Monthly Archives: January 2015

Your microbiome is shared with your family … including your pets

Jan 30

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29 August 2014, 12.23pm AEST

Your microbiome is shared with your family … including your pets

Microbial communities vary greatly between different households but are similar among members of the same household – including…

Humans transport microbes around their environment. Argonne National Laboratory

Microbial communities vary greatly between different households but are similar among members of the same household – including pets – according to research published in Science today.

Microbes are everywhere. They live on and inside us, and cover most things we come into contact with, including our personal belongings. We also know that microbes play a role in human health, and the destruction of our personal microbial community (known as our microbiome) is thought to be contributing to the rapid rise of certain diseases.

The research shows humans affect the microbial populations of their surroundings rather than the other way around.

The dynamics of microbial transmission was studied, revealing that, more often than not, humans are the microbial vectors (transporters). When we move into a new house, rather than acquiring microbes from the new location, we bring our unique microbial profile with us.

Andrew Holmes, a microbial ecologist from the University of Sydney, said the results indicate microbial communities on household surfaces are “ecologically inert”. He said that, rather than harbouring actively growing microbes, surfaces “are continually reloaded with what you had already growing in and on you”.

“To put it another way – we inoculate the house, rather than the house inoculating us,“ he said.

The results of the study highlight the complex exchanges between humans and the microbes residing with us, and contribute to an understanding of how these microscopic communities may play a role in human health, disease treatment and transmission.

Your unique blend of housemates

Researchers from Argonne National Laboratory studied seven families and their homes over six weeks, sequencing the genomes of bacteria found daily on their skin, household surfaces and pets.

Researchers explain The Home Microbiome Project.

Four million different microbial DNA sequences were identified.

Within households, the most microbial similarity was found on the hands of individuals. Intriguingly, the most microbial variation between individuals was found in the nose.

Frequent physical contact between members of a household was also a factor, with those in close relationships sharing the most microbes.

The researchers suggest that samples of household microbial communities could potentially serve as a forensic tool to predict which family the sample came from.

Silvana Gaudieri, associate professor in the Centre for Forensic Science at the University of Western Australia, said that in the context of forensic microbiology, there is potential “predictive value” in the relationship between home surfaces microbiomes and those of occupants.

The research also showed that when individuals (and their microbes) leave a house, the microbial community changes markedly in the days following. This suggests the decay of a microbial signature could be used to assess not only if, but when, the person was in the house.

Don’t evict microbial tenants

While the study suggests that humans may routinely encounter potentially harmful microbes, there is no need to worry as they only cause problems for those with otherwise compromised immune systems.

Amanda Tipton/Flickr, CC BY-ND
Click to enlarge

“[The results] most certainly do not mean that the microbes occupying the household surfaces are biologically significant to the health of the household,” Associate Professor Holmes said.

“What it does emphasise is that we are continually surrounded by bacteria. In our domestic residences our bacterial environment strongly reflects our personal microbiota – which are essentially beneficial.”

“One reason for household members sharing similar microbial communities is that we have a high likelihood of exchanging microbes within a household,” he said. “This is relevant for control of the spread of antibiotic resistant bacteria within household members or in hospital wards.”

Cheryl Power, an Honorary Fellow in microbiology and immunology at the University of Melbourne, said other studies have shown excessive use of antibacterial compounds selects for more resilient bacteria.

“We should relax about the need to forensically clean our home spaces and not feel the need to use products that contain antibacterial chemicals claimed to make our home safe from ‘house germs’, as we are so often encouraged to do,” she said.

“This research shows that the microbiota of different home spaces are basically our normal microbiota with whom we live peacefully, even productively, most of the time.”

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Why irritable bowel syndrome causes pain

Jan 28

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20 August 2014, 2.36pm AEST

Why irritable bowel syndrome causes pain

A study has found the immune system is not working properly in people suffering from irritable bowel syndrome (IBS), which leads to pain.

The study involved specialised immune cell samples from part of the digestive system of 116 participants, where approximately half were healthy and half had IBS.

The results show that in healthy people, the immune cells normally secrete opioid chemicals, like morphine, that block pain. But in people with IBS, the opioid production by these cells is lower.

Dr Patrick Hughes’ research could help explain why some painkillers may not offer pain relief to people with IBS. The work could lead to more targeted treatments for IBS to help treat pain.

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The Lies That Doctors and Patients Tell

Jan 27

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Doctors February 20, 2014, 10:21 am

The Lies That Doctors and Patients Tell

By SANDEEP JAUHAR, M.D.

