Monthly Archives: April 2013

End of Life Decisions.

These are decisions we all have to make. See my section “Plan the end of Your Life” on my web site. With the aging of the population, medical resources are finite and many with serious and curable diseases may not be able to afford the necessary treatments. Governments may have to reduce medical staff and hospital beds due to budgetary restrictions. This article therefore becomes an important talking point for us all.
29 April 2013, 6.07am AEST

A conversation that promises savings worth dying for

On the eve of a federal budget looking for savings, I would like to report a medical intervention that reduces suffering, can prolong life and dramatically reduces health-care costs. The intervention itself costs nothing. But first, a story. Jim was 78 when, on an empty road, he drove his car at 100…

We require the largest amount of health-care dollars in the last 30 days of our life. Lee Haywood

On the eve of a federal budget looking for savings, I would like to report a medical intervention that reduces suffering, can prolong life and dramatically reduces health-care costs. The intervention itself costs nothing. But first, a story.

Jim was 78 when, on an empty road, he drove his car at 100 kilometres an hour into a tree. Maybe he’d had a minor stroke – he’d certainly had others due to vascular disease brought on by a lifetime of smoking. He was badly injured – limbs, pelvis, chest, intestines – and, on paper, had no chance of survival. His doctors had two options.

a) Talk to his family, establish any wishes or preferences Jim had expressed, assure them that he would receive the best of comfort measures and allow him to die in a quiet room.

b) Operate on all the fractures and ruptures, keep Jim on a ventilator in an intensive care unit for a month (during which time he would have more money spent on his health care than he had contributed in a lifetime via the Medicare Levy) and hope that he would beat the odds.

He didn’t. I know because we chose b. Or rather, in the absence of a conscious effort to choose anything, b just happened. In acute care (where Jim arrived after his accident), heroic management is the default setting.

This “do everything default” is a heady mix of historical, ethical and legal elements. It includes acting under the principle of necessity (the notion of “emergencies”), technical imperatives (a belief that because we have the technology we are obliged to use it in all cases) and medical imperatives. These are unnuanced notions of duty rooted in a parentalistic version of beneficence – medical ethics reduced to a bumper sticker.

It takes about one minute to treat a patient according to the standard default (admit-operate-ICU), and about two and a half hours to have a proper discussion with the medical teams, the patient and the family. It’s not surprising that the default generally wins out.

The truth is dying is not only scary but also scarily expensive. It’s widely known that the last year of our lives is when the most health-care dollars are spent. It’s less well-known that essentially all of this is spent in the last 30 days of someone’s life.

As in a war, it’s the last, futile battle that is the most costly, in a number of ways. Because the costs of dying come in many forms – financial, opportunity, emotional and physical, all borne variously by the individual, the family and society.

Though not all of us are destined to die like Jim, most Australians will die in acute care hospitals, and almost all will be suffering from chronic, incurable diseases. Which is, of course, not a good fit for an acute care system founded on the duty to rescue and to cure at all costs.

This modern conundrum arose from the rapidly shifting demographic: as we die at an older age, so we die of relapsing chronic diseases. And each relapse results in an admission to an acute care hospital, where we ultimately die.

At the same time as this demographic shift, we have seen the rise of patient autonomy – all previous notions of “best interests” and “futility” now are largely resolved around establishing what the patient would have wanted. Talking to patients and their families, and taking into account their wishes is now an expected part of health care.

Before 1980, medicine largely revolved around a “doctor-knows-best” approach. The notion that decisions were to be negotiated with patients and their families started with a series of high-profile legal cases in the United States. The first “Do Not Resuscitate” orders appeared in the late 1970s, and the first mention of “informed consent” was in 1980.

Acute care hospitals are ill-prepared for this new role as the default place of death for the elderly; few have any systems in place to recognise the signs of dying early enough to have chance to provide palliation. Indeed, for two-thirds of the people receiving acute care, dying is only recognised on the last day of life. Nor are attempts routinely made to establish what the wishes of the patient would have been.

There’s now abundant evidence to back up the extravagant claims I made at the start of this article – we can prove that talking to patients and their families reduces stress, that dying outside an intensive care unit is cheaper and less painful, that cancer patients managed palliatively may out-survive those treated more aggressively, and that talking about death in advance is associated with both lower cost of dying and a better death.

So what is this is this marvellous, free medical intervention? Maybe you have guessed by now – it’s just having a conversation. A conversation that starts when you are in your final years, that asks about your goals, and about who would speak for you if (and when) you lost the capacity to speak for yourself. A conversation that continues through hospital admissions, where your doctors and nurses expect to work with you, as well as for you.

This conversation rarely happens without support. The success of the Respecting Patient Choices program, which takes a systematic approach to initiating this conversation in both acute and residential care, is due the way it trains people to introduce and continue this dialogue.

Clearly any conversation needs two sides. We need to understand that our deaths will not be with a bang but with a series of diminishing whimpers. We can all start now: ask yourself “who will speak for me when I can’t speak for myself?” Then “what do I need to say to this person?” The role of acute care is to systematically pick up this conversation, to routinely ask for this information, and to have ways to translate this into forms intelligible to the acute care system.

