Tag Archives: wellness

The Appendix Reconsidered: What We Thought Was Useless May Be Vital

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For generations, the appendix was treated as a biological afterthought: a relic of evolution with no modern function, only remembered when it flared up in a bout of appendicitis. Like many others, I had mine removed in my early twenties. The procedure was quick and uncontroversial. At the time, we all thought that little wormlike organ at the junction of the small and large intestines served no purpose beyond creating emergency room drama.

But in the last two decades, and especially over the past five years, scientific understanding has undergone a dramatic shift. Far from being vestigial, the appendix is now recognized as playing an important role in immune education, microbiome regulation, and potentially even the gut-brain axis. This rethinking has serious implications for those of us who’ve had our appendices removed, and it’s informing how the next generation of clinicians approaches appendicitis.

The Microbial Safe House
Perhaps the most robust finding is that the appendix acts as a reservoir for beneficial gut bacteria, especially during and after intestinal illness. It contains dense biofilms that host species like Lactobacillus, Bifidobacterium, and Faecalibacterium, which are central to digestion, immunity, and even mental health.

A 2023 study published in Microorganisms found that individuals without an appendix had significantly reduced microbial diversity in the colon, especially after disruptions such as antibiotic use or gastrointestinal infections. Recovery of key beneficial strains was markedly slower. The conclusion? The appendix serves as a sort of microbial “Noah’s Ark,” helping to reseed the gut in times of stress.

A Teaching Ground for the Immune System
Immunologically, the appendix functions as a training ground for B and T cells, especially in children and adolescents. The tissue is rich in lymphoid follicles, producing IgA antibodies and shaping immune tolerance, key mechanisms that help the body distinguish between friend and foe in the gut environment.

In the framework of gut-associated lymphoid tissue (GALT), the appendix plays a role in shaping long-term immune health. Its removal may not lead to immediate issues, but over decades, this could alter inflammatory responses, vulnerability to autoimmune disorders, and gut permeability, factors now being linked to everything from Crohn’s disease to Parkinson’s.

Rethinking the Evolutionary Narrative
One of the most compelling shifts has come from evolutionary biology. Comparative anatomical research across 533 mammal species found that the appendix has evolved independently at least 30 times, a sign of adaptive usefulness, not redundancy.

This repeated emergence suggests that the appendix confers a survival advantage, likely tied to immune function and gut flora stability. That explains its persistence in primates and even some herbivorous animals with complex digestive demands.

Health Consequences of Losing the Appendix
This evolving view has naturally sparked renewed attention to what happens when the appendix is removed. While appendectomy remains a life-saving necessity in acute appendicitis, the long-term consequences are more nuanced than once thought.

Health ImpactPost-Appendectomy Risk/Outcome
Ulcerative Colitis (UC)Slightly lower risk observed—some protective benefit hypothesized.
Crohn’s Disease (CD)Higher risk in some populations, especially when surgery occurs without prior appendicitis.
C. difficile Recurrence2–2.5× higher recurrence in patients without an appendix.
Microbiome RecoverySlower and less robust in patients post-surgery.

For example, a 2023 analysis in Journal of Personalized Medicine tracked tens of thousands of appendectomy patients and found elevated risks of Crohn’s disease within the first 3–5 years after surgery, particularly in younger adults whose appendix was removed for non-inflammatory reasons.

The Gut-Brain Axis and Emerging Hypotheses
We’re now in the early days of understanding the appendix’s role in the gut-brain axis, the biochemical signaling network connecting the enteric and central nervous systems. Microbial metabolites such as short-chain fatty acids, dopamine, serotonin, and GABA, all partially modulated by gut flora, are being studied for their effects on depression, anxiety, and neurodegeneration.

Some early investigations even link appendectomy with Parkinson’s disease onset, although evidence is still preliminary. Nonetheless, the conceptual framework is gaining traction: by eliminating a stabilizing structure for the microbiome, appendectomy may subtly alter systemic inflammation and neurochemical signaling.

