Peoples Health Magazine, Volume 17, Number 8 Until September 25 PDM620

PEOPLES Health PRESCRIPTION DRUG ABUSE HELPFUL ADVICE ON

Helping People Live Better Lives

PSORIASIS UNDERSTANDING BULLYING

WHAT YOU NEED TO KNOW ABOUT

PENTICTON & COLWOOD SPOTLIGHT ON

COMPANY’S COMING RECIPE AUTUMN PORK & APPLE STEW

PEOPLES DRUG MART • PEOPLES PHARMACY

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PDM 620 Vol. 17 No. 8

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JAMIESON Vitamin D Promotes healthy teeth and bones.

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Peoples Pharmacists provide a wide range of health services. Ask about disease state management, on-site vaccinations, and in-depth medication reviews.

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HEMORRHOIDAL Relief and prevention for the symptoms of hemorrhoids.

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LACTAID Dairy Digestion Aid Help for people who have trouble digesting lactose.

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NEILMED Sinus Rinse or Nasal Care Soothing solutions for nasal passages.

Assorted Selection

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September 2016

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Features & Cover Articles 4 7 PRESCRIPTION DRUG ABUSE

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HEALTHY SAVINGS

Discussion and awareness can help minimize the risk of prescription drug abuse.

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

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

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

UNDERSTANDING BULLYING With school just beginning, its important to understand and hopefully prevent the different forms of bullying.

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AUTUMN PORK AND APPLE STEW

Brand new feature recipe From Company’s Coming 400-Calorie Slow Cooker

PSORIASIS A common chronic inflammatory skin condition that can be a burden of physical pain, discomfort and a heavy emotional toll.

Healthy Choices Page 5

PEOPLES DRUG MART • PEOPLES PHARMACY Community owned and operated pharmacies, proudly serving British Columbians since 1976. Peoples Pharmacists are truly committed to helping people live better lives by providing trusted and personal health care.

PRESCRIPTION DRUG ABUSE This is not a subject people, especially pharmacists, like to talk about. We all hope that people take their medications correctly and tablets never go astray. Sadly, this is not always the case.

Unfortunately we must address this issue, no problem has ever gone away by ignoring it. As with all social issues, these concerns will never go completely away. With education and a little planning, we can minimize the risks.

So how does a pharmacist define drug abuse?

We define drug abuse as intentionally taking medication in a way that was not recommended by your health care professional. These drugs may be either legal or illegal in nature. There might also be a component of self harm involved.

The next question is who is the usual drug abuser? Naturally, thoughts turn to those with illicit substance abuse issues. While this is a sad reality, it is not the focus of our discussion. To put it in perspective, Health Canada has data to suggest that 2% of Canadians used some form of illicit drugs in 2012. You can do the math, that is a surprising large number of people.

The statistics for prescription drug abuse surprised me. In 2012, 6.3% of Canadians, 15 years and older, reported that they abused some form of prescription medication. That is approximately 410,000 people. These numbers increased from data obtained in 2011. Health Canada also noticed that males are more likely to abuse medications 4 PEOPLES Health

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Ian Lloyd Pharmacist

than females. If you think that substance abuse does not affect you or anyone you know, statistics might not support this belief.

What sort of drugs are the most common for abuse potential? The range of medications for abuse potential is quite large. Over the counter medications for colds and flu, nausea, coughs and pain all have potential for abuse. Health Canada only keeps data on three category of drugs with abuse potential: opioid pain medications, benzodiazepine sedatives and stimulants for attention deficit disorders. By far, the most commonly abused medications are opioid pain relievers, these are your codeine, oxycodone and fentanyl type pain relievers. Almost daily, there is a news article detailing some tragedy involving prescription pain medication.

When we talk about prescription drug abuse, we tend to focus on teenagers. Teenagers are vulnerable within society. Their bodies and minds are still developing and accidents can damage them for life. They might think that prescription drugs are less dangerous to abuse than illicit drugs. Prescription drugs are also easier to obtain than illicit drugs. Drugs are often obtained from friends, relatives or home and often without their owners knowledge.

What can you do to help prevent drug abuse or diversion of prescription medications? The solutions are quite simple. Keep all medications in a Continued On Page 11

Services To Help Create A Safer Home Environment

PEOPLES Medication Manager Tells you exactly when to take your daily medications and helps in monitoring/controlling usage.

