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SUPPLEMENTS FOR OPTIMAL DIGESTIVE HEALTH DR. HISTER ON
URINARY INCONTINENCE BEING CALORIE CONSCIOUS
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People First contents
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Incontinence Dr. Hister looks at urinary incontinence, a common but distressing condition.
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Health & Wellness Save on quality health products.
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Digestive Supplements Peoples Pharmacist Ian Lloyd provides helpful advice on supplements that are benefical to your digestive system.
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Healthy Savings Take charge of your health with vitamins and supplements.
Digestive Health
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Pharmacist Recommended Need help quitting smoking? Find out how with the B.C. government smoking cessation program.
Page 7 Great selection of probiotics for optimal digestive health.
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Walking For ALS Join the Peoples Drug Mart B.C. & Yukon Walks for ALS.
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Calorie Consciousness Darlene Booth’s tips on dieting and how to shed a few pounds.
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INCONTINENCE
Dr. Art Hister
We live in a pretty weird world. There are so many examples I can think of but let me start with this one: just think how strange it would be to have to suddenly explain to a visiting space alien why an average Canadian hockey player, a sometimes-entertainer at best (when he feels like putting in the effort, that is), a stand-in for a two-by-four at worst, earns ten and even twenty times the annual salary of someone who really contributes something important to this world, such as a teacher, for example, or a surgeon, or someone really, really vital to our existence such as a health analyst on Global TV (and no, I don’t have any specific person in mind when I bring up that example; just musing about the key people in life). Now in case you’re wondering right about now where this rant is heading, let me tell you that the reason I thought of how strange this world sometimes seems to me is because of the subject I was asked to address in this month’s column, namely urinary incontinence. You see, these days, media airways and print outlets are filled with the most lurid and intimate details about people’s habits and preferences, and hardly a day goes by without yet some other “minor celebrity” (a person who, when not on TV, would have trouble getting recognized by a Walmart cashier) confessing to a particular “problem” they’ve suffered from for years, a problem that was (in an earlier era) rarely talked about even in pri-
vate but certainly never discussed in a public forum over post-dinner ice cream and cake. Yet, despite this seeming openness we have to talk about anything, anywhere, strangely, it seems to me, very few people – none that I can think of, in fact – will admit publicly that they suffer from incontinence. Yet, urinary incontinence, which is generally defined as any involuntary leakage of urine, is a very common (and more important) often an exceedingly distressing condition, but despite the psychological toll it can take, incontinence remains (uniquely, I think) a largely hidden or at least a not-referred-to condition. In fact, surveys reveal that many incontinence sufferers won’t even admit they have bothersome incontinence to their own doctors, which I for one think is strange, if only because incontinence can be a treatable condition. Before going on about what to do, however, I should make sure that we’re all familiar with the anatomy and physiology that’s involved with this problem. Thus, the kidneys produce urine, which then flows down the two ureters into the bladder. The urinary bladder acts like a holding tank with a valve at the bottom, and when that holding tank begins to feel too full (there are sensors in the bladder lining – see below), it sends a signal to the brain (and other parts) that translates as “Hey, get thee to a toilet so this stuff can be emptied.” Continued On Page 11
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DIGESTIVE SUPPLEMENTS When your tummy is happy, you are happy. Most of us ignore our stomachs unless they talk to us. Only gas, bloating and burning focuses our attention on the organ that provides us with our vital nutrition. You make sure your car's engine is running properly. Perhaps it is time to ensure your stomach and digestive system is running optimally. This month we shall focus on supplements and suggestions to help keep your tummy happy. The first thing I always mention for a happy tummy is to take extra probiotics. Probiotics is the generic term for all the good bacteria that live in your digestive tract. What can probiotics do for your health? It is a very competitive world in your digestive tract. In general, probiotics try to occupy as much space as possible within your digestive tract. By doing so, probiotics help to keep other bad bacteria and yeast from residing there. All bacteria (both good and bad) will alter a local environment to suit their particular needs. Probiotics will release hydrogen peroxide and organic acids to prevent other bad bacteria and yeast from living there. They will also release direct bacteria toxins to prevent the growth of other bad bacteria. While this does not sound very neighbourly, it is in your best interest. Another way probiotics can keep you healthy is by stimulating your immune system and maintaining a healthy digestive tract. The way bacteria accomplish this is not well understood. It is thought that good intestinal bacteria can actually help strengthen the cell lining in your intestines. This im6 People First Join us on
