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.

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.





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.

AuthorDanielle Cooper

A popular pastime in Victoria is hiking and spending time in nature. It grounds us and instills an appreciation for the natural beauty that surrounds us. However, you know me, I like to worry. Nature is also full of insects that bite, sting, cause rashes, allergic reactions and diseases. I hope I didn’t discourage you from spending time in the wilderness. You should be aware that the things buzz around our ears might not be entirely harmless. With a bit of knowledge these insect stings and bites can be treated at home.

There are many little creatures that seek to feast upon our flesh and suck our blood.  This seems a little bit dramatic, but I have always wanted to write that. We can divide insect related injuries into two broad categories; stings and bites. Luckily treatment for both of injures are similar. The first thing to do is try and avoid getting stung or bit in the first place. Avoid times when biting insects are active. Generally mosquitoes are most active during dawn and dusk. Wear light coloured clothing and long pants, socks and long sleeved shirts to protect your skin. The insect repellent called DEET works by masking our human scent. For infants six months to two years use a lower strength product (10% DEET) once a day only. Kids 2-12 years can use the 10% DEET up to three times daily. Everyone 12 years and older should use a 30% DEET product. Babies under 6 months of age have very sensitive skin so it is best to avoid contact with insect repellents and sunscreen.

I get asked if citronella and other essential oils can be used as insect repellents. There is some evidence to suggest that citronella is slightly effective, but DEET is still a better choice. There is an urban myth that ingesting higher amounts of vitamin B1 (thiamine) can act prevent bug bites, this is only a myth.

The most worrisome insects for people are the classic stinging insects: wasps, hornets and bees. If you do have one of these bugs flying around you, avoid the temptation to swat them away. Sudden or startling movements can make them more likely to sting. Sit still or gently blow them away. If you do get stung, look to see if the stinger is still on your skin. If so,try and scrape it off with your fingernail, credit card or any hard edged object. Do not try and grab the stinger with tweezers and pull it out. This might squish out more venom.

How you treat any insect sting or bite is essentially the same. First to ensure there is no immediate risk of an anaphylactic reaction. Symptoms of an anaphylactic reaction are usually easy to spot: wheezing, difficulty breathing, swelling in mouth and neck areas, dizziness or fainting. This is a time to find urgent medical care. While we are on the subject of anaphylactic reactions, it is a good to check and ensure your EPI-PEN has not expired. Applying a cold compress or ice pack over the bite and help to treat pain and reduce swelling. Do not apply ice directly to skin and only for 15 minutes at one time.

After the initial pain of the sting is over, there might be some swelling and redness from your body's allergic reaction to the venom. Very mild reactions might respond to topical hydrocortisone or diphenhydramine cream. For a more severe reactions, oral antihistamines might be needed. Ask your Heart Pharmacist for the best option to treat your allergic symptoms. If you were stung on the hand or wrist, consider removing rings, watches or bracelets. Swelling might make them painful and very hard to remove later. Generally the swelling and itching from bug bites will decrease after 3-4 days.

There is a rare chance the insect bites or stings can cause a longer lasting problem. There is the remote probability of West Nile Virus (mosquitoes) and Lyme disease (ticks). I told you I like to worry. The incidence of contracting these diseases in BC is low but not improbable. So watch for any of these symptoms after a bug bite: fever, headache, fatigue, muscle and joint pain, long lasting rashes and sensitivity to light. These are symptoms of concern and should be brought to the attention of a Physician quickly.

Most insect stings and bites are mild and resolve without any treatment. But it is best to know how to treat and avoid this summer health concern. So get out there and enjoy the natural beauty that surrounds Victoria.

AuthorDanielle Cooper

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.

AuthorDanielle Cooper