Monthly Archives: April 2020

What we may think are the healthiest bread and wrap options actually have the most salt

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What we may think are the healthiest bread and wrap options actually have the most salt

March 21, 2017 6.15am AEDT

Our new analysis looked at the salt content of 1,439 bread products sold in four major supermarkets since 2010.

What most surprised us was that the breads often thought to be the healthiest actually contain the most salt. For example, some rye breads in the survey contained twice as much salt as a serving of sea salt chips.

Wraps on average contained 33% more salt than sliced white bread. Some wraps had eight times as much salt as others.

This is important because while we’ve been trying to minimise sugar and fat intake, it seems we’ve been overlooking one of the biggest dietary killers of all – salt.

Heart disease is the leading cause of non-communicable disease deaths worldwide. Globally, it has been estimated more than 1.65 million heart-related deaths per year are attributed to excessive dietary salt intake.

That’s because salt increases blood pressure and, with that, risk of stroke and heart disease.

The forgotten killer

Salt is sometimes called the “forgotten killer”, and it’s easy to see why. We’re eating way too much of it, often without even realising. It’s hidden in the processed and packaged foods we buy, and in foods we don’t even think of as being salty.

The average Australian has a salt intake of around 8g to 9g per day. That’s almost double the World Health Organisation’s recommendation of less than 5g per day.

According to the most recent Australian Health Survey, the highest contributors of salt to the diet include bread and bread rolls (12.8%), processed meat (6.7%), ready-to-eat breakfast cereals (2-3%) and sauces, dips and condiments (6%).

We found rye breads contained on average 20% more salt than the voluntary sodium reduction targets that the Australian government set in 2009, to be achieved in three major food categories (ready-to-eat breakfast cereals, breads and processed meats) by 2013.

https://datawrapper.dwcdn.net/JyOaE/2/The results from our research show the targets have worked, with 81% of breads meeting them. Salt levels in breads and bread rolls had dropped by some 10% in seven years.

https://datawrapper.dwcdn.net/a5cvX/2/This is a promising start, but the bread targets covered only about two-thirds of the products analysed in this survey.

They did not cover flat breads – which had the highest average salt content. Breads such as wraps, naan, roti and tortillas also included unnecessarily high levels of salt. On average, these contained a third more salt than white bread.

This highlights the need for clear salt targets across all ranges of processed foods, as well as transparent monitoring systems to ensure all manufacturers are reducing salt across the product ranges.

https://datawrapper.dwcdn.net/60em8/1/ https://datawrapper.dwcdn.net/eCm9L/2/Some of our other findings included:

  • Schwob’s Dark Rye Sourdough contains twice as much salt as a serving of Kettle’s Sea Salt Chips.
  • Mission Wholegrain Wraps contain eight times more salt than one Vitastic Sorj Healthy Soft Wrap Wholemeal.

The huge difference in the amount of salt in breads is alarming. We need all bread manufacturers to reduce the amount of salt in bread to the lowest possible levels, across all types of products.

A good public health initiative example is in Victoria. The Victorian Salt Reduction Partnership, led by VicHealth, is supporting national activities to reduce salt. This includes working with industry partners to identify and promote solutions to lowering salt in processed foods in parallel with behaviour change campaigns.

If you don’t have the time to read nutrition information on packets of bread in the supermarket, then there is an app for finding find lower salt options: FoodSwitch.

Urogenital atrophy: prevention and treatment.

See comment in PubMed Commons below

Pharmacotherapy. 2001 Apr;21(4):464-80.

Urogenital atrophy: prevention and treatment.

