Monthly Archives: August 2020

Why so many people regain weight after dieting


Why so many people regain weight after dieting

November 25, 2016 7.13am AEDT

Anyone who has tried to lose weight and keep it off knows how difficult the task can be. It seems like it should be simple: Just exercise to burn more calories and reduce your calorie intake. But many studies have shown that this simple strategy doesn’t work very well for the vast majority of people.

A dramatic example of the challenges of maintaining weight loss comes from a recent National Institutes of Health study. The researchers followed 14 contestants who had participated in the “World’s Biggest Loser” reality show. During the 30 weeks of the show, the contestants lost an average of over 125 pounds per person. But in the six years after the show, all but one gained back most of their lost weight, despite continuing to diet and exercise.

Why is it so hard to lose weight and keep it off? Weight loss often leads to declines in our resting metabolic rate – how many calories we burn at rest, which makes it hard to keep the weight off. So why does weight loss make resting metabolism go down, and is there a way to maintain a normal resting metabolic rate after weight loss? As someone who studies musculo-skeletal physiology, I will try to answer these questions.

Activating muscles deep in the leg that help keep blood and fluid moving through our bodies is essential to maintaining resting metabolic rate when we are sitting or standing quietly. The function of these muscles, called soleus muscles, is a major research focus for us in the Clinical Science and Engineering Research Center at Binghamton University. Commonly called “secondary hearts,” these muscles pump blood back to our heart, allowing us to maintain our normal rate of metabolic activity during sedentary activities.

Why is it hard to maintain weight loss? Weight scale image via

Resting metabolism and weight maintenance

Resting metabolic rate (RMR) refers to all of the biochemical activity going on in your body when you are not physically active. It is this metabolic activity that keeps you alive and breathing, and very importantly, warm.

Quiet sitting at room temperature is the standard RMR reference point; this is referred to as one metabolic equivalent, or MET. A slow walk is about two MET, bicycling four MET, and jogging seven MET. While we need to move around a bit to complete the tasks of daily living, in modern life we tend not to move very much. Thus, for most people, 80 percent of the calories we expend each day are due to RMR.

When you lose weight, your RMR should fall a small amount, as you are losing some muscle tissue. But when most of the weight loss is fat, we would expect to see only a small drop in RMR, as fat is not metabolically very active. What is surprising is that relatively large drops in RMR are quite common among individuals who lose body fat through diet or exercise.

The “World’s Biggest Loser” contestants, for example, experienced a drop in their resting metabolic rate of almost 30 percent even though 80 percent of their weight loss was due to fat loss. A simple calculation shows that making up for such a large drop in RMR would require almost two hours a day of brisk walking, seven days a week, on top of a person’s normal daily activities. Most people cannot fit this activity level into their lifestyle.

There’s no question that eating a balanced diet and regular exercise are good for you, but from a weight management perspective, increasing your resting metabolic rate may be the more effective strategy for losing weight and maintaining that lost weight.

The connection between RMR and your heart

Metabolic activity is dependent on oxygen delivery to the tissues of the body. This occurs through blood flow. As a result, cardiac output is a primary determinant of metabolic activity.

The adult body contains about four to five liters of blood, and all of this blood should circulate throughout the body every minute or so. However, the amount of blood the heart can pump out with each beat is dependent on how much blood is returned to the heart between beats.

Cardiac output controls resting metabolic rate. Human heart image via

If the “plumbing” of our body, our veins in particular, was made of rigid pipes, and the skin of our legs was tough like that of bird legs, cardiac outflow would always equal cardiac inflow, but this is not the case. The veins in our body are are quite flexible and can expand many times their resting size, and our soft skin also allows lower body volume expansion.

As a result, when we are sitting quietly, blood and interstitial fluid (the fluid which surrounds all the cells in our body) pools in the lower parts of the body. This pooling significantly reduces the amount of fluid returning to the heart, and correspondingly, reduces how much fluid the heart can pump out during each contraction. This reduces cardiac output, which dictates a reduced RMR.

Our research has shown that for typical middle-aged women, cardiac output will drop about 20 percent when sitting quietly. For individuals who have recently lost weight, the fluid pooling situation can be greater because their skin is now much looser, providing much more space for fluids to pool. This is especially the case for people experiencing rapid weight loss, as their skin has not had time to contract.

Raising metabolic activity

For young, healthy individuals, this pooling of fluid when sitting is limited because specialized muscles in the calves of the legs – the soleus muscles – pump blood and interstitial fluid back up to heart. This is why soleus muscles are often referred to as our “secondary hearts.” However, our modern, sedentary lifestyles mean that our secondary hearts tend to weaken, which permits excessive fluid pooling into the lower body. This situation is now commonly referred to as “sitting disease.”

