Since Canada’s cannabis legalization, more and more, people are turning to this natural remedy for relief from pain, stress, anxiety, sleep, and more. Cannabis consumption among women, in particular, has grown steadily, with an increased number of women turning to cannabis for a variety of health needs.

Cannabis may be known by many names, but it’s usually referred to as “she,” with only the female plants producing the prized buds loaded with cannabinoids. Popular and consumer references still tend to focus squarely on men, however.
In fact, female cannabis consumption is becoming increasingly visible as more women turn to this natural remedy for their health.
Women are consuming nearly as much cannabis as men, according to reporting about Cannatrack, Applied Knowledge’s cannabis consumption tracker. It found that, from October 2018 to September 2019, approximately 33 percent of Canadian females had consumed cannabis, compared to 34 percent of males.
As cannabis slowly sheds its outdated association with the male “stoner” stereotype, consumption among women could potentially tip even higher.
“I think there are a lot of women who quietly use cannabis,” says Sabrina Ramkellawan, COO and co-founder of Knowde Group Inc., a research organization and consultancy specializing in plant-based medicine. “Women may be more reluctant than men to say that they’re users; it seems like it’s still more common, or acceptable, for men. With women being seen as caregivers, there’s that stigma.
“As more and more people are getting used to seeing and hearing about other women using cannabis, including professional women, the more women feel comfortable telling their own stories,” she says.

Who’s consuming cannabis?

Among male and female cannabis consumers, the greatest concentration is in the 21 to 39 age range, though women in the 19- to 24-year-old bracket are more likely to consume than men, Cannatrack showed.

How much do women use cannabis?

The Cannatrack data also revealed that among both genders, more consumers are shifting from being “light” users (less than once a month) to “high” or “medium” users (between once a week minimum and once a month).

The highest percentage of women who consume cannabis more than once a week is in those aged 19 to 20 and 25 to 29.

What types of health issues are women consuming cannabis for?

Menopause

According to the Midlife Women Veterans Health Survey, to help manage their menopausal symptoms, 27 percent of women said they had used or were currently using cannabis. Another 10 percent reported they were interested in trying cannabis to treat menopause-related problems. Only 19 percent reported using more conventional approaches such as hormonal therapy.

The Midlife Women Veterans Health Survey reported on women with an average age of 56 who reported menopause symptoms, including the following.

Cannabis may be helpful in mitigating the symptoms of menopause because, just as with the many changes that come with the cessation of menstruation, cannabis is a complex plant consisting of hundreds of compounds and having multiple effects.

“Menopause is not just one thing; it’s a bunch of things, and cannabis doesn’t just target one thing,” Ramkellawan says. “It affects mood, it affects pain, it affects sleep; it really lends itself well to many conditions for women because it hits on so many different receptors.”

Endometriosis

This disease is marked by the growth of endometrial tissue outside the uterine cavity, which causes chronic pelvic pain and can lead to infertility.

Endometriosis affects one in 10 women of childbearing age.

Although research is limited, mice studies have shown that daily treatments with THC alleviated pain and reduced cognitive impairments sometimes associated with the condition. Cannabis also inhibited the development of endometrial cysts.

Arthritis pain

Arthritis affects one in four Canadian women and one in six men.

A poll by the Arthritis Foundation found that 29 percent of people who participated in their recent survey reported current use of cannabis (mostly CBD in liquid or topical form), and nearly 80 percent of respondents were either using it, had used it in the past, or were considering it. People noted improvement in physical function, sleep, and pain or stiffness.

Fibromyalgia

Symptoms associated with fibromyalgia include widespread musculoskeletal pain as well as fatigue, cognitive problems, mood disturbances, irritable bowel syndrome, headaches, and sleep problems.

Fibromyalgia is far more prevalent in women than men, with approximately 90 percent of cases being diagnosed among females.

Although limited, research suggests that people with the condition who consumed cannabis experienced significant improvements in pain intensity.

Migraines, insomnia, and anxiety

These are other conditions some women are consuming cannabis to treat—issues that are far more common in women than men. “Some women are using cannabis to help with sexual function as well,” Ramkellawan says.

See our web exclusive at alive.com/webexclusive/for more on the role cannabis may play in improving women’s sexual health.

What does the future hold?

Ramkellawan hopes that there will more cannabis research dedicated specifically to women’s health, such as the plant’s effectiveness in treating endometriosis and menopause.

She also suspects there will be a greater variety of ways to administer cannabis, including vaginal suppositories. (“There are women currently making their own,” Ramkellawan says.) Effective topical applications, such as creams or gels that absorb easily, which are popular among seniors with arthritis, could also become more common.

High-ranking women in the cannabis field

Sabrina Ramkellawan

The co-founder of Knowde Group Inc. is a former registered nurse and one of Canada’s leading cannabinoid researchers. The president of Clinical Research Association of Canada, Ramkellawan also teaches a cannabis certificate program to health care providers at the Michener Institute of Education at the University Health Network.

Melinda Rombouts

The CEO of Eve & Co, a female-focused cannabis brand, has extensive knowledge in plant biology and experience in greenhouse operations. Through its wholly owned subsidiary, Natural MedCo Ltd., Eve & Co is a licensed producer and seller of dried cannabis and cannabis plants.

Rachel Colic

Founder of The Boss Ladies of Cannabis, Colic is a brand strategist with a background in advertising. Colic launched this listing of female leaders after noticing that just 25 percent of women hold executive positions in the industry.

Cannabis and anxiety in women

While cannabis may help relieve anxiety, some research suggests that women may be more likely than men to get anxiety-related symptoms from occasional use. If you’re consuming cannabis, watch for feelings of nervousness or restlessness or a heart-racing sensation. If those symptoms appear, consider reducing the dose.

Exercise, meditation, deep breathing, and rest are all ways to handle anxiety, depression, and stress. For some people, so is cannabis. With the legalization of medical cannabis in Canada, more people are turning to this medicinal plant to improve their mental health.
While its use may be widespread and its benefits promising, comprehensive research into the effects of medical cannabis on afflictions of the mind is only just beginning.
“I don’t think we need to spend time looking at whether cannabis might be beneficial for some people; it is,” says M-J Milloy, Canopy Growth professor of cannabis science and assistant professor in the faculty of medicine at the University of British Columbia.
“What we need to have a more even-handed view of is who might it be beneficial for, what kind of dosages might it work best at, and who is it not beneficial for?”
Adding to the challenge of understanding the way medical cannabis affects the brain is that it’s a complex herbal preparation that comes in several different strains and formulations. The two main active compounds are CBD (cannabidiol, the non-psychoactive component) and THC (delta-9-tetrahydrocannabinol, which leads to the feeling of being “high”).
“There are plausible indications that THC and its euphoric qualities could certainly be an effective antidote to acute and chronic stressors that people experience,” Milloy says.
“Whether or not that outweighs the risks that people might experience from using a psychoactive drug: that’s really the task scientists have now, to take the claims and put them to the test.”
Cannabis for mental health—the research 
Here’s what some of the early research into the impact of medical cannabis on stress, anxiety, and depression shows.

Cannabis capsules for acute stress relief

Medical cannabis may alleviate anxiety in certain stressful situations. According to a study published in the Brazilian Journal of Psychiatry in 2019, for example, capsules containing 300 mg of CBD helped reduce anxiety in people during a public speaking experience—a known stress-inducing activity.

Inhaled cannabis for depression, anxiety, and stress

Smoking cannabis, meanwhile, can significantly reduce short-term levels of depression, anxiety, and stress but may contribute to worse overall feelings of depression over time. That’s according to a 2018 study by Washington State University (WSU) that examined people’s self-reported feelings of well-being.