It’s the eve of a federal budget. You can almost hear the snap of the public purses closing all over Australia. There is a win–win out there, a conversation that can improve care and save an enormous amount of money. Can we afford silence?

Relief for Arthritis pain.

Get rub-on relief for arthritis joint pain

JAN 2013

Anti-inflammatory medications applied to the skin as creams, gels, sprays, or patches work best for mild to moderate pain near the surface.

Do you have mild to moderate osteoarthritis, or perhaps a sore shoulder or throbbing elbow from yard work? If the source of the pain is close to the surface, you should know about topical analgesics.

Topical analgesics are pain relievers applied to the skin instead of taken as pills or liquids. Prescription versions come as creams, sprays, gels, or patches. The active ingredients, nonsteroidal anti-inflammatory drugs (NSAIDs), soak in through the skin to reach the pain. In contrast, oral pain relievers flood the whole body with the medication.

The source of the trouble largely determines who can benefit from topical pain relievers. “They can be very helpful for the more superficial joints like the knees, ankles, feet, elbows, and hands,” says Dr. Rosalyn Nguyen, a clinical instructor in physical medicine and rehabilitation at Harvard Medical School. “In those areas, the medication can penetrate closer to the joint.”

NSAID targeting

There are about 20 NSAIDs available, including over-the-counter versions of ibuprofen (Advil, Motrin), and naproxen (Aleve).
For many people with osteoarthritis, NSAIDs are more effective than acetaminophen (Tylenol) because they target inflammation, which contributes to pain, swelling, and stiffness.

When taken by mouth, as a pill or liquid, the NSAID is absorbed in the gastrointestinal tract. Then the drug travels in the bloodstream toward the source of the pain. But the blood also carries it to places that don’t need it. For example, an NSAID can cause stomach upset or even bleeding or ulcers.

Applying a topical NSAID concentrates the medicine near the pain site. But a small amount does still enter the bloodstream. For this reason, topical NSAIDs may be off-limits to people at high risk for side effects. This would include people with a history of ulcers or gastrointestinal bleeding. “I would still be reluctant to use an NSAID, although the risk would be much less than it would be with oral formulations,” Dr. Nguyen says.

Are topical pain relievers for you?

Dr. Nguyen says that many people who ask her about topical NSAIDs are looking for ways to avoid adding new pills—and side effects. “Mostly they want to avoid the interactions of medications,” she says. “Some people really don’t want to be taking pills, or have trouble swallowing them.”

The ability to target pain more precisely helps to skirt the side effects of oral drugs. “If it’s a localized problem, with just one joint causing the pain, then there’s no need for a medication to travel throughout the body,” Dr. Nguyen says. If the pain affects an extended area, like the lower back, or affects more than one part of the body, topical pain relievers may not be the best choice.

How well do they work?

A recent scientific review by the Cochrane Collaboration, an international body of health experts, found that some prescription topical NSAIDs offer the same pain relief as oral medications, but with fewer gastrointestinal concerns.

The Cochrane review covered 34 studies involving 7,688 adults who experienced chronic musculoskeletal pain for at least three months. They received several different kinds of topical NSAIDs for their pain. The topical NSAID diclofenac (Voltaren) was as effective as oral NSAIDs for arthritis in the knee or hand.

Over-the-counter topical pain relievers

  • Counterirritants: These products (such as Icy Hot and Bengay) contain ingredients like menthol, eucalyptus, and camphor oil, which temporarily mask the underlying pain with a sensation of coolness or heat. Some counterirritants also contain salicylates, a type of chemical similar to aspirin that has a milder anti-inflammatory effect.
  • Capsaicin: These products (such as Zostrix) contain capsaicin, which is the stuff that makes hot peppers so fiery. Rubbing them on the skin overloads the pain sensing circuits. Capsaicin causes burning pain when it contacts your eyes or mouth, so use care when applying these products. Don’t use if you are allergic to hot peppers.

Limits on use of topicals

Applied as directed, two to four times a day, topical NSAIDs can control mild to moderate pain. For severe (bone-on-bone) osteoarthritis, topical options probably can’t match larger doses of oral medications. Still, even in these cases, a topical drug could help.

“I will recommend it even if the pain is severe in a superficial joint, on the chance it will help to reduce any portion of the pain,” says pain specialist Dr. Joanne Borg-Stein, medical director of the Harvard-affiliated Spaulding-Wellesley Rehabilitation Center in Massachusetts. (Don’t combine oral and topical NSAIDs—prescription or over-the-counter—without telling your doctor, however.)

Availability and cost may limit the use of topical NSAIDs for some people. In the United States, the only prescription topical NSAID widely available in pharmacies is diclofenac gel. Other types, such as ibuprofen, ketoprofen (Orudis), indomethacin (Indocin), and piroxicam (Feldene) may require a special order from a compounding pharmacy. This could raise the price, and insurance reimbursement varies according to the type of topical formulation prescribed.

