Sometimes we think of sleep as a trivial matter. However, a lack of quality sleep, and its consequences (such as daytime sedation),has a great impact on society. It is has been reported that sleepy and/or fatigued drivers are responsible for 4% of the fatal car crashes and about 20% of the non-fatal car crashes. One of the reasons for the Exxon-Valdez oil spill was thought to be the sleepiness of the bridge staff. There are many natural options to help with sleep at your Heart Pharmacy. This month I shall hope to explain why sleep is so complex and find options to help you get some more.

The information available about sleep is extensive because it is very important to our survival. During sleep, the mind and body rests and regenerates. Without it, our bodies and minds are unable to function well. What exactly is sleep? Sleep is divided up into five parts; stages 1-4 and REM sleep. Our bodies move between these five stages of sleep at various times during the night. This is all very interesting, but what is crucial is that the length of time you sleep is important. It is thought that your body needs REM sleep to rejuvenate. Any disruption in your sleep might make you get less REM sleep.

One important part of a good night sleep is sleep hygiene; this has nothing to do with cleanliness. These tips can be very helpful for people who have difficulty sleeping.

  • Try to have a fixed bedtime and wake-up time. This will help your body get into a regular sleep routine.

  • Try to avoid daytime naps. Some people do have a rest in the afternoon. If you must rest, try and limit it to 30-45 minutes.

  • Avoid alcohol in the evening. It is true that alcohol can make you drowsy, but it can also interfere with your sleep as it leaves you body.

  • Get some exercise, but not in the evening. Regular exercise is great for your body and can wear you out. Rigorous exercise in the evening though can have a stimulating effect.

  • Create a comfortable sleeping environment. The bedroom should be dark, cool (not cold) and free of any odd sounds.

  • Clear your mind before bed. Do not engage in activities that activate the mind. Avoid reading thought provoking books before bed.

  • If you cannot fall asleep within 30 minutes, get out of bed and leave the bedroom. Go elsewhere and have a light snack and read a light novel. Do not watch television or use a hand held electronic device. There are growing concerns that the blue light emitted from these devices can suppress melatonin production. Consider turning on the radio. Generally the voices are more relaxing and the programs are less engaging.

Are there any supplements that can help with insomnia/difficulty in falling asleep? Valerian is the most widely recognized herbal product for sleeping problems. Valerian seems to be more effective when used for longer periods of time (2 weeks), rather than for occasional problems. One study demonstrated that people who took a Valerian/Lemon Balm product ½ hour before bed, reported a 33% improvement in sleep quality. The researchers found this point interesting because the volunteers were healthy and did not complain of insomnia at the start of the study. Valerian is generally safe and well tolerated. Mild side effects of headache, morning sedation and stomach upset are sometimes seen. Paradoxically, valerian has been known to cause a slight stimulatory effect in rare occurrences. One complaint about valerian root is its unpleasant odour. I mention to my patients that this odour does not come out on the skin and is thought to be related to the product’s potency. While no drug interactions have been reported, be cautious of using valerian concurrently with products that have a similar action (sedatives, alcohol, narcotics, etc.) It is common to find valerian mixed with other herbs used for sleep; such as passionflower, hops and skullcap.

Another popular and effective natural sleep remedy is melatonin. Melatonin is a hormone that is produced by the pineal gland as the evening approaches. This hormone is produced as light decreases, but is blocked when things become brighter; remember the light emitted from handheld devices? The role of melatonin is to lower body temperature and chemically produce sleepiness. For some people melatonin can be very helpful to produce a good night's rest. Melatonin might not be for everyone. You should talk to your Doctor or Heart Pharmacist before starting melatonin. This medication can interfere with blood thinners, sedatives, antidepressants, and immunosuppressants.

For me the best way to fall asleep is to follow a good nighttime ritual. I brush my teeth, wash my face then sit in bed a read a novel until I become drowsy. This is thought to be helpful because it gives your body cues that it is time to fall asleep. No matter what works for you, it is important to get plenty of rest. Hopefully it is not my articles putting you to sleep.