The soleus muscles keep blood from pooling in the legs. Henry Vandyke Carter, via Wikimedia Commons

Moreover, excessive fluid pooling can create a vicious cycle. Fluid pooling reduces RMR, and reduced RMR means less body heat generation, which results in a further drop in body temperature; people with low RMR often have persistently cold hands and feet. As metabolic activity is strongly dependent on tissue temperature, RMR will therefore fall even more. Just a 1 degree Fahrenheit drop in body temperature can produce a 7 percent drop in RMR.

One logical, though expensive, approach to reduce fluid pooling after weight loss would be to undergo cosmetic surgery to remove excess skin to eliminate the fluid pooling space created by the weight loss. Indeed, a recent study has confirmed that people who had body contouring surgery after losing large amounts of weight due to gastric banding surgery had better long-term control of their body mass index than people who did not have body contouring surgery.

What can you do?

A much more convenient approach to maintaining RMR during and after weight loss is to train up your secondary hearts, or soleus muscles. The soleus muscles are deep postural muscles and so require training of long duration and low intensity.

Tai chi, for instance, is an effective approach to accomplish this. However, we’ve observed that many people find the exercises onerous.

Over the last several years, investigators in the Clinical Science and Engineering Research Lab at Binghamton University have worked to develop a more practical approach for retraining the soleus muscles. We have created a device, which is now commercially available through a university spin-off company, that uses a specific mechanical vibration to activate receptors on the sole of the foot, which in turn makes the soleus muscles undergo a reflex contraction.

In a study of 54 women between the ages of 18 and 65 years, we found that 24 had secondary heart insufficiency leading to excessive fluid pooling in the legs, and for those women, soleus muscle stimulation led to a reversal of this fluid pooling. The ability to prevent or reverse fluid pooling, allowing individuals to maintain cardiac output, should, in theory, help these individuals maintain RMR while performing sedentary activities.

This premise has been confirmed, in part, by recent studies undertaken by our spin-off venture. These unpublished studies show that by reversing fluid pooling, cardiac output can be raised back to normal levels. Study results also indicate that by raising cardiac output back to normal resting levels, RMR returns to normal levels while individuals are sitting quietly. While these data are preliminary, a larger clinical trial is currently underway.

Healthy diet cuts risk of dying from breast cancer

Healthy diet cuts risk of dying from breast cancer

Large US study shows women on a low-fat diet had a 21% lower risk of death 29th May 2019 By Reuters Health0 Comments

A low-fat, fruit and vegetable-rich diet significantly lowers the risk of older women dying from breast cancer, according to long-term data from a US clinical trial.


Nearly 49,000 postmenopausal women aged 50-79 with no previous breast cancer and with dietary fat accounting for at least 32% of total daily calories were enrolled in the Women’s Health Initiative Dietary Modification trial.

From 1993-98, the women were randomly allocated to a usual-diet comparison group or a dietary intervention group that aimed to reduce fat intake to 20% of daily calories and increase consumption of vegetables, fruit and grains.

Women stuck to the diet for roughly 8.5 years. The majority increased their intake of fruits, vegetables and grains, and cut their daily fat intake to 25% or less, although most did not reach the 20% goal.

The research team was able to track half of the women for nearly 20 years, according to the results presented at the 2019 American Society of Clinical Oncology annual meeting.

Women on the low-fat diet had a 21% lower risk of death from breast cancer and a 15% lower risk of death from any cause during follow-up.

“Ours is the first randomised controlled trial to prove that a healthy diet can reduce the risk of death from breast cancer,” said lead investigator Dr Rowan Chlebowski, from Harbor-UCLA Medical Centre in California, US.

“The balanced diet we designed is one of moderation, and after nearly 20 years of follow-up, the health benefits are still accruing.”

More than 3300 of the women developed breast cancer between 1993 and 2013.

The low-fat diet did not significantly reduce women’s risk of developing breast cancer, but women in the dietary intervention group experienced a range of short- and long-term health benefits compared with women in the normal diet group, Dr Chlebowski noted.

Postmenopausal women with metabolic syndrome were particularly likely to benefit from the dietary intervention.

Commenting on the findings during the briefing, Dr Lidia Schapira from Stanford Cancer Institute in California said the study was “very important”.

“It helps us understand that what we put on the plate matters, and it is worth coaching and pushing our patients to put fruits, vegetables and grains on their plate.”

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Female reproductive factors and the likelihood of reaching the age of 90 years.

Maturitas. 2019 Jul;125:70-80. doi: 10.1016/j.maturitas.2019.04.213. Epub 2019 Apr 17.

