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15/09/2022

Brad Phillips In All Articles, Dr Nick Chartres, Exercise, Mental health, Nutrition

These harrowing cancer statistics can actually be good news. Wait, what?

In this opinion piece, Good Mood Dudes founder Dr. Nicholas Chartres provides his view on this article: These harrowing cancer statistics can actually be good news

When I first read this headline, I assumed that this article was going to discuss new government regulations on industry (alcohol in this instance), spurred by more unequivocal evidence on the already established health effects caused by harmful products like alcohol.

Instead, the story focused on what the individual can do to change their behaviour, with education being a key component of that behaviour change.

Seems reasonable, I hear you say.

Let me explain the shortcomings of this approach and why it is the narrative that the industries that produce these harmful products love to see published.

While the story points to the fact that smoking rates in Australia have dropped from 24% in 1995 to 11% in 2021, this was not done through education campaigns alone. It took an aggressive suite of regulatory measures for this to occur. These included an increase in sales taxes, a complete ban on advertising and marketing (sports advertising was one of the first to go), and the introduction of plain packaging, coupled with aggressive graphic health warnings by the Australian government.

Government action must be part of the solution.

I study the commercial determinants of health. This includes the strategies that industries like tobacco, alcohol, packaged food, and fossil fuels use to sell their products, as well as the political and economic systems that they operate within.

As economic globalization has intensified over the last two decades, these determinants of health have not only become the leading cause of disease but have also created health inequities within and across countries. For example, communities of color and low-income communities have experienced disproportionate consequences and impacts on their health due to either higher consumption rates of alcohol, tobacco, and ultra-processed foods or higher rates of exposure to toxic air pollution (due to the combustion of fossil fuels) and chemicals.

These industries use a suite of tactics aimed at preventing government regulation, which includes distorting the science on the human and planetary health effects of their products, undermining the policy process via lobbying, and shaping the narrative on their brands and products through evocative marketing and corporate social responsibility campaigns.

Now I love a beer and a pie at the footy. However, it’s vital that stories covering chronic health statistics should not be presented as a “really good news story” without being accompanied by perspectives addressing the need for government regulation to implement strategies like those mentioned above which have proven successful in tobacco control.

Without strong government action, these statistics will continue to increase, and I cannot see the silver lining in that.

Dr Nicholas Chartres is the Director of Science & Policy at the University of California, San Francisco working with the Program of Reproductive Health and the Environment. His work focuses on US federal chemical policy and regulation.

Nick received his PhD from The University of Sydney, where his thesis examined ways to reduce bias in public health guidelines, including the primary studies that are used in our national Dietary Guidelines. Nick also has a Masters in Nutrition.

31/08/2022

Tayla Schuit In All Articles, Dr Nick Chartres, Exercise, Nutrition

Fast Food & Sports Stars Don’t Mix

In this opinion piece, Good Mood Dudes founder Dr. Nicholas Chartres provides his view on this article: GP-turned-MP to demand action on junk food advertising

Kids love sports stars.

They buy the shoes and clothes they wear, the cricket bats they use and the sports drinks they drink.

Therefore, a new bill to stop junk food sponsorship of children’s sport and ads shown during prime-time television like 20/20 cricket, when kids are watching with their families, is a welcome move to help reduce the number of overweight and obese Australian children.

We know from the success of smoking cessation rates globally that advertising, especially via mass media, is one of the most pervasive ways that companies can increase sales and consumption of their harmful products. If we cut advertising, we cut consumption and we can cut the resulting rates of disease that are caused by these harmful products.

Although advertisements for unhealthy foods and drinks are banned during broadcasts of television programs made for pre-schoolers, the average 5-8 old is still being exposed to more than 800 junk food television ads a year. Currently, the federal government has allowed the food industry to govern itself through a self-regulatory code, with junk food companies arguing that they are not advertising to children by sponsoring their sports because they only use their brand names and not pictures of their products.

However, the food industry knows that kids look up to sports stars and they still have a significant opportunity to get our kids hooked on their ultra-processed foods. If Australian men’s cricket captain Pat Cummins can eat KFC and still be one of the best athletes in the world, why wouldn’t an 8-year-old think that he can do the same?

It’s time to get serious and properly protect our children by banning all junk food advertising from sport.

17/08/2022

Brad Phillips In All Articles, Dr Marianna Szabo, Mental health

Understanding Burnout

After nearly three years of living with the COVID-19 pandemic and other worrying developments in the world, more and more of us feel ‘burnt out’.

