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Thursday, March 23, 2017
By Ross Walker
BPA is a chemical used in the lining of some food and beverage packaging, in particular plastics and aluminium cans to protect food from contamination and extend shelf life. Manufacturers give you a clue as to the BPA content by the RIC, or Resin Identification Code. It is marked (typically on the bottom of a plastic container) in an arrowed triangle. The triangle is usually so small it’s very hard to read the number without a microscope. RICs 1, 2, 4, 5 and 6 are very unlikely to contain significant amounts of BPA, whereas 3 and 7 are the typical suspects.
The BPA story is quite frightening. In 2007, a consensus statement was released by an expert panel suggesting the average BPA levels in humans were above those proven to cause harm in laboratory animals.
Apart from concerns about the foetus, there are links between BPA and obesity, diabetes and heart disease. Poor brain development has also been linked to BPA, with claims of links to autism and ADHD, along with heightened sensitivity to drugs of abuse.
There are also claims regarding BPA’s links to a variety of cancers.
The xenoestrogens, Phthalates, BPA and other synthetic oestrogen mimickers bombard the female endocrine systems, breasts and ovaries from a very early age. High levels during pregnancy, along with using hard plastic bottles, which are constantly rewarmed, to feed young children, leech these toxins into the milk.
This is a highly plausible argument as to why young girls are starting menstruation earlier and earlier.
So, since concerns over BPA in plastics, aluminium cans and other commonly used household appliances have been raised by various experts and media commentators, with the increasing awareness in the general public, people are rushing for alternatives. You must then ask the question, are the suggested alternatives any safer?
The correct answer here appears to be probably not! Two of the commonly used BPA alternatives are BPS and BHPF. The reality is that both of these chemical alternatives are still bisphenols, and there is now increasing scientific evidence that these so-called safer alternatives are still endocrine disrupting chemicals (EDCs), which have close to identical hormonal effects.
A recent study published in Nature Communications by a group of Chinese and Japanese researchers looked at the effects of BHPF in pregnant mice. This study showed very similar health issues seen with BPA. The group then tested water bottles by filling them with hot water and then testing the water for BHPF levels. They found significant levels of BHPF in just under half of the samples tested, including three baby bottles. They then collected blood samples from 100 random college students who reported drinking water from bottles and found significant levels of BHPF in seven out of 100 people tested.
Although there is no clear evidence of any health detriments from BHPF exposure, this, and previous research I have reported on BPS, raise concerns about the ubiquitous use of plastics to store food and fluid in modern society, regardless of the claims on the bottle, such as BPA free. If anyone opens their fridge, it is difficult to find something that is not stored in plastic.
Cardiovascular disease and cancer make up around 80% of the causes of death and disability in our society, and although we do not commonly associate our increasing exposure to many different forms of plastic and these diseases, this is something that health authorities need to seriously consider. Although it appears the greatest danger comes from reusing and reheating plastic containers, which is commonly done with baby bottles, it still comes back to the question I ask quite commonly: What is the safe dose of poison?
Thursday, March 16, 2017
By Ross Walker
I recently read a brilliant article in New Scientist by Teal Burrell titled A meaning to life: How a sense of purpose can keep you healthy.
When you think about it, there are really only two possibilities in life. The first: you’re born, you live to experience good luck and bad luck and then you die and basically rot in the ground. The second alternative, however, involves some purpose to life with some immeasurable, inexplicable driving force which some people refer to as God or our soul, which leaves the body at the moment of death, travelling in some fashion to a place that is not earthly.
Many people live their lives because of the prize at the end, with an absolute certainty about where they’re going. Some people see this exit from Earth as a welcome release from their current suffering. So, we have to ask ourselves the question: are people who see a purpose to living just deluding themselves?
Some people see this purpose in religion, their career, money, their family or quoting the article, “pure escapism”. I must say, I believe it is very important to have something to get you out of bed every day rather than just viewing your life as pure existence.
The point of this superb article by Teal Burrell was to analyse people with a sense of purpose and compare them to people without it. The article quotes the well-known Austrian psychiatrist, Viktor Frankl, who survived Nazi concentration camps and went on to develop Logotherapy which basically is summarised by his book Man’s Search for Meaning. The basic summary of Frankl’s work is that life is not about the suffering, but the way you handle the suffering, which makes it important and gives it meaning.
