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.

Researchers identify strange, simple trick to improve your memory

Featured Articles in Internal Medicine In the News

Researchers identify strange, simple trick to improve your memory

Melissa Sammy, MDLinx | October 11, 2019

We all know that walking does the body good. Time and again, researchers have shown the plethora of health benefits that this simple exercise can offer in terms of weight management and cardiovascular health, as well as libido and pain relief. But did you know that walking can also be good for the brain? In a recent study published in Cognition, UK researchers found that people who walked in reverse demonstrated better short-term memory recall than those who walked forward or sat still.

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Researchers have found that people who walk backward have better short-term memory recall than those who walk forward or stand still.

“The results demonstrated for the first time that motion-induced past-directed mental time travel improved mnemonic performance for different types of information. We have named this a ‘mnemonic time-travel effect,’” said lead author Aleksandar Aksentijevic, PhD, Department of Psychology, Centre for Research in Cognition, Emotion and Interaction, University of Roehampton, London, United Kingdom.

In this study, the researchers conducted six experiments to determine whether backward movement would spur cognitive recall relative to forward movement or no movement. Study participants (n = 114) were shown a video of a staged crime (experiments 1, 3, and 5), a word list (experiments 2 and 4), and a set of pictures (experiment 6). They were then directed to walk forward or in reverse, sit still, watch a video simulating forward or backward motion, or imagine walking forward or in reverse. Afterward, they answered questions regarding the video or were asked to recall certain words or image details.

Overall, compared with sitting still, reverse movement—whether real or imaginary—improved mnemonic performance with respect to eyewitness information, word recall, and picture recall among study participants.

Specifically, in five of the six experiments, cognitive recall following reverse motion was superior to recall following forward movement. For instance, in the staged crime experiment, participants watched a video of a woman sitting in a park who has her bag stolen. When the investigators tested participants’ ability to correctly answer 20 questions about the simulated crime, they found that those who walked backward were significantly more likely to answer more questions correctly—irrespective of age or other factors. Of note, however, this boost in memory lasted for about 10 minutes, on average, once study participants stopped moving.

Although there isn’t a well-developed explanation behind the mechanism for how all this works, one theory posits that the human brain somehow systematizes time and memory spatially; therefore, experiencing events in unusual spatial circumstances may result in memories being stored differently.

“It’s a partial vindication of this idea that time is really expressed via space,” noted Dr. Aksentijevic.

Daniel L. Schacter, PhD, William R. Kenan, Jr. Professor, Department of Psychology, Harvard University, Cambridge, MA, commented on the study findings, stating: “We know it can’t have anything to do with how they’ve encoded the information. But I found the results intriguing.”

He went on to say that backward motion could someday be added to existing techniques to boost memory recall, and may be especially helpful for eyewitness interviews following a crime. He cautioned, however, that “it’s really too early to say whether there would be practical applications.”

Richard Allen, PhD, associate professor, School of Psychology, University of Leeds, United Kingdom, echoed this sentiment, stating that the results are interesting and may offer ways to improve cognitive function, but that they need to be “clearly replicated by other research groups before we can start to be confident about this effect and its interpretation.”

Dr. Aksentijevic, however, is hopeful that further investigation of this research will materialize into a tangible benefit in the near future: “I am sure that some of this work could be useful in helping people remember things, but how is a question for more research.”

So, the next time you’ve misplaced your script pad or stethoscope, try retracing your footsteps—literally.

Telehealth Consultations.

From today I will be conducting consultations only either by telephone, or Zoom, a form of telehealth. If you are unfamiliar with Zoom, ask for help from anyone who is familiar with it. It is my first time using Zoom, so it will be novel for me as well so there may be some hiccups in the beginning. This is a very new world we are entering.

All consultations will be Bulk Billed, so there will be no cost to anyone.

I have asked Leanne if Zoom has a photoshop facility, so that it can remove all my wrinkles and make me look 30 years younger. Unfortunately, it does not appear to do so, but I am working on it. :))

Uncertain? Many questions but no clear answers? Welcome to the mind of a scientist

AAP Image/Dan Peled

Uncertain? Many questions but no clear answers? Welcome to the mind of a scientist

March 25, 2020 12.10pm AEDT

Author

  1. Darren Saunders Associate professor, UNSW

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Darren Saunders has previously received funding from NHMRC, US DoD, and MNDRIA. He is Secretary of Science and Technology Australia..

