Why I'm quitting 'I Quit Sugar' - a response to Sarah Wilson's views on helmets

This is a slightly tongue in cheek yet factual response to claims made that helmet use will not prevent injury. If you are offended by (very ordinary) humour, my apologies but drawing attention to a serious issue is vitally important. Dear Sarah Wilson,

I have, in the past, enjoyed your cookbooks and some of the sentiment in your program I Quit Sugar. Western societies consume a lot of things, including sugar in excess. I have made a few recipes from your cookbooks and found them to be quite tasty. But you have overstepped the mark I am afraid with your comments on bicycle helmets lacking evidence and not preventing head injuries. I understand that when you ride your fixie bike with trendy basket full of fresh vegetables (not fruit, fruit apparently contains too much sugar), a helmet can ruin your perfectly coiffed hair. We all feel your pain on that matter. But let me put it to you plain and simple: helmets have been shown to reduce the risk of head injury. Fact.

Your 2010 blog post on why it's okay to not wear a bicycle helmet has recently resurfaced after an instagram post suggested that people don't ride bicycles anymore because we legislate that people wear helmets.

Sarah, I am a real, certified, trained, educated doctor. And I have seen many, many head injuries during my career. And a number of those patients that I have seen have been at organ retrievals when I go and bring home the beautiful gift of donor organs from a person who has had a bicycle accident and sustained a serious head injury. But as I am a doctor who is trained to look for (real) evidence and not just sprout my opinion, here is some evidence for you.

Head injuries account for 75% of deaths in cyclists. The Cochrane review is a collaborative database that reviews the scientific evidence of many topics. The Cochrane review in to bicycle helmets looked at all of the best available evidence into the use of helmets in cyclists and discovered a reduction in head injury of 63-88%. Helmets also reduce the incidence of injuries to upper and mid face region by 65%. Facial injuries don't just disfigure you, you can indeed bleed to death from severe facial injuries, lose your sight, have difficulty speaking and swallowing. Same goes for offering protection from serious scalp injuries - helmets can help prevent you exsanguinating from your scalp. Yes it can happen - the scalp is one of the most well vascularised regions in the body. Not wearing a helmet leaves you five times more likely to have a serious head injury. That's data from Sydney by the way.

Sarah, you are absolutely correct that we have never done a randomised control trial into helmets. And here's why. A randomised control trial involves taking two groups of people. You give one group the treatment (in this case, a helmet) and the other group nothing (in this case, no helmet) and then you would have to subject them to serious trauma and see who does better. As you can see, we could never do that. I'm quite certain even you would not volunteer for this experiment and not wear a helmet. In instances like these, we clever doctor types put together all of the information available and come up with what is still a scientifically sound answer. And thanks to people like yourself who do not wear helmets, we have plenty to compare with.

I understand Sarah that you consider yourself somewhat of a guru, navigating through science and picking out what the people really ought to know. You even throw in scientific jargon every now and again. Except that your jargon isn't scientific at all. Linear speeding and angular acceleration are made up, just like the Easter Bunny. Neither are terms that would be used in a hospital to describe how an injury happened. Real doctors use terms like direct blow, contrecoup injury, axial loading, hyperflexion or hyperextension to describe how an injury happens. But I'd hate to correct a wellness blogger like yourself. What would we know?

Helmets may not prevent every injury every time. If you are unfortunate enough to go head first at speed into a bus or a truck, then a helmet may reach it's limits of helpfulness. But for serious accidents, even when you do hit a car on your push bike, there is evidence to say that wearing a helmet just might save your life. I'm quite sure people who have been involved in accidents where they were wearing a helmet are pretty grateful that they were.

Sarah, everyone is entitled to have a thirst for knowledge and even share that knowledge. But what is insufferable and inexcusable is sprouting dangerous, unsupported rubbish that may affect some of our most vulnerable and precious people like children. I am terribly sad that the medical profession is not as appealing to the general public as you seem to be (for the moment). I feel like we sometimes fall short of protecting the general public from anti-helmet crusaders like yourself. Perhaps we need to harness the power of social media a bit more? Maybe we need an Instagram page dedicated to an intensive care unit or a rehab ward? Would our message get across then?

I hope that when you go on an unsupported, selfish, incorrect and vile rant next time, you will spare a thought for the people's who lives have been transformed by a traumatic brain injury. Aside from dying from these injuries, sufferers of traumatic brain injuries are forced to endure a lifetime of conditions like seizures, severe personality change, loss of independence (that means someone else may have to wipe your bottom for you Sarah), speech difficulties and memory loss. Imagine forgetting who you are, who your spouse is, or having to be fed through a tube for ever. Traumatic brain injury is a terrible, terrible waste of many people's lives and should not be trivialised by a 'wellness guru'.

