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Environment Public Health

Something fishy going on…

Researchers at the University of Buffalo have discovered that human antidepressants and their breakdown products are building up in the brains of fish in the Niagra River that flows between Lake Erie and Lake Ontario. Researchers at two universities in Thailand have confirmed these results.

The researchers started out by looking for a variety of chemicals that are in human medications and personal care products. They checked the organs and muscles of 10 species of fish, and antidepressants stood out as the major problem. All 10 species they checked had detectable levels of these drugs.

How is this happening?

The drugs they found: Zoloft, Celexa, Prozac and Sarafem, are widely used in both US and Canada. Usage increased by 65% between 1999 and 2014, according to the US National Center for Health Statistics. The drugs people take do not magically disappear – a significant amount passes out of the body through the urine, sometimes intact and sometimes changed to a slightly different form that may be more or less active than the original drug. Water treatment systems do not remove these drugs, allowing them to flow into lakes and rivers where the fish live, along with treated waste water.

Worse, levels of antidepressants found in fish brains were several times higher than the concentration in the water, suggesting that the drugs are accumulating in fish over time. When fish are exposed to a drug but cannot break it down or clear it from their bodies, this can result in gradually increasing amounts being stored…in this case, in the fish’s brains.

The species tested were smallmouth bass, largemouth bass, rudd, rock bass, white bass, white perch, walleye, bowfin, steelhead and yellow perch. The rock bass had the highest concentrations of antidepressants, but several fish had a variety of drugs in their bodies and all 10 species tested were found to have some level of antidepressants.

What about humans?

The good news (if you can call it that…) is that we don’t eat fish brains, so this is unlikely to affect humans. But what about the fish? It is not yet known how these drugs might affect their health and behaviour, but other studies suggest they can affect feeding behaviour or survival instincts (for example, not noticing predators as readily).

However, if your drinking water originally comes from a lake or river, chances are you’re being exposed to a low-level cocktail of drugs, too. Many experts have felt that the drug levels in drinking water, being much lower than a person would take as treatment, could not have a significant effect. However, no one really knows whether a mixture of many active drugs, consumed at low levels over a lifetime, is a risk to people’s health.

A group of researchers found drug levels high enough to be “of environmental concern” in the Great Lakes and Minnesota River that included traces of acetaminophen (Tylenol), codeine, antibiotics, hormones, steroids, anti-epileptic drugs and dozens of other chemicals.

Health Canada reportedly found traces of drugs in samples of drinking water that came from lakes and rivers across Canada. Their report has not yet been published but was described in an article on cbc.ca website.

Some experts particularly worry about effects on the hormone and immune systems. Researchers have discussed a possible link between hormones from birth control pills that end up in the environment and increased risk of prostate cancer. Other compounds with estrogen-like activity, such as certain pesticides likely add to this risk.Scientists have already proven that these chemicals are creating “intersex” fish – male fish who have developed eggs in their testicles – putting the survival of certain species at risk in some waterways.

What can we do about it?

Wastewater treatment plants focus on killing disease-causing bacteria and removing solid matter, nitrogen, phosphorus and dissolved organic carbons. However, they pay little or no attention to drugs, hormones and chemicals that might be in human urine. Fish, especially those who live near sewage outlets, are being exposed to a cocktail of drugs 24 hours a day and it is not known whether humans exposed to a low level mixture of active drugs could be affected…

Its time to upgrade our sewage treatment systems and find ways to remove these chemicals from waste water, preventing their release into the environment. Treatment of waste water needs to be improved! Make your voice heard – ask for improvements to the waste treatment systems in your area.

Reference articles:

http://www.cbc.ca/news/technology/human-antidepressants-building-up-in-brains-of-fish-in-niagara-river-1.4274735

http://www.cbc.ca/news/health/drinking-water-contaminated-by-excreted-drugs-a-growing-concern-1.2772289

Categories
Health and Beauty

8 Ways to Keep Your Skin Younger and Healthier

Your genes will always have some influence on skin getting drier and thinner regardless of what you do, but there are preventive actions you can take to slow the effects of “extrinsic” aging, the aging caused by factors outside your body… limiting the effects of environment and making the best lifestyle choices for healthy skin!

Here are 8 ways to help keep your skin as healthy and youthful as possible:

  1. Protect your skin from the sun every day – sun or cloud, winter or summer.

    1. UVB rays result in a tan or sunburn and are largely blocked by cloud, while UVA rays can often pass through cloud or glass damaging skin without causing a visible burn or tan.

    2. Use a cream or lotion daily that contains SPF 15 to 30, depending on the sensitivity of your skin to sunlight, plus an effective UVA blocker (Note that “SPF” refers to effects on UVB rays only). Apply daily to your face and hands – the most exposed areas of the body.