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Watching the world adjust to the horrific new reality of the COVID-19 pandemic, has led me to contemplate a much more important lesson we might be learning together as we face this crisis.

We’ve all been ripped out of our comfort zones, with so much of the familiar rhythm of daily life suddenly replaced by a pervasive, visceral uncertainty.

So many questions without answers. So many experts with differing views. A brutal realisation that things don’t work the way we always thought. Seeing infinite shades of grey instead of that comforting black and white world.

Sound familiar?

Welcome to the mind of a scientist.


Read more: Coronavirus distancing measures are confusing. Here are 3 things to ask yourself before you see someone


Uncertainty is unnerving – but you can learn to live with it

When this feeling dawned on me years ago on one of many early morning drives to Canberra during my PhD, it was almost crippling.

Digging deep into the mysteries of biochemistry and molecular biology – the ghosts in the machine of life itself – can do that. It can be an incredibly challenging, even unnerving experience.

But I learned to let that uncertainty wash over me. Like being caught in a rip in the surf, resistance just tires you out and makes things worse. After swimming around in it for a while I soon learned to float.

I even managed to crack a wave or two.

I wonder if this shows us one potential way through the viral-induced trauma surrounding us? We are all faced with rapidly shifting information and advice. What is true at 8am might not be by 6pm.

What is true in the morning may not be true by evening. AAP/KELLY BARNES

A role for scientists

Maybe scientists have a role to play here beyond the hard work going on to understand this new coronavirus, chasing vaccines and new drugs? We are comfortable swimming in the unfamiliar, we know how to float on a sea of uncertainty. We know it’s OK to say “I don’t know” or “good question”.

There’s an opportunity here for scientists to lead by example, both in the way we act and the way we communicate. To show the way in dealing with uncertainty, with changing information, and with appropriate responses.

But we need to start from a place of empathy. People are anxious and scared and we should acknowledge that. They want clear information and advice, based on best available data, not to be lectured or patronised. And scientists should be upfront about the fact that the advice may change – rapidly – or be slightly different to the next person’s.

Uncertainty and public messaging

We need, as a society, to become more comfortable with doubt and uncertainty in public, politics and business.

I’m OK with public messaging reflecting that. We’re so used to politicians holding a particular line on an issue, but the COVID-19 crisis has shown it doesn’t work when the situation is fluid and dynamic.

Maybe I’m just more comfortable with that as a scientist. Politicians absolutely have to be held to account but there should also be space for their positions to evolve – genuinely – with evidence.

We can change

Our sudden interest in disinfectants and hand washing, had me reflecting on my early days in a research lab.

Learning how to grow human cells without contamination by bacteria and yeast, or setting yourself on fire, takes some learning.

“Don’t touch that!”

“No, not that way!”

“What did you do that for?”

“No, hold it like this.”

It’s not intuitive. It takes real concentration – until it doesn’t anymore. Deeply ingrained habits and muscle memories have to be erased and rewritten. It’s hard, frustrating work.

It feels like the whole planet is sharing a similar experience now, but the stakes are much higher.

We can learn and change, until what was once difficult and uncomfortable becomes second nature. We’ve rapidly become much better, as a society, at things like handwashing and cough etiquette. Our relationship with uncertainty will have to change too.

I’m taking glucosamine for my arthritis. So what’s behind the new advice to stop?

I’m taking glucosamine for my arthritis. So what’s behind the new advice to stop?

February 13, 2020 3.53pm AEDT

Authors

  1. Nial Wheate Associate Professor | Program Director, Undergraduate Pharmacy, University of Sydney
  2. Joanna Harnett Lecturer (Complementary Medicines) Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney

Disclosure statement

Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is also a director of the medicinal cannabis company Canngea Pty Ltd and a Standards Australia committee member for sunscreen agents.

Joanna Harnett has received funding in the past from, Sigma Pty Ltd (operating as Orphan Australia) and Bioceuticals Pty Ltd in the past to conduct probiotic research. She is a board member of the Australasian Integrative Medicine Association.

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The Australian Rheumatology Association this week warned people not to take the supplement glucosamine for their osteoarthritis due to possible allergic side-effects. The Australian Rheumatology Association warns against taking glucosamine to ease arthritis symptoms. Credit: 7 News Sydney

What’s the evidence behind this latest advice? And do you really need to stop taking it?

How did we get here?

