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Archive for the ‘Preventative Health’ Category

 

The Not –So- Sweet Truth about What You’re Drinking

Friday, December 4th, 2015
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By Liz Aziz, PharmD Student Cedarville University School of Pharmacy

Many Americans have grasped the warning on excessive sugar intake. The problem is, these sugary calories often creep into the average American’s diet through drink, not food. Sugary drinks have already been tied to an increased risk of Type 2 diabetes as well as weight gain.­1 But just this month, a study published by the British Medical Journal has now found that sweetened beverages can also be associated with increase heart failure.2  Life with heart failure is nothing to take lightly, that’s why this gives the nation all the more reason to twist the cap shut on sweetened beverages and to choose healthier habits.

Increased prevalence of heart failure and other heart complications.chf As mentioned above, the recent study found a correlation between frequent consumption of sugary drinks and heart failure.2 These drinks include any beverage sweetened by sugar including soda, fruit juice/punch, lemonade, powdered drinks, or energy drinks.2 The study was a 12-year long population based study on 42,000 men ages 45-79. Researchers tracked incidents of heart failure between 1998 through 2010. Using food-frequency questionnaires, they found that men who drink two or more drinks a day were 23% more likely to develop heart failure. 2 Men who did not consume such beverages did not experience as many incidents of heart failure.2 Though the study has its limitations, such as survey bias and outside variables affecting study subjects, there are other literature that support the declining heart health of sugary-drink consumers.

In a similar study published by Circulation, researchers discovered a 20% increase in coronary heart disease in those who drink sweetened beverages.3  This study took into account age and family history when considering the correlation.3 They also concluded that the association had to do with sugar-sweetened drinks, not artificially-sweetened drinks (no-calorie sugary drinks).3  The study found sugar to be the underlying problem. Women are not excluded from this risk. The Nurses’ Health Study tracked the health of over 90,000 women during a time period of twenty years.4 They found similar results as the studies done on men, however the results were even more severe. Women who drank more than two servings of sugary drinks each day had a 40 % higher risk of heart attacks or death from heart disease in comparison to women who were rare consumers.4

So what is heart failure and heart disease? Heart failure is essentially when the heart is too exhausted or damaged to pump blood and oxygen to the rest of the body.5 Those that suffer from heart failure live a very difficult and limited life.5 Daily tasks become a struggle due to shortness of breath.5 This can further result in a sedentary lifestyle which is associated with its own health problems.5 Illnesses that can lead to heart failure are coronary heart disease as well as diabetes.5 The issue with excess sugar is that the build-up of the glucose metabolite in the body and frequent insulin spikes can cause significant damage and stress to the heart, leading to heart failure and heart disease.5 According to the Center of Disease Control, there are already 5 million Americans suffering from heart failure and more and more each year are adopting habits that put them at risk. soda

Sugary drinks overload your diet with sugar. A statement made by the American Heart Association recommended that the average adult should not consume more than 5 to 9 teaspoons of sugar. 7 However, the average 20-ounce bottle of a sugary drink contains 16 teaspoons of sugar.8 That almost TRIPLES the amount of sugar a person should consume in one day. With individuals having two or more of these drinks a day, it’s no wonder it is having a detrimental impact on Americans’ health.

What is the take home message? Those that regularly consume sugary drinks should set goals and limit their consumption.9 Though this is not the answer to all heart-related problems; it is definitely a start. There is plenty of research that supports this recommendation not only when it comes to heart failure but also diabetes and obesity. However, the question remains: Is this enough to get Americans to put down that can?

 

References

  1. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84:274–288.
  2. Rahman I, Wolk A, Larsson SC. The relationship between sweetened beverage consumption and risk of heart failure in men. Heart. 2015;
  3. De koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB. Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation. 2012;125(14):1735-41, S1.
  4. Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89:1037-42.
  5. nih.gov. What Is Heart Failure? – NHLBI, NIH. 2015. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/hf. Accessed November 11, 2015.
  6. en S, Kundu B, Wu H et al. Glucose Regulation of Load-Induced mTOR Signaling and ER Stress in Mammalian Heart. Journal of the American Heart Association. 2013;2(3):e004796-e004796. doi:10.1161/jaha.113.004796.
  7. Johnson RK, Appel LJ, Brands M, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association.Circulation. 2009;120(11):1011-1020.
  8. Wang YC, Coxson P, Shen YM, Goldman L, Bibbins-Domingo K. A penny-per-ounce tax on sugar-sweetened beverages would cut health and cost burdens of diabetes.Health Aff (Millwood). 2012;31(1):199-207.
  9. Sandee LaMotte C. Study links sweetened soda and heart failure – CNN.com. CNN. 2015. Available at: http://www.cnn.com/2015/11/03/health/soda-heart-failure-study/. Accessed November 11, 2015.
  10. Sugary Drinks.; 2014. Available at: http://www.rethinksugarydrink.org.au/go-free. Accessed November 11, 2015.
  11. CHF.; 2015. Available at: http://pharmacologycorner.com/drug-therapy-heart-failure-ppt/. Accessed November 11, 2015.
  12. Creative Commons. Vending Machine.; 2015. Available at: http://www.wikihow.com/Buy-Something-from-a-Vending-Machine-That-Demands-Exact-Change-when-All-You-Have-Is-Bills#/Image:Vending-Step-2.jpg. Accessed November 11, 2015.

 

Teens, Smartphones, and Poor Sleep

Tuesday, December 1st, 2015

By Dominic Yeboah, Pharmacy Student Cedarville University

Technology has evolved tremendously over the past few years.  The use of cell phones, tablets, and computers among children and adolescents is also on the rise. Schools also use technology in the classroom to help with teaching and learning. Cell phone use, especially texting in middle school through high school is on the rise.1,2 Teenagers are often on their phones using the Internet or texting, especially at bedtime. It was reported in the New York Daily News that 57% of teenagers texted while in bed, and an additional 21% were awoken by text.1  This has led to kids and teenagers, especially those in high school and middle school, getting an inadequate amount of sleep.1

A recent study analyzed the impact of communication technology on teenagers’ mood, cognition and daytime functioning. The study was a cross-sectional study in a Middlesex county school district in New Jersey.  It involved a total population of 3,139 with the ages ranging between 12-17. The study reported that the use of smartphones in this age group has increased by 14% between 2011 and 2013, with texting, use of the Internet, social media activities, and online gaming reporting highest use.2

