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26/08/2021
Lara Gray
In All Articles, Dr Marianna Szabo, Mental health

The Four Horsemen of the Relationship Apocalypse

Having a happy, supportive romantic relationship is an important source of life satisfaction for most people. However, relationships can also be hard work, and are often a source of frustration and distress. It is no wonder then that nearly half of all marriages end in divorce. But is it possible to know what predicts divorce?

Professor John Gottman at the University of Washington was one of the first psychologists who did so successfully. In several research studies, Gottman and his colleagues observed newlywed couples interacting with each other and followed them up for several years, aiming to find interaction patterns that could predict which couples would stay married and which ones would get divorced within 5-10 years.  

Among the many predictors of divorce he identified, one of the best known is what Gottman called “The Four Horsemen”, referring to the biblical “Four Horsemen of the Apocalypse” bringing destruction. Gottman’s “Four Horsemen” describe four behaviours or emotional reactions during couple conflict. They build on one another and compound each other’s negative effects, leading to a cascade of increasingly hostile interactions and emotional withdrawal from the relationship.

So what are Gottman’s Four Horsemen? 

Criticism

The cascade starts with criticism. It is important to differentiate criticism from a legitimate complaint. In successful relationships, a complaint is expressed in a tactful, respectful way that concentrates on the actual behaviour to be discussed. Criticism, as one of the “Horsemen”, can be identified by harsh, broad statements that attack the whole person. It often starts with “you always…” or “you never…” or “you are so … (selfish, careless, cold, etc)“. Frequent criticism and attacks of this kind can then lead to the appearance of the next “Horseman”: defensiveness. 

Defensiveness

Defensiveness is a common response to criticism. It is not pleasant (and usually not fair) to be attacked in such harsh, broad terms. A partner may therefore respond by denying responsibility or even shifting blame from themselves and counterattacking their partner. Of course, this then can cause their partner to feel that their concerns are not taken seriously, so they intensify their criticism. A cascade of attacks and counterattacks follows, with each partner feeling increasingly frustrated and unsupported. 

Contempt

Repeated criticism of one another and responding to this criticism with defensiveness (such as shifting blame or countercriticism) can lead to a sense of contempt. At this phase of the interaction, a lack of respect is expressed by sarcastic statements about the partner, name calling, eye rolling, mockery, and hostile humour. Gottman suggests that contempt is the most destructive of “The Four Horsemen”. 

Stonewalling

Stonewalling is a response to the first three behaviours. In the middle of a fight, some people stonewall as an instinctive self-protection mechanism. Because they feel psychologically overwhelmed, they need to shut down emotionally or remove themselves from the situation physically. They may stop responding, or they may leave the interaction. In the long term, one or both persons in the couple begin to avoid interacting with the other. Very little communication takes place, and what does take place is either reduced to talking about trivial, “safe” matters or continue to be destructive, peppered with repeated low-level expressions of criticism, counterattacks, and contempt. 

Of course, not all couples who are stuck in such destructive interaction patterns end the relationship. There are many other predictors of relationship dissolution, as well as of staying in unhappy relationships. Nevertheless, if you notice getting engaged in increasingly hostile interactions, it may be a good time to stop and consider whether there is a more helpful way to solve conflicts with your partner. 

Gottman has written several books advising couples who would like to improve their relationship.  Some of these may be helpful: 

Gottman, J.  (1995). Why Marriages Succeed or Fail And How You Can Make Yours Last.

Gottman, J. & DeClaire, J. (2002). The Relationship Cure.  

Gottman, J. & Silver, N. (2015). The Seven Principles for Making Marriage Work.

 

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

19/08/2021
Lara Gray
In All Articles, Dr Kieron Rooney, Exercise, Nutrition

Expert Q&A: Introducing Dr Kieron Rooney

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

My day job entails conducting research and teaching on how what we eat, influences our metabolism. This work includes investigating for example, the influence of lower carbohydrate and higher fat diets in diabetes and obesity as well as on measures of performance in normal healthy individuals. I’ve also completed work on the role of high sugar diets in altering health status and the potential for non-nutritive sweeteners to assist recovery in diets focused on lowering sugar intake. I completed a PhD in Biochemistry in 2003 and since then have been an academic at the University of Sydney.

