Pillsnews. Pharmacy News

We live at a time when science is pursuing so many fields of research, and in the medical field so many more drugs and medications are available to improve our health. The growth of our population over the age of sixty-five can be due at least in part, to the availability of effective medicines and vaccines. The D.H.S.S. reports that during 1984 as many as 53 per cent of prescriptions dispensed in England were for women over the age of sixty and for men over sixty-five. Of course, it is only natural that older people have more long-term illnesses (such as arthritis, heart disease and hypertension). And it is not uncommon to have a number of disabilities or diseases at the same time for which you need to take a number of different medications. But have we become an over-medicated society?

Generally speaking, the elderly can have different reactions to medicines than the young or middle-aged, probably because of the decrease in the percentage of lean tissue (including muscle) and an increase in the percentage of fat. Consequently, these differences can affect the drug amount that is absorbed by body tissues and the length of time it remains in the body. Older people seem to have more undesirable reactions to drugs than younger people, probably because organs like the kidneys and the liver are working less efficiently, so that drugs (including alcohol) are slower to leave the body.

Prescription drugs are generally more powerful and may have more side reactions than over-the-counter medicines; and yet when large quantities of non-prescription drugs are taken, if they have strong ingredients, they might equal or exceed a dose available in a prescription. Some medicines (including antacids, alcohol, cold remedies, laxatives and vitamins) can create difficulties if overused or abused or taken in combination with prescription drugs, causing dizziness or drowsiness that could result in stumbling or falling. These few basic rules can help you use medicines, mineral and vitamin supplements more safely:

1. Before you have a new prescription, tell your doctor all the

other medicines you are taking, including oral contraceptives, insulin, non-prescription drugs and those prescribed by other doctors, plus vitamin and mineral supplements. If you are pregnant, a heavy smoker, or a heavy drinker, ask your doctor if there are any special foods, alcohol or aspirin to avoid, and if medicines should be with or between meals. Ask specifically what effect the new medication will have on your bone mineralization (especially if it is cortisone, an anticoagulant, anticonvulsant, tranquillizer or stimulant), and if additional calcium or vitamin supplements may be necessary.

Tell your doctor about previous adverse reactions you have had with medications (dizziness, rashes, indigestion, constipation, etc.). Know exactly what the medication is supposed to do for you, and ask about any side effects that may occur with a new prescription. Phone your doctor immediately if you have unusual effects.

Understand exactly what the dosage should be and how frequent, and take precisely the dosage your doctor prescribes. Oral contraceptives, oestrogens and a few other drugs usually have an information leaflet detailing risks and benefits. Read this brochure carefully.

Never take medicines prescribed for a relative or friend, or give your medication to anyone else, even though you may have similar symptoms or illness. Medicines can produce different effects in everyone.

Make a complete daily record of each drug and supplement you are taking, particularly if you are taking more than one. Note the name of the drug, the amount you take and the times of day for the dose, and don’t forget to tick off each dose as you take it.

Ask the chemist for easy-to-open containers if child-proof tops are difficult for you. Be sure to keep all medicines and supplements locked up and well out of the reach of children. Ask the pharmacist about any special storage requirements for the medicines you take, such as refrigeration.

Ask your chemist to put large type on the medicine label if you find the usual type difficult to read. Make sure you have the name of the medicine clearly on the label with the dosage

directions, and that you understand them. If you have any doubt that they are different from what your doctor has told you, mention this to your pharmacist or doctor.

Never put medicines into unlabelled containers. Fancy pill boxes are not always suitable.

Never take medicines at night without turning on the light. Be sure you can see clearly what you are taking and how much.

If you feel a medicine may be doing you more harm than good, don’t stop taking it without asking your doctor; he may want to change the dosage or substitute another medication that is more suitable to your changing needs.

Never resume taking a drug you happen to have in the medicine cabinet without checking with your doctor.

Many medications lose their strength and effectiveness over a period of time, so expiry dates should be carefully checked. Old medicines should be cautiously discarded and the labels clearly marked ‘Empty’ (to give peace of mind if children are found playing with the old jars or bottles).

