Monthly Archives: December 2012

Yoga on the Go

Yoga on the Road Infographic

A little holiday humour

This is my final blog for the year, so I have kept it light-hearted. I hope you have enjoyed my blogs as much as I have enjoyed doing them. I have concentrated mainly on hormonal and general health topics, which I hope are of interest to you, my readers. I will restart my blogs again early in the new year.  We have another wedding of one of our children, on the 29th Dec. Trevor is marrying Jingru Liu, an aeronautical engineer who works for Airbus, and spent 3 years at a French university doing a postgraduate degree. They make a lovely couple, and we wish them all the best for their futures. I will be returning to work on the 7th Jan, and I hope you all have a wonderful and relaxed Christmas and New Year.
This is a deviation from my usual more serious medical blog, but if laughter is the best medicine, then enjoy this piece.
 Q: Doctor, I’ve heard that cardiovascular exercise can prolong life. Is this true?

A: Heart only good for so many beats, and that it… Don’t waste on exercise. Everything wear out eventually. Speeding up heart not make you live longer; it like saying you extend life of car by driving faster. Want to live longer? Take nap.

Q: Should I reduce my alcohol intake?
A: Oh no. Wine made from fruit. Fruit very good. Brandy distilled wine, that mean they take water out of fruity bit so you get even more of goodness that way. Beer also made of grain. Grain good too. Bottom up!

Q: How can I calculate my body/fat ratio?
A: Well, if you have body and you have fat, your ratio one to one. If you have two body, your ratio two to one.

Q: What are some of the advantages of participating in a regular exercise program?
A: Can’t think of one, sorry. My philosophy: No pain…good!

Q: Aren’t fried foods bad for you?

A: YOU NOT LISTENING! Food fried in vegetable oil. How getting more vegetable be bad?

Q : Will sit-ups help prevent me from getting a little soft around the middle?

A: Oh no! When you exercise muscle, it get bigger. You should only be doing sit-up if you want bigger stomach.

Q: Is chocolate bad for me?
A: You crazy?!? HEL-LO-O!! Cocoa bean! Another vegetable! It best feel-good food around!

Q: Is swimming good for your figure?
A: If swimming good for figure, explain whale to me.

Q: Is getting in shape important for my lifestyle?
A: Hey! ‘Round’ is shape!

Well… I hope this has cleared up any misconceptions you may have had about food and diets.

And remember:

Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well-preserved body, but rather to skid in sideways – Chardonnay in one hand – chocolate in the other – body thoroughly used up, totally worn out and screaming “WOO-HOO, what a ride!!”


For those of you who watch what you eat, here’s the final word on nutrition and health. It’s a relief to know the truth after all those conflicting nutritional studies.

1. The Japanese eat very little fat and suffer fewer heart attacks than Brits.

2. The Mexicans eat a lot of fat and suffer fewer heart attacks than Brits.

3. The Chinese drink very little red wine and suffer fewer heart attacks than Brits.

4. The Italians drink a lot of red wine and suffer fewer heart attacks than Brits.

5. The Germans drink a lot of beer and eat lots of sausages and fats and suffer fewer heart attacks than Brits.

CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you.

Spinach? Good for you? eh!

8 December 2012, 5.39pm AEST

Popeye vindicated – why spinach is good for you

Researchers can now explain exactly how Popeye got superhuman strength from spinach. Marius Watz

Researchers have finally caught up with the wisdom of mothers, who, for decades have been coaxing their children to eat spinach.

We know this leafy green is a good source of folate, a very important B vitamin involved in cell division. Spinach is also rich in iron, making it a potentially important source of this mineral for vegetarians.

Now, researchers in Sweden have uncovered another reason to eat spinach. They appear to have provided an explanation for why Popeye, the cartoon character, had such large muscles and superhuman strength.

There’s a growing body of recent research demonstrating that the inorganic nitrate found in certain vegetables might have important biological functions.

Previously nitrate in food was seen as a potential hazard because a small percentage of it could be converted to nitrite in our bodies. Nitrites can react with other dietary constituents to form nitrosamines, which are suspected stomach carcinogens.

But researchers have now demonstrated that nitrate can be converted back to nitric oxide, a compound important for dilating blood vessels and preventing hypoxia (inadequate blood supply). During exercise, nitric oxide reduces oxygen consumption allowing muscles to exercise more efficiently.

The Swedish researchers, who published the findings of a research project that involved adding nitrate to the drinking water of mice. They gave one group of mice drinking water with added nitrate and a control group water without nitrate for a period of seven days.

