I mentioned earlier this week that anti depressants have many side effects and often are not the best treatments for anxiety or depression. Unfortunately, it is easier for doctors to write out a prescription than it is to talk to and counsel the patient.

Here are some very valuable resources available online, mostly at no cost, to help with anxiety and depression. All the studies done show that Cognitive Behaviour Therapy (CBT) is very effective at treating anxiety, and is often more effective than counseling. It is available at these online sites:

https://beacon.anu.edu.au/service/website/browse/1/Depression

http://www.mindhealthconnect.org.au

wwwblackdoginstitute.org.au/health[professionals/gps/emhprac.cfm#programs

Are these depression medications overprescribed?

Later this week I will post information about how you can access CBT online and at no cost. Evidence shows that this is just as effective as seeing a specialist (More convenient, and less expensive as well)

Naveed Saleh, MD, MS|February 2, 2021

Psychotropics are some of the most widely prescribed medications in the world. During the past few decades, the use of antidepressants has skyrocketed. This increase in prescription has been met with debate by experts who question whether overprescription is at play.

Antidepressant use is on the rise and some research shows these drugs are being overprescribed.

According to a literature review published in Trends in Psychiatry and Psychotherapy, “It has been suggested that overprescription of antidepressants is fueled by the increase in the incidence of depression, stress and anxiety, or due to the way psychotropic medications are marketed.”

They added, “However, regardless of the validity of the said reasons, another explanation could be suggested: psychiatric disorders, namely depression, are being overdiagnosed on a considerable scale, probably leading to a list of significant adverse consequences that mostly affect the most vulnerable groups of patients. At the end, further rigorous research should certainly be undertaken to examine the extent and cost of overprescription of psychotropic drugs in society.”

Scope

Compared with placebo, antidepressant treatment yields additional symptomatic relief in 25%-30% of adults diagnosed with major depressive disorders, according to a literature review published in the Journal of Clinical Medicine Research. These results are especially true for selective serotonin reuptake inhibitors (SSRIs). The same holds for benefit with respect to anxiety disorders.

With maintenance therapy, however, the results are less convincing. The review author cited high-powered research indicating that adults with major depressive disorder who started a 1-year course of antidepressant therapy averaged a 34%-50% relapse rate during this maintenance period, which the author noted was “strikingly high.”

Also, according to the literature review, only 15% of adults aged 65 years or older who took antidepressants met the diagnostic criteria for major depressive disorder during the previous year. In fact, few patients treated with antidepressants experienced the requisite number of symptoms to be diagnosed with the condition, with those with subthreshold symptomatology responding in a marginal manner at best. Moreover, 27% of those patients aged 12 years and older had been taking long-term antidepressants—for 10 or more years.

These data are concerning because, as with any other drug, antidepressants pose the risk of adverse effects. These include decreased sexual function, type 2 diabetes, weight gain, low bone density, and hypertension. To boot, at least 35% of those taking the drugs for 6 weeks or more experience withdrawal when drug dosages aren’t properly tapered. On a related note, antibiotics can impact the microbiome in ways that facilitate serious chronic illness.

Burden

It appears that the brunt of antidepressant overprescription occurs in elderly populations, according to the results of a study published in Pharmacology Research & Perspectives.

Researchers mined Minnesota health records for antidepressant prescription patterns in elderly patients between 2005 and 2012. Overprescribing was abstracted based on factors including expert review.

They found that potential antidepressant overprescription happened in 24% of 3,199 cases, concluding that this was “associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e‐mail, or patient portal.”

They added that this overprescribing pattern “occurred in elderly persons and involved mainly newer antidepressants used for non‐specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face‐to‐face patient contact.”

What to do?

Instead of prescribing psychotropic medications, cognitive behavioral therapy (CBT) could be used to treat mental illness, according to experts. CBT explores the relationships among feelings, thoughts, and behaviors, with the therapist uncovering unhealthy patterns of thoughts, and providing insight into how they lead to harmful behaviors and beliefs. This insight allows the therapist and patient to work together to develop constructive ways of thinking that yield healthier behaviors and outcomes. In sum, CBT replaces negative thoughts with positive ones via training.

According to the National Alliance on Mental Illness, “Studies of CBT have shown it to be an effective treatment for a wide variety of mental illnesses, including depression, anxiety disorders, bipolar disorder, eating disorders, and schizophrenia. Individuals who undergo CBT show changes in brain activity, suggesting that this therapy actually improves your brain functioning as well.”

They added, “Cognitive behavioral therapy has a considerable amount of scientific data supporting its use and many mental health care professionals have training in CBT, making it both effective and accessible. More are needed to meet the public health demand, however.”

Author supplied, Author provided (No reuse)

The FODMAP diet is everywhere, but researchers warn it’s not for weight loss

February 25, 2020 6.01am AEDT

Author

1. Jane Varney Senior Research Dietitian in the Department of Gastroenterology, Monash University

Disclosure statement

Jane Varney does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Monash University provides funding as a founding partner of The Conversation AU.

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The FODMAP diet is used to help manage irritable bowel syndrome (IBS), but it’s becoming more popular. Now bloggers and so-called health gurus have jumped on board, claiming it can treat everything from acne to weight loss.

While it would be great if the diet did help to manage these hard-to-treat conditions, these claims are closer to science fiction than science.

What are FODMAPs?

FODMAPs are a group of carbohydrates found naturally in a wide range of foods, including garlic, onion, dairy, many fruits and vegetables, breads, cereals, pulses, nuts and many manufactured foods.

