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

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)

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.

As if COVID-19 wasn’t a challenge enough for so many of us with job losses, financial strain, home-schooling kids and keeping little ones entertained, then as time went on an interesting bonus challenge emerged, popularly referred to as ‘COVID kilos.’ These are the pesky kilos associated with being in lockdown most often due to cancelled gym membership, endless trips to the fridge and cupboards whilst stuck at home and every day is a potential alcohol day. I’ve seen this phenomenon really get many people down and impact their mood, which often only makes it harder to shift back to healthy habits. In more severe cases, I’ve also seen patients’ cholesterol and blood pressure rise to the point where they need to begin medication, as well as a spike in blood sugar levels, leading to a diagnosis of type 2 diabetes. It seems that many people were expecting the life changes that came with COVID-19 to last only a short time but now six months later, our lives are different and this may be the case for some time to come. With this needs to be a change in the way we function and the way we care for ourselves, so here are a few tips that can really help to manage our health and our weight during COVID-19:

1. Eating habits

• Grazing all day – this is common if you’re used to being in the office and now working from or being home more often as there is no schedule or routine, so I’d encourage creating one. Set up meal times and snack breaks throughout the day and don’t eat outside of those times.
• More junk food – if this is because you have greater access to it because it’s at home and so are you, I’d encourage you to simply keep it out of the house and get some more nutritious alternatives to take its place. Think bliss balls, fruit, wholegrain crackers and yoghurt. Then if you really feel like that choccy bar or packet of chips, get just the one and enjoy it!
• Emotional eating – There are many ways to manage emotions and using food is a really common one. It’s ok to do this – but it can become problematic if it’s the only coping mechanism and it’s used often. Identifying exactly what it is that you’re feeling and matching it with the right response can help, for example, if you’re bored, have a list of things you want to do or get done around the house and tick one of those off before heading to the fridge.
• Difficulty accessing healthy food – this is a really tricky one but there are few things that are for sure, buying food and preparing it from home is always going to be more cost-effective and more likely a healthier option than take away as you have more control over the ingredients you use

2. Less activity

Trial other activities – If you were once a gym-goer and cancelled your membership, perhaps you’re a bit nervous to get back into the gym, which is completely understandable, it might be worth trialling some other activities.

• Get outside – Nothing could be better for the soul than being out in the fresh air getting a little safe sun exposure (hello vitamin D) so heading out for a walk or run, doing your own or a small group exercise session is a great way to stick to your workout routine. Many people are feeling lonely and isolated through this time too so meet a friend and get outside for a walk or a workout, with some safe social distancing of course.
• Take it indoors – there are now a plethora of home workouts available which have had a surge of popularity since the start of COVID-19. A search on Youtube will provide with you a huge variety of workouts to follow – from yoga to pilates, HIIT sessions to resistance training. There are also fitness apps available for download and most gyms, fitness centres and personal trainers have all taken it online now as well. It’s a new way of exercising for many people so it’s worth doing a little research and looking around at what’s now available and what might suit you. The beauty is there are workouts available that can be done on the spot with no equipment if you don’t have any, to workouts that use more space and some equipment if you do.

To help you get started, here is a receipt from my book Everyday Food As Medicine: EDAMAME, AVOCADO & SPINACH SOBA NOODLES PREP + COOK TIME 30 MINUTES  SERVES 4 4 green tea bags 250g (8oz) 100% buckwheat soba noodles 2 cups (300g) frozen shelled edamame (soybeans), thawed 1 tablespoon sesame oil 2 green onions (scallions), sliced thinly 3 cloves garlic, sliced thinly 1 long green chilli, chopped finely 120g (4oz) baby spinach leaves 1 cup coriander (cilantro) leaves, chopped coarsely ¼ cup (60ml) lime juice 2 medium avocados (500g), chopped coarsely ½ cup (80g) almond kernels, roasted, chopped coarsel

