Eating fruits regularly helps to prevent major diseases such as heart diseases, certain cancers, diabetes and obesity. It can also improve brain health.

Despite the benefits, less than half of Australians eat enough fruit. To try to make eating fruit easier, get the most nutritionally from what we eat and avoid wastage, it is important to consider the best stage to eat fruits from harvesting to over-ripening.

Fruits vary in nutritional quality

Fruits contain a range of nutrients essential for health, from energy-producing nutrients (mostly carbohydrates with some fat and protein) through to vitamins, minerals and fibre. The amounts of these nutrients vary, however, from one fruit to another.

Predominant sugars vary. In peaches, plums and apricots, there is more glucose than fructose. The opposite is the case in apples and pears. Fruits vary greatly in terms of their glycaemic index and the effect on our blood sugar (glucose).

If we look at vitamin C, relatively high amounts are found in strawberries and citrus fruits compared to bananas, apples, peaches or pears.

Passionfruit contains more phosphorus, an essential mineral used in releasing energy, than papaya. However, the opposite occurs in the case of calcium, the most common mineral in the human body.

According to a recent study, higher consumption of some whole fruits, especially blueberries, grapes and apples, significantly reduced the risk of developing type-2 diabetes. But eating oranges, peaches, plums and apricots had no significant effect. However, this does not mean the latter ones are bad fruits.

Sometimes, combinations of fruits work better than each individual fruit. Mixtures of orange and star fruit juices had higher antioxidant capacity than pure juices.

Even certain stages in fruit maturation showed better health effects. Bioactive compounds are chemicals that occur naturally in fruit and are not technically nutrients but appear to result in health benefits. These are found in higher levels in green (unripened) jujube fruit (red date) than in the ripe fruit.

Green or yellow bananas, does ripeness matter?

Fruit ripening involves a range of complex chemical processes. These cause changes in colour, taste, smell and texture. Generally fruits are more tasty when fully ripened, but this is not always the case. Guava, for example, tends to be more appealing when partially ripe.

Unripe fruits typically contain more complex carbohydrates, which can behave like dietary fibre and break down into sugars upon ripening. Unripe bananas contain higher levels of resistant starch (which we cannot digest, but can be a prebiotic acting as a food supply to the microbes in our gut), which is linked to lower risks of bowel cancer. This decreases during the ripening process.

With respect to vitamins and phytochemicals, researchers found the opposite is the case. The level of vitamin C decreases during the early stages of sweet cherry development but increases at the beginning of fruit darkening and accumulation of the pigment anthocyanin. Levels of glucose and fructose, the main sugars found in cherry fruit development, increase during ripening.

However, over-ripening leads to a loss of nutrients following harvest. It’s also linked to fruit darkening, softening and a general loss of sensory acceptability.

Impact of processing

Fruit can be processed by canning, freezing, drying, chopping, mashing, pureeing or juicing. Processing fruits can improve shelf life, but it can also lead to losses in nutrition due to physical damage, long storage, heating and chilling injury.

Usually, minimally processed fresh-cut fruits such as fresh fruit salad have the same nutritional qualities as the individual fruits. However, tinned fruit salad may contain added sugar as syrup and preservatives, which may be a less healthy option.

Eating whole fruit rather than drinking juice appears to be linked to better health. A study that gave participants whole fruit before a meal found it led to people eating less than if they drank juice. Additionally, those eating whole fruit appeared to have a lower risk of developing type 2 diabetes, although other studies suggest juices with added sugar may be the real problem.

It is also likely some processing such as juicing may help increase availability and quicker absorption of the beneficial nutrients in fruit. The benefits of this need to be weighed against the sugar being more available too.

So which to eat?

Nutritional qualities of fruits vary and it is hard to predict which fruit might be best. Generally, the more different types of fruits you can include in your diet, the better. For many fruits, eating fresh at its correct ripening stage may be more beneficial, perhaps more for taste than nutrition.

Overripe fruits may be still good to eat or easily convert into smoothie, juice or used as an ingredient such as in banana bread. Eating an over-ripe fruit such as a banana does not mean that you are putting more sugars into your body as the total amount of carbohydrates in the fruit does not increase after harvesting.

