Health Check: do you really need carbs to recover from exercise?

By Jackson Fyfe, Victoria University and Jon Bartlett, Victoria University

Carbohydrate-rich diets are often recommended as part of exercise regimes to promote recovery and maximise performance. But recent research suggesting such foods may not help exercise recovery and their potential link with metabolic diseases are raising questions about whether this advice is still appropriate.

The energy status of exercising muscles has been thought to be an important element in exercise performance since the late 1960s. As carbohydrate is the preferred energy source for muscle contraction during moderate–to-high intensity exercise, typical sports nutrition guidelines advocate eating carbohydrate-rich food before, during and after exercise to maximise performance.

Such guidelines, which are mainly for professional athletes, suggest consuming just over one gram of carbohydrate for every kilogram of your body mass, each hour for four hours, to maximise replenishment. But is a high carbohydrate intake really required to maximise exercise recovery? And is it appropriate for people who aren’t overly concerned with competitive performance?

Performance vs recovery

Before exploring these questions, it’s important to distinguish between exercise recovery and performance.

Recovery describes the processes within muscles that are stimulated by the stress of exercise sessions. These processes accumulate and eventually result in increased endurance and muscle growth. Adaptations like these improve the body’s ability to cope with future exercise stress.

Exercise performance, on the other hand, relates to the ability to perform exercise at a desired intensity and duration.

Nutrition plays a role in both, and the quality of recovery can affect future exercise performance. But nutritional recommendations for performance may not be ideal for promoting recovery in all instances.

Carbohydrates and endurance training

Although the beneficial role of carbohydrates for improving exercise performance is widely accepted, researchers have recently observed that restricting carbohydrate intake close to endurance training sessions might actually help muscle recovery. They found reducing carbohydrate availability (by either an overnight fast or restricting carbohydrate intake close to exercise sessions) may help promote early recovery, possibly leading to long-term improvements in endurance.

Several studies show that high carbohydrate intakes can suppress the activation of several genes linked to exercise adaptations. Our recent research shows it’s possible to complete two sessions of high-intensity interval exercise separated by up to 12 hours of carbohydrate restriction. We also found early recovery is more likely when exercise is performed with low carbohydrate availability.

Eating large amounts of carbohydrate during early recovery may also be counterproductive for achieving fat loss. We found restricting carbohydrates during recovery from exercise increased fat metabolism and decreased carbohydrate metabolism. In fact, approximately three times more fat was used when carbohydrate intake was restricted during exercise recovery.

Given that many of us exercise to lose weight, consuming carbohydrates before and after exercise may be doing more harm than good!

Carbohydrates and resistance exercise

But what about the role of carbohydrates for recovery from resistance exercise, which includes lifting weights or performing bodyweight-type exercises with the goal of increasing muscle mass and strength?

Consuming protein when doing this kind of exercise is known to benefit muscle growth. High carbohydrate intakes have traditionally been recommended to support resistance exercise performance and recovery.

But several studies now show that carbohydrates don’t further benefit recovery processes after resistance exercise compared to protein alone.

What’s more, performing resistance exercise when muscle carbohydrate stores are low also doesn’t compromise early recovery. Taken together, this suggests dietary carbohydrate plays little to no role in recovery from resistance exercise.

Another common belief is that people doing resistance training need extra energy intake (in other words, to eat more) to increase muscle mass. And one way of increasing energy intake is to increase the carbohydrate consumption. There’s no evidence for this belief but research does show muscle recovery after resistance exercise is promoted by protein, even when the person exercising is in energy deficit.

Potential health risks

Not only do the dietary recommendations for increasing carbohydrate consumption for better exercise recovery not apply for the non-athlete exerciser, they are actually a cause for concern. Carbohydrates have a potential role in the development of metabolic diseases, including type 2 diabetes and obesity.

