10:00am 14th August 2016 :: Think: Health

If you ever need a reason to eat more cheese, improving mental health could be one as new research is looking into the effect probiotics have on depression. We also look at what it takes to close in on those key milliseconds in the pool, and how cultural competency in healthcare may create more equality between Indigenous and non-Indigenous Australians.

-Dr. Lynette Roberts: Clinical Psychologist and Researcher in Mental Health, UTS
-Dr Elaine Tor: Biomechanist, Victorian Institute of Sport
-Juanita Sherwood: Wiradjuri woman & Academic director at the National Centre for Cultural Competence, University of Sydney
-Elizabeth Sullivan: Professor of Public Health, UTS

Presenter: Ellen Leabeater
Producer: Ninah Kopel


Ellen Leabeater: Hello and welcome to the show. I’m Ellen Leabeater. Today, what makes a good swimmer? And:

Juanita Sherwood: You have to be competent in the sorts of surgical or drug type therapies you’ve got to use…but cultural competency is just as important and can be just as dangerous if you don’t do it effectively.

Ellen Leabeater: How cultural competency could help close the gap.

[Music plays]

Ellen Leabeater: Well, the key to improving your mental health might be floating around in your gut according to new research. The research undertaken at the University of Technology Sydney is investigating the link between probiotics and mental health. Dr Lynette Roberts is leading the trial. Dr Roberts is a clinical psychologist and researcher in mental health at UTS. Producer Ninah Kopel spoke with Dr Roberts about her research, and started off by asking what sparked her interest in probiotics.

Lynette Roberts: Yeah, so it was kind of random to be honest! It was a couple of years ago. I remember going to this really interesting talk by the student at the University of New South Wales and they were talking about some really cool stuff she was doing with rats. They were stressing out the rats in this kind of stress model, and they found that when they gave them probiotics, it made them feel less stressed. So it was kind of really random and counter intuitive and I thought, “That’s so strange, but so cool! What’s going on there? How could something like bacteria change something like your stress?” And when I started to do more research about mental health, I started to come back to that idea about different ways of looking at mental health treatments and kind of more novel ways of looking at treatments and that’s kind of when I came back to the idea – could probiotics actually be a treatment for depression as well?

Ninah Kopel: Can you explain what probiotics are? Because it’s a big part of what you’re doing, and it just seems like quite a foreign concept to me.

Lynette Roberts: Yeah, absolutely. It’s definitely one of those buzzwords that we’re hearing all over the place. So probiotics are just basically healthy bacteria. So it’s good bacteria, it’s beneficial, you need it in your body, and you can eat it or drink it, because it occurs naturally in products like yoghurt. So anything fermented, you can get it in miso, kimchi, sauerkraut, soft cheeses… so, it’s just a naturally occurring thing that’s really good for your body.

Ninah Kopel: So what will that look like then? Can you see people just taking probiotic supplements?

Lynette Roberts: Well, the funny thing is if you look at TV advertisements, I feel like a lot of companies have already jumped on this idea and are running with it. So we know in general probiotics in a good diet of course is helpful for you. Yeah, I don’t think it’s the case that we should all be running into the shops and buying probiotic supplementation, but definitely a well-rounded diet is going to be helpful regardless, I mean, we know it’s good for mental health and physical health. The question is, if you are depressed, will it actually work as a treatment?

Ninah Kopel: So where are you in the stage of answering that question?

Lynette Roberts: Yeah, so there’s a lot of really interesting research being done in this area, and what we’re specifically looking at is are probiotics helpful as a treatment for depression in humans. So there’s been some really cool stuff coming out with animals which shows that if you depress an animal like a little mouse and then you give them probiotics, it actually cures their depression, so it’s quite similar to how medication works, which is really cool and really interesting. And if you give probiotics to really healthy people like you and I that aren’t actually depressed, it does help improve our wellbeing. So the next kind of logical step – and people are looking at in different ways – is that if you have an actual psychiatric population with a depressive disorder, can you use it like a treatment? So is it similar to an anti-depressant, is it similar to psychological therapy, and we don’t yet know the answer to that, so that’s why it’s really interesting. We’re running a trial now at the University of Technology Sydney trying to answer that question.

Ninah Kopel: So would the end results then be giving people supplements of probiotics as a kind of pre-emptive medication or as a cure?

Lynette Roberts: Yeah, so there’s research that shows you can do it pre-emptively and it does help improve your mood if you’re already quite healthy, but we’re actually in a way looking at it as a treatment right now. So people who are currently depressed – we’re giving them probiotics and we’re saying, does it cure your depression?

