Category: Health

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Health

Herbals and Prescriptions…

How safe are they?

Many people think that herbal medications, being natural, are completely safe to take. But this isn’t always true. Herbal medications are really medicines, but just still in their natural plant form.

A new study, published in January 2018 in the British Journal of Clinical Pharmacology, analyzed severe reactions between herbs and drugs that were written up in journals as clinical studies or case reports. They looked at which drugs and diseases were most commonly involved, and how severe the reactions were.

They found interactions of varying types. Herbs could either increase the rate at which regular medications were removed from the body resulting in too little medication, or they could slow down the clearance, leaving too much of the medication left in the person’s system. This could result in patients responding poorly to their prescription medication, or developing toxic reactions to their regular treatments. Either scenario could result in hospitalization for the patient, especially with certain medications.

Most common problems…

The most common serious interactions occurred in people who had heart disease, cancer and kidney transplants. The most common prescription medications affected were: the blood thinner warfarin, “alkylating” chemotherapy drugs, and the anti-rejection drug cyclosporin. For each of these drugs, there is a very narrow “treatment window” – getting just a little too much or too little of the drug they need could cause serious problems with their condition.

Many herbal medicines “thin” the blood (i.e. make it less likely for a clot to form) so can add to the effect of warfarin as well as other anticoagulant or “blood thinner” drugs. Too much thinning of the blood can mean a little bump could cause extensive bleeding under the skin, seen as bruising. Worse, the bleeding can sometimes happen inside the body, usually in the digestive system, where it can’t easily be seen, leading to significant blood loss. One sign that shows a person is losing blood in the digestive system is a black, “tarry” stool – by the time blood reaches the end of the digestive system, it has turned from red to a sticky black, and looks much like tar.

Warfarin works by blocking the production of substances made from vitamin K that the body uses to make a blood clot. Many plants contain vitamin K, including herbal medicines. Increasing the amount of vitamin K in the diet, whether as a green leafy food or a herbal medicine, can help the body make more vitamin K clotting agents – more for the warfarin to block – requiring a higher dose of warfarin to prevent clots. In other words, more vitamin K can suddenly mean the blood will be able to clot more easily, increasing the risk of a blood clot, the underlying cause of heart attacks and most strokes.

Both chemotherapy drugs and cyclosporin need to be given in exact amounts to work properly. Too little and they don’t work as well…too much and they become toxic. So even a small change in how quickly they are cleared from the body can result in too much or too little in the system. Any person taking these medications should check a reputable source of information before taking a herbal medicine – ideally their doctor or pharmacist.

Ask your pharmacist…

Pharmacists receive education in both herbal and standard medications as part of their training. They have access to information on diseases, drugs, herbals, and interactions between these. If you take any prescription medications and are considering starting a herbal medicine, check with your pharmacist first. However, you should realize that a thorough information search requires time. If possible, leave the question with your pharmacist and drop back later to allow time for a proper search.

As well, herbals can interact with a medical condition you have. For example, blood sugar levels can be affected by some herbal medicines and this can be significant if you have diabetes. So, be sure to ask about possible interactions with both medications you take and any medical conditions you have.

Keep a list…

It is recommended to keep a list of all your medications for emergency use. But, as you can see, it is equally important to include all supplements you take on your list. Many pharmacies now provide a printed list that is automatically updated each time you fill a prescription. If you take a herbal medicine or nutritional supplement regularly, ask your pharmacist to add these to your profile so their information – and your list – will be complete. And, having complete information in their computer system, means the computer will bring possible interactions to the pharmacist’s attention every time they fill a prescription. Lastly, share your list with all health professionals who give you treatment… it just might prevent an avoidable interaction!

Reference:

British Journal of Clinical Pharmacology

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Health

Is your body dying for vitamin D?

Vitamin D is widely recommended to be taken along with calcium to prevent or treat osteoporosis. But we are learning that vitamin D has other important actions in the body, that involve cancer, pain and your immune system…

Vitamin D was discovered in the 1930’s when researchers were looking for the cause of Ricketts (also called “childhood osteomalacia”). They realized that this substance is needed to absorb calcium, as well as magnesium and phosphorus from the intestine. When children do not get enough vitamin D, they don’t absorb enough calcium, magnesium and phosphorus to make healthy bone. The result is softened, fragile bones that break more easily or can even bend.

Osteomalacia, which adults can develop too, commonly starts with low back pain that spreads to arms, ribs and, eventually, legs. The pain is symmetrical and accompanied by sensitivity of the bones themselves, muscle weakness and fatigue. People with osteomalacia tend to walk with a “waddling” gait, and have problems with stairs and getting up from a squatting position.

The sunshine vitamin

You may already know that vitamin D is called the “sunshine vitamin” because you make it from cholesterol when the sun shines on your skin. Actually, the substances created in the skin, vitamins D2 and D3, have to go through several changes in the liver and kidneys to be turned into the active form of vitamin D, calcitriol, that our bodies are able to use. An intermediate stage, called 25-hydroxy vitamin D (or 25-OH D) is what is measured in the blood to determine what your vitamin D level is.

