Monthly Archives: November 2017

Three important wins for addressing obesity


Three important wins for addressing obesity

November 24, 2016 6.09am AEDT
Obesity: the challenges faced today will just make reaching that finish line tomorrow, all the more sweet. Flickr / Krieg, CC BY-NC
  • The national prevalence of obesity has increased significantly over the past few decades. Roughly three in ten Australian adults are now obese, with a further 36% classified as overweight. Together, that’s almost two in three of us.
  • Seven in every 100 children are obese (and around one in four, overweight or obese) – an increase from almost zero in 1980.
  • Overweight and obesity are second only to tobacco, in being the largest contributors to Australia’s disease burden.
  • If no further action is taken to curb obesity growth, leading economists estimate a total of A$87.7 billion in additional direct and indirect costs to the Australian economy by 2025.

As this public health challenge continues to grow, year on year, it is easy to feel like we are making limited progress. That we are letting the window for close, and failing not only ourselves and our peers – but also the next generation of young Aussies.

Yet despite all the challenging updates that crossed my desk this week, three good news items stood out. Here, I share them with you – because to paraphrase a favourite quote, let’s not risk quitting as we look forward at the long road ahead, but also take inspiration from a moment’s glance back, and the many miles already covered.

New report on a sugary drinks tax – recovering the community costs of obesity

The new report outlined what impact a sugary drinks tax might have on the health of Australians, and our federal budget. The Grattan Institute

Hot off the press this week, is a new report from the Grattan Institute focusing on the role and impact a “sugary drinks tax” might have on the health of Australians, and our federal budget.

Reflecting the building thirst for effective policy, it lays out the evidence for a tax levied at a rate of about 40 cents for every 100 grams of sugar in our drinks. Containing a whopping 210g of sugar (roughly seven times the adult daily recommendation), this would increase the price of a two-litre bottle of soft drink by about 80 cents – but could raise around A$500 million in annual revenue to recoup some of the hidden social costs of obesity.

While the authors acknowledge that one single policy is never a panacea, this latest report supports building evidence from around the world that shows price can play a crucial role in addressing obesity. It also reminds us that increasing the price of sugary drinks is not about taxing, punishing or implementing a new levy, but moving towards truer pricing of what these products actually cost.

Whether you agree or not, this latest analysis is well worth a thorough read.

TEDx talk on the politics of food

With growing support for smarter policies on obesity, a strenghtening counter-current emerges. Food and politics go together like vegemite and toast, and in this new TEDx talk from the Australian National University’s Dr Phil Baker, we learn the realities and challenges facing us as consumers and our food systems at large.

Not to be missed, Phil insightfully asks and answers what really influences our food choices, and what we can do about it.

Dr Phil Baker of ANU, on the politics of food.

New study shows 30 seconds and primary care, is time and money well spent

Finally, as someone working in public health to build and advocate an evidence-based case for greater action on obesity, it can sometimes feel a little like “two steps forward, one step back”. For clinicians and GPs working to address obesity with their patients, the tools available can appear similarly lacking.

The last piece of good news this week is a recent study published in the prestigious health journal, The Lancet. Despite the sometimes pervasive thinking that a limited impact on obesity can be accomplished in brief consultations with our GP, this new study shows the opposite. Through rigorous research methods, it reaffirms both the importance of strong, well supported primary care – and 30 seconds with your doctor – in bringing in the waistline.

The large study followed more than 1800 patients over one year and found that a:

behaviourally-informed, very brief, physician-delivered opportunistic intervention is both acceptable to patients and an effective way to reduce population weight.

In other words, it found 30 seconds of structured advice and a referral to a free weight-management group, with follow up after from the GP, was associated with 2.4kg weight loss at 12 months. Sounds small, but added over years and in contrast to the usual upward trend of weight, this is very good news.

It also supports the thousands of doctors, nurses and allied health professionals around the nation working hard to improve the health of us all.

Chin up – progress is being made

While meaningful action on obesity remains alarmingly elusive – our social appetite for accusations of “nanny statism” or individual blame continue to stagger.

But as we near the end of the month that saw an impressive, mounting list of American cities vote in progressive sugar taxes, and a year that saw global leaders and bodies support swift and comprehensive action on childhood obesity – we cannot lose sight or momentum.

It can be easy to look forward at the long road in front – yes, it will be long – and falter. But instead, let’s focus on the strong strides already made, the building movement for action and the incredible work being done by so many to move the dial on obesity policy.

After all, the challenges faced today will just make reaching that finish line tomorrow, all the more sweet. Pun intended

Calcium in the prevention of postmenopausal osteoporosis

This study, from a very prestigious group of specialists, is an important one for all women to take note of these findings. Calcium is necessary to prevent osteoporosis, but best in the form of the foods that we eat. Not as a supplement.
Maturitas. 2018 Jan;107:7-12. doi: 10.1016/j.maturitas.2017.10.004. Epub 2017 Oct 3.

Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide.

