Monthly Archives: April 2018

Quantifying the benefits and harms of screening mammography.

I have covered the benefits and harms from screening mammography over the years (see my web site) but more recent information is very interesting. Note – this only refers to screening mammography.  If you have a lump or other abnormality of the breast, mammography is essential.
JAMA Intern Med. 2014 Mar;174(3):448-54. doi: 10.1001/jamainternmed.2013.13635.

Quantifying the benefits and harms of screening mammography.


Like all early detection strategies, screening mammography involves trade-offs. If women are to truly participate in the decision of whether or not to be screened, they need some quantification of its benefits and harms. Providing such information is a challenging task, however, given the uncertainty–and underlying professional disagreement–about the data. In this article, we attempt to bound this uncertainty by providing a range of estimates-optimistic and pessimistic–on the absolute frequency of 3 outcomes important to the mammography decision: breast cancer deaths avoided, false alarms, and overdiagnosis. Among 1000 US women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly. We hope that these ranges help women to make a decision: either to feel comfortable about their decision to pursue screening or to feel equally comfortable about their decision not to pursue screening. For the remainder, we hope it helps start a conversation about where additional precision is most needed.

The use of proton pump inhibitors is positively associated with osteoporosis in postmenopausal women in Germany

 Proton pump inhibitors (PPI) are used for gastric reflux(heart-burn) and too much stomach acid. In Australia they go by the name Nexium, Losec, Somac and other generic names.

Climacteric. 2016 Jun 29:1-4. [Epub ahead of print]

The use of proton pump inhibitors is positively associated with osteoporosis in postmenopausal women in Germany.

Author information

  • 1a Department of Biology , École Normale Supérieure de Lyon , Lyon , France ;
  • 2b Department of Bone Oncology, Endocrinology and Reproductive Medicine , Nordwest Hospital Frankfurt , Germany ;
  • 3c IMS Health , Real World Evidence Solutions , Frankfurt , Germany.



To analyze the association between the use of proton pump inhibitors (PPIs) and osteoporosis in German postmenopausal women.


This study included 3092 women with osteoporosis and 3092 women without osteoporosis. Cases and controls were matched on the basis of age, health insurance, index year, and physician. The main outcome of the study was the risk of osteoporosis dependent on predefined risk factors. Gastrointestinal disorders potentially associated with osteoporosis were determined. The presence of PPIs including the duration of therapy was also assessed. Multivariate logistic regression models were fitted with osteoporosis as a dependent variable.


The mean age was 72.3 years; 5.6% of both osteoporosis patients and controls had private health insurance coverage. Gastrointestinal disorders occurred significantly more frequently in osteoporosis patients than in controls. The use of PPI drugs was also significantly more common in osteoporosis patients than in matched controls. Osteoporosis development was found to be associated with disorders of the esophagus (odds ratio (OR) 1.19, p = 0.013) and gastritis/duodenitis (OR 1.14; p = 0.045). Interestingly, the use of PPIs also led to an increase in the risk of developing osteoporosis (OR 1.62; p < 0.001). Finally, the odds of being diagnosed with osteoporosis increased with the duration of PPI therapy from 1.58 for 1 year of therapy or less to 1.72 for at least 5 years of treatment.


The use of PPIs was a risk factor for osteoporosis and this risk increased with therapy duration in German women. Esophagus disorders and gastritis/duodenitis also increased the risk of developing this chronic condition.


Germany; Proton pump inhibitors; osteoporosis; postmenopausal women

Fact or fiction – is sugar addictive?



Fact or fiction – is sugar addictive?

February 22, 2017 8.08pm AEDT

Some of us can definitely say we have a sweet tooth. Whether it’s cakes, chocolates, cookies, lollies or soft drinks, our world is filled with intensely pleasurable sweet treats. Sometimes eating these foods is just too hard to resist.

As a nation, Australians consume, on average, 60 grams (14 teaspoons) of table sugar (sucrose) a day. Excessive consumption of sugar is a major contributor to the increasing rates of obesity in both Australia and globally.

