Health Check: what’s the right way to blow your nose?



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One nostril or two? Hard blow or gentle? Some ways are more effective and less risky than others.
from www.shutterstock.com

David King, The University of Queensland

If you have a blocked or runny nose, chances are you’ll reach for a tissue or hanky to clear the mucus by having a good blow.

But is there a right way to blow your nose? Could some ways make your cold worse? And could you actually do some damage?

The three most common reasons for extra mucus or snot are the common cold, sinusitis (infection or inflammation of the sinuses, the air-filled spaces inside the face bones) and hay fever. Each of these conditions cause the lining in the nose to swell up, and to produce extra mucus to flush away infection, irritants or allergens.

Both the swelling and extra mucus lead to nasal congestion. This is when the narrowed passages increase the effort of breathing through the nose. Clearing the mucus by blowing the nose should reduce this congestion somewhat.

At the beginning of colds and for most of the time with hay fever, there’s lots of runny mucus. Blowing the nose regularly prevents mucus building up and running down from the nostrils towards the upper lip, the all-too-familiar runny nose.

Later in colds and with sinusitis, nasal mucus can become thick, sticky and harder to clear.


Further reading: Health Check: what you need to know about mucus and phlegm


Think of “snotty nosed kids”, in particular infants or toddlers who haven’t yet learnt to coordinate the mechanics of blowing their noses. They tend to repeatedly sniff thick mucus back into their nose or allow it to dribble down their upper lip.

Keeping this mucus (rather than blowing it out) is thought to contribute to a cycle of irritation that causes the snotty nose to persist for weeks or longer.

This may be due to the retained mucus acting as a good “home” for bacteria to grow in, as well as fatigue of the “hairs” (cilia) that cleanse the nose by moving along mucus and carrying with it irritants, inhaled debris and bacteria.

Thick retained mucus is also more likely to be transported to the throat rather than gravity working it from the nostrils, leading to throat irritation and possibly a cough. This is the mechanism behind the most common cause of prolonged cough after a viral infection or hay fever, known as the post-nasal drip cough.

So it makes sense to encourage people to blow their nose to remove unwanted mucus.

Rare risks if you blow too hard and too often

Although extremely rare, there are a few examples in the medical literature of people blowing so hard they generated pressures high enough to cause serious damage. In most of these cases people had underlying chronic sinusitis or an existing weakness in the structure they damaged after blowing too hard.

These injuries included fractures of the base of the eye socket; air forced into the tissue between the two lobes of the lung; severe headache from air forced inside the skull; and rupture of the oesophagus, the tube that sends food to the stomach.

One study looked at the pressures generated when people with and without a range of nasal complaints blew their noses.

People with chronic sinusitis generated pressures significantly higher than people without a nasal complaint, up to 9,130 Pascals of pressure. They also found blowing by blocking both nostrils generated much higher pressures than blowing with one nostril open.

One study showed how blowing your nose hard could send mucus from the nose into the sinuses, potentially infecting them too.
www.shutterstock.com

Another study comparing pressures from nose blowing, sneezing and coughing found pressures generated during blowing were about ten times higher than during the other two activities.

More worrying was their second finding – viscous fluid from the nose had found its way into the sinus cavities after vigorous nose blowing. The researchers said this could be a mechanism for sinus infection complicating some colds, with the introduction of nasal bacteria to the sinuses. But they did not produce evidence for this.

On balance it seems repeated and vigorous blowing of the nose may carry more risk than benefit, even though it seems to be a natural response to nasal congestion.

Can I take anything to stop the snot?

So looking to remove the need to blow so forcefully is probably a better option.

Decongestants and antihistamines, which you can buy without prescription from pharmacies, reduce both nasal congestion and the volume of mucus.

Decongestants contain ingredients like oxymetazoline and phenylephrine and come in tablets or sprays, and are often included in cold and flu tablets. They work by constricting (narrowing) dilated blood vessels in the inflamed lining of the nose, and decreasing the volume of mucus produced.

While decongestant sprays are effective, they are probably underused due to concerns about nasal congestion when you stop taking them after long-term use (rhinitis medicamentosa). But further studies have questioned this increased risk.

Antihistamines treat nasal congestion associated with hay fever, but may be less effective for treating cold symptoms.