FODMAP is an acronym that stands for Fermentable Oligo- Di- Monosacharides And Polyols. Our team at Monash University coined the term in 2005 when we showed this group of carbohydrates trigger symptoms of IBS in susceptible people, and reducing all of them together would have a greater impact on IBS symptom relief than reducing any one of them alone.

How do FODMAPs lead to IBS?

FODMAPs attract water as they pass slowly through the small intestine. They then pass undigested into the large intestine where bacteria ferment them. In people with IBS, this leads to excessive gas production and changes in bowel habit, along with many other typical IBS symptoms including pain, bloating and distension.

One in seven Australian adults are thought to have IBS. Our research, which has been replicated by groups all over the world, has shown the diet reduces IBS symptoms in three out of four sufferers.

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

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FODMAP is not a weight loss diet

While a limited number of studies indicate weight loss is an unintended consequence of a low FODMAP diet, the diet is ill fit for this purpose. For people needing to lose weight, the food restrictions the FODMAP diet imposes are unnecessary.

Unless carefully implemented, the diet can compromise intake of nutrients such as fibre, iron and calcium. This can lead to a shortage of these nutrients if the diet is followed strictly long-term.

One example of this is the diet restricts intake of prebiotics, the fuel source for good bacteria in our bowel. Numerous studies have shown an unintended consequence of the FODMAP diet is it changes the composition of the gut microbiota. While the long-term consequences of these changes are unknown, it is not advisable to restrict FODMAPs unnecessarily.

There is no scientific evidence to suggest the FODMAP diet reduces acne.

How should the FODMAP diet be used?

A FODMAP diet is a three step diet best followed under the guidance of an experienced dietitian.

People follow the diet strictly at the start, and relax and personalise the dietary restrictions over time. The aim is to strike a balance between adequate symptom control and a minimally restrictive diet.

In step 1, people reduce intake of all FODMAP groups below a threshold level. The aim of this step is to reduce IBS symptoms. If IBS symptoms improve sufficiently, people progress to step 2.

In step 2, people undertake a series of “food challenges” to determine which FODMAPs they can tolerate.

In step 3, well tolerated FODMAPs are brought back into the diet, while poorly tolerated FODMAPs are restricted, but only to a level necessary to control IBS symptoms.

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

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Growth in popularity

The success of the FODMAP diet is due to its widespread uptake among patients with IBS. Backed by scientific evidence, the diet is recommended in various local and international clinical guidelines as a first-line IBS treatment.

As consumer demand for low FODMAP food choices grows, some companies have started to adopt Monash University’s low FODMAP certification. Brands like Vegemite, Kellogg’s USA, and Bakers Delight now offer low FODMAP-certified products.

But with bloggers and “health gurus” promoting fad diets under the FODMAP name, our research team is spending more time combating disinformation. This takes time away from our research and the support we can offer IBS sufferers.

To learn more about the FODMAP diet, visit monashfodmap.com.

Is this little-known diet the secret to cholesterol woes?

Alistair Gardiner|February 4, 2021

It sometimes seems like the ketogenic, Paleo, and Atkins diets have taken over social media by storm. But what about the Pritikin diet? This cholesterol-conquering eating plan has been around for more than 40 years, yet it doesn’t get the publicity of its trendier peers—despite its evidence-based health benefits, outlined in a JAMA article last spring.

Have you heard of the Pritikin diet? Developed over 40 years ago, it aims to protect your heart.

The truth is, the Pritikin diet boasts some major bona fides that suggest it could be a good fit for dieters seeking heart health, including physicians. But what does the Pritikin diet entail? What benefits does it bring? And who’s this Pritikin guy, anyway?

The Pritikin diet’s origins

Born in Chicago in 1915, Nathan Pritikin dropped out of college during the early years of the Great Depression and became an inventor and engineer. He spent the first half of his career developing ideas and products for the likes of General Electric, Honeywell, Corning Glass, Bendix, and other corporations. The 20th-century innovator eventually held more than two dozen patents.ADVERTISEMENT -SCROLL TO KEEP READING

It wasn’t until he reached his 40s that he turned his mind to nutrition. In 1957, he was diagnosed with heart disease. At the time, however, most physicians didn’t consider diet a significant factor in cardiovascular issues. After 2 years of research, Pritikin grew convinced that his diet had caused his condition. He spent the rest of his life trying to spread the word that our eating habits could directly affect our risk of developing certain diseases.

Through his work, Pritikin homed in on the idea of a diet and exercise regimen geared to lower cholesterol levels. He laid out his recommendations in the 1979 book, The Pritikin Program for Diet & Exercise, which remains his most lasting legacy.

What is the Pritikin diet?

The Pritikin diet is low in fats and high in complex carbohydrates. Specifically, the diet consists of less than 10% fat, 10%-15% protein, and 75%-80% carbohydrates. Additionally, followers aim to consume no more than 25 mg or 100 mg of cholesterol per day, depending on whether they follow the “regression” or “maintenance” version of the diet, according to the JAMA article.  

The Pritikin plan encourages the consumption of healthy foods such as fruits and vegetables, whole-wheat pasta, whole-grain bread, fish, brown rice, oatmeal, potatoes, yams, lentil, beans, peas, and corn. Followers try to avoid full-fat dairy products, foods high in saturated fat such as red meat, eggs, butter, coconut oil, and palm oil, and foods with added sugar or salt. And, the diet calls for devotees to mostly avoid alcoholic drinks. 

