Health and Wellness Blog

Infertility

Canada's fertility rate (the average number of children per woman) is 1.66 - well below the replacement level fertility rate of 2.1 (the level of fertility the population needs to replace itself from one generation to the next).

Some people choose to be childless due to their lifestyle, others just can't get pregnant naturally or even with medical assistance - that is infertility. In a nutshell, infertility means not being able to become pregnant after a year of trying. It isn't uncommon: there are about 7% Canadian and 10% American having difficulty to get pregnant.

There are various causes of infertility.

• In about 20 percent of cases, infertility is due to a cause involving only the male partner.
• In about 30 to 40 percent of cases, infertility is due to causes involving both the male and female.
• In the remaining 40 to 50 percent of cases, infertility is due entirely to a cause involving the female.

See more details in Merck Manual.

Although Infertility isn't life threatening like cancer, it can be very emotional, and take a toll on your family relationships. Take a deep breath, calm down and check out what options are available out there: treatment or adoption.

Borrow some books from the Toronto Public Library on your topic:

      

More information on infertility:

• Infertility Awareness Association of Canada: Adoption
• MedBroadcast: Infertility
• MedlinePlus: Infertility
• New York Online Access to Health: Infertility

Bounty of summer...

This hasn't exactly been your typical Toronto summer -- cooler than usual temperatures, heavy downpours, and unpredictable thunderstorms. Yet in spite of the unseasonal weather, farmers' markets are going strong all over the City of Toronto.

Why go to farmers markets? Besides the fun of strolling past stands bursting with summer's bounty, for some people, it's a health issue. Produce picked ripe and not transported thousands of miles retains more of its phytochemicals. There is a growing awareness that eating food grown locally and in season is healthier for you. 

It may also be an economic issue. Supporting local farmers makes economic sense specially in bad economic times. 

What do you find at farmers' markets? In a nutshell, everything that's grown locally -- fresh fruits, vegetables, herbs and flowers of course. But you may also find jams, jelly, honey and baked goodies made with locally grown produce.  Some markets also carry meat and fish. You may even discover crafts produced by local artisans. So if you have never been to a farmers' market or haven't made it to one this year, it's not too late. Here is a list of markets in your neighbourhood, there is even a list by days of the week. 

So, no more excuses. Grab your basket or canvas bag and take in the bounty of summer...

Celebrating Earth Day...

Just in time for Earth Day (April 22nd), the Ontario Government is introducing a ban on  the sale and use of cosmetic and non-essential pesticides. All in all, more than 250 chemicals will be banned. According to Premier Dalton McGuinty, it will be the toughest ban of its kind in North America - going beyond ‘just lawns’, it will also include school yards and playgrounds and other public areas. (source) 

There is a growing body of evidence that exposure to pesticides may have ill effects on your health. (source)
The Canadian Cancer Society is particularly concerned that there might be cancer-causing substances in pesticides and has been advocating a ban on the sale and use of cosmetic and non-essential pesticides.(source) 

Pesticides are a group of chemicals that include:

•  Insecticides (for insect control)
•  Herbicides (for weed control)
•  Fungicides (for control of disease caused by fungi)
•  Rodenticides (for rodent control)
•  Fumigants (substances used in gaseous form to control insects)

The above listed chemicals can be used for a variety of reasons and in many settings ranging from controlling pests to improving the appearance of our lawns, commonly referred to as cosmetic use of pesticides. (source)

The Province of Quebec and communities in other parts of Canada have already banned the non-essential use of pesticides and according to public opinion polls, there is strong support to ban the use of pesticides all over Canada. (source)

While you may be supportive of the ban, you may still wonder what you can do to keep your lawn weed-free. For tips on how to wean your lawn off pesticides and go natural, check out the City of Toronto’s website. 

Last but not least, make peace with dandelions… revel in their beauty and maybe even discover some of their hidden health benefits.

Prepared by marietta forster-haberer -- Consumer Health Information Service -- Toronto Reference Library.

Further Reading

Canadian Cancer Society. Cosmetic use of pesticides. 25 March 2009.

Toronto Public Health. Lawn and garden pesticides: a review of human exposure & health effects research. April 2002

Toronto Public Health. Healthy people healthy environment.

CBC News. Pesticide timeline. May 21, 2004.

Health Canada. Healthy Lawn Tips.

Saskatechewan Environmental Society. Be pesticide free.

Is it food allergy or food intolerance?

One in three people believe they suffer from food allergies. However -- according to Health Canada -- only about three to four percent of adults and six percent of young children experience true food allergies. In reality, far more people suffer the unpleasant symptoms associated with food intolerance. So what's the difference?

