(Today another guest post by Dr Andrew Weissenberger. Read more about Dr Weissenberger here)

Chronic kidney disease (CKD), commonly also known as chronic renal disease, is a progressive, and generally permanent, loss of kidney function over a period of months or years.

If a permanent loss of more the one-third of kidney function occurs, this is defined as chronic kidney disease.

Chronic kidney disease if often associated with, or linked as a secondary condition to, heart diseases and diabetes.

Chronic kidney disease can lead to chronic kidney failure. An increased risk of developing chronic kidney disease is found with those who:

• Have diabetes
• Have high blood pressure
• Are obese
• Smoke- men who smoke are three times more likely to have reduced kidney function
• Are over 50 years of age
• Are of Aboriginal or Torres Strait Islander descent
• Have a family history of kidney disease

The most prevalent causes of chronic kidney disease are diabetic nephropathy, hypertension and glomerulonephritis. These make up for 75% of all adult cases and hence are the major causes of kidney failure. As kidney function decreases the risk of kidney failure will increase.

The major goal of medical treatment will be to slow down or halt the otherwise relentless progression of chronic kidney disease. Control of blood pressure, diet and lifestyle changes and treatment of the original disease, whenever possible, are the broad principles of management to increase the lifespan of the patient’s kidneys. Everyone, however can improve their kidney function simply by drinking more water, especially in the Queensland climate.

This being said, just because you develop kidney disease, it does not mean that you will acquire kidney failure. At least one sign of chronic kidney disease will appear in one out of seven Australian adults over the age of 25 years. Only a few presenting with such kidney problems will have lasting kidney damage, with even fewer developing kidney failure.

Ninety percent of kidney function may be lost before you may even feel sick, hence the reason why the damage and signs of kidney disease may go unnoticed until the kidneys become close to failure. In Australians aged 12 to 74 years, approximately 52,000 have severe cases of kidney damage.

Some causes of kidney disease include:

• Diabetic nephropathy
• Hypertension
• Polycystic kidney disease
• Reflux nephropathy- a bladder valve problem allowing urine to flow back into the kidneys causing scarring.
• Medications- some drugs such as lithium and cyclosporine can cause kidney failure. Non-steroidal anti-inflammatory drugs (NSAIDS), taken in normal therapeutic doses, may occasionally cause acute kidney failure.

Hope Island Medical Centre is participating in a local collaborative to try and improve the kidney health of our patients. Please talk to your doctor today.

image credit - PAandLAT

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Osteoporosis means “porous bones” and is a disease where bone density (the thickness of the bone) and structural quality deteriorate, leading to fragile and brittle bones causing an increased risk of fracture than in normal bone.

The bone density and structural quality deterioration occurs from the loss of minerals, such as calcium, from a persons bones more quickly then the body is able to replace them.

This creates thinner, porous bones where even a minor bump or fall can cause a serious fracture in a patient with this condition.

Although both males and females are affected by osteoporosis, women are at a greater risk. This is due to a sharp decline in the level of female hormone oestrogen in the five to ten years following menopause. As oestrogen plays a central role in maintaining bone mass balance, a decrease in this hormone results in accelerated calcium loss in bones.

Although less common, if an osteoporotic fracture occurs in a male these fractures are associated with higher disability and death than in women. Maintaining a good diet with an adequate intake of calcium and vitamin D in combination with active exercise can help prevent osteoporosis.

Risk factors for osteoporosis can include the following-

Your family history:

• Any family history of osteoporosis and fractures

Your medical history:

Certain conditions and medications have been associated with an increase in osteoporosis risk.

• Cortico-steroids (commonly used for Asthma)
• Rheumatoid arthritis
• Over-active thyroid or parathyroid glands
• Coeliac disease and other chronic gut conditions
• Chronic liver or kidney disease

The following symptoms may also indicate and increased risk of osteoporosis.
For men:

• Impotence
• Lack of libido
• Other symptoms of low testosterone levels

For women:

• If your period has stopped for 6-12 consecutive months (excluding pregnancy, menopause or hysterectomy)
• If you experience early menopause

Your lifestyle:

• Smoking
• Excessive alcohol consumption
• Diet lacking in calcium
• Lack of sunlight exposure, which may lead to vitamin D deficiency
• Sedentary lifestyle over many years

If a person is over the age of 50 and experiences a fracture from a bump or low fall, they should seek medical treatment for possible osteoporosis. Medication is available to increase bone mineral density and reduce the risk of further fractures.

