Monthly Archives: July 2015

Why do some breast cancers come back?

27 April 2015, 5.30am AEST

Explainer: why do some breast cancers come back?

Breast cancer is one of the most common cancers in the Western world, with 15,000 women (and about 70 men) diagnosed each year in Australia.

For 10% of patients the disease will return. Fotos593/Shutterstock

Cancer is a collection of many hundreds of diseases. The common factor is that once-normal cells have undergone a series of mutations in their genes that has led to uncontrolled growth and an impaired ability to die when they normally should.

Cancers may also spread into other organs, forming secondary cancers, called metastases. When patients die of cancer, it’s usually due to these metastases.

Breast cancer is one of the most common cancers in the Western world, with 15,000 women (and about 70 men) diagnosed each year in Australia. Fortunately, with modern treatments, more than 90% of women with breast cancer go on to have a normal life expectancy, though the side effects of both the cancer and its treatment affect many aspects of their lives.

When detected, cancer can be classified into stages, based on how advanced the disease is in the body.

In breast cancer, the important factors include the aggressiveness of the cells (the grade) and specific proteins that they make. These proteins drive the growth of the tumour cells, including some that bind to female hormones such as oestrogen and growth-promoting proteins such as HER2. Whether a tumour has involved lymph nodes under the arm is also of great importance in assessing its likely potential to spread further.

These markers guide us closely in what drug treatments to consider but also suggest a “prognosis” – that is, how likely the cancer is to be cured or to come back.

So, a patient with breast cancer may undergo surgery to remove the lump and any involved lymph nodes, radiotherapy to try to ensure the cancer does not come back in the breast or lymph nodes nearby, and drug treatments that depend on these markers of aggressiveness. This is done as an “insurance” to increase the chances that the tumour never returns. Scans such as computed tomography (CT scans) are not usually helpful to monitor for recurrence, as small numbers of tumour cells can still be present, but cannot be seen.

Yet for 10% of patients the disease will return – often many years later – and this person is likely to die eventually of cancer. Even though other treatments may shrink the cancer, they cannot get rid of it all together, so unfortunately cure is not possible.

It is assumed that before this recurrence occurs, tiny microscopic nests of cancer cells are lying dormant somewhere in the body. A major quest for cancer researchers has therefore been to find where these cells are hiding and what causes them to wake up and cause secondary cancer.

One intriguing observation has been that in up to 10% of patients previously treated for cancer who are apparently “cancer free”, very careful examination of both blood and bone marrow reveals a few residual cancer cells. This is strongly linked with a more likely chance of cancer coming back.

However, this is not universal. And we know that many supposed cancer cells floating in the bloodstream will in fact be mopped up by the bodies’ immune system or will die “of natural causes”. So, can we better define which are which?

One promising feature under intense scientific scrutiny is the so-called mesenchymal state of the cells. This indicates the cancer cells have changed from looking even less like their cell of origin – in this case, a breast cell – to more primitive cells that can move uninhibited in blood and spread through tissues. This is the same process the body uses in developing embryos and in other situations such as wound healing.

These mesenchymal features allow cancer cells to survive in the toxic environment of the bloodstream, to evade many of our current treatments such as chemotherapy and to set up home in distant organs – the process of metastasis, or secondary cancers.

We still don’t know what causes cancer cells to undergo mesenchymal change (termed epithelial-mesenchymal plasticity or EMP), but understanding it means we are a step closer to developing drugs that can modify or stop the process. It also takes us closer to identifying a biomarker, so we can determine which patient may benefit from these as-yet-undeveloped drugs.

No, you don’t have to finish all your antibiotics

17 April 2015, 6.24am AEST

No, you don’t have to finish all your antibiotics

Advice that you have to finish the whole course of antibiotics reflects long-standing convention or the drug manufacturer’s decision during an initial trial, rather than scientific evidence.

Recommended antibiotic courses are often arbitrary. Katy/Flickr, CC BY-NC-SA

Most people believe – and have been told by health professionals – that it’s essential to finish a course of antibiotics to prevent antibiotic resistance. But this advice is not only wrong, it could actually be harmful.

The idea that you have to take all the antibiotics you’re prescribed is based on the assumption that all the bacteria causing the infection have to be killed, so the surviving minority don’t become resistant. In fact, for most otherwise healthy people, significantly reducing, but not necessarily totally eliminating, the bacteria causing the infection allows the body’s natural defences to take over and mop up the remaining few.

Some important caveats

There are some special circumstances when it’s important to kill all the bacteria – when the patient’s normal defences are damaged for any reason, for instance, or when the infection is in a site that’s relatively inaccessible to antibiotics and the white blood cells that kill bacteria. This can be in the middle of an abscess or cavity filled with pus (as in tuberculosis infection), on a foreign body, such as a prosthetic heart valve, or in dead tissue that can’t be removed (as in osteomyelitis or infection of the bone).