 

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

To be honest, it was the only thing I was good at at University. I squandered most of my first year enjoying the freedoms that University Student life brought. However, by second and third year I found myself intrigued by metabolic biochemistry and the way in which our entire system is integrated to utilise the energy of food we eat and how our behaviors may change to seek out specific foods. Through the course of my PhD and then academic life, the relationship between what we eat, how we eat it and our health fascinated me.

 

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

I wax and wane. Periods of control and periods of laziness. I like to convince myself it is all by design. But to be honest sometimes I have all the energy in the world to commit to health and sometimes sleeping in, having an extra drink and getting take away feels like the right thing to do. When I am committed, there are 3 – 4, 7km runs a fortnight interspersed with some weights on alternate days and more often than not there are 10-11 home cooked dinners in that fortnight with leftovers for lunches. I typically avoid sugar sweetened beverages, and opt for extra veges over “passenger carbs” like bread and pasta 

 

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

Not really, since most of my runs and weights workouts are at home. But if you are in the Balmain / Birchgrove area The Gladstone Corner store does a great long black.

 

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

It takes a conscious effort to find it, grow it and keep it. And a subconscious effort to lose it.

 

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

That you have to cut the fat off your meat to make it healthy.

 

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

I really enjoyed “the art and science of low carb living” and “The case against sugar” otherwise I am somewhat of an online itinerant.

 

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

Every sugary drink is doing you harm

 

12/08/2021
Lara Gray
In All Articles, Dr Nick Chartres, Nutrition

The Truth About Supplements

Supplements

Supplements are often the first question I get asked about.

The magic bullet that will improve your overall health and wellbeing in one or two (or sometimes 6) tablets a day! There are few, but critically important populations that do need supplements. For example, any woman of reproductive age is recommended to take a multivitamin every day to get sufficient folic acid. Folic acid supplementation reduces the chance of having a baby with neural tube defects. These defects occur very early during gestation, often before a woman knows she is pregnant. 

The main challenge in determining if they work or not is the one size fits all approach. There is A LOT of research done on supplementation. It is a multibillion-dollar industry that benefits from making health claims demonstrating the efficacy and or effectiveness of their products. 

If you think about all of the different supplements out there and all of the different health outcomes they purport to benefit, you are going to find some that have evidence to support their use. For example, if you look at the Cochrane Library Database* that houses the GOLD standard in reviews of the evidence for clinical studies and type in “probiotic” you will see that there are 56 reviews on them spanning topics such as “probiotics for treating eczema” to “probiotics for non‐alcoholic fatty liver disease and/or steatohepatitis”… And you will see there are over 7381 individual trials on them! 

So do they work? Maybe. It depends on what you are trying to measure. 

One of the biggest issues (and sometimes dangers) with recommending supplements is that there is an assumption that a particular naturally occurring vitamin or mineral in food, if taken in isolation and in high doses will lead to better health as we believe we understand the mechanisms by which it works.

Let’s take vitamin A or E as an example. These are antioxidants that combat free radicals. We assume vitamin A or E will reduce the damage to cells caused by free radicals, including damage to our DNA, which may play a role in the development of cancer. Seems logical these vitamins could help reduce cancer. Better load up on antioxidants supplements. 

Well they did just that back in the 1990s and early 2000s with a series of studies that were designed to improve cancer outcomes in high risk groups. 

One study conducted in the 1990’s wanted to test if the health effects of vitamins found in fruits and vegetables, retinol and beta carotene, (think vitamin A), which had been seen to be in higher concentrations in people with lower rates of lung cancer, would be the same when taken as a supplement. 

Over 18,000 men and women at a high risk of developing lung cancer were either assigned a beta-carotene and retinyl  palmitate (vitamin A) supplement taken daily or a placebo. The study was stopped ahead of schedule because participants who were randomly assigned to receive the beta-carotene and Vitamin A were found to have a 28% increase in incidence of lung cancer and a 17% increase in incidence of death compared to the placebo group. 

A second study in 2001 was conducted to determine the long-term effect of vitamin E and selenium on reducing the risk of prostate cancer in approximately 34,000 relatively healthy men >55 years. It was assumed these antioxidants would reduce the risk of cancers in high enough doses. 

