Monthly Archives: December 2018

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When should you throw away leftovers?

Dec 31

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By Merrimon Crawford

Author

  1. Enzo Palombo Professor of Microbiology, Swinburne University of Technology

Disclosure statement

Enzo Palombo receives funding from Dairy Food Safety Victoria.

Victoria State Government
Swinburne University of Technology

Refrigeration is the most important invention in the history of food. But while commercial and home refrigerators have only been used for the past 100 years or so, people have long used cool natural environments to store foods for extended periods.

Temperature is important for controlling microbial growth. Just as we find food wholesome, bacteria and fungi also enjoy the nutritional benefits of foods. They will consume the food and multiply, eventually “spoiling” the food (think mouldy bread or slimy lettuce).

Read more: How to keep school lunches safe in the heat

If the microbe can cause disease – such as Salmonella, Campylobacter, E. coli or Listeria – you’re at risk of food poisoning. Most disease-causing microbes can grow to dangerous levels even before the food is noticeably spoiled without changing the smell, taste or appearance of the food.

How to stop bugs growing in our food

All forms of life require a few basic things to grow: a source of energy, (sugar for us, sunlight for plants), oxygen (for higher forms of life), water and simple chemical building blocks that provide nitrogen, phosphorous and sulphur – and the correct temperature. Water is key, and denying it severely restricts microbial growth.

That’s why salt has long been used as a preservative for perishable foods like meats; salt binds the water and makes it unavailable to microbes. Acid can also be used (via pickling or fermentation), as most microbes don’t like acidic conditions.

Don’t delay – put it in the fridge as soon as you can. Gary Perkin/Shutterstock

Of course, cooking kills the microbes of concern, but they can contaminate and grow in the food afterwards.

If the food can’t be salted or pickled, or you have leftovers of cooked food, you’ll need to store the food at a temperature microbes don’t like. Refrigeration is the most effective and economical option.

Typically, the greater the moisture level, the more perishable the food. That’s why we can store dry foods (such as nuts) in the cupboard but high-moisture foods (such as fresh meat, vegetables) will quickly spoil if unrefrigerated.

Read more: Food safety: are the sniff test, the five-second rule and rare burgers safe?

How to store food safely

The “danger zone” is the temperature range between 5°C and 60°C, where most common food poisoning bacteria like to grow. To avoid the danger zone, keep hot foods above 60°C and store foods below 5°C.

The two-hour/four-hour guidelines can also help avoid food poisoning from leftovers. If perishable food has been in the danger zone for:

  • less than two hours, use it immediately or store it appropriately
  • two to four hours, use it immediately
  • longer than four hours, discard it.

So, if the food has been sitting on the table after a long lunch on a warm day, it’s probably best to discard or consume it soon afterwards.

If the food is OK, store it in small portions, as these will reach the right temperature sooner than larger volumes, before refrigerating or freezing.

Read more: Monday’s medical myth: leave leftovers to cool before refrigerating

Using some common sense, and understanding how microbes grow, can help avoid a nasty case of diarrhoea – or worse. All food business must comply with food safety standards but how we prepare, store and consume food in our homes is equally important in preventing food-borne illness

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Olive oil consumption and human health: A narrative review.

Dec 12

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Maturitas. 2018 Dec;118:60-66. doi: 10.1016/j.maturitas.2018.10.013. Epub 2018 Oct 26.

Olive oil consumption and human health: A narrative review.

Foscolou A1, Critselis E1, Panagiotakos D2.

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Abstract

The potential health benefits of olive oil consumption, particularly within the context of the Mediterranean diet, have been extensively investigated. However, its specific health benefits remain to be confirmed. The aim of the present work is to review the scientific evidence regarding the specific impact of olive oil consumption on human health, including the prevention of cardiovascular disease, cancers, and diabetes mellitus. Ten related meta-analyses were reviewed to this effect. Olive oil consumption was found to be beneficial for several chronic non-communicable diseases (e.g. including cardiovascular disease, breast cancer and type 2 diabetes), whereas there were contradictory findings regarding its impact on several biomarkers.