Consuming a lot of carbohydrate-rich food is thought to over-stimulate the hormone insulin by causing chronically high blood sugar levels. One of the many roles of insulin is blocking the use of fats as a fuel source. At the same time, insulin promotes the storage of excess carbohydrate as fat and reduces the body’s ability to control blood sugar levels.

For recreationally active people whose exercise goals are often to improve general health and body composition – reduce fat mass and increase muscle mass – eating a high-carbohydrate diet may actually have the opposite result.

This article was originally published on The Conversation.
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The best cure for many ailments is always in our natural surroundings—plants. And, you would be hard-pressed to find a fruit with such a magical wand as durian. Yet it remains a mystery. A mystery because here is a plant that has been with humans since time immemorial, enjoyed for millions of years by natives of India, Thailand, Indonesia, Malaysia and Brunei, among other south-east Asian countries, without an inkling to its medical wonders.

For instance, Palita Subasinghe, a Sri Lankan, says in response to one of the stories about Durian. “We in Sri Lanka have been eating this fruit, probably for centuries, not knowing that it is a cure for cancer. However, I have been told that our Ayurvedic doctors are incorporating it in their decoctions for cancer cure. I have used it very successfully for getting rid of urinary stones.”

But first things first.

Durian is like a smaller version of jack fruit (ffene). It has a hard outer husk covered with sharp, prickly thorns. The colour of the husk is green to brown. Its shape ranges from oval to round.

The size of the fruit can be as large as 30 centimetres and weighs one to three kilogrammes. Its flesh is pale-yellow, which tastes as a mixture of banana, butterscotch, vanilla, peach, pineapple, strawberry and almond with a surprising twist of garlic.

The durian is a Graviola tree tropical in origin.

A hit in a WordWeb, a computer dictionary, returned the meaning: “Huge fruit native to southeastern Asia ‘smelling like Hell and tasting like Heaven.’

Now that is some description, huh? And it holds. Durian emits a pungent odour even when the husk is intact that some people reject it solely on that reason. But to others, the fruit’s smell is a pleasantly sweet fragrance. But the fruit is delicious, soft, succulent and very popular for its unique characteristics. It’s widely referred to as the “king of fruits” in the south-East Asian countries.

In Rwanda, it is rarely grown but in some parts like Nyamata, and Gitarama are grown. The Asian communities across East Africa are known to grow the Durian. For instance, at a Catholic Parish in Uganda where one of Healthy Times’ team members served as an altar boy, durian trees were planted in the gardens.

The medical wonder fruit

Medical research shows that with extracts from this miraculous tree it now may be possible to:

Attack cancer safely and effectively with an all-natural therapy that does not cause extreme nausea, weight loss and hair loss

Protect your immune system and avoid deadly infections

Feel stronger and healthier throughout the course of the treatment

Boost your energy and improve your outlook on life

Effectively target and kill malignant cells in 12 types of cancer, including colon, breast, prostate, lung and pancreatic cancer.

The tree compounds proved to be up to 10,000 times stronger in slowing the growth of cancer cells than Adriamycin, a commonly used chemotherapeutic drug.

Unlike chemotherapy, the compound extracted from the Graviola tree selectively hunts down and kills only cancer cells, it does not harm healthy cells.

Several online sources indicate that extracts from durian tree effectively target and kill malignant cells in 12 types of cancer, including colon, breast, prostate, lung and pancreatic cancer.

However, Dr Fidel Rubagumya, from Butaro Cancer Centre, while admitting that durian contains antioxidants that has given rise to the wide belief that they can prevent cancers, there is no proven evidence so far to back up the claims.

“There are some studies that have been done to investigate whether the antioxidants really can be used as primary prevention for cancers. So far, nine studies that have been done but they all conclude with no evidence of these antioxidants being primary prevention for cancer, so basically there no results yet,” Dr Rubagumya says.

He says the antioxidants can prevent several diseases in the body but that most of the antioxidants that are used to heal cancers are chemically purified and not derived from the foods directly.

