Playing sport might protect against concussion harms

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So, Tegan, have you ever had a concussion?

Yes. When I was about seven or eight, I fell off a slide at a public pool,

like a water slide, and smacked my head on the concrete

and had several days of feeling really nauseous and dizzy.

But it cleared up. I haven't really thought much about it since.

How about you?

Yeah, I've had a couple of concussions.

One was when I was filming for Four Corners.

We were filming secretly on a boat.

And being a young cub reporter, I was helping the crew on with their gear.

And I slipped and fell and hit the back of my head on the wharf

and fell into the water unconscious.

And I'm here to tell the story because there was somebody fishing on the wharf,

because nobody else noticed it because it was really quiet,

and fished me out of the water.

I felt pretty crap for a few days.

But I had to film on the boat without my specs on.

For the rest of that day.

Oh, gosh, seasickness and concussion sounds like a horrible combination.

Yeah, no time out with the ABC.

I mean, so you obviously remember your concussions.

There's probably people who might have had one and not remembered it.

There's actually not a lot that we know about mild concussions

because it's not something we hear a lot about.

But as I will tell you in a little while, that's starting to change.

What we do hear a lot about is concussion in sport.

But I've been speaking to someone who reckons that the long-term impacts of concussion,

it might be mitigated by playing sport.

Fascinating.

Well, that's coming up on The Health Report with me, Norman Swan.

And me, Tegan Taylor.

And today, we are both on Jagera and Turrbal land.

Also ahead, we know it's hard to get men to go to the doctors.

And men have a shorter life expectancy.

And perhaps not going to the doctor when you need to is part of that.

We're going to be talking about two symptoms,

which might indicate to men that they need to get along to see their GP.

One of them is erectile dysfunction, which I suppose is a motivator.

And the other is getting up to pee during the night,

which many men might think is just part of aging or an enlarged prostate, but maybe not.

And you've also got a story about why it is so hard to prize

a screen out of a preschool kid's sticky little hands.

Yeah, you might get an angry reaction, an angrier than you think.

And the angry reaction may be actually the result of the screen itself,

particularly a tablet.

A fascinating study of the use of iPads and tablets in preschoolers.

Parents.

And grandparents just turned the volume right up on this one.

So let's get on to news.

It's a juicy news section for us this week, Norman.

I thought about trying to limit the number of stories, but I've just decided to go all in.

And I want to start with supermodel Elle Macpherson.

She's done an interview with the Women's Weekly.

Yes, this is a health story.

It's not just a celebrity spotting segment now.

And pretty much the backstory here is that some years ago,

Elle Macpherson was diagnosed with breast cancer.

And this interview that she's done is all about,

she decided not to go the medicine route with chemo and radiation.

She's gone for alternative therapies,

which is a choice that someone is free to make about their own body.

But given her platform and the fact that she runs a wellness company,

there's a real chance, I suppose, that people take her choice as health advice.

Yeah.

Your history to this in terms of celebrities making a difference to women with breast cancer.

You had Olivia Newton-John.

You had Kylie Minogue.

And largely, the messages were very positive and in terms of involvement.

And in fact, Olivia Newton-John was herself committed to complementary medicine in cancer,

but not at the expense of regular treatment.

So this has had a lot of coverage in terms of Elle Macpherson.

And there's a danger to this story.

So she thinks that complementary medicine solved her problem with her breast cancer.

It turns out, at least looking at the reporting in the Women's Weekly,

that what her form of breast cancer was not invasive breast cancer.

It was what's called ductal carcinoma in situ.

Ductal carcinoma in situ is where the cancer has not invaded the rest of the tissues.

And there's this huge debate about in what proportion of women it will go on to actually turn out to be cancer.

And it's very hard to predict which.

Again, according to the reporting, she had a genetic abnormality in the tumor,

which suggests it was prone to growth.

But nonetheless, it's thought that maybe about 30 percent of women with DCI,

ductal carcinoma in situ, will not go on to get cancer.

And I think that really Elle Macpherson has been lucky.

She's just probably lucky that she's part of that 30 percent.

But it's a roll of the dice.

And here's the kicker to this story, is that breast cancer has become a chronic disease.

Women live for a long time with breast cancer.

And that has not occurred because women are eating mung beans or on complementary therapies.

It's happened because they are able to...

typify the breast cancer better, target treatment more closely,

and shown that...

And not every woman needs the full battery of chemotherapy and radiation therapy.

It really depends on a woman's circumstances, whether she's postmenopausal or menopausal and so on.