Obviously, stopping antibiotics before a serious infection is cured will risk a relapse. That’s what happened to Albert Alexander, the London policeman who was one of the first people to be treated with penicillin by Howard Florey in 1941.

Alexander had a terrible infection that started with a scratch on his face. He developed abscesses all over his head and had already had an eye removed, but he was dying.

Within 24 hours of being given a small dose of penicillin, his fever fell, his appetite returned and the abscesses started to heal. But when the penicillin supply ran out after five days, the infection flared up again. Alexander died four weeks later.

We now know that severe staphylococcal infection with multiple abscesses, which is what Alexander had, is a type of infection that needs antibiotic treatment for weeks to prevent relapse. But there’s a lot we still don’t know about the best way to treat some types of infection. It has recently become clear that some of the conventions around antibiotic prescribing are neither based on evidence nor harmless.

Antibiotics are generally benign but they all cause allergies and other rare side effects in a small proportion of people. And there’s a universal effect that’s less well known – even a very short course will kill many of the friendly bacteria in the gut.

The effect lasts for weeks, and the longer the antibiotic course, the greater the risk that antibiotic-resistant bacteria will take their place and cause harm. What’s more, they can spread to other people and add to the pool of antibiotic resistance in the community.

They can do worse damage too. Antibiotic-resistant bacteria include Clostridium difficile, which can be carried harmlessly in the bowel until a course of antibiotics kills off its competition. This allows it to multiply and produce toxins, potentially causing life-threatening diarrhoea.

Antibiotics are generally benign but they all cause allergies and other rare side effects in a small proportion of people. Melissa Bowman/Flickr, CC BY

This, in turn, increases the risk of the bug spreading to other people, especially in hospitals and nursing homes where serious outbreaks often occur. Again, the longer the antibiotic course, the greater the risk of antibiotic-associated diarrhoea.

The right dose

The rate of antibiotic resistance (in a community, a hospital or a whole country) is proportional to the total amount of antibiotics used. The relationship is complex but the dangerous increase in multidrug-resistant bacteria has led some experts to predict the “end of the antibiotic era”. This is the downside of 75 years of antibiotic therapy.

Antibiotics have saved countless millions of lives, but have been often misused because of the misguided belief that they are harmless.

The most important – but hardly novel – message for doctors is “don’t prescribe antibiotics unnecessarily, especially for colds and flu, which are nearly always viral”. Antibiotics simply don’t work in acute upper respiratory infections. We all know from experience that a cough will often last for around ten days and there’s not a lot we can do to change that.

The problem is that it’s not always obvious whether some illnesses are due to infection and whether they are bacterial – and so might need treatment – or viral. Tests might help, but the patient would have to wait for results. So the decision to treat is usually based on clinical judgement – often influenced by the patient’s anxiety and the doctor’s (in)tolerance of risk.

The challenge for doctors and patients is to weigh the risks and benefits of treatment. Unless there are compelling reasons to start immediately, we should wait for test results or to see how symptoms develop. Equally importantly, we should stop the treatment immediately if, in hindsight, the diagnosis was wrong or symptoms disappear quickly.

Some serious bacterial infections, of course, need urgent and quite prolonged treatment. How long depends on the type of infection, how serious it is, the patient’s underlying condition and response to treatment.

But recommended antibiotic courses are often arbitrary; they may reflect long-standing convention or be based on a manufacturer’s decision during an initial drug trial. Recent clinical trials show that even for some serious infections, shorter antibiotic courses can be as effective as conventional, longer ones.

The general rule is: the shorter the course, the lower the risk of side effects or resistance. More trials are needed to determine the shortest courses that can be recommended without increasing the risk of relapse. But ultimately, it will still depend on clinical judgement not arbitrary rules, conventions or package inserts

Brainy bones: the hidden complexity inside your skeleton

17 April 2015, 12.18pm AEST

Brainy bones: the hidden complexity inside your skeleton

The network of bone cells inside your skeleton rivals your brain in terms of complexity.

Your bones are cleverer, and more complex, than you might think. Michael Dorausch, CC BY-SA

Your bones are savvy. They are light yet strong and they repair themselves when they break. What’s more – although you can’t tell – your bones continually renew themselves, replacing old bone for new.

This isn’t unique. Other tissues and cells (most noticeably skin) replace themselves. But bones do it with adaptation, adjusting to meet the body’s mechanical and physiological needs.

How does the skeleton achieve something so remarkable? New imaging technology is revealing a previously under-appreciated dimension of bones: the living cellular network built deep inside them. This living network is composed of the most abundant cell in bone: the amazing osteocyte.

Osteocytes (literally “bone cells”) are buried alive in bone tissue whenever bone is formed. They develop long branch-like dendritic fingers that infiltrate the tissue and reach out to interconnect with one another.

Living inside hard, rock-like bone, osteocytes have been difficult to study. They were considered inactive and uninteresting for a long time. They are now known to sense mechanical strains, orchestrate bone tissue renewal, and regulate calcium levels in the bloodstream.

