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Ross Walker
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Tips for keeping healthy over the Christmas break

Thursday, December 14, 2017

By Ross Walker

Well, it is that time of the year when the very common burnout sets in and most of our thoughts turn to the Christmas break. Although Christmas should always be a time for rest, reflection and rejuvenation it often becomes a time for excessive partying, overeating, overindulging in other bad habits, not to mention those interactions with relatives who we hardly see throughout the year. Interestingly, my daughter, Dr Ali Walker, who has a PhD in Human Consciousness & presents Conscious Living on my radio show, Healthy Living each week, told us during a recent segment on the show that there is now a new term for this overdose of relatives at Christmas. The term is hyper-co-presence. I would prefer to call this an unavoidable overdose!

Rather than heading towards the inevitable Christmas weight gain, the very common New Year’s Day hangover and the perennially failed New Year’s resolutions, why not resolve before the holiday season gets into full swing to really make this Christmas break the chance to make a fresh start by following what I call my 5 Point Power Plan.

  1. Decision
  2. Correct your limiting patterns
  3. Create a new pattern
  4. Train the habit
  5. Live the program

Decide what life habits you want to break and which ones are not working for you. A very good start here is to create a journal or a diary where you actually write down in decreasing order of importance your life goals for the coming year including the list of bad habits that are not serving you well and you wish to change.

What is stopping you right now from not making these changes? If, for example, you wish to cease smoking but every Friday night you go down to the hotel with your friends and have a few drinks, this will certainly weaken your resolve and this pattern may need to change. Many people, as another example, are comfort eaters, often sitting in front of the television consuming unnecessary food. Rather than doing so, now that it is daylight saving, why not go for a walk instead.

Nature abhors a vacuum. When you change a bad habit that has occupied a significant amount of your time, whether it be excessive eating, drinking or smoking, it should be replaced with a better, more, healthier habit. One of the greatest examples I have witnessed in my medical practice was a patient of mine who was a serious alcoholic. He consumed around 20 schooners of beer per day leading to a severe dilated cardiomyopathy. This gentleman made the decision to stop alcohol on my very strong advice and replaced this with an interest in Egyptology. All of the money he used to spend on alcohol was placed in a bank account. He had eventually saved up enough money to take him and his wife to Egypt where he had the trip of a lifetime. His severe heart disease returned to normal & he is still a regular patient of mine 25 years later.

Any new habit requires discipline. You need to discipline yourself for a full month for this new habit to be trained and to become a normal part of your life. It is very important, also, to associate rewards with this new habit. For example, once I had destroyed my knee through too much sport, I needed to replace my very enjoyable soccer and squash games with a less rigourous form of exercise. I therefore started using an exercise bike 8 years ago but my reward was to watch enjoyable TV series whilst exercising to associate pleasure with the habit rather than the boredom of the exercise bike for 45 minutes staring out the window. I am delighted to say that I have already broken two exercise bikes through excessive use and have ordered my third bike. My favourite TV series is “The West Wing”. I’ve just finished watching the seven series through for the third time. Jed Bartlet is the President every President should be. What a pity we don’t have world leaders that emulate this character! 

A number of years ago I wrote a book “Diets Don’t Work”. The reason diets don’t work is that you go on a diet in the same way as you go on a holiday. You always come back from the holiday. 12 week programs also have a finite ending which see you return to your old habits. When you have created new, good and healthy habits, these need to stay with you for the rest of your life. You need to have a commitment to maintaining these habits as part of your new way of thinking.

Life is not about making the big decision to be healthy and happy, it is about making 30-50 small decisions every day of your life. Decisions like “I want eat that biscuit”, “I’ll walk up the stairs rather than take the escalator”, “I will not yell at that fool who just cut in front of me in the traffic”. These are split second decisions that can either take you towards good health and happiness or bad health and unhappiness. Why wait for the new year to make these decisions and resolutions? Why not start right now before the, often bad, habits of the Christmas break take over.

 

Myth - all alcohol is equal

Thursday, December 07, 2017

By Ross Walker

With the festive season fast approaching, most of us are looking forward to winding down and recovering from the very common burnout that occurs at this time of the year. Unfortunately, the festive season is typically a time for excessive partying, overeating, often the over consumption of alcohol and quite disturbingly the continual use of illegal drugs for some.

