What is cholesterol?

Cholesterol is found in every cell of the body and has important natural functions. It is manufactured by the body but can also be taken in from food. It is waxy and fat-like in appearance.

Cholesterol is oil-based and so does not mix with the blood, which is water-based. It is therefore carried around the body in the blood by lipoproteins.

The parcels of cholesterol are carried by two types of lipoprotein:

• Low-density lipoprotein (LDL – cholesterol carried by this type is known as ‘bad’ cholesterol)
• High-density lipoprotein (HDL – cholesterol carried by this type is known as ‘good’ cholesterol).

Cholesterol has four main functions, without which we could not live. It:

• Contributes to the structure of cell walls
• Makes up digestive bile acids in the intestine
• Allows the body to produce vitamin D
• Enables the body to make certain hormones.

What causes high cholesterol?

High cholesterol is a major risk factor for coronary heart disease, a cause of heart attacks, and reducing blood lipid levels lowers the cardiovascular risk.

High levels of LDL lead to a build-up of cholesterol in the arteries, whereas HDL carries cholesterol to the liver for removal from the body. A build-up of cholesterol forms part of the process that narrows arteries, called atherosclerosis, in which plaques form and cause restriction of blood flow.

Two types of cause lead to high cholesterol levels – modifiable and non-modifiable risk factors. The major two risk factors are highly modifiable – something can be done to change them:

• Diet
• Exercise and weight.

Limiting intake of fat in the diet helps manage cholesterol levels, limiting foods, in particular, that contain:

• Cholesterol (from animal foods, such as egg yolks, meat and cheese)
• Saturated fat (found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods)
• Trans fat (found in some fried and processed foods).

Being overweight or obese can lead to higher blood LDL levels so exercise can help manage this risk factor.

The primary causes of high cholesterol are genetic – very high LDL levels are found in the inherited condition familial hypercholesterolemia.

Abnormal cholesterol levels may also be secondary to the following:

• Diabetes
• Liver or kidney disease
• Polycystic ovary syndrome
• Pregnancy and other conditions that increase levels of female hormones
• Underactive thyroid gland.
• Drugs that increase LDL cholesterol and decrease HDL cholesterol (progestins, anabolic steroids and corticosteroids).

Fast facts on cholesterol

Here are some key facts about cholesterol. Find more detail and supporting information in the article.

• Cholesterol is an essential substance that is produced by the body but is also available from foods.
• The greatest risk factors for high cholesterol are modifiable lifestyle choices – diet and exercise.
• High cholesterol levels can be inherited with the genetic condition, familial hypercholesterolemia.
• Having high cholesterol does not produce any symptoms.
• Cholesterol levels should be blood-tested once every five years.
• First-line ways to reduce cholesterol involve lifestyle changes.
• If lifestyle changes are unsuccessful or cholesterol levels are very high, lipid-lowering drugs such as statins may be prescribed.
• High cholesterol levels are an important contributor in the calculation of an individual’s risk of having a heart attack within the next ten years.

Signs and symptoms of high cholesterol

Having high cholesterol levels, while a risk factor for other conditions, does not itself present any signs or symptoms. Unless routinely screened through regular blood testing, high cholesterol levels will go unnoticed and could present a silent threat of heart attack or stroke.

Cholesterol tests and diagnosis

High cholesterol can only be diagnosed by blood testing. Doctors’ guidelines state that everyone over the age of 20 years should have their cholesterol levels checked once every five years.

The cholesterol test is done after a period of fasting – no food, drink or pills for 9 to 12 hours – to enable an accurate reading of LDL cholesterol from the blood test. The screening also gives information about total cholesterol, HDL cholesterol and triglyceride levels.

The guidelines set cholesterol levels that help determine the individual heart risk, as follows:

LDL cholesterol

• Optimal: less than 100 mg/dL
• Near-optimal: 100 to 129 mg/dL
• Borderline high: 130 to 159 mg/dL
• High: 160 to 189 mg/dL
• Very high: 190 mg/dL and above.

Guidance is also set out for the other measures in the lipid profile:

Total cholesterol

• Desirable: less than 200 mg/dL
• Borderline high: between 200-239 mg/dL
• High: 240 mg/dL or above.

HDL cholesterol

• Low: below 40 mg/dL
• High: 60 mg/dL or above.