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Ian Lloyd Peoples Pharmacist
proved cell lining can reduce the ability of foreign bacteria to cause infections. Good bacteria can also interact directly with your body's own immune system to make you healthier. Probiotics can help the cells in your intestine form antibodies, which will help to fight off invading bacteria. The next question is how much probiotic should one take and which kind? There is no real set dose for probiotics. Luckily, it is a very safe product. There have been few side effects and no drug interactions noted at any dose. I generally recommend that if you are taking probiotics for general health, 2-5 billion bacteria a day is enough. If you are trying to actively treat some condition, you should take 20 billion bacteria or more a day. Speak to your Peoples Drug Mart Pharmacist for more information about probiotic formulations and possible dosages. Something else that keeps your tummy happy is fibre. It does so much more for you than to promote bowel regularity. It may be surprising to learn that most people do not get enough fibre in their diets. While you can get extra fibre from drinks or capsules, food sources are best. Basically any brown grain, fruit, berry or vegetable contains some fibre. Small changes in your diet can increase your daily intake of fibre. Switch from white to whole grain bread, try a high fibre breakfast cereal, use brown instead of white rice and eat at least 1-2 pieces of fresh fruit a day. You would be surprised how many people do not eat a single piece of fruit during the day. Continued On Page 8
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Ian Lloyd...Continued From Page 6
High fibre diets can also have other health benefits. Increasing your intake of fibre can reduce your risk of developing colon cancer. This is mostly due to fibre's ability to reduce intestinal transit time. More fibre in your diet can also help you lose weight. It is thought that the extra bulk in your stomach will help you feel full longer and reduce your desire to eat. Fibre can also reduce your risk of developing type 2 diabetes. Again this is due to a reduced calorie intake and the slowed absorption of dietary sugars. Let us not forget about the reduced risk of cardiovascular disease. This is primarily because fibre can help to reduce your cholesterol levels. Are these enough reasons to encourage you to get more fibre in your diet? I promise to stop if you go and eat an apple. Lastly, no article on digestion can be complete without mentioning supplemental digestive enzymes. Normally our digestive tract produces many enzymes to help break down the food we eat into easily absorbable parts. Sometimes this system may not work perfectly. Undigested fats, starches and
proteins, that make it to the large intestine, may cause diarrhea, gas or unpleasant symptoms. Taking extra digestive enzyme supplements may help your body’s natural digestive process, and reduce gastrointestinal upset. Better still; with each meal, eat plenty of raw foods; such as, salads, carrot sticks or other raw vegetables and fresh fruit. Unprocessed fruits and vegetables contain natural digestive enzymes. I can never stress this enough: slow down when you eat! Take the time to chew your food thoroughly and enjoy it. Your food needs to be properly ground up before it hits your stomach. Did you know that your body produces digestive enzymes in your mouth? It’s true. If you don’t believe me, chew a piece of white bread for a long time. After a while it will start to taste sweet, as the starches in the bread are digested into easily tasted simple sugars. Next, I tend to think that water is important. Water, not sugary pop, provides a little extra volume for your stomach to digest. The extra water also helps to fill up Continued On Page 10
Don’t Play A Guessing Game With Your Daily Medications Many people today are on more than one medication, and when you combine this with a busy and active life, it can lead to the confusion of properly taking your medications. Medication non-compliance is a major concern and accounts for approximately 25% of all hospital admissions among seniors. Peoples Drug Mart and Peoples Pharmacy offer a medication compliance program called “Med Manager.” The Med Manager is a medication compliance card that conveniently organizes your medications for a full week, and helps you easily identify what medications are to be taken at what time of the day. Talk to your Peoples Pharmacist about the convenient and safe Med Manager program.