The doctor-patient relationship is ideally an intimate partnership where information is exchanged openly and honestly. That is seldom the reality, however. Deception in the doctor-patient relationship is more common than we’d like to believe.

Deception is a charged word. It encapsulates precisely what we dread most in a doctor-patient relationship, and yet it is there in medicine, and it often runs both ways.

Dr. Sandeep JauharMaryanne Russell Dr. Sandeep Jauhar

I once took care of a young woman who told me she suffered from a rare blood disorder that caused clots to develop in her heart and lungs. She’d had multiple surgeries, as evidenced by the scars on her back and abdomen. However, when we called her grandmother to get more information about her illness, she told us that her granddaughter was just fine — physically. It turned out she suffered from Munchausen syndrome, a psychiatric disorder in which patients intentionally produce or distort symptoms because of a need to be seen as ill or injured. They will undergo painful tests or diagnostic procedures if necessary to maintain the lie.

Physicians sometimes deceive, too. We don’t always reveal when we make mistakes. Too often we order unnecessary tests, to bolster revenue or to protect against lawsuits. We sometimes mislead patients that our therapies have more value, more evidence behind them, than they actually do — whether it was placebo injections from my grandfather’s era, for example, or much of the spinal surgery or angioplasty that’s done today.

Perhaps the most powerful deceptions in medicine are the ones we direct at ourselves — at our patients’ expense. Many physicians still espouse the patriotic (but deeply misconceived) notion that the American medical system is the best in the world. We deny the sickness in our system, and the role we as a profession have played in creating that sickness. We obsessively push ourselves to do more and more tests, scans and treatments for reasons that we sometimes hide from ourselves.

Despite thinking about these issues for much of my career, I am not immune to this sort of masquerade. Several years ago I took care of a woman with a severely leaky heart valve that was constantly putting her into acute heart failure. She was one of my most beloved patients who, at 88, and despite the ravages of her disease, always wore a powdered face, thick lipstick and salon-done blondish hair sitting on bony, wasted temples. She called me several times a week to update me on her condition — or sometimes just to chat.

So it came as a shock when I learned one afternoon that she was in the intensive care unit. She had been brought in several days earlier by ambulance to the emergency room, intubated with a breathing tube because of respiratory arrest and admitted to the I.C.U. with a diagnosis of worsening multi-organ failure.

I went to the I.C.U. for three straight days to check on her. Though she was sedated and breathing with the aid of a ventilator, her lips would curl upward in a smile whenever she’d see me. Her skin was jaundiced, a sign of liver failure. She had kidney failure, too, and had stopped making urine.

On the third day I went to see the attending physician, a colleague in his late 40s, to press him about why more wasn’t being done for this patient. Wouldn’t she benefit from dialysis?

He told me no, that she was at the end of her life, and laid out the reasons why dialysis would be futile and inappropriate.

I pressed him to reconsider, but he would not budge. Storming back to my office, I didn’t know what to think. Was my judgment being clouded by sentiment? Was I trying too hard to save my patient? Or was the I.C.U. physician not trying hard enough?

Two days later I took the unusual step of transferring my patient to the cardiac intensive care unit, and took care of her myself. Her sojourn there was a disaster. She was unable to be weaned from the ventilator. Her liver failure worsened. Even as it became clear to me that she was going to die and that my aggressive interventions had been for no good purpose, I became very reluctant to change course.

We checked blood tests several times per day. I inserted a pressure catheter in her pulmonary artery to monitor her hemodynamics. I started her on continuous veno-venous hemodialysis, but the dialysis catheter repeatedly got clotted due to low blood pressure. The breathing tube remained in her throat till the end. Eventually she succumbed to multisystem organ failure and sepsis, nearly a week after I’d transferred her to my care. She was 89.

At their core, my actions were a kind of deception — convincing myself, despite all the evidence, that I could save her, stay the inexorable course of her disease. Perhaps I was afraid of failure, or embarrassed by my impotence. Those last few days of her life she almost ceased to be a person for me. She became an experiment, a puzzle — one that I desperately wanted to solve.

Today, when I think about end-of-life care in America, I often think of my patient and my deluded response to her illness. In the end, we all practice a certain amount of self-deception. But when it originates in the doctor-patient dyad, patients are usually the worst victims.

Sandeep Jauhar, a cardiologist in New York, is the author of “Intern: A Doctor’s Initiation” and the forthcoming memoir “Doctored: The Disillusionment of an American Physician.