Author information

1
Pharmacy Department, Fairview University Medical Center, University of Minnesota, Minneapolis, USA.

Abstract

Fifteen percent of premenopausal women, 10-40% of postmenopausal women, and 10-25% of women receiving systemic hormone therapy experience urogenital atrophy. The most common symptoms are dryness, burning, pruritus, irritation, and dyspareunia. Estrogen loss, drugs, and chemical sensitivities are causes. Estrogen or hormone replacement therapy (ERT-HRT) is the treatment of choice in postmenopausal women. Dosages prescribed for menopause symptoms or to prevent osteoporosis (and, potentially, other conditions) can restore the vagina to premenopausal physiology and relieve symptoms. Concomitant progestins are necessary for women with an intact uterus to minimize or eliminate estrogen-induced endometrial cancer. Low-dosage oral and vaginal ERT can relieve urogenital atrophy but might not produce systemic effects. Progestins are not necessary with vaginal rings and vaginal tablets. If ERT is given only to treat urogenital atrophy, estrogen creams 1 or 2 times/week may prevent recurrence after symptoms are resolved. Progestins are not required for occasional estrogen cream use. Vaginal moisturizers provide longer relief by changing the fluid content of endothelium and lowering vaginal pH. Vaginal lubricants provide short-term relief. Women with contraindications to ERT-HRT could use lubricants for intercourse-related dryness or moisturizers for more continuous relief. The lay press promotes agrimony, black cohosh, chaste tree, dong quai, witch hazel, and phytoestrogens for vaginal dryness and dyspareunia; however, no evidence exists to support these specific claims. Pharmacists should be actively involved in identifying, preventing, and treating urogenital atrophy.

What are the deadliest diseases in the world?

Featured Articles in Internal Medicine In the News

What are the deadliest diseases in the world?

Liz Meszaros, MDLinx | October 03, 2019

As human beings, we are susceptible to hundreds, if not thousands, of diseases throughout our lives. Yet some diseases are far deadlier than others. As the world’s foremost international health organization, the World Health Organization (WHO) has ranked the 10 diseases with the highest global mortality rates.

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As the world’s foremost international health organization, the WHO has ranked the 10 diseases with the highest mortality.

Here they are, ranked according to the number of deaths each causes worldwide.

10. Cirrhosis. Accounting for 2.1% of all deaths worldwide, cirrhosis is caused by chronic damage to the liver from kidney disease, hepatitis, or chronic alcoholism. Risk factors include chronic alcohol abuse, nonalcoholic fatty liver disease, and chronic viral hepatitis. The complications of cirrhosis cause 1 million deaths per year throughout the world, and mortality rates have increased from 905,000 in 2000 to 1.2 million in 2015.

9. Tuberculosis. Tuberculosis accounted for 2.4% of deaths worldwide in 2015. But luckily, the prevalence of this disease—caused by Mycobacterium tuberculosis—is decreasing as is its mortality rate, from 2.3 million in 2000 to 1.3 million in 2015. Tuberculosis, however, remains one of the primary causes of death in people with HIV (35%). Risk factors for tuberculosis include low body weight, regular use of corticosteroid or immunosuppressive drugs, diabetes, HIV infection, and living in close proximity to those with tuberculosis. Preventive measures include the bacillus Calmette-Guerin (BCG) vaccine, usually given to children.

8. Diarrheal disease. Dehydration caused by diarrheal disease resulted in 1.4 million deaths in 2015, but its prevalence is decreasing, having dropped from 2.2 million deaths in 2000 to 1.4 million in 2015. Unfortunately, diarrheal disease is the second leading cause of death in children under the age of 5 years, and a primary cause of malnutrition in this age group. Worldwide, almost 1.7 billion cases of childhood diarrheal disease occur each year. Risk factors include living in areas with poor sanitary conditions, malnourishment, a weakened immune system, young age, and no access to clean water.

7. Alzheimer disease. This progressive neurologic disease accounted for 1.5 million deaths in 2015, and for 2.7% of all deaths worldwide. Its prevalence over the past 15 years (2000-2015) has increased from 1.2 million to 1.5 million. Risk factors include being female, over age 65 years, genetic predisposition, an unhealthy lifestyle, previous head trauma, and family history. In current studies, researchers have shown that diet may play a large role in reducing the risk of Alzheimer disease, especially one that is heart-healthy, low in saturated fats, and high in monounsaturated fats from fish, nuts, and olive oil.

6. Diabetes-related. The prevalence of diabetes-related death has increased from 1.0 million to 1.6 million from 2000 to 2015. In 2015, diabetes-related illnesses accounted 2.8% of all deaths throughout the world. Diabetes-related illnesses include cardiovascular disease, neuropathy, nephropathy, and retinopathy, along with a host of skin conditions and other complications.

5. Respiratory cancers. Cancers of the lungs, bronchus, larynx, and trachea comprise this group, and were responsible for 1.7 million deaths worldwide in 2015, totaling 3% of all deaths, and up from 1.2 million deaths in 2000. Pollution and smoking (both primary and secondary) are the primary causes of respiratory cancers. In fact, experts predict an 81% to 100% increase in respiratory cancers in developing countries due to these causes.

