Author: Jeannie Collins Beaudin

Categories
Health

A must-read for coffee lovers!

Many good things have been said about the benefits of drinking tea, but what about coffee? Rally ‘round, coffee lovers…here’s some good news!

An analysis of 9 studies suggested that 1 to 2 cups of coffee daily was associated with a decrease in the occurrence of Alzheimer’s disease, dementia and cognitive decline or impairment. They stated that drinking a moderate 1 to 2 cups daily was found to be more beneficial than no coffee or more than 2 cups daily.

Coffee can help your circulation by improving the function of small blood vessels. A study, looking at blood flow in the finger, found a 30% increase in blood flow for 75 minutes after a cup of coffee compared to people drinking a cup of decaf. So a cup of hot java really does warm up cold hands and feet! The American Heart Association described this action as “perking up your blood vessels”… The study also noted, however, that caffeinated coffee also slightly raises blood pressure, so don’t have a cup just before checking your pressure, to ensure a true reading.

In people with chronic hepatitis-C liver infection, higher caffeine intake (123-308 mg per day) is linked to a 61% decreased risk for advanced hepatic failure, a possible outcome of hep-C infection. They also noted that the liver enzyme, ALT (an enzyme that is often elevated in liver disease), was lower in people who drank more caffeinated beverages. Two studies suggested increased coffee drinking is associated with decreased liver cancer. However, they did state that more research is needed.

Although previous studies have suggested an association between coffee drinking and lung cancer and favoured black tea as a better choice, a study sponsored by the Canadian Cancer Society and Canadian Institute for Health Research found there is no strong support for this link. Their study of over 2,500 people did not show any significant difference between coffee and black tea when it comes to lung cancer risk, once the numbers were adjusted to take smoking into consideration. Perhaps previous study results were due to people being more likely to have a cigarette with coffee than with tea!

Several compounds in coffee have been found to be protective against colorectal cancer. A 2016 study published in Cancer Epidemiology, Biomarkers & Prevention found that regular coffee consumption was associated with 26% lower chance of developing colorectal cancer. Additionally, the study stated that those who developed this cancer were less likely to be physically active or eat 5 or more servings of vegetables daily and were more likely to report a stronger family history of colorectal cancer.

Caffeine content is affected by the type of coffee bean, roast style, how the coffee is brewed and the cup size. An average cup of coffee is estimated to contain 95mg of caffeine but can range from less than 15mg (decaffeinated) to over 500mg for the largest sizes served at some coffee shops. See this article for more details.

References: Univadis.ca; Medscape.com

Categories
Health

Increase in child inflammatory disease

Recent reports in the news discussed a significant increase in inflammatory bowel disease (IBD) in Canadian children…7.5% each year between 1999 and 2010. IBD most commonly begins around age 20, and in the past has almost never been seen in children less than 5 years old. But now, even babies are being diagnosed with it. So, what is happening?

IBD is a group of diseases that include Crohn’s disease and ulcerative colitis. These are lifelong diseases with no cure… medications only control and reduce the symptoms to a varying extent, depending on the individual patient’s response. Those affected experience recurring bouts of abdominal pain, cramps, diarrhea and severe fatigue.

Almost 250,000 cases have been diagnosed in Canada, and 10,000 new cases are diagnosed each year. The cause is vaguely described as likely being a combination of hereditary and environmental factors that trigger the immune system to malfunction and attack the digestive system. As well as genetics and environment, vitamin D and gut bacteria have been proposed as being involved in the cause.

Lack of vitamin D has been linked to increased inflammation and pain. In northern countries like Canada, insufficient sunshine is available to enable production of adequate vitamin D during the winter months, putting people at increased risk of deficiency.

As well, babies under 6 months are recommended to be kept out of sunlight and to be protected with sunscreens after 6 months of age. Since breast milk does not contain adequate vitamin D and without sun exposure babies are unlikely to produce adequate amounts of their own vitamin D, supplementation of 400iu per day is recommended.