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Five supplements that may help with depression

Jan 26

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25 August 2014, 2.39pm AEST

Health Check: five supplements that may help with depression

Over two-thirds of Australians are thought to use complementary medicines ranging from vitamin and mineral supplements to herbal to aromatherapy and homeopathic products. Mental health concerns are one…

While there’s evidence for the efficacy of some supplements as potential treatments for depression, there’s none for others, and some have been found to be ineffective. Михал Орела/Flickr, CC BY-SA

Over two-thirds of Australians are thought to use complementary medicines ranging from vitamin and mineral supplements to herbal to aromatherapy and homeopathic products. Mental health concerns are one of the reasons why people use supplements, but are they really useful?

While there’s evidence for the efficacy of some supplements as potential treatments for depression, there’s none for others, and some have been found to be ineffective. But effectiveness is not the only concern – the quality and cost of unregulated products can also be problematic.

And then there’s the issue of discerning between bone fide evidence from double-blind randomised controlled trials and slick company marketing campaigns.

Of the supplements that have been studied for improving general mood or treating clinical depression, omega-3 fatty acids, St John’s wort, S-adenosyl-methionine (SAMe), N-acetyl cysteine (NAC) and zinc are the most researched and commonly used.

Omega-3 fatty acids

There are three types of omega-3 fatty involved in human physiology. They are important for normal metabolism.

Epidemiological studies show that low dietary intake of omega-3 oils from fish may be related to increased risk of depressive symptoms. A review of dozens of clinical trials on major depression that assessed the efficacy of these fatty acids alone or in combination with antidepressants, supported their use in depression.

And a meta-analysis combining the results of five similar studies found a significant effect in favour of omega-3 fatty acids for reducing bipolar depression.

SAMe

S-adenosyl-methionine (SAMe) is a naturally occurring compound found in almost every tissue and fluid in the body that’s involved in processes, such as producing and breaking down brain chemicals including serotonin, melatonin, and dopamine.

Double-blind studies show injected and oral preparations (between 800 milligrams to 1600 milligrams) of SAMe are as effective as antidepressants, and tend to produce relatively fewer adverse effects. SAMe also improves the response to antidepressant medication.

It’s a little expensive but SAMe appears well tolerated with only mild adverse effects such as headaches, restlessness, insomnia and gastrointestinal upsets.

St John’s wort

St John’s wort (Hypericum perforatum) is a flowering plant that has a long history of medicinal use. It’s been studied for treating depression in over 40 clinical trials of varying methodological quality.

A 2008 Cochrane review of 29 trials involving 5,489 patients analysed comparisons of St John’s wort with placebo or dummy pills and with antidepressants. It showed people were significantly more likely to respond to St John’s wort than to placebo. In the same analysis, St John’s wort had an equivalent effect to antidepressants.

Because of the risk of drug interactions, people taking other medicines should only use St John’s wort with low amounts of the plant chemical hyperforin, which has effects on drug levels in the body (see an appropriate health professional for advice on this).

The supplement should not be taken with antidepressants as it can cause serotonin syndrome, a potentially fatal nervous system event.

NAC

N-acetyl cysteine (NAC) is an amino acid with strong antioxidant properties that has a history of use in the management of paracetamol overdose. It’s been found to significantly reduce depression in bipolar disorder.

In a 24-week placebo-controlled trial of 75 people with bipolar disorder, one gram of NAC twice a day significantly reduced depression. The supplement appears to have no significant adverse reactions but is currently only available from compounding pharmacies or from overseas.

Zinc

Zinc is a mineral found in some food, and there’s emerging evidence that it improves depressed mood.

A 2012 review of randomised controlled trials found two 12-week trials, with sample sizes of 60 and 20 people, showed zinc as an adjunct to antidepressants significantly lowered depression.

Zinc can be safely prescribed in doses up to 30 milligrams a day, although it should have amino acid another aid to improve absorption. While zinc is a fairly safe supplement, it may cause nausea on an empty stomach.

A cautionary note

This is a very basic overview of the evidence for these five supplements, and people considering their use should get health professional advice before starting to take them.

The studies mentioned here tend to support that “add-on” prescription of a range of nutrients, such as omega-3 fatty acids, SAMe, folic acid, N-acetyl cysteine and zinc, with various medicines, such as antidepressants, have a beneficial effect in improving treatment beyond that of placebo. But again, be sure to seek medical advice before combining any supplements with medications.

Clinical trials have demonstrated little or no effect for valerian in insomnia, St John’s wort in anxiety disorders or attention deficit hyperactivity disorder, n-acetyl cysteine or docosahexaenoic acid (DHA) fatty acids for unipolar depression, and omega-3 for bipolar mania, among others.

