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Be aware of hidden heart risks in your medicine cabinet

Nonsteroidal anti-inflammatory drugs (NSAIDs), take up a large portion of pharmacy shelves and many of us have examples of these drugs sitting in our bathroom medicine cabinets. Examples such as Advil, Aleve, Anaprox, Celebrex, Motrin and Voltaren can be purchased without a prescription, are promoted for a range of conditions including pain relief, reduction of fever and relief from inflammation, and consequently many people will pop one or two casually at the slightest sign of need in a number of the above areas. However, NSAIDs can increase the risk of heart attack, with the level of risk tied to the type of NSAID, how much is taken, and for how long. This doesn’t mean you should stop taking them altogether, but understanding their risk is important when assessing whether they are needed. There are about 20 different Non-Steroidal Anti-inflammatory Drugs or NSAID’s available in Canada. If you did not know better you might think there is little difference amongst this group of NSAID’s but in fact there are significant differences.

Looking back, the NSAID and pain killer of choice for many years was Acetylsalicylic Acid (ASA) or good old Bayer Aspirin (the one with the cross symbol) which has been around since 1899. Salicylates in various forms have been used since 400BC to reduce pain and fever with indigenous peoples using Willow Bark extracts long before the synthesis of ASA by the German company. Many of our peer group use a low dose coated ASA (81mg) on a daily basis to help prevent heart attacks and stroke because of its ability to function as an anti-coagulant. If you take daily aspirin, make sure you know why and understand the small but real bleeding risk. Taking low-dose aspirin for “secondary prevention” is not controversial. Secondary prevention is for people who already have had a heart attack, certain kinds of strokes, or other diagnosed cardiovascular disease that puts them at high risk of additional problems. The risk of serious bleeding is outweighed 6:1 by incidence of preventing heart attacks, strokes, and sudden death. Taking daily low-dose aspirin does not have the same risk/benefit profile for “primary prevention” where bleeding risk is outweighed by potential benefit in prevention.

The term “Non-Steroidal” is used to distinguish these drugs from steroid anti-inflammatory drugs like Prednisone and also to ensure no confusion with the stigma of “Anabolic Steroids”. NSAIDs block two enzymes (Cox-1 and Cox-2) that are part of the production of substances involved in the process of inflammation and blood clotting. Some NSAID’s are Cox-2 selective so less able to reduce inflammation but are useful to reduce pain. Note that Acetaminophen (Tylenol) is not considered to be a NSAID since it has minor anti-inflammatory activity but does block COX-2 to effectively treat pain. If taken regularly in appropriate doses Acetaminophen is also useful in reducing acute or chronic pain.

Acetaminophen is not an NSAID but is effective at pain relief

In general terms all NSAID’s can reduce the blood’s ability to clot and also increase the risk of gastrointestinal ulcers/bleeds. There are differences in their actions and side effects. The COX-2 inhibitors have less stomach upsetting side effects but can cause thrombosis, kidney damage and substantially increase the risk of a heart attack.

The NSAID group of drugs has had a somewhat chequered history since their introduction in the 1990’s. In 2004 Merck voluntarily withdrew Rofecoxib (Vioxx) from the market due to concerns of increased incidence of cardiovascular adverse events (MI/stroke). Vioxx was used by patients seeking relief from arthritic joint pain and inflammation. In 2005 Pfizer suspended sales of Valdecoxib (Bextra) due to concerns of increased serious skin reactions. NSAID’s are generally promoted for symptom control in patients with inflammatory arthritis and osteoarthritis (OA), muscle pain, dysmenorrhea, gout, migraines and as opioid-sparing agents in acute pain. Patients may have to cycle through several courses of treatment with different drugs to determine which works best for them. Note that some NSAID’s are available for topical use, example, Diclofenac Gel (Voltaren).

The contraindications and warnings which come with all the NSAID’s make scary reading including warnings about hypersensitivity reactions, history of allergic-type reactions, use during pregnancy, uncontrolled heart failure, gastric irritation/ulceration, bleeding disorders, liver/kidney damage and increasing blood pressure, however like all medications, if this class of drugs is used sparingly and for short courses the side effects should be minimal.

The takeaway here should be to check with your MD or pharmacist before taking any NSAID’s, be aware of possible side effects, use only short courses at the lowest dose that works for you and use the longer acting daily dose products if possible, example, Naproxen (Aleve). Also consider using CBD in an appropriate dose as a safe alternative to NSAID’s and don’t discount the use of targeted exercises to ease pain and improve mobility.

This article is written and posted by our guest contributor, Bryce Miller. Bryce is a peer group member and a practicing Pharmacist. Bryce will be contributing to our website from time to time and will also be part of our “Experts Panel” when this feature is launched in May,2021.