In conclusion, the aggregated evidence supports the assertion that olive oil consumption is beneficial for human health, and particularly for the prevention of cardiovascular diseases, breast cancer, and type 2 diabetes mellitus.

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Which medicines don’t go well with flying?

Dec 10

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Which medicines don’t go well with flying?

•

Nial Wheate

Author

  1. Nial Wheate is a Friend of The Conversation.

    Associate Professor | Program Director, Undergraduate Pharmacy, University of Sydney

Disclosure statement

Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is affiliated with the Royal Australian Chemical Institute.

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Every day, more than 10 million people take a flight somewhere in the world. While flying is relatively safe, the unique environmental conditions can put passengers at risk if they’re taking certain medications.

These include any hormone-based drugs, like the contraceptive pill and some fertility medicines, and drugs used to prevent heart attack and stroke. Antihistamines should also not be used to help passengers sleep during a flight.

What makes flying different from other forms of travel?

While flying is one of the safest forms of travel, there are specific risks that come with air travel, regardless of the length of the flight.

Passenger planes are typically pressurised to the same atmospheric conditions that are found at 10,000 feet altitude. At that level, the effective oxygen level is only 14.3%, which is much lower than the 20.9% found at ground level.

An additional risk is reduced blood flow from a lack of movement and sitting in cramped conditions, unless of course you’re fortunate enough to be in business or first class. And finally, dehydration is also a common side effect of flying due to the lack of humidity in the air.

When these conditions are combined, it results in an increased risk of deep vein thrombosis, which is also known as DVT. This is a type of blood clot that occurs in the veins deep in the body and occurs most often in the legs. The development of a blood clot can result in blocked blood flow to the lungs, heart, or brain, which in turn can cause a heart attack or stroke.

Read more: Explainer: what is deep vein thrombosis?

Contraceptive pill and other hormone-based medicines

Given the inherent risk of a blood clot when flying, a passenger should use with caution any medication that can further increase the risk of a clot.

Some brands of contraceptive for women (tablet or implant formulation) are known to increase the chances of a blood clot, although the overall increase in risk is small. While it’s thought the major risk comes from the hormone estrogen, a review of all the medical evidence in 2014 showed there’s a risk of blood clot from all contraceptive medicines.

It’s important you talk to your doctor about flying if you take hormonal medicines. from http://www.shutterstock.com

Likewise, hormone replacement therapy, particularly those that include estrogen, or some fertility medicines, such as gonadotrophins, can increase the risk of a blood clot.

If you take one of these medicines, it does not mean you cannot fly, nor that you should necessarily stop taking the drug. Many millions of women fly while taking these medicines and suffer no ill effects.

But the risk is also increased if you have an underlying health condition that includes type II diabetes, heart disease, and prior heart attacks or strokes. As such, passengers who also take medications to help prevent heart attacks and strokes should consult their doctor or pharmacist before flying.

If you’re at increased risk of a blood clot, then an anti-platelet medication may be suitable for you. These medicines act by stopping the blood cells from sticking together and include prescription medicines such as warfarin and clopidogrel, and over-the-counter medicines such as low dose aspirin.

Antihistamines

Many passengers can have trouble sleeping when flying, especially on long-haul flights. Parents flying with young children can also be concerned about them not sleeping or being unsettled and annoying other passengers.

In these instances, many will turn to sedating antihistamines, like promethazine to try to induce sleep. But this is a bad option.

The Australian Medical Association specifically recommends parents do not do this, as sometimes it can have the reverse effect and make children less sleepy and more active. These types of antihistamines are also known to depress breathing, and in the low oxygen environment of the aircraft this can be especially dangerous.

If you feel you or another family member will need sedation when flying, don’t use an antihistamine. Consult your doctor or pharmacist for a more suitable medication. Examples include prescription sleeping tablets, such as melatonin, or natural remedies, such as valerian.

