Amitha Mundenchira

Mississauga

The weighing scale has become synonymous with the indicator of being healthy. Weight comes not only from fat but also from muscle and bone. Weight can also fluctuate within the same day and from day-to-day. Also, as our age increases, the changes in our metabolism can bring about genetic-related changes in our weight.

When the scale shows a reading higher than either the average same-profile people or the usual baseline number, distress sets in and there is an almost immediate desire to ‘lose weight’. This is propagated by the media which is bombarded with messages about looking good by losing weight or about weight-loss procedures.

The focus should be about being physically and mentally fit, even if it means being at a weight higher than average or higher than the prior baseline. Being at a lower reading on the scale may not necessarily be healthy; for example, low weight can put us at risk for osteoporosis.

Researchers measuring health in terms of body fat generally rely on the American Council on Exercise’s guidelines – anything below 10% and above 31% in women, or below 2% and above 24% in men is considered a health risk. Direct measure requires expensive imaging like MRI or CT scan. So, we rely on indirect measures like skin fold thickness and body mass index (BMI). These measurements are inappropriately used to represent fitness and media discussion about healthy bodies. As per World Health Organization assessment in 2011, waist-hip ratio is good predictor of health risk – healthy ratio for women is <0.85 and for men is <0.9.

Thin-ideal-promoting media has flourished. As a result, the diet and weight loss industries are thriving like never before. Self-body-image is hitting an all-time low. Life insurance industry collects higher premiums from those they themselves define as being “overweight”. It is no wonder that we have come to believe the myth that being thin is what being fit means.

The truth is: measuring health according to activity level is a more accurate gauge of true wellness. Our luxuries have reduced our amount and intensity of physical activity. There is evidence that cardiorespiratory fitness is a more powerful predictor of risk than body weight. Even when we don’t lose as much weight as we think we should, we are still likely gaining some serious health benefits from being active. One meta-analysis of medical studies concluded that overweight and active people may be healthier than those who are thin and sedentary. In other words, there should be a focus on healthy behaviors like exercise that can promote physical and mental health at any weight.

In addition to regular physical activity, eating well should also be part of the healthy lifestyle. It is best to have 6 small-portioned meals daily; unless there are some sensitivities, these meals should have a balance of all the food groups. Skipping meals slows down metabolism. Healthy cooking techniques like grilling and steaming should be adopted over frying.

Researchers have identified body dissatisfaction (“feeling too fat to exercise”) as one of the major barriers to regular exercise. We easily give up due to the perception that “healthy” or “average” as defined by the media is unreachable.

There is a difference between media representations of bodies and real-life bodies. The media personalities are not the average people; their livelihood depends on maintaining unusual body proportions, not necessarily healthy in all cases. Photoshopping is common in published images. Extreme diet and exercise routines are followed for periods closer to public appearances and photoshoots. Even these media personalities have periods where they do not resemble their published images.

            Self-comparisons to body ideals in mass media may reduce the motivation to exercise either because the results are not immediate or more commonly because the goals are unrealistic. This leads to negativity which, in turn, can propagate emotional unhealthy eating. Unhealthy eating is known to demotivate further. This becomes a vicious cycle. Breaking this cyclic pattern is possible with the simple step of exercising because it boosts serotonin (“the happy neurotransmitter”). The happier you are, the healthier you eat. The healthier you eat, the more motivated you stay to carry on these healthy behaviours.

 In short, less focus on the actual weight and more focus on a healthy lifestyle is the key to a more physically and mentally fit you.

By Dr. Amitha Mundenchira

Mississauga

 As a physician, I care for many women from the South Asian background. Regardless of culture, it remains a fact that majority of women put their families before themselves and their own health.

 The proof lies in the “26-year-old teacher who gives up her career to stay at home to take care of her children and her extended family, while her husband works” or in the “50-year-old homemaker who is working 24/7 to take care of her different family members with different schedules”.

