Monday, December 21, 2009

Dr Joes DIY Health Guide to Christmas

At live presentations this month I have been asking the audience “Who is looking forward to Christmas”? A number of hands go up. The next question is Who is looking forward to Christmas being…over? A second set of hands goes up.

If I asked a group of year one school children the same questions all hands would go up the first time. The reason that some of us look forward to Christmas being over is of course stress.

It is a slightly sad reflection on society that so many people see Christmas as a stressful time. Yet as I have said before “stress is not about events themselves but what we make of them”

At one level Christmas is a day of the year like any other. At another it is a day of celebration of the birth of Jesus Christ. At a third level it is a secular celebration with gifts and get togethers. Finally there is the “festive season” which can start in mid November involving a series of events at which one may eat and drink.

The biggest stress issues around Christmas are weight gain from overindulging, bank balance loss from overspending and anxiety from interacting with those who you would prefer not too.

So this year rather than Survive Christmas why not enjoy Christmas. There is much that can be done to make sure you enjoy Christmas based on the 8 Pillars of DIY health.

1 Each day spend 30 seconds to take 3 slow deep breaths do this at least 4 times a day. This will reduce stress.
2 Drink water. Before you go to a function have a glass or two of water. Keep yourself hydrated. If at a party alternate water with alcoholic drinks.
3 Finger food is notoriously high in calories. Eat a carrot or other piece of vegetable before you go out. This way you will not be as hungry and hence you will eat less.
4 Keep active. Do some walking or other exercise everyday (or at least 3 times a week).
5 Don’t be the last to leave. You need your sleep.
6 Realize you have choices about whom you see and what you buy. Your stress levels will be a function of your choices not the “world out there”. Be honest with yourself and others about what you can and can’t reasonably do.
7 Buy your Christmas presents with cash. That way you know you can afford them and you won’t stress about the credit card bill in January
Only buy gifts for people you really want to give one to.
8 Christmas is a time for goodwill to all but if you really don’t like spending
time with certain people (even if they are your family) then it may still be better not to. Be polite but firm in declining invitations. Make sure you spend time with those you really care about If there is “no way out” then say to yourself “this too will pass” as often as needed. It will pass and by adopting this approach you will not stress.
9 Christmas day lunch is a meal. If you are having people around you don’t need more food than if they were coming any other day. If it’s a big gathering have everyone contribute a plate. You don’t have to eat till you feel like you will “explode”.
10 For some the preferred option is to “cancel” Christmas and just go to ground and emerge again on December 27.
11 Have fun. Children enjoy Christmas. There is no reason adults can’t do the same. Allow yourself to be a child again. Pop crackers enjoy unwrapping presents and playing with the wrapping paper.
12 Consider having some “purpose” around Christmas. Maybe do some volunteer work? Perhaps reflect on what you can do to be a better person or how you can contribute to your community.

For virtually everyone there was a tie when Christmas meant fun. Somewhere along the line this has been lost for some of us. This year ask yourself what needs to happen for me to enjoy Christmas as much as when I was six years old? Then go and have fun.

Wednesday, December 16, 2009

Cholesterol- a different view

Here is something that you may not know. Cholesterol is found in every cell in the human body, all 60 trillion of them, as it is part of the cell membrane. It is also the base component for a number of hormones. Some of these hormones are involved in regulation of fluids and salt within the body. Others are involved with energy pathways and glucose metabolism whilst the third group are the sex hormones (estrogen, progesterone and testosterone).

So how did a molecule, which is actually essential for life, become public enemy number one? Good question. It basically goes back to the 1970s and various studies which looked at factors contributing to coronary artery (heart) disease. To cut a long story short, the idea took hold that cholesterol is bad therefore the levels in the bloodstream needed to be reduced. This was later modified to allow for lowering “bad” cholesterol (LDL) but not “good” or HDL cholesterol.

It wasn’t till the late 1980s when the first statin drugs appeared that the big push to lower cholesterol really took off. This of course was encouraged by the pharmaceutical industry, which makes billions of dollars from the sales of statin drugs.

However circulating cholesterol has never and will never be the problem. The problem is plaque (which may include cholesterol) building up on the artery (blood vessel) wall. This is why some people with high levels of cholesterol never have heart problems (including some French and Italian populations with very high levels) and as many as 40% of those with heart disease have none of the “official” risk factors including raised cholesterol.

The real cause of vascular disease (including heart disease) is slow inflammation. In this setting cholesterol may contribute to plaque on the vessel walls, which narrows the bloods vessel restricting (or stopping) blood flow but is not the primary cause.

Recent studies have now shown that lowering cholesterol does not equate to lowering heart disease. Two drugs were compared. What was shown was that whilst one group of people had their cholesterol lowered more than the other there was no difference in rates of heart disease.

Lets get back to our original question about cholesterol as public enemy number one. In the 1970s it was observed that LDL (bad) cholesterol was raised by saturated fat. It was (and still is) assumed that saturated fat is bad because it raises LDL and in turn LDL is bad because it is raised by saturated fat. This is a circular rather than cause and effect argument.

Hence it became case closed that cholesterol was bad and anything, which raised it, was bad and hence lowering it was good. A bit like in George Orwell’s animal farm “for legs good two legs bad”.
Now what is interesting is that statins seem to be associated with lower rates of heart disease. However these new trials, which used non-statin medications, might be suggesting that the primary benefit of statins may not be lowering cholesterol but some other effect.

There are many scientific studies, which raise questions over the widespread use of statin medications. This is from the perspective of side effects and costs but mainly questioning the assumed benefits. Not surprisingly the manufacturers fund most of the studies supporting statins. Like many pharmaceuticals, there is a role but not as big a one as they end up with.

