Monthly Archives: July 2016

If being too clean makes us sick, why isn’t getting dirty the solution?

If being too clean makes us sick, why isn’t getting dirty the solution?

January 13, 2016 9.59pm AEDT

Wash up. Riccardo Meneghini/Flickr, CC BY-NC-ND
Today rates of allergic, autoimmune and other inflammatory diseases are rising dramatically in Western societies. If that weren’t bad enough, we are beginning to understand that many psychiatric disorders, including depression, migraine headaches and anxiety disorders, are associated with inflammation. Perhaps the most startling observation is that our children are afflicted with the same inflammatory problems, contributing to the fact that over 40 percent of US children are on medications for some chronic condition.

And the cause, according to the “hygiene hypothesis,” is that being too clean causes a malformation of the immune system, leading to a wide range of inflammatory diseases. The original idea was that decreased infections in childhood due to hygiene led to a weak immune system, prone to become allergic and inflamed.

If the problem is that we are too clean, then, hypothetically, the issue can be easily resolved. We just need to get dirty, right? Wrong.

Getting dirty doesn’t help our immune system and generally makes inflammation worse. Much worse. That means there is something very wrong with the hygiene hypothesis.

Biodiversity is the real issue

What we actually have is a biodiversity problem. Our clean, indoor-centered lives and a Western diet rich in processed foods have depleted our biomes – the bacteria and worms that naturally live in our bodies, our guts in particular. These organisms play a role in the development and regulation of our immune systems, and scientists have identified the loss of biodiversity as being central to the high rates of inflammatory disease in the developed world.

Giving up soap won’t help your biome. Bar of soap via

The hygiene hypothesis was right…in its day

An increase in inflammatory disorders, like allergies, was first observed about 150 years ago among the aristocracy in Europe, then reached the entire population of the industrialized world by the 1960s, and seems only to have climbed steadily since then.

When trying to understand why inflammatory diseases increased in the late 1800s and throughout the 20th century, scientists put their finger on things such as toilets and water treatment facilities. In those days, having a toilet was “hygiene.”

But times change. After generations of living with toilets and water treatment facilities, some of the wildlife in our bodies has been driven to the point of extinction. Our loss of contact with the soil due to indoor working environments has further depleted the wildlife of our bodies. And the typical Western diet doesn’t help either.

Even if you were to never use soap again for the rest of your life, you would not recover the wildlife your body is missing. Many of the lost organisms of our body don’t exist in North America in the wild, and others you simply won’t come across in your daily life.

On top of tremendous social difficulties imposed by a lack of soap, you’d likely increase your exposure to a lot of aggravating and even dangerous germs. The bacteria and viruses deposited on your shopping cart handle or the light switch at a hotel are generally not good. Those are often the germs of modern society that cause infection and inflammation. Your immune system would remain inflamed, and perhaps be even more agitated than before.

So what exactly are we missing? For practical purposes, it’s important to divide the wildlife of our bodies into two groups: microbes and more complex organisms such as worms. Microbes and worms affect our immune systems in different ways and both are important to be healthy. Biodiversity is the key.

A healthy crop of microbes and a few good worms

What would the gut biomes in our hunter-gatherer ancestors have looked like? A study by Jeffrey Gordon at Washington University in St. Louis showed that people living in modern preindustrial societies had more diverse micriobiome compositions than people living in the United States today. Seventy bacterial species Gordon found in preindustrial people’s biomes were present in very different amounts from those found in the modern U.S. participants.

While each group may have been exposed to different kinds of bacteria in their day-to-day life, the primary reason for the difference in diversity was attributed to diet. The preindustrial folks ate a diet rich in corn and cassava, compared to a US diet rich in animal fat and protein.

And you might think that antibiotics are an issue, but they are usually less of a long-term problem for biodiversity. They can deplete bacteria in the gut microbiome, but the dangerous and disease-inducing tailspin is generally temporary. The microbiome usually recovers quite nicely, for the most part, although some lingering effects can remain.

The second group of organisms that we need are intestinal worms called helminths. These worms are called mutualists, because they benefit from us and we benefit from having them hanging around in our intestines. They used to naturally live in our gut. In fact, only 150 years ago most people in the West had intestinal worms that helped regulate immune function and prevent inflammatory disease. The culprit here isn’t diet, but cleanliness and sanitation.

Eat some fiber. Ali Karimian/Flickr, CC BY-SA

If getting dirty won’t help your biome, what can you do?

When it comes to bacteria, a healthy diet is the critical ingredient. We can actually achieve a good mixture of gut bacteria very similar to that of our hunter-gatherer ancestors by adopting a good diet high in fiber and low in processed foods. The right diet helps the good bacteria in your gut flourish, and might make it easier for new varieties of good bacteria to take root.