But what is burnout? How is it different from being generally stressed or tired? What causes it, and how can we prevent it?

What is burnout?
The World Health Organisation defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. It refers specifically to experiences in the occupational context, rather than in other areas of life. Of course, if chronic stress is present in other areas of life, workplace stress will be more difficult to manage, and vice versa.

Burnout was first described by psychologist Christina Maslach and her colleagues in the 1970s. They identified this issue among professionals working in human services, such as doctors, nurses, or counsellors. Their research suggested that burnout has three distinct aspects: emotional exhaustion, depersonalization and a reduced sense of personal accomplishment.

Emotional exhaustion refers to a state of feeling overextended, constantly tired, and having a sense of depleted energy, or ‘running on empty’.

Depersonalization, which is sometimes also referred to as cynicism, is the interpersonal dimension of burnout. It is a negative, detached, insensitive, uncaring attitude to work and especially towards one’s clients.

Low personal accomplishment refers to a diminished sense of professional competence, and reduced productivity at work. The Maslach Burnout Inventory is a widely used questionnaire to assess these three aspects of burnout.

Burnout itself is not classified as a medical condition or psychological disorder. There is no ‘cut-off’ point on the questionnaire above which one can be called ‘burnt out’. Instead, high scores on a burnout questionnaire indicate that all is not well: you are exhausted, you don’t care about your clients, and you constantly feel that you are not doing a good enough job.

Burnout is associated with serious physical and psychological health conditions, such as depression, insomnia, chronic pain,
increased susceptibility to respiratory infections, gastrointestinal problems, and cardiovascular diseases.

So, if you do feel burnt out, it is time to look at the causes and to begin doing something to improve the situation.

What causes burnout?
Christina Maslach’s original research showed that burnout was most likely to develop in people who had been suffering from chronic work stress. When a stressful event occurs, the body responds with the activation of a characteristic stress response, called the fight or flight response.

During evolution, the threats we faced were usually physical. We needed to run away or face a potential predator (flight or fight). Even though nowadays we are rarely in such physical danger, our biological system still reacts with the same flight or fight response to social stress, such as an unpleasant encounter at work.

When this response is activated, both body and mind increase preparedness to deal with a potential threat. For example, blood pressure increases, breathing patterns change, blood flow increases towards the large skeletal muscles and away from the guts.

This activation reduces processes needed for rest and recuperation, such as digestion or sleep. Importantly, these bodily changes are accompanied by changes in the mind: you become more vigilant for negative information, and it becomes more likely that you interpret ambiguous information as threatening. In other words, your thinking becomes more negative.

Humans evolved to deal with short term (acute) stress very well. When the stressful event ends, the body returns to its normal state, and it can rest and recuperate. However, if stress is ongoing (chronic), that rest and recuperation can not happen. The constant activation of the stress response can eventually cause physical and psychological health problems, including burnout.

We know that several work circumstances can increase employee stress. These include:

unreasonable time pressure
an unmanageable workload
a lack of role clarity
a lack of control and autonomy
a lack of communication and support from managers
unfair treatment from managers, clients, or co-workers.

However, not everybody reacts to stressful situations the same way.

Personality traits, strongly held beliefs and values, and certain thinking patterns can contribute as well. For example, people who are highly perfectionistic tend to experience more stress, which can then lead to burnout. Strong individual values placed on achievement can also cost personal wellbeing if they are not balanced with a sense of self-care and compassion. Sometimes underlying such tendencies for perfectionism and high achievement orientation is a deep-seated feeling that something is about to go wrong, and one needs to be constantly in control to stave off disaster – even if the nature of that disaster is not always clear in your mind.

What can we do about it?
As most of us are already aware, to avoid burnout, we must reduce chronic stress or manage stressful situations better. If the workplace is open to creating a healthier work environment, talking to a supervisor may solve the problem. Simple self-care strategies, like eating a healthy diet, getting enough exercise, social support, improving your sleep quality, and regular breaks from work may also help to fend off the effects of high-stress jobs. Sometimes a change of position or job is an option.

However, such strategies are often ineffective if one’s personality, beliefs or thinking are at least partially responsible for a tendency towards experiencing chronic stress. No amount of fresh green vegetables and lavender oil will solve the problem for a person whose thinking is habitually negative or self-critical, who keeps putting others’ needs ahead of their own, or who has difficulty relaxing control over minor aspects of life.

If you are that kind of person, start watching your thinking and asking yourself whether a healthier thinking pattern would also be helpful. It is hard work, but it is possible to change our thinking.

