Category: Health

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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!

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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.

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Health

Hormones and chemicals in plastic

I used to think that “microwave-safe” simply meant that the container would not melt or warp when used in the microwave. However, many plastics contain harmful ingredients that can leach into food, especially when heat or oils are present, and should never be used in a microwave. So, in addition to being structurally intolerant to heat, some plastics actually become harmful to our health when used in the microwave.

I learned this the hard way. When my kids outgrew their Tupperware “sip ‘n’ seal” cups and lids I thought they would work well for coffee in the car. Eventually, the plastic taste in my coffee became so strong I discarded the cups, never realizing I had been endangering my health.

During this time I had a series of health problems with mammogram and Pap test recalls… but I didn’t connect the two until I attended a lecture on environmental connections to breast cancer, sponsored by our local breast cancer support group.

We watched a film entitled “Exposure: Environmental Links to Breast Cancer” then participated in a discussion with the producer and director of the film. They described many different types of environmental chemicals that have been connected to increased rates of cancer, including ingredients in plastic that contacts our food, some of which can disrupt the action of hormones in the body. I believe this film may still be available – I found a source online (www.womenshealthyenviroments.ca) or you could check with your local library if you are interested in seeing this film.

So, when it comes to plastics, some are safer than others. A numbering system, 1 to 7, has been developed to help sorting plastics for recycling, but the numbers also help us know which plastics are considered safer. You’ve probably noticed these numbers surrounded by a triangle, embossed or printed on the plastic container, usually on the bottom.

Basically, types 2, 4 and 5 are considered safest, with types 1 and some 7’s considered safe with some precautions. Here are the details:

  1. PET (or PETE) – Polyethylene Terephthalate

    • Thin, clear plastic

    • Used in water bottles, cooking oil, peanut butter jars, soda pop bottles

    • Safe for one use only

    • Do not heat or reuse (or leave in a hot environment, such as in a car)

    • Can be recycled once into other products

  2. HDPE (High density polyethylene)

    • Thick, opaque plastic

    • Used in milk/water jugs, juice bottles, containers for detergent, shampoo, motor oil, toys

    • Limit how often they are refilled

    • Can be recycled as with type 1 plastic

  3. PVC (Polyvinyl chloride)

    • Can be rigid or flexible

    • Used for bibs, mattress covers, commercial plastic wrap, some food and detergent containers

    • Recommended to avoid. Manufacture of PVC creates dioxin, a potent carcinogen

    • PVC may also contain phthalates to soften it. These are hormone-disrupting chemicals linked to reproductive problems and birth defects. (It seems likely that I mistakenly exposed myself to this type of chemical)

    • Difficult to recycle

  4. LDPE (Low density polyethylene)

    • Soft flexible plastic

    • Used for grocery bags, household plastic wrap, garbage bags

    • One of the safer plastics but best to recycle and reuse when possible to reduce impact on the environment

  5. PP (Polypropylene)

    • Hard but flexible

    • Used to make ice cream and yogurt containers, drinking straws, syrup bottles, salad bar containers, some dishware, diapers

    • One of the safer plastic, but recycle when possible as with type 4 plastic.

  6. PS (Polystyrene)

    • Rigid

    • Used for styrofoam coffee cups, meat trays, opaque plastic spoons and forks

    • Avoid. Can leach styrene, a known neurotoxin with other harmful effects

  7. Other (includes polycarbonate, bioplastic and acrylic)

    • Polycarbonate – used for 5-gallon water bottles, sports bottes, clear plastic cutlery, linings of food cans

    • Bioplastics – uused for biodegradable garbage bags

    • Safety grab bag:

      • Polycarbonate is made from BPA (bisphenol-A), a harmful synthetic estrogen (hormone disruptor). Usually labeled “Not for microwave use”. Best to avoid.

      • Bioplastics are considered safe for their stated use. Must not be recycled with other plastics (due to programmed degradation)

      • Acrylic (Plexiglass) – non-BPA, usually labeled “hand-wash”, “BPA-free”, safe to use but microwavable

      • Tritan (SAN) – BPA-free clear plastic. Looks similar to polycarbonate but does not contain BPA.

      • Melamine – considered less safe, not microwavable. Melamine is toxic if ingested with food.

    • Often type 7 plastics are not labeled. Check if BPA-free labeling.

So, to uncomplicated things a bit, here are some basic recommendations to follow to reduce potential exposure to harmful ingredients in plastic and protect the environment at the same time…

  • Choose glass, metal or food-safe ceramic to heat and store food whenever possible

  • Plastics labeled as recycle types 2, 4 and 5 are safest, with type 1 acceptable for single use only. Type 7 plastics need further investigation. Avoid food contact with other types of plastic.

  • Avoid exposing any plastic to high temperatures as much as possible (do not microwave or put in dishwasher)

  • Even with safer plastics (2, 4 and 5) acidic food, fat/oils and heat will promote breakdown of plastic and leaching of plastic ingredients into food

  • Recycle or discard cracked or worn plastic items as these are more likely to leach chemicals

  • Always recycle plastic except for biobased plastics

  • Avoid buying processed and packaged foods if possible. Buy from bulk and use reusable containers from home as much as possible

  • Use reusable shopping bags and lunch containers (stainless steel, glass, ceramic or wax paper) whenever possible

If you are interested in a chart of plastic types to download or print, a good one is available here.

References: healthychild.com, babygreenthumb.com, davidsuzuki.org

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Health

Drug-induced nutrient depletion

Did you know that some drugs can cause you to lose nutrients from your body? Some side effects of prescription drugs may not be directly due to the drug itself, but may instead be caused by a nutritional deficiency caused by the drug over time.

While much research has been done in this area over the past 50 years, the results of many of these studies are not widely known… If you are aware of these potential deficiencies, you can then adjust your diet or take a supplement to replace what is being lost, and this may improve your tolerance of the medication and avoid some negative health effects.

Here are some examples:

  • Antibiotics – Broad spectrum antibiotics, those that kill a wide range of bacteria, also kill the good bacteria in your digestive system that help digest food, and protect us from harmful infections. These good bacteria, lactobacillus and bifidus, also produce a range of B vitamins and vitamin K. This interaction is of particular concern in those taking the blood thinner, warfarin, which works by blocking vitamin K’s action to promote blood clotting. Less good bacteria, means less vitamin K, which increases the effect of warfarin, leading to an increased tendency to bleed. B vitamins have many functions in the body, so a lack of these may have many effects.

  • Acid suppressing drugs – Stomach acid is necessary to absorb many nutrients, so suppressing or neutralizing acid long-term can cause depletion of various vitamins and minerals. Simple antacids can reduce absorption of calcium and phosphorus; histamine-2 receptor inhibitor drugs like ranitidine (Zantac) can deplete calcium, folic acid, iron, vitamin B12 and zinc; proton pump inhibitor drugs, such as omeprazole (Losec), pantoprazole (Tecta) and esomeprazole (Nexium) can reduce absorption of vitamins C, B6, B12, folic acid, magnesium and zinc.