The health advantages of having a sense of purpose are quite striking. The well-known public health researcher Victor Strecher at the University of Michigan in Ann Arbor (whom I’ve had the pleasure of meeting) is the author of the book, Life on Purpose. When Dr Strecher analysed alcoholics who developed a sense of purpose, he found they were less likely to resume heavy drinking. People who have a higher purpose in life are less likely to develop sleep disturbances as they age. Interestingly, women with more purpose rated their sex lives as being more enjoyable.
A large study from the US followed over 7000 middle-aged people and found that having a sense of purpose was associated with the significant reduction in the risk of dying over a 14-year period. The same is true for 9000 people in the UK over the age of 50. In this group, those with the highest sense of purpose had a 30% lower risk of death over a 10-year period. The article also went on to quote lower rates of heart disease, stroke and Alzheimer’s disease in people with a higher sense of purpose.
Prof Strecher was quoted as saying that the reason that having a sense of purpose isn’t seen as a significant public health priority is that it is too vague a concept to be measured or assessed. Unfortunately, many reductionist scientists along with cynical members of the public still want to believe that having a sense of purpose is purely a form of self-delusion and fear of death.
One of the concepts discussed in the article was whether having a sense of purpose is really just a replacement for religious faith. Interestingly, being religious didn’t predict a low risk of heart attack or stroke, and again, it was pointed out that many non-religious people also have a high level of purpose through other facets of their life. Some people argue that if you have a stronger sense of purpose, you’re more likely to practice healthy lifestyle principles. But, there is now increasing research to suggest that a sense of purpose by itself improves biologic markers of good health. Prof Steven Cole from Los Angeles has actually performed research on the influence of well-being and sense of purpose. He focused on two different types:
1. Hedonics – those who derive their purpose from self-gratification with pleasure and reward
2. Eudaemonics – those who have a sense of purpose beyond self-gratification.
This is where it becomes fascinating. Those people who were basically hedonistic had a high expression of inflammatory genes and a lower expression of genes that produced disease fighting antibodies. This pattern is also seen in people who are lonely or stressed. For people scoring high on the Eudaemonic scale, the blood markers were exactly the opposite. Often people in the group with a higher sense of purpose and service have much lower heart and breathing rates, and lower adrenaline levels. Basically, this form of sense of purpose switches off the fear-flight-fight system. Interestingly, focusing on a higher purpose and things of value stimulates the part of the brain known as the ventral striatum and suppresses the more emotional part of the brain such as the amygdala.
It appears that this form of sense of purpose can also lengthen telomeres which is associated with reduction in biologic ageing. A practice such as meditation can also protect the telomeres. Both Cole and Strecher give advice on how to strengthen your sense of purpose. It is always important to start small by focusing on making your work more meaningful and putting more effort into your important relationships. Setting goals in each domain of your life, family, work, community and personally can also improve your sense of purpose.
The evidence actually appears quite overwhelming that having a sense of purpose is more than just self-delusion. Whether there is something beyond the grave is a discussion for another time and another place but from all the scientific evidence that has been presented, it appears quite clear that having a sense of purpose and a sense of service to other people is an important end in itself.
Thursday, March 09, 2017
By Ross Walker
Recently, Pauline Hanson was hijacked by Barry Cassidy on the ABC Insiders program when she was put on the spot about her opinion regarding vaccinations. Up until now, she has been riding high in the polls, in my opinion, more from the poor performance of her opponents. Her recent ill-informed and ignorant comments unfortunately do represent the views of a minority of the population.
A recent survey suggested that around 95% of the population have their children vaccinated, but a third are still suspicious around the dangers of this practice. The anti-vaxxers are still trotting out the nonsense that there is a link between vaccination and autism. This issue was first raised by a now totally discredited researcher by the name of Andrew Wakefield, where it has been demonstrated that his research is fraudulent. There has never been one, non-fraudulent study demonstrating any link between vaccination and autism.
The anti-vaxxers carry on about the mercury in vaccinations in the form of thiomersal, as a potential cause of autism. These ignorant people do not realise that thiomersal has not been used in vaccinations in children for decades. The reason why this entire argument around vaccination and autism continues is that the MMR vaccine is given at around 18 months, which is when a child’s speech starts to develop beyond monosyllables. Regardless of vaccination, if the child is autistic, the signs of poor speech and the other manifestations of autism become clearer around this time. But, parents who have to endure this difficult diagnosis are always looking for something to blame and vaccinations are an easy target, despite the lack of any evidence whatsoever.
