Cardiovascular Disease, the silent killer

Martin McDaid

Martin – Pharmacist, Finglas

Cardiovascular disease, or heart disease, is the most common cause of death in Ireland, accounting for about 1 in 3 of all deaths, and it is expected to dramatically increase in the next decade. In the general public, it is probably the most poorly understood major disease and because of this, few people know the signs and symptoms to watch out for. In this blog, I will outline the general conditions associated with heart disease, what you can do to help prevent the onset of heart disease, and how the highly qualified pharmacists in LloydsPharmacy can help reduce your risk factors for cardiovascular disease.

CVD (cardiovascular disease) includes all of the diseases of the heart and circulation, including heart attack, stroke, angina and blood vessel diseases. A heart attack is where the supply of blood to the heart is suddenly blocked, usually by a blood clot. A stroke is similar, except in this case the blood supply to the brain is cut off either by a clot or less commonly, a weakened blood vessel in the brain bursts.  Both heart attacks and strokes are medical emergencies and require immediate treatment; the sooner a person receives treatment, the less damage is likely to happen.  Angina is chest pain caused by restriction of blood flow to the muscles of the heart; this usually happens because the vessels supplying the heart have narrowed. Narrowing and hardening of arteries elsewhere in the body is known as peripheral vascular disease and can affect the kidneys, feet, eyes and other organs. All of the effects of CVD are caused by plaque build-up in the various arteries of the body; this plaque is made of cholesterol, fat and calcium and coats the arteries, and can break open leading to blood clots.

There are a number of commonly known factors which increase your risk of CVD: high blood pressure, high cholesterol, obesity, smoking, inactivity, family history, ethnicity and having diabetes. Addressing these factors helps to minimise your overall risk of developing CVD. It is important to note at this stage that a persons overall risk increases slowly over time and, as such, modifying your lifestyle today starts to immediately reverse this risk. CVD is known as a “silent killer” because a lot of the signs and symptoms are “silent”, and only become apparent later on, and present as a medical emergency. Because of this, it is important for everyone to start creating the conditions to minimise your chances of developing CVD early on in life.

High blood pressure is one of the most important risk factors for developing CVD as high pressure damages the blood vessels. At LloydsPharmacy we offer a free blood pressure checking service in all our stores. If we find your blood pressure is high, we will either recheck in the next few weeks or if very high, we will refer you to a doctor. This is a key part of our Change Your Health Direction (CYHD) initiative. As part of this, we also offer advice on smoking cessation and losing weight healthily. Our pharmacists have specialised knowledge to help reduce your cholesterol and how to properly manage your diabetes. None of these risk factors act solely to increase your risk of developing CVD; they are all linked together in some way. For example, being obese makes you more likely to be inactive, have diabetes, have high blood pressure and have high cholesterol. In this case, addressing the obesity can have positive effects in all the other factors and decrease the risk overall.

To summarise, CVD is our nation’s biggest killer and is increasing with each passing generation. We must try to holistically look at our cardiovascular health and take steps to live more healthy, positive lives.  Our LloydsPharmacy team are here to help you achieve this goal and with our CYHD initiative, we are in a prime place to give you the best advice to improving your heart health.

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GRILLED SEA BASS WITH SALSA VERDE, NEW POTATOES &TOMATOES

This dish reminds me of summer holidays on the Med bursting with flavour from nutrient dense herbs, garlic, capers and an assortment of antioxidant-rich tomatoes. Jersey royal new potatoes which have a distinct, sweet flavour, and whilst many diet camps have shunned the white potato in favour of sweet potatoes, white potatoes are in fact a better source of essential minerals such as iron, magnesium and potassium, as well as being a great source of vitamin C and fibre.  Fish is a lovely light alternative to meat on warm summer evenings and I particularly love Sea Bass.  It’s an excellent source of protein, selenium and omega-3 fatty acids whilst being light and low in calories.