Peoples offers a medication compliance program called “Medication Manager.” This medication compliance card conveniently organizes medications for a full week, and helps easily identify what medications are to be taken at what time of the day. This program provides comfort and some assurance to family and the health care team that medications are being taken as directed.

Speak to a Peoples Pharmacist today about the convenient and safe Medication Manager program.

PEOPLES Medication Disposal Make your home safer by bringing your unused and expired medications to Peoples for environmentally safe disposal. By bringing your unused or expired medications to Peoples for disposal, you are removing the risk of accidental poisonings and potential abuse.

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JAMIESON Salmon & Fish Oils Omega-3 Complex A rich source of fatty acids.

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JAMIESON B50 Complex Contains the essential B vitamins. 90 + BONUS 30

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CALCIUM or With Magnesium For healthy bones.

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WEBBER NATURALS Melatonin Naturally promotes a restful sleep.

3mg 90’s or 5mg 60’s

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WEBBER NATURALS Probiotic Multiple strains helps to maintain healthy digestion.

30-60’s

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CENTRUM Multivitamins New Women’s Gummies 130’s or Gummies 130-150’s, Tablets 90-100’s or Flavourburst 120’s

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PSORIASIS Psoriasis is a common chronic inflammatory skin condition that involves red elevated patches and flaking silvery scales. It can take on several different forms and appearances, and symptoms can range from mild to severe.

Signs and Symptoms The lesions can be painful and/or itchy and vary in size. Since plaques consist of dry, flaky inflamed skin, it may also crack and bleed. While lesions can appear anywhere on the body, the most common sites include elbows, knees, scalp, chest and lower back. The plaques tend to appear in the same place on both sides of the body.

Who is at risk?

Psoriasis can develop at any age, although it is typically seen in adults. One form of psoriasis called guttate psoriasis tends to occur in childhood and early adulthood. Psoriasis occurs equally among men and women and across different races. Family history of psoriasis is a leading risk factor. In recent years, research has been discovering some of the genes involved in psoriasis.

What causes it?

While it is not known exactly what causes psoriasis to develop in certain individuals, experts believe that the condition may involve malfunctioning of the immune system and the consequent production of inflammation. White blood cells (T cells) in the immune system are triggered and this causes inflammation to occur, which then causes skin cells to rise to the surface and shed at an abnormally quick rate. Skin cells shed every 3 to 4 days in psoriasis whereas in normal healthy skin, the skin cells turnover cycle is typically 30 days.

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Living with psoriasis Despite being labelled as a skin disease, psoriasis has an impact on patients that extends beyond the cosmetic or physical aspects. It negatively affects quality of life from the burden of physical pain, discomfort and limitations to exacting a heavy emotional toll. According to a national patient survey, psoriasis and related conditions “impose a severe burden on the daily lives of Canadians with a history of moderate to severe psoriasis.” Over one third of respondents (176 of 500) viewed their skin condition as a significant problem in their daily life. The perception seemed to correlate with the extent of disease or how much of their body surface psoriasis affected. People with psoriasis have an increased risk of depression, anxiety and suicide.

Psoriatic lesions can be itchy, painful and bleed, making it difficult to sleep, dress or engage in various daily activities. If there is joint involvement, the pain can also make it challenging for the individual to function physically.

In terms of physical and mental disability, psoriasis has been compared to having cancer, arthritis, hypertension, heart disease, diabetes, and depression.

The quality of life is the major concern. The aim of treatment is ultimately to reach an appropriate quality of life.

Quick facts about psoriasis • Psoriasis affects 1 million Canadians and 125 million people worldwide.

• The most common form is plaque psoriasis, which affects approximately 90% of patients.

• Psoriasis often causes as much disability as cancer, diabetes and other major medical diseases.

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peoplesdrugmart.com PEOPLES Health 7

• Up to 30% of patients with psoriasis have or will have arthritis and 5–10% may have some functional disability from arthritis of various joints.

Having psoriasis may increase the risk of developing other chronic systemic diseases, including heart attack and stroke, diabetes, cancer, liver disease and other serious health conditions.

What can trigger a psoriasis flare?

Psoriasis may be permanent or episodic, meaning that it can flare up then subside and disappear altogether for a while before another episode occurs. Triggers or precipitating factors may cause a flare-up in disease or even lead to the development of psoriasis, such as emotional stress, local injury to skin, systemic infections, and the use of certain medications.