In addition, there are some products that might, in theory, support a more hunter-gatherer-like bacterial flora, by exposing us to the kind of bacteria we don’t encounter anymore, but they haven’t been tested in clinical trials.

Probiotics, generally formulations of bacteria such as bifidobacteria and lactobacilli that grow readily in milk, are safe to use unless patients are severely ill. They could help support biodiversity in our guts if we need to take antibiotics.

Worms are a bit more challenging. There are two schools of thought on how to help helminth-less guts: one is to figure out what makes good worms good for us, and develop a drug that can do the same thing. The other is just to have these good worms living in your intestines.

Personally, I don’t think we can replicate complex biological relationships using a drug. My view is that modern medicine will eventually embrace the actual worm or maybe complex single-celled organisms called protozoans that work the same way, but research in this field is still in the early stages of development.

In the meantime, some intrepid people are going straight for the worm. As in actually acquiring worms in their gut. The challenge for these adventurers is to find a worm that has more benefits than disadvantages.

For instance, the same species of worm can have different effects in different people. The human hookworm, for instance, is commercially available and easily cultured at home. It has been found to treat multiple sclerosis and severe airway hypersensitivity but can also cause severe gastrointestinal distress in many patients.

For now, most individuals interested in immune health will focus on those factors that are risk-free, like avoiding chronic psychological stress, eating well and exercising, and watching out for vitamin D deficiency. These factors, all within our control, are important for avoiding a wide range of inflammation-related diseases, including allergy, autoimmunity, depression and cancer.

Urinary incontinence can be a problem for women of all ages, but there is a cure

 I have been in London for the last 2 weeks, attending my niece’s wedding, which was held in the Tower Of London. The chapel was the resting place for 3 beheaded queens (Anne Bolyn, Catherine Howard and Jane Seymour) as well as Thomas Moore and Guy Faulkes. This made for a wonderful atmosphere. The wedding was beautiful, in a lovely setting. One of the bridesmaids was Anna Torv, a well-known film Star. I visited an old friend from Uni., whom I have not seen in 40 years, in Cambridge. We had a punt down the Cam, and all in all a lovely day.
I return to work on Monday. I apologize for any tardy replies to emails and messages, but I was completely switched off while in London, but intend to return to normal from Monday.
Image 20160129 27156 le0h63

Urinary incontinence can be a problem for women of all ages, but there is a cure

February 12, 2016 6.01am AEDT

This article is part of our series examining women’s hidden health conditions. You can read about endometriosis, menopause and other pieces in the series here.

Urinary incontinence is urine leakage from a loss of bladder control that mainly affects women after childbirth. But it can happen to anyone. Around 37% of Australian women have some form of the condition compared to 13% of Australian men.

Mild incontinence is the most common form, affecting about two out of three sufferers. This is where small amounts of urine leak out onto clothing a few times a week and require a light pad or pantyliner to catch the flow.

Moderate to severe incontinence is less common and affects about a third of sufferers. Women need to use a specific incontinence pad (with absorbent gel) and change it more than once or twice daily. This might not be enough though, and they may get accidental wetting through to their clothing even if using the pad.

Whatever form it takes, the impact of incontinence can be debilitating and women are often too embarrassed to seek help from their doctor. This is unfortunate as there is more likelihood of a cure for those who receive treatment at an earlier point.

Stress and urge incontinence

There are two main forms of urinary incontinence: stress incontinence and urge incontinence.

A urethra is like a hose. Amy Stanley/Flickr, CC BY

In stress incontinence, urine leaks out during coughing, sneezing, laughing, or exercising. People with this condition have weak pelvic muscles around the urethra, which are overwhelmed during times of physical stress.

About 28% of young women who engage in high-impact sports – such as gymnastics, basketball and tennis – develop stress incontinence.

The second form, urge incontinence, is a desperate need to go to the toilet due to spasms in the bladder muscle. Sometimes this results in leaking. People often go to the toilet more than eight times a day, and get up to go more than once at night.

There’s another form called overflow incontinence, which is actually more common in men who have an enlarged prostate gland. It partly blocks the urethra so a pool of residual urine builds up in the bladder and leaks out when capacity overflows.

The problem is rare in women and happens when the bladder has prolapsed or dropped down into the vagina. This can block off the urethra, leading to incomplete emptying with overflow leakage.

Incontinence across the ages

Women are more prone to incontinence because their urethra is very short (only 4 cm) while the male’s is quite long (11 cm). If you imagine a garden hose, the shorter it is, the more likely water from the tap is to leak out. In a longer hose, the tap water might stop flowing before it reaches the end.

About a third of women who have had children suffer from incontinence at some point. Adolescent girls and older children also experience urine leakage, mainly in the case of bed wetting. This is due to an overactive bladder and affects about 4% of children between five and 12.

Weak pelvic muscles around the urethra can lead to stress incontinence. from

Bed wetting gradually declines during adolescence, but urge and stress incontinence persist in up to 10% of women. Incontinence then becomes more common after menopause as women produce less oestrogen which weakens ligaments and pelvic floor muscles supporting the urethra.