Rather than feeling rested and rejuvenated for the return to work in the New Year, many people have gained a few kilos and feel even more burnt out from the effects of all the above.

The background side-effects of the chronic hangover many people feel around this time include throbbing headaches, a dry mouth and even persistent nausea. The reasons for these symptoms are multiple and include the following:

1) Alcohol itself does not cause the hangover directly, rather the metabolite acetaldehyde which becomes manifest a few hours after the ingestion of whatever alcoholic beverage you are consuming. Acetaldehyde is a direct cellular poison which not only causes the acute symptoms of the hangover which can lead to a variety of toxic effects within the body and on a chronic basis, cellular damage also, in particular, the liver, brain and the heart.

2)  Alcohol is a diuretic, thus leading to dehydration. It is felt that part of the reason for the throbbing headache and dry mouth is dehydration but no doubt the vasodilating effects of acetaldehyde also contribute.

3) Sleep apnoea-alcohol and acetaldehyde have potent effects on disrupting sleep markedly increasing the severity of sleep apnoea which is present, to some degree, in all males and postmenopausal females. After a bad episode of sleep apnoea, your blood pressure is driven up, you feel unbelievably tired and unwell.

4) But, it also appears that there are other aspects to drinking and certain types of alcohol are more prone to causing a more intense hangover. There are certain chemicals present in the variety of forms of alcohol known as congeners which are separate to alcohol and acetaldehyde. These containers include sulphites, amines, amides, acetone, histamine and methanol. Certain types of alcohol have higher concentrations of congeners, typically the more coloured forms such as the darker liquors such as whiskey and cognac and of course the increasingly popular red wine.

Interestingly, for the more moderate drinkers who will keep the wine for a few days, after the wind is opened and exposed to the air, the longer time increases the concentration of congeners.

I’m not suggesting this as an excuse to ensure that every time you open a bottle of wine you finish it in one-hit but I am suggesting that you obtain the suction devices to take as much air out of the partly consumed bottle as possible and also leave the wine in the fridge, which will reduce the concentration of congeners.

It appears that the colourless liquors such as vodka and gin have much less congeners and appear to cause less hangover. But, the clear point is that the more you drink, regardless of the drink, the greater your risk for a hangover and on a chronic basis, significant health issues.

For those people who do overindulge, especially at this time of year, there is an evidence-based hangover treatment known as rapid recovery. Rapid recovery contains all natural products and has been shown in a placebo-controlled trial to reduce the intensity and length of hangover symptoms. It contains L-cysteine, ascorbic acid along with B1 and B6 which help regenerate glutathione within the liver and prevent the accumulation of acetaldehyde. It has been developed by a Professor of pharmacology and fellow cardiologist, Prof Laurie Howes from Queensland. It can be obtained from a variety of pharmacies including Chemist Warehouse but also from the websites www.rapid-recovery.com.au

Interestingly, a recent survey from the UK published in the “British Medical Journal Open” looked at information from the Global Drug Survey from 30,000 respondents aged 18 to 34 from 21 countries.

They looked at the different emotions generated by the variety of alcohol that people consume. Generally, it appears that spirits tend to generate more negative moods and violence whereas wine and beer appear to have a more positive response.

Around 50% of respondents surveyed suggested that red wine and beer allow them to relax and wind down whereas only 20% of spirit drinkers stated that this type of alcohol consumption relieved tension. Meanwhile, 30% of the respondents said that they felt more aggressive after consuming spirits whereas only 2.5% of red wine drinkers said the same.

Of spirit drinkers, 50% suggested that consuming this form of alcohol boosted confidence and energy and a further 42% said that spirits make them feel sexier.

There also appeared to be some effect on age with those surveyed between 18 to 24 suggesting that any alcohol boosted confidence and improved their energy and also made them feel more attractive. Interestingly, heavier drinkers did state that alcohol gave them more energy but also made them more aggressive and tearful, regardless of whether they drank at home, alone or with friends.

It is hard to conceive that the different types of alcohol would lead to these variety of emotions but rather the reasons and the settings for this form of consumption would be a much more likely explanation.

For example, the alcohol of choice at a hotel or pub is, of course, beer where people go to socialise and wind down typically after a busy day at work. I would suggest it is the socialising and winding down and not the beer that is specifically doing the job here. With the example of red wine, this is typically consumed with a meal with the family or friends and again I believe it is the setting, not specifically the red wine, that is leading to the winding down and relaxation in this situation.