Alexis Mucumbitsi, the in-charge of nutrition at the Ministry of Health, says all the antioxidants that reduce oxidative stress on the organs of the body are bonuses to the immune system, and durian is packed with them, including vitamin-C, vitamin-B complex, and vitamin E, as well as phytonutrients that battle cancerous cells.

This article was originally published on The New Times Rwanda

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Explainer: what's the difference between an outbreak and an epidemic?

By Arinjay Banerjee, University of Saskatchewan

More than 8,000 people have died from Ebola in West Africa since February 2014 and it has spread beyond the three countries initially affected. So, it’s an epidemic, right? Or is it an outbreak?

What about H1N1? The 2009 pandemic infected people around the world. But, so did the SARS epidemic in 2003. What’s the difference between an epidemic and pandemic? What about diseases like malaria and Dengue? Dengue fever infects between 50 and 100 million people each year in countries all over the world. So that’s the same thing as a pandemic? Not quite. Maybe you’ve seen headlines about West Nile Virus, Chikungunya fever or Middle East Respiratory Syndrome. And what are emerging and reemerging diseases?

It’s time to brush up on the vocabulary that can help you understand just what infectious disease experts are trying to tell us.

Outbreaks, epidemics and pandemics

An outbreak is the sudden occurrence of a disease in a community, which has never experienced the disease before or when cases of that disease occur in numbers greater than expected in a defined area. The current Ebola scenario in West Africa started as an outbreak, which initially affected three countries.

So what exactly is an epidemic? It is an occurrence of a group of illnesses of similar nature and derived from a common source, in excess of what would be normally expected in a community or region. A classic example of an epidemic would be Severe Acute Respiratory Syndrome (SARS). The epidemic killed about 774 people out of 8,098 that were infected. It started as an outbreak in Asia and then spread to two dozen countries and took the form of an epidemic. The same is true for Ebola, which is now being termed an epidemic.

A pandemic on the other hand refers to a worldwide epidemic, which could have started off as outbreak, escalated to the level of an epidemic and eventually spread to a number of countries across continents. The 2009 flu pandemic is a good example. Between the period of April 2009 and August 2010, there were approximately 18,449 deaths in over 214 countries. The flu virus (H1N1) probably originated in Mexico and within two months, sustained human-to-human transmission in several countries on different continents was reported, prompting the WHO to announce the highest alert level (phase 6, pandemic) on June 12, 2009.

Endemic diseases

Some diseases can remain active in a given area for years and years. A disease is described as endemic when it is habitually present within a given geographic area. For example, Dengue, which is spread by mosquitoes, is endemic in more than 100 countries. So why isn’t dengue considered a pandemic yet? The point to consider here is that the dengue cases are not from a common source. Mosquitoes do not fly beyond a few hundred meters, so the cases in each country are from a different source. Rotavirus-induced infant diarrhea is another example of an endemic disease, which is rampant in developing countries.

Emerging and reemerging diseases

We also come across words like “emerging” and “re-emerging.” An emerging disease is one that has appeared in a population for the first time or one which may have existed before, but is rapidly increasing in incidence. Examples of emerging infectious diseases are SARS, HIV and H1N1.

Despite advances made in the field of medicine, global travel has added to the complexity of controlling infectious diseases. Both the 2003 SARS epidemic and the 2009 H1N1 pandemic were spread to a large extent due to air travel.

Chikungunya is another viral disease that is emerging in the Western Hemisphere. The first known cases in the Western Hemisphere occurred around October 2013 among residents of the French side of St. Martin in the Caribbean. WHO confirmed more than 31,000 probable and confirmed cases, which were not imported but indigenous in nature, from numerous other Caribbean islands as of April 2014.

Middle East Respiratory Syndrome (MERS) emerged around April 2012 and has affected countries in the Middle East, Europe, Africa, Asia and North America, with 945 human cases, including 348 deaths as of January 6, 2015.

