Monthly Archives: October 2016

Treating ‘stage 0’ breast cancer doesn’t always save women’s lives so should we screen for it?

Treating ‘stage 0’ breast cancer doesn’t always save women’s lives so should we screen for it?

August 27, 2015 5.45am AEST

Women with DCIS or stage 0 breast cancer have the same chance of dying from breast cancer as the rest of the population – 3.3%. CristinaMuraca/Shutterstock

We’re told that “prevention is better than cure”; that finding symptoms of disease early will prevent the more serious consequences of that disease, particularly for cancer.

Women largely understand that a regular screening mammogram may decrease their chance of dying from the disease by allowing earlier detection and therefore less aggressive treatments. This is largely true: for every 1,000 women screened over a 25 year period, nine will not die from breast cancer because of that screening. But it does not give the entire picture.

For a minority of women diagnosed with the “pre-cancerous” lesion ductal carcinoma in situ, or DCIS, treatment doesn’t reduce their chance of getting or dying from breast cancer.

DCIS consists of abnormal cells in the breast ducts that rarely cause any symptom but are detectable on mammogram, often calcium deposits in the breast. This is also known as “stage 0” breast cancer.

Many of these indolent lesions are unlikely to ever cause a problem in a woman’s lifetime. So finding one can be said to be “over-diagnosis”. This detection will result in “overtreatment”, with surgery (lumpectomy or mastectomy, where the lump or breast is removed) and perhaps radiotherapy.

A recent Australian analysis concedes it is hard to put a definite figure on this, but it around eight women in every 100 screened over 25 years may have one of these “over-diagnosed” and “over-treated” lesions.

The real problem is that we currently have little ability to predict which of these DCIS lesions will either progress into an invasive cancer or predict the development of a future invasive cancer, with the potential to spread and impact on a woman’s life.

A study released last week in JAMA Oncology adds further data to this debate, but perhaps leads to more questions than answers. This study is a detailed examination of a huge North American registry database of outcomes of 100,000 women diagnosed with DCIS between 1988 and 2011 were studied.

The authors show that, overall, women diagnosed with DCIS have the same chance of dying of breast cancer than women with no breast problems: 3.3% after 20 years of follow up.

However, there were some important exceptions. Very young women (under 35) diagnosed with DCIS, women of African American ethnicity, and those with the more aggressive types of DCIS (larger, high-grade and non-hormone-dependent) had a higher risk of dying of breast cancer.

The researchers found treating DCIS did not save lives. Having a more radical surgery – mastectomy rather than lumpectomy – or adding radiotherapy to a lumpectomy overall did not decrease the chance of ultimately dying of breast cancer.

Interestingly, having a mastectomy or radiotherapy lowered the chance of getting an invasive cancer in the treated breast yet did not alter the chance of dying of breast cancer. This suggests that some DCIS lesions do have the ability to spread.

What can we conclude from this study? Well, it seems to confirm that there are at least two types of DCIS – and the more aggressive one does need to be treated.

But the majority of women with DCIS will not go on to get invasive cancer. So perhaps we need to consider DCIS more as a warning sign of potential future cancer risk. This opens the way for new research into less aggressive treatments for these types of DCIS, and how best to lower future cancer risk with drug treatments or even lifestyle changes such as weight loss and exercise.

Breast cancer screening undoubtedly has benefits but the size of these benefits is debated. A recent review from the United Kindom suggested perhaps only one out of 15 women diagnosed with cancer by mammographic screening will be helped:

  • three will die of breast cancer anyway
  • eight will likely have survived even if not treated until symptomatic
  • three have cancers that would not have manifested or killed them anyway
  • one will avoid breast cancer death.

The Australian breast screening program probably offers better odds than this, with more frequent screens, excellent equipment, staff and quality assurance, and good access to care for the majority of Australians.

Only further research can unravel exactly which DCIS is really a risk to health and needs aggressive treatment, which DCIS may be a marker of future cancer risk and how we can modify this risk, and perhaps which DCIS is an indolent condition which will never affect a woman in her lifetime.

When deciding whether or not to go for a mammographic screening test, getting balanced comprehensive information is important. Working out your individual cancer risk (via calculators such as this) and what you can do about it may help inform not only your screening choices but also your lifestyle choices which in turn can help prevent a number of diseases.

Understanding your individual risk also relies on emotions, anecdote and personal experience; this all feeds into decision-making.

