Monday, May 30, 2011

The costs of workplace stress

Recent statistics indicate that between 70-80 percent of all health related problems are either precipitated or aggravated by stress and it is estimated that 75-90% of all healthcare visits still result from stress related health problems. Conservatively stress costs the economy billions of dollars per year. Up to 75% of sick days are stress related and the American Institute of Stress report that stress was a major factor in up to 80 percent of all work related injuries and 40 percent of workplace turnovers
Other problems associated with workplace stress include sleep problems, digestive disorders, headaches, anxiety, depression, anger and hostility, alcoholism and drug abuse, heart and cardiovascular disease have reached epidemic proportions in affluent society.

In the workplace other consequences of stress include
•lost productivity
•increased absenteeism
•increased presenteeism
•decreased concentration, mental focus
•working at 50% of capacity or less
•shorter work life
•less fun and motivation

While some of the health effects of stress include
•Peptic ulcers
•Irritable bowel syndrome
•Coronary heart disease

One study found that those who expressed a high amount of despair had a 20% greater chance of developing atherosclerosis over a 4-year period. They suggested this was the same magnitude of increased risk as seen in a pack-a-day smoker. While another study showed that a sense of hopelessness can affect the arteries in the process of plaque build up.

As well as the effects on the immune system and an increased risk of
•Viral infections

Current research reveals that psychological stress is responsible for immune suppression on a range of fronts, including T-Cell response, antibody production and breaking down the natural killer cell which fight off viruses and cancer.

Unfortunately a lot of stress goes unrecognised and we rarely take action yet a few simple strategies like the meditation I have written about above can have such a profound effect on your stress. So if you have a bit of stress in your life do the little mediation exercise I have suggested.

Stress Management – Meditation exercise

Meditation is a great and simple way to deal with life’s stresses. Meditation calms the mind and the body. It produces a state of being all of us can learn and apply our daily lives. As a part of a healthy lifestyle, meditation can add energy, focus and enjoyment to our personal experience. With as little as ten minutes a day, significant mental and physical improvements can be gained.

As we age, our bodies and minds begin to show signs of long-term stress. Meditation strengthens and promotes continued health and vigour. It is an invaluable tool that balances our minds, bodies and spirits. Regular practice creates a marvelous integration physically, emotionally and spiritually.

Meditation for beginners

The breath

This meditation is a simple introduction if you are new to the practice. It is also recommended for experienced meditators, strengthening concentration and focus.

Close your eyes, and start to focus on your breath as you inhale and exhale.
Become aware of how the breath feels as it goes in and out of your body.
Relax your body as your breath and find your natural rhythm.
Continue to focus on your breath.
To maintain your focus it helps to keep your attention on an area where you can actually feel the breath is some way as it moves in and out, like the nose or abdomen.
If you find your mind wandering, simply bring your focus and attention back.
When starting out, you may find your mind begins to wander within seconds.
It may take many minutes before you even realize. Know that this is a natural party of the process.
With practice you will be able to continuously focus on your breath for longer periods of time. You will become aware faster that the mind has wandered.
Try this exercise for 1-5 minutes, gradually increasing your time as you improve. When you feel ready, bring your awareness back to your body and open your eyes.

Inner stability

Developing an inner stability allows us to experience and maintain emotional balance, even whilst our outer world fluxes and changes around us.

Close your eyes and notice your breath as you deeply inhale (for the count of 4) and exhale (for the count of 6). With each in breath imagine a soft calming energy entering your being, filling it with a soothing sense of peace. With each exhale, relax your muscles, breathing out any tension and worries you may be holding. Try exhaling through your mouth, as this will facilitate a 'sigh' style of relaxation.

Take your attention to the very centre of your being, and see a golden ball of energy there glowing brightly. Here is the source of all that you need to know, and all that you need to feel and experience. It is made up entirely of love. If you are ever needing guidance or needing to feel loved, supported or nurtured this is where you can go. See this golden energy grow, filling your entire being with its light. See this light expand out, filling your environment, town, country, the earth and the entire universe with its glowing energy. Allow it to radiate whatever you most desire to feel in this moment; eg. love, warmth, peace, calm, vibrancy, vitality, joy. Immerse yourself in feeling. Staying with this feeling bring your focus back to your centre and open your eyes. Take this feeling with you into the day, re-connecting with it whenever you need to.


As someone who practices meditation daily I can honestly say it has saved my life and is the single most important factor in overcoming major trauma in my life. Last year, despite finding no negative outcomes against me, the Western Australian media had totally destroyed my professional and personal reputation. In the coroners court the absence of rules of evidence meant that anyone can say anything even 5th person hearsay or make wild and unsubstantiated claims and it is reported as evidence and put on the front page of the paper, as it was in my case. My whole life seemed shattered at the time, what had taken me 25 years to build up was taken from me in days and I had done nothing wrong. My response, more meditation and through the mediation and my writing I got immense clarity and my new direction. It is really only when you take the time to stop and take control of your mind do you really see what is important.

Meditation is about learning to control the mind and not allowing it to control you. Meditation has been practiced by most cultures for thousands of years. However, the first Western study was not until the 1960s at Harvard Medical School. Today, many doctors advise their patients to meditate to reduce stress or blood pressure and to help manage other health problems and meditation classes are run all over the country. Research has shown the benefits of meditation in reversing the effects of cardiovascular disease and aging. From what I can glean from the scientific literature meditation adds about five years to your youth span.

In case you’re thinking “it is not for me” it will benefit everyone and so many chronic health conditions. Meditation shows benefits for many conditions including: anxiety disorders, panic attacks, headaches, back pain, arthritis, cancer pain, other chronic pain conditions, gastro-intestinal problems such as irritable bowel syndrome, hypertension, angina and heart disease, menopausal hot flashes, pre-menstrual syndrome, infertility, and nausea and vomiting associated with chemotherapy. It has also been used to stabilise blood sugar levels in diabetics and reduce their recovery time after surgery, reduce the length of labour and discomfort during childbirth, strengthen the immune system to reduce upper respiratory infections and help cancer and HIV patients. So you can see it has many benefits for everyone not just me.

Meditation has been demonstrated to dampen the busy neural activity in the frontal cortex. This probably exerts its therapeutic effects in part by quieting the emotional activity in the internal monologue of the frontal lobes. During meditation the alpha brainwave activity typically rises during the first few minutes followed by increases in theta levels. It appears that the level of brainwave change is also associated with the length of time subjects have practised meditation. Theta is the key brain wave that changes during meditation and increases with the number of weeks practised. The slower brain wave patterns such as theta waves indicate reduced arousal level of the cortex and the more you are in control.

Research shows meditation reduces the level of the stress hormones adrenaline and cortisol. Elevated cortisol is closely linked with cardio vascular disease as well as other forms of chronic illness. In a study, people who meditated had decreased cortisol (the major stress hormone) during and between meditating. These levels remained lower even after the meditation compared to people who did not meditate. Research shows that increasing meditation increases the activity of the left prefrontal cortex. Depressed, stressed or angry people tend to have greater activity on the right side, whereas the left prefrontal cortex is associated with happiness and relaxation. These studies have shown that people who meditate also produce more melatonin, the body’s main sleep chemical, than people who do not meditate. Related to this is a study of insomniacs in which 75% were able to sleep after regularly practicing meditation. Another by product of anxiety and tension is a rise in the level of lactate in the blood. Meditation decreases the level of lactate in the blood, bringing on a feeling of calm.

Other studies have shown that DHEA (Dehydroepiandrosterone, also known as the youth hormone) is much higher in people who meditate. People who meditate regularly have average DHEA levels of people ten years younger than they are! Various studies have shown that those people meditating for more than five years had an average biological age that was 12 years lower than their chronological age.

Meditation also reduces activity in the nervous system. It stimulates the parasympathetic branch of the autonomic nervous system; as a result the area of the system which is responsible for calm energy becomes dominant. When the body runs on calm energy it doesn’t tire as quickly. When the parasympathetic nervous system is stimulated, a person is able to think more clearly and perform at a comfortable level for longer periods of time. Taking deep breaths and smiling also stimulate the parasympathetic nervous system.

