Poor mother toddler bonding linked to teenage obesity.

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I read an article today from Ohio State University which appears to reinforce my belief that the first five years of life are so critical for the normal development of a toddler.

The researchers there looked at the quality of parenting in early life and then looked at the rate of teenage obesity: as you would unhappily expect, those with weak mother-child bonding had a higher rate of obesity - in fact it was over a quarter of them, or 26%. This compared with under 15% for those with observed better bonding skills.

The knee jerk response is then to blame the parents for "causing" their kids to be obese in their later life, with all the associated medical problems that can be associated with it - diabetes, heart disease and some cancers. But the findings highlight the fact that changes must be ocuring in the toddlers brain to account for the metabolic responses to these early life experiences. According to Sarah Anderson, Assistant Professor at Ohio State, “Sensitive parenting increases the likelihood that a child will have a secure pattern of attachment and develop a healthy response to stress. A well-regulated stress response could in turn influence how well children sleep and whether they eat in response to emotional distress – just two factors that affect the likelihood for obesity.”

So instead of just focusing on eating healthy food and getting adequate physical exercise - which is necessary for all children anyway - systems need to be developed to support and improve the parenting skills of those who currently lack them. This is easier said than done and cannot be left solely to government agencies to find solutions. This is something that everyone who knows someone with kids needs to be aware of. Bringing up kids is tough; doing it by yourself is even tougher; doing it in an environment where unemployment is high and making ends meet is a never ending struggle, would just about make a saint weep.

An offer of help, a word of encouragement: maybe even taking the child to the park whilst Mum has a break, or reading stories to the little one whilst she takes "five" - there are many small ways in which we can make a big difference. As Professor Fiona Stanley here in Perth said many years ago, "It takes a village to raise a child".
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Maintaining the balance in 2012

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Here are some figures from the CDC about falls in the over 65yr olds:

• One out of three adults age 65 and older falls each year,  but less than half talk to their healthcare providers about it.
• Among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.
• In 2008, over 19,700 older adults died from unintentional fall injuries.
• The death rates from falls among older men and women have risen sharply over the past decade.
• In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized.
• In 2000, direct medical costs of falls totaled a little over $US19 billion—$US179 million for fatal falls and $US19 billion for nonfatal fall injuries. This equals $US28.2 billion in 2010 dollars.

In other words, falls are a real issue for everyone, assuming that we all want to live to a ripe old age! But it's not just the elderly that have trouble staying on their feet: here's some information from New South Wales, Australia,


"The total average annual frequency of deaths and hospitalisations respectively, for falls in buildings in Australia were 343 and 105,968 for the period July 2002 – June 2005. The estimated annual cost for these deaths was $250 million, and $1.28 billion for hospital admissions, excluding indirect costs."

So anything that we can do to reduce the trauma caused by "slip ups" is not only saving lives, it's keeping people out of hospital and its saving a fortune. So what can we do?

Staying fit is the first thing to do. Our muscles not only are used for locomotion, but also act as "shock absorbers" when we land - think jumping off a low wall. Without any decent tone or strength in your muscles, doing that small jump could lead to serious injury. One simple way to help improve your leg strength is to find a nice shiny wall or locked door and stand with your back to it: now slowly slide your back down the wall so your knees bend to 90 degrees, and then push back up. If 90 is too far then only go half way: the point is to start within your ability and then to slowly increase the load you put on your legs as the weeks go past. Start with say 5 bends, have a break and then repeat. As the weeks go on, increase the number you do and lower yourself down to 90 degrees (but don't go any lower).

The second thing to do is to work on your balance. Many elderly people have problems with balance and it is wise not only to check with your physician before starting any balance exercises, but also to seek out a physical therapist who can demonstrate them to you in safe physical surroundings. Balance exercises are not rocket science, but they do need to be done away from sharp objects and preferably on a soft surface - just in case! The Mayo Clinic have a simple routine so check out 

http://www.mayoclinic.com/health/balance-exercises/SM00049

Finally, whenever we go out there is a potential to have a fall or a slip: what would you do? Would you put your hands out to break your fall and risk snapping your wrists? Probably the best way to prevent serious injury is to learn to roll as you fall and spread the impact over your trunk and reduce the chance of serious injury: you'll still get a battering and some great bruises, but you might also avoid a life threatening fractured hip. Luckily we live near the beach so that the young bride and I can practice this on the soft sand - it still jars, but it's fun too.

So in 2012, be aware, be strong and stay balanced!  

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A sight for sore eyes: good news on Trachoma

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 Trachoma has been a scourge for centuries and it's effects have been recorded on papyrus in Egypt and even earlier in ancient China. It is unacceptable that in so many countries, including Australia, that sections of those communities are still threatened with blindness caused by this preventable infectious disease.

A report in the MJA 2010 by Taylor et al, concluded that "Blinding endemic trachoma remains a major public health problem in many Aboriginal and Torres Strait Islander communities." This is a disease that we know the causative agent - Chlamydia Trachomatis - and we have an antibiotic that we know works - Azithromycin, and yet there are communities both here in Australia, and around the world where blindness is occurring as a result of this preventable condition.

First some facts:

• Trachoma is found in Africa, Asia, the Middle East, parts of Latin America and in the Aboriginal and Torres Strait Islanders of Australia.
•  Worldwide 41 million people are affected by it.
• 8 million will go blind because of it annually.

The Great News is that things are going to get better!!

Up to the present, prevention programs have been used in affected communities where they administer bi-annual doses of Azithromycin to eradicate Trachoma from those afflicted. Stopping the infections means stopping the resultant deformity of the eyelids, and it's the damaged, scarred eyelids that eventually lead to permanent distortion of the cornea and thence blindness.

Bruce Gaynor MD and his colleagues at the University of California, San Francisco, have just reported in the Lancet, that Azithromycin given once a year is just as effective as when given twice a year: that means current resources can be made to go twice as far.  "We will now be able to reach more people and make the treatment go twice as far as before,” Gaynor said. “This will make a huge impact in slowing down trachoma-related blindness globally.”

All that we need now is for Governments to match the enthusiasm generated by these findings -by increasing their funding, not cutting it - so that a disease that was eradicated in the developed world 100 years ago, can also be eradicated from those communities who most need their sighted citizens.

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Our body's "Homeland Security" system

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Electron Microscope image of an Effector cell.