Published in the Journal of Affective Disorders, the study found that one puff of cannabis high in CBD and low in THC was optimal for reducing symptoms of depression, while two puffs of any type of cannabis diminished symptoms of anxiety. Ten or more puffs of cannabis high in CBD and high in THC led to the largest reductions in stress.

Participants reported a 50 percent reduction in depression and a 58 percent reduction in anxiety and stress following cannabis use.

Short-term versus long-term effects 
The WSU study also found that symptoms of depression <increased> significantly over time and with the number of sessions. The study concludes that “… cannabis may temporarily mask symptoms of negative affect but may not effectively reduce these symptoms in the long term.”

Smoking cannabis comes with risk 
While the research points to stress, anxiety, and depression relief from smoking cannabis, this form of ingestion comes with its own health consequences because it directly affects the lungs. This is an area of study that’s on far more solid ground.

“Although studies have not found a link between smoking cannabis and lung cancer, there are clear risks associated with smoking versus other routes of ingestion,” Milloy says. “Canada’s Lower-Risk Cannabis Use Guidelines clearly recommend avoiding smoking over other routes, such as eating.”

Research highlights different effects on males and females

The WSU study also found that although both sexes reported a drop in symptoms of short-term stress, anxiety, and depression related to the use of medical cannabis, women reported a much greater reduction in anxiety.

Indeed, just as with other substances, cannabis affects female and male bodies differently. But when it comes to gender differences around the impact of cannabis use on mental health, findings vary.

For instance, some US research has found an association between depressive symptoms and cannabis use for girls (as well as frequency of cannabis use among men and young men). Other studies, however, suggest no association between depressive symptoms and cannabis use in girls.

Women who experience social anxiety may be more likely to use cannabis than men. In one US study, women reported a desire to use cannabis during a lab-based anxiety-provoking scenario, but the same was not found for male counterparts.

“At a very general level, it is well understood there are important sex and gender differences in cannabis use and effects,” Milloy says. “Unfortunately, to the best of my understanding, there has not been the type of research that would allow us to understand the sex and gender differences in response to cannabis and stress.

“There is so much to learn,” he adds. “We need to figure out what benefits there might be and what the risks are to get a better handle on what the proper role for cannabis might be in clinical settings.”

Strains for mental strain Cannabis sativa and Cannabis indica are the two main types of cannabis used for medicinal purposes. Although scientific research is lacking into how each affects stress, depression, and anxiety, there are some generalities to note.

Indica

These strains often contain higher levels of CBD and lower levels of THC and are sought out for their relaxing effects.

Sativa

Typically, sativas have lower amounts of CBD and higher amounts of THC. They can lead to a creative, energizing effect.

Safe use tips 
Medical cannabis affects people differently, and it’s important to reduce the risk of harmful effects. Here’s how.

Know your THC and CBD levels

Products with high THC (the mind-altering component) can lead to dependence or mental health problems, while CBD can counteract some of THC’s psychoactive effects. Consider products with a low THC content or a higher ratio of CBD to THC.

Hold off

The younger you are when you start using cannabis, the greater the chance of serious health problems, such as depression, anxiety, or addiction.

Get help if you need it

Some people who use cannabis may become dependent. If your use is affecting your work, school, social, or family life, seek support.

It has been described as the best meditation by the Dalai Lama, heaven on earth by poet Edward Lucas, and the bridge between despair and hope by entrepreneur E. Joseph Cossman: sleep is something most people crave and few get enough of.

Sleep needs a cred boost 

It’s as essential to our very survival as water, food, and shelter, yet sleep tends to be pushed aside when it comes to priorities, considered an afterthought or even an inconvenience amid our busy schedules. That sleep ranks so low in terms of healthy lifestyle habits is a phenomenon that can have serious effects on our well-being.

“At the end of the day, we’re not valuing sleep,” says Dr. Charles Samuels, medical director of Calgary’s Centre for Sleep & Human Performance. “Most of the problem comes from people not understanding the health benefits of normal sleep.”

Lack of sleep and poor sleep are two distinct issues. In North America, 20 to 30 percent of the population has a sleep debt averaging approximately 10 hours. They are normal sleepers who lack sufficient shut-eye. Others have a sleep disorder—such as insomnia or obstructive sleep apnea (snoring)—that disrupts their nighttime rest.

Sleep debt comes with high costs 

Both come to the same end point: cognitive, behavioural, and physical impairment, and a higher likelihood of developing chronic illness.

“When you either have not enough sleep or poor quality sleep, you end up with cognitive impairment; your ability to think, your memory, and your concentration are impaired,” Samuels says.

“Classic signs of behavioural impairment are irritability, sleepiness, and fatigue. Classic examples of physical impairments would be increased appetite for calorie-dense food, leading to obesity or problems with weight control.

“As you accumulate sleep debt or have a sleep disturbance, you’re at higher risk of cardiovascular disease, metabolic disease, and diabetes,” he says. “There’s a higher risk of mood disorders. Anxiety is exacerbated.”

Blissful, sufficient sleep doesn’t have to be the stuff of dreams, however.

Children 
Developing sound sleep habits starts early in life. Little ones need to learn to self-soothe so they can fall asleep and stay asleep on their own.

As they grow, kids need different amounts of sleep

Note: Amount of required sleep in a 24-hour time span includes naps and varies among individuals.Approximately 30 percent of kids have sleep problems. 

Sleep-onset association disorder

Common in young children, sleep-onset association disorder is characterized by a child needing certain conditions from a caregiver to fall asleep, such as being rocked or having their back rubbed.

Delayed sleep phase syndrome

Older kids and teenagers commonly experience this sleep problem marked by going to bed very late and waking up late. Being a night owl can negatively affect daytime responsibilities. “Delayed sleep phase syndrome is often misinterpreted as insomnia,” Samuels says, referring to the condition involving dissatisfaction with sleep quality or duration.

Sleep disturbances in teens can be associated with mental illness, such as anxiety and depression.

Developing healthy sleep habits 

Quiet darkness

To help develop lifelong healthy sleep habits, it’s crucial that a child’s brain recognizes nighttime, with a bedroom that’s quiet and dark. That same sleep-inducing environment is vital for teens as well.

Technology-free space

Kids (like adults) need a technology-free zone for good quality sleep. That means not having a computer, mobile phone, tablet, gaming console, or other electronic devices in their room. Technology stimulates brain activity, making it harder to fall asleep, and electronic devices emit bright light that interferes with sleep.

Consistent sleep/wake times

Bedtime and waking time should be similar every day and not vary by more than 30 minutes between weekdays and weekends.

Adults 
Adults typically sleep seven and a half or eight hours a night, on average, but that can range between six and nine hours.

Healthy young adults take 10 to 20 minutes to fall asleep on average, and many adults enjoy consistent sleep: they go to bed at regular times, fall asleep quickly, and experience little wakefulness.

About 32 percent of adults have sleep problems. 

Insomnia

Work demands, especially in conjunction with parenting and caring for aging parents, financial strain, and substance use are just some of the things that can get in the way of sufficient sound sleep. “With adults, insomnia is associated with stress and lifestyle habits or with mental illness,” Samuels says.

Sleep apnea

The most common sleep disorder affecting adults is obstructive sleep apnea, where breathing stops and starts. There are a number of possible causes, including obesity, hormone issues, and large tonsils.

Developing healthy sleep habits 

Give it priority

Adults can improve their sleep by making it a priority, deeming it as important as exercise and diet when it comes to healthy living.

Avoid before bedtime

• caffeine
• nicotine
• alcohol
• heavy meals

Create a sleep sanctuary

• Reserve your bedroom for sleep and intimacy.
• Keep your bedroom cool and dark.
• Skip the screens.

Seniors 
Our sleep changes as we age. Older adults tend to go to bed earlier than younger adults, may sleep more during the day, and might experience more nighttime awakenings.

