Monthly Archives: May 2015

Kidneys are amazing for all they do, be sure to look after yours

How often do we even think about our kidneys? Time we paid them the respect they deserve.
12 March 2015, 2.00pm AEDT

Kidneys are amazing for all they do, be sure to look after yours

Rather innocuous-looking and tucked away below the ribcage, kidneys are crucial for keeping us alive and well.

Kidneys are a feature-packed, highly efficient filtration and waste elimination system. Helen Taylor/Flickr, CC BY-NC

Tucked away just below your ribcage near your spine are two bean-shaped organs known as the kidneys. And when they’re quietly getting on with their job, it’s easy to forget they’re there and how important they are. But their absence, or even less-than-optimal performance can have dire consequences.

Kidneys are a feature-packed, highly efficient filtration and waste elimination system as well as the source of some essential hormones and vitamins. When all is said and done, the “factory-fitted” system for all they do beats alternatives for efficiency and convenience. They’re compact, built-in, self-contained, portable and low maintenance.

About 1,500 litres of blood pass through the kidneys each day, through a series of highly-regulated pumps and channels. Essential nutrients and water are reabsorbed and the waste products created by our cells are removed in volumes ranging from as little as 500 millilitres to as much as ten litres, in the form of urine.

Together with the bladder, which acts as a mechanism to batch this output, kidneys are the ultimate personal waste disposal system, requiring little maintenance. In fact, you could say the greatest inconvenience they pose is the need to occasionally quickly locate “conveniences”.

When things go wrong

Although the list of conditions causing kidney disease is long, dietary and other lifestyle issues are beginning to dominate. More than a third of all new patients are now reaching end-stage kidney disease due to diabetes and about one in eight as a result of high blood pressure.

In contrast, the most common genetic cause of kidney disease (polycystic kidney disease) only accounts for one in 20 patients. Less common causes include autoimmune diseases and the toxic side effects of some medicines. Not only are many of the risk factors for kidney disease the same as those for heart disease, kidney disease itself is considered a risk factor for developing heart disease.

Dietary and other lifestyle issues now dominate as causes of kidney disease. Heather Wizell/Flickr, CC BY-NC-SA

The development of kidney disease is often insidious, as symptoms are non-specific and occur late. Indeed, more than 90% of kidney function may be lost before any symptoms occur.

Common symptoms include nausea, a change in taste or loss of appetite, fatigue and itching, which reflect the build-up of toxins normally eliminated by the kidney. Less often patients may present due to swelling, or because they have noticed the presence of blood or protein in the urine (protein may cause urine to become frothy).

Thanks to advances in technology, kidneys are the only major organs that can completely fail but leave patients alive and reasonably healthy, even out of hospital. If your kidneys do fail, the first step is to get an alternative filtration system up and working. This is known as dialysis.

Dialysis and transplants

The two main types of dialysis are peritoneal dialysis and haemodialysis. Both involve having some sort of permanent access point to enable regular dialysis. While these interventions keep people alive, they only provide at best about 10% to 15% of health kidney function.

Peritoneal dialysis, which can be done at home by patients themselves, involves having a tube surgically inserted into the abdominal cavity to enable fluid to enter.

Haemodialysis, which takes four to five hours and has to be performed three times a week, requires direct access into the bloodstream. This usually involves a surgical connection between an artery and a vein. Once these access points have been established, dialysis can begin.

Both kinds of dialysis involve having some sort of permanent access point into the body. Dan/Flickr, CC BY

For eligible patients, a kidney transplant may avert the need for dialysis but it comes with its own problems. In addition to the risks of having an operation and general anaesthetic, unless the patient has an identical twin, the transplanted kidney will be seen by their immune system as foreign.

Left unchecked, transplanted kidneys are soon rejected, and fail. Immune-suppressing drugs can prevent this, but they have serious side effects and have to be taken for the rest of your life. The problem is that currently available immunosuppressants are relatively non-specific in their actions, and suppress the patient’s whole immune system. This makes them much more vulnerable to all sorts of infections, and also cancers.

Clearly, current treatments for kidney failure come with their own significant downsides. Life expectancy on dialysis, for instance, is considerably shorter than that of the general population.

Love kidneys, yourself and others

Chances are, if you are looking after your kidneys, you are also looking after the rest of your body. You’ve probably heard it all before but if you eat a balanced diet that’s low in salt, fat, and sugar, maintain a healthy weight, exercise regularly, drink sufficient water, restrict your alcohol intake and don’t smoke, you are caring for your kidneys.

There will be other benefits too. You’ll also be reducing your risk of diabetes, heart disease, high blood pressure and even cancer.

