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Ross Walker
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Exercise - Is more really better?

Thursday, March 15, 2018

Since the recent death of Steve Folkes at the age of 59, still incredibly fit and a regular exerciser, along with the sudden death of the 31-year-old Italian soccer player, Davide Astori, many questions have been raised about the role of exercise and its ability to prevent cardiovascular disease.

In my professional talks, I have a slide with the picture of Jim Fixx next to a picture of Winston Churchill. Jim Fixx wrote the complete book of running, didn’t have an ounce of body fat and had completed multiple marathons. He died in a race at of the age 53. Winston Churchill, smoked,  drank, was overweight and depressed and died at the age of 91. I have recently completed a lecture series titled “Cardiovascular disease - it’s your genes that loads the gun and your environment that pulls the trigger”.

The reality is that all cardiovascular disease has an element of genetics, and those with the more severe genetic abnormalities may still die earlier despite exquisite lifestyle principles.

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


A recent, long term study of 25 years followed just over 5,100 people aged between 18 to 30 years old at the entry of the study. For various reasons, the final analysis reviewed 3,175 participants who had undergone eight examinations over the 25 year period and answered at least three questionnaires regarding the amount of exercise they performed along with other lifestyle factors as well.

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

  1. Those who exercised less than 2 ½ hours per week
  2. Those who exercised between 3 to 5 hours per week
  3. Those who exercised more than 7 1/2 hours per week.

The results were quite surprising and in many ways, somewhat disturbing. When the group who exercised more than 7 1/2 hours were compared to the other groups there was a 27% increase in coronary artery calcification, suggesting lack of protection from heavy exercise for heart disease risk.

Interestingly, and somewhat difficult to explain, is the fact that white males in the third group had an 86% increased risk for coronary artery calcification. The higher level exercise group, for some reason, did not appear to affect cardiac risk in black men or all women. Although there is no clear explanation for this difference, I propose the following explanations.


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

People who exercise for more than 7 1/2 hours per week are typically (although not always) joggers or cyclists, or professional athletes. There is no doubt that African Americans do make up a significant proportion of the high-level athletes in America, not to mention the Africans who tend to win most of the marathons. It could be that people with darker skin are more physiologically adapted to exercise for longer periods and thus have less evidence of cardiovascular disease.

Regardless, it does appear for those of us who are not professional athletes (i.e. sport being their major source of income), that if you are exercising for good health, the 3-5 hour dose per week appears to be the healthiest level.


The second study was fascinating in that it looked at the type of exercise which may be important for specific disease prevention. There are two basic types of exercise, aerobic - cardio, or anaerobic - strength and resistance training. This study of 80,000 people, older than 30 years, commenced in 1994 and continued until 2008 with an average follow-up of around nine years. It looked at strength and resistance training for 50 to 60 minutes per week as opposed to moderate intensity exercise 50 minutes per week e.g. walking, as opposed to high-intensity exercise such as running or cycling for 75 minutes per week.

In all these groups, compared with people who were inactive, there was around an 18% lower risk of early death purely by performing the various types of exercise. But, with resistance & strength training there was a 31% reduced cancer risk, whereas with aerobic exercise there was a 21% reduction in cardiovascular risk. The reduction in cancer death has been repeated in a number of studies in people who regularly perform some form of resistance training.

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


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


A study from the Journal, Circulation reviewed one hundred and 52 middle-aged endurance athletes with an average age of 55 and compare these people with normal activity age matched controls. All participants in the study had no prior history of coronary heart disease or any other significant risk factors. A CT coronary angiogram was performed and in both groups 60% demonstrated no significant coronary artery disease. But, in the athletes there was double the amount of coronary plaque compared with those who performed normal activity. Those in the highest risk group had a direct relationship to the amount of years of training i.e. the more exercise the higher the risk.

Another study looked at males older than 45 again with an average age of 55 and show that 53% of these athletes had coronary artery calcification. Again, the more activity performed, the higher the coronary artery calcification and thus, an higher atherosclerotic burden.

Studies performed on marathon runners have shown that a third had elevated levels of troponin, a marker of heart damage, along with echocardiographyic changes in the right ventricle at the end of the marathon.

