What is mindfulness? Nobody really knows, and that’s a problem



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The concept of mindfulness differs depending on who you speak to.
Lua Valentia/Unsplash

Nicholas T. Van Dam, University of Melbourne and Nick Haslam, University of Melbourne

You’ve probably heard of mindfulness. These days, it’s everywhere, like many ideas and practices drawn from Buddhist texts that have become part of mainstream Western culture.

But a review published today in the journal Perspectives on Psychological Science shows the hype is ahead of the evidence. Some reviews of studies on mindfulness suggest it may help with psychological problems such as anxiety, depression, and stress. But it’s not clear what type of mindfulness or meditation we need and for what specific problem.

The study, involving a large group of researchers, clinicians and meditators, found a clear-cut definition of mindfulness doesn’t exist. This has potentially serious implications. If vastly different treatments and practices are considered the same, then research evidence for one may be wrongly taken as support for another.

At the same time, if we move the goalposts too far or in the wrong direction, we might lose the potential benefits of mindfulness altogether.

So, what is mindfulness?

Mindfulness receives a bewildering assortment of definitions. Psychologists measure the concept in differing combinations of acceptance, attentiveness, awareness, body focus, curiosity, nonjudgmental attitude, focus on the present, and others.

It’s equally ill-defined as a set of practices. A brief exercise in self-reflection prompted by a smart-phone app on your daily commute may be considered the same as a months-long meditation retreat. Mindfulness can both refer to what Buddhist monks do and what your yoga instructor does for five minutes at the start and end of a class.

To be clear, mindfulness and meditation are not the same thing. There are types of meditation that are mindful, but not all mindfulness involves meditation and not all meditation is mindfulness-based.

Mindfulness mainly refers to the idea of focusing on the present moment, but it’s not quite that simple. It also refers to several forms of meditation practices that aim to develop skills of awareness of the world around you and of your behavioral patterns and habits. In truth, many disagree about its actual purpose and what is and isn’t mindfulness.

Mindfulness can both refer to what Buddhist monks do and what your yoga instructor does for five minutes at the start and end of a class.
from shutterstock.com

What’s it for?

Mindfulness has been applied to just about any problem you can think up – from relationship issues, problems with alcohol or drugs, to enhancing leadership skills. It’s being used by sportsmen to find “clarity” on and off the field and mindfulness programs are being offered at school. You can find it in workplaces, medical clinics, and old age homes.

More than a few popular books have been written touting the benefits of mindfulness and meditation. For example, in a supposedly critical review Altered Traits: Science Reveals How Meditation Changes your Mind, Brain and Body, Daniel Goleman argues one of the four benefits of mindfulness is improved working memory. Yet, a recent review of about 18 studies exploring the effect of mindfulness-based therapies on attention and memory calls into question these ideas.

Another common claim is that mindfulness reduces stress, for which there is limited evidence. Other promises, such as improved mood and attention, better eating habits, improved sleep, and better weight control are not fully supported by the science either.

And while benefits have limited evidence, mindfulness and meditation can sometimes be harmful and can lead to psychosis, mania, loss of personal identity, anxiety, panic, and re-experiencing traumatic memories. Experts have suggested mindfulness is not for everyone, especially those suffering from several serious mental health problems such as schizophrenia or bipolar disorder.

Research on mindfulness

Another problem with mindfulness literature is that it often suffers from poor research methodology. Ways of measuring mindfulness are highly variable, assessing quite different phenomena while using the same label. This lack of equivalence among measures and individuals makes it challenging to generalise from one study to another.

Mindfulness researchers rely too much on questionnaires, which require people to introspect and report on mental states that may be slippery and fleeting. These reports are notoriously vulnerable to biases. For example, people who aspire to mindfulness may report being mindful because they see it as desirable, not because they have actually achieved it.

Evidence calls into question claims that mindfulness can help with memory.
from shutterstock.com

Only a tiny minority of attempts to examine whether these treatments work compare them against another treatment that is known to work – which is the primary means by which clinical science can show added value of new treatments. And a minority of these studies are conducted in regular clinical practices rather than in specialist research contexts.

A recent review of studies, commissioned by the US Agency for Healthcare Research and Quality, found many studies were too poorly conducted to include in the review and that mindfulness treatments were moderately effective, at best, for anxiety, depression, and pain. There was no evidence of efficacy for attention problems, positive mood, substance abuse, eating habits, sleep or weight control.

What should be done?

Mindfulness is definitely a useful concept and a promising set of practices. It may help prevent psychological problems and could be useful as an addition to existing treatments. It may also be helpful for general mental functioning and well-being. But the promise will not be realised if problems are not addressed.

