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SEASONAL FLU HOW TO FIGHT

SHINGLES

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People First

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October 2014.

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Features & Cover Articles 4 8

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SHINGLES

HEALTHY CHOICES

Helpful information on shingles, a viral infection that causes a painful rash. Read about treatment and prevention options.

Take charge of your health with beneficial vitamins and supplements.

Feeling a bit run down? Read tips on putting the spring back into your step.

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15

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SEASONAL FLU With flu season coming, find out about influenza and ways to prevent and treat the flu bug.

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SPOTLIGHT ON OUR COMMUNITIES A look at New Westminster and Vancouver, two B.C. communities that Peoples is proud to be a member of.

SAVE ON HEALTH Great selection of quality health and wellness products from Peoples Pharmacy.

38th Anniversary 1976-2014 Proudly celebrating 38 years of helping people live better lives. Peoples Drug Mart and Peoples Pharmacy are community owned and operated pharmacies that have provided trusted health services since 1976.

FIGHTING FATIGUE

GREEK CANNELLONI

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Ian Lloyd

SHINGLES

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 varicellazoster virus) is also responsible for shingles. After your body successfully fights off chickenpox, some of the virus travels up into nerve fibers and becomes dormant. Later, the virus reactivates and travels down the nerve fibers to the skin surface.

This causes the classic symptoms of shingles: • Numbness, tingling, itching, or pain in the place where the rash is about to appear • Fever (sometimes with chills), nausea, or headache • The appearance of bumps or blisters that contain clear fluid • A rash or odd sensation 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) 4 People First Join us on

Pharmacist

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 pain.

This condition sounds like a horrible state, but there are prevention options. One of the wisest choices made by the BC Government was to provide vaccinations for the chickenpox (varicellazoster) virus. All infants are now able to get this new vaccine with their normal immunization shots. There is promising evidence showing that children who received the chickenpox vaccine are less likely to develop shingles when they are older.

Luckily, there is a vaccination against the virus that causes shingles. Ask your Peoples Pharmacist if they 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 Continued On Page 11

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SEASONAL FLU

The flu is a respiratory (i.e., nose, throat, and lung) infection that can be caused by a variety of influenza viruses. Many people use the word flu when they actually have a cold. Although the common cold is also caused by viruses, the flu and common cold differ in several ways.

In North America, the flu almost always strikes between November and April. Up to 25% of the population may be infected in an average year.

Stronger epidemics (i.e., when the flu occurs in more people than expected in a given area or season) come every 2 or 3 years, infecting twice as many people as during an off year.

Most people who get the flu will recover within 1 to 2 weeks, but some people are at risk of developing complications such as pneumonia.

On average, about 4,000 to 8,000 people in Canada die each year from complications of influenza, and about 20,000 people with the flu are hospitalized. Most of these people have other medical conditions, are seniors, or are very young children.

Causes Influenza is contagious, which means it can be spread easily from person to person. Viruses that cause influenza spread from person to person mainly by droplets of respiratory fluids sent through the air when someone infected with the virus coughs or sneezes. Other people inhale the airborne virus and can become infected.

In some cases, the flu can be spread when someone touches a surface (e.g., doorknobs, countertops, telephones) that has the virus on it and then touches his or her nose, mouth, or eyes. The flu is most easily spread in crowded places such as schools and offices.

There are three families of influenza virus: A, B, and C. Type C more commonly affects ducks, geese, turkeys, and chickens, but it has also been involved in a small percentage of human cases. Type B mainly affects humans and causes a milder disease, and it changes very little from year to year.

Type A influenza poses the most serious problems for humans. Strains of this type have also been found in birds, humans, horses, pigs, seals, whales, and ferrets. Viruses that affect two different species sometimes combine and mix-and-match genetic information to create a new strain that nobody is immune to and for which no vaccine has been prepared.

There are potentially infinite new varieties of type A influenza. Avian flu is a type of influenza A that had been seen only in birds, including chickens and ducks, until 1997 when the first human case was reported in Hong Kong. Although the avian flu affected mostly animals, it did cause a few cases of severe disease with a high risk of death in humans. Many birds were slaughtered in Hong Kong to prevent the disease from spread-

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ing. In early 2004, outbreaks of the avian flu re-emerged in Japan, South Korea, Vietnam, Thailand, Cambodia, China, and Indonesia. Human cases have been reported in Vietnam and Thailand. Millions of chickens have been affected and killed in the countries listed in an attempt to stop the spread of the disease.