These women may be happy with their roles but biological factors do catch up. Not attending to one’s own needs eventually does take a toll on both mental and physical health. There is a risk of missing health conditions in early stages when intervention can prevent progression or a risk of death from these conditions.

Heart disease is one of many such conditions. One of my patients in her late 60s kept ignoring her 3-month- history of chest pains at night because she was too busy taking care of her children/grandchildren and did not want to bother anyone for a ride to my office. Eventually, she got care when she ended up in the emergency with a massive heart attack.

February has been declared HEART MONTH by the Heart&Stroke Foundation – it is the foundation’s largest grassroots fundraising initiative. The Heart Truth as defined by the foundation is that heart disease and stroke is a leading cause of death for women in Canada, but most don’t know it. It is a bigger killer than even breast cancer. The Heart Truth campaign is lead by a Leadership Council of 18 prominent Canadian women like Olympic athlete Diane Jones Konihowski and TV broadcaster Vicki Gabereau; it is financially supported by leading Canadian corporations. http://ca-mg5.mail.yahoo.com/neo/launch?.rand=dq8mok722n3uf – mail.

A key component of The Heart Truth is the Red Dress Fashion Show, which typically takes place during Fashion Week in March. The iconic Red Dress symbol is designed to engage women of all ages, sizes, ethnic backgrounds and socio-economic status in the campaign.

South Asians—including Indians and other ethnic groups like Pakistanis and Sri Lankans—are up to three times as likely as all other ethnic groups combined to die of heart disease, according to a study from the Palo Alto Medical Foundation. The overall heart disease rates among South Asian women are as high as or higher than South Asian men – this can be attributed to genetics.

Women often fail to make the connection between risk factors, such as high blood pressure and high cholesterol, and their own chance of developing heart disease. If women make appropriate lifestyle changes to cater first to their own health, they can reduce their risk of heart disease. The lifestyle changes include eating well and staying active – this automatically can help reduce the stress that comes naturally with putting oneself last. Staying active can be as simple as daily 30-minute routines of brisk walking without breaks; walking inside the home or inside a mall are alternatives for the cold or snowy days.

Eating well includes both eating the right food and the avoidance of skipping meals. When in the grocery store, choose more products with the Health Check logo (http://www.healthcheck.org/). Also, read the Nutrition Facts table to compare products and make healthier choices. Using oil is a major part of our South Asian cooking. A simple possible change is to try baking, broiling, grilling, steaming or roasting instead of pan frying or deep frying. Choose vegetable oils that contain healthy unsaturated fats like canola oil, soybean oil or olive oil. Limit fats that are high in saturated or trans fat such as ghee or vegetable ghee, butter, hard margarine, lard or shortening. The following link has heart-healthy South Asian recipes as reviewed and approved by the Heart&Stroke Foundation dietitians – high in fibre and low in saturated fat/cholesterol/salt:

http://www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.3581617/k.655C/South_Asian_Resources.htm

The above link also has resources to help prevent and manage risk factors like high blood pressure – the pamphlets are in different South Asian languages including Hindi.

Dealing with day-to-day stress may be the hardest. However, managing stress early is important to prevent progression to depression or other psychiatric disorders. Some simple steps include sharing feelings and setting aside daily time for self to pursue a hobby or to just relax.

Putting others before oneself leads women to downplay their symptoms. The following may be symptoms of a heart attack and should not be ignored:

(1)   sudden discomfort or pain that does not go away with 10-15 min of rest

(2)   pain may be in the chest, neck, jaw, shoulder, arms or back

(3)   pain may feel like burning, squeezing, heaviness, tightness or pressure

(4)   chest discomfort that is brought on with exertion and goes away with rest

(5)    pain with difficulty breathing

(6)   pain with sweating or clammy skin

(7)   pain with nausea or indigestion

(8)   pain with anxiety

A diagnosis of heart disease that may result from not taking the above mentioned preventative measures may be further devastating. However, the sooner the acceptance of the condition, the easier it will be to manage with the help of the healthcare system and with the support of family/friends.

