Monthly Archives: February 2015

How much sleep do we need?

12 September 2014, 6.25am AEST

Explainer: how much sleep do we need?

The amount of sleep adults need has once again come under the spotlight, with a recent Wall Street Journal article suggesting seven hours sleep is better than eight hours and the American Academy of Sleep…

Most adults need seven to nine hours sleep to function at their best. Jiuck/Flickr, CC BY-NC-SA

The amount of sleep adults need has once again come under the spotlight, with a recent Wall Street Journal article suggesting seven hours sleep is better than eight hours and the American Academy of Sleep Medicine drawing up guidelines surrounding sleep need.

So, what should the guidelines say? Unfortunately, when it comes to the amount of sleep adults require there is not really a “one size fits all”. Sleep need can vary substantially between individuals.

Sleep is regulated by circadian and homeostatic processes, which interact to determine the timing and duration of sleep. The circadian process represents the change in sleep propensity over 24 hours, or our internal “body clock”. The homeostatic process represents the accumulation of sleep pressure during wakefulness and the dissipation of sleep pressure during sleep.

Both the circadian and homeostatic processes are influenced by internal factors, such as genes, and external factors, such as prior sleep history, exercise and illness. Individual variations in sleep timing and duration can be largely explained by these internal and external factors.

Individual sleep need

Genes are important in determining diurnal preference: whether we are “night owls” who prefer to stay up late at night, or “early birds” who prefer to get up early in the morning. Genes may also contribute to whether we are “short” or “long” sleepers.

But although genes form the foundation for sleep timing and duration, many external factors also affect sleep need.

Perhaps one of the more common causes affecting sleep duration relates to sleep history. Many adults, whether they know it or not, experience sleep restriction, often on a daily or weekly basis. Restricting sleep or going without sleep (pulling an “all-nighter”) increases sleep pressure.

This sleep pressure dissipates within sleep, so higher sleep pressure requires longer sleep duration. As such, following sleep loss, sleep need increases.

Restricting sleep increases sleep pressure. Kevin Jaako/Flickr, CC BY-NC

Health, exercise, heavy labour, and even mental workload can affect sleep duration. During times of illness, following exercise, or even following periods of mental stress (such as exams), the amount of sleep needed to recover or restore back to normal can increase. Likewise, individuals who suffer from disease or who have poor health may need more sleep than their healthier counterparts.

Sleep need also varies with age, with elderly people generally sleeping less than younger individuals. Age-related changes associated with sleep duration are thought to be due to changes in the interaction between the circadian and homeostatic processes.

The individual variations in sleep need make it difficult to provide a specific recommendation as to how much sleep adults need. However, most sleep researchers generally agree that seven to nine sleep is what the majority of adults require to function at their best.

Why eight hours sleep?

Sleep restricted to seven hours or less results in impairments to reaction time, decision making, concentration, memory and mood, as well increased sleepiness and fatigue and some physiological functions.

On the other hand, eight hours or nine hours sleep has little impact, either negatively or positively, on performance.

Based on these findings, it would seem that for most of the adult population, somewhere between seven and nine hours of sleep is the “right amount”.

This is not to say that more than nine hours sleep is not good. Rather, extending sleep duration may help to “protect” waking function during subsequent periods of sleep loss. While we may not need ten hours sleep all the time, there are some clear benefits from getting more sleep.

Needing an alarm clock to wake up suggests you may not be meeting your sleep need. Jim Wall/Flickr, CC BY

But I am fine with six hours sleep…

The first question you need to ask yourself is, are you really?

You may be one of the lucky few with the “right” genetics. However, it’s more likely that you are simply unaware of how sleep loss is impairing your waking functions.

How we feel does not always reflect how badly we may be functioning, which may result in delusions about how much sleep we really need. Needing an alarm clock to wake up and the desire to sleep-in on weekends/holidays suggests that sleep need is not being met.

Critically though, if you have difficulty sleeping for a continuous eight hours, try not to worry too much, as this may make things worse.

Finding your optimal sleep duration

The amount of sleep need can vary significantly and can depend on multiple different factors, making it difficult to work out optimal sleep need. Below is a guide that might help to determine sleep need.

  1. Keep a diary of your sleep. Include the times you went to bed and woke up, how you slept and how you felt during the daytime
  2. Go to bed when you feel sleepy/tired
  3. If you can, don’t use an alarm clock, rather, let your body naturally wake up
  4. Try to get natural sunlight exposure during the day
  5. Keep to a regular sleep schedule all days of the week.

After a while, you should be able to work out the best timing and duration for your sleep. If you are still unsure or concerned, see your general practitioner. Remember, though — sleep need can change with circumstances, so always listen to your body.

