Monthly Archives: November 2014

Here’s what you need to know about testosterone

I am going on holiday(Yay :)) for the next 5 weeks, will be back for a week early in Jan, and away again for another week. My blogs are likely to be erratic over this period. Happy holidaying to all.
Dr Colin Holloway
18 September 2014, 6.29am AEST

Here’s what you need to know about testosterone

Testosterone is blamed for violence in males, implicated in sport scandals, linked to sexual prowess, desired by gym devotees, and promoted as a tonic for ageing. But how many of us really understand what…

Testosterone is important for the physical changes that happen during male puberty, and features typical of adult men, such as facial and body hair. Dave 77459/Flickr, CC BY-NC-SA

Testosterone is blamed for violence in males, implicated in sport scandals, linked to sexual prowess, desired by gym devotees, and promoted as a tonic for ageing. But how many of us really understand what testosterone is, what it does, and why it’s important?

Testosterone levels are about ten times higher in men than women. While it does have important functions in women, its role is quite different so this article will focus on testosterone in men.

Testosterone and development

Testosterone is the most important male sex hormone (androgen); it’s needed for normal reproductive and sexual function. Hormones are chemical messengers made by glands and carried in the blood to act on various organs.

This particular hormone is important for the physical changes that happen during male puberty, such as development of the penis and testes, and for features typical of adult men, such as facial and body hair. Testosterone also acts on cells in the testes to make sperm.

It’s important for overall good health; testosterone helps the growth of bones and muscles, and it affects mood, libido (sex drive), and certain aspects of mental ability.

The hormone is present in the body from the early stages of fetal life to old age. At the earliest stage of development, it helps the fetus develop both a male body and a “male brain” (there are gender differences, or “sexual dimorphism” in the human brain).

Levels are highest between the ages of 20 and 30. As men age, testosterone levels fall by about 1% to 2% every year, although recent research suggests this may not be true of all men as they age. It seems a large part of the drop in testosterone levels in older men is due to chronic conditions, such as obesity and diabetes.

If men remain very healthy into old age, their testosterone levels may stay the same as when they were younger.

Too little and too much

Low testosterone is usually caused by a genetic disorder (such as Klinefelter’s syndrome, the commonest chromosomal disorder in males that leads to poor testicular function) or damage to the testes or, in rare cases, a lack of certain complementary hormones made by the brain.

It’s thought that about one in 200 men under 60 years of age and about one in 10 older men may have low testosterone levels, but exact numbers are not known.

Low testosterone levels have a variety of effects at different ages. In young boys and teenagers, it means the testes and penis don’t grow properly and there’s poor development of muscles and facial and pubic hair. Boys with low levels of the hormone may be taller than their peers and their voice may not deepen.

In adults, low energy levels, mood swings, irritability, poor concentration, reduced muscle strength and changes in body fat distribution, and low sex drive may result from low testosterone. But that’s not to say that low levels of the hormone is the only possible cause of these symptoms.

Research suggests that men with low testosterone may have a higher risk of chronic conditions, such as stroke and heart disease. Older men with low testosterone also have thinning bones and that puts them at risk of fractures.

Too much testosterone can cause problems too. Although people link the hormone with aggression, this hasn’t held up under scrutiny. Rather, research has shown testosterone levels are associated with quite different traits, such as care-giving and empathy.

Supplementing needlessly

Longevity is highest for those men with testosterone levels in the mid-range – not too high or too low – and recent research supports the idea that too much or too little testosterone is best avoided.

For men with a clinical diagnosis of low levels, testosterone therapy can bring the amount of the hormone in their blood back to normal and restore and maintain good health. In boys, it can restore sexual development.

But in men with normal testosterone levels, taking supplements of the hormone is not appropriate and can cause problems. Taking testosterone can lead to a reduction in the size of the testes, and it can slow or stop sperm being made. And it can take many months to go back to normal once the man stops taking testosterone.

