Don’t rely on doctor Google for health information on the wild wild web

Self diagnosis on the internet. A good idea?By Rachael Dunlop, University of Technology, Sydney

If you typed “pins and needles” into Google, what kind of results would you expect to find? According to a recent study from Bupa Health, the search engine could diagnose you with anything from a completely reversible vitamin B12 deficiency, to sciatica, or worse, multiple sclerosis.

Entering “stomach cramps” into Google returns indigestion, appendicitis, or something as serious as heart disease or angina. Even a condition as benign as a rash comes up with dermatitis, psoriasis, eczema, or much more serious diseases such as meningitis.

No wonder there’s a dedicated term to describe patients who develop paranoia from googling their symptoms – cyberchondria.

The most recent statistics about Australians’ computer use shows around 80% of us now have access to the internet at home and the use of mobile devices is on the rise, thus nearly all of us can access the world-wide-web 24/7. Google is the search engine of choice for 93% of us, so when it comes to sourcing information about our health and medications, Dr Google seems an obvious place to go.

The Bupa study also revealed that: approximately a third (34%) of us would like to have the ability to text an image of our problem to receive a diagnosis; 45% would like to have access to our doctor by email; half of us self-diagnose; and 70% research our medications online. But while there is a plethora of information available online, it remains largely unregulated.

So how can you determine if the health information you find is accurate?

Well, mostly you can’t. In fact studies analysing the accuracy of Google results for the search term “vaccination” reveal 60% are actually against vaccination. (Interestingly searching “immunisation” is more likely to return accurate results since people opposed to vaccination do not believe that vaccination induces immunity).

All of this has created a difficult scenario for health care practitioners and patients alike. A patient could self-diagnose mild abdominal pain as constipation, for example, when they might have gallstones. Or on the flip side, another patient could incorrectly diagnose their headaches as meningitis.

Some doctors are justifiably worried that patients are diagnosing and treating themselves, using devices such as a gastric bypass surgery kit which was sold on Amazon. Or apps to scan moles and determine if they’re cancerous.

But while some doctors are frustrated by patients’ desire to research their conditions online, others are resigned to the fact it will happen, so are prepared to help guide patients to accurate information on the web.

If you self-diagnose, you’re not alone but you might save a lot of anxiety by seeing your doctor instead. MNicoleM

My top ten health websites

No website is completely free of errors or spurious or out-of-date information, so you will always need to exercise scepticism. A few rules of thumb include checking the date the information was updated, checking the “about us” section for the author’s/publisher’s qualifications and reputations. Also look for any evidence of peer review published data, as opposed to testimonials.

The Australian government offers accurate, consumer-driven information that’s generally kept up to date. Of note is its vaccination information which provides easy to read information for parents (the “Understanding Childhood Immunisation Booklet”, is just one example). The government’s National Prescribing Service and Health Insite provide consumer-driven health information, as do state government websites such as the Better Health Channel in Victoria.

The commercial My Doctor website will give you comprehensive local health and medical information from the MIMS medical reference tool.

Concise and accurate fact sheets on vaccination can be found at the National Centre for Immunisation Research and Surveillance (NCIRS) and facts sheets on other medical conditions are available from the Consumer Health Forum.

Other international sources include WebMD, The Mayo Clinic, NIH Health and the National Cancer Institute, which are all good places to find reliable and easy-to-understand medical information.

Government health websites are a reliable first stop for online health information. Ed Yourdon

There are also a number of crowd-sourced tools that indicate the quality of a site, based on user experience. Web of trust (WOT) is a browser plug-in which rates sites from green (good) to red (bad) depending on consumer reviews compiled from four categories: trustworthiness, reliability, child safety and privacy.

The HON (Health on the Net Foundation) Code is the oldest rating system and was founded in 1995 by the Economic and Social Council of The United Nations to encourage the dissemination of quality health information for patients, professionals and the general public.

If you come across information that makes you suspicious, you can always google it with the word “sceptic” or “debunk” and you’ll usually find several blog posts that offer a second opinion. A large community of scientists and health professionals lurk on the intertoobs and take great pleasure in applying their expertise to debunking suspicious and spurious medical claims. Science Based Medicine is one such multi-author blog, with contributions from pharmacists, cancer specialists, neurologists, infectious disease doctors and researchers.