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pharmacist recommended Health & Wellness Information From Your Peoples Pharmacist
Smoking Cessation Quitting smoking can be a challenge, but the health benefits of quitting far outweigh the barriers you may face. Did you know: within 1 year of quitting, risk of smoking related heart attack is cut in half. Within 10 years of quitting, risk of dying from lung cancer is cut in half. Your Peoples Pharmacist can provide helpful advice on smoking cessation and nicotine replacement therapy. Understanding smoking triggers, developing coping strategies, and having realistic expectations, are important steps in smoking cessation. B.C. Smoking Cessation Program The B.C. government’s Smoking Cessation Program helps eligible B.C. residents stop smoking, or stop using other tobacco products, by assisting them with the cost of smoking cessation aids such as nicotine replacement therapy products (nicotine gum or patches). You do not need a prescription for nicotine gum or patches. You may still want to talk to your doctor or pharmacist about your plans for using nicotine gum or patches, especially if you are taking other medications or have serious health issues. They can tell you if nicotine gum or patches might not be the best choice for you. You have to register for the nicotine replacement program with HealthLink BC before you can get the nicotine gum or patches. Call HealthLink BC at 8-1-1 to register. When you register, HealthLink BC will ask you for the following information: • Your BC Care Card number (also known as your personal health number or PHN for short) • Your name as it appears on your BC Care Card
HealthLink BC will also ask you several questions to make sure you are eligible. If you’re not sure which nicotine replacement product is best for you, HealthLink BC will ask a few questions to help you choose. If you need more support, speak to a Peoples Pharmacist, or HealthLink BC will refer you to QuitNow Services, who can help you make a decision. The B.C. Smoking Cessation Program covers 2 strengths of the Thrive™ nicotine chewing gum and 3 strengths of the Habitrol® nicotine patches.
Picking up your order at a Peoples Pharmacy When you pick up your gum or patches at a Peoples Pharmacy, HealthLink BC will give you a reference number to take to the pharmacist. Be sure to write this number down. When you visit the Peoples Pharmacy, give the Peoples Pharmacist your reference number. If you have already decided which product you want, let the pharmacist know. If you would like help in deciding which product and strength is best for you, ask your Peoples Pharmacist for advice. The pharmacist will then give you a supply of the product. It’s a good idea to ask your Peoples Pharmacist for advice on how to take the nicotine gum or patches. peoplesdrugmart.com People First 9
Ian Lloyd...Continued From Page
your stomach so you are less likely to overeat. Eating too quickly may not allow your body to realize it is full until it’s too late. A stomach that is too full might lead to heartburn. A supplement that I sometimes recommend for indigestion is Iberogast. Some people have found this product helpful for all sorts of stomach ailments. It is a mixture of various plant extracts: chamomile, Clown's mustard, Angelica root, caraway, milk thistle, lemon balm, celandine, licorice root and peppermint. All of these herbals have historical use for treating all types of digestion ailments. There are a few studies that have shown that when taken long term, Iberogast can help to reduce symptoms of heartburn, stomach pain, cramping and nausea. Most symptoms of indigestion are short lived and have an identifiable cause. Perhaps it is a stomach bug, or too much spicy salsa at a Mexican restaurant. Still, there are a few general warning signs to look for. Contact a doctor if you notice any of these symptoms:
• • • • •
Nausea lasting longer than 1 day Diarrhea every 1-2 hours for 2 days High fever, chills or blurred vision Stools or vomit that are bloody or black Intense pain in the lower, right side of your abdomen (below you belly button) • If vomiting or diarrhea persists for more than 4 hours in an infant or child Perhaps the best tip for good digestive health is to remember the phrase, “never again is what you swore the time before.” If you know something will upset your stomach, then avoid it. Don’t get me wrong, I can value the necessity of gastronomic hedonism, but I also know that I can’t eat New York Fries and a Caramel Macchiato without getting a very upset stomach. So be good to your stomach and it will be good to you. Also, don’t forget to eat your yogurt. Written By Ian Lloyd, Pharmacist & Chartered Herbalist, Peoples Pharmacy
