Last article was about some of the important B vitamins. Let’s keep going with the next in line, niacin. Niacin and its related vitamins (nicotinic acid, nicotinamide and niacinamide) are responsible for assisting in over 200 chemical reactions in the body. It is also plays a part in the creation of fatty acids and cholesterol. The current focus for niacin is its ability to help lower cholesterol. Higher doses of niacin, 1-2grams a day, can lower LDL (bad) cholesterol, raise HDL (good) cholesterol and lower triglycerides. These higher doses should only be taken under recommendation from your physician. The most troublesome side effects of niacin at these doses are a very intense flushing and stomach upset. Taking it in divided doses after meals, and slowly increasing the dose over several weeks can reduce these problems. Some people take a ‘no-flush’ version of niacin called Inositol Hexanicotinate. While it does not cause a flushing reaction; there is some evidence to suggest that it might not work as well as regular niacin in reducing cholesterol. Niacinamide also does not cause flushing but is ineffective in lowering cholesterol.

Vitamin B6, Pyridoxine, has many therapeutic uses in the body. It is helpful in improving immune system function and helping to preventing kidney stones, PMS, depression, morning sickness, and carpal tunnel syndrome. Perhaps the most important use of vitamin B6 is in the reduction of homocysteine. Homocysteine is a semi-toxic byproduct produced when your body creates the amino acid methionine. It is not entirely clear how it is toxic to your body, but studies have shown that it is. It is known that high levels of homocysteine can increase a person’s risk of developing cardiovascular disease. There is also early evidence that suggests that it may be a risk factor for developing Alzheimer's disease. Your body requires a regular supply of folic acid, vitamin B6 and B12 to rid itself of homocysteine. The recommended dosage for vitamin B6 is 10–50 mg per day.

 

After six comes seven; which brings us to vitamin B7 or biotin. I fear that I am beginning to sound like a broken record; biotin (like niacin and pantothenic acid is used in many chemical reactions in the body). Deficiency is very rare because the bacteria in our intestines make this vitamin and it is found in so many foods. It has only one real known use; that is to help strengthen finger nails. Some small studies have shown that taking 2.5mg of biotin a day can help to increase finger and toenail strength. One interesting observation is that the demand for biotin is thought to be increased during pregnancy. Some people take biotin in hopes that it will help to prevent hair loss; sadly there is no proof that this actually happens.

We skip number eight, which brings us to folic acid, vitamin B9. Yup, you guessed it right; folic acid (like biotin, niacin and pantothenic acid) is used in many chemical reactions in the body. It is also used to help reduce homocysteine, treat certain kinds of anemia and prevent birth defects. I think folic acid is one of the most overlooked vitamins. It has so many important uses in the body and many medications can deplete your body of this vital nutrient. Concerns about deficiency caused the US FDA to recommend that flour and other grain products be fortified with folic acid. Folic acid primarily is found in green leafy vegetables. To get the recommended daily amount of folic acid one would have to eat one cup each of spinach and asparagus. Take a critical look at your diet and see if you eat these many greens every day. I’m a vegetarian and some days I’m doubtful. So take your multivitamin and don’t worry about it. You should still eat your greens though.

The last vitamin on our list is B12 (cyanocobalamin). This vitamin is mainly found in meat and fermented soya products. A deficiency of this vitamin can be a problem with people who do not eat meat, such as vegetarians and vegans and is also a concern for the elderly. Vitamin B12 deficiency is estimated to affect 10%-15% of individuals over the age of 60.  Your body requires sufficient stomach acid and something produced by your body called intrinsic factor to absorb B12 into the body. As one ages, your body generally produces less of these two items. Also people may be taking medications to treat reflux disease, heartburn, or other stomach disorders. These medications can reduce the amount of acid produced by your stomach. A medication for diabetes call metformin, can also reduce absorption of this vitamin.  Symptoms of vitamin B12 deficiency include fatigue, confusion, and difficulty concentrating. If you are experiencing any of these symptoms, contact your Physician. A simple blood test can determine the amount of B12 in your body.

