Shorts

briefed by Jule Klotter

Aluminum, Antiperspirants, and Breast Health

Do aluminum-containing antiperspirant formulas contribute to the formation of breast cysts and breast cancer? Philippa D. Darbre at University of Reading (Whiteknights, Reading, UK) contends that they do. Aluminum (Al) salts in antiperspirants combine with proteoglycans and damaged cells to form a plug that blocks sweat ducts. While the etiology of breast cysts is presently unknown, it is curious that cysts, caused by blocked mammary glands, occur most often in the breast’s upper outer quadrant, the region closest to the armpit. Moreover, the percentage of breast cancers located in the upper outer quadrant has risen over the decades. Antiperspirants are a significant source of aluminum for humans; at least three studies have shown that aluminum from antiperspirants is absorbed into the body through the skin, according to Ferdinando Mannello (2009). Aluminum is also known to damage genes. However, only a few studies have investigated a link between aluminum-containing antiperspirants and breast health.

Mannello’s 2009 study looked at aluminum levels in breast cyst fluids and compared these levels with Al levels in blood and breast milk. The researchers took fluid samples from breast cysts present in 48 premenopausal women and analyzed the Na⁺:K⁺ ratio in each sample. Type 1 cysts contain a Na⁺:K⁺ ratio of less than 3.0, and type 2 have a ratio of 3.0 or more. The researchers found that the type 1 cysts (n= 27) had a higher mean level of Al compared to the type 2 cysts (n = 21): 150 µg 1⁻¹ compared to 32 µg 1^-1 (P < 0.0001). Type I cysts tend to recur after aspiration. This study does not prove that aluminum is a cause of breast cysts; it simply shows a correlation. The authors, however, point out that aluminum inhibits Na⁺:K⁺ -ATPase enzyme activity: “ … it is an interesting possibility that the Na⁺:K⁺ ratio might itself be influenced by the aluminium [sic] in the [breast cyst fluid]. …”

A 2010 study, also led by Ferdinando Mannello, looked at aluminum content and iron-binding protein homeostasis in nipple fluids aspirated from healthy women and from women with breast cancer (a total of 35). Al is known to disrupt iron homeostasis; this disruption is linked to breast cancer. Researchers also took blood samples and human milk samples from healthy women. Aluminum was present in all samples, but “mean levels of Al were significantly higher in all [nipple aspirate fluids] samples [205.7 ± 19.4 µg] than in human milk [24.8 ±0.8] or in human serum [5.6 ± 0.5 µg].” Mean Al levels differed significantly between the two subgroups of nipple aspirate fluids (Cancer vs. NoCancer). Mean Al levels were higher in nipple fluids from women with cancer (n = 19; 268.4 ± 28.1 µg) compared to those without cancer (n = 16; 131.3 ± 9.6 µg). Also, mean ferritin and transferring levels (used to assess iron-binding protein homeostasis) were significantly higher in nipple fluids taken from women with cancer compared to the NoCancer group. This study did not try to track the source of the aluminum exposure; subjects were not questioned about use of antiperspirants.

At this point, the evidence linking aluminum-containing antiperspirants to breast cysts and cancers is by no means conclusive. Still, women who prefer to follow the precautionary principle – particularly those with a history of type 1 breast cysts – need to seek alternatives to Al-containing antiperspirants.

Darbre PD. Underarm antiperspirants/deodorants and breast cancer. Breast Cancer Res. 2009; 11(Suppl 3):55. Available at http://breast-cancer-research.com/content/11/S3/S5/ref. Accessed January 11, 2013.

Mannello F, Tonti GA, Darbre P. Concentration of aluminium in breast cyst fluids collected from women affected by gross cystic breast disease. J Appl Toxicol. 2009;29:1–6. Available at www.researchgate.net. Accessed January 26, 2013.

Mannello F, Tonti GA, Medda V, Simone P, Darbre PD. Analysis of aluminium content and iron homeostasis in nipple aspirate fluids from healthy women and breast cancer-affected patients. J Appl Toxicol. 2011;31:262–269. Available at www.researchgate.net. Accessed January 26, 2013.