Obesity increases the likelihood of incontinence too, as abdominal fat puts pressure on pelvic floor muscles. Likewise, constipation and repeated straining to pass a bowel motion weakens these muscles, increasing the risk.

Other factors influencing incontinence include urinary tract infection, which is known to worsen its prevalence and severity. Anxiety also contributes to symptoms with studies showing 28% to 32% of women with urge incontinence, and 22% with stress incontinence, suffer from anxiety.

Treatment options

Urinary incontinence implies lack of control which leads to feelings of shame and reluctance to seek help. As one study showed 55% of women who wore pads for incontinence had not consulted a general practitioner in 12 months.

This is unfortunate as treatment options have advanced enormously in the last 20 years. If a patient seeks treatment when leakage is mild, it’s much more likely to be successful. The more severe the incontinence, the more difficult and expensive it is to treat.

First-line therapy for stress incontinence is pelvic floor muscle training by a specialist continence physiotherapist, which doesn’t require a doctor’s referral. This has a 65% likelihood of cure for mild, and 35% for moderate, incontinence with no side effects or risk.

If this doesn’t work, there are two kinds of vaginal ring pessaries available to support the urethra. These are particularly useful for women who only leak with active sports or gym classes.

The final option is to have an operation. The most widely performed is one where a mesh tape is placed under the urethra like a sling for support. About 93% of women are found to be cured three years after having the surgery and it shows good long-term results.

For urge incontinence, first-line therapy is training to increase bladder capacity. A tablet or patch that reduces bladder spasms is prescribed alongside training for at least three to six months.

Urge incontinence after menopause is treated with vaginal oestrogen cream that helps strengthen the urethra and enhance bladder capacity.

About 40% of women who don’t respond to these are found to have a low grade infection of the bladder, known as cystitis. More treatment options are being developed for this. For instance, a randomised trial is currently underway exploring bladder-specific antibiotics together with a muscle spasm reduction tablet for urinary incontinence.

No woman should have to suffer urinary incontinence in silence or shame. The above treatments are not difficult, but they require a professional to steadily work through the options to find the right cure for each woman.

Specialist continence physiotherapists can be found at the Australian Physiotherapy Association’s website and at the Continence Foundation of Australia’s website.

New Email Address

Please note a new email address:


Is breast cancer risk the same for all progestogens?

I keep getting told by patients that their own doctors are against Bioidentical hormones, and claim the synthetic HRT is just the same. I keep having to explain that there is a big difference between them. The major difference is in the progesterone component. Every study shows that natural (Micronised) progesterone is much safer. Here is further evidence for the same, not that we need more after the overwhelming previous studies showing the same.
Arch Gynecol Obstet. 2014 Aug;290(2):207-9. doi: 10.1007/s00404-014-3270-0.

Is breast cancer risk the same for all progestogens?

Author information

  • 1Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland,


The population-based case–control study CECILE investigated the impact of various menopausal hormone therapy (MHT) products on breast cancer (BC) risk in 1,555 postmenopausal women [1]. The case group (n = 739) included incident cases of in situ (!) or invasive BC in postmenopausal women. The control group (n = 816) included women from the general population within predefined quotas by age and socio-economic status (SES). While quotas by age were applied to obtain similar distributions by age among controls and among cases, quotas by SES in control women were applied to reflect the distribution by SES of women in the general population in the study area. Data of participants were obtained by a structured questionnaire during in-person interviews, and from pathology reports if applicable, respectively. Women were divided into current and past MHT user. MHTs were classified in estrogen-only therapy (ET), estrogen combined with progestin therapy (EPT) and tibolone. EPT was subdivided in three subtypes according to the progestogen constituent: natural micronized progesterone, progesterone derivatives, and testosterone derivatives. In comparison to never MHT users, any current or past MHT use (ET, EPT, tibolone) was not associated with an increased BC risk. However, in subanalysis BC risk was significantly increased for current use of EPT for 4 or more years (n = 73 cases and n = 56 controls, adjusted OR 1.55; 95 % CI 1.02–2.36). Within the group of current EPT users for 4 or more years, 14 cases had used estrogens combined with micronized progesterone (n = 17 controls), and 55 a combination with a synthetic progestogen (n = 34 controls), respectively. Compared to never MHT use, current use of EPT containing a synthetic progestogen for 4 or more years was associated with a significantly increased BC risk (adjusted OR 2.07; 95 % CI 1.26–3.39), but EPT containing micronized progesterone was not (adjusted OR 0.79; 95 % CI 0.37–1.71). 73 % of current MHT users started treatment within the first year of onset of menopause. Early EPT (n = 52 cases and n = 38 controls, adjusted OR 1.65; 95 % CI 1.02–2.69), but not early ET, starters had a significantly higher BC risk compared to never MHT users. In contrast, MHT initiation beyond 1 year after menopause was not associated with an increased BC risk.

