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Is apple cider vinegar really a wonder food?

I am going to be away for the next 2 weeks. I am going to my nephew’s wedding in Devon, UK, and will visit some friends while I am there. Dr Anne Nixon will look after any urgent issues that arise while I am gone. I take apple cider Vinegar daily and feel better for it. ?placebo effect – perhaps.

Is apple cider vinegar really a wonder food?

Folk medicine has favoured apple cider vinegar for centuries and many claims are made for its supposed benefits.

Apple cider vinegar is made by chopping apples, covering them with water and leaving them at room temperature until the natural sugars ferment and form ethanol. Bacteria then convert this alcohol into acetic acid.

Strands of a “mother” will form in the cider. These are strained out of many products but left in others, and are often the target of health claims. The “mother” can also be used to start the production of the next batch of cider.

But will apple cider vinegar really help you lose weight, fight heart disease, control blood sugar and prevent cancer? And what about claims it is rich in enzymes and nutrients such as potassium?

Read more: The long, strange history of dieting fads

Weight loss

The evidence that apple cider vinegar helps fight fat is weak.

A short-term study in Japan added two daily drinks of 15 millilitres of apple cider vinegar mixed with 250 ml of water to the usual diet of overweight men and women. Their weight fell by about one kilogram over 12 weeks, but returned to usual levels within four weeks.

According to a UK study, it may be that vinegar can suppress appetite. When offered a pleasant-tasting vinegar drink, one that was less palatable, or a non-vinegar drink with their breakfast, volunteers who downed both vinegar drinks felt slightly nauseated. Not surprisingly, this depressed their appetite, with the least palatable vinegar drink having the greatest effect.


The ‘mother’ is strained from some cider vinegars and left in others. Mike Mozart, CC BY

Others claim taking apple cider vinegar with meals will help digest proteins faster and therefore generate higher levels of growth hormone. This is claimed to break down more fat cells. Unfortunately, there’s no evidence to support such ideas.

Claims that pectin – a type of viscous dietary fibre – in cider vinegar will help weight loss by making you feel full for longer ignores the fact that the pectin in apples is not found in apple cider vinegar.

Heart disease

Pectin is again credited for cider vinegar’s supposed benefits for heart disease, with claims it “attracts bad LDL cholesterol”.

However, the Japanese study referred to for weight loss found no difference in LDL cholesterol with either a low or higher amount of cider vinegar over a 12-week period.

Read more – Heart disease: what happens when the ticker wears and tears

Others claim that cider vinegar works like a broom to clean toxic wastes out of the arteries. Sadly, there’s no evidence for that one either.

Blood sugar and diabetes

Several studies have reported on the effects cider vinegar can have on blood glucose levels. One small study of healthy volunteers found that adding vinegar to a meal reduced glucose and insulin levels – at least for 45 minutes – and increased satiety for up to two hours.

Another small study of people with type 2 diabetes reported adding vinegar to a high carbohydrate meal reduced the subsequent rise in the blood glucose level.

However, this effect was only apparent for a high glycaemic index carbohydrate, such as mashed potatoes. When the carbs came from a lower GI food such as wholegrain bread, the vinegar had no effect.

Read more – Explainer: what is diabetes

A word of warning for those with type 1 diabetes who also have damage to the vagus nerve (a common co-problem): when taking apple cider vinegar in water before a carb-rich meal, the delay in the stomach contents passing to the small intestine may alter the quantity of insulin so the usual daily injection may be inappropriate.

Other diseases

As for allergies, acne, arthritis, hiccups and leg cramps, there is no evidence that apple cider vinegar prevents or cures any of these conditions.

Nor is there evidence from any studies that cider vinegar has benefits for preventing or curing cancer. Unproven cancer cures can waste valuable time in seeking reliable treatments.

So is it worth taking?

Some sites promoting unrefined cider vinegar claim it is a good source of potassium. We certainly need potassium to help regulate the balance of water and acidity in the blood.

But with apple cider manufacturers declaring their products have just 11 milligrams per 15 ml serve (and a recommendation for two serves a day) it is a negligible source. The recommended dietary intake of potassium is 2,800 mg/day for women and 3,800 mg/day for men. Bananas have around 400 mg.


An average banana has 400 mg of potassium. Scott Webb/Unsplash

In Australia, products cannot claim to be a source of any nutrient unless a reasonable daily intake provides at least 10% of the recommended daily intake (RDI). A “good source” must have 25% of the RDI.

There is also no evidence to support the idea that apple cider vinegar makes it easier to absorb calcium.

On the good side, like all vinegars, it has virtually no kilojoules and, mixed with extra virgin olive oil, makes an excellent salad dressing.

Finally, a word of warning: don’t drink apple cider vinegar “neat”. It can damage the throat and oesophagus. Even diluted, its acidity can damage tooth enamel.

Daily Baby Aspirin May Lower Ovarian Cancer Risk

Daily Baby Aspirin May Lower Ovarian Cancer Risk

A standard aspirin did not lower ovarian cancer risk.

  • Taking low-dose aspirin is a daily routine for many people because it may lower the risk for heart attacks and strokes, and some research has tied it to a lower risk of colorectal cancer. Now a new study in JAMA Oncology suggests it may lower the risk for ovarian cancer as well.

Researchers followed more than 200,000 women for more than 25 years, recording data on lifestyle, health factors and disease outcomes and updating information with periodic interviews.