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

The results indicated that close to 62% of teens used a smart phone or tablet after bedtime, 56.7% texted or tweeted messages in bed, and 20.8% were awoken by texts messages. Continuous wakening to use and check cell phones led to changes in sleep pattern and in some cases insomnia. Teenagers may not be able to go back to sleep because they end up texting or checking other social media when they are awaken from sleep.3,5  The inadequate night-sleep has led to daytime sleepiness, academic problems, mood swings, aggressive behaviors, increased risk of accidents, as well as an increase risk of substance abuse.4-7 Studies have also shown that reduced sleep time can contribute to obesity in children which may also lead to an increase in type 2 diabetes and other chronic diseases later in life.3,8

Reasonable limitations and appropriate smart phone and tablet use are very important. Maintaining good sleep hygiene can prevent the effects listed above. It is essential for teenagers to practice good and effective sleep hygiene. Therefore, non-pharmacological treatment is the most appropriate and desired form of treatment. This includes making choices at bedtime that will foster a good night sleep such as maintaining a cool and quiet sleeping space, eliminating all use of electronics (especially cell phones, tablets or television), eliminating bright lights, and decreasing caffeine intake before bedtime.9

Parents of teenagers who still have problems with insomnia after trying and implementing proper sleep hygiene  (non-pharmacological treatment) may consult their child’s primary care provider for further evaluation.

Reference

  1. Robins B(2015). Late night texting is linked to insomnia and poor grades, study finds. New York Daily News.
  2. Polos P, Bhat S, Gupta D, O’Malley R, Debari V, Upadhyay H, et al (2015). The impact of Sleep Time-Related Information and Communication Technology (STRICT) on sleep patterns and daytime functioning in American adolescents. Journal of Adolescence, 232-244.
  3. Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of nonprescription Drug: An Interactive Approach to Self-care. 18th Washington, D.C.: American Pharmacists Association; 2015: 853-860.
  4. Institute CM, Gary J. (2014). What happens when teenagers don’t get enough sleep | child mind institute. Available at: http://www.childmind.org/en/posts/articles/2014-7-1-consequences-teenage-sleep-deprivation (Accessed: 17 November 2015).
  5. Fossum IN, Nordnes LT, Storemark SS, Bjorvatn B, Pallesen S. The association between use of electronic media in bed before going to sleep and insomnia symptoms, daytime sleepiness, morningness, and chronotype. Behave Sleep Med. 2014; 12(5): 343-57.
  6. Chung KF, Cheung MM. Sleep-wake patterns and sleep disturbance among Hong Kong Chinese adolescents. Sleep. 2008; 31(2): 185-94.
  7. Asarnow LD, Mcglinchey E, Harvey AG. The effects of bedtime and sleep duration on academic and emotional outcomes in a nationally representative sample of adolescents. J Adolescent Health. 2014; 54(3): 350-6.
  8. Chaput JP. Is sleep deprivation a contributor to obesity in children?. Eat Weight Disord. 2015;
  9. Lemola S, Perkinson-gloor N, Brand S, Dewald-kaufmann JF, Grob A. Adolescents’ electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age. J Youth Adolesc. 2015;44(2):405-18.

Caffeine intake & bone density..what’s the scoop?

Wednesday, November 11th, 2015

By Morgan Bailey, PharmD Student Cedarville University School of Pharmacy

In college and even in the workplace, caffeine has consumed our lives. Our generation turns to caffeine to give us the burst of energy that we need to make it through the day. According to Healthresearchfunding.org, almost 90% of people in the world consume at least one beverage with caffeine in it daily.1 These beverages would include coffee, energy drinks and soda or pop. Caffeine is considered to be a stimulant to the body, which is why whenever you drink a lot of caffeine you tend to feel more energized and awake. Even though we may get a great feeling from these drinks, are they really being beneficial to our bodies? Recent evidence debates whether consuming large amounts of caffeine can increase your risk for osteoporosis.

Image courtesy of samuiblue at FreeDigitalPhotos.net

Image courtesy of samuiblue at FreeDigitalPhotos.net

Osteoporosis is condition where your bones become brittle and can make you become more at risk of breaking or fracturing your bones. Research on this topic leads some to believe that the caffeine stops the absorption of calcium in the bones, therefore causing them to become thin. Studies have also shown that caffeine acts on the bone promoting an increase of calcium excretion, inhibition of osteoblast proliferation and delay in tissue repair process, raising the risk of fractures, osteoporosis, periodontal disease and affecting the success of bone reconstructive procedures.2, 3

In 2015, The European Journal of Clinical Nutrition published a study looking at the influence of dietary patterns on bone mineral density and osteoporosis. This was a cross-sectional study that looked at Brazilian women aged 45 and over. The five categories retained were; “healthy”, red meats and refined cereals”, “low-fat dairy”, “sweet foods, coffee and teas”, and “western”. After analyzing that data that they received, they found that excessive sweet foods and caffeinated beverages appeared to have a negative affect on the bone mineral density. Although the study did find a negative effect on the bone density, they could not make a direct link to increased risk of osteoporosis. This was also a cross-sectional study, which was only looking at a specific time period; other results may have been revealed with a longer follow up study.4 In addition, recall bias may have affected the results due to patients self-reporting diet. There was also not any specific type of caffeine separated out (ie is there a difference between coffee, tea, or soda).

Similar findings were found in a 2006 study that found women with high coffee consumption, more than four cups a day, had an increase risk of bone fractures.5 On the other hand, a 2012 systemic review of multiple trials, concluded coffee intake did not increase risk of bone fractures, however suggested more research is needed.6 In 2013, a study was conducted on the long-term effects of coffee consumption and how that relates to the risk of bone fractures. The researchers found that there was no increased risk when the women drank low amounts of coffee, but when they drank more than four cups per day then they found that there could be a reduction in density of the bones.7 This cannot be directly linked to osteoporosis, but is considered a possible risk factor.

While it is not completely clear whether or not caffeine intake (or which type of caffeine) can increase the risk of osteoporosis and bone fractures, there is a lot of promising research being done to answer these questions. It appears there is a trend that over 4 cups a day may be an issue. If you are someone that drinks a lot of caffeine throughout the day, you could discuss supplementing with calcium and/or vitamin D and also consider limiting the amount of caffeine that you consume in a day and increase exercise.8, 9

Even though you may not be seeing the results of your caffeine intake now, would you still drink the same amount of caffeine if you knew that it could potentially hurt you in the future?