What is food allergy?

A food allergy is an immune system reponse. When your immune system mistakenly identifies a specific food as harmful -- usually a protein -- it releases antibodies called immunoglobulin E (IgE) and histamines. Allergy symptoms develop when these antibodies fight the mistaken "invaders". (source)

What is food intolerance?

A food intolerance does not involve the immune system. It occurs most often when your body is unable to properly digest certain types of food due to a lack of digestive enzymes. Unlike food allergies, where even a miniscule amount of the offending food can trigger a serious reaction, it usually takes normal sized portions to cause symptoms. While symptoms vary, they tend to originate in the gastrointestinal system. (source)

What are the symptoms of food allergy?

Symptoms of food allergy can range from mild to severe. Anaphylaxis is the most severe type of allergic reaction and can be fatal. Symptoms typically appear within minutes to two hours after you have eaten the offending food. Symptoms may include: (source)

• tingling sensation in the mouth
• swelling of the tonge and throat  
• difficulty breathing  
• rashes and hives
• vomiting
• abdominal cramps
• diarrhea
• drop in blood pressure
• loss of consciousness and death

 What are the symptoms of food intolerance?

Because food intolerance may produce symptoms similar to food allergies, people often confuse the two. They include: (source)

• nausea
• stomach pain
• gas, cramps, bloating
• vomiting
• heartburn
• diarrhea
• headaches
• irratibility, nervousness

 What are the most common food allergens?(source)

• peanuts
• tree nuts (walnuts, almonds, hazelnuts etc.,)
• milk
• eggs
• fish/shellfish
• soy
• sesame seeds
• wheat

What are the causes of food intolerance?

Often it is not the actual food that causes the food intolerance, but substances used in the preparation of food. For example, sulfites used as a preservative may trigger asthmatic reactions. Other substances include artifical colours, nitrates and nitrites; salicylates; preservatives BHA & BHT; MSG and artifical flavourings.

Another major cause of food intolerance is the absence of enzymes needed for proper digestion. A prime example is lactose intolerance. If you lack the enzyme lactase, you won't be able to digest lactose, the main sugar in milk products. (source)

Can you outgrow a food allergy? (source)

Babies and toddlers may outgrow allergies to foods like milk, egg, wheat and soy. Allergies acquired after age three are less likely to be outgrown. Allergies to peanuts, treenuts and seafood may persist throughout a person's life. But there is hope, even for the most severe cases. An exciting new study   describes how people with anaphylactic food allergy can be desensitized and may be able to eat peanuts again. (source)

What should you do if you suspect a food allergy or food intolerance? (source)

First of all, it is important to get a proper diagnosis. Talk to your health care practitioner who can refer you to an allergy specialist for tests. If you have been diagnosed with food allergy or food intolerance, you may have to avoid certain foods alltogether or supplement the missing enzymes. Reading food labels, checking with manufacturers and restaurant owners about ingredients is also very important. And if you are at high risk for anaphylaxis, you have carry an Epipen with you at all times!

Prepared by marietta forster-haberer -- Consumer Health Information Service -- Toronto Reference Library.

Further Reading:

National Agricultural Library USDA. Food and Nutrition Information Center. Resource List on Food Allergies and Intolerances. (February 2008)

http://www.nal.usda.gov/fnic/pubs/bibs/gen/allergy.pdf     

 

U.S. Department of Health and Human Services. National Institute of Allergy and Infectious Diseases. Food Allergy: an overview. (July 2007)

http://www.allergywatch.org/basic/food_allergy.pdf     

 

U.S. Food and Drug Administration. Food Allergies: when food becomes the enemy. (April 2004)

http://www.fda.gov/FDAC/features/2001/401_food.html

 

Mayo Clinic. Food Allergy. (February 2007)

http:// www.mayoclinic.com/health/food-allergy/DS00082

 

 

Good night, sleep tight...don't let the bedbugs bite!

This rather archaic nursery rhyme may not mean much to children nowadays, but there is strong evidence that bed bugs are on the increase in Canada.  According to Toronto Public Health “the number of complaints about the blood suckers have quadrupled over the past two years.” But this is not just a Toronto phenomenon. It’s a worldwide trend and cities all over North America are reporting an upsurge in bed bug infestations - and not just in homeless shelters and hostels…even five-star hotels and upscale condos are no longer safe. (source)

 

Why is there a resurgence of bed bugs?