Big muscles for a small man. Wikimedia Commons

The authors suggest the amount of nitrate fed to the mice is equivalent to what an adult might obtain from 200 grams to 300 grams of fresh spinach. The standard serving size for fresh spinach is about 30 grams, and for cooked spinach, it’s about 180 grams.

So to consume the same amount as the mice, you’d have to eat one to two serves of spinach every day for a week. We can’t determine what effect smaller amounts of nitrate over a prolonged period might produce.

After one week, the mice were sacrificed for knowledge and their muscles dissected for experiments. The extensor digitorum longus muscle that extends down the front of the leg and contains fast twitch muscle fibres and the soleus muscle (which has slow-twitch muscle fibres) were tested. Fast-twitch fibres generate short bursts of strength or speed as in sprinting while slow-twitch fibres involve prolonged contraction as might be used in a marathon.

The isolated muscles were stimulated and the contractions measured. Researchers found that the mice that had consumed nitrate had increased contractile force in the fast-twitch muscle, that is, they had stronger muscles.

Further studies indicated that nitrate-fed mice had higher concentrations of two different proteins in their muscles; calsequestrin 1 (CASQ) and dihydropyridine receptor (DHPR). These proteins allow increased calcium storage and subsequent release in the muscle for contraction.

The researchers now plan to look for applications of nitrate supplementation not only in exercise performance but for a therapeutic role in diseases with or causing muscle weakness.

Now that science has shown that spinach makes you stronger, there’s no longer a reason to not eat it and excuses won’t do. But if you still can’t be convinced, you will be pleased to know that beetroot, celery, rocket, lettuce and bok choy are also rich in nitrate.

Drink coffee and live longer.

In my Book “Live Well Over 100” I alluded to the fact coffee may be bad for you, due to the caffeine in coffee. The latest study disproves that, as there are other substances in coffee which are good for us, so you can drink coffee with a clear conscience. Hooray!
Prev Med. 2007 Apr;44(4):305-10. Epub 2006 Dec 29.

Non-alcoholic beverage and caffeine consumption and mortality: the Leisure World Cohort Study.


Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA.



To examine the effects of non-alcoholic beverage and caffeine consumption on all-cause mortality in older adults.


The Leisure World Cohort Study is a prospective study of residents of a California retirement community. A baseline postal health survey included details on coffee, tea, milk, soft drink, and chocolate consumption. Participants were followed for 23 years (1981-2004). Risk ratios (RRs) of death were calculated using Cox regression for 8644 women and 4980 men (median age at entry, 74 years) and adjusted for age, gender, and multiple potential confounders.


Caffeine consumption exhibited a U-shaped mortality curve. Moderate caffeine consumers had a significantly reduced risk of death (multivariable-adjusted RR=0.94, 95% CI: 0.89, 0.99 for 100-199 mg/day and RR=0.90, 95% CI: 0.85, 0.94 for 200-399 mg/day compared with those consuming <50 mg/day). Individuals who drank more than 1 can/week of artificially sweetened (but not sugar-sweetened) soft drink (cola and other) had an 8% increased risk (95% CI: 1.01-1.16). Neither milk nor tea had a significant effect on mortality after multivariable adjustment.


Moderate caffeine consumption appeared beneficial in reducing risk of death.

Attenuation in the observed associations between mortality and intake of tea and milk with adjustment for potential confounders suggests that such consumption identifies those with other mortality-associated lifestyle and health risks. The increased death risk with consumption of artificially sweetened, but not sugar-sweetened, soft drinks suggests an effect of the sweetener rather than other components of the soft drinks, although residual confounding remains a possibility.

Good news about HRT – Makes you live longer.

The news about HRT keeps getting better. Read the results of this large study and tell me what you think.

Increased longevity in older users of postmenopausal estrogen therapy: the Leisure World Cohort Study


Long-term users of ET (Estrogen Therapy) seem to have a lower death rate in the Leisure World population. The reduction in the risk of death from all causes was 15%. Considering only mortality as the index of therapeutic success or failure, these results suggest that long-term therapy may extend life. Our results add to the complexity of issues surrounding the risk-benefit equation of hormone therapy. However, with the results of recent clinical trials and other observational studies, our findings suggest that after an initial period of increased risk, use of ET may be without excess adverse effect.

In the post-WHI era, some women will continue to use hormone therapy and others will be started on hormones for menopause-related symptoms. It is especially important that the postmenopausal patient be fully informed of the current state of knowledge regarding these risks and benefits and fully participate with her doctor in decisions regarding choice of therapy.

Oestrogen and Alzheimers Disease.