The mindfulness community must agree to key features that are essential to mindfulness and researchers should be clear how their measures and practices include these. Media reports should be equally specific about what states of mind and practices mindfulness includes, rather than using it as a broad term.

Mindfulness might be assessed, not through self-reporting, but in part using more objective neurobiological and behavioural measures, such as breath counting. This is where random tones could be used to “ask” participants if they are focused on the breath (press left button) or if their mind had wandered (press right button).

Researchers studying the efficacy of mindfulness treatments should compare them to credible alternative treatments, whenever possible. Development of new mindfulness approaches should be avoided until we know more about the ones we already have. Scientists and clinicians should use rigorous randomised control trials and work with researchers from outside the mindfulness tradition.

The ConversationAnd lastly, mindfulness researchers and practitioners should acknowledge the reality of occasional negative effects. Just as medications must declare potential side effects, so should mindfulness treatments. Researchers should systematically assess potential side effects when studying mindfulness treatments. Practitioners should be alert to them and not recommend mindfulness treatments as a first approach if safer ones with stronger evidence of efficacy are available.

Nicholas T. Van Dam, Research Fellow in Psychological Sciences, University of Melbourne and Nick Haslam, Professor of Psychology, University of Melbourne

This article was originally published on The Conversation. Read the original article.

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Health Check: is margarine actually better for me than butter?



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The type of fatty acid is what’s most important when choosing a spread.
from http://www.shutterstock.com.au

Evangeline Mantzioris, University of South Australia

Only 20 years ago butter was the public villain – contributing to raised cholesterol levels and public concern over an increased risk of heart disease. Now this public perception seems to have been reversed, and reality cooking shows seem to use butter in every recipe. But what has caused this shift in perceptions and is it based on scientific evidence?

In the domestic market more people buy margarine than butter, with 27% of respondents in an ABS survey eating margarine the day before, and 15% consuming butter.


Read more: Eat food, not nutrients: why healthy diets need a broad approach


Do we still need to be concerned about butter’s links to heart disease, and is there any evidence to suggest butter is better for our health compared to margarine? To answer this we first need to look more closely at the make-up of butter and margarine.

Where do our favourite yellow spreads come from?

Butter is made from the processing of cream. The cream is churned until the liquid (buttermilk) separates from the fat solids. These fat solids are then rinsed, a little salt added, and shaped to form the butter we all love.

Margarine was first developed in France by Napoleon as a substitute for butter to feed the armed forces and lower classes. Margarine is made from vegetable oils, beta-carotene (added for colour), emulsifiers (to help the oil and water mix), salt and flavours (which can include milk solids). Vitamins A and D are also added to the same level present in butter.

We have Napoleon to thank for the advent of margarine.
from shutterstock.com

Any diet app will tell you margarine has about 10-15% fewer kilojoules than butter. But whether this is significant will largely depend on the amount you consume each day.

A national nutrition survey indicates the average person over 19 years consumes 20 grams a day of spreads (either butter or margarine), which equates to a difference of 100kj. This difference is largely insignificant in a usual daily intake of 8700kj/day.

It’s all in the fatty acids

The significant nutritional difference actually lies in the fatty acid profiles of the two products. The health differences between butter and margarine are based on the presence of different types of fats.

There are three types of fats in our food: saturated fat, monounsaturated fats and polyunsaturated fats. The difference between these lies in their chemical structure. The structure of saturated fats has no double bonds in between the carbon atoms, monounsaturated fats have one double bond between the carbon atoms, and polyunsaturated fats have two or more double bonds between the carbon atoms.

These subtle differences in structure lead to differences in the way our body metabolises these fats, and hence how they affect our health, in particular our heart health.


Read more: Viewpoints – is saturated fat really the killer it’s made out to be?


Margarine can be made from a number of different oils. If coconut oil is used the margarine will be mainly saturated fat, if sunflower oil is used it will mainly be a polyunsaturated fat, and if olive oil or canola oil is used it will mainly be a monounsaturated fat.

Butter, derived from dairy milk, is mainly saturated fat, and the main saturated fats are palmitic acid (about 31%) and myristic acid (about 12%). Studies have shown these raise blood cholesterol levels.

While there is debate in the scientific world about the relative contributions of saturated fats (and the different types of saturated fatty acids) to heart disease, the consensus is that replacing saturated fats with monounsaturated or polyunsaturated fats will lower the risk of heart disease.