There is some controversy around studies suggesting that older men taking testosterone have an increased risk of cardiovascular disease but the jury is still out. What we do know is that there’s no good evidence for the much-publicised “benefits” of testosterone supplements in old age, except for men with clinically diagnosed low testosterone

Link between stress and heart disease

Nature Medicine
30 March 2014

Exposure to psychosocial stress is a risk factor for many diseases, including atherosclerosis1, 2. Although incompletely understood, interaction between the psyche and the immune system provides one potential mechanism linking stress and disease inception and progression. Known cross-talk between the brain and immune system includes the hypothalamic-pituitary-adrenal axis, which centrally drives glucocorticoid production in the adrenal cortex, and the sympathetic-adrenal-medullary axis, which controls stress-induced catecholamine release in support of the fight-or-flight reflex3, 4. It remains unknown, however, whether chronic stress changes hematopoietic stem cell activity. Here we show that stress increases proliferation of these most primitive hematopoietic progenitors, giving rise to higher levels of disease-promoting inflammatory leukocytes. We found that chronic stress induced monocytosis and neutrophilia in humans. While investigating the source of leukocytosis in mice, we discovered that stress activates upstream hematopoietic stem cells. Under conditions of chronic variable stress in mice, sympathetic nerve fibers released surplus noradrenaline, which signaled bone marrow niche cells to decrease CXCL12 levels through the β3-adrenergic receptor. Consequently, hematopoietic stem cell proliferation was elevated, leading to an increased output of neutrophils and inflammatory monocytes. When atherosclerosis-prone Apoe−/− mice were subjected to chronic stress, accelerated hematopoiesis promoted plaque features associated with vulnerable lesions that cause myocardial infarction and stroke in humans.

Does alcohol have medicinal properties?

With the festive season beginning, and many of us celebrating with alcohol, do not use the excuse that it is healthy for you when drinking.
19 May 2014, 3.01pm AEST

Health Check: does alcohol have medicinal properties?

Since the late Stone Age, people have been drinking alcohol to help them feel better. For the most part, this has been in order to “remember their misery no more” (Proverbs 31:6-7). But it’s widely believed…

Healthy or harmful? Matthew Rogers, CC BY-NC

Since the late Stone Age, people have been drinking alcohol to help them feel better. For the most part, this has been in order to “remember their misery no more” (Proverbs 31:6-7). But it’s widely believed alcohol also has a range of medical virtues.

Many studies have found that people who regularly consume a small amount of alcohol have a lower incidence of heart disease, stroke, diabetes and some cancers when compared to those who don’t drink at all or drink only occasionally.

By a small amount – we’re talking about having no more than one or two drinks most days for men and half this for women, whose blood-alcohol levels tend to be higher after drinking the same amount.

Of course, moderate drinking takes discipline and self awareness. So it’s hardly surprising these are also the kind of people who have fewer health problems.

How might it work?

Nonetheless, researchers have repeatedly attempted to establish the direct actions of drinking on health and well-being.

For example, alcohol has favourable effects on HDL cholesterol. This is also known as “good cholesterol” because people with high levels of HDL cholesterol have lower risks of heart disease and stroke.

But if this was how alcohol works, why would more selective strategies to increase HDL cholesterol be universally unsuccessful in preventing heart disease?

Most alcoholic drinks also contain antioxidants. Becky Stern, CC BY-SA

A glass before or during an evening meal is often said to be the most beneficial. This may be partly because this social pattern of drinking is easier to regulate and habituate. Alcohol is also less intoxicating with food in the stomach.

However, drinking with food also slows down stomach emptying. This may have health benefits by slowing the flux of sugars and fats into the bloodstream and their subsequent burden on the body.

Many alcoholic drinks also contain antioxidants, not just red wine. In fact, some beers and ciders also have quite high levels of antioxidants, some of which may better absorbed or more potent than those in wine.

But again, the medicinal effects of regularly taking the amounts of antioxidants found in a single glass every day are unclear. Even when taken in high doses as supplements, there is little evidence of health benefits.

Is wine better than beer or spirits?

In some head-to-head trials red wine seems to outperform beer or spirits with respect to surrogate markers of health, such as vascular stiffness and oxidative stress.

However, when you look at overall health outcomes in moderate wine drinkers, they appear to be much the same as those in moderate beer drinkers or those who have a glass of scotch or gin every night.

But this does not mean they are equally healthy, overall. In fact, one reason wine gets all the kudos is that the lifestyle factors that permit a regular but limited intake are more common with wine drinkers.

Certainly, beer has some advantages because there is less alcohol in a can, which you can finish while the bottle of wine remains temptingly open. Light beers also have expediency as the potential for intoxication and abuse is reduced, along with the alcohol content. Many also contain fewer calories, while retaining both flavour and flavanoids.

The downward slide

Before you start thinking a having a drink or two may be good for you, it is literally sobering to remember that excessive drinking is a leading cause of preventable death, particularly in young adults and men, but also increasingly, in women. Excess alcohol contributes to the global burden of disease to a greater extent than smoking.

