Monthly Archives: November 2019

Vaginal estrogen use and chronic disease risk

Menopause. 2018 Dec 17. doi: 10.1097/GME.0000000000001284. [Epub ahead of print]

Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study.

Bhupathiraju SN1,2, Grodstein F1,3, Stampfer MJ1,2,3,4, Willett WC1,2,3, Crandall CJ5, Shifren JL6, Manson JE1,3,4.

Author information



To examine the associations between vaginal estrogen use and multiple health outcomes including cardiovascular disease (total myocardial infarction, stroke, and pulmonary embolism/deep vein thrombosis), cancer (total invasive, breast, endometrial, ovarian, and colorectal cancer), and hip fracture.


We included postmenopausal women from the Nurses’ Health Study (1982-2012) who were not current users of systemic hormone therapy at the start of the study or during follow-up. Vaginal estrogen use was self-reported on the biennial questionnaires. Information on incident health outcomes were self-reported and confirmed by medical records. We used Cox proportional hazards regression to model the multivariable adjusted hazard ratios and the 95% confidence intervals for vaginal estrogen use and multiple health outcomes.


Over 18 years of follow-up, after adjusting for covariates, risks for cardiovascular disease, cancer, and hip fracture were not different between users and nonusers of vaginal estrogen. No statistically significant increase in risk of any health outcome was observed with vaginal estrogen use. In sensitivity analyses, when we examined associations by hysterectomy status, the stratified results were generally similar to those for the total cohort.


Vaginal estrogen use was not associated with a higher risk of cardiovascular disease or cancer. Our findings lend support to the safety of vaginal estrogen use, a highly effective treatment for genitourinary syndrome of menopause.

Kombucha, kimchi and yogurt: how fermented foods could be harmful to your health

Kombucha, kimchi and yogurt: how fermented foods could be harmful to your health

November 13, 2019 9.17pm AEDT


  1. Manal Mohammed Lecturer, Medical Microbiology, University of Westminster

Disclosure statement

Manal Mohammed 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 Westminster
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Fermented foods such as yogurt, kimchi, and sauerkraut, are all popular sources of probiotics. Nina Firsova/ Shutterstock

Fermented foods have become very popular, thanks to claims about their nutritional properties and reported health benefits, such as improving digestion, boosting immunity and even helping people lose weight. Some of the most popular fermented foods include kefir, kombucha, sauerkraut, tempeh, natto, miso, kimchi and sourdough bread.

But though these fermented foods might offer us many health perks, most people aren’t aware that they might not work for everyone. For some people, fermented foods might cause serious health issues.

Fermented foods are loaded with microorganisms, such as live bacteria and yeast (known as probiotics). However, not all microorganisms are bad. Many, like probiotics, are harmless and are even beneficial to us.

During the process of fermentation, probiotics convert carbohydrates (starch and sugar) into alcohol and/or acids. These act as a natural preservative and give fermented foods their distinctive zest and flavour. Many factors affect fermentation, including the type of probiotic, the primary metabolites these microbes produce (such as lactic acid, or certain amino acids), and the food undergoing fermentation. For example, probiotic yogurt is produced by fermenting milk, most commonly with lactic acid bacteria that produce lactic acid.

Fermented foods contain high amounts of probiotics, which are generally considered safe for the majority of people. In fact, they’ve been shown to have anti-oxidant, anti-microbial, anti-fungal, anti-inflammatory, anti-diabetic and anti-atherosclerotic activity. However, some people might experience severe side effects after consuming fermented foods.

1. Bloating

The most common reaction to fermented foods is a temporary increase in gas and bloating. This is the result of excess gas being produced after probiotics kill harmful gut bacteria and fungi. Probiotics secrete antimicrobial peptides that kill harmful pathogenic organisms like Salmonella and E. Coli.

A recent study showed this antimicrobial effect of probiotic Lactobacilli strains found in commercial yogurt. Although bloating after eating probiotics seems to be a good sign that the harmful bacteria are being removed from the gut, some people might experience severe bloating, which can be very painful.

Drinking too much kombucha can also lead to excess sugar and calorie intake, which may also lead to bloating and gas.

2. Headaches and migraines

Fermented foods rich in probiotics – including yogurt, sauerkraut and kimchi – naturally contain biogenic amines produced [during fermentation]. Amines are created by certain bacteria to break down the amino acids in fermented foods. The most common ones found in probiotic-rich foods include histamine and tyramine.

Some people are sensitive to histamine and other amines, and may experience headaches after eating fermented foods. Because amines stimulate the central nervous system, they can increase or decrease blood flow, which can trigger headaches and migraines. One study found that low-histamine diets reduced headaches in 75% of participants. Taking a probiotic supplement might be therefore preferred.

3. Histamine intolerance

Histamine is plentiful in fermented foods. For most, our body’s specific enzymes will naturally digest them. However, some people don’t produce enough of these enzymes. This means histamine won’t be digested and will instead be absorbed into the bloodstream.

This can cause a range of histamine intolerance symptoms. The most common are itching, headaches or migraines, runny nose (rhinitis), eye redness, fatigue, hives and digestive symptoms include diarrhoea, nausea and vomiting.

However, histamine intolerance can also cause more severe symptoms, including asthma, low blood pressure, irregular heart rate, circulatory collapse, sudden psychological changes (such as anxiety, aggressiveness, dizziness and lack of concentration) and sleep disorders.

4. Food-borne illness

While most fermented foods are safe, it’s still possible for them to get contaminated with bacteria that can cause illness. In 2012, there was an outbreak of 89 cases of Salmonella in the US because of unpasteurised tempeh.

Two large outbreaks of Escherichia coli, were reported in South Korean schools in 2013 and 2014. They were associated with eating contaminated fermented vegetable kimchi.