References

  1. 25 Shocking Caffeine Addition Statistics. HRF website. http://healthresearchfunding.org/shocking-caffeine-addiction-statistics/. August 30, 2014. Accessed October 20, 2015.
  2. Hallstrom H. Coffee consumption in relation to osteoporosis and fractures: Observational studies in men and women. DiVA. 2013.
  3. Vanin, Carla, Harter ,Danielle, Ribeiro RV,Pinto, Kato ,Sergio, Dibi R,Papandreus, Stein ,Airton. Effects of caffeine intake on bone tissue in an animal model of osteoporosis. 2015. 10.1016/j.maturitas.2015.02.185
  4. De Franca N.A.G., Camargo M.B.R., Lazaretti-Castro M., Peters B.S.E., Martini L.A. Dietary patterns and bone mineral density in brazilian postmenopausal women with osteoporosis: A cross-sectional study. Eur J Clin Nutr. 2015; doi: 10.1038/ejcn.2015.27. [Epub ahead of print]
  5. Hallstrom H, Wolk A, Glynn A, Michaelsson K. Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of swedish women. Osteoporos Int. 2006; 17(7):1055-1064.
  6. Huifang L, Ke Y, Wenjie Z, Jun Z, Taixiang W, Chengqi H. Systematic review/Meta-analysis
coffee consumption and risk of fractures: A meta-analysis. Arch Med Sci. 2012;8(5).
  7. Hallstrom H, Byberg L, Glynn A, Lemming EW, Wolk A, Michaelsson K. Long-term coffee consumption in relation to fracture risk and bone mineral density in women. Am J Epidemiol. 2013; 178(6):898-909.
  8. Sanders S, Geraci SA. Osteoporosis in postmenopausal women: Considerations in prevention and treatment: (women’s health series). South Med J. 2013; 106(12): 698-706.
  9. Suzanne Sanders, M.D., Stephen A. Geraci, M.D. Osteoporosis in postmenopausal women: Considerations in prevention and treatment (women’s health series).

Acetaminophen: Is it Really Your Safest Option?

Friday, November 6th, 2015

By Tori Bumgardner, PharmD Student Cedarville University

Acetaminophen has long been a popular over-the-counter product used to treat pain and fever in both adults and children (1). It is recommended to women as the preferred pain medication while pregnant. The FDA has been approved for dosing in individuals of all ages, from infants to adults, who may be suffering from pain or fevers (2). While it is known that acetaminophen causes liver damage to people who take it at high doses for an extended period of time, recent studies have investigated the possibility that it can lead to dangerous levels of toxins in the body, potentially increasing the risk of attention deficit hyperactive disorder (ADHD) and even autism (3,4). The buildup occurs when one of the metabolites of acetaminophen, N-acetyl-p-benzoquinone imine (NAPQI), inhibits the detoxification of reactive oxygen species (ROS) in the body (5). When ROS builds up, inflammation can occur, giving it the potential to cause ADHD or autism. Additionally, a meta-analysis was conducted looking at the correlation between use of acetaminophen during pregnancy and occurrence of asthma in offspring (6). The study found that mothers who used acetaminophen while pregnant increased the risk of their child developing asthma. This blog post will review the recent evidence on the dangers associated with pre-natal exposure to acetaminophen.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

A study from 2014 examined the relationship between mothers who took acetaminophen during pregnancy and the subsequent occurrence of ADHD in their children (4). In this study, 1714 European children were followed for 11 years and their mothers were surveyed when the children were newborn, 1, 3.5, 7, and 11 years old. For the newborn interview, information on the mothers’ pregnancy was collected. The other interviews were focused on the child, paying special attention to cognitive development, behavior, and physical activity. In the final interview, at age 11, the children also completed and interview that asked about topics like behavior, emotions, and self-esteem. The investigators examined the relationships between different drugs that were taken during pregnancy with the results of the strengths and difficulties questionnaire that were completed throughout the study. Interestingly, it was found that the group who used acetaminophen showed higher difficulties and lower social scores. The findings of this study indicate that acetaminophen use during pregnancy is correlated with higher rates of ADHD in children. Limitations to the study included a low follow-up rate, lack of generalization since the study was specific to European women and their children, and a possibility of selection bias if both parents were already predisposed to ADHD. Authors concede that additional research should be done to determine the actual risks associated with exposing children to acetaminophen at young ages. Other data found that children whose mothers used acetaminophen while pregnant had a higher incidence of behavior problems and hyperkinetic disorders (HKDs) like ADHD during a follow up when the children were seven years old (7). Due to the safety concern in allowing pregnant women to continue taking acetaminophen, since research seems to suggest its harm, the FDA has begun looking into the issue (8).

Though research is not yet conclusive, they encourage women to talk to their healthcare providers before taking anything.While it is always a good recommendation to talk to a doctor first, what does that leave women to use when they are in pain, but don’t have time to see or call the doctor, and are left with no options to provide relief? There are certainly alternatives available that don’t include drugs and can help relieve pain caused by headaches and aching in other parts of the body. Sometimes headaches are caused by stress and can be helped by practicing relaxation through deep-breathing, yoga, or any other technique that is convenient and will divert their mind off stress-inducing stimulation (9). A regular sleeping schedule is also important and exercise can help to relieve headaches, so taking a nap or a walk are both ways to relieve stress and pain without taking medication. Pain in other parts of the body may be troublesome, but a gentle massage or an external, topical pain relief product can be used to help establish comfort.

The data is still uncertain on the magnitude of risk with acetaminophen use in pregnant women, it is best to err on the side of caution and avoid use if possible. At the end of the day, the question that is left is one of risk versus benefit. Since nothing is conclusive about the danger that acetaminophen may have on babies, is it ultimately worth the risk to use it as a quick fix for a couple of hours free of pain?

