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Ross Walker
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Can you be obese and healthy?

Thursday, July 12, 2018

By Ross Walker

There are an estimated 600 million obese people across the globe as of 2016. It is estimated that 2.8 million deaths per year are attributed to obesity. There is a clear link between obesity and cardiovascular disease, type 2 diabetes and cancer - not to mention the significant trauma to weight bearing joints.

It’s been suggested, however, that certain people can experience what is known as ‘healthy obesity.’ Healthy obesity refers to obese people who have no evidence of underlying metabolic abnormalities such as insulin resistance, or any cardiovascular risk factors.

Is healthy obesity possible?

A new study from Sweden raises some doubts about the concept of healthy obesity. Although not a large study, this was a very intensive, well-designed protocol that looked at 15 healthy people and then compared them to 50 people who were obese and about to undergo gastric bypass surgery. On testing, 21 of the 50 people were insulin sensitive and the remaining 29, insulin resistant. A technique known as the insulin clamp technique (which is a very intensive and research based analysis for insulin resistance) was performed on all of the subjects in the trial. They also had biopsies of their white abdominal fat. The conclusion of the trial was that all obese people, regardless of their insulin status, showed abnormal gene expression within the white fat, predisposing them to all the above described health concerns.

Another recently published study performed by the International Agency for Research on Cancer (IARC) showed there was a clear link between the duration and severity of obesity and cancer risk. The study looked at just under 74,000 postmenopausal women. Two thirds were overweight or obese and followed up for 12 ½ years. Disturbingly, 60% of the women in this trial who were significantly overweight or obese at some stage during the trial showed that the length and intensity of obesity was linked to cancer risk (and in particular, breast and endometrial cancers).

A recent study has also looked at the link between gallstone disease and cardiovascular disease. Although thin people can suffer gallstones, this is typically related to obesity, and studies show a 23% increase in risk for coronary heart disease in people with gallstones.

The obesity paradox

This brings us to a discussion of the obesity paradox. There has been a large meta-analysis of 2.9m people from 97 trials, with an average follow up of 15 years. This meta-analysis looked at the BMI in varying groups and the associated death risk. Those with a BMI between 20 and 25 had the same death risk as those with a BMI from 30 and 35, or so-called grade 1 obesity. Those with a BMI between 25 and 30 (considered overweight) had a 6% lower death risk compared to the group with a BMI of 20-25, and those with grade 1 obesity. So, once you got to a BMI of between 35 and 40 (considered grade 2 obesity) the death risk increased by 30%. My explanation for the benefits of being slightly overweight includes having somewhat more fat in your cell membranes, which acts as a protective coating against outside toxins.

Another aspect of the obesity paradox is that once obese people develop cardiovascular disease, they seem to fare better than those who are thin. My explanation for this is very straightforward. Thin people who develop cardiovascular disease typically have a much stronger genetic predisposition to the disease, and tend to be younger as well. The more genetic your cardiovascular disease, the more dramatic the presentation, and the worse the outlook. Lifestyle changes do not appear to make as much of a difference in this situation, and therefore, more intensive medical therapy is necessary. When an obese person develops cardiovascular disease, there is obviously so much more room to move, so to speak.

Finally, to give the analogy of cigarette smoking, there are occasionally people who are lifelong smokers who do not appear to come in the way of harm. In the same way, you may occasionally see an obese person that appears relatively healthy. The vast majority of smokers and obese people, however, are at risk for many and varied diseases, and there is no doubt that if any of these people lose a significant amount of weight, their long term health outlook would be so much better.

[This article was first published September 1, 2016]

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What's wrong with our modern diet?

Friday, July 06, 2018

By Ross Walker

Colorectal cancer is the second most common cancer in men and women in Australia. The risk of diagnosis by age 85 is one in 11 for men and one in 15 for women. There are many factors that contribute to colorectal cancer including genetics, diet, inflammatory bowel disease, inactivity and to a lesser extent, alcohol and cigarette smoking. 

There is increasing evidence that the modern diet commonly consisting of processed, packaged muck masquerading as food may strongly be contributing to this cancer risk. Over the past decade there has been increasing emphasis placed on the importance of the gut microbiome. The mix and diversity of gut microbes are now being strongly linked to a variety of diseases. These diseases not only involve the bowel itself, but disorders of gut microbes are also increasingly being linked to conditions such as obesity, diabetes, cardiovascular disease and a number of common cancers including colon cancer. 