• One donor can save up to eight lives through organ donation and enhance the lives of up to 75 others through tissue donation. Every three days someone dies in Ontario waiting for a life-saving transplant. There is a chronic shortage of organs and tissue in Ontario and the need for organs and tissue continues to outweigh their availability. More than 1,600 Ontarians are waiting for a life-saving organ transplant and thousands more are waiting for a tissue transplant.
• Everyone is a potential organ and tissue donor, regardless of their age. To date, the oldest Canadian organ donor was over 90 years of age while the oldest tissue donor was 102 years old.
• Ultimately the ability to become an organ and tissue donor depends on several factors including the health of the organs and tissue at the time of death.
• Recovery of organs and tissue is carried out with respect and dignity. It does not interfere with funeral practices and no one will know about your gift of life unless your family tells them.
• Organs and tissue that can be donated after death include the heart, liver, kidneys, pancreas, lungs, small bowel, stomach, corneas, heart valves, bone and skin.

Studies show that donating the organs and tissue of a loved one who has died can provide immediate comfort and long-lasting consolation to family members in their grieving.

Who is affected?

• Mental illness indirectly affects all Canadians at some time through a family member, friend or colleague.
• 20% of Canadians will personally experience a mental illness in their lifetime.
• Mental illness affects people of all ages, educational and income levels, and cultures.
• Approximately 8% of adults will experience major depression at some time in their lives.
• About 1% of Canadians will experience bipolar disorder (or “manic depression”).

How common is it?

• Schizophrenia affects 1% of the Canadian population.
• Anxiety disorders affect 5% of the household population, causing mild to severe impairment.
• Suicide accounts for 24% of all deaths among 15-24 year olds and 16% among 25-44 year olds.
• Suicide is one of the leading causes of death in both men and women from adolescence to middle age.
• The mortality rate due to suicide among men is four times the rate among women.

What causes it?

• A complex interplay of genetic, biological, personality and environmental factors causes mental illnesses.
• Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem.
• Stigma or discrimination attached to mental illnesses presents a serious barrier, not only to diagnosis and treatment but also to acceptance in the community.
• Mental illnesses can be treated effectively.

What is the economic cost?

• The economic cost of mental illnesses in Canada for the health care system was estimated to be at least $7.9 billion in 1998 – $4.7 billion in care, and $3.2 billion in disability and early death.
• An additional $6.3 billion was spent on uninsured mental health services and time off work for depression and distress that was not treated by the health care system.
• In 1999, 3.8% of all admissions in general hospitals (1.5 million hospital days) were due to anxiety disorders, bipolar disorders, schizophrenia, major depression, personality disorders, eating disorders and suicidal behavior.Sources: The Report on Mental Illness in Canada, October 2002. EBIC 1998 (Health Canada 2002), Stephens et al., 2001

How does it impact youth?

• It is estimated that 10-20% of Canadian youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide.
• Today, approximately 5% of male youth and 12% of female youth, age 12 to 19, have experienced a major depressive episode.
• The total number of 12-19 year olds in Canada at risk for developing depression is a staggering 3.2 million.
• Once depression is recognized, help can make a difference for 80% of people who are affected, allowing them to get back to their regular activities.
• Mental illness is increasingly threatening the lives of our children; with Canada’s youth suicide rate the third highest in the industrialized world.
• Suicide is among the leading causes of death in 15-24 year old Canadians, second only to accidents; 4,000 people die prematurely each year by suicide.
• Schizophrenia is youth’s greatest disabler as it strikes most often in the 16 to 30 year age group, affecting an estimated one person in 100.
• Surpassed only by injuries, mental disorders in youth are ranked as the second highest hospital care expenditure in Canada.
• In Canada, only 1 out of 5 children who need mental health services receives them.

Here are some tips in helping to beat those pregnancy blahs:

1) Eat healthy and get plenty of rest. Choose healthy foods and ensure that your intake is nutritious.