The major benefits of stimulating the parasympathetic nervous system include:

• Improved thinking, clarity of mind, creativity and memory;
• Reduced cardiovascular disease;
• Improved sleep;
• Increased sense of relaxation;
• Reduced pain and reduced healing time;
• Reduced stress and anxiety;
• Enhanced psychological well being;
• Enhanced self control, confidence and self esteem; and
• A longer life.

There are also many potential social benefits of meditation. In the 1990s, Professor John S. Hagelin brought 4,000 TM practitioners to Washington, D.C. He had designed an experiment to test the effects that mass meditation would have on homicide, rape and assault (HRA) crimes in the city district. The idea of the experiment was to reduce crime through reducing social stress, as it is a fact that 44 percent of Americans suffer from stress-related health problems. Meditation was conducted for fifteen to twenty minutes in the morning and again in the evening. The experiment worked on the theory of a collective consciousness in the community, so theoretically there would be a drop in communal stress also. During the course of the experiment HRA crimes dropped by up to 24.6% and overall violent crime rates dropped by 15.6%. It was estimated that if this experiment were continued for the long term, HRA crimes would be reduced by 48%.

Premeditated crime, such as robbery, was not reduced during the experiment, but unpremeditated, violent crime was reduced in proportion to the number of people meditating. This study was very thorough and built upon more than 100 previous studies. It’s amazing to think we could reduce violent crime if more people meditated. The social benefits would be enormous, not to mention huge savings of taxpayer money. On this topic there are many cases now where meditation is used in prisons and has a dramatic impact on reducing violent and aggressive behaviour of the prisoners. Maybe we should get everyone to do it so we don’t have so many prisoners.

Probably most confusing about meditation are the different styles and the claims by some schools that their meditation is the only way (which sounds a bit too much like promoting a religion). Meditation can come in many forms. For example, the connection to nature (looking out on trees) by hospital patients mentioned earlier can be considered a form of meditation. My perspective is that there are many forms of meditation and each has some benefit.

Prayer is probably the best known form of meditation. Every culture has adopted some type of meditation to suit its needs and desires. For example prayer is usually used to ask for help and guidance, whereas mindfulness meditation is used to release unwanted emotions and focus on the inner light. The common link between all forms of meditation is the purpose of quieting one’s mind. The idea is not to remove stimuli but to focus concentration upon one healing element. When the mind is at ease and filled with peace and tranquillity it cannot become stressed, worried or depressed and therefore can become refreshed and rejuvenated.

Multiple Sclerosis (MS) a preventable disease

Just over a year ago a student of mine motivated me to look into multiple Sclerosis. Bruce put up a slide quoting the official authorities saying there was no link between MS and nutrition. He then presented a slide with more than 40 peer reviewed scientific papers on the link between MS and nutrition. Along with Bruce it continually confuses me as to why such supposed authorities continue to deny the existence of nutritional treatments and even worse the role of poor nutrition in the causes. Since inspiring me I have now seen dozens of people suffering from MS begin a new life through really simple changes in nutrition and one of the simplest changes follows on from one of my earlier articles on vitamin D. Many Australians just don’t get enough sun anymore. But more on that later. What is even more important is that this information can help prevent the development of MS in the beginning.

There is now overwhelming evidence of the risk of developing MS is linked to a number of environmental factors such as excessive dietary intake of saturated fats and deficiencies in polyunsaturated fatty acids, vitamin D and antioxidants (1,2). As a result of these findings good nutrition appears critical in limiting the development and ongoing effects of MS and enhance quality of life while limiting the risk of secondary conditions (3).

Over the past 200 years MS has significantly increased in incidence and prevalence. MS is a disease that effects an estimated 2.5 million people worldwide with over 18, 000 people in Australia with the disease, the incidence rate in Australia is increasing by 7% each year and financially costs approximately 2 billion dollars each year 4. It is twice as common in females (who have lower vitamin D than males) as in males and is the most frequent neurodegenerative disease in young adults 5,1. Geographically MS is common across northern Europe, Scandinavia and across the US and is much higher in incidence among whites then other racial groups (5).The disease is very rare in Japan, the Indian subcontinent and is unknown to black Africans however these groups are at significant risk to developing MS, when they go to other places to live, which supports the concept that an environmental factor is responsible for MS (5).

MS is a chronic, degenerative and autoimmune initiated inflammatory disease of the central nervous system, which may involve the brain, optic nerve or spinal cord and is characterized by demyelination (5,6). That is the myelin, that wraps around and insulates the nerve axons in the central nervous system, suffers self-destruction and degeneration (7). This means damaged myelin results in damaged nerve axons and causes the various disabilities of MS (7). It is worth noting here that myelin is around 80% lipids (fats) and cholesterol (which I have written on in past articles) makes up an indispensable component of myelin membranes (8). The inflammatory reactions are poorly controlled and result in substantial damage to the myelin (7). As a result of demyelination MS patients suffer functional impairments such as abnormal walking mechanics, poor balance, muscle weakness and fatigue which result in individuals reduced ability to perform activities of daily living (9).

The single most important factor linked to the development of MS is a reduced supply of vitamin D (7), which I have written on extensively in the past. Research has shown that the active hormonal form of vitamin D, 1,25-dihydroxyvitamin is a natural immune system regulator with anti-inflammatory action (10). Vitamin D is received from two sources, diet and sunshine, however it is considered diet provides insignificant amounts and therefore sensible exposure to sunlight is considered the most effective source (11). Even Scandinavian diets (rich in oily fish) scarcely exceed a few hundred IU/d of vitamin D (12). Sunshine is therefore the principal natural source of vitamin D, providing approximately 90% of requirements. Sunbathing can provide 10,000–20,000 IU in 15–30 min, but this will only last a few weeks before it needs to be replenished (13,14). It is interesting to note that women generally have lower serum levels than men (15,16) and have significantly higher levels of MS.

There is a 41% decrease in MS risk for every 50 nanomoles per liter increase in vitamin D (1,25-hydroxyvitamin) in the blood. The prevalence of MS is highest where environmental supplies of vitamin D are lowest (18). There is significant epidemiological data from Australia that shows a very strong correlation between vitamin D supply from ultraviolet (UV) radiation and MS prevalence (7). The correlation is indeed stronger than that of UV radiation exposure and melanoma development (7). Globally countries of high latitudes with insufficient UV radiation for most of the year report a higher incidence of MS 19,20. One case-control study has also shown that vitamin D status in individuals at the time of diagnosis of MS is significantly lower then healthy controls, indicating a further link (19).

It is theorized that vitamin D deficiencies may lead to an increase in T-helper cell autoimmune responses and therefore resulting in excessive damage to the myelin and MS symptoms (21).

Vitamin D supply through dietary intake also appears critical, as it has been reported that through vitamin D supplements there is an inverse relationship with MS (19). The role of vitamin D is supported by animal studies where mouse models have shown that vitamin D deficient mice succumb faster to MS but once administered with vitamin D the symptoms diminish (22).

The idea that an increase in saturated fats in modern diets may result in increased risks for MS (and diabetes type 2) has been known since the early 1950’s and reinforced on several occasions (23). Epidemiological studies in Norway have shown inland farming communities with high intake of animal products had higher MS incidence rates then coastal communities where consumption of fish is high while subsequent studies have also shown a negative correlation between MS and the consumption of fish, fruits and vegetables (23). Any wonder the rates of MS are increasing so fast in Australia knowing the poor diet most kids are having. It has been shown that MS sufferers have deficiencies in essential polyunsaturated fatty acids (PUFA), primarily the omega 3 fats which is demonstrated in that the lipid and fatty acid composition in plaque tissue from the MS brain is altered compared to the normal brain white matter (1).

It is believed that humans evolved on a diet with a ratio of omega-6 to omega-3 of approximately 1:1 where as in western diets the ratio is varied between 15:1 – 20:1 24. We just have too much vegetable oil (omega 6) in our diet. It is literally added liberally to all processed foods.