 

References:

  1. Medline Plus: Trusted Health Information for You Web site. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a681004.html. Published 08-15-2014. Updated 2014. Accessed October 16, 2015.
  2. DailyMed (package inserts). National Institutes of Health; National Library of Medicine.  http://dailymed.nlm.nih.gov/dailymed/ (accessed October 26, 2015).
  3. Jennifer Margulis PD. Could A common painkiller cause brain inflammation — and even autism — in children? http://reset.me/story/could-a-common-painkiller-cause-brain-inflammation-and-even-autism-in-children/. Published 09-08-2015. Updated 2015. Accessed 10-16-2015.
  4. Thompson JMD, Waldie KE, Wall CR, Murphy R, Mitchell EA, the ABC study group. Associations between Acetaminophen Use during Pregnancy and ADHD Symptoms Measured at Ages 7 and 11 Years. Hashimoto K, ed. PLoS ONE. 2014;9(9):e108210. doi:10.1371/journal.pone.0108210.
  5. Shaw W. Evidence that increased acetaminophen use in genetically vulnerable children appears to be a major cause of the epidemics of autism, attention deficit with hyperactivity, and asthma. Journal of Restorative Medicine. 2013;2:1. Accessed October 26, 2015. doi: 10.14200/jrm.2013.2.0101.
  6. Cheelo M, Lodge CJ, Dharmage SC, et al. Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: A systematic review and meta-analysis. Arch Dis Child. 2015;100(1):81.
  7. Liew Z, Ritz B, Rebordosa C, Lee P,Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatrics. 2014;168(4):313-320.
  8. FDA drug safety communication: FDA has reviewed possible risks of pain medicine use during pregnancy. U.S. Food and Drug Administration Web site. http://www.fda.gov/Drugs/DrugSafety/ucm429117.htm. Published 01-09-2015. Updated 2015. Accessed October 16, 2015.
  9. Krinsky D, Ferreri S, Hemstreet B, et al. Headache. In: Young L, ed. Handbook of nonprescription drugs: An interactive approach to self-care. 18th ed. Washington, DC: American Pharmacists Association; 2015:65-83-95. Accessed 10-16-2015.

Goodnight, Sleep Tight, Make Sure Your Blood Pressure is Right

Friday, October 30th, 2015

By: AJ OliverMoon_by_Adam_Cebula

Take a quick moment to think about your typical nightly routine. It most likely includes actions such as washing your face, showering, brushing your teeth or setting aside your outfit for the next day. If you are someone who has been diagnosed with high blood pressure (hypertension), adding the task of taking your medication may prove more beneficial to your health. In 2011, a new study reported by Harvard Health Publications claimed that taking your daily blood pressure medications at night will help lower the reading in those diagnosed with high blood pressure.1 Although that sounds like a no brainer, it is important to note that those not diagnosed with hypertension experience blood pressure readings that alternate based on the time of day. Getting out of bed is the hardest part of the day but once you do get out of bed, blood pressure rises. Before you start getting scared that your blood pressure will reach sky high before you start eating lunch, do not worry because your blood pressure will remain steady. Guess when your blood pressure will be at its lowest? Yep, you guessed it – it is lowest at night, usually between midnight and three or four o’ clock in the afternoon.1 This phenomenon is called “dipping”. However, people with high blood pressure experience “non-dipping,” meaning their blood pressure does not decrease at night – making the finding above important.2

Unfortunately, the same hormone that contributes to hypertension also increases the release of sugars from the liver and lowers insulin sensitivity.2 The combination causes an increase of risk for Type 2 diabetes in those who have hypertension. This was investigated in a study published in the Journal of Human Hypertension.3  In the study of 2,012 people with high blood pressure, half of the participants were instructed to take their blood pressure medications at night while the other half were instructed to take these medications in the morning.4 They monitored the participants for six years over which time 171 of the participants developed Type 2 diabetes.2 The researchers found that the half who took the blood pressure medications at night before going to bed had lowered their blood pressure more than those who took it in the morning.4 Additionally, these same participants also had a 57 percent lower risk for diabetes. Therefore, study authors concluded that taking a blood pressure medication before going to bed could benefit those who have hypertension by lowering blood pressure readings at night and decrease the risk of developing diabetes.1 However, with these studies there is a point that is important to note. Authors found that some older participants taking their blood pressure medications at night had critically low readings in the morning when trying to rise out of bed causing an increased risk of falls.1

Considering the evidence, taking blood pressure medication at night appears to be effective for improvement in blood pressure and risk of diabetes. However, it is necessary to take the proper precautions before starting blood pressure medications at night. Contact your doctor and pharmacist to see if you are suitable for taking blood pressure medications at night. Also, make sure that you use the same methods as you would use if you were to take these medications during the day. For instance, be sure to make a list of all the blood pressure medications taken.5 Also, try to get a good understanding of the side effects of your medications, not all blood pressure medications should be taken at night. For example, blood pressure medications like hydrochlorothiazide and Lasix are within a class of medications called diuretics.6 One of the side effects of diuretics is an increase in the volume of urine, which may result in multiple trips to the bathroom throughout the night.  For the medications you do take at night, make it a routine to take it at the same time every day.5 Do not alternate between taking the medications at night and during the day. Finally, keep your doctor informed and get your blood pressure checked regularly. If your primary care physician says you are good to go for taking your blood pressure medications at night then get to it! This may be a hard change and a lot to keep in mind. What are some ways to remind yourself to take these medications at the same time every night as well as reminding yourself to check your blood pressure? Do you think that taking blood pressure medication at night would be helpful for you?

References:

  1. LeWine H. Taking blood pressure pills at bedtime may prevent more heart attacks, strokes. Harvard Health Publications. October 25, 2011. http://www.health.harvard.edu/blog/taking-blood-pressure-pills-at-bedtime-may-prevent-more-heart-attacks-strokes-201110253668. Accessed October 29, 2015.
  2. Thompson D. Timing your blood pressure med right might prevent diabetes. News & View. September 24, 2015. http://news.health.com/2015/09/24/taking-blood-pressure-drugs-at-night-may-help-prevent-type-2-diabetes/. Accessed October 29, 2015.
  3. Hermida RC, Ayala DE, Mojón A, Smolensky MH, Portaluppi F, Fernández,J.R. Sleep-time ambulatory blood pressure as a novel therapeutic target for cardiovascular risk reduction. J Hum Hypertens. 2014;28(10):567-574. Accessed October 29, 2015.
  4. Bakalar N. Hypertension drugs may be more effective if taken at night. Well. October 2, 2015. http://well.blogs.nytimes.com/2015/10/02/hypertension-medicines-are-best-taken-at-night/?ref=health&_r=1. Accessed October 29, 2015.
  5. Web M. D. Taking high blood pressure drugs properly. http://www.webmd.com/hypertension-high-blood-pressure/how-take-blood-pressure-medicine-properly-why-you-should. Accessed October 29, 2015.
  6. Drugs.com. Diuretics. http://www.drugs.com/drug-class/diuretics.html.

