Why I am OK with Losing the Health Competition

Because health is not actually a competition. It is not a dress size. It is not a weight. It is NOT a number.

 

I am healthy – how do I know? It’s just the vibe. Because despite what many think, health is not defined by a single number like weight or BMI; it’s dependent on much more that. For instance, the fact that I eat everything in moderation and get 5 serves of vegetables every day. I eat dairy (and get at least 2 serves per day through my coffees) and try to get enough iron in my diet. Red meat isn’t my favourite thing but I do aim for lots of other iron rich foods like eggs and lentils. I’m also active enough– I don’t run or cycle 20KM a day but I get in enough exercise through my walks with Miss S and Pilates. My weight and blood pressure are in the healthy range. My pap smear is up to date. I meditate occasionally, sleep well 99% of the time and right now my mood is pretty good. Sure I get stressed sometimes, but who doesn’t?

 

I am a size 10. I have a “pudgy” bit below my belly button that appeared after Miss S and I suspect will stick around regardless of how many crunches I do – truth is, I don’t care anymore. Granted it has taken me 18 months to say that but I am now genuinely comfortable with my new padded bits because I know I am healthy regardless. I currently weigh 60 kilograms. I don’t fit into my wedding dress anymore, and likely never will. I don’t look good (in my opinion) in lots of Sass and Bide clothes because that stuff is made for people taller and thinner than me. But I look cracking in my high waisted pair of blue jeans on most days. The truth is that my days of competing with models and friends who naturally have a different body shape to me are over.

 

Many young people define healthy by the photos on their Instagram feed – the girl in the red hot bikini is attractive I agree– but she is not always the picture of health. Restricting one’s food intake or exercising to the point of exhaustion is not ideal regardless of how good you look in a bikini. Likewise, the mega buff dude at the gym who can bench both his mum and sister isn’t necessarily the healthiest person either – gaining muscle mass and shredding fat through use of anabolic steroids or guzzling natural remedies like Garcinia Cambojia certainly isn’t heathy (by the way many natural remedies like the one mentioned can cause liver failure). Social media and the media are shaping what we see as healthy and being “healthy” has become a competition or a badge of honour – “but look at how much greener my almond milk low fat, chia seed loaded smoothie is.” Damn it I don’t drink smoothies– does this mean I am not “healthy”?

 

When does the drive to be healthy become pathological and obsessive and ironically, bad for your health?

 

I often see patients aiming for a lower weight and smaller waist size when their BMI is in the healthy range. People eliminate meat and dairy completely from their diet for no good reason proudly proclaiming they are “healthy”. Wait a minute- what about your iron deficiency anaemia? And have you thought about your now increasing risk of osteoporosis? (We reach our peak bone mass in our 20s so cutting dairy can be very problematic!) Exercise can start to become addictive – patients can’t go a single day without a 10-kilometre run. Or they tell me they feel guilty if they don’t do something calorie-burning in their day. The quest for “healthiness” can in actual fact tip the other way and become unhealthy for both body and mind.

 

To be honest with you, being a type A personality, I am at serious risk of this healthy quest becoming an obsession. And if I’m honest with myself when I was in 5th year medical school it did all get a bit unhealthy – my weight went too low, I cut out food groups convincing myself that I didn’t need carbohydrates or meat because hey, no one else seemed to need it either. And I couldn’t go a day without doing something active. I was young. I was using the wrong ruler to measure healthiness. I was measuring up to people around me, to the girls in the magazines. Now I know I’m healthy without measuring against any of that – but it took me 10 years to get to this place! I look at the guidelines, the suggestions for preventative health and I know I’m close enough. I want to be very very clear here – I am not perfect, I do not live my life perfectly but I am doing OK.

 

There are so many guidelines I could spout off at you, but these are the ones that I choose to care about:

2 serves of fruit and 5 serves of vegetables per day

30 minutes of moderate intensity exercise on most days

2 1/2 serves of dairy daily for someone in my age group

7-9 hours of sleep per night

No more than 2 standard drinks of alcohol per day

2-3 fish or vegetarian meals per week for cholesterol management

 

 

They are GUIDELINES. At the end of the day we can’t strictly live by all of them – it just isn’t possible! I certainly follow them “loosely” but there are some days I literally cannot fit the exercise in. There are some days when I eat no fruit at all. There are lots of days when I don’t get enough dairy or sleep (hello we have a toddler). And there are certainly days when I have more than the 2 standard drinks. I love lots of naughty things; smoked cheddar, chorizo, bacon – and yes, I do eat them all in moderation without feeling guilty. Please don’t think I am promoting perfection or a strict lifestyle where you live by guidelines and don’t actually “live.”