A large study conducted over a 35 year period showed MS patients on a diet with low saturated fat and supplementation with cod liver oil provided long term benefits on mortality, relapse severity and disability, particularly if initiated during the earliest stages of MS (25). The results of this have shown that MS patients can expect to survive and be ambulant and otherwise normal to an advanced age if following an extreme low fat diet and omega-3 supplementation (26). The rarity of MS in the Japanese, whose diet consist of low saturated fat and high omega-3 fatty acids is another indication of the role of omega 3 oils in MS (27). There is now significant evidence to show it is a contributing factor to the development of the disease in conjunction with other environmental factors (7).

The development of MS is also believed to be linked to oxidant stress in the body from a lack of antioxidants (28). Along with other possible environmental factors the actual role of oxidative stress in patients with MS is poorly understood (29). The brain and nervous system are particularly susceptible to oxidative damage due to the low content of antioxidants in this area of the body due to them having to be imported (30).

Studies have shown that oxidative stress causes an activation where the production of pro-inflammatory chemical messengers called cytokines occurs which then contributes to the process of demyelination (31). Having sufficient antioxidants therefore ensures neuroprotection through suppression of inflammation, this limits the effects of MS (29,31,32).

Oligodendrocytes, a particular type of brain cell, that produce the extensive myelin sheaths are known to be particularly vulnerable to oxidative stress, this helps explain the lack of remyelination during remission stages 1. Oxidation (free radicals) literally stops the repair work on any damage to the myelin sheath.

In helping to prevent and restrict the development of MS there are a number of recommendations that can be applied as determined through scientific studies:
• Regular moderate sun exposure (15-30 min/day)
• Decreased intake of saturated fat and omega-6 PUFA accompanied with an increased consumption of omega-3 PUFA through consumption of fish and supplementation
• Daily supplement of vitamin D to ensure circulating level of vitamin D remains between 100 – 150 nanomoles per liter
• Consume at least 5-7 serves of antioxidant rich fruits and vegetables each day and supplement.

Acknowledgements. Bruce Greatwitch

1. Meeteren et. al. 2005
2. Liuzzi et. al. 2007
3. Timmerman, Stuifbergin 1999
4. MS research Australia 2008
5. Undurti 2003
6. Kanwar, 2005
7. Embry 2004
8. Saher et al 2005
9. White et. al. 2004
10. Van Amerongen 2004
11. Cantorna, Mahon 2004
12. Mark and Carson, 2006
13. Hollis, 2005
14. Vieth, 2007
15. Yetley, 2008
16. Zadshir et al 2005
17. Anonymous 2007
18. VanAmerongen et. al. 2004
19. Barnes et. al. 2007
20. Kampman et. al. 2007
21. Toohey 2004
22. Mandavilli 2007
23. Nordvik et. al. 2000
24. Simopoulos 2002
25. Swank cited in Weinstock-Guttman et. al. 2005
26. Swank, Goodwin 2003
27. Undurti 2003
28. Lutskii, Esaulenko 2007
29. Koch et. al. 2006
30. Syburra, Passi, 1999
31. Gonsette 2008
32. Gilgun-Sherki et. al. 2004


Is salt the real problem that it is made out to be? It seems that by oversimplifying the information on salt and its relationship to health we complicate what is a really simple and important issue. After reviewing more than 100 scientific papers it became clear that salt is not the public enemy that it is made out to be, rather it appears to be an imbalance of minerals as a result of eating processed foods. And some very simple changes can make a lot of difference. This does not mean you go out and lather salt on all your food and justify it from my article, instead it means back to some common sense dietary changes.

Salt, in the form of sodium chloride, has been consumed by humans since the late Palaeolithic period, when it was used to preserve and flavour food. In modern times, however, some very limited studies and an incomplete understanding of nutrition have led to salt being labelled “public enemy number one” when it comes to blood pressure and cardiovascular disease. But is salt really so bad?

Salt in the human diet has been the subject of a great deal of research. Health professionals have, for many years, recommended reduction or even elimination of salt intake. This is mainly due to findings that link the excessive salt in the modern human diet to health problems such as high blood pressure. Yet it would be shortsighted to simply accept or reject such recommendations, as there are other factors involved requiring further investigation.

Salt intake is widely recognised by public health and medical organisations as the leading cause of blood pressure disparities (1). However, it is simply not valid to state that reducing salt intake will lower our prevalence of hypertension; the truth is that a number of factors, including lifestyle and nutrition, play an important role.


Sodium is essential for many functions in the human body. The average human body contains around 90 grams of sodium, most of which is in the fluids that surround cells, some in bones and the rest retained in the cells (2). Sodium is passively absorbed and hence excess intakes are easily achieved. Sodium is excreted mainly by the kidneys; therefore a high sodium intake must be balanced with a large intake of water and other fluids. Sodium is the main component of the body’s extracellular fluids; it helps carry nutrients into and waste products out of the cells, regulates body functions such as blood pressure and fluid volume and works on the lining of blood vessels to keep the pressure balance normal (3). So you can see it is pretty important.

Chloride (Cl), the other half of the salt molecule (NaCl), is just as important as sodium yet often ignored. Chloride is essential for the production of hydrochloric acid, which is necessary to digest proteins in the gut and is essential for destroying bacteria and other potentially toxic microbes.
How much salt?

In terms of the adequate amount of daily intake of salt, various organizations, including the National Academy of Sciences’ Institute of Medicine, have published recommendations for daily sodium intake between 1,500 milligrams (mg) and 2,400mg per day for healthy adults (4)

The main regulators of sodium levels in the body are the kidneys. If sodium levels drop too low, the hormone aldosterone is released and this increases the amount of sodium held in the body by reducing the amount lost in urine. Excessive sodium loss is very rare, but low sodium levels in the body can be dangerous if not treated. Some people do not get rid of enough sodium through their urine; this causes the body to retain water, resulting in swelling of the body and, with the increased blood and fluid volume, in turn causes high blood pressure (5). The high blood pressure puts a strain on the heart, which must work harder to pump the increased volume of blood (Fox 2007). This is one reason that many health professionals recommend a reduction of salt intake—to reduce the risk of excess sodium in the blood; they believe that lower sodium intake has a beneficial effect on blood pressure. Thus people with existing hypertension and kidney disease may benefit from a reduction in salt intake.

Health problems

While there is evidence to suggest that salt plays a role in hypertension, it is a bit simplistic to target salt and ignore information that contradicts this. It is critical that we assess all the information available. It is important to take a multidimensional approach and look at the whole body. The increase in blood pressure as a result of increased salt intake may be due to the human kidney’s inability to excrete large amounts of (6,7,8). Results from various studies—including epidemiological, animal and migration studies as well as randomised trials—support the claim that as dietary salt increases, blood pressure increases (6). However, in humans at least, individuals seem to vary significantly in how they tolerate salt. Some people appear to be salt sensitive or have certain conditions that predispose them to hypertension.

High dietary salt intake in some individuals has been shown to contribute to cardio vascular conditions including the incidence of stroke (9). Research has found that individuals with a high salt sensitivity (in particular those with hypertension) have an increased risk of cardiovascular disease and death (10). High dietary salt intake can increase the risk of osteoporosis because of high urinary calcium excretion. In particular, it has been found that individuals with hypertension excrete high levels of calcium in their urine (11,12). However, provided that intake of calcium and potassium are at recommended levels, the risk of osteoporosis is low (13).

Salt is not the problem

So what is the problem? Research dating back to 1964 contradicts the simplicity of the link between salt and hypertension (14). In one study, a significant blood pressure decline was observed as a result of acute dietary salt increase (14). While limited studies of salt levels and blood pressure support the salt-hypertension link, the data are somewhat contradictory (14-23). It appears that this link affects only those with existing health conditions, not healthy persons. The question that remains is whether beneficial hypertensive effects of sodium restriction will outweigh its hazards.

Inadequate salt intake has also been associated with undesirable metabolic situations such as alteration in plasma lipoproteins and inflammation (24), a potential increase in cardiovascular stress, and increased serum cholesterol, triglycerides and insulin resistance (25). Contrary to common belief, the effects of low-salt diets—the unfavourable effects on blood coagulation, inflammatory and metabolic disturbances—outweigh the benefits of lowered blood pressure (Nakandakare et al. 2008). One study found that low-salt diets can actually cause harm to people with high blood pressure (26,27). So too little salt has greater adverse effect on health than too much salt. Epidemiological evidence suggests that a reduction in salt can decrease the risk of coronary disease significantly for overweight patients (28); however, low-salt diets are not warranted in patients with normal blood pressure (24).

