Monthly Archives: July 2019
Featured Articles in Internal Medicine In the News
How to treat pain without medication
Naveed Saleh, MD, MS, for MDLinx | July 19, 2019
Medical pain management is in a time of crisis. The opioid epidemic has spooked providers about prescribing opioids. Issues like dependence, diversion, and overdose plague physician efforts to curb the pervasiveness of pain and onerous burden of inadequate pain treatment. Furthermore, the costs of treating this pain are ballooning, and various state and federal agencies—including the CDC, FDA, NIH, DOD, and VHA—have stepped in to manage the repercussions of pain management care.
The efficacy of nonpharmacologic treatments for pain has been demonstrated in many studies, and their use is suggested for the treatment of common pain conditions, including lower back pain, knee osteoarthritis, and headache.
Pressure exists among physicians to use non-pharmacologic pain management. With that in mind, here are six options to consider.
Acupuncture is the insertion and manipulation of solid needles at specified points on the body. With acupuncture, stimulation can be applied via electricity, pressure, and heat. It is sometimes combined with other traditional remedies, including cupping, moxibustion, and herbal medicines. Acupuncture is based on ancient Asian calculus focusing on the inter-relationship of organs, body points, channels, associated symptoms, disability, and disease.
Various meta-analyses have demonstrated that acupuncture is effective in treating post-surgical pain. According to the research, acupuncture reduces opioid need at 8 hours post-op by 21% and at 72 hours by 29%.
Acupuncture is also effective at treating chronic pain. For instance, based on the results of meta-analysis, the American College of Physicians recommends it for the first-line treatment of lower back pain. Furthermore, research has shown that acupuncture is comparable to drugs when treating acute back pain in the emergency department. Other lines of research support the use of acupuncture to treat migraine, burns, and acute injuries.
- See Also: 7 clinically proven natural remedies
Acupuncture has a low rate of negative side effects. In fact, some people who receive the intervention claim to feel elation and relaxation post-treatment. Incidences of infection and pneumothorax trace back to the inexperience of the practitioner. Of note, some people feel itching at the point where the needle is inserted.
With massage therapy, soft tissue structures are manipulated to prevent or alleviate pain, spasm, tension, and stress to enhance wellness. Researchers of a systematic review spanning 16 studies found that massage therapy was effective compared with active comparators in reducing pain intensity/severity and anxiety in patients undergoing surgery. Massage therapy is safe, with low rates of muscle soreness and other minor complaints.
The effects of music on pain has proven to be a buzzworthy topic in media coverage. A meta-analysis of 97 studies on many different types of pain—acute, procedural, cancer, and chronic—showed significant reductions in pain intensity, emotional distress, analgesic use, and opioid/non-opioid pain medicine intake. Other research has shown that music therapy can decrease post-Caesarean pain.
This intervention serves as a distraction to pain by immersing the patient in a three-dimensional, digital environment. According to the research, when paired with standard anesthesia, virtual reality has been shown to help with the reduction of burn-induced pain and burn-wound care in children and adults alike. Virtual reality has also shown promise in inpatient cancer care. Researchers of one study found that virtual reality-assisted burn and non-burn wound care compared with no virtual reality yielded a reduction in opioid need by 39%. Levels of anxiety and pain, however, were comparable.
To avoid collision and injury while using virtual reality, designated safe areas and spotters can be used. Moreover, children and those sensitive to the effects of the immersive experience should be educated following treatment.
Spinal manipulative therapy
This intervention falls within the domain of chiropractors and osteopathic physicians. It involves the treatment of joints in the body with high velocity, low amplitude thrust techniques, in addition to low velocity, low amplitude joint mobilization techniques.
Researchers of systematic reviews have found that spinal manipulative therapy is effective for the treatment of lower back pain, neck pain, sprains, plantar fasciitis, headache, knee and hip osteoarthritis, and more. Adverse effects of this intervention are usually minor and related to soreness or transient heightening in pain. Rarely, spinal manipulation can lead to cervical artery dissection, neck injury, and stroke.
Biofeedback for chronic pain entails training the patient to manipulate body physiology (ie, heart rate and muscle tension) by means of a signal generated by a machine. Results from a meta-analysis indicate that biofeedback reduces pain, depression, disability, and muscle tension in patients with lower back pain. Consequently, the American College of Physicians issued guidelines recommending electromyography biofeedback for the treatment of chronic lower back pain. Other research has indicated that biofeedback could help reduce the pain of tension headaches and fibromyalgia.
Nonpharmacologic treatments have been shown to be cost-effective in addition to being clinically effective. Experts suggest that they should be considered for the treatment of common conditions such as lower back pain, knee osteoarthritis, and headache.
Researchers Explore a Cancer Paradox
Healthy cells carry a surprising number of cancer-linked mutations, but they don’t turn into tumors. What’s holding them back?
Some of these mutations can be caused by assaults from the environment, such as ultraviolet rays and cigarette smoke. Others arise from harmful molecules produced by the cells themselves. In recent years, researchers have begun taking a closer look at these mutations, to try to understand how they arise in healthy cells, and what causes these cells to later erupt into full-blown cancer.