The truth is, nobody knows for sure. There are many theories, among them increased international travel and immigration, more homelessness, and a shift in pesticide use. After the Second World War, bed bugs were all but wiped out due to extensive use of pesticides, leading among them the lethal compound DDT. The ban of DDT and a general shift to more eco-friendly, but perhaps less effective pesticides, seems to fuel the theory that the change in pesticide use is the main culprit for the bed bug epidemic.

 

Here are some quick facts about the common bed bug (source) 

Also known as Cimex lectularis, the common bed bug is about 4 to 5 millimetres long, has a reddish brown colour, and is flat and oval shaped without wings. 

Bed bug eggs which are white and pin-head sized can be found in cracks in the floor, along the seams of mattresses and on luggage racks in hotels.

Bed bugs feed by sucking blood from birds and mammals. Most species are nocturnal.

They may leave a row of three itchy bites on the skin which may cause an allergic reaction.

 

How do I know if I have bed bugs?

Tell-tale signs are the bites on your skin lined up in a straight row which can be very itchy. Other signs include, tiny bloodstains on sheets and mattresses; dark spots of insect waste and possibly a sweet odour… and of course, the insects themselves which may congregate around the seams of mattresses.

Can bed bugs spread disease?

Bed bugs are normally not known disease carriers although they may be host to the organisms that cause hepatitis B and Chagas' disease. Their bites are a nuisance disrupting sleep and causing allergic reactions in some individuals. (source)

What can I do to prevent and treat infestation?

Vigilance is the first line of defence. When travelling, keep luggage closed and off the floor. Inspect the bed and surrounds carefully for signs of the blood sucking critters and examine what you take home with you for unwanted hitch-hikers. Be careful about picking up second-hand stuff, in particular mattresses, beds and bedding.

If you suspect that you have a bed bug problem, call Toronto Health Connection (416-338-7600). A Public Health Inspector will provide information over the phone about bed bug identification and what is needed to treat the infestation. In severe cases, exterminators may have to be called in to deal with the infestation. Toronto Public Health has several fact sheets on the subject including advice on how to pest-prove your place if you live in an apartment building. They also address the issue of landlord’s and property manager’s responsibility for keeping your place bug free. (source)

Marietta Forster-Haberer -- Consumer Health Information Service, TPL

Further reading

Toronto Public Health.  Bed Bugs Fact Sheets. (2008)

Toronto Public Health. Bed Bug Project. (2008)

eMedicine. Bedbug Bites. (May 2008)

MedlinePlus. Bed bugs, nearly eradicated, make a comeback. (Jan 2009)

Mayo Clinic. Bed Bugs. (Dec 2007)

National Geographic News. Video: Bedbug infestations plaguing hotels, houses. (October 19, 2006)

C'est c. difficile

According to an article in the Toronto Star dated July 4, 2008, over 463 elderly patients have died of Clostridium difficile (c. difficile) in Ontario hospitals in the past 30 months.

This and other coverage has prompted a flurry of concern around this issue. Ontario hospitals are now required to report the number of cases of c. difficile on a public website - Patient Safety Ontario, the CBC reported last week. However, this website does not list c. difficile-related deaths.  Because c. difficile typically attacks patients who are already sick, cause of death is sometimes difficult to determine. Also, consumers should bear in mind that it is not easy to compare hospitals:

Since the number of cases a hospital has depends on how large it is, what type of patients are admitted and how well the hospital controls it, the website doesn't give a sense of "good" or "bad" hospitals, cautioned Dr. Alison McGeer, a microbiologist and director of infection control at Toronto's Mount Sinai Hospital. (source)

What is c. difficile?

Toronto Public Health defines clostridium difficile as:

bacteria found in feces that can cause diarrhea and more serious intestinal conditions such as colitis (inflammation of the colon), sepsis (disease-causing bacteria or toxins are found in the bloodstream and tissues) and even death.

Because it is commonly abbreviated, many people miss the association of c. difficile with related bacteria clostridium botulinium (which causes botulism or food poisoning) and clostridium tetani (which causes tetanus or lock jaw). 

According to the Public Health Agency of Canada, c. difficile is one of the most common diarrheal infections in hospitals and long-term care facilities in the industrialised world. Whereas healthy people don't usually get c. difficile, the elderly and people who have other illnesses or conditions requiring the use of antibiotics are at greater risk of infection. In these people, toxins produced by the bacterium can damage the bowel and cause diarrhea. This condition is known as Clostridium difficile associated disease (CDAD). (source)

On June 17, 2008, an article in the Canadian Medical Association Journal noted that c. difficile rates in Ontario hospitals have surpassed those in Quebec, but that the most virulent strain of the bacteria "remains associated with Quebec, where outbreaks led to an estimated 2000 deaths earlier this decade". This article goes on to observe that mandatory reporting is hampered by a lack of clear legislative authorities for surveillance activities.