The immune system has long fascinated me. We naturally assume that if we get an infection, then our body's immune system will detect and destroy it: but how does it do it? How does the body know that you have an infected ingrown toenail? And how do the body's white cells discover that germs are "down there"; and then how does the white cell "hit squad" travel through the blood stream and find the exact spot where the infection is? And finally, how do these cells get through the blood vessel wall to where the infection is situated? That's a lot of questions, and after reading an article from the Weismann Institute of Science in Israel, I'm blown away by the cleverness of the whole system.

As far as I can work out, this is how it appears to work: a bacteria gets into the system and the first thing to happen is that local inflammation occurs. Specific immune-system cells such as Dendritic cells - think border protection - which wander around looking for interlopers, are switched on by this inflammation and bring genetic information about the bacteria back to the local lymph node. Enter a specialized cell called an Effector Cell - think special forces - which is "trained" by the lymph node nearest the site of inflammation in the subtle art of recognizing this new invading threat. The effector cells then re-enter the blood stream to find the nearest "jump off point" so that they can get close to the site of infection and "terminate" the opposition. But how do they find the right spot to exit the artery whilst hurtling through the blood as it is pumped around the body?

Well according to Prof Ronen Alon and his co-workers Drs Ziv Shulman and Shmuel Cohen, the lining of the blood vessels is not just a passive sticky barrier, but lined by endothelial cells that have the ability to "signal" to passing Effector cells where to exit the system. But what the researchers found was that these chemical signals were held within the endothelial cells  - presumably so they don't get washed away - in structures called vesicles, and that the Effector cells have literally to reach within the endothelial cells to discover that they are at the correct location. What also amazed me was that these defensive white cells have appendages like thin legs and actually crawl along the inside of the blood vessels: and as they crawl along, they "reach inside" the endothelial cells looking for the right chemical signals. It's a bit like driving down the street and stopping at each store to ask where the fire is, when you get to a cluster of stores that say "You're here", then the endothelial cells literally help the Effector cells to pass through "between the buildings" and carry out their mission!


There are still a great many puzzles to answer, but the complexity of the system is only equaled by the beauty of its organization.
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A Child is born ..

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Being Christmas time there is a great deal of activity happening around the place, with the buying of presents, preparing food and having parties; and in all the fuss and turmoil, one senses that the real meaning of Christmas is being overlooked - apart from the dreaded "canned" carols in all the major malls and shopping centers! Ocassionally one stumbles across a Nativity scene in a large store, and as always, the little children are still fascinated by the strange sight of a baby in a crib surrounded by cattle, sheep and men in funny clothes.

Being born is a miraculous event - what starts off as two cells fusing into one, ends up becoming a living, breathing human being, and all in the space of 9 months. But the passage from conception, to the time when the baby becomes independent and able to forage for itself, is probably the most "dangerous" period in our lives. For Jesus to be born in a "cattle shed" to a young teenager who had no ante-natal care, and who is having her first baby surrounded by men,and not a midwife in sight, would classify as an extremely high risk birth. And to highlight what faced infants born before the time of modern medicine, here's a quote on conditions in a well known country in the mid 18th century:

    "Infants under one year old accounted for a quarter of the total deaths in England and Wales. Half of all of the deaths were infants under five. Sanitation and hygiene were serious problems. Filth or contaminated foods often caused infection. Diarrhea was so common and dangerous that it could cause death in a baby in less than forty-eight hour." Palestine at the time of Christ was a fairly primitive place and under siege, (not much seems to have changed!) so it would be a fair guess to think that similar conditions would have existed in His time.

If Christ were to be born today in an undeveloped country such as Mali, there would still be a one in five chance that He would be dead before the age of 5! Paradoxically, if He were to be born in Egypt or Albania, He would have a one in five chance of being overweight by the time he was five!

Where we are born has a significant impact on our health and longevity, and for many infants on this planet, they have a fairly rugged start in life. Where a child is born is a major factor in predicting its future health, but the family - or lack of - into which that child is born and which nurtures it in those first 5 years, is equally vital. Critical biological imprinting goes on in those vulnerable first five years, and if parents neglect themselves or their child, the result could well be that the child will spend the rest of their life paying the price.

The gift of one child 2,000 years ago gave us all hope: lets make sure that for what remains of the rest of our lives, that we try our best to give every child the best opportunities in those critical first five years.
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Hydrogel hope for scar free burns

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As humans, we have a natural fear of fire. Anyone who has burnt himself or herself will instinctively flinch if they get too close to dangerous heat – and with good reason. Burns are one of those traumas where everyone, medical staff included, has an emotional response. Not only is there the pain, both physical as well as mental and emotional to cope with, but there is also the reality of long term hospital treatment and the inevitability of scarring.

Over the past couple of decades, burns management has come into it’s own as a speciality with excellent protocols to fast track severe cases, and wound management aimed at reducing infection and hopefully reducing the scarring too. Technology has been introduced with the aim of restoring skin coverage as quickly as possible, with people such as Prof Fiona Woods here in Perth WA, being an internationally regarded expert in the area of “Spray on Skin”.

Now workers at John Hopkins in America have developed an engineered Hydrogel that could form the basis of an inexpensive burn wound treatment that appears to work better than currently available dressings or clinical therapies. Using mouse studies, they have shown that the jelly like material appeared to regenerate healthy, scar free tissue, which John Harmon, a professor of surgery at John Hopkins described as “Absolutely remarkable. We got complete skin regeneration, which never happens in typical burn wound treatment.”

The Hydrogel was developed with a team of engineers and promotes the early development of new blood vessels in the area under treatment: this leads to regeneration of the more complex structures found in skin such as hair follicles and the exocrine glands that produce oil on the skin.

Although a patent is protecting the gel, the researchers admit to not fully understanding how the gel works. One theory goes that the gel attracts bone stem cells that take up residence in the matrix and morph into the cells required to produce healthy skin. As there are no drugs or growth factors within the Hydrogel, it is possible that it could be classified as a “Device” and thereby get into the healthcare system quicker than if it had to undergo extensive pharmaceutical trials.

Lets hope what’s good for mice is good for humans too!

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Keeping an eye on the future

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Macular Degeneration (MD) is the leading cause of blindness in Australia with 1 in 7 people over the age of 50 being affected by it. In hard numbers this means that each year there are 17,700 new cases and the frequency of the problem increases as we get older. In the US the numbers are even more startling with over 7 million people suffering from the condition. The experts talk of Dry and Wet forms of the disease with the wet form being more amenable to treatment, and the dry form - the far more common one - having no effective treatment at all.