Oral selenium and vitamin E was planned to be taken for a follow-up of a minimum of 7 and maximum of 12 years at very high doses. It was found that the risk of prostate cancers in men that were supplemented with vitamin E was 17% greater compared to a placebo (no supplement). In the selenium group there was also an increased risk but it wasn’t statistically significant.

So what does all of this mean?

Both of these studies highlight that caution should be used when recommending or using high doses of vitamins or micronutrients. Naturally occurring dietary constituents (i.e. vitamins and minerals) are part of normal physiology, and either deficiency or excessive doses are harmful. 

It doesn’t mean you shouldn’t adhere to advice given to you by your doctor or dietician if treating a medical condition, but it does show that the assumed benefit of a vitamin or mineral is not always correct when taken in isolation. 

This lack of benefit/potential harm from single antioxidants was later confirmed in 2012 with one of those GOLD standard Cochrane reviews I was talking about before that looked at Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. 

This review included 78 clinical trials with 296,707 participants randomised to antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. They found, wait for it, an increased risk of mortality was associated with beta-carotene and possibly vitamin E and vitamin A, but was not associated with the use of vitamin C or selenium, with absolutely no benefit of antioxidant supplements in the general population or in patients with various diseases.

Ok, but you are really here for me to tell you whether fish oil is good for you or not. Right? Well. 

A recent large Cochrane Review assessed the effects of increased intake of fish and plant-based omega-3 fats on all-cause mortality, cardiovascular events and blood lipids levels, mainly via capsules, as many people believe that taking omega-3 supplements reduces risk of heart disease, stroke and death. 

The review included 86 clinical trials and over 120,000 participants that compared greater omega-3 intake versus lower omega-3 intake for at least a year. The review found that increasing EPA and DHA (omega-3 fats found in fish) had little or no effect on all cause mortality, cardiovascular death, stroke, or heart irregularities.

So, what’s the take away from all this?

Some supplementation is necessary for some people. 

There will be new studies that may change what we know on some of the topics I have shared with you here, and if they do, and the reviews are high quality, without industry funding then the thinking around supplementation may change. But if you’re healthy, and not a female trying to fall pregnant or sexually active and of reproductive age, eat a minimally processed, plant-based diet and you are going to be in good health!

 

* Cochrane Library Database – If you ever want a summary of the evidence on a topic that uses randomized controlled trials to test an intervention, then this is the place to look – and they now give great plain language summaries.

 

​Dr Nick 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.

05/08/2021
Lara Gray
In All Articles, Exercise, Mental health, Nutrition, Simone Chartres, Sleep

The Stages of Change

People know that smoking is bad for their health, but still choose to smoke. People know they ‘should’ go for that run, but still choose to sleep in. People know that the McDonalds drive through is not the healthiest option for dinner, but still use it on a Friday night after work. People are informed and educated around healthy behavioural choices, however still make unhealthy choices. Even when an individual has a serious health scare, they still may not want to change or know how to change the behaviours that have led them to their condition. 

The Transtheoretical Model (Stages of Change) can explain why. 

Social psychological research into dietary change and levels of physical activity are often the forgotten piece in understanding how to promote healthy behavioural change, long term. 

Health Behaviour Models

The contribution of social psychology is now becoming more and more influential in affecting long term dietary and exercise change. The most important contribution has been the advancement and application of various health behaviour models to initiate and promote change.

Some of the most popular models of health behaviour include: the health belief model; social cognitive theory; protection motivation theory; the theory of planned behaviour; and finally, and importantly, the transtheoretical model of change.

The Transtheoretical Model of Change (Stages of Change Model)

Developed by Prochaska and DiClemente, the model’s central concept is that all individuals pass through similar stages of change regardless of the problematic behaviour that they are trying to change.

These stages are:

  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance

With relapse common in the attempt to maintain any new behaviour.

Think of a current behaviour in your life that is potentially unhealthy. It doesn’t need to be anything too sinister; perhaps your partner has been telling you to drink less wine during the week, or you’re staying up past midnight binging on Netflix, or you’ve only exercised once in the past month. Look at each stage outlined below and see if you can identify which stage you are currently in, where you have been, and most importantly, where you would like to be!