In addition, the program recommends regular exercise, particularly walking and strength training.

Does the Pritikin diet work?

Pritikin designed his diet for the prevention of and treatment for cardiovascular disease by lowering cholesterol and blood pressure. It’s also cited as a weight-loss diet that can be used as a preventive measure against diabetes, as the program tends to control blood glucose levels. 

According to the JAMA article, the diet does indeed reduce cholesterol, by limiting the intake of high-fat and calorie-dense foods. While long-term data on the effects of the diet on mortality, cancer, and other diseases are unavailable, the article suggests that patients who want to lower their risk of cardiovascular disease might benefit from the Pritikin diet.ADVERTISEMENT -SCROLL TO KEEP READING

And research has found that the diet can lead to improvements in various cardiovascular disease risk factors. An earlier study, published in the Journal of Cardiometabolic Syndrome, examined the impact of short-term Pritikin therapy on the metabolic risk factors for coronary heart disease in 67 patients with metabolic syndrome. Following a 12- to 15-day stay at the Pritikin Longevity Center and Spa in Florida (one of a number of institutions that Pritikin established), the patients’ BMI decreased by 3% on average, researchers found. Participants’ systolic and diastolic blood pressure, and serum glucose and low-density lipoprotein cholesterol concentrations dropped by 10-15%, according to the study. 

What’s more, 37% of participants no longer met the National Cholesterol Education Program criteria for metabolic syndrome. Researchers concluded that even brief treatment with a low-fat, low-sodium, high-fiber diet and regular exercise can reduce multiple coronary heart disease risk factors.

More recent studies corroborate these findings. In a study published in Current Developments in Nutrition in 2020, authors sought to establish the effectiveness of a Pritikin-based cardiac rehabilitation program on patients with heart disease. The researchers analyzed changes to BMI, weight loss, waist circumference, blood pressure, low-density lipoprotein, high-density lipoprotein, total cholesterol, and Hemoglobin A1c.

They gathered data from 138 adult patients with pre-existing heart conditions, all of whom had completed a 12-week cardio rehab program based on Pritikin’s principles. The study found that patients experienced significant decreases in average weight and measurements of BMI, waist circumference, total cholesterol, and triglycerides. Plus, patients maintained key changes, such as weight loss, after a 3-month follow-up.

Another study, published in 2019 in Circulation, explored the impacts of the Pritikin program on a number of similar cardiovascular disease risk factors. Looking at 140 patients who completed 24 sessions of the outpatient Pritikin ICR (intensive cardiac rehabilitation) program at Barnes-Jewish Hospital/Washington University School of Medicine, researchers found that patients gained significant cardiovascular benefits. They reduced adiposity, improved lipid profiles, and enhanced exercise capacity. Researchers concluded that all of those outcomes would likely lead to fewer cardiovascular events.

Possible risks

While evidence suggests that the Pritikin diet can help reduce cholesterol and lower weight among strict adherents, the aforementioned JAMA article notes the potential for some adverse effects. During the first 2 weeks on the diet, enthusiasts could see significant increases in urine production and fluid shifts, which could force changes to medication regimens for hypertension, heart failure, and diabetes. As such, it’s important to examine whether the benefits outweigh the risks. And another pitfall: The Pritikin diet might lack adequate protein for maintaining muscle function, strength, and stamina—which might not be ideal for anyone who hopes to nail down the exercise portion of the program.

Review Articles

Efficacy of progestin-only treatment for the management of menopausal symptoms: a systematic review

Dolitsky, Shelley N. MD¹; Cordeiro Mitchell, Christina N. MD²; Stadler, Sarah Sheehan MD³; Segars, James H. MD²Author Information Menopause: February 2021 – Volume 28 – Issue 2 – p 217-224 doi: 10.1097/GME.0000000000001676

Abstract

Importance: 

Menopause is associated with bothersome symptoms for many women, including mood changes, hot flushes, sleep problems, and fatigue. Progesterone is commonly prescribed in combination with estrogen therapy. Although monotherapy with progestins has been used as treatment of menopausal symptoms in women with contraindications to estrogens, the optimal route, and dosage of progestin monotherapy has not been established.

Objective: 

To assess whether progestin as a standalone treatment is effective for treating vasomotor and mood symptoms associated with menopause.

Evidence review: 

We conducted a systematic review using PubMed and Embase databases from January 1980 to January 2020. We included randomized controlled trials (RCTs) that investigated different forms of progestin for the treatment of vasomotor or mood symptoms associated with menopause.

Findings: 

A systematic search of 892 studies identified seven RCTs involving a total of 601 patients. The available literature was heterogeneous in terms of formulation and dose of progesterone; administration ranged from 5 to 60 mg of transdermal progesterone, 10 to 20 mg oral medroxyprogesterone acetate, and 300 mg of oral micronized progesterone. Duration of treatment also differed between studies, ranging from 21 days to 12 months (median: 12 wks). Three of seven RCTs reported that progestin therapy led to an improvement of vasomotor symptoms (VMS) in postmenopausal women. The largest study administering oral progestin using 300 mg micronized progesterone reported a 58.9% improvement in VMS (vs 23.5% in placebo group, n = 133), whereas the largest study using transdermal progesterone reported no improvement (n = 230). No study reported an improvement of mood symptoms. Side effects, such as headaches and vaginal bleeding, were significant in five of seven RCTs and led to discontinuation of treatment in 6% to 21% of patients.

