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People First contents

Childhood Obesity Dr. Hister looks at overweight children, a growing health concern that affects up to 19 percent of 5 to 17 year olds.

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Antibiotics Peoples Pharmacist Ian Lloyd provides advice on antibiotics and how to achieve the best health outcome.

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Healthy Choices

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CHILDHOOD OBESITY I figure most of my readers are close to my own demographic, that is, gorgeous, brilliant, witty, talented, exceedingly charming although also totally modest baby boomers, a huge demographic blip that is, however, aging far more readily than we ever thought possible so that these days on the rare occasions that a few of us manage to stay up beyond our customary bedtime of 9 PM to attend a party with others of our cohort, our main – and very often our only - topic of conversation is our various aches, ills and losses of function, with inevitable side dishes, of course, of how hard it is to deal with our even older parents and how gorgeous our grandchildren are. What happened to us, eh? Didn’t you also think we were going to live nearly forever? Not to mention, stay young and vigorous till the day before our demise? Ah well, at least we’re still here to complain (and to torture our kids). Anyway, all that is to say that I’m on pretty safe ground when I assume that most of you reading this didn’t know many obese kids when you were growing up. I can’t, for example, recall any significantly overweight kids in any of my schools, and just to make sure that assertion isn’t just a trick of my increasingly faulty memory (see above under: losses of function), I looked up a picture of my grade 7 graduating class, after which I hauled out my high school graduation yearbook, and after recovering from the guffaws at the hair styles and the clothes of that era (and boy! did we ever look earnest), all I could find were a few

Dr. Art Hister

roly-poly kids, including me, but none who would have been obese or even “very overweight.” But my how times have changed. Thus, according to Statistics Canada, in 2011, 19.8 % of 5-17-year-olds were overweight and another 11.7 % were classified as obese, so if you graduated in my era, you’d nearly instantly figure out that 31.5 % of kids are now overweight or obese. (Graduates of the new math should just try to figure out how they feel about those numbers). In other words, over the last 30 years or so we’ve gone from relatively negligible numbers (in 1978, 3 % of Canadian kids were judged to be obese) to a situation in which 1.6 million Canadian kids are now overweight or obese. So why have kids gotten so much fatter over the last 3 decades? Well, it doesn’t take a rocket scientist to figure out that the main reasons behind this explosion of fatness have to be environmental since genes couldn’t have changed all that much over just a few decades. And again, although there are a host of potential environmental suspects (pollution, chemicals, etc), it’s pretty easy to finger a couple of suspects as the most likely ones to account for this drastic change: alterations in diet – namely, what our kids are eating and drinking and especially how much they eat and drink - and a huge change in kids’ levels of exercise and activity. When it comes to diet, again, there are several potential factors but for me the outstanding “negContinued On Page 11

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ANTIBIOTICS

Antibiotics are one of the greatest discoveries of medicine. Before their discovery, things didn't end well for people with infections. Today, we think nothing about seeing the doctor for a nasty cough or skin infection. We walk in the door, have a quick chat, get a prescription for antibiotics and all will be well. But a 100 years ago, these minor medical conditions could have proven fatal. Maybe with a little history lesson and knowledge of today's antibiotics, we can learn to appreciate this medical miracle. Many people think of penicillin as the first antibiotic. This is partially true. Actually, the first antibiotic, called pyocyanase, was discovered in the 1890s by German doctors, Rudolf Emmerich and Oscar Low. However, it was not always effective and sometimes proved to be toxic. Penicillin was the first useful and safe antibiotic. Sir Alexander Fleming first discovered this new drug in 1928. He shared the 1945 Noble Prize for medicine with the two chemists who discovered how to manufacture it: Sir Howard Florey and Ernst Chain. All of these discoveries stemmed from the work of Louis Pasteur. He believed that germs and microbes were the cause of diseases; which was controversial in his day. Louis Pasteur is one of my heroes, he also madegreat discoveries in the area of brewing science. When you visit your doctor's office, how does he choose which antibiotic to use? The first thought is: do you need antibiotics at all? It is thought that one third of all antibiotic prescriptions are unnecessary. 6 People First

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Ian Lloyd Peoples Pharmacist

