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Dr Robert Peers, Bulk Billing Family Doctor, Carlton North

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The two best diets for heart disease prevention
Researchers compare Mediterranean and vegetarian approaches

A study comparing the efficacy of either a vegetarian or Mediterranean diet has found both are equally good at preventing cardiovascular disease.

Both diets reduced body fat and overall weight by the same amount.Those on the vegetarian diet had greater reductions in LDL cholesterol but Mediterranean dieters achieved greater reductions in triglycerides.

Previous research has confirmed the effectiveness of both diets, but this is the first time researchers have compared the two, say the authors.

The study included 107 healthy but overweight people aged 18-75, who were randomly assigned to follow either a low-calorie vegetarian diet (including dairy and eggs) for three months or a low-calorie Mediterranean diet for three months.

The Mediterranean diet included poultry, fish and some red meat, as well as fruits, vegetables, beans and whole grains.

After three months, participants switched diets.

The take-home message is that both diets are equally effective in preventing cardiovascular disease risk factors, say the Italian authors.

In an accompanying editorial in Circulation, Dr Cheryl Anderson, an associate professor of preventive medicine at the University of California, writes the similarities between the two diets may explain the results.

Both follow “a healthy dietary pattern rich in fruits and vegetables, legumes, whole grains and nuts; focusing on diet variety, nutrient density and appropriate amount of food; and limiting energy intake from saturated fats”, she says.

Dr Anderson says the results suggest healthcare professionals can confidently offer either as a possible solution.

You can access the research here
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Don’t sweat it: Bikram yoga is no more effective than yoga practised at room temperature

Bikram yoga, a hot yoga style, is no more effective at improving health than the same yoga postures at room temperature - that’s what research published in Experimental Physiology and carried out by Texas State University and the University of Texas at Austin, USA, has found.
Bikram yoga is popular worldwide and involves 26 poses performed in a room heated to 40°C. Despite its popularity, little is known about the health benefits associated with it and even less is known about the stipulation that it is carried out in a hot environment. This is the first publication to date to isolate the effects of the heat in Bikram yoga, and it found that the heated environment did not play a role in causing improvements in vascular health.
The research showed that Bikram yoga can reduce changes in the lining of blood vessels that are involved in the development and progression of heart disease. It also found that it can possibly delay the progression of atherosclerosis, which is a disease in which plaque builds up inside arteries and can cause a heart attack or stroke. However, crucially, it found that it is not necessary for the yoga to be performed at a hot temperature with the effects also being seen at room temperature.
80 participants were enrolled and randomised to one of three study groups after preliminary screening. In addition to the heated and room temperature yoga groups, a control group was also included to account for the effect of time on our primary results. The intervention lasted for 12 weeks and participants were asked to attend 3 Bikram yoga classes per week.
Stacy D Hunter, corresponding author said, ‘The new finding from this investigation was that the heated practice environment did not seem to play a role in eliciting improvements in vascular health with Bikram yoga. This is the first publication to date to show a beneficial effect of the practice in the absence of the heat.’
(Source: The Physiological Society, Experimental Physiology)
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Gas-sniffing pill that transmits from the gut passes first human trials.

Scientists from Australia’s RMIT University reveal promising results from human trials of swallowable capsule that transmits data to a mobile phone,
An electronic gas-detecting pill could help in diagnosing gastrointestinal ailments, including irritable bowel syndrome.

Scientists from Melbourne’s RMIT University first unveiled their swallowable capsule early in 2015 in the hope it would it would help doctors work out what foods were problematic for their patients by detecting and measuring intestinal gases produced by gut bacteria.

Now they have released results from the first human trials of the capsule, which collects information about the gases and transmits it to a hand-held device and mobile phone for doctors to read.

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A group of 26 people took part in the trials last year and proved the capsule was safe for use in humans, paving the way for more extensive tests in 2019.

As a bonus, the trials delivered a surprising batch of new information about the workings of the gut’s microbiome, the colony of trillions of bacteria that are believed to help keep us healthy.