Author information

Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain. Electronic address:
Institute of Biomedicine, Research Area for Women’s Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
Polyclinique de l’Atlantique Saint Herblain, F 44819 St Herblain France, Université de Nantes, F 44093, Nantes cedex, France.
School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, 4006, Australia.
University Women’s Hospital of Tuebingen, Calwer Street 7, 72076, Tuebingen, Germany.
Levent M. Senturk, Istanbul University Cerrahpasa School of Medicine. Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul, Turkey.
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy.
National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, SW3 6NP, UK.
Department of Obstetrics and Gynecology, University Women’s Hospital, Bern, Switzerland.
University and Helsinki University Hospital, Eira Hospital, Helsinki, Finland.
Women’s Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece.



Postmenopausal osteoporosis is a highly prevalent disease. Prevention through lifestyle measures includes an adequate calcium intake. Despite the guidance provided by scientific societies and governmental bodies worldwide, many issues remain unresolved.


To provide evidence regarding the impact of calcium intake on the prevention of postmenopausal osteoporosis and critically appraise current guidelines.


Literature review and consensus of expert opinion.


The recommended daily intake of calcium varies between 700 and 1200mg of elemental calcium, depending on the endorsing source. Although calcium can be derived either from the diet or supplements, the former source is preferred. Intake below the recommended amount may increase fragility fracture risk; however, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces risk. The addition of vitamin D may minimally reduce fractures, mainly among institutionalised people. Excessive intake of calcium, defined as higher than 2000mg/day, can be potentially harmful. Some studies demonstrated harm even at lower dosages. An increased risk for cardiovascular events, urolithiasis and even fractures has been found in association with excessive calcium intake, but this issue remains unresolved. In conclusion, an adequate intake of calcium is recommended for general bone health. Excessive calcium intake seems of no benefit, and could possibly be harmful.

Five myths about the new cervical screening program that refuse to die

Five myths about the new cervical screening program that refuse to die

March 10, 2017 6.23am AEDT

Women are confused about what changes to the cervical screening program will mean for their sexual health. from

Their comments also reveal a number of misconceptions about the new screening program, which will now be rolled out in December 2017, rather than in May as planned.

It seems that in concentrating on the science behind shifting away from Pap smears every two years to testing for the human papillomavirus (HPV) every five years, our medical authorities have failed to convince many Australian women this move will save lives.

Convincing women to come on board is, of course, critical to the success of the new screening program, which is forecast to improve cervical cancer detection rates by at least 15% and is good news for women.

So let’s have a look at some common misconceptions and concerns about changes to the cervical cancer screening program raised by some of my patients and by the many people signing up to the petition.

Myth #1: no more Pap tests means no more invasive examinations

Quite a few of my patients have thought the new screening program means the end of invasive examinations. And I say “unfortunately not”. For most women the collection procedure will be exactly the same as before. This means you will still have to lie on a couch and a doctor or nurse will still insert the dreaded speculum. This instrument is needed to hold the vaginal walls gently apart so that the cervix at the end of the vagina can be seen.

Two small brushes are used to sample cells from both the outside of the cervix and from the opening which leads up to the uterus. Rather than the specimen being smeared on a slide (as with Pap smears), the two brushes are swizzled around in a preservative liquid, which separates out most of the collected cells and any HPV, the virus responsible for at least 99.7% of cervical cancers.

But it’s not until the specimen gets to the pathology lab that the process really changes.

First, the specimen is checked for HPV and only if HPV is present will cells be examined for signs of pre-cancer or cancer.

There is also the option for women who have previously avoided having Pap tests for cultural, religious or personal reasons to collect their own HPV sample. It is estimated that even if a woman has only one self-collected test at age 30 she reduces her risk of cervical cancer by about 40%.

Myth #2: the new test could miss types of cervical cancer not related to HPV

Almost 85% of cervical cancers are actually skin cancers, triggered not by the sun but by HPV. This type of cervical cancer usually takes about 15-20 years to develop. So, HPV testing gives us a chance to detect potential problems long before there is anything to see on a Pap test.

In the new program, women who carry the highest risk HPV types will then have their cells examined using a more sensitive test known as liquid-based cytology. They will also be automatically referred to a gynaecologist for further tests. If other kinds of HPV are found, a check whether the cells show any changes will guide whether the woman is referred for other tests or simply monitored more closely.

The new screening program relies on detecting human papillomavirus (HPV), which cause the vast majorities of cervical cancers. from

Some 15% of cervical cancers start in glandular cells. HPV also triggers these cancers but they are often beyond the reach of the little brushes used to collect cells in a Pap test. They can hide away quietly, growing and spreading for many years before they are detected.

When you hear of someone diagnosed with cervical cancer after previously normal Pap tests it is almost always a glandular-type cancer.

The good news is that HPV testing should pick up this kind of cancer earlier and more reliably than a regular Pap test.

There are also some very rare cervical cancers (less than 1%) that start off from muscle, nerve or pigment cells deep within the cervix and are not related to HPV infection. It is true that the new screening program is not designed to detect these types of cancer but then they were also almost impossible to detect on a traditional Pap test as well.

Myth #3: young women will miss out on early detection if screening starts at 25

There are many online testimonies from women signing the petition saying they had cervical cancer before the age of 25. It is more likely that most of these were pre-cancerous changes because cervical cancer in this age group is really rare – around 1.7 in 100,000 Australian women under 25.