The important thing to remember about researching health information online is to be sceptical, be critical, and never replace the trained eye and diagnosis of an experienced health professional with diagnosis by Dr Google. The internet can assist you, perhaps even calm your fears temporarily (or not, as case may be) but it will never replace the expertise of your doctor.

Finally, respect your doctor. Don’t be fooled into thinking you know more than them just because you’ve spent a few hours at Google University.

This list of websites is by no means exhaustive, so please feel free to add your favourites in the comments section below.

Rachael Dunlop receives funding from the Heart Research Institute and The Institute for Ethnomedicine, Wyoming. She has previously received funding from the NHMRC.

The Conversation

 

This article was originally published at The Conversation.
Read the original article.

Thumbnail Image courtesy of [Stuart Miles] / FreeDigitalPhotos.net

How Do I Find Time To Exercise?

Ever heard yourself saying “I don’t have time to exercise”. I’ve said it myself on occasion. But you know what? We all have the same 24 hours in a day. So to those of you who say “I don’t have time to exercise” I say, yeah, you do actually. You just choose not to.

Instead of saying you don’t have time to exercise, why not ask yourself “how do I find time to exercise’? You might find the answer surprisingly simple.

 

Know your priorities.

We don’t all have time to do every little thing on offer in our worlds today, so living smart these days is a case of prioritising what is important to you. If you’re reading this article, you must have at least some interest in exercising. Exercise is at least somewhat important to you, either because you enjoy exercising, you know it makes you feel good, or you know it is good for you and you need to exercise for your health.

Whatever the reason, be clear on why exercise is important. Then you need to figure out just how important it is in your life. Does it rate right up there with the welfare of your children, the pursuit of wealth, a raging social life, or is it a little lower on the order of what’s important to you? Remember that these things are not always mutually exclusive. Your physical health and mental wellbeing are extremely important for the welfare of your children. You can’t give your children the best part of you if you’re tired, run down and unhealthy, and exercise can make a real difference to your mental and physical health. You’ll also be a great role model for your kids if they see you exercising and making exercise a priority. Want to see your friends more? Why not go for a run with a friend, or join an exercise group with a friend, and both of you will meet more people?

 

Develop a Good Support System

Once you’ve figured out just where exercise sits on your list of priorities, you need to develop a good support system to help you keep it up. Schedule some exercise time for yourself, in consultation with anyone else who needs to make it happen. If you need your partner to spend time with the kids when you’re exercising, then make sure you involve them in your scheduling. Make sure they know how important exercise is to you, and how you will be a much nice person if you keep it up J. Over the years I’ve had heaps of my runners tell me their husbands won’t let them stop, because they become grumpy and hard to live with if they aren’t running.

If you find it hard to get away from work on time to enable you to exercise, then think about arranging to meet up with someone to exercise with. You’ll have to leave on time so you don’t let them down.  Or join a regular exercise group after work and have a trainer do all the thinking for you! Again, the commitment should get you out the door.

In another life I used to do a bit of rowing. The rest of my crew included a police woman, a midwife and a flight attendant, so trying to find a time to train was to say the least, challenging. So when we set our training times, they were cast in stone. There was no way I was going to let work get in the way of training. There was never anything so pressing in the office that I couldn’t walk away from to get to training on time.  Surprisingly (or not) when I stopped rowing, my office hours grew longer and longer. Where I used to leave work at 5:15 two or three afternoons a week, I was finding I was working till 7pm most nights, and all because I hadn’t developed a support system to replace my boat crew. It wasn’t that I liked exercising any less, I just didn’t have the same level of support around me. I didn’t know how to find time to exercise.

Exercising before the rest of the household is awake is also a good option, though it does take a bit of getting used to, and definitely some understanding from kids and partners. If you’re going to get up early to exercise, you need to be able to go to bed earlier so you’re not missing out on sleep.

 

Take the decision making out of exercise

We all like to think that we are good decision makers, but are we? Researchers at Ben Gurion and Columbia universities have shown that the decisions made by judges in parole hearings was more likely to be favourable to the prisoner if the hearing was at the beginning of the day or after a food break.

You’d expect consistent decision making in the courts, but the research shows judges are more likely to accept the status quo when a decision is needed after they’ve  already made a lot of decisions. So, extrapolating from this, if you have to consciously decide whether or not to exercise, and you’re deciding at the end of a decision filled day, you are more likely to decide to accept the status quo-that is you’ll decide against exercising.