The research has produced some major surprises. For instance, it turns out that a large portion of the cells in healthy people carry far more mutations than expected, including some mutations thought to be the prime drivers of cancer. These mutations make a cell grow faster than others, raising the question of why full-blown cancer isn’t far more common.
“This is quite a fundamental piece of biology that we were unaware of,” said Inigo Martincorena, a geneticist at the Wellcome Sanger Institute in Cambridge, England.
These lurking mutations went unnoticed for so long because the tools for examining DNA were too crude. If scientists wanted to sequence the entire genome of tumor cells, they had to gather millions of cells and analyze all of the DNA. A mutation, to be detectable, had to be very common.
[But as DNA sequencing grew more sophisticated, Dr. Martincorena and other researchers developed methods for detecting very rare mutations, and they began to wonder if those mutations might be found in healthy cells, hidden below the radar.
Dr. Martincorena and his colleagues began their search in skin; its cells are battered daily by the sun’s ultraviolet rays, which trigger mutations. “We thought it was the lowest-hanging fruit,” Dr. Martincorena said.
In a study in 2015, he and his colleagues collected bits of skin left over from cosmetic surgeries to lift drooping eyelids. They examined 234 biopsies from four patients, each sample of skin about the size of a pinhead. They gently coaxed the top layers of cells, known as epithelial cells, from the underlying tissue.
Dr. Martincorena’s team then fished the DNA from the healthy epithelial cells, and carefully sequenced 74 genes that are known to play an important role in the development of cancer. Mutations that are common in cancer genes were remarkably common in these healthy skin cells, too, the researchers found. About one of every four epithelial cells carried a mutation on a cancer-linked gene, speeding up the cell’s growth.
It was possible, the scientists knew, that skin was peculiar. Maybe inside the body, away from the onslaught of ultraviolet rays, were healthy cells that didn’t carry these key mutations.
To find out, the researchers decided to study cells of the esophagus. The team gathered tissue samples from nine healthy organ donors who had died, then they sliced the tissue into dozens of tiny squares and examined the same 74 cancer-related genes.
Dr. Martincorena and his colleagues found that new mutations arose more slowly in the esophagus than in skin. But once those mutations emerged, they caused the esophageal cells to multiply faster than normal esophageal cells. Over time, these rogue cells spread out across the esophagus, forming colonies of mutant cells, known as clones. Although these clones aren’t cancer, they do exhibit one of cancer’s hallmarks: rapid growth.
“These mutant clones colonize more than half of your esophagus by middle age,” said Dr. Martincorena. “It was eye-opening for me.” Dr. Martincorena and his colleagues reported their findings on Thursday in the journal Science.
By examining the mutations, the researchers were able to rule out external causes for them, like tobacco smoke or alcohol. Instead, the mutations seem to have arisen through ordinary aging. As the cells divided over and over again, their DNA sometimes was damaged. In other words, the rise of these mutations may just be an intrinsic part of getting older.
“It seems that no matter how well one takes care of oneself by eating well, getting exercise and limiting certain vices, there’s likely only so much one can do against the need of the body to replace its cells,” said Scott Kennedy, a cancer biologist at the University of Washington who was not involved in the study.
The study also raised questions about efforts to detect cancer at its earliest stages, when cancer cells are still rare, Dr. Kennedy said: “Just because someone has mutations associated with cancer doesn’t mean actually they have a malignancy.”
Given the abundance of cancer mutations in healthy people, why isn’t cancer more common? Dr. Martincorena speculated that a healthy body may be like an ecosystem: Perhaps clones with different mutations arise in it, compete for available space and resources, and keep each other in check.
If so, fighting cancer might one day be a matter of helping harmless clones outcompete the ones that can lead to deadly tumors.
“There is no therapy being thought out in these terms now,” said Dr. Martincorena. “But I think it opens up new avenues. I think knowledge is always a weapon.”
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The gene therapy revolution is here. Medicine is scrambling to keep pace
June 5, 2019 1.30pm AEST
Severe immune system problems seen in the “bubble boy” syndrome can be targeted with gene therapy – but there are risks. Quique Garcia / AAP
- Elizabeth Finkel Vice-Chancellor’s Fellow, La Trobe University
Elizabeth Finkel does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
This article is an edited extract from Elizabeth Finkel’s address Gene therapy: cure but at what cost? to the National Press Club June 5 2019.
We’re publishing it as part of our occasional series Zoom Out, where authors explore key ideas in science and technology in the broader context of society and humanity.
Gene therapy – for so long something that belonged to the future – has just hit the streets.
A couple of weeks back, you might have picked up a headline alerting us to the most expensive drug in history – a one off gene therapy cure for spinal muscular atrophy. Novartis have priced the drug Zolgensma at A$3 million (US$2.1 million).
Traditionally a parent of a baby with spinal muscular atrophy was told: take your baby home and love her or him. Have no false hope, the baby will die paralysed and unable to eat or talk by the age of two.
What’s the narrative going to be now? There is a cure but it costs A$3 million.
I think we are in for some poignant dilemmas.
‘Heads up’ from a mother
The person who gave me a recent “heads up” on the gene therapy revolution was not a scientist. She is the mother of two sick children.