Female reproductive factors and the likelihood of reaching the age of 90 years. The Netherlands Cohort Study.

Brandts L1, van Poppel FWA2, van den Brandt PA3.

Author information



The aim of this study was to prospectively assess the relationship between several reproductive factors in women and the likelihood of reaching the age of 90 years (achieving longevity).


For this study, data from the oldest birth cohort (1916-17) of the prospective Netherlands Cohort Study (NLCS) were used. These participants filled in a baseline questionnaire in 1986 (at age 68-70 years). Follow-up for vital status information until the age of 90 years (2006-07) was >99.9% complete.


Multivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 2,697 women with complete exposure and co-variable data to calculate risk ratios (RR) of reaching age 90.


No associations were observed between the likelihood of reaching the age of 90 years, and age at menarche, age at menopause, parity, menstrual lifespan, and oral contraceptive use after adjustment for potential confounders. A later age at first childbirth pointed towards a higher chance of achieving longevity (age ≥30 vs. 20-24; RR,1.17; 95%CI,0.98-1.39).

Ever-use of hormone replacement therapy (HRT) was significantly associated with a higher chance of achieving longevity compared with never HRT-users, but only in women who had had an early menopause (<50 years)(RR,1.32; 95% CI, 1.07-1.61).


Age at first childbirth, and ever-use of HRT in women with an early menopause (<50 years) were associated with the likelihood of reaching the age of 90 years.

Copyright © 2019 Elsevier B.V. All rights reserved.


Aging; Childbirth; Hormone Replacement Therapy; Longevity; Menarche; Menopause

7 clinically proven natural remedies

Featured Articles in Internal Medicine In the News

7 clinically proven natural remedies

Naveed Saleh, MD, MS, for MDLinx | July 10, 2019

It may be hard to imagine, but in the days before prescription medications, people turned to natural remedies to treat conditions such as infections and toothaches. Currently, about 4 out of 10 adults still turn to alternative therapies and the like, including herbal supplements, to treat what ails them.


Echinacea harbors immune modulatory, antiviral, and anti-inflammatory effects, and is most effective during bouts of acute illness.

Ideally, it’s best for patients to consult with their physicians before trying any natural remedy. In turn, it’s a good idea for physicians to understand which of these remedies actually work.

Let’s take a look at some examples.


Probiotics—live bacterial or yeast cultures—are considered to be strong defenses against “bad” bacteria, such as Clostridium difficile, that can take over your gut. You’ve likely been bombarded with advertisements promoting probiotics in the form of yogurt. But does this stuff help? And is it worth shelling out a small fortune for bulk-sized packages at your local wholesale warehouse?

According to one JAMA review, various mechanisms have been suggested to explain how certain probiotics could exert health benefits—especially with respect to diarrhea. For instance, Saccharomyces boulardii, a strain of the yeast Saccharomyces cerevisiae, has been demonstrated to stymie the pathogenicity of bacterial toxins. Furthermore, acetic, lactic, and propionic acid produced by Lactobacillus species could lower intestinal pH and inhibit the growth of pathogenic bacteria such as Escherichia coli and Clostridium species. Moreover, the presence of Lactobacillus species and other probiotics in the intestines may physically or chemically prevent adhesion and colonization of pathogenic bacteria. Lastly, such probiotics could induce or enhance an immune response.

Not all strains of probiotics help relieve diarrhea, and it remains to be elucidated which specific strains of probiotics are most helpful in treating this unpleasant condition.


Dating back to ancient Greece, peppermint has long been used as an herbal remedy to treat gastrointestinal ailments. Nowadays, peppermint oil and leaves are commonly used to treat irritable bowel syndrome (IBS). Symptom relief is likely owed to the menthol found in peppermint, which has an antispasmodic effect on the intestinal smooth muscle. Menthol is also used in various over-the-counter topical products targeting respiratory congestion, headache, and muscle pain.

According to results from a large meta-analysis published in BMC Complementary and Alternative Medicine, peppermint oil vs placebo is effective in treating global complaints of IBS, such as abdominal pain. Furthermore, peppermint oil posed no negative side effects. The number of patients needed to treat to avoid one patient from having persistent IBS symptoms was three, with four patients needed to avoid one case of abdominal pain.


In the Middle East, flavoring tea with spices is a common practice—and for good reason. In addition to enriching flavor, spicing tea could yield various metabolic benefits. In an Iranian trial, subjects who incorporated cardamom, cinnamon, ginger, or saffron in their tea for 8 weeks experienced improvements in metabolic biomarkers, such as lipid profiles, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein levels compared with controls. These spices, however, failed to decrease fasting blood sugar, insulin, and HbA1c levels, or body weight.  