Many studies show that hypertension is not related solely to dietary salt intake but to other factors such as a sedentary lifestyle, alcohol consumption, protein intake and lack of potassium, calcium and magnesium (29,30,31). The most realistic strategy for preventing and treating hypertension is not focusing on one risk factor but instead on a combination of interventions to reduce a number of risk factors (30). A proven effective intervention is Dietary Approaches to Stop Hypertension (DASH), which is a diet rich in fruit and vegetables, therefore rich in potassium, magnesium and other minerals (30,32). Not only has the DASH diet shown a beneficial effect on lowering blood pressure but also it is accompanied by the benefits of cholesterol-lowering and high antioxidant content, which could improve overall health and lower the risk of other diseases (32).

Studies indicate that only about 12% of subjects in a society with a high salt intake (eight grams to 12 grams of salt per day) will become hypertensive (33). According to a Tufts University research group (1997), only people with high blood pressure should be advised to limit sodium. Data from several large studies show that when adults meet or exceed the recommended dietary allowance of calcium, potassium and magnesium, the simultaneous ingestion of a diet high in sodium chloride is not associated with high blood pressure (34).

Overall there is only a weak relationship between dietary salt intake and high blood pressure in the general population (10). The effects of dietary salt on blood pressure are governed by “salt sensitivity” of individuals where large blood pressure changes can occur due to varying levels of salt intake (Franco and Oparil 2006). To compound the issue, research shows that sodium reduction in younger people frequently results in increased blood pressure, whereas those over 45 generally experience decreased blood pressure when sodium intake is restricted (34,35). Diet can also affect the response of dietary salt intake on blood pressure. An appropriate diet and a high potassium intake can curb the rise in blood pressure associated with an increase in dietary salt intake (10,37). More than 25 separate studies show that increasing potassium intake (without decreasing sodium) is an effective way to lower blood pressure. One of those studies demonstrated that with just one daily serving of a potassium-rich food the risk of death by stroke may be cut by as much as half (21). So why don’t we take this approach?

An eight-year study found those on low-salt diets had more than four times as many heart attacks as those on normal-sodium diets—the exact opposite of what the “salt hypothesis” would have predicted 38. Scientists at the University of Toronto concluded that limiting salt in the diet has no effect on people with normal blood pressure. In another study, 269 medical students were tracked; about 50% had no change in blood pressure when salt intake was increased by 12 times 39. Half of the remainder had a rise in blood pressure and the other half experienced a drop in blood pressure.

Data from the National Health and Nutrition Examination Survey found that individuals with the lowest sodium intake had a 20% higher chance of dying from a cardiovascular cause than individuals with the highest sodium intake (40). An earlier study also found an independent relationship between levels of sodium measured in urine and subsequent heart attacks and strokes: the lower the levels, the higher the rate of heart attacks and strokes (41). So not enough salt may kill you.

In support of this most of the big observational studies indicate an inverse relationship between salt intake and health outcomes (21). That is more salt less overall poor health. While a low salt diet may reduce blood pressure, it isn’t necessarily good for one’s overall health. It may make things worse (21) and could be outweighed by its negative effects on other health outcomes (21). In one of the big studies on hypertensive patients those who took in the least amount of salt were most likely to have heart attacks (21). A low-sodium diet also increases your resistance to insulin (21).

When salt is not salt

Some types of salts are: mine salts, sea salt and refined salt. The difference between sea salt and salt from saltshakers is that sea salt is richer in minerals such as magnesium, although it does not have iodine (42). Sea salt contains 84 different mineral elements but, during the process of refining sea salt to make “table salt,” 82 of the 84 mineral elements are extracted (43). Thus refined salt or table salt is not a healthy choice as it contains mainly sodium chloride.

The solution

Rather than viewing sodium as the direct culprit leading to various diseases, it may be more useful to look at sodium as an indicator of diets that are low in calcium, potassium and magnesium (44) while containing too many overly processed foods and soft drinks.

No single universal prescription for sodium intake can be scientifically justified (40). A healthy person can regulate a reasonable excess of salt especially if the diet contains a balance of other essential minerals. People with existing health problems may require a reduction in salt from their diet based on their individual needs and advice by health professionals but it is probably more important to increase their other mineral levels.

Rather than eradicate salt from the diet altogether, it makes more sense to restrict the ingestion of salt to a feasible level while encouraging consumption of organic sodium salts in conjunction with good nutrition to control blood pressure, promoting vascular health and preserving bone density (45). It is easy to increase the potassium in your diet. High potassium fruits include apricots, bananas, melons and citrus fruits. Vegetables with good amounts of potassium are mushrooms, spinach, asparagus, potatoes, green beans, avocados, lima beans, winter squash and cauliflower. Other foods high in potassium include whole grain products, seafood and dry beans such as peas and lentils. All these foods contain significant amounts of magnesium and calcium, which will also contribute to the lowering of blood pressure.

It is too simplistic to target salt as the enemy. Rarely is anything simple when we are dealing with the human body. If we adopt a healthy diet with the nutrients we need and reduce our intake of processed foods and soft drinks, we reduce not only blood pressure but also many other forms of chronic illness including all forms of cardiovascular disease. What I don’t understand is why we don’t target the real culprits? We need to adopt a multidimensional view of health and illness rather than looking at just one aspect. For the sake of our health, we must look at the entire picture.

1. Antonios and MacGregor 1996
2. Reavley 1998
3. Greeley 1997
4. Mayo Clinic 2007
5. Fox 2007
6. Appel 2008
7. Menton et al. 2005
8. Havas et al. 2008
9. Sergei and Mongin 2007
10. Franco and Oparl 2006
11. Gilbert and Heiser 2005
12. Navidi et al. 1995
13. Heaney 2006.
14. Brown et al. 1964
15. Freedman et al. 2001
16. Alderman 2000
17. Cassels 2008
18. McCarron et al. 1997 and 1998
19. Freeman and Petitti 2002
20. Graudal et al. 1998
21. Cohen et al. 2006
22. Meneton et al. 2005
23. Taubes 1998
24. Nakandakare et al. 2008
25. Ivanovski et al. 2005
26. Rivera 1999;
27. Grassi et al. 2002
28. McCarty 2003
29. Boyles 2003
30. Suter et al. 2002
31. Cann 2005
32. Beilin et al. 2001
33. Finn 1999
34. McCarron et al. 1997
35. Ian and Robertson 2003
36. Overlack et al. 1993
37. Appel 2008
38. Young 2008
39. Freeman and Petitti 2002
40. Alderman 2000
41. Alderman 1995
42. Largeman 2006
43. Dearing 2008
44. Boyles 2003
45. McCarty 2003

Sunday, May 29, 2011

Wednesday 10th August 6.30pm
Whitford Church of Christ large auditorium
9 Scaphella Avenue, Mullaloo WA 6027

Entry is by Donation

Monday, May 16, 2011

Dr Peter Dingle Qualifications

Dr Dingle the public health advocate

In his role over the last 25 years as a public health advocate Dr Dingle has ruffled many feathers, particularly on his stance against large pharmaceutical and junk food companies. As a result it is not unexpected that there are a lot of myths floating around about Dr Peter Dingle’s qualifications and so called sceptics on the internet trying to denigrate him. As a public health advocate Dr Dingle has been campaigning for truth in health on topics including processed breakfast foods, food additives, pesticide use, toxic chemicals in the home, heavy metal contamination and toxic pharmaceuticals for a long time. As a result of this he has been threatened and abused many times, but continues to stand up for what is right based on the evidence.

Dr Dingle’s Degrees

Dr Peter Dingle has a 4 year Bachelor of Education in science with a sub major in physical education dating back 3 decades. As a result in the early eighties Dr Dingle taught human biology and health education in year 12 and physical education and science throughout the years in high schools around Australia.

