Certain Foods and Meds Don’t Mix

Raise your hand if you typically ignore the tiny little writing on your prescription medication bottles or on the box that comes with your over-the-counter meds. You are not alone because according to medical researchers, millions of Americans—by some estimates, half or more of the people using medications or drugs – ignore the warning labels, either partially or completely.

Medical compliance broadly applies to how well you adhere to the directions, warnings, and advice you’ve received from your physician, pharmacist, or the drug company. It concerns frequency, dosage, time of day for taking a medication, and what foods, other medications or liquids to avoid when using certain drugs.

While it may be hard to imagine that food would play such an important role in how well our medications work, think vitamins, digestion, compounds, and chemicals . . . . lots and lots of chemicals. That’s what food and the medications we ingest, inhale, or otherwise insert into our bodies are made of.  How they work together – and if they work well together – is important information for medical consumers to understand and employ. Failure to comply with these warnings can minimize the effectiveness of the medications you are taking and, in some cases, endanger your life.

The range of foods that can counteract, boost, or reduce medicinal potency are far reaching. Some may be surprising — the list includes everyday items such as bananas, kale, grapefruit, black licorice, caffeine, alcohol, salami, and walnuts, just to name a few. Here’s a rundown on some common food/drug interactions consumers should be aware of:

Bananas shouldn’t be mixed with ACE inhibitors and so-called “potassium-sparing” diuretics, which can increase the amount of potassium in our bodies. Too much potassium can cause an irregular heartbeat and heart palpitations. So people who take those drugs should avoid large amounts of food high in potassium, including bananas, oranges, green leafy vegetables, and salt substitutes such as Morton Lite Salt. The meds that fall into these categories include captopril (Capoten), enalapril (Vasotec), and lisinopril (Prinivil, Zestril), which are used to lower blood pressure or treat heart failure. Also avoid mixing with certain diuretics, such as triamterene (Dyrenium), used to reduce fluid retention and treat high blood pressure.

Kale shouldn’t be mixed with blood thinners such as warfarin (Coumadin). Kale and other greens, including broccoli, cabbage, spinach, and brussels sprouts are rich in vitamin K, which can reduce the drug’s anti-clotting effects. It’s good to eat a balanced diet with lots of greens, but if you have the urge to start drinking a daily kale smoothie, speak with your doctor first.

Black licorice shouldn’t be mixed with Digoxin (Lanoxin), which is used to treat heart failure and abnormal heart rhythms. Glycyrrhizin, a component of black licorice, can cause irregular heartbeat or even death when combined with digoxin. Licorice also appears to make certain drugs less effective. The list includes blood-pressure medications, blood thinners, pain relievers, and birth-control pills. Be careful if you eat a lot of it (only the real stuff counts; some candy is just licorice-flavored, so look for “licorice extract” on labels) or if you take licorice-root supplements for heartburn.

Grapefruit juice shouldn’t be mixed with cholesterol drugs such as atorvastatin (Lipitor) and lovastatin (Mevacor). Drinking grapefruit juice can raise the level of the drug in your bloodstream and increase the risk of side effects, especially leg pain. Grapefruit and grapefruit juice can interfere with other drugs, too.

 Walnuts shouldn’t be mixed with thyroid drugs such as levothyroxine (Levothroid, Levoxyl, Synthroid). Walnuts, soybean flour, cottonseed meal, and high-fiber foods can prevent your body from absorbing those medications. So if you eat a high-fiber diet, you might need a higher dosage.

Milk shouldn’t be mixed with Tetracycline antibiotics (Sumycin). Calcium, which we derive from dairy foods such as milk, yogurt, and cheese, and calcium supplements and fortified foods can prevent the body from absorbing the drug. In general, tetracycline works better if taken one hour before or two hours after eating.

Salami shouldn’t be mixed with drugs such as metronidazole (Flagyl) and linezolid (Zyvox), used to treat bacterial infections. If you eat or drink too much of anything that contains the amino acid tyramine, your blood pressure could spike. Tyramine is found in foods that are aged, pickled, fermented, or smoked such as processed cheeses, anchovies, and dry sausage. It’s also in avocados, bananas, chocolate, and alcoholic drinks.