So, don’t give your self the hard work of making a decision. Just get out, and do your exercise without thinking about it. Create a routine and stick to it, or get up and exercise first thing in the morning when you don’t have a chance to think about it. If you do deliberate first thing in the morning, you’ll be more likely to base a decision on what’s important to you, rather than what’s the easiest decision to come to.

If you know you are unlikely to exercise at night after you go home, then don’t go home first. If your kids tug at your heart strings, your shoes strings, or whatever else they can get their hands on, don’t buy into it. We’ve all had our kids cry their eyes out at the thought of their precious mummy leaving them, only to be told that they stopped crying as soon as you walked out the door.

Next time you hear yourself saying you don’t have time to exercise, don’t kid yourself. You do have time to exercise,  you just choose not to.

Instead, ask yourself  “how can I find time to exercise?”

 

Low Fat Christmas Recipes

I thought I might get into the Christmas spirit and share a few healthy Christmas recipes with you, so I turned to that trusty source, “the internet”, and duly typed in “healthy Christmas recipes”. The entire front page of the search results was devoted to low fat Christmas recipes, which got me thinking.

Why do we still equate healthy food with low fat food? Hello people out there in Google land, fat is good for you. Yes, you heard me right. Fat is good for you. The right sort of fat of course. Generally, animal fats should be eaten sparingly, except for fish and fats found in unfarmed kangaroo, and to an extent free range beef (which is pretty much all beef farmed in Australia) which are high in omega 3 and omega 6 fats. Good fats are also found in vegetable oils such as flaxseed oil, olive oil, hemp oil, nuts and seeds, avocado, to name a few. A great book on fats is Fats That Heal, Fat’s That Kill by Udo Erasmus. There is a bit of biochemistry for you to digest, but on the whole, a pretty easy read and very informative.

Anyway, my point is, as a population, we need to stop thinking that all fat is bad for you, and that if a food is low fat, it must be good for you. There are so many other factors to take into consideration. Mostly, low fat foods are high in carbohydrates, which is not necessarily always a bad thing – look at carrots, capsicum and peaches, just to pick three foods at random.

Processed foods which have a low fat label, are generally high on processed carobhydrates. Something needs to give the food the yummy flavour which brings us back to the packet, clammering for more!

The other thing I noticed when I looked at a few of the recipes was that yes, some of them were not only low in fat but also low in calories per serve. But who can eat just one tiny midgy little shortbread, so small that it only yields 31.5 calories per biscuit? Not me, that’s for sure.

My plan for eating healthily at Christmas time is simple.

Eat what I like on Christmas day.

Eat too much of all the wrong things.

Eat chocolate money and ham on toast for breakfast.

Piles of Christmas pudding with brandy butter and my mum’s excellent coffee icecream, all the turkey I can look at.

It’s just one day of the year, and honestly, if you’re worried about putting on weight, or in fact taking it off, one day of the year is not going to make or break you. But that’s the key. If you’re going to overindulge, it needs to be just one day. And that’s where many people fall down. I’ve been fasting 1-2 days a week for the last 4 weeks now, so I know I can do it. And yes, I do get hungry. If you’re planning on it, be aware it’s not for the faint hearted. (Quite literally – don’t even consider fasting if you have any type of medical condition, or if you are pregnant).

If you know that you find it almost impossible not to eat when you start feeling really hungry, you’re better off just to eat small portions of your favourite food, and don’t risk getting to the end of Boxing Day and reaching for the leftovers in a half crazed manner.

I don’t plan to be eating and picking at bits and pieces for the weeks leading up to Christmas (well not much anyway), and I do plan to fast on Boxing Day, and possibly the next day as well-ready for New Year’s Eve. I’ll be more than doubling my daily caloric intake on Christmas day-more than enough to see me through till the end of the week I should think!

I’ll throw in a decent run as well, and voila, there you have it. Reasonably healthy Christmas eating. And I really don’t have to think about it.

 

What are your plans for avoiding excess energy intake over the Christmas period?

Fact or Fiction

These days there’s heaps of information being fired at us from all directions about all sorts of topics, and the health and fitness area is no exception. We thought it would be helpful to look at some fitness facts and fictions. Which of the following list are fact, and which are fiction?