Research in mice, from the US, has demonstrated that even in low concentrations of the commonly used emulsifiers in food there is low grade inflammation in the body, with subsequent, obesity and metabolic syndrome. This has occurred at even a 10th of the dose commonly used in foods. 

When they studied mice and administered emulsifiers at the same concentration given to humans in food, there was a marked increase in pro-inflammatory gene expression and a change in the balance between cell proliferation and cell death, which tips the balance towards tumour development. 

These emulsifiers - carboxymethylcellulose and polysorbate-80 - are commonly used in many processed foods throughout the western world. 

Energy drinks

Equally disturbing is a recent report discussing the potential problems of energy drinks which I have mentioned and wrote about repeatedly. This report from the US suggested that the majority of energy drinks are consumed by young males in the 18 to 34-year-old age group, and also disturbingly, a third of teenagers consume energy drinks regularly between the ages of 12 to 17. Between 2007 to 2011, the number of energy drink related emergency visits doubled. This is especially so when combined with alcohol, which leads to a marked increase in binge drinking. It is felt that the combination of caffeine and sugar imparts the biggest risk and there is no doubt that these are major culprits. 

But, just in the same way as we don't really consider the significant potential health risks of all the additives in processed, package foods that may be contributing to poor health, rather we focus on the fat, sugar or protein content of the food.

It appears the combination of caffeine and sugar imposes the biggest risks here. 

But, an interesting case report has highlighted the potential for more hidden components of energy drinks to cause harm. This report detailed a 50-year-old man who was consuming four to five energy drinks on a daily basis and had done so for three weeks. He had no change in his diet, alcohol consumption, prescription or over-the-counter medications, did not use illegal drugs and he did not have a family history of liver disease. He was admitted with an acute severe hepatitis and what surprised me is the research has suggested it was the excess dose of vitamin B3 in the form of Niacin in the energy drinks that led to the liver damage. When his liver was biopsied there was acute fatty liver and inflammation in the liver. He was also found to have hepatitis C which may have contributed as well. 

Regardless of the nuances of either of these examples, it certainly highlights the facts that there are downsides to our modern “Quick fix” approach. It’s clear to me that if it is in a box or a container it is probably not particularly good for your health, and the information I have included above certainly supports this argument. 

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Type 1 Allergies - one of society’s most common conditions!

Thursday, June 28, 2018

Around 25% of the population suffers one form of type 1 allergy. The most common being hayfever, closely followed by asthma, which affects around 10% of people, then urticaria, an itchy skin rash and the less common but occasionally lethal, anaphylaxis.

The actual cause of these conditions is unknown but, no doubt, precipitated by a variety of allergens. Possibly the most common are the variety of grass pollens typically released around spring. A number of infections can also precipitate acute exacerbations of any of these conditions.

Hayfever, although not life threatening, can significantly affect the quality of a person’s life. Over the years, a variety of desensitisation techniques have been used with varying degrees of success. For those people more inclined to use complementary medical techniques, preparations containing horseradish, which are typically combined with garlic and vitamin C or the other herb, fenugreek, are often quite effective. There are now a variety of over-the-counter steroid nasal sprays which can offer preventative relief, especially around spring. Antihistamines are also quite effective in this regard.

Asthma, which typically commences in childhood, is extremely well managed these days with a combination of bronchodilator therapy and inhaled steroids for prevention. Other new therapies are being released on the market. Although we occasionally hear of deaths from asthma, such as the recent tragic premature death of the wonderful Australian musician, Phil Emmanuel at the age of 65, most cases are managed very effectively with asthma care plans and regular monitoring of peak flow, allowing an asthmatic to have a new normal quality of life, with no reduction in lifespan.

Last year in Victoria they were a number of deaths from the condition thunderstorm asthma. In this condition the thunderstorm markedly stirs up grass pollens which are released into the air and inhaled by susceptible asthmatics. This may cause a dramatic severe exacerbation of asthma.

Type 1 allergies, in all their forms, are extremely common but with modern medical techniques we have markedly improved the management, allowing 25% of the population to have a much better quality of life with no impact on longevity.