Saline nasal sprays and washes can help.
from www.shutterstock.com

Saline nose sprays have some evidence they work for acute and chronic rhinosinusitis (inflammation of the nasal lining and sinuses), and can reduce the need for medications. They are believed to clear mucus through increasing the effectiveness of the cilia as well as diluting thick and sticky mucus.

A related technique, known as nasal aspiration, is when you squirt liquid saline up the nose with a special medical device to flush out mucus and debris from the nose and sinuses. One study found it lowered the risk of developing acute otitis media (inflammation of the middle ear) and rhinosinusitis.

What’s the verdict?

If you have mucus in the nose, it is probably best to get it out, so blow gently or by clearing one nostril at a time. Use of appropriate treatments can lessen the need to blow, and the force required to clear your nose.

If you are repeatedly blowing your nose you probably have a nasal condition, like hay fever or sinusitis, which should be treated more comprehensively.

The ConversationAnd if you see a snotty-nosed kid, please wipe away the mucus discharge for the benefit of all.

David King, Senior Lecturer, The University of Queensland

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

Therapy for life-threatening eating disorders works, so why can’t people access it?



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Eating disorders are among the leading causes of hospitalisation for mental-health-related issues in Australia.
from shutterstock.com

Richard Newton, University of Melbourne

Eating disorders are complex mental illnesses that have one of the highest death rates of any psychiatric disorder. Among people with anorexia nervosa – who commonly deprive themselves of food due to an obsessive fear of gaining weight – this rate is more than five times greater than in the general population. The Conversation

All eating disorders are associated with significant, wide-ranging physical health complications such as starvation, cardiac arrest (sudden loss of heart function), kidney problems, food intolerance and fits. These are among the leading causes of hospitalisation for mental-health-related issues in Australia.

Because serious medical complications so frequently accompany eating disorders, they defy classification solely as mental illnesses. They should be viewed as complex health-care issues requiring urgent and multidisciplinary care.

Yet many health-care providers have not been provided with enough basic education and training to be able to recognise and respond appropriately to someone presenting with an eating disorder. So despite their severity, eating disorders often go unrecognised.

This leads to substantial economic costs for the Australian health system and devastating effects for sufferers, loved ones and the communities that surround them.

What are eating disorders?

Eating disorders have been around through recorded history. Even an ancient Egyptian tomb painting depicts a noble self-inducing vomiting.

There are several types of eating disorders. These include anorexia nervosa, bulimia nervosa and binge eating disorder. Collectively, these are characterised by abnormal eating behaviours, poor body image, overemphasis on weight and shape, and extreme weight-control behaviours.

In the case of anorexia, such behaviours lead to severe weight loss and often life-threatening complications. Vomiting, laxative abuse and excessive exercise can be features of both anorexia and bulimia, as can binging and purging.

Unlike the severe weight loss associated with anorexia, bulimia is characterised by the presence of binging and usually purging at a relatively normal weight. Binge eating disorder features frequent binging, in the absence of purging or other compensatory behaviours, which often leads to significant weight gain.

Eating disorders are also commonly accompanied by low self-esteem, guilt and disgust, along with depression, severe anxiety and suicide risk.

Who gets eating disorders?

There are psychological, environmental and biological (including genetic) risk factors for developing eating disorders. A genetic predisposition in combination with poor body image is one of the strongest predictors of disordered eating.

Poor body image has been reported in nearly half of Australian women and over one-third of Australian men. Disturbingly, the rate of body-image concerns is even greater in children and adolescents. A study of Australian children found up to 61% of girls and boys between the ages of eight and 11 are trying to control their weight.

Around 10% of the Australian population will experience an eating disorder in their lifetime, and the rate is increasing. For example, one study observed a two-fold increase in disordered eating between 1995 and 2005 in South Australia. And a more recent study in the same state observed a more than two-fold increase in extreme dieting and binge eating between 1998 and 2008.

While the reasons for this increase have not yet been fully explored, they may be related to increasing concerns about weight in the general Australian population.

Contrary to the long-held belief eating disorders are the domain of wealthy young females, the greatest increase has been observed in older people, males and those in lower socio-demographic groups.

This may be due, at least in part, to inadequate access to treatment, differences in people seeking treatment, or detection in under-represented groups, and stigma surrounding the development of a disorder commonly associated with a specific (different) group in the community.

