Pharmacists talk and Pharmacists listen. This is certainly not a surprise to our patients. Our Heart Pharmacists discuss new information that we have learned during our weekly morning meetings. Some of things we discuss might actually be of interest to our patients. From time to time I will include these pearls of wisdom in my articles. They might not be pearls but certainly shiny rocks.

The first bit of useful Pharmacy information came from Dr. Google. One of our patients asked, “I heard that my diabetes medication can cause nerve damage”. Dr. Google is great for vast amounts of unfiltered knowledge. Where a Pharmacist can help is to determine when this information applies to you.

Part of this patient’s statement is true. Do you remember an article about drug induced nutrient depletion that I wrote last fall? No worries, if you forgot, I will refresh your memory. In this patient's case, they read about a potential side effect of metformin. Metformin is a common medication to treat diabetes by lowering blood sugar. The most prevalent side effects of metformin are stomach related: constipation, gas and heartburn. However, one of the long term side effects of metformin is that it can deplete your body of vitamin B12. This side effect of metformin was first noticed in 1969. It was found that patients who were taking metformin had difficulty absorbing vitamin B12 from their diet.

As you can imagine, vitamin B12 is rather important to your body. Vitamin B12 is used to make red blood cells, maintain healthy nerve cells and protect against osteoporosis. Not surprising, symptoms of low levels of vitamin B12 include fatigue, confusion, tongue sores and tingling in the hands and feet. Some people have difficulties getting enough of this important vitamin from their diet. The most notable are vegetarians/vegan, people over the age of 60 and those taking medications to reduce stomach acid. So bringing us back to the patient's question: yes metformin can deplete the body of vitamin B12. If vitamin B12 deficiency is not treated then, yes, long term nerve damage is a possibility. Oddly some of the long term complications of diabetes include nerve damage and dementia. Didn’t those same issues occur with Vitamin B12 deficiency?

So what did we decide to recommend for this patient? The first was to have a blood test to determine if there was indeed any vitamin B12 deficiency. The next step was to recommend a high dose sublingual (under the tongue) form of this vitamin. Vitamin B12 can be absorbed from under the tongue, this will overcome any stomach absorption issues. Vitamin B12 doses for sublingual tablets are quite high, in the 1200mcg to 2000mcg range. This seems very high when the recommended daily intake for this vitamin is around 3mcg. Doses this high are safe as you only absorb about 1-2% of this amount. As a final option there are vitamin B12 injections, this option certain overcomes stomach absorption issues. Your local Heart Pharmacist can be a great source of health information, all you need to do is ask.

Any discussion about Vitamin B12 is not complete without mentioning the two forms that can be found on pharmacy shelves: cyanocobalamin and methylcobalamin. Most supplements and injections contain cyanocobalamin which your body readily converts to the active methylcobalamin form. Sometimes people express concerns about the fact that cyanocobalamin does contain cyanide, albeit in microgram doses, which is quite safe. What might come as a shock to people is that cyanide is naturally occuring, our most familiar sources are spinach and apple seeds. If fact there is far more cyanide in apple seeds than in vitamin supplements.





AuthorDanielle Cooper

Can eating yogurt or taking a probiotic help prevent the common cold? At first, it does not make sense. How could a pill or a fermented milk product help increase your immunity? Well it is true and there is science that confirms my wild claims. Let us look deep into the bacteria that inhabit our intestines.

What do we mean when we say probiotic? You might also know them by their generic name, acidophilus.  In this context we are referring to the good bacteria and yeast that live in your digestive tract. It is thought that there are over a trillion bacteria and yeast cells in your digestive tract. In fact, they outnumber your own cells by tenfold. If you think about it, there are more of them than there are of you. These numerous microbial friends perform many functions deep in your bowels. They keep out foreign bacteria, help you stay regular and synthesize certain vitamins. We get these helpful bacteria from our diet. Most, non-alcoholic, fermented foods contain helpful bacteria. Foods such as yogurt, kimchi, sauerkraut, tempeh, kombucha and kefir are sources of probiotic. Or you can get them in a supplement pill form. I take my probiotics everyday.

The next question is how does something in your gut improve your immune system?  Well let me tell you. These gut bacteria love to eat non digestible carbohydrates (sugars) and dietary fiber and produce short chain fatty acids (SCFA). It is these SCFA that have unique health benefits. They have a positive effect on maintaining gut integrity, appetite regulation and stimulating the immune system.  This is all good in theory, but does it actually work in the real world? It does. One small study of nursing home residents received a 3 billion strength probiotic supplement daily for two weeks. Those that got the probiotic, responded better to the influenza vaccine and experienced fewer respiratory infections during the following five month flu season.