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Antibiotics - the end of an era?

Thursday, June 21, 2018

In 2017, a woman in Philadelphia died from a colistin resistant E. coli urinary tract infection. There have now been reported, especially in animals, the detection of bacteria completely resistant to all known antibiotics. 

Every year in the United States of America, it is estimated that there are 23,000 deaths related to superbugs resistant to the vast majority of antibiotics. We have been told for a number of years that antibiotics are overprescribed by the medical profession for infections that are typically not bacterial. In the pre-antibiotic era, it was not unusual for people to die from standard bacterial illnesses such as pneumonia, urinary tract infections and even tonsillitis. Death from perioperative wound infection was also very common. 

The introduction of antibiotics around the middle of last century saw a dramatic change in the way that medicine was practiced. Unfortunately, doctors prescribed antibiotics for all manner of infections, typically viruses, for which antibiotics have absolutely no effect. Many people still do not realise that antibiotics make a viral illness worse by killing our normal healthy bacteria that live throughout the body in the respiratory and gastrointestinal tracts, helping fight off viral infections. 

The other major source of excessive antibiotic use is in the veterinarian world and also in domestic animals. Therefore, with this excessive use, the only way bacteria can survive is to develop resistance to antibiotics which has clearly happened. Many experts believe that we are only somewhere between 10 to 20 years away from the post-antibiotic era and thus if human beings are to continue reasonable survival we need to develop clever ways to combat this issue.

Interestingly, a therapy that has been used for many years in Russia is known as bacteriophages.

Bacteriophages are viruses that infected bacteria, leaving the human cell untouched. Interestingly, these are highly specific to certain strains and spare healthy bacteria in the gut. A recent study of 31 people (in a placebo-controlled trial) who had non-specific gastrointestinal symptoms were given bacteriophage therapy for a four week period with two weeks of washout and then this technique was reversed with the placebo group receiving active treatment and the active treatment group then receiving placebo.

When the 31 people were given the bacteriophage therapy which was specifically designed to attack E. coli, a pathogenic gut bacteria, there was a significant reduction in symptoms and a reduction in inflammatory markers related to allergies, also with the increase in healthy gut bacteria such as Bifidobacteria. Not only was there a reduction in E. coli but also a significant reduction in clostridium species which are one of the causes of food poisoning. These people also did not experience any side-effects from the treatment.

The treatment is also being proposed for chronic diarrhoea and to generally improve the presence of healthy gut bacteria. Using this scientific reasoning, there is no reason why bacteriophages could not be used for all bacterial diseases once the specific viruses have been developed.

Regardless, the medical scientific world is well aware that we need a fresh new approach to treating bacterial illnesses, because if we don’t develop new therapies we will see the return to the pre-antibiotic era where many people died unnecessarily.

 

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Cancer - not the death sentence it used to be

Thursday, June 14, 2018

There was a time when a diagnosis of cancer typically meant a death sentence with doctors often telling patients they had a limited time to live. There is also the story about the doctor who says to the patient, “I have some bad news for you and some bad news for you”. The bad news is you have cancer and the other bad news is I’m going to make you sick with chemotherapy.

A recent study published in the June 3 New England Journal of Medicine has given some good news for women experiencing breast cancer. A new test known as the 21 gene Recurrence Score, quantitatively measures the gene expression in an individual’s breast tumour tissue. A score between 0-100 gives an accurate estimation of the likelihood of recurrence.

  • 0 to 10 indicates low risk for recurrence and thus no need for follow-up chemotherapy
  • 10 to 26 is the mid-range score
  • Greater than 26 is the high range score where chemotherapy has proven benefits. 

50% of women with breast cancer are in the hormone positive, axillary node negative group and this is the most common form of breast cancer in women worldwide. Although the studies clearly show the benefits for chemotherapy in the high risk groups and no benefit for the low risk group, 70% of women in this category had a mid-range recurrence score and to this point the benefits of chemotherapy were uncertain. 

This recent study looked at around 10,000 women with this particular breast-cancer category of which just under 70% had a mid-range recurrence score of 11 to 25. They were randomly assigned to receive either chemotherapy and endocrine therapy (such as Tamoxifen) or Endocrine therapy alone. 