Conclusions and relevance: 

A beneficial effect was reported in some trials with the transdermal route at longer duration and with oral treatment at higher doses for VMS for progesterone-only therapy. This report may help to inform future studies of progestin-only therapy for the treatment of menopausal symptoms.

Iakov Kalinin/Shutterstock

Why going for a swim in the ocean can be good for you, and for nature

December 31, 2020 11.15am AEDT

Author

1. Rebecca Olive ARC DECRA Fellow, The University of Queensland

Disclosure statement

Rebecca Olive receives funding from the Australian Research Council.

Partners

We believe in the free flow of information

Republish our articles for free, online or in print, under Creative Commons licence.

Summer is the season when we like to cool off with a plunge into water. For some it’s in the local or backyard swimming pool, but others prefer the salt water of the ocean.

Sometimes referred to as “wild swimming”, it is happening at many of the beaches, coves, bays or estuaries in Australia.

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Read more: Why should my child take swimming lessons? And what do they need to know?

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But wild swimming is not only good for our health, it can also be good for ocean and beach ecologies too.

Get your news from people who know what they’re talking about.

A healthy ocean plunge

Annual competitive ocean swims, such as the Byron Bay Winter Whales and the Bondi to Bronte, are a mainstay of many Australian coastal towns and city suburbs. Daily and weekly recreational swimming groups are also well established at many of our beaches.

In European cultures, immersion in salt water has long been believed to be good for human health and seaside resorts there remain popular.

Ocean swimmers often wax lyrical about the health and wellbeing benefits they get from their regular ocean swims. And research from both the humanities and sciences backs up these claims.

It’s common to hear swimmers describe their troubles and anxieties washing away in the water. Like a daily cleansing, they emerge from their swim feeling energised, calm and ready to face their days.

Journalist and broadcaster Julia Baird has written about how her daily swims in Sydney inspire a sense of awe that shifts how she navigates other challenges in her life.

Other research talks about swimming as a process of “therapeutic accretion” whereby the pleasures of our regular short dips and longer swims in the ocean layer onto us and “build to develop a resilient wellbeing”.

In the UK, online movements such as #risefierce and Mental Health Swims promote regular swimming as a positive practice for our health and wellbeing.

Part of this is accepting that ocean conditions can change day to day. Some days are calm and clear, others are wild with waves and winds. If we want to swim, we have to learn to navigate the conditions we are dealt.

This capacity for decision-making in the face of challenge is helpful for a sense of confidence and resilience – something that has been clear during COVID-19 lockdowns around the world.

Encounters with the wild

For swimmers, the water offers other rewards.

Swimming, like other ocean sports like surfing and diving, is a way of immersing us in ecologies and bringing us into contact with animals, plants, weather, waves and rocks in a way that we cannot control.

We may encounter fish, birds, rays, turtles, cephalopods and other animals. All are reported to help with a sense of wellbeing. This highlights how we are part of these ecologies too.

The recent film My Octopus Teacher resonated with many people who swim and who regularly encounter the same animals. https://www.youtube.com/embed/3s0LTDhqe5A?wmode=transparent&start=0

Some swimmers even relate the effect of swimming to animals that live in oceans. In a study on swimming in the UK, one swimmer explained how they “went in like a cranky sea lion and came out like a smiling dolphin”.

Care for the oceans

Being part of an ecology means we have responsibilities too. In Australia, we need to take a lead from Indigenous Australian people to care for the sea country we swim in.

Ocean plastics, sewage and the antibiotics in agricultural run-off are a potential problem for our health as we swim in polluted oceans.

Our encounters with animals that live close to shore can impact their health too, so we need to remember to respect their space.

Many cultures are aware of the interconnections between people and the environments they live in. For example, Native Hawaiian and Māori researchers write about their links to oceans, and the Ama women in Japan connect with underwater soundscapes as they dive for abalone.

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Read more: Swimming with whales: you must know the risks and when it’s best to keep your distance

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In Australia, Aboriginal and Torres Strait Islander people are deeply aware of the connections between the health of people and the land, sea and sky countries they live on.

People cannot be healthy if Country is not healthy, nor can Country be healthy if people are not.

And that’s why wild swimming could be good for ocean and beach ecologies too. The more we learn about the health and wellbeing impacts of ocean and coastal ecologies, the more we should feel invested in taking care of them.

Let’s swim together

The lack of control we have over conditions in ocean waters can be frightening, and the same encounters that thrill some people are terrifying for others.

Even for experienced swimmers, drowning is a very real risk. Between July 2019 and June 2020, 248 people drowned in Australia, with 125 of those coastal drowning deaths.

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Read more: Shark nets are destructive and don’t keep you safe – let’s invest in lifeguards

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For others their fear of shark attacks and encounters is enough to keep them out of ocean water.

So if you want to give the ocean a try this summer, many people find comfort and safety by wild swimming with others. This is reflected in the growth of swimming groups.

Websites such as oceanswims.com and Swim Sisters list ocean swimming groups and competition swims around Australia. It’s easy to find information through your local community too.

Swimming in the sea can be as simple as taking that first plunge in knee-deep water, or as challenging as an hours-long marathon along the coast. Whatever you prefer, take the time to enjoy being immersed in a watery world. https://www.youtube.com/embed/1d8oqmCtcuM?wmode=transparent&start=0 You’re never too old (and it’s never too cold).