The authors concluded that: (1) ET and EPT containing natural progesterone did not increase BC risk whereas, (2) BC risk was increased in users of tibolone (Livial) or EPT containing a synthetic progestogen, respectively, and that (3) MHT use early after onset of menopause was associated with an increased BC risk as compared to women who delay MHT beyond 1 or more years.

Health Check: will intermittent fasting diets help you lose weight?

Health Check: will intermittent fasting diets help you lose weight?

December 14, 2015 2.28pm AEDT

No or little food and drink is allowed during fasting periods. from

Intermittent fasting diets involve periods of fasting cycled with periods of feeding. Fasting involves a zero or reduced calorie intake from foods and drinks. Feeding can involve food and drink consumption under strict rules – or not – and can be ad libitum (eating based on your hunger and fullness) – or not.

The term intermittent refers to the fact that the fasting periods are not continuous. Continuous “fasting” diets also exist and, conversely to intermittent fasting diets, involve energy restriction to below-“normal” requirements for continuous, prolonged periods: weeks, months, or more. Of course, you couldn’t fast continuously on zero calories, because you’d starve to death.

Intermittent fasting has been part of some health and religious practices, such as Islamic Ramadan, for thousands of years. It has been – and currently is – linked to living a longer life. More recently, intermittent fasting has gained popularity in weight-loss circles, partly due to both obesity and society’s “thin ideal”.

Intermittent fasting methods

There are many ways to fast intermittently. Each way differs in when and how fasting and feeding are recommended. I list three examples from the various schemes that seem to have gained popularity recently.

The 5:2 Fast Diet™ was created by British medical doctor Michael Mosley and British journalist Mimi Spencer in 2012-3. It involves five days of “normal” eating and two days of a reduced calorie intake of approximately one-quarter of a person’s usual requirement.

This is about 500 calories for women and 600 calories for men. A 500-calorie day might include: a black coffee and a small-medium boiled egg with three asparagus spears for breakfast; one piece of bread with no butter, a slice of ham and some lettuce for lunch; a herbal tea or low-calorie hot chocolate for an afternoon “snack”; and a small piece of fish with 100g of boiled potatoes and 100g of peas for dinner. Which doesn’t actually sound that bad!

There is an online calculator on the Fast Diet website, which can more accurately estimate what one-quarter of energy intake means for you (a heavier body weight and higher levels of physical activity mean a higher fasting day calorie intake). The two fasting days can be one after the other, although they don’t have to be, and you can eat what you like on the five non-fasting days.

Another example is the 16:8 diet, which was popularised as Leangains by US “nutritional consultant” and personal trainer Martin Berkhan. It involves repetitions of the schedule of 16 hours of fasting overnight and in the morning, and then eight hours of feeding in the afternoon and evening.

No calories are ingested during the fasting phase, although foods and drinks with minimal calories are allowed, such as coffee with a splash of milk and “calorie-free” sweeteners or gum. The feeding phase can also involve calorie intake reductions, depending on weight-loss goal, starting body weight and exercise habits.

Leangains – as the name suggests (lean refers to muscle tissue) – targets fitness enthusiasts by providing specific guidelines on pre- and post-exercise nutrition. There are suggestions as to the amount of calories and protein consumed before and after a workout. Apparently, Hugh Jackman followed this way of eating in preparation for his role in Wolverine.

Intermittent fasting diets can involve recommendations for resistance exercise. from

The final example is Canadian Brad Pilon’s Eat Stop Eat, where the fasting period lasts for 24 hours and is carried out once or twice per week. Similar to Leangains and 5:2, it involves calorie reductions tailored to your weight loss aim, body weight and physical activity.

Similar to Leangains, you are required to do resistance training to build muscle mass. In contrast to the fasting periods in Leangains, but similar to 5:2, you still actually eat – albeit a very much reduced calorie intake.

The evidence on intermittent fasting for weight loss

It is well known that prolonged and severe dietary energy restriction (such as not eating anything or eating very little for many days/weeks) can result in changes to your body’s physiology that will make it more efficient at using any calories that you do give it. That is, it goes into “starvation mode” (also called the “famine reaction”), where post-energy restriction re-feeding results in more weight and fat being recovered in feeding than was lost during starvation.

This is because the human body is a beautiful product of evolution, having adapted to periods of famine. The problem is, those of us who are lucky enough to have plenty to eat – at all times – need to avoid this adaptation if trying to lose weight.

Several 2015 reviews outlined below report that intermittent fasting can result in successful weight loss. This means that, overall, intermittent fasters apparently don’t compensate during feeding periods for the reduced calorie intake of the fasting periods.

One 2015 review summarised studies that investigated the effect of intermittent fasting on body weight and other health markers over a maximum of about six months.

