Saturday, November 27, 2010

When Should You Treat a Fever?

Fever is a normal and healthy response of our bodies to an illness. The body's immune system releases chemicals that raise the body temperature. This is part of the normal infection-fighting process. Studies that look at the relationship of fever and outcome show an overall decreased time being sick and a better outcome for patients who have a fever when fighting off an illness.

WHAT TEMPERATURE CONSTITUTES A FEVER?
(based on oral temperature – to use chart to compare temperature from under the arm add 1 degree to actual temperature, to compare rectal subtract 1 degree from actual temperature)
Normal temperature – 97 to 99 degrees (36 to 37.2 Celcius).
Low-grade fever – 99 to 100.9 degrees (37.3 to 38.3 Celcius).
Common fever – 101 to 103.5 degrees (38.4 to 39.7 Celcius).
High fever – any fever over 103.6 degrees (39.8 Celcius).

Most fevers in healthy adults are short lived and harmless. Fevers are naturally lower in the morning and higher in the afternoon. It is important to try to determine the cause of the fever before you treat it. Is it a viral infection like the cold or flu which just needs to run its course? Or is it bacterial like strep throat, bladder infections, pneumonia, ear infections, etc. that may require an antibiotic?

It is generally a good idea to avoid the use of acetaminophen or ibuprofen to treat fever until it rises to 102 degrees Fahrenheit unless directed to do so by your doctor. If you are taking care of older children who have a fever this can also be true. Fever in infants, however, should be handled more cautiously. You should get a plan from your physician on when and how to treat fever in a child or infant.

If a fever is present with any of the following symptoms, a physician should be consulted right away: Irritability (more than just crabby), confusion, lethargy (doesn't easily wake up), difficulty breathing, rapid and weak pulse, refusal to eat or drink, ill-appearing even after the fever is brought down , severe headache or other specific complaint (burning with urination, limping, pain, etc). Physicians should also be consulted for all ages if temperature rises to 104 degrees, if fever above 102 lasts more than three days or if low grade fever lasts more than 3 weeks.

If you or your child are uncomfortable or can’t sleep you can still give acetaminophen or ibuprofen when you have a fever. It is just important to know that you don’t have to automatically give fever reducers for fevers under 102 if there are no other reasons to do so.

Our pharmacists at Kemper Drug are happy to answer your questions about medications to treat fever and how to dose them in children. We can also help you choose cold medications that treat only the symptoms you have and don't contain acetaminophen or ibuprofen if you don't need them.

Thursday, October 7, 2010

Preventing Colds and Flu

We would all like to find the magic pill that will prevent us from getting sick during cold and flu season. There is a large amount of advice available as to what that magic pill is! While most of the magic pill advice won’t cause you any harm, there isn’t good evidence that it will help prevent or cure a viral infection like a cold or the flu.

The proven best things to do to keep your body healthier are:
• Get enough sleep
• Eat regular meals
• Exercise 30 minutes daily
• Keep your stress level down
• Make sure you are drinking a normal amount of fluids so that you are not dehydrated
• Wash your hands frequently during the day
• Keep your distance from people who have cold or flu like symptoms
• Get a Flu Shot.

Some evidence for the Magic Pills:
• Vitamin D: People with low levels of vitamin D are more prone to infections. It wouldn’t hurt to take up to 1000 units of vitamin D everyday from supplements.
• Probiotics: Good bacteria that normally live in our bodies which help us fight off infection. Taking a probiotic supplement may help
• Multivitamins: Just to make sure that you are covering all your bases.

Less evidence for the Magic Pills:
• Vitamin C
• Echinacea
• Zinc

Check with your pharmacist or other healthcare professional before adding a new medication. Some medications may interfere with ones you are already taking and some medications shouldn’t be used if you have other health conditions.

Sunday, August 1, 2010

Do you know what your fasting blood sugar is?

If you are often hungry, are overweight (have a roll around your middle not looking like a six pack), have high triglycerides, low HDL and high blood pressure, there is a good chance that your body is insulin resistant. When your body is insulin resistant, more insulin is released than normal to try to get glucose (sugar) into your cells for energy. The extra insulin causes excess fat storage in both the blood (in the form of cholesterol and triglycerides) and in the body in the form of a fat roll around the stomach area.