Importantly, if you have chronic kidney disease you may not be able to activate the vitamins D2 and D3 produced by your skin and that are available as common supplements. This would require you to take the activated form of vitamin D, calcitriol, that is available only by prescription (and, unfortunately, is quite expensive compared to D3…).

A vitamin or a hormone?

Vitamin D is really misnamed. It’s not a true vitamin… in many ways, it’s more like a hormone! Vitamins are “vital amines”, chemicals that humans cannot make and therefore need to consume in our food. Hormones, on the contrary, are substances produced in the body that travel through the blood to act at a different body location. Of course, we can get some vitamin D from a few foods:

  • fatty fish, such as tuna, mackerel or salmon

  • egg yolks

  • beef liver

  • cheese

  • food to which it has been added (some dairy products, juices and cereals…check labels!)

  • supplements found in a drug store or grocery

but most is made in our bodies when we exposure our skin to sunshine.

Vitamin D deficiency is reported to have increased in the past decade. Could it be partly due to the current emphasis on the dangers of sun exposure and increased regular use of sun screens? That certainly could be a contributing factor. However, also at risk are house-bound elderly and chronically ill people who spend little time outdoors, as well as women who wear traditional veils and clothing that blocks sunshine from falling on bare skin.

But the underlying problem for those of us who live in the north, is that the sun is not strong enough between October and April to stimulate the conversion of cholesterol to vitamin D in the skin. Although vitamin D is fat soluble and can be stored in the body for use later, we are advised to take vitamin D supplements during the winter (unless you take regular winter vacations in the south, of course!).

Not supplements are created equal…

When shopping for a supplement, be sure to check the label of the vitamin D you buy: Studies have shown than vitamin D3 raises blood levels of the vitamin twice as much as the D2 form. Fortunately, most supplements available now are vitamin D3, but you want to be sure not to waste your money on the less effective version.

The official recommended daily intake of vitamin D is 400iu, but newer studies suggest that this needs to be revised. Most doctors and nutritionists (and pharmacists too!) now advise at least 1000iu daily, with more being recommended if a blood test has determined that you have a deficiency.

Vitamin D and cancer, immune system, pain, diabetes

The other thing you should know about vitamin D, is that it does more than just help you absorb minerals and prevent bone problems… It is also needed for a healthy immune system. Immune system cells have receptors where vitamin D attaches, indication it acts on these cells. Vitamin D deficiency is associated with an increased risk of autoimmune diseases (like MS in those who are genetically susceptible), and increased risk of some cancers (like colorectal, breast and bladder).

In mice studies of vitamin D and breast cancer, vitamin D blocked growth and spread of cancer cells. Although they state that more research is needed, some researchers believe taking supplements to avoid vitamin D deficiency might be a safe, cost-effective way of preventing cancer and improving outcomes in those who have been diagnosed with it.

Studies in newborns even suggest that the mother’s vitamin D status can have lasting effects on the child after birth. Babies born to mothers who received daily amounts of vitamin D supplements to significantly raise their blood level (in this case, 4400iu daily) had healthier immune systems at birth and lower rates of asthma, allergies and respiratory infections as toddlers and young children.

Perception of chronic pain may also be influenced by vitamin D. One study found that chronic pain patients taking narcotics for their pain needed only half as much if they had adequate vitamin D levels.

As well, Type 2 diabetes (T2D) may be affected by low vitamin D levels, studies suggest. People diagnosed with T2D tended to have lower vitamin D levels. Supplementing vitamin D was also found to help control blood sugar levels and reduce symptoms of diabetes in some studies, but more research is needed to confirm this.

So, this amazing hormone-vitamin has many actions in various body systems. Research is ongong, so stay tuned for new benefits in health news in the future. And think seriously about what your intake and production of vitamin D could be, and whether you should consider taking an inexpensive supplement.

How much vitamin D do you need?

How much vitamin D you need is controversial and how much you make in response to sun exposure is highly variable. It is estimated that, under ideal conditions, you can produce 10,000 to 20,000iu of vitamin D3 in just 30 minutes in the sun. Five to 30 minutes of sun exposure, 2 to 3 times a week ideally could enable you to produce all the vitamin D you need.

However, many factors can affect vitamin D production in skin:

  • Skin pigmentation absorbs the UVB rays needed to create vitamin D. Darker-skinned people would need longer exposure than fair-skinned.

  • Fat cells absorb vitamin D (because it’s a fat-soluble vitamin). A person who is significantly higher than their recommended weight could have as much as 50% less vitamin D in their blood after the same sun exposure as a person of normal weight.

  • Older people are less able to convert cholesterol into vitamin D3. A 70-year-old person generally makes about 75% less than a 20-year-old.

