Complementary medicines include vitamin and mineral supplements, herbal medicines, traditional remedies including Chinese, Ayurvedic and bush medicines, homeopathic preparations, and some nutritional supplements including weight loss products.

Just like pharmaceutical medicines, complementary medicines can have side effects or interact with other medications or supplements you take. So if you are one of the many Australians who choose to use these products, you can do so safely by keeping the following points in mind:

• Always tell your doctor about any complementary medicines you are using and why you are taking them – make a list to take to your appointment or take the bottles with you. Studies have shown that many people taking supplements never tell their doctor and many doctors don’t ask about them.
• Find out if there’s any reliable evidence for the use of the supplement.
• Speak to your doctor about whether the supplement is safe for you. Could it interact with any of your prescription medications or affect any medical conditions you have?
• Know the right dose, including how much and how often you should take it.
• Be aware of any side effects and when you should stop taking it. For example, fish oil can cause blood thinning and might need to be stopped if you have surgery.
• Choose a reputable brand, preferably manufactured in Australia.
• If you are planning to start more than one new complementary medicine product, start one at a time so that if there are benefits or side effects, you will be able to pinpoint which one was responsible.

Another important consideration is where you purchase complementary medicines. While buying products over the internet might be tempting because of a lower price or easier availability, it can be risky. With overseas sites, the safety and quality of products may not comply with strict Australian standards, the manufacturing processes are unknown and there is no local point of contact in case you have problems. So even at a higher price, shopping for Australian-made products locally is a safer bet.

In Australia, complementary medicines are regulated by the Therapeutic Goods Administration (TGA). This is a two-tiered system based on risk. Most complementary medicines are considered low risk, so are ‘listed’ medicines, while most prescription and over-the-counter medications are considered high risk, so are ‘registered’ medicines.  Once approved, complementary medicines are included in the Australian Register of Therapeutic Goods (ARTG) and are labelled with a number starting with AUSTL. The TGA assess listed medicines for safety and quality but not for efficacy, although the manufacturers of listed medicines are required to have data to support the claims they make for their product. To ensure quality and safety, the product must only contain ingredients from a pre-approved list that the TGA has already assessed for safety and quality and must be manufactured in a certified facility that meets quality standards.

For more information, watch this short video from the TGA: Department of Health and Aged Care: Buying Medicine and Medical Devices Online

References:

• Department of Health and Aged Care: How are vitamins regulated in Australia?
• Department of Health and Aged Care: An overview of the regulation of complementary medicines in Australia
• Department of Health and Aged Care: Buying medicines and medical devices onlin
• NPS MEDICINEWISE: Complementary medicines explained

If you have a chronic health condition, having ongoing support from your general practitioner (GP) is important. One way they can do this is by preparing a GP Management Plan (GPMP) and, where needed, Team Care Arrangements (TCAs).

A GP Management Plan (GPMP) can help by providing an organised approach to your health care. It is a plan of action that you agree on with your GP, which identifies your health and care needs, outlines the services your GP will provide, and lists the actions you can take to help manage your health condition.

If your health condition requires you to see at least two other health care providers, such as medical specialists or allied health professionals, your GP may also prepare a Team Care Arrangement. This is a plan to help coordinate the care you need from your GP and the other health care providers.

If your GP has prepared you both a GPMP and TCA, you may be eligible for Medicare rebates for certain allied health services if they are directly related to the management of your chronic health condition. For example, if you have diabetes, this could include a diabetes educator, dietitian and/or podiatrist. This provides you with a rebate of $56 per consultation for up to five consultations per calendar year. However, if you are seeing more than one allied health professional, these visits need to be split between them – for example, you could have two consultations with a diabetes educator, two with a dietitian and one with a podiatrist.