Infection such as upper respiratory bacteria or viruses can actually cause someone to develop psoriasis. For example, psoriasis may first appear a few days after one develops strep throat.

Skin injury or any break in the skin can lead to psoriasis. This can include a razor nick or burn, an insect bite, cut, abrasion, sunburn, needle puncture (from vaccination), blister or bruise. Patients often find that new lesions appear at the site of injury.

Medications such as lithium (antidepressant) can also predispose one to a flare-up or cause psoriasis to first appear. Other drugs that can trigger psoriasis or aggravate it include anti-malarials, beta blockers (a type of high blood pressure medication) and an arthritis drug called indomethacin. Even oral corticosteroids can worsen psoriasis symptoms with overuse or if treatment is stopped abruptly.

Psoriasis...Continued From Page 6

Stress is a factor in a number of health conditions and seems to be a trigger for psoriasis as well. It can worsen symptoms and, in some cases, a stressful event may trigger the onset of psoriasis. Living with psoriasis also contributes to stress, which in turn, can negatively affect the skin condition.

Weather is another factor that can cause psoriasis to improve or worsen. In particular, the dry cold winter season seems to adversely impact on psoriasis because it dries and irritates the skin. Sun helps psoriatic plaques to fade which suggests why UV light therapy is often used to help treat psoriasis.

Hormones are suspected since puberty can often coincide with the onset of psoriasis symptoms, while pregnancy has been shown to improve or worse psoriasis, depending on the individual.

Other factors that science is discovering includes smoking and heavy alcohol use. Studies have found that people who smoke run a much higher risk of developing psoriasis compared to non-smokers. The same goes for people who drink heavily. Both smoking and alcohol use also seem to interfere with treatment success and disease remission.

Treatment Options There are several treatments available to help manage psoriasis. Determining the most appropriate treatment is very individual and based on the type and severity of disease, how large or widespread plaques are, on what the patient agrees to use based on benefits and risks and how well a patient responds to a given treatment. A physician may change a patient’s treatment dose, combine one kind of therapy with another, or switch treatments if one doesn’t work for a patient.

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1in2

If you’ve had chickenpox, you’re at risk for shingles.

Will have shingles in their lifetime

By age 85, 1 in 2 will have had shingles

Talk to a Peoples Pharmacist about the benefits of a shingles vaccination.

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Spotlight

On Our Communities

Colwood The City of Colwood is one of the most rapidly growing municipalities in the greater Victoria area. It is located l0 kilometers west of downtown Victoria in area of the Western Communities.

Colwood has a rich history that begins with Coast Salish heritage followed by European settlement dating back to the 18th century.

One of Colwood's historic landmarks is Fisgard Lighthouse, constructed in 1860, at the base of what is now Fort Rodd Hill.

Hatley Park National Historic Site offers a world of opportunities to visitors of all ages.

Hatley Castle, built in 1908-09, is one of many attractions found in this Edwardian estate.

Photo courtesy Province of BC

Photo courtesy Province of BC

Photo courtesy Province of BC

Penticton

Photo courtesy City of Penticton

Photo courtesy City of Penticton

Nestled between Lake Okanagan and Skaha Lake in British Columbia. The name Penticton means ‘a place to stay forever’ and once you visit you will know why.

Tourists come from all over North America to float the iconic ‘Channel’ which drifts lazily along between our two beautiful lakes. Voted one of the Top 10 Travel Destinations for 2012, visitors enjoy the relaxed atmosphere and small-town feel that Penticton offers.

With over 60 wineries within a 20 minute drive, local farmers markets, over 5 kilometers of golden sandy beaches and many wonderful festivals and events throughout the year, Penticton has something for everyone.

Photo courtesy City of Penticton

$1000 was donated to the Pathways Addiction Resource Centre. Pathways Addiction Resource Centre promotes the well-being of people affected by, or at risk of developing alcohol, drug or related problems in the Penticton area. Photo: Brent Atkinson, Pharmacist & Owner, (Left), Steve King, Pathways Clinical Supervisor, (Middle) receiving cheque from Anthony Rage, Pharmacist & Owner.

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

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Psoriasis..Continued From Page 8

Topical Topically applied treatments, such as creams and ointments, are usually recommended first, particularly for mild psoriasis. The aim of this kind of treatment is primarily to slow down and regulate skin cell turnover, reduce inflammation and suppress the immune system.

