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Dr Ross Walker
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A major breakthrough for spinal cord injuries

Thursday, July 18, 2019

One of the worst traumas imaginable is to suffer a spinal-cord injury and to be left with either paraplegia or even worse quadriplegia. In Australia alone, there are over 12,000 people with spinal cord injuries, with 400 new cases a year. Of these, 15% are complete quadriplegics and 20% complete paraplegics. The typical causes are some form of motor vehicle or motorbike accidents or through the various types of body contact sports.

Surgeons at the Austin hospital in Melbourne have performed study on 16 young adults with quadriplegia, with the average age of 27. These young people had nerve transfer surgery, with or without tendon transfer surgery, in an attempt to restore some degree of their upper limb function. Some improvement in upper limb function would allow elbow extension, grasp, pinch and hand opening. The ability to perform these functions would then allow these young people to perform day-to-day activities, that the vast majority of people take for granted, such as brushing your teeth or being able to use the toilet without assistance.

This nerve transfer surgery in 13 out of the 16 adults demonstrated that these previously dependent, complete quadriplegics could feed themselves, brush their teeth and hair, write and use a variety of electronic devices. In the three people where the procedure was not successful, there were no complications. So in reality, they were not worse off, so the procedure was worth the risk. Interestingly, nerve transfer surgery was more effective when the operation was delayed for at least 12 months after the injury.

So often the media reports new therapies or studies as major breakthroughs, dashing the hope of sufferers of various conditions when they find out that the so-called breakthroughs have only been in a variety of cells in a laboratory or in experimental animals (typically mice) and the chance for the so-called breakthroughs to be available to humans can be anywhere between 5 to 20 years away, if it all.

This nerve transfer surgery, through superb Australian research, has been performed on humans with spinal cord injury and has had a clear, practical success in restoring upper limb function in this situation. Over the past few decades there have been some extraordinary approaches to treating spinal cord injury with some anecdotal marked improvements. To date, not many of these approaches have been demonstrated in clinical trials to have consistent success.

I am delighted to be able to call this a major clinical breakthrough which will hopefully, in the near future, become standard of care for people with significant spinal cord injuries.

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The power of the gut

Wednesday, July 10, 2019

With the increasing evidence regarding the importance of the gut microbiome, two more studies were released recently showing the importance of having healthy gut bacteria. Both published in Nature Medicine, the first (from Harvard University) looked at the relationship between specific gut bacteria and allergies.

It’s estimated that around 10% of the population are now experiencing some degree of food allergies. It’s also estimated that human beings are only 10% human and 90% bacteria, most of which reside in the gut. There are trillions of microorganisms, including thousands of species of bacteria living within the gastrointestinal tract. It’s well known that there are strong interactions between gut bacteria and the immune system, which can trigger a range of diseases from cancer, cardiovascular disease, autoimmune disease and now even allergies.

It appears the risk for food allergies is higher in people who come from smaller families, those who were not breastfed, those who were born by caesarean section and young children who had significant antibiotic use throughout their early years.

The Harvard researchers collected for faecal samples from babies every few months and compared the gut bacteria of 56 infants with food allergies compared with 98 age-matched individuals who didn’t have food allergies. They found different bacteria living in the allergic children compared with those who were nonallergic.

They then transplanted the gut bacteria from the children into mice that were sensitive to eggs. The mice who received gut bacteria from children without food allergies were less likely to have an allergic reaction compared with those who received the gut bacteria from the children with food allergies. It was found that certain Clostridial species and also Bacteroides species protected the mice from food allergies.

The second study looked at a particular bacteria known as Akkermansia Muciniphila. This particular bacteria has been previously linked to people with healthy metabolism, reduced weight and low blood sugar levels. This study from Belgium also published in Nature Medicine, initially gave 20 healthy volunteers a probiotic of Akkermansia Muciniphila for a 3-month period and found a better insulin response, lower cholesterols and slight weight loss and this was despite no change in diet and exercise.