During birth and early life, babies are exposed to their mothers’ bacterial flora. With antibiotic use, however, good bacteria are destroyed along with the infectious bacteria, so mothers do not always have the ideal bacteria to share with their infants.

In my previous blog reviewing the book Bacteria for Breakfast, I discussed how the type of bacteria in our digestive system can influence the function of the immune system. It seems to me that correcting the balance of bacteria in the digestive system should be part of the basic treatment for any autoimmune disease…or a strategy for prevention.

Standard treatments for inflammatory bowel disease, however, tend to ignore the environmental factors that might prevent the disease if avoided or changed…instead they focus on which elements of the immune system can be blocked by drugs to reduce the inflammatory response in the bowel. Since they don’t correct the underlying problem, these drugs are needed lifelong to control symptoms…certainly more lucrative than finding and correcting the underlying cause. Perhaps this is the reason researchers are not addressing the root of the immune malfunction.

However, you don’t need a prescription to replace vitamin D or try probiotics. Both are safe to take, even for young children, as long as recommended daily amounts of vitamin D are used. Specially formulated versions of vitamin D and probiotics are available for children and even for young babies.

With an increase in an inflammatory disease like IBD and other immune dysfunction conditions such as allergies, perhaps gut bacterial health and vitamin D status will be given greater consideration in childcare recommendations, and will become an increased focus of research for possible causes of the increase of inflammatory diseases in children.

The role of inflammation in chronic diseases is an area of current study for me and in upcoming blogs I plan to address this topic further…sign up for my mailing list if you’d like to receive notice of these postings!

Categories
Article reprint Health

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

Categories
Uncategorized

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.

Categories
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!

Categories
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!

Categories
Health

5 Questions you should ask about your medications…

Medication errors can happen for many different reasons, but you can work along with your health care providers to prevent these errors, both as a patient and as a person who helps a friend or relative with their medications. An important way to prevent errors is to have all the right information…

With that in mind, the Institute for Safe Medication Practices (ISMP) has developed a list of 5 questions you should ask whenever you are:

  • Being discharged from hospital

  • Having an appointment with your doctor or specialist

  • Talking to your pharmacist or

  • Having a visit with a home care nurse

These times are referred to as “transitions of care” and are the most likely times that your medications might be changed and mistakes could happen. Asking questions will help ensure you understand how your medications are supposed to be used. These occasions also give you an opportunity to learn more about your medications, such as what each does, how it is to be used, how long it should be taken, and what side effects you should watch for.

Here are the recommended questions you should ask:

  1. Changes? – Have any medications been added, stopped or changed and Why?

  2. Continue? – What medications do I need to keep taking and Why?

  3. Proper use? – How do I take my medications, and for how long?

  4. Monitor? – How will I know if my medication is working, and what side effects to I watch for?

  5. Follow-Up? – Do I need any tests, and when do I book my next visit?

To make this easier, ISMP has organized these questions onto a page you can download and fill in on your computer or tablet, or just print off and take to your doctor, pharmacist or nurse. You can download it here.

Be aware that most pharmacists can book an appointment with you to review your medications in detail. For some people, this may be a benefit of your prescription medication insurance coverage. But even if it is not covered, it can be a good investment in your health if you take several medications or have a complicated medical therapy. If you specifically ask the pharmacist to look for medications that can be stopped or “deprescribed”, a review may mean you have lower medication expenses and a simpler medication program in the future.

It is also important to keep an up-to-date medication record. You can find a free app for your computer or phone (Apple, Android or Blackberry) by clicking here or googling “my med rec”. Be sure to include a list of drug allergies, any vitamins or minerals, herbal or natural products, and any non-prescription products in your medication record. This list can be especially helpful when being admitted to hospital or when trying to determine if any medications can be discontinued.

More medication means greater chances for drug interactions. While drugs can be life saving, drug interactions and unwanted side effects can harm your health. Sometimes a drug is added solely to counter a side effect of another drug you are taking, when the problem could have been solved by changing the original medication.

