The Greatest Error in the History of Medicine?

High carbohydrate, low fat diets: A time for change?

Is your “healthy” diet:

1. Really all that good for you?
2. Doing you more harm than good?
3. Slowly killing you?
4. Based off the greatest error in the history of medicine?

Is it time for change?

Earlier in 2015 Nutrition Australia produced an updated version of the “Food Pyramid” which was seen as a big step towards reversing the trend of our heavily processed carbohydrate rich diet. 

The new model moved fruits & vegetables to their rightful place as stand-alone holders at the base of the pyramid, wholemeal grains were shifted up a tier and the “sometimes foods” such as confectionary and burgers were removed completely, along with margarine’s and added sugar.

But is this really enough to reverse the worrying trend of population obesity leading to chronic disease that is devastating westernised society?

Professor Tim Noakes, an “A rated” South African professor & co-founder of the Sports Science Institute of South Africa strongly disagrees with the inclusion of Carbohydrates at all in a “healthy” diet.

Professor Noakes published in a recent 2015 peer reviewed meta-analysis discussion piece 5 key arguments as to why the current “low fat” dietary recommendations “Represent the single greatest error in the history of medicine”.

With bold statements such as that you would hope there would be strong scientific evidence backing it up… There is no shortage of peer reviewed evidence that makes for compelling reading.

The 5 key points outlined were:

1. Absence of scientific proof in original food guideline implementation
2. Explosive increase in Obesity & Type II diabetes since their introduction
3. Scientific explanation into why Obesity & Type II diabetes would increase under a high carbohydrate low fat diet
4. A low carbohydrate, high fat diet reverses all known risk factors for cardiovascular disease and Type II diabetes
5. Recent multi-million dollar studies have disproven the effect of a low fat diet in reducing the risk of cardiovascular disease    

So without going into scientific mumbo jumbo what does this mean for the everyday individual when we hit the shopping aisles and are preparing foods for ourselves and our family?

Here are 3 very simple tips to make the healthiest choices regarding your food intake: 

1. Fresh is best!

-          Eat more foods that don’t require you to open a packet. Fresh fruit, vegetables, meat, fish, dairy, eggs, nuts and seeds are a great start, and give you plenty of options!

2.  Carbohydrates aren’t the devil, but make sure they have a secondary benefit.

-          It is unfair to tar all carbohydrates with the same brush, unprocessed carbs such as whole fruits and vegetables provide a secondary benefit as great sources of fibre essential for good health. Carbohydrates also play an important role in the performance of athletes.

3.    Knowledge is power! Know what you are eating, plan ahead in advance.

- Most of the time the simplest and easiest option is not always the healthiest. Know what you are eating and when, make sure it is good for you and you are on your way to fantastic health and vitality! 

For more information regarding reduced carbohydrate diets, and to see if they could work for you, please call 9783 9990 or email info@tsic.com.au

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There is no right or wrong way to feel when you hear bad news about your condition. You might feel numb at first, and unable to take in the news, or strangely calm and matter-of-fact. As time passes, you may experience a range of emotions. It’s normal to feel some or all of the following: 

• shock
• fear
• anger
• resentment
• denial
• helplessness
• sadness
• frustration
• relief
• acceptance

You may also feel isolated and alone, even if you have family and friends around you.

You might not experience all of these feelings, and if you do they will not necessarily come in any particular order. Whatever you feel, you do not have to go through it alone.

When you hear the news

Hearing that your illness cannot be cured can be a frightening experience. Many people will be unable to take everything in. If you are alone in the consultation, ask if you can bring a relative or friend in to hear everything the doctor has to say. This may involve asking for a follow-up appointment so that someone can be with you. 

Ask the doctor what support is available to you. They may refer you for additional specialist palliative care alongside the care you are already receiving.

Your GP will also know of any local sources of support. Get in touch with your GP to explain what has happened and ask what help is available near you. This may include information services about your illness, financial benefits you may be entitled to, support groups and counselling.