1. Bring 3 litres (12 cups) water to the boil in a large saucepan. Turn off the heat. Add tea bags; steep for 10 minutes. Discard tea bags.
2. Fill a large bowl with cold water. Return tea water to the boil; add soba noodles, then cook for 5 minutes or until tender. Drain, reserving ½ cup (125ml) cooking liquid. Working quickly, refresh noodles in the cold water; drain. Cover until ready to serve.
3. Pat thawed edamame dry with paper towel. Heat oil in a wok or large frying pan over high heat. Add green onion, garlic and chilli; cook, stirring frequently, for 1 minute or until fragrant. Add edamame; cook, stirring occasionally, for 2 minutes or until edamame are blistered slightly.
4. Add noodles to wok with spinach, half the coriander, the lime juice and reserved cooking liquid; cook, tossing continuously, for 2 minutes or until well combined and spinach has wilted.
5. Serve topped with avocado, remaining coriander and the almonds. tips  Make sure you buy unsalted edamame as they are better for heart health. Seed the chilli if you prefer less heat. swap  You can use peas instead of the edamame, if you like.

THE Doctor SAYS Buckwheat soba noodles are often more nutritious than noodles made with other refined flours. Buckwheat is also better for heart health and blood sugar control. THE dietitian says Edamame (soybeans) have heart-health benefits because they are a great plant-based replacement for a meat meal, which is high in saturated fats. Roasting the almond kernels brings out their flavour

Like many things we take for granted in life you don’t miss it until it is gone. And like many things we take for granted, once it is gone it is all you think about. All too soon you dread going to sleep. The nights have never seemed so long and the days seem endless both for you and those close to you who have to listen to you talking about your insomnia. While you could fall asleep at work in a heartbeat, it becomes the last thing your brain will let you do at night. The reasons why people lose the ability to sleep are many and varied. The statement we hear most commonly is that nothing has changed. In reality insomnia usually results from an accumulation of reasons although a crisis can certainly precipitate insomnia. The solutions are equally many and varied. A short course of sleeping pills does help some people but if continued for too long they wear off and become addictive.  There are a variety of natural supplements, some available only on prescription and some not, that may help in the short to medium turn. Sleep hygiene is a detailed analysis of all the things you do before bed that affect your sleep. Blue light suppresses Melatonin production. Too much adrenaline before bed such as exercise, or the latest 11pm instalment of your favourite series can make it hard to switch off. There are professionals who can help. Sleep medicine is a specialty whereby a GP refers you to a doctor experienced in sleep medicine who takes a detailed history and works out a sleep diagnosis. Sometimes the sleep specialist needs to admit you to hospital for a sleep test whereby you are wired up and analysed while you are sleep. There is also a home version of this test which can be referred by a GP.

Many happiness researchers  have discovered that about 60% of your happiness comes from things that are within your control. The other 40%… well… that is influenced by genetic/personality and contextual factors – neither of which you or I can do much about. But here’s some tips to give you some control over the stuff you can do something about!!  

1. Define your own version of happiness

Happiness is about what you WANT  – NOT what you don’t want! Stop allowing yourself to think of happiness as the absence of something! Happiness is not “less stress” or “no money problems”. Less stress is simply, less stress. It doesn’t magically become happiness. Spend some time really thinking of what happiness would look like if you could see yourself happy. What are you spending time on and with whom? How do you act when you are happy? What does your facial expression look like? What does your tone of voice sound like? Imagine a week in the life of this happy version of you. How do you spend your free time? What activities do you participate in? Who do you spend most of your time with? This exercise can be very helpful in clarifying what is most meaningful to you. It should provide you with a list of activities, relationships and behaviours that you can start engaging in RIGHT NOW.

“You cannot always influence what you experience from the outside but you are always able to influence how the outside world experiences you.”

