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Ross Walker
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Exercise - is more better?

Thursday, November 16, 2017

By Ross Walker
I have repeatedly suggested that the ideal amount of exercise every week is somewhere between three to five hours. So, is this just my gut feeling or is there any good evidence for these comments?

I would like to review three recent interesting studies around exercise which address this important issue.

A recent, long term study of 25 years followed just over 5100 people aged between 18 to 30 years old at the entry of the study. For various reasons, the final analysis reviewed 3175 participants who had undergone eight examinations over the 25-year period and answered at least three questionnaires regarding the amount of exercise they performed along with other lifestyle factors as well.

A coronary calcium score was performed at some stage between age 43 to 55 and the participants were divided into three groups.

  1. Those who exercised less than two and a half hours per week
  2. Those who exercised between three to five hours per week
  3. Those who exercised more than seven and a half hours per week.

The results were quite surprising and in many ways, somewhat disturbing. When the group who exercised more than seven and a half hours were compared to the other groups there was a 27% increase in coronary artery calcification, suggesting lack of protection from heavy exercise for heart disease risk.
Interestingly, and somewhat difficult to explain, is the fact that white males in the third group had an 86% increased risk for coronary artery calcification. The higher-level exercise group, for some reason, did not appear to affect cardiac risk in black men or all women. Although there is no clear explanation for this difference I would like to propose the following explanations.

Atherosclerosis, which is the progressive build-up of fat, inflammatory tissue and calcium in the walls of arteries, tends to occur later in women (on average 10 years) and a coronary calcium score performed between age 43 to 55 is too early to detect significant atherosclerosis in a female population.

People who exercise for more than seven and a half hours per week are typically (although not always) joggers or cyclists, or professional athletes. There is no doubt that African Americans do make up a significant proportion of the high-level athletes in America, not to mention the Africans who tend to win most of the marathons. It could be that people with darker skin are more physiologically adapted to exercise for longer periods and thus have less evidence of cardiovascular disease.

Regardless, it does appear for those of us who are not professional athletes (i.e. sport being their major source of income) that if you are exercising for good health, the three to five-hour dose per week appears to be the healthiest level.
The second study was fascinating in that it looked at the type of exercise which may be important for specific disease prevention. There are two basic types of exercise, aerobic - cardio, or anaerobic - strength and resistance training. This study of 80,000 people, older than 30 years, commenced in 1994 and continued until 2008 with an average follow-up of around nine years. It looked at strength and resistance training for 50 to 60 minutes per week as opposed to moderate intensity exercise 50 minutes per week e.g. walking, as opposed to high-intensity exercise such as running or cycling for 75 minutes per week.
In all these groups, compared with people who were inactive there was around an 18% lower risk of early death purely by performing the various types of exercise. But, with resistance and strength training there was a 31% reduced cancer risk whereas with aerobic exercise a 21% reduction in cardiovascular risk. The reduction in cancer death has been repeated in a number of studies in people who regularly perform some form of resistance training.

My suggested reason for this is that cardio exercise improves cardiovascular efficiency through more efficient pumping of the heart and better blood flow to muscles. Because of the more efficient cardiovascular system there is logically a reduction in cardiovascular death. Interestingly, strength and resistance training increases the fitness and size of muscles thus improving muscle metabolism and requiring a much higher level of blood flow to the muscles. Logically, this would redirect blood flow away from tumours and thus help prevent cancer death.

Finally, a study in the American Journal of Preventive Medicine reviewed 140,000 people participating in the Cancer Prevention Study II Nutrition cohort. It found that as little as two hours per week of walking compared with those who did no exercise reduced overall death risk from all causes. Those who performed the recommended 150 minutes of walking demonstrated a 20% reduction in all-cause death. Interestingly those who walked for more than six hours per week had a 35% reduction in death related to respiratory causes, a 20% reduction in cardiovascular death and a 9% reduction in cancer death.

Probably the most disturbing statistics from all the studies is that 27% of people are inactive and only 50% of people meet the guidelines for recommended exercise.

I have stated on numerous occasions that exercise is the second-best drug on the planet after happiness but it also appears that the correct dose of exercise is important along with the type of exercise to reduce specific conditions. This is why I constantly say that the suggested dose is three to five hours per week which should be divided into two thirds cardio and one third resistance training. Just as the real estate agents say the most important principle is “location, location and location”, those of us involved in preventative medicine state “movement, movement and movement”.

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Depression: Is it just a brain disorder?

Thursday, November 09, 2017

By Ross Walker

Over the past decade, depression has received significant coverage in mainstream media with many high-profile organisations, such as Beyond Blue and the Black Dog Institute as good examples, not to mention a number of prominent individuals publicly declaring their own demons in this very common area of mental health.