If you are experiencing chronic stress or burnout and you’re having difficulty finding your way out, it may be a good idea to seek professional support. Talking to a mental health professional can help clarify the problem and identify strategies to solve it. You deserve to feel your best.

References and further reading

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.

27/07/2022

Brad Phillips In All Articles, Dr Marianna Szabo, Mental health

Do I have adult ADHD?

Until recently, Attention Deficit Hyperactivity Disorder (ADHD) has been considered primarily a childhood disorder, with only a minority of children continuing to have symptoms in adulthood. A surge in adult ADHD diagnoses occurred in recent years after changes to the diagnostic system made it easier to detect ADHD in adults. This increase has been accompanied by a lot of media
interest, with #ADHD trending on TikTok and other social media platforms as well.

Many people may have now encountered messages such as this:

Are you someone who can focus on some projects or activities so intensely that you completely lose touch with time?
At the same time, are you also a person who keeps forgetting appointments, can’t pay bills on time, is always late, can’t get organized, and can’t concentrate on unexciting projects, despite your best efforts?
Have you often wondered why you find “adulting” so difficult?

If you answered yes to these questions, you may have adult ADHD.

As usual, however, the story is more complicated.

How is ADHD diagnosed in adults?

What are the symptoms?

The diagnostic criteria for ADHD are essentially the same for adults and children. The current diagnostic manual lists 9 symptoms of inattention and 9 symptoms of hyperactivity. Children need to report 6 out of the 9 symptoms of either inattention or hyperactivity to receive a diagnosis of ADHD. Adults need to report only 5 out of the 9 symptoms in either group.

An example of an inattention symptom is “Often fails to give close attention to details or makes careless mistakes at school, work, or during other activities (e.g., overlooks or misses details, work is inaccurate”.

An example of a hyperactivity symptom is “Often blurts out an answer before a question has been completed (e.g., completes people’s sentences, can not wait for turn in conversation).” (DSM-5, APA, 2013)

Adults and females of all ages are more likely to have inattention, rather than hyperactivity symptoms.

However, saying ‘yes’ to 5 or more symptoms is not enough for a diagnosis. To have a clear picture, we need to ask further questions.

Do these symptoms interfere with important life functions?

We all become inattentive, unfocused, forgetful, or impatient sometimes. To receive a diagnosis of ADHD, the symptoms need to directly cause serious problems in the person’s life. For example, do these symptoms result in lower achievements at work or in education? Do they increase social and family problems? Could they be responsible for accident proneness, legal difficulties, or substance misuse in the person’s life?

Do the symptoms occur in several different situations?

If a person is hyperactive or inattentive in some situations (e.g., at work) but not in others (e.g. with friends or family), it is possible that the situation itself is responsible for the problem, not the person.

However, people are not always aware of the problems that their symptoms cause. It can be helpful to consult others in different settings (e.g., friends, spouses, co-workers) to find out whether they see any substantial, ongoing signs of inattention or hyperactivity in those settings.

Have the symptoms been present before age 12?

ADHD is a neurodevelopmental disorder. Therefore, it must have already been present in childhood. Because recall of childhood memories tends to be unreliable, it is important to consider family history very carefully and to find informants or school records to confirm that ADHD caused problems in several different settings (school, home, social situations) before age 12.

Is there an alternative explanation for these symptoms?

This question is perhaps the most important, but also the most difficult to answer.

Sometimes apparent symptoms of ADHD are better explained by another psychological condition or disorder. This other condition may have been with you since childhood. For example, anxiety, stress, depression, and adverse childhood experiences (i.e., family discord, mental health or substance use problems in the family, emotional or physical abuse or neglect of a child) can all cause attention and concentration problems, forgetfulness, impatience and impulsivity both in adults and in children. In those cases, a diagnosis of ADHD would not be helpful, and could in fact be harmful.

Only a very careful clinical assessment can disentangle the cause-and-effect relationships among these symptoms and disorders.

In summary

Symptoms need to be understood in the wider context of the person’s life, rather than just being a shopping list of items to be ticked off. Mental health professionals following best practice guidelines take a very thorough family history and, if possible, seek information from family, friends, significant others, and previous written records (with the client’s informed consent, of course). Therefore, establishing a diagnosis of ADHD with some certainty can be a lengthy and difficult process.

If you think that you have symptoms of ADHD

Don’t jump to conclusions. You may want to start with a well-validated screening questionnaire, such as this. Consider if your symptoms have been present since childhood and whether they are possibly better explained by other problems, such as anxiety, depression, stress, or adverse childhood experiences.