2) Exercise. Even a short walk in the outdoors will uplift your spirits.

3) Make yourself feel attractive by taking the time to groom yourself. Do your hair and put on makeup. We all feel so confident and alive when we look good.

4) Buy maternity outfits that will make you feel good. Don’t buy just because they fit you.

5) Ensure to include pretty accessories in your daily wardrobe such as nice earrings or a pretty scarf. Most of us raid our spouse’s closet for clothes that we can wear throughout our pregnancy. Lovely accessories even dress up your spouse’s wardrobe.

6) If you start to feel bored with your pregnancy, choose an activity that you will enjoy to help you through the boredom. Many woman will prepare for the baby by going shopping or decorating the nursery. Other woman choose a hobby such as gardening, preparing a scrapbook, writing in a pregnancy journal, etc.

7) Roughly 10 percent of women experience mild or moderate depression during pregnancy. If you feel persistent depression or anxiety, seek professional help.

8) Spend quality time with your spouse. Go for a romantic dinner or out to a movie. Enjoy this time because it’s hard to find time after the baby is born.

9) Take time out for yourself. Motherhood is just around the corner so take this time to enjoy your independence.

Although it may seem like 9 months is taking forever, really, it goes very quickly. Enjoy the wonderful experience of pregnancy each step of the way. There will be a time in our lives when our children have grown up and we wish to live the pregnancy experience all over again.

A growing understanding of human genetics holds the promise to dramatically change health care through customized preventative care and treatments. In his upcoming Stanford Continuing Studies course, “Your Genes and Your Health,” Douglas Brutlag, PhD, will discuss how the billions of bits in our biological code shape who we are and how tapping into this information can reveal a lot about your potential health and future well-being.

As Brutlag explains in the following Q&A, understanding the way specific genetic variants influence disease risk can lead to reduced health care costs and a new approach to a healthy lifestyle.

What percentage of our health is dictated by our genetics, and what portion can be attributed to a person’s behavior or environment?

The percentage of our health dictated by our genetics and the faction by behavior and environment depends on individual diseases. Some diseases are entirely genetic and they are called 100 percent penetrant. Diseases such as Huntington’s disease, cystic fibrosis, sickle cell anemia, Tay-Sachs disease and Downs syndrome are purely genetic. Other, more complex diseases such as Type 2 diabetes or rheumatoid arthritis have a significant behavioral component. That means that even if a person has a genetic predisposition towards the disease there is a lot one can do behaviorally to prevent it.

Complex or multifactorial diseases often have several genetic components as well as several behavioral components. For example, there are now at least a dozen known genes that can contribute to Type 2 diabetes. This is because there are many pathways that lead to the disease. Decreased production of insulin, decreased secretion of insulin and decreased response to insulin are the most common. On the other hand, many behavioral aspects can contribute to causing or exacerbating the disease. Obesity and sedentary life style are but two of them. Many other diseases, such as lung cancer, are nearly entirely behavioral. Others, such as most infectious diseases, are entirely environmental.

How can understanding the way specific genetic variants influence individuals’ disease risk enable awareness and possible prevention or treatment?

If someone knows that they have genes predisposing them to a particular disease, then they can be more vigilant to other symptoms of that disease and also discuss further clinical tests for the disease with their doctor. For example, if someone has certain alleles of the gene for clotting factor F5, it could be an indication that the person might be at a high risk of developing deep vein thrombosis (DVT) and one should perform a test of their thrombin levels. This is very important as DVT can lead to strokes and pulmonary embolisms resulting in death.

Other examples are familial breast cancer. If a person has a family history of breast cancer and genetic tests indicate that they have one of the BRCA 1 or BRCA 2 mutations, then they should make sure that they have regular mammography exams. Familial breast cancer is one of the complex diseases that is not 100 percent penetrant. Twenty percent of individuals carrying these mutations will not get breast cancer or ovarian cancer during their entire life. Nevertheless, all such individuals should be much more vigilant than those without these genes.