The Australian Dietary Guidelines and World Health Organisation recommend the lowering of saturated fats to below 10% of daily energy intake. Depending on the overall quality of your diet and intake of saturated fats, you may need to swap your butter for margarine.

Check the labels

Extra-virgin oil protects against heart disease.
from shutterstock.com

There is strong evidence extra-virgin olive oil (a monounsaturated fat) provides strong benefits for heart disease protection – but there isn’t enough extra-virgin olive oil in margarine products to confer this benefit. Using olive-oil-based margarines is going to contribute very little to your daily intake of extra-virgin olive oil.

And this is why it’s confusing for the consumer – despite a margarine being labelled as being made from olive oil, it may contain only small amounts of olive oil and not be as high in monounsaturated fats as expected. It’s best to read the nutrition information panel to determine which margarine is highest in monounsaturated fats.

Another point of difference between butter and margarine is that margarine may contain plant sterols, which help reduce cholesterol levels.

At the end of the day, if you consume butter only occasionally and your diet closely adheres to the Australian guidelines for healthy eating, there is no harm in continuing to do so.

Another option to consider would be the butter blends. These provide the taste of butter while reducing saturated fat intake to half, and they are easier to spread. Of course, if you consume lots of butter, swapping for a low saturated fat margarine is your healthier option – perhaps reserve the butter for special occasions.

If you’re concerned about saturated fat levels in your diet, you should read the nutrition information panel to determine which margarine is lowest in saturated fat, regardless of which oil is used in the product.

The ConversationAs always, people need to base their decision on their family and medical history and obtain advice from their dietitian or GP.

Evangeline Mantzioris, Lecturer in Nutrition, University of South Australia

This article was originally published on The Conversation. Read the original article.

Health Check: which vaccinations should I get as an adult?



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Vaccines are one of the greatest public health achievements in history.
from shutterstock.com

C Raina MacIntyre, UNSW and Rob Menzies, UNSW

Before vaccines were developed, infectious diseases such as diphtheria, tetanus and meningitis were the leading cause of death and illness in the world. Vaccines are one of the greatest public health achievements in history, having drastically reduced deaths and illness from infectious causes.

There is a large gap between vaccination rates for funded vaccines for adults in Australia and those for infants. More than 93% of infants are vaccinated in Australia, while in adults the rates are between 53-75%. Much more needs to be done to prevent infections in adults, particularly those at risk.

If you are an adult in Australia, the kinds of vaccines you need to get will depend on several factors, including whether you missed out on childhood vaccines, if you are Aboriginal or Torres Strait Islander, your occupation, how old you are and whether you intend to go travelling.

For those born in Australia

Children up to four years and aged 10-15 receive vaccines under the National Immunisation Schedule. These are for hepatitis B, whooping cough, diphtheria, tetanus, measles, mumps, rubella, polio, haemophilus influenzae B, rotavirus, pneumococcal and meningococcal disease, chickenpox and the human papillomavirus (HPV).

Immunity following vaccination varies depending on the vaccine. For example, the measles vaccine protects for a long duration, possibly a lifetime, whereas immunity wanes for pertussis (whooping cough). Boosters are given for many vaccines to improve immunity.

Measles, mumps, rubella, chickenpox, diphtheria and tetanus

People born in Australia before 1966 likely have natural immunity to measles as the viruses were circulating widely prior to the vaccination program. People born after 1965 should have received two doses of a measles vaccine. Those who haven’t, or aren’t sure, can safely receive a vaccine to avoid infection and prevent transmission to babies too young to be vaccinated.

Measles vaccine can be given as MMR (measles-mumps-rubella) or MMRV, which includes varicella (chickenpox). The varicella vaccine on its own (not combined in MMRV) is advised for people aged 14 and over who have not had chickenpox, especially women of childbearing age.

Booster doses of diphtheria, tetanus and whooping cough vaccines, are available free at age 10-15, and recommended at 50 years old and also at 65 years and over if not received in the previous ten years. Anyone unsure of their tetanus vaccination status who sustains a tetanus-prone wound (generally a deep puncture or wound) should get vaccinated. While tetanus is rare in Australia, most cases we see are in older adults.


In July 2017, the government announced free catch-up vaccinations for all newly arrived refugees. This covers any childhood vaccine on the National Immunisation Schedule which has been missed.
Information sourced from betterhealth.vic.gov.au and healthdirect.gov.au/The Conversation, CC BY-ND

Whooping cough

Pregnant women are recommended to get the diphtheria-tetanus-acellular pertussis vaccine in the third trimester to protect the vulnerable infant after it is born, and influenza vaccine at any stage of the pregnancy (see below under influenza).