Almost as complex as the brain

As more researchers investigate these cells and their network, the picture has become more elaborate. Osteocytes are clearly numerous and densely interconnected (see the image below), but putting an actual number on them had never been done. But it’s worth doing.

Numbers in biology help us discover new insights, so much so that researchers have set up a database and handbook of many “bionumbers” across many species, collected from the scientific literature.

For example, the number of synapses in the human neural cortex is estimated at 150 trillion. An MIT-led citizen science project involving 120,000 online gamers has already helped in understanding how the brain sees movement by mapping these connections through a project called EyeWire.

But why should anyone care about the number of osteocytes? Because, as well as controlling bone strength and the release of vital minerals such as calcium and phosphate into the bloodstream, there is now evidence that these cells might influence how your immune system works, how fat you are, how your kidney works, and even male fertility.

So, to get a sense of the size of the osteocyte network, we started to quantify it in the human skeleton. What we found exceeded even our expectations. It turns out that inside your skeleton lives a network that is almost as complex as the neural network of your brain.

Osteocytes and their dendritic fingers form a network within bone Kevin Mackenzie, University of Aberdeen, Wellcome Images (B0008430), CC BY-NC-ND
Click to enlarge

How the numbers stack up

Taking recent imaging data (e.g. here and here), we calculated that the human skeleton contains about 42 billion osteocytes. That’s about six times the Earth’s population. In comparison, the human brain contains 86 billion neurons, packed in a volume (around 1.2 litres) comparable with that of the skeleton (which is about 1.75 litres). Although, of course, the skeleton is more spread out.

When we added together the length of these little cell fingers, imagining them being placed end to end, we found that this network is about 175,000 kilometres long. That’s more than four times the Earth’s circumference, and almost identical to the total length of axons in the brain: 180,000 km.

We based many estimates on simple algebraic manipulations of previously published data. But one essential piece of information could not be estimated easily: the number of connections osteocytes make with their neighbours. A brain without connections can do nothing, so estimating connections in the osteocyte network is important.

Unfortunately, connections between osteocytes are hard to see directly. What is seen instead are the little tunnels through the bone that osteocytes and their fingers live in.

So to measure this proxy tunnel network and the cell network within, we resorted to a mathematical model of dendritic finger branching. Feeding this model with data on the proxy network, we calculated that 23 trillion connections exist in the osteocyte network of the human body.

An evolved smart biomaterial

So, by these measures, your skeleton is a lot like your brain, with a similar number of cells interconnected in a similar sized space. But why do our skeletons need such a complex network? We don’t know exactly, but we do know that these cells exchange information, just like neurons do.

The tunnels that osteocytes occupy can still be seen in old bones, including dinosaur fossils. We can use this information to understand how bones have evolved to become the self-detecting and self-regulating biomaterial we own; that’s something that can’t be done with brain fossils.

Osteocytes communicate with each other about where the skeleton is weak and needs to be strengthened, or where there is damage that needs to be fixed. These messages are transmitted to cells on the bone surface that are able to remove damaged bone (osteoclasts) and form new bone (osteoblasts).

We know very little about how these cells communicate. But if we did, we could find better treatments for skeletal disorders like osteoporosis or osteogenesis imperfecta, and find ways to get football players back on the field more quickly (and more safely!) after a fracture.

In the meantime, the next time you stand up, walk around or do weights, think about how the network of osteocytes in your bones is responding to the stresses and strains you are putting it through. And thank your osteocytes for keeping your skeleton strong (and smart) enough to support you.

The Fish we Eat

Every study shows the benefits of eating fish, and humans have been doing this from time immemorial. However, most fish today contain nasty contaminants, and are not that healthy. This is sad for a country like Australia, with a big coastline and huge fisheries. So how come most our fish come from Vietnam or Thailand. Make sure the fish you eat is genuine reef fish, or go for New Zealand fish if available. (Hoki)
Is Tilapia Unhealthy? Dr Weil
Published: 3/11/2015

Farm-raised tilapia is one of the most commonly consumed fish in America, yet it has very low levels of beneficial omega-3 fats compared to its content of omega-6 fatty acids. Omega-6’s are essential, but the American diet typically includes far too much of this kind of fat. An overabundance of dietary omega-6 is pro-inflammatory, and inflammation is a key contributor to many chronic health conditions.

In addition, farmed fish (tilapia or not) are raised in crowded conditions that are unnatural – and to help prevent infection they are given antibiotics. This means the fish are likely to contain residues of antibiotics and other synthetic compounds used to control diseases that occur when fish are crowded in pens. They may also have lower levels of protein – as much as 20 percent less – compared to wild fish, and higher concentrations of cancer-causing chemicals such as PCBs and dioxin. They represent environmental negatives as well – they are resource- and energy-intensive (it takes several pounds of feed fish to produce one pound of farmed fish) and do not protect dwindling wild stock.