I met Megan Donnell last August 29th at a Melbourne startup conference called “Above All Human”.
Megan Donnell is a person who strikes you with her vibrancy and charisma. What you can’t immediately see is her life’s greatest tragedy and her life’s greatest mission.
Both of her children suffer from the rare genetic illness Sanfilippo syndrome. They lack a gene for breaking down heparin sulphate, a sugar that holds proteins in place in the matrix between cells. The high levels of the sugar poison the organs, particularly the brain. In the normal course of the disease, the children die in their teens, paralysed, unable to talk or eat.
When Megan Donnell’s kids were diagnosed at the ages of four and two, she was told “do not have false hope”. She didn’t listen.
The one time IT business manager started the Sanfilippo Childrens’ Foundation, raised a million dollars and invested in a start-up based in Ohio that was trialling gene therapy to treat the disease. Part of the deal was that the company would conduct trials in Australia as well as in the US and Spain. So far 14 children have been treated worldwide.
I’d missed a revolution
Megan Donnell’s story stunned me.
I’d written two books about coming medical revolutions: one on stem cells, the other on genomics. But when a medical revolution actually arrived, I’d missed it. It was all the more remarkable because for six years I’d been the editor of a popular science magazine – Cosmos.
We scanned the media releases for hot papers each week but gene therapy never came up on our radar.
Probably because we’d been dazzled by CRISPR – the powerful technique that can edit the DNA of everything from mosquitoes to man. But CRISPR has barely entered clinical trials.
Meanwhile there are already five gene therapy products on the market. And with 750 working their way through the pipeline, the US Federal Drug Administration (FDA) predicts that by 2025 between 10-20 gene therapy treatments will be added to the market each year.
Some of the gene therapies are having incredible effects.
The star example is the Novartis treatment for spinal muscular atrophy. Untreated babies die paralysed by the age of two. But those treated with Zolgensma have now reached the age of four and some are walking and dancing.
In 2017, the FDA approved Luxturna, now marketed by Roche. This gene therapy can restore sight to children suffering from a form of retinal blindness that begins months after birth.
For the first time I can recall, medical researchers are using a four letter word for some diseases: cure.
These treatments appear to have fixed the underlying conditions. Especially when they are given early. Indeed spinal muscular atrophy treatment is being offered to babies a few month old – before their motor neurons have started to wither.
30 years in the making
These gene therapy treatments have been over thirty years in the making. And the saga of their journey to the clinic, I suspect, reveals some common plot lines.
The potential of gene therapy, was obvious as soon Marshall Nirenberg cracked the genetic code back in the 1960s.
The New York Times opined: “The science of biology has reached a new frontier”, leading to “a revolution far greater in its potential significance than the atomic or hydrogen bomb.”
In a 1967 editorial for Science, Nirenberg wrote:
This knowledge will greatly influence man’s future, for man then will have the power to shape his own biological destiny.
But if the end goal was obvious, the pitfalls were not.
What made the dream of gene therapy possible was viruses. They’ve evolved to invade our cells and sneak their DNA in next to our own, so they can be propagated by our cellular machinery.
Throughout the 1980s, genetic engineers learned to splice human DNA into the viruses.
Like tiny space ships, they carried the human DNA as part of their payload.
By 1990, researchers attempted the first gene therapy trial in a human. It was to treat two children with a dysfunctional immune system, a disease known as severe combined immunodeficiency (SCID).
The results were hardly miraculous but they were promising. Researchers raced to bring more potent viruses to the clinic.
Children have died
In 1999, 18 year old Jesse Gelsinger paid the price.
He had volunteered to try gene therapy for his inherited condition: ornithine transcarbamylase deficiency. It meant he couldn’t break down ammonia, a waste product of dietary protein. But his condition was largely under control through medication and watching his diet.
Four days after his treatment at the University of Pennsylvania, Jesse was dead – a result of a massive immune reaction to the trillions of adenovirus particles introduced into his body. These are the same viruses that cause the common cold.
Tragedy struck again in 2003. This one involved so-called “bubble boys”.
They too carried an immune deficiency, X-SCID, which saw them confined to sterile bubble; a common cold can be fatal. This time round the gene therapy appeared far more effective. But within a few years of treatment, five of 20 boys developed leukaemia. The virus (gamma retrovirus) had activated a cancer-causing gene.
The two tragedies set the field back. Many researchers found it very hard to get funding.
But the huge clinical potential kept others going.
The key was to keep re-engineering the viral vectors.
It was a project that reminds me of the evolution of powered flight. From the biplanes that the Wright brothers flew in 1903 to the epic Apollo 11 flight in 1963, took 60 years.
The virus engineers have been a lot faster.
Use engineered viruses
Ten years after the disaster of the leukaemia-causing viruses, researchers had re-engineered so-called lenti viruses not to activate cancer genes. They had also found other viruses that did not provoke catastrophic immune responses.
Instead of the adenovirus, they discovered its mild-mannered partner – known as adeno associated virus (AAV). There’s a whole zoo of these AAVs and some species are particularly good at targeting specific organs.