An Increase in Rare Appendix Cancers
There is one surprising wrinkle in recent data: appendix cancer rates are rising, especially in younger adults. According to Health.com and Axios, diagnoses have tripled for Generation X and quadrupled for millennials since the early 2000s. While still rare (about 1–2 per million), the uptick is enough to concern oncologists.

Whether this rise is linked to better detection, environmental exposure, or changes in gut health remains unknown. But it’s another reason the once-dismissed appendix is back under the microscope, this time, literally.

New Therapeutic Paths: Do We Have to Remove It?
Perhaps most exciting is the development of non-surgical treatments for uncomplicated appendicitis. In China, a technique called Endoscopic Retrograde Appendicitis Therapy (ERAT) uses a colonoscope to drain and treat the inflamed appendix without removing it. Early results are promising and could offer a new model: one that resolves the acute episode but retains the long-term functionality of the organ.

Western clinical trials are beginning to explore similar conservative strategies, aligning with the broader trend in medicine: when in doubt, preserve structure.

Final Reflections
We now recognize that the appendix is a small, but vital contributor to long-term health. Its microbiological and immunological functions support resilience across the lifespan, and its loss, while often necessary, comes with subtler trade-offs than we once believed.

For those of us living without one, the implications are not cause for panic, but for mindfulness. Supporting gut health through diverse fiber intake, probiotics, and reduced antibiotic overuse can help compensate for what the appendix once did invisibly.

And for clinicians, this shift means asking new questions about when, and whether, to remove the appendix in borderline cases. Medicine’s job is not only to treat but to understand. And in the case of the appendix, understanding has taken a very long time, but it’s finally catching up.

Sources:
• Microbiome recovery after appendectomy – PubMed, 2024
• Evolutionary analysis of appendix function – J. of Evolutionary Biology, 2022
• Appendectomy and IBD risk – Journal of Personalized Medicine, 2023
• Appendix immune role – The Scientist, 2024
• C. diff recurrence study – MDPI, 2023
• Appendix cancer in young adults – Health.com, 2025
• Non-surgical ERAT approach – Clinical discussions, 2025
• Appendix and infection resistance – Axios, 2024

Transparency on Tap: Why All Canadian Cider Should List Sugar Content

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Back in December 2024, I wrote about the need for Ontario Cider to be labeled with its sugar content, and now with removal of interprovincial trade barriers there is a more urgent requirement for this change to be implemented nationwide.

As Canada steadily dismantles its long-standing patchwork of interprovincial trade barriers, from wine to eggs to trucking regulations, we must also address the smaller, subtler obstacles to open commerce and informed consumer choice. One such barrier, hidden in plain sight, is the inconsistent requirement for sugar labelling in Canadian craft cider.

Currently, cider producers are not required to list residual sugar content on their bottles or cans: not in Ontario, not in Quebec, not in B.C., or anywhere else in Canada. This lack of transparency undermines both public health goals and consumer trust. It also creates an uneven playing field for craft producers committed to lower-sugar products who must compete in a marketplace where consumers are left guessing.

Sugar Content: A Consumer Right
Residual sugar in cider can vary wildly, from dry, brut-style ciders with under 5 g/L to sweet dessert ciders with over 60 g/L. Yet without disclosure, consumers are flying blind. For diabetics, keto adherents, or simply those who want to monitor their sugar intake, this is more than a minor inconvenience, it’s a barrier to safe and informed consumption.

By contrast, wine labels often include sweetness descriptors like “dry” or “off-dry,” and many producers voluntarily publish grams per litre. Even big-brand soda discloses exact sugar content, so why are fermented apple products exempt?

A Barrier to Fair Trade
The newly energized national push to eliminate interprovincial trade barriers, backed by premiers and the federal government alike, is about more than just moving goods freely. It’s about creating a common regulatory language so producers in Nova Scotia can sell into Alberta without retooling their labels or marketing. If one province (say, Ontario) were to mandate sugar content on cider labels and others did not, that becomes a de facto barrier.