Pre-contemplation: This is where a person has little to no awareness that their current behaviour is unhealthy or problematic. People in the pre-contemplation stage have no intention to change their behaviour in the foreseeable future. This is your husband or wife who you have desperately wanted to exercise for the past ten years, and despite your every attempt to change his or her behaviour, they haven’t even walked past the gym!! They’re thinking… “What problem?! It’s not a problem!”

Contemplation: This is where a person is thinking about making a change, but they haven’t yet taken any kind of action. This may have been you before joining the gym. People in contemplation see the advantages and disadvantages of their problematic behaviour… “I know that half a bottle of red wine each night isn’t great for my waist line, but it really helps me to relax once the kids have gone to bed.” Sound familiar?! 

Preparation: This is the third stage where a person shows intent to act and has gone about planning for changing their behaviour. This may have been you when you hired a personal trainer and started arranging for a regular time to be available in your week for exercise. 

Action: Once a person is engaging in their new healthy behaviour, they are in action. For example, doing your first exercise session!! This is also known as the “doing” stage.

Maintenance: Once a person has continued with their new behaviour for 6 months or more, they are in the final stage of change.  

Relapse: A relapse or a ‘lapse’ is a normal part of changing an unhealthy behaviour. A relapse is defined as going back to the problematic behaviour (or worse), whereas as a ‘lapse’ is like a little slip up. The important thing is to learn from any lapses or relapses by identifying the trigger, and then putting strategies in place for preventing another one from occurring in the future. 

As you pass through each identified stage of change, so too does your level of self-efficacy. In other words, once you progress to maintenance (especially if you have been following a detailed program) you will find it easier to identify and overcome any common barriers in the future. Therefore, when you relapse or lapse (which is very normal), you can re-implement your new learnt and healthful behaviours. The goal is to move towards maintenance, while increasing your levels of self-efficacy. 

It is important to note however, that ‘at-risk’ populations are often not prepared for the action stage and will not be served by traditional educational programs. Therefore, helping people set more realistic goals and assisting them in moving towards action with a trained professional is a very important step in this process. Professionals who have the right skills can guide you in changing your thinking and attitudes.

If you have issues with self-worth, or anxiety around changing your behaviour, or perhaps a belief that prevents you from acting, this is completely normal! Seeing a psychologist may be a crucial step for you in changing your problematic behaviour. Psychologists are well trained in dealing with ambivalence. It is very common for people to be ‘stuck’ in the contemplation stage. If this sounds like you, a psychologist can guide you in working through the pros and cons of changing your behaviour and collaborate with you to start preparing for change. 

Take Home Message

Changing life long behaviours and creating new healthy habits can be incredibly difficult. The first and most crucial step to the process is about identifying the behaviours in your life that are problematic. If you believe that you don’t have the ability to change, it is recommended that you seek professional help from a psychologist to guide you in commencing the process of change. Everybody can change a problematic behaviour; you may just have to change your attitude towards the behaviour first!

 

Simone Chartres is an endorsed Clinical Psychologist with the Australian Health Practitioner Regulation Agency (AHPRA). She has over 10 years of clinical experience working with young people and adults with complex presentations in the public and private sector. Simone has extensive clinical experience in the assessment, diagnosis and treatment of anxiety disorders, mood disorders, substance use disorders and eating disorders.

29/07/2021
Lara Gray
In All Articles, Exercise, Jemma McGeachie

Expert Q&A: Introducing Jemma McGeachie

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

I am a Women’s health and Musculoskeletal physiotherapist who has worked for nearly two decades helping people achieve their goals.

My passion is helping women through pregnancy and beyond and also the journey of back pain and how exercise rehabilitation can be the change.

 

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

I was fortunate to work with specialist physiotherapists early in my career both in Sydney and in London, who were truly inspirational.

After the birth of my 3 boys I was extremely passionate about helping women in this space, returning them to work pain free and helping them to reach their exercise goals.

 

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

Habits and routine are so necessary for me. I love pilates which makes it easy to attend and I also enjoy running with my friends. My boys keep me active too!

 

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

Somewhere in the sun with  good coffee and a good friend.

 

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

It can mean something different to everyone! And that’s okay!

 

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

High intensity workouts can damage your joints and weaken your pelvic floor. This is simply untrue!

