Monthly Archives: October 2012

Thought for the day.

The best time for planning a book is while you’re doing the dishes.

Agatha Christie


PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines. Aromatherapy is based on the idea that aromatic substances, usually the essential oils of plants, can change how people feel or have an effect on the symptoms of various conditions. Aromatic…

There is no convincing evidence that the therapy works. Cafemama

PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines.

Aromatherapy is based on the idea that aromatic substances, usually the essential oils of plants, can change how people feel or have an effect on the symptoms of various conditions. Aromatic substances can be delivered through massage, direct inhalation, or diffusion into the air.

People have used essential oils for medicinal purposes for centuries: Chinese traditional medicine uses aromatic plants; the ancient Romans used aromatic plants in their baths; and there are records of Greek doctors using them as far back as the first century.

But the modern practice of aromatherapy as we know it now is only about a hundred years old and probably began with a French chemist, Gattefosse, who published a study about his use of lavender oil to treat his burnt hand.

Different oils are claimed to have different effects on anxiety, agitation, nausea, pain, hair loss, dementia, hypertension, concentration, sleep, depression and infant colic, among others. But much of the research in this area is of poor quality and contradictory.

Often, the recommendations found in aromatherapy texts are based on anecdote or clinical experience rather than strong evidence.

How does aromatherapy “work”?

The best known and most investigated uses of aromatherapy are for conditions such as anxiety, agitation, stress and nausea. But the mechanism, if any, by which these actions occur remains controversial.

One idea is that scent activates the olfactory system (responsible for our sense of smell) which triggers the brain’s limbic system. This in turn may produce emotional responses and enhance the retrieval of learnt memories connected with the scent.

Research has shown that our response to scent is cultural, in that people of particular cultures often perceive different scents as being pleasant or unpleasant. Our response to scent is also able to be influenced by the prompting of researchers, and is dependent on the participant’s perception of the scent, which of course makes assessing cause and effect more difficult.

A small study has shown our brains respond emotionally to smell. Express Monorail

When participants of one study were exposed to certain scents and had their responses recorded through functional MRI brain imaging, researchers saw activation in the areas of the brain responsible for emotions. Although this is interesting and could point to evidence of an effect, this study was small and did not report its methods well, so it’s hard to know how much weight to put on it.

Supporting evidence

There are a few well-conducted studies that show aromatherapy may be effective. Laboratory studies using animals have shown that some aromatherapy preparations cause observable changes in biochemistry.

In humans, a small pre-clinical study of aromatherapy using healthy volunteers showed a measurable reduction in stress hormones in saliva samples when lavender and peppermint aromatherapy were given following a stressful event.

But these results have yet to be reflected in strong clinical studies and, more importantly, in systematic reviews, the highest level of clinical evidence. Statistical pooling, or meta-analysis, of study results can help us to understand the overall effectiveness of an intervention much more clearly than a single study alone.

Some systematic reviews have found weak evidence of an effect for aromatherapy for some conditions such as the behavioural and psychological symptoms of dementia, and post-operative nausea and vomiting (although this was with a non-traditional aromatherapy product).

One systematic review found convincing evidence of an effect for the use of massage with lemon balm (Melissa officionalis) oil for agitation associated with dementia, however this was based only on one randomised controlled trial.

The verdict

When studies of aromatherapy are subjected to close scrutiny, and the results combined, there is no convincing evidence that the therapy works.

But this may come down to a shortfall of well-designed randomised controlled trials, which provide the best experimental evidence when studying a therapy.

It’s difficult to know just how effective aromatherapy is, and it may be that while there are some products that are effective for some conditions, there are many other products on the market that have no effectiveness at all. Either way, it’s important consumers know what they’re using and are alert to the possibility of adverse effects. Just because a product is “natural” does not automatically mean it is “safe

I’M sick of Exercise.

No, you better not be. In my book “Live Well Over 100”, the first commandment is to exercise. The last commandment is exercise. Better than all the other things we do put together. If you don’t like exercise, then try movement. If you don’t like that, try activity. If still no, then fidget. If that is beyond you, then check you have a good funeral plan 🙂

29 October 2012, 10.44am AEST

Extra exercise increases life satisfaction

People’s general satisfaction with their life is higher on days when they exercise more than usual, new research has found.

The study looked at 253 college students who answered questions aimed at determining participants’ satisfaction with life, physical activity, and self-esteem. Entering this information into a diary daily, researchers noted that the amount of physical activity a person undertakes in a particular day directly influences his or her satisfaction with life.