I have always thought that I could take on board bits and pieces from your books and websites and integrate it into my own solid, scientific background. However, as I write this, I am putting your book into the trash where it belongs. I hope many, many others will follow suit. And I also hope that if you continue to ride your bike with no helmet, trendy glasses and golden locks flowing, that you never have an accident where you or your family wishes you were wearing your helmet.

Sincerely, wearing a bright green Stackhat,


Sisters are doin' it for themselves: a girl's guide to heart disease

Welcome to June sisterhood! June is the month the Australian Heart Foundation uses as it's Go Red for Women month. A time to raise awareness and funds for women's heart disease. Yesterday was Go Red for Women day and it was lovely seeing social media awash with red as we all remember how scary heart disease in women. A lot of people would be forgiven for thinking that breast cancer is the leading cause of death in Aussie women. But unfortunately, that is not the case. Heart disease is the leading cause of death for Australian women. It's so important that we recognise that and understand that it is not just a bloke's disease. It can affect any of us and unfortunately, if it does, the consequences can be terrifying. Women with heart disease don't fair as well as the blokes. Even in younger women, ladies with heart disease die of the disease more often and have poorer quality of life. Think of quality of life as being able to do the things you need or want to do. Dancing, swimming, walking, shopping, stairs or going to the toilet yourself.

So in honour of Go Red for Women, here is my brief guide to heart disease in women.

Coronary artery disease in women

Coronary artery disease refers to blockages in the coronary arteries. These are the arteries that supply blood to the heart muscle. When these get blocked, you have what is commonly referred to as a heart attack. A bit of the heart muscle dies - this can be a big bit or a little bit. Coronary artery disease kills nearly 10,000 women a year in Australia (compare this with breast cancer which is about 3,500).

The risk factors for coronary artery disease in women are being overweight or obese, high blood pressure, high cholesterol, diabetes, genetics and smoking. See what is interesting about that list? They're virtually all changeable risk factors.

After a heart attack, a number of things can happen. Some people who have a heart attack can die immediately from the heart attack due to an abnormal heart rhythm, a rupture of part of the heart muscle or the pumping mechanism of the heart being so badly damaged. Other people may recover to a point, but some of these people have longer term problems. These can include heart failure which can stop you doing even simple things like getting dressed or angina which are like multiple 'near heart attacks' and can seriously limit how you live your life.

Ladies with coronary artery disease don't do as well as the blokes

I hate to say it but this is one area the men have us covered. Women with heart disease tend to see the doctor later, have it detected later and do badly after a heart attack. This is partly because the symptoms of a heart problem tend to be a little different to the men. Women tend to present with vaguer symptoms like being tired doing physical things or short of breath. The typical chest pain in the middle of the chest may be a slightly more vague discomfort, not even in the chest but in the jaw or arm. As such, the symptoms are not usual and it can be easy for patients and health care professionals to miss.

The way women block their coronary arteries is different to the men. Women have very small blood vessels blocked which makes the symptoms different and the diagnosis and treatment harder. It means that if you are a woman with risk factors for heart disease, you should be vigilant for changes in your ability to do physical tasks, funny niggles in the chest region or getting super short of breath doing things like climbing stairs.

The later diagnosis and later or different treatment mean that women who get coronary artery disease don't do as well. Even younger women with heart attacks fair badly. They unfortunately die from their disease more often and don't recover particularly well.

Modern medicine is pretty cool but not always able to save the day

Prevention is better than cure. It's a bit of a modern way of thinking that if we get sick, we can have a tablet or an operation and everything will be okay. I'm afraid that is simply not always the case. We see patients regularly who have heart disease who cannot have an operation to fix their blockages in the coronary arteries. These patients have to be treated with medicines that don't fix the problem. They're more like putting band-aids on a gun shot wound.

The best defence we have against heart disease is to not get it in the first place. And with modern life catching up with a lot of us leading to inactivity, weight gain, high cholesterol, smoking rates alarmingly high in young women, we need to put the brakes on immediately. Today is as good a day as any to stop smoking, get active and lose weight. It's not easy or fun. Well sometimes it's fun. But I can guarantee you, recovering from heart surgery or worse yet, dying from heart disease is even less fun.

Don't forget about other forms of heart disease

Coronary artery disease is the main offender but not everything. We see a number of women with other nasty heart conditions like heart failure, rheumatic heart disease or congenital heart disease. The number of women with these conditions are growing and doctors and researchers are working tirelessly to manage these growing problems.

Worried? Get checked up.

Like that ad for the national terrorism hotline a few years back, we should be alert, not alarmed. (Who would have thought that phrase would have stuck so much?) If you are worried that you are at risk of heart troubles or have a heart problem, see your GP and get everything checked.

For more information: visit the Heart Foundation Australia website here

And importantly to donate to Go Red for Women: click here

And lastly - watch this fabulous video by C. Noel Bairey Merz about women's heart disease

And - #WeWillBeRed