So, learn as much as you can about your medications and how to benefit most from what you are taking. Communicate clearly with your doctor, pharmacist and nurse practitioner that you want to be taking the least number of medications possible for the shortest time necessary to keep you healthy. And, lastly, learn what lifestyle or diet changes can be tried to improve your health. Work hard to make these changes so you can minimize the medication you need to control chronic diseases like diabetes, heart disease and arthritis.

The CEO of the Canadian Patient Safety Institute (CPSI), Chris Power, advises:

“Be as informed as you can be and go into that relationship with your doctor, your nurse or your pharmacist or whomever is providing care, knowing that you’re a partner and you have a right and a responsibility to ask questions and to understand what’s happening with your health care.”

Categories
Health

Testosterone – Women need it too!

Testosterone has been described as the hormone of desire… Although it’s in the androgen hormone class, considered to be “male” hormone, both men and women produce testosterone. It’s the difference in amounts produced and the balance between estrogen and testosterone that determine male or female body characteristics.

Interestingly, many more articles have been written about overproduction of testosterone in women, as can occur in polycystic ovary syndrome, for example. Underproduction can also be a problem for women, but doctors rarely test for this.

With low testosterone, women can feel fatigued and notice less interest, not only in sex, but in doing things they normally like to do. The term “lack of a sense of wellbeing” has been used to describe how women with low testosterone can feel.

Physically, they may notice decreased muscle size and strength, and reduced hair growth on the body, particularly underarm, pubic and leg hair. These physical changes often carry more weight when speaking with your healthcare provider about the potential for this type of hormone imbalance.

Interestingly, taking hormones by mouth can lead to low testosterone effect. The liver filters virtually everything you swallow as soon as it is absorbed from your digestive system. This is referred to as the “first pass effect”, where the drug is changed or partially removed from the blood stream before it has a chance to reach the rest of the body. This is one reason that transdermal drugs (or drugs administered through the skin) are generally used in lower doses. With the transdermal route, the drug reaches the body before the liver has a chance to metabolize it. Hormone preparations are generally 1/10th the dose when given through the skin, as compared to dosing by mouth.

However, with oral hormones there is another known effect… In response to swallowed hormones, the liver produces a special protein, called sex hormone binding globulin (SHBG) that binds to hormones making them unavailable to act in the body and, essentially, inactive.

When estrogen is swallowed, such as with hormone replacement or birth control tablets, the liver is stimulated to produce SHBG, presumably a mechanism developed to protect us from accidentally ingested hormones in our food.

However, SHBG binds testosterone 10 times more strongly than estrogen. This means that taking estrogen by mouth will result in increased SHBG that will scoop up much of the testosterone your body is producing. Testosterone is still being produced but you may experience the symptoms of low testosterone. Regular blood tests for total testosterone would show a normal amount, but a test for “free testosterone” (testosterone not bound to proteins) would show the effective deficiency.

So, what can be done to correct testosterone deficiency? I always recommend treating the cause if one is identified so, for women with a secondary deficiency caused by taking estrogen by mouth, a simple solution is to change the estrogen to a patch, cream or gel formulation, eliminating the first pass effect on the liver and reducing production of SHBG.

If this is not the cause, and total serum testosterone is found to be low, testosterone replacement can be considered. Swallowed testosterone is known to be hard on the liver, with increased liver cancer reported with some oral forms. As well, available tablets and capsules currently on the market are dosed for men and contain far more hormone than women need. I’ve seen prescriptions for women to take one man-sized 40mg capsule once or twice a week, but even this is more than women would produce, and would result in swings in testosterone blood levels that would be far too high on the days immediately after taking a dose.

Women produce less than 1mg of testosterone daily. It is easy to understand that a 40mg capsule would come with the recommendation to stop taking it if she developed facial hair growth or acne. Even the cream formulas that are available come in 25 and 50mg pouches or pumps with no accurate way to measure a lower amount.

However, testosterone cream can be accurately compounded by a pharmacist and loaded into needle-free syringes for accurate measurement. I always prepared the cream as 1% testosterone (10mg/ml) making it easy to calculate the desired dose. A 1ml syringe would contain 10mg – generally enough for 10 days of testosterone replacement, although some women have reported results with doses as low as 0.15mg!