Darker Isn’t Always Better

Thursday, October 29th, 2015

By: Maame Debrah-Pinamang, PharmD Student

ChocolateFor years, the scientific world has been shouting to the masses about the benefits of eating dark chocolate. The health benefits of dark chocolate have been extensively studied to provide us with the knowledge that habitual consumption of dark chocolate will lead to lower risk of cardiovascular disease, raise your high density lipoprotein levels (good cholesterol), as well as provide antioxidant properties to keep you looking younger, longer.1 Evidence such as this has led people to choose dark chocolate over regular milk chocolate. What if that’s not necessarily the case? Recently, there was an article stating that milk chocolate provides the same benefits of dark chocolate, as well as an increase in research on what the health benefits of dark chocolate come from, and whether the heart benefits that dark chocolate has is present in other types of chocolate.2 Besides color and taste, there is very little difference between dark and milk chocolate. Different companies include different levels of sugar and cocoa powder in their formulations, although the FDA sets standards for what cocoa levels constitute each type of chocolate. In order to be considered milk chocolate, the piece of chocolate must not contain less than 10% chocolate liquor, and at least 12% milk ingredients. For dark chocolate, the required amount of chocolate liquor is greater than or equal to 35%.3

A recent study analyzed the chocolate consumption of over 20,000 people for a period of 11 years, on average. Participants consumed a median of 4.6 grams (about 1.25 individual squares on a standard bar of Hershey’s chocolate) of chocolate per day, and had their cardiovascular health assessed.4 The data used in the first study looked at the effects on HDL and LDL with the participants self-reporting their consumption of chocolate. Participants that consumed a higher amount of chocolate had an increase in cardiovascular health, a lower body mass index (BMI), as well as lower blood pressure. However, the self-reporting of chocolate consumption leads to errors in reporting and inconsistent measurements. The study also failed to report the specific type of chocolate the participants consumed, making it difficult to pinpoint the exact cause of the reduced health risks. In order to produce a more reliable study, the researchers should have produced a specified amount of chocolate to each participant as well as recording the specific kind of chocolate.

Of the more common types of chocolate, dark chocolate is more extensively studied for the benefits that it may provide, but that kind of chocolate may be irrelevant. In a similarly conducted study in Japan, researchers gave participants 13, 19.5, and 26 grams of chocolate per day.5 Similar to the first study, those who ate more chocolate saw a greater increase in cardiovascular health. Those who ate at least 13 grams of chocolate per day found approximately 3.23 mmol/L decrease in LDL cholesterol. Some limitations of the study was that the study participants were given cocoa powder, which is not readily available to most people, as well as the cocoa powder being added to hot water, and not taken as a piece of chocolate that is easily available to all people.

In order to gain all the heart benefits of chocolate, each person should attempt to get approximately 1.5 grams of chocolate per day. Although a consistent consumption of chocolate could provide an increase in heart health, the benefits may not apply to everyone. Different health conditions may not allow for self-care with chocolate consumption. Given the results of the research, it is inconclusive that the impact of dark chocolate on heart health is greater than milk chocolate. The studies performed in the articles allow a safe assumption that either kind of chocolate would provide the same benefits.  The health benefits stemming from cocoa powder and not from the color of the chocolate allow for a greater range of chocolate that will provide heart healthy benefits. The recommended daily amount of chocolate from The Cleveland Clinic Wellness is 1.5 to 3 ounces to ensure maximum heart benefits from chocolate (Godiva sells chocolate in 1.5 ounce size).6 The small amount of chocolate provides us with right correct amount of chocolate to ensure heart health, without the excess sugar that comes with eating too much chocolate. Although it is important to take self-care measures to reduce your risk of heart disease, do not rely solely on chocolate as your cardiologist. Before beginning any self-care regimens, contact your primary care provider to ensure that the measures you are starting are safe and the best options for your needs.

 

References

  1. Kwok, C. S. et al. Habitual Chocolate Consumption and Risk of Cardiovascular Disease Among Healthy Men and Women. British Medical Journal. 2015.
  2. Wanjek, Christopher. “Even Milk Chocolate is Good for you, According to new Study” Huffington Post. June 16, 2015. Accessed October 14, 2015.
  3. Hershey’s. Types of Chocolate. Available at: http://web.archive.org/web/20090126124820/http://hersheys.com/nutrition/chocolate.asp Accessed October 28, 2015.
  4. Smit, H. J., Gaffan, E. A., Rogers, P.J. Methylxanthines are the psycho-o Kondo. pharmacologically active constituents of chocolate. 2004; (176)3-4:412-19.
  5. Baba, S, et al. Plasma LDL and HDL Cholesterol and Oxidized LDL Concentrations Are Altered in Normo- and Hypercholesterolemic Humans after Intake of Different Levels of Cocoa Powder. The Journal of Nutrition. 2007;137(6): 1436-1441.
  6. Cleveland Clinic Wellness. Eating Chocolate can be Healthy. Available at: http://www.clevelandclinicwellness.com/Promos/Pages/Chocolate.aspx#. Accessed October 28, 2015.

Weighing in on Liquid Measurement Error

Friday, December 5th, 2014

By Bryan Feldmann, PharmD student

If someone were to ask you what the difference was between a teaspoon and a tablespoon, would you know what to say? You might have prescriptions from your doctor or medications you bought over-the-counter that tell you to take a number of tablespoons or teaspoons of the medication. A teaspoon will usually be abbreviated as “tsp” and tablespoon as “tbsp.” Because the two abbreviations look very similar, it can be easy to mix them up at a first glance. This can be a big problem, because it is so important that meds are taken exactly as directed.

You may already know what teaspoons and tablespoons are, but many people do not. Tablespoons and teaspoons are two different units of measurement. Similarly to gallons and liters, teaspoons and tablespoons are both used for determining how much volume something has (in other words, how much space it takes up). You will usually see units of volume used when your medication is a liquid.
So, how do these two similar units of measure differ? To begin, a teaspoon is smaller than a tablespoon. You can remember this by thinking of how big a table is compared to a cup of tea. In fact, tablespoons are three times larger than teaspoons. Now, just think about how dangerous it might be if someone accidentally took three times the amount of drug they were supposed to by mistake. According to a new study published by the American Academy of Pediatrics (medical care of children and teens) there are more than 10,000 calls to the poison control center every year because of errors patients made in how much of a liquid medicine they took.1 Just imagine the horror of the parents and caretakers being forced to call the emergency number because of an adverse reaction to a medication error. Since liquid medications are usually given to children, the study also specifically measured how many times parents made a mistake when pouring medicine for their kids. When they were supposed to measure with either teaspoons or tablespoons, they accidentally measured incorrectly 40% of the time, or 2 out of every 5 times!1 What can be done to fix this?