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AuthorDanielle Cooper

I enjoy seeing things. Trees, flowers, the sky, my pay cheque and my daughter are all things I enjoy gazing upon (I won’t bore you with which one I like the best). What if one day you couldn’t see,or even worse, what if the vision loss was gradual, so you knew it was coming? This is the reality of macular degeneration, the progressive damage of the part of the eye which is responsible for sharp, central vision. This month, I will discuss the early warning signs, prevention and treatments for this sight-robbing condition.

 The bodily function known as sight is fascinating, complicated and fragile. Light passes into our eye and is focused onto the thin tissue on the back of the eye, called the retina. The central portion of the retina is called the macula and it is this area that is responsible for sharp, central vision. An early symptom of macular degeneration is the  gradual blurring in the central area of vision. Another symptom may be when straight lines begin to appear wavy. Macular degeneration may only occur in one eye; in this case no vision changes may be noticed. This is why regular visits to your optometrist are important.

There are two forms of macular degeneration (MD), wet and dry. The dry form is the most common; about 85% of cases are of this type. Dry MD occurs when the cells of the macula break down and cause yellow deposits to form under the retina. As the deposits increase in number, there is a greater risk of developing the other form of MD, referred to as wet MD. This occurs when small, fragile blood vessels form under the retina. These fragile blood vessels tend to leak blood and fluid and can rapidly damage the retina and macula. While both types of MD can cause significant vision loss or blindness, the risk associated with wet MD is greater. In general, both forms of this disease are referred to as age-related macular degeneration (AMD). The degeneration can be caused by other factors, such as a genetic predisposition, but these types are rare.

There are many things a person can do to protect their eyes from AMD and other eye conditions. Seeing that is is summertime, the first is to protect your eyes from sunlight; wear your sunglasses. While sunlight has not been proven to worsen AMD, many people still believe that it can cause damage and it is an easily avoidable risk factor. I think everyone should wear sunglasses, especially young children and infants. Their sensitive eyes need protection from the sun’s harmful rays. Smoking can also increase your risk of developing this and other eye diseases. High cholesterol also may play a part in the development of macular degeneration.

 There is a supplement that has been shown to help prevent AMD. A high potency multivitamin was shown to help AMD in the National Eye Institute’s Age-Related Eye Disease Study (AREDS). In this large study, people with and without AMD took a multivitamin containing zinc, beta-carotene, vitamin C, and vitamin E. What the researchers found was that there was a risk reduction of 27% for vision loss in people who had advanced AMD, and a risk reduction of 25% for the progression of AMD to a more advanced stage of this disease. In people with no or early AMD there appeared to be no benefit .

The AREDS vitamin formula is 500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene, 80 milligrams of zinc, and two milligrams of copper. Some vitamin manufacturers are making this formulation; look for the word “AREDS” in the name of the product. There are few contra-indication for taking this product; ask your Heart Pharmacist if this vitamin is right for you. There is some concern that people who smoke and take beta-carotene increase their risk of developing lung and prostate cancer. One way to reduce this risk is to quit smoking.  This risk is not seen in non-smokers.

It has also been reported that DHA (Docosahexaenoic acid), a fatty acid found in fish oil, may help to prevent AMD. This was determined by a prospective study of dietary fat intake. The researchers found that the amount of all dietary fat intake was directly related to an increased risk of developing AMD. Upon looking deeper, they also found that those who ate fish, more that 4 times a week, had a 35% lower risk of developing AMD. DHA is a fatty acid that is unique to fish, so it was thought that it was the fatty acid that was associated with the reduced risk.

With many of my articles warning of the dangers of sun exposure, you might think I am some sort of vampire. Far from it, exposure to sunlight is very important for our health and mood. Just be wary of over exposure. Be good to your eyes and use them often. There are so many wonderful things to see in our lovely city.

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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.

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:

q  Numbness, tingling, itching, or pain in the place where the rash is about to appear

q  Fever (sometimes with chills), nausea, or headache

q  The appearance of bumps or blisters that contain clear fluid

q  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.