Serves 2 | Prep & Cooking Time: 30 min | Rating: Moderate

Nutrition: approx. 435 calories per serving. Source of omega-3 fatty acids, fibre, iron, magnesium

Ingredients:

  • 1 garlic clove, peeled
  • 1 large handful of fresh flat leaf parsley
  • 1 large handful of fresh basil
  • 1 large handful of fresh mint leaves
  • 1 heaped tbsp capers
  • 1/2 tbsp dijon mustard
  • 1 tbsp Bragg apple cider vinegar (available in LloydsPharmacies nationwide)
  • 4 tbsp good quality extra virgin olive oil plus 1/3 tbsp for frying
  • 2 fillets sea bass approximately 180g raw weight (or other white fish like sea bream, hake or cod)
  • 175g Jersey Royal new potatoes
  • 150g assorted tomatoes plus 1 large beef tomato
  • Sea salt flakes and finely ground black pepper

Method:

  1. To make the salsa verde, de-stem the herbs and finely chop along with the garlic and capers on a large chopping board. Transfer to a bowl, stir in the dijon mustard, apple cider vinegar and slowly add 4 tbsp of olive oil, mixing well. Taste and season with a pinch of sea salt flakes and finely ground black pepper. Transfer to an airtight jar or serving bowl. (This salsa verde recipe makes up to four servings, so the extra can be stored in the fridge for 3-5 days).
  2. Slice the new potatoes into halves and steam or boil for 8 minutes until tender and then remove from the heat.
  3. Arrange the tomatoes onto a large roasting tray with the potatoes and carefully lay the two sea bass fillets on top, skin side up.
  4. Season with sea salt, freshly ground pepper and a 1/3 tbsp extra virgin olive oil. Place under a grill on a medium-high heat and grill for about 10-12 minutes until the fish is cooked and the skin starting to crisp.
  5. Remove from the grill and serve with a tablespoon of salsa verde spooned onto the top of each sea bass fillet. Enjoy!

Created by: Pamela Ryan Qualified Nutritionist*

Website: www.thehealthonist.com

Instagram: @the_healthonist

* Pamela Ryan (Dip.NT, NTOI) is a Qualified Nutritional Therapist recognised by the Nutritional Therapists of Ireland (NTOI), the professional association supporting qualified nutritional therapists. All NTOI members study biomedicine and nutrition for a minimum of 3 years at a recognised college, are trained in clinical practice and must comply with NTOI requirements for Continuous Professional Development (CPD). Nutritional Therapy is an evidence-based approach to maximising health through individually formulated nutrition and lifestyle strategies. Pamela continues to attend training and lectures on a regular basis through various bodies including The Institute of Functional Medicine and The Institute of Health Sciences. These trainings help her to gain increased expertise in the ever advancing field of nutrition.

Keeping summer allergies at bay!

maria

Maria: Clinical Governance Pharmacist

Summer Allergies

With Summer time, comes longer evenings and the extra incentive to get out and get active. Many of us are now fully engaged with the Change Your Health Direction programme and have our meal and exercise plans in full swing. Despite the extra effort to improve our health and feel well, some of us may be experiencing symptoms of nasal congestion, sneezing, runny nose, dry eyes and itchy skin. Welcome to summer allergy season. It keeps going long after April’s showers and May’s flowers are gone. However there is always a solution to help ease and prevent the symptoms of summer allergy season. We in LloydsPharmacy are on hand, with our in store experts available to provide the best advice for you and your family.

What causes summer allergies?

Pollen is the main culprit! The pollen count is naturally higher in the summer months. Pollen travels very easily and therefore exposure is very easy. Also insect bites can trigger allergies and irritations. It is not just the countryside that can prove hazardous for summer allergies. Air pollution for city dwellers is a major player. Therefore it is important to keep this in mind if you are experiencing allergy symptoms and are city based. Our bodies, once they are exposed to any of these triggers produce a chemical called histamine. It is this chemical histamine that causes the symptoms of inflammation, irritation, and itching.

What can I do?

We strongly recommend that you present to any of our 94 stores. There you will be met with any of our highly trained OTC colleagues and pharmacists. Our colleagues will assess your symptoms and take into account your lifestyle, any other medications you are on, potential triggers and bespoke a treatment course that works for you.

