Research Check: is white meat as bad for your cholesterol levels as red meat?



Whether you’re eating red meat or white meat, a lean cut is the healthier way to go.
From shutterstock.com

Clare Collins, University of Newcastle

You’ve probably heard eating too much fatty red meat is bad for your health, while lean meat and chicken are better choices. So, recent headlines claiming white meat is just as bad for your cholesterol levels as red meat might have surprised you.

The reports were triggered by a paper published in the The American Journal of Clinical Nutrition earlier this month.

The study did find lean white meat had the same effect on cholesterol levels as lean red meat. While this might be construed as good news by lovers of red meat, more research on this topic is needed for a clearer picture.

How was this study conducted?

The researchers set out to compare three diets: one where the main dietary source of protein came from eating red meat (beef and pork), another where it came from poultry (chicken and turkey), and a third where it came from plant foods (legumes, nuts, grains and soy products).

They wanted to measure the impact of these diets on specific categories of blood fats, as markers of heart disease risk. They tested blood fat markers including low density lipoprotein cholesterol (or LDL, commonly known as “bad cholesterol”), apolipoprotein B (apoB), and the ratio of total cholesterol to high density lipoprotein cholesterol (or HDL, commonly known as “good cholesterol”).




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How to get the nutrients you need without eating as much red meat


The researchers also wanted to know whether blood fat levels changed more when the background dietary patterns were high in saturated fat, derived mostly from full-fat dairy products and butter, or when they were low in saturated fat.

To achieve this, 177 adults with blood cholesterol levels in the normal range were randomised to follow either a high-saturated fat diet (14% of total energy intake) or a low-saturated fat diet (7% of total energy intake).

Within these two groups they were further randomly assigned to follow three separate diets for four weeks each: red meat, white meat, and plant protein sources. The main protein sources in the meat groups came from lean cuts of red and white meat. In the plant diet, protein came from legumes, nuts, grains and soy products.

Participants met research staff weekly to collect their food products and received counselling on following their specified diet. Participants were asked to maintain their physical activity level and keep their weight as stable as possible so these factors did not bias the results.

To eliminate any carry-over effects from eating one type of protein to the next, participants were given between two and seven weeks break in between each diet and told to return to their usual eating patterns.




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Organic, grass fed and hormone-free: does this make red meat any healthier?


What did the study find?

Some participants dropped out along the way, so in the end researchers had results from 113 participants.

Blood concentrations of LDL cholesterol and apoB were lower following the plant protein diet period, compared to both the red and white meat periods. This was independent of whether participants were on a background diet of high- or low-saturated fat.

There was no statistically significant difference in the blood fat levels of those eating red meat compared to those eating white meat.

We’re often told to limit our consumption of red meat.
From shutterstock.com

Eating a diet high in saturated fat led to significant increases in blood levels of LDL cholesterol, apoB, and large LDL particles compared with a background diet low in saturated fat.

So, all the dietary protein sources as well as the level of saturated fat intake had significant effects on total cholesterol, LDL cholesterol, non-HDL cholesterol, and apoB levels.

How should we interpret the results?

Although the test diets only lasted four weeks each, this study is important. It’s rare to see intervention studies that directly compare eating different types of meat and sources of protein and the impact on heart-disease risk factors. This is partly due to the challenge and expense of providing the food and getting people to follow specific diets.

Most studies to date have been cohort studies where people are categorised based on what they eat, then followed up for many years to see what happens to their health.

One review of cohort studies found no greater risk of stroke in those who eat more poultry compared to less poultry, while another showed a higher risk of stroke among those eating more red and processed meat relative to poultry intake.




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There are a few things to keep in mind with this study. First, the researchers used the leanest cuts of both red and white meats, and removed all visible fat and skin. If participants were eating fatty meat, we may have seen different results.

The significant variation in breaks between different diets (ranging from two to seven weeks) may have also affected the results. Participants with a longer break would have had more time for their blood cholesterol levels to change, compared to those with shorter breaks.

Finally, in reporting their results, it would have been better to include all 177 participants who began the study. People who drop out often have different health characteristics and leaving them out may have biased results.

This short-term study does not provide evidence that choosing lean white meat over red meat is either better or worse for your health.

But the findings are consistent with recommendations from the Heart Foundation to include a variety of plant-based foods in our diets, foods containing healthy types of fat and lower amounts of saturated fat, and in particular, to choose lean red meat and poultry. – Clare Collins


Blind peer review

The article presents a fair, balanced and accurate assessment of the study. In this study, they showed lean red meat and lean white meat (with all visible fat and skin removed) had the same effect on blood fat levels.

Importantly, plant protein sources (such as legumes, nuts, grains and soy products) lowered blood fat levels compared to the red and white meats, and this was independent of whether the participants had been placed on a background diet low or high in saturated fats. This study did not look at the impact of a fish-based diet on blood fats. – Evangeline Mantzioris




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Three charts on: Australia’s declining taste for beef and growing appetite for chicken


Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.The Conversation

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

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Sick with the flu? Here’s why you feel so bad



You might feel terrible. But your runny nose, sore throat and aches are signs your body is fighting the flu virus. And that’s a good thing.
from www.shutterstock.com

Stephen Turner, Monash University

“You never forget the flu”. This is the title of the Victorian health department’s current campaign, which highlights people’s recollections of having the flu.

‘The flu knocked me out for weeks’, part of the Victorian health department’s winter flu campaign.
Vic Dept Health & Human Services

Phrases include “I’ll never forget the pain of the fever”, “the flu flattened me”, “the flu knocked me out for weeks”.

