Monthly Archives: June 2015

How the bacteria in our gut affect our cravings for food

7 November 2014, 2.00pm AEDT

How the bacteria in our gut affect our cravings for food

We’ve long known that that the gut is responsible for digesting food and expelling the waste. More recently, we realised the gut has many more important functions and acts a type of mini-brain, affecting…

Gut bacteria can manufacture special proteins that are very similar to hunger-regulating hormones. Lighthunter/Shutterstock

We’ve long known that that the gut is responsible for digesting food and expelling the waste. More recently, we realised the gut has many more important functions and acts a type of mini-brain, affecting our mood and appetite. Now, new research suggests it might also play a role in our cravings for certain types of food.

How does the mini-brain work?

The gut mini-brain produces a wide range of hormones and contains many of the same neurotransmitters as the brain. The gut also contains neurons that are located in the walls of the gut in a distributed network known as the enteric nervous system. In fact, there are more of these neurons in the gut than in the entire spinal cord.

The enteric nervous system communicates to the brain via the brain-gut axis and signals flow in both directions. The brain-gut axis is thought to be involved in many regular functions and systems within the healthy body, including the regulation of eating.

Let’s consider what happens to the brain-gut axis when we eat a meal. When food arrives in the stomach, certain gut hormones are secreted. These activate signalling pathways from the gut to the brainstem and the hypothalamus to stop food consumption. Such hormones include the appetite-suppressing hormones peptide YY and cholecystokinin.

Gut hormones can bind and activate receptor targets in the brain directly but there is strong evidence that the vagus nerve plays a major role in brain-gut signalling. The vagus nerve acts as a major highway in the brain-gut axis, connecting the over 100 million neurons in the enteric nervous system to the medulla (located at the base of the brain).

Research has shown that vagus nerve blockade can lead to marked weight loss, while vagus nerve stimulation is known to trigger excessive eating in rats.

This brings us to the topic of food cravings. Scientists have largely debunked the myth that food cravings are our bodies’ way of letting us know that we need a specific type of nutrient. Instead, an emerging body of research suggests that our food cravings may actually be significantly shaped by the bacteria that we have inside our gut. In order to explore this further we will cover the role of gut microbes.

Gut microbiota

As many as 90% of our cells are bacterial. In fact, bacterial genes outnumber human genes by a factor of 100 to one.

The gut is an immensely complex microbial ecosystem with many different species of bacteria, some of which can live in an oxygen-free environment. An average person has approximately 1.5 kilograms of gut bacteria. The term “gut microbiota” is used to describe the bacterial collective.

We each have around 1.5kg of bacteria in our guts. Christopher Pooley, CC BY

Gut microbiota send signals to the brain via the brain-gut axis and can have dramatic effects on animal behaviour and health.

In one study, for example, mice that were genetically predisposed to obesity remained lean when they were raised in a sterile environment without gut microbiota. These germ-free mice were, however, transformed into obese mice when fed a faecal pellet that came from an obese mouse raised conventionally.

The role of gut microbiota in food cravings

There is growing evidence to support the role of gut microbiota in influencing why we crave certain foods.

We know that mice that are bred in germ-free environments prefer more sweets and have greater number of sweet taste receptors in their gut compared to normal mice. Research has also found that persons who are “chocolate desiring” have microbial breakdown products in their urine that are different from those of “chocolate indifferent individuals” despite eating identical diets.

Many gut bacteria can manufacture special proteins (called peptides) that are very similar to hormones such as peptide YY and ghrelin that regulate hunger. Humans and other animals have produced antibodies against these peptides. This raises the distinct possibility that microbes might be able to directly influence human eating behaviour through their peptides that mimic hunger-regulating hormones or indirectly through antibodies that can interfere with appetite regulation.

Practical implications

There are substantial challenges to overcome before we can apply this knowledge about gut microbiota in a practical sense.

First, there is the challenge of collecting the gut microbes. Traditionally this is collected from stools but gut microbiota is known to vary between different regions of the gut, such as the small intestine and colon. Obtaining bacterial tissue through endoscopy or another invasive collection technique in addition to stool samples may lead to more accurate representation of the gut microbiome.

Second, the type of sequencing that is currently used for gut microbiota screening is expensive and time-consuming. Advances will need to be made before this technology is in routine use.

Probably the greatest challenge in gut microbiota research is the establishment of a strong correlation between gut microbiota patterns and human disease. The science of gut microbiota is in its infancy and there needs to be much more research mapping out disease relationships.

Probiotics contain live microorganisms. Quanthem/Shutterstock

But there is reason to be hopeful. There is now strong interest in utilising both prebiotics and probiotics to alter our gut microbiome. Prebiotics are non-digestible carbohydrates that trigger the growth of beneficial gut bacteria, while probiotics are beneficial live microorganisms contained in foods and supplements.

Faecal transplantation is also now an accepted treatment for those patients that have a severe form of gut bacterial infection called Clostridium difficile, which has been unresponsive to antibiotics.

The use of such targeted strategies is likely to become increasingly common as we better understand how gut microbiota influence our bodily functions, including food cravings.

I have covered this topic in previous posts:

Nature, not nurture, holds key to gut bacteria

Why must some medications be taken with food?

8 January 2015, 2.22pm AEDT

Explainer: why must some medications be taken with food?

Have you ever been advised to take a medicine with food? How about taking a medicine with cola or avoiding grapefruit? Hundreds of medicines have food-related dosing instructions. With four out of five…

Food can prevent certain medicines being absorbed into the bloodstream. Bertalan Szürös/Flickr, CC BY-NC-ND

Have you ever been advised to take a medicine with food? How about taking a medicine with cola or avoiding grapefruit?

Hundreds of medicines have food-related dosing instructions. With four out of five Australians aged above 50 taking daily medication, most people will encounter instructions about medicines and food at some point in their lives – some of which may seem rather strange.

If a medicine isn’t taken as recommended with respect to food, the medicine may not have an effect. Worse, it could lead to side effects. The timing of the meal, the size of the meal, and the types of food and drinks consumed can all affect the body’s response to a medicine.

Absorption of medicines from the gut

Eating food triggers multiple physiological changes, including increased blood flow to the gut, the release of bile, and changes in the pH (acidity) and motility of the gut. These physiological changes can affect the amount of medicine absorbed from the gut into the bloodstream, which can then impact on the body’s response to a medicine.

Certain medicines are recommended to be given with food because the physiological changes after eating can increase the amount of medicine absorbed by the body. Itraconazole capsules (used to treat certain fungal infections), for instance, should be taken with food, and in some cases acidic drinks such as cola, because this product needs an acidic environment to be absorbed.

In other cases, changes in gut secretions and the digestive process can reduce the effectiveness of a medicine. Certain antibiotics, such as phenoxymethylpenicillin (also known as penicillin V), are best taken on an empty stomach as they can be less effective after prolonged exposure to acidic conditions.