Aging can also introduce all sorts of sleep-disrupting factors. Sleep apnea is common; so are repetitive limb movements. That’s not all.

About a third of seniors have sleep problems. 
“In the elderly, chronic pain, congestive heart failure, chronic obstructive pulmonary disorder, and other medical illnesses can disturb sleep,” Samuels says. He notes that certain medicines can have detrimental effects. It’s important for people to talk to their health care practitioner about the effects of drugs on their sleep. Turning to sleeping pills isn’t the answer.

“People seeking medication in any form means they have a clinical, significant sleep disturbance, and that should be discussed with their primary care physician,” Samuels says.

“We do not promote over-the-counter medication for sleep. At the Centre for Sleep, we have a very strong behavioural sleep medicine program. There’s an array of interventions based on the principles of cognitive behavioural therapy, but it goes beyond that into relaxation techniques, exercise, diet, and more.”

Developing healthy sleep habits 
Older people can improve their sleep by adopting regular sleep/wake cycles, being physically active, and diminishing worry as much as possible before bedtime.

Sleep disorders through the ages 

Children

Sleep-onset association disorder

What it looks like: 
Common in young kids, this occurs when a child needs to have their caregiver do certain things to help them fall asleep, whether it’s being fed, rocked, or having someone lie down next to them. When they wake up in the middle of the night, they can’t get back to sleep without those same activities.

How to fix it: 
To overcome this problem, kids need to learn how to soothe themselves to sleep. It helps to have a bedtime routine, such as a warm bath followed by reading alone in bed.

Delayed sleep phase syndrome

What it looks like: 
Although this can occur at any age, teens are particularly prone to becoming “night owls,” developing a routine of going to bed late, sleeping in, and skipping breakfast.

How to fix it: 
It’s important for teenagers to go to bed at roughly the same time every night and wake up around the same time daily. Also important is to avoid caffeine and other stimulants during the evening.

Insomnia

What it looks like:
Insomnia can strike people of all ages, including children. It involves trouble falling asleep, waking up throughout the night, or waking too early. It becomes a clinical problem when people experience difficulty falling or staying asleep several nights per week, leading to mood disturbances, concentration problems, and overall fatigue.

How to fix it: 
Relaxation techniques can help; so can going to bed only when you feel sleepy, exercising regularly (but not right before bed), and taking at least one hour to unwind before going to bed, whether it’s listening to music, reading, or writing down worries and setting them aside for the evening.

Adults

Obstructive sleep apnea

What it looks like: 
This condition involves intermittent cessation of breathing during sleep. Severe cases can raise the risk of heart disease, stroke, and diabetes. Sleep apnea can be caused by obesity or being overweight, while drinking alcohol and smoking can also increase the risk.

How to fix it: 
Along with healthy lifestyle changes, someone diagnosed with obstructive sleep apnea can use continuous positive airway pressure (CPAP), which consists of a portable machine that delivers pressurized air to the nose through a mask.

Seniors 

Periodic limb movement disorder 

What it looks like:
This phrase describes repetitive, uncontrollable movements of the arms and legs during sleep that may cause “microarousals.” There may be a genetic link or other issues, such as iron deficiency or nerve or blood circulation problems.

How to fix it: 
If iron deficiency is detected, supplementation may be suggested; in other cases, regular exercise can help alleviate symptoms.

Restless legs syndrome What it looks like: 
Uncomfortable or unpleasant sensations in the legs when lying down lead to an overwhelming urge to move the legs during rest, affecting the ability to sleep.

How to fix it: 
Warm baths, leg massages, and applying hot and cold packs can help. Making sure you’re getting enough magnesium (food sources include leafy green vegetables, wheat germ, pumpkin seeds, and almonds) may also help alleviate the symptoms.

Herbs and supplements to help you sleep

The single most important tip for getting good sleep
Dr. Charles Samuels, former president of the Canadian Sleep Society, has this to say to people of all ages who have trouble sleeping: “Get off your phone.”

“The number-one issue affecting people’s sleep is technology. People need to learn about the negative effects of technology on health and sleep and limit their exposure. It’s becoming a serious problem.”

Even if you’re not using your phone in bed, it can detract from sleep with alerts, sounds, vibration, and light.

Tech to measure sleep 

Polysomnography

When it comes to the measurement of sleep, supervised polysomnography (PSG) is widely considered the gold standard. PSG typically involves an eight-hour monitoring of someone sleeping through audio and visual recording with electrodes in varying positions, as well as assessment of breathing and leg movements. This is usually done in a controlled setting such as a sleep clinic or hospital.

PSG has been around for more than five decades, but other approaches have been introduced to measure sleep.

Actigraphy

Said to diagnose circadian rhythm disorders via a device worn on the wrist, actigraphy can measure sleep over extended periods of time in the patient’s natural sleep environment.

2B‐Alert App

A more recent innovation is the 2B‐Alert App. The first mobile application that progressively tracks a person’s response to sleep deprivation in real time, it generates individualized predictions of alertness.

Multi‐sensor activity trackers

Also called fitness trackers, devices such as the Fitbit Alta HR are used to quantify sleep duration and REM sleep.

How effective are they?

The effectiveness of new technology on accurately measuring sleep—and our understanding of it—has yet to be determined.

With the potential for variability in results among different technologies, there’s concern among some experts that the routine application of data from such devices in clinical practice could introduce significant diagnostic error, according to the Journal of Sleep ResearchDieter Riemann, the journal’s editor-in-chief, is calling for ever more comprehensive ways to study sleep.

“I think what we really need in the sleep field is to overcome the artificial situation of the sleep laboratory and furthermore move to consecutive unobtrusive measurements over periods of seven to 14 days,” Riemann wrote in a March 2020 article. “Such data could really alter our perception of sleep disorders and sleep itself.”

From politics and film to business and science, women are routinely underrepresented. There’s another sphere in which female representation is lacking, and it’s one that threatens women’s well-being and very survival: health care. Women are falling through what’s known as the “health gap.”

Gender differences overlooked

Whether it’s research, policy, diagnosis, or treatment, gender differences have not been adequately studied to date—if they’ve been taken into account at all. Women’s physiology, biology, cultural norms, and life circumstances are often overlooked, and the consequences are both real and dangerous.
“From a research perspective and care perspective, differences between sex and gender really haven’t been well considered,” says Toronto geriatrician Paula Rochon, vice-president of research at Women’s College Hospital. “As a result, women don’t necessarily have information about them that’s very particular to their needs, so this creates a gap.

“Often, women haven’t been adequately included in clinical trials in a way that represents how a particular condition might impact them,” adds Rochon, noting that Women’s College Hospital is prioritizing gender in its research and study proposals.
“The other piece to this, and I think the most glaring, is that even when women are included in trials, investigators don’t necessarily report the information in such a way that you can distinguish how women did and how men did, therefore you lose information. One-size-fits-all isn’t what you want.”

Deadly consequences for women’s heart health

Heart disease and stroke may make for the most alarming examples of how the gender health gap translates to potentially deadly real-world experiences. Combined, the two conditions are the leading cause of premature death of women in Canada, according to the Heart and Stroke Foundation of Canada.

Hormonal changes, pregnancy, and menopause are among the risks specific to women’s hearts. However, two-thirds of related clinical research is done on men. Compared to men, women are underdiagnosed and undertreated.

In fact, 53 percent of women with symptoms of heart attack have those signs go unrecognized. Some have died as a result. Heart and Stroke is responding by doubling the dollars it invests in health care for women.

Drug dangers for women

Certain pharmaceutical therapies are another stark illustration of how the health gap hurts women. Consider Ambien, which is used for sleep. In 2013, the US Food and Drug Administration cut the recommended dosage for women in half after discovering that American women were routinely overdosing on the active ingredient, zolpidem.