Possible explanations for this are that:

  1. Many high-level exercisers have the delusion that because they perform so much exercise they can eat what they like which can still lead to significant cardiac issues
  2. A study from many years ago published in the New England Journal of Medicine review the psychological profile of Marathon on runners and found this was very similar to people with anorexia nervosa. This is a condition which is also associated with sudden cardiac death
  3. Possibly, the reason many people take up endurance running is because of a poor family history, a game with the delusion that they can out run their genetics
  4. Another minor explanation is that many high-level athletes suffer recurrence musculoskeletal issues often requiring anti-inflammatory medications which have been associated with a higher risk for cardiac disease.


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

I have stated on numerous occasions that exercise is the second best drug on the planet after happiness but it also appears that the correct dose of exercise is important along with the type of exercise to reduce specific conditions. This is why I constantly say that the suggested dose is 3-5 hours per week which should be divided into two thirds cardio and one third resistance training. Just as the real estate agents say the most important principle is “location, location and location”, those of us involved in preventative medicine state “movement, movement and movement”.

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Opinion: Media Watch needs to get its medical facts straight

Friday, March 09, 2018

Last Monday night (March 5th), Media Watch critiqued a segment I gave on the Channel 10 program, Studio 10. Typical of Media Watch, there was a blatant criticism of a commercial television station presenting commercial television.

This segment on Studio 10 ran for about ten minutes and was basically about heart health. I was asked by the company Nutralife to present this segment, and they requested that I mention their product, which is a Kyolic garlic preparation.

I have used this product in my practice for a number of years with significant benefits in blood pressure reduction for my patients. There are also two very well-performed studies published in peer-reviewed literature showing a reduction in the progression of coronary artery disease, using coronary calcium scoring and a regression of coronary artery disease after 12 months of high-dose Kyolic garlic (four capsules daily) using CT coronary angiography.

Media Watch cited a Dr Ken Harvey, an Associate Professor at Monash University. He had previously labelled a Nutralife ad featuring Lisa Wilkinson that stated that Kyolic garlic preparation supported the reduction of blood pressure as “unconscionable”. I strangely did not receive his memo that I should be agreeing with this opinion.

I have never suggested that any form of complementary medicine is a replacement for the stronger, well studied and well-funded orthodox medicine. But I argue that some forms of evidenced base complementary medicine are excellent adjuncts to lifestyle principles in healthy people, and orthodox medicine for people with established disease.

Just because one so-called “expert” cannot interpret the medical literature correctly, doesn’t make him right. And therefore I have no interest in reading “his memo,” to quote Mr Barry from Media Watch.

Mr Barry also stated that the study of the 88 patients with high blood pressure (that showed a similar reduction in BP to a standard pharmaceutical regimen) was paid for by the company. Almost all scientific studies receive some funding by the manufacturers of the therapies, whether they be pharmaceutical, devices or complementary medicines. The researchers publish the data independent of the companies, regardless of whom was offering the funding. Thus, to suggest that the information is of no value is blatantly ridiculous.

Mr Barry suggested that the segment was purely a giant commercial for Nutralife. Firstly, there was no mention on the Media Watch segment that for nine minutes out of the ten minutes I discussed heart health, and during the final minute discussed Kyolic garlic with no mention of the company or the specific product. I had no idea that any mention of Nutralife would be made after the segment. I also had no idea that the company had actually paid Channel 10 for the segment.

The only part of the Media Watch segment that was accurate was that I was paid nothing to appear on Studio 10, and purely did so because I believe in complementary medicine and feel is important to promote the message of good health.

As I said to good friend of mine, I will be out to dinner when Media Watch is next shown on the ABC and will miss the segment along with millions of other Australians.

Watch the full Media Watch segment here

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5 major factors that make your ticker stop ticking

Wednesday, March 07, 2018

There are five major or primary risk factors for heart disease:

  1. Some abnormality in blood fats and, in particular, cholesterol.
  2. High blood pressure which is typically a pressure consistently above 135/85. Up to the age of 50, the lower pressure is more important but over the age of 50 the higher pressure is typically more linked to cardiac risk.
  3. Cigarette smoking – the more you smoke, the more you are at risk.
  4. Diabetes, or a tendency to diabetes known as insulin resistance, which is closely aligned with metabolic syndrome (a topic of future blog/article).
  5. Having a family member who has some form of cardiovascular disease typically before the age of 60.

