CMOH Media Blog

Yukon Chief Medical Officer of Health

Dr. Brendan Hanley

CMOH Media Blog

Last Updated: March 28, 2018


Immunization Awareness

April 24, 2018
The threat of vaccine preventable diseases often seems so distant that we take vaccines for granted. However, the pertussis outbreak of 2017, and the rise in measles cases are indications that we need to keep on top of our vaccine schedules.

Today we have a number of vaccines available to prevent serious infectious diseases that have devastated past populations. However, in order to stop the spread of these diseases, we need to stay up to date with our vaccine programs. In 2017 we encountered a pertussis outbreak, a highly infectious disease that causes a whooping cough and can be a serious if not fatal disease in infants. One way to help protect new babies is to receive the pertussis vaccination with each pregnancy, and to ensure that you are also up to date with the vaccine if you intend to visit a family that has a newborn baby. Yukon adults should receive at least one pertussis booster shot during their adult years, in addition to the childhood series and grade 9 booster that everyone should be getting.

The potential of vaccines when administered in full is remarkable. Smallpox has been eradicated today thanks to vaccines, and polio remains endemic in only three countries worldwide: Afghanistan, Nigeria, and Pakistan. In fact, there were only 22 cases worldwide in 2017 so we are getting tantalizingly close to elimination. Canada has been polio free since 1979. However, we should not become negligent in vaccinating against polio. Until polio transmission is interrupted in the countries where it remains endemic, all countries remain at risk of polio importation. 

Anti-vaccine advocates have been around since vaccines were first invented and recent years are no exception.  In 1998, a study later proved not only false but fraudulent, was published claiming a link between vaccines and autism. This study had major flaws, including systematic biases and vested interests from the author Andrew Wakefield, as well as the ridiculously small sample of 12 children. Unfortunately, the study was picked up by the media, and consequently many parents, particularly in Europe, stopped vaccinating their children. Hundreds of studies have been carried out since, each disproving this original 1998 study. A study published just last month sampled almost 600,000 children, of which approximately 4,000 had autism. Interestingly, they found that children with autism spectrum disorders were less likely to be fully vaccinated compared to children without autism spectrum disorders1. What’s more, another study looking at more than 1.2 million vaccinated children found that while there was no link between the development of autism and vaccines, the MMR (measles-mumps-rubella) vaccine was associated with a decreased risk of developing autism2. Although we still don’t know what causes autism, experts believe it is a combination of both genetic and environmental factors.

In addition to this, parents worry that too many vaccines are administered at once. However, this is a problem of perception, not of reality. In today’s world of modern, purified vaccines, the antigen load is minimal, even when multiple vaccines are combined into one visit. For example, at the two-month visit there are a total of about 50 antigens administered. In 1980 the equivalent vaccine contained about 3000 antigens because the products administered were less refined than today’s. At the same time, due to the almost unlimited supply of antibodies that even babies can produce, it is estimated that an infant could handle up to 10,000 vaccines in one visit. We have a lot of comfort in being able to say that kids can easily handle multiple vaccines in one visit. It’s also a kinder way to give vaccines. Combining multiple vaccines into one visit means that you get the local reactions, any fever or irritability or other common but minor side effects that might occur, all over in the one visit.

Another concern that is often brought up during routine immunizations is the presence of thimerosal-an ethyl mercury derivative. Thimerosal has been extensively studied and has not been shown to produce any negative health effects. Ethyl mercury is very different from methyl mercury; the kind that you might get exposed to from a can of tuna for instance and which tends to persist much longer in the body. Ethyl mercury in thimerosal gets metabolized and eliminated within a few days. Anyway, no vaccine in Canada, except for our multidose influenza vaccines, has contained thimerosal since 2001.

