Monthly Archives: March 2015

Neuron study helps explain why we forget

9 May 2014, 6.38am AEST

Neuron study helps explain why we forget

Memories from early childhood are notoriously elusive but why can’t we recall our most formative experiences? New research…

Childhood memories seem few and far between – if they still exist at all. So why can’t we dig them up as adults? Rob./Flickr, CC BY-NC

Memories from early childhood are notoriously elusive but why can’t we recall our most formative experiences? New research suggests it could be a case of the old making way for the new – neurons, that is.

A study, published today in Science, has found that neurogenesis – the generation of new neurons – regulates forgetting in adulthood and infancy and could significantly contribute to the phenomenon of “infantile amnesia”.

Throughout life, new neurons are continually generated in the dentate gyrus, part of the brain’s hippocampus. This is one of only two areas in the mammalian brain that consistently generates neurons after infancy, aiding the formation of new memories of places and events.

These new neurons compete for established neuronal connections, altering pre-existing ones. By squeezing their way into these networks, new neurons disrupt old memories, leading to their degradation and thus contributing to forgetting.

Neurogenesis is particularly rampant in humans during infancy but declines dramatically with age. So researchers hypothesised that this increased disruption to hippocampal memories during childhood renders them inaccessible in adulthood.

Rodent recollections

To investigate the correlation between neurogenesis and forgetting, a team from the University of Toronto conducted a series of tests on mice, guinea pigs and a type of small rodent called degus.

First, a group of infant and adult mice were trained to fear a certain environment through the use of mild electric foot shocks.

Some of the adult mice were then provided access to running wheels, an activity that has been shown to boost neurogenesis. When returned to the initial environment, the adult mice who used the running wheels had largely forgotten their fear of the electric shocks, while those without the wheels maintained an association between the space and fear.

From the group of infant mice a number were given drugs to slow the rate of neurogenesis to see if decreasing the generation of new neurons mitigated the forgetting normally observed in infant mice. In accordance with the researchers’ hypothesis, the ability of these animals to retain memories improved in comparison to their untreated counterparts.

The study was then moved to rodents whose infancy period distinctly differs from mice – and humans – guinea pigs and degus. These rodents have a shorter postnatal hippocampal neurogenesis because they are more neurologically mature at birth. That means they have extended memory retention as infants so those animals were given drugs to artificially increase neurogenesis – which resulted in forgetting.

Psychologist Dr Amy Reichelt, from the University of New South Wales, said it was good the study used infant guinea pigs and degus.

“These animals are born in a ‘precocious’ way – they are basically miniature adults – able to run about independently, as opposed to mice, rats and humans who are vulnerable and dependent at birth,” she said.

“In young animals where neurogenesis is at a high level, memory circuits are constantly changing, so this supports that certain memories are ‘pruned’ out and thus forgotten – supporting the notion of infantile amnesia.”

How could you forget?

Previous studies have examined the relationship between hippocampal neurogenesis and memory, with a focus on its importance in the consolidation of memories in adult animals. But they have not considered how neurogenesis can also jeopardise memory retention.

Behavioural psychologist Dr Jee Hyun Kim, Head of the Developmental Psychobiology Lab at Melbourne’s Florey Institute of Neuroscience and Mental Health, said: “It has long been speculated that the ‘immaturity’ of the hippocampus may be responsible for infantile amnesia. Back in the days ‘immaturity’ was interpreted as dysfunctional, or low in function.

“However, recent studies speculated that immaturity can also occur in the form of hyper functionality. This study shows that the extreme plastic nature of our brains early in life can be the reason why we forget quickly episodic memories happening early in life.”

Infantile amnesia is not restricted to hippocampus-dependent memories in humans and animals. Dr Kim said it was likely that neurogenesis formed only a part of the story.

“I wouldn’t be surprised if we find undiscovered neurogenesis in other parts of the brain,” she said.

A spotless mind

But does this research hint at ways of improving memory retention in the future?

“It would not be feasible to discourage neurogenesis and reduce forgetting of existing memories,” Dr Kim said, “as adult neurogenesis has a well-established link to depression (low neurogenesis means high depression)”.

Surprisingly, it’s the other side of the coin that promises more potential opportunities. Harnessing neurogenesis to destabilise pre-existent memories could have its own benefits. Dr Kim said depressed or anxious people may want to forget and focus on creating better memories and/or thought patterns.