Teaspoon (tsp) and tablespoon (tbsp.) look so alike it is no wonder people can mix them up, but there is another common way to measure volume— the milliliter, or “mL.” A milliliter looks and sounds nothing like a teaspoon or a tablespoon, so it would stand to reason that people would not confuse it with anything else. There are 5 milliliters (mL) in a teaspoon, meaning there are 15 mL in a tablespoon.2 So milliliters are also useful for being more precise, since not everything must be in multiples of 5 milliliters. In another study, parents who had to measure medications in teaspoons or tablespoons were compared to those who measured in milliliters.3 The parents who were asked to use teaspoons and tablespoons were about twice as likely to make a mistake.3 287 single parents or pairs of parents were studied to get these results.3 This is a very small sample when compared to how many parents there are giving medications to children in the country, so more research should still be done.

Just mixing up the units is not the only reason these forms of measurement are so problematic, however. Many homes have kitchen teaspoons and tablespoons spoons just for measuring in teaspoons and tablespoons, but a study in the International Journal of Clinical Practice showed that the spoons that people have differ drastically from one another and are not accurate.4 Another study, published in the Archives of Pediatric and Adolescent Medicine, which is itself published by the American Medical Association, found that oral syringes and droppers are the best tools to use to measure volume and avoid error.5 300 parents were asked to measure out one teaspoon of acetaminophen with dosing cups, dosing spoons, oral syringes, and droppers. 70% of the parents made an error when it came to using the dosing cups with printed markings, and 50% made an error when using dosing cups with etched markings. More than a third of just these mistakes alone would have been highly dangerous overdoses if this study were not conducted in a controlled environment. According to the Institute for Safe Medical Practices’ reporting on this study, “Parents who make mistakes when using dosing cups are often confused about the differences between teaspoons and tablespoons.”6 Mistakes were only made 6% of the time when using a dropper, 10% of the time when using an oral syringe, and 14% of the time when using a dosing spoon. Keep in mind that a dosing spoon is different than a kitchen teaspoon or tablespoon, in that it is accurately calibrated to hold the amount it purports to, unlike the others, which have been shown to vary from spoon to spoon. So we can rest assured that it would be much safer to measure a number of milliliters in a liquid measuring device such as a dropper instead of simply trusting in one of these spoons. Additionally, it is not very easy to measure the exact amount of medication such that it is lying flat at the brim of the spoon without making a mess. This could be much easier if a dropper or oral syringe was used.

It would be great if milliliters replaced teaspoons and tablespoons on all drug labels over time, but at the moment we will likely continue to encounter all three units of measure. Armed with the knowledge of how much each unit represents and being careful when you’re reading instructions will decrease your chances of committing a liquid medication measurement error. As a future pharmacist, I would recommend always using a measuring cup or another device such an oral syringe over a spoon to measure tablespoons and teaspoons, even if the spoons say they are designed specifically for that purpose. Share these important tips with friends and family and always be careful in order to guarantee positive outcomes for yourself and your loved ones. And if you are a health care provider follow the link here to see ISMP’s recommendations for preventing liquid medication errors.

Have you ever mixed up tablespoons and teaspoons? Have you seen someone else mix them up? What steps will you take to avoid liquid medication mistakes?

References

  1. Schmidt C. Child medication measurements confuse parents. cnn.com  http://thechart.blogs.cnn.com/2014/07/14/child-medication-measurements-confuse-parents/. Published July 14th, 2014. Accessed November 6, 2014.
  1. Teaspoon v. tablespoon: What’s the difference? Ismp.org https://www.ismp/org/consumers/teaspoon.asp Updated 2014 Accessed November 6, 2014
  1. Yin H, Dreyer B, Ugboaja D, et al. Unit of measurement used and parent medication dosing errors. American Academy of Pediatrics. 2014;134(2).
  1. Falagas ME, Vouloumanou EK, Plessa E, Peppas G, Rafailidis PI. Inaccuracies in dosing drugs with teaspoons and tablespoons. Int J Clin Pract. 2010;64(9):1185.
  1. Shonna Yin H, Mendelsohn AL, Wolf MS, et al. Parents’ medication administration errors: role of dosing instruments and health literacy. Arch Pediatr Adolesc Med. 2010;164(2):181-186.
  1. Use an oral syringe or dropper to measure children’s medicines, not a cup.ismp.orghttps://www.ismp.org/newsletters/consumer/Issues/20100105.asp. Published June 2010. Accessed 12/02, 2014.

Lather, Rinse, and Repeat

Tuesday, December 2nd, 2014

By Logan Conkey, PharmD Student

Students are in the swing of things now that fall has begun. Students are at a higher risk of spreading sickness to others because of the environment they are in.  October is here and this month initiates flu season as well as a time where more illness is being shared.1 To prevent the spread of illness, the CDC recommends cleaning hands frequently, including after using the restroom.2 Many people do not like to wash their hands and a survey reported by the American Society for Microbiology reported 1 in 5 teenagers and adults claimed they do not wash their hands after they use the restroom.3 With so many germs being passed around, students often become sick and have to miss school. Recently, a group of researchers in New Zealand wanted to see if there was a relationship between the amount of school days missed due to illness and hand hygiene that included hand sanitizer combined with normal and frequent hand washing.

CNN Health published the article; Hand sanitizer doesn’t help in schools in August this year.4 The article was based on a study that took place in elementary classrooms in New Zealand and compared students who hand washed only and students using alcohol based hand sanitizer along with normal hand washing. All classrooms were taught proper washing techniques to ensure a standard practice and the alcohol sanitizer was provided to make certain it was the same strength throughout. The trial was conducted in 68 elementary schools, during the winter term, with children ages 5-11 The control group was instructed only to use regular hand washing with soap and water when cleaning their hands. The intervention group was instructed to wash their hands with soap and water and include the use of an alcohol-based sanitizer after they coughed, sneezed, and before meals. The outcome was to be determined by comparing the amount of total days students missed due to illness only. The results suggested there was not a significant difference between the groups regarding total days missed. The study did not look at specific illnesses such as flu when collecting data and the study may have been limited because there was a flu epidemic during this season. Another limitation included parental direction and whether the parents were instructing students to differ from the provided procedure. Some students also complained about the taste of the sanitizer on their hands when eating and this believed to have made the children less compliant when using it. The complaints came from a handful of schools and the sanitizer was replaced with an equivalent.5

The CDC says hand washing with soap should be the first option and hand sanitizer should be used if soap and water are not available. Alcohol-based sanitizers do not eliminate all forms of germs.6 It is confirmed that proper hand washing and/or the use of alcohol-based hand sanitizers has shown to reduce the risk of infection from certain viruses.7 Alcohol based sanitizers must be strong enough to be effective. Not all sanitizers are created the same and the recommended strength should be at least 60%.8 Other studies performed in the classroom regarding the used of alcohol based hand sanitizers has not persuaded researchers to consider them beneficial enough to place high priority on them and that hand hygiene education is the largest benefactor.9

The study performed in New Zealand provides proof we should not be putting a high priority on placing alcohol-based hand sanitizer in classrooms. Parents should encourage proper hand hygiene and instruct children when the most important times are to wash hands. If hand washing is not an option then hand sanitizer is a good second choice. While there does not seem to be a great benefit to sanitizer in the classroom, there have been no reported risks or problems with using it. The parent or teacher must decide if they want to incorporate sanitizer. There is no way of eliminating illness in children but parents and teachers can work together to improve the health of the classroom.