Skip the breakfast grapefruit when taking certain medications. liz west/Flickr, CC BY
Click to enlarge

Food can act as a physical barrier to the surface of the gut wall and prevent certain medicines being absorbed into the bloodstream.

Specific components of food, such as calcium or iron, may also bind to certain medicines. This can reduce absorption into the bloodstream, and lead to reduced effectiveness. For this reason, osteoporosis medicines risedronate and alendronate must be taken on an empty stomach with water only.

Taking certain medicines with food can reduce the risk of side effects. Diabetes medicines such as gliclazide or glimepiride (belonging to the group of medicines known as sulfonylureas), for example, should be taken with food to reduce the risk of low blood sugar.

Taking medicines such as ibuprofen (for pain and inflammation) or metformin (for diabetes) with food is also recommended to reduce nausea and stomach upset.

Does size really matter?

The relationship between meal size and medicine effect has not been widely studied. If you need to take a medicine with food and it’s not mealtime, sometimes a snack is enough. But for some medicines, the size of the meal is important. Orlistat, for example, reduces the absorption of fats from food to assist weight loss, so it’s important to take this medicine with main meals for optimal effect.

Always follow the advice of your health professional. Taki Steve/Flickr, CC BY
Click to enlarge

Meal composition can also be important. Eating foods high in fibre, protein or fat can impact on the absorption of some medicines.

Drinks such as tea, coffee, milk and fruit juice can also affect the way certain medicines act in the body.

Dairy products should be avoided within two hours of taking antibiotics such as ciprofloxacin or norfloxacin, however they can be eaten at other times.

You may need to avoid grapefruit altogether as it can interfere with the metabolism (processing) of certain medicines in the body, leading to side effects.

Medicine labels demystified

Check medicine labels carefully for advice about food or drinks. Unless otherwise advised, tablets or capsules should be swallowed with water.

If the label states “take with or after food”, it means the medicine should be taken during the meal, or within half an hour of eating.

To take a medicine “on an empty stomach”, check you have not eaten in the past two hours, and wait at least half an hour after taking the medicine before eating again, unless the label states otherwise.

Finally, it’s important to take medicines at the same time each day and be consistent with respect to food and drinks.

If you have specific questions about taking medicines with food, ask your pharmacist for further advice, check the consumer medicines information (CMI) for each medicine, or call Medicines Line on 1300 633 424

Secret to health benefits of sunshine is more than vitamin D

A point I have made for a long time is that excessive avoidance of the sun, which is often pushed to the extreme, especially in Queensland, may be damaging to our health. Tis sun avoidance is sometimes taken to obsessive levels, where children are denied any sun at all. Surely this is harmful. This article makes some interesting points.
25 February 2015, 6.31am AEDT

Secret to health benefits of sunshine is more than vitamin D

Summer sunshine makes most of us feel better, but there may be more to the benefits than just feeling good.

Research suggests that sunlight may have benefits that we have not yet discovered. Joseph D’Mello/Flickr, CC BY-NC

Summer sunshine makes most of us feel better, but there may be more to the benefits than just feeling good. A growing body of evidence suggests sunlight itself – with adequate protection, of course – may actually be good for health.

Sunlight comprises two types of solar radiation: UVA, which causes reddening and burning of the skin, and UVB. The latter increases the production of an inactive form or precursor of vitamin D by the skin, which is then activated by the liver and kidneys.

Unfortunately, both UVA and UVB also increase the risk of skin cancer, including the most deadly type, melanoma, which is why you should always take a balanced approach to sunlight exposure.

Only a few foods, such as fatty fish and mushrooms, contain vitamin D, so we get most of it from sunlight. This means not enough sun exposure, or pigmentation of the skin (which diminishes the production of vitamin D precursors), often results in low vitamin D levels.

Vitamin D deficiency is associated with many signs of ill health and diseases. These include low bone density and broken bones due to osteoporosis, muscle weakness, diabetes, multiple sclerosis, cardiovascular disease, colon cancer and an overall increased risk of dying prematurely. But studies of supplementation with this vitamin have not always shown beneficial effects on treating these conditions.

This raises an important question about the actual source of vitamin D deficiency: could low vitamin D levels actually result from an unidentified underlying disease process (such as inflammation) leading to ill health? In other words, could low vitamin D levels be the symptom rather than the cause of illness?

An intriguing prospect

My colleagues and I previously found support for this theory when we discovered an association between low vitamin D levels and the development of type 2 diabetes. For every ten-unit decrease in blood vitamin D levels, we found a 10% increased risk of developing this form of diabetes over the following five years.

Everyone loves sunshine. Matt/Flickr, CC BY-NC-SA

But when we gave supplements of vitamin D to patients with low vitamin D levels who were already at risk of developing diabetes, there was no overall improvement in their sensitivity to insulin. Nor was there a change in their blood glucose levels compared with those given inactive tablets.

This disconnect between low vitamin D levels increasing the risk of disease, and the failure of consuming more vitamin D (by increased sun exposure or supplementation) to reduce risk, could mean sunshine has unknown effects on health. These could include the impact of sunlight on daily biological rhythms, such as the one governing our sleep cycle (circadian rhythms), on reducing physical stresses on the body’s cells and by increasing heat production.

Another important potential effect of sunlight is UV-induced suppression of the body’s immune system. Solar radiation does this by altering the activity of the white cells involved in turning on the body’s defence mechanisms.

At first glance, this may seem to be a bad thing because it could increase the risk of infections and skin cancer. But it can also have a protective role in reducing inflammation and therefore help against some inflammatory diseases.

Finding the balance

People who don’t get enough sunlight have altered cellular defence mechanisms that predispose them to excessive inflammation, which can result in autoimmune diseases.

It’s important to get the right balance between too much or not enough sunlight. Dmytro/Flickr, CC BY-NC

These diseases involve the body mistakenly attacking its own tissues, and include multiple sclerosis, lupus, type 1 diabetes and inflammatory bowel diseases, asthma and skin disorders such as psoriasis and atopic dermatitis. A little sunlight can reduce the numbers of the activated cells that lead to inflammation, and so the risk of getting these diseases.

UVA has also been shown to lower blood pressure, increase blood flow and heart rate, all of which are beneficial to the heart and blood vessels. This is probably the result of UVA causing the release of nitric oxide from skin stores, which promotes widening of blood vessels. It also acts as an antioxidant to prevent damage to cells.

Future research will try to determine whether increasing vitamin D by UVB, or other sunlight-induced mechanisms such as altering the body’s immune defence mechanisms, are better for improving health outcomes, but at least a little sunshine definitely appears to be a good thing for health.

Still, it’s important to get the right balance between too much or not enough sunlight. Guidelines try to minimise the risk of skin cancer while ensuring people can still harvest the health benefits of sunshine.