Making the Mind-Body Connection Real to Patients

For all the talk about mind-body, people rarely grasp the extensive physiological consequences of stress-filled or depressing thoughts and emotions. Most are trapped in a belief that physical dysfunctions are solely a matter of anatomy, genetics, or other factors beyond their control. This belief, which is only partly true, prevents patients from taking part in behavioral or lifestyle changes that would alleviate symptoms and promote healing. A recent article, written by Erik Peper, PhD; Dianne M. Shumay, PhD; and Donald Moss, PhD, gives two examples that demonstrate the effect of emotion and thought on physiology. One example involves biofeedback, and the second uses somatic feedback (a.k.a. muscle testing).

Biofeedback gives people a tangible way to observe the effect of unconscious behavior patterns. It consists of measuring physiologic activity (e.g., heart rate, muscle tension, blood pressure, etc.) with electronic sensors. Electronic signals travel from the sensors to a computer, which stores the data and translates the signals into numbers and graphs that clients can view on screen. “Seeing the changes – which are based upon scientific physiological monitoring, computer analyses, and immediate feedback signals – is usually accepted by the patient as evidence of hard data,” the authors explain, “whereas the verbal comments made by a therapist might be denied as the therapist’s subjective opinion.”

Biofeedback was instrumental in convincing a 42-year-old man that his difficulty urinating was caused by anxiety and stress. The man believed his problem was physiological and that surgery (which “terrified” him) was the only solution. Medical assessment, however, indicated a “high arousal/activation and body-fear pattern,” compounded by multiple major life stresses, to be the key factor. The practitioner explained that difficulty urinating (and defecating) is a normal physiological reaction to fear as the pelvic floor muscles tighten during times of anxiety/fear. Talk, however, is usually not enough to change beliefs.

The first evidence that anxiety-related muscle tension was contributing to the man’s problem came when he was taught a relaxation practice. The practice reduced his feelings of anxiety; he reported feeling safer. In addition, the man was able to urinate without difficulty after the session. The improvement continued at home where he practiced “in-depth relaxation as well as mini-practices during the day.”

Biofeedback to measure muscle tension in the pelvic floor, legs, and buttocks was the next step. When the sensors were in place, the man consciously tightened his anus and pulled up, as if to stop urine flow. After some moments, he was asked to relax. He could see the corresponding rise in tension and then relaxation on the computer screen. “This data was used to point out first, that he needed time to relax, and second, that with training he could learn to relax more quickly,” the authors explain. The muscle activity was also recorded “covertly” while the man discussed his job, a source of aggravation, anger, and fear. Sensor readings documented increased muscle tension in his buttocks, legs and/or pelvic floor. “Seeing the data was his ‘aha experience,’ which transformed his illness beliefs,” the authors write. “He now knew that his emotional and cognitive behaviors directly affected his pelvic floor/leg/buttock muscle tension and ability to urinate.”

While biofeedback tracks specific muscle and physiological responses, somatic feedback is a nontechnical way to demonstrate the power of positive and negative thoughts on physical strength and overall energy level. Somatic feedback is another name for the muscle testing technique discussed by John Diamond, M.D., in his book Your Body Doesn’t Lie. The technique requires two people: the subject, who extends an arm straight out to his/her side at shoulder level, and the tester. The tester faces the subject and applies gentle downward pressure on the wrist of the extended arm after asking the subject to resist.

Peper has used the following somatic feedback exercise to demonstrate to his students the effect that thought and emotions have on the body. The subject is told to focus on a past experience that produced (1) hopeless, helpless, and powerless feelings or (2) empowered, positive, and successful feelings. Without saying which type of memory was chosen, the subject extends the stronger arm; and the tester applies pressure to gauge the subject’s ability to resist. After testing, the subject relaxes for a few moments, then concentrates on an opposite memory and is tested again. The subject and tester do not exchange feedback until the second test is complete.

“In 98% of all cases, when people think of hopeless, helpless, or powerless memories, they have significantly less strength than when they think of empowering, positive, and successful memories,” Peper and colleagues state. In the remaining two%, the hopeless memories had no effect or produced an increase in arm strength. In these cases, the subject either felt anger or resentment at the thought of the “hopeless” memories (increasing their strength) or was unable to switch focus from one memory to the next, according to unpublished observations that Peper gathered from using the exercise with students at San Francisco State University. Peper views “the change in strength … as a metaphor for immune competence.”