 

To me, a GP, being healthy is trying your best to follow the evidence-based guidelines to reduce your risk of chronic disease and certain cancers. It’s trying to eat a balanced diet, restricting the bad stuff and bumping up the good. It’s trying to be active and taking every opportunity to do so. And it’s keeping a note on your mental health – managing stress/anxiety/depression as it creeps up. To me, the person who walks through my door with a varied diet, who gets fruit and vegetables most days, who exercises 3-4 times a week and whose weight is in the healthy range is healthier than the person who obsessively cuts numerous food groups from their diet and exercises regardless of the weather, life commitments, their mental health or injuries.

 

I am a size 10, I eat everything (in moderation), I love wine, I am a working mum who can get stressed but is pretty content 90% of the time, I exercise 5 out of 7 days most weeks and meditate occasionally using the Smiling Mind app. No six pack, not a model (definitely not a model!) but healthy. You won’t see me posing in a red bikini on a beach anytime soon (or ever FYI) but I can assure you I am still healthy and I shouldn’t need to strip down and show you my six pack (or lack thereof) to prove it.

 

 

 

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Why Health Should Dictate Where you Holiday

 

 

Will and I love travelling. Prior to Miss S we smashed through Europe with backpacks (and a pillowcase of food – seriously, don’t ask!). The same backpacks took us to places like South America, India, Indonesia and Morocco. We’ve continued to travel since Miss S arrived but I can tell you the adventure dial has been turned right down whilst she is young. Despite our desires, we will not be taking her on an African safari tomorrow given the significant malaria and chikungunya risk (both mosquito transmitted diseases). We also won’t be jetting into Nepal as a family to hike to Mount Everest base camp (a dream of mine) given the potential for altitude sickness in our toddler. Planning a holiday for us now takes much more thought – how long is the flight? Is there access to easy English speaking medical care? Is there risk of malaria, Dengue and yellow fever and is it a risk we are willing to take with Miss S?

 

I often have patients including couples and families come in for a travel consultation, all booked and ready to go, with no idea about the health implications of their destination choice. Recently a patient of mine cancelled her trip as she was pregnant and did not realise that Fiji was on the zika virus list. I had another patient cancel flights and re-route her entire travel because she was not willing to have the Yellow Fever vaccination – it meant she could not enter several countries around her after leaving yellow fever affected areas. After a lengthy discussion about the vaccination she opted not to have this so had to change her travel plans. Many patients see cheap flight deals and book (I’ve done the same thing don’t worry) and realise only in my consulting room that they may need to take anti-malarial medication, have a Yellow Fever vaccine and consider taking tablets to prevent altitude sickness if they want to venture to certain parts of South America. The health aspect is an afterthought a lot of the time. Choosing a travel destination should be about the sites, beaches, food, culture – but taking your health, or your family’s, into account should be a big factor too.

 

So here it is:

 

Your Health Checklist to Guide your Next Holiday Destination:

 

Mosquitoes are more than annoying, and more than just malaria!

 

If you are pregnant or planning pregnancy then you should be completely avoiding areas with Zika virus (which is nearly everywhere now). By the same token males planning conception should avoid Zika areas for at least 6 months before they start trying. Unfortunately, right now nearly all the favourite baby moon spots outside Australia are Zika affected – Bali, Singapore, Fiji. Currently only Vanuatu and New Caledonia are Zika free though this might change so you need to keep an eye on this. There are not many close international destinations that are safe when pregnant so currently lots of my pregnant patients are remaining within Australia for their trip away. Now, do not let this blog deter you from your baby moon (please, its important stuff to have a chill out before life changes in a big way!!) but be careful with your destination choice.

 

Still talking about mosquitos, if you are travelling with young infants you should ideally avoid malaria ridden areas. Whilst the newer medications like Malarone come in paediatric formulations, between all the available medications there is nothing for infants under 5 kilograms which makes prophylaxis tricky; it’s all about mosquito avoidance but that might not be enough particularly when malaria can be lethal. Everyone knows mosquitos are malaria go hand in hand but Yellow Fever and Dengue Fever are 2 other infections that can be transmitted via mosquitos. The Yellow Fever vaccine is approved for use in children older than 9 months of age so taking a child younger than that to a Yellow Fever affected area is risky stuff. Whilst I don’t want mosquitos to be the first thought when you’re planning a holiday – they should certainly factor into the decision if you’re travelling with children!

 

The geographical location – is it safe?

