The GP Show

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.

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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

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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.

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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.

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Dr Ron Granot is a specialist neurologist working in Bondi Junction, Sydney. He is involved in various research projects and has appeared on multiple radio and TV platforms. He writes a blog on his website https://eastneurology.com.au/.

Today we discuss migraines, including:

• Prevalence
• Pathophysiology and risk factors
• Types of migraines
• Diagnostic features
• Role of investigations
• Management = Acute, lifestyle, prophylaxis including new medications like Erenumab
• Botox
• Future treatments on the horizon
• Resources for therapists

Some info on biofeedback, relaxation for those interested = https://headaches.org/resources/

Good mindfulness apps = Smiling Minds, Headspace

There are no conflicts of interest to declare.

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Dr John Sykes is a GP in Sydney, trained in the UK, a certified nutritionist with Mac-Nutrition Universal and a Trustee and Director of the British Society of Lifestyle Medicine.

Today we discuss physical activity vs sedentary behaviour.

Moving Medicine – a useful resource for clinicians that gives advice on how to discuss exercise for several different medical conditions: https://movingmedicine.ac.uk

Parkrun – Information about the volunteer-led association of Parkrun and how to get involved: https://www.parkrun.com

International Obesity Conference October 16-18 via ANZOS-ASLM-ICCR mentioned at the beginning of the podcast:

http://anzos-aslm-iccr.org/

David Katz Lifestyle Medicine Masterclass October 19:

http://anzos-aslm-iccr.org/post-conference-masterclass-with-dr-david-katz/

Podcast with Dr David Katz "The Truth About Food" - http://thegpshow.libsyn.com/the-truth-about-food-with-dr-david-katz-md

Use the code "thegpshow" when becoming a member of ASLM and the first year is only $110.

https://www.lifestylemedicine.org.au

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Professor Craig Pennell is Chair in Obstetrics and Gynaecology and Professor in Maternal-Fetal Medicine at the University of Newcastle (John Hunter Hospital). He is also a senior researcher at Hunter Medical Research Institute HMRI in the Mothers and Babies Research Centre within the Priority Research Centre in Reproductive Health and Chair of the National Scientific Advisory Group of Red Nose. His research can best be categorised into personalised medicine in perinatal health and the developmental origins of health and disease. His research is focussed on the use of genetics and genomics to predict and prevent preterm birth and non-communicable diseases. Over his research career, he has written more than 200 papers with 4 in Nature, 19 in Nature Genetics and 5 in Nature Communications.

Today we discuss the Developmental Origins of Health and Disease (DOHaD).

Further resources:

1. https://dohadsoc.org/
2. DOHaD 2019 conference October 20-23 Melbourne = https://dohadsoc.org/dohad-world-congress/
3. Patients: https://thousanddays.org
4. www.telethonkids.org.au
5. https://www.telethonkids.org.au/information-for/parents-and-families/

Further episodes at www.facebook.com/thegpshow.podcast

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