Over-the-counter medications include:

Medications available can target specific symptoms along with preventative treatment options.  If you experience prolonged symptoms over the summer months, we recommend to simply take a daily antihistamine.  Our first line antihistamines are simple and easy to take and more importantly are non-drowsy. We in LloydsPharmacy are all about preventative medicine along with treatment. For patients, that experience recurrent sinus infections and end up on antibacterial treatments, we can offer nasal irrigation kits. Again by simply using this kit on a daily basis, the recurrence of sinus infections can be greatly reduced. For skin based reactions there is a selection of products available, following a proper consultation. From corticosteroid, antiseptic and antihistamine creams, the full range of symptoms will be treated. Many people present with dry and irritated eyes in conjunction with skin and nasal allergies. Treatments available cover dryness, redness, and irritation. Our pharmacists are always available to discuss simple and more complex conditions. We are always able to advise should a referral be required to your GP. Should OTC medication not treat the symptoms, prescription alternatives are available which we can dispense and counsel on, once a valid prescription is presented. There is always a treatment option available and it is important to keep this in mind.

What patient groups can be exposed more to summer allergies?

  • Asthmatics
  • Eczema suffers
  • Patients prone to anaphylaxis
  • Chronic dry eye suffers
  • Polyps and sinus conditions

Therefore it is essential to discuss with your GP and pharmacist the options to prevent exposure and possible symptoms.

It is important that we are fully equipped to enjoy all of what summer has to bring. There is no need to suffer with allergy symptoms.  Speak to your local LloydsPharmacy team today and discuss the best treatment option that works for you. It’s time to put your allergy symptoms at bay so as to enjoy your best summer yet.  Here’s to a healthier, better version of you.

Walnut Brownies

I use only four ingredients – walnuts, cacao, dates and vanilla. Walnuts are rich in omega-3 fats which may improve brain health and prevent heart disease. I’ve spoken about the benefits of eating good quality dark chocolate before, and raw cacao powder is just as nutritious. Cacao is loaded with antioxidants (one of the highest sources along with blueberries and walnuts), as well as iron, copper and magnesium which are essential for energy metabolism (the process of generating energy). Feel free to substitute some of the walnuts for ground almonds, or you could use a combination of your favourite nuts. Replacing the vanilla powder with a tablespoon of good  quality espresso powder is another very popular option!

Makes: 15 | Prep Time: 15 minutes | Rating: Simple

Nutrition: approx.193 calories per serving. Source of omega-3 fatty acids, fibre, iron, magnesium

Ingredients:

  • 150g pitted dates (try to use preservative-free dates)
  • 300g raw walnuts (plus 15g extra for topping – optional)
  • 70g raw cacao powder (plus a little extra for dusting – optional)
  • 15g dark chocolate drops (optional, replace with 15g walnuts if not using)
  • 1 heaped teaspoon vanilla powder

Method:

  1. Tip the dates into a heatproof bowl, cover with hot water and leave to soak for ten minutes to soften.
  2. Meanwhile pulse the walnuts, cacao powder and vanilla in a food processor until they resemble coarse breadcrumbs.
  3. Once the dates have softened drain off the water and add them to the food processor. Pulse the mixture again a few times until a dough forms.
  4. Tip the mixture onto the lined baking tray and press out into the corners. To even out the top place a sheet of parchment on top of the mixture and use a rolling pin or the palm of your hand to smooth out the mixture.
  5. Refrigerate for about an hour to set before slicing into squares. Press some chopped walnuts on top of each brownie and dust lightly with a little cacao powder or some cinnamon.

Created by: Pamela Ryan Qualified Nutritionist*

Website: www.thehealthonist.com

Instagram: @the_healthonist

* Pamela Ryan (Dip.NT, NTOI) is a Qualified Nutritional Therapist recognised by the Nutritional Therapists of Ireland (NTOI), the professional association supporting qualified nutritional therapists. All NTOI members study biomedicine and nutrition for a minimum of 3 years at a recognised college, are trained in clinical practice and must comply with NTOI requirements for Continuous Professional Development (CPD). Nutritional Therapy is an evidence-based approach to maximising health through individually formulated nutrition and lifestyle strategies. Pamela continues to attend training and lectures on a regular basis through various bodies including The Institute of Functional Medicine and The Institute of Health Sciences. These trainings help her to gain increased expertise in the ever advancing field of nutrition.

Changing My Health Direction

Change Your Health Direction is so much more than just simple weight loss or switching from smoking cigarettes to chewing gum. It’s about literally changing the direction in how you view health and how you’re going to get to where you want to be.

