September is Prostate Cancer Awareness month; the Prostate Cancer Foundation of Australia is asking Australia to get involved and help create awareness and raise the much-needed funds to assist in the fight against prostate cancer. The most common cancer in Australia sees 20,000 men diagnosed with prostate cancer each year, with close to 3,300 deaths. About the size of a walnut, the prostate gland surrounds the bladder and urethra. It continues to grow throughout a man's life. 

The prostate can become enlarged over the age of 50, a condition known as benign prostatic hyperplasia (BPH). Because of enlargement and inflammation, the flow of urine out of the bladder can become blocked, resulting symptoms can include the urge to urinate, waking up in the middle of the night to urinate, painful ejaculation and erectile dysfunction. There may also be a feeling of fullness in the bladder and incomplete emptying. BPH can also cause bladder, urinary tract or kidney problems.  

Although the development of BPH is not completely clear, testosterone may play a role. It may be that a metabolite of testosterone, dihydrotestosterone, builds up in the prostate, causing it to grow. 

As well as regular medical checks and consulting a doctor if symptoms develop, enjoying a healthy mixed diet is essential for prostate health. So:

Get into and stay in a healthy weight range

Exercise regularly 

Cut down on red meat and saturated fats

Moderate alcohol intake

Certain nutrients are also thought to contribute to prostate health.

Add omega-3s

Try to put fish on your dish twice a week or more. Oily fish, including salmon, mackerel, sardines and tuna, are rich in omega-3 fatty acids which are powerful anti-inflammatories. All fish contains some omega-3s, though so white fish, canned tuna and seafood are good choices, too. Try oysters, calamari, prawns and crab are rich in zinc. A normal prostate has the most concentrated levels of zinc in the body. Research shows that prostate tissue from men with BPH had significantly less zinc than normal prostate tissue. It is not clear if prostate problems cause the depletion of zinc, or if lower levels of zinc contribute to prostate health problems.

Berries and more

Berries, citrus, and other fruits are packed with antioxidants and vitamin C; these battle free radicals, which are by-products of normal body reactions. Over time, the build-up of free radicals can cause damage such as inflammation which is an important factor related to prostatic enlargement. 

Don’t skimp on veggies

Vegetables provide a whole range of vitamins, minerals, antioxidants and phytochemicals. Cabbages, broccoli, bok-choy, cauliflower, onions, and garlic contain sulphur and help to fight inflammation.

Love lycopene

One of the greatest prostate-protecting superstars is tomatoes. The pigment that gives them their rich, red colour is the powerful antioxidant lycopene. Cooking tomatoes with olive or coconut oil makes the lycopene easier for the body to absorb. Watermelon is also lycopene-rich.

Turn to turmeric

A cousin to ginger, turmeric gives curry and mustard their deep yellow colour. It has been used in India as a spice and medicinal herb for thousands of years and now, science has proven turmeric's medicinal qualities. Curcumin is turmeric’s active ingredient and consuming it with piperine in black pepper enhances its absorption by a massive 2,000%. Most Australian curcumin supplements contain piperine. High doses of curcumin over a gram per day are needed for the medicinal results seen in studies.

It is essential to discuss any concerns about regarding prostate health with a medical professional as soon as possible.

The truth is that where it comes to beating inflammation, there is no one single remedy but healthy, lifestyle choices can help.

So, anyone for salmon, spinach and turmeric-pepper tomatoes?

By guest contributor Michelle Boyd MHSc WHM, GradCert HEd, BHScNat, FNHAA Naturopath and Herbalist, University Lecturer, Clinical Educator & Author.

Michelle Boyd, Naturopath, Herbalist, Lecturer, Clinical Educator and Author.

Menopause is a natural stage of life; it is not a disease. Managing menopausal symptoms is only one part of the big picture in supporting a woman’s adjustment through mid-life changes. Ideally, planning for menopause should begin long before it starts.

The menopausal transition usually occurs from 45 to 55 years of age and may take a woman 5 to 10 years to transit menopause, with this stage of fluctuating hormones (and hence irregular menstrual cycles) referred to as perimenopause¹. Perimenopause is recognised by many as a time of ‘hormonal chaos’ during which up to 80% of women suffer from both physical and emotional symptoms (60% mild to moderate; 20% severe), including hot flushes and sweats(mostly), anxiety/depressed mood and insomnia.²

Hot flushes

Menopausal hot flushes are thought to be hormonally driven, however they are also influenced by stress and diet (blood sugar fluctuations). No matter what the cause, it’s all about the ‘bothersome’ factor – whether women have 2 or 20 hot flushes a day, if it’s ‘bothersome' enough for them to seek help then they need relief!

The most reliable herbal relief for hot flushes is found with Actaea racemosa (Black cohosh). Most recent Actaearacemosa studies^3,4,5 involving 1200+ menopausal womendemonstrated statistically relevant reduction of major menopausal symptoms especially the incidence and severity of hot flushes with results seen within 2-4 weeks, with continued improvement shown over 3 and 9 months.

Stress/diet related factors that may exacerbate hot flushes also need to be identified. Erratic eating behaviour plays havoc with blood sugar levels promoting the incidence/severity of hot flushes. Menopausal women need to eat (less) more regularly and think ‘paddock to plate’:Combine good quality protein with colourful plate of antioxidant rich fruits and vegetables

Relax before meals and eat dinner (early) at the table

Alcohol promotes hot flushes – reduce/stop intake

Anxiety and stress

Midlife women have many sources of anxiety and stress -juggling work with life, bringing up teenagers, caring for grandchildren and/or aging parents and their own ageing. 

