in-law connected us by video chat!

So, I think we all can talk to ourselves about how we can create something good from the forced isolation caused by the coronavirus. Life is always changing but the pandemic is forcing us to do this more quickly. Which of the changes we’ve made will we decide to keep in the future? What else can we do to make a better world and a better life for ourselves and others? We can look at this time of rapid change as a chance to improve our world and take the opportunity to consciously make good choices about our relationships, our environment, our thoughts.

Time to start talking to ourselves… to create positive changes we want and need!

#selftalk #COVID19emotions

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Hair Loss in Women

Losing your hair can be very distressing, especially for a woman, but it can often be treated successfully. Getting a correct diagnosis of the cause of the hair loss is the first step and your family doctor can often help.

To make a proper diagnosis, your doctor will likely ask you about your recent history and your family history of hair loss. They will also examine your scalp and check for other symptoms you may have that suggest a disease that could cause hair loss. They may even do some blood tests. While hair loss can be caused by conditions of the scalp, it can also be caused by other conditions in the body.

Some hair loss is normal

Hair grows in a cycle. At any given time, 90% of your hair is actively growing, while about 10% is in a stage of degeneration, eventually resulting in shedding. This is normal. The hair growth phase is called “anagen”, the degenerating phase is “catagen” and the shedding is referred to as “telegen”. We see these terms pop up in the names given to different types of hair loss, described below.

We all lose about 50 to 100 hairs every day. One test for hair loss that is sometimes used (although not highly reliable) is the Pull Test. When 40 to 60 hairs are grasped and pulled gently; not more that 4 to 6 hairs should pull away from the scalp. However, this test is difficult to standardize, and a negative result does not rule out a diagnosis of hair loss. Trying it immediately after shampooing or brushing the hair will result in a false negative, as loose hair is already removed.

Hair loss can occur in patches or diffusely, across the top and sometimes the sides of the head, depending on the cause. In women usually the hairline at the forehead is not affected while men generally have receding of the hairline on both sides, and/or thinning on the top. Some hair loss is self-limiting, regrowing after several weeks or months, while other types of loss can progress for many years. If the hair follicle is lost, it is referred to as scarring of the scalp, and the hair loss can be permanent. This condition is rare and a consultation with a dermatologist is recommended.

What causes increased hair loss?

The most common type of hair loss is caused by hormone changes, usually too much or too little testosterone (an androgen). This is called androgenetic alopecia, and it results in diffuse hair loss in women, “male-pattern” loss in men. In women, too high levels of testosterone [or its metabolite, dihydrotestosterone (DHT)] is often accompanied by acne and oily skin, and can be the result of Polycystic Ovary Syndrome (PCOS), or cysts on the ovaries that produce androgen hormones. Too little testosterone is also associated with scalp and body hair loss (underarms and pubic hair), fatigue and decreased muscle mass. A rapid decrease in female hormones, estrogen and progesterone, such as occurs after a pregnancy or when stopping hormonal birth control, can also cause temporary hair loss.

Thyroid disease (low thyroid), iron deficiency and malnutrition (e.g. lack of protein) are other causes of diffuse hair loss that do not originate in the scalp. Hair products, like dyes and straighteners, and treatments, such as blow dryers and curling irons, can cause diffuse hair loss through breakage close to the root. In these cases, the hair will usually regrow once the cause is corrected or once the woman has overcome or adapted to the stress.

Other causes of hair loss that often result in patchy hair loss, include scalp infections and habitual nervous pulling on the hair, eyebrows or eyelashes. A physical stress, such as an illness with high fever, or an emotional stress can also cause hair loss that often comes out in clumps.

Types of hair loss

The names of types of hair loss are, unfortunately, quite complex and confusing. However, I’ll list them below with their details, causes and treatments.

Androgenetic alopecia – likely a hormonal cause, most common type (mentioned above), often a family history.f

  • Diffuse hair loss in women, male-pattern loss in men (sides of front hairline and top of head) caused by increased levels of dihydrotestosterone (DHT)
  • Women usually develop this after menopause when estrogens drop and androgens (male-type hormones) dominate.
  • Can be treated by using Minoxidil 2% scalp lotion
  • Note that Minoxidil 5% sometimes works better in men than 2% but gives no extra benefit in women, according to studies.
  • Alternative treatment for men is the drug finasteride, that blocks conversion of testosterone to its stronger form, dihydrotestosterone (DHT). However, it has many side effects.
  • Sharp decreases in hormones in women, such as after childbirth or after discontinuing birth control pills, can result in temporary hair loss.
  • Hair loss due to low thyroid, iron deficiency or malnutrition can mimic androgenetic alopecia. Low testosterone in women is also associated with thinning of hair but often not recognized.

