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In the Loop 
Issue 260 - December 30, 2020

Hypertension (High Blood Pressure)
 
The number one most Googled health question in 2019 was “How do I lower my blood pressure?” According to Hypertension Canada, over 7.2 million Canadians have hypertension, and 7.5 million more have high blood pressure that will lead to hypertension without preventative action. Globally, hypertension is the leading preventable cause of death and disability. 

Blood pressure is the measurement of the pressure or force of blood pushing against blood vessel walls. Hypertension occurs when the blood pressure in your arteries rises and is consistently too high (think of overfilling a balloon or tire with air), making your heart work harder than normal to pump blood through the blood vessel. This can damage your blood vessels and cause health problems. Anyone can develop high blood pressure, but it becomes more common as you get older. Because having high blood pressure does not have obvious symptoms most of the time, it is important to monitor your blood pressure regularly at home with a home monitor, at your local pharmacy or at your doctor’s office. How often should you monitor? The Heart and Stroke website suggests following the recommendation of your family doctor or health care professional regarding the frequency of monitoring. If you monitor your blood pressure at home, it is very important to ensure you are doing this accurately. A video provided by Heart and Stroke discusses how to measure your own blood pressure. If you are looking to purchase a home monitor, visit the Hypertension Canada website for recommendations.

Managing your blood pressure is important since high blood pressure is the number one risk factor for stroke and a major risk factor for heart disease, and it can also lead to dementia and kidney disease.
 
Risk factors for high blood pressure
Some risk factors cannot be controlled such as age, ethnicity/genetics, and gender. There are, however, several lifestyle changes you can make that can help manage your blood pressure and reduce the need to take medication. Hypertension has the distinction of being the leading preventable cause of death and disability around the world. 
  • Follow a healthful diet - a diet like the DASH diet (Dietary Approaches to Stop Hypertension has been shown to improve blood pressure) or Mediterranean diet focus on fruits, vegetables, whole grains, low-fat dairy, low fat, and low cholesterol, lean meats, poultry, fish, and nuts. This pattern of eating is high in protein and fibre, and limits or eliminates sugary drinks, sweets, and red meats.
  • Manage your weight - the Heart and Stroke website indicates that weight loss of 5 to 10 percent can reduce blood pressure along with reducing the risk of having a stroke or heart attack. Also, be aware of your waist circumference. For men, you want a circumference less than 40 inches, and for women, a circumference of fewer than 35 inches.
  • Exercise regularly - follow the recommendations for physical activity i.e., 150 minutes of moderate-to-vigorous physical activity per week. You want to make your heart and lungs work a little harder. The Heart and Stroke website reminds people to speak with their family doctor or other healthcare professional before starting a physical activity program.
  • Watch your salt (sodium) intake - according to Hypertension Canada, reducing your salt intake is one of the best ways to help curb your blood pressure, especially if you have been diagnosed with hypertension. Salt (sodium) makes the body retain water and this extra water increases blood pressure. Heart and Stroke recommend that people with hypertension eat less than 2,000 mg of sodium per day, and for people without high blood pressure, eat less than 2,300 mg a day (or about 1 teaspoon) from processed foods and salt added while preparing food and salting food at the table. Processed foods include hot dogs, deli meats, fast foods, prepared meals, canned and dried soups, bottled dressings, packaged sauces, condiments, and salty snacks. Also, limit the salt added when preparing food and at the table. Be aware of sources of sodium by reading food labels, but better yet have whole foods that don’t have labels. When looking at labels, choose products with less than or equal to 5 percent daily value of sodium.
  • Ensure you get enough potassium - if someone is lacking potassium, it makes it more likely for them to have higher blood pressure. Aim for 3000 to 5000 mg a day. Examples of potassium sources include a medium banana at 420 mg. If you have kidney disease or you are on certain medications that interact with potassium, you have to watch your potassium intake so speak with a dietitian.
  • Manage stress - especially if you use alcohol, smoke, are sedentary, or eat unhealthy foods to cope with stress. Turn to healthy stress management techniques such as meditation, breathing and yoga. Take time for yourself. Don’t forget the importance of socializing and laughter.
  • Avoid excessive alcohol consumption - this can raise blood pressure by several points. Excess alcohol can increase blood pressure as well as lessen the effectiveness of blood pressure medications. Follow the Canadian Low-Risk Alcohol Guidelines. Hypertension Canada reports that consuming no more than 2 drinks per day can potentially drop your systolic blood pressure by 3.9 mmHg and diastolic blood pressure by 2.4 mmHg.
  • Quit smoking - this habit can increase blood pressure and increase the risk of a heart attack. Smoking damages the blood vessels’ lining and makes it harder for the blood vessels to relax. Like alcohol, smoking can affect how well blood pressure medications work. As well, minimize exposure to second-hand smoke.
  • Be mindful of your caffeine intake - if you do not regularly drink caffeinated beverages, doing so can cause a spike in blood pressure. WebMD points out that with the exception of people sensitive to caffeine and their blood pressure doesn’t go down, limiting caffeine is not required to avoid developing high blood pressure. Speak with your doctor regarding caffeine limits.  The Unlockfood website recommends safe amounts of caffeine as being no more than 400 mg per day for men and women 19 years of age and older, and 300 mg for pregnant and breastfeeding women.
  • Get adequate sleep - blood pressure lowers when you get adequate sleep. WebMD describes adequate sleep as having at least 7 hours of sleep, falling asleep within 30 minutes, waking up no more than once, and falling back to sleep quickly upon awakening during the night.
  • Manage other health conditions - such as diabetes (many people with diabetes also have high blood pressure), high cholesterol, sleep apnea, and thyroid disorders.
Taking your blood pressure
The Heart and Stroke website explains that you cannot determine your blood pressure reading based on just one reading; rather, you need to repeat the process two more times on separate days to see if it remains high. They provide a tracking card for you to record your readings.
 