It is estimated that around 7% of people living in the modern world will experience an episode of major depression on a yearly basis. Depression is defined as five or more of the following symptoms persisting for more than two weeks.

  1. A depressed mood with the loss of pleasure in normally pleasurable activities
  2. Abnormal weight loss or weight gain
  3. Poor sleep and, in particular, early morning wakening, but this may also include too much or too little sleep
  4. Physical agitation or slowness
  5. Fatigue
  6. Feelings of guilt/worthlessness or hopelessness
  7. Lack of focus and at its extreme, thoughts of death and suicidal thoughts.

Thankfully, depression is no longer seen as a purely psychological illness or as a sign of weakness or poor character; a condition that the person should toughen up and pull themselves out from.

Probably the most accepted theory is that depression is a disorder of brain chemicals-typically a reduction in the mood chemical, serotonin. This hypothesis is strengthened by the strong observation that serotonin altering pharmaceutical drugs are the mainstay of medical therapy for depression. Although this is probably the case, there are some researchers in the area who dispute this and until we have better methods to assess brain function and neurotransmitter levels within the brain, this explanation will have to suffice.

Interestingly, recent work has suggested that depression could also be a gut disorder. 90% of our serotonin is produced by gut bacteria and it may be that a pathologic gut microbiome may not be producing enough serotonin to maintain a balanced, non-depressed state.

Recent work has also strengthened the notion that depression may have serious systemic health effects through a number of mechanisms.

A recently published study in the Canadian Medical Association Journal followed 3410 adults from Canada over a 60-year period. This examined the death risk associated with depression in both males and females, average age 49 years at study entry. This very long study had three distinct periods, each around 20 years, and found that in males the increased death risk was present through each period but was very prominent in females for the most recent period from the 1990s and onwards. This rose to a 50% increased death risk for women during that period.

Equally disturbing was the findings that the younger the diagnosis was made, the much higher the death risk. There are three possible explanations for the higher death risk associated with a diagnosis of depression.

  1. Depression leads to reduced motivation to follow healthy lifestyle principles with a poorer diet, reduced motivation to exercise and a much higher rate of substance abuse.
  2. Depression leads to an increase in stress related hormones and a reduction in the variety of “happy chemicals”- both conditions being associated with chronic illnesses.
  3. Depression is the leading cause of suicide

Although it is important to make the distinction (a distinction that is often blurred) between depression and grief or loss, there is no doubt that depression is not just a serious mental health issue but significantly increases the risk for a variety of (at times) lethal physical diseases.

As with all conditions, the best management is prevention or at least early detection and intervention. But, this is not possible unless you seek help. Remember, symptoms are nature’s tickets into the medical system and if you have any of the symptoms mentioned above, seek help early. It may just save your life.

Lifeline 131 114 beyondblue 1300 224 636

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Is healthy eating always good for you?

Thursday, October 26, 2017

By Ross Walker
Two and a half thousand years ago, the father of medicine, Hippocrates stated, “let food be the medicine and medicine be thy food”. Of course, that was back in the days where food was very simple with little interference by humans apart from catching or preparing natural foods.

Food over 2000 years ago was of course a vital part of existence but certainly not the major pleasure it is nowadays. Our modern world is bombarded by constant food advertisements, television shows elevating celebrity chefs to superstar status, not to mention the quick-fix easy foods which take the strain out of food preparation.

With any major life pleasure, there is always the shadow, the underbelly, which in this case often leads to the excessive belly. But, apart from the obvious and increasing problems of obesity, could there possibly be a problem with so-called healthy eating?

My favourite medical website for excellent general review of modern medical issues, Medical News today, has “nailed it” again with two superb articles on orthorexia nervosa and food addiction. I thought I would review some of the key points from both of these articles and give my own perspective.

Orthorexia nervosa is defined as a pathologic obsession with healthy eating which may lead to social isolation, psychological disturbance and often physical harm. I had previously told the story of Professor Roy Walford who wrote the book, “The 120 year diet”. Walford suggests that if you consume a daily diet of 1500 calories of pure plant food with no coffee, alcohol or meat you will live to 120. Walford had a small group of loyal followers around the world who call themselves calorie restrictors. They don’t have an ounce of body fat, are constantly cold, tired, miserable and often depressed, but they live with the delusion that they will live until 120. The average age of death in the modern world for males is around 80 and for females around 84. A few years back, Prof Walford died at the ripe old age of 79, having lived that miserable existence of disciplined restriction for many years.

