Monthly Archives: September 2014

Female fertility: Whats testosterone got to do with it?

Female fertility: Whats testosterone got to do with it? Full Text
EurekAlert!, 03/05/2014

New study shows male hormones play an important role; may enhance IVF therapy. Several fertility clinics across the country are beginning to administer testosterone, either through a patch or a gel on the skin, to increase the number of eggs produced by certain women undergoing in vitro fertilization (IVF). Women are also purchasing the over–the–counter supplement DHEA, which is converted by the body into testosterone, to boost their chances of pregnancy with IVF. A few clinical trials support the use of testosterone given through the skin, while others have shown no benefit of DHEA – also used in attempts to slow aging and enhance muscle mass – in increasing pregnancy and birth rates in women who don’t respond well to IVF therapy. Lacking a large and convincing body of data on the topic, the jury is still out as to whether male hormones such as testosterone improve female fertility. A new study suggests that male hormones, also called androgens, help drive the development of follicles – structures that contain and ultimately release an egg that can be fertilized by a man’s sperm. Published in the Proceedings of the National Academy of Sciences, the research also details how male hormones boost the production of follicles in mice.

To Age Well, Walk


To Age Well, Walk

Mildred Johnston walking along a path in Kanapaha Veterans Memorial Park in Gainesville, Fla. Ms. Johnston participated in a large study that showed the benefits of walking for older people.Rob C. Witzel for The New York TimesMildred Johnston walking along a path in Kanapaha Veterans Memorial Park in Gainesville, Fla. Ms. Johnston participated in a large study that showed the benefits of walking for older people.
Phys Ed

Gretchen Reynolds on the science of fitness.

Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.

The results, published on Tuesday in the journal JAMA, reinforce the necessity of frequent physical activity for our aging parents, grandparents and, of course, ourselves.

While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.

“For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people,” said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.

Countless epidemiological studies have found a strong correlation between physical activity in advanced age and a longer, healthier life. But such studies can’t prove that exercise improves older people’s health, only that healthy older people exercise.

Other small-scale, randomized experiments have persuasively established a causal link between exercise and healthy aging. But the scope of these experiments has generally been narrow, showing, for instance, that older people can improve their muscle strength with weight training or their endurance capacity with walking.

So, for this latest study, the Lifestyle Interventions and Independence for Elders, or LIFE, trial, scientists at eight universities and research centers around the country began recruiting volunteers in 2010, using an unusual set of selection criteria. Unlike many exercise studies, which tend to be filled with people in relatively robust health who can easily exercise, this trial used volunteers who were sedentary and infirm, and on the cusp of frailty.

Ultimately, they recruited 1,635 sedentary men and women aged 70 to 89 who scored below a nine on a 12-point scale of physical functioning often used to assess older people. Almost half scored an eight or lower, but all were able to walk on their own for 400 meters, or a quarter-mile, the researchers’ cutoff point for being physically disabled.

Then the men and women were randomly assigned to either an exercise or an education group.

Those in the education assignment were asked to visit the research center once a month or so to learn about nutrition, health care and other topics related to aging.

The exercise group received information about aging but also started a program of walking and light, lower-body weight training with ankle weights, going to the research center twice a week for supervised group walks on a track, with the walks growing progressively longer. They were also asked to complete three or four more exercise sessions at home, aiming for a total of 150 minutes of walking and about three 10-minute sessions of weight-training exercises each week.

Every six months, researchers checked the physical functioning of all of the volunteers, with particular attention to whether they could still walk 400 meters by themselves.

The experiment continued for an average of 2.6 years, which is far longer than most exercise studies.

By the end of that time, the exercising volunteers were about 18 percent less likely to have experienced any episode of physical disability during the experiment. They were also about 28 percent less likely to have become persistently, possibly permanently disabled, defined as being unable to walk those 400 meters by themselves.

Most of the volunteers “tolerated the exercise program very well,” Dr. Pahor said, but the results did raise some flags. More volunteers in the exercise group wound up hospitalized during the study than did the participants in the education group, possibly because their vital signs were checked far more often, the researchers say. The exercise regimen may also have “unmasked” underlying medical conditions, Dr. Pahor said, although he does not feel that the exercise itself led to hospital stays.

A subtler concern involves the surprisingly small difference, in absolute terms, in the number of people who became disabled in the two groups. About 35 percent of those in the education group had a period of physical disability during the study. But so did 30 percent of those in the exercise group.

“At first glance, those results are underwhelming,” said Dr. Lewis Lipsitz, a professor of medicine at Harvard Medical School and director of the Institute for Aging Research at Hebrew SeniorLife in Boston, who was not involved with the study. “But then you have to look at the control group, which wasn’t really a control group at all.” That’s because in many cases the participants in the education group began to exercise, study data shows, although they were not asked to do so.

“It wouldn’t have been ethical” to keep them from exercise, Dr. Lipsitz continued. But if the scientists in the LIFE study “had been able to use a control group of completely sedentary older people with poor eating habits, the differences between the groups would be much more pronounced,” he said.

Over all, Dr. Lipsitz said, “it’s an important study because it focuses on an important outcome, which is the prevention of physical disability.”

In the coming months, Dr. Pahor and his colleagues plan to mine their database of results for additional followup, including a cost-benefit analysis.

The exercise intervention cost about $1,800 per participant per year, Dr. Pahor said, including reimbursement for travel to the research centers. But that figure is “considerably less” than the cost of full-time nursing care after someone becomes physically disabled, he said. He and his colleagues hope that the study prompts Medicare to begin covering the costs of group exercise programs for older people.

