DHEA vaginal suppository good alternative to estrogen creams

January 5, 2016 / 3:15 PM / 2 years ago

DHEA vaginal suppository good alternative to estrogen creams

(Reuters Health) – A vaginal suppository containing the hormone known as DHEA is a good alternative to estrogen for treating vaginal issues related to menopause, according to a new trial.

Pain during sex and vaginal dryness improved more in postmenopausal women taking the daily suppositories than in women using placebos, researchers report. Gynecologists said the overall vaginal health of those taking the suppositories improved more, too.

The new ovule-shaped suppositories are as good as estrogen creams applied inside the vagina, said Dr. Fernand Labrie, who led the trial for EndoCeutics Inc in Quebec, Canada.

Before menopause, estrogen produced by the ovaries keeps the vaginal lining healthy. With menopause, the ovaries stop working, and the vaginal lining becomes thinner, dryer and less elastic. The loss of estrogen and effects on the vagina may cause other complications, such as pain during sex.

Estrogen cream can be prescribed to replace the hormones, but that may not be an option or choice for some women, according to Dr. James Woods, who is past chair of the Department of Obstetrics and Gynecology at the University of Rochester School of Medicine in New York.

For example, breast cancer is sometimes driven by estrogen, and women with those cancers take drugs to block their body from making the hormone. They also can’t risk increasing the amount of estrogen circulating in their bodies.

“For people who can’t take estrogen into their system, this is a huge advantage for them, because it brings them back to more of a normal life,” said Woods, who was not involved with the new trial.

DHEA – or dehydroepiandrosterone – is a hormone that can be transformed into male and female sex hormones. It’s thought that when DHEA is delivered directly to the vagina, the nearby tissue convert it to the estrogen known as estradiol without raising levels of the hormone in the rest of the body.

“This has been such a positive contribution for the breast cancer patients,” said Woods, who added that doctors currently prescribe a compounded DHEA cream to patients.

Compounded creams, however, must be made-to-order at special pharmacies. The suppositories tested in the study, if approved by the U.S. Food and Drug Administration, would be commercially available with a prescription.

For the new study, the researchers assigned 325 postmenopausal women to take a 0.5 percent DHEA suppository daily for 12 weeks. Another 125 were assigned to take a placebo, with inactive ingredients. All women answered questionnaires and were examined throughout the study period.

Overall, women taking the daily DHEA suppository improved more than the placebo group on measures of dryness and thinning of the vaginal lining, the researchers reported in Menopause: The Journal of The North American Menopause Society.

The women using DHEA also reported a significantly larger decrease in pain during sex, compared to women taking the placebo.

Woods said the findings did not surprise him since the percentage of DHEA in the suppository is the same as what is used in compounded creams.

The only side effect was reported by six percent of women, who said they had vaginal discharge from the suppository dissolving.

The question, Woods said, is how the compounded cream and the suppository will differ in terms of cost, if and when the FDA approves it.

SOURCE: bit.ly/1Pc1GwH Menopause: The Journal of The North American Menopause Society, online January 5, 2016.

Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause

Original Investigation
February 2018

Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition. A Randomized Clinical Trial

Author Affiliations

  • 1Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
  • 2Department of Psychiatry, University of North Carolina at Chapel Hill
  • 3Section on Behavioral Endocrinology, National Institute of Mental Health, Department of Health and Human Services, Bethesda, Maryland
JAMA Psychiatry. 2018;75(2):149-157. doi:10.1001/jamapsychiatry.2017.3998

Question  Is 12 months of transdermal estradiol and intermittent micronized progesterone more effective than placebo in preventing the development of depressive symptoms in the menopause transition and early postmenopausal period?

Findings  In this randomized clinical trial that included 172 perimenopausal and early postmenopausal women, 32.3% of women receiving placebo developed clinically significant depressive symptoms, while 17.3% of women taking transdermal estradiol and intermittent micronized progesterone did so.

Meaning  If confirmed in future research, clinicians may consider prescribing hormone therapy to mitigate the increased risk of clinically significant depressive symptoms that accompany the menopause transition and early postmenopausal period.

Importance  The menopause transition and early postmenopausal period are associated with a 2- to 4-fold increased risk for clinically significant depressive symptoms. Although a few studies suggest that hormone therapy can effectively manage existing depression during this time, to our knowledge, there have been no studies testing whether hormone therapy can prevent the onset of perimenopausal and early postmenopausal depressive symptoms.

Objective  To examine the efficacy of transdermal estradiol plus intermittent micronized progesterone (TE+IMP) in preventing depressive symptom onset among initially euthymic perimenopausal and early postmenopausal women. A secondary aim was to identify baseline characteristics predicting TE+IMP’s beneficial mood effects.

Design, Setting, and Participants  Double-blind, placebo-controlled randomized trial at the University of North Carolina at Chapel Hill from October 2010 to February 2016. Participants included euthymic perimenopausal and early postmenopausal women from the community, aged 45 to 60 years.

