Author: Jeannie Collins Beaudin

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Book review Health

Bacteria for Breakfast, Probiotics for Good Health – A book review

Did you know that at least 90% of our bodies’ cells are not human? They are bacteria that live mostly in our digestive system (about 3 pounds worth!), as well as on our skin, in the lungs, and within the urinary and genital tracts.

These are “good” bacteria that help prevent disease by reducing growth of “bad” bacteria that can cause harm. These good bacteria also produce some nutrients that we need, help digest our food, provide energy in the form of short chain fatty acids, and stimulate our immune systems. And, just being there in sufficient numbers, they crowd out other bacteria that could cause us harm. The make-up of this bacterial flora varies from person to person, and may account for our variable risks for certain diseases.

Pharmacist, Dr. Kelly Dowhower Karpa, wrote Bacteria for Breakfast, Probiotics for Good Health after using probiotics (supplements of good bacteria) to cure her 2-year-old son’s infection of C. Difficile bacteria that was resistant to all antibiotics that his doctors tried. She did extensive research into how these good bacteria keep us healthy before beginning to write and, although some parts of her book are quite technical with explanations designed to answer questions doctors may have, the book is written for the general public. The goal of her book is to educate patients themselves, and to enable them to discuss their gut health with physicians. I will present a brief overview of some of the topics she discusses.

The book focuses on bacteria that live in our digestive systems, from the mouth where they prevent bad breath and dental cavities that can be caused by unfavourable bacteria, to the intestines where imbalances can promote inflammatory diseases. It explains how the stomach is designed to produce acid that kills bacteria that may be in our food but when acid is chronically suppressed with commonly used medications, such as Zantac, Losec (Prilosec), Nexium, etc., or is naturally reduced these bacteria are more likely to survive and the risk of gut infections is increased.

Food allergies can occur when overgrowth of bacteria damages the lining of the bowel, allowing undigested food particles to pass through into the blood stream, triggering allergic reactions to these large proteins that are not normally found in blood (termed “leaky gut syndrome”). This “leakiness” is also associated with inflammation, severe infection, organ failure and even death. Wide-spread activation of the immune system can lead to inflammation, severe allergies, asthma, eczema and even anaphylaxis (a life-threatening allergic response).

The incidence of these immune-related conditions has exploded in the past 50 years, suggesting non-genetic factors are involved. Two major changes are increased hygiene resulting in less exposure to various bacteria, and change in diet with more sterile pre-packaged food and less fresh, fermented and dried foods that would contain various bacteria. Our first exposure to bacteria usually occurs during birth, when passing through the birth canal, so babies born by Cesarian Section do not receive this initial dose of good bacteria and sometimes never develop an ideal gut flora. As well, if the mother has a less than ideal balance of bacteria, then this is what is passed on to the baby.

The effect of our bacterial flora can easily be seen in changes in the daily elimination function of the bowel. After treatment with a course of antibiotics, which kill healthy bacteria along with the infectious bacteria being treated, bowel function often changes with development of either diarrhea or constipation that can be corrected with supplements of good bacteria (probiotics). You may have noticed a difference in your digestion after eating fermented foods that still contain live bacteria. Chronic constipation that is resistant to various laxatives or returns as soon as the laxative is discontinued, will also sometimes respond to a course of probiotics. Keep in mind that probiotic supplements generally contain much more bacteria than you would get in foods like yoghurt, and might be preferred when trying to correct a serious imbalance in gut bacteria.

Dr. Karpa also explains an additional hypothesis for how bacteria may increase our risk for disease in detail with supporting evidence from studies. Although complex, I will try to explain this briefly…

The gastrointestinal tract is considered to be the largest immune system organ, and it communicates with the immune system throughout the body by producing immune particles called cytokines. Good bacteria activate the immune system, by stimulating production of cytokines that create a low-level inflammation. Some of these cytokines also enable production of the thick layer of mucous that protects the cells that line our digestive system. Still other cytokines are produced that limit the amount of inflammation that is created.

If we do not have the correct balance of cytokine-producing bacteria, we could be missing the protective mucous layer (allowing damage to occur in the intestinal wall with resulting leakage of undigested food proteins), we could be lacking enough stimulation of the immune system (leading to poor protection against common infections) or we could become less able to block excessive inflammation (leading to autoimmune diseases like allergies, asthma, inflammatory bowel disease, rheumatoid arthritis, etc.). The book cites many examples of improvement in chronic health conditions with adequate supplementation of probiotics (or good bacteria) and explains in detail how changes in gut flora are connected with various health conditions.

Disturbed gut flora has been described as potentially playing a critical role in the development of various autoimmune diseases (where the body’s immune system attacks an organ system) such as:

  • Inflammatory bowel disease

  • Type 1 diabetes

  • Rheumatoid arthritis

  • Hashimoto’s Disease (thyroiditis)

The book also briefly describes the benefit that some patients experience by also adding pancreatic enzymes or plant enzymes to help digest food, leading to a reduction in food allergies presumably by increasing the breakdown of proteins they contain. This might be another avenue to discuss with your physician if you have chronic severe food allergies.

As a pharmacist, I believe it is preferable to prevent disease or to treat the root cause, if possible, rather than to simply control the symptoms. I think this is why I found this subject fascinating and wanted to share a little of this information with you.