People who consume spirits tend to do so away from food and often on empty stomach. As spirits have such a high concentration of alcohol, the propensity to get more drunk quicker can lead to aggression, violence and a false sense of confidence. This would also probably include a false sense of being sexy.

Regardless, the regular consumption of alcohol is more the norm then the exception in our society and if used responsibly and in lower doses can be a very pleasant adjunct to any social setting.

I can think of no situation where a drunk person benefits themselves or anyone with whom they are interacting and regardless of the particular nuances of the type of alcohol consumed, the clear message of moderation is definitely the most important catch cry for alcohol consumption.

 

The case for compassionate medicine

Friday, December 01, 2017

By Ross Walker

With the recent vitriolic debate in the Victorian parliament and the repeat in New South Wales, I thought I would give my position on the topic of euthanasia.

There are many people who are concerned that once euthanasia is passed then vulnerable elderly people will be prematurely taken off the planet often at the behest of their greedy relatives looking to cash in early on the inheritance. The laws suggested around euthanasia will absolutely prevent this from happening.

But, I do not want to get into a debate about the particular nuances of these laws but would like to give my view on the place of euthanasia in medicine as it stands today. I have no doubt that there are some very rare cases where the only answer is euthanasia and if a person is suffering and their life is miserable, I have no problems whatsoever with assisted suicide.

But, it is my opinion that in most cases this is completely unnecessary and rather than supporting or promoting the practice of euthanasia, it is my opinion that doctors should be practising (which let me say many are doing so under the radar) what I call “compassionate medicine”.

As a doctor, I believe our first and most important responsibility is to relieve suffering. A good doctor relieves suffering, attempts to make an accurate diagnosis and form a reasonable and appropriate management plan for whatever condition the person suffers. I believe we should do everything we can to prolong someone’s life but do nothing to prolong their death.

Most sensible and well-trained doctors can clearly determine in conjunction with the person and their family, when the patient has entered the death phase. The death phase in my view is when a person has a terminal illness with absolutely no possibility of recovering.

This doesn’t just relate to terminal cancer but it also involves end stage Alzheimer’s disease, a severe stroke with a subsequent disability from which there is no reasonable chance of recovery, severe intractable pain for which no reasonable medical therapy is leading to any degree of relief and of course end stage neurologic conditions, such as motor neurone disease.

Without wishing to sound crude, I call this the “bum wiping rule”. If another person has to wipe your backside and there is no possibility that this will change and you consider the quality of your life to be miserable or you aren’t in a position to even discuss the issue, it is my view that all medical therapy should be stopped apart from pain relief and sedation. I would administer progressive doses of narcotics placing the sufferer in a peaceful oblivion allowing nature to take its course rapidly.

What we have now is many people languishing in institutions such as nursing homes at times for months to years, dying slowly in total misery. This is more the norm than the exception and in my view, society has gone mad to accept its dying citizens being treated in this fashion.

There are many people working in palliative care already practising compassionate medicine but often palliative care is not extended to those people languishing in nursing homes.

I’m not suggesting that compassionate medicine will be the answer for everyone but in my view, it is certainly the answer for most of us if we are placed in this situation. It is my view that we will markedly reduce suffering for many people if compassionate medicine becomes the norm not the exception.

 

Heart disease – is it reversible?

Friday, November 24, 2017

By Ross Walker

I received a very thoughtful and interesting question recently asking, “If 90% of heart disease is preventable, why are all forms of cardiovascular disease still our most common cause of death and disability?”

The commonest cause of heart disease is atherosclerosis, which is the progressive build-up of fat, inflammatory tissue and calcium in the walls of arteries over many decades. When these fatty plaques reach a critical mass, the plaques may rupture internally into the arterial channel and a subsequent clot forms, blocking the artery. If this occurs in the coronary arteries, it is highly likely that the person will suffer a heart attack. This is still the commonest cause of death around the world and certainly the most common manifestation of cardiovascular disease.

This is an explanation of what pathologically happens in the walls of arteries but does not explain what causes atherosclerosis in the first place. In our modern world, 70% of atherosclerosis and therefore heart attack (as I’ve stated the commonest manifestation of atherosclerosis) is directly related to the insulin resistance gene.