The second component of the study looked at 32 overweight/obese individuals and gave them either placebo or 10 billion Akkermansia Muciniphila per capsule. Those in the active treatment group had much lower inflammatory markers, lower cholesterol and just under 2 ½ kg weight loss over the 3-month period. Large studies will be performed in the near future.

It’s interesting that there is a strong possibility in the near future of all these healthy bacteria species being put into a probiotic capsule, which may help food allergies, diabetes, cholesterol levels and weight loss. There are a variety of different treatments for all these conditions already available on the market but to be able to use healthy bacteria as another form of effective therapy is a very exciting proposition.

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More evidence for the Brain-Gut connection to Parkinson’s disease

Wednesday, July 03, 2019

Over the past decade, there has been increasing evidence regarding the vital importance of gut health, not only as an indication of well-being, but also as a guardian against a number of other diseases. Two months ago, I wrote an article about the vital importance of the appendix. I detailed a large study of 62 million people in the US. Of the just under 500,000 people who’d their appendix removed, just under 5,000 developed Parkinson’s disease i.e. an incidence of 1%. Of the 61.7 million people who hadn’t had their appendix removed, just under 180,000 developed Parkinson’s disease i.e. an incidence of 0.29%.

For those of us with enormous skills in mathematics, this is around a 3 times higher incidence of Parkinson’s disease in those who have had their appendix removed. It appears that the appendix harbours a protein known as alpha synuclein and when the appendix is removed, it appears the alpha synuclein is released with toxic clumps being found in parts of the gastrointestinal tract. Interestingly, the same toxic clumps appear in the brains of people with Parkinson’s disease and an associated condition known as Lewy body dementia.

This misfolded protein, alpha synuclein, clumps together within certain parts of the brain and replaces normal nerve tissue with dead clumps of cells, which are called Lewy bodies. Interestingly, one of the early symptoms of Parkinson’s disease is constipation, which is now felt to be also due to the alpha synuclein in the gut altering normal gastrointestinal function.

One of the major connections between the gut and the brain is the vagus nerve system. Researchers at the Johns Hopkins university set out to see whether the alpha synuclein can travel up the vagus nerve from the gut to the base of the brain.

They took a group of mice and injected 25 µg of synthetic, misfolded alpha synuclein into the gastrointestinal tract of healthy mice. They then sampled brain tissue at a variety of intervals over the next 10 weeks after the injection. The researchers found the alpha synuclein building up from where the vagus nerve starts in the gut and then followed the spread to-related parts of the brain.

The next step was to cut the vagus nerve in one group of mice and again inject alpha synuclein into the gastrointestinal tract. At seven months, there were no signs of alpha synuclein in the vagus nerve or the brains of these mice, compared with those who had intact nerves.

The next step was to determine whether the specific injections affected the progression of Parkinson’s disease so the mice were split into three groups. The first injected with misfolded alpha synuclein, the second had the injections but severed vagus nerves and, finally, the control mice had no injections and normal vagus nerves.

They looked at the indications of Parkinson’s disease as seen in mice, which included the mice’s ability to construct nests and also measured mice anxiety levels by seeing how often they explored new cages and general mice behaviour.

The study found that only the mice injected with misfolded alpha synuclein with intact vagus nerves developed Parkinson’s disease.

This very elegant study clearly shows a link between the gut and the brain. This information takes us much closer to developing specific treatments for conditions such as Parkinson’s disease and Lewy body dementia with research directed at blocking the ability of the vagus nerve to take up alpha synuclein. I believe this is a significant breakthrough at many levels, which hopefully will see a cure at some stage in the relatively near future for two diseases, Parkinson’s disease and Lewy body dementia, both of which have a very deleterious effect on quality of life and lifespan.

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You’re much more than my best friend

Wednesday, June 26, 2019

Over the past decade, there has been mounting evidence that owning pets is extraordinarily good for your health. The stress relieving benefits of dog and cat ownership have been proven beyond doubt with low rates of chronic illnesses having been demonstrated in a number of studies.