To reduce the negative physiological impact of disempowering memories from the past or worries about the future, the authors suggest recognizing and naming the negative emotion: “‘I feel [anxiety, sadness, hopeless, etc.] at this moment.’” The next step is to shift one’s attention to the present or to an empowering memory. Looking at a picture or listening to music that holds positive associations can help. Spending time in a different location, particularly a nature-rich location, can also produce a shift from negative to positive. Peper, Shumay, and Moss recommend the book Fighting cancer: A Nontoxic Approach to Treatment, by R. Gorter and E. Peper, to those who seek other ways to counteract the effects of negative thoughts and emotions.

Peper E, Shumay DM, Moss D. Change illness beliefs with biofeedback and somatic feedback. Biofeedback. Winter 2012; 40(4):154–159. Available at http://biofeedbackhealth.files.wordpress.com/2013/01/change-in-illness-belief-published.pdf. Accessed January 22, 2013.

Torticollis, Birth Trauma, and Chiropractic

It’s hard to understand why an infant would benefit from chiropractic care – until you think about the biomechanical consequences of residing in a cramped womb or being extracted by vacuum or forceps. All chiropractors are taught to treat infants and children. Some even choose to take postdoctoral certification training in pediatric chiropractic. Chiropractors use safe, gentle palpation, and noninvasive techniques to coax a child’s misaligned vertebrae back into position.

In addition to producing restricted movement and inflammation, subtle misalignments (subluxations) of the spinal column are posited to interfere with the body’s self-regulation. Long-term, an uncorrected subluxation will led to overt dysfunction and/or disease, according to chiropractic theory. “Perinatal trauma can have lasting effects on the atlanto-occipital joints, and this can lead to a variety of structural, postural, functional, and kinesological [sic] disturbances including torticollis, cranial asymmetry, delayed motor response, increased infections, and impairment of the hip, and sacroiliac joints,” according to Karen Erickson and coauthors of “A Pediatric Perspective on Chiropractic.” Although the existence of subluxation has been debated for decades, researchers are now documenting evidence that subluxation alters nerve input to the brain (Haldeman S, ed. Principles and Practices of Chiropractic. New York: McGraw-Hill Professional: 755.).

Infants with a persistent head tilt (torticollis), poor head control, a dislike of “tummy time,” asymmetrical crawl, delayed walking, or/and poor balance will likely benefit from chiropractic care. Spinal alignment also improves a number of other conditions, including difficulties breast-feeding on one side, irritability, poor sleep, snoring or sleep apnea, colic, reflux, chronic constipation, and chronic infections, according to clinical evidence and medical literature. Erickson and colleagues point out that even the most “benign” fall while learning to stand and walk can cause subluxation. Regular chiropractic care can prevent these subtle misalignments from turning into chronic dysfunction.

Erickson K, Hewitt EG, Watson AL, Rosner AL, Hewitt RL. A pediatric perspective on chiropractic. In: Culbert T, Olness K, eds. Integrative Pediatrics. New York: Oxford University Press; 2010:146–161.

Conjugated Linoleic Acid

and

Breast Milk

European researchers are investigating the immune-modulating effects of conjugated linoleic acid (CLA) as part of the Netherlands’ KOALA Birth Cohort Study. The KOALA Birth Cohort Study aims to identify lifestyle factors that prevent atopic disease in children. CLA is produced by bacteria in the rumen of cows, sheep, and goats. It is found in dairy and meat from these animals and in human breast milk. (About 10% of CLA in breast milk is made by the mammary gland.) CLA, which makes up about 1% of the fats in human breast milk, appears to be a potent biological compound with multiple positive effects. In addition to immune-modulation, laboratory research indicates that it protects against cancer, heart disease, diabetes, and obesity. A 2007 KOALA study sought correlations between a mother’s diet and the amount of CLA in her breast milk. Using the same mother-baby pairs, researchers performed a follow-up study in 2011, that compared CLA levels in the mom’s breast milk with the babies’ incidence of atopic disease by age 2.