I admit this is a lot of information to digest, no pun intended. What should one do? Simple, take a multivitamin that contains plenty of the B vitamins. Taking vitamins is not a substitute for eating well, but it will help to fill any nutritional gaps. Ask your Heart Pharmacist to recommend a vitamin supplement that is best for you. You could also visit our Fairfield location and have a chat with our natural health adviser Angeline. Don’t forget to eat your fruits and veggies.

 

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AuthorDanielle Cooper

There are two thoughts about taking a multivitamin. One group thinks if you eat a well balanced diet, you shouldn’t need to take supplements. This might be true if you ate 7-10 servings of fresh fruits and vegetables every single day. That is almost 5 cups of fruits and vegetables, that are minimally processed and have not been in storage for months. Take an honest look at what you ate yesterday, did you get enough fruits and vegetables? You spend approximately 2 dollars per day on car insurance. Shouldn’t you spend about 25 cents a day ensuring that your body gets enough vitamins and minerals? I think you know where I stand on this matter.

One of the more important parts of a multivitamin are the B vitamins. There are seven essential B vitamins that I will discuss over the next two articles. The B vitamins are essential for the general day to day functioning of our bodies. Their uses range from energy and fat metabolism to wound healing to memory. Your body doesn’t store a large reserve of these vitamins and is constantly using its reserve. That is why eating your fruits and veggies and taking a vitamin is important; they help to replace the lost B vitamins.

The B vitamins are sometimes numbered; this numbering system is loosely based on the order in which they were discovered. This is also why some of the B vitamin numbers are not found in multivitamins. Further research has shown that some were not true vitamins; such is the case with Vitamins B4, B8, B10, B11 and B13-17. This leaves the true B vitamins: B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folic acid) and B12 (cyanocobalamin).

I guess the logical place to start is at number 1. Vitamin B1, also called thiamine, was the first chemical to be recognized as a vitamin. Your body primarily uses thiamine for carbohydrate (sugar) metabolism and the proper functioning of nerves and muscles. A deficiency of this vitamin is almost unheard of these days, but it is called beriberi. Symptoms of beriberi include weakness in the arms and legs, ‘burning feet’, edema, swelling of the heart and difficulty breathing.  Alcoholism or excessive consumption of sugary foods may lead to thiamin deficiency. Some plants contain anti-thiamin factors that can render thiamine inactive in the body. The most notable are tea, coffee and betel nuts. There are also thiaminases, enzymes that can breakdown the thiamine found in food. These thiaminases are found in some raw freshwater fish and raw shellfish. Excessive consumption of these food items may also lead to thiamin deficiency. There are also some medications that can deplete the body of thiamine; they include, diuretics (water pills) and phenytoin. While the above evidence may suggest otherwise, thiamine deficiency is rare these days. The recommended daily dosage of thiamine is 1-2mg per day. At these doses side effects are rarely seen.

Next up is number 2, riboflavin. Vitamin B2 has too many functions in the body to mention them all. It is primarily responsible for carbohydrate and protein metabolism and energy production. Sadly, taking more riboflavin will not give you more energy, unless you are deficient in this vitamin. Deficiencies are rare. One of the most notable uses of riboflavin is the prevention of migraine headaches. Doses of 400mg per day have been shown to significantly reduce the frequency of migraine attacks. Best results were seen after three months of continuous use. There are no side effects with riboflavin, except that it can turn the colour of your urine bright yellow. There are also some medications that can reduce the effectiveness of riboflavin in the body, such as tri-cyclic antidepressants.

Now we skip number three and four for brevity to discuss vitamin B5, pantothenic acid. Vitamin B5 specific use is the production of the brain chemical acetylcholine. Acetylcholine is associated with memory; unfortunately taking more of this vitamin doesn’t help increase your memory. Deficiency of this vitamin is very rare. It is so rare that special diets and drugs must be used to study vitamin B5 deficiency.

Well I ran out of space rather quickly. Perhaps this will be a three part article or maybe I should just not write so much. Nutrition is very important as it is one of the easiest ways to keep our bodies healthy. The next few articles will feature the other B vitamins and why they are so important to our health.

 

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AuthorDanielle Cooper

Despite its caustic sounding name, acid reflux is not the newest rock band the young people are listening to. Acid reflux is sometimes referred to as heartburn; a condition where your stomach contents rises up into your esophagus. Like loud music, heartburn can be painful and irritating. Luckily, for most of us, we simply take an antacid and the pain goes away. For others, the pain can be quite intense and  return frequently. This month, we shall learn what acid reflux is and what it isn't.