Use the Reply box below if you have questions

Increasing Metabolism

I am always keeping my eyes open for helpful tips on this subject. I am told that our metabolism slows as we age and that even if we eat the same we will probably gain weight over time. Conversely if we eat the same but increase our metabolism we should lose weight? Well not so fast depends how we increase metabolism. One way is to gain muscle (which as an aside is pretty important as we age). You could start an RT program and find that you gain weight due to increased muscle mass. Your clothes will probably fit better.

I came across this short video clip on Global News. Watch it for the key messages around metabolism, avoiding crash diets and the importance of RT.

https://globalnews.ca/video/7642809/increasing-metabolism-after-40/

Mindful Eating in Support of Weight Management

A family member of mine has lost over 30 pounds in the last seven months and contributes part of her success to mindful eating. Well I had to look to up and came cross this article.

Courtesy of Harvard Medical

Research reveals that the very act of eating quickly may contribute to overweight and obesity.

Here’s how: As you eat and drink, your stomach fills, activating stretch receptors in your stomach. These receptors send satiety messages to your brain via the vagus nerve, which connects the brain to the stomach. Then, as food enters your small intestine, appetite hormones are released, sending additional fullness messages to your brain. This process doesn’t happen immediately, though. It can take 20 minutes—or longer—for your brain to realize it’s time to put down your fork. Eating too quickly doesn’t allow this intricate system sufficient time to work, making it easy to overeat without even realizing it.

There’s another downside to distracted eating that has nothing to do with speed. Eating while you’re busy doing other things robs you of the opportunity to fully enjoy your food, so you may not feel completely satisfied—and may keep on eating in an attempt to gain satisfaction.

Enter mindful eating

Mindful eating is the act of fully focusing on your food as you eat. It encourages you to pay closer attention to the tastes, smells, and textures of your food as well as your body’s hunger and satiety cues. As basic as it sounds, this practice is surprisingly powerful. In one small study, 10 obese volunteers enrolled in weekly mindful eating classes that focused on listening to their feelings of hunger and fullness. They also paid close attention to their cravings and emotions. Not only did the participants drop an average of 9 pounds by the end of the three-month program, but they also reported less hunger, stress, anxiety, depression, and binge eating.

In addition to savoring the flavors and aromas of your food, the following techniques can help you attain more mindful eating:

  • Create a calm, beautiful space for eating. A cluttered table does not create the sense of inner tranquility you need in order to cultivate a peaceful mindset.
  • At the beginning of your meal, set a timer for 20 minutes. Then pace yourself to make your meal last until the timer goes off.
  • Let the answering machine take care of incoming phone calls.
  • Put away all computers, phones, and reading materials, so you can concentrate on your food.
  • Turn off the television, another source of distraction.
  • Eat only at the kitchen or dining room table to minimize distractions.
  • Think only about the bite of food you’re actually eating at that moment. It’s all too easy to think ahead to the next bite without focusing on the food that’s actually in your mouth.
  • Put your fork down between bites.
  • Chew each mouthful 30 times.
  • Before you help yourself to seconds or dessert, ask yourself if you’re really hungry.

“First Weigh In” Resolutions Group Off To A Good Start

6 of 7 in the group want to lose 65lbs in total

After about three weeks the group has dropped 13 pounds with one of us laid up with some back pains. So we are content with our start but know there is continued effort ahead. Here are some of the things we are doing differently.

  • Cutting out the afternoon snack unless it is a veggie.
  • Eating healthy foods throughout the day to eliminate eating a big dinner in the evening.   Breakfast, snack, lunch, snack, dinner.  This way I am not really hungry at dinner time and overeating. 
  • Cut my wine consumption in half.
  • Still watching in between meals and snacks also cutting back on some meats when dinner time comes around.
  • Mainly I have tried to cut down the size of portions that I eat.  Have increased my step count and Zone Minutes (Heart Rate Zones). I have also tried to get outside every day for a walk
  • I have stopped buying cheese.

Weight Management

A Weight Management Resource

A detailed reference guide with information and interactive tools has been added to the Live Life Well Tools ( https://cardiorehabgrads.com/live-life-well-tools/ )page on the Peer Group website. Try it out, it should answer most of your questions and help you with managing your weight.

Before you look, a quiz. What is the suggested range for first steps in weight reduction goals (in % terms)? Enter your answer in the comments section below.

The Mathematics Behind Weight Loss

Easy Peasy………

In our recent 2021 resolutions survey just over 75% of you said you wanted to drop some pounds this year. This post is not about dietary strategies or shaming each other for the foods we eat. Each of you will choose tactics to lose weight, which could include more exercise, less sedentary behavior, more good foods (fruits, vegetables, legumes, whole grains, etcetera), less food overall and so on.