  • Diuretic blood pressure medications – Hydrochlorothiazide, the most widely prescribed “fluid pill”, can deplete potassium, magnesium, Vitamin B6, coenzyme Q10, and zinc. Pharmacists will often advise to drink orange juice or eat a banana a day when taking these to replace lost potassium but potatoes actually contain more potassium than bananas… In extreme cases, potassium supplements are necessary, but changing to a different fluid blood pressure medication is a simpler approach to correcting the problem.

  • Birth control pills – Hormonal birth control medications deplete vitamins B2, B6, B12 and C, folic acid, magnesium and zinc. Low folic acid is associated with the birth defect, spina bifida, and this is one reason it is advised to stop birth control pills a few months before trying to become pregnant.

  • Beta-blockers and “statin” cholesterol drugs – Both of these classes of medications, often used together in heart patients, can reduce production of coenzyme Q10. CoQ10 is used in the mitochondria, the energy factories inside our cells, to produce the energy that is needed for all body functions, and it is an important antioxidant as well. Low coQ10 can affect many functions, in particular heart function. It is widely used in Japan as a treatment for various cardiovascular problems. Although coQ10 is present in small amounts in many foods, it would be difficult to get an amount comparable to what is normally produced by the body, making supplementation the best way to prevent coQ10 depletion.

  • Metformin – This drug, used to treat type-2 diabetes, depletes vitamin B12, a vitamin that is necessary for producing red blood cells and nerve growth and repair. One of the long-term consequences of diabetes is numbness of the extremities, due to nerve damage, known as peripheral neuropathy. In one study, nursing home residents with peripheral neuropathy who were taking metformin were given vitamin B12 supplements – 30% reported that their neuropathies improved, suggesting that lack of B12 was the cause. Deficiencies of B12 in the elderly can also cause moodiness, confusion, abnormal gait, memory loss, agitation, delusions, dizziness, dementia and hallucinations. Vitamin B12 is also depleted by numerous other drugs, as noted above. A simple blood test can readily identify low B12.

  • Mineral oil and stool softeners – Used for treating constipation, mineral oil is poorly absorbed from the digestive system and it works by creating a lubricant effect in the bowel. Stool softeners also stay in the bowel where they mix with stool, preventing it from hardening and causing constipation. However, vitamins A, D, E and K as well as the vitamin A precursor, betacarotene, tend to dissolve in these laxatives, reducing their absorption into the system and, instead, being excreted in the stool. Laxatives containing mineral oil or stool softeners can deplete these fat-soluble vitamins, especially if taken multiple times daily with meals. For this reason, they are best taken at bedtime, away from meals.

These are just a few examples of nutrients that can be depleted by medication. So, if you are taking medications regularly, ask your pharmacist to research whether you may need to replace any particular nutrients. To ensure they have sufficient time to research your question properly, I would suggest leaving your request and checking back in a day or two, rather than expecting them to give a quick answer from memory.

Not all nutrient depletions will occur in all individuals, however; ask your doctor to include tests for nutrients that may become depleted due to medication you are taking, along with your regular annual blood tests, to avoid taking unnecessary supplements. Also ask whether simply adjusting your diet would be adequate, given the degree of nutrient depletion found in testing.

Reference: Drug-Induced Nutrient Depletion Handbook; R Pelton, JB LaValle

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Health

How to Be a Skeptic…

We’ve all seen the reports and advertisements… alcohol and sunshine are completely bad for us, calcium makes strong bones, Nutella is part of a healthy breakfast…

Research isn’t black and white – there is a lot of grey that is subject to interpretation. Even numbers can be manipulated to make the results of a study sound more dramatic. And sometimes, some numbers and facts (and even entire studies) are ignored when they don’t support the idea a researcher wants to prove. Of course, this isn’t good science but, unfortunately, we are starting to see this more and more…

Some years ago, I presented several lectures at an event sponsored by Dalhousie University. One presentation was provided to me by a pharmaceutical company co-sponsoring the event. A Dal professor was in the audience and, afterward, politely pointed out the bias that was in the data, with a graph stretched out to make the curved lines look more separated – making the drug’s effect look greater than it actually was. I was quite embarrassed but, in the end, thanked him for educating us in what to look for.

So, here are some “red flags” you can watch for when you are reading about a study in the media:

  1. Observational study (versus an Interventional study) – An observational study looks at what factors or events tend to occur together but provides no conclusion about a cause. An interventional study, in contrast, uses two groups that are well matched, changes the one factor they want to test, and then measures whether this made a difference at the end of the study. An observational study can give us an idea what could be tested, but an interventional study is needed to prove a cause.

  2. The words “is associated with” – This simply indicates that the factor they are talking about occurred along with a particular disease or condition in an observational study. An association does not demonstrate a cause. For example, yellow fingers (from smoking) could be said to be associated with heart disease; however, we know it is smoking that causes heart disease, not yellow coloured fingers. Scrubbing the colour off the fingers would do nothing to prevent heart disease. So, humour me while I say this again… if something is associated with a disease, it doesn’t necessarily mean it causes the disease.

  3. “Relative Risk Reduction (RRR or RR)” – This method of presenting results, compares the outcomes from 2 groups by using a percentage difference rather than subtracting the actual numbers, and can make differences appear much larger than they actually are. An example explains it more clearly: If you had 2 groups of 100,000 people and the results were 2 cases in the untreated group but only 1 in the treated group, this would be a 50% relative risk reduction. However, in actual numbers, called the “Absolute Risk Reduction”, where the results are simply subtracted, the difference is only 0.001%, a much less impressive figure. RRR is often used to make results appear more significant than they actually are, especially when the difference is very small. All too often, it is not specified that the results are RRR, creating misunderstanding of the study conclusion, even with doctors.

  4. The time over which the results were gathered is not specified – Was the effect observed after a short period of treatment or did they study participants take the drug for years in order for it to make any difference? We see this often when “Number Needed to Treat (NNT)” presentation of data is used. This number tells you how many people they needed to treat to make a difference for 1 person, so the lower the number, the fewer they needed to treat to see an effect. However, did you need to treat these people for 10 years to make a difference for one, or only for a month? The time frame makes a big difference, and needs to be specified.

  5. The study only uses deaths from one disease, not total mortality – The factor being studied could improve one disease state while worsening another. If total mortality is not mentioned, it is likely that the drug did not increase the overall lifespan of the study participants. Overall health and quality of life are what is important… we want to live longer healthier lives, not just change our cause of death. An example would be looking only at decreasing heart disease, while ignoring a drug’s effect on increasing death from other causes. New, less publicized reports of the well-known JUPITER study have pointed out that the cholesterol drug being tested did not change overall survival, yet the study results touted a significant reduction in deaths from heart disease.