This can be especially constructive for children who experience trauma in early life, Dr Reichelt said.

“Increasing neurogenesis could be a useful therapy to treat or prevent the onset of post-traumatic stress disorder,” she said.

Quit sugar, go paleo, embrace ‘clean food’: the power of celebrity nutrition

18 March 2015, 2.24pm AEDT

Quit sugar, go paleo, embrace ‘clean food’: the power of celebrity nutrition

Nutrition celebrities often promote strict diets that eliminate entire food groups. Not only are they based on flimsy evidence, some of their advice can lead to serious harm.

Nutrition celebrities draw us in with fancy blogs, colourful cook books, stylised food photography and inspirational stories. jhard/flickr, CC BY-NC-SA

Celebrities of nutrition evoke feelings of awe, envy and adulation in many of us. While the Gwyneth Paltrows of the group first achieve celebrity status in other fields, others first make a name for themselves in food and nutrition, despite not having formal nutrition qualifications. Think Pete Evans, Sarah Wilson and Belle Gibson, whose nutrition empire has crumbled over the past week.

Nutrition celebrities often promote “fad diets”, which are strict diets that often eliminate entire food groups and don’t have a solid scientific basis. In fact, they often demonstrate a misunderstanding of biochemistry and other basic nutrition science.

The Paleo Way by Pete Evans forbids grains, legumes, dairy and coffee, among other things. Evans’ website claims “Paleo is all about balance”, but in reality, is anything but balanced.

Before Belle Gibson’s cancer diagnosis was questioned, she touted “clean eating”, discouraging the consumption of gluten, dairy and genetically modified foods, among other things. She promoted “detoxing”, which involved “alkalising your system” by drinking lemon water, and recalibrating “your digestive and immune system” by cutting out fruits such as bananas and apples.

Sarah Wilson “quit sugar” and recommends cutting out fruit for the first few weeks of her eight-week I Quit Sugar program because it “allows you to break your sugar addiction and for your body to recalibrate”.

It’s no surprise that the British Dietetic Association listed the paleo diet and the sugar-free diet as two of their top five worst celebrity diets.

When it comes to healthy eating, we know what works. The Australian Dietary Guidelines may not sound as sexy as these fad diets, but they’re the result of painstaking work to summarise the best scientific evidence on what constitutes a healthy diet and how diet can promote health.

So why do nutrition celebrities have so much pull? And what impact might it have?

The good

Nutrition celebrities have done some good in the world. They have undoubtedly changed the nutrition habits of some of their followers for the better. This might include increasing their intake of fruits and vegetables, abandoning added sugar- and salt-laden foods such as some breakfast cereals, and helping followers who are overweight or obese to lose weight.

These changes are of particular importance when you consider the high rate of excess weight and obesity and the low intake of good foods like vegetables in the Australian population.

The bad

The negative effects of celebrity nutrition range from public confusion about what is good to eat and drink, to death.

A trusting, vulnerable and adoring member of the public might just decide that Belle Gibson is right – who needs modern medicine for cancer? Gibson claimed she cured her multiple cancers through alternative means. Jessica Ainscough, founder of the Wellness Warrior, died prematurely last month after choosing alternative cancer therapy that included endless juices and coffee enemas.

Belle Gibson’s book, The Whole Pantry, has been pulled from circulation in Australia and the US launch of the book next month has been cancelled. Her “health, wellness and lifestyle” app has also been pulled from Australian and US app stores.

Also this week, Pete Evans’ Bubba Yum Yum DIY baby milk, which is composed of blended liver and bone, has attracted criticism that it could risk the health of babies. This broth provides toxic levels of micronutrients such as vitamin A. This can cause permanent damage and even death.

While Evans’ publisher Pan McMillan has announced it will not be releasing the book, Evans plans to release it as an e-book.

Followers of celebrity nutrition advice may become unnecessarily strict with their eating and drinking (think awkward dinner parties), develop an eating disorder, or become malnourished.

A paleo diet can compromise bone health by reducing calcium intake. A gluten-free diet can be associated with reduced fibre and vitamin intakes.

A sugar-free diet that suggests reducing fruit intake is just plain unhealthy. And sugar-free eating isn’t actually sugar-free. Many recipes contain rice malt syrup, which is chemically defined as a sugar and increases blood sugar levels much more so than an apple would.

The marketing

So, why do nutrition celebrities have so many followers when what they are selling isn’t usually evidence-based, reliable or healthy for most?