Basically, avoid sunlight when the UV index is three or higher. Take all protective measures if you have to be outside at these times. And seven minutes of sun exposure to the face, arms and hands at or before 11 am, or after 3 pm on most days in summer is adequate for getting enough sun for health benefits, especially when combined with exercise.

So, remember, get outside for a little bit of sunshine whenever you can do so safely.

The Top 10 Insights from the “Science of a Meaningful Life” in 2014

I have had many posts on the benefits of mindfulness, and here is another article which discusses it as well.

The Top 10 Insights from the “Science of a Meaningful Life” in 2014

By Jeremy Adam Smith, Bianca Lorenz, Kira M. Newman, Lauren Klein, Lisa Bennett , Jason Marsh, Jill Suttie | December 26, 2014 | 0 comments

The most surprising, provocative, and inspiring findings published this past year.

It’s time once again for our favorite year-end ritual here at UC Berkeley’s Greater Good Science Center: Our annual list of the top scientific insights produced by the study of happiness, altruism, mindfulness, gratitude—what we call “the science of a meaningful life.”

We found that this year, the science of a meaningful life yielded many new insights about the relationship between our inner and outer lives. Cultivating mindfulness can make us more aware of knee-jerk prejudice against people who are different from us; believing that empathy is a skill helps overcome barriers to taking another person’s perspective; concern for others, even for animals, can move people to action for the greater good more quickly than focusing on ourselves.

But this year we also learned more about how to cultivate pro-social skills like gratitude—and we discovered how those skills can yield far-reaching benefits to our mental and physical well-being, and even to our pocketbooks.

With input from our staff, faculty, and some of the leading outside experts in our field, here are the 10 findings from 2014 that we anticipate will have an impact on both scientific research and on public debate for years to come.

Mindfulness can reduce racial prejudice—and possibly its effects on victims.

Racial bias in policing is at the forefront of our national news. So it was heartening this year to see a study that found bias could be reduced through training in mindfulness—the nonjudgmental moment-to-moment awareness of one’s thoughts, emotions, and surroundings.

Adam Lueke and Brian Gibson of Central Michigan University looked at how instructing white college students in mindfulness would affect their “implicit bias”—or unconscious negative reactions—to black faces and faces of older people. After listening to a 10-minute mindfulness audiotape, students were significantly less likely to automatically pair negative descriptive words with black and elderly faces than were those in a control group—a finding that could be important for policing, which often involves split-second assessments of people.

Why the connection between mindfulness and bias? Mindfulness has the power to interrupt the link between past experience and impulsive responding, the authors speculate. This ability to be more discerning may explain why another study this year found that people who were high in mindfulness were less likely to sink into depression following experiences of discrimination.

As we reported back in 2009, numerous programs have successfully helped officers become aware of their own unconscious biases. But by specifically looking at the effects of mindfulness training—even just 10 minutes’ worth—these new studies point to innovative techniques that might help prevent fatal mistakes from being made in the future.

Gratitude makes us smarter in how we spend money.

For years, Greater Good has been reporting on the social, psychological, and physical benefits of gratitude. This year, research suggested that there might be profound economic benefits to a grateful mindset as well—which might pay emotional dividends down the line.

In one study, published in Psychological Science, researchers asked participants how much money they’d be willing to forgo in the present in order to receive a greater sum in the future—a measure of their self-control and financial patience. People prompted to feel grateful were willing to pass up significantly more cash than were people not feeling grateful, even if those less-grateful people were feeling other positive emotions. For instance, happy people were willing to sacrifice $100 in the future (one year later) in order to receive $18 in the present, but grateful people preferred to receive the larger, future payment; they only gave up that $100 when the amount offered to them right away reached $30.

The results suggest that gratitude reduces “excessive economic impatience” and strengthens self-control and the ability to delay gratification, according to the authors. This finding challenges the long-held notion that we must rein in our emotions in order to make smarter spending decisions; instead, it seems that consciously counting our blessings can serve our long-term economic interests.

Another study published this year, in Personality and Individual Differences, suggests that gratitude can guide us toward better decisions about what we actually choose to spend our money on. Participants who were more materialistic—meaning that they place a lot of importance on acquiring material possessions—reported lower feelings of gratitude and lower satisfaction with life. In fact, the researchers determined that materialists feel less satisfied with their lives mainly because they experience less gratitude. Their findings help to explain why, according to much previous research, materialistic people are less happy.

Prior research has also found that less happy people make more materialistic purchases, creating a vicious cycle. But the authors of this new study argue that gratitude can help break this cycle. Based on their results, they suggest that boosting one’s level of gratitude might reduce materialism and its negative effects on happiness.

So gratitude might not only encourage financial decisions that are better for our long-term economic health but better for our long-term emotional health as well.

It’s possible to teach gratitude to young children, with lasting effects.

One of parents’ biggest fears is that their child will become an entitled brat; one of their biggest questions is what they can do to prevent that.

This year research pointed to an answer. In a study published in School Psychology Review, psychologists Jeffrey Froh, Giacomo Bono, and their colleagues presented the encouraging results of a curriculum they developed to teach gratitude to elementary school students.

Instead of just lecturing about the importance of gratitude, the curriculum encourages kids to think about something nice that another person did for them, and to see that kindness as a “gift.” Through the curriculum, the students reflect on the value of the gift, the cost incurred by the person who gave it, and the kind intentions that motivated the gift.

The curriculum was taught to 8-11 year olds for half an hour every day for a week—and the kids started to show increases in gratitude just two days after the curriculum ended. When Froh and Bono offered the curriculum once a week or five weeks, they found that it increased gratitude and other positive emotions for at least five months.

Dozens of previous studies—many of which we have covered on Greater Good—have suggested that gratitude can combat feelings of entitlement and foster happiness. But only a small handful of these studies have examined the effects of gratitude on children, and the kids in Froh and Bono’s study were the youngest ever involved in a study of a gratitude program.

Their results offer hope that it’s actually possible to nurture lasting gratitude—and happiness—in children from the time they’re young. And their curriculum provides parents and teachers with concrete guidelines for achieving that goal.

Having more variety in our emotions—positive or negative—can make us happier and healthier.

Is the route to happiness simply to feel more positive emotion and less negative emotion? Our top insights from 2013 cast some doubt on that view, and an even stronger rebuttal emerged this year in a paper published in the Journal of Experimental Psychology: General.

Researchers from four different countries and six different institutions—including Yale University and Harvard Business School—measured participants’ positive emotions (like amusement, awe, and gratitude) and negative ones (like anger, anxiety, and sadness). They not only looked at the level of these emotions but also their variety and abundance—what the researchers call “emodiversity.”

Their first study surveyed over 35,000 French speakers and found that emodiversity is related to less depression. This was the case for all types of emodiversity: positive (experiencing many different positive emotions), negative (many different negative emotions), and general (a mix of both positive and negative emotions). In fact, people high in emodiversity were less likely to be depressed than people high in positive emotion alone.