Other recent research I have stumbled across, suggests that gut bacteria may also be associated with changes in the frontal lobe of the brain that could be associated with autism or schizophrenia. Another report suggests a possible association between gut bacteria and the ability to create the protective myelin sheath (the covering that insulates nerve cells) that is destroyed in degenerative nerve diseases like Multiple Sclerosis. Probiotics have even been noted to increase the beneficial effect of vaccines. So you can easily see that many problems may originate with imbalances in the digestive system’s bacteria, and research continues to look for these associations and how they occur.

If you are interested in reading further, here is information on the book I have reviewed:

Bacteria for Breakfast; Probiotics for Good Health, Dr. Kelly Dowhower Karpa, Trafford Publishing, ISBN 1-4120-0925-0.

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Health

FINGERNAILS… What they can tell you about your health

Grooves, streaks, colour and splits in our fingernails… they all give us clues about the state of our health. Changes in your nails may even be a signal to see your doctor right away! Here is what I learned from Mayo Clinic, WebMD, Boots, and skincare.about.com about how our health affects fingernail growth and appearance…. and ways to correct minor problems.

Pale nails can simply be linked to aging, but they can also be a sign of a serious problem, such as anemia, heart failure, liver disease or malnutrition.

White nails, also known as “Terry’s nails”, are nails that are mostly white but with darker rims. They can be caused by liver disease, such as hepatitis, heart failure or diabetes.

Yellowed nails can be caused by smoking or using dark coloured nail polish without a protective base coat underneath. However, yellow discolouring can also be caused by a fungal infection. If this is the cause, you may also see separation of the nail from the nail bed, nail thickening and crumbling of the nail as the infection progresses. Yellowed nails can also occasionally be associated with thyroid disease, lung disease (such as chronic bronchitis), swelling of the hands (lymphedema), or psoriasis.

Bluish nails can indicate the body is lacking oxygen. Hospitals will often request that nail polish be removed before surgery so natural nail colour can be checked as an indication of oxygen levels during the procedure. Lung problems like emphysema and some heart problems can also be associated with bluish nails.

Rippled or pitted nails may be an early sign of psoriasis, or other connective tissue diseases. These can also be a sign of alopecia areata, an autoimmune disease that causes hair loss. With pitted nails, the skin under the nail may also appear reddish brown.

Cracked nails or nails that split in layers have been connected with thyroid disease. However if yellowish colour is also present, cracking may be due to a fungal infection.

Puffiness around the nail is known as inflammation of the nail fold. This can because by lupus or another connective tissue disorder but can also be caused by infection. Try a non-prescription antibiotic but, if not improved within 2 or 3 days, see your doctor.

Dark streaks that run the length of the nail could be caused by melanoma under the nail – see your doctor as soon as possible!

Nail biting (onchophagia) or picking can be just an old habit but could also be a sign of persistent anxiety or obsessive-compulsive disorder.

Nail separation, known as oncholysis, can be caused by injury or infection, or by a reaction to a product such as a nail hardener or adhesive. Thyroid disease or psoriasis can also cause detached nails.

Beau’s lines are indentations that run across the nails. Interruption of nail growth by injury or severe illness, such as high fever or pneumonia, can be a cause. Uncontrolled diabetes, zinc deficiency or chemotherapy treatment can also cause Beau’s lines.

Spoon nails, or koilonychia, are soft nails that scoop outwards. These are often a sign of either too little iron (iron deficiency anemia) or too much iron (hemochromatosis). Spoon nails can also be associated with heart disease and hypothyroidism.

Nail clubbing, is the enlargement of the tips of the fingers with nails that curve over the fingertips, a condition that develops over the course of years. It’s the result of low oxygen in the blood and could be a sign of lung disease. Nail clubbing is also associated with inflammatory bowel disease, cardiovascular disease, liver disease and AIDS.

Lengthwise ridges in nails are very common and appear more frequently as people age. They are generally caused by a lack of moisture so applying oil or lotion around the nails often can help prevent this problem. You can also smooth ridges away with a nail file (four sided nail buffers are recommended) – just be cautious not to file too hard or too long, as this may cause irritation or inflammation of the nail bed and excessive thinning of the nail.

So, that problem with your nails may be a cosmetic issue or it could be a signal of a serious health problem. It’s probably a good idea to discuss it with your doctor at your next visit, just to be sure!

Presuming a serious underlying disease is not causing your nail problem, here are four key nutrients you can add to your diet to improve the health of your nails…

  1. Protein – Nails are made of keratin, a protein. If meat, eggs and other protein-rich foods are part of your regular diet… no worries! But if you are a strict vegan, make sure you have adequate vegetable protein sources, such as quinoa, beans, and tofu, included every day.

  2. Zinc – A lack of dietary zinc can result in weak, slow growing nails with white spots. Sources of zinc include oysters, pumpkin seeds, sesame seeds, lamb, beef and oats.

  3. Iron – As discussed above, a lack of iron can result in thin, curved nails with ridges. In addition to red meat, leafy greens (e.g. spinach and kale), and shellfish are good sources of iron.

  4. Biotin – One of the B-vitamins, biotin, promotes healthy cell growth and metabolism of protein-building amino acids, and these promote healthy nails and hair. Biotin is found in swiss chard, eggs, wheat germ, whole grains, and salmon.

And, if it seems too difficult to add foods with these nutrients to your diet, there are supplements available that contain what you need. Ask your pharmacist or a pharmacy cosmetic specialist!

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Health

Is Your Memory a Little Foggy?

I’ll bet you’ve gone to a room to get something, only to have no idea what it was when you arrived there… It’s enough to make you wonder if you’re losing your memory! But I’ll also bet you were thinking about something else more important at the time that had nothing to do with the item you were looking for…

Even though you’re not aware of it, your brain is constantly deciding what information is more important and prioritizing the formation of new memory circuits for this information, at the expense of remembering what it was that you wanted in that room.

