Syndrome X- The mystery syndrome

Antoaneta Sawyer, PhD

Syndrome X — a term, coined by Gerald Reaven (1988), describes a cluster or group of symptoms and abnormalities including high blood pressure, abdominal (visceral) obesity, insulin resistance, dyslipidemia [elevated blood triglycerides, increased bad cholesterol (LDL), and decreased levels of good cholesterol (HDL)].

In 1988, at the end of his Banting Memorial lecture (Stanford University) Reaven states: "At first blush it appears outlandish to suggest an association between hypertension, hypertriglyceridemia and hyperinsulinemia."
The terms 'metabolic syndrome,' 'insulin resistance syndrome' (IRS), 'dysmetabolic syndrome,' 'Syndrome X,' 'Raven’s syndrome,' 'plurimetabolic syndrome,' 'hypertriglyceridemia waist syndrome' 'visceral fat syndrome,' 'cardiometabolic syndrome,' 'general cardiovascular syndrome,' and CHAOS (in Australia) are all synonyms that define a cluster of conditions or abnormalities that occur together in a person, and increase the risk for development of type 2 diabetes, atherosclerotic vascular disease (AVD), coronary artery disease (CAD), and stroke.
Metabolic syndrome is also named the “Deadly Quartet” (1989) by Norman Kaplan, MD (professor of internal medicine at the University of Texas) as it can include upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Kaplan believes that underlying the "Deadly Quartet" is the excessive blood-insulin levels often associated with insulin resistance.(Women'sHeartAdvantage)
Gale (2002) identifies the acronym CHAOS as an abbreviation for coronary artery disease, hypertension, atherosclerosis, obesity, and stroke. Actually, the metabolic syndrome is a cluster of disorders, all of which are affected by genetics, diet, and other environmental and lifestyle (intrinsic and extrinsic) factors (Grundy et al., 2005).
Five metabolic risk factors (dyslipidemia, hyperglycemia, hypertonia, and a general prothrombotic state with a proinflammatory state) are blamed for its appearance. (Source, Wiki and WD) Above all, they are commonly clustered together. As the cluster of abnormalities is frequently observed in allopathic clinical practice, it has been well documented in prospective studies by several cluster-analytical trials (Grundy, 2007; Hanley et al., 2002).
Experimental evidence suggests that it is the exact nature of the cluster which appears to bring additional risk, over and above that which would be expected from each one of the components separately and together. Stern et al. (2004) conclude that people with metabolic syndrome have five fold greater risk of developing Type 2 diabetes, if not already presenting with this disorder.
There are statistic expectations that up to 80% of the almost 200 million adults worldwide will die of CVD, according to the International Diabetes Federation (IDF, 2003). Hence, people suffering from metabolic syndrome are also at increased risk of mortality, as they are three times as likely to die from stroke or heart attack, and twice as likely to die from a coronary event, compared to people without metabolic syndrome. More than 300 million worldwide are now classified as obese, according to the World Health Organization (WHO, 2009), while another billion of people are considered overweight. The European health report (2005) places metabolic syndrome far ahead of HIV/AIDS in morbidity and mortality.
Jean-Pierre Després, PhD, FAHA (director of the lipid research center at Laval University Hospital in St. Foy, Quebec) claims, "Syndrome X is the most important public health problem in North America. Having this syndrome is as high a cardiovascular risk as having high cholesterol, yet most of the people who have it have normal or close-to-normal cholesterol they think they're fine."
Finally, the syndrome has been identified as an actual disease state with the code ICD9. "Nothing helped metabolic syndrome more than the establishment of the ICD9 code." - Yehuda Handelsman, MD (co-chair of the International Committee for Insulin Resistance and medical director of the Metabolic Institute of America).
Joanna Breitstein (2004) states,” The science is beginning to understand the role of insulin resistance,” and proceeds, “A new disease is being born. Unlike a new pathogen bursting from the jungle like Ebola or mutating from something familiar like each year's "new" strain of influenza, metabolic syndrome must be both socially and scientifically constructed. Well-known medical facts have been reorganized into a new understanding. And with that knowledge comes the need and opportunity for new research, new modalities of treatment, and, on the pharma side, new market risks, demands, and opportunities."
Author's final prediction is that “By 2025y - 86 million Americans will have the metabolic syndrome.” Some of the clinical syndromes and diseases, following the metabolic syndrome appearance are: (a) type 2 diabetes mellitus; (b) cardiovascular disease (CVD); (c) essential hypertension; (d) polycystic ovary syndrome (PCOS); (e) nonalcoholic fatty liver disease; (f) certain forms of cancer; (g) sleep apnea; (h) gout; (i) kidney failure, and (j) Alzheimer's disease (Annual Rev. Nutr. 2005).
The American College of Cardiology (ACC) and the American Diabetes Association (ADA) recently launched "Make the Link," campaign informing physicians and consumers that people with metabolic syndrome are undeniably linked to type 2 diabetes what can increase risk of heart disease and stroke. At the same time a new society called the "International Society of Diabetes and Vascular Research" launched its own journal-"Diabetes & Vascular Disease Research" (May, 2004)