Dr. Pahor cautioned that the LIFE study is not meant to prompt elderly people to begin solo, unsupervised exercise. “Medical supervision is important,” he said. Talk with your doctor and try to find an exercise group, he said, adding, “The social aspect is important.”

Mildred Johnston, 82, a retired office worker in Gainesville who volunteered for the LIFE trial, has kept up weekly walks with two of the other volunteers she met during the study.

“Exercising has changed my whole aspect on what aging means,” she said. “It’s not about how much help you need from other people now. It’s more about what I can do for myself.” Besides, she said, gossiping during her group walks “really keeps you engaged with life.”

A version of this article appears in print on 05/28/2014, on page A12 of the NewYork edition with the headline: Exercise for Older Adults Helps Reduce Their Risk Of Disability, Study Says .

The myth that old people don’t have sex

The myth that old people don’t have sex

April 28, 2014
Matty Silver

Sexual health therapist

Stigmatised: sex and seniors.Stigmatised: sex and seniors. Photo: Mark Bowden

I spoke to a man recently who had a dilemma and needed some advice. His 73-year-old mother-in-law, who has early dementia, had been living in a nursing home for about six months. He and his wife were contacted by the staff who told them that she had started a relationship with another resident. They were seen kissing and holding hands, often spending time in each other’s room.

My client felt that as long as the relationship was consensual, it should not be a problem; he had noticed she seemed happier lately and couldn’t understand why the nursing home felt it necessary to inform them. But his wife was outraged – she had never seen her parents show any affection at all, and the thought that her mother might be having sex with a “stranger” was abhorrent to her.

In today’s society many people believe old people are not sexual any more and often managers of aged-care facilities think so too. Nursing home residents should be able to enjoy a healthy sex life, which is important to their psychological and physical wellbeing. It shouldn’t be a taboo. We are not just talking about intercourse – kissing, cuddling, holding hands or lying in bed together can be great sexual intimacy.

Aged-care facilities have a duty of care to make sure there is no abuse, but just because someone has dementia doesn’t mean they can’t consent. Carers have to remember that their residents are adults, not children, and having dementia doesn’t always stop them from making decisions. They may decide what TV show they want to see, what to eat, what to wear or even to refuse their medication. Therefore no one has the right to deny them the fundamental right of sexual expression.

Service providers need better education to understand that the most important challenge is to determine the capacity of an older person to consent to sexual activity, and to be able to put aside their beliefs and values. They also have to realise that they can’t discriminate against older lesbian and gay people, who often feel they have to get back into the closet.

More practical matters need to be addressed, too, since privacy can be a problem, with staff often “just walking in” without knocking at the door. And what about providing single king-size beds?

Over the past few years, several surveys have been conducted to find out more about the sex lives of older Australians, and the good news is that sexual activity is enjoyed into advanced age. Ageing doesn’t end sex, it changes it. Sometimes a couple may end up not having penis-vagina intercourse any more, but there are many other satisfying ways to be sexual.

Dr Lesley Yee of the Australian Centre for Sexual Health believes there are a number of ageist stereotypes in our community that make it difficult for both doctors and patients to discuss sexuality openly as patients become older. Many physicians may see sexual dysfunction in the elderly as a biological part of the ageing process and therefore not a medical issue. Discussing sex remains difficult or embarrassing for many GPs and in turn patients also find it difficult to raise sexual issues with their doctors.

Ageing changes sex; women start to experience menopausal changes such as vaginal dryness. The vaginal lining thins and sometimes intercourse becomes uncomfortable. Libido and sexual self-esteem may decrease, and for both men and women it often takes longer to have an orgasm. Men may experience erection problems and arousal can take more time. As a result many older people are not prepared for the sexual changes and they withdraw. But it doesn’t have to be that way as there are so many other ways to be sexual.

Keep your sex life alive by making time for it. Try different approaches that allow you to get excited and enjoy each other. Use hands, mouth, and sex toys to make love and enjoy an orgasm. Try to have sex in the morning when you are not tired and men’s testosterone levels are higher. Having sex releases several hormones in the body, which increases intimacy and bonding and works against loneliness and depression. When you are on your own, solo sex is a great option.

The United States seems to be less ageist than Australia. My favourite sex educator Betty Dodson is still working at age 84 and produces YouTube videos with business partner Carlin Ross. New York sex therapist Ruth Westheimer, better known as Dr Ruth, has her own YouTube channel and is 85 years old. American writer Joan Price is an advocate for ageless sexuality; check her out on YouTube where she discusses her books about ageless sex.

Read more:

Choosing strong painkillers

26 May 2014, 2.49pm AEST

Health Check: how do you choose strong painkillers?

Commonly used over-the-counter painkillers such as paracetamol, aspirin and ibuprofen will usually be strong enough to alleviate common aches and pains. But if you’re suffering from acute pain from dental…

Only around 10% of the codeine dose will give you analgesia, but 100% of it will give you side effects. Andrzej Wilusz

Commonly used over-the-counter painkillers such as paracetamol, aspirin and ibuprofen will usually be strong enough to alleviate common aches and pains. But if you’re suffering from acute pain from dental work, minor surgery or migraine headaches, you may need something stronger.

So, how do you choose what’s best for you? And what are the side effects?

Pharmacy-only painkillers are usually rendered more effective by adding the opioid drug codeine. Adding codeine to paracetamol creates Panadeine from Panadol (or any other brand of paracetamol) or Nurofen Plus from ibuprofen alone.

Codeine is a naturally occurring opioid with a very long track record of relatively safe use. It constitutes around 3% of the alkaloids found in opium juice, but is synthetically derived for medical use.