While fruit products (juice, dried or tinned products) that are higher in sugars and also preservatives in some cases are not as good as whole fruit, consuming fruit in this form is better than consuming no fruit at all.

But fruits alone cannot do all the work. It is important to choose foods from all the core food groups within the Australian Guide to Healthy Eating to reap the maximum health benefits of fruits.

Media reports have emerged of psychotic episodes in children brought about by a common asthma medication, Singulair. The Therapeutic Goods Administration (TGA), which approves and monitors drugs in Australia, has apparently received 90 reports of psychiatric events.

So this leads to the question of how drugs are approved, and whether we are all at risk of harmful side effects from the medicines we take.

This issue is more complex than telling everyone about every possible side effect. First, there is no way to predict if an individual will be affected until they try the medication.

Second, to do so would be a scare campaign – as a pharmacist, I can scare anyone off taking anything if I put my mind to it, but that’s not my job. My job is to weigh risk and benefit – and taking any medication is a calculated risk.

How are side effects determined?

The list of side effects on the product information inside your medicine boxes is determined during clinical trials. Patients in the trial are monitored and regularly asked to report all symptoms they experience. At this stage, neither the patient nor the doctor knows if the patient is on the real (active) drug or the placebo.

All the reported symptoms are recorded and hence side-effect lists are developed, even if just one of the patients suffers this particular side effect once, and without knowing if they are in the active or placebo group.

The big thing missing in this recording process is causality – did the drug cause the effect, or was it coincidence?

For rare effects, the study size will probably not be large enough to pick them up. For example, a side effect that occurs in one in a million patients would be detected only about nine times if the entire Australian population (almost 18 million adults in 2015) was split into active and placebo groups for a trial.

So how do we find out about these effects? It happens through “pharmacovigilance”, or watching what happens once the drug is used in the general population. Only then will the rare things be seen. The Singulair® case is an excellent recent example of this – the company says tens of millions of patients have taken the drug (around the world), but the Australian market is much smaller.

The active drug in the medication, montelukast, has been available in Australia since 2000, and on the PBS since 2003. From listing in 2003 to December 2015, just over 2 million prescriptions for it have been dispensed. (Available statistics do not determine number of patients, or show figures from 2000-2003 when it was a private prescription not on the PBS.)

To put the new reports in context, the TGA received 90 reports of psychiatric events in just over 16 years. Out of these 90 reports, 16 were related to the specific event highlighted in the report (suicidal thoughts and depression). So 16 cases in over 2 million prescriptions makes this a truly rare effect.

This is not to make light of the seriousness of these effects for the people involved. Ideally, these effects would not occur. However, expecting such rare events to be included on warnings is not feasible. It was listed, however, on the medication product information.

When are warnings warranted?

To determine if an effect is caused by a drug, the pharmacovigilance experts at the TGA need to filter the “signal” (drug-caused) effects out from the “noise” (same effect occurring in the population without the drug).

A US study showed the rate of non-fatal suicide attempts in ten- to 17-year-olds was 197 per 100,000 people over a five-year study period. Fatal suicide was 6.4 per 100,000. While the same data aren’t available in Australia, we can use the US data as a rough benchmark.

If we assume (albeit unrealistically) the 2.049 million scripts were evenly spread over the 12 years and each patient took the drug continuously for that period (one prescription per month), then the number of prescriptions equates to a low estimate of 14,299 patients. The US suicide study was conducted over five years, so the annual incidence of non-fatal suicide attempts would average 39 people per 100,000 people.

Using data from the media reports, there was approximately one report (16 reports over 16 years) of suicidal ideation or depression per year per 14,229 patients. That’s an incidence of seven per 100,000 people per year, yet the US data show a “background” rate of 39 per 100,000 people per year. Therefore it can be difficult to find this “signal” within the background “noise”.

Drug risks and benefits

The TGA has determined a likely connection between the drug and the psychiatric events, so parents of affected children are asking why they weren’t warned. I answered this earlier – it’s all about risk and benefit. If patients (or their parents) were provided with a list of every side effect, many people would be scared off taking useful medicines.