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Hippocrates once said: ‘Thy food shall be thy cure’, and perhaps he was on the right track. The quality of your life can depend on the quality of your food. Some foods, or lack of them, can cause diseases; others prevent them. A sensible diet may add years to your life. There’s no doubt, diet has an influence. Food is not a preventive nor a cure for all human diseases, but more is being learned about the interaction of food on health, and how much is needed to give a full and happy life span. Sometimes the only difference between a healthy person and a sick person is the food eaten. When poorly nourished and abused, your body gets out of order, you can get sick, and might age and die needlessly prematurely. There’s still much you can do for yourself with preventive health practices and better nutrition. It’s a combination of the right living habits, the right food and ways of preparing food, knowing which foods to avoid and which supplements may be needed. For fitness and the longest life span, you need a lifetime concern for good nutrition. But it’s never too late to start on a programme of self-improvement, with the key points being: moderation in quantity, attention to ‘quality, and especially a variety of items from the four main food groups – milk and milk products; fruits and vegetables; breads and cereals; meat, fish, poultry, eggs or beans. As no individual item contains all the nutrients you need, an assortment of whole food makes for better health.

As a mother, you probably feel your family’s needs come first, and urge your youngsters to drink their milk or fruit juice and eat their vegetables, but make sure you too have your proper share of these foods.

Frequently, young people as well as the elderly, have to work with a limited budget for food. You may be bored with food and its preparation, or be in a hurry, or have little appetite, especially if you are living on your own. You may have difficulty chewing because of poor teeth or ill-fitting dentures, or have problems of indigestion. Or it may not be easy for you to get to the shops if you live some distance away from them, so you may not have much fresh food and choices may be limited or unwise. As years go by, you are probably less active and need fewer calories, but every calorie has to provide good sound nutrition and really count. There’s little room for the ‘empty calories’ in fats, sugars and alcohol. Each day can make different demands on your body and the nourishment it needs, with varying levels of activity, days of stress and days of relaxation.

For determining good bone health, it is crucial to consume sufficient calcium, largely found in dairy products, especially during adolescence and young adulthood, and to have the right ratio of calcium to other foodstuffs. In Yugoslavia, a study of women’s bone mass was conducted in two villages in regions of the country with different eating habits, one group consuming twice as much calcium as the other. In the village where calcium consumption was high, the women’s bones were definitely stronger at skeletal maturity, and fewer fractures were suffered by the elderly. It has been found that women with osteoporosis have generally had poor nutrition, with less calcium, or have had difficulty in absorbing it from their food. As we grow older, it can become more difficult to absorb calcium. Later on, you will read of the different foods that are calcium-rich and the role played by vitamins.

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You need plenty of foods rich in this vitamin, also known as ascorbic acid. Vitamin C is utilized by your body for the production of collagen forming connective tissue; this vitamin will help if you have bone fracturing, sore or bleeding gums, or wounds that fail to heal. When our bodies evolved, they were not designed to store vitamin C for any length of time (because fruits and vegetables were plentiful), so the body needs vitamin C daily. The adrenal gland has a high level of vitamin C, and it is known that, in stressful situations, as the production of hormones goes up in this gland, its level of vitamin C goes down. Oral contraceptives, or overuse of laxatives, can decrease your absorption of vitamin C, with consequent reduced levels of this vitamin. Osteoporosis can develop from such nutritional disorders as scurvy, vitamin C deficiency; although only a few elderly people develop scurvy, many more have low reserves of this vitamin.

How much vitamin C do you need each day? The recommendation of the D.H.S.S. for adults is 30mg, with 60mg for pregnant women and nursing mothers.

There are between 50-60 mg of vitamin C in 0.5 cup of orange juice or one medium orange. Orange-flavoured breakfast drinks can be misleading, with many advertised as having more vitamin C than orange juice, but they have little else but vitamin C and sugar, with more calories. And the ‘juice’ in which fruit is canned, usually a sugar-water syrup, has no vitamin value. Real unsweetened orange juice has vitamin C plus other natural minerals and nutrients, so check the labels.

Other produce with this vitamin are: citrus fruits and natural citrus juices, blackcurrants, kiwifruit, canned pineapple juice and cranberry juice cocktail (but little in prune juice). Potatoes, especially baked and eaten with the skin, contribute substantial amounts of vitamin C. Other good sources are fresh picked tomatoes, tomato juice, green peppers and fresh green leafy vegetables.

Since water-soluble vitamin C is easily destroyed by heating, fruits and vegetables not eaten raw should be lightly cooked or steamed for a short time only. Carefully refrigerate leafy vegetables and don’t leave them soaking in water before cooking. Generally, more vitamin C is retained if cooking is in a microwave oven, well covered, than on a conventional stove-top.

