You Really Are What You Eat: Can Food Actually Have an Impact on Health and Disease?

I get a lot of questions from patients about food. There’s a lot of interest lately in using food to treat disease. Now, we know that “eating right” is “healthier” in that too much of anything can make us gain weight, and being obese can put us at risk for heart disease and diabetes, for example. But more and more people are asking me if certain foods can reduce inflammation in the body, reduce cancer risk, and actually change their risks for certain diseases – not just based on the caloric content and impacts on their weight.

Along those same lines, I am seeing more and more patients who tell me that a certain dietary change had a major impact on something totally unrelated and unexpected – like their otherwise hard to treat skin condition, or their child’s behavior in school.

Is there any validity to this?

Though the temptation is to dismiss these associations as coincidence, our growing understanding of the human microbiome has opened our eyes to ways in which food might possibly have a major impact on determining our health and disease states.

What is the microbiome?

The human microbiome is the genetic blueprint of all the organisms (viruses, bacteria, fungi, etc – also called microbiota) that live within the human body. Typically, we think of “bugs” as causing infections. But there are a few areas in our bodies that organisms call home, such as the gut, vagina, lungs, and skin. They feed off of our bodies, and often help us out in various ways in exchange. In recent years, there have been efforts in Europe, the US, and China to sequence and characterize the human microbiome. And what we’ve found is that it’s rich and diverse. You thought humans had a lot of genes? The human microbiome has at least 30 times the number of genes as the human genome!

So now that the human microbiome has been sequenced, the next step is to slowly understand what all the different genes and organisms do.

What determines a person’s microbiome?

The specific organisms living in a person’s gut and the genes that those organisms carry are different from those found in that same person’s lungs, and different from those found in another person. But we’ve noticed that there are also a lot of commonalities. And the people who have more similar microbiota to one another tend to either be related, or live near each other. We’ve also noticed that people who have the same illnesses also have similar changes in their microbiome.

No one knows exactly what determines a person’s microbiome, but we know it’s complicated. It’s likely a combination of genetics and environmental determinants. We know that antibiotics and chronic inflammation can alter the microbiome, as can food.

So why does this matter? Well, it’s hard to change our genetics, and often hard to change a lot of things in our environment. But we can change what we eat, and in turn manipulate our microbiome.

Why does our microbiome impact our health?

As we begin to understand the role of the different microbiota, we’re starting to understand the important role the microbiome plays in maintaining the “status quo” of our bodies. We’re also starting to see that these organisms play a role in how our bodies develop immunity and mediate inflammation.

For example, some of the genes in some of the organisms in our gut are responsible for allowing our bodies to digest certain foods. Without these genes or these organisms, we would not be able to digest these foods. This would be both a nuisance because we would feel sick or bloated when we ate them, but would also lead to significant nutritional deficiencies if these foods were supposed to be major parts of our diets. So why is this concept unique? Because that isn’t our genes that allow us to digest our food – it’s a gene that belongs to a bacteria, that lives inside of us.

On the negative, some of the microbiota in our guts are responsible for releasing from our foods certain compounds that can signal tumours and cancers to grow. Again – these aren’t our genes doing this – these are genes that belong to a bacteria, living in our gut.

I know what you’re wondering – if certain organisms cause inflammation and cancer, and others are good and promote health, why can’t we just eat differently and create a more favourable microbiotic environment?

Food as Medicine?

Believe it or not, this is concept that isn’t far off. We already know that taking antibiotics can decrease the richness of the gut microbiota and can lead to overgrowth of a bacteria called clostridium difficile, that can lead to a severe diarrheal illness. We also know that repopulating the microbiota can treat a stubborn clostridium difficile infection – we do this by transplanting stool from an uninfected person into a person with the infection. A less dramatic example is using a probiotic to treat infectious diarrhea or irritable bowel syndrome.

We know that people with fewer species making up their microbiota have more obesity, diabetes, high cholesterol, and inflammation. We also know that diets with more fiber, fruits, and vegetables lead to a richer microbiome. And we’ve shown a positive association between diets high in fiber, fruits, and vegetables, and  a lower risk of inflammatory bowel disease.

What next?

The problem is, we have a lot we still need to understand about the human microbiome, and the complex role it has in health and illness. We need to recognize that the microbiome is only one piece of the puzzle – we also have to contend with different genetic predispositions to certain diseases, and a whole host of other factors. But the more we understand, the closer we are to being able to actually change one major determinant of our health, and we can potentially do that by modifying what we eat.

So for the time being, when people ask me what they can do to “be healthier” – eat a diet high in fiber, fruits, and vegetables.  Consider reducing the amount of meat. And most importantly, stay tuned, because in the next few years, we will likely have gained a much better understanding of how to use food as medicine. But for now, there are very few conditions we can treat with diet alone. That being said, when people come in telling me that changing their diet lead to a major improvement in a symptoms or condition they have, I believe it! And I think it’s likely because they changed their microbiome.