It is this new generation of vectors that are responsible for the results we are witnessing now. The AAV 9 vector for instance can cross into the brain, and that’s the one used to treat spinal muscular atrophy.
Turning the table on viruses, and hacking into their code: this is the bit that particularly fascinates me in telling the story of gene therapy.
But another intriguing aspect is that, contrary to long held wisdom, we are seeing big pharma galloping in to treat rare diseases.
In the US, the spinal muscular atrophy market is probably around 400 babies per year. Luxturna might treat 2,000 cases of blindness a year.
It’s not the sort of market size that would bring joy to investors. But clearly the companies think it’s worth their while.
For one thing, the FDA has provided incentives for rare, so-called “orphan diseases” – fast-tracking their passage thought the tangled regulatory maze.
And there is a convincing business case. If gene therapy is a one shot cure then it really may end up saving health systems money.
That justifies, they say, some of the most extraordinary prices for a drug you’ve ever heard of.
Of course, all this relies on the treatments being one time cures.
And though the patients seem to be cured, whether or not the treatments last a lifetime remains to be seen.
The situation in Australia
Historically, this country has been a world leader when it comes to bargaining down exorbitantly priced cures.
In 2013 when the drugs for curing Hepatitis C first came out, the price was around A$100,000 for a 12 week course. But in Australia, all 230,000 of those living with Hepatitis C will be treated for the lowest price in the world. Prices are much higher in the US.
Greg Dore at the Kirby Institute of NSW participated in Australia’s Hepatitis C pricing discussions, and believes our model will work for the new gene therapy drugs – notwithstanding their eye-popping price tags – and the fact that the patient populations for these rare genetic diseases will be tiny.
However, the real reason companies are getting into gene therapy is not just to treat rare disease. It’s because they realise this technology will be a game changer for medicine.
They have already entered the field of cancer with a gene therapy approved for acute lymphoblastic leukaemia – CAR-T cells. Health Minister Greg Hunt announced this year the government will pay the cost (around A$500,000 per treatment).
But after cancer, what then?
If you have a vector than can take a gene to the brain and cure spinal muscular atrophy, what else could you cure. Alzheimer’s disease, strokes?
Australian researchers are jostling to be part of the gene therapy revolution.
Paediatrician Ian Alexander together with virologist Leszek Lisowksi are engineering the next generation of vectors in their labs at The Children’s Hospital at Westmead, Sydney. They are designing them to home efficiently to specific organs and produce therapeutic levels of proteins.
Curiously it turns out that a major bottleneck is scaling up the production of these exquisitely engineered viruses. Who’d have thought there’d be a problem churning out the most abundant organism on the planet?
Researcher David Parsons in Adelaide is refining methods to deliver vectors across the viscous mucus of children with cystic fibrosis.
Scientist John Rasco in Sydney is a pioneer when it comes to treating patients with gene therapy, having been a part of international trials treating patients with beta thalassemia.
Medical researcher Elizabeth Rakoczy in Perth is developing a treatment for macular degeneration.
And Alan Trounson, who spent six years at the helm of the world biggest stem cell institute, the California Institute for Regenerative Medicine, is advancing a technology to develop off the shelf, universally compatible, CAR-T cells, to attack ovarian cancer.
One thing is for sure: medicine is set for a major disruption from the arrival of gene therapy.
As we enter an era, where once incurable diseases become curable; be prepared for some challenging debates about how to pay for gene therapy and the value of a human life.
In Search of a Safe Natural Sleep Aid
Sleep deprivation is associated with an elevated risk of various diseases and leads to a poor quality of life and negative socioeconomic consequences. Sleep inducers such as drugs and herbal medicines may often lead to dependence and other side effects. l-Theanine (γ-glutamylethylamide), an amino acid naturally found abundant in tea leaves, has anxiolytic effects via the induction of α brain waves without additive and other side effects associated with conventional sleep inducers. Anxiolysis is required for the initiation of high-quality sleep. In this study, we review the mechanism(s), safety, and efficacy of l-theanine. Collectively, sleep studies based on an actigraph, the obstructive sleep apnea (OSA) sleep inventory questionnaire, wakeup after sleep onset (WASO) and automatic nervous system (ANS) assessment, sympathetic and parasympathetic nerve activities, and a pediatric sleep questionnaire (PSQ) suggest that the administration of 200 mg of l-theanine before bed may support improved sleep quality not by sedation but through anxiolysis. Because l-theanine does not induce daytime drowsiness, it may be useful at any time of the day. The no observable adverse effect level (NOAEL) for the oral administration of l-theanine was determined to be above 2000 mg/kg bw/day.
It is available from Dallas Parade Compounding chemist,
This is one of the most important posts I have had this year, and recommend you take careful note of this. It is available from Amazon Australia. If there are any compounding chemists or health food shops that stock it., let me know. Now I know why I always feel better after a cup of tea.
One supplement you should start taking now
Kristin Bundy, for MDLinx | January 08, 2019
Finding ways to avoid burnout—which occurs twice as often in physicians than in those in other professions—became the focus of several health-care systems and universities this year. In fact, several health-care institutions have implemented wellness programs and formed committees charged with improving work conditions and decreasing stress in physicians.