However, choice does not solve the fundamental dilemma of screening: is it ethically acceptable to cause serious harm in some people in order to improve the prognosis of others?

Aspirin use and risk of breast cancer

I have had other posts on this topic, and a chapter in my book “Live Well Over 100″was devoted to the health benefits of aspirin.

Cancer Epidemiol Biomarkers Prev. 2015 Aug 27. pii: cebp.0452.2015. [Epub ahead of print]

Aspirin use and risk of breast cancer: Systematic review and meta-analysis of observational studies.

Author information

  • 1Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University.
  • 2Xuzhou Medical College.
  • 3Jiangsu Cancer Hospital Affiliated to Nanjing Medical University.
  • 4Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University


Previous studies concerning the association between aspirin use and breast cancer risk yielded inconsistent results. We aimed to investigate the association by meta-analysis. PubMed and EMBASE were searched for relevant studies. We calculated the summary relative risks (RRs) and 95% confidence intervals (CIs) using random-effects models. Seventeen cohort studies and fifteen case-control studies were included. The overall result showed that aspirin use decreased risk of breast cancer (RR=0.90, 95% CI: 0.85-0.95). However, there was evidence of publication bias and heterogeneity and the association disappeared after correction using the trim-and-fill method. When stratified by study design, a significant benefit for aspirin users was only found in population-based and hospital-based case-control studies but not in cohort or nest case-control studies. Further subgroup analyses showed that aspirin use could decrease risk of in situ breast tumors or hormone receptor-positive tumors and reduce risk of breast cancer in postmenopausal women. Aspirin use may not affect overall risk of breast cancer, but decrease risk of in situ breast tumors or hormone receptor-positive tumors and reduce risk of breast cancer in postmenopausal women. Considering between-study significant heterogeneity and publication bias, confirmation in future studies is also essential.

Copyright © 2015, American Association for Cancer Research.

Sleep disturbances in menopausal women: Aetiology and practical aspects.

Maturitas. 2015 Jul;81(3):406-9. doi: 10.1016/j.maturitas.2015.04.017. Epub 2015 May 15.

Sleep disturbances in menopausal women: Aetiology and practical aspects.


Sleep deteriorates with age. The menopause is often a turning point for women’s sleep, as complaints of insomnia increase significantly thereafter. Insomnia can occur as a secondary disorder to hot flashes, mood disorders, medical conditions, psychosocial factors, underlying intrinsic sleep disorders, such as obstructive sleep apnoea (OSA) or restless legs syndrome (RLS), or it can be a primary disorder. Since unrecognized OSA can have dramatic health-related consequences, menopausal women complaining of persisting sleep disturbances suggesting primary insomnia or intrinsic sleep disorders should be referred to a sleep specialist for a comprehensive sleep assessment. Patients suffering from primary insomnia will be preferentially treated with non-benzodiazepine hypnotics or melatonin, or with cognitive behavioural therapy. Insomnia related to vasomotor symptoms can be improved with hormone replacement therapy. Gabapentin and isoflavones have also shown efficacy in small series but their precise role has yet to be established. In patients suffering from OSA, non-pharmacological therapy will be applied: continuous positive airway pressure or an oral appliance, according to the severity of the disorder. In the case of RLS, triggering factors must be avoided; dopaminergic agonists are the first-line treatment for moderate to severe disease.

In conclusion, persisting sleep complaints should be addressed in menopausal women, in order to correctly diagnose the specific causal disorder and to prescribe treatments that have been shown to improve sleep quality, quality of life and long-term health status.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.


Insomnia; Menopause; Obstructive sleep apnea; Restless legs syndrome; Sleep disorders

Chili Peppers Could Be the Secret to Killing Cancer

Chili Peppers Could Be the Secret to Killing Cancer


Munchies Staff

September 15, 2015 / 3:28 pm

In the 2000 song “B.O.B,” Andre 3000 of Outkast once rapped, “Stack of question with no answers / Cure for cancer, cure for AIDS.” And at the time, there truly were no answers.

But flash forward 15 years, and we’ve made a little bit of headway. New medicines for AIDS and HIV have proven surprisingly promising, and more research is being done to combat cancer than ever before. Which is important, because cancer is the second-leading cause of death in the US, accounting for about one out of four deaths, according to the American Cancer Society.

And now, a compound found in chili peppers could be bringing us one step closer to eliminating the deadly disease.