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Every few months, I’ll stumble upon something on my Facebook feed about a celebrity, and their opposition to vaccinating their children. When did it become totally mainstream to not vaccinate your kids?

As a mom and a doctor, it really freaks me out when I read about measles outbreaks in Canada or the United States.  It actually freaks me out more than when I read about Zika virus, or Ebola.

Back in the first half of the 20th century, hundreds of thousands of children were left dead or debilitated from diseases like polio and  measles.  Before the polio vaccine was introduced in 1955, thousands of Canadian children were affected.

Polio used to be called “infantile paralysis” or “the crippler”; because it could permanently damage nerve cells that control muscles. Thanks to immunization, Canada has been polio free for the last 20 years.

So that’s why we never hear about these diseases anymore.

We managed to effectively eradicate many devastating diseases from a large part of the world through vaccination programs, however, unfortunately, there are other parts of the world where widespread vaccination isn’t possible. And every year, travelers who aren’t immune, visit places where diseases like measles are active, and bring them back. If parents choose to not vaccinate their kids, there will be whole crops of susceptible people, so that one infected traveler can pass the disease on to others including infants who are too young to be vaccinated.

So why not keep your kids away from people who seem really sick, and prevent transmission?

Well, that’s good sense, and I’m certainly not knocking it. But it’s important to remember that these infections are highly contagious, and can manifest themselves as illnesses of varying severity in different people. Like how you may have had the sniffles, but your husband was down for a week with the flu? Well the same is true of measles, for example. It may cause nothing but a mild ear infection in one kid, but a horrible brain infection in another.  And there’s no way to know the outcome ahead of time.

The other thing to know is that some groups of people, like young babies, elderly people, and pregnant women, are more susceptible to catching and getting sick from the disease. So like, when your sister who hasn’t told anyone she’s pregnant yet comes to visit your child who you think just has a cold, but is actually shedding whooping cough…  You get the idea.

As parents, we all want the same thing – to protect our kids from harm. I’m a mom to 3 young boys, and my main concern is to keep them safe and happy. I’ve chosen to vaccinate them because I am overwhelmed with the amount of sound data supporting the benefits of vaccines. I don’t want my boys to get sick from whooping cough, measles, or mumps.  If I had daughters, I wouldn’t want them to get cervical cancer. I’ve reviewed the literature, and haven’t seen any compelling quality evidence to suggest that vaccines are bad.

So my advice to the editors of that tabloid magazine? Stick to what you know. And I won’t talk to my patients about what colour pants they should or shouldn’t wear after Labour Day…

This post was developed in association with the Ontario Ministry of Health and Long-Term Care. The opinions of the author are their own.

Getting your family immunized is an important part of creating a foundation for a healthy life and it’s normal to have questions. Here’s the information you need to make an informed decision for your family.

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Pourquoi ne suis-je pas les conseils des célébrités sur l’éducation des enfants?

Tous les deux ou trois mois, je tombe sur un article de mon fil d’actualité Facebook au sujet de l’opposition d’une célébrité à la vaccination de ses enfants. À quel moment la non-vaccination des enfants est-elle devenue une tendance à la mode?

En tant que mère et médecin, je ressens un profond malaise lorsque je lis des articles sur les éclosions de rougeole qui surviennent au Canada ou aux États-Unis. Mon malaise est en fait encore plus profond lorsque je lis des articles sur le virus Zika ou Ebola.

Dans la première moitié du 20e siècle, des maladies telles que la polio et la

rougeole ont tué ou affaibli des centaines de milliers d’enfants. Avant le lancement du vaccin contre la polio en 1955, des milliers d’enfants canadiens étaient touchés.

On appelait la polio la « paralysie infantile » parce qu’elle pouvait causer des dommages permanents aux cellules nerveuses qui activent les muscles. Grâce à la vaccination, aucun cas de polio n’a été signalé au Canada au cours des vingt dernières années.

C’est la raison pour laquelle nous n’entendons plus parler de ces maladies.

Nous avons réussi à éradiquer efficacement de nombreuses maladies dévastatrices dans une grande partie du monde au moyen de  programmes de vaccination.  Cependant, il n’est pas possible malheureusement d’utiliser la vaccination à grande échelle dans d’autres régions du globe. Chaque année, les voyageurs non immunisés qui visitent des endroits où des maladies comme la rougeole est active les ramènent au Canada. Si les parents choisissent de ne pas faire vacciner leurs enfants,  des cultures entières de personnes sensibles seront atteintes de sorte qu’un voyageur infecté peut transmettre la maladie à d’autres, y compris à des nourrissons qui sont trop jeunes pour être vaccinés.

Pourquoi donc ne pas tenir vos enfants éloignés des personnes qui semblent réellement malades et ainsi prévenir la transmission des maladies?