 Luckily, there is a vaccination against the virus that causes shingles. Your Heart Pharmacist is able to give the Zostavax vaccine against shingles. In studies, people who received this vaccine had a reduced occurrence of shingles by about 50%. It is also thought that if you do get shingles, after having the vaccine, there is a reduction in the severity of nerve pain. This vaccine is 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 if this vaccine is right for you. There are a few side effects experienced after receiving the vaccine. 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 have 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.

 

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AuthorDanielle Cooper

June is usually a month of sun, gardening and planning for vacations. Not for your Heart Pharmacist, June is stroke awareness month. I think every month should be stroke awareness month. It is thought that over 12,000 deaths a year are attributed to strokes. What shocked me was that 10% of all stroke deaths occurred in people under 65 years old. This is why all months should be stroke awareness month. Let’s look at the signs of a stroke and what you should do.

How can you tell if you or someone you know might be having a stroke? There is a very handy word you learn about the signs of a stroke. It is called F.A.S.T.

 F- Face. Is one side of the face drooping or does not look right

 A- Arms. Often a person who is having a stroke can not raise both their arms at the same time

 S. Speech. Is the person's speech slurred, jumbled or are they unable to speak?

 T. Time. Speedy treatment is essential. Time to call 9-1-1 right away.

 Don’t worry if you forget this word. It is written on the side of every BC ambulance.

There is often some question as to whether you should give an aspirin to someone you suspect is having a stroke.  The current thought is that you should NOT give an aspirin. It is recommended to give aspirin for heart attacks but NOT for a stroke. This is because there are two types of strokes and it is hard to determine which type a person might be having. There is the ischemic stroke where a blood clot has obstructed blood flow in the brain. Then there is the hemorrhagic stroke. This later type of stroke is where a blood vessel has ruptured and blood is leaking out. Giving a blood thinning aspirin to someone with a hemorrhagic stroke might complicate treatment. So only give aspirin for heart attacks, chew one regular strength or two low dose aspirins. Just in case you forgot.

What is a T.I.A.? Some people call them mini-strokes. TIA stands for Transient Ischemic Attack. This is caused by a blood clot partially blocking or only temporarily an artery . Many people recover fully from these events so they might be tempted to think that they are no big deal. This is not a good idea. Think of a TIA as a “warning stroke”. Something is not going well with your blood circulation in the brain and should be brought to the attention of your Doctor promptly. A TIA could suggest that a full stroke might occur in the near future.

There are many ways to reduce your risk of having a stroke. The greatest benefit comes from stopping smoking, getting to a healthy weight, make healthy food choices and reducing your intake of caffeine and alcohol. Another way to prevent strokes, or heart disease, is to check your blood pressure regularly. Untreated high blood pressure is perhaps the greatest risk for your cardiovascular system. Check your blood pressure at any Heart Pharmacy. And don’t forget about F.A.S.T.

 

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AuthorDanielle Cooper

What is the big deal about cholesterol? It is discussed on the news, at dinner parties and especially at your Doctor's office. Why is everyone so concerned about their cholesterol? The answer is simple: high cholesterol is a major risk factor for heart disease. To further complicate matters, there is both good and bad cholesterol. And what about eggs? Eggs yolks contain cholesterol, is eating eggs a risk factor for heart disease? This month, I shall try and explain all about cholesterol, how it can affect your health and eggs too.

There are two main types of cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). The LDL, or bad cholesterol, carries cholesterol throughout your body to the cells that need it. Cholesterol plays an important role in your health. Your body uses it to make sex hormones, vitamin D, and help nerves function properly. The problem with LDL, is that if you have too much, it just keeps floating around. After a while, these LDL pieces get smaller and are more likely to enter the walls of blood vessels. Deposits of bad cholesterol particles are called plaques. Eventually, these plaques can build up and narrow the space in blood vessels leading to impaired blood flow. This is referred to as atherosclerosis, which is a major risk factor for heart disease. In contrast HDL, or good cholesterol, travels around your body and picks up extra cholesterol. It then takes the extra cholesterol back to the liver for disposal. Generally, the more 'good' cholesterol you have, the less 'bad' cholesterol is present in your arteries.