Most benefit if:

  • your stomach is sensitive to NSAIDs
  • the source of pain is near the surface
  • the pain comes from a focused area, such as a single joint.

Less benefit if:

  • you have active ulcers
  • you have a history of gastrointestinal bleeding
  • you have severe pain.

Possible side effects

Adverse side effects from topical medications are mild and uncommon. They usually include redness, itching, and other skin irritation. Dr. Borg-Stein says that when her patients experience skin irritation, the cause is often the material used to make the cream or gel. In these cases, a pharmacist can create a topical preparation with ingredients that are less irritating to your skin.

A key safety tip for all topical drugs is to wash your hands thoroughly after use so that you don’t smear the drug into your eyes, nose, mouth, or other mucous membranes.

Oestrogen and Alzheimers disease

More evidence that oestrogen helps protect women from Alzheimers Disease (AD) However, women must start early in menopause, and take oestrogen for over 10 years to get maximum anti-Alzheimers benefit.
Neurology. 2012 Oct 30;79(18):1846-52. doi: 10.1212/WNL.0b013e318271f823. Epub 2012 Oct 24.

Hormone therapy and Alzheimer disease dementia: new findings from the Cache County Study.


Department of Public Health, Weill Cornell Medical College, New York, NY, USA.



Observational studies suggest reduced risk of Alzheimer disease (AD) in users of hormone therapy (HT), but trials show higher risk. We examined whether the association of HT with AD varies with timing or type of HT use.


Between 1995 and 2006, the population-based Cache County Study followed 1,768 women who had provided a detailed history on age atmenopause and use of HT. During this interval, 176 women developed incident AD. Cox proportional hazard models evaluated the association of HT use with AD, overall and in relation to timing, duration of use, and type (opposed vs unopposed) of HT.


Women who used any type of HT within 5 years of menopause had 30% less risk of AD (95% confidence interval 0.49-0.99), especially if use was for 10 or more years. By contrast, AD risk was not reduced among those who had initiated HT 5 or more years after menopause. Instead, rates were increased among those who began “opposed” estrogen-progestin compounds within the 3 years preceding the Cache County Study baseline (adjusted hazard ratio 1.93; 95% confidence interval 0.94-3.96). This last hazard ratio was similar to the ratio of 2.05 reported in randomized trial participants assigned to opposed HT.


Association of HT use and risk of AD may depend on timing of use. Although possibly beneficial if taken during a critical window near menopause, HT (especially opposed compounds) initiated in later life may be associated with increased risk. The relation of AD risk to timing and type of HT deserves further study.

3 ways to prevent a heart attack

3 Ways to Prevent a Heart Attack

To help reduce the risk of a recurrence, heart attack survivors need to take charge of their lifestyle. Diet and exercise are key components of a successful recovery, and the following tips will benefit anyone at risk for a second (or first) heart attack.

  1. Manage the big risk factors. Quit smoking, and if you have diabetes, high cholesterol or high blood pressure, talk with your doctor about getting them under control – follow his or her advice about appropriate medications.
  2. Eat a heart-healthy diet. Avoid trans-fats and include more vegetables, fruits, whole soy products, legumes, whole grains, omega-3 fatty acids and monounsaturated fats.
  3. Get active. Moderate physical activity helps keep the heart muscle strong and the arteries flexible, lowers cholesterol and blood pressure, increases overall energy and helps elevate and stabilize mood.

Yoga Pose for Your Heart

The Bridge Pose is a powerful tonic for body and mind. It provides an invigorating stretch for the chest, neck and spine. It is therapeutic for high blood pressure, asthma, osteoporosis and sinusitis. Other possible benefits include:

  1. Calming the mind and alleviating stress and mild depression
  2. Stimulating abdominal organs, lungs and thyroid
  3. Rejuvenating tired legs
  4. Improving digestion
  5. Relieving the symptoms of menopause
  6. Reducing anxiety, fatigue, backache, headache and insomnia

Add the Bridge Pose to your healthy cardiovascular fitness routine – click here to see how to perform this pose. And for more yoga poses, join

Mammography for symptomless women – not so wise?

I have touched on this subject often in previous posts, and more is on my Breast Screening – Mammography section of my web site. My point is that women are not well informed about both sides of this debate, and the decision to have a routine mammogram or not should be taken with all the facts and evidence in mind. Here is another recent article along the same lines.
Climacteric. 2013 Feb 20. [Epub ahead of print]

Mammography for symptomless women – not so wise?


Athena Institute for Women’s Wellness , Chester Springs, PA , USA.


For over 20 years, medical authorities have urged asymptomatic peri/postmenopausal women to undergo frequent mammography. In a recent paper, the authors tested whether early detection reduced the incidence of previously undetected late-stage cancer and saved lives. They compared data from 1976-1978 (pre- mammography) to 2006-2008 US data. Annualized age-adjusted cancer data per 100 000 women ≥ 40 years old showed that early-stage cancer detection cases increased, from 105 to 178 cases of localized disease and from seven to 56 cases of ductal carcinoma in situ; regional invasive late-stage cancer diminished slightly, from 85 to 78 cases; distant late-stage cancer showed no decline, with 17 cases in both 1976-1978 and 2006-2008; breast cancer mortality declined by 20 per 100 000 women, from 71 to 51 cases.