Common medication myths busted

Common medication myths busted by Sydney University pharmacy Professor Andrew McLachlan

Be wary ... medication myths can make people sick, says Professor Andrew McLachlan. Pictu

Be wary … medication myths can make people sick, says Professor Andrew McLachlan. Picture Thinkstock

Know your pain killers

Know your pain killers

YOU can drink alcohol while taking antibiotics says Sydney University pharmacy guru Professor Andrew McLachlan who is on a medication myth-busting crusade.

However, if you believe the drug company hype that painkillers can target specific parts of the body you are mistaken.

Professor McLachlan will bust the six most common medication myths during a talk at Sydney University on Tuesday.

The man who heads the University’s Faculty of pharmacy and who works at Concord Hospital says many people are making themselves sick because they don’t understand how their medicines work.

“As a pharmacist who works at a university and is based at a hospital I see people using medications in ways that surprise me,” he says.

Not true ... it’s a myth that you can’t drink alcohol when you are on antibiotics, says P

Not true … it’s a myth that you can’t drink alcohol when you are on antibiotics, says Professor Andrew McLachlan. Picture: News Corp Australia

Too many people think because they are taking a cholesterol lowering statin medication they don’t need to change their lifestyle to beat heart disease, he says.

“The idea that it’s all about cholesterol is only part of the story, the benefits we get from statins come from studies where people took medication and made lifestyle changes that improved their diet and included moderate exercise,” he said.

“Rarely is a simple tablet a magic cure all,” he says.

AUSSIES SUFFER: Nation being ripped off for medicines compared to Britain

NOT THE ANSWER: Paracetamol won’t reduce back pain

Professor McLachlan has authored more than 185 research papers on how drugs are absorbed and metabolised by the body including one that found paracetamol did not cure lower back pain.

He says it’s a myth that you can’t drink alcohol when you are on antibiotics.

“There is only one class of antibiotics you can’t use with alcohol,” he said.

“The vast majority of people who take antibiotics are not influenced by alcohol at all,” he says.

“The reason you may feel sensitive to antibiotics and alcohol when you are not well is because of the illness,” he said.

Not true ... it’s a myth that you can’t drink alcohol when you are on antibiotics, says P

Not true … it’s a myth that you can’t drink alcohol when you are on antibiotics, says Professor Andrew McLachlan. Picture: News Corp Australia.

There are some medications that affect the central nervous system, and anxiety medications which don’t mix with alcohol, but you can’t generalise he says.

Marketing can mislead consumers into buying medicines they don’t need.

“For example, consumers can pay a lot more for pain relievers that claim to work on specific parts of the body, but the truth is they can’t target specific types of pain,” he says.

Another common problem is patients who stop taking their medications when they feel better.

While this is appropriate for many medicines like antibiotics and pain killers those with chronic conditions like blood pressure and cholesterol need to keep taking their drugs.

“With chronic or long term conditions you are mitigating your health risks, avoiding a train crash in the future like a heart attack by taking your medicines,” he says.

The common belief that complimentary medicines like herbs and vitamins are safe because they are natural is also a problem.

Dismissed ... claims painkillers can target specific parts of the body are incorrect, an

Dismissed … claims painkillers can target specific parts of the body are incorrect, an expert says. Picture: Thinkstock

Herbal medicine can interact in a profound way with prescription medicines, he says.

The herbal antidepressant St John’s wort has been shown in studies to reduce the impact of cholesterol lowering statins drugs.

Some juices like grapefruit, apple and orange juice can increase the effect of prescription medicines.

Patients must always inform their doctor about any complimentary medicines and vitamins they are taking, he says.

Patients who are wary of using generic versions of medications have no scientific basis for their fear because in Australia these cheaper brands must contain exactly the same amount of active ingredient as the brand name version.

The way people respond to their medicines can depend to a large degree on the placebo effect, even the colour of the pill can have an influence he says.

Studies have found patients in pain find a red pill more effective than a white pill, he says.

If you need a sedative a blue tablet seems to be more effective than a white tablet.

And many people feel better simply by taking a pill, they feel their pain subside after taking a tablet even before it has had time to work, he says.

Mindfulness: how to be in the moment … right here, right now

3 October 2014, 6.17am AEST

Mindfulness: how to be in the moment … right here, right now

Remember then: there is only one time that is important – Now! It is the most important time because it is the only time when we have any power. This quote by Leo Tolstoy in What Men Live By and Other…

Right now you have an opportunity to just be. patrick wilken/Flickr, CC BY-NC

Remember then: there is only one time that is important – Now! It is the most important time because it is the only time when we have any power.

This quote by Leo Tolstoy in What Men Live By and Other Tales is valuable wisdom and a fitting prompt for us to take this moment to intentionally direct our attention to what is actually happening now.