It's a complicated story.

But because what's called the adjunctive therapy, which is you have the lump out,

and then you have appropriate chemotherapy and radiation therapy,

that's why women are living longer with breast cancer.

We haven't had...

There's a massive mass uptake of complementary medicine in breast cancer.

In fact, the use of complementary medicine is incredibly common in people with cancer.

But it's common in the context of their regular treatment.

It gives people back control.

It almost certainly makes them feel better.

But the best complementary therapy you can do is a great diet and exercise.

Exercise improves outcomes with all forms of cancer pretty much.

And if you want to call that complementary therapy,

then fine.

But many women and men with cancer will choose some complementary therapies.

But most complementary therapy practitioners are responsible and don't say,

stop doing this.

I'm always a bit cautious of weighing into celebrity stories like this.

But given that this has had so much coverage,

I think it's important for us to sort of talk about it.

Like, what's the takeaway message for our audience?

Look, I think there are a couple of messages here.

One is, don't be afraid of complementary therapies if that's what you want to do.

But don't give up on exercise and good nutrition.

And don't...

And don't give up on the regular treatment.

And if you've got total carcinoma inside you,

there is a chance that it won't go on to breast cancer.

But it's just a chance.

I think that Elle McPherson has probably won the lottery on that one.

But you don't know.

And specialists don't know whether it's going to progress.

And if you want to be safe and live a long time, go for the regular treatment.

And so another story that kind of plays into cancer and hype

is this long-running claim that has again been debunked,

maybe linking mobile phone use to cancer.

And so there's been a huge review of the highest quality evidence around.

It's been commissioned by the World Health Organization

and again found, no, the link isn't there.

There has been a sense for some time that radiation in the form of radio waves,

some people believe from the electrical supply,

causes cancer or interferes with cells.

The biology behind this is dubious.

But mobile phone use is so ubiquitous and everybody's using it.

But if indeed there was a risk, we'd see booming rates of brain cancer.

And we're not.

We're not.

Brain cancer rates are roughly stable and they might have gone up a little.

But if there was a real problem here, they would have rocketed up

the way lung cancer rocketed up with smoking.

And smoking was almost ubiquitous in the 40s and 50s.

And what this study from WHO is, is a review of the evidence.

And there have been many, many studies there.

And there's no signal there at all, so to speak.

And one more piece of research news that I wanted to chat about

because it feels like it validates my life choices.

And in saying that, it feels too good to be true.

We love it.

So this is a study that was presented to a meeting

of the European Society of Cardiology.

And the claim is that people who didn't sleep enough in the week

but caught up on missleep at the weekend,

i.e. had a sleep in on a Saturday or a Sunday,

had a lower risk of heart disease compared to those who don't.

Tell me this is true.

Well, the people who did the study think it's true.

This is from a database called the UK Biobank Study

where hundreds of thousands of people in the UK have agreed,

very generously, to be registered with this study.

They've had biological samples taken.

Many of them have actually had their genes done.

And we know lots about their health and well-being

and their lifestyle and so on.

So from this study, they looked at about 20,000,

just under 20,000 people who were sleep-deprived

as defined by having fewer than seven hours sleep a night.

So that's quite a lot of sleep.

This is you talking.

Yeah, and we've also heard that less sleep increases your risk,

of coronary heart disease.

This is not necessarily a clean study to look at,

much as we'd like to think that catch-up sleep is good for you.

And it may be people who can have catch-up sleep

are in different circumstances, socially, economically,

from people who can't.

And those circumstances may increase or decrease

their risk of coronary heart disease.

It would be great to think that we could,

but who's going to knock a sleep in on a Saturday morning?

Well, it is very...

It is very apt for us to be talking about this

because it is sleep-tember, according to the ABC,

where we're focusing on sleep this month.

And on our other podcast, which is called What's That Rash?

This week, we are actually digging into sleep

and answering as many of your sleep questions as we can

in the short, short time we have.

So make sure you search What's That Rash

and have a listen to that one.

You're listening to The Health Report here on Radio National.

So Norman, I want to revisit a topic

that we talked about a couple of weeks ago,

which was basically around kids and screen use.

A couple of weeks ago, we talked about

whether screen content mattered more than screen time.

Today, we're going to talk more about the behavior challenges

that seem to arise when especially young kids

get a lot of screen time.

If you talk to people in early childhood education and care,

they are seeing unprecedented levels of challenging behaviors.

These are kids who are acting out.

They're angry and frustrated,

and they cannot control their emotions.

And it's a huge problem.