Since mammogram detection produced no decline in late-stage distant cancer presentations (with high mortality rates), and an extremely modest reduction in invasive regional disease (with low mortality rates), improved treatment, not early detection, is the likely engine for the lives saved. Overdiagnosis – estimated at about 70 000 US women per year – inflicts terror, and triggers biopsies followed by unnecessary medical treatments that are painful, potentially harmful, may impair immune responsiveness and increase the risks for other cancers. Given the availability of annual clinical exams, routine mammography screening should now be seriously questioned.

The Boston Marathon Horror.

By now most of you would have seen the horrific images of what happened in Boston. As a doctor, I am aware about the negative effect this may have on you and your family. Like you, I am also  severely disturbed and negatively effected by this. We all have to deal with it in our own way. We live in a world of instant information, and multiple cameras, mobiles and sources of information, so that any disaster is instantly shared around the world. This has a very unhealthy effect on those that view these images, and none of it any good – depression, PSTD, sadness, alienation, anger and worse – now imagine if you are a child, and what the effect this would have on you.

When we lived in villages, minus TV and 24 hour news media, we did not have to cope with any of this. Here are some ways to help cope with horrors like this, and others that will inevitably happen in the future:

Limit your exposure.

We are seeing the same images again and again. We do not need to see the twin towers in New York disintegrating hundreds of times. Once is enough. Take a break after one viewing and disengage. For younger children, restrict this as much as possible. For older kids, this may not be possible as they have mobiles and internet connections, so this leads to the next tip:

Find out what kids know.

Talking to your own children, will surprise you as to how much they know. However, the information may not be accurate so talking to them about it may help you to correct misinfomation. After 9/11. some children thought that hundreds of buildings had fallen down, because they had seen the images of buildings falling down replayed ad nauseum. So asking kids what they know helps to clarify misconceptions.

Remind kids, and yourself, of the good in the world. Blood and explosions may make more sensational images, but they should not overshadow the countless acts of kindness and heroism that follows these disasters. Such goodness was clearly on display in Boston, with ordinary people rushing in to help those severely injured, even in the face of bombs going off around them. We saw many examples of this in the floods in Queensland, and the fires in Victoria a few years ago. These axamples are not the exception but the norm. In adversity and tragedy, we help each other, and rarely respond with panic, recklessness or selfishness. The human propensity for compassion is a real, deep and even defining part of our nature.

A quote from Fred ” Mister ” Rogers resonates today

“When I was a boy and I would see scary things in the news, my mother
would say to me, “Look for the helpers. You will always find people who
are helping.” To this day, especially in times of disaster, I remember
my mother’s words and I am always comforted by realizing that there are
still so many helpers — so many caring people in this world.

Identify ways you can take action and help.

Terrorist attacks and other acts of violence can make us feel powerless and see the world as evil. One of the hardest things for us psychologically about an attack like the one in Boston is that we don’t have any explanation for it—we don’t know the perpetrators, the motive, anything. The excess of images combined with a dearth of explanations might be very distressing for adults and children

An empowering response is to find ways we can help other people. This could mean doing something to benefit victims in Bundaberg, like going up to help rebuild the town, or money, or clothes, or making a donation to the Red Cross. But even lending a hand to someone in your own community could improve your mental health, by reaffirming your own efficacy and your ability to make a positive impact on the world.  A great deal of research backs this up, as Meredith Maran has reported in her Greater Good article on the “activism cure.”

While yesterday’s events were terrifying and heartbreaking, and the resulting images can feel overwhelming, the work by Houston and other researchers shows how it’s possible for adults and kids alike to respond with resilience. For more tips, I suggest reading:

Ideas and quotes from the  Greater Good: The Science of a Meaningful Life, the online magazine of the Greater Good Science Center at UC Berkeley.

Teas for stress.


A popular product class is the “sleepy time” tea. These are the teas which purport to help you unwind from a rough day, relax in the midst of exterior (or interior) chaos, and chill out in a state of relatively peaceful bliss. Many of us live in a state of constant stress punctuated by bouts of acute but transient ease of mind, when it should be the other way around (constant ease of mind punctuated by bouts of acute but transient stress), and these teas and their ingredients claim to help you correct the imbalance. But supplement manufacturers say a lot of things, not all of them true.

What works? What actually helps you ease troubled thoughts? What’s actually worth your money and the time it takes to brew a cup of hot water?