One beer can easily become two. Kai Schreiber, CC BY-SA

Alcohol inhibits the functions of the brain, especially at the front end where we think through what we are doing. When this area is intoxicated, we lose some of our inhibitions. This is why alcohol seems relaxing and takes away (thoughts of) our worries. But this can also lead to bad choices, such as dancing on tables, violence or driver error.

Consume more alcohol and other areas of the brain are also affected, leading to disturbed balance, slurred speech, blurred vision and other symptoms recognisable as being drunk.

Heavy drinkers have more heart disease, hypertension, dementia and some cancers. Even episodic binge drinking is associated with an increased risk of chronic disease.

Rather than alcohol being toxic, these associations are more likely due to the characteristics of people who drink more (their mood, their stress, their lifestyle, their self control, and so on) when compared to those who drink in moderation or don’t drink at all.

Alcohol, like food, should be one of life’s shared pleasures. But both need restraint. A little glass can easily become more, especially if the bottle is already open. And sometimes, its far healthier to not drink at all than go down this slippery slope

Talking to Men About PSA Testing

 This applies to me just as it does to most men my age. What to do? This is similar(but some big differences to having a mammogram in women). Many of my friends have had prostatectomies, with all the problems that go with it – I know many of them did not need to have it done, but try telling that to them. They all believe it saved their lives. Read ” Mammograms” on my web-site under “Breast Screening” for the latest recommendations.

Talking to Men About PSA Testing



My patient looked back at me with a blank stare. I had just finished my take on the pros and cons of having a PSA test, and he looked lost. “What would you do if you were me, Doc?” he said.

I had just finished explaining the decision every man faces when he turns 50: whether to be screened for prostate cancer with a prostate-specific antigen (PSA) test. The decision is still unsettled despite the results of a giant, long-term study published earlier this month in the journal The Lancet. The study did not support the use of widespread screening.

What makes the decision so tricky? It’s partly that prostate cancer is a weird cancer. Unlike cancer of the breast or the lung or the colon, which tends to kill people within five or 10 years, prostate cancer is usually slow growing. Men tend to die with it rather than of it. In fact, many live with it for 30 years or more and never even know they have it.

That said, 3 percent of men do die of prostate cancer. So if we had an easy, safe treatment for prostate cancer, it would make sense to screen everyone and treat all the cancers we found. But the main treatments for prostate cancer carry a high risk of causing urinary incontinence and erectile dysfunction.

As a result, when a man decides to be screened for prostate cancer, there’s a high risk he will sustain permanent harms from treating a cancer that he never would have known he had. And that risk is probably much higher than the chance that he will live longer because he was screened.

This complex bottom line is very hard for doctors to explain. So many doctors skip explaining it, and instead simply order PSA tests routinely, brushing off expert guidelines recommending against such routine screening.

Why is it so hard for doctors to change how they approach the test? Partly it’s because the pros and cons of PSA testing are so difficult for doctors to explain to patients. But doctors are also understandably afraid of missing cancer. What if their patient decides not to get the PSA screening test, and then later is found to have an incurable prostate cancer? Patient and doctor might look back with great remorse at a missed opportunity.

Friends’ and celebrities’ stories play a role as well. People who have been treated for prostate cancer are relieved and want to spread the word. Their stories of a life-threatening diagnosis followed by a lifesaving cure are compelling, but they gloss over the fact that the majority of those cancers didn’t need to be treated. Their stories are even more compelling next to the stories of men who opt not to be tested, men who might live happily for decades with a cancer that causes no symptoms. Those stories are not told at all, because men with those stories don’t know they have a story to tell.

In response to my own patient, who asked what I would do, I paused. I am asked that quite a bit, and it’s tough to answer, because it depends on the man, his priorities and experiences. In the end, I told him that it’s such an individualized decision, it’s a difficult one to make for someone else.

Doctors can’t make this decision for patients. We need to learn to face this issue head on and become better at helping men understand the pros and cons of PSA testing so they can make an informed decision. The alternative, continuing to automatically screen men for prostate cancer starting at age 50, is causing a lot of harm.