Back in 2006, trials on mice showed that capsaicin, the compound in peppers that gives them their fiery flavor, inhibits the growth of and destroys prostate cancer cells without harming non-cancerous cells. In fact, the compound shrank the size of tumors in mice to one-fifth the size of those in untreated mice. But what they couldn’t figure out was how, or why. Needless to say, the discovery warranted further investigation.

Scientists and medical experts wanted to figure out how to process capsaicin into a cancer-fighting medication that could be used practically, since the number of chili peppers a human would need to eat in order to reach the therapeutic level would be unrealistic to achieve through diet. A 200-pound man would have had to eat about ten whole, fresh habaneros per week to attain the levels of capsaicin given to the lab mice. (That might not sound like much to lovers of spicy food, but it’s a whole lot for the average joe—especially someone who is undergoing cancer treatment and might not have the most voracious appetite.)

Researchers from the Indian Institute of Technology, Madras, have unlocked the process that causes this effect on prostate cancer cells. According to study leads Ashok Kumar Mishra and Jitendriya Swain, capsaicin binds to the membranes of the cancerous cells. It then pulls the membrane apart, destroying the whole cell in the process in about 80 percent of cases.

Best of all, it has no adverse side effects on other parts of the body. Their findings are published in the American Chemical Society’s Journal of Physical Chemistry B.

A separate study from last year found that capsaicin also fights bowel cancer, extending the lifespan of tumor-prone mice by some 30 percent.

This information also follows the release of a study last month showing that moderate to high consumption of spicy foods can help to lower the risk of early death. Capsaicin already has other medical applications, such as being used in numbing creams and topical pain relievers.

But more importantly, it’s what adds the heat to your hot sauce. Just one more reason why you can feel good about going heavy on the Tapatío tonight.

Hot flushes among aging women and exercise

Hot flushes among aging women: A 4-year follow-up study to a randomised controlled exercise trial – Maturitas.requiresJS{display:none}.dartAd{display:block !important}<!– [if IE 6]> /wro/9q1y/ie6.js



The aim of this follow-up study was to explore the long-term effects of a 6-month trial of exercise training on hot flushes. The follow-up was 4 years after the exercise intervention ended.

Study design

A cohort study after a randomised controlled trial. Ninety-five of the 159 randomised women (60%) participated in anthropometric measurements and performed a 2-km walk test. Participants completed a questionnaire and kept a one-week diary on physical activity, menopause symptoms and sleep quality. The frequency of 24-h hot flushes was multiplied by severity and the total sum for one week was defined as the Hot Flush Score (HFScore). Multilevel mixed regression models were analysed to compare the exercise and control groups.

Main outcome measure

Hot Flush Score (HFScore) as assessed with the one-week symptom diary.


The women in the exercise group had a higher probability of improved HFScore, i.e. a decrease in HFScore points, adjusted for hormone therapy (OR 0.95; 95% CI 0.90–1.00) than women in the control group at the 4-year follow-up. After additional adjustment for sleep quality, the result approached statistical significance at HFScore ≥ 13 with women in the exercise group. Women who had the least amount of hot flushes, HFScore < 13, benefited most from exercise during the 4-year follow-up when compared with women in the control group.


Women in the exercise group had positive effects on their HFScore 4 years after a 6-month exercise intervention.


Probiotics for treatment and prevention of urogenital infections in women

I take probiotics daily, and have for many years, for maintaining a healthy gut. I don't take anything fancy - just natural, plain yoghurt from the supermarket - make sure it is fresh. I choose a good brand as well.

Probiotics for treatment and prevention of urogenital infections in women: A systematic review

Journal of Midwifery and Women’s Health, 05/31/2016

This study extends the work of researchers who systematically investigated the scientific literature on probiotics to prevent or treat urogenital infections. he quality of the studies in this systematic review varied. Although clinical practice recommendations were limited by the strength of evidence, probiotic interventions were effective in treatment and prevention of urogenital infections as alternatives or co–treatments. More good quality research is needed to strengthen the body of evidence needed for application by clinicians.


  • A systematic review was conducted to determine the efficacy of probiotics for prevention and/or treatment of urogenital infections in adult women from January 1, 2008, through June 30, 2015.
  • They searched in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Dissertations and Theses, and Alt–HealthWatch.
  • After removing duplicates and studies that did not meet inclusion criteria, 20 studies were reviewed.
  • All included at least one species of Lactobacillus probiotic as an intervention for treatment or prevention of urogenital infections.
  • Data extracted included samples, settings, study designs, intervention types, reported outcomes, follow–up periods, and results.
  • They evaluated all randomized controlled trials for risk of bias and made quality appraisals on all studies.