Reemerging diseases are those that have historically infected humans, but continue to appear in new locations or reappear after apparent control or elimination. Most of the reemerging disease agents appeared long ago and have survived and persisted in the environment. A classic example is the West Nile virus (WNV). It is thought that WNV arrived in the United States via an infected traveler, bird or mosquito, which entered America through air travel from the Middle East.

Why bother?

Although people use terms like outbreak and epidemic interchangeably, it would only be fair to understand the definitive meaning behind each word. An outbreak can take the form of an epidemic and eventually a pandemic, but that does not entitle us to use these words incorrectly.

This article was originally published on The Conversation.
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Explainer: why must some medications be taken with food?

By Janet Sluggett, University of South Australia

Have you ever been advised to take a medicine with food? How about taking a medicine with cola or avoiding grapefruit?

Hundreds of medicines have food-related dosing instructions. With four out of five Australians aged above 50 taking daily medication, most people will encounter instructions about medicines and food at some point in their lives – some of which may seem rather strange.

If a medicine isn’t taken as recommended with respect to food, the medicine may not have an effect. Worse, it could lead to side effects. The timing of the meal, the size of the meal, and the types of food and drinks consumed can all affect the body’s response to a medicine.

Absorption of medicines from the gut

Eating food triggers multiple physiological changes, including increased blood flow to the gut, the release of bile, and changes in the pH (acidity) and motility of the gut. These physiological changes can affect the amount of medicine absorbed from the gut into the bloodstream, which can then impact on the body’s response to a medicine.

Certain medicines are recommended to be given with food because the physiological changes after eating can increase the amount of medicine absorbed by the body. Itraconazole capsules (used to treat certain fungal infections), for instance, should be taken with food, and in some cases acidic drinks such as cola, because this product needs an acidic environment to be absorbed.

In other cases, changes in gut secretions and the digestive process can reduce the effectiveness of a medicine. Certain antibiotics, such as phenoxymethylpenicillin (also known as penicillin V), are best taken on an empty stomach as they can be less effective after prolonged exposure to acidic conditions.

Food can act as a physical barrier to the surface of the gut wall and prevent certain medicines being absorbed into the bloodstream.

Specific components of food, such as calcium or iron, may also bind to certain medicines. This can reduce absorption into the bloodstream, and lead to reduced effectiveness. For this reason, osteoporosis medicines risedronate and alendronate must be taken on an empty stomach with water only.

Taking certain medicines with food can reduce the risk of side effects. Diabetes medicines such as gliclazide or glimepiride (belonging to the group of medicines known as sulfonylureas), for example, should be taken with food to reduce the risk of low blood sugar.

Taking medicines such as ibuprofen (for pain and inflammation) or metformin (for diabetes) with food is also recommended to reduce nausea and stomach upset.

Does size really matter?

The relationship between meal size and medicine effect has not been widely studied. If you need to take a medicine with food and it’s not mealtime, sometimes a snack is enough. But for some medicines, the size of the meal is important. Orlistat, for example, reduces the absorption of fats from food to assist weight loss, so it’s important to take this medicine with main meals for optimal effect.

Meal composition can also be important. Eating foods high in fibre, protein or fat can impact on the absorption of some medicines.

Drinks such as tea, coffee, milk and fruit juice can also affect the way certain medicines act in the body.

Dairy products should be avoided within two hours of taking antibiotics such as ciprofloxacin or norfloxacin, however they can be eaten at other times.

You may need to avoid grapefruit altogether as it can interfere with the metabolism (processing) of certain medicines in the body, leading to side effects.

Medicine labels demystified

Check medicine labels carefully for advice about food or drinks. Unless otherwise advised, tablets or capsules should be swallowed with water.

If the label states “take with or after food”, it means the medicine should be taken during the meal, or within half an hour of eating.