  • Those who live in the north (north of Washington DC) where the sun is not as strong in winter, do not get enough sun for part of the year. That’s all of us in Canada! It is estimated that a UV index greater than 3 is needed to provide enough UVB rays to make vitamin D. Cloud or smog can reduce UV rays reaching the earth by 50%.

  • Using SPF 8 or greater sunscreen blocks our skin’s ability to produce vitamin D. Delaying application for an appropriate length of time for your skin type and the time of year would be a sensible strategy to get adequate vitamin D while protecting skin.

Even the ideal blood level of vitamin D is controversial. Some authorities state that 12.5mg/ml of 25-OH D is enough to prevent bone problems. But others say this is not enough for a healthy immune system and other effects, stating that more than 20 or even 30ng/ml is ideal. A few, citing questionable accuracy of blood tests and safety of higher levels, advise maintaining as much as 40 to 60ng/ml of vitamin D to be sure of optimal effects.

After researching this article, I’ve decided to take 2000iu daily during the winter. In summer, being retired, I am able to spend lots of time outdoors in the sun, so I plan to stop for the summer when I am unlikely to need an extra supplement.

What about you? Do you need a little extra vitamin D to make sure your health is optimum? Post a comment in Facebook or send me a note by email. I’d love to hear whether this information made a difference for you…

References and further reading :

WebMD; Chronic Pain: Does vitamin D help?

Journal of Endocrinology; The interfaces between vitamin D, Sleep and pain

The Journal of Allergy and Clinical Immunology; Vitamin D supplementation during pregnancy: Effect on the neonatal immune system in a randomized controlled trial

Medical News Today; Vitamin D May Increase Survival for Breast Cancer Patients

Journal of Investigative Medicine; Vitamin D and the Immune System

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Health

On family dinners and living longer…

I remember Sunday dinners that seemed to go on for hours when I was growing up… My grandparents would join us, we’d have dinner, then coffee for the adults, and just hang around the table talking for ages. My dad loved to get a good discussion going, often about current news or sometimes about mischief he and his brother did as kids (that was our favourite topic!). This photo was taken by 11-year-old me, with my new camera in 1966!

So, it struck a chord when I read about a study done in Quebec that conducted surveys of families with young children to find out whether the environment during a typical family meal might influence learning, lifestyle and socializing.

They began by surveying families with 6-year-olds to determine the environment of a typical family meal. Four years later, when the children were age 10, they conducted more surveys: asking parents to assess their children’s lifestyle habits, teachers to gauge academic achievement, and the children themselves to assess their social adjustment from their point of view.

They found that improved family meal environment quality (eating together and engaging in conversation during the meal), predicted higher levels of physical fitness, decreased soft drink consumption, and less physical aggression and oppositional behaviour. Maybe all those family dinners had something to do with my dislike of Coke and joining the gymnastics and track and field teams… who knows?

But frequency of family meals is reported to be generally in decline. The Euromonitor International’s annual study of global consumers reports a world-wide trend towards less structured meal occasions, resulting from busy lifestyles, more unconventional working hours, increased single parent households and increased numbers of working women.

Breakfasts, once a regular sit-down meal, are reported to have become less consistent and are often now eaten on the run or skipped altogether. Snacking has increased because of smaller breakfasts and generally shorter lunch breaks (with many eating in their car while doing errands or even at their desks due to work pressures), leading to an increased demand for pre-packaged portable foods, unfortunately often highly preserved to increase shelf-life.

The annual study found that younger, urban consumer groups have particularly been trending towards more flexible and informal eating habits. Only approximately half of the populations around the world they surveyed still cook a meal entirely from raw ingredients at least once a week.

However, researchers also found a trend in recent years toward eating in rather than out. They reported that this was likely due to financial pressures from the recession that began in 2008. Use of prepared ingredients, such as sauces, is also reported to be on the rise, making home-cooked meals easier to prepare for those with less time. The researchers opinion was that now would be a good time for a public awareness program to encourage more frequent family dinners with conversation between adults and children, what they termed a quality eating environment.

Many of us just enjoyed a wonderful family dinner on Christmas day. The studies described above suggest that we should consider making this a regular event, especially if there are small children in the family.

But socialization is important for adults too. Studies of communities around the world with higher proportions of centenarians (people over 100 years old), referred to by researchers as “Blue Zones”, looked for shared characteristics. This is a list of what these communities had in common:

  • Family and social engagement

  • Semi-vegetarianism (majority of food from plant sources)

  • Legumes commonly consumed

  • Consistent moderate physical activity as part of life

  • Less smoking

This list seems to fit with the idea that eating food at home in a quality family environment could result in improved physical, academic and social outcomes for young children that persist for years. It also echoes Michael Pollan’s food rules (“Eat real food, mostly plants, and not too much”) that I discussed in an earlier blog.