You might begin to notice the variety of sights and sounds in your environment. Within your space you can then become aware of your body, its posture and all of its sensations such as those coming from skin, muscles, organs and so on.

Take this moment to tune into your breath, noticing the natural process of breathing in and out. Notice the sensations and movements associated with breathing – in your lungs, chest and abdomen, for example.

Keep breathing naturally as you now observe your current feelings or the quality of your emotions. You can also take notice of your thoughts, accepting them as they are, rather than dismissing or altering them.

Right now you have an opportunity to just be. Pause and grant yourself a short break. Gently close your eyes, if appropriate, and for a few quiet minutes be still.

Follow the above suggestions to openly explore your body, breath, feelings and thoughts at this moment. Begin now and then read on when you are done.

Well done! You have just completed a short mindfulness exercise. For those who declined the invitation, there is still time to go back and have that experience.

What is mindfulness?

Mindfulness is commonly defined as paying purposeful attention to one’s moment-to-moment experience in a non-judgemental and accepting way.

Mindfulness can be considered to be a natural capacity of the human mind. But because we typically shape our mind to wander and be distracted, mindfulness must be cultivated by regularly engaging in techniques that explicitly promote paying attention to the moment.

Increasing mindfulness has a number of benefits including improved psychological well-being and reduced symptoms of anxiety and depression.

Mindfulness techniques can be applied to day-to-day routines. Basilievich/Flickr, CC BY

Accordingly, there has recently been a dramatic uptake of mindfulness training by individuals seeking to improve their health and well-being or to improve their performance in education, sport or corporate settings.

But as promising as the benefits of mindfulness seem to be, the research evidence supporting its efficacy is not conclusive. We don’t yet understand how exactly it works.

One line of thought is based on the capacity of the practices to change the brain in ways that lead to increased attention and cognitive abilities. These changes arise because the techniques of mindfulness emphasise the use of regions of the brain responsible for attentiveness, discernment and behaviour control.

By strengthening these faculties, the brain is better able to regulate emotions and stress. It also becomes better at higher-order processes like divergent thinking, which is an element of creativity.

Researchers are exploring other potential benefits. This year, for example, my colleagues and I published research on the quality of life and emotional well-being benefits of mindfulness development for stroke survivors.

One common debilitating consequence of stroke and other neurological conditions, such as multiple sclerosis, is fatigue. My research review provides preliminary evidence that mindfulness-based interventions may reduce the symptoms of fatigue in those living neurological conditions.

Other researchers are investigating the benefits of mindfulness interventions for chronic fatigue syndrome, cancer-related fatigue and management of chronic pain.

More broadly, research is exploring how mindfulness can support lifestyle changes as part of treatment of medical conditions such as diabetes, high blood pressure and heart disease.

Getting started

Although mindfulness is considered to be relatively safe, before starting out, those with an existing physical or mental health condition should first talk to a health professional. Mindfulness practices should not replace or delay conventional health care.

A variety of techniques can be used to cultivate mindfulness. Some involve purposeful movements such as yoga asana or tai chi, while others are meditation-based.

No conclusive evidence indicates that one technique is superior to another. The technique must emphasise mindfulness development at a level appropriate to one’s experience and preference. Beyond that, participation and outcomes are determined by intention, motivation, expectations and attitudes.

It’s important to get regular practice. Mitchell Joyce/Flickr, CC BY-NC

It is common for people to learn a mindfulness technique by completing a mindfulness course. They then integrate the technique into their daily routine. Regularity of practice is important, even if it is for just a few minutes each day.

As with any skill, learning mindfulness can be quite frustrating. For many, this is the significant barrier to their practice. Working with frustration, or boredom, often provides the initial important lessons of mindfulness.

A well-trained and experienced instructor will ensure the novice is well supported and receives adequate feedback on their progress. And the rapport between instructor and trainee is increasingly being recognised as another important factor developing mindfulness.

In summary, the best way to learn about mindfulness is to practise it. As Albert Einstein said:

Learning is experience. Everything else is just information.

The Evolution of Sleep: 700 Million Years of Melatonin

When the sun sets, the encroaching darkness sets off a chain of molecular events spreading from our eyes to our pineal gland, which oozes a hormone called melatonin into the brain. When the melatonin latches onto neurons, it alters their electrical rhythm, nudging the brain into the realm of sleep.

At dawn, sunlight snuffs out the melatonin, forcing the brain back to its wakeful pattern again.

We fight these cycles each time we stay up late reading our smartphones, suppressing our nightly dose of melatonin and waking up grumpy the next day. We fly across continents as if we could instantly reset our inner clocks. But our melatonin-driven sleep cycle lags behind, leaving us drowsy in the middle of the day.