Treatment and prevention of high cholesterol

Four changes to lifestyle are recommended for all people with high cholesterol levels – including those receiving drug treatment – in order to reduce the risk of coronary heart disease and heart attack:

1. Eat a ‘heart-healthy diet’ (for example, use low-fat toppings and sauces, and avoid foods high in saturated fat; eat vegetables, fruits and fiber-rich whole grains)
2. Take regular exercise
3. Avoid smoking
4. Keep a healthy weight.

Ten-year risk of a heart attack

Cholesterol levels play a major part in an individual’s risk of having a heart attack within the next ten years. The National Heart, Lung and Blood Institute provide an online calculator of cardiovascular risk. Using research evidence, it weighs the risk dictated by these factors:

• Age
• Sex
• Cholesterol levels
• Smoking status
• Blood pressure.

Monitoring the ten-year risk according to data from the Framingham Heart Study, which continues today, helps in the management of lifestyle and other measures to reduce cholesterol levels, and so cut the chances of cardiovascular disease leading to heart attack or stroke.

What is diabetes?

Diabetes is a chronic, often debilitating and sometimes fatal disease, in which the body either cannot produce insulin or cannot properly use the insulin it produces. Insulin is a hormone that controls the amount of glucose (sugar) in the blood. Diabetes leads to high blood sugar levels, which can damage organs, blood vessels and nerves. The body needs insulin to use sugar as an energy source.

What is the pancreas and what does it do?

The pancreas is an organ that sits behind the stomach and releases hormones into the digestive system. In the healthy body, when blood sugar levels get too high, special cells in the pancreas (called beta cells) release insulin. Insulin is a hormone and it causes cells to take in sugar to use as energy or to store as fat. This causes blood sugar levels to go back down.

What is type 1 diabetes?

Type 1 diabetes occurs when the immune system mistakenly attacks and kills the beta cells of the pancreas. No, or very little, insulin is released into the body. As a result, sugar builds up in the blood instead of being used as energy. About five to 10 per cent of people with diabetes have type 1 diabetes. Type 1 diabetes generally develops in childhood or adolescence, but can develop in adulthood.

Type 1 diabetes is always treated with insulin. Meal planning also helps with keeping blood sugar at the right levels.

Type 1 diabetes also includes latent autoimmune diabetes in adults (LADA), the term used to describe the small number of people with apparent type 2 diabetes who appear to have immune-mediated loss of pancreatic beta cells.

What is type 2 diabetes?

Type 2 diabetes occurs when the body can’t properly use the insulin that is released (called insulin insensitivity) or does not make enough insulin. As a result, sugar builds up in the blood instead of being used as energy. About 90 per cent of people with diabetes have type 2 diabetes. Type 2 diabetes more often develops in adults, but children can be affected.

Depending on the severity of type 2 diabetes, it may be managed through physical activity and meal planning, or may also require medications and/or insulin to control blood sugar more effectively.

What is gestational diabetes?

A third type of diabetes, gestational diabetes, is a temporary condition that occurs during pregnancy. It affects approximately two to four per cent of all pregnancies (in the non-Aboriginal population) and involves an increased risk of developing diabetes for both mother and child.

What are the complications of diabetes?

Having high blood sugar can cause diabetes-related complications, like chronic kidney disease, foot problems, non-traumatic lower limb (leg, foot, toe, etc.) amputation, eye disease (retinopathy) that can lead to blindness, heart attack, stroke, anxiety, nerve damage, and erectile dysfunction (men).

Diabetes-related complications can be very serious and even life-threatening. Properly managing blood sugar levels reduces the risk of developing these complications.

What are the risk factors for type 1 diabetes?

Researchers continue to work hard to find out what causes type 1 diabetes. It is known that having a family member (parent, sibling) with type 1 diabetes slightly increases the risk; however, definite risk factors are currently not known.

What are the risk factors for type 2 diabetes?