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Dr. Hister...Continued From Page 4
The bladder gets emptied by muscular action that pushes urine into the urethra, which has its own outlet valve, and when you relax that last vital barrier, you can then deposit your urine somewhere of your choosing (clearly, men and women have very differing concepts – and abilities – about where this can or indeed should be done). So incontinence can occur from anything that interferes with this pretty complex set-up such as, for example, an injury to any of the tissues (particularly to the bladder or the urethra, as can often happen in childbirth), or an increasing weakness with age or because of neurological disease in any of the muscles involved or in the way the valves open and close, or inappropriate signals of bladder fullness either to or from the brain, not to mention that in men there’s the added problems of a prostate gland that surrounds the urethra – God surely made a major mistake with that arrangement; either that or it’s some sort of Godly humour that us mere mortal men cannot understand - and which then squeezes the urethra more and more tightly as the prostate balloons with age. No surprise, then, that incontinence is such a common problem, especially as we get older and the tissues involved inevitably weaken, stretch, and sag. Anyway, the bottom line (no joke) is that incontinence can be due to many different factors, but happily, some of these can be treated or ameliorated, so if you do happen to be suffering from incontinence and it’s bothering you, don’t remain silent about it, but make sure to talk to your doctor about particular tests you might undergo to discover if you have a correctable cause for your condition. After you get the benefit of a proper and specific diagnosis, depending on what they come up with as an explanation for your problem, treatment should always start with the least harmful and most natural approaches, such as pelvic floor exercises, biofeedback, and behavioral therapies. If those don’t work well enough, treatment can
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Dr. Hister...Continued on Page 13
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Peoples Drug Mart B.C. & Yukon Walks For ALS Each year participants in 16 communities across B.C. raise funds and lace up their shoes to walk in events organized by local volunteers. In 2012 the ALS Society of BC had 14 Peoples Drug Mart WALK for ALS locations across BC and one in the Yukon and raised over half a million dollars. THE WALK FOR ALS IS MORE THAN JUST A FUNDRAISING EVENT: • It is a celebration of hope for those living with ALS. • It is a celebration of lives lived for the family and friends of those who have lost their lives to the disease. • It gives participants the chance to share and connect with other families who have been affected by the disease. • It provides an opportunity to generate funds to support the ALS community. • It serves to increase awareness of and support for ALS. With increased awareness comes increased financial support which will enable people living with ALS to have the services they need to live with independence, dignity, and choice. WHAT IS ALS? ALS (Lou Gehrig’s disease) is a paralyzing, life-ending condition with a prognosis of 2 - 5 years of life. ALS attacks and kills the motor neurons in the body, denying you the ability to move, to speak and finally to breathe. It has no known cause, no effective treatment or cure yet. ALS Society of BC provides equipment and support services for people living with ALS in BC and Yukon, and funds breakthrough research towards treatments and a cure. HOW YOUR DONATION HELPS You can feel proud that your efforts for the Peoples Drug Mart WALK for ALS provide direct benefits to people living with ALS in BC and Yukon that we are privileged to serve. You provide the Gift of Mobility through our Equipment Program – wheelchairs, lift chairs, tilt commodes, and more.