This gives the impression that when you have the flu, you know you have it. What makes the flu so memorable is the severe symptoms. These include fever, aches and pains, a sore throat, runny nose, cough, and feeling weak and lethargic.

But what causes the flu? And why are the symptoms so severe?




Read more:
Health Check: how long should you stay away when you have a cold or the flu?


What causes the flu?

Influenza is caused by a virus, a small microbe that needs to enter our cells to replicate and produce more viruses. The influenza virus infects cells that line our airways and so is easily transmitted via the spread of droplets released when we sneeze or cough.

Coughs, sneezes and the other symptoms we feel after getting the flu, are largely due to our bodies fighting the infection.




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I’ve always wondered: why is the flu virus so much worse than the common cold virus?


The immune response is a double-edge sword

When you are infected with the flu virus, your innate immune system kicks in. Special receptors recognise unique parts of the virus, triggering an alarm system to alert our bodies that an infection is under way.

This produces a rapid but non-specific response — inflammation.




Read more:
Explainer: what is the immune system?


Inflammation results from the action of small proteins called cytokines. A primary role of cytokines is to act locally in the lung to help limit the initial infection taking hold.

They can also make their way into the circulation, becoming systemic (widespread in the body) and act as a “call to arms” by alerting the rest of the immune system there is an infection.

Unfortunately, your body’s inflammatory response, while trying to fight your infection, results in the flu symptoms we experience.

Inflammation can trigger increased mucus production. Mucus (or phlegm) is a sticky substance that helps capture virus in the lungs and upper airways. The increased amount of mucus in the airways can trigger coughing and/or sneezing, and can lead to a runny nose. This helps expel the virus from our body before it can infect other airway cells.




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


Inflammation also results in an increase in body temperature or fever, which creates an inhospitable environment for the flu virus to replicate.

While an increased body temperature helps fight the infection, it also results in you feeling colder than usual. That’s because you feel a greater temperature difference between your body and the outside environment.

This can induce rapid muscle contractions in an effort to heat you up. This is why you can feel like you can’t stop shivering while at the same time burning up.




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Monday’s medical myth: feed a cold, starve a fever


Finally, some of these inflammatory molecules act directly on infected cells to stop the virus replicating. They can do this by either interfering with the replication process directly, or alternatively, by actually killing the infected cell.

One of these factors is tumour necrosis factor alpha (TNF-alpha). While its actions limit where the flu virus can replicate, its side effects include fever, loss of appetite and aching joints and muscles.

Calling in the big guns

Inflammation induced by the innate response also helps alert the adaptive immune system that there is an infection.

While innate immunity provides an immediate, albeit non-specific, response to viral infection, it is the adaptive immune response that can efficiently clear the infection.

The adaptive immune system consists of specialised white blood cells called T and B cells that when activated provide a highly specific response to infection.

Your flu symptoms are likely the result of your body fighting off infection with the the tiny flu virus.
from www.shutterstock.com

Activation of flu-specific T and B cells in tissues called lymph nodes results in the generation of hundreds of thousands of clones, all specific for the flu virus. These can migrate into the lungs and specifically target the virus and its ability to replicate.

This enormous expansion of T and B cell numbers in response to infection results in swelling of the lymph nodes, which you can feel under your armpits or chin, and which can become sore.

Flu-specific T cells are also a source of the inflammatory molecule TNF-alpha and help fight influenza infection by killing off virus-infected cells. Both actions can contribute to the flu symptoms.

Why can flu become a serious problem?

Our ability to see off a flu infection requires a coordinated response from both our innate and adaptive immune responses.

If our immune system function is diminished for some reason, then it can prolong infection, lead to more extensive damage to the lung and extended symptoms. This can then result in secondary bacterial infections, leading to pneumonia, hospitalisation and eventually death.

Then there are people whose immune system doesn’t work work so efficiently who are particularly susceptible to the flu and its complications. These include:

  • the very young, whose immune system is still yet to mature
  • the elderly, whose immune system function wanes with age
  • people with other conditions where immune function might be compromised, or be taking medication that might suppress the immune system.

Preventing the flu

Washing your hands and covering your mouth when coughing and sneezing are simple things we can all do to reduce the chance of catching the flu in the first place.

And getting the flu vaccine activates your adaptive immune response to induce the sort of immunity efficient at protecting us from infection.

With the flu season well under way, prevention is our best bet that you won’t be saying “Remember the time I got the flu”.




Read more:
What the flu does to your body, and why it makes you feel so awful


The Conversation


Stephen Turner, Professor, viral immunology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We’re not just living for longer – we’re staying healthier for longer, too



Improvements in heart health accounted for more than half of the improvements in our overall health.
From shutterstock.com

John Goss, University of Canberra

In the 12 years to 2015, life expectancy in Australia increased by 2.3 years for men (to 80.4) and 1.6 years for women (to 84.6). Our health-adjusted life expectancy increased along with it – by two years for men (to 71.5) and 1.3 years for women (to 74.4).

Health-adjusted life expectancy estimates the number of full health years people can expect to experience over the course of their lives. By comparing this measure to life expectancy, we can see whether longer life expectancy is accompanied by more years lived in full health.

Pleasingly, these trends show we’re not just living for longer – but we’re staying healthy for longer, too.




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Health Check: why do women live longer than men?


In the Australian Burden of Disease study, released today, the Australian Institute of Health and Welfare has mapped the impact and causes of illness and death in Australia between 2003 and 2015.

The improvement in health-adjusted life expectancy alongside life expectancy in the last 12 years builds on continual improvements in life expectancy seen in Australia over several decades.