 
My journey started 5 years ago. Realistically it started YEARS before. I was always heavy. I started ‘gymming’ when I was 16 but nothing proper. I fell into the trap of ‘I’m going to the gym so I’m going to eat what I want’. This game was played for years until I saw the pictures go up of the New Years party we had reeling in 2013. I looked a state. Drunk. Grossly overweight. I’d a holiday coming up in September so wanted to use that as my focus. I got in touch with an Irish Personal Trainer who was just starting out, and who was looking to break into the online client business, so after a conversation, he took me on for a 12 programme. His name is Darren Farrell, and I haven’t looked back.

ross

Ross – Pharmacist Technician

He supplied me with workouts, nutrition and all the motivation. The pic on the right was me 12 weeks later in a water park. Going from 96kg-74kg, I’d so much more confidence, but much more drive. 5 years later, I’m a practicing Personal Trainer, putting people through their own fitness journeys while still working in LloydsPharmacy. I want people to start their journey with me, but small steps. Look at introducing supplements. Vit C, multivitamin, Omega 3s, probiotics… All these help. I can vouch for these products. I still use them. They’re just a part of my life after taking that step to include them.

 
Each person has it in themselves to be the change they want to be. Each person just needs to believe in that change.
 

Call into any of our 94 stores nationwide to sign up to our FREE 8 week Change Your Health Direction Programme today!

Barbecue Turkey Skewers with Tahini Dip

These Middle Eastern inspired turkey skewers are ideal for a summer barbecue or picnic, and can be packed into lunch boxes for a work week lunch served with grilled pitta breads, fresh leafy greens and gut-loving kimchi (fermented vegetables). The recipe makes between two and four servings as a light lunch or larger meal. Serving suggestions are optional of course so free to improvise. A big green salad, fresh hummus, and a bowl of tabbouleh (a herby salad made with bulgur wheat, tomatoes, lots of fresh mint and parsley) are great healthy options for a summer feast!

Serves: 2-4 | Cooking Time: 15 minutes | Rating: Simple

Nutrition: High Protein, Low Fat, Low Saturated Fat

Free From: Gluten, Wheat, Dairy, Refined Sugar

Ingredients:

  • 1 tbsp olive oil
  • 1 large clove garlic, peeled and crushed
  • Juice and rind of half a large lemon
  • 1 heaped teaspoon ground cumin
  • 1 heaped teaspoon of dried or finely chopped oregano
  • A good pinch of sea salt
  • 3 large skinless turkey breasts cut into strips
  • 6 wooden or metal skewers

Tahini Dip

  • 2 tbsp light tahini
  • 2 tbsp water
  • Juice of 1 whole lemon
  • A good pinch of sea salt
  • 1 garlic clove peeled

To Serve:

Rocket leaves, diced cucumber, kimchi, grilled pitta pockets or flatbreads.

Method:

  1. If using wooden skewers, soak them in cool water whilst marinading the turkey (about 20 mins).
  2. In a large mixing bowl combine the olive oil, garlic, lemon juice, lemon rind, cumin, oregano and sea salt. Add the turkey strips and mix to combine. Cover and leave to marinate for at least 20 minutes (or overnight in the fridge).
  3. Preheat the grill or barbecue to a medium temperature. Remove the turkey from the marinade and thread onto the six skewers (you can discard the marinade).
  4. Place the skewers directly onto the barbecue grill and cook for about 8-10 minutes until cooked and slightly charred.
  5. To make the dip, put the tahini, water, lemon juice, salt and garlic into a small blender and pulse until combined (or whisk together with a fork, making sure to chop and crush the garlic into a paste with the back of a knife first). The dip should have a yogurt-like consistency.
  6. Transfer the dip to a bowl. Remove the turkey skewers from the grill and transfer to a plate lined with parchment.
  7. Serve with grilled pitta pockets or flatbreads (if coeliac or gluten-intolerant you can buy gluten free pittas in most supermarkets), piles of fresh rocket leaves, some fermented vegetables like kimchi or finely diced cucumber.