Dr Dingle’s second degree is a Bachelor of Environmental Science from Murdoch University and first class honours. Dr Dingle’s honours project was on the topic of exposure and health effects of pesticides used for termite control in WA. In 1994 Dr Dingle completed a PhD also at Murdoch University on the topic of health effects of chemicals and toxins people are exposed to in their home. Since then Dr Dingle continued to research in the area of health and the environment.

Dr Dingle’s teaching and research

Dr Dingle has held a teaching position at Murdoch University (where he obtained his later 2 degrees) teaching “Pollutants and Toxicology” and “Health and the Environment” since 1989 and coordinating the degree program in Health and the Environment.

Since taking on his academic position at Murdoch University Dr Dingle has had more than 25 honours students (full time research for a year), half a dozen Masters students (6 months to 2 years) and 4 PhD students (3-5 years) have graduate under Dr Dingle’s leadership.

In addition he has supervised literally thousands of undergraduate students over the years in their study of health and the environment and the topics they have written their essays which range from pesticides and pharmaceuticals to nutritional illnesses and cancer. Many of Dr Dingle’s undergraduate student have inspired his work as a public advocate. The latest was Nadia Uink and her original research on cholesterol deception lead to the research and publication of the book by the same name by Dr Dingle with Nadia as a co-author. Many of Dr Dingle’s students have also gone on to work in various careers in health and the environment from state and federal health authorities to careers in occupation health with large mining companies.

Beyond just a degree

A qualification however is not just an undergraduate degree. In fact most academics do not have qualifications specific to a narrow undergraduate area. They create new fields of research as a tangent to our earlier studies. That is why they stand at the cutting edge of their field. If they only accepted undergraduate or even PhDs as a qualification then at least 50% of academics would have no qualifications in the area they teach and research and are so called expert in, maybe even as many as 90%. For example, one professor of sustainable agriculture has a degree in biochemistry, not agriculture or sustainabilty. Another one has a degree in physics and is recognised as one of Australia's leading researchers in climate change, another professor teachers environmental management and did his undergraduate degree in botany. Peter Newman a well know professor in Sustainability did his original degree in organic lead chemistry, John Bailey the current Dean of Environmental Science did his degree in chemistry and started the course at Murdoch University in environmental law and impact assessment. Very few if any of the toxicologists working for the government have any actual qualification in toxicology. Usually it is biology, biochemistry or chemistry. A far cry from toxicology. And so the list goes on. David Suzuki a well-known environmentalist has a degree in biology and PhD in genetics. It is really what academics do in their research that builds their credibility in the field.

20 years of research and teaching is much greater than a simple undergraduate degree or diploma. Academics, like Dr Dingle live their profession, surrounding themselves with all the information, research and people to help you be a leader in the chosen field.

Dr Dingle has also been scoffed at because he is not a medical doctor but he is writing and speaking about health. On the contrary many doctors comment on nutrition and some adds on television suggest to go and see your doctor for health advice yet very few have any qualification in nutrition or lifestyle matters related to health, even worse they did not study it in any of their 5 years at university. This is compared to Dr Dingle’s 10 years of study at University on the topic and 20 years plus as a researcher in this field. There is extensive research in the scientific publications showing GP training has little or no nutrition. Even better just ask your doctor or look at their title on the wall. The leading GP health speakers in the country have no research or qualifications in nutrition or health. They are great at what they do but Medicine is not health.

While Dr Dingle began his research in environmental toxicology and the health effects of exposure to toxic substances, for the past 15 years, along with dozens of graduate research students (honours and PhD), and hundreds of hours of teaching and undergraduate research students and their essays he has been researching areas in nutritional toxicology from food additives, toxic effects of medications, foods and food labelling and healthy digestion and probiotics. This transition was natural because it deals with many of the same concepts. For example what is nutritious at one level is toxic at another, you have the same exposure routes and it is the same basic biochemistry and physiology. Both areas are quite similar and have a lot of overlap.

Nutritional toxicology is the study of nutritional and food substances and their contribution to or reduction of toxic effects on the human body. For example what are some of the toxic effects of some of the components of milk or the toxic effects of animal proteins. As well as the role nutrients have in the reduction of the effects of toxic substances. It became apparent that you cannot just study toxicology without studying the other side of the same equation.

To put the concept of research into perspective when Dr Dingle researches a topic it can be dozens or even hundreds of hours. For example, along with one of Dr Dingle’s students has been researching cholesterol together for the past 2 years. Not may other people if any in the country can make that claim.

Dr Peter Dingle has spoken at many international and national conferences as an expert on health. In January 2011 he spoke at an international conference in the US on health and wellbeing and was asked to be a key note speaker by the organiser for a conference later in the year on “Food and health”. At a national level Dr Dingle has been a keynote speaker at more than 20 professional conferences speaking on health and wellbeing. Including medical and veterinary conferences in Western Australia.

In the second half of 2011 Dr Dingle has been invited to run a course on nutritional medicine for fifth year chiropractic students at Murdoch University where he has done all his research and teaching for the past 20+ years. It is worth noting here that chiropractic students do significantly more on nutrition in their degree than do GPs.

Some examples of research Dr Dingle has carried out includes

Research reports
Breakfast foods
Yoghurt and probiotic
Food labelling
Soft Drinks

Research students Thesis topic on

Allergies and asthma
Food labelling
Breakfast foods
Grain consumption and breakfast foods
Nutritional qualities of take home dinners
Allergy and probiotics
Pesticides and health
Developing health lifestyle programs (including living smart and seniors smart with my PhD students)
Healthy ageing (PhD)
Developing a health, environment and lifestyle program (PhD)
Effect of indoor air quality on causes and symptoms of asthma (PhD)

University text books Dr Dingle has written

Second and third year text books on:
Pollution and toxicology
Pollutants and the human environment
Health and the environment

Dr Dingle is currently writing a text book on
Nutritional and environmental toxicology (due 2011)
Workplace Wellness (Due 2012)

Public Essays (all referenced to scientific journals) on nutritional and environmental toxicology including:
Vitamin D
Milk the poison
Milk and calcium
Allergies and probiotics
Life expectancy
Sick homes and toxic chemicals
Statin drugs
Medical research bias
Corrupt drug companies
Kids chemicals and cancer
Breakfast junk foods
Multiple Sclerosis
Vitamin D
Non ionising radiation
Organic food
Slow eating

Dr Dingle currently has 8 books in print including
My Dog Eats Better Than Your Kids
The 6 week healthy eating planner
The great cholesterol deception

Scientific publications

Dr Dingle has more than 100 scientific papers published of which 90% or more relate to one aspect or another to health. For more information on this go to his profile at the Murdoch University website.

Thank god he is not a medical doctor

Finally it should be noted that Dr Dingle is not a medical doctor and has never said he is a medical doctor. Dr Dingle has a PhD which took 4 years of full time research after his initial degrees. A medical “doctor” has an honorary doctorate bestowed after completing a Masters on them while they practice medicine. When they stop practicing they can no longer claim to be a Dr. Dr Dingle has a complete doctorate which is a title he has all his life. So when the media says Dr Dingle does not have a medical degree they fail to acknowledge Dr Dingle will remain a Dr in the true sense of the qualification always.

Only a fool would say Dr Dingle has no qualifications in health.

To see some of Dr Dingle’s articles visit
Vitamin D
Raw eating

Friday, May 6, 2011

Great feed back from a follower

Dear Peter
After I got your newsletter about your book & Dr. Kendrick's book, I decided to order them from our local library (Mandurah). Had to wait a little bit for Dr. Kendrick's, but when I read it, I found it a bit technical (I am not from a medical/nursing background), but very interesting. However, I had to wait quite a while for your book, and finally it came in about 6 weeks ago. Our local library must have got it in especially for me - I was the first person to borrow it the Librarian said!! Your book was much easier to read for a lay person, and as I had it out for a month (and read it in 3 nights) I lent it to a friend who also enjoyed it. Now I'm going to give 2 of my cousins (from Balcatta and Noranda) the name of your book so that they can order it from their libraries. I've dallied a bit doing this as their libraries will probably borrow it from the Mandurah Library; Dr. Kendrick's book came from another library, and that's why I had to wait a couple of weeks.