Anyone over the age of 40 should be tested for diabetes every three years. Anyone who has one or more risk factors should be tested more frequently. Risk factors are:

• Having a parent, brother, or sister with diabetes;
• Being a member of a high-risk group (Aboriginal, Hispanic, South Asian, Asian, or African descent);
• Having health complications that are associated with diabetes;
• Having given birth to a baby that weighed more than four kilograms (nine pounds) at birth or having had gestational diabetes (diabetes during pregnancy);
• Having been diagnosed with prediabetes (impaired glucose tolerance or impaired fasting glucose);
• Having high blood pressure;
• Having high cholesterol or other fats in the blood;
• Being overweight, especially if that weight is mostly carried around the tummy;
• Having been diagnosed with polycystic ovary syndrome;
• Having been diagnosed with Acanthosis nigricans (darkened patches of skin);
• Having been diagnosed with psychiatric disorders: schizophrenia, depression, bipolar disorder;
• Having been diagnosed with obstructive sleep apnea;
• Having been prescribed a glucocorticoid medication by a doctor.

There are many signs and symptoms that can indicate diabetes.

Signs and symptoms can include the following:

Unusual thirst
Frequent urination
Weight change (gain or loss)
Extreme fatigue or lack of energy
Blurred vision
Frequent or recurring infections
Cuts and bruises that are slow to heal
Tingling or numbness in the hands or feet
Trouble getting or maintaining an erection
If you have any of these symptoms, it is important to contact your health-care provider right away. Even if you don’t have symptoms, if you are 40 or older, you should still get checked.

It is important to recognize, however, that many people who have type 2 diabetes may display no symptoms.

Symptoms of diabetes in children

Diabetes affects children of all ages. Most children who develop diabetes do not have a family history of diabetes.

Symptoms of diabetes in your child could include:

• Drinking and going to the bathroom more frequently than usual
• Starting to wet the bed again
• Lack of energy

If you think your child might have diabetes, see a doctor today.

Diagnosis of diabetes

Speak with your doctor and ask him or her to test you for diabetes using one of the following tests. The amount of glucose (sugar) in your blood is measured in mmol/L.

Fasting blood glucose

You must not eat or drink anything except water for at least eight hours before this test. A test result of 7.0 mmol/L or greater indicates diabetes.

Random blood glucose

This test may be done at any time, regardless of when you last ate. A test result of 11.0 mmol/L or greater, plus symptoms of diabetes, indicates diabetes.

A1C

This test may be done at any time, regardless of when you last ate. A test result of 6.5 % or greater (in adults) and in the absence of factors that affect the accuracy of the A1C indicates diabetes.

Oral glucose tolerance test

You will be given a special sweetened drink prior to this blood test. A test result of 11.1 mmol/L or greater taken two hours after having the sweet drink indicates diabetes.

A second test must be done in all cases (except if you have acute signs and symptoms). Once diabetes has been diagnosed, ask your doctor to refer you for diabetes education. The Canadian Diabetes Association also has many resources to help you understand diabetes better and live a long and healthy life.

Key elements in diabetes management

• Education: Diabetes education is an important first step. All people with diabetes need to be informed about their condition.
• Physical activity: Regular physical activity helps your body lower blood glucose levels, promotes weight loss, reduces stress and enhances overall fitness.
• Nutrition: What, when and how much you eat all play an important role in regulating blood glucose levels.
• Weight management: Maintaining a healthy weight is especially important in the management of type 2 diabetes.
• Medication: Type 1 diabetes is always treated with insulin. Type 2 diabetes is managed through physical activity and meal planning and may require medications and/or insulin to assist your body in controlling blood glucose more effectively.
• Lifestyle management: Learning to reduce stress levels in day-to-day life can help people with diabetes better manage their disease.
• Blood pressure: High blood pressure can lead to eye disease, heart disease, stroke and kidney disease, so people with diabetes should try to maintain a blood pressure level at or below 130/80. To do this, you may need to change your eating and physical activity habits and/or take medication.

– See more at: https://www.diabetes.ca/about-diabetes/treatments-medications#sthash.snugL5Fv.dpuf

About antibiotic resistance

Antibiotics are used to slow the growth of or kill bacteria that cause infections and illnesses. When antibiotic resistance develops, the antibiotics normally used may not work as well or fail completely.

Antibiotic resistance can happen naturally, but the inappropriate use of antibiotics in people, animals and plants is largely increasing the problem. Antibiotic resistant bacteria can spread easily among people and among animals.

What is shingles?

Shingles is a painful blistering rash caused by reactivation of varicella zoster virus, the chickenpox virus. It is correctly known as herpes zoster.

Chickenpox or varicella is the primary infection with varicella zoster virus. During this widespread infection, which usually occurs in childhood, virus is seeded to nerve cells in the spinal cord, usually of nerves that supply sensation to the skin.