Knowing your numbers
Hypertension Canada says that the first step in understanding high blood pressure is to learn what numbers mean.
  • Systolic (the higher number) occurs when the heart contracts.
  • Diastolic (the lower number) occurs when your heart relaxes and fills with blood.
Blood pressure is measured using millimetres of mercury (mmHg), which is a standardized measurement of pressure. The higher the systolic or diastolic blood pressure, and the longer time it stays high, the greater the potential damage to blood vessels.

Heart and Stroke provide three blood pressure categories (but notes that there are some exceptions to these categories) and encourages people to find out which category applies to them:
  • Low risk is 120/80
  • Medium risk is 121-139/80-89
  • High risk is 140+/90 
Note: people with diabetes have a slightly lower high-risk category and should be less than 130/80.
 
Resources
  • Hypertension Canada website for the public and blood pressure log
  • Dietary Approaches to Stop Hypertension (DASH) Diet website 
Sources: Heart and Stroke website, Hypertension Canada website, Hypertension Canada website, WebMD website, Unlockfood website, American Heart Association website, Cleveland Clinic website
 


High Blood Pressure and Tai Chi

High blood pressure is a major risk factor for cardiovascular disease. A challenge of having high blood pressure is that you can have it without experiencing symptoms while damage occurs to the heart and blood vessels. Failure to control high blood pressure increases the risk of serious health problems such as heart attack and stroke.

The primary approach to addressing hypertension is through medications, but a non-pharmacological approach that can be used as an adjunct or add-on is tai chi. Previous research on the effect of tai chi has been mixed - some studies have shown a reduction in both systolic and diastolic blood pressure and improvement in quality of life, while others have reported conflicting results. Researchers in China published a meta-analysis (the study of studies) in March 2020 looking at the effect of tai chi on risk factors for cardiovascular disease (including blood pressure, blood glucose, and lipid profiles) and quality of life in adults with hypertension and analyzing the short- and long-term effects of each outcome indicator and quality of life.

Tai chi is an ancient Chinese practice focusing on physical flexibility and whole-body coordination. The Mayo Clinic explains that tai chi was introduced as a martial art for self-defense in 13th century China and has evolved into an exercise described as “meditation in motion.” It promotes serenity through constant and gentle flowing movements and is used to reduce stress and other health conditions.