So many of us are stressed and tired, and looking for quick fixes. We associate celebrity with happiness and wealth. We’re sold a whole lifestyle and the idea that food can be a magical elixir that can cure all ails.

We are drawn in by fancy blogs, colourful cook books, Instagram feeds of stylised food photography shoots, the Twitter hashtags #paleo #cleaneating #rawfood #sugarfree #glutenfree #detox #juice, and Facebook stories of struggling lives turned around in an instant.

It’s easy to see why this is more appealing that listening to government guidelines and advice from doctors, nutritionists and dietitians that scientific evidence doesn’t support the elimination of entire food groups or elements such as dairy, gluten, legumes, grains and fruit from the diets of most people.

Perhaps we need to strategically market evidence-based nutrition information to have broader appeal.

So, turn this:

Screen shot of Eat for Health – Australian Guide to Healthy Eating.
Click to enlarge

Into this:

Screen shot of The Paleo Way website.

To counter the fads, we need to consider innovative ways of communicating to Australians about what constitutes a eat a healthy, balanced diet that is based on evidence. Nutrition celebrities’ marketing strategies might teach us a thing or two about how to sell this message.

Further reading: The ‘hole’ in the pantry story: should Penguin have validated Belle Gibson’s cancer claims?

Antidepressants may be no better than a placebo, so why take them?

28 October 2014, 2.55pm AEDT

Antidepressants may be no better than a placebo, so why take them?

Seventeenth-century Oxford scholar Robert Burton’s lifework, The Anatomy of Melancholy, weighs in at a door-stopping 1,400 pages. But his cure for the “Black Choler” of depression came down to just six…

A growing body of research suggests placebos may be as good as real drugs for treating depression. Victor/Flickr, CC BY-SA

Seventeenth-century Oxford scholar Robert Burton’s lifework, The Anatomy of Melancholy, weighs in at a door-stopping 1,400 pages. But his cure for the “Black Choler” of depression came down to just six words: “Be not solitary, be not idle.” Writing today, he might add: “And maybe take a placebo.”

Placebos are sham treatments that work even though they lack an active ingredient. Pills made of sugar or corn starch have improved Parkinson’s disease, anxiety and pain. Now research suggests placebos may be as good as real drugs for treating depression.

Placebo power

In this most recent study, people with at least moderate depression received support and encouragement alone, or coupled with an antidepressant or a placebo. Those who received an antidepressant or placebo did better than those who got only support. But placebos improved depression nearly as much as the active drug and the difference wasn’t significant.

An earlier review found antidepressants offered minimal benefit over placebos except in very severe depression, where the benefit was substantial. And a 2008 study found antidepressants were no more effective even in severe depression; very depressed people were just less responsive to placebos.

One theory suggests placebos work because people expect them to. A grave doctor and austere consulting room help convince patients a drug works. Indeed, believing a dummy pill stops pain triggers endorphins in the same brain area targeted by real painkillers.

Another theory cites Pavlov’s dogs, who, after a while, just had to see the white coats of the assistants who brought their food to start drooling. This conditioning theory suggests people only need to see the pill, cream or syringe to get the intended effect, even without the active drug.

But we know active drugs cause placebo effects too. Painkillers work a lot better when a medical person says they will work. A 1998 study claimed placebo effects accounted for an estimated 75% of the effects of antidepressants.

Nonetheless, the drugs still figure prominently in Australian guidelines and in 2012-13 Australian doctors wrote 20.5 million prescriptions for antidepressants.

The right fit

But if antidepressants are little better than a placebo, why do so many people take them? Well, the placebo data have been criticised, among others, for selective analysis of studies. They may be wrong.

And there are reasons why doctors and patients might favour medication that could help even a little. A busy waiting room makes speedy prescription writing attractive; advertising could make doctors think of drugs as the first option; patients often want a “quick fix”; and our culture reinforces drugs as a natural response to illness.

A trickier question is whether doctors should even prescribe antidepressants if they are really just placebos. But placebos can be powerful and some argue we shouldn’t jeopardise their strength by telling patients. A 2008 US study of 1,200 doctors found more than half prescribe placebos, often vitamin pills.

But there may be differences between countries too. Direct-to-consumer advertising of prescription drugs, legal only in the United States and New Zealand, may influence placebo responses. Advertisements for drugs show dramatic improvements that heighten expectations. Pictures of smiling people and beautiful scenery also promote positive attitudes and beliefs.