 

2. Be realistic and flexible – don’t expect it to feel like fireworks

So what does happiness feel like? Most of us  have experienced a number of times when we have felt very happy or joyous. Joy, while very pleasant, like any feeling is impermanent and fleeting. Happiness is often described as a feeling of deep satisfaction, gratitude and vitality. It is not the experience of a momentary emotion, but rather more long lasting. It is like the memory of a happy vacation… We may recall this as a happy time, with the experience of many pleasant and warm emotions but we may not have been feeling fireworks the whole time (and quite frankly TG! ). You may have even experienced moments such as sadness, anger, frustration, loneliness or anxiety during this ‘happy’ time. Unpleasant experiences do not negate your happiness. In fact, unpleasant emotions are just part and parcel of everyday healthy, happy living. Happiness is about more than just an emotion. It’s the recognition that your life is full of people, activities, pursuits and passions that are meaningful to you.

“Put simply, happiness comes from being proud about the way you live, who you are and what you stand for – and that path ain’t always easy or joyful!”

3. Schedule 2 – 4 things each week that bring you happiness

So now that you’ve defined what happiness is for you, and you know not to expect it to feel joyous and exciting the whole time, you should go ahead and commit to engage in at least 2-4 more activities that are meaningful for you each week. Be realistic, plan well and ahead of time, alert others and muster all the grit you have to just get out there and start making small additions that may have big payoffs in the long run. It may mean that yo may have to forego a loved activity (such as watching the latest G.O.T episode) to get to that sports game or wake up earlier to get the dinner cooked before you leave for work in the morning so that you can go for a sunset walk on the beach in the evening. This may sound too tough to do, but think of it like this – how happy does not going for a walk at sunset make you? What motivates me to get up 1 hour early to exercise or cook is this – no one lies on their death bed reminiscing about how great that extra hour of sleep felt, or how awesome it was to watch TV at night.

“Rest and relaxation are not the same thing. You’ll recharge your batteries and feel relaxed more by engaging in a meaningful activity than by resting.”

 

4. Take in the good – create lasting impressions of happiness

In Hardwiring happiness, Rick Hanson, Ph.D. Clinical Neuropsychologist and Mindfulness expert, has written an amazing and well-researched handbook on using the new science of neuroplasticity to improve your brain’ s capacity to experience happiness. The technique, which he breaks down into simple steps, involves learning to recognise when you are experiencing a happy moment, to pause and to really experience this feeling and moment in it’s entirety. Most of your feelings will manifest between your neck and lower abdomen so really focus your attention on these regions. Notice in detail how happiness feels in your body. Take deep breaths and allow yourself to just notice this experience. Now that you have had this in depth experience of happiness, make a point of trying to recall that experience throughout your week. Work hard to recall the sensations of happiness in your body. You may soon find yourself smiling!  

5. Take care of your business!

Let’s revisit the first point for a second. Recall that our definition of happiness was important in defining the person we need to work on being. While most of us don’t want to be cleaners, bankers, clerical administrators, grocery shoppers, personal assistants etc etc, being able to engage in these roles is necessary to maintain stability, order and calm. Constantly putting off activities that on the surface do not seem meaningful to you only ends up creating chaos, overwhelm and may just end up stopping you from being able to reliably engage in meaningful activities. Whether it’s activities at work you are always putting off, or always forgetting to do your internet banking, never getting on top of your housework, laundry or other necessary activities is the number one cause of ongoing underlying stress and usually the ‘straw’ that breaks the proverbial back.  Taking care of your business is meaningful – it’s about who you are as a person. Being consistent and organised with your housework (doing a little every day) allows you and your family to enjoy the comfort of a neat and organised home (whom ever walked into a beautiful hotel suite and thought the neatness and niceness was stressful – no. one. ever!). While cleaning may not be meaningful, giving yourself the gift of a comfortable and relaxing space is. Setting aside an hour a week to do your banking, plan your week, schedule your housework and get to all of your clerical duties gives you a sense of responsibility and allows you to take more control of your life.  Not many are truly happy when the bills are unpaid and the house is chaotic. Similarly, putting off activities at work that make you nervous or you dislike may only exacerbate how negative you feel about that activity because it is still on your plate. Getting on top of these things finally removes them off your plate, giving you a sense of relief, freedom, achievement and pride in your self. These experiences are worth having, and worth having regularly. If you truly want to be self-compassionate, give yourself the gift of ease tomorrow by getting into the hard work today!