Interventions  Transdermal estradiol (0.1 mg/d) or transdermal placebo for 12 months. Oral micronized progesterone (200 mg/d for 12 days) was also given every 3 months to women receiving active TE, and identical placebo pills were given to women receiving placebo.

Main Outcome Measures  Scores on the Center for Epidemiological Studies–Depression Scale (CES-D), assessed at baseline and months 1, 2, 4, 6, 8, 10, and 12 after randomization, and the incidence of clinically significant depressive symptoms, defined as a CES-D score of at least 16.

Results  Of 172 participants, 130 were white (76%), and 70 were African American (19%), with a mean household income of $50 000 to $79 999. The mean age was 51 years, and 43 developed clinically significant depressive symptoms. Women assigned to placebo were more likely than those assigned to TE+IMP to score at least 16 on the CES-D at least once during the intervention phase (32.3% vs 17.3%; odds ratio [OR], 2.5; 95% CI, 1.1-5.7; P = .03) and had a higher mean CES-D score across the intervention period (P = .03). Baseline reproductive stage moderated the effect of treatment (β, −1.97; SEM, 0.80; P for the interaction = .03) such that mood benefits of TE+IMP vs placebo were evident among women in the early menopause transition (β, −4.2; SEM, 1.2; P < .001) but not the late menopause transition (β, −0.9; SEM, 0.3; P = .23) or among postmenopausal women (β, −0.3; SEM, 1.1; P = .92). Stressful life events in the 6 months preceding enrollment also moderated the effect of treatment on mean CES-D score such that the mood benefits of TE+IMP increased with a greater number of events (β, 1.22; SEM, 0.40; P = .003). Baseline estradiol levels, baseline vasomotor symptoms, history of depression, and history of abuse did not moderate treatment effects.

Conclusions  Twelve months of TE+IMP were more effective than placebo in preventing the development of clinically significant depressive symptoms among initially euthymic perimenopausal and early postmenopausal women.

Laugh a little.

Surgery isn’t the only option for prostate cancer yet many men aren’t offered others

Surgery isn’t the only option for prostate cancer yet many men aren’t offered others

August 22, 2017 5.19am AEST

Australian men with a recent diagnosis of prostate cancer that require active treatment, as opposed to careful monitoring, are often not given all the options available to them.

This means not all men are getting the necessary information and support to make a decision on what treatment is best. A growing body of evidence and treatment guidelines support the fact that less invasive radiation therapy is equally effective in curing or controlling cancer as surgical removal of the prostate, known as radical prostatectomy.


Read more: How’s your walnut, mate? Men rarely talk about their enlarged prostate


While all patients see a urologist – the specialist surgeon who does the biopsies and gives the diagnosis – they only see a radiation oncologist if the urologist or GP refers the man on. In this way, the urologist is the gatekeeper to men receiving optimal (or sub-optimal) care. The fear of cancer and a natural emotional response to get it out may lead to a less than fully-informed decision for surgery, and to possible regret of this decision later on.

Bias in medicine is a reality, and it is not surprising doctors favour familiar treatments. But it is problematic when bias creates a hurdle to men getting accurate, balanced information. There is plenty of evidence men aren’t getting the chance to hear about their radiation therapy options. A recent US study found that men seeing both a radiation oncologist and urologist were six times more likely to choose radiation therapy compared with men seeing only a urologist.

In Australia, the proportion of men receiving radiation is much lower than research on effectiveness of radiation therapy would predict if men with prostate cancer were exhibiting truly informed choice. Meanwhile, prostate surgery rates are higher and continue to rise, especially in the case of robotic surgery.

Prostate Cancer Foundation of Australia.

The gold standard of care

The gold standard of care for prostate cancer begins with the patient and his support person talking with the experts – the surgeon (urologist), a radiation oncologist and a specialist nurse. In doing so, the man is provided with the relevant information and impartial advice he needs to make an informed decision about his preferred treatment.

Virtually all specialist doctors who treat cancer profess to be part of a multi-disciplinary team, that includes surgeons, medical and radiation oncologists and other experts, and attend meetings where the relevant health professionals discuss patient “cases” to decide on management. These team meetings are valuable, but they are only one aspect of a high quality service. Meetings do not include the patient, the man with prostate cancer, who is integral to the decision-making process.

The multi-disciplinary team model has been successful in the treatment of breast cancer. There is nearly always more than one good treatment option available for men with prostate cancer, sometimes several. For men with low risk cancers, many may not require active treatment up front (or ever) and are appropriately managed by active surveillance or careful monitoring.


Read more: Latest research shows surgery for early stage prostate cancer doesn’t save lives


But other men with prostate cancer require active treatment to reduce the chance of dying, or suffering symptoms, from cancer. Alternative treatment pathways are very different for the individuals involved, in terms of patient experience, potential side-effects, the need for additional treatments, and potential out-of-pockets costs. This is why the man with prostate cancer has to be the most important member of the team who decides on the treatment.