Tilapia is not necessarily unhealthy, but I recommend reaching for the best fish of all – wild-caught Alaskan salmon. It has an impressive omega-3 to omega-6 fatty acid ratio and is a species associated with fewer concerns about environmental toxins. While it is more expensive than tilapia, it is a worthy investment in your health that can reap dividends for the future. If you prefer white fish, look for wild-caught halibut or black cod as a healthy alternative.

Taste over waste: ugly food movement winning friends

20 March 2015, 3.57pm AEDT

Taste over waste: ugly food movement winning friends

Convincing people to love ugly food makes sense for farmers and retailers, but will shoppers buy it?

The warty pumpkin: beautiful on the inside. Circleville Pumpkin Show/Flickr, CC BY

Consumer driven food trends are nothing new. “Organics”, gluten-free, and more recently buying “local” have all captured consumers, encouraging supermarkets around the globe and in Australia to respond. But the next emerging European food trend that may have the biggest impact on what we buy each week is “ugly food”.

What is the ‘ugly food’ movement?

It is estimated that a third of all the food produced in the world is never consumed, with the total cost of that food waste being as high as US$400 billion a year.

In response to the European Commission’s plan to make 2014 the “European Year Against Food Waste” and the EU’s scrapping of rules that prevented the sale of oddly-sized or misshapen fruit and vegetables, supermarkets across Europe were quick to respond.

The overarching objective of the ugly food movement is to reduce food waste by selling to consumers those fruit and vegetables that would normally be either rejected by supermarket buyers or dumped by farmers.

Celebrity adds integrity

How do you market ugly food? The first rule is don’t use the word “ugly” to describe the product.

French supermarket Intermarché instead use the term “inglorious” fruit & vegetables. UK retailer ASDA promotes “wonky” fruit & vegetables.

And late last year, Australia’s largest supermarket retailer, Woolworths released its “Odd Bunch” campaign, a replication of the ASDA “ugly good” strategy, right down to the same celebrity chef. At the same time NSW food retailer Harris Farms launched its “imperfect picks” range.

More recently, Canada’s largest supermarket, Loblaws, announced the rollout of its “naturally imperfect” range.

Celebrity chef Jamie Oliver has been used by both ASDA and Woolworths to help add credibility and consumer interest to the campaigns.

How ‘ugly’ is too ugly?

Not all supermarkets have been quick to follow suit, with some instead cautiously approaching this new phenomenon.

The UK’s largest food retailer Tesco last year told the House of Lords EU Sub-committee on Agriculture that its supermarkets regularly supplied misshaped fruit and vegetables to Eastern and Central European stores, but found British consumers consistently demanded better quality. It called for consumer education campaigns to support the program.

In Australia, both Coles and Aldi have remained silent on whether they will implement such a program. While it’s too early to tell whether this foray into “ugly food” will be a resounding success for supermarket retailers, it is not unreasonable to assume Woolworths, and other Australian supermarkets may struggle to get Australian shoppers onside. After many years of produce buyers rejecting blemished and oddly shaped produce, and store managers removing offending items from shelves, Australian shoppers have been conditioned to expect only the very highest levels of freshness, quality and aesthetics.

The benefits of a ‘taste, not waste’ campaign

Supermarkets that have effectively launched an “ugly food” program have gained from both a perceived positive corporate social responsibility position and increased sales. Intermarché gained strong public support during the initial launch of its “Inglorious Fruit & Vegetable” campaign, selling 1.2 tonnes of misshaped fruit and vegetables across its stores in just two days, receiving a 24% increase in foot traffic, 3.6 million views on Youtube and over 500,000 Facebook “likes”.

Being able to provide lower priced fresh fruit and vegetables to low socio-economic consumer groups, while promoting healthy eating, is also a positive outcome for both retailers and shoppers. Ultimately, an “ugly food” program is a win-win for all those in the supply chain; growers, retailers and consumers.

It also allows supply chain costs to be reduced. “Ugly” produce would normally be transported from the farm gate to the market, only to be rejected, then transported back and disposed of. Now, such produce can be accepted, albeit at a lower “buy” price and sent onto stores as an “ugly food” alternative. This reduces costs to farmers, supermarkets and eventually shoppers.

A cautionary note

Assuming retailers are successful in convincing consumers of the merits of “ugly food”, the strategy could create price pressure across the category. From a shopper’s perspective, when provided a choice of loose, somewhat misshaped carrots at a low price, versus perfectly presented, aesthetically pleasing, high priced carrots, will shoppers simply switch to the cheaper option? Will price discounted, lower quality produce reduce waste? Some say no.

If campaigns to promote “taste over waste” are successful on a grand scale, there could be unintentional consequences for farmers. Consider the grower who has invested heavily in agriculture infrastructure and processes to ensure their potatoes meet very high standards set by supermarkets, only to find the market has now shifted to the “ugly” alternative.

Finally, the alleged power of the major supermarkets has come under increasing criticism and inquiry. Potentially the “ugly food” movement could inadvertently create a market where supermarket buyers are able to set very low “buy” prices for subjectively imperfect fruit and vegetables, with the alternative being to reject.