What we do know about MD is that it's hereditary with a 50% chance of developing in those with a strong family history. We also know that smokers are at three times greater risk of developing MD and may show signs of the condition 10 years earlier than non smokers: but quitting smoking for 20 years reduces the risk to that of the normal population. We might not be able to change our genetics, but we can stop smoking or make sure our children never smoke!

On the microscopic scale, the problem is one of "neuro-inflammation" caused by activation of Microglial cells, inflammatory cells in charge of cleaning up dead and dying material in the eye. Enter Mayo Clinic ophthalmologist Raymond Iezzi, M.D and his colleagues who worked with Nano-engineers to develop a Nano-particle called a Dendimer, that has enabled them to deliver Steroids to the retina and reduce the inflammation. According to Dr Kannan, a collaborator of Dr Iezzi, "The activated Microglia in the degenerating retina appeared to eat the Dendrimer selectively, and retain them for at least a month. The drug is released from the Dendrimer in a sustained fashion inside these cells, offering targeted neuroprotection to the retina."

Predictably, all the work so far has been done on rats, and researchers are not suggesting that this is a cure but offers the prospect of good control. If, as hoped, the results are reproduced in humans, then this will be an enormously relief for everyone who hopes to live beyond the age of 50!
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Asthma Prevention: you've gotta suck it up!

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Most Doctors who write prescriptions for their patients live under the impression that the patient will follow the Doctors advice and take the medications "As directed". Sadly, in a great number of cases this is not the truth: antibiotic courses are not completed, contraceptive pills are missed, 'Statin usage drops off as the patient feels OK - the list is depressingly long. One of the key principals of modern medicine is Prevention, and that means that patients need to comply with the advice given, if we are to achieve a good level of success.

Asthma is a good case example. In asthma, a trio of events occurs,

• Inflammation of the lining of the airways leading to a narrower tube through which to breath.
• A thickening of the normal dust-trapping, watery mucous secreted by the inner lining, which leads to blocking of the narrowed airways with these thick, sticky mucous plugs.
• A thickening of the circular muscle that controls the diameter of these small breathing tubes and which exacerbates the overall narrowing of these smaller airways.

In an asthma "attack", some irritant or triggering event - smoke, virus infection, stress - causes the circular muscles in the tubes to contract and narrow the tube, reducing airflow. Now if the diameter of that airway is already narrow due to inflammation, and has thick mucous plugs blocking up the smaller tubes, then the patient is going to wheeze and to get very short of breath: sometimes fatally so!

So the key to reducing the risks of suffering a significant asthma attack is to reduce the inflammation so that the airways are at their maximal diameter, and to make sure that they are not clogged with tenacious mucous: enter the principal of using Inhaled Cortico-Steroids (ICS). If it's going to be effective and keep people out of hospital, then they've got to take the medications on a daily basis. This has been backed up by research just released by the Henry Ford Centre in the US where lead author Dr Keorki Williams reported "We found that every 25 percent increase in ICS adherence was associated with an 11 percent decrease in asthma attacks, but most importantly, we found that causal use of these medications is not enough, especially among patients whose asthma is not controlled. Patients must use their asthma controller medication as prescribed if they want to have the best chance of preventing serious asthma attacks."

As my dear old Mum used to say: "An ounce of prevention is worth more than a pound of cure".
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A heartfelt gift from the US to India

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In the spirit of this time of year, my attention was drawn to an article in the American Journal of Cardiology about re-using pacemakers from "deceased" patients. As far as I am aware, it is illegal in most western societies to re-use a cardiac pacemaker once the patient/owner has died, but this article reports that the prohibition does not apply if the pacemakers are sent to other, more needy parts of the world.

The project reported in the journal, was initiated by an Indian medical student prior to his move to Loyola University. He interviewed 53 poor patients in Mumbai who had severe rhythm disorders that had left them breathless with even the mildest of exertion. Their poverty meant that the price of between $2,200 to $6,600 for a pacemaker, was way beyond their wildest dreams. On reaching Loyala, the now Dr Kulkarni started out a philanthropic venture to get the pacemakers from donor families to be sent to India. This then progressed to research to confirm how safe the process was.

Each pacemaker was rigorously cleaned and sterilized after removal, and then only those with a remaining battery life of at least three years were chosen for future implantation. After two years follow up, all the patients are alive and all but two reported much improved health. Importantly there have been no battery failures and no reports of infection.

Dr Kulkarni appears to have taken a simple idea and followed through with it: the families of those who no longer need their pacemakers have shown true generosity, and the needy recipients have been given a new lease on life. It's an idea that ticks so many boxes, and one that deserves our world wide support as the global family celebrates this very special time of giving gifts at Christmas.
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Keep the kids safe at Christmas

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Specialists are warning of a possible upsurge of Button Battery ingestion over the Christmas period. These Litium based batteries are used in portable electronic devices, such as  watches, camcorders, digital cameras, thermometers, calculators, communication equipment and remote car locks. They usually have a CR number printed on one side: the first part of the number refers to the diameter and the second part the thickness, and it's the bigger batteries, greater than 15mm that are potential sources of concern. If they stick in the oesophagus - the tube through which food travels from the mouth to reach the stomach - then it can cause a potentially fatal perforation.

In children under 4 who have smaller diameter oesophagi, then the chances of this happening are significantly greater. So if you know your little one has swallowed a button battery, take them straight to the emergency department. The chances of death are rare: in one study only 15 deaths were reported out of 56,535 "reported ingestions", but no one wants their child to be one of the 15!

The other group of people who tend to swallow these small button batteries are the old folk. That's when they're changing the batteries in their hearing aids and oops, down she goes! In this group the battery can get stuck in the lower part of the bowel, so it is important to make sure that it does pass through by checking the bowel motion. If there is any concern then it is important to check with your Physician who will order some Xrays.

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Tiny Ticks can carry a big punch!

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When we were kids, one of the "Ditties" that we used to sing was "If you go down in the woods today, you're sure of a big surprise", which I think ended up being about teddy bears. But what got me humming my old nursery rhyme was nothing to do with bears, but ticks! My eye had been caught by an article about a rare new infection, a bacterium called Neoehrlichia mikurensis which was first identified in Japan, and which had now been found to be transmitted by ticks on the other side of the world in Gothenburg Sweden !

I like to go walking in the country north of Perth WA, and at this time of year it is so easy to pick up ticks - kangaroo ticks, and "salt and pepper" ticks - as you walk through the bush or the woods, and there are as many folkloric ways to manage tick bites as there are different species of those pesky arachnids. So any information about reducing risks always attracts me.