The truth about the COVID-19 vaccines

Newswise: Vaccines|February 2, 2021

The COVID-19 vaccines have been described by many as the light at the end of the tunnel and the best tool we have to stop this pandemic. But along with the vaccine rollout, there have been a number of myths circulating about their safety and effectiveness. To set the record straight, Cedars-Sinai’s Newsroom talked with Priya Soni, MD, a pediatrician and an infectious disease specialist.

Newsroom: MYTH #1: The vaccine was rushed into development and might not be safe

Soni: “While the development of the COVID-19 vaccines using mRNA technology is new, scientists have been working on this technology for many years, in fact decades. We are very excited that they are now being able to use the mRNA technology for vaccines in a safe way. The reason it was developed so rapidly is because scientists were able to implement this technology since they had the RNA sequence of the virus as it was released in January 2020. This allowed them to incorporate the mRNA for the spike protein into the vaccine. Nothing about the clinical trials for the vaccines was rushed nor any shortcuts taken. In fact, the numbers of participants in the clinical trials for both Moderna and Pfizer were quite robust and very similar to the number of participants needed and required in prior vaccine studies.”

MYTH #2: I’m young and healthy, so I don’t need a vaccine

“COVID-19 is still a very unpredictable infection, and just because you are young and healthy doesn’t mean you won’t have any of the complications of the infection that we continue to see. There are a few risk factors for severe disease that we have identified, but there’s still no guaranteed way to predict that you would have a mild or severe course with the infection. It is much safer and wiser to get the vaccine and deal with the slight discomfort and side effects temporarily than to subject yourself to the infection.”ADVERTISEMENT -SCROLL TO KEEP READING

MYTH #3: The COVID-19 vaccine will affect my chances of becoming pregnant

“There has been no link between the COVID- 19 vaccines and a negative impact on female fertility. The data is reassuring regarding the use of this vaccine during pregnancy, and because the mRNA degrades so rapidly, it would be highly unlikely that the vaccine could cause issues with fertility.”

MYTH #4: I can get COVID-19 from the vaccine

“What you may feel after you receive the COVID-19 vaccine is a mild fever, muscle soreness at the site of injection and fatigue. That is your immune system activating and starting to form the protective antibodies that it needs to fight off this virus if you are infected in the future. Compared to some of the live attenuated virus vaccines we have previously seen, the vaccine is noninfectious, so there is no way you can get COVID-19 infection from taking the vaccine itself.”

Myth #5: I’ve had COVID-19, so I don’t need the vaccine

“As far as we know, the antibody response that you are going to get from a vaccine is far more robust and more predictable than natural antibodies post-infection. Even if you’ve had COVID-19, it is a great idea to get a vaccine when you are able. Don’t forget to schedule your second dose for the vaccine as well. We also remind all those getting a vaccine to stick with the same platform–if you got Pfizer for your first dose, make sure you get the same for your second dose.”

MYTH #6: I received the vaccine, therefore I don’t have to wear a mask or social distance

“Vaccines are one of the many tools in our toolkit that we know can help prevent the spread of COVID-19. However, just because you received the COVID-19 vaccine does not mean you should stop wearing masks or social distancing. We are still trying to determine whether or not a person can spread the infection to others even when they are not infectious and have been vaccinated. Until we learn more, we should continue to do our part and remain masked and socially distant.”

To read more, click here

These 5 foods are claimed to improve our health. But the amount we’d need to consume to benefit is… a lot

May 15, 2019 6.13am AEST Blueberries contain anthocyanins, which might reduce your risk of heart disease. If you eat 150-300 in a day, that is. Andrew Welch/Unsplash

Authors

1. Emma Beckett Lecturer (Food Science and Human Nutrition), School of Environmental and Life Sciences, University of Newcastle
2. Gideon Meyerowitz-Katz PhD Student/Epidemiologist, University of Wollongong

Disclosure statement

Emma Beckett receives funding from the National Health and Medical Research Council. She is a member of the Nutrition Society of Australia, the Australian Institute of Food Science and Technology and the Early and Mid Career Researcher Forum.

Gideon Meyerowitz-Katz does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Food gives us the nutrients we need to survive, and we know a balanced diet contributes to good health.

Beyond this, many people seek out different foods as “medicines”, hoping eating certain things might prevent or treat particular conditions.

It’s true many foods contain “bioactive compounds” – chemicals that act in the body in ways that might promote good health. These are being studied in the prevention of cancer, heart disease and other conditions.

But the idea of food as medicine, although attractive, is easily oversold in the headlines. Stories tend to be based on studies done in the lab, testing concentrated extracts from foods. The effect seen in real people eating the actual food is going to be different to the effects in a petri dish.

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Read more: Health check: can eating certain foods make you smarter?

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If you do the maths, you’ll find you actually need to eat enormous amounts of particular foods to get an active dose of the desired element. In some cases, this might endanger your health, rather than protecting it.

These four foods (and one drink) show the common healing claims around the foods we eat don’t always stack up.

Cinnamon

Cinnamon, which contains a compound called cinnamaldehyde, is claimed to aid weight loss and regulate appetite.

There is evidence cinnamaldehyde can reduce cholesterol in people with diabetes. But this is based on studies of the chemical in large doses – not eating the spice itself.

These studies give people between 1 and 6 grams of cinnamaldehyde per day. Cinnamon is about 8% cinnamaldehyde by weight – so you’d have to eat at least 13 grams of cinnamon, or about half a supermarket jar, per day. Much more than you’d add to your morning porridge.