Finally, if one has two or three of the genes that predispose them to Type 2 diabetes, they should watch their weight, exercise regularly and have their blood glucose measured routinely. Also knowing the type of genetic defects associated with a person’s Type 2 diabetes can help in planning their treatment. There are genetic loci that reduce the number of insulin producing cells in the pancreas that are best treated with drugs that stimulate insulin production from the remaining cells. Obese people often become insulin resistant and they would need a different or additional treatment.

How can knowing one’s own genetic profile help reduce health care costs and motivate patients to make healthier decisions?

Preventive medicine is always the best and least expensive medicine. We currently use vaccines to prevent many infectious diseases. This is far less expensive and much better for the patient than using antibiotic or anti-viral treatments to try to cure an infection. The risks are also substantially lower with vaccines. Much of the cost of the current health care is due to expensive diagnostic methods and interventions for patients who already have a disease. So preventing the disease in the first place is by far, the best way to reduce health care costs.

Hopefully, genomics and genetic testing will do for inherited disease what vaccines have done for infectious disease. I see genomics as being the way toward preventing the manifestations of inherited disease. More importantly, the cost of sequencing is coming down so fast that in the next three to five years we will be able to determine the complete genome sequence of every individual at birth for less than $1,000. This genomic information, coupled with our knowledge of the genes causing disease mentioned above will give people a genetic roadmap of their potential inherited diseases. This will empower doctors to design specific tests for each person to track his progress along their genetic roadmap as well as recommendations for behaviors likely to improve one’s health by dimishing the chance of a given disease.

Preventing disease will also become the responsibility of the patient. He will know what the risks he takes if he smokes, over-eats or leads a sedentary life style. The risks will be personalized based on his own genetics.

A 2009 survey showed that a significant number of doctors don’t have the knowledge necessary to interpret genetic test results and use the information to guide medical decisions. Beyond primary care doctors, what other resources, tools or members of the health-care community can patients use to understand genetic disease?

We are in state of transition where we need more physicians in the medical genetic specialty and more trained genetic counselors. Interpreting the current genetic tests requires knowledge of statistics, probability and utility functions. However, I see a time in the near future where we know the causal mutations in the human genome and we understand the molecular basis for most diseases. Then the genetic diagnosis will move from a probabilistic analysis to a more deterministic or rule based approach that could provide the doctor directly with the correct advice. Even then, I think that we will want to have medical genetic specialists and genetic counselors in every hospital and clinic.

Many medical schools, including Stanford, are now training their students in the interpretation of genetic and genomic data. Yet it will take several years to provide the level of expertise that will be needed to use this kind of data. Hopefully there will be a time soon when the genetic tests will appear as just another clinical test that doctors order for their patients.

You use data from your own genome analysis to demonstrate to students how to look at their own ancestry, family relationships and inherited diseases. How has the experience of analyzing your own DNA affected your health-care decisions?

Greatly. I am a type 2 diabetic and by knowing the alleles of my specific genes that are associated with my disease, I have been able to tailor my drug regime to best fit my genetic situation. It has also permitted me to eliminate some of the more expensive diabetic drugs I really did not need and now I use only less expensive generic drugs, lowering my pharmacy bill tremendously. Similarly these tests have helped the rest of my family and their physicians become aware of potential inherited disease, long before debilitating symptoms have appeared.

1) The flu shot makes you sick.

The flu shot can give you a sore arm and aches. Each year’s vaccine is only designed to protect against the strains it includes. Fever occurs infrequently after vaccination, according to the Public Health Agency of Canada.

2) I have to get a needle to be vaccinated against flu.

A nasal spray version of the vaccine is approved for use in Canada. Provincial health plans may not cover the cost.

3) Flu vaccines don’t work.

A review of studies from 1967 to 2012 concluded that standard inject able influenza vaccines containing three strains protect healthy adults aged 18 to 64 at a rate of about 59 per cent. Michael Osterholm, an infectious disease expert at the University of Minnesota and the report’s lead author.