Anxiety and stress can be part of the menopause picture and/or result from a very busy, caffeinated and stressful mid-life! Either way, these women need nervous system support, e.g., herbal Hypericum perforatum (St. John’s wort) is shownto relieve stress and anxiety, improving midlife mood – as does reducing caffeine intake!

Insomnia

Women can suffer hot flushes and/or sweats 24/7 which can cause insomnia. Alternatively, insomnia may be due to worrying about ‘midlife stuff’ becoming tired, cranky and frustrated – more midlife moodiness! Reducing the incidence/severity of hot flushes/sweats and promoting a good night’s sleep will help resolve her suffering and Valeriana officinalis (Valerian) and Humulus lupulus (Hops)combination, mimic the body’s natural sleep hormone (melatonin) promoting a restful good night’s sleep.⁶

Silent changes

Post-menopausal women may continue to experience menopausal symptoms; however, it is the ‘silent changes’ due to the decline in the ‘protective effects’ of oestrogen that require far more important attention. Cardiovascular disease (CVD) is the leading cause of death in post-menopausal women and cardiovascular markers like increased body weight (especially abdominal fat), high blood pressure and high cholesterol, all increase in post-menopause.⁷ Lifestylechanges are essential to increase longevity and decrease the risk of osteoporosis and CVD. Healthy eating and regular exercise are most important to manage weight and prevent disease. 

Healthy heart

A diet rich in antioxidant/anti-ageing culinary herbs and spices have been shown to be beneficial for cardiovascular health.⁸ Most notable is turmeric, the ‘spice of life!’ with antioxidant/anti-inflammatory properties providingtherapeutic benefits for various conditions ailing menopausal women.  Others include ginger, cumin, marjoram, cardamom, garlic, cinnamon, oregano and rosemary.

Periodic testing of blood pressure and blood lipid (fat) levels (importantly triglycerides) is recommended for menopausalwomen as is bone mass density (BMD).

Healthy bones

Menopause is an important time to check BMD to identify any health issues early. On average, it is estimated women will lose up to 10% of their BMD in the first 5 years post menopause. Promoting healthy bones requires both regular exercise and adequate vitamin D levels and calcium intake.⁹

Menopausal women require 1300 mg/day of calcium, preferably from low calorie dietary sources (which will also contain other healthy nutrients),¹⁰ with a calcium supplement (maximum 500-600 mg per day) to top up the difference if need be. 

Low levels of vitamin D are commonly seen in menopausal women. Vitamin D is naturally produced in our skin when exposed to ultraviolet sun light. Osteoporosis Australia’s website www.osteoporosis.org.au provides a vitamin D sunshine map to help you identify the best time/duration depending on location/time of year for optimal exposure and regular intake of vitamin D3 supplement is beneficial for those with inadequate levels.

Exercise

Regular exercise is important for menopausal heart and bone health and there are several reasons why.¹¹

Upright weight-bearing activity promotes strong healthy bones. 

Inner core strength exercise helps maintain balance to help prevent falls.

Improving reflexes promotes quicker response to help break falls. 

Menopausal women need to consult their doctor and a qualified exercise specialist to establish their individual needs.  

Exercise builds muscle cells providing benefits for metabolism and improved energy to enjoy midlife and beyond!  

In closing …

Many menopausal women (including myself) soon realise their menopausal symptoms just don’t go away overnight and some of us must endure them for many years. In knowing this, our focus becomes that of finding efficacious, clinically proven, natural treatments with good safety track records.Look for them – they’re out there 

References

1. Menopause Symptoms, Signs, Treatment, Definition (medicinenet.com)

2. Symptoms of menopause | Jean Hailes

3. Lopatka L et al. Black Cohosh in the Treatment of Menopausal Complaints – Results of an Observational Study with Cimifemin Uno. Journal of Menopause(English version) 2007; 2:16-21.

4. Schellenberg R et al. Dose-Dependent Effects of the Cimicifuga racemosa Extract Ze 450 in the Treatment of Climacteric Complaints: A Randomized, Placebo-Controlled Study. Evidence-Based Complementary and Alternative Medicine. 2012. doi: 10.1155/2012/260301. 

5. Drewe et al. The effect of a Cimicifuga racemosaextracts Ze 450 in the treatment of climacteric complaints – an observational study. Phytomedicine.2013; 20:659-666.

6. Koetter U et al. A Randomized, Double Blind, Placebo-Controlled, Prospective Clinical Study to Demonstrate Clinical Efficacy of a Fixed Valerian Hops Extract Combination (Ze 91019) in Patients Suffering from Non-Organic Sleep Disorder. Phytotherapy Research. 2007; 21:847-851.

7. Menopause | Health and wellbeing | Queensland Government (www.qld.gov.au)

8. Iyer A et al. Potential Health Benefits of Indian Spices in the Symptoms of the Metabolic Syndrome: A Review. Indian Journal of Biochemistry & Biophysics. 2009; 46:467-481.

