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GASTROESOPHAGEAL REFLUX DISEASE WHAT YOU NEED TO KNOW ABOUT

OBESITY AN ERA OF

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REVELSTOKE & UCLUELET SPOTLIGHT ON

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June 2015

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Features & Cover Articles 4 7 MEDICATION INTERACTIONS

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HEALTHY SAVINGS

Pharmacist Ian Lloyd writes on common drug interactions, a very beneficial read if you take multiple medications.

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SAVE ON VITAMINS Sale priced vitamins and supplements for optimal health & wellness.

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AN ERA OF OBESITY

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

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

An interesting observation on how unhealthy diets and lifestyle changes have made people out of sync with nature.

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GREEK CHICKEN THIGHS

Brand new feature recipe From Company’s Coming 400-calorie Mains.

GASTROESOPHAGEAL REFLUX DISEASE Read about GERD, the most common acid-related condition in Canada. About 10% - 20% of the western world suffers from GERD.

Healthy Choices Page 7

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MEDICATION INTERACTIONS

The phrase “drug interaction� can cause thoughts of ambulance rides and emergency room visits. While this might be the case for some drug interactions, luckily this is a rare occurrence. Some drug interactions are known, and sometimes they can even be helpful for your therapy. Others might be detrimental to your health; it is all about context. Odds are if you are taking more than five medications, at least two of them will interact. In most cases, your doctor or pharmacists knows about the interaction. Hopefully, I have you interested in this months topic. Lets discuss drug interactions; the dangerous, the known and the boring.

A drug interaction is just what it sounds like; one drug affecting how another drug acts within the body. This can happen in a few ways. One way is that one drug can increase or decrease the quantity of another drug within the body. Perhaps I should explain this a little better. Your body is very efficient at removing medications. When you first start taking a new medication, your body works to remove it and this is expected. If another drug is introduced, this system might be disrupted, either temporarily or permanently. This may cause the amount of the first drug in your body to either rise or fall. If this persists, the increase of drug levels might cause more side effects, or if they drop you 4 PEOPLES Health

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Ian Lloyd Pharmacist

might lose the effectiveness of the first drug. These are the most worrisome types of drug interactions, but luckily they rarely occur. Your pharmacist and doctor often use computer databases to ensure these interactions don't occur.

Another way drugs can interact is when one drug enhances or antagonizes the effectiveness of another medication. Sometimes this might be intentional.

The classic example of this is using multiple medications to help treat high blood pressure. In many cases, the exact cause of high blood pressure is not known, it could be caused by a few factors. If one medication does not reduce your blood pressure. to the desired range, another medication might be given. These medications are technically interacting by enhancing the reduction in blood pressure. In some circumstances this might be useful. If you raise the dose of the first medication, it might cause more side effects, yet if you add a lower dose of another medication it might lower the blood pressure as desired with fewer side effects.

Did you know that vitamins, herbals, over the counter medications and even foods can interact with drugs? Well it is true. There are quite a few vitamins that can interfere with the actions of Continued On Page 11

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GASTROESOPHAGEAL REFLUX DISEASE

GERD stands for gastroesophageal reflux disease, which is the backflow of stomach contents (including stomach acid) upward into the esophagus (the swallowing tube that extends from the mouth to the stomach and sits behind the breast bone). The lining of the stomach protects the stomach from the effects of its own acids. Because the esophagus lacks a similar protective lining, stomach acid that flows backward (refluxes) into it causes heartburn (also called dyspepsia).

Many people experience heartburn occasionally; however, people who get heartburn or other GERD symptoms persistently are considered to have GERD. GERD is the most common acid-related condition in Canada. About 10% to 20% of the western world suffers from GERD. Adults, children, and even infants can have GERD. Causes GERD occurs when a valve located at the bottom of the esophagus (called the lower esophageal sphincter, or LES) that normally keeps acid in the stomach, isn't functioning properly. Acid that moves from the stomach into the esophagus damages its lining and can cause burning and pain.