Mainly with dog ownership, it’s almost a form of enforced exercise but also the companionship of domestic animals is a proven stress reliever and often great therapy for those who are lonely. But, a recent study published in the Journal of the American Osteopathic Association has demonstrated another benefit from our four-legged friends.

There’s no doubt that the best treatment of cancer is early detection. Unfortunately, many of our screening studies are not overly accurate with a significant false positive and false negative rate. Also, many of the scans performed are expensive and not always 100% accurate.

This study involved training three beagle dogs to sniff out lung cancer from blood samples. As most of us are aware, the olfactory acuity (smelling ability) of a dog is 10,000 times more sensitive than that of a human being. A beagle, which is also known as one of the scent hounds has 225 million olfactory receptors compared with the human beings measly five million.

Following an eight-week training period, the dogs were exposed to a number of samples from patients with lung cancer and with those from healthy patients. The samples were placed in one room at a sniffable height and the dogs were trained to sit down if the sample contain the scent of lung cancer but to move on if the samples were considered normal. The extraordinary results showed that the dogs were accurate in predicting or excluding cancer with a 97% hit rate. Dogs are now being trained to detect early breast and colorectal cancer as well.

There has been research performed all over the world but particularly in Israel moving towards detecting early cancers with breath testing. These tests are detecting volatile organic compounds which are released into the breath in people with a variety of cancers. When the DNA mutates to become cancerous, protein fragments are released from the altered DNA which create a different footprint compared with people without cancer.

It may be that at some stage in the relatively near future, as part of a routine screening assessment we either blow into a bag to detect these volatile organic compounds or possibly we may see the day when trained beagle dogs, such as those that we see at airports to sniff out illegal drugs, are used in medical practices to detect early cancers. In our extremely high tech world where medical investigations and treatments are becoming incredibly sophisticated, there is something quite compelling about man’s best friend providing us with an even simpler solution.

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Top billing: Exercise & the great outdoors

Wednesday, June 19, 2019

We were designed to wander around a jungle for 30 to 40 years hunting and searching for food sources to keep ourselves nourished to basically stay alive. In our modern world, which is much less harsh, for most of us food is freely available and the hunter-gatherer existence is certainly a thing of the very distant past.

But our physiology was certainly designed for feast and famine in natural environments, where we had to use our legs all day to survive. Thus, regular exercise is a vital component of good health. The evidence is overwhelming that 3 to 5 hours of moderate exercise per week reduces the risk for a number of modern diseases by somewhere between 30% to 50%. This includes cardiovascular disease, cancer, diabetes, Alzheimer’s disease, depression and osteoporosis.

Two very interesting recent studies, the first around exercise and the second, nature, are worth reviewing. The first study from the University of Copenhagen in Denmark and University of Irvine in California looked at the different responses to exercise, depending on the time of day exercise is performed. The studies were done in mice and found that exercising in the morning increased metabolism in skeletal muscles, whereas exercise in the afternoon has more of a general effect on whole-body energy expenditure that was extended beyond the period of exercise seen in the morning.

My interpretation of this study is that it is probably better to do strength training and yoga in the morning and perform aerobic exercises such as walking, jogging, cycling and swimming after 2pm. You will probably build better muscles this way and have a more efficient cardiovascular system.

It is better to avoid heavy aerobic exercise in the morning because this is when the blood pressure is at its highest, your blood is thicker and your vascular beds are shutdown.

The second study, from the University of Exeter in England, looked at the benefits of spending time in nature. They examined the habits of 20,000 people living in England and determined the amount of time these people spend in nature on weekly basis. The best good health and higher psychological well-being was reported in those people who spent on average two hours per week visiting parks, woodlands, country or beaches. This was regardless of whether the person was male or female, older or younger, their occupation, ethnic group, rich or poor, healthy compared to those with chronic illnesses.

The message here from both the studies is very clear. Have a regular exercise habit and perform exercises at appropriate times during the day but also spend two hours per week in nature. Now here’s a novel idea! Get out of the gym and perform your exercise in nature and you’ll get two bangs for your buck.