Because hormones are stored away in fatty tissues in the body, I generally recommended using 2mg daily for the first week or two (since some of this would be stored away) then reducing to 1mg or less daily to avoid any chance of overdosing. One of the first signs of too much testosterone is often an outbreak of acne. I encourage women to identify the lowest dose that is effective for them – the “normal” amount can vary from person to person, and we need to remember that we are adding to the amount being produced, which can also vary from person to person.

Men can also become deficient in testosterone. Some refer to this as “andropause”… others have jokingly called it “grumpy old man syndrome” since deficiency most commonly occurs later in life, the man may be stooped and thin due to decreased muscle and possibly the onset of osteoporosis, and his mood may have become less than cheery.

Testosterone replacement for men is readily available in capsules, injections and creams and, although somewhat less convenient, the creams or injections would be preferred to reduce the effect of hormone on the liver. However, as injections are generally given every 2 to 4 weeks, they have the disadvantage of producing a higher blood level of hormone immediately after the injection and a lower level before the next injection is scheduled. A simple blood test would confirm that testosterone is needed and that the dosing is correct.

So, if any of the symptoms of low testosterone sound familiar, talk to your doctor about it. If you are interested in more information, I would recommend “The Hormone of Desire” by Dr. Susan Rako as an excellent source of information on testosterone deficiency in women.

Categories
Health

How to handle food in a power outage

Just days after arriving in Florida, hurricane Matthew began its advance up the coast. A category-4 hurricane was a new experience for my husband and me…what should we do? Stay or go? This was a frequent topic of conversation with neighbours, even those we didn’t know…

We decided to take the safe route and flee, but what to do with a fridge full of food when we returned? I learned from others how to reduce health risks from spoiled food after you get back…unfortunately, most of it only after the storm, although ideally some preparation should have been done before leaving.

Many of these tips would apply to any power outage situation, so I thought I’d share these with you…

The best approach is to start preparing at the first warning of the approach of a storm. Turn down the settings of both fridge and freezer so you are starting with a lower temperature – a cooler refrigerator and deeper freeze will last longer when the power goes out.

Frozen jugs or ziplock bags of clean water will work as ice packs in the fridge and freezer, maintaining the coolness and, at the same time, eliminating air space. We know that heat rises and cold air falls, so filling up the dead space will reduce the air exchange that occurs each time the door is opened.

These frozen bottles and bags will also provide clean drinking water later if needed. Often tap water is deemed unsafe for several days after power is restored while the system is flushed, especially in warmer climates… This is not such a worry in Canada, where most power outages occur in the winter, but for those of us in rural areas with our own water supply, no power means no pump and no water!

Next, you want to pack your foods closely together to mimic how they would be packed in a cooler, rather than being nicely spread out on the shelves. Just as a block of ice takes longer to melt than smaller chunks, a block of tightly packed foods will stay frozen or cool longer, especially if surrounded tightly by ice packs, creating a “cooler” within your fridge.

It’s relatively easy to determine how long the power was out, especially if you are able to stay at home, but it can be more difficult to know how long the food in your refrigerator stayed cold or frozen.

The rule of thumb you will find on government websites is: food will stay cold in an unopened refrigerator without power for at least 4 hours, frozen food in a full freezer for up to 48 hours and in a half-filled freezer for about 24 hours. That being said, a lot depends on the quality of the refrigerator and how the food is packed into it.

The ideal way to monitor the fridge temperature is with a probe thermometer similar to those often used in cooking these days. An ordinary fridge thermometer inside the fridge will tell you the temperature but you need to open the fridge to see it, allowing cold air to escape each time you do this…definitely not recommended if the power is out! Checking the temperature after the power is back is helpful if it’s still below the recommended 5C (40F), but if the temperature is higher you have no way to know how long it’s been out of the safe zone.