Can physical activity prevent physical and cognitive decline in postmenopausal women

Can physical activity prevent physical and cognitive decline in postmenopausal women? A systematic review of the literature
Maturitas, 07/01/2014  Clinical Article

Anderson D, et al. – This paper aimed to review research on the impact of leisure–time and general physical activity levels on physical and cognitive decline in postmenopausal women and in a systematic review of the literature, empirical literature from 2009 to 2013 is reviewed to explore the potential impact of either commencing or sustaining physical activity on older women’s health. These findings suggest that programs should facilitate and support women to participate in regular exercise by embedding physical activity programs in public health initiatives, by developing home–based exercise programs that require few resources and by creating interventions that can incorporate physical activity within a healthy lifestyle.

The review also suggests that clinicians should consider prescribing exercise in a tailored manner for older women to ensure that it is of a high enough intensity to obtain the positive sustained effects of exercise.

Emergency Rooms Are No Place for the Elderly

I believe Australia is ahead of the USA in this respect, but this can happen here as well due to the aging population and pressure on hospital emergency departments.
Doctor and Patient March 13, 2014, 12:01 am

Emergency Rooms Are No Place for the Elderly


Dr. Pauline Chen on medical care.

The elderly man lived alone in an apartment complex not far from the hospital. A younger neighbor, who’d watched him hobble down the building’s stairwell for nearly a week, insisted on taking him to the emergency room. Doctors there immediately diagnosed an infection in his painful toe and prescribed antibiotics for him to take at home.

But they also advised the man to be sure to take his diabetes medicine, since the infection could elevate his blood sugar to dangerous levels. And as the surgical consultant, I urged him to keep his foot up, check the toe once a day and come to our vascular surgery clinic in a week to make sure the infection was clearing up. He needed close follow-up to prevent serious complications, even the loss of his foot.

“Of course, if things get worse before the week’s up,” I said, raising my voice to be heard over the clatter beyond the makeshift curtain walls of the E.R. examining room, “come back here right away.”

Under the glaring fluorescent lights, there was no mistaking the blank look that passed over the man’s face. He was overwhelmed.

But so was the emergency room.

None of the staff members had been trained in coordinating the complex outpatient care this elderly patient needed. None knew of a way for the emergency department to check on him a day or so after discharge to ensure his care was proceeding as planned. And when a social worker from another department agreed to pitch in with outpatient care, the emergency room doctors and nurses became alarmed rather than relieved, because arranging such follow-up could take several hours. With patients spilling out of the waiting room and into the hallways, they were under pressure to either admit or discharge patients as quickly as possible.

An older nurse finally pulled me aside. “Just admit him,” she whispered. “It’ll cost more, but it’s the only way you’ll be sure he’s getting the right care.”

I remembered the nurse’s advice, and the patient I ended up admitting, when I came upon a recent paper and report on the care of elderly patients in American emergency rooms.

The number of older people seeking health care is expected to increase significantly over the next 40 years, doubling in the case of those older than 65, potentially tripling among those over 85. In a health care system already critically short of primary care providers and geriatrics specialists, many of these older patients will likely end up in emergency rooms.

But given longstanding trends in American medicine, it’s hard to imagine a health care setting more ill suited for the elderly than today’s emergency rooms.

Over the last five decades, quality emergency care has become synonymous with speed. Survival rates for patients in the throes of a stroke, heart attack or traumatic injury depend on the number of minutes needed to triage, diagnose and treat. Even the physical environment where emergency care takes place has become a paragon of medical efficiency — large echoing spaces that can be divided at a moment’s notice with panels of curtains, slick linoleum floors that can be mopped up in minutes and bright fluorescent lights.

More recently, as overcrowding has become a significant problem, the drive for efficiency has become more pronounced, with doctors and nurses having to work as quickly as possible simply to see all the patients.

But when it comes to elderly patients, it is nearly impossible to work quickly. Many are plagued by multiple chronic diseases like diabetes, high blood pressure and heart disease, take numerous prescription drugs that can cross-react in potentially dangerous ways and suffer from ills like dementia that can make the answer to even the simplest of questions – What brought you to the emergency room today? – difficult to understand.

For several years now, a small but dedicated group of emergency medicine and geriatrics specialists has been working to improve this situation. And over the last three months, first in an article published in the national health policy journal Health Affairs, then in an impressive set of evidence-based guidelines supported by several national professional medical and nursing organizations, they have issued a call to arms to the rest of the medical profession.

To meet the needs of the rapidly growing elderly population, these specialists assert, medical centers must “geriatricize” their emergency departments.