The insulin resistance gene is a survival advantage if you are a hunter-gatherer but a survival disadvantage if you live in modern society. The gene allows you to store fat around the belly after a big feed to tide you over until the next few days until this happens again. In the meantime, you are wandering around a jungle looking for more food but often go without a decent meal for a day or two. In modern society, we have breakfast, lunch and dinner and typically sit on our backsides all day in sedentary jobs. This gene is present in 30% of Caucasians, 50% of Asians and close to 100% of people with darker or olive skin. Thus, when anyone with this gene is exposed to modern living, it is very common to develop diabetes (or prediabetes), High blood pressure, specific cholesterol abnormalities which include high triglycerides and low HDL, along with abdominal obesity.

All of these factors combined or, even in isolation, predispose the individual to cardiovascular disease.

Two or more of these factors combined are known as the metabolic syndrome which is the commonest syndrome in the world and, as I’ve stated, accounts for 70% of heart attacks.

Another 20% of the cause of atherosclerosis comes from an elevated Lipoprotein(a). One in five people around the world have an excessive level of Lipoprotein(a) in the bloodstream which places them at a 70% higher risk for heart disease. Unfortunately, this simple test is not routinely performed by most doctors. It is purely genetic and is the typical reason why someone who practices healthy lifestyle principles still has a premature heart attack.

I have just given an explanation for 90% of heart disease with the remaining 10% being due to a variety of other factors which are clearly not as common. So, in most cases 20% of the causes of heart disease are being missed because people are not being screened for Lipoprotein(a).

In the remaining 70% of cases related to insulin resistance, many people continue to gain weight through excessive eating, are sedentary and are affected by the ever present stresses of the modern world, not to mention the use of a variety of substances such as cigarettes, excessive alcohol and illegal drugs.

A recent trial from Holland, known as the Morgen study, demonstrated clearly that if you followed the five keys to being healthy you reduce your risk for cardiovascular disease by 83%. If you then include appropriate genetic screening such as Lipoprotein(a) and take steps to control this issue, then we will see the rates of cardiovascular disease plummeting.

Over the years, there have been a number of studies demonstrating reversal of cardiovascular disease but this is not a passive process purely involving pharmaceutical therapy and medical procedures, it requires enormous responsibility on the part of the patient to completely rearrange their lifestyle, follow appropriate medical advice and take high quality supplements.

I have been practising medicine for over 40 years and have been a cardiologist for over thirty years and during this time I have seen numerous patients stabilise and often reverse the disease with this integrated approach to their care. It does require a lifelong commitment to being healthy and working with a trusted medical practitioner and unfortunately for many reasons, the majority of people can’t or won’t do so.

The Walker Rule Number One of Medicine is very straightforward, “the most important coronary arteries in this world are your own - if you’re not prepared to look after them, why should I bother to help you?

 

Exercise - is more better?

Thursday, November 16, 2017

By Ross Walker
 
I have repeatedly suggested that the ideal amount of exercise every week is somewhere between three to five hours. So, is this just my gut feeling or is there any good evidence for these comments?

I would like to review three recent interesting studies around exercise which address this important issue.

A recent, long term study of 25 years followed just over 5100 people aged between 18 to 30 years old at the entry of the study. For various reasons, the final analysis reviewed 3175 participants who had undergone eight examinations over the 25-year period and answered at least three questionnaires regarding the amount of exercise they performed along with other lifestyle factors as well.

A coronary calcium score was performed at some stage between age 43 to 55 and the participants were divided into three groups.

  1. Those who exercised less than two and a half hours per week
  2. Those who exercised between three to five hours per week
  3. Those who exercised more than seven and a half hours per week.


The results were quite surprising and in many ways, somewhat disturbing. When the group who exercised more than seven and a half hours were compared to the other groups there was a 27% increase in coronary artery calcification, suggesting lack of protection from heavy exercise for heart disease risk.
 
Interestingly, and somewhat difficult to explain, is the fact that white males in the third group had an 86% increased risk for coronary artery calcification. The higher-level exercise group, for some reason, did not appear to affect cardiac risk in black men or all women. Although there is no clear explanation for this difference I would like to propose the following explanations.

Atherosclerosis, which is the progressive build-up of fat, inflammatory tissue and calcium in the walls of arteries, tends to occur later in women (on average 10 years) and a coronary calcium score performed between age 43 to 55 is too early to detect significant atherosclerosis in a female population.