You can use the "services near you" box at the side of the page to search for services in your area, or you can use the Find me help service on the Dying Matters website.

Find someone to talk to

Not everyone wants to talk about what they are going through. Some people might not want to talk about it at all at first, and this is normal.

However, a terminal (sometimes called life-limiting) diagnosis can bring up worries and fears, and it can help to talk about these so that they do not start to feel impossible to deal with.

You might want to talk to your partner, family, or friends, or to a doctor, nurse, counsellor, or chaplain.

People close to you will be dealing with their own feelings about your diagnosis. If you or they are finding it hard to talk about it, you might want to talk to someone less close to you. Your doctor or nurse can help you to find a counsellor, or you can search for counselling services in your area.

You may also want to talk to other people who are in a similar situation. This can help if you are feeling alone or confused about how others deal with the news that they are dying.

You can ask your doctor or nurse about local support groups for people who are living with a life-limiting illness, or for people who have the same condition as you. You can also look on the internet. Many specialist charities offer support through local groups, email contact, phone lines and web forums. For example, Marie Curie has an online community.

Some people keep a blog or online diary about living with a terminal illness. Dr Kate Granger's blog talks about her life as both a doctor and terminal cancer patient. 

You can find out more about talking to children about your illness.

It can also be useful to have someone to talk to at night time. Liz Bryan, nurse practitioner at St Christopher’s Hospice, London, says: “The night time can be particularly hard, lying in the dark and thinking about what it will be like to die. Make sure you have someone you can ring, but also don’t make yourself lie in the dark. Turn on the light, read a book, recognise that you don’t have to keep on trying to sleep.”

Living with uncertainty

Knowing that you have a life-limiting condition inevitably leaves you living with uncertainty. You will probably have questions to which there are no definite answers, such as how and when your body is going to change, the effect this will have on your independence and your relationships, what will happen at work, and exactly how much time you have left.

Not knowing exactly what is going to happen to you can feel overwhelming and upsetting. It is normal to feel like this, and it is OK to talk to people about how you are feeling.

It might also be helpful to talk about this with others who are in a similar situation, and to hear how they cope with these feelings.

If you think you are depressed

Everyone is unique and you will react in your own way to news that your condition is life-limiting. It is normal to feel shock, sadness, anger and helplessness.

However, for some people, the feeling that they are not able to cope with their situation does not go away, and they feel too low to be able to do any of the things they want to. If this happens to you and these feelings persist, it may be helpful to talk to your doctor.

Medication often helps and counselling or cognitive behavioural therapy (CBT) can make a difference to how you are coping.

Find out about benefits

You may be entitled to benefits if you are ill and need treatment or care. These include travel costs if you need to go to hospital for treatment, prescription costs and the Personal Independence Payment (PIP). The PIP replaced the Disability Living Allowance in April 2013. Your carers may qualify for benefits too.

You can ask your nurse or doctor to find out what benefits you are entitled to. You can also contact the Citizens Advice Bureau, or use the GOV.UK benefits calculator.

Read more about money issues and what you and your carers may qualify for.

Living with your diagnosis

Penny Hansford, director of nursing at St Christopher’s Hospice, offers the following suggestions, which you might find helpful.

One step at a time

What you are dealing with can feel overwhelming, but you may be able to make it feel less so by thinking about it as smaller "pieces".

“It’s an old saying, but take one step at a time,” says Penny. “Try to put life into bite-sized chunks, so take one day at a time, or one week at a time.” Decide on some small, achievable goals, so that you gain confidence. This could be something like putting family photos into an album, or visiting a friend.

You can still think about bigger issues, such as where you would like to receive your care in the future, but don’t feel that you have to tackle everything at once.  

Write down your worries

Some people feel helpless and that everything is out of control. Writing down worries and questions can begin a process of deciding what is important to you and how to tackle it.

Penny says: “Start by thinking about what the important issues are for you, what things you want to do, what your feelings and worries are. Making that a bit more concrete by writing it down can help you put some structure around what may feel unmanageable and chaotic.”