Having a longer and healthier life does not have to be complicated. Plan simple meals that include plenty of fruits and vegetables, eat with family and friends whenever possible, and keep active throughout the day to stay fit — all good habits to start creating a healthier lifestyle. Some claim you could add 10 quality years to your life by following this simple strategy.

So, doesn’t that sound like a great New Year’s Resolution? Here’s to a healthy 2018 for all of you!

References:

Euromonitor

Quebec study

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Health

10 Ways to Reduce Jet Lag

I’m back from Spain! Glad to be back, but dealing with some nasty jet lag… so, I decided to write a blog about it. Should have written it before I flew home because I learned a few ways to reduce symptoms and shorten the duration of jet lag.

What is jet lag anyway?

The dictionary defines jet lag as “a feeling of extreme tiredness and other physical effects after travelling a long distance through different time zones by plane”. Some sources simply describe it as a “temporary sleep disorder” but, while it is temporary it can affect more than just your sleep. Some people are more sensitive to time change than others and will even notice mild effects when adjusting clocks for Daylight Savings Time in the spring and fall.

Medically, it is referred to as “desynchronosis” and is believed to result from difficulty adjusting the body’s circadian “day/night” rhythm or internal body clock to match the local clock. Shift workers can experience symptoms similar to jet lag when readjusting to normal hours after working the night shift. Strategies for reducing jet lag may be helpful to shift workers as well.

What are the symptoms?

Symptoms can include daytime drowsiness, tiredness, lethargy, slight disorientation or dizziness, insomnia, sometimes headaches, difficulty focussing, loss of appetite, and digestive upset such as diarrhea or constipation.

Of course, a long trip itself can be fatiguing, and dehydration and lower oxygen levels in planes can contribute to the symptoms experienced. More time zones travelled generally result in worse jet lag, with some individuals being more susceptible than others. Older adults and those with other health conditions often have worse symptoms and take longer to get back in sync, while children are often minimally affected.

What are circadian rhythms?

Many of our body’s systems, including those that regulate sleep, waking, eating and body temperature, run on cycles over the 24-hour day. This is called the circadian rhythm or “body clock” – the regular ups and downs of hormones and functions that occur at certain times each day.

A little technical stuff for those who are interested in detail…

The theory behind jet lag, is that there are two groups of neurons or nerve cells in the base of the brain that control sleep:

  • An area associated with deep sleep and physical recovery and repair

  • An area that controls the dream state, known as “rapid eye movement” or REM sleep

    • During REM sleep the brain sorts out thoughts and memories.

    • The REM area takes longer to adjust to a new sleep/wake cycle, and the two sections become out of sync, throwing off the sleep cycle and reducing quality of sleep.

So, the body clock is driven by an internal time-keeping system, but it’s affected by external factors like light and darkness. For example, we know that production of melatonin (a hormone that is associated with sleeping) is blocked by light falling on the back of the eye. This is why it is recommended to have your room completely darkened for a good night’s sleep and why it might be a good idea to use a sleep mask when trying to sleep on a plane or during the day.

Most references state that travelling east tends to cause more symptoms than travelling west, but I have always found the opposite to be true for me. However, I think it depends somewhat on your behaviour when you arrive at your destination, and on the timing of the flights you take.

My experience…

On my trip to Spain, I took an overnight flight. Although I only had a very few hours sleep on the plane, I was excited about arriving and needed to buy groceries so spent time outside in the sunshine. I pushed myself to stay up until close to a “normal” bedtime for where I was and, being exhausted by then, had a great night’s sleep. Of course, the next day I was out in the sunshine seeing the sights, and light exposure (especially sunshine) helps you to adjust to a new time zone more quickly.

In contrast, when I came home, it was a daytime flight with a late-night arrival which, for me, meant arriving finally at home at 7:30 the following morning, Spain time! And since it was still part of a normal but extended day for most on the final flight, it wasn’t a good sleeping environment… no rest for me! Since I’ve been home, it’s been mostly cloudy with sunset at 4:30pm so much less light exposure. I’ve also been busy indoors catching up after being away for 2 months and, of course, it’s chilly compared to the Costa del Sol, so that’s keeping me indoors more too!

Here’s what you could do next trip to experience less jet lag than I did:

  1. Prepare ahead if possible:

    1. Heading east – get up and go to bed early for a few days before the trip.

    2. Going west – delay bedtime and waking as above.

  2. Set your watch to local time at your destination as soon as you board the plane.

  3. Keep active during the flight – stretch, do seat exercises, walk along the aisle.

  4. Use an eye mask and ear plugs and try to sleep when it’s night time at your destination.

    1. Aim for 20-minute naps during daytime hours to reduce fatigue.

  5. Drink plenty of water on the flight, and avoid alcohol and caffeine to reduce dehydration (If you do decide to have a glass of wine, drink extra water along with it…).

  6. Wear sunglasses during your destination’s nighttime hours during the flight if you can’t sleep. This may help your brain to start to adjust by altering light exposure.