Ninah Kopel: So are probiotics things that we just get from food anyway? Why do you need it as an extra supplement?

Lynette Roberts: Yeah, that’s a really good question. So, we should get it from our food naturally if we have a really well balanced diet high in fibre, high in fermented products, but the reality is that most of us don’t, so if we’re eating kind of a high processed, a high-fat or high-sugar diet, we won’t be getting it as naturally, or it won’t be growing as well as it could be in our gut. One of the other things that effects our gut is stress. So your stress affects the level of good and bad bacteria. Antibiotics, hormonal changes, travelling… so there’s so much stuff that actually does disrupt the health of our gut, so [gut health] is not happening as naturally as it potentially could.

Ninah Kopel: How much of this – when we’re talking about depression, how much of it actually is these physical things like diet and physical health as opposed to just your mental state of being?

Lynette Roberts: Yeah, so that’s the hard thing about depression – it’s complex and there are lots of things that cause it. So it could be your genetics, it could be the chemicals in your brain, it can be your environment, it could be a psychology – so how you think about things and how you react to things. So, because it’s so complex and there are so many different causes, there’s not going to be one kind of cure-all treatment. We know that medications are helpful; we know psychological therapies are helpful, we know just in general that your diet, your lifestyle and your sleep are useful. So it’s more just finding out if probiotics could be one more kind of novel component to that multi-faceted treatment.

Ninah Kopel: The first thing that came to my mind was, “that’s really obvious.” I’ll eat well and then I’ll be happier. But how does this push further? What is the big difference with probiotics as opposed to just having that really healthy diet and physical exercise?

Lynette Roberts: Yeah, so, what we’ve started to find out is how much your gut health really does actually effect your brain, and so that’s quite a novel and quite a crazy idea that’s come out, and the research is really starting to support that. So, your gut actually directly as well as indirectly communicates with your brain. So keeping your gut healthy with a good diet and good probiotics are really important, but what happens if you don’t have that is it’s like your gut gets “leaky”. So, the toxins in your gut can leak out into your bloodstream, and when they’re there, they trigger all these systems in your body, so you’ve got this immune response, you’ve got your stress response… and that actually ends up effecting how your brain functions, so it actually directly effects the chemicals in your brain that are responsible for your mood. So this idea of toxins leaking out of our gut and affecting our mood is kind of crazy but it looks like there’s strong evidence to suggest that this is happening. So, where the probiotics come in is that the probiotics are kind of plugging the holes in this leaky boat. So, the probiotics keep your gut really strong and healthy and stops that leaking, and all of that helps decrease the inflammation, and so that decrease in stress and inflammation and improvement in mood – that’s what’s so cool and specific about the probiotics, and it’s something that we never would have thought of a long time ago. It’s only now that we’re getting all these different, really interesting results with animals and cells and people that we’re trying to put it all together and make sense of it, and it looks like something like that is starting to happen.

Ninah Kopel: When you say toxins, do you mean things like alcohol and caffeine and bad things, or is it just unhealthy things in general?

Lynette Roberts: I mean bad bacteria. So, bacteria could be helpful or unhelpful. If you don’t have enough of the “good” bacteria, there’s too much of the “bad” bacteria that’s left. It’s those toxins that then get into your bloodstream because you don’t have all the protective elements of the healthy gut that’s kind of keeping it, processing it and then kind of getting rid of it out of your body.

Ninah Kopel: And then your brain obviously gets the message that things are wrong?

Lynette Roberts: Yeah, exactly, so it’s kind of like, you know, the rest of your body is trying to sort out and deal with these invaders, because they’re not supposed to be there, there supposed to be in the gut.

Ninah Kopel: That’s really freaky – there could be a cure for depression… that concept just blows my mind!

Lynette Roberts: Yeah, I completely agree, I thought the same thing as well, you know, “That’s crazy that probiotics could affect your mood!” But there’s a definite strong link between the health of your gut and your mental health.

Ellen Leabeater: Dr Lynette Roberts, clinical psychologist and researcher at the University of Technology Sydney speaking there with Ninah Kopel. And if you’d like to hear an extended version of that chat, you can head to our website, 2ser.com/thinkhealth

Ellen Leabeater: The swimming at the Rio Olympics has been a source of highs and lows for Aussies this week, from Kyle Chalmers surprising everyone and winning gold in the 100-metre freestyle, to the Campbell sisters missing out on a podium finish by a fingernail. But in a sport that comes down to the millisecond, what is it that makes a good swimmer? And will our speed keep improving in the pool? Dr Elaine Tor is from the Victorian Institute of Sport. She joined us from Rio and started off by explaining why Aussies are so fascinated by swimming.