The numbers don’t have it: why measuring won’t lead to better health

7 May 2015, 5.49am AEST

The numbers don’t have it: why measuring won’t lead to better health

Weight and girth have become shorthand for health but these are blunt instruments that provide an unreliable and reductive snapshot of its complexities.

Weighing people may do more harm than good by giving an unreliable picture of the complex realities of health and weight. Jonathan Cohen, CC BY-NC

A recent study of patient data from Melbourne’s eastern suburbs published in the Medical Journal of Australia (MJA) showed GPs are not checking their patients’ Body Mass Index (BMI) or measuring their waist circumference. The article’s authors interpret this as a shortcoming but these doctors may actually be avoiding the trap of thinking simplistic measurements help patient health and well-being.

The paper’s authors assume – as does the National Health and Medical Research Council – that if GPs weighed and measured their patients, they’d be better able to address weight-related health problems.

But there are good reasons to be sceptical about whether scales are an effective weapon in the so-called “war on obesity”. In fact, weighing people may do more harm than good by giving an unreliable picture of the complex realities of health and weight.

Poor indicators

Take, for example, Body Mass Index (BMI), which is calculated by dividing weight (in kilograms) by the square of height (in metres). BMI was originally devised to determine the “average” person in a given population. While a population is obviously made up of individuals, the two are clearly not the same thing and BMI is a blunt instrument when it comes to the latter.

Consider this 2008 article in Internal Medicine that found just over a half (51.3%) of people in the overweight range (BMI of between 25 and 30) and almost a third (31.7%) of those considered obese (BMI of between 30 and 35) are metabolically healthy. That means they don’t have raised blood sugar levels, raised cholesterol, or high blood pressure, all of which pose a risk to good health. The study authors also found nearly a quarter (23.5%) of people in the so-called “healthy” range, that is, with a BMI between 20 and 25, may have these risks to their health.

Pulling a measuring tape around someone’s waist simply won’t tell you if they’re healthy or unhealthy. Africa Studio/Shutterstock

Waist circumference is similarly inaccurate. Pulling a measuring tape around someone’s waist simply won’t tell you if they’re healthy or unhealthy because health is far more complex than a certain number of centimetres.

In fact, one number — be it BMI, waist circumference or whatever comes next — will never tell you about any one individual’s health and well-being. If we’re looking across a population, then we may see some associations between increased BMI and an increased risk of diabetes, for instance, but that’s completely different to assessing any one person visiting a doctor.

Numbers aren’t a map

Even supposing you could reduce something as complex as health to a number, how this might help someone make positive changes to their well-being and health is another question entirely. Doctors have been weighing and measuring patients in an effort to get them to lose weight for over half a century. But there’s nothing to suggest this approach has been remotely successful.

Many GPs are also time poor and, in many cases, through no fault of their own, poorly equipped to discuss health-related weight issues. There’s virtually no training for GPs and other health professionals in how to help people be the healthiest they can be, or the healthiest weight they can be.

In many cases, this lack of training results in insensitive discussions about weight. A 2012 study in the journal Obesity, for example, found 69% of women reported experiencing weight-related stigma from a GP on at least one occasion; 52% said it had happened on multiple occasions.

Such comments can lead to worse health outcomes as people start to avoid seeing doctors for other health-related matters for fear of being judged and weighed. A 2005 study published in the Californian Journal of Health Promotion found:

the most important factor in women postponing or cancelling medical appointments was fear of being weighed, and increase BMI is consistent with decreased preventive health services.

This is not the answer. Alan Cleaver/Flickr, CC BY

Of course, there will be GPs — some of whom will be reading this article — who will say it’s their duty to give patients the unvarnished truth. But this misses the point. Our argument is not that doctors ought to remain silent about the relationship between health, weight and well-being. Rather, that research shows weight is an extremely poor proxy for health.

A better approach

Before giving any advice, doctors need to find out whether a person is likely to be above their most healthy weight or not. That means taking an appropriate history, and asking questions such as the amount of physical activity they may be doing, whether that particular person is doing a significant amount of “non-hungry eating”, whether he or she is a fast eater, and so on. You can’t determine all this simply by looking, or measuring anything.

And if blood pressure or blood tests reveal some areas the patient would be willing to discuss further, it’s vital to talk about them in a non-judgemental and supportive fashion. This doesn’t mean sugarcoating the message; it means doctors should opt for neutral language, which does not carry pejorative overtones or imply a moral judgement about the person.

Such a discussion would avoid BMI and tape measures, as well as the prescription of one-size-fits-all weight-loss diets, or unhelpful advice such as “eat less and exercise more”. Instead, it would focus on giving doctors the best chance of finding out the reasons why their patient may be above their most healthy weight.

If we’re serious about supporting people to be healthy, it’s time to end our fixation with unhelpful and inaccurate measures of weight. Instead, we need to train GPs and other health professionals to better discuss weight concerns with their patients in a meaningful way; one that focuses on the complexities of the individual and eliminates the stigma and shame around fat.