  7. Although not well tested, taking melatonin at the destination’s bedtime on the plane and for a few nights after you arrive may be helpful, researchers suggest.

  8. When you arrive, try to sleep at a normal time for your destination, realizing you will likely want to sleep later when going east and rise earlier when going west.

    1. If you’re on a short trip, and your schedule allows it, you may be able to adjust your day to stay closer to “home”, clock-wise. On a 4-day trip to Vancouver (4 hours “earlier” than my home on the east coast), I decided to just get up very early and skip some late-evening social activities. My conference friends were so impressed with my daily 6am walks in Stanley Park, but it was just a leisurely 10am “walk in the park” in NB time!

  9. Spend as much time as possible outdoors, preferably in sunlight, when you arrive or at least expose yourself to bright indoor light. It’s the cycle of light and darkness that prompts the brain to realign itself to your new time zone.

  10. If you know you are prone to severe jet lag, consider breaking up the trip or making part of your travel overland, rather than by air to adjust to the new time in stages. It’s the speed of travel that causes jet lag, not simply the time change itself.

Give these suggestions a try on your next east/west trip and let me know if they help you to have a “bon voyage”!!

References:

Mayo Clinic

Medical News Today

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Book review Health

No-one likes the Mr. Throat picture…

This week, I want to share an article about smoking…not about quitting, but about why people smoke and how much they love it… And how it takes over the smoker’s life… And how hard it is to quit.

I was never a smoker. I tried a few cigarettes in my younger days when out to a bar with smoking friends, but I never formed that love/dependency relationship with “smokes”, as the writer of the article fondly refers to them. As a pharmacist, I learned about medications to help people quit, how difficult the process is and things I could do or say to help people overcome the habit (or let’s call it what it is: an addiction). But I often would wonder why so many people, roughly 20% in Canada, still choose an activity that might kill them.

The article, written by a long-term smoker and posted in a blog called “LongReads”, fascinated me as a non-smoker and health professional, and I found it helped me understand why people smoke in spite of all the evidence that it is slowly damaging their health. I’d recommend the article, not only for smokers, but for those who would like to help people quit. Understanding “why” can sometimes be the key…

Spoiler alert: the photos on the cigarette package, especially the photo of a man with throat cancer, are the most negative part of the writer’s smoking experience. The title of the article is: “Mr. Throat and Me”.

You’ll find the article here: LongReads “Mr. Throat and Me”.

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Health

For Coffee Addicts Only…

How many times have you read that you should quit drinking coffee? Well, a new study suggests that coffee may actually be good for you…

I just read a report from the European Society of Cardiology about a study on coffee consumption done in Spain looking at the association between coffee consumption and the risk of dying in middle-aged Mediterraneans. Researchers surveyed the amount of coffee 20,000 people drank along with other lifestyle, social and demographic characteristics and previous health conditions. Then they followed them for an average of 10 years.

Here’s what they found…

  • People who drank at least four cups of coffee per day had a 64% lower risk of dying from any cause (“all-cause mortality”) than those who never or almost never drank coffee over the 10 years of follow-up.

  • There was a 22% lower risk of all-cause mortality for each two additional cups of coffee per day.

  • In those who were at least 45 years old, drinking two additional cups of coffee per day was associated with a 30% lower risk of dying during follow-up.

Very interesting, isn’t it! The researchers didn’t offer any explanation for why coffee might have this effect but here’s my theory (for what it’s worth) …

I rather doubt that it’s anything particular in the coffee (or tea for that matter, for tea enthusiasts), but more likely it’s what we do most of the time when we have a coffee: we take a break, relax, maybe chat with a friend or read a magazine. That has to help reduce our stress, and stress (I hear) is suspected as being an underlying cause of many health conditions! Coffee is often a social drink – recent studies also suggest that socialization is also good for our health and longevity, so that may be part of the effect too,.

I base my humble opinion on theories why the French have lower rates of heart disease that North Americans in spite of the rich higher-fat diet they consume… Some experts propose that it’s not so much what you eat, but how much you eat and how you eat it. Consuming food in a relaxed atmosphere with good company just seems to be healthier for us.

So, meet a friend or take a break from work with a co-worker, relax, and enjoy a tasty cup of coffee. Or, if you don’t have someone available to share a cup with, simply put your feet up, contemplate all the great things in your life and maybe listen to some of your favourite music as you enjoy the wonderful taste of a fresh cup of brew! You may just be healthier for it…

Now, I guess I’ll go get myself another cup…. umm, that will be three for today so perhaps one more later… maybe an iced coffee version…

Enjoy!

Reference: Science Daily

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Health Public Health

Fat vs sugar – time to rethink!

