Weekly Dose: from laughing parties to whipped cream, nitrous oxide’s on the rise as a recreational drug

 
Nitrous oxide inhaled out of a balloon gives the user euphoric feelings.

Nang is a slang name for the small metal cylinders usually used in whipped cream siphons. They are also called nossies or whippets. The cylinders have about eight grams of nitrous oxide in them that can be inhaled for a euphoric effect.

The 2016 global drug survey found nitrous oxide is the seventh most popular drug in the world excluding alcohol, tobacco and caffeine.

 

Who uses nangs?

Nang use seems to be increasing in Australia. An annual national survey of people who use ecstasy found a significant increase in the number of people also reporting recent nitrous oxide use from 26% of people surveyed in 2015 to 36% in 2016. But not much is known about how widespread nang use is.

The Australian household drug survey does not report nitrous oxide use specifically and does not list it in the range of pharmaceutical drugs or inhalants. A 2013 survey of 1,360 university students in New Zealand found 12% of the sample reported using nangs in the past year. The average number of bulbs used in one session ranged from two to six.

Picture of young people inhaling from balloons
  A survey of NZ university students found 12% had used nangs in the past year. from www.shutterstock.com

How do they work?

Nangs are cheap, legal and easy to get. A box of ten costs less than A$10 and they are stocked in supermarkets and service stations. To use them, the cylinder is pierced and the gas released into a balloon, then inhaled.

A balloon is used because the gas is freezing and can burn the face and lips. It takes about one minute to feel an effect that lasts about one minute.

Nitrous oxide is a colourless gas used for pain relief in hospitals and dentistry. It’s a dissociative anaesthetic. This means that at low doses, it gives a sense of floating and separation from the body without causing unconsciousness.

The positive effects of nangs are reported as euphoria, a feeling of floating and heightened consciousness. The negative effects include nausea, vomiting, disorientation and lack of oxygen to the brain. Some people make strange sounds and movements while intoxicated.

Picture of canisters
Canisters are very cheap. from www.shutterstock.com

Heavy users may get a vitamin B12 deficiency, because nitrous oxide inactivates B12 in the body. The symptoms include numbness and tingling in toes and fingers. Difficulty walking may happen in serious cases, that lasts until B12 levels are increased. Some regular users have reported memory loss and trouble concentrating. Seizures and collapse have also been reported, but usually when nangs are used in combination with other drugs.

How was it developed?

Nitrous oxide was synthesised by an English chemist, Joseph Priestly, in 1722 and used as a recreational drug at laughing gas parties. It wasn’t used as an aid to surgery until 1844.

Manufacturers started using nitrous oxide for whipping cream and making aerosols in 1869 and to increase engine performance in cars. An explosion in a Florida factory where nitrous oxide was made has reduced supplies in the USA, including in whipped cream products.

The word “nang” as a name for small nitrous oxide cylinders appears to be Australian. It’s thought to come from Western Australia, and mimics the sound distortion people hear while intoxicated. Nang is also a British slang word for excellent or awesome.

What are the long-term risks?

Seventeen deaths in six years in the UK were reportedly caused by nitrous oxide, while the USA reports about 15 deaths per year. Australia has not reported any. The long-term health risks associated with nitrous oxide use include B12 deficiency, brain damage from reduced oxygen, incontinence, depression and psychological dependence.

However, there are few reports of people using nangs for long periods of time. Nang use may be overlooked as a health risk because most people using them are likely to use other drugs as well. It’s also important to note that nitrous oxide is linked to climate change, so there are environmental risks too. This gas is about 300 times more damaging than carbon dioxide to the atmosphere.


This article was written by:
Image of Julaine AllanJulaine Allan – [Senior Research Fellow, Charles Sturt University]

 

 

 

 

 

This article is part of a syndicated news program via

Tom Petty died from a cardiac arrest – what makes this different to a heart attack and heart failure?

 
Tom Petty was said to have died from a heart attack, 
when it was actually a cardiac arrest. MIKE NELSON/EPA/AAP

Rolling Stone magazine landed in a spot of bother on Monday after publicising news of rock star Tom Petty’s death prematurely, while others said it was the result of a heart attack rather than a cardiac arrest. Petty unfortunately did subsequently pass away, from a cardiac arrest, but it’s important to note neither a cardiac arrest nor a heart attack is synonymous with death.

Albeit infrequently, sufferers of cardiac arrest can be revived and a heart attack is associated with a relatively low risk of dying within 18 months with current treatment in Australia. Both are types of heart disease, as is heart failure. So what are the differences between cardiac arrest, heart attack and heart failure?

The heart beats in a very controlled and synchronised manner. from shutterstock.com

Cardiac arrest

The easiest way to understand these conditions is to think of the heart like a building and approach it like a tradesman. Cardiac arrest is the sparkie’s domain because it’s essentially an electrical failure. The heart beats in a very controlled and synchronised manner, due to a flow of electricity from the “pacemaker” cells at the top of the heart (sinoatrial node) steadily down to the base.

The wiring is present throughout the heart, because the heart muscle cells themselves transmit and respond to this electrical signal, beating as it travels through and powers them. But there are also “mains” electricity circuits that direct the flow of energy and can act as backups along the way if one part of the circuit fails. These are the atrioventricular node, “bundle of His” and “Purkinje fibres” – all can cause the heart to beat, but at a slower rate than the sinoatrial node.

All this doesn’t always go according to plan. Diseases such as blocked arteries, genetic conditions and degeneration of the heart with ageing can cause disruptions to the circuit.

This may result in two things. The first is a power failure, with no electricity whatsoever – called “asystole”. The second is a surge of electricity from an area of the heart muscle that is disruptive and prevents the heart from pumping properly – the most dangerous of these surges are commonly referred to as ventricular arrhythmias. These are the two main types of cardiac arrest.