If you want, you can use what you have written to help you talk about things with your family, friends and carers.

Look after yourself

Try to take some time to do things you enjoy. This is particularly important when you are feeling tired and weak.

Complementary therapies, such as massage and aromatherapy, may help you feel better. You will probably have many concerns about the people close to you and it will help them if they know you are looking after yourself. There may be things that you can do together.

If friends and family offer help, try to accept this and give specific examples of support you need and would like. For example, someone might be able to help by taking you shopping, bringing you some meals to put in the freezer, or driving you to appointments.

Healthtalk.org has videos and written interviews of people talking about their feelings when told they had a life-limiting illness and their emotions in the following weeks and months.

They also have videos of people reflecting on the positive aspects of knowing they are approaching the end of life and talking about how their philosophy or faith helps them.

10 Top Medical Breakthroughs

Exciting advances to health care are coming next year

by Candy Sagon

A mind-controlled robotic limb may help those who suffer from paralysis in the future. — Zackary Canepari/ The New York Times/Redux

En español |A game-changing new clot retriever for strokevictims. A way to restore movement by linking the brain to paralyzed limbs. New vaccines for our deadliest cancers. These will be the biggest medical advancements for 2016, according to three nationally known experts: Francis Collins, M.D., director of the National Institutes of Health; Michael Roizen, M.D., director of the Cleveland Clinic's Wellness Institute; and pathologist Michael Misialek, M.D., of Tufts University School of Medicine and Newton-Wellesley Hospital. Here are their top predictions.

1. Personalized treatment

What if you could get medical care tailored just for you, based on genetic information? The Precision Medicine Initiative, set to launch in 2016, would revolutionize how we treat disease, taking it from a one-size-fits-all approach to one fitted to each patient's unique differences. The project, Collins says, hopes to answer such important questions as: Why does a medical treatment work for some people with the same disease but not for others? One million volunteers will be asked to share their genomic and other molecular information with researchers working to understand factors that influence health.

2. Busting brain clots

A tiny new tool to get rid of brain clots will be a "game changer for stroke treatment," Roizen says. Although clot-dissolving drugs are the first line of treatment for the most common type of stroke, when they don't do the trick, physicians can now use a stent retriever to remove the small mass. A wire with a mesh-like tip is guided through the artery into the brain to grab the clot. When the wire is removed, the clot goes with it. The American Heart Association has given the device its strongest recommendation, after studies found it improves the odds that certain patients will survive and function normally again.

3. Brain-limb connection

The goal of linking the brain to a robotic limb to help paralyzed people and amputees move naturally is closer than ever. Previously, brain implants to help move these artificial limbs have had limited success because the person had to think about each individual action (open hand, close hand) in order to move the limb. But now researchers are putting implants in the area of the brain that controls the intention to move, not just the physical movement itself. This allows patients to fluidly guide a robotic limb. "We think this will get FDA approval in the next year and will have a major clinical impact on paralyzed patients," Roizen says.

4. Fine-tuning genes

Next year could see major strides toward the goal of cutting harmful genetic mistakes from a person's DNA. A gene-editing tool is a powerful technology that allows scientists to easily correct or edit DNA. "It basically gives you a scissors to cut out pieces of genes," Roizen explains. The technology was recently used to eradicate leukemia in a British child by giving her gene-edited immune cells to fight off the disease. This could represent a huge step toward treating other diseases, including correcting gene mutations that cause inherited diseases, but ethicists and scientists worry the technology could also be used to alter traits for nonmedical reasons.

5. New cancer vaccines

Your body's immune system fights off germs that cause infections — could it be taught to fight off cancer cells? That's the idea behind new immunotherapy cancer vaccines, which train the immune system to use its antiviral fighting response to destroy cancer cells without harming healthy cells. The Food and Drug Administration (FDA) already has approved such vaccines for the treatment of advanced prostate cancer and melanoma. Current research is focused on pairing new and old vaccines, including the tetanus vaccine with a newer cancer vaccine to treat glioblastoma, a type of brain cancer. Those who received the dual vaccine lived three to seven more years after treatment than those who received an injection without the tetanus portion. Among the most eagerly anticipated vaccines in 2016, Misialek says, is a lung cancer vaccine. Work on such a vaccine, first developed in Cuba, is already underway here.