    3. Wear a wide-brimmed hat to further reduce sun exposure to the face and neck.

    4. Like a tanned look? Try a self-tanner – they’re much improved from earlier versions, giving a more natural skin tone and won’t damage your skin.

    5. Avoid tanning beds and lamps – they also cause skin damage and aging.

    6. Remember the sun is strongest between 10am and 3pm, and you will need greater protection during these hours.

  2. If you smoke – stop!

    1. Toxins in cigarette smoke speed skin aging.

    2. Smoking can cause a dull, sallow complexion and decreased blood flow to the face resulting in less healthy skin.

    3. Preventing aging is yet another good reason to quit!

  3. Pay attention to your facial expressions – especially frowning…

    1. Repeated frowning, squinting or pursing of lips creates skin folds or lines that eventually become permanent.

    2. Watch for lines that indicate facial muscles you frequently use:

      1. Between brows – frowning

      2. “Crows’ feet” at corners of eyes – squinting (wear sunglasses to reduce this)

      3. Lines radiating from your mouth – pursing lips

    3. Smiling uses far fewer facial muscles, so avoids potential lines and wrinkles…and brightens your day and that of everyone around you at the same time!

  4. Eat a healthy diet

    1. Fresh fruit and veggies provide nutrients needed for healthy skin:

      1. Vitamin C is needed to form collagen, part of the support structure of skin.

      2. Vitamins E, A and Biotin (a B vitamin) are also important for skin.

      3. 5 to 7 servings of fruit and vegetables daily will generally provide enough of these nutrients to help keep skin healthy (although a new study suggests that 3 to 4 servings may be adequate for maximum health benefit – stay tuned for recommended dietary changes in the future!).

  5. Limit Alcohol – Alcohol is reported to dehydrate skin, making it look more aged.

    1. Avoid binge drinking, drink only in moderation (1 to 2 drinks per day), and keep hydrated by drinking water along with alcohol.

      1. A guideline could be one glass of water for each drink, for example.

  6. Exercise on most days

    1. Exercise boosts circulation and immune function throughout the body, including the skin

    2. Incorporate activity into your daily routine.

      1. It may give your skin a more youthful appearance.

      2. And, being fit looks good at any age!

  7. Cleanse skin

    1. Many references suggest cleansing gently but thoroughly to remove makeup, sweat and bacteria without irritating skin.

    2. However, exfoliating (gently removing the outer layer of dead skin cells) has long been used to give skin a fresher, smoother surface.

      1. Exfoliating before applying a moisturizer may help the moisture to penetrate the skin more readily.

      2. Author’s note: I have used a “buff puff” type sponge to cleanse daily for many years with good success, originally to keep pores open to prevent blemishes, but I continued to use it for its exfoliiant action. This might not be an option, however, for those with very sensitive skin, although “gentle” versions are available.

  8. Apply a facial moisturizer every day.

    1. Even an inexpensive facial moisturizer will help maintain hydration of the skin, giving a more youthful appearance.

    2. Using a moisturizer with sunscreen added can simplify your skincare regimen — 2 steps in one!

    3. Drinking water regularly also helps keep skin hydrated. Avoid bottles or straws that cause you to “pucker up” your mouth when drinking (see #3!)

Having compounded cosmetics for several years in my pharmacy, I have a few “favourite” skin ingredients:

  • DMAE – helps to tighten the tiny muscles that support the skin temporarily (12-24 hours)

  • Glycolic Acid – help loosen dead skin cells on the surface of the skin, creating a smoother surface (not recommended for those with sensitive skin, and use with caution in eye area)

  • Lipoic Acid – reported to help improve dark circles under the eyes

  • Vitamin C Ester – helps with collagen formation to prevent thinning of the skin (the ester form is better in creams as it can pass through skin easier and is less irritating than plain vitamin C)

These are inexpensive ingredients, so you can likely find reasonably-priced creams containing some of these.

Keep in mind that sun exposure is considered the greatest avoidable cause of skin aging and damage. Brown “age” spots (also referred to as “liver” spots) are a visible indication of sun damage. If numerous spots appear, ask for an assessment by a dermatologist. These spots can be removed with a prescription strength peeling agent targeted to the damaged area – ask your doctor!

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Public Health

Is it the chicken or the egg?

So, I’ve arrived in Spain…picking up a few groceries, and I can’t find the eggs… I’ve checked every cooler… “Donde estan los huevos?” Where are the eggs?

Well, for heaven’s sake, they’re stacked up in the middle of the aisle! Not in a cooler? Strange. Wouldn’t they go bad? I had to investigate why eggs must be refrigerated at home but not in Europe… after all, the chickens and eggs are not any different in North America!