For those who balk at the idea of supplementing an otherwise solid Primal eating plan, don’t be so hasty in your dismissal. Modern life presents novel stressor after novel stressor after novel stressor. Not all of us spend blissed out lives at the beach, or on a remote mountaintop communing with nature, or floating through life on a cloud of bodhisattva farts. Life is hard and often unpleasant, and we don’t get a lot of downtime these days. Smart use of select herbs and roots with anxiolytic, calming, soothing, relaxing properties can go a long way toward restoring the Primal balance between active engagement with the hectic world and passive downtime. The way I see it is if we’re trying to emulate the physiological, psychological, and spiritual state of human being established as “normal” by natural selection, we may have to take a few extra steps to get there. Humans don’t do very well under chronic stress, so mitigating supraphysiological stress by supraphysiological means (whether through meditation or chamomile or taking a plane to Hawaii) makes sense and is unabashedly Primal.

Ultimately, it’s about feeling better and improving our health, no matter the means. I go with what works, regardless of some kind of ideology, using our human evolutionary heritage as a starting point and utilizing the best of 21st century technology to get real results with the least amount of pain, suffering and sacrifice as possible.

Now, let’s take a look at some of these so-called stress relief tea ingredients:

Kava Kava

What is it?

Kava is a crop grown in the South Pacific. Traditionally, its roots were chewed fresh (with the resultant liquid often spit into communal bowls), pounded to release the moisture, or sun-dried, ground, and steeped in water to make an intoxicating, relaxing mild sedative. Nowadays, the active kavalactones are also extracted and pressed into capsules.


Most Pacific cultures used kava, including those of Hawaii, Polynesia, Tonga, Fiji, and Papua New Guinea (to name a few).

What is it purported to do?

It’s supposed to reduce anxiety, induce calmness, cause sedation without mental impairment, and generally chill a person out.

Does the research back that up?

Yes. A Cochrane review concluded that kava extract is effective against anxiety, while another review found that kava has no significant negative effects on cognition.

Is it safe?

There appears to be some concern toward hepatotoxicity. The tendency of some supplement makers to use the leaves and sticks (which contain toxins) to increase yield may lead to hepatotoxicity, but the root itself appears reasonably safe. Preparation may also matter; traditionally, kava is prepared with water, whereas modern processing often uses alcohol. Water-based kava preparations extract different proportions of active compounds than alcohol-based kava preparations. For instance, water extracts glutathione (a powerful antioxidant that our bodies manufacture) from kava, whereas alcohol does not, and this could have ramifications for toxicity. Like many other psychoactive compounds, though, kava root should not be consumed with alcohol, prescription drugs, or any other substance which stresses the liver. Kava Kava root itself is non habit forming, and does not appear to impair driving ability.

Where to find it? has several options available (here, here, or here if you prefer extracts), but there are also designated online vendors. Make sure you stick with actual root (dried, ground, whole, or fresh) or supplements that only use the root and not the leaves.


What is it?

An amino acid found in tea leaves, especially green tea.


It’s technically been around for thousands of years, or as long as people have been harvesting and brewing tea (and even longer, unless you answer in the negative to “If green tea grows in the forest and nobody brews it, does it still impart a healthy dose of L-theanine?”), but it wasn’t until 1949 that L-theanine was isolated and identified by Japanese scientists who proceeded to stick it into a variety of different products.

What is it purported to do?

L-theanine is promoted as a stress-relieving compound that binds to GABA receptors and induces changes in brain waves indicative of relaxation.

Does the research back that up?

Yes, it appears to lower the negative effects of stress, reduce anxiety, and improve relaxation, as a quick look at the literature shows:

Is it safe?

The LD50 of L-theanine is incredibly high and impossible to reach via tea and nearly impossible to reach via supplement (you’d have to take dozens of bottles or drink hundreds of gallons).

Where to find it?

It’s richest in green tea, with matcha appearing to have the highest L-theanine content. Taking L-theanine via capsule is roughly the same as taking it via tea. It’s also present in Primal Calm.


What is it?

A flowering plant similar to the daisy that can be infused in hot water to produce a relaxing, calming tea.


The use of chamomile as a medicinal herb dates back at least to the ancient Egyptians. In medieval Europe, chamomile was a “strewing herb” (herbs which were strewn about the floor of living spaces), a beer-making ingredient, and one of the Nine Sacred Herbs used by Anglo-Saxon god Woden (or Odin in Norse mythology) to “smote the serpent.” In other words, it was pretty dang significant to people throughout history.

What is it purported to do?

Act as a mild sedative and anti-anxiety agent.

Does the research back that up?

Yes, several studies show efficacy:

Is it safe?

It’s pretty safe, with a couple exceptions: pregnant women, for whom chamomile can induce uterine contractions (PDF), potentially leading to early labor; and people with ragweed allergies, for whom chamomile can exhibit cross-reactivity symptoms.

Where to find it?

Chamomile tea, being one of the more common varieties, is easy to find. This is a legit brand, or you could grow your own. Chamomile provides attractive (and useful) ground cover for your garden.

Valerian Root

What is it?

It’s a root, obviously, most often served up as dried powder in capsules, a tea, or a tincture. The plant itself has lovely flowers and leaves that resemble ferns, but it’s the root and rhizome we’re interested in.