  • Fourteen of the studies focused on bacterial vaginosis (BV), 3 on urinary tract infections (UTIs), 2 on vulvovaginal candidiasis, and one on human papillomavirus (HPV) as identified on Papanicolaou test.
  • Studies were heterogeneous in terms of design, intervention, and outcomes.
  • Four studies were of good quality, 9 of fair, and 7 poor.
  • Probiotic interventions were effective for treatment and prevention of BV, prevention of recurrences of candidiasis and UTIs, and clearing HPV lesions.
  • No study reported significant adverse events related to the probiotic intervention

How Australians Die: cause #1 – heart diseases and stroke


How Australians Die: cause #1 – heart diseases and stroke

June 6, 2016 6.13am AEST
Coronary heart disease is almost always a consequence of atherosclerosis; a build-up of cholesterol and other material in the walls of our arteries. Heart Attack Heaven/Flickr, CC BY

How Australians Die: cause #1 – heart diseases and stroke

June 6, 2016 6.13am AEST

Disclosure statement

Garry Jennings receives funding from the National Health and Medical Research Council. He is affiliated with Baker IDI Heart & Diabetes Institute, The National Heart Foundation, Alfred Health and Monash University.


Diseases of the heart and the vessels running to and from it are the number one reason people die in Australia, and we’re not alone. They are the number one cause of death in the world.


According to the Australian Bureau of Statistics, ischaemic heart disease (IHD) is the leading cause of death in Australia. In 2014, 20,173 people died from it.

But ischaemic heart disease is not really the disease itself. Rather, it is the term used to cover the clinical manifestations of coronary heart disease such as heart attacks and angina.

The How Australians Die series has combined all cancer deaths to make them the second leading cause of death after heart diseases and stroke. Alzheimer’s is third, respiratory diseases fourth and diabetes fifth.

Coronary heart disease

Coronary heart disease is almost always a consequence of atherosclerosis. This is a build-up of cholesterol and other material in the walls of our arteries (tubes that carry blood and oxygen to the heart). The build-up can cause heart attack and block access to the brain, leading to stroke – another of Australia’s top killers.

Ischemia describes insufficient oxygen supply to the heart muscle. Lack of oxygen can cause discomfort in the chest, such as a tightness or squeezing known as angina. This is most often brought on by exercise but is more serious when it happens at rest.

Persistence of angina over time, particularly at rest, can lead to death of some heart muscle. This is called an acute coronary syndrome, or colloquially, a heart attack. We used to call this myocardial infarction. No wonder people find the terminology confusing.

The Australian Bureau of Statistics classifies ischaemic heart disease as the leading cause of death in Australia. Cerebrovascular diseases (stroke) are the third, heart failure is at number seven; hypertensive diseases are at 13, and cardiac arrythmias at 19.

But there is considerable overlap among these, which is why this article has combined them under one umbrella. Hypertension (high blood pressure), for instance, is a major cause of stroke and a risk factor for coronary disease. At least half of heart failure is due to coronary heart disease, while the most common cardiac arrhythmia (irregular heartbeat), atrial fibrillation, is often caused by hypertension, heart failure or coronary heart disease. Further, atrial fibrillation is the cause of about one-third of strokes.

Although ischaemic heart disease is responsible for 20,173 deaths in 2014, the number of deaths due to the above circulatory diseases in 2014 was 38,741.

History of heart disease

Heart disease is not new. CT scans of Egyptian mummies who lived 3,500 years ago show they had narrowings in their arteries, which means they had coronary heart disease. Pharaoh Merneptah, for instance, who died in 1203 BC, had severe coronary disease.

CT scans show Pharaoh Merneptah had atherosclerosis. G. Elliot Smith/Wikimedia Commons

The real and documented epidemic of heart disease occurred after the second world war. This could in part be explained by higher rates of smoking, blood pressure and poor diets after and during the war. Rates increased for three decades at this time.

Then they fell; first in Australia and the United States, and then in other developed countries. Half of this fall could be attributed to public health measures such as tobacco control and availability of blood pressure and cholesterol treatments; the other half to better treatment of people with heart disease.