The meta-analysis (a study of studies) included 15 randomized controlled trials from 2006 up to December 2018 with a total of 1453 patients with hypertension and 772 patients who performed tai chi. Practicing tai chi was associated with:
  • Lower systolic blood pressure (the top number, measures the force your heart exerts on the walls of your arteries each time it beats)
  • Lower diastolic blood pressure (the bottom number, measures the force your heart exerts on the walls of your arteries in between beats)
  • Better quality of life
  • Lower lipids (including total cholesterol, low-density lipoprotein-cholesterol (LDL) or “bad” cholesterol)
  • Low blood glucose
  • No effect on high-density lipoprotein-cholesterol (HDL) was found
The authors conclude that there is “reasonably strong evidence for the short-term efficacy of tai chi exercises,” but the evidence was of low to moderate quality and high in heterogeneity (interventions try to achieve the same result but they are different in nature).

Based on the review, the authors suggest that people with hypertension should consider tai chi as a way to better control cardiovascular disease risk factors and improve quality of life, but add that the evidence should be treated with “caution” because of the high heterogeneity and low quality of the studies. A limitation of the meta-analysis was that the studies used were from China, so the effectiveness found with this population may not apply outside of China. A lack of information prevents the authors from commenting on the long-term effectiveness of tai chi. Future research should look at the effect of tai chi exercises done over the long term, as well as consider the issue of adherence to the intervention.
 
Another benefit of tai chi is that it is an ideal activity for inactive older adults who want to increase their physical fitness gradually and gently. Movements can be adapted for persons with a disability or who are seated in a wheelchair. 

If you are interested in tai chi, the UK National Health Service advises people to get advice from their family doctor before starting if they have any health concerns or existing health conditions. People who may need to take certain precautions include pregnant women and people who have a hernia, back pain, or severe osteoporosis. Dr Ruth Taylor-Piliae of the University of Arizona, who conducts research on the psychological benefits of tai chi for people living with coronary heart disease, heart failure, hypertension, and stroke, cautions against learning the movements from scratch online because knee pain can result from incorrect foot placements. During COVID, she suggests that you research group-based tai chi classes so that you are ready to join when in-person classes become available again. 

Resource: Gentle Tai Chi and Qui Gong LEAP Service
This gentle exercise video combines tai chi and qi gong with a variety of adaptations to help make the routine safe and comfortable for you. Developed by the therapists in Toronto Rehab's LEAP Service (Living Engaged and Actively with Pain), this routine is great for starting a gentle exercise program at home. The video, which includes a disclaimer, can be viewed to see the different types of movements used in tai chi. 

Sources: Mayo Clinic website, Cochrane Training website, National Health Service (UK) website, Medical Xpress website
 
 


Reduce Sodium Intake   

The Dietitians of Canada Unlockfood website advises us to look for ways to reduce the salt added in cooking. The Canada Food Guide recommends preparing foods with little or no added salt. The World Health Organization (WHO) website reports that most people are consuming around twice the recommended maximum level of intake of salt (averaging 9 to 12 grams per day). About 70 to 80 percent of the salt we eat comes from highly processed foods, e.g., fast foods, prepared meals, processed meats (such as hot dogs and lunch meats), canned and dried soups, bottled dressing, packaged sauces, condiments, and salty snacks. 
 
What is sodium?
The Heart and Stroke website explains that sodium is a mineral found in food, table salt, and sea salt. All types of salt are high in sodium. The American Heart Association explains that while salt and sodium are often used interchangeably, they are not the same. Sodium, a mineral, is found in foods naturally and/or is added in processing. Table salt by weight is 40 percent sodium and 60 percent chloride. While the body needs some sodium, excess causes the body to retain fluid and this makes the heart work harder. A build-up of fluid can lead to swelling in the legs, feet, or belly. You can have difficulty breathing when fluid builds up in the lungs.  
 
How much salt?
The WHO recommends having less than 5 grams a day of salt for adults, with the greatest benefit of reducing blood pressure and also reducing the risk of cardiovascular disease, stroke, and coronary heart attack. The Unlockfood website indicates that healthy adults only need 1500 mg of sodium per day, and healthy children only need 1000 to 1500 mg of sodium per day, but people with health issues may need a lower amount based on the advice of their doctor.
 