Some think advertising is the reason placebos in antidepressant drug trials have become 14% more effective in the last 20 years.

And people with depression may show stronger placebo responses. Psychologist Irving Kirsch thinks this is because hopelessness is so dominant in depression. Placebos give hope so they may work better for this particular illness.

Limiting placebo use

Nonetheless, the American Medical Association has vetoed the use of deceptive placebos, saying they undermine trust, frustrate patient autonomy and delay proper treatment. But a 2010 study showed placebos work even if you tell the patient.

Others argue real drugs are actually superior placebos. In blinded drug trials, people who get side effects often work out they’re on the real drug and not the placebo. This makes them expect to improve, so the placebo effect kicks in.

But this too gets complicated because placebos can also cause side effects. This “nocebo” phenomenon happens when people expect bad things from a sugar pill. Maybe placebos will work better if the doctor “suggests” some side effects too?

An alternative to grappling with this often conflicting information is to raise the profile of non-drug treatments for depression. Psychotherapies such as cognitive behavioural therapy are as good as drugs, except for people with severe depression.

But adding another twist is a recent study that showed psychotherapy isn’t significantly better than a pill placebo for depression. Still, psychotherapy does provide important knowledge that promotes autonomy, a factor not measured in study comparisons.

Many active treatments are effective partly because of the placebo effect. The effect is strong in antidepressants, a fact that may need to be disclosed to patients to ensure fully informed consent. Whether sugar placebos should ever enter medical practice is another question entirely, and one that invites wide community debate.

What does my blood group mean?

3 November 2014, 3.08pm AEDT

Health Check: what does my blood group mean?

Few discoveries have revolutionised the practice of medicine as much as the discovery of human red blood cell groups. Unlike modern vampire and Time Lord mythologies, blood groups don’t have a particular…

Blood is categorised by the naturally occurring proteins and sugars on the surface of red blood cells. Jon Åslund/Flickr, CC BY

Few discoveries have revolutionised the practice of medicine as much as the discovery of human red blood cell groups.

Unlike modern vampire and Time Lord mythologies, blood groups don’t have a particular flavour (Tru blood) or make humans susceptible to hypnotic mind control (Dr Who). Rather, blood is categorised by the naturally occurring proteins and sugars on the surface of red blood cells.

For most people, which blood group you are does not matter one jot, unless your life is at risk and you need a blood transfusion. In this case, the proteins and sugars can act as a barrier to safe transfusion of red blood cells from one person to another.

The ABO blood group system

Prior to the 20th century, early attempts at transfusing blood into humans could be unpredictable and lead to death. Looking for a solution, immunologist Karl Landsteiner found that the blood of two people could be either “compatible” or “incompatible” in a predictable way: “incompatible” blood led to “clumping” (agglutination) of red blood cells in a test tube, while “compatible blood” did not.

Along with Alfred von Decastello and Adriano Sturli, Landsteiner identified the four major blood groups: O, A, B and AB or what is known as the ABO blood group system.

Landsteiner realised what made blood types compatible or incompatible were antibodies produced against specific red blood cell sugar molecules, causing agglutination of the red cells in the test tube and destruction of the red cells in the circulation. For this work, Landsteiner was awarded the Nobel Prize in Medicine.

Blood transfusions are no longer analogous to medical ‘Russian roulette’. sfam_photo/Shutterstock

Ludwig Hektoen developed rigorous testing procedures of blood grouping and cross matching in 1907 which were first performed by Reuben Ottenberg. These methods have been used to reliably select the correct donor blood ever since.

Beyond the ABO blood group

In general, everyone can be classified within ABO blood group system, based on the ABO sugars. Red blood cells also contain many other proteins and sugars, known as red cell antigens. Researchers have discovered more than 300 blood group antigens, each representing different proteins on the red blood cell that perform different functions.

The importance of these red cell blood groups, however, is not necessarily what they do; you could live without several blood group antigens and be none the wiser. Their importance of lies in how they elicit an immune antibody response, and whether these new antibodies can destroy foreign red cells against which they are targeted.

The immune system of person who doesn’t have these antigens can be stimulated to make antibodies against red cell antigens that aren’t their own. This can cause red cell destruction (haemolysis) which, in its most immediate and dramatic form, can lead to severe stress to the heart and circulation, kidney failure and death. It can also lead to a delayed form of red cell destruction that occurs a week or so after a blood transfusion.