For the first study, researchers enrolled 312 breast-feeding mothers. They collected diet information from each mom, focusing on the amount of dairy and meat (from ruminant animals) consumed. Researchers also asked how much of the dairy and meat was conventionally-raised, organically-raised, or biodynamic (raised according to the organic agricultural practices of Rudolf Steiner). Organic and biodynamic dairy products have significantly higher amounts of CLA than conventional products, according to several European studies. Then, the researchers took breast milk samples and analyzed the fat content. For this study, they were particularly interested in rumenic acid (cis-9,trans-11-octadecadienoic acid), considered the “biologically most relevant” CLA isomer, and trans-vaccenic acid, a precursor of rumenic acid.

Rumenic acid levels were significantly higher in women who consumed organic dairy and meat than in the conventional group. In addition, rumenic acid levels increased with the amount of organic dairy/meat eaten. Women who ate organic dairy/meat over 90% of the time had the highest level of rumenic acid. This group also had the highest level of trans-vaccenic acid (TVA). Rumenic acid levels fluctuate according to season. CLA in sheep milk was 44% higher in spring-summer than in winter, according to a 2009 study. Rumen acid in human breast milk also peaks in early-summer.

The 2011 follow-up, involving the same mother-baby pairs, found “ … a consistent association between high breast milk concentrations of [rumenic acid and vaccenic acid] and lower risk of parent-reported eczema, [atopic dermatitis], allergic sensitisation [serum IgE levels to cow’s milk, hen’s egg, and/or peanut], and total IgE at 1 year. …” In addition to CLA, breast milk contains n-3 long-chain polyunsaturated fatty acids (n-3 LCPs), known to protect against atopic disease. A multivariable logistic regression analysis indicated that “the inverse associations between ruminant fatty acid concentrations in breast milk and atopic outcomes were found to be independent from n-3 LCPs.” When looking at the entire KOALA cohort of over 2500 children, the researchers found that children who ate organic dairy had a lower risk of eczema by age two than those who ate conventional dairy. Dairy fat from butter and full-cream milk (conventional and organic) has been associated with lower risk of asthma and atopic disease in previous studies, according to C. Thijs and colleagues.

DeLaFuente LF, Barbosa E, Carriedo JA, et al. Factors influencing variation of fatty acid content in ovine milk [abstract]. J Dairy Science. August 2009; 92(8):3791–3799. Available at www.ncbi.nlm.nih.gov/pubmed/19620661.

Accessed January 26, 2013.

Rist L, Mueller A, Barthel C, et al. Influence of organic diet on the amount of conjugated linoleic acids in breast milk of lactating women in the Netherlands. British Journal of Nutrition. 2007; 97:735–743. Available at www.orgprints.org/10645/1/1885.pdf. Accessed January 20, 2013.

Thijs C, Müller A, Rist L, et al. Fatty acids in breast milk and development of atopic eczema and allergic sensitization in infancy. Allergy. 2011;66:58–67. Available at www.ncbi.nlm.nih.gov/pubmed/20659079. Accessed January 26, 2013.

Food Additive Regulation

When Congress approved its food additive regulation program in 1958, no one envisioned over 10,000 chemicals’ being added to the food supply. We consume human-produced chemicals that prevent spoilage, chemicals that enhance flavor, appearance, or texture – not to mention chemicals that leach from packaging. The regulatory program was supposed to ensure a chemical’s safety before it reached the marketplace. Safety was assumed (then and now) to be a simple measure of acute toxicity, birth defects, and cancers in laboratory test animals. Subtle yet vital effects on human biochemistry have not been assessed. Safety testing and monitoring is in the hands of the manufacturers. Nowadays, the FDA simply rubber-stamps over 97% of food industry requests to use a chemical in food, according to Pew Health Group. This “expedited approach,” initiated in 1995, does not allow for public comment. Companies do not have to tell FDA about postapproval research concerning a chemical’s safety, and FDA does not monitor how much of a chemical is added to a product. Pleading a lack of resources, FDA is unlikely to make changes in its approval process anytime soon.