How are they treated?

A number of evidence-based treatments are available for eating disorders. It is important to note that no single approach will be effective for all individuals.

People who are unable to access effective treatment early experience greater duration and severity of illness. They then need more complex, prolonged treatment.

Structured, psychological therapies are considered the cornerstone of treatment for eating disorders. For adolescents with anorexia, this takes the form of family-based therapy. This involves helping the whole family support the person with the disorder.

In adults with eating disorders, evidence shows a minimum of 20 sessions of cognitive behaviour therapy (CBT) – which challenges learnt ways of thinking – is necessary. In severe cases of anorexia, at least 40 CBT sessions that include a strong emphasis on restoring healthy eating attitudes and behaviours are required.

A multidisciplinary team is best equipped to address the complex nutritional, medical and psychological needs of someone with anorexia.

Increasing funding to improve outcomes

The total social and economic costs of eating disorders in Australia exceed A$69 billion per year. These costs can be reduced with early detection.

Most people with eating disorders go a long time before receiving adequate care. One study of over 10,000 adolescents found that, while nearly 90% of those with an eating disorder contacted a service provider for help, in only a minority (3-28%) of cases were the services specifically for their eating disorder.

Factors such as denial, shame, stigma and a lack of recognition of eating disorder symptoms by health-care professionals are likely contributors to this discrepancy.

Medicare provides Australians with funding for ten sessions with an allied mental-health professional (such as a psychologist or social worker). This is below the minimum treatment recommendation of 20 sessions for all eating disorders.

We should not accept a system that prevents people with a severe life-threatening mental illness from accessing a treatment that is available, effective and will save costs in the long term.

Federal Health Minister Greg Hunt recently requested the Medicare Benefits Schedule Review Taskforce investigate increasing Medicare coverage to treat people with an eating disorder. We urgently need early identification of eating disorders and the delivery of quality, targeted treatments at evidence-supported durations.

This article was co-authored by Tina Peckmezian, Principal Research Officer at The Butterfly Foundation.


If this article has raised concerns for you or anyone you know, call Lifeline 13 11 14, Suicide Call Back Service 1300 659 467 or Kids Helpline 1800 55 1800.

People with eating disorders or their families can get help at the Butterfly Foundation, 1800 33 4673, or The National Eating Disorders Collaboration.

Richard Newton, Associate Professor, University of Melbourne

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

Food as medicine: how what you eat shapes the health of your lungs



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Shifting your diet away from processed foods and towards fruits and vegetables can reduce symptoms of asthma.
from www.shutterstock.com

Lisa Wood, University of Newcastle

This article is part of a three-part package “food as medicine”, exploring how food prevents and cures disease. Read other articles in the series here. The Conversation


We all understand that eating too much of the wrong foods – those that are high in energy and low in nutrients, such as fast foods, processed foods and takeaways – causes weight gain and can lead to obesity. These foods are often high in saturated fat, refined carbohydrates (or sugars) and sodium, which increase the risk of developing diabetes, heart disease and some cancers.

But eating poorly has other, somewhat more surprising ramifications. Recently we have come to understand that unhealthy eating patterns can affect our lungs. Switching your diet to one rich in fruit and vegetables could help you breathe easier.

Healthy diets and healthy lungs

Most of the epidemiological evidence linking diet with lung function has focused on chronic obstructive pulmonary disease (COPD). Linked to smoking, COPD causes progressive lung deterioration and asthma.

Several large studies have observed people over time, and found that an unhealthy eating pattern (including refined grains, cured and red meats, desserts and French fries) increases the risk of lung function decline and COPD onset, compared to a healthy eating pattern (including fruit, vegetables, fish and wholegrains).

A recent study followed more than 40,000 men for 13 years, and found a high fruit and vegetable intake was associated with reduced risk of COPD. Current and ex-smokers eating five or more serves a day of fruit and vegetables were 30 to 40% less likely to develop COPD compared to those eating fewer than two serves per day.

A three year study in patients with existing COPD revealed those consuming a high fruit and vegetable diet had an improvement in lung function.

In asthma, there is evidence westernised diets, fast foods and processed foods increase the risk of asthma attacks, lung function decline, wheeze and breathlessness.

