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The dangers of overcooking your food

Thursday, February 16, 2017

By Ross Walker

It’s often been said that ‘you are what you eat’, but could it also be – as many people have suggested for a long time – that many common diseases are also what we eat and how we cook what we eat? I, as well as many other health professionals, have been saying for many years that many common diseases are linked to our modern lifestyle.

There’s no doubt that following the five keys to good health markedly reduces the risk for all diseases by around 70%, and a recent study has shown a reduction in cardiovascular disease by 83%.

1. Quit all addictions

2. Seven to eight hours of quality sleep each night is as good for your body as not smoking

3. Nutrition: eat less, and eat more naturally

4. Exercise three to five hours per week, in some form

5. Happiness is, no doubt, the best drug on the planet

Three recent disturbing reports have linked common aspects of Western diets with diverticular disease and also cancer risk. The first report was part of the Male Physicians Trial in Boston, which followed 46,500 doctors for an average of 26 years. One component of the trial was for the doctors to fill in a food questionnaire every four years. Specifically, to look at intake of red meat, poultry and fish and, in this case, the link to diverticular disease. When they looked at red meat intake, the higher the intake, the higher risk of diverticular disease whereas more poultry and fish reduced the risk. Specifically, they compared the doctors who never ate red meat with those who would consume red meat at least six times per week.

Red meat intake was also associated with an increased intake of non-steroidal anti-inflammatory drugs, other painkillers, cigarette smoking, being sedentary and reduced dietary fibre. Those doctors with an increased intake of fish and poultry were also more likely to use aspirin, be non-smokers and be regular exercisers. After controlling for all of these factors, men with the highest red meat intake versus those with the lowest intake had a 58% increased risk for diverticular disease. Strangely, the strongest risks occurred with the highest intake of unprocessed meats. Swapping red meat for fish and poultry reduced this risk by about 20%.

Those with the higher intakes of red meat also had higher levels of C-reactive protein and ferritin, both markers for inflammation. High levels in the blood stream of these two proteins were also linked to a higher rate of cardiovascular disease, cancer and diabetes, again through the common factor of high inflammatory risk. It is believed that high intake of red meat has a direct effect on the gut microbiome. Unprocessed meats typically require higher temperatures for cooking, which release a number of chemicals that may lead to damage in the bowel wall.

A number of studies in the past have also linked high consumption of grilled, barbecued or smoked meats to an increased risk for breast cancer. This particular study followed just over 1500 women who were diagnosed with breast cancer in the mid 1990s. All answered a food questionnaire every five years and were followed for over 17 years. During this time, 597 women died, of which 40% died of breast cancer. Those with the highest intake of grilled, barbecue or smoked meats prior to diagnosis had a 23% increased risk for all-cause death, compared with those who had the lowest intake, at the start of the trial.

Finally, a report from the Food Standards Agency - UK (FSA) has recently launched a campaign about the potential damage from acrylamide, the chemical which is formed when starchy foods are subjected to high temperatures. This new campaign is called “Go for Gold”, and suggests that people should cook all of these particular types of foods to a much lighter, golden-yellow colour rather than burning foods to much darker colours. This includes foods such as potatoes, breads, chips and other cereal based products. The dangers of acrylamide have been discussed for a number of years, but this recent report continues to highlight the potential issues of overcooking food.

When combining the results of all three reports there is a common message. It may not be the foods themselves that are the problem, but the way we are cooking the foods. The Aussie barbecue is a tradition, but should not be seen as a licence to chargrill foods to a state where the meat is not only well done, but almost black. The dangerous chemicals released by overcooking are almost certainly causing more health issues than the food itself.

Let’s not forget the wise words of the Father of Medicine, Hippocrates, when he said: “Let food be thy medicine and medicine be thy food”.

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Myth: you can’t teach an old drug new tricks

Thursday, February 09, 2017

By Ross Walker

As most people age in our modern world, the amount of chronic disease increases with each decade of life. Not only does this cause significant disability, it also often requires multiple medications which may benefit one condition, but make the other condition worse (not to mention interact with other medications, often confuse the sufferer as to which pill is for what condition, and without diligent management, may lead to poor compliance, mistakes in drug dosing and mistaking side-effects for the emergence of new medical conditions and vice versa).