Both these conditions will stop the heart pumping. Because blood can no longer travel to the brain, the person will lose consciousness.

In the movies, they are treated with defibrillator paddles delivering electric shocks in a dramatic manner. But while this is an important treatment for ventricular arrhythmias, as it is able to re-organise the surge of electricity, it is ineffective for asystole (where there is no electricity at all).

Picture of paddles being used to revive a patient
In the movies, people with cardiac arrest are treated with paddles delivering electric shocks in a dramatic manner. from shutterstock.com

In this case, good-quality CPR is crucial. If someone is left too long without blood supply to their brain and the rest of the body, they will die. Survival from cardiac arrest occurring outside of a hospital setting in Australia is 24% after the day of event, dropping to 11.5% at one year later.

Heart attack

This is the plumber’s area. While a heart attack is often used to describe a range of heart problems, it actually refers to what is medically termed an acute myocardial infarction, or AMI.

The heart provides blood to the rest of the body, but it also needs its own blood supply and does not get it from the blood that flows through its chambers. Instead, the heart is supplied with blood, giving oxygen and taking away carbon dioxide, by arteries and veins that sit on the outside of the heart.

But our Western diet and lifestyle have contributed to extremely high rates of disease inside these arteries, termed “atherosclerosis”. This causes the arteries to narrow and can lead to sudden blockages, which result in heart attacks.

AMIs usually occur when there is a sudden rupture of the atherosclerotic plaque, containing cholesterol, fatty cells and immune cells. This causes a large blood clot to form, blocking off the blood flow.

Image of the heart
The heart is supplied with blood, giving oxygen and taking away carbon dioxide, by arteries and veins that sit on the outside of the heart. from shutterstock.com

When the heart muscle tissue that is usually supplied by these arteries no longer receives blood and oxygen, it starts to die within minutes, causing intense pain. Within 90 minutes, that whole section of heart wall can die, meaning it will not beat. This reduces the overall performance of the heart and predisposes it to the aforementioned ventricular arrhythmias (the dangerous surge of electricity).

Fortunately, modern medicine has markedly improved survival from heart attacks. In 1960, one-third of people died within a month of having a heart attack. This improved to 16% 18 months after having one in Australia in 2012.

Even though the survival rate from heart attacks is quite high, the burden of disease is heavy. Heart attacks are responsible for 12% of all deaths in Australia, and one Australian dies from a “heart attack” every 27 minutes.

Heart failure

Heart failure is a structural issue, so it’s the carpenter’s problem. It results from the heart being unable to adequately supply the body with blood, so the tissues don’t receive oxygen and other nutrients, and blood pools in the legs, abdomen and lungs. Heart failure either results from weakness in the strength of the pump, or stiffening of the heart so it loses elasticity and can’t fill with blood in the first place.

It is the end result of a myriad of conditions, from genetic disorders, to heart attacks, to infections and high blood pressure. Heart failure is more chronic than the other two. People with heart failure see a gradual worsening of shortness of breath, fatigue, swelling and light-headedness, with a significant impact on quality of life.

Death from heart failure is often as a result of cardiac arrest, as disruption to the construction of the house causes electricity problems too; along with organ failure from lack of oxygen supply due to failure to pump the blood and also fluid in the lungs reducing oxygen transfer.

The good news is all three of these conditions can largely be prevented and treated with a healthy lifestyle, seeing your doctor and taking medications to reduce your risk of heart disease.


This article was written by:
Image of Anna BealeAnna Beale – [Medical doctor, PhD candidate in cardiology, Monash University]

 

 

 

 

 

This article is part of a syndicated news program via

When life is coming to a close: three common myths about dying

Three common myths about dying Dying at home isn’t 
necessarily a good death. 

On average 435 Australians die each day. Most will know they are at the end of their lives. Hopefully they had time to contemplate and achieve the “good death” we all seek. It’s possible to get a good death in Australia thanks to our excellent healthcare system – in 2015, our death-care was ranked second in the world.

We have an excellent but chaotic system. Knowing where to find help, what questions to ask, and deciding what you want to happen at the end of your life is important. But there are some myths about dying that perhaps unexpectedly harm the dying person and deserve scrutiny.

Myth 1: positive thinking can delay death

The first myth is that positive thinking cures or delays death. It doesn’t. The cultivation of specific emotions does not change the fact that death is a biological process, brought about by an accident, or disease processes that have reached a point of no return.

Fighting the good fight, remaining positive by not talking about end of life, or avoiding palliative care, have not been shown to extend life. Instead, positive thinking may silence those who wish to talk about their death in a realistic way, to express negative emotions, realise their time is limited and plan effectively for a good death or access palliative care early, which has actually been shown to extend life.

For those living closer to the prospect of death, being forced to manage their emotions is not just difficult but also unnecessary, and counterproductive to getting the help we know is important at the end of life.

Myth 2: dying at home means a good death

The second myth is dying at home always means a good death. While Australians prefer to die at home, most die in hospital. Managing a death at home requires substantial resources and coordination. Usually at least one resident carer is needed. This presents a problem. Currently 24% of Australians live alone and that’s predicted to grow to 27% by 2031. We also know many Australian families are geographically dispersed and cannot relocate to provide the intensive assistance required.

The role of the carer may be rewarding but it’s often hard work. We know timing of death is unpredictable, depending on the disease processes. Nurses, doctors and allied health professionals visit, problem solve and teach the carer to perform end-of-life care. They don’t move in, unless they’re hired in a private capacity; a possible but pricey alternative. Finally, specialist equipment is required. While this is usually possible, problems can arise if equipment is hired out for a specific time and the patient doesn’t die within that allotted time.