They found 1,054 cases of ovarian cancer. After adjusting for other variables, they found that women who took a baby aspirin — 100 milligrams or less — had a 23 percent reduced risk for ovarian cancer compared with those who did not. They found no risk reduction for those who took a standard 325-milligram pill.

“Our study has limits,” said the lead author, Mollie E. Barnard, a postdoctoral fellow at the Huntsman Cancer Institute at the University of Utah, “but we do have prospective data, and a very large sample followed over a long period of time. And we were able to look at standard and low-dose separately.”

How obesity causes cancer, and may make screening and treatment harder


How obesity causes cancer, and may make screening and treatment harder

March 20, 2017 6.26am AEDT

Today, almost two in every three Australian adults are overweight or obese, as is one in four children. Obesity is a disease itself and a risk factor linked to ischaemic heart disease (the leading cause of premature deaths today in Australia), stroke (the third leading cause), and musculoskeletal conditions (the second major cause of disability), among others.

This rising obesity burden is the outcome of a host of factors, many of which are beyond the control of the individual. It is having a devastating impact on the health of the nation. What’s often overlooked though, is the link between obesity and cancer.

Cancer is a disease of altered gene expression that originates from changes to the DNA caused by a range of factors. These include inherited mutations, DNA damage, inflammation, hormones, and external factors including tobacco use, infections (for example viruses such as HPV), radiation, chemicals, and carcinogenic agents in food.

Strong evidence also links obesity to a number of cancers. These include oesophageal adenocarcinoma; bowel cancer (the third leading cause of preventable death in Australia); cancer of the liver, gall bladder and bile ducts; pancreatic cancer; postmenopausal breast cancer; endometrial cancer; kidney cancer; and multiple myeloma (cancer in the plasma in the blood).

This is just the tip of the iceberg, as highly suggestive evidence exists for a further eight cancers.

How does obesity increase the risk of cancer?

There are many complex ways obesity is thought to cause or increase the risk of cancer.

Increased body fat is associated with increased inflammation in the body, increased release of oestrogens (in part from the fat cells themselves), and decreased insulin sensitivity associated with raised insulin production.

Insulin, “insulin-like growth factor-1” (IGF1) and leptin are all elevated in obese people, and can promote the growth of cancer cells.

Secretion of the hormone insulin is usually tightly controlled and a healthy part of our body’s sugar regulation processes. But it can be significantly elevated in people with obesity-related pre-diabetes or diabetes due to insulin resistance.

This state of elevated insulin levels in the blood can act as a growth signal for tumour cells, and increases the risk of cancers of the colon and endometrium (the lining of the uterus), and likely of the pancreas and kidney.

Insulin-like growth factors (IGFs) regulate cell growth, differentiation and death, and IGF-1 has been associated with prostate, breast and bowel cancers.

Leptin, a hormone implicated in hunger and satiety, can stimulate proliferation of many pre-cancer and cancer cells. Increased leptin levels in obese people are associated with bowel and prostate cancers.

Sex steroid hormones including oestrogens, testosterone, and progesterone are crucial to healthy body development and sexual function, but are also likely to play a role in obesity and cancer. Increased levels of sex steroids are strongly associated with risk of developing endometrial and postmenopausal breast cancers, and may contribute to other cancers such as bowel cancer.

Fat tissue is the main site of oestrogen production in the body for men and postmenopausal women (while in premenopausal women the ovaries are the major producer). Obesity can predispose premenopausal women to polycystic ovarian syndrome, which causes elevated testosterone and therefore could contribute to cancer risk.

Obesity also causes inflammation in the body, meaning the body’s immune system is consistently more active than is normal in healthy weight people.

Evidence for a role of sex hormones and chronic inflammation in affecting the relationship between obesity and cancer is strong, and the evidence for a role of insulin and IGF is moderate. There are a range of other mechanisms still under investigation.

Where does obesity lie on cancer-risk scale?

Overall, obesity-associated cancers represent up to 8.2% of all cancers in the UK, compared to smoking which is responsible for approximately 19%.

Of all deaths from cancer in the USA, excess body weight is close behind smoking as the attributable cause, at 20% versus 30% respectively.

Does obesity affect the screening and detection of cancer?

Focusing on just two types of cancer, breast cancer in women and prostate cancer in men, some evidence suggests that obesity can delay the identification of cancer through screening – but does not reduce the importance or accuracy of screening tools or programs.

For breast cancer, the most common form of cancer in women in Australia, the good news is that screening accuracy is similar across weight status. The Swiss national health survey found the accuracy of mammography is maintained in obese women – with similar ability of the tests to detect cancers, but reduced ability to ensure the positive result definitely means cancer. This meant obese women had a 20% higher false positive rate than normal weight individuals, but does not suggest any cancers were missed.

The troubling news though is, studies suggest obese women with breast cancer detected through mammogram tend to present to their doctors later, and when the cancer is more serious, than their healthy weight counterparts. The exact reasons for this are not clear but may include possible difficulties in breast self-examination and delayed health-seeking. Such findings reinforce the crucial importance of strategies to encourage appropriate cancer screening and timely medical follow-up among overweight and obese women.

For prostate cancer, the most common form of cancer in Australia, large studies suggest a link between obesity and decreased risk of low-grade or early prostate cancer, but increased risk of advanced disease.

The reasons for this are again thought to be numerous, but one potential reason may be linked to greater difficulty in diagnosing prostate cancer in overweight men. While this is thought to possibly delay diagnosis and treatment, it is unlikely entirely to explain the links between obesity and prostate cancer risk.