I have always considered that oestrogen reduces the risk of dementia and alzheimers disease.  Recent research is encouraging. The study below shows that HRT (Oestrogen) should be taken for at least 10 years to reduce the chances of alzheimers. This is another positive outcome for oestrogen. It is a hormone that justs keeps giving.
JAMA. 2002 Nov 6;288(17):2123-9.

Hormone replacement therapy and incidence of Alzheimer disease in older women: the Cache County Study.


Department of Mental Hygiene, School of Hygiene and Public Health, the Johns Hopkins University, Baltimore, Md, USA.



Previous studies have shown a sex-specific increased risk of Alzheimer disease (AD) in women older than 80 years. Basic neuroscience findings suggest that hormone replacement therapy (HRT) could reduce a woman’s risk of AD. Epidemiologic findings on AD and HRT are mixed.


To examine the relationship between use of HRT and risk of AD among elderly women.


Prospective study of incident dementia among 1357 men (mean age, 73.2 years) and 1889 women (mean age, 74.5 years) residing in a single county in Utah. Participants were first assessed in 1995-1997, with follow-up conducted in 1998-2000. History of women’s current and former use of HRT, as well as of calcium and multivitamin supplements, was ascertained at the initial contact.


Diagnosis of incident AD.


Thirty-five men (2.6%) and 88 women (4.7%) developed AD between the initial interview and time of the follow-up (3 years). Incidence among women increased after age 80 years and exceeded the risk among men of similar age (adjusted hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.22-3.86). Women who used HRT had a reduced risk of AD (26 cases among 1066 women) compared with non-HRT users (58 cases among 800 women) (adjusted HR, 0.59; 95% CI, 0.36-0.96). Risk varied with duration of HRT use, so that a woman’s sex-specific increase in risk disappeared entirely with more than 10 years of treatment (7 cases among 427 women). Adjusted HRs were 0.41 (95% CI, 0.17-0.86) for HRT users compared with nonusers and 0.77 (95% CI, 0.31-1.67) compared with men. No similar effect was seen with calcium or multivitamin use. Almost all of the HRT-related reduction in incidence reflected former use of HRT (9 cases among 490 women; adjusted HR, 0.33 [95% CI, 0.15-0.65]). There was no effect with current HRT use (17 cases among 576 women; adjusted HR, 1.08 [95% CI, 0.59-1.91]) unless duration of treatment exceeded 10 years (6 cases among 344 women; adjusted HR, 0.55 [95% CI, 0.21-1.23]).


Prior HRT use is associated with reduced risk of AD, but there is no apparent benefit with current HRT use unless such use has exceeded 10 years.

The best sunscreens.

10 December 2012, 6.12am AEST

Time to dispel the fear of nanoparticles in sunscreens

It’s the sun rather than nanoparticles in sunscreen that poses the real health risk. Edson Soares

The sunny season has well and truly started, as has the daily summer ritual of applying sunscreen. So now is the perfect time to consider whether “nano sunscreens”, which contain UV filtering nanoparticles, are safe for use.

“Nano” is short for nanometre (one billionth of a metre), and a nanoparticle is very small, ranging from only one to 100 nanometres (about one thousandth of the thickness of hair). Because some nanoparticles behave differently to larger versions of the same substance, manufacturers have started to make useful “nanomaterials” with them.

The nano form of zinc oxide is used in sunscreens because it’s both transparent and 50% more effective in UV filtering than the bulk zinc oxide particles in thick white sunscreens. Using an inorganic UV filter such as zinc oxide has many advantages over conventional organic chemical UV filters, which can cause skin irritation and allergies, and have much greater skin absorption.

And unlike zinc oxide, some unstable organic UV filters break down under UV light, so you need to reapply those sunscreens more frequently. What’s more, because individual organic UV filters usually absorb only narrow parts of UV light (either UVA or UVB light), only mixtures of organic chemicals can provide similar broad spectrum UV protection to zinc oxide.

What risk?

Concerns about nano-sunscreens were first raised when a 2008 BlueScope Steel report stated that metal oxide nanoparticles in some sunscreens were capable of bleaching painted surfaces of coated steel. But this is a completely different type of exposure to nano sunscreen, which is formulated to remain on the skin’s surface.

Many scientific studies have shown that nanoparticles don’t readily penetrate human skin. A landmark 2010 Australian study showed that there was little difference between nano or bulk zinc oxide sunscreens because of the negligible amount absorbed into the body (less than 0.01% of the applied dose).