Ticks have eight legs and pass through several stages before they reach adulthood - egg, larva, nymph and then the adult. They mainly appear in the spring and summer months and attach themselves to the tips of long grass or bushes before attaching themselves to "passers-by". If that's a human, they then tend to climb up inside the clothing to the warmer areas of the body, such as the head and neck, and then settle down for a feed by burying their snout and head under the skin to suck blood.

Ticks can cause problems by a reaction to their saliva causing

• local reactions and itching
• generalized allergic reactions
• paralysis due to toxic proteins - dogs
• spread infections such as Lymes disease in the Asia, Europe and North America

This new infection reported in Sweden has only been found in 8 people worldwide since 2004, so it's unlikely to be coming to an "Tick" near you anytime soon, but it is a timely reminder that these seemingly simple "beasties" can cause significant health issues.

Importantly, the Tick will release more saliva if disturbed, which raises questions as to how best to remove them without causing more problems. For those with a known Tick allergy, the best answer is to leave them well alone and get them removed in a Clinic setting where there are appropriate medical supports and adrenaline is available if necessary. As to the best method of removal, unfortunately there is no consensus on this that I am aware of. But you shouldn't squeeze them, try to pull them out or even poison them as this will upset them and make them release more saliva and potentially upset you in the process!

The Australian Society of Clinical Immunology and Allergy have suggested a novel approach and that is to use a freezing spray - such as Aerostart: apparently used for cleaning Carburetors - which instantly freeze dries the insects and kills them before they can release any more saliva. On paper this seems a great idea, but they also warn that:

• this advice is based on clinical experience of those treating patients with tick allergy
• this product is not “registered” for such use
• this product is highly flammable, and thus should not be used near naked flame or when smoking
• rapid cooling of the skin and thus skin irritation may occur
• since it is unlikely that formal studies in this area will occur in the near future, such advice is based on a consensus of “expert opinion” rather than derived from results of formal clinical studies.

So be warned!

The best idea is to avoid getting bitten in the first place so:

• Wear appropriate clothing when outdoors in tick areas including long sleeved shirts, long pants tucked into socks and a wide brimmed hat. Ticks are more easily detected on light coloured clothing.
• Spray clothes and hats with an insect repellent and wear a repellent that contains DEET or Picaridin.
• When returning from an area known to have ticks, remove clothing and search for ticks, especially behind the ears, on the back of the head, groin, armpits and back of knees. Be careful where clothes are placed as they may introduce ticks to inside the house. Don't forget to check children and pets

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Fish Tales for young women.

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Traditionally, research into Heart Disease has been focused on the male of the species: the obvious reason being that men seemed to be "slipping off the twig" far more frequently than their female companions! And this is true ... to a certain extent, but in fact heart disease kills more women than breast cancer and has been the bridesmaid of what ails women when it comes to research. Thankfully, over the last 10 years this has changed and its really good to see researchers publishing articles based on how to reduce Heart risk for women which is both relevant and practical.

A group of researchers in Copenhagen have recently published their findings after following 49,000 women - median aged just under thirty - for an eight year period and found that those who incorporated some fish in their weekly diet were 50% less likely to have had a cardiovascular problem.

The following points are interesting to note:

1. Hardly any of the women who ate fish, actually took fish oil supplements: in fact the few who did take supplements were excluded from the study.
2. This was a group of young women of child bearing age, and the benefits accrued to them from eating fish rich in Omega 3 fatty acids was measurable in a relatively short time. In other words, this wasn't a "superannuation effect" - one which you have to wait until your over 65 to benefit from!
3. The quantity of fish eaten varied, with benefits being noticeable with as little as two servings per month. However, the recommended amount is to have fish as a main meal twice a week.
4. The study was based on phone interviews which I am always a little wary about: but the numbers were high and the subject not a threatening one, so my feeling is that the results do carry significant weight.

The big question is "What fish should I consume"? This will depend on the area of the planet you live on, but Sardines, Salmon and Tuna are always reliable sources. For those of us in Oz,

• Sardines
• Ocean trout
• Atlantic salmon
• Tuna
• Herring
• Mackerel

are all good sources of Omega 3 fatty acids: Bon Apetite!
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Special Christmas "Gifts" from my patients.

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As it comes towards Christmas, I have been reflecting on the "gifts" that I have received over the years from patients whom I have cared for. These gifts are not the regulation bottle of plonk, but are those experiences that have helped forge me into the person I am now. Some of the gifts I would rather not have received, but they have been a part of the tapestry that is my life story.

There was dear old Mrs Little, a lady I had never met until I received a phone call from her. "My son Bill is wetting the bed still, any suggestion?" she asked. I asked a few pertinent questions such as how long had this been going on, and what sort of things had she tried already. Then I asked "How old is Billy", to which she replied, "65". It turned out that Bill was an alcoholic who lived in the caravan at the back of her ancient home in rural Victoria! When I visited him, it also turned out that Bill had advanced head and neck cancer that he had never bothered to get checked. Over the months of caring for Bill in his final illness, I got to spend a lot of time with Mrs Little who was full of ancient wisdom: "Catholics should be graded like eggs" was one that sticks with me, and this from a lady who attended almost daily Mass. She lived to be 105 with her faculties still intact.

Another delightful lady who always cheered me for other reasons was a lady in her 80's who was also an alcoholic. When I visited her at home, usually mid morning, she was already drunk and greeted me with the words "God, you're handsome", which always does some good to a middle aged man's ego!

Mr D'Arcy was a gentleman to his bootlaces, always gracious and always welcoming. He had the most severe airways disease and yet always walked me to my car after a visit and shook my hand in thanks for coming to his house.

Matt was a very intelligent, but troubled teenager, who made his parents life hell. But there was something about the kid that I liked. He was smart and insightful, but he was an unmitigated risk taker and "defier" of authority. We used to have long conversations on life and all the great opportunities that were opening before him and how he could do great things, if just he could accept that life does present us with boundaries which we all have to live within. Matt would smile, and I knew he was in some other place that I could never enter. He was seeing psychiatrists and taking various medications: I think he used to see me more for a chat than anything medical. He committed suicide and I was devastated not only for his family, but for a life that had so much, and yet chose oblivion over challenge. Thanks Matt for teaching me about how tough life is for some teenagers.