Red wine

The headlines on the health benefits of red wine are usually because of a chemical in grape skins called resveratrol. Resveratrol is a polyphenol, a family of chemicals with antioxidant properties.

It’s been claimed resveratrol protects our cells from damage and reduces the risk of a range of conditions such as cancer, type 2 diabetes, Alzheimer’s disease, and heart disease.

There is some limited evidence that resveratrol has benefits in animal models, although studies done in humans have not shown a similar effect.

It varies by wine, but red wine contains about 3 micrograms (about 3 millionths of a gram) of resveratrol per bottle. The studies that have shown a benefit from resveratrol use at least 0.1 grams per day (that’s 100,000 micrograms).

To get that much resveratrol, you’d have to drink roughly 200 bottles of wine a day. We can probably all agree that’s not very healthy.

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Read more: Health check: is moderate drinking good for me?

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Blueberries

Blueberries, like red wine, are a source of resveratrol, but at a few micrograms per berry you’d have to eat more than 10,000 berries a day to get the active dose.

Blueberries also contain compounds called anthocyanins, which may improve some markers of heart disease. But to get an active dose there you’re looking at 150-300 blueberries per day. More reasonable, but still quite a lot of fruit – and expensive.

Chocolate

The news that dark chocolate lowers blood pressure is always well-received. Theobromine, a chemical in chocolate has been shown to lower blood pressure in doses of about 1 gram of the active compound, but not at lower doses. Depending on the chocolate, you could be eating 100g of dark chocolate before you reached this dose.

Chocolate is a discretionary food, or “junk food”. The recommended serve for discretionary foods is no more than 600 kilojoules per day, or 25g of chocolate. Eating 100g of chocolate would be equivalent to more than 2,000kJ.

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Read more: Treat or treatment? Chocolate is good but cocoa is better for your heart

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Excess kilojoule consumption leads to weight gain, and being overweight increases risk of heart disease and stroke. So these risks would likely negate the benefits of eating chocolate to lower your blood pressure.

Turmeric

Turmeric is a favourite. It’s good in curries, and recently we’ve seen hype around the tumeric latte. Stories pop up regularly about its healing power, normally based on curcumin.

Curcumin refers to a group of compounds, called curcuminoids, that might have some health benefits, like reducing inflammation. Inflammation helps us to fight infections and respond to injuries, but too much inflammation is a problem in diseases like arthritis, and might be linked to other conditions like heart disease or stroke.

Human trials on curcumin have been inconclusive, but most use curcumin supplementation in very large doses of 1 to 12 grams per day. Turmeric is about 3% curcumin, so for each gram of tumeric you eat you only get 0.03g of curcumin. This means you’d have to eat more than 30g of tumeric to get the minimum active dose of tumeric.

Importantly, curcumin in turmeric is not very bioavailable. This means we only absorb about 25% of what we eat, so you might actually have to eat well over 100g of turmeric, every day, to get a reasonable dose of curcumin. That’s a lot of curry.

What to eat then?

We all want food to heal us, but focusing on single foods and eating mounds of them is not the answer. Instead, a balanced and diverse diet can provide foods each with a range of different nutrients and bioactive compounds. Don’t get distracted by quick fixes; focus instead on enjoying a variety of foods.

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Read more: Science or Snake Oil: can turmeric really shrink tumours, reduce pain and kill bacteria?

How Foods May Affect Our Sleep

A growing body of research suggests that the foods you eat can affect how well you sleep, and your sleep patterns can affect your dietary choices.

By Anahad O’Connor

• Published Dec. 10, 2020Updated Jan. 1, 2021

This has not been a very good year for sleep.

With the coronavirus pandemic, school and work disruptions and a contentious election season contributing to countless sleepless nights, sleep experts have encouraged people to adopt a variety of measures to overcome their stress-related insomnia. Among their recommendations: engage in regular exercise, establish a nightly bedtime routine and cut back on screen time and social media.

But many people may be overlooking another important factor in poor sleep: diet. A growing body of research suggests that the foods you eat can affect how well you sleep, and your sleep patterns can affect your dietary choices.

Researchers have found that eating a diet that is high in sugar, saturated fat and processed carbohydrates can disrupt your sleep, while eating more plants, fiber and foods rich in unsaturated fat — such as nuts, olive oil, fish and avocados — seems to have the opposite effect, helping to promote sound sleep.

Much of what we know about sleep and diet comes from large epidemiological studies that, over the years, have found that people who suffer from consistently bad sleep tend to have poorer quality diets, with less protein, fewer fruits and vegetables, and a higher intake of added sugar from foods like sugary beverages, desserts and ultra-processed foods. But by their nature, epidemiological studies can show only correlations, not cause and effect. They cannot explain, for example, whether poor diet precedes and leads to poor sleep, or the reverse.

To get a better understanding of the relationship between diet and sleep, some researchers have turned to randomized controlled trials in which they tell participants what to eat and then look for changes in their sleep. A number of studies have looked at the impact of a diverse array of individual foods, from warm milk to fruit juice. But those studies often have been small and not very rigorous.

• Some of these trials have also been funded by the food industry, which can bias results. One study funded by Zespri International, the world’s largest marketer of kiwi fruit, for example, found that people assigned to eat two kiwis an hour before their bedtime every night for four weeks had improvements in their sleep onset, duration and efficiency. The authors of the study attributed their findings in part to an “abundance” of antioxidants in kiwis. But importantly, the study lacked a control group, so it is possible that any benefits could have resulted from the placebo effect.