Health care providers use blood tests to determine whether a person has pre-diabetes but do not usually test for insulin resistance. If tests indicate pre-diabetes, insulin resistance most likely is present. One way to test for this is to have your blood sugar tested when you haven't eaten anything for 8 hours -preferably in the morning. A normal fasting blood sugar is less than 100, pre-diabetes blood sugar is between 100 and 126 and Diabetes is diagnosed at a fasting blood sugar over 126.

People who have pre-diabetes often benefit from a low carbohydrate diet. Eating less carbohydrates helps them keep their blood sugars down and causes them to release less insulin.

If you have pre-diabetes, I think you could benefit from reading The Metabolism Miracle by Diane Kress who is a Registered Dietitian and a Certified Diabetes Educator. She struggled to eat properly and control her weight using the knowledge that she had learned in school. Even though she was doing what she thought were the right things, she continued to gain weight. She discovered that she was pre-diabetic and insulin resistant and figured out that she had to try to change her diet in a different way.

The program that she designed has helped her lose weight and become less insulin resistant. The program has three steps. In the first step you retrain your body to become insulin sensitive again. The first step is an 8 week low carbohydrate diet that lets your pancreas rest and puts your body in fat burning mode rather than carbohydrate burning mode since you are only eating 5gm of carbohydrate per meal and snack. For the second 8 weeks you can increase carbohydrates to 11-20 Gm per meal - no more than 5 hours apart. Her third and final step is a diet in which 30 to 35% of daily calories come from carbohydrates. If you exceed your carbohydrate intake for more than 3 days in a week in step 3, she tells you to go back and repeat step 1 for ten days and then step 2 for ten days.

The Metabolism Miracle gives meal plans and recipes for each step of the way. She also answers questions which her patients had as they progressed through the steps.

I had always wondered why people who successfully lost weight felt it was important to eat breakfast every day. The book explains that glycogen is sugar that is stored in your liver and muscles for energy. If your pancreas detects that your blood sugar is getting too low, it releases a hormone called glucagon which tells your liver to release glycogen. The Glycogen releases its sugar and makes your blood sugars go up even if you haven't eaten anything! This is one reason why you should eat breakfast within 30 minutes of getting up in the morning and why you should have a small amount of carbohydrates at every meal and snack (no more than 5 hours apart)- if you don't, your body will release glycogen which will make your blood sugars spike. You will spend the day having your insulin chase your blood sugars up and down.

Links: The Metabolism Miracle
Insulin Resistance and Pre-diabetes National Diabetes Information Clearinghouse (NDIC)

Thursday, June 3, 2010

Please Stand Up!

According to James A Levine MD., PhD, in his new book Move a Little, Lose a Lot our bodies weren't made to spend long periods of time sitting down. We are meant to be moving. We have gotten too clever and efficient at using machines to do things we used to use energy to do before. His goal is to get us to increase the NEAT in our lives. NEAT stands for nonexercise activity thermogenesis. It sounds complicated, but it couldn't be more simple. NEAT is the calories you burn living your life. It is the calores you burn walking to lunch, running errands, folding laundry, tapping your toes, standing up, even chewing gum. It is not going to the gym. It is the energy we use simply living.

When we sit at a desk we are burning 5 calories/hr. When we are standing we burn 15 calories/hr. If we throw in a little gum chewing for 20 calories/hr, walking at 100 calories/hr and stair climbing at 200 calories/hr it becomes obvious that we can increase the number of calories we burn a day without having to go to the gym! His research shows that the loss of NEAT from work and play, when we are spending our day sitting down, can decrease our daily calorie use by up to 2000 calories a day.

Dr. Levine has set up his office so that he can walk on a treadmill while he works at his computer or talks on the phone. He is only moving at 1 to 2 miles an hour so he doesn't even break a sweat. Don't have a treadmill in your office - stand up while you talk on the phone, or better use a cordless phone or headset that allows you to pace as you talk. You can put a simple stair stepper by your desk or sit on an exercise ball rather on a desk chair. Doing these things while you work helps your body work better without having to find time during the day to go to the gym.

Don't forget to think about NEAT movement when you are at home. Multitask while watching tv or surfing the internet - stand up, ride an exercise bike or pace. While sitting you can use a peddler or knit or use stretch bands or weights. Stand up and stretch during commercials or while waiting for a website to load. It's the little movements that add up for great benefits!

Sitting all day can be a brain drain! NEAT movement can also help in brain cell growth. Moving about improves the blood flow to your brain! This increased muscle movement and blood flow to your brain triggers changes that increase the production of new brain cells. This growth of new brain cells appears to be in the parts of the brain that affect memory, multitasking and decision making. Try to remember when your best ideas come to you - are they while you are sitting at your desk or while you are moving around?