Despite the limitations of kidney transplants, they can transform and extend the lives of those with kidney failure. Only people with healthy kidneys can donate kidneys for transplantation. So looking after your kidneys may turn out to be an investment in someone else’s future and allow you to give the gift of life.

Is the medical marijuana debate even worth having?

16 February 2015, 8.10pm AEDT

Is the medical marijuana debate even worth having?

Given the recent thawing in political attitudes in New South Wales and Victoria towards so-called medical marijuana, one could be forgiven for assuming that the medical care of certain individuals is being disadvantaged by the lack of access to THC (tetrahydrocannabinol) products. One of the most frequently cited reasons for legalising marijuana for medical use is its efficacy for chronic pain.

By way of background, there is no dispute scientifically that molecules derived from marijuana (cannabinoids) are involved in pain signalling. The class of biological molecules that activate this system are called endocannabinoids and their biological activity is very complex. The sheer complexity of these actions is essentially the problem with finding suitably safe and effective medications for pain. There is an enormous amount of crossover from pain regulation into other brain functions such as motivation, memory, appetite and thermoregulation (body temperature control). The basic science is complex, and clinical trials to date have been disappointing. This usually suggests we have more to learn before a treatment is ready for adoption. When we have the clinical pharmacology of a drug nailed down, the results in trials are usually clear cut successes.

If you want a slightly technical but very accurate and balanced view of the current state of the evidence regarding the risks and benefits of cannabinoids in pain, you can read these lecture notes. If you don’t have the time or inclination, the summary of the serious literature is as follows:

  • The evidence supporting efficacy in neuropathic pain or any type of chronic pain is mixed, and the basic question of whether it really works is a long way from settled.
  • The most generous estimate of the effect size for THC-derived products in clinical trials to date is small. Simply put, THC-derived products are about as useful as paracetamol for pain.
  • There are significant concerns that lifetime consequences can occur from periods of exposure to THC-derived products, particularly in adolescence and young adulthood.
  • Currently available prescription products such as Sativex do not have evidence supporting their efficacy in pain conditions that would qualify them for serious consideration. They do have evidence of side effects and potential harm, like all prescription drugs.

The situation regarding hemp oil and other “cottage industry” products is even less encouraging. There is no compelling evidence that stronger preparations are better for pain relief than the relatively less potent ones available on prescription. The quality and safety of such products is unregulated and does not deserve any sober consideration as a useful treatment for pain. They may be highly regarded by connoisseurs but they don’t even approach the benchmarks for ethical prescribing.

Is more research needed? Yes, I think much more research is needed into endocannabinoids to identify more promising targets for new drugs. Do we need any more trials looking at hemp oil or other currently available forms of cannabinoids? Not really. We would probably get better value for increasingly scarce research dollars by looking at other more promising treatments

Safe Menopausal Treatment.

If you ask doctors which medical publications dealing with menopause have the highest reputation, they would reply Climacteric, Maturitas or Menopause International. These journals represent the top research and medical experts in menopausal issues. This article I am reproducing here, is therefore very credible and important. When doctors are negative about BHRT, and some of you have had that reaction from your own gps and specialists, refer them to this article. This should give them pause to rethink their attitude to BHRT.

Climacteric. 2012 Apr;15 Suppl 1:3-10.

What’s new in hormone replacement therapy: focus on transdermal estradiol and micronized progesterone.


Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20036, USA.


The original conclusions of the Women’s Health Initiative study have been questioned as a result of the availability of age-stratified data. Initial concerns regarding the risk of coronary heart disease (CHD) in association with the use of hormone replacement therapy (HRT) have been replaced with concerns regarding thromboembolic disease, encompassing venous thromboembolism (VTE), particularly in younger postmenopausal women, and stroke, particularly in older women. The original publication of the study results led to a dramatic decrease in the use of oral HRT; however, the use of transdermal HRT has increased over recent years.

 Guidelines from the North American Menopause Society, the Endocrine Society, the International Menopause Society, and specific guidelines from the Menopause and Andropause Society for the management of menopausal women with a personal or family history of VTE all contain positive statements regarding both transdermal estradiol and micronized progesterone.

Unlike oral estrogens, transdermal estradiol has been shown not to increase the risk of VTE, or stroke (doses ≤ 50 μg), and to confer a significantly lower risk for gallbladder disease. Unlike some progestogens, progesterone is also not associated with an increased risk of VTE, or with an increased risk of breast cancer. Based on these data, which are now included in the guidelines, the use of transdermal estradiol and micronized progesterone could reduce or possibly even negate the excess risk of VTE, stroke, cholecystitis, and possibly even breast cancer associated with oral HRT use.

I have continued this theme for the last few days, because it is so important that women get the best and safest menopausal treatment, and also to educate those doctors who are ignorant of menopausal matters.