The majority of Australians, especially women, already take a range of nutrient and herbal-based supplements for a number of mental health problems. But, consumers should be mindful of the evidence for their effectiveness and differences between the quality and standardisation of supplements, as well as potential drug interactions.

Click here for information on participating in a clinical trial, running in Brisbane and Melbourne, assessing the use of nutraceuticals for people who are depressed.

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Changes to bugs in the gut could prevent food allergies

Jan 23

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26 August 2014, 6.47am AEST

Changes to bugs in the gut could prevent food allergies

Changing the bacteria in the gut could treat and prevent life-threatening allergies, according to research published in the…

Allergic reactions to food have dramatically increased over the past 10 to 20 years. Dan Peled/AAP, CC BY

Changing the bacteria in the gut could treat and prevent life-threatening allergies, according to research published in the Proceedings of the National Academy of Sciences (PNAS) journal today.

“These findings are a game changer for understanding how allergies develop,” said Dr Simon Keely, senior lecturer in immunology and microbiology at the University of Newcastle. “The number of hospital admissions due to reactions to food have increased dramatically over the past 10 to 20 years.”

The study authors examined how changes in the trillions of bacteria that normally populate the gastrointestinal tract influence allergic responses to food. They started by inducing peanut sensitivity in mice by giving them antibiotics soon after birth.

Antibiotics disturb the harmony between the bacteria and immune system of the gut, creating an allergic sensitisation to peanuts. They prime the immune system to mistakenly recognise peanuts as a threat.

The researchers then introduced a peanut solution directly into the mice’s gastrointestinal tract through a feeding tube. When the rodents were exposed to this solution, they became sensitive to peanuts.

A group of bacteria called Clostridia was then introduced into the gut of the mice and the researchers found it got rid of the peanut sensitivity. They believe the findings will inform the development of similar approaches for allergy prevention in humans.

Although the research was done in mice, Professor Katie Allen, paediatric gastroenterologist and allergist at Murdoch Childrens Research Institute, said the results were profound for allergy research because they showed proof of concept of the importance of gut bacteria and their interactions with the developing immune system.

Dr Keely said the study demonstrated previously unrecognised pathways by which the immune system interacts with the bacteria in the gut.

“When you disrupt that interaction, you become more susceptible to developing allergy,” he said.

The study underlines how bacteria in the gut and the immune system are intrinsically linked, he said, adding “they regulate each other. If you disturb one, you disturb the other.”

But both Allen and Keely highlighted some of the limitations of the research.

“We can’t say that gut bacteria that are shown to be protective for mice will also be protective for humans but it is an interesting concept nonetheless,” said Professor Allen.

Dr Keely said humans have a much more diverse diet than mice and tended to be exposed to a very broad environment of bacteria, unlike mice, which tend to live in relatively clean cages.

The good news is that this research suggests the potential for modifying gut bacteria in humans as a way of prevention of allergic disease – in particular food sensitisation, Professor Allen added.

Professor Allen said researchers have been looking at many ways of preventing allergy including kick starting the immune system in newborn babies, studying migration changes on human allergies and studies in probiotics.

This current study provides further supportive evidence for the role of gut bacteria in allergy development, she said. The most important thing to take away from it is that there may be group of bugs that will be helpful in protecting against allergic sensitization and therefore also food allergy.

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Getting on and getting it on: good sex isn’t just for the young

Jan 21

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30 September 2014, 5.18am AEST

Getting on and getting it on: good sex isn’t just for the young

Research tells us that women’s sexual functioning declines after midlife, manifested by reductions in arousal and orgasm, and increases in sexual pain. This is linked to reports of reduced sexual activity…

Believing sex to be important is the strongest predictor of embodied sexual desire in older women. Candida.Performa/Flickr, CC BY-SA

Research tells us that women’s sexual functioning declines after midlife, manifested by reductions in arousal and orgasm, and increases in sexual pain. This is linked to reports of reduced sexual activity and satisfaction in older women, which appear to confirm the myth that sex is only for the young.

But a longitudinal study from earlier this year challenges the idea that sex is only for young people, as well as raising questions about the biomedical model that underpins the idea.

Out of 602 women aged between 45 and 70 who participated in the study, the majority were still sexually active. And the strongest predictor of sexual activity was the belief that sex was important. Physical levels of sexual functioning were irrelevant.

Body and mind

Does this suggest that sex for women over 40 is all in the mind? The mind can certainly affect the body; believing sex is important has previously been found to be the strongest predictor of embodied sexual desire in older women.