If you and your GP agree you would benefit from a GPMP, they will prepare the plan and provide you with a copy. They should also let you know if there will be a fee for preparing the plan or if they bulk bill for this service. The plan should be reviewed regularly, so that you and your GP can check that your goals are being met and decide if any changes might be needed to the plan. If your GP practice has a practice nurse, they can also provide you with support and monitoring between visits to your GP.

To be eligible for a GPMP and TCA, you need to have a chronic medical condition which is a condition that has been or is likely to be present for at least 6 months. This includes diabetes, heart disease, kidney disease, stroke, cancer, asthma and musculoskeletal conditions, such as arthritis.

To find out more about GP management plans, speak with your GP or practice nurse or visit the Department of Health website: Department of Health and Aged Care: Chronic Disease Management Patient Information

References:

•  Chronic disease GP Management Plans and Team Care Arrangements
• Chronic Disease Management Patient Information

Coeliac disease is a condition where eating gluten causes an immune reaction in the small intestine, damaging the intestinal wall and reducing its ability to absorb nutrients from food. According to the Coeliac Society, around 1 in 70 Australians have coeliac disease, but 4 out of 5 remain undiagnosed.

The symptoms of coeliac disease vary widely and while some people have all or many of these symptoms, others may only have a few or none at all.

Typical symptoms include:

• digestive symptoms including wind, bloating, stomach pain or cramps, nausea, vomiting, diarrhoea and constipation
• fatigue, weakness and lethargy
• deficiencies in certain nutrients, including iron, vitamin B12 and vitamin D
• weight loss
• poor weight gain, delayed growth and delayed puberty in children
• recurrent mouth ulcers
• bone and joint pains
• easy bruising of the skin
• unexplained infertility and recurrent miscarriage
• osteoporosis (low bone density)

It is more common in individuals with a family history of coeliac disease and those with other autoimmune conditions, such as type 1 diabetes and autoimmune thyroid disease.

Coeliac disease is treated with a lifelong strict gluten-free diet. Gluten is the protein found in grain foods, including wheat, rye, barley and oats. So a strict gluten-free diet means cutting out all products made from these grains, which include most breads, cereals, biscuits, crackers, pasta and noodles and a range of processed foods which may contain small amounts of gluten.

When someone with coeliac disease removes gluten from their diet, the intestinal wall can heal so that nutrients can be absorbed, and symptoms will improve. If not diagnosed and treated, coeliac disease can affect a child’s growth and development and in adults it can lead to long-term health problems including osteoporosis, infertility, miscarriage, tooth decay and an increased risk of cancers of the digestive system. Taking all steps to avoid gluten is therefore important for anyone with the condition.

If you have symptoms of coeliac disease it’s important to see your doctor to be tested. Don’t start a gluten-free diet before you see your doctor, as this makes the tests used to diagnose coeliac unreliable. The initial screening test (a blood test) requires you to have been eating gluten regularly for at least 6 weeks prior to the test.

For more information:

You can find out more about Coeliac disease, including the symptoms, diagnosis and management, by visiting the Coeliac Society: Coeliac Australia or calling them on 1300 458 836.

References:

• Coeliac Australia: Coeliac Disease
• Coeliac Australia: Coeliac Disease Symptoms
• Coeliac Australia: Coeliac Disease Diagnosis

With so much conflicting information about carbs and the rising popularity of low-carb diets, you may be confused about how and where carbs should fit into your eating plan. Here is a quick overview of the role of carb-containing foods and which foods to consider including and avoiding.

Carbohydrate is found in the foods we eat in the form of starches and sugars – both added sugars and the naturally occurring sugars in fruit and dairy foods.

Carbohydrate is an important fuel source for the body. When you eat carbs, either in the form of starches or sugars, they break down to glucose, which is absorbed into your bloodstream. Insulin then takes glucose from the bloodstream into your muscles and cells to use for energy. For this reason, many people find that cutting out carbs can lead to poor energy levels and fatigue, and can make exercise difficult.