Elaine Tor: We’re a country surrounded by water, so obviously most kids have to learn how to swim as a safety thing, and I think it just progresses on from there, and I think it’s also because we have such a rich history at the Olympics that people just get inspired to compete at the highest level, so for example, Kyle Chalmers was probably 14 years old watching the London Olympics, feeling inspired, and here he is today. I think that’s just one of many many stories that you’ll hear about.

Ellen Leabeater: And are swimmers born or made? You mentioned Kyle Chalmers. I understand he’s got large hands and feet. Do those physical traits make a big difference in swimming?

Elaine Tor: You know, obviously being born with certain genetics and certain anatomical features – and yes, Kyle does have that sort of advantage with the way he’s built, as with Mack Horton – but I think with swimming the way it is at the moment, having anatomical features that are I guess superior to others will only get you so far. I think the rest is how good you are technically and also how dedicated you are to training, because the margins at the top are really small. We saw Maddie Groves get the silver medal by 0.03 of a second, so it’s really really slim at the moment.

Ellen Leabeater: This Olympics has been quite interesting in that you’ve got Kyle Chalmers who’s just 18 in, and Michael Phelps who’s 31. What’s a peak age for a swimmer?

Elaine Tor: You know, it differs with males and females. I think girls tend to be faster at a younger age, but Michael Phelps was very very good at a very young age as well. He’s just an exception to all the rules, which is why he’s still so good. But usually, the peak age for swimming is probably between 17 and 22. I think that’s the average age of the Australian team at the moment.

Ellen Leabeater: You mentioned that it’s milliseconds between gold, silver and bronze. What do you see the future of swimming coming down to when you try to make up those marginal gains?

Elaine Tor: I think the future of swimming will come down to a really fine balance of training, strategy and also how technically well-conditioned a swimmer is, so, in terms of their stroke and their efficiency travelling through the water.

Ellen Leabeater: Can we keep breaking world records in swimming?

Elaine Tor: Definitely, definitely. I mean in swimming, there are some world records that still exist from the super suit era, which are ridiculously fast. And you know, if you asked this question four years ago, I would’ve said no, it’s not possible. But I think the world records in swimming are more attainable than the ones in athletics. You know, every year, new training strategies are developed, new physiological things are developed and when you can closely analyse stroke with technology, I don’t see why we can’t continue to get faster and faster.

Ellen Leabeater: Elaine Tor from the Victorian Institute of Sport.

Ellen Leabeater: The health disadvantages of Aboriginal and Torres Strait Islander people is much canvased, but could cultural competency hold a key in restoring the balance? Cultural competency is the attitudes and policies that allow systems such as the healthcare system to work effectively with people of other cultures. Juanita Sherwood from the University of Sydney and Liz Sullivan from UTS joined Ninah Kopel to discuss the importance of cultural competence.

Juanita Sherwood: Hi, I’m Juanita Sherwood. I’m a Wiradjuri woman and director of the National Centre for Cultural Competence at Sydney University.

Elizabeth Sullivan: Hello, my name’s Liz Sullivan and I’m a Professor of Public Health at the University of Technology Sydney.

Ninah Kopel: What is cultural competency?

Juanita Sherwood: Well that’s a big question. Cultural competency is really about providing care to people, to all people equitably, and ensuring that you’re respectful of their culture, and adapting your services to meet the needs of cultural diversity.

Ninah Kopel: I want to ask you Professor Sherwood about your experiences and what sort of drove you to go into this area in the first place, and what needs your saw in the community and in health practice.

Juanita Sherwood: I’ve been working in Aboriginal health for the last 30 something years, and I think there’s been many many times and opportunities that have come that’ve made me appreciate that people aren’t being respectful of Aboriginal and Torres Strait Islander people in their health services, and that’s had major implications on people’s health and wellbeing. We’ve all worked in this space and we’ve experienced, in our own work as health service providers and as family members and as patients ourselves, the lack of cultural respect and strong racism in health services. So this is why cultural competency is vital, because people will die if we’re not culturally competent.

Ninah Kopel: Professor Sullivan, has this been some of things that you’ve confronted in your research and some of the things you’ve had to think about in the work you’re doing as well?