Putting the patient at the centre

Only the patient can weigh up the trade-off between the risk of bowel problems (with radiation therapy) and the risk of urinary incontinence (with surgery). Likewise, the choice between attending the cancer centre for radiation treatment every weekday over several weeks versus hospitalisation and time off work for recovery after surgery. There are many other pros and cons that may sway a man to prefer one approach over another.

As already mentioned, the ideal model for decision-making for prostate cancer treatment is that the man has a consultation with a urologist and a radiation oncologist. As the two types of prostate cancer specialists have distinct expertise in different areas, seeing both is the only way men can get complete, up-to-date information.

The man can then consider his options and discuss these with his family and GP if he wishes. The good news is that men can take time to do this, as most prostate cancers are relatively slow-growing.

In the United Kingdom, Canada, and select centres including some in Australia, prostate cancer teams do place the man at the centre of decision-making. But this must become the rule rather than the exception and Australian men should be strongly encouraged and assisted to see all experts.

Ultimately, men need to be empowered in their decision-making through being part of a process that enables and supports them in making fully informed choices. Until then, men who require active prostate cancer treatment need to insist on seeing all the specialists in the area, including a radiation oncologist.

Myths about palliative care.

Five common myths about palliative care and what the science really says

This article is part of our series on demystifying palliative care, where experts explain the process of end-of-life care in Australia.


We may have heard it said, and in that curiously familiar tone, something along the lines of: “They’re having palliative care now.” And it’s almost as if the meaning of those words is so universally understood they need no further explanation. Most people simply assume they mean the person is now dying.

Yet, when a health professional suggests “palliative care” might be a useful addition to a patient’s care, they most likely mean something different.

So what is it the patient actually takes from the suggestion? We asked this question of people being treated for cancer in hospital, as well as their families. We wanted to explore people’s initial perceptions of palliative care when this term, or suggestion, was first raised with them in a clinical setting.

We found people held narrow, often inaccurate and outdated understandings of palliative care. Below are some of the common beliefs about palliative care, and what the science actually says.

Myth 1. It’s just nursing care

From its inception, palliative care has definitely always involved nurses. But by today’s standard there is much more to it than, for example, a nurse assisting a person with showering.

Palliative care is delivered by a multidisciplinary team of experts, such as social workers, counsellors, nurses and volunteers, who are trained to respond to the needs of people with serious illness.

For most patients, this will include consultation with a specialist palliative care doctor who has undergone additional medical training to become an expert in managing and treating the concerns that commonly arise from serious illness.

Palliative care has always involved nursing care, but it’s evolved to be a lot more than that. from shutterstock.com

Myth 2. It’s just about pain relief

Palliative care is often called on to provide expert advice on optimal pain relief. But, just as frequently, palliative care is there to help manage symptoms other than pain that result from a serious illness or its treatment.

For example, a palliative care specialist has particular experience with medications and strategies that may help with problems such as nausea, breathlessness or constipation – which, left unattended, may reduce a person’s quality of life.


Read more: What is palliative care? A patient’s journey through the system


Myth 3. It’s a place to wait for death

Palliative care does provide care for those at the end of life who may prefer to receive care or have needs best attended to in hospital or at a hospice. However, it is not just about end-of-life care.

Palliative care is available at any stage of serious illness. Palliative care can be helpful and is recommended early in an illness to work alongside other medical teams to diagnose and treat the cause of symptoms, manage medications, help with communication or decision-making about treatment options, or provide family support.

Palliative care is not just about end-of-life care. Yevgeniy Gradov/Unsplash, CC BY

Myth 4. Palliative care services are offered only in the hospital

Palliative care does provide support to people in the hospital, but just as frequently palliative care services in the community provide care to people in their own homes.

Additionally, just as a person with heart disease may go to a clinic at the hospital to see a cardiologist, people with serious illness can attend an appointment to see a palliative care specialist.


Read more: Governments must ensure palliative care is available to all who need it


Myth 5. It means depending on others for care

The principal goal of palliative care is actually the opposite of dependency. It aims to support a person to maintain their independence and quality of life while living with serious illness.

This may mean providing equipment or strategies that may be needed to ensure a person can continue to live their life to the fullest.

The aim of palliative care is to help the person maintain independence. Lukas Budimaier/Unsplash, CC BY

What does the science say?

There are now over ten high-quality, randomised clinical (human) trials, conducted internationally, that demonstrate the benefits of accessing palliative care if faced with serious illness.


Read more: Randomised control trials – what makes them the gold standard in medical research?


These studies, mostly conducted with people recently diagnosed with a serious cancer, compare the outcomes of people randomly allocated to receive either just best-practice cancer care or best-practice cancer care with palliative care.

Collectively, this science shows that people with a serious cancer who access palliative care soon after their diagnosis, alongside their recommended cancer treatments, have better outcomes.