9. Menopause and osteoporosis - Better Health Channel

10. Calcium - Better Health Channel

11. Grindler NM & Santoro NF. Menopause and exercise. Menopause. 2015; 22(12):1351-1358. 

By guest contributer, Sarah Culverhouse, Head of Education at  Fusion Health.

Naturopath and Head of Education at Fusion Health, Sarah Culvershouse, talks herbs, hormones and tradtional Chinese Medicine. 

Traditional Chinese medicine (TCM) has an interesting understanding of the changes that occur in a woman’s body during menopause. The insights offer a window into some of the core concepts of TCM as well as traditionally used symptom relief strategies for women experiencing menopausal symptoms.

Menopause is a time of Yin and Yang imbalance

The concepts of Yin and Yang and the key role that balance and harmony play in health and wellbeing¹ is an aspect of TCM that most of us have some awareness of. These days, the familiar Yin-Yang symbol can be seen around the world, featured on everything from t-shirts and surfboards – and even the Fusion Health logo!

In summary, TCM teaches that Yin and Yang are two opposing forces that exist in an ever-changing relationship. One may dominate the other under certain circumstances, but as long as they’re continuously returning to balance, optimal health and wellbeing will be maintained.

In TCM, all Yin and Yang in the human body is traditionally believed to arise from the Kidney organ-meridian system, which is also regarded as governing all aspects of reproductive health and function – including the menopausal transition¹.

During menopause, it’s traditionally understood that Kidney Yin becomes deficient relative to Kidney Yang².

Yin has cooling and moistening properties, so when Kidney Yin is deficient, symptoms can develop that are characterised by heat (such as hot flushes and sweating²) and lack of moisture (such as vaginal dryness).

On the other hand, Yang is heating and drying, so as it becomes more dominant or hyperactive in comparison to Kidney Yin, heat-related menopausal symptoms worsen, and the fluids in the body begin to dry up.

In TCM, this symptom pattern is known as ‘internal heat in Yin deficiency’ or ‘deficiency heat’¹.

Traditional Chinese Herbal Medicine for Menopause

Anemarrhena: traditional cooling herb

When the Kidney Yin deficiency pattern described above is present, anemarrhena is traditionally used to relieve hot flushes, night sweats and vaginal dryness in TCM.

It’s traditionally regarded as having cooling properties and the ability to moisten dryness, so is traditionally used in TCM to nourish Yin and cool deficiency heat.

Dong quai: traditionally used to relieve menopausal hot flushes

Dong quai is traditionally used to relieve menopausal symptoms, including hot flushes in TCM, and is also traditionally taken as a blood tonic.

Yoga for menopausal women

Research suggests that practising yoga might help women who are peri-menopausal or post-menopausal manage both vasomotor symptoms like hot flushes and night sweats, and psychological symptoms such as mood swings.

In particular, regular yoga may lead to a small-to-moderate reduction in the severity of hot flushes – but you’ll need to develop a regular practice, as these effects don’t occur in the short-term, according to research published in the journal Complementary Therapies in Medicine.

References:

1.    Liu, Z. & Liu, L. (Eds.) (2009) Essentials of Chinese Medicine (vol 1) Springer London.

2.    Bensky D and Barolet R. Chinese Herbal Medicine Formulas & Strategies. 1990. Eastland Press.

3.    Shepherd-Banigan, M. et al. Complement Ther Med, 2017;34156-64

Asthma is a chronic lung disease; symptoms include coughing, shortness of breath and wheezing. Caused by inflammation and swelling in the airways of the lungs, severe asthma attacks can be dangerous and even life-threatening.

The incidence of asthma seems to be higher in western countries, which can be rich in refined sugar, fats, and processed foods. Poor diet may, in turn, be linked to widespread deficiencies of certain nutrients, including vitamins. Focusing on fresh vegetables and fruit may help. There is no single superfood or nutrient that helps to improve asthma symptoms. Still, a diet rich in vegetables and fruits may help your symptoms and whole-body health.

As well as taking prescribed medicines and following advice from a healthcare professional carefully, some dietary factors and forms of exercise, movement and breathing may help. 

Vitamin D

Fat-soluble vitamin D is also known as the sunshine vitamin because most of our vitamin D is derived when the sun reacts with a cholesterol-like substance in the skin. Essential for bone health, vitamin D also affects the part of the immune system that identifies specific disease-causing microorganisms. Some of these microorganisms, such as respiratory viruses, may trigger asthma attacks.

To boost your vitamin D levels, practice safe sun. Dietary sources include dairy, eggs, fatty fish and UV treated mushrooms.

Vitamin C

Unlike most mammals, humans can't make water-soluble vitamin C, but all body cells need this water-soluble vitamin. A daily intake is important because the body can't retain large amounts. It's antioxidant and has anti-inflammatory properties that reduce oxidative stress, including placed on tissues in the airways. Vitamin C might reduce an individual's hypersensitivity to asthma triggers while reducing inflammation and hypersensitivity in a similar way that prescribed inhaled steroids work, according to researchers. 

Find vitamin C in vegetables and fruits. Enjoy seasonal and raw, when possible, to retain as much vitamin C destroyed by heat and exposure to air. 

Omega-3 fats

Several studies link fish and fish oil consumption - omega-3s - with a lower risk of asthma in children and young adults. Other research suggests that taking fish oil during the third trimester of pregnancy might cut children's risk of developing asthma. A study from Copenhagen found that consuming fish oil supplements could reduce childhood asthma rates.