Nutrition Information

Created by: Pamela Ryan Qualified Nutritionist

Website: www.thehealthonist.com

Instagram: @the_healthonist

Let us help you control those Bad Behaviours!

donal blog image

Donal – Pharmacist Aylesbury

The more i read from the latest research articles the more it seems that the old sayings we’ve heard repeated again and again about food, sleep and exercise are true. We should go to bed early, eat natural foods and exercise every day.

But often in the media we see people who break these rules idolised and celebrated. People who work around the clock, who party through the night, people who binge and diet in repeated cycles. These behaviours are enticing and misleading. Often we believe we can accomplish something greater, meet deadlines by pushing through walls of fatigue, or that we can make up for bad eating behaviours afterwards by upping our exercise regimen.

I  will often hear people relate and discuss behaviours such as late night snacking, insatiable appetites and craving snacks, remarking on them as inexplicable and unavoidable. Night binging can leave a person with low energy levels the next day. People who regularly do this often have high insulin levels which can lead to diabetes and they find it difficult to exercise from fatigue and lack of sleep. Without knowing how our bodies work it can be difficult to understand where these cravings come from. Being now in my thirties some of these bad habits have already caught up with me and I see the effects of poor diet and snacking in my energy levels and some of my blood tests. Not a good scenario to be in at such a “young” age. LOL.

What I have found helpful in trying to control my own bad behaviours is an understanding of what exactly is going on in my body to drive these unhealthy habits I seem drawn to constantly repeat. In this blog I will briefly discuss one aspect of the body’s many mechanisms that control appetite, weight fluctuations and as researchers are currently finding out potentially a lot more.

Ghrelin is an appetite stimulating hormone released from the empty stomach. It signals our brain to encourage anticipatory and goal-directed behaviours. This basically means it makes us look out for our next meal, make us think about food and it affects what we crave in terms of sugar, fat, protein and carbohydrates. On its own ghrelin seems to direct us toward a more nutritious meal than we might choose without its influence. This might sound familiar if you think of what you crave when you are really hungry. Usually the ice cream, chocolate or biscuit treat (my personal favourites!) doesn’t seem sufficient and we actually want a heart slap up meal with more nutritious ingredients. This is actually a good effect of the hormone.

However studies have shown that as ghrelin levels rise, the amount of eating it encourages rises dramatically. This makes sense in the natural world. The longer the period between eating the more our body is going to want to stock up on energy the next time food is available. However this effect is contributing to our modern day obesity problem. We have such busy lives that people are often jumping from the bed out the door skipping what the old maxim calls the most important meal of the day. Breakfast. Breaking the fast.

As we sleep our bodies are stilling whirring away with countless processes like a laptop on standby. In fact the energy our body would use if we were to simply lie on the couch all day accounts for up to 60 to 70% of the energy we spend each day even when we move around and work as normal. That is why it is so important to supply your body with a source of healthy energy soon after waking up in the morning. Otherwise the body will demand an even greater meal off you later in the day.

Studies have shown that  ghrelin, the hunger hormone, will not be suppressed without a proper breakfast. People who skip breakfast think they are cutting out part of their day’s calorie intake but it is proven that those people eat more for lunch, dinner AND supper partly due to higher ghrelin levels the skipped breakfast causes.

Also sleep deprivation has been shown to increase cortisol (our stress hormone) and in doing so mimic starvation and hunger. Both stress and cortisol increase our hunger hormone ghrelin which increases our cravings and likelihood to overeat. Poor sleep is another of the factors linked to increasing obesity in Ireland.

There are several ways we can affect our ghrelin levels. One large egg provides varying amounts of 13 essential vitamins and minerals, high-quality protein, and the antioxidants lutein and zeaxanthin yet regular consumption of eggs is still met with uncertainty. In the 1970s excess cholesterol in our blood was linked to a higher risk of heart disease. Many scientists assumed that eating high-cholesterol foods like butter, red meat and eggs must then be bad for our health. In fact sugar, trans fats or excessive saturated fat is more harmful to use and produces more cholesterol in our blood that dietary cholesterol.

In a study comparing eating eggs for breakfast versus a bowl of healthy oatmeal on the symptoms of heart disease (a change in the cholesterol and lipid balance in the body) there was not a huge difference between the two. The eggs did raise cholesterol levels somewhat compared to the oatmeal but not in an unhealthy amount and the sugar levels, liver function and fat levels in the body were the same. The eggs did seem to keep the person eating them fuller for a longer time than the porridge. I have tried alternating both porridge and a boiled egg into my breakfast regime and from my experience I can see how an egg can help space out meals across a day and prevent the urge to snack in between. But the benefits of porridge on health are also proven so if anything I would recommend fitting both into your morning diet if possible.