One of the most common conditions in our modern world, suffered especially by many people after age 50, is arthritis. Our most common killer is cardiovascular disease. Many people suffer both conditions in some form and although arthritis is typically not lethal, it is certainly very uncomfortable and has a marked effect on the quality of life. Our current standard anti-inflammatories and painkillers often have significant, and at times, life-threatening side-effects.

Around the turn of the century, a new group of anti-inflammatories known as Cox-2 inhibitors were released onto the market with great fanfare. By 2004, the commonly used Vioxx was withdrawn from the market because of a marked increase in heart attack in the people regularly taking the drug. A very similar drug, Celebrex, didn’t appear to have the same severity of side-effects but certainly made the medical profession act cautiously when prescribing this drug and, in many ways, it fell out of favour.

A new study of 24,000 patients who suffered either osteoarthritis or rheumatoid (average age 64), were treated with either Celebrex, Naprosyn or Brufen. All of these patients had either pre-existing heart disease or were at increased risk for developing the condition. They were followed up for 10 years looking at the incidence of heart attack, stroke or death. Those taking Celebrex had a 2.3% rate of these conditions with 2.5% in the Naprosyn group and 2.7% percent in the briefing group. The rates of upper gastrointestinal bleeding or ulcers was 54% higher in the Brufen group and 41% higher in the Naprosyn group compared with Celebrex. Again, Brufen led to a 64% higher risk of worsening kidney function compared with Celebrex, and death from any cause was 25% higher in the Naprosyn and Brufen group, albeit small absolute numbers.

Regardless, many cardiologists are suggesting that these absolute numbers of death over 10 years are actually quite low for people with either established cardiovascular disease or other high-risk patients. It is my view that we should try to use as many natural anti-inflammatories as possible but the end game is pain relief, mobility and improved function. I would much prefer to have patients take a relatively safer drug such as Celebrex and be able to exercise rather than avoid exercise because of pain. The health benefits of exercise in my view certainly override the potential side effects of a drug such as Celebrex.

Another unrelated study from Greece looked at a completely new benefit from the drug Celebrex. This study enrolled 55 patients with bipolar disorder aged between 18 to 65 who were in the depressive phase of the disease. The patients were either given Lexapro, a commonly used antidepressant, plus Celebrex or Lexapro with a placebo. The startling results of this trial showed that 78% of the patients in the Celebrex group had at least a 50% reduction in the depression scores with 63% reporting their depression had gone away completely. The group taking Lexapro and placebo show that only 45% of this group had at least a 50% reduction in their depression scores with only 10% saying the depression had been resolved completely. Although it usually takes somewhere between 4 to 6 weeks to get significant benefits from antidepressants, in those taking Celebrex, they noticed significant gains within one week.

There is increasing evidence that depression affects the immune system leading to chronic inflammation and it is therefore logical that effective anti-inflammatories such a Celebrex will show this benefit.

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Does an aspirin a day keep the doc away?

Thursday, February 02, 2017

By Ross Walker

I’m often asked by my patients whether they should be taking a daily dose of baby aspirin i.e. 100mg, to prevent heart disease. Unfortunately, there is no definitive answer to this very important and very intelligent question. When one study is released supporting the benefits of daily aspirin, there is a rush to pharmacies with people wanting to ensure they receive their daily dose of this little miracle. Then, a further study is released refuting the benefits, leading to everyone who hears of the study immediately stopping this therapy.

As with most answers in medicine, the true approach should be somewhere in the middle. For many years, it has been well established that taking aspirin, around 100mg daily, may reduce your risk for cardiovascular disease and in particular heart attack by around 25%, taken from trials in high-risk patients. Over the past decade, there have been a number of studies also suggesting reduction in many common cancers with the daily ingestion of aspirin. Some studies have even suggested up to a 50% reduction in colon cancer, purely by taking aspirin on a daily basis.

So, what’s the downside? Once we all reach 50, why don’t we all start ingesting this little pill? The problem with making this across-the-board recommendation is that some people do experience significant problems, in particular bleeding and reflux, by taking aspirin. Aspirin is an highly effective blood thinner, even in low doses, working by reducing the stickiness of blood cells known as platelets which are intricately involved in the formation of clots, thus the benefits in reducing heart disease. Possibly because of their anti-inflammatory effects but also due to a direct effect on cancer cell growth and spread, it does appear that there is some cancer preventive benefits with the use of prophylactic aspirin. But, aspirin has been shown to commonly irritate the lining of the stomach and when this is combined with an increased tendency to bleeding, in some cases, may be a recipe for disaster precipitating significant gastrointestinal bleeding.