Medical News Today quotes the case of a 29-year-old female who progressed through the steady slope of vegetarianism to veganism to becoming a raw foodist and finally only consuming fruit to then losing her hair and becoming quite ill. They quoted French nutritionist, Sophie Ortego, who stated she had a patient who was “a pure, unbending vegan who even refused to take B12 supplements preferring to lose her sight rather than betray her commitment to animals.”

Orthorexia nervosa is not actually medically recognised and many people believe this is more a phobia than a food disorder. Many people in the field believe orthorexia nervosa has occurred because of the fear of modern issues such as mad cow disease, the use of pesticides in modern agriculture along with antibiotics given to domestic livestock, genetically modified foods and corporate farming. Many people who go down the slippery path of orthorexia nervosa believe that going organic and vegan will help prevent the toxicity of western lifestyle.
The other article presented by Medical News Today was on food addiction. This is where the need to eat becomes compulsive and uncontrollable and may be in response to an emotional disorder, stress, sadness or anger. Food addictions are also linked to cravings, typically chips, lollies (candy), white bread, chocolate pasta or ice cream.

Food addiction may lead to other disorders like obesity, bulimia or binge eating.

 Regardless, there is, no doubt, that food is a vital part of our existence. If you don’t eat, you die. But, not achieving a balanced, nutritional program may have serious consequences. In a modern world where a solution to obesity is bariatric surgery rather than drastic lifestyle changes, we need to review the deeper issues as to why a significant proportion of human beings are obese, experience anorexia and/or bulimia or even more recently have these new obsessions with healthy eating, veganism or some fad diet.

It is my experience as a doctor of 40 years that I have never met one person (and I’m not excluding myself from this observation) that has life in balance. We all struggle in some way and this struggle may lead to overeating, undereating, an addiction to some substance (cigarettes, alcohol or illegal drugs), anger, anxiety, depression or somatic symptoms.

It is my opinion that any issues around food, whether it be any of the problems I have discussed above, are purely manifestations of much deeper emotional factors. We are all the sum total of our various life experiences, genetics and our upbringing. Until we recognise the reason why we have whatever obsession, phobia, addiction or any other issue for that matter, we humans will continue to make the same mistakes and continue the same patterns.

Albert Einstein was once quoted as saying, “there is no more certain sign of insanity than to do the same thing over and over again and expect a different result”.
Rather than seeking a medical solution to your problem or starting on yet another diet or bizarre eating program, why don’t you find out the real cause of the problem, fix that cause and start an entirely different, healthier pattern.

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Myth - An elevated PSA always means cancer

Thursday, October 12, 2017

By Ross Walker

There was an excellent article published on the superb medical website, Medical News Today recently on this very subject. I thought I would give my take on this excellent review.

PSA stands for prostate specific antigen and not prostate cancer antigen. An elevated PSA does not always imply prostate cancer. Thus, there has been significant controversy as to the utility and benefits of a PSA.
PSA is a specific protein produced by the prostate gland. The level of PSA varies with age but typically most men with prostate cancer have a PSA level above 4 ng per ml. Unfortunately, 15% of men with prostate cancer will have a PSA lower than this. It is my experience that the trend of PSA levels is more important than the absolute amount.

The typical screen for prostate cancer is the combination of a PSA level and a subsequent Digital rectal examination(DRE). The problem is that various experts in the area question the validity of both forms of examination and it is difficult to get a healthy consensus.

What are the causes of an elevated PSA other than cancer?

1) The older you are, the higher your PSA. If you examine the prostate glands of all men over 80 you’ll probably find traces of prostate cancer in everyone. The problem is that most people will die with the disease not from the disease. The real issue is who has the more aggressive forms as opposed to the more benign forms of prostate cancer. Many people argue that PSA testing should stop over age 70.

2) Prostatitis - any condition that inflames the prostate gland will also elevate the PSA level. Most people with prostatitis will have symptoms such as problems with urination and often changes with sexual function

3) Benign prostatic hypertrophy - as men age and especially if their sexual function reduces as well, it is very common for the prostate to swell. A man with benign prostatic hypertrophy may also experience significant problems with urination such as frequency, urgency and difficulty passing urine.
4) Medical intervention - having a digital rectal examination will significantly elevate the PSA as will any instrumentation of the urinary tract such as a catheter or cystoscope.

5) Urinary tract infection - although urinary tract infections are more common in women, they can also occur in men and may elevate the PSA levels
6) Vigorous exercise, especially cycling - often the middle-aged men in Lycra experience problems with erectile dysfunction as the bicycle seat can affect the nerves important in achieving an erection but also putting pressure on the prostate gland elevating the PSA. Even high-level activity apart from cycling may raise the PSA.