6. Faster public health vaccines

In the wake of the Ebola outbreak last year, the process for producing vaccines to protect the public against a possible epidemic has gone into warp drive — a feat that makes it the Cleveland Clinic's top medical innovation for 2016. The fear that, with international travel, a single person could potentially infect huge numbers of people "has led to a system to be able to immunize a large number of people really fast," Roizen explains. Where previously it took decades to develop a vaccine, the Ebola vaccine was ready in six months. A similarly accelerated process was behind the approval of a meningitis B vaccine following outbreaks at two universities.

7. Targeting cancer

Researchers are closing in on the day when a single drug will treat many different cancers. While traditional clinical trials focus on testing a drug for a particular type ofcancer based on its location — breast or lung, for example — new studies are testing therapies that target a specific genetic mutation found in a tumor, regardless of where the cancer originated. "We're throwing all cancers with the same mutation in one basket," pathologist Misialek says, and then testing a drug that targets that mutation. Results of an international basket trial found that a drug focused on a single genetic mutation can be effective across multiple cancer types, including a common form of lung cancer and a rare form of bone cancer.

8. Wearable sensors

Wearable health sensors could soon change the way people with chronic diseases, such asdiabetes, heart disease and asthma, control and monitor their condition. Drug companies and researchers are looking into using wearable technology to monitor patients more accurately in clinical trials, and hospitals and outpatient clinics could use it to monitor patients after discharge. Devices, from stick-on sensors to wristbands and special clothing, can already be used to monitor respiratory and heart rates, including EKG readings, as well as body temperature and glucose level. Stress levels and inflammation readings may be next, Roizen says.

9. Fighting superbugs

Decoding the DNA of bacteria is transforming the way we identify infectious diseases in the microbiology lab. That could help prevent the spread of dangerous, drug-resistant infections in hospitals and nursing homes, says Misialek. "Instead of identifying bugs in the traditional way and waiting days or weeks for the results, we can analyze genes and get exact identification sooner," he adds. That could help protect vulnerable patients against the spread of superbugs like MRSA, C. diff and streptococcus pneumoniae that currently resist treatment.

10. Better cancer screening

Some of the deadliest, most difficult-to-find cancers may be detected by analyzing blood for abnormal proteins. Cancer produces these abnormal protein structures. Up to now, blood tests weren't sensitive enough to identify them. A new type of analysis allows researchers to find the proteins earlier, which means cancer treatment can be started at an earlier stage. Cleveland Clinic experts predict this will lead to more effective tests for pancreatic cancer, considered the most deadly type with only about 7 percent surviving five years, as well as for prostate and ovarian cancer. A new test trial using protein analysis identified twice as many cases of ovarian cancer at an earlier stage than current tests.

The latest plot twist in the treatment of prostate cancer

January 27, 2015 Misha Gajewski

Understanding how tumour cells can become resistant to treatment is one of the biggest challenges facing scientists and doctors today.

At times, the twists and turns a cancer takes can feel more like the plot of a Hollywood thriller than something rooted in biology. And prostate cancer is just one example of a disease with several complicated plotlines.

In 1941, at the University of Chicago, Dr. Charles Huggins pioneered a therapy that would transform how we treat prostate cancer that has spread.

The approach works by limiting the levels of the body’s male sex hormones – known as androgens – which the tumour cells rely on to grow.

It’s still used today, and hasn’t really changed since 1941. But tumour cells often find ways to overcome this ‘androgen deprivation therapy’ and start growing again.

Researchers around the world are trying to understand how cells develop resistance and a new study, published in the journal Science Translational Medicine, turns accepted wisdom on its head in an attempt to tackle it.