It reported that both alternate-day and whole-day (5:2 and Eat Stop Eat) fasting reduced body weight and body fat in normal-weight, overweight and obese people; but that research on the less-than-24-hour, time-restricted feeding schedule (like 16:8 Leangains) “is limited, and clear conclusions cannot be made”. However, remember that weight loss can occur on a number of dietary regimes, including those that don’t advocate intermittent fasting.

One 2015 systematic review of 40 clinical trials involving intermittent fasting periods of one to seven days over about three months (but up to about two years) concluded that intermittent fasting methods were valid – but not superior – ways to lose weight compared to continuous energy restriction. That is, consuming 500 calories on Tuesday and Thursday and then “normal” calories the rest of the week may not mean that you lose more weight compared to if you ingested 1,400 calories every day that week.

Another 2015 systematic review outlined how three higher-quality randomised controlled trials on intermittent fasting over three months all reported that their participants lost weight.

So, it seems that the evidence suggests intermittent fasting is effective for weight loss in the short term – just like other popular diets. However:

substantial further research in humans is needed before the use of fasting as a health intervention can be recommended.

This is partly due to the lack of clinical studies of more robust design that look at long-term weight loss (over many years), and partly due to the negative aspects of intermittent fasting.

Intermittent fasting may make you feel very hungry, or “hangry”; and may be quite impractical for some people. You wouldn’t want to be in a fasting period during a wedding, for example.

Intermittent fasting may also lead to malnourishment if someone already has a poor diet or takes it to the extreme. Additionally, it may not be suitable for pregnant women and people with specific health conditions, such as diabetes or a history of eating disorders. I know I would struggle being so strict with my eating pattern with my history of bulimia.

The verdict?

The evidence suggests that intermittent fasting can be an effective way to lose weight over months, and may work for some. However, one size does not fit all, and it could be another’s idea of hell. It may not be superior to other methods of weight loss and may not work in the longer term. More research is needed, including on the long-term effects of intermittent fasting and the effects of combining intermittent fasting with exercise.

Friut and veggies reduce breast cancer risk.

Vegetable and fruit consumption and the risk of hormone receptor–defined breast cancer in the EPIC cohort1,2


Background: The recent literature indicates that a high vegetable intake and not a high fruit intake could be associated with decreased steroid hormone receptor–negative breast cancer risk.

Objective: This study aimed to investigate the association between vegetable and fruit intake and steroid hormone receptor–defined breast cancer risk.

Design: A total of 335,054 female participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort were included in this study (mean ± SD age: 50.8 ± 9.8 y). Vegetable and fruit intake was measured by country-specific questionnaires filled out at recruitment between 1992 and 2000 with the use of standardized procedures. Cox proportional hazards models were stratified by age at recruitment and study center and were adjusted for breast cancer risk factors.

Results: After a median follow-up of 11.5 y (IQR: 10.1–12.3 y), 10,197 incident invasive breast cancers were diagnosed [3479 estrogen and progesterone receptor positive (ER+PR+); 1021 ER and PR negative (ER−PR−)]. Compared with the lowest quintile, the highest quintile of vegetable intake was associated with a lower risk of overall breast cancer (HRquintile 5–quintile 1: 0.87; 95% CI: 0.80, 0.94). Although the inverse association was most apparent for ER−PR− breast cancer (ER−PR−: HRquintile 5–quintile 1: 0.74; 95% CI: 0.57, 0.96; P-trend = 0.03; ER+PR+: HRquintile 5–quintile 1: 0.91; 95% CI: 0.79, 1.05; P-trend = 0.14), the test for heterogeneity by hormone receptor status was not significant (P-heterogeneity = 0.09). Fruit intake was not significantly associated with total and hormone receptor–defined breast cancer risk.

Conclusion: This study supports evidence that a high vegetable intake is associated with lower (mainly hormone receptor–negative) breast cancer risk.

No internet Connection.

I no longer have an internet connection at home, and have had to change my email address. This is a long complicated saga but I hope to be back on the net this weekend, but with a new email address. I will let you know this when I get it. My apologies to all those trying to email me, but  this  was out of my control.

The ongoing taboo of menstruation in Australia

The ongoing taboo of menstruation in Australia
February 3, 2016 6.05am AEDT .

We are still profoundly uncomfortable about the fact that females bleed once a month for half of their lives. Stuart Richards
Carla Pascoe
ARC Discovery Early Career Research Fellow, University of Melbourne

Disclosure statement

Carla Pascoe does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

University of Melbourne

University of Melbourne provides funding as a founding partner of The Conversation AU.

Ask any young woman whether she feels embarrassed by her periods and she’ll likely deny it. Her grandmother might have hidden all evidence of “the curse” but not today’s liberated women. Right?