Bob Jefferies was a grumpy, hard individual who was rude to all and sundry, Doctors included. He was one of those "heart sink" patients whom you dreaded to see in the waiting room. For some reason he picked on me, and over the years I got to know Bob really well and also got an insight into why he was grumpy. He had been a rear gunner in the last great war and was shot down over Germany. He jumped from the burning plane at a height of 2000 feet, with his parachute on fire too! Fortunately it was winter and he fell into a snow covered pine plantation and skidded down the trees into deep snow fracturing both feet into the bargain. He tried to walk to safety, but all he got was frostbite to his burnt broken feet before he was captured and interred. After the war he married and had a son: when his son was a teenager, he was killed in an accident that left the parents devastated. Bob never talked about his son, his wife told me, but he did open up about his war years and when he left these consultations, he would shake my hand and smile and say "Thanks Doc".

To all the patients with whom I have shared such amazing moments, I would like to say "Thanks to you all", you have enriched my life.


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A not so fishy story!

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Firstly, a technical term that I had to look up: it's the term "Broiled"! For the ignorant, like myself, it's a form of cooking where you use the Grill in your oven, as opposed to using the barbeque, where the heat comes from the other side. Both barbequing and broiling would produce the same end results with the meat nicely cooked on the outside and the inner part remaining moist and tasty!

This relevant fact became apparent to me when reading why baked or "broiled" fish could help reduce the risks of Alzheimer's disease by preserving critical areas of grey matter within the brain. Dr Rajii, from the Pittsberg Medical Centre Mercy Hospital, reported his findings after following a group of people 65 years and older, over a 20 year period and measuring the size of their brains using imaging techniques. He found that in certain critical areas of the brain - the Hippocampus and the Frontal Lobes - the grey matter was better preserved in those who consumed between 1 to 4 servings of fish per week. These areas are considered important in Alzheimers disease as they are vital pathways for memory and cognition.

Why this happens is uncertain, but the theory goes that fish oils contain omega-3 fatty acids which are thought to reduce inflammation within the brain, and in Alzheimers, the inflammatory process plays a significan role. Last year Dr Rajii reported a similar finding when following up on the effects of regular exercise, but reported the opposite effect in obese people - where the relevant grey matter volume decreased.

Eating fish has been shown to help with cardiovascular disease, and now it's been shown to lessen the risks for Alzheimers disease: sounds like good news to me!

PS: for those of you who think it works with fried fish - sorry, but no. There were no measurable benefits from eating fried fish. Take it from an expert, broiling is the way to go!
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World HIV AIDS Day

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Today is World HIV AIDS day and if the Three Wise Men were to arrive this Christmas, then I hope one of them would bring a cure for this terrible scourge and donate the Patent and Intellectual Property Rights to all humanity!

Here are some figures from UNAIDS from Nov 2010 and refer to the year 2009.

	Estimate	Range
People living with HIV/AIDS in 2009	33.3 million	31.4-35.3 million
Adults living with HIV/AIDS in 2009	30.8 million	29.2-32.6 million
Women living with HIV/AIDS in 2009	15.9 million	14.8-17.2 million
Children living with HIV/AIDS in 2009	2.5 million	1.6-3.4 million
People newly infected with HIV in 2009	2.6 million	2.3-2.8 million
Adults newly infected with HIV in 2009	2.2 million	2.0-2.4 million
AIDS deaths in 2009	1.8 million	1.6-2.1 million
Orphans (0-17) due to AIDS in 2009	16.6 million	14.4-18.8 million

At the end of 2009, women accounted for just over half of all adults living with HIV worldwide.

Although the number of cases has "stabilized" over the past few years, there is still an awesome challenge ahead to treat, manage and recover from this global devastation. For every case reported, several other people are affected by the disease. In Africa, if the HIV patient is the mother or father, then the whole family faces severe economic hardship, if not starvation. So when we talk of 33 million people with HIV, then we must extrapolate that to say that over 100 million people SUFFER from the effects of HIV AIDS.

And it isn't just a simple fact of finding the right treatment, and hey presto, everything in the garden will be rosey. A report from the US suggests that "Only 28% of people infected with HIV in the United States have achieved viral suppression"according to a report from the CDC. One of the reasons behind these bleak figures is that 1 in 5 HIV sufferers don't even realize that they carry the infection, and of those who are aware, only 51% are receiving ongoing medical care. If that is the situation in a country with "first world" Hospitals and Health Care, what chance for those in Sub Saharan Africa?

Most of you who read this will wonder "what can I do to make a difference, because where I live, I've never met anyone with HIV, so it doesn't really affect my life?" And you're right, it does seem hard to effect a change on a world scale, but perhaps what we can do to begin with is to be compassionate. Just by talking about HIV in a compassionate way amongst your friends and colleagues will help alter attitudes because 3 million children live with AIDS and there are over 16 million orphans as a result of AIDS, and they need help. The second thing to remember is that every small donation to an accredited HIV AIDS organization will help effect change: maybe not immediately, but with increasing awareness and support, the future lives of millions can be changed.
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Aged Care: room for improvement?

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Continuing on with difficult subjects as we progress towards Christmas: this time it's the subject of those infirm, aged people who will spend their Festive season in Nursing Home facilities across the world.

For over three decades I visited patients in Aged Care facilities and have witnessed a massive increase in the quality of care provided during that period of time. My first visits were to what were old houses where the bedrooms contained three or four frail aged who often spent the majority of their time in bed, and the stench of urine pervaded the whole "institution". It was not unusual for "restraints" to be used on more difficult patients, which meant that they were literally tied to their chairs; and there was always at least one patient who would call out a garbled cry with the regularity of a metronome, which in retrospect was probably "help"! Remember, this was at a time when the Berlin wall was still standing, before computers were on every desk, and the only phones were fixed to a wall!

Today in Australia, the modern aged care facility is a bright "village" type arrangement with high care units to look after the most frail residents. Each facility has to undergo regular accreditation and the standards that I observed were of the highest order. But all is not sweetness and light for the aged around the world. In 2008 the Office of Aged Care Quality and Compliance reported that there were 3947 cases probed nationally between July to December 31 2007, and this included cases of serious physical assault, medical mismanagement and failed personal care. Recently in NSW, a fire was started in a Nursing Home and lives were lost as the result of suspect arson - a man has been charged with the offense and is awaiting trial.

In the US, Amber Paley runs a website called Nursing Home Abuse which focuses on the plight of those aged relatives of ours who may be at risk, and gives practical advice on how to ensure that your family member who is no longer able to defend themselves, is treated with the dignity and respect that they deserve. As well as recording the blight of abuses that she has documented, there is also valuable educational and preventative advice on how to best protect your relatives. The Australian Government Department of Health and Aging also has a useful webpage to help those who suspect that abuse may be occurring.