An issue to make my blood boil!

A patient told me today that her doctor had a go at her when she told her that she was on the natural hormones. It amazes me that doctors still mislead patients to this degree and are ignorant of the developments in HRT that are taking place. I also get angry that doctors will take cheap shots at me without knowing the facts. One of the reasons for this web-site is to give you the information about your hormone treatment, from the best sources available.

At last the mainstream(some of them anyway) medical profession has woken up at last to something women have realized for many years. A recent study (published below) in a mainstream medical journal, has accepted the fact that BHRT is preferred by women, has extra safety built in, and leads to less side effects. The result is that a pharmaceutical company is now producing natural estrogen and natural progesterone in a pill to compete with the form that women have been getting it in the past.

To quote from the article”. An increase in the use of compounded bioidentical hormone therapy (CBHT) has occurred in the United States, indicating that women  appear to be concerned with the hormones contained in FDA-approved HT. Using a combination of cross-sectional Internet survey data, US Census Bureau statistics, and PHAST 2.0 prescription data, a recent US study estimated that Compounded BHT may account for 28% to 68% of all HT prescriptions and may be used by 1 to 2.5 million women aged ≥40 years annually, accounting for $1 to $2 billion in health care spending every year”

Comparison of progestogen effects on the breast

The impact of HT on the breast is a significant concern. While both CEE “Premarin” and estradiol stimulate breast cancer cell proliferation, it is the progestogen component that likely has the greatest influence on breast cancer risk with HT. See my blog of the 11th June about the study from France, where natural progesterone is much more popular than the synthetic forms.

The type of progestogen can also influence the incidence of breast cancer. Observational studies have reported that oral estrogens plus micronized progesterone has less effect on increasing breast cancer risk than oral estrogens with various synthetic progestins. A more detailed analysis of the E3N study showed estrogens plus dydrogesterone significantly increased lobular breast cancer and that estrogens plus other progestins significantly increased ductal, lobular, pure lobular and mixed ductal/lobular cancer, but that estrogens plus progesterone did not increase any of these breast cancer subtypes . In addition, differences in mammographic breast density and abnormalities have been reported between progestogens. Mammographic breast density and breast cancer cell proliferation significantly increased in studies of postmenopausal women receiving CEE/MPA(synthetic hormones) but these parameters did not increase with administration of transdermal estradiol with oral micronized progesterone. The progestin drospirenone (DRSP) has been shown to significantly increase breast density when used in combination with estrogen in perimenopausal women.

Furthermore, the study says:

Review of reported differences between estrogens and progestogens

As discussed above, TX-001HR(the new BHRT produced by a drug company) contains estradiol and progesterone combined in a single capsule. This formulation is expected to offer both efficacy and safety for treating menopausal symptoms in women with a uterus, as suggested by preliminary data on the bioequivalence of the new capsule formulation to separate approved estradiol and approved progesterone products. Published data suggests that this hormone formulation may represent a safer alternative than existing HT regimens. The following review of the literature supports the use of natural estrogen combined with natural progesterone over other combinations of estrogens and synthetic progestins.”

Also” a cross-sectional study of 176 women who had previously switched from HT containing MPA to HT containing micronized progesterone, 71% had switched because of the better side effect profile, 35% because they believed the long-term risks would be fewer, and 23% because of intolerance to MPA. When evaluated at 1 to 6 months after switching, the women experienced significantly better quality of life, including less depression and anxiety, than with MPA (both P < 0.001) [21]. Patient satisfaction questionnaires also indicated that women preferred micronized progesterone over their previous regimen for better symptom control and fewer adverse effects. In the study by Ryan and Rosner of CEE with either progesterone or MPA, results on the Women’s Health Questionnaire showed a significant group-by-visit interaction indicating better quality of life in the progesterone group in the cognitive difficulties domain.”

Here is the study:

Maturitas. 2015 May;81(1):28-35. doi: 10.1016/j.maturitas.2015.02.266. Epub 2015 Mar 9.

17β-Estradiol and natural progesterone for menopausal hormone therapy: REPLENISH phase 3 study design of a combination capsule and evidence review.