A province of Finland, North Karelia, initially held the dubious record for the highest rates of heart disease in the world. In the early 1970s, the region had around 672 per 100,000 people dying from heart disease. The mantle then passed to Eastern Europe and Russia where rates are currently 320 per 100,000 people. This is astounding compared to Australia where the rate is 54 per 100,000.

In 1990, heart disease was the third-highest cause of death in developing countries, but by 2013 it was number one. The rates rose from 70 per 100,000 people to 91 per 100,000 people in those years respectively. This is because the developing world acquired the habits of the developed world. There are now more people in the world who are overweight than underweight.

Hypertensive diseases are rising in most developing countries, together with diabetes, while smoking remains common. Infections and trauma used to cause death in people too young to have heart disease, but that is no longer the case due to antibiotics, immunisations and better safety standards.

In 1990, there were 12.3 million deaths globally from heart disease. By 2013, this had risen to 17.3 million. Most of this 40.8% increase occurred in developing countries and in disadvantaged people in developed countries like Australia.

ABS Causes of Death, Australia, 2014, CC BY-SA

Every country in the world is at some point in the transition from low to high to medium rates of heart disease related to their stage of development. There is nothing inevitable about heart disease being the number one cause of death in Australia or the world as a whole.

The stereotype of a harassed executive having a heart attack no longer applies. Heart disease has become a blue-collar disease or one seen initially in urban populations in developing countries.

Where to from here?

The documented epidemic of heart disease occurred after the second world war. AV Dezign |, CC BY

Today (and for the foreseeable future) global rates of heart disease are driven by development, inequality and prosperity. The rate of heart disease deaths was almost double for Australians in the lowest socioeconomic group compared to the highest socioeconomic group, and 20% more for those living in remote to very remote regions compared to those in major cities. They were 40% higher for Indigenous Australians compared to their non-Indigenous counterparts.

For years, we have been comforted by falling rates of heart disease deaths in Australia. But as the population increases, ages and people survive diseases such as cancer earlier in life, the burden on the health system has not been falling to the extent that rates would suggest.

Alarmingly, in people aged 55-69 both rates and the absolute number of people dying from heart disease have increased, according to the latest data.

As Australia has become one of the fattest nations in the world, with rates of diabetes increasing and other metabolic consequences leading to heart disease, overweight and sedentary men and women with multiple risk factors have replaced the thin male smokers who died of heart disease in the 50s.

Why women’s eggs run out and what can be done about it


Why women’s eggs run out and what can be done about it

May 3, 2016 2.56pm AEST

Disclosure statement

John (Jock) Kerr Findlay received funding from the National Health & Medical Research Council of Australia. He is affiliated with the Robinson Research Institute, University of Adelaide as Chair of its Advisory Board.

Karla Hutt receives funding from the National Health & Medical Research Council of Australia and the National Breast Cancer Foundation.

Kate Stern is a minority shareholder of Virtus Health. She is a clinical director at Melbourne IVF and head of clinical research at Melbourne IVF and the Royal Women’s Hospital, Melbourne. She receives no external funding. Institutional research projects within these organisations, and with which she is affiliated, have received grants from MSD and Merck-Serono.


Monash University and University of Melbourne provide funding as founding partners of The Conversation AU.

Victoria State Government provides funding as a strategic partner of The Conversation AU.


Most women will have been made aware they have a “biological clock” and that it’s ticking. Most know the older women become the harder it is for them to conceive. But most probably don’t know it’s because women are born with a limited supply of eggs, and eventually they will run out.

Eggs are made when women themselves are in the womb. By 20 weeks’ gestation the tiny developing ovaries in a human fetus contain about five million eggs (the technical names for which are gametes, oogonia or oocytes). This is the maximum number of eggs a female will ever have, because new ones stop being made after this time.

For reasons that are still unclear, more than two-thirds of these newly made eggs degenerate in the following months, leaving a much smaller supply of eggs at birth. Egg numbers at birth range anywhere from half to one million.

The eggs present at birth constitute the only supply of eggs a woman will have in her lifetime. This stockpile of eggs, which is called the ovarian reserve, is housed in structures called primordial follicles.

Although quite a few follicles (30-40) start to develop in waves before each ovulation, usually only one follicle makes it to ovulation to release an egg. The rest degenerate over the six-to-eight-week development phase. So a woman actually ovulates only about 400 eggs during her reproductive life. This is about 1% of the pool of follicles ever produced.