The endpoints of the study were invasive disease free survival or in other words, the risk of recurrence of some form of invasive cancer, a second primary cancer or both. 

The great news from the study was that women in the mid-range recurrence score group did not benefit from chemotherapy with an identical survival at nine years of 94%. The only women who appeared to benefit from chemotherapy in this mid-range group were those women younger than 50 who had a tumour recurrence score, 16 to 25. Although the tests cost around AU$500, it is much less expensive than chemotherapy and more importantly, spares women from all of the side-effects associated with this very strong but rather intrusive treatment. Another great feature of this trial was that after nine years follow-up around 84% of the women in the mid-range recurrence score group had not experienced a recurrence of disease, demonstrating how effective our modern therapy has become. 

Another recent trial published in Clinical Cancer Research performed at Cardiff University in Wales, reprogrammed viruses to kill ovarian cancer in a mouse model of the disease, without affecting normal cells. Up to now, the five years survival rate for ovarian cancer is only 15% if not detected very early and the therapies available have limited effectiveness. 

The researchers took a common, well studied virus known as respiratory adenovirus and altered the virus so that it could only enter a particular receptor unique to cancer cells but not present in normal cells. Once the virus invaded the cancer cell it replicated and destroyed the cellular machinery, thus killing the cancer. This was highly effective in the mice and the researchers are now working to modify the virus for specific components found in breast, pancreas, lung and other tumours. There is also the suggestion that specific anti-cancer antibodies and other human chemotherapy agents can be tagged with the virus that would then only enter cancer cells. It is expected that human trials will begin within the next five years.

With the enormous advances in many forms of cancer from a variety of different approaches over the past decade, it is my opinion that we ae close to seeing a cure for this once lethal disease.

 

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Women and heart disease

Thursday, June 07, 2018

 

For many years there was this false notion that heart disease was typically a disorder of males. Thankfully, there has been increasing publicity over the past decade, educating both the public and the medical profession about the importance of the variety of ways cardiovascular disease may affect women. 

Firstly, the most common form of cardiovascular disease is atherosclerosis which is the progressive build-up of fat, inflammatory tissue and calcification in the walls of arteries. This is the most common cause of heart attack and stroke. In this condition, a fatty plaque reaches a critical mass in the wall of the artery involved and suddenly ruptures with a subsequent clot forming leading to a blockage in the artery.

This condition is typical in people with major risk factors for heart disease, such as hypertension, high cholesterol, cigarette smoking, pre-or frank diabetes and a strong family history of vascular disease. The only difference between men and women in this situation is that typically women are protected by their hormones until menopause and may, on average, experience a typical atherosclerosis related heart attack 10 years later in the female compared with a male with similar risk factors. 

But, there is now increasing evidence that lesser well known forms of cardiovascular disease are more common in women than men and in some cases, for obvious reasons, only affect women. 

  1. MINOCA-this acronym stands for Myocardial Infarction in Non-Obstructive Coronary Arteries. This is being increasingly recognised in typically younger women with, at times, atypical symptoms but still evidence of heart attack. When they are investigated with a coronary angiogram there is minimal to no blockages in the arteries. What is happening here is that a lesser fatty plaque in the wall becomes acutely inflamed & erodes the lining of the artery and a large clot forms to acutely block the artery. By the time the angiogram is performed, the clot has dissolved and the artery looks normal or has only minor blockages. These types of cases need more aggressive anti-inflammatory and blood thinning rather than focusing on the more standard risk factors.
  2. Peri-partum cardiomyopathy-obviously, this condition only affects women and can cause varying degrees of heart failure either during or after a pregnancy. This requires ongoing cardiologic management after the condition is diagnosed, typically indefinitely.
  3. IVF associated heart disease. For reasons that are unclear, it appears that women who fail IVF have double the risk of cardiovascular disease when followed for 10 years after the procedure.
  4. SCAD-this acronym stands for Sudden Coronary Artery Dissection, which is not related to atherosclerosis and most commonly occurs in younger women, again, often but not always around the time of pregnancy. If diagnosed, it can be effectively treated with coronary stenting but again, this is not an atherosclerotic condition so does not require aggressive risk factor modification such as cholesterol-lowering therapy. This condition is not exclusive to women but certainly more common in the female gender.
  5. Takotsubo’s Cardiomyopathy-this is stress induced constriction of the coronary arteries that often leads to symptoms very similar to a heart attack. It was felt until recently that this was a one off phenomenon but work from the UK has suggested the potential for recurrence and ongoing cardiac damage. Again, this needs to be recognised and managed appropriately.
  6. Pre-eclampsia-this is a relatively common condition associated with a significant rise in BP during pregnancy. This is very well managed at the time but recent work has shown that women who suffer pre-eclampsia during pregnancy have up to a 4 times increased risk of high blood pressure in later life, twice the risk of stroke or heart attack and 1.5 times the risk of death. Also it appears that women who suffer these issues following an episode of pre-eclampsia tend to experience the cardiovascular complications 10 years earlier than other women. Thus, anyone with a history of pre-eclampsia should have regular cardiac assessments.
  7. Coronary artery spasm-this condition can affect men and women but tends to be more common in women. It may or may not be associated with the lesser degrees of blockages in the arteries. There is also an association between coronary spasm, migraine and a condition of the micro-circulation in the hands and feet known as Raynaud’s phenomena.