Several formulations combining estrogens and progestins for hormone therapy (HT) have been approved worldwide for the treatment of menopausal symptoms, yet recent data indicate a decline in their use and an increase in compounded bioidentical HT. Up to now, no single product combining natural 17β-estradiol and progesterone has been approved by the US Food and Drug Administration (FDA) or the European Medicines Agency (EMA). A phase 3 trial (REPLENISH) is underway to study a novel oral formulation of solubilized 17β-estradiol and natural progesterone combined in a single gelatin capsule (TX-001HR; TherapeuticsMD, Inc, Boca Raton, FL) for treating vasomotor symptoms (VMS) in postmenopausal women. The REPLENISH trial evaluates the efficacy and safety of TX-001HR (4 doses) versus placebo for the reduction of moderate to severe VMS frequency and severity at 4 and 12 weeks and evaluates the endometrial safety of the combinations at 1 year. TX-001HR contains hormones that are molecularly identical to endogenous estradiol and progesterone and is intended as an option for women who prefer bioidentical hormones; further, it does not contain peanut oil, a common allergen. The constituents of TX-001HR, in a pharmacokinetic report, showed similar bioavailability and safety compared with reference estradiol tablets and micronized progesterone capsules administered together. Published data suggest a safer profile of estradiol and natural progesterone compared with HT containing conjugated equine estrogens and progestins. This report summarizes the methodology of the REPLENISH trial and reviews the evidence suggesting clinical differences between HT containing progesterone or progestins, and estradiol or conjugated equine estrogens.

Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

If you can wade through all the medical language, the conclusion is that women prefer the natural HRT because all studies show that they have a better quality of life, and are safer than the alternative. So why, oh why, are so many doctors still ignorant of these facts? Now you know why I get so mad over this, because I hate the fact that women are being sold short with hormones that have greater risks of harm.

Risk of breast cancer by type of menopausal hormone therapy: a case-control study among post-menopausal women in France.

This is further evidence that if women are to go on HRT, it must be the natural form, especially of progesterone. Any other form increases the risk of breast cancer. Livial (Tibolone) also increases the risk of breast cancer, yet I see so many women who see me already on Livial, as it is especially popular with Specialist Obstets and Gyne. The French have known this for a long time, which is why the natural progesterone is so popular there. I really don’t know why doctors are still so reluctant to embrace natural HRT in view of the large amount of evidence out there in favour of it.
PLoS One. 2013 Nov 1;8(11):e78016. doi: 10.1371/journal.pone.0078016. eCollection 2013.

Risk of breast cancer by type of menopausal hormone therapy: a case-control study among post-menopausal women in France.



There is extensive epidemiological evidence that menopausal hormone therapy (MHT) increases breast cancer risk, particularly combinations of estrogen and progestagen (EP). We investigated the effects of the specific formulations and types of therapies used by French women. Progestagen constituents, regimen (continuous or sequential treatment by the progestagen), and time interval between onset of menopause and start of MHT were examined.


We conducted a population-based case-control study in France in 1555 menopausal women (739 cases and 816 controls). Detailed information on MHT use was obtained during in-person interviews. Odds ratios and 95% confidence interval adjusted for breast cancer risk factors were calculated.


We found that breast cancer risk differed by type of progestagen among current users of EP therapies. No increased risk was apparent among EP therapy users treated with natural micronized progesterone. Among users of EP therapy containing a synthetic progestin, the odds ratio was 1.57 (0.99-2.49) for progesterone-derived and 3.35 (1.07-10.4) for testosterone-derived progestagen. Women with continuous regimen were at greater risk than women treated sequentially, but regimen and type of progestagen could not be investigated independently, as almost all EP combinations containing a testosterone-derivative were administered continuously and vice-versa. Tibolone was also associated with an increased risk of breast cancer. Early users of MHT after onset of menopause were at greater risk than users who delayed treatment.


This study confirms differential effects on breast cancer risk of progestagens and regimens specifically used in France. Formulation of EP therapies containing natural progesterone, frequently prescribed in France, was not associated with increased risk of breast cancer but may poorly protect against endometrial cancer.

Australia vying to be world champion of inactivity

22 September 2014, 6.42am AEST

Australia vying to be world champion of inactivity

If we could go back 100 years in a time machine, what would kids be like? They’d be shorter, leaner, probably dirtier and less well-fed — but would they be fitter? It turns out we actually have a beautiful…

Australia tops the world for physical activity-friendly built environments but ranks second last for levels of children’s activity. drpavlof/Flickr, CC BY-NC

If we could go back 100 years in a time machine, what would kids be like? They’d be shorter, leaner, probably dirtier and less well-fed — but would they be fitter?

It turns out we actually have a beautiful window on the past. In 1919, a young woman named E.M. Bedale started postgraduate research at University College London, an uncommon undertaking for a woman at that time. Her studies focused on energy balance in children, which led her to spend several years at a serendipitously eponymous school called Bedales in rural Hampshire.

During her two years at Bedales, Miss Bedale measured the energy expenditure and intake of the school’s students, using methods that are still considered to be gold standards today.

Her data provide a startling contrast to our time. Children from almost 100 years ago were 50% more active than kids today. They accumulated over four hours more of physical activity and sat for three hours less than today’s kids – every day.