So what is the bottom line here? Essentially cholesterol has been made into an ogre, which it is not. In the process billions of dollars worth of drugs have been sold for far less benefit to many of those taking them than the pharmaceutical companies would have you believe.

For the individual interested in their own health the solution as usual is simple. Eat mainly food which till recently was growing or moving around. Make water your main beverage. Minimize processed and packaged foods.

This together with the other 7 pillars is your best way of staying healthy and in turn not getting sick.

Wednesday, December 9, 2009

Medical Screening- More Not Allways Better

There is a great line in the movie Men in Black when Agent K (Tommy Lee Jones) is telling soon to be agent J (Will Smith) about aliens on the planet which until then J had no knowledge of. It goes like this - “ 1500 year ago people knew that the earth was the centre of the universe, 500 years ago people knew the earth was flat, yesterday you knew there were no aliens on earth what will you know tomorrow?”

Now I am not entering into a discussion about aliens but the real point is that our knowledge changes. This mainly happens through trial and error and also through creative genius. The medicine man in the seventeenth century applying leeches didn’t think he was doing the wrong thing. He was going with the knowledge of the day.

Today science is able to make greater progress than in centuries gone by. However it remains an extension of trial and error. The simple reason for that is that science is an extension of our senses and capacity to interpret what we find. Before the invention of microscopes we couldn’t see bacteria-it didn’t mean they weren’t there. Before the electron microscope we couldn’t see our genes (DNA) –again it didn’t mean it wasn’t there.

Science then is limited by the five senses and an assortment of aids such as microscopes. More importantly scientific discovery is a reflection of our capacity to “understand and interpret” what we find. Ultimately what we “know” today may be found to be totally wrong tomorrow. This is how knowledge advances.

The recent furor over cancer screening fits into the above scenario. In the USA new guidelines for mammograms now recommend that it be done two yearly starting at age 50 rather than annually starting at 40(this now matches Australian guidelines) .The new guidelines comes from looking at the actual results of the screening program. New guidelines are also being considered for cervical cancer screening. Prostate cancer screening remains highly controversial as to what is best.

It is easy to paint all cancer screening as “saving lives” and dismiss the problems. However screening can lead to unnecessary procedures (including surgery) and stress for people who have false positive results (results which show an abnormality but where the person has no disease). Also we are seeing that some very early “cancers” might not actually develop and some resolve themselves.

Now none of this is to say that screening is not helpful. It is to say that what we “knew” ten years ago may no longer be relevant. It is also important to note that the loudest arguments against change usually come from those who are doing the screening. They necessarily have a vested interest, which may be financial or reputational. The medical industrial complex has spawned industries around screening and follow up treatment.

Sadly this debate may get tied up in arguments about payments and “rationing”. More tests have been seen as being only positive. The reality is that indiscriminate testing has downside. Whilst it is easy for a person to say “my cancer was found and I don’t care how many other people had needless tests and stress to allow this”, that is only one side of the issue, albeit the only side that gets much airtime. Furthermore real questions can now be asked as to whether all these cancers would have progressed anyway. In other words it may not be the screening that “saved all the lives.”

As our knowledge grows and more importantly our capacity to understand what we “see” grows there will be changes in what is regarded as best medical practice. These should always “challenge “ current ideas and generate debate. Clinging to what has been done before when new knowledge supersedes it is the modern equivalent of insisting the earth is flat.

Monday, November 30, 2009

A weighty issue- time to think differently

Here we go, another piece on weight-hasn’t it all been done to death? Well maybe its time to look at it a different way. I have written previously about the importance of putting the right fuels into your body and how this means you will feel better and probably eat less.

There is no question that carrying excess weight is not healthy for a number of reasons. The question is what constitutes overweight? This article (see link) looks at some of the politics of obesity. It describes the background to the Body Mass Index (BMI), which derives from work done in the 1940s by insurance actuaries and work on “normal “ weight from the 1830s. The arbitrary cutoffs came from the International Obesity Task Force. All this seems a bit out of date and perhaps of questionable relevance today.

What is so special about a BMI of 25 as against 27? Many sports people are classed as overweight because they are muscle bound. Arnold Schwarzenegger was “obese” when he won Mr. Olympia. Many football players would also be technically overweight. The BMI also does not include a differentiator for men and women.

A recent study has followed over 11,000 people for 12 years and found those who were technically overweight (BMI 25-29.9) had lower death rates than those with a “normal” BMI (18.5-24.9). Now I am always suspicious of studies but whenever there is one, which challenges conventional wisdom, I am more interested. Whilst research is presented as “scientific “, to publish findings, which are against the herd, mentality is difficult.

There has been a whole industry set up to deal with the obesity “epidemic”. This includes countless jobs for health officials to set up taskforces and attend meetings. The pharmaceutical industry has tried to get on board, although with limited success as some “weight loss” pills had to be taken off the market. More recently weight loss surgery has been a winner for surgeons.

To get a drug to market requires years of development including trials to establish that the drug works and that the side effect profile is acceptable. New surgical procedures are not subject to this. The long-term effects of weight loss surgery may be only just becoming visible. Two recent reports show
increased rates of fractures and kidney stones for people in the years after surgery.

It does not surprise me that when you interfere with the absorption of food that there will eventually be consequences. Belatedly a study is being done to see if there actually are long-term benefits from weight loss surgery.

The central question in all this is what constitutes overweight and obesity. We can probably all spot it when we see it but can we define it? More importantly can one measure be applied to all people in all circumstances – the answer to that one is no.

Like most things with the body there is a “right” level above and below which there are health issues. With weight there is a level, which will impact on your health. That level may not be a BMI of 25. The likelihood is that the “correct “ BMI for most people is somewhere between 20 and 30.The other likelihood is that there are much better markers for health issues than the BMI.