These improvements in our health can be accorded to advancements in science and medicine, and certain changes we’ve made in our lifestyles. But there’s still plenty of room to do better.

How have we achieved this?

Some 89% of the health improvement between 2003 and 2015 was due to improvements in heart health, reductions in cancer, and improved infant health.

Health improvement refers to reductions in the burden of disease, measured in disability adjusted life years (DALYs). DALYs take into account premature death as well as the burden of illness and disability caused by disease and injury.

Heart disease and stroke

In the period from 2003 to 2015, there was a 36% reduction in the age-standardised burden of disease due to heart disease and stroke. Improvements in heart health accounted for 56% of the overall improvement in health.

The vast majority of the reduction in the cardiovascular disease burden has been due to reductions in smoking, high blood pressure and high cholesterol. Some of the improvement is due to better treatment (for example, surgical interventions like stent insertions).

We’ve been seeing strong progress in this area over many years. The chance of dying from heart disease or stroke is now one sixth of what it was in 1970.




Read more:
How Australians Die: cause #1 – heart diseases and stroke


Cancer and infant health

The reduction in the burden of disease from cancer, which accounted for 25% of the improvement in health, has been partly due to the reduction in risk factors such as smoking. Prevention through screening has also played an important role.

But improved treatment, in the form of drugs, radiation and surgery, has been the most important factor. Five year survival rates for cancer increased from 50% in 1986-1990 to 69% in 2011-2015.

Reductions in the burden of disease due to infant and congenital conditions accounted for 8% of the improvement in health between 2003 and 2015. This was due to improved treatment of infants with congenital conditions and better prevention of problems such as sudden infant death syndrome (SIDS).

Advances in medicine – both prevention and treatment of disease – contribute to Australians living longer than they used to.
From shutterstock.com

Managing our risk factors is key

Overall, reductions in risk factors has been responsible for 51% of the health improvement we’ve seen between 2003 and 2015.

Although some risk factors like overweight and obesity have worsened, the decline in smoking, high blood pressure, high cholesterol and alcohol use has more than compensated for those risk factors which have worsened or those risk factors, like physical inactivity, which have not improved.

We’re by no means reaching the end of the line in terms of opportunities to improve our health.

Some 38% of the burden of disease in 2015 was due to risk factors like smoking (still accounting for 9.3% of the burden), overweight and obesity (8.4% of the burden), poor diet (7.3%), high blood pressure (5.8%), excessive alcohol intake (4.5%), high cholesterol (3%), insufficient physical activity (2.5%) and child abuse and neglect (2.2%).

Health isn’t equal

The report reveals significant inequalities in health, with those living in the poorest areas having a health-adjusted life expectancy at least five years lower than those living in the richest areas.

The burden of disease in the poorest areas is 50% higher than in the richest areas. For some diseases like heart disease, the burden of disease is 70% higher in the lowest socioeconomic areas, whereas for cancer the burden of disease is 40% higher.




Read more:
Low-income earners are more likely to die early from preventable diseases


So the news isn’t all good. While there’s opportunity for us to manage our risk factors on an individual level, these health disparities warrant urgent attention on a broader health policy level.The Conversation

John Goss, Adjunct Associate Professor, Health Research Institute, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Antibiotic resistance is not new – it existed long before people used drugs to kill bacteria



Antibiotic resistance can spread between microbes within hours.
Lightspring/Shutterstock.com

Ivan Erill, University of Maryland, Baltimore County

Imagine a world where your odds of surviving minor surgery were one to three. A world in which a visit to the dentist could spell disaster. This is the world into which your great-grandmother was born. And if humanity loses the fight against antibiotic resistance, this is a world your grandchildren may well end up revisiting.

Antibiotics changed the world in more ways than one. They made surgery routine and childbirth safer. Intensive farming was born. For decades, antibiotics have effectively killed or stopped the growth of disease-causing bacteria. Yet it was always clear that this would be a rough fight. Bacteria breed fast, and that means that they adapt rapidly. The emergence of antibiotic resistance was predicted by none other than Sir Alexander Fleming, the discoverer of penicillin, less than a year after the first batch of penicillin was mass produced.

Yet, contrary to popular belief, antibiotic resistance did not evolve recently, or in response to our use and misuse of antibiotics in humans and animals. Antibiotic resistance first evolved millions of years ago, and in the most mundane of places.

I am a bioinformatician, and my lab studies the evolution of bacterial genomes. With antibiotic resistance becoming a major threat, I’m trying to figure out how resistance to antibiotics emerges and spreads among bacterial populations.

A billion-years-old arms race

Most antibiotics are naturally produced by bacteria living in soil. They produce these deadly chemical compounds to fend off competing species. Yet, in the long game that is evolution, competing species are unlikely to sit idly by. Any mutant capable of tolerating a minimal quantity of the antibiotic will have a survival advantage and will be selected for – over generations this will produce organisms that are highly resistant.

So it’s a foregone conclusion that antibiotic resistance, for any antibiotic researchers might ever discover, is likely already out there. Yet people keep talking about the evolution of antibiotic resistance as a recent phenomenon. Why?

Resistance can and does evolve when bacteria are persistently exposed to a new antibiotic they have never encountered. Let’s call this the old-fashioned evolutionary road. Second, when bacteria are exposed to a novel antibiotic and are in contact with bacteria already resistant to this antibiotic, it is just a matter of time before they get cozy and trade genes. And, importantly, once genes have been packaged for trading, they become easier and easier to share. Bacteria then meet other bacteria, which meet more bacteria, until one of them eventually meets you.

Bacteria can evolve resistance to high levels of antibiotics in just days.