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I can tell by the way you smell

Friday, June 14, 2019

Although our sense of smell is vital for existence, it is often not mentioned as a part of good or bad health. With an acute sense of smell, we can appreciate the extraordinary aromas of the variety of foods and fluids we enjoy, the sweet smell of flowers and particular perfumes, not to mention the pheromones that can lead to attraction or repulsion depending on your own personal biology.

Then there are noxious smells that are very powerful and at times, may lead to death. Being able to detect these noxious smells allows us to immediately vacate the area in which they emanate, potentially saving our life.

But it also appears that the sense of smell may be an indication of good or bad health. A recent study released in the Annals of Internal Medicine examined 2,289 adults aged between 71 to 82 using a technique known as the Brief Smell Identification Test (BSIT) and rated people as to whether they can detect different odours. They were rated as good, moderate or poor sense of smell and then were followed up for 13 years. 1,211 participants in the study died during the 13-year follow-up period, which is not particularly surprising as this was an older age group.

The study showed that a poor sense of smell was higher in males, the black population, cigarette smokers or heavy consumers of alcohol. There was a strong association between poor sense of smell and Dementia, Parkinson’s disease, chronic kidney disease and depression. There was, however, no relation to cancer, hypertension or diabetes. It was suggested that a deteriorating sense of smell can be either age-related, with the general deterioration of olfactory neurons as we age, post viral, related to head trauma or the typically ubiquitous genetic abnormalities that determine many characteristics in our body. The study basically said that those participants with the poorest sense of smell, compared with those who had a good sense of smell, had a 46% increased death rate at 10 years into the study.

Interestingly, the participants rated their health at the start of the study and those who stated they had good health had even worse results, with a poor sense of smell increasing the death risk at 10 years to 62%.

There was no great explanation as to why a poor sense of smell was associated with poor health. One explanation given was that an impaired sense of smell led to reduced enjoyment of food and subsequent weight loss. A number of studies have demonstrated that as we age, people in the lower weight range i.e. a BMI from 20 to 25 have the same death rates as people with a BMI from 30 to 35 i.e. grade one obesity. Interestingly, the healthiest BMI for people over the age of 50 has been deemed to be 25 to 30, which is considered overweight.

There is, however, some hope on the horizon from a recent study performed, albeit on mice, showing that particular types of stem cells, known as globose basal cells replace olfactory sensory neurones when given via nasal drops to a genetic mouse model, where the mice were genetically primed to have a poor sense of smell.

Although this has not been trialled in humans as yet, it certainly shows promise that such a simple technique as a nasal spray may be able to restore the sense of smell. Unfortunately, these animal trials take years before they are translated to humans but, it is still hope for the future.

So the next time you’re taking in the wonderful aroma of a sweet smelling rose or the variety of your favourite wines, don’t take it for granted.

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And do you want pills with that?

Thursday, June 06, 2019

I often state the statistics that the commonest cause of death and disability in the world is cardiovascular disease. It keeps me in a job. The second commonest cause of death and disability and closing in fast is cancer.

Disturbingly, the third commonest cause of death and disability is Western Healthcare. The most expensive health care system in the world, the United States of America, rates number 45 in terms of longevity. Clearly, over investigation, unnecessary medical procedures and the excessive use of pharmaceutical drugs contribute significantly to this statistic.

Although there have been enormous strides in medical investigations and therapies over the past few decades, significant complications of medical procedures and side effects from pharmaceuticals are unfortunately rather commonplace. It could be easily argued that, if the person was left alone, their underlying condition could either cause them significant issues or even bring on an early death. But there are increasing concerns, both within and outside of the practice of medicine, that we should look carefully at the medications we prescribe and the medical procedures we perform on many patients.

Two recent studies have clearly shown the concern over commonly prescribed medications. The first from the University of South Australia published in the journal “Australian Prescriber” looked at just under 8,900 veterans with hip fractures and compared them to 35,310 people without this condition. The average age in the study was 88 and 63% were female. The study showed that those patients who were chronically taking antidepressants, opioid painkillers, anticonvulsants and the common anxiety relieving pills the benzodiazepines such as Valium, had a significant increase risk for hip fractures. One or a combination of any of these medications may lead to an alteration in the level of consciousness, dizziness, blurred vision and unsteadiness. All these factors can then contribute to a fall leading to a traumatic hip fracture.

