All posts by rajeshsyd

Cold exposure is all the rage…but is it beneficial for metabolic health?

General Health

Protocols vary but cold plunging (ice bath) commonly involves immersing the body in water as cold as -1 to 4 degrees celsius for 2-3 minutes. Cold therapy (CT) can also include cold showers, cryotherapy, open water swimming and even short walks in cold weather. The goal of cold therapy is to boost energy expenditure and improve metabolic health. Energy is required to produce heat. Mammals are known to produce heat through either skeletal muscle shivering or “non-shivering thermogenesis”. The latter relies on a special type of fat called brown fat, or brown adipose tissue (BAT).

Why take the plunge?

The vast majority of fat in the human body is known as white adipose tissue (WAT). Unlike WAT, brown fat contains a high concentration of iron-rich mitochondria, which, in addition to giving the tissue a brown colour, make BAT far more metabolically active than WAT.

Cold exposure activates brown adipose tissue. The literature explores whether this increase in BAT increases energy expenditure and therefore could help with obesity and insulin sensitivity/metabolic health. Increasing BAT mass and activity may represent a promising new therapeutic target for the treatment of both obesity and insulin resistance.

There is also evidence that ice baths could help reduce Delayed Onset Muscle Soreness (DOMS) after exercise. The greatest benefits appear to occur when treated with CT 24 to 72 hours post exercise. Some studies have shown that cryotherapy decreases inflammation however not all results agree and more data is needed.

Is cold therapy safe?

Whilst generally considered safe to cold plunge in a controlled environment, it is important to warm the body immediately after cold water plunging to avoid a phenomenon known as afterdrop.

Under cold conditions, your body tries to keep the core temperature as warm as possible, at the expense of the peripheral temperature. At some point the colder blood in the periphery is dumped into the warmer core blood. Afterdrop occurs when the core temperature drops from something safe like 35-36 degrees celsius to something unsafe like 33 degrees celsius, which could technically result in a ventricular arrhythmia or abnormal heart rhythm.

Dr Nikki’s anecdotal experience: I do regular cold plunges at home and feel amazing afterwards (but I admit it could be the placebo effect)… Are you keen to take the plunge?

Written by Dr Nikki Fisicaro

References:

  • Effect of Acute Cold Exposure on Energy Metabolism and Activity of Brown Adipose Tissue in Humans: A Systematic Review and Meta-Analysis (Huo et al., 2022)
  • Role of human brown fat in obesity, metabolism and cardiovascular disease: Strategies to turn up the heat (Ruiz et al., 2018)
  • Human Brown Adipose Tissue: What we have learned so far (Betz & Enerbäck, 2015)
  • Temperature-Acclimated Brown Adipose Tissue Modulates Insulin Sensitivity in Humans (Lee et al., 2014)
  • Brown Adipose Tissue Improves Whole-Body Glucose Homeostasis and Insulin Sensitivity in Humans (Chondronikola et al., 2014)
  • Effects of recovery method after exercise on performance, immune changes, and psychological outcomes (Stacey et al., 2010)
  • The effect of recovery strategies on physical performance and cumulative fatigue in competitive basketball (Montgomery et al., 2008)
  • Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise (Bleakley et al., 2012)
  • Cold water immersion and recovery from strenuous exercise: a meta-analysis (Leeder et al., 2011)
  • The efficacy of cryotherapy on recovery following exercise-induced muscle damage (Burgess and Lambert, 2010)
  • Time-course of changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise (Pournot et al, 2011)
  • Cold exposure and immune function (Shephard & Shek, 1998)
  • The effects of cold water immersion and recovery on molecular factors that regulate growth and remodeling of skeletal muscle after resistance exercise (Peake et al, 2020)
  • https://en.wikipedia.org/wiki/Afterdrop

Fire In The Sky – How To Protect Your Skin

Skin Health

With record heat temperatures breaking across the world and summer fast approaching, many of us are increasingly concerned on how to best protect ourselves and loved ones this season. Summer in Australia is often associated with the beach, holidays, celebrations and fun. However, we too often forget the dangers that come with such long and intense summers, in particular UV radiation exposure.