This is because most common colds and flus are caused by viruses, for which antibiotics will not help. It can be very hard to determine if an infection is caused by a virus or a bacteria. Here are a few things the might warrant a visit to your family doctor: • The infection is limited to a specific area of the body, such as the sinuses or a finger • Symptoms do not improve, or worsen, after 72 hours • You have a medical condition that might lead to complications: heart disease, asthma, immune system suppression. • There is a significant amount of pain associated with the infection. So you have seen your doctor and you do have a treatable bacterial infection, why not just pick just any antibiotic for treatment? The reason is that specific antibiotics are only effective against certain types of bacteria. This is referred to as an antibiotic's spectrum of activity. It is also known that certain bacteria are associated with certain types of infections. The bacteria that causes skin infections is different from the bacteria that causes kidney infections. If you do receive a prescription for antibiotics, what is the most important thing to do? The answer is: finish your entire course of antibiotics. You do this for a few reasons. The most important reason is to help prevent antibiotic resistance. This is where a particular bacteria is able to survive in the Continued On Page 8

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Ian Lloyd...Continued From Page 6

presence of an antibiotic which previously would have been able to cause its eradication. One thing medical science has learned is that bacteria are great at adapting to new threats to prolong their survival. Take the threat of antibiotics for example. When you take a full course of antibiotics, it will most likely eradicate upwards of 90% of the offending bacteria. If you only take the antibiotic for half its intended duration, perhaps only 50% of the bacteria will be eradicated. The remaining bacteria have the opportunity to learn about this new antibiotic threat and adapt in order to survive next time. If this happens, the bacteria might be immune to a particular antibiotic. If you think this is improbable, you are wrong. Currently, Physicians have to consider known antibiotic resistance when choosing a treatment. This is why it is important to finish your complete course of antibiotic therapy. Side effects, side effects, side effects. It can be a major concern and the reason most people stop taking their antibiotics early. While this article is not long

enough to discuss all the issues with antibiotic side effects, your local Peoples Pharmacist is a wealth of information. The most common side effect, with all antibiotic treatment, is stomach upset. Issues range and are associated with all areas of the digestive system from: nausea, gas, bloating to diarrhea. From top to bottom, so to speak. Perhaps taking your medicine with food will help. Sometimes reducing the dose and increasing the frequency of taking it will help. The most common cause of stomach side effects is the disruption of your normal bacterial flora. Our entire gastrointestinal tract is lined with helpful bacteria. Actually, our entire body is covered with bacteria. I try not to think about this too much. These good bugs perform a multitude of functions: aiding in digestion, keeping out infectious bacteria, making certain vitamins and positively affecting our immune system. The antibiotics you take are not selective about which bugs they get rid of. This could lead to a reduction in your natural intestinal good bacteria. One possible way to remedy the side effects of gas, 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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Osteoporosis - The Silent Disease Osteoporosis is a disease that causes bones to lose mass and become thin and brittle. Weaker bones mean there is more risk of breaks, which can result in pain, deformity, and other serious consequences. As people age their bodies start to re-absorb calcium from their bones, leading to some loss in bone density. Osteoporosis occurs when the bone loss is excessive. Osteoporosis is sometimes called the “silent disease” because many people do not notice symptoms until they break a bone. Symptoms for older people may include fractures of the hip, wrist, or vertebrae (back bone), back pain, loss of height, vertebral collapse, which shortens and curves the spine. Osteoporosis affects about one in four women over the age of 50 and one in eight men over 50. You are more at risk of osteoporosis if you: • are 65 years or older • are of Caucasian or Asian descent • have a history of osteoporosis in your family • have a thin (small-boned) frame. • started menopause before age 45 You have an increased risk for osteoporosis if you: • eat lots of high-protein foods • drink a lot of alcohol or caffeinated beverages • smoke • do not get enough calcium or vitamin D • do not do much weight-bearing exercise Certain drugs or other products may also increase your risk of osteoporosis. If you are taking medications, ask your Peoples pharmacist about risks. Talk to your doctor if you have risk factors for osteoporosis. There are several ways to determine how much bone mass you have lost. Your doctor may recommend a heel ultrasound, bone density scan, or other tests. You can reduce your risk for osteoporosis by making healthy choices about what you put into your body. Follow these basic guidelines: • Eat plenty of fruits and vegeta-