Try to add more NEAT movement into your day. By the very act of standing and moving you can boost your metabolism, lower your bood pressure and increase your mental clarity. You probably will find that you are also less tired at the end of the day.

Links:
Mayo Clinic NEAT laboratory
Muveinc: we believe desk-sentenced workers should stand up.

Sunday, April 25, 2010

If you have a choice - Choose Fiber!

Are you including foods with fiber at every meal and snack? Who knew all the good things that dietary fiber does! Fiber in your meal or snack makes you feel full more quickly. It keeps food in your stomach longer so your blood glucose doesn’t go up as high after a meal and you won’t get hungry as quickly. Fiber helps the bacteria who live in your intestines stay hard at work keeping the bad things from your food and environmental toxins from being reabsorbed into your body. Fiber helps lower cholesterol levels in your blood.

Looking for ways to get more fiber in your diet? Eat more fruits, vegetables, whole grains, and legumes - beans. Add high-fiber foods into recipes -- for example, adding beans to soup or oats to muffins -- also helps to increase the amount of fiber in the diet. The Goal here is to replace lower fiber foods with higher fiber foods in your diet. Increase the amount of fiber in your diet slowly or your intestines will complain loudly!

Whole fruits are a great place to start adding more fiber to your diet. But remember, if you just add more fruit to your diet without taking something else away, you are adding extra calories and extra calories result in extra pounds. Apples (4gm fiber 95 Calories) are easy to carry with you if you need a snack. If you add a Tbsp of almonds (1.5gm fiber 81C) or walnuts (1.1gm fiber 91C) to that you are well on your way to reaching the 25 to 35gms of fiber you should be eating every day. ½ of a large banana (2gm of fiber 60 calories) with 1 Tbsp Chunky Peanut butter (1.5gm 94C) balances the higher sugar content of the banana with the fat and protein in the peanut butter (or just have nuts with your banana).
If you eat cereal for breakfast add berries (frozen or fresh) ½ Cup Raspberries (4gm of fiber 32C) Blueberries (2gm of fiber 42C) or Strawberries (1.5gm of fiber 27C). Eat an orange (4gm of fiber 86C) with your eggs for breakfast or put 1 Cup of sautéed kale (3g of fiber 36C) in your scrambled eggs.

Flaxseed meal can be sprinkled on food instead of nuts. 1 Tbsp has 2gm of fiber and 30 calories. The downside of flaxseed meal is too much can cause GI discomfort, like nuts you have to make sure it is stored properly to protect it from becoming rancid and you should not use more than 3 Tbsp daily.

How to measure your success. You are doing a great job if you start having a bowel movement every day. Remember the bile in your blood picks up the excess cholesterol and toxic substances in your body. The fiber binds to the bile and helps to flush these substances through your intestines and out of your body faster. You should also see your Ldl Cholesterol, Triglyceride Levels and your Blood Pressure All Go Down!

Links of Interest: Fiber: Why it Matters More Than You Think in Experience Life Magazine
Nutrition Data Link to find out how much fiber is in everything (and all the other nutrients)

Sunday, March 21, 2010

Too much insulin or Too many calories

Our genetics play a role in how our bodies use food. Our bodies break down most of the calories we eat - from carbs, protein and fat into glucose (a sugar) which gives energy to our cells. The bad news is that there are many people whose bodies are very sensitive to glucose levels and their bodies develop something called insulin resistance to protect their cells from getting too much glucose in them. Their bodies produce more and more insulin to try to get the glucose into the cells. People who are insulin resistant are hungry because the glucose can't get into the cells and they have high levels of insulin floating around. So they eat more. Meanwhile, their bodies put those excess glucose calories into storage - fat in our stomachs and livers. People who don't have insulin resistance can still store some of the extra calories in the muscle cells and liver as glycogen not fat. Since the glucose levels are high, the body thinks it has to produce more insulin and the more insulin causes more glucose to be stored as fat. It becomes a viscous cycle!

The problem in this is that too much glucose in your blood can cause damage to your kidneys, eyes and nerves and can also damage or destroy the cells in your pancreas that make insulin. Too much insulin can cause inflammation which can damage our hearts and blood vessels and can cause increased blood pressure, strokes and heart attacks. Type 2 or adult onset diabetes is diagnosed when your body can no longer produce enough insulin to keep your blood sugars in the normal range (70-110). This is most often the result of the body having to produce too much insulin to try to overcome the insulin resistance and damage to the pancreas cells from too much glucose in the blood when the insulin isn't effective in getting the glucose into the cells.