I often quote the personal case of my mother who, 10 years ago, unbeknownst to her son started taking aspirin and within six months had wiped out the lining of her stomach and lost half her blood volume. When I asked my mother why she was taking aspirin, she remarked that she read it was good for the heart. I then reminded her that I had been a cardiologist for 25 years and she could’ve discussed this with me.

The regular ingestion of aspirin is also associated with reflux oesophagitis in around 5 to 10% of cases. It is, however, my opinion that all people with established heart disease should be taking aspirin unless they have significant reflux, gastric irritation or a history of bleeding.

A recent analysis from the University of Southern California has estimated that if all Americans aged 50 to 80 took daily low dose aspirin, 11 cases of heart disease and four cases of cancer would be prevented for every thousand people. In pure financial terms, it was suggested that this would save the US economy just under $700 billion dollars over a 20-year period.

So with all of this evidence, it would be my suggestion that if you have strong risk factors for heart disease or cancer, our two common killers, then taking daily low dose aspirin will probably give you additional health benefits. If, however, you have a prior personal history of significant bleeding, typically from the gastrointestinal tract or possibly even a prior history of a brain bleed, easy bruising, or you are prone to reflux oesophagitis, then it is probably better to avoid aspirin.

As with all my suggestions in these articles, it is vital you discuss these issues with your general practitioner before making a medical decision on your own.

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Diet v non-diet soft drinks

Tuesday, January 31, 2017

For decades now, society has been experiencing a love affair with soft drinks, laden with sugar. Over this time, we have seen a very strong marketing campaign by the big players in the industry ensuring us all that our life goes so much better if combined with consuming particular types of soft drink.

I remember as a child, the state government supplied milk to all public schools encouraging us to consume this as our primary source of fluid. These days, it is not unusual for children, teenagers and young adults (not to mention some older people) to consume at least one soft drink per day as part of their regular fluid intake. To encourage and maintain this habit in many people, the beverage companies introduced the word “diet” on the side of bottles and cans with the strong inference that consuming this form of drink may have health benefits. Let’s face it, we’ve all been bombarded with the importance of following a good diet, so if this is written on the side of the packet, bottle or a can, then whatever is in that container must be good for us!

So, is this reality? Are diet drinks really that beneficial and do they provide a more healthy alternative to the sugar laden soft drinks that in the view of many health professionals have contributed to many modern health problems and in particular the alarming rates of diabetes and obesity in our community?

I have often spoken about what I call white death. This includes

  1. Sugar/Salt
  2. White bread
  3. White rice
  4. Australian and American pasta
  5. Potatoes

It is estimated that the average can of soft drink contains around 10 teaspoons of sugar per drink. A number of recent trials have suggested that consuming one standard soft drink per day has been associated with the following health problems

  1. 50% increased risk for Type II diabetes
  2. Marked increase in dental decay
  3. Seven times the rate of bone fracture
  4. Increasing incidence of behavioural abnormalities in children, adolescents and young adults because of the high sugar content and the caffeine seen in Cola base drinks and especially the very high doses in energy drinks
  5. Potential cancer risk especially with cola based drinks

Therefore, the diet alternatives of soft drinks must be healthier! Well, it certainly appears that this is not the case. Firstly, the concentration of phosphoric acid (cleverly called food acid by some companies), which  contributes to the bone and teeth issues, is identical in the diet and non-diet drinks. Secondly the Cola colourings that have been linked to cancer is no different as well. In reality, this leaves us with the question as to whether artificial sweeteners are healthier than the 10 teaspoons of sugar in a standard can of soft drink. A recent study from the Imperial College London in the United Kingdom certainly suggests that this is not the case. This report firstly makes the disturbing observation that sugar sweetened beverages such soft drinks make up a third of the total sugar intake amongst teenagers. In the United States alone these account for half of the added sugar in a standard American diet. Because of the concerns around diabetes & obesity, there is increasing consumption of artificially sweetened beverages in children and adults.