“Self-indulgence and happiness are not the same thing. Don’t let your self-indulgence rob you of true self-compassion.”

try and commit to these 5 steps for the next month  and let me know how you feel!

Mental illness affects about one in five Australians in any year. Only a third of these will seek treatment. The most common problems are anxiety, depression and substance use disorder and these three types of mental illness often occur in combination. For example, substances like alcohol or cannabis might be used as a form of self-medication in an attempt to relieve symptoms, or a person with disabling anxiety may develop depression. Almost half of Australians will experience a mental illness in their lifetime, so a strategy for dealing with it becomes an essential life skill. The symptoms of anxiety and depression can be very difficult to tolerate and there is a temptation to reach for a pharmaceutical solution to ease the emotional pain and the physical symptoms.  It can be quite a struggle to have the patience to persist with a non-pharmaceutical strategy for anxiety or depression, but the effort is worth it. Over recent decades there has been a dominant philosophy of prescribing medication for these problems.  Antidepressants, sedatives, sleeping pills, “benzos” like Xanax or Serepax have become common ways of patching over mental health problems without providing skills that can help you to deal with the underlying issues. In recent years a number of pieces of evidence have emerged to fundamentally change the way we approach the management of anxiety and depression. Major scientific reviews have shown that antidepressant medications are ineffective in treating all but the most severe cases of depression, yet they continue to be prescribed for milder forms of depression or episodes of grief or sadness. Side effects of anti-depressants often mimic anxiety disorder and continuing or increasing medication can exacerbate the problem. We have come to realize the disturbing impact of over-reliance or addiction to medication for anxiety.

WHERE TO GET HELP

Your general practitioner is a good place to start.  If you are diagnosed with anxiety or depression, you will qualify for a mental health care plan. Under these plans, Medicare provides some subsidy for counselling with a qualified psychologist. Counselling will help you to identify and understand early life traumas or recent life circumstances that might be contributing to your feelings. They will also help you to think differently about situations in a way that helps you avoid anxiety. This is called cognitive behaviour therapy, or CBT. You may also learn self-treating techniques such as breathing exercises, and relaxation. Activities like Tai Chi and yoga can also be helpful. Mindfulness is a thinking technique which helps you to alleviate anxiety and depression and more fully engage with life here and now.  This needs to be taught by an expert. Massage therapy can be  useful for relaxation and easing of muscle tension.

REMEMBER THE BASICS

Anxiety and depression can dominate your life, and take your attention away from the basics of good health such as nutrition, sleep routines and exercise. Healthy lifestyle habits also work as therapy. If you are anxious, you need to avoid caffeine completely. Alcohol is best avoided too, as are illicit substances such as cannabis, cocaine and ecstasy. The right diet is essential. The Medical Journal of Australia reviewed the evidence on the direct effects of food on mood and concluded the following:

• Eating breakfast regularly leads to improved mood, better memory, more energy and feelings of calmness.
• Eating regular meals and nutritious afternoon snacks may improve cognitive performance.
• Slow weight reduction in overweight women can help to elevate mood.
• High levels of refined sugar consumption were also found to be linked to a greater prevalence of depression.

Make sure you are eating the recommended 5 vegetables and 2 pieces of fresh fruit a day as well as daily sources of protein including seafood. High levels of saturated fat consumption may be linked to a greater prevalence of depression so a low fat diet is helpful. It is important to eat regular meals throughout the day to avoid hypoglycaemia (low blood sugar). Regular moderate exercise elevates your mood and can improve your energy and concentration. Make sure you get exposure to sunlight during the day because lack of sunlight can depress your mood. It is important to look at sources of stress which you can reasonably avoid. Get organized, and cull things that are not important for you to deal with.  Make space in your life for the activities that will help you manage your anxiety and depression. Allow enough time to sleep and provide a calm quiet sleeping environment.