Another interesting comment by Ms Hanson was the test to see if the child was allergic to vaccinations. I’m not sure what this test is, but it is certainly not in the medical arena. A recent study published in AIMS Public Health has clearly shown that between the years of 1963 to 2015, vaccination has prevented around 200 million cases of polio, measles, mumps, rubella, varicella, adenovirus, rabies and hepatitis A, with the estimated prevention of 450,000 deaths.
In 1962, Prof Leonard Hayflick from the University of California in San Francisco developed a normal human cell strain which is able to safely grow viruses and subsequently produce vaccines against more than 10 diseases. In a recent interview, Prof Hayflick was quoted as saying, ”Vaccination is a particularly important issue to think about now, given the rise of the anti-vaccine movement that has the potential to reverse the health gains achieved through one of the most powerful interventions in medical history. The anti-vaccination movement endangers the health of an entire generation children”.
The problem I see is that the new generation of parents have no idea about the incredible dangers that were seen in the last century from the diseases now almost totally prevented by vaccination. Smallpox has been completely eliminated from the face of the earth through vaccination. People are no longer suffering the severe debilitating neurologic problems from polio. Preventing measles helps stop the dreadful intellectual impairment seen with the condition known as subacute sclerosing panencephalitis.
Unfortunately, we are now seeing re-emergence of whooping cough which certainly can kill young children. This is clearly because people are refusing to the vaccinate their children. If a person such as Ms Hanson chooses to be in public life, and clearly is gaining traction as a political force in Australia, it would be wise for her to choose her words carefully and be more educated around subjects that are clearly outside her area of expertise.
Thursday, March 02, 2017
By Ross Walker
With the burgeoning world population, the need to prevent pregnancies has become an increasingly discussed topic. The recent Dan Brown novel and subsequent movie, Inferno, was interestingly all around this topic, albeit the villain’s solution was somewhat too drastic. It is my opinion that for long-term sustainability of our resources and environment, the world can only cope with around four billion people. At present, we are approaching eight billion. Any visit to an intensely populated city is evidence that our current population growth is unsustainable.
So, regardless of your own personal view, I believe it’s time we all adopted a less self-centred worldview to responsibly contribute to better control the world’s population through prevention of pregnancy. The real solution here which, unfortunately, will be unpalatable for many people, is for only financially viable couples in long-term relationships – who only desire to have a small family – to be the ones becoming pregnant.
So, to quote the excellent New South Wales Family Planning Association website, I would like to give a brief overview of available methods of contraception, and their assessment of what information we should consider when accessing it.
1) The proven effectiveness of the method
2) Health issues which the person considering contraception may suffer that may limit particular choices
3) The ease-of-use
4) Potential side-effects of the method of contraception
5) All the alternatives available to the person
7) Protection against sexually transmitted infections
Contraception is divided into reversible and irreversible techniques. The most effective is the “fit and forget” long acting, reversible contraceptives which include IUDs and contraceptive implants. They are suitable for any age and have no contraindications to people with other health issues. They are easily removed and promptly reversible but you require a health professional to supervise and perform the implantation. There is also no protection against sexually transmitted infections. These are over 99% effective.
The Implanon subcutaneous contraceptive device is close to 100% effective and lasts for three years. The intrauterine devices last for around five years.
For those people who would prefer more short-term solutions, there is a depot injection of a form of progesterone, which can be given every 12 weeks. This is also highly effective.
Apart from condoms, the most commonly used form of contraception is the oral contraceptives pill, the minipill and the NuvaRing. The NuvaRing is inserted vaginally by the woman and replaced every three weeks.
At this stage, the only commercially available reversible contraceptive device for males is a condom, which has somewhere between 80 to 98% effectiveness depending on how carefully it is used. There is also a female condom which has a similar effectiveness rate and, of course, the diaphragm, which is somewhere between 88 to 94% effective. Condoms also offer protection against sexually transmitted infections.
Interestingly, a very effective form of contraception is breastfeeding, which is around 98% effective if the woman has given birth in the previous six months, is still not having periods and is fully breastfeeding.
The other less effective methods are fertility awareness based methods, which include the rhythm and temperature methods, which are over 75% effective, and the commonly used withdrawal method, which ranges in effectiveness of between 78 to 97%.
Emergency contraception, the so-called morning after pill, can be taken up to five days after unprotected sex but it is most effective within the first 24 hours.
Reversible contraception includes tubal ligation for a female and vasectomy for males. There is the potential for reversal but this requires re-operation and is not highly successful. Both of these forms of contraception are around 99.5% effective.