As I say in my book, Dr Joes DIY Health-Putting you in charge of your health, focus on eating food that until recently was moving around or growing somewhere, food that your ancestors from 100 years ago would recognize as food, food that if not eaten would have to be thrown out next week. Following these simple guidelines will make it far more likely that your weight will be in the zone that is right for you.

Saturday, November 21, 2009

Swine flu-Chicken Little Rides Again

In the story of Chicken Little, it was Chicken Little’s view that the sky was falling. She, of course became very fearful of this and was able to convince others that this was the case. All those who believed it became fearful too. There are two endings to this story, a happy one where Chicken Little and friends are saved and a tragic one where Foxy Loxy eats them all.

The moral of the story is don’t believe everything you hear. Chicken little jumps to a conclusion, whips up others into fear and hysteria, which plays right into the hands of the fox that uses the hysteria to his advantage.

Whipping up fear, which can be used to advantage is sadly seen in health matters. Some expert has a view that the sky is falling and countless deaths will occur. In most instances the people running the scare have a “solution” of sorts, which either involves them, making money or wielding influence/power.

In the book Scared to Death by Christopher Booker and Richard North health scares are brilliantly defined as having four components:
1 The source of danger must be universal so anyone can be affected.
2 The danger must not have appeared in the current form before (even though it may have appeared previously.)
3 Whilst the scientific basis of the scare must be plausible there must also be an element of uncertainty to allow for alarmist speculation.
4 Societies response must be disproportionate.

Ladies and gentlemen I give you swine flu, a classic health scare where alarmist speculation about a virus has led to a massive over reaction. A lot has been written and said about H1N1 virus over the past 7 months.

However this article from the New York Times (see link) perhaps best sum up the situation. We have two polarized groups. There are those who desperately want a vaccine, as they are fearful of the H1N1 virus and those who are fearful of the vaccine itself. In amongst this are conspiracy theories with a fair amount of disinformation and a thriving industry.

Of course there is also a silent majority who wonder what all the fuss is about.
Yes there have been deaths associated with the H1N1 virus. There are deaths every year associated with the flu. Yes some previously healthy people for unknown reasons will succumb to overwhelming illness. The vast majority either has a mild illness or no illness at all.

Through all this I am yet to hear anyone in officialdom suggest that a healthy immune system is the best way not to get ill. I am yet to hear about the ways to strengthen your immune system.

Advice like put the right foods into your body, a balanced diet with adequate fruit and vegetables as well as sources of essential fatty acids such as fish, olives (or olive oil), linseed or nuts. Advice like taking vitamin supplements, particularly antioxidants such as vitamins A, C and E, D. Folate and zinc which help the immune system.

Advice to get enough sleep, as this is the bodies recharge the battery time and drink 35ml/kilo of water each day. Advice to lower your stress. This will significantly help the immune system.

No, we get a diet of fear, which increases people’s stress, and a line that there is nothing you as an individual can do, only a vaccine can save you. In turn you are encouraged to look to the medical industrial complex and government to save you in your hour of need. This is not the way to go if you want to be in charge of your own health.

Here is the bottom line. The sky is not falling. The H1N1 virus is a mild strain at absolute worst and there is no need for mass panic or the mass over reaction we have been subjected to.

The best way not to get sick is to be healthy.

Monday, November 16, 2009

Getting real about our children

The adage about our children being our future remains true today. So that being the case what are we doing about the health of our children? Statistics suggest that 25% of Australian children are overweight or obese. Figures from the USA are comparable and many European countries like Greece Portugal and Spain are in the same boat.

The figures from Greece are the most interesting as they reveal one of the key reasons we have this problem. Between 1982 and 2002 there had been a trebling in the number of overweight Greek 12 year olds. During this time there had been a move away from the “traditional” Mediterranean diet and an embracing of processed high sugar foods. The traditional diet was based on vegetables fruit, unrefined grains olive oil for cooking with a bit of fish nuts poultry and eggs thrown in. There was not a lot of red meat consumed and virtually no refined sugars. This diet provides lots of nutrition and is not calorie dense.

Contrast this with a diet of hamburgers, soft drinks, biscuits and other processed foods which make up, a “typical” western diet. This is the exact opposite - calorie dense with not much nutrition. If you then add into the mix that many children are not physically active, spending hours in front of screens, we can see why children like adults are getting heavier.

There is much hand wringing going on about childhood obesity. There is no shortage of opinions on how to “manage the crisis”. As is usually the case, calls are made to ban advertising of “junk foods” and for government to provide “funding” for various programs. Of course this funding goes mainly to program providers, often the same people who are arguing for funding for such programs.

Then there are the ridiculous suggestions like banning children under two from watching TV. Not only is this pointless but how on earth would it be implemented? The most bizarre one recently was for lap banding surgery for children. Not only is this completely the wrong approach to take with children but no one has considered the long term effects on their growth if one interferes with food absorption.(It is emerging that long term issues with bones and kidneys may follow lap band surgery but this takes years to appear).

In amongst the nonsense, there is a shining light. A school in Queensland (Australia) has won an award for teaching children how to grow and cook fresh food. Angela Skerman,the teacher in charge of this was quoted as saying "There's a lot of benefit of getting children to go back to the basics and being able to grow their own food and see the relevance and importance of eating seasonal produce rather than things that have been held in a fridge for eight months “

In my view this sums it up. Rather than berate children and parents about all the wrong things they are supposedly doing or treat them like imbeciles who will do anything just because it was on an ad, teach useful skills and provide useful information. This is best done at a grass roots level.

The two key ways to help our children with their eating is to teach them the basics and the connections between nature, what we eat and our health. The other key is to lead by and set a good example.

Thursday, November 5, 2009

A giraffe in a plane

It is amazing how new learning’s come at the most unexpected times. Last Saturday I had a new lesson in relaxation, pillar 6 of DIY Health, at the local markets. Now Saturday can be fairly busy in our house.

