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Dr Robert Peers, Bulk Billing Family Doctor, Carlton North
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Supplements blamed for increasing liver damage.

The growing popularity of herbal and dietary supplements is being blamed for a marked increase in cases of liver damage, say hepatologists.

Drug-induced liver injuries linked to supplements in the US jumped from just 7% in 2003 to about 20% in 2014, a recent study finds. Studies in Europe also show similar increases.

In Australia last year, two cases of severe liver toxicity in Australian men involving green tea extract, garcinia cambogia and valerian prompted calls for tighter regulation.

In the latest research, the major culprits of drug-induced liver damage were identified as multi-ingredient nutritional supplements (where the main component responsible for the toxicity was usually unknown or could only be suspected), anabolic steroids (marketed as bodybuilding supplements) and green tea extract.

About 700 cases of liver damage were reported during the study’s time frame. And 130 of those cases were linked to dietary supplements. Of those, 24 were attributed to green tea extrac,t which causes an acute, hepatitis-like injury.

The researchers noted that a major obstacle to better understanding and improving the safety of herbal and dietary supplements was the difficulty in determining what was actually in them.

“Liver injury from herbal and dietary supplements is a growing problem that poses special challenges in clinical care, clinical and basic research, and regulatory oversight,” they wrote in the journal Hepatology.

“A heightened awareness of the problem, stimulation of clinical and basic research, and new approaches for the monitoring and regulation of supplements to ensure their safety to the consumer are important priorities.”

In Australia, herbal and dietary supplements are regulated by the TGA.


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What’s this about beetroot juice?

Beetroot juice may provide benefits for heart disease patients by reducing overstimulation of the sympathetic nervous system that occurs with heart disease.

This is the main finding from a small study that suggests it’s the dietary nitrate in beetroot juice that does the trick.

The authors say beetroot juice could potentially be a targeted treatment option for people with cardiovascular disease.

For their study, they recruited 20 young adults who blindly received either a nitrate supplement or a placebo on two separate visits.

On both occasions, the research team recorded the blood pressure, heart rate and muscle sympathetic nerve activity (MSNA), and measured muscle activity at rest and during handgrip exercise with the participants’ non-dominant hand.

Measurements were recorded at the beginning of the visit and then again after the volunteers drank nitrate-rich beetroot juice or a placebo and had rested on their backs for three hours.

MSNA burst rate, denoting the frequency of nerve activity, was lower when they drank beetroot juice compared with when they drank the placebo.

Sympathetic nerve activity also decreased during exercise.

“Surprisingly, no differences in blood pressure were detected at rest or during exercise,” the researchers note.

“These results provide proof-of-concept that dietary nitrate supplementation can modulate central sympathetic outflow and suggest that the established cardiovascular benefits [of dietary nitrate] are likely to involve a neural contribution.”
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Move over, Heimlich: This chair thrust could save your life.
Next time a piece of food goes down the wrong way, look for a chair.

UK researchers have developed a DIY variation of the Heimlich manoeuvre and they’re urging Australians to adopt it.

While the controversial Heimlich manoeuvre has never been recommended for use in Australia, respiratory specialists at the Royal Brompton Hospital are now suggesting our guidelines be changed to include their instructions for self-administered abdominal thrusts using the back of a chair.

In a series of tests involving healthy volunteers they found that self-administered abdominal thrusts could be more effective at generating expulsive intrathoracic pressure than thrusts delivered by first aiders.

How to perform the Heimlich manoevre on yourself

Their auto-administration technique involves the choking person positioning themselves above a high backed chair, with the chair back positioned below the upper half of the abdomen. Using gravity, bodyweight and arm strength, the person allows the back of the chair to thrust up into their abdomen.

In their laboratory tests, they found that chair thrusts created the most thoracic pressure, followed by the circumferential abdominal thrust, where the rescuer stands behind the victim.

Similar thoracic pressure was achieved by the victim placing their own hands in the same position and pulling backwards into their stomach.

“We recommend that the manoeuvre should be performed by inward thrust over the fleshy part of the abdomen, around the level of the navel,” they suggest.

The case for using the chair thrust is strengthened by its lack of reliance on an external operator, they add.

The researchers note that Australian Resuscitation Council guidelines recommend against the use of abdominal thrusts because life threatening complications have been reported when thrust are directed upwards into the ribcage and organs.

Instead, Australian guidelines recommend up to five sharp back blows, or five chest thrusts by a rescuer.

However the UK researchers say their modified technique, using inward rather than upward thrusts, will minimise these risks and should be adopted by First Aiders globally.

“Concern about possible risk needs to be balanced against the almost certain risk of death if obstruction persists,” they suggest.

“We advise that everyone with complete airway obstruction should, in the first instance, either autoadminister abdominal thrusts or perform a chair thrust.

"The various manoeuvres should be more widely taught in schools, first aid courses, to staff in restaurants and publicised as widely as possible."

More Information:

BMJ Thorax 2017; online.

ANZCOR Guidelines 2016; online.

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The deadly impact of a poor diet: study

New US research shows just how deadly a poor diet can be.