If you’re considering adding L-theanine to your daily wellness practice, a dose of 100- 400 mg is recommended, beginning with the smallest dose and gradually increasing until feeling the effects.
Many of these programs rely on peer interaction and may take time to implement and achieve results; however, physicians can work to improve their own mental health now by taking a dietary supplement that has been shown to ease stress and anxiety.
L-theanine, a water-soluble, non-protein amino acid commonly found in green tea and some mushrooms, has been widely studied for its ability to encourage wakeful relaxation without sedation. L-theanine is thought to work by decreasing “excitatory” brain chemicals that contribute to stress and anxiety while increasing brain chemicals that encourage a sense of calm. It’s even been known to lower stress-related blood pressure and heart rate.
On their website, Memorial Sloan Kettering Cancer Center breaks down L-theanine’s proposed mechanism of action. Essentially, L-theanine crosses the blood-brain barrier, and has the ability to modulate inhibitory neurotransmitters, selective serotonin, and dopamine to bring about anxiolytic and calming effects. L-theanine can also improve cognition and selective attention, perhaps due to changes in alpha brain wave activity. Finally, its ability to selectively bind to glutamate receptors may confer neuroprotective effects as well.
In addition to promoting relaxation, L-theanine has been shown to stabilize cognitive function affected by stress hormones. More specifically, L-theanine decreases levels of corticosterone, which when elevated can inhibit spatial learning and memory formation. Other researchers have shown that, in people with anxiety, L-theanine improved attention span and reaction time. Taken with caffeine, L-theanine improved visual information processing and accuracy when moving between tasks.
Given its ability to encourage attention and focus, it may come as a surprise that L-theanine has also been found to improve time to sleep as well as quality of sleep. Instead of acting as a sedative, L-theanine works to promote better rest by reducing anxiety and promoting relaxation.
It could be L-theanine’s ability to stabilize glutamatergic concentrations that supports the benefits seen in patients with schizophrenia. Studies demonstrated that L-theanine in combination with antipsychotic treatment improved sleep and eased anxiety.
In patients with major depressive disorder, the supplement ameliorated symptoms of anxiety and depression and improved sleep quality and cognitive function.
From 2017 and 2018, 63 newly published studies outlined the effects of L-theanine. According to results of these studies, L-theanine may also help with weight loss in obese individuals, improve elevated lipids and offer neuroprotection and anti-tumor effects.
There have been no reported adverse effects linked to L-theanine. Indeed, adults generally tolerate L-theanine well. If you’re considering adding L-theanine to your daily wellness practice, a dose of 100-400 mg is recommended, beginning with the smallest dose and gradually increasing until you feel the effects. When used in combination with caffeine, consider 12-100 mg of L-theanine to 30-100 mg of caffeine.
Of course, L-theanine is not a catch-all to relieve stress. Certainly, a multi-modal approach is necessary to improve wellbeing. Nonetheless, L-theanine could be a way (and relatively cheap at approximately $22 for 120 200-mg capsules on Amazon) to help integrate more calm into the workday.
Crit Rev Food Sci Nutr. 2017 May 24;57(8):1681-1687. doi: 10.1080/10408398.2015.1016141.
L-theanine, unique amino acid of tea, and its metabolism, health effects, and safety.
Tea has been a very popular beverage around the world for centuries. The reason that it is delicious, enabling hydration, showing warming and relaxing effect can be mentioned why it is consumed so much in addition to its prominent health effects. Although the catechins and caffeine are the primary bioactive components that are related with the health effects of the tea, the health effects of theanine amino acid, which is a nonproteinic amino acid special to tea, has become prominent in recent years. It has been known that the theanine amino acid in tea has positive effects especially on relaxing, cognitive performance, emotional status, sleep quality, cancer, cardiovascular diseases, obesity, and common cold. The results of acute and chronic toxicity tests conducted on the safety of theanine express that L-theanine is reliable in general even if it is consumed too much with diet. However, it has not revealed a clear evidence-based result yet regarding theanine metabolism, health effects, and its safety. Within this frame, chemical structure of theanine, its biosynthesis, dietary sources, metabolism, health effects, and safety are discussed in present study.
How do I increase my libido?’
July 17, 2019 12.40pm AEST
- Melissa Kang Associate professor, University of Technology Sydney
Melissa Kang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
University of Technology Sydney provides funding as a founding partner of The Conversation AU.
Hi I’ve been in a relationship for nearly 4 years now and have gone from having a high libido to a very low one, is there ways that I can change this? – Anonymous
- Our libidos fluctuate. Changes are normal
- Most relationships start on a high, then libidos can decrease
- Communication is key to working through these types of issues.
Changes in libido are common throughout life, and affect all genders. This can cause worry, especially when you notice what seems like a dramatic drop. But there are plenty of ways to help!
Your libido isn’t a switch
Libido is your sexual desire or drive and it’s affected by a combination of physical, emotional, psychological and relationship circumstances.
Going through puberty often leads to the first experiences of libido, which helps us understand the importance of certain hormones in triggering the sex drive. In women, oestrogen is responsible for a lot of the sex drive, while in men it’s testosterone.