Risk factors for GERD include: T age (over 50 years old) T being overweight or obese T eating and drinking certain types of foods and drinks (see below) T having excess abdominal fat T pregnancy T smoking 6 PEOPLES Health Join us on

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T asthma T taking certain medications (e.g., NSAIDs, some antidepressants, calcium channel blockers, corticosteroids) The following foods can cause symptoms of GERD, but may not necessarily cause GERD itself: T alcoholic drinks T chocolate T coffee, tea, cola T foods with high acid content (e.g., tomatoes, orange juice) T fried or fatty foods T garlic T onions T peppermint T spicy foods GERD may sometimes be associated with a condition called hiatus hernia in which a portion of the stomach lining pushes up through the diaphragm into the chest cavity. People with severe GERD almost always have a hiatus hernia.

Symptoms and Complications The main symptom of GERD is heartburn, which is a burning pain behind the breastbone that can travel to the back of the throat. The pain can last up to two hours and is often worsened by eating, lying down, or bending over.

Because heartburn and a heart attack have similar symptoms, it is important to note their differences. For someone having a heart attack, burning pain generally travels progressively down the left arm or both arms. For someone with GERD, the Continued On Page

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GERD..Continued From Page 6

burning pain is localized to the upper chest. In addition, exercise may worsen the chest pain for someone having a heart attack (or someone with heart disease), while rest and certain medications may help to relieve it. On the other hand, the burning pain associated with GERD is usually not affected by physical activity. In any case, even people with characteristic features of GERD may require tests to ensure the symptoms are not being caused by a heart attack.

Other symptoms of GERD include regurgitation (swallowed food or liquid going back up into the throat or mouth), a sour or bitter taste in the throat or back of the mouth, excessive saliva, belching, upset stomach, or vomiting. People who inhale the reflux acid may experience coughing, hoarseness, or wheezing. Symptoms of GERD are generally worse after meals.

If GERD is not managed well, other complications can arise over time. These include: • esophageal strictures (scarring of the lining of the esophagus), which reduce the diameter of the esophagus and make swallowing difficult • esophagitis (inflammation of the esophagus),

which can make swallowing painful • pharyngitis (inflammation of the throat), which affects the vocal cords and can alter a person's voice and speech • dental problems, such as an increased risk of cavities or tooth damage due to the acid reflux • asthma, especially in adults • Barrett's hyperplasia or Barrett's esophagus, which occurs when abnormal healing takes place after an ulcer has destroyed an area of the esophageal lining (The usual lining is replaced with tissue like that found in the stomach or intestine. People with this condition may be at a higher risk of developing cancer of the esophagus over time.)

Making the Diagnosis Doctors usually diagnose GERD by assessing symptoms. Only people with severe chronic heartburn are likely to be tested for GERD. Tests may include a series of X-rays of the stomach to look for other possible problems, such as peptic ulcers. A blood or breath test may be performed to rule out the presence of the bacteria called H. pylori.

There are also tests to measure the pH (acidity) of Continued On Page 10

Focus On Acid Reflux Get Back To Enjoying Food 10-20% of the western population suffers from acid reflux, a condition that can cause heartburn.

Treatment is typically via lifestyle changes, prescription and over the counter medications like: Heartburn Relief contains an alginate, which is a type of medication that’s particularly effective for relief from acid reflux. This medication works by forming a foaming protective barrier between your stomach and esophagus (throat).

Acid Reducer (Ranitidine) can reduce and control acid for up to 12 hours. It contains a histamine2 blocker that starts reducing stomach acid before it even starts.

Talk to a Peoples Pharmacist about lifestyle changes and medications that can help you manage acid reflux.

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Spotlight

On Our Communities

Revelstoke Situated at a strategic crossing of the Columbia River, and bordered by both Mount Revelstoke National Park and Revelstoke Mountain Resort, this Kootenay Rockies city is surrounded by the impressive and towering Selkirk and Monashee mountains.

People choose Revelstoke for a healthy, active lifestyle that could include skiing, snowmobiling, cross-country skiing, and ski touring. Although Revelstoke has become a major winter destination, its roots are the railroad. For more than a hundred years, it has been a railroad town S the Canadian Pacific Railway is still the town's second largest employer, and the place resonates with down-toearth authenticity and friendliness.