By the age of 30, women will have on average only 12% of the number of eggs they had at birth. This number is still sufficient to support fertility for the next few years, provided the ovary is not subjected to external influences such as cancer drugs or serious ovarian surgery.

But what about IVF?

IVF can lead to pregnancy, but only if the eggs are healthy. IVF cannot make an unhealthy egg healthy again, given our current state of knowledge and techniques.

The chances of establishing a pregnancy with the assistance of IVF as women age is well documented. It can be 30-45% in women under 38 and has been shown to decline to less than 10% after 42 years of age.

IVF can fertilise a healthy egg – but you need that egg to begin with. from

What about freezing eggs?

Egg freezing can be performed to preserve a number of mature eggs for later use. This involves a process of ten to 12 days of hormone administration to stimulate development of multiple follicles.

The number of follicles that develop depends on the age of the woman and her intrinsic fertility. The average number of eggs collected and subsequently frozen for a 35-year-old woman is about ten.

Although 90-95% of eggs make it through the thawing process, we would still expect only one to three good embryos to develop from that group of ten eggs. This is the same as fresh eggs – about 50% fertilise and then fewer develop to make good embryos.

Both the processes of embryo creation and the pregnancy potential of embryos are similar from fresh and from frozen eggs. But the “normal” loss that occurs, as the eggs are fertilised, made into embryos and then develop, means that at most the process of egg freezing will offer a small finite number of additional opportunities for a woman to conceive in the future.

Can new technology make new eggs?

A recent report shows new healthy eggs can be made from stem cells. Stem cells are present in human embryos, as embryonic stem cells, and in most organs including the ovary. Alternatively, an induced form of stem cells can be obtained by treating mature cells with a cocktail of reagents in the laboratory.

The procedures required to create new eggs out of stem cells are very complex and still experimental. There are ethical issues, such as the need to destroy a human embryo to obtain embryonic stem cells, and further experiments will be necessary to show there are no genetic or fertility problems with subsequent generations.

It will require much more research to establish the safety and efficacy of the procedures before they are allowed into clinical use.

Women do not have an unlimited supply of eggs, but it may be possible in the future to create healthy eggs from stem cells in the laboratory. Until such a time, it’s essential all women and men understand the limitations of the fertility of women and plan their lives to take full advantage of the fertile lifespan should they choose to have children.

Do we crave the food our bodies need?


Health Check: do we crave the food our bodies need?

February 22, 2016 2.41pm AEDT

Food cravings are very common. One study of more than 1,000 people revealed 97% of women and 68% of men experienced cravings. Food cravings occur more commonly later in the day, with an average of two to four craving episodes per week.

Nutritional deficiencies

It has been long thought that food cravings were due to the body’s effort to correct nutritional deficiencies or food restrictions.

Under this theory, a craving for a juicy steak might indicate the body’s need for iron or protein. A craving for chocolate may indicate that people lack phenylethylamine, a chemical that has been associated with romantic love. Phenylethylamine is found in significant amounts in chocolate.

Nutritional deficiencies are linked to food cravings in certain situations. Pica is an unusual behaviour where people crave non-food substances such as ice, clay or raw starch. Pica behaviour is sometimes found in conjunction with micronutrient deficiencies such as zinc.

Deficiencies in vitamins may potentially result in food cravings. A severe deficiency of vitamin C led to scurvy in maritime explorers who did not have ready access to fresh fruit and vegetables during their long sea voyages. A British chaplain who wrote about the accounts of sailors suffering from scurvy reported they had intense cravings for fruit and when they finally were able to eat it they experienced “emotions of the most voluptuous luxury”.

Sailors suffering from scurvy were said to crave fruit. Ajith Kumar/Flickr, CC BY

In general, however, there is no real evidence to link our common food cravings with nutritional deficiencies.

Firstly, food cravings have been shown to decrease during weight-loss diets rather than increase, as might be expected.

In one study, a group of obese people was restricted to a very low-calorie diet over a 12-week period. Only meat, fish or poultry was allowed and all other foods were forbidden. Their cravings for low-fat, high-protein foods and complex carbohydrates decreased markedly on the diet. There was no reported increased craving for forbidden foods.

Restriction of certain types of foods also appears to decrease food cravings rather than increase them. A study of low-carbohydrate and low-fat diets in obese adults found that restricting carbohydrates resulted in decreased food cravings and restriction of fats decreased their craving for high-fat foods.