Some medical conditions and medications as well as commonly used drugs like alcohol can affect hormones and brain chemicals which lower the sex drive – in other words, there is a physical component to a person’s libido.
For example, depression can cause the sex drive to take a dive, and yet so can medication to treat depression.
Similarly, some people experience lower libido on some hormonal contraceptives, while others find it helps. Everyone is different and things can change over time.
Read more: ‘Are Kegel exercises actually good for you?’
Crazy in ‘limerence’
Most importantly, libido is hugely influenced by circumstances and experiences around us, from the past or present. A common scenario is like your own – where libido drops as a relationship gets older.
The early part of a relationship can be full of sex drive and something called limerence. Limerence is an emotional reaction to a new partner or relationship that is intensely romantic – plenty of love songs are written during this phase of a relationship! It’s due to the activation of certain brain chemicals and for some people feels like an addiction or obsession, the feeling of being “madly in love”.
As the relationship continues, limerence declines and sometimes sex drive does too. For some couples, this is fine and doesn’t cause too much concern. For others, having a lower libido creates distress for one or both people. Actually Beyoncé, it’s called limerence.
Communicate, communicate, communicate!
Sometimes simply knowing that a drop in libido can be normal is reassuring. Other times it’s not and it’s worth checking out a few things. Do a quick scan of your general health, including stress and lifestyle (alcohol, drugs, sleep habits, exercise).
Alternatively chat with your partner and look at what’s happening inside and outside the bedroom. Here’s some good questions to ask them (and remember, talk through them honestly with each other):
- do you have different levels of libido or body clocks (one falls asleep at 9pm the other at 1am)?
- does your partner want sex much more (or much less) than you do? This can create tension or anxiety which will affect your sex drive
- over the four years you’ve been together, have you been able to communicate with each other about what gives you pleasure and does that feel mutual?
- what sort of variety do you like in bed?
- could there be issues going on outside the relationship, such as financial stress, worry about parents/family or study or work?
- could there be issues from the past that have been weighing on your mind?
If you’re worried about a medical issue, see your GP to start with. If it’s more likely to be related to stress or your relationship, then you could see a counsellor on your own or as a couple.
You might not need professional intervention – many couples can figure out this stuff with good communication, but don’t hesitate to reach out for help if you want to.
Foods that help you look and feel young
Melissa Sammy, MDLinx | July 11, 2019
The secrets to youth and vitality may be closer at hand than you think—in fact, you need only stroll through your local grocery store, or better yet, take a look in your pantry.
Capsaicin is an active compound found in chili peppers that has demonstrated anti-cancer and antioxidant properties, protection against some neurodegenerative diseases, and anti-obesity effects. Researchers have found that capsaicin may also limit skin aging and promote satiety and fullness upon consumption.
Each year, people across the globe collectively invest trillions of dollars in the wellness market—purchasing beauty products, anti-aging treatments, and nutritional supplements—in hopes of maintaining their inner and outer juvenescence.
In the United States alone, men and women spent over $16.5 billion on cosmetic procedures in 2018, with wrinkle treatment injections reported as the most frequently performed minimally invasive procedure (about 7.4 million) and facelifts reported as the most expensive ($7,655).
Consider also that the average US adult will likely spend just over $40,000 on dietary health supplements over the course of a lifetime, equating to nearly $56 per month.
While this growing global consciousness of, and dedication to, health and wellness is positive, it doesn’t have to break the bank. Let’s take a closer look at some dietary must-haves that can keep you looking and feeling young and fresh over the long term—and at a fraction of the price of a facelift.
Capsaicin is an active compound found in chili peppers that has numerous health benefits. In some studies, capsaicin has been shown to have anti-cancer and antioxidant properties, and may even be protective against some neurodegenerative diseases, including Alzheimer’s disease. In one review, researchers suggested that dietary capsaicin may also have anti-obesity effects and play a protective role in metabolic health. Capsaicin may limit some age-related changes that occur in skin cells as well, according to a study published in the Journal of Cutaneous Pathology. In another study, published in Appetite, researchers found that the compound can increase satiety and fullness when added to the diet, and may thus prevent overeating.
Blueberries are often referred to as a “superfood,” and for good reason. They are rich in antioxidants, folate, and polyphenols, which all work together to boost your mood, reduce oxidative stress, and help prevent disease. Blueberries also contain flavonoids—compounds that possess antioxidative, anti-inflammatory, anti-mutagenic, and anti-carcinogenic properties—which have been shown to inhibit amyloid beta production in Alzheimer’s disease. In one study published in the European Journal of Nutrition, blueberry consumption resulted in improved cognition in older adults.
Avocados are abundant in monounsaturated fat and have been touted to positively affect lipid profiles. In one meta-analysis published in the Journal of Clinical Lipidology, researchers assessed 10 studies representing 229 individuals to investigate the impact of avocado-enriched diets on plasma lipoprotein concentrations. They found that avocado consumption significantly decreased total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels.
In another study, published in Archives of Dermatological Research, investigators noted that polyhydroxylated fatty alcohols found in avocados reduced ultraviolet (UV)-induced cellular damage and inflammation in human skin.