They report feeling better, with fewer symptoms associated with their cancer and its treatment, improved mood and better quality of life. There is also growing evidence to show the people receiving palliative care live longer.

So, next time we hear a friend is receiving palliative care, we should also remember the science and think of the possibilities, accomplishments and high-quality care they may receive.

Ten facts you need to know about the chicken and eggs on your table

­

Ten facts you need to know about the chicken and eggs on your table

July 27, 2016 5.52am AEST

Disclosure statement

Sonia Yun Liu receives funding from Rural Industries Recent and Development Corporation.

Partners

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

 

When I am asked by friends what I do for living, I tend to raise eyebrows because my job is somewhat odd to many city people. That’s because I’m a poultry nutritionist.

Typically, the conversation turns into a friendly debate on the myths around eating chicken. Do we feed chicken hormones? Are any chickens genetically engineered? Do free range chickens taste better? And so on.

So to save everyone some time, here are some of the most common questions I get asked, and the answers I give.

1) Should you buy hormone-free chicken?

The truth is that no chickens or eggs produced in Australia contain added hormones, and they have not been given hormones for decades.

Independent tests by the Department of Agriculture, Fisheries and Forestry, as part of the National Residue Survey, confirm that Australian chicken meat is free of added hormones.

Not that it would be easy to give them hormones anyway. Growth hormones are proteins similar to insulin used to treat diabetes.

Like insulin, they can only be injected into the body because they are broken down in the digestive tract. Therefore, it is pointless to provide chickens growth hormones in their food because they would be rendered ineffective.

And given a typical commercial shed may accommodate 40,000 to 60,000 birds per shed, it is simply logistically impossible to inject hormones into each chicken.

2) Are meat chickens genetically modified to grow fast?

Our chickens are not genetically modified, and their genes have not been altered artificially. Modern meat chickens grow more quickly and are more “meaty” than chicken breeds available decades ago due to selective breeding and optimal nutrition.

Just like pedigree dog breeders breed their puppies for desired traits, selective breeding involves those animals that show the desirable characteristics being selected as the parents for the next generation in the breeding program, and this process being repeated over many generations.

In the 1960s, the goal of selective breeding in meat chickens was simply increased growth rate and increased meat production. Nowadays, the focus has changed from growth and yield to a broad spectrum of outcomes, with a clear emphasis on improving animal welfare, reproduction and overall fitness.

3) Are meat chickens raised in cages?

All commercial meat chickens are kept in large poultry sheds on litter floors, covered with things like rice hulls or wood shavings. They are not kept in cages.

Additionally, some meat chickens also have access to the outdoors, such as those often referred to as either free-range or organic. A simple comparison is shown below.

https://datawrapper.dwcdn.net/zSK2S/2/

4) Are free range chickens healthier?

Not always. In fact, free range chickens are more likely to catch diseases, get injured and die earlier than those kept inside.

In the UK, free range egg layers have a mortality rate of 8-10%, which is far higher than caged hens’ death rate of 2-4%.

The contact between free range chickens and wild birds also increases the risk of spreading bird flu. And birds can die from over-consuming grass.

Cannibalism can also happen in egg layers and it is a big challenge for free range egg production systems in particular.

We always assume animals behave in a civilised manner. But the fact is free range layer hens may peck each other to death. Cannibalism in poultry is part of their natural behaviour and, unfortunately, it has proven difficult to get rid of.

5) Do free range or organic chickens taste better?

There is very little data supporting the idea that free range or organic chickens actually taste better than conventionally farmed ones.

Commercial meat chickens do not tend to like running around, as they were selected to maximise their growth. So it’s a myth that more exercise makes chicken meat more tender.

Is it organic? Does it matter? Shutterstock

6) Why are some meat chickens yellow in colour?

In some cultures, chickens with yellow fat and skin are considered to be better quality. However, this is not true.

The yellowness of the skin, fat and egg yolk depends on the level of beta carotene in the diets. So those yellow chickens are fed with a corn-based diet, which is higher in beta carotene.

7) Are meat and egg laying chickens the same breed?

The meat and egg industries have different requirements, and use different breeds of bird.

The only eggs produced in the meat industry are those needed to produce the next generation of chickens.

Ross and Cobb birds are the two common commercial breeds selected for meat production.

The egg industry houses their hens quite differently and uses very different breeds of chickens, which are bred selectively over many generations to exhibit optimal egg producing characteristics.

The common breeds of laying hens in Australia are the Hyline Brown and the Isa Brown.

8) Why are some eggs white and others brown?

The colour of eggshells is the result of pigments being deposited during egg formation. The type of pigment depends upon the breed and is genetically determined.

To get a hint about the egg colour, look at the colour of the chicken’s ear lobes!

Interestingly, people have strong preferences for different egg shell colours in different markets. In Australia and parts of Asia, brown eggs are preferred, whereas in the US and Japan, people prefer white eggs.

The nutritional value of the egg only depends on the chickens’ diet, not the system of production or the colour of the egg shell.