And they offer a plethora of practical advice for doing so. Among their suggestions: Hire providers trained in caring for older patients. Routinely administer quick but effective screening tests for dementia and other cognitive impairments. Install non-slip flooring and more sound-absorbing materials to decrease the risk of falls and dampen noise levels. And train all staff members to be more attuned to social factors that can affect care for the elderly, like the necessity of arranging for transportation to get to follow-up medical visits, the need for walkers, canes and other medical equipment to get around the home and for extra help to get prescriptions filled and taken correctly.

Similar changes have already been put in place to improve pediatric, trauma and cardiac emergency care. But a larger stumbling block remains: getting a greater proportion of hospital administrators, health care providers and the public at large to become interested in care for the elderly.

“Older adults aren’t the kind of patients people gravitate toward,” said Dr. Ula Hwang, lead author of the paper in Health Affairs, a member of the task force that compiled the guidelines and an associate professor of emergency medicine and geriatrics and palliative care at the Icahn School of Medicine at Mount Sinai. “There’s a reason you don’t see the frail, cognitively and functionally impaired older patient on television medical shows.”

Nonetheless, Dr. Hwang and her colleagues remain optimistic. About 50 medical centers have incorporated such changes into their emergency departments, a notable improvement from a decade ago, when none existed. And by emphasizing close attention to the individual’s experience, many of these redesigned departments are not only improving care but also redefining what is possible for doctors and patients, even in one of the most critical of care settings.

“We can really become partners in improving care, instead of just putting a Band-Aid on the problem,” Dr. Hwang said. “We can give our elderly patients, our parents and our grandparents the kind of respect and understanding that we owe them.”

How cancer eats itself to survive our therapies

This is what science is all about, and why patients with cancer should be treated by those with this kind of knowledge and avoid those (Charlatans) offering some sort of magic with no proof of efficacy.
31 July 2014, 2.28pm AEST

How cancer eats itself to survive our therapies

Can you imagine being so desperate for food that you would eat yourself to survive? Most people can’t but our cells do exactly this. When cells are deprived of energy and nutrients from their external…

When cells are deprived of energy and nutrients from their external environment, they package up and consume their own components to survive. Kevin McShane/Flickr, CC BY-NC

Can you imagine being so desperate for food that you would eat yourself to survive? Most people can’t but our cells do exactly this.

When cells are deprived of energy and nutrients from their external environment, they look internally, packaging up and consuming their own components to survive until an energy source becomes available. Once a food or nutrient source is available, cells are able to replace these components.

This cellular process is called autophagy, from “auto-” the Greek word for self and “phagein” meaning to eat. And cancer cells take advantage of this survival mechanism to evade some anti-cancer therapies.

Autophagy has remained largely unchanged across species throughout evolution occurring in organisms from yeast (simple cells) to eukaryotic (complex cells, like ours) systems in response to stressful conditions.

As we learn more about this process, we are garnering an understanding of how cancer cells survive therapy (from radiation to chemotherapy and novel targeted therapies) by digesting and recycling their own components to synthesise essential nutrients and provide energy.

Cancer hungry for energy

Cancer cells require a lot of energy to grow, make new cells and spread. They achieve this by harnessing survival processes used by normal, non-malignant cells.

Ordinarily, these survival processes are controlled by external factors, such as access to blood supply or growth signalling molecules from nearby cells. As these processes determine the life and death of non-malignant cells, they are highly regulated.

Importantly, in cancer cells these survival processes are independent of normal control mechanisms and therefore drive the uncontrolled growth and spread of the cancer.

In cancers such as chronic myeloid leukaemia where we know what drives the disease (a mutant gene, referred to as the oncogene, which tells the cells to multiply and progress), therapies target cancer cells while leaving non-malignant cells alone.

This targeted approach has also been utilised in other cancers in which the driver of disease is known, resulting in more personalised anti-cancer therapies with fewer side effects.

Such targeted treatments essentially starve cancer cells by blocking their survival processes. This causes their death and results in remission for most patients.

Cancer’s self-cannibalising survival

Resistance to therapy is an obstacle faced by both historic and current cancer therapies. One of the biggest challenges we now face in the development of new cancer treatments is persistent, low-level disease.

While some new treatments control cancer very well, cure is yet to be proven in many settings.

Work from our group recently demonstrated that when we use targeted therapy to attack cancer’s survival processes, such as signals to trigger cell growth, cancerous cells start to package up and consume their own contents.