Heart and Stroke reports that about one-third of people are sensitive to the sodium component of salt. Because generally, most people are eating too much salt, even people with normal blood pressure can benefit by reducing their salt intake. A startling statistic from the WHO is that reducing global salt consumption to the recommended level would save an estimated 2.5 million people from dying.
 
Salt is salt!
Be aware that salt is salt - table salt, sea salt, and kosher salt are different in how they are processed and their taste and texture, but they all contain 40 percent sodium by weight. Unlockfood points out that one teaspoon of salt is equal to 2300 mg of sodium. Dr. Suzanne Steinbaum, a cardiologist at the Mount Sinai Hospital, tells NBC News that salt “is not good for us, and sea salt is no more healthy than table salt in terms of its effect on blood pressure and heart health.” Here are examples of the sodium content in foods from the Canadian Nutrient File. Some of these may surprise you!
  • Salted mackerel (75 grams) = 3,337 mg of sodium
  • Bacon, turkey, cooked (2.5 oz) = 1,516 mg of sodium
  • Soy sauce (1 TBSP) = 1,244 mg of sodium
  • Processed cheese slice, cheddar (1.5 oz) = 907 mg of sodium
  • Chicken broth (1 cup) = 869 mg of sodium
  • Plain baked beans, canned (3/4 cup) = 644 mg of sodium
  • Canned tomato sauce (1/2 cup) = 614 mg of sodium
The American Heart Association lists the “Salty Six” or the top six sodium sources in the US as bread and rolls, pizza, sandwiches, cold cuts and cured meats, soups, and burritos, and tacos. Bread and rolls would probably not come to mind for most people as the top listed source of sodium, especially because they do not taste salty.   
Dr. Michael Roizen of the Sharecare website suggests a three-step process to reduce the salt - read, reduce, and season.

Read - check all labels before choosing foods 
  • Look for low-sodium versions of any item e.g., frozen, canned or jarred foods and sauces/condiments
  • When possible, choose fresh vegetables over canned vegetables
  • Check ingredient lists and Nutrition Fact tables and choose products with a sodium content of less than 15% DV (daily value). Choose foods that have less than 360 mg of sodium per serving.
Reduce - look for ways to reduce the sodium 
  • Canned foods e.g., vegetables - rinse before using to wash away some of the sodium or better yet, use fresh when possible
  • Canned beans, peas, and lentils - substitute the dry version that can be soaked ahead of time
  • Broth - make your own using fresh or dried herbs, onions, and garlic, onion, or celery powder, or choose low-sodium, sodium-reduced, or no-sodium versions. Remember that fresh herbs can be washed, chopped, and frozen for later use.
  • Boiling water for pasta or rice - don’t add salt to the water
  • Flavour packets - do your own seasoning instead of using the high sodium flavour packets e.g., pasta, noodles, rice, and taco kits. For example, one package of instant noodles has 1,040 mg of sodium.
  • Condiments - reduce the amount of condiments such as soya sauce or ketchup for recipes. Better yet, make your own condiments using seasonings such as garlic, onion, or celery powders.
  • Meat and fish - choose fresh meat or fish over-processed, pressed, cured or canned.  
  • Tomato sauce - make your own using 1 can (156 mL) tomato paste and 1 and 1/3 cups (300 mL) of water to make 2 cups of sauce. To add flavour, use garlic, onion, basil, carrots and celery.
  • Butter/margarine - choose unsalted versions or use oil.
  • Eating out - check the nutrient information on the menu so that you can choose items lower in sodium. Restaurant meals and fast food are higher in sodium compared to foods prepared at home. 
When following recipes, try using less sodium, except in baking, as salt can be crucial in the chemistry of the recipe e.g., salt controls yeast growth. Kathleen Purvis, a Lifestyle writer for the Seattle Times, points out that there is such a small amount of salt in baked goods that taking it out won’t remove that much sodium from the diet. As salt enhances flavour, you could end up eating more. The biggest bang for the buck is to focus on reducing the consumption of processed foods.