Codeine has relatively poor analgesic ability by itself. Most of the painkilling effect of codeine is produced when metabolised by the liver. An average person will produce around 1mg of morphine from the 10 to 15mg of codeine in many of these over-the-counter analgesics.

But there is major variability in our ability to metabolise codeine. As many as 25% of the people in the community are unable to produce morphine from codeine and therefore will get very little pain relief. But they will endure the same side effects.

Codeine has relatively poor analgesic ability by itself. Brian Hansen, CC BY-NC

A much smaller percentage will be very active metabolisers who will produce a far higher percentage of morphine from the same dose.

In practice, adding codeine to paracetamol or ibuprofen does increase the overall effectiveness and is fine for occasional use for acute pain as long as you know you’re not one of those unlucky ones who doesn’t convert the codeine into morphine.

But codeine is too unreliable and modest in its effectiveness for use as a long-term treatment for persistent types of pain.

The side effects of codeine (apart from pain relief) can be quite significant. It is very constipating and can cause drowsiness, itchiness, nausea and a dry mouth. I encourage my students and registrars to think of codeine as a “constipating cough suppressant that gives some people pain relief as a side effect”.

In high doses, codeine can suppress the user’s breathing and cause drops in blood pressure on standing or sitting too quickly. In these respects, it’s typical of the opioid class.

Fatal overdoses involving codeine regularly occur, though in the case of compound analgesics, the paracetamol and ibuprofen may be more immediately damaging to the internal organs.

Adding an opioid to a formulation also leads to concerns about compulsive use and addiction. The tendency of all opioids to reinforce their own use by activating the dopamine reward system is perhaps the main reason why many people keep taking them when it’s clear that they’re having little effect on the pain they are supposed to be treating.

Dose increases due to tolerance are frequently an issue with drugs containing codeine, especially when treating chronic migraines and back pain. Your GP has a number of questionnaires you can take if you’re concerned about your risk of becoming addicted to codeine.

Opioids activate the dopamine reward system, which can drive dependence. Flood G., CC BY-NC-ND

You should avoid over-the-counter codeine altogether if you are pregnant or breast-feeding. Due to their immature livers, children have much more erratic metabolism of codeine, and can accumulate potentially fatal levels of morphine from “average” doses if they are fast converters.

As codeine is excreted in the breast milk, it can cause side effects in the baby, and the same problems apply as for children. Always discuss the use of strong analgesia for children or while pregnant or lactating with your doctors.

Another ingredient added to some formulations is doxylamine succinate. Doxylamine is a first-generation antihistamine, and it is a very sedating one at that. Pharmacists and GPs sometimes use obsolete terminology to describe it as a “calmative” or “relaxant”.

The major brand of doxylamine-containing formulation is Mersyndol, which contains paracetamol and codeine as well. It’s often sold as a treatment for severe headaches. But this is the only paper I can find on its use in severe headaches. It’s a small study of migraine sufferers from 1976 – not exactly compelling evidence to support its current widespread use.

If you’re taking Mersyndol (or another drug containing doxylamine) more often than once a week on a regular basis, you should see a neurologist or other headache specialist to get a diagnosis as early as possible. Delayed diagnosis means your headaches can become much more difficult to control once the headache type is established and more specific treatments given.

Short-acting opioids or doxylamine are never recommended long-term treatment for any type of chronic headache.

Tips for choosing stronger painkillers:

  • Use over-the-counter drugs containing codeine for the shortest possible time at the lowest dose, if you know your liver makes the conversion to morphine.
  • Don’t keep taking drugs containing codeine if they don’t seem to be working.
  • Remember, only around 10% of the codeine dose will give you analgesia, but 100% of it will give you side effects.
  • Avoid formulations containing doxylamine for headaches except for very occasional use (once or twice a month). If you take it more than that, you need a proper diagnosis and a long-term treatment strategy.
  • Avoid codeine altogether for children and if you are breastfeeding.

You’re not Barbie and I’m not GI Joe, so what is a normal body?

2 June 2014, 6.19am AEST

You’re not Barbie and I’m not GI Joe, so what is a normal body?

We live in a world of improbable bodies; they populate our television screens, magazines and billboards. If you’re like most Australians, you might sometimes get the feeling your body isn’t normal. But…

The virtual bodies around us are so unrealistic that it’s not unusual for people to question whether they’re normal. Emergency Brake/Flickr, CC BY-SA

We live in a world of improbable bodies; they populate our television screens, magazines and billboards. If you’re like most Australians, you might sometimes get the feeling your body isn’t normal. But don’t fret — it’s all the virtual bodies around us that aren’t.

Pick up a Barbie doll and have a good look at her. Which part do you think is the most anatomically improbable? No, you’ll have to look lower.

Relative to the average young Australian woman, Barbie’s feet (adjusted for height) are 17 standard deviations below the mean. Other parts are almost equally unlikely: her bust-to-waist ratio is 13 standard deviations above the mean.

It’s not just young girls who are presented with improbable bodies: the biceps on the GI Joe doll action figure has almost trebled in girth since the original version in the 1960s. And the ratio of chest girth to waist girth has increased by 40%.

So, here we are, surrounded by images of ideal bodies: actors, sports stars, steroid-pumped bodybuilders, shop mannequins, dolls, dolled-up personal trainers, air-brushed models and digitally-enhanced videogame avatars. And not one of them reflects reality.

Bigger dresses

Take female shop mannequins. On average, they’re 172 centimetres tall. That’s about ten centimetres taller than the typical Australian woman. They have much broader shoulders, narrower waists and longer calves.