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New Update on Qnexa®

Antoaneta Sawyer, PhD

The FDA Endocrinologic and Metabolic Drug Advisory Committee (July 15, 2010) failed to endorse the new obesity drug Qnexa® (Phentermine/ Topiramate) of Vivus Inc. for a final approval, due to concerns of its safety. In a final 10-6 vote, the FDA Advisory Panel concluded that they were concerned that Qnexa was too experimental. (Source, FDA and ChicagoTribune)
Most, if not all members agreed that Qnexa® is very effective drug- a combination of two separate drugs working in obvious synergism in inducing sensible weight loss. The drug alters the taste of food and boosts human metabolism, by cutting a person's body weight up to 15 percent. (Source, Vivus)
Despite their agreement on the efficacy of the drug, a number of side effects (e.g. depression, anxiety, insomnia, attention deficit/ hyperactivity disorder,metabolic acidosis, tachycardia, language and cognitive disorders, suicidal thoughts and teratogenicity) postponed the final Advisory Committee approval. It is obvious that the benefits of Qnexa® did not outweigh its potential risks.
Abraham Thomas, MD, MPH (Whitehouse Chair of Endocrinology at Henry Ford Hospital, Detroit, MI) agreed, "Qnexa® is far superior to anything else on the market. But our concerns are with safety. These have to be addressed, and I think it's best if these are addressed before approval." He especially was concerned about the metabolic acidosis that may occur with its use, reflecting young individuals bone health.
Some of the members proposed further pharmacodynamic studies and longer period of a follow-up (five years), while emphasizing on the increasing necessity of new anti-obesity drugs, due to the pandemic rate of obesity in U.S. The short follow-up of one year, was the major reason for casting a negative vote, for some of the panel members.
Michael Rogawski, MD, PhD (Chair of Neurology at the UC,Davis, Sacramento, CA) agreed, "Clearly we need more information about this medication, but the type of information we need, particularly with respect to teratogenicity, cannot be gained in a clinical trial setting, it can only be gained once the drug is on the market and large numbers of individuals are exposed to it."
Michael Proschan, PhD (Statistician from the National Institutes of Health, Bethesda, MD), explained his negative vote with the following statement, "A lot of these potential problems are brain related — depression, anxiety, memory, cognitive, and that always makes me worry a little more than with other kinds of problems. I don't think we have enough data to be able to say whether they are serious issues or not. I think if we had had longer follow-up I probably would have voted the other way but I just don't feel comfortable with 1-year follow-up."
Jessica Henderson, PhD (Acting Consumer Representative on the panel) voted in favor of Qnexa® approval, although she agreed that long-term safety data are missing. She concluded, "As a consumer representative, I put a lot of credence into quality of life and the pursuit of life, liberty, and happiness and a patient's right to those things."
Kenneth Burman, MD – (Acting Chair and endocrinologyst at Washington Hospital Center in Washington, DC) finally concluded, "We know that obesity is a major health problem and all efforts to address this issue should be lauded. Qnexa® does meet or exceed the agency's requirement for efficacy. On the other hand the medication has serious potential adverse effects, including potential teratogenicity, increased suicidal ideation, cognitive issues, tachycardia, and possible renal stones. Some of these side effects are serious and could be life threatening, and they have to be weighed against the potential of a relatively modest weight loss and its long-term health benefits."

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Is Metabolic Syndrome Contagious?