Sugar is the problem — not fat. Years of advice to choose low-fat and fat-free foods does not appear to have been based on sound research…

New Canadian research found no significant association between eating more than the recommended amount of fat (30% of total calories) and developing heart disease or having a stroke. In fact, they found that those who got 35% of their energy from fat had a lower overall risk of dying than those who ate less than the recommended 30%!

In addition, they found that the low-fat diets recommended to us for many years have resulted in many people overeating carbohydrates, resulting in a higher risk of dying when their carbohydrate intake exceeded 60% of their total calories. Replacement of dietary fat with sugary carbohydrate is also being suggested as a cause of the current increased rates of obesity.

Scientists lead by nutritional epidemiology expert, Mahshid Dehghan at McMaster University in Hamiltion, Ontario, studied diets of 135,000 people in 18 countries for an average of 7 years. She observed “When you recommend lowering fat, by default, people increase their carbohydrate consumption, and increasing consumption of carbohydrates results in higher risk of mortality.”

Study in Japan

This Canadian finding agrees with another article I recently read describing how the stroke rate in Japan dramatically fell almost 6-fold from 1,334 to 226 per 100,000 between 1958 and 1999, after the government encouraged the population to increase their intake of fat. Cholesterol levels rose from an average of 3.9mm/l to 4.9mmol/l due to dietary fat rising from 5% to 20% of total calories. Heart disease rates, interestingly, also decreased although not as dramatically. This is a stark contrast to our current recommendations to lower cholesterol in the blood as much as possible to reduce the risk of heart disease…but more about that in a future blog!

Population studies

Studies of diets from diverse healthy populations suggest that there is not one single “best” diet. The high-fat diets of the Innuit of the north, the Maasai tribes of Africa and the French in France seem as healthy for their populations as the low-fat Mediterranean diet of Italy.

This has lead some to speculate that it is not so much what we eat (as long as the diet is a traditional balanced one) but how much we eat and ­how we eat. Avoiding overeating and enjoying food in a relaxed environment with family or friends (rather than eating on the run or in your car!) seem to be positive factors for overall health too!

Canada Food Guide 2018

Even our Canada Food Guide is being revised…and I hear the meat and dairy industries are not happy with the plans. Although the new finalized guide will only be released in two stages over 2018 -19, Health Canada says less emphasis will be placed on individual nutrients and more will be placed on:

  • avoiding processed foods (that commonly have added sugar, trans fats, salt and other ingredients),

  • reducing consumption of sugary drinks, and

  • limiting portion sizes.

This seems to agree with other experts like University of Toronto’s nutritional scientist, Richard Bazinet who advises “Moderation is the solution. Don’t eat too much of any single thing” and Michael Pollan’s Food Rules: “Eat food (real food, not processed). Mostly plants. And not too much.” Check out my previous blog on his Food Rules here.

It seems difficult to understand why low-fat diets have been recommended for so long – some suggest that influence from the sugar and grain industries may have been a factor. Currently, news outlets have reported meat and dairy industry lobbyists are “up in arms” against the suggestion that the new Canada Food Guide may decrease emphasis on consumption of these food groups.

However, the purpose of any food guide or advice is to improve the health of a population, not to support food industries. Health Canada has stated that it will not be consulting with food producers, although they are permitted to engage in open public consultations.

Trans fats

When it comes to fats, however, there seems no question that trans fats should be avoided. Trans fats, also known as hydrogenated oils, are stable artificially created fats that have been used to extend the shelf-life of processed foods…good for food, but not good for our health! Trans fat content appears on food labels so you can avoid buying foods containing these fats, and some governments are moving to ban these completely from food!

Trans fats often occur in foods that also contain saturated fats and may be responsible for the bad reputation assigned to saturated fat. Wikipedia has an interesting summary of studies comparing the effect of saturated fat (SFA) with unsaturated fat (PUFA). At the very least, one could say there is conflicting evidence when it comes to the dangers of saturated fat, with newer studies being less likely to find that fat in the diet has any effect on heart disease. It will be interesting to see what the new Food Guide recommends as an ideal amount of fat in the diet, considering the results of new studies!

Have you been cutting fat out of your diet? Leave a comment below!

References:

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Health

C. Difficile…so difficult!

Clostridium difficile is a bacterium that is resistant to many antibiotics – hence the name “difficile” since it’s difficult to treat! It is the most common cause of infectious diarrhea in hospitals and nursing homes in Canada and other industrialized countries.

Most cases occur in patients taking certain antibiotics that kill a wide range of bacteria (referred to as broad-spectrum antibiotics) in high doses or for a long period of time. The normal bacterial flora in the digestive system that keep c. difficile in check is destroyed by the antibiotic, allowing the resistant c. difficile to take over. These infectious bacteria produce toxins that damage the bowel, and cause diarrhea and inflammation in the lining of the bowel.

Some people can have c. difficile in their bowel and not show symptoms, likely because other bacteria are keeping its growth in check. There are different strains of c. difficile and some cause more serious illness.