Australia has the highest rate of skin cancer in the world; with two thirds of Australians being diagnosed with a skin cancer over their lifetime. For this reason, it is extremely important of us to take care of our skin during summer.

General precautions include:

– wearing SPF30 or higher sunscreen (water resistant is best, especially at the beach or pool), ensuring to apply 20 minutes prior to going outside and reapplying every 2 hours

– wearing a broad brim hat and breathable clothing that protects your skin as much as your skin as possible

– sunglasses that meet Australian Standards for UV protection

– stay in shade/under umbrella as much as possible when outdoors

– avoid sun exposure in the middle of the day as this is generally when UV levels are most dangerous

As particular note, babies under 12 months should not be exposed to direct sun when UV levels reach 3 or higher (and use of sunscreen on babies under six months old should be avoided).

Monitoring UV levels is particularly useful to assess your daily risk. A good resource can be found on: cancer.org.au/SunSmartApp.

Children are particularly vulnerable to sunburn (as little as 10 minutes of sun exposure) and heatstroke, and so extra precautions should be taken.

If your child does get sunburnt, ensure they are adequately hydrated by encouraging them to drink water. You can also use cool compresses on the skin and simple pain relief such as paracetamol can assist. Any signs of severe sunburn such as blisters, swollen skin or severe pain should be reviewed by a GP as soon as possible.

Extended duration in the sun can also cause heatstroke in child or vulnerable people in the community. Signs and symptoms include fever, headaches or nausea and vomiting. If any of these symptoms occur after time in the sun, present to your GP immediately (or your local emergency department if outside practice hours).

Having regular skin checks is also an extremely important screening tool to help detect and treat any irregular skin lesions early that may be cancerous. Talk to your local GP for more information to assess your individual risk of skin cancer and form a personalised plan to protect yourself and your family this summer.

References:

Kids Health Information : Safety: Sun protection (rch.org.au)

National Skin Cancer Action Week | Combatting Australia’s ‘national cancer’ | Cancer Council

Smoke On The Horizon – How To Protect Your Lungs

General Health
With La Niña’s reign over the last 3 years coming to end, Australia will once again face the fierce nature of bushfires. Not only can the fires themselves put lives at risk, but many people in the community can be vulnerable to the dangers of smoke inhalation. This includes people with lung conditions such as asthma and chronic obstructive pulmonary disease (COPD), those with hay fever, people with heart conditions such as angina and ischaemic heart disease (IHD), people over 65 years of age, children 14 years and younger, pregnant women, people with diabetes and people with active respiratory infections including COVID-19. Some general measures to take during bushfire season include: – keeping your home window and doors closed, especially with active fires nearby – utilize air conditioners with recycled air setting activated – air purifiers inside the home – monitor air quality everyday to assess your risks of outdoor activities/pollutant exposure; a good resource for this is Air Pollution in Australia: Real-time Air Quality Index Visual Map (aqicn.org) – constantly check in and monitor on health of children, elderly people and others at risk It is highly recommended that you see your GP for an individualised management plan to optimise your protection this bush fire season, especially if you are at risk. This can facilitate many important interventions such as an updated Asthma/Wheeze Management Plan, medication optimization, ensuring adequate supply of relievers/preventors on hand, discussing preventative strategies, and consolidating an escalation plan for emergency situations. References: Fact-sheet-Bushfire smoke – vulnerable people (health.gov.au)