Regulation failings are by no means the only problem; the scientific paradigm that underlies US toxicology testing for food additives is antiquated. Dan Fagin, writing for Nature, points out that safety tests still adhere to Paracelsus’s 16th-century assertion that dose and effect are linear: “lower exposures to a hazardous compound … always generate lower risks.” Government-mandated safety tests focus on overt problems (e.g., cancer, deformities, and death), which tend to adhere to the linear dose-toxicity pattern. Current tests are not designed to assess the effect on endocrine function. Instead of showing a linear toxicity pattern (monotonic), endocrine-disrupting chemicals tend to produce curves shaped like a “U” or inverted “U” (nonmonotonic). Experiments may show toxic effects at low levels, no effect at mid-range, and toxicity at high doses – or vice versa. Very low, real-world levels of endocrine-disrupting chemicals are probably “contributing to a wide range of human health problems – including obesity, diabetes, cancer, cardiovascular disease, and infertility and other disorders related to sexual development,” says Fagin. The status quo has downplayed these concerns, saying more research is needed. However, the Endocrine Society (Chevy Chase, MD) released a statement in 2009, declaring “ … endocrine disrupters a ‘significant concern to public health’ … even infinitesimally low levels of exposure – indeed, any level of exposure at all – may cause endocrine or reproductive abnormalities.’” Also, a 2012 review article “Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses” drew on over 800 articles to present evidence that endocrine-disrupting chemicals cause health problems at extremely low doses.

Some consumers have bypassed FDA, taking their concerns directly to manufacturers; and manufacturers have responded to their outcries … sometimes. In January 2013, PepsiCo announced that it will remove the emulsifier brominated vegetable oil (BVO) from Gatorade. (The company will use sucrose acetate isobutyrate in its place.) BVO has been linked to skin lesions, nerve disorders, and thyroid hormone abnormalities. In 1977, FDA ruled that brominated vegetable oil was safe up to 15 parts per million but called for more studies. The studies never happened – at least not in the US. The European Union and Japan have banned BVO’s use in food. Recently, 15-year-old Sarah Kavanagh started a petition on Change.org, asking PepsiCo to remove it from Gatorade. Over 200,000 people signed the petition, and the New York Times and other mainstream media outlets picked up the story. PepsiCo then announced that it had been working on a new Gatorade formula and plans to eliminate BVO this year. Brominated vegetable oil is added to other drinks including PepsiCo’s Mountain Dew and Coca-Cola’s Powerade, Fanta Orange, and Fresca.

Scientists who worry about endocrine-disrupting chemicals are also taking matters into their own hands. T. T. Schugg and colleagues have recently published detailed instructions, telling industry chemists how to screen for endocrine-related effects before a chemical reaches the market place (“Designing endocrine disruption out of the next generation of chemicals” Green Chemistry. 2013;15:181–198). Why wait for FDA to take the lead?

Eng M. PepsiCo to take controversial ingredient out of Gatorade. Chicago Tribune. January 25, 2013.

Fagin D. Toxicology: The learning curve. Nature. October 24, 2012. Available at www.nature.com/news/toxicology-the-learning-curve-1.11644. Accessed January 11, 2013.

Pew Health Group. What did Pew Health Group find in its review of the U.S. food additive regulatory program? [press release]. Available at www.pewtrusts.org. Accessed January 11, 2013.

Strom S. Drink ingredient gets a look. New York Times. December 12, 2012. Available at www.nytimes.com/2012/12/13/business/another-look-at-a-drink-ingredient-brominated-vegetable-oil. Access January 2, 2013.

Vandenberg LN, Colborn T, Hayes TB, et al. Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses. Endocr Rev. June 2012:33(3):378–445. Available at www.ncbi.nlm.nih.gov/pubmed/22419778. Accessed February 4, 2013.

Medical Ecology and How Microbes Help Us

Just as ecologists track interconnections between life forms and Earth’s environment, medical ecologists are investigating the trillions of microbial organisms and their relationship with the human bodies where they reside. The Human Microbiome Project has identified thousands of bacterial species living at various sites on and in the body. The unique combination of microbes varies from person to person. And that’s just the bacteria. Researchers have barely looked at the body’s viral and fungal inhabitants. This new field of medical or clinical ecology “is making it increasingly apparent that microorganisms constitute a kind of second genome to our own that complements our … metabolic capabilities,” says Australian microbial ecologist Phil Hugenholtz.