Pertussis (whooping cough) is a contagious respiratory infection dangerous for babies. One in every 200 babies who contract whooping cough will die.

It is particularly important for women from 28 weeks gestation to ensure they are vaccinated, as well as the partners of these women and anyone else who is taking care of a child younger than six months old. Deaths from pertussis are also documented in elderly Australians.


Read more: ‘No Vax, No Visit’? If mum was vaccinated baby is already protected against whooping cough


Pneumococcal disease and influenza

The pneumococcal vaccine is funded for everyone aged 65 and over, and recommended for anyone under 65 with risk factors such as chronic lung disease.

Anyone from the age of six months can get the flu (influenza) vaccine. The vaccine can be given to any adult who requests it, but is only funded if they fall into defined risk groups such as pregnant women, Indigenous Australians, peopled aged 65 and over, or those with a medical condition such as chronic lung, cardiac or kidney disease.

Flu vaccine is matched every year to the anticipated circulating flu viruses and is quite effective. The vaccine covers four strains of influenza. Pregnant women are at increased risk of the flu and recommended for influenza vaccine any time during pregnancy.


Read more: Millions of Australian adults are unvaccinated and it’s increasing disease risk for all of us


Health workers, childcare workers and aged-care workers are a priority for vaccination because they care for sick or vulnerable people in institutions at risk of outbreaks. Influenza is the most important vaccine for these occupational groups, and some organisations provide free staff vaccinations. Otherwise, you can ask your doctor for a vaccination.

Any person whose immune system is weakened through medication or illness (such as HIV) is at increased risk of infections. However, live viral or bacterial vaccines must not be given to immunosuppressed people. They must seek medical advice on which vaccines can be safely given.


In July 2017, the government announced free catch-up vaccinations for all newly arrived refugees. This covers any childhood vaccine on the National Immunisation Schedule which has been missed.
Information sourced from betterhealth.vic.gov.au and healthdirect.gov.au/The Conversation, CC BY-ND

Hepatitis

Australian-born children receive four shots of the hepatitis B vaccine, but some adults are advised to get vaccinations for hepatitis A or B. Those recommended to receive the hepatitis A vaccine are: travellers to hepatitis A endemic areas; people whose jobs put them at risk of acquiring hepatitis A including childcare workers and plumbers; men who have sex with men; injecting drug users; people with developmental disabilities; those with chronic liver disease, liver organ transplant recipients or those chronically infected with hepatitis B or hepatitis C.

Those recommended to get the hepatitis B vaccine are: people who live in a household with someone infected with hepatitis B; those having sexual contact with someone infected with hepatitis B; sex workers; men who have sex with men; injecting drug users; migrants from hepatitis B endemic countries; healthcare workers; Aboriginal and Torres Strait Islanders; and some others at high risk at their workplace or due to a medical condition.


Read more – Explainer: the A, B, C, D and E of hepatitis


Human papillomavirus

The human papillomavirus (HPV) vaccine protects against cervical, anal, head and neck cancers, as well as some others. It is available for boys and girls and delivered in high school, usually in year seven. There is benefit for older girls and women to be vaccinated, at least up to their mid-to-late 20s.

The elderly

With ageing comes a progressive decline in the immune system and a corresponding increase in risk of infections. Vaccination is the low-hanging fruit for healthy ageing. The elderly are advised to receive the influenza, pneumococcal and shingles vaccines.

Influenza and pneumonia are major preventable causes of illness and death in older people. The flu causes deaths in children and the elderly during severe seasons.

The most common cause of pneumonia is streptococcus pneumonia, which can be prevented with the pneumococcal vaccine. There are two types of pneumococcal vaccines: pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPV). Both protect against invasive pneumococcal disease (such as meningitis and the blood infection referred to as septicemia), and the conjugate vaccine is proven to reduce the risk of pneumonia.

The government funds influenza (annually) and pneumococcal vaccines for people aged 65 and over.

Vaccination is the low-hanging fruit for healthy ageing.
from shutterstock.com

Shingles is a reactivation of the chickenpox virus. It causes a high burden of disease in older people (who have had chickenpox before) and can lead to debilitating and chronic pain. The shingles vaccine is recommended for people aged 60 and over. The government funds it for people aged 70 to 79.


Read more – Explainer: how do you get shingles and who should be vaccinated against it?


Australian travellers

Travel is a major vector for transmission of infections around the world, and travellers are at high risk of preventable infections. Most epidemics of measles, for example, are imported through travel. People may be under-vaccinated for measles if they missed a dose in childhood.