Stomach acid helps to kill unfriendly bacteria like c. difficile if we happen to swallow some. Acid-suppressing drugs, especially proton pump inhibitors (like Losec®, Tecta®, and Nexium®) that strongly block acid production, can increase the risk of a symptomatic infection of c. difficile.

How is it passed from person to person?

C. difficile bacteria and their spores are found in feces. People can get infected if they touch surfaces contaminated with feces and then touch their mouth… (How gross!) This helps you understand how important it is to wash your hands regularly!

If you are healthy, generally there is actually little risk of developing an infection. But in the elderly and those with other illnesses whose immune system may be less healthy, there is a greater chance of infection.

It’s important to keep the normal gut bacteria healthy. When there are fewer normal healthy bacteria in the gut, c. difficile have a better chance to grow and cause infection. Include fermented foods that contain live bacteria in your diet, and take probiotics after a course of antibiotics. This will help to replace the good bacteria that are often destroyed along with the bad ones that caused the infection and maintain a healthy gut flora.

What are the symptoms?

C. difficile infection causes watery diarrhea, fever, decreased appetite, nausea, and abdominal pain or tenderness. The diarrhea usually does not respond to regular diarrhea medications and will last more than the 2 or 3 days of diarrhea from other causes. A stool sample is often tested to confirm that the cause of the diarrhea is c. difficile.

How can you prevent c. difficile?

Wash your hands often with soap and water. Healthcare workers should always wash their hands after touching every patient to prevent passing bacteria and other infectious organisms from one patient to another (or to themselves!). At home, always wash your hands after caring for an ill person, using or helping with toileting and before preparing or eating food.

Alcohol-based hand washes help but are not as effective as soap and water as they do not kill c. difficile spores. Wearing disposable gloves when caring for someone with c. difficile is recommended and hands should be washed with soap and water when the gloves are removed.

How is c. difficile infection treated?

The antibiotic that caused the infection should be stopped right away, and a new antibiotic that kills c. difficile will often be started. Very mild cases may clear on their own.

C. difficile is resistant to many antibiotics, hence the name “difficile – difficult to treat! Metronidizole (Flagyl®) is an antibiotic that may be effective for mild to moderate infections. Vancomycin (Vancocin®) is used for more severe infections and it is considerably more expensive than metronidazole. A new antibiotic, fidaxomicin (Dificid®) showed better results against c. difficile in studies, but it is very expensive.

Taking probiotics (good bacteria in capsule form) in large doses has been reported to help when all else has failed, or as an add-on to antibiotic treatment. It also helps to prevent reinfection, which occurs in 20% of cases.

In extreme cases, the diseased part of the bowel may be surgically removed. Fecal microbiota transplantation (also known as stool transplant) is another new therapy that may be tried in recurrent infection. Donors are screened for infections, parasites, viruses and other bacteria. Stool from the donor is then placed into the infected person’s bowel using a colonoscope or nasogastric tube.

References

https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

http://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/treatment/txc-20202426

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Health

Artificial sweeteners may cause weight gain!

You could be gaining weight because you are using sugar substitutes… A new study suggests use of artificial sweeteners is linked to weight gain (not loss!) and increased risk of developing diabetes…

Considering the widespread use of sugar substitutes, it is surprising that there are comparatively few long-term studies that have been done. Most are “observational” studies rather than the higher level intentional type of study (randomized groups, placebo-controlled studies referred to as “randomized controlled trials” or RCT’s), so cannot prove a cause-and-effect relationship.

However, in the long term RCT’s averaging 6 months that the researchers found, regular users of artificial sweeteners had an increased risk of type 2 (adult onset) diabetes, higher blood pressure, and modest increases in weight and waist circumference.

The Canadian researchers could find no solid evidence for long-term benefit from artificial sweeteners, and there was some evidence of harm from long-term consumption.

But why would artificial sweeteners be linked to weight gain, not loss? Researches couldn’t explain, but had some thoughts:

  • Artificial sweeteners may disrupt healthy gut bacteria.

  • They may confuse metabolism. For example, the sweet taste may cause the body to be expecting sugar, stimulating a release of unneeded insulin. Increased blood insulin is the first stage in the development of type 2 diabetes. It also would cause a decrease in blood sugar that would stimulate appetite.

  • The appetite-stimulating mechanism may overcompensate for missing calories from sugar when eating other foods.

  • Artificially sweetened foods may simply be a common part of an overall unhealthy diet.

An Australian study suggests that artificial sweeteners may increase appetite for calories by up to 30%. When sweetness versus energy is out of balance for a period of time, researchers say, the brain re-calibrates and increases total calories consumed. They called this the “starvation response”.

They also learned that the brain produces 2 waves of “pleasure” producing dopamine – one with the taste of sweetness and a second wave when the blood sugar rises. If there is no blood sugar rise (because an artificial sweetener was used) the brain sends hunger signals.