The rise and fall of sulfa drugs

For all their might, antibiotics are not the only substances capable of effectively killing bacteria (without killing us). A decade before the mass production of penicillin, sulfonamide drugs became the first commercial antibacterial agent. Sulfa drugs act by blocking an enzyme – called DHPS – that is essential for bacteria to grow and multiply.

Sulfa drugs are not antibiotics. No known organism produces them. They are chemotherapeutic agents synthesized by humans. No natural producer means no billion-year-old arms race and no pool of ancient resistance genes. We would expect bacteria to evolve resistance to sulfa drugs via the good old-fashioned way. And they did.

Just a few years after their commercial introduction, the first cases of resistance to sulfa drugs were reported. Mutations to the bacterial DHPS enzyme made sulfa drugs ineffective. Then penicillin and the antibiotic era came about. Sulfa drugs were relegated to a secondary role in medicine, but they gained popularity as cheap antimicrobials in animal husbandry. By the 1980s resistance to sulfa drugs was rampant and worldwide. What had happened?

At odds with resistance

To answer this question our research team took sequences of sulfa drug resistance genes from disease-causing bacteria and compared them to millions of “normal” versions of the DHPS enzyme in nonpathogenic bacteria.

The team identified two large groups of bacteria that had DHPS enzymes resistant to sulfa drugs. By studying their DNA sequences, we were able to show that these resistant DHPS enzymes had been present in these two groups of bacteria for at least 500 million years. Yet sulfa drugs were first synthesized in the 1910s. How could resistance be around 500 million years ago? And how did these resistance genes find their way into the disease-causing bacteria plaguing hospitals worldwide?

The clues left in gene sequences are too fuzzy to conclusively answer the latter, but we can certainly speculate. The bacteria we identified as harboring these ancient sulfa drug resistance genes are all soil and freshwater bacteria that thrive under the well-irrigated subsoil of farms. And farmers have been adding huge amounts of sulfa drugs to animal feed for the past 50 years.

The sublethal concentrations of sulfa drugs in the soil are the perfect setting for resistance genes to be transferred from these ancient resistant bacterial populations to other bacteria. All it takes is for one lucky bacterium to meet one of these ancient resistant ones in the subsoil. They trade some genes, one bacterium to the next, and resistance spreads until a newly minted resistant bacterium eventually makes it to the groundwater supply you drink from. You do the math.

Nothing new under the sun

As for why sulfa drug resistance genes would be around 500 million years ago, there are two plausible explanations. On the one hand, it could be that 500 million years ago there was a bacterium that synthesized sulfa drugs, which would explain the evolution of resistance. However, the lack of remnants from such a biosynthetic pathway makes this unlikely.

On the other hand, resistant bacteria may have been around just by chance. The argument here is that there are so many bacteria, and such diversity, that chances are that some of them are going to be resistant to anything scientists come up with. This is a sobering thought.

Then again, this is already the baseline for antibiotics. Like climate change, antibiotic resistance is one of those problems that always seem to be a couple decades away. And it may well be. A turning point for me in the climate change debate was a decade-old opinion piece in New Scientist. It stated that we should make every possible effort to prevent climate change, especially in the unlikely case that it was not caused by man, because that would mean that all we can do is palliate a natural phenomenon.

Our research points in the same direction. If resistance is already out there, drug development can offer only temporary relief. The challenge then is not to quell resistance, but to avoid its spread. It is a big challenge, but not an insurmountable one. Not feeding wonder drugs to pigs would do nicely, for starters.The Conversation

Ivan Erill, Associate Professor of Biological Sciences, University of Maryland, Baltimore County

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Does hitting the snooze button really help you feel better?



How many times do you hit snooze before getting out of bed?
DGLimages

Steven Bender, Texas A&M University

To sleep or to snooze? You probably know the answer, but you don’t prefer it.

Most of us probably use the snooze function on our alarm clocks at some point in our lives. Just a few more minutes under the covers, a time to gather our thoughts, right?

While such snoozing might seem harmless, it may not be. For starters, it is important to understand why we are using the snooze button in the first place. For some it’s a habit that started early on. But for many, it can signal a significant problem with sleep. Poor sleep has been shown to be associated with a number of health disorders including high blood pressure, memory problems and even weight control.

I’m a facial pain specialist and have extensively studied sleep and how it impacts painful conditions. With testing, we discover that many of our chronic pain patients also suffer with various sleep disorders.

What does normal sleep look like?

If one is tired when the alarm goes off, is it helpful to use the snooze button? While there are no scientific studies that address this topic specifically, the answer is probably not. Our natural body clock regulates functions through what’s known as circadian rhythms – physical, mental and behavioral changes that follow a daily cycle.

Most adults require approximately seven and a half to eight hours of good sleep per night. This enables us to spend adequate time in the stages of sleep known as nonrapid eye movement sleep (NREM) and rapid eye movement sleep (REM).

We tend to cycle from the three stages of NREM into REM sleep four to six times per night. The first portion of the night is mostly NREM deep sleep and the last portion consists of mostly REM sleep.

The stages of sleep.
arka38/Shutterstock.com

Good sleep is important

Maintaining this well-defined structure is important for good, restful sleep. If this process is disturbed, we tend to awaken still feeling tired in the morning.

A number of factors can affect the sleep cycles. For example, if a person is not breathing well during sleep (snoring or sleep apnea), this will disturb the normal sequences and cause the individual to awaken feeling unrestored. Sleep quality can be diminished by the use of electronic devices, tobacco or alcohol in the evening. Even eating too close to bedtime can be problematic.