Unfortunately, in the nearly 30 years our present screening program has been running there has been no significant impact on the numbers of cervical cancers reported in Australian women under 25.

Another complication in this younger age group is that cellular changes may look worse than they actually are because of a robust immune reaction to the HPV infection. Unfortunately this can lead to well-meaning advice to treat changes that are very likely to get better on their own.

Myth #4: less cervical testing reduces the chances of picking up other cancers such as ovarian and uterine cancer

Pap tests were designed to pick up pre-cancerous changes in the cells of the cervix. They are absolutely useless at detecting endometriosis, polyps, ovarian cancer or sexually transmitted infections other than HPV. They occasionally pick up uterine cancer if it is advanced enough for the cells to be shedding through the cervix that day.

The important point here is that screening tests are only for women with no symptoms. If a woman develops symptoms, such as irregular bleeding, pain or abnormal vaginal discharge, she needs to see her doctor for advice regardless of when she had her last cervical screening test.

Myth #5: the government is motivated by a cheaper option and will shift the costs of the test to the woman herself

The new tests are more expensive than a traditional Pap test, but because they are so much more sensitive there is no need to do them as frequently.

They will be funded under Medicare just as the Pap test is now. Any out-of-pocket costs depend on whether health care providers bulk bill (as they often do with screening tests) or charge the scheduled fee.

Trying the Feldenkrais Method for Chronic Pain

Trying the Feldenkrais Method for Chronic Pain

CreditPaul Rogers

After two hourlong sessions focused first on body awareness and then on movement retraining at the Feldenkrais Institute of New York, I understood what it meant to experience an incredible lightness of being. Having, temporarily at least, released the muscle tension that aggravates my back and hip pain, I felt like I was walking on air.

I had long refrained from writing about this method of countering pain because I thought it was some sort of New Age gobbledygook with no scientific basis. Boy, was I wrong!

The Feldenkrais method is one of several increasingly popular movement techniques, similar to the Alexander technique, that attempt to better integrate the connections between mind and body. By becoming aware of how one’s body interacts with its surroundings and learning how to behave in less stressful ways, it becomes possible to relinquish habitual movement patterns that cause or contribute to chronic pain.

The method was developed by Moshe Feldenkrais, an Israeli physicist, mechanical engineer and expert in martial arts, after a knee injury threatened to leave him unable to walk. Relying on his expert knowledge of gravity and the mechanics of motion, he developed exercises to help teach the body easier, more efficient ways to move.

I went to the institute at the urging of Cathryn Jakobson Ramin, author of the recently published book “Crooked” that details the nature and results of virtually every current approach to treating back pain, a problem that has plagued me on and off (now mostly on) for decades. Having benefited from Feldenkrais lessons herself, Ms. Ramin had good reason to believe they would help me.

In her book, she recounts the experience of Courtney King, who first experienced crippling back spasms in her late 20s. Ms. King was taking several dance classes a week and practicing yoga, and she thought the stress of these activities might be causing the pain in her tight, inflexible back. But after a number of Feldenkrais sessions, she told Ms. Ramin, “I realized that the pain had more to do with the way I carried myself every day.”

Even after just one session, I understood what she meant. When I make a point of walking upright and fluid, sitting straight, even cooking relaxed and unhurried, I have no pain. The slow, gentle, repetitive movements I practiced in a Feldenkrais group class helped foster an awareness of how I use my body in relation to my environment, and awareness is the first step to changing one’s behavior.

One common problem of which I’m often guilty is using small muscles to accomplish tasks meant for large, heavy-duty ones, resulting in undue fatigue and pain.

The group class, called Awareness Through Movement, was followed by an individual session called Functional Integration with a therapist that helped to free tight muscles and joints that were limiting my motion and increasing my discomfort. Using gentle manipulation and passive movements, the therapist individualized his approach to my particular needs.

The ultimate goal of both sessions is, in effect, to retrain the brain – to establish new neural pathways that result in easy, simple movements that are physiologically effective and comfortable. Although the Feldenkrais method was developed in the mid-20th century, neurophysiologists have since demonstrated the plasticity of the brain, its ability to form new cells, reorganize itself and, in effect, learn new ways to do things.

The beauty of Feldenkrais lessons is that they are both relatively low-cost (group classes average $15 to $25, individual sessions $100 to $200) and potentially accessible to nearly everyone. There are more than 7,000 teachers and practitioners working in 18 countries, including large numbers in the United States. You can be any age, strength, fitness level and state of well-being to participate. The exercises are slow, gentle and adjustable to whatever might ail you. Their calming effect counters the stress that results in contracted muscles, tightness and pain.

Many Feldenkrais practitioners, like Marek Wyszynski, director of the New York center, start professional life as physical therapists, although many other practitioners begin with no medical background. They then undergo three years of training to become certified in the Feldenkrais method.

Mr. Wyszynski explained that he starts by observing how patients are using their skeletons – how they sit, stand and walk in ways that may cause or contribute to their pathology, be it spinal disc disease, arthritis, shoulder pain or damaged knee joints. In accordance with Dr. Feldenkrais’s astute observation, “If you don’t know what you are doing, you can’t do what you want,” patients are then given a clear sensory experience of how their posture and behavior contribute to their pain and physical limitations.