Exploring IUD’s

Women’s Health
IUD FAQs. The information below is based on my experience and recommendations as a GP practicing in women’s health for nearly a decade. I am not endorsed by any particular device or brand. Please consider all of the advice below and select the device which is best suited for your needs. What is the best contraceptive option? I consider the Hormonal IUD (Mirena or the Kyleena) as the most reliable and convenient contraceptive option for women both before and after having children. The IUD is a long active reversible contraceptive (LARC) which are the contraceptive type recommended by many peak health bodies including the RACGP as first line contraception for women as they are safe, effective and reversible. (https://www.racgp.org.au/afp/2017/october/larcs-as-first-line-contraception) Compared with the oral contraceptive pill, the IUD is set and forget method that lasts up to 5 years. And because they are inserted directly where they are needed to work (in the uterus), they have the least side effects in terms of mood, weight and skin changes compared with the other hormonal contraceptive options. One particular benefit of hormonal IUDs in addition to contraception are that they also often make periods lighter and less crampy. The Mirena IUD is considered first line management for women with troublesome heavy or painful periods due to conditions such as endometriosis. What do you think of the Copper IUD? The copper IUD is also a very reliable form of contraception, but as it increases menstrual blood loss and period cramping in most women. I usually recommend the hormonal IUDs first. Do IUD’s have a negative impact on your fertility? IUDs have been used for over 30 years and have not shown to have a negative impact on fertility. (reference link: https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-018-0064-y ) Why haven’t I heard of the IUD before? Traditionally IUDs have only been inserted by specialists and thus less commonly known about. Thankfully access has improved now that specialist GPs are upskilling in insertion. We are still trying to improve public education around this contraceptive option. The fact that there is a small procedure involved in getting the device also serves as a bit of a barrier. Thankfully due to the increasing number of women looking for alternative contraception to the oral contraceptive pill, it has become a lot more popular in the last decade. I haven’t had children, is the IUD still suitable for me? Yes yes yes! There is a frequent misconception that IUDs are more suitable for women post birth, but that is simply not true. https://societyfp.org/wp-content/uploads/2021/06/PIIS0010782416303857.pdf What is the procedure like? For most women, insertion is a short 10-15 minute procedure, but insertion appointments are made for 30-45 minutes to allow for discussion, set up and recovery time. It can be crampy during the procedure and also for 1-2 days after. We advise women to take oral analgesia such as Panadol and Nurofen 1 hour prior to the procedure, and we can discuss further analgesic options that we offer at the clinic at your booking appointment.  What is the best time to do the IUD insertion? If possible, IUD insertions should be timed for during your period. How do I arrange getting an IUD device? While IUDs are suitable for most women, it is still crucial to have a consultation to discuss your personal medical history and your individual benefits and risks of choosing the IUD as contraception. We often also arrange tests prior to doing the insertion, such as an STI screen and cervical screening test (if due). We usually advise a 15-30 minute planning consultation to answer any questions about the insertion and after care as well as arrange any investigations that may be required beforehand.  How do I obtain more information about IUD insertion? You can request general information about the procedure and costs involved before booking in for your initial consultation by discussing with our reception.

Turning 50? Gift yourself these health checks

General Health
Turning 50 is one of life’s major milestones. You’ve reached the half-century mark and are closer to retirement, while still in the prime of your life. But with age being a risk factor for many diseases, it’s also beneficial to celebrate this birthday as a guidepost to preserving your health.
“One thing I’ve found working with patients who are older is that the ones who have the best outcomes are those who took control of their health at a younger age,” explains Dr Jason Juggapah of Sydney’s Bourke Street Clinic. “Like with a car or any kind of machine, parts eventually wear out. Our bodies are the same. Cells don’t replicate with the same accuracy they did when we were younger. “By having regular checks you’re more likely to spot these things when they start to go wrong, meaning interventions can be made earlier to prevent any further damage or reduce the likelihood that issues could progress.” Here are the important health checks that every 50 year old should consider.

Cancer screenings

The risk of certain cancers increases as we age. Thankfully in Australia, there are Commonwealth-funded screening programs that make these check-ups accessible. “For 50 and beyond, the main cancers you want to screen for are breast, cervical, bowel and prostate,” says Dr Juggapah. “The bowel screening is the biggest, and as part of your 50th birthday present the government sends you a bowel screening kit.” Dr Juggapah ensures every one of his patients complete the screening, as it is effective in detecting colon and bowel cancers at an earlier stage, therefore enabling better treatment options.