SUPPLEMENTS

If your diet is deficient or you have medical problems which make it difficult for you to absorb nutrients from food, you may benefit from a balanced multivitamin and mineral supplement, at least in the short term.  Avoid excessive B vitamins as they can cause jitteriness that exacerbates anxiety. Calcium and magnesium work together and can help with anxiety.

HERBAL MEDICINES

Traditional herbal treatments for depression and anxiety have been used for many hundreds of years. If you are planning to try herbal medicines in conjunction with your lifestyle changes, you need to see an expert to prescribe them correctly and to make sure there are no interactions with your other prescribed medicines.

• St. John’s wort has the best evidence for treatment of depression, or anxiety associated with depression. It must not be taken at the same time as SSRI antidepressants.
• Kava kava (Piper methysticum), passionflower (Passiflora incarnata), lemon balm (Melissa officinalis), lavender (Lavandula angustifolia), withania and skullcap (Scutellaria lateriflora) are popular herbs for anxiety.

So you’ve read about the signs and symptoms of low iron, but what are the options for treating it? As mentioned treatment can by oral tablets, diet, injections and even blood transfusions.  Oral tablets are the most readily available treatment, that  can be taken to increase the iron levels at a steady rate over a period of time.  However, there are situations where this is neither possible nor desirable and this is where the option of an iron infusion might be considered. Why might I need an infusion? There are a number of reasons why oral medication and diet might not the ideal form of treatment. They include:

• Unable to tolerate oral tablets
• Difficulty in iron absorption from the gut
• The need for a rapid increase in iron
• Have chronic renal or heart conditions

What happens during an infusion? The process is relatively simple and usually takes between 30-40 minutes. On the day of your infusion

• You can eat prior to the infusion and take any regular medication – you do not need to fast
• You can drive to and from the appointment on the day of your infusion
• You will receive an explanation of the why you are having the procedure and what will happen
• You must consent to the procedure – you will need to sign a form to say that you understand what will happen and the potential risks and side effects
• Baseline observations – your blood pressure, heart rate and temperature will be taken
• Cannulation – a small needle is inserted into the vein and this is where the iron is infused
• During the infusion a small bag of fluids with the iron mixed in will be infused. You will have some observations taken at certain points during this process.
• Post –infusion observations, after the infusion you will be monitored and have observations taken. You will need to wait for a short period after the infusion has ended to ensure that you are well enough before you leave.
• After your infusion your doctor will tell you when you need to come back to have your blood levels checked

What are the risks? The main risks are a small chance of being allergic to the IV infusion. If there is an allergic reaction you will be given medication to counteract these symptoms.  There is a very small risk that in certain individuals this allergy can be life threating; whilst this is very rare, staff and medications are on hand to deal with this or to be transferred to hospital for onward care.  There may be some pain Some people are worried about the risk of skin staining – this is also a possibility during the infusion process, and is again very rare.  In the rare instance that staining occurs, it is usually irreversible.  Every step is taken to minimise the chances of this occurring. Whilst you can have infusions during pregnancy, they should be avoided in the first trimester, so it is important to discuss with your doctor whether you are/might be pregnant before the infusion. What are the most common side effects? The most common side effects are listed below . It is not an exhaustive list but can include Headache/ Dizziness Nausea/vomiting Fast/slow heart rate, transient changes in blood pressure Slight changes in temperature Rashes/itchiness Muscle/joint aches Changes in bowel habit Shortness of breath In very rare cases Anaphylaxis You will be monitored whilst having the infusion; if you experience any of the above symptoms you should also make staff aware.  Many of these side effects will settle with simple measures and usually subside after 1 or 2 days. What do I do? Many people feel much better after an iron infusion, but naturally they have many questions. Please feel free to book an appointment with one of our doctors to see whether this is a suitable option for you.