Clearly, we’re now in the grip of an inactivity epidemic.

A shrinking world

Consider, the global decline in kids walking or cycling to school. In 1970, almost 70% of Australian kids walked or cycled to school. Today, this proportion is barely 25%. The trend is similar in the United Kingdom, Brazil, Switzerland, the United States and Canada.

In some ways, sports participation is going the same way. While overall yearly participation in sport is increasing, kids are playing fewer different kinds of sports. In 1985, 40% of Australian children played three or more sports every year. By 2000, only 11% of children reported playing this number of sports within the same period.

Free play — climbing trees in the backyard, mucking around in parks or bushland, informal ball games — is also declining.

In 1957, 12 to 14-year-old kids were asked to nominate their favourite play spaces. Four out of five boys and three out of five girls nominated outdoor spaces (parks, backyards, the local creek). When the survey was repeated in 2000, only 35% listed outdoor spaces.

In the 1960s, 83% of kids were allowed to play unsupervised in the neighbourhood. When those kids from the 1960s grew up and became parents, only 25% allowed their own children to play unsupervised in the neighbourhood.

Not just kids

Australia is not alone. There are other signs of a global collapse in physical activity too. Worldwide, children’s fitness has been declining at the rate of 3% to 5% per decade since 1970. And Australian kids are now in the bottom third of the world in fitness.

Australia finished second last in the Global Report Card on Kids’ Physical Activity released earlier this year, which showed data from 15 countries. (Thank goodness for the Scots, who finished last.)

We’re third worst in terms of screen time – television, computers and videogames. And it’s not just kids.

In the 1960s, half the jobs in private industry in the United States required at least moderate-intensity physical activity, compared to less than 20% today.

Work in factories and farms has given way to office work, and that has amounted to over 400 kilojoules less each day that adults expend at work. This difference alone results in a weight increase of about 13 kilograms over 50 years, which pretty closely matches actual changes in weight. The situation is similar here.

It’s not that we don’t have the opportunity or the facilities or the climate for physical activity. Global Report Card data show Australia tops the world for physical activity-friendly built environments, and is third on school facilities. It seems that we built it but they didn’t come.

Post-industrial malaise

The roots of inactivity go deep into the cultural and socioeconomic logic of post-industrial societies. In many ways, the whole ethos of ease now saturates our society, and efficiency is the hallmark of modernity.

Think about it this way – nobody is in the market for a labour-creating device. Sit-on mowers, leaf blowers, self-opening doors and automatic car windows, robot vacuum cleaners, sensor lighting, dishwashers and microwaves all yield daily microsavings in energy expenditure that add up to hundreds of kilojoules.

In 1900, the average American housewife spent an estimated 40 hours every week in food preparation. Today, that time is barely four hours — and it appears to have reached an absolute minimum.

What can be done about it? We’re not going to wind back time to the days of kids playing cricket in the street, families driving the Vauxhall Viva with wind-down windows, dads pushing hand mowers and mums using wringers.

The challenge is to fashion spaces where alternative forms of active leisure can be pursued. And we’ve already started: the gymnasium is such a space, internalising the lost world of manual labour. Exergaming (think Wii), which transposes outdoor play spaces into virtual worlds, is similar.

We all need to re-imagine physical activity if we’re to overcome this malaise of post-industrial society

Ginger effective for heavy periods

Phytother Res. 2014 Oct 8. doi: 10.1002/ptr.5235. [Epub ahead of print]

Effect of Ginger (Zingiber officinale) on Heavy Menstrual Bleeding: A Placebo-Controlled, Randomized Clinical Trial.


Objective: A wide range of herbal plants have been reported to treat various gynecological problems of women. This study was set out to investigate the effect of ginger (Zingiber officinale) on heavy menstrual bleeding (HMB) in high school girls. Methods: Ninety-two young women who experienced HMB and met the inclusion criteria were recruited in this study. Participants were evaluated for six consecutive menstrual cycles. During 3 assessment cycles, their HMB was confirmed by Pictorial Blood Assessment Chart. They were then randomly allocated to two study groups to receive either ginger or placebo capsules. The participants filled in the same chart during three intervention cycles. Results: The level of menstrual blood loss dramatically declined during the three intervention cycles in ginger-receiving group. The decrease of blood loss in ginger-receiving group was significantly more remarkable than that of participants receiving placebo (p < 0.001). Minimum number of participants reported adverse effects. Conclusion: HMB is highly prevalent among young women.

Considering the significance of appropriate and timely treatment and also the importance of prevention of unwanted consequences, ginger may be considered as an effective therapeutic option for HMB. Copyright © 2014 John Wiley & Sons, Ltd.

Copyright © 2014 John Wiley & Sons, Ltd.