With almost 1,300 Belgian participants, the second study linked emodiversity to less medication use, lower government health care costs, and fewer doctor visits and days spent in the hospital. It was also related to better diet, exercise, and smoking habits. Surprisingly, the effect of emodiversity on physical health was about as strong as the effects of positive or negative emotion alone.

The message? Emotional monotony is a drag, so we may be better off mentally and physically if we seek out and embrace a variety of emotional experiences—even the negative ones.

Natural selection favors happy people, which is why there are so many of them.

If you subscribe to the philosopher Thomas Hobbes’ view of life as “nasty, brutish, and short”—as many people do—you’d naturally expect humans to live a pretty miserable existence. But many studies from around the world have suggested that, on average, humans’ default emotional state is to be pretty happy, regardless of their life circumstances—a phenomenon researchers call “positive mood offset.”

This year, a massive review of the research on happiness set out to explore “Why People Are in a Generally Good Mood”; the study, published in Personality and Social Psychology Review, was led by Ed Diener, a pioneer in the science of happiness.

Given the benefits they find to be strongly associated with happiness, the researchers conclude that the ubiquity of happiness is a product of human evolution. Why? Because many of the chief benefits of happiness—including better health, longer lives, greater fertility, higher income, and more sociability—increase a person’s chances of passing his or her genes to the next generation.

“People are happy most of the time because they are descended from ancestors who were happier and engaged in fitness-maximizing behavior more frequently than their neighbors who were less happy,” they write.

In other words, natural selection favors happy people, leaving us with more of them today.

Of course, though based on an especially comprehensive review of happiness research, Diener and his colleagues stress that this is just a hypothesis—albeit one worth subjecting to future study. “Although our opposable thumbs, big brains, and upright posture have all received in-depth attention and study as reasons for human [evolutionary] success,” they write, “it is time to consider how positive mood offset might have also contributed.”

Activities from positive psychology don’t just make happy people happier—they can also help alleviate suffering.

This idea that happiness might arise from natural selection suggests that, perhaps, you’re either born happy or you’re not. But research on positive psychology activities—like keeping a gratitude journal or regular meditation—has offered compelling evidence that it’s possible to cultivate happiness over time. What’s more, during the past year, we saw many different papers suggest that positive activities aren’t just for positive people, and that negative conditions aren’t just alleviated by targeting negative influences. Instead, nurturing positive skills can help pull people out of depression, anxiety, and even suicidal thoughts.

The key, it seems, lies in the way these skills enhance relationships. One study found that 11 people who had gone through an eight-week Mindfulness-Based Cognitive Therapy course became less stressed about relationships with friends, family, and coworkers—which, in turn, helped prevent future episodes of depression.

A different study in the July issue of the Journal of Affective Disorders looked at the impact of another positive behavior, forgiveness, on reducing suicidal thoughts in impoverished, rural people. The researchers found that participants’ ability to forgive themselves and others seemed closely associated with the will to keep on living. They also found that forgiveness seemed to reduce participants’ feelings of being a burden to others, and people who were able to forgive themselves for being a burden to others were much less suicidal. Yet another study found that keeping a journal about gratitude or kindness helped people who were on waiting lists to receive psychological counseling.

The upshot of this research is that there are likely far-reaching applications of the skills targeted by positive psychology. As researchers move forward in understanding how we can foster human strengths and use them to save lives, clinicians and teachers can put these insights to use in real-world settings.

People with a “growth mindset” are more likely to overcome barriers to empathy.

Just as many people believe that you’re either happy or you’re not, so many believe that you’re either empathic or you’re not. The trouble with this “fixed mindset” about empathy is that the ability to sense the feelings or take the perspective of others is very sensitive to situational forces, such as when we are stressed or overwhelmed by other people’s needs. Some research is even showing that stressed-out, hyper-connected Americans are becoming less and less empathic.

According to a recent paper published in the Journal of Social Psychology, our beliefs about empathy are critical to fostering it. Stanford University researchers recruited 75 participants, asking them to pick one of these two statements as being true: “In general, people cannot change how empathic a person they are” or “In general, people can change how empathic a person they are.” Across five studies, they tested their hypothesis in situations where empathy is both challenging and “crucial to positive social outcomes,” such as pitting the participant against someone with different political views.

In the final study, researchers told half of the participants that they had failed a diagnostic test of emotional understanding and that the other half succeeded. Then they gave participants a chance to go through exercises that might improve their empathy—theorizing that “participants induced to have a malleable, as opposed to fixed, theory of empathy would be more likely to capitalize on this opportunity to develop their empathic abilities.”

This turned out to be true. People primed to see empathy as a skill—in other words, people given a “growth mindset” about empathy, seeing it as something one can build through practice—were more likely to “stretch themselves to overcome their limitations.” Across all of their studies, they found that people who believe empathy can be developed expended greater effort in challenging contexts than did people who believe empathy cannot be developed, suggesting that our beliefs about ourselves are key to expanding empathy on both individual and societal levels.

This insight echoes a trend we highlighted in last year’s list of top scientific insights: Anyone can cultivate empathic skills—even psychopaths. And in fact, another study this year from the United Kingdom extended those findings to narcissists, finding that even they could be coached into taking another person’s perspective.

To get people to take action against climate change, talk to them about birds.

Imagine what might happen in the future if climate change goes unchecked. Are you more likely to take action to prevent that outcome if you feel like it is a threat to humans? Or are you more likely to reduce your carbon footprint if you fear for the safety of other animals, like birds? Well, according to a group of scientists at Cornell University, birds may be the answer.

The researchers surveyed 3,546 people (largely bird watchers) to evaluate how their willingness to engage in climate-friendly actions might be affected by how the problem of climate change is described to them. Specifically, respondents were presented with these four statements and, after each, asked about their willingness to lessen their carbon footprint:

  1. Climate change is a danger to people.
  2. Climate change is a danger to birds.
  3. If a large number of Americans do something small to reduce their use of fossil fuels, it would have a large impact on our national carbon footprint.
  4. If a large number of Americans do something small to reduce their use of fossil fuels, it would have a large impact on our national carbon footprint—and be of benefit to future generations.

As expected, the findings revealed that the positive framing of the climate problem (numbers 3 and 4) increased people’s willingness to take action. Numerous earlier studies have shown that positive messages—such as those that emphasize the collective impact of carbon-cutting measures—are generally more effective than fear-based messages. But responses to the two fear-based messages (numbers 1 and 2) revealed a surprise: Invoking a threat to humans led to no significant impact on the respondents’ willingness to reduce their carbon footprint—while invoking a threat to birds led to the most significant change of all.

Why would a threat to birds provoke more willingness to act than a threat to humans? One theory suggests that threats to humans cause us to think about death, which activates defenses against the anxiety caused by confronting our own mortality. Researcher Janis Dickson says the findings do point to a potentially important lesson for educators and communicators: Combining a sense of empowerment (by reminding people of our collective impact) with compassion (for non-human others) can help cultivate the psychological resilience needed to overcome denial and inaction.