Being a daily porridge devourer I want to explain how it can benefit you. When food enters the stomach it lowers your ghrelin but it doesn’t stop you from eating. The signal for satiety and to stop eating is actually located twenty two feet or almost seven meters into the intestine! Naturally it takes time for food to travel this far. The Japanese have a saying which is “eat until you are 80% full” which is basically allowing your food time to reach this point. Alternatively trying to eat with chopsticks will get you there! The best way to get food moving faster through the intestine is through fiber.

Ever notice how a plate of pasta or chips and cheeseburgers doesn’t always make you feel full? This is because fast food and processed cereals have had their fibre stripped away to improve taste and shelf life. They sit into your stomach instead of moving into the intestine where they should be signalling the brain that the stomach is full. Anything that speeds food transit through the gut will make you feel fuller faster and reduce hunger and the amount eaten. The insoluble fiber in porridge does this. Its soluble fiber also helps by forming a sticky gel that delays stomach emptying which makes you feel fuller faster. Processed foods and cereals contain little of these or have it artificially added back in which doesn’t seem to work as well as when it is in its original form.

There was a study I found interesting on how water, milk, a yogurt drink and fruit juice drunk either before or with a meal would affect appetite, satiety (feeling full after eating) and the amount of food eaten. Milk reduced the overall  food intake and appetite while increasing the satiety (feeling full after meal) compared to a sweetened yogurt or fruit drink. But in all cases drinking water meant the overall calorie intake was less before and after the meal. One esteemed dietician in America suggested keeping to milk, water and tea only as the beverages of choice and leaving the rest out of our diets. Sugary beverages and even fruit juice are thought to be unnecessary additions to our diet that we might be better avoiding. Fruit it appears is best eaten whole rather than juiced or pulverised into a smoothie. Also I will add in here that fructose which is known simply as sugar when it comes to talking about our modern processed foods does not affect ghrelin release unlike other carbohydrates and proteins which lower ghrelin levels. So sweets and sugary drinks in the morning will not reduce the amount of food you are likely to consume later for lunch and dinner compared to the egg and porridge discussed earlier.

Is it better to spread out calorie intake over a period rather than breaking the day into say three solid meal times? One study used liquid meals of protein, fat and carbohydrates taken in a single go versus splitting it up into five smaller portions taken every half hour to examine this idea. No difference was found in how the food was burnt off meaning that splitting meals up across the day has little effect on avoiding hunger later in the day or keeping up your energy. In fact where the food was consumed in a single go the people reported great and longer lasting fullness.

We often hear about losing weight by different approaches (intermittent or irregular dieting versus continuous dieting). A study tried to determine the effect of this on the body’s systems and discovered little difference in how the body was reacting to the weight loss. The people who achieved the same weight loss by dieting on and off seemed to be under no greater or lesser drive by their bodies to regain weight than those who had dieted in a more consistent manner. To me this study shows the power of habit. Studies have shown that consistent dieting has a greater chance of success but this study shows there is no biological measurement (in terms of hunger hormone, insulin levels) to account for it. Making lifestyle changes your everyday practice is the way to sustain weight loss because the likelihood that all lost weight will be regained is simply the reflection of how likely you are to return to old habits if you haven’t been practicing new ones.

So in summary breakfast is still the main meal of the day. Don’t skip it and try to have healthy oats and maybe an egg as a large part of it, though don’t forget your daily intake of whole fruit. We in LloydsPharmacy are here to support you in attaining a healthy lifestyle and so we can advise you on your diet, help motivate you and supply a range of products that will boost the positive changes you make in your daily life. Chromium is supposed to aid in reducing cravings by enhancing insulin function and effect in the body. Our pharmacies can supply this in more than one brand (Sona or Pharmanord). Products such as Miss Fit Skinny Tea and XLS Medical have proven popular among customers who are making healthy changes in their diets. We have Change Your Health Direction experts in each store so please pop in and tell us how you are doing and ask us how we can help.