A recent study of 14,000 people over the age of 20, over a twelve year period of follow up, has detected another vitally important risk factor for heart disease. It appears that insufficient sleep is probably as damaging to the cardiovascular system as cigarette smoking.
In this study the researchers recognised four traditionally healthy lifestyle behaviours, i.e. a healthy diet, regular exercise, drinking alcohol in moderation and not smoking and found that those who practise all four of these behaviours have a 57% lower risk of cardiovascular disease and a 67% lower risk of dying from a cardiac event.

If you have seven hours or more quality sleep a night, this boosted the overall protective benefit, leading to a 65% lower risk of cardiovascular disease and a staggering 83% lower risk of fatal cardiac events.

Good quality sleep rejuvenates the body for the next day by allowing the vital organs, including the heart and blood vessels to slow down and have a rest. I will stress the importance of healthy sleep and how to achieve it in future blogs/articles.

Dr. Ross Walker

[First published July 31, 2013]

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Frailty - all you need to know

Thursday, March 01, 2018

When you think of a person being frail, you have the picture of someone who is very elderly, thin, bent over typically with at least a walking stick or possibly even in a wheelchair. Unfortunately, frailty is more common and more pervasive than this typical stereotype.

A recent study of 3000 people over the age of 65, followed for two & a half years, revealed that frailty is much more common than once thought. It appears that 6% of people over the age of 65 who were surveyed were considered frail, whereas 38% were considered pre-frail, leaving only 56% considered robust. The news is even worse for women where this is 8% being frail and 41% pre-frail whereas with men frailty occurs in 5%, pre-frailty in 34%.

So, what is the definition of frailty? Frailty is defined as a heightened risk of illness or injury from even relatively minor stresses. Pre-frailty is where the symptoms of frailty may be present but physical capability is not diminished compared with those who are frail. The physical and physiologic consequences associated with frailty are increasing weakness, falls and tendency to fracture.

There is a very useful frail scale which goes by the acronym, strangely, FRAIL. For every one yes answer, you score one point and if you answer yes to three or more questions you are considered frail, whereas one to two questions are considered pre-frail.

Frail scale

  1. Fatigue - are you tired most of the time?
  2. Resistance – do you need help walking up stairs and do you have difficulty getting out of a chair?
  3. Ambulation-can you walk one block without any problems?
  4. Illness-Do you have five or more illnesses? When you think about this answer it may be as simple as High blood pressure, obesity, diabetes, osteoporosis and arthritis. These are five illnesses and this gives you one point.
  5. Loss of weight - Have you lost more than 5% of your body weight unintentionally over the past six months?

It is fact that from age 30 we lose muscle mass and bone mass. This is especially so for people who are inactive where you can lose 3 to 5% of bone and muscle mass per decade which accelerates over age 65. At age 30 we have maximum bone strength and especially after menopause, women for five years the rate of bone loss can be as much as 2-3% per year and then 1 % per year, thereafter. Typically, a female loses 53% of their peak bone mass by age 80.

Some recent interesting studies around frailty looked at 3200 adults 65 and older in the Health and Retirement study commencing in 2008. This study showed that those who consumed a moderate amount of alcohol, (two standard drinks per day) were less frail and had lower inflammatory markers compared with people who were heavy drinkers or non-drinkers. This has also been shown to reduce the risk for cardiovascular disease.

The second study revealed in just over 3100 adults 50 and older found that people who were considered frail and also had prolonged sitting had a much higher death rate whereas people who were not frail and sat for prolonged periods of time did not have any health effects.

The final study showed that those people who consumed basically a Mediterranean diet were much less likely to be frail.

My five tips for preventing and treating frailty are as follows:

  1.  Exercise is definitely the most important aspect here. The Walker suggested dose is three to five hours per week with two thirds cardio and a third resistance training
  2. Dietary intake along the lines of the Mediterranean diet with good regular doses of high-quality protein
  3. Medication review-many people are on multiple therapies for different conditions which can lead to significant side-effects. The most commonly prescribed drugs in the world are statin drugs to lower cholesterol which can cause fatigue and muscle pain. Many other drugs can lead to fatigue, dizziness and excessive drops in BP. It is vital to check with your doctor and pharmacist as to whether these drugs are all vitally necessary and what potential interactions can occur.
  4. Vitamin D-Through sunlight or supplements is vitally important and low levels of vitamin D are associated with the number of illnesses along with fatigue. These include osteoporosis, cardiovascular disease, cancer, multiple sclerosis, depression, asthma and Type II diabetes.’
  5. Ubiquinol - the active version of coenzyme Q 10 and one of the major drivers of the little fuel packs in every cell, called the mitochondria. This is an excellent supplement to take for people who are tired, people with muscle pain or people taking statin drugs.