It’s not a failure to die in a hospital, and may be the best option for many Australians. While it would appear that large public or private hospitals may not be the best places to die, in many areas they provide excellent palliative care services. Appropriate end-of-life planning needs to take this into account.

Myth 3: pushing on with futile treatment can’t hurt

A window of opportunity exists to have a good death. Pushing on with treatment that has no benefit or is “futile” can be distressing for the patient, family and the doctors. Doctors are not obliged to offer futile treatment, but unfortunately patients or family may demand them because they don’t understand the impact.

There are cases where people have been resuscitated against better medical judgementbecause family members have become angry and insisted. The outcome is usually poor, with admission to the intensive care unit, and life support withdrawn at a later date. In these cases, we have merely intervened in the dying process, making it longer and more unpleasant than it needs to be. The window for a good death has passed. We are prolonging, not curing death and it can be unkind – not just for those sitting at the bedside.

The story of a good death is perhaps not as interesting as a terrible one. Yet there are many “good death” stories in Australia. There are likely to be many more if some of the myths that surround dying are better understood.


This article was written by:
Image of Sarah WinchSarah Winch – [Health Care Ethicist and Sociologist, The University of Queensland]

 

 

 

 

 

This article is part of a syndicated news program via

Flu is a tragic illness. How can we get more people to vaccinate?

Flu Vaccination 
Most people don’t take flu seriously enough.

Flu (influenza) has traditionally been the underdog of vaccine-preventable diseases. People tend not to worry about the flu too much, and there are various myths about its prevention and the vaccine. It’s true most people experience flu as a mild disease, but many don’t recognise it can be more severe.

Each year flu is estimated to kill at least 3,000 Australians aged over 50 years alone. It took more children’s lives than any other vaccine preventable disease in Australia between 2005-2014, and is the most common vaccine preventable disease that sends Australian children to hospital.

The tragic death of eight-year-old Rosie Andersen from flu last week has followed the recent outbreaks in aged care facilities and subsequent deaths of residents in South AustraliaTasmania and Victoria. A 30-year-old father died earlier this month due to complications from the flu, and now Sarah Hawthorn, who was infected late in her pregnancy, remains in a coma, unaware her baby was safely delivered six weeks ago.

This year’s flu season has been a bad one. And it’s not over yet.

Australian studies have shown the flu vaccine can usually reduce the risk of flu in those who are vaccinated by 40-50%, and by 50-60% for childrenEarly indications are showing the effectiveness of this year’s flu vaccine may be lower.

Experts are calling for a better vaccine, which is needed. But even a more effective vaccine won’t address all the barriers to uptake.

Who’s most at-risk?

Annual flu vaccination is recommended for any person six months of age or older who wishes to reduce the likelihood of becoming ill with flu. It’s free for certain groups at higher risk of the severe effects of the disease including:

• people over 65 (80% of whom are vaccinated)

• Aboriginal and Torres Strait Islander people from six months to five years (12% of whomare vaccinated)

• Aboriginal and Torres Strait Islander people over 15 (34% of whom are vaccinated)

• pregnant women (45% of whom are vaccinated)

• people aged six months and over with medical conditions such as severe asthma, lung or heart disease, low immunity or diabetes (58% of these adults are vaccinated, and 27% of these children).

Why don’t they vaccinate?

Researchers have looked at why many people in these groups don’t have their yearly flu vaccine. A common theme emerges – health professionals are not recommending it enough, people aren’t aware they need it, they’re not sufficiently motivated, or they don’t have easy access.

These themes come out in studies with parents of  young children,  pregnant women,  Aboriginal and Torres Strait Islander childrenadults with other disease, and people over 65.

Image of a syringe
The flu vaccine isn’t free for all kids. from www.shutterstock.com

Our research is now looking at the children who end up in hospital with severe flu. We’re trying to better understand the barriers to flu vaccination, along with vaccine efficacy issues.

We’ve heard that not only are health care workers not recommending it enough, some doctors are even recommending against it, as they don’t believe the child is at risk. This is even though over half of children hospitalised from the flu are those without medical risk factors. Other times it’s simple awareness – parents didn’t know their child can receive a flu vaccine if they’re over the age of six months.

Busy lives can mean making time to go to the clinic for a vaccine falls down the list of priorities. A four-year-old in our study was hospitalised only three days before a visit to the clinic had been booked.

Some of the children in our study were not theoretically at high risk of flu and so not in the group where the vaccine is free. This was a major barrier, as it has been in other studies in children and adults. Parents report to us that their child is up-to-date with their scheduled vaccines, but annual flu vaccination is not being ticked off as it’s not on the schedule.

The challenge with flu vaccine is it’s given yearly. In the UK it’s recommended and funded for all children of primary school age using a school-based delivery program and currently between 53-58% of children have it. When this many children are vaccinated there can be indirect protection of others who are not vaccinated because the virus is not able to spread from person to person as easily.

Misconceptions about the flu vaccine

Misconceptions about flu vaccine are also a barrier: that it causes flu, that it’s not effective, that it’s not needed. People might say they never get the flu, not realising symptoms can be mild or not noticed and they can pass it on to the vulnerable. Others reported their belief was that the flu was not a serious disease. Some believed contracting flu “naturally” was likely to provide greater immunity.

Some parents also have concerns about the safety of the flu vaccine. Australians were spooked by a 2010 incident when there was a temporary suspension of flu vaccine for children under five after reports of an increase in the rate of convulsions in children.

The one vaccine found to be the cause (BioCSL/Sequiris Fluvax™) is no longer approved for use in children younger than five, but there are other seasonal flu vaccines children can have. But public and professional confidence is yet to fully recover, despite having reassuring safety data.

Image of a flu virus
People may say they never get the flu so they don’t need the vaccine, but you can pass on the virus without knowing you have it. from www.shutterstock.com
Western Australia has had a free child vaccine program for years which was achieving relatively good coverage, but this dramatically declined after 2010, and coverage languishes at around 15% today. In other words, mud sticks.