 

People often don’t think about access to medical care if something goes wrong on a holiday. I know we all want to think nothing bad will happen (and I have my fingers and toes crossed for you) BUT you need to be prepared particularly if travelling with children. Whilst I recommend every single person have travel insurance it’s generally no good to you if you are in a distant remote area with your kids away from any medical assistance or easy evacuation. If you have any medical condition that is affected by climate then that should be taken into consideration when choosing a destination; are you particularly sensitive to the sun because you have lupus? Does your rheumatoid arthritis flare in cold weather? Does your dishydrotic eczema flare to the point of unbearable discomfort in the hot weather? Is your Raynaud’s disease particularly painful in the cold weather?

 

Also, if you carry medication with you plan for this – take enough of the stuff (we can give you increased supply if you are travelling for a long duration) and carry a medication letter with you to avoid any issues with customs.

 

Food safety

 

This is a big consideration particularly when pregnant, travelling with young kids or if you have a chronic illness that is vulnerable to traveller’s diarrhoea (like inflammatory bowel disease). I’m not saying don’t travel if you fit into any of the aforementioned categories but perhaps remote areas of Papua New Guinea with poor access to safe food and water isn’t the best idea in pregnancy (if it can be avoided). By the same token travelling to remote areas of India with an infant (where sterilising is difficult) may also be ideally avoided. We took Miss S to India as a 6-month-old – but we made sure we avoided malaria prone areas and took food and water safety extremely seriously. We purposely stayed on the worn in well-known track (despite the heavily adventurous streak in both Will and I) and it paid off. With Miss in our life we have managed to continue travelling BUT the type of travel and destinations have been dictated by her health and safety and that’s how it should be.

 

The flight

 

There are so many wonderful places we all want to visit but is it worth a day in the plane with a toddler? Our current cap is 6 hours – we just know anything beyond that with the adventurous Miss S right now would be a struggle and not worth it for us! If you are pregnant are you still allowed to fly? Every airline has a different cut off for domestic and international travel for pregnant women, and the cut off is lower with twin pregnancies so you need to be aware of this if travelling when pregnant. If you are claustrophobic or an anxious flyer take this into account too – patients often come in to the GP asking for heavy sedatives just before flying – something I am not willing to prescribe given the risk for potential error (imagine trying a drug post a beer on a plane – the consequences can be pretty hairy!). Are you better of road tripping or going on a short flight? Think about it before you book that 24-hour journey!

 

 

 

 

 

So yes, let the cuisine, culture, beaches and shopping opportunities all be part of the decision process when you next decide on a holiday destination. But please (pretty please) let health be a factor in there too.

 

 

If you are looking for up to date health travel information the CDC is an excellent resource and can be visited at https://wwwnc.cdc.gov/travel 

 

 

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The Flu Vaccine – Worth a Shot?

 

Our clinic just received its supply of Government funded flu vaccines (insert hands up emoji here). It got me thinking – how many people know who is eligible to receive the free Govenmernment funded flu vaccine ? And why might you still want to get the jab even if you have to pay for it?

 

Lots of patients will say that they don’t get the vaccine anymore because they “had it once and got the flu straight after.” I swear I say this a thousand times in flu season – “the vaccine CANNOT give you the flu.” It is not a live vaccine – we do not inject any of the live virus into your body. It dose make your body mount an immune response (that’s how all vaccines work) so you may experience some muscle aches (but most likely you will just have a sore arm). What is MORE than likely (if you do get sick a few days after it) is that you were incubating some sort of virus before you got jabbed, and the illness declared itself coincidentally in the few days after and you blamed the poor vaccine, when it fact you should be blaming the snotty guy at work who doesn’t wash his hands – ever! A reminder also that like any vaccine, the flu vaccine isn’t 100% effective and covers 3 or 4 strains of the flu virus (depending on which vaccine you get) when there are in fact many other strains in the community. Despite the fact it isn’t the magic bullet the vaccine does reduce the risk of flu by about 50 to 60% in the general population – and trust me if you’ve been in bed for 2 weeks with aching muscles and fevers you’ll take anything you can get to reduce your risk of getting it again.