Thus, frailty is not a condition reserved for the very elderly but is something that can seriously affect health in middle age. As with all conditions, the best management is prevention.

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Myth - Calcium is essential to prevent osteoporosis

Friday, February 23, 2018

How often does the public receive confusing messages from the health experts? One minute we are told one definite scientific fact only to be informed that this is no longer true. You’d be forgiven if you’ve developed healthy cynicism around these issues because the reality is that in many areas, science is conflicted and a researcher’s perspective, their own individual results and biases, along with a clouded view of statistics, leads to data about a particular scientific issue possibly being contradictory.

For many years, the debate has raged on around the place of calcium supplements for osteoporosis and general bone health. There have been recent suggestions from a variety of sources that calcium supplementation may not only have any place in osteoporosis management and fracture prevention but can also increase risk for heart attack.

So, taking the calcium story as one very good example of contradictory scientific information, a group from Auckland published a meta-analysis suggesting the regular ingestion of calcium supplements led to a 30% increase risk for heart attack. Firstly, to put this in perspective, this doesn’t mean that if you swallow calcium pills you have a one in three risk for a heart attack. It purely means that if you examine the cardiac risk profile of the study group and estimate (for example) that the particular demographic group in question has a 10 year risk for heart attack of 10%. Those who take oral calcium pills increased the risk up to 13%, which is a 30% increased relative risk. This makes the data somewhat less scary.

A recent study from the UK published in the journal “Bone and Mineral Research” followed 500,000 men and women age 40-70 and reviewed the relationship between calcium and/or vitamin D supplementation and the risk for cardiovascular events such as a heart attack. This study, contrary to the work from the Auckland group, found no increased risk of calcium supplementation, whatsoever. This was regardless of the intake of vitamin D.

So, although the potential for calcium supplements to cause harm is suggested, but, by no means definite, the major question is whether taking calcium supplements has any benefit at all? The answer here appears more straightforward and that is, no. In 2014, a large meta-analysis involving 100 trials of calcium supplementation asked 2 major questions. Does calcium supplementation with or without vitamin D prevent or treat osteoporosis and secondly does it prevent bone fracture? The review showed minimal to no benefits in the vast majority of trials with the exception of elderly patients in a French nursing home trial where calcium supplementation appeared to afford a reasonable benefit for osteoporosis prevention and management.

So, with our current level of evidence suggesting no real benefits and a possible potential for harm, it’s best to avoid supplementing with oral calcium and seek your calcium from dietary sources.

Even then, there are some health professionals who maintain the evidence for dietary calcium as part of osteoporosis management has minimal compelling evidence to support its recommendations in this situation. The problem here is to prove the benefits from dietary calcium sources, such as dairy products, for the prevention and management of osteoporosis would require a very long term study in thousands of people which could only be observational as you cannot perform a randomised controlled clinical trial with a “placebo dairy group”. (The reality is that this is true for all lifestyle interventions as you cannot have placebo smoking, dietary, alcohol, exercise, sleep or stress groups).

So, where does this leave us with osteoporosis management? Firstly, osteoporosis occurs in many people as we age, women more so than men. There are many factors that are associated with increased risk apart from age which include genetics, lower body weight, smoking, alcohol, thyroid disease and a number of other factors.

The best non-pharmacological management is the following:

  1. Exercise-This is easily the most important aspect of management for osteoporosis. The Walker suggested dose is 3 to 5 hours per week with two thirds cardio and one third resistance training such as weights, yoga or Pilates.
  2. Avoid fizzy drinks. In the vast majority of soft drinks, regardless of whether they are sugar sweetened or artificially sweetened, is a chemical additive to induce the fizz, known as phosphoric acid. Some of the cleverer companies call this “food acid” to make it sound somewhat safer. Phosphoric Acid rips the calcium out of bones and should be avoided.
  3. Calcium from dietary sources, not pills.
  4. Vitamin D-the evidence that vitamin D prevents and manages osteoporosis is certainly not definitive but there is a clear link between low levels of vitamin D (it is estimated that around a third of the population is deficient) and increased risk for osteoporosis. So, 10 to 15 minutes in the sun during the non-burning times or a harmless supplement of D3(between 1000 to 5000 I.U. daily, depending on blood levels) is the best way to combat vitamin D deficiency.
  5. Vitamin K2-the “new kid on the block” has a reasonable evidence base to demonstrate the removal of calcium from arteries, putting it back in the bones were it belongs. The best study of vitamin K2 followed 244 postmenopausal women with half receiving vitamin K2 180 µg daily for three years and the other half receiving placebo. This is demonstrated clear evidence for improving bone strength and arterial flexibility.