7) Ejaculation - if you are due for a PSA test, it is important to avoid ejaculation for a 48-hour period prior to the test.

If you have an elevated PSA, my strong advice is not to panic. I would carefully consider the advice given above and have a repeat test at some stage over the next few months once any of the other potential conditions have settled.

There have been a number of studies showing the inverse link between sexual activity and prostate cancer. I have often said that the best cancer prevention technique is to use the organ for what it was designed for. If your PSA is elevated, I would suggest you empty your prostate a few times a week (i.e. sexual activity) and then have the PSA repeated 48 hours after the last episode of the ejaculation and do not perform very vigorous exercise (in particular cycling) in the two days before the test.

If your PSA hasn’t changed, I would suggest referral to a urologist but always obtain a second opinion before a definitive procedure is performed.

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Choosing wisely

Thursday, October 05, 2017

By Ross Walker
It is a sad fact of modern medicine that, tragically, the third commonest cause of death and disability in modern society is Western health care. It is estimated that around 10% of admissions to hospital are due to medical error. Over 100,000 deaths per year in the United States are due to the appropriate prescription of pharmaceutical preparations.
NPS MEDICINEWISE in Australia has continued its Choosing Wisely campaign with further important recommendations which will hopefully improve these statistics and also reduce the enormous burden from medical costs in this country, but also carried by all countries around the world for exactly the same reasons.

This latest campaign has focused on three main areas:

1. The overall ordering of x-rays in children. There are far too many x-rays performed for children with respiratory complaints. The vast majority of respiratory tract infections can be managed clinically without a chest x-ray and certainly without antibiotics. This is also true for the vast majority of children with abdominal pain, where abdominal x-rays and, in particular, abdominal CT scanning carries little value in the diagnostic pathway. What all of this excessive radiation does, however, is predispose children to developing some form of cancer later on in life because of this excessive and unnecessary radiation.

2. Encouragement of people to remain in the work force for as long as possible. This recommendation tries to encourage doctors, patients and employers to focus on capacity and not incapacity. To quote the president of the Australasian Faculty of Occupational and Environmental Medicine, Associate Professor Peter Connaughton, “we are recommending doctors only certify patients being totally unfit for work when it is clinically necessary. Where appropriate, we are encouraging willing patients to continue working in some capacity as part of their overall healthcare management. Declaring a person medically unfit for work can often see them experiencing a range of issues including loss of self-esteem, feelings of isolation, depression and anxiety, as well as poor physical health and slow recovery times from their injuries.”
Safe Work Australia estimates that work related injury and time away for illness can cost the Australian economy around $61.8 billion per year in direct and indirect costs such as loss of productivity. There is no doubt that a return to the work force is good for the individual and good for the country. Not only are the fiscal benefits obvious, but the sense of purpose and the ability to socialise outside of their immediate family and friends has profound physical and psychologic benefits.

3. Over the past decade there has been a significant backlash from the public regarding the widespread prescription of medications for a variety of conditions. One of the great cases in point here is that of statin therapy. It is estimated that around 19 million prescriptions are written every year in Australia alone and with 12 prescriptions per year per patient, this implies that just under 2 million people in the Australian population are prescribed statins. There is no doubt that this is excessive and unnecessary and with prolonged use, many chronic side effects can arise such as muscle issues, poor thinking and even increased risk for diabetes.
This new recommendation focuses on the fact that many people over the age of 65 are taking five or more different pharmaceutical preparations for a variety of conditions. Unfortunately, sometimes this is necessary but the problem is that many people in the modern world have been influenced to think that there is a pharmaceutical solution to every problem. This recommendation suggests that the risk of medication related harm rises significantly once the amount of regularly prescribed medications exceeds five and exponentially when greater than eight. The list includes benzodiazepines such as Valium, a variety of antipsychotic agents, hypoglycaemic agents to treat diabetes, antithrombotic agents to thin the blood, antihypertensives, antianginals, statins and the proton pump inhibitors.

When you visit your doctor and an investigation or treatment/procedure is suggested, ask the following five questions:

  1. Why do I need this?
  2. What are the risks?
  3. Are there safer, simpler or more natural options?
  4. What happens if I don’t have this?
  5. What are the costs involved?

The reality is that practising the five keys to being healthy;

  1. Quit all addictions
  2. Develop a good quality sleep habit (7-8 hours per night)
  3. Eat less, and eat more naturally
  4. Exercise three to five hours per week
  5. Cultivate peace and happiness every day

reduces your risk for all diseases somewhere between 70-80%. Taking a medication on average has around a 20-30% reduction in most common diseases but with the potential for significant side effects. Once you’ve been prescribed multiple medications then the drug interactions abound.
I congratulate the Choosing Wisely Australia campaign for bravely examining the current practice of medicine in this country which can only help to improve the general health of the population. Although strong medicine has strong effects, it also has strong side effects and complications and all doctors must be reminded of the first line of the Hippocratic Oath, first do no harm.