If Health Canada or the Canadian Food Inspection Agency mandated a national requirement for sugar content in grams per litre on all cider products, we’d level the playing field and remove an ambiguity that hinders cross-provincial commerce. More importantly, we’d be empowering Canadian consumers to make more informed decisions in a market that’s become increasingly diverse, from bone-dry craft ciders to syrupy-sweet fruit blends.

The Health Argument Is National Too
According to Statistics Canada, the average Canadian consumes about 89 grams of sugar per day, well above the World Health Organization’s recommended maximum of 50 grams. Alcoholic beverages, especially “alcopops” and flavoured ciders, are a hidden contributor. The federal government has already moved to require nutrition labels on prepackaged foods and some alcohol categories; cider should be next.

A Simple, Feasible Fix
Requiring sugar content on cider labels is not technically difficult. The metric, grams per litre, is already measured during fermentation and used internally by cideries to define style and taste profile. A national labelling requirement would cost little to implement and make a meaningful difference to consumers.

One Label, One Standard
As Canada moves toward true internal free trade, let’s make sure consumer transparency travels alongside it. Listing sugar content on cider labels isn’t just good policy for public health, it’s a smart, simple step toward harmonizing our food and drink economy. When it comes to cider, it’s time Canadians knew exactly what they’re drinking, no matter where it’s made.

On a personal note, my interest goes beyond the health issue, it’s that I much prefer ciders with less than 5 g/L and that currently just because a can or bottle says “Dry” doesn’t mean the cider is actually dry. 

Patients Are Not Property: Time to Rethink How We Regulate the Sale and Retention of Primary Care Rosters

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In the midst of Canada’s growing primary care crisis, it’s time we take a hard look at how patient rosters are handled, or mishandled, when physicians transition or leave their practices. Across the country, millions of Canadians are without a family doctor. Against this backdrop, we can no longer tolerate a system in which doctors purchase entire rosters of patients only to turn around and drop half of them, not based on clinical need, but lifestyle preference.

This is not a matter of gender. It is a matter of professional accountability and ethical stewardship. Patients are not chattel. They are people, often elderly, immunocompromised, managing multiple chronic conditions, who place their trust in a system that is supposed to protect their continuity of care. When a physician acquires a patient list, they are not buying a gym membership or a book of business. They are assuming responsibility for the long-term health of hundreds, sometimes thousands, of human beings.

Let’s be clear: physicians have every right to structure their practice in a way that supports their well-being. Burnout is real, and work-life balance matters, but that personal balance cannot come at the expense of vulnerable patients being systematically cast adrift.

Professional colleges, including the College of Physicians and Surgeons of Ontario (CPSO), do provide formal mechanisms for a doctor to reduce their patient list. These guidelines exist to allow flexibility, but they were never meant to be a loophole for roster triage based on convenience. If the intention was always to serve only a part-time practice, why was the entire roster purchased? Why was the community not informed in advance? And why are regulatory bodies permitting what amounts to a public harm, wrapped in private contractual terms?

These are not just hypothetical concerns. The abandonment of patients, especially those without alternatives, has ripple effects throughout the entire healthcare system. Walk-in clinics become overwhelmed. Emergency rooms fill with non-emergency cases. Preventable conditions go unmanaged until they become acute, and meanwhile, the public’s trust in the integrity of primary care continues to erode.

If physicians wish to buy a practice, that is a valid path to establishing their career; but there must be clear, enforceable rules to ensure that patient care is not commodified in the process. A few policy options worth considering:

  • Conditional licensing of roster transfers: Require binding disclosure of the incoming physician’s intended working hours and patient capacity before the sale is finalized, with oversight by a neutral third party such as the local health authority.
  • Mandatory transition plans: If a physician intends to offload more than 10% of a newly acquired roster, they should be required to demonstrate how those patients will be supported in finding alternate care – not simply left to fend for themselves – meaning that there is actually an alternative primary caregiver available who is willing and able to add them to their existing roster.
  • Public-interest reviews of large roster changes: Just as utility companies can’t hike rates without justification, physicians shouldn’t be able to restructure public-facing services without transparent public reasoning.