Swine flu is another type of influenza A that is normally found in pigs.

Swine flu is passed from pig to pig, and although it usually only infects pigs, there have been periodic infections in humans, resulting in H1N1 flu virus (human swine flu). Most of these cases occur in people with direct exposure to pigs (e.g., people working on pig farms). Person-toperson transmission of the H1N1 flu virus (human swine flu) does occur, but it is not clear how easily the virus is spread among people.

The flu takes 1 to 4 days to incubate in humans, but infected people become contagious before symptoms appear, often just the day after the virus enters the body. Adults remain infectious (i.e., they can spread the virus to others) for about 6 days, and children remain infectious for up to 10 days.

Symptoms and Complications Initial flu symptoms include headaches, chills, and a cough. Symptoms such as fever, loss of appetite, and muscle aches soon follow. Other symptoms such as nausea, vomiting, and diarrhea are rare in adults but more common in children.

Since many people think they have the flu when it's actually a bad cold, here's a quick guide to help you tell the difference: Symptom Cold Flu fever uncommon usually present, high (38[C to 41[C or 102[F to 104[F); lasts 3 to 4 days headache uncommon very common aches & pains slight common and often severe fatigue and weakness mild significant; can last 2 to 3 weeks extreme exhaustion never very common at the start stuffy nose common sometimes sneezing common sometimes sore throat common sometimes mild to moderate common; often severe with chest discomfort and cough hacking cough painful cough For most people, the flu lasts 1 or 2 weeks, but it can last for up to 1 month. The main complications are secondary bacterial infections of the sinuses or lungs (pneumonia). Symptoms include fever; chills; and yellow, green, or brown sputum (nasal discharge). Children are prone to ear infections like otitis media.

Continued On Page 10

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Getting the flu vaccination is your best defense against seasonal flu and most Peoples Drug Mart and Peoples Pharmacy Ea. locations offer convenient on-site flu vaccination services.

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Spotlight

On Our Communities

New Westminster Known as the “Royal City,” New Westminster has history and geography on its side. In 1959, it was named by Queen Victoria as B.C.’s first capital and is Western Canada’s oldest city.

New Westminster hosts numerous events and the renowned Hyack Festival each spring is the most popular.

Situated in the centre of the Lower Mainland on the banks of the Fraser River, New Westminster is a vibrant transportation point featuring five rapid transit stations and access to major highways. New Westminster features distinctive neighbourhoods a network of greenways and a vibrant waterfront that makes it a great place to live, work and play.

Photo courtesy Stephanie Petrie/PictureBC

Photo courtesy Stephanie Petrie/PictureBC

Photo courtesy Stephanie Petrie/PictureBC

Vancouver

Photo courtesy Josh McCulloch/PictureBC

Photo courtesy Josh McCulloch/PictureBC

While known for its beautiful skyline, the city of Vancouver also has many communities that add to its charm. Champlain Heights is such a neighbourhood.

Champlain Heights was one of the last areas of Vancouver to be urbanized. Located in the south eastern corner of Vancouver. It is not uncommon for visitors to Champlain Heights to get lost due to the numerous winding tree-lined streets and cul-de-sacs.

Everett Crowley Park, a 40-hectare park (the city's 5th largest) is located in the area.

Champlain’s parks and relaxed style makes it country living in the city.

Everett Crowley Park

1000 was donated to the Salvation Army Southview Terrace & Heights Senior’s lodge to help purchase blood pressure monitors and assist in a hydration program. Jenny DeMarchi, Front Store Manager, Henry Kwok Pharmacy Manager and Partner, presenting cheque to Major Lorraine Burry, Executive Director and Veeta Deol, Assisted Living Manager The Peoples Drug Mart Healthy Communities Fund (HCF) is a community support program that provides financial assistance to health related organizations in Peoples Drug Mart communities. The HFC is funded by the owner operators of Peoples Drug Mart and from the proceeds of the Peoples Drug Mart Golf Event. peoplesdrugmart.com People First

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Seasonal Flu..Continued From Page 6

People in nursing homes are at a higher risk of complications from flu because they may have weak immune systems and often have other medical problems. People with asthma, chronic obstructive pulmonary disease, or congestive heart failure are also at a higher risk of developing bacterial infections like pneumonia.