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How long can we really live?

Thursday, September 28, 2017

By Ross Walker

One of the holy grails in medicine is improving our longevity. I have made the point for a number of years that we should be focusing more on health span rather than lifespan. There is no point surviving an extra 20 years if you are living in the misery of a serious chronic illness, in constant pain or are desperately unhappy. I am a great believer in prolonging everyone’s life but no one’s death.
Over the past few decades, there have been a number of suggestions of interventions to prolong life. For the last half century, it has been proven and well-known that calorie restriction does extend the life of various animals. This has been proven in a variety of worms, rats and monkeys but has never been proven in human beings.

A number of years ago, Prof Roy Walford wrote the book “The 120 year diet”, where he suggested if you followed his diet of 1500 calories a day of plant food with no meat, no alcohol or coffee, you would live until you are 120. He had a small but loyal group of followers around the world known as calorie restrictors. They didn’t have an ounce of body fat, felt constantly cold, tired, miserable and often depressed but existed under the delusion that they would live to 120. The average age of death in our society is around 80 for a male and 84 for a female. I’d like to report that tragically, a few years back, Prof Walford died at the ripe old age of 79.

Over the past decade there has been seminal research, especially by Professor David Sinclair at Harvard University, looking at the anti-ageing properties of resveratrol and more recently the benefits of nicotinamide, one version of vitamin B3, with some rather exciting results in laboratory animals. Again, this has not been proven in human beings because of the difficulty of performing a randomised controlled, long-term study of ageing over many years in a number of people.

There has also been some interesting work around the drug rapamycin, which comes from a bacterium found in the soil at Easter Island. Rapamycin affects a molecular pathway known as M-tor and again has been shown to prolong life in laboratory animals.

Two fascinating pieces of research have just been released around ageing. The first revisited the calorie restriction concept in mice and monkeys, finding that the reason calorie restriction appears to prolong life is through a direct effect on a process known as DNA methylation. The study reduced calorie intake by between 30-40% in young mice and in middle aged monkeys with both interventions showing significant improvements in methylation with age.

Possibly even more interesting was a study recently published in the journal “Genes and Development” looking at a vital body process known as autophagy. Autophagy is a mechanism that clears out used and damaged proteins to be recycled, creating new products for cellular use.

It appears that autophagy promotes health and fitness in the young but drives the process of ageing later in life. The theory of evolution has demonstrated that natural selection results in the fittest individuals being able to pass on their healthy genes. The more beneficial a trait is at promoting reproductive success, the stronger the chance that the trait is passed on to the offspring. Interestingly, once you have survived your reproductive years then the traits that were beneficial for fitness and reproduction may have a paradoxical effect on promoting ageing.

One of the lead authors of the paper, Jonathan Byrne, stated that ageing is a revolutionary oversight. In this particular paper he found 30 genes that demonstrated this paradox by only examining 0.05% of the genes in a particular worm known as C. elegans.

The genes that are involved in regulating autophagy, maintaining fitness and reproductive ability in the young, tend to accelerate the ageing process. These genes are essential for young ones to reach maturity but after reproduction they tend to malfunction with age.

This is where it becomes very interesting in that it appears to be better to switch off the autophagy genes in the regulator neurones of worms completely than allow them to rundown to the point where they are defective and promote ageing.

When the researchers switched off the autophagy genes in the ageing worms they prolonged their life by 50% but also their cells functioned better and more efficiently.

Although these benefits to human beings are still a long way off, if we can find a mechanism to switch off autophagy in our neurones as we age, this could be a major key to longevity.

As the iconic comedian Woody Allen once said, “it’s not that I’m afraid of death it’s just that I don’t want to be there when it happens”.
A survey was once done on a group of 20 year olds asking them how long they would like to live. The average answer was around 70 years old. When the same survey was given to a group of 79-year-olds, they were happy for as long as they could be given.
When you hear the “wings of the angel of death flapping around your ears” you certainly want to maintain your existence for as long as possible if, of course, your existence is enjoyable and viable. It will be very interesting to see where all this research takes us and sadly, the elephant in the room - of overpopulation - is a topic for another discussion.

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Low fat is dead

Thursday, September 21, 2017

By Ross Walker
In 1955, an American scientist known as Ancel Keys presented his Diet-lipid-heart disease hypothesis at a meeting of the World Health Organisation in Geneva. This prompted members of the American Heart Association to appear on a television program in 1956 suggesting that large amounts of butter, lard, eggs and beef were a major cause of heart disease. This then prompted the American government to recommend people adopt a low-fat diet in order to prevent heart disease.