If you think that your experiences fit the diagnosis of ADHD, seek a full assessment from a clinical psychologist or a psychiatrist. Ideally, your mental health professional will follow best practice guidelines to make sure that they do not miss a diagnosis of ADHD, but also that they do not diagnose ADHD when the problems stem from alternative causes, such as anxiety, depression, stress, or early trauma.

Because the most effective treatment for ADHD is stimulant medication, we need to exercise extra caution about potential misdiagnoses. The prescription of stimulants for adults who do not in fact have ADHD can have many far-reaching consequences for the person and society.

References and further reading

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
https://www.tandfonline.com/doi/full/10.1080/13803395.2021.1950640?src=recsys
https://www.tandfonline.com/doi/abs/10.1080/13803395.2021.1923665?journalCode=ncen20
https://www.psychiatrist.com/pcc/psychiatry/adult-adhd-in-the-dsm-era/
https://psychology.org.au/for-the-public/psychology-topics/adhd-in-adults
What’s ADHD and why are more adults being diagnosed with it?

Dr Marianna Szabo is a Clinical Psychologist, a leading expert in Mindfulness and a Senior Lecturer in Psychology at the University of Sydney.

21/07/2022

Brad Phillips In All Articles, Dr Nick Chartres, Nutrition

About those five serves of veg a day you’re not eating

In this opinion piece, Good Mood Dudes founder Dr. Nicholas Chartres provides his view on this article: About those five serves of veg a day you’re not eating

If you’re eating your 5 & 2 each day you’re in the minority in Australia.

But before you beat yourself up, Dr Nicholas Chartres, who conducted the first in-depth study on how industry sponsorship influences nutrition research, and is an expert in identifying and analyzing industry influence in the research process, encourages us to consider the role of government and ‘Big Food’ in all of this.

Here are his 3 takeaways from this story:

– ~6% of Australian adults and ~9% of children eat the recommended two serves of fruit and five serves of vegetables per day. This is actually up from 5.1% in 2014/15 and 4.2% in 2011-12.
– Affordability of buying vegetables is the single greatest barrier to consuming them (despite the unequivocal evidence that the more of them we eat, the lower our risk of dying a premature death from things like heart disease).
– “We need to move away from blaming the individual”.

So, the simple solution??

The government could subsidize farmers/primary producers to reduce the price of fruits and vegetable to consumers, increase their availability and in theory increase consumption (although removing the highly processed foods from our shopping aisles would also need to be addressed, I think to see meaningful change in consumption patterns of fruits and vegetables).

This would then lead to reductions in non-communicable disease risk and early dying, therefore significantly reducing our health care spending without any additional government spending. How?

The government could offset these subsidies by taxing ‘Big Food’ – the companies that reap millions of dollars from making our children sick with highly processed food commodities, that offer no nutritional value and are ubiquitous in our food systems and environment (think sugar-sweetened beverages – which have been taxed successfully in several countries of the world, leading to reduced consumption patterns).

Sounds simple, right?? Why isn’t it happening here?

It is due to the structural influence (economic and political) ‘Big Food’ has on our decision-makers.

However, there is hope. The Australian government led international efforts for cigarette plain packaging and a tobacco tax, which were successful in reducing smoking prevalence. And since obesity has overtaken smoking as the leading cause of premature death and illness in Australia, I think it’s time for government action.

11/07/2022

Brad Phillips In All Articles, Dr Nick Chartres

The US supreme court has declared war on the Earth’s future

In this opinion piece, Good Mood Dudes founder Dr. Nicholas Chartres provides his view on this article: The US supreme court has declared war on the Earth’s future

As an academic working in US environmental science policy, and a father of three children, I was deeply concerned by the Supreme Court of the United States (SCOTUS) opinion in West Virginia vs. EPA that will significantly weaken the US Environmental Protection Agency’s (US EPA) authority to regulate carbon dioxide emissions from power plants (the second-largest source of planet-warming pollution). Let me explain why.

The Case

The original case is about the Clean Power Plan that sought to combat climate change by capping carbon pollution from power plants, a rule developed during the Obama administration. That would have allowed US EPA to use the most effective regulatory tools to address greenhouse gas emissions from power plants – a shift from coal to energy sources that produce fewer emissions. However, in an unprecedented action, the plan was put on hold in 2016 due to pressure from the coal industry.

Congress granted US EPA authority to regulate toxic pollutants through laws like the Clean Air Act (CAA) and Clean Water Act (CWA), which have led to vast improvements in the air and water quality in the US. Such authorities granted by Congress are critical as it gives an expert agency like US EPA the power to address significant and quickly evolving environmental health issues, as and when they arise.