Many of the questions I am asked about probiotic supplements involve what kind to take. Should one get a single strain or multi-strain version? Should it be kept in the fridge and how many billions do I take? My answer is simple. If you want the absolute best, get the probiotics that are kept in the fridge. I personally don’t take these kinds as they are more costly. If you are treating something specific or acute, like antibiotic induced diarrhea, look for a single strain product. Our Heart Pharmacists should be able to find a suitable supplement for you. For general health,  a multi-strain formulation is fine. It is thought that over 2000 unique strains of bacteria could be found in the human digestive tract. So to say that one strain is the best to maintain a healthy gut is hard to argue. In terms of numbers, if the need is more acute take a higher amount. For general health, I recommend around 6 billion cells a day.

But don’t forget to have fermented food whenever you can. It might contain unique and helpful probiotics. Also these foods will provide different, as possibly, delicious flavours. Variety is the “fermented” spice of life!


AuthorDanielle Cooper

This is a medical term that made news a few years ago, but we may not remember why. Homocysteine is bad for our health, but how? If you have too much in your blood it is a risk factor for cardiovascular disease.  Where does it come from and how can I make it go away? This month I explain almost everything you need know about homocysteine.

Homocysteine is a semi-toxic byproduct produced when your body creates the amino acid methionine. 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. The next question you might be asking is, "Why would our body produce something so harmful?" Homocysteine is meant to be changed quite quickly into other harmless substances, but it is thought that certain nutrient deficiencies may delay this conversion. Your body requires a regular supply of folic acid, vitamin B6 and B12 to rid itself of homocysteine. Coincidentally, it has been found that people who have higher levels of homocysteine in their blood have lower levels of the three vitamins I just mentioned.


So why don't you just take these three vitamins and be done with it? Some people do; either on their own or under the advice of a Physician. The recommended dosages for the three vitamins will vary, but a good amount is 400–1,000 mcg of folic acid per day, 10–50 mg of vitamin B6 per day, and 50–300 mcg of vitamin B12 per day.  I would recommend that you take a good multivitamin that has these ingredients in it. Check with your Heart Pharmacist to see which multivitamin may be right for you.

While it is true that taking folic acid, vitamins B12 and B6 will help to reduce homocysteine and thus your risk of heart disease, this does not mean that taking these vitamins makes you completely safe or that you can eat pizza and ride the couch all day. Homocysteine is only one of the many risk factors for heart disease. Other things that your can do to lower your risk of heart disease include; get regular exercise (30 minutes five times a week), reduce your intake of caffeinated and alcoholic beverages, and quit smoking. Diet is also important: eat more fruits and vegetables, reduce your intake of meat, and increase your intake of fish and soy products.

Stress reduction is also very helpful in reducing your risk of heart disease. Reducing the stress in your life need not involve quitting your job and practicing yoga on a mountaintop, but it would work very well. All you need to do it get some exercise and perform some other tasks that relaxes you. Some people like to garden, while others take long walks or read a book.  Removing stress from your life can be hard. One of the easiest things to do is to avoid watching the news on TV. Many of the stories involve unhappy situations or disturbing images of war, famine, tragedy, and government overspending. Almost all of which does not directly affect us, but can still cause us a great deal of stress. It is hard for compassionate people, like us, to view these images and not feel some distress.

February is heart month and a good time to focus on your health.  Get lots of rest, drink plenty of clean water and relax. Take some time to learn about the many ways to reduce your risk of cardiovascular disease. Your heart will thank you for it.





AuthorDanielle Cooper

Most people have heard of the condition referred to as shingles. It is a painful skin rash caused by the same virus that gave you chickenpox as a kid. Almost anyone can get shingles. It is thought that one in three people will experience shingles during their lifetime. The reason why people develop shingles is not known. This month we shall discuss signs and symptoms of shingles and if there is a means of prevention. This year there is a new shingles vaccine, that is thought to be more effective than the previous vaccine

Almost everyone has had chickenpox at sometime in their life. This is usually a short-lived affliction that causes a lot of skin itching and goes away after a week or two. The truly sad part is that it doesn’t really go away. It is thought that the virus that causes chickenpox (the varicella-zoster virus) is also responsible for shingles. After your body successfully fights off chickenpox, some of the virus travels up into nerve fibers and becomes dormant. Later, the virus reactivates and travels down the nerve fibers to the skin surface. This causes the classic symptoms of shingles:

  • Numbness, tingling, itching, or pain in the place where the rash is about to appear
  • Fever (sometimes with chills), nausea, or headache
  • The appearance of bumps or blisters that contain clear fluid
  • A rash or odd sensations usually appearing in a band or patch on just one side of the body (Any part of the body can be involved, including the back, chest, abdomen, arms, legs, or face

Remember these symptoms, it can save you a great deal of misery one day. If you, or someone you know, mentions these symptoms, GO DIRECTLY TO A DOCTOR. DO NOT WAIT UNTIL MORNING OR A MORE CONVENIENT TIME. Generally, your Physician will order a course of antiviral medications. This slows down the rapid growth of, and subsequent nerve damage caused by, the varicella-zoster virus. These medications help your immune system to “catch up” and fight off the virus. It is essential to start the antiviral drugs as soon as possible. Delaying treatment will not lead to a good outcome and can leave you with long lasting nerve pain.

