Joel Salatin has been called "America's best farmer" by Time magazine.  He is a self-described Christian libertarian environmentalist capitalist lunatic farmer (his words, not mine!).  He runs Polyface Farms and has helped develop the movement of regenerative agriculture, written 12 books, done multiple TED and TEDMED talks, featured in Michael Pollan's bestselling book The Omnivores Dilemma and multiple award-winning documentaries like Food Inc, and he is the Editor of The Stockman Grass Farmer.

Today we talk about the symbiotic connection between the land, soil, animals and our health. 

More info at www.polyfacefarms.com

Joel Salatin's TED talk (one of them): https://www.youtube.com/watch?v=4Z75A_JMBx4

A different regenerative agriculture method called agroforestry by Ernst Gotsch that is not dependent on animals (this is a beautiful short film) https://www.youtube.com/watch?v=gSPNRu4ZPvE&vl=en

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Dr Frank Meumann is a GP with 40 years’ experience and a senior medical educator with General Practice Training Tasmania. He received the 2010 GPET Medical Educator of the Year award for excellence in GP registrar training, and he is the past president of the Balint Society of Australia and New Zealand.

Today we cover an important but often overlooked topic - health professionals reconnecting and supporting each to manage the often difficult natures of our/their jobs, improving doctor-patient relationships and enhancing self-reflection and communication skills.  this seems particularly relevant to the current bushfire and drought crisis in Australia.  One well-established format is Balint Groups, and more can be found here; https://www.balintaustralianewzealand.org/

Book mentioned in the podcast = "Skills for Communicating with Patients, 3rd Edition", Jonathan Silverman, Suzanne Kurtz, Juliet Draper

If you find these podcasts valuable, rating it 5 stars and leaving a review in iTunes or Facebook is a huge help.  

For more podcasts and resources for both health professionals and patients including websites, handouts, courses, apps, books and more, please check out www.thegpshow.com 

You can join The GP Show Podcast Facebook page here.

If you would like to provide feedback or request a topic you can contact us or complete a quick survey here. 

Thank you for listening and supporting.

Dr Guy Leschziner is a consultant neurologist at London Bridge Hospital, the Cromwell Hospital and within the Department of Neurology and Sleep Disorders Centre at Guy's and St Thomas' Hospitals. He is the clinical lead for the Sleep Disorders Centre, Guy's Hospital, one of Europe's largest sleep units. He has presented a three-part series on BBC Radio 4 and BBC World Service on the brain and sleep - "Mysteries of Sleep" and filmed "The Secrets of Sleep" for Channel 4 Television. 

Today we discuss his most excellent recent book "The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep".

Website - http://www.guyleschziner.com

More resources including apps, assessment tools etc at www.thegpshow.com under "Sleep"

Rating 5 stars in iTunes and leaving a positive review is very helpful and much appreciated.

Enjoy friends,

Professor Amanda Barnard is a GP, member of the National Asthma Council Board and Chair of the Australian Asthma Handbook guideline committee, Australia's national guidelines for asthma management.  She is interim head of the School of Rural Medicine, a Charles Sturt University and Western Sydney University joint program in medicine.  She has written and researched widely and is currently a member of the General Practice Advisory Group for the Lung Foundation Australia. An awarded teacher and educator, Amanda currently serves on a number of state and national bodies with education, training, rural workforce and health system briefs.

Australian Asthma Handbook = www.asthmahandbook.org.au

"How-to use" inhalers educational videos = https://www.nationalasthma.org.au/living-with-asthma/how-to-videos

Contents:

1. Review and management of wheezing and asthma in children from 0-12 years
2. Definitions of good vs poor control
3. How often to review
4. Reducing medications
5. General principles of asthma management
6. Referring and resources

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Dr Greg Rowles is a General Practitioner from Riddells Creek in rural Victoria, and a member of an Expert Group which developed and reviewed Version 16 of the Antibiotic Guidelines.