In most cases, probiotics found in fermented milk products such as cheese, yogurt and buttermilk can effectively prevent the growth of certain bacteria, such as Staphylococcus aureus and Staphylococcal enterotoxins which can cause food poisoning. But in some cases probiotics fail and bacteria can actually secrete toxins, so the product may be hazardous.

Staphylococcus aureus can cause skin and respiratory infections, as well as food poisoning. Kateryna Kon/ Shutterstock

5. Infection from probiotics

Probiotics are generally safe for the vast majority of people. However, in rare cases, they can cause infection – especially in people who have a compromised immune system.

A London study reported the first case of a 65-year-old diabetic patient whose liver abscess had been caused by probiotic consumption. Susceptible patients, such as those with compromised immunity, should be advised against consuming too many probiotics.

Treatment with probiotics can cause serious infections, such as pneumonia in vulnerable people and systemic infections, including sepsis and endocarditis.

6. Antibiotic resistance

Probiotic bacteria can carry genes that confer resistance to antibiotics. These antibiotic resistance genes may pass to other bacteria found in the food chain and gastrointestinal tract via horizontal gene transfer. The most common antibiotic resistance genes carried by fermented foods are against erythromycin and tetracycline, which are used to treat respiratory infections and some sexually transmitted diseases.

Researchers found resistant probiotic strains in commercially available dietary supplements, which could mean resistance to several common types of antibiotics used to treat serious bacterial infections.

Read more: Antibiotic resistance: researchers have directly proven that bacteria can change shape inside humans to avoid antibiotics

Research has also found six probiotic Bacillus strains found in food products (including kimchi, yogurt and olives) are also resistant to several antibiotics.

And, a recent Malaysian study showed probiotic Lactobacilli bacteria in kefir carry resistance to numerous antibiotics, including ampicillin, penicillin and tetracycline. These are used to treat serious human diseases including bladder infections, pneumonia, gonorrhoea, and meningitis.

Another study also showed lactic acid bacteria found in Turkish dairy products were resistant mainly to vancomycin antibiotic, which is the drug of choice for treatment of MRSA infection.

While there are a wide variety of health benefits that can happen from consuming fermented foods, these may not work for everyone. While most people will be fine eating fermented foods, for some they could cause serious health problems.

One avocado a day helps lower ‘bad’ cholesterol for heart healthy benefits

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One avocado a day helps lower ‘bad’ cholesterol for heart healthy benefits

I clearly remember our lecturer in nutrition at medical school telling us that if you were stuck on a desert island and could only have 1 food, then he would choose an avocado, as it is the complete food. I have never forgotten that.

MedicalXpress Breaking News-and-Events | October 29, 2019

Move over, apples—new research from Penn State suggests that eating one avocado a day may help keep “bad cholesterol” at bay.

According to the researchers, bad cholesterol can refer to both oxidized low-density lipoprotein (LDL) and small, dense LDL particles.

In a randomized, controlled feeding study, the researchers found that eating one avocado a day was associated with lower levels of LDL (specifically small, dense LDL particles) and oxidized LDL in adults with overweight or obesity.

“We were able to show that when people incorporated one avocado a day into their diet, they had fewer small, dense LDL particles than before the diet,” said Penny Kris-Etherton, distinguished professor of nutrition, who added that small, dense LDL particles are particularly harmful for promoting plaque buildup in the arteries. “Consequently, people should consider adding avocados to their diet in a healthy way, like on whole-wheat toast or as a veggie dip.”

Specifically, the study found that avocados helped reduce LDL particles that had been oxidized. Similar to the way oxygen can damage food—like a cut apple turning brown—the researchers said oxidation is also bad for the human body.

“A lot of research points to oxidation being the basis for conditions like cancer and heart disease,” Kris-Etherton said. “We know that when LDL particles become oxidized, that starts a chain reaction that can promote atherosclerosis, which is the build-up of plaque in the artery wall. Oxidation is not good, so if you can help protect the body through the foods that you eat, that could be very beneficial.”

While previous research demonstrated that avocados could help lower LDL cholesterol, Kris-Etherton and her colleagues were curious about whether avocados could also help lower oxidized LDL particles.

The researchers recruited 45 adult participants with overweight or obesity for the study. All participants followed a two-week “run-in” diet at the beginning of the study. This diet mimicked an average American diet and allowed all participants to begin the study on similar nutritional “footing.”

Next, each participant completed 5 weeks of three different treatment diets in a randomized order. Diets included a low-fat diet, a moderate-fat diet, and a moderate-fat diet that included one avocado a day. The moderate-fat diet without avocados were supplemented with extra healthy fats to match the amount of monounsaturated fatty acids that would be obtained from the avocados.

After 5 weeks on the avocado diet, participants had significantly lower levels of oxidized LDL cholesterol than before the study began or after completing the low- and moderate-fat diets. Participants also had higher levels of lutein, an antioxidant, after the avocado diet.

Kris-Etherton said there was specifically a reduction in small, dense LDL cholesterol particles that had become oxidized.

“When you think about bad cholesterol, it comes packaged in LDL particles, which vary in size,” Kris-Etherton said. “All LDL is bad, but small, dense LDL is particularly bad. A key finding was that people on the avocado diet had fewer oxidized LDL particles. They also had more lutein, which may be the bioactive that’s protecting the LDL from being oxidized.”

The researchers added that because the moderate-fat diet without avocados included the same monounsaturated fatty acids found in avocados, it is likely that the fruit has additional bioactives that contributed to the benefits of the avocado diet.

Kris-Etherton said that while the results of the study—published in the Journal of Nutrition—are promising, there is still more research to be done.

“Nutrition research on avocados is a relatively new area of study, so I think we’re at the tip of the iceberg for learning about their health benefits,” Kris-Etherton said. “Avocados are really high in healthy fats, carotenoids—which are important for eye health—and other nutrients. They are such a nutrient-dense package, and I think we’re just beginning to learn about how they can improve health.”