There are two and sometimes three sports and most weeks it is the day for food shopping (unfortunately in Perth we are very restricted in when we can go shopping), as there is no time during the week.

Anyway we were due to start at 9am with basketball for my son. We arrived a bit before 9 and by the designated start time there were only three of our team and none of the other team and no referee.

This seemed odd. At five past I felt it was time to ask the question at the reception desk. Apparently the other team had forfeited at the last moment and the rest of our team who had arrived two minutes before us had been “headed off at the pass” and had gone off for a refreshment.

There are two choices one has in this situation. One is to get stressed, the other is to accept what is and move on to the next thing. We chose the latter.By late morning it was time for the weekly food run. We go to the local supermarket for non-perishables and to the local markets for fruit and veggies, bread and produce from the continental grocer. Now the markets are not flash (as my daughter reminds me) but the produce is good, fresh and actually cheaper than in the supermarkets.

Our last stop was to be the continental grocer as it was on the way back to the car. On the way we noticed the face painting for children was set up next to the grocer (it is usually at the other end) and you can guess what became the added stop.

Despite it being a busy lunchtime there were no takers for face painting. My daughter wanted a swan. One of the painters was trying to “sell” the idea of a painted giraffe in a plane. She had been practicing this but had no takers. “Dad “ she asked “would you like a small giraffe on a plane on your arm?” With a bit of encouragement I agreed.

On sitting down the painter said to me this is a good thing to relieve stress. This seemed an odd description of an adult having a picture painted on his arm. Then as I sat watching her paint, the penny dropped. I had been pretty much on the go all week and through Saturday. This was a chance to not only sit down but also watch an artist in action.

As the aviator giraffe formed on my forearm, I was relaxing as just watching her paint absorbed me and I stopped thinking about the other things that still needed to be done that day. It was also just “fun”. At what age did I become too old to have a fun painting on my arm? It was cute and colorful.

Watching a giraffe in a plane being painted on my arm had brought me into the present moment, allowed me to sit down and to be a kid for a while. I got up more relaxed than when I sat down. The opportunity to relax may present itself in unexpected ways. Be open to them and when they arise take the opportunity to do something that a serious adult would reject but a child would see as fun.

Wednesday, October 28, 2009

A Glass of Wine is OK

One of the reasons that public health messages struggle to get through is that they are presented as very black and white, a bit like in George Orwell’s Animal Farm -“four legs good - two legs bad”. Yet with virtually all matters of health it is not that simple. There is usually a right amount. Too little or too much is a problem.

Even essentials like air and water come under this rule. If you breathe too quickly you get anxious and light headed. There is a “right” amount of air that the body needs. Too much water can be a problem as is too little.

Most public health messages are based on the tobacco principle. Tell people its bad and don’t allow any wriggle room. It is fair to say that tobacco is not healthy in any amount (although like with all poisons less is better than more). However with foods and alcohol the situation is not as clear-cut.

Now the problems associated with alcohol abuse and misuse, dwarf the combined problems from all illicit drugs. The problems include violence, road trauma, relationship breakdowns and of course numerous health problems from liver disease through to dementia. These are problems from excessive consumption of alcohol.

Yet consumed in smaller quantities these problems do not occur. Furthermore it is likely that the consumption of red wine is actually good for our hearts. This idea has been around for a while but has struggled to get much coverage as the public health people are terrified that if the public are told that a glass or two of wine is healthy that they will drink much more than that.

The really interesting thing is that those who drink harmful amounts of alcohol are not wondering about the health effects of their behavior, be it good or bad, and no one who doesn’t like wine will suddenly start drinking it for medicinal purposes.

So lets just stick to the facts. It has long been observed that the French have lower rates of heart disease despite eating diets higher in fats compared to Anglo-Saxon countries. Attempts to explain this have always come back to the consumption of red wine. This has been documented many times. There are a few mechanisms-the main one being Resveratrol. There are some “cardio protective” effects from this including an increase in HDL or good cholesterol.

Resveratrol is now marketed as a supplement and this likely has some benefits. However, it is also likely that the benefits from red wine are not just due to Resveratrol and that there are other bio-active compounds working in with it. Reducing nature to one working part will generally mean something is left out.

So what is the take home message in all this? A glass or two (1-2 for men 1 for women) of red wine a few days a week is not only not bad for you but probably good for you. Is this a reason to take up wine? —No. Is more better? —No it’s worse.

Can you enjoy a glass of wine with your meal and not feel guilty? –absolutely.

Monday, October 19, 2009

If it wasn't a pill that caused it...

It is reported in The New York Times(see link) that 3 new diet drugs are lining up for regulatory approval. It is estimated that Americans spend $59 billion annually on a range of weight reduction measures from diet books to stomach surgery.Yet as the paper reports only a very small amount of this is spent on prescription drugs.

There are two main reasons for this. Number one is that they don’t work particularly well and secondly there is a track record of diet tablets being taken off the market due to safety concerns. The new drugs have shown some “positive” results over a one-year trial. This is not a long time though and the safety issues with previous drugs only became apparent after they were used by a much larger number of people.

Given the huge potential profits it is easy to see why the pharmaceutical industry may be keen to get involved (the drugs are owned by biotech firms looking for a pharma partner). This is despite sales of current weight loss pills being small and the safety/liability issues. There is also the FDA concern of them being used “recreationally” by people who are not overweight but say want to drop one clothes size.

Here is something to think about. If it wasn’t a pill, which made you put on weight why do you, need a pill to reverse the process. It is always interesting to hear when people say diets didn’t work. Diets have no moving parts .The only way it can “work” is if the individual sticks to it.

