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PEOPLES Health WHAT YOU NEED TO KNOW ABOUT

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Helping People Live Better Lives

DRUG-INDUCED NUTRIENT DEPLETION HELPING YOU UNDERSTAND

VICTORIA & BURNABY BENEFITS OF A FIT BRAIN SPOTLIGHT ON

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January 2015

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Features & Cover Articles 4 7 DRUG-INDUCED NUTRIENT DEPLETION

Read on how certain prescription medications can deplete your body of important vitamins.

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SAVE ON VITAMINS Great savings on beneficial vitamins and supplements.

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A FIT BRAIN

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

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Helpful tips on keeping your brain active and healthy. Exercising the brain helps to ensure optimum cognitive health.

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SPOTLIGHT ON OUR COMMUNITIES

CARIBBEAN VEGETABLE RICE

A look at Victoria and Burnaby, two B.C. communities that Peoples is proud to be a member of.

Brand new feature recipe From Company’s Coming Vegetarian Recipes.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE Over 700,000 Canadians have chronic obstructive pulmonary disease, or COPD. Smoking is the main cause of COPD.

Healthy Choices Page 5

People First is now PEOPLES HEALTH We’ve changed the name of our magazine to better reflect our commitment of helping people live better lives. Peoples Health magazine is dedicated to helping improve people’s health and wellness by providing trusted health information.

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DRUG-INDUCED NUTRIENT DEPLETION

Ian Lloyd Pharmacist

Many people who have high blood pressure are Is this really a thing? Does drug-induced nutrient taking a diuretic (water pill) of some sort. These depletion actually exist? Actually, it does occur. medications work very well and generally have few Certain prescription medications can deplete your side effects. Your doctor and Peoples Pharmacist body of important vitamins. This is not something are aware of these medications ability to alter the that comes up during the usual dialog about medamount of potassium in your body. However, ication side effects. Luckily, this is changing. Your some diuretics can also deplete your body of magPeoples Drug Mart Pharmacist is always learning nesium, calcium and thiamin and passing this information Certain nutrients (vitamin B1). A lack of magnealong. This month we shall sium might lead to muscle highlight some of the most immight be removed weakness, stiffness, constipaportant drug-induced vitamin from the body as a tion and osteoporosis. Calcium depletions, so you and your side effect of a is very important for bone pharmacist can work together health. Thiamin is very importo help you stay healthy. medication. tant for heart function and enHow can a prescription medergy production. If you are taking a diuretic, this ication reduce vitamins in the body? There are a might be a good time to talk to your Peoples Pharfew ways this can happen. The first is that certain macist to see if this depletion might affect you. medications might decrease the absorption of Sometimes all it takes is to take extra vitamin B1 nutrients from your diet. Some medications are and ensure you are getting enough magnesium intended to reduce stomach acid production. and calcium in your diet.

Vitamins and minerals that require stomach acid Another group of medications that can cause for absorption might be affected. Certain nutrients nutrient depletion are those which reduce the promight be removed from the body as a side effect duction of stomach acid. These medications inof a medication. Diuretics (water pills) make the clude the proton pump inhibitors (PPI) and H2 kidneys work better at removing sodium from the receptor blockers. Ask your Peoples Pharmacist if body, but this action also removes certain you are taking these medications and if it could afvitamins. Other medications might change your fect your nutritional status. While these drugs work body's metabolism and increase the utilization of well to reduce the symptoms associated with excertain vitamins. Some of these drug and nutrient cessive stomach acids, certain nutrients require interactions might not be monitored. This is why stomach acid for absorption. The most notable are it is important to ask your Peoples Drug Mart the minerals calcium, iron and zinc. Normally, Pharmacist about your medications.

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Supplement Your Health & Wellness

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CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic bronchitis and emphysema are the airways to produce excess mucus that lines together called chronic obstructive pulmonary the walls of the airways, making the air passages disease, or COPD. This is a chronic condition very narrow. This makes it easier to get a where not enough air enters or leaves the bronchial infection. An infection can cause lungs. even more damage to the airways by causing In chronic bronchitis, the airways (or more mucus production. bronchi) that connect the Less common causes of windpipe and the lungs beCOPD include a rare genetic It's a very common concome inflamed and swollen. disorder called alpha-1 antitdition, especially among The airways become narrow rypsin deficiency, air pollution, people who smoke. and are clogged up with exposure to occupational More than 700,000 thick mucus, called phlegm. dusts and chemicals, and Chronic bronchitis may be frequent lower respiratory Canadians have COPD. found together with emphyinfections during childhood. sema, in which destructive changes of the air Symptoms and Complications sacs in the lungs cause them to become larger, People with chronic bronchitis may cough up reducing the surface area where oxygen phlegm almost every day. exchange takes place. Both diseases make it It is common for someone with chronic difficult to breathe. bronchitis to persistently cough and wheeze It's a very common condition, especially when breathing. It is also common to feel short among people who smoke. More than 700,000 of breath. Low oxygen in the blood due to the Canadians have COPD. In the United States, decreased ability to diffuse oxygen across the about 12 million are affected with this condiair sacs may cause the lips or fingernails to tion. COPD is the fourth leading cause of death become bluish in colour. in both Canada and the United States. More COPD can lead to heart failure, as the heart women than men have COPD, except in the has to work harder to pump blood into the age category above 75. lungs. When the heart fails to pump blood Causes properly, it collects in the blood vessels of the Smoking is the main cause of COPD. It causes legs and ankles and causes them to swell - this 6 PEOPLES Health Join us on