Scientists have long wondered how this powerful cycle got its start. A new study on melatonin hints that it evolved some 700 million years ago. The authors of the study propose that our nightly slumbers evolved from the rise and fall of our tiny oceangoing ancestors, as they swam up to the surface of the sea at twilight and then sank in a sleepy fall through the night.

Photo

A highly-magnified view of young larva of the marine worm Platynereis dumerilii. Credit Harald Hausen

To explore the evolution of sleep, scientists at the European Molecular Biology Laboratory in Germany study the activity of genes involved in making melatonin and other sleep-related molecules. Over the past few years, they have compared the activity of these genes in vertebrates like us with their activity in a distantly related invertebrate — a marine worm called Platynereis dumerilii.

The scientists studied the worms at an early stage, when they were ball-shaped 2-day-old larvae. The ocean swarms with juvenile animals like these. Many of them spend their nights near the ocean surface, feeding on algae and other bits of food. Then they spend the day at lower depths, where they can hide from predators and the sun’s ultraviolet rays.

Maria Antonietta Tosches and her colleagues examined how different genes became active in the worm larvae. They discovered that some cells on the top of the larvae make light-catching proteins — the same ones we make in our eyes to switch melatonin production on and off. These same cells also switch on genes required to produce melatonin.

The scientists wondered if the worms were using this network of melatonin genes the way we do. To find out, Dr. Tosches and her colleagues tracked the activity of the genes over 24-hour periods.

They found that the worms didn’t produce melatonin all the time. Instead, they made it only at night, just as we do.

The scientists also found that this nightly surge of melatonin allowed the worms to move up and down in the ocean each day.

The worms travel by beating tiny hairs back and forth. During the day, they rise toward the surface of the ocean. By the time they get there, the sun has gotten so faint that the worms start making melatonin.

The hormone latches onto the neurons that control the beating hairs and cause them to produce a steady rhythm of electrical bursts. The bursts override the beating, causing the hairs to freeze and the worm to sink. When dawn comes, the worms lose their melatonin and start to swim upward again.

When it comes to melatonin, humans and worms are so similar that they can both get jet lag.

“If you take larvae in daytime and put them in darkness, they stay in their own daytime behavior,” Dr. Tosches said. The melatonin-driven cycle continues to determine how they swim. “They have a clock that’s controlling this,” she said.

That the melatonin network works so similarly in worms and humans suggests that it was what arose in their common ancestor. “It could have been the first form of sleeping,” said Detlev Arendt, a co-author of the new study.

David C. Plachetzki, an evolutionary biologist at the University of New Hampshire who was not involved in the study, called it “an exciting paper — it’s a very complete story.”

Still, he added that while the similarities between worms and humans were striking, there was more work to be done to confirm an evolutionary link. It would still be necessary to find melatonin playing a similar role in other animals.

“We just have this tantalizing hypothesis,” Dr. Plachetzki said. “But it’s a great hypothesis.”

The new study offers an intriguing idea for how our vertebrate ancestors adapted the melatonin genes as they evolved a complex brain.

Originally, the scientists argue, the day-night cycle was run by all-purpose cells that could catch light and make melatonin. But then the work was spread among specialized cells. The eyes now took care of capturing light, for example, while the pineal gland made melatonin.

The new study may also help explain how sleep cuts us off from the world. When we’re awake, signals from our eyes and other senses pass through the thalamus, a gateway in the brain. Melatonin shuts the thalamus down by causing its neurons to produce a regular rhythm of bursts. “They’re busy doing their own thing, so they can’t relay information to the rest of the brain,” Dr. Tosches said.

It may be no coincidence that in worms, melatonin also produces electrical rhythms that jam the normal signals of the day. We may sink into sleep the way our ancestors sank into the depths of the ocean.

Use your illusion: how to trick yourself and others into eating less

1 October 2014, 5.48am AEST

Use your illusion: how to trick yourself and others into eating less

We know that bigger portions lead us to eat more but portions that appear bigger have a reverse effect. Stephen Holden, Author provided

Science has a simple and incredible trick that will help you lose weight. The idea, it seems, is to make portions appear bigger because this leads people to serve and eat less.

While many such fat-fighting claims are fake, this idea is that a fiction can have a real effect. We know that bigger portions lead us to eat more (bite-sized  version here), but portions that appear bigger have a reverse effect.

Visual illusions have long fascinated humans but mostly they are viewed as problems to be explained. Philosophers study them for the challenges they offer to the nature of being (ontology) and of knowledge (epistemology).

Nouvelle cuisine is often criticised as providing tiny portions. Ross Pollack/Flcikr, CC BY-NC-SA

Psychologists study them for the light they throw on our understanding of how the human brain works and its limitations.