Are you and your students taking the proper precautions to prevent sickness?

 

References

  1. The Flu Season. CDC Website. Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 3, 2014.
  2. Preventing Seasonal Flu Illness. CDC Website. Available at: http://www.cdc.gov/flu/about/qa/preventing.htm. Accessed October 3, 2014.
  3. Hand Sanitizer doesn’t help in schools. CNN Health Website. Available at: http://thechart.blogs.cnn.com/2014/08/12/hand-sanitizer-doesnt-help-in-schools/?iref=allsearch. Accessed October 3, 2014.
  4. Bratsis M. Flu Season: The Best Defense. Science Teacher [serial online]. October 2012;79(7):68. Available from: Education Research Complete, Ipswich, MA. Accessed October 3, 2014.
  5. Priest P, McKenzie J, Audas R, Poore M, Brunton C, Reeves L. Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trial. Plos Medicine [serial online]. August 2014;11(8):1-14. Available from: Academic Search Complete, Ipswich, MA. Accessed October 3, 2014.
  6. When & How to Wash Your Hands. CDC Website. Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 3, 2014.
  7. Prazuck T, Compte-nguyen G, Pelat C, Sunder S, Blanchon T. Reducing gastroenteritis occurrences and their consequences in elementary schools with alcohol-based hand sanitizers. Pediatr Infect Dis J. 2010;29(11):994-8.
  8. Roy K. Rethinking the use of hand sanitizers. Science Scope [serial online]. September 2009;33(1):74-76. Available from: Education Research Complete, Ipswich, MA. Accessed October 3, 2014.
  9. Meadows E, Le Saux N. A systematic review of the effectiveness of antimicrobial rinse-free hand sanitizers for prevention of illness-related absenteeism in elementary school children. BMC Public Health [serial online]. January 2004;4:50-11. Available from: Academic Search Complete, Ipswich, MA. Accessed October 3, 2014.

Magnesium and physical activity – does it make a difference?

Monday, December 1st, 2014

By Matthew Johnson, Pharm.D. Student.

Magnesium is a mineral involved in many bodily functions such as muscle and nerve regulation, blood sugar control, energy production, and the making of proteins.Recommended Dietary Allowance (RDA) is the average daily amount needed to meet the body’s needs of a dietary substance for most healthy people.The RDA for magnesium varies by age and gender. For women 19-30 years old it is 310 mg (men 400 mg). For women aged 31 years and older the value is 320 mg (420 mg for males). A deficiency of magnesium can result in seizures, abnormal heart rhythms, low blood calcium and potassium levels, and muscle contractions/cramps. Furthermore, magnesium deficiency has been linked to both lower physical activity and exercise ability.2  This is even more important for the elderly population because of the impact the aging process has on physical activity.Specifically, the aging population is at greater risk for magnesium deficiency than young people due to low dietary intake, reduced absorption, and a greater amount excreted in stools and urine. It is important to note, however, that excessive magnesium intake from supplements may cause diarrhea, abdominal pain, and/or cramping. Furthermore, intake of amounts greater than 5000mg per day can lead to magnesium toxicity and death. 4

The current standard of care for improving physical activity is sufficient aerobic and muscle-strengthening activities.5  The Center for Disease Control and Prevention recommends for adults 65 years and older to do muscle-strengthening activities that work all of the major groups of muscles (hips, back, shoulders, arms, legs, chest and abdomen) on two or more days per week. Muscle-strengthening activities include lifting weights, resistance band usage, push-ups, sit-ups, yoga, and gardening activities such as digging or shoveling. The CDC also recommends that all adults 18 years and older get either 5 hours of moderate-intensity aerobic activity or 2 hours and 30 minutes of vigorous-intensity aerobic activity. Moderate activity is a 5 or 6 on a 10-point scale in which 0 is defined as sitting and 10 is full effort activity. Vigorous activity is a 7 or 8 on this same scale.

A study recently published in the American Journal of Clinical Nutrition looked at the effects of oral magnesium supplementation on physical performance.3  This study only involved healthy elderly women that were involved in a weekly exercise program. There were two groups of healthy women in the study: one group received oral magnesium supplements of 900mg magnesium oxide/day for 12 weeks while the second group did not receive supplements or any other differences in treatment. The purpose of the study was to see if magnesium supplementation would improve physical performance. Short Physical Performance Battery (SPPB) tests were used in part to examine physical performance. A SPPB test involves checking lower limb activities such as walking and balance. The study found better physical performance in the group taking the magnesium supplements. There were no harmful effects seen in either of the groups. One major factor that limited the results of the study was that it only included healthy elderly women that exercised and so the same results may or may not occur in populations such as adolescents, men, or people that do not exercise. A different study published earlier this year in the Journal of Sports Sciences supports the findings that magnesium supplementation can improve physical performance.6

For individuals seeking to improve physical activity, it appears that magnesium supplements in the appropriate RDA range can be taken to boost physical activity performance.  Have you tried magnesium supplements before? If so, what form did you take and did you notice any differences after taking them?

Sources:

  1. S. Department of Health & Human Services, Nation Institutes of Health, Office of Dietary Supplements. Magnesium Fact Sheet for Health Professionals. http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ Reviewed November 04, 2013. Accessed October 2014.
  2. Lukaski HC. Magnesium, zinc, and chromium nutriture and physical activity. Am J Clin Nutr. 2000;72(suppl):585S–93S.
  3. Nicola V, Berton L, Carraro S, et al. Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program:a randomized controlled trial. Am J Clin Nutr. 2014; 100: 974-981.
  4. Kutsal E, Aydemir C, Eldes N, et al. Severe hypermagnesemia as a result of excessive cathartic ingestion in a child without renal failure. Pediatr Emerg Care. 2007;23:570-572.
  5. Center for Disease Control and Prevention. Physical activity: How much physical activity do older adults needs? http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html. Updated June 17, 2014. Accessed November 2, 2014.
  6. Setaro L, Santos-Silva P, Colli C, et al. Magnesium status and the physical performance of volleyball players: effects of magnesium supplementation. Journal Of Sports Sciences[serial online]. March 2014;32(5):438-445. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 12, 2014.