In conclusion, the long held belief that calcium supplementation used to prevent & treat osteoporosis does not have strong scientific support with the potential for harm. Osteoporosis, especially when severe may also require pharmaceutical therapy but as with all conditions, prevention is better than cure.

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It’s extraordinary what humans will put into their bodies

Friday, February 16, 2018

By Ross Walker

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

Enter the modern world!

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

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

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Hospital complications a leading cause of death

Thursday, February 08, 2018

The most common cause of death and disability in the world is cardiovascular disease, closely followed by cancer. Coming in at number three and closing in fast is Western health care. It is estimated that in the US alone there are 780,000 deaths on a yearly basis as a consequence of doctors treating patients.

A preventative health expert from the United Kingdom has recently suggested that 10% of hospital admissions are directly due to medical error. A recently released report from the Grattan Institute has basically assessed the complication rate for Australian hospitals. It appears that one in nine patients being treated in an Australian hospital will suffer a complication and this increases to 1 in 4 if the person is lucky enough to be admitted overnight.

Interestingly, however, this review did show that some hospitals have a complication rate of a whopping 16.6% whilst others only 2.9%. This raises the question-if some institutions are so low why aren’t all witnessing complications at the same rate? It Is not clear from the report if it is the institutions with the highest rate are purely treated the sickest of the sick i.e. people at greater risk or whether the higher complication institutions do not have the same rigid safety protocols, high-quality or less constant staff.

These complications range from anything between the catastrophic and very rare situations e.g. the two babies who were accidentally gassed with nitrous oxide leading to their tragic death at the Bankstown-Lidcome Hospital.

Complications may also involve healthy patients contracting infections after surgery. The federal government has published a list of 16 relatively common hospital acquired complications which in many cases may be prevented. To give some examples, these include pressure injuries leading to skin ulceration; unsupervised falls within the institution leading to either fractures or head injury; the very common infections which can be anything from hospital-acquired urinary tract infection to infections complicating surgery; other surgical complications requiring return to the theatre such as haemorrhage or wounded dehiscence, to name a few.

As I am suggesting, these complications can vary from minor wound infections or modest reactions to prescribed medications to the more life-threatening severe infections, bleeding and clotting or kidney failure.

In defence of my hospital colleagues, the reality is that the more serious complications typically occur in the sickest of the sick who would possibly die without medical intervention and it is hardly fair to blame the hospital, medical nursing staff on that person’s complications. But, often healthy people undergoing elective procedures may develop serious complications. Some examples here are a person who goes for routine colonoscopy experiencing a bowel perforation. Another example is the person who has been sent for a radiologic procedure involving intravenous dye developing a serious, life-threatening anaphylactic reaction to the dye.

The reality is that strong medicine has strong effects but also strong side-effects and complications. The more aggressive the therapy, often the greater the benefit but also the greater risk.

Regardless, the current figures are unacceptable, especially where there is such variation between institutions and we do need better explanations and solutions than this report is offering. Hospital care is an essential component of modern society but those who avail themselves in this care need to know that hospitals are safe places.

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Opinion: Solving earth's overpopulation dilemma

Friday, February 02, 2018

It is my strong opinion that doctors should be prolonging everyone’s life, but no one’s death. But, I am a stronger believer in health span rather than life span. Any sensible doctor knows when a person’s life has finished and their death phase has begun. When a person has entered the death phase, I believe it is the responsibility of the medical profession to ensure that person’s death occurs as quickly, painlessly and with as much dignity as possible. Unfortunately, many relatives and members of the medical profession believe it is their responsibility to pull out all stops and do everything possible to maintain someone’s existence, regardless of the quality of that existence.

The death phase, in my view, is when a person has a terminal illness with absolutely no possibility of recovering.