Feelings of well-being might spur extraordinary acts of altruism.

What would motivate someone to donate a kidney to someone they have never met?

A study published in the journal Psychological Science looked at this act of extreme altruism in all 50 states, cross-referencing donations with data on each state’s levels of “well-being,” which refers to people’s levels of life satisfaction, emotional health, physical health, healthy behavior (e.g., exercise, good diet), job satisfaction, and ability to meet their basic needs like food and safety. By analyzing statewide data, the Georgetown University researchers hoped to find large-scale trends that might not be apparent from looking at individual cases.

Their efforts paid off. Results showed that states with high levels of well-being tended to have higher rates of “altruistic” kidney donation—kidney donation to a stranger. Indeed, the researchers found that even when controlling for key factors such as education, race, age, income, and religiosity, a state’s level of well-being still significantly predicted donation rates. Furthermore, analyses combining states into larger geographical regions confirmed that as well-being increases, so do rates of kidney donation to strangers. And because altruistic kidney donation happens relatively rarely, the researchers were able to rule out the possibility that these altruistic acts caused widespread increases in happiness rather than the other way around.

So while prior research has suggested that performing altruistic acts fosters feelings of happiness, this important study adds a new twist: Feelings of happiness might actually spur extraordinary acts of altruism. This insight has real-world implications. As the researchers write, “Policies that promote well-being may help to generate a virtuous circle, whereby increases in well-being promote altruism that, in turn, increases well-being. Such a cycle holds the promise of creating a ‘sustainable happiness’ with broad benefits for altruists, their beneficiaries, and society at large.”

Extreme altruism is motivated by intuition—our compassionate instincts.

While the previous insight relied upon big-picture aggregate data to understand how social context influences altruistic acts, this year the same Georgetown University team that conducted that study went deeper into the individual human mind to understand the psychology of altruism. Past research has identified patterns of brain activity related to extreme anti-social behavior, but this new study tried to locate the neural mechanisms that might support extreme pro-social tendencies.

Researchers Kristin M. Brethel-Haurwitz and Abigail A. Marsh used brain imaging technology to map the brains of kidney donors, who make an extraordinary sacrifice for total strangers; they then compared these brain images with those of psychopaths and people who did not show extremes on either side of the pro-social divide. They found that the brains of extraordinary altruists had slightly larger right amygdalae—a brain area associated with a fearful response—and they reacted very strongly to fearful facial expressions—the exact opposite of psychopaths.

How might these different brain structures show up in behavior? Another research team, this one at Yale University, examined the testimony of Carnegie Hero Medal Recipients, who all risked their lives to save others. The researchers found that recipients’ decisions to help were “overwhelmingly dominated by intuition” and “significantly more intuitive than a set of control statements describing deliberative decision-making.” This remained true even when researchers took into account that the medal winners had enough time to think before they acted, suggesting that the gut-level decision overrode any deliberative process.

Taken together, these findings from Yale and Georgetown reveal how extreme, heroic acts of altruism might be motivated by deeply-rooted, even instinctive, psychological processes.

To what degree are these different brain structures—and the instincts that spring from them—shaped by nature or nurture? That’s a question that research will need to tackle in 2015

About The Author

Lauren Klein is a Greater Good editorial assistant. Bianca Lorenz is a Greater Good editorial assistant and a course assistant for the GGSC’s online course, “The Science of Happiness.” Jason Marsh is the editor in chief and director of programs of the Greater Good Science Center. Kira M. Newman is a course assistant for “The Science of Happiness” and a digital journalist. Jill Suttie is Greater Good’s book review editor and a frequent contributor to the magazine. Jeremy Adam Smith is producer and editor of the Greater Good Science Center‘s website.

Vaginal estrogen for genitourinary syndrome of menopause

Vaginal problems are common in menopause, and that includes bladder and urinary symptoms. The fact is that both the bladder and vagina thrive under the influence of oestrogen, and so oestrogen is essential for both vagina and bladder health. Unfortunately, too many women suffer in silence over menopausal vaginal problems and do not discuss it with their doctors.

Vaginal estrogen for genitourinary syndrome of menopause: A systematic review

Obstetrics and Gynecology, 12/05/2014  Evidence Based Medicine  Review Article

Rahn DD, et al. – In this study, authors want to comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines. All commercially available vaginal estrogens effectively relieve common vulvovaginal atrophy–related complaints and have additional utility in patients with urinary urgency, frequency or nocturia, SUI and UUI, and recurrent UTIs. Nonhormonal moisturizers are a beneficial alternative for those with few or minor atrophy–related symptoms and in patients at risk for estrogen–related neoplasia.

Methods

  • MEDLINE and Cochrane databases were searched from inception to April 2013.
  • Authors included randomized controlled trials and prospective comparative studies.
  • Interventions and comparators included all commercially available vaginal estrogen products.
  • Placebo, no treatment, systemic estrogen (all routes), and nonhormonal moisturizers and lubricants were included as comparators.
  • Authors double–screened 1,805 s, identifying 44 eligible studies.
  • Discrepancies were adjudicated by a third reviewer.
  • Studies were individually and collectively assessed for methodologic quality and strength of evidence.

Results

  • Studies were extracted for participant, intervention, comparator, and outcomes data, including patient–reported atrophy symptoms (eg, vaginal dryness, dyspareunia, dysuria, urgency, frequency, recurrent urinary tract infection (UTI), and urinary incontinence), objective signs of atrophy, urodynamic measures, endometrial effects, serum estradiol changes, and adverse events.
  • Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI).
  • Urinary tract infection rates decreased.
  • The various estrogen preparations had similar efficacy and safety; serum estradiol levels remained within postmenopausal norms for all except high–dose conjugated equine estrogen cream.
  • Endometrial hyperplasia and adenocarcinoma were extremely rare among those receiving vaginal estrogen.
  • Comparing vaginal estrogen with nonhormonal moisturizers, patients with two or more symptoms of vulvovaginal atrophy were substantially more improved using vaginal estrogens, but those with one or minor complaints had similar symptom resolution with either estrogen or nonhormonal moisturizer.

Milking the market: are you pouring additives on your cereal?

15 January 2015, 6.31am AEDT

Milking the market: are you pouring additives on your cereal?

There’s a milk revolution going on in supermarkets and it’s showing no sign of retreat. Where formerly we might have had a simple choice between cow milk and soy milk, with a few other niche products available…

Some alternative ‘milk’ products are startlingly low on nutrition and many are packed with additives despite their ‘natural’ tag. Iryna Yeroshko/Flickr, CC BY-SA

There’s a milk revolution going on in supermarkets and it’s showing no sign of retreat. Where formerly we might have had a simple choice between cow milk and soy milk, with a few other niche products available in the bigger supermarkets, suddenly we’re facing a bewildering range: almond or macadamia milk? Cow, sheep, or goat? Coconut? Rice, oat or quinoa?