The virus remains in a resting phase in these nerve cells for years before it is reactivated and grows down the nerves to the skin to produce shingles (zoster). This can occur in childhood but is much more common in adults, especially the elderly.

Shingles patients are infectious (resulting in chickenpox), both from virus in the lesions and in some instances the nose and throat.

Who gets shingles?

Anyone who has previously had chickenpox may subsequently develop shingles. They can be male or female, young or old. In general, it is more common in older adults and certainly tends to be more severe in this group. People who have had shingles previously rarely get it again (the risk of getting a second episode is about 1%).

Shingles is more common and more severe in patients with poor immunity. Blisters can occur in more than one area and the virus may affect internal organs, including the gastrointestinal tract, the lungs and the brain.

Chickenpox or shingles in the early months of pregnancy can harm the fetus, but luckily this is rare. The fetus may be infected by chickenpox in later pregnancy, and then devlop shingles as an infant.

It is not clear why shingles affects a particular nerve fibre. In some cases, it may be set off by pressure on the nerve roots, by radiotherapy at the level of the affected nerve root, by spinal surgery, by an infection such as sinusitis or by an injury (not necessarily to the spine).

Occasional clusters of shingles cases are reported. It is suggested that contact with someone who has chickenpox or shingles may cause one’s own virus to reactivate.

Clinical features of shingles

The first sign of shingles is usually pain, which may be severe, in the areas of one or more sensory nerves, often where they emerge from the spine. The pain may be just in one spot or it may spread out. The patient usually feels quite unwell with fever and headache. The lymph nodes draining the affected area are often enlarged and tender.

Within one to three days of the onset of pain, a blistering rash appears in the painful area of skin. Sometimes, especially in children, shingles is painless.

It starts as a crop of closely-grouped red bumps in a continuous band on the area of skin supplied by one, occasionally two, and rarely more neighbouring spinal nerves. New lesions continue to appear for several days, each blistering or becoming pustular then crusting over. Shingles occasionally causes blisters inside the mouth or ears, and can also affect the genital area.

The pain and general symptoms subside gradually as the eruption disappears. In uncomplicated cases recovery is complete in 2-3 weeks in children and young adults, and 3 to 4 weeks in older patients.

Occasionally pain is not followed by the eruption – shingles “sine eruptione”. These cases can be difficult to identify because there is no characteristic rash.

The chest (thoracic), neck (cervical), forehead (ophthalmic) and lumbar/sacral sensory nerve supply regions are most commonly affected at all ages but the frequency of ophthalmic shingles increases with age. Rarely the eruption may affect both sides of the body.

In elderly and undernourished patients the blisters are deeper. Healing may take many weeks and be followed by scarring. Muscle weakness arises in about one in twenty patients because the muscle nerves are affected as well as the sensory nerves. Facial nerve palsy is the most common result. There is a 50% chance of complete recovery and in time some improvement can be expected in nearly all cases.

Post-herpetic neuralgia (after-pains)

Post-herpetic neuralgia is defined as persistence or recurrence of pain more than a month after the onset of shingles. It becomes increasingly common with age affecting about a third of patients over 40 and is particularly likely if there is facial infection. The pain may be continuous and burning with increased sensitivity in the affected areas, or a spasmodic shooting type, or, rarely, of an itchy, crawling variety. The overlying skin is numb or exquisitely sensitive to touch. Sometimes, instead of pain, the neuralgia results in a persistent itch (neuropathic pruritus).

Treatment of shingles

If you think you may have shingles, see your doctor as soon as possible. Antiviral treatment can reduce pain and the duration of symptoms, but it is much less effective if started more than one to three days after the onset of the shingles

Prevention of shingles

Because the risk of severe complications from shingles is more likely in older people, those aged over 60 years might consider zoster vaccine.

A herpes zoster vaccine has been produced which can prevent varicella zoster virus reactivation. The vaccine (called Zostavax®) is estimated to be 14 times more potent than the chickenpox vaccine and can be given to people aged 50 years or older. It should not be given to people with weakened immune systems. The herpes zoster vaccine can reduce the incidence of shingles by half. In people who do get shingles despite being vaccinated, the symptoms are usually less severe and after-pains are less likely to develop.

What is HPV?

HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). HPV is so common that nearly all sexually active men and women get it at some point in their lives. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening.