It appears, however, that artificially sweetened beverages still have a profound effect on metabolism by stimulating taste receptors, which then leads to increasing appetite and abnormal secretion of gut hormones. The other concern around this pathway is the fewer calories in artificially sweetened beverages ,because all of these mechanisms are switched on, leading to increasing consumption of other foods and thus a higher caloric intake. The end result of all these mechanisms being just as worrying rates of diabetes and obesity in people who consume artificially sweetened beverages and thus no significant health benefits. Randomised controlled trials of artificially sweetened beverages have shown minimal to no effects on weight loss whatsoever. You may be shocked to hear that the trials that show any positive benefits for artificially sweetened beverages have been sponsored by the beverage industry.

I believe the answer here is very straightforward. Health professionals should be discouraging both children and adults from consuming sugar sweetened beverages and artificially sweetened beverages. The devastating effects on health from the combination of all the chemicals in these drinks, in my view, makes these forms of fluid something that should be consumed either very infrequently or not all. The major epidemic of the 21st-century is Diabesity i.e., the combination of diabetes and obesity. It appears that both sugar sweetened beverages and artificially sweetened beverages are contributing equally to this devastating problem. With all of the other associated health issues with any form of fizzy drink, I would call for a ban on energy drinks and a distinct warning on the side of all soft drinks about these potential health issues.

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Be a health nut

Thursday, January 19, 2017

By Ross Walker

I have been saying for many years that the regular consumption of nuts is a very good method for assisting in the prevention of cardiovascular disease. A recent study from Norway has taken this concept further. They reviewed 20 prospective cohort studies from the United States, Europe, Asia and one from Australia which looked at the risk for cardiovascular disease, cancer and death in men and women.

12 of the 20 studies followed just over 376,000 adults and found that consuming a handful of natural nuts per day (which equates to around 10 to 15 nuts) reduced the risk of cardiovascular disease. Each 21g serve was linked to a 21% reduction in cardiovascular disease. Interestingly, the risk for heart disease specifically was reduced by around 29%, with a statistically insignificant reduction in stroke of 7%. 

Nine cohorts of just over 304,000 adults found that a similar serving of nuts per day reduced cancer risk by 15%, although the consumption of tree nuts specifically led to a 20% cancer reduction (whereas peanuts were less powerful, bringing the risk down by only 7%).

15 cohorts, including just under 820,000 people, specifically looked at death rates. There were just under 86,000 recorded deaths, and again, one serving of nuts daily reduced death rates by around 22%. When they examined the specific causes of death, there was a surprise reduction of people dying from lung disease by 52% and 39% from diabetics.

Other specific causes of death such as neurodegenerative diseases (e.g. Alzheimer’s disease, Parkinson’s disease, Motor neurone disease) were not affected by nut consumption, nor were kidney or infectious diseases.

The staggering conclusion of this report was that nearly four-and-a-half million premature deaths could be prevented in the USA, Europe, the Western Pacific and Southeast Asia just by people consuming a handful of nuts daily. 

These types of studies are not randomised controlled trials, as it is very difficult to perform this type of analysis with a diet. It may purely be that people who regularly consume nuts also practice a healthier lifestyle than people who don’t consume nuts. Therefore, nut consumption may be purely a marker – and not the cause – of the health benefits. But, nuts do contain a variety of healthy fats that have been shown to have significant health benefits with regular consumption, including omega three fatty acids and monounsaturated fats.

Nuts also contain high-quality amino acids e.g. arginine which is the precursor to nitric oxide, the ubiquitous vasodilator factor which improves blood flow to organs and helps to maintain lower blood pressure. Nuts also contain a variety of vitamins and trace metals that are vital for good health. 

It is my opinion that having 10 to 15 natural nuts on a daily basis should be part of our health strategy but I stress the word, natural. The salted, roasted variety has been tainted with vegetable oils which are hydrogenated and part of the trans fatty acid family. You lose the benefit when you have these types of nuts. You should also not view consuming nuts as an excuse to practice poor lifestyle habits such as cigarette smoking, the excessive ingestion of calorie dense, nutrient poor food, inactivity and excessive consumption of alcohol

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Blame Mary Jane

Thursday, January 12, 2017

By Ross Walker

In Australia over the past few years, there has been increasing debate about the potential health benefits of medical cannabis. This was highlighted by three very important examples demonstrating significant benefits.