  • As long as I exercise for 30 minutes three times per week, I will continue to get fitter.
  • I will bulk up if I lift weights.
  • Now that I am exercising, I can eat more and not gain weight.
  • Exercising on an empty stomach will improve weight loss.
  • Working in the “fat burning zone” will increase fat loss.
  • I need to warm up before exercise.
  • I need to stretch before exercise.
  • A training diary is a waste of time.
  • I need one of those new wizz-bang GPS type workout recording gadgets to be really effective with my running training.

How Did You Go?

As long as I exercise for 30 minutes three times per week, I will continue to get fitter. Fiction

Getting stuck in a training rut is probably the most common training error of all. Yes, 20 minutes on the treadmill and three sets of 10 reps with 5kg weights might be fine when you start out – but if you fail to increase either the length or intensity of the run, and the weight or number of repetitions that you do, the improvements will plateau out. In fact, one study found that in beginners, aerobic fitness began to plateau in as little as three weeks when the training load was not increased. So, to continue making progress in fitness, you have to keep moving the goalposts every time they get close enough to touch – every six weeks at least, but ideally more often. This is why your sessions with us never seem to be getting any easier. It’s not that you are not getting fitter. You are! We are just working you harder.

I will bulk up if I lift weights. Fact and fiction, it depends on the weight.

Increasing Muscle Size: If you want to increase the size of your muscles, you need to be lifting a heavy weight, one which you are able to lift no more than 12 times. For good muscle hypertrophy (ie bulking up) you need to be lifing weights which you can lift 4-6 times (or even less in some cases). You shouldn’t try this sort of lifting on your own. Enlist the help of someone who knows what they are doing- yes, that would be us- and always have someone “spotting” you when you are lifting heavy weights.

Muscle Toning: Muscles consist of long, thin fibres which come in two principal varieties: ‘type 1’ fibres, which are highly resistant to fatigue and recruited mainly at low intensity; and thicker, more powerful ‘type 2’ fibres, which only kick in when the going gets tough. The fibres within a muscle are always recruited in the same order – type 1 first, then type 2. So, if you only ever lift light weights, (no matter how many times), you will never work the muscle in its entirety, nor engage the type 2 fibres. What will happen, however, is that as the fibres within the muscle grow bigger, they will fill some of the empty space within the muscle sheath (an untrained muscle contains lots of space between fibres). The result? The muscle will become firmer and denser, but not bigger.

Now that I am exercising, I can eat more and not gain weight. For the most part, fiction.

You can eat more and not gain weight, but only if you are burning more calories than your extra eating puts into your system. Imagine you are a car, and your food is petrol. If you drive to Brisbane, you will need more fuel than if you drive to Newcastle. If there is not enough room in the tank to hold all the fuel you want to put in, the tank will overflow. Think of that overflow as fat, as that’s what happens to all the extra fuel you put into your body, no matter what time you eat it, no matter whether it is protein or carbohydrate, fruit or chocolate. Too much food turns to fat! Since running for about an hour will burn approximately 500 calories, and your average cheese sandwich is about 300 calories, it doesn’t take much to tip the scales the wrong way.

Having said that, exercise does burn a lot of calories especially if you are training for longer distance running events. If you intend to get up and do it all again the next day or even if you have a life to lead and need to be on the ball for your family and work commitments,  then you will need to ensure your glycogen stores are replenished post-workout. Your muscles use glycogen for energy and when the muscles are depleted they need to be refuelled quickly to maximise the training effect. It is important to refuel within half an hour of completing exerise, but be careful not to consume more calories than you have just burned. Some people refuel soon after their exersise session is finished, and then go home and have a meal as well! If you are training in the morning and have not been exercising constantly for more than 1 hour, going home to your normal breakfast should be sufficient, as long as you eat as soon as you get home. Likewise for dinner. If however you have been on a longish run of more than about 50 minutes, we recommend Endorox R4 to aid with recovery. I haven’t come across anyone who hasn’t said this is the best thing since sliced bread for preventing exhaustion and that inability to satisfy hunger after long duration exercise. Ask us about this fantastic training aid.