Although it has been many years since we have confirmed a measles case in Yukon, it does crop up here and there in Canada. In fact, the number of measles cases increased in Canada from 2016, where we saw 11 cases, to 45 cases in 2017. Typically, these cases are imported from Europe or elsewhere. Indeed, Europe saw 21,000 measles cases in 2017, up from 5,000 in 2016. Unfortunately, large numbers of measles cases result in severe and complicated cases. The European outbreak has resulted in 35 deaths, primarily in children. The good news is that the MMR vaccine is very effective against measles. Our current schedule gives one dose at a year of age with a second dose at the prekindergarten age of 4-6 years. We need a very high rate of people vaccinated in the community to protect against measles-at least 90%. Our data indicates that we are close to the mark but not quite there. Thus, if you are not sure if you are up to date, it’s best to check your status at your local health centre.

While we do well in Yukon to vaccinate our children, our vaccine completion data shows that only about 2/3 of children are up date on all their vaccines by age 7 years. That said, if you look at any one vaccine they are mostly in the high 80% to 90% completion rate, indicating that we have very few people who actively resist vaccines. What is much more common is families just missing appointments, or not getting around to making them.  If you are unsure whether you are up to date with vaccines, please contact your local health clinic.

References:

  1. jamanetwork.com/journals/jamapediatrics/article-abstract/2676070?redirect=true
  2. www.sciencedirect.com/science/article/pii/S0264410X14006367

Helpful Information:



Healthy eating: quality over quantity

March 13, 2018
Do you struggle to lose weight, keep weight off, or often feel lethargic? New studies suggest that focusing on what you eat could more be important than how much you eat.

Busy lives, the ability to grab food on the go, and the temptation to order-in has made us a nation of unhealthy eaters. In Canada as a whole, one in four adults and one in ten children are considered clinically obese1, which means they have a body mass index greater than 30. Here in Yukon, obesity levels are currently around 31.5%, which is higher than the Canadian average of 26%. Obesity is associated with many chronic health issues, including type 2 diabetes, high blood pressure, heart disease, stroke, arthritis and cancer.

With our ever-growing waistlines, the diet industry is booming. However, quick-fix diets are failing us, weight loss is often quickly followed by rebound weight gain, and obesity- related diseases continue to rise. Drastic changes in diet are almost always unsustainable and maintaining weight loss once it has been achieved is difficult. Upon losing weight, your metabolism slows down, meaning you burn fewer calories than previously. Thus, unless long term lifestyle changes are made the lost weight often returns once the diet is over.

And don’t be falsely reassured by a normal BMI if you aren’t eating well. Eating processed foods high in sugar, salt and fat, even if you look good on the scale, can still lead to high blood pressure, diabetes, heart disease, stroke and cancer. Many of us find ourselves prone to drinking sweetened beverages, eating sugary snacks at work, grabbing pizza on a busy night etc. None of these is harmful on occasion, but those occasions can add up and lead us into a nutritionally unhealthy lifestyle. 

If your goal is to lose or maintain a healthy weight, look at what you are eating, not only in terms of amounts, but the types of food you typically consume. A recent study discovered that the quality, rather than the quantity of food you consume is key to weight loss and weight maintenance2. Overweight adults followed either a low-fat diet consisting of high-quality, carbohydrate foods such as beans, lentils, oats, brown rice, sweet potato and fresh fruit, or a low carbohydrate diet consisting of high-quality fats such as avocado, nuts, seeds, oily fish and olive oil. No limitations on calories were placed on the participants: they could eat as much food as they wanted so they didn’t get hungry.  By eating these high-quality foods, participants in the study often ate 500 fewer calories/day without realising it. After one year both the low fat and low carb participants lost similar amounts of weight, without counting calories and measuring food. In addition, neither genes nor the level of insulin resistance of the participants played any role in how they responded to the diet they were placed on. Thus, focusing on high-quality home-made food was a successful strategy for weight loss regardless of their genetic make-up or the type of diet a person was on.

Not all calories are created equal- a calorie from fruit is different from a calorie in pizza. Although all calories have the same amount of energy, the way the body processes them to regulate energy balance is different. Healthy, unprocessed nutrient-dense foods will keep hunger at bay by maintaining stable blood glucose levels, reducing cravings, and allowing your brain to signal to your stomach that it's full. Nutrient-poor highly processed foods will have the opposite effect, spiking insulin levels, increasing cravings, suppressing satiety signals and encouraging us to overeat. Ask yourself, would you feel fuller eating one regular chocolate bar, or 3 bananas or 4 apples? All have an equivalent number of calories.