Find omega-3s in fatty fish such as fresh tuna, salmon and sardines. Canned fish contains less omega-3s but is still a healthy option.

Exercise and yoga

Regular physical activity may help to reduce asthma symptoms by improving your lung health. As well as aerobic exercise and weight training to building muscle strength, you may want to add yoga into the mix. The ancient Indian practice of yoga involves held postures and movements performed with breathing techniques. Yoga aids relaxation and enhances fitness. Regular practice may help by improving posture and opening the chest muscles, which encourages better breathing.

Research suggests that yoga may improve quality of life and asthma symptoms to some extent. Always talk to your doctor about your exercise options. 

In a recent article in Australian Prescriber: ‘The safety of commonly used vitamins and minerals’, dated 2 August 2021, Dr Geraldine Moses says that: "Dietary supplements have a range of potential risks and few benefits” and that “Consumers should be aware that there is no case for vitamin or other supplements in normal healthy people who are not pregnant or breastfeeding.” CMA respectfully disagrees.

According to researchers writing in the American Journal of Nutrition, Enhancing iron absorption. 100 mg of vitamin C may improve iron absorption by 67%.

Risks of dietary supplements - Interactions do exist, in a similar way that foods can also interact with drugs. Fortunately, decades of research have shown there are only a small handful that are clinically significant.  

Dose is also important - just like every medicine when the dosage is too high, side effects my result. Geraldine Moses fails to mention that the very high doses required to result in side effects are clinically challenging to consume and unlikely to occur under normal supplemental intake.

Manufacturers of Australian complementary medicines recommend appropriate dosages on the labels. The TGA requires at least 25% of the recommended daily intake to make statements about the role of vitamins and minerals in the body.

Contrary to Dr Moses’ statement: “Unlike conventional medicines, manufacturers of vitamins and minerals are not required to provide warnings of their potential side effects,” warnings ARE required on supplement labels or before point of purchase.

More than 25 mandatory warnings apply to a variety of nutrients.

Increasing health literacy

Geraldine Moses does not acknowledge the health literacy of the Australian public either; CMA believes growing understanding is inspiring people to take increasing control of their health. Using individually-sought or shared research with the advice of health professionals (from pharmacists and integrative GPs to nutritionists, dentists and more) and by paying close attention to the individual effects that supplements are having, an increasing number of people are using nutritional supplements as an essential part of their therapeutic and preventive approaches to good health.

Geraldine Moses says there a few benefits of dietary supplements. Again, CMA disagrees and we present a small number of examples.

Vitamin D

“Some people may not be able to spend enough time in the sun or may not be able to produce vitamin D easily. Health professionals may recommend vitamin D supplements after considering individual circumstances, including whether vitamin D deficiency is present and how severe it is.”

According to NPS Medicine Wise, 

Vitamin B12

According to HealthDirect: “Vitamin B12 deficiency can be caused by not eating enough foods that contain Vitamin B12, especially meat and animal products. More often it is caused by the body not being able to absorb the Vitamin B12 properly.”

According to Harvard Health: “Older adults can have difficulty absorbing vitamin B12, and  have a lower threshold when checking this level; if someone is taking an acid-reducing medication, it is very likely that they will become deficient in B12, as well as iron, vitamin D, and calcium, among other things. This cohort may very well benefit from a quality multivitamin.”

Iron deficiency anaemia

According to Australian Prescriber: Correcting iron deficiency anaemia: “Oral iron replacement is the most appropriate first-line treatment in the majority of patients.” 

Vitamin C

According to researchers writing in the American Journal of Nutrition, Enhancing iron absorption. 100 mg of vitamin C may improve iron absorption by 67%. Thus, vitamin C may help reduce the risk of anaemia among people prone to iron deficiency.

B vitamins

According the researchers, “B complex deficiency in alcoholism primarily arises due to malnutrition or intake of a diet deficient in necessary vitamins and minerals. Additionally, alcohol consumption exacerbates the effect of a poor diet and reduces absorption of B vitamins.

Consuming 24g alcohol (240ml red wine or 80ml vodka) per day for two weeks leads to a decrease in folate and B12 levels in healthy individuals.”

Poor nutritional status

The long-term consumption of poor dietary quantity (e.g., due to loss of appetite) or quality (e.g., restrictive, unbalanced, or low-nutrient dense diets increase the risk of poor nutritional status. In older age groups, many changes, including physical, physiological, and psychosocial factors make it more difficult for nutritional needs to be met, leading to shortfalls in nutrients.

Contrary to Dr Moses’ comments, the Australian Bureau of Statistics reports that a number of Australians are not meeting vitamin and mineral requirements.

Vitamins

Approximately one in twelve (9%) adult females (aged 19 and over) did not meet their requirements for folate (dietary folate equivalents) based on their intakes from foods.

Approximately 7% of males and 16% of females had inadequate thiamine intakes.

Approximately 17% of males and 14% of females had inadequate usual intakes of vitamin A (as retinol equivalents)..

Three in every ten people aged two years and over had an inadequate intake of vitamin B6.

The proportion of females aged 14 years and over with inadequate usual intakes of vitamin B12 ranged from 5 to 8% for different age groups.

Minerals

Three in four females aged two years and over (73%) did not meet their calcium requirements, compared with one in two males of the same age group (51%).