How to improve uptake

To improve uptake we first need timely and accurate coverage figures. We now have the capacity to get coverage estimates from the expanded Australian Immunisation Register but these are not yet available.

The vaccine needs to be recommended more often, available more readily, free and recommended as part of the schedule, and myths addressed more effectively.

We need to motivate and support health care workers to implement the recommendations, such as with automated reminders, incentives and performance indicators. Systems need to ensure people can get the vaccine easily – from the GP or other health clinic, the specialist clinic, the antenatal care clinic, or from an Aboriginal or Torres Strait Islander health worker.

Promoting flu vaccine to everyone is important, as is providing ease of access, awareness and opportunity. Although the flu vaccine isn’t perfect, it’s far better than no protection at all.


This article was co-authored by:
Image of Julie LeaskJulie Leask – [Associate Professor, University of Sydney]
and
Image of Samantha Carlson Samantha Carlson – [Research Officer for the National Centre for Immunisation Research and Surveillance, University of Sydney]

 

 

 

 

 

This article is part of a syndicated news program via

I’ve always wondered: does anyone my age have any chance of living for centuries?

 How likely is it that someone alive 
today may live for centuries?

Does anyone my age have any chance of living for centuries? Will younger generations have a chance? – Adam Barclay, 44, Newcastle.

One century? Yes, a decent chance. We might in theory be able to live for centuries. This is a dream that many are working towards – but we aren’t there yet.

The subject of living longer, and more importantly, healthier lives is now a serious, mainstream endeavour in biology and medical science.

Molecular biologists, geneticists, and nutritional scientists are reaching for the ultimate goal of delaying onset of age-related conditions, which would reduce the incidence of nearly every non-communicable disease ageing brings.

Although reduced disease burden is the public health goal that motivates governments and the medical science community to pursue ageing research, it is living longer – finding the elixir of youth, seeking immortality – that captures the public imagination.

With the exception of wars, famine, or major economic dislocation, human lifespan has been steadily increasing around the world for the past century. Life expectancy in Australia is around 83 years, the fourth greatest in the world. These gains are largely due to improved access to and quality of health care. We are yet to see the impact of therapies specifically targeted to treat ageing, which could turbo-charge this increase in life expectancy.

What researchers are working on

Most of the anti-ageing or “geroprotective” compounds under development work by mimicking the effects of calorie restriction or physical exercise. Lifelong calorie restriction, reducing calorie intakes by around 30%, is one of the strongest interventions known for extending lifespan.

For the past two decades, research into ageing has sought to determine which genes and molecular pathways are turned on and off by eating less and exercising more. This has resulted in the discovery of a number of pathways (called the sirtuins, insulin/IGF-I signalling, mTOR, and AMPK) that can be manipulated in animals to extend lifespan. An anti-diabetic drug called metformin activates one of these, and is being trialled to improve health in old age.

Another way to extend lifespan might be to remove so-called “senescent”, or old and damaged cells, which cause disease. But here’s the thing – those pathways extend lifespan by only up to 30%, which on a “normal” human lifespan of 83 years, takes us to merely one century.

While increasing life expectancy to over a century would be an astounding achievement, this is nowhere near the centuries that many people dream of. To achieve that, the biology of ageing will have to move beyond mimicking calorie restriction, tinkering with metabolism, and trimming away old cells.

Image of an empty plate
Calorie restriction is one of the most reliable ways to extend lifespan. from www.shutterstock.com

Possible future directions

Instead, we might look to nature for inspiration. The jellyfish Hydra has no discernable biological ageing, and is functionally immortal, most likely due to a high content of stem cells that can replenish the adult body. Another species, Turritopsis dohrnii, the “immortal jellyfish”, can reverse back from its adult body into its juvenile state, as a polyp growing on a rock, and then grow back into an adult, and repeat that cycle to achieve near immortality.

So how could we imitate the immortal jellyfish? Well, we could reprogram our “epigenomes” – which is the arrangement that keeps different parts of our DNA code turned on and off. Excitingly, we already know how to do this. There are just four genes, called “Yamanaka factors”, which rejuvenate adult cells back into embryonic stem cells – like Benjamin Button, this would mean turning our cells from aged adults back to those of a developing baby.

In theory, turning these factors on for the right amount of time in the right places could rejuvenate our bodies back into those of young people – at which point, in theory, we might be able to live for centuries.

The trick will be figuring out when, where, how much and for how long to turn these Yamanaka factors on. Too much, and our organs could turn into a mass of undifferentiated embryonic stem cells, which could grow back into the wrong tissue type. Too little, and there would be no effect. Getting the dosage just right could be very powerful. Testing for the first time in humans would be risky.

It’s worth remembering that extending lifespan alone is not the same as extending quality of life or healthy years. Advancement of lifespan should not occur by delaying death following long periods of sickness. Instead, shortening the amount of time people are unwell should be the ultimate goal.

At some point prior to death, everyone crosses the threshold of being independent, healthy and active, to becoming dependent, sick and immobile. The duration spent below this threshold is unique to the individual, but everyone agrees this time should be minimal in comparison to the person’s healthy years.

Lifestyle changes, and advances in technology and medicine, aim to maximise the proportion of time spent living life to the fullest and delaying the (unavoidable) onset of age-related conditions. But living for centuries remains a dream – for now.


This article is co-authored by:
Image of Lindsay Wu Lindsay Wu – [NHMRC Senior Lecturer, School of Medical Sciences, UNSW]
and
Image of Stefanie Mikolaizak Stefanie Mikolaizak – [ Postdoc Fellow, Robert Bosch Krankenhaus]

 

 

 

 

This article is part of a syndicated news program via

 

 

Health Check: what’s better for you, fresh, dried or frozen fruit?