Many carbohydrate containing foods also provide important health benefits. These include fruits, vegetables, wholegrains and legumes.

Low-carb diets are often promoted for weight loss and managing blood glucose levels. However, studies show that while low-carb diets often lead to more rapid initial weight loss and reductions in blood glucose levels (in the first 6-12 months), in the longer term they don’t appear to be any better than low-fat, or other types of energy-restricted diets. They can also be pretty hard for most people to stick to. And unless you can continue your new way of eating for the long term, it’s unlikely that any benefits will be sustained.

There are certainly some carbs that are best avoided for health and weight management. These include nutrient-poor, highly processed carb foods containing refined grains and added sugars. However, cutting out nutrient-dense carbohydrate foods such as wholegrains, fruit, vegetables and legumes is unnecessary for weight or blood glucose management, can lead to nutrient deficiencies and may increase the risk of other chronic diseases. In fact, research has shown that eating more of certain carbohydrate-rich foods including wholegrains, legumes, fruit and vegetables is associated with a reduced risk of many chronic diseases, including cardiovascular disease, type 2 diabetes and some types of cancer.

So, rather than cutting out carbs, it is better to be choosy about which carbs you eat.

The best carb choices are those that are minimally processed, high in fibre and nutrient-dense, such as:

• fresh fruits
• vegetables (although non-starchy vegetables have very little carbs)
• legumes including lentils, chickpeas and dried or canned beans
• wholegrains such as rolled or steel-cut oats, barley, quinoa, cracked wheat (burghul), buckwheat and brown rice
• dense wholegrain breads
• wholemeal or wholegrain pasta or noodles
• unsweetened dairy foods like milk and natural yoghurt

The carb foods that are best to avoid or limit are nutrient-poor foods containing refined grains and added sugars, including:

• Snack foods such as biscuits, cakes, lollies, chocolate and chips
• Sweetened dairy foods, including flavoured milks, flavoured yoghurt and ice-cream
• Refined grains including white bread, puffed and flaked breakfast cereals and white rice
• Sugar-containing drinks including soft drinks, cordials and energy drinks
• Fruit juices
• Added sugars including table sugar, glucose, honey, maple syrup, rice syrup and agave nectar

If you are one of the many Australians who enjoys a daily coffee (or a few) you may wonder about the impact of this on your health. The good news is that for most adults, regular moderate coffee consumption has several health benefits that appear to outweigh any potential risks.

Two review papers published in 2016 and 2017 combined the findings of hundreds of studies looking at the impact of coffee drinking on multiple health outcomes. Both concluded that moderate coffee consumption (around 3-4 cups per day) is more likely to benefit your health than cause harm.

Drinking coffee has been associated with a lower risk of:

• Type 2 diabetes
• Cardiovascular disease
• Cardiovascular mortality
• Cancer
• Neurological conditions, including Parkinson’s disease and cognitive decline
• Liver conditions including non-alcoholic fatty liver disease, liver fibrosis, liver cirrhosis and liver cancer
• Gallstones
• Dying from all causes

The health benefits of coffee have been attributed to many of the different bioactive compounds found in coffee, including caffeine, the polyphenol (beneficial plant compound) chlorogenic acid and the diterpenes, cafestil and kahweol. There is some evidence that these compounds may have antioxidant, anti-inflammatory or anti-cancer effects that could explain the association seen in research between coffee drinking and health outcomes. However, most studies investigating coffee drinking and health are observational, so further research, including randomised control trials, is needed.

It’s also not all good news. Coffee drinking during pregnancy has been associated with low birth weight, preterm birth in the first and second trimester, and pregnancy loss. For this reason, Food Standards Australia & New Zealand (FSANZ) recommend that pregnant women limit their caffeine consumption to no more than 200 mg/day from all sources, including coffee.

While more research is needed, some studies also suggest an association between coffee consumption and bone health, including fracture risk, particularly in women.