Alcohol doesn’t mix well with most medications. Many medications come with instructions not to drink alcohol while you’re taking them. It’s an important warning—even a single glass of wine could be too much. Alcohol alone can make you drowsy, light-headed, and less coordinated; mixing it with certain drugs can magnify those effects. Even worse, it can cause serious problems, including internal bleeding and breathing and heart problems. And alcohol can make a drug less effective, even useless, or it can make a drug toxic. For example, just a few drinks mixed with acetaminophen (Tylenol) can damage your liver.

Finally, beware of mixing supplements with your prescription and over-the-counter medications without consulting your physician or pharmacist. Like the foods and drinks above, some dietary supplements, including vitamins, minerals, and herbals, can cause problems if you take them with some drugs.

Even a multivitamin with iron can negate the effects of many drugs. But herbs are the worst offenders. For example, combining St. John’s wort with over-the-counter cough medicines or prescription antidepressants or migraine drugs can cause serotonin syndrome, a dangerous condition that can cause rapid blood-pressure changes, confusion, muscle spasms, and even death.

The most common drugs involved in negative interactions with supplements were, in order, warfarin (Coumadin), insulin, aspirin, digoxin (a heart drug), and ticlopidine. The supplements that most often caused problems were St. John’s wort, magnesium, calcium, iron, and ginkgo biloba.

Just because these foods and supplements might interact with certain drugs you’re taking doesn’t mean you have to avoid them completely. Speak with your physician about any short- or long-term medication you’re taking, read labels carefully, and learn when it’s safe to eat what you like, when you like it.


 

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Seeing Clearly Is Good for Your Whole Body

Remember those stories we heard as children about eating carrots to keep our eyes strong? While it’s true that the beta carotene found in carrots converts to vitamin A during digestion and is rich in antioxidants, the best way to keep our eyes strong is to eat a balanced diet, get plenty of sleep, wear eye protection when appropriate, and make sure to schedule regular eye exams for yourself and your family members.

Millions of Americans wear corrective eye wear or contact lenses, but taking our eyes for granted is common and easy to do. Wearing approved safety glasses on a job site, while working in the yard, or when competing in sports seems obvious enough. But there are so many ways to hit ourselves in the eye or to be injured by thrown objects, splashed liquids, and even wind-blown contaminants or materials. Hospital emergency rooms treat patients with eyes damaged by all manner of chemicals, fish hooks, baseballs, wood chips, and much more. So if you’re doing something that might result in an injury, take the safe and easy step to cover your eyes.

Being aware of the potential damage from ultraviolet light also is important. Sunglasses and clear eyeglasses with protective coatings filter out the sun’s damaging rays, so if you work or spend a lot of time outdoors, you need that extra protection.

Visit your eye care professional regularly

Adults should visit an ophthalmologist at least once every other year, and annually if you have bad eyesight or a family history of glaucoma, cataracts, or other congenital or age-related eye ailments. Many eye maladies develop as we get older, part of the natural aging process. Through a comprehensive eye exam that typically involves dilating your pupils and conducting a number of standard (and painless) tests, eye care professionals (ophthalmologist and optometrists) not only determine sight deficiencies and illnesses, but also find warning signs pointing to other dangers such as heart disease, diabetes, high blood pressure, and cancer. Opticians can prescribe glasses and contacts, but aren’t as highly trained to spot illness and to deal with injuries.

Dry eye syndrome and glaucoma are two common ailments that affect people as they age. If the glands in your eyes stop making enough natural lubricants, you can buy over-the-counter remedies, but you should have your eyes checked for inflammation or infection. Sometimes dry eyes occur from living or working in windy, dry, or low-humidity environments, or in buildings with air-blown hot air. Doctors recommend “fake tears,” which don’t have as many chemicals as the “get the red out” eye drops. Anti-inflammation medications and vitamins or foods like fish oil which are high in Omega-3 are often recommended.

Glaucoma is a group of illnesses that can lead to blindness if not treated. When fluid builds up inside the eye, pressure and tension can result in damage to the optic nerve, including blindness. Glaucoma has no early warning signs. However, symptoms can include blurriness or clouded vision, sensitivity to light, headaches, reduced peripheral, or “tunnel vision”. It’s more common in adults over 60, in African American adults over 40, or in adults with diabetes, or a family history of glaucoma. It is most often treated through medications and surgery.