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COPD...Continued From Page 6

is called edema.

Sometimes you may become housebound because of breathing difficulties, even when doing simple tasks such as getting dressed or washing.

If you have COPD, it is likely that you may catch one or two infections every winter. You may also occasionally cough up blood. If this happens, it may be a sign of a more serious problem and it's important to see your doctor.

Making the Diagnosis Your doctor will test to see how much air you can forcefully exhale in one second. These pulmonary, or lung breathing, tests are simple and painless. If you exhale less than normal, your airways are inflamed, in spasm, or clogged up with mucus. If this persists, then you may have COPD.

Treatment and Prevention Even with treatment, COPD often becomes progressively worse. The only treatment to slow the progression of COPD is stopping smoking.

Lung function deteriorates with age, and it happens much faster if you're a smoker.

Your doctor may prescribe medications called short-acting bronchodilators, including salbutamol*, ipratropium bromide, or a combination of the two, which relax and widen the bronchi and help relieve shortness of breath.

If symptoms are persistent, treatment with as long-acting bronchodilators such tiotropium, salmeterol, or formoterol can be added. If there is any inflammation present (not as common in COPD as in asthma), your doctor may suggest that you try inhaled or oral corticosteroids to help with breathing.

Continued On Page 10

It is estimated that nearly 1 in 3 people will experience shingles in their lifetime and the risk increases after the age of 50

Shingles Vaccination The shingles vaccine protects against herpes zoster, more commonly referred to as shingles. Shingles is caused by the varicella zoster virus, which also causes chickenpox. The shingles vaccine is the best way to protect you from getting shingles. The vaccine has been shown to reduce the risk of getting shingles by 50%. For those who still get shingles after being immunized, the vaccine can reduce pain, including the type of pain that lingers after shingles.

Talk to your Peoples Pharmacist today to find out how to help protect yourself against shingles and if the shingles vaccination is right for you.

Peoples Locations That Administer The Shingles Vaccination ABBOTSFORD

CRANBROOK

MACKENZIE

REVELSTOKE

SURREY

1945 McCallum Rd.

East Kootenay Hospital

700 MacKenzie Blvd.

555 Victoria Rd.

107-15551 Fraser Hwy

ASHCROFT

KELOWNA

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TRAIL

403 Railway Ave.

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1892 Peninsula Rd.

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VANCOUVER

166-1848 Main St.

107 Centennial Square

531 Main Street

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7160 Kerr St.

Spotlight

On Our Communities

Victoria Elegant old world charm meets hip shopping, sophisticated dining tastes, a myriad of museums, galleries, theatres, lush landscapes and a lively civic spirit in a picture perfect harbour setting.

Situated in Canada’s warmest climate, Victoria is truly in-bloom year-round. Visit worldfamous Butchart Gardens. Take high tea at the renowned Fairmont Empress Hotel or visit the colourful Chinatown.

The inner harbour comes alive with cruise ships, dragon boats, tall ships and street performers. The vibrant community of Victoria welcomes millions of tourists from around the world, year round.

Photo courtesy Michael Tourigny/Picture BC

Photo courtesy Michael Tourigny/Picture BC

Photo courtesy Michael Tourigny/Picture BC

Burnaby

Photo courtesy Jon Pesochin/PictureBC

Photo courtesy Jon Pesochin/PictureBC

Beautiful Burnaby is located in the heart of Metro Vancouver. The city that has it all is a mature, urban community with a whopping quarter of its land as park and open space.

Get lost in the valleys, two freshwater lakes, mountain forests, ocean beach and riverfront on opposing shores.

Enjoy high adventure and amazing views from Burnaby Mountain or seek urban adventure in B.C’s largest shopping mall. Located on the spectacular Burrard Inlet, Barnet Marine Park is one of Burnaby’s best kept secrets.

Another great family outing is the Burnaby Central Railway. This 7-acre site located at Confederation Park is run by miniature locomotive enthusiasts and is open to the public.