It is sad that abuse occurs, but the good news is that there are 99 good people in the Aged Care business for every one that inappropriately manages their patients under their care. In fact, those who do work with the frail, the deaf, the incontinent and the demented deserve our enormous thanks and respect for what they do and how they do it. Lets give them a present this Christmas when we visit our older relatives, and give them our affirmation and thanks for sharing the final part of so many peoples final journey, with professionalism and grace.

 

Tis the season to be jolly: not drunk

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It's a strange but sad reality, that with each Christmas season, there is a spike in road deaths, suicides, violence, un-planned pregnancies ... the list is a long yet tragic one. One common denominator in all of this is alcohol. I am not a "wooze" as we say here in Oz, but I do know something about the chemistry of alcohol and its effects on the human body - particularly the brain - and alcohol can best be described as having a very narrow "therapeutic index". What this means is that, like Warfarin which we use to "thin the blood" in people with certain medical conditions, just enough is OK, but too much can be lethal: and with alcohol, if you exceed the recommended "dose", you might be putting your life at risk.

After a couple of standard drinks, the effects of alcohol become depressant and start to anesthetize the brain: too much can lead to coma and death. To counteract this drowsying effect, there is a trend amongst young people to mix alcoholic drinks, and other so called "recreational" drugs,  with Energy Drinks. This has led to a spike in Emergency Room admissions in the US, and worldwide concern amongst health care workers that the "collateral damage" from these sorts of Caffeine/alcohol/drug combinations is going to get worse this Christmas.

Apparently the rationale behind adding caffeine to alcohol is that it makes the user feel less drunk: the reality is that  "You're every bit as drunk, you're just an awake drunk," according to Mary Claire O'Brien, associate professor at Wake Forest University Baptist Medical Centre in Winston-Salem. In her 2006 study published in Academic Emergency Medicine, she showed that students who mixed energy drinks with alcohol got drunk twice as often as those who consumed alcohol by itself, and were far more likely to be injured or require medical treatment while drinking. Energy drink mixers were more likely to be victims or perpetrators of aggressive sexual behavior.

According to a report from SAMHSA in the US, "Studies indicate that excessive caffeine intake from energy drinks can cause adverse reactions, such as arrhythmias, hypertension, and dehydration. Combining energy drinks with substances of abuse raises the risk for serious, even life-threatening, injury and for the likelihood of engaging in risky behaviors, such as driving under the influence."

We need to let those young people who down their "alco pops" - or other energy drink/alcohol/drug combinations - and go out "clubbing", know that they might in fact end up dancing with death: theirs, or one of their friends.


So lets celebrate Christmas with clear heads, not hangovers: and may the only one with a red nose be Rudolf!
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New tools to fight infections.

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I know someone who has an implant known as Deep Brain Stimulator, and which has given him significant relief from advancing Parkinson's Disease. He's in his early 60's so it's enabled him to remain reasonably active and to enjoy one of the great pleasures of his life, gardening. However, recently he had a fall in the garden and cut his leg in several places, and for a time there was a real fear that if the wounds became infected, then bacteria could spread to his implant and create a Bio-film on the surface. Unfortunately, the only way in which this sort of infection could be “got rid of”, was by removing his implant. If that happened, then he would literally freeze and not be able to move. It would devastate his life.

One of the challenges of modern medicine is to be able to counter the effects of Bacteria that not only cause serious infections, but have the ability to colonize metallic surfaces and are all but resistant to every known antibiotic, and it’s this ability of bacteria to create bio-films that is the cause of the problem. But all this may be about to change.

Science reports this week of some interesting information on why bio-films become resistant to antibiotics and provide clues as to how Doctors can use this information to allow antibiotics to work effectively.

Apparently it’s all to do with the need for nourishment, without which all things will starve, including bacteria. In a bio-film, the top layer of bugs consume the food first leaving the inner bacteria literally starving, but lead researcher Dr Dao Nguyen and his team discovered that these starving bacteria are the ones that are virtually impossible to kill. Scientists have known for some time that when bacteria sense that their nutrient supply is deteriorating they “issue a chemical alarm”, so Nguyen and his team devised an experiment to see if this was also the way that the bacteria developed its antibiotic resistance: and it looks like it is.

“Our experiments suggest that antibiotic efficacy could be increased by disrupting key bacterial functions that have no obvious connection to antibiotic activity” he reports.

In another unrelated report, Nano-Scientists have produced a biodegradable particle that has an electrostatic attraction to bacterial cells, and not healthy human cells, disrupting their cell membranes and killing them. This opens up alternative approaches to treating infections without the need to use discover more powerful antibiotics.

It looks like life is going to get fairly tough for those pesky bacteria in the near future, and not before time too!
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Cholesterol control gets new boost.

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High cholesterol has been known to be a risk factor for Coronary Heart Disease for some decades now. But the sorts of medications that we take for cholesterol and what are their possible downsides has also concerned Doctors and patients alike. Well, there's some good news for those who take Statins, and also hope for a new, potential weapon in the war to rid the coronary arteries of life threatening Cholesterol plaques.

A report from the Heart Protection Study published recently in the Lancet has shown that Statins are both safe and effective when taken long term. They followed a group for five years initially and found Statin usage reduced major heart events by 23% in that period. Post study, they followed patients up for a further 11 years and found that patients maintained the lower risk rate, but there was no increase in other health areas such as cancer. So Statins do reduce risk and they don't cause Cancer - and that's got to be reassuring for the millions who take those medications.

But despite Statin usage, some people still have a coronary event, despite "doing all the right things", and some Cardiologists will often shrug their shoulders and say "Blame your genes", which is a good line, but not very helpful!

As most people know, Cholesterol is the name for a family of fats that circulate in the blood stream: and like all good families, most are OK, but some are the "bad guys". In the Cholesterol family, LDL is the bad guy and HDL the good guy. Statins generally work on lowering LDL but don't do a great deal to raise the HDL - although Roscuvastatin does a pretty good job -. Enter cholesteryl ester transfer protein (CETP) inhibitors as cardioprotective agents! These medications lower LDL but also really give a boost to HDL, and the theory then goes that this will reduce the Cholesterol plaque burden within the Coronary arteries where heart attacks are born.

Like many new classes of drugs, the first up effort wasn't the greatest and the Torcetrapib trial was rapidly brought to a premature halt. However, Anacetrapib and Evacetrapib have both been shown to hold great promise in achieving their targets of lowering LDL and raising HDL either alone or in combination with a Statin.

The big question is: will this lead to a reduction in cardiovascular "events" - heart attacks or death? Watch this space!