Ayurvedic, Chinese, and classical Hellenic medical systems employed valerian as an anti-insomnia and anti-anxiety medicine. More recently, it was prescribed to Edward Norton’s insomniac character in Fight Club (“chew some valerian root”). I can’t remember if it was in the book, too.

What is it purported to do?

It’s said to be a mild but effective sedative, anxiolytic, and sleep aid, akin to the benzodiazepine class of drugs without the side effects.

Does the research back that up?

Kinda. There are a few studies, but the results are mixed:

  • Among patients with generalized anxiety disorder, valerian extract has an anxiolytic effect on the “psychic symptoms of anxiety.”
  • Valerian may be effective against obsessive compulsive disorder.
  • Among insomniacs, valerian extract improves the “sleep efficiency,” reducing morning grogginess and improving sleep architecture. Another study, using lower amounts of valerian, did not get the same results.
  • A 2006 meta-analysis was unable to decide whether or not it was effective against anxiety, however. Another review concluded that valerian “might improve sleep quality without producing side effects,” while a more recent one (of just RCTs) found it likely to improve subjective insomnia symptoms.

Overall, the weight of the anecdotal evidence, my own experience with it, and the fact that some, but not all, clinical trials find efficacy, leads me to the tentative conclusion that valerian can be useful against anxiety and maybe insomnia.

Is it safe?

Valerian is safe, well-tolerated, and seems to have fewer side effects than pharmaceutical sedatives and anti-anxiety meds. Pregnant women should avoid it due to a lack of safety studies.

Where to find it?

Any health food store should carry the capsules and the tea, and perhaps even the whole or ground root. Online is always an option, of course. I recommend buying the root direct.

Rhodiola Rosea

What is it?

Also known as rose root or arctic root, rhodiola rosea hails from Siberia originally and pretty much everywhere else that’s cold – the Arctic, the Rockies, Northern Europe, the mountains of central Asia – and possesses a root with interesting characteristics.


Ancient Greeks, Viking raiders, Central Asian horsemen, Chinese emperors – they all prized rhodiola rosea as an anti-fatigue, anti-stress medicinal herb.

What is it purported to do?

Act as a powerful adaptogen, a compound which improves your ability to adapt to physiological stressors without compromising your body’s normal ability to function once removed.

Does the research back that up?

Definitely. Although most of the research comes from Scandinavia and Russia, there are a good number of trials available on Pubmed:

Overall, rhodiola rosea improves your ability to handle stress. If you’re lagging, it’ll bring things up. If you’re freaking out, it’ll bring you closer to baseline.

Is it safe?

It seems to be extremely safe.

Where to find it?

Primal Calm has it, as do plenty of other products. You can even buy it in bulk.

Magnolia Bark

What is it?

Magnolia bark is the lay name for magnolia officinalis, a deciduous tree whose bark is prized in traditional Chinese medicine.


People have been using the bark for its medicinal qualities as far back as 100 AD.

What is it purported to do?

It gets billed as a sedative with strong anti-anxiety and anti-stress effects.

Does the research back that up?

For the most part, yes:

Is it safe?

While there are no long-term safety studies, trials indicate an extreme paucity of negative side effects. As always, exercise caution if you’re pregnant.

Where to find it?

I use it in Primal Calm. Chinese herb stores will have it (if you’ve got a Chinatown in your city, you can probably find it there).

Some teas blend some or all of these (and other) ingredients, so not only are you getting the dozens of bioactive compounds found in this herb, root, or rhizome, you’re getting the hundreds of bioactive compounds found in these other herbs, roots, and rhizomes. Plus, one ingredient might potentiate, inhibit, or otherwise modify the action of another ingredient, so it’s difficult to predict exactly what you’ll be getting out of a blend. Take valerian and lemon balm, which combine to become an effective anti-anxiety blend against acute stress.

With the possible exception of kava kava, though, I wouldn’t worry too much about any interactions – and even with kava, it seems reasonably safe as long as you’re smart and moderate about it while avoiding alcohol and other compounds with a liver load.

That’s it for this week, folks. Next week, I’ll explore some other helpful ingredients in tea. Thanks for reading!

What’s In Your Soymilk?

I covered Soy milk on the 6th March in a blog titled ” Soy vs Milk- which is better?” Here is some more interesting facts about soymilk.
Published: 4/13/2013

Soymilk is made by soaking dried soybeans in water, then grinding, heating and pressing them. The fluid is then strained and packaged as “milk.” Among its many benefits, soymilk:

  • Can substitute for cow’s milk in many culinary applications.
  • Does not contain milk protein (casein), which can increase mucus production and irritate the immune system in some people.
  • Does not contain milk sugar (lactose), which can cause digestive distress in those who are lactose intolerant.
  • Is a good source of protein – one cup contains four to 10 grams of soy protein.

When choosing soymilk, opt for a brand that is:

  • Fortified with calcium – while soymilk is naturally a good source of calcium, it doesn’t have as much as cow’s milk.
  • Organic – many soy crops are heavily treated with pesticides.
  • Free of the thickening agent carrageenan, a seaweed derivative, which I believe may be harmful, especially to the intestinal tract.