The findings reinforce the idea that engaging in physical activity is a healthy behaviour with important consequences for daily well-being. Researchers hope it will be considered when developing national policies.


30 October 2012, 6.08am AEST

Explainer: what are phobias?

What makes a fear a phobia? jasonbolonski/Flickr.

A life without fear sounds idyllic but it would be no paradise. Fear protects us from present danger, alerts us to future threat, sharpens our minds and blunts our selfishness. Friedrich Nietzsche once said that fear is the mother of morals, and people who lack it do indeed tend to be nasty, brutish and short-lived.

While useful to a point, people often suffer from an excess of fear. Although many of us are afraid of snakes, spiders, heights and blood, when these normal fears are taken to extremes they become phobias.

To qualify as a phobia, a fear must be lasting, intense and seen by the sufferer as excessive and irrational. It must also be a source of distress or impairment in the person’s occupational life and social relationships.

Phobias affect about 10% of the general population at some point in their lives, with women affected twice as commonly as men.

What are we afraid of?

Phobias commonly involve objects and situations that were realistic dangers for our distant ancestors: poisonous or vicious animals and invitations to injury. As a result, many people are terrified of things that no longer pose a contemporary threat.

Ancestral fears are learnt with remarkable ease. One study found that young rhesus monkeys acquired a fear of snakes when they viewed a film of older monkeys acting terrified in the presence of a snake, but did not come to fear flowers when they viewed monkeys going ape in the presence of a blossom. Fears related to things that were threats to our forebears are more easily acquired than others.

Deliciously scary? EuroMagic/Flickr.

Although many common phobias are of this ancient or “prepared” kind, the spectrum of human fears is astonishingly broad. The clinical literature records phobias of rubber bands, dolls, clowns, balloons, onions, being laughed at, dictation, sneezing, swings, chocolate and the wicked, beady eyes of potatoes. Unusual fears are particularly common among people with autism, who have been known to dread hair dryers, egg-beaters, toilets, black television screens, buttons, hairs in the bathtub and facial moles.

It is hard to see the evolutionary threat posed by these innocuous things. As Stanley Rachman, the psychologist who treated the chocophobe wrote, “it is difficult to imagine our pre-technological ancestors fleeing into the bushes at the sight of a well-made truffle”.

How do phobias develop?

Given that many modern phobias make little logical sense, it is interesting to explore how they emerge. There are three main identified ways that phobias come about: a terrifying personal encounter, witnessing another person’s fright, and receiving threatening information. A person might acquire a spider phobia after a close encounter in the shower, after seeing a sibling run screaming from an infested room or after being told that spider bites cause you to turn purple and die.

Only a small minority of people will develop phobias after common experiences such as these. Those who had inhibited temperaments in childhood and neurotic personalities in adulthood are more vulnerable, and this vulnerability has a substantial genetic component.

A study that followed a sample of young women over a 17-month period found that those who developed phobias tended to have more pre-existing psychological problems, poorer coping skills and a more pessimistic mindset than their peers.

Let’s consider one odd but surprisingly common aversion, the fear of frogs.

One published case documented a woman who developed ranidaphobia, as it is known, after running over a knot of frogs with a lawn-mower. Paralysed by fear and tormented by amphibian dreams, she was persecuted every evening by an accusing chorus of survivors on a nearby riverbank.

In another case, a Ghanaian schoolboy developed his phobia when he stepped on a frog while touching itchy leaves. After his brother told him that frog urine could cause itching and a painful death, the boy became paralysed with the fear that frogs were hiding in his bed.

This fear was put to productive use elsewhere in west Africa, with one anthropologist reporting that bed-wetting children were frightened into bladder control by having a live frog attached to their waists.

Ranidaphobia is surprisingly common. Ltshears/Wikimedia Commons.

What gives these puny creatures – with big eyes and scrawny, hairless bodies – their power to inspire fear and trembling? They pose no realistic threat to life: phobic individuals understand that in an encounter with a frog they are unlikely to be the one to croak.

The fear of frogs is viscerally unreasonable. To many people it reflects the frog’s slimy, skin-crawling ickyness. To others, it is the creature’s propensity for sudden movement, a trait it shares with another tiny source of terror, the mouse.