For years, glucosamine has been marketed as a treatment for osteoarthritis, which can occur when the protective cartilage in the joints wears down over time.

This is despite conflicting evidence on whether the supplement works. Yet many patients may buy glucosamine, presuming that even if it doesn’t help, at least it’s “natural” and so won’t do any harm.


Read more: Arthritis isn’t just a condition affecting older people, it likely starts much earlier


But an Australian study, which has been online since last year and was cited in one of this week’s media reports, has given us more information about glucosamine’s safety.

The study found hundreds of allergic reactions to glucosamine have been reported to Australia’s medicines watchdog, the Therapeutic Goods Administration (TGA).

So is it safe for you to take glucosamine? In short, if it works for you and you haven’t had any side-effects, and your doctor and pharmacist know you are taking it, it is likely to be safe based on the multiple trials conducted to date.

What is glucosamine?

Glucosamine is a naturally occurring substance the body uses to help build joint tissue, such as cartilage and tendons. In a supplement, the glucosamine can be made from the shells of prawns and other crustaceans, or it can be made synthetically in a factory.

Whether it works to manage osteoarthritis seems open to debate. The most recent evidence suggests little to no clinical benefit.


Read more: Science or Snake Oil: is glucosamine good for joints?


But advice to GPs about how to treat osteoarthritis says the issue isn’t just confined to glucosamine.

When the Royal Australian College of General Practitioners looked at about 62 other medicines and possible treatments for osteoarthritis of the knee and hip (which include registered drugs and complementary medicines), none were backed by high-quality evidence to say they worked. Most of the evidence was based on low- or very low-quality studies.

Is glucosamine really as dangerous as people say?

The Australia study found 336 cases of side-effects to glucosamine (and to another supplement used for osteoarthritis called chondroitin) were reported to the TGA over 11 years. Of these, 263 cases were allergies, which ranged from mild to severe.

We don’t know if these reactions included those from people with a known allergy to seafood or sulfur, as these would increase their risk of a reaction to glucosamine (glucosamine can come in different formulations, including glucosamine sulfate).

The glucosamine in supplements can come from the shells of prawns and other crustaceans, which is thought to trigger allergic reactions in some people. Shutterstock

But a large percentage of people take glucosamine daily in Australia, with no ill effects. The cases reported to the TGA amount to just 30 people a year, with 16% of allergic reactions considered severe.

Beyond allergic reactions, there are other safety concerns about glucosamine.

For instance, if you are taking glucosamine and a medicine that thins your blood (such as warfarin after a stroke), this can increase your risk of bleeding.


Read more: Weekly Dose: Warfarin, the blood-thinner that’s still used as a rat killer


Glucosamine supplements have also been implicated in chronic liver disease and in worsening underlying asthma. Some patients may also experience digestive symptoms such as heartburn.

The risks of other side-effects seem unclear, including whether it raises blood glucose levels in people with or without diabetes.

Conflicting advice

While the Australian Rheumatology Association has warned people to stop taking glucosamine, other advice is not so clear-cut.

Arthritis Australia reports glucosamine is a relatively safe treatment option for people with osteoarthritis and has relatively few side-effects compared with traditional medicines.

And the guidelines for GPs on how to manage osteoarthritis of the knee and hip makes a “conditional” recommendation not to use it, based on uncertainty over the balance of harms with potential benefit.

So, what should I do?

What should you do if you’re taking glucosamine? If it works for you and you want to keep using it, then do so only on the advice of your doctor. That’s especially the case if you have any underlying medical conditions including diabetes, allergies or asthma.

Next, let your pharmacist know so they can check for any possible interactions with your other medicines, which can increase your risk of side-effects. You are most at risk if you are also taking warfarin, or any other type of blood thinning medicine.

Finally, if you do have unwanted side-effects from glucosamine, stop using it immediately and report it to your doctor.

Coronavirus distancing measures are confusing. Here are 3 things to ask yourself before you see someone

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Coronavirus distancing measures are confusing. Here are 3 things to ask yourself before you see someone

March 23, 2020 5.01pm AEDT

Author

  1. Julie Leask Professor, University of Sydney

Disclosure statement

Julie Leask has received funding from the National Health and Medical Research Council, the World Health Organization, NSW Health, and the National Centre for Immunisation Research and Surveillance.

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Editor’s note: This article is based on the coronavirus and COVID-19 situation as of March 23. It’s important to remember that the situation is rapidly developing and official advice may change.


