Sunday, June 28, 2009

The best way not be sick is to be healthy

Over the last 30 years we have seen the rise of preventative health. Three recent articles shine a spotlight on this and raise good questions. A US study (link 1) questions the cost effectiveness of certain health programs. In Germany (link 2) it is suggested that many “preventative” health programs may do more for doctor’s wallets than patients. Along the same theme questions are raised over the value of routine bone density screening (link 3)

Earlier this year in a UK study that simple lifestyle changes would reduce rates of bowel cancer far more than screening programs (testing blood in the stool). An Australian bowel cancer screening program is currently in disarray due to problems with lab results. Mass skin cancer screening in Australia has seen the ratio of spots removed per cancerous spot go from 1 in 4(1980) to 1 in 30 today.

The issue with most public health and preventative health campaigns is that are focused on trying to detect or prevent specific diseases. There is rarely an emphasis on keeping people healthy overall.

Now, lets be clear, it is better to find disease early than late. However this is not the same as not getting disease and certainly not the same as focusing on being healthy

There are unintended consequences of this “disease specific” approach For example; skin cancer campaigns that urge people to stay out of the sun may be partly responsible for a staggering increase in vitamin D deficiencies. This may be causing more cancers (bowel and breast for example) than it is preventing. Vitamin D deficiency is also possibly linked to diabetes

Since the late 1970’s, there has been a big push to reduce fat intake. This has come about because of concern that cholesterol in the blood stream leads to heart disease. Interestingly, the original study (Frammingham), which sparked this whole reduced fat movement, never actually concluded that circulating cholesterol levels were the problem. It was always to do with the build up of cholesterol plaque in certain artery walls and even more to the point, the rupture of this plaque. The reasons why this occurs in certain individuals and not others, has always remained a mystery.

Indeed, there are populations around the world who have very high levels of cholesterol and very low levels of heart disease and vice versa and up to 40% of people with heart disease have none of the “common risk factors”.
Nevertheless, the “fat is bad” mantra gained traction.

The proverbial baby has been thrown out with the bathwater, as many people may not get enough good fats. Omega 3 and omega 6 are called essential fatty acids because the body can’t make them and needs them. Also in a push to lower fat intake, consumers sought out low fat foods. What people didn’t think about was these foods were very high in carbohydrates (sugars) in general and refined carbohydrates in particular. Not only those, but also these foods do not provide much nourishment and often leave you with the munchies two hours later.

If the body gets excess calories it will store them. It can’t store them as sugars, it stores them as fat, so regardless of how many low fat foods a person eats, the excess calories are converted to fat. The gradual result of this over 25 years has been an increase in the rates of obesity. People have been eating less fat but guess what happened? They have been getting fatter.

The next knock-on effect has been an increase in the rate of diabetes. Obesity has skyrocketed since the mid 1980’s - all this under the watchful eye of the public health and preventative disease authorities. By focusing on trying to prevent one illness, a whole range of other effects were overlooked. The messages are not bad or negatively intended in any way, but too narrow in trying to stop one particular disease.

The solution of course is to focus on being healthy rather than trying to prevent specific diseases, especially when trying to prevent one disease can lead to getting another. This is the essence of DIY Health and is covered in my book, Dr Joes DIY Health due out in August . Some practical ways to stay healthy are also covered in previous blogs

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




Thursday, June 18, 2009

ADHD- A different perspective

News recently (see link 1) that the FDA has advised parents not to stop giving their children ADHD drugs yet despite a government backed study showing a six fold increase in deaths in children on medication compared to those not on medication. In the same week a cold remedy was pulled off shelves (link 2) due to it affecting the sense of smell.
Let me be up front on this. I do not believe that attention issues in children (or adults) are caused by a lack of amphetamine like stimulant medication in the blood stream. Lets examine the facts .
There are children who display behaviors, which are consistent with some of the diagnostic criteria for ADHD. This presents a genuine management issue for the child, their parents and often the school as well. There has been a significant increase in the number of children (and more recently adults) who are being diagnosed ADHD or similar over the last 20 years.
So what has led to this increase in diagnosis and, what can be done to manage the problem? The diagnosis of ADHD is based on fulfilling certain criteria and is completely subjective. There is no scan or blood test to detect the condition. Certain behaviours may be acceptable in certain circumstances but not others. For example, grabbing a person and throwing them to the ground is acceptable on some sports fields but not in the street. The behaviour is the same but the context is different. Answering questions early is rewarded on TV quiz shows with buzzers but is one of the diagnostic criteria for ADHD in a classroom setting.