Conversely, even when mid-life women report lowered sexual response or vaginal dryness, the majority still report sexual satisfaction. So making assumptions about women’s sexuality based on clinical measures of sexual functioning is clearly problematic. Attitudes to sex are more important than biomedical changes.

Chronic illness – such as cancer, heart disease or diabetes – can affect older women’s sexual functioning. In research my colleagues and I conducted on women with cancer, for instance, the majority reported reductions in sexual desire and response, as well as increased sexual pain.

But these women still wanted to engage in sex, and found new ways of being intimate. This included touching, masturbation, kissing and hugging, as well as use of sex toys and lubrication. Indeed, many couples reported that their sex life was better as a result. They spent more time having sex and enjoyed a sense of increased intimacy.

Enjoying an expanded sexual repertoire is not peculiar to people with cancer. One-fifth of women at midlife have reported to have a desire for non-penetrative sex.

The foreplay reminiscent of youth can bring a lot of pleasure, often lasting longer than sex focused on intercourse. It also helps avoid the sexual pain caused by vaginal dryness following menopause.

In heterosexual relationships where older men experience erectile problems, sex can stop altogether. This can leave women feeling sexually frustrated and men depressed.

Medical interventions such as Viagra can provide a solution for some, but the other option is non-penetrative sex. Perhaps this is why women in lesbian relationships are less likely to report sexual changes as they age. They were never tied to narrow notions of sex as intercourse in the first place.

Increasing desire

Being willing to change sexual activities, talking about sex and having a good relationship are major predictors of continued sexual activity at midlife and beyond. Professional support can also help.

The other solution to a waning sex life is relationship change: finding a new partner, feeling more positive towards your current partner, or adult children leaving home can rekindle a couple’s sex life.

The increasing number of older women being treated for sexually transmitted infections reflects a surge in the sex lives of the newly separated. Absence of safe sex knowledge, combined with increased risk of sexual infections because of vulva and vaginal mucosa thinning, are the downside to this rekindled sex drive.

Good sex is not the preserve of the young. Many women experience increased sexual pleasure and desire at midlife and into their older years.

We’ve interviewed women in their 60s, 70s and 80s who still enjoy an active sex life. We’ve also spoken to women who feel great sadness because their sex life is over due to divorce or bereavement. Indeed, the absence of a partner is the biggest predictor of older women having no sex life at all.

Improved sex after 40 can be due to increased self-confidence, being less worried about the “small stuff” and having more time to focus on pleasure. Women who feel “sexy” in their bodies, and who have a lower BMI, report higher sexual activity.

Not having to worry about pregnancy after menopause is also a big plus. Women’s mental health and well-being generally improves with age. This can also influence sexual activity and satisfaction.

The baby boomer generation invented the sexual revolution. So why expect these women to become asexual in their later years? The generation that brought us free love, the pill and guilt-free divorce is re-writing the rules on sex in later life.

As the boomers challenge myths about ageing and sexuality, they are a living testament to mind over matter where sex is concerned. The sexual body may change as we age, but pleasure and satisfaction can stay the same – or even get better.

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Smoking increases breast cancer risk.

Jan 20

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An earlier posting today was about reducing risk of Breast cancer with aspirin, now you can further resuce the risk by not smoking.

Lifetime cigarette smoking and breast cancer prognosis in the after breast cancer pooling project

Journal of the National Cancer Institute, 12/24/2013 Pierce JP, et al.

There is controversy on whether former smokers have increased risk for breast cancer recurrence or all–cause mortality, regardless of how much they smoked. Lifetime cigarette smoking was statistically significantly associated with a poor prognosis among women diagnosed with breast cancer, dose–dependent increased risks of recurrence, and breast cancer and all–cause mortality.

Methods

  • Data were from three US cohorts in the After Breast Cancer Pooling Project, with detailed information on smoking among 9975 breast cancer survivors.
  • Smoking was assessed an average of 2 years after diagnosis.
  • Delayed entry Cox proportional hazards models were used to examine the relationships of smoking status, cigarettes per day, years of smoking, and pack years with breast cancer prognosis.
  • Endpoints included breast cancer recurrence (n = 1727), breast cancer mortality (n = 1059), and overall mortality (n = 1803).