Fresh, dried or frozen fruit? Frozen, dried and freeze-dried  
fruit are certainly convenient. But are they as good for you as fresh fruit? 

Eat more fruit and vegetables” is one of the most common recommendations we hear when we’re encouraged to eat healthily. But when it comes to eating more fruit, we get mixed messages about how healthy fruit really is.

Some say its sugar content means fruit isn’t as healthy as many experts suggest.

Others suggest fruit is healthy as its sugars are natural and are contained in the fruit’s cells. It’s thought we eat less of sugar contained in fibrous cells as it is more filling; we also absorb it more slowly than “free sugars” found in sugary drinks and processed foods.

Then there’s the range of fruit products you can buy – including traditional dried fruits and the newer freeze-dried products.

So, when it comes to eating healthily, which fruit is best? And how do these fruit products compare?

What’s in fruit?

The idea that fruit is good for you is largely based on the fact that many fruits have a low energy (calorie) content and are packed with nutrients. Nutrients include vitamins, minerals, fibre and bioactive nutrients (often pigment compounds known as polyphenols and carotenoids).

Fruit also contains sugar, and the content can vary considerably. Some are very low in sugar, like cranberries (3.5% sugar) and blackberries (1.5%).

But some tropical fruit contain surprisingly high levels. These include mango (14% sugar) and jackfruit (19%).

The type of sugar in fruit can also vary according to the type of fruit and also how ripe it is. Generally, the most common sugar in fruit is fructose, typically making up 40-55% of the sugar in most fruit. Sucrose (normal table sugar) makes up most of the rest.

While some people say fructose is worse for you than other sugars, there is limited evidence for this.

How does freezing affect fruit?

Freezing tends to involve minimal processing, with only brief heat treatment before freezing to stop enzymes breaking down the fruit that would otherwise lead to spoilage and flavour changes.

Freezing generally is a good way to preserve nutrients compared to other methods like canning and refrigeration. This is mainly linked to the relatively short period of heat treatment used to blanch food before freezing compared to longer heat treatments for canning.

Thawing should not lead to significant nutrient loss. However, the effect of ice crystals damaging cells during freezing soft fruit can lead to the fruit turning to a mush and then water soluble vitamins and minerals leaking out.

How does drying affect fruit?

Drying (losing water) concentrates the fruit’s sugar dramatically. For example, apricot sugar levels rise from 9.5% when fresh to 54.2% when dried.

This is why some have described dried fruits as like sugar bombs. Although the World Health Organisation does not classify dried fruit as something we should limit in the diet.

Image of dried apricots
Dried fruit, like these dried apricots, contain higher sugar levels than their fresh equivalent. from www.shutterstock.com

Dried fruit can also be six times higher in energy than their fresh equivalents, due to a concentration effect through the removal of water. So, if you are trying to watch your weight, it would be sensible to watch your serve sizes of dried fruits.

But it’s not all bad news for dried fruit. Drying increases levels of some vitamins and minerals, again through the effect of concentrating the nutrients when water is lost. This means a 30g serve of dried apricots can contain over 5% the daily recommended intake of iron; you would need to eat 175g of fresh apricots to get the same amount.

How about freeze-drying?

Freeze-drying involves first freezing a fruit and then placing it in a vacuum under very low pressures. Low pressure causes ice crystals to rapidly sublime, turning them straight from solid ice into water vapour. This process removes water much more efficiently than traditional drying.

Effectively, the fruit’s water content is reduced but the fruit’s structure is maintained. This makes this method of preserving food particularly suited to soft fruit, like raspberries and strawberries, which are low in sugar.

Freeze-drying is said to be one of the fastest growing trend in food, with sales of freeze-dried fruit forecast to reach US$66.5 billion by 2021.

While the public perceives freeze-dried fruit as a healthier alternative to candied fruit and possibly dried fruit, freeze-dried fruit has a much higher sugar content than its fresh equivalent.

And as freeze-drying is a more efficient way to remove water than traditional drying, it can mean per 100g, freeze-dried fruit can contain more sugar than dried fruit.

Image of freeze dried strawberries
These freeze dried strawberries contain 14 times as much sugar as fresh ones. from www.shutterstock.comSo, fresh strawberries contain 4.9% sugar. But freeze-dried strawberries contain 71% sugar, a 14-fold increase. That’s a sugar content similar to some lollies.

Like freezing, freeze-drying helps to preserve nutrients. However, we will still see losses in these, especially vitamin C.

But as freeze-dried fruits contain less water than fresh fruits, you could end up eating more pieces of them than fresh, which means more nutrients (but also more energy and sugar).

So, what’s the bottom line?

The bottom line is to try and eat more fruit, in the least processed form possible, ideally fresh.

And if you choose dried or freeze-dried fruit for convenience, these contain more concentrated sugar than the original fresh product.


This article was co-authored by:

 

 

 

 

This article is part of a syndicated news program via

How the media oversold standing desks as a fix for inactivity at work

 Media reports failed to mention limits to evidence  
in new guidelines about sitting and moving at work, and missed commercial 
interests  that were initially not disclosed.

 

Sitting is so culturally ingrained at work, at the wheel, in front of the TV and at the movies, it takes a great effort to imagine doing these things standing up, let alone peddling as you work at a “bike desk”.

So, when the world’s first specific guidelines on sitting and moving at work were published, they generated headlines such as:

Abandon your chair for four hours to stay healthy, office workers are told
and:
Stand up at your desk for two hours a day, new guidelines say

But what many media reports did not mention was the guidelines were based on limited evidence. They were also co-authored by someone with commercial links to sit-stand desks (desks you raise and lower to work at standing or sitting), a link not declared when the guidelines were first published in a journal.