These options include topical corticosteroids, topical derivatives of vitamin D (calcitriol and calcipotriol), topical derivatives of vitamin A (tazarotene), and coal tar. Physicians may recommend a combination of these topical agents or combine them with oral and/or light therapy.

Systemic A number of oral drugs can help to manage psoriasis and are usually reserved for the treatment of more severe and/or widespread symptoms Traditional systemic treatments are methotrexate, also used to treat arthritis, acitretine, used for psoriasis only and cyclosporine, a potent immunosuppressive agent to be used only for short periods. In addition to these traditional drugs, novel agents such as biologic response modifiers (or biologics), can be given by injection or infusion. Many biologics are now available: alefacept, etanercept, adalimumab, infliximab, ustekinumab. Ongoing research will also bring new options. Systemic treatments work generally by helping to regulate and normalize skin cell turnover and suppressing the immune response that causes inflammation and plaques.

Light therapy Both natural and artificial ultraviolet (UV) light are used to treat psoriasis. Many patients with psoriasis find that sunlight exposure seems to improve their skin symptoms. However, sunburn can worsen the condition, which is why only a modest amount of exposure is recommended. One form of light therapy is Narrow Band UVB phototherapy, which emits a short wavelength of UV light that penetrates the epidermis or outermost layer of skin. Another form of light therapy is psoralen and UVA (PUVA), which combines an oral or topical form of the drug, psoralen, and UVA light exposure. The drug makes the skin more sensitive to the UVA light, helping it to work better.

Combination therapy There are many treatment options for patients with psoriasis. The challenge for both physician and patient is to find what works most effectively for the individual. In many cases, a physician may choose to combine 2 or more treatments for the best outcome.

Reprinted with permission of the Canadian Dermatology Association Copyright © 2016 Canadian Dermatology Association. All rights reserved.

“Source: Canadian Dermatology Association. Modified with permission 2016.” *The contents of this article provides basic information, but is not a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Peoples is committed to providing top-quality products with affordable prices. Biomedic brand products are the family brand for Peoples and when you compare biomedic products to national brand items - you’ll quickly discover incredible value.

We stand behind each and every Biomedic Brand product with our 100% guarantee: if you are not fully satisfied with any Biomedic Brand product, we will refund the full amount.

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Ian Lloyd...Continued From Page 4

secure place; if you want to go one step further, keep medications in a locked cabinet. Only keep out the medication needed for the week in an easy to track container. Using a weekly dosette or plastic pill box is an excellent idea for all medications.

This way you will know if you took your medication at the correct time. If you have multiple medications, ask your Peoples Pharmacist about blister packing your medications. Keep track of your medications. Mark on the calendar when your medication supply should run out. This will also help you plan your visits to the pharmacy. Even better, if you take multiple medications ask your Peoples Pharmacist to synchronize your medication refills so they run out at the same time.

Avoid sharing medications with friends and family, even if they are currently taking the same medication. This will draw attention to the fact that you have a supply of this medication on hand. Return any unused medications to the pharmacy for disposal. This is a good idea for any prescription medications or over the counter items. There is also the thought that prescription pain medications patches should be returned before a new supply is issued. The drugs within pain relieving patches are quite potent and have a great potential for abuse. Keep track of your refills with the pharmacy. If you have concerns about your medications, ask that only you are able to refill and pick them up.

Are there any signs or symptoms that might suggest that someone you care about might have an issue with substance abuse? No one intends to have trouble with medications or drugs, but things happen. Most people with substance abuse problems maintain a normal appearance and demeanor. There are a few warning signs that things might not be all right in their lives. One of the most common are behavioral changes. This can manifest itself in many ways, neglecting personal responsibilities, avoiding friends or stop going to

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.

Brent Atkinson

Pharmacist & Owner, Penticton

We Can Help With Medication Compounding.

Peoples Pharmacists can custom prepare medication in the exact strength and dosage form as required by the patient.

Yoshi Ito

Pharmacy Manager, Colwood

We Can Help With No Cost To You Smoking Cessation.

Eligible B.C. residents can now get direct access to free smoking cessation therapy products at Peoples Pharmacy.