Some people also experience negative symptoms when they drink coffee, particularly in large amounts. This can include feeling agitated or anxious, increased heart rate, difficulty sleeping, and heartburn. Caffeine is also addictive, so some people may experience withdrawal symptoms when cutting down on their coffee intake, including headaches, tiredness, irritability and difficulties concentrating. So if you are a big coffee drinker and plan to cut down, it is best to do this gradually.

However, if you are not pregnant and don’t experience any negative effects from drinking coffee, there appears to be no reason not to enjoy a daily coffee, or three.

References:

Pourshahidi LK, Navarini L, Petracco M, Strain JJ. A Comprehensive Overview of the Risks and Benefits of Coffee Consumption. Compr Rev Food Sci Food Saf. 2016; 15(4):671-684. doi:10.1111/1541-4337.12206

Poole R, Kennedy OJ, Roderick P, Fallowfield JA, Hayes PC, Parkes J. Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes [published correction appears in BMJ. 2018 Jan 12; 360:k194]. BMJ. 2017;359:j5024. Published 2017 Nov 22. doi:10.1136/bmj.j5024

Your body clock is an internal clock which helps to regulate the timing of different processes in the body, including circadian rhythms. Circadian rhythms follow a roughly 24-hour cycle and regulate things like sleep/wake cycles, body temperature, blood pressure, hormone secretion and immune function.

The main factor affecting our circadian clock is light, which is why circadian rhythms are closely aligned with day and night. However, other environmental factors also play a role.

Factors that can negatively affect your circadian rhythm include:

• Shift work, particularly overnight shifts or work shifts with varying hours
• Irregular sleep habits including having different sleep timing on work and non-work days (known as social jetlag) and/or unequal sleep duration on work days and non-work days, often to compensate for sleep deficit on work days (known as social sleep restriction)
• Lifestyle habits that mean you stay up late or wake very early
• Other poor sleep habits, including eating or drinking late at night, watching bright screens close to bedtime and not having a comfortable sleeping environment
• Travelling across different time zones
• Certain medications
• Stress and anxiety

Disruptions to your circadian rhythm can have both short-term and long-term effects on your mental and physical health, including increasing the risk of chronic health conditions such as obesity, type 2 diabetes, cardiovascular disease and cancer.

You can optimise your circadian rhythm by:

• Having a regular daily routine, including regular wake and sleep times and eating at similar times each day, both on work and non-work days
• Spending time outdoors during daylight, particularly in the morning
• Exercising regularly
• Building good sleep habits
• Having a comfortable sleep environment
• Avoiding bright light in the evenings – dim your lights or use lamps instead of overhead lights, and avoid or limit screen time before bed (including TV, computers, tablets and smartphones)
• Avoiding alcohol, caffeine and nicotine in the evenings, all of which can affect sleep quality
• Avoiding late afternoon and evening naps

For more information: Sleep Health Foundation: Body Clock

References:

Cable J, Schernhammer E, Hanlon EC, et al. Sleep and circadian rhythms: pillars of health-a Keystone Symposia report. Ann N Y Acad Sci. 2021;1506(1):18-34. doi:10.1111/nyas.14661

Fishbein AB, Knutson KL, Zee PC. Circadian disruption and human health. J Clin Invest. 2021;131(19):e148286. doi:10.1172/JCI148286

Endocrine-disrupting chemicals (EDCs) are chemicals that can interfere with hormones produced in the body. Research suggests that exposure to these chemicals may contribute to a wide range of health problems, from obesity and type 2 diabetes, to reproductive and neurodevelopmental problems, to reproductive cancers.