bles — at least 5–10 servings a day. • Limit your daily salt intake to less than 2100 mg. • Limit your daily alcohol intake to two beverages or less. • Limit your daily caffeine intake to three cups of coffee, tea, or soda. • Quit smoking. Other things you can do to help prevent osteoporosis include getting enough calcium, getting enough vitamin D, and staying physically active. Its important to get enough calcium. Ask your Peoples pharmacist about calcium supplements if your diet does not provide enough calcium. Your body will absorb calcium better if you get enough vitamin D. Its important to get enough vitamin D. Your body manufactures some Vitamin D when exposed to sunlight. You should also include vitamin D in your diet, particularly if you’re over 65. Ask your Peoples Pharmacist about calcioum and Vitamin D supplements if your diet does not provide enough. You can help prevent osteoporosis by doing some weight-bearing physical activity most days of the week — exercise at a light to moderate intensity for at least 30–60 minutes. Weight-bearing activities include walking, low-impact aerobics, and dancing. Weight training and other resistance exercises can help maintain bone density as well. For more infomation, talk to your doctor or Peoples Pharmacist about osteoporosis prevention.

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Ian Lloyd...Continued From Page

bloating and diarrhea is to replace these lost bacteria. As you might have guessed, I am a big fan of probiotics and take them every day. Probiotics is the generic name which refers to supplements that contain healthy intestinal bacteria. Probiotics are often called acidophillus, which is the Latin name for most prevalent bacteria within our digestive tract. But which kind should one take and how much? I tend to recommend a multi strain variety. With over 100 different bacteria in our digestive tract, it is hard to say that any one is best. As a dosing guideline I recommend 1-5 billion cells for daily health and over 10 billion for treatment of any stomach issue. Should probiotics be kept in the fridge? The form of probiotic does not really matter, as long as it gives a guarantee of potency on the label. Some forms of probiotics do not have to be kept in the fridge. If you bought it out of a fridge, it should stay in the fridge. If you are currently taking antibiotics, you should take the probiotic supplement at a different time of day from the antibiotic. If you are taking it for general

health, it does not matter when you take it. The next major antibiotic side effect is fatigue. I'm not sure why this happens. Often people with an infection are feeling tired already. The best way to deal with this side effect is to rest. It does sound overly simplistic, but rest is the perfect way to allow your body to heal and fight off any infection. If fatigue gets excessive or worsens, contact your Physician or Peoples Pharmacist. Headache is another common side effect of antibiotic therapy. Again people with infections tend to have a fever which could lead to increased fluid loss from sweating. Dehydration can cause headaches. It would be best to drink extra hydrating fluids to help your body heal. This is by no means a complete article about antibiotics. If you have any questions about antibiotics, or any other question about your health, ask your Peoples Pharmacist. They can be a wealth of information. Written By Ian Lloyd, Pharmacist & Chartered Herbalist, Peoples Pharmacy

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Dr. Hister...Continued From Page 4

ative” for today’s kids is the incredible array of highlycalorific foods and beverages which were just not available to us, and in sizes that we only dreamt about: gigantic portions of pop and popcorn and burgers and fries and muffins, in fact, the default for nearly everything available to a kid to eat or drink is now “giant” sized, and not just for kids: at Starbucks, a short (what to me is a normal-sized) cappuccino is not even on the menu, although you can get one if you ask for it. But what I think is even more important as a cause of obesity in kids is that “down” time for kids has changed so dramatically over the years. The rule once was, most of you can acknowledge, that your mom sent you out to play and told you to come home only if you got beat up (and then, only if you were bleeding enough) or if she yelled that it was time for bed, and you didn’t play indoors – there was, of course, next to nothing to do indoors – you played on the street, in the parks, on any patch of grass you could find (in east end Montreal, patches of grass were virtually non-existent, so that street ball hockey was by far the most popular game, even in mid-July or just a few weeks, in other words, after we kids had thrilled to watch the Canadiens bring home yet another of their nearly annual Stanley Cups. One day, one day surely kids here in BC will also get that thrill. I just hope it happens before I die). Now, of course, for many and varied reasons, “playing” has changed completely, which to me, is the greatest loss suffered by today’s kids because “play” – simple loose, un-chaperoned time in the park or on the pavement with other kids – brought us so many crucial skills that we got to apply in key ways in our adult years: we learned to judge what we could actually do successfully (or at least without major accident) and what might be beyond our abilities or skills to accomplish, we learned to get hurt and pick ourselves up instantly away (because, of course, we didn’t want to be excluded from the game which had quickly moved on without us), we learned to solve disputes without adults butting in to help us “share”, we learned to make our own decisions, and on and on. (I know, I know: if you’re under