  6. Who paid for the study – Any study that has been sponsored by a party with an agenda runs the risk of being biased. Negative results are more likely to be ignored or never published, if money is on the line! Unfortunately, much of our drug research is done by manufacturers of medicines, and has lead to incorrect results, whether intentional or not. Examples are Provera used in hormone replacement therapy, and the arthritis drugs Vioxx and Bextra. Although these drugs were tested thoroughly and used for years by millions of people, they were eventually found in balanced independent studies to cause more harm than benefit.

  7. Small numbers of participants – It is easier for a false result to be drawn when there are fewer people in a study. Using larger groups and ensuring that these groups are as similar as possible before changing one factor for testing, is more likely to give an accurate result. Of course, a very large study done over several years that quotes only relative risk reduction for one condition should send a red flag alert even though it is a large study.

  8. Multifactorial testing or making several changes at once – No conclusion can be drawn regarding one particular drug if several changes were made for the test. This was done with calcium supplement testing, where participants were given Calcium and vitamin D and were told to exercise more, and it was concluded that calcium supplements strengthened bone. It has since been demonstrated that dramatically increasing calcium intake by using supplements does not reduce bone fractures.

  9. Using a “surrogate end point” or measuring something other than the actual beneficial outcome you are trying to achieve. For example, simply measuring bone density does not give a true picture of how strong bone is… many years ago, fluoride was given to create more dense bone, and it certainly did this well. However, the bone created was brittle and broke easily, somewhat like a piece of chalk. The goal of treating osteoporosis is to prevent bone fractures, not simply make more dense bone. Unfortunately, it is difficult to measure actual bone strength so our medical system continues to measure bone density as a gauge of bone health. However, studies for osteoporosis prevention now must demonstrate fewer bone fractures, not just more dense bone.

This week I received a pharmacy flyer, with a 2-page article on the dangers of alcohol consumption. While it is factually correct, I’m sure, and offers some good advice about avoidance of drinking in excess, there is no discussion of study results showing benefits of light to moderate drinking over total abstinence. Only on a side bar, is there mention that “you may have heard that drinking a glass of red wine is good for your heart” and that this “may be true”. In actual fact, there is no study that found red wine reduced heart disease more than any other type of alcohol; this has simply been proposed as a possible reason why the French (in France) have low rates of heart disease in spite of their high-fat diet.

As for the dangers of sunshine, we know that we need some sun exposure in order to make the vitamin D we need, but no studies have been done to determine how much is too much, and the safe amount likely varies widely, depending on the angle of the sun, skin characteristics and other factors. The “5 servings a day” recommendation for vegetables and fruit consumption came out of thin air, and alcohol “limits” vary widely, since there is no real science to support the limits. The benefit versus risk of statin cholesterol medications is being questioned in many areas of the world (as discussed in last week’s blog) and, well, Nutella really doesn’t add a lot of nutrition to a breakfast even if it does contain ground hazelnuts along with the sugar and yummy chocolate! But, that last one was just an advertisement, not a “study”, so not many of us were likely taken in by that…

I still remember how dejected a friend was years ago, telling us he couldn’t have gravy on his Thanksgiving turkey because his triglycerides were elevated… and now we realize how inaccurate these measurements really were and how little effect triglycerides have on heart health. I think we all, especially health professionals, need to question how good the evidence is behind scientific “facts” that are presented to us. “Everything in moderation” may just be the best approach to life, especially when it comes to depriving yourself of what you enjoy most based on questionable reports.

If you are interested in reading further on this issue, I can suggest “Doctoring Data” by Scottish physician, Dr. Malcolm Kendrick.

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Health

THE CHOLESTEROL CONTROVERSY…

Did you know there is a controversy over whether low-density cholesterol (LDL-cholesterol) actually causes heart disease or is simply a secondary effect of the true cause? I didn’t until I stumbled across an article by researchers at several Japanese universities last winter…

This research article, written by independent university researchers in Japan, examined cholesterol levels and longevity, and reported that increased blood cholesterol was correlated to a longer life span – the opposite to what we would expect if high cholesterol causes cardiovascular disease (heart attacks and strokes). This study, entitled “Towards a Paradigm Shift in Cholesterol Treatment”, is available at www.karger.com/Article/PDF/381654 if you are interested in reading it yourself.

Having studied hormones for many years, I know that our hormones are made from cholesterol. Cholesterol is also used to make bile (a fluid produced by the liver and used to digest and absorb fat), and vitamin D, and it is a component of the walls of our cells. We get cholesterol from our food, and our liver also produces it; when we eat more cholesterol our liver produces less, and when we eat less the liver makes more, attempting to keep the blood level more or less constant. Our bodies do this with many essential nutrients, like calcium, magnesium, iron, sugar, etc. storing away, pulling from storage sites or producing as necessary to maintain the blood levels our bodies need to function. This is known as “homeostasis”. Cholesterol is one of these essential molecules in our body.

As a pharmacist, I have seen many reports of studies over the years that, I believed, proved the cholesterol/heart disease theory without question. Through my professional education, I learned that high cholesterol, especially LDL-cholesterol, in the blood was a major cause of plaques that blocked arteries carrying essential blood to the heart, and that lowering cholesterol would reduce the risk of a heart attack. I counseled patients to reduce their intake of animal fat and increase their consumption of “good” polyunsaturated fats such as the omega-3 oils.

Now that I’m retired and have more time to read, and with my interest piqued by the article I stumbled across in February, I started looking more closely at the research… I was shocked at what I found!

I found articles from researchers in several areas of the world that questioned cholesterol as a cause of heart disease. In particular, a text by Uffe Ravnskov, entitled “The Cholesterol Myths”, seemed to cover the controversy well, describing flaws in a number of studies that were interpreted to support the diet/cholesterol/heart disease theory. Dr. Ravnskov is a family physician, now retired, who noted that this new idea didn’t seem to agree with information he had previously read. He examined the original full version of studies used to support this idea, and found what he believed were flaws. He continued reading related research and found a number of other studies that appeared to conflict with the idea that dietary fat and cholesterol cause heart disease. He began writing articles and eventually wrote a book on his findings. The original 1998 version of the book is available free online at www.ravnskov.nu/cm/ and an updated version can be found at Amazon.com or at your local bookstore. It certainly is an interesting read.

Ravsnkov begins with discussing the original study done by Dr. Ancel Keyes in 1953 that started us into the world of low fat diets and cholesterol medications. This study used data from six countries that clearly demonstrated higher fat in the diet resulted in higher rates of heart disease. But, data were available from 22 countries at the time, and when all countries were included, the association was much less clear. Some countries with similar dietary fat to that in US actually had only 1/3 to 1/4 the rate of heart related deaths but these were not included in his assessment. It seems that he cherry-picked his countries to make a graph that best supported his idea.

Ravnskov also describes several studies of populations with high cholesterol and high fat diets that have very low heart disease rates, and populations within the same country, where the affluent are reported to have much higher rates of heart disease than the poor, but where blood cholesterol and genetics would be similar.