Antoaneta Sawyer, PhD

The etiopathogenesis (the cause and development) of obesity, as part of the metabolic syndrome, remains problematic, questionable and still rather unknown. Insulin resistance (IR), which is often despite not always seen as a consequence of an increased obesity, is probably the cornerstone of metabolic syndrome and the main link to the metabolic cluster appearance.
Recent cascade of clinical trials is oriented to the viral etiology of the metabolic syndrome and obesity. Latest studies predict that a “Common Cold” virus may be the reason behind the metabolic syndrome and obesity appearance. (Source, Wiki) It is well known that common cold is an infection shown with symptoms like sniffles and sore throat for a period of one to three days, after the viral respiratory inhalation. In fact, common cold is a viral infection of the upper respiratory tract infection caused by several viruses, the most common of which is the human Rhinovirus, and several others known as Coronavirus, Adenovirus, and human Para influenza virus (HPIVs) might be involved in its pathogenesis.
A new clinical study published in Stem Cells (Pasarica et al. 2008) at Pennington Biomedical Research Center suggest that an adenovirus called “AD-36” may be the new adipogenic factor, involved in some cases of obesity. AD-36 it is proven to cause obesity in chickens, mice, rats, and monkeys. The human adenovirus 36 (AD-36) is one of the 52 types of adenoviruses known to infect humans. It was first shown to be associated with obesity in chickens by Dhundhar et al. (2000).
The authors speculate that the virus seems to show similar serotype as the one that causes sore throat, cough and common cold, but it may also contribute to weight gain. The same research claims that 33% of all obese adults have contracted AD-36 at some point in their lives, compared to just 11% of thin (lean) people.

According to the lead author, it seems quite likely that the virus triggers obesity by spreading to other parts of the human body. The team considers that when the virus goes to the fat tissue- it replicates, making more copies of itself increasing the number of new fat cells, which may explain why people get fat when they are infected with this virus. They concluded that a person exposed to AD-36 virus may recover from related viral ailments rather quickly, but he/she could gain weight for a period of 3 months. This is the period until the body will build up resistance to the same virus. Above all people infected with the virus could remain contagious for three months.
Further, it was found in several other studies that AD-36 could turn adult stem cells from fat tissue into fat cells. To recent date, AD-36 is the only human adenovirus that has been linked with human obesity, present in 30% of obese humans and 11% of non-obese humans (Albu, 2005; Augustus et al., 1967; Atkinson, 2007).
Another team of researchers led by Vangipuram (2007) infected ‘young’ fat cells with a variety of adenoviruses. The authors found that the adenovirus AD-36 suppresses the production of leptin by up to 51% and increases the reuptake of glucose in fat cells infected with this virus, leading to the secondary simulation of fat production. It was found that the fat accumulation is significantly higher than in cells that had not been infected. (Souce, Health24) Finally, the authors’ concluded that people could be fat for reasons other than viral infections so it's really pointless for fat people to try to avoid infection.

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FDA sets the day for a final Qnexa® approval

Antoaneta Sawyer, PhD

Vivus Inc. a biopharmaceutical company- producer of the new generation weight loss drug- Qnexa®, with encouraging weight loss results offering a great promise for a sensible weight loss in both, overweight and obese patients, is seeking for final FDA approval. (Source, Vivus)
Qnexa® is a drug combination of two drugs- Phentermine and Topiramate that are believed to work synergistically addressing satiety and appetite in patients who are overweight or obese. The expected effect of the drug is directed to address the metabolic syndrome cluster effects: hypertension, type 2 diabetes, dyslipidemia, central adiposity, including sexual health. (Source, Vivus)
Phentermine, known as the most widely prescribed weight loss pill in the U.S., was approved in 1959 for a short period of treatment in obesity. Caloric restriction, behavior modification and daily exercise are prescribed as an adjunct to the drug that must be used for a period of several weeks. Topiramate is an anticonvulsant drug FDA approved (1996) as antiepileptic drug and later on as a prophylactic drug for migraine. (Source, WebMD, Wiki, Answers)