What risks does obesity pose in the treatments of cancer?

Obesity can impact cancer treatments and their success. Obese patients have a significantly higher risk of heart attack following surgery, as well as risk of wound infection, nerve injury, and urinary infection. Obesity alone increases the risk of poorer health outcomes following surgery, and morbid obesity increases the risk of death.

In cancer treatments, one study has shown significantly increased surgical complications and prolonged hospital stay with morbid obesity in bowel cancer. Another suggests obesity may reduce chemotherapy efficacy in breast cancer, with lower disease-free survival rates.

Is this risk reversible?

By 2025 it’s estimated that more Australians will be obese than normal weight. At the same time, cancer is a leading contributor to early deaths and disability in Australia and the major cause of years lost from people’s lifespans.

The question is not whether obesity can cause cancer; it is how we can better prevent or mitigate this important risk factor. Reassuringly, there is suggestive evidence that weight loss may reduce or reverse many of the above processes and their associated risks.

While obesity is just one of the drivers of the cancer burden in Australia, it is one that is preventable and in doing so, would bring other enormous health benefits

Decreased mortality risk due to first acute coronary syndrome in women with postmenopausal hormone therapy use

A point I have stressed over the years is that hormone treatment in the menopause is good for your heart. It will reduce the risk of a heart attack. So when we consider that heart disease kill most women over 50 (far more than die from breast cancer), it is a very important finding. I have published many other studies over the years showing the protective effect of oestrogen on women’s cardiovascular system in the menopause.

Decreased mortality risk due to first acute coronary syndrome in women with postmenopausal hormone therapy use – <!– [if IE 6]> /wro/ayds~ie6.js<![endif]–>


The role of postmenopausal hormone therapy (HT) in the incidence of acute coronary syndrome (ACS) has been studied extensively, but less is known of the impact of HT on the mortality risk due to an ACS.


Study design and main outcome measures

We extracted from a population-based ACS register, FINAMI, 7258 postmenopausal women with the first ACS. These data were combined with HT use data from the National Drug Reimbursement Register; 625 patients (9%) had used various HT regimens. The death risks due to ACS before admission to hospital, 2–28, or 29–365 days after the incident ACS were compared between HT users and non-users with logistic regression analyses.


In all follow-up time points, the ACS death risks in HT ever-users were smaller compared to non-users. Of women with HT ever use, 42% died within one year as compared with 52% of non-users (OR 0.62, p < 0.001). Most deaths (84%) occurred within 28 days after the ACS, and in this group 36% of women with ever use of HT (OR 0.73, p = 0.002) and 30% of women with ≥5 year HT use (OR 0.54, p < 0.001) died as compared to 43% of the non-users. Age ≤60 or >60 years at the HT initiation was accompanied with similar reductions in ACS mortality risk.


Postmenopausal HT use is accompanied with reduced mortality risk after primary ACS.

Dealing with anxiety during a cancer prognosis

Dealing with anxiety during a cancer prognosis

Posted by Andreas Obermair on 23 February 2017 | 0 Comments

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Anxiety is a common feeling that patients sometimes have when coping with upcoming surgery or even the possibility of a cancer diagnosis.  Seeing medical specialists, going through tests and having cancer treatment can be stressful. Some patients living with cancer have a low level of distress, whilst others can be highly distressed. During cancer diagnosis and treatment, patients may feel a loss of control, be fearful, panicked, or uncertain. They are not unusual responses to the upheaval of cancer.

In contrast to the adjustment to surgery or a potentially life-threatening condition, anxiety can also be a condition that has been present for a very long time. During the normal daily life, anxiety can be managed reasonably well; however, with additional stressors, patients lack options to handle these new stressors. In such cases anxiety can suddenly have profound effects on the health of patients needing the input of a gynaecological oncologist.

Our physical and mental health are connected. Poor physical health can affect you mentally, and poor mental health can affect you physically. In my almost 20 year experience, I find that patients with severe anxiety that is left untreated face a worse prognosis than patients with no anxiety or where the anxiety is treated.

It is important for our practice to find ways of helping you to deal with your feelings. Here I discuss some ways that may help reduce anxiety during cancer.

  • Find other patients to talk to who are going through the same journey. In my office, we can arrange contact between patients, we can also do this for patients who require certain operations that don’t involve cancer. It can greatly help someone when you can share your experiences and ways of coping with someone in a similar situation as you.
  • Develop relaxation methods. Breathing, mindfulness, or yoga. Try deep breathing and relaxation exercises several times a day. Researchers reviewed seven clinical trials which overall included 888 cancer patients and found that mindfulness-based interventions effectively relieved anxiety and depression among patients. Another review of studies found women with a breast cancer diagnosis who practiced yoga improved their mental health.
  • A balanced and nutritious diet will help you to keep as well as possible.
  • Exercise.  Regular exercise can be a healthy distraction. Exercise produces endorphins (chemicals in the brain that act as natural painkillers) and also improve the ability to sleep, which reduces stress. Physical exercise has attracted increased interest in rehabilitation of cancer patients. Particularly for patients undergoing chemotherapy, exercise can reduce the number and severity of physical and psychosocial treatment-related side effects and improve a patients’ quality of life. I am currently involved in the ECHO trial. The ECHO trial evaluates the effects of an exercise intervention during firstline chemotherapy for ovarian cancer. For those who may be interested in participating in the trial see here
  • See a GP with a special interest in anxiety. I do not prescribe medication for anxiety because it is outside the spectrum of my qualification. I witnessed that for some patients medication has worked wonders. They are so more relaxed and are able to tolerate treatment a lot better and enjoy life again. Think about also asking your GP to refer you to a psychologist who can work with you and your family for ongoing help.
  • Beyond Blue also has a 24-hour anonymous phone service for those suffering mental distress. The Cancer Council (13 11 20) helpline is a free, confidential telephone information and support service for cancer patients.