Season - get creative to add flavour without turning to the salt shaker
  • Add flavour by using fresh herbs or salt-free spices.
  • Instead of high salt condiments such as ketchup, barbeque sauce, and soy sauce, try oils infused with herbs or citrus, a mashed up avocado, or balsamic, red, or white vinegar.
  • Make your own salad dressings.
  • Use onions, mushrooms, garlic, and peppers to season meats or vegetables.
  • Use vegetables in sandwiches instead of high salt pickles or olives.
Resources Sources: Sharecare website, Unlockfood website, World Health Organization website, Cleveland Clinic website, NBC News website, Heart and Stroke website, Heart and Stroke website, HealthLink BC website, HealthLink BC website, American Heart Association website, Seattle Times website
 

 


Chili Peppers 

Experimental and small sample studies have established that the bioactive components of spices can play a role in the prevention and treatment of chronic health conditions. The evidence base, however, is limited on the association of spice consumption, and chili peppers in particular, and mortality. A 2015 study carried out by Chinese researchers Jun Lv and colleagues examined the associations between the regular consumption of spicy foods and total and cause-specific mortality. Participants included 199,293 men and 299,082 women between the ages of 30 and 79 at the beginning of the study (baseline).  Participants with cancer, heart disease and stroke were excluded. At baseline, participants reported how often they ate spicy foods. Chili peppers are one of the most popular spices in the Chinese diet. At the conclusion of the study, the level of spicy food consumption showed highly consistent inverse associations with total mortality for both men and women after adjusting for known or potential risk factors (i.e., an association where the more spicy food, the less mortality)

Another study, published in 2017 in the journal Plos One, was conducted by researchers at the University of Vermont’s Larner College of Medicine. The researchers found a 13 percent reduction in total mortality, mostly in deaths from heart disease or stroke, when comparing people who ate red hot chili peppers to those who did not. This was a large prospective study with more than 16,000 Americans followed for up to 23 years. The authors concluded that hot red chili peppers may be a beneficial component of the diet and that the chemical compound in chili peppers, capsaicin, could possibly be responsible for health benefits.

A 2019 study, published in the Journal of the American College of Cardiology, set out to examine the association between chili pepper consumption and the risk of death. Participants were adults living in Italy. The researchers also wanted to account for the biological mediators of the association. Longitudinal analysis was performed on 22,811 men and women enrolled in the Moli-sani Study cohort (2005 to 2010). The conclusion was that regular consumption of chili pepper is associated with a lower risk of total and cardiovascular disease death independent of cardiovascular disease risk factors or adherence to a Mediterranean diet.

Recently, a team of researchers looked at chili peppers and the risk of death from heart disease, cancer and other conditions.  The study reviewed the health and dietary records of a large sample of more than 570,000 participants taken from 4,728 studies conducted in the US, Iran, China and Italy. Health outcomes were compared among people who ate chili peppers to those who rarely or never ate them. The results from this preliminary research were shared at the American Heart Association’s Scientific Sessions 2020 in November, 2020. The findings included: 
  • People who ate chili peppers had a 26 percent reduction in death from heart-related causes, a 23 percent reduction in death from cancer, and a 25 percent reduction in all-cause mortality (death from all causes) during the study period.
  • Despite the four countries having different diets and cultural practices, similar trends were seen for the association of chili peppers and mortality.
Dr. Bo Xu, a cardiologist at the Cleveland Clinic’s Heart, Vascular & Thoracic Institute and senior study author, stated in an American Heart Association press release, “We were surprised to find that in these previously published studies, regular consumption of chili pepper was associated with an overall risk-reduction of all cause, CVD and cancer mortality. It highlights that dietary factors may play an important role in overall health.”

What might be responsible for the effect of chili peppers? Researchers believe the chemical capsaicin, which gives chili peppers their mild to intense flavour, may play a role. Dr. Bo Xu says further research, and especially evidence from randomized controlled trials, is needed to confirm the preliminary findings. He added that the exact reasons and mechanisms are currently unknown. At this time, they cannot “conclusively say that eating more chili pepper can prolong life and reduce deaths, especially from cardiovascular factors or cancer.”