How Does Memory Work?

Your brain actually changes when you learn something new or have a new experience, forming new connections between brain cells or neurons. This is called “neuroplasticity”.

Memories are formed in 3 stages:

  • Stabilization is the initial encoding of a memory that takes only 6 milliseconds (0.006 seconds!). This encoding happens when you decide to get something from another room.

  • Enhancement is the process of consolidation of the memory that occurs over minutes, several hours or days (depending on how complex the memory is). When you’re busy thinking about something else, the memory for what you wanted to get doesn’t get enhanced properly for easy retrieval. However, when you stop and think for a minute or two, you can usually find the initial encoding of the memory for the thing you wanted…

  • Integration is the process of connecting recent memories into existing memory networks and takes hours to years. Integrating new memories with old ones helps us recall the information more quickly. This might be the stage where you connect the memories of how often you are forgetting what you were looking for, and start to wonder if you’re losing your memory!

  • Reconsolidation is the retrieval of a consolidated memory into short term or working memory. At this stage, new information and experiences can “interfere”, altering the memory. This is called “retroactive interference” and is important in eyewitness testimonies in court proceedings. If, for example, you were the victim of a robbery, it might be a good idea to write down your memories right away to prevent this from happening.

Factors that affect your memory

Neuroscience, the study of the brain and nervous system, has identified 10 factors that help rehabilitation of people with brain damage. These factors were also found to affect memory in healthy people.

  1. Brain circuits that are not being used begin to degrade over time, so when it comes to memory, “use it or lose it”!

  2. “Cognitive training”, using memory techniques such as repeating out loud, using imagery, etc. helps improve memory.

  3. Learning a new skill or information produces significant changes in patterns of connections between neurons in the brain, not seen with repetition of known behavior. Our brains continue to grow and develop if we practice life long learning.

  4. Repetition may be required to induce long lasting memories, and makes it easier to retrieve and process information needed for a task. Repetition also makes memory retrieval faster and more automatic.

  5. Intensity and emotional involvement increase the degree of long-term memory formation. Memories from early childhood are often associated with a time of emotion.

  6. New learning brain cell connections are more likely to degrade more quickly. Stable consolidation of memories requires time. Summarizing what you’ve just learned helps to enhance memory formation and is a common technique used in adult learning programs.

  7. The more important you judge the information to be, the more likely you are to remember, encode and recall it. Often this judgment is an unconscious one.

  8. Aging causes a reduction in the ability to form new connections in the brain. New connections can still be formed but may be less profound or slower to form than in the younger brain. Older folks just need to work a little harder at it!

  9. “Transference” can occur, where the formation of one set of connections can increase the ability to form new, similar connections. Behaviours similar to those we already know are easier to learn.

  10. “Interference” can also occur. Having strong circuits for one brain activity can potentially interfere with formation of new memories that use the same circuitry, disrupting learning and task performance. These last 2 factors may explain why we find some things easier to learn than others.

How can you improve your memory?

Chronic and acute stress has negative effects on memory. When we’re stressed, we produce increased amounts of cortisol, the stress hormone that is known to affect memory negatively. So, decreasing stress often helps to improve memory.

Attention is crucial to processing information and forming memories so focusing on information helps you to remember it better.

Sleep and even daytime naps enhance the processing of memories into a more consolidated form. Sleep disruption, with less time in deeper stages of sleep, affects this processing of memories and memory function the following day. Interestingly, Alzheimer’s Disease (AD) patients have more sleep disruption than healthy elderly adults, and increased time in the deeper stages of sleep improves memory in these patients. The AD drug, donepezil, was found to increase time spent in deep sleep in a study in healthy adults.

Another study found caffeine helps memory more in sleep-deprived people than in those who had a good night’s sleep. Interestingly, sleep deprived people in this study were also more likely to believe their memories were correct, when they were actually wrong.

Nicotine was also found to improve learning and memory tasks in a study setting in Alzheimer’s, schizophrenia and ADHD patients. This is certainly not a reason to start smoking, but might explain the high smoking rates found in patients with schizophrenia.

And what about diet? Sugar may have a positive impact on memory, but not in young adults. Animal studies suggest that saturated fats, hydrogenated (trans) fats and high cholesterol diets may impair memory. Human studies suggest that saturated fats, high cholesterol and high calorie diets deficient in vitamins and antioxidants tend to promote Alzheimer’s Disease, whereas diets with good fats (omega-3’s and mono- and polyunsaturated fats) may decrease risk.

Studies found that exercise speeds mental processes and enhances memory storage and retrieval. Exercise also lowers levels of the stress hormone, cortisol, so may enhance memory by this mechanism also.

Inhaling oxygen before a word list recall test improved memory, although only short term. Blood oxygen saturation and heart rate are correlated – increased heart rate is associated with improved memory in the short term, so an increased heart rate from exercise could be helping boost memory. However, oxygen seems to only help with forming memories, not with recall, so exercise should theoretically help more before you study than before your test.

Music training, for example piano lessons, was noted to improve memory in adults and children. Learning a new language is also reported to improve brain function and memory.

I had many women clients with low levels of progesterone report that their memory for words and names improved when they started using progesterone cream. In contrast, allopregnanolone, the hormone produced when progesterone is broken down, seems to make memory worse. Large amounts of allopregnanolone are produced when progesterone is taken by mouth causing drowsiness not seen with the cream form. This has created conflicting results to studies of progesterone and memory, but my clinical experience suggests that progesterone itself improves memory recall, specifically for words and names.