And it's going into school

because one of the things

that predicts successful transition to school

is emotional self-regulation.

Can a child control their emotions,

control their frustrations,

and as a result, get on better with other kids

and express themselves clearly

in terms of their wants and desires?

So this is a problem.

What's causing it?

A study in Canada has looked at iPad tablet use.

I use the word iPad because if I just say tablet use,

you'd think, well,

I'm just swallowing Panadol.

Make a difference to children's behavior.

So we're talking about electronic tablets here

and childhood use.

Now, it turns out, this is an amazing statistic,

that nine out of 10 children aged four in the United States

have an iPad or a tablet of their own.

And we don't know what that number is in Australia,

but people say it's pretty high,

but probably not as high as that.

The question is, what effect, if any, is that having?

So this is a longitudinal study,

which means they followed kids for about two or three years

from the ages of three to five

and repeatedly checked in with parents

about time not spent on the screen.

So they didn't look so much at content

and particularly monitoring challenging behavior.

So emotional outbursts, angry outbursts.

And the person who led this study

is Dr. Gabrielle Garand-Carrier,

who is in the Department of Psychoeducation

at the University of Sherbrooke.

In Quebec.

We were looking at outbursts of anger,

the tendency of the child to express anger and frustration

during daily routines.

So for example, telling the child that it's time to go to bed.

And so the child becomes very angry

and manifests some behaviors of frustration, for example.

And so we examined the associations

between child tablet use and expression of anger and frustration.

And what we found is that child tablet use at the age of three,

was associated with increased expression of anger and frustration

one year later at the age of four.

And in turn, greater proneness and expression of anger and frustration

led children to use more tablet at the age of five years.

So in other words, if they were expressing more challenging behaviors

or emotional outbursts,

that was also correlated with increased tablet use at age five.

Exactly.

And so that's why we're talking about this vicious cycle,

cycles during the preschool years,

where when you spend more time in front of the tablet,

it leads to more challenging behaviors

or lower ability to adequately regulate their emotions.

And in turn, it seems that they internalize this

of when I have some frustration and anger,

I tend to use a tablet to calm myself.

So what you're saying, in a sense,

if there is a cause and effect here,

the children are self-medicating their behavior with their tablet.

Yeah.

They regulate their emotion with an external object,

which is called the tablet.

Yeah.

Now, there's a mountain of other factors here

because all you've shown is an association

that tablet use is linked to challenging behaviors.

But challenging behaviors are also related to your zip code,

your postcode, where you live, the village,

what you see around you as a child, parenting style,

how well-educated your parents are,

how much money is in the household.

So all sorts of other things could have influenced this.

And tablet use,

it's got nothing to do with the challenging behaviors.

And also, if it's a real cause and effect,

then there's a dose effect.

The more tablet use, the more problematic the behavior.

So can you just disentangle that a little bit

in terms of how we get to a stronger notion

that this is cause and effect?

The type of methodology that we use,

we compare each child to himself or herself across times.

And by doing so,

it accounts for several type of confounding variables

that we don't need to control for.

Such as socioeconomic status are already taken into account.

And the dose effect, more use, more problems?

Yeah, significant more problematic behaviors.

On the basis of the precautionary principle in public health,

what's the public health implication of this?

No tablets for preschoolers?

I think the implication is just to be informed

and careful and cautious.

I do not think this paper shows

that we should not at all expose children to screen,

but we should definitely try to limit the exposure to screens,

especially when they're young,

because they do a lot of new learning during their preschool years.

It is not something that you can learn in front of a tablet

or in front of a screen.

This is something that you learn

when you're actually in interaction with other humans,

other children, adults,

so that you know how to decode the emotions,

understand the social context and manage it adequately.

So you believe that if it's cause and effect,

it's actually that the child is on the screen

and not interacting with other human beings,

learning how to control their emotions?

Yeah.

For most children, especially in our study,

some parents kind of use the tablets as a digital pacifier.

They use the tablets for the parents to have more time

to be on the daily occupation.

Okay.

Out of this study and your other work,

what's your advice for parents of young kids?

It's to limit the time spent in front of tablets for young children,

especially when they're during the preschool years,

and to closely monitor preschool-age children's tablet use.

We also recommend for families to adopt a screen media use plan

so that can set out the limits and rules of screen use

for each family members.

And this is a great way to manage screen within the families.

So it's not just the child,

but it also involves the parents

because parents should be aware of their own screen use,

especially in the presence of children.