Other studies funded by the cherry industry have found that drinking tart cherry juice can modestly improve sleep in people with insomnia, supposedly by promoting tryptophan, one of the building blocks of the sleep-regulating hormone melatonin. Tryptophan is an amino acid found in many foods, including dairy and turkey, which is one of the reasons commonly given for why so many of us feel so sleepy after our Thanksgiving feasts. But tryptophan has to cross the blood-brain barrier to have any soporific effects, and in the presence of other amino acids found in food it ends up competing, largely unsuccessfully, for absorption. Studies show that eating protein-rich foods such as milk and turkey on their own actually decreases the ability of tryptophan to cross the blood-brain barrier.At Home: Our best suggestions for how to live a full and cultured life during the pandemic, at home.

One way to enhance tryptophan’s uptake is to pair foods that contain it with carbohydrates. That combination stimulates the release of insulin, which causes competing amino acids to be absorbed by muscles, in turn making it easier for tryptophan to cross into the brain, said Marie-Pierre St-Onge, an associate professor of nutritional medicine at Columbia University Irving Medical Center and the director of the Sleep Center of Excellence at Columbia.

Dr. St-Onge has spent years studying the relationship between diet and sleep. Her work suggests that rather than emphasizing one or two specific foods with supposedly sleep-inducing properties, it is better to focus on the overall quality of your diet. In one randomized clinical trial, she and her colleagues recruited 26 healthy adults and controlled what they ate for four days, providing them regular meals prepared by nutritionists while also monitoring how they slept at night. On the fifth day, the subjects were allowed to eat whatever they wanted.

The researchers discovered that eating more saturated fat and less fiber from foods like vegetables, fruits and whole grains led to reductions in slow-wave sleep, which is the deep, restorative kind. In general, clinical trials have also found that carbohydrates have a significant impact on sleep: People tend to fall asleep much faster at night when they consume a high-carbohydrate diet compared to when they consume a high-fat or high-protein diet. That may have something to do with carbs helping tryptophan cross into the brain more easily.

But the quality of carbs matters. In fact, they can be a double-edged sword when it comes to slumber. Dr. St-Onge has found in her research that when people eat more sugar and simple carbs — such as white bread, bagels, pastries and pasta — they wake up more frequently throughout the night. In other words, eating carbs may help you fall asleep faster, but it is best to consume “complex” carbs that contain fiber, which may help you obtain more deep, restorative sleep.

“Complex carbohydrates provide a more stable blood sugar level,” said Dr. St-Onge. “So if blood sugar levels are more stable at night, that could be the reason complex carbohydrates are associated with better sleep.”

One example of a dietary pattern that may be optimal for better sleep is the Mediterranean diet, which emphasizes such foods as vegetables, fruits, nuts, seeds, legumes, whole grains, seafood, poultry, yogurt, herbs and spices and olive oil. Large observational studies have found that people who follow this type of dietary pattern are less likely to suffer from insomnia and short sleep, though more research is needed to confirm the correlation.

But the relationship between poor diet and bad sleep is a two-way street: Scientists have found that as people lose sleep, they experience physiological changes that can nudge them to seek out junk food. In clinical trials, healthy adults who are allowed to sleep only four or five hours a night end up consuming more calories and snacking more frequently throughout the day. They experience significantly more hunger and their preference for sweet foods increases.

In men, sleep deprivation stimulates increased levels of ghrelin, the so-called hunger hormone, while in women, restricting sleep leads to lower levels of GLP-1, a hormone that signals satiety.

“So in men, short sleep promotes greater appetite and desire to eat, and in women there is less of a signal that makes you stop eating,” said Dr. St-Onge.

Changes also occur in the brain. Dr. St-Onge found that when men and women were restricted to four hours of nightly sleep for five nights in a row, they had greater activation in reward centers of the brain in response to pepperoni pizza, doughnuts and candy compared to healthy foods such as carrots, yogurt, oatmeal and fruit. After five nights of normal sleep, however, this pattern of stronger brain responses to the junk food disappeared.

Another study, led by researchers at King’s College London, also demonstrated how proper sleep can increase your willpower to avoid unhealthy foods. It found that habitually short sleepers who went through a program to help them sleep longer — resulting in their getting roughly an hour of additional sleep each night — had improvements in their diet. The most striking change was that they cut about 10 grams of added sugar from their diets each day, the equivalent of about two and a half teaspoons.

The takeaway is that diet and sleep are entwined. Improving one can help you improve the other and vice versa, creating a positive cycle where they perpetuate one another, said Dr. Susan Redline, a senior physician at the Brigham and Women’s Hospital and a professor of sleep medicine at Harvard Medical School who studies diet and sleep disorders.

“The best way to approach health is to emphasize a healthy diet and healthy sleep,” she added. “These are two very important health behaviors that can reinforce each other.”

Beware the hidden dangers of these highly prescribed drugs

You will notice a change in your prescriptions from today. Doctors have to prescribe generic medicines (active ingredients) by legislation. This is a money saving exercise, as generics are much cheaper. This will be a good thing for most people, but not everyone. If you can afford it, then it is better to go by brand name.

Naveed Saleh, MD, MS|January 26, 2021

The price of prescription drugs is on the rise, with no reprieve in sight. Based on recent research done by GoodRx, prescription drug prices have gone up by 33% since 2014. 

Consumers are increasingly taking generic drugs, and health insurance companies often require patients to switch to generics as a way of keeping costs down.