Read more: Prepare for a healthy holiday with this A-to-E guide

What to do before and during your flight

Before you fly, if you’re taking any form of medication, it’s recommended you meet with your doctor or pharmacist to discuss the suitability of your medicines. They may advise you there’s little risk for you, or if there is a risk, they may recommend a different medicine for the trip or recommend a new medicine to reduce the risk of blood clots.

During your flight, don’t take antihistamines, and reduce your chance of a blood clot by drinking lots of water, stretching in your seat, and moving about the cabin as much as is appropriate.

Finally, the effects of alcohol can be increased when flying – so drink in moderation, and try to avoid tea, coffee, and other caffeinated drinks as these can have dehydrating effects and make it harder to sleep.

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Hormones and weight gain

Dec 9

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Climacteric. 2018 Nov 27:1-14. doi: 10.1080/13697137.2018.1514003. [Epub ahead of print]

Impact of micronized progesterone on body weight, body mass index, and glucose metabolism: a systematic review.

Coquoz A1, Gruetter C2, Stute P1.

Author information

Abstract

In women, body weight increases with age. Often menopausal hormone therapy (MHT) is blamed for enhancing this effect. In recent years, the debate on bioidentical MHT including micronized progesterone (MP) has increased. Among others, the question has been raised of whether MHT containing MP has an impact on body weight and glucose metabolism. Based on a systematic literature review on the impact of MHT containing MP on body weight, body mass index (BMI), and glucose metabolism, the following conclusions can be drawn:

estrogens combined with MP (1) either do not change or reduce body weight in normal weight postmenopausal women, (2) do not change BMI in normal and overweight postmenopausal women,

(3) do not change or improve fasting serum glucose levels in (non-)diabetic postmenopausal women, (4) do not change or improve fasting serum insulin levels in (non-)diabetic postmenopausal women, and (5) do not have an impact on serum glycated hemoglobin in postmenopausal diabetic women. This beneficial effect is probably mostly due to the estrogen MHT component.

KEYWORDS:

Micronized progesterone; body mass index; body weight; glucose metabolism; hormone therapy; menopause

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A dry vagina.

Dec 5

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Climacteric. 2018 Nov 19:1-6. doi: 10.1080/13697137.2018.1527306. [Epub ahead of print]

What should guide our patient management of vulvovaginal atrophy?

Shapiro M1.

Author information

Abstract

Genitourinary syndrome of menopause including vulvovaginal atrophy is commonly experienced by postmenopausal women, reducing their quality of life. The aim of this review is to assess current treatment options within the framework of recent management guidelines. Recommendations include use of treatments addressing both symptoms and the underlying pathophysiology, and proactive patient discussion. Both prescription and non-prescription options are recognized, including non-hormone-based approaches. Local therapy is preferable in the primary treatment of genitourinary syndrome of menopause symptoms as risk of adverse events is reduced, although long-term safety data are limited. Management of patients with a history of breast cancer requires careful consideration, although estrogen therapy has not been associated with increased risk of breast cancer or of recurrence. Treatment should consider ongoing cancer therapy. As multiple, comparable options exist, treatment choice may be due to experience and patient preference. Best management requires effective patient-physician communication and shared decision-making.

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Should healthy people take probiotic supplements?

Dec 3

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Health Check: should healthy people take probiotic supplements?

Chris Irwin, Corneel Vandelanotte, and Saman Khalesi

Authors

  1. Lecturer in Nutrition and Dietetics, School of Allied Health Sciences, Griffith University

  2. Professorial Research Fellow: Physical Activity and Health, CQUniversity Australia

  3. Lecturer in Nutrition, CQUniversity Australia

Disclosure statement

Chris Irwin has previously received probiotic and prebiotic products from Health World Limited (the manufacturers of Inner Health Plus) to conduct research into the impact of probiotics on alcohol metabolism.

Corneel Vandelanotte receives funding from Queensland Health (for maintaining the 10,000 Steps Australia program), the National Health and Medical Research Council (project funding) and the National Heart Foundation of Australia (salary support). He does not receive any funding or support from probiotics manufacturers or suppliers.