SCOTUS was called to rule on whether the CAA allows US EPA to issue nationwide regulations over the power sector or if the Agency should be limited to regulating changes at individual power plants.

The Court Ruling

In a 6-3 opinion, consisting of the recent conservative Justice appointments made under the Trump Administration, SCOTUS sided with West Virginia and the coal industry in adopting a narrow interpretation of the CAA and rejected the idea that US EPA has the authority to regulate greenhouse gas (GHG) emissions.

SCOTUS ruled that if Congress wanted to give an administrative agency (like EPA) the power to make “decisions of vast economic and political significance,” it must explicitly state this. It did so by applying a doctrine it enshrined into the case law, the “major questions doctrine”. So if the court thinks an agency is overreaching in future cases it can strike down any manner of policies. This reasoning is a concerning departure from traditionally held deference to federal agencies to regulate and develop rules based on their expertise.

In the dissent, Justice Elena Kagan writes “Whatever else this Court may know about, it does not have a clue about how to address climate change…The Court appoints itself—instead of Congress or the expert agency—the decision-maker on climate policy. I cannot think of many things more frightening.”

Why I am so concerned

The precedence this ruling sets is deeply concerning as certain rulemakings across federal agencies like US EPA (along with the financial sector, health care and others) will now need to rely on clear legislative authority to withstand legal challenges, but with a narrowly divided House and Senate, which is in gridlock, these actions seem unlikely.

The most troubling thing for my children and others is that to cut GHG emissions by 50% by 2030 to prevent the catastrophic effects of climate change, we need the US government to have every policy tool at its disposal. Historically they have been the largest contributor to GHG in our atmosphere, and they are now number two only to China. So what they do really matters. This SCOTUS decision now takes one of the most important tools away and has the potential to undermine all federal authority and agency power.

Finally, this damaging court decision once again makes clear the importance of efforts to expose industry tactics and influence on the judicial, executive, and legislative branches of government.

23/06/2022

Tayla Schuit In All Articles, Dr Kieron Rooney, Nutrition

The NOVA Food Classification System Explained

NOVA is a system by which foods (and food products) are classified by their degree of processing and the purpose for processing, into one of four groups. It is not an acronym, it is just a name. So we thankfully don’t have to try and remember what it stands for.

How does NOVA classify foods?

Group 1 represents the unprocessed or minimally processed foods and includes edible parts of plants and animals which are either eaten directly after removal from nature (raw) or have had some minor level of processing performed to make them edible such as roasting, boiling, and pasteurisation.

Group 2 refers to processed culinary ingredients – think oils, syrups, preserves and butter – these are substances obtained from Group 1, but with higher degrees of processing to make products that are used in the kitchen to cook with. The general recommendation then is to make Group 1 foods the basis of your diet using Group 2 foods in small amounts for seasoning and cooking.

As we increase the level of processing towards Groups 3 and 4 however we enter troubled waters.

Group 3 are plain and simple – processed foods. These will be made from a collection of Group 1 and 2 foods. They contain a handful of ingredients but the process employed is for the purpose of increasing the durability and sensory qualities of the Group 1 and 2 foods. Here we are thinking smoked or cured meats, canned fruits and vegetables, cheeses and breads – and for those waiting to see where beer wine and ciders sit – they are right here as products of fermentation.

Group 4 are the ultra-processed products. A subtle note here that the word “food” is intentionally dropped from the group heading by the NOVA creators. These are industrial formulations typically with 5 or more ingredients. The ingredient list might look like there are Group 1 foods present, but they no longer represent anything like the way nature intended. The ingredients list here reads like a who’s who of chemistry’s rich and famous. Additives whose main purpose is to either mimic the qualities of Group 1 foods or to disguise the bitter taste the many “preservatives”, “emulsifiers” and “humectants” (whatever they are!?) that have been packed into the product possess. Some of the more common Group 4 product examples are supermarket breads, breakfast cereals, muesli bars and packet sauces and many of the frozen reheat meal options.

Which groups of foods should we be consuming?

The general recommendation in regard to these groups is to consume Group 3 sparingly. They can be consumed in small amounts and as part of a meal based around Groups 1 and 2 but only on occasion. Group 4 however, are to be avoided. That’s it. Just avoid them.

Can ultra-processed foods be healthy?