Photo courtesy Province of B.C.

Photo courtesy Province of B.C.

Photo courtesy Province of B.C.

Ucluelet

Photo courtesy Province of B.C.

Photo courtesy Province of B.C.

The environment of tranquil Ucluelet provides a stimulating and dramatic backdrop for working, living, and recreating. The town of Ucluelet offers beaches, multi-use sports fields, community parks, waterfront promenades, restaurants, unique shops and galleries, and a mini aquarium.

Ucluelet is growing as a major tourist destination and besides stunning scenery, it features interesting events and activities, and a rich cultural history. The word Ucluelet (pronounced you-KLEW-let) is a local First Nations word meaning safe harbour. Archaeological evidence indicates the presence of First Nations for at least 4300 years.

Photo courtesy Province of B.C.

1000 was donated to the Westcoast Community Resources Society. The Society will use the funds to update and upgrade emergency kits at three worksites. The Westcoast Community Resources Society is celebrating its 20th year offering navigation, counselling and resource services to community members on the west coast.

Mervin Banting, partner presenting cheque to Margaret Morrison, Director.

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 corporate fundraising. peoplesdrugmart.com People First

GERD...Continued From Page 8

the esophagus and the internal pressure of the lower esophageal sphincter (LES). The most important diagnostic tool is the endoscope, a fibre-optic tube passed down the throat that permits the doctor to see the inside of the esophagus (a procedure called endoscopy).

People who have had regular or daily heartburn for 5 years or more should be tested for Barrett's esophagus. For patients who have this condition, many doctors perform regular checkups to look for changes that may eventually develop into cancerous growths.

Treatment and Prevention Most symptoms of GERD can be managed with a combination of medications and lifestyle changes.

Surgery is reserved for people with severe complications but is needed only rarely.

Medications that can be used to neutralize stomach acid are antacids (e.g., aluminum or magnesium hydroxide*, calcium carbonate, bismuth subsalicylate).

Medications that can be used to reduce the production of stomach acid include H2-antagonists (e.g., cimetidine, ranitidine, famotidine, nizatidine) and proton pump inhibitors (e.g., dexlansoprazole,

omeprazole, lansoprazole, pantoprazole, esomeprazole, rabeprazole).

In addition to medications, symptoms of GERD can be improved by making one or more lifestyle changes. For example: • Eat meals earlier, especially dinner.

• Eat smaller meals more frequently, instead of 2 or 3 large meals.

• Avoid lying down within 2 or 3 hours after meals.

• Reduce alcohol and caffeine intake.

• Stop smoking.

• Lose excess weight.

• Exercise regularly.

• Place the head of your bed 6 inches higher than the foot of the bed.

Most people can have successful treatment by taking medications and making lifestyle and diet changes. *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.

If you’ve had chickenpox, you’re at risk of shingles The shingles vaccine is the best way to protect you from getting shingles and it’s potentially devastating effects.

Talk to your Peoples Pharmacist about a shingles vaccination, no prescription is neccessary.

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Ian Lloyd...Continued From Page 4

certain drugs. The most problematic are mineral supplements. Minerals (calcium, magnesium, etc) can prevent certain antibiotics from being absorbed from the stomach. This same interaction also applies to drugs that help treat osteoporosis.

In these cases, the drugs work by binding to calcium, either within bacteria or in your bones. If these drugs encounter calcium in the stomach, they will bind to it there and will not be able to reach the part of your body where they are needed. The same might also be true of thyroid hormone medications and calcium. Ask your Peoples Pharmacist for more information.

To make matters worse some foods can interact with medications. Grapefruit juice is an interesting food; not only does it taste good. but it also has many drug interactions. The exact reason for this is not known, but it is believed that components of grapefruits (naringin and others) interfere with the bodies ability to eliminate drugs. These effects can persist for up to three days after ingestion of grapefruit juice. A partial list of drugs affected include: cyclosporin, calcium channel blockers, beta blockers, buspirone, benzodiazepine, carbamazepine, statins, and others. It might be best to avoid grapefruit juice altogether, if you are taking any of these medications. Check with you Peoples Pharmacist for a complete list of medications that interact with grapefruit juice. The next question I am often asked is about eating the actual “fruit� of a grapefruit. Not much is known if the same interactions apply, but I always assume they do.