For example, some people may use excessive force, clench their teeth, hold their breath or rush, causing undue muscle tension and skeletal stress. Years ago, I realized that my frequent headaches resulted from an unconscious habit of clenching my jaw when I concentrated intently on a task like sewing or cooking. Feldenkrais teachers do not give formulas for a proper way of behaving; rather, they rely on their patients’ ability to self-discover and self-correct.

Once aware of their counterproductive habits, students are given the opportunity to experience alternative movements, postures and behaviors and, through practice, create new habits that are less likely to cause pain.

Mr. Wyszynski told me that there are more than 1,000 distinct Feldenkrais lessons currently available, most of which involve everyday actions like reaching, getting up from a chair, turning, bending and walking.

As a mechanical engineer and physicist, Dr. Feldenkrais understood that the job of the human skeleton was to accommodate the effects of gravity in order to remain upright. And he wanted people to achieve this in the most efficient way possible.

Using two tall foam cylinders, one perched on top of the other, Mr. Wyszynski demonstrated a guiding principle of the Feldenkrais method. When the top cylinder was centered on the bottom one, it stood in place without assistance. But when it was off center, perched near the edge of the bottom cylinder, it tipped over. If instead of cylinders these were someone’s skeletal parts that were askew, tightened muscles would have to keep the patient from falling over.

As Mr. Wyszynski explained, “Good posture allows the skeleton to hold up and support the body without expending unnecessary energy despite the pull of gravity. However, with poor posture, the muscles are doing part of the job of the bones, and with poor skeletal support, the muscles have to remain contracted to prevent the body from falling.”

How to choose toothpaste


Health Check: how to choose toothpaste

October 24, 2016 1.19pm AEDT

Everybody has bacteria in their mouth which live on sugars in the diet. During the day, this bacteria forms plaque on our teeth and gums. Over time, this begins to dissolve the teeth, causing dental decay (holes).

At the same time, the bacterial plaque irritates the gums and can lead to gum disease.

Here’s what to look for when choosing a toothpaste.


The most important ingredient in toothpaste is fluoride. Fluoride assists with remineralising (strengthening) the teeth to reverse and prevent decay. More than a decade of evidence shows using a fluoride toothpaste twice a day results in less decay.

Common forms of fluoride in toothpaste are sodium fluoride, sodium monofluorophosphate and stannous fluoride. Stannous fluoride also has an antibacterial effect which further helps prevent decay and gum disease, and may provide some protection against sensitivity.

High-fluoride toothpastes provide increased protection to those at high risk of dental decay. But they should be used only on the recommendation of your dentist or hygienist, and are only available from pharmacies.

Children’s toothpastes usually contain less fluoride, as children may not effectively spit toothpaste out. Too much fluoride increases the risk of fluorosis, mottling of the enamel, especially among children under six years old where their water supply is fluoridated.

From age six, children can use a regular-strength toothpaste.


Triclosan is another common ingredient in toothpaste. It’s a well-proven antibacterial agent that helps to reduce plaque buildup and therefore helps protect against decay and gum disease.

Although the US Food and Drug Administration recently banned the use of triclosan in soaps, it’s currently still approved for use in toothpaste.


Whitening toothpastes work primarily by increasing the abrasiveness of the product. Mild abrasives help keep teeth clean and prevent staining. Abrasives might be listed as phosphates (calcium pyrophosphate), carbonates (calcium carbonate), silica compounds or aluminium compounds.

Some whitening toothpastes also contain hydrogen peroxide. Higher concentrations of hydrogen peroxide are used professionally. But at the percentages added to toothpaste, there is no strong evidence for its effectiveness.

Where do you start? junpinzon/Shutterstock

Whitening toothpastes without hydrogen peroxide rely on detergents and abrasives to help remove and prevent staining.

Detergents (foaming agents) assist in loosening debris and staining. Sodium lauryl sulphate (SLS) and cocamidopropyl betaine are two popular foaming agents in toothpaste. SLS can contribute to irritation and mouth ulcers in some people, so you may want to use an SLS-free toothpaste.


Some people experience tooth sensitivity, especially to cold foods and drinks. The most common cause is when part of the root is exposed through gum recession. This can occur through brushing too hard, gum disease or ageing, or a combination of the three. But rather than self-diagnosing, have a dental checkup to make sure there are no cavities or other causes for concern.

Sensitive toothpastes are very effective. However there is a confusing array of choices. Active ingredients are broken into two categories.

The first category includes potassium nitrate and potassium citrate. These work by stopping the nerve from transmitting signals. It takes about two weeks for these to accumulate enough to be effective. These products tend to be a bit less expensive.

The second category includes ingredients such as strontium, arginine (Pro-Argin®) and calcium sodium phosphosilicate (NovaMin™). These work by blocking the dentine tubules (the “pores” in the roots of the teeth). Strontium is an effective desensitiser, however some products may not contain fluoride, so check the box for this. Pro-Argin and NovaMin are also effective desensitisers.

There are two big players in the sensitive toothpaste market: Colgate and Sensodyne. It’s often difficult to determine the difference between their products, and many of the so-called active ingredients have not been independently proven.

