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.