The foods that are sabotaging your sleep

Featured Articles in Internal Medicine In the News

7 foods that are sabotaging your sleep

Naveed Saleh, MD, MS, for MDLinx | October 18, 2019

Sleep deprivation is a common health problem in physician culture. In fact, at least 25% of cardiologists reported suffering insufficient sleep in a 2018 survey published in the Journal of the American College of Cardiology. Like stress, dietary habits can adversely affect your sleep architecture and quality.


Sleep deprivation is a common health problem in physician culture. Like stress, dietary habits can adversely affect your sleep architecture and quality.

There are several foods and diets that may inhibit your sleep or disrupt your sleep patterns. Here are a few to consider:

High-carb foods

Although not all carbs are high on the glycemic index, such as intact carbs (eg, whole grains), excess consumption can still interfere with your sleep. For instance, in a now classic study published in the Lancet, consumption of a high-carb, low-fat diet led to less slow-wave sleep—the deepest phase of NREM—compared with consumption of a low-carb, high-fat diet or normal balanced diet. Of note, all tested diets were equal in calories.

High-glycemic foods

Refined carbs like white bread and white rice might be yummy, but they are high on the glycemic index. Diets high in high-glycemic foods not only increase your risk for type 2 diabetes and other serious health problems, but can also disturb your sleep. Although some researchers have shown that eating a carb-based, high-glycemic meal 4 hours before bed can induce sleep, it’s important to note that doing so will not translate to better sleep quality. In fact, because refined carbs are generally very easily and quickly digested by the body, this can lead to surges in blood sugar and subsequent crashes, which can keep you up at night after a heavy meal.  

High-fat food

Watch out for fried or other high-fat foods—they not only pack on the pounds, but can impair your sleep. And it’s not just that cheeseburger and fries you should be wary of. Even healthy high-fat foods, like avocado and fish, can compromise a good night’s sleep. One reason is that meals rich in high-fat foods activate digestion, which can lead to frequent nighttime trips to the bathroom.

In one review of the effects of diet on sleep quality, researchers noted the following: “[High-fat] intakes promote lower [sleep efficiency] and REM and higher [slow-wave sleep] and arousals. However, longer-term effects have not been examined in randomized controlled studies.


It should come as no surprise that caffeine upends sleep. Caffeinated beverages—including coffee, green tea, energy drinks, and soda—have been shown to increase heart rate and can cause feelings of nervousness and anxiety. But exactly how long before slumber should you forgo caffeine? According to the results of one study, moderate caffeine consumption (400 mg) within 6 hours of bedtime can significantly disrupt sleep.

The researchers noted the following:

“The results of this study suggest that 400 mg of caffeine taken 0, 3, or even 6 hours prior to bedtime significantly disrupts sleep. Even at 6 hours, caffeine reduced sleep by more than 1 hour. This degree of sleep loss, if experienced over multiple nights, may have detrimental effects on daytime function. Thus, the present results suggest the common practice of afternoon consumption of caffeine should at a minimum be restricted to before 17:00, particularly with regard to the moderate-large doses of caffeine commonly found in increasingly popular premium coffees and energy drinks.” 


Studies of the effects of alcohol on sleep date back to 1939—a subject that has since been extensively covered in the literature. In those who only occasionally drink alcohol, both high and low intakes have been shown to improve sleep. However, higher intakes have also been proven to interfere with REM sleep. Furthermore, people who drink more alcohol can become tolerant to the beneficial sleep effects of alcohol, but may continue to suffer from REM disruption. Thus, alcohol makes for a bad bedfellow. 

Acidic foods

Acidic foods can irritate the stomach lining and elevate acidic PH levels in the body—triggering indigestion, heartburn, and acid reflux—which can interfere with sleep. Despite their high vitamin C, iron and lycopene profiles, tomatoes are surprisingly highly acidic. They also contain the amino acid tyramine, which triggers the brain to release norepinephrine, a stimulant known to increase brain activity and inhibit sleep.

So, to prevent sleep issues, it’s probably best to skip the late-night pizza or pasta.

Spicy food

Similar to acidic foods, eating spicy foods like hot sauces and peppers before bed can lead to a restless night. In addition to raising your core temperature—which can make it difficult to drift off—many spicy foods also tend to be acidic, which can lead to abdominal discomfort and heartburn.

In one low-powered study, the consumption of Tabasco sauce and mustard with an evening meal interfered with rest by altering slow wave and stage 2 sleep, as well as lengthening total time awake and sleep onset latency. The study authors suggested that an increase in total body temperature secondary to the foods could be playing a role in resultant insomnia.

We all love food and sleep—but they don’t always go hand in hand. Staying away from these seven foods before bed will go a long way in making sure you get a restful night’s sleep.

Making sense of menopausal hormone therapy means understanding the benefits as well as the risks

Grappling with the pros and cons of menopausal hormone therapy can be confusing. From

Making sense of menopausal hormone therapy means understanding the benefits as well as the risks

November 18, 2019 6.21am AEDT


  1. Susan Davis Chair of Women’s Health, Monash University

Disclosure statement

Susan Davis consults with Que Oncology. She receives funding from NHMRC and the Grollo Ruzzene Foundation and her institution has received funding from Que Oncology. She has received honoraria from Besins Healthcare and Pfizer Australia for unrestricted presentations to health practitioners on menopause. She is affiliated with the International Menopause Society.


Monash University

At menopause, a woman’s ovaries lose their reproductive function. Eggs are no longer released and the production of the hormones oestrogen and progesterone falls. It’s the lowered levels of oestrogen after menopause that gives rise to troublesome postmenopausal symptoms.

Most women experience menopause between the ages of 45 and 55. It’s a natural event, but for many women it has significant health consequences.

The fortunate few have minimal symptoms, but at least three-quarters of women will have some symptoms. One-third of all menopausal women are moderately to severely affected.