“If you’re looking at drugs and you’re not necessarily thinking about the differences between women and men, you don’t understand that women may need drugs in slightly different ways,” Rochon says.
“Women may require a lower dose, or the way they absorb or metabolize the medication may be different. It may end up that women are getting doses higher than they actually need, and that can result in side effects.”

Inappropriate long-term treatment

Gender can also affect how health professionals provide care. Women are more likely than men to report severe and long-lasting pain, for instance. But doctors tend to approach women’s pain as psychological or psychosocial and are more likely to refer women to a therapist rather than a pain clinic. Women who report chronic pain are also more likely to be prescribed antidepressants over pain medication.

It goes on. From tuberculosis to attention deficit hyperactivity disorder, women are less likely than men to be properly diagnosed.

A history of omission

In Canada, the inclusion of women in clinical studies is a relatively recent phenomenon.

One of the first initiatives to include women in research stemmed from dismay over the lack of scientific investigation into breast and reproductive cancers. In 1997, Health Canada released the Guidance Document on the Inclusion of Women in Clinical Trials. The policy was replaced in 2013 with Considerations for Inclusion of Women in Clinical Trials and Analysis of Sex Differences.
However, these efforts are merely recommendations. To date, it is still not mandatory to include women in research, and there’s no indication whether monitoring will ever be enforced. Until women are equally involved, the health gap remains, and women’s health will continue to suffer.

Stop dismissing women: Close the data gap

The health gap—and the urgent need to close it—is a topic that Caroline Criado Perez covers in her award-winning book, Invisible Women: Data Bias in a World Designed for Men (Abrams Press, 2019). The London, England-based writer and feminist campaigner describes how women are being let down by the medical establishment.
“The bodies, symptoms, and diseases that affect half the world’s population are being dismissed, disbelieved, and ignored,” Criado Perez writes.
“And it’s all a result of the data gap combined with the still prevalent belief, in the face of all the evidence that we do have, that men are the default humans. They are not. They are, to state the obvious, just men. And data collected on them does not, cannot, and should not, apply to women.
“We need a revolution in the research and the practice of medicine, and we need it yesterday,” she continues. “We need to train doctors to listen to women, and to recognize that their inability to diagnose a woman may not be because she is lying or being hysterical: the problem may be the gender data gaps in their knowledge.
“It’s time to stop dismissing women, and start saving them.”

Ways to help

• On an individual basis, people can narrow the health gap by supporting organizations that are working to accomplish the same, whether it’s through volunteering or donating money.
• Raise awareness of the health gap through your social channels.
• Contact research organizations and demand gender considerations be a requirement for successful proposals.

Narrow the gap

For more on why we need to narrow the women’s health gap, visit alive.com/webexclusive

Gail Johnson is a Vancouver-based writer, broadcaster, and fitness instructor.

This article was originally published in the May 2020 issue of alive Canada, under the title \”Health Gap Harms Women.\”

Becky Lee remembers being in shock when, in 2017, she found out she had breast cancer. Once she began learning about what lay ahead—a mastectomy, chemotherapy, and radiation—she decided to add cannabis to her strategies to cope with some of the intense side effects of treatment. The Vancouver-based working mom is glad she did.

Pain and stress relief

Now 51, Lee used cannabis to reduce pain from the removal of her breast and the nerve pain that accompanied radiation. The substance stimulated her appetite throughout chemotherapy; without it, she says, she wouldn’t have eaten very much. She consumed cannabis on days when the whole ordeal
felt overwhelming.
“I had a lot of anxiety,” Lee says. “There are so many layers to cancer. They throw a lot of medical information at you, and you’re worried about every decision you make. On low days, it made me feel calmer.
“I also did things like exercise and meditation to deal with everything,” she adds. “But I found it [cannabis] really helped me throughout.”

Positive results spur research

Anecdotal reports such as Lee’s are common when it comes to the way medical cannabis can help people with the disease. As interest among patients has grown, more research is being done into the role that cannabinoids—the chemical compounds found in the resin of the cannabis plant—may play in cancer.

Dr. Pippa Hawley is spearheading that research in Canada. The medical director of the provincial pain and symptom management/palliative care program at BC Cancer led a study published in the journal Current Oncology that surveyed the state of cannabis use in cancer during August 2018, just over one month before federal legalization.

More than half of patients in that study had tried cannabis at some point, and almost one-quarter were currently taking cannabis to help manage their symptoms or to treat their cancer—even though evidence to support the latter is lacking.

“What existing research shows is that the most common symptoms people use cannabis to address are pain, anxiety, sleep disturbance, and nausea.”

Research will help guide treatment

Patients and health care practitioners alike are seeking a better understanding of how best to incorporate cannabis into treatment plans.
“The study came about because of the enormous number of cancer patients who are taking medical cannabis products for symptom management and other reasons,” Hawley says. “We felt we couldn’t guide the patients appropriately, because we don’t have enough information.”

Hawley and BC Cancer have applied to Health Canada to conduct the first national study on cannabis use in cancer. What existing research shows is that the most common symptoms people use cannabis to address are pain, anxiety, sleep disturbance, and nausea.
“A lot of people are saying it helps,” Hawley says. “One would think they would have to derive benefit from it to bother with it, because it’s expensive and not usually reimbursed.”
While some cancer patients may experience a beneficial effect from taking cannabis, there’s a dearth of research when it comes to dosages, safe usage, and potential adverse effects.

Research to guide safe usage

Of patients using cannabis in the BC study, only 31 percent had medical authorization. Many obtained it “from a friend” or a dispensary, rather than from a licensed producer (LP) with proper labelling. (Although there are now some legal recreational cannabis dispensaries, all storefront medical cannabis dispensaries in Canada are as yet illegal.) The low rate of medical authorizations in the study suggests that few people had talked to their health care practitioner about cannabis use.
“It’s not a harmless treatment,” Hawley says. “We don’t know what the risks are yet. It’s very much unknown.”

Some people who use cannabis for cancer hope or claim it will cure cancer, a point that concerns Hawley. Patients might ignore adverse effects or take dangerously high doses.

What are possible side effects?

• sleepiness
• dry mouth
• impaired short-term memory and coordination
• anxiety or paranoid thoughts
• can also interfere with the effects of other medications

Accessing medical cannabis

From your pharmacy

For severe nausea and vomiting caused by chemotherapy, your doctor can prescribe a synthetic cannabinoid medicine in pill form (dronabinol or nabilone) and for intractable pain, a mouth spray purified and formulated from a standardized whole plant extract of the cannabis species Cannabis sativa L. (nabiximols). These are not covered by provincial drug plans, but they may be covered by some extended health plans.

From licensed cannabis producers

You can get plant-derived cannabis products from a list of approved licensed producers (LP) available through Health Canada. Your health care practitioner will have to complete a medical document on your behalf and you will need to contact an LP, who will mail the product to your home once the required forms are processed. You can find all the required forms by searching “Medical use of cannabis” at canada.ca. You may be able to claim the cost of these products on your tax return.
“We don’t have human clinical trial results to say that it is safe or effective in treating cancer itself,” Hawley says. “We’re not saying it’s not worth looking at, but there’s a lack of evidence of effect.”
Cannabis is never a first-line treatment, Hawley says. She may endorse patients trying cannabis if they’re having difficulty with side effects of conventional treatments or medications or if they’re overburdened by having to take so many pills (polypharmacy).
For those who wish to use cannabis to manage cancer symptoms, Hawley urges them to talk about it with their health care practitioner.