After a five-day beach trial with twice-daily skin applications, the sunscreen zinc appearing in blood was only 1/1000th of the total zinc naturally present in blood. Not only is this minute compared to normal levels of zinc required as an essential mineral for human nutrition, it’s also small compared to the non-essential chemicals more commonly used as UV filters.

Safety tests

Nano zinc oxide (ZnO) in sunscreen has been extensively and repeatedly assessed for safety by regulatory authorities around the world, and is widely accepted as being safe to use in sunscreens.

Kanaka Menehune

In September 2012, the European Union Scientific Committee on Consumer Safety, “concluded on the basis of available evidence that the use of ZnO nanoparticles … at a concentration up to 25% as a UV-filter in sunscreens, can be considered not to pose a risk of adverse effects in humans after dermal application.”

The committee also said that using lipstick or other lip products didn’t pose a risk, but that nano zinc oxide sunscreens shouldn’t be used in spray-on form because of the potential risk of inhalation.

My research team has investigated the worst-case scenario by asking what human skin and immune cells would do if they happened to directly encounter inorganic sunscreen nanoparticles. We found that zinc oxide nanoparticles are as well tolerated as zinc ions and conventional organic chemical sunscreens in human cell test systems.

We recently published a scientific paper identifying the zinc-containing nanoparticles that form immediately when dissolved zinc ions are added to cell culture media and pure serum. Our work suggests that these nanoparticles may actually play a part in natural zinc transport within the body.

Sun protection

Not all nanoparticles behave in the same way biologically, nor are all of them potentially hazardous. Indeed, many engineered nanoparticles are designed with both function and safety in mind. The substance that the nanoparticle is made from is of vital importance in any hazard assessment. And nano zinc oxide has been thoroughly assessed for safety when used in sunscreens and in lip products.

Excessive UV light on the other hand, poses a serious risk for skin damage and cancer. Rest assured that the nano sunscreens can be used safely, so don’t stop using the most effective broad spectrum sunscreen as part of your sun protection measures.

I recommend using non-aerosol zinc oxide sunscreens containing either nano or bulk particles. Their broad spectrum UV filtering ability (including the UVA range), and high UV resistance and negligible skin absorption make them the safest and best way to protect yourself from sunburn. If still in doubt, know that the same conclusions were made by the US Environmental Working Group in their 2012 sunscreen report.

Hair Loss in Midlife.

I mentioned the benefit of oestrogen in menopausal osteoarthritis (see blog Dec 6th). Now we have another of the benefits of oestrogen in menopause – on your hair (and skin). If you look under the heading “HRT- More information” subheading ” Benefits” you will find an article describing the 10 main reasons to be on HRT. One of them is that oestrogen reduces the loss of collagen in the skin and bones by 25%  in the menopause. This study below adds additional information to what we already know.
Maturitas. 2012 Nov 24. pii: S0378-5122(12)00368-4. doi: 10.1016/j.maturitas.2012.10.020. [Epub ahead of print]

Managing hair loss in midlife women.


Department of Dermatology, The Permanente Medical Group, Vallejo, CA, United States; Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States; Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States. Electronic address:


Hair is considered one of the most defining aspects of human appearance. Hair loss, or alopecia in women is often met with significant emotional distress and anxiety. In midlife, women may encounter various hormonal and age-related physiologic changes that can lead to alterations in hair texture and growth. The most significant hormonal alteration is the onset of menopause in which there is a cessation of ovarian estrogen production.

This decrease in estrogen is known to have deleterious effects on the skin and cutaneous appendages. As our understanding of the molecular and hormonal controls on the hair follicle has grown, there has been increased interest in the various modulators of hair growth, including the potential role of estrogen.

Further study of hair changes in midlife women provides an important opportunity for identification of the complex regulation of hair growth as well as identification of treatment targets that may specifically benefit women. In this review, management of hair loss in midlife women is discussed with a focus on three most commonly encountered clinical conditions: female pattern hair loss, hair shaft alterations due to hair care, and telogen effluvium.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[PubMed – as supplied by publisher]


In my book “Live Well Over 100”, the 15th commandment is to throw away the salt shaker and reduce the salt in our diet. Excess salt raises the blood pressure, leads to kidney stones, aggravates asthma, leads to osteoporosis. PMS, oedema and other health issues, too numerous to mention. Here is what you have to do:

5 ways to use less salt

Sodium chloride (salt) is essential to the body. The sodium in salt helps transmit nerve impulses and contract muscle fibers. Working with potassium, it balances fluid levels in in the body. But you only need a tiny amount of salt to do this, less than one-tenth of a teaspoon. The average American gets nearly 20 times that much.