And at last, I would say that parents should be careful

to avoid using screens as a digital pacifier

or as a tool to calm children

when they're experiencing strong emotions.

So it might be very appealing for parents

when the child has challenging behaviors

to prevent them from using screens.

Provide with a tablet so that the child can calm himself,

but it might backfire later on.

Dr. Gabrielle Garon-Carrie is in the Department of Psychoeducation

at the University of Sherbrooke in Canberra, Canada.

So the Australian guidelines,

which is sort of part of the physical activity

and exercise guidelines that the health department put out,

say that for preschoolers, these kids sort of age three to five,

that you shouldn't allow more than about an hour

of sedentary screen time per day.

And they say that less is better,

which kind of puts some of that into perspective.

When you see how low that recommended amount is.

This study showed that for every hour on a screen,

you've got something like a 22% increase

in challenging behaviors.

And the question here is whether or not

they should be on screens at all.

I do wonder how much like parenting styles

and a child's temperament plays into this though.

Those things all play a role.

The way the study was designed is that stable factors,

such as income, education,

and perhaps that parenting style,

assuming that it was constant,

then all those factors are held constant.

The screen use was the significant variable.

And the children tended not to have challenging behaviors

at the start of the study.

So this was the evolution or worsening of challenging behaviors

through the study.

And then that feedback loop into more screen use.

Whilst you can never say cause and effect,

it was a pretty conclusive, strong association.

Which starts to get close to cause and effect.

It's a fertile field for more study by the sands of it as well.

It is indeed.

On Radio National, you're with the Health Report.

And coming up here on the Health Report,

symptoms in men, which indicate that they should really go

and see their GP and the symptoms are below the belt.

But what do they indicate?

You've got to stay away.

Stay away.

Stay on with the Health Report to find out.

All right, then.

So we've heard a lot in the last few years

about how damaging concussion can be to your long-term brain health.

And a lot of the research that comes out has been about professional athletes.

Huge publicity about this.

Although I've come across neurologists

who are just that little bit skeptical about it.

You know, they say, are we making more of this than is there?

But there's no question that concussion is brain injury

and we've got to be careful about it.

But you've found that maybe,

there is something that can reduce the risk of long-term effects.

So we're talking about concussion in sport.

And I suppose whenever we're talking about concussion and sport,

we're talking about a very broad spectrum.

There's people who play high-impact sports professionally,

which means they've probably been playing them since they were a child,

right through to adulthood,

multiple severe brain knocks throughout their lives.

And then on the other hand, you have, you know, recreational users of sport.

And that's really what this study is all about.

And it's a study that turns a lot of what we thought we knew

about concussion on its head, so to speak,

it's found that for the average person having a sports-related concussion

didn't seem to have a detrimental effect on cognition.

It was actually linked to performing better in some areas.

Gosh, that's really counterintuitive.

It is, isn't it?

So I've been chatting with the lead author, Dr. Matthew Lennon,

who's from the Center for Healthy Brain Aging at the University of New South Wales,

about how this seems to go against everything we've heard in recent years.

It's interesting, right?

Because what we have heard is from the people that we look to,

with regards to sports, and from the people that we see getting concussed.

And who are they?

They're professional sports people.

They're the AFL players, they're the NRL players,

they're the American football players.

And the stories that we hear are pretty devastating.

We're hearing they're getting concussed week in and week out.

And we're hearing from older players in their 50s and 60s

that they're suffering from depression, from cognitive impairment.

And I've no doubt that these cases are real.

And we know that concussion is kind of intuitive,

that getting smashed in the head time and time again

and getting knocked out is not a good thing for you.

But whether we can generalize those findings

to people playing community sport at a non-professional level

is not something that's been properly investigated.

And that's what our study's about.

So you've looked at a huge data set of mostly older people,

50 to 90 years old, over a number of years,

basically asked them if they've ever had concussion before.

And in brief, tell me if I'm wrong,

you found that...

that if someone had had a sports-related concussion,

it didn't seem to affect their cognitive ability.

In fact, it almost went the other way.

Correct.

We should clarify that that's only for some domains.

So we looked at five different domains of cognition

and one behavioral domain.

And what we found was that if you'd had a sports-related concussion,

then you had marginally better working memory and verbal reasoning

than people who'd never had a concussion.

But when we looked at the data set,

we looked at people by the number of concussions they'd had.

If you had more than one sports-related concussion,

then there was no beneficial effect.

So the beneficial effect is small.

And we don't think it's related to the concussion itself.

We think it's related to the kinds of people

who get sports-related concussions,

that is, people who play sport.