But why?

First, let’s take a moment to reflect on the possible reasons for this phenomenon. The current interest in the Palaeolithic diet may certainly have something to do with it. Adherents seek alternatives to dairy and soy foods under the misconception that humans had entirely completed their evolutionary process before any use of these foods. They argue that this somehow means we are not “meant” to consume them.

People with lactose intolerance have long avoided animal milks, which all contain lactose as their natural (but sometimes poorly absorbed) sugar. Environmental concerns are another possible reason people want to reduce their consumption of animal milks.

Distrust of soy foods has also grown in recent years because of concerns about their hormonal effects, although there’s little evidence to support the idea they’re harmful. Nonetheless, people are looking further afield to find a suitable swap for cow’s milk if they have a dairy protein allergy or if they’re avoiding casein to help manage neurological conditions such as autism or dementia (as part of a diet that has been popular but controversial).

Distrust of soy foods has grown in recent years because of concerns about their hormonal effects. mc559/Flickr, CC BY-NC-ND

Soy allergy is another reason people search for milk alternatives. The ranks of these searchers are boosted by the fact that plant-based and raw diets are on the increase.

Not so good

Unfortunately, unless they’re reading the packaging carefully, many consumers are probably being misled by the labelling of these alternative products as milk. What’s more, some are startlingly low on nutrition and, ironically, many are packed with additives despite their “natural” tag.

Indeed, compared to animal milks, which usually contain only milk, a typical ingredients list for one of these alternative products might contain between ten and 18 different added substances. These include oils, thickening agents (starches, carrageenan, or vegetable gums), flavourings and syrup sweeteners, emulsifiers and added vitamins and minerals. And their main ingredient is water.

The large amount of added water means that many of these products are quite dilute. Other than soy milk, none of the others have even a tenth of the protein in animal milks.

If you adjust for the amount of added water by looking at their nutrition relative to calorie content (instead of just per 100 millilitres as most labels show), then some of the nut products look a bit better. They’re still very high in fat.

And really, you’re mainly paying for some very expensive water. Then, there’s added salt, which surprisingly seems to be a supplement to every nut milk product on the market.

Nut milks are a mixture of ground nuts and water, usually with a sweetener and salt. Vrangtante Brun/Flickr, CC BY-NC

Calcium content is not comparable either, unless it has been added. Unfortunately, the form of calcium commonly used is not easily absorbed by the human body compared to what’s present in animal milks.

The low-down

Nut milks are a mixture of ground nuts and water, usually with a sweetener and salt. They provide the beneficial fats that are found in nuts, as well as protein and calcium in very small amounts.

Cereal milks, such as oat, rice or quinoa, are a starchy mixture of grain flours or brans – or both. They usually have added oil and, again, salt. Generally, these cereal milks provide little protein but the added oil usually has beneficial mono-unsaturated and polyunsaturated fatty acids.

Coconut milk sold as a beverage usually has added water and salt. It is also very low in protein. Coconut oil is mostly saturated fat. While many advocates will argue for the specific benefits of the medium-chain triglycerides present in this fat, these form only part of the fat content of coconut. And it still doesn’t stack up as a healthier fat than the mono- and poly-unsaturated fats.

Unsustainable?

The environmental implications of Palaeolithic-style eating are rarely mentioned. Eating like a cave-dweller sounds so natural, how could it be bad for the environment, right? But the world’s population is more than 6,000 times the size it was in the Palaeolithic era, so sustainability is now a much bigger issue!

Coconut milk sold as a beverage usually has added water and salt. Tom Woodward/Flickr, CC BY-NC

There would be huge environmental implications if six billion people tried to follow a diet high in meat, but the type of milk we choose may be very important too. The amount of water used to grow almonds is very large, for instance, and coconut milk will be high in food miles for most of us. So there isn’t a clear front-runner amongst these milks in the environmental stakes.

Given the strict rules about what products can be called juice, it’s curious that manufacturers are allowed to call these products milk at all, since they really aren’t. Other than in the sense of being a white liquid you can put on cereal and in tea, and use in cooking, that is.

If that’s all you’re looking for, then it’s up to you to choose which one you like most – but do read the label to see what else you’re getting!

Caffeinated coffee lowers risk of breast cancer.

Good news for those coffee lovers.

Breast Cancer Res. 2015 Jan 31;17(1):15. [Epub ahead of print]

Coffee and tea consumption and risk of pre- and postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study.

Abstract

Introduction:

Specific coffee subtypes and tea may impact risk of pre- and post-menopausal breast cancer differently. We investigated the association between coffee (total, caffeinated, decaffeinated) and tea intake and risk of breast cancer.MethodsA total of 335,060 women participating in the European Prospective Investigation into Nutrition and Cancer (EPIC) Study, completed a dietary questionnaire from 1992 to 2000, and were followed-up until 2010 for incidence of breast cancer. Hazard ratios (HR) of breast cancer by country-specific, as well as cohort-wide categories of beverage intake were estimated.ResultsDuring an average follow-up of 11 years, 1064 premenopausal, and 9134 postmenopausal breast cancers were diagnosed. Caffeinated coffee intake was associated with lower risk of postmenopausal breast cancer: adjusted HR¿=¿0.90, 95% confidence interval (CI): 0.82 to 0.98, for high versus low consumption; P trend¿=¿0.029. While there was no significant effect modification by hormone receptor status (P¿=¿0.711), linear trend for lower risk of breast cancer with increasing caffeinated coffee intake was clearest for estrogen and progesterone receptor negative (ER-PR-), postmenopausal breast cancer (P¿=¿0.008). For every 100 ml increase in caffeinated coffee intake, the risk of ER-PR- breast cancer was lower by 4% (adjusted HR: 0.96, 95% CI: 0.93 to 1.00). Non-consumers of decaffeinated coffee had lower risk of postmenopausal breast cancer (adjusted HR¿=¿0.89; 95% CI: 0.80 to 0.99) compared to low consumers, without evidence of dose¿response relationship (P trend¿=¿0.128). Exclusive decaffeinated coffee consumption was not related to postmenopausal breast cancer risk, compared to any decaffeinated-low caffeinated intake (adjusted HR¿=¿0.97; 95% CI: 0.82 to 1.14), or to no intake of any coffee (HR: 0.96; 95%: 0.82 to 1.14). Caffeinated and decaffeinated coffee were not associated with premenopausal breast cancer. Tea intake was neither associated with pre- nor post-menopausal breast cancer.

Conclusions: Higher caffeinated coffee intake may be associated with lower risk of postmenopausal breast cancer. Decaffeinated coffee intake does not seem to be associated with breast cancer.

PMID:
25637171
[PubMed – as supplied by publisher]

6 Factors for Preventing Heart Disease in Women

6 Factors for Preventing Heart Disease in Women

Establishing healthy lifestyle habits early is key.