Ultimately, the issue is not about lifestyle choices. It’s about stewardship. Every doctor, upon licensing, accepts a social contract with the people they serve. That contract includes not just the right to treat patients, but the responsibility to do so with equity, consistency, and integrity.

We wouldn’t accept it if a public school principal took over a school and expelled half the students because they only wanted to work mornings. We shouldn’t accept it in primary care either.

The Case for Nurse Practitioners in Canadian Leadership Roles

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Canada’s healthcare system, founded on the principles of universal access and fairness, remains a cornerstone of the nation’s social fabric. As a system that treats all citizens equally, free from the influence of private insurers, it exemplifies the values of equity and solidarity. However, despite these strengths, the Canadian healthcare system faces significant challenges, many of which stem from outdated management practices and an evolving healthcare landscape. These issues highlight the need for changes that can improve both cost-effectiveness and patient-centered care, ensuring the system remains sustainable and responsive to the needs of all Canadians.

A key area for reform is the current model of leadership within healthcare systems. Medical doctors (MDs), who are critical to patient care, are often placed in executive management roles, a practice that can lead to inefficiencies. While MDs possess exceptional expertise in clinical medicine, their training typically does not prepare them for the complex demands of system management or strategic decision-making. As a result, healthcare systems may miss opportunities to optimize operations and reduce costs. This misallocation of skills can contribute to administrative bottlenecks, inefficient resource distribution, and, ultimately, higher healthcare expenses.

To address these challenges and ensure that Canada’s healthcare system remains both effective and sustainable, it is time to reconsider the traditional leadership structure. One promising solution lies in empowering nurse practitioners (NPs) to take on leadership roles within healthcare organizations. NPs, as advanced practice nurses, are already deeply involved in patient care and bring a wealth of experience in managing illnesses, prescribing treatments, and leading care teams. Their training, which focuses on holistic, patient-centered care, is well-suited to the evolving demands of Canada’s healthcare system, where preventative care, wellness, and population health are becoming increasingly important.

By elevating NPs to leadership positions such as Clinical Directors, Canadian healthcare systems could achieve several benefits. First, NPs represent a cost-effective alternative to MDs in management roles. Their salaries are typically lower, allowing healthcare organizations to redirect the savings towards improving clinical services, investing in technology, and addressing social determinants of health. This would allow the Canadian healthcare system to better meet the growing demand for services without compromising care quality.

Moreover, NPs’ patient-centered approach aligns well with the goals of Canada’s public healthcare system. Their emphasis on preventative care and wellness can help drive the system towards more proactive, rather than reactive, care models. This shift not only helps manage costs but also improves access to care, especially in underserved areas, where NPs are already providing essential services. Empowering NPs to lead could also help address the physician shortage, particularly in rural and remote communities where healthcare access is often limited.

Another significant advantage of promoting NPs to leadership positions is their ability to foster collaboration and innovation within healthcare teams. NPs excel in creating multidisciplinary environments that prioritize communication and teamwork—skills that are critical for reducing staff burnout and improving employee retention in a healthcare workforce that is under increasing strain. By empowering NPs, the system can better support its frontline workers, ensuring that healthcare providers are not only skilled in their clinical roles but also in building a positive and efficient workplace culture.

Despite these advantages, there remains resistance to changing the leadership structure in Canadian healthcare. Some may argue that NPs lack the formal medical education of MDs, but this perspective overlooks the fact that NPs’ training is often better suited to the management and collaborative tasks required in today’s healthcare landscape. While MDs offer invaluable expertise in specialized medical fields, NPs’ holistic approach and focus on system-wide efficiency are precisely what is needed to ensure that Canada’s healthcare system can continue to meet the needs of its diverse population.

While Canada’s healthcare system remains one of the most equitable in the world, it is clear that reforms are necessary to ensure its continued success. By shifting leadership to include more nurse practitioners in management roles, we can foster a healthcare environment that is more cost-effective, patient-centered, and capable of addressing the challenges of the 21st century. This change is not about diminishing the role of MDs, but rather recognizing that the complexity of modern healthcare requires a broader range of skills and perspectives to ensure optimal outcomes for both patients and healthcare workers.