One in eight people aged two years and over had inadequate usual intakes of iron. The prevalence of inadequate intakes was highest amongst females aged 14-50 years, with nearly two in five having inadequate iron intakes.

One in three people aged two years and over (37% of males and 34% of females) did not meet their requirements for magnesium. Inadequate intakes of magnesium were more common in those aged nine years and over, with 61% of males aged 14 to 18 years consuming less than their requirements for magnesium, and 72% of females of the same age.

More than one in three males (37%) and one in ten females (9%) had inadequate usual zinc intakes. The greatest prevalence of inadequacy was among males 71 years and over, where 66% had inadequate zinc intakes.

Half of all Australians take expensive vitamin and mineral supplements, but they are not always harmless shout the headlines in today’s newspaper, but is this sweeping statement factually correct? Is the researcher applying this broad declaration to every supplement available in Australia?

The audacious blanket statements made in the published article by Geraldine Moses are just untrue.

Australia has the most highly regulated environment in the world for complementary medicines’ quality and safety. A manufacturer’s use of the AUST L or AUST R number on the label proudly displays the fact that the product has been regulated to minimise the possibility of side effects. Side effects are rare and all listed in the Database of Adverse Event Notifications (DAEN).

Dr Geraldine Moses from the School of Pharmacy at the University of Queensland has flagged potential harms associated with using dietary supplements in the journal Australian Prescriber and subsequently reported in The Courier Mail and other news outlets. Here are ten questions that arise from her latest and well-worn attack on complementary medicines.

1. “One reason for the persistent popularity of vitamins and minerals is the perception that they are harmless.”

Is the author suggesting that people take supplements because they are harmless and not for their health benefits? Indeed, this is a blanket insult to the intelligence of the public.

2. “Like all medicines, supplements can cause potential harm. Still, unlike conventional medicines, manufacturers of vitamins and minerals are not required to provide warnings of their potential side effects, drug interactions or risks from an overdose.” 

Interactions exist in a similar way in which foods can also interact with drugs. Fortunately, decades of research have shown there is only a small handful that are clinically significant. The industry produces interaction checkers for healthcare Practitioners. For example, Blackmores Institute produces one that is reviewed by academics at Sydney University and offer practical training for pharmacists via their training portal.

Dose matters - like every medicine, too high, and you get side effects. Geraldine Moses fails to mention that the high doses required to result in side effects are clinically challenging to consume. Manufacturers of Australian complementary medicines recommend dosages on the labels.

Geraldine Moses does not acknowledge the health literacy of the Australian public, which CMA believes is inspiring people to take increasing control of their health. Using individually-sought or shared research with the advice of health professionals (from pharmacists and integrative GPs to nutritionists, dentists and more), more and more people are using nutritional supplements as an essential part of their therapeutic and preventive approaches to good health. The industry takes the training of health care practitioners and pharmacy assistants seriously, with a significant focus on these areas.

3. “Vitamins and mineral supplements are not all they are cracked up to be and can bring false hope and disappointment.”

We are not sure which supplements the researchers believe: “not all they are cracked up to be.” Nor which supplements bring false hope. The author comments on a diverse range of the supplements available in Australia, from fish oils to probiotics, iron supplements to vitamin D, turmeric to CoQ10; it is unclear just what Geraldine Moses is referring to.

Australians choose different supplements for many reasons, and a myriad of evidence supports their nutritional health benefits. Making blanket statements is not just inaccurate; it is unworthy.

4. “Vitamin supplements may be a waste of money.”

Another broad-ranging and vague statement, which is much less helpful than a definitive statement, might have been.

5. “Eating too much of certain antioxidants may increase mortality rate.”

It would be interesting to know which ones are being referred to and for which group of society.

6.“The expensive products are big sellers and used by almost half of all Australians.”

Over seven out of 10 Australians use complementary medicines. Just as any products that have been researched and formulated, regulated and distributed, costs are incurred. CMA does not and cannot put a price on a person’s preventive and therapeutic health choices.

7. “Manufacturers are not required to provide warnings of potential side effects, drug interactions or risks from overdose.”

The label warnings on Australian complementary medicines clearly state dosage instructions and consult a health professional if symptoms persist. Certain complementary medicines can only be purchased via health professionals, including pharmacists, naturopaths and dentists. Discussing the use of medicines – including complementary medicines – is an essential part of effective health literacy.

As already mentioned, the industry holds training sessions for pharmacy staff and health professionals. It encourages free-flowing and ongoing communication to protect and support customers’ health while promoting the education of healthcare professionals and staff.

8. “What many people don’t realise is that high doses of some supplements can be dangerous.”

Again, improving health literacy and the encouragement of dynamic and robust communication with health professionals is vital. Consumers are also strongly advised to read and abide by the warning statements on the labels. The complementary medicines industry is in the business of health protection. It will do everything possible to ensure customers understand the medicines that they are using and that they obtain the advice of a health professional to guard their wellbeing at every stage.

9. “Another thing to remember is that the same vitamin or mineral can be in multiple different products, so a person can accidentally overdose if those products are all taken together.”

Once more, transparent and honest dialogue with health professionals and individuals is vital. The risk of overdose is small; however, taking numerous supplements with the same ingredients can be dangerous.