So, focus on what you want to remember and use memory-enhancing tricks like repeating or associating facts with imagery. Consciously decide which information is important for you to remember. Get your rest and deal with the stress in your life as a strategy to improve your memory. And, if you do happen to have a rough night, that coffee the next day probably will help your memory!

And, did you notice that I bolded some key words to draw attention to them and help you to remember? 🙂 Have a memorable day!

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Health

Restless Legs Syndrome (RLS)

Can’t sit still? Leg discomfort keeping you awake? Read on to find out if Restless Leg Syndrome (RLS) might be your problem…

What is Restless Legs Syndrome?

People with RLS have a strong compelling urge to move the legs, described as uncomfortable or painful, that:

  • Occurs when inactive

  • Increases in the evening and at night

  • Is relieved by movement of the affected arm or leg

  • Often causes difficulty falling or staying asleep

  • May cause involuntary jerking of limbs when asleep or awake

You may have difficulty describing the sensation, using words such as creepy-crawley, tingling, pulling, tightening or uncomfortable. Children can also have the syndrome and are sometimes misdiagnosed as being hyperactive or having “growing pains”.

As many as 15% of the population may have RLS, but because it is so difficult to describe and people affected with it often don’t realize there are effective treatments, symptoms may never be mentioned to their doctor. It is also sometimes misdiagnosed as another condition.

How is it diagnosed?

RLS can mimic other conditions such as: diabetic neuropathy, nighttime leg cramps, arthritis pains, back pain, depression or insomnia of other causes. There is no specific test for RLS and it is diagnosed by its symptoms, once other conditions have been ruled out. It will sometimes run in families (“Familial or Primary RLS”) and is often diagnosed sooner in these cases, as the family is familiar with the symptoms.

What are the causes?

RLS-like symptoms can also be caused by other conditions:

  • Low iron, magnesium, folic acid or vitamin B12

  • Problems with the spinal cord (spinal stenosis or a damaged disk) or nerves

  • By-products of kidney disease

This is called “Secondary RLS” and treating the underlying cause will result in improvements of the RLS symptoms in these cases.

There is also a third type of RLS, called “Idiopathic RLS”, where the cause cannot be identified. “Idiopathic” simply means “unknown cause”.

Research suggests a cause of RLS may be decreased function in a specific part of the brain called the “substantia nigra”, the same part that malfunctions in Parkinson’s Disease. However, in Parkinson’s the cells are gradually destroyed whereas in RLS function is simply reduced, either because of a lack of the iron they need to function or because the iron cannot be transported into that part of the brain properly.

What medications are helpful or harmful?

Because RLS is caused by the same part of the brain involved in Parkinson’s Disease, some Parkinson’s medications can be helpful, increasing the dopamine that the affected part of the brain is supposed to produce.

Eliminating any drugs that block production or action of dopamine can also be helpful. This means your symptoms may improve if you avoid drugs such as certain stomach medications (ranitidine, cimetidine, famotidine, omeprazole, lansoprazole and others in these groups), antihistamines, phenytoin, lithium, calcium channel blockers (used for heart disease and blood pressure), and others that decrease the effect of dopamine. Ask your pharmacist to review your file for any of these medications.

Because of the tie to decreased dopamine action, drugs that increase dopamine or act like dopamine can be helpful for RLS. These include levodopa/carbidopa (Sinemet), ropinirole (Requip), pramipexole and others. Be sure to tell your pharmacist why you are taking these medications, if they are prescribed for you, so they will explain their use correctly. For example, taking short-acting levodopa/carbidopa in the morning would be helpful for Parkinson’s but wouldn’t help nighttime RLS symptoms.

Narcotics can help some people with daytime symptoms. Some seizure medications, such as carbamazepine and gabapentin, may be tried when dopamine therapy fails.

Sleeping medications are sometimes used to help sleep, but they do not have any effect on the actual symptoms of RLS. Also, as these medications and the narcotics mentioned above can be habit-forming, it is better to improve sleep problems and other symptoms by treating the cause if possible.

Clonidine can be particularly helpful when symptoms are associated with substances that are increased in patients with kidney failure.

Caffeine, alcohol, and smoking can make symptoms worse and, if so, should be avoided.

In summary…

RLS is often untreated or under-treated because patients have difficulty describing the sensations that they are experiencing and are often unaware the syndrome exists. There is no cure, other than correcting underlying causes in secondary RLS, and the symptoms tend to worsen with time. As well, the effect of medications may diminish over time requiring the patient to change therapy periodically.

It is easy to become confused about your new medication, as the various medications for RLS are also used for other conditions such as Parkinson’s disease, blood pressure, seizures, etc. Be sure to tell your pharmacist why you were prescribed this medication so you can have an effective discussion.

Remember that there are additional things you can do, like exercise, hot or cold therapy, or distracting activities than can help to reduce the severity of symptoms, improving your sleep and your ability to sit still when travelling or doing other sedentary activities.

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Health

Preventing Bladder Infections… Update!

I received a useful comment from a reader and have decided to pass her suggestion along. She tells me she has had good success in preventing bladder infections by taking d-mannose powder daily. This product was actually somewhat familiar to me from my study of natural medicines several years ago. I decided to do a little research to update my knowledge.