Is estimated that if an older person is on one of these medications, he or she has double the risk for hip fracture but, for example, if you combined antidepressants with anti-anxiety treatments, the risk is five times.

It is estimated that in Australia alone there are 28,000 hip fractures per year in people over the age of 50. 5% of these people die during the hospital stay and 10% are admitted to aged care. Clearly, the best treatment of hip fracture is prevention and most doctors and patients need to examine carefully the medications they are prescribing and swallowing to determine whether they are vitally necessary.

The second equally disturbing study was published recently in the British medical Journal by researchers at the Washington University School of medicine in St Louis. This study examined the use of the commonly prescribed heartburn drugs known as PPIs, such as Nexium, Pariet and Somac, to name a few. They examined the data from 2002 to 2004 from 157, 625 people prescribed PPIs and 56,842 people prescribed the gentler H2 blockers. These patients were mainly male, caucasian & over the age of 65 followed for 10 years. The study showed that there were 45 excess deaths per 1,000 people prescribed PPIs compared to H2 blockers and in particular deaths related to cardiovascular disease, stomach cancer & chronic kidney disease.

The risk of death increased with the duration of treatment, even at low doses. The suggestion from the study was that taking PPIs for months and especially years is not safe and, in fact, should not exceed 14 days.

It is important to realise, however, that heartburn and other forms of peptic ulcer disease can be disabling in many people and the PPIs are wonder drugs for the relief of symptoms. Over the past decade there have been a number of studies linking chronic PPI therapy to not only cardiovascular death but also heart attack and actual fibrillation. One study suggested a 40% increase risk for dementia especially with Nexium. There is also a link with osteoporosis and as mentioned gastric cancer and chronic kidney disease.

Strong medicine has strong effects, no doubt, but clearly may also have significant strong side-effects. Anyone reading this article who has been prescribed any of these therapies on a chronic basis should not stop treatment without discussing the pros and cons with your doctor.

The first line of the Hippocratic oath is “first do no harm”. For something written 2 ½ thousand years ago, it still is highly relevant for today’s practice of medicine.

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Do you want your family to suffer?

Friday, May 31, 2019

A recent ad to raise awareness about heart health and have their hearts checked has caused outrage and consternation amongst the general public.

The heart health ad in question basically had this theme: “Do you want your family to suffer?”.

There has been a groundswell of opposition against the underlying sentiment of this commercial. Don’t get me wrong, as a cardiologist I’m all for raising awareness about the planet’s most common killer. I have spent the last 25 years of my career focusing on preventative cardiology so it warms my heart, so to speak, when heart health gets significant airplay.

But, it is my view that this advertisement reaches an all new low and I’m surprised that National Heart Foundation approved its release. I believe it is acceptable to make people feel guilty about drink-driving, speeding or using illegal drugs but should we now be parading obese people in the street, shaming them as well and telling them they don’t love their children. Certainly not, we should be showing some compassion to people who have different metabolic issues and no doubt less self-control when it comes to tempering their eating habits.

But, we must look at the reality of heart disease and, in almost all cases, it is purely genetic. Again, your genes load the gun but your environment pulls the trigger. The most common form of heart disease is atherosclerotic heart disease which is basically the progressive build-up of fats, inflammatory tissue and calcium in the walls of arteries over many decades. If you imagine a doughnut, as an analogy here to arteries, the blood goes through the hole in the middle but the fat & other components builds up in the wall. When the fat and other tissue reaches a critical mass it suddenly ruptures within the channel inducing a clot to form and blockages occur, which may lead to a heart attack or stroke depending on the site of the rupture. 

All people with cholesterols above 3 mmol per litre and systolic blood pressure (top reading) above 100 mmHg have a degree of atherosclerosis in the walls of their arteries. But, genetic factors contribute to either more significant build-up of atherosclerosis or a person possesses protective factors to prevent severe disease.