Western culture has believed this nonsense ever since. The low-fat message has made billions of dollars for the food industry, creating processed packaged food sitting on a shelf for three months with a use by date, with graffiti written on the side of the box such as low-fat or no cholesterol. There are still many experts in the medical and nutritional field who continue to demeanour saturated fat and cling on to the belief that there is a link between high saturated fat intake and coronary heart disease.

In 2002, I wrote a book, “The Cell Factor”, where I clearly stated, based on a 27 trial meta-analysis published in the British medical Journal, that the link between saturated fat and heart disease was tenuous.

In 2013, Dr Maryanne Demasi was vilified by the medical profession and the nutritional world when she presented two segments on the ABC television show, Catalyst, suggesting there was no link between saturated fats and heart disease. 12 months later, the prestigious university, Cambridge in the UK, published a meta-analysis of 72 trials involving 600,000 participants showing clearly there was no link between the intake of saturated fat and heart disease. There were some criticisms of the methodology of this meta-analysis but the results were still rather striking.

Only a few weeks ago, the results of the PURE study conducted by the well-respected Professor Salim Yusuf examined 135,335 people in 18 countries and followed them up for 7.4 years. Over the time there were 5796 deaths and 4784 major cardiovascular events. The study’s findings were quite surprising but again reinforce the same message. Those participants with the highest carbohydrate intake (74 to 80% of calories) had a 28% increased risk for death over the study period. A carbohydrate intake between 65.7 to 69.7%, a 17% increase and up to 62.3% there was no significant increased death risk.

The study also showed that a high intake of fruit, vegetables and legumes were beneficial but all other carbohydrates were not. The study also showed that raw vegetables were better than cooked vegetables.

In my opinion, the most interesting part of the study was the analysis of fat intake when related to cardiovascular events. There was no link whatsoever between total fat or saturated fat intake and cardiovascular events. When the highest intake versus the lowest intake of fat was compared there was a 23% reduction in all cause death and for saturated fat, a 14% reduction, monounsaturated fat a 19% reduction and polyunsaturated fat a 20% reduction.

When looking at the upper levels of saturated fat intake compared with those consuming a low saturated fat intake there was a significant reduction in death and a very low saturated fat intake was actually found to be harmful.

With all the evidence I have presented above, it is now time to finally conclude that the low fat con job that has been shoved down our throats for the past 60 years should be put in the dustbin of bad medical history.

Over the past 60 years, coinciding with this ridiculous message, has been growing rates of obesity and diabetes because people are shifting their food intake to carbohydrates rather than fats. The only poor quality fat is trans-fats which emanates from the hydrogenation of vegetables used by the food industry to thicken and harden food so it can sit in a box for a few months with a use by date. Also, don’t be conned by the food companies that write “no trans fats” on the side of the box. They are purely using a different form of processing known as inter-esterification to thicken and harden the food and the poor health effects are no different.

Regarding diets, it is very straightforward. The best form of eating is to follow a low-calorie, high-quality fat, high-quality protein and high-quality carbohydrate diet, in a balanced form. This is best demonstrated by the Mediterranean diet which encourages regular fruit and vegetables, Olive oil, nuts, meat, fish, eggs and dairy.

The Mediterranean diet is the best studied diet in the world showing anywhere between a 30 to 50% reduction in all modern diseases. The evidence is overwhelming from a number of studies and hopefully we will no longer hear anyone discussing the poor health effects of saturated fat. It’s very difficult to change an attitude that has been a core belief in society for many years but being able to do so is the mark of an intelligent person.

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Sudden death - can it be prevented?