Alopecia areata – autoimmune hair loss (the body attacking itself)

  • Patchy hair loss, broken hair shafts, short thin hairs, yellow or black dots
  • Usually sudden, acute onset
  • Treated with steroid injections into the scalp, creams or ointments, or recovery can be spontaneous

Tinea capitis – fungal infection of the scalp, patches of hair loss, red, scaly, itching, pustules

  • Although antifungal shampoos are available, in a severe infection they do not reach the infection in the root of the hair adequately, and it is necessary to take a prescription anti-fungal medication by mouth

Telogen effluvium – caused by physical or emotional stress

  • Non-inflammatory, non-scarring, scalp appears normal
  • Caused by an intense emotional shock or physical stress, for example, surgery or rapid weight loss
  • Usually hair will regrow when the cause is resolved (person adapts to stress, recovers from surgery, etc)

Trichotillomania or traction alopecia – physical tension on the root of the hair

  • Habitual pulling on hair, usually front/sides but can also include eyebrows and eyelashes
  • Tight hair styles, like buns, ponytails, braids, cornrows, extensions
  • Treated with cognitive behavioural therapy (CBT) to reverse the damaging habits or changing hairstyle to a looser one

Trichorrexis nodosa – trauma sufficient to cause hair shafts to break

  • Caused by overuse of hair products (dyes, straighteners, perms) or styling techniques (hairdryers, curling irons)
  • Treated by changing or stopping use of offending product or tool

Anagen effluvium –interruption of hair growth cycle causing abnormal diffuse hair loss

  • Common with some chemotherapy, radiation
  • Can also be due to malnutrition with a nutrient essential for hair growth being missing
  • Cooling the scalp during treatment sometimes helps reduce hair loss with certain chemotherapies
  • Hair will regrow when the growth cycle is no longer interrupted

Medications – Certain medications can cause hair to fall out as a side effect

  • Blood thinners (warfarin), Accutane (a strong acne treatment), antidepressants (Prozac, Zoloft, etc), beta-blockers, some cholesterol drugs

Nutritional deficiencies – Certain nutrients are needed for hair growth

  • Low protein, iron or vitamins in the diet can result in temporary hair loss
  • Replacing the nutrient in the diet allows hair growth to return to normal

So, as you see, there are many different causes of hair loss. Some types are treatable while other will resolve on their own once the cause is eliminated. It’s important to get a diagnosis of the cause to give you an idea of what treatment would work best to improve hair growth.

Note: My latest activity is an online course on how to create an audiobook. As a learning project, I created an “audioblog” from one of my most popular blogs Masks 4 All. I even figured out how to add music to fade in at the beginning and out at the end! If you care to listen, it’s on my blog homepage, http://jeanniebeaudin.wixsite.com/author (only 11 minutes long). Let me know what you think!

References:

Hair Loss: Common Causes and Treatment – American Family Physician

How much hair loss is normal? – Medical News Today

Causes and treatments for hair loss – Medical News Today

What’s to know about alopecia areata? – Medical News Today

Finasteride (Propecia) — RxList

#hairlos

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“Sorry, dear, not tonight…”

Some years ago, when my husband and I owned a pharmacy, we attended huge pharmacy buying shows in Toronto each year to find new products to sell in our pharmacy. At one of these, I saw an interesting display of “Play” brand products… essentially a line of sex toys designed to be sold in a pharmacy. I was quite surprised to see it there (aren’t these things only sold in sex shops?)

The company representative explained that sex is part of a healthy lifestyle, and some just need a little help to get things going, especially as they get older. But many people would be too embarrassed enter a sex shop, and some might hesitate to even bring up their problem with their doctor.

But everyone goes to a pharmacy and might consider a discreetly packaged aid to improving their sex life. Pharmacists have private counselling areas where women could discreetly ask a woman pharmacist about ways to address a minor problem, such as dryness or irritation.

Of course, what’s considered “normal” can very from person to person, and in the same person over time. A reduced interest in sexual activity is only a problem if you feel it is, or if it creates friction with your partner.