The use of snooze buttons often starts during the teenage years, when our circadian rhythms are altered somewhat, causing us to want to stay up later and get up later in the morning. Delaying getting out of bed for nine minutes by hitting the snooze is simply not going to give us any more restorative sleep. In fact, it may serve to confuse the brain into starting the process of secreting more neurochemicals that cause sleep to occur, according to some hypotheses.

Bottom line: It’s probably best to set your alarm for a specific time and get up then. If you are consistently tired in the morning, consult with a sleep specialist to find out why.

[ Like what you’ve read? Want more? Sign up for The Conversation’s daily newsletter. ]The Conversation

Steven Bender, Clinical Assistant Professor of Oral and Maxillofacial Surgery, Texas A&M University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health Check: why do women live longer than men?


Biology and behaviour can explain why men tend to die younger than women.
From shutterstock.com

Melinda Martin-Khan, The University of Queensland

In Australia, an average baby boy born in 2016 could expect to live to 80, while a baby girl born at the same time could expect to live until closer to 85. A similar gap in life expectancy between men and women is seen around the world.

As we better understand why people die, we’re learning how biological and behavioural factors may partly explain why women live longer than men.

Scientific advancements also impact the health of women and men differently.




Read more:
Australian women outlive men then struggle with disadvantage


Biology and behaviour

While women may live longer than men, they report more illnesses, more doctor visits and more hospital stays than men. This is known as the morbidity-mortality paradox (that is, women are sicker but live longer).

One explanation is that women suffer from illnesses less likely to kill them. Examples of chronic non-fatal illnesses more common in women include migraines, arthritis and asthma. These conditions may lead to poorer health, but don’t increase a woman’s risk of premature or early death.

But men are more susceptible to health conditions that can kill them. For example, men tend to have more fat surrounding their organs (called visceral fat) and women tend to have more fat under their skin (called subcutaneous fat). Visceral fat is a risk factor for coronary heart disease, the leading underlying cause of death for Australian men.

Coronary heart disease, which results from a combination of biological factors and lifestyle habits, is a major reason for the difference in mortality between men and women.

Other biological factors may contribute to men ageing faster than women, but these remain to be fully understood. For example, testosterone in men contributes to their generally larger bodies and deeper voices. In turn, this may accelerate the age-related changes in their bodies compared to women.

On the flip side, women may have a slight advantage from protective factors connected with oestrogen. Coronary heart disease has been observed as three times lower in women than in men before menopause, but not after, indicating that endogenous oestrogens could have a protective effect in women.




Read more:
Not just about sex: throughout our bodies, thousands of genes act differently in men and women


Some behaviours that can lead to an earlier death are more common in men. Accidental deaths, including those caused by assault, poisoning, transport accidents, falls and drownings, are particularly high among young males aged 15-24.

Men also have a greater tendency to smoke, eat poorly and avoid exercise. These habits lead to often fatal chronic illnesses, including stroke and type 2 diabetes, and are also risk factors for dementia.

Developments in science and public health

Many scientific discoveries have led to improved clinical practice or changes in government health policies that have benefited the lives of women.

For example, innovations in birth control have enabled greater choice and control over family size and timing. This has resulted in fewer pregnancies that may have led to dangerous births, and improved general physical and mental health for women. Improved clinical care has resulted in fewer women dying during childbirth.

As people reach an older age, the gap in life expectancy narrows.
From shutterstock.com

Public health programs such as screening for breast cancer have had impacts on life expectancy over time. Similarly, vaccines to prevent cervical cancer have now been distributed in 130 countries.

Of course, there have been similar public health policies and clinical innovations that have benefited men too, like screening for bowel caner.

So although we may have some insights, we can’t conclusively answer why women continue to live longer than men.

Mind the gap

The gap between men and women decreases the longer they live. In 2016, at birth in Australia, the gap was 4.2 years, with a male expected to die at 80 on average. But as that male gets older, the gap decreases to 2.7 years at age 65, to one year at age 85 and to just 0.3 years at age 95.

This suggests men who live to an older age have been able to avoid certain health risks, giving them a greater prospect of a longer life.




Read more:
Indigenous health leaders helped give us a plan to close the gap, and we must back it


Ultimately, none of us have control of when or how we’re going to die. But paying attention to factors that we can change (such as maintaining a healthy diet, doing exercise and avoiding smoking) can reduce the risk of dying earlier from a preventable chronic disease.

While women may always live longer than men, by a year or two, men can try to make some lifestyle changes to reduce this gap. That being said, women should work towards these goals for a long and healthy life, too.The Conversation

Melinda Martin-Khan, Senior research fellow, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

It’s perfectly legal for doctors to charge huge amounts for surgery, but should it be allowed?



Desperate families are increasingly turning to crowdfunding campaigns to raise tens of thousands of dollars for surgery and other medical expenses.
From shutterstock.com

Louisa Gordon, QIMR Berghofer Medical Research Institute

Australia’s Chief Medical Officer Brendan Murphy will investigate how to better protect patients from doctors charging “really unjustifiable, excessive fees” of up to A$10,000 or more for medical procedures.

Murphy said it was potentially unethical for doctors to charge such high out-of-pocket fees that left families in severe financial pain, and that contrary to some patients’ hopes, paying more didn’t equate to better outcomes.

The call comes as desperate families increasingly turn to crowdfunding, remortgaging their homes and eating into their superannuation to raise tens of thousands of dollars for surgeries and other medical expenses.




Read more:
We need more than a website to stop Australians paying exorbitant out-of-pocket health costs


It is perfectly legal for a doctor working in private practice to charge what they believe is fair and reasonable. It’s a private market, so buyers beware.