In a small, early stage study, US scientists have shown that prostate cancer cells could be killed by high doses of a particular male hormone called testosterone, something that contradicts the very nature of prostate cancer.

But first let’s start with what we know.

The theory of prostate cancer

Prostate cancer is the most common cancer among UK men, with more than 110 patients diagnosed with the disease each day.

It can be cured if diagnosed early, but once it starts to spread the story can become more complicated.

Following the discovery that prostate cancer is influenced by androgens, Dr. Huggins found that using oestrogen to “chemically castrate” men with advanced prostate cancer helped patients by slowing down the growth of their tumours. He was even awarded a Nobel Prize in 1996 for this ground breaking work.

His study was the first to show that you could use drugs to stop androgen production but it wasn’t until the 1960s that scientists concluded that chemical castration was as effective as surgical castration and began using oral oestrogen to treat men with advanced prostate cancer. However, they soon noticed that lowering testosterone levels with oestrogen came with some pretty serious side effects and wasn’t enough to cure the men of their prostate cancer.

So over the next 20 years scientists worked at developing drugs that would either stop androgens from being made or stop androgens from reaching the tumours.

But the sad truth is that more often than not, men who have their androgen levels subdued will become resistant to ‘castration’ treatment at some point.

In order to overcome the drug resistance doctors give a “second-line” therapy that works by blocking signals sent by protein molecules that sit on the surface of cells and respond to androgens. Unfortunately, tumour cells can develop resistance to these treatments too.

And it’s here that the latest study steps in.

Plot Twist

The team, led by Professor Samuel Denmeade from Johns Hopkins University in the US, enrolled 16 patients with castration-resistant prostate cancer onto their study. They found that in some patients, drug-resistance could be reversed by first boosting levels of testosterone to far beyond what’s normally seen in the body, before dropping testosterone levels again. For some men it was like hitting a reset button and they responded to castration drug therapy again.

The men received treatments that switched their testosterone levels from high to low over a four week period – something the researchers dub ‘bipolar androgen therapy’. And this treatment cycle was repeated three times.

Of the 16 patients enrolled in the study, 14 men completed these three cycles and were monitored further. The team analysed levels of the blood marker PSA, which can be used as an indicator of how the disease is progressing (although there are some well documented challenges that come with using this marker).

The new treatment approach produced a notable decrease in PSA levels in half of the patients (seven out of 14), suggesting that the tumour cells may be responding to the treatment. Ten of the men also had secondary tumours that could be picked up by CT scan, and half of these patients saw those tumours shrink following the bipolar therapy.

Interestingly, 10 out of 10 patients who were suitable for follow up after they completed bipolar therapy saw their PSA levels fall again when the hormone therapy that they used to be resistant to was reintroduced. And the researchers believe that this re-sensitisation to treatment could be a promising avenue for further research.

But this new approach goes against pretty much everything we generally know about prostate cancer.

Prostate cancer cells thrive on testosterone. So on paper it doesn’t really make sense to load up the body with more of what fuels tumour growth. That would be like throwing a grenade at a house that’s on fire. Surely it can only make things worse?

But this new study complements recent research showing that tumour cells that are used to low levels f testosterone can be killed by a surprise high dose of the hormone. Researchers believe this may be down to the unexpected increase in the hormone stopping the cancer cells’ ability to copy their DNA. And it may also trigger catastrophic breaks in cells’ DNA, causing them to die.

But further, larger scale studies will be required to confirm this.

“This is major new hope,” says Professor Charlotte Bevan, a UK based prostate cancer expert from Imperial College London. The men can start re-taking their hormone therapy, that they were previously resistant too, which, according to Professor Bevan is “the best case scenario”.

“However, no one is saying this isn’t a risky strategy,” she adds.

Risky Business

This new approach is risky because at the start the remaining cancer cells are weakened but by giving high doses of testosterone, BAT may feed the really strong cancer cells which could be detrimental.

The authors themselves are quick to caution in their paper: “BAT is in no way ready for widespread adoption and should only be administered in the context of a clinical trial until its safety and efficacy can be confirmed,” they write.