Endocrine-disrupting chemicals can be found in food, water and many consumer products. Common EDCs include:

• Brominated flame retardants (BFRs), used in electronics, clothing, and furniture such as sofas and mattresses to reduce flammability.
• Phthalates, used to make plastic more flexible and as stabiliser in fragrance to extend the scent, these are used in hundreds of products, including plastic food wraps, vinyl flooring, soft toys and fragranced cleaning and personal care products. However, Australia how has restrictions on the phthalate diethylhexyl phthalate (DEHP) in children’s products including toys, baby bottles, dummies, cups, bowls, plates and utensils.
• Parabens, used to preserve foods and personal care products such as skincare and cosmetics.
• Bisphenol A (BPA), used in many water bottles and plastic containers, in the lining of canned foods and in thermal paper used for receipts. It has now been banned in children’s products such as baby bottles.
• Pesticides and herbicides used in agriculture and at home, in the garden or around the house.
• Per- and polyfluoroalkyl substances (PFAS) used as oil and water repellents and coatings for common products including non-stick cookware, and stain and water-resistant carpets and textiles.

Studies have shown that nearly everyone has detectable levels of EDCs is in their body. While we can’t completely avoid or remove them, we can make changes to reduce our exposure to these chemicals and their effects on our health. You can do this by:

1. Learning about common EDCs and where they are found.
2. Reading labels and avoiding products containing known EDCs.
3. Looking for alternatives – there are an increasing number of healthier alternatives now available, from cleaning and personal care products to food storage and drink containers to natural pest control products.
4. Minimising consumption of processed foods, particularly those wrapped or packaged in plastic.
5. Getting a water filter and reusable glass or stainless-steel water bottle, rather than buying bottled water and reusing plastic drink containers.
6. Avoiding microwaving or heating food in plastic containers.
7. Reducing chemical use around house and using natural cleaning and pest control products instead.

For more information: download a free copy of: the Environmental Working Group (EWG) Guide to Endocrine Disruptors

References:

Gore AC, Chappell VA, Fenton SE, Flaws JA, Nadal A, Prins GS, Toppari J, Zoeller RT. EDC-2: The Endocrine Society’s Second Scientific Statement on Endocrine-Disrupting Chemicals. Endocr Rev. 2015 Dec;36(6):E1-E150. doi: 10.1210/er.2015-1010. Epub 2015 Nov 6. PMID: 26544531; PMCID: PMC4702494.

The EWGs Guide to Endocrine Disruptors

Australian Competition and Consumer Commission: DEHP in Children’s Plastic Items

Rheumatoid arthritis is a chronic health condition which causes pain and swelling in your joints.

According to the Australian Institute of Health and Welfare (AIHW) about 456,000 Australians (around 1 in 50 people) have rheumatoid arthritis. While it is most common in those over 75 years of age, most people are first diagnosed between the ages of 35 and 64 years. Women are more likely to be affected than men.

Rheumatoid arthritis is an autoimmune disease where your immune system mistakenly attacks the tissues around your joints. When this happens, some joints become swollen and painful. While the cause is still unknown, having a family history and smoking both increase the risk. Rheumatoid arthritis is quite different from osteoarthritis, which occurs when the cartilage that protects your joints breaks down.

Common symptoms of rheumatoid arthritis include:

• pain or swelling in the joints of both hands or both feet
• stiffness in your joints, particularly in the morning
• symmetrical pain and swelling (meaning that the same joints on both sides of the body are affected)
• persistent fatigue.

For some people, the symptoms gradually worsen. Others may have flareups followed by periods of time with little or no symptoms, which may last months or even years. Rheumatoid arthritis can cause permanent joint damage, but early diagnosis and treatment can help to prevent this. For this reason, it is important to see your doctor if you have symptoms.

The treatment of rheumatoid arthritis will depend on your symptoms and their severity. There are several medications that can help with pain management and reducing inflammation. These include:

• pain relief medications such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs)
• corticosteroids (available as tablets or injections) which can help to manage pain and stiffness during flareups
• disease-modifying anti-rheumatic drugs (DMARDs) and biological DMARDs, which can help to reduce symptoms and joint damage.