Luckily for phobia sufferers, treatment is generally quick and effective. Cognitive-behaviour therapists have an assortment of techniques for confronting fears and challenging the avoidance and thinking biases that sustain them. Usually these methods involve progressive exposure to the feared object or situation up the steps of a “fear hierarchy”, from relatively nonthreatening encounters to the most terrifying.

These “behavioural experiments” are often supplemented by relaxation techniques, modelling of exposure by the therapist and correction of catastrophic thoughts.

In another case of ranidaphobia, a young nursing student, fainted in a biology class when her laboratory partner severed a frog’s spinal cord (“pithing”). A course of therapy was commenced in which she repeatedly viewed a videotape of the operation and practised relaxation techniques.

Such was the success of the treatment that in a single sitting immediately afterwards she was able to deliver electric shocks to one frog, pith another and cut open the abdomen of an anaesthetised rat, remaining calm even when one frog hopped loose, bleeding profusely from its injuries.

By facing what we dread, under the guidance of a psychologist, we can find freedom from irrational fear.

Protect your eyes – you cannot see without them!

You may be aware of the dangers of UV exposure to your skin, but are you aware that your eyes are vulnerable to UV damage anytime of the day, anytime of the year?

U are Vulnerable to UV damage all times of day, all year round. This summer, always use UV protective lenses in combination with other UV protection measures such as remaining in the shade, wearing a hat and sunscreen.

This summer you will be seeing and hearing a lot about protecting yourself from the damaging effects of UV rays. The Optometrists Association’s national UV Eye Protection public awareness campaign aims to explain the importance of protecting your eyes from damaging UV rays.

You can get involved by joining our campaign Facebook page and ordering your own U are Vulnerable campaign materials to help promote the importance of always wearing UV eye protection.

Despite 60 per cent of Australian adults being concerned about ultraviolet (UV) damage to their eyes, nearly half fail to always wear sunglasses or UV protective lenses on sunny days.

Accumulated UV exposure to your eyes can lead to cataracts, macular degeneration (a leading cause of blindness), pterygium (a fleshy growth on the eye), solar keratopathy, and skin cancer of the eyelids and around the eyes.

Even short bursts of unprotected UV exposure can lead to eye pain, irritation and sensitivity to light. All UV eye exposure, regardless of how short, adds up in the long term.

UV radiation levels are three times higher during summer than in winter. Higher levels of UV are also experienced at high altitudes such as at ski fields and when light is reflected off a surface such as water or snow.

It is important to wear suitable UV protective lenses all the time and have your
eyes tested regularly or as advised by your Optometrist.

Adding a UV protective coating to your prescription lenses, buying prescription sunglasses with back surface UV protection or buying sunglasses that can be worn over your glasses is a great way to reduce your UV exposure. Some contact lenses also have built-in UV protection, but it is recommended that you still wear sunglasses over the top to protect the rest of the eye.

The quality of sunglasses does not necessarily relate to their darkness or cost so you must check the label to ensure they meet Australian Standards. For the best UV eye protection, choose sunglasses that meet Australian Standards for UV protection by checking that they are labelled as category 2, 3 or 4, are marked EPF (Eye Protection Factor) 9 or 10, have a bridge setting as close to your eyes as possible without touching your eyelashes and have side protection (wrap-around style) to block outside glare. Did you know that EPF is SPF for the eyes? To find out more click here.


Make UV protection part of your everyday routine, all year round.
Your optometrist can give you the best advice to suit your lifestyle

Viagra for Women

There have been a number of news items about “Viagra for women” in  the media today. The announcement has been about the amazing discovery of a testosterone gel applied to the mucous membrane of the nose, that boost a women’s sex drive. This has been promoted by Dr Susan Davis, one of Australia’s foremost researchers in women’s hormones, working at the Jean Hailes Foundation in Melbourne.  Women produce testosterone throughout most of their lives, and this assists in sex drive, energy, strength and well-being. From age 40 onwards (the perimenopause) this testosterone level drops and many women find their libido declines, as well as energy and assertiveness. This can create disharmony with partners, frequently leading to broken marriages and relationships.. Men sometimes find it hard to comes to terms with the decrease in their partners libido and interest in sex.