Eh bien, cela a du sens, et je ne dénigre certainement pas cette idée. Mais il est important de se rappeler que ces infections sont hautement contagieuses et peuvent se présenter comme des maladies de divers degrés de gravité chez différentes personnes. C’est comme si vous aviez eu un léger rhume, mais que votre mari avait la grippe pendant une semaine. Eh bien, il en va de même pour la rougeole, par exemple. Cela ne peut causer rien d’autre qu’une légère infection des oreilles chez un enfant, mais une horrible infection du cerveau chez un autre. Et il n’y a pas moyen de connaître le résultat à l’avance.

Il faut aussi savoir que certains groupes de personnes tels que les jeunes bébés, les personnes âgées et les femmes enceintes sont plus susceptibles d’attraper une maladie.  C’est comme si votre sœur qui n’a dit à personne encore qu’elle est enceinte vient rendre visite à votre enfant qui, à votre avis, n’a qu’un rhume, mais a en fait des quintes de toux coquelucheuse… Vous comprenez?

En tant que parents, nous voulons tous la même chose   ̶  protéger nos enfants contre la maladie. Je suis mère de trois jeunes garçons et ma plus grande priorité est de les garder en sécurité et heureux. J’ai choisi de les faire vacciner parce que j’ai accès à de nombreuses données solides appuyant les avantages des vaccins. Je ne veux pas que mes garçons aient la coqueluche, la rougeole ou les oreillons. Si j’avais des filles, je ne voudrais pas qu’elles aient le cancer du col de l’utérus. J’ai passé en revue la documentation et je n’ai vu aucune preuve solide irréfutable laissant indiquer que les vaccins sont mauvais pour la santé.

Donc, mon conseil aux rédacteurs de ce tabloïde? Tenez-vous en à ce que vous savez. Et je n’aurai pas une discussion avec mes patients sur la couleur des pantalons qu’ils doivent ou ne doivent pas porter après la fête du Travail.

Ce blogue a été rédigé en association avec le ministère de la Santé et des Soins de longue durée de l’Ontario. Les opinions de l’ auteur lui appartiennent.

The post Why I Don’t Take Parenting Advice From Celebrities appeared first on Talia Zenlea.

There are more than 100 types of Human Papillomavirus (HPV) out there, and it’s a VERY common virus that affects both females and males.

How common?

About 75% of sexually active Canadians will have at least one HPV infection during their lifetime.

And we have to remember that it’s not just intercourse that spreads HPV – any sexual contact can potentially cause an infection. Luckily, most people who are exposed to a strain of HPV clear the virus without any lasting effects. However, some people don’t, and the effects can be devastating.

As doctors, we care a lot about HPV, and here’s why: HPV causes not only genital warts, but cancer as well.

In women, HPV can cause cervical cancer, and in men, it can cause throat and anal cancer.

I have personally seen young, otherwise healthy people diagnosed with these cancers. Yikes. Cervical cancer is the second most common cancer in women aged 20-44, and in Canada, almost 400 women die each year from it. Young women. Our daughters, sisters, mothers, friends.

Thankfully, a safe and very effective vaccine exists against the most problematic strains of HPV – the ones that cause the majority of cancers and warts. In Canada, two vaccines exist to protect us from HPV – Gardasil and Cervarix. Gardasil protects against strains that cause warts AND cancer; Cervarix protects against two strains known to cause cancer only. Health Canada has recently approved Gardasil 9, which protects again 9 strains of HPV. These 9 strains are known to cause 90% of cervical cancers, 75% of vaginal and anal cancers, and over 90% of warts. Wow – in vaccine talk, that is a very effective vaccine! This vaccine is approved for females aged 9-45 and males aged 9-26.  There are three doses and it is important to complete all three. As always, talk to your own doctor to see if these vaccines are right for you, given your personal medical history.

And an important point to remember: being vaccinated does not take place of regular Pap tests to screen for early changes of cervical cancer. These are still a very important part of your health.

As a family doctor, this vaccine excites me. A vaccine against cancer – how amazing! Gardasil underwent years of testing before hitting shelves. It is safe. My own children will absolutely be getting vaccinated ASAP. Happy 9th birthday, kids!! Research is ongoing, but it is thought that the vaccination is most effective when given before the age of 15. But it’s still effective anytime in the above stated age ranges.

A website I like to direct my patients to for more information is www.hpvinfo.ca. Educating yourself and your children is a powerful thing. Protecting your children from harm is never going to be a mistake. Telling them to wear a seatbelt does not make them want to drive recklessly. Ensuring they wear a bike helmet does not guarantee they will be signing up for BMX races. Talking to them about safer sex and vaccinating them against HPV does not mean they will want to be sexually active early or often. It means that when they do become sexually active, they will be protected from the worst strains of HPV.

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What You Need to Know About Post-Partum Depression

Recently many celebs, such as Hayden Panettiere and Drew Barrymore, have opened up about their battles with Post-Partum Depression (PPD). However, despite the “awareness” raised by their stories, most of us still don’t know when the line is crossed from being a hormonal, sleep deprived new mom, to being a woman suffering from a serious mental health condition.

Even doctors are only just beginning to understand what post-partum depression is.