For example, it has been shown that vitamin D-enhanced eggs can be produced if the diet is supplemented with high level of an active form of vitamin D.

9) What types of chickens do restaurants use?

It is often difficult to tell.

Fast food chains are more likely to use chickens produced conventionally unless specially labelled. Restaurants vary in the chickens they use. If you prefer a particular type of chicken, be sure to ask before you order.

10) Does Australia import chickens from elsewhere?

All the raw chicken meat available in Australia is grown in Australia.

According to Australian Chicken Meat Federation, we consumed 45.3kg of chicken meat per person in 2015, which means 870 grams of chicken meat per week.

Last year, more than 1.1 million tonnes of chicken meat was produced in Australia and almost all of it was consumed here.

The claim “produced in Australia” is applicable to almost all chicken meat sold in Australia with only very small quantities of cooked chicken meat being imported from New Zealand and some canned products containing chicken also potentially imported.


Sonia will be online for an Author Q&A between 1:30 and 2:30 on Wednesday, 27 July, 2016. Post any questions you have in the comments below.

NOTE: The word “happier” was removed from question number 4 as the answer focuses exclusively on the health of the chickens.

How we can protect our brains from memory loss and dementia

What is ‘cognitive reserve’? How we can protect our brains from memory loss and dementia

June 23, 2017 12.46pm AEST

As we get older we have a greater risk of developing impairments in areas of cognitive function – such as memory, reasoning and verbal ability. We also have a greater risk of dementia, which is what we call cognitive decline that interferes with daily life. The trajectory of this cognitive decline can vary considerably from one person to the next.

Despite these varying trajectories, one thing is for sure: even cognitively normal people experience pathological changes in their brain, including degeneration and atrophy, as they age. By the time a person reaches the age of 70 to 80, these changes closely resemble those seen in the brains of people with Alzheimer’s Disease.

Even so, many people are able to function normally in the presence of significant brain damage and pathology. So why do some experience symptoms of Alzheimer’s and dementia, while others remain sharp of mind?

It comes down to something called cognitive reserve. This is a concept used to explain a person’s capacity to maintain normal cognitive function in the presence of brain pathology. To put it simply, some people have better cognitive reserve than others.

Evidence shows the extent of someone’s cognitive decline doesn’t occur in line with the amount of biological damage in their brain as it ages. Rather, certain life experiences determine someone’s cognitive reserve and, therefore, their ability to avoid dementia or memory loss.

How do we know?

Being educated, having higher levels of social interaction or working in cognitively demanding occupations (managerial or professional roles, for instance) increases resilience to cognitive decline and dementia. Many studies have shown this. These studies followed people over a number of years and looked for signs of them developing cognitive decline or dementia in that period.

As we get older we have a greater risk of developing impairments in cognitive function, such as memory. from shutterstock.com

Cognitive reserve is traditionally measured and quantified based on self reports of life experience such as education level, occupational complexity and social engagement. While these measures provide an indication of reserve, they’re only of limited use if we want to identify those at risk of cognitive decline. Genetic influences obviously play a part in our brain development and will influence resilience.

Brain plasticity

The fundamental brain mechanisms that underpin cognitive reserve are still unclear. The brain consists of complex, richly interconnected networks that are responsible for our cognitive ability. These networks have the capacity to change and adapt to task demands or brain damage. And this capacity is essential not only for normal brain function, but also for maintaining cognitive performance in later life.

This adaptation is governed by brain plasticity. This is the brain’s ability to continuously modulate its structure and function throughout life in response to different experiences. So, plasticity and flexibility in brain networks likely contribute in a major way to cognitive reserve and these processes are influenced by both genetic profiles and life experiences.

A major focus of our research is examining how brain connectivity and plasticity relate to reserve and cognitive function. We hope this will help identify a measure of reserve that reliably identifies individuals at risk of cognitive decline.

Strengthening your brain

While there is little we can do about our genetic profile, adapting our lifestyles to include certain types of behaviours offers a significant opportunity to improve our cognitive reserve.

Activities that engage your brain, such as learning a new language and completing crosswords, as well as having high levels of social interaction, increase reserve and can reduce your risk of developing dementia.

Regular physical activity increases cognitive reserve. Jenny Hill/Unsplash, CC BY

Regular physical activity also improves cognitive function and reduces the risk of dementia. Unfortunately, little evidence is available to suggest what type of physical activity, as well as intensity and amount, is required to best increase reserve and protect against cognitive impairment.

There is also mounting evidence that being sedentary for long periods of the day is bad for health. This might even undo any benefits gained from periods of physical activity. So, it is important to understand how the composition of physical activity across the day impacts brain health and reserve, and this is an aim of our work.

Our ongoing studies should contribute to the development of evidence-based guidelines that provide clear advice on physical activity patterns for optimising brain health and resilience.