Labels on Australian complementary medicines have clear guidelines on dosage and instruction. These labels provide relevant consumer warnings for well-established information. Consumers should read and adhere to the dosage directions and warnings on the label and talk to a healthcare professional should they feel overdosing on supplements or prescription medicines, or over-the-counter medicines.

10.“Vitamin and mineral supplements can be important to treat certain illnesses or nutritional deficiencies. For example, vitamin B3 can be used for high cholesterol, and folic acid can be used in pregnancy to prevent birth defects. When used for general wellness, however, their risks may outweigh their benefits.”

CMA must question this incredibly bold statement that the use of vitamin and mineral supplements for general wellness that the risks may outweigh the benefit. Do the authors disagree with the use of iron supplements to treat anaemia? Or vitamin D supplements for up to 40% of Australians with diagnosed deficiency? Or B12  for the increasing number of people choosing a plant-based diet? Or fibre supplements for the easing of constipation and more? This audacious blanket statement is incorrect.

CMA reiterates the need for consumers to communicate with their doctor and pharmacist when choosing complementary medicines. Whether the consumer has a medical condition or risk factor or is taking specific prescription or over-the-counter medications are important factors that should be considered.

CMA is justly proud of the Australian complementary medicines industry. Increasing knowledge and understanding of customers, growing education on complementary medicines and pharmaceutical medicines for healthcare professionals, including pharmacists, pharmacy assistants and more; this, teamed with the increasing demand for high-quality Australian supplements, has resulted in an Australian success story. Ours is the most highly regulated environment for complementary medicines globally, and it means that consumers can be confident about the quality and safety of Australian complementary medicines.

The Australian public is more educated about health than ever before and more than seven out of ten of us now use some form of complementary medicine to support our health. This diverse range of treatments include:

• herbal medicines

• vitamin, mineral and nutritional supplements

• probiotics

• Ayurvedic and traditional Chinese medicines and more.

“Australian complementary medicines are among the safest in the world, manufactured to the highest pharmaceutical standards."

A recent newspaper story reports that as well as liver toxic pharmaceutical drugs such as paracetamol and antibiotics, other pharmaceutical drugs and supplements may be involved in liver damage in a small number of cases.

Where referring to complementary medicines, the researchers do not reveal the ingredients in the products or whether these products are single- or multigradient formulations. Further, we are not told whether these products are from Australia or bought from overseas; all of these factors make accurate commentary and response difficult.

What researchers do reveal, is that the products fall into the categories of muscle growth in males and weight-loss in women.

With regards to bodybuilding supplements in males, it is mere speculation as to whether the products examined contained anabolic steroids. There are no Australian complementary supplements listed on the Department of Health’s Therapeutic Goods Administration (TGA’s) Australian Register of Therapeutic Goods that contain such ingredients. For females, the story cites weight-loss supplements. Again, the affected products, their source and the ingredients investigated are not provided, making accurate commentary difficult.

It is known that both bodybuilding supplements and weight-loss supplements are more likely to be imported for personal use and when tested are more likely to include ingredients that are not declared on the label.

Look at the label
Complementary medicines including herbal medicines that are supplied to consumers in Australia (with an AUST L or AUST R number on the label) are regulated to minimise the possibility of liver associated side effects including the absence of herbs with well-known
effects. In those where reactions are very rare and without known cause, they come with consumer safety information or warnings, similar to pharmaceutical medicines that pose a similar rare risk of liver effects.

CMA reiterates the following factors to support health when choosing complementary medicines.

1. Beware of products purchased from overseas that may contain unlabelled and potentially harmful ingredients.
Some overseas-based products may be adulterated and non-compliant with Australian
regulations. The ingredients are may either not be listed or their concentrations inaccurately reported.

2. Trust in Australian made
Australia has the most highly regulated environment in the world for complementary medicines quality and safety. Manufacturing is required to adhere to pharmaceutical standards under principles of Good Manufacturing Practice (GMP) and products meet specific guidelines set by the TGA.

In the Australian regulatory system, all complementary medicines (bearing an AUST L or AUST R number) that contain herbs must undergo identification tests to ensure each herb is what it says it is. This stringent
governing has resulted in discerning consumers choosing Australian-made products and has made the Australians' complementary medicines industry a national and worldwide success story.

3. Follow the instructions on the label
Labels on Australian complementary medicines have clear guidelines on dosage and instruction. These labels provide relevant consumer warnings for well-established information. If unsure of suitability or if other health concerns exist, consumers should seek the help of a healthcare professional before use.

4. Better health literacy for all
The researchers in the above story note that almost half the patients with supplement-induced liver damage were of non-European ethnic backgrounds. They called for more culturally appropriate community education about the risks of supplements. CMA agrees that more education is necessary regarding health literacy among the population including the use of all medicines
particularly in regards to purposeful overconsumption or potentially higher risks of imported products not regulated under the therapeutic goods scheme in Australia.

CMA welcomes greater investment in improving heath literacy. Recent data tells us that only
39% of the population find it always easy to understand health information well enough to know what to do¹.It is well known that people with low health literacy are more likely to have worse health outcomes overall and adverse health behaviours, including ability to self-manage care.

Further, targeting health literacy programs at diverse population groups has the potential to reduce health inequalities.