“Rather than conducting indiscriminate slaughter [with more and stronger antibiotics, medical ecologists] want to be microbial wildlife managers,” writes Carl Zimmer for the New York Times. They want to nurture the body’s ecosystems and work with these resident organisms to promote health and find new, less-ecologically disruptive ways to combat illness. Wide-spectrum antibiotics kill beneficial bacteria as well as pathogens.

Currently, we have little appreciation for how many benefits our microbial inhabitants give us. Skin bacteria, for example, generate a moisturizing film as they eat waxy cell secretions, contributing to skin integrity and its ability to form a barrier against pathogens. Gut bacteria do more than help digest plant compounds and produce vitamins. Dutch researchers have found that gut bacteria also affect sugar metabolism (in humans) and body weight (in mice).

Most viruses, living in cells and the microbiome, do not cause disease. In fact, some actually protect against disease. Lymphotropic viruses, for example, prevent mice from getting type 1 diabetes; and herpes viruses protect them from bacterial infections. Endogenous retroviruses have beneficial effects on development and “ … almost certainly have contributed to the evolution of human and other mammalian genomes,” according to plant virologist Marilyn J. Roossinck.

Our symbiotic relationship with the microbiome begins with birth, as Zimmer explains in his article. Obstetrician Kjersti Aagaard-Tillery and colleagues discovered that a woman’s vaginal microbiome changes during the first trimester of pregnancy; Lactobacillus johnsonii, normally found in the gut, proliferates. This bacteria produces enzymes that digest milk. Babies ingest some of the bacteria as they make their way down the birth canal during vaginal delivery. Ingested Lactobacillus johnsonii helps infants digest breast milk. Breast milk contains as many as 600 bacterial species that become part of the gut microbiome, according to a 2011 study by Katherine M. Hunt and colleagues. Breast milk also contains oligosaccharides, sugars that provide nourishment for beneficial gut bacteria: “The more the good bacteria thrive, the harder it is for harmful species to gain a foothold.” Moreover, a complex community of good bacteria appears to teach the immune system how to respond appropriately to threat. Mice without a microbiome produced “abnormally high levels of … invariant natural killer T cells,” resulting in inflammation in the lungs and gut. “As adults, the mice were more likely to suffer from asthma and inflammatory bowel disease,” says Zimmer.

Using a broad-spectrum antibiotic is like clear-cutting a rainforest. Restoring the diversity of healthy gut ecology takes more than a probiotic, just as restoring a forest requires more than planting one or two species of trees. This new understanding and appreciation of the microbiome may allow medicine to tread more lightly in its quest to heal.

Hugenholtz P. Guest commentary: The human microbiome and the promise of clinical ecology. Microbiology Australia. September 2012; 90. Available at www.theasm.org.au. Accessed January 11, 2013.

Roossinck MJ. Even viruses can be beneficial microbes. Microbiology Australia. September 2012; 111-112. Available at www.theasm.org.au. Accessed January 11, 2013.

Zimmer C. Tending the body’s microbial garden. New York Times. June 18, 2012. Available at www.nytimes.com. Accessed January 11, 2013.

Nausea and Vomiting During Pregnancy

Nausea and vomiting primarily during the first trimester of pregnancy is common, but the cause is unknown. “In most cases, as long as the pregnant woman is staying hydrated and keeping some food down, nausea and vomiting do not put the pregnancy at risk, even if she gains no weight or loses a little bit in the early weeks,” write naturopathic doctors Jamie Oskin, Laurinda Kwan, and Natalie Ham. Persistent vomiting, however, can lead to life-threatening dehydration, electrolyte imbalance, undernourishment, and weight loss (hyperemesis gravidarum). Most pregnant women do not experience severe vomiting. Nonetheless, pregnant women need safe and effective ways to cope with frequent bouts of nausea that disrupt their lives.