Saman Khalesi has previously received probiotic and prebiotic products from Health World Limited (the manufacturers of Inner Health Plus) to conduct research into the impact of probiotics on alcohol metabolism.

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A visit to the supermarket these days can feel more like walking through a pharmacy, with an ever-expanding range of milks, yoghurts, pills, powders and speciality foods promoting their “probiotic” prowess.

Advocates of probiotics have hailed them as the answer to all sorts of health issues and conditions. But what exactly are probiotics? And, more importantly, should you be taking them?

Read more: What supplements do scientists use, and why?

Probiotics are scientifically defined as “live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host”. In simple terms, they’re “good” bacteria that are beneficial to the body.

Probiotics exist naturally in some foods (such as some types of yoghurt and fermented vegetables such as pickles and sauerkraut), but can also be taken in dietary supplement form, via products such as Yakult and Inner Health Plus.

While our digestive system ordinarily contains trillions of microbes, including both “good” and “bad” bacteria, sometimes the balance between these can get out of whack. Diseases, poor lifestyle behaviours (such as not eating enough fruit and vegetables, heavy drinking, smoking, and physical inactivity) and ageing can all disrupt this balance.

By many accounts, probiotics can improve the number and diversity of “good” gut bacteria that help to keep our digestive system healthy and working efficiently. As such, probiotics have been proposed to:

However, most scientific research on the health benefits of probiotic supplementation seems to have been done in people with existing health problems. Evidence supporting the health benefits of probiotics in healthy adults is very limited. Probiotic supplements are most likely to be consumed by the general (and otherwise healthy) population, despite this group receiving relatively little documented benefit.

Read more: Poo transplants and probiotics – does anything work to improve the health of our gut?

We reviewed the scientific literature (45 original studies) on probiotic supplementation in healthy adults. Our findings, published in the European Journal of Clinical Nutrition, found that giving healthy adults live bacteria (either in yoghurt, capsules, or drinks) can have a few benefits:

1) it can increase the concentration of “good” bacteria. So, if an imbalance of digestive system bacteria does occur in healthy adults (due to poor lifestyle, the use of antibiotics, or ageing), probiotic supplementation may help restore the balance

2) it can reduce abdominal discomfort caused by irregular bowel movements and constipation

3) it can increase the population of “good” bacteria in and around the vagina. From the four studies conducted in this area, all four demonstrate improvements in vaginal lactobacilli after probiotic capsules or suppositories were used. This may help prevent urinary tract infection and bacterial vaginosis

4) there is some evidence that it can boost the immune system, and help reduce the incidence, duration and severity of the common cold. While the exact mechanism for this is not clear, probiotics might influence immune responses by stimulating production and improving activity of cells that fight respiratory infections. But only three studies have shown these benefits in healthy adults.

While this sounds like great news for probiotics, let’s not get carried away. Our review also found the changes appear to be short-lived. In other words, you need to keep taking the probiotic supplements for the effects to last. If you stop taking them, your gut bacteria are likely return to their pre-supplementation condition within one to three weeks.

Foods high in fibre feed healthy bacteria. Toa Heftiba

You may be able to get longer-lasting changes by “feeding the healthy bacteria”. Like all living organisms, bacteria need food to survive. Foods that are high in dietary fibre, such as fruit and vegetables, can be used as energy sources (or so called “prebiotics”) for these bacteria.

We also found little evidence that probiotic supplements can reduce cholesterol in healthy adults. And there is little evidence to show that probiotics can improve glucose (blood sugar) and insulin responses in healthy adults. Taking probiotics won’t reduce heart disease risk, or prevent you from developing type 2 diabetes.

Read more: Plain, Greek, low-fat? How to choose a healthy yoghurt

So if you have a poor diet (you eat too much take-away food and not enough fruit, vegetables and whole-grain products, or you drink alcohol too much and too often) and don’t exercise regularly, your digestive bacteria may benefit from probiotic supplements, though you’ll have to keep taking them to get lasting effects.

But if you are otherwise healthy, probiotic supplements are likely to be a waste of money. Here’s some simple advice: take what you spend on probiotic supplements, and use it to buy and eat more fruit and vegetables.