Clearly, cardiovascular disease is not just in the domain of men. Any symptoms referable to the heart in men and women need to be assessed immediately. A person doesn’t need to have the Hollywood heart attack i.e. Crushing central chest pain radiating to the throat and down the left arm to justify a cardiovascular workup.

The earlier these conditions are recognised, more effective treatments can be offered.

 

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Do vitamin supplements help prevent cardiovascular disease?

Friday, June 01, 2018

One of the most respected cardiology journals in the world is the Journal of the American College of cardiology. In a very recent addition of this journal (JACC, Vol 71, Issue 22) there was an article titled, “Supplemental Vitamins and Minerals for CVD Prevention and Treatment”

The researchers reviewed just under 1,500 different papers on the subject and published analyses of 179 randomised controlled clinical trials after excluding studies they felt were not adequate to provide the requested information.

The three key conclusions of this trial were as follows:

  1. There was moderate to low quality evidence for the use of folic acid in preventing cardiovascular disease. There was also moderate to low quality evidence for folic acid and B group vitamins to help prevent stroke.
  2. There was no effect in regard to cardiovascular prevention for Multivitamins, vitamin C, vitamin D, beta-carotene, calcium and selenium.
  3. There was an increased risk for antioxidants and in particular niacin, in studies that also used statin drugs, to increase all cause death.

So, that’s the end of the story. These conclusions are definitive and should be taken as gospel. Firstly, I need to make the point that I do have my own supplement company developing high quality pharmaceutical grade supplements targeting Asia and the Middle East. But, none of the supplements mentioned in this article are in my range, and therefore I’m arguing without bias and no conflict of interest. Secondly, I must comment that this is a well-designed, scientifically validated analysis that needs to be read objectively but also, with all science, questioned for its relevance.

Before I give my full analysis, I am reminded of a parable originated from India of the three blind men asked to describe an elephant. It is a story of a group of blind men, who have never come across an elephant before. Each man feels a different part of the elephant, but they’re unable to agree what the elephant is. The lesson being that humans tend to project their own partial experiences as the whole truth, often ignoring others' experiences.

I believe this parable and this report from Journal of the American College of Cardiology highlights the bigger issue of the orthodox, conservative medical profession and scientific world wanting to prove beyond a doubt that complementary medicine has no value, especially when compared against our stronger, evidence-based orthodox medical treatment strategies.

'HIGH PERFORMANCE' DRUGS

There is no doubt that strong medicine has strong effects, but unfortunately also has strong side-effects. As an example, every year in the United States alone, there are over 100,000 deaths from the appropriate prescription of pharmaceutical medications. All modern drugs are tested in rigid, well conducted, randomised controlled clinical trials to prove their efficacy and also their safety. But, here’s the problem- because these trials are enormously expensive and involve typically thousands of participants, their length of time is usually less than five years.

Many pharmaceutical drugs cause minimal harm over the short-term i.e. less than five years but once taken for 10 years or longer, start to cause problems. We have seen this with the withdrawal of drugs such as Vioxx from the market in 2004 after it was shown to increase the rate of heart attacks with long-term ingestion; the increasing long-term side-effects from the PPI drugs to treat indigestion and the ever present concern over the excessive prescription of statin therapy to lower cholesterol, purely to give a few examples.