 What normally happens when we eat or drink is the food travels down our esophagus and then into our stomach. There is a tight band of muscles at the top of our stomach called the lower esophageal sphincter (LES) which keeps all of your stomach contents where it should be. Sometimes the muscles of the LES can relax, allowing the acidic contents of the stomach to come up into the esophagus. This is referred to as acid reflux. The resulting irritation to the esophagus causes a burning sensation, which is usually felt just behind the breastbone and below the throat. The onset of this pain can be quite intense, but it usually goes away when a person takes antacids.

There is one thing that acid reflux is not: a medical condition called gastroesophageal reflux disease (GERD). GERD can be thought of as a persistent form of acid reflux. The symptoms of GERD are the same as for acid reflux, except that people who have GERD may also show symptoms of a dry cough or difficulty swallowing. GERD can also cause asthma-like symptoms. If you are having persistent acid reflux symptoms, more than twice a week, it might be wise to bring these symptoms to the attention of your Physician.

For many people, non-drug options work very well. The first thing is to avoid any foods or beverages that trigger your acid reflux. Some foods that can trigger heartburn are coffee, mint teas, spicy or fatty foods. If you must eat your trigger foods, take an antacid prior to or just after the meal. If you smoke, stop. Try not to lie down for at least three hours after eating a meal. If acid reflux is a problem at night, try raising the head of your bed. You only need to raise it by approximately 6-8 inches, about the thickness of a large phonebook. Some people find it helpful to eat smaller meals more frequently, about 5-6 meals throughout day.

One health tip that I feel is over looked is to eat slowly. People tend to eat their meals too fast, I feel this causes them to eat too much.  This is an old weight loss tip that can be helpful for heartburn sufferers. Consciously eat your meals. As a parent, I am often at fault for this. I fill my plate and stuff my face so fast that I am done before my little one is done. The next time you have a meal; take reasonably sized bites, put your fork/spoon down between bites and chew your mouthful at least 20 times. This delay in eating may seem odd at first, but it can be very helpful. It allows your stomach to fill slowly and gives you the signal that you are full, before you eat too much and feel 'stuffed', which can lead to heartburn.

The other way to help treat acid reflux is to reduce stomach acid content. The best treatment for mild and infrequent heartburn is calcium carbonate tablets (Tums, Rolaids, etc). These products neutralize stomach acid and help to reduce that burning feeling caused by the stomach acid. They tend to work quite well and have few side effects. You can also get sodium bicarbonate products that act similarly to calcium carbonate tablets. Usually these products are effervescent (ie. Bromoseltzer). These products contain a lot of sodium and might be contraindicated for people with high blood pressure. Ask your Physician or Heart Pharmacist if these antacids would be right for you.

Another option for acid reflux relief is an alginic acid containing product (Gavison, etc). This is a natural product, as it is derived from brown seaweed. The alginic acid forms a layer of foam that floats on top of the stomach contents. This helps to protect the esophagus from the acidic contents of the stomach, and thus stops any burning sensation.

 If these two options do not help your heartburn, you can try the group of medicines referred to as the H2 blockers. You might know them better as ranitidine (Zantac) or famotidine (Pepcid). These medications work by actually stopping your body from producing stomach acid. They are especially helpful if you know that a certain meal will cause heartburn. They are more effective than the antacids, but should be taken about ½ hour before meals. There are a few side effects with taking medications to help reduce stomach acid. The most common ones are digestive problems; bloating, gas, diarrhea, or constipation. This is because your body needs some stomach acid to completely digest your food. With prolonged use, these medications can lead to  vitamin and mineral deficiencies. The most common deficiencies  include: vitamin B12, calcium, magnesium and other minerals. If you are taking acid suppressing medications you might want to consider taking a multivitamin. Make certain any mineral supplements you are taking are in the citrate form (ie. calcium citrate). The citrate form of minerals are not as dependent on stomach acid for adequate absorption.