Why it is difficult to agree with Dr Harvey

Self-professed and very vocal critic of complementary medicines and the TGA, Dr Ken Harvey, commented that the study only examined severe cases of supplement-induced liver harm saying that the actual rate of damage was likely to be much higher. This is also difficult to agree with since the studies ingredients are not stated and because all recorded events to complementary medicines are reported and available to the public on the TGA’s Database of Adverse Event Notifications (DAEN).

The published article cited 115 cases of paracetamol induced liver injury in the same time period, and it is not clear whether Dr Harvey also believes that the rate of damage of this substance is also much higher than stated in the study, or which information warrants these types of claims.

Australia takes each report extremely seriously

“Australian complementary medicines are among the safest in the world, manufactured to the highest pharmaceutical standards. We lead the world in adverse reporting process and take each and every single report extremely seriously to ensure consumer safety. CMA welcomes detailed investigation and examination by the research community to inform and strengthen our high-quality standards,” ends Carl Gibson.

Dear editor, AJP

I was very disappointed to see that a respectable publication such as MJA would run a biased one-sided story by Dr Ken Harvey, without commentary from the TGA or CMA, the industry Association.

"Dr Harvey is incorrect and biased": Carl Gibson.

If you had reached out to me, I would have told you that Dr Harvey is incorrect and biased before you ran a story that is wholly wrong.

The latest Aust-Listed (Assessed) product has been through two years of rigorous review by the TGA. The highly respected and world class medicines regulator that is the TGA which assesses evidence not Dr Harvey and his merry band of naysayers.

Dr Harvey does not have all the facts, or the latest evidence and you should know by now that he is clearly biased against our industry. However, you ran the one-sided piece without any thought on the damage this does to the reputation of the Regulator or the new Registration Pathway, which is designed to encourage investment in the evidence base for complementary medicines.

Yours sincerely

Carl Gibson, Chief Executive Officer, Complementary Medicines Australia

That was the letter sent by our CEO to the editor. Here is some more background reading ...

Why now more than ever, consumers of Australian complementary medicines can feel more confident about the science than ever before

Complementary Medicines Australia (CMA) and the Australian complementary medicines industry promote appropriate regulation of our industry and advancement for this world-class industry supporting jobs nationally and internationally. We work to ensure that consumers have access to complementary medicines of the highest quality and the strict regulations within which Australian complementary medicines are manufactured in Australia means that consumers can be assured of the highest quality, efficacy, and safety. The extremely high standard to which Australian complementary medicines are manufactured also means that they are prized around the world for these reasons.

Whether natural medicines are registered or listed on the Australian Register or Therapeutic Goods (ARTG), Australian complementary medicines, are manufactured in licensed or approved facilities that follow the principles of good manufacturing practice (GMP).

AUST L (A) are assessed for efficacy

The TGA recently introduced the Aust L (A) system; it gives sponsors of

complementary medicines a new pathway. Medicines that carry the new AUST L (A) on

their label is 'assessed listed' medicines; they have had their health claims extensively

assessed for efficacy. The TGA examines and assesses the presented evidence

in detail, and it is this due diligence that means that consumers can be assured that extensive evidence supports the indications made on the label.

For more information, please see the TGA website: https://www.tga.gov.au/assessed-listed-medicines-pathway-complementary-medicines

CMA supports the evidence-based research that underpins Australian weight loss supplements. Weight gain is multifactorial in nature, and so is weight loss. 

An onoing healthy diet and regular exericise are vital losing weight and maintaining a healthy weight - there is no silver bullet 

Complementing a healthy lifestyle

It is essential to acknowledge that complementary medicines for weight loss are just that – complementary to a healthy lifestyle. Where it comes to losing weight, there is no magic bullet. A determined mindset and a real commitment to adopting and maintaining a more nutritious reduced-calorie diet and regular exercise are essential. Advertisements for any therapeutic goods, including complementary medicines that contain any claim relating to weight management, must balance the claims with the need for a healthy energy‑controlled diet and regular physical activity.

Complementary and traditional medicines are wide-ranging and have been used globally to complement a healthy lifestyle for thousands of years and are backed by traditional and medical research. They play many beneficial roles when used to address specific deficiencies or health requirements when taken as recommended. An integrative approach to taking medicines, including complementary medicines, speaks to the fundamentals of the principles of quality use. 

Obesity – a growing health challenge

Most Australians – around two thirds –  are overweight, and people are keen to explore ways to aid weight loss. One such method may be complementary medicines.

The complementary nature of these ingredients, which carry mild or low-level weight-loss claims, also speaks to their low level of side effects. When complementing physical activity and a healthy energy-controlled diet, these are substances whose ongoing safety profile permits them to be offered self-selection by consumers. Sometimes these ingredients offer additional positive effects to health and wellbeing, such as enhancing blood flow or feelings of energy and wellbeing. 

Ongoing care from a healthcare professional

Informed consumers will inevitably have questions; complementary medicines manufacturers are committed to responding with detailed, professional advice backed by sturdy evidence used to support formulations. For ongoing health and healthy weight, it is important to obtain regular care from a healthcare professional. Offering consumers a choice in a range of potential options is an important factor as a part of self-determined care.

Regulated to standards considered to be the global benchmark, manufacturers of natural health care products in Australia have a justified, respected reputation for quality and purity and do not promote them to diagnose, treat, cure, or prevent any disease, including weight loss. The marketing and advertising of complementary medicines encourage the quality of products; it is socially responsible and does not mislead or deceive consumers.