Anyone travelling should discuss vaccines with their doctor. If unsure of measles vaccination status, vaccination is recommended. This will depend on where people are travelling, and may include vaccination for yellow fever, Japanese encephalitis, cholera, typhoid, hepatitis A or influenza.

Travellers who are visiting friends and relatives overseas often fail to take precautions such as vaccination and do not perceive themselves as being at risk. In fact, they are at higher risk of preventable infections because they may be staying in traditional communities rather than hotels, and can be exposed to risks such as contaminated water, food or mosquitoes.

Aboriginal Australians and Torres Strait Islanders

Indigenous Australians are at increased risk of infections and have access to funded vaccines against influenza (anyone over six months old) and pneumococcal disease (for infants, everyone over 50 years and those aged 15-49 with chronic diseases).

They are also advised to get hepatitis B vaccine if they haven’t already received it. Unfortunately, overall vaccine coverage for these groups is low – between 13% and 50%, representing a real lost opportunity.


Read more – Dr G. Yunupingu’s legacy: it’s time to get rid of chronic hepatitis B in Indigenous Australia


Migrants and refugees

Migrants and refugees are at risk of vaccine-preventable infections because they may be under-vaccinated and come from countries with a high incidence of infection. There is no systematic means for GPs to identify people at risk of under-vaccination, but the new Australian Immunisation Register will help if GPs can check the immunisation status of their patients.

The funding of catch-up vaccination has also been a major obstacle until now. In July 2017 the government announced free catch-up vaccinations for children aged 10-19 and for all newly arrived refugees. This covers any childhood vaccine on the National Immunisation Schedule that has been missed.

The ConversationWhile this does not cover all under-vaccinated refugees, it is a welcome development. If you are not newly arrived but a migrant or refugee, check with your doctor about catch-up vaccination.

C Raina MacIntyre, Professor of Infectious Diseases Epidemiology, Head of the School of Public Health and Community Medicine, UNSW and Rob Menzies, Senior Lecturer, UNSW

This article was originally published on The Conversation. Read the original article.

Four myths about water fluoridation and why they’re wrong



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Adding fluoride to tap water to prevent tooth decay is one of our greatest public health achievements. Yet, myths persist about whether it’s safe and works.
from www.shutterstock.com

Matthew Hopcraft, University of Melbourne

Evidence gathered over 60 years about adding fluoride to drinking water has failed to convince some people this major public health initiative is not only safe but helps to prevent tooth decay.

Myths about fluoridated water persist. These include fluoride isn’t natural, adding it to our water supplies doesn’t prevent tooth decay and it causes conditions ranging from cancer to Down syndrome.

Now the National Health and Medical Research Council (NHMRC) is in the process of updating its evidence on the impact of fluoridated water on human health since it last issued a statement on the topic in 2007.

Its draft findings and recommendations are clear cut:

NHMRC strongly recommends community water fluoridation as a safe, effective and ethical way to help reduce tooth decay across the population.

It came to its conclusion after analysing the evidence and issuing a technical report for those wanting more detail.

Here are four common myths the evidence says are wrong.

1. Fluoride isn’t natural

Fluoride is a naturally occurring substance found in rocks that leaches into groundwater; it’s also found in surface water. The natural level of fluoride in the water varies depending on the type of water (groundwater or surface) and the type of rocks and minerals it’s in contact with.

Fluoride is found in all natural water supplies at some concentration. Ocean water contains fluoride at around 1 part per million, about the same as levels of fluoridated drinking water in Australia.

There are many places in Australia where fluoride occurs naturally in the water supply at optimum levels to maintain good dental health. For example, both Portland and Port Fairy in Victoria have naturally occurring fluoride in their water at 0.7-1.0 parts per million.

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The type of fluoride commonly found in many rocks and the source of the naturally occurring fluoride ion in water supplies is calcium fluoride.

The three main fluoride compounds generally used to fluoridate water are: sodium fluoride, hydrofluorosilicic acid (hexafluorosilicic acid) and sodium silicofluoride. All these fully mix (dissociate) in water, resulting in the availability of fluoride ions to prevent tooth decay.

So regardless of the original compound source, the end result is the same – fluoride ions in the water.

2. Fluoridated water doesn’t work

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Evidence for water fluoridation dates back to US studies in the 1940s, where dental researchers noticed lower levels of tooth decay in areas with naturally occurring fluoride in the water supply.

This prompted a study involving the artificial fluoridation of water supplies to a large community, and comparing the tooth decay rates to a neighbouring community with no fluoride.