If the nutritional deficiency theory were to be true, this does not explain why some foods that are richer in nutrients lead to generally less cravings than other foods. Cheddar cheese and salami, for example, have much higher levels of phenylethylamine than chocolate but not nearly the same intensity of craving.

What causes food cravings?

Food cravings are believed to come from a mix of social, cultural and psychological factors. In North America, chocolate is the most-craved food, but this is not the case elsewhere. In Egypt only 1% of young Egyptian men and 6% of young Egyptian women reported craving chocolate. Japanese women are more likely to crave rice and sushi, reflecting the influence of traditional food products and culture.

Japanese people are more likely to crave sushi because it’s what they eat regularly. Kana Hata/Flickr, CC BY

The nature of the relationship between specific foods and cravings is important. Food cravings can develop from matching consumption of certain foods with hunger, suggesting a conditioning response. In one study, some participants were assigned to eat chocolate only when hungry (between meals). They developed greater cravings for chocolate after two weeks than other participants who ate chocolate exclusively when full (just after meals).

A theory of food cravings that includes the biological, psychological and social aspects suggests they can arise from matching food intake with other conditions such as emotional states (“stress eating”). Food cravings have been shown to be linked to higher levels of stress.

Evidence is also emerging that suggests our gut microbes (the bacteria in our guts) influence our food cravings.

Controlling food cravings

As described earlier, restricting certain types of foods can decrease food cravings. In the study of obese patients with restriction of carbohydrates and high-sugar foods it was found that food preferences and to a lesser extent food cravings were suppressed during a two-year period, suggesting long-term benefits.

Committing to implementing change is not easy. Cognitive techniques such as mindfulness can help.

Researchers gave 110 self-identified chocolate cravers a bag of chocolates each to carry around for a week. They instructed half the group in “cognitive restructuring”, a technique that involves challenging inaccurate thoughts and replacing these with more accurate ones.

The other half of the group was taught a mindfulness-based technique – “cognitive defusion”. Participants were asked not to change their thoughts but simply to notice their thoughts and to visualise themselves as different from their thoughts.

At the end of the study participants in the defusion group were more than three times more likely to abstain from chocolate than participants in the restructuring group.

Defusion interventions work to resist food cravings by creating a sense of distance from them rather than trying to eradicate and replace them.

Diet and fracture Risk in Postmenopausal Women

Diet & Fracture Risk in Postmenopausal Women

JAMA Intern Med; ePub 2016 Mar 28; Haring, et al

April 12, 2016

A healthy dietary pattern, including a higher adherence to a Mediterranean diet, may play a role in maintaining bone health in postmenopausal women and lower the risk of fractures. This according to results from the Women’s Health Initiative (WHI) and 90,014 participants (mean age 63.6 years). The WHI food frequency questionnaire was used to derive nutrient and food intake at baseline and diet quality and adherence were assessed by scores on the alternate Mediterranean diet (aMED). Researchers found:

• During a median follow-up of 15.9 years, there were 2,121 cases of hip fractures and 28,718 cases of total fractures.

• Women scoring in the highest quintile (Q5) of the aMED index had a lower risk for hip fractures (HR=0.80), with an absolute risk reduction of 0.29% and a number needed to treat of 342.

• No association between the aMED score and total fractures was observed (Q5 HR=1.01).

Citation: Haring B, Crandall CJ, Wu C, et al. Dietary patterns and fractures in postmenopausal women: Results from the Women’s Health Initiative. [Published online ahead of print March 28, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.0482.

Commentary: Previous research has shown that both osteoporosis and osteoporotic fractures are lower in Mediterranean countries than in northern European countries. The Mediterranean diet emphasizes plant foods, fish, nuts, and monounsaturated fat. It has been shown to decrease the risk for diabetes and cardiovascular disease and in addition has been associated in some studies with a decreased risk of hip fractures.1,2 While the decrease in the risk of osteoporotic hip fractures was modest at 20%, that combined with positive metabolic effects make the Mediterranean diet an attractive option to recommend to patients. —Neil Skolnik, M

1. Benetou V, Orfanos P, Pettersson-Kymmer U, et al. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int. 2013;24(5):1587-1598. doi:10.1007/s00198-012-2187-3.

2. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: A randomized trial. Ann Intern Med. 2009;151(5):306-314. doi:10.7326/0003-4819-151-5-200909010-00004.