Calamine lotion

As a kid, you may recall being painted in pungent calamine lotion for itchy skin ailments like mosquito bites, poison ivy exposure, or chicken pox. Calamine lotion is a mineral mix of zinc and ferric oxide used in lotions, liniments, and ointments to soothe the itching, pain, and discomfort of minor skin irritations.

In a study published in the Journal of Orthopaedic Surgery involving kids aged 6-15 years who were wearing casts, those who used calamine lotion experienced less itching and fewer skin lesions vs controls. Calamine lotion users were also less sweaty. It seems that mother really does know best. Hooray for the pink stuff!

Chamomile tea

Poor sleep quality is often associated with postpartum women, but chamomile tea may be able to help. According to the results of a Chinese trial, postnatal women who drank chamomile tea for 2 weeks experienced better sleep quality and greater alleviation of symptoms of depression than did controls.


Echinacea is derived from the roots of coneflowers. For some time, experts have been interested in the immune effects of this natural supplement. In a meta-analysis published in Advances in Medicine, echinacea extract was found to decrease the risk of recurrent respiratory infections and complications, such as pneumonia, ear infection, and tonsillitis. Experts hypothesize that echinacea harbors immune modulatory, antiviral, and anti-inflammatory effects that appear strongest in susceptible individuals. Notably, it seems that echinacea is most effective during bouts of acute illness.

Horse chestnut

Buckeyes, which sports fans may be familiar with, are part of the horse chestnut family. Horse chestnut has been used as a conservative therapy for varicose veins in lieu of compression stockings. According to the authors of a review published in Cochrane Database of Systematic Reviews: “The evidence presented suggests that [horse chestnut seed extract] is an efficacious and safe short?term treatment for [chronic venous insufficiency]. However, several caveats exist and larger, definitive

[randomized, controlled trials]

are required to confirm the efficacy of this treatment option.

Although there is some evidence supporting the use of natural remedies to treat certain conditions, overall there are many more examples of such treatments providing no scientifically proven health benefits. For instance, some people believe that cranberries (including juice and supplements) are an effective treatment for urinary tract infections despite the lack of sufficient clinical data—which experts have highlighted. Furthermore, taking clove oil for toothache doesn’t work according to the FDA.

Low Dose Naltrexone and chronic pain

I have been using LDN for about 5 years now for a whole range of conditions, mainly Hashimotos disease, crohns disease and a range of autoimmune diseases. Generally the results have been positive, but not in everyone. Due to the low dose and minimal side effects, most people with these conditions do not have much to lose in trying LDN.

Low Dose Naltrexone and chronic pain – Pradeep Chopra, MD

Pradeep ChopraOpioids (narcotics) have been used for many years. It’s counter-intuitive to think that a drug like naltrexone which blocks the effect of opioids can help manage chronic pain. We do have some understanding that LDN (Low Dose Naltrexone) helps with autoimmune conditions. Current literature in pain medicine supports the view that chronic pain, especially chronic nerve pain conditions such as Complex Regional Pain Syndrome, Reflex Sympathetic Dystrophy, Diabetic Peripheral Neuropathy are autoimmune based. A study done on treating Fibromyalgia pain with LDN showed a 30% reduction in symptoms. Below is a short description of the mechanism behind chronic nerve pain. 

The Central Nervous system (CNS) is made up of nerves and cells called glia.  The glias make up about 80% of the CNS while the nerves make up about 20%. The function of the glia is to provide immune protection and host defense to the CNS. Under normal conditions the glia remain in an inactive state. They become activated readily in response to infection or injury. The most important change that happens during inflammation of the brain and spinal cord (Central Nervous System) is activation of glia cells. 

When glia cells are activated they trigger the release of certain chemicals known as pro-inflammatory and neurotoxic factors. These factors include several cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin one beta (IL1-β), fatty acid metabolites and free radicals such as nitric oxide and superoxide. In painful conditions such as Complex regional pain) and neuropathic pain, damage to the peripheral nerves shifts the glia to an activated state within the spinal cord. 

The family of glia cells are made up of microglia and astrocytes. Each of these family members have a specific role. The microglia guard and protect the immune system and the astrocytes help maintain cell fluid balance which is important for the action of chemicals in the cells called neurotransmitters (needed to control nerve function). Glia are activated by trauma, injury, infection, opioids. When activated, glia release pro-inflammatory and neurotoxic factors (cytokines). 

Drugs that block the effect of opioids (morphine) may help prevent activation of glia. Such drugs are naltrexone and naloxone.  Low dose naltrexone (hence, LDN) may inhibit the activation of glia. 