If you have family members who have been diagnosed with type 2 diabetes, or if you are overweight, there is a good chance that you could have insulin resistance. (Estimates are that 1 in 4 Americans are insulin resistant.) If you wait to be diagnosed with diabetes to change how you eat, you will already have lost 60 to 80 percent of your bodies ability to produce insulin and will most likely need medications to help you control your blood sugars so that you can reduce the damage your body. Plus you probably will also need medications to treat high blood pressure and high cholesterol levels that can be a result of this problem!

The good news is that by making wise food choices now, and being physically active we can actually decrease our insulin resistance. We can protect the cells in our pancreas so that we have enough of our own insulin to help us process glucose properly without having to rely on oral medications or injecting insulin.

There are many good places you can go to get information on making wise food choices. I like the ideas of Mark Hyman M.D. http://www.huffingtonpost.com/dr-mark-hyman/5-steps-to-reversing-type_b_263424.html but caution you that he will regularly try to sell you something. Many insurance plans will pay for you to visit with a dietitian. Make sure the key message you hear is that you need to carefully keep track of the calories that you get from carbohydrates and that the carbohydrates that you do eat should be good sources of fiber and not overly processed - a blog idea for another day.

Sunday, February 28, 2010

Eating a Healthy Diet VS Exercise

I have been getting the question lately, which is more important - making healthy food choices or exercising vigorously everyday? There is not an easy answer to this question. Exercise keeps our hearts and blood vessels in good shape, improves the blood flow to our vital organs and helps us use the foods we eat more efficiently. And, exercise doesn't have to be vigorous to be helpful. Even walking or light housework is good for us.

If you eat a diet that is high in added sugar (juice, milk shakes, pop, baked goods), along with a lot of saturated fat from cold cuts, processed meats and hydrogenated or partially hydrogenated oils, you are clogging your blood vessels, causing inflammation that can increase your blood pressure, cause joint pain and probably cause your pancreas to become overworked and cause blood sugars to rise. Exercise can't fix these things.

My response to the question is this: You are what you eat. Find a way to eat foods that are healthy most of the time. Don't stress your body by eating foods that interfere with it's ability to do its job of keeping you alive and alert. Keeping your blood sugars lower and your blood vessels open will keep your mind sharp, your vision better, your circulation better and will give you more energy to enjoy life.

So, the moral of the story is; if you can't or don't have time to exercise, eating a healthy diet is still very beneficial to your health. Eating a healthy diet can make a difference in how you feel all by itself!

Saturday, February 20, 2010

TV, Sleep and Eating Out – Who Knew?

I just read about an interesting study that looked at preventing obesity in children. The 3 characteristics they looked at were the amount of sleep the children got, whether they sat down with their family at home and ate dinner and how much television that they watched. They found that in the families that regularly ate dinner at home together, where the children got 10 hours of sleep and spent less than 2 hours per day watching television (videos, dvds etc) the children were 40% less likely to be overweight.

I have read other studies that have found that adults who eat out more than 3 times per week, watch more than 2 hours of television per day and don’t get enough sleep are more likely to be overweight.

So why is television a culprit? One reason is that when you watch TV your metabolism slows down – more so than if you read a book. Your body goes into a semi-comatose state where your energy requirements drop and your metabolism slows down. Another reason is that there are so many commercials for food that we are driven to eat more! (Interestingly, the foods they are trying to sell us are often highly processed or contain lots of added sugar which we are trying to avoid).

What does sleep have to do with your weight? There are many studies that show that adults need to get 7 to 8 hours of sleep a night. A recent study compared a group of nurses who slept less than 6 hours a night to those sleeping more. The nurses who slept less than 6 hours a night were overweight. Surprisingly, the overweight nurses were significantly more active than their normal-weight peers. The overweight nurses took an average of 13,896 steps per day, compared to 11,292 for normal-weight nurses. The overweight nurses also burned nearly 1,000 more calories per day on average than their normal-weight peers.

The moral of the story is having some weights or a balance ball on hand to play with while watching TV will help us keep moving. Going for a walk after dinner - helps our bodies use the calories better and may improve sleep quality at night. And you might want to consider taking the TV out of your bedroom.