Friday, September 15, 2017

By Ross Walker
With the untimely death of the Ironman, Dean Mercer, at the age of 47, we are strongly reminded of the frailties of our existence and the clear point that no one has a 100% guarantee of a long life, despite following healthy lifestyle principles. Dean, allegedly, died of a cardiac arrest whilst driving and I am not privy to his autopsy results. The media, incorrectly, reported Dean died from a heart attack. Although this may have been the cause, there are many other causes of sudden cardiac death, both in elite athletes and the less fit members of the general public.
Although it is not rare for a younger person to suffer a heart attack (which is where a fatty plaque in the wall of an artery suddenly ruptures, blocking the artery), there is also the possibility of a number of other cardiac and at times, non-cardiac conditions, causing a cardiac arrest, which is where the heart actually stops pumping.
The commonest cause of death in people below the age of 40 is, in fact, hypertrophic cardiomyopathy, a genetic, excessive thickening of the heart muscle which often, under conditions of stress, such as excessive exercise, emotional stress or the use of legal or illegal drugs, may irritate the heart to the point of cardiac arrest.
So, the big question here is how do we determine who is at risk for any of the number of conditions that may lead to a cardiac arrest? The answer here is that in certain cases it is not possible. We have screening tests for the most common conditions but even then they are never 100% accurate and are not designed to detect many of the less common causes.
I am a strong advocate of coronary calcium scoring which is a non-invasive, no dye, no injection snap shot of the coronary arteries in the heart, using a CT scan that, as the name suggests, measures in a quantitative fashion the amount of coronary calcium in your arteries. This is an indirect marker for the amount of fat and basically assesses cardiac risk. The higher the coronary calcium, the higher your risk. But, regardless of cardiac risk, the younger you are, the less calcium you have.

0 = low risk
1-10 = trivial
10-100 = mild atherosclerotic load
100-400 = moderate
 > than 400 = high risk
But, any calcium in a person below age 50 is too much. So, a coronary calcium score of 20 in a 45-year-old is much more serious than score of 200 in a 70-year-old. Also, coronary calcium is almost always only an indicator of common, garden variety coronary atherosclerosis and does not detect hypertrophic cardiomyopathy, inflammation, clotting potential and many other early cardiac issues.
The entire issue of what causes and how to prevent sudden cardiac death is far too complex to cover in a single article. But, tragic incidences, such as the death of a prominent Australian Sports star do require a healthy debate.
Although we all know exercise is very beneficial, is there a point where more is not better? Increasing evidence seems to be pointing to the fact that 3-5 hours per week of moderate exercise is the right dose and beyond that does not help. But, of course, the greatest risk is being inactive. What factors actually precipitate an event? Often people suffer the cardiac arrest after vigorous exercise, not during. Many people die during sleep, raising the spectre of sleep apnea and other sleep associated disorders. What part does any stressor (combined with vigorous exercise) contribute to a cardiac arrest? Here I am referring to other forms of physical stress such as an intercurrent illness (do not perform heavy exercise when you have a virus); emotional and mental stress; pharmacologic stress-legal and illegal; e.g. exercising following strong coffee, a night out on the grog, having recently used illegal drugs et cetera et cetera
Although this is definitely not a comprehensive analysis of sudden cardiac death, this clearly shows that a visit to your general practitioner to have your BP checked, a few simple blood tests such as cholesterol, blood sugar levels and possibly a basic ECG is a very inadequate screen for serious cardiac conditions.
As a preventative cardiologist, I treat each case on its own merits, investigate and treat accordingly. I believe it is possible to screen for, manage and potentially prevent most common illnesses.  Unfortunately, there will always be the occasional patient who despite all best intentions will still "fall through the cracks", so to speak. It is not the doctor or the patient’s fault, it is the disease’s fault, along with the environmental and genetic circumstances underlying that particular person and disease.

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New study another nail in the coffin for E-cigarettes

Thursday, September 07, 2017

 By Ross Walker

If you were asked, what drug causes the most deaths in our society, many people would say heroin, some may say cocaine or, possibly, the very recent modern scourge of Ice. The reality is that illegal drugs only contribute 3% to the death rate from drug abuse - 17% is from alcohol and 80% from cigarette smoke.

In Australia, we have one of the lowest rates of cigarette smoking in the world where now only 13% of the adult population continue to smoke. In my view, it is a great pity that is not 0%.

Over the past 5 to 10 years we have seen the increasing use of E-cigarettes as an alternative to normal cigarette smoking. We therefore have to ask ourselves the question - are e-cigarettes safe?

A recent study from the US looked at the acute and long-term exposure in mice to e-cigarettes and its impact on cardiovascular health. The aim of the study was to compare the effects of e-cigarettes to that of conventional cigarettes to determine the effects on the cardiovascular system.

The research team studied female mice exposed acutely to e-cigarettes (a single exposure lasting five minutes) and six female mice exposed to e-cigarettes for 4 hours every day, five days per week for eight months.

The researchers then assessed the normal function of the blood vessels in these mice to determine whether the reactivity of the small blood vessels was affected by the exposure. The stiffness of the aorta (the main artery from the heart) was also measured.

The study showed that within one hour of being exposed to only five minutes of e-cigarette vapour there was around a 30% narrowing of the arteries and chronic exposure to e-cigarettes induced significant aortic stiffness which was two and a half times higher than the control group, only exposed to filtered air.

Prior studies on orthodox cigarette smoking have shown around a 50% reduction in endothelial function within one hour of smoking one cigarette which is clearly more significant than the above data, but, this information clearly shows that e-cigarettes are not a harmless alternative.