In American studies, influenza hospitalization rates for children under 5 years of age were second only to the hospitalization rate in people over 65 years of age. School-aged children have the highest infection rates both during and between epidemics, and they are likely to be infected early in the season. Households with school-aged children have infection rates 30% above the average rate.

Making the Diagnosis Since the symptoms of an influenza infection are very different from the common cold, the diagnosis can be made fairly quickly. Your doctor will be able to tell that you have the flu if you have at least some or most of these symptoms: • aches and pains everywhere, especially in the back and legs • bad headache • burning sensation in the chest • dry cough at first, then bringing up sputum • high fever • nausea and possible vomiting • sore throat • runny or stuffy nose • extreme tiredness If there is any doubt, your doctor can make sure that it's the flu by taking a throat swab and testing it for the virus. This is rarely needed.

Treatment and Prevention The normal treatment for flu is rest and plenty of liquids. Treatment also includes ways to prevent spreading the flu virus, such as proper handwashing, keeping common surfaces clean, and coughing or sneezing into your arm or sleeve.

Medications for specific symptoms can help. Cough suppressants can be used for cough. Acetylsalicylic acid* (ASA), ibuprofen, or acetaminophen can be used to treat symptoms of the flu, such as aches and fever.

Children and teenagers with flu shouldn't take ASA or other salicylates (medications related to ASA, such as salsalate or magnesium salicylate).

The combination of influenza and ASA is linked to Reye's syndrome, a rare

but serious condition affecting the brain and liver. Many over-the-counter cold medications contain ASA or other salicylates. Ask your doctor or pharmacist about this.

Antibiotics are not effective against viral infections like flu and the cold, but they are prescribed for complications such as bacterial infections.

Antiviral medications are sometimes used to treat the flu. These medications can help shorten the duration of the flu and reduce symptoms if they are taken within 2 days of the start of symptoms. Antiviral medications are also recommended to prevent flu infection for some people. Antivirals can be used to prevent flu in children and adults after they come into close contact with a person who has the flu, such as flu-infected people who live in the same household. Generally, this is not recommended for most people; however, antivirals may be recommended for people at risk for flu complications. In these situations, antiviral medications should be started as soon as possible after becoming exposed to the person with the flu. Your doctor can decide whether you should start antiviral medications.

Flu antibodies can prevent the flu. The only ways to generate antibodies are to be infected or to get vaccinated. Because the flu viruses can change from year to year, vaccination needs to be repeated every year.

Each spring, a worldwide network of physicians and testing labs decide which flu strains are likely to cause trouble and design that year's vaccine accordingly. The vaccine gives resistance to the type B strain and the two type A strains that are expected to predominate in the coming flu season.

The vaccine is over 80% effective in preventing flu in healthy adults, which means there is still a chance that you can get the flu – although your symptoms may be milder. The flu vaccine is given to anyone classified as high risk for flu complications, and for people who are caregivers, health workers, and anyone who wants to avoid the flu. The flu vaccine is paid for by the government in some Canadian provinces, and universal vaccination is encouraged.

High-risk groups for flu complications include: • anyone aged 65 years or older • children under 5 years old (especially if they are less than 2 years old) • people with underlying medical conditions, including people with: asthma and other chronic lung diseases (e.g., chronic obstructive pulmonary disease [COPD], cystic fibrosis) • diabetes Seasonal Flu...Continued On Page 12

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PEOPLES PHARMACISTS

Ian Lloyd...Continued From Page 4

had shingles in the past 12 months, speak with your doctor or your Peoples 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. Many Peoples Pharmacists can provide this, and other, vaccines right in their stores.

The most tragic after-effect of shingles is called postherpetic neuralgia. This is the medical term for shingles induced nerve damage. The pain can range from mild or slightly irritating to excruciating and unbearable. The pain can last for a few months or it can even last for years. This is why taking the antiviral medications promptly is important. They help to reduce the severity of postherpetic neuralgia.