Wednesday, February 10, 2010

Eat Real Foods

Eating Healthy isn’t about losing weight(although that can be a good side effect). Eating healthy is about taking the time to eat real foods! Our bodies know how to process real foods. Real foods give us better feed back when we are full - and they keep us full longer. Real foods in combination don't make our blood sugars go up too quickly. It is important to plan ahead and have real whole foods as they come from the earth: fresh vegetables, fruits, beans, whole grains, nuts, seeds, herbs and spices and lean meats on hand to cook with and to eat when you are hungry. When we are rushed - which is often the case - being prepared makes it so much easier to grab real food on your way out the door.

The more naturally BRIGHT colors in the foods that we eat, the better! Foods that can sit packaged on a shelf for a long time without spoiling are not likely healthy foods- and unless artificial color has been added, are pretty white or colorless. In processed foods, most or all of the healthy oils in the grains have been removed for stability, the fiber has been removed and there are often preservatives and additives to keep it fresh. Try to eat a rainbow of foods every day.

Breakfast is an important meal to eat every day. It should be eaten within an hour and one-half of getting up. Breakfast should be made up of a mix of carbohydrates, proteins and fats. Eating a good breakfast helps prevent food cravings later in the day. Make sure that you are getting fiber in your breakfast. 5 to 10gm of fiber is ideal for breakfast. Also, try to avoid added sugar. One way cereal eaters can do this, is by dividing the number of grams of fiber in their cereal into the number of grams of carbohydrate. If the result is 7 or less the cereal does not have too much added sugar and is probably a good choice. For example if there is 25 gm of carbohydrate and 5 gm of fiber the result is 5 so that it is good choice for a cereal.

Sunday, January 24, 2010

Where to Start: How Much Should I Eat?

Do you wonder how much you should eat? Eating until you were full used to work when you were younger and before food became so processed. Recent studies have shown that in a world of quick to eat - shelf stable food, eating until you feel full no longer keeps you from eating more calories than your body needs. The extra salt, sugar and fat found in many foods we eat today interfere with our feeling full! Just for fun, take a few days and write down everything that you eat and drink. Click here for a printable food journal page. Choose at least 1 weekend day and 1 week day because diets vary on weekdays and weekend days. Use the food labels on the side of the packages of what you are eating to determine the number of servings you are eating or the grams/ounces and the number of calories for the amount you are eating. Click here to go to the FDA's website that explains how to understand and use the nutrition labels. (The DV values they refer to are OK for some diets and not OK for others so don't rely too heavily on them). If there is not a nutrition label, you can get this information on the internet at http://www.nutritiondata.com/ (you don't have to register or log in) or you can buy a calorie book or get one at the library. (You can also do this online at Sparkpeople.com -they make you do a free registration to access their information - or at Nutrition Data .)

Now that you know how many calories you are eating each day the question is are you eating too much or too little? The first step to finding this out should be to determine how many calories your body needs to function well based on how much you currently weight and how active you are. I have found a great website where you can get this information. Visit Ask the Dietitian Website at http://www.dietitian.com/calcbody.php fill in the questions it asks and put their Healthy Body Calculator to work for you. (If you don’t have a computer or don’t know how to use the internet, we can help you fill this information out at Kemper Drug). You will be provided with a printout of the total number of calories that you should be eating along with essential nutrients. This is important to know so that you make sure you are getting these nutrients during the day.


Wednesday, January 13, 2010

Be Healthy in 2010!

I recently heard the statistic that 50% of the medications that we dispense from our pharmacy treat diseases or illnesses that are a result of how people take care of themselves. My goal in starting this blog is to help our patients, and friends focus on the importance of taking care of their bodies and minds.

In Minnesota we have a lot of snow and cold. We are prepared for when it snows. We have shovels to clear our driveways and sidewalks. We have snow tires on our cars and good treads on our boots. We have warm clothes to keep our body heat in. We are practicing snow risk prevention. We don't want to deal with the hassle of sliding into the snowbank and risking injury to our cars or ourselves. We don't like feeling cold so we do something to prevent having to feel the worst of it.

Lets apply this being prepared approach to your health! We can help you use some tried and true prevention techniques to keep you healthier this winter.
  • We are currently offering H1N1 and Seasonal Flu shots at Kemper Drug because we want our patients to stay healthy this winter.
  • We can meet with you to discuss your medications and make sure that you are reaching your treatment goals.
  • We can also sit down and discuss what the impact of making lifestyle changes can have on the numbers and types of medications you need to take and on your health in general.

Here is to a great 2010 together!
Wendy Simenson R.Ph