Anxiety is not a condition that can simply go away easily, and like all forms of therapy, the effect can vary.

Anxiety, if not addressed properly can affect cancer diagnosis and treatment in many ways. Almost never patients decline or request procedures acknowledging that they are anxious. Some patients may decline certain diagnostic procedures. This means that the information collected from a blood test or CT scan may be lost.

Other patients request procedures because they are anxious.

The above strategies are a good starting point to controlling anxiety, and after trying some different options you will find what works for you.

If you wish to receive regular information, tips, resources, reassurance and inspiration for up-to-date care, that is safe and sound and in line with latest research please subscribe here to receive my blog, or like Dr Andreas Obermair on Facebook. Should you find this article interesting, please feel free to share it.

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

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

The alcohol industry has been misleading the public about the real link between alcohol and cancer, with tactics similar to those used by the tobacco industry. This is the finding from research published today in the Drug and Alcohol Review journal. The misleading information is being passed off as health messaging to a public largely unaware that it’s coming from the industry itself.

For nearly three decades, we have known cancer risk increases with alcohol consumption levels, on a dose-to-response basis. That is, the more we drink the greater the risk.

Back in 1988, the World Health Organisation’s cancer research arm concluded that alcohol consumption was a group one carcinogen – a direct cause of cancer in humans. In Australia in 2010, about 3,200 cases of cancer were attributable to alcohol consumption.

And it doesn’t matter if you’re swilling shiraz at the Mosman Park Dinner Society or downing lager at the Bullamakanka Darts Club, it’s the alcohol, not the type of beverage, that does the damage.

Read more: Does alcohol cause cancer?

Led by the London School of Hygiene and Tropical Medicine, the latest study concluded:

The [alcohol industry] appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer. These activities have parallels with those of the tobacco industry.

The authors pointed to three main strategies the industry uses to do this:

  • denying, omitting or disputing the evidence that alcohol consumption increases cancer risk
  • distorting the evidence by mentioning cancer but misrepresenting the link, such as implying risk is present only with higher levels of drinking
  • distracting or diverting discussion away from the independent effects of alcohol on common cancers, such as mentioning alcohol is one of many causes. Breast and bowel cancer appeared to be particular targets for this type of misrepresentation.

Dodgy public health messages?

The study assessed key messages provided by 27 organisations run, funded or controlled by the alcohol industry in English-speaking countries. Known as social aspects and public relations organisations, these bodies seek to shape consumer messaging about alcohol and seem to be gaining increasing resources and prominence.

One example of such an entity is the International Alliance for Responsible Drinking. The research paper states that its members include some of the world’s leading beer, wine and spirits producers.

Industry messages often distort alcohol’s link to cancer. Photo by Artem Pochepetsky on Unsplash

The Australian example included in the study is DrinkWise. Its 13-member board includes six alcohol industry representatives from groups such as the Distilled Spirits Industry Council of Australia, the Brewers Association of Australia and New Zealand and the Australian Hotels Association. DrinkWise says its “primary focus is to help bring about a healthier and safer drinking culture in Australia”.

A recent survey showed that, of the one in two people who had heard of DrinkWise, only around a third (37%) knew the alcohol industry funded it.

Drinkwise’s message on alcohol’s impact on cancer opens by saying alcohol is “one of a number of factors that contribute to the risk for developing certain types of cancer”. This is true. But some might consider this “distraction”.

The second message is:

Cancer risk associated with the consumption of alcohol is related to patterns of drinking, particularly heavy drinking over extended periods of time.

Again, technically true. But it avoids the fact low levels of consumption lead to low levels of risk increase. The research out today classified this as “distortion”.

Learn more about cancer risk: Interactive body map

The way information is framed is essential to the message people take from it. And there’s little doubt the alcohol industry are masters of communication.

Information such as that given by DrinkWise may invite a drinker looking to avoid the thought their own drinking might increase their risk of cancer to think: “but other things are more important causes of cancer” and “I am not a heavy drinker over a long period of time so I am OK”. Conveniently, “heavy drinker” is not clearly defined.

Too few people know alcohol is a significant contributor to cancer, and this is a problem.

Not enough know the link

A survey conducted in 2008 in Western Australia found over 55% of adult women, when prompted, recognised a link between alcohol consumption and cancer risk. In the same survey, around 42% of women reported believing red wine consumption helped to prevent cancer.

A more recent national survey found 53% of adults linked alcohol with cancer risk. And funnily enough, just over half (52%) of those drinking at high or very high risk levels did not perceive their drinking to be harmful.

Read more: Social acceptance of alcohol allows us to ignore its harms

In 2010-11, the WA government ran an education campaign to show how alcohol increased the risk of breast cancer. This improved community awareness of the link from 62% to 87%. It also led to more women reporting the intention to reduce their drinking.

Before the campaign, 10% of those who drank fewer than two standard drinks per day reported they intended to reduce drinking. This rose to 25% after seeing the campaign. Among those who drank more than two drinks a day, the figure went from 28% to 38.5%.

If these effects play out in the wider community through a national campaign, it may well result in a meaningful reduction in alcohol sales. Obviously, this is not in the industry’s interest.