A “min/max” thermometer, used for storage of critical items such as vaccines, has a probe (sometimes wireless) that is placed inside the fridge, while the thermometer itself remains outside where it can be read without opening the fridge door. It records the minimum and maximum temperatures and the times that these occurred. It can also be set with the desired temperature range sounding an alarm and noting the time that the temperature left this range…valuable information if you have to leave home during the storm. Like many electronics these days, prices of these units are dropping and can be found for under $100 (I found one for $35CDN for my vaccine storage!). It might be worth the investment if you lose power often and end up discarding food because you don’t know if it is safe.

A simple tip, however, which I learned from a hurricane-savvy friend, is to freeze a glass of water and place a coin on top. If the water thaws then refreezes before you return, the coin will no longer be sitting on top of the ice. If it is halfway down, your ice was partially thawed then refrozen; if it is at the bottom, then it is likely that your food, like the ice in the glass, completely thawed before the power came back on. Nice trick!

Some foods are more likely to spoil than others. These include meats, dairy, eggs and leftovers. It is suggested to remove these from the refrigerator and store them in a cooler packed with ice. This system is easier to monitor and the ice can be replaced as it melts, extending the life of the food. If you’re in a cold climate, it is recommended to freeze water outdoors to restock your cooler, rather than actually putting the cooler outside – sunshine can warm the food even if it is below freezing outside, and animals can also be attracted to the food.

Be aware that juices from meat can contaminate other foods – store separately or in leak-proof packaging. As a general rule, store foods that will not be cooked before eating above meats and fish in the refrigerator so juices cannot drip onto them, potentially causing contamination.

Government sites suggest that food poisoning occurs in 1 person in 8 each year… Never taste food to determine if it is spoiled. When in doubt, throw it out!

If you are interested in more detail, including a list of stability of various foods, check out this site: http://www.fsis.usda.gov

We survived the experience with no damage to our condo and only minor damage to our boat. But it is so sad to see many others who did not fare so well, and it was stressful just worrying about what might happen. I think I’d take a good old Canadian snowstorm over a hurricane any time!

Categories
Book review Health

A Healthy Diet Should Be Easy and Fun…

What makes a diet healthy? Does it have to be complicated? Do we really need to learn about saturated fat, omega-3’s, carbohydrates, and antioxidants? Maybe it’s time to simplify what and how we eat…

A recent news report described how the scientists, who first claimed that saturated fat was bad for us years ago, had received payments from the sugar industry. Newer reports are saying that it is really sugar, and not fat, we should avoid to prevent chronic conditions like diabetes and heart disease. Other reports say that refined white flour acts very similar to sugar once it is absorbed into the body.

Even the basic Food Pyramid – remember this? Its emphasis on grains and drastically reduced fat intake is being questioned after so many years of use. Current thought is that it is too vague, with no indication of serving sizes, and places too much emphasis on carbohydrates.

It seems that eating healthy has become a complicated matter, with conflicting recommendations. Scientists seem to be searching for which nutrient is causing increased rates of chronic disease in North America. The fact that they seem to change their minds about what is good or bad for us every few years suggests that we need to look at the bigger picture rather than single nutrients in food.

Nutritional science is a relatively new field, in existence for about 200 years. Some have compared this “science” to the surgery in the 1600s… not yet very advanced! Well-meaning scientists’ attempts to identify individual nutrients that are causing the problems have led to a great deal of confusion for consumers. The reason behind all this research is that our Western diet has been linked to obesity, type-2 diabetes, about 80% of cardiovascular disease, and over one third of all cancers. The good news is that changing from a Western diet to a healthier one results in rapid improvements in health.

Many very different traditional diets exist that are not associated with chronic diseases. These include the high fat diet of the French, the high animal protein diet of the Masai tribes in Africa, and the high carbohydrate diet of Central American Indians. None of these traditional diets have been linked to the chronic diseases that we see associated with the typical Western diet, although they are very different from each other. Our Western diet is unique in containing large amounts of processed food and meat, lots of added fat and sugar, and lots of refined grains, but very little vegetables fruit and whole-grains.

So, after so much talk about what to avoid, what should we eat?