This year there are two vaccines to help prevent shingles. The original one is called Zostavax. In studies, people who received this single dose vaccine had a reduced occurrence of shingles by about 50%. But this effectiveness decreased with age. A new multidose vaccine, called Shingrix, has been shown to reduce the incidence of shingles by 90% in all age ranges. Shingrix just became available in Canada in early 2018.  Both vaccines are indicated for all people over the age of 50 years old. If you have had shingles in the past 12 months, speak with your Doctor or your Heart Pharmacist to see which vaccine is right for you. There are a few side effects experienced after receiving these vaccines. It might sting at the injection site for a day or two. You may also experience mild flu like symptoms for a few days. There is also a chance that you might develop a short lived rash at the injection site.

It is not certain what causes the varicella (chickenpox) virus to reactivate. People have told me that they were feeling “run down” at the time. Sometimes it was after a particularly bad bout of the flu. Others have said it was after a very stressful event; such as a death in the family. Another person told me that they hadn’t been getting enough sleep. There is also a thought that with routine vaccination of children against chickenpox, which I think is a good thing, there is a possible increased incidence of shingles in the middle aged and elderly. With fewer children with active chickenpox, there will be reduced virus exposure to parents and grandparents. This is increased risk is only a theory.  All of these things can lower the activity of your immune system, so stay healthy and get lots of rest.


AuthorDanielle Cooper

I shall make a bold claim, most people take better care of their cars than they do their own bodies! People take their cars in for regular maintenance and screenings. Cars have recalls, oil changes and scheduled tune ups. I know that I don’t delay my car appointment too long. But how often do we delay, or skip, the maintenance for our bodies? How often do you floss your teeth or go in for regular dental cleanings? Do you take a multivitamin and eat 5-7 servings of fruits and veggies daily? I’m speaking to the men here, have you ever ignored a medical symptom longer than normal? Routine screenings and medical appointments are important.  Perhaps this rant was overly dramatic, but I needed something to hook you in. It will also keep you reading when I start talking about awkward bits.

Has everyone undergone routine screening for colon, cervix, breast and prostate cancer? I warned you it would get awkward. These screenings are important and should not be delayed, there will be a heartwarming story at the end of this article. These screenings for cancers do involve awkward and uncomfortable tests but the benefits of early detection far outway the risk and inconveniences.  

Cervical cancer is a routine screening that most Physicians perform on their female patients. This is why your Physician does a Pap test every 2-3 years. In fact, screening for cervical cancer every 3 years can reduce your risk of developing this cancer by 70 percent. Survival rates with early detection are over 85%. Cervical cancer rarely causes symptoms, but they may include abnormal vaginal bleeding or discharge and pelvic pain. If you have experienced any of these symptoms, or have not had a Pap test in the last three years, please see your Physician.

Prostate cancer was diagnosed in over 3,000 BC men in 2012, that is about 1 in 7 men within their lifetime. The most common sign of prostate cancer, or an enlarged prostate, are difficulty urinating, blood in the urine or urinary frequency (especially at night). At this point, your Physician will perform a quick finger rectal exam to check the health of the prostate, or send you in for a blood test. This blood test is checking for a protein called Prostate Specific Antigen (PSA). If these results come back with positive results there are several treatment options. One treatment option is to do nothing. Well not really nothing, but it is call active surveillance. You go have your PSA checked on a regular basis and monitor prostate symptoms. If there are no significant changes, no further treatment may be required. Prostate cancer screening can be a relatively minor procedure and no further action may be required, but it is still good to know.

Colon cancer is the second most common form of cancer and third most common for women. It is thought that 1,300 BC residents will die of colon cancer each year. My youngest aunt was one of them. Unusual symptoms of blood in the stool, narrow stools, unexpected weight loss or changes in bowel frequency should be brought to the attention of your Physician. Normally screening tests might include a stool sample or a colonoscopy. Screening is very important because they can detect colon polyps (clumps of cells), and remove these before they become cancerous. At this point there is an issue with the stool sample testing, so check with your Doctor's office about screening options.

I always save the best for last.  Breast cancer always gets the attention and rightfully so. It is the most common form of cancer in women, if you ignore non-melanoma skin cancer. 1 in 8 women will be diagnosed with breast cancer during their lifetime. While it is true that screening is a little bit uncomfortable, it can lead to early detection. Most women over the age of 40 are eligible for a mammogram without a Doctor’s referral. This is where the heart warming story comes in. A friend and important member of our staff was one of these early detection stories. A routine mammogram picked up a lump so small that neither her surgeon nor Physician could feel it. For the holidays we are wishing her a speedy recovery and thankful that she had the vision to take charge of her health.

May you and yours have a happy and healthy holiday season.


AuthorDanielle Cooper