Positive or negative

One of the most important non-ABO blood groups is the Rhesus blood group system, which Landsteiner discovered in 1940 in collaboration with Alexander Weiner. This system categorises people as either positive or negative, depending on whether they have Rhesus D antigen on their red cells (O- or O+ for example).

Since the late 1800s, physicians had noted that following a successful first pregnancy, some mothers could lose their subsequent babies through a disease called haemolytic disease of the fetus and newborn. For the majority of babies, this condition was attributable to the Rhesus D antigen.

Researchers realised that Rhesus D-negative mothers were exposed to Rhesus D antigen through the course of their pregnancy. The baby had inherited this red cell antigen from their father. The mother’s immune system therefore reacted against this foreign red cell antigen by producing antibodies which could cross the placenta and destroy the red cells of the baby in subsequent pregnancies.

ABO and Rhesus are the most important red cell blood groups. Ian Humes/Flickr, CC BY-NC-ND

The understanding of the Rhesus system led to strategies that have dramatically reduced haemolytic disease among newborns. Rhesus D-negative women of child-bearing age are only given blood transfusions of Rhesus D-negative blood to prevent stimulating the immune system against this antigen.

Pregnant Rhesus D-negative women are also given special anti-D immunoglobulin during their pregnancy, after delivery and following any trauma or pregnancy-related procedure. Again, this helps prevent foreign Rhesus D-positive red cells from stimulating the mother’s immune system.

Rare blood groups

What ultimately determines our blood group is our genetics: our parents, our ancestors and also their migration patterns.

Rare blood groups arise from inheritable mutations of red blood cell genes in different populations. This can make it very difficult to find correctly “matched” blood donor units for people with rare blood groups simply because they are uncommon in the usual volunteer blood donor population.

The red cell blood group Kidd(null) phenotype (Jka-b-) which is more common in Finnish and Polynesian populations, for instance, is very rare in Australian blood donors. Unless a correctly matched Jka-b- blood is found, there is a risk of developing a haemolytic transfusion reaction or haemolytic disease of the newborn, as patients develop antibodies that are acquired to Kidd red cell blood groups on the transfused blood.

People with the Bombay red cell phenotype have only a one in a million chance of finding a suitable blood donor. In this setting, transfusion may be sought from a family member, who is much more likely to have the correct blood phenotype.

It’s likely that you or someone you know will require a blood transfusion at some stage in life. One of the simplest things we can do as individuals is to become a volunteer blood donor.

Should I choose a gluten-free diet?

15 September 2014, 2.51pm AEST

Health Check:

Gluten is a protein found in the grains wheat, rye and barley. For people with the autoimmune condition coeliac disease, eating foods that contain gluten can damage the lining of the intestines. Over time…

As many as 326,000 Australians may be unnecessarily avoiding gluten. Martin/Flickr, CC BY

Gluten is a protein found in the grains wheat, rye and barley. For people with the autoimmune condition coeliac disease, eating foods that contain gluten can damage the lining of the intestines. Over time, this damage can lead to nutritional deficiencies, osteoporosis and cancer.

Coeliac disease affects 1% of Australians, though only one in five of those may know they have it. The only way to diagnose coeliac disease is to have a positive intestinal biopsy. People with coeliac disease must follow a gluten-free diet; there is currently no other treatment.

But others are also choosing to go gluten-free. According to the latest National Health Survey, 2.5% of Australians aged two or over reported avoiding gluten (about 544,000 people). This means that 1.5% or 326,000 people may be unnecessarily avoiding gluten.

So, is a gluten-free diet warranted by anyone but people with coeliac disease?

The alternative medicine crowd would have you believe gluten- and grain-based foods cause a host of nasties from dementia to cancer. Others tout gluten-free diets as a helpful weight-loss tool. And the grain-avoiding paleo philosophy rules the lives of some vocal, yet otherwise sensible, Australians.

It’s no wonder some people are questioning their gluten intake. But rest assured, there is no credible evidence grain-based foods cause disease. Nor is there any evidence gluten-free diets aid weight loss, though there is strong evidence to the contrary.

While it’s certainly helpful for long-term health to reduce processed foods, grains form the staple foods of many societies and provide key nutrients. The Australian Guide to Healthy Eating encourages a variety of grain-based foods precisely because these foods make achieving nutritional adequacy more straightforward and are culturally appropriate for the majority of Australians.