D-mannose is a simple sugar found naturally in apples, oranges, peaches and some berries, including blueberries and cranberries. It may actually be the d-mannose content of cranberries that gives it its ability to prevent bladder infections. Like cranberry, d-mannose works by preventing bacteria from sticking to the bladder walls and starting an infection.

I found a study that compared d-mannose 2 g daily mixed in 200 ml water, with nitrofurantoin 50 mg and no treatment. The effect of d-mannose in reducing recurrence of bladder infection was similar or slightly better than the effect of nitrofurantoin, and both were significantly better than taking no treatment at all. It should be noted that d-mannose only works to prevent infection from e-coli, the bacteria normally present in our anal area that causes an estimated 90% of bladder infections. So, although an infection caused by other types of bacteria could still occur, d-mannose can still make a significant difference in the infection rate.

Other studies, done in mice, suggest that d-mannose is safe to take long-term if taken in appropriate amounts, but excess may cause kidney damage. Side effects may include bloating or loose stools and, if this occurs, reducing the dose would likely reduce these effects.

Caution is recommended in women who are pregnant or breast-feeding — although it is thought by some experts to be safe, being a simple sugar, it has not been studied in these populations. It is also recommended to use caution if you have diabetes, as it may make it harder to control your blood sugar, since it is a sugar. However, as most d-mannose is absorbed more slowly than regular sugan and excreted intact through the urinary system relatively quickly, people with well-controlled diabetes generally do not have any problem, according to other sources. Checking your blood sugar more often when starting this therapy would be advised to alert you to any potential problems.

As an interesting sideline, studies also suggest d-mannose may act as a prebiotic, encouraging growth of “good” bacteria in the digestive system.

The recommended dose of d-mannose for prevention of urinary tract infections, as used in the study, is 2 g (or approximately one teaspoon) once daily in adults, and one half to 1 teaspoon for children, dissolved in a glass of water. Dr. Jonathan Wright, one of the first physicians to begin using d-mannose, claims 85 to 90% effectiveness from this treatment in his patients. D-mannose is available in health food stores and some pharmacies. He also discusses a high success rate in treating active infections with the same dose given every 2 to 3 hours, but cautions that another treatment should be considered if no improvement within 1 to 2 days. I noted that he used an equivalency of 1gram = 1 teaspoonful… Regardless of the actual equivalency, 1 teaspoonful appears to be the dose commonly recommended for adults. Your pharmacist could weigh a sample of the powder for you, if you want to calibrate your 5ml teaspoon from your set at home!

If you decide to stay with cranberry, it is probably best to choose a cranberry concentrate capsule with a high amount of cranberry content (and presumably more d-mannose) rather than the sweetened juice to avoid the increased intake of glucose (sugar) it contains. A price calculation I did several years ago also found high-dose capsules were less expensive than an equivalent amount of juice!

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Health

Preventing Bladder Infection…

I received a question from a reader asking what women can do to prevent bladder infections. Here is some information about these infections that are so common and some strategies to prevent them.

Bladder infections can affect both men and women, but are 10 to 50 times more common in women (depending on which reference you read!), probably due to the much shorter urethra we have. The actions you can take to prevent a bladder infection will likely also reduce your risk of a vaginal infection and, in men, prostate infection.

Generally, infections start in the urethra, travel up to the bladder and, if not treated, can continue to spread up the ureters to the kidneys, leading to a much more serious infection. The recommendations below are for preventing infection; if you have signs of infection – pain or irritation with urination, needing to go frequently or urgently, blood in the urine, pelvic pressure or lower abdomen discomfort – you should see your doctor right away for diagnosis and treatment.

Bacteria that are normal to have in the bowel can cause an infection if they move into the reproductive or urinary systems. So, one of the first preventive measures is to pay attention to how you wash your genital area, making sure you are moving bacteria away from your vagina and urethra and toward the rectum when you wash or wipe these areas. Basically, always wipe from front to back with a clean tissue or cloth.

Infectious organisms also like warmth and moisture, so wearing looser-fitting cotton underwear can help keep the area drier – boxer shorts for men may help but I haven’t seen this style for women yet! However, at least we can choose comfy 100% cotton undies and avoid synthetic “non-breathing” materials. Thong-style underwear may increase the chance of movement of bacteria from the rectal area to the vagina or urethra, and are also more likely to irritate these areas – might be best to avoid this style of undies if you have recurring problems with urinary tract infections (UTI).

Avoiding long baths can be helpful, as bath water can become contaminated with bacteria fairly quickly, and using tampons is advised to keep the bladder opening drier, limiting bacterial growth.

Avoiding long intervals between urinating can also be extremely effective, and make sure to completely empty the bladder each time. Try to urinate every 4 hours if you are prone to infections, even if you do not feel the need to go. Drinking more water is thought to be helpful to dilute the urine, encourage more frequent urination and flush any bacteria from the bladder before it can attach to the bladder wall and start an infection.

Sexual activity can increase the risk of infection because it tends to introduce bacteria to the urethra opening. Keep in mind that spermicidal jellies and creams also kill normal flora that help keep harmful bacteria in check. If an association between sexual activity and infection is identified, doctors will sometimes prescribe a dose of a mild antibiotic to be taken afterward. Urinating after sex can help to flush away bacteria before it has a chance to enter the urethra, too.

The tissues of both the urethra and vagina are dependent on estrogen for growth and, as women age, these tissues can become thinner, less healthy and more prone to infection. Sometimes doctors will prescribe estrogen in suppository or cream form to improve the health of this area directly. Only a low dose is needed (for example, 10 micrograms of estradiol is used as a suppository, as compared to 1000 micrograms as a common strength of the tablets given by mouth for menopause symptoms). Compounding pharmacists can also make a gel or cream using estriol, a very weak estrogen that is very effective in improving the health of the genital tissues. Estriol has little or no effect in stimulating the growth of breast or endometrium tissues and is therefore sometimes preferred for women who would benefit from a local estrogen effect but have increased concerns about reproductive cancers.