4. Chronic obstructive pulmonary disease (COPD). Chronic bronchitis and emphysema are the two primary forms of COPD, and there is some thought to adding asthma as well, although no consensus has been reached. COPD deaths accounted for 5.6% of all deaths worldwide, totaling 3.1 million in 2015. Risk factors include smoking, secondhand smoke, lung irritants, family history, and a history of respiratory infections as a child.

3. Lower respiratory infections. Flu, pneumonia, bronchitis, and tuberculosis are lower respiratory infections, and comprise 5.7% of deaths worldwide. But the number of deaths from lower respiratory infections decreased from 3.4 million in 2000 to 3.2 million in 2015. Viruses are the main cause of these infections, but bacteria are implicated as well. Risk factors include the flu, poor air quality, frequent exposure to respiratory irritants, smoking, asthma, HIV, immunocompromised status, and crowded childcare settings.

2. Stroke. Between 2000 and 2015, the mortality from stroke increased from 5.7 million to 6.2 million. Stroke was responsible for 6.2 million deaths in 2015, accounting for 11.1% of deaths worldwide. Stroke is also the leading cause of long-term disability. Diabetes, hypertension, hypercholesterolemia, smoking, and obesity are the leading causes of stroke. Risk factors include high blood pressure, family history of stroke, smoking (especially when combined with oral contraceptives), African American race, and female sex.

1. Coronary artery disease (CAD). The number one deadliest disease is CAD, responsible for 15.5% of all deaths worldwide. And mortality rates have been increasing, with a significant jump from 6 million deaths in 2000 to 8.8 million deaths in 2015. The good news is that mortality rates have gone down in the United States and many European countries, but the bad news is that deaths due to CAD are rising in many developing nations. Risk factors for CAD include hypertension, hypercholesterolemia, smoking, diabetes, overweight and obesity, and family history.

Had constipation? Here are 4 things to help treat it

Had constipation? Here are 4 things to help treat it

January 29, 2020 2.01pm AEDT

Author

  1. Clare Collins Professor in Nutrition and Dietetics, University of Newcastle

Disclosure statement

Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.

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Chronic constipation is incredibly common. Around one in four people worldwide report symptoms, while in Australia and New Zealand, it’s around one in seven.

Lots of things can trigger constipation: being out of your usual routine (think holidays, illness or injury), having a low fibre intake, not drinking enough water and inactivity.

Certain medications can also cause constipation including iron supplements, painkillers, diuretics (to help you get rid of sodium and water), and other drugs to treat heart disease, mental health conditions and allergies.


Read more: Health Check: what causes constipation?


Constipation is more common in older adults and in women, due to hormonal changes that slow bowel motility – the time it takes for your body to digest food and expel the waste products (stools or bowel motions). Pregnant women are particularly prone to constipation.

How do you know you’re constipated?

Symptoms include:

  1. lumpy or hard stools
  2. feeling that your bowels haven’t emptied completely or your anus is blocked
  3. straining to pass a bowel motion
  4. manipulating your body position to try and pass a bowel motion
  5. having fewer than three bowel motions per week.

If over a three-month period you answer yes to two or more of these symptoms most weeks, then you have “constipation”.

The good news is it can be treated and then prevented.

Women are more likely to become constipated than men because they experience more horomonal changes. Kongsak/Shutterstock

If your bowels are so packed you can’t pass any bowel motions at all, see your GP. You may need treatment with specific laxatives to clear your bowels before you can start on a prevention plan.

Here are four things that research shows improve bowel function, which refers to the time it takes for food to move through your digestive system and be expelled as a bowel motion (called gut transit time), the frequency and volume of bowel motions, and stool consistency.

1. High-fibre foods

Dietary fibres are complex carbohydrates that aren’t digested or absorbed in the gut.

Different types of dietary fibres improve bowel function through the following processes:

  • the fermentation of fibre in the colon produces water and other molecules. These make stools softer and easier to pass
  • absorption of water into stools stimulates the gut to contract and makes bowel motions softer
  • a higher fibre intake creates bigger stools, which pass more quickly, resulting in more regular bowel motions.