Ellen Bovair

Pharmacy Manager, Chase

Ian Lloyd...Continued on Page 13

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Focus On CoQ10 Supports Cardiovascular Health Coenzyme Q10 (CoQ10) is a naturally occurring compound found throughout all cells in the body. This nutrient is essential for producing the energy that cells require to function effectively. The cells of the heart are particularly abundant in CoQ10 to help satisfy the demand for energy to keep the heart beating and efficiently circulating blood throughout the body.

Research has shown that use of statins (cholesterol-lowering medications) can deplete CoQ10 levels in the body. However, since CoQ10 plays an important role in maintaining normal functioning of the heart, depletion of this nutrient may cause a number of cardiovascular health concerns. Supplementation with CoQ10 in combination with long-term statin therapy can help to prevent depletion of this essential nutrient. Talk to a Peoples Pharmacist about the benefits of CoQ10.

Going Away For Winter Holiday?

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

social activities. For teenagers, substance abuse could result in problems at school: poor grades, absenteeism or stopping extra curricular activities.

Money problems can also be an issue. For adults this could mean unpaid bills, avoidance of discussions about spending money or missing items of value. For teens the signs are similar: theft, missing items or secretive about personal possessions.

One's personal appearance or habits could also signal substance or prescription drug abuse. Decreased appetite, nausea and changes in sleep pattern are the most common. There could also be more subtle changes like memory problems, use of room deodorants or personal fragrances to hide odd smells. The use of eye drops to cover up blood-shot eyes can also be a sign of drug use.

Is there anything you can do to help? This is a tough one because the person with an abuse problem might think there is no problem.

People will only change their behavior if they feel there is a need. Perhaps the best option is to be supportive and available for unbiased discussion.

If you think your teen is having trouble, ask about information for an unnamed family “friend”. This might help start the discussion that help is available. For more information about services and information about substance or prescription drug about, look on Health Canada's website.

I hope this article does not provide a bleak image of your friends, family and teenagers. When 6.3% of Canadians have reported prescription drug abuse, it means that over 90% of the population do not have any issues. This does not mean that we should ignore this issue and hope that it goes away. It will not go away. If we take precautions to prevent opportunities for drug diversion and watch for warning signs, we can help those in need. Remember statistics are full of voices that said, “this could never happen to us.”

Written By Ian Lloyd, Pharmacist & Chartered Herbalist

PEOPLES PHARMACISTS Helping People Live Better Lives

We Can Help With Menopausal Hormone Therapy.

Select Peoples locations provide menopausal hormone therapy to help people transition through menopause more comfortably.

Talk to a Peoples Pharmacist about this health service.

NEW PHARMACY Michael Barbary

Pharmacist & Owner, Chilliwack

We Can Help With Flu Shots.

The flu shot is your best defense against seasonal flu. Protect yourself and those around you by getting a flu shot this season.

Most Peoples locations will offer flu shots this fall. Talk to a Peoples Pharmacist about availability.

Sheri Ukrainetz

Pharmacy Manager, Mackenzie

We Can Easily Transfer Prescriptions.

Transfer your prescriptions today simply speak with a member of our pharmacy team and we will take care of the rest.

NEW PHARMACY 308 Wallace Street, Hope

Tarek Mahmoud

Pharmacist & Owner, Hope

peoplesdrugmart.com PEOPLES Health 13

Darlene Booth

UNDERSTANDING BULLYING A bully is defined as someone who uses power, cruelty or intimidation to oppress or dominate another. Historically, the bully is and always has been present to some degree on the playground and in the workplace. However, the fact that we have recently added “Bullycide� to our vocabulary is a societal alarm. Too many lives are ending in suicide as a response to the pain and torment of a targeted bullying campaign. The game has changed. The bully is no longer confined to face-toface confrontation; the Internet has provided a venue where the bully has a degree of anonymity and a 24/7 platform. The victim has nowhere to hide. Clearly, our response to the escalating problem needs to change and it begins with education and understanding.

Bullying is an act of intention and it can be physical, verbal or social; it may be a singular event or an ongoing series of events. A bully may act alone or round up support from a group of peers. Social ostracism is a powerful force that has gained momentum with the rise in social media outlets.

Cyberbullying is popular in the teen world and it involves intimidation through email, text, social networks or websites. The cyberbully is not always easy to track as they may have an anonymous online presence. A victim of bullying often feels powerless but the law is on their side when it comes to physical assaults, threats of harm or death, criminal harassment or posting intimate photos without consent.