Sex education classes explain the biology of menstruation in interminable detail. Pad and tampon ads screen on prime-time television. And no girl in modern Australia suffers the terror of discovering blood between her legs before she’s had “the talk” with her parents.

But delve a little deeper and you’ll find that we are not as frank about menstruation as we like to think. How many girls proudly announce that they’ve reached menarche (first menstruation)? How many women openly carry a tampon to the toilet?

Why do we use quaint euphemisms such as “sanitary products” and “feminine hygiene products” in supermarket aisles? We are still profoundly uncomfortable about the fact that females bleed once a month for half of their lives. It’s messy, it’s unsettling and no one wants to talk about it.

This ancient taboo has stubbornly persisted across cultures and time periods. The idea that menstruating women are contaminated has inspired countless bizarre myths: that their touch can turn wine into vinegar, make flowers wilt, and even drive dogs mad.

Clearly, menstruation has tremendous cultural power. Why, then, has so little been written on the history of menstruation in Australia? Perhaps it’s because Australians have spent most of our past trying very hard not to mention it.

In the late 19th and early 20th centuries, menstruation was seen as similar to a monthly disability. The Ladies Handbook of Home Treatment (1905) listed activities that should be avoided at “that time of the month”, including running, dancing, bicycle riding, sewing and novel-reading.

As the Kotex booklet Preparing for Womanhood (1920s) announced:
there is less muscular strength, less steadiness – and even less mental efficiency. So you must not try to be as active, or do as much work during these few days as you can perform during the rest of the month.

Towe My.

Women and girls wore cumbersome pads at this time, contributing to the view that physical activities were ill-advised. Although commercially-produced menstrual products became available in the western world from the mid to late 19th century, most women still used rags which were washed after use. Some women wore a kind of fabric nappy, others constructed pads which were pinned to clothes or belts.

By the late 1920s several disposable pads had entered the Australian market, but only wealthier women could afford them. The advent of the second world war changed the way that many Australian women menstruated, with some introduced to disposable pads through their army or Red Cross service.

Other women on the home front were unable to buy pads due to war-time shortages. But overall, the role of Australian women in the war effort demonstrated their capacity to participate in public life. The female paid workforce continued to rise in the 1950s and 1960s, fuelling demand for the convenience of disposable menstrual products.

Sex education booklets of the 1940s and 50s such as Life and Growth: Hygiene for Girls (1941) argued that “menstruation is […] not in any sense an illness”.

Nevertheless, they emphasised that menstruation should be carefully disguised. In As One Girl to Another, Kotex explained that their pads would:
never make tell-tale outlines […] [and] never give your secret away.

The middle of the 20th century was a turning point in the methods used to manage menstruation. In one 1948 New Zealand survey, less than a quarter of high school girls purchased disposable pads while nearly three-quarters used home-made pads (7% used both).


Australian oral history interviews reveal that the use of reusable pads dwindled over the 1950s, with most girls using disposable pads by the 1960s.

By the 1960s, booklets such as The Guide to Womanhood (1961) were completely dismissive of any “disagreeable features” of menstruation, proclaiming that:
a girl who finds herself getting downhearted, moody or cross during her menstrual periods should take careful stock of herself, so that she does not get into a regular habit of having menstrual disturbances and getting out-of-sorts.

In Growing Up (circa 1960), Johnson & Johnson assured girls that prudent choice of menstrual products was crucial because:
physical comfort and peace of mind […] can make the difference between the girl who is awkward and self-conscious, and the girl who goes right ahead and has a swell time.

Australian attitudes towards menstruation and the practical ways women manage bleeding have changed immensely over the past century. Whereas once menstruation was described as an illness, today we insist that girls and women behave the same every day of the month.



While, previously, Australian females used rags to staunch their menstrual flow, we now choose from an assortment of slickly-marketed products.

But what have these changes meant?

Some historians argue that girls and women have been liberated by more effective menstrual products and the belief that menstruation doesn’t impair female capacity. This is certainly true on some levels. Yet in other ways changes in attitudes and behaviours have also entrenched the menstrual taboo.

Rather than embracing menstruation and talking openly about it, girls and women use modern products to hide their bleeding more effectively than ever.

Should we eat red meat? The nutrition and the ethics

There are lots of things to consider when pondering whether we should eat red meat. Guilio Nepi/, CC BY-SA

Many types of red meat and red meat products are available, from farmers’ markets, to supermarkets, to restaurants. The impacts of their production and consumption on human health, animal welfare and the environment are complex.

So what should we be thinking about when we’re deciding whether or not to eat red meat?

The nutrition

Consuming lean products and different cuts, or muscles, of meat from cattle, sheep, pig, goat and kangaroo is recommended in the Australian Dietary Guidelines as part of a balanced diet. Lean refers to animal muscle tissue that has lower amounts of total fat and saturated fat compared to higher-fat alternatives.