Unfortunately, the Australian population (generally) does not have sufficient health literacy to be able to put such information into context – look at the anti-vaccination and other scare campaigns. Health professionals are usually time-poor and often do not do the best (or even a good) job explaining the potential side effects to patients.

Patients should be empowered and encouraged to ask questions and discuss risks and benefits with their health-care professionals, about a range of issues, not just medication.

Sometimes an effect is deemed by the TGA to constitute a major risk to the public and a specific warning is attached to product information and even the packaging. These effects pose a significant risk to health and occur with a frequency that warrants such warnings. There are no hard and fast cut-off values. Like most things in the medical world, it’s about judgement and shades of grey.

The information available at the time of prescribing or starting a medicine is often not complete, so the risk-benefit balance is not a certain science. Health professionals must ethically have their patients’ best interests as their primary concern, but when we try a medicine we need to watch carefully to see if it works for that individual.

Yes, some side effects can be scary, but put in the context of the good medicines can do, judgement calls need to be made. People make risk-benefit decisions throughout daily life, such as crossing the road, driving a car and other dangerous daily tasks.

Medical decisions are no different, but people feel less empowered because a product is recommended by an “expert” or they do not have sufficient knowledge to make an informed decision. This is why it’s important for patients to empower themselves by asking questions and making all decisions shared.

Balance is the vital sense that gives much-needed stability to our teetering, upright bodies. Good balance is usually associated with having stable posture, but it also has a lot to do with visual stability.

The importance of the balance system is shown by the vast number of connections it makes with the brain. These connections reveal that the forces of motion we create and encounter in the environment can go on to affect many parts of the brain, including those that control vision, hearing, sleep, digestion, and even learning and memory.

How does balance work?

Every sensory system uses detectors or receptors outside the brain to gather information about the environment. For example, the visual system uses light-sensitive receptors in the retina to detect visible light. The balance system relies on specialised motion-sensitive receptor cells in the inner ear.

While obviously associated with hearing, the inner ear is also the shelter for balance. It has a labyrinthine structure, made up of a series of fluid-filled canals and ducts. Within this labyrinth are five balance receptors that are ideally placed to detect different types of movement. There are three receptors for head rotation, another for horizontal acceleration, and one for vertical acceleration (or gravity).

Each balance receptor is an organ made up of thousands of cells with long hair-like projections. As a result of head movement, these so-called hair cells are excited when their projections are pushed in a particular direction by fluid called endolymph.

Movement of endolymph within the inner ear is complex. When you spin a bowl of water, for instance, the water takes time to “catch up” with the turning bowl. This lag is due to inertia and applies to all fluids, including endolymph.

When the head begins to move, the endolymph initially stays still. This actually translates to a fast relative movement of the endolymph in the opposite direction to the head. This relative movement excites the hair cells that are aligned to detect that particular head movement.

So in an elegant and precise way, endolymph and hair cells work in concert to provide a constant stream of information about head movement to the brain.

The inner ear balance organs are remarkable in their ability to detect head movements both small and large, fast and slow, and in any direction. The brain uses signals from the organs to orchestrate a suite of balance reflexes that control our muscles, right down to our toes!

However these reflexes not only control our muscles of posture but our eye muscles as well. Together, these reflexes underlie our ability to remain upright with stable vision in an ever-changing and ever-moving physical environment.

Why doesn’t our vision bounce up and down when we jog?

Maintaining our upright posture is an obvious job for our exquisitely sensitive and responsive balance system. However, it also has a profound effect on the control of our eye movements. The up-down movement generated when walking or jogging would have a destabilising effect on our vision.

Like footage from a hand-held camera, even a simple jog along a flat path or a smooth road would result in unstable and shaky images. When watching hand-held camera footage, it can be unpleasant and difficult to focus on stationary objects like trees because they are moving too violently.

But what about our eyes? Thankfully, our visual field is remarkably stable when we jog. This is due to a reflex most of us take for granted, called the vestibulo-ocular reflex.

The vestibulo-ocular reflex is one of the fastest and most active reflexes in the human body. It uses head movements detected by the inner ear to generate compensatory eye movements that are equal – but opposite in direction – to head motion. This subconscious, ongoing adjustment of eye position results in a stable visual field, despite significant movement of the head.