Results

  • Compared with never smokers, former smokers with less than 20 pack–years of exposure had no increased risk of any outcome.
  • However, former smokers with 20 to less than 34.9 pack–years of exposure had a 22% increased risk of breast cancer recurrence (hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 1.01 to 1.48) and a 26% increased risk of all–cause mortality (HR = 1.26; 95% CI = 1.07 to 1.48).
  • For former smokers with 35 or more pack–years of exposure, the probability of recurrence increased by 37% (HR = 1.37; 95% CI = 1.13 to 1.66), breast cancer mortality increased by 54% (HR = 1.54; 95% CI = 1.24 to 1.91), and all–cause mortality increased by 68% (HR = 1.68; 95% CI = 1.44 to 1.96).
  • Current smoking increased the probability of recurrence by 41% (HR = 1.41; 95% CI = 1.16 to 1.71), increased breast cancer mortality by 60% (HR = 1.61; 95% CI = 1.28 to 2.03), and doubled the risk of all–cause mortality (HR = 2.17; 95% CI = 1.85 to 2.54).
 

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Aspirin and serum estrogens in postmenopausal women

Jan 19

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It has been known for some time that a small daily dose of aspirin reduces the risk of someone getting breast cancer. An added bonus, is low dose aspirin also reduces the risk of colon cancer. This study is another one confirming this fact, as well as ahowing that the aspirin intake has no effect on menopausal women’s oestrogen level.

Aspirin and serum estrogens in postmenopausal women: A randomized controlled clinical trial
Cancer Prevention Research, 06/16/2014  Clinical Article

Duggan C, et al. – This study suggest a reduced risk of breast cancer among women who use aspirin. Result suggest that a single daily administration of 325 mg of aspirin for 6 months had no effect on serum estrogens or SHBG in postmenopausal women. Larger doses or longer duration of aspirin administration may be needed to affect circulating estrogens.

  • In a randomized placebo–controlled trial, the authors evaluated the effects of 6–months administration of 325 mg/day aspirin on serum estrogens (estradiol, estrone, free estradiol, bioavailable estradiol) and sex hormone binding globulin [SHBG] in 144 healthy postmenopausal women.
  • Eligible participants, recruited 2005 – 2007, were not taking nonsteroidal anti–inflammatory medication including aspirin > 2 times/week or menopausal hormone therapy, and had a BI–RAD mammographic density classification of 2, 3, or 4.
  • The intervention effects (intent–to–treat) were evaluated by differences in the geometric mean outcome changes at 6 months between aspirin and placebo groups using generalized estimating equations (GEE).
  • Participants were a mean 59.4 (SD 5.4) years, with mean body mass index (BMI) of 26.4 (SD) 5.4 kg/m2.
  • Between baseline and 6–months, none of the serum estrogens or SHBG changed substantially and there were no differences between groups.
  • Stratifying by BMI did not change results

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What’s the best diet for weight loss?

Jan 18

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Health Check: what’s the best diet for weight loss?

Find a healthy eating regime you can stick to. foshydog/Flickr, CC BY-NC-ND

When it comes to weight loss, there are no magic tricks that guarantee success. What works for you is likely to be different to what works for your partner, neighbour or workmate.

The best advice is to find a healthy eating regime – let’s call it a diet – that you can stick to. You may choose a specific diet book or commercial program to kick start your weight loss, but in the longer term, switch to an eating pattern you can live with for good.

The diet that works best will depend on many factors: your current weight, dieting history, how much weight you need to lose, reasons for wanting to lose weight, your knowledge and skills around food preparation and nutrition, personal supports and the time you have to focus on weight loss.

But first, a warning about fad diets.

Fad diets can work in the short-term because they lead to a reduction in total kilojoules but are usually nutritionally inadequate.

They often ban specific foods or food groups, such as carbohydrates, and promise miraculous results. Or they may promote unproven fat burning or other supplements. Fad diets generally contradict advice from credible health professionals.

Research shows the more radical the diet approach, the more likely you are to give up because of boredom or unpleasant side-effects including bad breath, constipation, and even gall bladder disease.

Getting started

First up, decide on your weight loss goal. If your body mass index (BMI) is over 25, aim to lose up to 10% of your body weight in six months.

Next, decide how you’re going to monitor your progress. You can record your weight weekly using an app, at your weight-loss group or program, or use a pen-and-paper diary.

If you’re overweight or obese, aim to lose 10% of your body weight. sarahluv/Flickr

Reducing your energy intake

Everybody’s total daily energy needs are different, depending on your level of activity – this calculator can help you work out your individual energy needs.

A weight-loss diet should reduce your daily energy intake by at least 2,000 kilojoules (kJ) per day compared to what you usually eat when weight stable.

That is enough of a kilojoule reduction to lose a quarter to half a kilogram per week, which can add up to 12 to 25 kilograms over a year.