Now, here is the relevance to this particular report. 179 randomised clinical trials involving supplements were analysed. There was no mention in the article of the average length of time of these trials, but as they were randomised controlled clinical studies I am assuming they were mainly less than five years, because of all the reasons I mentioned above. So, a key and vital point here is that supplements should not be regarded using the same methods as pharmaceutical drugs. 

I often make the analogy between the high-performance motorcar and a bicycle. The high-performance motorcar gets you from A to B very quickly but with the potential for crashing and causing significant harm. Thus, the need for strict road rules, seat belts and very well designed safety mechanisms within the car to minimise harm. This is why randomised controlled trials are necessary for pharmaceutical drugs which are like the high-performance motorcar i.e. very effective but also with a small, but, significant element of harm.

With a bicycle, you will get from A to B much slower, but with much less harm and much less need for rigid rules and safety mechanisms apart from a helmet. Unless, of course, you start to mix bicycles with high-performance motorcars and unsurprisingly it is the cars that do the damage, not the bicycle. Vitamin supplements can be compared to the bicycle when you don’t take the “blind men at the elephant” approach but rather look at the totality of studies performed over many years.

I often quote one of the longest epidemiological studies, with the largest numbers i.e. The Nurses Health study and the Male Physicians trial from Harvard University. When examining the multivitamin component of these studies, there was no benefit whatsoever from taking a multivitamin on a daily basis up until 10 years. But, when you examined the data from 10 years and beyond the significant benefits with taking a multivitamin and on a daily basis starts to accrue.

For example, the 20-year data from the Male Physicians trial showed that those doctors who persisted with taking a multivitamin on a daily basis for 20 years demonstrated a 44% reduction in cardiovascular disease compared with those doctors who didn’t. These data were not included in the recent analysis in the Journal of the American College of Cardiology.

CHERRY PICKING DATA?

Now to examine each of the conclusions of this study with the short time course kept in mind for these 179 randomised controlled trials:

  1. Folic acid and B group vitamins have reasonable evidence for the prevention of cardiovascular disease and stroke. Again, these were all short-term trials but still some showed a significant benefit for the supplements. 
  2. The second conclusion suggested that multivitamins, vitamin C, vitamin D, beta-carotene, calcium and selenium had no effect. Again, the short time frame is not long enough to show any benefits. But for example, many studies looking at a variety of vitamins use the lower quality synthetic vitamins such as dl-alpha-tocopherol which is synthetic vitamin E (which has already been proven to be ineffective and potentially harmful in a number of trials).

For some bizarre reason, the researchers performed the analysis with and without the selenium data, claiming that selenium did appear to have somewhat of an effect. This appears to be cherry picking the data purely to suit your argument.

Also, the most striking trends towards harm came from the use of oral calcium supplements for which a recent meta-analysis showed no benefits for the reduction of osteoporosis or bone fracture but a potential 30% increase risk for heart attack. So, in isolation, I believe it is better to avoid oral calcium supplementation and obtain your calcium from organic sources of dairy.

Finally, the most bizarre part of this analysis was talking about three studies using the pharmaceutical version of vitamin B3, slow release nicotinic acid and then inferring that this drug is a vitamin. I have been using immediate release nicotinic acid in thousands of patients for 40 years with incredible benefits. It is my clinical experience that 10% of patients cannot tolerate statins at all and in these patients I have found the combination of immediate release nicotinic acid (a drug, not a vitamin ) combined with Bergamot polyphenol fraction-a natural substance from citrus fruits grown on the southern Ionic strip of Calabria in Italy, still affords patients excellent control of the vascular risk when combined with healthy lifestyle principles.

I agree that the evidence for slow release nicotinic acid (I repeat, a drug, not a vitamin) is concerning and certainly does not justify its use in the majority of patients.

Thus, I see this most recent report, one of many such reports over the past 20 years to be an excellent analysis of the short term trials of supplementation but really saying nothing about the long-term benefits for people who are conscientious enough to continue healthy lifestyle practices, along with evidence based supplementation for the long haul i.e. 10 years and beyond. It is my view that the totality of evidence still supports high quality supplementation but don’t expect to see the results within five years.