“If they’re thinking of doing it, discuss it with their medical care providers,” she says. “They may find their health care professionals don’t feel altogether comfortable with it, which is not unexpected. It’s not because of ignorance but because cannabis hasn’t been fully tested. People should be open with their care providers.”
Patients and health care practitioners alike are seeking a better understanding of how best to incorporate cannabis into treatment plans.”

Who should not use cannabis?

• anyone with a history of psychosis or who is confused
• young people under age 25 with a long life expectancy (“There’s some evidence that high doses can impair cognitive development,” says Dr. Pippa Hawley.)
• people with a cardiac condition or unstable angina
• pregnant women

Other potential uses of medical cannabis

Arthritis

Cannabis may help relieve pain and possibly reduce inflammation. Research, so far, has focused on animals, but there have been some anecdotal reports of noticeable pain relief, sleep improvement, and anxiety reduction.

Epilepsy

Cannabis may help reduce the number and severity of seizures in some forms of the disease. Many more clinical trials involving cannabis are underway to learn more about how epilepsy patients can benefit.

Multiple sclerosis

Cannabis may help address muscle stiffness and spasms as well as sleep. Studies have also explored the effectiveness of cannabis for MS-related pain, including neuropathic pain and musculoskeletal pain.

Gail Johnson is a Vancouver-based writer, broadcaster, and fitness instructor.

This article was originally published in the April 2020 issue of alive Canada, under the title \”Cannabis in Cancer Treating.\”

Men and women experience heart attacks in unique ways. The stories of two heart attack survivors demonstrate just how different the experience can be and why paying attention to what our bodies are telling us is so important.

Just like fingerprints and snowflakes, no two hearts are alike. And men and women experience matters of the heart—physically, at least—much differently.
A heart attack happens when blood flow to the heart muscle becomes blocked, restricting oxygen. Depending on how long blood supply is cut off, heart damage can occur, from mild to severe, and can sometimes be fatal.
Men and women experience heart attacks in unique ways. The stories of two heart attack survivors demonstrate just how different the experience can be and why paying attention to what our bodies are telling us is so important.

Marjorie Sanders—“Don’t ignore subtle signs.”

After a successful career as a legal assistant, in 2001 Marjorie Sanders retired to the Okanagan in the BC interior with her husband. The 73-year-old grandmother of four walks everywhere and doesn’t smoke. Although she had developed slightly high blood pressure a few years ago, she considered herself to be the picture of health until the fall of 2018.

Sanders rolled over in bed one night and noticed “a bit of a pop” on the left side of her chest. But it was over in a flash, she had no pain, and by morning she didn’t give it another thought. A few weeks later, she started feeling unwell in a subtle way: she was unusually tired on her regular walks, but upon resting at home she would feel better.

Then her teeth and jaw started to hurt. A Google search led her to believe it was probably reflux, so she carried on with acetaminophen. The discomfort persisted. She went to her doctor, who noticed nothing wrong.

That aching jaw should have been a red flag: it’s a telltale sign of heart attack in women. About a week later, still taking pain relievers, Sanders went to bed, only to experience strange sensations in her chest.

“There was never any pain,” Sanders recalls. “It was like a rumble or spasms. I would sit up and it would go away. Lying down seemed to make it worse. It wasn’t painful, but it was something you couldn’t ignore or put up with. I said to my husband, ‘I think we should go to the hospital.’”

Many women experience a heart attack but, even upon going to hospital, don’t get a diagnosis or explanation of cause, says cardiologist Dr. Tara Sedlak. This is called a “silent heart attack.”

“This is because women are more likely to experience heart attacks from less well-understood conditions such as vasospasm, and these do not show up on a standard angiogram,” Sedlak says. “These undiagnosed patients are at risk for future events and often have high levels of anxiety over not receiving a diagnosis for this heart condition.”

There, she learned she was having a heart attack. An ultrasound the next day showed that one of her arteries was 95 percent blocked. “I couldn’t believe it,” she says. “We were stunned. On TV, you see people clenching their chest. My arms weren’t sore, and I had no nausea or vomiting. I don’t have any history of it in my family.”

Surgeons placed a stent in her heart, and Sanders recovered fully. She takes blood pressure medication, checks in with her cardiologist regularly, and is back to feeling great.

Looking back on her experience now, Sanders says it’s important to deal with high blood pressure, especially understanding possible reasons behind it. Women know their bodies; Sanders encourages them to pay attention to anything that just doesn’t feel right. Jaw pain is an often-overlooked symptom in females.

“My symptoms were vague; I felt just not well,” she says. “It wasn’t grand and dramatic like you see on TV. Don’t ignore subtle signs.”

Risk factors

• For men and women, risk factors include smoking, unhealthy weight, high blood pressure, diabetes, stress, and lack of exercise. Age and family history also contribute to greater chances of heart attack.
• Excessive use of alcohol and recreational drugs such as cannabis can increase the risk of heart disease.
• Women have other unique factors. Menopause, hormone replacement therapy, and pre-eclampsia during pregnancy all affect women’s hearts.

John McLellan—“Stress can affect anybody.”

In May 2017, Jon McLellan ran a half marathon. A month later, at age 41, he had a heart attack.

The founder of Gillespie’s Fine Spirits in Squamish, BC, McLellan recalls the weekend it happened. His daughter was not yet two years old, and his business wasn’t much older.

After pulling an all-nighter to get ready to travel to Vancouver to sell products at a farmers’ market there, the self-employed husband and dad spent the day working, then returned to Squamish and went straight to a family gathering. Later that evening, he was loading heavy items into his car when he felt a wave of nausea.

“I was overheating, just instantly sweating,” McLellan says. “I was kind of dizzy and remember thinking ‘I don’t feel so good.’ The entire night, it felt like somebody had been sitting on my chest.”

He went to his doctor in the morning. She sent him straight to hospital. Tests revealed a heart attack but no obvious physiological cause. Doctors surmised that McLellan’s heart attack was stress induced.

“Stress is the number-one killer,” McLellan says. “It was a good slap in the face.”

“Broken heart syndrome”

Otherwise known as stress cardiomyopathy or takotsubo cardiomyopathy, this condition causes rapid and severe heart muscle weakness; can follow an event involving intense emotional or physical stress, including grief, fear, extreme anger, or surprise; and is more common to post-menopausal women.

McLellan, who now takes a daily aspirin (as a blood thinner), is keeping up with regular physical activity and healthy eating. Since his health scare, however, he sees things in a different light. His health and his family are the most important things in his life, and he doesn’t let work get to him. He’s training a replacement so that he can have more time away from the business.

“I’d rather be poor and happy than wealthy and dead,” he says. “Don’t think you’re ever too young or too invincible to have a heart attack. Stress can affect anybody.”

Warning signs

Chest pain is the most common sign of a heart attack for both men and women, says Cindy Yip, director of data, knowledge management, and heart program at the Heart & Stroke Foundation. Here are some other signs people may experience.

Women

• Sore jaw
• Back pain
• Fatigue
• Shortness of breath
• Nausea
• Indigestion

Men

• sensation of squeezing, pressure, heaviness, fullness, or burning in the chest
• pain or discomfort in the upper body, including arms, left shoulder, and stomach
• rapid or irregular heartbeat
• shortness of breath
• light-headedness
• cold sweat

Dr. Tara Sedlak, cardiologist at Vancouver General Hospital, says it’s important not to dismiss subtle signs.

“I tell people that when they have significant uncharacteristic pain lasting for more than 15 to 20 minutes in locations that could be associated with a heart attack, or severe breathing problems, or fainting with no warning, it’s always safer to get checked out than to stay at home and miss a possible heart attack,” she says.

A version of this article was published in the February 2020 issue of alive Canada with the title “Matters of the Heart.”

Diabetes is one of the most common chronic diseases in Canada. Yet it also seems to be one of the most poorly understood, with people’s knowledge of risk factors and complications being surprisingly low.