Sounds easy, but it’s a lot more difficult in practice. You have to be consistent every day and every week. This is why you need to choose a diet that really appeals to your tastes and preferences. It doesn’t really matter which diet that is, so long as it specifically targets a reduction in total energy (kilojoules or calories), and you can stick to it.

When it comes to weight-loss diets, there are three levels of energy restriction:

Reduced-energy diets (RED)

Cutting out TV snacks will help you stay within your kJ limit. Shutterstock

REDs aim to reduce a person’s usual energy intake by 2,000 to 4,000 kJ per day from their usual needs. You can achieve this by changing some food habits, such as cutting down your portion sizes, swapping soft drink for diet versions or soda water, or not eating after 8pm to reduce snacking.

Other approaches that fit this category are low glycemic index (GI) diets or avoiding foods with added sugar.

Low-energy diets (LED)

LEDs prescribe a daily energy intake of about 4,200 to 5,000 kJ per day. This is usually a list of specific meals and snacks that you follow closely to ensure your kilojoule intake matches the daily target.

Most commercial weight-loss programs – such as Weight Watchers, Biggest Loser Club, Jenny Craig or home delivery Lite n Easy – provide this. Weight-loss diets that give you a meal plan, such as those designed by accredited practising dietitians, are usually LEDs.

Very low-energy diets (VLED)

VLEDs limit total energy intake to only 1,800 to 2,500 kJ per day.

This approach uses formulated meal replacements (FMRs) to ensure your energy intake is kept very low. FMRs are supplemented with vitamins and minerals to try and meet the body’s requirements, despite the severe energy restriction.

VLEDs, such as Optifast or KicStart, are used when you need to lose weight quickly for health reasons or ahead of surgery. Talk to your GP first because they need to be supervised by a doctor or dietitian due to potential side-effects such as gall bladder or liver inflammation, constipation, headaches and bad breath.

Long-term change

The level of energy restriction to aim for depends on what you think you can stick to. If your weight is going up by a few kilograms each year, then your current energy needs are probably around 9,000 to 11,000 kJ per day.

If you have never been on a diet before, then start with an RED.

If you want to lose weight faster, you will need the lower kilojoule target of an LED, but it will be harder to stick to.

For weight loss, it doesn’t matter what diet you choose, as long as you decrease your energy intake. cleber/Flickr, CC BY-NC

Once you have set the level of energy restriction, then further manipulating nutrients – by eating more or less protein, for instance – will not lead to greater weight loss. This applies to altering the proportion of total fat, the glycemic load or glycemic index of the carbohydrate.

For weight loss, it is kilojoule total that counts.

Monitoring your success

The National Health and Medical Research Council’s (NHMRC) 2013 guidelines for weight management, which are based on the best available scientific evidence, highlight the importance of recognising and avoiding triggers that prompt eating and learning to modify unhelpful thinking patterns that become barriers to following a diet.

The guidelines also note that self-monitoring is key to weight-loss success. If you track your progress in a weight-loss diary and monitor your dietary intake, physical activity, body weight and measurements, you’re more likely to lose weight and keep it off.

Once you have found the eating pattern that allows you to lose 250 grams to one kilogram per week, share your success story. That way more people will discover that “the best diet” for weight loss might not have a fancy name, but is an approach that you can live with, for good.

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Talking therapies can harm too – here’s what to look out for

Jan 15

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14 August 2014, 6.24am AEST

Talking therapies can harm too – here’s what to look out for

People seeking therapy should always talk to a practitioner who provides good quality treatment that’s appropriate to their needs. Because research shows that even the innocuous-sounding “talking therapies…

You may find yourself talking to a therapist who is completely inappropriate to your needs. James Nash/Flickr, CC BY-SA

People seeking therapy should always talk to a practitioner who provides good quality treatment that’s appropriate to their needs. Because research shows that even the innocuous-sounding “talking therapies” (essentially counselling and psychotherapy) can be harmful for some when they’re unsuitable.

Reflecting my day job, I’m going to focus here on mood disorders. Some of these (melancholic depression, for instance, and bipolar disorder) are essentially “diseases” because their causes are largely genetic, and reflect primary biological brain changes.

The wrong model

People with these mood disorders tend to respond to medication but not usually to talking therapies. Therapists with a narrow treatment approach will generally fail to be of any assistance to people who suffer from such conditions.

But sadly, as per the aphorism “if all you have is a hammer, then everything looks like a nail”, some therapists reject any possibility they might be providing totally inappropriate treatment.

I cringe when recipients of such treatment – many substantially impaired for years – tell me their practitioner has reassured them that their continuing depression (which might have responded within weeks to an antidepressant drug) needs to be “experienced before it can be worked through,” or some other defensive pseudo-profound explanation.