Canned fruits and vegetables have generally lost some of their vitamin C through processing; some brands may have extra ascorbic acid added to make up the losses. Check the labels. Frozen fruits and vegetables will usually retain good amounts of vitamin C during freezing – but drying to preserve foods will destroy this delicate vitamin.

Small amounts of vitamin C are naturally present in milk, but 25 per cent is destroyed by pasteurization, with further losses in the heat process for UHT milk and sterilization. Don’t leave bottled milk on the doorstep in sunlight – substantial amounts of vitamin C can be lost. Don’t rely on milk alone to supply you with this vitamin.

It has been several years since Dr Linus Pauling wrote his book Vitamin C and the Common Cold advocating megadoses of vitamin C. Many subsequent studies, however, have shown no benefits from this practice. In fact, taking more than 1 gram daily can result in acidic urine and encourage the growth of kidney stones. Some studies show that high dosage vitamin C can change the level of oestrogen in oral contraceptives, according to Dr Daphne A. Roe, Professor of Nutrition at Cornell University, USA.

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A minor but not insignificant factor in osteoporosis can be pollution in the environment, affecting your bone mass in two ways: the reduction of sunshine under murky skies (see vitamin D section on p. 96) and the toxic effects of particles of matter in pollution – the aluminium toxicity noted earlier, and especially high levels of lead, cadmium, mercury and zinc. When calcium in the body is low, it tends to be replaced by these other harmful minerals.

Lead. D. Bryce-Smith in Chemistry in Britain describes lead as ‘. . . one of the most insidiously toxic of the heavy metals to which we are exposed, particularly in its ability to accumulate in the body, and has been said to interfere with practically any life-process one chooses to study.’

When lead enters the bloodstream, about 10 per cent is excreted but the remainder is lodged in bone tissue. Lead can cross the placental barrier to a growing foetus and reach a nursed infant through lactation. It is well-known that high levels of lead in the blood can be fatal, but recent research has found that 30 micrograms per decilitre of blood can have an adverse effect – a level considered free of risk only two years ago. A safe level of lead in the blood has not been established. Unborn children are in danger of acquiring birth defects and children of one to three years of age are most susceptible to permanent damage. It can be absorbed into the body by inhaling, ingesting or through the skin.

Where is lead found? It is in the air, mainly from petrol and industrial processes, from burning coal or refuse. Lead is in food, from fertilizers, insecticides, pesticides and some ceramic glazes. It may be in drinking water, flowing through lead plumbing; and it is in lead-based paints, ammunition, fishing weights and some cosmetics.

What can you do to avoid it? Because children are most at risk from lead pollution, check around the home for old lead-based paint on walls (especially if it is chipping and peeling), or on painted toys, since youngsters tend to chew on paint chips. Unleaded paints are now available in shops for home decorators. In urban areas, lead accumulates in dust, so it is a good idea to do indoor dusting frequently, as well as sweeping porches, steps and driveways where children often play. Be sure that dirty hands are washed before food is prepared, and especially before eating. Buy fresh foods whenever possible, since metallic lead (mainly solder) gets into food during the canning process, particularly if the food is acidic. If you have to use tinned food, wipe the tops of cans carefully before opening; remove food promptly, without scraping the cans too vigorously, and transfer the contents to glass containers. Never store food or juices in tins. All unprocessed fruits and vegetables, from a greengrocer or home-grown, should be thoroughly washed in water or a mild vinegar-water solution, and outer leaves discarded, to remove pesticides, insecticides and contaminated soil as much as possible. If you take your own pie-shells and pastry-cases using pellets to weight the dough, use glass or ceramic beads or dry beans and not lead or aluminium shot. Discard old toothpaste tubes that sometimes contain lead – more recently, tubes are made of plastic.

If you have lead plumbing, use Water only from the cold water tap for the kettle or for food preparation, running it for a few minutes before using. And before installing a water softener, check that you have no lead pipes.

Controversy still surrounds the addition of lead to petrol, to increase the octane rating (in 1986, at the rate of 0.15g per litre), although the practice is a serious health hazard. Australia, New Zealand and the United States now have programmes for marketing lead-free petrol, and it is earnestly hoped that car manufacturers and the petroleum industry will soon reach agreements to ban completely the use of lead additives in the UK, EEC countries and world-wide. Meanwhile leaded petrol continues to be used and to cause concern.