Eating their own components allows them to generate the energy required to survive therapy. This results in persistent disease, or relapse.

Increasing evidence indicates that autophagy is a resistance mechanism used by several cancers, including, but not limited to, ovarian, pancreatic, brain, colon and breast cancers.

But if this is a survival mechanism on which several cancers converge, can we use our understanding of autophagy against cancer cells?

Eating itself to death

And the answer is yes, because of the vast and ever-increasing knowledge base about autophagy, we now know how to block it.

In a stroke of luck, we’ve even found a common drug used for other conditions that blocks autophagy. It does this by preventing the breakdown of cellular components.

When autophagy blockers are used in combination with targeted treatment in the leukaemia cells, the cells start to eat themselves, but are prevented from using what they consume for energy.

The cancer cells literally eat themselves to death.

Approaches targeting autophagy are now being taken into clinical trials in combination with anti-cancer therapy for leukaemia and other cancers.

Cancer is responsible for over eight million deaths worldwide every year (out of 46 million diagnoses). By investigating how cancer cells avoid being killed when patients are on therapy, we can more effectively treat cancers by “eating” cancer at its own game. And that’s exactly what we’re doing.

Eat Your Way To Healthier Hair!

Eat Your Way To Healthier Hair!
Published: 6/30/2014
Dr Weil.

Whole foods rich in protein, omega-3 fatty acids, zinc and biotin may help promote a healthy scalp and hair. Add these foods to your grocery cart – think of them as ingredients in a healthy hair recipe!

  1. Dark leafy greens. Kale, Swiss chard, spinach and other dark leafy greens are good sources of vitamins A and C, which the body needs to produce the oily substance sebum, a natural conditioner for your hair.
  2. Salmon. Omega-3 fatty acids, of which salmon is an excellent source, are important to a healthy scalp. Salmon (choose wild Alaskan salmon) is also a good source of protein. If you don’t like the taste of fish, try a high-quality fish oil supplement.
  3. Beans and legumes. They are a good source of protein which helps promote hair growth, as well as iron, biotin and zinc. (Biotin deficiencies can occasionally result in brittle hair.)
  4. Nuts. Specific varieties of nuts contain vitamins and minerals that can help promote the health of your scalp. Brazil nuts are a good source of selenium (limit yourself to no more than two nuts per day). Walnuts provide the omega-3 fatty acid alpha-linolenic acid, which may help condition your hair, as well as zinc, which can minimize hair shredding. Cashews, almonds and pecans are other hair-healthy choices. Aim for raw varieties as often as you can.
  5. Eggs. A good source of protein, which helps prevent dry, weak and brittle hair. Choose organic, omega-3 fortified eggs from cage-free hens

Eat food, not (blockbuster) nutrients

7 July 2014, 2.43pm AEST

Health Check: eat food, not (blockbuster) nutrients

Turmeric is said to be the latest “blockbuster nutrient”, helpful for “everything from heart disease to Alzheimers, asthma to arthritis.” But is there any scientific evidence behind this claim, or is it…

Undue emphasis on individual nutrients rather than on the diet as a whole leads to an unhealthy reductionism that has no scientific basis. U.S. Department of Agriculture/Flickr, CC BY-SA

Turmeric is said to be the latest “blockbuster nutrient”, helpful for “everything from heart disease to Alzheimers, asthma to arthritis.”

But is there any scientific evidence behind this claim, or is it just another example of the tendency to get hyped-up about certain food components, which may be doing more harm than good?

Turmeric is the yellow spice that gives curry its familiar colour. It has been used as a traditional medicine in much of Asia for thousands of years. As for “blockbuster nutrient”, I’m going to assume the term implies a nutrient or food component that’s especially powerful at preventing or curing disease.

There’s good evidence that curcumin — the primary active component of turmeric — has many potentially beneficial biological properties, including anti-inflammatory, antioxidant, anti-proliferative and anti-microbial activities.

It shows promise in the treatment of a wide range of diseases, including Alzheimers, Parkinson’s, cardiovascular disease and cancer. But the authors of this paper also note that much of the evidence for its efficacy comes from laboratory studies that usually didn’t involve humans, so the evidence is actually for potential therapeutic effectiveness.

Curcumin clearly shows promise as a drug-like agent to treat disease (that is, it’s extracted from turmeric, concentrated and then taken either through the mouth or by injection). But this doesn’t necessarily mean that turmeric – the food that contains curcumin – is health-promoting.