 

There are certain people who get the flu vaccination for free in Australia- anyone over 65, Aboriginal and Torres Stait Islander people, pregnant women and patients with chronic medical conditions such as asthma (where the flu can trigger severe flares) or diabetes (where the immune system is suppressed). There are many other conditions that qualify for the Government funded vaccine so it is worth checking with your GP if you have a chronic medical illness. If you are fit and healthy then you can still get the vaccine- you just have to pay for it (between 15 to 20 dollars). I get it every year – I would be stupid not to in my line of work. I couldn’t tell you how many people I see in the flu season with the classic fevers and aches who look like they’ve walked straight from a steam room into my office – I’m talking sweaty, clammy, “death warmed up” kind of look. If you’ve had the flu before you will do anything to get the vaccine. And before you say “I’ve had the flu and it wasn’t that bad”– the flu is NOT a cold- they are caused by completely different viruses. A cold is often something like rhinovirus or human metapneumovirus whereas the flu is caused by viruses like Influenza A, B or H1N1 (also known as swine flu) – completely different nasties. The flu is debilitating – muscle aches, high fevers, runny nose, headaches, low appetite for up to 4 weeks – you are house if not bed bound. It can lead to pneumonia and even death in the vulnerable (infants, elderly, immunocomporomised to name a few). The flu isn’t the sore throat and headache you had for 5 days last week – it’s much much more than that, trust me.

 

I’m terrified of needles (yes, no joke!). Happy to jab my patients but if you come near me with a needle I will hyperventilate a little (and try very hard to hide it) which sometimes makes me  bit woozy and faint (I know, could it be any more dramatic?!). But guess what I’m doing this week? Yep, getting a flu shot because for me, a young mum, I can’t afford 4 weeks off and I certainly can’t be bringing the flu home to my little girl. A quick jab in the arm versus 4 weeks in bed – up to you!

 

If you would like to read more about the Influenza vaccine, including vaccination of children, check out http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-influenza

 

 

 

 

 

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A Healthy Spin on a Comfort Meal Version 1 – Tuna Mornay

 

 

Tuna mornay is a love of mine – it holds a special place in my heart… alongside twiggy sticks (I know I know!), smoked salmon and goats cheese. It’s a meal I yearn for when I’m celebrating something or when I’m devastated and need a pick-me-up. But MY tuna monray isn’t like yours- I can assure you. It’s one of the healthiest and easiest meals I make and lasts in the fridge for 2-3 days feeding the entire family – Miss S included.

 

If you follow me on Instagram you’ll have seen it in my posts – I make it often – so I thought it was time to share how I do it. So here it is – the Preeya twist on tuna mornay.

 

Firstly, tuna mornay (or my version of it sans white sauce and other fancy bits) is a very healthy vegetable packed meal that only needs one pot. Tuna is so good for you – rich in omega 3 hence, great for the heart and the brain of little ones especially. If you’re attempting to adopt the Mediterranean diet, because of all its wonderful evidence-based health benefits including reduced risks of cancers and heart disease, then it’s a wonderful meal for you because it contains seafood, is loaded with vegetables and uses olive oil as the cooking base.

 

What you will need:

Step 1 – Pick 2 425g cans of tuna (this makes a mammoth quanitity to last for 2-3 days, if you don’t need this much only use 1 can). It doesn’t matter what type of tuna you pick – either spring water or olive oil will do but ensure you don’t pick a flavoured one – we can add that ourselves! You will also need 1 or 2 cans of creamed corn (you can get this from the canned vegetable area at the supermarket) – 1 can for a small batch, 2 for large. In the recipe you might find some other bits I add sometimes.

 

Step 2 – Look in your fridge, veggie patch and pantry – what veggies do you have? I always use what I have – the half chewed broccoli sitting in the crisper is perfect, so are the tomatoes in the garden! Sometimes I’ll use cauliflower I have sitting around and other times I’ll use some celery, mushrooms and tomatoes. Grated zucchini is always easy and fabulous. Use what you have but make sure you add at least 3 types of veggies and one that adds some crunch like celery. I hear the critics already – “tomato in a tuna mornay??” – it’s a great addition – adds some additional moisture and sweetness!

 

Be creative with the veggies especially if you have kids. I tend to blitz my broccoli and cauliflower (if I’m using it) in the thermomix before I add it to the pot – it makes it like a cous cous and makes the mornay thick and creamy!

 

Step 3 – Always add peas and corn – it’s just how I roll.

 

Step 4 – Be creative with your grain! Doesn’t HAVE to be pasta. I sometimes add brown rice (cooked before I throw it in to the mix) but more often than not add quinoa which is just lovely and adds a nice texture! You can use wholegrain pasta or even chickpeas. Sometimes I don’t add a carbohydrate at all – usually because I’ve put in so many veggies there is no room. It’s always just as delicious!