Warfarin, warfarin, warfarin, every pharmacists favourite drug for interactions. The water we drink and the air we breathe can interfere with warfarin.

This might be an exaggeration, but the drug interaction list for warfarin is quite long. Your physician and Peoples Pharmacist will ensure that your prescriptions will not conflict with warfarin.

But what about over the counter products? Be wary of OTC pain killers; some might contain

Helping People Live Better Lives

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Being locally owned, the owner operators of Peoples Drug Mart and Peoples Pharmacy take great pride in living in and helping contribute to to a healthy community.

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The Med Manager blister pack program takes the guesswork out of your daily medications.

This convenient and easy to use blister card is ideal if you are on multiple medications.

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

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Ian Lloyd...Continued on Page 13

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Are your medications working effectively for you?

Medication Review Service A Peoples Drug Mart medication review provides an opportunity for you to sit down one-on-one with your Peoples Pharmacist to help identify and resolve common medication-related issues, so you can get the most benefit from your medication. This medication review can help you better understand your medication therapy, and ensure that medications are being taken as prescribed.

Medication review includes: • Detailed analysis of all medications (prescription and over-thecounter), vitamins and supplements, to ensure safe and effective use. • In-depth consultation to improve health outcomes by helping resolve any issues that may have arisen due to your medications.

Speak to a Peoples Pharmacist about scheduling a medication review.

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Ian Lloyd...Continued From Page 11

acetylsalicylic acid (ASA), ibuprofen or naproxen.

All of these products can interfere with how warfarin works. The same caution applies to the old stomach remedy Alka-seltzer, it also contains acetylsalicylic acid (ASA). It might be a wise idea to ask your Peoples Pharmacist if any OTC medications will interact with your warfarin before taking them. The same advice applies to vitamin and herbal supplements.

If you are concerned about drug interactions, just ask your Peoples Pharmacist. Don't forget to tell your Pharmacist about any other supplements you might be taking; that information can be very useful. They can determine which medicines are right for you and which may be detrimental. If you are curious about possible drug/herbal/food interactions, look them up yourself. The website www.drugs.com has a free and robust drug interaction checker. Just take this information with a grain of salt - unless you are on a sodium reduced diet. Medical websites are great and can provide you with ample information to make health choices. However what they are not able to tell you is whether this information is applicable to you. Your Peoples Pharmacist can add context to the information you have found - all you have to do is ask.

Perhaps the best advice to protect your health is to ask these questions whenever starting a new medication: • Can I take it with other drugs?

• Should I avoid certain foods, beverages or other products?

• What are the possible drug interaction signs I should know about?

• How will the drug work in my body?

• Is there more information available about the drug or my condition (on the Internet or in health and medical literature)?

Written By Ian Lloyd, Pharmacist & Chartered Herbalist

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We Can Help With Trusted Counselling Understanding and following your medication therapy is vital in your health outcome.

Peoples Pharmacists provide the trusted and personal counselling to help you live a better life.

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AN ERA OF OBESITY

In watching a documentary that had been filmed in the 1970's, I was struck by the absence of obvious obesity in both the foreground and background population. If one films a crowd scene today, you are likely to see more muffin tops than six packs - not so in the 70's. It was a snapshot moment that highlighted how insidiously our cultural norms for body shape have morphed since my childhood. This topic does strike a personal chord as I have never been considered lean or lithe. .uite frankly, I was that random chunky sized kid in my grade school. Yes, once a minority, I now feel more akin to a barometer for a changing world; a canary in the proverbial cage. Obesity rates are soaring; it is a complex issue that we tend to individualize but it has roots in the collective. We need to look beyond the common recipe of calories in versus calories out to really understand this era of obesity.

Body weight is measured and categorized using a standard BMI index. This measure calculates body fat ratios based on a height and weight calculation. By this measure, a BMI equal to or greater than 25 is considered overweight; 30 and over is considered obese. According to the World Health Organization, global obesity rates have more than doubled since 1980 and approximately 40% of the world's population are considered overweight. While America holds the top spot on most obesity lists, Canada is not too far behind. It is estimated that the Canadian obesity rate has tripled over the past 30 years.