According to the “Scientific Method”, the basis of all scientific study, any consistent conflicting study results indicate that the original hypothesis or theory must be re-evaluated. While the “statin” cholesterol medications have been shown to reduce heart disease deaths, they have many actions in the body other than simply lowering LDL cholesterol. It appears that there is enough conflicting evidence that the benefit versus risk of these drugs should be reassessed.

Lack of physical activity, mental stress, smoking and obesity are all considered risk factors for heart disease and stroke. These factors also increase the level of cholesterol in the blood. If the blood cholesterol level is merely secondary to the actual causes of heart disease, then artificially lowering it without changing the underlying sedentary lifestyle, stress, smoking and overweight would have little effect on reducing heart disease risk. If this is the case, we need to reevaluate our focus on LDL-cholesterol, and place more importance on changing lifestyle factors that are associated with increased risk.

I am certainly not advising anyone to stop taking his or her medication, but the question is: Should we be focusing more on the factors that raise cholesterol and less on trying to lower our cholesterol numbers artificially? Statins are known to exert several beneficial mechanisms along with their cholesterol lowering effect, such as reducing inflammation and “thinning” the blood. As one reference suggests: “It may be wiser to search for the lowest effective dose instead of the dose with maximal effect on LDL-cholesterol.”

If you are taking medications for cholesterol, discuss this information with your doctor, encourage him or her to examine the evidence and discuss it with local specialists, and thoroughly review possible adverse effects of your medication to ensure you receive more benefit than risk from what you are taking. And, given the importance of increasing activity, reducing stress and quitting smoking in reducing cardiovascular risk, focus on continuing to improve your lifestyle in these areas.

By constantly questioning the status quo when new evidence comes to light, we can continually improve the quality of our healthcare.

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Article reprint Health

Keeping Acne Under Control

Here’s a little “Acne 101” for the students in your life heading back to school, and for those like me who have acne-prone skin… what causes those blemishes and how to prevent and treat them!

Sebum (a waxy oily substance produced by glands in our skin), mixed with dead skin cells, blocks the openings to the pores, creating whiteheads or, if oxidized, blackheads. When oil and bacteria (specifically propionibacterium acnes [P. acnes]) become trapped in pores, the bacteria breaks the oil down into fatty acids that create irritation and inflammation along with the P.acnes infection. It is known that androgen (male hormone) stimulation causes changes in the pilosebaceous units (the oil-producing glands in hair follicles) that result in increased production of the problematic sebum.

The actual cause of acne is actually not well understood, but we do know that it is often associated with a hormone imbalance that involves increased androgen production, leading to excessive sebum production.

During adolescence, both males and females have increased levels of androgens and, in perimenopause and conditions such as polycystic ovarian syndrome, this type of hormone imbalance can occur also. Acne vulgaris, or common acne, affects areas that have the largest density of sebaceous follicles, and hence occurs most commonly on the face, upper chest and back.

Some sources have suggested that in certain skin types, the stratum corneum (the outside layer of skin), grows into the pore opening, creating a condition where pores are more easily blocked than in normal skin; other sources suggest that certain individuals may naturally produce a thicker sebum that blocks the pores more readily. Although these theories have not been well demonstrated, they could explain why some people have a greater tendency to develop acne than others.

Treatments are aimed at reducing oil, decreasing bacteria counts on the skin and keeping pores open. Many of our more effective acne treatments, such as correcting underlying hormonal imbalance, reducing sebum production with vitamin A derivatives, or reducing bacteria counts through antibiotic treatments, require prescription. However, there are many non-prescription options for mild to moderate acne problems. I am one of those unfortunates who have acne-prone skin so, although I generally try to base my articles on research-based information, forgive me if I take the liberty of adding a comment or two based on personal experience.

The 3-Step Approach
One trend we have seen in the acne marketplace is treatment “packages” that include a cleanser, toner and treatment cream or gel. A positive aspect of this idea is that it encourages acne sufferers to take a multiple strategy approach to treatment. Some of the more widely advertised products of this type (such as ProActiv and Acne Complex) are not available for sale in pharmacies and must be ordered by mail or Internet. However, it makes sense to simply select multiple products from the acne section with an understanding of the rationale for each, and create a customized “kit” for yourself.

Step 1: First, you want a mild cleanser, preferably soap-free, to remove excessive skin oils and some of the bacteria. The natural acidic nature of the skin is unfavourable to the growth of P. acnes and, as soaps are generally alkaline in nature, they can tend to reduce some of our natural resistance to these bacteria. Extra additives to the cleanser, such as keratolytics that mildly peel the skin, or benzoyl peroxide (discussed below), are thought to have little additional effect because of the short contact time with the skin.

While most sources recommend avoiding cleansers containing “scrubbing” particles that may increase inflammation, I have found personally that these can work well on non-inflamed acne-prone skin to prevent pores from becoming blocked by promoting exfoliation (or removal of the outer layer of dead keratin cells). Be aware, though, that many of these particles are made of plastics that can contaminate the environment – if you use one of these, choose one with natural, biodegradable particles.

Another option is to use an exfoliating sponge. Buff-Puff is one brand name, but they are available from many generic manufacturers. As exfoliation is also a common strategy for reducing the appearance of fine wrinkles, this may be an option that will interest older women with mild non-inflammatory acne. The use of an exfoliating sponge with a non-soap cleanser has been a personal favourite for 30 years; however, remember the caution against use in inflammatory acne.

Step 2: The second step, using a toner, often functions simply to remove more of the oil. Many toners have a high alcohol content, in the range of 30%, which may also kill some bacteria. Toners designed for use in acne often have 0.5 to 2% salicylic acid added, however, and this keratolytic agent, when left on the skin, can be useful to help keep pores open, preventing the trapping of oil and bacteria that is problematic in acne. Toners are designed to be applied using a cotton pad and are not rinsed from the skin afterward. Note that salicylic acid, an oil-soluble beta hydroxy acid, is often preferred in acne preparations for its ability to penetrate the oily sebum that is plugging the pores. It is sometimes referred to as a “comedolytic” action.

Some sources of information I have read in the past have suggested that alcohol alone may make an effective acne treatment, but many will complain that 70% alcohol causes burning and irritation while the lower content of alcohol in toners is generally tolerated quite easily. However, if you are a teen on a limited budget this might be a “step” to skip to reduce cost.

Conversely, an adult woman might appreciate this additional treatment from which she may benefit. As an example, one available multi-kit contains a toner with a low percentage of the alpha hydroxy acid (AHA) glycolic acid as an exfoliant to keep the pores open, while another has arnica added for its anti-inflammatory activity. A toner designed to reduce inflammation might be a welcome addition to the skincare regimen of a client with adult acne.

Step 3: The third step included in the multi-kits is a treatment gel or cream. There are numerous treatment products that we can recommend. My personal favourites, based both on theory and experience, are the benzoyl peroxide products. The maximum concentration that can be sold without prescription in Canada is 5% but in US the 10% is also out on the shelf. Most can easily tolerate 5%, but those with very sensitive skin may want to try a lower strength initially.