There are many things that you can do to help lower your cholesterol without leaving home. Don't smoke; smoking can lower HDL cholesterol. Getting regular exercise can help raise HDL cholesterol and help you lose weight, both of these health changes can improve your cholesterol. With approval from your Doctor, try to get at least 30 minutes of physical aerobic activity 5 times a week. What exactly is physical aerobic activity? An easy way to recognize it is that it should raise your heart rate, make you breathe heavier, but not so much that your can't maintain a conversation. This might include brisk walking, cycling or ballroom dancing. Drink alcohol in moderation. This recommendation is a controversial one. Studies have shown that moderate consumption of alcoholic beverages can reduce the risk of developing certain diseases. Conversely, too much alcohol can raise your risk for developing these same diseases. It seems that one drink a day for women and two drinks a day for men appears to be optimal. It is unwise to recommend people start drinking to improve their health, because the evidence is not that convincing. So continue to imbibe, in moderation, if it is something you already enjoy.

Your diet can also affect your cholesterol, but not the way you think. The American Heart Association wrote, “Saturated fats and trans fats are the main dietary factors in raising blood cholesterol.” Saturated fats generally come from animal products, palm and coconut oils. Trans fats mainly come from processed foods, look for the phrase “partially hydrogenated vegetable oils”. What about eggs? It is thought that if you eat less than seven eggs per week, there is no increased risk of heart disease. All of the cholesterol in eggs comes from the yolk, so scrambled egg whites do not contain cholesterol. Perhaps the significant risk of heart disease at the breakfast table are from the bacon, sausages and cooking oil. They may contain saturated and trans fats.  

Cinnamon is not normally associated with cholesterol reduction. However, in one small study 6g of cinnamon daily helped reduce LDL cholesterol by 27% and total cholesterol by 26%. Six grams of cinnamon is not that much, it's about one teaspoon. This could easily be sprinkled on cereal or oatmeal in the morning, provided you like the taste of cinnamon. It is important to use the correct kind of cinnamon as there are two main varieties. The type of cinnamon used in this study was Cinnamomum cassia. This spice is generally safe to use, but you should check with your Doctor or Heart Pharmacist before use. Higher doses of cinnamon can sometimes lower blood sugar and complicate the treatment of diabetes.

Dietary fibre is one of the most overlooked options to help lower cholesterol. One study found that 3.4 g of psyllium taken three times a day lowered LDL by 20%. Fibre works due to its ability to bind to cholesterol in the gut, correct? Not necessarily. There is evidence that the metabolism of fibre may lead to the products, propionate (a short-chain fatty acid) and alpha-tocotrienol (similar to vitamin E), both of which can prevent your body from making its own supply of cholesterol. Consuming extra fibre can cause stomach related side effects such as gas, bloating and indigestion. If you wish to increase your intake of fibre, start with small amounts and work your way up from there. Increased fibre intake can interfere with the absorption of certain medications, ask your Heart Pharmacist for more information.

This is certainly a lot to digest, but there are many natural options to help reduce cholesterol. Many of these suggestions can be incorporated in one’s lifestyle, without even purchasing a supplement; increasing fibre intake, adding cinnamon, getting regular exercise and avoiding 'convenience' foods. Many convenience products have little nutritional value anyways; think about having an apple instead. Don’t be fooled by the ‘low-fat’ food phenomenon, which I feel can be a real problem. In many cases, these products are lower in fat but they have similar amounts of calories as their regular fat counterparts. Most of the fat calories are often replaced with sugar; high-fructose corn syrup and/or sucrose (50% fructose) to be exact. So you may not be any better off. So watch those labels, but better yet avoid processed foods. Your heart will thank you for it.

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AuthorDanielle Cooper