What many people don’t understand is that very often, PPD can begin during pregnancy. It can affect women of any age, regardless of their mental health or prior reproductive history. Furthermore, we know very little about other debilitating conditions, such as anxiety disorders, that can happen during this very vulnerable time as well.

Here are 5 warning signs that you, or any new or soon-to-be mother, should consider seeing a mental health professional:

Another “bad day.” Sure, the early stages of parenthood are prone to frustration, but if you are finding yourself constantly sad or irritable, overwhelmed, or have trouble enjoying hobbies, food or your new bundle of (would-be) joy, then take note and monitor your feelings. If weeks go by and you still feel the same or worse, seek help.

Counting sheep. Sleep deprivation is almost universal among new parents, but in most situations is due to the wee one’s tendency to rely on mom and dad for soothing in the early hours of the morning. However, if you are counting sheep while your little lamb is fast asleep, then there may be a problem.

The world is blue. We often seek solace in that first month of motherhood in the hope that the screaming, purple-faced little ball of flailing fists will soon become a babbling, cooing and smiling little joy in the coming months. We also at the end of the day are able realize that we are doing the best we can. But if you find yourself dwelling on the negatives when it comes to the past, the future, and especially yourself, this could be a sign that you need help. This extends far beyond what many of us would experience as simple “mommy guilt” when we let the crying go on a little too long while we unload the dishwasher. Depressed moms can become hopeless and self-loathing.

It’s all too much. It is natural to feel wiped out by sleep deprivation, but most of the time we are able to attend play groups, take out the stroller for a walk and throw together dinner (even if it is just PB and J). It is not normal to consistently be too exhausted to play with your little one, or to get out of the house. This can especially be a problem if you are putting off going to the doctor because you are simply too tired to get off of the couch or too anxious to leave the house.

Mega Mommy brain. As a new mom, nobody would expect you to write a novel, but if you just spent an hour watching Grey’s Anatomy and really can’t remember who Dr. McDreamy is currently dating, then take it as a sign that something is brewing. People with depression often feel too foggy and exhausted to focus, while those with anxiety sometimes feel too frazzled or distracted by other thoughts and worries.

And remember to trust yourself. If you feel something just isn’t right, and you’re concerned you might have post-partum depression, don’t hesitate to seek help. You’re doctor is there to help you, and you aren’t alone.

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Good bone health is essential for all women. Osteoporosis and osteopenia, or low bone density, are diagnosed based on a bone mineral density (BMD) test.

Low bone density increases the risk of fractures and is very common in women, increasing in risk as we age.

Fortunately, bone loss is not inevitable.

Here are 5 ways you can ensure good bone health.

DRINK YOUR MILK: Calcium is a necessary building block for healthy bones, and builds bone density. In people who do not have enough calcium, the body will actually take calcium from the bones to meet its needs. It is very important for all women to make ensure that their diet is high in calcium. Children, postmenopausal women, and women who are pregnant have the highest calcium requirements. The best sources of calcium are dietary and include dairy products, leafy green vegetables and fish.  A general rule is that one serving of calcium-rich foods contains approximately 300 mg of calcium. Current recommendations are for 1000-1200 mg of calcium daily, either in the diet, as a supplement, or both, for all women over the age of 50.

GET OUTSIDE: Vitamin D is necessary for healthy bones because it helps your body absorb calcium. The best source of vitamin D is from sunlight. Low levels of vitamin D are common in many women, especially women who live in colder climates and spend less time outside in the sun. (In case your wondering, sunscreen probably does act as a barrier, but it’s not a good reason not to slather it on!). Dietary sources of vitamin D include fish, eggs, and foods fortified with vitamin D, such as certain cereals. Vitamin D can also be taken as a supplement, but because Vitamin D requirements can vary from person to person, ask your doctor to check your levels before starting on a supplement.

KEEP MOVING: Any activity that places weight on your bones stimulates bones to increase in density. I always encourage my patients to focus on activities that they already like to do, like running, walking, dancing, playing tennis, yoga, and Tai chi. Resistance exercises, like using free weights or weight machines are another great option. It is a good idea to speak with your doctor about which exercises are good for you.

DON’T SMOKE: In addition to all of the other terrible side effects of smoking, it can also worsen your bone density. The bottom line is, if you smoke, stop. If you need help stopping, reach out to your doctor as there are lots of options available to help you.

KNOW YOUR HISTORY:  It is important to understand if there are other family members with osteoporosis, as family history can be a risk factor. All post-menopausal women should be screened for osteoporosis with a bone mineral density test (also called a DXA scan) regardless.

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I get asked about hiatal hernias a lot – what are they, can they be fixed, and most importantly, are they the cause of my symptoms.

Chances are, if you’ve been told you have a hiatal hernia, it’s because you underwent some sore of upper-GI investigation, like an endoscopy or barium swallow, as part of a work-up for symptoms. There’s no way a hiatal hernia can be diagnosed just be looking at you or through a regular physical exam. So it’s no surprise that most people who know they have a hiatal hernia also tend to have upper GI symptoms, like heartburn, pain or trouble swallowing. This can sometimes lead people to conclude that the hiatal hernia must be responsible for the symptoms – because everyone else on the online forum with a hiatal hernia also has symptoms.