 

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

I love what Noom is doing with their app. Lots of great tips and tricks based on evidence based psychology on how to achieve health and fitness goals.

 

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

Prioritise yourself first and really work out what makes you feel good. Reward yourself often and smile more. Your brain will believe you are happy if you do!

 

19/07/2021
Lara Gray
In All Articles, Dr Tony Boutagy, Nutrition

Research Review: Diets Rich in Fermented Foods Reduce Inflammation in our Bodies

In this article, our expert Dr Tony Boutagy – reviews Gut-microbiota-targeted diets modulate human immune status   by Wastyk et al. 2021, and breaks it down to give us the vital parts we need to know. 

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

The microbial cells that live in the human gut are collectively called the gut microbiota or microbiome. These cell colonies significantly affect our metabolic and immune health and we know that diet plays a major driving factor in the composition and function of these microbiota.

This study found that a diet rich in fermented foods (things like sauerkraut, cottage cheese, kombucha, miso and kimchi)  enhances the diversity of these gut cells and decreases several markers of inflammation, which are linked to increased risk of chronic disease.

This is the first study to show that we can boost the diversity in these cells and lower certain markers of inflammation by eating a diet rich in fermented foods.

 

2) How was the study undertaken and what did it try to measure? 

This was a clinical trial of 36 healthy adults who were randomly assigned to a 10-week diet that included either fermented or high-fibre foods. The two diets were analysed to examine the potential for different effects on the gut microbiome and the immune system.

 

3) What did the study find? 

Over the course of the 10-week intervention, the researchers observed a decrease in many inflammatory markers in individuals consuming fermented foods and an increase in microbiota diversity. Eating foods such as yogurt, kefir, fermented cottage cheese, kimchi and other fermented vegetables, vegetable brine drinks, and kombucha tea led to an increase in overall microbial diversity, with stronger effects from larger servings

The results suggest that fermented foods may be powerful modulators of the human immune system and may provide an avenue to combat many diseases of modern civilization.

The findings also paint a nuanced picture of the influence of diet on gut microbes and immune status. On one hand, those who increased their consumption of fermented foods showed similar effects on their microbiome diversity and inflammatory markers, consistent with prior research showing that short-term changes in diet can rapidly alter the gut microbiome. On the other hand, the limited change in the microbiome within the high-fibre group supports previous reports of a general resilience of the human microbiome over short time periods, with the researchers speculating that changes in the microbiome may require more than 10-weeks in response to increasing dietary fibre intake.

 

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

It has been known for some time that the microbiota is highly malleable and can be radically reshaped within days to months of certain events, such as when someone migrates to another country, takes antibiotics or changes their dietary habits. 

Previous research has demonstrated that humans living today in industrialised areas have reduced diversity in gut microbiota compared to our ancestors. Studies have also shown reduced diversity in these cells in modern industrialised communities compared to those eating a traditional, non-Western diet, without heavy food processing. 

This is the first study to demonstrate an increase in microbial diversity and lowered inflammation in response to a diet rich in fermented foods. The findings support previous reports that diet is an important modulator of the composition and function of the microbiome, and these changes can occur over a relatively brief period of time.

 

5) How much weight should we give this research?

This study was conducted by a multi-centre team of world leaders in both diet and the microbiome. They used state-of-the-art technologies to examine the composition of the microbiome and several markers of inflammation and found that high-fibre and high-fermented-food consumption influence the microbiome and human biology in distinct ways. While these findings are promising, they need to be further demonstrated in larger studies across diverse populations, 

However, given the fact that our present understanding of low microbiota diversity is associated with many chronic diseases of modern civilisation, such as obesity and diabetes, coupled with the knowledge that high levels of sanitation in industrialised populations has led to reduced microbial diversity, studies like this that show increases in microbial diversity by simply eating fermented food appear to be a simple and user friendly way to improve health.

 

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

There is an immense body of literature that supports the role of fibre in health and lower rates of mortality. Studies also reveal the role dietary fibre plays in supporting gut microbiota diversity and metabolism and the positive role of short-chain fatty acids, a product of fibre fermentation by the gut microbiota, in maintaining gut barrier health and reducing inflammation

Dietary interventions that specifically alter dietary fibre, such as increasing total fibrous carbohydrates, whole grains, and resistant starch have shown impacts on the microbiota along with improvements in numerous health markers.