But what was interesting was that across the board,

across all the measures we looked at,

there wasn't any deficits associated with people

who'd had any sports-related concussions,

zero.

One, two, or three-plus sports-related concussions

compared to people who hadn't had any.

That was really against what you might intuit

and what certainly the public sentiment seems to be at the moment.

Yeah, talk to me about what you think is going on here.

You sort of hinted at it before.

It's a really interesting finding.

And I think what it points towards is that there are lots of things

that are risks to our long-term cognitive health and longevity.

We know that around a third of Australians are obese

and another third are overweight.

We know that around one in 20 Australians have diabetes

and one in 10 have diagnosed high blood pressure.

We've probably doubled that walking around with actual high blood pressure

because with high blood pressure,

there's about 50% of people who are undiagnosed.

We know that people are more socially isolated and lonely than ever.

And we know that all of those things contribute to cognitive decline,

even social isolation.

That's some work that the Centre for Healthy Brain Ageing

has been doing over the last few years.

It's looking at social isolation.

And then we also know that having concussions

is a risk to your cognitive health.

But if playing sport means that you are more physically active,

that you have lower rates of obesity and being overweight,

that you have lower diabetes, lower cholesterol, lower hypertension,

that you're more socially integrated

and you kind of have a more solid community around you,

maybe playing sport, all those things,

mitigates the risk of being,

and I think that might be what we're seeing

because the other side of our study was

we looked at other kinds of concussion.

So concussion from falling over

or concussion from being in a motor vehicle accident.

And actually we did find that people

who'd had multiple concussions in other domains

had cognitive deficits

compared to people who'd never been concussed.

So it isn't that all concussions are equal

and it may be that sports-related concussions,

there's some benefits associated with playing sport.

But there's also some benefits associated with playing sport.

that may mitigate or compensate for the risk of being injured.

So what should sporting bodies take away from this?

Recreational sport is probably more protective than harmful,

but professional sport still needs to have a lot of caution?

Our study didn't look at professional sport.

There's more research out there on professional sport

and the risks for cognition.

But I think that the sporting bodies,

they often do tend to focus on the professional sport,

on the people who are in front of the television,

on the cameras that are making the money.

But in some ways, it's the community sport that's more important,

especially for a public health point of view,

because that's where the vast majority of sports players are going to be.

They're not going to be in the professional leagues.

And so identifying and promoting those social and physical

and cognitive benefits of playing sport

is going to be really crucial

if we're going to see sporting participation rise in the future

instead of continuing to decline.

Thank you.

Lennon is a researcher at the Centre of Healthy Brain Ageing

at the University of New South Wales,

and he's also a local doctor in Sydney.

He's just finished his PhD, so he's now a doctor squared.

Great, doctor, doctor.

So how much do we know about really what's going on in the brain

in mild concussion?

It's really hard for us to know on that milder end of the spectrum

what's happening because it's hard to find people to study.

If something's mild, people may be less likely to go to the doctor

in the first place or to have follow-up.

They may be less likely to be captured.

A new study from Curtin University,

different researchers are trying to change this.

They're asking people to use an app to track their symptoms

so that they can get better insights

into why some people recover better than others

from quote-unquote mild concussions.

Leading this study is Professor Melinda Fitzgerald.

It's estimated that only about half of people

who experience a mild traumatic brain injury or a concussion

actually seek medical care.

So it's very difficult to collect data from people,

and we have to resort to novel methods

that rely on people self-reporting their symptoms.

So the study that you are embarking on now,

the data isn't in yet,

but what do we currently know about mild traumatic brain injury or concussion?

We know that most people will recover fine after a concussion.

After a few weeks, their symptoms will resolve

and they'll be back to their normal lives.

However, estimates of about 25% to even up to 50% of people

can have continuing symptoms that last for longer.

So it's very difficult to collect data from people

for months and in some cases even years after their injury.

The difficulty is that we don't know what it is

about the person and their injury,

perhaps some of their pre-existing health conditions

or other things about their circumstances

that influence whether or not they are going to recover

quickly and normally

or whether they're going to continue to have problems

after their concussion.

How do you hope the use of the app will help you gather this data?

So this app is quite a bit of a world-famous app.

First, we're actually gathering a much broader range of data

from people who have experienced a concussion.

We're going to learn about people's pre-existing health conditions,

a bit more about their injury and about their circumstances

and also what sort of treatment they seek

and how they act, whether they exercise or not.

And so we'll be able to gather all of that information

and from it we'll be able to determine what it is

about the person and their injury

that predicts how well they go or not.