There are also things that you can do to help to manage your rheumatoid arthritis, including:

• Building healthy lifestyle habits, including eating a healthy diet (particularly a Mediterranean-style diet), exercising regularly, not smoking, managing stress levels and getting adequate sleep and rest.
• Learning how to protect your joints and manage your pain and fatigue.
• Seeking help from an occupational therapist if you need help with managing day-to-day activities due to joint pain and stiffness.
• Including more omega-3 fats in your diet (from oily fish, walnuts, flaxseeds and chia seeds) and considering an omega-3 supplement to help with reducing inflammation.
• Getting enough vitamin D from sensible sunlight exposure and/or supplements.

For more information:

• Health Direct: Rheumatoid Arthritis
• Arthritis Australia: Rheumatoid Arthritis

References:

• Australian Institute of Health and Welfare: Rheumatoid Arthritis
• Rheumatology: Condition Information
• Health Direct: Rheumatoid Arthritis
• Arthritis Australia: Rheumatoid Arthritis
• Better Health Channel: Rheumatoid Arthritis

Harrison SR, Li D, Jeffery LE, Raza K, Hewison M. Vitamin D, Autoimmune Disease and Rheumatoid Arthritis. Calcif Tissue Int. 2020 Jan;106(1):58-75. doi: 10.1007/s00223-019-00577-2. Epub 2019 Jul 8. PMID: 31286174; PMCID: PMC6960236.

Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients. 2020 May 18;12(5):1456. doi: 10.3390/nu12051456. PMID: 32443535; PMCID: PMC7284442.

The diabetes annual cycle of care is a checklist for reviewing your diabetes management and general health – if you have diabetes it is recommended that you do this review with your general practitioner (GP) each year. As part of this process, your GP may refer you to other health professionals, such as a dietitian, diabetes educator, podiatrist, ophthalmologist, exercise physiologist or endocrinologist, to help you in managing your diabetes and reducing the risk of complications.  

The health checks included in the cycle of care include:

• HbA1c: a blood test to measure your average blood glucose levels over the past 2-3 months. Persistent high blood glucose levels can lead to diabetes-related complications such as heart, eye, kidney and nerve damage. Keeping blood glucose levels in your target range can help to reduce the risk of developing these complications.
• Blood pressure: is a measure of the force of circulating blood on the walls of your blood vessels. High blood pressure increases the risk of heart disease, stroke, eye damage and kidney damage.  This means that managing blood pressure is just as important as managing blood glucose levels when it comes to preventing diabetes-related complications.
• Foot checks: An initial foot check should be done by your doctor, diabetes educator, practice nurse or podiatrist. If your feet are found to be low risk, then it is recommended that you have an annual foot check. If assessed as high or intermediate risk then you will need more regular checks – at least every 3-6 months, or more often if needed.
• Eye checks: Visit an ophthalmologist or optometrist once a year to check your eyes through dilated pupils. This is needed to check for diabetic eye damage (retinopathy), as well as cataracts, glaucoma and other eye disorders that occur more frequently in people with diabetes. If any problems are detected, you may need more regular visits.
• Kidney health: An annual urine test, the urinary albumin to creatinine ratio (UACR), shows whether small amounts of protein are passing into the urine can indicate very early signs of kidney damage. At this stage treatment can often slow or prevent further damage. A blood test to check kidney function, called estimated glomerula filtration rate (eGFR) is also recommended.
• Blood fats: a blood test to measure the different types of fats in your blood including LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides (TG). As with high blood pressure, high blood fats can increase the risk of heart disease, stroke and other diabetes-related complications.
• Weight, waist measurement and body mass index (BMI): Carrying extra weight, especially around the middle, can make it harder to manage your blood glucose levels, blood pressure and blood fats, so it is important to keep a check on these.

During the review your GP should also ask about your lifestyle habits (such as diet, activity levels, smoking and alcohol intake), medications and emotional health.

