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How Much Sugar Is Enough? View from a Doctor’s Desk – Dr Lisa Surman

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Sugar and healthy eating

The recent Four Corners’ episode on television discussing the obesity epidemic in Australia, and the burgeoning health-care costs associated, exposed the food, nutrition and health politics in Australia over many years and the powerful grip Big Food has on Australian food and nutrition policy. 

There have been clear links made for some time between free dietary sugars, sugary drink consumption and obesity. Evidence is strong and growing regarding the effect sugary drink taxes have in driving down consumption and incentivising manufacturers to put less sugar in their products. Taxing sugary drinks is far from the single solution to the obesity or diabetes epidemics, but is a start.

The World Health Authority (WHO) recommends adults and children limit their intake of free sugars to less than 10% of their total energy intake daily. If you are and average-sized adult with a healthy body weight, this translates to about 54 grams of sugar (approximately 12 teaspoons) per day.

Free sugars are defined as monosaccharides (glucose) and disaccharides (table sugar), added to food and drinks by the manufacturers, cooks or person. It also applies to sugars present in honey syrups, fruit juices and fruit juice concentrates. These sugars are different to those found in whole fruit and vegetables, which do not apply. Sugar added to food and drinks can have different names, all remain sugars: sucrose, glucose, corn syrup, maltose, dextrose, raw sugar, cane sugar, malt extract, fruit juice concentrate, molasses.

More than 52% of Australians are estimated to exceed these recommendations, sugars are added to processed foods and pre-packaged foods and drinks. The largest proportion of our free sugar intake comes from sugary drinks (over 50%). Australians consume more sugar-sweetened drinks than Britons who implemented a tax in 2016. Should we introduce a sugar tax, we would join 28 other countries and 7 US cities. Two years after Mexico introduced the tax, sugary drink purchases decreased by 7.6%. One 600ml bottle of sports drink contains 36g or 8 teaspoons of sugar, 600ml of coke contains 64g or 14 teaspoons of added sugar.
Sugary drinks are heavily advertised, available everywhere and promoted – they provide large numbers of kilojoules and provide no nutrients.

Changes you can make immediately to help reduce your sugar intake while waiting for some policy change include:

  • Carry and use a refillable water bottle
  • Eat fewer foods with free sugars, reduce sweets such as lollies and chocolates, cakes and biscuits
  • Don’t walk down the sugary drink aisle of the supermarket
  • Keep sparkling water or home made iced tea in the fridge
  • Avoid vending machines
  • Make some swaps – swap your cereal for a lower-sugar variety and limit the sugar you add
  • Read the labels on food – if there is more than 15g of sugar per 100g, check to see if sugar is one of the main ingredients (it will be listed as one of the first three ingredients on the ingredient panel)

Other foods high in sugar are breakfast cereals – one cup of some types of cereal can contain 30-50% of the daily sugar allowance. Many “health” foods and sugar-free recipes can be misleading – they are referring to the product being ‘sucrose-free’, but sugar derivatives such as rice-malt syrup, agave and maple syrup are still forms of sugars.

For a helpful guide for swaps, top tips, recipes and a sugary drink calculator to estimate your own intake and percentages, see livelighter.com.au

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

“Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.

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Influenza Update – View from a Doctor’s Desk – Dr Lisa Surman