Researchers have suggested that the antioxidant activity of pomegranate juices may be actually be higher than those found in red wine and green tea, and may thus offer protection from UV rays and help to heal skin damage. Pomegranates have also been hailed as “cosmeceuticals” due to their collagen-stimulating properties. In addition, compounds found in pomegranates—including punicic acid, methanolic seed extract, and pomegranate peel extract—have been shown to reduce fasting blood glucose levels, which could help to manage or even prevent type 2 diabetes in some individuals.
Made from cooking the bones of meat, poultry, or fish for a prolonged period of time, bone broth is rich in collagen, which can help to reduce the signs of aging. Collagen has also been shown to exert beneficial effects on bone health. For example, in a double-blind, placebo-controlled, randomized study, researchers found that collagen peptides may serve as therapeutic agents for the management of osteoarthritis. In another study, investigators found that simultaneous resistance training and collagen peptide supplementation improved body composition and muscle strength in elderly men with sarcopenia.
Cinnamon has been shown to promote skin firmness and elasticity via collagen production, and reduce skin damage caused by advanced glycation end-products. The spice may also have positive effects on serum glucose levels, according to the results of one recent systematic review and meta-analysis.
Purple sweet potatoes
Though they may be a bit harder to find in your local supermarket, purple sweet potatoes are a powerhouse of nutrition. Also known as Okinawan sweet potatoes, these tubers are high in vitamin A—which is an essential micronutrient for eye, immune, and reproductive health—and anthocyanin, a flavonoid pigment found in plants that has been shown to have cancer-preventive properties. In some studies, mice that were fed a diet consisting of purple sweet potatoes demonstrated a reduction in hyperuricemia and kidney inflammation as well as overall renal damage.
This member of the daisy family, which grows in much of Europe and North America, has long been used as an herbal remedy to treat a myriad of health ailments ranging from headaches and arthritis to inflammation and menstrual cramps. According to some studies, feverfew may also help to reduce damaged skin cells and inflammation, alleviate dermatitis and psoriasis, and improve skin appearance. The medicinal plant is rarely sold in grocery stores; however, you can find fresh and dried forms in many farmers’ markets.
Olive oil is perhaps one of the healthiest fats known to man, and is an integral component of the oft-praised Mediterranean Diet—which has been consistently ranked as one of the best diets to follow due to its plethora of associated health benefits. Like avocados, olive oil is high in monounsaturated fat, and its consumption—especially the extra-virgin variety—has been associated with lower rates of cardiovascular disease and mortality.
Whether you consider them to be fruit or vegetables, tomatoes boast an array of impressive health benefits that are largely attributed to their high lycopene profile. Lycopene is a type of bright red carotenoid with antioxidant properties found in some red fruits and vegetables, such as tomatoes, watermelon, and papaya. Researchers have shown that incorporating ample quantities of tomatoes into the diet can reduce the risk of heart disease, stroke, and prostate cancer; offer dermal protection against UV rays; and reduce wrinkles caused by sun damage.
Can we turn back time?
Aging, unfortunately, is just a natural part of life that we must all contend with. While there’s no way to turn back time, as Cher once lamented, it is possible to improve your inner health and outward beauty. Regularly incorporating some or all of these listed food items into your diet can help you to age gracefully, and look and feel younger for longer.
Pushing Our Limits to Achieve Health
The human body is an absolute marvel. The more I learn and experience, the greater my sense of awe. It’s incredible that we have studied our anatomy for years and there are still organs and functions we don’t fully understand. We have yet to create any piece of technology that rivals the body’s efficiency and complexity. This fact is illustrated by those among us who choose to test the perceived limits of our bodies’ capabilities. The account of one such individual has forever altered my life and transformed my view of our innate abilities.
The man’s name is Wim Hof. He has developed the ability to control his autonomic nervous and immune system. This allows him to perform feats such as withstanding extreme cold and avoiding the sequelae of exposure to endotoxin. I initially thought that he was born with a genetic variant that provided him with these abilities. However, extensive studies and examinations of him and his twin brother have proved otherwise. Furthermore, Mr. Hof has shown that he can teach others to do the same. Check out a documentary on the subject here.
The more I learned about Mr. Hof, the more I wondered, could I use his methods to tap into the human body’s innate ability to persevere and heal?
Pushing my limits
I decided to test my own limits of cold tolerance. Over the past year, I have been experimenting with cold showers. I had heard about the possible benefits of reducing inflammation, improving mood, and strengthening personal mindsets by promoting tolerance to uncomfortable situations.
In winter, I started gradually by wearing a sport coat instead of a heavy winter coat when outdoors. Eventually, I was able to comfortably go out in a short sleeved polo shirt with scrub pants regardless of the temperature or weather, even in heavy snow. The experience was exhilarating and empowering.
I had been taught and grew to believe that I needed to protect myself from the cold in order to avoid illness. Though many of us are aware of the fact that cold exposure is not directly associated with respiratory ailments such as the common cold or flu, we still choose to adhere to the habits we learned as children that support comfort rather than health. I echo the sentiment expressed by Wim Hof that our pursuit of comfort and our modern day obsession with it is limiting the resilience of our bodies and our ability to overcome and prevent disease. My experiences, to date, corroborate this.