How can you avoid c. difficile? (source)

The bacteria in feces can contaminate surfaces such as toilets, handles, bedpans, or commode chairs. When you touch a contaminated surface, your hands can become contaminated. If you touch your mouth or food without washing your hands, you can become infected. Your unwashed hands can also spread the bacteria to other surfaces.

If you are visiting a hospital, hand hygiene is the most effective way avoid spreading or catching c. difficile and a number of other infections. Use an alcohol-based hand sanitizer or wash your hands with anti-microbial soap and warm water, for as long as it takes to sing the alphabet (about 15 seconds). Turn off the tap with a paper towel. Do this before and after visiting and between seeing patients (if you are visiting more than one person).

Although healthy people are not usually affected by the bacterium, if you have concerns that you might have been exposed, a thorough cleaning of your home, clothes and dishes with soap and hot water will minimise the risks posed to you and your family.

Donna MacLeod for Consumer Health Information Service, Toronto Public Library

Further reading

• Patient Safety Ontario website (Find by hospital name)
• Government of Ontario. Clostridium difficile Associated Disease (CDAD) Fact Sheet for Patients (no date provided)
• Toronto Public Health Clostridium difficile fact sheet  (November 2006) and Handwashing instructions (no date provided, available in many languages)
• Public Health Agency of Canada Fact sheet: C. difficile (June 20, 2008)
• Canadian Medical Association Journal Ontario's hospitals surpass those of Quebec in C. difficile rates. CMAJ, June 17, 2008; 178 (13). doi:10.1503/cmaj.080804
• Mayo Clinic's comprehensive overview of C. difficile (December 13, 2006)
• MedlinePlus's Clostridium difficile infections (June 24, 2008)
• Physician's Desk Reference Clostridium difficile infection (2008)

Listeriosis outbreak

Listeria (Listeria monocytogenes) is a bacterium commonly found in soil and water, and in domestic animals. It can be responsible for a relatively uncommon but serious food-borne illness called listeriosis or listeria infection. Listeriosis is caused by eating food contaminated with the bacteria. Types of food commonly contaminated by listeria include dairy products, fish, meat, and vegetables. Contamination can occur at any point in the farming, distribution, and food preparation process.

Listeria is different from other bacteria that cause food poisoning because it can survive and continue to grow even when in the refrigerator. Foods contaminated with listeria look, smell, and taste normal. Not everyone who is infected with listeria will develop listeriosis. For those who do, however, symptoms may develop suddenly as soon as 1 day after and up to 90 days after eating food contaminated with listeria. (source)

Fortunately, listeria can be killed by proper cooking methods. However, even thoroughly cooking food does not guarantee that it is safe to eat if proper food-handling techniques were not used. For example, if the cooked food becomes cross-contaminated by infected, raw food, it is no longer safe to eat.

While otherwise healthy people do not generally become ill from a listeria inflection, pregnant women, newborns, seniors and people with a weak immune system may become seriously ill. Pregnant women in particular are about 20 times more likely to acquire the disease than other healthy adults.

Listeria infection can often be controlled with antibiotics. Prevention, however, is the best method to avoid illness. Always taking simple food-safety precautions can drastically reduce your chances of contracting most food-borne illnesses.

For more information

Regarding the current outbreak of listeriosis connected to the Maple Leaf Foods recall, more information is available from the following sources:

• Maple Leaf Foods consumer affairs infoline 1-800-568-5801 and website
• List of recalled products
• Listeria investigation: Ready-to-eat meat products (Questions and answers for consumers)
• How the Canadian food safety system works: Food recalls

Health Canada and the Public Health Agency of Canada estimate that every year between 11 and 13 million Canadians suffer from illnesses caused by foodborne bacteria. (source)

Donna MacLeod for Consumer Health Information Service, Toronto Public Library

Further reading

For more information about listeriosis:

• Mayo clinic Listeriosis
• Health Canada What is listeria
• Public Health Agency of Canada Listeriosis (Listeria) outbreak

For more information about food safety:

• Health Canada Listeria and food safety
• Health Canada Reminds Canadians of Steps They Can Take to Protect Themselves from Salmonella
• Canadian Partnership for Consumer Food Safety Education Food safety factsheets
• Canadian Food Inspection Agency Food safety facts on Listeria and Food safety games for kids