And then we can use that information to redesign the app

and have a tailored management and care plan

for an individual based on what we learn.

So this is something that you've researched

and published on several times.

What do you think are some of the pervasive misconceptions

around concussion in Australia?

Well, there are a few.

I think a lot of people,

a lot of people think that concussion is something

that happens on the sporting field.

But in actual fact, only 20% of concussions occur

as a result of sports.

The vast majority occur in the home or out and about,

motor vehicle accidents, falls.

There's a big spike when people are young

with the normal activities in the playground

and then when people are elderly.

So a lot of elderly people in community

experience concussion injuries

and they're not going to be able to get out of the car.

And they're often not detected

because you have quite a lot of confounding factors.

They might already be having a few difficulties

in thinking and cognition.

And they also don't necessarily want to report things

because they don't want to be seen as not coping.

So there's that incidence element.

And also another pervasive misconception

is that it's just getting your bell rung.

It's just a head knock.

In actual fact, we do need to manage concussion well.

And there are new guidelines

that have just recently been developed and released.

And those guidelines clearly step out

how people can recover well

in terms of best practice evidence-based care

as we know it now.

So the best thing is not complete rest for a week.

It's actually to take things easy for the first day or two,

but then to gradually get back

into the activities of daily living in a graded way.

So you increase activities,

a bit, and then a bit more the next day and so forth.

When are you expecting the results

from this study that you've just begun?

Well, we are going to be recruiting

as quickly as we can this year.

And then I'm hoping that we'll be able

to revise the Hedge Tech app further.

And I hope that that will be out by the end of next year.

It's actually the benefit to the individual

to sign up to the study

because you'll be able to track your own symptoms

with a graph so that you can then show that to the doctor

and sort of see if there's any problems.

And then we'll be able to revise the Hedge Tech app

and sort of revise the Hedge Tech app further.

And I hope that that will be out by the end of next year.

And I hope that you'll have a clear record

of your recovery following concussion.

So that was Professor Melinda Fitzgerald.

She's leading the Australian Mild Traumatic Brain Injury Study.

She's also Deputy Vice-Chancellor at Curtin University.

And we'll put links to the app

as well as the recently updated

Concussion Management Guidelines

on the Health Report website.

The Health Report on Radio National.

I feel like since I joined the show, Norman,

we do a lot more women's health stories

than perhaps is fair.

Yeah, well, we're both feminists, so why not?

But I think today it's important to talk about men's health

because this is actually a genuinely

very important story for men.

Yeah, men's life expectancy is less than women

by two or three years.

By the way, that's a universal phenomenon through nature.

So you look at most animal species,

the male of the species lives less long

than the female of the species.

Not entirely clear why.

So one of the things in human males is

once they've survived childhood

and the death rate of male babies

is higher than female babies

and accidents in childhood

and so on.

But once you get to adulthood,

one of the thoughts is

that men are dying prematurely

because they're not getting adequate medical care

because they're late going to see the doctor.

Right.

So women may be more proactive in seeing doctors

or maybe just more likely to be at the doctor regularly

because they're getting birth control prescriptions

and that sort of thing.

So this is a really good reason to go and see a doctor.

Well, what is the reason to go and see your doctor?

Obviously, if you've got symptoms like chest pain

or weight loss or trouble thinking,

then it's obvious that you're going to do that.

But you've often got to be dragged by your partner

kicking and screaming to see the doctor.

But a group at the Royal Adelaide Hospital

reckon that there are two symptoms

that men think are due to aging,

which might be due to preventable causes.

One is erectile dysfunction.

The literature around that's fairly clear

is that men with diabetes and heart disease

have problems with their erectile function.

But the other is something that medical students,

doctors are taught, and indeed the public are taught,

is that when you get up at night to pass water,

it's because you've got an enlarged prostate.

Well, in some men, it may not be because they've got an enlarged prostate.

It may be due to other factors.

And that's why I spoke to Dr. Sam Tafari,

who's an andrology, in other words,

a study of men's health,

and men's health fellow at the Royal Adelaide Hospital.

See, the point that we're making

is that these are important canaries in the coal mine

and we're really out to seek them out

and help get men the treatment they need

before they have adverse health outcomes.

Let's now look at the evidence.

We'll come to erectile dysfunction in a minute.

Let's talk about what you call

lower urinary tract symptoms in men,

which is getting up during the night and passing water.

I wasn't aware that this was a risk factor for anything

other than a large prostate.