But that doesn’t mean it’s right, or that it should be allowed to continue.

Not everything is available in the public system

Some patients’ out-of-pocket costs are from the gap between what their private health insurance and/or Medicare will pay for a procedure or treatment.

But some treatments aren’t funded by Medicare or offered in public hospitals because their safety, efficacy and value for money have not yet been demonstrated.

Medical technologies, devices and surgical techniques need to be rigorously tested in clinical trials to demonstrate safety and clinical effectiveness. They will only be widely adopted when they have a strong evidence base.

Out-of-pocket costs can be particularly high for patients with cancer.
From shutterstock.com

When the government pays for a health service, value for money is also considered. For really expensive services and medicines that have the potential to greatly benefit patients, the government will try to negotiate prices down, to reduce the impact on the health budget.

While a lack of evidence of a benefit does not necessarily mean the procedure does not benefit patients, the outcomes need to be reviewed and demonstrated to justify its ongoing use.

Sometimes new technologies are adopted prematurely based on weak evidence and strong marketing which can lead to poor investment decisions. This was the case with robotic surgery for prostate cancer, offered early in private practice in Australia, only to find later it was no better than traditional surgery.

If a patient chooses to spend money on a high-risk surgery, is it really anyone’s business?

Sometimes patients will choose to undergo high-risk surgery, not covered under the public system, and are willing to pay out of their own pocket, or raise the funds through crowdsourcing or remortgaging their home.

Some will argue the value is whatever the patient is willing to pay for it and it’s up to the patient’s own risk-benefit preferences.

There are some major problems with this. Patients often make health decisions while distressed, ill and emotional. They may not be able to determine the best course of action or have all the information at hand. They must trust the doctor and his or her superior knowledge and experience.




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Health economists call this “asymmetric information”. The doctor has extensive years of training, expertise and qualifications. The patient has Dr Google.

A key reason governments intervene in health care systems is to avoid market failure arising from unequal information and the profiteering of providers.

Our ‘fee-for-service’ system is failing

In the private system, doctors are paid a fee for each service they provide. This creates an incentive for doctors to provide more services: the more services they provide, the more they get paid.

But the high volumes of testing, consultations and fragmented services we’re currently seeing aren’t translating to a better quality of care. As such, economists are calling for major reforms of our fee-for-service private health system and the way that doctors are paid.

This could involve paying doctors for caring for a patient’s medical condition over a set period, rather than each time they see the patient, or charging private patients a “bundled fee” for all the scans, appointments and other costs associated with something like a hip replacement.




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More visits to the doctor doesn’t mean better care – it’s time for a Medicare shake-up


Out-of-pocket costs are very high for some Australians with cancer. A quarter of Queenslanders diagnosed with cancer will pay provider fees of more than A$20,000 in the first two years after diagnosis.

While what constitutes “value” will be in the eye of the beholder, a well-functioning and sustainable health system is one that puts patients’ interests above all others and holds health providers accountable.

Australia’s universal health care system is one of the best in the world and we need to work hard to preserve it. Surgeries costing tens of thousands of dollars will continue unless the government regulates private medical practice or reforms the way doctors are remunerated.

It’s time to cap what physicians can charge for services and provide incentives for specialists to bulk-bill their patients.




Read more:
Why do specialists get paid so much and does something need to be done about it?


The Conversation


Louisa Gordon, Associate Professor – Health Economics, QIMR Berghofer Medical Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Are you burnt out at work? Ask yourself these 4 questions



In today’s digital age, we’re losing the ability to switch off from our work.
From shutterstock.com

Michael Musker, South Australian Health & Medical Research Institute

It’s normal to feel stressed at work from time to time. But for some people, the stress becomes all-consuming, leading to exhaustion, cynicism and hatred towards your job. This is known as burnout.

Burnout used to be classified as a problem related to life management, but last week the World Health Organisation re-labelled the syndrome as an “occupational phenomenon” to better reflect that burnout is a work-based syndrome caused by chronic stress.

The newly listed dimensions of burnout are:

  • feelings of energy depletion or exhaustion
  • increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
  • reduced professional efficacy (work performance).



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Extinguished and anguished: what is burnout and what can we do about it?


In the era of smartphones and 24-7 emails, it’s becoming increasingly difficult to switch off from the workplace and from those who have power over us.

The new definition of burnout should be a wake-up call for employers to treat chronic stress that has not been successfully managed as a work health and safety issue.

How do you know if you’re burnt out?

If you think you might be suffering burnout, ask yourself the following questions:

  1. has anyone close to you asked you to cut down on your work?

  2. in recent months have you become angry or resentful about your work or about colleagues, clients or patients?

  3. do you feel guilty that you are not spending enough time with your friends, family or even yourself?

  4. do you find yourself becoming increasingly emotional, for example crying, getting angry, shouting, or feeling tense for no obvious reason?

If you answered yes to any of these questions, it might be time for change.

These questions were devised for the United Kingdom Practitioner Health Programme and are a good starting point for all workers to identify if you are at risk of burning out.

(You can also complete the British Medical Association’s online burnout questionnaire, although it’s tailored for doctors so the drop-down menu will ask you to select a medical specialty).

If you think you’re suffering burnout, the first step is to talk to your line manager or workplace counsellor. Many workplaces now also have confidential external psychologists as part of their employee assistance programme.



Wes Mountain/The Conversation, CC BY-ND

What causes burnout?

We all have different levels of capacity to cope with emotional and physical strains.

When we exceed our ability to cope, something has to give; the body becomes stressed if you push yourself either mentally or physically beyond your capacity.