Elizabeth Sullivan: Yes, and you know, I’ve had the privilege to work with Juanita over many years now, partnering and collaborating with her and really learning more everyday about the issues and seeing more of the issues in terms of the lack of culturally competent healthcare that we offer. And I think that there’s enormous inequity still in the access to health services and in us strengthening health services so that communities are happy to access them.

Ninah Kopel: Now that you’ve brought up that idea of communities – is this an issue of access well? Is inability to access healthcare one of the things that comes into this, or is there different access to be had in different communities in Australia?

Juanita Sherwood: It’s multi-dimensional. I mean, basic access to a service can be totally shut down by you walking into a medical surgery and being growled at by the receptionist, and that can be enough to… if someone’s not feeling great that day, thinking “Oh my god, why am I even thinking I can talk to anybody about my problems…” – that’s enough to shut someone down. But you can go into a hospital situation… I was just talking to somebody about this today. I can remember when I was nursing, this neurosurgeon decided that because this woman was an Aboriginal woman, that she had to lie. So she told everybody that they could not believe her because she was an Aboriginal woman. And this was some myth he’d been told and it informed the way he practised medicine, and informed the way he talked to other people about how we cared for this patient, which was highly problematic.

Ninah Kopel: Is this an issue of selectivity in research as well? Are health issues not being addressed because people aren’t interested in looking into the health concerns of Indigenous people in Australia, or is the research happening without taking their interests into mind?

Juanita Sherwood: There’s good research happening with Aboriginal people. It’s governments who don’t fund the good outcomes of that good research. I think in the last 15-20 years, there’s been some great Indigenous research with Aboriginal communities, and the only way you’re going to have good research is if you work with Aboriginal communities, and the only way you’re going to have good policy is if you work with Aboriginal communities. And we’ve been watching governments turn policy round and round and round without involving Aboriginal communities, and it’s been destructive and negative.

Ninah Kopel: So something that you’ve bought up already is this idea of women in prison. I know it’s an area that both of you are researching and both of you are looking at. So, how does cultural competency and health fit into the way we think about people and prison?

Juanita Sherwood: It’s the link to everything. I mean, being able to respect somebody immediately gives you an opportunity to have access. If I made you feel that I didn’t respect you, would you want to talk to me? So, that’s the very basis of trying to set up a relationship between a client and myself. And if you’re feeling that this person is looking at me the wrong way, this person is giving me the dirty look… I know that look, I mean, I see it in classrooms where people stick their arms across their chest. I see the look, I mean, we can smell it 200 miles away almost, and people pick that up very clearly because they’re used to it. And so, people can say straight away whether they can trust you, and share and build and talk to you around their health issues or not.

Ninah Kopel: What strikes me with that is… I mean how do you teach someone that a look is that powerful? Can you train people in that kind of basic human interaction?

Juanita Sherwood: Well it’s not about looking, it’s about being open. I suspect what we really need to be thinking about is going back and getting people to become a bit more open minded, and realise that there’s not one culture that runs health, which is hard for health professionals to consider, and that there are many ways of knowing health, and that other cultures have different ways, including Indigenous Australians. But, every other culture has their way of looking at health. That needs to be respected. And so, health services need to adapt their approach to meet the needs of people that they’re working with, and they’re funded to do that.

Ninah Kopel: We’ve talked a lot about these big ideas, about what’s culture and how we relate to other people. In day-to-day life though, with someone who’s presenting to their doctor for a normal medical conditions, is this something that’s really playing out with GPs everyday across Australia?

Juanita Sherwood: It should be. A doctor should be saying, you know, “Is it OK for me to talk to you, or would your family like to be in here with this consultation with you?” A lot of communities believe that it’s really important to have the family, and especially if the person is ill, they don’t necessarily have the nous to be able to answer all the questions that the doctor wants, and it provides a really solid history. And I guess history-taking with an open mind, and appreciating… this is what is difficult. What you see in front of you, you won’t necessarily have the context for, because you don’t have enough information. So, it does require a bit of reading. If you have a big Aboriginal population clientele, do some reading in this area. If you have a big Muslim population clientele, do some reading in this space. Build up your knowledge. You have to be competent in the sorts of surgical or drug-type therapies you’ve got to use. But competence culturally is just as important and can be just as dangerous if you don’t do it effectively.

Ellen Leabeater: Juanita Sherwood and Liz Sullivan speaking there to Ninah Kopel about cultural competence.



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