Numbers from Diabetes Canada

• One in three people across the country lives with diabetes or prediabetes—and rates are rising.
• Fewer than 50 percent of all Canadians can identify less than half of the early warning signs.
• Only 33 percent of Canadians are aware that stroke is a complication of diabetes.
• Just 40 percent identified heart disease as a potential complication.

There are misconceptions, such as diabetes being caused by eating too much sugar. (Consuming excess sugar can, however, indirectly raise the risk by contributing to weight gain and increased body fat.) Other myths exist.

“There’s no medicine to prevent diabetes,” says naturopathic doctor Maria A. Cavallazzi, founder of Mindful Healing Integrative Naturopathy in Mississauga, Ontario. “I work with a lot of people who are prediabetic and who are trying to prevent becoming diabetic, but it can be overwhelming for people.

“For patients who have diabetes, a lot of prevention focuses on complications,” Cavallazzi adds, noting that some people are unaware that the disease can lead to vision problems, for example. “I do lots of education with my patients.”

The basics about diabetes

Diabetes comes in two forms.

Type 1

Also known as insulin-dependent diabetes, type 1 diabetes occurs when the pancreas doesn’t produce insulin, the hormone that helps regulate levels of glucose, or sugar, in the blood. People require daily insulin injections to survive.

Type 2

Sometimes called adult-onset (though it’s increasingly being seen in children), type 2 diabetes occurs when the body doesn’t make enough insulin or doesn’t use the insulin it produces efficiently. Type 2 diabetes accounts for 90 to 95 percent of all diabetes cases.

Complications of diabetes

Damage to blood vessels and nerves from elevated blood-glucose levels can, over time, lead to serious complications, including blindness. Every year, Canadians with diabetes account for:

• 30 percent of strokes
• 40 percent of heart attacks
• 50 percent of kidney failure requiring dialysis
• 70 percent of non-traumatic amputations

Prediabetes

Prediabetes occurs when blood glucose levels are higher than normal but not high enough for a diabetes diagnosis. If unmanaged, more than half of the people with prediabetes will develop type 2 diabetes within eight to 10 years.

Diabetes symptoms

Signs of diabetes include:

1. excessive thirst
2. frequent urination
3. unexplained weight gain or loss
4. extreme fatigue
5. frequent or recurring infections
6. cuts that are slow to heal
7. tingling or numbness in hands or feet

Diabetes risk factors

There are several risk factors, besides prediabetes. These include:

• being overweight or obese
• age (40 and above)
• family history of diabetes
• physical inactivity
• high blood pressure

The risk of type 2 diabetes goes up when fat is stored around the belly, rather than the hips and thighs. Men with a waist circumference of 102 cm (40 in) or greater and women with a waist circumference of 88 cm (35 in) or greater are at higher risk. Measure your waist after exhaling and avoid holding your breath.

Prevention

On the positive side, prediabetes and type 2 diabetes can be prevented and managed through various lifestyle modifications. (Sometimes, prediabetes can even be reversed.)

1. Diet

“I always start with nutrition,” says Cavallazzi, who was a medical doctor in her native Colombia before pursuing research and then naturopathic medicine. “That’s my base. Nutrition is the most important element of prevention.”

This is where a lack of knowledge can add to risk: Cavallazzi says that many of her patients think they’re eating healthy foods, when in fact what’s in their kitchen cupboards may not be nutritious at all. Diet shakes and granola bars are common culprits. “Those are full of sugar,” Cavallazzi says. “You have to be very careful, because sugar is masked in so many different ways.

“Eat a whole-food diet,” she adds. “Eat less processed food. Cook and prepare your own food using the best ingredients you can. Make changes [to] gradually so you don’t feel deprived.”

Consuming a nutritious diet can also help people lose weight or maintain a healthy weight, which will also help prevent the disease.

2. Exercise

The “exercise prescription” is another extremely effective preventive strategy as well as a requisite management tool.

Cavallazzi says regular physical activity improves the body’s insulin sensitivity and can be as useful in fending off diabetes as glucose-lowering medication, without the side effects. “It doesn’t have to be overly challenging,” Cavallazzi says. “Even gardening or walking will help.”

3. Diabetes helpers

Low-GI diet

The glycemic index (GI) is a 100-point scale that ranks carbohydrate-containing foods by how much they raise blood sugar levels after being consumed. High-GI foods increase blood sugar higher and faster than those with a low GI. Low-GI foods include chickpeas, baked beans, apples, bananas, peas, barley, and quinoa. “You can lighten your glycemic load by eating lots of salads, legumes, and green vegetables,” Cavallazzi says.

Infrared light therapy

This therapy uses red low-level wavelengths of light to help relieve the pain of diabetic peripheral neuropathy, by purportedly strengthening mitochondria. It may also help stimulate regeneration of skin and promote the repair of slow-healing wounds such as diabetic foot ulcers.

4. Supplemental diabetes helpers

Berberine

A chemical found in barberry and goldenseal, among other plants, berberine seems to reduce blood sugar levels in people with diabetes. Certain supplement dosages may be as effective in controlling blood sugar as common medications.

Gymnema sylvestre

Used since ancient times in Ayurvedic medicine, this climbing shrub contains substances in its leaves that may increase the amount of insulin in the body and boost the growth of cells in the pancreas, where insulin is made.

Probiotics

Probiotics and healthy intestinal bacteria have been shown to produce biochemicals and hormones that may help prevent diabetes from developing.

Grape skin extract

Early studies suggest grape skin extract inhibits high blood sugar (hyperglycemia) and may help manage diabetes.

Vitamin D

New research shows a possible link between low vitamin D levels and a higher risk of type 2 diabetes and heart disease.

Gail Johnson is a writer, broadcaster, certified fitness instructor, and mom.

A version of this article was published in the December 2019 issue of alive Canada with the title “Diabetes 101.”

You’ve heard of macronutrients and micronutrients. They’re both vital for optimal nutrition. Now, there’s a newly defined category that could be just as important for well-being, one that sits right in between: mesonutrients.

Macro vs micro

Macronutrients are energy-producing nutrients needed in relatively large quantities in our diet: water, protein, fats, and carbohydrates. Micronutrients, which include vitamins and minerals, are just as crucial, but we only require them in small amounts.

And then there’s mesonutrients

Taking their name from the Greek word meso, which means middle, mesonutrients are the active compounds or ingredients in superfoods that are responsible for their health benefits. In other words, they put the “super” in superfoods.

What’s known as mesodosing involves isolating those substances in order to get a concentrated dose of nutrition.

“It’s the act of supplementing your diet with certain compounds that research has started to identify as beneficial in certain foods,” says Liz Powell, a registered dietitian at Vancouver’s Yaletown Nutrition. “People are taking these superfoods and trying to isolate the key nutrients that makes them ‘super’ to try and get as much benefit as possible in their diet.”

Take turmeric as an example. The health benefits of the spice have been well researched; a member of the ginger family, it has antioxidant and anti-inflammatory properties. These effects are attributed to curcumin, turmeric’s main active ingredient, aka mesonutrient.

This mesonutrient can help manage arthritis, anxiety, and exercise-induced muscle soreness. Mesodosing would involve supplementing with curcumin specifically to get a greater amount of that potent polyphenol and harness its positive impact.

What should you know before mesodosing?

While it might make sense to want to target a particular nutrient to max out on its nutritional goodness, experts say middle-dosing calls for a certain degree of consideration.

Bioavailability

Bioavailability is one consideration. The term refers to how much of a substance enters the bloodstream and can have an active effect as a result. Certain mesonutrients may be hard for the body to absorb when ingested on their own; curcumin is one. (Black pepper contains piperine, which has been shown to increase curcumin absorption.)