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Dr. Hister...Continued From Page 11

50, I sound like a geezer, right? But hey, it’s true, so deal with it). Not to mention, of course, that we got a ton of exercise every day, although we didn’t called it exercise (the words “exercise” and “aerobics” had probably not even been invented yet), we called it playing (adults referred to it as “staying out of your mother’s hair”). These days, of course, play is organized, heavily supervised, sanitized, and worst of all, limited, so no surprise that one recent British study found that many kids actually try to avoid going to the park to “play.” Anyway, my main point in raising these issues is that unfortunately, the future doesn’t look bright for obese kids, since studies have shown that being overweight in childhood and adolescence is linked to much earlier onset of those complications commonly linked to obesity: high blood pressure, strokes, diabetes, and so on. In fact, one study from the American “stroke belt”– a belt that stretches from the Carolinas through Georgia, Alabama, Louisiana, and Mississippi, where the rate of strokes is significantly higher than in other American states – concluded that a person who grows up and remains as a teenager in the stroke belt retains a higher risk for stroke for the rest of their lives, even if they eventually move out of the stroke belt and change their habits to become more resistant to stroke. In other words, teen years are crucial in reducing the eventual risk of stroke (and probably lots of other negative consequences, too). So the bottom line is simple to understand, devilishly hard to apply: as is also true for many of us, our kids desperately need to learn to eat less (and better) and move more. Soon. Unfortunately, how you achieve those goals is way beyond my limited abilities to figure out, so I think I’ll just got out and play some ball hockey, if that is, my wonky knee and my bad back and my asthma allow me to do that. 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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SSY EATE ST ATE IES Parents have so many things to worry about and their children’s health tops the list. When a child rejects food or only wants to eat the same thing every day we become concerned that they won’t thrive. It can be labelled food neophobia, fussy eating, being picky or “selective eating disorder”; but to some degree, a healthy dose of scepticism is a good thing. Children have an evolutionary survival mechanism prone to fear new things but sometimes this may swing out of balance in relation to food. This may create mealtime stress and lead to food related power struggles. Fussy eaters do present the ultimate challenge for parents but some awareness and simple survival tips can help smooth the way for mealtime peace. As a mother of two children with appetites on the opposite ends of the spectrum, I feel that I earned a PHD in surviving “fussy eater” syndrome. My daughter used to turn up her nose at most animal flesh and my son would literally gag on beans and legumes. Meals were carefully scrutinized should they contain onions, mushrooms or tomatoes in a form other than sauce and there were days when I literally felt like I was a short order cook. By the way, the short order cook gig was one of my first major mistakes. Had I “Googled it” back in the day, I likely would have stumbled across information against it and avoided the pitfall. But we did not have Internet “back in the day” hence, my lessons came fast and furious and mostly through trial and error. When they say hindsight is 20 20, they mean it; if I had it all to do over again, I would do it differently. Here are a few things I have learned along the way: 1. Most kids will grow out of picky eating eventually if given the chance. The more we cater to it, the more we enforce it. I learned this when my son (who gagged on beans) stocked his cupboard full of canned chili when he started buying his own groceries. When questioned he replied that they were cost effective and though they weren’t his favourite, he could justify eating them based on supply and demand. 2. Sometimes it is a cultural thing. My daughter’s cohort were primarily from vegetarian families. When she went to Brazil