Media reports also overplayed the dangers of sitting at work, incorrectly saying it wiped out the benefits of exercise.

Our new study reveals the nature of this media coverage and its role in overselling sit-stand desks as a solution to inactivity at work.

Yes, sitting is associated with health risks, such as dying early from any cause, having heart disease and even cancer progression. So, no wonder we want to know if we should be sitting less.

Employers are also starting to see sitting as an occupational health and safety issue and sit-stand desks, standing desks and even treadmill desks are popping up at work.

To address these issues, the guidelines recommended measures including:

  • aiming for two hours a day of standing and light activity (slow walking) during working hours, eventually progressing to a total of four hours a day for all office workers with mainly desk-based roles
  • regularly breaking up sit-down work with standing using adjustable sit-stand desks or work stations
  • avoiding long periods of standing still, which may be as harmful as long periods sitting
  • changing posture and doing some light walking to alleviate possible musculoskeletal pain and fatigue, and
  • recommending employers warn staff about the potential dangers of too much sitting at work or at home, as part of workplace health and wellness activities.

How did the media report this?

Our team analysed news articles about the guidelines published in media outlets around the world.

We found all the articles reported the top-line recommendation to reduce sitting by two hours a day, and to replace the sitting with standing or slow walking.

Almost two-thirds of articles also noted the recommendation that people should regularly break up seated work with standing, and that this could be done with a sit-stand desk.

Image of a person sitting at a desk
The guidelines recommended breaking up long periods of sitting down at work. But are sit-stand desks the answer? from www.shutterstock.com

Even though the guidelines’ authors said the recommendations were based on the best evidence so far and more evidence was needed, these caveats did not make it into most news media reporting.

These caveats are important because the authors acknowledge the evidence quality is weak and that guidelines are likely to change.

Commercial interests

The news media also seemed to be unaware of amendments to the journal article, including to expand the disclosure of competing interests to clarify one author, Gavin Bradley, has a connection to the business of selling sit-stand desks.

The revised version notes Gavin Bradley is 100% owner of a website that sells sit-stand work products called Sit-Stand Trading Limited. He is also director of the Active Working Community Interest Company (CIC).

The Active Working CIC runs the Get Britain Standing campaign and is active in other parts of the world including the EU, USA and Australia.

According to the Australian arm, Get Australia Standing, these campaigns aim to raise awareness and educate the community about:

… the dangers of sedentary working and prolonged sitting time.

The website also features a range of sit-stand work products and providers.

We are not suggesting Gavin Bradley skewed the sit-stand desk evidence in the guidelines. But the initial failure to disclose his interests is a concern.

No, sitting doesn’t cancel out exercise

In our study, we also found more than one-third of articles incorrectly warned that too much sitting cancels out the benefits of exercise.

This is contrary to recent research showing high levels of moderate intensity physical activity (about 60–75 min a day) seem to eliminate the increased risk of early death associated with high levels of sitting time (eight hours a day or more).

Image of a runner, at the starting block
Most media reports claimed that sitting cancels out the benefits of exercise, which isn’t true. from www.shutterstock.com

This rigorous study, analysing data from one million adults, also found this high activity level reduces, but does not remove, the increased risk linked to high levels of TV-viewing.

Yet, this study does not appear among the research resources on the Get Australia Standing campaign website, which appears to promote the message that it doesn’t matter if you are physically active, if you sit a lot you are doing yourself harm.

How realistic are the recommendations anyway?

Regardless of the media reporting of the guidelines, we need to ask ourselves how realistic the guidelines are.

The recommendations may be premature and hard to put into practice given that studies involving motivated participants have only managed to reduce the time spent sitting by 77 minutes in an eight-hour work day.

Workers may use sit-stand desks and they may reduce sitting time but the evidence is not yet in to show this produces detectable health benefits, at least in the short term. And standing too long at work has been linked to an increased risk of heart disease.

The guidelines also contrast with recently updated Australian national physical activity guidelines.

These make general recommendations to sit less and break up periods of uninterrupted sitting because the experts conclude the evidence does not point to a specific amount of sitting time at which harm begins.

Given the evolving research field and the vested interests, we need to pay attention to sitting time, standing, and physical activity levels as well as the role of industry players and their contribution to advice on health.


This article was co-authored by:

Image of Catriona BonfiglioliCatriona Bonfiglioli – [Senior Lecturer, Media Studies, University of Technology Sydney]

and

Image of Josephine ChauJosephine Chau – [Lecturer in Prevention and Research Fellow in Public Health, University of Sydney]

 

 

 

 

This article is part of a syndicated news program via

 

Science or snake oil: is manuka honey really a ‘superfood’ for treating colds, allergies and infections?

Healing properties of manuka honey Sure it tastes nice, but what else 
can it do?

Manuka honey is often touted as a “superfood” that treats many ailments, including allergies, colds and flus, gingivitis, sore throats, staph infections, and numerous types of wounds.

Manuka can apparently also boost energy, “detox” your system, lower cholesterol, stave off diabetes, improve sleep, increase skin tone, reduce hair loss and even prevent frizz and split ends.

Some of these claims are nonsense, but some have good evidence behind them.

Honey has been used therapeutically throughout history, with records of its cultural, religious and medicinal importance shown in rock paintings, carvings and sacred texts from many diverse ancient cultures.

Honey was used to treat a wide range of ailments from eye and throat infections to gastroenteritis and respiratory ailments, but it was persistently popular as a treatment for numerous types of wounds and skin infections.

Medicinal honey largely fell from favour with the advent of modern antibiotics in the mid-20th century. Western medicine largely dismissed it as a “worthless but harmless substance”. But the emergence of superbugs (pathogens resistant to some, many or even all of our antibiotics) means alternative approaches to dealing with pathogens are being scientifically investigated.