A US study, published in the American Journal of Public Health in 2014, found that overweight and obese people ate more when they drank artificially sweetened drinks.

The Australian study also noted increased hyperactivity, insomnia and glucose intolerance as well as an increase in appetite and calories consumed in animals they studied.

Altogether, these studies suggest that we would be much better off to avoid sugar substitutes completely and use a small amount of sugar instead. Better yet, switching to water (flavoured with a herbal tea if you like) might be a good way to promote a healthier waistline!

References:

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Health

Waking up with a stiff one in the morning???

Of course, I’m talking about a stiff neck, back or, heaven forbid, a Charley-horse! What causes those awful muscle spasms and can you prevent them?

Skeletal muscles are the muscles attached to our bones that are generally under our conscious control. We use these muscles to move parts of our bodies and to make facial expressions, such as smiling.

A muscle spasm, or muscle cramp, is an involuntary contraction of a skeletal muscle. Spasms of the skeletal muscles are often caused by overuse and muscle fatigue, by electrolyte imbalances or can be associated with a previous injury. Usually they occur abruptly and don’t last long. If they are extremely painful and don’t resolve on their own, you should seek a medical assessment to look for possible underlying causes.

Causes

Although the precise cause of a muscle spasm is not always known, electrolyte imbalances are believed to contribute. Spasms occur more frequently when exercising or doing physical work in hot weather, when dehydration and electrolyte loss occurs due to sweating. Muscles require enough water, glucose, sodium, potassium, calcium and magnesium to allow the muscle proteins to develop an organized contraction. A lack of any of these elements can cause the muscle to become irritable and develop spasm. The muscle soreness and increased risk of spasm that occur after new or increased exercise is thought to be due to a lack of electrolytes. With continued exercise, blood flow capability increases, bringing increased electrolytes, nutrients and oxygen to the muscle, and soreness no longer occurs.

Other causes of muscle spasms include:

  • decreased blood supply to the muscle, due to narrowing or disease of the arteries,

  • arthritis or other injury of a joint (where muscles spasm to try to support the damaged joint),

  • obesity, where increased weight can cause stress and strain of the core muscles of the trunk, leading to spasms of the neck and upper or lower back

  • diseases like diabetes, anemia, kidney disease and thyroid or other hormone issues (can potentially disrupt electrolyte balance)

  • diseases of the nervous system, such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or spinal cord injury

Treatment

If a skeletal muscle goes into spasm, the initial treatment is to gently stretch the muscle lengthwise to break the spasm and resolve the acute situation. A physiotherapist or massage therapist can teach you exercises to stretch less obvious muscles, relieving spasm and pain. Heat and anti-inflammatory medications, such as ibuprofen (Motrin, Advil) or diclofenac (Voltaren Gel) can also be helpful for short-term pain relief. Your doctor may prescribe stronger pain medication and/or a muscle relaxant in more severe situations when the spasm does not readily subside. In Canada, the muscle relaxant, methocarbamol (Robaxicet and generic versions) can be bought without a prescription.

Quinine, an anti-malaria drug, is a very effective medication for nocturnal leg spasms and was used for many years for prevention of the nighttime “Charley-horse”. However, quinine was found to have serious side effects (vision problems and abnormal bleeding) and is only used now in severe cases where other medications do not help.

Trigger Points

A “trigger point” is a small area of contraction in a muscle, that shortens and weakens it, creating pain where the muscle attaches. The trigger point is often not located where the muscle pain is perceived. In medical terms, this is described as “referred pain”, much like the way a heart attack (damage in the heart muscle) is often felt in the left shoulder or arm. A trigger point is defined as a “highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue” — so it’s an area that is painful when pressed and can be felt as a lump under the skin in the muscle. Drs. Travell and Simons wrote extensively about trigger points starting in the 1940s, mapping out common muscle trigger points and the areas where pain from each is commonly felt. Their work is the basis for today’s therapeutic massage and for some physiotherapy.

Massage, either by a professional or self-massage, can be helpful for muscle spasm. Massage can increase circulation to the muscle, bringing nutrients and removing breakdown products. Pressure on the trigger point of a muscle can also help to relax a spasm and trigger points are sometimes used as the site for acupuncture or accupressure. If you are interested in learning self-massage for relief of pain from chronic muscle spasms, I could suggest The Trigger Point Therapy Workbook, by Clair Davies, an excellent self-treatment guide that I have used with my clients (and myself!) for many years.

Conclusion…

So, if you are exercising or doing physical work, especially in a hot environment, be sure to drink extra water to replace fluids you are losing. If you are prone to muscle spasms, consider also replacing minerals, for example, by consuming a supplement or electrolyte containing foods or drink during activities on warm days. Ensure your diet contains adequate minerals: calcium, magnesium, sodium and potassium. If the spasm lasts more than a few days and is not due to an obvious overuse of the muscle or dehydration, see your doctor or physical/massage therapist and, together, look for an underlying cause.