The issue then is how we look at behaviours may have changed more over the last 20 years than the behaviours themselves. Furthermore, children are not actually designed to sit still for long periods of time. Boys in particular need to be running around to use up pent up energy. The number of avenues for them to do this has decreased. Fewer children walk or ride to school and they are less likely to run around in a park after school. They still have the same amount of energy to burn up as their predecessors. Bottle up this energy and it may well come out where you don’t want it.

Another significant change has been the teaching methods for literacy. The whole of language approach, which has become almost a religion in certain education circles does not serve the interest of all children and particularly not a large number of boys who will learn literacy in a phonetic manner. Guess what happens to a child sitting in a classroom if they are not able to keep up or understand the lesson. They will get bored and they will misbehave.

By creating circumstances that don’t necessarily suit children and restricting their outlets for letting off steam behavioural issues can be created. However, these are behavioural issues and do not necessarily constitute a medical illness which requires a drug treatment.

Another big issue with children these days is their nutritional status. There is a growing view that children are often overfed but malnourished. This paradox comes about because whilst they are consuming increasing amounts of food, they are not getting the nutrients that they need and in particular, not the essential fatty acids, vitamins and minerals. Furthermore, their bodies may be exposed to a variety of preservatives and toxins, which their young bodies are even less designed to cope with than adult bodies.

We need to look at the child in their total environment, look at what their genuine needs are and consider what expectations are placed on them. Not all children will be brilliant scholars and it is ridiculous to expect them to be so. This is not to say that doing your best in school is not important, but many extremely successful people did not score brilliantly in school exams. One of the justifications for use of medication is that it improves academic performance. This argument would not be acceptable in a sporting environment.

Ensuring that simple things like vision and hearing have been checked is important. Ensuring that children do have the opportunity to be active and are encouraged to be so is critical. Allowing children to have a variety of interests and be on the move is also important. Simple dietary changes like cutting down on processed and packaged foods, minimizing food colorings and additives and ensuring adequate intake of key minerals, vitamins and essential fatty acids is critical. The study in link 3 shows that children eating a Mediterranean type diet (lots of fruit and veg) had less behavioral issues than those eating a “typical” western diet of processed grains. This may mean saying no to demands for soft drinks and other packaged foods. Parents need to be aware that saying no is quite ok.

It is likely that in 20 years time, people will look back in horror at the medicalisation of behavior that we have seen over the last two decades and in particular, the over medicalising of childrens behavior where we have repackaged behavioral phenomenon and labeled it a disease and provided a drug treatment. By that time we will hopefully be catering to the genuine needs of our children rather than seeking to force them to fit a narrow definition of “normality” and labeling them as diseased when they don’t.




Wednesday, June 10, 2009

Pigs might fly but the sky is not falling

I keep waiting for sanity to return when it comes to dealing with swine flu. Looks like I could be waiting a while. Not surprisingly this strain of flu like thousands upon thousands before it and thousands yet to come is spreading like … a virus.

Every winter, people all over the world get cold and flu illnesses. Schools are not closed and people are not put into quarantine and masks are not recommended.
The question arises what is actually different about this strain? To the best of my knowledge and based on events that have occurred, the answer is…nothing.

In my city of Perth ,literally half way around the world from the beginning of this issue in Mexico, schools are being closed this week. One child went on a school camp before even getting ill triggering one closure (see link 1). An 11 year old told the West Australian Newspaper that apart from having a sore throat, blocked nose and slight cough he felt fine. His whole school has been closed .The health department has ordered two class years of another school be shut down for a week. If I were a kid I would love this.

Here are some interesting questions. What is so special about a week? If this is the average incubation time than some may come down with it on day 8 or 9. What about siblings in other years? If a child in one of the “closed” years has a brother or sister in another year, maybe at another school what do they do? What about the parents going to work?