Be aware that benzoyl peroxide can increase sensitivity to the sun, so using it at bedtime and washing off in the morning makes sense, especially in the summer. As well, higher strengths, up to 10%, are available in Canada with a prescription. For me, a prescription for Panoxyl 10% alcohol gel was a turning point in acne control.

Benzoyl peroxide 10% would be a logical product to ask your pharmacists about, however, as they now have the ability to prescribe for acne in most jurisdictions. They would likely first ask questions about the severity of your problem, what you have already tried, and would verify that you had previously tolerated a 5% version of benzoyl peroxide.

As well as the tried and true OTC favourites, some alternative anti-acne ingredients have appeared in the literature and in various acne products. Here’s a little about how these ingredients are understood to work:

Arnica and calendula are herbal/homeopathic ingredients that have anti-inflammatory action. Calendula is also reported to have antibacterial activity.

Benzoyl peroxide is a favourite because of its dual action: it kills P. acnes bacteria plus has a keratolytic action. Don’t forget to ask about the 10% prescription if the 5% on the shelf doesn’t make a difference. Note: Be sure to use white towels and washcloths, as benzoyl peroxide will bleach coloured ones—I once ruined some of my Mom’s pretty green ones [sorry, Mom!].

Niacinamide (or nicotinamide) appears, when used as a 4 to 8% gel or cream, to have an anti-inflammatory effect and was shown to have comparable efficacy to topical clindamydin (a prescription antibiotic cream/lotion). It has also been credited with increasing synthesis of collagen and keratin, reducing skin hyperpigmentation (as can occur with acne scars), increasing skin moisture and reducing fine wrinkles. This is likely an ingredient that women with adult acne would be interested in. LaRoche-Posay’s Effaclar Duo Cream contains 8% niacinamide, or a pharmacist could compound this for you.

Resourcinol is included in acne products for its antiseptic action, presumably against P. acnes, and is often combined with the keratolytic, salicylic acid.

Sulfur, commonly found in acne products, is effective as a micro-exfoliant and a mild antiseptic and is probably the oldest known acne remedy, having been cited in ancient Greek, Roman and Chinese texts for this use. It is also helpful in promoting collagen synthesis, and is an active ingredient in lotions, creams, gels, washes and shampoos. It has also been used for seborrheic dermatitis, rosacea, eczema, psoriasis, and, in much higher concentrations, for scabies and lice.

Tea tree oil (5%) has been cited as being comparable in effect to benzoyl peroxide but without excessive drying, so might be a good option for adult acne. It kills P. acnes and has been shown to have anti-inflammatory action. It would also present a good option for those allergic or sensitive to benzoyl peroxide, or for those who are keen on a more natural option.

Zinc supplements, taken by mouth, have been shown to be helpful in inflammatory acne, although less so than oral tetracyclines (prescription antibiotic). Zinc tablets would also present an option for those who wish to avoid long-term antibiotics.

Camouflage techniques
Acne can be a distressing condition, particularly when it occurs at adolescence, a difficult time for many. It is natural for many teenagers, especially girls, to want to “cover up” their acne, and some advice from a pharmacist or trained cosmetician may help them to successfully do this without making their acne worse.

First, be sure to realize that bacteria, including the P. acnes that are involved in the acne process, can grow in your makeup products. Wash your hands before using, avoid dipping into the product with your fingers, and replace the products regularly. Use oil-free cosmetics to avoid adding additional oil to skin that is most likely already producing too much. Sheer or translucent makeup is recommended for commodonal acne, and fuller, opaque types for lesions or scars. You can also mix translucent powder with your makeup or dust it on afterward for better coverage. Multiple thin layers can be applied for additional coverage with drying time between.

Skin camouflage, such as Hyperflage, Dermablend, and CoverMark Face Magic, may be “just what the pharmacist ordered” for a teenager with acne heading to a special event. Proper application is important for best results and, generally, these products include instructions for use that should be read carefully to achieve a natural look. General recommendations are to cleanse the skin first, apply the camouflage makeup sparingly, blend the edges carefully, let dry, then apply foundation with a dry wedge sponge, if desired.

Previously published in Drugstore Canada

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Article reprint Health

Stress – The Elephant in the Room

Remember those predictions about working a four-day workweek in the new millenium? Well, it hasn’t worked out that way, has it! Computers and BlackBerrys, while making us more efficient, have also made us more accessible to work on evenings and weekends. Cutbacks often result in one person doing work that was previously assigned to several people. In my world, a lack of pharmacists often means long hours and less vacation time.

The result is increased stress—a contributing factor in many disease states that is rarely addressed in the course of a routine medical visit. Stress is listed as one of the modifiable causes of heart disease, and several of the effects of the stress hormone, cortisol, match up alarmingly with the symptoms of metabolic syndrome: increased blood pressure, weight gain around the waist, increased cholesterol and insulin resistance. Could it be that excess production of cortisol due to stress is that elusive cause of metabolic syndrome?

Researchers have observed that the appearance of cancer in many patients is preceded by a stressful event about two years earlier. Anyone who suffers from cold sores will tell you that they are most likely to show up when they are under stress. Emergency wards and student health centres note an increased demand for services during stressful times. Excessive production of cortisol is known to have a negative effect on the immune system, and the metabolic pathways by which this occurs have actually been identified. And stress hormones, being structurally similar to our reproductive hormones, can worsen the symptoms of menopause.

It’s enough to make you wonder why we don’t routinely test for and treat elevated cortisol blood levels…Perhaps it’s because physicians themselves have not been spared from the increased pace of life, and few are able to take time during an appointment to discuss the issues surrounding stress in a patient’s life.

Non-drug options for stress

Anti-depressants and tranquilizers are standard medications offered to highly stressed patients, but, as well as having high side effect profiles, they do not directly address the production of cortisol. However, in the herbal world, there are a number of medicines known as cortisol modifiers and adaptogens that lower cortisol production and lessen the impact of stress. As well, simple changes in lifestyle, attitudes and nutrition can result in a healthier response to the everyday stresses of life.

Those who really need help should be see a stress specialist. However, for those who are less severely stressed, I can pass along some self-help suggestions and recommend nonprescription supplements.

A good place to start is with a lifestyle assessment. Make a list of factors that are “good for me” versus “bad for me,” then devise a plan to relieve the worst factors, using a strategy to “change, adapt to, or leave” the most stressful situations. As stress hormones set up the body for “fight or flight,” exercise can be recommended to help reverse some of the effects of these hormones. Dietary recommendations to lower cortisol include eating balanced meals regularly throughout the day, ingesting a small amount of salt (sodium is required for adrenal function), avoiding simple sugars, increasing protein and essential fatty acids, and avoiding coffee, including decaffeinated (both contain theobromine, which tends to raise cortisol).