Most lean red meats are cuts, rather than processed products such as hot dogs or canned meat. Cuts provide many beneficial nutrients, including: protein, vitamin B12, zinc, iron and unsaturated fat (such as omega-3 polyunsaturated fats).

In comparison, fattier red meat cuts and most processed meat products provide higher amounts of potentially harmful nutrients, such as saturated fats, salt and sodium nitrate.

In general, horse and kangaroo meats have been reported to have the lowest total fat and highest polyunsaturated fat contents. Beef and sheep meats have the highest total fat and lowest polyunsaturated fat. Grass-fed beef is a better source of omega-3 polyunsaturated fats compared to grain-fed beef, although fish provides significantly more omega-3 than any red meat.

Australian livestock is mostly grass-fed in fields, rather than grain-fed in feedlots. This is better for both nutrient levels in the meat and animal and environmental ethics. Feedlots are more common in the United States, for example.

The type of grain that is fed to an animal affects its muscle nutrient composition, as well as shelf-life, taste, colour and quality. For example, pigs can be fed on a certain amount and type of linseed to increase omega-3 polyunsaturated fat in their meat.

Associations with ill health

The links between red meat products and human health are not fully understood, but you may have seen recent media reports about processed meat and cancer risk.

Eating red meat probably increases your risk of cancer. from

It is likely that eating less processed meat will reduce your risk of getting cancer. It’s also probable eating less red meat will reduce your cancer risk.

Similarly, if unsaturated fats – especially polyunsaturated fats – replace saturated fats (for example, in red meat) in someone’s diet, the risk of coronary heart disease might be reduced. Further, processed meats have been linked to a higher incidence of coronary heart disease and diabetes.

The ethics

The ethics of consuming food, including animal produce, is a fraught topic for both animal welfare and environmental damage. The vast scale of commercialised livestock production is overwhelming.

Yes, any food that humans consume comes with consequences, especially when that food is mass-produced. However, with red meat, efficiency and cost can outweigh animal welfare when animals become “a commodity, a unit in the production line”. And there is huge environmental damage from livestock production, such as methane from manure and enteric fermentation (that is, farts!).

Animal rights and greenhouse gas emissions should also be taken into account. from

The Food and Agriculture Organisation of the United Nations stated in 2006:

The livestock sector emerges as one of the top two or three most significant contributors to the most serious environmental problems, at every scale from local to global.

It must be hoped the animal welfare and environmental aspects of food consumption will be highlighted in future revisions of the Australian Dietary Guidelines.

What can you do?

You probably care about your health, and hopefully you care about other animals and the environment. Luckily, you can do a few things to try to improve all of these aspects of red meat and red meat product consumption:

  • When (or if) you eat red meat: choose leaner options that have less total and saturated fat, such as lean beef mince in place of standard beef mince; choose meats that contain more polyunsaturated fats, such as kangaroo or grass-fed beef (I don’t envisage many Australians eating horse, which is also higher in these fats); avoid processed meat such as bacon, sausages and salami; and buy from retailers and eat at restaurants where the red meat is sourced from more ethical, smaller-scale, local and sustainable farms
  • Eat less red meat (Meat Free Mondays is one good idea)
  • Join the 4% of the Australian population following vegetarian or vegan eating habits.

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Moments of acute stress can cause molecular alterations in immune response

Moments of acute stress can cause molecular alterations in immune response

UC San Diego Health System, 03/02/2016

Findings come from study that involved participants jumping out of planes.
Chronic psycho social and emotional stress has well–documented negative effects upon the human immune system, measurably increasing the risk of disease. Much less is known about the health effects of acute but transitory episodes of stress, such as jumping out of an airplane. Do these panic–inducing moments also raise the risk of stress–related conditions and disorders, such as cardiovascular disease, sleep dysfunction, impaired wound healing, depression and obesity? A team of researchers at University of California, San Diego School of Medicine, Stony Brook University in New York and elsewhere addressed that question by asking study participants to literally jump out of a plane, taking blood samples before and after to measure key immune response indicators. Their findings are published in the March 4 issue of Brain, Behavior and Immunity. The novelty of the study, said Rana, is leveraging advanced computational and molecular tools to assess large–scale immune system responses, to more finely detail the effects of acute, short–term stress.

March 01, 2016  |  Scott LaFee


Chronic psychosocial and emotional stress has well-documented negative effects upon the human immune system, measurably increasing the risk of disease. Much less is known about the health effects of acute but transitory episodes of stress, such as jumping out of an airplane. Do these panic-inducing moments also raise the risk of stress-related conditions and disorders, such as cardiovascular disease, sleep dysfunction, impaired wound healing, depression and obesity?

A team of researchers at University of California, San Diego School of Medicine, Stony Brook University in New York and elsewhere addressed that question by asking study participants to literally jump out of a plane, taking blood samples before and after to measure key immune response indicators.