Today we discuss:

• Antibiotic stewardship and practical GP considerations in antibiotic prescribing including shared decision making, penicillin hypersensitivity, paediatric recommendations etc
• Ear nose throat: Acute otitis media and tonsillitis update
• Respiratory: Community-acquired pneumonia update
• Genitourinary: UTI and STI update
• GIT: Diverticulitis and parasite update
• Dermatology: Cellulitis, bite wounds, diabetic foot infection

And tangential questions in-between!

Conflict of interest: Dr Rowles is obviously associated with the Therapeutic Guidelines.  However, there are no conflicts of interest for myself/The GP Show podcast.   I did NOT receive any financial payment for this episode.  

Enjoy friends.

Professor Sir Michael Marmot is Professor of Epidemiology at University College London, Director of the UCL Institute of Health Equity, and Past President of the World Medical Association.

He is the author of The Health Gap: the challenge of an unequal world (Bloomsbury: 2015) and Status Syndrome: how your place on the social gradient directly affects your health (Bloomsbury: 2004).  Professor Marmot holds the Harvard Lown Professorship for 2014-2017 and is the recipient of the Prince Mahidol Award for Public Health 2015. He has been awarded honorary doctorates from 18 universities.

Professor Marmot has led research groups on health inequalities for over 40 years. He chairs the Commission on Equity and Health Inequalities in the Americas, set up in 2015 by the World Health Organizations’ Pan-American Health Organization (PAHO/ WHO).  He was Chair of the Commission on Social Determinants of Health (CSDH), which was set up by the World Health Organization in 2005, and produced the report entitled: ‘Closing the Gap in a Generation’ in August 2008. Professor Marmot served as President of the British Medical Association (BMA) in 2010-2011, and is President of the British Lung Foundation. 

In 2000 he was knighted by Her Majesty The Queen, for services to epidemiology and the understanding of health inequalities.

Today we discuss his 2015 book The Health Gap: the challenge of an unequal world, available at Bloomsbury - https://www.bloomsbury.com/uk/the-health-gap-9781408857991/

This episode is to supplement my interview with Dr David Unwin and is just with me reviewing and discussing some areas in more detail that David and I ran out of time to cover, including:

• Pathophysiology of DMT2 and different dietary considerations
• Environmental and farming practices
• Ending the Diet Wars

Some further reading for those that want it:

Environmental considerations: https://www.lifestylemedicine.org.au/content/is-the-path-to-health-the-same-path-to-environmental-sustainability/

Nutrition: Principles Before Position Part 3: The externalities of our food choices https://thegpshow.com/musings/pntpart3/ 

University of Oxford Grazed and Confused report: https://www.oxfordmartin.ox.ac.uk/downloads/reports/fcrn_gnc_report.pdf 

UK Sustainable Food Trust: https://sustainablefoodtrust.org/articles/grazed-and-confused-an-initial-response-from-the-sustainable-food-trust/

EAT Lancet: https://eatforum.org/ and https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30055-3/fulltext 

2019 Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report from the American Diabetes Association https://care.diabetesjournals.org/content/diacare/early/2019/04/10/dci19-0014.full.pdf

Diabetes Australia position statement on low carb approaches https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/dbd70857-a834-45b0-b6f1-ea2582bbe5c7.pdf

Metabolic ward studies/randomised controlled feeding studies on various dietary composition:

https://www.ncbi.nlm.nih.gov/pubmed/29844096

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951141/

Other paper on dietary composition: https://jim.bmj.com/content/65/8/1102

Five Stages of Evolving Beta-Cell Dysfunction During Progression to Diabetes https://diabetes.diabetesjournals.org/content/53/suppl_3/S16

Combination of saturated fats with high GI carbs causing further disease that saturated fats alone in "Saturated fat, carbohydrates and cardiovascular disease", 2011 https://www.ncbi.nlm.nih.gov/pubmed/21978979

Insulinogenic response of foods https://www.ncbi.nlm.nih.gov/pubmed/9356547

Personalized Nutrition by Prediction of Glycemic Responses https://www.ncbi.nlm.nih.gov/pubmed/26590418

Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis (observational) https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext

High/low animal protein diets and CVD:

https://www.ncbi.nlm.nih.gov/pubmed/11108325

Dr Ornish Lifestyle Heart Disease Reversal study https://www.ncbi.nlm.nih.gov/pubmed/9863851

Other potentials for low carb approaches:

The Therapeutic Potential of Ketogenic Diet Throughout Life: Focus on Metabolic, Neurodevelopmental and Neurodegenerative Disorders, 2019, Professor Sarnyai et al  https://www.ncbi.nlm.nih.gov/pubmed/31493223

Adherence to diets: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302176/

https://pubmed.ncbi.nlm.nih.gov/29522789/ 

https://www.mdpi.com/2072-6643/12/5/1251 

Enjoy friends

Dr David Unwin is a GP based in the UK.  He is a Royal College of General Practitioners (RCGP) clinical expert in diabetes, RCGP National Champion for Collaborative Care and Support Planning in Obesity & Diabetes, Ambassador for the All Party Parliamentary Group on Diabetes, Founder member of The Public Health Collaboration Senior Collaborator NNEdPro at Cambridge (Need for Nutrition Education / Innovation Programme) and NHS Innovator of the year 2016.  He has published multiple times on his low carb cohort and in 2017/18 his practice saved £57,000 on drugs for type 2 diabetes, hypertension and other conditions by offering patients a dietary alternative to medications.

Today we discuss Low Carb for Diabetes.  

References:

2019 Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report from the American Diabetes Association https://care.diabetesjournals.org/content/diacare/early/2019/04/10/dci19-0014.full.pdf

Diabetes Australia position statement on "Low carbohydrate eating for people with diabetes" https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/dbd70857-a834-45b0-b6f1-ea2582bbe5c7.pdf

Part 2 will follow this with just me following up on a few points.

Enjoy friends.

Professor Gregory Phillips is the CEO of Abstarr consulting and Professor of First People’s Health in the School of Medicine at Griffith University.  Gregory is from the Waanyi and Jaru Aboriginal Australian peoples and comes from Cloncurry and Mount Isa. He is a leading change maker, thought leader and medical anthropologist.  He developed an accredited Indigenous health curriculum for all medical schools in Australia and New Zealand, founded the Leaders in Indigenous Medical Education (LIME) Network, and co-wrote a national Indigenous health workforce strategy. He established the Aboriginal and Torres Strait Islander Healing Foundation Ltd in the wake of the federal apology to Indigenous Australians, has advised federal ministers on Indigenous health inequality and was honoured in 2011 with an ADC Australian Leadership Forum Award. 

More info at:

http://abstarr.com/

https://www.limenetwork.net.au/

Today we discuss Aboriginal and Torres Strait Islander (ATSI) knowledge in the context of modern healthcare.  

1. The context of history and its impact on ongoing health factors in ATSI peoples
2. Some of the challenges and frustrations faced by ATSI people in healthcare, and in particular the prevalence and impact of unconscious bias/racial bias
3. Positive examples that we can learn about and the resilience and strength demonstrated
4. The differences in approaches to healthcare
5. What is cultural safety?
6. What aspects and values of Aboriginal culture can the health system learn from, adopt and apply?
7. In a clinical setting, how can we change our approach to work with Aboriginal people?  
8. Ongoing resources

Apologies for the less than ideal sound quality (mostly when I am talking) as we had to use a backup recording software.

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Dr Joseph Firth completed his PhD at The University of Manchester in the United Kingdom. His initial research projects investigated the physiological and psychological effects of physical activity in young people with mental illness. Since then, his research has expanded to cover multiple aspects of health behaviours (including physical activity, sedentary behaviour, sleep, technology and diet) and the interaction this has with mental illness and brain health - particularly in young people. Dr Firth has published over 100 peer-reviewed articles in leading medical journals and recently headed The Lancet Psychiatry Commission on a blueprint for protecting physical health in people with mental illness.

Full commission: https://www.thelancet.com/commissions/physical-health-in-mental-illness

There are no conflicts of interest to declare.

Enjoy friends.