 

The actual steps I follow:

 

  1. I heat olive oil in a fry pan and fry off onions (brown or red) until browned – about 5 mins
  2. I add the tuna (with the olive oil or spring water drained beforehand) and just brown it slightly for another 4 mins
  3. In go ALL the veggies I have – the spinach, tomatoes, peas and corn, cauliflower – whatever it is I chuck it in now. Stir it all in and give in another 2-3 mins.
  4. Add your binder of the dish (some fluid!) – the creamed corn! If you have a load of veggies you might need 2 cans – but 1 is usually enough. Once the binder is in – chuck you grain in now – whatever it is: pasta, quinoa – this is its moment to join the party!
  5. SOMETIMES I add a soup packet (cream of chicken or celery) to bind it further but I rarely need this. If you do choose to add a cream of chicken soup pick one with low salt (especially if your child is going to eat this).
  6. Add your herbs – I normally add parsley and spring onion from the garden but play around –there are no fixed rules – try what you have!! Parsley goes beautifully in this though as does basil.
  7. Pepper – of course!!! Be careful with salt ESPECIALLY if your child is going to eat this. I don’t add any if Miss S is going to have this for dinner – which is always given she loves the stuff!!
  8. Once it’s all bound, shove it in an oven dish – 2 cans of tuna gives you lots of food so you will need a big tray – sprinkle some cheddar cheese on top and pop it in the oven on 180 degrees for 20 mins until the cheese is golden on top! Don’t freak out – I know there isn’t any white sauce nor bread crumbs but trust me this is delicious! People don’t realise that adding something like white sauce to a meal is adding extra calories you don’t need.

 

And that’s it – you have a healthy tuna mornay!! You may be skeptical – is this even delicious? Hell yes it is – the veggies give it texture and sweetness, the cheese gives it the edge and the tuna is the hero as it should be!

If you have a serve for dinner this meal will give you at least 2 serves of veggies easily. Imagine how good it is for kids! I can hear you saying “Preeya this isn’t really a strict recipe with steps to follow” – I know but this is how I cook – it changes every time and you have a framework now to work off.

 

The wonderful thing about my mornay, like all my cooking, is there are no set rules – play around, try things out, chuck in as many good tasty things as you can! Try a comfort meal without the naughty things like white sauce – it can be just as delicious and good for you!

 

If you like this – I’ll pop up some of my other healthy versions of comfort food – lasagne, pasta sauce, shepard’s pie, enchiladas!! The possibilities are endless!!! Check out my Instagram feed for other healthy food ideas!!

 

 

 

 

 

 

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A Peek Inside Our Medical Kit for India

 

I’m a type A packer – I’m talking lists, repeated cross checking with the lists, caressing of the lists – I love the lists!! My type A personality flourishes when it comes to holiday packing.

 

I tell all my patients that if they are going to travel overseas they need to pack a medical kit and if travelling to the developing world then the medical kit needs to be more extensive.

 

So here is a look in our travel kit for India – I use the term “kit” very loosely – it’s a plastic bag filled with an abundance of ammunition in case we get unlucky. In addition to the medications I’ve packed Milton’s tablets for sterilising Miss S’s utensils and bottles (seriously handy for travel!) and water purification tablets just in case.

 

 

  1. The Basics

 

These are the things people sadly tend to forget (and you will kick yourself trust me!) – the every day items that you take for granted at home. Paracetamol when you have a headache, a fresh bandaid when your child falls over and grazes their knee. The basics should go on every holiday with you!

 

What I packed – Paracetamol and Ibuprofen (both for Miss S and ourselves), antihistamine tablets for adults (to stop my allergic husband from ruining the entire trip with his sneezing), bandaids.

 

 

  1. Traveller’s Diarrhea Essentials – incase it hits (insert worried face here)

 

Traveller’s diarrhea is common and affects up to 50% of international travellers. Nausea, vomiting and diarrhea are horrendous but it’s the dehydration as a result that is the big killer. Hydration solutions are essential- we have effervescent tablets and jelly in our medical kit this time in case Miss S gets hit. Food and water safety is key when it comes to avoiding traveler’s diarrhea (I can’t emphasise this enough!!!) but if you get unlucky anti-diarrhoea tablets (NEVER use these in children as they can have severe bowel complications) and an anti spasmodic agent like Buscopan, for that awful crampy belly pain, can help. You should always see your GP before you travel to countries where traveller’s diarrhea are likely to hit (South East Asia, India, Africa etc) for antibiotics you might be able to take with you in case – antibiotics can help as more than half of traveller’s diarrhea cases are bacterial in nature.