Sometimes the problem can be “in our head”

Problems in the bedroom, or even being interested in the first place, can originate in our mind as well as our body. It can happen at any age but becomes more common in women as we move into the mid-life years.

For example, many of us can become “sandwiched” between caring for teenagers and elderly parents while still working at full-time jobs. Being stressed and overtired is a recipe for a lack of libido, our interest in sex. “Please, not now, I just want to sleep.”

For some, just creating time and the environment for intimacy is all that is needed – booking a “date night” to spend unpressured time together. For others, it may mean addressing an underlying worry that is taking too great a toll.

Depression can be a reason for low libido but I’m sure anyone who is depressed has more worries on their mind than a lack of sex. Always best to talk to your doctor if blue feelings seem to hang on longer than they should and are affecting your quality of life.

There are psychologists who specialize in helping overcome the psychological side of low libido. Of course, I’m not a psychologist but I used to work with such a professional – we referred patients to each other when we felt the other could better address a woman’s problem. If, after her analysis she believed the source of the woman’s low libido was hormonal, she referred her to me; if I saw no signs of a hormone imbalance that would contribute to a lack of sexual interest, I would suggest the woman see my colleague.

There can be physical causes too…

Mis-matched libidos can cause difficulties in a relationship or they can be the result of a problem unrelated to sex in a relationship. Presuming that you have a good relationship with your partner that is not contributing to a disinterest in sex, and don’t have any overwhelming stresses in your life, the root of the problem might be something physical that can be quite easily solved by your pharmacist.

A common cause of sexual problems in women is lack of lubrication. As we age our production of vaginal mucous generally decreases. Taking a little time to “warm up” with extra foreplay may be all that is needed. Let your partner know this. Being a little dehydrated can also result in less lubrication and alcohol is dehydrating. Try drinking a glass of water along with that wine and avoid overdoing the alcohol to prevent dehydration.

There are also lubricants made especially for intimate use. If you are treating dryness avoid ones with ingredients added to create a “warming sensation”, flavours or scents at least initially, as these extra ingredients increase the chance the product itself will cause irritation. KY Jelly is a popular brand and there are several generic ones also available. Look for a water-based “personal lubricant” as a good choice. There are also silicone- and oil-based lubricants but there can be compatibility issues with condoms or sexual aid products. Note that silicone lubricants tend to last longer, while oil-based ones last less time. In a pinch, a kitchen oil can be tried, but regular use of these can increase risk of a vaginal infection. Many stores display lubricants next to their selection of condoms, or you may find them in the feminine hygiene product section.

Be aware that there is also a higher-level product for dryness, called Replens. This gel contains added ingredients that help the product cling to the surface of the vagina, prolonging its action. It is designed to be used less often than a personal lubricant, usually every 3 days, as the product stays effective for several days.

Vaginal atrophy

The tissues of the vagina depend on both estrogen and testosterone for growth and health. With very low levels of either of these hormones, or if sexual activity has been out of the picture for a long time, the vagina can wither or atrophy. Sex itself increases the blood circulation to the vaginal area, keeping it healthier.

Taking hormone replacement supplies the vagina with hormones along with the rest of the body but, if the only problem is vaginal atrophy, there are hormone replacement products that can be applied directly and only a low dose is needed. There are suppositories and creams available for vaginal use, and compounding pharmacists commonly make a cream or gel from a weak estrogen, called estriol, that works well on vaginal tissues. You would need to see your doctor to discuss these options.

Vaginal infections

If you experience irritation of the vulva area (the outside of the vagina), consider the possibility of a vaginal infection. Symptoms of infection vary with the type. You will note that these involve irritation but also a discharge, not actual dryness. Here are two common types of vaginal infections:

  • Yeast infection (vaginal candidiasis)—itchiness; thick, white, cottage-cheese-like discharge; soreness or burning during intercourse or while urinating; no odour
  • Bacterial vaginosis—itching; burning during urination; thin, grey, white or greenish discharge, “fishy” odour
  • If you haven’t experienced an infection before you will need to see your doctor for a diagnosis. Many women recognize the symptoms when an infection reoccurs. Yeast treatments can be purchased without a prescription but treatments for a bacterial infection usually require one. Depending on laws in your jurisdiction, a pharmacist may be able to renew a prescription based on your description of symptoms similar to a previous episode.