We still need to work out whether eating the stuff is the right way to make it have a therapeutic effect, and look into the possibility that it may have some untoward side effects. For example, there’s some evidence that it may promote cancer under some circumstances.

The primary active component of turmeric, curcumin, has many potentially beneficial biological properties. Steven Jackson/Flickr, CC BY

So the jury is still out on whether turmeric truly qualifies as a blockbuster nutrient. Continue to enjoy the occasional curry by all means, but it may be premature to start consuming large quantities of turmeric (or curcumin) on a daily basis just yet.

Enter nutritionism

The claim that turmeric has some special health-promoting properties (so people should eat large quantities each day) aligns neatly with the concept of “nutritionism”.

This term was coined by Australian sociologist Gyorgi Scrinis to describe an undue emphasis on individual nutrients rather than on the diet as a whole. Nutritionism is therefore a kind of “reductionism”, that is, the simplification of a complex idea until it’s distorted.

It is based on the false premise that we know enough about nutritional science to accurately predict how intake of individual nutrients will impact on human health and well-being. Scrinis also points out that excessive concern over the health effects of specific foods or food components can lead to adoption of potentially harmful fad diets.

He identifies three eras of nutritionism over the past century or so. These are the quantifying era, the good-and-bad era, and the functional era.

The quantifying era took off with the discovery of vitamins about 100 years ago. This quickly led to claims these essential factors were deficient in the general diet, so they had to be taken as supplements.

Many people today take supplementary vitamins, despite a scarcity of evidence that they help anyone other than those suffering vitamin deficiencies to the point of being ill because of them. In fact, evidence suggests taking supplementary vitamins may even lead to earlier death in some circumstances.

Many people take vitamin supplements despite the scarcity of evidence showing supplements help. Rob/Flickr, CC BY-NC-SA

And one recent study found US children are actually in danger of toxic effects from over-consumption of vitamins even without supplementation. This is the unintended consequence of fortification of a wide range of foods with vitamins, just in case the normal diet doesn’t provide enough.

It involves a certain level of irony — being overly concerned about possible inadequate vitamin consumption may have inadvertently led to excessive vitamin consumption!

Fear and marketing

More recently, in the era of good-and-bad nutritionism, fear of excessive intake of particular nutrients has been added to the fear of nutritional deficiencies. Perhaps paradoxically, two of the major forms — fat-phobia (fear of fat) and carbophobia (fear of carbohydrates) — have co-existed quite happily for much of the past decade or so.

According to this branch of nutritionism, fat is bad and carbohydrate is good (or vice versa depending on your stand). Again, evidence is not conclusive that either fat or carbohydrate is bad as such. Rather, a moderate intake of each (as opposed to an extremely high intake of either) is likely to be most appropriate for good health.

A recent refinement of carbophobia is the conclusion by some writers (who usually have no qualifications or experience in nutritional science) that sugar is killing us all. This is a throwback to British physiologist and nutritionist John Yudkin’s 1972 depiction of sugar as Pure, White and Deadly.

This concept temporarily disappeared under pressure from the fat-is-killing-us-all brigade, but is now making a strong comeback. The main difference is that the current sugar phobia is predominantly about fructose, which is one of sugar’s two components, alongside glucose.

In the pop science literature, fructose has been accused of being the sole cause of obesity, heart disease and type 2 diabetes, and of being a toxin at any dose.

A recent refinement of carbophobia is the conclusion by some that sugar is killing us all. Kurtis Garbutt/Flickr, CC BY

Although it’s appropriate to limit sugar intake, “fructophobia” doesn’t have a firm basis in science. But that hasn’t stopped the bandwagon rolling on for several years now.

Finally, Scrinis identifies the “functional food” era of nutritionism, which began about 20 years ago with the development of foods modified to provide specific health benefits.

Foods fortified with either long-chain omega-3 fatty acids (fish oils), plant sterols, probiotics or some other supposed health-giving component are becoming increasingly common in supermarkets. In essence, we’re now being trained to worry about not getting enough functional components unless we buy specially fortified, and in many cases, more expensive versions of normal foods.

There are specific instances where food fortification is entirely appropriate; the addition of folate to a range of foods, for instance, appears to have reduced the risk of neural tube defects in newborn babies.

But unless there’s a demonstrated public health benefit, or a diagnosis by an appropriate professional, it’s best to ignore the latest nutritionism fad and follow this simple but elegant recommendation by Michael Pollan:

Eat food. Not too much. Mostly plants.