It’s only through carefully piecing together each element of this complex story that scientists will have the final word on advanced prostate cancer.

And this study shows that for some people, an unexpected twist could be just what their story needs. We’ll be keeping an eye out for the sequel.

– Misha

Reference

• Schweizer, M., et al. (2015). Effect of bipolar androgen therapy for asymptomatic men with castration-resistant prostate cancer: Results from a pilot clinical study Science Translational Medicine, 7 (269), 269-269 DOI: 10.1126/scitranslmed.3010563

Image

• Image via flickr, used under a CC-BY 2.0 license

Emergency Medicine: The Good, the Bad, and the Ugly

Emergency medicine (EM) is a fast-paced, team-oriented
specialty where you can have a tremendous impact on your
patients. Emergency physicians are experts on diagnosing and
managing the acute, undifferentiated patient.
The landscape of the EM workforce has changed
tremendously. Only a few decades ago, most US emergency
departments (EDs) were staffed by physicians with no EM
training. Many of these early physicians had little interest or
expertise in EM.
EM residency training began in the 1970s, and the American
Board of Emergency Medicine was recognized in 1979.
Dramatic growth in EM residency programs boosted the
number of EM specialists now staffing EDs throughout the
country; about 70% of emergency physicians are EM trained,
according to a 2008 study. In addition, the study shows
nearly all (98%) emergency physicians who graduated within
the past 5 years are EM trained.
Before you opt for a career in EM, it helps to understand its
many advantages, such as the ability to work flexible
schedules and see a variety of cases, as well as its
challenges. Here are some pros and cons you might consider.
Advantages
Feeling like a "real" doctor. Emergency physicians are trained
to handle virtually any emergency. Although many patients
require additional care (for example, surgery), the emergency
physician has the tools needed to begin the management of
any acute medical condition or injury. You will manage sick
patients every day and have a major impact on their lives. You
will have the opportunity to perform many procedures, both
routine and life-saving.
Making the diagnosis. EDs have become the diagnostic
centers for the healthcare system. Patients come to the ED to
find out what is wrong, and we can often make a diagnosis
during the ED visit that could take weeks or longer in an
outpatient setting.
Variety. Emergency physicians see a tremendous variety of
patients, including babies and elderly patients, the critically ill
and the worried well, pregnant patients, psychiatric patients,
and people from every walk of life. Emergency physicians
manage patients with all types of medical and surgical
illnesses and injuries. Within a few hours of a shift, you may
reduce a shoulder dislocation, manage a cardiac arrest,
evaluate a suicidal teenager, place a chest tube for a tension
pneumothorax, manage a multiple trauma moving vehicle
collision, and evaluate a 3-year-old and a 90-year-old for
abdominal pain.
Flexible schedule. Emergency physicians typically work 8-12
hours at a time, at all hours. Due to the intense nature of EM,
emergency physicians work between 1500 and 2000 hours per
year. Most EM practices do not have on-call time. This allows
emergency physicians to have time off, often during the
weekdays, to pursue outside interests. Many emergency
physicians work part-time or take extended vacations, and it is
not uncommon for an emergency physician to devote time to
other professional pursuits such as administration, leadership,
research, education, or entrepreneurship.
Chance to build teamwork and relationships. Emergency
physicians work closely with emergency nurses and ancillary
staff, other emergency physicians, the medical staff, and
many other members of the healthcare team. A successful ED
has excellent interpersonal staff relationships and works well
as a team.
Compensation. A greater proportion of emergency physicians
(65%) -- compared with 53% of physicians overall -- feel they
are fairly compensated. Emergency physicians typically
work more intensely for fewer total hours compared with other
physicians and enjoy above-average compensation per hour.
Challenges
Stress level. Emergency physicians work very hard, often
managing many critical patients at one time. Some patients
will die in front of you. You will see patients who are victims
of child abuse, rape, or other terrible situations. Litigation
stress is common: emergency physicians ar