Unfortunately, plain acetaminophen or ibuprofen are generally not effective for helping to treat post-shingles nerve pain. Stronger opiates, such as codeine or morphine, are needed to treat this severe form of pain.

Most times postherpetic neuralgia requires other options to help treat the pain. One current treatment option is to use medications that can alter your perception of pain. For some unknown reason, many of the drugs that treat epilepsy can also be used to treat pain. These drugs include gabapentin (Neurontin), carbamazepine (Tegretol) and Lyrica. The advantage of these drugs is that they can greatly reduce the amount of pain medications needed to feel comfortable. Some older antidepressants are also used for this purpose; amitryptylline and nortryptylline.

Some Peoples Pharmacists are able to compound specialized creams to help treat shingles pain. Some formulas contain many of the medications listed above. Sometimes they also use a topical anesthetic called lidocaine. Lidocaine tends to numb the top few layers of the skin and can be quite helpful for treating shingles pain.

One last type of topical product contains a plant extract called capsaicin. Capsaicin is extracted from hot chili peppers. When applied to the skin in very small amounts, capsaicin is effective in

Helping People Live Better Lives

We Can Help With Shingles Vaccinations.

About 1 in 3 people will get shingles in their lifetime. Select Peoples locations offer convenient on-site shingles vaccinations that can prevent or reduce the severity of shingles.

Henry Kwok

Pharmacist & Partner, Vancouver

We Can Help Reduce Strain On Achy, Tired Legs.

Select Peoples Drug Mart and Peoples Pharmacy locations offer compression stocking and fitting services, which help treat painful venous leg disorders.

Check with your local Peoples for this health service.

Colleen Hogg

Pharmacist &Owner,Quadra Island

We Can Help With Medication Reviews.

Medication reviews are in-depth consultations that improve health outcomes by helping resolve any issues that may have arisen due to your medication. Ask about the medication review service.

Jay Ross

Pharmacist & Owner, Trail

Ian Lloyd...Continued on Page 13

peoplesdrugmart.com People First 11

Flu Vaccinations Flu season is coming and Peoples Drug Mart is committed to helping you stay healthy all season long.

Getting the flu vaccination is your best defense against seasonal flu and many Peoples Drug Mart and Peoples Pharmacy locations offer convenient flu vaccination services. It’s easy and can help you beat the flu bug.

Peoples Locations That Administer Flu Vaccinations Abbotsford Ashcroft Burnaby Ifluenza..Continued From Page 6 Campbell River Chase Chetwynd Cranbrook

Golden Kelowna West Kelowna Kitimat Lytton Mackenzie Nakusp

Nelson Penticton Port Hardy Port McNeill Quadra Island Revelstoke Richmond

Salmo Scotch Creek Sooke Sparwood Surrey - Ocean Park Trail Ucluelet

Vancouver (Champlain) Vancouver (West 57th Ave.) Victoria (Quadra St) White Rock

Seasonal Flu..Continued From Page 10

• heart disease (e.g., coronary artery disease, congestive heart failure, congenital heart disease) • chronic kidney or liver disease • a weakened immune system (immunocompromised), which can be caused by: - HIV/AIDS, an infection that attacks the immune system - cancer - medications for certain conditions, such as: organ transplants: steroids, medications that suppress the immune system to prevent it from rejecting the organ (e.g.,cyclosporine, tacrolimus, mycophenolate mofetil) - cancer: chemotherapy - certain types of arthritis, such as rheumatoid arthritis: steroids, biologics (medications that modify the response of the immune system, such as adalimumab or infliximab), medications that suppress the immune system to prevent it from attacking the body (e.g., methotrexate, azathioprine) - Crohn's disease: steroids, biologics (see above), or medications to suppress the immune system • blood disorders (e.g., anemia, sickle cell anemia) • neurologic and neurodevelopmental disorders that affect their ability to swallow and breathe • morbid obesity (BMI of 40 or higher) • residents of nursing homes or other chronic care facilities, regardless of age • children receiving long-term ASA therapy

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• pregnant women (especially if they are in their second or third trimester) and women who were recently pregnant (within the last 6 weeks) • Aboriginal peoples People who should not receive a flu shot include children less than 6 months of age and people who have had an allergic reaction to a previous flu vaccine.