Nearly half of all deaths due to heart disease, stroke, and type 2 diabetes in the US in 2012 were associated with the low consumption of fruit and vegetables, nuts and seeds and omega-3 fatty fish, according to a study published in the JAMA journal.

The largest numbers of estimated diet-related cardiometabolic deaths were also linked to the high intake of salt and sugary beverages.

“These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health,” the authors wrote.

Related: Healthy pregnancy weight vital for baby

Using data from the National Health and Nutrition Examination Surveys, researchers at Tufts Fiedman School of Nutrition Science and Policy in Boston examined mortality due to heart disease, stroke, and type 2 diabetes in 2012 and the consumption of 10 foods/nutrients associated with cardiometabolic diseases.

In 2012, just over 700,000 cardiometabolic deaths occurred in US.

Of these, an estimated 45 per cent due to heart disease, stroke, and type 2 diabetes were associated with “suboptimal” intakes of 10 dietary factors, the study found.

Despite the known health benefits of a good diet, only half of all Australian adults meet the dietary guidelines for the recommended daily consumption of two or more serves of fruit.

Just seven per cent eat the recommended 5-6 serves of vegetables, according to the latest Bureau of Statistics figures.
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Coffee and cancer: it’s a hot topic
Latest News

Coffee can be enjoyed with impunity as long as you don’t drink it too hot, is the take home message from a landmark Lancet study.

An international working group of 23 scientists has evaluated the carcinogenicity of drinking coffee and very hot beverages.

It found no conclusive evidence that coffee causes cancer. However, the experts did find that drinking very hot beverages above 65 degrees celsius probably causes cancer of the oesophagus in humans.

The results suggest it is the temperature rather than the drinks themselves that have adverse effects.

To reach their findings - the working group, convened by the International Agency for Research on Cancer (IARC), which is part of the World Health Organization (WHO) - reviewed more than 1,000 human epidemiological studies and animal experimental studies.

Not only did IARC’s report let coffee off the hook as a cause of cancers of the breast, pancreas and prostate, it found the brew may have protective benefits, including reducing the risk of liver and endometrial cancer.

The results contradict previous work that found coffee was a potential carcinogen.

“Coffee had previously been thought to be possibly associated with bladder cancer,” says Dr Ian Olver, who is Professor of Translational Health Research and Director of the Sansom Institute for Health Research at the University of South Australia.

“This shows how just having a small number of studies can cause uncertain results which are clarified by considering a very large number of studies. It also shows that if other known causal factors are not controlled for, in this case smoking, the cause of the cancer can be attributed to an agent that is merely associated with the cancer but does not cause it.”


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Dental Hygiene Affects Brain Health
By Karen Merzenich.

Did you know that your dental health and hygiene is related to your brain health? It may sound strange, but research has found that people with poor dental health suffer from higher rates of memory loss than people who brush their teeth regularly. And scientists in Europe found that losing adult teeth is correlated with a loss in certain types of memories.

While the connection between tooth decay and memory loss is still not completely understood, some scientists believe that periodontal bacteria may lead to increased inflammation in the body and brain—which could affect brain areas related to memory. One large study found that Alzheimer’s disease and gum disease are correlated, and that treating gum disease may reduce the risk of Alzheimer’s onset.

I don’t know about you, but these studies definitely make me want to brush, floss, and visit the dentist a bit more often!

References:

Paganini-Hill, A, White, SC, Atchison, KA. (2012.) Dentition, dental health habits, and dementia: the Leisure World Cohort Study. Journal of the American Geriatric Society, Aug;60(8): 1556-63.
Hansson, P, et. al. (2013.) Relationship between natural teeth and memory in a healthy elderly population. European Journal of Oral Sciences, Aug;121(4): 333-40.
Ide, M, et. al. (2016.) Periodontitis and cognitive decline in Alzheimer’s disease. PLoS ONE, 11(3): e0151081.

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A handful of nuts a day cuts the risk of a wide range of diseases.

A large analysis of current research shows that people who eat at least 20g of nuts a day have a lower risk of heart disease, cancer and other diseases.

A handful of nuts daily was associated with a 30 per cent reduced risk of heart disease, a 15 per cent reduced risk of cancer, and a 22 per cent reduced risk of premature death, as well as reduced risk of dying from respiratory disease and diabetes.

Study co-author Dagfinn Aune from Imperial College London said: "We found a consistent reduction in risk across many different diseases, which is a strong indication that there is a real underlying relationship between nut consumption and different health outcomes. It’s quite a substantial effect for such a small amount of food."

"Nuts and peanuts are high in fibre, magnesium, and polyunsaturated fats - nutrients that are beneficial for cutting cardiovascular disease risk and which can reduce cholesterol levels,” he explained. "Some nuts, particularly walnuts and pecan nuts are also high in antioxidants, which can fight oxidative stress and possibly reduce cancer risk."

The findings are published in the journal BMC Medicine .



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Postmenopausal women who eat a high protein diet may be at increased risk of heart failure, especially if most of the protein comes from red meat.