Here is what I learned:

In North America, eggs are cooled right after laying to about 7C (40F), washed, and then sprayed with a chemical sanitizer to kill bacteria. Once chilled, eggs should not be left out of refrigeration for more than 2 hours as the condensation that forms on the shell will provide a place for bacteria to grow.

In Europe, it is unlawful to wash eggs because this is believed to damage the outside layer of the shell (the “cuticle”), allowing bacteria to penetrate the egg more easily.

But Europe has also required farmers to vaccinate their hens since 1997 when thousands of people became ill from salmonella bacteria. This has lead to a rapid decline in cases of salmonella in Europe.

In North America, farmers are not required to vaccinate chickens, although some do. In 2010, the US FDA said it would not legally require vaccine use as “there was not enough evidence to conclude that vaccinating hens against salmonella would prevent people from getting sick”, according to a report in the New York Times.

Instead, North American governments have regulations requiring regular testing for salmonella, refrigeration standards, and strict sanitary codes in place to control the threat of salmonella infection. While it makes sense to have such standards, vaccines have proven to be very effective in controlling many types of infections… and this appears to have been well demonstrated with salmonella in Europe.

Farmers also complained it would be expensive to vaccinate every hen… However, when the costs of washing and spraying millions of eggs, refrigeration, additional inspections and testing are considered, vaccinating hens must be far less expensive …

In Europe, the goal is to prevent eggs from getting dirty in the first place, so washing isn’t necessary. One expert has even suggested that not allowing washing of eggs may be helping to maintain good farm practices…

So, is it better to treat the chicken or the egg? What do you think??

For us, even though it is recommended in Europe to store eggs between 17 – 23C (62 – 73F), it still feels weird to leave them on the counter so ours still end up in the fridge once we take them to our apartment!

Now, where are the olives kept? Las Aceitunas, por favor? It took us a while to find them too… with the snack foods! I guess potato chips and olives are often served together over here!

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Uncategorized

Learning how to learn…

I’ve been trying to learn Spanish for a couple of years now… never making much headway. But our upcoming trip to Spain has motivated me to work harder and I think I’ve finally turned a corner – I’m getting it! Nothing like a little motivation…

Are you finding it more difficult to learn new things that when you were younger? One skill we are not taught, is how to learn… or maybe how to convince ourselves that we really do want to learn what we need to know!

Facts are quickly becoming less important in the digital age – what matters is being able to find information we need (or want) to learn and being able to use what we find. So, we need to focus on becoming better at using the information technology that is available to us and better at processing the data that we find. Information is cheap and readily available… it is thinking skills that matter although sometimes we do need to know enough to trigger us to look further. We need a balance of knowledge, and skills to use that knowledge effectively.

How do we learn best? Here are some suggestions I found in a book I recently read:

  1. Establish value – I think this is one of the most important factors. We need to see knowledge and skills as valuable, or the brain simply discards the information soon after we “learn” it. We need to create meaning, make sense of the information, think about how and why it’s important to you. This may be best done by thinking how it relates to what you already know. If you’re a Big Bang Theory fan, you may recall the episode where Amy stops reading and stares into space for several minutes, explaining that she’s finished reading and now she’s thinking about what she read… (establishing its value and relating it to what she already knows, no doubt!)

  2. Target your learning – Decide what you want to learn and know why you want to learn it. Set goals and targets. Have a reason to learn.

  3. Be curious – Take on the challenge of learning things you don’t know but find interesting.

  4. Extend your skills – These days, average won’t do, especially in the workplace. Develop skills, knowledge and understanding beyond the basics to become an expert. Expertise is needed if you want to be essential to the system and it’s gratifying to gain a thorough understanding of a subject that interests you, or just to be the best you can at your work!

  5. Relate – Nothing can be isolated. Knowledge needs to be related to other facts/procedures/systems. Understand how new knowledge fits with the old. For my Spanish, I’ve noticed similarities with French (in which I am already quite fluent), and this helps me remember more easily.

  6. Rethink – You need to constantly review knowledge and understanding as the environment changes. You need to “learn from your learning”, updating previous knowledge with new facts and techniques. Keep an open mind to new ideas presented by others in the field you are studying. With the volume of information available in this electronic age, it is impossible to read and learn every aspect of a subject. Discussion and sharing with others enables you to have a broader perspective that may influence your understanding of the subject and future direction of learning.

Constantly ask yourself: “How does this new learning relate to what I already know?” Understanding what you’re learning, versus memorizing facts, increases retention and keeps you more interested in what you’re learning.

But, understanding where to find information quickly is now often more important than acquiring a vast knowledge base. I have my phone loaded with translation files so I will be able to quickly look up the Spanish words I can’t remember.