The avoidance of processed products is far more easily said than done. For the most part, well over a third of our diet comes from products in this group. And more concerning is that many of the Group 4 products can be found with a healthy-looking 5 stars, low GI, tick of approval! These products are aggressively marketed, displace Group 1 foods from our daily diets and have a huge negative impact on our health. In a recent analysis of over 100,000 French adults, compared to those that reported consuming at least one-fifth of their diet from Group 4, overall cancer risk was increased in those consuming higher amounts of Group 4 products.

Progressively, nutritionists around the world are beginning to re-frame their understanding of healthy diets in the context of NOVA classifications. The good news is, we do not have to completely re-invent wheels here. We can look to a number of very popular dietary patterns in the community today as examples that are fundamentally built on diets of Group 1 and 2 foods.

When Did Eating A Healthy Diet Become So Hard?

According to the Australian Bureau of Statistics, only 1 in every 20 Australians consumes the minimum serving of vegetables per day. While over a third of our diet comes from packaged junk food. Nutrition based public education campaigns don’t work. Sure, most of us know what we are supposed to be doing – 5 serves of vegetables, 2 serves of fruit, some protein but not too much, and go easy on the fats – and so to some extent, the message has got through. But they haven’t worked in affecting change or establishing good routine behaviours.

What does the Government have to say?

Governments, past and present, say it is the individuals’ fault for ignoring some 40 years of public awareness campaigns. More than one former Prime Minister and/or Federal Health Minister have proudly proclaimed that the only person that should tell them what to eat is themselves and Governments have no place in restricting food choices. But it is not the fault of the individual. It is a consequence of the food environment in which education must compete against marketing practices that overwhelm the senses and fatigue even the most committed shopper. Messaging in both public health campaigns and marketing practices seem to be widely varied and misinforming in many cases. With some 2 in every 3 Australians overweight or obese, we need a more authorative and thorough approach to public health messaging than just being told what is good for us.

Why are we all so confused on what to eat?

Over the past 40 years there has been and continues to be a fundamental shift in our understanding of nutritional science. In the early days, a reductionist approach was embraced in which foods were identified by their individual nutrients. Such as, did they contain saturated fat or unsaturated fat? Are they high protein or low protein? The result of this approach was a re-conceptualising of food, not as food. But rather as a vehicle of specific nutrients resulting in what is termed nutrient based criteria. Foods were quickly classified good or bad for you on the basis of perhaps only one ingredient. With the most consumed products being made up of three or more ingredients today, this approach can skew the validity of what is healthy and what is not.

The Health Star Rating System

The popular Health Star Rating System (HSR) is derived from this more reductionist approach. Where the apparent health of a food is determined by an algorithm incorporating component ratios of certain ingredients and correction factors for different food categories. While this system relies on science and a few calculations, in no living system, has the accuracy of the star ratings been tested, examined and shown to be true. Controversially, in some studies where interventions were supposed to improve the health of participants, incidence of disease increased. There are many examples of where the HSR fails to meet its lofty advocacy as a universal indicator for healthy choices. Not least the automatic allocation of 5 stars to fruit juice which the World Health Organisation arguably classifies as a sugar sweetened beverage and recommends we avoid. However, if adequately explained, consumers may still be able to find some use in the HSR.

The Glycemic Index or GI

An alternative approach to understanding the healthfulness of some foods has been to focus on the carbohydrate content, both the quantity and quality. The early steps in this approach saw the creation and development of the glycemic index. In brief, members of the community would be asked to eat small portions of a test food and their blood glucose response would be monitored. On another day an equivalent portion of white bread or some other comparative food would be consumed and the relative difference in blood glucose response would be used to calculate the GI. The general belief being – the lower the GI the healthier it is for you.

Over the past 20 or so years, millions of dollars and hours of effort have gone into validating this tool as an indicator of the healthfulness of a product. At the same time however, shortcomings in the methodology and high variability between individuals has chipped away at confidence in this commonly advocated front of pack label.

What do we do now?

If the two most immediately recognisable and advocated front of pack labels for helping consumers make informed choices are of limited use – where does that leave us? Well one of the first things we need to recognise with approaches such as the HSR and the GI, is that they focus only on some of the components in a product. And not necessarily the food, in the context of our daily lives and how we eat. Food is greater than the sum of its individual parts.

When we look beyond our borders we see a vastly different approach to “dietary guidelines”. For example in Brazil, there is no singling out of saturated fat, carbohydrates or even alcohol. Rather there are steps towards a healthy diet focussing on the avoidance of ultra-processed foods. They encourage planning, developing and sharing cooking skills and eating in social contexts. It is out of Brazil that the NOVA food classification was borne. A system that has both excited nutritional science in providing a whole new scope of data to play with but more importantly has provided community members and public health advocates with a simple enough guide to improving diets – focussing on food processing.