“During some influenza seasons vaccination offers substantially more protection for most of the population than being unvaccinated; however, influenza vaccine protection is markedly lower than for most routinely recommended vaccines and is suboptimal,” the report concluded.

Osterholm said current flu vaccines play a role in reducing flu illnesses but called the status quo in vaccine research and development unacceptable.

Nasal spray containing live attenuated influenza vaccine protects children aged six months to seven years at a rate of about 83 per cent, according to the review.

Dr. Danuta Skowronski , a physician epidemiologist with the BC Centre for Disease Control, agreed there’s room to improve flu vaccines.

“I think increasingly people are understanding there’s uncertainty and it behooves health experts to be better able at communicating that,” Skowronski said.

“The current vaccine can provide substantial protection and that can be critical to those at high risk of severe complications.”

4) Only doctors and nurses can give flu vaccinations.

Pharmacists in four provinces — British Columbia, Ontario, Alberta and New Brunswick, can give flu shots. Official regulations for pharmacists are pending in Manitoba, Quebec and Nova Scotia, said Jeff Morrison of the Canadian Pharmacists Association.

Matthews said that by expanding the scope of practice for pharmacists gives people more options to get immunized, such as coming in for a flu shot during their lunch break.

5) Pregnant women can’t be vaccinated.

Getting immunized during pregnancy protects women and infants for the first six months of life when they can’t be vaccinated, said Dr. Scott Halperin, head of the Canadian Centre for Vaccinology in Halifax.

If you are pregnant (or planning to get pregnant) it is safe to get immunized with the inactivated influenza vaccine, Alberta Health Services says.

The holidays are not a time of year to accept the inevitable weight gain. Now that we are officially engulfed in the holiday season follow these tips to keep your health on track.

Have the Celebration in Your Home

When you are in control of the menu, the portions and the ingredients, you are in control of your health. Guests always love the holiday classics, but try spicing it up a bit. Being creative and offering healthier choices can spark healthy conversations—and impress your friends around the table.

Share Edible Gifts

Roasted edamame, curried chickpeas, spiced nuts and warm breads can all be prepared quickly. Wrap it up in pretty cloth and tie a recipe on it; it’s always accepted with gratitude. These edible gifts will introduce the recipient to possibly a whole new world of healthy options.

Be a Rebel

Try a new recipe; something outside of your comfort zone. If you have never worked with a pomegranate before, then pick out a few recipes to try. If you are unsure about serving fish at a traditional meal, try it out. It shows creativity and offers your guests a new perspective.

Go Green

Serve and carry “no packaging needed” whole foods. This way you avoid clean up and you’re sticking to the recommended plant based diet. Many studies have found that a diet abundant in whole, real foods is associated with a reduced risk of diseases such as, cardiovascular disease, cancer and diabetes.

Lighten Up

Traditional dishes can pack in a tremendous amount of fat and calories, but lightening them up may even improve their flavor. Try using organic, cold pressed, canola oil, which has nearly half the saturated fat of traditional butter and it includes heart healthy omega 3′s.

Or, try substituting fat-free evaporated milk or, unsweetened coconut milk in place of heavy cream. Another option is to top entrées with warm fruit or vinaigrette in place of creamy sauces. Maybe try a vegetable purée that’s made with water as a soup base. The smooth, creamy texture feels indulgent, and the puréed veggies provide a nutritional boost.

Stay in Control

Holiday weight gain is not as extreme as you may think. According to a study published in The New England Journal of Medicine people may actually put on less than a pound from October to January. This doesn’t give you any free passes. If holiday weight gain becomes a yearly tradition, the years can pack on many pounds and lead to trouble.

Research at Pennsylvania State University found that being around friends and family may cause people to indulge a little more freely. This study shows that dining in a group causes the average person to eat 44 percent more calories than they normally would eating alone.