Cancer is the most feared illness. This is particularly so for middle-aged and older people who see their peers increasingly getting cancer diagnoses. And yet new research shows people in the baby boomer generation are the group least likely to be reducing their consumption.

Research on health warnings on alcohol labels suggests messages about the link between booze and bowel cancer have the greatest effect on making drinkers think twice. So should we be surprised the industry selling the product is keen to muddy the waters about what is a clear connection between drinking and cancer?

For too many people, the alcohol and cancer story is new news. The more we drink the more we increase the risk of cancer.

This is another inconvenient truth to add to the list. But we must all have the information to allow us to make the choice. And the alcohol industry is clearly not the best source of that information.

Why our brain needs sleep, and what happens if we don’t get enough of it

Why our brain needs sleep, and what happens if we don’t get enough of it

Many of us have experienced the effects of sleep deprivation: feeling tired and cranky, or finding it hard to concentrate. Sleep is more important for our brains than you may realise.

Although it may appear you’re “switching off” when you fall asleep, the brain is far from inactive. What we know from studying patterns of brain electrical activity is that while you sleep, your brain cycles through two main types of patterns: rapid eye movement (REM) sleep and slow-wave sleep.

Slow-wave sleep, which occurs more at the beginning of the night, is characterised by slow rhythms of electrical activity across large numbers of brain cells (occurring one to four times per second). As the night progresses, we have more and more REM sleep. During REM sleep we often have vivid dreams, and our brains show similar patterns of activity to when we are awake.

Read more – Health Check: three reasons why sleep is important for your health

What are our brains doing while we sleep?

Sleep serves many different functions. One of these is to help us remember experiences we had during the day. REM sleep is thought to be important for emotional memories (for example, memories involving fear) or procedural memory (such as how to ride a bike). On the other hand, slow-wave sleep is thought to reflect the storing of so-called “declarative” memories that are the conscious record of your experiences and what you know (for example, what you had for breakfast).

We also know experiences are “replayed” in the brain during sleep – the memories of these experiences are like segments from a movie that can be rewound and played forward again. Replay occurs in neurons in the hippocampus – a brain region important for memory – and has been best studied in rats learning to navigate a maze. After a navigation exercise, when the rat is resting, its brain replays the path it took through the maze. Replay helps to strengthen the connections between brain cells, and is therefore thought to be important for consolidating memories.

While we’re asleep our brain does a tidy-up, only keeping what it needs. Sashank Saye/Unsplash

But is it that important for you to remember what you had for breakfast? Probably not – that’s why the brain needs to be selective about what it remembers. Sleep allows the brain to sift through memories, forgetting certain things so as to remember what’s important. One way it may do this is by “pruning away” or “scaling down” unwanted connections in the brain.

A leading theory of sleep function – the “synaptic homeostasis hypothesis” – suggests that during sleep there is a widespread weakening of connections (known as “synapses”) throughout the brain.

This is thought to counterbalance the overall strengthening of connections that occurs during learning when we are awake. By pruning away excess connections, sleep effectively “cleans the slate” so we can learn again the next day. Interfering with this scaling down process can, in some cases, lead to more intense (and perhaps unwanted) memories.

The importance of sleep for keeping our brains optimally active may be reflected in our changing sleep patterns as we age. Babies and children sleep much more than adults, probably because their developing brains are learning much more, and being exposed to new situations.

Later in life, sleep declines and becomes more fragmented. This may reflect either a reduced need for sleep (as we are learning less) or a breakdown in sleep processes as we age.

Read more – Children and sleep: How much do they really need?

Sleep is also needed to do a bit of brain “housekeeping”. A recent study in mice found sleep cleanses the brain of toxins that accumulate during waking hours, some of which are linked to neurodegenerative diseases. During sleep, the space between brain cells increases, allowing toxic proteins to be flushed out. It’s possible that by removing these toxins from the brain, sleep may stave off neurodegenerative diseases like Alzheimer’s.

What happens if we have a bad night’s sleep?

Getting enough sleep is important for attention and learning during our waking hours. When we are sleep deprived, we can’t focus on large amounts of information or sustain our attention for long periods. Our reaction times are slowed. We are also less likely to be creative or discover hidden rules when trying to solve a problem.

When you haven’t had enough sleep, your brain may force itself to shut down for a few seconds when you’re awake. During this “micro-sleep” you may become unconscious for a few seconds without knowing it. Drowsiness while driving is a leading cause of motor vehicle accidents, with sleep deprivation affecting the brain just as much as alcohol. Sleep deprivation can also lead to fatal accidents in the workplace – a major issue in shift workers.

Read more – Explainer: how much sleep do we need?

The beneficial effects of sleep on attention and concentration are particularly important for children, who often become hyperactive and disruptive in class when they don’t have enough sleep. One study found getting just one hour less sleep per night over several nights can adversely affect a child’s behaviour in class.

What are the long-term effects?

The longer-term effects of sleep deprivation are more difficult to study in humans for ethical reasons, but chronic sleep disturbances have been linked to brain disorders such as schizophrenia, autism and Alzheimer’s. We don’t know if sleep disturbances are a cause or symptom of these disorders.

Overall, the evidence suggests having healthy sleep patterns is key to having a healthy and well-functioning brain.

Estrogen Dominance and Hypothyroidism: Is it Hypothyroidism or Hormone Imbalance?

Estrogen Dominance and Hypothyroidism: Is it Hypothyroidism or Hormone Imbalance?