For details of how often to have these checks and recommended targets, download a copy of the NDSS Annual Cycle of Care Fact Sheet

For more information:

• NDSS Annual Cycle of Care Podcast Series
• NDSS Annual Cycle of Care Fact Sheet

Metabolic syndrome is a collection of risk factors which together increase the risk of heart disease, stroke and type 2 diabetes.

Metabolic syndrome is diagnosed when you have three or more of the following risk factors:

• Excess weight around the middle (a waist circumference of more than 88cm for women and more than 102cm for men of Caucasian background, but these may vary for those from different ethnic backgrounds–your doctor can advise you on your individual targets)
• High triglyceride (fat) levels in the blood
• Low levels of HDL (‘good’) cholesterol
• High blood pressure
• Insulin resistance or type 2 diabetes

While each of these are risk factors on their own, their combined risks are even greater. If you have metabolic syndrome, your risk of cardiovascular disease and diabetes are much greater than in those who don’t have the condition.

While genetics and age both play a part, lifestyle modification is the key to preventing and managing metabolic syndrome. Following are the dietary and lifestyle changes that can help.

• Eating a Mediterranean-style diet. This is an eating plan rich in minimally processed wholegrains (such as traditional rolled or steel-cut oats, barley, quinoa, freekeh, burghul, brown rice, wholemeal or wholegrain pasta, dense wholegrain breads), vegetables, fruits, nuts, legumes (lentils, chickpeas and dried/canned beans), olive oil and fish but relatively low in red meat and dairy products. Refined grains, added sugars, sugar-sweetened  drinks and ultraprocessed foods are best avoided or kept for special occasions. Use fresh or dried herbs and spices rather than salt to flavour foods.
• Exercising regularly, increasing incidental activity and reducing sedentary time and/or breaking up your sitting time regularly.
• Losing weight, particularly around the middle, by combining a healthy eating plan with being more active.
• Quitting smoking, if you smoke. If you need help to do this, speak with your doctor or call the Quitline on 13 7848.
• Getting adequate sleep and managing stress levels.

Dietary and lifestyle changes are recommended as the first line of treatment. However, some people also need medications to manage individual risk factors such as high blood pressure, high cholesterol and elevated blood glucose levels.

For more information:

• Better Health Channel: Metabolic Syndrome
• Health Direct: Metabolic Syndrome

 References:

Castro-Barquero S, Ruiz-León AM, Sierra-Pérez M, Estruch R, Casas R. Dietary Strategies for Metabolic Syndrome: A Comprehensive Review. Nutrients. 2020 Sep 29;12(10):2983. doi: 10.3390/nu12102983. PMID: 33003472; PMCID: PMC7600579.

Fahed G, Aoun L, Bou Zerdan M, Allam S, Bou Zerdan M, Bouferraa Y, Assi HI. Metabolic Syndrome: Updates on Pathophysiology and Management in 2021. Int J Mol Sci. 2022 Jan 12;23(2):786. doi: 10.3390/ijms23020786. PMID: 35054972; PMCID: PMC8775991.

Zhang et al. Leisure-time physical activity and incident metabolic syndrome: a systematic review and dose-response meta-analysis of cohort studies. Metabolism. 2017 Oct;75:36-44.

Lane MM, Davis JA, Beattie S, Gómez-Donoso C, Loughman A, O’Neil A, Jacka F, Berk M, Page R, Marx W, Rocks T. Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies. Obes Rev. 2021 Mar;22(3):e13146. doi: 10.1111/obr.13146. Epub 2020 Nov 9. PMID: 33167080.

Papadaki A, Nolen-Doerr E, Mantzoros CS. The Effect of the Mediterranean Diet on Metabolic Health: A Systematic Review and Meta-Analysis of Controlled Trials in Adults. Nutrients. 2020 Oct 30;12(11):3342. doi: 10.3390/nu12113342. PMID: 33143083; PMCID: PMC7692768.