Eating sugary foods can become ingrained into our lifestyles and routines. That spoonful of sugar makes your coffee taste better and dessert can feel like the best part of dinner. If you’ve ever tried to cut back on sugar, you may have realised how incredibly difficult it is. For some people it may seem downright impossible. This leads to the question: can you be addicted to sugar?

Sugar activates the brain’s reward system

Sweet foods are highly desirable due the powerful impact sugar has on the reward system in the brain called the mesolimbic dopamine system. The neurotransmitter dopamine is released by neurons in this system in response to a rewarding event.

Drugs such as cocaine, amphetamines and nicotine hijack this brain system. Activation of this system leads to intense feelings of reward that can result in cravings and addiction. So drugs and sugar both activate the same reward system in the brain, causing the release of dopamine.

This chemical circuit is activated by natural rewards and behaviours that are essential to continuing the species, such as eating tasty, high energy foods, having sex and interacting socially. Activating this system makes you want to carry out the behaviour again, as it feels good.

Our brain systems encourage us to undertake activities that will continue our species – such as eating high energy foods. from

The criteria for substance use disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) cites a variety of problems that arise when addicted to a substance. This includes craving, continuing use despite negative consequences, trying to quit but not managing to, tolerance and withdrawal. Although sugary foods are easily available, excessive consumption can lead to a number of problems similar to that of addiction. So it appears sugar may have addictive qualities. There is no concrete evidence that links sugar with an addiction/withdrawal system in humans currently, but studies using rats suggest the possibility.

Sweet attractions

Dopamine has an important role in the brain, directing our attention towards things in the environment like tasty foods that are linked to feelings of reward. The dopamine system becomes activated at the anticipation of feelings of pleasure.

This means our attention can be drawn to cakes and chocolates when we’re not necessarily hungry, evoking cravings. Our routines can even cause sugar cravings. We can subconsciously want a bar of chocolate or a fizzy drink in the afternoon if this is a normal part of our daily habits.

Sugar tolerance

Repeated activation of the dopamine reward system, for example by eating lots of sugary foods, causes the brain to adapt to the frequent reward system stimulation. When we enjoy lots of these foods on a regular basis, the system starts to change to prevent it becoming overstimulated. In particular, dopamine receptors start to down-regulate.

Now there are fewer receptors for the dopamine to bind to, so the next time we eat these foods, their effect is blunted. More sugar is needed the next time we eat in order to get the same feeling of reward. This is similar to tolerance in drug addicts, and leads to escalating consumption. The negative consequences of unrestrained consumption of sugary foods include weight gain, dental cavities and developing metabolic disorders including type-2 diabetes.

Quitting sugar leads to withdrawal

Sugar can exert a powerful influence over behaviour, making cutting it out of our diets very difficult. And quitting eating a high sugar diet “cold turkey” leads to withdrawal effects.

Sugar can trigger similar addictive responses as do drugs. from

The length of unpleasant withdrawal symptoms following a sugar “detox” varies. Some people quickly adjust to functioning without sugar, while others may experience severe cravings and find it very difficult to resist sugary foods.

The withdrawal symptoms are thought to be factors of individual sensitivity to sugar as well as the dopamine system readjusting to a sugar-free existence. The temporary drop in dopamine levels are thought to cause many of the psychological symptoms including cravings, particularly as our environment is filled with sweet temptations that you now have to resist.

Why quit sugar?

Cutting sugar from your diet may not be easy, as so many processed or convenience foods have added sugars hidden in their ingredients. Switching from sugar to a sweetener (Stevia, aspartame, sucralose) can cut down on calories, but it is still feeding the sweet addiction. Similarly, sugar “replacements” like agave, rice syrup, honey and fructose are just sugar in disguise, and activate the brain’s reward system just as readily as sucrose.

Physically, quitting sugar in your diet can help with weight loss, may reduce acne, improve sleep and moods, and could stop those 3pm slumps at work and school. And if you do reduce sugar consumption, sugary foods that were previously eaten to excess can taste overpoweringly sweet due to a recalibration of your sweetness sensation, enough to discourage over-consumption!