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in grade 11, she came back with a healthy appetite for all things pork and beef; the more mysterious the better. I had created a mealtime culture that enforced individual menu plans and both kids were happy to abide. 3. It’s okay to stick with staple favourites but switch up the side dishes frequently. The more often a child is exposed to new foods the more likely they are to embrace them eventually. Tempt them with appetizing dips, interesting shapes and conversations around the new food. I began to involve my children in meal planning and shopping and it helped too. 4. Sometimes it is the principle of the phobia you are dealing with more than a taste thing. My son had a thing about onions so I used to tell him they were bits of cabbage. You can also hide or disguise some foods by pureeing them and blending them into their favourite dishes. Be careful here though. I have a friend whose grandmother used to make “use up the fridge” cookies. 1ucchini loaf is one thing, but even the family dog would hide when Grandmother was baking. 5. Children learn by modelling their parent’s behaviour. It did not help my culinary challenges when my children’s father modelled his own picky eating preferences. Thankfully, given time and plenty of perseverance on my part, even he began to enjoy a wider range of foods than when we first met. Mealtimes should be a family time for connection and not a stressful event that ends with a winner and a loser. Build family culture around sharing a wide variety of healthy food and your children will grow up without questioning the “norm.” My daughter is now a young mother who has begun to research her own strategies for introducing foods to her son. Baby led weaning is a practice that introduces real food to children when they are capable of feeding themselves. Some research has shown that introducing foods with interesting textures tends to limit the tendency toward future food fussiness. However she proceeds with his diet, my job is to be the best grandmother I can be and you can bet my cookies will be delicious! Good Health to You!

Chicken Coconut Curry

A modernized twist on an Indian classic, this recipe uses a creamy curry to blend the flavours of stewed chicken, onions, spinach, tomatoes and garlic. Tasty without being too spicy, this dish will appeal to adult and child alike, and busy cooks love the ease of preparation. Just sit back and let this meal take care of itself. 11⁄2 lbs (680 g) boneless, skinless chicken breast halves 1 ⁄4 tsp (1 mL) ground cumin 1 tsp (5 mL) curry powder 1 ⁄4 tsp (1 mL) ground cinnamon 1 ⁄8 tsp (0.5 mL) ground cloves 1 ⁄8 tsp (0.5 mL) cayenne pepper 1 tsp (5 mL) paprika 3 ⁄4 tsp (4 mL) salt 1 ⁄2 tsp (2 mL) pepper 1 white onion, diced 3 carrots, julienned 1 tomato, diced 4 cloves garlic, minced 1 ⁄2 cup (125 mL) coconut milk 1 Tbsp (15 mL) brown sugar 1 ⁄2 cup (125 mL) tomato paste 1 cup (250 mL) brown rice 11⁄4 cups (300 mL) boiling water 3 cups (750 mL) fresh spinach leaves, lightly packed 7 oz (200 g) raw cashews 2 Tbsp (30 mL) chopped fresh cilantro

Heat a large crock pot and add first 15 ingredients. Set on medium-high heat and cook for 3 to 5 hours. Add brown rice and boiling water and cook for another 45 minutes or until rice is tender. Fold in spinach and cook for another 2 minutes or until spinach has wilted. Garnish with cashews and cilantro. 1 serving: : 520 Calories; 21 g Total Fat (8 g Mono, 3 g Poly, 7 g Sat); 65 mg Cholesterol; 50 g Carbohydrate; 7 g Fibre; 37 g Protein; 470 mg Sodium

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The articles published in People First are for the general information of the reader. While effort is made to reflect accepted medical practice and knowledge, articles should not be relied upon for the treatment or management of any specific medical concern or problem and People First accepts no liability for reliance on the articles. For proper diagnosis and medical care, you should always consult your family physician promptly. Opinions expressed in sponsored articles by, Dr. Art Hister, Ian Lloyd, and Darlene Booth are paid editorials and are not necessarily shared by Peoples Drug Mart stores or Peoples Drug Mart (B.C.) Ltd. Some advertised products are not available in all stores. We reserve the right to substitute products or limit quantities. Prices effective while quantities last. Sale in retail quantities only.

Travel Vaccinations At Peoples Pharmacy Most Peoples Pharmacists can now administer travel vaccinations on-site Planning a trip for this winter? A visit to your doctor, and a subsequent visit to a Peoples Pharmacist that is trained and certified to provide travel vaccinations, can help you with travel health. Besides travel vaccinations, a Peoples Pharmacist can also recommend medications for stomach troubles and motion sickness. Talk to a Peoples Pharmacist for advice on staying healthy while you travel.