Dosage

There are also questions around how much to take of any given mesonutrient. Although we know, for example, that curcumin is a powerful anti-inflammatory, research hasn’t yet revealed the optimal dosage of curcumin. And we also don’t know definitively what the short-term and long-term health effects of particular doses of a single compound might be.

What we do know is that superfood mesonutrients, along with foods loaded with necessary macronutrients and micronutrients are the keys to good health. Eating a healthy whole foods diet will ensure that all the bases are covered—micro, macro, and meso!

With mesodosing, remember: safety first

Getting a megadose of mesonutrients might be tempting, but before you load up on the concentrated splendour of superfoods, be sure to be careful. And don’t overlook the overall nutritional makeup of superfoods, rather than isolated components of them.

“Therapeutic dosing will have an impact on the body, which might not be for everybody,” says Dr. Alexia Harris, naturopathic physician at Sage Clinic Vancouver. “Just like medications, herbal medicines are very powerful, and you want to dose it the way it’s recommended. Even with matcha green tea, it’s so good for you, but it’s not recommended in pregnancy because it has caffeine. So it’s important to be careful.”

Noteworthy mesonutrients

Besides curcumin, here are some of the many other mesonutrients worth noting.

1. Safranal

Safranal is one of the main active ingredients in saffron, the orangey-red spice that comes from the dried stigma of crocus flowers.

Having been used for centuries in traditional healing modalities, it’s said to have antioxidant, antitumour, antidiabetic, and anti-inflammatory effects. Safranal may also be helpful in treating depression, Alzheimer’s disease, and age-related macular degeneration.

2. EGCG

Green tea has been consumed for millennia as a healing beverage. EGCC (epigallocatechin gallate) is the drink’s most abundant catechin, a type of antioxidant, which has powerful anticancer properties.

EGCG holds great promise in cancer prevention because of its bioavailability, safety, and low cost. The substance is also being studied for its role in improving cardiovascular and metabolic health.

3. Berberine

Berberine is a bitter yellow compound found in several plants, including European barberry and goldenseal, a medicinal herb.

Berberine is sometimes taken for diabetes, because it seems to regulate how the body uses blood sugar. Some people take it to alleviate high cholesterol and high blood pressure. The substance has also been shown to reduce the pain and redness of canker sores, when applied in gel form. Emerging research suggests berberine may also be effective in treating second-degree burns and lowering the death rate in some people with congestive heart failure.

4. EPA and DHA

EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are long-chain highly unsaturated fatty omega-3 acids which are synthesized by algae and marine plants.

Found in fish and their oils and krill oil, these substances are present in every cell in the human body and are essential for growth and health. They provide our bodies with energy and support healthy cardiovascular, pulmonary, immune, and endocrine function. DHA, in particular, is found in abundance in our brains and retinas.

Gail Johnson is a Vancouver-based writer, broadcaster, and fitness instructor.

With the dangers of nicotine having been firmly established over the years, fewer Canadian teens have been taking up tobacco. Now, however, there’s a disturbing related trend: more youth are vaping.
The term refers to the use of e-cigarettes, or “vapes.” The battery-operated devices heat nicotine, along with flavourings and other chemicals, to create a water vapour that’s inhaled. There’s no smoke, burning, or scent.
The gadgets, which are also called vape pens, mods, tanks, and e-hookahs, were originally designed to help people stop smoking. While not all products contain nicotine, they tend to appeal to smokers more than patches or gum because they mimic the smoking experience.
The problem is that many teens perceive vaping as less toxic than cigarettes or, worse, altogether harmless. Some aren’t even aware that they could be ingesting nicotine.

Vaping is increasing among youth

David Hammond, professor at the University of Waterloo’s School of Public Health and Health Systems, says the prevalence of vaping has been increasing for the last several years. While this is clearly a concern, up until recently, much of that rise among youth was attributed to “trial”: kids trying it once or twice rather than using regularly. That has changed.

“Our data suggest that in the past year—from 2017 to 2018—more kids are vaping in general, and they’re vaping more regularly,” Hammond says. “We saw increases in nonsmokers as well.”

According to his research, in 2018, about 15 percent of youth reported vaping in the past 30 days, and about 10 percent reported vaping in the past seven days. “This is almost double the prevalence estimates from 2017,” Hammond says.

Other research backs up his findings.

The prevalence of e-cigarette use (including trying an e-cigarette) went up to 23 percent among Canadian students in grades 7 to 12 in the 2016-17 school year, up from 20 percent in 2014-15, according to the Canadian Student Tobacco, Alcohol and Drugs Survey.

What’s driving the trend?

E-cigarettes aren’t new; they were introduced to Canada in 2007. So what’s driving the trend?

Hammond points to several factors, including new vaping technology and design along with aggressive marketing strategies.

Canada began allowing the sale of nicotine-containing vaping products in May 2018. That’s when the Tobacco and Vaping Products Act came into effect, replacing the 1997 Tobacco Act.

Cool-sounding flavours

Along with the release of new products came an onslaught of ads that didn’t previously exist. One of the selling points of vapes has been the range of flavours: e-juice or vape juice comes in varieties such as mango, melon, berry, chocolate, peach, sugar cookie, and banana cream pie—tastes that are tantalizing to young people in particular.

Scientific advances

Then there are scientific advances. San Francisco-based Juul Labs, which entered the Canadian market in September 2018, was the first company to offer “nicotine salt.” This chemical formulation of nicotine decreases the drug’s harshness, diminishing that rough feeling in the throat that accompanies smoking.

Also called nic salt or salt nicotine, nicotine salt consists of a chemical, often benzoic acid, that neutralizes the nicotine to create a more stable compound—one that’s smoother and more comfortable to consume.

Juul (which has even become a verb, “juuling” or “to juul”) also came up with a sleek new look. Smaller than previous market models, its vapes resemble a computer USB flash drive.

“These represent a new class of products,” Hammond says. “What we are understanding now is that nicotine salts allow these products to deliver very high levels of nicotine, and they do it in a very palatable way. It’s true of tobacco too, but if you have too high a concentration of nicotine in vapour, it leaves an acrid taste in your throat. Nicotine salts appear to get around that.

It’s new; it’s cool; it’s not smoking

“Kids don’t see vaping like smoking: smoking is something your dad or grandpa does; most kids think it’s dirty,” he says. “Why would you want to do it when vaping is fun, it’s modern, it doesn’t smell, and you’ve got these great flavours?

“A lot of parents might not even recognize vaping products. One of the reasons kids like it is because it’s so easy to hide. Kids can do it in school. They
can just put it in their sleeve and no one will know they’re vaping.”

Vaping’s negative effects on kids

Hammond emphasizes that e-cigarettes play an important and effective role in helping people quit smoking. However, they were never intended to introduce kids to nicotine, which is a highly addictive substance, and they are certainly not harmless.

Brain development

Youth are especially susceptible to vaping’s negative health effects. The practice can affect brain development, memory, and concentration. It can also lead to addiction and physical dependence.

Higher nicotine levels

An Ontario study assessing vaping products at retail outlets determined that it was common for products to be mislabelled. Twenty-seven percent of products labelled as “with nicotine” had concentrations above what was stated.

Other harmful chemicals

Even if a vaping product does not contain nicotine, there is a risk of being exposed to other potentially harmful chemicals. Besides nicotine and flavouring agents, other ingredients found in vaping liquids include glycerol and propylene glycol. When the liquid is heated, other chemicals, such as formaldehyde, may form.

The long-term health effects of ingesting such chemicals isn’t known; neither are the lasting consequences of vaping in general on a person’s physical and mental well-being.

A gateway drug?