The new trend that’s reviving sex lives everywhere.

All about Karezza: the new trend that’s reviving sex lives everywhere


An unconventional approach to sex known as karezza has been linked with improving health and restoring relationships, says Fiona Baker.

There’s an interesting new idea being discussed in sex therapy circles as a way to enhance relationships and revive sex lives. It involves having regular intercourse without it ending in orgasm.

The practice is called karezza and while the trend is new, its roots are in ancient times, borrowing from Taoist and Tantric principles, says Marnia Robinson, a karezza devotee and author of Cupid’s Poisoned Arrow (Random House), in which she writes about climax-free sex.
It should be noted that karezza is a sexual practice, not just kissing and cuddling.
“In simplest terms, karezza is affectionate, sensual intercourse without the goal of climax,” Robinson says.
“Intercourse is generally frequent, although not necessarily daily. But couples will typically also engage in daily ‘bonding behaviours’ – non-erotic skin-to-skin contact, gentle stroking and so forth.”

Why people do it
“Removing the goal of orgasm puts the focus on sex as a sensual experience and puts couples in the moment, so they are thinking about giving and receiving pleasure, not just aiming to get to the end,” body+soul sexologist Dr Gabrielle Morrissey says.
“Research shows that when it comes to sex, people value the connection with a partner more than the physical release. Karezza, and practices like it, can shift that focus to the connection instead of couples constantly chasing the orgasm.”
Robinson adds that karezza has been found to keep the romance alive between couples when the honeymoon period or new relationship high inevitably dissipates after a few years.
“Bonding behaviours and karezza are two ways to keep the romantic feelings flowing even without the racy hit of those extra new-love neurochemicals,” she says.
“Couples practising karezza tend to make love more frequently than they did with conventional sex, which is a very positive outcome in my view.”
Robinson also cites research which claims that orgasms don’t always make everyone feel good and can even lead to a kind of biochemical hangover.
“Researchers are discovering that a surprisingly large percentage of women report chronic tears and irritability
after sex,” she says.
She says this can happen even after satisfactory sex with a loving partner.
Robinson says orgasms bring the level of dopamine – the neurotransmitter that helps control the brain’s reward and pleasure centres – to an all-time high, only to crash later. She says this feeling can last for some time.

Could it be healthier?
In contrast, the responses she has received from couples who have tried karezza have reinforced her belief that this sexual practice enhances health and happiness.
“Women use words like ‘blissful’, ‘pure contentment’, ‘heart-burstingly loving’. They report that their relationships are more harmonious and playful. Some report less menstrual pain and feeling and looking younger,” she says.
“One man said, ‘I have fallen deeply in love with my wife really for the first time. We’re like teenagers… and are able to have intimacy and sex now that was simply unheard of before.’
“Other men have said things like ‘deeply satisfying’ and that they feel more virile. They report feeling more attracted to their partners and say they are having sex more frequently.”
Robinson says karezza can also help people overcome sexual dysfunction caused by addiction to adult videos.
Many sceptics may question the claim that it is “deeply satisfying”, as having sex without an orgasm may be like trekking to the top of a mountain but not bothering to see the sunrise. But Robinson says that with practice, karezza is totally satisfying.
“Karezza definitely takes a bit of getting used to at first,” she says. “Lovers must learn what they’re doing and why, take a slow enough approach to intercourse, and make love in gentle waves – that is, when things heat up, they allow their arousal to drop down repeatedly, so they end in a relaxed, trance-like state.”
It’s not forever Morrissey describes karezza as a “safe” way to change up your love life and says the practice is not that far removed from the homework exercises prescribed by sex therapists for couples seeking help.
“If adopting a new way of having sex helps bring back some excitement and opens up a positive dialogue between a couple about their sex life, that’s great,” she says. “But I don’t see it as something a couple needs to, or would probably want to, practise forever.”
While Robinson knows couples who practise karezza full time and have for years, she suggests that couples still have conventional sex every now and then, particularly when they are beginning with karezza.
She advises couples take a consistent approach over a three-week period, gradually adding intercourse to the mix. “It can be good to schedule lovemaking during your karezza experiment, so both lovers can look forward to the occasions.”
Robinson says no-one should go into this arrangement without fully understanding the reasons and the techniques.
“Get educated. It’s almost impossible to make any progress with karezza unless you have a clear understanding of why you both want to do it,” she says. “Karezza is a duet, not a solo.”

Dangerous Dietary Supplements Return to Store Shelves

Dangerous Dietary Supplements Return to Store Shelves


About 55,000 dietary supplements, largely unregulated, are sold in the United States.
About 55,000 dietary supplements, largely unregulated, are sold in the United States.Credit Chester Higgins Jr./The New York Times

The Food and Drug Administration frequently recalls dietary supplements that are found to contain banned substances. But a new study suggests that many of these products return to store shelves months later with the same dangerous ingredients.