 

What I packed – Ciprofloxacin and Azithromycin for traveller’s diarrhea (for the adults), Azithromycin (for Miss S), antispasmodic agent, Loperamide, hydration solutions (both tablet and jelly), Weetbix – if something super simple is needed for Miss S (yes it is going in the medical kit area!!)

 

  1. Sun and mosquito safety

 

Another big one people tend to forget! Sun cream (make sure it’s water resistant and OK for children if you have them!) and mosquito repellant are VITAL. For some reason people don’t consider these as vital components of the medical kit – to me they are perhaps more important than some of the antibiotics you can take. Severe sunburn on a holiday is dangerous and malaria can be lethal – so put your insect repellant and sun cream purchase high on the agenda!

 

DEET repellant is the tropical strength stuff you can buy from the chemist. For Miss S we have the cream version to apply (not to the hands as they put these in their mouth), a mosquito net to place over her cot (Kathmandu sells these) and 50+ suncream for her (and a version for us). We have tailored our trip for Miss S (and are not travelling to high risk malaria areas) because there are no antimalarial drugs for her and having seen malaria as doctors we were not willing to take the risk so our itinerary sticks to low risk areas only. Again a visit to the GP before you travel is a great way to find out if you are going to high risk malaria areas, in which case you might need preventative medication.

 

What I packed – 50+ suncream for the entire family, DEET insect repellant, mosquito net, citronella candles, hats and sunglasses for the 3 of us.

 

  1. The “Just In Case”

 

You don’t know when a cold will hit so I take things for the dreaded “in case we get a cold on holiday” scenario. For adults that’s some form of decongestant tablets lest it strikes before we have to fly. For Miss S that means a bit more – the FESS nasal suction, eye wipes and Vicks are also coming along. A thermometer takes minimal room and you won’t regret packing it if someone gets sick and whilst I really want to take my stethoscope and entire diagnostic kit (did I mention I’m type A haha) I’m refraining (and I think my husband would secretly unpack it even if I tried). BUT we do have comprehensive travel insurance (please don’t go anywhere without it!!) and we have checked the English speaking hospitals that will see children in each place we are visiting – it pays to be prepared.

 

 

 

So I know what you’re thinking – how do you have room for all this? A few less dresses packed (I know the sacrifices we make!!) – but I won’t miss the dresses if I’m bent over the toilet bowl! And whilst I have fingers and toes crossed we won’t need anything from the medical kit – it’s ALL there if we do!!

 

 

 

 

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The Definition Of “Healthy” (from a GP’s Perspective)

 

Everyone wants to be “healthy.” What is the definition of healthy though – is there a clothing size? A specific weight we should aim for? Is there a magic supplement or vitamin that automatically makes us healthy? The answer is no – determining health is so much harder than just looking at a person, their clothing size or their weight.

 

Last year at the Australian Fashion Week there was uproar when a particular model took to the catwalk – the comments and tweets came thick and fast – “Oh she is so unhealthy.” The very people who were labeling her “unhealthy” and hence, determining what the definition of “health” was were not part of the health profession and the same people who place pictures of size 6 women with thigh gaps and 6 packs in our faces. See the problem?

 

You are likely not healthy if you are too thin or if you are overweight or obese. So let’s clear this up.

 

A male or female who walks in my consultation room with a very low body mass index (BMI) is equally as concerning to me as a patient who is obese. Being seriously underweight (through restriction of food, purging, not eating at all or excessive exercise) can lead to issues with fertility (women for instance, will not have regular periods), nutritional deficiencies (like iron) and osteoporosis (where the bones become brittle).

 

You can be seriously underweight and have a cholesterol of 8, which is very high and not healthy. By the same token neither is being overweight or obese – it carries risks of high blood pressure, diabetes, heart disease and high risk of certain cancers.

 

Health to me is the general “vibe” of an individual – yes, I’m talking The Castle and Mabo type of “vibe.” What’s your blood pressure, cholesterol, weight, height, body mass index? What do you eat – and do you eat a bit of everything in moderation? Do you exercise – how much and how often? Do you smoke? (Please say no!) Do you drink alcohol – and if so how much? And what’s your mood like – do you think you could be depressed or anxious? That’s the stuff I want to know to gauge whether or not you’re healthy. And here’s a hot tip mental health is just as vital as the body stuff.

 

I am not looking at your six pack or bicep size. And I certainly won’t think you’re any healthier for purposely cutting out foods groups like dairy and meat for no particular medical reason.

 

There really is no concrete measure for “health” or “healthiness.” But as GPs we make those assessments every day. So am I healthy? I do something active every day, I eat fruit, vegetables, protein, carbohydrates and drink plenty of water. I love my wine and on occasion will have more than the 2 standard drinks I should but, hey I’m human!