My recommendation is to find a desensitising product that contains fluoride that is effective for you. If it has some additional benefits, consider that a bonus.


While mouthwashes can offer some benefit, they’re generally unnecessary as part of an everyday routine.

Effective brushing and flossing is key – no toothpaste in the world will replace the need for this. Relying on toothpaste or mouthwash to clean your teeth is like slopping a bucket full of soapy water over your muddy car and expecting it to come up shiny.

The Importance of BioIdentical Hormones

Natural Red HeadThe Importance of BioIdentical Hormones

by Jeffrey Dach MD

  In a previous article, we discussed the safety of bioidentical hormones.  This article answers the question, why are bioidentical hormones important?  What do they do and why do we need them?

What is a bioidentical hormone?

First of all, let us look at the definition of a bioidentical hormone,  and how they differ from the synthetic hormones offered by the mainstream medical system.

Left Image: Natural Redhead courtesy of Wikimedia Commons

How is a Synthetic Hormone Different from A Bioidentical Hormone?

Bioidentical hormones are the hormones that exist in the human body naturally.  Synthetic hormones are these very same human hormones that are chemically altered.

Why Chemically Alter a Human Hormone?

The drug company hires chemists to alter the structure of human hormones in the laboratory so the drug company can obtain a patent on the new chemical structure, which is a new drug.  This alteration is required in order for the drug company to obtain a patent which gives exclusive marketing rights to the drug company.  The patent is necessary to protects profits.  Because of a quirk in our patent laws, only chemically altered substances can be patented.  Natural substances like human hormones cannot be patented, and are therefore generally not as profitable to manufacture.

Chemically Altered Hormones Are Monsters Chemically Altered Hormones are Monster Hormones

Hormones fit onto their receptors just like a “lock and key”, so any slight alteration of their chemical structure creates a “monster hormone”.   These resulting “monster hormones” are never found in the human body or anywhere else in nature.  The reality is that these synthetically altered monster hormones should never have been approved for marketing and sale to the American People, and yet that is exactly what your mainstream medical doctor will offer you if you ask for hormones.

Left Image: Boris Karlof in Frankenstein 1931 Courtesy of Wikimedia Commons.  Respresents Monster Hormones.

Examples of a chemically altered hormone
(see below):


Bioidentical Progesterone    Above Right: Chemical alteration (see red side group) creates a monster hormone called Provera, a synthetic altered version of progesterone.

Why do we use the word bio-identical to describe natural human hormones?

You are probably wondering why do we use the word, “bioidentical”?  That’s an excellent question.  I can remember back when I was in first year medical school learning biochemistry at the University of Illinois in Chicago.  Our class used Lehninger’s classic textbook of biochemistry.  Lehninger never used the word, bio-identical hormones, because all hormones are by definition, bioidentical hormones.  They simply used the word, “hormone”.  Using a word like “bioidentical” was simply redundant and unnecessary for a biochemistry textbook, as it should be today.

The Information War and Terminology

Years ago, after the invention of synthetic monster hormones, an information war was launched by the drug industry creating confusion in the public and even among medical professionals about the difference between natural human hormones and synthetic monster hormones.  Because of this information war, we must now use the terminology, “bioidentical” hormones which really means human hormones in order to different these from the monster altered hormones.

So it is an embarrassment to medical science that we are forced to use the word “bio-identical” for natural hormones found in the human body.  We shouldn’t feel that we are forced to do this.  It should be sufficient to  use the same old names in the biochemistry text books.  The simple word  “hormone” should suffice.  Yet here we are again finding ourselves using the word “bio-identical hormone” thanks to the “Information War” going on between natural medicine and the drug industry.

How do Hormones Work?

Hormones are messengers that attach directly on to the DNA of trillions of our cells and influence gene expression.

See diagram below showing hormone attaching to DNA in the Nucleus:

Hormones attach to Receptors and to DNA
Hormones Bind to DNA and Turn on Protein Synthesis

The hormone enters the cell, attached to a receptor, and then enters the nucleus of the cell where it binds directly to the DNA.  Once bound to the DNA, the hormone messenger turns on DNA expression of protein synthesis.   DNA contains the source code for the manufacture of proteins.  The Hormone is a messenger that tells the DNA to produce these proteins.

Why Are Proteins Important ?

Proteins are the major building block for the human body, and all life for that matter.  Proteins serve a variety of functions.  For example, “structural” proteins make up the structural elements of the body such as bones, skin, arteries, hair, connective tissue, ligaments, tendons, muscles.  Other proteins called enzymes are involved in energy production.  There are proteins involved in communication, neurological function,  and cognition called  neurotransmitters.  There are proteins involved in the immune system called antibodies, and the list goes on.  The types of proteins are a very important part of the makeup of the organism.

Regenerative and Reparative Proteins

We need a constant supply of proteins to repair the body’s wear and tear.  A marathon runner, for example, suffers wear and tear on the tendons, ligaments and muscles used in the marathon run.  Recovery time after a marathon depends on the speed of repair of these injuries.  During recovery,  new proteins and new cells are manufactured and used for repair.