Evidence-based research

Academics worldwide and the industry here in Australia are heavily involved in the practical application of evidence-based research to support the rational and effective use of ingredients. Robust evidence supports the use of single and multiple ingredients used in proprietary products. One of these is green tea; it contains caffeine found to aid fat burning and improve exercise performance.

Before exercise, men who consumed caffeine consumption burned 17% more fat than men who didn’t take the supplement, which suggest that it can boost the fat-burning effects of exercise. Again, this benefit is complementary to a healthy lifestyle – it does not claim to replace it. Labels may state that ingredients increase satiety, promote healthy weight, and more – these are not intended to be compared to or replaced by pharmaceutical, prescription weight loss medications, some of which directly affect the brain’s satiety centre.

Again, it must be stressed that these products are promoted as complementary medicines, i.e. they complement a healthy mixed weight-loss diet which remains the first line of weight reduction. They are not intended to be used alone and do not promise miraculous results without adopting lifestyle choices.

The Australian complementary medicine industry is thriving because of increasing demand from consumers at home and internationally. This growth is backed by a global reputation for quality and safety and supported by a robust regulatory system that benefits.

Committed to enhancing rigorous research

Australia’s complementary medicines industry is committed to increasing and enhancing more rigorous research translating into practical benefits for consumers looking for traditional and scientific evidence-based preventive health choices.  

What does sustainability mean to you and your company? That is one of the questions we asked Raffaele D'Alisa from the Blackmores group. Here’s what he shared with us.

"When my children are my age, we will need three planets to meet our collective resource requirements."

What is sustainability to you and your company?

Blackmores was founded by a naturopath who understood that you could not have healthy people without a healthy planet. We continue to have a vision for a world where people and nature thrive together. We know that to have a legitimate and purpose-driven role in our community, sustainability and corporate citizenship needs to be ingrained into how we do business.

There’s a traditional view of sustainability as energy, waste and water management and recyclable packaging. But being genuinely sustainable extends to the partnerships with our suppliers, our customers, our consumers, and our employees and truly understanding our impact on people and our natural world.

For me personally, I’m driven by the knowledge that when my children are my age, we will need three planets to meet our collective resource requirements, so we need to start changing now if we’re going to secure their future.

What actions are you taking to ensure ethical and sustainable practices?

Blackmores Group has committed to net zero emissions by 2030. We have started by transitioning to renewable sources of energy and deploying a series of efficiency projects. We have a current focus on deepening our understanding of our supply chains and partnering with suppliers to measure and manage the elements that matter to our sustainable development; this started with assessing and addressing human rights risks in our supply chain. We’re working to understand the resilience of our ingredients and our operations to the impacts of climate change. We have started to scope what biodiversity loss could mean to future access to natural medicines. These issues focus on our engagement with our suppliers, where we are building awareness, diagnosing risks, and identifying short and longer-term solutions that provide win-win outcomes. Our view is that we need to have an evidence-based understanding of our precious natural ingredients and to take a solid position to ensure they are protected for future generations.

What has the public asked for in this regard?

Consumers are very focused on companies taking responsibility for their impact. Giving greater transparency about our products and their packaging will become increasingly important. What have been the challenges along the way? Progressing truly sustainable packaging is a fundamental challenge for us to address. We are aware that there is an intention for brands and manufacturers to take greater responsibility for the materials they use and expect regulation to evolve in the coming years. We are supportive of the focus on the delivery of the national packaging targets. We are working towards our own complementary sustainable packaging targets. But as therapeutic goods, it’s important not to lose focus on the protection of shelf life and product quality. We know that addressing packaging challenges means solving the right problem, not moving the issue to a different part of the value chain.

It’s essential to do better now and be part of the systemic change that all consumer products will need to consider as we push towards a circular economy. Our packaging footprint is not limited to our bottles and containers, and B2B is about 40% of the total packaging mass put on the market. Hence, it is all aspects of the packaging ecosystem that we need to be mindful of. In support of both Modern Slavery mitigation, climate resilience and ethical sourcing, the lack of transparency in the extended supply chain remains a challenge faced not only by Blackmores but our industry as a whole.

Our approach includes both contract-driven engagements and building these issues into the supplier relationship over the medium term to encourage the sharing of information and partnering in response.

What has been relatively easy?

We have been inspired by the support we’ve had from our team, our suppliers and from other companies who share our commitment to sustainability. We were concerned that the global pandemic would harm our sustainability progress. Still, interestingly there is a growing understanding of the importance of addressing our most significant global challenges. We’ve seen the benefits of being guided by science and taking responsibility for our impact through the COVID crisis, so mitigating our climate impacts seems more achievable than ever before.

Will being sustainable cost more for the consumer?

It’s misguided to believe that being sustainable costs more when it drives value through more efficient operations and more substantial corporate credibility and trust. There will be a higher cost in not addressing sustainability in the long term than investing in the right programs in the short term.

What advances do you see in the future?

We’re excited to see an intention to transform recycling systems and supporting markets for developing recycled content for packaging. We expect to see a convergence of consumer trends and sustainability solutions for carbon sequestration – for example, plant-based diets. We see rapid transformation in energy markets which is supporting our transition to renewables. There is going to be a stronger dialogue about climate change resilience and biodiversity impacts, and that will lead to change