Even dress sizes imply a body shape real people rarely match. That’s why it’s so hard to find a suit or dress that fits you; clothing size templates bear only a passing resemblance to the real shape of Australians.

Barbie’s feet (adjusted for height) are 17 standard deviations below the mean. Pinke/Flickr, CC BY-NC

Australia uses, in principle, the Standards Australia system, which goes down to size eight. Sizes change by regular increments and you can use the size eight measurements to calculate what a size six or four would be. But hardly any retailers follow the Standards Australia system, or any system for that matter, and most label their clothes idiosyncratically.

A woman fitting the Standards Australia dress size eight would have to weigh 40.5 kilograms. In spite of this, 25% of young women report wearing size eight, and I was recently obliged to buy a size four dress for my 54-kilogram daughter.

How does that work? Well, over time there has been an inflationary debasement of dress sizes: what is now called a size eight is actually closer to the original size 12 or 14. And a typical Australian woman actually fits size 16.

Changing perceptions

So pervasive are images of unreal people that we no longer know what real people look like. Asked to judge their own weight category, about 30% of US adults got it wrong. Women tend to think they’re fatter, while men – I’m sure you can guess – think they’re leaner.

Parents are even worse when it comes to judging their kids’ size. A recent meta-analysis found over half the parents of overweight or obese kids’ thought they were normal weight or underweight.

Part of the problem is that there are few key metrics of size and shape. The most common are height, weight, body mass index (BMI, which is your weight in kilograms divided by the square of your height in metres), and waist girth.

While these are good measures across the population, they don’t always work well for individuals. BMI, for instance, doesn’t distinguish between fat mass and muscle, so almost every member of the current Australian Rugby team would be classified as obese.

Real sizes

In 2008, the average adult Australian male was 176 centimetres tall and weighed 85 kilograms, with a waist girth of 96 centimetres. That’s a BMI of 27.5, right in the middle of the “overweight” category.

Female shop mannequins are about ten centimetres taller than the typical Australian woman and have much broader shoulders, narrower waists and calves. EYECCD/Flickr, CC BY-NC-ND

The average adult woman was 162 centimetres tall, and weighed 70 kilograms, with a BMI of 26.7. Her waist girth was 86 centimetres.

People are definitely getting bigger. For over 100 years, height has been increasing at the rate of one centimetre per decade, and weight by one kilogram every decade. But it’s been up to three kilograms per decade in recent years.

About 63% of Australian adults and 25% of kids are overweight or obese. The proportion of overweight people continues to increase in Australian adults, but has plateaued in Australian kids since about 1996.

Myriad shapes

The variety of body shapes is also increasing. Look at pre-war photos of workers or school kids, and you’ll be struck by how similar (and lean) their bodies are. Today, this distribution is skewed with more overweight bodies and more extremely overweight ones.

We’re also seeing increasing distribution at each extreme, with separate peaks for the fit and lean, and the overweight. Ethnic diversity is also increasing the spread of body shapes, as are extreme body practices such as steroid use and illnesses such as anorexia.

Athletes are changing size and shape faster than the general population. Top level basketballers have been increasing in height at the rate of two and a half centimetres per decade, and shot-putters have been putting on weight at the rate of seven kilograms every ten years.

At the 1928 Olympics, the average weight of shot-putters in the finals was 80 kilograms; today it’s 140 kilograms. This extraordinary rate of growth is fuelled by (and fuels) new training techniques, supplements, growth-stimulating drugs and huge salaries to recruit the best and biggest around the world.

Butter factory workers from 1926 showing great similarity in bodies.

Big bodies are a very tradeable commodity.

Nurture and nature

So what kinds of things determine body size and shape? For height, the best advice is to choose your parents wisely. Genes account for about 90% of the variance in height, but both childhood malnutrition and exposure to infections can limit how tall you’ll be as an adult.

Weight is much more subject to environmental influences, such as socioeconomic status; about 27% of Australian kids from the poorest quartile of homes are overweight or obese, compared to 19% from the richest quartile.

Body size and shape also vary across ethnicities. The Dutch are the world’s tallest people (184 centimetres for men and 171 centimetres for women), while the Indonesians are the shortest (158 centimetres and 147 centimetres respectively).

And the fattest seven countries are all in the South Pacific, headed by Nauru, where almost 95% of adults are overweight or obese. In spite of what we often hear in the media, Australia is not in the top 20 – but we’re getting there.

So I’m not GI Joe, and you’re not Barbie, but it’s not all bad news. There are a lot more people in this world like you and me than there are like these dolls. Best to aim for good health and get comfortable with your normality

Ticks in Australia.

21 May 2014, 2.40pm AEST

Tackling the tricky task of tick removal

Tick bite poses a potentially serious health risk in itself but sometimes the way people try to remove ticks just makes things worse. This is because urban myths and conflicted advice from local and overseas…

Of the over 70 bloodsucking arthropods known as ticks that live in Australia, the paralysis tick, Ixodes holocyclus dominates. Doggett

Tick bite poses a potentially serious health risk in itself but sometimes the way people try to remove ticks just makes things worse. This is because urban myths and conflicted advice from local and overseas health authorities have created confusion among both health professionals and the community.

Of the more than 70 bloodsucking arthropods known as ticks that live in Australia, the paralysis tick, Ixodes holocyclus dominates when it comes to interaction with people.

This tick is most commonly found in wet sclerophyll forests along the east coast. While their life cycle (including egg, larva, nymph and adult) can take a year to complete, adult ticks are most commonly encountered in the spring and early summer.