This doesn’t just relate to terminal cancer but it also involves end stage Alzheimer’s disease, a severe stroke with a subsequent disability from which there is no reasonable chance of recovery, severe intractable pain for which no reasonable medical therapy is leading to any degree of relief and of course end stage neurologic conditions, such as motor neurone disease.

If we had a more compassionate system of assisting dying people in reducing the length of their death phase, not only would people be able to leave the planet with a bit of dignity and end their discomfort, but we also would be saving millions of dollars in government resources.

Another major issue here is that modern medicine is unbelievably expensive and requires, not only very expensive medicine, procedures and investigations but also high-level expertise to administer all of the above. Unfortunately, our finite world only has finite resources and there is no world leader and only an occasional high-profile person who attempts to make any comments about what is the major issue on this planet i.e. overpopulation. Until this issue is addressed, it is my opinion that as a species we probably have somewhere between 50-100 years left on the planet.

If I can make the analogy here with cancer; what happens with cancer is the cells rapidly divide, rip the nutrients out of the host and pour toxic chemicals into the body leading to death. Therefore, cancers are stupid because they kill the host and therefore themselves. Clearly, human beings are rapidly dividing, ripping the nutrients out of the earth and pouring toxic chemicals into the earth & atmosphere, with the ultimate result that we are destroying all life on earth. Human beings are therefore stupid because they are killing the host and therefore themselves. There is this ridiculous argument for and against climate change with one side being strong advocates and the other side saying it does not exist and is not man-made.

The argument is a side issue because again, using the cancer analogy, if someone is significantly affected by cancer if the temperature goes up or down this is not the central problem but purely a symptom of the cancer or a secondary infection. There is no doubt that human beings are destroying the planet along with many other plant and animal species in humanity’s wake and whether the temperature goes up or down is purely a symptom of this obvious assault by humanity.

Obvious proof for this is now the clear fact that one in eight deaths around the planet are directly related to pollution and in the most heavily populated area of the world i.e. China, this is now one in four deaths.

Some experts have estimated that as a species we can only sustain indefinitely around 4 billion people across the planet and we are now getting close to 8 billion. Unfortunately, I can only see two major areas where this assault on the earth by humanity can be altered. The first is to reduce the amount of people coming into the system in the first place through restrictions on the number of children being born across the planet. The second being my earlier comments about ending the suffering of the dying.

Ever since homo sapiens first evolved we have believed it is our God-given right to bear children. In fact, a previous treasurer of Australia, Mr Peter Costello once encouraged each family to have three children, one for the mother, one for the father and one for the country. But, for the sake of our species and the planet we have to rethink this position. At the least, I believe contraception should be freely available and governments should sponsor programs to encourage contraception with any medical consultation involved in seeking contraception being free. At its most draconian, it may be suggested that if you are not financially contributing to your community then you forfeit the right to have children. Interestingly, an Australian Labor politician suggested this a few years ago.

There are many civil libertarians who will be horrified by this argument but I am purely making the suggestion that to prevent all of humanity dying off at some stage over the next 50-100 years we should be preventing births into families where the members cannot afford to bring up the child without government assistance.

Certainly, in my view, there should be no encouragements for people to have children such as baby bonuses et cetera. Assisted reproduction is another discussion & argument altogether.

Let me make the strong point that I do not believe it is acceptable in a country such as Australia where only 48% of the population is paying net tax and 40 cents in every dollar of our tax money goes to paying social welfare, that we can continue to fund such expensive social programs. Australia is already in $600 billion debt & growing daily, and our ever-increasing younger population will be saddled with paying back this debt unless we start to make some drastic changes.

I strongly believe it is the job of every government to look after the disenfranchised and disabled but we all need to strongly consider the contribution each one of us is making to society rather than what we believe is our right to extract from the public purse.

Unless someone with a public profile is brave enough to make these comments and to change the thinking of the population, we will continue to see an exponential rise in the population, wars fought over food and water and a continually rising divide between the haves and the have nots.

As Albert Einstein famously once said, “We cannot solve our current programs with the same thinking we used to create them”.

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What causes autoimmune disease?

Thursday, January 25, 2018

The function of every organism is to survive. This survival is achieved by the finally tuned processes of metabolism and homeostasis.

Metabolism is defined as the chemical processes that occur within a living organism in order to maintain life.

Homeostasis is defined as the tendency towards a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes.