Now herein does lay the issue. Many “diets” are considerably removed from what people normally eat each day. Hence the change is too hard to sustain. Even when people stay the course for long enough to reduce weight, they then revert to the previous eating patterns, and not surprisingly this takes them right back to where they started.

Whilst this should not come as a surprise it usually does.

So is there a solution? Of course there is. It starts with taking personal responsibility. You must accept that it is your own actions, which have led you to this place, and that it is only your own actions that can take you to a different place.

The solution is to change your eating patterns. It is no use repeating the same thing and expecting a different result. You need to change the way you relate to food . For example, if you comfort eat then recognize this and deal with the underlying issue. If you have a sweet tooth (like I do) accept this and allow yourself some small treats rather than going without for so long that you end up binging.

Keep at the front of your mind this simple concept. The body stores energy it does not use up as fat. The only way to reduce weight is to use up more energy each day then you put in. This gives you two dials to adjust. Use more energy by being active and consume less energy(calories).

Do not go hungry. Choose foods, which provide nutrition without excess calories. In simplest terms this will be whole food. Food that till recently was moving around, or growing somewhere.

Cut down on processed and packaged foods. Drink mainly water. For sustainable change these must become what you do daily not just a “diet” for a few weeks.

It has been done, it can be done and you can do it if you so choose.

Friday, October 9, 2009

Live Better for Longer

Two interesting pieces recently on longevity caught my eye. It was reported in The Lancet (link 1) that life expectancy is continuing to increase and that a large number of babies born this century will live to be a century.

I was first shown statistics like this in 2003 at an anti aging conference in Singapore run by The American Academy of Anti-Aging Medicine (A4M). The statistics showed that life expectancy in the developed world has been steadily increasing at the rate of one quarter of year per year (1 year each 4 years) since the late 1800s and that the graph was not plateauing. These latest findings confirm this.

Many reasons are cited and not surprisingly there will be many lining up to take the credit. It is due to a combination of many factors. One of the main ones is that average life expectancy is strongly influenced by childhood deaths. As these have bee reduced significantly the average has gone up. Better food, sanitation and living conditions have helped too. Modern medicine has had a role but less than it might claim.

Life expectancy still differs in different countries. Japan has one of the longest life spans and it is thought that half of its 80 year old women will make it to 90.It is also estimated that in very near future the number of people over 65 will exceed the number under 5.

The second article (link 2) looks at the effects of recession on life span and shows perhaps surprisingly that bad economic times correlate with greater increases in longevity. In other words health increases in bad times more than good. Again there are many reasons put forward. Less stress is a key factor .If people have less work to do they slow down, get more sleep and may make more time for exercise. Now there are downsides to recessions too so this effect is not across the board. However the overall effect on the health of the population is positive.

Averages reflect numbers on both sides of the “average”, the question then becomes what are the people who live longer than “average” doing and what can be learned from them. From my experience as a doctor talking to thousands of people over the years, those who live healthiest longest are looking after their bodies. They are putting in the right fuels, they are active on a regular basis, they get enough sleep and relaxation, they keep themselves hydrated, they have good relationships and they enjoy what they are doing. None of this is difficult or beyond the reach of anyone

What matters most is quality of life. Living more years if you are in pain or immobile or have lost your memory is not appealing to most people. The good news is that looking after your health means you enjoy a better life and it in turn makes it more likely that you will live longer and enjoy those years.



Thursday, October 1, 2009

Let the Sun Shine

Without the sun there would be no life on earth. Yet somehow over the last 30 year the sun has become something evil to be feared and avoided at almost all costs. Lets be very clear up front -getting sunburnt is not a good idea and if you do it often enough there is an increased chance of you developing skin cancer

Much like there is a difference between your steak being raw medium rare or burnt; there is a difference between getting adequate sun exposure, too little and too much. In the rush to avoid the sun at all costs there have been an unexpected problem. Many (estimated up to 40%) are now deficient in vitamin D. -the active form of which (D3) is produced in the body under uv light exposure.

Classic vitamin D deficiency (rickets) was associated with underground miners in the late 1800’s. It was thought that in the modern era, such deficiencies of vitamins would be unheard of in the developed world.

European studies on trials involving 57,000 people published in the Archives of Internal Medicine, showed vitamin D had an important role in helping protect against colon and breast cancer as well as diabetes and heart disease. The trials found that those with adequate levels of vitamin D had a 7% lower overall death risk during the six year period of the trial. The results prompted Professor Edward Giovannucci from the Harvard School of Public Health to call for a debate on the merits of “moderate sun exposure”.

The Moore’s Cancer Centre at the University of California suggested that up to 600,000 breast and colorectal cancers could be prevented each year if vitamin D3 levels among populations worldwide were increased.

Inadequate vitamin D may also have a role in the development asthma, osteoarthritis and Alzheimer’s

So the obvious question becomes, how can one get the right amount of sunlight so as to get the benefits of adequate vitamin D in the body but not get excessive exposure .The exact amount of time doesn’t seem to have been determined yet, however, it is likely that something between 10-15 minutes per day on 4-6 days per week of sun exposure to the arms and face is likely to be enough for most people.

In other words, it is not about laying for three hours sunbaking. In particular, the best time to be out in the sunshine is before 10am or after 3pm. At this time, the risk of burning is reduced. The closer to sunrise and sunset, the longer one can stretch this out as the rays aren’t as strong and the risk of burning is lessened.

Unfortunately, the public health people are still paranoid about sunlight .For those doing DIY health the take home message is get the right amount of sun without getting burnt. This means getting a ”healthy” tan but not burning.

Tuesday, September 22, 2009

The Weekly Fitness Challenge

One of my great learning's this year has been social media in general and Twitter in particular. One of the interesting things to me has been the sense of community that develops in online gatherings. Whilst you may not personally have met the people,you certainly get a feel for who they are through the words and comments posted.