What happens when balance goes wrong?

For many, the idea of suddenly losing a sense like vision or hearing is terrifying (and rightly so), and a sudden loss of your sense of balance would be similarly catastrophic.

Initially, a debilitating and frightening dizziness would prevent you from completing even simple daily tasks without falling over. The worst symptoms would subside with time as you begin to rely more heavily on other senses such as vision. But even a partial loss of the vestibulo-ocular reflex would mean stopping and standing still every time you wanted to recognise a face or read the price of a grocery item.

The fact that we are almost totally unaware of this elegant reflex is evidence of the superb, undercover work the balance system does for us. It not only allows us to walk without falling over, but also gives us a constant and reliable view of a beautifully changing world

Our gut does more than help us digest food; the bacteria that call our intestines home have been implicated in everything from our mental health and sleep, to weight gain and cravings for certain foods. This series examines how far the science has come and whether there’s anything we can do to improve the health of our gut.

The healthy human body is swarming with microorganisms. They inhabit every nook and cranny on the surfaces of our body. But by far the largest collection of microorganisms reside in our gastrointestinal tract – our gut.

These tiny organisms, which can only be seen with the aid of a microscope, make up our microbiota. The combination of microbiota, the products it makes, and the environment it lives within, is called the microbiome.

Great advances in DNA sequencing technologies have enabled us to study the gut microbiota in intricate detail. We can now take a census of all the microorganisms that are in the microbiota to help us understand what they are doing.

Typically, our gut microbiota consists of several thousand different types of bacteria, as well as other microbes such as viruses and yeasts. Some types will be in abundance, while other types will be rare.

The exact composition of each person’s microbiota is as unique as their finger prints. But unlike finger prints, the microbiota is constantly changing.

Microbes start to colonise our gut and skin the moment we are born. The mode of birth, either natural or by caesarean, determines the sort of microbes a baby first contacts. This can have a profound effect on the early development of the microbial populations that contribute to the microbiota.

The structure of the microbiota – that is, what microbes are present and the relative numbers of each type – undergoes significant change from its establishment at birth until it matures in early adolescence.

In healthy adults, changes over time are likely to be small. But major shifts in composition can occur when we radically change our diet or take antibiotics, which are, of course, designed to kill bacteria.

It’s also been found that, like our own body, the composition of our microbiota changes in old age, including a loss of diversity.

Our microbiota is not an accidental, free-loading passenger living in our gut and stealing the nutrients from our food. Over the millennia we have evolved with our microbiota. We now know it can affect many aspects of our biology, from our digestive system to our brain function.

How our bodies develop and function is dictated by our genes. We have approximately 20,000 genes encoded in our genetic material.

The different microbes that make up our microbiota have their own genes. As a rough estimate, the 2,000 different types of microbes may, on average, each carry 3,000 genes. That means the microbiota carries six million genes. Although many will have similar functions, it still indicates the microbiota has a much more complex =genetic complement= than we ourselves have.

This genetic complement of the microbiota means it can do things other parts of the body cannot. Our microbiota provides digestive enzymes to allow us to use food that otherwise we could not digest. It provides essential vitamins we cannot make ourselves. And it interacts with our hormonal and neural systems to help shape our physiology.

Perhaps most important of all, it helps to develop our immune system to fight off bugs. The body must be able to distinguish between the beneficial members of the healthy microbiota and invading pathogenic microorganisms that can cause disease. The immune system has to learn to live with and nurture the microbiota while fighting off pathogens.

Disruption of the correct interaction between microbiota and the immune system may be one of the causes of the massive increase over the past few decades in immune-related diseases, such as diabetes, food allergies, rheumatoid arthritis, and inflammatory bowel disease.

Many of these diseases seem to be diseases of affluence, probably influenced by poor diets and excessive cleanliness, affecting the early establishment of an appropriate microbiota.

The intimate connection between host and microbiota and the rich contribution that each brings to the partnership has resulted in the concept of a metaorganism. This recognises that as humans, we are really the product of the mutual cooperation between our own bodies and our microbiota.

Indeed, our microbiota is so important and has such specific functions that it’s reasonable to view it as another organ of our body. It’s just as important as our liver or kidneys.