And, don’t forget that You Tube now has a database of videos demonstrating everything from appliance repair to setting up a website and more! A friend we were visiting complained that she had never figured out how to lower the racks in the dishwasher she had bought 2 years before. My husband (who uses the internet regularly to learn how to do all kinds of things!) pulled out his phone and within 2 minutes found a video of how to adjust the racks in her model of dishwasher. We all learned something about learning that evening!

Various fields may have specific sources for the highest quality information. A focus of learning that may give the greatest benefit, especially in the workplace, is to learn the best sources of the information you need. Peer learning – learning from each other – is often a very effective way to gain this type of information. A role for leadership in today’s workplace is helping workers develop skills needed to quickly find information they need themselves. Often, part of this is simply providing an avenue for employees to share the knowledge they already have.

Keep in mind that spreading learning over time and acquiring knowledge when you need it enhances integration into actual practice and helps decrease the inevitable forgetting. Having the skills to learn “on demand”, when the information is needed, avoids the necessity of memorizing facts and processes before they are needed and gives the advantage of better retention because the meaning and need are clear to us!

As a practicing pharmacist, some of my best learning was in response to questions from clients. In fact, I became a “hormone expert” because I received so many questions about menopause, as treatment went through radical change in response to study results. I even received a phone call one morning from a woman asking to speak to the “Hormone Lady” as my reputation spread… all due to learning “on demand” in response to a need.

So, “learning how to learn” (and where to find the info you need) may be the most important skills we can acquire. And our best learning is very often in response to an immediate need…

What do you need to learn about? The goal of my blog, in addition to sharing interesting health information I’ve read, is to help readers with health and wellness related questions they have. Click the red “Questions/Comments” box to let me know what health information you’d like to see in a future blog!

(Note: Names are never mentioned in articles to maintain confidentiality!)

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Health

For Coffee Addicts Only…

How many times have you read that you should quit drinking coffee? Well, a new study suggests that coffee may actually be good for you…

I just read a report from the European Society of Cardiology about a study on coffee consumption done in Spain looking at the association between coffee consumption and the risk of dying in middle-aged Mediterraneans. Researchers surveyed the amount of coffee 20,000 people drank along with other lifestyle, social and demographic characteristics and previous health conditions. Then they followed them for an average of 10 years.

Here’s what they found…

  • People who drank at least four cups of coffee per day had a 64% lower risk of dying from any cause (“all-cause mortality”) than those who never or almost never drank coffee over the 10 years of follow-up.

  • There was a 22% lower risk of all-cause mortality for each two additional cups of coffee per day.

  • In those who were at least 45 years old, drinking two additional cups of coffee per day was associated with a 30% lower risk of dying during follow-up.

Very interesting, isn’t it! The researchers didn’t offer any explanation for why coffee might have this effect but here’s my theory (for what it’s worth) …

I rather doubt that it’s anything particular in the coffee (or tea for that matter, for tea enthusiasts), but more likely it’s what we do most of the time when we have a coffee: we take a break, relax, maybe chat with a friend or read a magazine. That has to help reduce our stress, and stress (I hear) is suspected as being an underlying cause of many health conditions! Coffee is often a social drink – recent studies also suggest that socialization is also good for our health and longevity, so that may be part of the effect too,.

I base my humble opinion on theories why the French have lower rates of heart disease that North Americans in spite of the rich higher-fat diet they consume… Some experts propose that it’s not so much what you eat, but how much you eat and how you eat it. Consuming food in a relaxed atmosphere with good company just seems to be healthier for us.

So, meet a friend or take a break from work with a co-worker, relax, and enjoy a tasty cup of coffee. Or, if you don’t have someone available to share a cup with, simply put your feet up, contemplate all the great things in your life and maybe listen to some of your favourite music as you enjoy the wonderful taste of a fresh cup of brew! You may just be healthier for it…

Now, I guess I’ll go get myself another cup…. umm, that will be three for today so perhaps one more later… maybe an iced coffee version…

Enjoy!

Reference: Science Daily

Categories
Health Public Health

Fat vs sugar – time to rethink!

Sugar is the problem — not fat. Years of advice to choose low-fat and fat-free foods does not appear to have been based on sound research…

New Canadian research found no significant association between eating more than the recommended amount of fat (30% of total calories) and developing heart disease or having a stroke. In fact, they found that those who got 35% of their energy from fat had a lower overall risk of dying than those who ate less than the recommended 30%!

In addition, they found that the low-fat diets recommended to us for many years have resulted in many people overeating carbohydrates, resulting in a higher risk of dying when their carbohydrate intake exceeded 60% of their total calories. Replacement of dietary fat with sugary carbohydrate is also being suggested as a cause of the current increased rates of obesity.