It’s important to remember that hiatal hernias are very common, and most often are totally asymptomatic. Here’s what you need to know about hiatal hernias.

What is a hiatal hernia?

The diaphragm is layer of muscles, that acts as a divider between the chest and the abdomen (like the floor of the chest cavity and the ceiling of the abdominal cavity). The esophagus is the swallowing tube that runs from your mouth to you stomach, meaning it passes through the chest to end up in the abdomen. In order to allow the esophagus through, there’s an opening in the diaphragm, known as the hiatus. Think of it like those pole firefighters slide down (that’s your esophagus), and the hole in the floor of the upstairs to allow the pole to extend to the floor below. Typically, the stomach sits right below the diaphragm (in the “downstairs” abdominal cavity). In people with a hiatal hernia, a part of the stomach pushed up through the hole in the diaphragm. Most of the time, this is because unlike the firefighter’s pole, the esophagus isn’t fixed, and can slide up and down a little bit, bringing the stomach along for the ride. This is called a sliding hiatal hernia. In rare cases, the top of the stomach can push up through the hole in the diaphragm, along side the esophagus. This is a more serious condition called a paraesophageal hernia. Since paraesophageal hernias are pretty uncommon, for the purposes of this discussion, when I refer to a hiatal hernia, I mean a sliding hernia.

What are some symptoms of a hiatal hernia?

The vast majority of the time, a hiatal hernia causes absolutely no symptoms at all. Some people have hypothesized that a hiatal hernia can worsen symptoms of acid-reflux, because when the top of the stomach slides up above the diaphragm, the diaphragm “pinches” that bubble of tissue, making it hard for the stomach acid to move back down to the lower parts of the stomach, and instead causes them to reflux upwards into the esophagus. Symptoms of acid reflux include heartburn, pain in the chest or stomach, acidic taste or pain in the throat, or trouble swallowing. (But these symptoms are general and can be caused by any number of things – so always discuss symptoms like these with your doctor!).

How is a hiatal hernia treated?

Most of the time, hiatal hernias do not cause symptoms and do not require treatment. If it’s thought that you have symptoms of acid reflux, your doctor may suggest a combination of dietary and lifestyle changes, and/or medications – the same things doctors would suggest whether or not you have a hiatal hernia. To learn more, read about heartburn here.

If you have an exceptionally large hiatal hernia that’s causing a lot of trouble, your doctor may recommend that it be corrected. The only way to do this is with an operation to pull the stomach down and prevent it from going back up.

So the long and the short of it: unless your doctor has told you otherwise, your hiatal hernia is most likely just something that was found by accident, and not something you need to treat.

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Neonatal Eye Ointment and the Canadian Controversy

Local mommy groups are abuzz this week after Canadian news outlet, Global, reported that the mandatory application of prophylactic eye ointment to newborns was “ineffective, outdated and unethical.” What followed were two camps: happy hippies, and a lot of pissed off doctors. All of this suggesting to me that a lot has been misunderstood.

Here’s why this is a really big deal.

Antibiotic eye ointment is mandatory in many states and Canadian provinces. In some places, parents who refuse it on behalf of their newborns can be reported to Child Protective Services. In Texas, medical staff who fail to give it can be criminally charged for a class B misdemeanor. That sends a pretty clear message to the public and to the medical community that antibiotic eye ointment is considered REALLY IMPORTANT, and that the benefits must inarguably outweigh the risks. Unfortunately, not everyone agrees.
Now often in matters of health and wellness, we have people who disagree, even with messages as clear as this one. But this time, it’s not just anybody (cough, cough Jenny McCarthy). This time, it’s the Canadian Society for Pediatrics. In March 2015, they came out with a position statement quite clearly stating that erythromycin eye ointment should not be routinely recommended. Have the Canadians gone completely insane?

Back up. Why do we give infants eye ointment, anyway?

The reason we give infants eye ointment is to prevent something called ophthalmia neonatorum. Ophthalmia neonatorum is an eye infection that occurs in babies in their first month of life, and generally, it’s no big deal. Except for when it’s caused by an organism called N gonorrhoeae (the same bug that causes gonorrhea). In those cases, it very often progresses rapidly to a devastating eye illness and eventually blindness. The way a baby would get gonorrhea in their eye would be from passing through the birth canal of an infected mother, or even from a Cesarean delivery where the bugs crawl up the cervix into the uterus. Because a woman doesn’t always know if she is infected with N gonorrhoeae, and because it used to be pretty common, it was a no-brainer to give all babies ointment to prevent an infection that could otherwise lead to blindness.

So what’s the issue?