Consequently, by making healthier food choices such as reducing processed foods, and by increasing vegetables and fruits, healthy grains, and healthy fats you will start to see positive effects not only with weight loss but with your overall health. Even those who are not overweight but are prone to unhealthy eating habits may find they have more energy, sleep better, and have lower stress levels.

As important as healthy eating is, exercise and activity remain vital components for maintaining a healthy lifestyle and weight. Achieving fitness is a better goal than reducing fatness, but we can and should work towards both. People who diet but don’t exercise might reach a healthy weight, but still carry too much visceral fat and not enough muscle on the inside. On the other hand, people who rely solely on exercise to lose weight will almost never get there.  Ideally, we should aim to do 30 minutes of activity 5 days a week. Increasing activity regardless of calorie counts, will pay off in health benefits: less risk of heart disease, high blood pressure, cancer, and other chronic diseases.

References:

1) infobase.phac-aspc.gc.ca/datalab/adult-obesity-blog-en.html
2) jamanetwork.com/journals/jama/article-abstract/2673150?redirect=true

Helpful Information:

Weight Wise Yukon
www.hss.gov.yk.ca/16-210.php



Is sugar making us sick?

March 06, 2018
Health Canada is proposing new regulations for food packaging-warning labels on the front of food packaging stating if the item is high in fat/salt/sugar. Sugar has recently been linked to Alzheimer’s and infertility. Let’s get the facts straight.

Yet sugar is everywhere, not just as a prime ingredient for treats and chocolate but making its way into common food items we don’t even think of as sweet.

Naturally occurring sugars such as those found in fruit, vegetables, nuts, legumes and milk are full of other nutrients such as fibre, protein and vitamins, adding flavour to food and contributing to our energy needs. In general, we don’t need to worry about these sugars. Added sugars, however, are the bad guys. These sugars and syrups are put in foods during preparation, processing or added at the table. They are found in soft drinks, sauces (pasta sauces, baked beans, ketchup) candy, cakes, cookies, pies and fruit drinks dairy desserts and milk products (ice cream, sweetened yogurt and sweetened milk); and other grains (cinnamon toast and honey-nut waffles). In fact, ¾ of packaged foods have sugar added to them. To tell if a processed food contains added sugars, you need to look at the list of ingredients. Sugar has many other names. Besides those ending in “ose,” such as maltose or sucrose, other names for sugar include high fructose corn syrup, molasses, cane sugar, corn sweetener, raw sugar, syrup, honey or fruit juice concentrates.

Unfortunately, apart from its value as a sweetener and short-lived energy source, sugar has no positive traits. Sugar is a carbohydrate. When you eat sugars, your body either converts it into energy to be used right away, if needed, or into fat, if not needed right away, and that fat is then stored away in your fat cells. As sugar enters your blood stream it goes to your pancreas, releasing a hormone called insulin – your body’s sugar regulator. However, our bodies are not perfect machines. Consumption of too much sugar can lead to a release of too much insulin, causing our blood sugars to drop. We may in turn be compelled to reach for more of the same, and as our energy needs are met, the body just continues to store the extra energy in fat cells for later use. Thus if we eat sugar and don’t use the energy it provides, we start to see the pounds packing on, leading to obesity.

Sugar is a major concern-primarily because we’re consuming so much more of it than we used to. In the past, we worried about its increasing the risk of diabetes and obesity and causing dental cavities, but now research has also linked sugar to heart disease, hypertension, strokes, gout, periodontal disease, fatty liver disease, and most recently Alzheimer’s and infertility. Let’s look at three studies. A study published in 2014 observed that individuals consuming more than 10% but less than 25% of total daily calories from added sugar had a 30% higher risk of death from heart disease or stroke when compared to those who consumed less than 10%1. A second study, published early 2018 discovered that people with high blood sugar had a faster rate of cognitive decline than those with normal blood sugar, irrespective of whether their blood-sugar level technically made them diabetic. In other words, the higher the blood sugar, the faster the cognitive decline2.  A third study, also published early 2018 found that the intake of one or more sugar-sweetened beverages a day by either partner decreased the couple’s chances of getting pregnant3.