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Middle ear infections: Nasal Sprays beat antibiotics

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One of the downsides to medicine having access to antibiotics, is that all too often we get to use them ... for the wrong reasons! There is also the trend, covered in a previous blog, for patients to ask for a "really strong" antibiotic, instead of asking for the correct antibiotic!

I was reminded of this when reading about a study from California and recently presented at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting. In a relatively small study of children with a history of allergy, Dr. Nsouli and colleagues compared the effects of an 14 day course of antibiotics - amoxycillin and clauvulinic acid - with a 14 day course of an aqueous nasal spray containing the steroid Ceclosonide.

Their findings revealed that the Spray worked in 8 days, whereas the antibiotics took 14 days!

The problem with middle ear infections in children is a combination of size and obstruction: but it has nothing to do with the ear that we see on the side of the head - which Doctors call the outer ear. That the problem appears to lie within the external appendage is compounded by the fact that Doctors look into the Outer ear, in order to view the eardrum and thus confirm their suspicions of a Middle ear infection, which they do when we see a red ear drum bulging with fluid within the Middle ear.

Now the real reason the fluid is trapped within the Middle ear is because the Eustachian tube, that connects the back of the nose with the Inner ear is blocked - usually by the swollen, inflamed membranes of the nasal passages. But most Doctors don't look up the nose of a child because it's already blocked with yellow/green mucous,  and so patients often find it difficult to connect the idea that in order to fix the ear, you have to squirt something "up the nose"!

Dr Nsoulis study is another resource to help convince both patients and Doctors that in the case of middle ear problems, where there is a history of allergy, then inhaled nasal steroids are much the better option than repeated doses of antibiotics which, if truth be known, only lead to increased bacterial resistance of pathogens within the rest of the body: and that's not good medicine for anyone!

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Another insight into Malignant Melanoma

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The first patient I ever saw as a medical student was a Dentist in the UK who had terminal, metastatic Melanoma: it wasn't a pretty sight and one that has stayed with me for nearly 40 years! Melanoma is still on the increase and is one of the more common amongst young people: there has been a staggering 50% increase amongst women under the age of 30 since 1980, so any advance in its research and treatment is to be welcome.

Apparently there is a gene called BRAF that is implicated in the spread of Malignant Melanoma, and one of the proteins associated with that gene - P-Rex1 (sounds like a pop group) - is found in higher levels in those with advanced disease. Now scientists have developed a drug that blocks this protein which so far has had beneficial results in experimental models, and has also shown significant survival benefits in human clinical trials.

This is not the end of the story by a long way, but may be the end of the beginning for our understanding where P-Rex1 protein fits into the overall picture, and how Melanoma spreads around the body. From this scientist will be able to develop more targeted treatments so that Melanoma can join all those other cancers that are now in decline, or being managed so much better.
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Soft drinks not so kool?

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Non diet soft drinks have been around for decades in the developed world, and what was once deemed a luxury is now casually bought and consumed, often without any awareness of the action. But dieticians and health workers have been concerned for some time about the current calorie binge in the "West" and in the developing world, and it's connection to the epidemic of worldwide obesity. One element of the excess intake of calories has been the universal availability of high sugar content, carbonated soft drinks, and many health education programs are focused on reducing the consumption of such drinks.

A report out of Boston has raised another possible negative link relating to carbonated soft drinks, and this time it's an increased rate of violence amongst teenagers in those who consume large amounts of such drinks. David Hemenway, MD, professor of public health and director of the Injury Control Center at the Harvard School of Public Health, Boston, Massachusetts, and his colleagues reviewed self reported data from 2725 teenagers (self reported data always makes me a bit dubious about any conclusions drawn from them) in the Boston Youth Study: and his findings are sure to stimulate debate for some time to come.

What they found was that teenagers who consumed more than five 12oz (350mls) of carbonated soft drink per week:

• Were more likely to carry a weapon, and
• Were more likely to be violent towards siblings, dates and friends.
• Were getting insufficient sleep and 
• Were using alcohol and tobacco within the past 30 days.

And of concern was the fact that nearly one in three reported that they consumed more than five cans of carbonated drinks per week. Interestingly, the authors did not report a link with obesity.

Soft drinks not only contain carbon dioxide dissolved in water, but they also contain
high fructose corn syrup, aspartame, sodium benzoate, phosphoric or citric acid, and often caffeine, so should the link be confirmed the next question would be "Which one(s) is(are) the culprit(s)"? But we shouldn't jump to the conclusion that soft drinks must be the "root of all evil" and legislate to ban them on the findings of this self reported research. But perhaps we should try to view carbonated soft drinks as something quirky to be tried on occasion, and not the first thing to quench a thirst when walking through the Mall: in many respects, iced-water is a much better choice.
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Future shock for teenagers?

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Oh dear! A few years ago there were headlines declaring that the current generation would not live as long as their parents because of premature heart disease. I have to admit that at that the time I thought that there was an element of truth in the statement, but kept my head down when there was a "backlash" suggesting that this was too "emotional" a statement and would be counter-productive.

But it seems that Donald Lloyd-Jones, M.D., chair and associate professor of preventive medicine at Northwestern University Feinberg School of Medicine, has decided to stick his head above the parapet and declare that as far as the current generation of US teenagers is concerned, "The future is bleak"! When it came to the established risk factors for heart disease, none of the 5,547 children profiled in the study fitted the criteria for ideal cardiovascular health: now that seems scarey! But before we think that our teenagers are letting the side down, I vividly remember attending a conference 10 years ago where the lecturer went through the list of cardiovascular risks and asked attendees to keep their hands up if they fitted into each criteria. With each new criteria, more hands went down: and by the end, ther were only one or two hands left up! And these were all Doctors!

But back to the teenagers: their biggest downfall was diet, which appears to be terrible with high sodium and saturated fats. Then approximately a third of them had higher than normal cholesterol, blood sugars and were overweight or frankly obese! Amazingly, considering all the health information regarding tobacco, 25% of them reported that they had smoked in the past month.

The conclusion is not that these teenagers are a lost cause, but rather that we must look at new ways of getting health information through to them so that they can maximize their health and their lives.  This is a complex challenge and one that perhaps should start with the idea that the easy option is not always the smartest or best option.

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Can Cheese affect your Cholesterol?

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Being one of those people with very few risk factors for heart disease, but who have had stents and also by-pass surgery, I tend to be fairly fanatical about “living the great life” with lots of exercise and fantastic food prepared by the young bride! But there are a few things that I have missed and secretly yearned for over the years, and one of them is Cheese!