A recent study found differences in microbiota composition among fermented food consumers versus non-consumers. Given that fermented foods have historically been part of many diets around the world, consuming fermented foods may offer an effective way to reintroduce evolutionarily important interactions. They may also provide a way to rebuild microbes that have been lost over the course of the over sanitising of our modern environment.

Extensive data across the field of gut microbiome science has established that diet is a major driver of the species and functions that reside within an individual’s gut. Poor diet is a known contributor to many diseases of modern culture that are rapidly spreading globally as more populations adopt Western-style diets. Furthermore, many modern diseases are driven by chronic inflammation, an immunological state that is modulated by the gut microbiota.

 

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

This is the first study to demonstrate that eating a diet rich in fermented foods can both improve the diversity of the microbiota and reduce markers of inflammation. This increase in microbial diversity may play an important role in reducing the risk of developing several chronic diseases, such as type II diabetes and obesity.

 

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

I have made a concerted effort to include fermented foods several times a day in both my and my family’s meals. These have included yoghurt, kefir, pickles, sauerkraut, kimchi and cottage cheese. I’m looking forward to exploring more food options that will bring in a greater variety of fermentation to our diets.

 

Tony Boutagy holds a PhD in exercise science, where his primary interest is in body composition and human performance. Dr. Boutagy shares his time between hands-on coaching in Sydney and online education on topics which include health, exercise and lifestyle.

05/07/2021
Lara Gray
In All Articles, Mental health, Simone Chartres

Expert Q&A: Introducing Simone Chartres

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

I’m a Clinical Psychologist and have worked with various mental health presentations. I started out working with homeless adolescents, and have since worked in drug and alcohol rehabilitation, in a phobia clinic, within the area of perinatal mental health, as well as the school setting. I love the variety that a career in psychology brings, however I have a particular interest in working with trauma and anxiety disorders. 

 

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

I’ve always been passionate about people being able to access quality and affordable mental health support. I find human behaviour fascinating and feel so fortunate that I get paid to help people improve their lives!

 

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

Exercise, good food, good coffee and socialising!

 

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

Anywhere with outdoor seating and the smell of the ocean!

 

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

There is no quick fix or magic pill! It’s about a lifestyle and slowly making positive changes that you can maintain.

 

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

During my Clinical Masters training I was fortunate enough to do a placement at Royal North Shore Hospital Pain Management Clinic.  It was incredible. The patients came in with chronic pain that they had been suffering from for years. They were all on a cocktail of drugs, but still in pain. They completed a 6 week course with a team of psychologists, physios and doctors, and walked out on no drugs and pain that they were able to manage. Opioids do not work for managing chronic pain, despite what the pharmaceutical companies try to tell us!

 

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

I love listening to Conversations with Richard Fidler and Sarah Kanowski. It always reminds me of how interesting humans are and the incredible things that people have survived. Often when we are anxious we are stuck in our minds thinking about ourselves. Taking the time to listen to the life of someone else can be incredibly healthy for your own wellbeing.

 

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

Build self awareness and be able to recognise when a behaviour is more hindering than helpful. And stay connected to other people!

 

01/07/2021
Lara Gray
In All Articles, Dr Tony Boutagy, Exercise, Sleep

Research Review: Why Sleep is Critical for a Healthy Body Composition

In this article, our expert Dr Tony Boutagy – reviews The effect of acute sleep deprivation on skeletal muscle protein synthesis and the hormonal environment by Séverine Lamon et al. 2021, and breaks it down to give us the vital parts we need to know. 

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

A single night of sleep deprivation can induce considerable effects on, muscle breakdown (catabolism) – by causing a significant reduction in both muscle growth by 18% and the growth (anabolic) hormone testosterone by 24%. Further, the researchers found that the muscle breakdown (catabolic) stress hormone cortisol increased by 21%. 

The findings of this study provide the support for long-term observations that show that a reduction in sleep has negative consequences on body composition.

 

2) What did the study try to measure?

Inadequate sleep duration has been demonstrated in several studies to negatively impact numerous aspects of health, especially metabolism and brain function. 

For example, short sleep impairs how well you can control your blood glucose and increases the risk of developing type II diabetes while also reducing cognitive function and mental performance. 