Lead researcher and co-inventor of the capsule, Prof Kourosh Kalantar Zadeh, said they discovered the stomach releases oxidising chemicals to get rid of foreign bodies, possibly as a protection mechanism.

They also discovered that people on high-fibre diets had high amounts of oxygen in their colon – information that overturned a long-held theory that the colon was oxygen free and may help scientists work out how colon cancer develops.

“For the first time we have a tool that actually gives information about the activities of the microbiome inside the gut,” Kalantar Zadeh said.

The scientists are trying to raise up to $8m for the next round of clinical trials of the device in 300 patients with digestive issues including irritable bowel syndrome and intestinal bacterial overgrowth.

All going well, they hope the capsule will be on sale by 2020 for between $100 and $200.

The capsule’s other co-inventor, Dr Kyle Berean, said the trial results suggested the capsule was more accurate and less invasive than existing methods used to measure intestinal gases.

The most common methods currently used are breath and faecal tests, however some patients undergo surgery so direct samples from the gut can be examined.

The results from the first human trials were published on Thursday in the journal Nature Electronics.

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Contact lens wearers at risk in the water.
28 August, 2017 Michael Woodhead

Contact lens wearers are being warned of eyesight-threatening amoebic infection from swimming pools or washing their lenses with tap water.

Acanthamoeba keratitis is uncommon, but can have devastating consequences including blindness, according to ophthalmologists who reviewed 34 cases in Melbourne that occurred over an 18-year period.

Clinicians from the Royal Melbourne Hospital and the Corneal Unit at the Royal Victorian Eye and Ear Hospital found that an overwhelming number of cases of infection (86%) occurred in contact lens wearers, six of whom admitted to swimming with their contacts in, while seven said they'd rinsed theirs with tap water.

Most of the patients with Acanthamoeba keratitis presented with eye pain, redness and swelling.

Signs associated with early infection included epithelial infiltrates, while signs of late infection included uveitis, ring infiltrate, endothelial plaque and corneal thinning.

Most of the cases were treated successfully with medications such as propamidin and chlorhexidine.

Surgical treatment was required in 20% of cases and 80% of cases showed some improvement in visual acuity.

The 20% with poor outcomes tended to be those who presented with later stages of infection.

“Patients with late diagnosis had worse presenting and final visual acuities as well as a prolonged disease period, indicating need for early recognition and management. Knowledge of clinical signs may help clinicians towards early diagnosis and effective treatment,” they said.

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Cheers to alcohol’s protective effect.

A couple of alcoholic drinks a day might actually have a protective effect after all, according to a large US retrospective analysis that challenges other recent work.

The study of 333,247 adults found that compared to lifetime abstainers, those who were light or moderate drinkers had a reduced risk of mortality from all causes including cancer.

In particular, they had fewer cardiovascular-related deaths.

However, people who drank heavily lost any protective benefits from their daily tipple.

The researchers found this group put themselves at greater risk of premature death, as did those who binged (five or more drinks on one day) about once a week.

"Using a large sample of US adults, our study re-emphasised the existence of a J-shaped curve in the alcohol-mortality association, supporting current findings that light to moderate drinking might be protective, especially for cardiovascular disease," write the authors in the Journal of the American College of Cardiology.

This is in contrast to the accepted wisdom that light to moderate drinking is more likely to be a marker for good health (especially among middle-aged and older people), not a cause of it, and that any cardiac benefits from drinking have been overestimated.

So, to overcome any “methodological issues” of previous work the researchers used lifetime abstainers as the reference instead of abstainers.

In addition, they adjusted for confounders such as demographic variables, lifestyle factors and current health status.

However, the findings do not mean that lifetime non-drinkers should hit the bottle, caution editorialists, who suggest a randomised controlled trial is needed.

"Lifelong alcohol abstainers should not start drinking for health reasons only, but should be encouraged to adopt healthy lifestyles (regular physical activity, no smoking, weight control, and dietary habits such as the Mediterranean diet)," they wrote in an accompanying commentary.

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Sugar plus protein a recipe for weight gain.
Having a sugary drink with a high-protein meal is a recipe for weight gain, nutrition scientists say.

Their research suggests that a combination of the two negatively affects energy balance and causes the body to store more fat.