The first was the case of Dan Haslam, the young man who died of bowel cancer in his 20s. His mother, Lucy, has become a very active campaigner for the widespread use of medical cannabis for a variety of conditions, because cannabis was the only treatment that relieved his suffering, from not just his condition, but also the treatment. The second example was the 60 Minutes program Charlotte’s Web, which highlighted the case of a young girl with severe refractory epilepsy caused by a rare condition, Dravet’s syndrome. Medical cannabis stopped her severe recurrent fitting. The third high profile case was that of Barry and Joy Lambert’s granddaughter who also suffers Dravet’s syndrome. Since commencing medical cannabis 18 months ago, she has had no further seizures.

Although there are no large, long-term randomised controlled trials of medical cannabis for a variety of conditions, there is growing scientific evidence for the benefits of medical cannabis for many cases of refractory epilepsy, especially in children.

There is also increasing work for a variety of aspects of cancer management, such as nausea and vomiting induced by chemotherapy, cancer pain and, potentially, reduction in cancer growth and spread.

There’s also some good work for medical cannabis relieving the spasticity of multiple sclerosis, with some early potential studies suggesting benefits for Alzheimer’s disease, Parkinson’s disease, a number of autoimmune diseases including lupus, rheumatoid arthritis and psoriasis, osteoporosis and a number of mental health issues.

But, this does not give a clean bill of health to the smoking of illegal, so-called recreational marijuana which is a completely different form of cannabis – which in my view should stay illegal.

Over the years, a large body of evidence has accrued suggesting the smoking of illegal marijuana may lead to mental health issues, predisposition to dementia, and possibly even cardiac rhythm disorders. There’s also evidence to suggest hormonal abnormalities, affecting a variety of endocrine glands such as the pituitary, adrenals and sex glands.

Although there are 100s of cannabinoid compounds that occur in a cannabis plant, there are two well known cannabinoid receptors in the body. The first is CB1 and the second, logically CB2. CB1 is basically found in the brain and nerves, whereas CB 2 is more a regulator of the immune system and gastrointestinal tract.

Recent research has demonstrated that CB1 is located in the mitochondria of nerve cells. The mitochondria are the fuel packs of the cells as they convert nutrients and oxygen into the energy or fuel that the cell needs to function. The activation of CB1 receptors within the mitochondria leads to damage to the nerves, with memory loss through reduced production of energy within nerves.

Another recent study also demonstrated that individuals who smoked illegal marijuana had a marked reduction in blood flow to nearly all areas of the brain, especially the hippocampus (which had the largest reduction in flow).

The hippocampus is the brain region associated with learning and memory and is also the first region affected in patients with Alzheimer’s disease. The researchers use the technique known as SPECT to accurately measure the blood flow within the brain. They examined just under 1000 individuals who had been diagnosed with marijuana use disorder and compared this with 92 controls who did not smoke marijuana. The SPECT study, which is a specific form of CT scanning, measures blood flow and activity during a mental concentration task. Clearly, the combination of a direct effect on the CB1 receptors in the mitochondria of nerve cells, coupled with reduction in blood flow, is a very cogent explanation as to why high concentration THC may lead to Alzheimer’s disease in regular users of marijuana.

In another blow for people who believe recreational marijuana use is of no concern, it has also been shown that high concentration THC (as found in the modern marijuana joint) can have a direct effect on dopamine levels which is the key chemical in the brain’s pleasure-reward system. Dopamine plays a key role in many aspects of brain function, including learning, movement, motivation, emotion and reward. It appears that the chronic ingestion of marijuana can significantly lower the levels of dopamine within the brain which has been associated with changes in mood, depression, lack of motivation, fatigue and associated with a number of other disorders such as Parkinson’s disease and ADHD.

Long-term marijuana use is associated with the number of mental health conditions such as depression, anxiety and even schizophrenia, and again, this may be related to low dopamine levels, not to mention the previously stated reductions in blood flow and effects on the fuel packs in the cells (the mitochondria).

Although I am a great supporter of the introduction of medical cannabis for specific health conditions, the overwhelming evidence for the detrimental effects of recreational, illegal marijuana places this drug in an entirely different category.

It is vital that the public understands the incredible difference between smoked, illegal marijuana and what may well be one of the next big things in medicine, medical cannabis.