Qnexa® is in its 3d clinical phase of approval, seeking final registration by the U.S. FDA, being evaluated in over 4,500 patients as a treatment for obesity, completed under a special protocol assessment (SPA) by the FDA. Despite its final stage Qnexa® is currently not approved. There were three separate studies performed at its first clinical phase. The first study (EQUATE) evaluated the drug in 756 obese patients over 28 weeks at 32 sites. The second (EQUIP) and the third (CONQUER) studied the drug for 56-weeks in 1,267 morbidly obese people (with or without co-morbid conditions) and 2,487 overweight and obese patients, (with at least two co-morbidities) respectively.
There were found the following encouraging results:
A. Weight loss of up to 14.7% (37 lbs) was achieved by patients treated with the drug across the 56 weeks in the EQUIP study.
B. During the two 56-week studies, the most commonly reported side effects were dry mouth, tingling and constipation.
C. There were found statistically significant results of improvement in all (cardiovascular, metabolic and inflammatory) metabolic risk factors among patients treated with the drug
D. The efficacy points of reference (benchmarks) for weight loss agents were exceeded at all three doses of the drug
E. The therapeutic results were significantly (69%) higher than the placebo results at all three doses of Qnexa®, showing good drug tolerability (Source, Vivus)
Tomorrow (July, 15) an FDA advisory committee meeting will be taking place to evaluate Qnexa® for obesity treatment. It is expected that upon the conclusion of the meeting, a panel of medical doctors is preparing to make a recommendation on the drug's approval. The FDA has set October 28, 2010 as the date by which the agency will make a formal decision on the approval of the drug.
FDA decided to publish the background material at the location of the advisory committee meeting (prior to the meeting), and the material is expected to be published on the FDA's web site (after the meeting). The Committee is supposed to discuss the safety and efficacy of new drug application (NDA, 22-580), with the trade name Qnexa® (Phentermine/Topiramate). FDA briefed in their online publications (this Thursday) that the review panel should take into account a number of potential side effects, despite acknowledging the drug’s effectiveness in helping patients losing weight. It is expected that FDA will announce its final decision in October, 28 (2010). (Source, FDA) Given two-thirds of adults in the United States are either overweight or obese, weight loss products, such as Qnexa®, may have widespread exposure, and the potential for associated safety issues must be considered," the FDA said, as the Associate Press reported. (Source, HealthNews)

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Metabolic syndrome and HGH connection

Antoaneta Sawyer, PhD

Human Growth Hormone (HGH) is a hormone produced by the anterior pituitary gland in the brain. Humans begin producing HGH at birth and varying levels of HGH circulate in the bloodstream until death. HGH levels reach their peak during adolescence and begin to drop with each passing year. Unfortunately, as we age- beginning as early as age 25, our HGH levels decline to a fraction of the levels of our young age.
Many scientists link this decrease to multiple health threatening degenerative diseases and complications of advanced aging, which include loss of muscle (sarcopenia) and bone strength, an increase in body fat and decrease in metabolism and immune function along with multiple other problems.
Many anti-aging specialists name HGH--the old age “Performance Enhancer” and believe that supplementing our diets with HGH is an effective way to avoid the diseases and conditions associated with aging and improve vitality and appearance. HGH promotes tissue repair, cell regeneration, bones’ repair, muscles and vital organs rejuvenation, and supports immune system in combating infection and disease.
HGH facilitates the building of bone and muscle as well as production of cells that help organs and tissues grow and repair themselves. It also provides for the growth and repair of human muscles and tissue in advanced aging and has also show rejuvenating, regenerating effects on the human body that have been documented in multiple of scientific papers. In addition to all the above, HGH promotes an active metabolism and accelerates the way your body uses energy.
There are multiple symptoms and factors of aging that negatively affect quality of life, such as increased body fat, loss of lean muscle tissue, lower energy levels, decreased sexual function, common depressive symptoms, and weakened immune function or decreased skin turgor.
As explained in the HERS (2002) study, the low circulating level of hormones (HGH and testosterone) in particular promotes an increase in adipose tissue bulk. This leads to free fatty acids release, which are immediately transported to the liver, consequently stimulating the production of Apo-B, containing very low density lipoproteins (VLDL). At the same time insulin resistance leads to overproduction of triglyceride-rich lipoproteins and there is also a reduced activity of peripheral lipoprotein lipase which in turn supports the accumulation of triglyceride-rich lipoproteins in the circulation. Hlatky et al. (2002) teach that via the action of cholesterol ester transfer protein, triglycerides are transferred from these lipoproteins to high density lipoproteins in exchange for cholesterol esters. The enrichment of the triglyceride-rich remnant particles with cholesterol ester leads to formation of small dense LDL, known as VLDL. Moreover, because of this exchange, the level of high density lipoprotein (HDL) cholesterol simultaneously falls.
According to the New England Journal of Medicine study (1990) HGH helps with: restoring muscle mass; decreasing body fat; thickening the skin; reducing wrinkles; restoring lost hair; restoring hair color; increasing energy; improving cholesterol profile; restoring size of internal organs; improving vision; improving memory; elevating mood and improving sleep; increasing cardiac output and stamina; improving immune function; increasing mental function; increasing sex drive
http://www.ncbi.nlm.nih.gov/pubmed/19897679
An increasing prevalence of metabolic syndrome among U.S. adults is proved in a study published in J. Clin Endocrinol Metab (2010) by Attanasio et al. found metabolic syndrome age-adjusted prevalence in the United States was significantly higher than in Europe (51.8 and 28.6%, respectively). The metabolic syndrome prevalence in HGH deficient patients was higher than in the general population in the United States and higher in the United States than Europe. After HGH treatment significant changes were found in waist circumference, fasting glucose, and blood pressure measurements. Prevalence was unaffected by GH replacement, but baseline metabolic syndrome status and obesity were strong predictors of metabolic syndrome after HGH treatment.