How might capsaicin play a role? Past research has shown an effect of capsaicin on the growth of cancer cells and this may contribute to the reduction in death from cancer and all causes. Other features of chili peppers that may have health benefits include its potassium, fibre, and vitamins A, B6 and E content, all of which can help with blood pressure. Chili peppers could represent a flavour alternative to salt, which is consumed in excess by Americans and Asians. The negative side of chili peppers is that too much can cause nausea, vomiting, diarrhea and a burning feeling in the gastrointestinal tract, according to Penny Kris-Etherton, a Pennsylvania State University professor of nutrition who shared her comments about the study to WebMD.

A limitation of the study was that the type of and amount of chili pepper varied among the studies, impeding the researchers’ ability to determine how much, how often and which type of chili pepper may be associated with health benefits. Another limitation was that the studies had little specific health data on individuals or other factors that may have impacted results. More research is needed before chili peppers can be added to dietary guidelines. The researchers are planning further analysis and hope to publish a full paper in the near future.

Your diet and heart health
Dr. Xu encourages people to eat a Mediterranean diet which focuses on fruits, vegetables, nuts, protein, fish and olive oil. 

Using chili peppers
Chili peppers come in a variety of sizes, shapes, colours and ranges of heat from mild to extremely hot depending on the capsaicin content which is measured in Scoville units. A Scoville unit is the number of times a sample of dissolved dried chili must be diluted by its own weight in sugar water before it loses its heat. When choosing peppers, the bigger the pepper generally means  less heat. Registered Dietitian Leslie Beck suggests choosing vibrantly coloured and firm peppers without soft spots. Look for hardy and fresh stems. For storage, use a vegetable drawer in the fridge. The Healthiest Foods website suggests wrapping peppers in a paper towel or placing them in a paper bag prior to refrigeration. Removing the seeds will reduce the heat, while cooking or freezing peppers will not. If you find a pepper is too hot, avoid drinking water and instead drink milk or eat some rice or a piece of bread. The World’s Healthiest Foods website provides some tips for preparing chili peppers:
  • Capsaicin is found mostly in the seeds and fleshy white inner membranes of the pepper.
  • Handle chili peppers with care since the capsaicin can give a severe burning sensation on your skin, lips and eyes. You may want to wear thin rubber gloves or ensure that you wash your hands thoroughly after touching them, as well as your knife and cutting board.
  • Be careful when adding chili peppers to a recipe. Overdoing peppers can cause heartburn by increasing gastric acid.
Penn State University Penn Medicine website reminds us to choose healthy spicy foods because choosing fast foods with peppers and high fat can cancel out many of the benefits of the peppers. Chili peppers can be added to a stir-fry, omelette, or guacamole.

Chili peppers are not for everyone. Atli Arnarson, PhD and writer for the Healthline website, reports that these peppers can cause abdominal pain, a burning sensation in your gut, cramps and painful diarrhea, especially for people with irritable bowel syndrome (IBS). Individuals who experience digestive problems when eating chili peppers would be advised to avoid them.

Sources: WebMD website, American Heart Association website, Today's Dietitian website, Penn Medicine website, Science Daily website, The World's Healthiest Foods website, Leslie Beck, RD website, Healthline website, BBC website, Medical News Today website
 

 


Anniversary Reaction of Grief

Grief is defined by the University Health Network in Toronto as “a personal reaction to loss. It is the body’s way of responding to the loss of someone we have loved or cared for.” Grieving is defined as “how we move through the experience of significant and intense losses.”

The emotions you can experience include feeling numb, alone, anxious or worried, angry, guilt, sad (crying spells), depressed, confused, relieved, irritable, frustrated, and hopeless. You may be disinterested in usual activities. Physically you can feel exhausted, have aches and pains, nausea, and an upset stomach. You can have trouble sleeping, changes in appetite, difficulty with decision making, lowered immunity, and find it hard to believe the person you love is gone. You may also dream or see images of your loved one.

Amy Morin, a writer for Psychology Today, a psychotherapist and internationally recognized expert on mental strength, summarizes the process of grief - “Time doesn’t heal the pain associated with a loss; it’s what you do with that time that matters. Grief is a process by which you heal.”