Back at the show…

So, when I saw this interesting line of products at the trade show designed to help with common problems with sexual function that can arise during and after the menopausal change, I decided to write an article for a pharmacy journal, where I had a monthly column, to bring these to the attention of other pharmacists. As I often did my own photography for my articles, I asked for some samples to take home. I didn’t want the boxes crushed in my suitcase, so I decided to just carry them home carefully in a plastic bag. As we approached the security check at the airport, I felt a little embarrassed that the agents would be examining the parcel I was carrying. I asked my husband if he would take the bag through the checkpoint for me.

We ended up in different security lines for some reason. And as my husband went though, the agent examining his things looked over at me, smiled and waved. How odd. Afterward, I asked my hubby what that was about… He said, “I told him these were sex toys that belonged to my wife in the next line, and I was just carrying them for her!” I thought I’d die laughing…

I shouldn’t have been so embarrassed really. But, especially in North America, sex is something that almost everyone has done but never talks about, even when problems develop that could easily be resolved. We should feel comfortable discussing low libido or physical difficulties that prevent us from enjoying a wonderful part of our relationship with our partner. And remember, if it’s a minor problem, such as mild vaginal dryness, you can ask to speak to your pharmacist about it in a private area.

Lastly, we should realize that a sexual relationship doesn’t necessarily need to include sexual intercourse. Couples can still enjoy intimacy that fosters a close relationship and displays their love, even if they are no longer capable of performing the actual act. It’s all about loving, enjoying and giving pleasure to each other, and being close, after all.

References:

Can I Speak to the Hormone Lady? J Collins Beaudin

Yeast infection (vaginal)—Mayo Clinic

Bacterial vaginosis—Mayo Clinic

FAQ Replens

#lowlibido #causesoflowlibidoinwomen

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Your daughter is going Vegan…What now?

I received a question from a reader whose daughter has decided to follow a vegan diet. She is wondering whether her daughter is making a good choice and is worried that she might develop health problems in the future.

What is a vegan diet?

A vegan diet is one that does not include foods from any animal source, including foods produced by the animals themselves, like milk, eggs and even honey. Of course, there are different levels of vegan diets that are not as strict:

  • Pescatarian—no meat or poultry, but fish is included
  • Lacto-ovo vegetarian – a plant-based diet, plus dairy and eggs
  • Flexitarian – a plant-based diet that includes occasional animal products

Examples of foods that vegans can eat include fruits and vegetables, legumes (peas, beans and lentils), nuts and seeds, breads, rice, pasta, dairy alternatives (soy milk, coconut milk, almond milk) and vegetable oils. The full vegan diet does not include any meats (beef, pork, poultry, fish or shellfish, eggs, cheese, butter, milk and all dairy products, mayonnaise (includes egg yolks), and honey.

What might be her motivation?

A 2014 study asked 329 shoppers at vegan supermarkets in Germany about their motivation. Over 80% had more than one reason for their diet choice. About 90% gave reasons related to animals, 70% cited personal health and well-being and about 47% discussed environmental reasons. One-third of those who participated in the study indicated they would consider including animal products in their diet if the producers could guarantee the animals were raised to standards above current agricultural practices.

Health benefits

Studies show that vegans have better heart health and lower odds of developing high blood pressure, obesity, diabetes, and some kinds of cancer (breast, ovaries, uterus and digestive tract cancers). Better weight control may be one reason for these health benefits. Vegans, on average, have a lower body mass index (BMI), a measure of body weight in comparison to height. Going vegan, when done correctly, could help you live longer, especially if total daily calories are reduced.

But are there risks?

While a vegan diet, with its emphasis on fruits, vegetables, legumes and whole grains, is healthy overall, it is easy to miss some key ingredients if the diet is not well-designed. Protein, calcium, iron, omega-3 “good” fats, zinc and vitamin B12 are important nutrients that most of us easily get in the animal products we eat, but could be missed if foods containing them are not included in the vegan diet.

One key nutrient, vitamin B12, is extremely difficult to get from plant sources alone. This vitamin is essential for healthy nerves and making red blood cells. Without enough of it, a person will commonly develop symptoms such as paresthesia (“pins and needles”) in hands and feet, poor balance, anemia (“low” blood) or other symptoms. Taking a daily supplement of this vitamin is highly recommended when following a strict vegan diet. Note that all these nutrients are especially important for growing children and pregnant women.