In other research, the Peter G. Peterson Foundation cited that US spending on prescription drugs grew from $783 per capita in 2007 to $1,025 in 2017. This spending is expected to hit $1,635 per capita by 2027, which represents a bump of 60%.   

According to the Foundation, “The rising cost of prescription drugs is a key driver of overall healthcare spending in the US. This trend has significant implications not only for Americans who rely on medications, but also for our nation’s budget and fiscal outlook. Recent proposals to reduce such costs indicate a bipartisan desire to curb growth in prescription drug prices, but there has been a lack of consensus on the exact path forward.”

They added, “The growth in aggregate spending on prescription drugs can be attributed to several factors, such as the number and type of drugs prescribed (for example, specialty drugs are typically much more expensive than other drugs).”

Meanwhile, consumers are increasingly taking generic drugs, and health insurance companies often require patients to switch to generics as a way of keeping costs down. But are generics as safe as you think? Many generics sold in the United States are now manufactured overseas, and concerns remain about their safety and quality. Here’s what you need to know about generics.  

The problem

In July 2018, manufacturers recalled three angiotensin-receptor blockers (ARBs)—valsartan, losartan, and irbesartan—after investigators found adulterants in the form of nitrosamine compounds present in the drug. These adulterants are likely carcinogens, which are also found in rocket fuel. A few months later, concerns over the safety of generics intensified, when major pharmacies yanked the generic heartburn medication ranitidine from shelves, which was also found to have similar impurities.

Results from an interrupted time series analysis published in Circulation: Cardiovascular Quality and Outcomes demonstrated that among users of losartan, valsartan, and candesartan, compared with brand-name iterations, there was an 8% increase in rates of adverse events during the month that these generics hit the market.

The authors concluded, “Among generic users, immediate or delayed differences in adverse events rates were observed right after generic commercialization for 3 antihypertensive drugs. Rates of adverse events remained higher for generic users. Increases were more pronounced for generic candesartan, which is the studied product with the largest difference in comparative bioavailability. Risk and survival analysis studies controlling for several potential confounding factors are required to better characterize generic substitution.”

In other dismaying news, American Cancer Society blogger Dr. Len (Leonard Lichtenfeld, MD) noted that although the quality of medicines produced in the United States ranks high, drugs from China and India are of diminished quality, with certain pharma executives expressing no confidence in drugs from these countries. Moreover, he cited a case where a patient with heart failure decompensated on shoddy generics, only to recover after switching off the drugs. 

What the FDA has to say

In 2018, more than 1,000 generic drugs were approved by the FDA. Generic drugs decrease costs and boost access, noted the FDA. In case of a shortage or natural disaster, for instance, availability is no longer a concern, with several manufacturers in place. With producers worldwide, the American pipeline for needed drugs is secured.

The FDA assures that the review process for any new generic drug is rigorous, and that applicant generic doppelgängers have the same effects on the human body, the same active ingredients, and the same indications and safety as their prescription counterparts. Specifically, foreign-manufactured generics need to meet the same approval standards as domestic manufacture, with the FDA denying import to offending agents as needed. 

Regardless of its measures and safeguards, the FDA recognizes that bad actors exist. In recent years, the FDA’s Center for Drug Evaluation and Research (CDER) has substantially increased the number of warning letters it sends. In 2018, for instance, it issued nearly five times as many warning letters to human drug manufacturers than in 2015. 

“The FDA does not believe that increased numbers of warning letters reflect a growing problem in drug quality, but rather our ability to best utilize our resources to target problem areas,” wrote the agency. “We use ‘risk-based’ targeting to prevent, uncover and combat data and manufacturing problems. Risk-based means that we strategically direct our inspection and oversight efforts toward facilities most likely to exhibit quality issues in need of resolution.The agency also oversees the global manufacturing market by building relationships with other international regulatory agencies. “Among many other synergies generated by these partnerships, we utilize the results of inspections done by many countries in the European Union to avoid inefficient and unnecessary duplication of inspections,” the agency noted.

Importantly, the FDA inspects foreign and domestic drug-manufacturing facilities with “depth and rigor.” Some inspections are high priority—based on recall trends, compliance, time ever since last inspection, processing complexity, and risks of drugs manufactured. Although most inspections are announced beforehand, it is within the FDA’s purview to do unannounced inspections. In recent years, more unannounced visits have been performed.

During inspections, FDA investigators can access data via the company’s technology, and discover whether data has been removed or manipulated. The FDA can then act expeditiously to protect patients by placing the facility on import alert or block import.

“Although it only takes one bad actor to create a health issue for patients, it is important to note that the vast majority of facilities and companies pass our inspections and are manufacturing safe, effective and high-quality medicines,” concluded the FDA. “FDA laboratory testing for drug quality has consistently shown medicines manufactured in foreign countries meet U.S. market quality standards using testing standards set by the United States Pharmacopeia (USP) or submitted in marketing applications.”

What can you do?

Despite assurances from the FDA, it remains to be elucidated exactly how dangerous generic drugs can be. Only trends, time, and data will tell. But if you have a concern about the safety or efficacy of generics, it’s incumbent to report. And of course, you can err on the side of prescribing brand names.

After a drug is approved and marketed, patients and clinicians can report adverse effects or quality issues to the FDA’s MedWatch program. When a drug or safety issue is identified, a multidisciplinary team reviews the concerns. Depending on the team’s findings, the FDA can ban import, update product patient or clinical information, restrict use, relay new safety concerns, or yank the drug from the market.