In the past, gonorrheal infection was a lot more common than it is now. Nowadays, the vast majority of cases of ophthalmia neonatorum (like, 99% of them) are caused by other organisms. Though erythromycin eye ointment may very well kill some of those other bugs, it’s not really necessary since those other bugs don’t cause a severe illness or blindness, the way N gonorrhoeae does.
The issue brought to light by the Canadian position statement is that it’s not really clear that erythromycin eye ointment actually works to prevent ophthalmia neonatorum caused by N gonorrhoeae, which is sort of the whole point of using it. The reason for this is that emerging strains of N gonorrhoeae are resistant (about 25%).  Does overuse of erythromycin eye ointment breed this resistance? Unclear. And just to add more murk to these waters, one recent meta-analysis, which is a study that looks at the quality and findings of all the other studies on this topic, showed that the quality of all of the evidence pretty much sucked, and the prophylactic agents (like erythromycin eye ointment) had significant failure rates at preventing the disease they were being given for.  So I know when I said that the vast majority of cases of ophthalmia were not caused by N gonorrhoeae anymore, many of you probably thought—well duh, that’s because we give prophylactic eye ointment now. But this argues against that—it argues that it’s not doing much at all.

But my 3 kids got erythromycin eye ointment and they’re fine.

So here is where many of the media reports missed the point. This wasn’t a discussion about the safety of erythromycin eye ointment. Some groups argue that it could blur vision and interfere with mother-baby bonding. It can also cause eye irritation in rare cases. But that wasn’t the point of the position statement. They didn’t argue that we should stop using it because it’s harmful. They argued that we should stop using it because it doesn’t work.

So why not just use it anyway? I’d take the risk of some minor eye irritation to prevent a devastating infection and blindness.

According to the Canadian Pediatrics Society (and by the way, also Denmark, Norway, Sweden and the United Kingdom, who haven’t mandated universal ocular prophylaxis in decades), there’s no reason to do something that doesn’t work. It’s like saying why not just stand on your head when you have a flat tire.
Now, the other thing they aren’t saying is that we just suck it up and deal with a small percentage of blind babies. The Canadians, like Texas, agree that gonococcal ophthalmia is really, really important. The whole point of their article was to find the best, most effective way way to prevent its devastating consequences. They went on the suggest strategies that might be better at preventing gonococcal ophthalmia, like more aggressive maternal and infant screening strategies, more aggressive medical prophylaxis for at-risk babies, early aggressive treatment when infection is identified, education, and close follow-up.

OK, so we’re good with the new plan then?

Well, not really. And this is where I think a lot of the confusion lies, and a lot of the backlash.
It’s all well and good to suggest, as the Canadian Pediatrics Society did, that we screen pregnant women for gonorrhea and treat them, and this way you’re actually preventing N gonorrhoeae from being where it shouldn’t be. The real problem is that we have no idea if this is actually an effective strategy AND it raises a whole slew of other problems.
Some people refuse testing because they don’t believe they’re at risk. But, as any doc can tell you, we’ve all seen the pregnant nun in the office, or the little old happily married lady with syphilis.  Some sexual partners lie, and unfortunately, you often don’t know until something bad happens. Like your baby going blind from a gonorrheal eye infection. Also, sexually transmitted infections like gonorrhea are gifts that keep on giving. You have to treat ALL the partners. Meaning that poor pregnant lady whose partner would never cheat on her needs to be treated, but so does her husband who swears he picked it up on a public toilet seat. And probably also the women he’s adamant he’s not sleeping with.
See how this can get really tricky? So even if you manage to identify and treat the pregnant mom, you can’t control that they won’t get reinfected the next day. You know the great old wives tale of the best thing you can do to bring on labour? Well, you can even contract gonorrhea then (and no, I’m not talking about jumping up and down. Or about Flamin’ Hot Cheetos, though I’m 99% sure those worked for me.)

Did anyone ask the experts?

So, it’s cool that Global news asked a midwife what she thought. But what about the people who actually treat babies with gonococcal eye infection? Turns out, they think the Canadian Pediatrics Society’s position statement is a load of crap. The President of the Canadian Association of Pediatric Ophthalmology and Strabismus published a letter to the editor of the Canadian Journal of Ophthalmology, in which he expressed his feeling that the statement failed to recognize that gonococcal ophthalmia is a lot more common than we think because it often goes unreported, and that c trachomatis (aka chlamydia) can also cause serious problems when it finds it way into a newborn’s eye and can also be prevented with eye ointment. Additionally, it fails to consider the risks of stopping prophylactic eye ointment, and fails to present any evidence that the proposed alternatives are effective. Most importantly, it fails to adequately review the evidence. Meaning that that meta-analysis I told you about? They eye doctors interpreted the findings to say the exact opposite of what the pediatricians reported. So basically, the eye doctors think the report is a giant failure in all aspects. The author ends the letter by urging the Canadian Pediatrics Society to reconsider their position statement, and retract their recommendation to stop eye prophylaxis. Oh, and they suggested that next time the pediatricians write a position statement about eye prophylaxis, they talk it over with the eye doctors first.

Here’s the story behind the story.