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People who burn out often feel a sense of emotional exhaustion or indifference, and may treat colleagues, clients or patients in a detached or dehumanised way. They become distant from their job and lose the zeal for their chosen career.

They might become cynical, less effective at work, and lack the desire for personal achievement. In the long term, this is not helpful for the person or the organisation.

While burnout isn’t a mental health disorder, it can lead to more serious issues such as family breakdowns, chronic fatigue syndrome, anxiety, depression, insomnia, and alcohol and drug abuse.

Who is most at risk?

Any worker who deals with people has the potential to suffer from burnout. This might include teachers, care workers, prison officers or retail staff.

Emergency service workers – such as police, paramedics, nurses and doctors – are at even higher risk because they continually work in high-stress conditions.

A recent survey of 15,000 US doctors found 44% were experiencing symptoms of burnout. As one neurologist explained:

I dread coming to work. I find myself being short when dealing with staff and patients.

French research on hospital emergency department staff found one in three (34%) were burnt out because of excessive workloads and high demands for care.

When you’re close to burnout, there’s a fine line between coping and not coping.
gpointstudio/Shutterstock

Lawyers are another profession vulnerable to burnout. In a survey of 1,000 employees of a renowned London law firm, 73% of lawyers expressed feelings of burnout and 58% put this down to the need for a better work-life balance.

No matter what job you do, if you are pushed beyond your ability to cope for long periods of time, you’re likely to suffer burnout.

It’s OK to say no to more work

Employers have an organisational obligation to promote staff well-being and ensure staff aren’t overworked, overstressed, and headed towards burnout.

There are things we can all do to reduce our own risk of burnout. One is to boost our levels of resilience. This means we’re able to respond to stress in a healthy way and can bounce back after challenges and grow stronger in the process.




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You can build your resilience by learning to switch off, setting boundaries for your work, and thinking more about play. As much as you can, inoculate yourself against job interference and prevent it from ebbing into your personal life.

No matter what your profession, don’t let your job become the only way you define yourself as a person.

And if your job is making you miserable, consider moving jobs or at least have a look at what else is out there. You may surprise yourself.

If you or anyone you know needs help or support, you can call Lifeline on 13 11 14.The Conversation

Michael Musker, Senior Research Fellow, South Australian Health & Medical Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health Check: what’s the best way to sit?


There’s not only one correct sitting posture. Mixing it up is the best thing to do.
From shutterstock.com

Leon Straker, Curtin University

Many people spend the majority of their waking hours sitting – at home, commuting and at work.

Particularly when we’re sitting for long periods at a desk, there are a few things we should keep in mind.




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How should we sit?

Many people think there is one “good” posture. But actually, there isn’t just one way of sitting. Different ways of sitting will place different physical stresses on our bodies, and variety is good.

To work out if a posture is “good” or not, we can assess it based on several things:

  • the amount of muscle activity required to hold the position (too much muscle activity could be a problem as it can result in fatigue if held continuously for a long period)

  • the estimated stress on joints, including the discs between the vertebral bones of the spine (too much physical loading stress could be a problem as it may cause pain in the joints and ligaments or muscles around them)

  • whether the joints are in the middle of their range of movement or near the extreme (awkward, near end-of-range postures may put more stress on tissues around joints)

  • the amount of fidgeting people do (moving about in your seat, or fidgeting, can be an early indicator of discomfort and may suggest a risk of later pain).

Given these criteria, research suggests there are three main options for how you can sit well at a desk. Each option has different pros and cons, and is suitable for different tasks.

Option 1: upright sitting

This is probably the posture you think of as “good” posture. The defining feature of this option is that the trunk is upright.

A key component of upright sitting is that the feet can comfortably rest on a surface, whether the floor or a footstool. This position also makes it easy to adjust posture within the chair (fidget) and change posture to get out of the chair.




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It’s also important the arms hang down from the shoulders vertically with elbows by the trunk, unless the forearms are supported on the work surface. Holding unsupported arms forward requires the muscles connecting the shoulder and neck to work harder. This often results in muscle fatigue and discomfort.

The head should be looking straight ahead or a little downwards. Looking upwards would increase tension in the neck and likely lead to discomfort.

This posture is useful for common office tasks such as working on a desktop computer.


The Conversation, CC BY-ND

Option 2: forward sitting

The defining feature of this posture is that the trunk is angled forward, and the arms are rested on the work surface. Allowing the thigh to point down at an angle may make it easier to maintain an inward curve in your lower back, which is suggested to reduce low back stress.

For a time special chairs were developed to enable the thigh to be angled downwards, and usually had a feature to block the knees, stopping the person sliding off the angled seat base.

By perching on the front of an ordinary chair and resting your elbows on the work surface, you can use this posture to provide variety in sitting. This posture is useful for tasks such as drawing or handwriting on a flat work surface, either with paper or a touch screen device.


The Conversation, CC BY-ND

Option 3: reclined sitting

The defining feature of the third option is the trunk is angled backward, supported by the chair’s backrest. Back muscle activity is lowest in this posture, as some of the upper body weight is taken by the chair.

This position may reduce the risk of fatigue in the back muscles and resultant discomfort. But sitting like this for hours each day may result in the back muscles being more vulnerable to fatigue in the future.

This posture is useful for meetings and phone conversations. But it doesn’t work well for handwriting or using a computer as the arms need to be held forwards for these things, requiring neck and shoulder muscle activity likely to result in discomfort.