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Flu shot
In past years there was a push to get your influenza vaccine done as soon as vaccine was available, usually in early March. Research has demonstrated that protection following vaccination starts to wane after three to four months, explaining the strong recommendations from the Australian health departments and the RACGP to have the vaccination closer to the expected ‘influenza season’. It is possible to track the current influenza notification statistics at immunisationcoalition.org.au. It is important to note that many people do not get tested for influenza and some delays may occur in reporting of confirmed influenza cases, but the statistics that are gathered do provide an understanding of influenza activity across Australia. To the start of 23 April, there have been 11,524 confirmed influenza notifications across Australia. Unfortunately, some pharmacies have not followed advice about timing and have been heavily promoting access to the 2018 influenza vaccine since February.  GP surgeries have now all ordered the various influenza vaccine supplies from the Health Department for those entitled to the free vaccine, but supplies have been slow and restricted for most surgeries, causing many people to worry about receiving their vaccine too late, which is not the case (even though the uncertainty about the timing of receiving the supplies is a frustration for both the GP staff and patients). Last year was the worst year on record for cases of influenza, with 248 000 confirmed cases, double the normal hospitalisations, and 1100 influenza-associated deaths. The new strain A(H3) was especially severe for the elderly, with nine out of ten deaths occurring in the over 65 year group. Two ‘super’ vaccines are now available for free to Australians over 65 years of age. These enhanced vaccines have been developed to improve the immunity offered by the vaccine. These vaccines have been available in other countries for many years, but are being introduced in Australia for the first time this year. The influenza viruses circulating change regularly and rapidly. The vaccine helps our immune system catch up with these changes. The current data suggests both influenza A and B strains are circulating at similar levels, including cases of Influenza A (H3N2).  Last year’s seasons in Australia and the United States were dominated by A/H3N2 strains, while B/Yamagata viruses predominated in Asia and a mix occurred in Europe. The A(H3N2) strain cause more severe epidemics affecting the entire population and the A(H1N1) tend to cause disease in children and young adults. The effectiveness of the seasonal vaccine varies from 40 to 70%, but last year provided only 33% overall and was not effective against A(H3N2) Despite the lack of full protection, and the possibility of getting the flu despite a vaccination, the seasonal influenza vaccine is the best way to protect against influenza viruses.  It is free for at-risk groups when supplies are available and otherwise available from GPs and some pharmacies immediately. Data suggests 56% of Australians don’t intend to get the ‘flu’ shot. Higher vaccination rates contribute to a healthy community. The strains contained in the 2018 routine vaccine : : A(H1N1) : A(H3N2) : B:a B/Phuket : B:a B/Brisbane You cannot get flu from the vaccination, but it is possible to have 1-2 days with muscle aches, headaches and occasionally mild fevers as a side-effect to the vaccination. AusVaxSafety is a national program to monitor the type and rate if reactions to each year’s new influenza vaccine in young children. In the 2017 flu season there were no vaccine-attributable serious events recorded. Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee “Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.
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When Should I get my Flu Vaccination? View from Dr Surman’s Desk

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Flu Shot

The RACGP president Dr Bastian Seidel is advising us not to get the flu vaccination too early in the season, as protection during the flu season will be less effective. He made the media announcement in response to many pharmacies this week launching campaigns that encouraged people to get their flu shots as early as possible. 

Protection from vaccination is known to reduce over time and recent evidence demonstrated this to be by 6-11% per month and those over 65 years particularly have been shown to lose vaccine-induced immunity at an even faster rate. The flu season is usually between June to September, with a peak in August. The community is strongly advised to have the vaccine closer to the start of the flu season, closer to May.

The vaccine usually provides about a 60% protection from the circulating flu strains during the winter. The flu strains contained in the vaccine are chosen after assessing the circulating strains in the opposite hemisphere winters and the predictions can be poor as a result of the complicated possibilities, the nature of the influenza virus and perhaps the modern ease and frequency of travel across continents by large numbers of people. The vaccine strain can change in the 6 months between being chosen for the next winter and manufacture and distribution. The egg-grown H3N2 vaccine virus strain also changed during vaccine production for the 2017 vaccine in Australia.

There are several flu types circulating every year, the different strains posing different threats to the various age groups in the community. The different strains can be easily distinguished by laboratory tests, but not by clinical symptoms. The types of circulating virus strains are published at the end of winter from national Influenza Centres and data is reported to FluNet internationally. The WHO FluNet Summary provides real-time data on the current global circulation of influenza viruses and the vaccine effectiveness for the past season is also provided. The WHO network provides early detection of new influenza subtypes with the potential to cause a pandemic and monitors antigenic and genetic changes occurring in recently circulating influenza A and B viruses to assist the WHO in formulating the twice yearly recommendations on the most appropriate compositions of influenza vaccines. The information is available on the World Health Organisation website here.

Worldwide, influenza A and influenza B accounted for similar proportions of infections in the northern hemisphere winter of 2018.

The UK season had “Aussie flu”, influenza A ( subtype H3N2) in circulation, particularly causing serious illness and death in the elderly. The vaccine effectiveness was estimated as 39.8% for all ages , but gave no effectiveness in those older than 65 years. The Influenza B, Yamagata lineage was also circulating in similar numbers and caused significant illness in the UK and was not included in the vaccine. Children are most susceptible to the Influenza B viral strains

The Aussie Flu (AH3N2) was most prevalent last season in the USA and also caused most complications in the elderly. The US vaccine all-age effectiveness last winter was 32% for H3N2 and 10% for Influenza B Yamagata.