Above all else, what is the big deal with swine flu? It is the flu-like any other, possibly less serious than most. The “death” toll is smaller than the usual winter flu and it is spreading in the way any flu does. The same authorities who are running around like chicken little saying the sky is falling have also conceded that the virus will spread and that a large number of people may get it .If so, then why the current circus?

Plans are also underway for a vaccine. The likelihood is that by the time it comes out the whole issue will be yesterdays news. In 1976 a vaccine developed in similar circumstances (ie panic) lead to 500 deaths from complications of the vaccine. Hardly a great result.

The other interesting question is why the authorities are so keen on Tamiflu. A look at the product information reveals that if used at onset of symptoms the median time to resolve symptoms was reduced by 30 hours compared to placebo. In other words you will get better one day earlier if taking it compared to not taking it. In teenagers the difference was 24.2 hours. For those in “high risk” groups (people with cardiac or respiratory disease) there was no difference. In terms of preventing spread the studies in the product information show reduction is spread of between 3 and 10%. This is not massive.

There have been reports out of Japan (see link 2) of suicides associated with use of Tamiflu. This may be coincidence. However the more widely a drug is used ,the more one sees rare side effects It would be a travesty if more deaths arose from the “cure” than the disease.

So why are the authorities running around like chicken little making such a big issue of this? It makes them look important. They are keen to do “what they can” regardless of whether it makes a difference Mainly they are paranoid about being accused of not doing something.

There is no need to be frightened of swine or any flu. All you need to do is look after your health and support your immune system .As I wrote on April 27, “there is much that can be done to strengthen our immune system. Putting the right fuels (foods) into your body is the key. Eat 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. In addition to this many people may benefit from vitamin supplements, particularly antioxidants such as vitamins A, C and E which help the immune system. Zinc, Vitamin D and Folate supplements are also helpful.

Make sure you get enough sleep, as this is the bodies recharge the battery time and drink 35ml/kilo of water each day.

Most importantly examine your workload and stress levels and take steps to reduce them before they reduce your immunity to illness.”

None of this guarantees you cant get ill at times .It does mean that you are less likely to and that you will get better quicker, without need for quarantine or expensive antiviral drugs. 1 2

Friday, June 5, 2009

Stopping smoking- Made simple

Smoking rates have declined over the last 30 years in many countries particularly the USA and Australia. Most of this has been from people just quitting or going “cold turkey” as it is called. Cigarette consumption does vary considerably around the world (link 1).

More recently there have been pharmaceuticals developed to help people quit smoking. There are two main types. Patches and chewing gums, which provide a small dose of nicotine to ease the cravings and tablets which alter the desire for cigarettes.

The tablets of which there are two have been developed from a line of antidepressants. Whilst helping some people they are like all medications, not without their side effects. The FDA is investigating problems with one of these (see link 2 ) with reports of blackouts and other problems

The key point is that people have been ceasing smoking long before the development of drugs, which have “medicalized” smoking. This recent article (see link) confirms that those who quit by themselves have double the success rate of those who seek “help.” The promotion of the need for help to stop smoking may lead people to doubt that they can do it themselves.

As Henry Ford said, “Whether you believe you can or you can’t you will be right.” Therefore the most important aspect of stopping smoking (or any health change) is the belief that you can do it. The idea that it can only happen with drugs or even other support is disempowering.

This does not mean that some support particularly from family and friends is not helpful. It does mean that the only person who can stop you smoking is you. People often feel or are made to feel disempowered by the term “addict”. This implies that the cigarette (or other drug) is somehow more powerful than you. This is, sadly, a view pushed by public health authorities. Believe that and it will be so. Choose to believe that you are in command and you are.

Elle McPherson was quoted in Tattler as not smoking, drinking or taking any type of drug (including aspirin) yet used to smoke 20/day and enjoy a drink. When asked how she coped at parties she said it was easy-“If I’m not comfortable in a situation I just leave”.

The lesson in this for all of us is that we have choices. It is up to us as to what choices we make. If you want to quit smoking (or any other habit) you must first change your attitude and mindset. The rest will flow from that.