Harnessing natural abilities
As discussed by Dr. Lissa Rankin in multiple TED Talks, Dr. Ranjan Chattergee in his book, The Stress Solution, and Dr. Joe Dispenza in his book, Evolve Your Brain, our bodies have the natural ability to deal with essentially every disease and ailment we know of. We simply have to figure out what is interfering with the intrinsic processes and/or develop the ability to maximize their effectiveness.
Pain management is one I investigated for myself. As I learn more about the shortcomings of pharmaceuticals, I look to minimize or eliminate my reliance on them. Thankfully, the only medication I have taken consistently for most of my life is over-the-counter pain relievers as needed. However, after reviewing the nature of pain and the body’s response to it, I have changed this habit as well.
As many of you may remember, pain is a neural impulse that the brain receives, signifying an abnormal condition involving the tissue adjacent to the nerves (for example, irritation or injury). Feeling uncomfortable or upset about pain is a learned behavior that actually perpetuates the discomfort. Research shows that neurotransmitters and hormones that promote negative moods slow healing and promote upregulation of pain receptors. In individuals with chronic pain, this cycle gains strength and efficiency to the point that it actually becomes their homeostasis.
The opposite is true of endorphins and other neurotransmitters, such as dopamine, associated with euphoria and bliss. They are natural opioids and are more potent than their prescribed counterparts. Therefore, they are the best option for pain management and elimination.
Moving beyond pain
I can attest to this. Over the last six months, I have successfully eliminated severe back and calf pains without medication. Instead, I expressed gratitude for the pain and committed to regular exercise and stretching of the affected areas in order to release endorphins and train my body to do this effectively and efficiently. I believe many of us are capable of this through dedication and discipline. We can use similar habits and practices to manage and eliminate conditions such as hypertension, glucose intolerance and diabetes, depression, and arthritis. The potential benefit is significant. Why remain dependent on medications when the superior therapeutic processes of our bodies can be bolstered and utilized?
For those of you who are not already convinced or lack the personal experience of the benefits of these methods, I recommend practicing them first for yourself before making suggestions to patients and others. Once you discover the power and wide ranging ability of the incredible machines we call our bodies, you will want to share the knowledge. Let’s stop underestimating and dismissing its ability to self-regulate and maintain in most instances. The might of the body’s internal forces can do without the interference and often unnecessary assistance of many external tools we choose to employ.
Emeka Onyedika, MD, is a physician evaluator conducting in-home health evaluations. To contact him, please send messages to: firstname.lastname@example.org
Some of my patients have been concerned about a recent ABC report on BHRT. As I was away in Singapore and have just returned, I will repeat a blog I had some time back when this issue was raised in a local newspaper. Remember, pharmaceutical companies, especially those that produce synthetic HRT, are significant donors to various medical groups and menopause associations. This does not mean that they are swayed or influenced by these donations, as they are all ethical and moral organisations, I am sure. This issue comes up again and again. I have addressed it in many blogs I have posted.
Posted by Dr Colin Holloway 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
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.
1 Departments of Obstetrics and Gynecology and Psychiatry, Yale University School of Medicine, New Haven, CT, USA. email@example.com
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
Posted by Dr Colin Holloway
One of the criticisms of Bioidentical HRT is that it is not FDA approved. It does not need to be, as it is not synthetic. It is interesting however that there has never been a complaint of an adverse event to the FDA – yet there are numerous adverse event report about the synthetic HRT. Here is part of a transcript from a recent Press conference run by the FDA.
The FDA had a press conference on BHRT. They generally were negative about BHRT.Here is one of the questions put to Kathy Anderson of the FDA (USA):
“Anna Matthews(Reporter): Hi. Couple of questions; one is have you guys received any reports of adverse events or other harm to patients from these products?
Kathy Anderson: Sorry, this is Kathy Anderson. With your respect to your question about whether we received any adverse event reports, we have not.”
Furthermore, the article did not mention the amount of damage done by synthetic HRT :
Prempro Causes Breast Cancer and Loses Court Case with Huge Punitive Damages
by Jeffrey Dach MD
A 112 million dollar punitive is a very loud statement. It states that the jury was outraged by the “wanton and reckless” conduct by Wyeth. 112 Million Dollars in punitive damages was awarded to two breast cancer victims who took Wyeth’s synthetic hormone, Prempro, all the while thinking it safe. The jury was outraged that Wyeth ignored and suppressed evidence that Prempro causes breast cancer. Wyeth paid consultants and ghostwriters of medical journal articles to play down concerns about breast cancer, and declined to study known risks. Once again, company profit was placed ahead of patient safety. This is the tip of the iceberg, as another ten thousand cases are waiting for their day in court.
Premrpro is similar to premarin or premia, as used in Australia. I have been using these compounded products for the last 25 years, and have had 1 case of uterine cancer in that time. She was cured by a hysterectomy and is still fine today.Endometrial thickening can occur in women, with or without hormones, and, as the article stated, may be caused by obesity.