Gluten sensitivity

For some people, reducing wheat can help reduce uncomfortable gastrointestinal symptoms.

Wheat also contains fructans, a form of fibre which is rapidly fermented by bowel bacteria. This can lead to flatulence and discomfort in some people.

Many irritable bowel syndrome (IBS) sufferers have achieved good symptom control following a low FODMAP diet, which restricts a number of carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) which can be poorly absorbed in the small intestine. Fructans are one such carbohydrate.

Non-coeliac gluten sensitivity is a fall-back diagnosis if symptoms are not relieved with a low fodmap diet.

But a recent small but clever study now disputes the diagnosis all together. All the food for the study participants was provided and the diets were controlled for gluten, FODMAPs, and food chemical components known to elicit responses in food sensitive people (such as salicylates, amines and glutamates).

Many participants reported symptoms, but they weren’t being caused by gluten. There is clearly more work to be done here but it looks like gluten has been unfairly accused.

A word of warning to young women

People who avoid gluten without a medical reason and without individualised dietetic advice are at risk of nutrient inadequacies, especially if an unplanned pregnancy occurs.

Even with expert advice from a dietitian, people with coeliac disease do not easily achieve nutrient adequacy. A recent study of the gluten-free diets of new and experienced coeliacs found that significant numbers of adult female participants did not achieve the recommended dietary intakes (RDI) or even the population averages of thiamin, folate, calcium, iron or fibre. The most concerning of these nutrients is folate.

Australian women of child bearing age have the highest prevalence of gluten avoidance: 5% of 19- to 30-year-olds and 4.8% of 31- to 50-year-olds. This is not surprising, given women are more likely to suffer from IBS and also more likely to diet with the intention of weight control.

Folic acid (folate) has been added to wheat flour in Australia as a public health measure since 2009 to help prevent neural tube defects such as spina bifida in babies. Fortification of the food supply is particularly helpful given that up to 50% of pregnancies are unplanned and folate should be consumed for at least a month before conception.

But gluten-free breads are not routinely fortified with folate and gluten-free grains and vegetable starches are not rich sources, leaving those following a gluten-free lifestyle without a folate safety net.

For some people, reducing wheat can help to reduce uncomfortable gastrointestinal symptoms. Memphis CVB/Flickr

What about the health claims?

Gluten-free foods may be found in the health food aisle of the supermarket, but the reality is gluten-free food manufacturers chase dollars, not health. In the rush to meet consumer demand, many food manufacturers have prioritised meeting gluten-free criteria and palatability over true substitution for gluten.

Foods that are naturally gluten free are now even being labelled gluten-free in order to capitalise on this growing market.

To be truly helpful for their consumers, manufacturers need to take measures to keep their products nutrient-rich, not just gluten free.

Regardless of whether the reason to follow a gluten-free diet is medical or philosophical, it’s important to focus on achieving adequate nourishment. A nutritionally adequate gluten-free diet needs to be well planned and well executed. It’s not simply a matter of cutting out grains and choosing labels which say “gluten free”.

Understanding weight gain at menopause.

Many women are concerned that oestrogen will make them gain weight. The evidence shows the opposite.
Climacteric. 2012 Oct;15(5):419-29. doi: 10.3109/13697137.2012.707385.

Understanding weight gain at menopause.



The aim of this review was to summarize the literature regarding the impact of the menopause transition on body weight and body composition.


We conducted a search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2012) for English-language studies that included the following search terms: ‘menopause‘, ‘midlife’, ‘hormone therapy’ or ‘estrogen’ combined with ‘obesity’, ‘body weight‘ or ‘body composition’.


Whereas weight gain per se cannot be attributed to the menopause transition, the change in the hormonal milieu at menopause is associated with an increase in total body fat and an increase in abdominal fat. Weight excess at midlife is not only associated with a heightened risk of cardiovascular and metabolic disease, but also impacts adversely on health-related quality of life and sexual function. Animal and human studies indicate that this tendency towards central abdominal fat accumulation is ameliorated(reduced) by estrogen therapy.

Studies mostly indicate a reduction in overall fat mass with estrogen and estrogen-progestin therapy, improved insulin sensitivity and a lower rate of development of type 2 diabetes.


The hormonal changes across the perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. There is strong evidence that estrogen therapy may partly prevent this menopause-related change in body composition and the associated metabolic sequelae. However, further studies are required to identify the women most likely to gain metabolic benefit from menopausal hormone therapy in order to develop evidence-based clinical recommendations.