Scientists lead by nutritional epidemiology expert, Mahshid Dehghan at McMaster University in Hamiltion, Ontario, studied diets of 135,000 people in 18 countries for an average of 7 years. She observed “When you recommend lowering fat, by default, people increase their carbohydrate consumption, and increasing consumption of carbohydrates results in higher risk of mortality.”

Study in Japan

This Canadian finding agrees with another article I recently read describing how the stroke rate in Japan dramatically fell almost 6-fold from 1,334 to 226 per 100,000 between 1958 and 1999, after the government encouraged the population to increase their intake of fat. Cholesterol levels rose from an average of 3.9mm/l to 4.9mmol/l due to dietary fat rising from 5% to 20% of total calories. Heart disease rates, interestingly, also decreased although not as dramatically. This is a stark contrast to our current recommendations to lower cholesterol in the blood as much as possible to reduce the risk of heart disease…but more about that in a future blog!

Population studies

Studies of diets from diverse healthy populations suggest that there is not one single “best” diet. The high-fat diets of the Innuit of the north, the Maasai tribes of Africa and the French in France seem as healthy for their populations as the low-fat Mediterranean diet of Italy.

This has lead some to speculate that it is not so much what we eat (as long as the diet is a traditional balanced one) but how much we eat and ­how we eat. Avoiding overeating and enjoying food in a relaxed environment with family or friends (rather than eating on the run or in your car!) seem to be positive factors for overall health too!

Canada Food Guide 2018

Even our Canada Food Guide is being revised…and I hear the meat and dairy industries are not happy with the plans. Although the new finalized guide will only be released in two stages over 2018 -19, Health Canada says less emphasis will be placed on individual nutrients and more will be placed on:

  • avoiding processed foods (that commonly have added sugar, trans fats, salt and other ingredients),

  • reducing consumption of sugary drinks, and

  • limiting portion sizes.

This seems to agree with other experts like University of Toronto’s nutritional scientist, Richard Bazinet who advises “Moderation is the solution. Don’t eat too much of any single thing” and Michael Pollan’s Food Rules: “Eat food (real food, not processed). Mostly plants. And not too much.” Check out my previous blog on his Food Rules here.

It seems difficult to understand why low-fat diets have been recommended for so long – some suggest that influence from the sugar and grain industries may have been a factor. Currently, news outlets have reported meat and dairy industry lobbyists are “up in arms” against the suggestion that the new Canada Food Guide may decrease emphasis on consumption of these food groups.

However, the purpose of any food guide or advice is to improve the health of a population, not to support food industries. Health Canada has stated that it will not be consulting with food producers, although they are permitted to engage in open public consultations.

Trans fats

When it comes to fats, however, there seems no question that trans fats should be avoided. Trans fats, also known as hydrogenated oils, are stable artificially created fats that have been used to extend the shelf-life of processed foods…good for food, but not good for our health! Trans fat content appears on food labels so you can avoid buying foods containing these fats, and some governments are moving to ban these completely from food!

Trans fats often occur in foods that also contain saturated fats and may be responsible for the bad reputation assigned to saturated fat. Wikipedia has an interesting summary of studies comparing the effect of saturated fat (SFA) with unsaturated fat (PUFA). At the very least, one could say there is conflicting evidence when it comes to the dangers of saturated fat, with newer studies being less likely to find that fat in the diet has any effect on heart disease. It will be interesting to see what the new Food Guide recommends as an ideal amount of fat in the diet, considering the results of new studies!

Have you been cutting fat out of your diet? Leave a comment below!

References:

Categories
Health

C. Difficile…so difficult!

Clostridium difficile is a bacterium that is resistant to many antibiotics – hence the name “difficile” since it’s difficult to treat! It is the most common cause of infectious diarrhea in hospitals and nursing homes in Canada and other industrialized countries.

Most cases occur in patients taking certain antibiotics that kill a wide range of bacteria (referred to as broad-spectrum antibiotics) in high doses or for a long period of time. The normal bacterial flora in the digestive system that keep c. difficile in check is destroyed by the antibiotic, allowing the resistant c. difficile to take over. These infectious bacteria produce toxins that damage the bowel, and cause diarrhea and inflammation in the lining of the bowel.

Some people can have c. difficile in their bowel and not show symptoms, likely because other bacteria are keeping its growth in check. There are different strains of c. difficile and some cause more serious illness.

Stomach acid helps to kill unfriendly bacteria like c. difficile if we happen to swallow some. Acid-suppressing drugs, especially proton pump inhibitors (like Losec®, Tecta®, and Nexium®) that strongly block acid production, can increase the risk of a symptomatic infection of c. difficile.

How is it passed from person to person?