Yeah, and that's unfortunately a misconception

that the broader community has,

but also really hasn't been challenged

in medical education at all either.

But I've been working with Professor Gary Widdett

from the Freemason Centre of Men's Health and Wellbeing,

and initially an observation he'd made,

and later what he's characterised

in several publications has been

that actually getting up overnight to pass urine

has a number of associations.

It's been associated with things like depression,

sleep apnea, high blood pressure,

elevated cholesterol,

and indeed even an increased risk of cardiovascular events.

So we're not saying that all men

who get up overnight to pass urine have this.

Certainly a proportion do have enlarged prostates

and prostate symptoms,

but we think that men who are having a degree

of passing urine overnight

are certainly at an increased risk of these conditions.

If you're getting up during the night,

what's the mechanism that ties it to heart disease?

I can see about getting up,

you wake up because you're depressed or anxious

and your bladder feels full

and you go and empty your bladder,

but that's not what's walking you up.

It's the fact that you've got a psychological issue.

But what's the line between getting up during the night

and cardiac disease?

What we think it is,

is it probably reflects a degree of underlying dysfunction

of both the muscles

and the lining of the urethra and the inner bladder.

So we think it sort of mirrors

what happens in the blood vessels, for instance,

in someone who's got erectile,

where, for instance, in erectile dysfunction,

we think that they're through a number of issues.

The function of the lining of blood vessels is impaired

and that leads to an increased risk of cardiovascular disease.

And so we think that looking at the sort of internal lining

of the bladder and the urethra around the prostate,

as well as the muscles that come in and around that area,

that these risk factors impair their function

and lead to these sorts of symptoms,

which include urine frequency and passing urine overnight.

There's also the thought that even in people with depression

that a degree of cardiac disease is a risk factor.

So we think that there's a risk factor

that a degree of this might even be inflammation-mediated.

Something's going on in your brain

that's triggered by the immune system

helping to cause the depression.

Yeah, no, that's what we're thinking at the moment.

Now, erectile dysfunction is incredibly complicated,

but it is commoner in men with diabetes,

with heart disease, and who are overweight or obese.

As you've said, it's easier to link erectile dysfunction with those.

And my understanding is there's some evidence

that if you can reverse the cardiovascular disease,

diabetes and obesity,

in fact, the erectile dysfunction improves.

Yes.

This is an area of...

Evolving research,

but certainly looking at things like dropping weight,

improving diabetic control,

stopping smoking,

cutting back on alcohol consumption.

With all these things,

there is evidence that there is some improvement

in the degree of erectile dysfunction.

Even, you know, if someone who's got sleep apnea,

using a CPAP device can lead to an improvement in symptoms.

So we think this is really great

because not only, one, does erectile dysfunction

potentially represent underlying health problems

that we need to identify and get to the bottom of,

but two, this is something that really affects a man's quality.

So, you know, if we can identify it

and to an extent reverse the degree of erectile dysfunction

that they have,

then that's a great way to get a bit of immediate buy-in from men.

The question is,

is there any proof that intervening makes any difference at all?

You're making a promise to men,

turn up at your GP,

go and get checked up.

Well, it doesn't make any difference.

We know already there's a risk getting your PSA done randomly.

You might end up being overtreated for prostate cancer

that doesn't matter.

There's potential harm in getting men to turn up

with symptoms.

If you're not promising an improvement.

What we think this is more than anything

isn't a chance to make up for

what might be gaps in engaging men in primary care.

So you want to scare the shit out of them

so they turn up at their GP.

Is that what you're doing?

Not necessarily.

We're just wanting to say that these symptoms

can be representative of an underlying problem.

We're not saying that they definitively always are,

but we're saying that there is a chance they could be.

You know, men have a somewhat lower health literacy than women.

And this leads to a number of behaviours

that lead to sometimes delayed diabetics,

and unfortunately increased morbidity and mortality.

We have this habit where we say,

look, I've noticed something's not quite right,

but look, I'm just going to watch it.

Maybe it'll get a bit better.

If it gets to the point where it's affecting me,

then I'll go see my doctor.

The other thing that sometimes is present in men as well,

men who are older are less likely

to take care of their doctor with this.

And that's because they often attribute it to age.

They just say, I'm getting older.

If it gets normal.

The gear doesn't work.

That's it.

So we're wanting to say, look,

these are actually important symptoms

and they are associated with them.

We're just saying it might trigger a conversation around

if someone hasn't had recent cholesterol checks,

checking for diabetes,

having a look at their blood pressure,

talking about lifestyle,

talking about weight and weight management.