The normal human bacterial flora, a mixture of non-harmful bacteria that grow on and in our bodies, is increasingly recognized as an important defense to infection. And since antibiotics kill normal flora along with the infecting bacteria, they may actually set us up for recurrent infections. As well, bacterial resistance to antibiotics is a growing problem – they quickly learn how to survive our cures. We need to be careful to only use antibiotics when they are truly needed, and to finish the full treatment so none of the infectious organisms are left behind… the bacteria that are the slowest to be destroyed are those that have already begun to develop some resistance to the antibiotic being used.

Probiotics are products containing live, non-harmful organisms that are beneficial when given in adequate amounts. When taken by mouth or applied to an area of the body that needs protection, they tend to overgrow disease-causing organisms and create an environment that is resistant to infection.

Studies suggest that when taken by mouth or applied vaginally, probiotics can reduce recurrent urinary tract infections (UTIs). Although somewhat less effective at prevention than low dose daily antibiotic therapy, probiotic treatment does not cause the bacterial resistance that is seen with antibiotics. So, although more research needs to be done to find the ideal way to use probiotics, it’s worth discussing with your doctor if you have recurrent UTIs.

Lastly, cranberries and blueberries contain a substance that can help prevent bacteria from sticking to the bladder wall, an essential step in the beginning of an infection. Cranberry juice, however, contains a lot of sugar to counter its bitter taste, and this sugar can promote the infections you are trying to prevent. Cranberry concentrate capsules are an option without sugar, but you need to read and compare the labels carefully – all cranberry supplements are not created equal! Some may contain as little as 5mg of concentrate but be labeled as over 1000mg – the amount of fruit it was extracted from… very misleading! Also, cranberry, like grapefruit, can interact with other medications you may be taking. Be sure to check with your pharmacist before taking large amounts of cranberry if you take other medications!

In summary, actions that reduce the amount of bacteria that reach the urethral opening, prevent bacteria from sticking to the bladder wall and maintain a healthy bacterial flora (especially after a treatment with antibiotics) will all help to prevent recurrent urinary tract infection.

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Menopause

A step-wise approach to menopause treatment…

I like to think of treatment of menopause treatment as a series of “steps”… always consider the lowest level treatment and only advance to the next step if it is necessary for control of symptoms. With medications, “less is more” — in other words, a person is always better off taking the lowest amount and lowest level of treatment that will work for them. Especially with women who need hormones, the lowest amount should be taken that will give the relief that is needed.

The steps I consider when helping a woman control symptoms related to the menopausal change include:

1. exercise, diet, lifestyle changes

2. herbal medications, nutritional supplements

3. low dose hormones that are the same as the body produces

4. pharmaceutical hormones, stronger than our natural hormones

Step 1 – Exercise, Diet, Lifestyle Changes

The first step: exercise. improving diet, and making changes in your lifestyle are improvements all women who have mild symptoms should make to feel more comfortable and improve their health in the future. Exercise can help to even out hormone production and, since it also helps to reduce circulating stress hormones, can be useful in women who note their symptoms are worse during and after stressful situations. Stress hormones, your “fight or flight” reaction, set you up for exercise, speeding up your heart rate, increasing your blood pressure and blood sugar, and more… and exercise works to reverse these effects. And, of course, exercise improves health in many ways at the same time. Even as little as 30 minutes of moderate exercise 3 times a week can make a difference. Building exercise into your daily routine works too – it doesn’t have to be a session at the gym – take the stairs whenever you can, park in the far corner of the lot if it isn’t raining… see how you can add more activity to your day, wherever possible.

Since many vegetables contain plant-based hormones, also called “phytohormones”, eating more vegetables can help to even out our own hormone levels to a certain extent… When hormone levels are very low, these weak phytohormones can exert a small hormone-like effect. When natural hormone levels surge, phytohormones can have a dulling effect, moderating natural hormone action. A simple piece of advice I stumbled across, is to serve your plate with ¾ vegetables and ¼ meat, and to have 5 different colours of food in each meal!

Dressing in layers that can be quickly and easily shed, and installing a ceiling fan over your bed are two changes you can make that can improve your comfort and your sleep if you are suffering from hot flashes. I have found that the more quickly you can cool yourself off when your internal temperature setting rises, the less time the hot flash tends to last and the less discomfort you will feel.

These general “step 1” improvements, and others along these lines, are good for all women experiencing hormonal change to consider. Small changes can add together to make a significant difference and can add to any higher level therapy you may need to consider. As well, these are all healthy changes. Your reproductive years are becoming part of your past and you want to look forward to a healthy and happy retirement doing things you’ve always wanted to do. It’s a good time to consider what you can do to stay healthy and active as you age gracefully and make these changes part of your life.

Step 2 – Herbal Medications, Nutritional Supplements

The second step to consider is herbal medications and nutritional supplements. I’m not a fan of taking a lot of supplements, but you might benefit from targeted ones. The two herbal medicines I have found most useful in my clients are black cohosh and vitex (also called chaste berry). Some women find good relief from hot flashes with black cohosh alone but others do better with a combination product that contains both ingredients. These combinations are available from several reputable companies and are much simpler and less expensive to take than taking each separately. Black cohosh is rich in phytohormones, so helps to regulate swings in estrogen levels, while vitex helps to increase progesterone effect, creating improved hormone balance. I have had perimenopausal women with heavy menstrual flow (a sign of low progesterone in relation to the amount of estrogen being produced) report normalizing of their periods after starting vitex.