If the flurry of new orders released in the last 24 hours has you feeling confused about what’s OK and what’s not when it comes to social contact, you’re not alone.

It’s so difficult to adopt a set of hard and fast rules with the advice changing so quickly. Government departments have put out detailed guidance but that won’t cover all situations. Experts in the public sphere will give different advice.

The fact is, if there’s an activity you want or need to do and you’re not sure if it’s advisable, often you’ll have to make a call. After ensuring that it doesn’t breach public orders, your decision will need to be based on your assessment of the risks and benefits.

Whatever activity you’re considering, it can help to first clearly list your options. For example, if I’m talking to a friend with kids, we could organise to meet at the park, in a house, online or not at all. Or if I want to catch up with my sister, I could do it in person or on the phone.

Then ask yourself some important questions as you consider your options.

Here are three considerations that should help you make an informed decision on behalf of your family and the wider community.


Read more: Coronavirus: how long does it take to get sick? How infectious is it? Will you always have a fever? COVID-19 basics explained


Sign up to The Conversation

1. What’s the latest advice of my state or territory health department?

The first is to look to the latest advice for your state and territory health department, and be aware that they may change from day to day or even within a day. So keep checking.

Some departments are now developing quite detailed lists of dos and don’ts that are being updated as quick as is humanly possible.


Read more: 4 ways to talk with vaccine skeptics


2. Do I know the latest on how the virus moves between people?

Understanding as much as you can about the way that the virus moves between people can help you make an informed decision about whether an activity you’re considering doing poses a higher risk of passing coronavirus on or picking it up.

The coronavirus causing COVID-19 is currently thought to be passed on through contact and droplet transmission. It comes from the mucous membranes (meaning the wet parts of your face – mouth, nose and eyes). A person with the infection might cough or sneeze or touch their mouth or nose and then touch another surface where it can remain infectious for a time.

The virus is able to move to another person through direct contact with droplets from the cough or sneeze or if they touch that surface with their hands then touch their mouth, nose or eyes. The more symptomatic somebody is, the more easy it is to get the infection but people with very mild symptoms can still pass it on. More is being learnt about the virus and this knowledge may change.

That is why handwashing and cough or sneeze etiquette is so important.

COVID-19 is currently thought to be mostly spread by people who have symptoms and have been in close contact with others. Those more at risk of it are those who have had contact with someone who has been diagnosed with it or have recently returned from overseas.

However, that is changing as it moves more in the general community in Australia.

That basic understanding of how it moves can help people make decisions of who to see, how to see them, how to behave in public places and at home.

3. How do the risks of a certain activity weigh up against the benefits?

Whenever you are considering doing some activity with somebody, you need to weigh up the risks of harm with the potential benefits.

First, make sure you are abiding by the public health orders. Also remember that this is not just a decision about your personal risk. We are all reducing the chain of transmission by reducing our contact with others as much as we can.

Sometimes, we will still want or need contact with others.

First of all, we need to accept that we take a risk whenever we have contact with another person and we need to weigh that risk against the potential benefits.

There might be really important social benefits, for example, for seeing a person for whom contact with others is extremely important.

There might be benefits in helping someone who has less access to resources than we do – for example, helping a neighbour in need.

In these instances, if you decide to take the risk, it is important to follow guidance on doing everything you possibly can do to minimise the spread of COVID-19 within that encounter.

That means proper hand hygeine; washing hands when arriving and leaving. Try to stay 1.5 metres or more apart. Never go out and meet with others if you have respiratory symptoms such as a cough, or a fever. And it means trying to avoid contact with people at greater risk of severe disease, such as those with existing chronic disease, an older person, or person who is Aboriginal or Torres Strait Islander.

If the COVID-19 risk is really high to that person, then maybe the benefits don’t outweigh the potential harm. You may be forced to make a really hard decision.

Hard decisions ahead

There’s no magic cut off where you stop all risk. We have got to accept it is about degrees of risk and what we collectively do to minimise it.

If we choose to have contact with another person, while staying within the boundaries of what is permissible based on the government requirements, then it’s important you have a set of evidence-based principles that helps guide your decision-making.


Read more: Parents’ decisions about vaccination and the art of gentle persuasion


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Message from Dr Holloway

I will only be doing telehealth consultations from today. There will be no face-to-face appointments. I am doing this to protect both my patients and myself from the coronavirus. All these consultations will be bulk billed, so will cost my patients nothing. This should ease the financial burden you are all suffering. This will only be a temporary measure, and will last as long as this crisis remains with us.