Read more: What is perimenopause and how does it affect women’s health in midlife?

Typical symptoms include hot flushes, night sweats, anxiety, low mood, disturbed sleep, joint pain and vaginal dryness. These symptoms can be debilitating.

The fall in oestrogen also leads to bone loss and an increased risk of fragility fractures. And women going through menopause have increased central abdominal fat, even without an increase in weight. This contributes to a heightened risk of diabetes and heart disease.

An absence of symptoms doesn’t mean bone loss and other metabolic changes aren’t occurring, as these develop silently.

Menopausal hormone therapy (MHT) – which used to be known as hormone replacement therapy, or HRT – is the most effective treatment we have for menopausal symptoms. Yet many women and health-care providers remain confused about the benefits and risks of MHT.

What is menopausal hormone therapy?

MHT replenishes oestrogen supplies in the body to treat the symptoms of menopause. Taking oestrogen causes thickening of the lining of the uterus, so progestogen (which acts like progesterone) is added to MHT to stop this.

This is important because a thickened uterus lining may undergo cellular changes that have the potential to develop into uterine cancer. For a woman who has had a hysterectomy (surgery where the uterus is removed) MHT will be oestrogen-only.

Oestrogen is usually taken in tablet form, but can be applied as a skin patch or skin gel, or as a vaginal pessary. Progesterone is taken as a capsule. There are a range of single formulations and combinations, so the dose and formulation of MHT should be tailored to each woman’s health profile and personal preferences.

Read more: A shift in social attitudes can make menopause a positive experience

Women shouldn’t take MHT if they have a malignancy sensitive to oestrogen, like breast cancer, or have undiagnosed vaginal bleeding.

Unless there’s a specific reason they can’t, it’s especially important women with early menopause take MHT to optimise their health. This is true regardless of how severe their symptoms are.

Menopause before age 45 is classified as early menopause. Prematurely menopausal women are at significantly greater risk of osteoporosis and fracture, heart disease and premature death.

Menopause normally happens between age 45 and 55. From

For women going through menopause at the usual time, the choice may be less clear-cut.

Importantly, MHT cannot be seen in one dimension; that is, as only having one benefit or one risk. To make an informed choice, it’s essential to evaluate the total effects of MHT, including how it influences the risk of premature death, heart disease, fracture, other cancers, and of course, well-being and quality of life.

Balancing the risks and the benefits

Clinical trials have found specific formulations of oral oestrogen with progesterone result in a small increase in breast cancer risk. One study reported roughly a 1.25-fold increase in risk. This is equivalent to about four extra cases of breast cancer per 1,000 women per year in women who were taking this specific MHT formulation before and during the study period.

However, this risk estimate may be incorrect as the women in this study who had never used MHT prior to starting the study had no increased breast cancer risk compared with the placebo group. So some degree of uncertainty as to the risk remains.

There was no increase in risk for oestrogen-only therapy, and whether these risks apply to non-oral therapies is not yet known.

These risks should be balanced with the benefits. Women who take MHT gain less abdominal fat and are less likely to develop diabetes. MHT prevents bone loss and therefore the risk of fragility fracture, an effect that continues after treatment is stopped. Oestrogen alone is associated with reduced heart disease risk, while oestrogen plus progestogen also lowers the risk of colon and uterine cancer.

Read more: Chemical messengers: how hormones change through menopause

The most comprehensive summary of the safety of MHT is from the Women’s Health Initiative study in which 27,347 participants were randomised to receive MHT or a placebo for five to seven years. The researchers followed up to see if death rates differed between women who had taken MHT compared with the placebo.

After 18 years, cancer mortality and death overall from any cause did not differ between the groups, irrespective of whether the MHT was oral oestrogen-only or oral oestrogen plus progestogen.

So if we add symptom relief to the equation, the benefits of MHT will outweigh the potential risks for most symptomatic women who start MHT within ten years of menopause (the time frame measured in this study).

Some women using MHT will continue on the treatment for five or ten years to manage their symptoms. More than 40% of women aged 60 to 65 still have hot flushes and night sweats, and one in seven of these women describe their symptoms as “severe”.

The length of time a woman uses MHT for will depend on her symptom severity and individual needs, which should be re-evaluated alongside her risk profile every year with a health professional.

The alternatives aren’t evidence-based

Claims over-the-counter or internet-purchased nutritional supplements or herbal tablets will “balance your hormones” and relieve symptoms cannot be substantiated.

Studies have consistently failed to show meaningful benefits of nutritional supplements or herbal tablets over placebo for hot flushes. And these treatments do not prevent bone loss or protect against heart disease.

Further, unproven therapies can also have side effects. Women considering herbal or naturopathic remedies should have a face-to-face consultation with a qualified therapist (as opposed to internet-based communication) to ensure their full symptom and health profile, as well as medication use, are documented to minimise adverse effects.

Read more: Don’t count on freezing ovarian tissue to delay menopause or stop your biological clock

7 foods with antibacterial properties

Featured Articles in Internal Medicine In the News

7 foods with antibacterial properties

Naveed Saleh, MD, MS, for MDLinx | November 14, 2019

Although plenty of prescription antibiotics are available, the threat of antibiotic resistance has sparked interest in foods that have antibacterial properties. To boot, consumers seem to be interested in minimally processed foods with antibacterial effects—so a market for these products exists.


Consumers are interested in minimally processed foods with antibacterial effects.

The natural pathogen-fighting benefits of garlic and ginger are fairly well known, but let’s take a look at some other foods and spices that can offer the same immunoprotection.


Like people, plants can also get sick. For instance, when threatened, grapes will release organic compounds to defend their vines against phytopathogens.