Photo courtesy Jon Pesochin/PictureBC

Proud to Support Our Communities Peoples Drug Mart believes in supporting and strengthening our local communities. Peoples Drug Mart is proud to support the ALS Society of BC and offer assistance through the Peoples Drug Mart Healthy Communities Fund. peoplesdrugmart.com PEOPLES Health 9

COPD...Continued From Page 8

There are also medications available that combine long-acting bronchodilators with inhaled corticosteroids. Your doctor may also prescribe antibiotics for you to keep at home in case a bacterial lung infection develops.

Since influenza (the flu) may make COPD symptoms worse and can lead to respiratory failure, it is recommended that people with COPD receive the annual flu vaccine. Some people with COPD may also benefit from receiving a pneumococcal vaccine to lower their risk of getting pneumonia (lung infection), which can also lead to complications. Talk to your doctor about receiving these vaccines.

Inhaling oxygen from oxygen cylinders or an oxygen concentrator for at least 15 hours a day may also be helpful for some people with COPD. Finally, drinking plenty of fluids through-

out the day can help loosen phlegm buildup.

Exercise with or without a formal physiotherapy program can improve a person's quality of life and activities. A healthy nutritional intake is important, as weight loss due to the increased work of breathing presents a serious sign of advancing COPD. Lung reduction surgery or lung transplantation can also be considered in extreme cases. *All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.

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.

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Ian Lloyd...Continued From Page 4

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, choose 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 helps to treat diabetes. It appears this medication blocks your bodies 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 thanusual. 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 Peoples Pharmacist 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

Helping People Live Better Lives

We Can Help With Medication Compounding.

Medication compounding allows pharmacists to create custom medications to suit your specific health needs. Talk to a Peoples Pharmacist about medication compounding.

Ron Kumar

Pharmacist & Owner, Sooke

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.

Sheri Ukrainetz

Pharmacy Manager, Mackenzie

We Can Help Reduce Everyday Strain On Your Busy 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.

Troy Clark

Pharmacist & Owner, Nakusp

Ian Lloyd...Continued on Page 13

peoplesdrugmart.com PEOPLES Health 11

Focus On Calcium & Vitamin D Helps Reduce Risk Of Osteoporosis 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 affects about one in four women over the age of 50 and one in eight men over 50.

You can reduce your risk of osteoporosis by quitting smoking, limiting daily alcohol to two beverages or less, reducing caffeine intake and getting enough calcium, getting enough vitamin D, and staying physically active.

Talk to a Peoples Pharmacist about the benefits of calcium and vitamin D supplements.

Going Away For Spring Break?

Some immunizations for international travel require a series of vaccinations that are administered over a 2-3 month period.

Make Peoples Your First Destination For Travel Health Most Peoples locations conveniently administer travel vaccinations on-site. Talk to a People Pharmacist if you're travelling to a tropical destination and discuss the following common illnesses: cholera, hepatitis A, hepatitis B malaria, traveller's diarrhea typhoid fever Talk to a Peoples Pharmacist who can advise you on the medications, vaccinations and health supplies that you'll need for a safe and healthy trip.

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Ian Lloyd...Continued From Page 11

(CoQ10). CoQ10 is found in almost every cell in the human body. Its 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 Peoples 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 Peoples Pharmacist if your medications might be affecting your nutritional status. Even better, ask if your neighbourhood Peoples Pharmacist can book you in for a medication review.

During this review, your Pharmacist makes oneon-one time to explain your medications and answers any questions you might have. The more you know about your health and your medications, the better you can live.

Written By Ian Lloyd, Pharmacist & Chartered Herbalist

PEOPLES PHARMACISTS Helping People Live Better Lives

We Can Help With Travel Vaccinations.

Make Peoples your first destination for travel health. Most Peoples locations provide convenient on-site vaccination services so you can have a worry free and safe vacation.

Louisa Balbi

Pharmacy Manager, Golden

We Can Help With Vitamins & Supplements.

A Peoples Pharmacist can provide professional advice on possible interactions between vitamins, supplements and medications.

Trust your health with a Peoples Pharmacist.

Tamer Mahmoud

Pharmacy Manager, Chetwynd

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.

NEW PHARMACY Salim Datu

Pharmacist & Partner, Surrey

peoplesdrugmart.com PEOPLES Health 13

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Darlene Booth R.H.N., B.S.W.

A FIT BRAIN

Being a naturally curious person has served me well over the years. Curiosity has engaged me in lifelong learning adventures that included taking on university at the age of 50.

In spite of huge doubts as to the probability of the educational adventure turning out well, I am happy to report that what began as a 1 year trial period, turned out to be a 4 year ride resulting in a Social Work degree. It was a bumpy ride, but achieving Dean’s list status upon graduation far exceeded any expectations I had originally imagined. Year one was the hardest relearning how to learn was like walking through quick setting cement. Studying was tedious and it took a tremendous amount of time and effort. Perseverance was key and by year four the neurons were firing much quicker and my cognitive functions were noticeably fitter.