Specifically, they have found that about a third of the additional calories provided by the sugary drinks are not expended, fat metabolism is reduced and it takes less energy to metabolise the meals.

This decreased metabolic efficiency may “prime the body to store more fat”, says lead author Dr Shanon Casperson, from Washington’s Grand Forks Human Nutrition Research Center in the US.

“We were surprised by the impact that the sugar-sweetened drinks had on metabolism when they were paired with higher-protein meals,” Dr Casperson says.

This combination also increases the study subjects’ desire to eat savoury and salty foods for four hours after eating, he adds.

Dr Casperson explains that a sugary drink with a high-protein meal decreases fat oxidation by 8%.

“If a sugar-sweetened drink was consumed with a 15% protein meal, fat oxidation decreased by 7.2g on average,” he says.

“If a sugar-sweetened drink was consumed with a 30% protein meal, fat oxidation decreased by 12.6g on average.”

The results provide further insight into the potential role of sugary drinks in weight gain and obesity, write the authors in BMC Nutrition.

You can access the study here.
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Eating whole fruit is healthy, so it makes no sense to demonise all carbohydrates, writes Professor Garry Egger.

Scientists love a good paradox. And because the field of human nutrition is full of these, nutrition scientists could be mistaken for being in a constant state of arousal.

Here’s an example: If too much sugar in the diet is the main cause of the obesity epidemic, as the many proponents of anti-sugar diets claim, why is it that fruit, which contains lots of sugars (sucrose, fructose, glucose) is not only healthy, but associated with lower levels of body weight?

Let’s take the last point first. In a literature review,1 Korean scientists showed in a meta-analysis including several different study types (randomised controlled trials, prospective observation studies, cross-sectional studies), that high fruit consumption is regularly linked with reduced levels of overweight and obesity.

There are several possible explanations:

Fruits are high in fibre and water, and low in fat, and therefore displace energy from other food sources if eaten in large amounts;
The high fibre content of fruits increases satiety and hence reduces daily total food intake;
Micronutrients (vitamins, minerals) and non-essential phytochemicals in fruit have effects on reducing fat deposition and fat cell generation; and
Fruit in the diet may change bacteria in the gut to reflect a lean, rather than an obese, microbiota.
This is not to say that all forms of fruit are good for weight loss. Fruit juices, for example, which have a high concentration of sugars and minimal fibre, are associated with increased weight, particularly in children. Processed fruits (i.e. canned, dried) can also have additives or concentrated sugar levels that work against weight loss.

In general, however, most studies show that higher fruit intake is linked with lower body weight. Some even show that weight loss can be aided by increasing whole fruit intake.

In one prospective study of more than 74,000 borderline-overweight, middle-aged female nurses followed over 12 years, an increase of about two servings of fruit a day was associated with a 24% reduced risk of obesity. High fruit intake has also been shown to assist weight maintenance in normal-weight individuals.

A further complication has been the recent linking of fructose with weight gain and ill-health. This has been based on the use of high-fructose corn syrup as a sweetener in many foods in the US.

The use of corn syrup came about because of a political deal with farmers in the US and doesn’t occur in most other countries, including Australia. Also, the concentration of fructose in whole fruits, with fibre intact, is not enough to justify concern (although it could be an issue in fruit juice).

The vast majority of research has shown that, despite the demonisation of sugars as a whole in weight gain, the anti-obesity effects of fruit are significantly greater than any pro-obesity effects. The latter also seems to be based on the intake of processed (canned) or concentrated (dried), rather than whole, natural fruits.

-The sugar argument, if contingent on added sugars in uber-processed foods, no doubt has legs. Researcher Carlos Monteiro says processing is the problem, not foods.2

But to call all sugars bad carbs and say that all carbs are bad, is like saying that because mosquitoes cause disease, and mosquitoes are insects, therefore all insects cause disease!

The fruit paradox punches a hole in the argument that sugar alone has caused the modern obesity epidemic. Indeed, most singular explanations of complex processes are flawed.


Nutrients 2016; 8:633
Pub Health Nutr 2009; 12(5):729–31

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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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