The phenolic compounds found in wine and grape products can offer some protection against:

  • Iatrogenic pathogens (eg, Helicobacter pylori and Klebsiella pneumoniae)
  • Foodborne pathogens (eg, Escherichia coli, Listeria monocytogenes, Salmonella enterica, and Staphylococcus aureus)
  • Oral pathogens
  • Viruses (eg, adenovirus, hepatitis virus, and rotavirus)
  • Parasites (eg, Eimeria tenella and Trichomonas vaginalis)
  • Fungi (eg, Candida albicans)
  • Microbial toxins (ochratoxin A and Shiga toxin)


Water-soluble peptide extracts (WSPEs) are bacterial peptides that are released from dairy products like yogurt and possess antimicrobial properties.

“The WSPE exhibited stronger inhibitory activity against gram-negative compared with gram-positive bacteria. In addition, the WSPE inhibited proliferation of HT29 human colon cancer cells. Generation of inhibitory peptides against bacteria and HT29 human colon cancer cells improved with [pineapple peel powder] supplementation of yogurt. However, activities reduced substantially after

tract digestion. Taken together, the incorporation of

and probiotics in yogurts offers new opportunities in the development of novel functional foods, and this approach could lead to the development of novel bioactive peptides having antibacterial and anticancer activity,” concluded the authors of one study investigating the antibacterial effects of yogurt.


If interested in an exotic spin on healthy foods, consider moringa, also known as the horseradish tree. Like the turnip, moringa is a vegetable of the Brassicales order. It is most commonly found in India and Africa, and is used in food preparation as a spice.

Interestingly, moringa has been shown in several studies to have greater antibacterial activity against gram-positive bacteria, such as Staph., than against gram-negative species, such as E. coli and Pseudomonas.


Cinnamon extract is mostly made up of cinnamaldehyde and eugenol, which are compounds that attack respiratory and gastrointestinal pathogens. According to some studies, cinnamon may also protect against infection from H. pylori; however, there isn’t enough evidence to support cinnamon as a form of treatment for H. pylori-induced gastric ulcers.


When boiled or ground into a powder, turmeric can be used to create yellow or orange coloring for food or skin cosmetics, and offers a distinct taste to a variety of Indian and Middle Eastern dishes. This member of the ginger family is well known for its anti-inflammatory health benefits—but did you know that turmeric has antimicrobial properties as well? In mechanistic studies assessing minimum inhibitory concentrations for various pathogens, turmeric demonstrated antimicrobial effects against a gamut of bacteria. Turmeric is so effective that it has even been considered as a candidate to impregnate clothes for antimicrobial benefit. Moreover, it may synergize with current antibiotics, including ampicillin, and thus enhance treatment efficacy.

Cranberry juice and supplements

Pretty much everyone has heard that cranberry juice is effective against urinary tract infections (UTIs). Indeed, cranberry juice may prevent the adherence of bacteria to uroepithelial cells, and suppress inflammatory responses due to infection. Researchers have shown that cranberry juice not only helps mitigate UTIs but may be of use as UTI prophylaxis.

However, cranberry juice may not be effective in all populations, including those at the highest risk of developing UTIs. Additionally, it’s unclear how much cranberry juice is needed to prevent or fight UTIs, and the amount needed may not be cost effective.

Furthermore, there is some debate as to whether cranberry juice or cranberry capsules/supplements provide the greatest defense against infection. In a 2015 study, for instance, taking cranberry capsules lowered the risk of UTIs by 50% in women who had catheters in place while undergoing gynecological surgery.

According to Timothy Boone, MD, PhD, chairman, Department of Urology, Houston Methodist Hospital, Houston, TX, who commented on the study, “Cranberry juice, especially the juice concentrates you find at the grocery store, will not treat a UTI or bladder infection. It can offer more hydration and possibly wash bacteria from your body more effectively, but the active ingredient in cranberry is long gone by the time it reaches your bladder.”

He added: “It takes an extremely large concentration of cranberry to prevent bacterial adhesion…In this study, [the researchers] took the cranberry itself and put it in a capsule—the equivalence of drinking 28 ounces of cranberry juice. As you can see, it takes a large amount of pure cranberry to prevent an infection.”

Echoing the results of the 2015 study are those from a more recent study published in Current Pharmaceutical Biotechnology, in which researchers supported the use of cranberry supplements in women for UTIs:

“Additional well-designed, double-blind, placebo-controlled clinical trials that use standardized cranberry products for long study periods are strongly recommended in order to determine the efficiency of cranberry on the prevention of UTIs in susceptible populations. At present, cranberry supplementation can safely be suggested as complementary therapy in women with recurrent UTIs.”


You’ve likely heard that honey fights germs. But how exactly?

For thousands of years, people have used honey as a wound dressing. In recent years, researchers have shown that honey is much more than a saccharine syrup. It contains various bioactive compounds that aid with healing.

Different types of honey vary in their antibacterial properties. Most honeys contain hydrogen peroxide, which is antibacterial, but catalyzed and inactivated by blood and wound tissue. Often used in wound dressing, manuka honey contains methylglyoxal, which is not inactivated by the body. Manuka honey can be diluted by wound exudates and still inhibit the growth of bacteria.

Honey also potentially promotes immune response, tissue growth, inflammation suppression, and autolytic debridement.

With the antibiotic drug pipeline drying up, few antibiotics have been released recently. This lack of innovation has turned interest toward natural sources of antibacterial goodness. As Hippocrates said, “Let food be thy medicine.”

How big alcohol is trying to fool us into thinking drinking is safer than it really is

Australia’s drinking guidelines are currently under review. From

How big alcohol is trying to fool us into thinking drinking is safer than it really is

October 21, 2019 4.21pm AEDT


  1. Peter Miller Professor of Violence Prevention and Addiction Studies, Deakin University

Disclosure statement

Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Central Australian Aboriginal Congress, Northern Territory government, Australian Rechabites Foundation, Northern Territory Primary Health Network, Lives Lived Well, Queensland government and Australian Drug Foundation, travel and related costs from Queensland Police Service, Queensland Office of Liquor Gaming and Racing and the Australasian Drug Strategy Conference. He has acted as a paid expert witness on behalf of a licensed venue and a security firm.