Consumer scientists such as Brian Wansink and Koert van Ittersum have been exploring how optical illusions can be used to help reduce consumption and tackle the growing prevalence of obesity.

Using smaller plates is a fairly obvious solution to limit portion sizes. But there’s more to it than simply providing less space. Research shows that a portion served on a small plate will look bigger than it is, so people tend to under-serve on small plates and consume less.

The use of bigger plates leads to the reverse effect – the portion looks smaller than it is. This may underlie the common criticisms of nouvelle cuisine as providing “tiny portions” that are more art form than food.

The illusory effect of plate size on portion size is explained by theDelboeuf illusion, and the related Ebbinghaus illusion.

The Delboeuf illusion is one of the reasons for the effect of plate size on portion size. Washiucho via Wikimedia Commons

The Delboeuf and Ebbinghaus illusions are thought to critically depend on the contrast in size between the target (the circle in the centre) and the surrounding context.

A portion of food appears smaller when served on a bigger plate, encouraging us to over-serve. But the size contrast is complicated by the issue of colour contrast.

The tendency to over-serve on big plates is amplified when there’s not much of a contrast in the colour of the food and the plate, such as pasta with a creamy sauce served on a white plate. Over-serving on bigger plates is also more likely if there’s high contrast between the plate colour and the tablecloth colour.

So, if you are using large plates, choose plates of a colour different from the food and similar to the tablecloth.

People drink less from a tall, thin glass than a short, wide glass with the same volume. Luciano Meirelles/Flickr, CC BY-SA

You can also use these illusions with beverages. If you want to reduce your intake of sweetened drinks or alcohol, for instance, use tall, thin glasses in place of short, wide glasses.

People drink less from a tall, thin glass than a short, wide glass with the same volume. This effect is displayed by adults and is even stronger among children. It also holds for pouring drinks – even after training, and even among experienced bar-tenders.

Indeed, this illusion is so persuasive that many people are surprised to find the volume of large sizes is often little different from the next size down.

Sports fans in the United States recently revealed how a Seattle stadium and an Idaho stadium have sold small and large cups of beer holding roughly the same volume, even though the larger one costs more.

Similar claims have been made about more mainstream food retailers such as McDonald’s and the Canadian coffee shop chain, Tim Hortons. Hortons has responded with its own clip showing there is a difference.

McDonald’s medium and large cups hold the same volume.

The reason that the illusion works is not clear although it may be related to orientation anisotropy, the well-known tendency to perceive a vertical line as longer than an equivalent horizontal line.

What all this shows is that to encourage yourself and others to serve less, and to eat less, you should:

  • use smaller plates
  • use the same colour plates and tablecloth, and maximise the colour contrast with the food being served if using big plates
  • use tall, thin glasses, such as wine-tasting glasses.

To use the over-serve bias to encourage more consumption of healthy foods, use big green plates for vegetables and short, wide glasses for water.

Many claims about reducing consumption and losing weight hold little truth, but the illusions described here present little fictions that might actually help.

Genitourinary syndrome of menopause

Women are often not aware that a deterioration of the vagina, bladder and surrounds is a natural part of menopause, but is not pleasant. Oestrogen is the best and most effective treatment for this.
Menopause. 2014 Sep 2. [Epub ahead of print]

Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society.

Abstract

BACKGROUND:

In 2012, the Board of Directors of the International Society for the Study of Women’s Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms related to menopause.

METHODS:

The 2 societies cosponsored a terminology consensus conference, which was held in May 2013.

RESULTS AND CONCLUSIONS:

Members of the consensus conference agreed that the term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy. GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria and recurrent urinary tract infections. Women may present with some or all of the signs and symptoms, which must be bothersome and should not be better accounted for by another diagnosis. The term was presented and discussed at the annual meeting of each society. The respective Boards of NAMS and ISSWSH formally endorsed the new terminology-genitourinary syndrome of menopause (GSM)-in 2014.

Beating Back the Risk of Diabetes

Beating Back the Risk of Diabetes

Photo

Credit Scott Bakal
Personal Health
Personal Health

Jane Brody on health and aging.

This year, nearly two million American adults and more than 5,000 children and adolescents will learn they have a potentially devastating, life-shortening, yet largely preventable disease: Type 2 diabetes. They will join 29.1 million Americans who already have diabetes.

Diabetes and its complications are responsible for nearly 200,000 deaths a year; the fatality rate among affected adults is 50 percent higher than among similar people without diabetes. Alarmingly, recent studies even have linked diabetes to an increased risk of dementia and Alzheimer’s disease. Even people with above-average blood glucose levels, but not diabetes, have an elevated risk.