Substituting green tea for coffee, and vegetable juice for fruit juice is often advised. Vitamin C up to 3000 mg per day (either in divided doses or as a slow-release tablet) is recommended, as are B vitamins, particularly B5 or pantothenic acid, to support healthy adrenal function. Magnesium is a co-factor for many reactions that involve energy metabolism and nervous system function. Therefore the need for magnesium may be increased during periods of stress.

Magnesium is also necessary for muscle relaxation, and a deficiency increases the risk of muscle spasms that will often develop as a response to stress.

Herbal medications available for treating stress are divided into two major categories: the cortisol-modulating supplements (such as theanine, epimedium, and phytosterols) and the adaptogens or general anti-stress supplements (such as ginseng, schisandra, and astragalus). I will review some of the properties of some of these supplements to help distinguish which might be best for a particular client.

Cortisol modulating herbs

Theanine
Theanine is an amino acid. It acts as a non-sedating relaxant, helping to increase the brain’s production of alpha waves, one of the four basic brainwave patterns. Alpha wave production is associated with relaxed alertness, increased focus and concentration, promotion of creativity and improved overall mental performance. Theanine occurs naturally in tea leaves, and is converted by the plant gradually over time into catechins, the substance in tea known for its antioxidant benefits. Green tea, which is less aged than black tea, therefore contains more theanine than the other more aged varieties. As well, users should be aware that the decaffeination process removes theanine from tea along with the caffeine. Theanine has been shown in clinical studies to be effective in dosages from 50 to 200 mg per day. Three to four cups of green tea contain 100 to 200 mg of theanine. It is also available in supplement form.

Epimedium
Epimedium, also known as horny goat weed, has been shown to restore low levels of both testosterone and thyroid to normal levels, in addition to reducing cortisol levels when elevated. Hence, it has a reputation for improving libido in stressed individuals. Water-extracted epimedium, the traditional method of preparing this herb, is considered a safer form than the alcohol extract as rodent studies suggest that high doses of icariin, an alcohol-soluble constituent, may be associated with kidney and liver toxicity. A suggested dose for cortisol control is 250 to 1000 mg per day.

Phytosterols
Phytosterols include hundreds of plant-derived sterol compounds that are structurally similar to cholesterol but do not clog our arteries. By controlling production of inflammatory cytokines, phytosterols help modulate immune function, inflammation and pain levels. They have been shown to prevent immune system suppression and cortisol elevation usually seen in athletes after endurance events. Preliminary evidence from animal studies suggests that dietary phytosterols retard the growth and spread of breast cancer cells. Beta-sitosterol, one of the major phytosterols, has been shown in humans to normalize activity of T-helper lymphocytes and natural killer cells following stressful events that normally suppress immune system function. A typical dosage is 100 to 300 mg per day of mixed phytosterols, including 60 to 120 mg per day of beta-sitosterol. A handful of roasted peanuts or 2 tablespoons of peanut butter contain 10 to 30 mg of beta-sitosterol. Rice bran, corn, wheat germ and flaxseed are examples of rich food sources of phytosterols. See www.dietaryfiberfood.com for more information on the phytosterol content of foods.

Phosphatidylserine
Phosphatidylserine has been shown to modulate many aspects of cortisol overproduction, especially after intense exercise. There is scientific evidence that it can help improve mental function and depression, even in Alzheimer’s disease. Because cortisol causes catabolism of muscle tissue, athletes will frequently use this supplement to promote recovery from exercise and help slow muscle loss. Practitioners sometimes suggest phosphatidylserine supplements be taken late in the day to reduce nocturnal awakening due to surges in cortisol production during the night. Doses of 100 to 500 mg per day for one month are recommended for mental support, followed by a maintenance dose of 50 to 100 mg per day.

Tyrosine
Tyrosine is an amino acid that was studied by the U.S. military for its potential to help soldiers cope with the stress of battle. Their studies showed that 2000 mg of tyrosine helped memory and cognitive ability during stress. Studies, with volunteers exposed to stressful situations such as shift work, sleep deprivation and fatigue, found that 100 to 200 mg per day helped to prevent declines in mental performance and increased their ability to concentrate. Other amino acid groups, referred to as the branched chain amino acids (BCAAs) have been shown to counteract the rise in cortisol and drop in testosterone and immune function that is often seen in endurance athletes. Although tyrosine and BCAAs are available in supplement form, they can easily be obtained from protein foods. Hence, the recommendation above to increase protein content of the diet.

Adaptogenic herbs

Ginseng
Ginseng is the best known of the adaptogens. Many animal and human studies have shown that ginseng can increase energy and endurance, improve mental function and improve resistance to various stressors including infection, extreme exercise and sleep deprivation. Human studies have shown improved immune function and reduced incidence of colds and flu with Panax ginseng 100 mg per day. Siberian ginseng (Eleuthrococcus), while not a true ginseng, contains compounds that give similar effects. While generally considered safe, ginseng has been reported to increase blood pressure in some individuals, and caution should be used in those prone to hypoglycemia, due to its reported effect of reducing blood sugar levels.

Schisandra
Schisandra is a traditional Chinese medicine used to promote energy, protect the liver, alleviate exhaustion and correct immune system disturbances caused by stress. It is generally considered safe when used in recommended doses of 100-500 mg per day, although mild indigestion and skin rash has been reported. Because it may induce uterine muscle contractions, it should not be used by pregnant women.

Astragalus
Astragalus is an adaptogen herb commonly recommended for stimulation of the immune system and for energy-promoting properties. It has been used for centuries both in Traditional Chinese and Native American medicines, and animal experiments suggest that it enhances function of T-cells, lymphocytes and neutrophils. It is often combined with other adaptogenic herbs to keep the immune system functioning during periods of high stress. As a single ingredient it would be used in doses of 250 to 500 mg per day, or in combination as 100 to 200 mg per day.

Treating the cause

Many of these herbal medicines are available in combination “stress formula” products, and this is often the easiest way to supplement with them. People with high levels of stress on an ongoing basis would be well advised firstly to maintain a healthy diet and supplement with vitamin C, vitamin B complex and magnesium. If they are having difficulty coping with chronic stress or if stress is causing detrimental physical effects, they should next consider taking cortisol-modulating supplements as well. Adaptogenic herbs, available as combination products from several herbal manufacturers (for example: AdrenPlus from Enzymatic Therapy, Corti Lite from Vita Plus), would generally be used periodically during episodes of increased stress to counteract the detrimental effects of elevated cortisol.

Animal studies have shown that stress-induced rises in cortisol levels lead to increased visceral (in the abdominal cavity) fat deposits that are associated with disease states such as diabetes and heart disease. It would appear that we are focusing on treating all the diseases caused by excessive stress, while ignoring the “elephant” in the room. Perhaps the tools described above, along with improvements in diet and lifestyle, can help us to become healthier and improve our chances of avoiding chronic disease.

Originally published in Drugstore Canada

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Health

Acid Reflux Anyone?

Heartburn, sour taste, chest pain, hoarseness, sore throat, sensation of a lump in your throat, difficulty swallowing… sound familiar? You may have GERD (GastroEsophageal Reflux Disease), also called Acid Reflux…

WHAT IS GERD?