The Mayo Clinic explains that an “anniversary reaction” is grief that returns on special days/events during the year e.g., Christmas and other holidays, birthdays, and the anniversary of a person’s death. These occasions can exacerbate our sense of loss and sorrow, especially during the trying times of living with a pandemic. Loss can come not only with death, but also with the loss of a spouse through divorce or loss of a relationship, friendship or a pet. In fact, grief can stem from any form of loss including the loss of health, employment or a dream, or from changes such as retirement, selling a home, or changing jobs.   

Facts about grief
  • Having an anniversary reaction to grief is normal
  • Grief is a personal experience that affects people differently. Each person has their own path.
  • There is no “normal” or “perfect” or right and wrong way to respond to the loss of your loved one. No one can tell you how to grieve or how long it will take. Victoria Hospice states, “It [grief] is a journey with its own timeline.”
  • Reactions of grief can last from days to much longer. There is no time limit to grieving. The course of grief is unpredictable. Generally, over time, feelings of grief will surface less often and with less intensity.
  • The course of grieving is like a roller coaster with good and bad days. A wave of grief can come from reminders or for no reason at all.
  • An anniversary reaction triggers the same emotions as those first experienced when the loss occurred.
How to deal with anniversary reactions
The message from the Mayo Clinic is to prepare for reminders of the loss. Amy Goyer, a writer for AARP, reminds us that there is no one right way to get through the occasion (a day, week or season). Choose to get through it in a healthy way that is comfortable for you. Steps you can take to address anniversary reactions include:
  • Do what feels right for you. Do not feel obligated to participate in activities. You may choose activities that are distractions e.g., connecting with others via phone or internet, watching a movie or going for a walk.  Kenneth Doka of the Hospice Foundation of America speaks about the three C’s of coping with holidays: choose, communicate, and compromise. The “choose” means that you choose what activities you want to do and with whom. This also involves communicating, because our choices affect others and they also have needs. If you turn down an invitation, it is important to communicate with those involved. If a family is making decisions on what to do during special dates, compromise comes into play, because when we communicate our needs and feelings, we may find that different family members will differ in the way that they cope. You have the right to leave an event (during COVID-19, this would be a virtual event). Be honest about what you are comfortable doing.
  • Skip the occasion. You may choose to avoid the occasion altogether and simply opt out.
  • Be prepared and anticipate how you will feel so that you can take the opportunity to heal. Accept what you are feeling. Amy Morin states, “Experiencing the pain - rather than constantly trying to escape it - can actually help you feel better in the long term.” Victoria Hospice suggests allowing a place in your life for grief - plan restorative time alone or with others who support you.
  • The anticipation of an anniversary reaction can be worse than the actual anniversary. Planning ahead can help curb the dread and give you something to look forward to.
  • Remember your loved one and focus on the positive memories rather than the loss. Write down good memories or write a letter to the person.
  • Because an annual tradition may never be the same after the loss of your loved one, consider making new traditions to recognize and acknowledge the loss of your loved one in a positive way e.g., light a candle in honour of your loved one, plant a tree, or set a place at the table for your loved one. It is your choice on how to “mark” the loss during the holidays, a birthday or the anniversary of the death of a loved one.
  • Seek social support - surround yourself with a “positive circle” made from your trusted and close friends and loved ones. Find someone who will encourage you to talk about loss. Continue your social connections such as church, social groups or a bereavement support group.
  • Be okay with not being okay - feel the emotions, and allow yourself to feel a sense of loss and joy/happiness. Be aware of the signs of depression, anxiety or complicated grief (grief that interferes with daily functioning).
  • Take time to take care of yourself by eating in a healthful way, getting adequate sleep, and keeping up exercise which is an excellent way to manage stress. Do activities that you like such as reading, walking or exercising.
  • Practice self-compassion. Psychologists Rebecca Schrag Hershberg and Yale Schonbrun explain that self-compassion means treating yourself with kindness, tapping into a sense of common humanity and making space for emotions, thoughts and experiences including negative experiences. While self-compassion cannot take pain away, it can help us manage it more skillfully.
  • Give to others as a way to counter feelings of loss. Amy Goyer notes, “Taking action that makes a difference can help widen our perspectives.” You can make a donation in memory of your loved one to a charity that was meaningful to them, or virtually volunteer to help others.
When to seek help
You may need to seek help for your grief if you experience complicated grief - a psychological condition characterized by long-term and very intense grief that prevents you from functioning day-to-day and worsens rather than improves over time. Untreated grief can lead to depression and other mental and physical health conditions. Talk to your doctor about any physical issues you may be experiencing. Other health professionals who can provide support include counsellors, therapists, or grief organizations that provide services by phone.  