Cells use chemicals called neurotransmitters to communicate with each other. Like most drugs, neurotransmitters work by attaching to specific receptors on cells. When neurotransmitters attach to receptors on cells, it allows for the passage of other substances into the cell (such as sodium, calcium). When these substances enter the cells they trigger the cells to fire and transmit signals along the nerve fiber. 

Glutamate is the most abundant neurotransmitter found in the central nervous system. It is an excitatory neurotransmitter. Glutamate binds to a receptor called NMDA (N-methyl D-aspartate).

The NMDA receptor is the most common receptor found in the Central Nervous System. When the NMDA receptor is activated by glutamate it opens up calcium channels which cause the nerves to fire. 

To summarize, when glial cells are activated they release chemicals and neurotransmitters that cause NMDA receptors to be activated which cause nerves to fire. 

LDN (Low Dose Naltrexone), by its ability to inhibit microglial activation, suppresses activation of NMDA receptors by decreasing the release of glutamate neurotransmitter.

Whether to try LDN for CRPS must be seriously considered, especially since it can have interactions with existing medical regimens, particularly if medications are opioids (morphine like drugs). It should not be taken by patients who are on opioids or tramadol. Often, the choice is easiest for patients who are not on opioids. Fortunately, LDN has a low risk of side effects before taking LDN, one must consider current research, clinical trials, strength of anecdotal reports, severity of CRPS, response to other therapies, drug interactions and any contraindications.  

Most physicians are unfamiliar with LDN. Be prepared to discuss LDN with your physician and acquaint him or her. There are some resources at the end of this article to help you acquaint yourself and your physician. 

What to expect from LDN

LDN does not work immediately. It may take anywhere from a few weeks to many months. Users have reported to notice a difference after 9 to 12 months. After the initial response, it continues to show a benefit. The main goal of LDN is to slow or halt the progression of disease. In addition, symptoms may improve. Improvements seen in pain include decreases in exacerbation of pain, symptom improvement, improved functioning and better tolerance to pain.

LDN may increase endorphins (morphine like substances produced by the body) which may result in a feeling of well being. Human trials have demonstrated improvement in mood and in quality-of-life scores. This feeling helps lower stress, reduce depression, and increase healing. This is especially true for conditions like CRPS where stress can lead to exacerbations. 


Naltrexone was initially tested in humans for safety at the 50 to 100 mg dose level. There have been a number of studies such as a Crohn’s disease study.  Studies have assessed naltrexone administered at low-dose for safety and found no major issues to date.

Physicians who prescribe LDN feel that at such a low dose, it is unlikely to cause any harm. At high doses (50mg to 300mg of naltrexone) it may affect the liver. Patients with pre-existing liver and kidney conditions using LDN should have their metabolic functions monitored by their doctors.

No studies have been done to see the long term effects of LDN and its intermittent opioid blocking effect. Naltrexone has different effects when used in high doses and it is unknown whether the long-term use of LDN could have effects similar to those of high dose naltrexone. Patients who are considering taking LDN long term should approach with caution if they do not have a serious condition. 

LDN does not stay in the body very long, hence if an emergency arises and a patient has to be administered an opioid for managing severe pain, they are unlikely to see any withdrawal effects. 


LDN can be taken with other medications or supplements as long as they do not contain opiates or synthetic narcotics, examples of which include fentanyl, meperidine (Demerol, Pethidine), tramadol, morphine, oxycodone and  hydrocodone. Naltrexone blocks the opioid receptors. Therefore pain medications will be blocked from working and could lead to withdrawal problems. Check with your doctor and pharmacist to make sure that none of your medications are contraindicated. They can also advise you on stopping pain medications that might interfere with LDN and offer advice and amount of time to allow between stopping opiates and starting LDN.

After starting LDN, if you have surgery scheduled or a procedure that may require pain medications, consult with your doctor to determine the amount of time needed to clear again from your system so that it does not interfere with anesthesia or pain medications. LDN must also be stopped if your doctor plans to prescribe opiate-based medications for postoperative use. The time required to clear naltrexone for the body may vary, based on dosage and body weight. After a procedure under anesthesia or requiring pain medications allow adequate time for the opiates to clear from your system before restarting LDN.

Side effects

Considering that the naltrexone is such a low dose, it is uncommon to cause any side effects; potential side effects diminish as the body adjusts to LDN and increased endorphin levels. Side effects are less likely to occur when a small starting dose is used and gradually increased over time. It is better to start LDN at the lowest dose possible and increase slowly to allow for any side effects that may occur. If side effects occur, the dose can be reduced. Some of the more common side effects are: sleep disturbance, insomnia, vivid dreams.

If sleep disturbances do occur, LDN can be taken in the morning. Sleep disturbances diminish after taking LDN for some time.