We now understand the traditional popularity of honey as a wound dressing is almost certainly due to its antimicrobial properties. High sugar content and low pH mean honey inhibits microbial growth, but certain honeys still retain their antimicrobial activity when these are diluted to negligible levels.

Many different types of honey also produce microbe-killing levels of hydrogen peroxidewhen glucose oxidase (an enzyme incorporated into honey by bees) reacts with glucose and oxygen molecules in water. So, when honey is used as a wound dressing it draws moisture from the tissues, and this reacts to produce hydrogen peroxide, clearing the wound of infection.

The antimicrobial activity of different honeys varies greatly, depending on which flowers the bees visit to collect the nectar they turn into honey. While all honeys possess some level of antimicrobial activity, certain ones are up to 100 times more active than others.

How is manuka different to other honey?

Manuka honey is derived from the nectar of manuka (Leptospermum scoparium) trees, and it has an additional component to its potent antimicrobial activity. This unusual activity was discovered by Professor Peter Molan, in New Zealand in the 1980s, when he realised the action of manuka honey remained even after hydrogen peroxide was removed.

The cause of this activity remained elusive for many years, until two laboratories independently identified methylglyoxal (MGO) as a key active component in manuka honey in 2008. MGO is a substance that occurs naturally in many foods, plants and animal cells and it has antimicrobial activity.

Australia has more than 80 species of native Leptospermum, while New Zealand has one, but the “manuka” honeys from each country have similar properties. There is currently a great deal of debate between the two countries over the rights to use the name “manuka”, but for simplicity in this article we use the term to describe active Leptospermum honeys from either country.

Can manuka honey kill superbugs?

The activity of manuka honey has been tested against a diverse range of microbes, particularly those that cause wound infections, and it inhibits problematic bacterial pathogens, including superbugs that are resistant to multiple antibiotics.

Manuka honey can also disperse and kill bacteria living in biofilms (communities of microbes notoriously resistant to antibiotics), including ones of Streptococcus (the cause of strep throat) and Staphylococcus (the cause of Golden staph infections).

Crucially, there are no reported cases of bacteria developing resistance to honey, nor can manuka or other honey resistance be generated in the laboratory.

Image of manuka honey
There is good evidence manuka honey kills bacteria. Ryan Merce/Flickr

It’s important to note that the amount of MGO in different manuka honeys varies, and not all manuka honeys necessarily have high levels of antimicrobial activity.

Manuka honey and wound healing

Honey has ideal wound dressing properties, and there have been numerous studies looking at the efficacy of manuka as a wound dressing. Apart from its broad-spectrum antimicrobial activity, honey is also non-toxic to mammalian cells, helps to maintain a moist wound environment (which is beneficial for healing), has anti-inflammatory activity, reduces healing time and scarring, has a natural debriding action (which draws dead tissues, foreign bodies and dead immune cells from the wound) and also reduces wound odour. These properties account for many of the reports showing the effectiveness of honey as a wound dressing.

Honey, and in particular manuka honey, has successfully been used to treat infected and non-infected wounds, burns, surgical incisions, leg ulcers, pressure sores, traumatic injuries, meningococcal lesions, side effects from radiotherapy and gingivitis.

What about eating manuka honey?

Most of the manuka honey sold globally is eaten. Manuka may inhibit the bacteria that cause a sore (“strep”) throat or gingivitis, but the main components responsible for the antimicrobial activity won’t survive the digestion process.

Nonetheless, honey consumption can have other therapeutic benefits, including anti-inflammatory, anti-oxidant and prebiotic (promoting the growth of beneficial intestinal microorganisms) properties. Although, these properties are not solely linked to manuka honey and various other honeys may also work.

What doesn’t it do?

There is a commonly touted belief that eating manuka (or local) honey will help with hay fever because it contains small doses of the pollens that are causing the symptoms, and eating this in small quantities will help your immune system learn not to overreact.

But there’s no scientific evidence eating honey helps hay fever sufferers. Most of the pollen that causes hay fever comes from plants that are wind pollinated (so they don’t produce nectar and are not visited by bees).

There is some preliminary work showing honey might protect from some side effects of radiation treatment to the head and neck that warrants further investigation. But other claims honey has anti-cancer activity are yet to be substantiated.

Image of honey being applied to hair
If you’re putting honey in your hair you’re probably just making a sticky mess. from shutterstock.com

There isn’t any robust scientific evidence that manuka lowers cholesterol, treats diabetes or improves sleep. Although one interesting study did show honey was more effective than cough medicine for reducing night time coughs of children, improving their sleep (and their parents’). Manuka honey wasn’t used specifically, but it may well be as helpful.

Claims that anything helps to “detox” are innately ridiculous. Similarly “superfood” is more about marketing than much else, and the cosmetic and anti-ageing claims about manuka are scientifically unfounded.

Final verdict

If consumers are buying manuka honey for general daily use as a food or tonic, there is no need to buy the more active and therefore more expensive types. But the right kind of honey is very effective as a wound dressing. So if manuka is to be used to treat wounds or skin infections, it should be active, sterile and appropriately packaged as a medicinal product.

The best way to ensure this is to check the product has a CE mark or it’s registered with the Australian Therapeutic Goods Administration (marked with an AUST L/AUST R number).

Manuka honey isn’t a panacea or a superfood. But it is grossly underutilised as a topical treatment for wounds, ulcers and burns, particularly in the face of the looming global superbug crisis.


This article was co-authored by:

Image of Nural CokcetinNural Cokcetin – [Postdoctoral Researcher, University of Technology Sydney] and

 

Image of Shona BlairShona Blair – [General Manager, ithree institute UTS]

 

 

 

 

This article is part of a syndicated news program via

 

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

 
The type of fatty acid is what’s most important when choosing a spread. 

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

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

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

Where do our favourite yellow spreads come from?