Hope Island Medical Centre will be inviting selected patients to complete a screening survey for osteoporosis in September and October. Please take advantage of this and discuss your Osteoporosis risk factors with your doctor today.

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Ingredients:

Pumpkin, diced coarsely

Red Capsicum, diced coarsely,

Mushrooms (I prefer large, flat, or Swiss Brown, but any will do), diced coarsely

Tomatoes (I prefer small vine ripened, tomatoes, but any will do), chopped coarsely

Danish Feta Cheese, diced

Spinach Leaves

Place the pumpkin on one tray and then dry roast in an oven at approximately 210degC for 10 minutes.  Leave the pumpkin in the oven and then add a second tray with the capsicum, mushrooms, feta and tomatoes and dry roast all of these for a further 10 minutes (or until the pumpkin is cooked).

Remove from the oven and toss through with the Spinach Leaves and serve.  I don’t think this needs any dressing at all, but you could add a balsamic vinaigrette if needed.

Image credit: taste.com.au

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Here are some quick facts about why you should include strength or resistance training into your exercise regime…

• Each day ~275 adult Australians develop Type 2 Diabetes.  This is the diabetes that occurs due to insulin resistance.  Insulin resistance occurs in skeletal muscle.  During exercise, muscle glucose uptake is increased by 7-20%.  Before 2000, most exercise recommendations focused on aerobic exercise.  Recent research has revealed that resistance exercise and strength training (ie lifting weights) increases insulin signaling in skeletal muscle. (Because this training converts 2b muscle fibres to 2a, which are more insulin sensitive.)  Thereby reducing risk of Type 2 Diabetes

• Studies have shown that high intensity resistance training has led to the greatest improvements in HbA1C (where Haemoglobin gets covered in glucose residue).  HbA1C is the test that predicts the long-term ability of a person to manage Blood Sugar Levels without insulin injections.  Exercise will improve HbA1C, even in the absence of weight loss.

• Decreases risk of Cardiovascular Disease

• Decreases systolic blood pressure (which reduces strain on your heart)

• Decreases fat (including abdominal fat)… the more muscle your body has the more fat you burn (a muscular body is a fat burning machine!!!)

• Improved arthritis, mental health, and sleep apnoea

• Increased Bone Density (extremely important for post menopausal women, as this is the time when Calcium is being stripped from your bones).

• Increased Strength, mobility and independence  (As we age, we are fighting against muscle loss and decreased bone density)

• Increased energy

• Studies have shown that Cancer Patients have benefited from weight training.

• Studies have shown that weight training combined with high intensity anaerobic exercise (like boxing etc) is the best form of exercise and promotes a leaner form as it uses more triglycerides (fats) than you would under normal exercise.

Okay…now some facts about combining cardiovascular exercise with your strength training…

• 80% of cardiovascular disease and Type 2 Diabetes and 40% Cancer can be prevented by eliminating the following major risk factors… unhealthy diet, physical inactivity and smoking.

• Low fitness has been shown to be one of the biggest risks for cardiovascular disease (even bigger risk than cholesterol and high blood pressure).

• Physical inactivity ranks second only to tobacco use as a risk factor for all chronic diseases (ie CVD, Cancer, and Type 2 Diabetes).

• Strength training increases muscular power which helps with preventing “Falls” in old age

• When the body is stressed it produces Cortisol.  The body’s response to Long-Term Stress is:  Retention of Sodium and Water in the Kidneys, Increased Blood Volume and therefore increased Blood Pressure, Increased Blood Sugar Levels, Insulin Resistance, Mood Changes and Suppression of Immune System.  Weight training helps reduce stress by providing a physical release to reduce Cortisol.  Excess cortisol also causes the body to lose muscle, it reduces metabolic rate, increases appetite, interferes with serotonin (which in turn makes us depressed), accumulates fat and impairs insulin action (no more energy storage!)

• Strength Training improves posture… Musculoskeletal collapse is a major reason why people feel sore and unwell.  The skeletal system must be properly aligned to allow the correct length-tension relationships of muscles.  Joints that rest in poor alignment will contribute to movements performed with poor alignment leading to micro then macro trauma.  Improved posture also affects the nervous system and therefore reaction times.

• Benefits of Stretching:  Increased mobility reduces risk of injury, increases joint range of movement which also helps with strength training, and stretching also helps with relaxation.

• 10 minutes of relaxation through Classical Music, Meditation or deep breathing is excellent for decreasing Cortisol.  Every 90 minutes you should have 10 minutes of relaxation.