Vaping could be considered a gateway drug. Research suggests that e-cigarette use in youth is associated with smoking tobacco in later years. Plus, some youth are using e-cigarettes for cannabis. According to a study published in Journal of the American Medical Association Pediatrics, about one-third of middle and high-school students in the US in 2015 reported using e-cigarettes with non-nicotine substances.

Because of widespread concerns about the effect of vaping on youth, in April 2019, Health Canada launched consultations on how to reduce youth access and appeal. Potential measures included restrictions to online sales, prohibiting certain flavours, and limiting the concentration or delivery of nicotine in vaping products.

“I would argue that nicotine salt products like Juul’s are the first products that actually fulfil the potential promise of vaping along with the potential threat,” Hammond says.

“When I’m asked what does that mean for governments and regulators: they must find a way of cutting that cord and making sure these products are targeted to smokers rather than kids. That’s not been the case to date.”

Vapes by any other name

Vaping products go by many names, and they may also be known by various brand names. Slang terms include: juice, smoke juice, e-smoke, mods, PV (personal vaporizer), and e-nic. Brands include Aspire, Eleaf, and Kanger.

Talking to your kids

To help kids understand the potential harms of vaping, consider these tips.

1. Avoid lecturing or criticizing.
2. Encourage an honest exchange, open-door policy, and an ongoing dialogue. The topic isn’t meant for a one-off conversation.
3. Suggest your child speak with other trusted adults, such as coaches, counsellors, relatives, friends, and health care

Gail Johnson is a certified fitness instructor, mother of two, and award-winning journalist in Vancouver.

In our wired, 24-7 world where people are facing more demands than ever, getting a good night’s rest is typically the one thing that gets cut. We soldier on, complaining about how tired we are between trips to the closest café for a double-shot Americano (with a splash of oat milk, of course).
“People wear lack of sleep as a badge of honor,” says Atul Khullar, a psychiatrist who specializes in managing sleep, mood, and anxiety disorders. “That’s a psychological mindset that leads us to devalue sleep and not to make sleep a priority.”
He adds, “There’s a coffee shop on every corner for a reason. People are fully aware of how sleep deprived they are—they can’t go for long without a significant amount of caffeine, which just makes the problem worse.”
A lack of sleep is more of a flashing warning light than a badge of honor. The list of detrimental effects includes a weakened immune system, a link to obesity, and even increased mortality. But it’s the effects on our minds that are perhaps most pronounced: poor memory, slower reaction time, diminished decision-making abilities, poor mood, and the exacerbation of depression and anxiety.
In his practice, Khullar sees everything from disorders like sleep apnea (when breathing stops and starts) to sleep deprivation. “Someone may present with mood problems or they’re nodding off during meetings, both of which can be due to lack of sleep,” says Khullar.

Are you drunk from tiredness?

Here’s a sobering thought: Being tired can be just as dangerous as being drunk.

Fatigue Science, a company that has devised fatigue management technology that’s used by corporations, professional sports teams, and military units, has done fascinating research on this.* In a fatal single vehicle accident a few years ago, for example, the company found that the level of fatigue the driver was experiencing at the time was equivalent to having a blood alcohol concentration between about 0.08 and 0.05 percent in terms of their reaction time and ability to concentrate.

By analyzing the driver’s schedule leading up to the accident, Fatigue Science found that the driver was likely slower to react by 34 percent and more than four times as likely to suffer a microsleep—a period of sleep that lasts up to a few seconds—than someone who was sufficiently rested.

And the effects of sleep deprivation are cumulative. Using specialized software to assess the performance of someone sleeping from midnight until 6 am over a two-week stretch, Fatigue Science determined that effectiveness would drop by 19 percent and reaction time by 24 percent. The chronically sleep-deprived person would be three times more likely to suffer an excessively long lapse in reaction time than someone who’s well-rested.

Maybe falling asleep at your desk?

A recent study showed that 76 percent of US workers surveyed feel tired many days of the week, while 15 percent fall asleep during the day at least once per week.

All that lethargy adds up.

“When people are feeling groggy, when they can’t get out of bed, they end up taking more sick days,” says naturopathic doctor Chris Habib. “They can’t function, so they find their capacity for work has decreased. They’re less productive. They’re quicker to anger, and they have a shorter fuse. They find their capacity for social interaction has decreased. As a result of all that, they’re more exhausted and more stressed, and it’s a cycle that feeds on itself negatively.”

That cycle involves poor sleep, poor work, and poor health.

“I frequently see people whose lack of sleep is causing health issues, and vice versa,” says Habib. “Sleep is such an important component of mental health. A lot of people who have insomnia end up suffering from depression or anxiety as a result … and a lot of people with anxiety will wake up in the middle of the night, and all they can think of is work.”

Wanna sleep better?

Figure out what’s standing in your way

Avoid caffeine, nicotine, and alcohol, especially in the evenings. Ensure your bed is only used for sleeping or sex, get physical activity during the day, and don’t do anything stressful in the bedroom (like sending late-night work emails), says Habib.

“Identify any obstacles to good sleep,” he says. “Ensure that the room is quiet and dark. You can try wearing a face mask or using ear plugs. It’s good to have a nighttime routine; make sure you wind down.”

Stop watching Netflix in bed

TVs, laptops, cellphones, and other mobile devices should get a hard pass at bedtime.

“There should be no electronic media in the bedroom,” says Khullar. “The phone is the worst. People end up texting or using it as an alarm clock, but it’s very distracting. The light emitted from these devices can keep us awake.”

Avoid long, late naps

“If you have to, do it earlier in the day and not for as long,” says Khullar. Keep naps to a maximum of 30 minutes, ideally between 2 and 3 pm.

Don’t lie awake

“Stop watching the clock,” says Khullar. “If you’re awake, you should be getting up. Sit quietly somewhere else and do something very boring. Go back to bed when you feel tired.”

Be mindful

If anxiety is preventing you from falling asleep or is waking you up in the middle of the night, Habib says approaches like meditation, deep breathing, and mindfulness can help.

Supplements to promote a good night’s sleep

These supplements have shown promise in some studies, though more research is needed to fully understand their mechanisms of action.

GABA

Gamma-aminobutyric acid (GABA) is a neurotransmitter that blocks impulses between nerve cells in the brain and seems to have a calming effect on the nervous system.

“For people who have difficulty falling asleep because they have restless thoughts, GABA can be relaxing and reduce the amount of those restless thoughts, helping people fall asleep,” says naturopathic doctor Chris Habib.

Valerian

The herb valerian is often used to treat insomnia. It’s also frequently used in conjunction with other herbs. “Supplements that combine GABA, valerian, skullcap, and lemon balm, each in a specific dose, can be helpful,” says Habib.

Melatonin

Melatonin is a hormone produced by the pineal gland that helps control our sleep and wake cycles. Normally, melatonin levels go up in the evening and remain high for most of the night, then drop in the early morning. Natural melatonin levels decrease gradually with age. Melatonin supplements are used to treat insomnia and jet lag.

Gyms for air travelers are taking off

Who wants to sit at a departure gate for three hours before sitting on a plane for another eight? No one. That’s why full-on gyms are appearing in airports from BWI Marshall in Baltimore to Changi in Singapore, often behind security.

Airport gym startup Roam Fitness, for example, is aiming to be in 20 airports in the next five years. It supplies everything the fitness-minded traveler on a layover might need, from reservable showers to vegan protein powder. You can even buy or borrow workout clothes—think lululemon shorts or Brooks running shoes in exactly your size. If you’d rather wear your own gym clothes, staff will vacuum-seal the sweaty stuff post-workout so it doesn’t stink up your carry-on.

Will gyms on airplanes be next? Maybe. Australian airline Qantas is contemplating turning unused cargo space into an in-flight gym, and aircraft manufacturer Airbus has made a prototype of a modular “flying gym” that can easily be moved on and off a plane.