We asked five experts: is vegetarianism healthier?

We asked five experts: is vegetarianism healthier?

March 4, 2019 6.14am AEDT Four out of five experts say a vegetarian diet is healthier. brooke lark unsplash

Author

  1. Alexandra Hansen Chief of Staff, The Conversation

Interviewed

  1. Dr Amelia Harray Lecturer and Research Dietitian, Curtin University
  2. Katherine Livingstone Lecturer Population Nutrition, School of Exercise and Nutrition Sciences, Deakin University
  3. Malcolm Forbes Medical Doctor and Clinical Senior Fellow, University of Melbourne
  4. Natalie Parletta Adjunct Senior Research Fellow, University of South Australia
  5. Rosemary Stanton Nutritionist & Visiting Fellow, UNSW

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Vegetarianism is on the rise in Australia, as many vegetarians will gladly tell you. While many people who eschew meat products do so for the sake of animals and the environment, we’re starting to learn more about the negative health effects of meat and the benefits from eating a plant-based diet.

We asked five experts if a vegetarian diet is healthier.

Four out of five experts said yes

Amelia HarrayDietitianYes-close

Yes, so long as the vegetarian foods are also healthy. Vegetarian eating patterns have been associated with lower risk of premature death, while red and processed meats increase the risk of colorectal cancer. Australian diets are typically high in meat and low in vegetables and legumes.

Plant-based alternatives to meat, such as legumes, nuts, seeds and tofu, have similar distinguishing nutrients (iron, protein, zinc), while being naturally lower in saturated fat and higher in fibre. These meat-free options are widely available, affordable and becoming more socially acceptable in this country.

A recent article strengthened the importance of people considering the impact of their food choices on the environment, not just health. In most climates and settings, the production of meat and dairy foods has more of a negative environmental impact than plant-based foods. Even without following a strict vegetarian diet, frequently replacing meat meals with plant-based alternatives can benefit our health and that of the environment.

Malcolm ForbesDoctorYes-close

A balanced vegetarian diet is healthier than the current diet of most Australians. There is a large body of evidence that has consistently demonstrated vegetarians enjoy lower rates of cardiovascular disease, type 2 diabetes and high blood pressure. A vegetarian Mediterranean diet may also be associated with lower rates of depression, however this relationship is less clear.

I regularly enquire about the diet of my patients and recommend an increase in plant-based foods. While a vegetarian diet is no panacea, it is one easy step to reduce a patient’s risk of lifestyle diseases.


Natalie ParlettaNutritionistYes-close

Ample evidence suggests vegetarians live longer and have lower rates of chronic diseases – in part because of their diet and possibly also because people who choose vegetarian diets may be more health conscious anyway. Plant foods, including fruit, vegetables, nuts, seeds and legumes, deliver abundant fibre, nutrients and polyphenols that are essential for a healthy body and mind.

For vegetarians – and particularly vegans – it’s important to eat a varied and well-balanced diet, making sure to get enough of certain nutrients such as omega-3 and vitamin B12.

More recently, scientists are also promoting the benefits of plant-based diets to reduce our footprint on the planet: to improve environmental sustainability and feed our growing population. Then there’s the ethical concerns about animal welfare. Plant-based diets – whether totally vegetarian or dominated by plant foods – are a win-win-win for people, animals and the planet.

Rosemary StantonNutritionistYes-close

Yes – if you’re comparing a well-chosen vegetarian diet with a typical Australian junk-food diet. Any comparison depends on the whole diet. A well-chosen vegetarian diet has a good selection of vegetables, fruits, legumes, nuts, seeds and wholegrains. Including eggs, milk, cheese and yoghurt (or calcium-fortified plant alternatives) make it especially easy to meet nutrient needs. By contrast, the typical Australian diet, high in meat and junk foods, and low in wholegrains, vegetables, legumes, fruit, nuts and seeds is much less healthy and plays a prime role in many diet-related health problems.

Claims a vegetarian diet lacks iron, protein or zinc are unfounded. It’s true those who follow a vegetarian diet have lower levels of iron stored as ferritin, but the levels are in the normal range and do not equate to a deficiency. And with ferritin, more is not better. It must be said, however, that plant-based diet recommendations from the World Health Organisation and others do not preclude including small amounts of appropriately-sourced seafood, poultry or a small amount of red meat.