This amazing breakthrough is not a breakthrough at all, as I have been using testosterone for women for over 10 years, for its benefit in well-being, energy, self-confidence and libido. Instead of a gel, I use it as a troche, as it also absorbs through the mucous membrane, just as the gel described above will do. I have many younger women using testosterone as a cream, very successfully, for libido problems. I had a letter during the week from a specialist expressing concern about my use of testosterone in women.  A few points I will mention to him – the doses I use are individualized to be correct for each women I give it to, unlike the “viagra for women” gel mentioned in the news report today, which will be one size fits all. Second, there are a number of medical papers pointing out that testosterone appears to reduce the risk of breast cancer in women. Lastly, it has been proven to be of great benefit to the women I give it to, and I have never had any problems with its use.

For more information on Libido in women, check it out on this web site under “More on HRT”.


24 October 2012, 11.07am AEST

Chiropractic therapy: placebo or panacea?

PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines. Chiropractors use manual therapy to address musculoskeletal-related conditions (joints, ligaments, muscles and nerves of the body). In recent times the chiropractic profession has attracted criticism…

Most people see chiropractors for spine pain or other musculoskeletal conditions. Michael Dorausch

PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines.

Chiropractors use manual therapy to address musculoskeletal-related conditions (joints, ligaments, muscles and nerves of the body). In recent times the chiropractic profession has attracted criticism about its effectiveness and safety, outdated theories, and the promotion of anti-vaccination views.

There are approximately 4,200 registered chiropractors in Australia. The general public can access a chiropractor without referral from another health-care practitioner. A 2004-5 survey indicated that 2% of the Australian population consulted a chiropractor in the two weeks prior to the survey.

Chiropractic training in Australia is taught at Macquarie University, Murdoch University, RMIT University and Central Queensland University. A chiropractic degree takes five years to complete.

Chiropractors are trained to provide mainly hands-on care, combined with physical therapy modalities (such as ultrasound), exercise, nutritional advice and lifestyle modification. The profession is regulated by the Chiropractic Board of Australia, which is part of the Australian Health Practitioner Regulation Agency.

History of chiropractic

Chiropractic was founded in the United States in the 1890s by a magnetic healer David Daniel (DD) Palmer. He reportedly cured deafness in his janitor through the application of a chiropractic adjustment (a type of spinal manipulation) to a “chiropractic subluxation”.

Palmer hypothesised that spinal subluxations, or misalignments, compromised health by interfering with nerve flow and innate intelligence, and that subluxations could be related to almost all health conditions.

Much animosity towards chiropractic, and an area of controversy within the profession, is based on these historical origins. There is vigorous debate within the chiropractic profession about subluxations and scope of practice, and commentators have divided the profession into two broad groups.

For one group, the fundamental approach to chiropractic practice is in finding and correcting chiropractic subluxations. The other group wish the profession adopt a more contemporary, evidence-based approach, and restrict chiropractic care to musculoskeletal conditions (see here, here and here).

Some chiropractors, and some professional chiropractic organisations, promote the use of the term subluxation and its effects on human health as proposed by Palmer. Other chiropractic organisations have adopted the UK General Chiropractic Council statement that chiropractic vertebral subluxation complex is an historical concept and is not supported by clinical research linking it to the cause of disease.

Clinical studies have not demonstrated the existence of chiropractic subluxations, and many studies show that chiropractors cannot agree on where these spinal lesions are located. Surveys conducted in North America suggest that more than three quarters of chiropractors consider the presence of subluxations in their clinical decision making. Similar data for Australian chiropractors are not currently available.

Missing evidence

Little is known about why people seek chiropractic care and what chiropractors do in practice. From available data it seems most people who present to chiropractors have spine pain (low back or neck pain), or other musculoskeletal conditions (such as sports injuries, neck-related headaches and sciatica).

For common back and neck pain there’s no single, optimally effective therapy. Most therapies examined in high quality systematic reviews demonstrate only low to moderate effects and few therapies are better when compared to other therapies.

Chiropractors use a range of therapies and many have not been subjected to rigorous scientific scrutiny. A 2010 review provided the most comprehensive examination of the evidence for commonly used chiropractic manual therapy techniques (spinal manipulation, mobilisation and massage).

This review, alongside high quality Cochrane systematic reviews summarising the best available evidence, support chiropractic care for the symptomatic relief of back and neck pain. But the effects are typically small.

Treatments used by chiropractors are equally effective as other common therapies for the management of low back and neck pain. Although chiropractic treatment has a low risk of serious adverse events.

Some chiropractors claim to provide relief for non-musculoskeletal conditions, such as infantile colic, bed wetting, asthma, period pain, ear infections and high blood pressure. There’s no evidence to support the use of chiropractic treatment for these conditions and indeed, we have some evidence against its use.