What the Canadian Pediatrics Society is ACTUALLY suggesting is not to avoid the evils of Western medicine, but rather to aggressively prevent and treat infection in at-risk babies with a shot or infused antibiotics; and aggressively screen and treat pregnant moms.
As you can see, the alternative to eye ointment is fraught with a lot of potential problems, not the least of which being that the eye doctors don’t agree that it’s even necessary. I don’t know what the “right answer” is here, nor was my goal to force my opinions onto you. The purpose here was just to make sure we’re all on the same page about what the Canadians actually said. So now you know, eh?

The post Oh, Canada: The Controversy Over Neonatal Eye Ointment appeared first on Talia Zenlea.

The topic of gift-giving has come up recently in my family.

I love seeing the smile on my kids’ faces when they get something they like. That something doesn’t necessarily need to be huge – yesterday my son got a free paper subway and it hasn’t left his side since.

I want to teach them to appreciate that special feeling of having something they love, taking good care of it, and valuing it, but it sometimes conflicts with me also wanting to teach them to appreciate what they already have, and not to always expect more and more and more.

A few months ago, I had my third baby boy.  It was the first time I had a baby in the city where most of my family lives, so there was an out-pouring of gifts, not only for the new guy but for the other boys, too. (This was compounded by the fact that my new baby was born on my older son’s third birthday…) At one point, a family member came, and my older son asked if she had brought him a present. She said she had, he opened it, and told her he didn’t like it.

It was the first time I’ve ever been mortified by my kid’s behaviour.

And I realized it wasn’t his fault at all. I was embarrassed for myself, and what we had unintentionally taught him over the previous few weeks.

As the winter holiday season gets nearer, I want to be mindful of how we approach the topic of gifts with my toddlers, and hopefully teach them a better lesson this time around.  I also know how much fun it is to buy a cool gift for someone and know they’ll love it and use it. I want to make sure that’s part of the process, too.

So this year, I’ve decided to have my kids participate in Project Snowman, a really awesome effort by a local mom in my area to outfit 1000 kids in need of snowsuits. I plan to take them shopping, have them pick out a snowsuit they love, wrap it, decorate it, and drop it off, and hopefully have them understand the meaning and value of the gifts they are giving. I’m also having them pick out one thing to buy for their brothers, so they can actually see the joy a gift can bring someone else.

I’m hoping that this time around, they learn to enjoy the process of giving, more than that of receiving.

I’ll let you know how it goes.

How do you approach gift-giving with your toddlers? Join me in a conversation! I’d love to hear your ideas, too.

The post Project Snowman: Teaching My Kids To Give appeared first on Talia Zenlea.

Last week, the journal Pediatrics published a study describing the characteristics of physicians who dismiss families for refusing vaccines. Perhaps most shocking was the finding that 83% of the over 500 physicians surveyed reported that in a typical month, at least 1% of parents in their practice refused at least 1 infant vaccine.  Many personal stories from doctors followed in the news, and as I read them, my first thought was – how terrible. How could a doctor refuse to care for a whole group of patients?  Especially vulnerable children, who had no say in the decision. It goes against everything we’ve been taught.

But then I read on.

One of these doctors instituted the policy of refusing to care for unvaccinated families after an unvaccinated child showed up in his waiting room with whooping cough, exposing several infants and another child with leukemia to this potentially fatal and preventable illness.

It hit a chord. As the mom of 3 young boys, someone is always sick in my household. We’re cautious, but not over-the-top about germs. I know kids get sick, and I know they can fight colds with strong immune systems, and that it’s not the end of the world. I’ve had the flu, I even had chicken pox, and I lived to tell.

But whooping cough, influenza, chicken pox, measles, and many other vaccine-preventable infections aren’t “just colds.” They are serious infections that can kill people. And just because one of these didn’t cause a debilitating illness in me or you, it doesn’t mean that if or when we get them we can’t pass them on to someone who doesn’t have the immune strength to fight them. You may have already read about why I chose to get a flu shot this year  – to protect my son, my grandmother, and my good friend, all of whom could die from the infection that in me might only feel like a no-big-deal-kinda-cold.

The recent study in Pediatrics showed that in the states where doctors were less likely to dismiss patients for refusing vaccines, there were lower vaccination rates and higher rates of vaccine-preventable diseases. So while my gut reaction was at first that these doctors were betraying their patients by dismissing them, I then thought about all of the other vulnerable children in their practices that they were protecting. And I thought about the Hippocratic oath we all took in medical school – where we vowed to “take care that [our patients] suffer no hurt or damage.” And things got a lot less obvious.

As an adult gastroenterologist, I don’t have a ton of conversations about vaccinating children, but every day I talk to people about illnesses and various ways of treating them. And my stance has never been to be someone who paternalistically dictates a treatment plan to a patient. My patients are adults, my peers, and I respect their intelligence. I think it’s overstepping my boundaries to be telling them what to do. Instead, I see it as my job to provide them with all the info they need, so that they can make educated decisions for themselves. Except in really unique circumstances, most of the people I see are competent adults, who have the right to make their own decisions, even ones that I don’t agree with.