Women suffer from hypothyroid disease at a rate of almost ten times that of men. Though reasons remain unclear, the close link between estrogen and the thyroid is considered a factor. Some doctors suggest many hypothyroid cases are actually the consequence of “estrogen dominance”; a term which implies low progesterone. The estrogen/progesterone hormone imbalance directly affects thyroid function. The prevalence of estrogen dominance is higher than ever before and the causative factors are many. Environment, diet, and lifestyle are all contributors, as is chronic stress. Hypothyroidism itself can also lead to estrogen related issues, i.e. infertility, miscarriage, PMS, polycystic ovarian syndrome (PCOS), fibroids and cancer. The key is to look at the big picture and an individual’s unique case. Once estrogen, thyroid and stress are considered together, one can map out a customized action plan towards improved overall health.

Hormones: The Importance of Balance

Balance is the most important thing to keep in mind when it comes to hormones. Hormones are part of the endocrine system, which is a complex network of checks and balances. They regulate metabolism, energy, growth, temperature, and reproduction. Considered to be the “master regulator” is the thyroid. When the thyroid is sluggish, a variety of symptoms can ensue, including weight gain, moodiness, memory problems, hair loss, and dry skin. The connection between the symptoms and the thyroid often goes unrecognized. Other areas of the hormone network affect the thyroid too (i.e. blood sugar), but the focus of this discussion is the Hypothalamus-Pituitary-and Ovaries, (HPO-axis). Simply put, this translates to the thyroid, estrogen and the adrenals.

Estrogen’s Role in Thyroid Function

The link between estrogen and hypothyroidism is hard to miss, considering the high rate of disparity between the sexes. It’s also noted that during transitory times in women’s reproductive status is when the risk of hypothyroidism is highest. Thyroid expert Dr. Sara Gottfried explains, it is the change in reproductive hormones that triggers hypothyroidism and the symptoms of fatigue, weight gain and depression. Since many of the symptoms overlap with imbalanced reproductive hormones, practitioners have nicknamed the condition “thyropause”.

Symptoms of estrogen dominance include:

  • PMS
  • Endometriosis
  • Cervical dysplasia
  • Breast cancer
  • Uterine fibroids
  • Overweight

Estrogen Dominance and Thyroid

It is important to note, estrogen levels are balanced proportionate to progesterone. This means, one can have estrogen dominance when estrogen levels are low if progesterone is deficient. The effect of having this hormone imbalance has the potential of causing hypothyroid in those susceptible. In many cases, hypothyroidism manifests as the autoimmune disease, Hashimoto’s thyroiditis. In order for Hashimoto’s to occur other factors must also be in place, namely genetic predisposition, a trigger, and “leaky gut” (intestinal hyperpermeability). The problem many patients have is ongoing symptoms despite treatment, which is typically Synthroid, levothyroxine or Armour Thyroid. Thyroid hormone replacement drugs are ranked the third most common prescribed in the county and yet many users continue to suffer. With the strong connection between the thyroid and estrogen, and the amount of hormone disrupting factors listed below, it is easy to see why the affected population is so high. Contributing factors include:

  • Poor diet, high in meat and dairy, low in fiber
  • Genetics
  • Liver and bilary congestion
  • Obesity
  • Medications
  • Synthetic hormone replacement therapy (HRT) and oral contraceptives
  • Pesticides
  • Stress
  • Xenohormones which are in foods, plastics, personal care items, air pollution, pesticides, etc.
    *Xenohormones interfere with estrogen and they are everywhere: hormones in meats, pesticides on foods and in our yards, household products, and the polluted air that we breathe.

The causative factors listed impact every aspect of our daily lives. The degree to which these estrogen disruptors exist has increased in recent decades, which is of great concern to scientists who recognize the effects. Produce has more pesticides, livestock are injected with hormones, obesity is on the rise, and being “really busy” is the accepted norm. People are so busy they often don’t realize they are stressed, much less hurting their health. The good news is there is a lot one can do.

How to Avoid Excess Estrogen

  • Avoid diet high in meat and dairy, low in fiber. Eat fiber to flush out excess estrogen.
  • Minimize exposure to hormone disruptors, i.e. plastic water bottles, Styrofoam, pesticides, cosmetic products, and cadmium.
  • Avoid cigarettes.
  • Avoid oral contraceptives.
  • Avoid chronic stress.

Why Stress is so Important

When a person is stressed, it means the adrenals are secreting excess cortisol. When this becomes chronic, it disrupts the normal circadian rhythm and the stress response of the (HPA) Hypothalamus-Pituitary-Adrenal axis. When the body is so busy trying to keep up with cortisol production it takes priority over the sex hormones. Since estrogen and progesterone are made from the same chemical (pregnenolone) as cortisol, it becomes depleted affecting production. Other ways chronic stress impacts estrogen dominance and the thyroid include:

  • Reduces the liver’s ability to process and eliminate excess estrogen.
  • Increases thyroid binding globulin (TBG), which keeps it bound and inactive.
  • Hinders the function of the hypothalamus and pituitary reducing thyroid hormone production.
  • Interferes with T4 to active T3 production.
  • Weakens the intestinal lining causing leaky gut.

What Else Should I Do?

  • Have a full thyroid panel that includes TSH, freeT3, T3, T4, rT3, TPOAb and TgAb antibodies.
  • Check for iron deficiency with iron panel including ferritin.
  • Maintain vitamin D levels in the range of 50-70ug/dl.
  • Avoid gluten when a hypothyroid condition exists.
  • Eat organic foods.
  • Maintain healthy body weight.
  • Minimize and manage stress.