Although my main job is as a cardiologist, I’m also a professional speaker travelling the world talking about how to be healthy and manage stress. One of my slides shows a picture of Winston Churchill & Jim Fixx. Jim wrote “The Complete Book of Running” and had run multiple marathons. He didn’t have an ounce of body fat and dropped dead in a race at age 53. Winston Churchill smoked, drank, was obese and suffered intermittent depression throughout his life, dying at age 91. Clearly genetic factors operated in both cases, with Mr Fixx in the negative sense and in Winston’s case, keeping him alive despite his very poor life habits.

The commonest genetic abnormality in the world is insulin resistance affecting 30% of Caucasians, 50% of Asians and close to 100% of people with darker or olive skin. This genetic abnormality accounts for around 70% of cardiovascular disease. This leads to tendencies for diabetes, hypertension, specific cholesterol abnormalities with a high triglyceride and low HDL, along with a significant tendency to abdominal obesity. 20% of cardiovascular disease is related to Lipoprotein (a) and the remainder due to less common genetic abnormalities such as familial hypercholesterolaemia.

It is my strong suggestion that all males at age 50 and females at age 60, have a coronary calcium score which does not involve injections or dye, is low radiation and inexpensive. It is important to realise that this test is not covered by Medicare. The coronary calcium score is the most predictive test for heart attack risk.

I also suggest that everyone, regardless of age or cardiovascular risk follows the five keys to being healthy

Depending on risk, you may also need to take long-term medications to control your blood pressure, cholesterol, manage diabetic risk and possibly blood thinning agents.

Clearly, the National Heart Foundation advertisement is trying to shame people into having a cardiac assessment, along with take better care of their health. Hopefully some good will come out of this, despite the rather abhorrent message.

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Too old to be a Mum or Dad?

Thursday, May 30, 2019

Our bodies were designed to wander around a jungle for 30-40 years, having our head ripped off by a sabre-tooth tiger or dying of some infection. Young girls went through puberty at around 10-12 years old and had conceived a child in those days in their early teens. The grandmother was in her late 20s and helped the teenage girl look after the baby. The fathers were all less than 25 years old and most did not survive beyond age 40.

Heart disease and cancer were almost unheard of with the vast majority of people dying from trauma or infection. This article published in the Journal Maturitis came to the disturbing conclusion that older fathers affect the health of their partners and put unborn children at risk. The article reviewed 40 years of research looking at the effects of paternal age on fertility, pregnancy and the health of the conceived child.

It has been well established that women conceiving over the age of 35 have issues in 3 areas:

1. Fertility

2. The health of the mother during pregnancy

3. The health of the unborn child and also health throughout the life of the child following birth.

We therefore have to ask the question: does the age of the father affect any of these factors? Advanced paternal age has been defined as anywhere between 35-45. In the United States of America, children born to fathers older than 45 has increased 10% over the past 40 years.

The study showed clearly that men conceiving beyond the age of 45 have issues in the following areas, almost certainly related to reduction in testosterone, sperm degradation and quality.

1. Reduced ability to conceive

2. Increased risk for pregnancy complications affecting the mother such as gestational diabetes, pre-eclampsia-(which is severe hypertension, kidney problems and fluid retention), along with preterm birth

3. Problems for the child-including late stillbirth, preterm birth and low Apgar scores (which are indications of the health of the child at birth), low-birth-weight, increased tendency to seizures and birth defects such as congenital heart disease and cleft palate. As the child ages there are increased risk for childhood cancers, schizophrenia, ADHD and autism.

To take the example of schizophrenia, the incidence is 1 in 141 infants for fathers conceiving below age 25 but increases to 1 in 47 for fathers older than 50. It is also an interesting fact that older fathers struggle with fertility even when their partners are younger than 25.