Deakin University

Deakin University provides funding as a member of The Conversation AU.

Over recent weeks, the alcohol industry has been drumming up media discussion around Australia’s new drinking guidelines.

Australia’s guidelines on alcohol consumption are under ongoing review by the National Health and Medical Research Council (NHMRC), with new draft guidelines expected to be released in November.

The alcohol industry has labelled the current guidelines (two standard drinks per day and four in any heavy episode of drinking) as harsh, and voiced concern the guidelines may be tightened further.

Read more: Politicians who become lobbyists can be bad for Australians’ health

The global alcohol industry has been increasingly proactive in trying to undermine the ever-improving science on the harms associated with the product they make money from manufacturing, promoting and selling.

This is somewhat unsurprising given the industry would be significantly less profitable if we all drank responsibly.

Drinking guidelines

Panels of scientists develop drinking guidelines around the world by assessing the best and most up-to-date evidence on alcohol and health, and determining consumption levels which might put people at risk.

They then provide the information to health professionals and the public to allow people to make informed decisions about consumption. The guidelines are neither imposed nor legislated.

The current 2009 Australian guidelines recommend healthy adults should drink no more than two standard drinks per day to reduce their lifetime risk of alcohol-related disease or injury. They recommend no more than four standard drinks on one occasion to reduce a person’s risk of injury and death.

So how are the industry players trying to protect our drinking culture from such “harsh” guidelines?

Alcohol Beverages Australia: who they are and what they’re claiming

Alcohol Beverages Australia (ABA) is an industry body for global alcohol producers and retailers, including Asahi Brewers from Japan, Diageo Spirits from the UK, Pernod Ricard from France, Coca-Cola Amatil from the USA, and many others. Bringing together multiple industry groups to lobby government was a key strategy developed by the tobacco industry.

The NHMRC review of Australia’s drinking guidelines was open to public submissions on the health effects of alcohol consumption until January 2017. At this time, the ABA submitted a report claiming drinking alcohol carries health benefits including a reduced risk of heart disease, stroke and diabetes. They requested the review take this into account in drafting any new guidelines.

In their communications with the media this month, the ABA resurfaced their 2017 submission to the process. It seems they have not updated the information to reflect the latest evidence.

Read more: Ten reasons some of us should cut back on alcohol

The most up-to-date evidence has shown previous research was substantially flawed in terms of the relationship between alcohol consumption and heart disease, blood pressure, breast cancer and overall mortality.

We know consuming any type of alcohol increases the risk of developing cancer of the bowel, mouth, pharynx, larynx, oesophagus, liver and breast. The World Health Organisation has classified alcohol as a class 1 carcinogen, along with asbestos and tobacco, for decades.

Any health benefits the ABA demonstrated evidence for is outweighed by the risks.

The current drinking guidelines in Australia recommend no more than two standard drinks per day for healthy adults. From

Alongside claiming the benefits of drinking alcohol need to be considered, to make their case, the ABA have compared drinking guidelines across different countries. In doing so, they are seeking to highlight Australia’s guidelines are ‘stricter’ than those of most other countries.

In making sense of these figures, the difference in drink driving levels is worth considering. It takes the average male four standard drinks to reach 0.05 in two hours and around seven standard drinks to reach 0.08. This is a big difference for most of us.

Those countries with 0.08mg of alcohol per L of blood as the legal limit are willing to accept more than triple the risk of having a car accident than Australia’s 0.05.

We need to ask whether these are countries whose health and safety models we want to follow.

Read more: Health check: is moderate drinking good for me?

This is not a new problem

The industry is using language like “harsh” and “strict” to ferment public opposition to any tightened guidelines.

This spin strategy is predictable. The alcohol industry has been fighting for many decades to preserve profits over public safety, disregarding consumers’ rights to know the contents of their products, and the harms associated.

They fought against the 0.05 drink driving limit in the 1950s, and have successfully stopped Australian governments telling us about the cancer risk associated with alcohol consumption. For example, while policymakers have proposed warning labels with information about cancer risk be placed on alcoholic drinks, this is yet to eventuate.

The ABA is currently resisting a push to explicitly warn consumers drinking is harmful to unborn babies by means of mandatory labelling on all alcohol containers, suggesting it’s “too much information”.

These examples show how the industry continues to actively muddy efforts to educate the public of the harms of alcohol consumption.

Read more: Alcohol increases cancer risk, but don’t trust the booze industry to give you the facts straight

Notably, we’ve seen all of this before, particularly in the tobacco industry, or “big tobacco”, which has previously employed strategies to minimise health concerns and delay effective legislation.

So it’s hard not to wonder if the ABA are worried about the bottom line of their corporate masters, and therefore trying to influence deliberations through a media campaign, similar to those previously used by the tobacco industry.

Needless treatments: anti-fungal creams or tablets don’t always work for vaginal itch

November 19, 2018 5.56am AEDT Sometimes the symptoms of thrush can be caused by other infections. from


  1. Cathy Watson Research Fellow in Women’s Health at Monash University and Honorary Researcher, General Practice and Primary Health Care Academic Centre, University of Melbourne

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Many women who experience persistent vaginal itch or discharge assume they have vaginal thrush (vulvolvaginal candidiasis). Treatments for thrush are available without a prescription. Since having a vaginal condition can be embarrassing, it’s sometimes preferable to buy creams or tablets from the chemist and treat yourself.

But this also means some women may be using treatments that aren’t best for their condition, or that could be ineffective. Guidelines on treating vaginal itch, from a campaign to eliminate tests or procedures that could be harmful or ineffective, state:

Do not treat recurrent or persistent symptoms of vulvovaginal candidiasis with topical and oral anti-fungal agents without further clinical and microbiological assessment.