January 20, 2015

Among young women, primordial prevention of coronary heart disease (CHD) through healthy lifestyle factors can substantially reduce the burden of cardiovascular disease (CVD), according to a prospective analysis of 88,940 women ages 27 to 44 years enrolled in the Nurses Health Study.

During 20 years of follow-up, 456 CHD cases were documented. Researchers attribute 73% of CHD cases and 46% of clinical CVD cases to poor adherence to a healthy lifestyle. The 6 healthy lifestyle factors studied include:

• not smoking

• having a normal body mass index

• physical activity of at least 2.5 hours a week

• watching less than 7 hours of television a week

• following a diet in the top 40% of the Alternative Healthy Eating Index-2010

• drinking 0.1 to 14.9 grams of alcohol per day

Compared to subjects with no healthy lifestyle factors, those with all 6 factors had the lowest risk of CHD (hazard ratio, 0.08).

Citation: Chomistek AK, Chiuve SE, Eliassen AH, Mukamal KJ, Willett WC, Rimm EB. Healthy lifestyle in the primordial prevention of cardiovascular disease among young women. J Am Coll Cardiol. 2015;65(1):43-51. doi: 10.1016/j.jacc.2014.10.024.

Commentary: The decrease in risk of over 90% in CHD by practicing a health lifestyle is remarkable. This study is similar in outcome to a previous study of more than 20,000 men that showed that following a healthy lifestyle could prevent 4 out of 5 myocardial infarctions (MI).1 Similarly, another study showed that following five healthy lifestyle behaviors decreased women’s risk of stroke by over 50%.2 The data on the benefits of health lifestyle are abundant and there is no question that primary prevention, that is the development of healthy lifestyle habits including diet and exercise  is essential if we are going to improve health and decrease the burden of disease. —Neil Skolnik, MD

1. Akesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: a population-based prospective cohort study. J Am Coll Cardiol. 2014;64(13):1299-1306. doi: 10.1016/j.jacc.2014.06.1190.

2. Larsson SC, Akesson A, Wolk A. Healthy diet and lifestyle and risk of stroke in a prospective cohort of women. Neurology. 2014;83:1-6. doi: 10.1212/WNL.0000000000000954

Are mammograms a scam?

I am not taking a position on this topic, although my views are well known to many of you. I offer this purely so that women are informed that there is another side to the decision whether to have a mammogram or not. I believe that transparency and an informed debate is essential, especially over such a sensitive topic as breast cancer. Professor Gotzsche is no crackpot, so needs to be taken seriously. This talk was some years ago, but not much has changed since then.

Are mammograms a scam?

6 March, 2015 12 comments

Are mammograms a scam?

LProfessor Peter Gotzsche says women are being deliberately misled about the value of mammography screening.

Critics rubbish him. But is he that rare breed — an evidence-based conspiracy theorist?

In a stout brick community centre in a back street on Sydney’s north shore, Professor Peter Gotzsche is asking an audience why women have not taken to the barricades to express outrage at a major health scandal still largely unknown to the wider world.

“Women have been patronised and treated like children who cannot make their own decision,” he declares.

“They have been coerced into this, based on misleading information that has overstated the benefits and understated the harms, or omitted them altogether.”

The audience of about 80 men and women stares up at him enthralled as he goes on to condemn breast cancer screening programs — which, after 20 years, are generally seen as one of public health’s significant success stories.

Related News: Big Pharma hit back at touring ‘agitator’

You could dismiss Professor Gotzsche as just another conspiracy theorist — like the anti-vaxers or the fluoride obsessives — preaching to a gullible public their messages of mass harm at the hands of a health industry riddled with ugly self-interest.

But Professor Gotzsche is different. He’s a physician and co-founder of the Cochrane Collaboration, whose utterances are based solely on evidence that exists to back them up. Professor Gotzsche says he has come armed with facts, as well as words.

Working the numbers
Of course, that there is controversy over the overall risk vs benefit of breast cancer screening is not in dispute. Researchers crunch the numbers from the same clinical trials but have the ability to generate wildly different interpretations.

While they tend to agree that screening leads to harm from overdiagnosis, the divergence centres on how often this occurs.

A 2012 landmark UK review estimates somewhere between 11% and 19% of women who undertake mammographic screening are overdiagnosed.1

Professor Gotzsche, who said breast screening programs were unjustified back in 2001, tells you it’s 50%.

The director of the Copenhagen-based Nordic Cochrane Centre hit Australian shores last month to deliver a series of lectures on the topics of mammography screening, Big Pharma and the (allegedly) criminal way they have peddled useless but harmful psychiatric drugs.

The mammography talk is being held on a Friday night in the Sydney suburb of Chatswood.

The sky threatens rain.

The female MC — from the local Cancer Information and Support Society — introduces the Danish professor as “one of the bravest people I have heard of”.

“It takes a huge amount of bravery to be able to defend a profession that has been spawned by unethical companies, and medicine has certainly been taken over well and truly,” she says.

“I think we have a hero with us tonight.”

Professor Gotzsche, seemingly unfazed by this glowing reception, proceeds directly to a 30-minute PowerPoint presentation to canvas the scientific literature that supports his case.

As he clicks through a series of slides and graphs, Professor Gotzsche doesn’t mince words.

“You don’t live longer if you attend breast screening. That is my main message for tonight.”

His evidence includes his own 2013 Cochrane review of seven randomised clinical trials involving 600,000 women examining the effect of mammography screening on mortality and morbidity.2

The review concludes that while screening may reduce breast cancer mortality by 15%, it also leads to a 30% rate of overdiagnosis and overtreatment. It seems in the past two years, he has revised this overdiagnosis figure to 50%.

“A few years ago, I’d just had enough because very many scientists published deliberately dishonest science in order to tell the world there is virtually no overdiagnosis and screening has a huge effect,” he tells the audience.

“So I just needed to write the book [Mammography Screening: Truth, Lies and Controversy] pointing out how they torture the data until they confess.”

He goes on to tell the audience how screening kills at least as many women through overdiagnosis and subsequent overtreatment of harmless cancers as it saves.

“You could say it causes cancer, but don’t get me wrong. It is not the little radiation you get on a mammogram. It is because you find a lot [of cancer] you shouldn’t have found.”

This identification of indolent cancers leads to unnecessary radiotherapy that can cause potentially fatal complications such as lung cancer and heart disease, he tells them.

Screening also causes other harms, such as psychological distress, with false-positive results that occur after 10 mammograms for between 20% and 60% of women, he says.

He further claims that while the rationale for screening is to catch cancers early before they spread, evidence from Australia, Italy, Norway, Switzerland, the Netherlands, the UK and the US shows screening does not reduce the rate of advanced cancers.

In Norway, the risk of stage 3 and 4 cancer was exactly the same in the screened and non-screened populations.