I hope this article has answered all of your burning questions about acid reflux. If you do suffer from acid reflux, first try the non-drug ideas I mentioned above. These options will usually help to relieve your symptoms. Another worrisome issue is that the pain from a heart attack is similar to that caused by acid reflux. If chest pain appears suddenly, does not occur after eating or happens after physical exertion, you should seek medical attention quickly. Eat well and eat slowly; you should only have to experience your meal once.

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AuthorDanielle Cooper

As winter approaches, we think about many things. Where are the mittens, do I have enough salt for melting the ice and when can we visit somewhere warm? One question that rarely arises is, “When can I get my yearly flu shot?” Getting a yearly influenza vaccine makes a bit of sense. It protects us and those around us from catching a nasty viral infection. But there are so many questions about this vaccine.  How does this world travelling virus turn into a yearly vaccine? How is this vaccine made?  The newest question is can the yearly influenza vaccine protect my heart?

 Who makes this yearly vaccine? The answer is also WHO; the World Health Organization actually. Each year, laboratories all over the world track which kinds of  influenza causing viruses are in their community. They get samples from people, who have come into the hospitals with flu-like symptoms. Once a year, usually in February, these labs send their findings to the WHO. A vaccine choice is made based upon which influenza virus strains are the most prevalent and troublesome. Three or four virus strains are chosen to be included in that years vaccine and then production starts.

 

When does the flu season start?  We usually recommend that people wait to get their vaccine until late October or early November. This is because the vaccine offers protection for about six months. Vaccination in October will provide coverage until the flu season is over in March. Generally, the peak of flu season occurs in January and February. People with weakened immune systems or young children might need to get a second vaccine around January. It would be best to check with your Physician or public health office for more details. Pharmacies often start their flu vaccine clinics around the end of October.

Why should you get a yearly flu shot? For most people, catching the yearly flu is only a minor inconvenience. They get sick for a few days, spend some time in bed and things are fine. However, for people with chronic medical conditions (asthma, diabetes, heart disease), the elderly and those with compromised immune systems, catching the flu can be very dangerous. This is why these individuals, their caregivers and friends should get a yearly flu vaccine. To explain why vaccination is a good idea, let's learn about the principle of herd immunity. Essentially, this means that if a significant amount of those around you are vaccinated or immune to a disease, you are most likely protected. Some businesses offer free vaccines it order to keep their employees healthy. Can you spare the time to spend three to four days in bed? In many cases, caregivers and those who work with people at risk can get a flu shot at no charge. Ask your Heart Pharmacist if you qualify for a free influenza vaccine.

There is some emerging evidence suggesting that getting a flu shot can help protect your cardiovascular system. A large study in the Journal of the American Medical Association, found that older people who got a flu shot had a 36% lower risk of having a major cardiovascular event in the next year. The numbers were even higher for those who recently had a heart attack or stroke. There are a few reasons for this protection. Firstly, infections cause a lot of inflammation. This might lead to impaired blood flow and an increased risk of heart attacks or strokes. Influenza can lead to respiratory symptoms and lower blood oxygen levels. This makes the heart work harder to deliver needed oxygen within the body. Finally virus can directly injure muscles, this is more problematic when heart muscles are involved.

Who knew that the simple yearly flu shot could help protect your heart. Your local Heart Pharmacy usually starts their flu vaccine clinics in early November. This might be a good time to see if you are up to date on your other vaccinations. Your Heart Pharmacist can also administer pneumonia, tetanus, shingles and many other vaccines.

 

 

 

 

Posted
AuthorDanielle Cooper

Is this really a thing? Does drug-induced nutrient depletion actually exist? Actually, it does occur. Certain prescription medications can deplete your body of important vitamins. This is not something that comes up during the usual dialog about medication side effects. Luckily, this is changing. Your Heart Pharmacist is always learning and passing this information along. This month we shall highlight some of the most important drug-induced vitamin depletions, so you and your Pharmacist can work together to help you stay healthy.

How can a prescription medication reduce vitamins in the body? There are a few ways this can happen. The first is that certain medications might decrease the absorption of nutrients from your diet. Some medications are intended to reduce stomach acid production. Vitamins and minerals that require stomach acid for absorption might be affected. Certain nutrients might be removed from the body as a side effect of a medication. Diuretics (water pills) make the kidneys work better at removing sodium from the body, but this action also removes certain vitamins. Other medications might change your body's metabolism and increase the utilization of certain vitamins. Some of these drug and nutrient interactions might not be monitored.