The World Health Organisation have recommended that we aim to keep our consumption of sugar at 5% of our total calorie intake, which amounts to 25 grams sugar/day (approximately 6-7 teaspoons). Now one can of Coke has more than 10 teaspoons of sugar. So many say that shooting for under 10% is more realistic. To achieve this, a simple place to start would be to tackle sugary drinks, sodas, energy drinks and yes, fruit juices. As an alternative drink, you could add a twist of lemon or lime to the water or make your own iced tea. Stock up on different food choices, for example dried fruits can tackle the sweet tooth, and vegetable sticks and hummous can be a fun alternative. For those with children, try not to forbid the sugary snacks; rather control them. Research has shown that forbidding foods makes them more attractive to children. The occasional cookie or chocolate bar will not jeopardise a child's eating health habits, so long as it is just one or two occasionally. Try to limit the number of sugary snacks in the home and explain to your children why it is important to limit these foods. Be a good role model – children learn from what they see adults doing. Dark chocolate can be a great alternative, with less sugar, and it might actually be good for you. Lastly, try to eat fresh foods as much as possible, avoiding packaged processed foods

Examples of sugar amounts in common foods:
An Oikos Greek yogurt portion: 12 grams of sugar
Granola bars:8-12 grams per bar
Breakfast cereals: 10-20 grams per cup
Wonderbread: 4 grams of sugar per two slices
Kraft BBQ Sauce: 10 grams of sugar per two tablespoons
Heinz Ketchup: 5 grams of sugar per tablespoon
Coke: 42 grams of sugar per 355 ml can
Red Bull: 27 grams of sugar per 250 ml can
Caramilk chocolate bar: 24 grams of sugar for the entire bar
Breyer’s Ice Cream: 20 grams of sugar per half cup
Minute Maid Grape Juice Box: 19 grams of sugar per juice box
Nutella: 11 grams of sugar per tablespoon
A single glass of apple juice contains the same amount of sugar as four or five apples do, without any of the fibre.

References:

1) https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1819573
2) https://link.springer.com/article/10.1007/s00125-017-4541-7
3) https://journals.lww.com/epidem/Abstract/publishahead/Intake_of_Sugar_sweetened_Beverages_and.98746.aspx



Navigating cannabis legalisation

February 20, 2018
Cannabis is due to become legalised July 2018. With Yukon experiencing some of the highest rates of cannabis use in Canada, we need to ensure we keep talking about it with our youth, and understand the health effects of cannabis use.

Of course, making cannabis legal does not mean that we can forget about all the health implications associated with using cannabis. Much like with alcohol, taking a public health approach means we can focus on cannabis use as a health issue, and not a criminal issue.

Within Canada, Yukon has one of the highest rates of cannabis use, with 21% of individuals aged 12 and over having used cannabis within the previous year based on self-reports of Yukoners from a survey only 2 years ago1. Cannabis use is particularly prevalent in youth and apart from alcohol is the most common substance used. In fact, over 7% of youths questioned had used cannabis by the age of 12.  Although rates of smoking cannabis have gone down over the years, the concentration of THC, the chemical compound in cannabis responsible for the “high”, has increased dramatically from approximately 0.8% of THC in the 1970’s to approximately 12% in 20152.