American Heart Association 7 simple steps for good health.

Life’s Simple 7


by the Go Red For Women Editors

Do you know there are seven easy ways to help control your risk for heart disease? Manage your heart risk by understanding “Life’s Simple 7.”

1. Get active

Daily physical activity increases your length and quality of life. If you get at least 30 minutes of moderate physical activity each day (like brisk walking), five times per week, you can almost guarantee yourself a healthier and more satisfying life while lowering your risks for heart disease, stroke and diabetes.

What To Do

Start by learning the basics about fitness. Also, children need 60 minutes a day–every day–of physical activity, so find ways to workout with your kids to help ensure their heart health in addition to your own.

2. Control cholesterol

When you control your cholesterol, you are giving your arteries their best chance to remain clear of blockages. Cholesterol is a waxy substance and our bodies use it to make cell membranes and some hormones, but when you have too much bad cholesterol (LDL), it combines with white blood cells and forms plaque in your veins and arteries. These blockages lead to heart disease and stroke.

What To Do

Try these tips to lower cholesterol with diet and foods.

3. Eat better

Healthy foods are the fuel our bodies use to make new cells and create the energy we need to thrive and fight diseases. If you are frequently skipping out on veggies, fruit, low-fat dairy, fiber-rich whole grains, and lean meats including fish, your body is missing the basic building blocks for a healthy life.

What To Do

Want more ways to eat better? Try these tips:

  • Track what you eat with a food diary
  • Eat vegetables and fruits
  • Eat unrefined fiber-rich whole-grain foods
  • Eat fish twice a week
  • Cut back on added sugars and saturated fats

4. Manage blood pressure

High blood pressure is a major risk factor for heart disease and stroke. When your blood pressure stays within healthy ranges, you reduce the strain on your heart, arteries, and kidneys which keeps you healthier longer.

High blood pressure, also known as hypertension, means the blood running through your arteries flows with too much force and puts pressure on your arteries, stretching them past their healthy limit and causing microscopic tears. Our body then kicks into injury-healing mode to repair these tears with scar tissue. But unfortunately, the scar tissue traps plaque and white blood cells which can form into blockages, blood clots, and hardened, weakened arteries.

What To Do

To manage blood pressure, you should:

5. Lose weight

If you have too much fat — especially if a lot of it is at your waist — you’re at higher risk for such health problems as high blood pressure, high blood cholesterol and diabetes. If you’re overweight or obese, you can reduce your risk for heart disease by successfully losing weight and keeping it off. Even losing as few as five or ten pounds can produce a dramatic blood pressure reduction.

What To Do

Calculate your body mass index (BMI) to help you determine if you need to lose weight.

6. Reduce blood sugar

Most of the food we eat is turned into glucose (or blood sugar) that our bodies use for energy. Your body makes a hormone called insulin that acts like a carrier to take your food energy into your cells. If your fasting blood sugar level is below 100, you are in the healthy range. If not, your results could indicate diabetes or pre-diabetes.

Although diabetes is treatable and you can live a healthy life with this condition, even when glucose levels are under control it greatly increases the risk of heart disease and stroke. In fact, most people with diabetes die from some form of heart or blood vessel disease.

What To Do

The following tips can all help reduce your blood sugar:

  • Reduce consumption of simple sugars that are found in soda, candy and sugary desserts
  • Get regular physical activity! Moderate intensity aerobic physical activity directly helps your body respond to insulin
  • Take medications or insulin if it is prescribed for you

7. Stop smoking

Cigarette smokers have a higher risk of developing cardiovascular disease. If you smoke, quitting is the best thing you can do for your health. Smoking damages your entire circulatory system, and increases your risk for coronary heart disease, hardened arteries, aneurysm and blood clots. Like a line of tumbling dominoes, one risk creates another. Blood clots and hardened arteries increase your risks for heart attack, stroke and peripheral artery disease. Smoking can also reduce your good cholesterol (HDL) and your lung capacity, making it harder to get the physical activity you need for better health.

What To Do

Whatever it takes for you to stop smoking, it is worth it! Visit the American Heart Association’s Quit Smoking website for tools and resources.

Learn more about “Life’s Simple 7″ and take action with MyLifeCheck from the American Heart Association.

How antibiotic pollution of waterways creates superbugs

12 March 2015, 6.26am AEDT

How antibiotic pollution of waterways creates superbugs

We are only beginning to recognise the growing problem of antibiotics polluting our environment. How antibiotoic has serious repercussions for health.

Antibiotics from both human and animal use end up in our waterways. Alex/Flickr, CC BY-SA

Humans pollute the world with many chemicals and some of these affect living things, even at very low concentrations. Endocrine-disrupting compounds, which interfere with hormones, are a good example, but recently more concern has been raised about pollution with antibiotics.