This is because if symptoms of thrush persist despite treatment, you may have an entirely different condition that would not be helped by anti-fungal creams or tablets.

What causes thrush?

Vaginal thrush is caused by a fungal organism from the Candida family, which usually exists in the vaginal environment (along with a huge number of other micro-organisms) without causing issues for women. When symptoms do occur, they may include itchiness, burning and discomfort, often accompanied by a “cottage-cheese” discharge.

A course of antibiotics (which can alter the balance of micro-organisms in the vagina and allow Candida to thrive) may bring about an episode of thrush. For others, it seems to occur after sexual intercourse. However, vaginal thrush is not considered to be sexually transmitted.

Read more: Recurrent thrush: how some women live with constant genital itching

Sometimes thrush occurs during pregnancy. It’s likely hormones play a part in the condition as vaginal thrush is rare in girls before their first period and in women after menopause. Genetics could play a part too, and diet is possibly implicated. But for most women, it’s not clear what causes episodes of thrush.

What is a topical and oral anti-fungal agent?

Health practitioners often recommend anti-fungal treatment for thrush. There are two main types of treatment: oral (tablets taken by mouth) or topical (creams or vaginal pessaries applied directly to the vaginal area). The topical treatment generally works a bit quicker than the oral.

There is no difference in effect between the types of treatments; it comes down to a preference or tolerability. Some women may experience stomach symptoms with the oral tables, for instance. And topical treatments may cause skin irritation for others. But generally both types of treatments are well tolerated.

Many assume if a woman is experiencing vaginal itch, thrush is the guilty party. from

Because thrush is so common, many assume if a woman is experiencing vaginal itch, thrush is the guilty party. Anti-fungal treatments are highly effective if the symptoms are caused by thrush. The trouble is, Candida albicans isn’t the only cause of these symptoms.

One study showed that of women who treated themselves for vaginal thrush, only one-third actually had thrush, and around 14% had no infection at all. The other women had conditions such as bacterial vaginosis which can cause an offensive vaginal discharge and is caused by a bacteria not a fungus.

Read more: We need a cure for bacterial vaginosis, one of the great enigmas in women’s health

Some women may also be experiencing a vulval dermatitis, or even a more serious but rare condition called lichen sclerosus, which can cause itching and require completely different treatment.

What’s wrong with self-treatment?

If a woman uses the anti-fungal treatment and the condition clears up, usually within a few days, it’s likely that Candida albicans were responsible. But if it doesn’t clear up or keeps coming back, it’s important to have this investigated by a health professional.

This is because:

  • The symptoms may not be caused by thrush but something else such as a sexually transmitted infection like bacterial vaginosis
  • There are a number of different types (or species) of Candida, and some don’t respond well to certain treatment
  • Inappropriate use of anti-fungals may lead to fungal resistance which means higher doses of treatment may be necessary, or that the anti-fungal treatment won’t work at all
  • There may be a more appropriate method of managing the condition, such as treating on a regular basis at certain times of the menstrual cycle
  • The woman may have an another medical condition, such as diabetes, which makes vaginal thrush more difficult to treat.

What if it’s thrush, but the anti-fungals don’t work?

If you have thrush, anti-fungal treatments are usually effective. But for around 5% of women, thrush keeps coming back or doesn’t completely clear despite treatment. In these case, it may be necessary to see a specialist.

The recommended management for problematic thrush is long-term treatment with regular (weekly or monthly) oral or topical anti-fungals. But tailored therapy may sometimes be needed, such as combinations of antifungal therapy (oral + topical) or different regiments according to response to the therapy.

Many women resort to alternative therapies such as tea-tree oil, garlic and gentian violet and yoghurt. But there is inconsistent evidence supporting these methods and they may cause allergic reactions.

Other treatments like probiotics also have limited supporting evidence and can be expensive. There are some promising treatments in the pipeline (such as vaccines, tetrazole antifungal agent and immunotherapy) but these are still under trial and not commercially available.

So, if you’re suffering from a vaginal itching, burning or abnormal discharge that isn’t relieved by oral or topical anti-fungals, seek professional help. You should have swabs taken to rule out other infections or conditions and to decide on the most appropriate method of management.

The evidence base for HRT: what can we believe?

Climacteric. 2017 Apr;20(2):91-96. doi: 10.1080/13697137.2017.1280251. Epub 2017 Mar 10.

The evidence base for HRT: what can we believe?

Langer RD1.

Author information


Prior to the unexpected early termination of the Women’s Health Initiative (WHI) trial of continuous conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA), the prevailing view was that hormone replacement therapy (HRT) was a low-risk intervention with immediate value for symptom relief in recently menopausal women, and that it probably conferred long-term protection against the major chronic diseases that affect women after menopause. Rather than replicating prior studies, the WHI was designed to test whether the beneficial associations consistently seen in women starting HRT near menopause would be found in women well beyond menopause. Views of the benefits and risks of HRT changed dramatically in 2002 with the unexpected early termination of the CEE + MPA trial and the alarming initial WHI report. HRT use plummeted world-wide, driven by fear of breast cancer and skepticism about cardiovascular benefits. Stunningly, the contrasting findings of the WHI trial of CEE alone reported 2 years later – suggesting prevention of coronary heart disease in women who began HRT at age <60 years, and a reduction in breast cancer overall – were largely ignored. Key lessons from the WHI are that the effects of HRT on most organ systems vary by age and time since last physiologic exposure to hormones and that there are differences between regimens. In the years since the first WHI report, we have learned much about the characteristics of women who are likely to benefit from HRT. The range of HRT regimens has also increased. Not all women have indications for HRT, but for those who do and who initiate within 10 years of menopause, benefits are both short-term (vasomotor, dyspareunia), and long-term (bone health, coronary risk reduction). Critically, the ‘facts’ that most women and clinicians consider in making the decision to use, or not use, HRT are frequently wrong or incorrectly applied.