Attending a chiropractor for musculoskeletal conditions, such as back and neck pain, is as reasonable as seeing any other healthcare practitioner. But traditional chiropractic practice based on finding and “correcting” subluxations is being challenged from within, and outside, the profession.

Much more research is needed to inform chiropractic practice and to optimise the health of Australians who seek chiropractic care.

The war against Cancer

Beginning of the end for cancer?

The first results of the most comprehensive genetic survey of cancer ever to be undertaken by an international consortium of researchers have just started to come in. The consortium is mapping mutations of different types of cancers with the aim of better targetting treatment. The findings for pancreatic…

The consortium’s work means cancer’s reign as one of our most devastating diseases may be over sooner rather than later.

The first results of the most comprehensive genetic survey of cancer ever to be undertaken by an international consortium of researchers have just started to come in. The consortium is mapping mutations of different types of cancers with the aim of better targetting treatment.

The findings for pancreatic cancer were published in the peer-reviewed journal Nature this morning. Professor Andrew Biankin from the Kinghorn Cancer Centre at the Garvan Institute of Medical Research and I led this survey, which sequenced the genomes of 100 pancreatic tumours from Australians and North Americans and compared them to normal tissue.

Pancreatic cancer and genome mapping

Pancreatic cancer is not the most common cancer to afflict Australians. It’s actually tenth on the list, but it kills more people than melanoma. And fewer than 5% of patients diagnosed with pancreatic cancer will survive more than five years. It’s one of the few cancers for which survival rates have not increased over the past 40 years.

The problem is that it’s a complex cancer that usually isn’t detected until it has spread. Clearly, there’s a lot of scope to better understand this disease and how we can treat it more effectively.

Our project is part of the International Cancer Genome Consortium (ICGC), which has brought labs across the world together to sequence the genomes of 50 different types of tumours.

Cancer arises from the accumulation of genetic damage. You can compare it to randomly deleting files from a hard drive. Some files, if deleted, won’t make any difference to the functioning of the computer at all, while others are vital. If these files are deleted, the computer will cease functioning.

The cancer genome consortium is seeking to identify these mutations – the ones that cause a healthy cell to turn cancerous – and make this data freely available to scientists and clinicians. It’s been 12 years since the draft copy of the human genome was made public, and in that time, sequencing technology has made incredible advances.

The Human Genome Project took over a decade and cost over US$2 billion. In our laboratories at the University of Queensland’s Institute for Molecular Bioscience, we can sequence a genome in a matter of days for a few thousand dollars.

Across the 100 pancreatic cancers we studied, we identified over 2,000 mutations, a small number of which appear to be the genes that really drive the formation of tumours. We’ve also learnt that, as with many other types of cancer, pancreatic cancer is actually an umbrella term.

This means there are many sub-types of pancreatic cancer, each with different prognoses and different potential treatments. These differences can’t be seen with a microscope; sequencing is required to pinpoint what sets one tumour apart from the next.

With patients, for patients

This research, indeed that of the whole of the International Cancer Genome Consortium, wouldn’t have been possible without the cancer patients who donated their samples. They did so because they wanted to make a difference, and that’s the overarching aim for this project.

Our findings emphasise the importance of treating patients as individuals, because when it comes to cancer types and treatments, one size most definitely does not fit all.

Our research aims to take the guesswork out of chemotherapy by allowing doctors to match the genetics of a person’s tumour with a treatment. We found some patients with mutations in genes that are commonly associated with other types of cancer, such as breast cancer.

The good news for these people is that some of these genes are already treatable with drugs and, in some cases, we were able to direct their doctors to treat them with the correct drug. Next year, we’ll begin clinical trials to assess the benefit of using this method of treating patients versus standard chemotherapy in advanced pancreatic ductal adenocarcinoma.

This type of personalised medicine, where the individual is treated rather than the disease, is the future of medicine. It probably won’t be too many years before it will be standard procedure to have your diseased cells sequenced and your genetic make-up examined to determine treatment.

Of course, there’s more work to be done, but we hope our research can make a difference sooner rather than later in the lives of those affected by pancreatic cancer.

And with scientists and clinicians from around the world joining forces through the International Cancer Genome Consortium, we hope that cancer’s reign as one of our most devastating diseases will be over sooner rather than later.

Breast cancer and Vit D.