To quote Wikipedia, “humans have a tendency to project their partial experiences as the whole truth, ignore other people's partial experiences, and one should consider that one may be partially right and may have partial information.” I believe this most recent offering from the Journal of the American College of cardiology is a great example of this statement.

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Are there downsides to being too clean?

Thursday, May 24, 2018

My grandfather said to me when I was a boy, “if a child hasn’t eaten a bucket of dirt by age 5, it’s not healthy”. My grandfather had absolutely no medical or scientific background, but it appears his comments may have been physiologically sound. 

Researchers in the past have suggested there is a bacteria in dirt that blocks an abnormal immune response leading to higher rate of allergies such as asthma, hay fever, urticaria and possibly even the most serious form of type 1 allergy, anaphylaxis. 

The “hygiene hypothesis” has been around for a number of years and this latest study from the UK Institute of Cancer Research is yet another piece of evidence to support this way of thinking. Prof Mel Greaves, who headed the study, is suggesting that with the much cleaner environment of smaller families and better hygiene, young children are being exposed to less infections and thus their immune system is not being challenged properly. This is potentially predisposing them to more serious issues such as leukaemia. He is suggesting that the rising rates of acute lymphoblastic leukaemia may parallel the increasing “sterility of the modern world”. 

We see everywhere now hand wipes and antiseptic lotions to ensure our hands and environments are germ free. When I was a child, we had sandpits and playgrounds created in a natural environment but these days everything is synthetic. 

Acute lymphoblastic leukaemia is the commonest form of childhood leukaemia. It is estimated that 5% of children have the mutation which predisposes them to leukaemia and of these 5%, 1% will go on to develop leukaemia. Around 180 children per year are diagnosed with this condition in Australia alone. The highest incidence is in children between the ages of 2 to 4, with no obvious cause known to date.

It appears that acute lymphoblastic leukaemia is triggered by certain types of viruses, especially in children who have not suffered the common colds and flu typically seen in preschool age children. I see the analogy here with exercise. If you do not have a regular exercise habit, when your body is called upon to perform some form of acute exercise it is much more difficult and causes significant fatigue in the attempt. In the same vein, if you have been exposed to a number of minor viruses throughout your life, it keeps your immune system active and more able to respond to more serious challenges.

The research was also supplemented by examining mice genetically engineered to develop acute lymphoblastic leukaemia. When they moved these mice from a germfree environment to a normal situation, the mice developed acute lymphoblastic leukaemia.

There have been a number of studies over the past decade suggesting the same is true for allergies and autoimmune disease. Again, when I was a child, we never heard of peanut allergies and now it appears that around 10% of children have some type of food allergy, the most common being allergy to peanuts.

Regardless, the next time your young child becomes ill with a virus, see it as a benefit to their immune system. If your child falls over and scratches their knee in the dirt, by all means wash the knee but don’t be too concerned, it means their immune system is being activated.

I find it interesting that my wise grandfather who had a number of these quirky aphorisms is now being proven correct by modern science.

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The common cold - could there soon be a cure?

Thursday, May 17, 2018

 

It has often been said that man can put a space rocket on the moon but cannot cure the common cold. It appears that we may be closer to ridding the planet of this annoying scourge.

Although the common cold is not life-threatening, it certainly disrupts your life, makes you feel dreadful for a few days and also is an extremely common cause of workplace absence. The common cold is significantly contagious and typically causes a sore throat, a blocked or runny nose, moderate fevers and a few days of feeling unwell. 

Researchers from the Imperial College in London have discovered a key protein in normal body cells. This protein known as N-Methyl tryptamine (NMT) basically allows the cold virus to attach to a normal cell, replicate and spread throughout the body. The UK scientists have developed a drug that targets NMT, blocking the cold virus’s ability to cause infection. In further studies, the scientists are developing an inhaled form of the drug which will work rapidly and because of lack of significant systemic absorption, should have less side effects. 

The test drug was used on several strains of the common cold virus, otherwise known as rhinovirus and blocks the effects on human cells in the laboratory without appearing to cause any harm.

There are no current treatments for the common cold and there are a number of common misconceptions that need to be stressed at this time of year as we in Australia are entering into winter. Although you can develop cold symptoms at any time of the year, they are clearly much more common in the cold months thus the term, the common cold. 