The barbecue-stopping finding comes from a five-year study into the diets of over 100,000 women aged 50 to 79.

The research presented in New Orleans this week shows the rate of heart failure in red meat eaters was significantly higher than those who ate less protein or who got it from other sources.

“Higher calibrated total dietary protein intake appears to be associated with substantially increased heart failure risk while vegetable protein intake appears to be protective,” researchers told delegates at the American Heart Association’s Scientific Sessions 2016.

The findings held true regardless of age, race or ethnicity, or if the women had other cardiovascular health problems.

Previous work has found a similar link.

While the results need to be interpreted with caution until there is a better understanding of dietary risk, the authors conclude that following a high-protein diet at this stage of life is not a good idea.
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I’m a Doctor. If I Drop Food on the Kitchen Floor, I Still Eat It.

You may have read or heard about the study debunking the five-second rule. It said that no matter how fast you pick up food that falls on the floor, you will pick up bacteria with it.

Our continued focus on this threat has long baffled me. Why are we so worried about the floor? So many other things are more dangerous than that.

I first became interested in the five-second rule years ago, when I was a co-author of a book on medical myths. We cited a number of studies showing that food that touched household surfaces — even for brief periods of time — could pick up bacteria or other harmful substances.

This most recent study was similar in that it tested a variety of foods, a variety of substances, for various periods. And, like those other studies, this one found that food touching the floor, even for a very short amount of time, could pick up bacteria.

There’s no magic period of time that prevents transmission. But even though I know bacteria can accumulate in less than five seconds, I will still eat food that has fallen on my kitchen floor. Why? Because my kitchen floor isn’t really that dirty.

Our metric shouldn’t be whether there are more than zero bacteria on the floor. It should be how many bacteria are on the floor compared with other household surfaces. And in that respect, there are so many places in your house that pose more of a concern than the floor.

Perhaps no one in the United States has spent more time investigating the occurrence of bacteria on public surfaces than Charles Gerba. He’s a professor of microbiology and environmental sciences at the University of Arizona, and he has published many papers on the subject.

In 1998, he and his colleagues investigated how well cleaning products could reduce coliform bacteria counts on household surfaces. As part of that research, they measured various locations in the house before any cleaning.

They found that the kitchen floor was likely to harbor, on average, about three colonies per square inch of coliform bacteria (2.75 to be exact). So there are some. But here’s the thing — that’s cleaner than both the refrigerator handle (5.37 colonies per square inch) and the kitchen counter (5.75 colonies per square inch).

We spend so much time worrying about what food might have picked up from the floor, but we don’t worry about touching the refrigerator. We also don’t seem as worried about food that touches the counter. But the counter is just as dirty, if not dirtier.

The same thing happens in the bathroom. I know a lot of people who are worried about the toilet seat, but it’s cleaner than all the things in the kitchen I just mentioned (0.68 colonies per square inch). What’s dirtier in the bathroom? Almost everything. The flush handle (34.65 colonies per square inch), the sink faucet (15.84 colonies per square inch) and the counter (1.32 colonies per square inch).

Things get dirty when lots of hands touch them and when we don’t think about it. We worry about the floor and the toilet seat, so we clean them more. We don’t think about the refrigerator handle or the faucet handle as much.

If we carry this logic out further, there are things we handle a lot and never really clean. One study, for instance, found that about 95 percent of mobile phones carried by health care workers were contaminated with nosocomial bacteria. Of those contaminated with staph aureus, more than half were contaminated with methicillin resistant bacteria (MRSA).

Think about how many people have handled the money in your wallet. A study of one-dollar bills found that 94 percent were colonized by bacteria, 7 percent of which were pathogenic to healthy people and 87 percent of which were pathogenic to people who were hospitalized or who had compromised immune systems. Where do you keep your money? In a wallet or purse? When did you last clean it? It’s probably filthy.

I see people pay for food every day and then eat what they’re handed with no concern that the food might have been contaminated. And the money and the hands that just held it could be much dirtier than the floor.

There are so many studies out there showing that things we touch every day are so, so dirty. Gas pump handles. A.T.M. buttons. Remote controls. Light switches. Computer keyboards.

The dirtiest thing in your kitchen, by far, is likely to be the sponge you keep near the sink. Most people almost never wash or disinfect those sponges. Mr. Gerba found they had, on average, more than 20 million colonies per square inch.

All of this should remind you that it’s always a good idea to wash your hands before you eat. Hand-washing is still one of the best ways to prevent illness.

People react to news like this in one of two ways. One is to become paranoid about everything. Such people start to clean compulsively, worry about all the things they’re touching, and use hand sanitizer obsessively.


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The alternative is to realize that for most of us, our immune systems are pretty hardy. We’ve all been touching this dirty stuff for a long time, without knowing it, and doing just fine.

I clearly fall into the latter group. If I drop food on the floor, I still eat it. I do that because the harm I might get from the floor is not worth my concern compared with many, many other things. You may feel differently. Either way, make an informed judgment based on relative risks, not on any arbitrary span of time that one thing has been touching another.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. Follow him on Twitter at @aaronecarroll.

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