To take a medicine “on an empty stomach”, check you have not eaten in the past two hours, and wait at least half an hour after taking the medicine before eating again, unless the label states otherwise.

Finally, it’s important to take medicines at the same time each day and be consistent with respect to food and drinks.

If you have specific questions about taking medicines with food, ask your pharmacist for further advice, check the consumer medicines information (CMI) for each medicine, or call Medicines Line on 1300 633 424.

This article was originally published on The Conversation.
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Producing medicines in Africa will only work if they can be distributed properly

By Julius Mugwagwa, The Open University

A parliamentary bill proposing that the UK allocate 0.7% of its GDP for international aid has led to the usual criticism levelled against international aid: that in times of austerity, the country can’t afford to spend money helping others overseas, let alone setting a mandatory amount. In times like this, however, no-one in their right mind would argue against better or more effective spending of international aid funds, something that has been called for before.

When it comes to health in developing countries, various UK aid agencies, including the Department for International Development and UKAID, a coalition of British NGOs, have for many years been at the forefront of efforts to strengthen health delivery systems. The House of Commons’ international development committee recently published the results of an inquiry into how DfID’s activities in this area could be made more effective. The inquiry noted that while progress had been made, spurred on by the Millennium Development Goals, more still needed to be done to ensure efficiency, tackle growing challenges such as non-communicable diseases and move countries towards self-sufficiency.

Our development and policy group at The Open University has been working on how the best outcome can be achieved from available resources. In one project we’ve focusing on two developing countries – South Africa and Zimbabwe – to see how and where money should be more effectively spent in health. One particular issue is access to medicines, which relies on both supply and distribution to work well. But which should come first when it comes to health spend?

Doing things locally

We looked at the role that companies and producers of medicines from, or based in, these countries can play in providing safe, efficient, affordable and high-quality medicines and other health products.

As in many other nations, healthcare systems in African countries such as South Africa and Zimbabwe are facing sustained pressure from changing regulations and an influx of patients demanding the same or better-quality care, at the same time as rising concerns about the cost, timeliness and adequacy of medicines supplied by multinational companies. At present up to about 70% of Africa’s need for medicines is covered by imports. It’s worth noting that, although the continent has 14% of the world’s population, Africa produces only 3% of the world’s medicines.

There are arguments therefore that if health system targets are to be met in Africa – and to satisfy the envisaged growth in the African medicines market – a good place for aid agencies and others with money to invest to start is on strengthening the capacity of local producers of medicines and health products. Some argue, however, that “health dollars” would be better spent on strengthening logistics and delivery systems to ensure that the medicines, whether produced locally or imported, can be more efficiently brought to hospitals, clinics and other outlets.

As one supply chain specialist based in Africa noted, we shouldn’t lose sight of the fact that it is expensive to set up and sustain manufacturing plants. The challenges in taking this route include dealing with heavy taxation, lack of access to inputs and raw materials, strong competition from foreign manufacturers and the lack of research and development. Also, in the absence of guaranteed local markets of sufficient size and good distribution services, the benefits of producing medicines locally may not be realised.

Distribution matters

The majority of developing countries face a number of unchanging health system and logistical weaknesses which constrain the extent to which health products can be brought to patients, or patients brought to health products. For example, South Africa and Zimbabwe have faced challenges when it comes to getting all deserving patients on HIV/AIDS treatment programmes, because some of the people are in hard-to-reach rural or farming areas – and because there is a shortage of doctors to prescribe medication and nurses to attend patients.

So there is debate about where the money should go first. For the current Ebola pandemic in West Africa, for example, an effective cure – whether produced locally or imported – would have saved lives, but would have hinged on healthcare and wider system preparedness (which unfortunately is missing in the affected countries). So regardless of where the products are coming from, what is indispensable is a “GDP” or a “good distribution practice” – and that’s where the first money should go.