People who exercise for more than seven and a half hours per week are typically (although not always) joggers or cyclists, or professional athletes. There is no doubt that African Americans do make up a significant proportion of the high-level athletes in America, not to mention the Africans who tend to win most of the marathons. It could be that people with darker skin are more physiologically adapted to exercise for longer periods and thus have less evidence of cardiovascular disease.

Regardless, it does appear for those of us who are not professional athletes (i.e. sport being their major source of income) that if you are exercising for good health, the three to five-hour dose per week appears to be the healthiest level.
 
The second study was fascinating in that it looked at the type of exercise which may be important for specific disease prevention. There are two basic types of exercise, aerobic - cardio, or anaerobic - strength and resistance training. This study of 80,000 people, older than 30 years, commenced in 1994 and continued until 2008 with an average follow-up of around nine years. It looked at strength and resistance training for 50 to 60 minutes per week as opposed to moderate intensity exercise 50 minutes per week e.g. walking, as opposed to high-intensity exercise such as running or cycling for 75 minutes per week.
 
In all these groups, compared with people who were inactive there was around an 18% lower risk of early death purely by performing the various types of exercise. But, with resistance and strength training there was a 31% reduced cancer risk whereas with aerobic exercise a 21% reduction in cardiovascular risk. The reduction in cancer death has been repeated in a number of studies in people who regularly perform some form of resistance training.

My suggested reason for this is that cardio exercise improves cardiovascular efficiency through more efficient pumping of the heart and better blood flow to muscles. Because of the more efficient cardiovascular system there is logically a reduction in cardiovascular death. Interestingly, strength and resistance training increases the fitness and size of muscles thus improving muscle metabolism and requiring a much higher level of blood flow to the muscles. Logically, this would redirect blood flow away from tumours and thus help prevent cancer death.

Finally, a study in the American Journal of Preventive Medicine reviewed 140,000 people participating in the Cancer Prevention Study II Nutrition cohort. It found that as little as two hours per week of walking compared with those who did no exercise reduced overall death risk from all causes. Those who performed the recommended 150 minutes of walking demonstrated a 20% reduction in all-cause death. Interestingly those who walked for more than six hours per week had a 35% reduction in death related to respiratory causes, a 20% reduction in cardiovascular death and a 9% reduction in cancer death.

Probably the most disturbing statistics from all the studies is that 27% of people are inactive and only 50% of people meet the guidelines for recommended exercise.

I have stated on numerous occasions that exercise is the second-best drug on the planet after happiness but it also appears that the correct dose of exercise is important along with the type of exercise to reduce specific conditions. This is why I constantly say that the suggested dose is three to five hours per week which should be divided into two thirds cardio and one third resistance training. Just as the real estate agents say the most important principle is “location, location and location”, those of us involved in preventative medicine state “movement, movement and movement”.

 

Depression: Is it just a brain disorder?

Thursday, November 09, 2017

By Ross Walker

Over the past decade, depression has received significant coverage in mainstream media with many high-profile organisations, such as Beyond Blue and the Black Dog Institute as good examples, not to mention a number of prominent individuals publicly declaring their own demons in this very common area of mental health.

It is estimated that around 7% of people living in the modern world will experience an episode of major depression on a yearly basis. Depression is defined as five or more of the following symptoms persisting for more than two weeks.

  1. A depressed mood with the loss of pleasure in normally pleasurable activities
  2. Abnormal weight loss or weight gain
  3. Poor sleep and, in particular, early morning wakening, but this may also include too much or too little sleep
  4. Physical agitation or slowness
  5. Fatigue
  6. Feelings of guilt/worthlessness or hopelessness
  7. Lack of focus and at its extreme, thoughts of death and suicidal thoughts.

Thankfully, depression is no longer seen as a purely psychological illness or as a sign of weakness or poor character; a condition that the person should toughen up and pull themselves out from.

Probably the most accepted theory is that depression is a disorder of brain chemicals-typically a reduction in the mood chemical, serotonin. This hypothesis is strengthened by the strong observation that serotonin altering pharmaceutical drugs are the mainstay of medical therapy for depression. Although this is probably the case, there are some researchers in the area who dispute this and until we have better methods to assess brain function and neurotransmitter levels within the brain, this explanation will have to suffice.