Research has also demonstrated  poor body composition – increased fat mass and decreased muscle mass – in those individuals who sleep less than 6 hours per night. 

Human muscle is in a constant state of breaking down and rebuilding. If rebuilding occurs to a greater magnitude than the rate of breakdown, then we gain muscle tissue over time. Periods of marked inactivity or bed rest cause breakdown to exceed the rebuilding process, and the loss of muscle mass follows. 

To measure the short-term flux (breakdown vs. rebuilding) of muscle protein balance, researchers can examine the synthesis of new muscle proteins in response to a variety of interventions, such as exercise modes, food types and in this instance, sleep deprivation. 

This study aimed to explore the mechanisms that can cause the negative change in body composition observed in those who experience short duration sleep by investigating the effect of sleep deprivation on muscle mass. 

In addition to measuring the synthesis of muscle proteins in response to sleep deprivation, the researchers also examined the levels of the growth hormone, testosterone and the muscle breakdown (catabolic) stress hormone, cortisol.

 

3) How was the study undertaken?

Thirteen young adults who were sleeping on average 7 hours per night were studied under two conditions: (1) a full, normal night of sleep and (2) complete sleep deprivation. The sleep environment, temperature and provided food were all carefully controlled. The next day after both sleep conditions, small biopsies of muscle were taken, and blood was drawn to examine markers of protein synthesis and hormones.

 

4) What did the study find? 

This study found that one night of complete sleep deprivation resulted in an 18% reduction in muscle protein synthesis and this was accompanied by a decline of 24% in the growth (anabolic) hormone testosterone and a 21% elevation in the break down (catabolic) stress hormone cortisol.

 

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

This study provides the actual mechanism behind the well-known observations that short sleep duration results in poor quality body composition. Previous investigations have observed reductions in muscle mass and testosterone and increases in cortisol with sleep restriction, and this study found the same using a model of complete sleep deprivation.

 

6) How much weight should we give this research?

This study used complete sleep deprivation as the intervention. Care should be given when attempting to extrapolate these results directly to those who have slept less than the recommended 7.5 to 9 hours per night. However, the results support previous research that has demonstrated reductions in muscle mass and an increase in fat mass when sleeping less than 6 hours per night. 

The protocols and methods used in this study provide what is considered to be the ‘gold standard’ level of evidence for providing a link between lack of sleep and muscle turnover, along with the hormones involved in this regulation. As such, we should take the results of this study seriously with respect to the lack of sleep and muscle health.

 

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

Often viewed as unimportant and wasted time, sleep has been demonstrated to play an extremely important role in maintaining our brain, metabolic and cardiovascular health. Studies like this one show how important sleep is to the quality of our muscle mass. 

 

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

Far from being wasted time, sleep duration should be a priority for those who consider muscle mass, and health in general, important. But don’t fear if you go through periods of your life when you are sleep deprived, such as raising small children or working hard to meet project deadlines. Just understand that over the long term in order to maintain a healthy body composition as you age, you must prioritise your sleep.

 

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

No! I already knew how important sleep is to every aspect of our health and do my best to maintain a routine of an 8-hour sleep opportunity and a regular sleep-wake cycle every day, or as best as I can with 3 young children!

 

Tony Boutagy holds a PhD in exercise science, where his primary interest is in body composition and human performance. Dr. Boutagy shares his time between hands-on coaching in Sydney and online education on topics which include health, exercise and lifestyle.

17/06/2021
Lara Gray
In All Articles, Dr Marianna Szabo, Mental health

Expert Q&A: Introducing Dr Marianna Szabo

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

I have a double BA degree in Psychology and in Theatre and Film Studies from the University of New South Wales. I graduated in 1998 with 1st Class Honours in Psychology, the Australian Psychology Society Prize for best performance in Honours, and the University Medal for Highly Distinguished Academic Merit. 

I continued at UNSW and gained a Master of Clinical Psychology and a PhD degree in 2003. My PhD research investigated worry and anxiety in both adults and children. It established my life-long interest in understanding anxiety disorders and a desire to help those who live with these often disabling conditions.