A naturopaths approach to iron deficiency is to encourage people to look at how they eat, how they digest and absorb foods and what other factors may be reducing iron intake. Most people can obtain adequate iron from food.  However this can be altered during the following health conditions

• Low gastric hydrochloric acid [1]
• Persistent heavy bleeding
• Gastric disorders and after surgery
• In chronic disease
• Dietary inadequacies
• Inhibited by supplements or prescribed medications [2]

Buying an iron supplement off the shelf is nothing less than a minefield. Iron tablets come in various forms, some forms may cause intestinal upset such as nausea, bloating and constipation. Self-prescribing with a multivitamin or iron supplement may not help you to reach adequate blood levels to relieve your symptoms.  Supplements can additionally be misleading as often multiple tablets are needed to reach the therapeutic level of iron. Talking to your accredited Naturopath can ensure you get the most from your supplement with lesser side effects and better efficacy and measurement of your progress [3]. The best forms of iron to avoid gastro intestinal upset are chelated, iron polypeptides and carbonyl iron and polysaccharide iron complexes rather than the ferrous or ferric salt forms. Some minerals such as calcium tablets can also blocked the absorption of iron absorption [4]. Quality supplements can be prescribed by a qualified Naturopath and are often naturopathic prescription only. This will ensure you get the best from your iron supplement [3]. Iron deficiency in Australia is very common.  In general females have greater iron needs than males throughout the life cycle.  It has been recorded that two out of every five females 14-50 years of age present with an inadequate intake of iron [3]. Having inadequate iron can affect a person’s immune function, how your brain functions (cognition), learning difficulties, work and exercise performance, temperature regulation and make a person feel fatigued [3]. Food sources of iron are easy to absorb from animal product and harder to absorb from plant foods despite some plant foods containing high levels of iron. Talk to Teresa about how to obtain more iron in your diet from non-animal or animal sources. There are risks from excessive iron intake, ensure you are guided by a professional to support your needs. *Always check with your health professional to ensure there are no serious health concerns causing iron loss.   References

1. Bezwoda W, Charlton R, Bothwell T et al. (1978) The importance of gastric hydrochloric acid in the absorption of nonheme food iron. Translational Research: J Lab and Clin Med 92 (1):108-116.
2. National Institutes of Health (2018) Iron fact sheet for Health Professionals. NIH Office of Dietary Supplements. Retrieved [Online] https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
3. ABS (2015) Australian Health Survey: Usual Nutrient Intakes 2011-12. Iron. Australian Bureau of Statistics. Retrieve [Online] https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.008~2011-12~Main%20Features~Iron~402
4. Hallberg L, Rossander-Hulthen L, Brune M et al. (1993) Inhibition of haem iron absorption in man by calcium. British Journal of Nutrition 69 (2):533-540.

SLEEP

A sleep history is medically important because if you do not get enough quality sleep, sooner or later it will have an impact on your health. Some sleep disturbances are clues to an underlying medical diagnosis, and certain sleep disturbances can themselves even be life threatening. So how much sleep is the right amount? Some people need very little sleep, but most of us need six to eight hours uninterrupted.

YOU HAVE A SLEEP PROBLEM IF:

• It takes you longer than half an hour to get to sleep
• You wake frequently during the night
• You have difficulty staying asleep
• You wake up in the early hours of the morning and have trouble getting back to sleep
• You wake feeling unrefreshed

HOW SLEEP CAN AFFECT YOUR HEALTH

Insomnia and other sleep disturbances cause more than bags under your eyes and the desperate need for an afternoon nap. It can also cause: • Impaired memory • Impaired alertness and co-ordination • Irritability and depressed mood • High blood pressure and increased risk of stroke • Obesity • Type 2 diabetes • Heart, immune system and hormone disruption • Increased tendency to accidents

SLEEP DISORDERS NEEDING MEDICAL ATTENTION

More serious sleep disorders call for medical diagnosis and intervention, initially with your GP and some cases will need specialist referral.