Type 2 diabetes runs in families, largely because its primary risk factor — excess weight — runs in families. But you can keep it at bay by losing weight and becoming more active.

Unfortunately, as numerous studies have shown, intensive efforts to get people to lose weight, eat healthier and become moderately active fail more often than not even among those who already have diabetes. It is easier (and more effective) to avoid becoming overweight in the first place.

But it is by no means impossible to lose weight, and at some point, your physical and mental well-being may depend on it. Here are some diet and exercise tips that can help.

Avoid drastic measures. Crash diets and kooky eating plans are doomed to fail. It’s better to make gradual changes in what and how much you eat to give your body a chance to adjust.

The Diabetes Prevention Program study, conducted among about 3,800 people who had pre-diabetes, found that moderate weight loss — an average of 12 pounds — reduced the odds of progression to diabetes by nearly 50 percent.

Although total calories must be reduced, you don’t have to count them. Rather, concentrate on your food choices and gradually reduce portion sizes. Some people find it helpful to write down everything they eat and drink each day for a week or two.

An excellent discussion of what is known about the effect on diabetes of various foods and supplements appeared recently in Nutrition Action Healthletter at cspinet.org/iceberg.pdf. Some highlights:

Carbohydrates — breads, grains, cereals, sugary drinks and sweets of all kinds — are most problematic for people with diabetes or at risk of developing it. Carbohydrates are eventually metabolized to glucose, which raises the body’s demand for insulin. Consume less of them in general, and choose whole-grain versions whenever possible.

If you must have sweet drinks, select artificially sweetened ones. In two huge studies of nurses and other health professionals who were followed for 22 years, those who drank one or more sugary soft drinks a day had about a 30 percent higher risk of developing diabetes than those who rarely drank them, even after their weight was taken into account.

Fruit juice is not necessarily safer than soda. All drinks with fructose (table sugar, high-fructose corn syrup, honey or agave) may increase body weight, insulin resistance and belly fat, all of which can promote diabetes.

But there’s good news about coffee. Two or three cups of coffee (but not tea) a day, with or without caffeine, have been consistently linked to a lower risk of Type 2 diabetes. Consider having coffee (unsweetened or artificially sweetened) in place of soft drinks. Keep in mind that specialty coffee drinks can be loaded with sugar and calories.

For protein, limit consumption of red meat, especially processed meats like sausages, hot dogs and luncheon meats, which are linked to a higher diabetes risk. Instead, choose fish, lean poultry (skinless and not fried), beans and nuts.

Low-fat dairy products, including yogurt, and even fatty ones may lower the risk of diabetes; the reason is unclear.

Most protective are green, leafy vegetables — spinach, chard, kale, collards, mustard greens and even lettuce — as well as cruciferous vegetables like cabbage, broccoli and cauliflower. But all vegetables are good and should fill at least two-thirds of your dinner plate.

Consider dining several times a week on a big salad, adding beans, fish or chicken for protein. Use dressing sparingly.

The nutrients magnesium and vitamin D are also potentially protective. In fact, the preventive value of leafy greens, whole grains, beans and nuts may lie in their high magnesium content. In a well-designed clinical trial of 32 overweight people with insulin resistance, the prelude to diabetes, blood glucose levels and insulin sensitivity improved in those who took a daily magnesium supplement for six months.

Don’t go overboard: More than 350 milligrams of magnesium daily can cause diarrhea.

Vitamin D, long known to be crucial to healthy bones, may also be helpful. In one study of 92 overweight or obese adults with prediabetes, those who took a supplement of 2,000 international units of vitamin D daily had better function of the pancreatic cells that produce insulin.

In studies of people who already had diabetes, however, vitamin D supplements did not seem to help, perhaps because their benefit was overwhelmed by the medications taken by participants.

Of course, how much you weigh and what you eat are not the only concerns. Regular, preferably daily, physical exercise is a vital component of any prevention and treatment program for Type 2 diabetes, or most any chronic ailment. Weight loss can reduce diabetes risk by about 50 percent, but adding exercise to that can lower the odds by 70 percent, compared with people who remain overweight and inactive, according to a study that followed nearly 85,000 female nurses for 16 years. Women who were active for seven or more hours weekly had half the risk of developing diabetes as did women who exercised only a half-hour a week.

It helps to live in a community where walking, the nation’s most popular form of exercise, is feasible and safe. A Canadian study of recent immigrants found a significantly higher incidence of diabetes among those living in areas where it was a challenge to walk.

When communities are retrofitted, or new living and working environments are developed, creating areas conducive to exercise should always be part of the plan.