To put it more simply, we need a balanced set of reactions in our body to keep us living. Although this seems rather obvious, the extraordinary complexity of metabolism does mean that with minor variations in our genetics or with an assault from different environmental toxins, our metabolism can go horribly wrong.

The most common causes of death and disability on the planet are heart disease and cancer. Less common, but certainly not rare, are the ubiquitous set of conditions known as autoimmune disease. Our immune system develops soon after conception and matures slowly into adulthood having been exposed to a variety of infectious agents, environmental toxins and other life stresses over time.

The immune system is basically the body’s security system that deals with damaged and ageing cells, invading organisms and toxins and, possibly most importantly, rids the body of renegade cells which are threatening to turn cancerous.

We live in a world that has many flaws and the same is certainly true for our body and it's safe to say that no one has a perfect immune system that copes with all of the above without any issues.

The immune system is made up of white cells such as lymphocytes and neutrophils along with many other cells which have variety of functions and also what is known as humoral immunity, where particular antibodies are produced against various toxins.

Autoimmune disease is where the immune system falsely recognises normal parts of the body as being foreign and sets up an immune reaction against these particular components. The best two and most common examples of autoimmune disease are rheumatoid arthritis and the condition, systemic lupus erythematosus.

Rheumatoid arthritis is a common cause of symmetrical, often destructive disorder of the joints and in particular affects the hands, the feet and the cervical spine. It is associated with a number of systemic conditions, most commonly affect the eyes, the lungs and often the blood.

Systemic lupus erythematosus has a lesser effect on the joints but can have a profound effect on the kidneys, the lungs, the cardiovascular system, the gut, the skin and also may cause quite severe neuropsychiatric issues. Lupus, in some cases, may only have mild limiting effects on the person, but in some cases may be life threatening. It is easily diagnosed with blood tests known as antinuclear antibodies and is effectively treated with modern immune suppressing agents.

As with all diseases, apart from obvious infections, the big question is what causes this to happen? The honest answer with our current level of scientific knowledge is that we really don’t know. What we do know, however, is that there are some interesting precipitants for a variety of autoimmune diseases which also appear to have a major contribution to heart disease and cancer as well.

There is no doubt in my opinion that the major precipitant of most illnesses is that ubiquitous term, stress. Stress, which is defined as a great pressure or strain can be manifested in any of the following ways:

1)  Physical-I’m not just referring here to excessive exercise but also to the physical stress of having a gallbladder full of rocks, as another example

2) Emotional-probably the biggest stressor for most people comes in this category. Relationship issues, divorce and probably the numero uno- the death of a loved one, are major precipitants for any illness

3) Mental-with the increasing demands of the modern world, work stress, studying and having to deliver presentations and lectures (many people fear public speaking, strangely, I fear not public speaking),  many people are suffering as a consequence

4) Pharmacologic stress-certain types of legal and illegal pharmacology may be great precipitants for a number of illnesses. Even the most common addiction in the world, Coffee, has been shown in low doses to have a beneficial effect but in high doses may cause all sorts of issues

5) Infective-there is no doubt that any type of infection has the potential to overload the immune system, thus taking its attention away from performing its regular job of maintaining the normal functioning of the body. Certain types of viruses and bacteria, not to mention the occasional parasite, can alter the immune reaction and precipitate an autoimmune disease.

However, many people don't realise that the immune system, like the rest of the body needs proper nutrition to function well. Thus, our modern diet with all its processed, packaged muck containing excessive amounts of salt, sugar and synthetic chemicals may also have a deleterious effect on the immune system. Recent work has shown that a particular component of the immune system known as Th17 is very sensitive to salt and an acute or chronic salt load may precipitate an acute episode of autoimmune disease, in particular rheumatoid arthritis and Lupus.

A recent study from the US evaluated just under 1400 patients with Lupus, average age 47 of whom 92% were female. They measured vitamin D levels and found those who were deficient, which was just over 27% of the patients had the highest risk of kidney damage, skin involvement and other organs being affected.

Vitamin D supplementation is inexpensive, very safe and may have significant health benefits for people with this particular condition.

As with all conditions, it is vitally important that an integrated approach to management is adopted to ensure the best possible outcomes. Fortunately, many health professionals are embracing integrative medicine and this attitude is certainly being welcomed with open arms by the general public.

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Myth - High blood pressure is 100 plus your age

Friday, January 19, 2018

Years ago, this incredibly simplistic dictum was taken as gospel by the medical profession. 