OBSTRUCTIVE SLEEP APNOEA (OSA)

The signs of OSA are snoring with breathing pausing for up to a minute then restarting with a gasping or choking sound. Obesity, smoking and alcohol increase the risk. In childhood the most common cause of snoring and OSA is enlarged tonsils and/or adenoids. This can make them tired or irritable during the day and their school performance suffers. Disturbed sleep causes daytime sleepiness and fatigue. It can start to affect mood and personality, your ability to concentrate, strain on the heart, an increased rate of accidents, morning headache and high blood pressure. Treatment starts with losing weight and cutting out alcohol and smoking.

RESTLESS LEGS

This is a condition where you feel jumpy and restless at night and you just can’t keep still. It is more common in women than in men. There may be an underlying medical problem such as iron or magnesium deficiency. It can be treated with exercise early in the day, hot baths, and magnesium or iron supplements.

TEETH GRINDING AND CLENCHING

Teeth grinding and jaw clenching might be seen by a dentist or doctor as headaches, jaw pain or worn down teeth. It can disturb the deeper stages of sleep. Your teeth may need to be protected with a night splint worn in your mouth between the upper and lower teeth. Treatment involves removing stimulants, reducing alcohol and managing stress.

SLEEP TERRORS AND SLEEPWALKING

Sleep terrors and sleepwalking usually happen between one and three hours after going to sleep, and happen during non REM sleep stages. The events usually cannot be remembered. They are both associated with lack of sleep, erratic sleep schedules, and life stresses.

NIGHTMARES

Nightmares usually happen during REM sleep. Treatment involves reducing life stresses, treating anxiety, avoiding excess alcohol, and avoiding the use of night sedatives.

HABITS FOR A BETTER NIGHT’S SLEEP

Sometimes all you need for a good night’s sleep is to improve some of your sleep habits.

• Check that you have a comfortable, supportive mattress and pillow that are not too old.
• Make sure the bedding is suitable for the weather conditions.
• Make sure your room is not too light or too noisy. Heavier curtains and ear-plugs are possible solutions.
• Medical problems can affect sleep such as frequent trips to the toilet or pain.
• Check if any of your medications or supplements can contribute to sleep problems.
• Exercise helps to relieve stress, improve daytime alertness and night-time sleep quality. Exercise early in the day. Afternoons are fine, but finish exercising several hours before your scheduled bedtime.
• Set up a bedtime ritual to help you to wind down. Dim the lights in your home about an hour before you go to bed. Turn off computers, electronic devices, televisions and other sources of light and stimulation.
• Have a warm bath, head to bed when you feel sleepy and set a regular time for getting up. Go outside soon after waking to expose yourself to morning sunlight. Make sure you give yourself enough bed time to get the amount of sleep you need.
• Maintain a healthy weight. Limit fatty foods, spicy foods and refined carbohydrates. Avoid eating large meals too close to bedtime.
• Alcohol may make you sleepy but it disrupts normal sleep patterns and worsens snoring and obstructive sleep apnoea.
• Cut out all sources of caffeine (medicinal, coffee, tea, cola drinks, chocolate) after about 3 pm then work backwards in the day from there, down to an average of zero to two coffees or the equivalent a day (early in the day).
• Nicotine is a stimulant and smoking also makes snoring worse because it inflames the soft tissues in the nose and back of your throat.
• If something is on your mind, try to talk it through with a family member, a friend or a work colleague early in the evening and then put it on the “to do list” for tomorrow.
• Stressful life events such as job loss, financial problems or relationship difficulties cause stress. Anxiety and depression can also show up as sleep problems. Counselling may help you to resolve these issues.
• Melatonin is the hormone secreted at night by a gland near the brain, which gives the signal to sleep. It is sometimes used for a few weeks to rest the sleep rhythm. Ask for medical advice about the timing and doses of melatonin.
• Tryptophan is a precursor of melatonin, so tryptophan-rich foods such as warm milk can boost melatonin levels.
• Medication may be prescribed by your doctor after you have been fully assessed.

HERBAL THERAPIES

Common herbal treatments for insomnia include valerian, lavender, camomile and lemon balm. You can find out more about a better night’s sleep in the book. ULTIMATE WELLNESS by Prof Kerryn Phelps AM