 

Why research beats anecdote in our search for knowledge

There is still so much snake oil peddled, and intelligent people who make wrong health choices for the best of reasons, because they forget to follow the facts and the evidence about what works. People often feel they are experts in something after a few weeks of study and research online, thinking they know better than their own doctors, who have spent years studying these subjects in great detail. I would not like to cross a bridge built by someone who learned how to do it online after a few weeks! I would trust a fully qualified engineer anytime. Well, so is it with medicine. The whole issue of deaths from unvaccinated children brings this into clear focus, just for one example.
22 September 2014, 6.40am AEST

Why research beats anecdote in our search for knowledge

UNDERSTANDING RESEARCH: What do we actually mean by research and how does it help inform our understanding of things? We begin today by looking at the origins of research. It is comforting to feel like…

US Army scientists analyse unknown samples to determine whether hazardous. That’s typical of research trying to understand the unknowns and expand on our knowledge. Flickr/US Army RDECOM, CC BY

UNDERSTANDING RESEARCH: What do we actually mean by research and how does it help inform our understanding of things? We begin today by looking at the origins of research.


It is comforting to feel like we understand the world around us and reassuring to have an explanation for everything. But where does our understanding come from and how reliable is it?

Certainty is seductive, so we tend to cling to it. We hunt for evidence that buttresses it, while ignoring or rejecting evidence that threatens to undermine it.

How does it all work? Flickr/Helga Weber, CC BY-NC-ND
Click to enlarge

We seek out friends and media commentators who share our certainty, and then reinforce that certainty in their company. We use certainty as a bulwark in our conversations with others and we use it to thump tables when we bump up against someone else’s convictions.

But deep down we all know that the universe is a bafflingly complex place, and that most things that happen will surprise us and challenge our understanding of how things really are.

In quiet moments, we might even acknowledge that much of our certainty rests on flimsy foundations of perceived wisdom, common sense and intuition, anecdote and wishful thinking.

How do we know?

Consider disease. For the majority of human history most people were certain that disease was caused by the machinations of malevolent spirits. Or they were sure it was cast upon us by witches and warlocks.

Or they were convinced that victims brought it upon themselves by their own wicked ways (irrespective of the easily overlooked fact that a mere babe dying of smallpox was incapable of malice).

More recently, many people were certain that disease was caused by “miasma” such as the fetid fog that wafted off the sewerage-laden Thames in 19th century London, UK.

Was it the fog on Thames that caused disease in old London – or something else? Flickr/tim_d, CC BY-NC-SA
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After all, those who lived in whiffing distance of the Thames were the ones most likely to be struck down by cholera (irrespective of the easily ignored detail that the disease could spread even without the miasma’s help).

These false notions of disease were, in a sense, intuitive. They fit with our common sense understanding of how the world works: if A happens before B, then A is the cause of B.

Yet no amount of certainty prevented these theories of disease from being utterly wrong, thus crippling our ability to treat them. As it happens, most diseases are caused by microscopic pathogens which are, by their very nature, invisible to our naked eye observations. As such, they were beyond the ken of common sense.

It took rigorous scrutiny of the available facts, acknowledgement of subtle inconsistencies and irregularities in the prevailing theories, as well as careful experimentation and detailed observation in order to reveal the true cause of disease.

Rise of the researcher

It also took a few brave people to embrace uncertainty. It took them to admit their ignorance and decide to follow the facts wherever they took them, even if that path was long and arduous, and raised more questions than it answered.

It took more than common sense and intuition, anecdote and wishful thinking to discover germs and transform medicine. It took genuine research to reveal the facts.

Research is the key to being a scientist. Flickr/Jabiz Raisdana, CC BY-NC
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The results speak for themselves: life expectancy at birth before germ theory was under 40, with between 10%-30% of infants never making it to adulthood.

Only half of those who reached the age of 20 went on to survive to 60. The primary killer was infections. Today in those countries that have embraced germ theory and modern medicine, it is closer to 80.

Research itself can be defined in many ways, but at its core it’s ultimately about rigour. Genuine research – whether in the sciences or the humanities – does not rely on intuition or common sense. It doesn’t lean on anecdote or conjecture. It doesn’t seek to reinforce pre-existing beliefs or ratify wishful thinking.

Genuine research acknowledges that reality is not transparent to human perception and that we have to work hard to uncover the facts. It uses uncertainty as a guidepost to knowledge rather than a stop sign for further enquiry.

Genuine researchers are those rare individuals who have come to terms with their uncertainty and confront it on a daily basis. They have embraced rigour in their methods of enquiry and value truth over comfort. Their hard work over the past couple of centuries has lifted us out of the fog of ignorance and into the world of knowledge and prosperity we inhabit today.

Then come the doubters

Yet, somehow, our appreciation for the power of rigorous research has diminished in recent years.