I think I’ve found a good answer in a little book I stumbled across called “Food Rules, An Eaters Manual” by Michael Pollan. He proposes 3 simple rules that make a lot of sense:

  1. Eat food

  2. Mostly plants

  3. Not too much

Sounds easy, right? I certainly thought so. Let me explain the rules a little and you will see why they make sense to me…

1. Eat food

This means, eat real food, with ingredients that you would find in your Mom’s cupboard, food that has not been highly processed. Food processing is designed to make food last longer on store shelves, not to make it taste better or to be healthier for us. The amount of processing of food is a major difference between the harmful Western diet and healthier traditional diets.

2. Mostly plants

Vegetarians generally tend to be healthier than those who eat meat. It is suggested, however, that using meat as a flavoring or in small amounts can result in a diet that is just as healthy as a vegetarian one. Whether it is some component of meat or the fact that larger amounts leave less room on the plate for vegetables has not been determined, but simply reducing the amount of meat in your diet and eating more plant foods is a simple rule to follow to improve your diet.

3. Not too much

How much you eat and how you eat it may be as important as what you eat. When you are distracted while eating, you tend to eat more so eating in front of the TV or while driving or working means you will likely eat more. When you eat quickly, you also often eat more, since it takes about 20 minutes for your brain to register that you are full. You should eat only until no longer hungry, rather than eating until you are full or have finished everything on your plate (in spite of what your mother may have told you!). Eating more slowly will allow you to more readily detect when you are no longer hungry before you have actually overeaten.

Here are some other suggestions for healthy eating:

  • Shop mostly on the outer areas of the grocery store; avoid the centre aisles that are mostly processed packaged foods. Buy at a farmers’ market as often as you can – they sell locally grown, whole foods that don’t need to be preserved to reach their market. If you worry about food spoiling, freezing is often the best way to preserve food without losing the nutritional value.

  • Avoid “lite”, “low-fat” and “nonfat” foods – generally these tend to be more highly processed and often sugar is added to boost flavour that is lost when fat is removed.

  • Eat only food that will eventually rot – if bacteria and fungi don’t go for the food, we probably shouldn’t either!

  • An old Chinese proverb says “Eating what stands on 1 leg (plants, mushrooms) is better than eating what stands on 2 legs (fowl), which is better than eating what stands on 4 legs (cows, pigs, etc).” Of course, this ignores healthy legless fish, but it’s an easy rule to remember!

  • Eat your colours – a variety of colours indicates a variety of nutrients and it helps your meal look more appetizing too!

  • Eat food that is grown in healthy soil (this often means organic) or is fed healthy food (usually this means pasture raised rather than grain fed). Just like us, plants and animals need healthy food to be healthy themselves! More nutritious food generally has better flavour and is more satisfying…

  • Alcohol of any kind has health benefits. It is best taken in moderate amounts with food and on a daily basis rather than binge drinking. How alcohol improves health is not well understood but it is part of several healthy traditional diets, notably the French diet.

  • “The whiter the bread, the sooner you’ll be dead” is an old saying that has merit…white flour is not much different from sugar once it’s ingested. The substances that are removed from whole grains to make them white are the most nutritious part of the grain – it just makes sense to eat the whole grain.

  • Eat when you are hungry, not when bored, as a reward, or for entertainment. Be aware of why you are eating.

  • Use a smaller plate and smaller serving containers. We eat more when a larger portion is served, and we serve ourselves more when using a larger plate or serving from a larger container.

  • Make eating an enjoyable experience – share meals with others whenever possible, take your time and enjoy the taste of the food and the company you are sharing it with. Treat the preparation and eating of meals as a family or social ritual to be enjoyed, to elevate it from a biological necessity to the enjoyable part of life that food should be!

Lastly, what matters is what we do routinely – breaking the rules for special occasions can be good for our happiness and probably also for our health. So all we really need to do to be healthy, is to keep “Everything in moderation” along with the basic 3 rules: “eat food, mostly plants, and not too much”!

To learn more, read Michael Pollan’s short, well-researched book, Food Rules: An Eater’s Manual or his more detailed In Defense of Food: An Ester’s Manifesto.