Think supplements are worthless? Think again

Featured Articles in Internal Medicine In the News

Think supplements are worthless? Think again

Liz Meszaros, MDLinx | October 07, 2019

Certain supplements may be helpful in treating some mental disorders, according to recent research published in World Psychiatry.


Results of this meta-analysis offer hope that patients with certain mental disorders may benefit from the addition of simple nutritional supplements.

In this meta-analysis of several supplements, researchers found the strongest evidence for the use of omega-3 supplements as adjunctive treatment to antidepressants for patients with depression. Folate-based supplements were also found to reduce symptoms of major depressive disorder (MDD), as well as help with the negative symptoms of schizophrenia. For over a decade, researchers have studied whether omega-3 supplements could be beneficial in treating some forms of depression. Although they did find some benefit, none of the studies were definitive.

The link between supplements and mental illness is not a surprising one, as previous research has documented a relationship between poor diet and mental illness. Data also support the metabolic and hormonal side effects of psychotropic medications on food intake.

“The importance of diet for maintaining physical health is widely accepted, due to the clear impact of dietary risk factors on cardiometabolic diseases, cancer and premature mortality. In parallel, the potential impact of diet on mental disorders is in­creasingly acknowledged,” wrote Joseph Firth, PhD, NICM Health Research Institute, Western Sydney University, Westmead, Australia, and colleagues.

To complement and round out dietary nutrients, many people take supplements. In fact, in the United States, 52% of adults take supplements in some form, despite a lack of evidence that supplement use has any effects on diseases or mortality.

“Currently, there is an increased academic and clinical interest in the role of nutrient supplements for the treatment of various mental disorders. This growth of research is partly attributa­ble to our evolving understanding of the neurobiological under­pinnings of mental illness, which implicates certain nutrients as a potential adjunctive treatment for a variety of reasons,” added Dr. Firth and fellow researchers.

In this study, they identified 33 meta-analyses of randomized, placebo-controlled trials, which included data from 10,951 participants. Here are their results, classified by the various types of supplements studied.

Polyunsaturated fatty acids (PUFAs). Dr. Firth and colleagues found the strongest evidence for the use of PUFAs as adjunctive treatment for depression. Omega-3 supplements (mean: 1,422 mg/d eicosapentaenoic acid) significantly reduced depressive symptoms (P = 0.006), and as adjunctive therapy to antidepressants, had moderate effects on depressive symptoms (P = 0.009), as they did when used as adjunctive treatment to antidepressant therapy in patients with MDD (P = 0.01).

When they assessed different omega-3 formulations for the treatment of individuals with any clinical depression, Dr. Firth et al found that those supplements containing ≥ 50% docosahexaenoic acid had no benefits, while those with ? 50% eicosapentaenoic acid had fairly significant positive effects on depressive symptoms (P < 0.001). Furthermore, longer treatment ( ? 12 weeks) with omega-3s demonstrated greater effects on depressive symptoms than treatment lasting 12 weeks or less (P < 0.01 vs P < 0.001, respectively). And adjunctive treatment was more effective for depression compared with monotherapy (P < 0.001 vs P = 0.017).

Omega-3s had no significant effects on mania in people with bipolar disorder, and there was no evidence that PUFAs provide any benefit in the treatment of schizophrenia.

However, the researchers did find that PUFAs may offer some benefits in the treatment of ADHD in young people and children, with significant benefits for hyperactivity/impulsivity (P = 0.006) and inattention (P = 0.006), but only on parent-rated measures, not teacher/clinician rated measures.

Folate-based supplements. Many of the included studies were focused on folate-based supplements as adjunctive treatment for depression and schizophrenia. Researchers found that high-dose methylfolate (15 mg/d) demonstrated positive effects in patients with MDD (P = 0.002), but lower doses had no significant effects.

Folate-based supplements, including folic acid and methylfolate, brought about significantly greater reductions in the symptoms of depression compared with placebo when used as an adjunct to treatment with to selective serotonin reuptake inhibitors in patients with unipolar depression.

For the adjunctive treatment of schizophrenia, however, folate-based supplements had non-significant effects on total symptoms, but approached significance in two trials of high-dose methylfolate (P = 0.06). Researchers found an overall absence of overall effects.

Inositol. For the treatment of depressive symptoms associated with bipolar disorder, unipolar depression, and premenstrual dysphoric disorder, researchers found no significant differences in effect between inositol (3.6-19 g/d) and placebo. Inositol was also associated with a higher incidence of gastrointestinal upset.

Amino acid cysteine (N-acetylcysteine). N-acetylcysteine (2-3 g/d) had small but significant effects on global functioning (P = 0.04) and other measures of functional impairment (P = 0.002) compared with placebo in people with mood disorders such as bipolar disorder and MDD.

Other findings included the following:

  • In patients with clinical depression, vitamin D significantly reduced depressive symptoms (P < 0.01)
  • As an adjunctive treatment for MDD, zinc (25 mg/d) demonstrated moderately significant effects on easing depressive symptoms (P ≤ 0.01)
  • In patients with self-reported depression, the effects of magnesium (225-4,000 mg/d) was no different than placebo
  • Antioxidant vitamins, including vitamins C and E, had no effects on symptoms scores in schizophrenia, as did zinc and chromium, and vitamin B6
  • N-acetylcysteine was also backed by data as a useful adjunctive treatment for mood disorders and schizophrenia
  • For managing the side effects of antipsychotic medications, specifically tardive dyskinesia, vitamin E was no better than placebo

These results offer hope that patients with these mental health disorders may benefit from the addition of simple nutritional supplements.

“In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentae­noic acid in depression), but also made aware of those currently lacking evidentiary support,” wrote the authors.