Eat more, lose more?

Tuesday, November 18th, 2014

By Stephanie Cailor, PharmD Student

You have probably heard the common dietary recommendation that you should eat more fruits and vegetables as a part of a healthy diet. WebMD provides some simple diet tips including one that correlates specifically with this theme. They explain that by “eating more fruits and vegetables, you shouldn’t feel as hungry because these nutrient-rich foods are also high in fiber and water, which can give you a feeling of fullness,” a claim that is supported by much research.1, 2 So how exactly does fiber play a role? Fiber is a component of food that is difficult for the body to digest. Two types of fiber exist: soluble fiber, such as that found in citrus fruits, strawberries, celery, and green beans, and insoluble fiber, found in foods such as broccoli, cabbage, and grapes. Soluble fiber retains water and slows digestion in the stomach and intestines; whereas, insoluble fiber works by adding bulk to the stool in order to speed up the passage of food through the stomach and intestines.3 For this reason,  among others, the World Health Organization recommends that adults eat a minimum of 400 grams of fruit and vegetables per day to prevent health conditions such as obesity.4 To bring this number into perspective, roughly half of each plate should be filled with fruits and vegetables. Further examples and information regarding serving sizes can be viewed at www.choosemyplate.gov/food-groups/.5 While the task of eating more fruits and vegetables may seem simple, is this general recommendation to help lose weight failing to tell us the whole story?

The claim that adding fruits and vegetables to the diet can help with weight management may be correct, but only increasing fruit and vegetable consumption may not lead to weight loss. A recently published meta-analysis reviewed the results of 7 research studies on this subject.6 Each of these studies looked at the impact of increased dietary intake of fruits and vegetables on weight loss; however, none saw a significant effect. One study involving 90 adults utilized an 8 week intervention that added either 0 grams, 300 grams, or 600 grams of fruits and vegetables to daily diet. The study concluded that groups increasing their fruit and vegetable intake lost some additional weight, but the amount was not statistically significant.7 Another study looked at adult women who increased the intake of their fruits and vegetables to 9 servings a day. The body weight of these patients changed very little, with no statistically significant reduction in weight loss over the course of the study.8 There are a few reasons why the included research studies may show the shared conclusion of no significant weight loss due to eating more fruits and vegetables. Some of the studies may not have looked long enough to see the effects of eating more fruits and vegetables on body weight. Others may have not had a large enough increase in fruits and vegetables in the diet to show any weight loss effects. Accordingly, more research needs to be done on this topic before a definitive statement can be made.

Overall, this meta-analysis concludes by stating that while eating more fruits and vegetables does promote a healthy lifestyle, in order to lose weight, other efforts are necessary to achieve desired outcomes.6 For example, adding fruits and vegetables without cutting out other unhealthy foods, primarily those with high calorie counts, will not provide desired weight loss effects.9 Other supporting research emphasizes that significant weight loss results can be seen by reducing caloric intake and balancing the diet with fruits and vegetables.4, 10

As a future pharmacist, I believe that eating more fruits and vegetables as a part of a healthy diet is beneficial due to their overall low caloric content and the fiber they contain. To lose weight, though, it is important to reduce the amount of unhealthy foods in the diet. Being healthy is a lifelong pursuit that does not consist of simply changing one bad habit. Alongside a healthier diet, it is also important to be physically active. For physical activity to provide health benefits, adults should spend 150 minutes per week doing moderate intensity aerobic activity (such as walking) and at minimum 2 days per week completing muscle strengthening activities, which includes strength training or endurance exercises.11 Small steps towards a healthy lifestyle for some people could mean adding one new vegetable to their plate tomorrow or not buying chips at their next trip to the grocery store. Others may choose to take a walk around their neighborhood every day for the next week. What are some unhealthy lifestyle and diet habits that you could change today to help you get on track for weight loss?

References

  1. Smith, M. W. (2014). 15 Best diet tips ever. Available from: http://www.webmd.com/diet/ss/slideshow-best-diet-tips-ever. Accessed on October 17, 2014.
  2. Tohill, B. C. (2005). Dietary intake of fruits and vegetables and management of body weight. World Health Organization.
  3. Dugdale, D. (2012, September 2). Soluble and insoluble fiber: MedlinePlus Medical Encyclopedia Image. Retrieved November 1, 2014.
  4. Amine, E., Baba, N., Belhadj, M., Deurenbery-Yap, M., Djazayery, A., Forrester, T & Yoshiike, N. (2002). Diet, nutrition and the prevention of chronic diseases: report of a Joint WHO/FAO Expert Consultation. World Health Organization.
  5. Dietary guidelines for Americans, 2010. (2010). Washington, D.C.: U.S. Dept. of Health and Human Services, U.S. Dept. of Agriculture.
  6. Kaiser, K. A., Brown, A. W., Brown, M. M. B., Shikany, J. M., Mattes, R. D., & Allison, D. B. (2014). Increased fruit and vegetable intake has no discernible effect on weight loss: a systematic review and meta-analysis. The American journal of clinical nutrition, 100(2), 567-576.
  7. Whybrow S, Harrison CL, Mayer C, James SR. Effects of added fruits and vegetables on dietary intakes and body weight in Scottish adults. Br J Nutr 2006;95:496–
  8. Maskarinec G, Chan CL, Meng L, Franke AA, Cooney RV. Exploring the feasibility and effects of a high-fruit and -vegetable diet in healthy women. Cancer Epidemiol Biomarkers Prev 1999;8:919–
  9. Sacks, F. M., Bray, G. A., Carey, V. J., Smith, S. R., Ryan, D. H., Anton, S. D., … & Williamson, D. A. (2009). Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New England Journal of Medicine, 360(9), 859-873.
  10. Wing, R. R., Hill, J. O. (2001). Successful weight loss maintenance. Annal Review of Nutrition, 21(1):323-341.
  11. Physical Activity Guidelines Advisory Committee. (2008). Physical activity guidelines advisory committee report, 2008. Washington, DC: US Department of Health and Human Services, 2008, A1-H14.