Regardless, conventional cigarette smoke demonstrates clear long-term harm, not just to the cardiovascular system but also increasing the risk for a number of common cancers. Many people can stop their cigarette habit by using nicotine replacement therapy or some of the other medications available on the market, which I believe are a much better alternative.
But, although e-cigarettes clearly can also cause harm, I suspect the harm is not as grave as that induced by conventional smoking. Regardless, the best approach for any human being is not to have an addiction to any substance, thereby living a much healthier lifestyle. Unfortunately, many human beings still struggle to do so.

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It’s extraordinary what humans will put into their bodies

Thursday, August 31, 2017

By Ross Walker

Over the past 10,000 years, our physiology has not changed much from the hunter-gatherer wandering around a jungle constantly looking for food. The human body has evolved purely to consume natural foods in a natural environment.

Enter the modern world!

Many of our modern dietary choices are based around processed, packaged muck masquerading as food, often with graffiti written on the side of the box such as “low-fat” or “no cholesterol” to make you falsely believe that there are some health benefits from consuming this rubbish. Also, there is now increasing evidence that the synthetic chemicals used in the packaging may cause significant health issues. Many of the preservatives, artificial sweeteners and other ingredients in the food itself, appear to be contributing to modern illnesses and other significant health issues.
One of the great scourges of our modern world is that of substance abuse. Whether this be alcohol or illegal drugs, the abuse of any substance can cause significant health and social problems for, not just the abuser, but also his or her loved ones, friends and also in the work place. For a number of years, I have been calling for the banning of energy drinks. A recent disturbing report from the US has revealed that one third of teenagers aged between 12-17 regularly consume energy drinks and that males in the 18-34 age group have the highest consumption. There have been many associated adverse health effects reported, such as headaches, cardiac rhythm disturbances, flushing, nausea and lethargy, along with loss of consciousness and even death. A few years back, I had a paramedic ring my Melbourne radio segment stating he had just been to the unsuccessful cardiac arrest of a 15-year-old girl who had consumed 3 energy drinks over the previous few hours.
This study from the US looked at 1100 young adults and followed them for four years up to the age of 25. It had already been previously reported that there is a clear link between energy drink consumption and drug and alcohol dependence but this was the first study that looked at the amount of energy drinks used and this issue. Disturbingly, it was found that 51% of young adults in this age group were regular users of energy drinks, 17% were occasional users and 11% were trying to cut down. 21% were non-users.

The study showed clearly that the higher use of energy drinks was associated with a higher dependence of alcohol and drug abuse. Surely these drinks are completely unnecessary and should be banned.
Another equally concerning study around artificial sweeteners, (which are strangely called “diet soft drinks” which is clearly an oxymoron) showed that if drinks are perceived to be of high sweetness but low calorie, this tricks the body into believing that it needs more calories. This is one of the explanations for where you may feel quite full after a meal but are still happy to tuck into the dessert. In nature, the intensity of sweetness reflects the amount of energy in the food consumed. For example, fruit is quite sweet because of the fructose content but this is quite proportionate to the number of calories in the particular fruit. Unfortunately, in our modern world with this sweet taste perception and calorie mismatch our brain’s reward circuits do not register the calories that have been consumed which is a significant contribution to overeating.
Finally, and just as disturbing, is the pervasive effect of many of the preservatives and other common chemicals that are so ubiquitous in our modern world. One of the most commonly used preservatives is Butylhydroxy toluene (BHT) which is used in foods to prevent fat from turning rancid. Perfluoro-octanoic acid (PFOA) is used in cookware and carpeting. Tributyltin(TBT) is used in painting but often ends up in the water supply and subsequently in seafood. A recent study showed clearly that all of these chemicals have a profound effect on human stem cells and block the signals between the gut and brain to make you perceive that you are full. It appears from this work that there is a link between the ingestion of these chemicals and obesity, clearly one of the scourges of our modern society.
There is no doubt that if you want to lose weight it is “calories in” versus “calories burnt”. Calories in is the food and fluid you consume and calories burnt is exercise, movement and metabolism. It appears from the last two aspects of this report that metabolism is also affected by many of the chemicals we do not even consider when we are ingesting that food or fluid. With all the evidence I have recently presented regarding the pervasive effects of the containers our food is stored in, along with the increasing recent evidence about the enormous amounts of synthetic chemicals used to colour, preserve and thicken our food, it is my opinion there needs to be a total rethink of how food is produced, stored and marketed to the public.
Until we start demanding these changes, we will continue to see the rampant increase in diabetes, cardiovascular disease and cancer.

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