Ticks don’t jump or fly. They find a host by climbing to the top of grasses or other nearby vegetation and slowly wave their legs about until they make contact with a passing potential host. They’re commonly associated with ground-dwelling mammals, particularly bandicoots, but can potentially be found on a range of wildlife.

Once they’ve found a host, ticks take a blood meal to obtain nutrients to either moult to their next developmental stage or, in the case of female adult ticks, develop eggs. They can stay attached for up to ten days while feeding.

Reactions to tick bites can vary from a mild itching with localised swelling, to severe allergic reactions and life-threatening anaphylactic condition. A recent study of 500 tick bite cases presenting to a hospital on Sydney’s northern beaches reported 34 individuals with anaphylaxis, 40% of whom had a history of allergy or previous anaphylaxis.

Spreading disease

There’s currently an acrimonious debate about the presence of tick-borne pathogens that cause Lyme Disease or a “Lyme-like” illness in Australia. No causative agent has been isolated from local ticks or wildlife, and Ixodes holocyclus has been shown to be unable to transit the strain of bacteria that causes Lyme disease.

But other tick-borne pathogens, such as Rickettsia and Babesia, have been documented in Australia. Infection with these pathogens typically results in a “flu-like” illness of varying severity but there will be a range of pathogen specific symptoms.

Notwithstanding pathogen transmission, there are other well-documented health risks associated with ticks.

Potentially fatal tick paralysis is a serious concern, as is mammalian meat allergy. Mammalian meat allergy is triggered in some individuals by substances in the saliva of ticks injected during feeding.

People who have an allergy to this may experience life-threatening anaphylaxis following the consumption of red meat or, in some instances, other animal-derived products, such as milk and gelatin.

Removing ticks

There has also been some debate in recent years about the best way to remove an attached tick, with opinions divided between killing the insect in place or forcibly removing it. It has been suggested that forcibly removing the tick may increase the severity of any allergic reaction.

The absence of clinical trials has led to uncertainty, as has advice from overseas health authorities that may not be appropriate in Australia due to differences in our ticks.

There’s no doubt the advice provided by health authorities in North America and Europe are suitable for those regions. They suggest quick removal, using forceps or other devices, to reduce the likelihood of pathogen transmission.

But the species of ticks prevalent in those places are not associated with possible tick paralysis or potentially serious allergic reactions caused by Ixodes holocyclus. Australians need a different approach and there’s growing consensus that killing the tick in place may be best way to minimise the risk of severe allergic reactions.

Killing ticks

Killing ticks is tricky. Some insecticides may be effective but involving any substance (such as methylated spirits, nail polish, alcohol or petroleum jelly), or physical disturbance (such as the use of forceps) that agitates the tick is likely to cause it to inject more saliva and toxins into the skin, resulting in a more severe reaction.

The Australasian Society of Clinical Immunology and Allergy (ASCIA) recommends using aerosol “freezing” sprays normally associated with wart treatments. These products are widely available from pharmacies and they rapidly kill the tick in place, minimising potentially serious reactions.

Once killed, the tick can then be left to fall out naturally.

What we really need are clinical trials assessing the effectiveness of these currently recommended tick removal techniques and the likelihood of preventing or minimising allergic reactions. Fortunately, this is the focus of the recently formed Tick-induced Allergies Research and Awareness (TiARA) group.

Clear tick removal guidelines, supported by research and clinical information – or both – will hopefully adopted by local health authorities and put an end to confusion.

Fat free and 100% natural: seven food labeling tricks exposed

11 April 2014, 6.40am AEST

Fat free and 100% natural: seven food labeling tricks exposed

If you’re confused by food labels, you’re not alone. But don’t hold your breath for an at-a-glance food labelling system that tells you how much salt, fat and sugar each product contains. Australia’s proposed…

We need to look past the colours, pictures and cleverly crafted claims. Art Allianz/Shutterstock

If you’re confused by food labels, you’re not alone. But don’t hold your breath for an at-a-glance food labelling system that tells you how much salt, fat and sugar each product contains. Australia’s proposed “health star rating” labelling scheme was put on hold in February, following pressure from the food industry. And it’s unclear whether the scheme will go ahead.

Marketers use a variety of tricks to make foods seem healthier and more appealing than their competitors, particularly when it comes to products aimed at children. One of the most powerful advertising tools a food manufacturer has is the packaging, as it’s what we look at immediately before deciding which food to purchase.

Next time you’re shopping for food, look out for these seven common labelling tricks:

The colour of food packaging can influence our perceptions of how healthy a food is.

A recent study found consumers’ perceptions of two identical chocolate bars were influenced by the colour of the nutrition label; despite the identical calorie information, people perceived the one with the green label to be healthier.

Another tool of savvy food marketers is the use of “ticks” and “seals” that we subconsciously process as indicating that the product has met some form of certification criteria.

A recent study found that nutrition seals on unhealthy food products increased perceptions of healthiness among restrained eaters. And a study with parents of toddlers found 20% of parents identified the presence of a quality seal as one of the reasons for their purchase of toddler formula rather than cow’s milk.

Food packaging often contains words that imply the food contains certain ingredients, or has been prepared in a way, that makes it healthier (or at least better than similar foods).

But many of the words – such as “healthy” or “natural” – have no legal or formal meaning. While the Australian New Zealand Food Standards Code regulates the use of specific health and nutrient content claims, it doesn’t regulate or define these loose terms.

“Weasel claims” describe modifiers that negate the claims that follow them. This allows manufacturers to avoid allegations of breaching advertising or labelling regulations, while being such a commonly used word that it is overlooked by the consumer.