I recommend one to two one-cup servings daily.

From Dr Weil.

Don’t mess with water.

Does your water need more ions?

Kent Sepkowitz

The latest health fad is even more ridiculous than most health fads.

Has your water got sufficient ions?
Has your water got sufficient ions?

After so many years of neglect, water appears ready to emerge as a cutting-edge health food.

Perhaps it’s the fault of Gatorade, that Technicolor concoction of salt, sugar and water people guzzle to “replenish their electrolytes.” The Gatorade inventors, some dweeby physiologists, were just trying to keep football players from collapsing in the Florida heat. They could not have foreseen what was to transpire in the decades ahead as the concept of the “sports drink” took hold, and then, more bizarrely yet, water itself became a symbol of health and status.

With each iteration, beginning with bottled waters derived from glaciers (tres European) to the recent “enhanced water,” H2O has moved closer to the first-class cabin. But the latest version is a real head-scratcher: ionised, alkalinised water.

Companies are in the game to sell you a gizmo to run your tap water through. The devices contain electrodes that purport to realign your water, split off some hydrogen atoms along the way, and rid it of various pesky problems so that it will taste better and be healthier and your arthritis will go away. In a week. Maybe two.

Water, in the western world at least, is a strange target for an expensive course in self-improvement. Top-notch plumbing remains perhaps our greatest achievement. We confront many ubiquitous environmental risks daily, but water is not among them. It is safe and unobjectionable. Plus it’s cheap – and yet Americans spent $21 billion last year on bottled water.

So why all the excitement about ionised water? And didn’t we go through this already with air? We were going to ionise air, too, to purify it – until that didn’t work out so well. In fact, Sharper Image, a purveyor of one of these air ioniser products, lost a large lawsuit because of their too optimistic claims.

Having read many articles and viewed countless videos about ionisation and alkalisation of water, I remain uncertain how the technology being hawked will help a single soul. There isn’t even a crummy clinical trial to criticise. Nothing.

Even by health fad standards, the science around ionisation and alkalinisation is remarkably thin. Here is the claim: We are ingesting food and drink that is set at a disadvantageous pH. You remember pH, the measure of acidity and its opposite, alkalinity (or baseness, as in acid-base balance), where perfect Swiss neutrality is 7.0. Any number below 7.0 refers to an acidic substance and any number above, alkaline.

A more important pH to remember is this: 7.4. That’s the pH of the human bloodstream. We work very hard to stay exactly there. Every chemical reaction, all trillion or two our cells crank through daily, is optimised for 7.4. The body does not work well outside a tight range between 7.35 and 7.45; indeed much more variation and you’re liable to drop dead. Here’s an example of how seriously our body takes its ambient pH. People with emphysema retain carbon dioxide in the distorted nooks and crannies of their lungs, and the carbon dioxide converts to a mild acid that would upset the body’s entire acid-base balance. Your heroic kidneys compensate for the extra acid by hanging onto bicarbonate, thereby maintaining the 7.4 pH and keeping the body from collapsing.

The body has a floating buffer system that shifts back and forth from the mildly alkaline (bicarbonate) to the mildly acidic (carbonic acid), depending on the need. The stomach, though, is a factory of harsh acid, creating a pH of 2 or so – the better to denature bacteria and viruses and anything else that might make you sick. So the idea that moving some water from a pH of 7.0, where it usually lives, to a pH of maybe 8.5 and claiming a major health triumph is quite puzzling. The premise, I think, is that slightly increasing the pH in your stomach will keep the stomach from having to secrete so much acid and in turn spare the pancreas from squirting out so much bicarbonate, thereby giving all your organs a bit of a holiday. And that holiday means we don’t have pains or arthritis or die, maybe.

So that’s alkalinisation. Ionising water for health is even more difficult to comprehend, but here goes: The ioniser splits water into its component parts, hydrogen and oxygen. The idea is that cleaving emancipates enslaved atoms from water’s neutral charge (hydrogen is positive and oxygen is negative) and that this liberation is salutary. You’re suddenly full of electricity, and everything feels better! This view that more ions are welcome stands in direct opposition to the free radical theory of disease. There, the bad guy is – you guessed it – a rogue negative charge looking for some unsuspecting molecule to glom onto and destroy, making you age and get arthritis and grey hair and all the problems that ionisation sets out to cure.

Water ionisation and alkalinisation is another fad without science to support it or even a particularly interesting group of nuts pitching it.

But so what? One could argue that there is nothing wrong with snake oil, that the crime is victimless but for the money lost. Surely it is unlikely that people will ionise or alkalinise their way to illness. There is harm, however, in all of this, similar to the harm that comes from tolerating a parallel universe of chronic Lyme and antioxidant cures and autism-causing vaccines and countless other persistent, willful misconceptions of what cold-hearted, gimlet-eyed science long ago has disproved.