Here are some examples of foods containing some of the key ingredients:

  • Protein – nuts, soy, beans, quinoa
  • Calcium – soy milk, fortified orange juice, tofu with calcium, broccoli, kale, almonds, dried fruit (raisins, prunes, figs, apricots)
  • Omega-3 fats – flaxseeds, vegetable oils, plant-based supplements
  • Iron – tofu, soy nuts, spinach, peanut butter, fortified cereals
  • Vitamin B12 – none, unless it has been added in processing (“fortified” foods)

It’s important to realize that a vegan diet, like all diets, is only as healthy as you make it. Just cutting out animal products from a regular omnivore (plant/animal) diet could easily result in malnutrition. It is important to add foods that will supply enough of the nutrients that most of us get from animal products. A consultation with a dietitian might be a good route to go, to ensure the diet change is done right.

Are vegan processed foods healthy?

Another part of my reader’s question was about the many vegan processed foods, like veggie burgers, that are available now. I happened to catch a discussion of these on the radio a few months ago (sorry I don’t have the reference to a recording of it, but I did find this similar discussion online) where a nutritionist evaluated some of the various meat-substitute products that are available in grocery stores and fast food restaurants. He explained that these are highly processed foods with many ingredients (some that are neither plant or animal based!). Many of the ingredients are not included for their nutritional value, but to make the food’s appearance and texture more like the animal food it was designed to replace.

This expert’s opinion was that because a great deal of energy was being expended to create this food, these meat substitutes are not better for the environment than the foods they replace. And many health experts recommend avoiding highly processed foods as much as possible, to avoid the many additives that could be harmful in the long run: added salt, sugar, fat and preservatives. Our new version of the Canada Food Guide emphasizes eating whole unprocessed foods to avoid these hidden additives. Although the occasional inclusion of prepared vegan foods, like the veggie burger, would have little impact on health and the environment, using these as a regular staple in place of real whole food is not advised. However, the expert I listened to suggested they might function as a bridge from a regular diet to a vegan one, as the person works through this complex diet change.

What could this mom talk about with her daughter?

So, to my reader who asked this question, I could suggest she talk to her daughter about her reasons for choosing a vegan diet. If, like most, her reasons are animal or environment-related, an alternative path (or a parallel one) could be to support local producers of animal products who respect the animals and the environment, and perhaps to become politically involved in requesting improvements in commercial agriculture practices.

She could also ask her daughter about the sources of information she is using to create a healthy diet. I would highly recommend a consultation with a dietitian to learn the important basics of the vegan diet and for help in tailoring it to her tastes while keeping enough of each food group and nutrient. She will need to thoroughly research the quality of any online or print resources used, and it would be beneficial to verify these with the dietitian as well. In a brief internet search, I found this article written for dietitians that describes the complexity of designing a well-balanced vegan diet. And, I would also suggest that she rely minimally on processed foods, opting for healthy whole foods as often as possible, as we all should be doing.

The bottom line…

One of the quoted benefits of any plant-based diet is the opportunity to reduce calorie intake when groups of high-calorie foods, like meats and some dairy, are eliminated. Calorie restriction is associated with a longer life! Of course, we all could achieve fewer calories by simply reducing portion sizes…just putting less food on our plates. Nutritionists recommend that we limit our intake of meat to ¼ of the plate, filling the other ¾ with lower-calorie plant-based foods, however, and recommend we consider having the occasional vegetarian meal. So, I think we could all learn something useful from a balanced vegan diet and the foods it includes.

References:

Motives of consumers following a vegan diet and their attitudes towards animal agriculture https://www.sciencedirect.com/science/article/abs/pii/S0195666316302677

What is a vegan diet? – WebMD https://www.webmd.com/diet/vegan-diet-overview#1

The vegan diet – NHS online https://www.nhs.uk/live-well/eat-well/the-vegan-diet/

Nine signs and symptoms of vitamin B12 deficiency – Healthline https://www.healthline.com/nutrition/vitamin-b12-deficiency-symptoms

Plan Healthful Vegan Diets – Today’s Dietician https://www.todaysdietitian.com/newarchives/021115p40.shtml

Dietitian, Dietician or Nutritionist? (on the spelling of dietitian/dietician) Journal of the Academy of Nutrition and Dietetics

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