For example, Activia “can” help to reduce digestive discomfort – but did you read the fine print? It “can” help if you eat it twice a day and “… as part of a balanced diet and healthy lifestyle”.

Similarly, Berri Super Juice contains antioxidants which “help” fight free radicals (but so does whole fruit, which also contains more fibre).

Unfinished claims tell us the product is better than something – but not better than what. In food labelling, we really have to hunt for the “what”.

Fountain’s Smart Tomato Sauce still contains 114mg of salt per serving, while the brand’s regular tomato sauce contains 186mg (more than several other brands).

The Heart Foundation defines low-salt foods as those with less than 120mg per 100g; Fountain’s Smart tomato sauce has 410mg per 100ml. It does, however, have less sugar than many of its competitors.

So, if you are trying to reduce your sugar intake it may be a good choice, but if you are trying to reduce your sodium intake, look for one of the low-salt varieties and read the label very carefully (reduced is rarely synonymous with low).

Smiths’ Thinly Cut potato chips contain 75% less fat than “chips cooked in 100% Palmolein Oil”. But they don’t contain less fat than Original Thins, Kettle, or most other brands on the market.

It’s also worth taking a close look at the recommended serving size – in both cases the nutrition information is based on a 27g serving, but Smiths’ “single serve” pack is 45g (15.7g fat; one-fifth of an average adult’s recommended daily intake, or RDI).

A common strategy is to list a claim that is, in itself, completely true – but to list it in a way that suggests that this product is unique or unusual (when in reality it is no different to most foods in that category).

“All natural” and “no artificial colours and flavours” are appealing features for parents looking for snacks for their children. But most standard cheeses (including many packaged products such as cheese slices) also contain no artificial colours of flavours.

This is not to suggest that Bega Stringers are a bad product or that you shouldn’t buy them – just that you may want to think about the cost per serve compared to other cheeses that are equally healthy.

Like most lolly snakes, Starburst snakes are “99% fat free”. The old adage of “salt-sugar-fat” holds here; products that are low (or absent) in one are typically very high in another. In the case of lollies, it’s sugar.

As with the potato chips above, serving size is important. Those of us who can’t resist more than one snake might be surprised to realise that if we ate half the bag, we would have consumed two-thirds of our daily sugar intake (although we can’t blame the pack labelling for that!).

Sun-Rice Naturally Low GI White Rice illustrates this use of technically correct claims. Let’s start with “cholesterol free” – this is totally true, but all rice is cholesterol free.

The pack also states in very large, bright blue letters that it is “Low GI”. In much smaller letters that almost disappear against the colour of the package is the word “naturally”. This use of different colours to attract, or not attract, attention is a common marketing technique.

The product is indeed low GI, at 54 it is just below the cut-off of less than 55. But the “naturally” refers to the fact that what makes it low GI is the use of basmati rice rather than another variety, and other brands’ basmati rice would have a similar GI.

Berri Super Juice proudly, and truthfully, claims it “contains no added sugar”. You may conclude from this that the sugar content is low, but a closer look at the nutrition information label may surprise you – a 200ml serve of this super juice contains 25.8g of sugar (29% of your recommended daily allowance).

While contentious, some have even suggested that there is a link between fruit juice and both obesity and metabolic disease, particularly for children. A better (and cheaper) way of obtaining the fruit polyphenols is to eat fruit.

Healthy sounding words are not only used as “claims” but are often used as brand names. This first struck me when I was looking for a snack at my local gym and noticed the “Healthy Cookies” on display; they had more sugar, more fat and less fibre than all of the others on sale (Healthy Cookies was the brand name).

Brand names are often seen as a key descriptor of the nature of the product. Research has found that people rate food as healthy or unhealthy based on pre-existing perceptions of the healthiness of a product category or descriptor, particularly among those who are watching their diet, and may thus select the unhealthier option based on its name or product category.

If, for example, you’re watching your weight, you may be attracted to the Go Natural Gluten Free Fruit & Nut Delight bar, assuming that it will be a healthier choice than a candy bar. But you might be surprised to note that it contains 932 kJ (11.0% of your RDI) and a whopping 13.6g of fat (10% of your RDI).

A 53g Mars bar contains slightly more calories (1020kJ) but a lot less fat (9.1g), although the Go Natural bar could argue for “healthier” fat given the 40% nut content.

So, can we really distinguish between healthy and unhealthy foods by looking at the wrappers?

The healthiest wrappers are made by nature, from the simple ones that can be eaten after washing (like apples and carrots) to those that need some disposal (like a banana or a fresh corn cob).

If you are buying your food wrapped in plastic or paper, it’s a little more complex. We need to see past the colours, pictures and cleverly-crafted claims and take a careful look at the ingredients and nutrition panel.

The 5:2 diet.

This diet is all the rage at the moment – the latest fad in a long line of similar fads. Here is what you need to know from someone who should know:
13 June 2013, 6.33am EST

Here’s the skinny on fasting for weight loss – the 5:2 diet

The “new” weight-loss strategy known as the 5:2 diet has been receiving much attention in the media since the book The Fast Diet: The Secret of Intermittent Fasting – Lose Weight, Stay Healthy, Live Longer was launched late last year. The 5:2 diet allows you to eat as usual for five days and to fast…

People on the diet need to restrict intake of calories on fasting days. Martin Lee

The “new” weight-loss strategy known as the 5:2 diet has been receiving much attention in the media since the book The Fast Diet: The Secret of Intermittent Fasting – Lose Weight, Stay Healthy, Live Longer was launched late last year.