The body can generally rid itself of excess sodium. In some people, though, consuming extra sodium makes the body hold onto water. This increases the amount of fluid flowing through blood vessels, which can increase blood pressure.

Most of the salt that Americans consume comes from prepared and processed foods. The leading culprits include snack foods, sandwich meats, smoked and cured meat, canned juices, canned and dry soups, pizza and other fast foods, and many condiments, relishes, and sauces — for starters. But enough comes from the salt shaker that it’s worth finding alternatives. Here are 5 ways to cut back on sodium when cooking or at the table:

  1. Use spices and other flavor enhancers. Add flavor to your favorite dishes with spices, dried and fresh herbs, roots (such as garlic and ginger), citrus, vinegars, and wine. From black pepper, cinnamon, and turmeric to fresh basil, chili peppers, and lemon juice, these flavor enhancers create excitement for the palate — and with less sodium.
  2. Go nuts for healthy fats in the kitchen. Using the right healthy fats — from roasted nuts and avocados to olive, canola, soybean, and other oils — can add a rich flavor to foods, minus the salt.
  3. Sear, sauté, and roast. Searing and sautéing foods in a pan builds flavor. Roasting brings out the natural sweetness of many vegetables and the taste of fish and chicken. If you do steam or microwave food, perk up these dishes with a finishing drizzle of flavorful oil and a squeeze of citrus.
  4. Get your whole grains from sources other than bread. Even whole-grain bread, while a healthier choice than white, can contain considerable sodium. And bread contains salt, not just for flavor but to ensure that the dough rises properly. You can skip that extra salt when you use whole grains outside of baking. Try a Mediterranean-inspired whole-grain salad with chopped vegetables, nuts, and legumes, perhaps a small amount of cheese, herbs and spices, and healthy oils and vinegar or citrus. For breakfast, cook up steel-cut oats, farro, or other intact whole grains with fresh or dried fruit, and you can skip the toast (and the extra sodium).
  5. Know your seasons, and, even better, your local farmer. Shop for raw ingredients with maximum natural flavor, thereby avoiding the need to add as much (if any) sodium. Shop for peak-of-season produce from farmers’ markets and your local supermarket.

For more information on lifestyle changes to treat hypertension and choosing the right medication, buy Hypertension: Controlling the “Silent Killer” by Harvard Medical School.

Oestrogen helps Arthritis.

Oestrogen is a wonderful hormone that is often misunderstood. More and more research is showing the benefits of this hormone to women.  Gynecologist Robert Wilson coined the term “Feminine Forever” in 1960 indicating the benefits of oestrogen to menopausal women. Recent research (see under “Safety of BHRT” under heading Natural hormones on this website) shows that oestrogen does not increase the risk of breast cancer if started soon after menopause and given transdermally- through the skin such as troches and cream. Now we have research showing Oestrogens benefits to our joints as we age. If you want to know more about the benefits of oestrogen, look under the heading “More on HRT” and sub-heading “Benefits” on this website.
Menopause Int. 2012 Sep 28. [Epub ahead of print]

The pathogenesis of osteoarthritis involves bone, cartilage and synovial inflammation: may estrogen be a magic bullet?


Nordic Bioscience A/S, Herlev, Denmark.


The female predominance of polyarticular osteoarthritis (OA), and in particular the marked increase of OA in women after the menopause points to a likely involvement of female sex hormones in the maintenance of cartilage homeostasis. This perception has inspired many research groups to investigate the role of estrogens in the modulation of cartilage homeostasis with the ultimate aim to clarify whether estrogen replacement therapy (ERT) could provide benefits in preventing the rapid rise in the prevalence of OA in postmenopausal women. The effects of ERT and selective estrogen-receptor modulators on the joint in various experimental models have been investigated. Clinically, the effects of estrogens have been evaluated by post hoc analysis in clinical trials using biochemical markers of cartilage and bone degradation. Lastly, the Women’s Health Initiative trial (WHI) investigated the effects of estrogens on the joint and joint replacements.Even though the exact mode of action still needs to be elucidated, the effect involves both direct and indirect mechanisms on the whole joint pathophysiology. Several animal models have demonstrated structural benefits of estrogens, as well as significant effects on joint inflammation.

This is in complete alignment with clinical data using biochemical markers of joint degradation which demonstrated approximately 50% inhibition of cartilage destruction. These finding were recently validated in WHI, where women taking estrogens had significantly less joint replacement.

In conclusion, the pleiotropic effect of estrogens on several different tissues may match the complicated aetiology of OA in some important aspects.