The systems and messaging in place in our modern society that were designed to aid in making healthy lifestyle changes when it comes to our diet are confusing and outdated. The government needs to take a new approach in advocating healthy lifestyle changes, like Brazil’s NOVA classification, where emphasis is put onto advocating for healthy food choices according to food proccessing standards without isolating a particular food group.

Expert Q&A Introducing: Dr Yu Sun Bin

1. Could you tell us a little about your career and areas of expertise/interest?

I work as a research fellow and senior lecturer in sleep and circadian health. My research is focused on how sleep and circadian rhythms affect the health of the community as a whole, and my teaching is focused on raising awareness of how important sleep and circadian rhythms are for health and wellbeing. I am particularly interested in how to promote sleep as a healthy habit; the impact of sleep disorders in pregnancy and in women more generally; and also applying circadian science to reducing jetlag.

2. What drew you to this line of work/research in the first place?

I went to uni thinking I would be a physicist! But I found psychology, particularly the ways of thinking and behaving that we all have in common as humans, more interesting. Since I wanted to focus on the things that people have in common, I was not interested in practicing (clinical) psychology, I was interested in how we can improve health for everyone. This is why I went into further study in public health, because it is all about how the environment we live in affects our health. By environment, I mean all aspects of the environment from our culture, values, and institutions, as well as the built and natural environments.

Sleep is a great example of something we all do and have in common, which is heavily influenced byhow much we value sleep, when we sleep, and who we sleep with. As a society, we are just beginning to realise how cultural changes in technology and work hours negatively affect our sleep, but we haven’t yet found systemic solutions to preserve sleep and our health.

3. How do you look after your own physical and mental wellbeing?

I get enough sleep and try to be realistic about what can be accomplished in one day. I know that if I over-work, I will only need to spend the next day recovering, rather than having gained extra time! I have learned to be more consistent in my work patterns and to try and approach life as one long marathon where I’m NOT in a hurry to get to the end.

4. Do you have a favourite post-workout cafe?

I think that question assumes I work out! I’m not a fan of gym-based exercise, but a big fan of walking everywhere and long walks with my dogs. I find that a coffee beforehand helps with my motivation to start and my ability to keep going; but no caffeine is needed afterwards.

5. What is one thing you wish people knew about wellbeing?

There are no secrets and we’ve known what works for a very long time! For sleep for instance, it’s well documented in the Bible – a text that is thousands of years old – that people knew that sleep deprivation was harmful and understood that insomnia was caused by stress and anxiety. They also understood that alcohol can negatively affect sleep while exercise could improve sleep.

We also have more recent evidence from the late 1890s, more than a century ago now, where people lamented in medical journals that there was more insomnia due to “the busy-ness of modern life” but that same comment is often made today. Neither the problems nor the answers have changed; we just need to be better at implementing those boring old answers and stop looking for panaceas.

6. What is one of the most ridiculous things you’ve read or seen about wellbeing that you know to be untrue?

I try not to repeat things that I know to be untrue. Unfortunately with the way that modern media and social media is designed, commenting on untruths only tends to spread them further!

7. Do you have any favourite books, podcasts or websites on health or wellbeing that you’d recommend?

I think reading books and listening to podcasts you actually enjoy is best for wellbeing! I personally enjoy listening to these podcasts:

No Such Thing as a Fish, in which the QI researchers discuss random facts in a light-hearted fashion
The Junkees , in which comedians Kitty Flanagan and Dave Hughes talk about and taste-test junk food (everything in moderation!)
Swindled, in which an anonymous American narrator with a very dry sense of humour talks about white-collar crimes and institutional and regulatory failures

8. What is your top tip for living a healthy and happy life?

Spend time outdoors! Apart from getting natural light that is essential for quality sleep, there’s also a whole wealth of research that shows that seeing and being surrounded by greenery, sky, and water provides people with a sense of restoration. We don’t know why exactly, but surely 50 million years of primates living and evolving in natural environments has something to do with it!

25/05/2022

Tayla Schuit In All Articles, Dr Yu Sun Bin, Sleep

Research Review: Can We Sleep To Much?

In this article, our expert Dr. Yu Sun Bin reviews: Can People Sleep Too Much? Effects of Extended Sleep Opportunity on Sleep Duration and Timing by Klerman EB, Barbato G, Czeisler CA, Wehr TA.