Exercising on an empty stomach will improve weight loss. Fact and fiction

Scientifically speaking, this is a fitness fact, however in practice, is is more a fiction. Performing cardiovascular exercise first thing in the morning before you’ve eaten, means that insulin levels are at their lowest, while another hormone, glucagon, is at its hightest.  Your body s then encouraged to draw on its fat reserves for fuel, seemingly increasing fat loss. HOWEVER……. fat metabolism is dependent on the availability of carbohydrate, when carb stores are low, fat metabolism is compromised. Exercising feels much harder, so you may tire sooner, or slack off and end up burning fewer calories – and less body fat – overall. You could also end up losing muscle as you start burning protein – as well as fat – for fuel. So exercising on an empty stomach is counter productive. Be sure to have at least a small amount of carbohydrate- eg fruit or a sandwich-an hour or so before you exercise.

Working in the “fat burning zone” will increase fat loss. Fiction

The idea that you only burn fat when you are exercising in a particular ‘zone’ of intensity – usually between 60 and 70% of your maximum rate went out with the ark. We actually burn fat 24 hours a day, but  the percentage of fat we use for energy varies at different levels of intensity. A greater proportion of fat is burned during low-intensity exercise, which is where the idea came from that we should exercise more gently – but while the percentage of fat contributing to energy expenditure may be lower during more vigorous activity, it is the overall number of calories burned that really counts when it comes to fat loss. More vigorous exercise will require more energy, and therefore more calories will slip away. This is not to say you should try for a 2 hour run at high intensity – you won’t be able to do it, but adding some more intense workouts (such as interval training) to your overall training programme will definitely help with energy expenditure.

I need to warm up before exercise. Fact

This one is a fitness fact, however it is the type of warmup which is important. Skipping a warm up will make things harder for yourself. Warming up reduces the risk of injury and improves performance. One study found that warming up reduced the accumulation of lactic acid in the muscles, and other research has showed that just five minutes of warming up enables runners to exercise for longer than those who did not warm up. 5-10 minutes is fine. Try to do a gentler version of the exercise you will be doing during the main part of your session. So if you are going for a run, walking briskly for a minute or two, then gentle jogging for up to 10 minutes should do the trick. If you are in for a weights session, 5 minutes of walking, slow jogging, then run through all the exercises you will preform either with no weights, or very light weights. If you are training with a group, don’t be late, or you may miss one of the most important parts of the session!

I need to stretch before exercise. Fiction (mostly)

There has been quite a debate around stretching before exercise in the last few years. Opinion is definitely lining up on the “no need to do it” side. That doesn’t mean you can neglect stretching altogether though. Stretching isn’t necessarily about lengthening muscles, it’s about restoring them to their natural length after all the shortening involved in exercise. Imagine an elastic band attaching two pieces of stick (representing your bones). If the elastic contracts (ie gets shorter) the sticks come closer together. That is how your muscles work. They contract to bring your limbs closer together. Think of the simple biceps curl. Your biceps contract, bringing your forearm closer to your upper arm. So why do you need to stretch this muscle BEFORE it needs to get shorter? You don’t, however you do need to stretch after exercise.

Stretching is also about putting joints through their full range of motion, which is important for keeping cartilage nourished and healthy, reducing stiffness, and maintaining correct alignment between the muscles and the skeleton. Stretch muscles when they are warm, holding for 30 seconds – and do it after every workout.

Having said all of that, there are some injuries which need to be stretched gently after a warm up and before the main part of the session. Many people feel they need to stretch their calves after warming up to prevent cramping, shin splints or plantar fasciosis. If you are one of those people, or if you have been told by your medical practitioner to stretch prior to exercsie, then keep doing doing so.

A training diary is a waste of time. Fiction

You may not be an elite athlete, but you should be keeping tabs on your fitness regime, otherwise you have no way of knowing if it is working, or whether you are getting fitter. If you are struggling keeping up with all of your planned training sessions, a training diary can help you to pinpoint which sessions you are finding hardest to get to. Then you can start asking yourself why? Is it because your boss always seems to call a 5 o’clock meeting every Monday, or is it because you don’t like the session you have planned? Keeping a diary is also a great way of staying motivated!