We have tested the effect of a high fruit and vegetable diet in asthma sufferers over three months. We found people consuming seven or more servings of fruit and vegetables per day had a reduced risk of asthma attacks, compared to people who consumed a low fruit and vegetable diet (fewer than three servings per day).

Another intervention study in asthma used a diet originally designed to reduce high blood pressure – the Dietary Approaches to Stop Hypertension (DASH) diet – for six months. One of the DASH dietary goals was to consume seven to 12 servings of fruit and vegetables, as well as two to four servings of low-fat/fat-free dairy products, and limiting daily fat and sodium intake. This led to improvements in asthma control and quality of life.

How do fruit and vegetables improve lung health?

People with respiratory diseases such as COPD and asthma typically suffer from inflamed airways. The airway tissue becomes swollen and hypersensitive, excess mucus is produced and the breathing tubes become damaged, sometimes irreversibly. The resulting narrowing of the airways makes it difficult for air to pass in and out of the lungs.

Failure to breathe freely can very quickly become life threatening. Restricted airflow can also have a debilitating effect on day-to-day activities, causing symptoms such as coughing, wheezing, breathlessness and chest tightness in people with asthma and COPD.

Fruit and vegetables are a rich source of several nutrients, in particular soluble fibre and antioxidants, that have been shown to reduce inflammation in the airways.

Dietary fibre reduces lung inflammation

Dietary fibre exists in soluble and insoluble forms. Soluble fibre is fermented by gut bacteria to produce short chain fatty acids. These can bind to specific receptors on the surface of immune cells, which suppress airway inflammation. We have shown a single dose of soluble fibre activates these receptors and reduces inflammation in human airways within just four hours.

Short chain fatty acids can also inhibit expression of the genes that cause airway inflammation, through a process known as epigenetic modification. So a high soluble-fibre intake has the potential to protect against airway inflammation through both activation of anti-inflammatory immune receptors, and inhibition of genes controlling inflammation.

Antioxidants are also anti-inflammatory

Antioxidants present in fruit and vegetables – such as vitamin C, carotenoids and flavonoids – are also beneficial, as they can protect against the damaging effects of free radicals, which are highly reactive molecules produced by activated inflammatory cells that can damage asthmatic airways. Many observational studies have linked antioxidants with lung health.

However, data from antioxidant supplementation trials in asthma are not convincing. Few studies show a beneficial effect, likely due to the use of individual nutrients. Multiple antioxidants exist together in fruit and vegetables, which have interdependent roles that are likely to be critical for their protective effects. So dietary modifications using whole fruit and vegetables is a better strategy.

Sometimes we can become overwhelmed by the nutrition messages in the media, which tell us to eat this and not eat that. Sometimes the advice seems contradictory and confusing. So here is a very simple and focused message for people with respiratory disease – eat more fruit and vegetables!

There’s really nothing to lose and everything to gain. As well as helping to maintain or achieve a healthy weight and reducing the risk of heart disease, diabetes and cancer, you will also be improving your lung health.


Further reading:

Food as medicine: why do we need to eat so many vegetables and what does a serve actually look like?

Food as Medicine: your brain really does want you to eat more veggies

Lisa Wood, Professor, University of Newcastle

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

Food as medicine: your brain really does want you to eat more veggies



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Diet reduces risk of depression through actions on bacteria in the gut, the immune system and the brain.
from www.shutterstock.com

Felice Jacka, Deakin University

This article is part of a three-part package “food as medicine”, exploring how food prevents and cures disease. Read other articles in the series here. The Conversation


As well as our physical health, the quality of our diet matters for our mental and brain health. Observational studies across countries, cultures and age groups show that better-quality diets – those high in vegetables, fruits, other plant foods (such as nuts and legumes), as well as good-quality proteins (such as fish and lean meat) – are consistently associated with reduced depression.

Unhealthy dietary patterns – higher in processed meat, refined grains, sweets and snack foods – are associated with increased depression and often anxiety.

Importantly, these relationships are independent of one another. Lack of nutritious food seems to be a problem even when junk food intake is low, while junk and processed foods seem to be problematic even in those who also eat vegetables, legumes and other nutrient-dense foods. We’ve documented these relationships in adolescents, adults and older adults.