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Ever wondered how to still create great tasting meals, but reduce the calories and/or fat intake? Well here’s a few tips that might help you out….

1. If for example you were making a Steak and Mushroom Pie and the recipe called for 750 g braising steak… you could try reducing the meat to 500g and add 200g of canned kidney beans.
2. Replace any butter with margarine or canola oil
3. Use reduced salt stock
4. Remove salt altogether
5. Use filo pastry instead of puff pastry
6. Always trim fat off meat
7. Use healthier cooking methods such as stir frying, steaming, microwaving, roasting/baking and grilling. And if you MUST add oil when stir frying, roasting or baking choice canola, sunflower or soybean oils.
8. Substitute full cream milk and yoghurt for the reduced fat varieties.
9. Use ricotta cheese whipped with a little icing sugar, fruit, and evaporated milk or reduced fat milk as a substitute for cream.
10. Use low or reduced fat natural yoghurt or evaporated reduced fat milk with lemon juice instead of sour cream.
11. Replace butter in baking cake recipes with apple sauce.
12. Choose reduced fat varieties of cheese.
13. Use a little grated parmesan cheese instead of grated cheddar.
14. Mix grated reduced fat cheese with oats, breadcrumbs or wheatgerm for toppings on casseroles, gratins and baked dishes.
15. Use margarine spreads instead of butter, lard, copha or cooking fats. Note: Reduced fat or “lite” spreads are generally not good for cooking.
16. Use salad dressings and mayo made from oils such as olive oil.
17. Make your own salad dressings using ingredients such as low or reduced fat yoghurt, buttermilk, tomato paste, balsamic vinegar, lemon juice, ricotta cheese, mustard and fruit pulp. Or go without dressing. Altogether!
18. Choose lean meats
19. Marinate or add flavour to meet with ingredients such as wine vinegars.
20. When making cakes and biscuits (or cookies for our American friends), the minimum amount of fat required for biscuits (cookies) is about 2 tablespoons per cup of flour. This will retain crispness.
21. Pastries… use filo and brush every 3^rd or 4^th layer with juice or egg white instead.
22. Replace coconut cream or coconut milk with reduced fat evaporated mil with a little coconut essence.

Don’t forget to consult an accredited practicing dietician for specific dietary requirements if you have any health concerns. Coming soon a delicious warm salad alternative…

Image credit: ionacas

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But in actual fact, eggs are highly nutritious. They contain good quality protein and 10 vitamins and minerals. One egg contains approximately 5g of fat…and that fat is mainly the “healthy” unsaturated fats that we need to include in our diets for healthy eating.

One egg contains about 1.5g of saturated fat and NO trans fat – the type of fats that raise blood cholesterol and increase the risk of heart disease.

The Heart Foundation says that “The Healthy population can include cholesterol rich foods such as offal (e.g liver, brains, kidney etc) and egg yolks as part of a healthy eating pattern.

Those at risk of cardiovascular disease, especially with high blood cholesterol, should discuss how much cholesterol rich foods they can eat with their doctor or accredited practicing dietician.

Because they are nutrient dense and relatively affordable, health professionals also recommend cooked eggs for ‘nutritionally vulnerable groups’ such as the elderly, vegetarians, pregnant women and children.”1

So maybe Eggs Benedict isn’t such a bad choice next time you go out for breakfast…you just might want to go easy on the sauce…

1: Source: Heart Foundation Fact Sheet

Thumbnail image credit: Peter Vanallen

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Reading food labels can be confusing…sometimes manufacturers can disguise saturated fats by calling various names, and ‘Reduced Fat’ doesn’t necessarily mean low fat and ‘Lite’ or ‘Light’ can mean anything.

With all these marketing smoke screens…its easy to fool yourself into thinking you’ve made some healthy food choices.

So here’s some information that might help you make better food choices on your next grocery shop…

Marketing/Labelling…

1. Cholesterol Free: This doesn’t mean that the food has to be healthy, low in fat or kilojoules, or low in saturated fat. It just means it’s free from dietary cholesterol. Some foods might be cholesterol free, but it doesn’t mean they aren’t high in saturated fat…e.g coconut and palm oil fit into this category. Commercial biscuits and cakes often contain coconut and palm oil which as usually listed on the ingredients as ‘vegetable fat’ or ‘vegetable oil’.
2. Lite or Light: This can refer to anything. They might have less salt, fat or sugar. It doesn’t necessarily mean low in kilojoules (or calories) or low in fat. In some cases ‘Lite’ is used to say something about flavour. E.g olive oil that is lite in flavour.
3. Reduced Fat: This doesn’t always mean low in fat. Reduced Fat cheddar cheese still has 25% fat, and therefore would still be considered a high fat food. Cream cheese claiming to be 82% fat free are therefore 18% fat full…still making them a high fat food. Always check the nutrition panels for total fat content.
4. Low Fat: Means that <3% fat for solid foods or <1.5% for liquid foods.
5. Toasted or oven baked: Toasted muesli still has double the fat of untoasted muesli. Baked products still have been cooked with oil.