Interestingly, recent work has suggested that depression could also be a gut disorder. 90% of our serotonin is produced by gut bacteria and it may be that a pathologic gut microbiome may not be producing enough serotonin to maintain a balanced, non-depressed state.

Recent work has also strengthened the notion that depression may have serious systemic health effects through a number of mechanisms.

A recently published study in the Canadian Medical Association Journal followed 3410 adults from Canada over a 60-year period. This examined the death risk associated with depression in both males and females, average age 49 years at study entry. This very long study had three distinct periods, each around 20 years, and found that in males the increased death risk was present through each period but was very prominent in females for the most recent period from the 1990s and onwards. This rose to a 50% increased death risk for women during that period.

Equally disturbing was the findings that the younger the diagnosis was made, the much higher the death risk. There are three possible explanations for the higher death risk associated with a diagnosis of depression.

  1. Depression leads to reduced motivation to follow healthy lifestyle principles with a poorer diet, reduced motivation to exercise and a much higher rate of substance abuse.
  2. Depression leads to an increase in stress related hormones and a reduction in the variety of “happy chemicals”- both conditions being associated with chronic illnesses.
  3. Depression is the leading cause of suicide

Although it is important to make the distinction (a distinction that is often blurred) between depression and grief or loss, there is no doubt that depression is not just a serious mental health issue but significantly increases the risk for a variety of (at times) lethal physical diseases.

As with all conditions, the best management is prevention or at least early detection and intervention. But, this is not possible unless you seek help. Remember, symptoms are nature’s tickets into the medical system and if you have any of the symptoms mentioned above, seek help early. It may just save your life.

Lifeline 131 114 beyondblue 1300 224 636

 

Is healthy eating always good for you?

Thursday, October 26, 2017

By Ross Walker
 
Two and a half thousand years ago, the father of medicine, Hippocrates stated, “let food be the medicine and medicine be thy food”. Of course, that was back in the days where food was very simple with little interference by humans apart from catching or preparing natural foods.

Food over 2000 years ago was of course a vital part of existence but certainly not the major pleasure it is nowadays. Our modern world is bombarded by constant food advertisements, television shows elevating celebrity chefs to superstar status, not to mention the quick-fix easy foods which take the strain out of food preparation.

With any major life pleasure, there is always the shadow, the underbelly, which in this case often leads to the excessive belly. But, apart from the obvious and increasing problems of obesity, could there possibly be a problem with so-called healthy eating?

My favourite medical website for excellent general review of modern medical issues, Medical News today, has “nailed it” again with two superb articles on orthorexia nervosa and food addiction. I thought I would review some of the key points from both of these articles and give my own perspective.

Orthorexia nervosa is defined as a pathologic obsession with healthy eating which may lead to social isolation, psychological disturbance and often physical harm. I had previously told the story of Professor Roy Walford who wrote the book, “The 120 year diet”. Walford suggests that if you consume a daily diet of 1500 calories of pure plant food with no coffee, alcohol or meat you will live to 120. Walford had a small group of loyal followers around the world who call themselves calorie restrictors. They don’t have an ounce of body fat, are constantly cold, tired, miserable and often depressed, but they live with the delusion that they will live until 120. The average age of death in the modern world for males is around 80 and for females around 84. A few years back, Prof Walford died at the ripe old age of 79, having lived that miserable existence of disciplined restriction for many years.

Medical News Today quotes the case of a 29-year-old female who progressed through the steady slope of vegetarianism to veganism to becoming a raw foodist and finally only consuming fruit to then losing her hair and becoming quite ill. They quoted French nutritionist, Sophie Ortego, who stated she had a patient who was “a pure, unbending vegan who even refused to take B12 supplements preferring to lose her sight rather than betray her commitment to animals.”

Orthorexia nervosa is not actually medically recognised and many people believe this is more a phobia than a food disorder. Many people in the field believe orthorexia nervosa has occurred because of the fear of modern issues such as mad cow disease, the use of pesticides in modern agriculture along with antibiotics given to domestic livestock, genetically modified foods and corporate farming. Many people who go down the slippery path of orthorexia nervosa believe that going organic and vegan will help prevent the toxicity of western lifestyle.
 
The other article presented by Medical News Today was on food addiction. This is where the need to eat becomes compulsive and uncontrollable and may be in response to an emotional disorder, stress, sadness or anger. Food addictions are also linked to cravings, typically chips, lollies (candy), white bread, chocolate pasta or ice cream.