Transdermal bio-identical progesterone cream as hormonal treatment for osteoarthritis.

Another interesting benefit from Bioidentical hormones. Oestrogen is also good for joints,(see my Blog from Dec 2013), as is Omega 3, cinnamon and turmeric.
Acta Med Indones. 2013 Jul;45(3):224-32.

Transdermal bio-identical progesterone cream as hormonal treatment for osteoarthritis.


Osteoarthritis (OA) is a condition found worldwide, is strongly associated with aging and is the most common type of arthritis. Because of its effect on ambulation and mobility, it has significant functional impact and is associated with considerable medical costs. Because of the aging of the society and the obesity epidemic, the burden of OA can be expected to increase over the next 20 years. Although OA has been regarded primarily as a non-inflammatory arthropathy, symptoms of local inflammation and synovitis are present in many patients and have been observed and even in the absence of classical inflammation, which is characterized by infiltration of neutrophils and macrophages into joint tissue, elevated levels of inflammatory cytokines have been measured in OA synovial fluid. Although the cartilage lesion is present at sites remote from synovium, the fibroblast- and macrophage-like synovial cells, as well as the chondrocytes itself, are potential sources of cytokines that could induce chondrocytes to synthesize and secrete cartilage-degrading proteases, cytokines, and other inflammatory mediators. The bio-identical progesterone shows its anti-inflammatory effects in OA by suppressing gene expressions in the production of inflammatory cytokines through the negative interaction between nuclear transcription factor and the progesterone receptor and/or the progesterone-induced increase of nuclear transcription factor inhibition in the nucleus. The bio-identical progesterone may indirectly regulate bone remodeling and may also play a role in the development and maintenance of cartilage. This review will discuss about transdermal bio-identical progesterone cream as suggested hormonal treatment of OA, based on its pathogenic process.

Food Allergies or Food Intolerance?

Food Allergies or Food Intolerance? Dr Weil
Published: 10/12/2014

A small minority of adults – less than five percent – have true allergies to foods. Common food allergens include milk, eggs, peanuts, tree nuts, shellfish, soy and wheat. When true food allergies occur, the immune system reacts to a benign substance as if it were a harmful one, and produces antibodies against it, releasing histamines and other compounds in the process. This causes symptoms such as a tingling mouth, hives, swollen tongue and throat, drop in blood pressure, or even anaphylactic shock.

Food intolerance – which is much more common – may produce less serious but still uncomfortable symptoms (diarrhea, gas, headaches or flushing). Food intolerance may be due in part to a lack of enzymes needed to break down food.

If you feel you have a true food allergy, or have been bothered by symptoms of food intolerance, talk with your physician about your concerns; he or she can arrange tests to determine what, if anything, is causing allergies or intolerance.

Food intolerance can often be difficult to nail down with testing. Consider a two to three-week trial of an elimination diet, taking out the most common offenders above. If improved, gradually add back foods one at a time and gauge any reaction.

Pathological actions of cholesterol in breast cancer.

Climacteric. 2014 Oct 16:1-6. [Epub ahead of print]

The estrogen receptor as a mediator of the pathological actions of cholesterol in breast cancer.


Despite increased survivorship among patients, breast cancer remains the most common cancer among women and is the second leading cause of cancer death in women. The magnitude of this problem provides a strong impetus for new chemopreventative strategies and/or lifestyle changes that reduce cancer incidence. It is of significance, therefore, that several studies positively correlate obesity to the development of breast cancer. Importantly, obesity is also highly associated with elevated cholesterol, and cholesterol itself is a risk factor for breast cancer. Furthermore, patients taking statins demonstrate a lower breast cancer incidence and decreased recurrence. The recent observation that 27-hydroxycholesterol (27HC) is produced in a stoichiometric manner from cholesterol, together with our recent demonstration that it exerts partial agonist activity on both the estrogen and liver X receptors, suggested a potential mechanistic link between hyper-cholesterolemia and breast cancer incidence. Using genetic and pharmacological approaches, we have recently shown that elevation of circulating 27HC significantly increases tumor growth and metastasis in murine models of breast cancer. Further, we have demonstrated in appropriate animal models that the impact of high-fat diet on tumor pathogenesis can be mitigated by statins or by small molecule inhibitors of CYP27A1.