The 5:2 diet allows you to eat as usual for five days and to fast for two days. On fasting days, the dieters need to restrict intake of food to approximately 2000 kilojoules (500 calories) a day for women or 2400 kilojoules (600 calories) for men.

The two days of fasting don’t have to be consecutive and you can decide how you want to spread your food intake on those days as long as you adhere to energy restriction. The food consumed during the two fasting days should have little fat and carbohydrate content and alcohol consumption is not recommended.

During the two fasting days, you are typically allowed protein foods such as eggs, or low-fat yogurt or cheese for breakfast and protein foods such as chicken, fish, lean meat, along with salad or other non-starchy vegetables for lunch or dinner. You are permitted water, green tea, or black coffee. While you can have milk with your beverages, it must be counted toward your caloric intake.

Not a fad?

Intermittent fasting or restricting energy intake for weight loss, which is what the diet is based on, is not a new concept. And there are other kinds of fasting diets around, such as “alternate day fasting”. But while energy restriction in the form of various weight-loss diets has been investigated in both humans and animals, there’s little research regarding the utility of intermittent fasting in humans.

A 2011 study in the United Kingdom that investigated the effects of intermittent energy restriction (to approximately 2266kJ a day for two days) compared to continuous energy restriction (approximately 6276KkJ a day for seven days a week) over six months, in 107 young overweight or obese women. It reported that both diets were equally effective for weight loss, as well as other markers of good health.

But there seemed to be potential difficulties in adherence. At the completion of the study, only 58% of the women in the intermittent fasting group planned to continue with the diet, compared to 85% of those in the energy-restricted group.

This study was one of the largest undertaken in this area so far and the few previous studies in the field have had a much smaller number of participants. Although these smaller studies have been conducted for shorter time periods, the UK study is also considered to be relatively short term.

Weight loss within the first six months is common with a lot of different types of diets. But research studies have shown that the majority of people put much of the weight back on within three to five years.

Many people who tried the 5:2 diet reported weight loss but did the weight stay off? Nata-Lia

Need for caution

Many people who have tried the 5:2 diet report that they have been successful in losing weight but this is the case for most weight-loss diets in the short term. The issue of long-term compliance with the two days of energy restriction remains unresolved, as does long-term weight maintenance because people usually are not able to keep to their new weight.

Difficulties in adherence resulting in weight regain may encourage some people to try another dieting attempt and this can lead to the cycle of weight loss and weight regain being repeated. This happens in most cases of dieting-related weight loss.

The risks or the potential to overeat or gorge on non-fasting days also needs to be investigated. Diet quality is of particular significance for those who fast intermittently to ensure that all nutritional requirements are met and that the intake of some nutrients that have low intakes anyway (such as calcium) is not further compromised.

What’s more, we still need to investigate whether intermittent fasting is a safe weight-loss strategy, especially for people with diseases such as diabetes. Starvation-type diets have side-effects such as dehydration, anxiety, irritability, tiredness and lethargy and whether we should be looking out for these in the 5:2 diet remains to be determined.

Intermittent fasting is reported to be effective among those who have used it for weight loss and it seems to be as effective as an energy-restricted diet in the short term. It may be a viable weight-loss option for some people but we need to research its effects beyond those reported, especially since many of these effects are anecdotal at present.

It’s best to follow healthy eating dietary guidelines and seek advice from your doctor before embarking on intermittent fasting as a weight-loss strategy.

Why Afternoon May Be the Best Time to Exercise

Phys Ed December 12, 2012, 12:01 am171 Comments

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Phys Ed
Phys Ed

Gretchen Reynolds on the science of fitness.

Does exercise influence the body’s internal clock? Few of us may be conscious of it, but our bodies, and in turn our health, are ruled by rhythms. “The heart, the liver, the brain — all are controlled by an endogenous circadian rhythm,” says Christopher Colwell, a professor of psychiatry at the University of California, Los Angeles’s Brain Research Institute, who led a series of new experiments on how exercise affects the body’s internal clock. The studies were conducted in mice, but the findings suggest that exercise does affect our circadian rhythms, and the effect may be most beneficial if the exercise is undertaken midday.

For the study, which appears in the December Journal of Physiology, the researchers gathered several types of mice. Most of the animals were young and healthy. But some had been bred to have a malfunctioning internal clock, or pacemaker, which involves, among other body parts, a cluster of cells inside the brain “whose job it is to tell the time of day,” Dr. Colwell says.

These pacemaker cells receive signals from light sources or darkness that set off a cascade of molecular effects. Certain genes fire, expressing proteins, which are released into the body, where they migrate to the heart, neurons, liver and elsewhere, choreographing those organs to pulse in tune with the rest of the body. We sleep, wake and function physiologically according to the dictates of our body’s internal clock.

But, Dr. Colwell says, that clock can become discombobulated. It is easily confused, for instance, by viewing artificial light in the evening, he says, when the internal clock expects darkness. Aging also worsens the clock’s functioning, he says. “By middle age, most of us start to have trouble falling asleep and staying asleep,” he says. “Then we have trouble staying awake the next day.”

The consequences of clock disruptions extend beyond sleepiness. Recent research has linked out-of-sync circadian rhythm in people to an increased risk for diabetes, obesity, certain types of cancer, memory loss and mood disorders, including depression.

“We believe there are serious potential health consequences” to problems with circadian rhythm, Dr. Colwell says. Which is why he and his colleagues set out to determine whether exercise, which is so potent physiologically, might “fix” a broken clock, and if so, whether exercising in the morning or later in the day is more effective in terms of regulating circadian rhythm.