Food addiction may lead to other disorders like obesity, bulimia or binge eating.

 Regardless, there is, no doubt, that food is a vital part of our existence. If you don’t eat, you die. But, not achieving a balanced, nutritional program may have serious consequences. In a modern world where a solution to obesity is bariatric surgery rather than drastic lifestyle changes, we need to review the deeper issues as to why a significant proportion of human beings are obese, experience anorexia and/or bulimia or even more recently have these new obsessions with healthy eating, veganism or some fad diet.

It is my experience as a doctor of 40 years that I have never met one person (and I’m not excluding myself from this observation) that has life in balance. We all struggle in some way and this struggle may lead to overeating, undereating, an addiction to some substance (cigarettes, alcohol or illegal drugs), anger, anxiety, depression or somatic symptoms.

It is my opinion that any issues around food, whether it be any of the problems I have discussed above, are purely manifestations of much deeper emotional factors. We are all the sum total of our various life experiences, genetics and our upbringing. Until we recognise the reason why we have whatever obsession, phobia, addiction or any other issue for that matter, we humans will continue to make the same mistakes and continue the same patterns.

Albert Einstein was once quoted as saying, “there is no more certain sign of insanity than to do the same thing over and over again and expect a different result”.
Rather than seeking a medical solution to your problem or starting on yet another diet or bizarre eating program, why don’t you find out the real cause of the problem, fix that cause and start an entirely different, healthier pattern.

 

Myth - An elevated PSA always means cancer

Thursday, October 12, 2017

By Ross Walker

There was an excellent article published on the superb medical website, Medical News Today recently on this very subject. I thought I would give my take on this excellent review.

PSA stands for prostate specific antigen and not prostate cancer antigen. An elevated PSA does not always imply prostate cancer. Thus, there has been significant controversy as to the utility and benefits of a PSA.
 
PSA is a specific protein produced by the prostate gland. The level of PSA varies with age but typically most men with prostate cancer have a PSA level above 4 ng per ml. Unfortunately, 15% of men with prostate cancer will have a PSA lower than this. It is my experience that the trend of PSA levels is more important than the absolute amount.

The typical screen for prostate cancer is the combination of a PSA level and a subsequent Digital rectal examination(DRE). The problem is that various experts in the area question the validity of both forms of examination and it is difficult to get a healthy consensus.

What are the causes of an elevated PSA other than cancer?

1) The older you are, the higher your PSA. If you examine the prostate glands of all men over 80 you’ll probably find traces of prostate cancer in everyone. The problem is that most people will die with the disease not from the disease. The real issue is who has the more aggressive forms as opposed to the more benign forms of prostate cancer. Many people argue that PSA testing should stop over age 70.

2) Prostatitis - any condition that inflames the prostate gland will also elevate the PSA level. Most people with prostatitis will have symptoms such as problems with urination and often changes with sexual function

3) Benign prostatic hypertrophy - as men age and especially if their sexual function reduces as well, it is very common for the prostate to swell. A man with benign prostatic hypertrophy may also experience significant problems with urination such as frequency, urgency and difficulty passing urine.
 
4) Medical intervention - having a digital rectal examination will significantly elevate the PSA as will any instrumentation of the urinary tract such as a catheter or cystoscope.

5) Urinary tract infection - although urinary tract infections are more common in women, they can also occur in men and may elevate the PSA levels
 
6) Vigorous exercise, especially cycling - often the middle-aged men in Lycra experience problems with erectile dysfunction as the bicycle seat can affect the nerves important in achieving an erection but also putting pressure on the prostate gland elevating the PSA. Even high-level activity apart from cycling may raise the PSA.

7) Ejaculation - if you are due for a PSA test, it is important to avoid ejaculation for a 48-hour period prior to the test.

If you have an elevated PSA, my strong advice is not to panic. I would carefully consider the advice given above and have a repeat test at some stage over the next few months once any of the other potential conditions have settled.

There have been a number of studies showing the inverse link between sexual activity and prostate cancer. I have often said that the best cancer prevention technique is to use the organ for what it was designed for. If your PSA is elevated, I would suggest you empty your prostate a few times a week (i.e. sexual activity) and then have the PSA repeated 48 hours after the last episode of the ejaculation and do not perform very vigorous exercise (in particular cycling) in the two days before the test.