Katherine LivingstonePopulation NutritionNo-close

For most Australians, eating small amounts of lean meats and reduced-fat dairy products can be consistent with good health. The Australian Guide to Healthy Eating recommends 1-3 serves of lean meats, poultry and fish, and alternatives such as beans and legumes, each day. Meats are a good source of protein, vitamins and minerals. Processed meats should be limited as they are high in added salt and saturated fat, which can increase your risk of heart disease.

A plant-based diet is high in a variety of fruits, vegetables, and wholegrains and low in processed foods, but can still include small amounts of lean meats and reduced-fat dairy products. Plant-based diets, such as the Mediterranean diet, are linked with lower risk of obesity, heart disease, cancer and type 2 diabetes. Eating a plant-based diet is good for us and the planet.

If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: alexandra.hansen@theconversation.edu.au


None of the authors have any interests or affiliations to declare.

What is a virus? How do they spread? How do they make us sick?

What is a virus? How do they spread? How do they make us sick?

March 13, 2020 2.42pm AEDT

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  1. Lotti Tajouri Associate Professor, Biomedical Sciences, Bond University

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Associate Professor Lotti Tajouri is affiliated with Dubai Police Scientist Council.

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  • Viruses are the most common biological entities on Earth. Experts estimate there are around 10,000,000,000,000,000,000,000,000,000,000 of them, and if they were all lined up they would stretch from one side of the galaxy to the other.

You can think of them as nature’s own nanotechnology: molecular machines with sizes on the nanometre scale, equipped to invade the cells of other organisms and hijack them to reproduce themselves. While the great majority are harmless to humans, some can make you sick and some can even be deadly.

Are viruses alive?

Viruses rely on the cells of other organisms to survive and reproduce, because they can’t capture or store energy themselves. In other words they cannot function outside a host organism, which is why they are often regarded as non-living.

Outside a cell, a virus it wraps itself up into an independent particle called a virion. The virion can “survive” in the environment for a certain period of time, which means it remains structurally intact and is capable of infecting a suitable organism if one comes into contact.

When a virion attaches to a suitable host cell – this depends on the protein molecules on the surfaces of the virion and the cell – it is able to penetrate the cell. Once inside, the virus “hacks” the cell to produce more virions. The virions make their way out of the cell, usually destroying it in the process, and then head off to infect more cells.

Does this “life cycle” make viruses alive? It’s a philosophical question, but we can agree that either way they can have a huge impact on living things.

This illustration shows the shape of a coronavirus particle. CDC / Alissa Eckert, MS; Dan Higgins, MAM, CC BY

What are viruses made of?

At the core of a virus particle is the genome, the long molecule made of DNA or RNA that contains the genetic instructions for reproducing the virus. This is wrapped up in a coat made of protein molecules called a capsid, which protects the genetic material.

Some viruses also have an outer envelope made of lipids, which are fatty organic molecules. The coronavirus that causes COVID-19 is one of these these “enveloped” viruses. Soap can dissolve this fatty envelope, leading to the destruction of the whole virus particle. That’s one reason washing your hands with soap is so effective!

What do viruses attack?

Viruses are like predators with a specific prey they can recognise and attack. Viruses that do not recognise our cells will be harmless, and some others will infect us but will have no consequences for our health.

Many animal and plant species have their own viruses. Cats have the feline immunodeficiency virus or FIV, a cat version of HIV, which causes AIDS in humans. Bats host many different kinds of coronavirus, one of which is believed to be the source of the novel coronavirus that causes COVID-19.

Bacteria also have unique viruses called bacteriophages, which in some cases can be used to fight bacterial infections.

Viruses can mutate and combine with one another. Sometimes, as in the case of COVID-19, that means they can switch species.

Why are some viruses so deadly?

The most important ones to humans are the ones that infect us. Some families of viruses, such as herpes viruses, can stay dormant in the body for long periods of time without causing negative effects.

How much harm a virus or other pathogen can do is often described as its virulence. This depends not only on how much harm it does to an infected person, but also on how well the virus can avoid the body’s defences, replicate itself and spread to other carriers.

In evolutionary terms, there is often a trade-off for a virus between replicating and doing harm to the host. A virus that replicates like crazy and kills its host very quickly may not have an opportunity to spread to a new host. On the other hand, a virus that replicates slowly and causes little harm may have plenty of time to spread. What’s the difference between COVID-19 and the flu?