A useful nutritional supplement that I have successfully used with clients, is magnesium, taken at bedtime. Magnesium tends to relax muscles, especially if it is lacking in the diet – and one study I read suggested that as many as 30% of diets are lacking in magnesium. A supplement taken at bedtime will sometimes help improve sleep and, since we also need magnesium for healthy bones, you might benefit from this supplement in more than one way! Also, magnesium is absorbed better if taken away from meals so taking it at bedtime makes sense regardless of the reason you are taking it.

Another supplement I have found useful for addressing sleep problems associated with stress, is pantothenic acid or vitamin B5. Waking in the middle of the night with your mind racing and unable to return to sleep in spite of being exhausted can be associated with a spike in production of stress hormones – hormones that should remain low during the night. Pantothenic acid can help prevent these nighttime spikes in production, improving your sleep. I usually suggest 100mg be taken at bedtime for middle of the night awakening, or at suppertime for those who have trouble falling asleep. Combination B-Complex vitamins all contain some vitamin B5. You will note that some combinations are labelled as “stress formulas” and these are safe and well worth trying for minor anxiety symptoms.

Of course, there are many herbal and nutritional supplements that can be helpful, and you may want to consult with a naturopath or specialized pharmacist for expert one-on-one advice. However, avoid getting caught up in taking a lot of different supplements and herbal medicines. As with prescription medicines, the more you take, the greater the chances of interactions and side effects. I generally suggest a trial of one month with a supplement and, if you don’t notice an improvement, don’t continue taking it.

Step 3 – Bioidentical Hormones

If you have severe symptoms of hormone imbalance, there’s a good chance you would benefit from directly supplementing the missing hormone(s) – step 3. Aiming for the lowest level for the minimum time you need it is especially important when it comes to hormones.

And, with hormones, it is also best to use a hormone that is exactly the same as the one you are replacing, if you want it to do everything that your own hormone would do. Hormones are very complex molecules. They work by attaching to a specific hormone receptor, much like the way a key fits into a lock. Different sections of the molecule attach to different receptors in various tissues in the body, so changing even just one part of the molecule means that it will then have a different action on receptors for that piece of the molecule that was changed. In other words, any change in the molecule will change some of its functions in the body.

Hormones that are exactly the same as those we produce, are sometimes referred to as “bioidentical” hormones, meaning that they are biologically identical to those we produce. These identical molecules would, of course, keep all the effects of our own hormones when supplemented in a similar amount and timing. Bioidentical hormones are available commercially or can be compounded by a pharmacist.

Estradiol, our strongest estrogen, is commercially marketed as tablets, patches and vaginal cream or suppositories. Progesterone, the hormone that balances estrogen, comes as capsules and vaginal gel. Testosterone, the “male” hormone that women also need in small amounts, is available in capsules and cream.

Some doctors will prescribe the commercial testosterone cream for women, but it is packaged in packets or pumps with measured doses suitable for men. Women risk being overdosed when using these, although some will try to guess at the correct dose – which would result in a different dose every day and the chance of overdosing very easily. Too much testosterone in women, by the way, tends to cause side effects of acne, increased facial hair growth and, if overdosed for long enough, lowering of the voice.

So, one of the pharmacist’s roles is to compound (or prepare from “scratch”) dosage forms that are suitable for a particular patient. Testosterone cream for women is one such preparation that many pharmacists have made for years. An appropriate testosterone dose for a woman would be 1mg or less daily when applied to the skin, although doubling the dose initially for a week or two is often advised to see results sooner. Commercial testosterone creams are available in Canada in packets or pumps of 25 and 50mg, so it is difficult to imagine how any woman could measure an accurate and appropriate dose from one of these products.

As well, the “route of administration” or method of getting the hormones into the body can make a significant difference in how much you need to take. Swallowing hormones, although convenient, is really not an efficient method of taking hormones. Everything you swallow is filtered by the liver, and the liver works hard to keep hormones out of the body. Generally, you need to take about 10 times more hormone if you swallow it than if you use a suppository, patch or cream that is absorbed through the skin. This filtering is probably a function that developed during our evolution to prevent hormonal effects from accidental ingestion of a part of an animal that contained hormones. Our digestive systems are really designed to keep hormones from reaching the rest of our bodies.

At the same time, swallowed hormones make the liver work overtime, and this is seen as increased risks of gall bladder disease and liver toxicity. Testosterone, in doses intended for men, taken by mouth is even associated with cancers of the liver when used for extended periods of time. So, from all of this information (and more!) I have concluded that introducing hormones into the body through the skin, or the mucosa (by using drops under the tongue, or inserting a suppository or cream into the vagina or rectum) offer the best method of replacement.

And the dose should result in a blood level that is no higher than a normal level for a younger women in her reproductive years. Considering that we would be adding to a woman’s existing production and that normal levels can vary from person to person, it is unlikely that the same dose would be ideal for everyone. Unfortunately, with many commercial forms of hormones, notably gels in pump containers, patches and some very tiny tablets, the dose form makes it difficult to individualize the dose to what is right for you.

As a compounding pharmacist, I was always looking for a system that would allow for accurate measuring while allowing a flexible dose. Creams can offer the advantage of an adjustable dosage, if they are packaged in a manner that allows this. Some patches can be cut without changing absorption (you would have to check each product to be sure) but, again, we would be dealing with “guessing” where to cut the patch.