With the increasing trend in our society for women to delay having children, this is typically associated with older fathers conceiving as well. Many people want to establish their careers and enough money to be able to fund the child’s existence. But, we must ask ourselves at what cost? There is no doubt that many older parents do conceive normally and have normal healthy children. But when the older parents do have children with some significant disability or the mother’s health is significantly affected by the pregnancy, this can lead to disastrous consequences for the family. I fully understand that our modern world has changed and there are increasing demands from many angles on individuals and families. But it is better to work and live closer to our physiology and thus consider having children at a much younger age for the health of all involved.

Another important point that seems to be forgotten here is that parents conceiving older means that you have to tolerate teenagers in your 50s and 60s which is not an easy task. Teenagers can certainly make a parent’s life misery by their (at times) objectionable behaviour and it is my view that you certainly need to be young and energetic to cope with this.

Another factor here that no one is really considering is that of grandparents. As people wait to conceive, they increasingly rely on members of their family and in particular grandparents to assist in the upbringing of the children and if they wait too long, the grandparents have either passed on or are too old to really get involved a significant level. It would be my suggestion that we need to start a firm debate in society around these issues as I believe this current generation of parents will be creating significant social problems at many levels.

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Is your appendix your friend or foe?

Friday, May 24, 2019

When I started medical school, I was taught that the appendix was a useless little organ hanging off the start of the large intestine. Because of the sophistication of the modern world, the usefulness of the appendix had evolved out of existence. The theory at the time was that particulate matter from food or purely an infection blocked the appendix, causing appendicitis with a myriad of complications, including peritonitis and, rarely, death.

At one stage, it was a rule that you could not travel to the Antarctic unless you had your appendix removed.

Over the past decade, there has been emerging evidence that the appendix may well be a very important component of the immune system. Firstly, it appears that the appendix acts as a reservoir for beneficial gut bacteria. There is a much higher concentration of immune tissue in and around the appendix and the theory is that it is a safe house for beneficial bacteria to recolonise the bowel after a severe infection. For example, a common cause of childhood deaths in developing countries is infectious diarrhoea and thus the appendix could contribute healthy bacteria back into the bowel after a bout of this potentially lethal condition.

An even more surprising function of the appendix brings up the very topical concept of the Brain-Gut interaction. A study recently presented at the Digestive Disease week in San Diego, California looked at the link between having the appendix removed and Parkinson’s disease in 62 million people living in the US. Interestingly, having your appendix removed increases your risk for Parkinson’s disease three times. There is a particular protein known as alpha-synuclein which forms toxic clumps in the brain of people with Parkinson’s disease known as Lewy bodies. Interestingly this same protein is also found in the gastrointestinal tract of patients with Parkinson’s disease. The hypothesis is that the appendix through some immune function maintains lower levels of this protein and thus less Parkinson’s disease.

Finally, an interesting study from Sweden published a few years ago looked at the link between appendicectomy, tonsillectomy and risk for heart attack. This study reviewed the health history of every Swedish resident born between 1955 to 1970 with an average follow-up of just under 24 years. If your tonsils and appendix were removed before age 20, this increased the risk for a heart attack by 33% with appendicectomy and 44% with a tonsillectomy. The explanation is rather clear in that both organs are felt to play an important role in the immune system. Removing these organs changes the inflammatory response and it is possible that both the tonsils and the appendix play a role in a more appropriate inflammatory response and thus less vascular disease.

Thus, if your child develops either tonsillitis or appendicitis and the doctors involved in their care take a more conservative approach rather than rushing into surgery, they are probably doing your child a great favour in protecting them from future significant illnesses.

On Wednesday 29 May, Dr Ross Walker will be giving a talk on ‘The 5 keys to Ultimate Health’ at Sydney’s City Tattersalls Club to raise money for The Gut Foundation. Click here to buy tickets.

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Can air pollution increase the risk of dementia?

Prevention is better than cure

Contraceptive Microchip

Weight loss - is it all about calories?

Is low dose alcohol safe?

Aspirin for all?

Can you die of a broken heart?

3 common myths about Fibromyalgia

Statin use in older people

Doctors warned about using the word pain

Euthanasia and compassionate medicine

Are hospitals always the safest place to be?

The death of general practice

Non-alcoholic fatty liver disease




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