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The dangers of Irukandji jellyfish

Tuesday, December 20, 2016

By Ross Walker

Just recently, we heard about the tragic deaths of two French tourists whilst snorkelling on the Barrier Reef. These people, both in their 70s, were snorkelling in the same area and suffered cardiac arrests within a few minutes of each other. The people owning the dive company and the local tourism authorities tried to infer this was a tragic coincidence. Two days later in a different location on the Barrier Reef a 60 year old English tourist died whilst scuba-diving.

The reality is that there have now been 10 deaths of divers and snorkelers in far north Queensland in 2016. The first death occurred in February and continued until May with a total of five deaths this during this period. From October until now there have been five more deaths. The break in the middle coincides with the time of the year when there are no marine stingers in the water.

When there was initial talk two weeks ago about the two deaths within a few minutes of each other whilst the French tourists were snorkelling, I was interviewed about the potential causes of their deaths. Of course, it may have been a pure coincidence that two elderly people with pre-existing heart disease both suffered cardiac arrests within a few minutes of each other. This is a simple explanation but, in reality, highly unlikely. When I suggested the most likely cause was the Irukandji Jellyfish, my comments were met with significant consternation by the people whose livelihood would clearly be affected if this was the case i.e. The people who own dive companies and members of the Queensland tourism bureau.

The Irukandji Jellyfish

The Irukandji Jellyfish

Mr Allan Wallish, who is the managing director of Passions of Paradise dive company said, “We don’t get Irukandji Jellyfish at this time of year and one of the people who arrested had a full stinger suit on.”

I ask the logical question, if there are no Irukandji Jellyfish at this time of the year why would someone bother to wear a stinger suit. Prof Mike Kingsford, who is the head of James Cook University Marine and Tropical Biology School said it was highly unlikely that the Irukandji Jellyfish was the cause for the deaths and proceeded to say there were multiple possibilities for why these people died without actually mentioning what these multiple possibilities were. Even one would’ve been good! 

The Irukandji syndrome is well described and it involves a reaction within 5 to 120 minutes of being stung with the average time being around 30 minutes. Symptoms of the sting can vary from headache, backache, muscle pains, chest & abdominal pain, nausea, vomiting, sweating, anxiety, rising blood pressure and heart rate and even fluid on the lungs.

One of the interesting components of this syndrome is a feeling of impending doom which may be mistaken for an anxiety attack. Interestingly, a third member of the French group was having what was described as a panic attack on the shore after the deaths of the two tourists, one of whom was his partner.

Clearly, the most feared reaction to an Irukandji sting is a cardiac arrest, possibly the cause for these 10 deaths in far north Queensland this year. The suggested management for an Irukandji sting is vinegar to the area, pain relief, antihistamines and possibly intravenous magnesium.

We won’t know for certain whether Irukandji sting was the cause for these deaths until we have the toxicology report from the autopsies. Regardless, I wouldn’t be swimming in the waters of far north Queensland from October to May regardless of whether I was offered a stinger suit. Even though there is no doubt we live in a magnificent country, there are clearly many hazards when trying to enjoy the magnificent outdoors life our country has to offer. The Irukandji Jellyfish is certainly one of them.

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5 tips to beat the Christmas bulge

Thursday, December 15, 2016

By Ross Walker

Well, it is that time of the year when the very common burnout sets in and most of our thoughts turn to the Christmas break. Although Christmas should always be a time for rest, reflection and rejuvenation, it often becomes a time for excessive partying, overeating and overindulging in other bad habits, not to mention those interactions with relatives who we hardly see throughout the year.

Rather than heading towards the inevitable Christmas weight gain, the very common New Year’s Day hangover and the perennially failed New Year’s resolutions, why not resolve before the holiday season gets into full swing to really make this Christmas break the chance to make a fresh start by following, what I call, my 5 Point Power Plan.

1. Decision

Decide what life habits you want to break and which ones are not working for you. A very good start here is to create a journal or a diary where you actually write down, in decreasing order of importance, your life goals for the coming year, including the list of bad habits that are not serving you well and you wish to change.

2. Correct your limiting patterns

What is stopping you right now from not making these changes? If, for example, you wish to cease smoking but every Friday night you go down to the hotel with your friends and have a few drinks, this will certainly weaken your resolve and this pattern may need to change.

Many people, as another example, are comfort eaters, often sitting in front of the television consuming unnecessary food. Rather than doing so, now that it is daylight saving, why not go for a walk instead?