Others argue instead that resource-poor African countries should give priority to strengthening their regulatory and governance systems, which would result in local pharmaceutical manufacturing having the desired positive impact on health system performance, equity, affordability and low-cost access to medicines and other medical products.

A number of countries in Africa have had pharmaceutical manufacturing activities for a long time, some dating as far back as the 1930s, yet some long-standing local pharmaceutical companies are ceasing operations (for example CAPS Pvt Ltd in Zimbabwe) while others are losing market share. The void they are leaving is easily being filled by products from India or China, leaving one to wonder whether local pharmaceutical production will have an impact that goes beyond saving factory worker jobs.

Keeping up with production costs is proving difficult, especially with outdated equipment and the compounding reality that, for many companies, their product range requires them to buy active pharmaceutical ingredients (and other key medicine components) from competitors in India and China.

How African countries will meet their needs for medicines, especially medicines that big multinational companies may not consider profitable, is a daunting challenge. Aid agencies have played – and continue to play – big and decisive roles in the supply of medicines to patients in Africa, through financial resources during emergencies or through programmes to strengthen the health system. But driven by local realities and experiences, new thinking and innovations in the way medicines are distributed may well be what African countries need most urgently.

When this is working properly, local manufacturers may well be able to then leap back into producing medicines locally – and crucially, be in a better position to compete.

This article was originally published on The Conversation.
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Health Check: do ice cream and cold drinks cool us down?

By Peter Poortvliet, The University of Queensland

All over the world summer is synonymous with water activities, cold beverages and, of course, ice cream. While most of us agree ice cream and cold beverages are refreshing summer treats, do they actually help cool us down?

To test whether they do, we need to know a bit more about how the body controls temperature in different environments. The process of maintaining an optimal body temperature is called thermoregulation, which involves a delicate balance between producing and losing heat.

Humans are warm-blooded or endotherms, which are scientific ways of saying we can control our body temperature independent of the environment. We can do this because our bodies are constantly producing heat as a by-product of internal chemical processes (metabolism).

How it all works

Metabolism is necessary to keep our bodies functioning correctly. It includes digestive processes involved in breaking down nutrients in food, the absorption and transportation of those nutrients to the cells, and their conversion into building blocks or energy necessary for physical activity.

The heat this generates is beneficial when it’s cold, but when outside temperatures rise, we need to avoid overheating. While it may seem logical that introducing something cold, like ice cream, into the stomach should help reduce temperature, its initial cooling effect is rapidly replaced by heat generated by digestive processes needed to break down the nutrients in ice cream. Digesting calorie-rich food leads to an increase in body temperature.

So ice cream is not the best option for cooling down, but what about cold beverages? The heat transfer between a cold beverage and the digestive system can directly influence temperature. But, this is only momentary and depends on the quantity and caloric content of the ingested liquid.

A small amount of liquid will lose its cooling effect quite quickly as it gets warmed up by the surrounding organs. And large amounts of cold liquids will cause blood flow to slow, making heat transport less effective.

As you can imagine, beverages with a high caloric content, such as soft drinks, will have a similar effect as ice cream and kick start our metabolism shortly after ingestion.

But I feel cooler…

The cooling effects of cold liquids are more likely explained by their rehydration effects. If heat does build up, the body will attempt to lose excess heat by transporting it away from the vital organs to the skin surface where it is transferred directly to our environment through convection and radiation.

For this to occur, the ambient temperature needs to be lower than our own temperature, or the opposite happens and heat will transfer into our body. Just like the heat radiated from the sun on a hot summer day.

Sweating is the most effective way our bodies lose heat. Sweating occurs when an increase in core body temperature is detected by the brain, which responds by stimulating the sweat glands distributed all over the body to produce sweat.

Sweat on the skin surface evaporates, causing the skin to cool down (also called evaporative cooling). Blood that’s flowing close to the surface of the skin gets cooled in the process and helps reduce core temperature.