  1. When a person says they have the flu, this is typically not the case and in fact they have the common cold. The flu actually refers to influenza which is a different type of virus that causes a much more severe, serious and prolonged infection
  2. The flu vaccine is specifically for influenza and does not prevent you developing the common cold
  3. You cannot develop influenza from the vaccine but you may have a flulike reaction (which is much milder than influenza itself) for a few days after the vaccination
  4. Antibiotics are completely unnecessary and actually harmful for people suffering the common cold or influenza. They are only useful if there is a proven bacterial infection following a throat swab or sputum culture.

Unfortunately, this potential cure for the common cold may not be available clinically for a few years to come, until it’s safety in actual humans (not cultured human cells in laboratory) has been proven.

In the meantime, there is a reasonable evidence base around the following treatments if you feel a cold starting to occur:

  1. A study from Finland using high dose vitamin C 6-8 grams daily for a few days has been shown to significantly reduce the severity and length of a cold
  2. High dose echinacea
  3. High dose garlic
  4. Zinc lozenges.

In my opinion and experience, one or a combination of all of the above are safe and should be used for a few days at the onset of symptoms, until relief. Regardless, the common cold is an imposition rather than a serious illness and it’s probably not that bad to challenge your immune system with minor viruses every now and then, purely to keep it on its toes.

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Male Menopause - does it exist?

Thursday, May 10, 2018

 

All women will experience menopause at some stage in midlife. For around 95%, this will occur at sometime between age 45 to 55. But, over the past few decades, scientific evidence has emerged that a similar process occurs in most males. This has led to the term, andropause. 

Basically, the peak of anyone’s life is age 30, and from that point on there is a slow but steady decline in all the body’s metabolic processes including our hormonal systems. This is also true for our reproductive hormones. For women, this is obvious through the loss of the normal menstrual cycle, along with many of the other symptoms that are common during this period of their life. Hot flushing, mood swings, irritability, depression and generalised aches and pains are very common during this time, with most women experiencing at least one of these symptoms during the course of menopause. But, many of the symptoms also occur in men. 

The additional symptom that also occurs in men is a degree of erectile dysfunction. Thus, andropause may certainly be a difficult time for men, just as menopause is for women. But, apart from the obvious discomfort and annoyance of symptoms, are there any health consequences in the reduction in the male hormone testosterone? 

A new study of 2,161 men 20 years & older examined the relationship between age, testosterone levels and a number of chronic conditions. The study particularly focused on nine chronic conditions including, cardiovascular disease, depression, hypertension, high cholesterol, high triglycerides, lung disease, stroke and type 2 diabetes. 

The study divided men into three groups:

  • Young men-20 to 40 years old
  • Middle-aged men-40-60 years old
  • Older men-age greater than 60

The study found that in young men and in the older men those with low testosterone levels had a much stronger link to two or more chronic illnesses. The obvious question here is whether the chronic illnesses lead to low testosterone or whether the low testosterone actually contributed to the illnesses. 

Over the past decade there has been a significant increase in various forms of testosterone therapy for males in this category. There are concerns that testosterone therapy may accelerate the growth of prostate cancer and some researchers have even linked higher testosterone levels to atherosclerosis (the progressive build-up of fat, inflammatory tissue and calcification in the walls of arteries leading to heart attack and stroke). But, other evidence points to the fact that testosterone therapy may improve metabolic syndrome (tendency to diabetes, high blood pressure, cholesterol abnormalities and abdominal fat) and thus possibly reduce the risk for a variety of conditions that can be linked to increased risk for cardiovascular disease and possibly even cancer. 

As with most subjects in medicine there are often varying and opposing views and most conservative experts in the area would suggest caution in using therapies that do not have robust long-term data. But, many men suffer, typically in silence, from the symptoms of andropause and with the variety of testosterone therapies which typically involve weekly injections or testosterone implants or the more user friendly testosterone creams, many of the symptoms of andropause are well managed and markedly improve the person’s quality of life. My strong advice in this area is to have a proper and extensive medical workup before commencing any of these therapies.

Regardless, it certainly appears that reducing levels of testosterone as we age are of no benefit and with proper monitoring and appropriate therapy this may be managed with a very good end result.

 

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