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Category Archives: Heart Disease

Very few products available in your local pharmacy can claim as many uses as Omega-3 fatty acids. Omega-3s are a type of unsaturated fat that are found in high quantities in certain fish (such as salmon, herring, sardines) as well as plant sources (such as flax).

The two most common Omega-3s found in supplements are EPA and DHA. Some supplements will have their Omega-3s derived from fish oils while others will be derived from plant sources. Be sure to choose a product that lists the amount of EPA or DHA per capsule.

There has been some concern by patients over the levels of heavy metals (such as mercury) in Omega-3 fish oils. However, heavy metals tend to accumulate in the protein of the fish rather than the fats. In addition, Health Canada tests all Omega-3 products for their heavy metal content before being made available to the public.

Here are 5 common medical conditions that Omega-3s can help treat:

1. Arthritis – Omega-3s have been shown to help decrease inflammation in the body, therefore they may help relieve some of the pain associated with both osteoarthritis and rheumatoid arthritis. Between 3 – 5 grams of EPA and DHA for 12 weeks are needed for the anti-inflammatory effects.

2. Hyperlipidemia – Omega 3-s can help lower triglyceride (fat) levels circulating in the body. High triglyceride levels contribute to the formation of fat deposits in blood vessels. This can lead to hardening of the arteries, which allows for the formation of dangerous clots which can cause a heart attack or stroke. Studies have shown that 2 – 4 grams of fish oils can lower triglycerides by 20-50%.

3. Hypertension – Omega-3s have a modest effect on reducing blood pressure and may be a viable option for patients with mild hypertension who do not wish to start a prescription medication at this time. Omega-3s reduce the production of agents that constrict blood vessels and increases production of agents that open blood vessels. For cardiac health, 1 gram of EPA plus DHA daily is recommended.

4. Depression – Studies have shown that 1 gram of EPA twice daily may yield anti-depressant and/or mood stabilizing effects. Omega-3s may be suited for the treatment of specific populations, such as pregnant or lactating women where conventional antidepressants must be used with caution.

5. Loss of Vision – Recent studies have shown the beneficial effects of omega-3s on vision, specifically decreasing risk of age related macular degeneration. Further investigations are needed to confirm the results of these studies, however many ophthalmologists are now recommending that their patients take Omega-3 supplements.

If supplements are not for you, try to replace the meat in two of your meals per week with fish. Certain populations (such as Mediterranean and Inuit) that eat high amounts of fish and little amounts of red meats have much lower rates of cardiovascular disease compared to the North American populations.

Omega-3s are not for everyone. For patients on blood thinners such as Coumadin (warfarin) or Aspirin (ASA), be sure to check with your physician or pharmacist before starting on Omega-3s as they may increase the risk of bleeding.

 

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Smoking is the most preventable cause of disease and death. In Canada, 45, 000 people die annually, and as many as half of all smokers will die due to tobacco use. Smoking is known to cause various types of cancer, COPD, heart disease, stroke and many other conditions such as influenza, peptic ulcers, osteoporosis, thyroid disease and cataracts. Despite the known risks, there are approximately 5 million Canadian smokers. Nicotine is the addictive chemical component in tobacco. It binds to the ‘reward’ receptors in the brain, which help people relax, improve mood and suppress appetite. Due to the continued stimulation of the reward pathway, people continue to smoke.

There are 2 primary options to smoking cessation; Cold Turkey or Medication. There have been many success stories of patients able to quit cold turkey, however it is much more difficult and shown to have an increased rate of relapse. It may be the most cost effective option, but these people suffer greatly from nicotine withdrawal symptoms, which include irritability, anger, restlessness, impatience, difficulty concentrating, depression and anxiety. These symptoms often start just a few hours after the last cigarette and are known to persist for weeks and months. Medications are available to help decrease these withdrawal symptoms, reduce the urge to smoke and help ease the patient to a continued smoke-free life.

Nicotine Replacement Therapy (NRT) is available over-the-counter in 4 forms; gum, patch, inhaler, and lozenge. There are different dosages available which is dependent on the amount of cigarettes the individual smokes. If you have questions regarding which dose you should start on and the proper technique to use the NRT, please speak to your pharmacist for assistance.

NRT provides nicotine in a safe form so the body does not have to endure nicotine withdrawal while a person adapts to not smoking. As opposed to cigarettes, NRT are medications that contain only nicotine and not the other harmful chemicals that are present in cigarettes. NRT is considered a ‘step down’ approach where the patient is exposed to a gradual decrease in the amount of nicotine in the blood. This enables the body to adjust to the changes in a slow and steady manner and experience less side effects.

The general length of therapy is 12 weeks, however this is NOT set in stone. It is also common practice to combine different forms of NRT such as using the patch and chewing gum. Some common side effects of the NRT include nausea, insomnia and local irritation if using the patch or inhaler.

The most commonly prescribed medication available for smoking cessation is Champix (Varenicline). Champix has recently been shown to have great success for smoking cessation. It works by binding to the same receptors as nicotine, which results in decreased cravings and withdrawal symptoms. Additionally, it decreases the pleasure that people get from smoking making the quitting process that much more effective.