The Conversation, CC BY-ND

Final tips

  • consider how much time you spend sitting each day, and if it’s more that around seven hours, look for ways to reduce the total amount of time you spend sitting. For example, if you’re an office worker you can stand instead of sit for some tasks (but don’t stand for too long either)

  • break up long periods of sitting with movement. Aim never to sit for longer than 30-60 minutes without allowing your body to experience alternative posture and movement, such as a short walk

  • vary your sitting posture using the three options outlined above so your body has changes in the stresses placed on it

  • remember there is no one good posture, but any posture held for a long period of time becomes a bad posture. Our bodies are meant to move regularly.




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Office workers, stand up from your desk for two hours a day


The Conversation


Leon Straker, Professor of Physiotherapy, Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health check: why do we get motion sickness and what’s the best way to treat it?



More than a quarter of us will suffer from motion sickness.
From shutterstock.com

Ric Day, UNSW and Andrew McLachlan, University of Sydney

Motion sickness can be mild, but in some people it’s debilitating, and takes the fun out of a holiday.

We think it’s caused by temporary dysfunction of our brain’s balance centres.

The perception of motion of any sort can bring on symptoms of travel sickness. These include dizziness, nausea, vomiting, excessive saliva, rapid breathing and cold sweats.

The good news is, there are strategies and medicines you can use to prevent motion sickness, or to help you ride it out.




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Ears and eyes disconnect

As we move through space, multiple sensors in our middle ear, limbs and eyes feed information to our balance centre in our brains to orientate us. It’s when these sources of information are in apparent conflict that we may experience motion sickness.

This diagram of the ear shows the vestibular nerve, which is central to our balance.
From shutterstock.com

For example, in those who are particularly susceptible, watching certain movies can induce motion sickness as our eyes indicate we are moving, although other sensors confirm we are stationary.

A boat trip in rocky seas or a car trip on winding roads means our head and body will be moving in unusual ways, in two or more axes at once, while sensing accelerations, decelerations and rotations. Together these are strong stimuli to bring on an attack of motion sickness.

Motion sickness is common

Around 25-30% of us travelling in boats, buses or planes will suffer – from feeling a bit off all the way to completely wretched; pale, sweaty, staggering, and vomiting.

Some people are extremely susceptible to motion sickness, and may feel unwell even with minor movements such as “head bobbing” while snorkelling, or even riding a camel.

Susceptibility seems to increase with age, while women are more prone to travel sickness than men. There is a genetic influence too, with the condition running in families. It often co-exists with a history of migraines.

Preventing motion sickness

Sufferers quickly work out what to avoid. Sitting in the back seat of the car, reading in a car or bus (trains and planes are better), facing backwards in a bus or train or going below deck on a boat in rough conditions are all best avoided if you’re prone to travel sickness.

Medicines that control vomiting (antiemetics) and nausea (anti-nauseants) are the mainstay of medicines used for motion sickness and are effective. But as there are unwanted side effects such as drowsiness, it’s reasonable to try behavioural techniques first, or alongside medicines.




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More time “on deck”, keeping an eye on the horizon if there’s a significant swell, and focusing on other things (for example looking out for whales) are good examples.

Desensitisation or habituation also work for some. For example, increasing experience on the water in relatively smooth conditions in preparation for longer and potentially rougher trips can help.

There tends to be a reduction in symptoms after a couple of days at sea. Medicines can then be reduced and even stopped. Symptoms often return when back on dry land, usually for just a day or two.

Motion sickness can hit us on boats, as well as planes, trains, buses and in cars.
From shutterstock.com

Chewing hard ginger has been claimed to work for naval cadets, but other studies have not confirmed its effectiveness.

Some people find wrist bands that provide acupressure to be effective, although when these have been studied in controlled trials, the proof is lacking.

Glasses with a built-in horizon to combat motion sickness were patented in 2018, so watch this space.

How medications work

Travel sickness medications are more effective when taken pre-emptively, so before your journey begins.

Antiemetics and anti-nauseants act on the brain and nervous system. Medicines used to prevent and treat travel sickness most commonly are either sedating antihistamines or anticholinergics. They block the effects of neurotransmitters (molecules that transmit information) such as histamine, acetylcholine and dopamine in our balance control centres.

But these sorts of medicines are not very specific. That is, they block the effects of acetylcholine and histamine wherever these neurotransmitters act throughout the body. This explains unwanted side effects such as sedation, drowsiness, dry mouth, constipation and confusion (in older, vulnerable people).

Drowsiness is more likely to reach dangerous levels if other central nervous system depressants are taken at the same time. This includes opioids (morphine, oxycodone, codeine), alcohol, sleeping pills and some antidepressants.

So what’s the best option?

A comprehensive review of clinical trials in 2011 compared the medicine scopolamine as a preventative with other medicines, placebos, behavioural and complementary therapies.

Most of the 14 studies reviewed were in healthy men serving in the Navy with history of travel sickness. Women have rarely been subjects, and there are no studies in children.

Although scopolamine was found to be marginally more effective than the alternatives, there’s not much to go on to recommend one travel medicine over another.




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If you’re somebody who experiences motion sickness, speak to your doctor or pharmacist. Most medicines for motion sickness are available over the counter. You may need to try a few different medicines to find the one that works best for you, but always follow dosage instructions and professional advice.

Once motion sickness is established, the only option is to ride it out. Lying down where possible, getting fresh air and focusing on the horizon can all help alongside appropriate medications. Importantly, for prolonged episodes, try to keep your fluids up to avoid dehydration (especially if vomiting occurs).

If you experience motion sickness for the first time, and if it’s associated with a migraine-like headache, you should seek the advice of a doctor to rule out other neurological conditions.The Conversation

Ric Day, Professor of Clinical Pharmacology, UNSW and Andrew McLachlan, Head of School and Dean of Pharmacy, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.