I have been beating the drum about the large amount of Vitamin D deficiency in the Australian population. Todays courier mail had an article reaffirming the connection between low Vit D and Breast Cancer. For goodness sake everyone, please take this seriously. Again today, I have a number of women who tested low for Vitamin D 1 year ago, and guess what?  Their levels are still low!. We all underestimate how much sunshine we need at our peril. Supplements are not very effective, which is why my patients get a shock when I tell them their levels are still low. “But I have been taking my Vitamin D supplements Doctor!”  I am afraid it is not enough. You cannot bottle sunshine.

Breast Cancer Risk Factors→ Low Vitamin D Levels

Low Vitamin D Levels

Last modified on September 17, 2012 at 7:04 pm

Vitamin D helps the body absorb calcium, which is essential for good bone health. Vitamin D also helps the immune, muscle, and nervous systems function properly. Most vitamin D is made when an inactive form of the nutrient is activated in your skin when it’s exposed to sunlight. Smaller amounts of vitamin D are in fortified milk and other foods, fatty fish, and eggs. As more and more people spend most of their time out of direct sunlight or wearing sunscreen when they are in the sun, vitamin D production from sun exposure is limited.

Research suggests that women with low levels of vitamin D have a higher risk of breast cancer. Vitamin D may play a role in controlling normal breast cell growth and may be able to stop breast cancer cells from growing.

New research may start to shed light on why Marin County has one of the highest rates of breast cancer in the world, and the answer may be related to vitamin D.

A small pilot study of Marin County women determined through testing to be at high risk for breast cancer found them to be almost twice as likely to have a variant of a vitamin D receptor as the overall population of 338 in the study.

Researchers have long been investigating and discovering variations in genes that could be associated with breast and other cancers. This is the first time a study has linked this vitamin D receptor – a protein molecule that signals the cell to activate vitamin D – with higher risk for breast cancer in Marin County women, the authors said.

Additionally, numerous studies have found a relationship between adequate vitamin D in the body and a lower risk of cancer.

“A lot of people have been doing analyses of vitamin D levels and breast cancer risk, but there haven’t been a lot of studies addressing the vitamin D receptor itself,” said Dr. Kathie Dalessandri, a surgeon scientist in Point Reyes Station and primary author of the study.

“I think this is just the tip of the iceberg,” she said, adding that the findings need to be validated in a larger study

Steps you can take

The two most reliable ways to boost your vitamin D level: get more direct sunlight exposure and take vitamin D3 supplements. Eating foods rich in vitamin D can help, but is less effective.

Sunshine exposure: Even short periods of direct peak sun exposure — 15 minutes 3 times a week, for example — can give you more than the recommended daily amount of vitamin D. It’s also impossible to overdose on vitamin D from the sun. While sun exposure offers vitamin D benefits, it does have risks. Sun exposure increases your risk of skin cancer, including melanoma, the most dangerous type.

In general, most experts recommend you continue to use sun protection when ultraviolet (UV) radiation levels are moderate or high. UV rays are invisible, so you can’t tell if you’re exposed or not. The ozone layer protects the Earth from UV rays. But the thickness of the ozone layer changes with the seasons and the weather, so some UV rays get through to the Earth. The U.S. Environmental Protection Agency and the National Weather Service developed the UV Index, which indicates the strength of UV rays on a scale from 1 to 11+ based on zip code.

There are many variables that can affect how much vitamin D you’ll produce from sunlight:

  • the darker your skin color, the less vitamin D you produce
  • the farther you live from the equator, the less vitamin D you produce
  • fewer daylight hours mean you produce less vitamin D

All these factors can make is hard to get enough vitamin D from sun exposure alone.

Supplements: Before you adjust your vitamin D intake, it’s important to know your vitamin D serum level. This is done with a simple blood test that your doctor can order for you when you’re in for a routine physical. Vitamin D researchers recommend a serum level of 40-60 ng/ml (nanograms/milliliter).

Before you take any supplements, talk to your doctor about the risks and benefits of the product, as well as what a good vitamin D serum level is for you. If your level was low and you’ve been taking a supplement to get back into the normal range, have your vitamin D level checked a few months later and adjust your supplement dose accordingly. Taking too much vitamin D occasionally can cause you to have too much calcium in your blood.

If you’re going to take a vitamin D supplement, most experts recommend taking the D3 form of the vitamin, not the D2 form.