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Obesity, recognized as the 21st century epidemic

Antoaneta Sawyer, PhD

Without doubt, obesity has reached epidemic proportions around the world and it is specifically reinforced in America. It is recognized as the most prevalent, recurrent, and relapsing pandemic disorder of the 21st century. (Source, ObesitySociety) Scientists are constantly defining obesity as the leading cause of chronic morbidity, disability and mortality, adding at around 112,000 excess deaths in the US. Latest study published in the New England Journal of medicine (Adams et al., 2006) showed an increased risk of mortality in overweight people (men and women). The excess body weight during midlife, including being overweight, was associated with an increased risk of death. (Source, NEJM). A potential decline in life expectancy in the US in the 21st Century is seen in a study done 2005, March 17, (Source, NEJM)
Obesity increases chances of developing all the co-morbid conditions that constitute the “deadly quartet” of the metabolic syndrome: abdominal obesity, type 2 diabetes, high blood pressure, and high cholesterol. In fact, obesity is considered the main feature of the metabolic syndrome cluster as it packs many negative health effects, including increased risk of stroke, heart disease, type 2 diabetes, hypertension and several common cancers and it has been also shown to reduce sexual activity (WHO, 2005). (Source, Third Age)
More than 300 million worldwide are now classified as obese, according to the World Health Organization (WHO, 2009). Another billion or people are considered now overweight in another study. The epidemic rate of morbid obesity in the US in the period (1986–2000) and (2000-2005) is studied by (Sturm, 2003; Sturm 2007).
Obesity is a disease that affects over one-third of the adult American population (approximately 72 million Americans). (Source, ObesitySociety) The U.S. Department of Health reports that each year, obesity causes at least 112,000 excess deaths in the US. Unfortunately, it doesn’t affect only adults as approximately 11 percent of all American children aged 6 to 17 are obese. (Source, ObesitySociety)
The rate of increased obesity is leading to major disability. The metabolic derangements, seen as part of metabolic syndrome can be outlined as a combination of: elevated Body Mass Index (BMI), an “apple shape,” visceral adiposity (belly fat), “nonalcoholic” type of liver cirrhosis, dyslipidemia (elevated LDL and triglycerides with decreased HDL), hypertension, glucose intolerance- all based on insulin resistance. Unfortunately this is one of the most mismanaged diseases in the clinical practice. (Source, NH-WC Beyond Holistic)
Obesity can shorten your life by 10 years, while extreme obesity - by 12 years, and put you at risk of developing a number of chronic conditions. Generally, obese people die young or develop premature morbidity and disability. (Source, About) The rate of morbidity and mortality is explained with maladies such as: type 2 diabetes, elevated cholesterol and triglycerides, hypertension, asthma, sleep apnea, cardiovascular diseases, gout, kidney failure, Alzheimer’s disease, degenerative (bone and joint) diseases, asthma, fatty liver, gallstones, infertility, miscarriages, birth defects, pancreatitis, irritable bower syndrome, heart failure, multiple cancers: hormonal (breast and prostate) cancers, colorectal, gallbladder, pancreatic, lung, uterine, cervical, ovarian, kidney, non-Hodgkin’s lymphoma, multiple myeloma, multiple myeloma, leukemia, and many others. (Source, Wiki)
Obesity is defined as excess adipose tissue, measured by the body mass index (BMI), defined as the weight in kilograms divided by the square of the height in meters. BMI is seen as an indicator of obesity. A person with BMI > 25 is defined as overweight and a BMI > 30 as obese. The main causes for obesity, according to the metabolic experts are: bad diet, including an increased reliance on highly processed foods, high level of stress, and increased immobility. (Source, ObesitySociety)
Fat tissue is recognized as an endocrine organ and as such, secretes a number of metabolites, cytokines, lipids, and coagulation factors, leading to chronic proinflammatory status and secondary insulin secretion, which can cause insulin resistance that leads to type 2 diabetes. (Axima, 2006)
Lately, obesity has increased across all age groups, reaching different ethnic groups and educational levels. Many features of modern life seem to promote weight gain. The combination of immobilization and stress, abundant and easily available calorically dense, nutritionally empty foods, in tandem with late social and economic influences are all likely contributors to the rising obesity pandemic. (Source, NHLBI)
It is well known fact that societies, which produce a steady stream of constant abundance tend to become overweight societies – especially when much of the diet consists of calorically dense but nutritionally empty foods. The human body has a natural system that helps prolong life when food becomes dangerously scarce. Although this is a helpful mechanism of survival, it does not adjust for a life lived in constant and perpetual plenty. All of these environmental and lifestyle factors lead many to overeat and get too little physical activity, with the result that many people are overweight or obese. (Source, NHLBI)
Authors strongly believe that current dietary recommendations to increase the consumption of carb-dense foods are counterproductive to weight management. Author’s hypothesis is that high-carbohydrate diets based on carbohydrate foods that promote high glycemic response (i.e., high-glycemic-index foods) alter appetite and energy partitioning in a way that is conducive to body fat gain. Thus, carbohydrate-dense foods that have strong impact and postprandial effects must be strongly limited in the case of metabolic syndrome (Holt et al, 1995; Holt et al., 2003).
As conclusion, being overweight, alongside diabetes, having elevated cholesterol levels, and an increased blood pressure, constitute the foundation of metabolic syndrome modern pandemic. In recent years, obesity and overweight are reaching epidemic proportions. Underlying reasons for this global obesity pandemic are complex and still not completely proven. Whereas genetic predisposition plays an obvious part, changes in genetic makeup cannot explain the dramatic rise in obesity rates over the past 10-15 years believe Flegal (1999) and Seidell (2000).
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The Canada Day celebration