Although the overall health risks of using cannabis are significantly lower when compared to alcohol, tobacco or illicit drugs, there are health effects that we need to pay serious attention to.  There is a risk of dependency, with at least 1 in 10 users becoming dependent on cannabis. Consequently, the addiction cycle that is seen with other substances: taking increasing amounts, becoming tolerant to the effects and interference with living daily and productive lives, can also occur with cannabis. Studies have also found subtle cognitive impairments associated with frequent, chronic use of marijuana. For example, daily users can exhibit poor academic performance and memory can be impaired for at least 7 days. Another critical cognitive effect is that cannabis impairs one’s ability to drive by delaying reaction time, affecting a driver’s ability to focus and causing variation in speed and steering. Cannabis impairment can lead to a crash risk double that of a sober driver.

Cannabis use in “at risk” groups such as youth and pregnant women can have lasting effects. For example, adolescents and young adults that use cannabis daily have a higher risk of developing psychotic disorders such as schizophrenia in adulthood. Substantial evidence indicates that initiating cannabis use at an earlier age is a risk factor for the development of problem cannabis use, with 1 in 6 adolescents developing cannabis dependence. This dependence can lead to a poor academic performance, loss of interest in extracurricular activities, social withdrawal, and conflict with family and friends. Infants who have been exposed to cannabis in utero often have lower birth weight, decreased growth, and lower IQ scores. There are also respiratory effects such as those seen from smoking, not surprising given that cannabis is most commonly smoked, and many of the same chemicals found in tobacco are present in cannabis.

However, cannabis is being used to treat certain medical conditions, so experience with its use is increasing. Anecdotally there are many stories of its effectiveness in relieving chronic pain and nausea, epilepsy, and mood disorders such as anxiety and depression. However, the evidence base to support medicinal use is thin, apart from some circumstances such as chemotherapy induced vomiting, muscle spasms with MS, and possibly a role in chronic pain.
In talking with parents and youth, and making resources available, our aims should be to encourage healthy conversations about how cannabis effects our health and brain, while acknowledging that some youth will be using cannabis for a variety of reasons. Knowing that the adolescent brain is in a period of intense growth and development, finding a balance between the protection of youth and harm reduction principles should be applied. That is, we want to ensure our youth have all the right material to make a choice about using cannabis, but don’t end up with criminal records at a young age. As the Canadian Public Health Association points out, legalization should not normalize usage, but it should normalize conversations and discussion about cannabis.

Recognizing the reasons for cannabis use may also help us lower usage rates in Yukon. For example, if youth are using cannabis to cope with distress or mental health issues, they need access to alternative supports and counselling. Youth who may be at risk, either due to behavioural issues, school performance, or family stresses, need early access to healthy alternatives to drug uses, such as physical and cultural activities.

For those who choose to use cannabis, consider lowering the THC content, avoid daily or near daily use, and use the safest methods and areas to consume cannabis. Avoid the use of high potency synthetic cannabis products (e.g. K2 or Spice) as they can lead to more severe health problems including death. Do not drive or operate machinery after using cannabis. If you are or are considering using at home, keep it safe, locked and out of sight of children or other unauthorized users. There have been cases of accidental toxic cannabis ingestion in children.
Cannabis smoke does contain the same cancer-causing chemicals as tobacco smoke, which can lead to chronic bronchitis, cough, wheeze and sputum. Thus, if you are smoking it, avoid smoking around children or vulnerable people.

For reasons above, where there are concerning effects on early childhood, pregnant women and breastfeeding women should avoid exposure to cannabis. In addition, if you or an immediate family member has a history of psychosis or substance use disorder, your risk of mental health problems related to cannabis use are higher; therefore, consider abstinence. Finally, remember to stick to the rules and regulations when they are in force. If well crafted, they will lead to the least harmful effects of cannabis use and allow you to be a positive role model for your children and youth.

References:

1) Statistics Canada CCHS 2016.
2) Health effects of Cannabis and Cannabinoids:
http://nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx

Cannabis use statistics
Statistics Canada CCHS 2016.
http://www.hss.gov.yk.ca/cannabis/cannabisabout.php
https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2015-summary.html

Health effects of cannabis
http://nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx
http://www.hss.gov.yk.ca/cannabis/cannabisabout.php

Useful tools for parents:
http://www.heretohelp.bc.ca/workbook/cannabis-use-and-youth-a-parents-guide
https://www.drugfreekidscanada.org/wp-content/uploads/2017/06/34-17-1850-Cannabis-Talk-Kit-EN-10.pdf



The rise of vaping

February 06, 2018
E-cigarettes are not benign, but usage of them among youth is on the rise. Though vaping is perceived as a cleaner alternative to smoking, there is mounting evidence of negative effects on people’s health.