We want to encourage men to have these conversations

with their doctor because they're often things

that overlap with having these symptoms.

So we're not trying to scare anyone,

but we're just trying to say, look,

these could be representative of things that are wrong.

And if you get in early enough to see your doctor,

it could just be some simple lifestyle changes

or maybe starting a medication for something

that's not good for you.

And that could be all it is.

And we could hopefully prevent some excess morbidity

down the line.

So the bottom line for men is that what happens below the belt

might have implications for above the belt.

Absolutely.

Dr. Sam Tafari from the Royal Adelaide Hospital.

On Radio National, you're with The Health Report.

So what have we got in the mailbox this week?

Very old-fashioned thing, mailbox.

I like to think that we've got like a little box

with one of those flag things on the side

that you can put up or down.

Sadly, most people email us, healthreport at abc.net.au

if you want to send one in.

A couple of people have been writing in about insomnia,

which we spoke about the other day.

And it's very apt because the ABC has decided

that this month is the month of sleep-tember.

And so talking about sleep is very timely.

Philip has written in saying that he listened

with interest to our story about his father,

phone being able to lull him back to sleep,

saying that oftentimes in the middle of the night

he has to listen to voices in order to turn off

the chattering in his own brain.

I can relate, Philip.

And a few years ago, Philip landed on our show

and found it not only compelling, but he says

the dulcet tones of Norman's voice lulled him

back to a comforting sleep.

So he says thank you for that.

And then he also says please don't leave the most

exciting parts of your show to the very end

because he might...

already be asleep by then.

Is this a compliment?

So this is not the first time I've heard this.

So I was once on holiday with friends in Port Douglas

and went to a very fancy restaurant.

And a woman who turned out to be the owner

came around to take our order.

And when she got to me, she said,

oh, you're Dr. Norman Swan.

So my friends thought this was...

they were very impressed with this, you know,

they recognized it.

And I said, yeah.

And she said, well, our family just loves...

your health report.

Well, that's nice.

But not as much as our pig.

Now my friends were getting very amused.

This was Shadden Freud, big time with my friends.

I said, oh yeah, really?

She said, yeah, we've got the noisiest pig you can imagine.

And when the health report comes on,

the pig goes quiet.

So there you go.

Join the poor sign listeners of the health report

anytime on the ABC Listen app.

There was also a comment about how this listener said

that certain types of insomnia

are protective against dementia,

especially sleep maintenance insomnia,

which is where you can go to sleep,

but then if you wake up early,

you find it hard to get back to sleep again,

is associated with a decreased dementia risk.

How much weight should we place on this, Norman?

Sleep is really important for brain health,

psychological health.

We renew ourselves in a sense overnight with sleep.

There is too much emphasis on sleep duration.

I looked at the evidence on this for one of my books.

They're really good.

And when you look at the evidence,

whilst a lot of sleep studies,

and some of them have really not been done that well,

focused on duration,

when you dig into them,

it's actually sleep quality that counts.

So are you sleeping through and getting a good night's sleep?

Turns out that people who sleep nine or 10 hours a night

are at more risk of dementia and other problems,

but they're probably sicker and older to start with.

And they're lying in bed for long periods,

hoping to get to sleep and feeling quite anxious about it.

Then there's the people who sleep,

six hours a night or less,

is also associated with increased risks for various things.

But again, when you burrow into it,

it's not so much about the duration, it's the quality.

And good sleep therapy does not necessarily turn you

from a six-hour-a-night sleeper into an eight-hour-a-night sleeper.

It turns you into a good sleeper.

And that's what's really important.

I think we're getting over-anxious about duration

rather than sleep quality.

And so bottom line here is,

I wouldn't get too upset about dementia one way or the other.

Just focus.

Just focus on getting a good night's sleep.

We do a lot of sleep stories on The Health Report.

Do scroll back through because there's a couple of gems in there.

And if you have an email that you want to send us,

you can email us.

We are healthreport at abc.net.au.

But...

If you've got a health question, a specific health question,

we've got a show just for you,

if you haven't already subscribed to it.

It's called What's That Rash?

And the email address for that is...

thatrash at abc.net.au.

And this week, we are talking all about sleep.

We are quick-fire answering your sleep questions.

As quick-fire as Norman gets.

And it's just another place where you can find

Norman's sleep-inducing intonations.

Yeah, it's usually me who falls asleep rather than other people.

But anyway.

Find that by searching What's That Rash?

where you get your podcasts.

And we'll see you back here next week.

See you again.

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