While a few bullies are born without empathy and a predisposition towards aggression, most are moulded and shaped by their environment. If we can understand where the behaviour is rooted we may be able to help them curb the behaviour. The need to bully another can be a symptom of a much deeper trauma or issue. It could be that the bully lives in a stressful environment where violence and aggression are commonplace. The need to exert power over another might be an expression of low self worth or an inability to fit in. Bullies sometimes lack social skills and have trouble reading people and processing emotions. They may lack impulse control, which means acting out before thinking. A bully may also get caught up in a group mentality where fitting in means going along with the social shaming of another to

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

avoid the same treatment. This aggressive personality can also be a reflection of current movie or gaming trends.

Anyone who stands out from the crowd can become a target for one who bullies. A stereotypical victim will be a shy, withdrawn loner and have a physical feature that attracts a bully but in truth bullies can be just as threatened by strength, talent and popularity. The bully succeeds by shaming their victims into believing that what is happening is their own fault. Victims often internalize their pain and can become withdrawn, depressed and afraid to share their experience for fear of bringing on retaliation from the abuser. They might avoid school, work and other social situations. They may suffer from stress related stomach pain, headache, anxiety and tension. In some cases, ongoing abuse has led the victim to end their own life or the life of the abuser.

There are usually three parties involved in most bullying situations. There is a bully, a victim and a bystander. The bystander is an onlooker that does not take a stand for the victim or against the bully. The rationalization for not getting involved usually comes from a fear for personal safety or a lack of understanding how to effectively help without making matters worse. Bystanders are in a powerful position to either further the abuse or contribute to a solution and as such, have been recognized as an important focus in anti bullying strategies. By empowering the bystander to take a stand in defence of the victim, reporting the incident or getting help, we begin to create a climate where bullying will not be tolerated.

Early intervention is the best prevention; children who bully may eventually become adults who continue to use aggressive behaviours to maintain a sense of power in relationships and the workplace. Schools are becoming more aware of the symptoms and effects of bullying. Many have begun launching educational campaigns to change the social climate of the school and communities children are raised in. Children need to know that they are safe, supported and accepted when they reach out for help. It is everyone’s responsibility to help create a world that is safe for our youth to grow up in.

Good Health to You!

Autumn Pork and Apple Stew A great stew for fall when temperatures are starting to cool. Serve over rice or mashed potatoes with a hearty crusty bread.

Baby carrots, halved Vegetable cocktail juice (such as V8) Small onions, quartered No-salt seasoning Dried whole oregano Paprika Pepper Ground Rosemary Medium cooking apples (such as MacIntosh or Golden Delicious), peeled, cored and cut into 8 wedges each Pork shoulder steak, trimmed of fat and cubed

1 lb.

1 cup 2 1 tsp.

1 ⁄2 tsp.

1 ⁄4 tsp.

1 ⁄4 tsp.

1 ⁄8 tsp.

2

454 g 250 mL 2 5 mL 2 mL 1 mL 1 mL 0.5 mL 2

2 lbs.

900 g

All-purpose flour Chopped fresh oregano Chopped fresh rosemary Vegetable cocktail juice (such as V8) Chopped fresh Rosemary

2 tbsp.

1 tbsp.

2 tbsp.

1 ⁄2 cup 2 tbsp.

30 mL 15 mL 30 mL 125 mL 30 mL

Autumn Pork & Apple Stew

Combine first 9 ingredients in a 4 to 5 quart (4 to 5 L) slow cooker. Arrange pork over mixture.

Cook, covered, on Low for 6 to 7 hours, or on High for 3 to 3 1/2 hours.

Stir flour, herbs and second amount of juice in a small bowl until smooth. Stir into stew. Cook, covered, on High for 30 minutes. Sprinkle rosemary over top. Serves 6.

1 serving: 370 Calories; 18 g Total Fat (8 g Mono, 2 g Poly, 6 g Sat); 100 mg Cholesterol; 18 g Carbohydrate (3 g Fibre, 10 g Sugar); 33 g Protein; 300 mg Sodium

20

%

400-Calorie Slow Cooker Cookbook

SAVE

are available at participating

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gested Off Sug rice Retail P

Reprinted from 400-Calorie Slow Cooker Cookbook Company's Coming Publishing Limited

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