In such cases, talking therapies are indirectly harmful by being inappropriate and ineffective.

Conversely, there are many depressive disorders that lack primary biological changes. But, despite the most appropriate treatment here being a talking therapy, the individual receives a procession of inappropriate and ineffective antidepressant drugs that may also have distressing side effects.

Sadly, as per the aphorism ‘if all you have is a hammer, then everything looks like a nail’, some therapists reject any possibility they might be providing totally inappropriate treatment. Jerry Swiatek/Flickr, CC BY

Here again, harm – and a lack of therapeutic response – may arise from the wrong therapeutic model. But harm may also accrue from the ingredients of therapy and how they’re applied by individual therapists.

Components and risks

Psychotherapies, such as cognitive behaviour therapy or dynamic psychotherapy, are all developed with an underlying logic and possess powerful specific ingredients.

Cognitive behaviour therapy, for instance, challenges faulty thinking patterns that cause people to view themselves, their future, and the world negatively. While dynamic psychotherapy, which is derived from psychoanalysis, is designed to identify the early formative events that led the individual to develop psychological problems.

But all psychotherapies also contain non-specific therapeutic ingredients that may – when present in some circumstances, or absent in others – benefit or harm the patient. These include the therapist being empathic, and providing a clear therapeutic rationale in a healing and restorative setting.

An analysis of several studies shows only 8% of patient improvement during psychotherapy is due to any specific therapy component.

Other research puts the figure at an estimated 15%, with the remainder emerging from non-specific components – a third from the therapeutic relationship, and some from patients “expecting” to improve, but most improvement from patient and extra-therapy factors such as the therapist being empathic, offering a logical model, hope and expectancy of improvement.

But just as the ideal therapist can contribute significantly to improvement, if he or she lacks such ingredients – or is actively “toxic” – then harm occurs.

Cognitive behaviour therapy challenges faulty thinking patterns that cause people to view themselves, their future and the world negatively. Fox valley Institute/Flickr, CC BY

Psychotherapists argue that because their work is “only talking… no possible harm could ensue”. But all effective medication is accompanied by risk and the same holds for talking therapies.

The harm of talking therapies

In 2009, a colleague and I published an overview of reported harmful effects from talking therapies, examining scenarios such as the insensitive, critical, voyeuristic or sexually exploitative therapist, and their prevalence.

In a subsequent research report, we developed a measure of adverse therapeutic styles experienced by people who had received a psychological therapy and left or (perhaps more concerning), remained in therapy and had their condition worsen.

The most common “negative therapist” style identified was a lack of empathy or respect, and not having the patient’s interests at heart.

Next, was the “preoccupied therapist” who made the patient feel alienated and powerless; the controlling therapist who encouraged dependency; and, finally, the passive therapist who was inactive, inexperienced or lacked credibility.

While side effects from medicines are generally physical, the adverse effects of psychotherapy and counselling naturally tilt to the psychological. They tend to leave the harmed person inclined to feel self-blame, helpless, and demoralised (or to become more self-centred and self-absorbed), while commonly remaining dependent on the therapist.

Better ways

To avoid this, all health practitioners should be evaluated by their clients in terms of both style and substance. Most patients seek practitioners who meets both requirements; who are perceived as caring and technically proficient. But, if invited to choose which to prioritise, most will generally go for “style” (preferring the kindly practitioner).

While side effects from medicines are generally physical, the adverse effects of psychotherapy and counselling naturally tilt to the psychological. Doug Wheller/Flickr, CC BY-NC-SA

This is also a matter of concern; kindly practitioners may meander without a therapeutic game plan so that, while the patient is appreciating their warmth, there is no actual progress.

Unfortunately, there are no formal processes in place for evaluating professional psychotherapists and counsellors. While a therapist would not (and could not) allow an independent observer to judge the therapy on a session by session basis, there’s no reason why a patient cannot seek a second opinion from another therapist to determine if the therapy being received is cogent and provided at a professionally logical level.

Informal ratings provided on platforms, such as websites, should not necessarily be trusted because ratings may be weighted to the aggrieved (satisfied customers are less likely to rate), and professional rivals may “load” negative reports.

If someone is exploited or abused by a therapist, they should make a report to the appropriate professional disciplinary board. If the therapist is less overtly concerning (whether simply passive, on the wrong wavelength or causing you to feel troubled or even worse), best to cut and run.

You may have psychological problems but rely on your instincts; therapy that matches your needs is an incomparable balm and will advance your recovery. Therapy that fails this is not worth your while.

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