The findings suggest that health authorities may be fighting an uphill battle against a small number of supplement companies that repeatedly sell contaminated products. The new study, published in JAMA, the Journal of the American Medical Association, found that out of more than two dozen supplements that were pulled from shelves after they were found to contain anabolic steroids or powerful prescription drugs, roughly two-thirds were back on the market a year later with the same illicit ingredients.

Most of the supplements were marketed for weight loss, exercise and sexual enhancement, and they were sold across the country at convenience stores, in health food shops and over the Internet. They were found to contain steroids and prescription drugs like Viagra and Prozac, an antidepressant.

The study also found that several of the weight-loss products contained Sibutramine, an amphetamine-like drug that was removed from the market in the United States, Asia and Europe after a clinical trial showed it increased the risk of heart attacks and strokes.

Since 2004, about half of all F.D.A. drug recalls have involved dietary supplements found to be contaminated with banned pharmaceutical ingredients. Supplement industry trade groups say that these products are usually manufactured and sold by a few bad actors who represent the fringe of the roughly $33 billion a year supplement industry.

Under a federal law enacted two decades ago — the Dietary Supplement Health and Education Act, or Dshea — dietary supplements can be sold and marketed with little regulatory oversight. Companies do not need F.D.A. approval to sell supplements to consumers, and they do not have to provide proof that their products contain the ingredients listed on their labels.

Unlike prescription drugs, dietary supplements are considered safe until proven otherwise, and generally they are pulled from shelves only after complaints of serious injury.

In recent years, research has shown that herbal supplements such as echinacea, Ginkgo biloba and St. John’s wort are frequently mislabeled or diluted with cheap fillers like powdered rice. Last year, a nationwide study by a network of liver specialists found that the number of liver-related injuries linked to bodybuilding and weight-loss supplements was on the rise.

Jennifer Dooren, a spokeswoman for the Food and Drug Administration, said that supplement companies “are legally responsible for marketing a safe product that is not adulterated.” But because companies do not need approval to sell their products, she said, the agency cannot identify tainted supplements before they reach consumers. And even supplements that are identified as contaminated can be difficult to pursue.

“The supply chain for these products is extremely fragmented,” she said. “One product manufactured by an unknown company overseas may be sold by dozens of different distributors in the United States. The individuals and businesses selling these products generally are difficult to locate, operate out of residential homes, and distribute via the Internet, small stores and mail.”

Between January 2009 and the end of 2012, the F.D.A. recalled at least 274 dietary supplements. Many of these products returned to the market a short time later. In the new study, Dr. Pieter A. Cohen, an assistant professor at Harvard Medical School, and his colleagues purchased 27 of these products on average about one year after they had been recalled.

Although many of the previously recalled products returned to the market with slight changes to their labels or brand names, Dr. Cohen and his colleagues limited their study only to those products that returned to shelves or websites with identical packaging.

“We excluded anything that wasn’t exactly the same as it was when the F.D.A. recalled it,” he said. “But a sizable percentage of these products that are recalled, about 25 or 30 percent, are still available.”

The study found that two-thirds of the 27 supplements analyzed contained at least one unlisted anabolic steroid, prescription drug or banned substance. A majority contained the same drug or illicit ingredient that led to them being recalled by the agency. And in some cases, the products contained not only the previously identified substance, but additional drugs as well.

Twenty of the supplements that were analyzed were manufactured in the United States. Out of this group, 13 contained banned ingredients, suggesting that the problem is not limited to unscrupulous companies overseas, Dr. Cohen said.

“This is the problem with supplements: They can be introduced without any vetting at all by the F.D.A.,” he said. “These products are recalled, and then the companies keep selling the pills without making one iota of change to the product. We’re talking about very blatant flouting of the F.D.A.’s requests.”

The authors of the study called for changes to the federal law to better protect consumers from such products.

“More aggressive enforcement of the law, changes to the law to increase the F.D.A.’s enforcement powers, or both will be required if sales of these products are to be prevented in the future,” they wrote in the medical journal.

In a statement, Steve Mister, the president and chief executive of the Council for Responsible Nutrition, an industry trade group, said that “responsible manufacturers and marketers of dietary supplements” applaud the agency’s recalls.

“We have zero tolerance for this problem and welcome not only recalls,” he said, “but also criminal enforcement against companies that put consumers at risk.”

But he said that the new research “grossly misrepresents” the extent of the problem and understates the success of the F.D.A. recalls “when the law is properly enforced.”