Compounding Low-Dose Naltrexone (LDN)

Naltrexone is manufactured as 50mg pills. Compounding pharmacies can prepare Low Dose Naltrexone to any dose specified. Because of differences in compounding pharmacies and the fillers, it’s suggested that patients use a compounding pharmacy that has experience with LDN. The pharmacy must produce LDN in an instant release formulation and not as timed release or slow release. The LDN must not be released in to the body slowly. Compounding pharmacies can prepare the drug as capsules, tablets, liquid or topical cream.  In preparing LDN, pharmacies can change the inactive ingredients (fillers) especially if a reaction is suspected. They can also make it in a gluten-free filler. For ultra low doses of naltrexone, it is prepared as a liquid suspension. 


The dose recommended by Dr. Bihari was 1.5mg to 4.5 mg taken at bedtime. However studies show that taking LDN at night is not necessary. If side effects occur then lowering the dose is recommended, or taking it in the morning in case of insomnia. 

This article is not intended to provide advice on personal medical matters or to substitute for consultation with a physician. The material in this article is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. The use of Low Dose Naltrexone is an off label use by the FDA. 

10 scientifically based aphrodisiacs to increase your sex drive

Featured Articles in Internal Medicine

10 scientifically based aphrodisiacs to increase your sex drive

Naveed Saleh, MD, MS, for MDLinx | July 20, 2019

The word aphrodisiac is derived from the name of Aphrodite, the Greek goddess of love. An aphrodisiac is defined as any food or drug that arouses sexual instinct, induces sexual desire, or increases sexual pleasure and performance. Traditionally made from plants, animals, or minerals, aphrodisiacs have been coveted for eons.

These science-based aphrodesiacs might actually work.

Many currently popular aphrodisiacs—such as strawberries, chocolate, and raw oysters—have not been proven to be effective. However, certain herbs have been shown to exhibit sexual effects.

Let’s take a look at 10 aphrodisiacs supported by at least some research. Importantly, most of this research is based on animal models—probably because it’s easier to study sex in animals.

Tribulus terrestris

This flowering plant, also known as puncture vine or goat’s head, is part of the family Zygophyllaceae, which is native to warm temperate and tropical regions. It has long been used in ancient Chinese and Ayurvedic medicine. Rabbits treated with Tribulus terrestris extract exhibited erection. Furthermore, research involving castrated rats suggests that this extract has androgen-releasing properties, which are related to sexual behavior and intracavernous (penile) pressure.

Safed musli

Safed musli (Chlorophytum borivilianum) is hypothesized to harbor immunomodulatory and adaptogenic properties. As a folk medicine, it has been used for impotency, sterility, and enhanced male potency. In rats, this extract has been shown to reduce mount latency, ejaculation latency, and post-ejaculatory latency, as well as increase mounting frequency. Other studies in rats have shown that the administration of the extract results in increased libido, sexual vigor, sexual arousal, and sperm count.

Mondia whitei

Mondia whitei hails from the Periplocaceae family and has been used as traditional medicine for the management of erectile dysfunction. In one study, an aqueous administration to human spermatozoa in vitro demonstrated heightened total motility, as well as enhanced progressive motility in a time-dependent manner. These findings could support the use of M. whitei in men with asthenozoospermia.


This extract originally comes from an evergreen tree native to West Africa, and is also found in some parts of Asia. Yohimbe has been used for more than 75 years as a treatment for erectile dysfunction. In the 1980s, the FDA approved yohimbe as the first plant-derived drug for the treatment of impotence and some called it “herbal Viagra.” Yohimbe is hypothesized to help alleviate erectile dysfunction via the stimulation of penile blood flow, resulting in tumescence. It may also boost the production of norepinephrine, which is needed for erections. Previous research has shown that yohimbe can restore sexual activity even in patients with diabetes and heart disease. In one study, a 20-mg dose of yohimbe was given to 29 men with orgasmic dysfunction, with 16 eventually reaching orgasm and ejaculation during either intercourse or masturbation.

Asian ginseng

Ginseng has been celebrated as one of the finest aphrodisiacs in the world. It has long been used in traditional Chinese medicines. Ginseng is thought to revitalize the whole body—not just the testicles. In one study in rabbits, administration of ginseng enhanced the release of nitric oxide in the corpus cavernosum, a process that plays a key role in erection.

Tropical almond

Tropical almond (Terminalia catappa) is a large tropical tree with edible nuts that have been touted for their aphrodisiac properties. The tree is found in Africa, Asia, and Australia, and has also been introduced to Florida. In rats, tropical almond extract has been shown to improve sexual vigor.


Saffron (Crocus sativus) is a stemless herb that is cultivated in Iran, Greece, and India. Commonly used to season foods, saffron is also used an aphrodisiac in traditional medicines. In rats, it has been shown to increase sexual frequency and decrease latency.