As in any gathering of people you tend to gravitate towards those who have similar interests and passions. With this in mind I find that I have “met up” with some wonderful people who are passionate about health and wellness and are doing something each day to make a difference.

One of my new Twitter buddies is Geoff Hampton who is the founder of The Weekly Fitness Challenge as well as being an author speaker and internationally respected business consultant. It is a great honor for me to have been appointed International Medical Director for The Weekly Fitness Challenge. There are a number of top people who have gotten involved on the board that Geoff has set up. (see link)

So what’s the big deal you may be asking? As I write in Dr Joes DIY Health-Putting You in Charge of your Health “The body is designed to be active and until recently, we didn’t have a choice as movement and physical activity were a normal part of life.
Our early forebears had to chase after food in order to survive and up until the industrial revolution most work was physical in nature.

Cars, labor-saving devices, escalators and remote controls have made for a very “easy” life. Collectively, the developed world is paying for its ability to automate simple everyday tasks and chores. The price is the growing rates of obesity and lower rates of fitness. It is worth noting that regular exercise is important at any weight and that being fit plays a role independent of weight in keeping you healthy.

Unfortunately, many people recoil in horror at this suggestion because exercise is seen as a chore. Furthermore, like many simple tasks where researchers and experts get involved, exercise has been portrayed as being far more complicated than it needs to be. “

Yet it doesn’t need to be hard. Exercise can be simple and most importantly fun.

This is why initiatives such as the weekly fitness challenge are so important. It is a program designed to get people who aren’t doing exercise to do so. It does this by encouraging those who do regular exercise to “reach out” to their family, friends or co-workers and get them active. There are 12-week cycles and each week there is a different activity. Each one is for group involvement emphasis is on fun and participation.

Geoff has designed the program to appeal to the unconverted. In other words it is fairly easy to get the message about exercise across to those who are exercising This is about reaching those who are not currently exercising regularly and helping them get started in a supportive environment.

The health benefits of regular activity are many. Whilst it may sound obvious, there is only benefit if you do it. Those who don’t exercise will get the benefits when they change behaviors and get active. The weekly fitness challenge is about getting people involved at a grass roots level and changing peoples lives for the better. I am very pleased to be able to contribute to this initiative.

Monday, September 14, 2009

Smoke,mirrors and farm animals.

Two issues caught my eye this week. In my home of West Australia new legislation is being passed to make smoking in cars illegal when there are children present( link 1). This is as usual being hailed as a measure that will “save lives”.

Whilst this sounds great there are some unanswered “awkward” questions. Firstly how exactly is such a law to be enforced? Police are busy enough without trying to see whether cars contain someone smoking in the presence of a child under 17. Practically speaking unless a police car pulls up next to you at the lights your chances of being caught are minimal. Furthermore those who smoke in cars will also smoke at home. Given most people spend more time at home than in a car then how much less smoke are these children being exposed to?

Now the supporters of the bill will say that now that it is illegal, people wont do it because they don’t want to break the law. In other words they will do the right thing. This is the crux of the matter. Issues like this are a matter of personal judgment and not law enforcement. Those who want to smoke in their car will continue to do so, children present or not. Given the extremely low likelihood of penalty the behavior will not change. Those who wouldn’t do so already are doing the “right thing”. Legislating in areas of personal behavior (such as smoking) sends a message that it is the governments responsibility not that of the individual.

Lets be honest-Smoking is not good for you. No one who has started smoking in the last 35 years is not aware of this - yet choose to do so anyway. Petty laws will not change this. As I wrote on June 5 (link 2) the best way to stop smoking is to just stop smoking.

The other issue this week is our old friend the swine flu. Australian Health Department figures show that the spread in Australia is diminishing and that the virus is generally mild. Total deaths associated with H1N1 have been 150. This is significantly less than the usual flu toll in winter.

Despite this plans continue for a mass vaccine roll out. As I predicted on August 28, the government has stepped in to indemnify doctors who administer the vaccine. A special consent form will be used and its distribution will be under a legal clause that endorses its safety. We now have special immunity from damages claims for both manufacturers and doctors, a vaccine which has had little testing and is to be administered from multi dose vials which were effectively banned many years ago.

Public health officials worry that the row over indemnity may have damaged public confidence in the vaccine. If the vaccine is so safe why the need for special indemnity for the manufacturers and the doctors?

For unknown reasons and despite clear evidence to the contrary, public health officials continue to treat H1N1 like they were chicken little and claim the sky is falling. Is this some bizarre farm animal thing? Chicken little doesn’t like the pigs?? Memo to the powers that be -the sky isn’t falling.

Interestingly according to Australian Doctor magazine (Sept 4) a poll of UK doctors revealed 60% would refuse to be vaccinated and 71% of Australian doctors were either unsure or would refuse.

This tells you something. For the record I am in the group that will refuse a vaccine and I will not let my family have one either.



Tuesday, September 8, 2009

Keeping fit may be easier than you think.

For many people exercise is something extra to do in a busy schedule. This was not always so. In previous years we had to be active to stay alive. Our more ancient ancestors could only eat what they caught or gathered. Through the ages most work has been physical right up to the advent of the technological age. This included work on farms or factories. Until the 1950s most people had to walk or cycle to get to places, as cars were not commonplace.

Cast your minds back even one generation. To change the television set you had to get up out of your chair. To open the garage door meant getting out of the car and opening the door, walking back to the car and then driving in. Clothes were mainly hung out on lines rather than bundled into driers and dishes were mainly washed by hand.

Now there is no case to be made for going back to live in caves, nor any need to abstain from devices which make our lives easier. However there is never such a thing as a free lunch. I have seen estimates that all the labor saving efforts of the last 25 years mean we use up about 2kg worth of calories less each year in our normal day to day lives. After 10 years this is 20kg.