 

I guess you need to ask yourself the same questions. Are you doing everything you can to reduce your risk of chronic diseases like high blood pressure, type 2 diabetes and high cholesterol? Are you active? Do you make an effort with your diet – do you eat enough? Or too much?

 

So finally, yes I think my vibe is somewhat “healthy” – is yours?

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The Supplement Saga

 

 

The supplement aisle at the chemist gives me a headache and it seems I am not alone – my patients will often ask me what they should be taking and I’ve had many of you approach me on Instagram asking for a blog on the topic. So here it is – my attempt at providing some guidance (which is no way replaces a visit to the GP to answer you’re specific needs). I agree with many of you that between cranberry, gingko biloba and calcium supplements it’s hard to know what you need and what you don’t.

 

I’ve had bursts of “I’m going on a huge health kick – I’m going to get supplements, exercise, lose weight and just nail life,” and I suspect you’ve had those moments too. You end up in the discount pharmacy drawn to all sorts of weird and wonderful supplements that can make you fit and fabulous. So if I get sucked in and I’m meant to know better – I can see how my patients struggle.

 

The truth is if you have a balanced diet and no underlying medical problems technically you should not need any supplements. You should be getting all the wonderful vitamins and minerals you need through your food.

 

And the truth is some supplements aren’t as safe as you think they might be. Just because they scream natural and come without a prescription doesn’t mean they are completely safe. For instance, good old fish oil can make it harder for your blood to clot so some surgeons won’t operate on their patients until they have stopped fish oil because of bleeding risk!

 

 

Women planning pregnancy/ pregnant or breastfeeding:

 

The guidelines recommend women planning pregnancy take a supplement with at least 150 micrograms of iodine and 400 micrograms of folic acid in it everyday for 4 weeks before they try to conceive and continue this for at least the first trimester. Both iodine and folic acid are vital for a baby’s development and it’s believed the latter can help reduce the risk of spina bifida (a disorder where the spinal cord does not correctly form).

 

I will always suggest women who are pregnant or planning pregnancy go on a pregnancy specific vitamin to avoid products like Vitamin A, which can be in normal vitamins but dangerous in pregnancy.

 

So if you fall into this group – a pregnancy specific supplement is definitely worth considering!

 

But what about calcium supplements?

 

We try and advocate that people get their calcium from their diet. For some reason patients love taking calcium supplements – but truth is as doctors we only recommend this for a very small portion of the population as there is some evidence (and this is hotly debated in the medical world) that it can increase your risk of heart attacks.

 

So taking the supplement because you think you need it isn’t necessarily the right thing to do. It’s worth speaking to your GP or trying to get the required amount of calcium from your diet instead. All you need is 3-4 serves per day and it isn’t all dairy – nuts, green leafy vegetables and tofu can also give you the required calcium hit!

 

Do I need to take iron tablets? (Something I commonly get asked)

 

No, we don’t all need iron supplements!

 

The figures suggest 15% of non-pregnant woman suffer from iron deficiency. Some symptoms of iron deficiency include fatigue, shortness of breath when you are physically active and pale skin – if you’re concerned you’re at risk seeing your GP is the first step not only to confirm the diagnosis with a blood test but also to investigate why you are iron deficient (which includes taking a good history and examination). If you have confirmed iron deficiency then yes you may a need supplement – but if it’s mild we may talk about dietary factors instead and if it’s a significant deficiency you may need iron infused through your vein (as tablets may not be enough). With constipation and an upset belly as some of the side effects of iron tablets, it’s not a supplement you want to take unless you really need it!

 

I see a lot of patients on iron tablets for no particular reason and truth is if you are having 2-3 serves of red meat a week and you eat green leafy vegetables then chances are you are getting enough iron. Of course there are certain people in the population with gut disorders that affect their ability to absorb iron and they may well need the supplement for long periods.

 

 

And what about these wonder tablets- the all in one “helps with energy/weight loss/amazing skin” tablets?

 

Oh dear – we all get sucked in by this at some point don’t we?

 

You have this desperation to be healthy and feel great and a tablet that offers all these things seems like the perfect step!

 

Alas no there is no natural supplement that will “improve your energy levels and help you lose weight quickly.” Unfortunately weight loss will always be best achieved through diet changes and exercise and popping a pill just isn’t going to cut it for the long-term changes you really want!

 

And what about this Probiotic business – do they work or not?