In Unani, or Perso-Arabic traditional medicine now practiced in India, nutmeg has been used for centuries to treat sexual disorders. In mice, it has been found to increase mating activity.

Date palm

Date palm (Phoenix dactylifera) originated in North Africa and is widely grown in the Arab and Persian worlds. Its pollen has been used in traditional medicines to treat male infertility. Researchers indicated that suspensions of date palm pollen administered to rats boosted sperm count, motility, and morphology, as well as increasing the weight of the testis and epididymis.


Maca (Lepidium meyenii) grows at an altitude of 4,000 m to 4,500 m in the central Andes. It has long been used in the Andean region for its purported aphrodisiac and fertility-enhancing properties. Results from a 12-week randomized controlled trial in which active treatment with different doses of maca were compared with placebo demonstrated increased sexual desire beginning at 8 weeks in men.


Take note that the studies cited in this article have largely been cherry picked. For instance, the same researchers who found that maca increased sexual desire in men discovered in a separate 12-week randomized-controlled trial that the herbal extract did not raise reproductive hormone levels over time. Ultimately, all this information is merely food for thought, and loads more research needs to be done.

Hormone therapy may protect against recurrent Urinary Tract Infection.

Hormone therapy may protect against recurrent UTI

US researchers compared genitourinary microbiomes in postmenopausal women: European Association of Urology Virtual Congress 2020

22nd July 2020 By Reuters Health

Older women who take menopausal hormone therapy have a greater variety of beneficial bacteria in their urine that may help guard against recurrent urinary tract infections, according to research presented virtually at a US conference.

Recurrent UTIs have a “profound impact on the quality of life of postmenopausal women and current therapies, namely antibiotics, are failing,” said lead author Dr Nicole De Nisco, from the Department of Biological Sciences, University of Texas in Dallas.

The researchers used whole-genome metagenomic sequencing to define and compare genitourinary microbiomes of three groups of postmenopausal women:

  • 25 women who never had a UTI.
  • 25 with recurrent UTIs in the past but no active infection.
  • 25 recurrent UTIs and active infection.

“The DNA analysis showed two things,” Dr De Nisco said in a press statement at the European Association of Urology Virtual Congress 2020 on 17 July.

“Firstly, women who have recurrent infections have fewer types of bacteria in their urine than women who do not have infections; women who don’t have recurrent UTIs have around 10 times greater variety of bacteria.

“Secondly, 34 of the women were taking menopausal hormone therapy, and they tended to have more Lactobacillus-type bacteria in their urine, which may imply that the estrogen in menopausal hormone therapy supports the growth of Lactobacillus in the urogenital tract.”

Interestingly, Dr De Nisco said women who were taking menopausal hormone therapy via patches or orally had more Lactobacilli than women taking it via vaginal cream.

“The finding that urinary Lactobacillus, which is associated with health in the vaginal environment, was strongly associated with particular forms of estrogen hormone therapy (oral and patch) but not vaginal was unexpected,” she said.

“This finding fuels even more questions as to why this is the case and what forms of estrogen hormone therapy may be best to prevent recurrent urinary tract infection in postmenopausal women.

“We are now looking towards clinical trials to test the effectiveness of combining estrogen hormone therapy and probiotic therapies in breaking the cycle of recurrent infection,” she added.

Low oestrogen may increase coronavirus risk

Low oestrogen may increase coronavirus risk

UK preprint research shows postmenopausal women are more likely to develop severe disease than other women

5th August 2020

Postmenopausal women with lower levels of oestrogen appear to be at higher risk of developing severe COVID-19, research suggests.

The study, led by a team at King’s College London, UK, found high levels of oestrogen may have a protective effect against the virus.

Using data from the COVID Symptom Study App, researchers examined the rate of predicted infection among postmenopausal women, premenopausal women using the combined oral contraceptive pill and postmenopausal women taking hormone replacement therapy (HRT).

More than 500,000 women were included in the study that took place between 7 May and 15 June 2020.


The researchers hypothesised that oestrogen could protect against COVID-19, according to the preprint study published in medRxiv.

Previous studies on SARS-CoV and MERS had suggested this might explain why men of all ages were at a higher risk of severe infection, they noted.

The study found postmenopausal women had a higher rate of predicted COVID-19 than the other women.

Women in the 45-50 age group were most likely to be at risk with reported symptoms of anosmia, fever and persistent cough.

The need for oxygen treatment in hospital was also significant in this group.

Women between 18 and 45 years who were taking the pill had a lower rate of predicted infection and reduced frequency of symptoms, including persistent cough, delirium, anosmia, skipped meals, severe fatigue and pain.