These findings suggest that pharmacological or dietary modifications that lower total cholesterol, and by inference 27HC, are likely to reduce the impact of obesity/metabolic syndrome on breast cancer incidence.

What do my blood pressure numbers mean?

9 September 2014, 2.25pm AEST

Health Check: what do my blood pressure numbers mean?

If you’re an adult and have ever visited a doctor, you’ve probably had your blood pressure measured. General practitioners tend to obsess over blood pressure. But with good reason: hypertension, or persistently…

Blood pressure refers to how hard the blood is pushing against the wall of arteries. Image Point Fr/Shutterstock

If you’re an adult and have ever visited a doctor, you’ve probably had your blood pressure measured. General practitioners tend to obsess over blood pressure. But with good reason: hypertension, or persistently high blood pressure, can lead to heart disease, stroke and diabetes, the nation’s biggest killers.

What is blood pressure?

Blood pressure refers to how hard the blood is pushing against the wall of arteries – these can be thought of as the pipes that deliver blood from the heart (the blood “pump”) to the rest of the body.

This pressure is necessary for the blood to flow. Using a plumbing analogy, imagine the effect of a drop in water pressure to water flow from the garden hose.

Blood pressure naturally varies throughout the day depending on posture, activity and stress. It can also be elevated or lowered as a consequence of illness or disease.

Stephen Hales, an 18th-century English clergyman and scientist, first measured the blood pressure of animals in a series of experiments that involved inserting tubes into their arteries. In one experiment with a horse, he describes the blood rising to eight feet in height in the tube!

Blood pressure measurement would almost certainly be unpopular if it involved inserting long glass tubes into people. Happily, Italian physician Scipione Riva-Rocci developed the conventional sphygmomanometer, or blood pressure meter, in 1896.

The conventional blood pressure machine uses a column of liquid mercury. Jiří Sedláček (Frettie)

Soon afterwards, Russian physician Nikolai Korotkoff discovered the sounds that can be heard with a stethoscope over the inner elbow while using a sphygmomanometer. His technique remains the standard method for measuring blood pressure today.

Interestingly, the conventional sphygmomanometer uses a column of liquid mercury to indicate the pressure. As mercury is so much denser than water or blood, even very elevated blood pressures result in it rising no more than about a foot.

This quirk of medical history gives us the modern measurement unit for blood pressure: millimetres of mercury (mmHg). A blood pressure measurement of 140 mmHg literally means that the pressure will push up a column of liquid mercury 14 centimetres.

Two numbers are given when reporting blood pressures, such as 140/90 mmHg. The first number is the systolic blood pressure. This is the pressure when the heart is contracting to pump its content of blood into the circulation.

The second number is the diastolic blood pressure. This is the pressure when the heart is relaxing and is refilling with blood.

The heart refills the blood (left = the bottom number) and pumps it out (right = the top number). udaix/Shutterstock

What is normal?

The National Heart Foundation guidelines define “normal” blood pressure withing the following range:

  • Systolic blood pressure: 100 to 139 mmHg
  • Diastolic blood pressure: 60 to 89 mmHg.

These thresholds are arbitrary, but a blood pressure less than 140/90 mmHg is not labelled as high.

We’re also moving away from categorical descriptions of hypertension, based on blood pressure reading alone, towards a model where blood pressure is considered alongside other risk factors to determine whether drug or lifestyle interventions are needed.

Clinicians now calculate the patent’s absolute cardiovascular disease risk: the probability they will have a heart attack or stroke in the short and medium term, which includes age and cholesterol levels. This calculator can help you work out your absolute disease risk.

All adults should consider having their blood pressure measured at least once every two years. If it’s elevated, and confirmed, you’ll work with your GP to create a management plan to lower your blood pressure. This is likely to lifestyle changes such as:

  • getting regular physical activity
  • quitting smoking
  • reducing the amount of salt you eat
  • increasing the amount of potassium you consume (from foods such as parsley, dried apricots, some nuts, bamboo shoots, bananas, avocados, soybeans and bran)
  • losing weight
  • drinking less alcohol.

Keep in mind that visiting the doctor can provoke anxiety, so the blood pressure can be elevated in response to the testing procedure itself. This has been called the “white coat effect”.

If this is suspected, your GP might try recording your blood pressure over a number of visits, or use ambulatory or home blood pressure monitoring to get an accurate reading.

This article was co-authored by Dr Patrick Khoury, a GP registrar at the General Practice Unit, Fairfield Hospital.