Man flu is real, but women get more autoimmune diseases and allergies

Man flu is real, but women get more autoimmune diseases and allergies

August 7, 2017 6.12am AEST

Men and women respond differently to diseases and treatments for biological, social and psychological reasons. In this series on Gender Medicine, experts explore these differences and the importance of approaching treatment and diagnosis through a gender lens.


We know that sex hormones drive characteristic male and female traits such as breast enlargement and hip widening in women, or increased muscle mass and growth of facial hair in men. But now we also recognise they have a major impact on the immune system – our body’s inbuilt mechanism that helps fight and protect us against disease.

Research suggests this has an evolutionary basis: survival of the species may mean men are harder hit by viruses, but a woman’s reactive immune system leaves her more susceptible to autoimmune diseases and allergies.

Viruses see men as weaker

Men die significantly more often from infectious diseases than women. For instance, men are 1.5 times more likely to die from tuberculosis, and twice as likely to develop Hodgkin’s lymphoma following Epstein–Barr virus (EBV) infection. Men are also five times more likely to develop cancer after infection with human papillomavirus (HPV), than women.

This is because women’s immune systems mount a stronger response against foreign invaders, particularly viruses. While the male hormone testosterone tends to dampen immune responses, the female hormone oestrogen increases the number of immune cells and the intensity of their response. So women are able to recover more quickly from an infection.

All this may reflect a sneaky evolutionary trick used by viruses to enable their survival. Women have developed multiple mechanisms to transmit infections; mainly through passing bugs from mother to child during gestation or birth, or through breastfeeding. So women are better vessels for viruses.

Viruses may have signalled men out as the weaker sex. Michael Verhoef/Flickr, CC BY

Meanwhile, viruses have singled men out as the weaker sex. While popular culture has come up with the term “man flu”, suggesting men are over-dramatising flu symptoms, evidence suggests they may in reality be suffering more due to this dampening down of their immune responses.


Read more – Health Check: is man flu real?


However, this increased susceptibility of men to infection may not be an advantage for the long-term (over tens of thousands of years) survival of a disease-causing organism (pathogen), if it induces such severe disease that it results in the death of the host.

Pathogens modify themselves so they can be transmitted by women during pregnancy, birth or breast feeding. Because of this, many have adapted to be less aggressive in women allowing wider infection, generally across a population.

However, this feature alone is not likely to be sufficient to ensure the ongoing survival of a virus. The fitness of both sexes is necessary to reproduce long-term and thus provide new hosts for invading pathogens. Thus, the hit to the male sex must somehow be balanced by other advantages to their immune system.

Autoimmune diseases

Women are good hosts for viruses. Romanova Anna/Shutterstock

The most striking sex differences in the immune system are seen in autoimmune diseases. Autoimmune disease affects about 8% of the population, but 78% of those affected are women. Women are three times more likely than men to develop these types of disease.

Autoimmune diseases occur when the immune system turns on and attacks the body’s own cells or tissues, initiating a chronic cycle that results in damage or destruction of specific organs. These diseases include type 1 diabetes, lupus, rheumatoid arthritis, multiple sclerosis, and up to 80 different diseases that affect systems such as the intestine, bones, joints and nervous systems.


Read more – Explainer: what are autoimmune diseases?


In the case of lupus, the immune system mistakenly attacks the person’s own DNA (the structure that carries a person’s genetic code) causing damage to multiple organs that will lead to weight loss, anemia and eventually heart and kidney failure. Nine out of ten patients with lupus are women and clinical observations suggest that, again, hormones are the culprits.

These differences of susceptibility between males and females tend to appear after puberty, and flare-ups increase during pregnancy. On the contrary, menopause is associated with a lower disease severity.

Studies have linked oestrogen levels with the exacerbation of lupus. Oestrogens directly act on a particular immune cell (called the plasmacytoid dendritic cell) to promote their capacity to secrete inflammatory signals, which exacerbate lupus symptoms. Although these dendritic cells are generally important for fighting viral infections, in the context of lupus and multiple sclerosis, they cause significant harm.

Hormones and allergies

One in nine Australians (more than 2.5 million in total) suffer from asthma – a disease that causes swelling and narrowing of the airways. This makes it difficult to breathe when we encounter environmental allergens such as pollen.

Twice as many women develop asthma compared to men. Photosmatic/Shutterstock

Twice as many women develop asthma compared to men. Interestingly, males are more susceptible to asthma before to the onset of puberty but, after puberty, females are more affected and develop more severe asthma than men. Until now, the reasons for this were not obvious, but hormones were speculated to play a role.

In a recent study, we showed that high levels of testosterone in males protect them against the development of allergic asthma. During puberty, the level of testosterone increases.

Testosterone acts as a potent inhibitor of a recently discovered immune cell called an innate lymphoid cell (ILC2), which accumulates in the lungs and initiates asthma. ILC2 cells release inflammatory signals that drive the swelling and airway narrowing characteristic of asthma when people are exposed to pollen, dust mites, grass or other common allergens. Testosterone reduces the numbers of ILC2 in the lungs of males, while female hormones provide no protective effect.