How is HPV spread?

You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms.

Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected making it hard to know when you first became infected.

Does HPV cause health problems?

In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer.

Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.

Does HPV cause cancer?

HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).

Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.

There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems from it.

How can I avoid HPV and the health problems it can cause?

You can do several things to lower your chances of getting HPV.

Get vaccinated. HPV vaccines are safe and effective. They can protect males and females against diseases (including cancers) caused by HPV when given in the recommended age groups (see “Who should get vaccinated?” below). HPV vaccines are given in three shots over six months; it is important to get all three doses.

Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer.

If you are sexually active

• Use latex condoms the right way every time you have sex. This can lower your chances of getting HPV. But HPV can infect areas that are not covered by a condom – so condoms may not give full protection against getting HPV;
• Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you.

Who should get vaccinated?

All boys and girls ages 11 or 12 years should get vaccinated.

Catch-up vaccines are recommended for males through age 21 and for females through age 26, if they did not get vaccinated when they were younger.

The vaccine is also recommended for gay and bisexual men (or any man who has sex with a man) through age 26. It is also recommended for men and women with compromised immune systems (including people living with HIV/AIDS) through age 26, if they did not get fully vaccinated when they were younger.

How do I know if I have HPV?

There is no test to find out a person’s “HPV status.” Also, there is no approved HPV test to find HPV in the mouth or throat.

There are HPV tests that can be used to screen for cervical cancer. These tests are recommended for screening only in women aged 30 years and older. They are not recommended to screen men, adolescents, or women under the age of 30 years.

Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers.

How common is HPV and the health problems caused by HPV?

HPV (the virus): About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of HPV at some point in their lives.

Health problems related to HPV include genital warts and cervical cancer.

Genital warts: About 360,000 people in the United States get genital warts each year.

Cervical cancer: More than 11,000 women in the United States get cervical cancer each year.

There are other conditions and cancers caused by HPV that occur in persons living in the United States.

I’m pregnant. Will having HPV affect my pregnancy?

If you are pregnant and have HPV, you can get genital warts or develop abnormal cell changes on your cervix. Abnormal cell changes can be found with routine cervical cancer screening. You should get routine cervical cancer screening even when you are pregnant.

Can I be treated for HPV or health problems caused by HPV?

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:

1. Genital warts can be treated by you or your physician. If left untreated, genital warts may go away, stay the same, or grow in size or number.
2. Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. For more information visit www.cancer.org.
3. Other HPV-related cancers are also more treatable when diagnosed and treated early. For more information visit www.cancer.org.

This vaccine is for babies whose mothers are carriers of hepatitis B.

What is hepatitis B?

Hepatitis B is an infection of the liver. It is caused by a virus. Most people who get hepatitis B recover completely. Some carry the infection for life and are called carriers.

Carriers may pass on the infection to other people. They may also get liver damage or liver cancer.

Can hepatitis B affect my baby?

Yes. Babies whose mothers are carriers may be infected during birth and also may become carriers. Doctors in Ontario test all pregnant women for hepatitis B. If you are a carrier, a vaccine can protect your baby from infection.

When will my baby get the hepatitis B vaccine?

If you are a carrier your baby will get one needle at birth, and one when a month old. The third needle is given at six months of age. A special needle called immune globulin is also given when your baby is born.

How well does hepatitis B vaccine protect my baby?

The vaccine protects nine out of 10 babies who get all three needles. After the last needle, talk to your doctor about a blood test for your baby. This test will show how well the vaccine is working.

Is hepatitis B vaccine safe?

Yes. Some babies may have mild pain, swelling or redness where the needle was given. A few get a slight fever or upset stomach. You should always discuss the benefits and risks of any vaccine with your doctor.

When should I call my doctor?

Call your doctor right away if your baby has any of these signs after getting a needle :

trouble breathing;
itchy raised blotches;
swelling of face and mouth;
high fever (over 40°C or 104°F).
Can others in my family get hepatitis B?

Yes. If you are a carrier, your sexual partner may also need the vaccine. Other people who live in your home may also need the vaccine. It protects children, adolescents and adults from getting hepatitis B.

What if I have more questions about hepatitis B?

Talk to your doctor or, contact your local public health unit.

Your record of protection

After you or your child get any immunization, make sure your doctor updates your personal immunization record, such as your “Yellow Card.” Keep it in a safe place !