I started taking medicine for cholesterol back in 1990 and my husband was very annoyed that I took it - had just shifted down from Kalgoorlie to Mandurah and went to the doctor to have a skin cancer removed, and he put me onto medicine for cholesterol (which was a bit high) and menopause (which I didn't need)!! However, when my husband died early in 1992 I found I was forgetting to take both medicines and 3 weeks after he died I gathered up all his medicines and what was left of both of mine and took them to the chemist to dispose of. When I have told friends what I did they all say I should not have stopped taking them instantly, should have slowly decreased the dosage. But, I'll tell you what, it didn't make one scrap of difference to me just stopping. However after reading your book I realise that it has affected me by depleting my CoQ10 and since I have been taking that over the past 16 months I feel so much better; but didn't really realise this until I read your book.

My late husband and I were both into alternative medicine, though I did listen to that registered doctor in 1990. But since he died I have really got more into alternative medicine and feel better for it. I'm sure my vitamin tablets are far better for me than drug medicines. I had to have a shoulder operation 2 years ago and the nurse admitting me at St. John of God Hospital in Subiaco, couldn't believe I didn't take a drug medicine of any type at my age (I will be 73 in a couple of weeks).

I belong to OSWA and went to the February meeting, which you were not able to make. The talk went off very well even though you were not there. I know it's a bit late but I wish to convey my sympathies to you on the passing of your dear mother.

Yours sincerely
Margaret Green
Silver Sands.

Tuesday, May 3, 2011

More Deception

The studies on statins also report “relative risk,” not “absolute risk” or “real risk.” The relative risk reduction is highly misleading (5,6,7,8,9) if not deceptive. An example of relative risk is: if you have four people in a study who die in the placebo group (no drug) compared to three people who die in the drug treatment group—that is, four were expected to die but with the drug only three did—then there is a 25% relative risk reduction. However, to get this effect of saving one life you would have to treat 1,000 people and the real risk reduction is 0.1%. Relative risk is like adding 1+1 to get 11 or 2+5 to get 25 or more. How can the pharmaceutical companies and the researchers working for them get away with this? This is probably because (at least in my experience) most people are afraid of statistics.

In studies by the Medical Research Council dating back to the late 1980s, researchers found that of 1,000 men ranging in age from 35 to 64 who received treatment for mild hypertension over five years, there were six fewer strokes and two fewer cardiovascular events than would be expected.(10,11) The real risk reduction over five years was 0.9%. Ten years later, a study of Pravachol® was released in the media, with much fanfare, as having a 22% drop (relative risk, not real risk) in mortality. However, when one looks at the numbers and statistics behind the calculations, treating 1,000 middle-aged men who had hypercholesterolemia (high cholesterol) and no evidence of a previous myocardial infarction with pravastatin for five years resulted in seven fewer deaths from cardiovascular causes, and two fewer deaths from other causes than would be expected in the absence of treatment.(12) The real risk reduction, however, was a mere 0.9%, less than 1% or nine lives out of 1,000 when treated for five years. The research was sponsored by Bristol-Myers Squibb Pharmaceutical (West of Scotland Coronary Prevention Study). Conservatively, put another way, researchers treated 1,000 people for five years at a total cost of over $5 million to save seven people from CVD. One might wish to compare this to the cost and efficacy of adopting healthy lifestyle choices.

In the Heart Protection Study in the United Kingdom, more than 20,000 participants aged 40 to 80 years with high risk of cardiovascular disease but average-to-low levels of total cholesterol and LDL cholesterol were treated with 40mg daily of simvastatin (marketed under several trade names including Zocor). Of 20,500+ study participants, 577 on statins died from a heart attack, 701 not treated died from a heart attack. That is a 25% relative risk reduction over five years. Sounds good, doesn’t it? The real percentage improvement is actually 1.7%. Over the five-year study(13), they saved 25 people per year in a high-risk population with previous cerebrovascular disease, peripheral artery disease, renal impairment or diabetes. These are seriously ill people and the researchers still achieved a benefit of only 1.7%. Researchers neglected to mention that around 30,000 people were not allowed in or dropped from the study and not counted in the percentage of people with side effects. There were 10,269 people on statins and 10,267 people on a placebo.(14)

A study of 90,056 participants combining 14 randomised trials looked at the best outcome for people who had pre-existing conditions: 47% had pre-existing chronic heart disease, 21% had a history of diabetes and 55% a history of hypertension. The death rate was 8.5% among the statin group compared to 9.7% in the control group. This difference represents 1.2% (15).

The well-known JUPITER study compared a placebo group to a statin-taking group. The study found that there were 68 heart attacks in the placebo group and 31 heart attacks in the drug treatment group—a 58% relative risk reduction. There were 64 strokes in the placebo group, compared to 33 strokes in the treatment group, a relative risk reduction of 48% (16). Sounds good, doesn’t it? However, the drug treatment group had 8,901 participants in it. In real terms, the heart attack risk went from a very low 0.76% to 0.35% and the risk of stroke went from 0.72% to 0.37%. Effectively, if you treat 300 people with expensive and dangerous drugs you might save one life. Under the best possible scenario, the real risk reduction was well under one half of one percent. The real risk reduction of consuming a handful of raw mixed nuts is much higher. It is interesting to note that one of the risk factors used to select the participants in the study was C- Reactive Protein (CRP) an indicator of inflammation, the real cause of CVD.

In an independent assessment of the same statistics in 2010 titled “Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy. A Critical Reappraisal “ by Michel de Lorgeril and her 8 colleagues found that “the JUPITER Study” was severely flawed (17). This recent analysis did a careful and independent review of both results and methods used in the Jupiter Study and reported that the “trial was flawed”. In an unprecedented attack on the study they (scientist other than myself usually don’t say boo even when it is serious) stated that “The possibility that bias entered the trial is particularly concerning because of the strong commercial interest in the study.” In other words the big pharmaceutical money influenced the study. And concluded "The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.” This is a scathing attack in scientific terms of the earlier drug company sponsored study. Scientist do not go out of their way to create waves but these ones have not just found different results but also criticised the earlier studies link with pharmaceutical industry. It highlights not only that the studies don’t show any significant results but these studies and the education of our doctors is strongly influenced by the drug companies.(18)

More recently, a study reported in the BMJ was a meta-analysis of 10 randomized clinical trials of about 70,000 people followed for an average of four years. In these trials, people with risk factors for cardiovascular disease but no history of existing disease were randomized to receive statins or no treatment. The relative risk reduction was 12% for total mortality, 30% for coronary event and 19% for a cerebrovascular event (stroke). However, the real risk reduction was 0.6%, 1.3% and 0.4% respectively. The actual number needed to treat to save one life was 167. Despite this outcome the authors of the study concluded, “In patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly (statistical not clinical) improved survival and large (statistical) reductions in the risk of major cardiovascular events.” (“emphasis added.”). In fact, the authors had significant associations with the drug companies and failed to mention it was statistically significant but not clinically significant. Again, busy medical professionals tend to read only the abstracts; claims like this are pretty convincing, though very misleading.

More telling however, is the latest findings in June 2010 where two major independent studies, one the re analysis of the Jupiter Study reported above and the other “A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants” (don’t worry about the title) by Ray Kausik and 6 other independent researchers. The study, wait for it, found the use of statins in high-risk individuals was not associated with a statistically significant reduction in mortality. That is, they don’t save lives. Their data combined from 11 studies with 65 229 participants followed for approximately 244 000 person-years, a very big study, reported that this “meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.” In other words they don’t save lives even in a high risk group. Even if you have all the elevated risk factors these drugs don’t work.

How many more studies to we need to do to show these drugs don’t work.

(5) Fidan, D., B. Unal, et al. (2007). "Economic analysis of treatments reducing coronary heart disease mortality in England and Wales, 2000–2010." QJM 100: 277-289.

(6) Franco, O.H., A. Peeters, et al. (2005). "Cost effectiveness of statins in coronary heart disease." Journal of Epidemiology and Community Health 59: 927-933.

(7) Franco, O.H., E.W. Steyerberg, et al. (2006). "Effectiveness calculation in economic analysis: the case of statins for cardiovascular disease prevention." Journal of Epidemiology & Community Health 60: 839-845.