The best system I could come up with, at a reasonable cost, was to pre-package creams in a syringe (with no needle) so a measured amount could be squeezed out and applied to the skin. Other measurement systems I’ve seen included a special jar or tube that allowed the user to fill a syringe themselves with the appropriate amount, but there could sometimes be problems with air bubbles that would result in a reduced dose plus women want a system that is convenient and easy to use. I’m waiting for an engineer to take an interest in our dilemma!

There is so much to discuss about low dose bioidentical hormone replacement – I’ve barely scratched the surface. Hopefully, this summary has given you some insight into issues you can discuss with your doctor, if you are unable to find relief with lower level menopause therapies…

Step 4 – Pharmaceutical Hormones

If considering pharmaceutical hormones or birth control pills for treatment of menopause symptoms, step 4 of our treatment choices, you need to weigh the pros and cons… These hormones, that are different from those produced by our bodies, are the strongest therapy option and one I rarely recommend for menopause symptoms, as there are better choices available, as explained in step 3 above. At one time experts seemed to believe that if hormones “kept you young” then the more, the better! However, now we know that too much hormone activity can be as problematic as too little, and dosages have been steadily reduced over the years.

A little history: Original doses of Premarin, conjugated equine estrogen (CEE), were as high as 2.5mg daily and it was taken alone. With use, it was noted that the endometrial lining of the uterus became thickened, and risk of cancer in this area was increased. Doses were reduced to 0.625mg and a second hormone, medroxyprogesterone, was added to prevent endometrial growth – this regimen worked very well to reverse the endometrial cancer risk. Several studies were done with the 0.625mg tablets that suggested it lowered risk factors for other diseases of aging so, although a lower 0.3mg tablet was available, it was less often prescribed. I suspect that the 0.3mg dosage would have been enough for many women.

While researching another issue years ago, I stumbled across early studies on medroxyprogesterone dating back to the early 1990s suggesting a possible increased risk of breast cancer. However, about the same time, a study by the World Health Organization failed to identify an increased risk of this cancer. So, its use continued until the landmark Women’s Health Initiative (WHI) study was stopped earlier than scheduled in 2002, due to its clear findings of more overall risk than benefit from the combination therapy of CEE and medroxyprogesterone. Stopping a study early gets the attention of the science community and the media, and most doctors stopped prescribing both of these hormone preparations right away.

Since then, risks of hormone therapies have been reassessed and researchers indicate that the warnings in the early 2000s were exaggerated. This resulted in a generation of women suffering more than necessary during the menopausal change. However, few doctors still prescribe the Premarin/Provera (medroxyprogesterone) pharmaceutical regimen that was once so popular.

When it comes to pharmaceutical hormones there are many different varieties, most of which are used for birth control. With all of these different “cousins” of our own hormones, we see subtle differences in their actions and side effects because of the differences in their structure (as described in Part 2 of this blog). There has also been a gradual reduction in the dose of birth control pills being introduced to the market over the years. All of this has made it difficult to analyze the side effects of long-term birth control use in women, with most being combination products with a variety of different hormones. In general, however, birth control pills have been found to be associated with reduced risk of endometrial and ovarian cancers, and with increased risk of breast, cervical and liver cancers. They are generally not recommended in women over 35 who smoke or who have heart disease, high blood pressure, diabetes or blood clots, due to added risk from the hormones in these pills.

Doctors will sometimes prescribe birth control pills to women in perimenopause (the years before periods stop when women are experiencing various hormone changes and symptoms) to control menopause symptoms as well as to prevent pregnancy. This may be a good option if you need birth control and don’t have any of the cautions listed above, but it’s a “one size fits all” approach that, in my experience, only addresses some symptoms a woman may be experiencing.

Perimenopause is characterized by lowered production of progesterone and normal or increased production of estrogen, with classic symptoms of heavier flow and skipped periods. While the synthetic progestin in the birth control pill generally will control the heavy periods, the extra estrogen is certainly not needed at a time when natural estrogen production is often higher than normal, creating a different set of excess estrogen effects for the woman. In contrast, the approach I used (and that of other pharmacists who do similar hormone analysis) offers assessment of symptoms to determine which hormones are missing and makes an effort to replace only those hormones. Some practitioners use saliva or blood hormone tests to assess what hormones are being over or under produced, and choose a therapy based on this information.

Humans have lived since the beginning of our existence with our own bioidentical hormones. While we still need to pay close attention to dosing and timing of supplements, and using the lowest effective dose for the shortest time needed, there is a definite trend toward using bioidentical hormones whenever possible with most physicians for treatment of menopause symptoms. Supplying hormones through the skin (as a patch, cream or gel) or as a suppository, rather than swallowing, also results in less hormone needed and fewer side effects, and avoids potential problems with the liver and digestive system.

Given the many years required for researchers to realize a long-used hormone therapy created more risk than benefit, and the possibility that other subtle but harmful effects could surface in the future, using low-dose bioidentical hormones whenever possible just seems like a logical route to take when non-hormonal therapies do not give sufficient symptom relief.

There is so much to say about understanding and correcting hormone imbalances – I’ve really just scratched the surface in this article. If you are interested in learning more, I have written a book on the topic — Can I Speak to the Hormone Lady? Managing Menopause and Hormone Imbalances, published in February 2019. It’s available in digital (e-book) and print forms through all major online retailers. Here’s a link…