The starting dose is 0.5mg once daily for the first 3 days, then 0.5 mg twice daily for the next 4 days, then 1mg twice daily thereafter. People are on Champix for 12 weeks, however many continue treatment for an additional 12 weeks to prevent smoking relapse. It should be taken with a glass of water with or without food. Common side effects include nausea, trouble sleeping and headache.

Caution: A patient may notice changes in their behavior, feeling depressed, agitated or not themselves. If this does occur, it is important to contact the physician.

Although there are medications and therapeutic options available, the single most important smoking cessation aid is a patients’ will and determination to quit. Having confidence and a support system are important for a smoker to kick the habit. Some other options for smoking cessation include hypnosis, counselling (individual and/or group), acupuncture, keeping busy, exercise (joining the gym or a class), or starting a new hobby. Studies have demonstrated that combining medication with advice or behavioural therapy increases the quit rates of up to 6 times. There are many support systems out there and available to help through the difficult time and it is important to know there is a light at the end of the tunnel.

“ The achievement of your goal is assured the moment you commit yourself to it” Mack R. Douglas.

Pharmacists are a great resource for information and support on your journey to quit smoking. Please come in and talk to us if you have any questions about smoking cessation.

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What can you start doing to prevent heart disease NOW?

  Start eating healthy!

  • Change the proportions of your plate such that; half of your plate is full of a variety of vegetables, a quarter of your plate contains whole grains such as brown rice or 100% whole wheat bread and the last quarter consists of fish, poultry, lean meat or legumes (chickpeas, lentils, tofu).
  • Slash the fat– trim all visible fat off of meat and remove the skin from chicken and fish to reduce fat and calories. Avoid pan frying or deep fryingà instead try broiling, baking or grilling food.
  • Try to limit salt intake. Try using other seasonings such as fresh or dried herbs. High salt intake is a major cause of high blood pressure. Reducing your salt intake, in certain instances, can be as effective as starting a blood pressure medication. It is recommended to eat no more than 1 teaspoon of salt/ day.
  • Increase your fibre intake– fibre helps make you feel fuller (so you don’t overeat) and may help lower cholesterol and control blood sugar. Increasing your fibre can be as easy as switching from a refined breakfast cereal to a high fibre one (such as 100% bran cereal), from white bread to 100% whole wheat bread, or from white rice to brown rice. Fruits and vegetables are another good source of fibre in the diet.

Get active!

  • Being active 30 to 60 minutes a day, most days of the week, can dramatically lower your risk of heart disease and stroke. Regular activity also helps prevent and control risk factors such as high blood pressure, high cholesterol, stress and obesity.
    • Typically 30-60 minutes of moderate exercise at least 4 days a week is recommended. Moderate exercise can include: brisk walking (not just going for a stroll), riding a bike, raking leaves, water aerobics, and swimming
    • Vigorous activities that make you breathe hard and sweat such as jogging, hockey or basketball require only 20-30 minutes a day
    • Find something that you enjoy doing and do it often!!ü  Lose weight!
    • Losing as little as 10 pounds can reduce your systolic blood pressure by up to 7.2mm Hg
    • A small but steady weight loss of a pound a week is much easier to attain and maintain and can be healthier for your heart than a large drop.
    • How?? – start eating healthy, reasonably sized (read as not heaping off the plate) portions and get active!! (see any common themes?!?!)

    Stop smoking!

    • Smoking contributes to the buildup of plaque in your arteries, increases the risk of blood clots, reduces the oxygen in your blood, increases your blood pressure and makes your heart work harder. All of which are bad for the heart.
    • Quitting smoking is not easy and requires a lot of will power. You must be fully prepared and willing to stop smoking before you can expect to actually stop. Even then, many smokers take several tries before they completely quit. So don’t give up keep at it!!
    • What can you do?
      • Identify your smoking triggers, (ie. when do you tend to smoke- is it with your morning coffee? or with your friends at night?) and try to avoid them as much as possible
      • Once you identify your triggers you will be able to break the connection between smoking and your routines. So when you feel the need to smoke, stop and ask yourself whether you really need this cigarette. Sometimes it helps to keep your hands or mouth busy by drinking water, snacking on carrots or celery, chewing gum or even taking a walk.
    • Make your home and car smoke-free zonesà the harder you make it for yourself to smoke the less you will!
    • Ask about nicotine replacement therapy at the pharmacy or ask your doctor about any prescription products that can help make it easier for you to get over the cravings and quit

    Reduce stress!

    • Although stress can sometimes be a good thing (ie. the fight or flight response), too much stress can actually harm your health and increase your risk of heart disease and stroke.
    • What can you do?
      • Identify the source of your stress – what is really bothering you?? Then try to eliminate or at least reduce it.
      • Share your feelings with friends, family, or coworkers. Get whatever is bothering you off of your chest and share it with others who may be able to help.
      • Make time to laugh. It’s your bodies’ natural stress release mechanism.
      • Take your vacations. Getting away from it all is important to your mental and physical health
      • Get active!! Being active is a great stress buster!
      • Eat healthy!! (still noticing any themes?!?!)

    Made by: Aaron Boggio, 4th year pharmacy student, Leslie Dan Faculty of Pharmacy,University ofToronto