How do viruses spread?

Once a person is infected with a virus, their body becomes a reservoir of virus particles which can be released in bodily fluids – such as by coughing and sneezing – or by shedding skin or in some cases even touching surfaces.

The virus particles may then either end up on a new potential host or an inanimate object. These contaminated objects are known as fomites, and can play an important role in the spread of disease.

The novel coronavirus that causes COVID-19 (yellow) emerging from the surface of cells (blue/pink) cultured in the lab. NIAID Rocky Mountain Laboratories (RML), U.S. NIH, CC BY

What is a coronavirus?

The coronavirus COVID-19 is a member of the virus family coronaviridae, or coronaviruses. The name comes from the appearance of the virus particles under a microscope: tiny protein protrusions on their surfaces mean they appear surrounded by a halo-like corona.

Other coronaviruses were responsible for deadly outbreaks of Serious Acute Respiratory Syndrome (SARS) in China in 2003 and Middle East Respiratory Syndrome (MERS) from 2012. These viruses mutate relatively often in ways that allow them to be transmitted to humans.

5 natural supplements that are as powerful as Rx drugs

Featured Articles in Internal Medicine In the News

5 natural supplements that are as powerful as Rx drugs

Liz Meszaros | March 19, 2020

In today’s booming health and wellness market, thousands of supplements are readily available and tirelessly promoted. Some are effective and can bring health benefits, while others may be purely snake oil. But, as physicians, did you know that there are several little-known supplements whose health benefits rival those of currently available prescription drugs? And that these effects are supported by research? 

Advertisement5 powerful supplements

Five little-known supplements may carry a wealth of health benefits, and these are backed by research.

Here’s a list of five such supplements–made from naturally occurring ingredients–with a brief overview of each, and some of their research-backed benefits. 

Curcumin (turmeric). Curcumin is a biologically active polyphenolic compound found in turmeric, which is a spice made from the rhizomes of Curcuma longa Linn, a perennial shrub indigenous to India. Curcumin has been used for centuries for medicinal purposes and is most commonly cultivated and consumed in Asian countries.

The potential health benefits of curcumin are many. To begin with, it has anti-inflammatory effects, which it achieves by blocking Nf-kB, an inflammatory signaling molecule. In several studies, curcumin has been shown to decrease pain when taken over the long term. For example, in elderly and middle-aged patients with osteoarthritis, curcumin (1,500 mg/d TID for 28 days) was as effective as diclofenac (an NSAID) in reducing pain, and demonstrated better tolerability. When compared with acetaminophen (2,000 mg), 400- to 500-mg doses of curcumin afforded equivalent pain relief for general day-to-day pain.

Curcumin also has antioxidant properties, and may work to decrease C-reactive protein levels and lipid peroxidation, both markers of oxidation. Better yet, curcumin seems to have anti-cancer benefits due to its ability to initiate autophagy. It has also been shown to decrease risks for colorectal, prostate, and breast cancers. And, for those with cancer, curcumin may enhance the efficacy of chemotherapy as well as protect healthy cells from radiation therapy.

The recommended daily dose for curcumin is approximately 500 mg. Because it’s fat soluble, curcumin should be taken with a meal or other source of fat (eg, fish oil) to boost absorption. Because it’s poorly absorbed, taking it concurrently with a supplement that contains bioperine and piperine, the active ingredient in black pepper, is recommended.

Berberine. Berberine is a compound found in many plants, including European barberry and the Oregon tree. Like curcumin, it is yellow, and—in ages past—used to dye wool, leather, and wood. This substance has anti-inflammatory properties and may also have lipid-lowering and anti-diabetic effects. These health benefits may be due to berberine’s ability to activate AMPK, an enzyme vital for cell growth, function, and maintenance of the cellular energy balance. Berberine may also have anti-fungal and antibiotic properties.

In one study, researchers found that berberine was as effective as metformin in lowering blood sugar levels.  In other studies, berberine was found to lower not only triglyceride and blood pressure levels, but total and LDL cholesterol levels as well. Finally, its antimicrobial effects, cardiovascular protection, and cancer-fighting abilities make berberine a multitasking supplement superhero.

The most common dosage is 1,500 mg/d, divided into 3 equal doses throughout the day, taken with meals. Take care, however: Berberine is a powerful supplement and has the potential to interact with numerous medications.