In 2003 I took up an academic position as a lecturer in the School of Psychology at the University of Sydney. At about this time I also developed an interest in mindfulness and other types of meditative, contemplative practices. My teaching and research have primarily focussed on anxiety, depression, stress, stress-related coping behaviours, and mindfulness. My research has been reported in more than 50 international publications and conference presentations.

In addition to my academic work, I have a private clinical practice in Sydney. My main approach to treatment is Cognitive Behaviour Therapy (CBT), known to be the ‘gold standard’ for the treatment of most psychological problems. I am also very interested in the practice of Schema Therapy, an approach that seeks to understand a person’s long-term patterns of behaviour and to achieve lasting change via the emotional processing of adverse early experiences. 

 

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

Anxiety is such a common experience, being able to know when it is helpful and when it is harmful is a very important aspect of being able to help people.  In term of therapy, I was naturally drawn to mindfulness and schema therapy, as they both provide an additional depth to working from a CBT background.

 

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

After I was diagnosed with a chronic pain disorder, I realised that I had not been following the advice I often give to my clients. Since then, I have made a commitment to making my health an absolute priority, working less, spending more time resting, sleeping well, and enjoying a state of calm.

 

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

I’m not usually hungry after a workout and have no desire to go to a cafe. I tend to walk home from the gym or the park after my workout and enjoy the feeling of elation I get from physical activity.

 

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

Achieving more and more while not caring for yourself will be detrimental for your wellbeing. 

Caring for others more and more while not caring for yourself will be detrimental for your wellbeing. (These are two things, but they tend to be the two main things that lead people to burnout.)

 

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

Too many to mention. Sadly, the number of conspiracy theories and anti-science messages grew exponentially during the COVID-19 pandemic. It is disheartening to see so many of these on social media.

 

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

I really like listening to anything by Dr Norman Swan.

 

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

Make your health a priority, and build positive, supportive relationships. Start today.

 

10/06/2021
Lara Gray
In All Articles, Dr Kate Edwards, Nutrition

Research Review: The Impact of Fruit and Vegetable Intake on Perceived Stress

In this article, our expert Dr Kate Edwards – Associate Professor in Exercise and Sport Science at the University of Sydney – reviews Fruit and vegetable intake is inversely associated with perceived stress across the adult lifespan by Radavelli-Bagatini et al. 2021, and breaks it down to give us the vital parts we need to know. 

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

The study found that reported perceived stress levels were associated with fruit and vegetable intake in adult Australians, with those people eating the most fruit and vegetables (>473g/day) reporting lower perceived stress than those eating the least (≤243 g/day). The World Health Organisation recommends eating 400g/day of fruit and vegetables. When looking at the effect across the different age groups,  it was found that the positive associations were greatest in adults between the ages of ≥45-<65 years.

 

2) How was the study undertaken & what was it trying to measure? 

The data came from a large study, the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. AusDiab is a national population-based survey of Australian adults aged ≥25 years, recruited in 1999–2000 (AusDiab1), they also included data from the 5-year follow up in 2004-2005. This study included 8689 adults at baseline and 5031 at 5 years follow up.

 

3) What did the study find? 

First the study looked at the cross-sectional association (looking at the data at a single time point) and found that fruit and vegetable intake was associated with perceived stress. They then added into their model other factors that might also be associated with stress and that could attenuate the effects, like overall energy intake, physical activity, smoking, age, sex, BMI, relationship status, socio-economic index and chronic disease. Even accounting for all those factors, fruit and vegetable intake was still associated with perceived stress. Interestingly, when they looked at the change in fruit and vegetable intake over time, perceived stress was not associated, which the authors suggest means that fruit and vegetables might reduce perceived stress rather than stress leading to reduced fruit and vegetable intake.

 

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

This data is similar in findings to other studies but is much more representative of the whole population. Prior studies have found similar associations in pregnant women and students and have included smaller numbers of people. The data is 20 years old, but Australian Bureau of Statistics suggests there has been little change in fruit and vegetable intake between 2007-2018.

 

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

Public health messaging about fruit and vegetable consumption might be well targeted to middle-aged adults, as the association between perceived stress and fruit and vegetable intake was strongest in that group, and if the effect can be confirmed the messaging of anti-stress effects could be powerful.

 

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

This study suggests accounting for diet and in particular fruit and vegetable intake in stress research is important, and suggests that work examining the effect of diet interventions should be considered.