Home potters use lead glazes because other safer glazes require firing at higher temperatures not always achieved with home kilns. If you are buying ceramics at a craft fair, or maybe in a foreign market, ask what kind of glaze was used. Coffee can pull the lead out of lead-glazed coffee mugs, for instance, and poison the person drinking it. Artist-potters may be exposed to glazes that contain the metals lead, cadmium and nickel; they are cautioned to read and follow the directions on labels of art material, use gloves and good ventilation. When glazing vessels intended for food and drink, use a lead glaze on the outside surfaces only, and some other non-toxic glaze on the inside.

Old traditional pewter may have a high lead content and should be avoided for drinking beer, cider or wines, or for storing fruits, pickles and preserves.

Although the sale of lead-containing cosmetics is banned in Britain, leaded eye make-up is still imported from the Indian subcontinent, and some medicines imported from the same area also have a high level of lead.

Cadmium. Cadmium is used in plating steel, iron, copper, brass and other alloys to prevent corrosion. It is used in storage batteries; as pigments in paints, enamels and lacquers. Poisoning can occur after drinking an acidic food or drink, such as lemonade, after preparation in a cadmium-plated can.

In Japan, cadmium poisoning is known as ‘Itai-itai’ disease, meaning ‘it hurts, it hurts’. In the 1960s, cadmium seeped downstream from toxic waste along the Jinzu River, contaminating drinking water and polluting rice paddies near the village of

Haginoshima. When villagers had had repeated pregnancies, severe bone disease developed in old age: calcium from their bones had been drawn off by each growing foetus, and replaced by cadmium, subsequently resulting in bones so weakened that they splinter with a sneeze. The Japanese cadmium dumping ended in 1971, but itai-itai disease is chronic; more than 100 villagers died, and other survivors receive benefits under the Japanese law devised to help people injured by hazardous waste or air pollution.

Closer to home, in Shipham, Somerset, where the village was built over old zinc mines, cadmium concentrations in the soil have been contaminating leafy vegetables and rhubarb. These villagers have now been cautioned to eat less home-grown produce to reduce their intake of cadmium. And in the Heathrow area near London, the use of sewage sludge on market gardens over a long period has increased the cadmium in lettuce and root vegetables. Cadmium is also known to accumulate in kidney meat and in brown crab; other shellfish is being carefully monitored by the Ministry of Agriculture, Fisheries and Food.

Mercury. Even in ancient Egypt mercury was known as a toxic substance, but was used for medical purposes. In the nineteenth century, a mercury compound was used to treat felt in the hat industry, causing poisoning with damage to the kidneys, tremors and other physical effects, hence the term ‘mad as a hatter’, and subsequently it was banned for that purpose. Today, under carefully controlled conditions, it is used in antiseptic salves, as a germicide, a fungicide, and in diuretics to increase urine flow. Because mercury compounds are presently used in fungicides for seeds, in water-based paints and in paper, the discharge of mercury-containing wastes into drainage systems is creating some concern. Build-up of mercury, through the ecological chain, in tuna, swordfish and salmon, has caused some governments to set definite limits on permissible levels in edible fish.

The Ministry of Agriculture, Fisheries and Food is monitoring the mercury content offish entering selected British seaports, and reporting to the D.H.S.S.’s Committee on Toxicity.

In the Mediterranean area, high mercury levels previously attributed to industrial wastes, have been found to be originating mainly in natural run-offs from mercury-rich soils, particularly from Spain, Italy, Yugoslavia and Turkey. Under the Mediterranean Action Plan, participating countries have banned dumping of the most dangerous wastes (mercury, DDT, PCBs, arsenic and radioactive substances), but eating raw shellfish in this region is still dangerous.

Zinc. The toxicity of zinc is lower, but still represents a hazard. Zinc is used as a coating for the protection of steel and the production of galvanized metal, frequently seen as a roofing material. It is in tyre production and in weedkillers. Zinc can occasionally enter pipes used for drinking water.

Approximately 63,000 chemical compounds are in common use, with 1000 new compounds added each year to that total. A recent study by the US National Academy of Sciences concluded that ‘of tens of thousands of commercially important chemicals, only a few have been subjected to extensive toxicity testing, and most have scarcely been tested at all.’ Is there any level of toxicity so low as to be harmless to humans? What is an acceptable risk? Many chemicals can cause cancer, damage to the central nervous system, liver and kidneys, from which it can be inferred that there is an effect on the proper functioning of these organs, impairing bone mineralization.