1) What was the high-level summary of the research?

People cannot sleep ‘too much’. The amount of sleep we get is regulated by the homeostatic and circadian systems which drive us towards a stable amount of sleep, provided we allow enough time for it.

While we cannot sleep too much, we can spend excess time in bed. When given 12-14 hours of opportunity to sleep, healthy people can develop patterns similar to those with insomnia and take longer to fall asleep, wake more often in the middle of the night, and wake too early and be unable to go back to sleep.

2) What did the study try to measure?

The study measured objective sleep using sleep studies. The study assessed whether, when given long periods of time in which to sleep, people could sleep to excess, or if they would reach a stable point with a roughly consistent amount of sleep every night.

3) How was the study undertaken?

The authors of this study analysed data from two of their previous studies.

In Study 1, healthy volunteers were given the opportunity to spend 14-hours in bed per night for 28 days; In Study 2, volunteers were given the opportunity to spend 12-hours in bed for 8 nights, with the addition of a 4-hour window for napping during the day.

Neither study interfered with the sleep of the volunteers, apart from giving instructions that they should try to sleep during those windows of time. Both studies involved volunteers sleeping in research labs so that factors such as work and socialising did not influence how much volunteers slept and when they went to sleep and woke up.

4) What did the study find?

In both studies, volunteers slept more during their first week in the lab – on average, sleeping 2 hours longer than they did at home. However, the differences between volunteers were marked: some did not sleep more at all when given the opportunity, whilst others slept almost 6 hours longer!

After the first week of extended opportunity for sleep, the total sleep time of the volunteers stabilised: on average, people in Study 1 slept 8.6 hours nightly, whilst those in Study 2 slept 8.9 hours on average. However, individual needs for sleep were very different: at one extreme, one volunteer stabilised at 5.2 hours of nightly sleep, whilst at the other extreme, another stabilised at 11.0 hours. These results show that during the first week in the lab, having protected sleep time was important for many of the volunteers to catch up on sleep. However, once they had caught up, their sleep stabilised and they tended to have roughly the same amount of sleep every night. This amount of sleep was unique to them.

Also important to note is that sleep quality decreased for many of the volunteers in these studies – that is, even though the same amount of sleep was achieved, it took them longer to fall asleep, they woke up more often or too early on some nights. However, unlike people with chronic insomnia, these healthy volunteers then made up for this slight sleep loss the next night. This is exactly how sleep is supposed to work as dictated by the sleep homeostatic process which maintains an equilibrium in our sleep/wake cycles.

5) Is there any other research out there that supports these findings or contradicts it?

There is plenty to support it! For example, in large scale epidemiological studies that link long sleep durations (>9 hours) to poor health, the association is no longer seen when existing health conditions are taken into account. This suggests that it is time in bed and poor sleep quality that contributes to poor health, or that poor health contributes to excess time in bed and poor sleep quality.

Similarly, in terms of performance, it is not possible to sleep more to ‘bank’ sleep, but it is possible to reduce existing sleep debt so that you are better protected from any effects of future sleep deprivation.

6) How much weight should we give this research?

This research is highly credible given the supporting evidence. The only thing to keep in mind is that the studies were limited to young people, aged 18 to 36 years, without any health conditions so the expectation of ~8 hours of sleep being average may not be applicable to other age groups and people with existing health conditions.

7) What does this mean for your work/research/industry?

There is often a disconnect and conflict in the sleep field about what advice we give to people with clinically significant insomnia and to the general public at large. The message we try to give to the general public is that typically, people should sleep more to get enough sleep. However, the clinicians who work with insomnia sufferers are unhappy with this message, because spending more time in bed can make insomnia worse.

This study shows that there is a direct connection between those two messages and that they are actually not in conflict. That is, we should all try to sleep enough, for us to be individually well-rested, but avoid spending more time in bed beyond that point, because it only creates poor sleep quality that’s similar to symptoms of insomnia.

8) What’s the key takeaway for us to take from this research?

It isn’t possible to sleep ‘too much’ but it is possible to spend too long in bed. If you spend too long in bed, the quality of your sleep can suffer.

9) Will you be doing anything differently because of this research?

I think this study highlights we should give ourselves the opportunity for enough sleep every night and try to figure out where our equilibrium point of ‘enough sleep’ is. We should then try to protect our sleep time to achieve our required amount of sleep as much as possible.

Dr Yu Sun Bin is an epidemiologist and public health researcher. Her particular research interests are on sleep and circadian rhythms and how these biological systems are reflected in behaviour, health, and disease.