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You provide the Gift of Voice and break the silence by equipping clients with the latest adaptive technology so that they can continue to be part of the great conversation of life. You provide the Gift of hope as 40% of Walk funds are invested in vital research to find an effective treatment and a cure for this devastating disease! Peoples Drug Mart is proud to be the presenting sponsor of the B.C. & Yukon Walks for ALS and are very appreciative of the hard work performed by the many walk volunteers. Join us in the fight against ALS. Peoples Drug Mart B.C. & Yukon Walk for ALS Schedule
June 2nd West Kootenay - Nelson June 9th Mid-Island - Parksville
June 15th Okanagan - Kelowna Vernon Fraser Valley - Abbotsford Surrey
June 16th Tri-Ci-es/Ridge Meadows Coquitlam J
June 22nd Agassiz Kamloops Williams Lake
June 23rd Prince George
September 7th Dawson Creek
September 15th Victoria
September 29th Whitehorse - Yukon
For More Information Register online www.walkforals.ca or contact the ALS Society of British Columbia & Yukon 1-800-708-3228 info alsbc.ca
Dr. Hister...Continued From Page 11
then progress to medications, although I’d warn that many of the commonly-used drugs for this problem can produce at least several potentially “uncomfortable” side effects, so if you do have to take some of these drugs, make sure to consult your pharmacist about them. One interesting relatively “newish” approach has been the use of Botox injections for some types of incontinence, which, the theory goes, allows some bladders to work more efficiently by minimizing bladder spasms, and some early reports of small trials have been quite encouraging, but be aware that this is not yet an approved use of this medication and that there are still no long-term safety studies on this mode of treatment. Finally, of course, for some types of incontinence, especially in women, there are various surgical options as well. Now, I always like to end with a bit of hopeful news, so according to a very interesting and exciting recent report in The FASEB journal, researchers claim to have discovered some proteins called integrins located in the bladder’s lining cells, which are released when the bladder is stretched to spread that news that “hey, time to empty this vessel.” (I guess integrins act much like a phone tree, or Twitter, or most efficient of all, I think, at spreading the news, my mother’s friends). So, the hope is that further research can come up with safe drugs to target those proteins and to allow a person to “hold on” successfully for longer periods, and for an aging male, like me, whose first job when arriving at a lecture is to immediately scout out where the nearest toilets are located, that’s the best news I’ve heard since the birth of my second grandchild. Dr. Art Hister can be heard on CKNW and other Corus Radio Network stations on House Calls on Saturdays at 10 AM, as well as seen on Global TV news on Saturday mornings at 9:20.
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CALORIE CONSCIOUSNESS
ar e e Boot
You diet yourself a few pounds lighter and then celebrate by eating a treat; one reward leads to another and before you know it you are looking in the mirror and thinking about dieting again. Does this sound even remotely familiar? If it does, you are not alone; dieting is a time-honoured tradition in our culture. Dieting can sometimes help us achieve our weight loss goals but until we come into a balanced relationship with our food, the yo-yo syndrome is likely going to be an inevitable pattern. There is a simple equation for weight loss; calories spent must be greater than calories stored. Your fat reserves are like your famine protection; this evolutionary survival mechanism served us well in our hunter-gatherer days, but not so much when we are sedentary and surrounded by access to food. Often, our food is poor in quality and high in calories. Adding weight to the gaining process is the fact that we now supersize our portions; it is almost expected that we will eat well beyond our individual caloric needs. Begin to pay attention to portions. Denial of how much we are actually eating is easy when we fall prey to portion distortion. There is a huge caloric difference between a graham cracker and a gigantic chocolate chip cookie. When the Canada Food Guide recommends