Yukon Chief Medical Officer of Health

Dr. Brendan Hanley

CMOH Media Blog

Last Updated: March 28, 2018


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/