The trial had to be discontinued after six years because the benefits to the children in the fluoridated community were so obvious it was deemed unethical to not provide the benefits to all the children, and so the control community water supply was also fluoridated.


Further reading: How fluoride in water helps prevent tooth decay


Since then, consistently we see lower levels of tooth decay associated with water fluoridation, and the most recent evidence, from Australia and overseas, supports this.

The NHMRC review found children and teenagers who had lived in areas with water fluoridation had 26-44% fewer teeth or surfaces affected by decay, and adults had 27% less tooth decay.

A number of factors are likely to influence the variation across populations and countries, including diet, access to dental care, and the amount of tap water people drink.

3. Fluoridated water causes cancer and other health problems

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The NHMRC found, there was reliable evidence to suggest water fluoridation at current levels in Australia of 0.6-1.1 parts per million is not associated with: cancer, Down syndrome, cognitive problems, lowered intelligence, hip fracture, chronic kidney disease, kidney stones, hardening of the arteries, high blood pressure, low birth weight, premature death from any cause, musculoskeletal pain, osteoporosis, skeletal fluorosis (extra bone fluoride), thyroid problems or other self-reported complaints.


Further reading: Why do some controversies persist despite the evidence?


This confirms previous statements from the NHMRC on the safety of water fluoridation, and statements from international bodies such as the World Health Organisation, the World Dental Federation, the Australian Dental Association and the US Centers for Disease Control and Prevention.

Most studies that claim to show adverse health effects report on areas where there are high levels of fluoride occurring naturally in the water supply. This is often more than 2-10 parts per million or more, up to 10 times levels found in Australian water.

These studies are also often not of the highest quality, for example with small sample sizes and not taking into account other factors that may affect adverse health outcomes.

There is, however, evidence that fluoridated water is linked to both the amount and severity of dental fluorosis. This is caused by being exposed to excess fluoride (from any source) while the teeth are forming, affecting how the tooth enamel mineralises.

Most dental fluorosis in Australia is very mild or mild, and does not affect the either the function or appearance of the teeth. When you can see it, there are fine white flecks or lines on the teeth. Moderate dental fluorosis is very uncommon, and tends to include brown patches on the tooth surface. Severe dental fluorosis is rare in Australia.

4. Fluoridated water is not safe for infant formula

Some people are concerned about using fluoridated water to make up infant formula.

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However, all infant formula sold in Australia has very low levels of fluoride, below the threshold amount of 17 micrograms of fluoride/100 kilojules (before reconstitution), which would require a warning label.

Therefore, making up infant formula with fluoridated tap water at levels found in Australian (0.6-1.1 parts per million) is safe, and does not pose a risk for dental fluorosis. Indeed, Australian research shows there is no association between infant formula use and dental fluorosis.

A consistent message

The ConversationAdding fluoride to tap water to prevent tooth decay is one of our greatest public health achievements, with evidence gathered over more than 60 years showing it works and is safe. This latest review, tailored to Australia, adds to that evidence.

Matthew Hopcraft, Clinical Associate Professor, Melbourne Dental School, University of Melbourne

This article was originally published on The Conversation. Read the original article.

Get headaches? Here’s five things to eat or avoid



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Drinking more water can help with headaches.
from http://www.shutterstock.com.au

Clare Collins, University of Newcastle

Last week I had a headache. Two hours in a traffic jam, hot day, no water, plans thrown into chaos. That day I was one of the five million Australians affected by headache or migraine. Over a year one person in two will experience a headache.

Mine was a “tension-type” headache, the most common category. Migraines are less common but about one person in eight will experience one in any given year.

Headaches are really common, so here are five things the research evidence indicates are worth trying to help manage or avoid them.

1. Water

A study was conducted in people who got at least two moderately intense or more than five mild headaches a month. The participants received a stress management and sleep quality intervention with or without increasing their water intake by an extra 1.5 litres a day.

The water intervention group got a significant improvement in migraine-specific quality of life scores over the three months, with 47% reporting their headaches were much improved, compared to 25% of the control group.

However, it did not reduce the number or duration of headaches. Drinking more water is worth a try. Take a water bottle everywhere you go and refill it regularly to remind you to drink more water.

2. Caffeine

Caffeine can have opposing effects. It can help relieve some headaches due to analgesic effects but also contribute to them, due to caffeine withdrawal. A review of caffeine withdrawal studies confirmed that getting a headache was the number one symptom of withdrawal, followed by fatigue, reduced energy and alertness, drowsiness, depressed mood, difficulty concentrating, fuzzy head and others.