C. difficile bacteria and their spores are found in feces. People can get infected if they touch surfaces contaminated with feces and then touch their mouth… (How gross!) This helps you understand how important it is to wash your hands regularly!

If you are healthy, generally there is actually little risk of developing an infection. But in the elderly and those with other illnesses whose immune system may be less healthy, there is a greater chance of infection.

It’s important to keep the normal gut bacteria healthy. When there are fewer normal healthy bacteria in the gut, c. difficile have a better chance to grow and cause infection. Include fermented foods that contain live bacteria in your diet, and take probiotics after a course of antibiotics. This will help to replace the good bacteria that are often destroyed along with the bad ones that caused the infection and maintain a healthy gut flora.

What are the symptoms?

C. difficile infection causes watery diarrhea, fever, decreased appetite, nausea, and abdominal pain or tenderness. The diarrhea usually does not respond to regular diarrhea medications and will last more than the 2 or 3 days of diarrhea from other causes. A stool sample is often tested to confirm that the cause of the diarrhea is c. difficile.

How can you prevent c. difficile?

Wash your hands often with soap and water. Healthcare workers should always wash their hands after touching every patient to prevent passing bacteria and other infectious organisms from one patient to another (or to themselves!). At home, always wash your hands after caring for an ill person, using or helping with toileting and before preparing or eating food.

Alcohol-based hand washes help but are not as effective as soap and water as they do not kill c. difficile spores. Wearing disposable gloves when caring for someone with c. difficile is recommended and hands should be washed with soap and water when the gloves are removed.

How is c. difficile infection treated?

The antibiotic that caused the infection should be stopped right away, and a new antibiotic that kills c. difficile will often be started. Very mild cases may clear on their own.

C. difficile is resistant to many antibiotics, hence the name “difficile – difficult to treat! Metronidizole (Flagyl®) is an antibiotic that may be effective for mild to moderate infections. Vancomycin (Vancocin®) is used for more severe infections and it is considerably more expensive than metronidazole. A new antibiotic, fidaxomicin (Dificid®) showed better results against c. difficile in studies, but it is very expensive.

Taking probiotics (good bacteria in capsule form) in large doses has been reported to help when all else has failed, or as an add-on to antibiotic treatment. It also helps to prevent reinfection, which occurs in 20% of cases.

In extreme cases, the diseased part of the bowel may be surgically removed. Fecal microbiota transplantation (also known as stool transplant) is another new therapy that may be tried in recurrent infection. Donors are screened for infections, parasites, viruses and other bacteria. Stool from the donor is then placed into the infected person’s bowel using a colonoscope or nasogastric tube.

References

https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

http://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/treatment/txc-20202426

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Categories
Health

Artificial sweeteners may cause weight gain!

You could be gaining weight because you are using sugar substitutes… A new study suggests use of artificial sweeteners is linked to weight gain (not loss!) and increased risk of developing diabetes…

Considering the widespread use of sugar substitutes, it is surprising that there are comparatively few long-term studies that have been done. Most are “observational” studies rather than the higher level intentional type of study (randomized groups, placebo-controlled studies referred to as “randomized controlled trials” or RCT’s), so cannot prove a cause-and-effect relationship.

However, in the long term RCT’s averaging 6 months that the researchers found, regular users of artificial sweeteners had an increased risk of type 2 (adult onset) diabetes, higher blood pressure, and modest increases in weight and waist circumference.

The Canadian researchers could find no solid evidence for long-term benefit from artificial sweeteners, and there was some evidence of harm from long-term consumption.

But why would artificial sweeteners be linked to weight gain, not loss? Researches couldn’t explain, but had some thoughts:

  • Artificial sweeteners may disrupt healthy gut bacteria.

  • They may confuse metabolism. For example, the sweet taste may cause the body to be expecting sugar, stimulating a release of unneeded insulin. Increased blood insulin is the first stage in the development of type 2 diabetes. It also would cause a decrease in blood sugar that would stimulate appetite.

  • The appetite-stimulating mechanism may overcompensate for missing calories from sugar when eating other foods.

  • Artificially sweetened foods may simply be a common part of an overall unhealthy diet.

An Australian study suggests that artificial sweeteners may increase appetite for calories by up to 30%. When sweetness versus energy is out of balance for a period of time, researchers say, the brain re-calibrates and increases total calories consumed. They called this the “starvation response”.

They also learned that the brain produces 2 waves of “pleasure” producing dopamine – one with the taste of sweetness and a second wave when the blood sugar rises. If there is no blood sugar rise (because an artificial sweetener was used) the brain sends hunger signals.

A US study, published in the American Journal of Public Health in 2014, found that overweight and obese people ate more when they drank artificially sweetened drinks.