Apart from condoms and vasectomy, there have been numerous attempts over the years to discover an effective male contraception. Until now, hormonal manipulation, such as used with the oral contraceptive pill for females, has been disappointing and rather difficult to achieve. Other methods have looked at reducing sperm production in the testicles, preventing the sperm fertilising the egg and targeting the sperm’s ability to swim. These techniques have shown reasonable promise. Another interesting approach is what is known as the “clean sheet method” which allows orgasm but not ejaculation. This affects some of the muscles that are involved in ejaculation.
Probably the most interesting and recently researched area is using a polymer gel known as VasalGel. This gel is injected directly into the vas deferens under local anaesthetic. The vas deferens is the tube that connects the testicles to the prostate gland. The gel blocks the flow of sperm through the vas deferens and has been coined a “reversible vasectomy”. This creates a 2cm barrier in the vas deferens and therefore the sperm cannot get through. It has been trialled in rabbits and has been shown to be reversible after two years. A recent study in 16 monkeys showed it was 100% effective in preventing pregnancy. Interestingly, in a similar environment, fertile monkeys mating with mature female monkeys showed an 80% percent pregnancy rate. The complication rate of VasalGel was minimal. Standard vasectomy has around a 30% rate of what is known as sperm granulomas, which was only 3% with VasalGel.
The development of effective male contraception, in my view, is a welcome innovation and should be encouraged. Always the concern with males is firstly whether they are prepared to go through this minor procedure, and secondly, whether they would be honest with new partners about whether they had pursued male contraception. Regardless, we all really need to start becoming more aware of the human footprint on this planet and effective, viable means of reducing the world’s population. If we don’t, we will be seeing a very different world over the next 50-100 years.
Thursday, February 23, 2017
By Ross Walker
I’m sure many people who read the Sunday Telegraph on January 22 of this year read that just over 2200 people in NSW died on the waiting list for elective surgery in the 2015-16 period. The report suggested that over half of these patients had been waiting more than 55 days, which is 18 days greater than the Australian average. Up to 10% of patients had to wait close to 12 months, again, greater than the Australian average.
We heard the usual outcry from the Labor opposition blaming the current health minister in New South Wales for this unacceptable situation. The New South Wales AMA President, Professor Brad Frankum, suggested it was the increasing pressure on accident and emergency departments that had a knock on effect to elective surgical waiting times.
In my view, no one is addressing the real issues which comes down to two key areas:
1) Over-population. With the world’s population increasing at a rapid rate, no government across the globe can continue to provide the necessary infrastructure for not just the health system, but all aspects of living in the modern world.
2) In Australia – the outdated and unaffordable Medicare system. It is said that 48% of Australians are on some form of welfare but the reality is that 100% of people are on welfare, i.e. Medicare.
Over $50 billion is spent every year on Medicare and this is paid for with borrowed money because of the incredible debt levels in Australia. Medicare was first introduced as Medibank in 1972 under the Whitlam government. In 1972, medicine was not particularly expensive with much less available pharmaceutical agents, medical procedures and investigations.
Over the past 40 years, we have seen an explosion in costs because of major advancements in all of these areas. The reality is that our current system is unaffordable when we expect the government to foot the bill for a significant proportion of medical costs. Don’t get me wrong, Medicare is very good for the medical profession as we have a steady income from the government, but, in my view, is not good for patients.
The system I propose is that we introduce free, non-discounted healthcare for the lower 20% of earners (including people on some form of welfare) and everyone else pays private insurance linked to their income. The 21st percent earner may only pay $2 per week, whereas extremely wealthy people clearly would be paying a substantial cost for private health insurance. I would also propose that anyone suffering a genuine emergency and admitted through an accident and emergency department would receive care for free under this system. This would not include people who use accident and emergency departments such as general practices.
This would ensure that socially disadvantaged people would not have to wait too long on elective waiting lists for surgery. Many people wait for over a year in pain to have spinal surgery or hip replacements because someone who could afford private insurance decided they would go through Medicare, thus displacing a person who can’t afford healthcare down the waiting list.
Unfortunately, the vast majority of people now living in Australia have grown up with the attitude that Medicare is their “God-given right”. However, unless we do something about our current population growth and debt levels, our children and grandchildren will be living in a completely different world where wars will be fought over food and water and expert medical care will be a thing of the past. Do we have the right to leave this type of legacy for future generations?
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”.
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.
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.
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
- White bread
- White rice
- Australian and American pasta
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
- 50% increased risk for Type II diabetes
- Marked increase in dental decay
- Seven times the rate of bone fracture
- 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
- 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.
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