(8) Capewell, S. (2008). "Will screening individuals at high risk of cardiovascular events deliver large benefits? No." British Medical Journal 337: a1395.

(9) Nuovo, J., J. Melnikow, et al. (2002). "Reporting number needed to treat and absolute risk reduction in randomized controlled trials." Journal of American Medical Association 287: 2813-2814.

(10) Medical Research Council Working Party (1985). "MRC trial of treatment of mild hypertension: principal results." British Medical Journal 291: 97-104.

(11) Miall, W.E. and G. Greenberg (1987). Mild Hypertension: Is There Pressure to Treat? An account of the MRC trial. New York, Cambridge University Press.

(12) Shepherd, J., S.M. Cobbe, et al. (1996). "Prevention of coronary heart disease with Pravastatin in men with hypercholesterolemia." New England Journal of Medicine 333: 1301-1307.

(13) Heart Protection Study Collaborative Group (2002). "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial." Lancet 360: 7-22.

(14) Ibid.

(15) Cholesterol Treatment Trialists' Collaborators, C. Baigent, et al. (2005). "Efficacy and safety of cholesterol lowering treatment: Prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins." Lancet 366: 1267-1278.

(16) Ridker, P.M., E. Danielson, et al. (2008). "Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein." New England Journal of Medicine 359(21): 2195-2207.

(17) Ray, K.K., S.R.K. Seshasai, et al. (2010). "Statins and all-cause mortality in high-risk primary prevention: A meta-analysis of 11 randomized controlled trials involving 65 229 participants." Archives of Internal Medicine 170(12): 1024-1031.

(18) de Lorgeril, M., P. Salen, et al. (2010). "Cholesterol lowering, cardiovascular diseases, and the Rosuvastatin-JUPITER controversy: A critical reappraisal." Archives of Internal Medicine 170(12): 1032-1036.

Monday, May 2, 2011

Statin Statistics: Lies and Deception

In an independent meta-analysis (when a number of studies are put together to achieve more statistical power) of randomized controlled trials in patients without CVD, statin therapy decreased the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality.(1) Taking statins for a number of years will not reduce mortality: “Primary prevention with statins provides only small and clinically hardly relevant improvement of cardiovascular morbidity/mortality.”(2) “Hardly relevant” means there is virtually no clinical benefit; as the authors of these particular studies are independent, they gain nothing by stating this. Another review found that “current clinical evidence does not demonstrate that titrating lipid therapy (trying to lower cholesterol with statins) to achieve proposed low LDL cholesterol levels is beneficial or safe.”(3) In other words, lowering lipids has no real benefit and has the potential for adverse effects. Following up on this, in a major independent review of studies funded by the Ministry of Health of British Columbia (Canada) on statins and primary prevention, researchers reported that “statins have not been shown to provide an overall health benefit in primary prevention trials.”(4) This is a government report carried out by an independent university yet its findings are still ignored.

The problem really comes down to vested interests and the abuse of statistics. To overcome the limitations of small studies, vested parties combine many studies into a meta-analysis. The researchers themselves select the studies used in the meta-analysis. A fundamental problem is that researchers with direct links to drug companies have the authority to select the most positive studies and ignore the rest—including independent studies not funded by pharmaceutical companies. Despite this, they have still not been able to show any clinically significant findings.

As readers of the scientific journals, we should not be confused between statistical significance and clinical significance. For an outcome to be “statistically significant” means that the outcome was likely result of the treatment—whether the result was 100% effective or less than 0.1% effective. That is, if you treat 1,000 people to save one life (0.1%) it may be statistically significant but it is not clinically significant. “Clinical significance” means 20% to 30% or more. The drug companies’ most positive studies on statins for prevention of CVD report statistical significance, mostly 1% or less, and none have found any clinical significance.
Busy medical professionals don’t have time to review the statistics; few of them may be aware of the different ways the statistics are manipulated. So if the experienced professionals don’t understand the results of these studies, how do we expect the media or public to understand?

(1) Thavendiranathan, P., A. Bagai, et al. (2006). "Primary prevention of cardiovascular diseases with statin therapy: A meta-analysis of randomized controlled trials." Archives of Internal Medicine 166: 2307-2313.

(2) Vrecer, M., S. Turk, et al. (2003). "Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke. Meta-analysis of randomized trials." International Journal of Clinical Pharmacology and Therapeutics 41(12): 567-577.

(3) Hayward, R.A., T.P. Hofer, et al. (2006). "Narrative review: Lack of evidence for recommended low-density lipoprotein treatment targets: A solvable problem." Annals of Internal Medicine 145(7): 520-530.

(4) University of British Columbia (2003). "Do statins have a role in primary prevention? A review by the Therapeutics Initiative of the Department of Pharmacology & Therapeutics of the University of British Columbia." Therapeutics Letter (48).

WorkPlace Wellness

Something I have been working on for a long time, and currently writing on as part of an upcoming book, is Workplace Wellness (WW). WW is really about looking after the health and wellbeing of the workers and the research shows it pays off for employers. The cost of poor health on personal and professional productivity is high and includes stress, absenteeism, presenteeism, low morale, low productivity, poor concentration and focus, low output, and risks increase sick leave, disability and more.

Many factors influence employee productivity; the list includes family issues, work environment, relations with other employees, autonomy, perceived control and health. However it is possible to relate health to many of these issues and it could be inferred that having good health will assist people to overcome these problems. The level of health is one of the most important factors enhancing and maintaining productivity in the labor force, affecting both the quantity (working time) and quality (productivity) of employees. By investing in the health of the organizations human resources, employee services and the general workplace environment, a positive impact on productivity can be observed.

The number of wellness promotion programs in an occupational setting has positively increased over the past 20 years. These programs have the potential, if properly designed and correctly implemented, to simultaneously increase employee health and employer profitability; by preventing occupational disease and injury and promoting positive employee lifestyle behaviors. Health is an extremely important determinant of an employees capacity to work productivity as even a skilled employee who enjoys their job, has job autonomy, a pleasant work environment, good relations with colleagues and is well compensated can still have very low productivity levels when they are sick or injured at work (presenteeism) or if they are absent (absenteeism). Health should be seen as not only the absence of disease but the presence of physiological and psychological wellness, this is the key to a highly competent and productive workforce.

Many studies have shown the benefit of health programs in the workplace. There is an increasing awareness that these programs may play a significant role in achieving improved organizational productivity and, for commercial enterprises, increased profitability. Workplace Wellness Programs Can Generate Savings The Effects of Behavioral Risks on Absenteeism and Health-Care Costs in the Workplace

Just one percent improvement in productivity of a person on $40000 per year assuming their output is double the value of their income ($80000) would return to the company approximately $800 per employee.

Other benefits include
• improved morale
• Increased attraction/Retention of staff
• job satisfaction,
• satisfaction with supervision,
• increased organizational commitment
• increased productivity
• reduced time loss from work/disability
• short-term health benefit cost savings
• long-term health benefit cost savings
• quality of life
• lower insurance rates
• lower legal liability

The value of health promotion programs in support of employee attraction, retention, and morale was clearly demonstrated when Glaxo Wellcome was named the best place to work in North Carolina in 1999 by the North Carolina Business Journal. These programs were cited as among the reasons people viewed Glaxo Welcome as a terrific company. In 1999, Glaxo welcome received the Everett Koop National health award, the American College of Occupational and Environmental Medicine Corporate Health Award, the American Association of Occupational Nurses Business Recognition Award. By prescription: Glaxo Wellcome has all the right ingredients to be the best place to work in North Carolina.

Citibank (Financial Services Bank) initiated a comprehensive Health Management Program in 1994, and reported the program had a positive Return on Investment, ranging from $4.56 to $4.73 saved per dollar spent on the program. The savings were even higher when absenteeism-related savings were added to health related costs, at $6.70 savings per dollar invested. Ten studies of worksite health promotion programs documented an average of $3.93 of health care benefit for each dollar of cost. Six studies of worksite health promotion programs documented and average of $5.02 of absenteeism cost savings for each dollar of program cost. So why aren’t you doing it?
A return on investment evaluation of the Citibank, N.A. Health Management Program.