Don’t get me wrong: I love what I eat and I never think of it as “healthy” eating, but as awesomely delicious and nutritious food. But there’s something just a little indulgent in say a fine grating of cheese on, perhaps, a sliced zucchini slipped under the grill until it is browned and then eaten whilst still hot!

Well, maybe that little indulgence could become a hope and then a reality because some kind physician at the University of Copenhagen in Denmark has looked at the effects of cheese and butter on Cholesterol levels. The results were that Cheese caused no increase in LDL or total Cholesterol, but with those who consumed the butter had a 7% higher level of LDL. Why there is a difference between cheese and butter is yet to be decided, but it may be to do with Cheese’s relatively high level of Calcium that may affect the excretion of fat by the gut.

But be warned: this does not mean that people with known heart disease should start loading their plated with seven different varieties of Cheese: it just means that once this research has been reviewed and expanded upon, if the Danish findings are confirmed, then that little morsel of Cheese will taste even more delicious.

And finally, just a quick “pat on the back” for our cousins across the ditch - as we in Australia describe New Zealanders! Apparently Kiwi fruit is better at lowering blood pressure than the good old apple a day: so well done guys! The downside is that you have to eat 3 of them a day - and they are pretty “tart” at the best of times! I think I’ll stick to Pomegranate juice!
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Unexpected Hormone supplements?

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I remember reading a newspaper article back in the '70's about strange events in the fish population of the Great Lakes: apparently the male fish were becoming feminized and it was thought to be due to the increased amounts of Oestrogen flowing into the giant waterway from the urine of women now on the Oral Contraceptive Pill.

This fact returned to me the other day when reading an article which highlighted the possibility of a link between the increased rate of Prostate cancer with the OCP. David Margel, MD, from the Princess Margaret Hospital, University of Toronto, Ontario, Canada reported a demographic study where he and his colleagues found that in areas with the highest use of the OCP, there was an increased rate of Prostate Cancer. He also stressed that this was an "observational" study and no way intended to link the Pill to Prostate cancer, or to suggest that women should come off the Pill: but it does open a window onto an area that is murky to say the least.

There have been many environmental reports over the years on how synthetic organo-chlorines, PCBs and Dioxins have had adverse effects on fish, reptiles and amphibians. Spare a thought for the poor, confused, male Cricket Frogs in Illinois, where 9% of their confreres, instead of having two testicles, have one testicle and one ovary! And 90% of male Tiger frogs had eggs in their testes!

But can synthetic hormones that are found in the OCP find their way into the waterways and cause environmental problems? The answer is yes: but 90% of those synthetic hormones do NOT come from humans, but from cattle! Also, most of the synthetic hormones from humans do get removed from the water supply through current sewage treatment management. The problem is that the largest offenders - cattle - tend not to use toilets and their urine and faeces eventually ends up in the waterways.

Finally, the link to prostate cancer is curious as we commonly use Oestrogens to help suppress the growth of Prostate cancer, so how does this theraputic medicine become a driver of malignancy? These uncertainties should remind us that this latest study is an "Observation", and not meant to point a finger. So, for me, this report is a timely reminder that as we develop these powerful medications to help us fight disease, we should constantly be thinking of what happens to medications and their metabolites, once they have gone through the body - think antibiotics, chemotherapy medications, radioactive tracer dyes used in Radiography and now the latest medical treatments using Nanoparticles - and perhaps even more importantly, that most of these medications will have been used in farm animals for many years before they are released onto humans!
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Adolescents, Hamsters and Sex.

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  I learn something new about our bodies each day! For instance, today I discovered that our human physiology is quite similar to that of a Hamster: this interesting fact surfaced when reading a stimulating article which raises the possibility that, for young male Hamsters at least, sex during adolescence can have a lasting negative effect on the body and mood well into adulthood.

It is now becoming more clear that the developing brain remains “plastic” well into the third decade of life, and so it can be vulnerable to permanent changes as a result of negative impacts during this time. That sex can be seen to be negative may seem odd to many people who think that sex sells everything, but there is no doubt that it can be a very complex emotional and physical event in the life of an individual when their nervous system is in a state of continuing evolution.

But is appears that adolescent sex in our furry friends can have the following effects:

• Increased signs of depressive like behaviors
• Lower body mass
• Smaller reproductive tissue
• Changes to cells in the brain

This would appear to suggest that for some sexually active “teenage” Hamsters, sex can be a serious stressor. 

Whilst there is a real temptation to smile at the extrapolation of teenage Hamster sex to adolescent humans having sex, there is a serious side to the findings. The teenage years are a time when the nervous system is developing and changing very rapidly and “There is a possibility that environmental experiences and signals could have amplified effects if they occur before the nervous system has settled down into adulthood”, according to co-author Zachary Weil of Ohio State’s Department of Neuroscience in a paper delivered to the November meeting of the Society for Neuroscience.

Definitely food for thought.

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Another plaudit for Pomegranates

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It doesn't seem all that long ago that I was having a long lunch one Sunday with a delightful ex airline pilot who was extolling the benefits of Pomegranate juice. He was telling me that it had great benefits for older men faced with prostate dis-ease! Since then I have discovered that the experts also tell us that it helps with lowering blood pressure and is "anti-aging" (whatever that might mean!)

Well, now there's another benefit from this ruby juice that originally hails from the hills of Afghanistan.According to Batya Kristal, MD, MHA, from the Nephrology Department at the Western Galilee Hospital in Nahariya, Israel, patients in her renal unit who were given the juice over a one year period experienced lower blood pressure, an improved lipid profile and required less anti-hypertensive medication!

Obviously with reports like this one does have to look behind the genuine enthusiasm of the researchers, and in this case the study was small and the results would only apply to patients with severe kidney problems. Also, Pomegranate juice is high in potassium, a salt that tends to accumulate in kidney disease and if not monitored closely could lead to serious consequences.

But it is reassuring to note that the juice did lower blood pressure in people who have naturally higher blood pressures because of their kidney problems. Also, when looking at how the "Lipid profile" was affected, it seems that not only did the bad Cholesterol go down, but the good HDL Cholesterol went up: and there are few safe things that I know of that can raise the good, cardio-protective HDL Cholesterol.

So as well as flossing my teeth for good gum hygiene, taking regular effective physical activity, eating lots of salmon, veggies and fruit, but avoiding animal fat whenever I can, I will be adding 100mls of Pomegranate juice to my daily regime: perhaps it will help wash down the handful of walnuts that I have with my brekky!!

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