The injectable flu shot (but not the nasal spray) has been shown to be safe for many people with egg allergies. Your doctor will need to assess whether you should have a flu shot if you are allergic to eggs. Be sure to tell your health care provider about this and any other allergies you may have before you are given your flu shot.

You can reduce your risk of getting the flu by washing your hands regularly using soap and warm water or an alcohol-based hand sanitizer. Also, cough or sneeze into a tissue or into your sleeve. Dispose of the tissue right away. If you have flu symptoms, stay home from work or school and avoid contact with people who are at a high risk of flu complications (e.g., seniors, nursing home residents).

All material © 1996-2014 MediResource Inc. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition

Ian Lloyd...Continued From Page 11

fighting the pain associated with arthritis and the neuralgia (nerve pain) associated with shingles.

How capsaicin works is rather unique. After topical application, capsaicin interferes with the actions of substance P. Substance P (SP) is thought to be associated with the transmission and perception of pain from the peripheral nerves. Once capsaicin cream is applied to the skin, it causes a rapid release of SP from the peripheral neurons. This release of SP is associated with a sensation of heat or burning at the site of application. After subsequent applications, SP stores are further depleted.

With this depletion of SP, the burning sensation after application is less noticeable and pain at the site is also less pronounced. Effects can be noticed after one or two days and can last for weeks. It is through these actions that capsaicin creams are effective treatments for arthritis, diabetic neuropathy and the pain associated with post shingles neuralgia.

Several products contain capsaicin, Zostrix® being the most common one. This product can cause a burning sensation when applied to the skin, so be very careful where you apply it. Generally, this sensation reduces the longer you use the product. It can take up to four weeks of continual use to feel the maximal effect of capsaicin, but it works very well. Avoid using these topical products on irritated or broken skin. Also, avoid using these products on sensitive areas of the body. Especially avoid contact with your eyes and mucous membranes. Always wash your hands after applying these products.

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. All of these things can lower the activity of your immune system, so stay healthy and get lots of rest.

Written By Ian Lloyd, Pharmacist & Chartered Herbalist

PEOPLES PHARMACISTS Helping People Live Better Lives

We Can Help You Live A Better Life.

Peoples Pharmacists have years of training - not only about your medications, but also about the conditions they treat. Talk to a Peoples Pharmacist, their role is changing to help you better manage your health.

Anna Thorrougood

Pharmacist & Owner, Richmond NEW PHARMACY!

We Can Help With Flu Vaccinations.

Getting the flu vaccination is your best defense against seasonal flu and most Peoples Drug Mart and Peoples Pharmacy locations offer convenient on-site flu vaccination services.

David Lafreniere

Pharmacy Manager, Revelstoke

We Can Help You Safely Dispose Your Unused Medications.

Make your home safer by bringing expired or unused medications to Peoples. We will environmentally dispose your old medications removing the risk of accidental poisonings or medication abuse.

Merv Banting

Pharmacist & Partner, Ucluelet

peoplesdrugmart.com People First 13

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Darlene Booth

FIGHTING FATIGUE

Last night I had a date with Netflix and before I knew it the hour was very late. I scooped myself off the couch and slumped into bed feeling the pinch of irony that today I will likely need coffee to fuel the writing of an article about fatigue. Thankfully, fatigue and I are not constant companions; one good night’s sleep will top up my energy levels and I will be flitting about once again. Fatigue can be a temporary self-induced state of weariness but sometimes fatigue is a deeper issue that can interfere with an individual’s capacity to participate fully in the dance of life. To fight pervasive fatigue, we need to play health detective and have a willingness to make some changes in diet and lifestyle.

To be a health detective, one has to enlist the help of a trained professional and rule out the possibility that a medical condition or underlying illness is the root of the problem. We need to look at health both on the physical and mental level.

Could fatigue be a symptom of allergy, heart disease, anxiety or depression? There is a comprehensive list of health problems that contribute to fatigue that only you and your health professional can figure out. It all begins with a phone call.