 

Essentially probiotics are yeast or bacteria that you can get in a capsule, powder or yoghurt. Some people take these every day “just because” – and given probiotics are generally regarded as safe it isn’t too much of a problem.

 

Truth is the hard medical evidence only stands behind probiotics for treatment of infectious diarrhea when it’s caused by a virus and for preventing diarrhea due to antibiotic use. Interestingly, there is also some evidence that taking a probiotic when travelling can reduce your risk of pesky traveller’s diarrhea – so worth a shot! But a probiotic every day “just because” is not likely doing a huge amount for you!

 

 

 

 

So the truth is if you’re fit, healthy and eat a balanced diet you likely don’t need a supplement! Save yourself some money- buy more fruit and vegetables, get moving and shaking and you’re likely going to do a lot more good for your health than popping a supplement.

 

But – if you fall into one of the groups I’ve mentioned above who should be on a supplement OR you think you might like to investigate a specific one further – it’s always worth asking your GP what they think. I know for my patients I’ll try to answer their questions with the most evidence I possibly can (even if I have to look up articles in the consult) so that they can make an informed decision for themselves.

 

I’d rather you checked with me before you popped a pill you didn’t need!

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My Night As An Insomniac

I totally 100% completely and utterly understand sleep troubles.

 

I’ve had those nights where I slept 30 minutes maximum.

 

My mind ran a million miles an hour with thoughts:

  • “Why can’t I fall asleep?”
  • “What’s the time now?”
  • “Should I check the clock or ignore it?”
  • “How many hours of potential sleep left?”
  • “Should I get up?”
  • “Should I read?”
  • “Will I survive tomorrow?”

 

I literally lost my mind.

 

I heard the birds start singing at 530 in the morning.

 

I heard my husband’s not so gentle snore ALL night.

 

I moved the pillow one thousand times and none of the positions I tried were comfortable.

 

I PANICKED! I now understand the term cold sweat because I had one!

 

I have so much empathy for people who have trouble sleeping, for the anxious souls who can’t switch their brains off. When a patient comes into my room and breaks down saying “I haven’t slept properly for ages” – I feel like hugging them and saying “Oh my gosh I know the feeling! You feel like you’re going crazy!” – and sometimes I do just that and I see the patient’s immediate relief!

 

Sleep hygiene is a massive area in medicine now – and after my recent horrendous night practiced VERY HARD what I preach to my patients. I wound down, I stopped watching TV in the hour before bed and I stopped all caffeine after midday. I started my hour before bed with a warm shower and had a milo – yep adults can drink it too – before I headed upstairs to bed.

 

Trust me – if you develop a routine – if you do it much the same every night and train your body to expect sleep then sleep quality does improve.

 

It’s all about preparation. Avoid things that wake your brain up (TV, computer, iPAD) in the hour before bed and if you’re in bed for 30 minutes tossing and turning – get out!!! Go into a chair and read for a bit – don’t just lie there!

 

Try progressive muscle relaxation – where you squeeze your feet first then relax, then your calves, then your thighs, keep going up each muscle group until you get to the face. Try soothing background noise from an app like sounds of rain or the forest. Try focusing just on your breath in and out – counting a slow 1, 2 for the breath in then the breath out. Try anything that works for you… but whatever you do – DON’T PANIC!

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The Truth about Type 2 Diabetes and Sugar

9 times out of 10 when I tell a patient their results show they have type 2 diabetes the respond with “thats impossible, I don’t eat that much sugar!”

There’s a few things you need to know about this increasingly common disease. Firstly type 1 and 2 diabetes are extremely different diseases – type 1 tends to affect younger children and adults – these people are unable to produce any insulin at all, their pancreas (the organ that makes insulin) has been destroyed by the body’s own cells. These patient’s need insulin every day for the rest of their lives.

 

Type 2 diabetes is very different – it tends to affect older adults (however, scarily we are now seeing children and teenagers with this) and is to do with weight, lifestyle and some genetic elements – essentially these people make insulin but their tissue does not respond to it as well so the sugar level stays high and more and more insulin is needed to try and normalise the sugar levels. Obesity is a MAJOR contributor to type 2 DM, so is lack of physical activity.

 

Unlike type 1 diabetes, type 2 is VERY lifestyle dependent and weight loss is the KEY way to reducing risk of type 2 diabetes or trying to control the high sugars once the diabetes is diagnosed.

 

So eating sugar alone really doesn’t have anything to do with diabetes. Its about your weight, how much exercise you do, what your diet is like – so I guess the news is don’t blame the sugar!!! There’s a whole lot more to it!

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