It is ironic that the world we live in today is built on a solid foundation of rigour in a number of fields such as science, medicine, economics, political science and many others. Yet that same world makes it easier than ever for non-experts to spread their intuitive falsehoods under the pretext of common sense.

We’ve probably all come across the various online ads saying some new easy health tip or other – such as easy teeth whitening – that was “discovered by a mom”, or seen Hollywood actors called upon as experts in fields other than acting. Jenny McCarthy might be photogenic, but her comments about vaccines are as dangerous as they are uninformed.

Anecdote often passes as evidence, and post-hoc explanations often pass as theories. Intuitive explanations spread throughout the internet, made appealing by their simplicity rather than their veracity.

Why research matters

Research, and researchers, deserve better than that.

If we value fact over falsehood then we should constantly remind ourselves of the dangers of certainty and the poverty of intuition. We should remind ourselves that our belief in something should be held with a conviction proportional only to the evidence we have in support of it.

And if we haven’t undertaken the rigours of research ourselves to uncover that evidence, then we should place greater credence on the words of those who have.

Certainty is seductive, wishful thinking is alluring and anecdote can be compelling. But they are also symptoms of a disease for which rigorous research is the only cure.

The Placebo Effect Doesn’t Apply Just to Pills

For a drug to be approved by the Food and Drug Administration, it must prove itself better than a placebo, or fake drug. This is because of the “placebo effect,” in which patients often improve just because they think they are being treated with something. If we can’t compare a new drug with a placebo, we can’t be sure that the benefit seen from it is anything more than wishful thinking.

But when it comes to medical devices and surgery, the requirements aren’t the same. Placebos aren’t required. That is probably a mistake.

At the turn of this century, arthroscopic surgery for osteoarthritis of the knee was common. Basically, surgeons would clean out the knee using arthroscopic devices. Another common procedure was lavage, in which a needle would inject saline into the knee to irrigate it. The thought was that these procedures would remove fragments of cartilage and calcium phosphate crystals that were causing inflammation. A number of studies had shown that people who had these procedures improved more than people who did not.

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Some types of knee operations have proved to be no more successful than fake surgeries. The results were all in people’s heads. Credit Michael Williamson/The Washington Post, via Getty Images

However, a growing number of people were concerned that this was really no more than a placebo effect. And in 2002, a study was published that proved it.

A total of 180 patients who had osteoarthritis of the knee were randomly assigned (with their consent) to one of three groups. The first had a standard arthroscopic procedure, and the second had lavage. The third, however, had sham surgery. They had an incision, and a procedure was faked so that they didn’t know that they actually had nothing done. Then the incision was closed.

The results were stunning. Those who had the actual procedures did no better than those who had the sham surgery. They all improved the same amount. The results were all in people’s heads.

Many who heard about the results were angry that this study occurred. They thought it was unethical that people received an incision, and most likely a scar, for no benefit. But, of course, the same was actually true for people who had arthroscopy or lavage: They received no benefit either. Moreover, the results did not make the procedure scarce. Years later, more than a half-million Americans still underwent arthroscopic surgery for osteoarthritis of the knee. They or their insurers spent about $3 billion that year on a procedure that was no better than a placebo.

Sham procedures for research aren’t new. As far back as 1959, the medical literature was reporting on small studies that showed that procedures like internal mammary artery ligation, a surgical procedure used to treat angina, were no better than a fake incision.

In 2005, a study was published in the Journal of the American College of Cardiology proving that percutaneous laser myocardial revascularization, in which a laser is threaded through blood vessels to cut tiny channels in the heart muscle, didn’t improve angina better than a placebo either. We continue to work backward and use placebo-controlled research to try to persuade people not to do procedures, rather than use it to prove conclusively that they work in the first place.

Gum disease linked to chronic health problems

This study shows the importance of flossing, brushing the teeth regularly, and having a regular dental checkup – all good preventative measures.
28 July 2014, 4.15pm AEST

Gum disease linked to chronic health problems

Researchers have found that treating gum disease (periodontal disease) may reduce heart disease, diabetes and other conditions.

The study involved health and dental insurance records from 338,891 people with one of five conditions. The conditions included type 2 diabetes, heart disease, cerebrovascular disease (disease of the blood vessels supplying the brain), rheumatoid arthritis and pregnancy.

Researchers found that within four years, the people who had gum disease treatment had lower medical costs and fewer hospitalisations compared with people who weren’t treated. For example, people with cardiovascular disease and diabetes who had the gum disease treatment had health-care costs that were between 20% and 40% lower.

The link between gum disease and chronic health conditions is inflammation. The build-up of inflammatory substances in the blood can worsen chronic health conditions.

The results of the study provide new evidence that the noninvasive therapy may improve health outcomes for chronic conditions.