The main reason people give for not exercising is lack of time. Given that most of the devices, which reduce our “labor”, also save us time, where is all this time going? Statistics show that the average American spends 151 hours per month watching television. I suspect Australian and European stats may not be too much different. This is 5 hours per day. One tenth of that (30 minutes) per day is enough for an exercise program.

As I write in the book Dr Joes DIY Health-Putting you in charge of your health

“Exercise can be broken down into three main types: aerobic, resistance and flexibility. It is important to incorporate all three into your activity program to include elements, which develop fitness, muscle strength, balance, co-ordination and flexibility. Our bodies are not designed to be sedentary. Lack of physical activity is a major risk factor in numerous diseases such as heart disease, high blood pressure and osteoporosis and a contributor to premature ageing.”

You need to do something you enjoy as this will mean you stick to it. Whether it’s running, swimming, tennis, bike riding or something else the key is to do it regularly.

There are also simple things you can do to be more active during the day .As link 1 shows walking or riding to work is good exercise (this wont suit everyone but is an option worth considering before dismissing). Given parking costs this could be a financial winner too (link 2).

Even easier is using the stairs at work instead of the lift or escalator. Again if you are on the 50th floor this may be impractical but you could walk the first 3 or 4 and see where that leads you. Many workplaces provide showers for employees, as the boss knows that a fitter employee is a more productive one.

When you go to the shops instead of looking for the closest park, look for one further away. This will man you get a walk and don’t have the agro of competing with others for that just outside the door spot.

Now many will be saying, I don’t have the time to do this sort of thing. Just pause and consider all the time you are not using with all the labor saving devices we now have. In fact next time you reach for the TV remote to change channels, why not push the off button instead and do something active.



Friday, August 28, 2009

H1N1 Vaccination - why the rush ?

It is never a good idea to cut corners in life. Whilst it is often easy to justify in the heat of the moment, down the track, the consequences, some predictable, others not will come back to haunt. It is with this in mind that I am increasingly uneasy about the rush to do mass vaccinations against the H1N1 virus, commonly known as swine flu.

Each year it is recommended that certain risk groups be vaccinated against the flu. This includes those over 65 and those with particular medical conditions. There is no mass vaccination against seasonal flu.

The Southern Hemisphere is getting to the tail end of winter. The number of cases of H1N1 is already waning. The number of deaths associated with it are less than with seasonal flu. There is nothing to suggest that the northern hemisphere winter experience will be any different.

So why are the authorities gearing up for mass vaccination. The vaccine has been tested on some hundreds of people. This is fine but side effects, which occur, say 1 in 10,000 will not be apparent yet but will be significant when 100 million are vaccinated. Rushing to market with inadequate testing is the worst form of cutting corners.

In the rush to do this multi dose vials are being used. These have not been acceptable for use by doctors for a decade due to risks of cross infection. Suddenly it is OK again. Governments are indemnifying manufacturers against claims that may be made in the event of side effects or harm caused. In the USA in 1976, in similar circumstances there were more than 500 deaths associated with the vaccine when 40 million were “mass vaccinated”. According to health authorities in Australia the new vaccine “seems to be very safe”.

In Australia, Medical Indemnity insurers are discussing whether doctors who administer the vaccine will be covered. If this isn’t resolved, no doctor will be able to administer it. I suspect that once again the government will step in and offer indemnity.

The big unanswered question in all this is why? What is the threat that justifies all the cutting of corners, that justifies rushing out a vaccine to use on people who wouldn’t normally even have a flu shot, that justifies allowing medical practices, which have been outlawed to be reinstated? H1N1 is not the bubonic plague. We are not seeing thousands of deaths. Compared to all other major flu outbreaks (1918, 1957 1967) this is mild. It is mild even when compared to seasonal flu where multi dose vials are not allowed and proper testing is done.

As I have written before, the best form of defense is having a healthy immune system (April 27 and June 10). As Louis Pasteur is reported to have said, “the seed (germ) is nothing, the soil (body) is everything. Whether you contract flu or not is about you rather than the virus.

The decision as to whether to have the vaccine against H1N1 must be left to the individual. Consider your own circumstances before deciding. Do not be influenced by Chicken Little “the sky is falling” fear.



Tuesday, August 18, 2009

Depressed, or a bit Down - There is a difference

It has been said that depression is the epidemic of the 21st century. Certainly the rates of diagnosis have increased over the last 10-15 years. Some claim that this is due to better recognition of the issue and that actual rates are unchanged. Others feel that we are collectively more depressed than in years gone by.

Figures from the USA (link 1) show that the number of Americans prescribed an antidepressant doubled between 1996 and 2005 and that those being treated took more tablets. Yet there is nothing to show that the population is better off. In fact the suicide rate has risen.

It is interesting to note hat $1 billion is spent each year on promoting anti depressants. Between 1999 and 2005 the amount spent on direct to consumer advertising nearly quadrupled.

When one looks at the definition of depression in the DSM4 (the psychiatry reference manual) there are a number of criteria, which need to meet for a diagnosis of depression. Some of these like a 5% change in weight are measurable; others like reduced concentration are subjective. There are 9 criteria 5 need to be present for at least 2 weeks and their needs to be an impact on the person’s ability to function either at work or socially.

This area is a touchy one. There are many people who feel bad, who have stress, who have issues that trouble them. These people may need help or assistance to get through a difficult time. There seems to be a tendency to label many of this group as being depressed. The rise in prescriptions in part represents a reclassification of stress as depression. The two may overlap but are not the same.

The de-stigmatizing of mental health has been a good thing. Mental health issues are no less real than any other. However, it has also led people to feel that having a bad hair day is somehow the same as having depression. I am staggered by the number of people who feel that because they are facing challenges in their life feel that they have got “a bit of depression”.