Write to your government representatives to express your concern; demand an acceleration in efforts to clean up the environment and ensure safe handling and storage of toxic wastes.

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Although insufficient information is available on whether moderate amounts of alcohol have an effect on bone loss, it has been observed that heavy drinkers have abnormally light bones that fracture easily, with impairment of calcium absorption through the intestines. Alcoholism produces inflammation of the liver, causing damaged cells to be replaced by scar tissue that impairs the organ’s function. Thus there is a reduced ability to produce enzymes for digestion and absorption of food nutrients.

Male alcoholics in their twenties have been known to have osteoporosis. A research team from Loma Linda University and Jerry Pettis Veterans Administration Hospital in California, has evidence that alcohol itself accelerates the breakdown of bone, although it is still uncertain whether alcoholics’ bone problems may also be the results of poor diet, the inability of the liver to activate vitamin D, and/or a lack of exercise. Heavy drinkers may be taking certain antacids to soothe their stomachs, adding further to their bone problems.

It is the amount of alcohol you drink, and not the particular kind of drink that the alcohol is in. Thus 1.5 oz of whisky equals

6 oz of wine, equals 12 oz of beer. Pure alcohol is 200° proof. Distilled spirits such as brandy, gin, vodka and whisky are about 40 per cent alcohol (80° proof). Fortified wines such as port, Madeira and sherry are about 20 per cent alcohol. Table wines, whether light or full-bodied, are about 10 per cent alcohol. Beers are about 5 per cent alcohol.

Many medications contain alcohol – for instance, medicines for coughs, colds and congestion – because alcohol is a better solvent and provides longer shelf-life than a water solution. A concentration of alcohol up to 35 per cent is used in many mouthwashes.

The problem is that we don’t stop to consider that alcoholic beverages are drugs that can have interactions with many other drugs, both over-the-counter and prescription. Alcohol can cause other drugs to be used more rapidly by your body, producing exaggerated effects (mixing alcohol with a high dosage of ‘Valium’ or ‘Darvon’ can be fatal). Drugs can intensify your reaction to alcohol, leading to more rapid intoxication. Your body’s response can also be influenced by menstrual periods and hormone levels, including the taking of oral contraceptives or hormone replacements after menopause – slowing the rate at which alcohol clears from your bloodstream.

Two-thirds of the population drink alcohol and certainly don’t think of themselves as drug users. Alcohol is present at most of the big celebrations: births and christenings, birthdays, graduations, weddings, promotions, deaths and funerals. Holidays and Christmas revolve around having a drink with family and friends.

But ask yourself honestly if you are drinking more than a moderate amount each day – an important factor when considering loss of bone mass. How would you answer the following questions?

Have you lost interest in food?

Do you crave a drink at a definite time each day, and need to

drink more to get the desired effect?

Do you drink to put yourself to sleep?

Do you gulp drinks too fast?

Do you drink alone?

Do you drink because you are shy, need to calm your nerves

or bolster your confidence?

Do you lie about how much you drink – and feel guilty?

Are you losing time from work because of drinking?

Has your efficiency and ambition decreased because of

drinking?

Has drinking made you indifferent about your family?

Do you drink to forget problems at home, at work, or to

reduce depression?

Is drinking making your life at home unhappy?

Are you in financial trouble because of heavy drinking?

Have you sought the help of a doctor or been to hospital

because of drinking?

Although alcohol abuse has been closely linked to the stresses of old age, with some studies estimating that 10 per cent to 15 per cent of people over the age of fifty-five may have a drinking problem, there is also great concern for the epidemic of teenage drinking. But the teen years are when the body should be building up its skeletal mass at the average rate of 10 per cent a year. Some young people under eighteen are already alcoholics or nearly so; many more are heading towards problem drinking that may be a lifetime handicap. Discourage your young daughter from drinking and smoking, and set yourself as an example.

For control of alcoholic beverage consumption, a physician will sometimes prescribe disulfiram (‘Antabuse’ by C. P. Pharmaceuticals) which is formulated to cause palpitations, flushing, sweating, shortness of breath or dizziness when even a small amount of drink is consumed or other drugs containing alcohol are taken.

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