On average, an adult can lose up to half or one litre of sweat every day, but in hot environments this can increase to almost a litre and a half an hour. That’s why it’s essential to keep the body hydrated during hot weather.

A different approach

What about alcoholic beverages? Many people reach for a cold beer on a hot summer day in an attempt to cool down. But alcohol is a diuretic, which means that it will make your body lose water and so reduce your ability to lose heat through sweating.

Surprisingly, warm beverages might be a good way to keep you cool. Although counter intuitive, drinking a warm beverage causes receptors in your mouth and throat to trigger a sweat response, allowing your body to cool down without having to ingest a large amount of the warm liquid.
Active ingredients in spicy foods have the same effect; they too trigger a sweat response that allows the body to cool down. That’s why these types of foods are popular in warm climates.

So while cold treats can be satisfying and are certainly refreshing, a better way of cooling down is to spice things up, get your sweat on and, most importantly, rehydrate!

This article was originally published on The Conversation.
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2014, the year that was: Health + Medicine

By Fron Jackson-Webb, The Conversation

2014 was dominated by discussions about better ways of paying for health care. But for all the talk, little progress was made.

The year began with former Howard government adviser Terry Barnes’ proposal to introduce a A$6 co-payment for bulk-billed visits to the GP. This, he said, would save money by reducing unnecessary visits to the doctor. The Commission of Audit swallowed the proposal and spat out a A$15 version (A$5 for concession card holders) ahead of the May budget.

The government initially settled on a A$7 co-payment for all GP visits and follow-up pathology and imaging. This was widely criticised for its potential to hurt the most vulnerable Australians who, according to research by the Grattan Institute, already paid more than their fair share of out-of-pocket health costs.

Modelling for The Conversation also showed the introduction of a GP co-payment could see average emergency department visits increase by between six minutes and three hours, as more patients opt for free hospital care rather than paying to see their local GP.

The impetus for the co-payment was concern that the nation’s health expenditure was rapidly spiralling out of control. But as data released in September revealed, Australia’s recent growth in health expenditure was the lowest since the mid-1980s. Per person spending fell from A$6,447 in 2011-12 to A$6,430 in 2012-13.

After seven months of trying to convince the crossbench Senators of the scheme’s merit, the government announced a compromise earlier this month: cutting GP rebates by $5 and freezing the rates until 2018. As Michelle Grattan wrote, this puts the onus on doctors to send a A$5 price signal to non-concessional patients.

In other key health news, Melbourne’s July AIDS2014 conference put HIV and AIDs back in the spotlight. Reema Rattan led our coverage, which included an In Conversation with Professor Rob Moodie and Nobel Laureate Françoise Barré-Sinoussi and interviews about HIV and the law with the Honourable Michael Kirby and Professor Nick Crofts.

Edwina Wright outlined the five promising steps forward in HIV science, including treatment as prevention, pre-exposure prophylaxis (giving antiretrovial drugs to people at risk of HIV to stop them contracting the disease) and new medications for people with both HIV and hepatitis C infections.

While a cure for HIV is a fair way off, there is reason for hope, wrote AIDS2014 co-chair Sharon Lewin. In August, scientists showed mice could be “cured” of HIV using a combination of four drugs to flush out and kill hidden HIV-infected cells.

AIDS2014 also addressed the human cost of the disease, with Australian experts focusing on three key groups: sex workers, people who inject drugs and men who have sex with men. While we’ve come a long way to reduce HIV in Australia, wrote Marion Pitts, there’s still more to do to reduce the spread of the disease and remove the stigma against people living with HIV.

Internationally, we’re no longer in an era of emergency response, but that doesn’t mean rich countries can stop funding HIV. Instead, David Wilson and Breadon Donald argue, developing countries still need donor assistance to strengthen their health system so they can treat HIV as a chronic disease.

This year Ebola also focused the world’s attention on the challenges of health care in West Africa. The disease spreads through bodily fluids – blood, vomit and feces – so it should, theoretically, have been easy to contain.