Before we start let’s determine just what our weight situation is. A universal measure of weight category is Body Mass Index or BMI. This index is not a perfect measure as your body type (bone structure and muscle mass) can affect the reading. But it is not a bad guideline. BMI is determined by weight and height. You calculate a number which places you on a range scale as outlined below.


Category

BMI Range
Severe Thinness<16
Moderate Thinness16-17
Mild Thinness17-18.5
Normal18.5-25
Overweight25-30
Obese Level 130-35
Obese Level 235-40
Obese Level 3>40
Courtesy of Calculator.net

I will not suggest that we should all be “Normal” nor will I recommend to anyone what their target should be. I am comfortable in sharing how I look at the index and what my goals are. When I started my “weight loss” resolution I was 198 pounds and a statuesque 5 foot seven. This gave me a BMI of 31.2, so in the Obese Class 1. My goal is to achieve a weight of 175 pounds, which as I laid out in a previous post, would be bring me to the mid range of normal body fat. My BMI at 175 would be 27.4, which is the midpoint of the overweight category. I am comfortable with that weight as I believe I have an above average level of muscle mass and the low 180’s is where I have been most of my adult life. You can calculate your own BMI using the link below.

http://BMI Calculator

Now let’s turn our attention to what it takes to lose weight. I used to think it was as simple as ingesting fewer calories that you burn. I now know it is way more complicated than that and I have been reading up on the topic. I will try to distill what I have learned in future posts.

I WAS ASKED TO POST THIS – HONEST…

Someone – who should probably remain anonymous – told me that he had recently made not one, but two errors when posting to our page. What did he get wrong, you might be asking? His email address, that’s what! That’s almost as bad as forgetting where you live or having to check your wallet or purse to find your driver’s license in order to remember your name.

‘Can you post something,’ this person asked me in an email this afternoon, ‘can you post something that pokes some fun at my forgetfulness and gives our members a laugh?’

It was a challenge too good to pass up.

So, there’s the cartoon at the top of the page. Task complete.

Oh, one more thing.

This person also asked if I could post the following email address. He said that readers of our recent website posts will know what to do with it. So here it is.

mikehammond2012@gmail.com

Editor’s Comment. Jeez – after typing that address, I can see why the heck he couldn’t get it right. Wouldn’t mh12@gmail.com be easier to remember, my friend?

Managing Heart Failure

Many of you know Mohan Singh the Heart Failure Nurse from SHN. He will be speaking on the latest information in the treatment and management of heart failure. If this is of interest to you you can join the web meeting using the link below. You can sign on anonymously if you wish. Try to log in starting at 9:20AM.

February 1st at 9:30 am

https://teams.microsoft.com/dl/launcher/launcher.html?url=%2F_%23%2Fl%2Fmeetup-join%2F19%3Ameeting_NzBiNDUyYmUtNTAwNS00MGQ2LWI3ZGItYzdiZTY1MjI5MmFm%40thread.v2%2F0%3Fcontext%3D%257b%2522Tid%2522%253a%2522239d3523-d847-433f-9d99-351ef6109122%2522%252c%2522Oid%2522%253a%2522388f44fe-61e3-42b9-8278-664108a38a01%2522%257d%26anon%3Dtrue&type=meetup-join&deeplinkId=54247fc8-3b99-4eed-9981-23d6cc228198&directDl=true&msLaunch=true&enableMobilePage=true&suppressPrompt=true

Weight Loss Targets

What should my target be for weight?

The answer to this question is very subjective and depends a lot on each individuals situation. Your gender, age, muscle mass, bone structure and body type can profoundly affect what is realistic for you. Still, I personally knew I needed to have a goal for me and I was looking for some objectivity or science to guide me. I looked at BMI calculations and I did not like the answer it gave me, and, ideal body weight (IBW) calculators were turning up numbers I Knew I could never achieve (like sub 150 pounds!) I came across a tool that made a lot of sense for me. A chart showing body fat ranges for different categories and a calculator you can use to determine your individual starting point. I have put a link to this tool at the bottom of this post but let me explain how I used it.

I used the calculator to determine my body fat % estimate to be 33%. The calculator also said, “Due to different body types in the population, your body fat (Cardioman) can be between: 30.1-36.8 %“. I next looked at the chart and isolated what the midpoint of normal body fat would be. This turned out to be 21%. So this told me I needed to lose about 1/3 of my body fat. Based on my starting weight that meant I needed to lose 23 pounds! This established my goal weight for me.

Try the calculator and see if it is helpful to you in establishing a goal.

https://www.omnicalculator.com/health/body-fat

If you need help with this tool, please send me an e-mail.