Note: It’s important to have sufficient iron, zinc, iodine and selenium for thyroid support. However, since the threshold is low it is important to be informed of dosing and not to overdo it.

It’s impossible to avoid all the causes of estrogen dominance yet with proper maintenance, the body is equipped to handle much of it. When problems do occur seeing a health provider who recognizes symptoms in the context of the body as a whole, rather than segregating symptoms, can offer improved outcomes.


1. Grunewald, J. Repair Your Thyroid. Experience Life. Published November 2012.

2. Kharrazian, D. Why Do I Still Have Thyroid Symptoms? When My Tests Are Normal. Carlsbad, CA: Elephant Printing; 2010.

3. Kresser, C. Five Ways That Stress Causes Hyptothyroid Symptoms. Published August 2, 2010.

4. Lee, J. Hopkins, V. What Your Dr. May Not Tell You About Your Thyroid. Virginia Hopkins Test Kits.

5. Pizzorno J, Katzinger, J. Clinical Pathophysiology: A Functional Perspective. Coquitlam, BC Canada: Mind Publishing; 2012.

6. Educational Resources: Xenohormones and xenoestrogens. Women Living Naturally.

Finally, unproven stem cell clinic practices might be curtailed

Finally, unproven stem cell clinic practices might be curtailed

There’s some good research being done in stem cells. But clinics peddling stem cell treatments largely lack evidence. from

In a welcomed move, the Therapeutic Goods Administration (TGA) has this week announced reforms will be introduced in 2018 to address long held concerns about the provision of unproven stem cell treatments to increasing numbers of Australian and international patients.

Regulation of stem cell treatments being offered outside hospitals will be increased. It will acknowledge the risks of these treatments, and advertising of certain treatments will be prohibited.

While more specific details are not yet available, it seems at last possible the most egregious practices of suburban stem cell clinics will be severely curtailed.

Stem cell marketing

Over the last six years, the number of private “stem cell” clinics operating across Australia has grown from a handful to more than 60. These clinics offer treatments for myriad conditions, from anti-ageing “facial rejuvenation” to treatment for osteoarthritis, lung diseases, infertility, motor neurone disease, dementia and multiple sclerosis.

Advertising their services online and in social media, the clinics use claims of efficacy and expertise to lure patients. But they offer little, if any, scientific proof their treatments work, and charge patients exorbitant fees for their services.

Stem cell clinics often rely on anecdotes and patient ‘testimonials’. Screenshot, Swiss Medica website

How is it these clinics have been able to flourish in Australia and provide unproven, expensive and potentially risky treatments to such a wide group of potential patients?

They have been able to exploit a loophole in TGA regulations that permits doctors to “transplant” a patient’s own tissue back into their body, without that tissue having been subjected to ordinary controls and standards that apply to the transplantation of biological tissue products.

This “exclusion” was intended to enable doctors to use patients’ own tissue to repair bone, joint, ligament and other injuries.

Stem cell risks

Some may argue adults should be able to make choices about their own health care, including to use innovative or unproven treatments. But there are harms in allowing stem cell clinics to operate as they do.

First, the collection and administration of stem cells is not without risk – some are very serious. In 2013, an Australian woman, Sheila Drysdale, died following complications from a liposuction used to the extract “fat stem cells” to treat her dementia – an indication that is not supported by any evidence.

More recently, three women have been left blind following “treatment” in Florida for a type of retinal disease with their own “fat stem cells”.

Second, stem cell “treatments” may cause other harms – including the financial burdens of these treatments (which are not Medicare rebated) on patients and their families, and the psychological harms vulnerable patients may feel from being tricked into paying for something that didn’t work.

Third, there are broader societal harms, including the erosion of public trust in established stem cell science, medical research and health care more generally.

Private clinics shouldn’t be able to make claims without evidence. Screenshot, ASC Treatment website

This doesn’t mean all stem cells are bad

The TGA has recognised the importance of enabling research and innovation in stem cell medicine. There is good work being done within hospitals and laboratories around the country, and patients should still have access to unapproved treatments through clinical trials and special access schemes.

But there remain some concerns. The TGA’s loophole may have provided the impetus for the explosion in clinic numbers, but it’s not the cause of some of the questionable behaviours engaged in by some clinics.

Laws exist to stop misleading and deceptive advertising, and there are strict regulations on the advertising of medical services. To date, these existing regulations haven’t been employed by regulators such as the Australian Competition and Consumer Commission or the Australian Health Practitioner Regulation Agency to crack down on dodgy practices.

Mechanisms for registering clinical trials are already being manipulated by stem cell clinics and the stem cell industry more widely, to cloak themselves in the authority of science and “satisfy” regulatory and ethical concerns about their practices.

The dangers here are clear. While regulatory reform is welcome, they will remain ineffective unless the TGA and other regulatory bodies have the will, power and resources to enforce them. And unless this happens – patients will continue to be harmed.

Selling stem cells has been a big business in Australia for too long. After two public consultations and much deliberation, we have some action. Researchers, health practitioners, patients and regulators have an interest in making sure the proposed changes to the regulations work.

The Flu Vaccination

High-dose, immune-boosting or four-strain? A guide to flu vaccines for over-65s

We have come to the time of the year when we decide whether to have the flu shot or not. I had mine over the weekend, and have done so for the last 25 years. It has worked for 24 of those years (no flu) but last year I had a mild dose of the flu in spite of having the needle. It works, especially for older people. This article might help.