Diagram below shows the hormone (red molecule at upper left) entering cell, attaching to the DNA, and turning on protein synthesis.(see below)

New Cell Layers Needed for Life

In order to live, we need to make new cells.   As our older cells and cell layers age and eventually die, we must have the ability to manufacture new cells.  Examples are blood cells that must be replaced by the bone marrow every 90 days, the skin cells that slough off as the outer layer to be replaced by new layers of cells underneath.  The gastrointestinal lining is generated at the basal cell layer.  THese basal cells mature as they migrate to the surface where they eventually live out their life span, die and slough off.

All of the parts of our bodies are require new cells to replace old ones.  These new cells are made of proteins , so regeneration of new cell layers requires the DNA to be “turned on” to make these new proteins and cells.

Hormone Levels Decline with Age

We know from observational studies that hormones levels decline with age.  Starting around age 50, hormones levels decline to low levels.  In women, this is sudden decline in hormone levels is called menopause around age 50 with cessation of ovulation.  In men, hormonal decline after age 50 is called andropause,  with a gradual in testosterone levels.

Chart of Life Span from 1600 to 2010. (see below)

Above chart courtesy of : Broken Limits to Life Expectancy Jim Open and James W.Vaupel

Starting around 1820, the time of the Industrial Revolution, we see a linear increase in life span.  I suspect this is due to the improved living standards, better nutrition and mass production of goods and services.  Before 1900, most people did not live past 50, so hormonal decline was not an issue.  However, after 1900, an increasing population was living longer after the age of 50 with hormonal decline.  This is an even greater trend now, with the largest over 50 population in the history of western civilization.  All of these people are living with hormonal decline, and the accompanying degenerative diseases associated with hormonal decline.

Lack of Reparative Proteins Leads to Degenerative Diseases of Aging

Without the hormone message attached to the DNA, which turns on DNA expression and protein synthesis, we all begin to suffer from the lack of reparative and regenerative proteins leading to the degenerative diseases of aging.

Natural Medicine will provide bioidentical hormone replacement which will serve to prevent or reverse these degenerative diseases of aging.  Here is a list with the mainstream drug treatment offered.

List of the Degenerative Diseases                 Drugs Used

 Osteoarthritis  Naprosyn, Ibuprofen
 Osteoporosis  Fosamax Actonel
Vascular Disease
 Cognitive Dysfunction  Aricept
 Immune System Dysfunction  Cipro, Z-pack
 Loss of Libido  Viagra
 Depression  Prozac, Zoloft

Degenerative Disease Means Great Profits for Drug Companies

The major drug companies make most of their profits on blockbuster drugs aimed at one of the above degenerative diseases of aging.

BioIdentical Hormones Prevent Degenerative Diseases of Aging

Since all of these degenerative diseases are directly caused by hormonal decline, they can be prevented or reversed (at least partially reversed)  with the use of bio-identical hormones, representing direct economic competition with the drug industry which sells a drug for each degenerative disease (see above chart).

Natural Medicine Means Lost Profits for the Drug Industry

If bio-identical hormones were widely used, this would mean massive lost sales and lost profits for the drug industry.  It is not difficult to understand why there is animosity and competition between the drug industry and natural medicine, and especially between the drug industry and natural bioidentical hormones, with a raging information war going on.

For more on this topic, read my previous articles:

The Safety of Bio-Identical Hormones

Water Droplet Impact Jeffrey Dach MDThe Safety of Bio-Identical Hormones

by Jeffrey Dach MD
Are Women’s Bio-identical hormones safe? Bio-identical hormones exist naturally in the human body, so it is axiomatic that these are safe.  However, we are interested in a slightly different question. What is the safety of bio-identical hormones as routinely used in medical practice?  Let’s try to answer this question.

The Safety of Water compared to Bio-Identical Hormones

Water is safe, beneficial and required for health.  Yet, even so, drinking excess amounts of water causes death from Fatal Water Intoxication.(1)

Left Image: Water with Droplets Courtesy of Wikimedia

Similarly, just like water, bio-identical hormones are safe and beneficial when used at proper dosages.  Like excessive water, excessive hormone dosage may result in their own adverse side effects.  Excess estrogen, for example, causes fluid retention, breast sensitivity and enlargement, and  disordered mood.

Humans Have Bio-Identical Hormones.

Another answer to the safety question is that bio-identical hormones are found in the human body naturally.  Any harmful substance in the human body would impair survival, and over millions of years of evolution would be eliminated by natural selection.  This is the basic concept of Darwinian evolution which is accepted by mainstream medical science.

A 50 Million Year Medical Experiment

Consider the following medical experiment, performed over the last 50 million years with the help of our friend, Darwinian evolution.(2)  Bio-Identical Hormones have been present in the human body for 50 million years, and we humans are still here on the planet.  I would consider that a successful medical experiment, wouldn’t you?