It’s common to have some stomach contents back up into the esophagus (the tube between the mouth and stomach) especially when we burp, and this is known as common heartburn. However, excessive backwash of stomach acid, sometimes also containing enzymes, causing symptoms twice weekly or more is what we refer to as GERD. It occurs regularly in an estimated 10 to 30% of us and, over time, can create damage in the esophagus, such as inflammation, bleeding, ulcers, narrowing or scar tissue, known as Barrett’s Esophagus, a pre-cancerous condition. It can even be the cause of chronic cough or asthma (when the acid is inhaled into the lungs), chronic sinusitis, dental erosions and laryngitis.

Risk factors include:

  • Conditions that increase the upward pressure on the “gastroesophageal sphincter” (the valve between the stomach and esophagus, also referred to as the “lower esophageal sphincter”) such as:

    • Being overweight (especially around the waist)

    • Being pregnant

    • Wearing tight clothes

    • Eating large meals

  • Anything that relaxes the sphincter, such as:

    • Smoking

    • Hiatal hernia – a tear in the diaphragm, the muscle surrounding the top of the stomach that supports the sphincter

  • Reduced “motility” – a decrease in the normal digestive movements that push food forward in the digestive system. Food sits in the stomach longer, increasing risk of reflux, and any stomach contents that do backwash into the esophagus will not be pushed back into the stomach as quickly.

  • A dry mouth – less saliva to help wash refluxed acid back into the stomach, plus saliva actually neutralizes some of the acidity.

Certain foods, such as coffee and tea, tomatoes and other acidic foods, alcohol, carbonated beverages, and chocolate, can aggravate reflux – note what you ate before episodes and avoid these foods as one strategy to help prevent the problem.

Keep in mind that the level of pain and the amount of damage are not necessarily correlated. Often we have reflux with no symptoms at all. Be aware that black, tarry stool is an indication of bleeding somewhere in the digestive system, and see your doctor as soon as possible if this occurs. Also, heartburn or chest pain that is not relieved by an adequate dose of antacid could be a sign of a heart attack – again don’t waste time getting medical help if this is the case.

Here is a link to a simple questionnaire to determine whether you may have GERD:

http://www.aafp.org/afp/2010/0515/p1278.html

Although questions 3 and 4 of the questionnaire seem counter-intuitive to me, with increased frequency of pain and nausea in the upper central abdomen awarding fewer points, this questionnaire has been found to be 65-70% accurate in predicting GERD, similar to a diagnosis by a gastroenterologist. Presumably, mild pain or nausea, such as is felt when hungry, must indicate an ability to sense the presence of acid and enzymes in the stomach and, therefore, also in the esophagus if present.

MEDICATIONS FOR REFLUX

Antacids can give rapid symptom relief, but do not help to heal any damage in the esophagus. Histamine H2-receptor antagonists, such as ranitidine (Zantac) and famotidine (Pepcid), like antacids, also give temporary relief, with slower onset but longer action than antacids. Long-term use is not recommended with these, as the body develops tolerance to their effect within 1 to 2 weeks, and they are not as effective as prescription medications for healing damage in the esophagus.

Proton pump inhibitors (PPIs), such as omeprazole (Losec or Prilosec), pantoprazole (Tecta or Pantoloc), esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Pariet or AcipHex) and others, block the production of acid in the stomach, greatly reducing the acidity of any stomach contents that regurgitate into the esophagus. They are the drug of choice for healing damage from acid reflux. However, not everyone responds well to these medications. Studies suggest that those who are average or over weight, have nighttime pain, get relief from antacids or H2-receptor antagonists or do not have nausea as a symptom are more likely to respond to a 2-week therapy of PPIs.

Concerns with these drugs include failure to respond, increased chance of infection with H. Pylori (the bacteria associated with increased risk of ulcers), increased risk of C. difficile infection, increased risk of pneumonia and decreased absorption of vitamin B12 and calcium from food (with corresponding increased risk of bone fractures if taken long term). Rebound acidity with a return of symptoms can also occur when discontinued after as little as 8 weeks of use and can last for 9 to 12 weeks, creating a dependency on these drugs. It is suggested that tapering off the medication slowly may help reduce rebound.

And, acid itself is one of the factors that encourage the sphincter to close more tightly. So, chronically lowering stomach acid essentially opens the door to more reflux. This may be why one tablet of a PPI is often not enough – stomach acid needs to be completely blocked to eliminate symptoms.

POSSIBLE ALTERNATIVES

So, what other options are available? Surgery to create a replacement valve at the top of the stomach (similar to what is done to replace heart valves) is one option. Another new idea being tried, according to Mayo Clinic, is the surgical addition of a magnetic ring around the lower esophageal sphincter, strong enough to support it but weak enough to let food pass through.

Surgery is suggested for those with osteoporosis, serious respiratory or esophageal complications of GERD, or poor compliance to medication – those with more severe disease or for whom PPIs may be less effective or possibly harmful.

Small studies suggest low carbohydrate diets along with avoidance of trigger foods may help. One study found acupuncture (used to increase motility, the normal digestive movements that push food forward) along with a single daily dose of PPI was superior to doubling the daily PPI dose, in those who did not respond to the once daily dose of PPI.

Animal and “in vitro” (outside of the body) studies suggest that natural compounds such as curcumin and quercetin that lower inflammation may be helpful in reducing esophagitis, but no studies have yet been done in humans.

A human study comparing 175 patients on omeprazole (Losec) with 176 patients on a combination of melatonin and a specific nutrient supplement showed better response to the melatonin/nutrients than to omeprazole 20mg daily, with 100% response after 40 days vs 66% of those taking omeprazole. The non-responders to omeprazole were switched afterward to the nutrient combination, and 100% of those responded as well.

The nutrients used were: melatonin 6mg, tryptophan 200mg, vitamin B12 50mcg, methionine 100mg, betaine 100mg, folic acid 10mg and vitamin B6 25mg. All of these are known to either increase the pressure of the lower esophageal sphincter or to increase motility (food-pushing movements) of the digestive system and could offer an alternative to PPI therapy. Two of these ingredients, tryptophan and folic acid (at that strength) require prescription in Canada. Another smaller but interesting study (60 patients) found that melatonin 3mg increased the lower esophageal sphincter pressure and relieved symptoms, alone and along with the PPI, omeprazole 20mg. These studies suggest treatments that might be especially helpful for those trying to discontinue PPI therapy.

Lastly, “raft-forming agents”, natural substances that create foam that can float to the top of the stomach, are effective in reducing symptoms of GERD and may be helpful in those weaning off long-term PPI therapy. Gaviscon is a brand name of this type of medication, and generic versions are also available. It is recommended to chew 2 to 4 tablets and follow with ¼ glass of water to enhance effectiveness.