Ingredients Lists:

These are generally listed with the main ingredients listed in order from the largest to smallest amount used based on the weight of the ingredients. The major ingredients are usually the first 3 listed.

Look out for Saturated Fats in Disguise: Other words that are high fat ingredients are:

Vegetable oil, palm oil, coconut oil, cottonseed oil, palm kernel oil, copha, animal fat, tallow, lard, shortening, chocolate, monoglycerides, diglycerides, full cream milk solids. Ghee, dripping, coconut cream etc

High sodium ingredients or high salt include: MSG (monosodium glutamate), sea salt, garlic salt, celery salt, rock salt, vegetable salt, sodium bicarbonate, sodium nitrate, stock cubes, baking powder and baking soda. High sodium would be >120mg per 100g in the sodium content of the nutrition panel.

So if one or more of these ingredients appear in the top 3 ingredients list… then chances are…it’s probably not a great food choice.

Hope this helps…

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Well…This is some information that I found on an information handout from the Heart Foundation…

What is a plant sterol?

Plant sterols are naturally occurring components mainly found in vegetable oils but are also present in smaller amounts in nuts, legumes, breads and cereals. Traces are also found in fruit and veges.

What effect do plant sterols have on blood cholesterol levels?

Plant sterols can lower blood cholesterol levels by around 10%, depending on how much is consumed. A reduced blood cholesterol level is associated with a reduced risk of heart disease and stroke.

How much plant sterol is needed to lower blood cholesterol levels?

A daily intake of about 2 to 3g of plant sterols is needed to have an effect on blood cholesterol levels. To achieve this level of intake, foods, such as margarine spreads, need to be enriched with plant sterols, consuming about 1 to 1.5 tablespoons of plant sterol enriched margarine spread each day.

Are there any side effects of plant sterol margarines?

In general, there doesn’t appear to be any evidence of safety concerns associated with the short-term consumption of plant sterols, although long-term safety studies haven’t been performed.

Plant sterols have been shown to lower the levels of carotenoids in the blood. People with lower levels of carotenoids may have a greater risk of coronary heart disease than people with higher levels of carotenoids. To counter balance any decrease in carotenoids people can include an additional daily serve of yellow or orange vegetables of fruit…e.g carrots.

People with a rare inherited metabolic disease called homozygous sitosterolaemia (1 in 6 million people affected) should restrict their consumption of plant sterols. These people have high levels of sterols in their blood because they have a high rate of gut absorption of plant sterols, which leads to premature atherosclerosis.

Can I eat too much plant sterol enriched margarine spread?

Plant sterol enriched margarine spreads can be included in moderate amounts as part of healthy eating. The recommended intake is 1 to 1.5 tablespoons per day.

It is important to understand though, that no single food can prevent against having a heart attack. Ultimately it comes back to maintaining an all over healthy lifestyle for good health it is still important to eat a variety of foods such as breads, cereals, rice, pasta, fruit, vegetables, legumes, lean meats, poultry, fish and reduced dairy products.

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Cholesterol and triglycerides are fatty substances that can be found in the blood. There are 2 types of cholesterol:

(1) Low Density Lipoprotein (LDL) cholesterol which is sometimes referred to as BAD cholesterol because it increases your risk of coronary heart disease
(2) High Density Lipoprotein (HDL) cholesterol, which is the GOOD cholesterol because it protects you against coronary heart disease

Triglycerides travel through your blood and are also stored as fat deposits in your body. High levels of triglycerides are common in people with high cholesterol, and in people who are overweight and have heart disease and/or diabetes.

LDL cholesterol accumulates along your artery walls, forming plaque and narrowing your arteries. HDL cholesterol then comes along and tries to clean it up.

So usually when you get a blood test the doctors will check both your total cholesterol and your HDL cholesterol levels and then sometimes they will calculate a ratio by dividing the total cholesterol by the HDL cholesterol. The lower this ratio…the better off you are when it comes to heart disease.