The problem is that up to 80% of an antibiotic dose passes straight through the body. So most of the antibiotics used in medical treatment or during animal production may end up in waste water. And waste treatment plants generally don’t remove antibiotics very well.

Antibiotic pollution also comes from spreading manure on crop land, or using sewage as fertiliser. Waste water released from hospitals and antibiotic production plants is another major source.

We would like to know how much antibiotic pollution there is, but the diversity of antibiotic compounds makes it difficult to measure all of them at once. It’s also hard to estimate the amount of antibiotics used globally each year. But most researchers agree that total agricultural and medical use exceeds 250,000 tonnes per year.

How much pollution?

Using this number, we can make a very rough calculation about the extent of antibiotic pollution. If, say, 50% of an antibiotic dose is subsequently excreted, then 125,000 tonnes of antibiotics are released into the environment each year. This of course does not count release from pharmaceutical plants, which are very significant. Antibiotics are then likely to find their way into rivers, lakes and dams.

Antibiotic-resistant Golden Staph (Staphylococcus aureus) cells against a dead human white blood cell (false colour image). NIAID/Flickr, CC BY-SA

In total, such freshwater sources contain 90,000 cubic kilometres of liquid water. This makes 12.5 x 1016 micrograms of antibiotic released into 9 x 1016 litres of freshwater each year. This results in a final concentration of about 1.4 micrograms per litre. This back-of-the-envelope calculation agrees surprisingly well with a growing number of reports on concentrations of particular antibiotics in waterways.

Of course, concentrations vary depending on how close you are to sources of antibiotic pollution. On the low end, Lake Baikal in Russia contains about one fifth of the world’s freshwater, but has little or no input of antibiotics.

At the other extreme, waste waters downstream from antibiotic production plants may contain antibiotics at levels hundreds of times higher than those found in the bloodstreams of people on antibiotic therapy.

Pollution and resistance

The consequences of this pollution are potentially very serious. Where the concentration of antibiotics is enough to inhibit bacterial growth, it’s almost certain to result in the appearance of antibiotic-resistant strains.

This happens because microorganisms in the environment collectively carry and share enormous numbers of genes for resistance, virulence and other general nastiness. These genes can hop from one bacterial species to another, and the presence of antibiotics favours cells that have acquired these genes for resistance.

Lake Baikal in Russia contains about one fifth of the world’s freshwater, but has little or no input of antibiotics. neverbutterfly/Flickr, CC BY

This allows existing pathogens to gain new forms of resistance, making them “super bugs” that are immune to all current antibiotics. Also, previously benign bacteria can acquire genes that transform them into emerging pathogens.

Even very low antibiotic concentrations have significant biological and evolutionary effects. Low, “sub-clinical” concentrations of antibiotics fall well below the concentrations used in antibiotic therapy. These concentrations do not kill bacteria. But they do induce bacteria to increase their rates of mutation, DNA recombination, and the rate at which genes hop from cell to cell.

Each of these changes at the DNA level can give advantages to bacteria, such as survival in the presence of heavy metals, disinfectants or antibiotics. So antibiotic pollution makes it vastly more likely that bacteria will become resistant or colonise new hosts, including humans.

Both the World Health Organization and the US Centers for Disease Control have identified antibiotic resistance as a high priority for research. We can help prevent resistance by using antibiotics wisely, by not dumping unused antibiotics in drains or toilets, and by improving water treatment.

We can also call for restrictions on the use of antibiotics as growth promoters in animal production, which actually accounts for the majority of antibiotic use worldwide. Australia has stringent regulations on the use of antibiotics in farm animals, but this cannot be said of elsewhere in the world. And in the modern age of rapid transport, a superbug in the United States, China or India will inevitably make its way to Australian shores.

Resistance is everyone’s problem

Thyroid hormone: Influences on mood and cognition in adults.

Something we have known for some time is that a normal thyroid test can be deceptive – people can suffer from a underactive thyroid yet still have a test within the normal range. If symptoms indicate an underactive thyroid, then treatment may be beneficial in spite of a seemingly normal result. Subtlety and an experienced clinician is necessary for the best outcome. See more under “Hypothyroidism” on my web site, and the section written by Dr Dach.
Maturitas. 2015 Mar 28. pii: S0378-5122(15)00606-4. doi: 10.1016/j.maturitas.2015.03.016. [Epub ahead of print]

Thyroid hormone: Influences on mood and cognition in adults.


The association of thyroid dysfunction with alterations in mood and cognition has been recognised since some of the earliest descriptions of thyroid disease. Over the years, researchers have aimed to further define these effects throughout the spectrum of thyroid disorders, to better understand the underlying condition and refine indications for treatment. More recently, attention has turned towards examining the impact of differences in thyroid hormones within the normal reference range, particularly in older adults, providing new insights into the association of thyroid hormone with cognitive decline. This review summarises the evidence assessing the influence of thyroid hormone on mood and cognition in overt and subclinical hypothyroidism, within the reference range, and in subclinical and overt hyperthyroidism. Treatment of overt thyroid dysfunction largely resolves associated disturbances in mood and cognitive dysfunction, however in the setting of overt hypothyroidism subtle detrimental effects on cognition may not be fully reversed. Subclinical hyperthyroidism and higher free thyroxine (FT4) within the normal range have been associated with poorer cognitive outcomes. Future research including randomised controlled trials are required to confirm causality and guide the assessment of benefits vs risks of intervention in the increasing population of older adults with subclinical thyroid disease.