Oskin, Kwan, and Ham offer several alternatives to the antihistamines and anti-motion-sickness drugs that are often prescribed for nausea and vomiting during pregnancy in their article for Homeopathy Today. First, they suggest that women avoid strong odors and foods that trigger nausea. A 2006 study by Gillian V. Pepper and S. Craig Roberts reported that women living in countries whose inhabitants consume higher amounts of cereals and pulses and low amounts of sugar/sweeteners, alcohol, and meat have less risk of nausea and vomiting during pregnancy. While triggers vary according to individual, this information provides a starting point for women to identify dietary triggers. In addition to avoiding triggers, Oskin, Kwan, and Ham recommend snacking or having small frequent meals to forestall nausea. Stress and anxiety can also contribute to nausea, so resting and asking for support are important. When nausea arises, an inch of fresh sliced ginger steeped in hot water or a cup of peppermint may bring relief. CAM modalities such as acupuncture, acupressure, and homeopathy can also alleviate nausea and vomiting during pregnancy (as well as motion sickness).

Oskin, Kwan, and Ham are experienced homeopaths. In their article, they describe seven common homeopathic remedies for nausea and vomiting in pregnancy. The remedy that most closely matches a woman’s symptoms is the one most likely to help. Colchicum is for women whose main symptom is nausea brought on by the thought, sight, or smell of food, particularly eggs or fish. If a woman also lacks appetite, tires easily, feels chilly and, possibly, has vertigo, Cocculus indicus is a closer match. Persistent nausea with retching, belching, and copious saliva indicates Ipecacuanha. Women who are irritable, impatient, and suffer with nausea that is worse in the morning need Nux vomica. Indifference to family, irritability, and nausea with an empty feeling in the stomach indicates Sepia. Pulsatilla is for weepy women whose nausea is worse in the afternoon and/or evening; they also tend to crave creamy, fatty foods. Women who experience intense motion sickness and become nauseous from tobacco smoke, but feel better with fresh air, may benefit from Tabacum. Most of these remedies are available in low potency at health food stores.

As the authors show in their article, knowledgeable homeopaths adjust potency and dosage frequency when patients show improvement but not resolution of their symptoms. At times, women may also need a second remedy that addresses a separate problem in order for the morning sickness to resolve. Oskin, for example, wrote about a woman whose morning sickness improved about 75% with Cocculus 30C, but who then revealed symptoms of grief over a past miscarriage that made her unable to feel joy about the approaching birth. Oskin asked her to stop taking Cocculus and to take one dose of Ignatia 10M for grief. The woman became emotionally lighter and had no problem with morning sickness for a couple of weeks. When symptoms of nausea began to return, Oskin prescribed Cocculus 200c, once a day. “Over the next six or eight weeks, Bethany continued to do very well on Cocculus, with a 95% reduction in morning sickness symptoms,” Oskin reports. Unlike pharmaceuticals, homeopathic remedies do not have side effects that can negatively affect the fetus.

Oskin J, Kwan L, Ham N. When the thrill of pregnancy is marred by morning sickness, homeopathy can help. Homeopathy Today. Summer 2012; 24–31.

Pepper GV, Roberts SC. Rates of nausea and vomiting in pregnancy and dietary characteristics across populations. Proc R Soc B. 2006;273;2675–2679. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC1635459/.

Accessed January 22, 2013.

Women and Empowerment

Over the past months, some disturbing, even horrifying, events have highlighted women’s unequal status. A 15-year-old Pakistani girl was shot for advocating girls’ right to education. A 23-year-old woman, who was riding home on a bus, died after being gang-raped and beaten by young men in India. Two high-school football stars in Steubenville, Ohio, raped a 16-year-old girl while other boys watched and Twittered. “Institutional rape tolerance” is still common in US colleges, says Soraya Chemaly. As a result, victims (usually female) see little purpose in reporting sexual assault to authorities. No single factor affects women’s health and well-being more than the threat and incidence of sexual violence and rape.

Violence is a symptom of a deeper issue: women’s cultural status. Think about it. No animal, including humans, threatens an equal or more powerful community member. We tend to beat up on those viewed as weaker (not just physically weaker) – unless we have a cultural taboo against doing so. Gender inequality means that women have less social, economic, and political authority to make choices that give them some control in their daily lives. “Powerlessness or lack of control in one’s life is a well-known risk factor for disease,” write Prathibha Varkey, MPH; Sarah Kureshi, MD; and Timothy Lesnick, MS. Since women are the primary caregivers, their lack of power directly affects the health of their family members as well as themselves.