The rate of hospitalisation was also significantly lower in this group.

Postmenopausal women between 50-65 years who took HRT had an increased rate of predicted COVID-19, but not with hospitalisation.

The researchers advised the HRT results should be considered with caution due to the lack of information about therapy type, route of administration and duration of treatment.

“We hypothesised that premenopausal women with higher oestrogen levels would have less severe COVID-19 when compared to women of the same age and BMI who had been through the menopause, and our findings supported this,” said joint lead author Dr Karla Lee from the university’s school of life course sciences.

“Additionally, when we compared a younger group of women on the combined oral contraceptive pill (COCP) with a similar group not taking the COCP we saw less severe COVID-19 among those taking the COCP, suggesting hormones in the COCP may offer some protection against COVID-19.

“More research is certainly needed to further our knowledge.

What are cataracts?


Explainer: what are cataracts?

September 20, 2016 5.58am AEST
Cataracts are one of the leading causes of visual impairment globally. Rakesh Ahuja, MD/Wikimedia Commons, CC BY

Cataracts remain one of the leading causes of visual impairment globally; they are responsible for blindness in 20 million people worldwide.

What is a cataract?

The word cataract comes from the Latin cataracta, which means waterfall. It is a clouding of the normally transparent crystalline lens in the eye.

The lens works together with the cornea to focus light onto the retina, which converts light to electrical signals that are transferred to the brain. This gives us the images we see.

Cataracts commonly cause blurring of vision, glare from bright lights – especially oncoming vehicle headlights – halos around lights, loss of colour saturation and poorer night vision. Affected people may notice they no longer need their reading glasses as a cataract causes a paradoxical increase in the focusing power of the lens.

Because cataracts develop slowly and painlessly, they may progress for many years before being diagnosed. If left untreated, however, they may eventually cause severe visual impairment in the affected eye. Cataracts commonly occur in both eyes but may occur in one eye alone, or progress at different rates in each eye.

If left untreated, cataracts may eventually cause severe visual impairment in the affected eye. from

What causes cataracts?

Cataract formation is part of the normal ageing process of the lens. More than 70% of men and women aged 80 and above will have a cataract.

The most common type of cataract is age-related, which is thought to occur due to breakdown and degradation of lens proteins over time. This process can be accelerated by smoking, chronic diseases, such as diabetes and high blood pressure, and exposure to ultraviolet light and radiation.

Less commonly, cataracts can occur following prolonged use of steroid medications, such as those taken for rheumatoid arthritis and other chronic inflammatory conditions. They can also occur following trauma or radiation to the eye.

A very small number – around 2.2 per 10,000 babies in one Australian study – are born with congenital cataracts. These usually occur on their own or uncommonly in association with other diseases, such as rubella infection.

How are cataracts treated?

No medications exist to treat a cataract or slow its progression. Stronger spectacles may be all that is needed to manage early cataracts. However, surgery may eventually be required as a cataract progresses and causes troublesome vision impairment.

Cataract surgery has been practised for thousands of years and has involved the same principle: removal of the cloudy lens. The Romans used to do this by inserting a sharp needle into the eye and rotating it.

The most common type of cataract surgery performed in Australia is called phacoemulsification. from

The most common type of cataract surgery performed in Australia is called phacoemulsification. Typically, an uncomplicated surgery lasts just under ten minutes and is done as a day procedure.

Local anaesthetic is used to numb the eye and a small incision is made through the front of the eye; a hand-held ultrasound probe then breaks apart the cloudy lens contents. This material is suctioned out of the eye and a plastic lens is inserted in its place.

Cataract surgery is one of the most frequently performed procedures in Australia and has a very high success rate.

Although very uncommon, complications can occur. These include retinal detachment, infection, incorrect refractive power of the lens, swelling of the cornea and dislocation of the newly implanted lens. These rare complications may require further surgeries or medications and could lead to permanent visual impairment in the affected eye.

Can we prevent cataracts?

The progression of age-related cataract may be slowed by wearing sunglasses when outdoors from an early age, avoiding smoking, carefully controlling blood sugar levels if diabetic, and consuming plenty of fruits and vegetables.

Antioxidant supplements are sometimes recommended for prevention of cataracts. Unfortunately, studies have shown these to be ineffective.

If you experience symptoms of a cataract, the first point of call should be an optometrist who can perform a bulk-billed eye examination and refer you to an ophthalmologist if a cataract is found.

However, wait lists for public hospital clinics may be lengthy (months, to over a year) for minor cataracts not severely affecting vision.

The author thanks Dr Cameron McLintock, ophthalmology registrar at Queensland Health, for his contributions to this article.