3. Create a new pattern

Nature abhors a vacuum. When you change a bad habit that has occupied a significant amount of your time, whether it be excessive eating, drinking or smoking, it should be replaced with a better, more healthy habit. One of the greatest examples I have witnessed in my medical practice was a patient of mine who was a serious alcoholic. He consumed around 20 schooners of beer per day leading to a severe dilated cardiomyopathy. This gentleman made the decision to stop alcohol on my very strong advice and replaced this with an interest in Egyptology.

All of the money he used to spend on alcohol was placed into a bank account. He had eventually saved up enough money to take him and his wife to Egypt where he had the trip of a lifetime.

4. Train the habit

Any new habit requires discipline. You need to discipline yourself for a full month for this new habit to be trained and to become a normal part of your life. It is very important, also, to associate rewards with this new habit. For example, once I had destroyed my knee through too much sport, I needed to replace my very enjoyable soccer and squash games with a less rigorous form of exercise. I therefore started using an exercise bike eight years ago, but my reward was to watch an enjoyable TV series while exercising to associate pleasure with the habit, rather than the boredom of the exercise bike for 45 minutes staring out the window. I am delighted to say that I have already broken one exercise bike through excessive use and now onto my second bike.

5. Live the program

A number of years ago I wrote a book “Diets Don’t Work”. The reason diets don’t work is that you go on a diet in the same way as you go on a holiday. You always come back from the holiday. 12-week programs also have a finite ending which see you return to your old habits. When you have created new good and healthy habits, these need to stay with you for the rest of your life. You need to have a commitment to maintaining these habits as part of your new way of thinking.

Life is not about making the big decision to be healthy and happy, it is about making 30-50 small decisions every day of your life. Decisions like “I won't eat that biscuit”, “I’ll walk up the stairs rather than take the escalator”, and, “I will not yell at that fool who just cut in front of me in the traffic”.

These are split second decisions that can either take you towards good health and happiness, or bad health and unhappiness. Why wait for the new year to make these decisions and resolutions? Why not start right now before the often bad habits of the Christmas break take over.  

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Does anxiety increase your risk for heart disease?

Thursday, December 08, 2016

By Ross Walker

There are five major categories of risk factors for heart disease:

1) Hypertension 

2) Genetic, metabolic and dietary fat/cholesterol issues 

3) Diabetes and metabolic syndrome 

4) Cigarette smoking 

5) Family history of vascular disease before age 60 

One, or a combination of any of these factors, is the major reason people develop fat build up in the wall their arteries, also known as atherosclerosis. 

But what puts the fat there in the first place has nothing to do with what makes a stable fatty plaque rupture. 

There are five major categories of the precipitation of plaque rupture:

1) Psychosocial factors

2) Infection

3) Extremes of exercise

4) Dietary excesses 

5) Bad life behaviour 

Let's focus on psychosocial factors, and in particular, anxiety. Around 20% of the population suffer some form of anxiety. Recent studies have shown that anxiety increases heart disease risk by a factor of eight times. Closely linked to this is depression, which is also associated with an increased risk for heart disease. A recent meta-analysis showed that anxious people have a 48% increased risk for a heart problem. It therefore appears that health anxiety is a self-fulfilling prophecy. 

Health anxiety is defined as excess worrying over serious illness, seeking medical advice at an excessive level despite the absence of any obvious physical disease.

People with health anxiety often misread physical symptoms as serious illnesses and they seek repeated medical assessments for the same issues. This is also called, of course, hypochondria. As I have mentioned previously, my daughter, Bridget, bought me a cup that I have in my medical clinic that says, “Please do not confuse your Google search with my medical degree”. 

A new study from the British Medical Journal-Open, looked at just over 7000 patients for 12 years who were born between 1953 to 1957. They had standard physical measures such as pulse rate, BP and weight, along with routine blood tests. They also reported their anxiety levels via the Whiteley index. Scores greater than 90% were deemed as anxiety levels. Over this 12-year period, 234 patients or 3.2% experienced a heart attack or angina. Health anxiety doubled the rate of heart disease, or in other words, increased heart disease risk by 73%. The absolute figures were a 6.1% risk of heart disease in those with health anxiety, compared with only 3% in those who did not exhibit this trait. 

It is an interesting phenomenon that people who are very concerned about their health and often attend doctors with large folders of health monitoring and their own health records, recording every single health parameter they possibly can, falsely believe that this form of taking control of their health will reduce their risk for disease.