Here are some common tips for helping to ensure good eye health:

  • Know your family’s eye health history. Talk to your family members about their eye health history. It’s important to know if anyone has been diagnosed with a disease or condition since many are hereditary. This will help to determine if you are at higher risk for developing an eye disease or condition.
  • Eat right to protect your sight. Eating a diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale, or collard greens is important for keeping your eyes healthy. Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.
  • Maintain a healthy weight. Being overweight or obese increases your risk of developing systemic conditions such as diabetic eye disease or glaucoma which can lead to vision loss. If you are having trouble maintaining a healthy weight, talk to your doctor.
  • Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.
  • Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataracts, and optic nerve damage, all of which can lead to blindness.
  • Be cool and wear your shades. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun’s ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100%of both UV-A and UV-B radiation.
  • Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.
  • Clean your hands and your contact lenses properly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate.

Through comprehensive, regular eye exams, your doctor can check for early warning signs of glaucoma, potential retinal detachment (which causes floaters or flashes in the eye but can be sight threatening) and other common eye diseases, and help keep those beautiful peepers of yours sparkling and healthy.


 

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

What’s That on Your Feet?!

It’s summer and many of us are fairly active outside or indoors; walking, jumping, biking, boating, playing sports, jogging, and exercising. Chances are we’re wearing sneakers or athletic shoes while we play or work, those leather, cloth, or mesh multi-colored foot coverings universally popular with children and adults alike. In the United States alone, the market for sneakers and athletic shoes comprises a multibillion-dollar industry that capitalizes on smart marketing, style, star power, peer pressure, practicality, and comfort.  We all wear them, yet how much do we actually know about what’s on our feet, like if they’re suitable for the activities we’re using them for and if they’re good for us?

At one time in the not-too-distant past, everyone wore sneakers when active. Now there are hundreds of athletic shoes to choose from, designed for practically every type of activity, though typically for running, training, and walking.

Court sports include shoes for tennis, basketball, and volleyball. Court sports require the body to move forwards, backwards, and side-to-side. As a result, most athletic shoes used for court sports are subjected to heavy abuse. The key to finding a good court shoe is its sole. Field sports include shoes for soccer, football, and baseball. These shoes often are cleated, studded, or spiked. The spike and stud formations vary from sport to sport, but generally there are replaceable or detachable cleats, spikes, or studs affixed onto nylon soles.

When it comes to track and field, athletic shoe companies produce many models for various foot types. One brand does not meet the needs of everyone, and the latest innovation or most expensive shoe may not be your best choice. However, even the best-designed shoes in the world will not do the job if they do not fit properly. You can avoid foot problems by finding a shoe store that employs a pedorthist or professional shoe fitter who knows about the different shapes and styles of shoes.

Here’s some guidance for choosing the athletic shoe that’s best for you:

Running Shoes:  A good running shoe should have ample cushioning to absorb shock, though there are advocates for minimalist running shoes with almost no cushioning. If you choose a cushioned shoe, look for overall shock absorption for the foot and good heel control. This may help prevent shin splints, tendinitis, heel pain, stress fractures, and other overuse syndromes.

Joggers should wear a shoe with more cushioning for impact. Running shoes are designed to provide maximum overall shock absorption for the foot. Such a shoe should also have good heel control. Together, these attributes help prevent shin splints, tendinitis, heel pain, stress fractures, and other overuse syndromes.

Walking Shoes:  If walking is a major athletic activity for you, wear a lightweight shoe. Look for extra shock absorption in the heel of the shoe,especially under the ball of the foot (the metatarsal area). This will help reduce heel pain (plantar fasciitis and pump bumps) as well as burning and tenderness in the ball of the foot (metatarsalgia). A shoe with a slightly rounded sole or rocker bottom also helps to smoothly shift weight from the heel to the toes while decreasing the forces across the foot. Walking shoes have more rigidity in the front so you can roll off your toes rather than bend through them as you do with running shoes.

Aerobic Shoes:  Shoes for aerobic conditioning should be lightweight to prevent foot fatigue and have extra shock absorption in the sole beneath the ball of the foot (metatarsal area), where the most stress occurs.