Read more: Health Check: are you eating the right sorts of fibre?


A good source of fibre is psyllium. It forms a viscous gel, which gets fermented in the colon, leading to softer bowel motions. Psyllium is the main ingredient in Metamucil, which is commonly used to treat constipation.

Psyllium is a type of fibre that helps soften bowel motions. Shawn Hempel/Shutterstock

A review comparing the effect of psyllium to wheat bran in people with chronic constipation found psyllium was 3.4 times more effective at increasing the amount of stool passed.

This is important because having a bigger bowel motion waiting in the colon to be passed sends signals to your gut that it’s time to expel the stool – and it helps the gut contract to do just that.

The review found both psyllium and coarse wheat bran had a stool-softening effect, but finely ground wheat bran had a stool-hardening effect.

Other foods rich in fermentable carbohydrates include dark rye bread and legumes (chickpeas, lentils, four-bean mix, red kidney beans, baked beans); while wholemeal and wholegrain breads and cereals are high in different types of dietary fibres.


Read more: Multigrain, wholegrain, wholemeal: what’s the difference and which bread is best?


2. Kiwi fruit

Kiwi fruit fibre absorbs about three times its weight in water. This means it helps make stools softer and boosts volume by increasing the amount of water retained in bowel motions. This stimulates the gut to contract and moves the bowel motions along the gut to the anus.

In a study of 38 healthy older adults, researchers found adding two to three kiwi fruit per day to their diets for three weeks resulted in participants passing bowel motions more often. It also increased the size of their stools and made them softer and easier to pass.

Kiwi fruit can help you go to the loo more regularly. Nitr/Shutterstock

Kiwi fruit are also rich in the complex carbohydrate inulin a type of fructan. Fructans are a prebiotic fibre, meaning they encourage growth of healthy bacteria in the colon.

But fructans can also aggravate symptoms in some people with irritable bowel syndrome (IBS). If you have IBS and constipation, check in with your GP before upping your fructan intake.


Read more: Explainer: what is irritable bowel syndrome and what can I do about it?


If you don’t like kiwi fruit, other vegetables and fruit high in fructans include spring onion, artichoke, shallots, leek, onion (brown, white and Spanish), beetroot, Brussels sprouts, white peaches, watermelon, honeydew melon and nectarines.

3. Prunes

Prunes are dried plums. They contain a large amount of sorbitol, a complex carbohydrate that passes undigested into the colon where bacteria ferment it. This produces gas and water, which triggers an increase in bowel movements.

Eating prunes is even more effective than psyllium in improving stool frequency and consistency.

One study of adults with constipation compared eating 100 grams (about ten) prunes a day for three weeks to those who ate psyllium. The prune group passed an average of 3.5 separate bowel motions per week compared to 2.8 in the psyllium group.

The prune group’s stools were also softer. They rated, on average, 3.2 on the Bristol stool chart compared to 2.8 for the psyllium group, meaning their bowel motions were more toward smooth to cracked sausage-shaped motions rather than lumpy ones.

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If you don’t like prunes, other foods that contain sorbitol include apples, pears, cherries, apricots, plums and “sugar-free” chewing gum and “sugar-free” lollies.

4. Water

Not drinking enough water is the strongest predictor of constipation. When your body is a bit dehydrated, there’s less water for the fibre in your colon to absorb, meaning your bowel motions also become dehydrated and harder to pass.

Aim for around 1.5 to two litres of fluid per day, which can include liquids such as tea, coffee, soup, juice, and even jelly and the liquid from stewed fruit.


Read more: Health Check: what your pee and poo colour says about your health


Putting it all together

Start by increasing the amount of water or other liquids you drink. You should be drinking enough that your urine is the colour of straw.

Aim for two litres of water a day. Pixel-Shot/Shutterstock

Next, add in psyllium. Start with a tablespoon once a day with breakfast cereal.

Psyllium forms a gel as soon as it comes into contact with liquids so to make psyllium more palatable, mix it with a small amount of stewed fruit or yoghurt and eat it straight away. If needed, increase psyllium to twice a day.

At least once a day, have some prunes (either dried or canned) or kiwi fruit and a variety of other foods high in fibre, fructans, sorbitol and fermentable carbohydrate.

If your bowel habits don’t improve, see your GP.