A prescription for better health: exercise after prostate cancer

16 April 2015, 6.36am AEST

A prescription for better health: exercise after prostate cancer

Prostate cancer is the most commonly diagnosed male cancer in Australia, with around 20,000 cases detected each year.

Many men living with prostate cancer are confronted with significant bodily changes that can make exercising difficult. Ivonne Wierink/Shutterstock

Prostate cancer is the most commonly diagnosed male cancer in Australia, with around 20,000 cases detected each year.

Depending on the type of treatment, many men living with prostate cancer are confronted with significant changes in their body composition. These can lead to generalised muscle weakness, fatigue and depression. This can make exercising difficult, particularly if it wasn’t part of their routine before diagnosis.

Androgen deprivation therapy or hormone therapy is commonly prescribed to reduce levels of male hormones, such as testosterone, to prevent the spread of prostate cancer.

Testosterone assists in maintaining heart, metabolic and muscular health, as well as sexual function. Hormone therapy can therefore have a profound impact on physical functioning, bone loss, muscle loss and fat gain. This results in an increased risk of falls and fractures, and a reduced quality of life.

Men with prostate cancer are also at increased risk of dying from other illnesses, including heart disease, diabetes and osteoporosis, which may be prevented or reduced through exercise.

Exercise programs for men with prostate cancer can maintain and improve muscle mass and strength, cardio-respiratory fitness and mental health outcomes, including reduced emotional distress, depression and anxiety.

Exercise and Sport Science Australia recommends people living with cancer exercise at a moderate to vigorous intensity level three to five times per week for at least 20 minutes per session. The guidelines recommend including aerobic, resistance (using weights, weight machines, or resistance bands) or mixed exercise to improve cardiovascular health, endurance, muscle and bone health and to reduce excess weight.

Increasing age, other health conditions, cancer stage and side effects of treatment influence the amount and type of exercise men living with the condition can participate in.

Exercise physiologists tailor exercise treatments around the patient’s side effects and monitor their activity to reduce the risk of injury. Deakin University

Despite the benefits of exercise for cancer survivors, this knowledge has not been translated into practice. Many men living with prostate cancer are uncertain about the type and amount of exercise they should participate in. Most do not recall receiving information from clinicians about integrating exercise into their lives.

Clinicians may not view their role as health promotion advocates, with 55% reporting “not having enough time” or a “lack of knowledge/resources” as the most common barriers to promoting physical activity to their patients. Clinicians don’t usually refer patients to supervised exercise programs following a cancer diagnosis.

Our research team suspected that if men were referred to exercise physiologists, they would gain the confidence and skills to start exercising and improve their health.

Exercise physiologists are university-trained and accredited therapists who can assist people with chronic health conditions. They tailor exercise treatments around the patient’s side effects, such as incontinence and decreased bone density, and monitor the patient’s activity to reduce their risk of injury.

Click to enlarge

We designed a referral process, using a form similar to a prescription (right), to formalise the recommendation by clinicians for patients to participate in the exercise program. Our research is published today in the journal Cancer.

A clinician-based recommendation and referral has a number of distinct advantages over traditional approaches to exercise promotion. Patients are likely to take notice of a recommendation about exercise when it is from a trusted source, such as their treating clinician. The referral is also quick and easy for busy clinicians who are seeing many patients, often with multiple health conditions.

We recruited men with prostate cancer to participate in an exercise program at their local YMCA. This was supervised by exercise physiologists and tailored to their individual capabilities, with endorsement by their trusted medical or nurse clinician.

We found that men who participated in the 12-week program (of two gym-based and one home-based session per week) undertook more than twice as much vigorous exercise (such as jogging on a treadmill, cycling and/or resistance training), compared with men in the control group. They were nearly four times more likely to meet the exercise guidelines (around 150 minutes per week) and nearly five times more likely to avoid complete inactivity.

Men in the exercise group were more alert and had fewer symptoms of depression. Most participants said it was rewarding and extremely beneficial to their health and well-being. Importantly, more than 80% achieved their exercise goals.

Clinicians also found referring patients to the exercise program simple and straightforward.

Combining a clinician’s referral to a tailored exercise program, which is planned, delivered and supervised by exercise physiologists, can significantly improve health outcomes for men with cancer.

If you’re living with prostate cancer, talk to your GP about increasing your exercise levels and, if needed, ask for a referral to an exercise physiologist. Medicare provides access to subsidised treatment from health practitioners, such as accredited exercise physiologists, with a referral from a GP.