The Australian study also noted increased hyperactivity, insomnia and glucose intolerance as well as an increase in appetite and calories consumed in animals they studied.

Altogether, these studies suggest that we would be much better off to avoid sugar substitutes completely and use a small amount of sugar instead. Better yet, switching to water (flavoured with a herbal tea if you like) might be a good way to promote a healthier waistline!

References:

Categories
Public Health

If you take them, you could be at risk…

Anyone regularly taking narcotic pain medications (“opioids”) is at risk of an overdose if taking more than 90mg of morphine or its equivalent per day, even if it’s being taken for significant pain.

Morphine 90mg per day is equal to:

  • Hydromorphone (Dilaudid) 11.25mg per day

  • Oxycodone (Oxycontin, Percocet, Endocet) 45mg per day

  • Codeine 200mg per day

  • Fentanyl (Duragesic Patch) 2.4mg per day (100mcg/hour as a patch)

Opioids depress the central nervous system and, if depressed enough, the person will stop breathing. New opioid prescribing guidelines for non-cancer pain recommend that anyone taking more than 90mg or morphine per day, or equivalent, should have their dosage gradually reduced to the safer 90mg limit. Even lower doses can be risky in some individuals, especially if they are taking other medications that depress breathing. Any drug that causes drowsiness (including alcohol) depresses the central nervous system and breathing. The person may simply look like they’ve fallen asleep…

If you see someone you know or suspect may have taken an excessive amount of narcotic pain medication (legal or illegal) here is what you should look for:

  • Breathing – slow or absent. May hear choking, gurgling or snoring.

  • Skin – cold or clammy

  • Pupils – tiny

  • Lips – cyanotic (blue)

  • Lack of consciousness – not responding to sound or touch, can’t be woken up

S.A.V.E.M.E. is an acronym to help you remember what to do.

Stimulate

Airway

Ventilate

Evaluate

Muscular injection

Evaluate again

Here are details of what you should do:

  • Stimulate: Try to wake them:

    • Talk loudly: Call their name. Identify yourself. Say “can you hear me?”

    • Shake them by the shoulder.

    • Tell them you are going to apply pressure. Rub knuckles vigorously on their chest bone.

    • Can’t wake them? CALL 911

    • Stay with the person.

  • Airway: Check their airway:

    • Look for chest movement

    • Tilt head back and listen for breath

    • If not breathing, ventilate

      • Use a breathing mask, if available

      • Pinch nostrils, head is already tilted back as you listened for breathing

      • Breathe into mouth

      • Watch that the chest rises and falls

  • Evaluate:

    • If not responding, give Naloxone (Narcan) if available

      • Available as nose spray or as injection (most common)

  • Muscular injection: How to give an injection of Naloxone:

  1. Prepare the syringe:

    1. Open syringe packaging part way to expose plunger, set aside

    2. Hold ampoule by the pointed top and swirl in a circular motion to collect liquid at the bottom

    3. Snap off the top (direction: away from you)

    4. Remove syringe from package, remove needle cap and draw up all liquid into syringe

    5. Push out excess air (a little air in syringe is OK)

  2. Inject the medication

    1. Insert the needle into a large muscle (meaty part of the thigh, butt, upper arm) like a dart at 90˚ angle (straight in, all the way to the hub), through clothing if necessary.

    2. Press plunger all the way in

    3. Most syringes included in Naloxone kits are safety syringes: pulling back on the plunger will pull the needle into the barrel of the syringe, preventing injury and any need to recap the needle. Other types of safety needles have a built-in system to cover the tip of the needle. If no safety mechanism is available, dispose of the needle and syringe in a glass or hard plastic container to prevent a needle-stick injury.

  • Evaluate again:

    • If effective, the person should wake up within 3 – 5 minutes or less

    • Keep watching the person – the effect can wear off after 20 minutes and you may need to administer Naloxone again, especially if a long-acting opioid was taken.

    • If no response in 3 – 5 minutes, give Naloxone again.

    • Repeat until they wake up, the emergency response team arrives, or you run out of Naloxone.

    • Giving Naloxone when it wasn’t needed won’t hurt the person.

When the person wakes, explain what happened. They may be confused or angry. They may have mild symptoms of opioid withdrawal. Do not allow them to take more narcotics – when the Naloxone wears off, they will have an increased chance of overdose again. Withdrawal effects usually wear off in several minutes.

Wait for the emergency response team. Tell them what you have done. Dispose of needle and glass ampoule in a sharps container (the ER team will have one) or in a bottle with a lid.

A video with detailed instructions is available here.