Medicine and science are fragile entities, easily tarred and assaulted. People love to hate conventional remedies and advice, the schoolmarmish admonishments to eat less, exercise more and wear a seat belt for gosh sake. How much more fun to embrace a retro-futuristic water ioniser that does whatever it does and makes the willies all go away. Stacked up against that sort of promise, what chance does methodical, earthbound science really have? Eventually it is the physician who seems the narrow-minded, dim-witted charlatan stuck on boring Earth, heavy shoes pulled down by gravity. Because it turns out that it is not science that people want but science fiction.

Kent Sepkowitz is a physician in New York City who writes about medicine.

Read more:

The Anti-Vacc lobby.

Two articles from Saturday’s Daily Telegraph which align with my thinking exactly (if you hadn’t guessed by now)

Is there a vaccine for idiocy?

IF there was a shot to immunise against haters of vaccines I’d cop a jab of that elixir right now.

Like a reoccurring rash the debate over vaccines resurfaces every few months, often bringing with it a swab of convoluted hippy science.

Reviving the story this week is the National Health Performance Authority which says Australia has about 77,000 children not fully immunised.

The numbers prove once again some parents are refusing to accept scientific consensus that vaccines can prevent children from dying.

The failure to immunise children flies in the face of Australian Academy of Science data showing child deaths by antiquated nasties such as measles, whooping cough, diphtheria, tetanus and infantile paralysis are near non-existent thanks to vaccines.

It’s almost as if the lack of deaths is causing a false belief that these diseases no longer exist.

I’m just thankful I was conceived in the 1980s before Australian parents got the internet because my mother would almost definitely withhold jabs if I was born today.

I love my mother, but she does live in the Sunshine Coast hinterland and has a history of exploring alternative medicines and falling for Goji Juice scams.

If I so much as cough at home she’ll ambush me with a lemon-honey tea, six garlic tables, vitamin C, a multi vitamin and there won’t be a Codral in sight.

As a former Army Reservist I’ve been injected with dozens of vaccines for everything from hepatitis B to meningococcal and I’m thankful for every last one of them.

I don’t ever want to know what shingles feels like or find out if whooping cough is as bad as people say.

I’m no doctor, and neither is Wikipedia, which is why I put my faith in the experts to vaccinate me against whatever pandemic’s floating around.

The truth inoculators will say things like “vaccines cause autism”, “elderberries are the best defence against the flu” or “vaccines are just a money-grab for greedy corporations”.

But until the haters can front up scientific proof vaccines are worse for me than measles, jab me up baby.

James Drew is neither a doctor nor scientist.  Instead of a doctorate in vaccinations, James has a bachelor’s degree in journalism which severely limits his job prospects and value to the human race. When James isn’t telling parents how to do their job, he writes for community newspapers Caboolture Shire Herald and Northern Times.

Follow James on Twitter: @JamesDrewQLD

Sarah Wilson’s apparent support of the ‘anti-vax’ movement irresponsible, writes Caroline Marcus

CALLING for debate on vaccination is like calling for debate on whether the earth is flat.

But while remaining cynical about the planet’s dimensions in the face of solid evidence is just as thick, that type of scepticism doesn’t lead to the death of children and babies.

Not having your kids jabbed very much does.

The anti-vaccination brigade have been a vocal minority, but their nutty claims – among other things, that vaccines cause autism – are swiftly shot down by the mainstream media.

The fact is, immunisation alone is responsible for the eradication in the developed world of small pox and polio, a debilitating disease that saw my late grandmother crippled with a severe limp from childhood to her death.

Measles and whooping cough were also virtually eradicated, that is, until the “anti-vax” movement started to spread.

Two children died on the NSW north coast last year during a whooping cough epidemic that infected 24,000 children, while western and southwest Sydney were hit by a measles outbreak.

It speaks volumes that the work of British medical researcher Andrew Wakefield, who became the posterboy for the anti-vax movement after his “studies” illustrated a supposed link between the measles, mumps and rubella vaccine and autism, was discredited as fraudulent and he was struck off the medical register in 2010.

But then we get people like Sarah Wilson, blogger and self-styled health expert, going on breakfast television saying vaccination research was “not conclusive”.

She went on to claim wealthy parents were less likely to vaccinate their children because they were “more educated” and “weigh up all the different research and so on”.

I was on the Kochie’s Angels panel with Wilson this morning and was horrified, even if she had hinted minutes before we went on set that she planned to say something controversial about vaccination.

Since the show, she received a massive backlash on Twitter and has been busy backpedalling ever since.

Wilson later posted a statement on her website saying she was not personally anti-vaccination, yet was still banging on about having an interest in the “other side of the debate”.

BUT THERE IS NO OTHER SIDE. There’s medical proof and then there’s medical proof.

The fact she even calls into question what medical experts agree is irrefutable evidence of the efficacy of vaccines, is – to my mind – criminally irresponsible.

There are ways to voice the thrust of the anti-vaxers while at the same time, discredit them. Wilson did not do this.

In the meantime, the mainstream media must persevere in debunking the ridiculous conspiracy theories that have seen immunisation rates drop to new, alarming lows.