Use it or lose it had pretty much been lip service to me but experiential learning now solidifies it as truth. My brain has been forever altered and I mean that in the best of ways.

Neuroscience has become fascinated with the brain and the aging baby boomer population is good incentive for researchers to study ways to keep cognitive functions healthy as we age. We used to believe that the brain was certain to deteriorate once we turned the corner into middle age but science is now touting that brain plasticity means the aging process can go either way. The brain is just like any other muscle in the body it will atrophy without use and it will expand through exercise. Plasticity is not age dependent but it does take more of a purposeful focus as the shadow of our youthful years lengthens. While enrolling in university is certainly a sure fire way to forge some new neural pathways, there are other ways to exercise the brain to ensure optimum cognitive health.

1. Be a student for life and never stop seeking out new experiences and knowledge. You may want to take up a new instrument or hobby, keep a good book handy or join a club or an organization that challenges you to new ways of thinking. You want to fully engage and exercise the brain in a variety of new activities.

2. If games are your thing there are benefits to solving jig-

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saw puzzles, Sudoku and crosswords. As much as technology may have a negative impact on our mindfulness and focus, many online programs are geared at exercises that help to strengthen brain functioning and speed.

3. Building models, knitting or playing an instrument strengthens the part of the brain involved in fine motor skills.

Work with your hands or practice using your non-dominant hand when doing some everyday activities like brushing your teeth and eating. The extra benefit of eating with your nondominant hand is that it forces you to eat slower which is fabulous for your digestive processes.

4. Actively practice using your memory. Often what we think of as a failing memory is just a result of sleepwalking through the day or relying too much on external memories like cell phones and computers. Engage the memory as you go about your day. Rather than just observing the world around you - participate in it. What is the name of that tree, flower or bird you observed? Make it your mission to commit new names and numbers to memory. Repetition and practice are important.

5. Engage all the senses and you will engage more of the brain. Be fully present with your activities and take time to register all sights, smells, sounds and sensations. When was the last time you really sat down to truly savour a meal or stop to take in the wholeness of a flower?

6. Your brain works while you sleep so make sure your sleep habits are optimal. One of the best things I learned while I was in school is that taking a nap after studying or learning a new skill can do wonders for helping the brain consolidate new information.

As with any pursuit of optimal health, success comes when we incorporate a variety of strategies. Challenging the brain is as important as getting rid of junk food, feeding the brain nutritionally sound food and getting a daily dose of oxygen through moderate exercise. The good news for most of us is that it is never too late to put on your thinking cap and give your brain a good workout.

Good Health to You

Caribbean Vegetable Rice Coconut rice and tender vegetables with flavours reminiscent of jerk seasoning. Pumpkin seeds add an interesting final touch.

Caribbean Vegetable Rice

Chopped peeled orange4 cups 1 Litre fleshed sweet potato (about 3⁄4 inch, 2 cm, pieces) Chopped cauliflower 3 cups 750 mL Chopped yellow pepper (3⁄4 inch, 2 cm, pieces) 2 cups 500 mL Chopped onion 1 cup 250 mL Long-grain brown rice 1 cup 250 mL Can of coconut milk 14 oz.

398 mL Prepared vegetable broth 1 cup 250 mL Brown sugar, packed 1 tbsp. 15 mL Chili paste (sambal oelek) 1 tbsp. 15 mL Finely grated ginger root 2 tsp.

10 mL (or 1⁄2 tsp., 2 mL, ground ginger) Garlic cloves, minced 2 2 (or 1⁄2 tsp., 2 mL, powder) 1 Dried thyme ⁄2 tsp.

2 mL 1 Ground allspice ⁄2 tsp.

2 mL 1 Ground cinnamon ⁄4 tsp.

1 mL 1 Salt ⁄2 tsp.

2 mL 1 Pepper ⁄4 tsp.

1 mL Chopped unsalted toasted pumpkin seeds 1⁄3 cup 75 mL Combine first 5 ingredients in greased 3 1/2 to 4 quart (3.5 to 4 L) slow cooker.

Whisk next 11 ingredients in medium bowl. Pour over vegetables. Stir.

Cook, covered, on Low for 8 to 9 hours or on High for 4 to 4 1/2 hours.

Sprinkle with pumpkin seeds. Makes about 8 cups (2 L).

1 cup (250 mL): 280 Calories; 11 g Total Fat (0 g Mono, 0 g Poly, 9 g Sat); 0 mg Cholesterol; 42 g Carbohydrate; 5 g Fibre; 5 g Protein; 320 mg Sodium

20

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Reprinted from Vegetarian Recipes© Company's Coming Publishing Limited

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