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PEA for chronic pain

Dec 2

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This is an interesting natural substance which shows great promise in treating chronic pain, It is much safer with less harmful side effects than most of the other painkillers used. It is available on prescription from someone familiar with its use. It costs about $100 for 2-3 months, so is not cheap.

J Pain Res. 2012; 5: 437–442. Published online 2012 Oct 26. doi:  [10.2147/JPR.S32143]PMCID: PMC3500919PMID: 23166447

Therapeutic utility of palmitoylethanolamide in the treatment of neuropathic pain associated with various pathological conditions: a case series

Jan M Keppel Hesselink and Thecla AM HekkerAuthor informationCopyright and License informationDisclaimerThis article has been cited by other articles in PMC.Go to:

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VideoKeywords: endocannabinoid, chronic, neuropathy, chemotherapy, itch, polyneuropathyGo to:

Abstract

Palmitoylethanolamide (PEA), an endogenous fatty acid amide, has been demonstrated to bind to a receptor in the cell nucleus – the peroxisome proliferator–activated receptor – and performs a great variety of biological functions related to chronic and neuropathic pain and inflammation, as has been demonstrated in clinical trials. These include peripheral neuropathies such as diabetic neuropathy, chemotherapy-induced peripheral neuropathy, carpal tunnel syndrome, sciatic pain, osteoarthritis, low-back pain, failed back surgery syndrome, dental pains, neuropathic pain in stroke and multiple sclerosis, chronic pelvic pain, postherpetic neuralgia, and vaginal pains. Probably due to the fact that PEA is an endogenous modulator as well as a compound in food, such as eggs and milk, no serious side effects have been reported, nor have drug–drug interactions. This article presents a case series describing the application and potential efficacy and safety of PEA in the treatment of various syndromes associated with chronic pain that is poorly responsive to standard therapies.Go to:

Introduction

Chronic pain and neuropathic pain are indications for which there is high need in the clinic, and as Loeser put it boldly recently, “… the lack of evidence for the outcomes of most of the things providers do for patients” is one of the preeminent crises in pain management today.1 Indeed, many patients suffering from neuropathic conditions have pain that is refractory to existing treatments.2 In this context, palmitoylethanolamide (PEA), an endogenous fatty acid amide, is emerging as a novel agent in the treatment of pain and inflammation. The compound was used many decades ago in some countries, but due to a lack of insight in its mechanism of action, interested weaned. Since the 1990s, interest has surged again due to the discovery of its effects in many different animal paradigms for pain and chronic inflammation. It is classified as a food for medical purposes or as a diet supplement in various countries of Europe. PEA has shown efficacy in many different preclinical animal models for chronic and neuropathic pain, and most importantly is effective in reducing pain in man in various clinical trials in a variety of pain states.3 The main target of PEA is thought to be the peroxisome proliferator-activated receptor alpha (PPAR-α).4 This receptor is a regulator of gene networks which control pain and inflammation5, probably by switching off the nuclear factor-kappaB signaling cascade,4–7 a key element in the transcription of genes for proinflammatory mediators (cytokine, chemokines, nitric oxide). PEA also has affinity to cannabinoid-like G protein-coupled receptors GPR55 and GPR119.8 PEA can influence ion channels (eg, potassium channels) that play a role in pain.9 Furthermore, PEA might desensitize transient receptor potential cation channel subfamily V member 1 channels on sensory neurons.10,11

PEA anti-inflammatory actions allowing for a reduction of peripheral and central sensitization are mediated via both neuronal and nonneuronal cells. The latter comprise glia (in particular microglia, which are the brain’s macrophages) as well as peripheral and central mast cells.12–15 This profile of PEA may thus explain its broad potential in treating many different disorders related to pain and inflammation.16

Based on this knowledge, we selected a number of pain treatment-resistant patients and started adding PEA to the analgesic treatment regime. This paper presents seven different clinical cases, six of which showed a clear beneficial effect of PEA

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