Dr. Antoaneta Sawyer

This 1st of July, Canadians from all groups, races and ages are proudly celebrating their day of independence from Great Britain. The Canada Day is a holiday elegantly and widely celebrated by the whole Canadian population.

On this day, years ago (in 1867) Canada became an independent dominion from Great Britain officially established with the British North Americas Act. Canada became a federation of four provinces: Nova Scotia, New Brunswick, Ontario, and Quebec. Known as the Dominion Day, since 1983 the day was officially renamed as the "Canada Day"- the way how it is celebrated today. (Source, About)

The Canada Day is the largest annual holiday event in Thunder Bay - the neighboring city of the Twin Ports (WI). With estimates of over 20,000 the municipality is planning to organize a multitude of outdoor events. The symbol of national pride- the Canadian flag can be seen everywhere on the Canada Day. It consists of two vertical red rectangles separated by a white square, containing a red image of a maple leaf.

The Canada Day will include a lot of ceremonies- city pancake breakfasts, concerts, official town's parade with evening firework display and many other official citizenship ceremonies for new Canadian citizens. The patriotic mood can be seen everywhere from the national flags in red and white displayed on cars and houses to the elegantly dressed Canadians with smiles on their faces.

The 1st of July is the day when the summer closes all school doors in Thunder Bay and all its students are proudly celebrating the beginning of summer vacation. Even the post office is closed. It is well known that only the public transport is still operating on that day, while most of the shops, small business offices, and little stores are closed. Only few pharmacies and gas stations may operate on this day.

For more info on the celebration of the Canada Day in Thunder Bay go to the article "Thunder bay to celebrate Canada day with a bang."