Tennis Shoes: Tennis players need a shoe that supports the foot during quick side-to-side movements or shifts in weight. A shoe that provides stability on the inside and outside of the foot is an important choice. Flexibility in the sole beneath the ball of the foot allows repeated, quick forward movements for a fast reaction at the net. You need slightly less shock absorption in the shoe if you’re playing tennis or other racquet sports. On soft courts, wear a softer-soled shoe that allows better traction. On hard courts, you want a sole with greater tread.

Basketball Shoes:  For basketball, choose a shoe with a thick, stiff sole. This gives extra stability when running on the court. A high-top shoe may provide added support but won’t necessarily decrease the risk of ankle sprain or injury.

Cross Trainers:  Cross-training shoes, or cross trainers, combine several of the above features so that you can participate in more than one sport. A good cross trainer should have the flexibility in the forefoot you need for running, combined with the lateral control necessary for aerobics or tennis.

We don’t necessarily need a different pair of shoes for every sport in which we participate. Generally, wear sport-specific shoes for sports you play more than three times a week. If you have worked out for some time injury-free, then stick with the particular shoe you have been wearing. There is really no reason to change.

For special problems, you may need a special shoe. If your ankles turn easily, you may need to wear a shoe with a wide heel. If you have trouble with shin splints, you may need a shoe with better shock absorption.

If the shoe fits, buy it!

Here are some useful guidelines for buying new athletic shoes:

  • If possible, purchase athletic shoes from a specialty store. The staff will provide valuable input on the type of shoe needed for your sport as well as help with proper fitting. This may cost a little more, but is worthwhile, particularly for shoes that are used often.
  • Don’t go just by size. Have your feet measured, and choose shoes that fit the larger foot first.
  • Try on athletic shoes after a workout or run and at the end of the day. Your feet will be at their largest.
  • Wear the same type of sock that you will wear for that sport.
  • When the shoe is on your foot, you should be able to freely wiggle all of your toes.
  • The shoes should be comfortable as soon as you try them on. There is no break-in period.
  • Walk or run a few steps in your shoes. They should be comfortable.
  • Always re-lace the shoes you are trying on. You should begin at the farthest eyelets and apply even pressure as you create a crisscross lacing pattern to the top of the shoe.
  • There should be a firm grip of the shoe to your heel. Your heel should not slip as you walk or run.
  • If you participate in a sport three or more times a week, you need a sport-specific shoe. Remember that after 300 to 500 miles of running or 300 hours of aerobic activity, the cushioning material in a shoe is usually worn down and it’s time to toss the shoes.
  • If you have bunions or hammertoes, find a shoe with a wide toe box. You should be able to fully extend your toes when you’re standing, and shoes should be comfortable from the moment you put them on. They will not stretch out.
  • Women who have big or wide feet should consider buying men’s or boys’ shoes, which are cut wider for the same length.

Finally, if your feet or back hurt, you should get them checked out by a physician. For the best advice, see an orthopedic surgeon, a doctor specializing in diseases of the bones and joints. The orthopedic surgeon is trained to treat problems of the foot and ankle. Pedorthists and orthotists are trained to make and modify arch supports (orthoses) and fulfill the surgeon’s prescription. Working with these professionals will ensure you get the right shoe for the best possible treatment.

Proper-fitting sports shoes can enhance performance and prevent injuries. But whatever you choose to wear on your feet, get out there, have fun, and be healthy!


 

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Flu Shot Protocols for Employers

The cost of getting sick taxes employers and employees alike. Chronic illness and injuries—though not always anticipated—can be managed, but it’s hard to limit exposure to viruses and bacteria. However, there are steps we can take to mitigate the chances that we and our fellow workers will come down with and share certain contagious illnesses, especially in the workplace.

High on the list of contagions that can be controlled is influenza, or the flu. Every year, millions of Americans contract the flu, losing three to five days of work or more, requiring visits to physicians or walk-in clinics, and for many, a stay in the hospital. It’s also life threatening for seniors, small children and adults with compromised immune or respiratory systems. The annual medical costs run in the billions, as do the costs of lost productivity.

With easy, convenient, and affordable access to safe immunizations for preventing the flu, employers across the country, especially in the healthcare industry, are taking a more proactive stance toward ensuring employee compliance. Some companies are shooting for 100%compliance, launching educational campaigns, team competitions, rallies, and incentive options such as discounts and premiums. Others are taking a carrot and stick approach, linking employer contribution incentives to medical savings accounts. Others are just wielding the stick, insisting that employees receive a flu vaccination as a condition of employment, with exceptions for those who have legitimate religious concerns or allergies to the vaccination.