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

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

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

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

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

It’s all in the fatty acids

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

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

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

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

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

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

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

Check the labels

Image of a bottle of olive oil
Extra-virgin oil protects against heart disease.from shutterstock.com
 

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

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

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

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

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

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

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


This article was written by:

Pregnant women shouldn’t start taking vitamin B3 just yet: reports it prevents miscarriage and birth defects are overblown

 The much-hyped study didn’t actually test  
vitamin B3 supplementation in humans. 

Reports on a new study claim supplementation with vitamin B3 during pregnancy could prevent miscarriages and birth defects.

So should all pregnant women start taking B3 supplements? Not so fast. While this is an interesting and well-done study, the researchers didn’t actually give vitamin B3 to any humans, so we need a lot more information before we can recommend it.

What the study found

The study identified genetic causes of a rare type of birth defect called “VACTERL association”. VACTERL stands for vertebral defects, anal atresia (problems with the tissue closing the anus), cardiac defects, tracheo-esophageal fistula (an abnormal connection between the windpipe and the foodpipe), renal anomalies (kidney defects), and limb abnormalities. Affected babies have anomalies in at least three of these.

US statistics show about one in 10,000-40,000 babies are affected by VACTERL association and some of these babies die. There are about 310,000 babies born in Australia each year.

The study authors looked at the genes of 13 families affected by this type of birth defect. For the defect to be passed on to offspring it has to be present in both parents’ genes – if it’s only present in one gene the other healthy one will compensate.

They pinpointed the variations in two genes responsible for these defects in four of the families. These two genes play a role in making “nicotinamide adenine dinucleotide” or NAD, which helps cells make energy out of glucose. NAD also assists in repairing DNA. NAD is synthesised in the body from tryptophan, an amino acid, or from niacin, also known as vitamin B3.

Then the authors genetically engineered mice and deleted these genes. They found that without them the mice had NAD deficiency, and similar malformations in their offspring.

However, when they provided extra niacin to pregnant mice, the pups were relatively normal despite the absent gene.

What does this mean?

This does NOT mean that taking niacin/vitamin B3 in pregnancy prevents miscarriages and all birth defects.

It means that high levels of niacin in pregnancy compensates for defects in the two selected genes, and prevents mice from experiencing miscarriage and birth defects in offspring. The paper does not report on human miscarriage or on malformations in human organs. The study did not supplement pregnant women with vitamin B3, or with anything else.

There have been previous studies showing mutations in other genes are also associated with VACTERL and it’s likely that different genes contribute to these malformations. Not all babies with VACTERL will have the same mutations.

But it’s important we understand the role of different genes in birth anomalies and this paper has not only identified genetic mutations in two genes, but also the mechanism by which they cause them and an easily obtained potential remedy for these cases.

Image of vitamin B tablest
Several B vitamins are related to birth defects. from www.shutterstock.com

Other causes of miscarriage

A large number of genes when deleted in mice have been shown to cause miscarriage and malformations. Many of these are not involved in the NAD pathway. Most have not been associated with human miscarriage but a few may be.

For example, deficiency in an immune system molecule (cytokine) called “GM-CSF” has been shown to cause miscarriage and defects in the placenta in mice. Addition of this molecule to IVF embryos prevents miscarriage in mice and in humans prevents miscarriagein high-risk women (those who have previously had a miscarriage following IVF). This is but one example unrelated to NAD.

Can supplements prevent birth defects?

From 1986-2007, 5.9% of South Australian births (so 590 out of 10,000) were complicated by congenital malformations, most of which were not severe or life threatening. The most common malformations are in the urinary and genital systems (164/10,000 births) and the cardiovascular system (119/10,000) and range from mild to severe life-threatening malformations requiring extensive surgery.

For many of these there is no known cause nor remedy. For neural tube (brain and spine/spinal cord) defects such as spina bifida (which occur in 16 in 10,000 births), maternal supplementation with folic acid from one month before conception and in the first trimester of pregnancy has been shown to reduce their incidence.

The Australian population is not considered to be deficient in niacin. Most breakfast cereals have niacin added to them as do some flours for baking; it is also present in meat, green vegetables and whole grain cereals.

2010 study in California showed that in women who did not use micronutrient supplements in pregnancy, low dietary intakes of folate, niacin, riboflavin, and vitamins B12, A and E were associated with one specific major heart defect but not another. So not one, but a number of micronutrients are involved in birth defects, notably several B vitamins.

Image of the announcement made regarding vitamin B
Not all of the reports are backed by the science. Screenshot, victorchang.edu.au

Clearly, folic acid supplementation to prevent neural tube defects has been successful, but emerging evidence suggests a potential downside. Specifically, the babies of women who supplemented with folic acid in late pregnancy were more likely to have persistent asthma in early childhood.

Since 2009 we’ve had mandatory fortification of flour for bread-making with folic acid in Australia and New Zealand. Together with folic acid supplementation in pregnancy, pregnant women are getting high amounts of folic acid. Given folate plays a part in gene expression (the process by which information from a gene is used), it’s possible too much may not be a good thing. But we’re yet to see hard evidence of this.

This new study is scientifically excellent and the authors have great credentials. But media reports, and the research institution itself, have made claims not supported by the science. Whether niacin is useful in human miscarriage has not been studied. The birth defects studied in the paper are rare and whether the findings apply to others is yet to be determined.

So potential parents need to be aware that, no, we have not found a way to prevent miscarriages and birth defects. And potential mothers should not start supplementing their diets with high levels of vitamin B3 because it hasn’t been tested in humans, and we don’t know what effects it will have.

 

This article was written by:
Image of Claire RobertsClaire Roberts – [Lloyd Cox Senior Professorial Research Fellow, University of Adelaide]

 

 

 

 

This article is part of a syndicated news program via