Adding to the opioid problem, some illegal versions of narcotics sold on the streets are copies made by amateurs that have been found to contain unlabelled dangerous potent drugs like fentanyl. Fentanyl is approximately 100 times more potent than morphine – when potent powders are not mixed to high standards, some tablets can easily contain stronger medication than others. Just a barely-visible speck, not mixed in properly, could provide a fatal amount.

Naloxone kits are increasingly being made available for free through pharmacies in Canada. If you are a caregiver for someone taking more than 90mg of morphine per day (or its equivalent), talk to your doctor about keeping a Naloxone kit on hand. If you work at a youth center or other facility that services youth or adults at risk, keep one or more kits on hand and review their use. It isn’t difficult to administer, and you could save a life…

Categories
Environment

It’s a shitty problem…

There seems to be a problem in the water…fecal bacteria above acceptable limits are showing up in water tests in some areas of the New Brunswick coastline.

I had a great discussion with my neighbour, Natasha Bell, this week about issues that increase the risk of pollution on our beaches. Initially concerned about the impact of a large proposed campground nearby, she quickly realized that the greater issue is damage to the delicate ecology of the shoreline along the entire coast of our province – and the potential for it to worsen with further development of the coastline. This lead her to become involved in a growing movement to protect our New Brunswick coastline. She established a local group, along with another concerned neighbour, Pierre Gagnon, to create awareness in members of our village council about our concerns.

They subsequently joined forces with 3 other similar groups, creating a large group that has been named SWWAT (Save our Waters, Wetlands and Tourism) to have a stronger voice with our provincial government. I attended a meeting last evening with Natasha and Pierre to discuss future actions concerned citizens can take to identify and correct existing problems and to prevent development of future problems along the NB coastline. It was attended by people from Shediac to Murray Beach, ready to exchange ideas and take action.

The issues are similar along the entire Atlantic coastline and, in fact, in many watershed areas of both fresh and salt waterways. Wetlands have been seen as “wasteland” and simply filled in to create developments for human use. Even my home was built into the wetland before existing regulations were in place. We have returned a swath of land along our property to natural vegetation along an area of water drainage from higher ground, both to try to restore some of the filtration function that was lost and because we love the appearance of the natural vegetation.

But as I thought about what we had discussed after talking to my neighbours and attending a SWWAT meeting, I wondered what I could do to help. I realized that in many ways this is an issue of education and awareness:

  • We need to educate people who use the coastline for recreation or industry that every small action is cumulative – everyone needs to be aware that actions that cause a small amount of damage can add together to cause significant problems for humans, birds, sea life and the overall ecosystem of the coastline.
  • We need to create awareness in municipal and provincial government employees and elected politicians who make decisions that affect our shores:
  • about the facts around issues that are causing damage now;
  • about the importance of finding and correcting the sources of existing problems that are potential health hazards;
  • and about the importance of considering both the current and future impact of decisions and legislation that are passed.
  • It isn’t simply about testing water quality so Public Health can predict when beaches should be closed, it’s about finding and correcting the causes of bacteria in coastal waters and taking action through legislation and policy that will correct existing problems and prevent future deterioration of the ecological systems along our shores.
  • We also need to educate our youth – the next generation – to ensure this wonderful resource is available in the future. Just on our small stretch of beach, we have had late night fires that consumed snow fencing used to prevent erosion of dunes and burned Christmas trees placed against damaged dune areas to trap sand. We’ve also had to pick up broken glass and garbage from impromptu midnight beach parties! But youth can also be a passionate force for positive change, educating their parents at the same time. We realized that the way to reach young people is through engaging their schools and increasing our reach through social media and our website. Youth communicate through electronic media!
  • We need to continue to research solid facts surrounding this issue and communicate these to government and the public to create knowledge and an awareness of the severity of the problem.
  • We want to continue to engage the attention of news media to enable wider awareness of our concerns.

Because I am a blogger and have already created a website and marketing materials when I had my business, I volunteered to work on similar approaches to spread the word about these environmental issues. It’s not only the health of people like me who use the beaches for recreation that is at stake, but also the tourism, fisheries and ultimately the economic health of coastal areas.

The SWWAT group has two requests of government:

  1. Moratorium – We are asking the Provincial Government to impose a temporary moratorium on significant development within 500 meters of wetlands draining into Northumberland Strait until the sources of fecal contamination have been identified and mitigated.
  2. Legislation – We are asking the Government to legislate a long-term wetlands protection plan supported by strict enforcement of protective regulations.

These actions will protect the health and safety of families and visitors to the beaches, as well as the future of the tourism and fisheries industries in the area.

Will you join our cause? Whether you are a resident of the area, enjoy vacationing there, or just want to help a worthy cause, please sign our petition. Help us to direct government attention to saving our shores for all to enjoy in the future!

#Environment #Wetlands