Are you still living your life like you were twenty something and aware that the kids today consider your wardrobe essentials fair game for Halloween? Work hard and play hard may have been your mantra back then, but your aging body actually needs ample downtime for maintenance and housekeeping. The second step of playing health detective calls for courage and honesty, as you own up to some of these common fatigue inducing lifestyle factors: 1. Is disordered sleep or a sleep disorder robbing you of energy? Are you getting a minimum of 8 hours quality sleep each night? Dealing with sleep issues is an essential first step in cleaning up the lifestyle. To do so you may have to reduce stress in your life, give up caffeine, stop late night eating, avoid sleeping pills and abstain from alcohol and internet use before bed.

2. Are you moving your body every day? Exercise oxygenates our body, helps move out waste products out and stimulates energy production at the cellular level. When you are in the

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grips of fatigue, the idea of exerting energy can feel counterproductive but it does help. 20 minutes of moderate daily exercise has been shown to have a positive effect on energy levels. Keep in mind that more is not always better; overexertion will certainly drain your reserves especially if they are low to begin with.

3. Are you thirsty? Many people walk around in a state of low-grade dehydration on a daily basis and fatigue is one of the early warning symptoms of dehydration. How much water you need will vary depending on your activity level and the climate you live in but if you are not drinking at least 8 glasses a day, chances are you will feel more energized once you do.

4. Are you eating an inferior diet and expecting a miraculous outcome? Quite simply – we are what we eat. If we eat nutritionally inferior food we live a low vitality outcome. Weed out the overly processed foods and adopt a whole foods approach to eating. If you need a first step here, start with sugar. Nothing creates an energy crash as efficiently as a blood sugar spike.

5. Are you relying on crutches to keep you going? While coffee was my friend this morning, I am mindful that it was a tool I could use but not rely on. If we become dependant on caffeine or other stimulants, we tax our endocrine system and risk burning out. Keep the crutches for emergencies only and try eating a piece of protein to perk you up. Protein gives us energy without causing a surge in our blood sugars.

6. Are you taking a multivitamin? I consider a good quality multi vitamin an essential piece of my personal health insurance. If you are not eating an optimal diet, chances are you may have a nutritional deficiency that is dragging you down.

It is worth your while to consult a natural health practitioner to make sure your individual nutritional needs are being met.

As for last night? I have no regrets, the movie was good and overall, my lifestyle is balanced enough to offset the occasional Netflix binge watching session. Now, it is time for my walk Good Health to You

Greek Cannelloni Flavours of Greece turn an Italian classic into a new favourite.

For faster preparation, melted cheese takes the place of béchamel sauce.

Olive oil Chopped fresh white mushrooms Chopped onion Diced green pepper Can of crushed tomatoes Prepared vegetable broth Greek seasoning Large egg Ricotta cheese Box of frozen chopped spinach, thawed and squeezed dry Crumbled feta cheese Grated lemon zest Oven-ready cannelloni shells Chopped kalamata olives Grated mozzarella cheese Crumbled feta cheese

2 tsp.

1 cup 1 cup 1 cup 28 oz.

1 cup 2 tsp.

1 11⁄2 cups 10 oz.

10 mL 250 mL 250 mL 250 mL 796 mL 250 mL 10 mL 1 375 mL 300 mL

3 ⁄4 cup 2 tsp.

18 1 ⁄2 cup 3 ⁄4 cup 1 ⁄2 cup

175 mL 10 mL 18 125 mL 175 mL 125 mL

Greek Cannelloni

Heat olive oil in large frying pan on medium. Add next 3 ingredients. Cook for about 10 minutes, stirring often, until onion is softened.

Add next 3 ingredients. Stir. Spread half of tomato mixture in greased 9 x 13 inch (23 x 33 cm) baking dish.

Combine next 5 ingredients in medium bowl. Spoon mixture into large resealable freezer bag with piece snipped off corner. Pipe into pasta shells. Arrange in single layer over tomato mixture in baking dish. Pour remaining tomato mixture over top.

Scatter remaining 3 ingredients, in order given, over top. Cover with greased foil.

Bake in 350ºF (175ºC) oven for about 1 hour until pasta is tender. Carefully remove foil. Bake for about 15 minutes until cheese is golden. Let stand for 10 minutes. Makes 18 cannelloni.

1 cannelloni: 140 Calories; 6 g Total Fat (2.5 g Mono, 0 g Poly, 3 g Sat); 25 mg Cholesterol; 13 g Carbohydrate; 2 g Fibre; 8 g Protein; 440 mg Sodium

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