IN SUMMARY…

Things you can do to help reduce reflux include:

  • Avoid trigger foods

  • If you smoke, quit

  • Don’t overeat

  • Avoid tight clothing

  • Lose weight

  • If you have nighttime symptoms, elevate the head of the bed 6 to 9 inches and avoid eating for 3 hours before bedtime

See your doctor if you have reflux symptoms that are severe or frequent. If you have another condition that can be caused by acid, ask if reflux may be the cause. Remember that black tarry stools or chest pain not relieved by antacid are warning signs that you should see a doctor about right away. If you have been on PPI therapy for a long time, talk to your doctor about tapering off and using alternatives, if necessary, to avoid the consequences of long-term use.

Hopefully this has given you a good sense of the issues and concerns around what may just seem like an annoying symptom, enabling you to have a better discussion with your doctor.

Send me your comments or ideas for a future blog through the comment button at the bottom of this page!

References:

Melatonin study: Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole.

Mayo Clinic: Mechanisms of GERD

Which is the best choice for gastroesophageal disorders: Melatonin or proton pump inhibitors?

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Dealing with Hashimoto’s Disease (Autoimmune Thyroiditis)

Hashimoto’s Disease is the cause of 90-95% of cases of hypothyroidism, or low thyroid. Also known as Hashimoto’s Thyroiditis, it is an autoimmune disease where specific antibodies produced in the body attack the thyroid gland, damaging it and blocking it from producing the thyroid hormones all cells in our bodies need to produce energy.

People who have Hashimoto’s generally have symptoms of low thyroid – fatigue, weight gain, feeling cold, joint and muscle pain, constipation, dry skin and hair, slow heart rate, and more – and they often have other autoimmune diseases as well, such as Type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease or Celiac disease too. In addition to the typical hypothyroid symptoms, patients with Hashimoto’s may have acid reflux, nutrient deficiencies, anemia, intestinal permeability, gut dysbiosis (“bad” gut bacteria), impaired digestion, and inflammation. These symptoms suggest something more is going on…

With Hashimoto’s, as the thyroid gland is destroyed and stored thyroid hormone is released, some people will also experience transient symptoms of high thyroid – sweating, rapid heart beat, nervousness, weight loss, heat intolerance creating confusion and misdiagnoses. Hashimoto’s is the main cause of low thyroid, accounting for 90-95% of cases of hypothyroidism. The thyroid hormone replacement medication, Synthroid (synthetic levothyroxine or T4), is generally the only treatment offered and this medication is one of the most prescribed drugs in North America.

Hashimoto’s disease is diagnosed by doing blood tests. These tests will show an elevated TSH (thyroid stimulating hormone, produced in the pituitary gland in the brain, that pushes the thyroid to produce more thyroid hormone), and the thyroid hormones, T4 and T3, will be normal initially as the thyroid responds to the increased TSH. As the autoimmune damage to the thyroid progresses, levels of these thyroid hormones will start to decrease. The key diagnostic test, though, is for TPOab (anti-Thyroid Peroxidase antibodies), the antibodies that attack Thyroid Peroxidase enzyme, causing damage to the thyroid gland and disrupting production of thyroid hormones.

So far, the only standard treatment offered is replacement of the missing thyroid hormones after the disease has progressed. There is debate whether starting replacement before thyroid hormones actually start to decrease may be beneficial. While replacing thyroid hormone can help make you feel better, it does not address the underlying problem with the immune system or the cause of the disease. Wouldn’t it make more sense to determine what is causing production of antibodies, treat the cause and prevent the damage, rather than simply replace thyroid hormone for the rest of your life?

The causes are elusive, but some of the additional symptoms of Hashimoto’s, over and above those of simple low thyroid, give us some clues. With Hashimoto’s, nutrient deficiencies, food sensitivities, adrenal dysfunction (impaired ability to handle stress), impaired ability to clear away toxins and intestinal permeability are also commonly seen.

Gastroenterologist and autoimmune researcher, Dr. Alessio Fasano, suggests there are three root causes of autoimmunity, and that all three need to be present for autoimmunity to develop:

  1. Genetic predisposition (genes that increase susceptibility)

  2. Exposure to an antigen (a substance that acts as a trigger)

  3. Intestinal permeability (or leaky gut)

You can’t change the genes you inherited, but you can remove triggers or decrease intestinal permeability by improving your gut health. The problem is, the triggers and causes of intestinal permeability are not the same for everyone, making it a challenge to find the root cause.

Triggers that start the autoimmune process could be infection, severe stress, or something that causes an allergic reaction. Reviewing your past to match events with worsening symptoms is one way to identify your trigger; testing for allergens, intestinal parasites or infection is another. Making lifestyle or diet changes, such as eliminating common allergy-causing foods like gluten or dairy, switching to a Paleo diet, or doing a parasite cleanse (consult a healthcare practitioner!) and noting whether your symptoms improve can also be helpful – just keep in mind that it can take 3 to 6 months for these changes to show results. A decrease in TPOab or reduction in the required dose of thyroid supplement would also suggest you are on the right track.

Addressing digestive issues can work to decrease intestinal permeability: ensuring healthy gut bacterial flora, avoiding foods you are allergic or sensitive to, and adding the supplement, L-glutamine (2.5g twice daily increasing gradually to as high as 10g twice daily) and sometimes adding digestive enzymes are often recommended to promote healing of the gut lining.

In my research for this article, I came across a website/blog that appears very complete and well-researched: http://www.thyroidpharmacist.com . It is written by Dr. Izabella Wentz, a pharmacist with Hashimoto’s disease, who treated it successfully with lifestyle and diet changes, and now writes about her experiences, both personal and with patients she has subsequently treated. She emphasizes that it is often difficult to find and remove triggers for the disease, and to correct digestive problems, as the causes can vary from person to person. She warns readers that it can take years, but encourages them to keep experimenting until they find the solutions that improve their health.

She has written a book about her experiences and strategies to find solutions: Hashimoto’s Thyroiditis: The Root Cause. Her blog also discusses many aspects of the development of Hashimoto’s and approaches to correct the underlying immune dysfunction with good explanations of the reasons for her recommendations.

For example, there is a strong association between development of Hashimoto’s and Celiac diseases, and the two will often occur together, although sometimes without overt symptoms. Absorption of the mineral, selenium, is impaired in Celiac disease and selenium is important in thyroid function. Selenium is also needed for the conversion of low-activity T4 thyroid into T3 thyroid, a form that is 4 times more active. It also protects thyroid cells from oxidative damage caused by hydrogen peroxide that is produced during the normal production of thyroid hormones. So, two of her recommendations to try initially are a gluten free diet to prevent the Celiac process and supplementation with selenium to protect the thyroid gland cells and improve thyroid activity.

Much more research remains to be done in this area and finding the interventions that work for you can take several years, but these changes are safe to try and have the potential to reverse the autoimmune process. I would encourage you to seek a proper diagnosis if you have the symptoms described above, to educate yourself further about options, to consult with a knowledgeable healthcare professional and to work for as long as it takes to improve your health.