we eat a serving of grains, it means 1/2 cup of cooked pasta, or rice not a whole plate full. A serving of bread is equal to about 35 grams or 1/2 of a regular bagel. Read the fine print on the foods you buy and you will soon come to realize that the bag of chips you mindlessly noshed on equaled a whole day’s worth of calories. Give up 3500 calories and lose a pound of fat. Just say no to your daily muffin and latte and you could feasibly lose up to a pound per week. Try incorporating some of the following suggestions into your lifestyle and you will be surprised at how easily the scales balance out: 1. Get a kitchen scale and learn what a real portion looks like. One ounce of cheddar cheese is about the size of a 2.5 cm cube and has approximately 112 calories. Does that make you think twice about nibbling on that cheese plate at the
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R.H.N
next office party? Go for the veggie plate instead and stay away from the dip. There are over 70 calories per tablespoon in your average ranch dip. 2. There are a lot of calories in fat, even when the fat is a healthy one. 24 almonds weigh in at approximately 160 calories; peanut butter has about 4 calories per tablespoon. Use a non-stick fry pan with a light spray of oil for sautTing and reduce the amount of fat you use in baking by substituting unsweetened applesauce for some of it. Choose low fat options and stay away from deep fried foods altogether. 3. Non-starchy vegetables are your best friends. When you are used to a big plate of pasta, the regular serving size can look really unsatisfying. Rethink your meals by making generous servings of steamed veggies the mainstay, toss in 1/2 cup to 3/4 cup of cooked pasta or rice and top with a low fat sauce. Accompany your veggies with a small serving of lean protein. Green leafy salads with low fat dressings are optimal choices too. 4. Drink water, coffee or tea (without milk and sugar). Enough said. Anything else has calories. Wine is a better choice than a daiquiri; light beer is better than regular. There is always a better choice – you just have to make it. 5. Slow down, chew thoroughly and turn off the TV. Be mindful of what you are eating. It takes 20 minutes before the stomach can alert the brain that it is full so use your eyes to guide your fork. It also helps to use smaller plates as the illusion of a full plate helps the brain settle into satisfaction. Calories in and calories out; I would not be doing you a service if I did not remind you to get moving. Daily exercise is what the human body is made for but we have created a world where physical labour is optional for the most part. Park a little farther away from work than usual. Take the stairs instead of the elevator and get out for a daily walk. It all adds up to feeling better and seeing smaller numbers on the scale each week. Good Health to You!
Black Bean Bolognaise
Black Bean Bolognaise
A comfort stew that is high protein and fibre. Use the leftovers for sloppy Joes or as a hearty sauce for pasta, rice or potatoes (as shown in the photo). For a little variety, substitute chickpeas or kidney beans for the black beans. 1 lb (454g) extra-lean ground beef 1 ⁄3 cup (75 mL) diced white onion 1 ⁄3 cup (75 mL) diced celery 1 ⁄3 cup (75 mL) diced carrot 1 ⁄2 cup (125 mL) white mushrooms, medium dice 1 Tbsp (15 mL) butter 1 ⁄2 cup (125 mL) red wine or water 8 green olives, finely chopped 1 ⁄2 cup (125 mL) tomato sauce 1 ⁄4 tsp (1 mL) finely chopped rosemary 1 Tbsp (15 mL) Dijon (or prepared) mustard 1 ⁄2 cup (125 mL) 2% milk 1 cup (250 mL) cooked black beans 1 ⁄2 tsp (2 mL) salt 1 ⁄2 tsp (2 mL) pepper 1 Tbsp (15 mL) brown sugar 1 lemon, juiced 1 tsp (5 mL) paprika 1 ⁄2 tsp (2 mL) cayenne pepper Heat a large pan over high. Add ground beef, breaking it up with a spatula, and allow to brown. Drain fat, then add chopped onion, celery, carrot, mushrooms and butter. Continue to cook on high heat until vegetables begin to soften and brown. Add red wine, shake pan and lower heat to medium. Mix in remaining ingredients. Simmer on low to medium heat for 10 minutes and allow to thicken. Remove from heat and serve. Serves 6 1 serving: 230 Calories; 7 g Total Fat (2.5 g Mono, 0 g Poly, 3 g Sat); 55 mg Cholesterol; 16 g Carbohydrate; 3 g Fibre; 21 g Protein; 550 mg Sodium
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