When “bad” things happen it is as normal to feel down as it is to feel happy when “good” things happen. To feel down after a relationship breakdown or job loss is no more abnormal than to feel happy after winning a lottery. There is a range of human emotion and feeling-all of which are valid.

We need to be careful about medicalizing the human condition. The idea that 3 year olds can have depression (link2) demonstrates this tendency. Children can have emotional and behavioral problems and those problems need help. This is not the same as saying they have a medical illness requiring a drug.

Without the dark we could not understand light. We all have lessons to learn in our lives. It is from the hardest times that the greatest growth and learning’s come. Some people will need medication to get them through or at least started. For a reasonable number of people who are experiencing life’s “downs” the answer is more likely to lie in confronting and resolving the issues rather than in a tablet.



Monday, August 10, 2009

Relationships - Pillar 7 of DIY Health

There are many relationships that we have in life. As I write in my upcoming book Dr Joes DIY Health –Putting you in charge of your health

“Humans are social creatures. We rely on relationships for our wellbeing. Relationships can broadly be regarded as external (those with others) and internal (which covers your view of yourself, your values and spirituality). Both are important to your health. If your relationships are out of balance then your health will be affected.

Arguably the most important relationship you have is the internal one you have with yourself. How you see yourself governs your mood, attitude, behaviour and beliefs. These beliefs and attitudes lie at your core. At another level are your thoughts and emotions

Our external relationships are first and foremost with other people. This includes our family, our friends as well as those we work with.”

Two reports in the last few months highlight the correlation between good relationships and good health.

The first (link 1) looks at life expectancy in older people. Those who have a good network of friends lived longer than those who didn’t. Other studies have looked at the role of friendship in cancer and heart disease and again found “good” relationships made a difference.

Whilst nobody has done a “reverse “study looking at the health impacts of bad or “toxic” relationships, I have had many people particularly with cancer tell me over the years how they felt toxic relationships had contributed to their illness

The second (link 2)looks at how marriage continues to “hold up” in this changing world. It has long been shown that the health of men in particular is improved in a good relationship (marriage or defacto). I have also seen recent reports about the adverse health affects of divorce.

Now the key in all of this is good relationships. Staying in a bad relationship for the sake of it is not the way to go. Equally life is not necessarily perfect so one always needs to be “working” at ones relationships. Perhaps tending them (like one might tend a garden) is a better analogy. After all if it feels like hard work then that may tell you something

We also have relationships with our environment –our home and workplace, and the broader environment. We all know that some places “feel “ right and other do not. Sometimes even the colors in a room affect how we feel. The in-depth study of this is of course Feng Shui .

There is also our relationship with the cosmos, universe, spirit world, or whatever term sits comfortably with you.

The first relationship to get “right” is the one with yourself. This is about acceptance of who you are in this current moment. You can strive to be better but not make your self-acceptance conditional on some future achievement. It is about forgiving yourself, and it is about being “present” in the moment

All other relationships that you have will in some way be a reflection of this central one. Relationships are pillar 7 of DIY Health



Sunday, August 2, 2009

DIY Health- Real Healthcare Reform

Health reform is front page news in The USA and Australia.(see links) Countries in Europe are also grappling with their health systems. The issues are the same in all developed countries-how can the” system” afford to pay for all the services that the population may want and need.

As I write in the upcoming book Dr Joes DIY Health-Putting you in charge of your health :

“The health system is in fact a disease system. Why? Because the only real way for you to enter the system is to have a disease. If you are healthy and you front up at your local doctor or hospital, there is a fair chance that you’ll be told to go away because there is nothing particularly wrong with you.
Despite the overall health of people having never been better, in an interesting paradox there is now a growing “crisis” and rising “burden” of disease which is crippling the various “health care” systems.

This burden of disease is a result of the lifestyles that people choose. Diseases such as diabetes, arterial sclerosis, hypertension, gastric reflux and irritable bowel syndrome, to name just a few, are called “lifestyle illness diseases” because they are brought about through elements of lifestyle. Western medicine tends to treat these conditions with medications rather than changes in lifestyle.”

Treatment with hospital beds and medication is expensive. Yet in all the proposals and discussions about ”reform” a fundamental assumption is always made-namely that people will continue to develop chronic illnesses in increasing numbers and will out increasing demands on the system to “fix them”. Essentially the arguments are about who pays how much, between the individual, private insurers and government. Hospitals, doctors and pharmaceutical companies are on the receiving end of these transactions

No consideration seems to be given to the notion of individual responsibility(interestingly the Australian report in its recommendations has the title “taking responsibility”).Most of the disease “burden” is preventable .The London based World Cancer Research Fund showed earlier this year that one third of cancers could be prevented through regular exercise and changed eating patterns .The diabetes toll could be massively reduced through dietary change.

None of this costs the system a cent and there is minimal if any cost to the individual. This will depend on the choices you make and how much you want to invest in your health. As I also say in the book

“The quality of your health will always be a reflection of the quality of your choices.
Some choices are better than others. Each day we make choices with regard to our health and in turn our health will always be a reflection of those choices.
The bottom line is; your health is your responsibility. It is not the responsibility of government, of the health system, the doctors, the natural health therapists or anyone else. It is solely your responsibility.

Maintaining your health has wrongly become thought of as very difficult and in this book I’ll tell you why that is and what you can do about it.
The message is clear: Your health is not reliant on anyone else except you. You have the power to be healthy. “

The 8 pillars of DIY Health a re a basis for being and staying healthy Whilst this will this reduce demands on the “disease system”- more importantly you will feel better and have more energy today as well as a significantly reduced chance of major illness later. Live and enjoy life for the duration of your stay on earth.