When it comes to weight gain, the common script is to place the sole responsibility on the individual to own the problem.

We think that eating less and exercising more is the solution and we fail to focus on the bigger picture. While it is certainly true that diet and lifestyle are huge contributors to our overall health and well being, the following are some of the collective cultural influences fuelling our expanded waistlines: 1. The food manufacturing industry has us convinced that healthy food comes in a box or bag and the fast food industry has contributed to portion distortion. The result is that we are eating far too much inferior food and far too little wholesome, nutrient dense foods. Snacking has become a national pastime

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and it starts early in childhood.

2. We are built to move but we have convenienced ourselves into sedentary living. The modern lifestyle has us sitting behind wheels and screens more than our ancestors. We have appliances to do the laborious chores that once took effort. Consequently, a gym membership has become a valuable asset (but you do actually have to use it).

3. Toxins in our environment and our food chain can disrupt hormonal balance which can slow down metabolism. The body also tries to protect us from these toxins by creating more fat tissue to store the toxins in. It's a double edged sword that makes shedding pounds extremely difficult. Hidden food allergies and some medications will slow metabolism as well.

4. Chronic sleep deprivation is linked to weight gain. We live in a 24/7 world and as a result, it is easy to burn the candle at both ends. A disrupted circadian rhythm interferes greatly with hormones that regulate both appetite and metabolism. Being tired does little to inspire exercise as well. Physical and/or emotional stress also contribute to weight gain.

5. Studies are finding that there is a correlation between lack of specific gut bacteria and a predisposition toward obesity. Some of the factors affecting proliferation of healthy gut flora can be linked to antibiotic use, chlorinated water, unhealthy food choices and bottle feeding infants rather than breastfeeding.

The antibacterial movement has also been said to create problems as beneficial bacteria are killed off with the bad.

Our body should be given credit where credit is due. No doubt obesity contributes to health problems, however, all weight gain is looked upon as a deficiency. We are evolutionarily programmed to survive during times of famine and the body's ability to store energy is nothing short of miraculous.

The problem we have today in our culture is that we eat to prepare for famine, but it never comes. We are eating ourselves sick and obesity is not just a condition, it is a symptom of living out of synch with nature. Returning to a wholesome diet is the first step toward balance.

Good Health to You

Greek Chicken Thighs Easy and delicious, the Mediterranean ingredients for this dish offer full-bodied colour and flavour. Hide your best china—guests may want to smash plates in approval as the Greeks used to do.

Greek Chicken Thighs

11⁄2 large red peppers 11⁄2 large yellow peppers 2 Tbsp (30 mL) Greek dressing ⁄4 cup (60 mL) black olive tapenade ⁄4 cup (60 mL) dry white wine 1 ⁄4 cup (60 mL) Greek yogurt 2 cloves garlic, minced 8 boneless, skinless chicken thighs (about 3 oz, 85 g, each) 1 1

1 large lemon, halved 1 ⁄2 cup (125 mL) crumbled feta cheese 1 Tbsp (15 mL) fresh oregano leaves Grill red and yellow peppers, skin-side down, on direct medium-high heat for about 10 minutes until skins are blistered and blackened. Remove to plate. Tent with foil. Let stand until cool enough to handle. Remove and discard skins. Cut peppers into long strips. Toss with dressing and set aside.

Combine tapenade, wine, yogurt and garlic in a large resealable plastic bag. Add chicken and chill for 30 minutes. Drain and discard marinade. Grill chicken on direct medium heat for about 7 minutes per side until internal temperature reaches 170°F (75°C).

Squeeze lemon over chicken. Sprinkle with feta cheese and oregano. Serve with grilled peppers.

1 serving: 350 Calories; 19 g Total Fat (6 g Mono, 2 g Poly, 6 g Sat); 115 mg Cholesterol; 21 g Carbohydrate (3 g Fibre, 5 g Sugar); 27 g Protein; 460 mg Sodium

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