But under-resourced health systems and a slow international response led to the worst Ebola outbreak in history, claiming more than 6,800 lives so far, including many health workers.

In our coverage of almost 100 articles spanning the US, UK and Australian sites, we bought you the basics on Ebola: what it is and how it affects the body; what went wrong in the Ebola respnse; vaccine development; as well as stories on how authorities can reduce “Ebolanoia”, why some people survive Ebola and others don’t, and how the outbreak has affected those left behind.

Other highlights for the year include series on testing alternative therapies, international health systems, biology and blame, domestic violence in Australia, child protection in Australia and our popular ongoing series Health Check.

Finally, this year we also welcomed new a columnist, psychiatrist Steve Ellen, whose Life on the Couch column shines a psychological light on people, culture and society. Next month public health veteran Simon Chapman will also join the ranks, with some plain speaking about public health.

Thanks to all columnists and authors, and of course, to our regular readers. Have a happy and healthy new year.

Health + Medicine’s most popular stories for 2014:

1. Health Check: five supplements that may help with depression
2. Six foods that increase or decrease your risk of cancer
3. Old dope, new tricks: the new science of medical cannabis
4. ‘Shock and kill’ approach cures mice of HIV in world first
5. Brains, genes and chemical imbalances: how explanations of mental illness affect stigma
6. Health Check: what you need to know about ear wax
7. Health Check: first must-have foods for your shopping trolley
8. How the bacteria in our gut affects our cravings for food
9. Health Check: five foods to always avoid at the supermarket
10. Explainer: how much sleep do we need?

This article was originally published on The Conversation.
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Common painkillers could decrease skin cancer risk

By Reema Rattan, The Conversation and Nicki Russell, The Conversation

Common over-the-counter painkillers, such as ibuprofen and aspirin, can decrease risk of developing squamous cell carcinoma, according to a study published today in the Journal of Investigative Dermatology. Squamous cell carcinoma is one of the most common types of skin cancer.

The results mean these drugs may have potential as skin cancer preventative agents, especially for high-risk people, said study co-author Catherine Olsen.

Olsen and her team, from QIMR Berghofer Medical Research Institute in Queensland, did a meta-analysis of nine studies on the use of painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), and the incidence of squamous cell carcinoma.

She said her team “synthesised all the published literature and found a reduced risk associated with NSAID use in total (18%) and also non-aspirin NSAIDs (15%)”. NSAIDs had the biggest impact on people who had previously had skin cancer, or people with solar keratoses, which are growths with the potential to become cancerous.

“We would like to think it may be another way to reduce your risk of developing these cancers,” Dr Olsen said. “Of course, the best way is to reduce your sun exposure – that will always be the number one preventative action for skin cancers – but this might be a supplementary skin cancer control measure.”

Clinical senior lecturer in dermatology at Australian National University, Andrew Miller, urged caution about the results.

“Aspirin is a cheap drug, and if you can use a cheap drug to deal with an expensive problem, then it’s worthwhile taking on,” he said. “But they [NSAIDS] are not benign drugs so you certainly can’t make a treatment recommendation at this stage.”

Olsen said people shouldn’t rush out and start popping anti-inflammatory drugs in the lead up to their next trip to the beach.

“There are significant side effects associated with these drugs, so anyone who wants to know more should speak to their health professional,” she said.

The meta-analysis was unable to pinpoint the ideal dosage or duration of use for NSAIDs as each of the studies included had different criteria for eligibility and measurement.

Olsen and her team are planning a study of nearly 44,000 Queenslanders to monitor their NSAID use and incidence of squamous cell carcinoma. This will help provide more information on the dose and duration of use required to have a cancer preventative effect.

Two out of three Australians are diagnosed with skin cancer by the time they are 70 years old, and cheap and effective preventative drugs would have a major impact on national well-being.

This article was originally published on The Conversation.
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