So by limiting your intake of fatty foods (foods high in saturated and trans fats) and high cholesterol foods and by keeping active you can have a dramatic impact on your cholesterol levels.

Foods that contain saturated fats are mainly full fat dairy products, fatty meats, butter and coconut and palm oil, deep fried take aways and commercially bakes products such as biscuits and pastries. Cholesterol containing foods are mainly animal products such as offal, fatty meats, egg yolks, some seafood, etc. Being overweight and drinking alcohol also raises blood triglycerides levels.

But I recently came across some other information out there (Book: “What Your Doctor Doesn’t Know About Nutritional Medicine May Be Killing You” by Dr Ray Strand) that suggests that LDL cholesterol is really not “bad”. According to this book, native LDL cholesterol (the stuff your body makes) is good. It is needed for building cell membranes and many hormones that our bodies need.

The only problem with LDL is apparently due to modifications by free radicals…or oxidation of the LDL cholesterol. Due to the fact that the LDL is modified, the normal cleaning up and repair process for the arteries no longer functions properly resulting in fatty streaks in the artery walls and leading to atherosclerosis.

Apparently in 1997 a researcher Dr Marco Diaz reviewed a lot of medical studies and concluded that patients with the highest level of antioxidants (which combat free radicals) in their bodies had the least amount of coronary heart disease. Apparently the anti-oxidants stop the LDL cholesterol from becoming “bad”.

So maybe this could be an underlying factor in our previous article that spoke about how Berries are “berry” good for your heart.

Aside from increasing your anti-oxidant intake you should still try to base your eating pattern on the following (according to the Heart Foundation handouts):

1. Use margarine spreads instead of butter or dairy blends (if you must use them at all)
2. Use a variety of oils for cooking such as canola, sunflower, soybean
3. Choose low or reduced fat milk and yoghurt. Try to limit cheese and ice-cream to twice a week
4. Have fish at least twice a week (even canned is okay)
5. Select lean meat cuts and limit fatty meats (including sausages and salami)
6. Snack on plain unsalted nuts and fresh fruit
7. Incorporate dried pease, beans and or lentils into two meals a week
8. Make veges the main part of your meal and choose wholegrain based foods.
9. Try to limit take-away foods to once a week.
10. Try to limit snack foods such as potato crisps and corn crisps to once per week.
11. Try to limit cakes, pastries and biscuits to once a week.
12. Try to limit cholesterol rich foods such as egg yolks and offal (e.g liver, kidney and brains)

Be active EVERY day. At least 30 minutes of moderately intense activity (such as brisk walking)… this can be accumulated in shorter bouts e.g 3 x 10 minutes.

Aim to achieve and maintain a healthy body weight. (See healthy eating and exercise)

If you follow these steps you should be well on your way to improving your cholesterol situation and don’t forget you should always speak to your doctor about any health concerns.

Coming Soon…I will be doing an article on the impact of margarines on cholesterol…do some margarines bring your cholesterol levels down?

Image credit: ABC Health & Wellbeing

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Broderick Lloyd Laswell, an inmate at the Benton County jail , has filed a lawsuit against the jail because he’s lost nearly 100 pounds while he’s been awaiting trial for murder.

Broderick entered the prison at a whopping 408 pounds…..This gentle giant who allegedly fatally beat and stabbed a man, is complaining that the menu just isn’t up to scratch….providing only 3000 calories a day.

“I could still eat a horse and chase the jockey” is the nightly call from the prison dining hall….But Why is he complaining?

100 pounds off his frame is just what he needs….it’s better for his health and possibly his jail love life…especially if he’s going to spend the rest of it inside.

And while we’re on that subject, allegedly, the latest reports from the Arkansas jail is that the hunger bug is spreading..apparently his cell mate was caught biting his pillow throughout the night yesterday because he was still peckish after dinner.

(For any inmates reading our blog tonight…we’re just joking about the pillows…sorry)

Ok, so I’m poking fun at the big fella….On a serious note though, does this character have a legitimate complaint…a man who allegedly killed a man…an obese man who’s now losing heaps of weight which is good for him….can this man sue for weight loss?

What’s next…..”Let me out your honor it wasn’t me…it was the other 100 pounds that did it…not me”…and stand by for the “Arkansas prison diet” book…someone has to be writing it as we speak?

Embrace the weight loss big man and drop the law suit….the courts have got more important things to do with their time.

What do you think?

Kel

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