Read more: Do kids grow out of childhood asthma?


Immunity and sex are far more intricately linked than we had previously appreciated. More research needs to be done to better understand the triggers involved in the different responses of males and females. But the recent discoveries open the door for tactics to potentially target hormonal pathways or receptors that are preferentially expressed on male or female immune cells.

Private clinics’ peddling of unproven stem cell treatments is unsafe and unethical

Private clinics’ peddling of unproven stem cell treatments is unsafe and unethical

July 7, 2017 3.40pm AEST

Such unregulated direct-to-consumer advertising – typically of cells obtained using liposuction-like methods – not only places the health of individuals at risk, but could also undermine the legitimate development of stem cell-based therapies.

Many academic societies and professional medical organisations have raised concerns about these futile and often expensive cell therapies. Despite this, national regulators have typically been slow or ineffective in curtailing them.

As well as tighter regulations here, international regulators such as the World Health Organisation and the International Council on Harmonisation need to move on ensuring patients desperate for cures aren’t sold treatments with limited efficacy and unknown safety.

So what’s on offer?

Hundreds of stem cell clinics post online claims that they have been able to treat patients suffering from a wide range of conditions. These include osteoarthritis, pain, spinal cord injury, multiple sclerosis, diabetes and infertility. The websites are high on rhetoric of science – often using various accreditation, awards and other tokens to imply legitimacy – but low on proof that they work.

Rather than producing independently verified results, these clinics rely on patient testimonials or unsubstantiated claims of “improvement”. In so doing these shonky clinics understate the risks to patient health associated with these unproven stem cell-based interventions.

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

Properly administered informed consent is often overlooked or ignored, so patients can be misled about the likelihood of success. In addition to heavy financial burdens imposed on patients and their families, there is often an “opportunity cost” because the time wasted in receiving futile stem cells diverts patients away from proven medicines.

The many recent reports of adverse outcomes demonstrate the risks of receiving unproven cell therapies are not trivial. In the USA three women were blinded following experimental “stem cell” treatment for macular degeneration (a degenerative eye disease that can cause blindness). One man was rendered a quadriplegic following a stem cell intervention for stroke. And a woman whose family sought treatment for her dementia died in Australia.

Many clinics make claims stem cell treatments are effective for a vast range of conditions, most of which there is limited evidence for. Screenshot, Stem Cell Therapy Plus website

Other notorious cases involving the deaths of patients include the German government shutting down the X-Cell Centre and the Italian government closing the Stamina Foundation it had previously supported.

What’s approved?

At present, the only recognised stem cell treatments are those utilising blood stem cells isolated from bone marrow, peripheral blood (the cellular components of blood such as red and white blood cells and platelets) or umbilical cord blood.

Hundreds of thousand of lives have been saved over the last half-century in patients with cancers such as leukaemia, lymphoma and multiple myeloma, as well as rare inherited immune and metabolic disorders.

A few types of cancer and autoimmune diseases may also benefit from blood stem cells in the context of chemotherapy. Different stem cells are also successfully used for corneal and skin grafting.

All other applications remain in the preclinical research phase or are just starting to be evaluated in clinical trials.


Further reading: Yes there’s hope, but treating spinal injuries with stem cells is not a reality yet


Often dismissed by for-profit clinics as “red tape” hampering progress, the rigour of clinical trials allows for the collection of impartial evidence. Such information is usually required before a new drug or medical device is released into the marketplace. Unfortunately, in the case of for-profit stem cell clinics, their marketing has gazumped the scientific evidence.

Marketing regulation is needed so private clinics can’t make claims without evidence. Screenshot, ASC Treatment website

So what can be done?

Action is required on many fronts. Regulators at both an international and national level need to tackle regulatory loopholes and challenge unfounded marketing claims of businesses selling unproven stem cell interventions.

Researchers need to more clearly communicate their findings and the necessary next steps to responsibly take their science from the laboratory to the clinic. And they should acknowledge that this will take time.

Patients and their loved ones must be encouraged to seek advice from a trained reputable health care professional, someone who knows their medical history. They should think twice if someone is offering a treatment outside standards of practice.

The stakes are too high not to have these difficult conversations. If a stem cell treatment sounds too good to be true, it probably is.


For more information on recognised stem cell treatments visit the National Stem Cell Foundation of Australia and Stem Cells Australia, Choice Australia, EuroStemCell, International Society for Stem Cell Research, and International Society for Cellular Therapy.

Five claims about coconut oil debunked

Five claims about coconut oil debunked

Is coconut oil all it’s really cracked up to be, or is it just another fad? Sebastien Gabriel/Unsplash, CC BY

Coconuts have been a valued food in tropical areas for thousands of years, traditionally enjoyed as coconut water from the centre of the coconut, coconut flesh, or coconut “milk” (made by steeping the flesh in hot water).