Either Excess or Deficiency of Anything Can be Harmful

One of our routine labs tests called the Chem Panel measures electrolytes and glucose levels in the blood. The body automatically maintains these within narrow ranges to maintain health.  If levels deviate above or below these normal ranges, this causes a serious health disturbance.  For example elevated potassium levels causes cardiac arrest.  Magnesium deficiency causes muscle spasm and arrythmia. Excessive amounts of Vitamins A and D are toxic.  Hormones levels enjoy a considerably wide range of acceptable limits.  Even so, a deficiency or an excess of women’s bio-identical hormones can produce adverse symptoms.  This is called estrogen deficiency/excess, and progesterone deficiency/excess, and they each have typical signs and symptoms easily recognized.(3)

Common Signs of Estrogen Deficiency (4)

Mental fogginess
Minor anxiety
Mood change
Difficulty falling asleep
Hot flashes
Night sweats
Temperature swings
Day-long fatigue
Reduced stamina
Decreased sense of sexuality
Lessened self-image and attention to appearance
Dry eyes, skin, and vagina
Loss of skin radiance
Feel balanced 2nd part of cycle
Sagging breasts and loss of fullness
Pain with sexual activity
Weight gain
Increased back and joint pain
Episodes of rapid heartbeat
Headaches and migraines
Gastrointestinal discomfort

Common Signs of Excess Estrogen (takes longer to notice)

Breast tenderness or pain
Increased breast size
Water retention, fingers, legs
Impatient, snappy behavior, but with clear mind
Pelvic cramps

Common Signs of Progesterone Deficiency

No period at all (no ovulation)
The period comes infrequently (every few months)
Heavy and frequent periods (large clots, due to buildup in the uterus)
Spotting a few days before the period. (Progesterone level is dropping)
Cystic breasts
Painful breasts
Breasts with lumps
Most cases of endometriosis, adenomyosis, and fibroids.
Anxiety, irritability, nervousness and water retention

Above list courtesy of Uzzi Reiss MD OB GYN. (4)

No Reported Adverse Events from Bio-Identical Hormones

Over-the-counter pain pills (NSAIDs) such as aspirin, naproxen and ibuprofen are considered fairly safe.  After all, you don’t need a prescription to buy them, yet they cause an estimated 16,500 deaths in the US annually, mostly from gastric bleeding.(5)  Compare this to no reported adverse events from bio-identical hormones last year, according to an FDA press conference January 2008.(6)

Do Bio-Identical Hormones Cause Breast Cancer?(7)

Eiffel Tower Jeffrey Dach MDThe answer is no. According to the French Cohort study, there is no increase in breast cancer in women using bio-identical hormones.(8)  However, having said that, avoiding excess environmental estrogens as well as excessive estrogen levels from any source, is the key to preventing breast cancer.(9)  My previous article covers our program for breast cancer prevention which includes iodine supplementation, Indole-3-carbinol and fiber. To read about this, see: Iodine Prevents Breast Cancer (10)

Left Image: Eiffel Tower Paris France Courtesy of Wikimedia Commons

Do Bio-Identical Hormones Cause Heart Disease ?

Again, the answer is no. A study of CAT calcium scores by JoAnn E. Manson in the June 2007 JAMA actually showed less heart disease in the women taking unopposed estrogen (they had hysterectomies and were not given the synthetic progestins).(11)  These same results had already been published 2 years previously in a calcium score study by Budoff in J Womens Health 2005. (12)

Compounding Pharmacy statement

In Australia, the Pharmacy Board stipulate the minimum professional practice guidelines that apply to the field of compounding. These standards ensure that the ingredients are of a quality standard and purchased through reputable suppliers, that an appropriately trained professional is preparing the product and that a number of checks are in place to ensure accountability. These are minimum standards. Larger more established compounding labs like the Dallas Parade Compounding Pharmacy (, go several steps further in the quality assurance of compounded medications.

Dallas Parade Compounding Pharmacy is a member of the Professional Compounding Chemists of America/Australia (PCCA) Standards Program. The Standards Program stipulates operating procedures for all aspects of compounding and includes requirements for independent testing of products made in our lab. At Dallas Parade Compounding Pharmacy, we only buy ingredients through PCCA, who supply the highest quality pharmaceutical grade ingredients that undergo the most rigorous testing in the industry.

We are one of only a handful of compounding pharmacies in Australia who meet the strict criteria of the PCCA Standards program, providing a level of confidence in the quality and safety of our compounded medications that significantly exceeds what is required by the Pharmacy Board guidelines.

Compounded HRT and the Sunday Newspapers.(part 2)