When people were experimentally put though controlled caffeine withdrawal, 50% got a headache, with withdrawal symptoms occurring within 12-24 hours, peaking between 20-51 hours and lasting from two to nine days. Caffeine withdrawal can happen from a usual daily dose as low as 100 mg/day. One cup of brewed coffee contains 100-150mg caffeine, instant coffee has 50-100 mg depending on how strong you make it and a cup of tea can vary from 10-90mg. It appears that maintaining usual caffeine consumption may subconsciously relate to avoidance of withdrawal symptoms.

Caffeine can lessen or worsen headaches.
Jonathan Thursfiled/Flickr, CC BY

Caffeine can dampen down pain. in a systematic review that included five headache studies with 1,503 participants with migraine or tension-type headache, 33% of participants achieved pain relief of at least 50% of the maximum possible after receiving 100 mg or more caffeine plus analgesic pain medication (ibuprofen or paracetamol) compared to 25% for the analgesic group alone.

A study in over 50,000 Norwegians, who have high caffeine intakes (more than 400 milligrams a day), examined the relationship with headaches. Those with the highest caffeine intakes (more than 540mg/day) were 10% more likely to get headaches, including migraine.

But when headache frequency was examined, high caffeine consumers were more likely to experience non-migraine headaches infrequently (less than seven per month) compared to those considered low caffeine consumers (less than 240mg a day). This was attributed to potential “reverse causation” where high caffeine consumers use caffeine to damp down headache pain. They found those with the lowest caffeine intakes (125mg a day) were more likely to report more than 14 headaches per month, which may have been due to greater sensitivity and avoidance of caffeine.

Hypnic headaches are a rare type that occurs in association with sleep. They typically last 15-180 minutes and are more common in the elderly. Hypnic headaches are treated by giving caffeine in roughly the amount found in a cup of strong coffee.

3. Fasting

Some people get a headache after fasting for about 16 hours, which equates to not eating between 6pm and 10am the next day. A study in Denmark found one person in 25 has been affected by a fasting headache. These headaches are most likely to occur when fasting for a blood test or medical procedure or if you are following a “fasting” weight loss diet or a very low energy meal replacement diet.

Fasting headaches are likely to be confounded by caffeine withdrawal. Check the test procedure instructions to see what fluids, such as tea, coffee and water are allowed and drink within those recommendations.

In a study 34 people with new-onset migraine who kept a headache diary for about a month, those who ate a night-time snack were 40% less likely to experience a headache compared to those who didn’t snack. For susceptible individuals this may prevent fasting headaches. Try a slice or wholegrain toast with a topping like cheese and tomato or avocado and tuna, with a cuppa.

4. Alcohol

Headache is the classic feature of alcohol induced hangovers. The amount of alcohol needed to trigger a hangover varies widely between individuals, from one drink to many. A number of factors mash up to produce a throbbing post alcohol headache. Increased urination and vomiting both increase risk of dehydration which leads to changes in blood and oxygen flowing to the brain.

Congeners, a group of chemicals produced in small amounts during fermentation, give alcoholic drinks their taste, smell and colour. Metabolites of alcohol breakdown in the liver can cross the blood-brain barrier contributing to hangover.

Alcohol can trigger tension-type headaches, cluster headaches and migraine. People with migraines have been shown to have lower alcohol intakes compared to others.
The wise advice is to drink responsibly, boost your water intake and don’t drink on an empty stomach. If you are sensitive to alcohol, avoidance is your best option.

5. Boost your intake of folate-rich foods

More folate in your diet helps migraines.
ahmadpi/flickr, CC BY

Some migraineurs are diet-sensitive. Triggers include cheese, chocolate, alcohol or other specific foods. A recent study found women with low dietary folate intakes had more frequent migraines. However a daily folic acid (1mg) supplement made no difference.

The ConversationBoost your intake of foods rich in folate such as green leafy vegetables, legumes, seeds, chicken, eggs and citrus fruits. Use our Healthy Eating Quiz to check your nutrition, diet quality and variety. Keep a headache diary to identify triggers and then discuss it with your GP.

Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle

This article was originally published on The Conversation. Read the original article.

Taxing sugary drinks would boost productivity, not just health



File 20170620 22151 8jzq1m
Taxing sugary drinks to tackle obesity would lead to a stronger economy, new research shows.
from www.shutterstock.com

Lennert Veerman, Cancer Council NSW

Many studies have looked at the potential benefits of a sugar tax in
terms of the longer, healthier lives and reduced health expenditure associated with tackling obesity.