Solid white coconut oil (I’ll use this popular term, although technically it’s a fat not an oil) is now the darling of celebrities and bloggers, paleo enthusiasts and sellers of so-called superfoods. Claims for its supposed medical value reverberate around the internet, but how well do they stand up to scientific scrutiny?

1. It helps you lose weight

No study has found coconut oil helps weight loss. The claim made on hundreds of internet sites that it has some special ability to get rid of body fat is based on the erroneous idea that coconut oil is synonymous with a semi-synthetic laboratory product known as MCT oil.


Read more: Health Check: are saturated fats good or bad?


Claims that coconut oil can get rid of body fat are based on false premises. From http://www.shutterstock.com

Unlike regular edible oils, MCT oil is soluble in water and was originally designed for use in tube feeding or for people who were malnourished because they lacked normal enzymes that split fat. Unlike most fats that are absorbed into the bloodstream, MCT oil is absorbed directly into the liver. This means it can be used more rapidly for fuel than other fats.

There is some evidence MCT oil may help with weight loss, although the dose required and its side effects – at least initially – can include nausea, stomach cramps and diarrhoea. Even so, internet sites that assume the effects of MCT oil also apply to coconut oil are wrong. The two products are not equivalent and you can’t switch the findings of one to the other.

MCT is made up of two fatty acids – caprylic and capric acids. Coconut oil has small amounts of these acids, but its dominant fatty acid is lauric acid. Lauric acid is not digested in the liver but is digested and metabolised in the body like the fatty acids in other edible oils.

If munching on a piece of coconut flesh (which is a reasonable source of dietary fibre) helps you eat less overall, that could be useful. However, a study of different fats, including coconut oil, found no beneficial effect on hunger, fullness, satisfaction or current thoughts of food.

2. It reduces heart disease risk

Careful studies show the overall effect of coconut oil on increasing LDL cholesterol (which increases the risk of heart disease) is greater than with corn, safflower or a mixture of soybean and sesame oils. It is, however, slightly better than butter.


Read more: Health Check: what’s healthier, butter or margarine?


Plenty of evidence from studies of people living traditional lifestyles with coconut (as flesh or the creamy liquid squeezed from the flesh) as their major source of fat show low levels of heart disease. They include 1960s studies of lean and active Pacific Islanders whose diets consisted mainly of fish, octopus, taro, breadfruit, bananas and coconuts.

Pacific Islanders use coconut as a major source of fat. Eddie Kopp/Unsplash, CC BY

The same applies to the very lean people of Kitava (a small island of Papua New Guinea), with their traditional diet of yams, cassava, sweet potato, taro, banana and other tropical fruits, fish and coconut. Their diet is not only low in fat, but also has little alcohol, salt, sugar, dairy or processed foods.

In contrast to these restricted diets of past times, coconut has not been able to protect against big changes in diet and activity. In Samoa, for example, coconut consumption hasn’t changed, but the total daily diet contributed 3,800 kilojoules (900 calories) more in 2007 compared with the 1960s. Pacific Islanders now top the world obesity tables, heart disease rates are high, and type 2 diabetes is three times more common than in Australia – all in spite of consuming coconut.


Read more: Got high cholesterol? Here are five foods to eat and avoid


As one recent review of 21 research papers and a further review have shown, coconut oil cannot be relied on to reduce blood cholesterol or protect against heart disease.

3. It kills bacteria and viruses

Some internet sites claim coconut oil can kill viruses, fungi and bacteria due to its content of monolaurin, a compound derived from lauric acid.

Studies in mice show monolaurin can provide some protection against the bacteria Staphylococcus aureus (responsible for some staph infections), but researchers doing this study found no effect with either refined or virgin coconut oil.

In particular types of infection, there is some possibility monolaurin might be of use, but it’s not valid to extrapolate from this to make claims about coconut oil when there’s no evidence the body can make monolaurin from coconut oil.

Instead, a manufactured form of monolaurin (glycerol monolaurate) is found in coconut oil and is popular for its emulsifying and moisturising properties in cosmetics, detergents and soaps. These properties in coconut oil could support its benefits as a surface moisturiser or make-up remover.

4. It repairs your hair

Several papers published in the Journal of Cosmetic Science claim that coconut oil applied to hair is better at penetrating the hair shaft than mineral oil.

This could be useful and it’s unlikely that coconut oil massaged into hair will have any adverse effect on human health, so if it appeals, it may be worthwhile to use it for this reason.

There are claims coconut oil will repair damaged hair. From shutterstock.com

5. It whitens your teeth

This claim is another extrapolation of the idea that coconut oil can kill harmful organisms. The practice of swishing oil in the mouth (called “oil pulling”) for 10-30 minutes before spitting hails from Ayurvedic practices in India and supposedly draws out toxins.

If it makes you feel sick or headachy, that’s meant to be proof you are extracting toxins.

There’s no scientific evidence to support this practice and it should not replace proper dental care.