Recognizing the central role businesses and employers play in protecting the health and safety of their employees, the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) have produced materials intended to guide employers in their planning and preparedness for seasonal and pandemic influenza. The guidance is intended to help employers take actions to decrease influenza spread, maintain business continuity, and secure critical infrastructure. OSHA recommends that employers prioritize vaccination because it is a long-term and effective intervention that reduces reliance on employee behavioral changes such as hand hygiene and respiratory etiquette.

As far back as February of 2010, the Advisory Committee for Immunization Practices (ACIP) released their provisional recommendation that all people six months of age or older receive an annual influenza vaccination, unless contraindicated. The CDC also recommends that employers encourage employees to seek vaccination against both seasonal and pandemic influenza, offer influenza vaccination opportunities at their worksite or consider allowing employees time off from work to seek vaccination.

Despite the potential benefits of vaccination, self-reports within the National Health Interview Survey suggest that vaccine coverage among healthy adults 18 to 49 years is only approximately 20%. Offering vaccination in the workplace could increase coverage by making vaccination more convenient, and reducing or eliminating the associated cost may further improve influenza vaccine participation.

Studies have shown that individuals who received influenza vaccine at work cited convenience as an important factor in the decision to be vaccinated. Following physicians’ offices, workplaces are the most common location to receive an influenza vaccination, with one-third of 18- to 49-year-old vaccine recipients and one-fifth of 50 to 64-year-old vaccine recipients receiving the vaccine at work. The addition of workplace education programs can provide information and alleviate employees’ concerns and misinformation about influenza vaccination.

Compliance and the law

More and more healthcare employers are requiring that all employees get the influenza vaccine in order to help protect patients and coworkers during flu season. This trend has resulted in questions pertaining to the legality of such policies, as well as how to properly implement a mandatory influenza vaccination policy for employees. Employers may adopt mandatory flu shot policies which are drafted and implemented in a legally compliant manner.

As a condition of employment, an employer may require that all employees receive a flu shot. However, an employer’s compulsory flu shot policy must provide for exemptions in order to comply with various laws regulating the employer/employee relationship. For example, if an employee with a physical or mental disability refuses a flu shot, the employer may have to make a reasonable accommodation in order to comply with the federal Americans with Disabilities Act (ADA). A reasonable accommodation could take the form of exempting the employee from the requirement and instead requiring a different protective measure, such as wearing a surgical mask. Similarly, if an employee objects due to a sincerely held religious belief, the employer may also have to provide a reasonable accommodation, unless doing so would impose an undue hardship on the employer.

If an employee refuses to comply with the employer’s policy and/or any reasonable alternative protective measures required by the employer if an exemption is granted, an at-will employer may pursue disciplinary action which could include termination. Employers should consult knowledgeable legal counsel before making employment-based decisions.

Employers wishing to require flu shots should adopt a written flu shot policy so that all employees have reasonable advance notice that receiving an annual influenza vaccination is a condition of employment. The policy should set an annual compliance deadline based on the anticipated start of the flu season and outline consequences for noncompliance. For instance, the policy may list the steps triggered by noncompliance, such as a written warning, suspension, and termination if the noncompliance is not addressed within a certain time frame. The policy should also specify what written documentation the employee must furnish the employer to prove that the employee was vaccinated.

An Employer’s Policy Should Include Exemptions

An employer’s influenza vaccination policy should provide a process for employees to request an exemption from the employer. Additionally, the policy should notify employees that if the employer grants an exemption, employees are required to comply, as a condition of employment, with reasonable alternative protective measures specified by the employer.
Exemptions should be allowed for reasons such as

  • A sincerely held religious belief or creed;
  • A qualifying physical or mental disability;
  • A prior severe allergic reaction to the flu shot;
  • A history of Guillain-Barré Syndrome; or
  • Some other relevant medical reason.

Ultimately, educating employees about the benefits and importance of the flu shot may help maximize employee participation. Just like frequent hand washing, the flu shot is an important protective measure for employees and their families. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers get vaccinated annually against influenza. The CDC has a variety of resources related to influenza vaccination  that may be helpful to employers and employees, especially those in the healthcare field.


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!