Their findings are published in the March 4 issue of Brain, Behavior and Immunity.

tandem skydivers

Researchers tested first-time, tandem skydivers to measure key immune response indicators.

“In our everyday lives, acute stress is manageable and does not cause physiological damage,” said study co-author Brinda Rana, PhD, associate professor in the Department of Psychiatry at UC San Diego School of Medicine. “However, for those who experience it frequently, it can be a risk for chronic diseases and disorders, such as cardiovascular and immune modulated inflammation. And since the health of the immune system is crucial to protection against pathogens and other diseases, it’s important to understand the impact of stressful life events on the ability of our immune system to properly do its job.”

The study involved 39 individuals (24 males, 15 females) who had independently contacted a New York-area skydiving school to schedule a first-time tandem sky dive in which the student skydiver was connected by harness to an instructor who guided the student through the jump, freefall and landing.

All of the participants were healthy adults with no history of cardiac or mental illness. They were divided into two groups: 13 would have their RNA expression profiles measured to understand molecular signatures associated with stress, and 26 would be studied by flow cytometry to access changes in immune cell composition in blood.

Blood sampling was precisely scheduled by the lab of co-author Lilianne R. Mujica-Parodi, PhD, associate professor in the Department of Biomedical Engineering at Stony Brook University. Participants provided a baseline blood sample at 9:15 a.m. within one week prior to or one day after the sky dive. On the day of the skydive, all participants awoke at 6:30 a.m. and arrived at Stony Brook University Hospital at 7:30 a.m. where “pre-boarding” samples were collected at 9:15 a.m., one hour before take-off.

The actual jump occurred at 10:30 a.m., when the airplane reached an altitude of 11,550 feet. Skydivers landed five minutes later, with post-landing samples taken at 10:45 a.m. and again at 11:30 a.m. back at the hospital.

“Our tandem skydive instructor is also a phlebotomist,” said Mujica-Parodi. “He carried the blood draw supplies with him on the jump and was poised to draw blood as soon as the skydivers hit the ground.”

In addition, saliva samples were collected every 15 minutes from 9:15 a.m. to 11:30 a.m. on both the day of the sky dive and the baseline hospital day.

Previous research has shown that acute, short-term stress provokes a mixed bag of immune responses, some beneficial, some not. For example, numbers of natural killer cells, which are part of the innate immune response, increase, but skin healing capacity is reduced. The novelty of the study, said Rana, is leveraging advanced computational and molecular tools to assess large-scale immune system responses, to more finely detail the effects of acute, short-term stress.

“Our study is the first to probe the rapid transcriptomic (messenger RNA) changes in white blood cells that occur before and after an acute psychological stressor,” said Rana. “We identified specific genes and pathways involved in both the innate and the adaptive immune response that were dysregulated in response to the acute stress of the sky dive, and which returned rapidly to natural baseline levels one hour after the jump.”

Interestingly, the researchers noted that modules of coordinately expressed genes responding to stress were different between male and female skydivers, which they say may help explain gender differences observed in development of stress related cardiovascular and autoimmune disorders, as well as conditions like post-traumatic stress disorder (which is twice as common in women).

Nadejda Beliakova-Bethell, PhD, first co-author of the study and an assistant project scientist at UC San Diego, with background in infectious diseases, said while the research was exploratory, it laid the foundation for future, more detailed experiments to elucidate the contribution of stressful life events and exposure to pathogens to the functioning of the immune system.

“The immune response to stress is similar to the response to pathogens,” said Beliakova-Bethell. “An instance of an acute stress or infection activates the immune system, while chronic stress or infection results in the exhaustion of the immune system, making it less effective at responding to new stressful events or new pathogens. The effects on the transcriptome of white blood cells, observed in this study, were very transient, returning to baseline levels within one hour after landing, but with repeated acute or chronic stress, these transcriptomic changes would be expected to be more permanent, and may be similar, at least in part, to the effects of chronic viral infection.

“Future studies could make an important contribution to identifying gene targets for developing therapeutic strategies that would help people to cope with the prolonged effects of a stressor or to fight new infections. This would be specifically important for the elderly, who would have accumulated effects of stressors and infections throughout their lifetimes.”

Co-authors include Michael S. Breen and Christopher H. Woelk, University of Southampton, UK; Joshua M. Carlson, Northern Michigan University; and Wayne Y. Ensign, Space and Naval Warfare Systems Center, San Diego.

Funding and support for this research came, in part, from National Institutes of Health (grants 5MO1-RR-10710, AG035031 and 2T32AI007384-21A1), the Office of Naval Research Stress Physiology and Biophysics Program (grant N00014-19-1-0351; UC San Diego #27283A); VA Center of Excellence for Stress and Mental Health; Center for AIDS Research at UC San Diego (grant AI36214), the San Diego Veterans Medical Research Foundation, the Pendleton Charitable Trust and the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development.