“We urge the F.D.A. to continue using its recall authority to eradicate adulterated products and, like the responsible industry, put consumer safety first,” he said.

Dr. Cohen, who has published a number of studies identifying dangerous or illicit ingredients in dietary supplements, said that consumers should be particularly wary of products containing a mixture of herbs or ingredients — what he called “herbal cocktails.” Many of these products may be unadulterated, he said, but consumers usually cannot be sure, and often these are the sort of products that are most likely to be spiked with dangerous ingredients.

“If you want to buy herbal supplements, buy individual ingredients,” he said. “Buy echinacea or black cohosh separately. But don’t buy a mixture and don’t buy a supplement that’s sold to cause weight loss or improve your workouts. These are exactly the types of supplements that these drugs have appeared in.”

Do ice cream and cold drinks cool us down?

5 January 2015, 6.12am AEDT

Health Check: do ice cream and cold drinks cool us down?

All over the world summer is synonymous with water activities, cold beverages and, of course, ice cream. While most of us agree ice cream and cold beverages are refreshing summer treats, do they actually…

An ice cream on a summer’s day may hit the spot, but it won’t help you beat the heat. Mark Crossfield/Flickr, CC BY-NC-SA

All over the world summer is synonymous with water activities, cold beverages and, of course, ice cream. While most of us agree ice cream and cold beverages are refreshing summer treats, do they actually help cool us down?

To test whether they do, we need to know a bit more about how the body controls temperature in different environments. The process of maintaining an optimal body temperature is called thermoregulation, which involves a delicate balance between producing and losing heat.

Humans are warm-blooded or endotherms, which are scientific ways of saying we can control our body temperature independent of the environment. We can do this because our bodies are constantly producing heat as a by-product of internal chemical processes (metabolism).

How it all works

Metabolism is necessary to keep our bodies functioning correctly. It includes digestive processes involved in breaking down nutrients in food, the absorption and transportation of those nutrients to the cells, and their conversion into building blocks or energy necessary for physical activity.

The heat this generates is beneficial when it’s cold, but when outside temperatures rise, we need to avoid overheating. While it may seem logical that introducing something cold, like ice cream, into the stomach should help reduce temperature, its initial cooling effect is rapidly replaced by heat generated by digestive processes needed to break down the nutrients in ice cream. Digesting calorie-rich food lead to an increase in body temperature.

So ice cream is not the best option for cooling down, but what about cold beverages? The heat transfer between a cold beverage and the digestive system can directly influence temperature. But, this is only momentary and depends on the quantity and caloric content of the ingested liquid.

A small amount of liquid will lose its cooling effect quite quickly as it get warmed up by the surrounding organs. And large amounts of cold liquids will cause blood flow to slow, making heat transport less effective.

As you can imagine, beverages with a high caloric content, such as soft drinks, will have a similar effect as ice cream and kick start our metabolism shortly after ingestion.

But I feel cooler…

The cooling effects of cold liquids are more likely explained by their rehydration effects. If heat does build up, the body will attempt to lose excess heat by transporting it away from the vital organs to the skin surface where it is transferred directly to our environment through convection and radiation.

The cooling effects of cold liquids are more likely explained by their rehydration effects. Josh Lowensohn/Flickr, CC BY-NC-ND
Click to enlarge

For this to occur, the ambient temperature needs to be lower than our own temperature, or the opposite happens and heat will transfer into our body. Just like the heat radiated from the sun on a hot summer day.

Sweating is the most effective way our bodies lose heat. Sweating occurs when an increase in core body temperature is detected by the brain, which responds by stimulating the sweat glands distributed all over the body to produce sweat.

Sweat on the skin surface evaporates, causing the skin to cool down (also called evaporative cooling). Blood that’s flowing close to the surface of the skin gets cooled in the process and helps reduce core temperature.

On average, an adult can lose up to half or one litre of sweat every day, but in hot environments this can increase to almost a litre and a half an hour. That’s why it’s essential to keep the body hydrated during hot weather.

A different approach

What about alcoholic beverages? Many people reach for a cold beer on a hot summer day in an attempt to cool down. But alcohol is a diuretic, which means that it will make your body lose water and so reduce your ability to lose heat through sweating.

Surprisingly, warm beverages might be a good way to keep you cool. Although counter intuitive, drinking a warm beverage causes receptors in your mouth and throat to trigger a sweat response, allowing your body to cool down without having to ingest a large amount of the warm liquid.

Active ingredients in spicy foods have the same effect; they too trigger a sweat response that allows the body to cool down. That’s why these types of foods are popular in warm climates.

So while cold treats can be satisfying and are certainly refreshing, a better way of cooling down is to spice things up, get your sweat on and, most importantly, rehydrate!