Source: http://www.active.com/

According to the Society of Obstetricians and Gynaecologists of Canada, most women experiencing low-risk pregnancies can safely continue to work outside the home. If, however, your job is physically demanding (e.g., it requires repeated stooping and bending, repeated climbing of ladders, poles, or stairs, heavy lifting, or a lot of standing); exposes you to radiation, toxins, or other harmful substances; or involves shift work or prolonged standing, you might want to consider switching jobs or requesting a job modification for all or part of your pregnancy. 

Even if your job doesn’t present any obvious threat, you’ll still need to make an effort to take care of yourself while you’re on the job. Here are a few tips:

• Get up and move around as often as you can – at least once every couple of hours.
Sitting down for more than three hours at a stretch can lead to fluid retention in your legs and feet, reduced blood flow to your baby, muscle strain (particularly in your lower back), and tension in your back and shoulder areas.

• Find a position that’s comfortable for you while you’re working at your desk.
Place a pillow behind the small of your back, prop your feet up on a footstool or an open desk drawer, and make sure you take regular breaks from typing if you work at a computer all day. Pregnant women are at increased risk of developing repetitive stress disorders such as carpal tunnel syndrome.

• Dress for comfort, not style.
You’ve got the rest of your life to try to squeeze into those high heels and power suits. For now, focus on comfort. Choose loose, comfortable clothing, and dress in layers so that you can remove a layer or two if you begin to feel overheated.

 Eat, drink, and be merry.
Make a point of stopping for snacks and meals at regular intervals, no matter how crazy things may be at the office. Keep a bottle of water on your desk so that you can remember to keep yourself well hydrated. And try to keep your stress level to a minimum.

• Master the art of the power nap.
If you’re feeling drop-dead exhausted (a not uncommon condition during the first and third trimesters, by the way), then try to squeeze in a nap during your lunch hour or afternoon break. If that’s not possible, make flopping out on the couch for half an hour a sacred part of your daily arriving-home-from-work ritual.

• Get your zzzz’s.
You can’t expect to function well on the job if you’re sleep-deprived, so be sure to hit the hay early enough to get a good night’s sleep. Your sleep needs increase while you’re pregnant. Instead of getting away with seven or eight hours a night — what a typical woman of childbearing age requires — you may find that you need nine or ten hours.

The number of kids under 18 living with the chronic disease has increased by about 50 per cent, rising from 1,034 in 1995 to 1,621 in 2005, according to a report released by the Crohn’s and Colitis Foundation of Canada. Unpublished statistics from the Institute for Clinical Evaluative Sciences, a non-profit health-research group, show those figures have increased even more, jumping to 2,070 in 2009.

The rate of new cases in Ontario has been stable in preadolescents and adolescents, but in children under the age of 10 it has increased by 30 per cent. IBD — a group of inflammatory disorders that includes Crohn’s disease and ulcerative colitis — causes sections of the gastrointestinal tract to become severely inflamed and ulcerated. Symptoms include chronic diarrhea, blood in the stool, abdominal pains and weight loss. In addition, children face long-term complications, such as problems with their physical growth and osteoporosis.

Researchers know that IBD, which is becoming more prevalent in the western world, is related to genetics and environment. But they still haven’t been able to pinpoint what triggers it. To date, no cures have been found. In Canada, incidence rates have been on the rise since 2001. About 233,000 Canadians have IBD, up from 201,000 in 2008. About 5,900 of those with the disease are children.

Scientists are still trying to answer the question of why IBD is growing. Part of the rise is due to physicians getting better at identifying the disease, but researchers believe the spike is also related to undetermined environmental factors and increased immigration of people from developing countries. For instance, people from South Asia are at low risk in their native countries, but once they arrive in Canada they are at increased risk for developing IBD, compared with the general population.

According to the report, the economic costs for IBD in Canada are estimated at $2.8 billion for 2012, about $11,900 per person. Direct medical costs, such as medications, hospitalization, physician visits, total $1.2 billion and indirect costs, such as work absences and out-of-pocket expenses amount to $1.6 billion.