I need one of those new wizz-bang GPS type workout recording gadgets to be really effective with my running training. Fiction

It’s great fun pressing buttons and finding out how fast you are running, or how far you’ve run, or what your heart rate is etc etc, and it can help with motivation, but let’s face it, all the modern gadgetry in the world is not going to do the work for you. Bottom line is you still have to put in the hard yards. Your workouts can be very effective just going on the way you feel. Using the Rating of Perceived Exertion (a 1 to 10 scale of how much you are exerting yourself) can be just as effective as a heart rate monitor. A “workout gadget” can be helpful if you are having trouble running at a steady pace, but for the most part, you can certainly be effective with your training with no more than a stop watch.

Calcium Rich Foods For Runners

Calcium is important for many functions in the body, including muscular contraction, maintaining blood pH levels, strong teeth, and of course for helping to maintain bone density.

When thinking calcium, many people automatically think dairy, but there are many more calcium rich foods.

Here are a few ideas for dairy and non-dairy calcium sources.

Calcium rich foods for runners

Is there an end in sight to portion size increases?

Yes and no, but mostly it would seem, no.

According to a 2007 paper published in the Journal of Public Health Policy, portion sizes offered by fast food chains are two to five times larger than when first introduced. When McDonald’s first started in 1955, its only hamburger weighed around 1.6 ounces; now, the largest hamburger patty weighs 8 ounces. Serving size increases in other fast foods can be seen in this graph.

Interestingly, since the movie Supersize Me, some portion sizes at McDonalds have actually decreased. This table shows some selected fast food items and the change in portion size from 1998-2006.

The mayor of New York Cityis planning to ban the sale of oversized soft drinks in restaurants in a bid to make people consume less. If his legislation is passed, restaurants will need to limit the size of soft drinks to 16oz (that’s two standard size soft drink cans by the way). Patrons can buy more than one serving of course, but will be forced to think about whether or not they want that second serve.

 

So…. we may be making some kind of headway in the right direction but we have a long way to go.

 

Reference

Portion Sizes and Obesity: Responses of Fast-Food Companies

Lisa R Young, Marion Nestle Journal of Public Health Policy28, 238-248 (5 July 2007) doi:10.1057/palgrave.jphp.3200127 Research

The Self Refilling Soup Bowl (and what it tells us)

 

Does portion size effect how much we eat? You bet it does! In a study which used self refilling soup bowls to measure whether visual cues relating to portion size effected how much we eat, participants who were unknowingly eating from the self refilling soup bowls ate 73% more than those who had your normal run of the mill, everyday, no tricks soup bowl.

 

Despite this large difference in soup intake, the subjects did not believe they had eaten more, nor did they report feeling more sated than those eating from normal bowls. In other words, we eat what’s in front of us, and the amount we eat doesn’t really determine when we stop.

 

How many of us grew up being told to finish what’s on our plate? I certainly was. How many of us tell our own children to? I’ve been guilty of it, but I must say generally because my 5 yr old announces he’s full when all that’s left on his plate is broccoli!

 

The bottomless soup bowl study shows us that if eating your plate clean is considered the norm, then we’ll eat what’s put in front of us, just because the expectation that is an appropriate sized serving has already  been set.

 

Larger portions and packages suggest larger consumption norms. The amount we put on our plate suggests the amount which is supposed to be eaten.  As the researchers put it “A person’s eyes may influence how much they consume, leading them to be less influenced by physiological cues of satiation. As a result, their estimate of how much they have consumed and how sated they are may have to do more with what they believe they saw themselves eat and less with how much they actually ate.”

 

Turning it around

It stands to reason that these visual consumption cues can also be used to suppress our food intake. Here are some tips for reducing the amount you eat

  • Use a smaller plate, bowl, cup or glass. This should lead you to thinking you are having a full portion, and make you less likely to ask for more.
  • Repackage bulk  products into smaller ziplock bags (eg nuts, seeds, and dare I say it potato chips). Doing this for kids especially will lead them to believe they’ve had a full serving and eat less than what they would normally consume.
  • Don’t serve food at the table. Having food sitting in front of you at the dinner table is very suggestive of it being normal to have more than what you are originally served.
  • Pick smaller pieces of fruit if possible.
  • Look at the weight and calorie yield of a slice of bread – compare packets before you buy the bread. The size of a slice of bread these days seems to be about twice the size it was when I ws a kid!

See more on portion size, and have a look at this very simple guide to portion sizes.

 

What are some of things which you’ve noticed have increased in portion size since you were a kid?