During the 2017 season, only 27% of all Australians were vaccinated at all, with 6% of children being vaccinated. The vaccine provided 33% protection ( 5-19% for H3N2 and 37% against H1N1 ). There were 1,100 deaths from flu-related causes – 90% were aged 65 years and over. Australia recorded 221,853 flu infections to November 2017, significantly more than other years.

This year two new vaccines are funded and recommended for those over 65 years, hoping to provide better protection than that given to the US and UK populations of over 65 year olds for winter 2018. Both contain 3 strains only for influenza A, not influenza B. The seasonal flu vaccine now contains four strains to cover all the relevant subtypes present, but protection against H3N2 infection appears to be poorer than the other strains. The benefits of better protection against the most common three flu strains appear to outweigh the potential loss of protection against the missing B strain for the elderly.

– Fluzone High Dose ( contains 4 times the flu antigen. This vaccine increases antibody response, particularly against the H3N2 strain which causes more problems for older people, particularly with a complicating pneumonia.

– Fluad, This vaccine contains an adjuvant to boost the immune response. It has been used overseas for some years and observational data indicates less hospitalisations and less pneumonia infections associated.

The new vaccines are not live, do not cause flu and both give more local side-effects such as painful injection sites or fever. There are no head-to-head comparisons of effectiveness and studies suggest similar results.

There is no data to support the use of different doses, nor multiple doses, with the vaccine given at each site most likely to be the one that has been made available to the Clinic.

No vaccine provides guaranteed protection, but reduces the risk of getting flu.

For very detailed information about influenza, the influenzacentre.org website is a useful resource and provides the current vaccine recommendations and surveillance report links available and the Australian Immunisation Guidelines for those who are at increased risk from influenza other than those over 65 years, such as pregnant women, those with lung and chronic diseases and with immunodeficiency states.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

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How Do I Avoid a Listeria Infection?

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Bacteria

Listeria infection has been in the news recently. However, it’s important to remember that it is is rare, is caused by eating foods contaminated by the bacteria and is not usually transmitted between people.

The overall number of cases reported in Australia each year has been about 65, with between 1 to 14 confirmed cases of listeriosis reported in pregnant women each year for approximately 300 000 births.

Foods associated with infection include unpasteurised milk, dairy products made from unpasteurised milk, soft cheeses including ricotta and fetta, juices, soft serve ice-cream, tofu, tempeh, sushi, seed sprouts, chilled ready-to-eat foods like pre-packed sandwiches, pate and deli meats, pre-cut fruit, oysters, packaged salads, cold ready-to-eat chicken, sashimi, smoked salmon. And, most recently, rockmelon (grown in the Eastern States) due to soil contamination on the skin of the fruit.

Listeria infection can be dangerous to those with weakened immune systems ( the elderly, those with cancer, diabetes, liver and kidney disease) and to pregnant women and their unborn babies. Symptoms range from fatigue, headache, diarrhoea, aches and fever to meningitis and septicaemia. The symptoms occur from as early as a few days to several weeks, usually three weeks. The diagnosis is made using a blood or spinal fluid sample

There are simple guides to avoid infection including advice about food preparation, handling and storage:

– washing hands before preparing food and between raw and ready-to eat foods

– defrosting food in the fridge or microwave

– washing raw fruit and vegetables before eating (due to soil contamination)

– not using the same knives and boards for raw and cooked foods unless washed in soapy water

– cooking all foods of animal origin, including eggs

– storing food covered

– avoiding raw food after their use-by-date

– cleaning the fridge and keeping the temperature below 5 degrees, but the organism can survive and grow at low temperatures

– placing cooked food in the fridge within an hour of cooking

– when reheating food, make sure the centre is piping hot as listeria is killed by cooking food to boiling point

Foods without listeria risk include yoghurt, hard cheeses, cheese spreads and processed cheese, milk, canned and pickled foods, ready-to-eat deli meats and smoked fish heated to above 100 degrees, soft cheeses in cooked products such as pizza, hard ice-cream and gelato.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

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