 My blood pressure has settled down since reading the article on HRT (specifically compounded HRT) causing cancer in the Sunday Papers. Those of you who follow my blogs, which should be all of you, will know that I have repeatedly published studies from reputable journals about the safety of the hormones that I use, in the way that I use it. I am also aware that not all doctors have the experience and knowledge that I do, and some do not prescribe bioidentical hormones (BHRT) in a safe or proper manner. Some doctors have jumped aboard the BHRT bandwagon without the required skills. These doctors have given the BHRT a bad name generally. I suspect the article is mostly aimed at these doctors. However, “cowboy”operators occur everywhere, and not only medicine.
Oestrogen should never be given to someone who has a uterus, without progesterone.  Oestrogen on its own can cause endometrial cancer. I am surprised at the number of times I have seen women who have not received progesterone, only oestrogen, from their doctors. This is a recipe for disaster. The amount of progesterone also needs to be adequate to have the protective effect. This is best monitored by regular blood testing. Saliva testing is not adequate and part of the poor practices I am talking about. For 25 years I have used Micronised Progesterone (natural progesterone) as being the safest and best form of progesterone. I have been attacked by the medical establishment, at conferences and the media for the use of “”unsafe and untried BHRT.”  Now a commercial Micronised Progesterone is available in Australia, and it has suddenly being hailed as the safest and best form of progesterone. The hypocrisy is amazing.
The other issue is how hormones are given. The safest and best way is transdermal, as a troche or a cream. Doctors who give it in any other way risk increasing the cancer rate. Also, the evidence is that BHRT should be continuous ( no week off) as any monthly break from the BHRT can increase the uterine cancer rate.
I have repeatedly mentioned that some compounding chemists are not as good as others – just as not all bakeries have the same quality of products.  For this reason it is important that you use one of the recommended pharmacies, because I have found them to have the best services and quality of hormones.
As I mentioned yesterday, I have only had one women develop endometrial cancer in the last 25 years, and this can be verified by authorized researchers from my database on my computer of all the women I have treated with BHRT over the last 25 years.
Finally, articles like the one on the weekend, do a great disservice to women, as it will scare many women away from taking HRT of any sort. These women will suffer a decreased quality of life, and many a premature death from avoiding HRT. The article below, from the American Journal of Public health and Yale university(how much more prestigious does that get) gives the actual figures, which are very concerning.
Am J Public Health. 2013 Sep;103(9):1583-8. doi: 10.2105/AJPH.2013.301295. Epub 2013 Jul 18.

The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years.

Author information

Departments of Obstetrics and Gynecology and Psychiatry, Yale University School of Medicine, New Haven, CT, USA.



We examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years.


We derived a formula to relate the excess mortality among hysterectomized women aged 50 to 59 years assigned to placebo in the Women’s Health Initiative randomized controlled trial to the entire population of comparable women in the United States, incorporating the decline in estrogen use observed between 2002 and 2011.


Over a 10-year span, starting in 2002, a minimum of 18 601 and as many as 91 610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET).


ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall. Our data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years. Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency.


Cancer Prev Res (Phila). 2014 Oct;7(10):1045-55. doi: 10.1158/1940-6207.CAPR-14-0054. Epub 2014 Jul 28.

Progesterone inhibits endometrial cancer invasiveness by inhibiting the TGFβ pathway.

Author information

Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Division of Gynecologic Oncology, and Gynecologic Cancer Translational Research Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland.
Department of Obstetrics and Gynecology and Women’s Health Integrated Research Center, Inova Fairfax Hospital, Falls Church, Virginia.
Division of Gynecologic Oncology, North Shore University Health System, University of Chicago, Evanston, Illinois.
Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Department of Molecular and Cell Biology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.


Increased expression of TGFβ isoforms in human endometrial cancer correlates with decreased survival and poor prognosis. Progesterone has been shown to exert a chemoprotective effect against endometrial cancer, and previous animal models have suggested that these effects are accompanied by changes in TGFβ. The goal of this study was to characterize the effect of progesterone on TGFβ signaling pathway components and on TGFβ-induced protumorigenic activities in endometrial cancer cell lines. Progesterone significantly decreased expression of three TGFβ isoforms at 72 hours after treatment except for TGFβ2 in HEC-1B and TGFβ3 in Ishikawa cells. Progesterone treatment for 120 hours attenuated expression of the three isoforms in all cell lines. Progesterone exposure for 72 hours reduced expression of TGFβ receptors in HEC-1B cells and all but TGFβR1 in Ishikawa cells. Progesterone reduced TGFβR3 expression in RL-95 cells at 72 hours, but TGFβR1 and βR2 expression levels were not affected by progesterone at any time point. SMAD2/3 and pSMAD2/3 were substantially reduced at 72 hours in all cell lines. SMAD4 expression was reduced in RL-95 cells at 24 hours and in HEC-1B and Ishikawa cells at 72 hours following progesterone treatment. Furthermore, progesterone effectively inhibited basal and TGFβ1-induced cancer cell viability and invasion, which was accompanied by increased E-cadherin and decreased vimentin expression. An inhibitor of TGFβRI blocked TGFβ1-induced effects on cell viability and invasion and attenuated antitumor effects of progesterone. These results suggest that downregulation of TGFβ signaling is a key mechanism underlying progesterone inhibition of endometrial cancer growth.

Compounding Pharmacies


I have asked some compounding chemists to respond to the attack on their integrity. Here is the reply from ACPharm (which many of you use)

Here is some information about Compounding and it’s regulations in Australia.

Compounding in Australia is regulated by the state governments and require that a registered pharmacist is the owner. Pharmacists need to ensure they abide by the Professional Practice Standards which include regulations regarding compounding and the supply of compounded products to the public on prescription. All ingredients must be purchased from TGA approved suppliers and the appropriate protocols must be followed to ensure a quality product to the customer.
Smaller compounders are not as highly regulated and may not be following the guidelines correctly, however larger more experienced compounders have strict Standard operating procedures to ensure a high quality product is obtained with each compound. Many larger compounders like ACPHARM QLD also send the raw materials to third party labs to test to ensure the potency and quality of the ingredients before it is used. ACPHARM QLD also test all compounding methods and the end product to ensure it is properly mixed and maintains its integrity until it’s best before date.