Put simply, screening “can’t work”.

“The best prevention of breast cancer we have is telling women to stay at home and not go to screening,” he tells the audience.

These are the blunt conclusions based on his assessment of the evidence. However, it is his willingness to speak of malign intent behind the promotion of breast screening that takes him beyond the sober, much-qualified conclusions of the average Cochrane review.

Cancer societies and health agencies deliberately mislead women by highlighting the benefits of screening and downplaying the risks, he says.

“This is a public health scandal in my opinion.”

Talking of women who have been “patronised and treated like children”, of those women who have been “coerced” into screening based on misleading information, it is at this point he asks: “Why haven’t I seen women on the barricades?”

Competing voices
Professor Gotzsche is not the only medical researcher or world-renowned doctor who has called for national mammography programs to end.

Leading UK breast surgeon Professor Michael Baum — who established the first breast screening centre in south-east England in 1987 — resigned a decade later from the country’s national screening committee over the issue of informed consent. He later called for the UK’s screening program to be scrapped, arguing it was not effective in saving lives.

By 2012, in an editorial in the British Journal of Hospital Medicine, he conceded it was “politically unacceptable” and called instead for a risk-adjusted approach.3

Professor Alexandra Barratt, an Australian expert from the University of Sydney’s School of Public Health, says with so much controversy surrounding the topic, it is also vital the country has a robust debate and that women are given enough information about the risks and benefits to make up their own minds.

“Trying to work out what is the best evidence is difficult [partly because] those randomised trials are so old now,” she says.

“We have much better detection and treatment so mortality is going down. Trying to work out how much drop is due to screening, awareness and improved treatment is actually very difficult.”

But that debate is just not happening, Professor Barratt says.

Unsurprisingly, this claim is rejected by Breastscreen Australia. A spokeswoman told Australian Doctor that there were online resources providing information on the risks as well as the benefits of breast screening.

“The program has been successful in reducing mortality from breast cancer at the current participation rate of 56% in the target age group of women aged 50 to 69 years, by approximately 21% to 28%,” she says.

“Decreased participation will result in less cancers being detected.”

Cancer Council Australia’s public health committee chair Adjunct Associate Professor Craig Sinclair quotes the same stats in dismissing claims organisations like his use fear tactics to boost participation.

“There is no scaremongering in the promotion of mammography screening,” he says.

But he acknowledges screening has been the subject of debate for many years.

“The key dilemma is trying to determine a mortality benefit in some women against the occurrence of overdiagnosis in others, without ever being clear about who is likely to fall into which category,” Professor Sinclair says.

“In general, we take the same position as health authorities in the UK. The 2012 Independent UK Panel on Breast Cancer Screening estimated that, for 10,000 women invited to screen from age 50 over 20 years, 681 cancers would be diagnosed, of which 129 will represent overdiagnosis and 43 deaths from breast cancer will be prevented.

“On balance, we think this is a mortality benefit worth achieving and that mammography should be promoted accordingly as long as women are informed about the risks of overdiagnosis.”

Changing old habits
Back in Chatswood, Professor Gotzsche is fielding questions from the audience.

“So if the evidence is so clear, what do you think drives governments to continue screening?” one man asks.

The audience erupts into laughter.

The professor is deadpan.

“It’s incredibly difficult to stop a national program. There are so many faces to be saved, so many investments, such a large income and so much propaganda,” he says.

“Which politician would be ready to stand up after 30 years of one-sided propaganda and say, ‘Sorry folks, we were all wrong, but please vote for me next time.'”

A woman asked whether women should continue with other forms of screening?

“Well you ask me, so shall I give you an honest answer?”

“Please,” she replies.

“Bobby McFerrin — Don’t Worry be Happy,” he quips, referring to the 1988 hit song.

The crowd laughs once more.

“We have done the Cochrane review on monthly breast cancer self-examination,” he continues. “It doesn’t work. It only doubles the number of biopsies and therefore also the number of worries.

“Thermography was never shown to be effective, ultrasound was never shown to be effective, and considering how harmful mammography screening is … So join our males, we are happy, no PSA testing.”

Some cold hard facts
Could all his talk about deliberately misleading study conclusions, dodgy number crunching and vested industry interests leave him open to being labelled a conspiracy theorist — or, at the very least, a crusader with his own barrow to push?

And if so, does this damage the Cochrane brand?

Not according to Australian Cochrane Collaboration reviewer Professor Chris Del Mar, professor of public health at Bond University, Queensland.

“What Gotzsche has brought to the debate is hard cold facts. The evidence of benefit is more questionable than we thought initially, the harms more serious than we had assumed,” Professor Del Mar says.

“This has to be a good thing in any controversy.”

“We now think much more about the harms as well as the benefits, about the quality of the evidence and also the potential for conflicts of interest.”

“This has resulted in calls for potential patients to be much more carefully informed about what are the benefits and harms of screening.”

After Professor Gotzsche finishes his presentation, he speaks to Australian Doctor.

“There are very few people who know so much about breast screening as I do,” he says.

“I’m regarded as one of the leading experts in the world by leading observers such as BMJ editor-in-chief Fiona Godlee, so I know very well about this literature, and I had to write a whole book to expose some of the most important scientific misconduct in this area.

“So there isn’t any piece of good evidence that I don’t know about and don’t take into account, it just didn’t exist.”

The role of dietary factors in prevention and progression of breast cancer

We always knew that diet is important in preventing cancer, but this study reveals more on this very important topic.

The role of dietary factors in prevention and progression of breast cancer .

Anticancer Research, 02/11/2015

 Review Article  Clinical Trial Below

Rossi RE, et al. – The aim of the present review was to evaluate the impact of dietary factors in breast cancer (BC) risk. There exist increasing evidence that dietary factors can play an important role in both the development and prevention of BC. Large randomized clinical and epidemiological studies are required but are difficult to design due to the number of variable factors.

Methods

  • Bibliographical searches were performed in PubMed, using the following terms: “nutrition and breast cancer”, “nutrition and breast carcinoma”, “dietary factors and breast cancer”, “risk factors and breast cancer”, “diet and breast cancer, “breast cancer epidemiology”, “breast cancer and prevention”.

Results

  • Consumption of well-done red meat appears to be associated with increased risk of BC, whereas fish may be protective.
  • Total cholesterol, triglyceride levels and glycaemic load should be monitored and controlled in at risk populations because they may be associated with increased risk of BC, although the exact mechanisms involved are not clear.
  • Alcohol intake should be minimized since it is a risk factor for BC.
  • High intake of polyphenol/phyto-oestrogen -rich food (i.e. flavonoids, soya products), as well as fibres, fruits and vegetables, may have potential protective effects against BC occurrence but the results might vary according to hormonal status.
  • Vitamin D supplements appear protective against BC development and similarly other vitamins and oligo-elements might decrease BC risk, although further large prospective studies are required.