This study, and a number of others, actually suggest it is the complete opposite. 

It appears that anxiety begets anxiety and subsequently anxiety begets heart disease. It appears that it's much better to smell the roses then to analyse them. It is situations like this where the wonderful parable of the little boy who cried wolf comes to mind. 

Maybe the epitaph on the hypochondriac's grave says it all: It says, I told you so.

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The lowdown on Vitamin D

Thursday, December 01, 2016

By Ross Walker

Vitamin D is a fat soluble vitamin that has an important place in calcium metabolism, steroid and cholesterol production. There are three possible sources of vitamin D which include sunlight, certain foods such as oily fish, fish and beef liver, egg yolks and certain fortified foods. The final source of vitamin D is supplementation. It is estimated that somewhere between 30 to 40% of adults are deficient in vitamin D. The definition of vitamin D deficiency is a blood level less than 50 nmol per litre.

Is the deficiency being overestimated?

A recent editorial in the New England Journal of Medicine, however, has raised concerns that the degree of vitamin D deficiency is being widely overestimated. A flow on effect of this alleged overestimation is excessive blood testing for vitamin D levels. The costs to governments has skyrocketed over the last decade, with vitamin D assessments being said to be the fifth most common test measured. The authors of this editorial are suggesting that the cut-off point of 50 nmol per litre is an overestimation of deficiency and for the vast majority of people less than 70, 600 international units daily from any of the sources mentioned, and 800 international units daily for people over 70, is adequate intake.

The bottom line

The bottom line from their interpretation of the studies is that, in reality, only 6% people living in the US up to age 70 are deficient, and we’re not really living in the epidemic of vitamin D deficiency. I must say, this is in contradiction to many studies that have been performed over the past decade, and just because it has been written up in the New England Journal of Medicine does not make it gospel truth. Interestingly, many conservative researchers are only focusing on the link between low vitamin D and osteoporosis, tending to ignore the other significant associations. There have been a number of research studies suggesting a link between low vitamin D levels and cardiovascular disease, cancer, multiple sclerosis, Type II diabetes and depression.

The benefits of normal vitamin D levels

Two recent reports have highlighted the potential benefits of maintaining normal vitamin D levels. In Australia alone, around 15,000 women are diagnosed each year with breast cancer with just under 3000 deaths per year from the disease. There is mixed information around the benefits of vitamin D as an adjunctive therapy for cancer, with strong evidence in animal experimentation that the active version of vitamin D known as calcitriol can reduce the proliferation and growth of cancer cells, decrease cancer blood vessel formation, and stimulate cancer cell death. There is not enough human data as yet to strongly support the use of vitamin D supplements as a way of preventing and treating cancer, but, some of the preliminary work is certainly suggestive. 

The studies

A new study from New York looked that just under 1670 women who were diagnosed with breast cancer. These women were part of the Pathways Study and followed regularly for an eight-year period. The average age was 59 years, and half were said to be vitamin D deficient. The lowest levels of vitamin D were found in women with advanced tumours and especially in premenopausal women with triple negative breast cancer. Levels of vitamin D were inversely proportional to disease progression and death rates. This was a purely observational trial, where vitamin D therapy was not actually used. It is not known whether the advanced nature of some women’s disease actually dropped the vitamin D levels or whether the low levels of vitamin D predisposed them to the disease in the first place. A proper placebo controlled trial needs to be implemented.  

Another recent trial presented at the Society for Endocrinology conference in Britain looked at the association between low vitamin D levels and bladder cancer. The group, from the UK, carried out a systematic review of seven studies to determine this link. The number of participants ranged from between 112 up to 1125. Five out of seven studies found a higher rate of bladder cancer with low vitamin D levels. High vitamin D levels also correlated with better survival outcomes in these groups. The researchers also looked at the cells that line the bladder known as transitional epithelial cells. The cells responded to vitamin D and vitamin D affected the local immune response recognising abnormal cells and preventing cancer formation. 

Although we do not have any large, well-controlled randomised trials of vitamin D for the number of the conditions I have mentioned above, it is my opinion that the evidence is so compelling that taking 1000 international units of D3 on a daily basis is harmless, and almost never puts the vitamin D into potentially toxic ranges, and it is certainly something I do on a daily basis for all of the above reasons.

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