There have been a number of myths over the decades surrounding high blood pressure and I would like to clear up some misconceptions around this very important topic. Blood pressure is simply the pressure within the arteries when the blood moves as it is pumped. 

The typical designation for BP is systolic/diastolic. The systolic pressure is an indirect measure of the force of contraction of the heart whereas the diastolic pressure is the resting pressure between heartbeats.

For many years, hypertension was defined as a BP of 140/90 or higher. Any level above 120/80 up to 140/90 was considered pre-hypertension and those in this category are at a higher risk than those with a completely normal BP.

Recently, a panel of 21 specialists in the field published new guidelines for the American Heart Association and American Academy of Cardiology task force after analysing 900 published studies.

Hypertension is now categorised as a BP of 130/80 or above. In an interesting twist, the task force is designating blood pressures 120-129 systolic as being elevated BP but not designated high. 

Interestingly, the research is suggesting that people with a blood pressure in the 130 to 139 systolic range and the 80 to 89 diastolic range should also have a 10-year risk assessment for heart disease and if this risk exceeds 10%, medications should be considered and the person treated until the BP is normalised. Recent data has suggested we should be aiming for a BP level of 120/80.

These new guidelines are suggesting that 50% of the adult population have hypertension.

Following on from these guidelines is the new study of 412 adults with elevated blood pressure which was published in the November issue of the Journal the American College of Cardiology. This study suggested that following the DASH diet, which is a diet of fruits and vegetables, whole grains along with dairy, fish, poultry, beans, seeds and nuts combined with low salt reduces blood pressure more than pharmaceutical medication.

The study looked at 412 adults including 234 women whose ages ranged between 23 to 76 with a systolic blood pressure somewhere between 120-159 mmHg a diastolic pressure between 80 to 95 mmHg. Over half were African-American.

No people were taking BP pills or Diabetic medication, and did not suffer heart disease, kidney disease, cholesterol elevation or diabetes.

The diet was continued for 12 weeks and the groups were also split into low salt, medium salt or high salt. For example, medium salt intake was considered the equivalent of 1 teaspoon of salt on a daily basis, which is much lower than what most people living in our society would be ingesting.

Those individuals consuming the DASH diet alone had an 11mmHg reduction in systolic pressure if their initial systolic was 150 compared with a 4 mmHg reduction if their systolic pressure was less than 130.

But when the researchers reviewed the people with the highest systolic blood pressure of 150mmHg also on the low salt arm, there was an average reduction of 21 mmHg compared to the high salt, control diet. This is actually better than most BP pills alone. Commonly used drugs such as ACE inhibitors, beta-blockers & calcium channel blockers would typically reduce systolic blood pressure by somewhere between 10 to 15 mmHg.

This study reinforces the vital importance of lifestyle modification for the management of hypertension, no doubt, the most important cardiovascular risk factor.

The most powerful lifestyle factors to reduce BP are follows:

1)  Weight loss and in particular loss of abdominal fat

2)  Regular exercise-3 to 5 hours weekly

3)  Markedly reduced the intake of sugar and salt

4)  No more than 1-2 standard alcoholic drinks per day

5)  Stress management techniques such as regular meditation

Kyolic aged garlic extract, two daily has been shown in a randomised controlled clinical trial of 88 patients with mild hypertension to have a significant reduction in BP similar to a standard pharmaceutical drug.

Bergamot polyphenolic fraction-One pill twice daily of the 47% polyphenolic extract has been shown to have an antihypertensive effect.

Two small pieces of dark chocolate, > 70% cocoa has been shown in a Cochrane review to have a reasonable effect on reducing blood pressure and improving blood flow to organs.

Management of sleep apnoea through either mandibular advancement devices or nasal CPAP has been shown to control BP in affected individuals.

Pharmaceutical therapy is also often necessary but unless there is evidence of end organ damage as seen typically in the heart, the kidneys or the blood vessels in the eye (a good marker for what is happening in the blood vessels in the brain), lifelong drug therapy should not be commenced until all of the other avenues have been utilised.

Regardless, hypertension is the most common cause of stroke and over the age of 60, heart attack. As we collectively become more educated about the vital importance of managing hypertension and bringing in measures to do so, we will see the rates of these devastating diseases markedly reduce. Unfortunately, at present, cardiovascular disease is still our biggest killer.

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