If your PSA hasn’t changed, I would suggest referral to a urologist but always obtain a second opinion before a definitive procedure is performed.

 

Choosing wisely

Thursday, October 05, 2017

By Ross Walker
 
It is a sad fact of modern medicine that, tragically, the third commonest cause of death and disability in modern society is Western health care. It is estimated that around 10% of admissions to hospital are due to medical error. Over 100,000 deaths per year in the United States are due to the appropriate prescription of pharmaceutical preparations.
 
NPS MEDICINEWISE in Australia has continued its Choosing Wisely campaign with further important recommendations which will hopefully improve these statistics and also reduce the enormous burden from medical costs in this country, but also carried by all countries around the world for exactly the same reasons.

This latest campaign has focused on three main areas:

1. The overall ordering of x-rays in children. There are far too many x-rays performed for children with respiratory complaints. The vast majority of respiratory tract infections can be managed clinically without a chest x-ray and certainly without antibiotics. This is also true for the vast majority of children with abdominal pain, where abdominal x-rays and, in particular, abdominal CT scanning carries little value in the diagnostic pathway. What all of this excessive radiation does, however, is predispose children to developing some form of cancer later on in life because of this excessive and unnecessary radiation.

2. Encouragement of people to remain in the work force for as long as possible. This recommendation tries to encourage doctors, patients and employers to focus on capacity and not incapacity. To quote the president of the Australasian Faculty of Occupational and Environmental Medicine, Associate Professor Peter Connaughton, “we are recommending doctors only certify patients being totally unfit for work when it is clinically necessary. Where appropriate, we are encouraging willing patients to continue working in some capacity as part of their overall healthcare management. Declaring a person medically unfit for work can often see them experiencing a range of issues including loss of self-esteem, feelings of isolation, depression and anxiety, as well as poor physical health and slow recovery times from their injuries.”
 
Safe Work Australia estimates that work related injury and time away for illness can cost the Australian economy around $61.8 billion per year in direct and indirect costs such as loss of productivity. There is no doubt that a return to the work force is good for the individual and good for the country. Not only are the fiscal benefits obvious, but the sense of purpose and the ability to socialise outside of their immediate family and friends has profound physical and psychologic benefits.

3. Over the past decade there has been a significant backlash from the public regarding the widespread prescription of medications for a variety of conditions. One of the great cases in point here is that of statin therapy. It is estimated that around 19 million prescriptions are written every year in Australia alone and with 12 prescriptions per year per patient, this implies that just under 2 million people in the Australian population are prescribed statins. There is no doubt that this is excessive and unnecessary and with prolonged use, many chronic side effects can arise such as muscle issues, poor thinking and even increased risk for diabetes.
 
This new recommendation focuses on the fact that many people over the age of 65 are taking five or more different pharmaceutical preparations for a variety of conditions. Unfortunately, sometimes this is necessary but the problem is that many people in the modern world have been influenced to think that there is a pharmaceutical solution to every problem. This recommendation suggests that the risk of medication related harm rises significantly once the amount of regularly prescribed medications exceeds five and exponentially when greater than eight. The list includes benzodiazepines such as Valium, a variety of antipsychotic agents, hypoglycaemic agents to treat diabetes, antithrombotic agents to thin the blood, antihypertensives, antianginals, statins and the proton pump inhibitors.

When you visit your doctor and an investigation or treatment/procedure is suggested, ask the following five questions:

  1. Why do I need this?
  2. What are the risks?
  3. Are there safer, simpler or more natural options?
  4. What happens if I don’t have this?
  5. What are the costs involved?

 
The reality is that practising the five keys to being healthy;

  1. Quit all addictions
  2. Develop a good quality sleep habit (7-8 hours per night)
  3. Eat less, and eat more naturally
  4. Exercise three to five hours per week
  5. Cultivate peace and happiness every day

reduces your risk for all diseases somewhere between 70-80%. Taking a medication on average has around a 20-30% reduction in most common diseases but with the potential for significant side effects. Once you’ve been prescribed multiple medications then the drug interactions abound.
 
I congratulate the Choosing Wisely Australia campaign for bravely examining the current practice of medicine in this country which can only help to improve the general health of the population. Although strong medicine has strong effects, it also has strong side effects and complications and all doctors must be reminded of the first line of the Hippocratic Oath, first do no harm.

 

How long can we really live?

Thursday, September 28, 2017

 

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