For the most part, I feel that way because their health decisions are their business and don’t have much direct impact on the physical health of anyone except themselves. But what I’ve realized is that when it comes to vaccines, that’s just not true. Those decisions impact the people around them far more than they impact themselves. So I really feel for those pediatricians who face this everyday. They’re trying to “do no harm.” Aren’t they doing a ton of harm by allowing unsuspecting vulnerable children to sit in their waiting rooms with people who could realistically be carrying preventable and life-threatening infections?

So why is it that people are more and more refusing to get vaccines for themselves and their kids? The short answer is, I have no idea. I set out to write a few of the most common reasons, and explain whether they are valid or not. But as I did, I realized I sounded like Charlie Brown’s teacher (whaamp-whaamp-whaamp) – this is really, really old news, and did I really need to be belabouring these points? I can’t imagine that anyone, especially someone who had made the conscious choice to refuse the vaccines the pediatrician was recommending for their child, would not know that the study showing a link between thimerosal and autism was retracted and the author totally discredited (but if you’re curious, the top three reasons people refuse vaccines article can be found here). I think it goes deeper – an inherent mistrust of mainstream science and medicine, maybe that all of this “good information” is just part of a giant conspiracy theory, or some sort of secret arrangement between every doctor and the companies that manufacture vaccines. How can a doctor carry on a relationship with a patient or family who feels this way? Mutual trust is fundamental to a sound doctor-patient relationship.

Like I said, I’m a mom to 3 young boys, and my main concern is to keep them safe and happy. I’ve chosen to vaccinate them because I am overwhelmed with the amount of sound data supporting the benefits of vaccines. I don’t want my boys to get sick from whooping cough, measles, or mumps.  I don’t want any potential future daughters-in-law to get cervical cancer. And I haven’t seen any compelling quality evidence to suggest that vaccines are bad. I’m a doctor and so are 90% of the people I know, and no one I know gets kickbacks of any sort from anyone for recommending or administering vaccines. The only juice we all drank was the one called I Practice Evidence Based Medicine. And as for the unvaccinated children sharing a pediatricians waiting room with my kids? I think it’s scary. Really scary. I’m comforted because I know my kids are most likely immune to those infections. Because I’m lucky and my kids are healthy. But that’s not the case for everyone, and if it weren’t for me, I’d be out of that waiting room in a heartbeat.

Oh, and Bellyblog’s very own media producer Dr. Seema Marwaha made this video that might help explain some of those misconceptions I talked about.

The post What You Don’t Know About Vaccines appeared first on Talia Zenlea.

In a previous blog post, I talked about a recent study describing the characteristics of physicians who refused to care for families who declined vaccines for their children. I talked about how I suspected it was about something much deeper than just misinformation, or misconception. But I also promised that I would make some of the info available here in case there was anyone who really didn’t know whether to believe the hype about vaccines and autism, and who was seeking to educate themselves in order to make a good decision for their child.

Here are the 3 most common reasons why people refuse vaccines, explained.

If these infections were so serious, why don’t we hear more about them?

So polio causes a really bad disease called poliomyelitis. In the 80s, hundreds of thousands of children across the world were left paralyzed by its effects. Then a world-wide vaccination program was implemented, and 15 years later, rates of poliomyelitis were down 99.9%, and the disease was completely eradicated from the Western Hemisphere, Europe, Southeast Asia, and the Pacific. That’s why we never hear about it anymore. Because we managed to eradicate a devastating disease from a large part of the world. Through vaccination.

Vaccines contain mercury (thimerosal) and that causes autism.

This association has not been shown. The study that described the association was retracted, because the guy who wrote it made up the results. They are no more valid than me saying right now that the MMR vaccines causes the apples on my apple tree to rot. I just made that up. I don’t even have an apple tree. This was a really, really bad case of research misconduct. There have been countless studies since then that have not supported the association between MMR and autism. The Institute of Medicine rejected the causal relationship in 2004.

Moreover, with the exception of certain flu shot formulations, no vaccines in the US or Canada have contained thimerosal in almost 20 years. And even if they did, thimerosal isn’t considered a dangerous form of mercury. The kind of mercury that can cause health problems is most commonly found in fish. So if you want to protect your children, ditch the tuna sandwich, not the flu shot. (PS – most single-dose flu shots and nasal flu mist don’t contain thimerosal.)

I had chicken pox and it wasn’t that bad.

Me too. Aside from some unfortunate family photos, I didn’t suffer any lasting consequences. But that’s because I was a healthy 5 year old with an intact immune system. Pregnant women, adults, babies, the elderly, and people who have compromised immune systems can die from chicken pox and other vaccine-preventable illnesses, and are much more likely to wind up in the hospital from complications. Since these diseases are so highly contagious, unvaccinated children pose a major health threat to these more vulnerable populations.

Bellyblog’s media producer Dr. Seema Marwaha made this video that also might help explain some of these misconceptions.

The post Vaccine Myths, Explained appeared first on Talia Zenlea.