But our new study goes one step further. It predicts that higher taxes on sugar-sweetened drinks will benefit the wider economy through increased economic productivity, by having more, healthier people in paid and unpaid work.

Obesity delivers a double whammy

A total of 63% Australian adults and one in four children are overweight or obese, making this both a health and an economic problem.

Obesity increases the risk of diseases including cancer, diabetes, heart disease and stroke. Obesity has also been estimated to cost Australia about A$8.6 billion a year or more. Not only does obesity drive up health-care costs, by causing illness and premature death, it also reduces people’s ability to work and contribute to the economy.

Added sugar contributes energy to the diet, but no useful nutrients. Increasingly, health experts suggest we should be treating sugar, and in particular sugar in soft drinks, as we do tobacco or alcohol, by taxing it to reduce consumption and so reduce obesity rates.

Taxing sugar is not a new concept. In the 1700s, Scottish economist Adam Smith wrote in An Inquiry into the Nature and Causes of the Wealth of Nations:

Sugar, rum, and tobacco, are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.

Smith’s proposal to tax sugar was not aimed at improving health, as it is today. Now organisations like the World Health Organisation, the Australian Medical Association and many non-governmental organisations are advocating a tax on drinks with added sugar, as part of wider efforts to tackle obesity.

What we did and what we found

Until our study, few worldwide had looked at the wider economic effects of taxing sugary drinks.

We modelled the Australian adult population as it was in 2010, in terms of consumption of sugar-sweetened drinks, body mass, obesity-related diseases, death rates, and the amount of paid or unpaid work people were likely to do.

We compared a scenario in which the prices of sugared drinks went up by 20%, compared to business-as-usual, and estimated what difference this would make for the number of obese people, the number of years lived, and for overall economic production.


Further reading: Dietary guidelines don’t work. Here’s how to fix them


We used data from the 2011-12 Australian Health Survey and found that obese people aged 15-64 had a lower chance of being in a paid job, compared to people whose weight was normal. We assumed this was related to illness.

Of people in work, obese workers needed more sick leave, but only about an hour a year.

We also looked at unpaid work (like cooking, cleaning and caring, and volunteer work). We included gains due to more people surviving for longer due to lower body weight. We assumed that if work was not done as unpaid work, somebody would have to be hired to do it (so there would be a replacement cost).

Our results show that a 20% sugar tax would mean about 400,000 fewer people would be obese. Three-quarters of these would be in the workforce, so that about 300,000 fewer employed people would be obese.


Further reading: Australian sugary drinks tax could prevent thousands of heart attacks and strokes and save 1,600 lives


Over the lifetime of the adult population of Australia in 2010, this would add about A$750 million to the formal, paid economy, due to more, healthier people producing more goods and services.

The gains in unpaid work were even larger at A$1.17 billion. Fewer obese people means more healthy people, who have a greater likelihood to do unpaid work, in the household or as volunteers.

These indirect economic benefits from increased employment in the workforce and from greater participation in unpaid work were larger than the savings in health care costs, which we estimated at about A$425 million over the lifetime of the adult population.

In all, the tax could deliver over A$2 billion in economic benefits in indirect economic benefits plus health care savings. And that does not even include the value of the gains in people’s quality of life and how long they lived.


Further reading: Fat nation: the rise and fall of obesity on the political agenda


The exact size of the benefits depend on assumptions about what people would drink (and eat) if they drink fewer sugared drinks. In this study, we used Australian evidence that found an increase only for diet drinks, which contain virtually no energy.

Other evidence finds a sugar tax reduces the consumption of sugar and energy-rich foods, but may also lead to people eating fewer fruit and vegetables and more salt. This would reduce the health benefit, and that study suggests it would be even better to tax all sugar instead of only sugared drinks.

Nevertheless, the available evidence shows health benefits of increased taxation of sugared drinks.

What’s happening overseas?

Studies in other countries have predicted similar effects of a sugar tax on the proportion of obese people. For example, a 20% tax is expected to reduce the number of obese people by about 1.3% in the UK and 2-4% in South Africa.

And an increasing number of countries, including the UK, France, Denmark, Finland, Hungary and recently Estonia and Saudi Arabia, have already announced or have implemented a tax on drinks with added sugar.

If Australia introduces a 20% tax on sugar-sweetened drinks, as many health advocates and economists have called for, that would not only improve health, our results predict it would also promote economic growth.


The ConversationThe author of this article will be available for a live Q&A today 1-2pm. Please post your questions in the comments below.

Lennert Veerman, Senior health economist, Cancer Council NSW

This article was originally published on The Conversation. Read the original article.