Diet has an impact early in life

The diet-mental health relationship is evident right at the start of life. A study of more than 20,000 mothers and their children showed the children of mothers who ate an unhealthier diet during pregnancy had a higher level of behaviours linked to later mental disorders.

We also saw the children’s diets during the first years of life were associated with these behaviours. This suggests mothers’ diets during pregnancy and early life are both important in influencing the risk for mental health problems in children as they grow.

This is consistent with what we see in animal experiments. Unhealthy diets fed to pregnant animals results in many changes to the brain and behaviour in offspring. This is very important to understand if we want to think about preventing mental disorders in the first place.

Teasing out the cause from the correlation

It’s important to note that, at this stage, most of the existing data in this field come from observational studies, where it is difficult to tease apart cause and effect. Of course, the possibility that mental ill health promoting a change in diet explains the associations, rather than the other way around, is an important one to consider.

What comes first, the junk food or the depression?
from shutterstock.com

Many studies have investigated this and largely ruled it out as the explanation for the associations we see between diet quality and depression. In fact, we published a study suggesting that a past experience of depression was associated with better diets over time.

But the relatively young field of nutritional psychiatry is still lacking data from intervention studies (where study participants are given an intervention that aims to improve their diet in an attempt to affect their mental health). These sorts of studies are important in determining causality and for changing clinical practice.

Our recent trial was the first intervention study to examine the common question of whether diet will improve depression.

We recruited adults with major depressive disorder and randomly assigned them to receive either social support (which is known to be helpful for people with depression), or support from a clinical dietitian, over a three-month period.

The dietary group received information and assistance to improve the quality of their current diets. The focus was on increasing the consumption of vegetables, fruits, wholegrains, legumes, fish, lean red meats, olive oil and nuts, while reducing their consumption of unhealthy “extra” foods, such as sweets, refined cereals, fried food, fast food, processed meats and sugary drinks.

The results of the study showed that participants in the dietary intervention group had a much greater reduction in their depressive symptoms over the three months, compared to those in the social support group.

At the end of the trial, 32% of those in the dietary support group, compared to 8% of those in the social support group, met criteria for remission of major depression.

These results were not explained by changes in physical activity or body weight, but were closely related to the extent of dietary change. Those who adhered more closely to the dietary program experienced the greatest benefit to their depression symptoms.

While this study now needs to be replicated, it provides preliminary evidence that dietary improvement may be a useful strategy for treating depression.

Depression is a whole-body disorder

It’s important to understand researchers now believe depression is not just a brain disorder, but rather a whole-body disorder, with chronic inflammation being an important risk factor. This inflammation is the result of many environmental stressors common in our lives: poor diet, lack of exercise, smoking, overweight and obesity, lack of sleep, lack of vitamin D, as well as stress.

Many of these factors influence gut microbiota (the bacteria and other microorganisms that live in your bowel, also referred to as your “microbiome”), which in turn influence the immune system and – we believe – mood and behaviour.

In fact, gut microbiota affect more than the immune system. New evidence in this field suggests they are important to almost every aspect of health including our metabolism and body weight, and brain function and health. Each of these factors is relevant to depression risk, reinforcing the idea of depression as a whole-body disorder.

What is the human microbiome?

If we do not consume enough nutrient-dense foods such as fruits, vegetables, fish and lean meats, this can lead to insufficiencies in nutrients, antioxidants and fibre. This has a detrimental impact on our immune system, gut microbiota and other aspects of physical and mental health.

Gut microbiota are particularly reliant on an adequate intake of dietary fibre, while the health of the gut may be compromised by added sugars, fats, emulsifiers and artificial sugars found in processed foods.

A diet high in added fats and refined sugars also has a potent negative impact on brain proteins that we know are important in depression: proteins called neurotrophins. These protect the brain against oxidative stress and promote the growth of new brain cells in our hippocampus (a part of the brain critical for learning and memory, and important to mental health). In older adults we have shown that diet quality is related to the size of the hippocampus.

Now we know diet is important to mental and brain health as well as physical health, we need to make healthy eating the easiest, cheapest and most socially acceptable option for people, no matter where they live.


Further reading:

Food as medicine: why do we need to eat so many vegetables and what does a serve actually look like?

Felice Jacka, Principal Research Fellow, Deakin University

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