April 16, 2019 6.17am AEST There are three types of flu vaccine available in Australia. Image Point Fr/Shutterstock


  1. Allen Cheng Professor in Infectious Diseases Epidemiology, Monash University
  2. Christopher Blyth Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, University of Western Australia

Disclosure statement

Allen Cheng receives funding from the Australian government and from the Australian National Health and Medical Research Council. He is the Co-Chair of the Australian Technical Advisory Group on Immunisation and the Advisory Committee for Vaccines; the views expressed in this article may not necessarily reflect those of these committees.

Chris Blyth has received funding from the Australian National Health and Medical Research Council, Commonwealth and State Governments to conduct influenza surveillance and evaluate the performance of the current influenza vaccination programs. He is the Co-Chair of the Australian Technical Advisory Group on Immunisation; the views expressed in this article may not necessarily reflect those of the Commonwealth Government


Monash University
University of Western Australia
Victoria State Government

Monash University and University of Western Australia provide funding as founding partners of The Conversation AU.

Victoria State Government provides funding as a strategic partner of The Conversation AU.

Flu vaccines work by exposing the body to a component of the virus so it can “practise” fighting it off, without risking infection. The immune system can then mount a more rapid and effective response when faced with a “real” virus.

Three types of influenza vaccines are available in Australia:

  • “standard” vaccines that contains four different strains of influenza
  • a “high-dose” vaccine (Fluzone High Dose) that contains three strains of influenza at a higher dose than standard vaccines
  • an “adjuvanted” vaccine (Fluad) that contains the standard dose of three strains of influenza, along with MF59, an immune stimulant designed to encourage a stronger immune response to the vaccine.

Read more: When’s the best time to get your flu shot?

The high-dose and adjuvanted vaccines are designed for use only in people aged 65 and over because they can stimulate a better immune response than the standard vaccine. Standard vaccines should be used those younger than 65 years.

This year, the Australian government is offering the adjuvanted vaccine for free for over-65s. The standard vaccine is available for free for some groups under 65 under national and state programs. The high-dose vaccine will only be available to buy through pharmacies and general practices on prescription.

Is the high-dose vaccine better?

Clinical trials have compared the high-dose vaccine with older forms of the standard vaccine that contained three strains.

One US study in over-65s found 1.4% of recipients who were given the high-dose vaccine were diagnosed with influenza, compared with 1.9% of those who received the standard vaccine.

A flu vaccination doesn’t completely eliminate the risk of getting the flu, but it’s likely to make the illness less severe. From

Subsequent studies also found people who got the high-dose vaccine were less likely to be hospitalised with influenza-related complications. A similar trial in nursing home residents also found a reduced risk of hospitalisation.

Although clinical trials are generally regarded as the gold standard when testing vaccines, it’s also important to consider data from other studies, where different flu strains circulate and where the vaccine may be used in groups that were excluded from clinical trials.

These studies have generally found that the high-dose vaccine is better than the standard vaccine. However, some studies have shown a lesser degree of benefit.

What about the adjuvanted vaccine?

Clinical trials have not been designed to show the different rates of flu infection after taking the adjuvanted vaccine compared with the standard vaccine. But studies have examined the effectiveness of this vaccine in preventing hospitalisations with influenza.

One trial found a small decrease in influenza infection in people who had been given adjuvanted vaccine, compared with standard vaccine, but this difference was not statistically significant.

Another recent trial has been performed in nursing home residents. Preliminary results suggest a very small reduction in hospitalisations compared with those who took the standard vaccine.

With different vaccination options available, it can be hard to work out which is likely to provide the most protection. From

Despite a lack of clinical trial data, several observational studies have found getting the adjuvanated vaccine means you’re less likely to be hospitalised with influenza than if you receive the standard vaccine.

As with the studies of the high-dose vaccine, the estimated degree of protection varies between studies, reflecting differences in circulating strains, study types, and populations.

Which is better?

There is not yet sufficient data to know whether one enhanced vaccine is better than the other.

One observational study suggests the high-dose vaccine is more effective than the adjuvanted vaccine at preventing hospital admissions with influenza. But this study was not designed to address this question specifically, and the differences observed were small.

Read more: A strong immune system helps ward off colds and flus, but it’s not the only factor

Both enhanced vaccines are safe. Although a higher proportion of patients who receive enhanced vaccines report a sore arm, compared to those who receive the standard vaccine, this is generally mild and rarely requires medical attention.

Immunisation expert groups in Australia, the United States, Canada and the United Kingdom have not recommended either enhanced vaccine over the other.

Can you get two for better coverage?

The currently available enhanced vaccines protect against three flu strains, whereas the standard vaccine protects against four.

But for most people, there is no evidence that receiving multiple doses of different vaccines in any one year is any better than getting a single dose of vaccine.

There’s no evidence that two shots are better than one. By Nyvlt-art

In theory, the four-strain vaccines protect against one more strain than the enhanced three-strain vaccines. But in most seasons, few infections are caused by the fourth strain.

There are some specific groups of people for whom two doses may be recommended, including young children receiving the vaccine for the first time, and some people with bone marrow or organ transplants. Seek advice from your doctor if this describes you or your children’s situation.

It’s important to note that none of the standard or enhanced flu vaccines are completely protective; they reduce, but don’t completely eliminate, the risk of getting influenza.

A single dose of any influenza vaccine in each season is the most effective strategy to reduce your chance of getting influenza.