Resources
  • BC Bereavement Helpline - this non-profit organization provides free and confidential services that connects the public to grief support services in BC e.g., bereavement support groups, agencies, and peer-based support. The website also provides resources and support materials. You can call between 9 am to 5 pm Monday to Friday at 604-738-9950 or toll-free 1-877-779-2223.
  • MyGrief.ca - a website provided by the Canadian Virtual Hospice. This online resource helps people work through their grief from the comfort of their own home, at their own pace. It was developed by family members who’ve “been there,” and grief experts to complement existing community resources and help address the lack of grief services particularly in rural and remote areas. It is also an education tool for health providers. Funding was provided by the Canadian Partnership Against Cancer. MyGrief.ca can help you understand your grief and resolve some of the most difficult questions that may arise. This site is not a substitute for professional counselling or other health services. There are nine sections with text and videos.
  • Victoria Hospice Grief: Special Days and Holidays book provides guidance on navigating an anniversary reaction 
Sources: Mayo Clinic website, Psychology Today website, HelpGuide website, Delta Hospice Society website, Delta Hospice Society handout, University Health Network Grief, Bereavement and Loss booklet, Greater Good magazine website, AARP website, Baylor College of Medicine website
 

 
 


Get Connected, Stay Healthy 

During COVID-19 restrictions, people may be feeling isolated, especially people living with chronic health conditions who are at increased risk of severe illness from the virus. Extensive research has shown a link between social isolation/loneliness and poor mental health. While sheltering at home, you can still connect with others and gain knowledge, skills and confidence to live a healthy life by participating in one of University of Victoria - Self-Management BC’s free self-management programs. These programs are offered in a variety of formats:

  • Tool Kit for Active Living (Chronic Conditions, Chronic Pain and Diabetes) - a one-time mailing of materials for independent learning
  • Tool Kit for Active Living Plus Calls (Chronic Conditions, Chronic Pain, and Diabetes) - receive the one time mailing with six 45-minute small group sessions using your telephone or internet connection
  • Better Choices, Better Health® Chronic Conditions Online program - a self-paced web-based program with a time commitment of 1 to 2 hours per week.
  • Health Coach Program - receive telephone support once a week for a period of three months 

Start connecting and stay healthy in 2021 by calling toll-free 1-866-902-3767, by emailing selfmgmt@uvic.ca or visiting www.selfmanagementbc.ca.

 


COVID-19 Questions?

Do you have questions about COVID-19? The Canadian Medical Association, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada provide a website called "Questions and Answers on COVID-19." A long list of answers are provided and if you cannot find the answer you are looking for, you can submit a question. The website has a disclaimer: "All content is sourced from reputable organizations and is for information only and not a substitute for medical advice." The website is available at https://covidquestions.ca.
 

Please send your ideas and suggestions to theloop@uvic.ca.


Self-Management BC is supported and funded through a partnership with the Patients as Partners Initiative within the BC Ministry of Health.
 
IMPORTANT DISCLAIMER
This information and research are intended to be reliable, but accuracy cannot be guaranteed. All material in this e-newsletter is provided for information only, and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this e-newsletter. Readers should consult their doctor or another qualified health professional on any matter relating to their health and well-being. The information and opinions provided in this e-newsletter are believed to be accurate and sound, based on the best judgment available to the authors. Readers who fail to consult with appropriate health authorities assume the risk of any injuries. The publisher, Self-Management BC, is not responsible for any errors or omissions. Self-Management BC is not responsible for the information in these articles or for any content included in this article which is intended as a guide only and should not be used as a substitute to seeking professional advice from either your doctor or a registered specialist for yourself or anyone else. 
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