Bon appetit!

Cleaning your hands may be more complicated than you think

This article is further evidence of how we are surrounded by various chemicals and substances that we think are safe, but may not be. This  is not just about the safety of handwashes, but many of the other chemicals we use. It is best to avoid them as much as possible and live simple lives using natural occurring substances wherever possible.
30 July 2014, 6.27am AEST

Cleaning your hands may be more complicated than you think

The next time you wash your hands with a liquid soap claiming to be antibacterial, keep in mind that you may not actually be sanitising them. There’s no evidence that the antibacterial ingredients of such…

There is no evidence that the antibacterial ingredients of such soaps do anything more than plain soap and water. Arlington County/Flickr, CC BY-SA

The next time you wash your hands with a liquid soap claiming to be antibacterial, keep in mind that you may not actually be sanitising them. There’s no evidence that the antibacterial ingredients of such soaps, which is usually triclosan, do anything more than plain soap and water.

Triclosan is a potent antibacterial agent able to kill most types of bacteria, both healthy and disease-causing ones. Its use in hospital hand washes has undoubtedly saved millions of lives by preventing infection and is not being questioned.

But it is also used at much lower concentrations in hundreds of household products including antibacterial liquid soaps and other personal-care products, such as toothpastes. And products sold as household antibacterial soaps are often no more effective than plain soap and water.

Indeed, using triclosan at the low levels put into these soaps and other domestic products may even encourage bacteria to become resistant to antibiotics.

Exposing bacteria to low levels of germ-killing chemicals can turn on lots of the mechanisms they have to protect themselves against such chemicals. Bacteria can thicken their outer walls, turn on pumps designed to expel toxic chemicals and even produce enzymes to inactivate the chemicals.

Low levels of exposure that don’t kill the bacteria can help them be ready to successfully defend themselves against later challenges.

Triclosan in the spotlight

Triclosan hit the headlines in December 2013 when the two agencies that have legal oversight over its use in the United States – the US Food and Drug Administration (FDA) and the US Environmental Protection Agency (EPA) co-announced they were taking a closer look at its safety and effectiveness.

In fact, the US Congress had tasked the FDA with reviewing the evidence for the effectiveness of antibacterial soaps way back in the 1970s, but the assignment was never completed.

The Natural Resources Defense Council, a US-based non-profit environmental advocacy group, was incensed by the delay of more than 30 years and took court action against the FDA for their failure to act.

The EPA is involved in the review because triclosan is also used as a pesticide. The agency reviews the active ingredients of all pesticides every 15 years, but this latest review is ten years early.

For its current use in household products to continue, the FDA and EPA have to remain convinced that triclosan is both effective and safe. But the effectiveness of triclosan products as antibacterial agents has been contentious for many years because of the lack of evidence that they provide a germ-killing benefit.

The exception is for toothpastes containing triclosan, which appear to be effective for reducing the gum disease gingivitis.

The US state of Minnesota has already placed a ban on triclosan that will take effect in 2017. Similarly, Johnson & Johnson, Procter & Gamble and Avon have committed to phasing triclosan out of all their consumer products by 2015. Such steps are likely to have knock-on effects.

Safety issues

Questions about the safety of triclosan have also been raised recently because evidence suggests some chemicals used widely in personal-care products, including triclosan, can mimic or interfere with hormones, at least in laboratory-based experiments and in animal models.

Known as endocrine-disrupting compounds, if these chemicals had a similar effect on people, they could potentially disrupt our bodies’ delicately balanced, finely-tuned and exquisitely sensitive endocrine systems.

In laboratory tests and in animals models, triclosan has been shown to behave like the human hormone oestrogen. It can dock at oestrogen receptors on human cells maintained in the lab and start a chain of cellular events in the same way as natural oestrogen. So far, there’s no evidence showing that triclosan is an endocrine-disrupting compound in humans.

But new research shows very low daily doses of triclosan can encourage cancer progression in mice that already have oestrogen-dependent breast cancer.

This work doesn’t prove that triclosan is an endocrine-disrupting compound that mimics oestrogen or that it can promote breast cancer in humans. But it does add weight to the argument that more research is needed into the effects of triclosan in humans and animals given its widespread use.

It also suggests that the recently announced review by the US FDA and EPA is timely and worthwhile. In the meanwhile, plain soap and water may be the way to go for safe, clean hands.