They began by letting healthy mice run, an activity the animals enjoy. Some of the mice ran whenever they wanted. Others were given access to running wheels only in the early portion of their waking time (mice are active at night) or in the later stages, the equivalent of the afternoon for us.

After several weeks of running, the exercising mice, no matter when they ran, were found to be producing more proteins in their internal-clock cells than the sedentary animals. But the difference was slight in these healthy animals, which all had normal circadian rhythms to start with.

So the scientists turned to mice unable to produce a critical internal clock protein. Signals from these animals’ internal clocks rarely reach the rest of the body.

But after several weeks of running, the animals’ internal clocks were sturdier. Messages now traveled to these animals’ hearts and livers far more frequently than in their sedentary counterparts.

The beneficial effect was especially pronounced in those animals that exercised in the afternoon (or mouse equivalent).

That finding, Dr. Colwell says, “was a pretty big surprise.” He and his colleagues had expected to see the greatest effects from morning exercise, a popular workout time for many athletes.

But the animals that ran later produced more clock proteins and pumped the protein more efficiently to the rest of the body than animals that ran early in their day.

What all of this means for people isn’t clear, Dr. Colwell says. “It is evident that exercise will help to regulate” our bodily clocks and circadian rhythms, he says, especially as we enter middle age.

But whether we should opt for an afternoon jog over one in the morning “is impossible to say yet,” he says.

Late-night exercise, meanwhile, is probably inadvisable, he continues. Unpublished results from his lab show that healthy mice running at the animal equivalent of 11 p.m. or so developed significant disruptions in their circadian rhythm. Among other effects, they slept poorly.

“What we know, right now,” he says, “is that exercise is a good idea” if you wish to sleep well and avoid the physical ailments associated with an aging or clumsy circadian rhythm. And it is possible, although not yet proven, that afternoon sessions may produce more robust results.

“But any exercise is likely to be better than none,” he concludes. “And if you like morning exercise, which I do, great. Keep it up.

Is male menopause real?

Is male menopause real?

May 27, 2014 – 12:01AM
Matty Silver

Sexual health therapist

<i></i>Photo: Getty

Do fewer erections and less interest in sex sound familiar? We know mood swings, hot flushes, low libido and depression can be some of the hormonal changes older women experience during menopause, but what is not well known is that some men will experience some of the same symptoms when they get older.

One of my favourite sayings is: “Male menopause is much more fun than female menopause. A female gains weight and gets hot flushes – a male dates younger women and drives a sports car.”

The medical profession is still debating the existence of male menopause and some prefer to call it “andropause”. Women experience a drop in oestrogen during menopause and men can face a decline in the production of testosterone. For men, the hormonal change is often more gradual and not all of them experience it.

The most common symptoms of male menopause involve changes in sexual functioning: reduced ability to obtain or maintain an erection, declining interest in sex and fewer spontaneous erections during sleep. Emotional changes include feeling sad or depressed, being moody and irritable and having trouble concentrating or remembering things, which can cause a decrease in motivation or self-confidence.

Various physical changes can occur, such as decreased bone density, declining strength and endurance, increase in fatigue and lethargy, having aches, pains and stiffness in joints and suffering from excessive sweating. Some men experience swollen or tender breasts, loss of body hair and an increase in abdominal fat.

There is also the much-debated “midlife crisis”, where some men find that having spent half a lifetime working and raising a family was not as fulfilling as they expected. With the physical signs of ageing comes the realisation that old age is around the corner and this becomes a psychological issue not a physical one.

Some doctors are concerned that the issue of male menopause has become a commercial opportunity for drug companies and private clinics. Several older men have told me they read so many advertisements promoting testosterone as a “wonder drug” that can rejuvenate your sex life that they wondered if they should give it a try.

Taking testosterone when they don’t need it is pointless, I told them. I usually refer such cases to a men’s sexual health physician, or a GP who specialises in this area, to first have their testosterone levels tested.

A diagnosis for testosterone deficiency involves several steps, including giving a full medical history, having a physical examination and providing at least two blood samples, taken in the morning on different days. Testosterone therapy is available in Australia in the forms of injections, gels, lotions, patches, capsules and tablets.

Andrology Australia has a brilliant website with more information and Brisbane doctor Michael Gillman, who focuses on men’s health and male sexual dysfunction, has an excellent fact sheet on his website, which is certainly worth checking out.

It is important to be aware that many of these symptoms are a normal part of ageing; others can be caused by a variety of factors. Many men who experience these age-related symptoms have unhealthy lifestyles; they may smoke or drink too much alcohol, do not exercise and are often overweight. These lifestyle factors may cause illnesses such as diabetes, heart disease, high cholesterol and depression.

However, if a man is healthy and starts to experience a diminished sex drive and difficulties in maintaining a strong erection, a visit to the doctor may help diagnose if he has low testosterone and more tests can rule out other possible conditions he may have.

Men are often in denial about their symptoms, they have an “it will get better” attitude, which is one reason the death rates of illnesses such as cancer and heart disease are much higher in men than in women and the reason why some men die prematurely.

Women should take note of changes in their male partners and suggest they seek medical advice as soon as possible because ignorance and denial can be a dangerous combination. It is important men explain their symptoms properly to their doctor. A detailed history is essential to get a clear and accurate picture that leads to the right treatment plan.

So, if you think your man is suffering from male menopause, give him some support.

And, if you are a man who recognises some of these symptoms, don’t be afraid to speak to your doctor.

There is still a happy and healthy sex life for both of you after the “menopauses”.