Vaping has grown in popularity with the rise of e-cigarettes, but vaping devices also include vape pens and advanced personal vaporizers. Vaping devices consist of a mouthpiece, a heating component powered by a battery and a cartridge for containing the e-liquid. The battery heats up the e-liquid, turning it into an aerosol that is inhaled and exhaled. Typically, the e-liquid in vaporizer products contains propylene glycol, a vegetable glycerin, and/or polyethylene glycol 400 to help create the vapour, mixed with concentrated flavours and often, a variable concentration of nicotine. Tobacco itself is not typically found in e-cigarettes*. Some people use vaping devices to vape THC, the chemical responsible for most of marijuana's mind-altering effects, instead of nicotine. However, the active ingredient of interest to most smokers is nicotine. In Canada, the selling of E-cigarettes or cartridges that contain nicotine is not authorized, and nor is the advertising of these devices as smoking cessation aids. However, it is easy to acquire nicotine online or in non-compliant vaping shops.

Vaping has become vastly popular across Yukon and Canada, with a 2015 Canadian survey finding that about a quarter of youth aged 15 to 19 reported trying an e-cigarette1. In Yukon, from our school aged behaviour’s survey2, 11.7% of grades 9-10 students in 2014 have tried e-cigarettes compared to 18.4% of the same students that have tried smoking. That number is likely changing rapidly with the increasing popularity in vaping.

The health risks and benefits of using these relatively new devices are still being evaluated, but for established smokers, e-cigarettes offer at first glance, an attractive alternative to cigarettes. There are said to be 7000 chemicals released from smoking tobacco, of which at least 70 are known carcinogens. When we look at lung cancer, heart disease, COPD and other chronic diseases, tobacco smoking is a leading cause. Half of active cigarette smokers will die from their addiction. Using E-cigarettes as a nicotine delivery device, can aid quitting and results in lower exposure to chemicals of concern. Tobacco smoke is also avoided as there is no smoke generated, leading to less exposure of second hand smoke to others.

However, there is a growing body of evidence indicating that the chemicals in e-liquid may be dangerous. Some studies have shown concerns about the effects of these propellants on the lungs, being able to trigger allergies and inflammation in the airways, and even some of the heated breakdown products being potential carcinogens. For the lungs of a smoker, these may be relatively minor considerations, but for the lungs of a youth we should be concerned. Consequently, we should balance the potential benefits of e-cigarettes as a harm reduction tool and as an aid to quitting, with the possibility of normalizing smoking again, especially if open use of vaporizers becomes more common. As a cleaner and “cooler” alternative to smoking tobacco, we risk that youth will take this up more easily. They will try nicotine, and nicotine is addicting, and it is possible that they will then turn more easily to tobacco.

Thus, we need to keep track of the evidence as it evolves. We also need focussed, realistic, and up to date educational materials and methods to engage our youth, maximize their education and reinforce their ability to make good choices, so that our youth understand more about what they may be using or thinking about using, and can make sensible decisions in that regard.

Meanwhile, for those who need help with their tobacco habits, Quitpath offers some great resources and personalized supports for both adults and youth.

* However, there is a growing rise in “heat-not-burn tobacco”. This new method of consuming tobacco involves heating tobacco to approximately 500 degrees Fahrenheit using battery power, which turns the tobacco into an inhalable aerosol. Although these products are available in Canada, e-cigarettes currently dwarf their popularity.

References:
1) www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey.html
2) www.hss.gov.yk.ca/pdf/healthbehaviourreport2015.pdf

Helpful Information:
www.quitpath.ca
http://www.smokershelpline.ca/