The current recommendation is that people younger than 50 get 200 international units (I.U.) of vitamin D per day. 400 international units per day is recommended for people aged 50-70, and 600 international units per day is recommended for people older than 70. The typical multivitamin contains 400 international units of vitamin D.

Still, many researchers believe these recommendations are too low. The United States National Academy of Sciences is studying this issue and is expected to issue new, higher dietary guidelines for vitamin D intake.

Foods rich in vitamin D:

  • salmon
  • herring
  • catfish
  • oysters
  • mackerel
  • sardines
  • steelhead trout

It’s important to choose your fish carefully to avoid any species that may have high levels of mercury. For more information, visit the Exposure to Chemicals in Food page in this section.

Taking 1 to 3 teaspoons of cod liver oil per day as a supplement can also help fulfill your vitamin D requirements. Still, most people don’t like the taste of cod liver oil, so you may want to try these other fortified foods (though they have lower levels of vitamin D):

  • milk
  • some yogurt (read the label to see if it says “fortified with vitamin D”)
  • some orange juice (read the label to see if it says “fortified with vitamin D”)
  • some soy milk (read the label to see if it says “fortified with vitamin D”)

Your Body and HRT

Menopause and Body Changes

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Women may find their body changes during menopause. Unpleasant symptoms such as dry skin, the sensation of crawling under the skin, dry vagina, pain during intercourse, joint and muscle aches, and frequent urination are common. Some of these symptoms can be due to lower levels of the hormone oestrogen, which is the main hormonal change at menopause. While the use of oestrogen replacement therapy may be useful for some women with some of the changes detailed below, it should not be regarded as an antiageing therapy.

alt Menopause and Body Changes 297.47 Kb


  • Dryness, loss of elasticity, and thinning of the skin occur around the time of menopause, along with increased wrinkles. These changes are due to a combination of deterioration due to ageing and hormonal changes. Wrinkles are made worse by smoking and exposure to sun throughout life.
  • Oestrogen therapy has beneficial effects on the skin. Studies have shown that oestrogen increases skin thickness as well as increasing the water-holding capacity of the upper layer of the skin. Oestrogen may also decrease skin slackness and improve the skin’s capacity for repair.
  • The sensation of crawling on or under the skin, called formication, is relieved by oestrogen therapy.
  • Acne may occur and may accompany unwanted hair growth.


  • Many women notice deterioration in the condition of their teeth after menopause.
  • It is common to experience reduced saliva, increased gingivitis (bleeding gums) and sometimes changes in taste and smell.
  • Osteoporosis (bone thinning) has been linked to tooth loss, with reduced bone in the jaw leading to lack of support for teeth.


  • The genital tract is highly oestrogen-dependent, so dry vagina and vulva are common complaints at menopause. This can lead to discomfort or pain during intercourse as well as bleeding or spotting after intercourse. It is normal for the labia (vulval lips) to become thinner with menopausal hormonal changes.
  • Vulval dryness can worsen other vulval skin conditions (e.g. eczema) which cause itching and irritation.
  • Avoiding soap and bodywashes on the vulva can help relieve irritation and dryness. Alternatives to soap include sorbolene with glycerine or special low-irritant cleansing lotions available from the chemist.
  • All of the above vulvovaginal symptoms respond well to locally applied oestrogen preparations as well as to hormone therapy (HRT).


  • Urinary frequency and incontinence are more common around the time of menopause.
  • The most common cause of incontinence is an overactive or irritable bladder. Vaginal oestrogen therapy may help this condition.
  • Some women find combined HRT beneficial for incontinence but others do not. In some women HRT may make incontinence worse
  • Other incontinence treatments include medication, physiotherapy and, if necessary, surgery. These may be considered after further investigations of the incontinence have been undertaken.


  • Joint and muscle aches and pains are common symptoms during menopause.
  • Conditions such as osteoarthritis are also common at this time.
  • Exercise is an important part of management of these symptoms. ( See AMS Healthy Ageing and Lifestyle pamphlet)
  • Joint and muscle aches may improve with the use of HRT.


  • Many women notice increased facial hair at menopause.
  • Thinning of scalp and pubic hair is also common.
  • HRT, particularly oral forms, can help to control facial hair in some women.
  • Other treatments for increased facial hair include waxing, laser therapy and antitestosterone medication.
  • There are some treatments using scalp lotions that can be applied to help thinning scalp hair.

AMS New directions in women's health