Power Lines and Electrical Devices

The ever-increasing use of electrical appliances, along with the consequent demand for electric power, have greatly increased awareness of possible risks from electric and magnetic fields at extremely low frequencies. In particular, concern has been raised about power lines. This concern has, in some cases, led to strong opposition to the installation of transmission facilities, which has delayed or even prevented their licensing. The proximity to power lines in suburbs usually means less demand for the properties and lower real estate values due to concerns about raising families near these powerful sources of electromagnetic radiation.

The idea that such fields might be deleterious has been seriously considered only since 1979, when researchers suggested, on the basis of a case-control study conducted in Colorado, that the fields associated with power lines and domestic electric wiring might cause cancer in children. At the time the idea seemed bizarre—power lines were such a normal part of everyday life and they had not been shown in laboratory experiments to have any effect that appeared to be even remotely connected with the development of cancer. During the past 25 years, however, numerous epidemiological studies have suggested a link between leukaemia and brain cancer in adults and exposure to similar and higher frequency fields at work places. Residential-based studies have found similar links. The findings are, however, difficult to interpret. One reason for this is that neither leukaemia, nor brain cancer, is a single entity; each consists of a variety of conditions that differ in childhood and adult life and may—and in some cases definitely do—have complex causes.

Residential studies do not always directly measure exposure, but frequently use surrogates. These surrogates might include the distance of the residence from overhead power lines or electrical transmission stations or the wiring configurations in the vicinity of the residence, which could be classified as “high” or “low” according to the presence or absence of transformers and the characteristics of the local electricity supply cables. However, in three Scandinavian studies in 1993, children who lived in houses within broad corridors around power lines had higher than normal rates of leukaemia and brain cancer. Other studies have shown similar results: the incidence of leukaemia with residential exposure equal to or greater than 0.2 uT (or 0.25 uT in the Danish series) was 2.1 times that in the unexposed population. A recent study in Canada, in which participants wore personal monitoring devices, supports a link between magnetic field exposure and an increased risk of childhood leukaemia. Evidence of a carcinogenic effect in adults has been supported by studies that have suggested occupational hazards for leukaemia and cancer of the brain. Magnetic fields and childhood cancer—a pooled analysis of two Scandinavian studies

In a three-year study of some 570 people in Auckland, New Zealand researchers found that people living within 20 metres of high-tension power lines were three times as likely to have asthma, twice as likely to experience major depression, twice as likely to suffer from immune deficiencies (including allergies and dermatitis) and more likely to have diabetes than those who did not live within such proximity to power lines.

Researchers have also found significant evidence that occupational exposure to electromagnetic fields may reduce melatonin levels. Melatonin levels appear to be affected by the intensity and length of exposure as well as time of day it occurred; levels did not return to normal when workers were away on weekends. Melatonin, produced by the body, regulates sleep cycles and is a potent antioxidant that protects us from cancer.

The magnetic field strength produced by overhead lines depends mainly on the current flowing and distance from the line. Unlike the voltage, the current may change considerably during the day according to the demand for energy and, therefore, the magnetic field from power lines will be highly variable, reaching its maximum values when the load is highest—that is, when many people are using electrical appliances. Objects and buildings provide little or no screening for the magnetic field. In other words, even though it is safer to be farther from power lines, buildings don’t block out the magnetic field.

Exposure to electromagnetic radiation from appliances in buildings is also an area of growing concern. The results from measurements in some offices show that magnetic induction levels are within the range 0.2 3.2 uT close to typical office devices such as personal computers and photocopiers, while at the writing desks and in usual conditions the mean value is equal to 0.37 uT, with a maximum value of 1.4 uT. Most new computers have a screening device on the front but unfortunately not behind the computers so don’t sit behind a computer. In a few buildings we have investigated, wiring ran inside internal columns in the buildings, with people working right next to the columns. The exposure was extremely high and resulted in many health complaints. Devices to measure electromagnetic radiation are relatively cheap and can be obtained from some electrical stores.

In the home environment, the most significant exposure is likely to come from electrical equipment, clocks and lights in the bed head or near where people sleep. In addition, exposure can be considerable if the bed backs onto a wall that has a circuit board behind it. In general the bedroom should not have too many electrical devices in it and none near the area where one’s head is during sleep.

Non-ionising Electromagnetic Radiation

There is so much confusion nowadays about the pros and cons of radiation I thought it best to try and clarify it as best I could. People are exposed to non-ionising radiation through natural sources such as the sun as well as human-generated sources: computers, microwaves ovens, mobile phones, radar systems and power lines. From the sun, UV radiation is a major concern related to sunburn, skin damage and skin cancer. Too much sun can have a negative effect on one’s immune system. On the other hand, without enough exposure to the sun, the body does not produce vitamin D. But more on that at a later date.

Microwave radiation or Microwaves are extremely high frequency radio waves on the electromagnetic radiation spectrum. While some microwaves and radiofrequency radiation occur naturally—the sun, the earth and the ionosphere create natural sources of low-level RF and MW radiation fields—the incidence of non-naturally occurring radiation has increased dramatically with the advance of technology. Microwaves can be used to carry satellite signals for communication in televisions, AM and FM radio, computers, global positioning systems and mobile phones. Microwaves can also be used to generate heat through the extremely rapid reversal in the polarity of electrons affected by magnetic and electric fields via a tube called a magnetron—this occurs in almost every kitchen and restaurant throughout the industrialised world, with the ubiquitous microwave oven.

Microwaves and radiofrequencies represent one of the most common and fastest growing environmental influences about which anxiety and speculation are spreading. Yet very little is known about the results of exposure to microwaves; even less is known about the relative dangers of different sources of microwaves. We do, however, know that microwaves can be reflected, transmitted or absorbed by matter in their path. Absorption occurs in matter that contains moisture, including human beings.

Living organisms absorb microwaves and radiofrequency energy at the molecular, cellular, tissue and whole-body levels. Heating of internal organs is a consequence of the absorption of energy. The energy is absorbed by water within the tissue; therefore, tissues with high water density and low blood density—such as the eyes and testes—are particularly vulnerable.

Scientists have known for a long time about the capacity of RF radiation to cause this type of heating and have discovered that prolonged exposure to RF radiation can lead to health problems such as fatigue, reduced mental concentration and, in the case of very high levels, cataracts. These effects are similar to subjecting a person to an extremely warm environment. Other possible thermal effects include foetal abnormalities, decreased thyroid function, cardiovascular mortality, impaired ability to perform complex tasks and the suppression of behavioural responses, gonadal function and natural killer cell activity. Studies have shown that environmental levels of microwaves and radiofrequency energy routinely encountered by the general public are far below levels necessary to produce significant heating and increased body temperature. However, there is concern for whole body heating amongst the elderly and those on specific medications that affect thermoregulatory function. Also of concern are people with cardiac and circulatory problems, those with implanted medical electronic devices (e.g., heart pacemakers), fever sufferers, infants and pregnant women.

The majority of studies in this area are concerned with cataracts, arguably the major hazard associated with microwave radiation. A cataract is a clouding of the lens within the eye. Authorities concerned with producing safety standards agree that little is known with any real certainty about the effects of microwave radiation beyond its thermal effects. However, microwave studies contain too many shortcomings to rule out the possibility that microwaves cause adverse health effects.

The recognition of non-thermal effects has been highly controversial, due to conflicting and inconclusive studies. Studies are complex, investigating possible effects of microwave radiation—from cancer to effects on the operation of all systems and parts of the human body. Cancer studies have examined cancers of the breasts, lungs, testicles and brain, as well as ocular melanoma and leukaemia. Other studies have included assessments of the relationships between radiation and cardiovascular disease, birth defects and hormone secretion rates. Research has also shown the effect of microwaves on reducing a cell’s ability to perform apoptosis, that is when the cell terminates its own life as a part of the life cycle of the cell, increasing the risk of spontaneous mutations, including cancer.

An example of the controversy surrounding microwaves occurred with a 1990 leaked draft EPA report in the USA, recommending that radiofrequency microwave radiation be considered a “possible human carcinogen.” The White House moved quickly to suppress the draft and commissioned another report, which stated that there was no EMF cancer risk. Unfortunately, politics has its influence in too many places it should not.