Empowerment is defined as having access to education, equal economic compensation, social connections, and political power, according to some research studies. Completing secondary education (or primary education in some countries) lessens the risk of domestic violence, especially if both partners have completed their education, according to a 2011 study led by Tanya Abramsky. Education, particularly learning to read, is empowering; it gives people access to ideas and options. Schools that provide nutritious meals and information about hygiene, nutrition, and disease become healthcare partners in improving a girl’s health and, through her, the health of others in the family and community (Ehrhardt). With education, girls have the potential to earn more money than their less-educated counterparts. The combination of knowledge and economic resources strengthens women’s ability to care for the health of themselves and family members.

Education and income, however, do not automatically lead to political power. Women make up only 18.1% of the US Congress in 2013, the largest percentage in history, despite equal access to education. Japan has a high percentage of college-educated women, but only a minority stay in the work force, citing an “unsupportive work environment and managers who do not value them,” according to Sylvia Ann Hewett. Seventy-one percent of the Japanese women interviewed in the WHO Multi-Country Study on Women’s Health and Domestic Violence (2006) reported experiencing domestic violence: the highest rate of the 15 countries in the survey (Abramsky). In some societies, education and improved economic resources can actually increase a woman’s risk of violence if she is viewed as “transgressing” cultural expectations and gender norms (Abramsky).

Cultural traditions and religious beliefs are the primary factors that underlie women’s inequality and victimization, according to The Elders. The Elders is a group, founded by Nelson Mandela in 2007, of male and female global leaders from different nations and religions who are independent of any government or other organization. The Elders “offer their collective influence and experience to support peace building, help address major causes of suffering and promote the shared interests of humanity.” They have made women’s rights a priority.

In 2009, The Elders focused on the role that tradition and religion have played in subjugating women. “This view that women are somehow inferior to men is not restricted to one religion or belief,” wrote former US President Jimmy Carter, one of the Elders. “It is widespread. Women are prevented from playing a full and equal role in many faiths. …This discrimination, unjustifiably attributed to a Higher Authority, has provided a reason or excuse for the deprivation of women’s equal rights across the world for centuries.” In an online statement, the Elders “especially call on religious and traditional leaders to set an example and change all discriminatory practices within their own religions and traditions” The health and well-being of all peoples will benefit.

Abramsky T, Watts CH, Garcia-Moreno C, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi-country study on women’s health and domestic violence. BMC Public Health. 2011:11:109. Available at www.biomedcentral.com/1471-2458/11/109. Accessed January 25, 2013.

Carter J. The words of God do not justify cruelty to women. The Guardian. July 11, 2009. Available at www.guardian.co.uk/commentisfree/2009/jul/12/jimmy-carter-womens-rights-equality. Accessed February 5, 2013.

Chemaly S. Notre Dame, Manti Te’o and Institutional Rape tolerance [online article]. Huffington Post. January 19, 2013. www.huffintonpost.com/soraya-chemaly/the-big-american-rape-on_b_2506761.html. Accessed February 5, 2013.

Ehrhardt AA, Sawires S, McGovern T, Peacock D, Weston M. Gender, empowerment, and health: what is it? how does it work? J Acquir Immune Defic Syndr. July 1, 2009;51(Suppl 3):S96-S105. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC3296368/pdf/nihms311686.pdf. Accessed January 25, 2013.

Religious and traditional practices discriminate against women and girls [online press release]. The Elders. July 2, 2009. www.theelders.org/article/religious-and-traditional-practices-discriminate-against-women-and-girls. Accessed February 5, 2013.

Hewett SA. Japan’s working-woman problem. Time. December 11, 2011. Available at ideas.time.com/2011/12/11/japans-working-woman-problem. Accessed February 5, 2013.

Varkey P, Kureshi S, Lesnick T. Empowerment of women and its association with the health of the community. J Womens Health. 2010;19(1):71–76. Available from ESBCO database. Accessed January 11, 2013.