Spirulina. A type of cyanobacteria, spirulina is blue-green mixture of algae species that contains bioactive compounds. It was a food source for the Aztecs and other Mesoamericans until the 16th century, but was recently popularized when NASA considered growing it in space to feed astronauts. And now we know why: Spirulina is chock-full of nutrients.

Consider that 7 g of dried spirulina powder (1 tbsp) contain 4 g of protein, 11% of the recommended dietary allowance (RDA) of vitamin B1 (thiamine), 15% of the RDA of vitamin B2 (riboflavin), 4% of the RDA of vitamin B3 (niacin), 21% of the RDA of copper, and 11% of the RDA of iron. It also includes both omega-6 and omega-3 fatty acids.

Another big plus: Spirulina contains vitamin C, magnesium, potassium, and manganese, and small amounts of almost every nutrient the human body needs.

Its health benefits are many and may stem from its ability to inhibit nicotinamide adenine dinucleotide phosphate oxidase (NADPH), a pro-oxidation compound that generates reactive oxygen species (ROS) that are important in antimicrobial defense and inflammation. Spirulina has been shown, in preliminary studies, to not only lower lipid peroxidation, triglyceride, and blood pressure levels, but also boost the immune system. And, great news for all the allergy sufferers out there: Spirulina may even significantly reduce nasal allergy symptoms.

The general dosage of spirulina is 1-3 g/d, usually taken in divided doses throughout the day.

Rhodiola rosea. This herb grows in the cold climates and mountainous regions of Europe and Asia—such as Russia, Scandinavia, and China—where it is commonly used in traditional medicine. The substances found in the roots of rhodiola are considered adaptogens, which help the body adapt to stress. As such, rhodiola can decrease mental and physical fatigue, and may be particularly beneficial in those faced with prolonged stress—like physicians struggling with stress or burnout. It is also thought to support overall good health and decrease depression and anxiety.

There’s a lot of research backing up the health benefits of rhodiola, but most of it is inconclusive. For example, in a meta-analysis of 11 clinical trials, researchers found that rhodiola reduced physical and mental fatigue, but noted that “methodological flaws limit accurate assessment of efficacy.”

In a systemic review, rhodiola was found to alleviate the symptoms of mild to moderate depression and mild anxiety, as well as enhance mood. However, the authors stated that their findings were “not definite due to the lack of available experimental data,” further noting that “randomized controlled trials with a low risk of bias are needed to further study the herb.”

Rhodiola is available in capsule or tablet forms, as a dried powder, or as a liquid extract. Dosages and amounts of the extract vary widely between brands and formulations. In general, normal doses range from 250 mg to 680 mg.

Red yeast rice. Red yeast rice is a fermented product of rice on which red yeast has been grown. It has been used in China for centuries as a medicinal food that promotes circulation. HMG-CoA reductase inhibitors—or monacolins—occur naturally in red yeast rice. If this sounds familiar, it may be because monacolins are also the active ingredients in statins (like lovastatin). Other active ingredients of red yeast rice include betasitosterol, campesterol, stigmasterol, and sapogenin (sterols), as well as isoflavones and monounsaturated fatty acids.

In light of this, it is not surprising that red yeast rice may reduce cholesterol levels and be beneficial in those with hyperlipidemia. In a meta-analysis of 93 studies on three red yeast rice preparations, researchers found mean decreases in total and LDL cholesterol levels of 34 mg/dL and 28 mg/dL, respectively, and a mean decrease in triglyceride levels of 35 mg/dL. They also observed increased HDL cholesterol levels (6 mg/dL). They concluded that the lipid-modifying effects of red yeast rice were similar to those seen with pravastatin, simvastatin, lovastatin, atorvastatin, and fluvastatin.  

Red yeast rice may also be useful for the secondary prevention of myocardial infarction. In a large study including nearly 5,000 participants with coronary heart disease and myocardial infarction history, researchers observed a 45% reduction of secondary myocardial infarction risk and a 33% reduction in mortality risk in participants taking a red yeast rice capsule formation (0.6 g bid) compared with placebo.

Red yeast rice formulations that contain monacolin K are considered to be drugs rather than supplements, according to the FDA. If you do buy a supplement formulation, in which there may be only trace amounts of monacolin K, make sure it is from a reputable vendor, and check the label carefully for ingredients and concentrations of monacolin. Of note, these supplements may not offer the same health benefits as those with monacolin K.