Many people who have high blood pressure are taking a diuretic (water pill) of some sort. These medications work very well and generally have few side effects. Your Doctor and Heart Pharmacist are aware of these medications ability to alter the amount of potassium in your body. However, some diuretics can also deplete your body of magnesium, calcium and thiamin (vitamin B1). A lack of magnesium might lead to muscle weakness, stiffness, constipation and osteoporosis. Calcium is very important for bone health. Thiamin is very important for heart function and energy production. Sometimes all it takes is to take extra vitamin B1 and ensure you are getting enough magnesium and calcium in your diet.

Another group of medications that can cause nutrient depletion are those which reduce the production of stomach acid. These medications include the proton pump inhibitors (PPI) and H2 receptor blockers. While these drugs work well to the reduce symptoms associated with excessive stomach acids, certain nutrients require stomach acid for absorption. The most notable are the minerals calcium, iron and zinc. Normally, stomach acid converts these minerals into a form that is easily absorbed from the stomach. It is generally known that long term use of these medications, especially PPIs, can cause an increased risk of osteoporosis. One vitamin that does require stomach acid for absorption is vitamin B12. Long term vitamin B12 deficiency can lead to neurological damage and anemia. If you are taking these medications you might want to ensure that you are also taking extra of these important vitamins and minerals. In the case of calcium and zinc, chose the citrate from as it does not require stomach acid for absorption.

One drug that can also affect the absorption of vitamin B12 is metformin. Metformin is a pill that help to treat diabetes. It appears this medication blocks your body's ability to absorb vitamin B12 from the intestines. If you are taking metformin, you might want to take extra doses of this important vitamin. Doses of 1000mcg a day are safe for most people. Ask your Physician to check your vitamin B12 levels from time to time. A lack of this vitamin can cause nerve problems.

Certain medications that help to treat epileptic seizures can also reduce the amount of important vitamins in your body. The drugs phenytoin, carbamazepine, phenobarbital and primidone could cause your liver to metabolize more vitamin D that usual. This reduction in vitamin D levels can reduce calcium absorption and lead to a greater risk of osteoporosis. It might be a wise idea to take extra vitamin D if you are using these medications. These anti-seizure medications can also reduce the amount of folic acid in the body. This could lead to an increased risk of anemia. You should check with your Doctor or Heart before taking extra folic acid. In some people, extra folic acid can lead to a decreased seizure control.

Another interesting drug-induced nutrient depletion occurs with medications used to lower cholesterol. A group of medications called 'statins' are widely used to help lower cholesterol and reduce the risk of heart disease. This is because the 'statins' can reduce the levels of a vitamin-like compound in your body called Coenzyme Q-10 (CoQ10). CoQ10 is found in almost every cell in the human body. It's primary purpose is to help your body produce cellular energy. Of interesting note, there is a rare genetic disorder of impaired cellular energy production called mitochondrial encephalomyopathy with symptoms that include muscle weakness, headaches and vomiting. Coincidentally, some of the major side effects of the 'statins' are muscle fatigue, headaches and vomiting. Supplementation with Co-Q10 can help resolve these conditions.

Supplementation with Co-Q10 might not be for everyone. This supplement can lower blood pressure, so people using anti-hypertension medications should use this supplement with caution. Co-Q10 can also interact with warfarin, a prescription blood-thinner. If your have any questions about Co-Q10 ask your Heart Pharmacist. They can be a wealth of information about all sorts of supplements.

This may be of interest to young women, oral birth control pills can reduce the amount of certain B vitamins in the body. Many of the B vitamins are affected, including folic acid, B6, B2 and B1. Many of these vitamins are very important for prenatal health, especially folic acid. It might be wise for women taking birth control pills to take a B complex vitamin supplement, or even better a prenatal vitamin. This will ensure that they will not be lacking any of these essential nutrients if they decide to start a family.

This is by no means a complete list of drug-induced nutrient depletions, there are many more. There are entire books written on the subject, so ask your Heart Pharmacist if your medications might be affecting your nutritional status. Even better, ask if you can book  a medication review. During this review, your Pharmacist makes one-on-one time to explain your medications and answers any questions you might have.

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AuthorDanielle Cooper